Source: Internet Archive scan of Hunt 1845 translation
Source URL: https://archive.org/details/mentalmaladiestr00esqu
Translator: E. K. Hunt (1845)
Public domain basis: Public-domain 1845 English translation by E. K. Hunt.ESQUIROL  ON  INSANITY. 


V 

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MENTAL  MALADIES. 


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TREATISE   ON   INSANITY. 


BY  E.  ESQUIROL, 


PHYSICIAN-IN-CHIKF    OF     THE    IMAISON    ROYALE    DES    ALtCNCS    DE    CHARENTON,    FORMERLY 

INSPECTOR-GENERAI.    OF    THE    UNIVERSITY,    MEMBER    OF    THE    ROYAL 

ACADEMY    OF    MEDICINE,    ETC. 


d'eromthSiiench,  wi 
BY  E.  K.  HUJNT,  M.  D. 


TRANSLATED  FROM  THSWRENCH,  WITH  ADDITIONS, 


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PHILADELPHIA: 
LEA    AND    BLANCHARD 

1845. 


Entered  according  to  the  Act  of  Congress,  in  tiie  year  1845, 

By  lea  &  BLANCHARD, 

In  the  Clerk's  Office  of  the  District  Court  of  the  Eastern  District  of  Pennsylvania. 


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L.    MBBH.IAM,    PRINTER, 
GREENFIELD,    MAS3. 


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TEANSLAXOR'S   PREFACE.. 


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The  writings  of  Esquirol  have  long  been  regarded  by  those  most  competent 
to  decide  upon  their  merits,  of  high  authority  on  all  matters  pertaining  to 
insanity.  In  addition  to  a  sound  and  vigorous  intellect,  improved  by  long  and 
close  application  to  study ;  his  habits  of  order  and  systematic  observation, 
together  with  his  vast  experience,  offer  to  the  reader  of  his  work,  a  sure  pledge 
of  accuracy  and  extent  of  research,  as  well  as  valuable  philosophical  deduc- 
tions. 

No  one  at  all  conversant  with  the  subject  on  which  he  treats,  will  fail  to 
observe,  that  he  speaks  from  the  abundant  stores  of  practical  knowledge ; 
every  thought  which  he  expresses,  and  every  suggestion  that  he  makes,  carry- 
ing with  it  the  force  of  truth,  and  the  evidence  of  profound  investigation.  It 
will  be  noticed  that  he  is  extremely  cautious  in  his  statements,  plain  and  pre- 
cise in  his  account  of  cases,  and  avoids,  for  the  most  part,  all  theoretical  spec- 
ulations. In  his  treatment,  he  will  be  found  judicious,  and  more  active  than 
the  majority  of  French  practitioners.  Judging  from  the  whole  tenor  of  his 
work,  as  well  as  from  examples,  furnished  at  intervals  throughout  its  pages, 
the  reader  will  justly  infer,  that  in  relation  to  the  moral  regimen  of  the  insane, 
"  the  law  of  love"  is  that  to  which  our  author  yields  his  assent,  and  that  which 
reigns  in  those  Institutions  over  which  he  has  presided. 

On  both  these  interesting  and  important  topics,  the  translator  has  briefly, 
though  he  believes  fully  enough,  expressed  the  views,  so  far  as  known,  of  the 
profession  in  this  country.     With  respect  to  several  other  points,  brief,  yet 


vi  translator'spretace. 

free  comment  has  been  made,  as  well  for  the  purpose  of  elucidating  truth,  as 
for  that  of  expressing  the  views,  at  present  prevailing  on  this  side  the  Atlantic. 

All  that  portion  of  this  Treatise,  relating  properly  to  insanity,  has  been 
published  entire  ;  the  remainder,  referring,  for  the  most  part,  to  the  statistics 
and  hygiene  of  establishments  for  the  insane,  together  with  the  medico-legal 
relations  of  the  subject,  have  been  omitted ;  as  they  would  only  serve  to  in- 
crease the  size  and  expense  of  the  volume,  without  adding  materially  to  its 
intrinsic  value. 

The  translation  has  been  made,  with  the  intent  to  furnish  to  the  public  and 
profession,  a  faithful  and  accurate  rendering  into  our  own  language,  of  the 
opinions,  sentiments  and  practice,  of  one  who  had  no  superior  in  the  depart- 
ment to  which  he  devoted  his  life.  For  those  errors,  whether  of  "  omission 
or  of  commission,"  which  may  appear,  the  translator  claims  only  that  measure 
of  courtesy,  which  may  be  fairly  accorded  to  undertakings  of  this  character. 

E.  K.  HUNT. 
Hartford,  February,  1845. 


CONTENTS  OP  THE  VOLUME, 


INSANITY. 


GENERAL    DESCRIPTION    OF    THE     MENTAL    CHARACTERISTICS    OF     THE    INMATES 
OF    AN    INSTITUTION    FOR    THE    INSANE. 

Symptoms  of  Insanity. —  Definition  of  term. — [Farther  definitions  from  eminent 
writers.) — Illustrations. — Primitive  type  in  some  of  the  passions. — Vital  forces  often 
greatly  exalted. — Physical  and  moral  sensibility  modified  or  changed. — Divisions  of 
Insanity  into  lypemania,  etc. — (Remarks  upon.) — Causes  of  Insanity. — Climates, 
seasons,  age,  se.x,  temperament,  professions,  modes  of  living,  laws,  civilization,  mo- 
rals and  political  condition  of  a  people. — Progress  of  Insanity. — Traced  in  a  general 
manner,  succeeded  by  details  respecting  its  terminations,  etc. — Prognosis  of  Insani- 
ty.— Considered  with  reference  to  its  divisions. — Treatment  of  Insanity. — Isolation, 
and  treatment  at  home,  compared  and  considered  at  length. — Effects  of  isolation  upon 
the  brain. — Moral  therapeutics  highly  esteemed. — Principles  of  physical  treatment. — 
Site  suited  to  the  insane. — Clothing,  bedding,  diet,  drinks,  corporeal  exercises. — 
Medical  treatment. — Use  of  water. — Evacuants,  purgatives,  emetics,  blood-letting. — 
Tonics  and  sedatives. — General  regimen. — Counter-irritants. — Electricity,  galvanism, 
magnetism. — Prophylactics. — {Farther  remarks  on  treatment.)  19 — 91 


HALLUCINATIONS 


Definition  of,  by  Esquirol,  Sauvages,  Sagar,  Darwin  and  other  English  physicians. 
— Illustrative  cases,  with  treatment. — Post-mortem  examinations. — Farther  raBiarks 
on  hallucinations. — How  accounted  for. — Distinction  between  hallucinati«a'^' 8om- 
nambulism,  and  ecstasy. — The  convictions  of  the  minds  of  the  hallucinate^  entire, 


Vlll  CONTENTS    OF    THE    VOLUME. 

and  their  acts  in  accordance  with  them. — Case  of  a  Jewess;  post-mortem  examina- 
tion of. — Seat  of  hallucinations. — Darwin's  and  Foville's  opinions  respecting. — Sub- 
jects to  which  hallucinations  usually  relate. — Very  common  in  insanity. — By  some 
regarded  as  synonymous  with  vision. — How  it  differs  therefrom. — Remarks  on  gene- 
ral treatment.  03 — 110 


ILLUSIONS  OF  THE  INSANE. 

Preliminary  remarks. — Illusions,  by  some  authors  confounded  with  hallucinations. 
— Distinction  pointed  out. — Illusions,  not  uncommon  when  in  a  state  of  health. — 
Examples. — Hypochondriacs  suffer  from  them. — Three  conditions  necessary  for  the 
correct  perception  of  a  sensation. — Remarks  on  the  causes  of  illusions. — Divided 
into  ganglionicillusions,  and  illusions  of  the  senses. — I.  Examples  of  the  former  class. 
— Post-mortem  examinations. — II.  Examples  of  the  latter  class. — Proof  that  illu- 
sions depend  upon  the  anormal  action  of  the  extremities  of  nerves. — Cases. — Inflam- 
mation or  other  lesion  of  the  nervous  centre  or  its  membranes,  often  give  rise  indi- 
rectly, to  illusions. — Conclusion.  Ill — 119 


FURY. 

Definition. — Causes  hemorrhages,  convulsions,  apoplexy  and  death. — Aspect  of 
countenance  in  a  state  of  fury. — Confounded  with  mania  by  the  ancients. — Rage, 
definition  of. — Fury  appears  in  all  forms  of  mental  alienation,  and  even  dementia. — 
Sanguine  and  bilious-nervous  temperaments  predisposed  to  fury. — By  what  caused. 
— Not  in  general  automatic. — Usually  intermittent. — Fury  sometimes  terminates  in 
dementia,  and  sometimes  is  the  last  link  in  the  chain  of  circumstances  that  affect  its 
cure. — Furv  renders  the  prognosis  in  mental  alienation  more  favorable  than  its  op- 
posite.— It  may  be  so  intense  as  to  create  danger. — Treatment,  witii  important  re- 
marks. 121 — 123 


MENTAL  ALIENATION 

OF    THOSE    RECENTLY    CONFINED,    AND    OP    NURSING    WOMEN. 

Preliminary  remarks.— Subject  divided  into  two  parts.— Part  Firsf.— Temporary 
delirium  of  early  confinement  briefly  noticed. — Nearly  one  twelfth  of  the  women  at 
the  Salpetriere  became  insane  after  confinement  — More  among  the  wealthy  insane 
after  confinement ;  among  the  poor  after  weaning. — History  of  this  form  of  insanity. 
— Period  of  the  first  appearance  of  insanity  in  92  cases,  succeeded  by  several  impor- 
tant deductions.— Symptoms  accompanying  an  attack.— Form  of  insanity  affecting 


C  O  N  T  E  N  T  S    O  F    T  H  E    V  O  L  U  M  E  .  "  IX 

92  cases. — .^ge  during  which  women  are  most  subject  to  this  malady. — Illustrative 
cases. — Is  the  suppression  of  the  milk,  the  cause  or  effect  of  insanity  .'  Does  the 
milk  act  as  a  foreign  body  in  those  accidents  which  follow  confinement  or  lactation.' 
Opinions  of  both  ancients  and  moderns  on  these  questions. — This  class  of  cases  ge- 
nerally cured,  unless  the  predisposition  is  too  energetic. — How  produced. — Duration 
of  attacks. — Relapses. — Mortality. — Remarks  on  post-mortem  examinations. — Gene- 
ral treatment. —  Part  Second. — Cases,  with  treatment  in  detail ;  together  with  an  ac- 
count of  certain  post-mortem  examinations.  125 — 143 


EPILEPSY. 


Synonyms  and  symptoms. — Medium  duration  and  frequency  of  attacks. — Lunar 
influences. — Notices  of  the  leading  mental  peculiarities  in  339  cases  of  Epilepsy. — 
Vertigoes  epileptic,  their  effect  upon  the  mind. — Pathognomonic  characteristics  of 
Epilepsy. — Causes. — Organs  upon  which  they  primarily  act. — Analysis  of  post-mor- 
tem examinations. — Diagnosis. — Divisions  and  subdivisions. — Feigned  epilepsy. — 
Prognosis. — Remarks  preliminary  to  the  details  of  treatment. — Attacks  often  lessen- 
ed temporarily  in  frequency  by  a  change  of  remedies. — Treatment,  with  notice  of 
numerous  remedies  employed  in  ancient  and  modern  practice,  with  their  effects. — 
Fear  as  a  curative  agent. — Hygienic  influences. — Traveling. — Music. — Moral  influ- 
ences. 145—171 


CRITICAL  TERMINATIONS  OF   INSANITY. 

General  remarks  on  the  doctrine  of  crises. — No  cure  without  a  crisis. — Causes  of 
incompleteness  of  crises. — The  physician  the  minister  of  nature. — Remarks  on  re- 
lapses.— A  marked  remission  usually  during  the  first  month. — Its  cause. — Insanity 
terminates  by  resolution. — Principle  of  cure  illustrated  by  cases. — Terminates  by  the 
predominance  of  activity  in  the  absorbent  system. — Terminates  by  great  prostration 
and  emaciation. — Example. — A  febrile  movement  often  serviceable. — Examples. — 
Hemorrhages  sometimes  eflfect  a  cure. — Examples. — Herpetic  eruptions  sometimes 
cure  insanity. — Examples. — Furuncles  sometimes  critical  in  insanity. — Examples. — 
Abundant  suppurations,  whether  spontaneous  or  provoked,  sometimes  terminate  insa- 
nity.— A  variety  of  illustrations  and  examples. — Influence  of  coition  and  continence. 
— Examples. — Pregnancy  and  confinement  sometimes  terminate  insanity. — Exam- 
ples.— Pregnancy  and  confinement,  when  they  effect  a  cure,  act  rather  as  exceptions 
than  in  accordance  with  a  general  rule. — Dentition  as  a  cause  of  insanity. — Exam- 
ples.— Crises  of  insanity  arranged  in  their  order.  173 — 198 

o 


CONTENTS    OF    THE    VOLUME 


LYPEMANIA  OR  MELANCHOLY. 

Definition  of  tei'm,  both  ancient  and  modern,  wfth  remarks. — No  advancement  in 
science  or  the  arts,  which  has  not  served  as  a  cause  of  mental  disease. — Monomania 
has  its  seat  in  the  heart  of  man. — A  disease  especially  of  civilization. — Modified  by 
state  of  society. — Illustrations. — Tristimania  of  Rush,  lypemania  or  melancholy  of 
Esquirol. — Views  of  the  ancients  respecting  melancholy. — Symptoms  of  lypemania 
OR  melancholy. — Description  of  the  person  of  a  lypemaniac. — Cases. — Great  torpor 
of  the  secretions. — Aversion  to  food. — Loss  of  rest  in  consequence  of  hallucinations 
and  illusions. — Dieams  terrify  many. — Secretions  become  greatly  disordered. — Urine. 
— General  description  of  the  emotions  of  the  lypemaniac. — Modifying  influence  of 
the  passions  on  the  mind. — Causes  of  lypemania. — Seasons  and  climates. — Spring 
and  summer  produce  the  greatest  number  of  lypemaniacs. — Table  illustrative. — 
Spring  most  favorable  to  the  cure  of  lypemania. — Age. — Childhood. — Adolescence. 
— Maturity. — Old  age. — Table  of  ages. — Sex. — Temperaments. — Professions  and 
mode  of  life. — Table  of  causes. — Lypemania  is  continued,  remittent,  or  intermit- 
tent.— Remittent  form  most  common. — Crises  very  numerous. — Diseases  which 
CAUSE  the  death  OF  LYPEMANIACS. — Post-mortcm  examinations. — Most  frequent 
termination,  phthisis  pulmonalis. — Pathological  anatomy  has  taught  us  nothing  posi- 
tive, respecting  the  seat  of  melancholy. — Table  of  diseases  to  which  lypemani- 
acs succumb. — Displacement  of  the  transverse  colon  frequent. — Interesting  case  and 
post-mortem  examination. — Other  cases  with  autopsies. — Table  of  the  pathologi- 
cal LESIONS  FOUND  IN  THE  POST-MORTEM  EXAMINATION  OF  ONE  HUNDRED  AND    SIXTy- 

eight  CASES  OF  LYPEMANIA. — TREATMENT  OF  LYPEMANIA. — It  may  be  hygicnic, 
moral  or  pharmaceutic. — Influence  of  atmosphere  on  health  and  disease. — Case,  re- 
ported in  the  language  of  the  suff'erer,  together  with  the  advice  given. — Clothing. — 
Food. — Exercise  both  of  body  and  mind  recommended  and  enforced. — Isolation. — 
Tepid  baths. — Continence  and  sexual  intercourse. — The  passions. — Fear. — Supersti- 
tion.— Love. — Means  used  to  break  the  chain  of  morbid  feelings. — Examples. — Mu- 
sic.— Physical  treatment. — Laxatives,  and  at  the  commencement  of  an  attack,  emetics 
and  emeto-cathartics. — Tartrate  of  Antimony  and  Potassa  with  drastics,  to  be  em- 
ployed under  certain  circumstances. — The  rotatory  machine. — Blood-letting,  local 
and  general. — Baths;  tepid,  vapor  and  cold. — Aff'usions. — Douche. — Internal  exhibi- 
tion of  cold  water. — Opium. — Magnetism. — Closing  remarks. — {Farther  remarks  on 
treatment.)  199—233 


DEMONOMANIA. 


Origin,  history  and  signification  of  term. — Origin  of  religious  melancholy.— Stellar 
and  lunar  influence. — Influence  of  the  doctrine  of  the  Platonists  on  mental  aliena- 
tion.— Origin  of  conjurations,  sorcery,  magic,  witchcraft  and  astrology. — Influence 
of  Christianity  on  the  form  and  treatment  of  insanity. — The  eff'ect  of  the  reforma- 
tion of  Luther  and  Calvin. — Mode  of  dissipating  the  errors  which  led  to  this  form 
of  insanity. — Analysis  of  symptoms  of  this  malady,  compared  with  those  that  attend 
other  forms  of  melancholy. — Case. — Post-mortem  examination. — Cases. — Sometimes 
epidemic. — Examples. — Demoniacal  possession  rarely  occurs  before  puberty. — Wo- 
men more  subject  to  this  disease  than  men. — Causes,  physical  and  moral. — Its  access 


CONTENTS  OF  THE  VOLUME.  XI 

generally  sudden. — Demonomaniacs  usually  emaciated,  etc. — Exhale  a  strong  odor. 
— Ecstasies  common,  and  modified  by  various  circumstances. — Demonomaniacs  sutler 
from  hallucinations  and  illusions. — Case. — Tenacious  of  their  delusions. — Examples. 
— Tests  of  demoniacal  possession. — Death  often  hailed  with  joy  by  the  possessed. — 
Convulsions  not  uncommon. — Important  conclusions. — Suicide  much  to  be  feared  in 
this  form  of  insanity. — Of  all  insane  persons,  lypemaniacs  are  the  most  cruel. — 
Treatment. —  Medical. — Moral. — Zoanthropy. — Lycanthropy. — Fatalists,  or  believers 
in  destiny. — Several  strange  views  referred  to. — Examples,  with  a  post-mortem  ex- 
amination. 235 — 252 


SUICIDE. 

