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(No, 59. New Series, No. 23.)
THE JOURNAL OF MENTAL SCIENCE, OCTOBER, 1866.
[Published by authority of the Medico-Psychological Association."}
CONTENTS.
PART I,-ORIGINAL ARTICLES.
PAGE
Mi*. Commissioner Browne.—-Address ; on Medico-Psychology. Head by the
President at the Annual Meeting of the Medico-Psychological Asso
ciation, held at Edinburgh, July 31st, 1866 ....
309
John Webster, M.D., F.R.S.—The Insane Colony of Gheel Revisited
.
327
J. Bruce Thomson, L.C.R.S. Edin.—The Effects of the Present System of
Prison Discipline on the Body and Mind
....
340
Franz Meschede, M.D.—Paralytic Insanity and its Organic Nature. Abridged
from ‘ Virchow’s Archives,’ 1865, by G. F. Blandford, M.B. Oxon ;
with a Prefatory Note
......
348
J. Keith Anderson, M.D. Edin.—Clinical Cases. Remarks on Aphasia, with
Cases
........
367
J. Mackenzie Bacon, M.D.— Clinical Cases. Cases illustrating the Diagnosis
of Paralytic Insanity, with Remarks (partly translated from the French)
381
PART II.-REVIEWS.
1. On Consanguineous Marriages. By Arthur Mitchell, M.D., DeputyCommissioner in Lunacy for Scotland. 2. Consanguinity in Marriage.
By William Adam. 3. Du Danger des Manages consanguins sous
le rapport sanitaire. Par Francis Devay. 4. Étude sur les Mariages
consanguins et sur les Croisements dans les Règnes Animal et Végétal.
Par Antony Chippault. 5. Sur la Consanguinité. Par Jules
Falret
........
389
�Con lents.
Il
PART
II I.-QUARTERLY REPORT ON THE PROGRESS OF PSYCHOLOGICAL
MEDICINE.
PAGE
English Psychological Literature. By S. W. D. Williams, M.D., L.R.C.P.L.
—On the Morbid Anatomy of the Nervous Centres in General Paralysis
of the Insane. By J. Lockhart Clarke, F.R.S., &c.—Practical
Observations on Insanity of Feeling and of Action. By Henry
Maudsley, M.D. Lond.—On the Functions of the Cerebellum.—
Notes of Lectures on Insanity. Delivered at St. George’s Hospital,
by George Fielding Blandford, M.B. Oxon.
.
.
401—410
PART IV.-NOTES AND NEWS.
The Medico-Psychological Association. Proceedings at the Annual Meeting
of the Association, held at the Rooms of the Royal Society, Edinburgh,
on Tuesday, July 31st, 1866.—The Want of Education in Physical
Science.—The Medico-Psychological Association.— Recent Contri
butions to Mental Philosophy.—Visions of Heaven and Hell.—Mr.
Carlyle on the Education of the Future.—Publications Received, 1866.
—Reports of County and District Asylums.—American Reports.—
Appointments.—Obituary
.....
415—455
Notice to Correspondents
.....••
List of Members of the Medico-Psychological Association
.
No. 60 {new series No. 24) n-ZZZ be published on the
lsZ of January 1867
•
456
457
�THE JOURNAL OF MENTAL SCIENCE.
No. 59.
OCTOBER, 1866.
Vol. Nil.
PART I.--ORIGINAL ARTICLES.
Address; on Medico-Psychology. By W. A. E. Browne,
Commissioner in Lunacy for Scotland.
(Read by the President at the Annual Meeting of the Medico-Psychological
Association, held at Edinburgh, July 31j/, 1866.)
This is the first occasion upon which we have assembled under
the title of the Medico-Psychological Association.
The event
appears to me auspicious both as inaugurating a more correct desig
nation, and as pointing to a wider and more legitimate destiny.
Me can no longer be mistaken for a mere friendly club or a mutual
defence society. We may now claim as among our objects the
investigation of all subjects bearing upon the science of mind in
connection with health and disease, as well as those which affect our
personal interests or the interests of those committed to our charge.
We claim even a wider, almost a universal range for the science
of Medico-Psychology, and we claim for it a distinct position in
science. The difficulty is to assign and to restrain it within limits.
The multiform phases of actual insanity will be confessed by
all to fall legitimately within its province. The still larger and
more proteiform affections, unequivocally morbid, but compatible
with such an amount of health and work-a-day self-control as
neither to violate law, nor decorum nor delicacy, may be tacitly
conceded, and, at a certain stage, naturally and inevitably come
within the same category. But it is held to be a corollary of the
definition of medico-psychology now accepted, that all physical
diseases, all changes in structure, have a psychical, and often a
morbid psychical side ; that to overlook the mental condition of
VOL. XII.
¿1
�310
Address ; on Medico-Psychology,
[Oct.,
the fever- or consumption-stricken patient because the disease is
corporeal, would be as absurd as to disregard the bodily condition of
the melancholic or of the general paralytic because the disease is
mental.
It would not be enough, according to this estimate, for the psy
chologist to interpret delirium as an indication of cerebral disturb
ance, to allay fear or to sympathise with suffering—acts which might
be performed by the humane and the uneducated ; but it would be
incumbent to connect the special mental condition with the particular
changes going on in the organisation, to employ the mind as a
medium of treatment, or, conversely, to act through the body upon
the mind—and, in short, to embrace all the phenomena presented,
and precisely in the same manner, as if they wyere of equal import
ance or demanded the same consideration.
A glance of the idiotic, imbecile, backward, hebete, criminal por
tions of our population will infallibly suggest the advantages of
bringing such views to bear upon the education and training of the
young, to such an extent, at least, as that the attempts to impart
knowledge should be in harmony with the laws of health, and with
the temper and temperament of the individual as affected by struc
ture. Tor in the errors of education may lurk the poison which grows
into insanity -or eccentricity, and, in like manner, into sound training
may be introduced the preservative against eventual latent mental
incapacity.
The conservative mission of our science in anticipating, prevent
ing, and modifying mental maladies is hitherto an unworked,
and, it is matter for regret, a neglected problem. The laws of
hérédité, moral and intellectual degeneration, and of intermar
riage, constitute a science in themselves; and, perhaps, contain
the basis of the future development and utility of prophylactic
medicine. The importance of due attention to transmitted ten
dencies, not merely in connection with alienation, but with cha
racter and conduct, where no open interference of medicine or
law could be thought of, and with other affections which are not
brought within our cognisance, illustrate the usefulness of such an
application of our science. There is a vast class of instances of
mental unsoundness, perversity, obliquity, extravagance, which
place the sufferer at nearly an equal distance from health and disease,
from insanity and crime, and which, undoubtedly, depend upon phy
sical causes, tend to modify other forms of disease, are the sources
of incalculable social, domestic, and personal evil, and may originate
the pronounced and palpable instances of alienation. The same
observation applies when epidemics of mental disease, of theomania,
or of suicidal impulse, arise, and even now agitate large communi
ties, in the broad, bright sunshine of modern intelligence, and in
what are styled, it may be ironically, the centres of civilisation. It
�1866.]
by W. A. E. Browne.
311
cannot be doubted that the ravages of such moral plagues, although,
like cholera or fever, they may select their victims from the predis
posed and susceptive, must owe their origin to some common cause
or causes, it may be political or religious commotion or excitement,
or imitation, or social conditions, or atmospherical changes, which,
if they cannot be counteracted, deserve to be studied. Even the
mental phases, the panic, the temerity, the fatalism which so often
accompany and aggravate the disasters of ordinary epidemics, claim
our consideration.
We may obtain a better view of the fair proportions of the subject
by clearing away the rubbish and obstructions which have gathered
around it, and by showing what it is not. The mere custody and
care of lunatics certainly do not constitute a man a psychologist.
Even where the physical wants and diseases of the class are attended
to, and where an intuitive penetration into character imparts a
certain suavity and address to the management, there may not be
even a remote or indistinct conception that it is the immortal part of
our nature, the godlike attributes of reason and imagination, and
even of faith itself, and their ultimate destiny in time, which are
dealt with, and which are, as the case may be, ignorantly neglected,
unconsciously tampered with, or rashly and ruthlessly invaded and
disturbed. It is true that, in many well-constituted and well-pre
pared minds, the experience which grows from mere contact with
and observation of the objects of care and solicitude—the actual
shortcomings and failures which experimentalisation involves—sug
gest, obtrude, necessitate the origin and growth of a philosophy, an
analysis of the laws of mind as influenced by disease, which, though
crude, is invaluable as affording a basis for moral treatment, and for
systematising the relations and responsibilities which connect the
physician with his patient. It is beginning at the wrong end to
learn the physiology from the pathology of mind; but it is better
to do this than to stagger and stumble blindly on without a physio
logy at all.
But could we realise the absurdity of a pure metaphysician being
entrusted with the study or reconstruction of the mind diseased, the
anomaly would be as egregious and disastrous. It would be vain
for such an expert to ponder over the states of consciousness as
presented in himself, or to form his opinions or his course of prac
tice upon abstract principles or the subjective analysis of intellect,
emotion, or impulse; and, though the unwelcome facts might be
forced upon his attention that his most delicate crux failed to detect
the elements of which a morbid act was constituted, or that a ten
dency handed down through and by a long line of ancestors—
“Through all the blood of all the Howards”—
perhaps, or that an attack of catarrh, or that a fit of indigestion
�312
Address ; on Medico-Psychology,
[Oct.,
introduced new and inappreciable relations into the mental pheno
mena, he would fail altogether in comprehending or combating the
difficulty.
It is not with the view of exciting a smile that I ask you to con
ceive a disciple of the “ pure reason” face to face with a furious
maniac, or an animist, exorcising the demon delusions that spring
from diseased lungs, liver, or ovaries.
Nor would the mere drug-worshipper fare more successfully.
Perhaps the recognition of insanity as a bodily disease, while it con
ferred incalculable benefits upon the patient, contributed to divert
the attention of the physician from the psychical side of the diagnosis;
and while he trusted to opium and tartar emetic, he was tempted to
forget the “ dietetics of the soul,” as Feuchtersleben designates our
dealings with the moral nature. There is, however, the greater and
more unpardonable fallacy in the proceedings of this class of pre
scribing, and over-prescribing, for the mental condition, of giving
opium to cure mania, or iron to cure melancholia; worse than the
old and inextinguishable error of treating a symptom, in place of
the disease; in so far as the morbid operations of mind are further
removed from the reach of remedies, and are actually the expressions
of changes in consciousness, depending upon the influence of im
pressions conveyed through altered structure. Such a view does
not exclude enlightened therapeutical treatment; it enhances its
value, and gives not only a wider scope, but a more precise and
intelligible aim, in its employment. If our knowledge of the
physical changes upon which the different forms of alienation de
pend was more extensive and sound, the limits and effects of reme
dies might be as much relied upon as in other maladies; but even
at the present stage of our science, when treatment is founded and
judiciously conducted on the principle of restoring to health the
organisation generally with which mind is connected and upon the
normal state of which its soundness depends, success attends the
attempt in a large proportion of cases. There is, consequently,
ground for regret that the millifidianism which has gained a footing
in the profession has contaminated the alienists, and that the con
sumption of drugs in asylum practice presents infinitesimal quantities,
even where these are not exhibited in infinitesimal doses ; that the
active medication of the insane is relinquished so early, that large
communities are consigned to the limbo of expectancy, and that so
many of our brethren entrust their charges to the kind but some
what dubious and unregulated influences of food, air, water, light.
He who refuses the aid of medicine is as much a heretic to the
true faith as he who doubts the efficacy of moral agents.
The pure hygienist—powerful handmaids and coadjutors although
food and air, &c., must be confessed to be—is likewise one-sided and
weak-sided, and restrained by self-imposed bonds. He who, with
�1866.]
by W. A. F. Browne.
313
that potent instrument, a well-appointed, smoothly moving asylum
at his command, contemplates, with self-complacency, exquisitely
clean, well-arranged, well-aired, and well-lighted and heated wards;
and has exhausted his resources when the meals are well served,
the baths sufficiently frequent, and the routine of exercise and occu
pation meets no shock nor hindrance—who marshals his trades, and
marches out his squadrons, and subjects all uninvalided patients to
the same discipline—is, perhaps, a good superintendent and a
splendid drill; but he has failed to embrace the entirety and the
grandeur of his mission.
Even he who addresses the aesthetical and imaginative part of our
nature-—-who seeks to reach the highest and purest qualities, and to
evoke their influence in spreading calm and order in the agitated and
confused spirit through our sense of the beautiful and symmetrical—
though wise, is only partially wise, if he trusts exclusively to deco
ration, and music, and distraction; miles of walls may be covered
with pictures and statues, his charges may be enabled to see scenes
of natural beauty or the wonders of art, and every succeeding day
and hour may have its appointed recreation and enjoyment; and
asylum life may be rendered more cheerful and gay, and more devoid
of care and duty, than home life; and still this humane system must
be characterised as incomplete, and when weighed against the
claims and necessities of the mind diseased, must be regarded as
frivolous.
In short, the man of one remedy or class of remedies, or who
elects such to the undue disparagement or disuse of others, is nearly
as rash and in as great danger of defeat as he who fights his anta
gonist with one hand, or as the physician with no remedy at all,
who consoles himself with the antiquated dogma that diseases have
a tendency to cure themselves.
We do not undervalue these fellow-labourers; for, humble and
limited although some of these approximations to medico-psychology
may be, there is involved such an amount of force and dignity of
character, such self-possession and self-denial, that neither the public
nor our profession know of, think of, and, from their ignorance of
the situation and the requirements necessary, cannot realise. There
is, however, now no excuse for partial knowledge, since public in
struction in medico-psychology may be obtained in conjunction with
almost every medical curriculum in Britain.
We are disposed to include in the same category those who con
ceived that they were curators of the health of the body, and left
the mind to its own devices ; those who neither courted nor could
conceive intercommunion, nor friendship, nor confidence between the
physician and his charges; nor who understood the sanatory influ
ence of the healthy over the disordered, of the clear and educated
over the ignorant and clouded intelligence, or of sympathy in bring-
�314
Address ; on Medico-P'sychoJogy,
[Oct.,
ing back the erring sentiments to calm and sobriety. These con
tracted modes of action have passed away, or are rapidly passing
away, not so much because we have become wiser philosophers or
better physicians, but because we have been brought experimen
tally into contact with the diseases we have to treat—because we
now regard the condition as a disease, and not as a superstition, or
an abstraction or a bugbear, and because our treatment is founded
upon a more just estimate of the laws of the nervous system.
In referring the origin of these opinions to a comparatively recent
date which are now recognised as the basis of medico-psychology,
my course has not been dictated by any supposition that the philo
sophers of antiquity were ignorant of the laws of mind. They are,
perhaps, open to the animadversion that each individual was a school,
a system, a philosophy to himself;—a result, it is probable, of their
depending more upon reflection than upon observation—of having
devoted their inquiries more to subtleties and to verbal abstractions
than to the analysis of mental phenomena; and, above all, they may
be arraigned of having neglected or omitted the study of insanity,
either because it did not come legitimately within the sphere of their
inquiry, or that it did not subserve as a mean of illustrating the
objects to which that inquiry was directed. They described as divi
nation or possession what was not “ dreamed of in their philosophy,”
but was actually, and what is now, admitted to be departures from
the ordinary laws of healthy mind■ and to the malign influence of
this theory may be attributed the cruel persecutions and punishments
to which certain classes of madmen have been exposed down almost
to our own time. There are, of course, many illustrious exceptions
to this condemnation. Aretseus seems to have anticipated the views
prevalent during last century ■ to have accurately described the two
grand categories, mania and melancholia, under which even now
many practical men would place all mental diseases; tracing them
to vitiation of the humours and fluids; secondly, to have distin
guished, with great ingenuity and delicacy, these typical forms from
transitory conditions, such as delirium, intoxication, and natural
depression; and, lastly, to have been the originator of moral treat
ment, although a foe to pictorial ornamentation.
In a still nobler mind there appears to have been a foreshadowing
of convictions which have coloured or interpenetrated the doctrines
and school so long in the ascendant in Germany, and which has
still its representatives. “ This internal physician, this councillor
and aid, is the power itself which, in every individual being, binds
and holds together, in a suitable manner, the finite and the infinite—
the soul. It cannot have the knowledge which it evinces from its
body, of whose existence and life it is the cause; nor from expe
rience which it has had in common with the body, for-that know
ledge, in fact, preceded this experience, and in the first instance made
�1866.]
by W. A. F. Browne.
315
it possible.” So spake Plato. I quote from Feuchtersleben, and so,
twenty centuries afterwards, spoke Stahl, very nearly in the same
words.
The views of alienation will correspond to and be a reflexion
from the popular or established opinions and creeds of the time.
They will be somatic or psychological as materialistic or idealistic
opinions prevail. All, however, will be disposed to admit that
Plato and Aretseus represent two great schools, lines of thought,
or modes of belief, which run through all history, and may, under
certain modifications, be as distinctly traceable in the present as in
any former age.
Out of the incubation of the fifteenth, sixteenth, and seventeenth
centuries there sprang, after many abortive attempts, in full and mature
development, the doctrine of theVitalists. The proposition of Van Helmont was, that all changes, structural or functional, in the body, whether
resulting from its own spontaneous action, or from the effects of food,
remedies, &c., are under the guidance and governance of a specific
agent connected with, but distinct from, the living system. This agent
is either an abstract principle or power distinct from matter, or matter
so endowed with new qualities and energies as to be entitled to be
regarded as an entity. Stahl designated this archseus, or intelligent
but unconscious principle, Anima, and recognised it as building up
the system, as detecting the presence of all noxious or destructive
influences and disorders, and as providing against their effects by
exciting such conservative molecular and other changes in the body
as may counteract or repair the injury threatened or inflicted.
Dr. Stahl, says Cullen, “ has explicitly founded his system on the
supposition that the power of nature is entirely in the rational soul.
The soul acts independently of the state of the body, and that
without any physical necessity from that state : the soul acts purely
in consequence of its intelligence perceiving the tendency of noxious
powers threatening or of disorders arising in the system, immediately
excites motions in the body as are suited to obviate the hurtful
or pernicious consequences which might otherwise take place.”—
Vol. i, p. 6, Preface to Cullen's ‘ First Series' (Gregory’s edition),
1829.
But, in addition to the recognition of this principle, which mani
fests the attributes of what may be called instinctive reason, and is
now dignified by the name of coenesthesis, or common feeling, and
is referred to the ganglionic system, but especially to the phrenic
focus; Stahl undoubtedly founded the German psychological school
in advocating the dogma that morality, independent of external in
fluences (more or less accidental), is the principle of order in the
corporeal and intellectual life, and stands in the same relation to
mental integrity and development that the anima does to nutrition
and growth ; and, on the other hand, that immorality is the sole
�316
Address ; on Medico-Pyschology,
[Oct.,
cause of perturbation and disease. And to this point may be traced
back, in modern times at least, the application of moral agents as
remedies.
Heinroth, who forms the next link in this series, held that man
lives, as far as he is man, by reason ; that the highest point of
human activity is gradual progression : that the first degree of this
is sense, or individualism; the second is where the individuality,
the me, is placed in opposition to the phenomena outside of it.
Between these intermediate stages, and in the essence of me,
grows up the third term, conscience, which is at this point nothing
more than the germ of a higher power, which is derived from a still
more elevated source. Health, again, is the equilibrium or har
mony of our thoughts and our desires, accompanied by the pleasure
which attends the complete exercise of a function. Disease is the
destruction of this unity in the suspension of one or more of the
vital forces; and its origin cannot be found in the body, but in
reason. We suffer, we fear, and the result is passion, which, as a
disorder of sensibility, reacts upon the other faculties ; throws reason
into grievous errors, influences the will, leads to extravagance and
dangerous delusions, and crime; which, however, Heinroth attempts
to distinguish from derangement.
To this disturbance of the spirit, or diathesis, all insanity is
traced; and somatic accidents, violent impressions—even educa
tion itself—are regarded as prejudicial or destructive to mental
health and serenity by and through this medium. This theory has in
the process of condensation, and in the attempt to eliminate obscu
rity and vagueness, been stripped of much of its attractiveness. And,
moreover, it would be unfair to measure HeinrotlTs precepts of
moral treatment by such cloudy magniloquence as “ the neutralisa
tion of sensibility is a new product, madness,” nor even by the
epitome now presented.
The precepts themselves form a code of moral management:—
I. Combat excitement or depression by recalling them within
their just limits.
II. If imagination suffer, abandoning itself to reveries and
unrealities, have recourse to sensible impressions and lively revul
sions.
III. When reason is perverted, it must be combated, not by direct
arguments or syllogisms, which irritate the patient, but by indirect
appeals through other powers—by tact and discrimination.
IV. If sensibility be blunted, it may be roused by joy or pain.
V. In partial insanity, utilise the healthy faculties in treating and
guiding those diseased through the influence of occupation, education,
and amusement.
The philosophy of Tdeler may be summed up in the propositions—
T. The knowledge of insanity should originate in that of the pheno-
�18G6J
by AV. A. T. Browne.
317
mena of the normal psychical state. II. Psychology stands in the same
relation to mental affections that anatomy and physiology do to phy
sical diseases. III. The want of correspondence between morbid ap
pearances and symptoms opposes the supposition that mental diseases
originate in organic changes. IV. Derangement is nota symptom—
it is a result of the moral organisation, in a state of change, of the un
equal growth and unequal rapidity of growth in the individual faculties.
Here is reproduced the equilibrium supposed by his predecessors
necessary to health. Ideler is better known, however, as the pupil
and biographer and the incarnation of the genius of Langerman, who
is said, epigramaticallv, to have written no book, but to have left a
living book in his disciple behind him. Their conjoined doctrine
was, that the lunatic mistakes the real end of life, and subverts the
true subordination which should regulate the relations of the facul
ties, not by an error of logic, but by the unhealthy exercise of the
will, and of the desires which precede volition ; states which together
regulate all human acts ; in other words, by the emancipation of
these powers from conscience.—Secondly, that the great objects of
the psychologists should not be reason, attention, but the moral
forces or character ; or the tendencies, sentiments, and general dis
positions of the mind, and of the passions, either singly or in rela
tion.—Thirdly, that the passions, or the product of sensibility, act
as the stimulators of our activity; morality merely modifies or
moderates their development. In their predominance and dispro
portion insanity consists. Joy is an index and measure of activity;
pain is the proof of an ungratified tendency. Pain is to the ten
dencies of the soul what vice is to morality. If passion gives time
for the exercise of reason, vice follows—if not madness. Spon
taneity determines the action of reason and of passion, which may
resist, or modify, or nullify its power. A symptomatic insanity is
admitted, as in fever, but the origin of genuine idiopathic mental
disease must be sought for in passion, l’état maladif, and in dis
turbance of the primitive instincts.—Lastly, not merely the intel
lect and sentiments, but even the physical forces, mould themselves
upon the type of passion ; an assertion which may be accepted as
the modern phasis of Stahlianism.
*
One whose name and fame still cling to the walls of our university
may be regarded as having passed the boundary line—or, perhaps,
more correctly, as forming the connecting link between the animists
and the modified doctrine which now prevails. Robert AVhytt is
claimed, and with apparent reason, as a partisan of their respective
opinions by the animists, the semi-animists, and the medico-psycho
logists. No higher tribute could be paid to his memory, or to the
judiciousness and moderation, or anticipative soundness of his views.
* “ Etudes Historiques sur l’Alienation mentale,” par Ch. Lasègne et Aug.
Morel,’ t. iii et v, ‘ Ann. Médico-Psychologiques,’ 1844.
�318
Address; on Medico-Psychology,
[Oct.,
lie was a physiologist of modern convictions, living and distinguished
in past time. With the Stahlians, he held that impressions con
veyed to the nervous centres excited, by a “ physiological necessity”
and according to certain laws indicating design and plan and pur
pose, animal movements—in other words, vital functions, such as
digestion, nutrition, circulation; and this without reason, attention,
or consciousness. It is very possible that he did not identify this
“physiological necessity ” with a psyche or anima ; but he apparently
viewed it as different from the rational intelligence—as never rising
into consciousness, as self-acting, and as productive of results in the
construction, maintenance, or reproduction of that machine, or or
ganisation, upon the integrity and health of which mentalisation
depends. His most recent and distinguished biographer seems to
be conscious of this; for, while vindicating Whytt from the allega
tion of Haller that he was a semi-animist, he writes, “ There is still
room in modern science for a psyche : when the inquirer, not content
with mere law, seeks the causes of organic phenomena, he cannot
dispense with such an active force. As human intelligence is required
to combine and regulate the natural forces which man avails himself
of to produce his own works upon earth, so with all the new-found
activity of matter derived from the interchange of such forces as
light, heat, aggregation, affinity, electricity, polarity, a psyche is in
dispensable to direct the order and course of these forces in the
development and working of organic bodies. Deduct the effects of
all these natural forces in the development and working of organic
bodies, and the residual force found to be necessary constitutes the
psyche—a force just as essential in a protococcus as in the human
frame. If it be otherwise sought for, it is nowhere else to be met
with, except in the potentialities existing in the reproductive cells
derived from the first parent or the first parents of every species in
the organic world.” He adds further, “ such a psyche as is held
essential by many modern physiologists—such a psyche as was upheld
with much force of argument by the present Professor of Anatomy,
in« a discourse which he has not yet published, delivered to the
Royal Medical Society.
*
While we most fully admit, however, that the mind of Whytt
was the bridge between the theory of a vital unconscious reason, and
those of unconscious cerebration and reflex action of the brain;
if he did not, according to Brown-Sequard, initiate or foreshadow
them; and, in addition to this, and more important than this, that
he advocated, and in his own experience carried into effect, the study
of vital and mental phenomena as affected by and observed through
organisation, in opposition to all purely chemical and mathematical
philosophies,—we cannot resist the conviction that, even as con
* ‘Transactions, Royal Society Edin.,’ vol. xxiii, part i, pp. 107-8.
�1866.]
l>y W. A. F. Browne.
319
veyed in the following lucid and definite words of Dr. Sellers, and
still more palpably in those of Whytt himself, there is a very
distinct adumbration of animism, and to which I do not object:
“ That the peripheral extremity of an afferent nerve being affected
by an impression, there results a corresponding condition of the
nervous centre, whence, ‘ in accordance with the constitution of the
living frame,’ a motor influence is determined through afferent nervous
filaments to particular organs which are thrown into movement.”*
It is highly probable that this determination of certain messages
to particular obedient organs, which act unconsciously for a useful
end, and this without any act or interference or cognisance of mind,
would have been accepted by Van Helmont and Stahl as an instal
ment, if not as a fair and accurate exposition, of their cherished
dogma. Even the theory suggested by the word co-ordination, now
in such constant use, involves a similar conclusion. This considera
tion has been largely insisted upon, because in it is, in my convic
tion, contained the true theory of the relation between our physical
and psychical nature—that the power which regulates must be dif
ferent from, independent of, superior to the forces regulated.
Running parallel to, mingling at various points, and ultimately
merging into one confluence with the school which we have described,
was that of which Friederich and Jacobi were the representatives,
which held—1. That the spiritualists erroneously regarded exorcism
and superstitious ceremonies as among the rational means of moral
treatment.
2. That the doctrine of the spiritualists is immoral, as placing
disease, and consequently the eventuality of destruction, in the
soul, which is one and indivisible.
3. That it is false, as it confounds moral error, delinquency, with
the mental state of lunatics. The untenability of such a proposition
being demonstrated by the facts—
(1) That large numbers of criminals have not beenunsound
of mind.
(2) Children are insane before they can distinguish right
from wrong.
(3) Upright individuals have been attacked with insanity.
4. That mental diseases originate as often in physical as in moral
causes.
5. That they are cured by physical remedies.
6. That our moral nature is superadded to the functions of
matter.
About the opening of this century, the opinions of writers and
thinkers upon this subject were capable of being divided into three
classes :
* ‘ Phil. Trans.,’ ut supra, p. 124.
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Address ; on Medico-Psychology,
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I. Where the mental operations were regarded as the functions of
matter, and mental diseases as bodily diseases.
II. Where the mind was held to have existence independent of
the body, and its diseases as resulting from the want or loss of equi
librium, or of due culture in its powers, or as the effects of immo
rality or crime. And,
III. Where an independent operation or life of mind was believed
in, and where its derangements were represented as partly psychical
and partly corporeal.
*
These represented, in fact, the schools into which physiologists
were divided. The recent establishment of sounder and broader
views, the result of more accurate observation, and, above all, of
the careful practical study of mental disease by educated meD,
have lessened the distance between these conflicting opinions, and
have so diminished the difficulties by which they were separated,
that mind is now admitted as having an independent existence, but
to be so intimately connected with organisation that its operations
.may be facilitated, impeded, or abrogated through this connection ;
and that mental diseases are the consequences of the disturbance
of that nervous power or influence which, under present circum
stances, connects mind and matter. Even Friederich, whom we
have cited as the champion of the pure somatic school, is de
tected by Feuchtersleben in propounding as “ one of the arguments
for the somatic nature of all mental derangements, that the mind
is an independent indivisible energy, and incapable of becoming
diseased.”
And we may triumphantly point to Griesinger, the pathologist,
as holding similar opinions : “ Entre ces deux actes fondamentaux
de la vie physique il s’entrepose toujours quelque chose excité par
sensation, un troisième élément, etc. Cette sphère, c’est l’intelli
gence.”—Pp. 28, 29.
Even the doctrines of Gall and many of the phrenologists, by a
route which seemed to end in materialism, led to the same proposi
tion. The assertion that the brain was the organ of the faculties of the
mind, by and through which it acted, involved its distinct existence,
as well as the proposition which constitutes the basis of medico
psychology.
The course of thought among German psychologists has been
introduced and pursued, because if it did not actually form the
channel through which all that is true and valuable of the philo
sophies of early times has descended to us, it certainly has con
tributed many of the materials of which modern belief has been
built up and composed ; and this whether we regard the firm and
substantial observations of the pathologists, or the more subtle and
* ‘ Feuclitersleben,’ p. 68.
�1866.]
by AV. A. F. Browne.
321
plastic experience derived from consciousness. The prevalent opinions
are a union, a harmonisation, a compromise, perhaps, between the ma
terialists and the vitalists; and the general consensus of living medico
psychologists in Europe who have thought out the subject, or thought
upon it at all, after making ample allowance for individualisations
and idiosyncrasies, may be represented as consisting of convictions
that the mind, whatever its nature may be, is intimately connected
with, but is not a property of, nervous structure ; that its laws, and
the relations of those states of consciousness which are named
faculties, feelings, instincts, can only be studied and understood in
relation to, and as influenced by, the conditions of organisation ; that
its disorders and diseases must be recognised as expressions of arrested
or undue development, or of molecular or other changes—even
healthy changes—or of degeneration and destruction of structure;
that the remedies when material act by influencing these changes
towards health, and thus establishing the normal relation between
mind and nervous matter; and when moral, or acting more directly
on the intelligence and feelings, they stimulate or repress, or alter,
as the case may be, the functional process upon which healthy mentalisation depends. It may be further observed, that this analysis
would not express the prevailing doctrine did it limit the relations
subsisting between mind and matter to the cerebro-spinal axis. The
great characteristic of current opinion appears to be, that wherever
there is nerve, there is psychical function, actual or potential, which
may act dynamically, or through the influence of nutrition, or rise
through pain or morbid activity into the range of consciousness.
This is the stage at which the archaeus of our predecessors ceases its
specific instinctive operation, and comes within human cognisance.
The nervous influence of the great mass of physiologists, the
coenesthesis of Feuchtersleben, the law of others which is repre
sented as acting altogether irrespectively if not independently
of intelligence, becomes part and parcel, and permanently so, of
our intelligent being, and furnishes materials for thought—or,
more correctly, thought itself. Such propositions as this, and more
especially that every mental process must be judged of and treated
in reference to the nervous structure and frame in general, and their
functions, enormously increase the domain and importance of psy
chology. If it discloses the innumerable sources of mental dis
turbance, and that the boasted supremacy of mind is a fable—that
it is really dependent for its activity, and integrity, and responsibility,
upon the laws and health of the general economy,—it further demon
strates that no circumstance, no impression internal or external,
which through these laws reaches our instinctive or conscious nature,
but is accompanied with molecular changes, and cannot and should
not be excluded from our philosophy. The construction of an
asylum—the dietary, the clothing of the insane—the laws under which
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Address ; on Medico-Psychology,
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they are disposed of and managed—are in this view as rightfully, if
not as much, within the province of medico-psychology as the rela
tion of reason to volition; of the evils of concentration, monoidealism,
or excitement upon the circulation in the brain ; or as the effects of
sleep, amusement, religious teaching, in bringing about the equili
brium of the faculties.
We are not open to accusation that the co-ordination of these
fragments, and the formation of a consistent and what promises to
be a mature view of the whole subject has been late in development.
The causes of the delay are to be found first in the late period at
which the insane were subjected to close and clinical observation,
and regarded through any other medium than that of superstition
and fear; and, secondly, in there being no body of observers spe
cially prepared or devoted to the investigation, or, indeed, as having
power and opportunity to devote themselves.
It is not asserted that to the German school or to any particular
class of authorities we exclusively owe the principles upon which our
science and treatment are founded or regulated. Such views grow
up under all systems, and without system, in every class of minds.
Every practical man, even he who boasts of his freedom from the
shackles of hypothesis and the vagaries of speculation, has a theory ;
and wherever that is true and sound, or to the extent to which it is
true and sound, and has led to a judicious and humane course, it
may be confidently claimed as a contribution to the science which
its possessor may scorn.
Pinel was an actor rather than a thinker. His writings contain, how
ever, valuable clinical observations. He records his inability to trace
mental disease to lesions in the nervous structure, and yet he calls
mania “ an act of the living principle which must change organisa
tion
but his habits of thinking and his treatment, though far from
heroic, and, in fact, a protest against the sanguinary and exhaustive
processes of his contemporaries, were in keeping with the principles
then and ever since triumphant in France. His fame depends greatly
on reposing unbounded and loyal faith in the law of love and kindness
as a mean of cure, amelioration, and management. It would be
vain to connect this revelation with the philosophy of his country
man Descartes, or with the lurid dawn of that sun of liberty which
was supposed to have disclosed for the first time the destiny of our
race ; suffice it that Pinel burst the fetters, levelled the oubliettes,
proclaimed humanity, and established rational paternal ministrations
as the right of the insane, because they remained men although they
were mad, and were susceptible of cure, or of improvement, though
labouring under the greatest and most grievous, but not the most
incurable, of diseases. He was born in 1742, the contemporary of
Langerman, born 1768; and they may be regarded as types of the
menial tone and tendencies of the races to which they respectively
�1866.]
l>n W. A. F. Browne.
323
belonged, and which were ultimately to converge and culminate into
a more catholic creed. Langerinan is rich and recondite in the
metaphysical and ethical aspects of alienation; Pinel is perspicuous,
practical, philanthropical, but not psychological.
The successor of Pinel was more of an observer than a philoso
pher, and he was more of a philanthropist than either of these.
The writings of Esquirol even now form an inexhaustible treasure
house of carefully noted facts, and when published new to the pro
fession, because the insane had scarcely until his time been submitted
to the observation of scientific men, and were placed in circum
stances calculated to change and aggravate the character of their
malady, and to render them dangerous and formidable, and to
suggest grotesque and erroneous ideas of their condition. The
achievements of Esquirol consisted in feeling in his gentle and
Christian heart, and developing in his practice, what Pinel had hoped
and initiated, but much more than he had dreamed of. To his
personal manners and example, as much as to the principles he had
laid down, are to be traced the rational views of insanity which now
prevail. His life was a long clinique, instigated and animated by
charity and sympathy. He built up no theory of his own ; but, so
far as he theorised at all, he may be claimed by the present gene
ration as holding their opinions. His immediate representatives,
pupils, and admirers have now for twenty-three years embodied
and developed these opinions in the ‘AnnalesMedico-Psychologiques?
Our science is of long and tardy growth; our name is due to the
school and the invaluable series of papers to which we are now
referring. From the prefatory address or profession of faith by
Cerise, in which the mixed or psycho-somatic view is expiscated
until now, with such deviation and diversity as are inseparable from
free discussion and the co-operation of different minds, the same
principles may be traced. This may be, in part, attributable to the
work having been conducted by the same editors ; but it is much
more due to the general acceptance and predominance of the prin
ciples themselves. How far this splendid record of the thoughts
and deeds of a section of our department may have exerted an in
fluence upon the convictions and literature of the profession in this
country, it would be presumptuous in me to say ; but we may pass
on to another topic with the remark that such an example is de
serving of all honour and of imitation.
The study of the literature of our department has become abso
lutely imperative, were it for nothing else than to prevent redis
coveries and the prosecution of inquiries long since exhausted.
American literature appears to justify the supposition that our
fellow-labourers in that country concur in the theory which now
prevails in Europe. No systematic works have reached us from the
United States since those by Caldwell, Brigham, and Ray ; and, in
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Address; on Medico-Psychology.
[Oct.,
speaking of American literature, reference is made to the ‘ Journal
of Insanity/ and to those valuable contributions which appear in
the form of annual reports from different asylums. These papers,
adopting a practice introduced but not generally followed in this
country, contain to a great extent the personal experience and re
flections of the writer. Although, being addressed to many non
professional readers for the very purpose of dispelling gross and
grievous errors, and of substituting sound and benevolent views,
they are so far popularised as to be freed from many unnecessary
technicalities; they preserve the dignity of the subject, and in no
degree derogate from the professional position of the writer, and
contain a body of important information and philosophical induc
tion so valuable, that the ephemeral nature of the vehicle to which
they are committed is to be lamented. The monographs of Drs.
Bay, Butler, Kilbride, Chipley, <kc., are of the highest order.
An examination of our own authorities, from the anticipative essay
of Beattie, published a century since, to the last profound analysis by
Professor Laycock, although they may be found to incline less or
more to one side or other, will justify the conclusion that the
psycho-somatic theory is here, as elsewhere, in the ascendant. Two
illustrations may suffice. Of the classifications now in use, one is
founded upon the mental phenomena as indications or symptoms of
mental disease; another refers mental diseases to the supposed
organic cause, and names them accordingly, but describes them by
the mental phenomena; and in a third, the attempt is made to dis
tinguish and arrange the morbid affections according to the primitive
instincts and powers involved. But in all the correlation of the
psychical and somatic aspects are either taken for granted or de
signedly recognised. The prevalence and sincerity of this belief
may be further exemplified in the principles which guide our therapeia.
Morphia is prescribed to produce sleep, and thereby to lessen mental
activity and to economise force, to check the metamorphosis of
nervous tissue, to facilitate nutrition, and, in these ways, to induce
healthy mental action. Cannabis Indica is resorted to in melancliolia as producing the same result, by reversing the order of the
process. Happy and joyous thoughts, and dreams, and even delu
sions, are suggested. Artificial and temporary convalescence, a
lucid interval, are created; active and healthy nervation ensues ; the
effect on nutrition and sanguifaction is such, that anaemia, generally
the origin of the moral suffering and other psychical phenomena,
are removed. All moral means, again, act perhaps through their
influence upon structure, or, at all events, less by direct operation
on the intellect and emotions than by stimulating the nervous struc
ture to that degree of activity which is necessary to the normal
exercise of the faculties. And, in contradistinction to this, the
shower-bath, counter-irritation, occupation, prove chiefly beneficial
�1866.]
by W. A. F. Browne.
325
by appeals to fear, suffering, and the sense of discipline. Iron,
iodine, bromine, all important agents in the removal of insanity,
are supposed to reach the mind through the blood; whereas joy
and other moral impressions reach the blood through the mind.
These are considerations which point emphatically to medical
men, as the only class who have even partially embraced such prin
ciples, and who are entitled to be autocratic in their exposition
and application.
Among those who have contributed largely and lovingly to the
promotion of medico-psychology, and to its organisation into the form
which it has latterly assumed, but have passed away since we last
met, must be remembered I. Jean Parchappe de Vinay. Prepared
by having passed through and distinguished himself in the offices of
lecturer, practitioner, medical superintendent for thirteen years, he
was elevated to the position of inspector-general of the insane and
of prisons; a combination which, though natural and appropriate in
itself, has not yet found a place in the British mind. The elevation
was, in one sense, a bauble dignity, as barren as the cross of the
legion of honour with which it was accompanied, as he left ample
emoluments and a large practice at the call of government. He is
described, by those familiar with his life, as simple and industrious
in his habits—as a learned physician, a profound philosopher, an able
administrator, and master of the most minute details. We, how
ever, know him chiefly as the author of f Treatises on the Brain, its
Structure, Functions, and Diseases / in which he advocated the
psycho-somatic doctrine, and discriminated the cerebral changes
found in the bodies of the insane, into those connected with and
those unconnected with the mental disease; as the architect of several
of the asylums recently erected in France ; and as the patron, pro
tector, and friend of those who, as he once was, are placed in the
trying circumstances inseparable from the due discharge of the
duties of a medical superintendent.
Ripe in years and wisdom, Sir A. Morrison recently died. Though
of a generation that has passed or is rapidly passing away, and
designated by one of his biographers as a patriarch—and though
living in the quiet suitable to the twilight of years—he never severed
the ties which connected him with our department. It must have
been among his latest acts to endow a lectureship in connection with
the Royal College of Physicians, now held by our honorary member
Dr. Sellers. He has other claims upon our memory and respect.
He was, perhaps, the first who, in this country, delivered a course of
lectures upon mental science. His attention was chiefly directed to
the physiognomy of insanity; and, I believe, these lectures, and the
drawings by which they were illustrated, now form a large portion
of his work upon this subject. The physician of two large hospitals
for the insane, and personally and practically acquainted with the
VOL. XII.
%%
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Address ; on Medico-Psychology.
[Oct.,
imperfections of the human instruments by which those who minister
to the insane are compelled to work out their plans of treatment,
he founded an association for the purpose of rewarding bv honours
and prizes the long-tried and faithful among the attendants in asy
lums, and thus to hold out encouragements to candidates of a higher
order of qualifications.
John Conolly displayed, within the university of this town, and
in the arena of the Royal Medical Society—:dear to many of those who
hear me—those predilections and preferences which ultimately deter
mined his destiny, and gave him a position of nearly equal rank
among physicians and philanthropists. His thesis was on Insanity,
and formed the foundation of that work by which he is most popu
larly known. A physician in increasing practice, one of the
editors and originators of the ‘ British and Foreign Medical Review
and Cyclopaedia of Practical Medicine/ and a teacher in a Uni
versity, John Conolly, 1 know, never felt that he had secured
his true position, or that he had found a fair field for the
exercise of his head and heart, until he was appointed medical
superintendent of Hanwell. It is not affirmed that he made per
sonal sacrifices in order to accept this distinction; but, like that
of many other great and good men, his life was one of much sacri
fice and much suffering. It is not my province here, however much
it may be my inclination, to speak of more of his good deeds than
of the assistance he afforded in the grand revolution effected in the
management, and of the effects of his teaching in the propagation
of sound views in the treatment, of the insane and of the idiotic.
I cannot refrain from claiming him as an advocate—and as a philo
sophical advocate—of a medico-psychology founded upon induction.
His ideas, it is true, seemed to have passed through his heart, and
his feelings to have raised and rarefied his intellect. Perhaps it is
because of the elegance and popular attractions of his style that
his habits of thinking have been regarded as less logical than illus
trative ; but his “ Indications of Insanity” show a familiarity with the
laws of file human mind, and especially with the peculiarities and
subtle defects by which it is disturbed and unhinged, requiring
great perspicacity and penetration, as well as careful analysis.
Sensitive in his rectitude, gentle and genial, ho was to all men
conciliating and courteous; to his friends, and I judge after an
experience of thirty years, lie was almost chivalrously faithful and
generous; and the insane he positively loved.
It would be trite to say merely that these men, “ though dead,
yet speak.” We repeat their very words, we think their very
thoughts ; are, or ought to be, animated by their very spirit; and
so far as we carry into our daily work lofty aspirations as to science
and duty, but humble pretensions as to ourselves, a severe and self
sacrificing sense of the peculiar nature of our professional obliga
�1866.]
The Insane Colony of Gheel Revisited.
327
tions, and sympathy for those committed to our care, we shall best
do honour to their memory, and best serve our country, our profes
sion, and our God.
The Insane Colony of Gheel Revisited.
M.D., F.R.S.
By John Webster,
(Read at the Annual Meeting of the Medico-Psychological Association, held in
Edinburgh, July 31«4 1866.)
Nearly ten years ago I visited the very ancient establishment
above named, whereof notes appeared in Dr. Winslow’s ‘ Journal
of Psychological Medicine’ for 1857, and which, I was led to
believe, by the discussion that ensued, rendered this interesting
institution better known in Great Britain than heretofore. Since
that period, various professional and other travellers, as well English
as foreign, have paid visits to Gheel, and also subsequently pub
lished valuable reports, with remarks on improvements recently
accomplished. Being anxious to inspect a second time this colony,
and observe the ameliorations which Dr. Bulkens, its able medical
superintendent, had effected, I again visited Gheel during May
last; and thinking some account thereof may interest members of
the distinguished Society I have the honour to address, my present
communication has been drawn up, trusting, at least, it may excite
some attention from philanthropists and psychological physicians.
However, I would first briefly notice the ancient legend whereon
the reputation of that far-famed retreat for insane persons is asserted
to rest, and which, I hope, will not prove wholly uninteresting,
although likely familiar to members of this learned Association.
According to tradition, late in the sixth century, Dymphna,
a daughter of an Irish king, was converted to Christianity by an
anchorite named Gerebert. The father of this young lady felt
greatly enraged at her conversion; and being also enamoured of
his own child, threatened dire vengeance. As the noviciate remained
obstinate to parental authority, accompanied by her spiritual adviser
she fled across the ocean, and ultimately arrived at Gheel, in which
remote district of western Europe, Dymphna then resolved to dedi
cate herself in future to devotion and celibacy, along with St.
Gerebert.
But the old pagan sovereign having subsequently discovered the
fugitives’ retreat, followed in their track, and insisted upon his
daughter again changing her adopted faith; but to such proposal
she still refused compliance. This continued obstinacy made the
savage monarch so furious, that at one blow with a sword he cut
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The Insane Colony of Gheel Revisited,
[Oct.,
off his daughter’s head, having also mercilessly beheaded St. Gerebert a short time previously. These cruel deeds, it is further
reported, so greatly frightened several lunatics then present, and
likewise produced such strong impressions upon their excited feel
ings, that they became cured as if by enchantment. Immediately
the cry a A miracle, a miracle ! ” was raised by wondering by
standers ; and thus “ Dymphna,” “ saint and martyr,” has ever
afterwards been the patron of all demented victims, in Gheelois
estimation. This belief having spread abroad, not only in Campine
but to other countries, lunatics hence flocked to Gheel, in order to
get cured through St. Dymphna’s intercession. About a.d. 1200,
a church was erected on the spot where the two murders just de
scribed had been perpetrated, in which the female saint’s bones
were subsequently deposited, and are still preserved in this sacred
temple, according to popular opinion.
Nevertheless, leaving that disputed question for casuists to
settle, it will suffice to state, that the tabernacle said to contain
St. Dymphna’s remains usually stands on four stone pillars behind
the church altar, and has a passage under it of about three feet in
height, through which lunatics formerly brought to Gheel were
accustomed to pass on bended knees. Poets say, “ the palace
stairs of great personages were often worn away in ancient times
by beggars asking favours.” Here that sarcasm is really verified,
since the stone floor of this much-revered locality is indented to
some extent by the crawling limbs of devotees, who came thither
to be freed from their mental malady. Similar genuflexions are
indubitably now much more rare than in ancient superstitious times,
although examples of such ceremonies have occurred in years not
long by-gone, where maniacs devoutly crawled through this hallowed
precinct, as well as some persons desirous themselves to obviate the
contingency of being subsequently attacked by mental aberration.
When these formalities took place, the parties accompanying a
lunatic continued singing hymns and praying during the whole time,
so as to assure more certainly the saint’s favorable intercession. Near
the central part of St. Dymphna’s church, and on the left of its
choir, a large case like a sentry-box contains the saint’s figure,
gorgeously clothed in velvet, with lace, gold, and other ornaments.
On the other side of this choir is placed, as if by way of counter
poise, nearly the half of what had formed a stone coffin, wherein,
tradition says, were found the saint’s mortal remains. But the most
singular portion of this sacred edifice is a dark dungeon-looking
apartment, in a small house attached to the principal church tower,
and apparently used as the present occupants’ kitchen, where
maniacs formerly brought to Gheel were first lodged, during at least
nine days consecutively. Throughout that period, persons reputed
insane remained during day-time closely bound to the fireplace by
�1866.]
by Dr. John Webster.
329
an iron chain connected with a ring, also iron, on one wrist, besides
having another attached to their ankle; while, at night, the wretched
victim was tied down in a wooden bed, containing straw instead of
a mattress, by strong iron chains, to prevent movement. Besides
such harsh treatment, during the entire nine days considered
essential to ensure recovery, nine young virgins, hired for that
specific purpose, made a daily procession round the church aisles,
passing nine times on bended knees under St. Dyinphna’s taber
nacle ; invocations being likewise offered up for the patient’s re
covery ; at the same time that a priest recited certain prayers, held
essential on these occasions. At one side of this room, close under
its roof, there is a small gallery, from whence relatives and curious
spectators could witness whatever mystical ceremonies might be
going on below. But proceedings like those described being now
rare, a stranger’s curiosity can be very seldom gratified.
The commune of Gheel, strictly speaking, constitutes part of a
province designated Campine, or “ Kempen-land,” which signifies
flat, or plain, without trees. It is fifty miles from Brussels, and
forms a level but somewhat elevated portion of eastern Belgium,
when compared with adjacent low-lying lands. Gardens and fertile
fields occupy the vicinity; but on several sides beyond, these often
pretty enclosures are surrounded by sandy steppes, or wastes of con
siderable extent, having quite a different character. The environs
are, however, much more productive than outlying districts ; while
the town itself occupies a moderately elevated position, lying betwixt
the river named “ Great Nethe ” and two tributaries, but much
smaller, called the Eastern or Little Nethes. Although not very
salubrious—intermittent fevers and typhus being sometimes frequent,
while during winter pectoral diseases often prevail—still the district
is not deemed so unhealthy as various portions of Belgium, where
damp soils and malarious emanations act injuriously on the human
frame. The entire commune has nearly 11,000 inhabitants, of
whom about 4000 reside in Gheel itself. The principal street is
long, broad, and possesses some good houses, with several shops and
comfortable hotels, especially the “ Turnhout Arms.” On one side
of its central Place stands the cathedral church of St. Amand, St.
Dymphna’s being in another quarter; besides which, adjacent streets
and hedge-enclosed gardens make Gheel resemble most Belgium
towns of the same magnitude.
The entire colony in superficial extent comprises 27,000 acres;
its greatest length, from north to south, being nearly fourteen miles;
the breadth, from east to west, eight and a half miles; and alto
gether may be reckoned at from thirty-seven to thirty-eight miles in
circumference. The commune is divided into four sections, within
which there are seventeen hamlets, some being almost little villages.
Each section has a physician, under whose special charge all lunatics
�330
The Insane Colony of Gheel Revisited,
[Oct.,
dwelling within its limits are placed, while the superintending phy
sician overlooks the whole establishment. The latter also receives
every new patient or lunatic transferred from any private dwelling
. to the central infirmary, either because the party’s physical health
had become seriously affected, or mental malady required special
medical attention ; and further, if temporary seclusion was deemed
necessary in particular cases, but which could not be properly
carried out at an ordinary residence by the patient’s usual at
tendant.
On the 20th of last May, the total insane residents in Gheel and
commune amounted to 1025, being 512 male and 513 female
lunatics, or an equality of both sexes, who were divided into four
separate classés, with reference to the respective sums paid for their
maintenance ; but, first, into indigent paupers ; and second, pen
sioners, or private patients, according to ordinary language. The
former class comprised 908, of whom 432 were male and 476
female lunatics ; the male pensioners being 80, with only 37
females in that category. Again, of the entire number, 867 were
native Belgians, the remaining 158 being born in other countries.
Throughout the district where lunatics are only allowed to reside,
the total licensed houses are 726, classified into four divisions; and
seeing the commune contains about 2100 different residences, it
hence follows, at least one in every three has a resident lunatic.
Houses of the best class amount to 72, where from 1000 to 2500
francs are paid annually ; the second comprises 148 residences,
in which from 500 to 1000 francs is the remuneration; the third
consists of 382 houses, the payment being beyond 200 and up to
500 francs; while dwellings in the fourth list are only 124, and in
these 200 francs is the usual allowance. Unless under particular
circumstances, not more than three lunatics can residç under one
roof; and two demented inmates cannot occupy the same room.
Special sanction may, however, be granted by the managing com
mittee, in concurrence with the superintending physician, for a
larger number of patients being received, but only after he
has reported that the locality and all essential appliances are
properly adapted for the proposed augmentation. Usually the
sexes are lodged in separate houses; nevertheless, with regard
to aged persons, whose malady may be chronic and deemed in
offensive, a male lunatic is occasionally allowed to live in the
same family where an insane old woman analogous in character
also resides. All suicidal, dangerous, homicidal, or mischievously
disposed insane persons are, however, rarely received, or allowed to
remain after they decidedly manifest such characteristics ; and when
patients so become, they are usually sent home, or transferred to
some asylum elsewhere. Further, the authorities generally place
boisterous and agitated maniacs at remotely situated cottages, or
�1866.]
by Dr. John Webster.