Origin  of  term. — Ancient  philosophers  not  agreed  with  respect  to  the  appreciation 
of  this  act. — Legislation  with  respect  to  it. — A  variety  of  circumstances  lead  man  to 
terminate  his  existe^. — The  impulse  of  lofty  sentiments, — false  popular  views, — 
national  usages, — passions, — febrile  delirium  and  mania, — hypochondria  and  lypenia- 
nia. — Suicide  provoked  by  the  p.\ssions. — When  strongly  excited,  always  pro- 
duce disturbance  in  the  organism  or  understanding  of  man. — Acute  and  chronic. — 
Examples  of  acute  suicide,  with  remarks. — Chronic  suicide. — Remarkable  exam- 
ples.— Suicide  preceded  by  homicide. — Mental  condition  previous  to,  and  after 
an  act  of  homicide  described. — Form  which  precedes  homicide,  usually  acute,  some- 
times chronic. — Examples,  and  development  of  important  principles. — Reciprocal 
suicide. — Examples. — Disposition  sometimes  feigned. — Examples  and  treatment. — 
Climates,  seasons,  age  and  sex,  considered  as  causes  of  suicide. — Climates 
one  of  the  proximate  causes,  but  less  active  than  morals,  civilization,  etc. — Table  of 
quarterly  admissions  at  the  Salpctriere  of  those  who  had  attempted  suicide. — Most 
frequent  during  the  warm  seasons. — Hereditary. — Examples. — Most  frequent  when. 
— See  table. — Children  sometimes  victims  of  suicide,  from  vicious  education. — Old 
age  rarejjf  exposed  to  suicide. — Examples. — Less  frequent  among  women  than  men. 
— Data  establishing  proportion  of  suicides  between  men  and  women. — Excep- 
tions.— Sometimes  epidemic. — Cause. — Preventive. — The  reading  of  immoral  and 
licentious  books  tends  to  suicide. — Description  of  chronic  suicide  only  given. — At- 
tempts usually  voluntary. —Often  great'insensibility. — Examples. — Instruments  which 
suicides  employ. — Great  precaution  used  by  some,  to  render  their  attempts  effective. 
— Several  cases  with  treatment. — Vanity,  and  a  spirit  of  revenge  sometimes 
manifested  in  this  act. — Illustrations. — Various  considerations  prevent  those  who  de- 
sire death,  from  the  commission  of  suicide. — Case  illustrative. — A  frightful  persever- 
ance manifested  in  some  cases. — Suicide  is  acute  or  chronic  ;  continued  or  intermit- 
tent.— Examples. — Pathological  lesions  observed  among  suicides. — Opinions 
of  Gall,  Home,  Recamier,  Loder  and  others. — Post-mortem  examinations. — Note 
from  M.  Leuret. — Query  respecting  the  influence  of  the  organs  of  digestion  in  the 
production  of  suicide. — Treatment  of  suicide:  means  of  preventing  it. — Mo- 
ral influences,  with  examples. — A  specific  treatment  recommended  by  some. — Bleed- 
ing.— Tonic. — Bark  in  combination  with  a  narcotic  or  sedative  agent. — Cold  bath. — 
Copious  draughts  of  cold  water  and  an  issue  over  the  liver. — Abundant  corporeal 
and  pleasant  mental  exercise. — (^Farther  remarks  on  Treatment.) — Constant  watchful- 
fiess  on  the  part  of  those  who  have  the  charge  of  persons  suffering  from  a  suicidal 


Xll  CONTENTSOFTHEVOLUME. 

propensity,  indispensable. — Restraining  apparatus  not  to  be  relied  upon. — Should 
sleep  in  public  halls  under  the  constant  watch  of  an  attendant. —  {Remarks  on.) — 
Success  of  this  measure  at  the  Salpetriere. — Mode  of  dissipating  a  repugnance  to 
food  in  the  early  stages  of  insanity. — Fear  sometimes  employed  as  a  restraining 
agent. — Is  suicide  a  criminal  act .'' — Can  it  be  prevented  or  lessened  by  legislation  .'' — 
Remarks,  etc.,  on  the  writings  of  Doct.  Burrows. — Suicides  greatly  increased  with- 
in the  last  half  century. — Relative  proportion  of  suicides  in  Paris  and  Berlin  com- 
pared.— Proportion  of  men  and  women. — Proportion  of  either  sex  who  have  availed 
themselves  of  certain  modes  of  committing  suicide. — Researches  of  M.  Guerry  on 
suicide. — Summer  produces  more  suicides  than  autumn. — Greatest  number  commit- 
ted between  the  hours  of  four  and  six,  and  least,  between  two  and  four,  in  the  morn- 
ing. ^53 — 317 


MONOMANIA. 


Distinctive  characteristics  of  monomania  and  lypemania. — Intellectual  monoma- 
nia.— Reasoning  mania  of  authors,  affective  monomania  of  Esquirol. — Monomania 
without  delirium,  or  instinctive  monomania. — The  physiognomy  and  leading  mental 
qualities  of  the  monomaniac  and  lypemaniac  described  and  contrasted. — Course  of 
monomania  more  acute,  and  its  termination  usually  more  favorable  than  lypemania. — 
Theomaniacs. — Melancholica  enthusiastica. — Delusions  of  monomaniacs. — Case  in 
detail,  with  post-mortem  examination. — Case  in  which  hypochondria  first,  then  lype- 
mania, and  lastly  monomania  were  successively  developed. — Cases  illustrating  cer- 
tain mental  peculiarities.— Case  of  Mad'e  de  R.,  with  post-mortem  examination. — 
Monomania  sometimes  epidemic. — Jl  modern  example. — Predisposing  and  exciting 
causes. — Remittent  or  intermittent. — Progress  sometimes  rapid  and  violent. — Termi- 
nates suddenly  and  unexpectedly. — Sometimes  passes  into  mania,  or  alternates  with 
lypemania. — When  prolonged,  degenerates  into  dementia. — Intermediate  state. — 
General  treatment. — Farther  remarks  on  treatment. — Erotic  monomania. — Erotoma- 
nia defined. — Distinguished  from  nymphomania  and  satyriasis. — Case  illustrating  the 
uncomplicated  characteristics  of  erotic  delirium,  with  treatment. — Mode  of  detect- 
ing it  in  its  earliest  stage. — Cases  illustrative  of  its  sudden  and  fatal  termination. — 
Suicide  one  of  its  terminations. — Amorous  lypemania  complicated  with  mania. — 
Examples. — Erotomania  may  degenerate. — Cannot  be  confounded  with  hysterical 
madness. — Has  existed  among  all  people. — Causes  of  erotomania  the  same  with  mo- 
nomaniain  general. — Is  the  cerebrum  or  cerebellum  the  part  aff'ected  in  erotomania.' — 
In  some  cases,  marriage  almost  the  only  remedy. — Reasoning  monomania. — Gene- 
ral description,  succeeded  by  numerous  examples. — Has  an  acute  and  chronic  course. 
— Three  periods  recognized  in  it. — Remittent  or  intermittent. — No  therapeutic  indi- 
cation different  from  what  is  found  applicable  in  other  forms  of  monomania. — Pecu- 
liar management  of  the  mind  requisite. — Reasons  offered  for  studying  it  with  care. — 
Monomania  from  drunkenness. — Fermented  drinks  common  to  all  people. — Use 
and  abuse. — Their  effects. — Intemperance  sometimes  hereditary. — Sometimes  pro- 
duced at  the  critical  period  in  women. — Examples. — Cologne  water  preferred  in 
some  cases  to  other  stimuli. — Paroxysmal. — Reasons  assigned  for  the  formation  of 
this  habit. — Tonics  proposed  for  some  cases,  oil  of  turpentine  for  others. — Incendi- 
ary MONOMANIA. — (Pyroinania  of  Marc.) — Causes  which  lead  to  it. — Examples. — 


CONTENTS     OF    THE    VOLUME.  .  Xlll 

An  instinctive  impulse  independent  of  the  will  sometimes  leads  to  incendiarism. — 
Inferences  from  foregoing  cases. — Farther  remarks,  with  respect  to  causes. — Relative 
proportion  of  male  and  female  incendiaries. — Hygienic  influences  relating  to  sexual 
development  in  France  and  Germany  described. — Enquiries  respecting  the  age  and 
sex  of  incendiaries. — Homicidal  monomania. — Synonyms. — Causes  which  lead  to 
it. — Mania  without  delirium. — Maniacal  fury. — Further  exciting  causes. — Examples. 
— All  periods  of  life  subject  to  attacks. — Usually  periodical. — Treatment  like  that  of 
other  forms  of  monomania. — Cases,  with  treatment  and  observations. — Cases  of  three 
little  girls,  with  remarks.  319 — 376 


MANIA. 

Description  of  the  maniac,  and  his  end  unless  restored. — Definition  of  Mania. — 
Mania  briefly  contrasted  with  Monomania  and  Lypemania. — Views  of  Heinroth 
and  Prichard  with  respect  to  the  connection  between  mania  and  fury. — Most  frequent 
causes  of  mania. — Table  of  ages. — Table  of  professions. — Causes. — Tables  of  physi- 
cal and  moral  causes. — Incursion  of  mania. — Symptoms. — Hallucinations. — Sensa- 
tions perverted. — Case  in  detail  with  treatment. — Other  cases. — Mania  usually  chro- 
nic.— Continued,  remittent  or  intermittent. — Sometimes  alternates  with  other  dis- 
eases.— Examples. — Critical  terminations. — Table  of  cures. — Table  of  cures  relative 
to  seasons. — Table  of  the  periods  of  mortality. — Remarks. — Post-mortem  examina- 
tions.— Remarks  upon.— Treatment. — Three  periods  characterize  mania;  treatment 
of  each. — Restraint. — Food. — Pinel's  cases  with  treatment.— Intercourse  of  physi- 
cian with  patient. — Visits  of  friends. — Convalescents. — Views  and  feelings  of  conva- 
lescents.— Their  treatment. — Remarks  on  medication. — Medicines  appropriate  to 
the  first  stage. — Pinel's  remarks  on  blood-letting. — Baths. — Cold  to  head. — Laxa- 
tive drinks. — Enementa. — Exercise. — Diet. — Critical  efibrts  to  be  managed  cautious- 
ly.— Case  illustrative. — Classification,  its  importance. — Quinine  in  intermittent  ma- 
nia.— Reasons  for  its  occasional  failure. — Treatment  adapted  to  cases  which  result 
from  the  suppression  of  habitual  evacuations. — Case. — Benefit  of  cold  affusions, 
with  cases. — Purgatives. — Camphor. — Opium. — Digitalis. — Bath  of  surprise. — Sub- 
mersion.— Rotatory  machine. — Moxas. — Actual  cautery. — Cases  illustrating  its  ef- 
fects.— Cups. — {Farther  remarks.)  377 415 


DEMENTIA. 


Definition  of  term. — Description  of  the  mental  manifestations  of  a  demented  per- 
son.— Physical  characteristics. — Paralytic  complications. — Dementia,  acute  or  chro- 
nic, simple  or  complicated  ;  continued,  remittent  or  intermittent. — Compared  with 
mania  and  monomania.— Cases  illustrative  of  the  decline  from  mania  and  monoma- 
nia, to  dementia. — Distinction  between  dementia  and  imbecility  and  idiotism. — Signi- 
fication of  term  insensate:— lis  causes,  complications,  terminations  and  changes  which 
post-mortem  examinations  reveal.— Influence  of  age.— Table  of  ages.— Exciting 
causes  of  dementia.— Table  of  CAUsEs!^^^Pl7ysical  and  moral  causes.— Remarks  on 
the  causes  of  dementia.— Varieties  and  complications  of  dementia.— Maladies  to 
which  the  demented  succumb,  etc.— Table  of  the  principal  organic  lesions.— Extend- 


XIV  CONTENTS  OF  THE  VOLUME. 

ed  description  of  the  condition  of  the  contents  of  the  great  cavities,  as  revealed  by 
post-mortem  examinations. — Illustrative  cases. — Remarks  with  reference  to  the  above 
cases. — Acute  dementia. — Causes. — Invasion. — Treatment. — Termination. — Illustra- 
tive case. — Chronic  dementia. — Causes. — Course. — Treatment  and  termination. — 
Third  variety. — Senile  dementia. — Cause. — Progress. — Treatment  and  termination. 
— Complicated  varieties. — Complications. — Incurable. — Invasion  gradual. — E.xtreme 
limits  of  this  disease,  usually  from  one  to  three  years. — Phenomena  of  the  last  period 
of  life. — Cases. — Comparative  frequency  of  paralysis  connected  with  dementia  in 
different  countries. — Several  authors  cited  on  this  point,  German,  Italian  and  Eng- 
lish.— Pathology  and  periods,  as  indicated  by  Bayle. — Symptoms  of  paralysis  usually, 
indicative  of  a  fatal  termination. — Sometimes  existing  very  early  in  an  attack  of 
insanity. — Cases. — Delirium  sometimes  ceases,  while  the  paralysis  persists. — Case. — 
Practical  considerations. — {^Brief  extracts  from  other  writers  icith  reference  to  the 
paralysis  sometimes  connected  with  dementia.)  417 — 444 


IDIOCY. 

Brief  account  of  the  views  of  authors  in  regard  to  idiocy. — Synonyms. — Origin 
and  signification  of  term. — Commences  with  life. — Idiots  never  reach  an  advanced 
age. — Vices  of  conformation  almost  invariably  discoverable  in  brain. — Dementia  and 
idiocy  contrasted. — Illustrative  cases. — Idiots  classed  in  two  divisions,  viz.,  imbeciles 
and  idiots. — Contrasted. — First  variety. — Imbecility. — General  description  of  im- 
beciles.— Cases,  together  with  admeasurements  of  the  head. — Remarks  respecting 
habits  and  mode  of  life  of  imbeciles. — A  few  whose  minds  are  capable  of  partial 
development. — Their  gayety,  piquant  repartees,  jovial  manners,  etc.,  have  been  the 
means  of  their  introduction  to  the  great. — At  Court  even  is  there  the  post  of  fool. — 
Origin  of  custom. — Employed  by  rogues  for  culpable  purposes. — Acts  to  which  pu 
berty  gives  rise. — Second  variety. — Idiocy. — Idiots  incapable  of  speech  — Case  of 
Queneau,  with  post-mortem  examination. — Other  cases,  describing  the  figure,  admea- 
surements of  the  head,  habits,  and  peculiar  characteristics  of  idiots. — Moral  and  phy- 
sical condition  of  the  mothers  of  idiots,  while  pregnant  with  them. — Account  of 
cases  representing  the  extreme  limit  of  idiocy  from  Pinel,  Gall,  and  the  records 
of  the  Salpetriere. — Idiots  nearly  or  quite  deaf  as  well  as  mutes. — The  senses  null 
or  exceedingly  obtuse. — Comparative  view  of  the  condition  of  the  blind  and  dumb, 
and  idiots. — Remarkable  aptitude  of  many  idiots  for  the  acquisition  of  music,  and 
their  fondness  for  musical  sounds. — Deductions  from  the  above  cases. — A  number  of 
the  physical  and  predisposing  causes  noticed. — Exciting  causes  of  idiocy. — Volume 
and  form  of  the  heads  of  idiots. — Gall's  limits  of  intelligence. — Researches  of  Fo- 
ville,  Parchappe  and  others,  respecting  the  vices  of  conformation  in  the  cranium  of 
the  idiot,  and  its  development  compared  with  that  of  the  health}'  subject. —  Table  of 
mean  results  of  certain  cranial  admeasurements. — Remarks  of  Morgagni  and  Meckel 
respecting  the  cerebral  substance  in  idiocy. — Malacarne,  on  the  convolutions,  etc.,  of 
the  brain  in  idiocy. — Remarks  of  Lavater  and  Camper  respecting  physiognomy  of 
idiots. — Remarks  on  treatment. — (Brief  account  of  some  recent  attempts  to  improve 
the  condition  of  idiots). — Cretins,  Cagots  and  Albinos. — Cretinism. — Origin  and  defi- 
nition of  term. — History  of  Cretinism. — The  person  of  the  cretin  described. — Like 
idiots,  cretins  may  be  divided  into  three  classes. — Description  of  first  class. — The 
first,  the  most  numerous  class. — Description  of  second  class. — Of  third  class. — Cre- 


CONTENTS    OF    THE    V^OLU  ME.  XV 

tins  not  necessarily  born  such. — Organism  develops  very  slowly. — Relative  propor- 
tion of  cretins  and  idiots. — Examination  of  the  crania  of  idiots  obtained  with  great 
difficulty. — (Description  of  one  belonging  to  Dr.  H.  A.  Grant,  of  Hartford,  Conn.) — 
Opinions  of  authors  respecting  the  causes  of  cretinism  various. — Views  of  several 
authors  noticed. — Opinion  of  M.  Bayle  in  respect  to  the  influence  of  water  in  the 
production  of  cretinism. — Opinion  of  M.  Vyn. — Immediate  cause  as  obscure  as  the 
predisposing  and  remote. — Opinions  of  authors  respecting. — Probable  cause,  the 
influence  to  which  infants  are  subjected. — Do  cretinism  and  goitre  depend  upon  the 
same  cause  .^ — Cretinism  diminishing. — Causes  assigned. — Albinos. — Definition  of 
term,  and  description  of  the  person  of  albinos. — Usually  found  in  connection  with 
the  goitrous  and  idiotic. — Born  of  parents  of  every  variety  of  complexion. — Intel- 
lectual and  physical  characteristics. — Natives  of  all  countries. —  Synonyms. — Testi- 
mony of  ancients  respecting  albinos. — Characteristics,  physical  and  intellectual,  of 
the  parents  of  albinos. — History  of  Roche. — Cagots. — Signification  of  term. — Pro- 
vincial appellations  of — Degradation  of  those  wretched  beings  for  centuries,  ex- 
treme.— Considerations  with  respect  to  savage  races  of  men. — Conclusion. — Cases  in 
illustration  of  the  history  of  idiocy,  giving  an  account  of  the  mental  and  physical 
condition  of  idiots,  together  with  a  description  of  their  physiognomy,  and  daily 
habits. — Several  autopsies.  445 — 496 


%. 


'S 


Isf 


P  E  E  r  A  C  E  . 


The  work  now  offered  to  the  public,  is  the  result  of  forty  years'  study  and 
observation.  I  have  noticed  the  symptoms  of  insanity,  and  have  studied  the 
manners,  habits,  and  wants  of  the  insane,  in  the  midst  of  whom  I  have  passed 
my  life.  I  have  also  tried  the  best  modes  of  treatment.  Confining  myself 
to  facts,  I  have  arranged  them  according  to  their  relations.  I  have  stated 
them  as  they  have  been  observed,  without,  in  general,  attempting  to  explain 
them ;  and  have  avoided  systems,  which  always  appeared  to  me  more  seduc- 
tive by  their  splendor,  than  useful  in  their  application. 

The  materials  of  this  work,  collected  at  the  Salpetriere,  at  the  Hospital  at 
Charenton,  and  in  my  private  practice,  have  been  successively  published  in 
the  Dictionary  of  Medical  Sciences,  and  other  medical  works. 

While,  as  it  respects  principles,  they  remain  the  same,  many  of  these  ma- 
terials have  been  subjected  to  various  modifications,  and  drawn  out  into  more 
detail,  in  order  that  they  may  more  perfectly  harmonize  with  my  later  obser- 
vations. Some  of  these  have  been  translated  into  various  languages,  and 
published  by  German,  and  Italian  Physicians ;  and  I  trust  that  the  result  of 
all  my  labors,  which  I  have  reviewed  with  the  greatest  care,  and  now  publish 
for  the  first  time,  will  be  favorably  received  by  medical  men. 

Most  highly  do  I  appreciate  the  advantages  of  a  work,  systematically  ar- 
ranged ;  and  without  doubt,  my  book  would  be  read  with  more  interest,  if  a 
general  idea  pervaded  all  its  parts.  But  it  would  engage  me  in  a  labor,  in- 
compatible with  my  numerous  avocations :  nevertheless,  we  shall  find  a  me- 
thodical connection,  in  the  distribution  of  the  materials  of  which  it  j^  com- 
posed. ...".-r 

The  first  Chapter,  entitled  Insanity,  is  a  summary  of  the  sent|Qiigpts  preva- 
lent on  this  subject;  the  remaining  ones,  are  commentaries,  jpi  *more  full 
exposition  of  these  views.  .  -  '^.,'' 


XVlll  PREFACE. 

Having  taken  part  in  the  earliest  efforts  that  were  made  to  ameliorate  the 
condition  of  the  insane,  I  have  aided  in  their  fulfillment,  both  by  my  writings, 
my  teachings,  and  travels. 

Happy  shall  I  be,  if  this  new  publication,  notwithstanding  its  imperfections, 
may  contribute  to  overcome  prejudices,  to  dissipate  errors,  to  throw  light  upon 
obscure  points  connected  with  mental  diseases,  and  to  make  known  truths,  of 
useful  application  in  the  treatment  and  regimen,  of  that  unfortunate  class,  to 
whom  I  have  devoted  my  life. 


MENTAL  DISEASES. 


ESSAYS  ON   INSANITY  AND  ITS  VARIETIES. 


INSANITY. 

GENERAL    DESCRIPTION    OF    THE     MENTAL    CHARACTERISTICS    OF    THE     INMATES 
OF    AN    INSTITUTION    FOR    THE    INSANE. 

Symptoms  of  Insanity. — Definition  of  term. — (Farther  definitions  from  eminent  writers.) 
— Illustrations. — Primitive  type  in  some  of  the  passions. — Vital  forces  often  greatly 
exalted. — Physical  and  moral  sensibility  modified  or  changed. — Divisions  of  Insanity 
iiito  lypemania,  etc. — (Remarks  upon.) 

Causes  of  Insanity. — Climates,  seasons,  age,  sc.x,  temperament,  professions,  modes  of 
living,  laws,  civilization,  morals  and  political  condition  of  a  people. — Progress  of  In- 
sanity. Traced  in  a  general  manner,  succeeded  by  details  respecting  its  tertninations, 
etc. — Prognosis  of  Insanity. — Considered  with  reference  to  its  divisions. — Treatment 
of  Insanity. — Isolation,  and  treatment  at  home,  compared  and  considered  at  length. — 
Efliects  of  isolation  upon  the  brain. — Moral  therapeutics  highly  esteemed. — Principles 
of  physical  treatment. — Site  suited  to  the  insane. — Clothing,  bedding,  diet,  drinks, 
corporeal  exercises. — Medical  treatment. — Use  of  water. — Evacuants,  purgatives,  eme- 
tics, blood-letting. — Tonics  and  sedatives. — General  regimen. — Counter-irritants. — 
Electricity,  galvanism,  magnetism.  Prophylactics. — (^Farther  remarks  on  treatment.) 

What  reflections  engage  the  mind  of  the  philosopher,  who,  turning  aside 
from  the  tumult  of  the  world,  makes  the  circuit  of  a  House  for  the  insane  ! 
He  finds  there  the  same  ideas,  the  same  errors,  the  same  passions,  the  same 
misfortunes,  that  elsewhere  prevail.  It  is  the  Scime  world  ;  but  its  distinctive 
characters  are  more  noticeable,  its  features  more  marked,  its  colors  more  vi- 
vid, its  effects  more  striking,  because  man  there  displays  himself  in  all  his 
nakedness  ;  dissimulating  not  his  thoughts,  nor  concealing  his  defects  ;  lend- 
ing not  to  his  passions  seductive  charms,  nor  to  his  vices  deceitful  appear- 
ances. 

Every  House  for  the  insane  has  its  gods,  its  priests,  its  faithful,  its  fanatics. 
It  has  its  emperors,  its  kings,  its  ministers,  its  courtiers,  its  opulent,  its  gene- 
rals, its  soldiers,  and  a  people  who  obey.  One  believes  himself  inspired  of 
God,  and  in  communication  with  the  Holy  Spirit.  He  is  charged  with  the 
conversion  of  the  world  ;  whilst  another,  possessed  of  a  demon,  given  over  to 
all  the  torments  of  hell,  groans,  and  is  frantic  with  despair  ;  cursing  heaven, 
earth,  and  his  own  existence.     Another,  bold  and  audacious,  commands  th€f> 


20  INSANITY. 

universe,  and  makes  war  with  the  four  quarters  of  the  globe ;  which  he  has 
subjected  to  his  laws,  or  delivered  over  to  the  chains  of  despotism.  A  third, 
proud  of  the  name  he  has  given  himself,  looks  with  disdain  upon  his  compan- 
ions in  affliction  ;  lives  alone,  retired,  and  preserves  a  seriousness,  as  affecting 
as  it  is  vain.  This  one,  in  the  pride  of  his  heart,  thinks  himself  to  possess 
the  science  of  Newton,  and  the  eloquence  of  Bossuet ;  and  requires  the  ap- 
plauses of  those  about  him  to  the  productions  of  his  genius,  with  a  comic  pre- 
tension and  assurance.  That,  stirs  not ;  nor  makes  the  least  movement ;  al- 
ways in  the  same  place,  and  in  the  same  position,  he  utters  not  a  word.  We 
might  take  him  for  a  statue.  He  lives  within  himself;  his  inaction  is  destroy- 
ing him.  Withered  by  remorse,  his  neighbor  drags  out  the  feeble  remnant  of 
a  life,  which  he  with  difficulty  sustains.  Uttering  reproaches,  he  curses  him- 
self, and  invokes  death,  as  terminating  the  evils  that  are  preying  upon  him. 
Near  him,  is  a  man  who,  appearing  happy  and  in  the  perfect  enjoyment  of  his 
reason,  calculates  the  moment  of  his  dissolution  with  frightful  indifference. 
He  prepares  with  calmness,  and  even  joy,  the  means  of  terminating  his  exist- 
ence. This  wretched  man,  both  day  and  night,  with  eye  and  ear,  watches  for 
secret  enemies.  Darkness  and  light,  sound  and  silence,  motion  and  repose, 
all  frighten  and  terrify  him  ;  he  fears  himself.  How  many  imaginary  terrors, 
consume  the  days  and  nights  of  this  lypemaniac  !  Proceeding  onward,  we 
see  one  who,  believing  himself  betrayed,  persecuted  and  dishonored,  has  be- 
come agitated,  exasperated,  furious.  Suspicion  and  hatred  raise  up  enemies 
on  every  hand.  In  his  unbridled  vengeance,  he  spares  no  one.  Another,  the 
sport  of  a  morbid  sensibility,  and  an  excited  imagination,  suffers  from  habitual 
anger.  He  breaks,  rends,  and  destroys,  whatever  comes  within  his  reach. 
He  cries  aloud,  threatens,  and  strikes,  alledging  always  a  motive  to  justify  the 
frightful  disorder  of  his  actions.  He  whom  you  see  confined,  is  a  fanatic, 
who  vociferates,  blasphemes,  and  condemns  to  the  fires  of  hell.  He  pretends 
to  convert  men  ;  and  as  it  is  by  the  baptism  of  blood  that  he  would  purify 
them,  he  has  already  sacrificed  two  of  his  children.  This  senseless  being, 
amid  the  noisy  ravings  of  his  delirium,  is  of  an  incoercible  petulance.  He 
would  injure  no  one,  though  ready,  apparently,  to  commit  the  greatest  disor- 
ders. To  witness  his  eager  activity,  you  would  believe  that  some  great  sub- 
ject engaged  his  attention,  and  that  his  destiny  depended  upon  his  movements. 
In  his  devious  course,  he  shocks  and  offends  every  one  that  surrounds  him,  and 
overthrows  whatever  opposes  his  progress.  He  follows  and  assails  you  with 
his  unintelligible  babble  ;  but  notwithstanding  this  torrent  of  words,  he  says 
nothing,  thinks  nothing. 

Another,  quite  at  his  ease,  passes  a  happy  life,  laughing  incessantly  :  yet 
who  can  excite  his  joy,  and  for  what  can  he  hope  ?  He  has  no  recollection 
of  the  day  just  past,  nor  any  desire  for  the  morrow. 

Thus,  in  a  House  for  the  insane,  one  can  hear  at  the  same  time,  the  shouts 
of  gladness  mingled  with  sentiments  of  sorrow  ;  expressions  of  joy,  in  connec- 
tion with  the  groans  of  despair.  He  may  see  contentment  in  some,  and  tears 
flowing  from  the  eyes  of  others. 

In  these  establishments,  the  social  bonds  are  broken  ;  habits  are  changed ; 
friendships  cease  ;  confidence  is  destroyed.  Their  inmates  do  good  without 
benevolence  ;  injure  without  dislike,  and  obey  through  fear.  Each  has  his 
own  ideas,  affections,  and  language.  With  no  community  of  thoughts,  each 
lives  alone,  and  for  himself  Egotism  isolates  all.  Their  language  is  ex- 
travagant, and  disordered,  like  the  thoughts  and  passions  which  it  expresses. 
An  asylum  of  this  character  is  not  exempt  from  crime.  They  denounce,  ca- 
lumniate, conspire.  They  give  themselves  up  to  brutish  libertinism  ;  ravish, 
rob,  assassinate.     The  son  curses  his  father,  the  mother  strangles  her  children. 

If  we  proceed  farther,  we  see  man,  fallen  from  the  high  rank  which  places 
him  at  the  head  of  creation,  despoiled  of  his  privileges,  deprived  of  his  most 


INSANITY.  21 

noble  character,  and  reduced  to  the  condition  of  the  most  stupid  and  vilest 
creature.  He  thinks  not.  Not  only  is  he  destitute  of  ideas  and  passions,  but 
has  not  even  the  determinations  of  instinct. 

Unable  to  provide  for  his  subsistence,  he  is  also  incapable  of  conveying  to 
his  lips  the  aliment  that  tenderness  or  benevolence  provides.  He  rolls  about 
amid  his  own  ordure,  and  remains  exposed  to  all  external  and  destructive  in- 
fluences ;  rarely  recognizing  his  fellow  beings,  and  having  no  proper  senti- 
ment of  his  own  existence.  In  this  assemblage  of  enemies,  who  know  only 
how  to  shun,  or  injure  each  other  ;  what  application,  what  devotion  to  duty, 
what  zeal  are  necessary,  to  unfold  the  cause,  and  seat  of  so  many  disorders  ; 
to  restore  to  reason  its  perverted  powers  ;  to  control  so  many  diverse  passions, 
to  conciliate  so  many  opposing  interests;  in  fine,  to  restore  man  to  himself! 
We  must  correct  and  restrain  one  ;  animate  and  sustain  another  ;  attract  the 
attention  of  a  third,  touch  the  feelings  of  a  fourth.  One  may  be  controlled 
by  fear,  another  by  mildness ;  all  by  hope.  For  this  untiring  devotion,  an  ap- 
proving conscience  must  be  our  chief  reward.  For  what  can  a  physician 
hope,  who  is  always  considered  wrong  when  he  does  not  succeed,  who  rarely 
secures  confidence  when  successful  ;  and  who  is  followed  by  prejudices,  even 
in  the  good  which  has  been  obtained. 

For  our  guidance,  in  this  chaos  of  human  miseries,  we  will  reduce  to  four 
principal  divisions,  what  we  have  to  say  concerning  insanity  :  1st,  we  will  ana- 
lyze the  symptoms  which  characterize  this  malady  ;  2d,  seek  for  its  causes ; 
3d,  trace  its  progress,  and  mark  out  its  different  terminations ;  4th,  and  final- 
ly, we  will  lay  down  the  general  principles  of  its  treatment. 


I.     SYMPTOMS  OF  INSANITY. 

Insanity,  or  mental  alienation,  is  a  cerebral  affection,  ordinarily  chronic,  and 
without  fever  ;  characterized  by  disorders  of  sensibility,  understanding,  in- 
telligence, and  will. 

I  say  ordinarily,  because  insanity  is  sometimes  of  brief  duration  ;  and  be- 
cause at  its  commencement,  and  sometimes  during  its  course,  febrile  symp- 
toms are  manifested. 

[Few,  if  any  systematic  writers  on  the  subject,  have  omitted  to  furnisli  a  definition  of 
the  term  "  insanity." 

After  a  lengtiiy,  and  able  description  of  the  faculties  of  the  mind,  in  their  healthy  and 
disordered  manifestations,  Conolly  has  given  us  his  definition  in  the  following  language  : 
"  Insanity  is  the  impairment  of  any  one  or  more  of  the  faculties  of  the  mind,  accompa- 
nied with,  or  inducing  a  defect  of  the  comparing  faculties." 

Pritchard,  after  a  cursory  notice  of  the  sentiments  of  earlier  writers  on  this  point,  des- 
cribes insanity  "  as  a  chronic  disease,  manifested  by  deviations  from  the  healthy  and  na- 
tural state  of  the  mind,  such  deviations  consisting  either  in  a  moral  perversion  or  a  dis- 
order of  the  feelings,  aff'ections,  and  habits  of  the  individual,  or  in  intellectual  derange' 
ment,  which  last  is  sometimes  partial,  namely  in  monomania,  affecting  the  understanding 
only  in  particular  modes  of  thought ;  or  general,  and  accompanied  with  excitement, 
namely,  in  mania,  or  raving  madness  ;  or  lastly,  confounding  or  destroying  the  connec- 
tions or  associations  of  ideas,  and  producing  a  state  of  incoherence." 

Doct.  Brigham,  superintendent  of  the  New  York  State  Lunatic  Hospital,  has  recently 
given  us  the  following :  "  Insanity  is  a  chronic  disease  of  the  brain,  producing  either  de- 
rangement of  the  intellectual  faculties,  or  prolonged  change  of  the  feelings,  aifections 
and  habits  of  an  individual." 

In  general,  it  is  regarded  as  a  disorder  of  the  system,  by  which  the  sound  and  healthy 
exercise  of  the  mental  faculties  is  impeded  and  disturbed. 


22  INSANITY. 

That  every  case  of  mental  derangement,  from  the  first  moment  of  its  existence,  can 
be  perceived,  and  referred  with  accuracy  and  precision  to  one  or  another  of  these  defini- 
tions, just  as  in  science  every  fact  may  be  referred  back  to  its  principle,  is  not,  by  those 
at  all  conversant  with  the  subject,  supposed  to  be  in  all,  or  perhaps  in  any  case,  possible. 

Who  can  tell  when  health  ends  and  disease  begins  ?  When  disease  is  found  to  have 
shed  its  blighting  influence  over  the  system,  is  it  possible,  after  establishing  this  fact,  to 
decide  what  amount  or  kind  is  necessary  to  occasion  aberration  of  mind,  and  when  this 
amount  and  quality  is  developed  ?  When  developed,  does  it  at  once  manifest  its  baleful 
influence  upon  the  brain,  by  producing  insanity ;  or  does  it  not  rather  brood  over  the 
delicate  organ  of  the  mind,  and  gradually  fulfill  its  dread  commission  ?  When  again  the 
mind  begins  to  totter,  and  reason  to  sit  insecurelj'  upon  her  throne,  do  the  friends  and 
acquaintances  of  the  unhappy  sufferer  recognize  these  first  monitions  ?  Or  do  they  not 
rather  behold, — if  indeed  they  observe  any  thing, — a  simple  change  of  habit,  slightly 
perverted  moral  feelings,  or  trifling  eccentricities  of  character  ? 