331
farmhouses located in open heaths distant from the town, where,
having few neighbours, they cannot disturb any insane patient or
cause much annoyance. Again, such parties, if much excited, may
walk about in gardens or fields adjacent without danger to others
or themselves. Being also thereby placed beyond the observation
of strangers, and not likely to come in contact with similarly afflicted
fellow-creatures, evil consequences seldom result from such arrange
ments.
Tranquil patients and ipany of the highest paying pensioners
live in Gheel, the total cases of that description being upwards of
230, or beyond one fifth of the whole insane population residing
within the commune.
On making inquiry, I learned only one house contained five
lunatic inmates ; several had four, or more frequently two, but one
was most common. It should be stated, however, that recently a
large mansion has been constructed in the chief street of Gheel, at
an expense of more than 50,000 francs, which will be adequate for
eight patients, each having separate bedrooms, and also several a
sitting apartment, should such additional accommodation be required.
There is likewise an extensive and well-laid-out garden adjoining,
with various other appliances deemed essential for the amusement
or occupation of lunatics. In short, this new dwelling forms an
excellent “maison de santé” of a superior description. Only four
insane patients lodged at this house when 1 visited its interior, all
being foreigners, viz., one English, two French, and one Swiss.
In consequence of varied improvements lately effected at Gheel,
every class, especially those designated pensioners, or who pay a high
annual board, have augmented in number since 1856, when the
aggregate insane population was 774, or 251 less than at present.
In other words, there are now one third more lunatics inhabiting
the commune than ten years ago, when I first visited “ Kempenland.” Such facts prove the increased repute which this colony has
acquired, and the more favorable opinion it has obtained among the
Belgian people, as also the constituted authorities, who now transfer
thither a greater number of insane patients, contrasted with pre
vious periods.
Through this large augmentation of resident
lunatics, the money received at least amounts to £15,000
annually, besides various collateral sources of revenue. In truth,
the town and vicinity almost exclusively depend upon such means
of income, especially as the commune has little or no trade, except
ing what its peculiar population may require for their necessary
wants and maintenance.
During five years ending 31st December, 1865, the total insane
patients admitted at Gheel amounted to 926, 500 being male and
426 female lunatics. The number of recoveries reported were 228,
or 24-62 per cent., calculated according to the aggregate admissions.
�332
The Insane Colony of Gheel 'Revisited,
[Oct.,
the deaths were, however, more numerous, viz. 409, or 43’06 per
cent. ; but this large mortality may be easily accounted for by the
chronic types of mental maladies which affected numerous inmates,
as likewise the long period many had been insane. Besides these
results, it should be also stated that a number of patients left the
colony ameliorated, in addition to others removed by relatives, or
the communes who had sent them to Gheel originally. According
to the authority already quoted, 141 male and female lunatics, after
being some time resident, left either uncured, or before they had
derived benefit.
Respecting this point, and likewise to illustrate further the Gheelois
system, I would refer to another instructive table, also kindly sup
plied by Dr. Bulkens. According to that valuable return, which
comprises ten years ending 31st December, 1865, among a total of
1623 insane patients of all categories, 45, or less than 3 per 100
escaped; while 133 were subsequently removed, either from being
dangerous or likely to disturb public tranquillity, and whose malady
was deemed incompatible with the regime, free-air liberty, and
family mode of management pursued. Remarking, however, that
only 133 lunatics, or about 8 per cent, of the whole admissions, were
so discharged, it cannot be consequently asserted, with justice, that
any extensive or special selection of cases different from the
practice prevailing at asylums was made during the period
specified.
Another important feature in reference to patients received at
Gheel during the same ten years, and also up to the 20th of last
May, equally deserves mention ; namely, the types of mental disease
which were noticed among 1696 cases it comprehends, besides the
actual recoveries registered under each category. Bv Dr. Bulkens’s
classification of these 1696 patients, 91 male and 127 female lunatics
laboured under “ melancholia,” being 218 altogether, or 12’85 per
cent, of the admissions. Among these, 46 males and 56 females
recovered, giving a ratio of more than 46 cures per 100, or
50 per cent, in males and 44 in females. “Mania” affected 586
individuals, or upwards of one third the whole admissions ; com
prising 298 male and 288 female lunatics, of whom 140 males and
114 females were cured; being 43’17 per cent, in that division, or
47 percent, in males, but only 39 in females. By “delirium”
96 patients were attacked, the sexes being equal, or 48 cases of each ;
among whom 17 females but only 11 males were cured, or 35’40
per cent, of the former against about 23 per cent, of the latter.
“ Dementia,” like mania, characterised a large proportion of the
admissions, viz., 242 males and 275 females, or 517 altogether,
forming nearly one third the total cases received ; but of whom not
more than 31 males and 19 females recovered ; that is, 12’80 per cent,
of the former and only 8’87 per cent, of the latter sex. In short,
�1866.]
by Dr. John Webster.
333
most of the patients thus classified were incurable, which opinion is
even more applicable to the 136 cases of general paralysis then
admitted, comprising 103 men and 33 women, of whom not one
recovered. This remark likewise applies strictly to 143 cases of
epilepsy, including 101 male and 42 female patients, seeing no case
ended in convalescence. Therefore, deducting these 279 instances
of general paralysis and epilepsy from the 1696 cases above enu
merated, it follows that among 1417 lunatics remaining, and
comprehending every other variety of mental disease, the total re
coveries being 434, the general ratio of cures amounted to 30'69
per 100 admissions; while, it should be further remembered,
many of the patients had remained a long time insane. But another
important fact deserves also special regard, viz., among 436 insane
patients deemed curable when admitted, and of whom some reason
able hope was then entertained respecting their ultimate recovery,
302, or 69 per cent., left Gheel convalescent. Such favorable
results speak strongly in support of the Gheelois system, and may
well bear comparison with statements given in official annual reports
emanating from various public institutions for lunatics both in Great
Britain as elsewhere.
Notwithstanding great freedom characterises the treatment pur
sued, objectors still assert that numerous lunatics residing in the
colony are confined within their domiciles, often wear straps, ma
nacles, and even have hobbles to prevent escape. In 1856, when
I formerly visited Gheel, the total patients then restrained in any
form were 69 among 774 lunatics at that period under treatment.
During my recent visit, among upwards of 1000 lunatic patients,
I learned that the daily average of persons under even temporary
restraint by manacles seldom if ever exceeded 20 examples; while
those who had hobbles, to prevent straying in fields adjacent,
by records kept rarely amounted to five instances. But even then
such patients could often promenade in the gardens attached to their
dwelling; and I heard of none being confined by strait-waistcoats
or analogous appliances. At the new infirmary, where seclusion
rooms have been constructed, only one patient, a female, was in
temporary confinement when I inspected that recent addition to the
colony; but, it should be added, this refractory case would ilkely so
remain during a few hours. Indeed, she had speedily become tran
quil after entry, and was very quiet when I visited her apartment.
The infirmary just noticed constitutes a novel feature in the im
proved appliances introduced at Gheel.
It forms a handsome
building in the immediate vicinity; has two storeys, with a frontage
of fifteen large windows, and every appendage usually seen at similar
structures. Indeed, the ventilation, amplitude of dormitories, court
yards for recreation, baths, sitting-rooms, with other appliances, are
all of a superior description, and prove highly creditable to Dr.
�334
The Insane Colony of Gheel Revisited,
[Oct.,
Bulkens, who, along with the architect, were the chief directing
authorities while it was in progress. About 60 lunatics can be
accommodated as patients should their physical ailments, mental con
dition, or recent arrival in the colony render a lengthened residence
necessary. At my visit, besides the female already mentioned under
temporary seclusion, 1 recognised a dozen other patients, of whom
several had been brought from their customary dwellings on account
of bodily infirmities requiring special treatment. In addition to
these objects, when a lunatic first arrives at Gheel the party is
always placed in an appropriate ward, so that the type and symptoms
of each individual case may be specially observed; as likewise thus
to enable the superintending physician to determine, among what
particular class or section the patient should be ranked. Again,
whenever any lunatic became bodily diseased, or if an access of mental
malady supervened which required special attention, or it was
deemed advisable to place the sufferer under more immediate ob
servation, than at a rural cottage or in town, then removal to the
infirmary was ordered by the sectional physician.
The recently opened infirmary, and licensing private houses of a
superior description for receiving pensioners, paying higher annual
boards than formerly, constitute important changes in the improved
arrangements at Gheel. Seeing this infirmary—often recommended
by physicians both native and foreign—has been finally established,
particularly through Dr. Bulkens's exertions, I suggested to a high
official authority in Belgium that it should be designated by a name
of much repute among European medical men and philanthropists.
During my former visit to the various lunatic establishments in
Belgium, I made an analogous suggestion respecting the new asylum
then constructing near Ghent, and which was built especially under
the immediate direction of Dr. Guislain, the eminent psychologist
and physician. As that proposition was ultimately adopted, and the
establishment is now officially called “Hospice Guislainf I hope a
similar resolution may be taken by the Belgian authorities, so that
the Gheel Infirmary shall be known in future as “Hospice Bulkens.”
Among a community comprising numerous lunatics, the police
and other arrangements must, of course, be strict and various, in
order to meet contingencies. Thus, during summer months patients
cannot leave their residence before 6 in the morning or after 8
in the evening; and during winter, before 8 a.m., or beyond 4
in the afternoon; while only tranquil lunatics and those who con
duct themselves decently, or seem not likely to annoy other parties,
are permitted to frequent entertainments and places of public resort
where they can drink beer, smoke, or enjoy themselves like ordinary
frequenters, unless with reference to spirituous liquors. In con
sequence of existing regulations, as also doubtless originating from
other causes, great tranquillity prevails throughout the town : and,
�1866.]
by Dr. John Webster.
335
speaking from my own personal observation during the period I
lately remained at Gheel, as likewise when formerly visiting the
colony, few towns of the same population, where the residents were
rational beings, seemed to contain better conducted inhabitants, or
appeared altogether so quiet as in the peculiarly constituted capital
of Campine, whether at night or daytime.
During recent years, much more care has been enforced respecting
the accommodation and general treatment, which insane residents
should receive from host or hostess. The licences of several have
been withdrawn, in consequence of not fully complying with the rules
established, or through negligence towards inmates. Many new
houses have also been licensed, in consequence of the augmented
number of lunatics sent to Gheel. Further, as the pensioner class,
who pay often larger sums than in former years, have also increased,
and as those houses where inmates were comfortable now more likely
obtain patients paying higher rates of board than otherwise, this
circumstance has produced emulation among householders, which
the authorities' very properly encourage. The accommodation af
forded is generally good,“considering tiie class of patients or their
previous mode of life; and the treatment indigent residents fre
quently receive from parties with whom they are placed, to my mind
seemed often more than commensurate with the established remu
neration. Nay, according to various statements, I firmly believe,
were it not on account of the labour and assistance many recipients
of insane boarders thereby obtain in their respective trades or occu
pations, having to lodge, feed, and maintain demented residents for
the very small payments allowed, cannot always prove profitable,
or even remunerative.
Irrespective of several other important features characterising the
Gheel system, this fact deserves special notice—viz., that it becomes
more easy, than sometimes at public asylums, to place patients under
circumstances where they can be employed in occupations analogous
to those they had pursued previously. A large proportion being
labourers, mechanics, domestic servants, and the like, the authorities
can at once transfer, for instance, an operative shoemaker, a black
smith, agricultural labourer, or dairy-servant, to dwellings wherein
they may be occupied much in the same manner as when enjoying
good mental health.
Further, being also under proper sur
veillance, whatever treatment is deemed judicious can likewise
be adopted.
Seeing a large proportion of insane residents at
Gheel are agricultural labourers—indeed, they usually constitute
about one fourth of the entire number—while persons employed in
household work are even more numerous, besides many dressmakers
and milliners, as also carpenters, tailors, with other handicrafts, it
thence becomes among the ordinary Gheelois population not difficult
to place lunatics with hosts where useful arrangements in that
�336
The Insane Colony of Gheel Revisited,
Oct.,
respect can be accomplished. Still, at Gheel numerous patients are
unwilling or unable to work through various causes, the proportion
being about 30 per cent, in that category, which therefore leaves
seventy among every hundred lunatics occupied according to their
respective capabilities.
Although proceedings of the kind mentioned are easily adopted
at this insane colony, impartial observers must admit, however
much the Gheelois method may meet approval in many respects, and
deserves imitation, it will often prove a difficult undertaking to in
stitute an analogous procedure elsewhere, especially in localities
whose general population has neither been accustomed to asso
ciate with, nor ever had any experience in managing lunatics, or
imbecile fellow-creatures. At Gheel the domestic arrangements and
customs are dissimilar to those in most other countries, while an
experience of many centuries has rendered its inhabitants like here
ditary attendants upon the insane, but which attribute is rare, or
would not be easily created among any large community. Hence the
obstacles which must always exist, whenever a similar colony on an
extensive scale is proposed. Further, it cannot be denied, for luna
tics belonging to the upper or middle classes, the discipline, em
ployments, and mode of life necessarily followed according to the
Gheelois method could be seldom enforced among ladies and gentle
men. For lunatics belonging to the lower orders the system there
adopted assumes, however, quite another aspect, and is entirely free
from several objections enunciated by adverse critics.
Occasionally writers entertain the opinion, that insanity is oftener
met with among persons born in the Gheelois commune, than through
out districts having a sane population. Both Dr. Parigot, late of
Gheel, and Dr. Bulkens especially, who has investigated the point,
think such idea erroneous. Indeed, the latter says,“ Mental diseases do
not prevail so frequently among Gheel natives, as in various localities
belonging to the province of Antwerp f while he has likewise ascer
tained that, in the adjacent canton of Herenthals and Turnhout,
where no lunatics are received, the proportion of insane among the
native population attains even a higher ratio than characterises
Gheel. Another feature should also be noticed, namely, Gheel be
ing situated in a plain extending a great distance, and having no
hills or mountains to protect it from any wind which blows, the
streets are often very dusty in summer, while during winter northerly
or easterly winds are not salubrious. Still, longevity occasionally
prevails among insane residents, several having been patients up
wards of half a century, others during forty or thirty years, and
some had become nonagenarians ; but I heard of no individual who
could be truly considered a centenarian.
The great annual fête or “Kermis”—viz., “wake” or fair, in
English—appointed for the Gheel commune, having taken place
�1866.]
by Dr. John Webster,
837
during my stay, I was therefore able to witness the manners and
customs of its general population, but more especially the effects
which public festivities, ecclesiastical ceremonies of unusual pomp,
much popular excitement, and the great crowds assembled from ad
jacent districts, produced among many lunatics who participated in
the varied proceedings of the four days dedicated, in the first instance
to religious duties, but afterwards to dancing, beer-drinking, and
frequenting various “ herb ergs/-’ estaminets, &c. On Whit-Sunday,
the 20th of May, or Pentecost, St. Dymphna’s church was crammed
with upwards of a thousand worshippers at one time, but always
changing, and of whom many had apparently come to see its gorgeous
decorations, or prostrate themselves before the patron-saint’s image
and tabernacle containing her relics, which was now placed in the
centre aisle on an elevated pedestal or throne.
Interiorly, the church was profusely decorated with flowers, gay
festoons, canopies, orange and other trees, besides a diversity of
ornaments specially prepared for this grand occasion. Over the
saint’s tabernacle, the figure of a little winged angel, having a laurel
sprig in its right hand, with a crown of flowers in the left, seemed
as if descending from above, in order to deposit both on the recep
tacle of St. Dymphna’s venerated remains. High mass was also
being performed by splendidly attired priests and many officials. An
organ pealed forth impressive music, accompanied by numerous
voices, whose singing was so good that altogether, I have seldom
heard any church service better performed, even in Italian or Spanish
cathedrals. Around St. Dymphna’s tabernacle, numerous devotees
were praying on bended knees, and appearing to invoke the saint’s
intercession. Many had strings of beads in their extended hands ;
and after praying during a few minutes, they walked round the pre
cinct several times, but finally resumed their former kneeling posi
tion, yet still praying, although inaudibly.
At one time I counted at least twenty-five persons so employed;
and whatever some critics may think of such superstitious devotions
addressed to what seemed only a covered box, but said to contain
the relics of an Irish maiden, none can doubt the sincerity of feeling
actuating parties who appeared thus to pray for their own recovery,
or of mentally afflicted relatives. After making these genuflexions,
generally three times, but occasionally oftener, a number went next
before an image of the Virgin Mary having Christ in her arms, both
gorgeously apparelled, with jewelled crowns on their heads, and
placed under an elegant canopy, having bouquets of flowers around,
to perform further devotions.
Subsequently, many of the same individuals also worshipped at St.
Dymphna’s image, much after the style enacted near her relics. As
additional indications of the veneration entertained respecting the
martyr whose shrine had here attracted such crowds, the numerous
�338
,
The Insane Colony of Gheel Revisited,
[Oct.,
silver offerings attached to her attire unmistakably demonstrate,
whilst indicating the great ignorance prevalent among a Campine
populace. Moreover, in order that such sentiments might not be
forgotten, or perhaps to proclaim the saint’s merits, on the border
of her bespangled velvet robe this inscription was embroidered
in golden letters so large as to make the words easily readable by
even distant spectators—viz., “ St. Rymphna, Hoop der Krankzinnigen ” (St. Dymphna, the hope of lunatics).
Sceptics may ridicule the absurd notions actuating apparently
numerous persons assembled in St. Dymphna’s church at this day’s
festival, which lasted several hours consecutively. That view is,
however, incorrect, seeing various individuals who had taken part in
the ceremonies acknowledge, they purposely visited St. Dymphna’s
Church, to pray for the saint’s intercession in favour of afflicted rela
tives or patients in the colony. Among several instances of this
description, I may mention that of a Belgian serjeant whose insane
wife had been some time in the commune. This otherwise intelli
gent soldier, although admitting the kind treatment received, never
theless felt faith in St. Dymphna’s influence, and had specially visited
her shrine on the present, as during a former occasion, in order
that he might, by imitating other devotees, promote his wife’s con
valescence.
At St. Amand’s, the chief or communal church of Gheel, a great
crowd was likewise assembled, its interior being also profusely deco
rated with flowers, flags, orange-trees, and numerous ornaments, at
the same time that high mass and so-forth. was performed. There,
as at St. Dymphna’s, I recognised various lunatics who, both in
this and the former sacred edifice, conducted themselves like rational
beings. However, as the services were purely ecclesiastical, although
conducted in grand style and really pompous, while many fashionably
attired ladies were noticed among a very crowded congregation, no
ordinary observer, ignorant of the fact, would have surmised that a
number of persons then present were actually insane. Indeed, I
have scarcely or ever observed more decorum than that which uni
formly prevailed during my protracted visits to both the churches
designated. Considering the multitude of persons congregated, the
consequent pressure occasioned by many people anxious to get near,
and the lengthened period they virtually remained, it is no exaggera
tion to say, the quietude and order which everywhere prevailed were
remarkable.
Next day, or Monday, similar services again took place at St.
Dymphna’s and St. Amand’s churches ; while the number of kneel
ing worshippers near the martyr’s sarcophagus was even larger than
the previous day, or Sunday. On this occasion, the silver receptacle
of the saint’s bones was now uncovered, which may account for the
much greater crowds who were constantly surrounding, and evidently
�1866.]
by Dr. John Webster.
339
contemplating with deep devotional feelings, what was really a splen
did specimen of art in the form of a temple, and which, from its size
as also elaborate workmanship, must have been very costly. Appa
rently, many of the votaries present had come from some distance
in order to invoke St. Dymphnaks aid in favour of a demented rela
tive or friend; while others were patients, as on the day previous.
Here, again, and throughout the whole time I remained, the greatest
order prevailed; and no one could have inferred from outward ap
pearances, or the behaviour of any individual, that lunatics formed a
portion of this large assemblage.
Another phase of quite a different character yet remains to be
described, so as to illustrate still further the popular proceedings and
festivities in which sane as likewise insane residents of Gheel, with
other spectators, took an active part during its kermis. Soon after five
in the afternoon, accompanied by Dr. Bulkens as cicerone, we visited
several “ herbergs ”—estaminets which had large rooms attached,
where many persons previously engaged in religious services at St.
Dymphna’s and St. Amand’s churches were dancing, or drinking
beer; while gay music and talking of numerous parties made the
whole scene highly exciting, but not disorderly or uproarious. In
one spacious apartment, at least 300 persons were assembled—several
being lunatics—who seemed to enjoy the spectacle quite as much as
any party present, and conducted themselves like their more rational
companions at this reunion. Indeed, had my conductor not pointed
out several male and female insane residents at Gheel, I should not
otherwise have known any patients were in that festive assembly. We
afterwards visited other dancing parties, where much hilarity also
prevailed; but in no instance could I recognise by their conduct
that any guest laboured under mental aberration. Similar amuse
ments took place next evening, while there was a grand pro
cession of St. DymphnaJs relics within her church and vicinity in
the forenoon; but everything went off satisfactorily. At least, I have
not since heard of any conduct which indicated that the varied pro
ceedings peculiar to the annual kermis then celebrated had caused
unpleasant consequences among the Gheelois lunatic population.
In concluding my sketches of the insane colony at Gheel, which
some gentlemen whom I have the honour to address may perhaps
think rather discursive, I would nevertheless beg leave to remark
finally, whether frequenting the dwellings of resident lunatics, peram
bulating streets, visiting churches, sauntering in secluded highhedged footpaths, gardens or fields; and notwithstanding I often
recognised insane patients as well idle as occupied, even sometimes
without an attendant, I never noticed any unpleasant occurrence.
On the contrary, I can confidently assert, from personal observation,
Gheel and its immediate neighbourhood seemed generally quieter,
than most localities having an equally numerous population, more
�340
The Effects of the Present System of Prison Discipline [Oct-,
especially where lunatics seldom if ever promenade public thorough
fares. Consequently, the idea of then residing in a town where mad
people were numerous, and lived almost like ordinary inhabitants,
appeared to my mind of doubtful realisation.
The Effects of the Present System of Prison Discipline on the Body
and Mind. By J. Bruce Thomson, L.C.R.S., Edin.; Resi
dent Surgeon, General Prison for Scotland at Perth.
(Read at the Annual Meeting of the Medico-Psychological Association,
held in Edinburgh^ July 31i/, I860.)
_ Mr. President,—My first duty on rising to address this Asso
ciation is to thank you, sir, personally, for your kindness in propos
ing me, and the members for electing me, to the honour of being a
member of the Medico-Psychological Association.
This paper is due chiefly to your own suggestion; and I do now
feel that it was somewhat bold in me to accept your hint, and ven
ture upon an inquiry so difficult, and of such paramount social and
psychological interest. I hope the subject may be found not alto
gether aside from the proper functions of this learned body, as I
certainly regard it opportune for my having the benefit of any
opinions that may emerge, in the minds of those I now’ address,
many of whom are eminent for ability and experience in mental
diseases so prevalent in prison life.
Can long sentences to penal servitude in prisons be carried through
without serious detriment to the bodily and mental condition of
prisoners ? This was the proposition propounded only a few years
ago, when the transportation of convicts was set aside, and the
present system, called the separate system of prison discipline, was
introduced. In this paper, what I propose is, to examine the
results of this sanitary experiment; and how far we are enabled
to judge of its success and solve the grave problem as to the effects
of long imprisonment on body and mind. The study of the cha
racter and diseases of the criminal population has become a specialty
confined to but a few ; and I feel it all the more incumbent to
tabulate my observations, which have been continuously given to
the subject for nearly ten years.
Physical suffering, as you know, for the last quarter of a century
has been almost wholly ignored in prison discipline. Howard and
Romilly did for criminals what Conolly and Pinel have done for the
�1866.]
on the Body and Mind, by J. Bruce Thomson.
341
insane; and the benign influence of criminal legislation has long
been and still professes to be chiefly reformatory—curative rather
than punitive—on the principles long ago enunciated by Cicero :
“ Omnis et animadversio et castigatio contumelia vacare debet.
Prohibenda autem maxima est in puniendo." Legislation has
been, like Penelope's web, a system of doing and undoing; but,
however much social reformers may differ as to the physical punish
ments of prisoners, I think that you will all agree as medical men that
it is our duty to return the criminal to society as well in body and
mind, if possible, as when he entered upon his sentence of imprison
ment.
I have said that the study of prison life is a specialty, and it
seems to me, therefore, necessary that I should offer you a few
prefatory remarks on criminals as a class distinguished peculiarly
from civilians.
All who have seen much of criminals agree that they have a
singular family likeness or caste. Prison officials and detectives
know them at a glance. An accomplished writer who is well
qualified to speak on this subject says, “ I believe I have looked as
many scoundrels in the face as any man alive, and I think I should
know all such wherever I should happen to meet them. The thief
appears to me as completely marked off from honest working people
as black-faced sheep are from other breeds." In this statement I
quite concur.
Their physique is coarse and repulsive ; their complexion dingy,
almost atrabilious; their face, figure, and mien, disagreeable.
The women are painfully ugly ; and the men look stolid, and many
of them brutal, indicating physical and moral deterioration. In
fact, there is a stamp upon them in form and expression which
seems to me the heritage of the class.
II The physical, being," as I take it, “ the foundation of the moral
man," the criminals as a class exhibit a low state of intellect com
pared with the industrial classes. A large proportion of prisoners,
as I shall afterwards show by figures, are weak-minded congenitally,
and give a large proportion of insanity compared with the civil
population. I know this is in the face of popular prejudice, encou
raged by the drama and sensational romance, which makes heroes of
criminals, endowing them wondrously—as some one said, “ with rare
abilities, of which God has given the use and the devil the applica
tion." These are drawn from exceptional cases for dramatic effect.
On the contrary, teachers say prisoners are slow to learn. Officials
find it a hard task to train them to the plainest industrial work.
Taste in any art or mechanical ingenuity we seldom see among
them. Sir W. K. Shuttleworth observed, what is plain to all in
telligent observers, that the juveniles at Parkhurst were defective in
vol. xii.
23
�312
The Effects of the Present System of Prison Discipline [Oct.,
physical organisation—from hereditary causes, probably, and early
neglect and privation.
These remarks in limine on the characteristics of the criminal
class it is necessary to carry along with us in our inquiry as to the
effects of imprisonment, so as to judge what belongs to caste and
what to imprisonment.
It seems necessary to premise also a few words on the separate
system of discipline in present operation.
The separate is a modification of the solitary system, which has
been everywhere almost wholly abandoned as injurious to the mind.
It is singular enough that Howard, the great friend of the prisoner,
and true philanthropist, was himself the author of the solitary
system, the most severe of all penal systems. The object was to
prevent the evils of association; but insanity was the frequent
result.
Even the original separate system has been much modified. At
first, the prisoner was strictly confined to his cell, which was his
workshop and dormitory. He had little or no communication with
officers. The exercise was short, and in isolated cages under abso
lute silence. A mask was worn to avoid personal recognition. The
chapel was cellularly divided ; or the chaplain stood in the corridors
of a gallery, each prisoner only hearing, not seeing him, through the
cell-door upon the bolt. The food was passed through a small
service door, so that even the warder was not seen. Two purposes
were aimed at by this—viz., entire isolation, and seclusion to en
courage self-communion and lead to reform.
As you may well believe, it was ’ not long until relaxations were
called for of the severities of separation. After a confinement of nine
months male convicts, and after twelve months female convicts are
partially associated. Exercise is had more freely in open airing
grounds. The chapels are not cellular, but open-seated. Masks are
abolished. Warders see and speak to prisoners at least twelve tines
daily. Silence is not strictly enforced ; and medical officers have free
power to associate all who are regarded unfit to bear the separate
system : such are juveniles, epileptics, weakminded, and suicidals,
Highlanders who cannot speak English, and all the sick.
I hasten to consider now—
I. The effects of the separate system of prison discipline on the body.
II. The effects upon the mind of prisoners.
I. Of the general health, sickness, and death-rate of prisoners.
The general health has of late been very good in Scotland, espe
cially during the last decennial period. During the decennial period
1844 to 1853 it was not so. General debility, scrofula, and scurvy
were found to prevail among our prisoners, in consequence of a de
�1866.]
on the Body and Mind, l>y J. Bruce Thomson.
343
fective dietary. The truth is, the dietary of prisoners must be good
for two obvious reasons : their systems are deteriorated by heredi
tary and habitual vices ; and in prisons, the same amount of assi
milation of food does not take place in imprisonment as in freedom.
This latter, I suspect,applies to asylum and hospital patients generally.
I am satisfied that a bare minimum of subsistence is a dan
gerous allowance to prisoners, and a liberal dietary is the truest
economy in prison. Hence, during the decennial period 1854
to 1863, an improved dietary proved more economic than the lower
dietary, there being reduced sickness and death-rate, and, conse
quently, more labour from prisoners. A good diet and careful
hygiene, also, I think, help to explain our singular exemption from
epidemics.
A table before me shows all the cases of disease (noting the dis
eases) which occurred during the decennial period 1856 to 1856,
inclusive, in the General Prison for Scotland under my charge.
The total ten years’ population was 646, of whom 1 out of 72
were placed on the sick register ; the sickness being, therefore, at
the rate of 14 per cent.
The prison rule for registering sickness is, “ The surgeon shall
enter in his register every case of illness which is sufficient to pre
vent a prisoner from working, or which is infectious.”
A few months ago, in a joint report by Professor Christison and
myself, the following statements in regard to our death-rate and
sickness of prisoners in the different prisons of Scotland are given :
“ In consequence of an improved dietary during the last ten years,
the death-rate (notwithstanding the substitution of long imprison
ments for transportation) has fallen from 1 *1 to 1T5 per cent.
4
“ Diseases from defective nutrition have disappeared.
“ Diseases contracted after admission to prisons have decreased
from 27 to 15 per cent.
“ Prisoners off work from sickness have been reduced from 41 to
31 days on the total average daily prison population.
“The amount of sickness has fallen from 65 to 45 per cent, over
all Scottish prisons.”
To this very favorable account of the general health, sickness,
and death-rate of prisoners, I must offer some exceptions.
1. Juveniles and those at the growing periods of life suffer much
from stiffness of limbs; and a standing rule is, to associate all under
fourteen years of age, and even sixteen, the governor and surgeon
concurring ; also juveniles are drilled to military manœuvres and
exercises, as precautions against stiffness of limbs.
2. Untried prisoners, partly from their recent dissipations, and
partly from being tossed betwixt hope and fear as to their trial and
sentence, fall off, but revive again after their trial.
3. Convicts, a few months befoie liberation, become anxious,
�341
The Effects of the Present System of Prison Discipline [Oct.,
sleepless, and lose health and strength from their anxieties as to the
future. Convicts say the most irksome period of imprisonment is
immediately preceding liberation.
4. Out-door labourers, shepherds, poachers, fishermen, as a
general rule, fall off' under imprisonment.
I am bound further to make this general observation, that more or
less in all prisoners there is a slow and torpid state of the locomo
tive organs (partly, perhaps, mental), which seems to be the result of
seclusion.
Upon the whole, the foregoing facts and figures satisfy us that
the effects of imprisonment do not materially injure the body ; but
rather that the general health is well sustained, and certain diseases,
phthisis and scrofula, are ameliorated or arrested. I look upon the
hygienic and sanatory treatment of prisoners as one of the best
triumphs of medical science ; and looking to the condition of paupers
when contrasted with prisoners, I do not wonder that some have
sneered at our care of criminals, like Rochefoucault, when he says,
“ 11 s’en faut bien que l’innocence trouve autant de protection que le
crime/'’
II. Effects of imprisonment on the mind.—What I have advanced
seems sufficient to relieve all anxiety as to the effects of imprison
ment on the mind. But, remembering the effects of the solitary
and silent systems, of which the separate is but a modification;
keeping in view the necessary ameliorations lately introduced into
the separate system ; and further, considering the sources, physical
and moral, of insanity belonging to the criminal class—there appears
a foregone conclusion that there is danger to the mental condition
from the separate system of prison discipline.
Let me bring before you figures showing the amount of mental
disease which is found to prevail in the General Prison for Scotland,
and compare this with the ratio found among the civil population.
I observe that among criminals there is a large amount of weakmindedness, not regarded as insanity, viz.:
Prisoners weakminded, but not in the lunatic department—of two
kinds : Separate, but under special observation; not separate, but
whose mental condition does not bring them within the category of
the insane.
Perhaps there are few see so much of this class as I do of various
grades, verging upon and lapsing at times into insanity, reminding
one of Hamlet’s description of falling
“ Into sadness—then into a fast;
Thence to a watch—thence to a weakness;
Thence to a lightness ; and by this declension,
Into the madness wherein madmen rave.”
Here is a decennial table, 1856 to 1865, showing the number of
�1866 .]
on the Body and Mind, by J. Bruce Thomson.
345
those associated, as unfit to bear the separate system of imprison
ment:—
1856 1857 1858 1859 1860 1861 1862 1863 1864 1865 Total.
Mental Condition—
Imbecile or Weakminded... 22 34
Ditto, and Suicidal ........... 3
2
Epileptic ............................ 4
7
29
43
14 21
2
4
4 11
20
7
2
16
9
7
26
6
13
13
2
6
17
4
15
15
1
7
198
40
76
20
29
32
45
21
36
23
314
36
For the last decennial period, we have had at the average of forty
per annum who, in addition to the above, have been placed under
special observation, expected to suffer from separation.
We have therefore had
Associated, as unfit for separation .......................
Separate, but specially observed .....................
314
400
Total.....................................................
714
The average daily population having been 6468, or 646 per
annum, we thus show that mental weakness (but not insanity) be
longed to about 11 per cent, (nearly 1 out of every 9) of the general
prison population. This is probably much within the actual mark.
In a paper I lately published in the ‘ Edinburgh Monthly Journal/
being an analysis of fifty-nine epileptic prisoners’ cases, it appeared
that all, with the exception of fourteen of these, were noted for
mental weakness; that prisoner epileptics were 1 per cent, of the
prison population, while the ratio in civil and army populations
was estimated at a mere fraction of this, viz., 0-009.
I proceed to give a table of the number of prisoners who have
become insane in the General Prison during the last decennial period :
1856 1857 1858 1859 1860 1861 1862 1863 1864 1865 Total.
From the General Prison... 244664
2339
43
In the form of an equation this gives-1—
The average daily population................................
The number becoming insane ............................
6468
43
1
150
One out of every 150 became insane during the last ten years.
The average daily population 1 speak of is the sum of all who during
the year have passed through the prison divided by 365. I should
add that I am aware of several who went out of our prison weakminded, and shortly afterwards went to asylums; so that 1 out of
150 is probably a small enough calculation of those becoming
insane under imprisonment.
Let me extend this inquiry beyond the General Prison for Scot
land, and show as near as I can the number of existing insane
�346
The Effects of the Present System of Prison Discipline [Oct.,
among the total prison population of ^Scotland. The criminal luna
tics of Scotland are nearly all placed in the lunatic department of
the General Prison for Scotland, under the authority of the Secretary
of State and during Pier Majesty’s pleasure.
Some years ago, the Medical Superintendents of Asylums objected
to the reception of criminal lunatics. It was not considered fair or
favorable to insane patients that they should be classed with crimi
nal lunatics, many of whom had committed heinous and violent
crimes ; and the Medical Superintendents objected to come under
the obligation called for by the Secretary of State, to keep the crimi
nal lunatics in “ close and safe custody”—a condition not only
highly responsible, but detrimental to the curative treatment of
milder and ordinary cases, admitting of considerable freedom within
and even without the asylum precincts. Lunatic asylums, therefore,
being found unfit places of detention for criminal lunatics, the late
General Board of Directors of. Prisons made arrangements, under
statutory powers, for the present lunatic department of the General
Prison to be fitted up for the custody, treatment, and maintenance of
all criminal prisoners unfit to be brought to trial, found upon their
trial to be insane, or at the time of committing the offence charged;
also prisoners who have become insane while undergoing punish
ment. The hospital for lunatics was opened in October, 1846, and
contains, with few exceptions, all the insane belonging to the criminal
population.
The following shows the existing insane in the lunatic department
for criminals during the last five years :—
1861
1862
1863
1864
1865
No.................... 33
34
34
40
51
The entire prison population of Scotland, annually averaged for
flic last five years, amounted to 2,316; and the above would show—
Annual average number of criminal lunatics 38 _
Number of criminals ......................................... 2316
1
60
One out of 60 existing criminal insane.
Criminal insanity is on the increase, however, and my report of
1865 shows—
Criminals insane......................................... 51
Total criminals of Scotland ................... 2416
1
47
One out of 47 existing criminal insane, as reported for 1865.
Compare this ratio with what is found in this and other countries.
The materials are by no means satisfactory, but I offer some of
them :
In
In
In
In
France the number of lunatics has been recently estimated at
England and Wales at ..............................................................
Scotland, about .................................................................... • ....
Ireland, at .................................................... . .....................
1
1
1
1
in
in
in
in
1028
824
473
1291
�1866.]
on the Body and Mind, ly J. Bruce Thomson.
347
The lowest calculation for England I have ever met with is made
by Drs. Bucknill and Tuke in their work on ‘ Psychology/ which is
an estimate made by adding a supposed number of lunatics and
idiots to the reported number given by the Commissioners in Lu
nacy ; and this lowest estimate supposes that 1 out of 300 is the
ratio of insane to sane in the population of England.
The foregoing prison statistics lead to the following conclusions :—
1. That weakmindedness is very prominent in the criminal popu
lation as a class.
2. That in the General Prison for Scotland about 1 out of 9, or
about 11 per cent, are weakminded.
3. That epilepsy shows a much larger proportion among prisoners
than among the army or civil populations.
4. That prisoners are noticed on admission in considerable num
bers to be weakminded; rendering it doubtful whether their mental
peculiarities are the result of hereditary influences, or may be due
to the seclusion of cell-life and frequent imprisonment.
5. That individual prisoners (not of the criminal class) suffer
much mentally from the seclusion, want of intercourse, and inaction
of mind as well as body under the separate system of imprisonment;
these effects being shown chiefly in juveniles, foreigners especially,
and Highlanders, who cannot converse in English, and those gene
rally who do not belong to the criminal class.
6. That the ratio of those who become insane in the General
Prison for Scotland has been 1 in 150.
7. That the existing criminal insane have been, during the last
five years, at the ratio of 1 out of every 60 of the prison population
in Scotland; and in 1865, 1 in every 47 of the prison population
were criminal lunatics; i. e., existing at the time.
The important corollary from these statistics is, that, with all its
recent relaxations, the separate system of prison discipline is trying
upon the mind and demands the most careful attention on the part
of medical officers, inasmuch as mental diseases are most prominent
among criminals in prisons, and seem to be on the increase.
I bring forward these facts and figures asking for further inquiry
and regular statistical information from the surgeons of English
convict prisons, especially on two points :
a. What is the proportion of insane (becoming insane or existing
insane) among the criminals of England ?
What proofs, if any, are there of this insanity being the result
of imprisonment ?
These statements seem to me extremely interesting, and I should
like your free comments upon them.
The number of weakminded renders it probable that much crime,
�318
Paralytic Insanity and its Organic Nature,
[Oct.,
when committed, is done by persons labouring under mental disease,
crime and insanity having clearly a natural alliance which puzzled
the old classic philosophers as well as modern psychologists, in re
gard especially to the question of responsibility. “A knave is
always a fool ” says the proverb; and Hale had an axiom, that “ all
criminals are insane.” It has almost been asserted in as many
words by eminent psychologists, that “ all murderers are insane.”
Without going this length, 1 must admit that I am satisfied that, as
a class, criminals are extremely liable to mental disorders and dis
eases, apart altogether from imprisonment.
Hear the divine Plato on this subject:—“ All disgraceful conduct
is not properly blamed as the consequence of voluntary guilt; for
no one is voluntarily bad ; but he who is depraved becomes so
through a certain habit of body and ill-governed education. All the
vicious are vicious through two most involuntary causes, which we
always ascribe rather to the planters than the things planted, and to
the trainers rather than those trained.” Such doctrines, whatever
truth may underlie them, are not tenable to the extent which this
philosopher held; otherwise we must in a great measure set aside all
moral responsibility.
Paralytic Insanity and its Organic Nature.
By Dr. Franz
Meschede. Abridged from ‘ Virchow's Archives/ 1865, by
G. F. Blandford, M.B. Oxon.; with a Prefatory Note.
The disorder commonly called “ general paralysis of the insane”
presents so many points of interest to the pathologist and the phy
sician, that as a necessary consequence it forms the commonest topic
among the writings of those who specially study insanity. But
after so much observation and so many treatises, it is disheartening to
find that even now scarcely more than one fact with regard to it is
laid down as settled and established beyond the possibility of doubt.
One there is, the saddest that can be. It is, that for this malady we
hitherto have found no cure; that to diagnose it is to pronounce
the sentence, not only of incurable insanity, but also of speedy
death. The marvel of the whole is, that although death occurs in
every case at no very distant period, though post-mortem examina
tions of general paralytics are made by hundreds every year in this
and other countries, yet even at this day no two observers are agreed
as to the pathology and morbid anatomy, as to the part in which it
has its origin, or which constitutes its peculiar and proper seat. No
�1866.]
by Dr. Franz Meschede.
349
wonder that the whole of the morbid anatomy of insane brain is
vague and ill-defined, when this, the specially fatal form of mental
disease, still hides itself from us—still wraps itself in the mystery
which envelopes all that relates to mind. I make no apology for
drawing the attention of the readers of this Journal to a paper on
the subject, published in the October and November numbers of
‘Virchow's Archives,' 1865, and for giving a short and necessarily
imperfect summary of its contents, it being too long for repro
duction. But as every outline must needs be unsatisfactory, I trust
my readers will go themselves to the original. In default of oppor
tunity of examining many brains of paralytic patients, I present as
a contribution to the English treatises on the subject these obser
vations of another.
First of all, however, I wish to make a few remarks; one upon
the nomenclature of this disease, and especially upon the new name
lately bestowed upon it. This, “ general paresis," was introduced
to us by Dr. Ernst Salomon, a translation of whose paper appeared
in this Journal in 1862. Paresis is not a new word; it is an old
medical term familiar to the readers of the ‘ Zoonomia' and other
works of that time. In barbarous Latin, worthy of the days of
Sprenger rather than of the era of the microscope, Dr. Salomon ex
plains paresis as “ insania paresans,” “ paresifying mental disease."
At the same time, he enumerates a great many but not all of the
synonyms of various authors. The term most universally known,
which has been, we may almost say, officially adopted, is the timehonoured “ general paralysis," or “ general paralysis of the insane."
There needs some strong reason for changing this. The name we
substitute ought certainly to be a better and not a worse. But is
there a single reason why paresis should be preferred to paralysis ?
Is there any meaning of the verb -rrapirip-i which squares with,the
symptoms of the disorder more than that of the verb TrapaXvto ?
Physicians in ordinary practice, who have seen with me patients in
the earliest stage of the disease, have objected to the term “ general
paralytic" as inapplicable to men who showed no diminution of
bodily strength. Yet the only meaning which paresis has which
makes it in the slightest degree available is that of slackness or
weakness. And not only is this word substituted for general para
lysis, but it is applied to ordinary hemiplegia, being usually con
verted into pareesis. An old gentleman the other day lost the use
of one side, and I was rebuked by the family for calling his malady
paralysis, and told that the most eminent of the faculty had pro
nounced it to be only pareesis. But are there no other names ? If
we object to the term “ general paralysis " as vague and unscientific,
must we go back a hundred years and rout out a disused word from
the garret of our great-grandfathers, and apply it to a new disease
unknown to them? We generally give M. Calmed the credit for
�350
Paralytic Insanity and Its Organic Nature,
[Oct.,
havingfirst fully described the disease with accuracy and clearness. No
work even now surpasses his own, or that part devoted to it in his
treatise on the inflammatory diseases of the brain. M. Calmeil de
nominates it “ periencephalite chronique diffuse.” Here we have a
definite appellation, almost a definition. It conveys a pathological
theory, true or false. It would be well, I think, to adhere to such
a term as this till we have reason to reject the theory and can sub
stitute another and a better in the place thereof. I have seen it
stated that M. Calmed considers it to be a meningitis. Dr. E.
Salomon says, “ Calmeil makes it a peri-encephalo-meningitis chro
nica diffusa.” Calmeil does nothing of the sort. In his ‘ Maladies
Inflammatoires/ i, 4-86, he says distinctly, “ Sans nier l’influence
réactive que l’état inflammatoire des méninges est à même d’exercer
sur les centres nerveux encéphaliques, dans les cas où se manifestent
les symptômes que nous venons de passer en revue, nous croyons
bien plus rationnel de les attribuer principalement à l’état d’inflam
mation permanent où se trouve elle-même la substance corticale des
hémisphères cérébraux.” The article of Dr. Meschede of which I
propose to give a summary will bring strong testimony to corrobo
rate this view of M. Calmeil, and will vindicate the propriety of still
maintaining the name he has originated, viz, “ periencephalitis
chronica diffusa.”
Much discussion has arisen as to whether the symptoms of gene
ral paralysis are simply added to ordinary insanity—epiphenomena,
as they are called—or whether it is altogether a distinct and special
disease. Here it would seem that we are drifting back to old doc
trines, according to which diseases are to be looked upon as entities.
If we put aside the question whether general paralysis be or be not
a special disease, and consider only what that is which is diseased,
what is the “ pars affecta,” we shall arrive at greater certainty.
The readers of this Journal do not require to be told that the
“ pars affecta ” in general paralysis and in non-paralytic insanity is
one and the same. We may arrive at this conclusion apart from
the post-mortem examination of diseased brain. The symptoms of
the two forms in life will indicate, I think, that the seat is the same,
and will aid us in interpreting the pathology of the disorder. Al
though, speaking generally, the exalted notions, the délire ambitieux,
stamp with a certain distinctiveness the mental disorder in general
paralysis, as the stutter marks the bodily affection, yet it is not to
be forgotten that in many cases these arc both absent. On the
other hand, there is not a single delusion of ordinary insanity that
we do not find in paralytic patients. “ Believes himself given over
to the devil”—“Thinks poison is put in his food”—“Believes he
has committed sins too enormous to be forgiven ”—“ Thinks he is
going to be arrested.” These are from four cases of general para
lysis. And in cases of ordinary curable mania we const ant ft find
�1866.]
by Dk. Franz Mesciiede.
351
exalted delusions of being kings, inventors, millionaires. All this
shows that the line of demarcation between ordinary insanity and
general paralysis is excessively fine, and the whole history and pro
gress of the latter points rather to a difference in degree than in
kind. That general paralysis is intractable, malignant, is the one
fact we are certain of. Probably the distinction between it and
other curable forms of insanity is analogous to the difference between
certain innocent and malignant growths. There is a tendency to
depart more or less from healthy structure. This tendency in some
is strong, and the growth is malignant; in others it is weak, and the
new formation is not so far removed from what is normal, and if
excised does not return.
It may be objected that the paralytic symptoms, the inarticulate
speech and quivering lips, point to a different seat of disease. It
may be said that in ordinary mania there are no paralytic symptoms,
that in progressive dementia following upon mania there is no loss
of muscular power. These objections do not, I think, point to any
different seat of disease, but only to a gradually advancing degene
ration and decay of the parts originally attacked. That these parts
are the same in both ordinary mania and in general paralysis, seems
indicated by these considerations :—
1. General paralysis constantly exists, and is evidenced beyond
any doubt by the mental symptoms without any perceptible defect
of articulation or other lesion of motility. This is a fact which
must be familiar to all my readers, and I therefore shall not stop
to adduce cases. It constitutes one of the difficulties of diagnosis
in this class of patients.
2. The defect connected with the inarticulate speech seems as if
it lav in the highest nerve-ganglia which impel the muscles and
supply force to them along the conducting fibres. The fault lies at
the origin, not in the course of the transmission, not in the trans
mitting organs. This appears if we closely examine the phenomena
of the defective articulation. The patient by an effort can correct
it. When he exerts himself—when he shouts, for example, he
speaks clearly. I am now speaking of the early stages. \\ lien, by
a violent effort of will, he forces all his nervous energy in one direc
tion, he does that which he wishes to do. The defect appears to be
in the nerve-centres which supply the volitional power. And this
will account for the absence of unilateral symptoms, which are often
absent throughout, and which, when they are found, are chiefly the
sequelae of apoplectiform or epileptiform attacks. Up to the last,
many patients seem to have nothing the matter with their limbs and
muscles except a deficient supply of force.
If we take other forms of abnormal muscular action, we may find
in a similar way that the defect arises not in the parts themselves or
iu the conducting nervous organs, but in what wc must call the
�352
Paralytic Insanity and its Organic Nature,
[Oct.,
highest mental originators of nerve-force. An instance is at once
suggested by general paralysis. This is ordinary stammering. In
spite of all that has been said about the action of the laryngeal
muscles, &c., it is now, I believe, generally held that stammering
depends on mental emotion; that the mental centres are the seat of
the disorder, and that to avoid it we must, as Dr. Carpenter says—
1. Reduce mental emotion; 2. Avoid exciting mental emotion;
3. Elude mental emotion. This has been well urged by Dr. Monro
in a pamphlet entitled i Stammering and its Treatment/ by Bacc.
Med. Oxon., 1850. General paralytics do not stammer always—do
not always lisp over the same word. This would appear to be an
affection of a very high nervous centre. And probably the same
may be said of some forms of chorea. Certainly it may, of all the
quiverings and shakings that depend on terror or the like. Poor
/Eneas says—
“ Obstupui, steteruntque comae, et vox faucibus haesit.”
3. Another reason for thinking that the seat of the disease we
call “ general paralysis ” is identical with ordinary insanity, is that
the cause is so often the same. Although it sometimes appears as
if the former were more often due to physical causes than the latter—
due to drinking, sexual excess, and the like,—yet it very frequently
is clearly attributable entirely to mental causes. Dr. Sankey gives
several cases, and every one will recollect some such. Now that
great mental emotion is capable of producing not only ordinary in
sanity, but actual organic lesion, whether of general paralysis or of
other kinds, is a fact, I believe, much overlooked. We are so apt
to think that organic lesion is the cause of the mental derangement,
that we overlook the fact that mental disturbance may produce
organic lesion. Yet, while writing this, I happened to take up the
May number of the (Medical Mirror,’ which contains a case related
by Dr. Broadbent:—“A servant-girl, set. 24, in perfect health, goes
for a holiday on September 24th to the British Museum: she meets
her sweetheart walking with another woman; a violent scene ensues,
the young man tearing a brooch containing his portrait out of
her shawl. Next day she fretted very much; on the following day
she became violent and delirious—in fact, maniacal. She then fell
into a state of stupor, and was admitted into St. Mary’s Hospital on
the 29th. She evidently heard and saw, but all the mental faculties
were oppressed. No paralysis. She was noisy all the night. Next
day she was delirious, constantly talking; not answering when
spoken to. On October 2nd she became rather suddenly comatose,
and died. P.M. exam.—The convolutions appeared to be slightly
flattened, and the surface of the hemispheres was paler and the veins
less full than usual. Brain-substance firm and pale : in the left
hemisphere, external to the thalamus and corpus striatum, and slightly
�1866.]
by Dr. Franz Meschede.
353
above their level, was found a very large recent clot, estimated to
weigh at least an ounce.” Here we have a healthy young woman
dying very rapidly of an apoplectic clot after violent emotional ex
citement at an age when apoplexy is rare, especially in women.
There was no paralysis, and the symptoms throughout were mental
as well as the cause. This case seems valuable to those who arc
considering the relations of functional and structural disorder in
mental diseases. General paralysis, then, may begin in the same
centres as ordinary insanity, and be produced by the same causes;
but it may go on progressively till it causes degeneration and de
struction of those parts—not remaining stationary, like chronic mania
or dementia.
One word as to the nature of the disease. Not long ago, general
paralysis was considered an inflammatory affection, and treated as
such by the remedies then supposed to be efficacious in such cases.
1 have seen many patients treated by a course of bichloride cf mer
cury, but without good result. It is possible, however, that the
theory was more correct than the mode of treatment. General
paralysis seems to be the peculiar degenerative inflammation of the
cortical part of the brain, ending in total annihilation of the life—
that is, the functional activity—of the part. It seems as if each of
the viscera has its own peculiar degenerative disease; other dis
orders, as cancer, tubercle, abscess, &c., being more or less inciden
tal and depending on extraneous causes. Thus, the liver has its
proper disease destroying its excreting and secreting function. So
have the spleen and the kidney. Dr. Salomon has noticed the ana
logy between general paralysis and Bright’s disease. And probably
the adhesion of the capsule of the kidney, the tearing of the granu
lar surface, and the disappearance of the cortical portion, may have
suggested a comparison even to superficial observers.
When we say that general paralysis is an inflammation, we must
clearly understand what we mean by this. In Mr. Simon’s admi
rable article in Holmes’ ‘ System of Surgery,’ we read that “the
phenomena of inflammation are modified phenomena of textural life.
There is an excess but an incompleteness of textural change, shown,
on the one hand, by effete material unremoved, softened and degerated tissue; on the other, by nascent forms unapplied, which have
either perished before maturity, or definitely ripened into mere abor
tions of texture.” And further he says, “ The action whereby in
flammation begins is one which physiologically cannot be distin
guished from hypertrophy. The line of distinction is drawn where
the effort of hypertrophy becomes abortive, and where the forms of
increased growth are mixed with palpable refuse of increased decay.
.............. Cancer and inflammation have the most intimate morpho
logical affinity; and probably what is distinctive of cancer lies
far less in the nature of its textural phenomena, than in the
�35 1
Paralytic Insanity and its Organic Nature,
[Oct.,
hitherto unknown causes which give them their fatally continuous
progress.”
A nodule of cancer continues to spread, returns where excised,
and progresses till it destroys life; while a similar non-cancerous
nodule is removed, and does not return. The cause of the ineradicability of the former, however, is not explained by any known
laws. In the same way, the hypersemic and hyperactive condition
of the brain in simple acute mania subsides, perhaps recurs, sub
sides again, and so on; while the hyperaemic condition of general
paralysis leads us at once to textural change and death. But we
cannot as yet discriminate the origins of the two conditions. Truly
we may call general paralysis the malignant disease, the true
morbus malejicus of the gray matter of the hemispheres.
I have presumed to offer these remarks as a preface to the sum
mary of Dr. Meschede’s paper. His strictly inductive observations
serve to test the accuracy of these views, which arc as much deduc
tive as inductive. The whole, I think, points to that unity of dis
ease which modern science teaches, rather than to the special entities
which diseases were thought to be in the days of nosological classifi
cations. Specific remedies are almost abandoned: probably specific
diseases will share the same fate.
I now proceed to the article by Dr. Meschede.
I. General view of the disease.
General paralysis appears to have greatly increased during the
last ten years. It is interesting to us, because it chooses its victims
as a rule from amongst the males of the better classes; it prostrates
those organisms which appear the strongest, and at a time when they
are at the height and zenith of life and activity. It is a problem
worth solving, the discovery of the nature, causes, and cure of this
fatal disease, which is as yet a psychological puzzle.
While the mental powers are sinking to destruction, the self
feeling swells to a pitch of grandeur. The patient, as he declines
to the condition of the brutes, feels himself lifted up to the dignity
of a god, thinks himself God and above God. The phenomena of
a violent storm pass before our eyes, agitating the depths of the
mind with fierce eruptions and never-ceasing force. Sometimes the
symptoms are milder; the mind-organ wastes with less sparkling
glow. The victims of this form appear in a state of beatific rest;
their life floats on as in an Olympus of the happy. If we only
observed these easy dreaming “ emperors of the world” and “ higher
gods,” we might be inclined to look on the disease as an exquisite
passive atony, to deny the first active symptoms, and to consider
the image of an overwhelming storm as an extravagant phrase—
only that suddenly outbreaks of mania flash out to tell us that
�1866.]
by Dr. Franz Mesciiede.
355
even here a consuming fire still burns under this covering, and
carries on slowly, but surely, the work of destruction.
Certain epochs in this work of destruction are prominently
marked out by the attacks of paralysis, in which the patient sud
denly collapses in convulsive movements in the midst of the appa
rent harmony of his existence. In cases running an acute course,
these attacks come on in the height of the fury, after the rush of
ideas and the tempest of emotion have been getting more and more
intense for some days. But even in the more chronic cases they
give notice of their advent by an increased agitation, and are
accompanied by a heightened temperature and unmistakable signs
of cerebral congestion. With and after each attack, the mental
and bodily strength declines. The motor ¡lowers are impaired so
that the central influence is withdrawn, and inharmonious irregular
muscular movements follow. Parts of the mental acquisitions, too,
are destroyed, and fade from the memory. So the world of mind,
step by step, sinks to ruin. Even if the patient after a few days
recovers somewhat, so as to leave his bed, if the connection of body
and mind is somewhat restored, yet it is evident that the cohesion
of the life of the mind is thrust down a step lower, and cannot
again be raised to the former level. So these attacks mark out the
steps by which the paralytic process goes on to complete annihila
tion. The actual cause of these attacks is not yet clearly made out.
There is not always a haemorrhage in conjunction with them. They
are the co-effects of the paralytic process, but are worthy of note
because even in the slower cases tfcey indicate an active organic
process of destruction, and draw attention to the decay which step
by step advances.
II. The exalted delirium, and the progressive destruction of the
mental strength, symptoms of organic processes going on in the
brain.
The exaltation which is so characteristic of general paralysis
arises not out of weakness of intellect; it is not only a disturbance
of the imaginative activity, but its essential point is an exorbitant
expansion of the feeling of self. The life of ideas is influenced by
the dominant emotion, and shapes itself so as to correspond. The
feeling is not the consequence of the ideas ; for often we find in
general paralysis the feeling of grandeur without any delusions of
greatness—also the feeling generally precedes the outbreak of the
peculiar delusions. The ideas vary, changing from minute to
minute; the feeling is constant, and forms the ground of the ideas.
Now the causes which bring about a change of feeling are partly
mental and partly bodily, and both work upon and through the
brain. The effect of sudden and violent passions is well known;
�356
Paralytic Insanity and its Organic Nature,
[Oct.»
it extends to tlie nervous system, to the secretions, ¿cc. On the
other hand, organic diseases of any part have a deep influence on
the emotional condition of the mind, and that without the interven
tion of ideas. Now everything which promotes the feeling of self
calls up pleasure, everything which thwarts calls up pain. The
brain is the organ through which the mental influences work upon
the remaining organisation, and vice versa, through which or
ganic conditions affect the feelings, being itself a part of the
organism and subject to organic changes. Therefore, we must con
clude that organic changes of the brain affect both the feelings and
ideas. The life and activity of mind and feeling ebb and flow
according- to the strength of the organic excitation. We see this
in the influence which exciting substances, as wine, exercise on the
emotional activity. We also observe that a certain degree of turgescence and of organic tension calls up a feeling of pleasure and
contentment. The turgescence and tension of the brain will pro
duce this feeling of pleasure, and affect the emotions and ideas
more than that of any other organ, because there is no intermediate
step. Out of the importance of the excitation by means of arterial
blood, arises the necessity for recognising the importance of changes
of the tissues. These principally take place in the inner layer of
the cortical substance of the cerebrum, which is provided with an
ample capillary network. On this we must particularly bestow our
attention.
The excitation which is produced by vital stimuli may in the
brain attain a strength which
e
*xceeds
the limit of health. In this
case the mental activity, especially the emotions, must also undergo
an increase. We see such an excess of excitation in intoxication.
In "eneral paralysis we see this heightened condition accompanied
by irritative turgescence and an accelerated change of tissue, which
awaken in the patient the feeling of an energy of life never known
before, of indescribable pleasure and delight, which, however, through
the consumption of the ‘ oleum vitae’ and the nerve-force, lead to
the annihilation of the organic elements. In this way we may ex
plain both the immense expansion of the self-feeling and emotional
impulses, and also the final disruption of the mental life. Certain
particles of the mind-organ on whose vitality the mental functions
depend are in a constant condition of heightened vital activity, and
so the ideas also undergo an increase, the idea of self gains in inten
sity, and the patient leads a life of greater power and greater plea
sure, and constructs his ideas accordingly.
Now, as the organic changes in the brain are chiefly brought
about by the nerve-cells, we conclude that the delusions of grandeur
of the paralytic are a manifestation of the disturbance of the cell-life.
The relation of his “ego ” to the outer world is altered, his “ ego ” be
coming continually greater and mightier. He feels himself hurried
�1866.]
by Dr. Franz Meschede.
357
along by the impetus of the organic processes, and free from all
hindrances and incumbrances such as usually influence the emotions,
but which now are no longer taken into account. There is now no
longer the oppressed feeling of a trouble-laden pilgrim of earth. He
is released from earthly bounds, and is a god. The consciousness of
insufficiency which always floats before our eyes, exists no longer
for the paralytic, All the old ideas which once were present in the
mind merely as wishes or imaginary thoughts, or ideal fancies, are
now revived, and acquire life and the appearance of reality; and
whatever ideas are started in the organ of ideation, are produced
only in the dominant note of the exalted feeling.
A new life and a new view of the world starts up to the patient
with the morbid and increased action of the nerve-cells. Out of a
new fountain of mental strength established in his organism he has
visions never before known.
Beautiful thoughts and ideas stream along and overleap all oppos
ing conceptions arising from external facts. The world needs re
forming. Of the relations of earthly life he takes no notice. Where
these really oppose his doings or wishes, his self-feeling reacts in
rage, which does not, however, last long. It vents itself in furious
mania and dangerous attacks, or in a volley of threats.
The destructive nature of the process is soon apparent. In the
intellect we see not only a stormy disturbance, but also striking de
fects. There is an extraordinary forgetfulness, an inability to take in
outer perceptions and occurrences, and fix and engrave them. All the
activity of the mind is centrifugal, not centripetal. And so the
mind gets worn out, and all the exaltation comes to an end, and
often intense depression follows. There is such a rapid metamor
phosis of the organic part, that the idea-images are wiped away and
are only of ephemeral duration. There is no fixed delusion except
in certain chronic and hybrid cases.
III. Different opinions of authors as to the seat and nature of the
organ ic process.
We have hitherto considered the phenomena of the distorted
mind. The deductions we have reached require completion by
means of pathological anatomy. This will determine whether, when
the storm has ceased and the fire is extinguished, real organic pro
ducts of this fire are to be found. We shall have to test our view
of the organic foundation of the “ megalomania” by the microscope
and micro-chemistry. We arrive at two questions: What is the
seat, and what is the nature of the anatomical change, which is at
the bottom of the paralytic process ? In the works of authors since
Haslam we find a jumble of contradictory opinions, arbitrary hy
potheses, and the strangest explanations. Almost every part of the
brain has been assigned as the seat—cerebrum and cerebellum, white
vol. xii.
24
�358
Paralytic Insanity and its Organic Nature,
[Oct.,
and gray matter, ventricles and cortex, membranes and cranium,
cellular tissue and vessels ; and every kind of change has been called
the cause—hardening and softening, oedema, sclerosis, hypertrophy
and atrophy; luemorrhagic, fibrinous, and albuminous exudations ;
meningitis, congestion, and extravasation; atony, rheumatism, athe
roma, stasis, &c.
This divergence of opinion leads us to think that the real organic
change is not yet known; and this is conceded by such men as
Esquirol, Calineil, Guislain, Falret, Conolly, and Griesinger.
IV. Parenchymatous inflammation of the cortical substance, the
basis ofparalytic insanity.
Looking at the series of phenomena thus briefly sketched out at
the time—the intensity, the progressive rise and fall of the storm
which bursts upon both mental and vital powers,—we cannot help
feeling that the so-called general paralysis of the insane is not a
mere negative state like other paralyses, but an active process, the
expression of an independent activity consuming the mind, and so
reducing the patient to a passive existence. Observation, not of the
dementia of the final stage, but of the behaviour in the acute and
early period, teaches that here all is fire and flame, storm and tu
mult, even in the bodily functions. Hasty eagerness, excesses in eating
and drinking, and profusion of secretions and excretions, salivation,
erections and ejaculations, accompany the first outbreak. And con
tinual and excessive play of the emotions is no less common. If
this be the character of the first stage, consideration of the final
state leads us to the a priori conclusion that the total confusion or
destruction of the mental life cannot come to pass without deeply
ravaging changes occurring to the organ which carries on the mental
processes.
A series of investigations earned on since 1857, by the eye and
the microscope, have led me to the conviction that degeneration of
the nerve cells of the hemispheres of the cerebrum, especially of the
cortical portion, constitutes the peculiar intrinsic pathologico-anatomical change in paralytic insanity. The alteration of the cells is
found in different degrees from mere parenchymatous swelling down
to their reduction to molecular detritus. In advanced cases all the
transition forms may be seen. There may be an aggregate of fat
globules with the characteristic outline and nucleus of nerve-cells.
The nucleus will be surrounded closely by small fat-globules highly
refracting, and also with pigment-granules yellowish and shining;
or the outline will be seen only round one half of the cell, the other
half being replaced by a margin of globules. And besides cells
with a perfect outline, but filled with fat- and pigment-granules,
there are others which have completely lost all outline, and are a
mere collection of granules round a nucleus, as to the nature of
�1866.]
by Dr. Franz Meschede.
359
which we should be in doubt if we met with them elsewhere or iso
lated. In acute cases running on quickly to death, we do not always
perceive these stages of degeneration so completely defined. The
granulated cells occur more rarely, and we find more with a definite
outline and with only a moderate amount of fat-granules and pig
ment. There is, however, a general swelling, a congestive turgescence and succulence of the cortical part. On section, it appears
wet and darker than it ought. Often we may notice with the naked
eye a bright red appearance, not so much of the surface or the pia
mater as in the inner layer. This redness only penetrates to the
surface in the more advanced stages and in certain spots. It is of
different degrees, ranging from pale rose to dark violet; sometimes
of as bright a red as a phlegmon or conjunctivitis. It is not due to
post-mortem causes, to blood-gravitation or imbibition, for it is
chiefly observed in the anterior parts of the cerebrum, especially on
the convexity and in the temporal lobes, and also the parts which
are most intensely red are frequently marked by punctiform capillary
apoplexies. The microscope shows us in this portion a highly de
veloped capillary network filled to excess with blood-corpuscles, with
here and there points of extravasation and elongated vessels. The
nerve-cells in this appear softened, more voluminous and more iso
lated. We seldom see this stage, because death does not usually
occur till much later.
So then we have hypersemia and parenchymatous swelling of the
inner layer of the cortical substance on the one hand, and fatty pigmentous degeneration on the other, as the beginning and the end of
the organic changes in general paralysis. Between these poles lies
the destructive process, which by analogy we conclude to be a
parenchymatous inflammation. Although the identification of hypermmia or redness with inflammation is a much-disputed point, yet
a marked and pronounced red injection and congestion are always
strong indications of inflammatory action. And if we go through
the cardinal symptoms of inflammation, we shall find not unfrequently that we may recognise swelling in the firm tension of the
sac of the dura mater. The next requisite, heat, is not to be proved
by the thermometer in loco ; but the investigations of Dr. Ludwig
Meyer have shown an actual increase of the general bodily tempera
ture, whilst my own prove that during congestive exacerbations the
heat is above the normal, whilst at times of collapse it is below.
And we are warned by the redness and turgescence of the face, the
hot temples, the reddened ears, that an increased cerebral congestion
is present, and that the proper heat of the brain undergoes an ad
vance. The fourth symptom, /mA, we must not look for, because
the malady attacks the organ of intellect, not that part of the brain
which perceives pain. Patients protest they never felt so well. But
they feel sensations in their heads which indicate what is going on
�360
Paralytic Insanity, and its Organic Nature,
[Oct.,
there, and in the premonitory period they often complain of actual
pain. These have been cases where traumatic or syphilitic affections
were at work, where meningeal irritation prevailed. And the ab
sence of pain in the best-marked stages of general paralysis is an
argument against the theory of its being a meningitis.
The passive character of the final stage in general paralysis must
not make us think that the whole is a passive process; neither must
we be misled by the diminution of the volume and weight of the
brain-substance. The brain-atrophy is only one of the results of
the disease; it is not the cause of the paralytic insanity. In the
outset, not the atrophic, but the hypertrophic, are the victims of this.
We have only to look at the strong athletic frames, with their full
muscles, the well-formed skulls and florid faces. Here we have an
excess of nutrition and over-stimulation. A primary atrophy cannot
produce the phenomena of excessive activity. The exaltation of the
self-feeling cannot be a consequence of depression of the nutritive
process.
In cases of some duration the degeneration of the nerve-cells is
visible even with the naked eye. We have no longer the redness
of the inner layer of the cortical structure, not even the light rose
tint, but a peculiar dark, dull yellow; and on trial with the scalpel
or finger the consistence of this layer appears altered—sometimes
softer, more frequently harder, like leather or felt. This is brought
about by the shrinking of the tissue on the destruction of the cells,
by condensation of the connective tissue, Virchow’s glia, and by
wasting of the vessels. In this yellow layer blackish-brown or rust
coloured spots, caused by pigment accumulations, are met with, the
result of capillary extravasations, of active processes connected with
an afflux of blood.
For the examination of the nerve-cells I have used preparations,
either fresh and wetted with cerebro-spinal fluid, albumenised water,
hydrochloric acid, glycerine, carmine solution, weak chromic acid, or
pieces macerated a long time in these media so as to isolate the
cells. I have also allowed pieces of the cortical substance to dry in
a dry chamber, so that thin transparent slices could be cut off with
a knife. With a low power, 40 to 120, we can survey at once the
whole thickness of the cortical part, and detect the change in the
integrity and size of the cells. I usually compare preparations
taken from parts of the brain which appear normal with those visibly
affected; and I also compare portions of the brain of paralytic patients
with others from the brain of the insane who are not paralytic, and
also with those from the brain of the sane. A favorable opportunity
for such an instructive comparison was afforded me by two patients
who died on the same day, one of whom suffered from paralytic
dementia, the other from epileptic dementia with hemiplegia. The
difference in the nerve-cells was most striking. In the general para
�1866.]
by Dr. Franz Meschede.
361
lytic, the cells appeared large, and, in very advanced stages of de
generation, filled with fat- and pigment- granules; the sharp outline
was partly obliterated, so that they often appeared only as heaps of
granules with a nucleus. In the epileptic, the cells were smaller,
sharper; the outline more perfect, much clearer and more transpaparent; very few fat- or pigment-granules. The capillaries here
appeared slender and delicate, and the network they formed
was but scanty; while in the paralytic patient the capillary network
was much developed, and the walls of the vessels thickened and
convoluted.
The degeneration of the inner layer is not uniform over the whole
of the cerebrum, but prevails in certain definite localities. It is
tolerably constant in the convolutions of the temporal lobes, and on
the convexity, along the longitudinal fissure, and also in the frontal
lobes; much less on the basilar surface, and least of all in the con
volutions of the posterior lobes. I have also found the cells of the
gray matter in the interior of the brain altered; e. g. the corpora
quadrigemina. My researches, however, in this direction are too
few to enable me to form a final judgment.
This much appears to me certain—that the changes in the inner
layer of the cortical substance constitute the peculiar and intrinsic
organic ground of paralytic insanity. This assertion, arrived at by
comparative pathological observation, tallies with physiological in
vestigations as to the functions of the different parts of the brain,
which, without discussing them here, amount to this—that the
convolutions of the great hemispheres, especially the cortical
part, have a closer relation to the functions of the mind, particularly
to the operations of ideas and thought, than any other part of the
encephalon.
The other cranial and cerebral changes which we meet with are
too variable and too inconstant to be able of themselves to consti
tute the essential pathological lesion of general paralysis. The
ventricles are often distended with fluid; but often they are of
normal size, or even contracted. The ependyma may be granular
and full of amyloid corpuscles. The choroid plexus may be hypersemic and full of cysts. The white substance of the hemispheres may
be dry and inclined to sclerosis, or oedcmatous and softer than it
ought to be; of dull colour, with stains of rose or yellowish hue.
The soft meninges are in many cases partially thickened, oedematous,
with stains of ecchymosis, occasionally with true thin blood extrava
sations. The vessels of the pia mater are often hyperaemic upon the
convexity, in places atheromatous, in a few cases blocked by emboli.
The arachnoid is, over a greater or less extent, milky and thickened,
studded with Pacchionian granules, and by these united to the dura
mater; also so luted with the pia mater to the surface of the brain,
that on removing the meninges the cortical substance comes away
�36.2
Paralytic Insanity and its Organic Nature,
[Oct.,
with them. On the inner surface of the dura mater we find in
many cases a thin, gelatinous, soft, haemorrhagic, pseudo-membranous
layer, reddened by points of extravasation, or by fine vessels, espe
cially on the parts corresponding to those of the inner layer usually
attacked by inflammation, viz., the temporal fossae, the convexity,
and anterior fossae. These layers are mostly thin, sometimes strati
fied, often only consisting of a rust-brown or blackish pigment.
They are the residua of an afflux of blood to the brain. Of them
selves they constitute no process of meningitis.
The condition of the skull varies. The dura mater is often
closely adherent to it. The condition of the connective tissue is not
clearly made out. It is easy to understand that this, especially its
cell elements, must undergo change, as a consequence of the inflam
matory parenchymatous degeneration.
Although no one of these changes can be looked upon as the
essential condition of paralytic insanity, yet they play their part,
albeit a minor one, in the psycho-paralytic drama. Their import
ance varies; they may be starting-points or predisposing influences,
or modifications of the process, or co-effects or consequences of
secondary significance. If the nerve-cells of the inner cortical
layer come into a chronic condition of irritation and altered nutri
tion ; if the organic vital motion of the same is altered and accele
rated, running on to dissolution and disorganisation; if the inflamma
tory state which was once outside the nerve-cells has extended to
them—then first do we have distinct general paralysis.
People are too fond of looking upon the nerve-cells and fibres as
a kind of privileged class of cell elements, whose higher dignity
cannot be subjected to the processes of vegetative life and disease,
and which can only undergo functional disturbance. Some think,
with reference to the nerve-cells, that there must be either perfect
integrity or total annihilation of their action. This is a mistake.
The nerve-cells are developed out of embryo-cells. They have a
common origin with all other cells. Their existence is prolonged
along with the whole living organism. From this they imbibe their
nutrition; cut off from this, they perish. Though through differen
tiation they have a specific mode of existence, yet they never cease
to depend on the continuous vegetative force of the organism, or
cease to take part, to live and move, therein. They have their de
velopment, their history, their different ages—their adolescence,
decrepitude, and premature old age. They depend on the arterial
blood, so that pressure on the carotids interferes with their function,
which is restored when the flow of thejoaiw/«^ vita is allowed to go
on again. If, then, the nerve-cells partake of the vegetative life,
they must be subject to the disturbances of it. Though they are
endowed with special energies and functions of a higher order, vet
their nutrition may undergo a degeneration which may pervert their
�1866.]
by Dr. Franz Meschede.
363
function, and lead it out of its accustomed track without reducing it
utterly to inaction. In this vegetative life there are many degrees
between perfect health and death. The nutritive functions may un
dergo a shock by which they may be brought into an anomalous
state, and a conflict of heterogeneous phenomena may result, exhibit
ing that condition which we call disease. We must here recall
Virchow’s stand-point of cellular pathology—the independence of the
individual cell-life, the relative autonomy of cells. If we grant this
to cells, so must we also presume a greater possibility of disturbance
of their vital movements, a greater capacity for disease; and we must
assign certainly not the lowest place to the cells of the central
nervous system, presiding as it does over muscular movement, and
receiving from all sides excitation.
The capillary network in which the nerve-cells of the cortical
substance are imbedded not only mechanically regulates the blood
flow, like the pendulum of the brain-clock, but it is the bearer of a
vital vegetative process; it is the canal system which conducts the
heating material which the nerve-cells need for their life and
strength. In the inner layer of the cortical substance the system of
conducting arteries resolves itself into a thick network of the finest
capillaries, and here the chief seat of the organic nutritive phenomena
is to be looked for. Here the vegetative life of the brain is most con
centrated, the interchange is most active; and if by irritation it is
forced, it must undergo an excitation which will exceed the bounds
of health. If severe mental distress inflames and breaks in upon
the mind, both the bounds of the vegetative life and of the functional
activity will be broken down, and then follows destruction of mental
strength. This violent action is inharmonious, turbulent, confused,
presenting the characteristics of destruction and annihilation, bring
ing into jeopardy the stability of the organ. Both the centripetal
and also the centrifugal energy of the cerebrum is weakened, the
receptivity and recollection, and also the expression of ideas and
wishes. This shows that not only dynamic or functional disorder
exists, but also organic disease—that the mind-organ is attacked at
its very core.
These views are confirmed by observation of the (etiology of the
disorder. It is favoured by everything which causes cerebral con
gestion and irritation. Men are attacked whose activity of brain
life and brain-circulation is in excess, whose feelings are much
excited, who are harassed by business, and who, by reason of a
kind of psychical hypersesthesia, feel keenly the weight of strokes of
fortune; men who eat a strong flesh diet, much meat and drink—who fully taste life’s troubles and joys, excitements and delights—whose brain is much irritated, somatically and psychically, and whose
�361
Paralytic Insanity and its Organic Nature,
[Oct.,
power of resisting is weakened by hereditary taint or illnesses. The
slower kind of men are seldom attacked.
Sex, too, confirms it. I have found seventy-seven men attacked,
while only twelve women were sufferers. Women have no business,
and less cerebral irritation; they are not injured by alcohol or
tobacco.
Age proves the same thing. General paralysis is a disease of
prime manhood. Few cases happen before the age of twenty-eight
or after sixty. It comes on when the brain is at the climax of
development and its maximum of weight. The average age is about
forty-one and a half years. Just before the brain reaches its highest
weight, there appears to be great nutritive excitation going on, and
great attraction of nutritive material to bring the development to
perfection. Any forced nutrition or over-stimulation at this period
will bring about parenchymatous swelling, and lead later to disor
ganisation. The inflammatory process goes on in a series of exa
cerbations, one following another, and attacking one set of cells after
another. The downfall of the mind is gradual, marked out by
apoplectiform or epileptiform attacks.
[Dr. Meschede then gives the result of four post-mortem exami
nations of typical cases to illustrate his theory.]
I. The first is that of F. G—, who when admitted was sixty-two
years of age, and had shown symptoms of general paralysis for three
and a half years. After nine or ten months he died. Post-mortem
examination thirty-six hours after death. The heart was enlarged,
the muscular substance soft and fatty; the aorta was thickened and
atheromatous; the arch was dilated like an aneurism; the spleen
contained many small calcareous concretions; the kidneys showed
traces of fatty degeneration; the skull was thick and heavy, the
diploe vascular; on the inner surface of the dura mater was a thin
pseudo-membranous layer, of a rusty colour, in the right temporal
fossa; the arachnoid was here and there milky and thickened, with
oedema of the pia mater and subarachnoid space; the pia mater was
adherent in places to the cortical substance; the arteria foss. Sylv.
dextr. was obstructed by an embolus. The cerebrum was oedematous
and soft; the white substance yellowish, with yellow and rosecoloured stains; the gray matter soft, dark, and yellowish—in certain
places reddened. Both ventricles distended and full of opaque serum.
The microscope showed on the surface of the left corpus striatum
a patch of softening, consisting of granular detritus, fatty particles,
fatty and degenerate nerve-cells, and cells in a state of transition.
The vessels were partially diseased, and one small capillary was
blocked by an embolus.
In the inner layer of the cortical substance of the cerebral con
volutions, the microscope showed considerable degeneration of the
�1866.]
ty
Dr. Franz Meschede.
365
nerve-cells, while in the outer layer little was to be seen. The cells
appeared to consist of fat- and pigment-granules. Many had lost
the sharpness of their outline; many were mere rudiments of cells;
many were larger than usual. Here and there were collections of
granules in the shape of cells. A portion of the inner layer, magni
fied from fifty to sixty-five times showed hundreds of opaque,
yellowish-brown, pyriform granules, standing out against the clear
connective substance. These appeared like miniatures of the de
generate nerve-cells, and were arranged with tolerable regularity,
increasing in number and size from the periphery to the white
matter. The vessels of the inner layer formed a thick network, and
were somewhat dilated, atheromatous, and fatty. These changes
were most noticeable in the discoloured portions. In the outer
layer this development of vessels was not to be seen.
In the gray substance of the corpora striata and quadrigemina
advanced fatty degeneration of the nerve-cells was visible.
II. E— was admitted when forty-three years of age, after a
month’s illness, with symptoms of acute general paralysis. In a
fortnight after admission he had an apoplectic-paralytic attack, and
died the following day.
Post-mortem examination forty hours after death.—The heart was
somewhat large and covered with fat. The muscular structure
showed commencing fatty degeneration. There was thickening and
atheroma of the aorta. There was congestion and hypersemia of
most of the viscera. The skull was rather thin. The sac of the
dura mater was completely filled by the brain. In the right half
of the basis cranii, chiefly in the temporal fossa between the dura
mater and arachnoid, was a dark, half-liquid, recent blood extrava
sation, from one half to one and a half line in thickness. Neither
the pia mater nor the arachnoid were perceptibly thickened.
Nowhere were there any pseudo-membranous formations. There
were some spots of atheroma on some of the arteries of the base.
' The whole of the right temporal lobe, especially the inner layer of
the cortical portion, was completely softened and almost gelatinous.
The cortical part, when cut through, displayed an outer layer of a
whitish-gray colour, and an inner very highly reddened. The first
varied little from the normal tint. The inner was of a dark red
colour, and showed, even to the naked eye, a highly developed
network of vessels, and many capillary apoplexies. The microscope
showed in the softened portions of this inner layer extravasated
blood-corpuscles, granular masses, nuclei, softened and fatty nerve
cells, and transition forms.
This was a case of paralytic insanity running an acute course.
The inflammatory character of the disorder is manifest, and it is
�366
Paralytic Insanity and its Organic Nature.
[Oct.,
the inner and not the outer portion of the cortical substance that is
softened and degenerate.
III. The next may be termed a subacute case. N—•, 53 years of
age, was admitted September 16th. Before he was attacked, he had
become religious and somewhat gloomy. In August his speech was
affected, and exalted ideas showed themselves. These were chiefly of
a religious character. In November he had two paralytic attacks,
and died November 24th.
Post-mortem examination thirty-one hours after death.—Skull
small, thickened. Dura mater adherent. The soft meninges thin
and delicate; the arachnoid atrophied and perforated. Here and
there the pia mater was adherent to the brain. The substance of
the cerebrum was soft and somewhat moist. In the posterior lobes,
the inner layer of the cortical portion was slightly reddened. The
change of texture was unmistakable; it was soft and pappy. - In
the temporal lobes and in the anterior part of the frontal lobes, the
inner layer was highly reddened, vascular, and very soft. The corti
cal substance was everywhere of its normal thickness, and presented
no appearance of atrophy.
The microscope showed in the reddened portions of the cortical
substance aggregates of fatty granules, either in the form of nerve
cells or in amorphous collections. In places the cells appeared full
of fat-granules, in others the cell-outline was lost. The network of
vessels was highly developed, the walls in a moderate stite of fatty
degeneration. The viscera of the body presented nothing remark
able. There was atheroma of the ascending aorta and its arch.
In this case, which may be called subacute, there was no marked
atrophy of the convolutions, nor sign of meningitis; but there was
great injection, softening, discoloration, fatty degeneration, and de
struction of the nerve-cells of the inner layer of the cortical sub
stance. There was some amount of alteration in the gray matter of
the optic thalami; very little in that of the corpora striata.
IV. The fourth was a chronic case of a man of great muscular
development, who had indulged in both sexual and alcoholic excesses.
X—, admitted October 1, 1855. His malady had commenced in the
first half of 1854, when 48 years of age. He displayed inarticulate
speech, kleptomania, and loss of memory. The course of the disease
was remitting, without active symptoms. Sometimes there was de
pression. He had hallucinations both of hearing and sight. After
a gradual decline, he died of pneumonia after an apoplectiform attack,
February 18, 1859.
Post-mortem, examination thirty-six hours after death.—The right
lung showed pneumonic infiltration and yellowish softening. The
�1866.]
Clinical Cases.
367
heart was healthy; atheromatous thickening at the commencemout
of the aorta. The other organs presented nothing very remarkable.
The skull was hard and thick. The soft membranes upon the
convexity, especially on the anterior half of the cerebral hemi
spheres, were thickened and adherent to the brain-substance. The
cortical substance was discoloured and soft, the nerve-cells were in a
state of fatty degeneration. There were many granule cells and
others m a state of transformation. The vessels were tolerably free
from fatty change. On the floor of the fourth ventricle were some
amyloid corpuscles.
. In conclusion, we observe that in these four cases the skull, me
ninges, and consistence of the brain differ. All four agree in there
being one constant and identical modification, a parenchymatous de
generation of the inner layer of the cortical substance, which we
must look upon as the essential change in general paralysis. AVe
find it in remitting and chronic cases, in acute and subacute. In
chronic cases we find residua of the active process, pigment-stains,
alterations of the membranes, regressive destruction of the cell
elements ; but without undervaluing the significance of the changes
of the meninges, we must look upon the parenchymatous inflammation
as the essential cause of paralytic insanity.
CLINICAL
CASES.
Remarks on Aphasia, with Cases. By J. Keith Anderson, M.D.
Edin.; President of the Royal Medical Society of Edinburgh.
(Read before the Royal Medical Society of Edinburgh, Mh March, 1866.)
In the following remarks I have endeavoured to combine and
arrange the opinions expressed by recent writers on the loss of
speech which depends on disease of the brain, and which is fre
quently present in cases of paralysis. This cerebral loss of speech
has been designated by the various names of alalia, aphemia,
aphasia, and verbal amnesia. As aphasia is the term generally
employed, I shall make use of it in this paper.
Aphasia is a disease, or a collection of symptoms, which it is
difficult strictly to define; but its leading features may be shortly
stated as follows:—Aphasia is distinguished from all other forms of
�368
Clinical Cases.
[Oct.,
loss of speech by its being due to a cerebral lesion alone, and not to
any paralysis or defect of the organs of voice or of speech. It
differs entirely from the silence of deaf-mutism, insanity, and defec
tive intelligence. The patient has ideas which he in vain labours to
express in words, although his organs of vocalisation and articula
tion are perfect. An inability to express thoughts by writing coin
cides, in most cases, with the loss of speech; and reading and cal
culation are also frequently lost. Loss of the power of articulate
speech is, however, the principal characteristic of aphasia. Tn most
cases the loss of speech is not complete; but there exists such an
impairment of that function as to render the expression of thought
by its means difficult or impossible. The impairment may exist in
all degrees, from that in which there is merely an inability to recol
lect or to cause to be pronounced certain words, to that in which
speech is altogether unintelligible.
In place of attempting a further definition of aphasia, I think it
better to give such a selection of cases as will suffice to convey an
idea of its principal characteristics.
Case I.—In 1863 a young man was brought to Professor Trousseau.
Four years previously he had had a hemiplegic attack of the right side. He
had recovered in a great measure the use of his limbs, but since the attack he
had never said any other words than “ Non,” and “Maman.” When asked
his name, he replied “ Mamanhis age, “ Maman, Non.” To all questions
he replied thus. He had learned to write with his left hand, but could only
write his surname. He was ordered to pronounce it, but he said “ Maman.”
He was asked to write this, but he wrote his surname. Thus this man had
only two words which he could say, and one which he could write; yet he
was able to play well enough at cards and at draughts. He appeared to
read; but as he kept the book for only a few minutes at a time, it was doubt
ful whether or not he could really do so. His intelligence appeared to be
tolerably good.
*
Case II.—A gentleman, ant. 46, had a hemiplegic attack, after which he
entirely lost the power of speech. The only articulate sounds which he
could utter were, “ ee—o.” He varied the tone of these so well, that, with
the aid of expressive gestures, he was able to convey to those about him his
meaning upon ordinary subjects. He perfectly comprehended what was said
to him, and clearly understood what he meant to answer, but was only able
to utter these sounds, “ee—o, ee—o.” He believed, however, that he used
the proper words for the expression of his ideas, and often appeared surprised
and displeased when he was not understood. He sometimes tried to explain
his meaning by writing on a slate; but he generally substituted one word
for another, and almost always erred in spelling what he wrote.f
Case III.—A lady, affected with cancer of the left anterior lobe of the
brain, was frequently unable to recall the names of the most familiar objects,
and was reduced to express them by signs, or to point to them with her
* Trousseau, ‘ Clinique Medicale de l’Hotel-Dieu de Paris,’ 2nd edition, p. 590.
+ Cooke ‘On Nervous Diseases,’ quoted in Forbes Winslow’s ‘ Obscure Diseases
of the Brain and Disorders of the Mind,’ p. 412.
�1866.]
Clinical Cases.
369
finger. When the word which she wanted was pronounced before her, she
recognised it, and could repeat it.
*
Case IV.—A man, set. 40, was attacked with hemiplegia of the right side.
The attack occurred during the night, and, when he was found in the
morning, the only articulate sounds which he uttered were, “ Cou si si,”
“ Cousisi.” For four months he could utter no other syllable, except, in
moments of anger, an oath. When he came under the observation of
M. Trousseau, he was able to write his name with his left hand. He was
asked to pronounce his name; he said, “Cousisi.” He was then asked to
write his name, and he wrote it correctly, “ Paquet.” The next request
was to write his address, and he again wrote “ Paquet.” Perceiving, how
ever, that this was an error, he turned away his head impatiently, saying
“ Cousisi.” He was made to copy the word “ billet,” and he wrote it cor
rectly ; but, being again asked to write his name, he wrote instead, “billet.”
He had good enough intelligence, and was able not only to play at dominoes
and draughts, but even to cheat at those games. He read books; but it was
observed that he read the same thing day after day, and even many times in
the same day.f
Case V.—A man, set. 60, had hemiplegia of the right side. The only
words which he could utter were, “ Ah! fou;” and these he used on every
occasion.J
Case VI.—Dr. Hughlings Jackson records the following case. E. H—,
set. 34, who had generally had good health, and who still looked healthy, was
seized suddenly whilst walking across a room. He staggered, and then fell;
and when put to bed it was found that the right arm and leg were paralysed,
and that he could not speak. For a year he could not speak at all, except
to say “yes” and “no
but about that time he began to talk, if such interjectional expressions could be called talking. He relearned to say “ d
n,
“ d___ n your eyes.” He had been in the habit of swearing, but now can
say nothing else except “ yes,” “ no,” and “ aye.” I think he can now make
signs, but not always correctly. He tried to tell me his age by his fingers,
but was not quite correct. His writing—the penmanship of which, con
sidering that it is written with his left hand, is pretty good—does not really
consist of words at all—scarcely, indeed, of letters. It appears to me to
resemble the word “ damn,” rather suspiciously.§
Case VII.—A boy, set. 18, had an attack of hemiplegia of the right side.
The paralysis rapidly disappeared, but for three weeks he was unable to
speak at all. After that time he was able to speak, but he made constant
mistakes in words. His mistakes in speaking were of this kind :—“I hear
quite wetty,” instead of “quite well.” “I can witter it in my ear” He
called a book a “ totano,” and a chair a “ handkerchief.” When reading, he
called farmer “ farming,” and consistent “ constant.” ||
Case VIII.—Dr. Graves gives the following case :—A farmer in the
County of Wicklow, set. 50, had a paralytic fit in the year 1839; since*
§
* “ A Case of Amnesia,” by Thomas Hun, M.D., ‘ American Journal of Insanity,’
1850-51, p. 358, quoted in ‘Archives Générales de Médecine,’ 1864, vol. i, p. 343.
f Trousseau, ‘ Clinique Médicale,’ p. 581.
J Ibid., p. 592.
§ Hughlings Jackson, ‘ London Hospital Reports,’ vol. i, 1864, p. 452.
|| Ibid., p. 415.
�370
Clinical Cases.
that time he never recovered the use of the affected side, and still labours
under a painful degree of hesitation of speech. He is, however, able to
walk about, take a great deal of active exercise, and superintend the business
of his farm. His memory seems to be tolerably good for all parts of speech
except noun-substantives and proper names; the latter he cannot at all
retain, and this defect is accompanied by the following singular peculiarity:
that he perfectly recollects the initial letter of every substantive or proper
name for which he has occasion in conversation, though he cannot recall to
his memory the word itself. Experience, therefore, has taught him the
utility of having written in manuscript a list of the things he is in the habit
of calling for or speaking about, including the proper names of his children,
servants, and acquaintances ; all these he has arranged alphabetically in a
little pocket dictionary, which he uses as follows:—If he wishes to ask any
thing about a cow, before he commences the sentence he turns to the letter C,
and looks out for the word “ cow,” and keeps his finger and eye fixed on the
word until he has finished the sentence. He can pronounce the word “ cow,”
in its proper place, as long as he has his eye fixed on the written letters;
but the moment he shuts the book it passes out of his memory and cannot
be recalled, although he recollects its initial, and can refer to it again when
necessary. ... He cannot recollect his own name unless he looks out
for it, nor the name of any person of his.acquaintance ; but he is never for a
moment at a loss for the initial which is to guide him in his search for the
word he seeks.
*
Case IX.—M. Bouillaud records an interesting case, in which the patient
was quite unintelligible by reason of a want of words, or.from using words
which did not apply to the objects which he wished to indicate. In writing,
the letters were well formed, but were placed without order, not forming
words, and their meaning could not be guessed at. The patient could
understand what he read, but could not read aloud more than two or three
lines at a time, and even then only by an extreme effort of attention and will.
He could sum up two lines of figures, and, most surprising fact of all, he was
able whilst in this condition to compose and write down a piece of original
music. He was then able to sing the air, without words.j"
Case X.—Dr. Hughlings Jackson mentions the case of an aphasic patient
who could sing “ I’m off to Charleston,” and “ So early in the morning,”
though he could say nothing else, except “ Don’t know,” and “ How d ye
do?” and some devotional phrases.j
Various attempts have been made to determine the situation of
that part of the brain to a lesion of which aphasia is due. I shall
mention the principal of these, with the arguments which have been
adduced in their support.
In 1808, Gall, the founder of phrenology, from observing the
peculiar position and appearance of the eyes in certain persons who
had a marked aptitude for learning and reciting by heart, was in
duced to place the seat of the faculties of the sense of words and
the language of speech in that part of the anterior lobes of the brain
* “ Observations on the Nature and Treatment of Various Diseases,” by Robert
J. Graves, M.D., F.R.S., * Dublin Quarterly Journal of Medical Science,’ vol. xi,
1851, P- 1f ‘ Bulletin de l'Acadé nie Impériale de Médecine,’ 1865, p. 752.
j * London Hospital Reports,’ vol i, 1864, p. 418.
�1866.]
Clinical Cases.
371
which rests on the orbital plates. He regarded as the organ of the
memory of words that part of the brain which rests on the posterior
half of the orbital plates.
Professor Bouillaud, of Paris, in his ‘ Traité de FEncéphalite/ *
and in various memoirs read before the Academy of Medicine,t
brought forward evidence to show that the faculty of articulate lan
guage resides in the anterior lobes of the brain. He has collected
the records of from 75 to 850 cases of cerebral disease, in 116 of
which there was aphasia with a lesion of the anterior lobes only ;
in the others there was no aphasia, and the anterior lobes were found
healthy. Trousseau J has put this localisation to the test by count
ing only those cases with autopsy observed during four years, as
these have all the necessary conditions of exactitude. These cases
are thirty-four in number, and of them eighteen are in favour of
BouiHauPs view, and sixteen against it. The numbers are thus
nearly equal ; but it is worthy of remark that, while all of the cases
favorable to Bouillaud’s doctrine are cases of aphasia, only four of
the contrary cases are of that character. Adding these four to the
eighteen cases favorable to Bouillaud, we have twenty-two cases of
aphasia, in eighteen of which the lesion was in the anterior lobes
only, making Bouillaud right in 82 per cent, of the cases of
aphasia. Various objections have been urged against the twelve
cases which were not aphasic, but it is needless to mention them.§
The next attempt to localise the cerebral faculty of language was
made by M. Marc Dax, of Sommières. He had been struck by the
fact that, in all of the cases of hemiplegia with loss of speech which
came under his notice, the paralysis was invariably on the right side,
indicating a lesion of the left half of the brain. He compiled these
cases in a memoir read before the Medical Congress held at Mont
pellier in 1836,|| in which he related forty cases of loss of speech,
the cerebral lesion being to the left in all. He therefore concluded
that in aphasia the lesion was invariably seated in the left half of
the brain. M. Baillarger has combined the statistics for and
against this doctrine with the following result :—He has collected
155 carefully reported cases of hemiplegia with aphasia, and he finds
that in 145 the hemiplegia was on the right side, and in the remaining
ten on the left.^f
In 1865 the son of M. Dax wrote a paper in which, after sup**
* ‘ Traité de l’Encéphalite,’ Paris, 1825.
f ‘Archives Générales de Médecine,’ 1825, t. viii, p. 25.
‘Bulletin de
l’Académie de Médecine,’ t. iv, p. 282, 1839. Ibid., 1848, t. xiii, p. 699. Ibid.,
1865, t. xxx, p. 613 and p. 735.
J ‘ Bulletin de l’Académie Impériale,’ 1865, p. 668.
§ See ‘ Bulletin de l’Académie Impériale de Médecine,’ 1865, p. 842.
Il “ Lesions de la Moitié gauche de l’Encéphale coïncidant avec l’oubli des signes
de la pensée,” ‘ Gazette Hébdomadaire de Médecine et de Chirurgie,’ p. 259.
V ‘ Bulletin de l’Académie Impériale,’ 1865.
** Ibid., p. 260.
�372
Clinical Cases.
[Oct.,
porting his father’s view, he attempted a still finer localisation. He
assigned the seat of the faculty of articulate language to the external
and anterior part of the left half of the middle lobe of the brain.
This localisation rested on very feeble evidence, and has not been
supported by further observations.
In 1861 M. Broca, of Paris, who had been an opponent of the
principle of cerebral localisations, was converted into its most earnest
advocate, under the following circumstances :—A discussion had
taken place, before the Society of Anthropology, between M. Gratiolet,
who maintained that the principle of cerebral localisations was false,
and M. Auburtin, who affirmed that Bouillaud’s localisation was at
least proved. In this discussion Broca took the side of Gratiolet.
A few days afterwards Broca found one morning, in his wards at the
Bicêtre, a patient in whom he recognised a typical case of loss of
speech from a cerebral cause. I shall give an abridgment of his
account of the case, as it is one of extreme interest, and gives a fair
idea of the condition of one class of aphasic patients.
A man, æt. 55, named Leborgne, attacked with diffuse gangrenous ery
sipelas of all the right lower limb. His history was as follows :—He had
been subject to attacks of epilepsy from his youth upwards, but had been
able to work till he reached the age of thirty. At that time he lost his
speech, and two or three months afterwards was admitted to the Bicêtre,
where he remained for the rest of his life. On his admission there, he pre
sented no symptom whatever, except the loss of speech. He could say
nothing except “ Tan,” and by this name he was known. He understood
whatever was said to him, but replied nothing except “Tan, Tan,” accom
panied with very significant gestures. When he was not understood, he
became excited, and swore, the oath being invariably, “ Sacré nom de Dieu.”
He bore a bad character, but was always considered responsible for his
actions. After he had been ten years in the hospital, a new symptom
supervened. The right arm became gradually weak, and finished by
becoming completely paralysed. Little by little, the paralysis extended to
the right leg, till it also became entirely paralysed, and the patient had to
remain constantly in bed. He reached this condition four years after the
beginning of the paralysis of the arm, and fourteen after the loss of speech.
During the next seven years no fresh symptoms showed themselves, with the
exception of some weakness of sight. At the end of this period he came
under the care of M. Broca.
From the weakness of the patient, Broca was unable to make a thorough
examination of the state of his intellectual powers, but the following details
were ascertained :—He appeared to comprehend all that was said to him, but,
being only able to manifest his ideas by the movements of his left hand, his
meaning could not be well comprehended. Numerical replies were those
which he made best, by opening and closing his fingers. He was asked how
many days he had been ill, and he sometimes replied five days, sometimes six.
He indicated, exactly, how many years he had been at the Bicêtre. When
this question was repeated, he again answered correctly; but the third time
he lost his temper, and emitted the oath already mentioned. He could tell
correctly the time on the clock, and could point out the order of succession
of his different lesions. Frequently, however, questions to which a man of
ordinary intelligence could have replied by a gesture, remained unanswered.
�1866.]
Clinical Cases.
373
Sometimes the meaning of his replies could not be made out, while at other
times the reply, though clear, was wrong. It was therefore evident that his
intellect was profoundly affected ; but he undoubtedly possessed a degree of
intelligence sufficient for the act of speech.
It was clear that in this case there had been a progressive cerebral lesion,
affecting at first only a limited portion of the brain substance, and gradually
extending till it caused the lesions of motility. That this lesion occupied
principally the left half of the brain was evident from the paralysis of the
opposite side of the body.
At the examination of the brain, which was not made till the organ had
been hardened by immersion in spirit for two or three months, a great loss
of substance was detected in the left anterior lobe, consequent on a chronic
softening which had originated there, and had spread to the corpus striatum
of the same side. By a careful analysis of the appearances, Broca satisfied
himself that the beginning of the softening had been most probably in the
posterior part of the third left frontal convolution, or, if not there, in the
second left frontal convolution. As for ten years the sole symptom had been
the loss of speech, he concluded that this was due to the initial lesion ; in
other words, that the loss of speech was caused by the softening of the second
or third left frontal convolution—most probably the latter.
*
Shortly after the’examination of this case, Broca met with another,
in which the loss of speech was the sole symptom, and in which the
intelligence appeared unimpaired. The patient had only three or
four words at his command; but by means of these and of expressive
gestures he managed to make himself perfectly understood. He
could not write from the trembling of his hand, so that it remains
uncertain whether or not he could express ideas by writing. At the
autopsy there was found an old apoplectic cyst occupying the pos
terior parts of the second and third left frontal convolutions, the
brain being otherwise healthy. The second convolution was much
less profoundly altered than the third ; Broca therefore concluded
that to the lesion of the latter convolution the loss of speech was
due.f
A number of subsequent observations have shown that there is a
remarkable connection between aphasia and lesions of this convolu
tion on the left side. So far as I know, no case has been published
in which there was a lesion of this convolution on the left side
without aphasia.
Several cases, however, have been recorded which show that
aphasia may occur independently of disease of this particular con
volution. These I shall briefly mention. M. Charcot had a case in
which there was aphasia with a lesion of the left parietal lobe. The
lesion was prolonged across the fissure of Rolando as far as the
transverse frontal convolution, which was diseased just at the point
where it joins the convolution of Broca. In the latter convolution
* Broca, ‘ Sur le Siège de la Faculté du Langage Articulé, avec deux obser
vations d’Aphémie (perte de la parole),’ Paris, 1861, p. 16.
f Broca, op. cit., p. 32.
VOL. XII.
25
�374
Clinical Cases.
[Oct.,
there was no appearance of disease, with the exception of a few
“compound granular corpuscles,” detected by the microscope
*
This case has induced Broca to modify his opinion, and to admit
that lesions of the left transverse frontal convolution may affect
articulate speech. This convolution is directly continuous with
that of Broca, and many anatomists class them as one. A somewhat
similar case is given by Vulpian.f Several cases of aphasia with a
lesion of the right side of the brain have been recorded. Boyer
mentions a case in which a man received a thrust of an umbrella in
the right eye, penetrating the orbital plate, and lacerating the right
anterior lobe of the brain. The patient instantly lost the power of
speech.J Several instances of aphasia with left hemiplegia are on
record; but such cases are not worth much without post-mortem
details. One case is, however, too important to be omitted, as a
careful autopsy was made. A woman with left hemiplegia was also
aphasic. After death, the right Sylvian artery was found obliterated
by a clot, and the posterior part of the third right frontal convolu
tion highly softened. The left side of the brain was healthy.§
That this convolution on the right side may be injured without
causing aphasia is shown by a case of M. Parrot's. In this case
the speech was perfect, and after death the third right frontal con
volution was found destroyed in all its posterior part. [| Similar
cases have been placed on record by Bernet and Charcot.*1
1
Having thus discussed the various anatomical sites which have
been assigned to the lesion causing aphasia, I shall now review the
different theories which have been proposed as to its nature. And,
first, it will be expedient to consider the nature of language
itself.
Language consists essentially in the establishment of a definite
relation between an idea and a sign by which that idea is manifested.
This sign may be verbal, vocal, graphic, or mimic. Language may
thus be divided into vocal language, written language, Ac. We
may speak, therefore, of the general faculty of language, meaning
thereby all the different modes of expressing thought, and of the
different special faculties of spoken language, written language, &c.
It is held by Bouillaud and others that all these special faculties
**
of language are distinct and independent.*
**
§
* See Trousseau, ‘Clin. Méd.,’ p.600; also ‘ Gazette Hebdomadaire,’ 17 Juillet,
1863 ; Auburtin, ‘ Considérations sur les Localisations Cérébrales,’ Paris, 1863,
p. 59; and Broca, ‘Remarques sur le Siège, le Diagnostique, et la Nature de
l’Aphémie,’ Paris, 1863, p. 6.
+ Trousseau, ‘ Clin. Méd.,’ p. 601.
J Auburtin, op. cit., p. 56.
§ ‘Bulletin de l’Académie Impériale,’ 1865, p. 665.
|| ‘ Gazette Hebdomadaire,’ 31 Juillet, 1863.
Trousseau, ‘Clin. Méd.,’ p. 601.
** ‘Bulletin de l’Académie Impériale, 1865, p. 605.
�1866.]
Clinical Cases.
375
Human speech or articulate language consists in the voluntary
production of a series of articulate sounds associated in words, and
has as its object the representation of a series of ideas corresponding
to these words, and joined together in such a manner as to express a
*
thought
The expression of thought by speech requires—1. The
intellectual possession of a language susceptible of being spoken ;
2. A proper conception of the relation between an idea and the
words which express it; 3. The will of expressing this idea by arti
culate sounds; 4. The possession of means of communication be
tween the will and the muscles concerned in articulation; and, 5.
The power of so co-ordinating the movements of these muscles as to
produce a scries of articulate sounds corresponding to the series of
ideas. Speech is, therefore, accomplished by the employment of
three distinct kinds of psychical force:—1. Of intellectual force, in
the formation of a thought capable of being expressed in words; 2.