Now  it  is  conceived  to  be  quite  possible,  not  to  say  probable,  that  even  during  this 
early  stage  of  insanity,  before  the  friends  or  immediate  associates  of  the  patient  are 
aware  of  its  existence,  or  before  it  becomes  developed  to  a  degree  that  brings  it  clearly 
within  the  limits  of  any  of  the  above  definitions,  that  a  source  of  excitement — fear,  ap- 
prehension, or  mental  disturbance  of  some  sort — shall  so  operate  upon  the  mind,  through 
the  medium  of  its  diseased  organ  the  brain,  as  to  lead  the  person  so  afflicted,  now  to  the 
commission  of  suicide ;  now  to  homicide,  or  other  acts  of  a  grossly  immoral  and  highly 
criminal  character.  , 

Experience  also  justifies  the  belief,  that  these  results  may  follow  in  the  train  of  excite- 
ment occurring  from  ordinary  intercourse  with  society;  and  equally,  from  the  perverted 
thoughts  and  emotions  of  the  individual — thoughts  and  emotions  too,  which  he  may 
never  have  expressed,  or  merely  hinted  at,  in  conversation  with  his  friends. 

If  this  be  true,  and  we  firmly  believe  it  is,  how  extremely  difficult  may  it  be,  to  sepa- 
rate the  acts,  whether  criminal  or  otherwise,  of  the  man  who  feigns  insanity,  and  Jiim 
whom  God  has  seen  fit,  in  his   providence  to  afflict.' 

How  utterly  inapplicable,  and  useless  indeed  in  emergencies  of  this  sort,  are  the  most 
elaborate  and  subtle  definitions  of  this  term  "insanity"!  Time,  and  time  alone,  will 
enable  us  satisfactorily  to  distinguish  between  them. 

No  skill  of  the  physician,  no  degree  of  experience  however  great,  no  penetration  or 
reach  of  thought,  will  suffice  at  a  glance  to  decide  this  momentous  question. 

Careful  observation  of  the  bodily  health,  and  particularly  those  organic  functions  that 
are  beyond  the  control  of  the  will  ;  and  watchfulness  by  day  and  by  night,  to  as  great  an 
extent  as  possible,  of  the  mental  operations  and  acts  of  the  patient — and  that  without  his 
knowledge  or  suspicion  of  the  fact — will  eventually  and  rightfully  decide  the  case. 

Such  are  a  few  of  the  general  considerations,  by  which  we  are  to  be  governed  in  our 
attempts  to  detect  and  decide  upon  the  existence  and  form  of  insanity,  from  which  a 
fellow  being  may  suffer. 

Yet,  as  if  to  baffle  all  our  efforts,  and  to  render  nugatory  the  best  concerted  plans  for 
its  detection,  a  form  is  known  to  exist  which  is  strictly  intermittent  in  its  character;  the 
patient  in  the  intervals,  furnishing  not  the  remotest  evidence  of  insanity.  Then  again  a 
progressive  derangement  may  form  a  sort  of  crisis  amid  the  horror  and  confusion  of  some 
dread  outbreak,  which  shall  compromise  if  not  terminate  the  existence  of  a  human 
being,  and  with  it  the  insanity  which  led  to  the  lamentable  result.  The  crisis  of  a 
child's  grief  and  pain  often  manifests  itself  in  sobs  and  tears;  of  anger,  in  a  brawl  or 
fight ;  in  a  word,  of  any  strong  emotion,  in  a  powerful  and  concentrated  exercise  of  it. 

Insanity,  when  it  assumes  this  form,  is  to  be  studied  successfully,  only  by  a  careful 
examination  of  all  the  facts  and  circumstances  of  the  case,  as  they  are  unfolded  previ- 
ously to,  and  many  times,  long  before  the  outbreak  which  renders  it  painfully  evident, 
as  well  as  during  its  manifest  existence  and  subsequently.] 


INSANITY.  23 

Among  the  insane,  sensibility  is  exalted,  or  perverted  ;  and  their  sensations 
are  no  longer  in  relation  with  external  or  internal  impressions.  They  seem  to 
be  the  sport  of  the  errors  of  their  senses,  and  of  their  illusions.  Many  insane 
persons  do  not  read,  because  the  letters  appear  to  be  mingled  in  a  confused 
mass,  so  that  they  are  unable  to  arrange  them,  in  such  a  manner  as  to  form 
syllables  and  words.  A  thousand  illusions  of  sight,  produce,  and  continue 
their  delirium.  They  recognize  neither  their  parents  nor  friends,  and  regard 
them  either  as  strangers  or  enemies.  They  are  no  longer  correct  in  the  ap- 
preciation of  the  qualities  and  properties  of  surrounding  objects  ;  many  be- 
lieving themselves  at  their  usual  places  of  abode,  when,  indeed,  they  are  very 
far  removed  from  them,  and  reciprocally. 

An  officer  of  talent,  of  strong  constitution,  and  about  forty-six  years  of  age, 
experiences  some  disappointments  in  the  service.  He  becomes  irritable,  is  re- 
manded to  Paris,  and  is  not  received  as  he  had  anticipated.  His  imagination 
becomes  excited.  After  some  days,  he  leaves  his  own  residence  at  eleven 
o'clock  in  the  evening,  traverses  the  Place  Louis  XV.,  and  finds  not  the  Co- 
lumn, elevated  in  the  Place  Vendome.  He  at  once  persuades  himself  that  the 
insurgents  have  overturned  it,  and  threaten  the  government.  He  stations 
himself  upon  the  bridge  Louis  XVL  to  defend  the  passage  again.st  the  pre- 
tended insurgents.  He  arrests  all  who  would  pass.  The  guard  appear.  He 
contends  desperately  ''gainst  these  enemies  of  the  State,  is  wounded,  and  yields 
only  to  numbers. 

A  lady  aged  twenty-seven  years,  in  the  last  stage  of  phthisis,  becomes  ex- 
ceedingly annoyed  by  the  odor  of  burning  charcoal.  She  believes  that  they 
wish  to  suffocate  her  ;  accuses  the  proprietor  of  the  house,  and  hastens  to  de- 
nounce him  to  her  friends.  This  odor  follov.s  her  every  where.  Every  where 
she  is  assailed  by  the  fumes  of  charcoal.  She  quits  her  lodgings,  changing 
them  many  times  in  a  month.  The  principal  disease  continues  to  make  pro- 
gress, and  the  patient  dies,  tormented  to  the  last  by  her  hallucination. 

Very  often  the  insane  repulse  with  horror,  and  obstinately  refuse  aliments 
after  having  smelled  them  for  a  considerable  time.  Frequently,  at  the  com- 
mencement of  insanity,  the  taste  is  perverted  ;  and  the  alienated  reject  all 
kinds  of  nourishment.  This  symptom,  alarming  to  those  who  have  no  ex- 
perience among  the  insane,  is  dissipated  with  the  inconvenience  which  causes 
it,  viz.,  gastric  irritation. 

A  student  breakfasts  with  a  friend,  gets  tipsy,  becomes  furious,  and  remains 
convinced  that  they  have  mingled  drugs  with  his  wine.     (See  Ulusinns). 

How  frequently  do  the  insane  deceive  themselves  with  respect  to  the 
volume,  form,  and  thickness,  of  those  bodies  which  they  touch  !  The 
greater  part  become  unskillful  in  labors  of  the  hands,  in  the  mechanic  arts, 
music  and  writing.  They  are  very  awkward,  and  the  touch  has  lost  its  sin- 
gular property  of  rectifying  the  errors  of  the  other  senses. 

These  errors  of  sensation  appear  to  affect,  sometimes  but  one  sense,  often 
two,  more  rarely  three,  sometimes  four,  and  even  all.  When  mental  aliena- 
tion manifests  itself,  and  sometimes  long  before,  both  the  senses  of  smell  and 
taste  are  altered,  but  errors  of  hearing  and  sight,  characterize,  and  continue 
more  generally,  the  delirium  of  the  greater  part  of  the  insane.* 

There  are  insane  persons  who  hear  voices  speaking  very  distinctly,  and  with 
which  they  hold  successive  conversations.  These  voices  proceed  from  the 
clouds,  and  from  trees ;  they  penetrate  walls  and  pavements ;  they  pursue 
and  fatigue,  those  who  hear  them,  d;iy  and  night ;  while  walking,  in  society, 
amidst  assemblies,  as  well  as  in  retirement.  They  take  the  accent  and  tone 
of  a  relative,  a  friend,  a  neighbor,  or  an  enemy.  They  make  proposals,  gay, 
erotic,  threatening  or  injurious  in  their  nature.  They  advise  to  actions,  con- 
trary to  honor,  to  interest,  or  to  the   preservation  of  the  patient.     A  gentle- 

*  See  Hallucinations  and  Illusions. 


24  INSANITY. 

man,  after  a  dreadful  catastrophe,  thinks  himself  accused ;  attempts  suicide, 
and  passes  more  than  two  years,  in  listening  to  the  threatening  voices  of  his 
accusers. 

Mrs.  A.  entertains  the  belief  that  men  enter  her  chamber  d\ix^a^  the 
night.  On  being  shown  that  this  is  impossible,  she  replies,  they  pass  through 
the  lock.  A  lypemaniac  speaks  aloud,  when  by  himself,  and  as  if  in  conver- 
sation with  another  person.  I  remarked  upon  its  impropriety,  assuring  him 
that  no  person  could  hear,  or  reply  to  him.  In  the  midst  of  our  discussion,  he 
says  to  me  :  Do  you  not  sometimes  think?  Doubtless,  I  replied.  You  think 
silently,  he  continued,  but  1  aloud.  If  insanity  is  characterized  and  maintain- 
ed by  errors  of  sensation,  by  illusions  and  hallucinations ;  it  is  also,  by  the 
multiplicity  of  sensations,  by  the  abundance  of  ideas,  the  versatility  of  the 
affections,  which  are  produced  in  melancholy  confusion,  without  order,  end, 
or  coherence.  This  exuberance  of  thought,  permits  not  the  patient  to  arrest 
his  attention  sufficiently  long  upon  each  sensation  or  idea,  to  separate  those 
which  have  no  relation  among  themselves,  or  to  remove  those,  which  exist  in 
excess.  He  can  no  longer  seize  upon  the  qualities  or  relations  of  things ; 
neither  compare,  nor  abstract.  There  results  from  this  disposition  a  volatile 
delirium,  whose  object  is  unceasingly  renewed,  and  takes  every  variety  of 
form.  Both  the  language  and  actions  participate  in  this  mobility,  and  give 
at  times,  a  very  elevated,  and  even  sublime  character,  to  the  thoughts.  Un- 
der other  circumstances,  the  attention  exercises  itself  with  so  much  energy  as 
to  become  fixed  upon  a  single  subject.  Constantly  confined  to  this,  nothing 
can  turn  it  aside.  All  reasonings  and  determinations,  are  derived  from  this 
all-absorbing  idea.  Monomania  offers  a  thousand  examples  of  this  form  of 
delirium. 

The  faculty  which  the  mind  possesses,  of  associating  our  sensations  and 
ideas,  of  arranging  them  among  themselves,  of  combining  them  with  our  de- 
terminations, presents  very  remarkable  alterations  among  the  insane.  The 
slightest  impression,  or  the  most  remote  coincidence,  provokes  the  strangest 
associations. 

The  city  of  Die  is  overlooked  by  a  neighboring  rock,  which  is  called  the 
U.  A  young  man  suggested  to  himself  the  propriety  of  adding  the  letter  U 
to  the  word  Die,  making  it  the  word  Dieu,  (God).  Hence  all  the  inhabi- 
tants of  Die,  became  gods  in  his  opinion.  He  immediately  perceives  the  ab- 
surdity of  this  Polytheism,  and  concentrates  the  divinity  in  the  person  of  his 
father,  as  the  most  reputable  man  of  that  country.  His  father,  although  at 
two  hundred  leagues  distance  acts  in  him,  and  he  acts  only  by  his  father.  A 
general  becomes  agitated,  cries  aloud,  and  takes  the  tone  of  a  commander, 
the  moment  that  he  hears  the  drum  or  the  cannon.  Often  the  delirium  allies 
itself  so  closely  to  the  cause  which  has  excited  it,  to  the  intellectual  and  mo- 
ral condition  of  the  patient  at  the  period  of  the  attack,  that  this  vicious  asso- 
ciation, persists  during  the  whole  disease,  characterizes  it,  and  becomes  the 
only  obstacle  to  its  cure.  An  emigrant  soldier,  thirty-five  years  of  age, 
having  returned  to  France,  is  arrested,  put  in  prison,  and  loses  his  reason. 
Restored  to  liberty,  he  sees  himself  every  where  surrounded  by  spies,  and 
agents  of  the  police. 

A  young  artist,  a  passionate  admirer  of  Rousseau,  not  obtaining  the  first 
prize  for  sculpture,  of  which  he  thought  himself  deserving,  gives  himself  up 
to  despair.  He  vows  eternal  hatred  to  men,  and  wishes  no  longer  to  live, 
except  after  the  manner  of  brutes.  He  walks  upon  all  fours,  and  if  placed 
upon  a  bed  rolls  himself  off  upon  the  ground.  If  confined,  he  has  convul- 
sions. He  will  eat  nothing  but  herbs,  or  crude  fruits  which  he  picks  up  from 
the  ground.  If  helped  to  them,  he  refuses  to  use  them.  This  condition  per- 
sists for  more  than  two  months,  after  which  he  fidls  into  a  state  of  dementia, 
to  which  h^  has  a  strong  predisposition,  having  several  brothers  and  sisters 
affected  wito  tJiis  form  of  disease. 


■  '•'-'•V 

INSANITY.  25 

With  another  class  of  the  insane,  the  enfeebled  organs  perceive  but  feebly, 
sensations ;  impressions  are  not  sufficiently  felt ;  memory  retains  them  not, 
and  is  unfaithful.  These  persons  remember  only  events  long  since  passed. 
Impeffectly  served  by  their  sensations  and  memory,  they  cannot  seize  upon 
affinities.  They  can  no  longer  arrest  their  attention,  as  it  is  not  excited  by 
the  impression  of  external  objects.  Their  determinations  are  uncertain. 
They  seem  to  act  only  from  recollections. 

Memory  presents  also  striking  anomalies  among  the  insane,  the  ideas  either 
requiring  an  actual  sensation  to  awaken  them,  or  a  continual  effort  to  recall 
them.  Memory  is  not  wanting  with  these  patients,  but  the  faculty  of  direct- 
ing and  fixing  their  attention  being  impaired,  memory  serves  them  imper- 
fectly. 

In  some  cases  of  mental  alienation,  man,  deprived,  in  some  sort,  of  the 
control  of  the  will,  seems  no  longer  to  be  master  of  his  determinations.  The 
insane,  controlled  by  their  predominant  ideas  and  impressions,  are  drawn 
away  to  the  performance  of  acts  which  t-hey  themselves  disapprove.  Some,  con- 
demning themselves  to  repose,  to  silence  and  inaction,  cannot  control  the 
power  which  represses  their  activity.  Others  walk  about,  sing,  dance,  and 
write,  without  the  power  to  refrain.  We  have  seen  some  escape  from  their 
relatives  with  no  other  motive  than  the  desire  of  moving  about,  hasten  from 
point  to  point  for  many  days,  scarcely  stopping  to  take  nourishment ;  while 
others  give  themselves  up  to  acts  of  madness,  which  cause  them  intense  agony. 
These  impulses,  these  irresistible  propensities,  these  automatic  determinations 
as  authors  call  them,  seem  to  be  independent  of  the  will.  However,  they  re- 
sult generally,  from  motives,  of  which  the  insane,  and  those  conversant  with 
them,  can,  to  a  certain  extent,  give  an  account.* 

The  insane  are,  as  Locke  remarks,  like  those  who  lay  down  false  principles, 
from  which  they  reason  very  justly,  although  their  consequences  are  errone- 
ous. 

A  public  receiver,  after  long  and  difficult  labor  upon  the  finances,  is  strick- 
en with  mania.  The  attack  terminates  in  melancholy  complicated  with  de- 
mentia and  paralysis.  He  refuses  for  some  days  to  drink  at  his  repasts. 
They  insist — he  becomes  enraged  ;  exclaiming,  rascal,  would  you  have  me. 
swallow  my  brother  !  Reflecting  upon  this  strange  notion,  I  perceive  that 
the  patient  sees  his  own  image  in  the  bottle  placed  upon  the  table.  I  remove 
it,  and  from  thenceforth  he  drinks  without  difficulty.  A  vine-dresser  slays 
his  children,  says  Pinel,  but  he  does  it  that  they  may  not  be  damned.  A 
woman  forty  years  of  age,  having  ftiUen  into  the  most  abject  misery,  throws 
herself  into  the  river.  She  assured  me  that  during  twenty-four  hours,  while 
walking  upon  its  banks,  she  had  suffered  indescribably,  and  had  resolved  upon 
suicide,  only  to  prevent  the  anguish  of  the  most  profound  misery. 

The  moral  affections  provoke  insanity.  The  symptoms  which  characte- 
rize it,  impress  often,  every  feature  of  the  passions.  The  determinations 
which  the  passions  produce,  are  not  in  harmony  with  those  by  which  the 
patient  was  formerly  affected,  nor  with  what  are  observed  among  other  indi- 
viduals. 

A  madman  is  passionate,  jealous ;  he  commits  murder.  He  is  impatient  of 
restraint ;  and  if  he  cannot  otherwise  escape,  will  precipitate  himself  from 
the  house  in  which  he  is  confined,  or  set  fire  to  it.  Among  the  insane,  some 
are  stricken  with  terror,  believe  themselves  ruined,  tremble  lest  they  shall  be- 
come the  victims  of  a  conspiracy,  fear  death.  Others  are  happy  and  gay ; 
think  only  of  the  good  which  they  fnjoy,  or  of  the  benefits  which  they  can 
dispense.  They  feel  persuaded  that  they  are  elevated  to  the  greatest* dignity, 
— that  the  homage  of  the  world  is  their  due, — that  they  inhabit  a  superior  re- 

*"  See  Homicidal  Monomania. 


26  INSANITY. 

gion,  where  they  are  eternally  to  dwell,  intoxicated  with  delight.  Witness,  for 
example,  the  madman  of  Athens,  who  believed  that  all  the  vessels  entering  the 
Pyraeus  were  his  own. 

A  young  chemist,  aged  twenty-seven  years,  and  of  a  strong  constitution,  labors 
night  and  day  in  researches  appropriate  to  his  department.  He  becomes 
greatly  excited,  and  is  at  the  same  time  amorous.  He  precipitates  himself 
from  the  fourth  story  of  the  house,  and  fractures  the  fibula.  Replaced  in  bed, 
the  delirium  continues  intense.  The  patient  distributes  millions,  and  promi- 
ses that  all  the  world  shall  be  happy.  At  the  expiration  of  three  months  he  is 
restored. 

The  first  sentence  which  he  wrote  his  parents  is  thus  expressed  :  '  /  fiel 
that  I  imtst  renounce  my  illusions.  Never  shall  I  he  so  happy  as  during  the 
three  months  which  have  just  passed.'  This  happy  state  of  some  deranged 
persons,  has  been  the  cause  of  many  errors  respecting  this  class  of  people. 
Some  who  see  them  thus,  conclude  that  the  insane  are  all  hapj)y,  that  they  do 
not  suffer  ;  whilst,  generally,  they  suffer  as  much  physically  as  morally. 

The  passions  of  the  insane  are  impetuous,  especially  in  mania  and  mono- 
mania. They  are  of  a  depressing  character  in  lypemania.  In  dementia  and 
imbecility,  those  only  exist,  which  spring  from  the  first  wants  of  man, — love, 
anger,  jealousy. 

He  who  should  say  that  rage  is  but  an  attack  of  anger  prolonged,  might 
also  say,  that  erotomania  is  love  carried  to  excess, — that  religious  lypemania 
is  zeal  or  religious  fear  carried  beyond  due  limits, — that  suicide  is  an  attack 
of  despair.  Thus,  from  a  condition  the  most  calm,  one  becomes  excited,  by 
insensible  gradations,  to  the  most  violent  passion,  and  even  to  the  most  furious 
mania,  or  sinks  into  the  profoundest  melancholy, — almost  all  forms  of  insani- 
ty, having  their  primitive  type  in  some  of  the  passions. 

The  insane  sometimes  surrender  themselves  to  the  most  disgraceful  acts. 
Here  is  one  of  strict   integrity,  of   irreproachable  morals,  connected   even 
with  the  highest  class  in  society  ;  but  who,  becoming  insane,  makes  infamous 
proposals,  indulges  in  indecent  gestures,  and  is  the  opposite,  in  every  respect, 
to  what  his  past  conduct  would  lead  us  to  expect. 
There  are,  in  fine,  those  who  rob. 

M.  ***,  forty  years  of  age,  after  the  storms  of  the  revolution  had  passed 
away,  returns  to  France  and  obtains  an  honorable  subsistence.  Two  years 
subsequently,  he  suffers  from  loss  of  memory,  and  his  friends  perceive  a 
change  in  his  character.  At  length,  while  dining  with  one  of  them,  he  car- 
ries off  certain  pieces  of  silver  plate.  On  arriving  at  Paris,  he  betakes  him- 
self to  the  cafe  de  Foy,  orders  a  cup  of  chocolate,  breakfasts,  and  leaves  with- 
out paying,  carrying  oft'  in  his  waistcoat,  a  spoon  and  saucer.  It  is  unneces- 
sary to  relate  here,  the  excesses  which  the  hysterical  and  nymphomaniacs 
commit. 

The  insane  become  pusillanimous  in  the  extreme.  They  permit  themselves 
to  be  easily  intimidated.  They  are  fearful,  difiident,  jealous.  It  is  this  which 
occasions  their  restlessness,  which  makes  them  anxious  to  be  any  where,  rather 
than  where  they  happen  to  be, — to  distrust  themselves,  and  to  withdraw  fi-om 
their  parents  and  friends.  This  feeling  of  distrust,  is  found  among  people  of 
little  intelligence.  Men  the  least  suspicious,  and  the  most  confident,  are,  be- 
yond contradiction,  those  who  cultivate  their  minds ;  so  true  is  it,  that  moral 
force  is  in  proportion  to  mental  development.  But  notwithstanding  this  dis- 
trust, the  insane  are  improvident,  to  a  degree  which  can  be  compared  only 
with  that  of  savages.  They  have  no  care  for  the  moment  which  has  just  past, 
but  are  extremely  anxious  for  the  present.  This  improvidence  exposes  them 
to  privations  of  every  kind,  if  a  careful  watch  is  not  exercised  over  them,  and 
their  wants  carefully  supplied. 

The  insane  often  entertain  an  aversion  towards  persons  who  were  previous- 


INSANITY.  ^27 

ly  dear  to  them.  They  i'nsuU,  misuse,  and  fly  from  them.  It  is  a  result,  how- 
ever, of  their  distrust,  jealousy  and  fear.  Opposed  to  all,  they  fear  all.  Some, 
appear  to  constitute  an  exception  to  this  general  law,  and  seem  to  preserve  a  sort 
of  affection  for  their  relatives  and  friends.  But  this  tenderness,  which  is  some- 
times excessive,  exists  without  confidence,  and  without  intimacy  with  those 
persons,  who,  before  their  illness,  directed  the  ideas,  and  actions  of  the  pa- 
tient. This  melancholic  person  adores  his  wife,  but  is  deaf  to  her  advice  and 
prayers.  This  son  would  sacrifice  his  life  for  his  father  ;  but  would  do  no- 
thing through  deference  to  his  counsels,  from  the  moment  they  have  his  de- 
lirium for  their  object. 

This  moral  alienation  is  so  constant,  that  it  would  appear  to  me  to  be  an 
essential  characteristic  of  mental  alienation. 

There  are  insane  persons  whose  delirium  is  scarcely  noticeable  ;  none  whose 
passions  and  moral  affections,  are  not  disordered,  perverted,  or  annihilated. 
The  return  of  the  moral  affections  within  their  just  bounds,  the  wish  to  see 
his  children  and  friends  once  more,  the  tears  of  sensibility,  the  desire  of  un- 
folding the  affections,  of  finding  himself  again  in  the  midst  of  his  family,  and 
of  returning  to  his  accustomed  habits,  are  certain  signs  of  a  cure ;  while  the 
contrary  had  been  a  sign  of  approaching  insanity,  or  the  index  of  a  threaten- 
ing relapse. 

The  diminution  of  delirium  is  a  certain  sign  of  returning  health,  only 
when  the  insane  return  to  their  first  affections. 

Closing  this  long  summary  of  the  intellectual  and  moral  symptoms  of  in- 
sanity, let  us  pass  to  the  principal  physical  alterations,  which  the  insane  pre- 
sent. 

The  vital  forces  acquire,  among  this  class  of  persons,  an  exaltation  which 
permits  them  to  resist  influences,  most  calculated  to  affect  the  health ;  but 
this  exaltation  is  not  so  general  as  is  commonly  believed. 

Examples  are  rare,  though  repeated  on  all  sides.  Some  insane  persons  ex- 
perience an  internal  heat,  so  intense,  that  they  throw  themselves  into  water, 
and  even  amid  ice,  or  refuse  all  clothing  at  the  coldest  season  of  the  year. 

With  others  the  muscular  system  acquires  an  energy,  the  more  formidable, 
as  force  is  joined  to  audacity,  and  their  delirium  renders  them  indifferent  to 
danger. 

We  have  seen  madmen  pass  many  days  without  food  or  drink,  and  pre- 
serve all  their  muscular  energy.  I  repeat  it,  these  examples  are  rare.  Al- 
most all  the  insane  crowd  around  the  fire  when  there  is  occasion  for  its  use, 
and  almost  all  eat  much,  and  very  frequently. 

Scrofula  aflfects  so  many  of  the  insane  in  every  hospital,  because  their 
habitations  are  damp,  cold,  and  imperfectly  ventilated :  and  because  this  class 
of  patients  live  in  idleness  and  inactivity.  Epidemics  and  contagions  spare 
them  not,  which  proves  that  they  are  not  so  insusceptible  to  external  influ- 
ences as  is  pretended. 

The  features  of  the  insane  are  convulsed,  and  their  physiognomy  wears  the 
impress  of  pain.  How  different  the  changeful  features  of  the  maniac ;  the 
fixed  and  lengthened  visage  of  the  melancholic;  the  relaxed  features,  and  ex- 
tinct expression  of  one  in  dementia,  from  those  of  the  same  individuals  after 
restoration  to  health ! 

Among  the  insane,  some  are  plethoric,  others  Ivmphatic  ;  some  are  strong, 
others  feeble  ;  the  pul.se  is  full,  voluminous  and  hard  among  the  former  ;  with 
the  latter,  slow,  soft,  and  concentrated.  Tormented  with  hunger  and  thirst, 
they  are  more  agitated  or  melancholic  after,  than  before  their  repasts.  Some 
have  acid  nidorous  eructations ;  some  debility  of  the  stomach,  which  induces 
them  to  drink  wine  and  liquors  ;  while  others  suflfer  from  abdominal  pains, 
and  heat  of  the  intestines. 

Maniacs,  monomaniacs  and  lypemaniacs,  do  not   sleep  ;    insomnia  conti- 


28  INSANITY. 

nuing  for  several  months.  Tf  they  sleep,  they  have  the  nightmare,  frightful 
dreams,  and  are  awoke  by  surprise,  vi^hiie  imbeciles  and  those  in  dementia 
would  like  to  sleep  constantly. 

There  are  those,  who  are  troubled  with  a  constipation,  which  persists  for 
eight,  thirteen  and  twenty-one  days, — those  whose  urine  is  retained  for  twenty- 
four,  sixty,  and  one  hundred  and  twenty  hours.  With  others,  the  alvine  de- 
jections and  urine,  pass  off  involuntarily. 

All  the  secretions  acquire  a  penetrating  odor,  impregnating  both  the  cloth- 
ing and  furniture,  and  which  nothing  can  remove. 

Many  insane  persons  suffer  from  violent  pains  in  the  head,  which  cause  them 
to  beat  it ;  also  from  pains  in  the  chest,  abdomen  and  limbs,  which  they  attri- 
bute often,  to  their  enemies,  to  the  devil,  or  to  harsh  treatment.  In  fine,  they 
are  subject  to  cutaneous  affections,  sores,  hemorrhoids,  convulsions,  organic 
diseases,  etc. 

From  all  that  precedes  we  conclude,  that  among  the  insane  the  vital  proper- 
ties are  changed  ;  that  physical  and  moral  sensibility ;  the  faculty  of  perceiv- 
ing, comparing  and  associating  ideas  ;  the  memory  and  will  ;  the  moral  affec- 
tions, and  the  functions  of  organic  life ;   are  all  more  or  less  impaired. 

As  I  have  interdicted  myself  from  all  explanation,  I  must  content  myself 
with  saying,  behold  the  facts.  However,  I  will  add  a  few  brief  observations, 
which  will  aid,  perhaps,  in  shedding  some  light  on  the  subject  of  delirium. 

A  young  man  sees  around  him  all  the  persons  composing  the  court.  He 
prostrates  himself  before  the  feet  of  him,  whom  he  believes  to  be  the  sovereign, 
and  refuses  the  attentions  they  are  about  to  render  him  ;  unwilling  to  be  serv- 
ed by  such  august  personages.  He  becomes  furious,  when  the  servants  treat 
with  familiarity  the  sovereign  of  his  creation.  I  cause  his  eyes  to  be  bandag- 
ed for  two  days,  and  his  delirium  ceases ;  but  on  removing  the  covering,  it 
again  returns. 

Reil  states  that  a  lady,  seeing  spectres  and  monsters  about  her,  fell  into  a 
convulsive  delirium  ;  and  that  her  chambermaid,  in  order  to  protect  her,  plac- 
ed her  hand  over  the  eyes  of  the  patient,  who  immediately  exclaimed  ;  I  am 
cured.  This  experiment  was  renewed  with  the  same  success,  before  the  phy- 
sician. 

The  insane,  when  restored,  preserve  the  most  perfect  recollection  of  their 
sensations,  whether  true  or  false.  They  recall  without  difficulty  their  reason- 
ings, and  the  determinations  resulting  from  them,  and  the  recollection  even, 
of  the  smallest  details,  acquire  distinctness,  as  they  advance  towards  the  en- 
joyment of  perfect  health.  Hence  during  delirium,  they  possess  the  know- 
ledge and  capacity  requisite  for  reasoning. 

As  to  lesions  of  the  understanding,  they  can  be  reduced  to  that  of  the  at- 
tention ;  Jean  Jacques  has  said,  "  The  state  of  reflection,  is  a  state,  contrary 
to  nature.  3Ian  who  meditates  is  a  depraved  animal."  Instead  of  this  misan- 
thropic freak  of  thought,  Rousseau  should  have  said,  that  all  reasoning  sup- 
poses an  effort,  and  that  we  are  not  naturally  reasoning  beings  ;  that  is  to  say, 
our  ideas  are  not  conformed  to  objects,  our  comparisons  exact,  our  reasonings 
just,  but  by  a  succession  of  efforts  of  the  attention  ;  which  supposes  in  its 
turn,  an  active  state  of  the  organ  of  thought ;  just  as  a  muscular  efibrt  is  ne- 
cessary to  produce  motion,  although  the  movement  may  no  more  exist  in  the 
muscle,  than  thought  in  the  brain. 

If  we  reflect  upon  what  passes  through  the  mind  of  even  the  most  sensible 
man  for  a  single  day,  what  incoherence  shall  we  notice  in  his  ideas  and  deter- 
minations, from  the  time  that  he  awakes  in  the  morning,  until  he  retires  to 
rest  at  night !  His  sensations,  ideas  and  determinations,  have  some  connec- 
tion among  themselves,  only  when  he  arrests  his  attention ;  and  then  only  does 
he  reason.  The  insane,  no  longer  enjoy  the  faculty  of  fixing,  and  directing 
their  attention',  and  this  privation  is  the  primitive  cause  of  all  their  errors. 


INSANITY.  29 

We  observe  this  among  children,  who,  although  very  impressible,  have  ne- 
vertheless kw  sensations,  for  want  of  attention.  The  same  thing  happens  to 
the  aged,  because  their  attention  is  no  longer  solicited  by  external  objects,  in 
consequence  of  the  feebleness  of  organs. 

The  impressions  are  so  fugitive  and  numerous,  the  ideas  so  abundant,  that 
the  maniac  cannot  .fix  his  attention  sufficiently  upon  each  object  and  idea. 
With  the  monomaniac,  the  attention  is  so  concentrated,  that  it  cannot  turn 
itself  aside  upon  surrounding  objects,  and  accessory  ideas.  Hence  these  mad- 
men feel,  but  do  not  think.  Among  those  in  a  state  of  dementia  or  the  con- 
trary, the  organs  are  too  much  enfeebled  to  sustain  the  attention,  and  there 
are  no  longer  sensations  or  understanding. 

The  attention  of  all  the  insane  is  so  essentially  disturbed  by  one  of  these 
three  causes,  that  if  sensation,  strong,  agreeable,  painful  or  unexpected,  fixes 
the  attention  of  the  maniac,  or  turns  aside  that  of  the  monomaniac  ;  if  a  vio- 
lent commotion  arouses  the  attention  of  him  who  is  in  a  state  of  dementia ; 
lie  immediately  becomes  rational,  and  this  return  of  reason,  lasts  as  long  as 
the  effect  of  the  sensation  ;  that  is,  whilst  the  patient  retains  the  power  of  di- 
rectinor  and  sustaining  his  attention. 

Imbeciles  and  idiots  are  deprived  of  this  faculty,  and  hence  are  incapable 
of  education.  I  have  very  often  repeated  this  experiment  among  them.  Hav- 
inor  taken  casts  of  a  great  many  insane  people,  I  have  succeeded  in  jjlacing  in 
a  suitable  attitude,  maniacs,  the  furious  even,  and  the  melancholic  ;  but  could 
never  cause  the  imbeciles  to  close  their  eyes  sufficiently  long  for  the  plaster  to 
flow,  whatever  degree  of  good  will  they  might  bring  to  the  undertaking.  I 
have  even  seen  them  weep,  because  the  casting  of  their  heads  had  not  succeed- 
ed, and  undertake  many  times,  but  unsuccessfully,  to  preserve  the  posture  that 
had  been  given  them.  They  were  unable,  also,  to  close  their  eyes  longer  than 
one  or  two  minutes. 

Will  the  pathological  study  of  the  fiiculties  of  the  soul,  conduct  to  the  same 
results  with  those  to  which  M.  Laromiguiere  has  arrived,  in  his  eloquent  dis- 
courses on  philosophy  ? 

Numerous  facts  will  justify  this  psychological  view,  upon  which  reposes  a 
principle,  fruitful,  with  respect  to  the  cure  of  mental  diseases. 

After  having  reduced  insanity  in  some  sort  to  its  elements ;  after  having 
isolated  them  ;  to  obtain  the  general  forms  of  insanity,  we  have  only  to  reunite 
these  elements.  Now  these  general  forms  are  embraced  in  the  terms  follow- 
ing, and  constitute  five  varieties. 

1.  Lypemania  (melancholy  of  the  ancients),  delirium  with  respect  to  one, 
or  a  small  number  of  objects,  with  predominance  of  a  sorrowful  and  depress- 
ing passion. 

2.  Monomania,  in  which  the  delirium  is  limited  to  one  or  a  small  number  of 
objects,  with  excitement,  and  predominance  of  a  gay,  and  expansive  passion. 

3.  Mania,  in  which  the  delirium  extends  to  all  kinds  of  objects,  and  is  ac- 
companied by  excitement. 

4.  Dementia,  in  which  the  insensate  utter  folly,  because  the  organs  of  thought 
have  lost  their  energy,  and  the  strength  requisite  to  fulfill  their  functions. 

5.  Imbecility,  or  idiocy,  in  which  the  conformation  of  the  organs  has  never 
been  such,  that  those  who  are  thus  afflicted,  could  reason  justly. 