Of voluntary force, in the determination to utter these words; and,
3. Of motor force, in the realisation of the movements necessary to
the articulation of the words.f All of these forces, though necessary
to the expression of thought by speech, are not necessary to the act
of speech itself. In moments of emotion, the first and second may
be dispensed with, and an oath or an ejaculation may be uttered
without any exercise of the intellect or the will.
It is probable that a number of cerebral co-ordinations are also
necessary to the proper expression of thought by speech. In ordei
that speech may be intelligent and fluent, the ideas and the words
require to be arranged in a certain order. In health the words may
be arranged properly by an exercise of the intellect and the will by
the speaker thinking over the words which he is about to use. In
such a case the utterance of words is slow and deliberate, as the
speaker requires to make a double effort of his attention in finding
first the idea, and then the words by which most clearly or elegantly
to express it. Where the speaker is engaged in ordinary conversa
tion, or where he is deeply interested and excited with the subject
on which he is talking, his words come quickly, and without his
bestowing any attention on them. In such cases speech woidd
appear to be automatic. To give a better illustration -An orator
is called on suddenly to speak on a subject on which he has not
prepared any remarks. On first rising he speaks slowly, and hesi
tates as to the words to be used. His ideas are confused, and he
has a difficulty in expressing himself in appropriate language. Gra
dually, as he warms with his subject, he finds his words come more
and more readily, and his ideas arrange themselves in more regular
order, till at length, in the full swing of his oration. Ins ideas and
his words appear to come spontaneously. There is here, 1 believe,
* See Parchappe, ‘ Bulletin de l’Academie Imperiale, 1865, p. 679.
f Ibid., p. 681.
�n T» p
oib
Clinical Cases.
[Od.7
an example of cerebral co-ordination—a co-ordination not merely of
the actions necessary to the furnishing and proper arrangement of
words, but also a co-ordination of those actions necessary for the
formation and arrangement of ideas.
For the consideration of aphasia, it will be convenient to adopt a
simple division of articulate language suggested by Bouillaud. He
divides articulate language into two distinct elements, viz., 1st,
the faculty of creating or of learning words as signs of our ideas,
and of preserving the recollection of them, which he calls interior'
speech; and, 2nd, the faculty of pronouncing, of articulating these
same words, which he calls exterior speech. Exterior speech is thus
only the expression of interior speech.
*
The simplest and plainest division of aphasia is that of Baillarger.f
lie divides it into simple aphasia, in which there is merely an in
ability to make use of words as signs of our ideas—and perversion of
speech, in which words are used to represent ideas with which they
have no connection in ordinary language. Although in actual
practice these two conditions are frequently found combined, it is
expedient to consider them separately.
To begin with the consideration of simple aphasia. At the first
glance, it is evident that in this division there are two chief groups.
In the first, there is loss of both speech and writing; in the second,
there is loss of speech only. By some ■writers these have been
designated respectively amnesic and ataxic aphasia.J
In amnesic aphasia, or that form in which there is loss of both
speech and writing, the easiest hypothesis is to suppose that there is
a loss of the memory of words—or, as it has been called, verbal
amnesia. Did the patient possess the memory of words, it is natural
to suppose that he would be able to express himself by writing ; but
such is not the case. Some writers have supposed that there are
special cerebral co-ordinating centres for speech and writing, and
that both of these have been injured to such an extent as to render
both speech and writing impossible, by reason of the co-ordinated
movements necessary to each being inefficiently performed. It
appears to me that such an explanation is very far-fetched, and
quite unnecessary, as the theory of forgetfulness of words, though
perhaps not altogether a satisfactory explanation of certain cases, is
sufficiently plausible. Trousseau § has argued that a person cannot
think without words ; but the statement of Professor Lordat, of
Montpellier, who was himself aphasic, is conclusive to the contrary.
* ‘ Bulletin de l’Académie Impériale, 1865, p. 618.
f Ibid., p. 818.
X See ‘ Edin. Med. Journal,’ March,1866: “Case illustrating the supposed con
nection of Aphasia (loss of the cerebral faculty of speech) with right Hemiplegia
and Lesion of the external left frontal Convolution of the Brain,” by William
R. Sanders, M.D., F.R.C.P.
§ ‘Clinique Médicale,’ p. 624.
�1866.]
Clinical Cases.
377
Lordat, after Iris recovery, stated that he was in the habit of com
posing lectures in his own mind, without being able to put a single
idea into words.
*
In the second or ataxic group of simple aphasia—viz., that class
in which the patient, though unable to speak properly, has still the
power to express his thoughts by writing—the explanation is more
difficult. And, first, in examining and considering such cases, it is
necessary to distinguish clearly between the mere mechanical act of
writing and the expression of thought by written language. It is
possible for some patients belonging to that class in which I assume
there is mere forgetfulness of words, to write clearly and distinctly
certain words which they possess, or which they have just heard
repeated, or which they have copied; but this is merely the art of
writing—it is not the expression of thought by that means. In the
group of cases of which I am now speaking, the patients, though
unable to express themselves by articulate language, remain perfectly
capable of expressing their ideas by writing.t In such cases it is
clear that the patients have not lost the memory of words. What,
then, is the particular lesion in such cases ? Several hypotheses
have been brought forward. Trousseau]: maintains that they re
semble the first class in their being due to a loss of memory. This
is a loss of the memory, not of words, but of the means of co-ordi
nating the movements necessary for articulate speech: in other
words, the patients have forgotten how to speak.
“The infant speaks,” says M. Trousseau, “only because it has
learned to speak; and one can comprehend that it can forget what it
has learned, and that aphasia can be the consequence of the loss of
the memory of the complicated movements necessary for the articu
lation of words.
Broca, who also holds this view, thinks that
the successive degrees of perfection which we observe in the speech
of children are to be explained by the successive degrees of per
fection of a particular kind of memory, which is not the memory of
words, but that of the movements necessary to the articulation of
words ; and that it is the latter kind of memory which is lost in this
form of aphasia.
Now, the movements necessary to the articulation of words,
though started by the will, are only incompletely directed by it.
When we wish to utter a certain word, or to pronounce it in a cer
tain manner, we do not consider how this is to be done. We only
look to the end to be attained; we do not trouble ourselves as to*
§
* ‘ Clinique Médicale,’ p. 621 ; also Lordat, ‘ Analyse de la Parole pour servir à
Ja Théorie de divers cas d’Alalie et de Paralalie,’ Montpellier, 1843.
+ An excellent example of this is given by Trousseau at page 615 of bis
‘Clinique Médicale.’
X ‘Clinique Médicale,’ p. 625.
§ Quoted by Baillarger.
See ‘ Bulletin de l’Academie Impériale,' 1865,
p. 819.
�378
Clinical Cases.
[Oct.,
the means. We do not know all the different movements required
for the articulation of words ; how, then, can we remember them ?
How can we recollect acts of which we have not been conscious ?
If we adopt this explanation of loss of speech, we may as well apply
it to all cases of partial or complete palsy in which the muscles
are in a normal condition. I therefore consider this theory of for
getfulness of co-ordinated movements as more than doubtful.
Another explanation is that of M. Bouillaud. Bouillaud believes,
and since 1825 has laboured to make others believe, that some
where in the anterior lobes of the brain there is placed a faculty
which presides directly over the co-ordinated movements necessary
for speech. He designates the seat of this faculty, the legislative or
*
co-ordinating organ of speech. He holds that, while some cases of
aphasia may be due to a loss of memory of words, the majority are
owing to a lesion of that part of the brain in which is seated this
co-ordinating organ of speech. This theory is a very tempting one,
inasmuch as it explains the phenomena of ataxic aphasia in an ex
tremely simple manner. It rests on the fact that, in complicated
voluntary movements, the will is only the point of departure. And,
since the most complex muscular co-ordinations can be accomplished
without being submitted to our examination or combined by our
reason, it is natural to explain this by supposing the existence of co
ordinating centres for these movements. But, granting the exist
ence of a separate co-ordinating centre for the movements of speech,
why place it in the brain ? The doctrine that the gray matter of
the cerebral hemispheres is the seat of intellectual power is univer
sally admitted. If, then, we accept the theory that a portion of
this gray matter is subservient to a purpose which cannot be con
sidered as in the least degree intellectual, we run counter to all our
former ideas of cerebral physiology. Is it not much more probable
that the co-ordinating centre of speech is seated in the medulla ob
longata ? Are not the olivary bodies much more likely, as supposed
by Schroeder Van der Kolk, to be the co-ordinating centres of
speech, than the gray matter of the anterior lobes of the brain ? M.
Bouillaud, it is true, has made a suggestion that this principle may
reside in the white substance of the anterior lobes, and that the
gray matter immediately in contact with it may be the seat of the
intellectual element of interior speech.t In other words, M. Bouil
laud believes that the white or conducting part of the brain substance
can regulate muscular co-ordinations. This theory is quite opposed
to modern physiology. Again, if there is a cerebral co-ordinating
centre for speech, does it reside on one or both sides of the brain ?
—in other words, is it single or double ? If single, how does it
* ‘ Bulletin de l’/Vcadémie Impériale,’ 30 Avril et 15 Mai, 1865, p. 617.
t ‘Archives Generales de Médecine/ 1825, t. viii -, quoted in Bulletin de
l'Académie Impériale/ 1865, p. 618, note.
�1866.]
Clinical Cases.
379
govern the muscles of both sides ? In those cases in which motor
organs are under the special control of certain parts of the ence
phalon, the muscles of each side receive their nervous supply from
separate sides of the encephalon; but here we should have an example
of a cerebral centre seated on one side of the body, governing mus
cular motions on both sides. On the other hand, if this cerebral
centre of Bouillaud is double, how is it that the majority of cases of
aphasia are caused by a lesion of one side of the brain only ? Were
the organ a double one, we should expect that its destruction on one
side alone would interfere only with the muscular motions of a single
side, leaving those of the other side unimpeded. In such a case
speech would not be greatly interfered with, for patients with parao
*f
lysis
one side of the tongue talk quite intelligibly.
The original authorship of the next theory I cannot ascertain; it
is upheld in France by M. Parchappe, and in this country by Dr.
Sanders. This theory maintains that, in those aphasic patients who
can write, the motor impulse to speech cannot be properly conveyed
to the articulating muscles, or to the co-ordinating centre of articu
lation, by reason of some injury of the voluntary initiating or con
necting apparatus. Of course in aphasia, which consists in a loss of
speech from cerebral causes, the lesion must be somewhere in the
brain. Supposing the memory of words and other faculties neces
sary to speech to reside in the anterior lobes, a lesion of the white
matter of those lobes might separate and cut them off from the
muscles of articulation. Thus the individual might have the
memory of words intact, and have all the inclination to pronounce
them, but, by reason of the interruption of the nervous current, he
might be unable to cause these muscles to act. This theory some
what resembles that of Bouillaud, but differs from the latter in this—
that it does away with the difficulty of establishing a cerebral co
ordinating centre for articulation. The co-ordinating centre might
be in the medulla oblongata or elsewhere, and the voluntary impulse
might be conveyed thither from the anterior lobes of the brain.
This theory may also suit those cases in which words are pronounced,
but in an imperfect manner. Supposing the conducting apparatus
to be in bad working order, the impressions conveyed by it might
be so altered and distorted as to give rise to altered and distorted
muscular motions.
I come now to the last theory or suggestion. It has occurred to
me, while considering the various phenomena of aphasia, that possibly
these, or some of these, may be due to a deficiency or impairment of
those cerebral co-ordinations, of which, in a previous part of this
paper, I have stated the probability. It is unnecessary here to
repeat the arguments which were brought forward to show that in
thought and in speech cerebral co-ordinations are necessary. If the
concurrence of many different parts of the brain is essential to the
�380
Clinical Cases.
[Oct.,
act of speech—an opinion held by many psychologists—then many
different lesions might give rise to aphasia by cutting off the com
munication between these different parts, and so preventing the
proper combination of their actions. In the present state of our
knowledge of cerebral actions, very little can be said with regard to
these co-ordinations; but it is conceivable that an interruption of
them, or of some of them, might give rise to a difficulty or an im
possibility of pronouncing, or of properly arranging, the series of
articulate sounds which constitutes speech. This theory would
allow greater latitude to the position of the lesion than Broca’s views
assert.
Having now mentioned the various theories with regard to the
simple aphasia, or that form in which there is merely a loss or im
pairment of speech, I come to the other division of aphasia—viz.,
that form in which there is perversion of speech, and words are used
to express ideas with which they have no connection in ordinary
language.
This form admits of division into two classes. In the one, the
patients believe themselves to be talking correctly ; in the other, they
are conscious of their errors of language as soon as the words are
uttered.
In that class in which the patient utters words totally at variance
with his meaning, without being conscious of the error, it is evident
that he has lost the proper sense of the relation of words to ideas.
The memory of words does not seem, in many such cases at least,
to be greatly deficient; it is the memory of their meaning that has
failed. There is, however, more than this. A false relation has
taken the place of the proper one. When a patient calls for his
boots, meaning his razor, and is astonished that his boots are brought
to him, his sense of the settled relation of words to things must have
become so perverted that he imagines words to express meanings
quite different from those assigned to them.
In the other class, or that in which the patient, when he gives
wrong names to objects, is immediately conscious of his error, it
would appear that the proper conception of the relation of words to
ideas or things, though impaired, is not altogether lost. The two
classes of patients may be compared to persons of different degrees
of education. The one person spells altogether badly, and is uncon
scious of his errors. The other also spells badly; but as soon as he
sees the words written down, he perceives that something is wrong,
and rectifies his spelling immediately. In like manner, the patient
in whom the relation of words to objects is lost in the minor degree,
as soon as he hears himself pronounce a word becomes aware that it
is the wrong one. The bad spelling is detected by the eye, the
wrong word by the ear.
Having now discussed the different classes into which I have
�1866.]
Clinical Cases.
381
divided aphasia, I shall speak shortly of those patients who, having
only a very few words at their command, are still enabled to swear
or utter ejaculations when under the influence of passion. The ex
planation of such cases appears to me very simple. Oaths are, under
such circumstances, emotional and automatic, being uttered without
the interference of the intellect or the will. They partake of the
nature of reflex phenomena, being excited by stimuli from without,
and being uttered without the consent of the individual.
In conclusion, I have only to make a single remark on the intellec
tual condition of aphasics. In all of the cases of aphasia which I have
seen, the intellect was decidedly weakened, but certainly not to such
an extent that the abolition of speech could have been due to an
abolition of ideas. I believe, therefore, that the loss of intelligence
does not necessarily enter into the definition of aphasia, as it is pro
bably due to the extensive softening of the cerebral gray matter
which is found in most confirmed cases of the affection.
II. Cam illustrating the Diagnosis of Paralytic Insanity,
with Demarks (partly translated from the French).
By G.
Mackenzie Bacon, M.D., Assistant Medical Officer of the
Cambridgeshire Lunatic Asylum, Fulbourne.
The ordinary features of so-called “ general paralysis” are so
familiar to those who treat the insane in numbers, that they are apt
to regard its diagnosis as a transparent and very easy matter. It
happens, however, sometimes that cases arise which offer all the
prominent early signs of the disease, and yet do not go on to a fatal
termination. In such instances the mental symptoms are not merely
arrested for a time, but the patient to all appearance recovers. It
is not unimportant to bear this fact in mind for other than patholo
gical reasons, as a too positive prognosis might recoil unpleasantly
on the giver were it refuted by an unexpected recovery, lhere is,
probably, no disease of the brain about which we should be more
ready to give a positive opinion than general paralysis, for its symptoms
are as a rule, easily recognised, and its course is so uniform ; yet
this very fact is liable to produce a false security, and so sometimes
to favour error. The most distinctive signs of this disease are allowed
to be the grand or optimist illusions and incoherence which precede
any actual palsy ; and, knowing that these symptoms are most fre
quently followed by certain destructive changes m the brain, we are
�3S2
Clinical Cases.
[Oct,
apt to assume that the former must always terminate in the latter.
This, however, is not an infallible rule; but one seldom hears of
the exceptions. The following cases occur to me as illustrating this
view of the subject: they have no special features of interest except
as representing the minority, and for that reason are the more
instructive.
Case 1.—John S—, set. 40, a tailor, was admitted into the Cambridge
shire Asylum May 1st, 1863.
This was stated to be his first attack, and of only a fortnight’s dura
tion. His mother and brother died insane. When admitted, he was de
scribed as “ a fine, well-made man, suffering from much excitement, very
talkative, and with excessive optimism, without signs of paralysis. Talks of
being the cleverest man in the world, possessing great wealth, great
strength, &c. AU his remarks consist of exaggerations . Health not much
impaired.” He was, during the first few weeks, very violent and excited at
times, and anxious to display the extraordinary powers he thought he
possessed; but by the end of June he was more quiet, and worked at his
trade, at which he was very skilful. At that time, however, he talked with
the greatest amount of optimism, as to the quality of his work and the
amount he could do, &c.
He improved gradually, becoming more quiet and steady in his habits,
and not showing the same caprices of conduct; but he continued to talk
in the same exaggerated style—not a mere boasting on his part, but a genuine
belief in his strength and abilities. After a period of probation, he was
discharged recovered in November 1863. He has since earned his living as
a tailor ; but his conduct has been marked by extravagances and oddities
difficult to reconcile with a sound state of mind. He is now (June, 1866)
in good health, living at large, and much the same in mind.
Case 2.—Edward M—, a?t. 49, married, a wheelwright by trade, was
admitted into the Cambridgeshire Asylum August 18th, 1864.
There was some hereditary taint, and a previous attack was said to have
occurred. An outbreak of violence led to his being sent away from home.
The certificate mentioned “ extreme restlessness and excitability. Incohe
rence, and threatened violence to those about him. Destruction of house
hold furniture, cruelty to his children, robbing his neighbours of their poultry
and rabbits, &c.”
At first he showed no signs of insanity, but after a month he became in
coherent and talkative. He had then unequal pupils, tremor of the facial
muscles, and talked in an incoherent and exaggerated style. He afterwards
got destructive, tore up the bed-clothes, and collected rubbish of all sorts, such
as pieces of wood, string, glass, rags, and useless articles ; he also said he was
well off, and offered to write cheques for large sums of money. He was
always repeating that ffie felt very strong and never was better in his life,
and would write incoherent letters every day. Sometimes he was very
abusive, and after swearing and declaiming about his ill usage, would begin to
cry, and then give way to some fresh emotional disturbance. About April,
1865, he improved, ceased to be mischievous, and employed himself steadily.
In July he was discharged, on the application of his wife, after a month’s
probation, and has not reurned to the asylum.
In the first case the exaggerated delusions were very remarkable,
and would have led many people to anticipate general paralysis; vet,
�1866.]
Clinical Cases.
383
though these remained in a greater or less degree, the patient im
proved in other respects, and sufficient time has now elapsed—setting
other reasons aside—to prove that the case was not what it seemed
likely to be at first.
The second case, perhaps, more nearly resembled ordinary general
paralysis; the partial dementia, destructiveness, tremor, and delu
sions as to wealth, &c., all pointing to such a conclusion. The
man has, however, since his discharge, returned to his business and
continued well. It is also curious that he had, according to his wife,
shown similar symptoms two years previously, and quite recovered
from them. It must be admitted that persistent optimism is hardly
known in any other disease than general paralysis, which is neces
sarily fatal; and this makes the anomalous cases the more striking.
In connection with this subject, I have read with interest an
article lately published in the f Annales Medico-Psychologiques/ by
Dr. Munoz, who has had charge of the asylum at Cuba. Familiar
with general paralysis as seen in this country, he mentions a class of
cases which have occurred to him, in which, though all the early
signs of this disease have been developed, the subsequent history
has belied his unfavorable anticipations. His experiences on this
point are valuable and clearly recorded. In Cuba, the differences
in race, climate, and in the conditions of life are so considerable as
to make a comparison of general paralysis as observed there and in
Europe a matter of some interest, and the author’s conclusions as
to the relative frequency with which the mixed races in the island
are attacked are rather striking.
I subjoin a translation of Dr. Munoz’s paper, which tells its own
tale too ably to require any further introduction:—
“ The population of the island of Cuba is composed of a mixture
of several races—of native and European whites, both of whom are
for the most part Spaniards; of African negroes, of native blacks
and creoles; and, lastly, of Chinese, who were introduced into the
country some fifteen years ago in great numbers, in order to stimu
late colonisation. This circumstance, as may be supposed, has given
me the opportunity to make a comparative study of insanity among
all these different people. I have thus been enabled to study the.
forms under which insanity shows itself among the negroes, the
Chinese, and the native whites; the relative frequency of these
forms, their course, termination, and variation.
“ For the present I will confine myself to an explanation of those
facts relating to general paralysis that I have observed in Cuba.
The population of Cuba is about 1,200,000, and this total is thus
composed—viz., 700,000 negroes and creoles (of whom 400,000 are
natives), 300,000 native whites, 150,000 European whites (mostly
Spaniards), and 50,000 Chinese. Among the natives (including
whites, negroes, and creoles) the proportion of the sexes is nearly
�384
Clinical Cases.
[Oct.,
equal. Among the negroes imported from Africa there is a dispro
portion between the sexes, the women being to the men as one to
two; but among the whites who come and settle in the country the
disproportion is much more considerable, the men being to the
women at least as four to one. As regards the Chinese, they are all
of the male sex. From these facts it results, of course, that the
women are much less numerous than the men in the whole popula
tion of the island. The numbers in the .asylum at Havana (the only
one for the island) were, on January 1st, 1865, as follows
men
334, women 136—total 470. Of the men, 120 were native white
*
94 foreign whites (Spaniards and Canadians for the most part), 96
negroes and creoles, and 24 were Chinese, while of the negroes 24
were Africans. Of the women, 46 were whites (natives mostly), and
90 were negresses, of whom 34 came from Africa. The enormous
difference existing between the number of male and female insane is
explained, not only by the disproportion existing between the two
seAes m the general population of the island, but also by the custom
which obtains in the country of keeping insane women at home,
the idea of placing such patients in a public hospital being opposed
to the general feeling. It is also to be remarked—and this is still
more curious—that the number of the white population insane is
nearly one fourth of the whole larger than that of the black, the
negro population of the island being nearly twice as large as that of
the white; for the insane negroes are to the sane as 1 to 3500,
whilst the insane whites are to the sane in the proportion of 1 in
“ From these facts we may conclude that insanity is twice as com
mon among the whites as it is among the blacks.
Having established these facts, I shall now give the results of my
observations relative to the frequency of general paralysis among
these different people.
°
“In order to thoroughly understand the conclusions that I shall
draw from this paper, I must remind the reader of the opinion held
by some distinguished authors as to the intimate connection existin'
*
between the ordinary commencement of general paralysis and
ambitious mania.
I believe also that the majority of alienists now hold this
opinion—viz., that general paralysis usually commences with marked
exaltation of the faculties, delirium of a grand or ambitious charac
ter, embarrassed speech, tremor of the lips, inequality of the
pupils, Ac. Ibis fact being established, we must admit that in
the case of a patient in whom these symptoms are well marked,
every physician must give an unfavorable prognosis, suspecting
the probable existence of commencing general paralysis. We
shall see, however, that this opinion mav sometimes be quite
wrong.
“
�1866.]
Clinical Cases.
385
“ This is what happened to me at an early period of my residence
in Havana, and further experience at the asylum of which I have had
charge has enabled me to confirm it. In June, 1862, I was sum
moned to a rich proprietor of Havana, a native of the country, and
about forty-eight years of age, who was attacked, for the first time,
with ambitious mania, hesitating speech, tremor of the lips, inequality
of the pupils, and weakness of the legs. The disease had existed for
more than a month, and did not seem in any way influenced by the
different modes of treatment already adopted. In view of the symp
toms presented by the patient, my prognosis was entirely unfavor
able; and the friends, alarmed thereat, had recourse to another
physician. I cannot say what treatment was adopted in this case;
but of this I am sure, that in September, 1864,1 saw this individual
in a most satisfactory state. This is not the only case of this sort
that I can mention, for in the same year (1863) I saw two other
patients also attacked with ambitious mania, combined with some
symptoms of general paralysis; the one aged thirty-eight and the
other forty-two, both natives of Cuba, and neither having had a
previous attack. I made the same prognosis as in the preceding
case; and, to my great astonishment, I saw the former of these
patients recover at the end of about three months, and this satisfac
tory state of health has continued; indeed, I saw him about eight
months ago perfectly well. As regards the other patient, who was
placed, like the former, under private care, his state improved at the
end of four months' confinement; but the friends, whose means were
rather restricted, determined to place him in the public asylum. He
remained in the asylum about two months and a half, and, upon
being thought, well, was discharged. Eight months after, a second
attack, of the same nature as the former one, came on, and he was
brought back to the asylum. The simple dementia became confirmed
in a short time; but no symptom of general paralysis showed itself
until April, 1864, at which date the patient was attacked by internal
inflammation, which carried him off.
“ The autopsy showed us decided injection of the cerebral mass,
a certain amount of serous effusion, and slight adhesion of the mem
branes. During the years 1863-64, I registered at the asylum
eight cases, on the male side, of ambitious mania, accompanied by
signs of paralysis, among the native whites. Three of these patients,
admitted in 1863, left in good health after four or five months
residence in the asylum. They have not returned during 1864 and
the first eight months of 1865. Of the five other patients, one died
of acute delirium, which came on in the course of a paroxysm of
mania; three remained in the hospital, although improved; the
fifth fell into paralytic dementia, and, at the time of my leaving the
island, was almost dying, with diarrhoea, extreme wasting, sloughing
sores on the sacrum and thighs, Ac- This is the only well-developed
�386
Clinical Cases.
[Oct.,
case of paralytic dementia that has come under my observation,
either in or out of the asylum, among the native whites, since I have
practised in the island. I should mention here that these indi
viduals are generally very sober, their only drink consisting of
water, sometimes mixed with a little red wine, and that taken with
the meals. In point of excesses, the only ones they indulge in are
of a venereal nature—the climate predisposing to an increased ani
mal temperature, which is a frequent cause of excitement of the
genital organs. The repeated exposure to the sun (to which so
many are liable in the island) may also have a certain influence in
determining the attacks of mania, this form of insanity being that
most commonly observed amongst those subjects; but I have met
with several cases of general paralysis among the white natives of
Europe and North America. Thus, I had the care of, at the asy
lum, two Frenchmen, who died in a state of paralytic dementia: the
first of these was only six months in the hospital, the second suc
cumbed after a year’s residence, and both had, from the first, wellmarked ambitious delirium, hesitating speech, tremor of the lips, &c.
I have also seen two North Americans die at the asylum from
general paralysis, the disease being prolonged for eight or ten months.
These patients had, from the commencement of the disease, excessive
excitement, ambitious delirium, and embarrassed speech. An Italian,
fifty years of age, entered the asylum attacked with paralytic dementia.
He had maniacal excitement, with incoherence and embarrassment
of speech, tremor of the lips and also of the limbs, unsteady gait,
unequal pupils, ambitious delirium, and excessive emaciation. He
had had, at first, an attack of cerebral congestion. At the end of
five weeks’ residence in the asylum he became more calm, and boils
then appeared on different parts of his body, on the back, the left
arm and leg. These had the character of true carbuncles, and in
creased to the size of a five-franc piece. They ended in a free sup
puration; and, as this proceeded, the symptoms, at first undecided,
progressive^ diminished. The treatment followed m this case con
sisted in the use of repeated purgatives (aloetic pills), lemonade
alternating with sarsaparilla, and, generally, warm baths during the
paroxysm of excitement. The patient, after the fourth month of his
residence, was evidently better; he had gained flesh, slept well,
was more reasonable, and asked to see his son, the only relation he
had in the country. I do not know what was the fate of this patient,
having left him in this state on my departure from Havana. Among
the native Spaniards that we received at the asylum during three
years, I have noted about ten who were attacked with paralytic de
mentia; most of them presented at the commencement maniacal
excitement, and in all of them, without exception, I have found, from
the beginning, embarrassed speech and extreme ambitious delirium.
“ Among the white women I have only had two cases of paralytic
�1866.]
Clinical Cases.
387
dementia, and both these women were natives of the Canary Islands.
The disease had commenced, in both cases, with an attack of am
bitious mania and embarrassed speech. One of these women died
at the end of ten months' residence in the asylum; the other was
still there when I left Havana. I have also observed general
paralysis among negroes, but much less frequently than among
the native whites of the north. In a considerable number of
coloured people that I have had to treat during my three years'
residence at the Havana asylum, numbering about 300, I have noted
nine cases of general paralysis—three men and six women. I
should mention that these people are generally less sober than the
whites; the drink that they generally take is tafia (spirit from the
sugar-cane). On the other hand, they take little food, and commit
excesses of all sorts. Paralytic dementia among the negroes presents
constantly the same symptoms, progress, and termination as among
the whites. In the three well-marked cases of this affection I have
noticed among coloured men, there was from the first maniacal excite
ment, ambitious delirium, tremor of the lips, and embarrassed speech.
The disease had lasted in one case eleven months, in another thirteen,
and in another fifteen. If the sphincters have been paralysed early,
the disease has always terminated with diarrhoea, marasmus, and
gangrenous sores. In these three patients there was muscular con
traction, the neck being bent forward, with permanent flexure of the
legs on the thighs, and of the thighs on the pelvis. The autopsy
revealed, in these three subjects, the same appearances as those
mentioned by authors in ordinary paralytic dementia—viz., softening
of the cortical layer of the brain, most distinct in the anterior lobes ;
adhesion of the membranes, abundant effusion of serum, granular
state of the gray substance, and visible diminution in volume of the cere
bral mass, &c. I should remark here, that among the native negroes,
as well as among the native whites, I have observed ambitious mania,
combined with tremor of the lips and embarrassed ,speech, and it
has always terminated in paralytic dementia. I could cite two
examples of this sort which occurred to me at the Havana asylum.
It is common to find among the negroes grand delusions, not com
bined with excitement nor depression of the faculties, and without
incoherence, preserving for years the same character, and terminating
nevertheless by a weakness of the intellectual faculties. There is
often to be observed in these cases a little lassitude in the movements,
in great contrast to the natural excitement of character, which offers
a certain analogy to that of epileptics. The patient becomes more
violent, sullen, and sometimes ill-disposed. According to the figures
which I have given above, it seems that, in the black race, contrary
to what is observed in the white population, dementia is more
common among women than men. I should also remark that, of the
nine negro patients that I have noted, two thirds were natives of
�388
Clinical Cases.
[Oct.,
Africa. From this observation, we may infer that among negroes, as
among the whites, general paralysis is in Cuba much less frequent
than among foreigners. I have observed in the case of two para
lytic negresses, congestive phenomena, unusual at the commencement
as well as in the course of the disease ; a profound stupor, swelling
and redness of the face, full and frequent pulse, and absolute
mutism. These phenomena lasted some days, and then disappeared,
to return later ; but the symptoms of paralysis became more and
more marked at the end of each attack. This form of congestion
and paralysis, which is much more common in women, has been
pointed out by M. Baillarger in his clinical lectures at the Sal
pêtrière. Of six cases of ambitious mania accompanied, from the
beginning, by embarrassed speech, that I have observed in coloured
people, two thirds were of the male sex. This fact seems to me the
more curious, as I have proved the contrary to be the case in para
lytic dementia. I think I can, for the present, make from this short
paper, as far as regards paralytic dementia, the following con
clusions :—
“ 1. That paralytic dementia is, in a general way, rare in the island
of Cuba.
“2. That almost all the cases of this nature observed in this
country occur in foreign whites, and in a much smaller proportion
than that which has appeared to be the case in temperate climates.
“ 3. That among the natives this disease is rare.
“ 4. That we often find cases of ambitious mania which do not
terminate in general paralysis.
“ 5. That paralytic dementia is more common among the negroes
than the native whites, although it is more rare among them than
it is with whites of temperate countries.
“ 6. That in the black race paralytic dementia is, contrary to what
is observed in the white race, more frequent among women than
men ; while ambitious mania not followed by general paralysis is
more frequent among the latter than the former.”
�1866.]
389
PART IL—REVIEWS.
1. On Consanguineous Marriages. By Arthur Mitchell, M.D.,
Deputy-Commissioner in Lunacy for Scotland. (‘ Edinburgh
Medical Journal/ March, April, June, 1865.)
2. Consanguinity in Marriage.
By William Adam.
(fThe
Fortnightly Review/ Nov. 1st and 15th, 1865.)
3. Du Danger des Manages consanguins sous le rapport sanitaire.
Par Francis Devay. Deuxième edition, refondue et aug
mentée. Paris, 1862.
4. Etude sur les Manages consanguins et sur les Croisements dans
les Règnes Animal et Végétal.
Par Antony Ciiippault.
Paris, 1863.
5. Sur la Consanguinité. Par Jules Falret. (f Archives Géné
rales de Médecine/ Février, Mars, Avril, 1865.)
One might fairly suppose that a question so commonly arising
and so often discussed as the influence of consanguine marriages
would have been definitely settled by this time. Settled, indeed, it has
been by the public long since, that such marriages are injurious; but
the insufficiency of the grounds on which this opinion has been
based is shown by the frequent appearance of opponents to this
dogma. The question seems to have lost none of its attractions by
age, and, indeed, the heretical side has displayed of late a fresh
vitality, stimulated, perhaps, by the favour that scepticism on any
subject has met with in recent times. All must admit that the in
fluence of such marriages on the offspring has a grave social impor
tance, but it is very doubtful whether, if it could be absolutely
demonstrated to be as injurious as is alleged, the world would pay
much heed to the conclusion. The large majority of marriages is
determined merely by personal attraction or passion, neither pru
dence nor a regard for future consequences entering into the ques
tion at all, and possibly the moral results are as fortunate as if
experience and age had a voice in the matter. In a few cases, and
those among the rich or titled, as a rule, the interests of wealth and
property are the main considerations ; but probably the simple
record that occurs in the sixth chapter of Genesis, “ that the sons of
vol. xii.
26
�390
Reviews.
[Oct.,
God saw the daughters of men that they were fair, and they took
them wives of all which they chose/" represents in this day, as it
did six thousand years ago, at once the most natural and the truest
explanation.
If it were needful to point out how little influence the most ordi
nary considerations of prudence have when weighed against inclina
tion, even amongst the educated classes, it would suffice to refer to
the statistics, either of phthisis or insanity, to show, that the most
positive proof of the hereditary nature of these diseases, does not
deter the heirs of these affections from transmitting tlie seeds of
scrofula, madness, or many other evils, to not only one but any
number of future generations. Be this, however, as it may, the
problem of the influence of consanguine marriages is one which
ought to be determined in the interests of science, and there are
many, happily, who are content to work it out for its own sake,
leaving the results as a legacy by which future generations may
learn to benefit. One cannot but feel some surprise that the
physiological aspects of matrimony are at the present time so en
tirely ignored, for it is extremely rare that anything save the imme
diate welfare of the contracting parties is taken into consideration;
yet it is abundantly clear that the fate of the probable offspring is
seriously involved. M. Devay, fully alive to the importance of this
subject, commences his book by the following remarks:—
“ There exists an almost universal blindness as regards what may
be called the organic constitution of the family—that is to say, the
health of future generations. Great efforts are made to transmit to
them wealth, but little thought is given to place them under suitable
conditions for enjoying it. Great importance is attached to the
appearance of the surface, but very little to the real quality of the
ground, that is to say, the blood. The observer must feel pained
when he considers the almost constant violation of hygienic laws in
marriage ....’" This point, however, will be admitted by all;
the difficulty is to apply the remedy, and the first step in this direc
tion is to acquire more accurate knowledge bearing on the subject.
As the controversy on cousin-marriages has been revived very
lately, we propose to give some account of the more recent views put
forth on either side. It will be needful in the first place to settle
what degree of consanguinity is allowable. Mr. Adam says in his
paper—
“ On the common assumption that the human race has sprung from one
pair, all mankind, without exception, must be consanguineous either in the
direct or in the collateral line ; and if consanguinity is an absolute bar to
marriage, then marriage as an institution must cease. If the abolition of
that institution is a notion that can enter only into the reveries of fanaticism,
then there must be some limit beyond which consanguinity shall be held to
be inoperative as an objection to the marriage union, and the question is,
where is that limit to be placed ?”
�1866.]
Reviews.
391
Let ns look first at the custom of various nations in different
ages. Turning to the Old Testament history, it seems clear that
“ Cain and Seth, the sons of Adam, must each have married his own
sister ’ that Abram married his half-sister, and that “ Moses and
Aaron were the fruits of a union between Amram and Jochebed, the
sister of Amram’s father ; that is, the nephew married the aunt.”
The Levitical law, representing a different stage of civilisation,
expressly prohibited the union of son with mother and of stepson
with stepmother ; of brother with sister, whether of whole or halfblood ; and of nephew with aunt; the penalty of transgression being
the excision of the disobedient from among the people. In profane
history several writers refer to the customs prevalent among bar
barous nations, as, for instance, Euripides, in the fifth century b.c.,
who affirmed “ that amongst all barbarians the father married the
daughter, the son the mother, and the sister the brother, and that
no law forbad such connections.” Ptolemy in the second, and St.
Jerome in the fourth century, bring forward the same allegations,
but it seems doubtful whether they were quite correct.
The Assyrians, of individual nations, are expressly accused of
close consanguineous marriages, but the Persians were, it is agreed,
the greatest offenders in this respect, some writers ascribing the
practice in question to the Persians generally, others to the Magians
or ruling class, and others to individual persons of rank and
authority.
Coming down to more modern times, we find that “ in Peru the
succession to the throne of the Incas in the line of Manco Capac
was sought to be secured by the authorised marriage of brother and
sister among his descendants. Of existing savage tribes, amongst
the Maories, in New Zealand, marriages between near relatives are
said to be not infrequent, but they are not usual between brothers
and sisters. Captain Speke relates that Mtesa, the King of Uganda,
was attended at a levée by ladies ‘ who were at once his sisters and
wives.’ ”
In China consanguineous marriages are prohibited ad infinitum,
as in Roman law, and even two persons of the same surname are
forbidden to marry.
“ The Levitical law of the Jews is,” continues Mr. Adam, “ the basis of
the ecclesiastical or canon law of Christian nations, and the Roman law
contained in the institutes, code, and digest of Justinian, is the basis of
modern civil law. In the computation of degrees of consanguinity there is
a difference between these two systems of law. The canon law counts the
degrees only up to the common ancestor, the civil law also down to the
Propositus. Hence those who according to the canon law are in the first
degree are placed by the civil law in the second degree, and those who
according to the former are in the second degree are placed in the latter in
the fourth degree. The substitution of the provisions of the civil law for
those of the canon law was effected in England by the Marriage Act of
�392
Reviews.
[Oct.,
1549 in the reign of Henry VIII. The degrees prohibited by the canon
law are all within the fourth degree of consanguinity, according to the com
putation of the civil law. All collaterals, therefore, in that degree or be
yond it may marry. First cousins are in the fourth degree by the civil law,
and, therefore, may marry. Nephew and great-aunt, or niece and greatuncle, are in the fourth degree, and may marry. For the same reason, as
Burge quaintly remarks, though a man may not marry his grandmother, he
may marry her sister. Such in brief is the existing law of England, Scot
land, Ireland, and the British colonies, in regard to consanguineous mar
riages.
“According to the present law of France marriage is prohibited in the
direct line between ancestors and their descendants, whether legitimate or
illegitimate, to the remotest degree. In the collateral line marriage is pro
hibited between brothers and sisters, whether legitimate or illegitimate.
Marriage is also prohibited between uncle and niece, aunt and nephew ; but
in these cases, as in regard to the age of marriage, Government possesses
the power, on serious grounds of expediency, of dispensing with the pro
hibition.
“ In Spain and Portugal the canon law is still in full force, prohibiting
the intermarriage of those related to each other in the fourth degree, but
for special reasons permitting dispensation from that prohibition.”
In most of the United States of America marriage between an
uncle and a niece is, we read, valid, but in Louisiana and Indiana
the law is assimilated to the English.
This subject is one which, as involving the descent of property,
lias engaged the attention of jurists, some of whom have spoken very
emphatically upon it. The opinion of Dr. Taylor, the author of
‘ Elements of the Civil Law/ is stated to be as follows :—
“ AVith respect to marriages in the direct line, that is, in the line
of ascendants and descendants, he says that though some limit the
prohibition to the first degree, others to the third, the canon law
to the fourth, and others again to the twentieth, yet in his judg
ment the voice of nature interposes absolutely and indeterminately,
and such marriages are prohibited in infinitum. The principle of
this rule he holds to be, that in such cases an exclusion is laid
against those who are parentwm in numero. Nature has set a per
petual bar to every such conjunction as shall damage or confound
the consideration of parentage.”
Mr. Burge, another great authority, thought the prohibition by
the canon and civil law “ prevents that confusion of civil duties
which would be the necessary result of such marriages.” And
Chancellor Kent, of New York, considered such prohibitions to be
iC founded in the law of nature.”
Mr. Adam, however, is by no means content to accept the theory
of a natural law as sufficient ground for objection, remarking—
“ The allegation of such a law is an unsupported assumption. Where,
when, how, to whom, has nature thus spoken ? In what language has nature
declared that a man may not marry his grandmother, but has left him at
liberty to marry his grandmother’s sister ? When nature speaks, she directs
�1866.]
Reviews.
393
her authority against possible evils. But who ever thought of marrying his
grandmother, his great-grandmother, his great-great-grandmother, and so
on, without limit ? The thing is impossible; and the impossibility consti
tutes the all-sufficient reason for its not being done, without any added
prohibition or penalty. Human laws often express human folly, but nature
does not issue frivolous edicts against imaginary evils.”
This writer thinks that consanguineous marriages must be un
equivocally condemned, though not for the reasons usually held
sufficient, and sums up the question in these words :—
“ In the absence of any natural or revealed law against them, the legiti
mate inquiries will be—Do they embarrass the descent of property ? Do
they confuse our judgments of the relations of life ? Do they vitiate our
perceptions of domestic and social obligations? In reply to the first and
second of these inquiries, the answer, as far as I am able to judge, must be
that they do not embarrass the descent of property, and that they do not
confuse our judgments of the relations of life. In reply to the third, the
answer must be more doubtful. The marriage union between uncle and
niece, between nephew and aunt, and between cousins, would seem to tend
to lessen the purity and mutual confidence which for the happiness of fami
lies and the benefit of society should subsist between those near relations.
There is, however, the utmost danger of pressing this consideration with too
great rigour, for at every successive remove from the first degree in the direct
and collateral lines the confusion of relation and duty becomes less, until at
last it entirely disappears, and exists only in a morbid imagination.”
The proofs of the evils resulting from consanguine marriages most
generally relied on are those drawn from the records of disease, and
it is on this ground that the battle of opinion has been so often
fought. There are, moreover, certain morbid conditions which are
supposed to result especially from these marriages, and so firmly
established is this opinion in the public mind that it has become
quite a tradition. Knowing this, authors are apt to commence with
a foregone conclusion, and, assuming the point at issue, announce a
triumph over all objections. Thus, M. Chippault opens his first
chapter in these terms :—“ Many authors have given their opinion
in favour of the injurious nature of these marriages; some few only
have taken the opposite view, Both have brought forward proofs
in support of their opinion, but up to the present time the anticonsanguinists alone have furnished convincing proofs ! According
to these proofs it does not seem possible to me to deny the danger
of these marriages, and still, to see the ardour with which some
doctors set to work to defend them, one must needs believe that the
problem is not settled.'” Brom such a horrible conclusion he en
deavours to save his fellow-creatures by bringing up all the cases of
disease which he can ascribe to such a cause. Mere denunciation
such as this carries no weight as argument, and is enough to pre
judice most people against the writer. The facts adduced by the
anti-consanguinists are by no means numerous, many of them rest
ing on very slight proof, and these have been ([noted again and
�394
Reviews.
[Oct.,
again by every fresh writer till we begin to wonder whether a new
idea on the subject is possible. Dr. Mitchell, though himself con
vinced of the evil effects of such marriages, discusses the question
with the greatest fairness, and early in his pamphlet makes the
following remarks:—
“Both general and professional opinions on this subject rest, in no small
degree, on a peculiar and faulty kind of evidence. When we are presented
with the question, “Does consanguinity in parentage appear to injure the
offspring ?” memory searches for instances of unions of kinship, from the
history of which the answer is to be framed. Now, it is certain that all
those cases which have been marked by misfortune will be first called up,
while many of those which have exhibited no evil effect or no peculiarity of
any sort will be passed over or forgotten. The attention, in all likelihood,
has been frequently drawn to the first, while nothing may have occurred in
the progress of the last to keep alive the recollection of relationship in the
union. I need scarcely say that facts collected in this manner are almost
sure to lead to inferences beyond the truth, yet it is from such data that
conclusions on this subject have frequently, if not usually, been drawn. .
. . . Startling illustrations of calamitous sequences to cousin-marriages
have been detailed, and pointed at with a finger of warning, the relation of
cause and effect being assumed. Such a relation may have existed, but it is
equally possible that it may not, for it must always be remembered that a
blood-alliance between the parents is far from being the only cause of defective
offspring.
“ Supposing the proof complete that it is a cause, it is still only one of
many, and we cannot therefore point with confidence to a particular case,
and say positively that the calamity there is due to consanguinity of
parentage, for it may really be due to injuries in parturition, to hoopingcough, to a blow on the head, or to starvation in infancy. Consanguinity in
the parents may very decidedly tend to injure the offspring, yet it by no
means follows that every defect in the children born of blood-related parents
is an expression of this tendency, for the general causes of defect will exist
among them as among other children, anil will give results at least equally
disastrous. It is clear, therefore, that isolated cases cannot be used in this
or in any similar question to indicate the measure of the evil which may be
expected, nor even to prove its existence.”
It is often objected, that the defects so generally attributed to
these marriages arc in reality due to hereditary transmission, and not
to mere consanguinity; but Dr. Mitchell justly observes that, if
certain tendencies are liable to descend to the offspring from the first
cause, the danger is still greater when both parents are related, and
that for this reason such unions should be avoided by the prudent.
He says—“If relations by blood are liable to possess the same
morbid tendencies, and if, by pairing among themselves for procrea
tion, they are likely to transmit these tendencies in a dangerously
increased form to their children, then it is surely their duty to avoid
such unions, and to seek among strangers alliances with individuals
wore likely to possess qualities calculated to modify or counteract
the morbid predispositions in question. It may be that there is
absolutely nothing whatever in the bare fact of consanguinity, and
�1866.]
Reviews.
395
that a marriage of kinship should be avoided on the same grounds
as a marriage between any man and woman both predisposed say to
insanity. In the case of cousins, though there may be nothing
common to them of so marked a character as a declared tendency to
insanity, still there may be common to them any one of a hundred
transmissible peculiarities, which it would be very undesirable to
send down to their children in an exaggerated form. Even a strong
temperament common to both might thus be intensified into disease
in their offspring.'”
It may happen, of course, that in the case of two cousins one
may possess qualities the best suited to neutralize those peculiarities
in the other which it would be undesirable to have transmitted to
their children; but the chances are the other way, as the inherited
qualities of relations must be in great measure derived from a common
source.
The chief defects commonly held to result from consanguine
marriages are insanity, idiocy, and deaf-mutism; at least, these are
the most important, and it is to them we would direct our attention.
It would be easy to collect a number of startling cases in proof of
the ill consequences of these marriages, but such evidence is worth
very little for a general conclusion. The fairest method of investi
gation seems to be, 1st, to take, as Dr. Mitchell proposes, a large
number of cases of the defects ascribed to kin marriages, and deter
mine in what proportion the parents were related; 2nd, to investi
gate the family history of every marriage in a given locality,
comparing the results of those in which the parents were related with
those in which there was no such kinship. In the first case the
number examined must be very large in order to make the inquiry
fair, and in the second the investigation should be carried over
a large field, and with scrupulous exactness.
Dr. Mitchell’s official position has enabled him to investigate the
subject in both these methods, in a way that private individuals
could hardly attain, and, though he modestly announces he has
“succeeded in doing a little,” other people will probably consider
that he has done a great deal, and has at considerable cost of time
and labour collected a mass of most valuable information.
He
says that, in visiting lunatics in private dwellings, the relationship
of the parents has been generally inquired into, and that, during
1860 and 1861, he made careful inquiry in every case in nine
counties, viz., in Aberdeen, Bute, Clackmannan, Fife, Kincardine,
Kinross, Perth, Ross and Cromarty, and Wigtown. These districts
include a large portion of Scotland, and represent a population of
716,210. The investigation was attended with great difficulties,
it may be easily imagined, and the result is given as follows :
“The whole number of idiots examined was 711, including those in receipt
as well as those not in receipt, of parochial aid. Of these, 421 were aster-
�396
Reviews.
[Oct.,
tained to be the children of parents not related by blood, and 98 were the
offspring of parents between whom there was a more or less close kinship.
In 84 instances the relationship was not known, and 108 of the whole
number were born out of wedlock. In a tabular form the results stand
thus:
(1) Whole uumber of idiots and imbeciles examined
(2) Of these—illegitimate ......
„
parentage not known
....
(3) Total number whose parentage was known
Of these—parents not related
....
„
parents related...................................
711
. 108
. 84
— 192
519
. 421
. 98
..
519
“ Taking the whole number of idiots examined, including both the ille
gitimate and those of whose parentage I could learn nothing, we have 13’6
per cent, of the entire number born of parents between whom there was a
blood relationship. In order, therefore, to believe that such relationship
does not influence the amount of idiocy, marriages of kinship would require
in these counties to be to other marriages in the ratio of 1 to 7, which they
notoriously are not, though, unfortunately, no facts exist to show precisely
their relative frequency. I think, however, that it may be regarded as
certain that such a ratio is about ten times higher than the reality.
“ But in order properly to test this influence of consanguinity, we must at
least deduct the cases of whose parentage I could obtain no information.
Those acquainted with the difficulties of such investigations will admit that
the number of these is not great. This deduction then being made, the pro
portion rises at once to 15 6 per cent. This last may be regarded as refer
ring to the whole community, since there is no reason for supposing that
among the 84 of whose parentage nothing was ascertained a greatly different
proportion would be found to be the offspring of blood-alliances.
“ It may appear to some that a further deduction should be made. The
paternity of the illegitimate is practically an unknown thing, and I have else
where shown that illegitimacy itself tends to produce defective children.
The illegitimate idiots should, therefore, be deducted, so that those idiots
born in marriage of parents related by blood may be compared with those
born in marriage of parents not so related. If this be done it will be found
that the former constitute 18'9 per cent, of the latter. Instead, therefore,
of every seventh or eighth marriage in the community, we should require
every fifth or sixth, to be between persons related by blood to each other, in
order to show that consanguinity of parentage does not influence the amount
of idiocy. *
“ Of the 98 idiots whose parents were related, the degree of relationship
was as follows:
Cousins in
........ 42 cases.
Second cousins in . .
.
.
.
.
. 35 ,,
Third cousins in
. .
.
.
.
.
. 21 ,,
98 „
“During the course of these investigations 64 cases came to my know
ledge in which more than one idiot existed in the family. In all of these
but 5 I obtained the history of the parents. In the remaining 59 no less
than 26 instances of blood-relationship occurred, or 44 per cent. This is an
instructive fact, showing that when we select cases in which the tendency to
�1866.]
Reviews.
397
idiocy appears with force, then kinship of parentage also presents itself with
a marked increase of frequency. Thus, while it appears that in nearly 1
out of every 2 cases in which more than one idiot, occurs in a family, con
sanguinity of parentage is found; in those cases, on the other hand, where
only one idiot occurs, such relationship only exists in 1 out of 5 or 6 cases.”
Of these 59 cases, the parents were related in twenty-six in
stances, giving 74 idiot children ; while in 33 the parents were
not related, and produced 76 idiots.
He adds:
“ The idiocy of our country is not due to one but to a great many things,
each of which contributes its share to make up the whole; one cause may
be more powerful than another, but each influences the total amount. The
facts which have been detailed render it very probable, if they do not prove,
that a blood alliance between parents is one of these causes, influencing
unfavorably the amount of idiocy in the land, but they do not exhibit
definitely the measure of this influence, though they may aid us in esti
mating it.
“There are many causes of idiocy which are undoubtedly of greater
power than kinship of parentage. Hooping-cough, scarlatina, and measles,
for instance, produce a large amount of the idiocy of Scotland, as they do
probably of other countries. Hooping-cough, in particular, is often followed
by imbecility or idiocy. We are too apt to think of idiocy as a congenital
condition. In point of fact, however, a large proportion of the idiocy of the
country has an extra-uterine origin, and, strictly speaking, is acquired and
not congenital.”
Deaf-mutism is perhaps the most notorious consequence of such
marriages, and the most easily traced out. According to M. Chip*
pault, there are about 250,000 deaf-mutes in Europe, and in
France there were (at the census of 1858) 21,321, 12,101 being
males, and 9,220 females. These statistics have been well analysed
by French authors, who conclude that it is impossible to deny the
fact that more deaf-mutes are born from related than from non
related parents, and M. Boudin is prepared to specify the pro
portion, viz., twelve to fifteen times greater in the former than in
the latter.
Inquiry into the statistics of ten of the Scotch and English deaf
and dumb institutions, showed a total of 544 pupils, representing
504 families, and among these the number of pupils whose parents
were related was 28, from 24 families.
Deducting 25 per
cent, for cases of acquired deaf-mutism, we have about one in
twenty resulting from consanguine marriages :
“ It will be observed,” says Dr. Mitchell, “ that the 24 cousin-marriages
yielded 28 deaf-mutes. Had the same proportion existed through the entire
number of pupils, they ought to have been represented by 466 instead of
504 families. There is therefore a greater frequency of two defective
members in one family when dealing with the offspring of blood-relations
* ‘ Etude sur les Mariagcs consanguins,’ p. 17.