[The  forms  of  insanity  here  given  by  our  autlior,  and  which  have  so  long  been  received 
and  admitted  by  those  concerned  in  the  management  of  the  insane,  are  destined  at  no 
distant  day  to  undergo  a  decided  modification,  if  not  a  radical  change. 

In  its  relations  to  insanity,  the  mind  is  regarded  as  susceptible  of  two  principal  divi- 
sions ;  namely,  into  an  intellectual  and  moral  portion. 

Each  of  these  have  their  peculiar  province,  the  one  presiding  over  all  operations  pure- 
ly mental,  the  other  over  those  involving  only  the  feelings  and  emotions^ 


30  INSANITY. 

They  may,  under  the  influence  of  appropriate  causes,  each  become  deranged  in  their 
manifestations,  and  give  rise  to  a  form  of  insanity  which  shall  involve  the  intellect  or 
moral  nature  exclusively. 

A  third  form  may  result  from  a  derangement  of  both  of  these  in  the  same  individual  ; 
and  thus  in  three  divisions  may  be  embraced  all  those  forms  of  insanity  of  which  the 
mind  is  susceptible. 

As  sub-divisions 'however,  among  writers  on  insanity,  as  well  as  in  common  parlance, 
the  terms  lypemania  or  melancholy,  mania  or  madness,  and  dementia,  will  doubtless  con- 
tinue to  be  employed  as  qualifying  or  explanatory  words  in  the  more  general  descriptions 
above  referred  to,  and  with  their  present  significations.  So  also  in  relation  to  monoma- 
nia, when  the  mental  aberration  is  limited  to  a  few  subjects. 

Notwithstanding,  the  intellectual,  moral  and  mixed  will,  at  no  distant  day,  become  the 
leading  divisions  of  this  important  subject.] 

These  forms,  sufficiently  well  distinguished  in  the  engravings  appended  to 
these  memoirs,  in  which  are  described  the  varieties  of  insanity,  have  served  as 
the  basis  of  classification  with  Pinel ;  and  express  the  generic  characters  of 
mental  alienation.  Being  common  to  many  mental  affections,  whose  orio-in, 
nature,  treat iiient  and  termination,  are  widely  different,  they  cannot  charac- 
terize the  .-peoies  and  varieties  which  are  reproduced  with  infinite  shades  of 
difference. 

Insanity  may  assume  successively,  all  these  forms ;  monomania,  mania,  and 
dementia,  may  alternate  and  replace  each  other,  and  become  complicated  in 
the  course  of  the  same  disorder,  and  in  the  person  of  the  same  individual. 

It  is  this  circumstance,  that  has  caused  some  physicians  to  reject  all  distinc- 
tions, and  to  admit,  in  insanity,  but  one  and  the  same  malady,  which  masks 
^  itself  under  various  forms.     I  do  not  concur  with  them  in   this  opinion,  and 
regard  the  varieties  of  which  I   have  just  spoken,  as  too  distinct  ever  to  be 
confounded. 

We  could  wish  to  establish  the  numerical  relation  which  subsists  between 
the  different  forms  of  insanity.  Some  authors  believe  that  melancholy  is  the 
most  frequent.  Pinel  would  seem  to  be  of  this  opinion.  However,  in  the  se- 
cond edition  of  his  "  Treatise  on  Insanity,''  he  makes  si.x  hundred  and  four 
maniacs,  and  only  two  hundred  and  ten  melancholies  or  monomaniacs. 

To  compare  the  returns  which  have  been  made  in  different  places,  and  by 
different  authors,  it  would  be  necessary  that  each  should  give  the  same  signi- 
fication to  the  terms,  dementia,  idiocy,  inania  and  melancholy ;  a  fact  which 
does  not  exist. 

According  to  the  foregoing  definition  of  these  varieties,  I  think  that  mono- 
mania is  more  frequent  than  mania.  Dementia  and  idiocy  are  more  rare,  par- 
ticularly the  latter,  which  is  endemic  in  certain  mountainous  districts. 


II.     CAUSES  OF  INSANITY. 

The  causes  of  mental  alienation  are  as  numerous,  as  its  forms  are  varied. 
They  are  general  or  special,  physical  or  moral,  primitive  or  secondary,  predis- 
posing or  exciting. 

Not  only  do  climates,  seasons,  age,  sex,  temperament,  profession  and  mode 
of  life,  have  an  influence  upon  the  frequency,  character,  duration,  crises,  and 
treatment  of  insanity  ;  but  this  malady  is  still  modified  by  laws,  civilization, 
morals,  and  the  political  condition  of  people.  It  is,  also,  produced  by  causes, 
whose  influence  is  more  immediate,  and  easily  appreciated. 


INSANITY.  31 

1.  Climates. — Warm  climates  are  not  those  which  produce  the  greatest 
amount  of  insanity ;  but  rather  temperate  climates,  subject  to  great  atmos- 
pheric vicissitudes  ;  and  especially  those,  whose  temperature  is  alternately  cold 
and  humid,  damp  and  warm.  We  see  less  of  insanity  in  the  Indies,  in  Ame- 
rica, Turkey  and  Greece  ;  more  of  it,  in  the  temperate  climates  of  the  north. 

We  have  greatly  exaggerated  the  influence  of  climate,  in  the  production  of 
insanity.  Montesquieu  believes,  that  the  foggy  atmosphere  of  England  is  the 
principal  cause  of  the  great  number  of  suicides,  of  which  the  English  speak 
with  a  kind  of  ostentation.  We  shall  see  farther  on,  that  it  is  the  most  power- 
ful and  immediate  cause  of  the  great  amount  of  insanity,  which  we  notice 
among  our  neighbors.  It  .seems  to  be  endemic  in  some  countries.  In  marshy 
districts,  dementia  is  more  frequent,  and  imbecility  multiplies  there. 

Cretinism  is  endemic  in  the  defiles  of  mountains.  Mountaineers  who  de- 
scend into  our  cities,  are  more  exposed  to  nostalgia,  than  the  inhabitants  of 
the  plains. 

The  causes  of  insanity  are  not  the  same  in  a  mountainous  country,  and  on 
the  sea-coast — in  an  agricultural  district,  and  one  which  enriches  itself  by 
commerce. 

2.  Seasons. — After  Hippocrates,  Areteus  and  Celsus  assure  us,  that  summer 
and  autumn  produce  rage.  Most  authors  state  that  melancholy  is  particularly 
severe  in  autumn. 

Dementia  appears  in  winter. 

Charles  VI.  became  insane  after  having  been  exposed  to  the  sun  at  the 
chase,  or  while  engaged  in  exercises  preparatory  to  war.  Were  not  the  inha- 
bitants of  Abderas  stricken  with  insanity,  in  consequence  of  remaining  too 
long  exposed  to  the  sun,  while  witnessing  the  Andromeda  of  Euripides? 

Dodart  saw  a  young  man  who  lost  his  senses  whenever  he  became  heated. 

The  author  of  the  Topography  of  Auvergne  remarks,  that  its  inhabitants 
who  go  into  the  southern  provinces  of  Spain,  return  from  thence  melancholies 
or  maniacs.  Many  Frenchmen,  before  our  soldiers  were  acclimated  in  Spain, 
became  insane. 

Excess  of  cold  causes  the  same  disorders  ;  a  truth  illustrated  in  the  ex- 
perience of  our  troops  during  their  disastrous  retreat  from  Russia,  when 
many  French  soldiers  were  seized  with  phrenetic  delirium,  and  even  mania. 

Doctor  Pienitz,  physician  of  the  hospital  for  the  insensate,  at  Pima,  near 
Dresden,  received  many  French  officers  who  were  insane.  Their  mania  was 
acute  and  passed  promptly  into  a  chronic  state. 

Heat,  like  cold,  acts  upon  the  insane,  with  this  difierence,  that  the  continu- 
ance of  warmth  augments  the  excitement,  while  cold  prolongs  the  depression. 
Great  atmospheric  commotions,  excite  and  exasperate  the  insane.  A  house 
for  the  insane  is  most  disturbed,  and  recpiires  the  most  carei'ul  supervision,  at 
the  period  of  the  equinoxes.  The  influence  of  certain  winds  upon  the  inha- 
bitants of  India,  the  Neapolitans,  and  Spaniards,  explains  suflicit-ntly  the  effect 
of  certain  atmospheric  states  upon  the  insane. 

From  the  following  report,  kept  at  the  Salpetriere  for  nine  years,  we  learn  ; 
1.  that  the  admissions  into  this  hospital,  are  most  numerous  during  the  months 
of  May,  June,  July,  and  August.  2.  that  this  proportion  decreases  from  Sep- 
tember to  December,  to  diminish  still  more  in  February  and  March. 


32 


INSANITY 


TABLE  OF  SEASONS.     No.  I. 


Months. 

Years. 

Totals. 

1806 

18 

1807 
19 

1808 
18 

1809 
13 

1810 
15 

1811 
13 

1812 
22 

1813 
26 

1814 

January  .... 

18 

162 

February  .  .  . 

23 

23 

27 

26 

13 

13 

15 

19 

14 

173 

March 

27 

27 

16 

18 

22 

17 

17 

27 

16 

187 

April 

32 

24 

15 

27 

19 

13 

28 

20 

18 

196 

May 

26 

27 

23 

26 

34 

30 

29 

31 

17 

243 

June 

32 

28 

33 

31 

22 

18 

32 

26 

29 

251 

July 

23 

37 

21 

39 

34 

24 

37 

21 

29 

265 

August 

20 

23 

25 

32 

21 

19 

29 

25 

45 

239 

September  .  . 

21 

24 

21 

25 

16 

25 

23 

26 

25 

206 

October  .... 

23 

24 

16 

17 

18 

18 

23 

23 

26 

188 

Noveniber  .  . 

23 

21 

23 

27 

28 

16 

16 

19 

25 

198 

December  .  . 

24 

292 

19 
296 

14 
252 

18 

18 

23 

20 

25 

288 

30 

191 

Totals 

299 

260 

229 

291 

292 

2499 

The  influence  of  the  seasons  extends  even  to  the  course  of  the  insanity. 
There  are  individuals  who  pass  the  summer  in  a  state  of  prostration  or  agita- 
tion ;  whilst  in  the  winter  they  are  in  an  opposite  condition. 

Delirium  changes  its  character  with  the  seasons. 

A  lady,  twenty-six  years  of  age,  after  an  attack  of  variola,  has  an  abscess 
form  in  the  arm-pit.  It  is  opened,  the  wound  cicatrizes,  and  insanity  bursts 
forth.  After  two  years  the  same  patient  is  committed  to  my  care.  Her  hus- 
band, at  each  succeeding  change  of  season,  announces  the  form  of  delirium 
about  to  occur,  and  this  has  been  repeated,  with  great  exactness,  for  several 
years. 

Insanity,  which  appears  in  spring  and  summer,  has  an  acute  course.  If  not 
speedily  cured,  it  terminates  during  the  winter.  The  monomania  and  mania 
of  autumn,  terminate  only  in  the  spring.  Summer  is  more  favorable  to  the 
cure  of  dementia. 

The  cures  which  take  place  during  the  warm  season  are  more  rare,  but 
more  lasting. 

Relapses  are  most  likely  to  recur,  at  the  season  of  the  year  corresponding 
with  the  first  attack.  They  are  most  frequent  in  spring  and  summer,  although 
they  may  occur  in  winter. 

Relapses,  although  after  an  interval  of  many  years,  recur  at  the  same  sea- 
son, with  perfect  regularity,  in  certain  cases  of  intermittent  insanity. 

Does  the  moon  exercise  any  influence  upon  the  insane  ?  The  Germans  and 
Italians,  believe  it  does.  The  English,  and  almost  all  the  moderns,  give  to 
the  insane,  the  name  of  lunatics.  Daquin  of  Chamberi,*  after  some  observa 
tions,  concludes  that  the  moon  exercises  an  influence  over  this  class  of  mala- 
dies. Certain  isolated  facts,  and  phenomena  observed  in  many  nervous  dis- 
eases would  seem  to  justify  this  opinion. 

I  have  been  unable  to  verify  this  influence,  though  I  have  been  at  some  pains 
to  assure  myself  of  it.  It  is  true,  that  the  insane  are  more  agitated  at  the  full 
of  the  moon,  as  they  are  also,  at  early  dawn.  But  is  it  not  the  light  of  the 
moon  that, excites  them,  as  that  of  day,  in  the  morning? 

Does  not  t^iis  brightness  produce,  in  their  habitations,  an  effect  of  light, 
which  frightens  one,  rejoices  another,  and  agitates  all  ? 

I  am  conviA&ed  of  this  last  effect,  from  causing  the  windows  of  certain  in- 


The  Philosophy  of  Insanity;  Chamberi,  1804,  in  8  vo. 


INSANITY.  33 

sane  persons,  who  had  been  committed  to  my  charge,  as  lunatics,  to  be  care- 
fully closed. 

Doctor  Hutchinson  never  perceived  this  influence  during  several  years, 
whilst  connected  with  the  Pennsylvania  Hospital,  in  the  capacity  of  Assistant 
physician. 

Haslam  has  not  been  more  fortunate  at  the  Bedlam  of  London. 

At  the  Hospital  Salpetriere,  where  practical  truths  have  become,  in  some 
sort  known,  among  the  inmates  of  the  house,  they  have  no  longer  any  suspi- 
cions of  lunar  influence.  The  same  is  true  of  the  Bicetre,  and  certain  pri- 
vate houses  of  the  capital. 

Nevertheless,  an  opinion  which  has  existed  for  ages,  which  is  spread  abroad 
through  all  lands,  and  which  is  consecrated  by  finding  a  place  in  the  vocabu- 
lary of  every  tongue,  demands  the  most  careful  attention  of  observers.* 

Many  authors  assure  us  that  mental  alienation  is  epidemic.  It  is  certain 
that  there  are  years,  when,  independently  of  moral  causes,  insanity  seems  sud- 
denly to  extend  to  a  great  number  of  individuals.  As  for  moral  contagions, 
they  are  incontestable.     We  shall  speak  of  them  hereafter, 

3.  Age. — Infancy  is  secure  from  insanity,  unless  at  birth,  the  child  suffers 
from  some  vice  of  conformation  or  convulsions,  which  occasion  imbecility  or 
idiocy.  However,  Joseph  Franck,  found  in  1802,  at  St.  Luke's,  London,  a 
child,  who  had  been  a  maniac  from  the  age  of  two  years. 

In  1814,  I  took  charge  of  a  child,  aged  eight  years,  of  an  agreeable  figure, 
and  endowed  with  the  usual  share  of  intellect,  who  had  been  very  nuich  fright- 
ened by  its  governess,  at  the  siege  of  Paris,  This  child  spoke  often  correctly, 
yet  nothing  could  restrain  him.  He  escaped  frequently  from  his  mother  and 
governess,  and  wandered  about  the  city.  He  was  accustomed  to  descend  into 
the  court  of  the  hotel,  and  to  order  the  horses,  pretending  to  be  master.  It 
was  confidently  affirmed,  that  he  had  gained  a  great  sum,  in  a  lottery.  Does 
he  visit  the  shop  of  a  tradesman,  or  pass  by  a  warehouse,  he  seizes  upon  the 
money  that  his  mother  or  customers  give,  in  payment  for  their  purchases.  He 
would  often  insult,  provoke,  or  strike  persons  whom  he  met,  especially 
those  who  were  accustomed  to  visit  his  mother.  He  slept  as  soon  as  he  sat 
down,  and  threw  every  thing  into  disorder  as  soon  as  he  rose  up,  making  a 
great  deal  of  noise.  He  abused  his  mother,  and  was  unwilling  to  do  any  thing 
that  she  desired. 

A  child,  nine  years  of  age,  having  recovered  from  an  ataxic  fever,  became 
a  maniac.  He  was  perverse,  insulted  his  father  and  sisters,  struck  every  one 
he  met,  often  wept,  was  unwilling  to  eat,  did  not  sleep,  and  was  noisy.  He 
was  much  emaciated,  and  affected  with  a  relaxed  state  of  the  bowels. 

He  was  committed  to  my  care,  August  13th,  1814,  about  the  eighth  day 
of  his  new  disorder.  We  permitted  him  to  give  a  loose  rein  to  all  his  desires, 
and  indulged  him  in  the  open  air  during  the  whole  day  ;  prescribed  for  him 
quinine,  together  with  a  tonic  regimen,  and  in  two  months  he  was  restored. 

In  December,  1815,  I  was  consulted  in  behalf  of  a  child,  endowed  with 
precocious  intelligence,  aged  eleven  years,  having  a  voluminous  head,  and  very 
devoted  to  study. 

He  was  melancholic,  with  hallucinations  of  taste  and  vision,  and  had  fallen 

*MM.  Leuret  and  Mitivic,  have  examined  the  subject,  with  a  view  to  ascertain  whe- 
ther the  moon  influences  the  pulse  of  the  insane;  and  they  decide  in  the  negative.  See 
their  work,  entitled,  '■^Frequency  of  the  pulse  among  the  insane,"  etc.  in  8  vo.  Paris,  1832  : 
with  engravings,  representing  the  phases  of  the  moon,  and  the  number  of  the  pulsations 
of  the  Insane,  taken  daily,  during  a  month  of  summer,  and  one  of  winter,  at  the  Salpe- 
triere, and  at Ivry. 

5  /'' 


34  INSANITY. 

into  marasmus.     He  often  refused  to  eat,  wishing  for  no  aliment,  from  the  time 
that  he  saw,  or  thought  he  saw  the  smoke  of  it. 

He  had  assumed  a  tone  of  command  and  authority  over  his  parents. 

Isolation  produced  the  effect  of  diminishing  his  repugnance  to  aliments, 
without  chancrinff  his  delirium. 

These  examples,  which  are  not  altogether  exceptions,  if  joined  to  those 
which  are  caused  by  the  jealousy  of  childhood,  and  by  masturbation  from  very 
early  life,  are  notwithstanding  very  rare. 

It  is  only  at  puberty,  during  the  earliest  menstrual  efforts,  or  during,  and 
after  a  too  rapid  growth,  that  we  begin  to  notice  certain  cases  of  mental  alien- 
ation. But  after  puberty,  we  see  much  of  erotic,  hysterical  and  religious  in- 
sanity. 

In  youth,  mania  and  monomania,  burst  forth  in  all  their  varieties  and  forms. 

Lypemania  is  rather  the  lot  of  adult  age  ;  while  dementia  attacks  those 
more  advanced  in  years,  and  such  as  have  reached  the  evening  of  life.  In 
youth,  insanity  has  a  more  acute  course,  and  is  terminated  by  more  distinct 
crises.  In  adult  age,  it  is  more  chronic,  and  is  more  frequently  complicated 
with  abdominal  affections,  cerebral  hemorrhages,  and  paralysis.  It  runs  its 
course  more  slowly,  and  terminates  by  hemorrhoids,  and  alvine  dejections.  Its 
cure,  also,  is  more  uncertain. 

It  is  dementia  only,  that  is  not  sometimes  observed  among  the  young,  and 
only  mania  and  melancholy,  that  do  not  appear  in  advanced  life.  Greding, 
Rush,  etc.,  have  seen  aged  maniacs,  of  eighty-five  years.* 

We  have  had  at  the  Salpetriere,  two  women,  aged,  the  one  eighty,  and  the 
other  eighty-one  years,  affected  with  maniacal  fury.  They  were  cured.  I 
have  attended  upon  a  man  seventy-eight  years  of  age,  who  had  melancholy 
complicated  with  mania.  These  persons  had,  however,  preserved  the  vigor  of 
consistent  age. 

Mental  alienation  might  therefore  be  divided,  relative  to  ages,  into  imbeci- 
lity for  childhood,  mania  and  monomania  for  youth,  lypemania  or  melancholy 
for  consistent  age,  and  into  dementia  for  advanced  life. 

We  have  only  to  repeat  with  Haslam,  that  among  sixteen  hundred  and  sixty- 
four  insane  persons  admitted  into  Bedlam  hospital,  from  1784  to  1794,  nine 
hundred  and  ten  were  from  twenty  to  fifty  years  of  age.  Rush  is  not  more 
exact,  when  he  says,  that  of  seventy  insane  persons  who  were  in  the  Pennsyl- 
vania hospital  in  1812,  sixty-four  were  between  twenty  and  fifty  years  of  age. 

It  is  not  surprising,  that  in  a  period  of  thirty  years,  and  at  a  time  of  life  too, 
when  man  is  most  exposed  to  every  variety  of  disease,  there  should  be  the 
greatest  proportion  of  insane  persons.  We  will  remark,  however,  that  the 
number  of  the  insane,  between  the  ages  of  twenty  and  fifty  years,  is  much 
more  considerable,  proportionally,  in  Pennsylvania  than  in  London. 

Can  there  be  in  England,  more  idiots,  and  individuals  in  a  state  of  demen- 
tia, than  in  Pennsylvania  ?  Hereditary  predisposition,  which  so  often  leads 
to  insanity  in  England,  and  morals,  which  exercise  so  great  an  influence  in 
the  production  of  this  disease,  furnish  sufficient  grounds  for  the  difference 
which  is  known  to  exist. 

*  Tliere  is  now  at  the  Retreat  for  the  Insane  at  Hartford  a  maniac  eighty-one  years  of 
age.     She  was  recently  admitted. 


INSANITY. 


35 


TABLE  OF  AGES.     No.  II. 


Report  kept 

at  the  Bicetre  for  ten  years. 

Years. 

Ages. 

Total. 

15 

20 

30 

40 

50 

60 

1784 

5 

33 

31 

24 

11 

6 

110 

1785 

4 

29 

49 

25 

14 

3 

124 

1786 

4 

31 

40 

32 

15 

5 

127 

1787 

12 

39 

41 

26 

17 

7 

142 

1788 

9 

43 

53 

21 

18 

7 

151 

1789 

6 

38 

39 

33 

14 

2 

132 

1790 

6 

28 

34 

19 

9 

7 

103 

1791 

9 

26 

32 

16 

7 

3 

93 

1792 

6 

26 

33 

18 

12 

3 

98 

1793 

4 

36 

28 

22 

13 

10 

103 

Totals, 

65 

329 

380 

236 

130 

53 

1193 

Report  kept  at  i 

he  Salpetriere  J 

^or  four  years. 

Years. 

Ages. 

Total. 

20 
34 

25 

30 

35 

27 

40 

50 

60 

70 

80 
4 

1811 

37 

38 

48 

38 

24 

12 

262 

1812 

52 

34 

33 

18 

38 

57 

26 

19 

3 

280 

1813 

43 

29 

33 

41 

32 

57 

31 

13 

6 

285 

1814 

42 

35 

38 
142 

31 
117 

26 
144 

53 

34 

22 

66 

10 
23 

291 

Totals,  ] 

[71 

135 

205 

115 

1118 

Report  of 

my  own  Establ 

ishment. 

86  64   43 

35  1  30   46 

15   5   3 

327 

To  determine  what  period  of  life  furnishes  the  greatest  number  of  insane 
persons,  it  was  sufficient  to  bring  together  the  records,  made  up  under  very 
different  circumstances.  One  of  them  was  made  at  the  Bicetre,  where  poor 
men  only,  are  received  ;  another  at  the  Salpetriere,  a  hospital  destined  for 
poor  women.  The  last  related  to  an  establishment  devoted  to  the  wealthy. 
From  these  reports  we  may  conclude  :  1st,  that  the  age  which  furnishes  the 
greatest  number  of  insane,  is  for  men,  that,  from  thirty  to  forty  years  ;  whilst 
for  women,  it  is  that,  from  fifty  to  sixty  years ;  2d,  that  the  ages  which  fur- 
nish the  least,  are  for  both  sexes,  childhood,  youth,  and  advanced  age  ;  3d, 
that  among  women,  insanity  appears  earlier  than  among  men  indeed  from 
twenty-nine  to  thirty  years  of  age ;  4th,  that  the  rich  are  affected,  in  compa- 
rison with  the  total  number  of  insane  persons,  in  a  greater  proportion  than  the 
poor.* 

4.  Sex. — Ccelius  Aurelianus  assures  us,  that  women  are  less  subject  to  insa- 
nity than  men  ;  and  what  was  true  in  his  time  is  still  so  in  Italy  and  Greece. 
In  the  north  of  France  the  contrary  is  true ;  the  number  of  insane  women 

*  To  determine  the  influence  of  age  in  the  production  of  insanity,  it  is  necessary  to 
compare  the  number  of  insane  persons  at  each  period  of  life,  with  the  whole  number  of 
people  living,  at  those  periods  respectively. 


36  INSANITY. 

being,  in  that  region,  greater  than  that  of  men.  In  England,  the  number  of 
insane  men  bears  a  more  equal  proportion  to  that  of  women.  We  find  the 
reason  for  this  difference,  in  the  comparison  of  their  habits. 

The  vices  of  education  adopted  by  our  young  ladies,  the  preference  given 
to  acquirements  purely  ornamental,  the  reading  of  romances,  which  o-ives  to 
the  intellect  a  precocious  activity  and  premature  desires,  together  with  ideas 
of  an  imaginary  excellence  that  can  never  be  realized  ;  the  frequenting  of  plays 
and  society  ;  the  abuse  of  music,  and  want  of  occupation  ;  are  causes  suffi- 
cient to  render  insanity  most  frequent  among  our  women. 

In  England,  women  receive  a  more  substantial  education  ;  they  lead  a  more 
retired  life,  and  do  not  take  so  important  a  part  in  public  affairs.  The  social 
existence  of  men  does  not  depend  so  much  upon  their  acts  or  caprices,  and 
hence  there  are  less  insane  women  than  in  France. 

From  1745  to  1775,  Raymond  found  no  difference  in  numbers,  between  the 
two  sexes,  among  the  insane  at  the  hospital  of  Marseilles.* 

In  1786,  Tenon  found,  that  the  number  of  insane  men  and  women,  in  the 
public  and  private  establishments  of  Paris,  were  nearly  equal. t 

In  1791,  the  Duke  de  Larochefoncault  Liancourt,  in  the  excellent  reports 
which  he  made  to  the  constituent  assembly,  respecting  the  public  charities, 
showed  that  a  very  great  difference  existed,  between  the  number  of  men  and 
women  at  the  Bicetre  and  Salpetriere. 

In  1802,  Pinel  established  the  difference  to  be  as  that  of  one  man,  to  two 
women,  in  comparing  the  Bicetre  with  the  Salpetriere. 

In  1804,  an  examination  at  the  establishment  at  Charenton,  indicated  that 
the  men,  numbered  more  than  half  of  the  inmates  of  the  House. 

The  men  are  always  more  numerous  here,  than  women  ;  a  fact  depending 
upon  localities,  and  peculiar  circumstances. 

In  1807  and  1810,  while  taking  a  hasty  survey  of  the  hospitals  of  the  prin- 
cipal cities  of  France,  I  found  about  6000  insane  persons  ;  in  the  proportion 
of  five  men  to  seven  women. 

In  1813,  the  prefect  of  the  department  of  the  Seine  ordered  an  enumera- 
tion of  all  the  insane,  then  in  the  public  and  private  Houses  of  Paris.  He 
found  the  number  of  females,  to  be  the  greater  by  one  quarter. 

In  my  establishment  there  were  received,  during  twelve  years,  one  hundred 
ninety-one  men,  and  one  hundred  forty-four  women. 

From  1744  to  1794,  in  the  hospital  of  Bedlam  among  nine  thousand  eight 
hundred  and  seventy-four  deranged  persons,  the  women  numbered  but  one 
hundred  more  than  the  men. 

The  director  of  St.  Luke's  Hospital,  London,  being  interrogated  by  a  Com- 
mittee of  the  House  of  Commons,  reported  that  they  received  annually  into 
that  hospital,  about  one  third  more  women  than  men. 

At  the  Retreat  near  York,  they  admitted  during  ten  years,  a  quarter  more 
women  than  men. 

At  the  Hospital  for  the  insensate  at  Vienna,  there  were,  in  1811,  one  hun- 
dred seventeen  men,  and  ninety-four  women. 

At  the  Hospital  at  Berlin  the  proportion  of  men  to  women  is  as  one  to  two. 

At  the  Pennsylvania  Hospital,  the  proportion  is  reversed ;  that  is,  one  fe- 
male to  two  males. 

*  Topography  of  Marseilles  in  the  Memoirs  of  the  Royal  Society  of  Medicine,  years 
1777,  1778 ;  Paris,  1780,  torn.  II.  fig.  124. 

t  Memoirs  respecting  the  Hospitals  of  Paris.     Paris,  1788,  in  4to.  p.  218. 


INSANITY.  37 

TABLE  OF  THE  SEX.     No.  III. 

1756. — Raymond  at  Marseilles,  50  men  to  49  women. 

1786.— Tenon  at  Paris,  500  "     509  " 

1786  to  1794.— At  Bedlam,                         4992  "  4882  " 

1807.— At  St.  Luke's,  110  "     153  " 
Bicetre  and   Salpetriere,  (mean 

year),  120  "     279  " 

Vienna,  117  "       94  " 

At  the  Retreat  near  York,  67  "       82  " 
1807  to  1812.— Several  Hospitals  of 

France,  488  "700       " 

1802  to  1814.— My  Establishment,  191  "     144  " 


Total,  6635  6892 

In  bringing  together  these  different  records,  casting  them  up,  and  compar- 
ing them,  we  may  conclude,  without  pretending  to  have  arrived  at  a  rigorous 
appreciation  of  the  influence  of  sex, — 

1.  That  in  a  very  considerable  number  of  insane  people,  selected  from  dif- 
ferent countries,  and  in  different  conditions,  the  disparity  in  numbers  between 
men  and  women,  is  much  less  considerable  than  is  usually  supposed  : 

2.  That  this  difference  approaches  very  nearly,  the  proportion  which  exists 
between  the  two  sexes,  in  the  general  condition  of  the  population : 

3.  That  this  difference  is  not  the  same  in  all  countries : 

4.  That  in  France  the  proportion  of  women  is  much  greater  than  in  Eng- 
land. 

As  to  the  reports  of  other  countries,  they  are  based  upon  too  small  a  num- 
ber of  cases,  and  extend  over  too  brief  a  period  of  time,  to  enable  us  to  form 
conclusions  on  which  we  can  rely,  either  with  respect  to  those  countries  them- 
selves, or  relatively,  to  France  and  England. 

Let  us  not  imagine  that  this  question  is  one  of  little  moment.  It  ought  to 
awaken  grave  reflections  respecting  public  morals,  and  the  influence  which 
women  exercise  over  them.  Its  solution  ought  to  furnish  one  of  the  prelimi- 
nary data,  in  the  construction  of  every  hospital  for  the  insane. 

Women  yield  to  the  causes  of  insanity,  proper  to  their  sex  ;  physical  causes 
act  more  frequently  upon  them  than  men  ;  they  become  more  frequently  in- 
sane before  the  age  of  twenty  years  ;  are  more  subject  to  dementia ;  and  their 
delirium  is  religious  or  erotic*  Almost  all  their  insanity  is  complicated  with 
hysteria. 

Women  practice  during  their  disorder,  more  concealment  than  men,  they 
speak  with  more  repugnance  of  their  condition,  and  try  to  hide  it  from  them- 
selves and  others. 

Men  are,  on  the  contrary,  more  maniacal,  more  furious.  They  are  more 
frank,  more  confident  in  their  delirium,  which  is  complicated  often,  with  hy- 
pochondria. Their  treatment  is  not  interrupted,  a  greater  proportionate  num- 
ber are  cured,  and  they  are  less  subject  to  relapses  than  women. 

5.  Temperament. — Simple  temperaments  are  so  rarely  met  with  in  practice, 
that  it  is  not  easy  to  point  out  with  precision,  that  of  this  or  that  individual ; 
and  for  a  still  stronger  reason,  that  of  one  insane  person  or  another. 

The  sanguine  temperament,  constitutes  one  of  the  predispositions  to  mania. 
The  nervous  temperament,  characterized  by  a  susceptibility  which  every  thing 

*  Thomas'  Essay  on  Women. 


38 


INSANITY. 


irritates  and  exasperates,  in  consequence  of  a  susceptibility  which  deprives  its 
possessor  of  the  facuhy  of  reasoning,  is  favorable  to  the  production  of  mania 
and  monomania.  Individuals  of  a  dry  temperament,  over  whom  the  abdomi- 
nal viscera  exercise  a  controlling  influence,  who  are  fearful,  timid  and  restless, 
are  predisposed  to  lypemania. 

The  lymphatic  temperament  may  be  met  with  in  connection  with  mania 
and  monomania,  but  we  ought  then  to  fear  dementia. 

Imbeciles  and  idiots,  offer  no  temperament,  to  which  we  can  assign  the  cha- 
racter. 

Among  two  hundred  and  sixty-five  insane  persons,  Haslam  found  two  hun- 
dred and  five  whose  hair  was  dark,  and  sixty  who  had  light  hair. 

In  Pennsylvania,  among  seventy  deranged  persons,  a  single  one  had  light 
hair,  and  fifty-six,  blue  or  light  eyes. 

Chesnut  colored  hair  and  eyes,  are  most  frequently  met  with  at  the  Salpe- 
triere,  because  it  is  the  general  color  of  these  parts  in  the  north  of  France. 
More  than  one  tenth  of  the  insane  admitted,  have  either  gray  or  white  hair, 
by  reason  of  their  advanced  age.  Blue  eyes  are  found  in  great  numbers,  in 
comparison  with  black  ones. 


No.  IV. 


External  aspects  of  the  body, 


Stature, 
Eyes,    . 


Hair, 


r  Moderate  fullness,    .     .  122 

<  Lean, 60 

(  Fat, 6 

(  Tall, 102 

}  Short, 19 

f  Chesnut  color  or  brown,  102 

Blue  or  light  color,  .     .  98 

Black, 17 

f  Chesnut  color,     .     .     ,118 

Flaxen, 39 

<(  Gray  or  white,     ...  36 

Black, 31 

(^  Dark  flaxen,    ....  2 


In  general,  those  who  have  black  hair,  who  are  strong,  robust,  and  of  a  san- 
guine temperament,  are  maniacs,  and  furious.  The  course  of  their  insanity 
is  more  acute,  its  crises  more  marked,  than  among  those  composing  the  other 
classes.  Those  whose  hair  is  of  a  flaxen  color,  who  have  blue  eyes,  and  a 
lymphatic  temperament,  become  maniacs  and  monomaniacs ;  but  their  insa- 
nity passes  readily  into  a  chronic  state,  and  degenerates  into  dementia.  Those 
who  have  black  hair  and  eyes,  and  who  are  of  a  dry,  nervous  temperament, 
are  more  frequently  lypemaniacs.  Those  who  have  red  hair,  are  furious,  trai- 
torous and  dangerous. 

6.  Profession,  and  mode  of  life. — Persons  who  devote  themselves  very  per- 
severingly  to  study,  who  abandon  themselves  to  the  vagaries  of  their  imagina- 
tion, who  fatigue  their  intellect,  either  by  a  restless  curiosity,  or  by  turning 
aside  in  obedience  to  theories  and  hypotheses,  or  the  allurements  of  specula- 
tive ideas,  present  a  condition  favorable  to  the  development  of  mental  aliena- 
tion. 

Some,  possess  an  uncontrollable  mental  mobility ;  glance  at  every  thing,  but 
are  incapable  of  thoroughly  investigating  any  thing.  Others,  take  an  interest 
only  in  certain  objects,  and  manifest  an  obstinate  tenacity  for  the  same  medi- 
tations and  conceptions. 


INSANITY.  39 

These  two  classes,  placed  at  opposite  extremes,  stand  upon  the  confines  of 
insanity,  unless  they  constantly  keep  in  check,  those  native  dispositions. 