�I
I
398
Reviews.
[Oct.,
than when dealing with others. In the Irish returns (1851) this is still
more evident. 154 cousin-marriages, in which deaf-mutism occurred, yielded
no less than 235 mute members.
“Dr. Peet, in his thirty-fifth annual report, in analysing Wilde’s ‘ Statics
of Disease,’ says, that it appears that ‘ of the Irish deaf and dumb, from
birth, about 1 in 16 were the offspring of parents who were related within
the degrees of first, second, or third cousins.’ This does not differ greatly
from the estimate which I have formed for Great Britain. Supposing
cousin-marriages to be to others as 1 to 70, it will follow, Dr. Peet says,
that congenital deafness appears at least four times, perhaps five times, as
often from a marriage between cousins as from a marriage between persons
not related.
“Of the 235 deaf-mutes in Ireland who were the offspring of cousins,
only 7 were cases of acquired deafness. This is greatly below the proportion
in the deaf-mute population of all Ireland, which shows 11 per cent, of
acquired deafness and 7 per cent, uncertain. Instead of 7, therefore, there
should have been 26 cases of acquired deafness. In other words, deafmutism, as it appears among the children of cousins, seems to be to a larger
extent congenital than when it appears among the children of persons not
related to each other by blood.”
This gentleman goes on to relate the results of his inquiries into
the history of the families in certain districts he visited, and the
places chosen are particularly suited for the purpose, being isolated,
and having but little communication with the general population.
As an instance, we will take the island of Scalpay. It has been
supposed that marriages of consanguinity were very prevalent in
the western highlands and islands, but the official ret urns of Scalpay
do not at all support the idea. Dr. Mitchell is of opinion that
popular report exaggerates, and official returns understate, the facts.
He reported on thirty-five cases of insanity in the island, and of
these, thirty-one were idiots or imbeciles, while twelve of the whole
were the offspring of parents related in different degrees. He
remarks—
“ On the supposition that this relationship has no influence on the pro
duction of idiocy, we should expect to find it in one third of all unions in
the island. This, however, would greatly exaggerate the frequency of such
marriages. So that, after deducting freely for other causes of idiocy, many
of which are unusually strong in this island, there still remains a large
measure of this calamity, which with good reason we may regard as due to
consanguineous marriages.
“Bodily malformations are frequent in the Lewis. In the parish of Uig
harelip is very common. Nine cases were brought to my own knowledge.
In the Lewis, and the parishes opposite to it on the mainland, I saw five
cases in which there were supernumerary little fingers, one in which there
were two thumbs, and one in which the fingers and toes were webbed.
Curvature of the spine, deformity, and lameness, were often seen in the
island. Cases of congenital blindness and deaf-mutism are also numerous.
I saw seven epileptics, several instances of chorea, and many of paralysis.”
In another page lie gives an account of the population of a small
town on the north-east coast of Scotland, the details of which are
very instructive :
�Tieviews.
399
“The fishing population is estimated at 779, and contains 119 married
couples, and about 60 widows and widowers with or without families.
“ Of the 119 married couples, in 11 cases the union is between full cousins,
and in 16 between second consins; or, in other words, in 27 instances there
is a blood-relationship. This is in the proportion of 1 to 4'4 of all marriages.
Of these 27 marriages, including 3 which are barren, 105 children have been
born. Of these children, 38 are dead (35 having died in childhood), 4 are
deaf-mute, 4 are imbecile, 4 are slightly silly (‘ want a cast ’), 1 is paralytic,
and 11 are scrofulous and weakly. In other words, 24 out of the 67 living
children labour under defects of body or mind, while 1 in 17 is an avowed
imbecile, and 1 in 8’4 is weak in mind. These facts are of such a character
as to lead us to suspect that more than one of the causes of idiocy must be
strong in this community.
“The children of those who are full cousins are described as being ‘all
of them neither strong in mind nor in body,’ and the fishers of this place, as
a class, are said to be ‘ below par in intellect.’ In this last opinion I am
inclined to concur. It is true, I believe, not of this locality alone, but of
nearly all the fishing villages which fringe the north-east coast of Scotland.
There is a general lowering of the physical and mental strength in these
communities, which is popularly attributed to this system of in-and-in
breeding. When compared with the agricultural population, or with the
tradespeople of the small towns in the neighbourhood, they are, as a race,
inferior both in bodily vigour and intellectual capacity, while their thrift
lessness and want of foresight are notorious. This opinion is founded
on personal observation, as well as on the testimony of others.”
The conclusions Dr. Mitchell has arrived at, as the result of his
most laborious investigations, are as follows :—
“ 1. That consanguinity in parentage tends to injure the offspring.
That this injury assumes various forms. That it may show itself
in diminished viability at birth; in feeble constitutions, increasing
the risk of danger from the invasion of strumous disease in
after-life; in bodily defects and malformations; in deprivation or
impairment of the senses, especially those of hearing and sight;
and, more frequently than in any other way, in errors and dis
turbances of the nervous system, as in epilepsy, chorea, paralysis,
imbecility, idiocy, and moral and intellectual insanity.
That
sterility or impaired reproductiveness is another result of consan
guinity in marriage, but not one of such frequent occurrence as has
been thought.
“ 2. That when the children seem to escape, the injury may show
itself in the grandchildren; so that there may be given to the
offspring by the kinship of their parents a potential defect which
may become actual in their children, and thenceforward perhaps
appear as an hereditary disease.
“ 3. That many isolated cases, and even groups of cases, present
themselves in which no injurious result can be detected. That this
may occur even when all other circumstances are of an unfavorable
character.
“ 4. That, as regards mental disease, unions between blood
relations influence idiocy and imbecility more than they do the
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Reviews.
[Oct.,
acquired forms of insanity, or those which show themselves after
childhood.
“ 5. That the amount of idiocy in Scotland is to some extent
increased by the prevalence of consanguine marriages, but that the
frequency of these marriages does not appear to be so great as has
been generally supposed?'’
There are other peculiarities besides the above recognised as due
to the same influences; for instance, harelip, epilepsy, &c. M.
Liebreich, of Berlin, too, has described a disease by the name of
pigmentary retinitis, which he found among the deaf-mutes, and
particularly among those whose parents were related, one half of the
cases coming under the latter category. His observations have been
carried on in Paris and other places, and always with the same
results. But perhaps the most curious anomaly illustrating this
subject is found in the pages of M. Devay ; it is as follows :—
*
“There is in the department of Isère, not far from the Côte-Saint-André
et de Rives, quite a small village, called Izeaux, isolated and lost, as it
were, in the midst of the uncultivated plain of Bièvre. The roads and
means of communication in this unfertile spot were difficult, if not imprac
ticable. The inhabitants of Izeaux, simple and almost abandoned to them
selves, had very little to do with the surrounding population, and inter
married constantly and frequently within the limits of the same family. At
the end of the last century, as a consequence of these marriages of relations,
a singular abnormality arose, which some forty years ago affected nearly all
the inhabitants. In this community, both men and women acquired a sixth
digit, i. e. a supplementary one both on the feet and hands.
“ ‘When, in 1829 and in 1836,’ says M. Pottou, ‘ I observed this strange
phenomenon, it only existed in a more or less rudimentary condition ; with
some it was only a large tubercle, in the centre of which was a hard bony
substance, terminated by a nail more or less formed, and fixed to the outer
side of the base of the thumb. The person who accompanied me, although
non-medical, pointed out to me that a happy change was observable in this
defect of growth since the habits of the people bad been modified, since the
roads had improved, and communication had become more frequent with
other places, in a word, since the races had mixed more freely. In 1847 I
saw a native of this locality, who had settled at Lyons. He had the pecu
liarity mentioned, but had four children who were without their father’s
defect. At the present time this anomaly has almost completely dis
appeared.’ ”
Another curious fact in connection with this subject is mentioned
by M. Chippault (p. 76) :—
“In a report addressed to the Minister of the Interior in 1861, M. de
Watteville stated that the number of deaf-mutes varied in France according
to the district, and that he found in twenty-two departments of a mountain
ous nature there was 1 deaf-mute in 1158 inhabitants, and in twenty-five
departments in which the country was flat and cultivated there was 1 in
every 2285. There were, then, twice as many deaf-mutes in the mountain
ous as there were in the flat country. The explanation is easy, for in the
* ‘ Du Danger des Mari iges consanguins,’ p. 95.
�18G6.J
Report on the Progress of Psychological Medicine.
401
mountainous districts the inhabitants have, so to speak, no relations with
the outer world ; in certain places they even remain attached to their
native place and never leave it. Under these conditions the marriage field
is very restricted, and the evil results of consanguinity are very numerous.”
M. Chippault is so impressed with this view of the subject that
he urges that consanguine marriages should be prohibited by law.
M. Jules Falret, on the other hand, "who has given a most able
résumé of the recent views on this question, thinks that fresh
researches are needed before the question can be considered as
settled in a scientific point of view, and adds—
“ To form a legitimate conclusion, by exclusion, on the real influence of
consanguinity as a cause of particular infirmities or diseases in descendants,
we must first have eliminated all other physical or moral causes which,
either in parents or children, may account for the production of these
diseases or anomalies of organisation.”
Such is the present state of the question, and it seems to us the
balance of evidence is certainly in favour of the popular notion, but
the strict proof is far from being as complete as it is generally
considered to be.
G. Mackenzie Bacon.
PART III.—QUARTERLY REPORT ON THE PROGRESS
OF PSYCHOLOGICAL MEDICINE.
English Psychological Literature.
By S. W. D. Williams, M.D., L.R.C.P.L., Assistant Medical
Officer of the Sussex Lunatic Asylum, Hayward's Heath.
On the Morbid Anatomy of the Nervous Centres in General Paralysis
of the Insane.
By J. Lockhart Clarke, F.R.S., &c.
(‘ Lancet,’ September 1st, 1866.)
We give this essay of Mr. Lockhart Clarke's on the Morbid Ana
tomy of the Brain in Paralytic Insanity in full. It does not admit
of abbreviation.
“The principal morbid appearance (he writes) that has been
�402
Report on the Progress
[Oct.,
described by pathologists as constant in general paralysis, is to be
found in the blood-vessels of the brain. It was first pointed out by
Wedl and Rokitansky, and has since been more fully described by
Drs. Salomon and Sankey. These observers have shown that many
of the capillaries and smaller arteries become wavy, more or less
tortuous, or convoluted into knots. ‘ There appears/ says Dr.
Sankey, ‘ to be some amount of tortuosity in the capillaries of every
case of general paresis. This tortuosity in places amounts to a
simple sharp curve or twist; in places to a kinking of the vessel;
in others, to a more complete twisting, until it forms, in fact, little
knots of varicose vessels of very complicated kind/ * These appear
ances are well seen in preparations which Dr. Sankey was kind
enough to show me, as well as in my own, and I have found them,
to a certain extent, in the brain of every case of general paresis that
I have examined; but they are much more striking in some cases
than in others, and I agree with Dr. Sankey so far, that the amount
of alteration is not always in proportion to the length of date, degree
of imbecility, or of impaired motility. In an old woman who had
been for a great many years an inmate of Hanwell Asylum, and
whom I saw only two or three weeks before her death, I found the
vessels of the cerebral hemispheres less altered in shape than in most
other cases of much shorter duration.
“ But the capillaries and small arteries which are thus thrown out
of their usual course are also surrounded by a fibrous and cellular
covering, or kind of sheath, which invests them somewhat loosely,
and frequently contains grouped or isolated nuclei, fatty particles,
and granules or grains of hannatoidin, of a brown or yellowish tint.
This secondary sheath is described by Rokitansky, Wedl, Sankey,
and others, as an abnormal deposit of hypertrophied connective
tissue, ‘ fitting, as it were, more or less closely to the vessel, in
greater or less degree of transparency and extent, in some cases
approaching a brownish hue, and marked by transverse lines like
commencing contractions .... Whether this excess (of connective
tissue fibres) is from what Rokitansky calls overgrowth of the origi
nal connective medium, or is thrown out by the capillaries, or is
formed conjointly by both, is, and must probably remain, hypo
thetical/ f
“ Rokitansky and Wedl believe that this investing substance is
formed from a material thrown out by the capillaries, and that in
the first stage the material is hyaline; that it afterwards contracts;
that in contracting it throws the capillaries into bends or kinks;
that as it goes on contracting it becomes less hyaline, more fibrous,
and at length like a sheath, f They do not, however, consider it as
* ‘Journal of Mental Science,’ No. 48, 1864; and ‘Lectures on Mental Dis
eases.’
f Sankey, loc. cit.
+ Ibid.
�1866.]
of Psychological Medicine.
403
peculiar to general paralysis, having observed it in other forms of
cerebral disease ; but still they describe it as an abnormal product,
and as assuming the appearance of a sheath in morbid cases only.
“ Now it is very important to be aware that in every healthy brain,
or at least in every brain that on examination is usually considered
healthy, a great number of the capillaries and small arteries are sur
rounded by secondary sheaths, precisely similar in all essential parti
culars to those which have been considered as morbid products in
general paralysis and other cerebral affections. This anatomical fact
was, I believe, first pointed out, about eleven years ago, by M. Robin
of Paris, and was afterwards made the subject of a paper, with
engravings, in the second volume of the ‘ Journal de Physiologie/
from which I extract the following passage :—
“ On trouve normalement autour d’un certain nombre des'capillaires du
cerveau, de la moelle, de l’épendyme, et de la pie-mère, une enveloppe
épaisse de 1 à 2 millièmes de millimètre, composée d’une substance homogène
ou à peine striée. Elle s’étend sous forme d’une tunique adventice, ou
extérieure à bords nets, mais onduleux depuis les capillaires, qui ont 1 à 2
centièmes de millimètre, en dehors même de la tunique de tissu lamineux de
ces derniers. Elle est distante de 1 à 3 centièmes de millimètre des parois
propres du capillaire qu’elle enveloppe. Or, cet espace est tantôt rempli
d’un liquide incolore mêlé de granulations moléculaires, tantôt de petits
noyaux libres, sphériques, larges de 5 millièmes de millimètre. Ces noyaux
sont tantôt rares, écartés, de manière à laisser voir les parois propres du
capillaire, tantôt ils sont contigus, ou au moins assez rapprochés pour
masquer les noyaux ovoïdes allongés de ces parois. Dans tous les cas,........
on trouve toujours, chez les sujets qui ont dépassé quarante à quarante-cinq
ans, des amas de granulations graisseuses, ou des granulations graisseuses
isolées, atteignant jusqu’à 2 centièmes de millimètre, qui sont dans cet espace
entre les parois propres du capillaire et cette tunique transparente extérieure.
Mais surtout on y trouve aussi, entre les petits noyaux ronds ci-dessus, une
grande quantité de granulationset de grains très-gros d’hématosine amorphe.
Ces grains d’hématosine peuvent atteindre jusqu’à 2 centièmes de millimètre,
et sont isolés ou réunis plusieurs les uns à côté des autres. Ils ne sont jamais
accompagnés de globules sanguins, et semblent provenir d’hématosine qui
aurait exsudé des parois propres des capillaires, et se serait déposée entre
ces parois et la tunique transparente à bords souvent onduleux, décrite
ci-dessus.”*
“ The author goes on to say that he has not found this special
sheath around the capillaries anywhere else than in the white and
gray substances of the cerebro-spinal nervous centres ; that it does
not belong to all the vessels, and that he is unable to say precisely
to what its presence or absence is due ; but that he has found it in
every cerebrum and cerebellum in which he has looked for it.f
“ My own observations confirm the general correctness of this
description and of the remaining statements of the author. 1 have
found such sheaths around a variable number of blood-vessels in the
* Page 513.
f Page 544.
�404
Tieport on the Progress
[Oct.,
brains of persons who have died without any apparent cerebral dis
order ; and one of these brains belonged to a fine, powerful, and
liealtliy-looking young man, who was killed by an accident in the
*
street.
“ Yet, on comparing vertical sections of the convolutions of a
healthy brain with those of a brain from a person who has died of
general paralysis, a striking difference between them is often observ
able even to the naked eye. In the latter case, a series of streaks or
lines may frequently be seen radiating through the white and gray
substances towards the surface; and in vertical sections of convolu
tions that have been hardened in chromic acid, it is very common to
perceive, in the white substance especially, what seems at first sight
to be a number of vertical fissures and oval slits, which, under the
microscope, however, are found to contain blood-vessels surrounded
by sheaths like those already described. But the sheaths in these
cases are often less delicate; they are thicker, more conspicuous, and
frequently darker than in the healthy brain; and sometimes, espe
cially when the vessels are convoluted, they appear as fusiform dila
tations along their course. Moreover, while in the healthy brain the
granules or grains of hsematoisin are commonly scanty, and frequently
absent altogether, in general paralysis they mostly abound, being
scattered in some places, and collected into groups in others. So
much for the state of the cerebral blood-vessels in general paresis. In
the nerve-cells of the convolutions I have frequently discovered cer
tain structural changes, which, as far as I am aware, have not been
mentioned by other observers. These changes consist of an increase
in the number of the contained pigment-granules, which in some in
stances completely fill the cell. In other instances the cell loses its
sharp contour, and looks like an irregular heap of particles ready to
fall asunder, t
“ A Trench writer, M. Joirc, has stated that, during an experience
of three years, he has always found in cases of general paralysis a
peculiar alteration of structure in the fourth ventricle of the brain.
This alteration consists of the formation of a considerable number of
granulations resembling the elevations produced on the skin under
the influence of cold. At an early stage of the disease the granula
tions are numerous and small, and suggest the idea of a surface
* It was this brain chiefly that I employed in my “ Researches on the Minute
Anatomy of the Cerebral Convolutions.” (‘Proceedings of the Royal Society/
vol. xii, No. 57.)
+ These are not to be confounded with the “ granule” or “ exudation” cells of
authors. The tilling of the nerve-cells with pigment-granules, as an early stage of
degeneration, I formerly pointed out in diseases of the spinal cord and of other
parts. (Beale’s ‘Archives of Medicine,’ No. xiii.) Dr. Hughes Bennett had also
described fatty degeneration and consequent disintegration of nerve-cells of the
nervous centres. This distinguished pathologist has repsesented the change in
Fig. 105 of his great work on ‘ The Principles and Practice of Medicine,’ fourth
edition.
�of Psychological Medicine.
1866.]
405
covered with grains of sand. In older cases the granules are larger,
and afford a rough sensation to the touch. They are most remark
able at the point of the calamus scriptorius.
*
“The appearance described by M. Joire is quite familiar to me,
but I have not always found it in general paralysis ; and it is cer
tainly not peculiar to this disease, for I found it in cases of an
entirely different nature. In Beale’s ‘ Archives of Medicine’ (No.
ix, 1861) I recorded a remarkable case of muscular atrophy, in
which, together with lesions of the cord, this granular appearance on
the floor of the fourth ventricle was very strikingly manifested. I
then showed that it was due to hypertrophy of the ordinary epithe
lium by which the ventricle is lined. It may be well to reproduce
my description. f The whole floor of the fourth ventricle presented
a very peculiar and unnatural aspect. Instead of being smooth and
shiny, as in the healthy state, it was entirely paved with a multitude
of granulations or small rounded eminences, which were very closely
aggregated, but differed from each other considerably in size. I
removed some of them for examination, first by scraping them off
from the surface, to which they adhered with considerable tenacity ;
and then by shaving off a section, together with a thin layer of the
subjacent tissue. When examined by a sufficiently high magnifying
power, the granulations or eminences were seen to consist of globular
aggregations of the ordinary epithelial cells, which, in a natural or
healthy state, are arranged side by side, and form a smooth or
level surface on the floor of the ventricle. The tissue immediately
subjacent, and which consists of exceedingly fine fibres proceeding
from the tapering ends of the epithelial cells, and running in various
directions, was more abundant than usual; and—as might be ex
pected from the homologous relation of this part to that which
surrounds the spinal canal — it was interspersed with corpora
amylacea, but certainly not to a corresponding extent.’!
“ In protracted cases of general paralysis the spinal cord is mostly,
if not always, more or less affected. In some instances I have found
it softened in certain parts to the consistence of cream. In other
instances, in which there was little or no external appearance of
softening, I have found numerous areas of granular and fluid disin
tegration within and around the gray substance.”
* ‘ Gazette Médicale de Paris,’ Aug., 1864.
f Beale’s ‘Archives of Medicine,’ No. ix, Oct., 1861, p. 18.
VOL. XII.
27
�406
lieport on the Progress
[Oct.,
Practical Observations on Insanity of Feeling and of Action.
By Henry Maijdsley, M.D. Lond.
(‘ Lancet,’ June 23rd, 1866.)
,
Dr. Maudsley publishes in the (Lancet’ some observations on the
vexed question of Moral Insanity. “ It is well known (he says) that
Dr. Prichard described, under the name of Moral Insanity, a variety
of mental derangement which has been the occasion of angry and
contemptuous reprobation by many who, without experience, but not
without self-confidence, have not cared to recollect Dr. Prichard’s
great experience and high philosophical character. The name was
perhaps ill chosen, and some of the examples which he brought for
ward in support of his opinion properly belonged to other recognised
forms of mental disease; but when these admissions have been made,
it still remains an unquestionable fact that there do occur in practice
actual cases of mental disorder in which, without any illusion, hallu
cination, or delusion, the derangement is exhibited in a perverted
state of what are called the active and moral powers of the mind—
the feelings, affections, propensities, and conduct. Experience esta
blishes, so far as experience can establish anything, the existence of
such a variety of insanity, whatever name it may be thought best to
give it. Moral insanity is an objectionable term, because it is not
sufficiently exact, and because it lends some show of justice to the
cavils of those who suspect the design of making out all sorts of
vice and crime to be insanity. But Dr. Prichard never for a moment
thought that a vicious act, or a crime, however extreme, was any
proof of moral insanity; for he expressly insists upon tracing the
disorder in each case to some recognised cause of disease. ‘There
is often,’ he says, ‘ a strong hereditary tendency to insanity. The
individual has previously suffered from an attack of madness of a
decided character; there has been some great moral shock, as a loss
of fortune; or there has been some severe physical shock, as an
attack of paralysis or epilepsy, or some febrile or inflammatory dis
order, which has produced a perceptible change in the habitual state
of the constitution. In all these cases there has been an alteration
in the temper and habits.’
“ Now, if, after a cause that is known to be capable of producing
every kind of insanity, a person in good social position, possessed of
the feelings belonging to such social state, does undergo a great
change of character, lose all good feelings, and, from being truthful,
modest, and discreet, becomes a shameless liar, shamelessly vicious,
and outrageously perverse, then it is surely impossible not to see the
�1866.]
of Psychological Medicine.
407
effects of disease. Or, again, if a person of religious habit of mind,
and hitherto without reproach in all the relations of life, does, under
conditions known in many instances to lead to insanity, suddenly
become desperately suicidal or homicidal, what avails it to point out
that he or she knows the nature of the act, and thereupon to affirm
that there is no insanity ? It were neither more nor less true to
assert that the man whose limbs are painfully convulsed is not suf
fering from disease because he is conscious of the wrong action of
his limbs—because he knows that he is convulsed. But if the evi
dence drawn from its own nature and causation were insufficient, the
fact that it is often the immediate forerunner of the severest forms
of mental disease might suffice to teach the pathological interpre
tation of the condition commonly described as moral insanity, but
which would be better called Affective InsanityP
Dr. Maudsley relates two cases which came under his care and
observation, as examples of such mental derangement without posi
tive intellectual alienation. In the first of them the attack was
clearly traceable to a strong hereditary predisposition, in conjunction
with physical and mental depression arising from the suckling of a
child and from frequent and long absence from home of the
husband.
A married lady, aged thirty-one, who had only one child, a few months
old, was for months afflicted with the strongest and most persistent suicidal
impulse, without any delusion or any disorder of the intellect. After some
weeks of zealous attention and anxious care from her relatives, who were all
most unwilling to send her from among them, it was found absolutely neces
sary to send her to an asylum, her suicidal attempts were so numerous, so
cunningly devised, and so desperate. On admission she was most wretched
because of her frightful impulse, and often wept bitterly, deploring piteously
the great grief and trouble she was to her friends. She was quite rational,
even in her horror and reprobation of the morbid propensity; and all the
fault which could possibly be found with her intellect was that it was enlisted
in the service of the morbid impulse. She had as complete a knowledge of
the character of her insane acts as any indifferent bystander could have, but
she was completely powerless to resist them. Her attempts at self-destruction
were varied and unceasing. At times she would seem quite cheerful, so as to
throw her attendants off their guard, and then would make with quick and
sudden energy a preconcerted attempt. On one occasion she secretly tore
her night-dress into strips while an attendant was close by, and was detected
in the attempt to strangle herself with them. For some time she endeavoured
to starve herself by refusing all food, and it was necessary to feed her by means
of the stomach-pump. The anxiety which she caused was almost intolerable,
but no one could grieve more over her miserable state than she did herself.
Sometimes she would become cheerful and seem quite well for a day or two,
but would then relapse into as bad a state as ever. After she had been in
the asylum for four months she appeared to be undergoing a slow and steady
improvement, and it was generally thought, as it was devoutly hoped, that
one had seen the last of her suicidal attempts. Watchfulness was somewhat
relaxed, when one night she suddenly slipped out of a door which had care
lessly been left unlocked, climbed a high garden-wall with surprising agility,
and ran off to a reservoir of water, into which she threw herself headlong.
�408
Report on the Progress
[Oct.,
She was got out before life was quite extinct, and after this all but successful
attempt she never made another, but gradually regained her cheerfulness and
her love of life. The family was strongly saturated with insanity.
In face of such an instance of uncontrollable impulse—and it is
not very singular—what a cruel mockery to measure the lunatic’s
responsibility by his knowledge of right and wrong! In Dr.
Maudsley’s other case the morbid impulse, not less desperate, was
homicidal.
An old lady, aged seventy-two, who had several members of her family
insane, was afflicted with recurring paroxysms of convulsive excitement, in
which she always made desperate attempts to strangle her daughter, who was
very kind and attentive to her, and of whom she was very fond. Usually
she sat quiet, depressed and moaning because of her condition, and appa
rently was so feeble as scarcely to be able to move. Suddenly she would
jump up in great excitement, and, shrieking out that she must do it, make a
rush upon her daughter that she might strangle her. During the paroxysms
she was so strong and writhed so actively that one person cold not hold her;
but after a few minutes she sank down, quite exhausted, and, panting, would
exclaim, “ There, there ! I told you ; you would not believe how bad I was.”
No one could detect any distinct delusion in her mind; the paroxysm had
all the appearance of a mental convulsion; and had she unhappily succeeded
in her frantic attempts, it would certainly have been impossible to say
honestly that she did not know that it was wrong to strangle her daughter.
In such event, therefore, she ought legally to have been hanged, though one
may doubt whether the juridical farce could have been played out, so pal
pably insane and irresponsible was she.
“ These cases are examples of uncontrollable impulse without mani
fest intellectual disorder; they properly belong to what might be
described as the impulsive variety of affective insanity. It is not
true, as some have said, that the morbid impulse is the entire dis
ease ; the patient’s whole manner of feeling, the mode of his affection
by events, is more or less perverted, and the springs of his action,
therefore, are disordered; the morbid impulse is the outward symp
tom of a deeper lying disease of the affective life, which is truly more
dangerous than disease of the intellectual life, because its tendency
is to express itself, not as intellectual derangement does, in words,
but in actions. Man feels, thinks, and acts; in other words, has
feeling, cognition, and volition. The feelings mirror the real nature
of the individual, and it is from their depths that the impulses of
action come, while the function of the intellect is to guide and to
control. Consequently, when there is perversion of the affective life
there will be morbid feeling and morbid action, which the intellect
acnnot check nor control, just as, when there is disease of the spinal
cord, there may be convulsive movement, of which there is conscious
ness, but which the will cannot restrain. The existence of dangerous
insanity of action and feeling, without marked intellectual derange
ment, is in strict accordance, not only with the physiology of the
�1866.]
of Psychological Medicine.
409
nervous centres, but also with the first principles of a sound psycho
logy ; it is established also beyond all possibility of question by the
observation of actual cases of insanity.
On the Functions of the Cerebellum,.
Dr. Davey has addressed the following letter to the editor of the
*Lancet’ on the Functions of the Cerebellum:—
“ In your review of Professor Owen’s ‘ Comparative Anatomy and Phy
siology’ I find it stated that his views are adverse to the existence of any
relation between the cerebellum and the sexual instinct as maintained by
Dr. Gall, but in favour of its more or less intimate connection with loco
motive power. With reference to this point, perhaps some of your readers
may be interested to know that at the meeting of the British Association at
Bath, in 1864, Mr. Prideaux, a warm advocate of the general soundness of
Gall’s views as to the special functions of different portions of the brain, read
a paper on the ‘ Functions of the Cerebellum,’ in which he adduced evidence
to show that the central and lateral lobes had separate functions; the median
lobe, or vermiform process, being the great ganglion of the nerves of mus
cular resistance, giving a perception of the position of the body and its
relation to gravity, and being constantly developed in the ratio of the animal’s
locomotive power and capacity for balancing the body during rapid motion ;
the lateral lobes being the great ganglion of the nerves of cutaneous sensi
bility, and always developed in proportion to the development of the cuticular
system of nerves.
“ These views were sought to be enforced by a comparison of the nervous
system and physiological manifestations of birds, cetaceans, and bats. The
cetaceans were illustrations of the extreme development of the cuticular
system of nerves, and equally so of the lateral lobes of the cerebellum. In
the porpoise the size of the cerebellum, compared with the cerebrum, was
as 1 to 2J, this unusual bulk being due to the enormous development of the
lateral lobes, which equalled in absolute size those of man.
“ In birds the development of the cuticular system was at a minimum, and
equally so that of the lateral lobes of the cerebellum, which were, in fact, quite
rudimentary, and consisted almost entirely of the root of the fifth pair of
nerves; whilst the development of the median lobe bore the closest relation
to the powers of flight, being as 1 to 13 in the slow gray owl, 1 to 11 in the
crow, 1 to 6 in the swift hawk, and 1 to 4 in the agile swallow. The bat
combined the acute tactile sensibility of the cetaceans with the agility of the
bird; and, in conformity, united the large lateral lobes of the former with
the large median lobe of the latter. In the common pipistrelle the weight of
the cerebellum was ’96 of a grain to a cerebrum of 178, being in the pro
portion of 1 to 1'85.
“ Gall’s mistake in locating sexual feeling in the cerebellum Mr, Prideaux
maintains to be rather an error of inference than observation, the convexity
of the lower fossa of the occipital bone and their protrusion backwards and
downwards being principally due to the development of the under surface of
the posterior lobe of the cerebrum, in the same way as the prominence of the
eye and pouching of the lower eyelid, indicative of philological talent, is
caused by the development of certain convolutions of the under surface of
the anterior lobe resting on the roof of the orbit. Gall’s views on the func
tions of the cerebellum were greatly strengthened by several remarkable
�410
Report on the Progress
[Oct.,
cases of loss of sexual feeling occurring after sabre wounds of the cerebellum
in French soldiers ; and for these cases he was indebted to Baron Larrev.
The juxtaposition of the parts, combined with the known effects of concus
sion of the cerebrum, render these symptoms perfectly compatible with the
location of the sexual feeling on the under surface of the posterior lobe of
the cerebrum.”
Notes of Lectures on Insanity. Delivered at St. George’s Hospital,
by George Fielding Blandford, M.B. Oxon.
(‘ Medical Times and Gazette.’)
Dr. Blandford, the Lecturer on Psychology in the Medical School
of St. George’s Hospital, is publishing his lectures in the 'Medical
Tinies and Gazette.’ Four lectures have already appeared. The
first is introductory, and in it he briefly speaks of the physiology of
that nerve-life and “ brain-life which constitute the mind of man.”
There are two methods of studying the human mind, says Dr.
Blandford, and we presume he refers to the subjective and the in
ductive methods. The latter, he believes, is the only true method.
DIAGRAM.
I.
¿■External events stimulate Cerebrum.
/IDEAS\
Stimuli ) Internal Hlcntal L With consciousness = FEELING------- WILL ..Voluntary ¿Mental.
<•
I Organic.........................
Acts/ (Bodily.
2. Without consciousness
Involuntary ¿Mental (unconscious mental
Acts (. Bodily.
[action).
II.
s™"''
stimulate Sensory Centres... Instinctive movements of man and higher animal«
All acts of invertebrata and lower fishes.
Stimuli i“"“1
< Internal
stimulate Spinal Centres ....Reflex action.
HI.
This diagram is given to show “ that the same thing happens in
the lowest manifestation of nerve function as in the highest intellec
tual act of man; that each act is made up of a stimulus, a stimulated
centre, and a resulting movement. No nerve action has less than
this or more.”
Dr. Blandford then proceeds to show how the functions of the
three varieties of the cranio-spinal system are acted on by this theory
and concludes his remarks thus.
3
The stimulation of any centre may be excessive, disproportionate,
exhausting. . The centre itself may be disordered or disorganized by
the stimulation, or through defect or disease it may be too much or
too little stimulated. The conscious feeling aroused in the highest
ctrcbial centres may be converted into an idea in no way adequate
which does not correspond to the feeling ■ or the idea, when stored
up, may be wrongly joined to other ideas, making the whole train
erroneous, a delusion; and so the will, basing its judgment on these
�1866.]
of Psychological Medicine.
411
false ideas, may carry out acts accordingly, acts which are denomi
nated those of a madman. Disorder may occur in any of these
physiological processes. Sometimes we may be able clearly to point
out the spot. Frequently it will elude us, but it is physiology, and
physiology alone, that can help us to find it, not the examination of
our own self-consciousness.
Dr. Blandford now broaches the question, “ What is the pathology
of insanity ?” By vivisections, and by accidents and disease in man,
we have arrived at the fact that the gray cerebral matter is the seat
of mind. The microscope reveals to us that this gray matter is made
up of minute cells and fibres, connective tissue and blood-vessels, and
that the white substance is formed of fibres connecting these cells
with distant nerve centres and other parts. All these parts are
necessarily nourished and kept alive by the blood, and increase or
diminution in the supply of which causes a proportionate excitation
or diminution in their functions. “ The chemist tells us that the
brain is a highly complex organic structure,” and that it is charac
terised by constant change in the arrangement of its atoms, “ by
rapid recomposition and decomposition.”
Dr. Blandford then proceeds to justify his theory by the facts
stated above, and thus writes:
“ Now, what I have said concerning structure and function may be recon
ciled with the diagram of nerve physiology which I drew at my first lecture.
If you recollect what I said about stimuli and the centres which are stimu
lated, you will understand, first, that where the stimulation of a centre is
excessive, disorder, or even disorganization, of that centre may take place,
with corresponding resulting action, either temporary or permanent;
secondly, that change may from other causes take place in the centre itself,
either from its inherent and inherited tendency to change, or from faulty
nutrition, or injury, or other accidental circumstance, and so disordered
action may result, permanent or otherwise, according to the persistence of
the change. In one of these two ways insanity is, I believe, in every in
stance, brought about.”
Then having briefly enumerated the principal appearances visible
to the naked eye in the heads of the insane opened after death, he
concludes this portion of his subject with the following words :
“We conclude, a priori, deductively, that the nerve-cells and the blood
vessels which supply them must of necessity be affected in cases of insanity,
and our microscopic observations teach us that this is the fact. The nerve-cells
undergo degenerative change, and appear in every stage of decay. Some
times they have lost their transparency, their contents are altered into fatand pigment-granules. Their outline is broken down, and they cease to be
cells, appearing as dark collections of granules. These differ according to
the form and duration of the attack. Much, however, still remains to be
learnt on this head. More attention has hitherto been paid to the cerebral
blood-vessels.
Microscopical examination has shown a thickening of the
walls of the capillary vessels going on to contraction and obliteration, with
atheromatous or osseous degeneration. This may be due to deposit within
�412
Report on the Progress
[Oct.,
or without the vessel. Excess and hypertrophy of the connective tissue of
the brain account, according to some, for this deposit on the vessels, and also
for the obliteration by pressure of the nerve-cells. These changes have been
observed in various forms of insanity, and even in other diseases of the brain.
The study of them bv means of the microscope is still in its infancy, beset
with the difficulties I have already alluded to; yet every year will bring
new results if we do but observe in the right way. The relation between
insanity and the other organs of the body I shall speak of hereafter.”
The subject of Dr. Blandford’s third lecture is the “ Causes of
Insanity/’ He commences thus :
“ The ancients used to vex their souls with metaphysical disquisitions
upon the nature of causes. Everything, said they, must have a material, a
formal, an efficient, and a final cause. Philosophers nowadays have given
up the first three, though they still cling fondly to the last. In medicine
you hear of ‘predisposing’ and ‘ exciting ’ causes; in books upon insanity
they appear as ‘ moral ’ and ‘ physical.’ Now, it must be clearly borne in
mind that the cause of any given case of insanity is the assemblage of all the
conditions which precede and contribute to it, whether they be events or states.
We may talk of causes, or conditions, or antecedent states, or actual casual
events, but it rarely happens that a case depends on one single state or
event; almost invariably there is a concurrence of several, which concur
rence or assemblage constitutes the cause. You will understand how little
events have to do with the production of insanity when I enumerate among
the most important causes that state which is termed hereditary predispo
sition, and such states as age, sex, and civilisation.”
He would therefore seem to divide the causation of insanity into
three classes—the predisposing, the moral, the physical.
The first includes hereditary predisposition, the states of age, sex,
and civilisation, and is a most prolific cause. The second, the
moral causes, are produced by abnormal stimulation of the nerve
centre, and include domestic losses and troubles, grief, disappointed
affections, jealousy, religious and political excitement, fright, over
study.
“ All these,” writes Dr. Blandford, "except perhaps the last, are violent
stimuli of the emotional centres, morbidly exciting the feeling of self, selflove, and self-interest. The balance of the relation which the individual
bears to his fellow-men is upset, and he stands isolated and self-centred.
Yet these events happen to men daily without driving them mad; therefore
we must look upon them as only a part of the cause, the remainder depending
on the constitutional defects of the patient. Often we hear that a man has
had much trouble, or excitement, or disappointment, when in truth, being
saturated with insanity, his own crazy brains have manufactured these socalled causes out of nothing at all, the excitement and worry being all along
subjective, and having no real existence whatever.”
The third, the physical causes, are produced by defect or disease
in the nerve centre through the bodily health. They may be sudden
or they may be protracted over years. They are very numerous, so
much so, indeed, that one noted psychologist (Dr. Skae) bases his
nosology entirely on the physical causes, denying all others.
�1866.]
of Psychological Medicine.
413
Dr. Blandford does not attempt any classification of insanity,
“the mind being too much a unit to admit of a classification
according to its parts.”
He therefore falls back upon the old
time-honoured system of symptomatology of Pinel, who gave but
four—idiocy, mania, melancholia, and dementia.
In his fourth lecture Dr. Blandford treats of “ Insanity without
Delusions—Impulsive Insanity—Transitory Insanity—Insanity with
The first of these, insanity without delusions, which he remarks is
also called “ moral insanity,” “ partial insanity,” “ impulsive insa
nity,” “ emotional insanity,” he illustrates by a case :—“ A city
merchant, past middle age, grave and respectable, suddenly takes to
drinking and low company, becomes extravagant, quarrelsome, gives
up business, takes to horses and riding, of which he knows nothing ;
is, in fact, an altered man.” At last his conduct becomes so out
rageous that he is confined in an asylum, but, although excitable and
rambling in argument, he has no delusion, no intellectual lesion.
This case Dr. Blandford considers a good specimen of manie sans
délire, or, as he calls it, the “ so-called moral insanity” of Dr.
Prichard. He does not give the termination of the case, which
would be interesting, as the symptoms described closely resemble
those so frequently observed in the premonitory stages of general
paresis.
Dr. Blandford considers the term “ moral insanity ” misapplied ;
he does not think there can be such a state as insanity of the feelings
and emotions without corresponding intellectual lesion, and he
believes this proved by the fact that all such cases degenerate into
cases of monomania. Dr. Blandford then refers to impulsive insa
nity, and writes—
“There is, however, another species of insanity at which the public sneers
still more than at the last mentioned, and which, if wrongfully applied, might
unquestionably be made to cover crime even more easily. This is the socalled ‘ impulsive ’ or ‘ instinctive ’ insanity. As described, it consists of a
sudden insane impulse in a previously sane individual to commit a crime,
which impulse ceases as soon as the deed is done, leaving the individual sane
as before ; consequently the crime stands out as the only evidence of the
insanity. This is an exaggerated account of a form of mental disorder which
really exists. A patient consciously, but involuntarily, in spite of every
wish and the utmost efforts of his will, is hurried by an irresistible impulse
to do some act of violence. The impulse in his brain-centres forces him
straight to action, reason and will being powerless to check it. The act is
as automatic and ‘instinctive’ as the acts of lower animals. Such cases
occur, and are seen in asylums ; they are not invented merely for legal pur
poses. The patients are often aware of their propensity, and beg to be
guarded against it. They have no delusions, they do not justify their
crimes ; be the impulse to suicide or to homicide, they deplore it, and seek
treatment and assistance. The diagnosis of such cases must necessarily be
guarded. There is little evidence of insanity beyond the act itself. The
patient’s feelings are not perverted except at the moment, for he bewails his
�414
Report on the Progress of Psychological Medicine.
[Oct.,
state, and often attacks those he loves best. He assigns no motive, but
rationally confesses his inability to resist. Such impulses have been ex
plained by the theory of the ‘ reflex action ’ of the cerebrum, which operates
in a manner analogous to the reflex convulsive action of the spinal centres.
If this does not explain, it at any rate illustrates the disease. It is involun
tary action coming from some morbid stimulation of a nerve centre, with
consciousness, but in spite of every effort of reason and will. Inquiring into
the history of such, we find generally a strong hereditary taint ; possibly
symptoms of head disorder may have been exhibited quite early in life, or
there may have been epilepsy or a blow on the head. It is essential in such
cases to try and discover a cause wherewith we may connect the manifesta
tion of disorder.
********
“ To conclude, cases occur of a spasmodic or transitory mania, during
which acts of great violence may be committed, there being for the time a
visible change in the look and demeanour of the patient, and which may
pass off in a few hours or days, leaving no trace of insanity. There is here
also a morbid stimulation of the cerebral centre, resulting in morbid and
irregular act, without the intervention of the mind proper. The act is not
the result of diseased will, but is independent of will, involuntary, and often
unconscious.”
)
i
Dr. Blandford now considers insanity with delusions, and com
mences by defining the meaning of the three words, delusions,
illusions, and hallucinations. Hallucinations, he says, are false or
fancied perceptions of the senses, as, for instance, when the eye or
ear fancies it sees or hears something when there is absolutely no
thing to see or hear, when, perhaps, it is the time of the darkest and
stillest midnight. Illusions also are false perceptions of the senses,
with this difference, that there is a foundation for them. There is a
noise or there is an object, but the patient thinks it some different
noise or different object from that which it really is. Illusions may
occur to every one. The mirage of the desert, the spectre of the
Brocken, are illusions; but they differ from those of the insane in
this, that a number of persons together will all see them, whereas
the illusion of the insane appears real to him alone; his companions
hear nothing and see nothing, or hear and see things as they really
are, not as they appear to him. A delusion is a false belief of some
fact, not a false perception of one of the senses; it is a categorical
proposition, false by reason of the diseased brain of the person who
believes it, and set down as false by others because it is contrary to
common experience of the laws of nature, or to former experience of
similar things, or is contrary to the knowledge of some or the evi
dence of the senses of the majority of mankind. There is no infal
lible test of delusions, and often when in signing a certificate you
mention one you will be obliged to state how and why you know it
to be a delusion, for many which have been so considered have
turned out to be facts, and not fancies.
We shall renew our notice of Dr. Blandford’s lectures as they
appear. The above is a summary of the four already published.
�1866.]
415
PART IV.—NOTES AND NEWS.
THE MEDICO-PSYCHOLOGICAL ASSOCIATION.
Proceedings at the Annual Meeting of the Association, held at the
The Council met in the Royal Society Rooms at half-past eleven a.m.
The morning meeting of the Association was held at half-past twelve p.m. ;
the afternoon meeting, at three p.m.
Members present:—W. A. F. Browne, Commissioner in Lunacy (President) ;
Sir James Coxe, M.D.,Commissioner in Lunacy for Scotland; Robert Stewart,
M.D. ; John Dale Hewson, M.D.; C. L. Robertson, M.D. ; H. Maudsley,
M.D.; John Sibbald, M.D.; Stanley Haynes, M.D.; W.Wood, M.D.; Henry
Monro, M.D.; W. L. Lindsay, M.D. ; J. Murray Lindsay, M.D.; Ed. Hart
Vinen, M.D.; J. F. Duncan, M.D.; W. H. White, M.D. ; Thos. Aitken,
M.D.; G. Gilchrist, M.D. ; J. W. C. MTntosh, M.D.; James Rorie, M.D.;
J. Crichton Browne, M.D. ; Alex. Robertson, M.D.; J. Bruce Thomson,
L. R.C.S. Ed.; James Rae, M.D. (Deputy Inspector-General R.N.); Charles
Henry Fox, M.D. ; David Brodie, M.D. ; J. T. Arlidge, M.D.; Robert
Jamieson, M.D.; James Howden, M.D.; John Smith, M.D.; AndrewSmart, M.D.; David Skae, M.D.; John Burke, M.D.; Frederick W. A.
Skae, M.D.; James Sherlock, M.D.; J. W. Eastwood, M.D.; Daniel Iles,
M. R.C.S.; J. S. Alver, M.D.; J. Dickson, M.D.; Harrington Tuke, M.D.
Visitors:—Sir John D. Wauchope, Bart., Chairman of the Board of
Lunacy, Scotland; Arthur Mitchell, M.D., Deputy Commissioner; George
Patterson, M.D., Deputy Commissioner; J. F. Wingate, Esq., London;
John S. Butler, M.D. (Retreat, Hartford, U.S. Amer.); J. II. B. Browne,
Esq.; Ernst Salomon, M.D. (Medical Superintend, of Malmo Asylum in
Sweden) ; Dr. Rutherford, Bo’ness; Dr. Wm. Seller, Edinburgh; Edward
Malins, M.R.C.S.; John M'Grigor, M.D. ; M. Munro, Esq.; Russell
Reynolds, M.D.; Sir J. Y. Simpson, Bart., M.D.; John Webster, M.D.;
J. Macbeth, Esq.; Rev. Edwin W. R. Pulling, M.A.; Archibald Hewins,
Esq.; Rev. Henry M. Robertson; David Murray, M.D.; Edward C.
Robertson, M.D.; W. H. Reed, Esq.
Dr. William Wood, the retiring President, said—
Gentlemen,—My race is run, and I am about to descend from the proud
position in which you have placed me during last year, in favour of a much
greater man-—a man well known to you all—and who has so much to say to
you, and in such eloquent terms, that I will not trespass upon your time.
I will therefore simply introduce to you our valued friend Dr. Browne, who
will take the presidency. (Applause.)
The President, on taking the chair, said—
Gentlemen,—I beg to thank you for the honour you have conferred upon
me, in placing me in the Presidential Chair of the Medico-Psychological
Association. I think, instead of dwelling on my feelings of gratitude, and
�416
Noies and News.
[Oct.,
your feelings of kindness in so doing, I had better at once proceed to tell
you what I think Medical Psychology is, and ought to be. (Applause.)
The President then delivered the usual Address from the chair. (See Part I,
Original Articles.)
Dr. Tuke.—I should not rise anywhere else to propose a vote of thanks to
our able President for his address, but I feel that, as a stranger here, I may
be excused for so doing. I feel I can hardly find words to thank our
President as I ought to do, after listening to the eloquent tribute he has paid
to the memory of my dear relative, our friend Dr. Conolly. (Applause.)
I will content myself, therefore, with expressing my own gratitude and
I am sure the gratitude of all of us, for the eloquent address which our
President has just delivered. (Applause.)
Dr. Monro.—I beg to second the motion. I feel that it is a very great
honour to this Association to have had Dr. Browne as our President on this
occasion. We have all listened to his interesting address with a great deal
of pleasure.
Dr. Tuke said—I have letters from several members expressing regret for
their unavoidable absence; among others, from our distinguished French
confreres M. Brierre de Boismont and Jules Falret, also a letter to the same
effect from Dr. Wolff, of Nova Scotia, containing suggestions which have
been laid before the Council. I have, lastly, another letter, a very im
portant one, from our esteemed friend Baron Mundy, who writes to me to
the following effect:—
“ To the Secretary of the British Medico-Psychological Association,
De. Haeeington Tube, in London."
“ Sir,—Having for some years regularly attended the annual meetings of
our Association, you will oblige me in excusing to the Society my absence
from the present one.
“ I deeply regret not being able to attend at a moment when our Association
will undoubtedly celebrate the commemoration of its best member, the late
Dr. John Conolly.
“For my part—I flatter myself you will agree with me—I could have not
done better in following by deeds his often-repeated principles, than by
entering the army of my native country as an honorary surgeon for the time
of this terrible war. That may justify my absence.
“ The bust of Dr. Conolly which I have sent to you is executed by one
of the most renowned Roman sculptors—Cavaliere Benzoni. Be kind
enough to present it to the Association as a humble gift of mine on this
solemn occasion. I leave it to you and to my dear friend Dr. Maudsley
to move, where—with the agreement of the Association—this memorial shall
be placed.
“ Believe me, Sir,
“ Yours very sincerely,
“J. Mundy,
“ Regimental Surgeon.”
“ Pardubitz, in Bohemia;
7th July, 1866.”
I can add nothing to this letter ; it speaks for itself, and I leave its answer
in your hands. The bust to which it refers is before you, Dr. Mundy having
taken especial pains to have it sent from Rome in time for this meeting.
The President.—I deem it altogether unnecessary that I should make a
formal motion that we accept, and accept gratefully, this most suitable
gift and donation from Baron Mundy. As to its ultimate destination, I
must leave that in the hands of the Council of the Association; and I
think we ought to record, in some more than usual manner, our sense of
�1866.]
Notes and News.
417
the appropriateness of the gift, our gratitude for it, and our hope that the
presence of the bust of our friend may not only bring back to the older
amongst us a recollection of all the good that he did and all the kindness
that he displayed, but may in some sense and in some degree animate others
to imitate the noble and glorious course which he so recently ended.
I move that the bust be accepted, and that, in due form, the thanks of the
Association be transmitted to Baron Mundy. (Applause.)
Dr. Wwd.—It is scarcely necessary, but for form’s sake, I second the
motion.
Dr. Tuke.—Iwill take care that the thanks of this meeting and my own shall
he transmitted to our friend for his munificent and thoughtful gift. I think, as
this letter leaves it to Dr. Maudsley and to me to suggest the destination of
this bust, with the agreement of the Association I may propose now a scheme
for the consideration of this meeting. We would ask the permission of the
Association to present the bust of Dr. Conolly to the Royal College of Phy
sicians in London. I have seen the president, Sir Thomas Watson, who will
cheerfully employ his influence with the Fellows to have the bust accepted
as a gift from the Association. If this proposition meets the approval of
the Association, the bust will probably be placed in the Library of the
Royal College of Physicians in London, where the meetings of this Associa
tion, through the kindness of the President and Fellows, have been so fre
quently held.
Dr. Maudsley.—I second the motion.
Dr. Monro.—I was not aware that this bust of Dr. Conolly was about to
be offered to the Association, but I came here intending to make a sugges
tion that a subscription should be inaugurated by this Association to raise a
memorial to Dr. Conolly. I feel that, as we have had the honour of having so
distinguished a man as Dr. Conolly amongst us, it will be one of the best
means of perpetuating this Association to get up such a memorial. I do not
exactly know what the memorial should be; but I have spoken to one or two
of my friends, and I find that they are favorable to getting up some me
morial of Dr. Conolly. I must advert to one or two peculiar reasons why I
have taken the great liberty of coming forward to make this proposal. I
believe I was Dr. Conolly’s first pupil at Hanwell; and since that period I
have been in the continual habit of meeting him in practice, and I have
always received such great kindness from him that I cannot help feeling a
most peculiar gratification in bringing forward this motion. I feel that it
would be utterly beside the mark to enter here into a general panegyric of
Dr. Conolly after the address to which we have just listened. We all of us
appreciate the high character and great worth of our late friend, and there
is no likelihood of his memory being forgotten by any of us. At the pre
sent moment I would suggest the idea of a subscription being commenced
by this Association, which might become a more general subscription or not,
as the gentlemen here may think right. I wish the question to be a little
discussed, whether we should raise such a subscription ; and if so, what the
memorial should be ? I am exceedingly glad to hear the proposal to pre
sent the bust to the Royal College of Physicians of London. That was the
scene of the labours of Dr. Conolly. He used to be constantly at the
meetings of the Fellows there.
The President.—Dr. Monro has permitted me to second his proposition, in
which I most cordially concur, for the reasons he has stated, and even broader
ones, on which I shall not dwell. I think it is desirable that some memorial,
emanating from the Association itself, as an abiding memento of this great
man, should be forthwith set about. As to its nature, and the mode in which
the matter is to be set about, that may be for the discussion and deliberation of
the Society now; and I shall be glad to hear any observations on the subject.
�418
Notes and News.
[Oct.,
Dr. Lowe.—I imagine the suggestion has been made to elicit the opinions
of those present ; but I wish to suggest a doubt whether we are right and
wise in alienating irrevocably the bust which has been presented to this Asso
ciation. (Applause). I cannot imagine any more appropriate place than the
College of Physicians as a temporary locality ; but I think the time may
come when we may value exceedingly for our own institution such a bust as
that (Hear, hear), and I would like to ask whether something might not be
introduced into the proposal which might recognise the possibility of the
return of the bust to this Association.
Dr. Stewart.—I quite agree with the last speaker. I think it would be in
a measure stultifying ourselves to give the bust of the individual whose
memory will ever be respected by us permanently away from the Associa
tion. It struck me, when the proposal was made, as rather a singular one,
that we should hand over to a different body a bust which was presented to
ourselves, and which should be retained by us a memorial of him who has
passed from amongst us. If Dr. Lowe moves an amendment to keep the
bust, I will second it.
Dr. Lowe.—I feel reluctant to take any marked step against the proposal ;
but I am quite ready to do so if it is considered advisable,
Dr. Skae.—Vt may save discussion if Dr. Tuke would modify his proposi
tion to this—that the bust should be placed in the guardianship of the College
of Physicians till the Association has a hall of its own.
Dr. Tuke.—The reason why 1 suggested the Royal College of Physicians
was, that, with great liberality, that body has always acknowledged the ex
istence of our Society, and has invariably allowed us, since Dr. Watson was
president, to meet in its rooms when the Association met in London. I
thought it would be a suitable act of courtesy towards that body; and, at
the same time, I think that the compliment to Dr. Conolly would be greater
than in our keeping it for a problematic hall of our own.
Dr. S/cae.—I think it would be courtesy to the giver that we do not
alienate altogether his gift to the Society, but that we request that the
College of Physicians will take the guardianship of the bust. If Dr. Tuke
would modify his proposal to that effect, I think the Society would at once
agree to it.
Dr. Wood.—I think the terms of this gift seem almost to imply that
the giver intended that the Association should place the bust of Dr. Conolly
in some suitable place. I almost doubt, although I have no authority what
ever for the statement, whether we could with propriety ask the College of
Physicians to keep the bust for us. Seeing we have received various acts of
kindness from them, I think we would perhaps hardly be justified in asking
them to accept the responsibility of keeping the bust for us. Of course,
the feeling of the Association generally is to do the greatest possible honour
to the memory of Dr. Conolly ; and if there is any other place in which
greater honour would be conferred on his memory than the Library of the
College of Physicians in London, I would by all means vote that it should
be placed there ; but it does appear to me that, until we have a local habi
tation, it is a little inconvenient to have the charge of such a valuable
bust—valuable as a very excellent likeness of a very great man, and also as
the work of a very eminent artist, and as coming to us in peculiar circum
stances. I feel assured that, as far as Baron Mundy is concerned, he would
be well content that the discretion of the Association should be exercised in
placing it wherever we think most suitable ; and as it has been left in the
hands of the two sons-in-law of Dr. Conolly to determine where it should
be placed, I think the Association would be paying proper deference to the
feelings of those two eminent psychologists to place it in the Library of the
College of Physicians^ as they suggest. The proposition of Dr. Monro seems
�1866.]
Notes and News.
419
appropriate to this occasion, because in talking over the affair before the
meeting, one of the various forms which were suggested for this memorial
was a copy of that bust by one of the most skilled of our sculptors, which
could be made at any time. For the present, however, it is of the greatest
importance to place the bust where it will be well cared for, and at the same
time that it confers honour on the College of Physicians to present it to
that body, it would perpetuate the memory of a great man.
The President.—I shall be happy to hear any observations from any member
on this subject. I may say, however, that in presenting this bust to the
College of Physicians, not as guardians, but as possessors, we are placing it
appropriately in the hall of that College of which Dr. Conolly was so dis
tinguished a member.
Dr. Monro.—I omitted to mention what was on my mind formerly, that it
had been suggested that a copy of this bust might be taken and retained
for ourselves. In that way we should have the double satisfaction of pre
senting it to the College of Physicians, and thus having it placed in a posi
tion of great honour, and also of having a memorial of Dr. Conolly amongst
ourselves.
Dr. Eastwood.—I would suggest whether it is not worthy of consideration,
whether steps should not be taken for having a permanent place of meeting
for this Association. If this was done, we might keep the bust, and the
place might be called the Conolly Rooms, or the Conolly Institution.
Dr. Dunean.—The idea of a permanent hall at present is out of the ques
tion, although it may not be Utopian at some future period. Probably it
might be advisable to ask the College of Physicians to take the guardianship
of the bust, which practically would be a gift.
Dr. Sibbald.—Might it not be possible to ask the College to become per
manent custodians of the gift ? That would be practically presenting the
bust to the College of Physicians, and at the same time continuing the con
nection between this Association and the bust which Baron Mundy has so
handsomely presented.
Dr. Vinen.—I would suggest that a proper inscription be placed on the
bust, with the name of the donor, and a statement of the circumstances in
which it was presented to the College of Physicians. That would free us of
all difficulties, and, at the same time, defer to the wishes of the two sons-inlaw of Dr. Conolly. (Applause.)
Dr. Tube.—In accepting the gift from us, I believe that the College of
Physicians would not in the slightest degree object to an inscription bein<
*
placed on the pedestal with the names and a statement of the circumstances
under which it came into the possession of the College of Physicians. I now
confess my own feeling of a great desire that the College of Physicians in
London should possess the bust, and I hope the resolution will now be agreed
to in the modified form suggested by Dr. Vinen. (Applause.)
The resolution was adopted unanimously, and it was agreed that the mode
of presenting the bust should be left to the Secretary and Chairman.
Dr. Monro.—I beg now formally to move that a subscription be raised for
a memorial to Dr. Conolly.
Dr. Sherlock.—I am anxious to see numerous copies of this elegant bust;
but, perhaps, some other plan might be suggested of having a suitable tri
bute to the memory of Dr. Conolly.
Dr. Wood.—There is a receptacle for the effigies of our great men. There
is a place called Westminster Abbey; and as Dr. Conolly was one of the
greatest men of our day, I do not know whether it would be asking too
much, if we could raise sufficient money to get a place for a statue in West
minster Abbey. As to the scheme of having a hall of our own, I am afraid
the youngest of us will scarcely see that day. We number at present 200.
�420
Notes and News.
[Oct..,
Suppose our number doubled, our expenses would leave us a small margin
for keeping house ; and if we are to have a local habitation, it must be some
thing worthy of the position we assume. I doubt whether we shall ever be
able to have a better place of meeting than the hall of the College of Phy
sicians in London ; and if we delay doing any honour to Dr. Conolly till
we have a hall of our own, I am afraid we shall never live to see it.
Dr. Monro.—It will be better to refer the matter to a small committee of
the Council, to report next year what subscriptions have been raised.
(Applause.)
Dr. Tuke.—According to the rules of the Association, the place of meeting
next year will be in London ; and the Council would have proposed to-day
the name of a most distinguished member of our body for the Presidency
next year, which we feel sure would have been received with gratification,
were it not that the illness of the gentleman in question prevents us having
the great pleasure of electing him as our President. I refer to Professor
Laycock, whose serious illness we much regret. In the circumstances, the
Council have not named any one as President-Elect, and it is for the Asso
ciation now to nominate a President.
Dr. Skae.—I have not had the opportunity of talking over the subject to
any of my fellow-members to any extent; but I have very great plea
sure in proposing as President for next year our esteemed friend Dr.
Charles Lockhart Robertson. (Applause.) I have great pleasure in making
the proposal. The interest which he has taken in the proceedings of the
Society, and the energy and activity which he has shown in many respects,
entitle him to be placed in the position of President at an early period. I
therefore propose that he should be President.
Dr. Monro.—As an old friend of Dr. Robertson, I beg to second the
motion.
The resolution was carried unanimously.
The President.—The next business is to elect Editors for the Journal; and
I propose that the Editors, Dr. Lockhart Robertson and Dr. Maudsley, be
re-elected Editors of the Journal.
The resolution was carried unanimously.
Dr. Paul was then re-elected Treasurer, and Dr. Harrington Tuke
Honorary Secretary,
Dr. Tuke moved that Dr. Crichton Browne be appointed with Dr. Sheppard
as Auditors, which was agreed to.
Dr. Wood proposed the re-election of Drs. Rorie and Stewart as the
Honorary Secretaries for Scotland and Ireland, which was seconded by Dr.
Maudsley and agreed to.
Dr. Robertson.—There are two vacancies in the Council: we propose to
fill these up by the appointment of our Ex-President, Dr. Monro, and Dr.
Campbell.
Dr. Skae seconded the resolution, which was agreed to.
In the unavoidable absence of Dr. Paul, Dr. Robertson presented the
Treasurer’s annual balance-sheet, which was unanimously adopted.
�1866.]
Notes and News.
421
�422
Notes and News.
[Oct.,
Dr. Tuke said that there had been proposed and seconded the following
list of new Members, twenty-three in number; and he had much pleasure in
stating that among them was the name of Dr. Wilks, the distinguished Phy
sician of Guy’s Hospital, the first who had joined the Association under our
new rule of admitting any member of the profession interested in our
special studies.
Thomas Howden, M.D., Haddington.
Edward Hall, Esq., Blacklands House, Chelsea.
J. H. Hughes, Esq., County Asylum, Morpeth.
G. R. Paterson, M.D , Deputy Commissioner of Lunacy, Scotland.
Evan Jones, M.D., Dare Villa, Aberdare.
Frederick Skae, M.D., Morningside.
W. B. Kesteven, F.R.C.S., 1, Manor Road, Upper Holloway.
F. Maccabe, M.D., District Asylum, County Waterford.
W. Smart, M.D., Allva Street, Edinburgh.
A. Robertson, M.D., City of Glasgow Asylum.
J. B. Thomson, Esq., General Prison, Perth.
Thompson Dickson, M.D., City of London Asylum, Dartford.
Arthur Mitchell, M.D., Deputy Commissioner of Lunacy, Scotland.
J. Shepherd, M.D., Eccles, near Manchester.
W. II. Reed, Esq., County Asylum, Derby.
H. L. Kempthorne, M.D., Bethlehem Hospital.
Ernst Salomon, M.D., Malmo Asylum, Sweden.
David Brodie, M.D., Institution for Imbecile Youth, Larpent, Stirling.
J. B. Tuke, M.D., Fife and Kinross District Asylum.
John Lorimer, M.D., Ticehurst, Sussex.
Samuel Wilks, M.D., St. Thomas’ Street, Southwark.
James Rutherford, M.D., Bo’ness, Linlithgowshire.
J. Hughlings Jackson, M.D., 28, Bedford Place, Russell Square, W. C.
The twenty-three gentlemen were unanimously elected.
Dr. Take.—The following gentlemen have been proposed as Honorary
Members :—The Hon. W. Spring Rice ; Sir James Young Simpson, Bart.,
M.D. ; William Seller, M.D. ; W. Laehr, M.D., Berlin. Their names are
well known to us all, and I need do no more than read the list, which has
been made out and circulated in accordance with our rules.
The Honorary Members were elected unanimously.
Dr. Robertson proposed that Mr. Cleaton, one of the Commissioners of the
Board of Lunacy, should be elected an Honorary Member.
Dr. Maudsley seconded the motion.
Dr. Tuke pointed out that the standing orders required notice to be given
before any honorary member could be elected.
Dr. Robertson withdrew his motion, and, in compliance with the standing
orders, converted it into a notice of motion for next meeting.
The Chairman.—There is a note from Mr. Blake, M.P., which has been
under the consideration of the Council, suggesting that we should present an
address to Her Majesty, praying for the appointment of a Royal Commission
to inquire into the treatment pursued in lunatic asylums towards the insane.
Dr. Crichton Broicne.—Mr. Blake proposes to devolve on a Royal Com
mission the functions already carried out by the General Board of Lunacy.
I do not suppose this Association would wish that there should be any more
inquiries into the subject that might appear to clash with the present Boards.
Dr. Monro.—I think this subject cannot be taken up without an exposition
from Mr. Blake himself of his exact object in making the proposal.
It was agreed that Mr. Blake should be informed that the Association
could not take up the subject without hearing his proposal from himself.
Dr. Tuke.—I have given notice of the following resolution for this meeting :
�1866.]
Notes and News.
423
“ That a diploma of membership should be lithographed for members and
honorary members, to be presented to them on their election.” I brought
this to-day before the Council, who were to some extent adverse to it; and I
have so far modified my original resolution, in consequence of the advice of
our President, so as to make my motion read as follows :—“ That the diploma
of membership should only be granted to members after having been so
for five years.” The reason for that is, that a gentleman may be elected
and take to another profession. I would propose, therefore, that the diploma
should only be given after five years, and that no diploma should be given
to any medical man who is not engaged in our speciality. At all events,
whatever may be decided as to ourselves, I think this resolution should be
carried in regard to honorary members. We have many honorary members,
and I think we might follow the example of our Parisian friends, and send
them a diploma. I have brought this sketch of a diploma, such as that which
I would suggest for the adoption of the Association.
_/)/•. Robertson.—I second the motion.
Dr. Monro.— It is now’proposed that the diploma should be given to those
who have continued members of the Association for five years, and more
especially to the honorary members. Now, I object a little to the whole idea
of this diploma; but I certainly feel that the granting of a diploma to
honorary members is the least objectionable part of this proposition. I agree
with Dr. Tuke that there should be a printed form expressive of the special
honour which is conferred upon the honorary members, but I should not be
inclined to call it a diploma, because, although I believe the real meaning of
the word diploma does not amount to very much, still we are in the habit
of considering a diploma as being granted where special powers are granted,
such as a diploma to practise, and so on. In associations similar to this,
such as the Medical and Chirurgical Society, there is no idea of a diploma, and
I do not see why we, a young and rather feeble Society, should have a diploma.
It is rather grand, and we might have it quoted against us that we were
bombastic in our treatment of the subject. I do not see any special reason
why members for five years should get a diploma. I do not see what use
they could make of this diploma. I presume no member of this Society
would frame such a diploma.
Dr. Tuke.—I do not know why not.
Dr. Monro.—Well, I should rather think it infra dig. for them to do so.
A five years’ member may have only shown his ability to pay five guineas
and his possession of a good moral character. I think it is far too grand a
thing to give to any of our ordinary members. It is not advisable to have
two sorts of members, some holding diplomas and some not holding diplomas.
If there is any real honour in our diplomas it is a little invidious to make
any selection, except in regard to the honorary members. It would be
literally impossible to give a diploma to guinea subscribers, because, suppose
a gentleman subscribed for one year and then gave up, he might use his
diploma as a sort of certificate in applying for the superintendence of an
asylum. I would move, as an amendment, “ That it is expedient that a
printed certificate of membership should be presented to honorary members
on their election.”
Dr Maudsley seconded the amendment.
Dr. Wood.—I sympathise with Dr. Monro’s view of this matter. It is
usual, when anything new is proposed, to hear reasons for it. Now, I am
not aware that Dr. Tuke has given us one reason why we should assume the
importance of issuing a grand certificate of the kind he has exhibited when
our illustrious friends the Royal Society of Edinburgh are content with
such a modest paper as this. There is this objection to our issuing this
diploma. In the first place, a diploma is to be given to men who have gone
�424
Notes and Neivs.
through a certain amount of work, and have fitted themselves legally for a
certain legal status. Now, this testimonial is to be given to men whom,
perhaps, none of us have ever seen, who may be personally unknown to us,
who may be known to just one or two from his official position, sufficient to
enable him to get admission to our Association, and after five years he is
to be considered eligible for this illustrious document. Now, it does appear
to me that if our members are worthy of admission to the Association they
are worthy of all we can do for them, and I cannot quite enter into the
view that they must wait five years before they can be so distinguished as to
receive this paper. Then there is this objection to issuing this official
diploma. It has been mentioned that it is not the most worthy members of
associations who think it worth while to frame and glaze evidence of their
membership, and I can conceive the possibility of such a document as this
being put to other than a most worthy purpose. It does appear to carry
with it a sort of recognition of the individual’s position (hear, hear), which,
perhaps, he may be fairly entitled to. I confess I am more disposed to adopt
the amendment than the resolution. It is reasonable that especially
foreign honorary members should have some distinct evidence of their
admission to honorary membership; but in regard to the ordinary members
it appears to me at least unnecessary, and no good reason has been assigned
why we should depart from the general custom in other associations. While
we were discussing this question in the Council our esteemed friend Dr.
Butler came into the room, and our friend Dr. Tuke referred to him
whether it was not the practice to confer distinction in that form iu the
United States, and he was a little disappointed to hear that there was
nothing of the sort there. I think that, for this year, we may be content
with having an official notification given to the honorary members, but for
the ordinary members there is something invidious in telling a man to wait
five years for a diploma.
Be. Tuke.—I have not the least objection to give it at once to all members.
The proposal to limit it to members for five years was made out of deference
to Dr. Browne’s opinion on the subject.
The Chairman.—I think my recollection was that it should be ten years.
[A vote was then taken, when the amendment was declared carried. The
original resolution was not pushed to a division.]
Lockhart Robertson.—I beg to move “
the Committee on Asylum
Statistics be reappointed, with the view of furthering the adoption of a uniform
system of statistics in the Annual Reports of the Public Asylums of Great Britain
and Ireland, and of our Colonies.” The Association is aware that I have for
some years now been urging their attention to the important question of the
adoption of a uniform system of statistics in the annual reports of public
asylums. At our annual meeting for i860 (held in London) I read a paper,
‘‘ Suggestions towards a Uniform System of Asylum Statistics,” which was pub
lished in the ‘Journal of Mental Science’ for October, 1860. Again, at our
annual meeting for 1864, held at the Royal College of Physicians, I moved
for a committee to prepare a report on this question. This report was sub
mitted at our last annual meeting (1865), and unanimously adopted. The
report is printed in the ‘Journal of Mental Science’ for October, 1865. The
committee on that occasion contented themselves with suggesting six tables
which might serve as a basis for a uniform system of asylum medical statistics.
These.tables were, however, regarded by them “only in the light of a prin
cipal instalment of those which are desirable.” I am glad to be able to
report that these tables of the committee have already met with considerable
success, and have this year been adopted in the reports of many of our county
asylums.
lhe labours of this committee have also been most favorably
noticed by the Commissioners in Lunacy in their last Annual Report to
�1866.]
Notes and News.
425
the Lord Chancellor. I take the liberty of reading to this meeting the ob
servations there made :—
“ The importance (observe the Commissioners) of adopting in all asylums a
uniform system of statistical tables and registers has long been felt by us, and we
are glad to find that the subject has recently been again under the consideration
of the Medico-Psychological Association, at whose last meeting a committee to
whom it had been referred submitted forms of tables which were adopted and
recommended for general use. These tables, confined to medical statistics, are
simple in form, and only include the main and most important facts required to
constitute a basis for more elaborate and detailed information.
“ The superintendents of most county asylums publish in their annual reports
tables more or less elaborate, and containing a large amount of valuable informa
tion. While, however, the facts recorded may be identical in many if not most of
the reports, the form in which they are recorded varies so greatly that it becomes
impossible to tabulate them for the purpose of showing general results.
“ In any future legislation it would no doubt be desirable, as suggested in the
report alluded to, so to revise the present ‘ Registry of Admissions’ as to include
some of the more important particulars required, in order to obtain correct
statistics of insanity. But in the mean time we trust that, with the view of
facilitating statistical comparison, the visitors and superintendents of all institu
tions for the insane will not object to adopt the forms of tables recommended,
which will be found in Appendix (I).
Table 1 gives the numbers of admissions, readmissions, discharges, and deaths,
with the average numbers resident during the year ; the sexes being distinguished
under each head.
“ Table II gives the same results for the entire period the asylum has been
in operation.
“ Table III furnishes a history of the yearly results of treatment since the
opening of the asylum.
“The table also embraces a column for the mean population, or average num
bers resident in each year. In other columns are shown for each year the propor
tion of recoveries calculated on the admissions ; and the mean annual mortality,
or the proportion of deaths, calculated on the average numbers resident. It is of
the first importance that these two principal results under asylum treatment, when
given, should be calculated on a uniform plan, and according to the methods here
pointed out.
“ Table IV gives a history of each year’s admissions ; how many, for example,
of the patients admitted, say in 1855, have been discharged as cured, how many
have died, and how many remain in the asylum in 1865.
“ The value of this table in regard to the vexed question of the increase of in
sanity is evident. The table is adopted from the Somerset Asylum Reports.
“ Table V shows the causes of death classified under appropriate heads. This
form is adopted from the Reports of the Commissioners in Lunacy for Scotland,
with some addition and modification. It appears sufficiently detailed for statistical
purposes.
“ Table VI gives the length of residence in the asylum of those discharged
recovered, and of those who died during the year.
“ Uniformity in recording the ages of patients on admission, the duration of the
existing attack, and the form of mental disorder under which they labour, is also
very desirable ; and it is to be hoped that the medical officers of asylums may see
the great importance of coming to some agreement upon these points. How far
the table of the causes of death may require modification or extension will be a
matter for subsequent consideration.”
In order to carry out the work thus begun, and here so favorably noticed.
I beg to move the reappointment of the former Committee on Asylum
Statistics.
J)r. Maudsley seconded the resolution, which was agreed to unanimously.
The meeting was then adjourned till Three o'clock.
�426
Notes and News.
[Oct.,
Afternoon Meeting. The President.—The first paper on our list is by
Dr. Webster.
Dr. Tube said,—Sir, before the business of the meeting commences I am
anxious to lay before you the following letter, which has just been put into
my hands. Dr. Butler is now present.
“ John S. Butler, M.D., of the Retreat for the Insane, Hartford, Conn.,
and Vice-President of tbe Association of Medical Superintendents of
American Institutions for the Insane, is appointed a delegate from this
Association to the Medico-Psychological Association of Great Britain, which
holds its meeting in Edinburgh, July 31st, 1866.
“John Curwen, M.D.,
“ Secretary of the Association of Medical Superintendents of
American Institutions for the Insane.
“ To the President, Medico-Psychological Association.
“ July, 1866.”
The President.—I am sure the meeting will receive the distinguished
delegate of our sister Association with much pleasure, and I trust that
he will join in our debates. We are glad to welcome him among us.
(Applause.)
Dr. Butler shortly expressed his thanks, and the President then called on—
Dr. Webster, who read the paper of which notice had been given, “ The
Insane Colony of Gheel Revisited.” See Part 1, Original Articles.
The President—I shall be happy to hear any observations that may be
made on Dr. Webster’s paper on the present condition of Gheel.
Dr. Monro.—I would like to know if I clearly understood Dr. Webster to
say that in about a thousand cases there were about five in hobbles, because
I understand that Dr. Webster upholds Gheel as a pattern place.
Dr. Webster.—Not the hobbles.
Z>r. Monro.—I was going to say that in Scotland or England we would
hardly dare to acknowledge that we used hobbles for any of our patients.
I am afraid that looks as if the Gheel system was something not so far ad
vanced as the English system.
Dr. Webster.—You know that though they have hobbles on they can walk
wherever they like.
Dr. Monro.—I do not know, exactly, what hobbles are.
Dr. Webster.—They are a band round the ankle, so that the patients can
not take a long step, but they can take a short step.
The President.—There was another point where I failed exactly to catch
the meaning of Dr. Webster. I think he spoke of the ratio of cures being
69 per cent. I presume that must have been recent cases and selected case”,
because if such be the per-centage in Gheel it is indeed a pattern place.
Dr. Webster.—This return of 69 per cent, refers to the last ten years’
patients, and only to those considered likely to be curable, excluding para
lytic patients.
Dr. Monro.—I should not call 69 per cent, a remarkable proportion if you
only take curable cases.
The President.—Not if you exclude all epileptic and paralytic cases—in
fact, if you exclude all incurable cases.
Dr. Monro.—We have had 68 per cent, of that class of patients cured at
St. Luke’s, but not just latelv.
Dr. Sibbald.—1 have listened with a great deal of interest to Dr. Webster’s
paper, and I do not like to let it pass without making one or two remarks
upon it. I visited Gheel twice myself, and I saw a great deal there that I
�1866.]
Notes and News.
427
thought was very instructive. I think that the principal lesson which may
be learned from Gheel is, that there are a large number of lunatics who may
be treated in private houses outside the walls of asylums, who previous to
recent times were supposed to require the restraint of an asylum. But I
saw at Gheel a great many symptoms of restraint which were certainly worse
than anything you will find in an asylum. I think that such things as these
hobbles, and a great many other forms of restraint which I thought exceed
ingly objectionable, and some of them most cruel, ought to be abandoned.
I think it is a great pity that, at the present time, Dr. Webster has not been
able to report that these things are now done away with in Gheel. Those
patients who are under restraint should not be in Gheel, and they would
not require restraint, and would be much more suitably treated in an
asylum.
Dr. Webster.—I state, in my paper, that the number of patients who have
hobbles were much fewer than on my previous visit. I saw no strait
waistcoats, which I am sorry to say I saw in many foreign asylums. It
must be kept in view that on the Continent many medical men have not
the same objection to force being used as we have in England, though in
many parts of France I found a great improvement in this respect. Those
persons who had the hobbles can walk about, though they cannot go a great
distance. I consider that I have seen worse forms of restraint than those I
saw in Gheel, where the system has greatly improved during the past ten
years, and I have no doubt that ten years hence it will be still further
improved.
Dr. Take.—I think it is much to be regretted that Dr. Webster did not
take up the question whether the Gheel system should not be more generally
followed than it is in England. I think we do not advance the matter by
merely describing Gheel as it is, unless we get some opinion as to whether
the Gheel system is or is not a right system ; and Dr. Webster has carefully
avoided giving such an opinion. 1 think that the Gheel system is not a right
one, and I say so with some hesitation, because I find that the opponents of
Gheel are described by those who advocate it as the opposers of all liberal
movements. Gheel is called—very improperly, I think—a free-air, liberal
system. All that is precisely begging the question. I deny that altogether,
and it is for the advocates of the system to show that it is so, and that it is
successful. Dr. Webster seems to me to have entirely failed in doing that.
He gives too few figures to justify any safe conclusion from them; but he
says that there were about 1500 patients, and that 290 were excluded as
being paralytic or epileptic. I made a note at the time that the cures
amounted, taking the whole cases, to something like 27 per cent. Now, a
proportion of cures of 27 per cent, in a place like Gheel is excessively bad.
The Report of the Commissioners of Lunacy is very imperfect in statistics
of this sort, but I find that the average number of patients received into
small asylums—which I take to be the nearest resemblance we can show
to Gheel—show a proportion of cures of 33 per cent., very much more than
that of Gheel. I do not produce this, of course, as proving anything; I only
say that, if the figures were the criterion, our figures show that the Gheel
system is inferior to the best form of a really more liberal, free-air system
which we have adopted in England. There can be no question that the
proper object of asylum treatment is to give as much liberty as is consistent
with safety to the patient and to the public. The question about Gheel
resolves itself into this—Is the treatment for the pauper poor at all to be
compared with the treatment of patients of a higher rank ? Do the advocates
of the Gheel system wish to treat the two classes together? If they do, I
tell them that the scheme of Gheel is absolutely and entirely impossible. It
is impossible to take people of rank and high social position and send them
�428
Notes and News.
[Oct.,
to a village like Gheel; and for this reason, that not only would there be the
danger of these doing some damage to themselves, but there would be a risk
of their injuring the reputation of their families by some act of folly. That
is one reason why the Gheel system cannot be carried out. But the question
has two sides : the one is, that private asylums can be very much improved ;
and the other is, that Gheel may be very much improved. The system of
restraint at'Gheel stands lamentably in need of improvement; and then there
is the question of medical treatment, which is the most important of all.
The whole question of the treatment of the insane ought to be primarily a
medical question, and it seems to me that if you scatter about 1500 patients,
say in 700 houses, they cannot have proper medical treatment, and without
proper medical treatment I look upon the whole treatment of insanity as
merely a question of board and lodging; and in my opinion, if there is not
proper medical treatment it is equally bad whether the patient is boarded
and lodged in a cottage by himself or in a larger house. My advice to the
advocates of Gheel would be to get up a whole colony of small asylums, and
give the charge of each asylum to a medical man. They would then find the
ratio of cures increasing, and they might some day attain to the rate of
cures to which we have attained in our private asylums in Scotland and
England.
Dr. Monro.—Dr. Webster will, perhaps, be so kind as to answer the question
whether he looks upon Gheel as an example for England, or whether he
looks upon it as at ail equal to theEnglish treatment, because certainly his
account would give the impression that it was very far behind.
Dr. Webster.—Dr. Tuke has alluded to the medical treatment of patients.
Gheel is divided into four sections, each of which has a physician who sees the
patients and attends to their medical treatment. If any serious illness
affects any of them they can be more frequently seen, or they can be sent
to the central hospice. The medical treatment at Gheel is pretty much the
same as elsewhere. These four medical gentlemen are men of experience;
and in addition to the four physicians there is one surgeon who attends to
surgical cases, and a medical superintendent. There are six medical men in
the place, therefore I do not think the medical treatment is at all defective.
It has been asked whether, in my opinion, such an establishment should be
set up in this country. I have no hesitation in saying that it might, but
that there are difficulties to be encountered. You must get proper atten
dants, people that are accustomed to it, and there are few places in this
country where it could be carried out to any extent. When I had the
pleasure of visiting the new asylum at Inverness I understood from Dr.
Aitken that they intended to have a system of that kind there—small
cottages for the patients upon the system of Gheel, though, of course, in a
less extensive form. Gheel is not at all adapted for ladies and gentlemen,
to a certain extent; but it is adapted for a larger proportion of lunatics,
and in such a place as that they are more likely to spend the rest of their
days comfortably. I do not wish to be a strong advocate of the Gheel
system. My eyes are open to the difficulties and objections that may be
urged against it; but I hold that a similar system is very desirable. It is
talked of in Belgium that they are to have another establishment of the
same kind.to the westward. There is one, I think, near Lyons. I have no
hesitation in saying that I think there are strong reasons why such an estab
lishment may be set up in this country, as elsewhere, but of course there are
certain cases for which it might not be adapted. As to the cases, I may say
that 1 mentioned that the average cures at Gheel, excluding general para
lysis, amounted to upwards of 30 per cent.
lhe President.—Thirty per cent. ? To what, then, did your G9 per cent,
apply ?
�1866.]
Notes and News.
429
Dr. Webster.—I said that of 1417 cases the per-centage of cures was 3069
per cent., excluding general paralysis.
Dr. Tuke.—What is the entire number of patients without any exclusion ?
Dr. Webster.—The patients of every description admitted for the last ten
years was 1696, and the cures were 434. Subtracting the cases of general
paralysis and epilepsy, of which none were cured, the average cures of every
form of insanity were about 30| or 30} per cent.
Dr. Monro.—I would ask Dr. Webster whether he does not think that is
a very small per-centage of cures, considering that paralytic and epileptic
cases are excluded ?
The President. — It is equal to the general per-centage of the county
asylums.
Dr. Webster.—It is even greater. It is greater than it was in Hanwell a
number of years ago.
Dr. Monro.—In Hanwell all cases are included.
Sir James Coze.—A great proportion of the patients at Gheel are already
incurable when they are sent there.
Dr. Wood.—Gheel is more strictly an asylum than any of our asylums.
In our asylums we have a considerable proportion of recent cases, greater
than at GheeL I think Dr. Tuke under-estimated the medical care at Gheel,
because, if he compares what is expected in the way of supervision from our
own medical officers, he will find that the patients are amply provided for at
Gheel. Indeed, taking the number of patients and the number of doctors,
I think it is at least equal to what we have in any of our asylums; and if
we compare it to a population extending over any considerable area, we
shall find that it is in excess of what we in England provide for the sick
poor. Therefore, it does not appear to me that the proportion of doctors to
patients is so small as Dr. Tuke would seem to fancy.
Dr. Tuke.—It appears to me that it will be 250 patients for one doctor, or
four to 1000, scattered about in separate houses.
Dr. Webster.—The superintendent is five and the surgeon six.
Dr. Tuke.—Well, take six, and assume that they are all there, I contend that
it is not enough. The system there is, perhaps, the best we can afford for the
poor; but the question is, not what we can afford, but what is best. Now the
Gheel system is not the best. It is of the most vital consequence, if you want
to cure the insane, that the moral influences of the trained, educated mind of
the medical superintendent should be brought as much as possible to bear
upon the wounded and diseased mind. I should think that Dr. Browne’s
recent report of the state of the poor in the Scotch cottages ought to have
settled the whole system of Gheel for years to come. But still, if it is to be
considered proper treatment, let us have it clearly stated, whether it is for poor
or rich, for curable or incurable patients. There can be no question that if an
insane tailor could be boarded with a sane tailor and his wife, and he could
be put gradually to work, that would be infinitely better than to put him to
work with many insane tailors in an asylum, containing a thousand patients.
But is that what can be done ? It appears to me that you should be careful
to decide that question before you destroy our public asylums, because the
advocates of Gheel would in reality destroy our public asylums (cries of
“ No, no.”) Pardon me, I am talking of what 1 know to be true. If a
man says that a certain system is a better one than that now in use, then, if
it be a better one, the better ought to be adopted. We have had it in our
own Journal put distinctly to us that it would be much better that all these
incurable, and paralytic, and foolish, and demented cases should be taken out
of our asylums and put in separate places. Now, there can be no doubt
whatever, I think, that that is very absurd.
Dr. Maudsley. —It is not a question of entirely overthrowing our county
�430
Notes and News,
[Oct.,
asylums, because it is well known that many of them are at present over
crowded, that a second asylum had been found necessary in many counties,
and that in many cases new asylums are proposed for boroughs. It therefore
becomes a serious and important question whether you are to go on extending
asylums in the way you are doing, or whether you cannot in some mode
relieve existing asylums. Now, there is one question that has not been con
sidered here for a moment. What right have you to deprive a man not dan
gerous to himself or others of his liberty by sending him to an asylum? So
long as he is not dangerous to himself and others, and proper medical care
is exercised over him, why deprive him entirely of his liberty ? Why not,
if possible, put him in a cottage with his own friends, or with others who are
willing to take charge of him for a suitable payment ? If he is a pauper, he
will be kept with his own friends at small expense. But it is not entirely a
question of expense either. If the man is hopelessly incurable, so long as
he is not dangerous to himself or others, that man has a right to the greatest
amount of comfort he can have. If he can have that in a cottage, then,
though it costs a little more there than in a county asylum, we ought to give
it to him. No one would speak of setting up in England the Gheel system
exactly. The population is too crowded in this country, the land too valu
able, and it would be practically impossible to do so. But the practical
question is whether, with so many asylums overcrowded, we cannot find any
other system; and whether this cottage system may not afford us the re
quired outlet for a certain class of incurable but harmless patients.
Dr. Crichton Browne.—How can Dr. Maudsley arrive at the fact that
a lunatic is not dangerous ?
Any day a lunatic may be liable to com
mit serious acts of violence. We have had lamentable instances of this
recently in this country; and it is not very long since a case of that
kind occurred in this city. So far as I know, there is no test by which we
can arrive at the knowledge as to whether a lunatic is dangerous or harmless.
As to medical treatment, that objection is scarcely fair, because if you go to
large county asylums you will find a large number of patients not subject to
medical treatment of any kind. Sometimes patients in these asylums are
not seen by the medical men because they are working out, and are not sub
ject to medical treatment. Of course, in the case of patients whose disease
has been chronic for ten years, it would be absurd to place them under me
dical treatment. There are no means known by which we can combat chronic
insanity in that stage, except by those general moral principles that regulate
an asylum. These are, of course, of great value; but I am not sure that
the moral agencies brought to bear in some homes and private cottages are
not still more valuable. I have not visited Gheel, and had no intention of
discussing it here. I would just mention an experiment I made during the
past winter. I had a small asylum of 120 patients. I selected ten patients
from the quietest, the most harmless, and the most inoffensive, and determined
to give them as much of the free and open-air system as possible. I allowed
them to go out every day on parole to their friends, and they had perfect
freedom to go in every direction within certain restricted bounds. Well,
within a month I had to withdraw that liberty in four instances. They
were the best patients I had, and vet I had to withdraw that liberty because
they grossly abused it, and complaints were made to me of their conduct.
Now, that certainly suggested itself to my mind that, if these very best
patients gave way when they were still subjected to a certain amount of
discipline, and knew that their conduct was watched, and that their privilege
would be withdrawn if they gave way, it was not at all a satisfactory stale
of things, and did not tend to give one confidence in the Gheel system.
Dr. Wood.—I heard with some surprise the doctrine which Dr. Maudsley
has mooted, which is one directly opposed to the teaching of our great Dr.
�1866.]
Notes and News.
431
Conolly. He will remember a yery remarkable case that was some years a»o
tried in the Court of Exchequer in London, when the Chief Baron held the
doctrine which Dr. Maudsley seems now to hold. That doctrine was con
sidered to be so opposed to the experience of all those who practised in
London that Dr. Conolly took it upon himself to publish a pamphlet on the
subject. The Lord Chief Baron held, as Dr. Maudsley appears to hold now,
that we were not justified in curtailing the liberty of an insane person if he
is not dangerous to himself and society. Now, I think there cannot be a
more dangerous doctrine. I thoroughly agree with what Dr. Crichton
Brown has said on that subject. We never know when an insane person is
dangerous, or at what moment he will become so ; and I think it must be
clear to Dr. Maudsley’s experience that many patients conduct themselves
with great propriety in an asylum and yet when at large become dangerous
lunatics. He shuts out of view some most important points. What is to
become of a patient who, though not dangerous in the ordinary sense of the
word, is so far dangerous in a moral sense that he may ruin himself, his
family, and all belonging to him. Insanity is a disease which requires treat
ment in all cases, and that treatment, I maintain, can only be properly car
ried out by placing him under control. I apprehend there is a danger even
greater than that which results from physical violence ; and, in considering
this question, we are apt to overlook one of the most important considera
tions of all. It is this, that a man who is in the prime of life and is beget
ting children is in a condition where he may propagate an insane race;
and, I think, in such circumstances it behoves us, as philosophers, seriously
to consider whether we are justified in placing a man who is avowedly in a
condition of disease in circumstances that will enable him to propagate a
diseased race. That has often struck me as one of the most important con
siderations in withholding liberty from patients who otherwise mi'dit be
trusted. And I must say that in my own personal experience it has often
influenced me in recommending the friends of patients to retain them, though
they might not appear to be dangerous to society in the common sense of
the word.
Dr. Maudsley.—Dr. Wood has been speaking to some extent under a mis
understanding of my meaning. It was no intention of mine to advocate the'
sending of patients out of asylums without, any control. The system I advo
cated was that of sending patients to reside in cottages.
Dr. Wood.—But you raised that question as to control.
Dr. Maudsley.—Yes. I raised that question, and I think it is important.
If you get an incurable patient, and see that he is incurable, and neither
dangerous to himself nor others, my question was, why should you shut
him up in a county asylum for the rest of his life ? Put him in a cottage
and allow his friends 5s. or 6s. a week to support him and take care of him,
and arrange for the doctor and the Commissioners of Lunacy to visit him :
see that he has proper superintendence. That would relieve your over
crowded asylums, but I never contemplated allowing insane persons to be left
entirely without control.
Dr. Wood.—I was speaking of a proposal to leave persons without con
trol. I have not the slightest objection to putting them in cottages if it can
be arranged that they shall be under control.
Dr. Alexander Robertson (Glasgow).—I may state as a fact, which is of
some importance in such a discussion as the present, that in the city paro
chial board a certain portion of selected patients whom I judged to be harm
less were sent to cottages in the country to reside there, and have now
been residing there for four years, and at our last inspection we were
altogether well pleased with their condition. The question was put to
almost the whole of them if they desired to get back to the asylum, and
�432
Notes and News.
[Oct.,
not one of them had such a desire. It is right to say that six months a«-o
we had to bring; one back who had been found to be improperly cared for,
but the person into whose care he had first been given had died. We are
so much pleased with that system in Glasgow that we are disposed to extend
it. I think that fact is of importance.
Dr. Crichton Browne.—I would ask Dr. Robertson if the Glasgow asylum is
not an aged structure of a rather dismal description—whether it is such a
building as that few persons would desire to return to it ?
Dr. Alexander Robertson.—Certainly we cannot contrast our building
favorably with the new institutions ; but with the aid of the Commissioners
it is now brought to a pretty good condition. The patients are boarded out
with cotters. There are several men and women. They reside there apd
work on the farm. They come to have an affection for their guardians, ot»d
the guardians have the same for them, and this proves that such patients can
be selected and trusted there without anything wrong occurring. We have
nine out of the small number of 150. In addition to that, I have selected
some six more to be sent to houses selected by myself.
Dr. Monro.—I have not had any prejudice one way or another as regards
this subject, because I am afraid I do not know sufficient about it to form a
very strong opinion ; but when I heard Dr. Webster read his paper I pre
sumed he was reading a paper about something which he esteemed a pattern
and example for others to follow. The few things that especially caught my
attention were matters such as that about the hobbles. I do not want to
make too much of that. But certainly the cures seemed to be an exceed
ingly small per-centage. I should say that fact after fact in Dr. Webster’s
paper seemed to intimate to me, who call myself an unprejudiced person,
that the asylum was not succeeding, and yet 1 presume Dr. Webster read
the paper in favour of that system. Then Dr. Maudsley spoke exceedingly
strongly as to letting every chronic insane person who is not actually dan
gerous have all the enjoyments of life.
Dr. Maudsley.—As many of the Chancery patients have.
Dr. Monro.—Now comes a very important question, which I think should
have been settled some time ago. Is it a more enjoyable thing for an insane
patient to be in the hands of a farmer or poor cottager than in one of our
county asylums? I think that that system of boarding out of workhouses,
to which this system is very like, was looked upon as a thing quite exploded.
I do not say the Gheel system is not a great deal better than that one, but
still that is a point that was gone into before asylums were built to meet the
great evils which existed then. Dr. Maudsley speaks of the comforts of
those poor people. Of course, those of them who happen to fall into the
bands of kind cottagers or kind farmers, and who are not obliged to hobble
or to wear strait-waistcoats may be exceedingly comfortable, more so than
in asylums. But I cannot conceive how a system which has a certain per
centage of things which we have utterly given up because we look upon
them as cruel can be considered a system which is kind to the poor and
allows the chronic insane to have the ordinary enjoyments of life.
Dr. Howden.—M\ e are all, no doubt, aware that a certain number of insane
people may live in cottages ; but before putting very much value on the liberty
enjoyed by those who live in those cottages, one would require to know more
about the. condition of these people. The cases referred to by Dr. Robertson
have additional interest on account of their having been drafted from an
asylum, though, in regard to what Dr. Maudsley has referred to, taking the
question in the abstract, as to whether we have a right to deprive an insane
person of his liberty unless he were dangerous to himself or others, it
appears to me that we deprive him of his liberty as much by putting him in
a cottage as in an asylum, and that the question is simply whether he is
�1866.]
Notes and News.
433
better managed in an asylum or a cottage. In the asylum with which I am
connected I have five cottages in which I occasionally board patients. There
are always four or five patients boarded in these cottages, and they are under
my own supervision, on the farm connected with the asylum. In some cases
I have the greatest.satisfaction in having the patients boarded there. In
cases of convalescent insanity, in particular, I think the system of placing
the patients in cottages, under a sort of supervision, before they are discharged
altogether, is a very desirable one. At the same time, 1 must state that I have
always great difficulty in getting patients to go to these cottages out of the
asylum. I do not like to put imbecile patients, totally unable to take care of
themselves, into cottages. I think they are better in an asylum, and I
must say that I have always had difficulty in getting the other patients to go
info those cottages who would be most likely to benefit by being in them.
Generally speaking, they prefer being in the asylum. That must be because
they find themselves more comfortable in the asylum. I think that we
will all agree that we ought to put the patient where he is best, and I
agree with Dr. Maudsley to this extent, that if the patient is better in
a private house by all means have him there; but if not, have him in an
asylum.
Dr. Sibbald.—I think we cannot lose sight of the lesson which we are
taught by Gheel, that there are many patients who can be very properly placed
in cottages, although there are many imperfections in the way in which Gheel
is managed at present, and although there are many patients there who, I
believe, none of us would approve of being there. With regard to the
remarks which have been made as to the difficulty of deciding what patients are
not dangerous either to themselves or others, there is, I think, no more diffi
culty in that than there is in deciding that a patient is dangerous to himself
or others, which every medical man has to do when he signs a certificate for
confining a patient in an asylum. The one question is just as easy of de
cision as the other. And in the public asylums, which are growing larger
and larger every year, there can be very little doubt, I think, that there is a
large number of cases which, if they were not in asylums at the present time,
would not now be placed in asylums; but from the fact that they are in
asylums at present the superintendent does not like to take the responsi
bility of saying, “ This case may be put out.” He says, “ Keep them in.”
I think if some means could be adopted whereby these patients might be
experimented upon—as is the case to a considerable extent in Scotland at
present—such a course would be productive of good both to the patient
*
and to the country generally.
Dr. Arlidge.—The great question of the day is what to do with the lunatics.
They keep growing on our hands. They grow by accumulation in w.ry
asylum, especially pauper lunatics, and therefore it becomes a grave ques
tion what we shall do with many of them. Those who belong to asylums
know that a large number of the inmates are doubtful inhabitants of asylums;
they have been put in many years ago, and they remain there, because they
have been once placed in an asylum; and the great question of the day is,
whether we shall go on constructing county asylums at an enormous ex
pense, as heretofore, or whether we shall adopt a new scheme in providing
for a certain class of pauper patients? With reference to providing (or a
certain class of patients, Gheel is of value in showing what might be done.
We cannot commend Gheel as a model to be actually followed, but the
proper course is to take out of Gheel what is valuable and adapt it to the
wants of this country. Dr. Webster has properly pointed out that Gheel
has been an insane colony for some hundreds ofyears. The whole population
of that little commune has grown up acquainted with the habits of lunatics ;
but we have no place in England which has the seclusion of Gbeel, or which
�434
Notes and News.
[Oct.,
has a population adapted to take charge of lunatics. We know that in this
country the great body of the population has numerous prejudices and fears
in regard to lunatics, and we could not possibly intrust even the most harm
less of our lunatics to them. The main importance of a discussion in reference
to Gheel is that it may lead us to the discovery of what is valuable in the
Gheel system and adapt it to our wants. It has occurred to me that we
might in some way adapt it by relieving some of our asylums of a proportion
of their patients, and placing them in cottages, under the supervision of the
attendant of the asylum. At the same time let these cottagers, if practicable,
be old asylum attendants, or others who may take their discharge from the
asylum and settle themselves in the neighbourhood. That would allow a
colony gradually to grow up. The example of Gheel has been of weight on
the Continent, and there is a strong tendency to reproduce Gheel in some
form or other elsewhere. Dr. Webster has mentioned that the Belgian
Government is about to institute another similar colony, and in France there
is a great disposition to imitate it. In France we have experiments going
on, showing what can be done in the way of dealing in cottages on detached
farms with lunatics for whom accommodation used to be provided in asylums.
Remarks have been made as to the proportion of cures. As Dr. Monro
rightly says, if you exclude all epileptics and general paralytics, 30 .} is cer
tainly a small per-centage. During the time I was superintendent of St.
Luke’s Hospital we exceeded 70 per cent, of cures.
Dr. Monro.—And it was 68 per cent, for many years running.
Dr. Arlidge.—If you read the reports of the American asylums they will
tell you that they can cure 90 per cent.; but that is partly accounted for by
their receiving cases of delirium tremens, and turning them out cured, so
that we cannot compare their cases with our own. As to curable cases, I
think there is a great defect in Gheel in not making special provision for
curable cases. Boarding out is not so well adapted for cases of recent
occurrence. These cases ought to be brought to an infirmary in the town,
and that plan is to be carried out.
Dr. Webster.—It is being carried out.
Dr. Arlidge.—The restraint that exists at Gheel is of small moment indeed.
We must remember that on the Continent medical men have strong preju
dices in favour of using restraint. Those men who put on hobbles would
say—“ It is much better to allow these men to walk about in hobbles than
to shut them up within the walls of an asylum.” Now, I do not advocate
restraint; but there is a measure of truth in that view, and it must not be
lost sight of. If there is restraint at Gheel you must put it down to the
habits of thought of medical men on the Continent. If medical men were
transplanted from England to Gheel, I dare say they could see how to do
away with the hobbles and with all restraint.
This closed the discussion.
Owing to the lateness of the hour, the other papers on the programme
were held as read.
Dr. Tuke.—I beg to move that we tender our best thanks to the Royal
Society of Edinburgh for the use of this hall.
The President.—May I suggest that our thanks should likewise be tendered
to the Royal College of Physicians, who offered their Library for our
meetings.
The motions were unanimously adopted.
On the motion of Dr. Monro, the following gentlemen were appointed as a
committee for promoting a memorial to Dr. Conolly :—The President and
council, and the past Presidents, with power to add to their number.
Dr. Tuke.—I beg to move a vote of thanks to our esteemed President, who
has presided over this long sederunt with so much kindness and courtesy,
�1866.]
Notes and News.
435
and who has given up so much time in attending to the private affairs of
this Society.
Dr. Webster seconded the motion, which was carried by acclamation.
The proceedings then terminated.
Annual Dinner.—The annual dinner was held in the evening, at the
Douglas Hotel, St. Andrew’s Square. There was a large attendance, and
the quality and style of the dinner and wines were of the very best. Amon«the guests of the evening were :—Sir J. D. Wauchope, Bart., Chairman of
the Scotch Lunacy Board ; Sir James Y. Simpson, Bart., M.D.; Dr. Seller;
the President of the College of Surgeons; the President of the College of
Physicians; Dr. Russell Reynolds; Dr. Gillespie; Dr. Argyll Robertson;
Dr. Webster; Dr. Butler (U.S.); Dr. E. C. Robertson; Rev. H. M.
Robertson. Sir James Coxe was also present in his right as a Member of
the Association.
In consequence of the very severe and serious illness of Professor Laycock,
the Medico-1 yschological Class connected with the University of Edinburgh
was conducted, for the greater part of the Summer Session, by Commissioner
Browne. By a happy coincidence the course was concluded and the prizes
awarded upon the eve of the meeting of the Medico-Psychological Society,
so that a number of its members and nearly all its officers were enabled to
be present.
After a Lecture on “ Hereditary Tendency to Mental Disease” had been
delivered, and strong commendation bestowed upon the diligence and.
interest displayed by the class—amounting, we understand, to about thirty
■ and upon the ability and industry of those who had especially distinguished
themselves, as attested by Drs. Seller and AV. Robertson, assessors to the
University, to whom the competitive clinical papers, essays, &c., had been
submitted, the prizes were delivered by Sir John Don Wauchope, Bart.,
Chairman of the Board of Lunacy, Commissioner Sir James Coxe, Professor
Balfour, &c.
Sir J. D. Wauchope, in presenting the prizes, expressed the satisfaction
which he experienced in being present on this occasion; his desire to
encourage such means of instruction in the study of mental disease as were
afforded by this class; and his conviction that holding the position which he
did he was performing a public duty in sanctioning all efforts to diffuse
knowledge which was calculated to diminish the numbers of the insane and
to ameliorate their condition.
The members of the class were then invited to attend the meeting of the
Association on the following day; a privilege of which they availed them
selves.
PRIZE LIST.
Class of Medical Psychology and Mental Diseases.
For Excellence in Clinical Examination (Dr. Gilchrist’s Prize).
1. Carlo Malan.
For Excellence in Written Examinations (University Medal and
Dr. Browne’s Prize).
1. John Macbeth.
Best Essay on “ Le Pitit Mai” (additional Prize from Dr. Browne).
1. Thomas Lauder Brunton.
�436
Notes and News.
[Oct.,
For Excellence in both Clinical and Written Examinations
(Certificates of Honour).
1. John Macbeth.
2. Carlo Malan.
3. Thomas Lauder Brunton.
4. William J. Williams.
5. William Munro.
6. Alexander R. Haughey.
T. LAYCOCK.
The Honorary Secretary has received the following letters, which he desires to
communicate to the members of the Association.
“ 1, Harrington Square, London, N.W. ;
“ 19/Zt July, 1865.
“ Mi .dear Sir,—I beg to acknowledge the honour conferred on me by
the Medico-Psychological Association, in electing me one of their honorary
.members ; and if at any time it should be in my power to forward the
interests of the Society I shall be pleased to avail myself of the opportunity.
“Accept my best thanks for your kind personal expression of good-will.
“ Believe me, yours faithfully,
“W. H. Wyatt.”
“ Dr. Tuke.”
“ 2, Savile Row, Burlington Gardens ;
“ 28<A September, 1865.
“ Dear Sir,—On arriving from Italy a few days ago I had the honour
of receiving your esteemed communication of the 12th inst., informing me
that the Medico-Psychological Association had conferred on me the distinc
tion of an honorary membership ; I feel, I assure you, very proud of this
honour, and beg you will take the first opportunity of conveying to your
Association my warmest thanks for their kindness.
“ It is a great satisfaction to me to find my very humble efforts to
ameliorate the condition of the insane approved of by such a body as yours,
and will be an encouragement to me to do all I can to forward the noble and
humane objects of the Association. I have just been visiting some of the
Continental asylums, with a view of obtaining additional information to assist
me in forming some legislative measures relative to public lunatic asylums
next session.
“ I beg you will accept for yourself my best thanks for the kind courtesy
with which you conveyed the resolution of the Association to me.
“ I remain, dear Sir,
“ Yours very truly,
“ John A. Blake.”
“ Harrington Tuke, Esq., M.D.”
“ Stabilimento Sanitario in Milano presso St. Celso ;
February, 1866.
“ Most honorable Sir,—I am very sensible to the honour that the
eminent Medico-Psychological Association of England has done to name me
between their honorary members. Whilst I tried, as I could, to demonstrate
to my countrymen the elevated scientific merits of the honorable English
�1866.]
Notes and News.
437
alienist physicians, I have, too, experienced their great kindness and goodness
for me.
“ I beg you, Sir, with all my thanks, to tell my feelings to the eminent
Association of which you are the noble general secretary.
“ Heartily and respectfully,
“ Your most obedient servant,
“ Dr. Biffi.”
“ Vienna ; 18/7t February, 1866.
“ Dear Sir,—By your letter of January 1st, which I have received on the
10th instant, you kindly informed me that the last meeting held at the ltoyal
College of Physicians did me the honour to select me an honorary member
of the Medico-Psychological Association.
“ I am desirous of expressing my grateful sense and high appreciation of
this honour, and pray have the kindness t» transmit my sentiment of warmest
gratitude to the Association.
“ I am, Sir, truly yours,
“Dr. L. Schlager,
“ Professor of Psychiatrie at the University of Vienna.”
“ Monsieur
et
très-iionoré
“ Gheel, le 22 Février, 1866.
Confrères, — J’ai l’honneur de vous
accuser réception de la lettre par laquelle vous m’annoncez mon agrégation
comme membre honoraire de l’Association Médico-Psychologique de Londres.
“ Cette marque de haute distinction m’honore et m’encouragera dans
l’accomplissement de la mission humanitaire qui m’est dévolue. Par mon
dévouement, je tacherai toujours de me rendre digne de votre savante et
philantropique Association.
“ Monsieur, et trcs-honoré Confrères, veuillez à ce sujet agréer person
nellement et exprimer à vos estimables collègues mes sincères remercîments.
Veuillez croire à la parfaite estime et à la haute considération, etc.
“ Votre dévoué Confrère,
“ Monsieur Harrington Tuke,
“ Dr. Bulcklns.’’
“ Docteur en Médecine, etc., Londres.”
The Want of Education in Physical Science.
To every man abhorrent of waste, the thought that thousands of his fellowcountrymen have received no useful training must prove a source of frequent
and deep regret. It is a trite remark, that while we devote our utmost
energies to the improvement of bullocks and sheep, we leave God’s last and
greatest work—man—too often untended and uncared for. The stimulus
to improve the breed of cattle lies in the immediate gain to the owner; but
the benefit to be derived from the improvement of the human race seems to
lie too remote from individual interests to excite the necessary sympathy,
unless exceptionally, in the breasts of philanthropists. Yet we are not an
inhumane people. We spare no cost to provide hospitals, asylums, poor
houses, and jails, for the care and recovery of our less fortunate brethren ;
and we appoint inspectors and commissioners to watch over and report on
the manner in which these establishments are conducted. So far, so well.
But, in spite of all this labour, a fear, strengthened by a consideration of the
VOL. XII.
29
�438
Notes and News.
[Oct.,
results, will nevertheless intrude that our exertions are in the main un
successful, and that our work of reform has been begun at the wrong end.
What should we think of a railway company which, instead of doing its best
to secure locomotives of the best material and most durable construction,
was to accept them from the maker, however indifferent in quality, and be
satisfied with fitting up a variety of workshops for their repair? No man
would have any difficulty in perceiving that this procedure was at once
short-sighted and ruinous. But it never seems to occur to our legislators
that sickness, insanity, pauperism, and crime are far more likely tcTbe suc
cessfully met and counteracted by measures calculated to ensure at starting
a healthy mental and bodily constitution, than by endeavours to restore this
condition after it has been destroyed by neglect. Every one, in the abstract,
admits the value of training. A trained dog, a trained horse, a trained
seivant, a. trained mechanic, a trained soldier, a trained physician, are all
valuable in their individual capacities through their training, and their
services aie estimated accordingly. But the training to an art is special in its
nature, and is a very different thing from that general training to which the
whole population should be subjected. A man may be a good ploughman,
a good watchmaker, or a good lawyer, and yet lack that knowledge which
will protect him from falling into sickness, insanity, or crime. The general
standard by which a man s education is estimated, is his capacity to read and
write; and, accordingly, in our Parliamentary blue-books, criminals, or
soldiers, or sailors, are classified as well- or ill-educated, according to this
test. But a man may be able to read and write with the utmost ease, and
yet be destitute of all knowledge of the simplest facts of science, and know
no more of the. manner in which he ought to live in order to secure his
mental and bodily health than the babe which was born yesterday. Bevond
a doubt, a man who. can read and write is armed with a very powerful
weapon foi the. acquisition of knowledge ; but pci' sc reading and writing are
merely extensions of the means of communication—facilities for hoFding
.intercourse with those who are absent. To what extent they are practically
useful will depend upon circumstances. One man has leisure and inclination
to read; another has neither the one nor the other. To the latter, accoidingly, the talent is of little use; and in neither does it constitute an
exact test of knowledge. Who does not look back on his schoolboy days,
and grieve over the little useful knowledge he then acquired, and wonder
that a system which aimed.principally at imparting a knowledge of dead
languages, of superseded religions, and of the manners and customiof extinct,
peoples, should still successfully struggle against the general introduction of
the study of living languages, of existing faiths, and of the laws and customs
of modern nations ? How few boys are there among those who have com
pleted the curriculum of even our best schools, who have any knowledge of
physical science and of the laws of health ; who can tell why they breathe,
or on what circumstances the normal performance of the function of respira
tion depends; who can give reasons for the necessity of ventilation; who
have, in short, even the rudimental knowledge necessary for the preservation
of their own health! How few are there who are acquainted with the
political and social constitution of their own country, who have any clear
ideas on the subjects of municipal government, church establishments, the
support of the poor, or the punishment of crime 1 How few who know any
thing of the past history of the earth, and of the wonders revealed by the
stones on which they tread ; how few who can read the book which nature
displays in the wood or in the meadow, on the mountain or on the shore !
A consideration of facts like these must show to every thinking man how
limited, how scanty, and how unsatisfactory must be our present system of
education.
�1866.]
Notes and News.
139
And if such be the results even among the so-called educated classes, what
state of matters can we expect to find among those who have been allowed
to grow up in ignorance, and too frequently in vice ? Who can walk through
the poorer districts of our large cities without a feeling of indescribable sad
ness over the wasted lives and energies of the miserable creatures he sees
on every side, who are reduced to a state of degradation such as is seen in no
other European country ? But alarm as well as pity may well be felt, for
the question cannot fail to present itself whether, with so large a mass of the
population so steeped in ignorance, so deficient in moral and intellectual
culture, so little acquainted with the duties and responsibilities of a loyal and
a Christian people, and with so little to lose in the event of civil strife or
convulsion, we are not sleeping on the brink of a volcano which, although at
present in repose, may at any moment break out in a fearful and devastating
eruption ? From time to time we hear of endeavours to provide for the
general education of the people; but opposition arises, and nothing is done
because we cannot agree on the religious tenets that should be taught by
the State. True, the proposal has repeatedly been made, that secular
knowledge alone should be imparted at the public expense; but hitherto it
has always been suppressed in a shout of horror against godless and infidel
training. And so it happens that year after year nothing is done, and a
population is left to grow up around us which fears not God and respects
not man. Every Sunday the clergy in their pulpits pray for blessings on
this corner of the Lord’s vineyard, and return thanks that their lot has been
cast among a loyal, a happy, and a religious people. Are they in reality
proud of the condition of those portions of the Lord’s vineyard which are
comprised in the Cowgate and Canongate of Edinburgh, or the Salt Market
and High Street of Glasgow ? Do they ever ask themselves how many
heathens are living in this Christian land—not the quiet, respectable heathen
of a pagan country, but the neglected outcasts of our boasted civilisation ?
Shall this state of matters be allowed to continue until some fearful con
vulsion shall shake the foundations of society and expose the rottenness of
our social fabric, even as we have seen the rottenness of the social and
military system of Austria brought to light ? Wherein lies the secret of the
success of Prussia in the recent contest? In the needle-gun? Yes, to a
certain extent; but the needle-gun, be it remembered, was placed in the
hands of educated and intelligent men, whose triumph was the triumph of
knowledge, and of the loyalty and national spirit which knowledge imparts.
That national spirit exists among us, the volunteer movement has sufficiently
proved; but this movement has not reached, and cannot reach, the lowest
strata of the people. In Prussia, education is compulsory. Every man is
brought under its influence; and herein lies a mighty instrument for impart
ing national sentiment and national virtue, and a power of co-operation in
circumstances of difficulty and danger. In the Northern States of America
we have recently seen an equal exhibition of national power springing from
similar sources; and we have all heard how strongly national sentiment,
although too often exclusive and bigoted, is fostered in these States by the
lessons of the school.
'
Every man in the narrow sphere of his business and of his home can
appreciate the value of education and training in his assistants and his
servants. Skilled labour everywhere commands a higher price than that
which is unskilled. The trained man is more valuable than the untrained,
and an educated people must thus necessarily be possessed of sources of
wealth and power and strength far beyond those of a people who is untrained
and ignorant. Every year immense sums are spent in improving our ships
and our guns, which are merely the inanimate instruments of our defence,
and will certainly fail us in the hour of need, unless used with judgment,
�440
Notes and Neins.
[Oct.,
zeal, and loyalty. But what caring can a man who has been drafted into
the army from the back slums of Edinburgh, Glasgow, or Aberdeen, be
expected to have in the honour and interests of his country ? The chances
are that he was driven to enlist to save himself from starvation, which stared
him in the face through want of education, vice, or intellectual deficiency.
When a man is fit for nothing else, he is still considered good enough to
defend his country’s honour. He may, indeed, fill a pit as well as another;
but a soldier, even of the kind we have, is too costly an article to be ex
pended in this fashion. Besides, we do not want him to fill a pit himself,
but, if need be, to fill pits with the bodies of the enemy.—The Scotsman,
¡September 15th.
'l’ie Medico-Psycholmjical Association.
/
Definition is dangerous, and never more so than when it seeks to ensnare
Psyche in its net. From the dawn of speculation to the present day, the
intelligence of mankind has been continually prying into the laws of its own
processes, and into the relation of these with the physical organism, through
which alone it becomes cognisant of them. In proportion, however, as specu
lation has grown scientific, it has desisted from seeking its object by what
Coleridge called “the high priori road,” and any progress it has made towards
the solution of its inquiries has been effected on the narrow and humble
pathway of inductive research.
Hitherto psychological investigation has had mainly a speculative interest;
and considering the method which it pursued, it could scarcely have had any
deeper one. Now, however, by the almost unanimous consent of its vota
ries, it has been content to range itself among the inductive sciences; and,
as a reward for this condescension, it has received a large reinforcement of
followers, who have given it a much more practical, not to say human, in
terest. The psychologist no longer sneers at the low and grovelling pursuits
of the physiologist. The physiologist no longer turns away in contempt
from the purblind gropings of the psychologist. They have united their
forces in an offensive and defensive alliance for the attainment of a common
end.
“ Alterius sic
Altera poscit opem res et conjurât amice.”
At no former meeting of the Medico-Psychological Association has this
fusion of the two sciences been more distinctly recognised than at the recent
one in Edinburgh, presided over with such ability by Dr. Browne. Medico
psychology now claims a definite place among the inductive sciences, and if
asked to show its credentials it points to the field which it cultivates, to the
method by which it proceeds, and to the results which it has already achieved.
The field is surely a sufficiently palpable one, and by no means likely in
these days to have its area diminished. The very fact that, in spite of the
much more normal mode of life pursued by the great body of the public,
the phenomena of lunacy have betrayed no tendency to decrease, is enough
to prove that there are forces working through our modern civilisation which
are directly injurious to mental health. The annual reports of Her Majesty’s
Commissioners in Lunacy for England, Scotland, and Ireland furnish a direct
answer to all who would question the significance of the medico-psycholo
gist’s department.
Again, the method by which the medico-psychologist proceeds is one with
which the most rigid votary of science has, now at least, no right to quarrel.
�1866.]
Noles and News.
411
True, the time is not very far distant when the subject was treated in a style
which could only irritate the inductive inquirer. Crude theories of psycho
logy, theories not less crude of physiology, were freely accepted and made
the groundwork of the most confident generalisations. A treatise on lunacy
was almost invariably a portentous cross-birth between bad metaphysics and
premature physiology. The subject which, from the obscurity and almost
evanescent fineness of its phenomena, required a rigidly accurate and con
sistent use of terms, was handled in the most loose and declamatory style.
Where a calm and clear exposition was wanted, the reader was generally
entertained with the inflated discourse of a little Bethel revivalist. Now,
however, such contributions to the literature of medico-psychology are no
longer tolerated, and a more rational, intelligible, not to say honest, method
of treating the subject is adopted. We are mainly indebted to Continental
writers for the happy change, and Germany has, according to her wont, sup
plied us with the most original and really valuable additions to the medico
psychologist’s library.
Not that we have had no able and effective workers in the same field at
home. 1 he late Dr. Prichard, so justly held in honour by the profession for
his high attainments in philology and in all that pertains to the history and
development of mankind, was one of these. The late Dr. Conolly was an
other—an enlightened physician whom Dr. Browne claims, in eloquent lan
guage, as “ a philosophical advocate of medico-psychology founded upon
induction.” The late Sir Benjamin Brodie was yet another; while the
names of living cultivators of the same difficult field will at once suggest,
themselves to our readers. The journalism of medical psychology is fairly
entitled, for its ability, for its originality, and for the scientific value of its
contributions, to rank with the journalism of any other department of medi
cine. Nay, in the very city where the last meeting of the Association was
held—a city which justly boasts of having founded a distinct school of
philosophy—a lectureship of medical psychology has been instituted under
the enlightened auspices of Professor Laycock, and, with the congenial
assistance of Sir James Coxe and of Dr. Browne himself', has already done
much to bring the philosophical studies of the place into harmonious relation
with those of the purely medical curriculum. Much as has been done for
the more accurate investigation of the phenomena of lunacy, we are entitled
to expect a great, deal more ; and the science of medico-psychology will have
nothing to fear if tested by the standard adopted by Mr. Lowe for Govern
ment schools—“ results.”
Even at present, the medico-psychologist can appeal with justice to much
valuable service done in the treatment of mental disease. If asked for speci
mens of successful labourers in his peculiar field, Dr. Browne might well
have pointed to his numerous audience and said, “ Circumspice!” There
was never a time when so many accomplished physicians made it the business
of their lives to investigate and treat the phenomena of lunacy ; and who
will say that the labours of all these men have been without result ? From
the treatment of the imbecile and idiotic at such asylums as Earlswood, and
Larbert in Scotland, to the treatment of even such apparently hopeless manifes
tations of mental disease as chronic mania and general paralysis, medico
psychology can point, in the language of Bacon, to many an instantia preerogutica which may well sustain her votaries in the prosecution of their bene
ficent work. Certainly it would be a hard dispensation for the followers of
any science if success refused to crown exertions carried on in the spirit, at
once scientific and philanthropic, of such physicians as Prichard and
Conolly.—The Lancet, August 15th.
�442
Notes and News.
[Oct.,
Recent Contributions to Mental Philosophy.
*
Wliat is the original meaning of salad or salade 1 In the oldest use
of the word it means a kind of helmet-cap worn hy soldiers, both in
French and Norman-English. We venture, though not without hesita
tion,—especially remembering that some derive it from salted,—a sur
mise that the mixture of herbs and dressing got its name, just as a
comfortable dose before going to bed came to be called a nightcap; as a
good kind of thing for the head. Be this as it may, we have before us
a salad, in either sense: a mixture of various esculents, and a stiff kind
of wear over the brain; not without salt either, though there might
have been more. But this was not the way we came to use the word.
It was our own considering-cap we thought of. Our readers know that
of late years we have been obliged to put books of mental philosophy
together in aheap, and make one job of them : how can we do otherwise
when the nature of things, in its totality, is presented to us for con
sideration once a fortnight ? On the present occasion, when we saw
that we had a budget ready, there came into our minds, in a whimsical
way, two lines of the satire on Wolsey—
“ Aryse up, Jacke, and putt on thy salatt,
For the tyme is come of bagge and walatt.”
And so we were reminded to ask for the connection between the two
meanings of salad, and to refer the question to the Philological Society.
We are by no means sorry that mental philosophy is exciting so much
attention; but we should be in despair if it were necessary to give a
discussion every time we open a book on the subject. It is not desirable
to examine the works whenever we are asked the time of day. We pro
* 1. ‘ Spiritual Philosophy: founded on the Teaching of the late Samuel
Taylor Coleridge. By the late Joseph Henry Green. Edited, with a Memoir, by
John Simon. (Macmillan and Co.)
2. ‘ An Examination of J. S. Mill’s Philosophy, being a Defence of Funda
mental Truth. By James M'Cosh, LL.D. (Macmillan and Co.)
3. ‘ Mill and Carlyle : an Examination of Mr. J. S. Mill’s Doctrine of Causation
in relation to Moral Freedom. With an occasional Discourse on Sauerteig, by
Smelfungus.’ By P. P. Alexander, A.M. (Edinburgh, Nimino.)
4. ‘ Three Essays on Philosophical Subjects.’ By T. Shedden, M.A. (Longmans
and Co.)
5. * The Battle of the Two Philosophies.’ By an Enquirer. (Longmans and Co.)
6. ‘ The Philosophy of the Unconditioned.’ By Alexander Robertson. (Long
mans and Co.)
7. ‘ An Essay on the Platonic Idea.’ By Thomas Maguire, A.M. (Longmans
and Co.)
8. ‘ The Harmonies of Nature, or the Unity of Creation.’ By Dr. G. Hartwig.
(Longmans and Co.
9. ‘ The Philosophy of Ethics: an Analytical Essay.’ By S. S. Laurie. (Edin
burgh, Edmonston and Douglas.)
10. ‘ E pur si muove.’ By N. A. Nicholson, M.A. (Triibner and Co.)
11. ‘ A Manual of Human Culture.’ By M. A. Garvey. (Bell and Daldy.)
12. ‘ Odd Bricks from a Tumble-down Private Building.’ By a Retired Con
structor. (Newby.)
13. ‘ Discourses.’ By [the late] Alexander J. Scott, M.A. (Macmillan and Co.)
�1866.]
Notes and News.
-143
ceed to a short notice of the several writings before us, which will be of
more use to our readers than any detached reviews.
1. Joseph Henry Green, so well known as a surgeon, died December,
1863, as his biographer ought to have told us, but forgot it. It is not
very widely known that he was all his life a diligent student of philo
sophy, a pupil of Tieck, the intimate friend of Coleridge, whose literary
executor he was. The posthumous works which have appeared under
Green’s editorship have been very little thought of in connection with
their editor. The present work is not Coleridge, but Green founded on
Coleridge. Its subdivisions are, “ On the Intellectual Faculties,” “ On
First Principles in Philosophy,” “ On the Truths of Religion,” “ On
the Idea of Christianity in relation to Controversial Theology.” The
reading will repay those who have a strong appetite for such subjects;
and it will give information, of a general kind, to those who want to
know something of Coleridge, subject to the difficulty of separation
incident to the writings of teachers who found their own instructions
upon those of the master. With those who come between these two
classes, we do not think these volumes will find much acceptance; in
fact, Green is not Coleridge.
2. Dr. M‘Cosh’s work involves no fewer than nine points: the nature
of things, Hamilton, J. S. Mill, the relations of each to the other, Dr.
M'Cosh’s relation to either, and Dr. M'Cosh’s relation to the way in
which either looks at the other. In this subject nothing but a very
long article would allow us to go into detail. Though, by title, we
should suppose that only Mill is examined, yet this is far too brief a
description of the work. There are twenty-one chapters, running
through as much difference of matter as could be brought in under the
general subject. Dr. M‘Cosh holds his ground fairly, and will be useful
to all readers of the psychology of the day. In such points as his attack
on Mr. Mill’s notion of intuition and necessity, he will have the voice of
mankind with him; in things which are more like matters of opinion,
there are many who will find him useful in attaining perception of the
point at issue. In the matter of Hamilton and his impugners and
defenders, we shall soon want a digested index, if we are to avoid utter
confusion. Dr. M’Cosh has given two pages of reference to the places
of his own writings which concern the matter; and it may fairly be said
that these are two of his most useful pages.
3. We shall not enter on freedom and necessity. Mr. Alexander
writes in a style of a “ little vivacity of expression,” for which he apolo
gises : this so far as Mr. Mill is concerned. If the reader should ask
which are the vivacities, he -will get from us no other answer except that
given to the little boy who asked which was Wellington in the peepshow—“ Whichever you please, my little fellow ! You pays your money
and you takes your choice.” As to the article on Mr. Carlyle, there is
internal evidence that it was intended for wit from beginning to end.
The author “ entirely honours ” Carlyle, and considers him “ simply our
greatest man of letters living.” Accordingly, he invests him with the
name of Sauerteig, which the German dictionary makes to be sour dough,
and gives him more than forty pages, of which the following is a speci
men :—“ Sauerteig indeed, nothing doubting, girt with his cook-aprons,
infinitely manipulating with his hero-gridirons, and due ‘inimitable
sauce piquante,’ cooks busily, with vigour even unusual in him. ‘ Right
stuff of properest hero-porkliood here,’ iterates the singular SauerteigSoyer, cooking . . . .” Surely this must be wit!
4. Mr. Sliedden’s three essays are on the Infinite, on Arabic Peripa
teticism. and on the controversy between Mr. Mill and the school of
�441
Notes and News.
[Oct.,
Hamilton. In the third he ranges himself rather on the side of Mill,
but not wholly. In his last sentence he expresses, but in other words,
that lie has much more agreement with Mr. Mill than with Hamilton,
except as to the value of formal logic, which he holds Mr. Mill grievously
to underrate.
. 5. The inquirer into the battle of the two philosophies takes the other
side : he assails Mill and defends Hamilton on various points. With a
bias which is not uncommon,—that of having a grand field of opponents,
—he informs us, that while Mill’s work against Hamilton was “ hot
from the press, it was pronounced by the writing public to be a com
plete success. We really were not aware of this. There are individuals
who will decide between two such opponents at a glance; but they are
neither the whole writing public nor the whole reading public.
6. Mr. Robertson s philosophy of the unconditioned is strong a priori
theism : the existence of God is to be finally reduced to a logical axiom.
He attacks both Hamilton and Mill, and criticises many others. There
is a great deal of vagarious thought, in less than a hundred pages.
7: Mr. Maguire informs us that his essay is the result of an indepen
dent study of Plato; and of this there is good appearance. His first.
conviction that mental science was not mere verbiage.” was derived
from the chapter on Socrates in Grote’s history: and his essay was
complete before Grotes ‘Plato’ appeared; on this his criticisms, <tc.,
are added in notes. Plato, under nine heads, in one hundred and fifty
pages, is of a concentration which we cannot separate; but many readers
who have the first smattering will find this short treatise both enlarge
and bind their knowledge.
8. Dr. Hartwig’s book at first looks like a system of natural history:
it swarms with woodcuts of zoology and comparative anatomy, ©ut it
properly belongs to general psycliology: for its object is comparison
and deduction, and a view of the chain of being, which, in a rough way,
may be described, like a rod and line, as having a fly at one end and a
fool at the other. After some general cosmogony, this book begins
at the lowest phases of vegetable life and ends with man. How little
the collection of harmonies can pretend to be a system of zoology is
manifest from the very small space taken up by the mammals when
compared with that given to low creatures with hard names. One
great object seems to be to illustrate the way in which all living things
are. the destroyers of their inferiors and the destroyed of their superiors.
This is carried the length of saying that it is the “ business ” of the
Deirodon snake to restrain the undue increase of the smaller birds by
devouring their eggs. It is just as much the business of the smaller
birds to produce eggs enough, over and above what are wanted for
hatching, to nourish the Deirodon family. There is one great omission.
When man is arrived at, it is not pointed out that, for want of a higher
race to destroy him, he is furnished with a wish to do the job for his
fellow-creatures, and with inventive power to find out means. A trea
tise on weapons of all kinds, from the club to the needle-gun, would
have been the proper ending. There should have been a double frontis
piece : on one side a Deirodon robbing a nest; on the other two highminded gentlemen snapping pistols at one another for their mutual
satisfaction ; and both performing the function assigned to them in the
order of things, as seen from the standpoint of a naturalist. This book
is very interesting, and fills a very useful place.
9. Mr. Laurie’s system of ethics places first manifestation of the moral
sense in a feeling of being pleased or displeased (complacence or displacenee), and, denying that right is discriminated by a special inner
�I860.]
Notes and Netos.
415
sense, finds all the rest in promotion of “ felicity,” either that of the
agent himself or of others. There is power of analysis shown in this
work : all other judgment we leave to the reader.
10. What is it that moves ? This the author does not explain, and
we cannot find out. There are chapters on Truth, Experience, Space,
Time, &c. We do not think much of them. The author desires for his
jury those who think calmly and examine closely: we doubt if they
would need to retire. We cannot approve of the division of the cardinal
virtue, justice, into justice towards one’s own self, and justice towards
other people : it is a perversion of terms quite parallel with the division
of murder into suicide and slaughter of others. We hardly know
whether the author is in joke or in earnest when he reconciles freewill
and foreknowledge by the hypothesis that God foresees what he pleases,
and doos not choose to foresee the acts of his creatures. The old chapter
from Volney, the meeting of the religions, to prove that there can be
no revelation because men advance and defend opposite revelations in
much the same way, is really behind the age. Most opponents of re
velation would now say, each for himself, Well! I know I do not believe;
but I trust I know a better defence of my unbelief than that comes to!
The only chapter of which we can almost unreservedly approve is that
on Space. There is in it a little reiteration, but no fallacy. It consists
of four pages, no one of which contains anything but the head-line and
the number of the page. Some more of the paper might have been
advantageously treated in the same way.
11. Mr. Garvey’s work begins, as a barrister’s work will often begin,
with a sound and sufficient table of contents. It goes through a large
number of points connected with the education of the reason and of the
feelings, and abounds in just remarks. At the end of each chapter is a
supplement, headed “ Practical,” containing suggestions of books to
rsad or courses to take. The whole is rather too much spun out: con
densation is wanted. But those who make education a study should
consult this book.
12. The odd bricks are piled into as much of system as is seen in some
of the buildings. They are in dialogue, brought out by a loan of Mill
upon Hamilton.
13. The late Alexander Scott—it will set him up with many to say
that he was a bosom friend of Julius Hare—was a man of remarkable
life, thoughts, and words. When he used to deliver Sunday evening
discourses at we forget what institution, he collected around him a small
audience who thought his sermons—so to call them—among the most
remarkable things of the day. In the work before us the greater part
has been printed before ; but some discourses appear for the first time.
Having thus looked through a considerable number of psychological
essays, a thought comes into our minds which has intruded itself on
former occasions. It is this : Do our writers mean the same things by
the same words ? Certainly, it will be answered, in some cases at Least;
for they explain their words in exactly the same way. We know they
do, is our reply: but Quis custodiet ipsos custodes ! Do the words in
which they explain carry the same sense in all the minds ? On this
point we crave leave to doubt; but we by no means despair of a final
settlement. Once more, to authors of all amounts of knowledge, and of
all grades of reputation, we recommend curtailment of prolixity. We
suspect that the streams of words which go to very fundamental points
indicate that the writers have no very brief enunciation which themselves
would understand; that is, that their fundamental words are not well
settled in their own minds.—The Athenaeum, July 28.
�446
Notes and News.
[Oct.,
Visions of Heaven and Hell.
*
From the time when these words were written, in the 32nd chapter of
Deuteronomy, “ a fire is kindled in mine anger, and shall burn unto the
lowest hell,” the human mind has exercised itself, not unnaturally, in
endeavours to penetrate the mystery. They are words which refer to a
temporal punishment, but they also mention a locality which is not
further defined. Men have variously speculated as to the whereabout of
of that dread place ; and after ages of vain speculation, the ‘ Catechism
of the Diocese of Bruges’ has definitely settled the dispute, as may be
seen in the reply to the query, “Where is Hell?”—namely, “ Hell is
situated at the centre of the earth, and is exactly fifteen hundred leagues
from this place.” Before this Catechism, however, was compiled, the
Jesuit Hardouin had detected the position, though he had not made out
the distance ; but he did something more,—he declared that the rotary
motion of the earth was caused by the efforts of the damned to escape
from Hell by climbing up the inward crust of the globe. As squirrels
set their cylindrical cages spinning, so the condemned souls keep the
world moving !
Cruel humanity has chosen, from various motives, to make a revelation
of that which more merciful divinity has shrouded in terrible mystery.
The Hindoo priests describe twenty-one hells. In Scandinavia, where
fire was a luxury, the priesthood despatched sinners to a hell of frosts.
In Thibet, where heat and cold alternate, the faithful were taught that
punishment for errors would be carried out in a hell of sixteen circles,
in eight of which they would be roasted in one half the year, and in the
other eight frozen during the remaining six months !
Some of the worthiest of men have dishonoured Divine mercy by their
savage and reckless assertions on this most awful subject. “ What,”
asked a sincere inquirer of St. Augustine—“ What was God doing before
he created the world?”—“ He was making Hell ! ” was the blasphemous
reply of the mistaken saint. How much more to the honour and glory
of God was the Talmudist reply to the same question,—namely, “ He
was creating repentance !”
St. Augustine would not have it so, and most of the Fathers were of
his opinion,—that sinners suffered eternal physical pains ; that they
burned for ever and were never consumed ; that they became saturated
with fire, and always with increase of torment ! St. Thomas Aquinas,
good man as he was, went even further than St. Augustine. He believed
that one of the chief joys of the blessed would be in contemplating the
tortures of the damned ! Berridge, unwilling to allow a gleam of hope
that Divine vindictiveness could pause for a moment in its exercise,
assures his readers, in the ‘ Christian World Unmasked,’ that “the
shortest punishment is eternal, and the coldest place in Hell will prove
a hot one !”
On the other hand, worthy men, whom the unco-righteous take for
heretics in this matter, have asserted opinions more consonant with the
spirit of Mercy. The Rabbins could not comprehend eternal punish
ment ; the utmost they allowed was that at the last day the sun would
* ‘ The Book of Visions ; or Heaven and Hell described by those who have seen
them’—Le Livre des Visions ; ou, l’Enfer et le Ciel décrits par ceux qui les ont
vus.’ Par Octave Delepierrej. (Trübner and Co.)
�1866.]
Notes and News.
447
burn up, once and for all, those who had sinned, and warm into eternal
happiness those who had merited salvation. Origen disbelieved the
local part of the subject, and held that Hell was in the fire of God’s
anger which lit up man’s remorse. Eternal punishment he vehemently
denied; and to this day it is matter of dispute whether this kindly natured man is, or is not, undergoing what he denied as being possible.
But Duns Scotus professed the same sentiments, on this one point, as
Origen; yet he has not been assailed for it. In later days M. Petitpierre, all Calvinist as he was, denounced the idea which the sterner Calvin
most cherished, that of the Divine anger never being appeased, inasmuch
as that they who had incurred it never ceased to endure extreme torture.
The beauty of mercy and the glory of Heaven were much better compre
hended by Origen and others, who believed that the divine glory and
mercy would be made manifest at last, by restoring to their vacant seats
in Heaven even those angels who had fallen from them through their
rebellion.
This subject, in short, took such possession of the minds of men, that
they passed from ideas to sensations, and these minds being more or less
diseased, when the body was stricken by epilepsy or buried in an unna
turally profound sleep, hurried abroad, like the soul of Hermotimus,
plunged into Hell, scaled Heaven, and came back to Earth to pour into
the ears of greedy listeners all their terrible or joyous experiences.
These visions form the staple of the very singular volumes which M.
Delepierre has contributed to mystical literature. There exist numerous
accounts of the secrets and secret places in Heaven and Hell, invented
by writers skilled in depicting imaginary horrors and delights. These
M. Delepierre discards altogether, confining himself to the relations of
monks and others who, having dreamed their dreams, accepted them as
realities, and perhaps exaggerated and poetized what then- active brains
had been deluded to believe.
In studying these remarkable records it is impossible to avoid the
conviction that priestcraft, kingcraft, and common human impulses have
been concerned in the building of them up. Godefroed warned his
hearers by the information that he saw in the lower regions the very
men whom he least expected to find there, and others in purgatory whom
Christian men had certainly assigned to hell. Charles Martel, tossed on
a sea of fire for robbing the Church, is an example in terrorem to all
princes who disregard the rights of the Church. Charlemagne, under
going unimaginable, certainly indescribable, tortures in return for his
loose gallantry in this world, is a monition to monarchs who love their
neighbours’ wives better than their own. Charles the Bald, after his
visionary foretaste of the future, probably laughed, at least in his sleeve,
as he looked in the faces of his household officers, while he told them of
the diabolical anguish inflicted by demons on the dishonest predecessors
of these officers. The bitter touch of on old bitter family quarrel is to
be detected in this prince’s vision, when he saw his own old father,
Louis, in hell, sitting up to the hips in a tub of ever-boiling water!
The readers of Odericus Vitalis need not be reminded how priests could
keep their womenkind in order by telling them how their pastors had
seen the disorderly and irregular tormented in the realm below.
The imagination runs wild riot in these visions, and the memory of the
reader toils in vain to collect a thousandth part of what is imagined.
We remember that souls, always retaining bodily form, are shadowless,
and the eyelids fixed in, if we may so say, eternal unwinkingness. South
says that some men’s souls only keep their bodies from putrefaction, but
beyond the barrier of the nether world soul and body suffer this process
�448
Notes and News.
[Oct.
as the least of the punishments due to them. Misers toss in coppers of
molten gold, from which they are dragged by red-hot grapnels to be
plunged in freezing liquid lead, after which they are hardened in fire,
forged into fresh shape on a red-hot anvil, whence they are taken to have
bushels of gold coins poured down their throats, and these they are made
to disgorge by the consequences of the rapid revolutions of a spiked
wheel to which they are bound. And this for ever ’—and for ever !
The most singular delight is taken by these visionaries in showing
that sinners are always punished in the members whereby they have
most sinned. The miser, as above. The slanderer hangs by his tongue
over horrible flames, from amid which demons prod at him with their
forks! Some demons are busy in converting, by hideous process, the
souls of sinners into essences that are to animate beasts; while the
grossest offenders of all undergo a penalty, the details of which (kept in
the original rough Latin) almost induce us to believe that the visionary
delights in his subject, and loves to dwell upon it. It is refreshing to
get away from these peculiar offenders and their sufferings to others who
suffer by a sort of Zez talionis. M. Delepierre might have lighted some
of the most lurid of his pages by showing how unskilful physicians are
engaged, in domo Diaboli, in eternally being subjected to the most hor
rible cathartics and emetics. We remember that an old German idea
states that all foolish mortal writers will in the next world be condemned
to everlastingly settingup their own works with red-hot types, for having
abused the critics in this! A more terrible penalty awaits the preachers
of dull sermons, who are condemned to be for ever reading, from pages
that burn their eyes out as they gaze and their fingers off as they hold
them, all the bad discourses that have been preached upon earth !
“ He that is hanged is accursed of God,” says the lawgiver, and that
decree probably gave rise to the long-preserved tradition that, as the
soul of a hanged man could only escape from the body in one way, and
that Satan always placed himself where he could receive it, for such soul
there was neither purification nor redemption. This idea, however,
su "«zests that for other souls in Tartarus, such merciful boons were
possible.
One other feature of this remarkable work is worthy of notice, namely,
that when the ladies throw themselves into the ecstatic condition they
become more unbridled in imagination and expression than the men.
St. Christine, St. Catherine of Sienna, St. Theresa, St. Hildegarda, and
other well-meaning women, helplessly uncontrolled as to judgment and
expression, fancied themselves the true and lawfid wives of the Saviour;
and they narrate their visionary experiences in proof thereof in such
terms as might have astonished even the persons of the not too fastidious
times to whom they were uttered. In comparison with these, Engel
brecht’s idea of marriage in heaven is a religious pastoral, and Sweden
borg's familiarity with Moses and angels and archangels, as he met them
in Cheapside, an amusing hallucination.
That Dante was acquainted with some of the earlier visions noticed in
this book is more than possible ; it is almost certain. They formed the
materials which Genius only knows how to select, appreciate, and
employ.
A more curious question is that of the condition of blood and of brain
in the visionaries who pondered over these subjects, "waking, till their
sensations connected therewith possessed them as ideas, in sleep, when
the deranged body and rudderless memory carried them into realms
which no ordinary or healthy imagination can reach. Even waking
spectral illusions take the form of "whatever has long and entirely pos
�1866.]
Notes and News.
440
sessed the mind; those of the hours of uneasy sleep seize and play with
those forms in wilder fancies still. Sleeping or waking, we can remember
but one man whose mind protested against the vision that haunted it.
M. Delepierre, indeed, says that many of the early visionaries retracted
more or less of the first editions of their wondrous narratives ; but Mr.
White, the Assessor of the Westminster Assembly, resisted the visions.
Satan (on whose works he had been long meditating) one night came to
the Assessor’s bedside, as the latter had just lain down, seated himself,
and looked at the astounded gentleman in a way to banish sleep for a
month. The Assessoi' rubbed his eyes, muttered “ This will never do,”
and then, gazing full in the face of the Prince of Darkness, quietly
remarked, “ I’ll tell thee what it is. If thou hast nothing better to do, I
have! I am going to sleep.” After this wholesome exercise of mind,
the Assessor was never more troubled by visionary visitors. His story
might well find place in a second edition of M. Delepierre’s collection of
narratives. But among the many singularities of what we may well
call this rare book is. that the author does not contemplate a second
edition, and has printed only twenty-five copies of that which, as we may
notice, is well illustrated, and which will doubtless meet fitting audience,
though, it may be, few.—The Athenceum, June 30.
Mr. Carlyle on the Education of the Future.
I confess it seems to me there is in it a shadow of what will one day
be ; will and must, unless the world is to come to a conclusion that is alto
gether frightful: some kind of scheme of education analogous to that ;
presided over by the wisest and most sacred men that can be got in the
world, and watching from a distance : a training in practicality at every
turn; no speech in it except speech that is to be followed by action, for
that ought to be the rule as nearly as possible among men. Not very
often or much, rarely rather, should a man speak at all, unless it is for
the sake of something that is to be done; this spoken, let him go and
do his part in it. and say no more about it.
I will only add that it is possible,—all this fine theorem of Goethe’s,
or something similar! Considei1 what we have already; and what ‘ diffi
culties’ we have overcome. I should say there is nothing in the world
you can conceive so difficult, primd facie, as that of getting a set of men
gathered together as soldiers. Rough, rude, ignorant, disobedient
people ; you gather them together, promise them a shilling a day; rank
them up, give them very severe and sharp drill; and by bullying and
drilling and compelling (the word drilling, if you go to the original,
means ‘ beating,’ ‘ steadily tormenting' to the due pitch), they do learn
what it is necessary to learn; and there is your man in red coat, a trained
soldier; piece of an animated machine incomparably the most potent in
this world ; a wonder of wonders to look at. He will go where bidden;
obeys one man, will walk into the cannon’s mouth for him ; does punc
tually whatever is commanded by his general officer. And, I believe,
all manner of things of this kind could be accomplished, if there were
the same attention bestowed. Very many things could be regimented,
organised into this mute system ;—and perhaps in some of the mecha
nical, commercial, and manufacturing departments, some faint incipien
ces may be attempted before very long. For the saving of human la
bour, and the avoidance of human misery, the effects would be incalcuable, were it set about and begun even in part.
�450
Notes and News.
[Oct.,
Alas, it is painful to think how very far away it all is, any real fulfil
ment of such things ! For I need not hide from you, young gentlemen,—
and it is one of the last things I am going to tell you,—that you have
got into a very troublous epoch of the world; and I don’t think you will
find your path in it to be smoother than ours has been, though you have
many advantages which we had not. You have careers open to you,
by public examinations and so on, which is a thing much to be approved
of, and -which we hope to see perfected more and more. All that was
entirely unknown in my time, and you have many things to recognise
as advantages. But you will find the ways of the world, I think, more
anarchical than ever. Look where one will, revolution has come upon
us. We have got into the age of revolutions. All kinds of things are
coming to be subjected to fire, as it were : hotter and hotter blows the
element round everything. Curious to see how. in Oxford and other
places that used to seem as lying at anchor in the stream of time, re
gardless of all changes, they are getting into the highest humour of
mutation, and all sorts of new ideas are afloat. It is evident that whatevei’ is not inconsumable, made of asbestos, will have to be burnt, in this
world. Nothing other will stand the heat it is getting exposed to..
And in saying that, I am but saying in other words that we are in an
epoch of anarchy. Ari arch y plus a constable ! (Laughter.) There is no
body that picks one’s pocket without some policeman being ready to take
him up. (Renewed laughter.) But in every other point, man is becoming
more and more the son, not of Cosmos, but of Chaos. He is a disobe
dient, discontented, reckless, and altogether waste kind of object (the
commonplace man is, in these epochs); and the wiser kind of man,—the
select few, of whom I hope you will be part,—has more and more to see
to this, to look vigilantly forward; and will require to move -with double
wisdom. Will find, in short, that the crooked things he has got to pull
straight in his own life all round him, wherever he may go, are manifold,
and will task all his strength, however great it be.
But why should I complain of that either? For that is the thing a
man is born to, in all epochs. He is born to expend every particle of
strength that God Almighty has given him, in doing the work he finds
he is fit for; to stand up to it to the last breath of life, and do his best.
Wc are called upon to do that; and the reward we all get,—which we
are perfectly sure of if we have merited it,—is that we have got the
work done, or at least that we have tried to do the work. For that is a
great blessing in itself; and I should say, there is not very much more
reward than that going in this world. If the man gets meat and clothes,
what matters it whether he buy those necessaries with seven thousand
a year, or with seven million, could that be, or with seventy pounds a
year ? He can get meat and clothes for that; and he will find intrinsi
cally, if he is a wise man, wonderfully little real difference. (Laughter.)
On the whole, avoid what is called ambition; that is not a fine prin
ciple to go upon,—and it has in it all degrees of vulgarity if that is a
consideration. “ Seekest thou great things, seek them notI warmly
second that advice of the wisest of men. Don’t be ambitious ; don’t too
much need success ; be loyal and modest. Cut down the proud towering
thoughts that get into you, or see that they be pure as well as high.
There is a nobler ambition than the gaining of all California would be,
or the getting of all the suffrages that are on the Planet just now.
(Loud and prolonged cheers.)
Finally, gentlemen, I have one advice to give you, which is practically
of very great importance, though a very humble one. In the midst of
your zeal and ardour,—for such, I foresee, will rise high enough, in spite
�1866.]
Notes and News.
451
of all the counsels to moderate it that I can give you,—remember the
care of health. I have no doubt you have among you young souls ar
dently bent to consider life cheap, for the purpose of getting forward in
■what they are aiming at of high; but you are to consider throughout,
much more than is done at present, and what it would have been a very
great thing for me if I had been able to consider, that health is a thing
to be attended to continually ; that you are to regard that as the very
highest of all temporal things for you. (Applause.) There is no kind
of achievement you could make in the world that is equal to perfect
health. What to it are nuggets and millions ? The French financier
said, “ Why, is there no sleep to be sold!” Sleep was not in the market
at any quotation. (Laughter and applause.)
It is a curious thing, which I remarked long ago, and have often
turned in my head, that the old word for ‘ holy’ in the Teutonic lan
guages, lieilig, also means ‘ healthy.’ Thus Heilbronn means indiffer
ently ‘ holy-well,’or ‘health-well.’ We have, in the Scotch too, ‘ hale,’
and its derivatives; and, I suppose, our English word ‘ whole’ (with a
‘ w’), all of one piece, without any hole in it, is the same word. I find
that you could not get any better definition of what ‘ holy’ really is than
‘healthy.’ Completely healthy; mens sana in corpore sano. (Applause.)
A man all lucid, and in equilibrium. His intellect a clear mirror geo
metrically plane, brilliantly sensitive to all objects and impressions
made on it, and imaging all things in their correct proportions; not
twisted up into convex or concave, and distorting everything, so that he
cannot see the truth of the matter without endless groping and manipu
lation : healthy, clear, and free, and discerning truly all round him.
We never can attain that at all. In fact, the operations we have got
into are destructive of it. You cannot, if you are going to do any de
cisive intellectual operation that will last a long while ; if, for instance,
you are going to write a book,—you cannot manage it (at least, I never
could) without getting decidedly made ill by it: and really one never
theless must; if it is your business, you are obliged to follow out what
you are at, and to do it, if even at the expense of health. Only re
member, at all times, to get back as fast as possible out of it into health ;
and regard that as the real equilibrium and centre of things. You
should always look at the lieilig, which means ‘ holy’ as well as ‘ healthy.’
And that old etymology—what a lesson it is against certain gloomy,
austere, ascetic people, who have gone about as if this world were all a
dismal prison-house. It has indeed got all the ugly things in it which
I have been alluding to; but there is an eternal sky over it; and the
blessed sunshine, the green of prophetic spring, and rich harvests
coming,—all this is in it, too. Piety does not mean that a man should
make a sour face about things, and refuse to enjoy wisely what his
Maker has given. Neither do you find it to have been so with the best
sort,—with old Knox, in particular. No ; if you look into Knox you
will find a beautiful Scotch humour in him, as well as the grimmest and
sternest truth when necessary, and a great deal of laughter. We find
really some of the sunniest glimpses of things come out of Knox that I
have seen in any man; for instance, in his ‘ History of the Reforma
tion,’—which is a book I hope every one of you will read (Applause), a
glorious old book.
On the whole, I would bid you stand up to your work, whatever it
may be, and not be afraid of it; notin sorrows or contradictions to yield,
but to push on towards the goal. And don’t suppose that people are
hostile to you or have you at ill-will, in the world. In general, you will
rarely find anybody designedly doing you ill. You may feel often as if
�452
Notes and News.
[Oct.,
the whole world were obstructing you, setting itself against you: but
you will find that to mean only, that the world is travelling in a different
way from you, and, rushing on its own path, heedlessly treads on you.
That is mostly all: to you no specific ill-will;—only each has an ex
tremely good-will to himself, which he has a right to have, and is rush
ing on towards his object. Keep out of literature, I should say also, as
a general rule (Laughter),—though that is by-the-by. If you find many
people who are hard and indifferent to you. in a -world which you con
sider to be inhospitable and cruel, as often indeed happens to a tender
hearted, striving young creature, you will also find there are noble hearts
who will look kindly on you ; and their help will be precious to you
beyond price. You will get good and evil as you go on, and have the
success that has been appointed you.
I will -wind up with a small bit of verse which is from Goethe also,
and has often gone through my mind. To me, it has something of a
modern psalm in it, in some measure. It is deep as the foundations,
deep and high, and it is true and clear:—no clearer man, or nobler and
grander intellect, has lived in the world, I believe, since Sliakspeare left
it. This is what the poet sings;—a kind of road-melody or marching
music of mankind :
“ The Future hides in it
Gladness and sorrow;
We press still thorow,
Nought that abides in it
Daunting us,—onward.
*
“ And solemn before us,
Veiled, the dark Portal
Goal of all mortal:—
Stars silent rest o’er us,
Graves under us silent.
“ While earnest thou gazest,
Comes boding of terror,
Comes phantasm and error;
Perplexes the bravest
With doubt and misgiving.
“ But heard are the Voices,
Heard are the Sages,
The Worlds and the Ages:
‘ Choose well, your choice is
Brief, and yet endless.
“ ‘ Here eyes do regard you,
In Eternity’s stillness;
Here is all fulness,
Ye brave, to reward you;
Work, and despair not.’ ”
Work, and despair not: JJT’r heissen ciich hoffen, “ We bid you be of
hope!”—let that be my last word. Gentlemen, I thank you for your
great patience in hearing me; and, with many most kind wishes, say
Adieu for this time.—Inaugural Address at Edinburgh, 1866.
k
�Y
1866.]
y otes and News.
453
Publications Received, 1866.
(Continued from the 'Journal of Mental Science * for July.)
* Lunacy. Twentieth Report of the Commssioners in Lunacy to the Lord
Chancellor.’ (Ordered by the House of Commons to be printed, June 4th,
1866.)
‘Eighth Annual Report of the General Board of Commissioners in Lunacy
Tor Scotland.’ (Presented to both Houses of Parliament by command of Her
Majesty.) Edinburgh, 18GG.
‘Lunatic Asylums, Ireland. The Fifteenth Report of the District Criminal
aud Private Lunatic Asylums in Ireland.’ (Presented to both Houses of Parlia
ment by command of Her Majesty.) Dublin, 18G6.
We shall review these three Official Reports in our next number (January,
1867).
‘Vorträge über die Erkenntniss und Behandlung der Geistesstörungen und
über das Vorgehen bei Forensischen Begutachtungen Psychischer Zustande.’
Von Dr. Ludwig Schlager, Landesgerichtsarzt und K. K. a. ö. Professor der
Psychiatrie an der Universität zu Wien. 1 Lieferung, Wien, 1865.
We are glad to have received the first part of Dr. Ludioig Schlager's able
‘ Lectures on Menial Diseases.' They are marked by a great breadth of view and a
careful working out of detail.
‘ Shakspeare’s Delineations of Insanity, Imbecility, and Suicide.’ By A. O.
Kellogg, M.D., Assistant Physician, State Lunatic Asylum, Utica, N.Y. New
York, I860, pp. 201.
These Essays were published in the 'American Journal of Insanity' at various
intervals between 1859 and 1864. The writer of these Essays, oddly enough,
makes no mention whatever of Dr. Bucknill''s papers published in the pages of this
Journal (and subsequently also published on a separate form) in the 1 Psychology of
Shakspeare' Yet any fair critic who read, for example, Dr. Kellogg's paper on
‘ Ophelia,' and then read Dr. Bucknill's, would be constrained to observe how
nearly Dr. Kellogg's thoughts and views were moulded on the pattern of Dr. Buck
nill's earlier and far abler Essays on the same subjects.
‘A Holiday in North Uist; a Lecture delivered in the Perth District Asylum,
Murthly, Nov. 17, 1865.’
“Zhave collected" (writes Dr. Mackintosh, addressing his patients) “a few
scattered notes, made during my absence from you in summer, and strung them
together by aid of recollection to form the following lecture, which consists of such
general topics as might interest and amuse you, with the assistance of the accom
panying specimens, coloured sketches, and drawings. I acted on the principle,
specially applicable to our case, that those who have opportunities of visiting in
teresting places at a distance should, if possible, be mindful of those at home who,
perhaps, in this respect, are placed in less favoured circumstances. You will thus
have the advantage ofgoing over the same ground in imagination, if not in reality,
of seeing some things in their most pleasant aspects, and of being saved all the
discomforts of travelling to and sojourning in such a land"
‘ The Medical Mirror,’ September, 1866.
(Exchange Copy.)
“ The ‘ Journal of Mental Science ' (says the Editor of the * Medical Mirror')
“ is one of those medical magazines where one is sure of finding interesting and
instructive matter by picked authors.
Kot mere hurried dissertations and
scribblings on crude and visionary theories, but sound essays in cultivated and
VOL. XII.
30
�454
Notes and News.
[Oct.,
often talented language, fill its pages, and we much regret that want of space often
precludes us from making long extracts from it. The Lunatic department of Great
Britain is happily managed by the magistrates of the kingdom. The salaries of the
medical officers are rising and sifficient, and the special journal of this great
scientific branch of the profession shows a comfortable condition by its scientific
and refined literature. But what time for study and self-improvement can a jaded
Poor-law doctor have ? Until the poor of the kingdom are controlled by the
magistrates and not by petty tradesmen, we have no hope qf any measure of Reform.
The Union medical men should combine together to demand their true position.
Resignation or Reform should be their watch-words. The profession would not be
niggardly in subscribing to a just cause like this?’
‘ Researches on the Daily Excretion of Urea in Typhus Fever, with Remarks.’
By Keith Anderson, M.D. Edin.
(Reprint from ‘ Edinburgh Medical Journal.’')
Clinical Inquiries into the Influence of the Nervous System and of Diathetic
Tissue-Changes on the production and treatment of Dropsies.’ By Thomas
Laycock, M.D., &c. &c.
{Reprint from ‘ Edinburgh Medical Journal?)
The folloicing Reports of County and District Asylums for the year
1865 have been received since the last notice (1866).
40. Twenty-sixth Annual Report of the Crichton Royal Institution and
Southern Counties’ Asylum. (Medical Superintendent, James Gilchrist, M.D.)
41. Thirteenth Annual Report of the Committee of Visitors of the Joint
Lunatic Asylum at Abergavenny. (D. M. M'Cullough,M.D., Superintendent;
T. Algernon Chapman, M.D., Assistant Medical Officer.)
42. Report of the Committee of Visitors of the Lunatic Asylum for the
North Riding of Yorkshire. (Samuel Hill, Esq., Medical Superintendent.)
43. Report of the Sligo and Leitrim Hospital for the Insane. (John
M'Munn, M.D., Medical Superintendent.)
44. First Annual Report of the Perth District Asylum, Murthly. (W. C.
MTntosh, M.D., Vledical Superintendent; Edward Rutherford, M.D., Assistant
Physician.)
45. Report of the Armagh District Lunatic Asylum. (Resident Physician,
Robert M'Kinstrey, M.D.)
46. Report of the Cork District Lunatic Asylum. By Thomas Power, M.D.,
Medical Superintendent.
47. Annual Report of the Royal Edinburgh Asylum for the Insane. (Dr.
Skae, Resident Physician; Dr. F. Skae and Dr. Spence, Medical Assistants.)
48. Eighteenth Annual Report of the Somerset County Pauper Lunatic
Asylum. (Robert Boyd, M.D., Medical Superintendent.)
49. First Annual Report of the Inverness District Lunatic Asylum. (Medi
cal Superintendent, Thomas Aitken, M.D.)
50. Thirty-sixth Annual Report of the Belfast District Hospital for the
Insane. (Robert Stewart, M.D., Medical Superintendent.)
51. Third Annual Report of the Argyll District Asylum for the Insane (two
copies). (John Sibbald, M.D., Medical Superintendent.)
52. Dorset County Lunatic Asylum. Annual Report. (T. G. Symes, Esq.,
Medical Superintendent.)
53. Sussex County Lunatic Asylum, Hayward’s Heath. (C. L. Robertson,
M.D., Medical Superintendent.)
54. Three Counties’ Asylum, Arlesey. Annual Report. (W. Denne, Esq.,
Medical Superintendent.)
�1866.]
Notes and News.
455
55. Medical Report of the Royal Lunatic Asylum of Aberdeen. (Robert
Jamieson, M.D., Physician and Superintendent.)
56. Lunatic Hospital, The Coppice, near Nottingham. Tenth Annual Report.
(W. B. Tate, Medical Superintendent.)
57. Report of the Royal Lunatic Asylum of Montrose. (Medical Superin
tendent, James C. Howden, M.D.)
58. The Twenty-first Report of the Committee of Visitors of the County
Lunatic Asylum at Hanwell, January Quarter Sessions, 1866.
American Reports.
Sixth Annual Report of the Board of Directors and Offiecrs of the Longview
Asylum, Ohio. (0. M. Langdon, M.D., Superintendent and Physician.)
Appointments.
Browne, J. C., M.D. Edin., has been elected Medical Superintendent of the
West Riding of Yorkshire Lunatic Asylum at Wakefield.
P. J. Simpson, M.R.C.S.E., L.S.A., late Resident Medical Officer of the
Westminster General [Dispensary, has been elected Apothecary to the Colney
Hatch Asylum.
W. Watkins, J. P., M.R.C.S.E., L.S.A., has been appointed Resident Sur
*
geon to the Lunatic Asylum and General Hospital, Berbice, British Guiana.
Stewart, Hugh Grainger, M.D., F.R.C.P., Edin., has been appointed Medical
Superintendent to the Newcastle-on-Tyne Borough Lunatic Asylum.
Obituary.
The late Sir Charles Hastings, M.D., D.C.L., Oxon.
At the first General Meeting for 1866 of the British Medical Association,
held at Chester, the following resolution moved by Dr. Jeaffreson, the retiring Pre
sident, and seconded by Mr. Carden, of Worcester, was unanimously adopted :
“ That the British Medical Association, assembled at the general meeting at
Chester, desires to express its deep sorrow at the loss the Association has sustained
in the death of its much-loved and highly esteemed founder, President of
Council, and Treasurer, Sir Charles Hastings, who, from the period of its esta
blishment to the present time, has, with singular courtesy and fidelity, exerted his
highest powers for the promotion of the best interests of the Association ; and that
a copy of this resolution be forwarded by the President to the family of the late
Sir Charles Hastings, with the condolence of the Association on the bereavement
they have sustained^
We cordially concur in the above resolution. Sir Charles Hastings was
President of the Medico-Psychological Association in 1859, and he took great
interest in the advancement of Mental Psychology.
The late Right Reverend Bishop Willson.
The late Bishop Willson, of Hobart Town, an honorary member of the
Medico-Psychological Association since its foundation, died at Nottingham on
the 30th June last, aged 71. He was consecrated Roman Catholic Bishop of
�456
Notes and News.
[Oct.,
Hobart Town in 1842. Bishop Willson was an active and energetic advocate
of colonial asylum reform, and lie worthily represented in Australia the
opinions and teaching of this Association.
Dr. Greenup, formerly of Salisbury, for the last fourteen years Superinten
dent of the Parramatta (New South Waies) Lunatic Asylum, holding also flic
offices of Medical Adviser to the Government and Examiner of Sydney Univer
sity, has been stabbed by one of the patients in the Asvlum, and died in two
days after much suffering. His last words were, “ No one is to blame for it.”
He fell a victim to his humane disposition, which led him to be too trustful
even of men confined in the criminal division of the Asylum.—‘ Sydney Morning
Herald' quoted in ‘Medical Times,' Sept. 22.
Notice to Correspondents.
English books for review, pamphlets, exchange journals, &c., to be sent either
by book-post to Dr. Robertson, Hayward’s Heath, Sussex; or to the care of
the publishers of the Journal, Messrs. Churchill and Sons, New Burlington
Street. French, German, and American publications may be forwarded to
Dr. Robertson, by foreign book-post, or to Messrs. Williams ami Norgate,
llcinietta Street, Covcnt Garden, to the care of their German, French/ and
American agents, Mr. Hartmann, Leipzig; M. Borrari, 9, Rue de St. Peres,
Paris ; Messrs. Westermann and Co., Broadway, New York.
Authors of Original Papers wishing Reprints for private circulation can have
them on application to the Printer of the Journal, Mr. Adlard, Bartholomew
Close, E.C., at a fixed charge of 30s. per sheet per 100 copies, includiim a
coloured wrapper and title-page.
3
The copies of The Journal of Mental Science are regularly sent by Book post
(prepaid) to the ordinary Members of the Association, and to our Home and
Foreign Correspondents, and we shall be glad to be informed of any irregu
larity in their receipt or overcharge in the Postage.
The following EXCHANGE JOURS ALS have been regularly received since
our last publication :
The Annales Médico-Psychologiques ; the Zeitschrift fier Psychiatrie; the
Corresponded Blatt der deutschen Gesellschaft fHr Psychyatrie ; Archie fur Psy
chiatrie ; the Irren Freund; Journal de Médecine Mentale; Archivio Italiano
per le Malattie Nervose e per le Alienazioni Mentali ; Medicinische Ahrenlese ;
Medizinisclie Jahrbiiclier {Zeitschrift der K. K. Gesellschaft der Aerzte in Wien) ;
the EdinburghMedical Journal; \\\o American Journal of Insanity ; the Bri
tish and Foreign Medico-Chirurgical Review; the Dublin Quarterly Journal ;
the Medical Mirror; the Social Science Review ; the Ophthalmic Review—a
Quarterly Journal of Ophthalmic Surgery and Science; the British Medical
Journal; the Medical Circular ; and the Journal of the Society of Arts ; also
the Morningside Mirror ; the York Star and Excelsior ; the Murray Royal Insti
tution Literary Gazette.
M e are compelled to defer to our next number the publication of the third
and fourth papers read at the Annual Meeting of the Medico-Psychological
Association, viz. :
“ The Pathology of Aphasia.” By Alexander Robertson, M.D.
“Asylum Architecture” (with plans). By C. Lockhart Robertson, M.D.
�1866.]
157
THE
MEDICO-PSYCHOLOGICAL
ASSOCIATION.
THE COUNCIL, 18GG—7.
president.—Mr.
Commissioner BROWNE.
president elect.—C.
L. ROBERTSON, M.D.
WOOD, M.D.
TREASURER.—JOHN II. PAUL, M.D.
C. L. ROBERTSON. M.D.
EDITOBS or JOURNAL.
HENRY MAUDSLEY, M.D.
(J. CRICHTON BROWNE, M.D.
AUDITORS.
tEDGAR SHEPPARD, M.D.
HON. SECRETARY FOR IRELAND.—ROBERT STEWART, M.D.
HON. SECRETARY FOR SCOTLAND.—JAMES RORIE. M.D.
ex-president.—WILLIAM
GENERAL SECRETARY.-
JAMES F. DUNCAN. M.D.
ROBERT BOYD, M.D.
JAMES G. DAVEY, M.D.
JOHN SIBBALD, M.D.
HARRINGTON TU KE, M.D.
JOHN HITCHMAN, M.D.
JOHN TllURNAM, M.D.
HENRY MONRO, M.D.
DONALD CAMPBELL, M.D.
Members of the Association.
Richard Adams, L.R.C.P. Edin., M.R.C.S. Eng., Medical Superintendent, County
Asylum, Bodmin, Cornwall.
Adam Addison, L.R.C.P. Edin., Assistant-Physician, Royal Asylum, Sunnyside,
Montrose.
Thomas Aitken, M.D. Edin., Medical Superintendent, District Asylum, Inverness.
Thomas Allen, Esq., L.R.C.S. Edin , M.R.C.S. Eng., Medical Superintendent,
Warneford Asylum, Oxford.
John Ihomas Arlidge, M.B. Loud., M.R.C.P. I.ond., Newcastle-under-Lyme,
Stafford (late Medical Superintendent, St. Luke’s Hospital).
Henry Armstrong, M.D. Edin., M.R.C.S. Eng., Peckham House, London.
G. Mackenzie Bacon, M.D. St. And., M.R.C.S. Eng., Assistant Medical Officer,
County Asylum, Fulbourn, near Cambridge.
Samuel Glover Bakewell, M.D. Edin., Church Stretton, Salop (late Oulton
House Retreat).
M. Baili.arger, M.D., Member of the Academy of Medicine, Visiting Physician
to the Asylum La Salpêtrière; 7,Rue de ¡’Université, Paris. (Honorary Member.)
Edward Robert Barker, M.D. St. And., M.R.C.S.Eng., Resident Medical Officer,
County Asylum, Denbigh, N. Wales.
Luke Baron, M.D., Staff Surgeon, Military Asylum, Fort Pitt, Chatham.
M. Battel, late Director of Civil Hospitals,'16, Boulevart de ¡’Hôpital, Paris.
(Honorary Member.)
T. B. Belgrave, M.D. Edin., 35, Euston Square, London.
Edward Benbow, Esq., M.R.C.S. Eng., Haves Park, Uxbridge, Middlesex.
Charles Berrel, Esq., M.R.C.S. Eng., Assistant Medical Officer, Countv Asylum,
Warwick.
M. Brierre de Boismont, M.D., Member of the Academy of Medicine, 303, Rue
de Faubourg St. Antoine, Paris. (Honorary Member.)
�458
Members of the Association.
[Oct.,
James Strange Biggs, M.D. St. And., M.R.C.P. Lond., Medical Superintendent,
County Asylum, Wandsworth, Surrey.
Thomas Bigland, Esq., M.R.C.S. Eng., L.S.A. Lond., Bigland Hall, Lancashire,
and Medical Superintendent, Kensington House, Kensington,
M. Biffi, M.D., Editor of the Italian 1 Journal of Mental Science,’ 16, Borgo di San
Celso, Milan. {Honorary Member.}
Cornelius Black, M.D. Lond., M.R.C.P., F.R.C.S. London, St. Mary’s Gate,
Chesterfield.
John Aloysius Blake, M.P., Stafford Club, 2, Savill Row,W. {Honorary Member}.
George Fielding Blandford, M.B. Oxon., M.R.C.P. Lond., Blackland’s House,
Chelsea; and 3, Clarges Street, Piccadilly.
George Bodington, L.R.C.P. Edin., L.S.A. Lond., Driffold House Asylum,
Sutton Coldfield, Warwickshire.
Theodore S. G. Boisragon, M.D. Edin., late Medical Superintendent, County
Asylum, Cornwall; Winslow,Bucks.
Mark Noble Bower, M.D. St. And., M.R.C.S. Eng., Medical Superintendent,
County Asylum, Stafford.
Robert Boyd, M.D. Edin., F.R.C.P. Lond., Medical Superintendent, County
Asylum, Wells, Somersetshire.
David Brodie, M.D. St. And., L.R.C.S. Edin., Superintendent, Institution for Imbe
ciles, Larbent, Stirlingshire.
Harry Browne, Esq., M.R.C.S. Eng., 18, Brandrum Road, Lee, Blackheath,
Kent.
John Ansell Brown, Esq., M.R.C.S. Eng., L.S.A. Loud., late Medical Staff
Indian Army, Grove Hall, Bow.
William A. F. Browne, M.D., F.R.S.E., F.R.C.S.E., Commissioner in Lunacy for
Scotland ; James Place, Leith. (President.) {Honorary Member.}
James Crichton Browne, M.D. Edin., M.R.C.S. Edin., L.S.A. Lond., Medical
Superintendent, County Asylum, Wakefield. {Auditor.}
Thomas Nadauld Brushfield, M.D. St. And., M.R.C.S. Eng., Medical Superin
tendent, County Asylum, Brookw’ood, Surrey.
Edward Langdon Bryan, M.D. Aberd., F.R.C.S. Eng., late Medical Superinten
dent, Cambridge County Asylum ; 15, Kensington Park Gardens, W.
John Charles Bucknill, M.D. Lond., F.R.C.P. Lond., F.R.S., Lord Chancellor’s
Visitor; Hillmorton Hall, Rugby; 49, Lincoln’s Inn Fields. Editor of Journal,
1852-62. (President, 1860.) {Honorary Member.}
John Buck, Esq., M.R.C.S., Medical Superintendent, Leicestershire and Rutland
County Asylum, Leicester.
M. Bulckens, M.D., Gheel, near Brussels. {Honorary Member.}
C. Mountford Burnett, M.D. Aberd., M.R.C.S. Eng., Westbrook House, Alton,
Hampshire.
Thomas Crowe Burton, M.D. Gias., M.R.C.S. Eng., Resident Physician, District
Asylum, Waterford.
John Bush, Esq., M.R.C.S. Eng., The Retreat, Clapham.
J. Stevenson Bushnan, M.D. Heidlb., F.R.C.P. Edin., Laverstock House, Salisbury.
M. Girard de Cailleux, M.D., Member of the Academy of Medicine, Inspector
General of Asylums in the Prefecture of the Department of the Seine, Hotel de
Ville, Paris. {Honorary Member.}
Donald C. Campbell, M.D. Gias., M.R.C.P. Lond., F.R.C.P. Edin., Medical
Superintendent, County Asylum, Brentwood, Essex.
M. Calmeil, M.D., Member of the Academy of Medicine, Paris, Physician to the
Asylum at Charenton, near Paris. {Honorary Member.}
Francis Wood Casson, Esq., M.R.C.S., Borough Asylum, Aulaby Road, Hull.
Thomas Algernon Chapman, M.D. Glasg., M.R.C.S. Edin., Assistant Medical
Officer, County Asylum, Abergavenny.
Barrington Chevallier, M.D. Oxon., M.R.C.P. Lond. The Grove, Ipswich.
Thomas B. Christie, M.D. St. And., M.R.C.P. Lond., F.R.C.P. Edin., Pembroke
House, Hackney.
Edward Clapton, M.D. Lond., M.R.C.P. Lond., Assistant-Physician, St. Thomas’s
Hospital, Visitor of Lunatics for Surrey; 4, St. Thomas Street, Borough,
�1866.]
Members of the Association.
459
John D. Cleaton, Esq., M.R.C.S. Eng., Commissioner in Lunacy, 19, Whitehall
Place.
Thomas Smith Clouston, M.D. Edin., L.R.C.S. Edin., Medical Superintendent,
Cumberland and Westmoreland Asylum, Garlands, Carlisle.
Sir James Coxe, Knt., M.D. Edin., F.R.C.P. Edin., Commissioner in Lunacy for
Scotland; Kinellan, near Edinburgh. {Honorary Member.)
William Corbet, M.B. T.C.D., F.R.C.S. Ireland, Resident Physician, State
Asylum, Dundrum, Co. Dublin.
James Cornwall, Esq., M.R.C.S.,Fairford, Gloucestershire.
M. Damerow, M.D.,Visiting Physician to the Halle Asylum, Prussia. {Hon. Member.)
George Russell Dartnell, Esq., M.R.C.S. Eng., Deputy Inspector-General,
Army Medical Department (formerly in charge of the Military Lunatic Hospital,
Great Yarmouth ' ; Arden' House Henlev-in-Arden, Warwickshire.
James George Davey, M.D. St. And., M.R.C.P. Lond., late Medical Superin
tendent of the County Asylums, Hanwell and Colney Hatch, Middlesex;
Northwoods, near Bristol, and 52, Park Street, Bristol.
Frederick Davidson, M.D. Edin., Medical Superintendent, District Asylum, Banff.
Robert A. Davis, M.D. St. And., L.R.C.P. Edin., Medical Superintendent, County
Asylum, Burntwood, Lichfield.
Barry Delany, M.D., Queen’s Univ. Ireland, Resident Physician, District
Asylum, Kilkenny.
M. Delasiauve, M.D., Member of the Academy of Medicine, Physician to the
Bicêtre, Paris, 6, Rue du Pont de Lodi, Paris. {Hon. Member.)
James de Wolf, M.D. Edin., Medical Superintendent, Hospital for Insane, Halifax,
Nova Scotia.
Warren Hastings Diamond, M.D. Edin., L.R.C.P. Edin., M.R.C.S. Eng., Dudley
Villa, Effra Road, Brixton.
John Dickson, M.D. Edin., Physician to the Dumfries Royal Infirmary, late
Assistant-Physician, Crichton Royal Institution; Buccleugh Street, Dumfries.
Thompson Dickson, Esq., M.R.C.S. Eng., Assistant Medical Officer, City of London
Asylum, Dartford.
J. Langdon Haydon Down, M.D. Lond., M.R.C.P. Lond., Assistant-Physician,
London Hospital ; Resident Physician, Asylum for Idiots, Earlswood, Surrey.
Valentine Duke, M.D. Edin., L.R.K. and Q.C.P. Ireland, Visiting Physician,
Society of Friends, Bloomfield, Dublin ; 33, Harcourt Street, Dublin.
James Foulis Duncan, M.D. Trin. Col., Dub., L.R.K. and Q.C.P. Ireland Visiting
Physician, Farnham House, Finglas; 19, Gardiner’s Place, Dublin.
James Duncan, M.D. Lie. Med, Dub., L.R.C.S. Edin.; 39, Marlborough Street,
Dublin, and Farnham House, Finglas.
Nugent B. Duncan, M B. Trin. Col., Dub., F.R.C.S. Ireland; 39, Marlborough
Steeet, Dublin, and Farnham House, Finglas.
Peter Martin Duncan, M.B. Loud., M.R.C.S. Eng., late Med. Super., Essex
Hall Asylum ; 8, Belmont, Church Lane, Lee, Kent.
George Eames, M.D., Medical Superintendent, District Asylum, Letterkenny.
J. William Eastwood, M.D. Edin., M.R.C.S. Eng., late Lecturer on Physiology,
Sheffield ; Dunston Lodge, Gateshead.
Richard Eaton, M.D. Queen’s Univ. Ireland, L.R.C.S. Ireland, Resident
Physician, District Asylum, Ballinasloe.
John Edmundson, M.D. Queen’s Univ., Medical Superintendent, District Asylum,
Clonmel.
James Ellis, Esq., M.R.C.S. Eng., L.S.A. Lond., Medical Superintendent,
St. Luke’s Hospital, London.
John Eustace, jun., B.A. Trin. Col., Dub., L.R.C.S. Ireland; 47, Grafton Street,
Dublin, and Hampstead House, Glasnevin, Dublin.
William Dean Fairless, M.D. St. And., M.R.C.S. Eng., late Medical Super
intendent, Old Royal Asylum, Montrose ; Hillgarden House, Coupar-Angus,
Perth.
M. Falret, Doctor of Medicine, Paris, Member of the Academy of Medicine,
Physician to the Asylum La Salpêtrière ; 114, Rue du Bac, Paris. {Hon. Member.)
Jules Falret, M.D.. 114, Rue du Bac. Paris. {Honorary Member.)
�160
Members of the Association.
[Oct.,
George Fayrer, M.D. St. And., F.R.C.S. Eng., Hurst House and Burman House,
Henley-in-Arden, Warwickshire.
C. F. Flemming, M.D., Editor of the ‘ Zeitsclirift fur Psvchiatrie,’ late of the
Saclisenberg State Asylum, Schwerin, Mecklenburgb. {Honorary Member.)
Charles Joseph Fox, M.D. Cantab., Brislington House, Bristol.
Francis Ker Fox, M.D. Cantab., Brislington House, Bristol.
Charles II. Fox, M.D. St. And., M.R.C.S. Eng., Brislington House, Bristol.
John Mitchell Garbutt, L.R.C.P. Edin., Dunston Lodge, Gateshead-on-Tyne.
Gideon G. Gardiner, M.D. St. And. M.R.C.S. Eng., Medical Superintendent,
Brooke House, Clapton.
Samuel Gaskell, Esq., F.R.C.S. Eng., late Commissioner in Lunacy; 19, Whitehall
Place. {Honorary Member.)
James Gilchrist, M.D. Edin., Resident Physician, Crichton Royal Institution,
Dumfries.
Thomas Green, Esq., M.R.C.S. Eng., Medical Superintendent, Borough Asylum,
Birmingham.
Professor Griesinger, M.D., University of Berlin. {Honorary Member.)
Edward Thomas Hall, Esq., M.R.C.S. Eng., Blackland's House Asylum, Chelsea.
Francis James Hammond, Esq., M.R.C.S. Eng., 12, Aldersgate Street, E.C.
Henry Lewis Harper, Esq., M.D. St. And., M.R.C.S. Eng., Medical Superin
tendent, County Asylum, Chester.
WiLliam Harris, Esq., F.R.C.S. Eng., L.S.A., House of Correction, Wandsworth.
Arthur R. Harrison, M.D. St. And., M.R.C.S. Eng., Medical Superintendent,
The Asylum, Adelaide, South Australia.
George W. Hatciiell, M.D. Gias., L.R.K. and Q.C.P. Ireland, Inspector and Com
missioner of Control of Asylums, Ireland; 13, llume Street, Dublin. {lion. Mem.)
Edward S. Haviland, M.D. Edin., M.R.C.S. Eng., 13, Lyon Terrace, Maida Hill.
Stanley Haynes, M.D., Laverstock House, Salisbury.
John Dale Hewson, M.D., Ext. L.R.C.P. Eng., Medical Superintendent, Coton Hill
Asylum, Stafford.
Robert Gardiner IIii.l, M.D., L.R.C.P. Edin., M.R.C.S. Eng., late Medical
Superintendent, Lunatic Hospital, Lincoln ; Earl’s Court House, Brompton.
William Charles Hills, M.D. Aber., M.R.C.S. Eng., Medical Superintendent,
County Asylum, Norfolk.
Samuel IIitch, M.D., M.R C.P. Loud., M.R.C.S. Eng., late Medical Superintendent,
County Asylum, Gloucester; Southwick Park, Tewkesbury. , {Treasurer and Hon.
General Secretary, 1841-51.)
Charles Hitchcock, M.D., L.R.C.P. Edin., M.R.C.S. Eng., Fiddington House,
Market Lavington, Wilts.
John Hitchman, M.D. St. And., M.R.C.P. Loud., F.R.C.S. Eng, late Medical
Superintendent, County Asylum, Hanwell; Medical Superintendent, County
Asylum, Mickleover, Derbyshire. (President, 1856.)
Samuel Hobart, M.D., F.R.C.P. Edin., M.R.C.S. Eng., Visiting Surgeon, District
Asylum, Cork ; South Mall, Cork.
Sir Henry Holland, Bart., M.D. Edin., F.R.C.P. Loud., Physician in Ordinary to
the Queen, F.R.S., D.C.L. Oxon.; 25, Brook St, Grosvenor Sq. {Honorary Member.)
William Charles Hood, M.D. St. And., F.R.C.P. Loud., F.R.C.P. Edin., Lord
Chancellor's Visitor; 49, Lincoln’s Inn Fields: Croydon Lodge, Croydon.
{Honorary Member.)
Thomas Howden, M.D. Edin., Medical Superintendent, District Asylum, Had
dington.
James C. Howden, M.D. Edin., late Senior Assistant-Physician, Royal Asylum,
Edin.; Medical Superintendent, Royal Asylum, Sunnyside, Montrose.
S. G. Howe, M.D., Boston, United States. {Honorary Member.)
John W. Hughes, Esq., M.R.C.S. Eng., Assistant Medical Officer, County Asylum,
Morpeth.
John Humphry, Esq., M.R.C.S. Eng., Medical Superintendent, County Asylum,
Aylesbury, Bucks.
William James Hunt, M.D., L.R.C.P. Edin., M.R.C.S. Eng., late Assistant
Medical Officer, County Asylum, Worcester; Medical Superintendent, Hoxton
House, London.
�ALeinhers of the Association.
461
Daniel Iles, Esq., M.R.C.S. Eng., Resident Medical Officer, Fairford House Retreat,
Gloucestershire.
George R. Irvine, M.D., M.R.C.S. Eng., Assistant Medical Officer, County
Asylum, Rainhill, Liverpool.
J. Hughlings Jackson, M.D. St. And., Assistant-Phvsician, Hospital for Epilepsy
and Paralysis, &c.; 28, Bedford Place, Russell Square, W.C.
Robert Jamieson, M.D. Edin., L.R.C.S. Edin., Medical Superintendent, Royal
Asylum, Aberdeen.
Edward Jarvis, M.D., Dorchester, Mass., U.S. (Honorary Member.)
Octavius Jepson, M.D. St. And., M.R.C.S. Eng., late Medical Superintendent,
St. Luke’s Hospital, Medical Superintendent, City of Lond. Asy., Dartford.
George Iurner Jones, M.D., L.R.C.P. Edin., Medical Superintendent, County
Asylum, Denbigh, N. Wales.
Evan Jones, M.D., L.R.C.S. Edin., Dare Villa, Aberdare.
W. B. Kesteven, F.R.C.S , Manor Road, Upper Holloway.
Henry L. Kempthorne, M.D. Lond., Assistant Medical Officer, Bethlehem Hospital
John Kitching, M.D. St. And., L.R.C.P. Edin., M.R.C.S. Eng., Medical Superintendent, The Friends’ Retreat, York.
John Kirkbride, M.D., Professor of Medicine, Philadelphia. (Hon. Member.)
John Kirkman, M.D., Medical Superintendent, County Asvlum, Melton, Suffolk
President, 1862.
William Philips Kirkman, M.D. St. And., M.R.C.S. Eng., Medical Superin
tendent, County Asylum, Maidstone, Kent.
II. Laeiir, M.D., Schweizer Hof, bei Berlin, Editor of the ‘Zeitschrift für Psychia
trie.’ (Honorary Member.)
Joseph Lalor, M.D. Gias., L.R.C.S. Ireland, Resident Physician, Richmond
District Asylum, Dublin. President, 1861.
Robert Law, M.D. Trin. Col., Dub., F.R.K. and Q.C.P. Ireland, Visiting Physician
State Asylum, Dundrum; 25, Upper Merrion Street, Dublin.
Martin S. Lawlor, M.D. Edin., L.R.C.S. Ireland, Resident Physician, District
Asylum, Killarnev, Kerry.
M. Lascuue, M.D., Paris, Physician to the Neckar Hospital. (Hon. Member.)
George William Lawrence, M.D. Lond., M.R.C.P. Lond., M.R.C.S. Eng.,
Medical Superintendent, County Asylum, Fulbourn, Cambridge.
William Lawrence, Esq., F.R.C.S. Eng., F.R.S., Serjeant-Surgeon to the Queen,
18, Whitehall Place, Whitehall. (Honorary Member.)
Thomas Laycock, M.D. Gottingen, F.R.C.P. Edin., F.R.S. Edin., M.R.C.P. Lond.,
. Professor of Medicine and of Clinical and Psychological Medicine, Edinburgh
University ; Rutland Street, Edinburgh. (Honorary Member.)
M. Leidesdorf, M.D., Universität, Vienna. (Honorary Member.)
Henry Lewis, Esq., M.R.C.S. Eng., late Assistant Medical Officer, County Asvlum,
Chester; West Terrace, Folkestone.
H. Rooke Ley, Esq., M.R.C.S. Eng., Medical Superintendent, County Asylum,
Shrewsbury.
William Ley, Esq., M.R.C.S. Eng., Medical Superintendent, County Asylum,
Littlemore, Oxfordshire. Treasurer, 185-4-1862. President, 1848.
■William Lauder Lindsay, M.D., F.R.S. Edin., F.L.S. Lond., Physician to the
Murray Royal Institution, Perth ; Gilgal, Perth.
James Murray Lindsay, M.D. St. And., L.R.C.S. Edin., Medical Superintendent,
County Asylum, llanwell, Middlesex.
Edmund Lloyd, Esq., M.R.C.S. Eng., late Assistant Medical Officer, County
Asylum, Wakefield; Medical Department, General Post Office, St. Martin’s-leGrand.
John Lorimer, M.D. Edin., Ticehurst, Sussex.
William II. Lowe, M.D. Edin., F.R.C.P. Edin., Satighton Hal), Edinburgh.
Th omas Harvey Lowry, M.D. Edin., M.R.C.S. Eng., Mailing Place, West
Mailing, Kent.
Frederick F. Maccabe, M.D , District Asylum, Waterford.
Donald Mackintosh, M.D. Durham and Glas., L.F.P.S. Gias., Dimsdale Park
Retreat, Darlington, Durham.
�462
Members of the Association.
[Oct.,
Alexandeb Mackintosh, M.D. St. And., L.F.P.S. Gias., Physician to Royal
Asylum, Gartnavel, Glasgow.
John Robert Maclintock, M.D. Aber., Assistant-Physician, Murray’s Royal
Institution, Perth.
Harry Manning, Esq., B.A. London, M.R.C.S., Assistant Medical Officer, Laver,
stock House, Salisbury.
William Carmichael Mackintosh, M.D. Edin., L.R.C.S. Edin., Medical
Superintendent, District Asylum, Murthley, Perth.
John Macmunn, M.D. Gias., L.F.P.S. Gias., Resident Physician, District Asvlum
Sligo.
Hyde Macpherson, Esq., M.R.C.S., Resident Medical Officer, Borough Asylum,
Norwich.
Charles W. C. Madden-Medlicott, M.D. Edin., L.M. Edin., Assistant Medical
Officer, County Asylum, Wells, Somerset.
John Manley, M.D. Edin., M.R.C.S. Eng., Medical Superintendent, County
Asylum, Knowle, Fareham, Hants.
William G. Marshall, Esq., M.R.C.S., Medical Superintendent, County Asylum,
Colney Hatch.
Henry Maudsley, M.D. Lond., M.R.C.P. Lond., Physician to the West London
Hospital, late Medical Superintendent, Royal Lunatic Hospital, Cheadle; 38,
Queen Anne Street, Cavendish Square, and The Lawn, Hanwell, W. (Editor of
Journal.)
David M. M'Cullough, M.D. Edin., Medical Superintendent of Asylum for
Monmouth, Hereford, Brecon, and Radnor; Abergavenny.
Robert M'Kinstry, M.D. Giess., L.K. and Q.C.P. Ireland, and L.R.C.S. Ireland,
formerly Physician, Trough Fever Hospital and Glasslough and Emyvale Dis
pensaries, Resident Physician, District Asylum, Armagh.
John Meyer, M.D. Heidelb., F.R.C.P. Lond., late of the Civil Hospital, Smyrna,
and Surrey Asylum ; Medical Superintendent, State Asylum, Broadmoor, Wokin°-.
John Millar, M.D., L.R.C.P. Edin., L.R.C.S. Edin., late Medical Superintendent,
County Asylum, Bucks ; Bethnal House, Cambridge Heath.
Patrick Miller, M.D. Edin., F.R.S. Edin., Visiting Physician, St. Thomas’s
Hospital for Lunatics; The Grove, Exeter.
Arthur Mitchell, M.D. Edin., Deputy Commissioner of Lunacy; Trinity, Edin.
Edward Moore, M.D. L.R.C.P. Lond., M.R.C.S. Eng., Thurlow House, Bethnal
Green Road, and Park House, Victoria Park.
Henry Monro, M.D. Oxon, F.R.C.P. Lond., Censor, 1861, Visiting Physician, St.
Luke’s Hospital; Brook House, Clapton, and 13, Cavendish Square. President
1864.
M. Morel, M.D., Member of the Academy of Medicine, Paris, Physician in Chief
to the Asylum for the Insane at St. Yon, near Rouen. (Honorary Member.)
George W. Mould, Esq., M.R.C.S. Eng., Medical Superintendent, Royal Lunatic
Hospital, Cheadle, Manchester.
Henry Muirhead, M.D. Gias., L.F.R.S. Gias., late Assist. Med. Officer, Royal
Asylum, Gartnavel; Longdales House, Bothwell, Lanarkshire.
Baron Jaromir Mundy, M.D. Wurzburg, Drnowitz, near Brunn, Moravia, Austria;
and of Brighton, England.
Robert Nairne, M.D. Cantab., F.R.C.P. Lond., late Senior Physician to St. George’s
Hospital, Commissioner in Lunacy; 19, Whitehall Place, and Richmond Green,
London. (Honorary Member.)
Frederick Needham, M.D. St. And., M.R.C.P. Edin., M.R.C.S. Eng., Medical
Superintendent, Hospital for the Insane, Bootham, Yorkshire.
Samuel Newington, B.A. Oxon., M.R.C.P. Lond., Ridgway, Ticehurst, Sussex.
William Niven, M.D. St. And., Medical Superintendent of the Government
Lunatic Asylum, Bombay.
Daniel Noble, M.D. St. And., F.R.C.P. Lond., Visiting Physician, Clifton Hall,
Retreat, Manchester.
John Nugent, M.B. Trin. Col., Dub., L.R.C.S. Ireland, Senior Inspector and Com
missioner of Control of Asylums, Ireland; 14, Rutland Square. Dublin. (Hon. Mem.)
�1866.]
Members of the Association.
463
Edward Paley, Esq., M.R.C.S. Eng., late Resident Medical Officer, Camber«
well House, Camberwell; Med. Superintendent, Yarra Bend Asy., Melbourne,
Victoria.
Edward Palmer, M.D. St. And., M.R.C.P. Lond., Medical Superintendent, County,
Lincoln.
William Henry Parsey, M.D. Lond., M.A. Lond., M.R.C.P. Lond., Medical
Superintendent, County Asylum, Hatton, Warwickshire.
G. A. Paterson, M.D. Edin., F.R.C.P. Edin., Deputy Commissioner of Lunacy;
Post Office Buildings, Edinburgh.
John Hayball Paul, M.D. St. And., M.R.C.P. Lond., F.R.C.P. Edin.; Camber
well House, Camberwell. {Treasurer.)
Thomas Peach, M.D., J.P. for the County of Derby; Langley Hall, Derby.
{Honorary Member.)
Edward Picton Phillips, Esq., M.R.C.S. Eng., Medical Superintendent, Haver
fordwest Boro’ Asylum ; High Street, Haverfordwest, Pembrokeshire.
Francis Richard Philip, M.D. Cantab., F.R.C.P. Lond., late Physician to St.
Luke’s Hospital; Colby House, Kensington.
Thomas Power, M.D. Edin., L.M. Dublin, Physician Superintendent, District
Asylum, Cork; Visiting Physician, Lindville House,Cork.
Thomas Prichard, M.D. Gias., M.R.C.P. Lond., F.R.C.P. Edin., late Medical
Superintendent, Gias. Royal Asylum; Abington Abbey, Northampton.
James Rae, M.D. Aberd., L.R.C.P. Edin., late Deputy Inspector-General, Naval
Lunatic Hospital, Great Yarmouth; 69, Port Street, Stirling.
Isaac Ray, M.D., Physician, Butler Hospital for the Insane, Providence, Rhode
Island, U.S. {Honorary Member.)
W. H. Reed, Esq., M.R.C.S. Eng., Assistant Medical Officer, County Asylum,
Derby.
John Foster Reeve, M.D. Aber., M.R.C.S. Eng., L.S.A. Lond., 4, Newington
Terrace, Kennington Park.
Hon. W. Spring Rice, 165, New Bond Street. {Honorary Member.)
Charles A. Lockhart Robertson, M.D. Cantab., M.R.C.P. Lond., F.R.C.P. Edin.,
formerly Assistant-Physician, Military Lunatic Hospital, Yarmouth; Medical
Superintendent, County Asylum, Hayward’s Heath, Sussex. {General Secretary.
1855-62.) Editor of Journal. President elect.
Alexander Robertson, M.D. Edin., Medical Superintendent, Towns Hospital and
City Parochial Asylum, Glasgow.
John Charles G. Robertson, L.R.C.P. Edin., M.R.C.S. Eng., L.S.A. Lond.,
Assistant Medical Officer, County Asylum, Hanwell, Middlesex.
George Robinson, M.D. St. And., F.R.C.P. Lond., 26, Welbeck St., Cavendish
Square.
William Francis Rogan, M.D. Trin. Coll., Dubl., L.R.C.S. Edin., Resident Phy
sician, District Asylum, Londonderry.
Thomas Lawes Rogers, M.D. St. And., M.R.C.P. Lond., M.R.C.S. Eng., Medical
Superintendent, County Asylum, Rainhill, Lancashire.
James Rorie, M.D. Edin., L.R.C.S. Edin., Medical Superintendent, Royal Asylum,
Dundee. {Honorary Secretaryfor Scotland.)
James Rutherford, M.D., Edin., Bo'ness, Linlithgowshire.
Edward Rutherfurd, M.D. Edin., Assistant Medical Officer, Perth District Asylum,
Murthly, Dunkeld.
James Sadlier, M.D. Edin., Gilmour House Asylum, Liberton, Edinburgh.
Ernst Salomon, M.D., Medical Superintendent, Malmo Asylum, Sweden.
Heurtley H. Sankey, Esq., M.R.C.S. Eng., Assistant Medical Officer, Oxford
County Asylum, Littlemore, Oxford.
W. H. Octa.vius Sankey, M.D., M.R.C.P. Lond.; late Medical Superintendent,
Hanwell, Middlesex; Sandywell Park, Cheltenham, and Almond’s Hotel, Clifford
Street, Bond Street.
M. Legrand du Saulle, M.D., Paris, 9, Boulevard de Sebastopol, Paris.
{Honorary Member.)
George James S. Saunders, M.B. Lond., M.R.C.S. Eng., Medical Superinteadent,
County Asylum, Exminster, Devon.
�K51
Members of the Association.
[Oct.,
L. Schlager, M.D., Professor of Psvcbiatrie; 2, Universitats Platz, Vienna. {Hono
rary Member.)
Frank Schofield, Esq., M.R.C.S. Eng., Camberwell House, Camberwell.
William Seller, M.D. Edin., F.R.S. Edin., Lecturer on Mental Diseases to tbe
Royal Coll, of Phys.; Northumberland Street, Edinburgh.
John Shepherd, M.D. Edin., Eccles, Manchester.
Edgar Sheppard, M.D. St. And., M.R.C.P. London, F.R.C.S. Eng., Medical Su
perintendent, County Asylum, Colney Hatch, Middlesex. {Auditor.)
J. W. Sheill, M.D. Edin., F.R.C.S. Eng., District Asylum, Maryborough, Ireland.
James Sherlock, M.D. Edin., M.R.C.P. Lond., F.R.C.S. Edin., Medical Superin
tendent, County Asylum, Powick, Worcester.
John Sibbai.d, M.D. Edin., M.R.C.S. Eng., Medical Superintendent, District
Asylum, Lochgilphead, Argyllshire.
Sir James Young Simpson, Bart., M.D. Edin., F.R.C.P. Edin., Professor of Medi
cine and Midwifery, University of Edinburgh. {Honorary Member.)
John II. Simpson, M.D., Assistant Medical Officer, County Asylum, Gloucester.
David Skae, M.D. St. And., F.R.C.S. Edin., Medical Superintendent, Royal
Asylum, Morningside, Edinburgh. (President, 1863.)
Frederick W. A. Skae, M.D. St. And., L.R.C.S. Edin., Assistant-Physician Royal
Asylum for the Insane, Morningside, Edinburgh.
W. Smart, L.R.C.S., Alloa House, Edinburgh.
Frederick Moore Smith, M.D. St. And., M.R.C.S. Eng., late Assistant-Surgeon,
4th Reg.; Hadham Palace, Ware, Herts.
George Pyemont Smith, M.D. Edin., M.R.C.S. Eng., The Retreat, Mount Stead,
Otley, Yorkshire.
Robert Smith, M.D. Aber., L.R.C.S. Edin., Medical Superintendent County
Asylum, Sedgetield, Durham.
John Smith, M.D. Edin., F.R.C.P. Edin., late Physician, City Lunatic Asylum;
Visiting Physician to Saughton Hall; 20, Charlotte Square, Edinburgh.
J. Walbridge Snook, Esq., M.R.C.S. Eng., House Surgeon, Infirmary, Bradford,
Yorkshire.
Robert Spencer, Esq., M.R.C.S. Eng., Assistant Medical Officer, County Asylum,
Maidstone, Kent.
Hans Sloane Stanley, Esq., late Chairman of Visiting Magistrates, County
Asylum, Hampshire, Paultons, Romsey. (Honorary Member.)
William Stamer Stanley, M.R.C.S. Eng., L.M. Dub., L.K.Q.C.P. Ireland, Orchardstown House, Rathfarnham, Dublin.
Peter Wood Stark, M.D. St. And., L.R.C.P. Edin., County Asylum, Lancaster.
Henry Stevens, M.D. Lond., M.R.C.P. Lond., M.R.C.S. Eng., late Medical Super
intendent, St. Luke’s Hospital; 78, Grosvenor Street, London.
Henry Oxley Stephens, M.D. Aber., M.R.C.P. Lond., M.R.C.S. Eng., Medical
Superintendent, Boro’ Asylum, Stapleton, Bristol.
Henry II. Stewart, M.D. Edin., F.R.C.S. Ireland, Resident Superintendent Phy
sician, Government Asylum, Lucan, Dublin.
Robert Stewart, M.D. Gias., L.A.II. Dub., Physician Superintendent, District
Asylum, Belfast. {Honorary Secretary for Ireland.)
Hugh G. Stewart, M.D. Edin., L.R.C.S. Edin., Medical Superintendent, Ntwcastle-on-Tvne Borough Lunatic Asylum.
William Piiillimore Stiff, M.B. Lond., M.R.C.S. Eng., Medical Superintendent,
County Asylum, Nottingham.
George James Stilwell, M.D. Edin., M.R.C.P.Lond., M.R.C.S. Eng.; Moorcroft
Hoi ise, Hillingdon, Middlesex, and 38, Park Street, Grosvenor Square.
Henry Stilwell, M.D. Edin., M.R.C.S. Eng.; Moorcroft House, Hillingdon,
Middlesex.
Alonzo Henry Stockwell, M.D. St. And., M.R.C.P. Lond., M.R.C.S. Eng.,
Medical Superintendent, Grove Hall Asylum, Bow.
William Stockwell, Esq., M.R.C.S. Eng., Millholme House, Musselburgh.
Alexander J. Sutherland, M.D. Oxon., F.R.C.P. Lond., F.R.S., Censor, 1847,
Consulting Physician to St. Luke’s Hospital; Blackland’s, and Whiteland’s House,
Chelsea, and G. Richmond Terrace, Whitehall. (President, 1854.)
�1866.]
Members of the Association.
465
Frederick Sutton, Esq., M.R.C.S. Eng., Assistant Medical Officer, Norfolk Lunatic
Asylum, Thorpe, Norwich.
Joseph P. Symes, Esq., M.R.C.S. Eng., L.S.A., Assistant Medical Officer, County
Asylum, Devizes, Wilts.
William Barney Tate, M.D. Aber., M.R.C.P. Loud., M.R.C.S. Eng., Medical
Superintendent of the Lunatic Hospital, The Coppice, Nottingham.
John Terry, Esq., M.R.C.S. Eng., Bailbrook House, Bath.
James Bruce Thomson, L.R.C.S. Edin., Resident Surgeon, General Prison,
Perth.
John Thurnam, M.D. Aber., F.R.C.P. London, late of The Retreat, York;
Medical Superintendent, County Asylum, Devizes, Wilts. President, 1344
and 1855.
Ebenezer Toller, Esq., M.R.C.S. Eng., late Medical Superintendent, St. Luke’s
Hospital; Medical Superintendent, County Asylum, Wotton, Gloucestershire.
M. Moreau de Tours, M.D., Member of the Academy of Medicine, Senior
Physician to the Salpêtrière, Paris. {Honorary Member.)
John Batty Tuke, M.D. Edin., Medical Superintendent, County Asylum, Fife and
Kinross, Cupar, Fifeshire.
Daniel Hack Tuke, M.D., Heidel., L.R.C.P. Lond., M.R.C.S. Eng., late Visiting
Physician, The Retreat, York; Wood Lane, Falmouth.
Thomas Harrington Tuke, M.D. St. And., F.R.C.P. Edin., M.R.C.P. London ;
M.R.C.S. Eng. ; The Manor House, Chiswick, and 37, Albemarle Street, Pic
cadilly. {Honorary General Secretary.)
Alexander Tweedie, M.D. Edin., F.R.C.P. London, F.R.S., late Examiner in
Medicine, University of London, 17, Pall Mall, and Bute Lodge, Twickenham.
{Honorary Member.)
Edward Hart Vinen, M.D. Aber., F.L.S., 6, Chepstow Villas West, Bayswater.
Francis Delaval Walsh, Esq., M.R.C.S. Edin., Medical Superintendent, Lunatic
Hospital, Lincoln.
John Warwick, Esq., F.R.C.S. Eng., 39, Bernard Street, Russell Square, W.C.
John Ferra Watson, Esq., M.R.C.S. Eng., Ileigham Hall, Norwich.
Sir Thomas Watson, Bart., President of the Royal College of Physicians, M.D.
Cantab., D.C.L. Oxon., F.R.C.P. Lond., F.R.S., Physician Extraordinary to the
Queen, 16, Henrietta Street, Cavendish Square. {Honorary Member.)
Francis John West, Esq., M.R.C.S. Eng., Medical Superintendent, District
Asylum, Omagh, Tyrone.
Samuel Wilks, M.D. Lond., F.R.C.P. Lond., 11, St. Thomas’s Street, Borough.
James Wilkes, Esq., F.R.C.S. Eng., Commissioner in Lunacy ; 19, Whitehall Place,
and 18, Queen’s Gardens, Hyde Park. {Honorary Member.)
Edmund Sparshall Willett, M.D. St. And., M.R.C.P. Lond., M.R.C.S. Eng.,
Wyke House, Sion Hill, Isleworth, Middlesex ; and 2, Suffolk Place, Pall Mall.
Caleb Williams, M.D. Aber., M.R.C.P. Lond., F.R.C.S. Eng., Consulting
Physician, York Lunatic Asylum, Visiting Physician to The York Retreat, and to
Lawrence House, York; 73, Micklegate, York.
William White Williams, M.D. St. And., M.R.C.P. Lond., Consulting Physician.
County Asylum, Gloucester; Whithorne House, Charlton Kings, Cheltenham,
{Hon. General Secretary, 1847-1855.)
S. W. Duckworth Williams, M.D. St. And., L.R.C.P. Lond., Assistant Medical
Officer, Sussex County Asylum, Hayward’s Heath.
Rhys Williams, M.D., and M.R.C.S. Eng., Resident Physician, Bethlehem Hospital,
London.
Francis Wilton, Esq., M.R.C.S. Eng., Medical Superintendent, Joint Counties
Asylum, Carmarthen.
William Wood, M.D. St. And., F.R.C.P. Lond., F.R.C.S. Eng., Visiting Physician,
St. Luke’s Hospital, late Medical Officer, Bethlehem Hospital; Kensington House,
Kensington, and 54, Upper Harley Street. (President, 1864-5.)
Alfred Joshua Wood, M.D. St. And., F.R.C.S. Eng., Medical Superintendent,
Barnwood House Hospital for the Insane, Gloucester.
�466
Members of the Association.
[Oct., 1866.
William H. Wyatt, Esq., Chairman of Committee, County Asylum, Colney Hatch,
88, Regent’s Park Road. (Honorary Member.')
Andrew Wynter, M.D. St. And. M.R.C.P. Lond., 76, Addison Road, Kensington.
David Yellowlees, M.D. Edin., L.R.C.S. Edin., Medical Superintendent, County
Asylum, Cardiff, Glamorganshire.
Notice of any alteration required in the above List to be sent to the Honorary
Secretary, 37, Albemarle Street, W.
���
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Victorian Blogging
Description
An account of the resource
A collection of digitised nineteenth-century pamphlets from Conway Hall Library & Archives. This includes the Conway Tracts, Moncure Conway's personal pamphlet library; the Morris Tracts, donated to the library by Miss Morris in 1904; the National Secular Society's pamphlet library and others. The Conway Tracts were bound with additional ephemera, such as lecture programmes and handwritten notes.<br /><br />Please note that these digitised pamphlets have been edited to maximise the accuracy of the OCR, ensuring they are text searchable. If you would like to view un-edited, full-colour versions of any of our pamphlets, please email librarian@conwayhall.org.uk.<br /><br /><span><img src="http://www.heritagefund.org.uk/sites/default/files/media/attachments/TNLHLF_Colour_Logo_English_RGB_0_0.jpg" width="238" height="91" alt="TNLHLF_Colour_Logo_English_RGB_0_0.jpg" /></span>
Creator
An entity primarily responsible for making the resource
Conway Hall Library & Archives
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Publisher
An entity responsible for making the resource available
Conway Hall Ethical Society
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Pamphlet
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
The Journal of Mental Science (No. 59, Vol. xii, October, 1866)
Description
An account of the resource
Place of publication: [London]
Collation: ii, [309]-466 p. ; 23 cm.
Notes: From the library of Dr Moncure Conway. Published by authority of the Medico-Psychological Association. The journal was established in 1853 as the Asylum Journal and named Journal of Mental Science from 1858 to 1963, when it obtained its present name. Includes bibliographical references. Contents: Part 1: Original Articles. II: Reviews. III: Quarterly Report on the Progress of Psychological Medicine. IV. Notes and News.
Publisher
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[s.n.]
Date
A point or period of time associated with an event in the lifecycle of the resource
1866
Identifier
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G5288
Creator
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[Unknown]
Subject
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Psychology
Rights
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<img src="http://i.creativecommons.org/p/mark/1.0/88x31.png" alt="Public Domain Mark" /><br /><span>This work (The Journal of Mental Science (No. 59, Vol. xii, October, 1866)), identified by </span><span><a href="https://conwayhallcollections.omeka.net/items/show/www.conwayhall.org.uk">Humanist Library and Archives</a></span><span>, is free of known copyright restrictions.</span>
Format
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application/pdf
Type
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Text
Language
A language of the resource
English
Conway Tracts
Mental Health
Psychiatry
Psychology
-
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PDF Text
Text
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Victorian Blogging
Description
An account of the resource
A collection of digitised nineteenth-century pamphlets from Conway Hall Library & Archives. This includes the Conway Tracts, Moncure Conway's personal pamphlet library; the Morris Tracts, donated to the library by Miss Morris in 1904; the National Secular Society's pamphlet library and others. The Conway Tracts were bound with additional ephemera, such as lecture programmes and handwritten notes.<br /><br />Please note that these digitised pamphlets have been edited to maximise the accuracy of the OCR, ensuring they are text searchable. If you would like to view un-edited, full-colour versions of any of our pamphlets, please email librarian@conwayhall.org.uk.<br /><br /><span><img src="http://www.heritagefund.org.uk/sites/default/files/media/attachments/TNLHLF_Colour_Logo_English_RGB_0_0.jpg" width="238" height="91" alt="TNLHLF_Colour_Logo_English_RGB_0_0.jpg" /></span>
Creator
An entity primarily responsible for making the resource
Conway Hall Library & Archives
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Publisher
An entity responsible for making the resource available
Conway Hall Ethical Society
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Pamphlet
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
The psycho-physiology of the moral imperative: A chapter in the psycho-physiology of ethics
Description
An account of the resource
Place of publication: [s.l.]
Collation: 528-559 p. : ill. ; 24 cm.
Notes: Includes bibliographical references. "Reprinted from the American Journal of Psychology, Vol, viii, No. 4" - see title page.
Creator
An entity primarily responsible for making the resource
Leuba, James Henry
Date
A point or period of time associated with an event in the lifecycle of the resource
[n.d.]
Publisher
An entity responsible for making the resource available
[s.n.]
Subject
The topic of the resource
Ethics
Rights
Information about rights held in and over the resource
<a href="http://creativecommons.org/publicdomain/mark/1.0/"><img src="http://i.creativecommons.org/p/mark/1.0/88x31.png" alt="Public Domain Mark" /></a><span> </span><br /><span>This work (The psycho-physiology of the moral imperative: A chapter in the psycho-physiology of ethics), identified by </span><a href="https://conwayhallcollections.omeka.net/items/show/www.conwayhall.org.uk"><span>Humanist Library and Archives</span></a><span>, is free of known copyright restrictions.</span>
Identifier
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G999
Format
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application/pdf
Type
The nature or genre of the resource
Text
Language
A language of the resource
English
Ethics
Psychology