Dryden  has  said  that  men  of  genius,  and  the  insane,  stand  near  too-ether. 
If  he  meant  by  this,  that  men,  who  possess  very  active  and  disorderly  imagi- 
nations, who  have  great  exaltation  and  mobility  of  ideas,  present  striking  ana- 
logies with  the  insane,  he  spoke  correctly.  But  if  he  meant,  that  great  intellec- 
tual capacity,  occasions  a  predisposition  to  insanity,  he  is  mistaken.  Men  of 
the  greatest  genius,  both  in  the  sciences  and  arts,  the  most  illustrious  poets, 
the  most  skillful  painters,  have  preserved  their  reason,  even  to  extreme  old 
age.  If  we  have  seen  painters,  poets,  musicians,  and  artists  become  insane, 
it  is  because  they  associate,  with  a  very  active  imagination,  great  errors  in  re- 
gimen, to  which  their  organization  exposed  them,  more  than  other  men.  It 
is  not  because  they  exercise  their  minds,  that  they  lose  their  reason  ;  nor  is  it 
the  culture  of  arts  and  letters,  that  we  are  to  accuse.  Men,  who  are  endowed 
with  great  power  of  thought  and  imagination,  have  special  need  of  sensations. 
The  greater  part  of  painters  also,  of  poets  and  musicians,  impelled  by  the  need 
of  emotions,  abandon  themselves  to  numerous  errors  of  reirimen ;  and  it  is 
these,  far  more  than  excessive  study,  which  are  the  true  cause  of  their  insanity. 

In  other  cases,  the  understanding  takes  an  exclusive  direction  ;  and  the 
man  meditates  without  cessation,  upon  subjects  connected  with  metaphysical 
speculations,  and  confines  himself  to  them,  with  a  determination  proportion- 
ate to  the  efforts  that  are  made  to  divert  his  mind.  All  his  physical  and  mo- 
ral faculties  are  absorbed.  He  neglects  the  most  important  personal  atten- 
tions, condemning  himself  to  practices  which  seriously  affect  his  constitution. 

Spasms  of  the  epigastrium,  are  immediately  followed  by  inertia  of  the  nu- 
tritive system,  the  digestion  becomes  deranged,  the  secretions  depraved,  and 
transpiration  is  suppressed.  Hence  hypochondria  and  melancholy  ;  so  famil- 
iar to  educated  men  of  a  meditative  cast  of  mind,  who  grow  pale  from  ex- 
cessive study  by  night  and  day. 

The  danger  is  much  greater,  and  far  more  imminent,  if  the  attention  con- 
centrates itself  upon  religious  ideas.  When  fanaticism  is  the  cause  of  all 
these  disorders,  religious  lypemania  bursts  forth  with  all  its  strangeness  and 
excesses.  It  is  what  was  witnessed  among  the  gymnosophists,  and  what  we 
at  present  observe  among  the  brahmins,  and  faquirs  ;  among  the  methodists 
in  England,  and  the  martinists  in  Germany. 

I  have  seen  many  students  who,  animated  by  the  desire  of  equaling  or  ex- 
celling their  companions,  after  long  continued  study,  became  deranged.  They 
were  almost  all  masturbators. 

I  have  had  charge  of  certain  officers  and  clerks,  who  became  insane  in  con- 
sequence of  exhausting  vigils,  or  the  monotonous  labors  of  the  office  ;  and  I 
ought  to  add,  of  pleasures.  The  same  may  be  said  of  scholars,  musicians  and 
artists,  in  behalf  of  whom  my  advice  has  been  sought.  Thus  excesses,  and 
errors  of  regimen,  ought  to  appear  prominent,  in  the  list  of  causes  of  mental 
alienation. 

The  prevailing  sentiments  of  every  age,  exercise  a  powerful  influence,  over 
both  the  frequency  and  character  of  insanity.  It  would  seem  that  certain  minds, 
impressed  with  new  conceptions,  cannot  divest  themselves  of  them.  The  same 
effect,  which  reflection,  too  long  continued,  produces  upon  individuals,  is  pro- 
duced upon  an  entire  population.  Thus,  historical  monuments  prove,  that  at 
the  birth  of  Christianity,  there  was  much  religious  melancholy. 

The  chivalrous  spirit  which  succeeded  the  crusades,  multiplied  erotic  me- 
lancholy. Civil  and  religious  discords,  excited  by  Calvinism,  caused  a  return 
of  religious  melancholy.  Magic  and  sorcery  have  had  their  turn.  Ideas  of 
liberty  and  reform  have  turned  many  heads  in  France,  and  it  is  remarkable, 
that  those  forms  of  insanity  which  have  appeared  within   the  last  thirty  years, 


40  INSANITY. 

have  been  characterized  by  the  political  convulsions,  that  from  time  to  time 
have  visited  our  country. 

Finally,  it  is  not  discoveries,  nor  is  it  a  new  institution,  which  always  pro- 
duces insanity. 

One  lady  witnesses  a  phantasmagoria,  and  persuades  herself  that  she  is  sur- 
rounded by  phantoms.  Another,  sees  the  pretended  invisible  woman,  and  hence 
believes,  that  by  some  similar  means,  her  lowest  whispers  may  be  heard  at  a 
distance. 

A  young  man  assists  at  certain  experiments  in  physics,  and  thinks  himself 
subjected  to  electrical  action,  which  causes  his  sufferings. 

A  lady  hears  the  subject  of  magnetism  spoken  of,  and  attributes  her  sleep- 
lessness and  unpleasant  feelings,  to  magnetizers 

The  frequency  of  insanity,  is  always  in  relation  with  conditions  in  life, 
which  render  man  more  dependent  upon  social  vicissitudes. 

Hence,  far  from  passing  by  the  palaces  of  kings,  mental  alienation  is  more 
frequent  there,  than  elsewhere. 

Aristotle  asks,  why  distinguished  legislators  are  all  melancholies.  Cour- 
tiers, men  eminent  in  society,  and  the  rich,  are  more  subject  to  this  malady 
than  the  poor.  Military  men,  the  sport  of  capricious  fortune,  merchants,  and 
above  all  reckless  speculators,  and  clerks  whose  existence  depends  upon  the 
will  of  their  principals,  all  run  the  same  hazards. 

TABLE  OF  PROFESSIONS  AND  MODE  OF   LIFE.     No.  V. 
Record  of  the  Salpetriere.  Record  of  my  Estahlishnent. 

Field  laborers 43      Husbandmen  .......  3 

Domestics 51      Soldiers 33 

Seamstresses        85      Mariners 3 

Cooks 16      Merchants 50 

Tradesmen  (with  fixed  residences)  21       Students 25 

Pedlers 16      Administrators  and  clerks       .     .  21 

Shoemakers 8      Engineers       2 

Varnishers 5      Lawyers,  Notaries  and  business 

men 11 

Chemists,  glass  dealers       ...  4 

Physicians 4 

Artists 8 


Total 245          Total 164 

Living  in  families 192         151 

Public  women ,33      Misconduct 6 

Abuse  of  wine 26         3 

Masturbation 10 .  14 

Change  of  condition     ....       3         3 

Misanthropy 3 

Education  (improperly  directed)  20 


o 


Total 264  Total 200 

In  casting  our  eyes  over  this  table,  we  see  that  a  sedentary  life,  such  as  the 
wealthy  lead  in  the  bosom  of  their  families,  and  the  poor  in  their  households 
and  the  exercise  of  their  callings,  is  the  most  common  condition  of  individuals 
who  are  aifected  with  insanity.  Some  travelers  assure  us,  that  idleness  is  the 
cause  of  the  greater  part  of  the  insanity  which  exists  in  Turkey.     Sudden 


INSANITY.  41 

change  of  state,  and  the  transition  from  an  active  life,  to  one  of  repose,  lead 
to  insanity.  This  happens  to  merchants  who,  after  having  acquired  an  hono- 
rable fortune,  retire  from  business.  We  observe  the  same  fact,  among  the 
French  soldiery,  who,  after  a  wandering,  vagabond  life,  passed  amidst  the 
greatest  privations  on  the  one  hand,  and  abundance  on  the  other,  obtain  per- 
mission to  retire.  After  the  year  1815,  I  noticed  the  same  circumstance  also, 
in  the  case  of  several  officers. 

The  desire  for  change  of  place,  the  mania  for  traveling,  the  uneasiness 
which  some  people  experience,  when  they  are  without  occupation,  the  break- 
ing up  of  habits,  leaving  the  heart  and  mind  a  void,  in  the  midst  of  which, 
man  is  tossed  without  the  power  of  being  satisfied,  predispose  to  mental  alien- 
ation ;  whilst  on  the  other  hand,  the  abandonment  of  long  formed  habits,  and 
the  necessity  for  forming  new  ones,  cause  insanity,  and  often  announce  its  im- 
mediate approach.  Occupations,  which  expose  man  to  the  heat  of  the  sun, 
and  to  the  fumes  of  charcoal,  favor  the  development  of  insanity. 

Those  who  are  obliged  to  work  in  the  midst  of  metallic  oxyds,  cooks  and 
miners,  are  liable  to  the  same  attacks. 

The  vapor  of  lead,  produces  in  Scotland  a  species  of  insanity,  in  which  the 
maniacs  lacerate  themselves  at  every  opportunity,  and  which  the  Scotch  pea- 
sants call,  mill-reeck. 

The  miners  of  Peru  and  Mexico,  are  subject  to  a  peculiar  form  of  insanity. 

It  is  pretended  that  dyers,  who  employ  indigo,  are  sad  and  morose. 

The  habit  of  drunkenness,  of  indiscriminate  gallantry,  of  disorderly  con- 
duct, or  an  apathetic  indifference,  are  capable,  says  Pinel,  of  degrading  the 
reason,  and  of  bringing  about,  well  marked  mental  alienation. 

Masturbation,  that  scourge  of  human  kind,  is  more  frequently  than  is  sup- 
posed, the  cause  of  insanity,  especially  among  the  rich. 

It  would  seem  that  this  vice  is  more  fatal  to  men  than  women.  It  is  believ- 
ed to  be  most  rare  among  the  latter.  This  is  an  error  which  is  to  be  attri- 
buted to  the  fact,  that  women  are  more  reserved  with  reference  to  it  than  men. 
If  continence,  in  some  very  rare  cases,  has  caused  mental  alienation,  liberti- 
nism is  a  more  frequent  cause  of  it,  especially  among  common  women. 

One  twentieth  of  the  alienated,  admitted  at  the  Salpetriere  have  been  pros- 
titutes.* 

These  miserable  beings,  cut  off  from  society,  are  in  a  state  of  utter  aban- 
donment. They  know  not  upon  what  to  support  their  wretchedness.  After 
giving  themselves  up  to  every  kind  of  excess,  they  generally  sink  into  the  most 
profound  misery,  and  as  a  consequence,  into  dementia  of  a  paralytic  form. 

We  shall  see  besides,  that  the  abuse  of  alcoholic  liquors,  and  the  amorous 
excesses  of  some  individuals,  are  not  always  the  cause,  but  sometimes  the 
first  symptoms  of  insanity. 

The  abuse  of  wine,  liquors,  and  aromatic  infusions  of  opium,  produce  a 
great  amount  of  insanity.  This  cause  ought  to  be  regarded  as  producing  half 
the  cases  of  insanity  that  occur  in  England.  In  Peimsyivania,  according  to 
Rush,  it  is  a  very  frequent  cause.  In  France  it  is  not  rare,  as  any  one  may 
convince  himself  by  observing  the  insane  of  the  Bicetre,  and  of  Charenton. 

In  my  own  establishment,  among  three  hundred  and  thirty  patients,  I  have 
seen  but  three,  who  had  given  themselves  up  to  the  excessive  use  of  wine,  and 
liquors ;  and  I  believe  that  one  of  them  used  it  to  excess,  only  after  becoming 
insane. 

The  abuse  of  wine  and  brandy,  conduct  either  to  suicide  or  dementia.  Is 
not  this  the  cause  of  so  many  suicides  in  England  ? 

The  consideration  of  professions,  and  modes  of  life,  leads  us  to  the  study  of 

*  Vide  Parent-Duchatelet :  Concerning  Prostitution  in  the  city  of  Paris,  etc.,  Paris, 
1836,  t.  I.  p.  262. 

6 


42  INSANITY. 

morals,  relative  to  mental  alienation  ;  which,  of  all  maladies,  is  that  whose  de- 
pendence upon  public  and  private  morals,  is  most  manifest. 

Humboldt  states,  that  he  saw  little  insanity  among  the   savages  of  America. 

M.  Carr  in  his  Ete  du  Nord,  states  that  it  is  rarely  met  with  in  Russia,  ex- 
cept in  the  large  cities.  In  France,  there  is  less  insanity  in  the  country,  than 
in  cities. 

The  countrymen  are  more  apt  to  contract  religious,  or  erotic  insanity. 
Among  them,  insanity  is  caused  by  the  simple  passions,  love,  anger,  and  do- 
mestic chagrin  ;  whilst  in  cities,  it  is  produced  by  wounded  self-love,  disap- 
pointed ambition,  reverses  of  fortune,  etc. 

The  less  depraved  morals  of  the  Anglo-Americans,  are  one  of  the  causes, 
in  consequence  of  which  there  is  less  insanity  among  them  than  elsewhere ; 
as  the  reports  of  travelers  prove,  not  less  than  the  records  of  their  own  hos- 
pitals. 

In  England,  where  we  find  united  all  the  caprices,  as  well  as  the  excesses 
of  civilization,  insanity  is  more  Irequent  than  any  where  else.  Unsuitable 
marriages  ;  those  contracted  by  parents,  and  above  all,  alliances  formed  with 
families  where  there  is  an  hereditary  predisposition  to  insanity,  the  hazards  of 
remote  speculations,  the  indolence  of  the  rich,  and  the  habitual  use  of  alco- 
holic drinks,  are  the  causes  which  multiply  insanity  in  England.  "  Every 
thing  degenerates  in  the  hands  of  man,"  said  J.  J.  Rousseau.  Without  doubt, 
civilization  occasions  diseases,  and  augments  the  number  of  the  sick,  because, 
by  multiplying  the  means  of  enjoyment,  it  causes  some  to  live  too  well,  and 
too  fast.  But  the  more  perfect  civilization  becomes,  and  the  more  the  life  of 
the  common  people  is  ameliorated,  the  greater  will  be  its  medium  duration. 
Moreover,  it  is  not  civilization  that  we  are  to  accuse,  but  the  errors  and  e.x- 
cesses  of  all  sorts,  which  it  enables  us  to  commit. 

The  morals  of  the  Italians,  render  religious  melancholy  and  erotomania, 
very  frequent  in  Italy. 

The  ignorance  of  the  middle  ages,  caused  demonomania  and  vampirism  to 
multiply,  and  they  are  now  reunited  in  the  extreme  north  of  Europe,  as  well 
as  in  other  countries  which  civilization  has  not  illuminated  with  its  light,  nor 
enriched  by  its  benefits. 

For  thirty  years,  the  changes  that  have  been  going  on  in  our  morals  in 
France,  have  produced  more  insanity  than  our  political  troubles.  We  have 
exchanged  our  ancient  usages  and  opinions,  for  speculative  ideas,  and  dange- 
rous innovations. 

Religion  comes  in  only  as  a  usage  in  the  most  solemn  acts  of  life, — it  no 
longer  brings  consolation  and  hope  to  the  unfortunate.  Religious  morality  no 
lonorer  guides  the  reason,  in  the  straight  and  difficult  paths  of  life  : — A  cold 
egotism  has  dried  up  all  the  sources  of  sentiment.  There  is  no  more  domes- 
tic affection,  nor  respect,  nor  love,  nor  authority,  nor  reciprocal  dependencies. 
Each  lives  for  himself;  no  one  forming  those  wise  combinations,  which  con- 
nect the  present,  with  coming  generations. 

The  ties  of  marriage  are  mere  pretences,  which  are  formed  by  the  wealthy, 
either  as  a  speculation,  or  to  gratify  their  self-love  ;  and  which  the  common 
people  neglect,  through  disdain  for  the  clergy,  indifference  and  libertinism. 
These  deplorable  facts,  have  prevented  me  from  taking  an  account  of  the  mar- 
riage state,  of  celibacy,  or  widowhood,  among  women  who  enter  our  hospital, 
and  consequently,  from  being  able  to  appreciate,  among  them,  the  influence  of 
marriage  in  the  production  of  mental  alienation. 

About  one  fourth  of  the  persons  admitted  into  my  establishment  were  ba- 
chelors y  twenty-six  only,  were  widowers.  Having  been  concerned  in  the 
treatment  of  many  soldiers,  as  well  as  students,  this  proportion  of  single  men, 
of  the  higher  class,  will  not  be  surprising. 


INSANITY.  43 

The  change  in  our  morals,  will  be  felt  longer,  in  proportion  as  our  educa- 
tion is  more  defective. 

We  take  great  care  to  form  the  mind,  but  seem  to  forget  that  the  heart,  like 
the  mind,  has  need  of  education. 

The  ridiculous  and  deplorable  tenderness  of  parents,  subjects  to  the  caprices 
of  infancy,  the  reason  of  mature  age. 

Each  gives  to  his  son  an  education  superior  to  that  which  is  suited  to  his 
social  position  and  fortune  ;  so  that  children,  despising  the  knowledge  of  their 
parents,  disdain  the  reproofs  of  their  experience. 

Accustomed  to  follow  all  his  inclinations,  and  not  being  habituated  by  dis- 
cipline, to  contradiction,  the  child,  having  arrived  at  maturity,  cannot  resist 
the  vicissitudes  and  reverses,  by  which  life  is  agitated.  On  the  least  adversity, 
insanity  bursts  forth  ;  his  feeble  reason  being  deprived  of  its  support,  while  the 
passions  cire  without  rein,  or  any  kind  of  restraint. 

When  we  add  to  these  causes,  the  manner  of  life  of  the  women  in  France, 
the  insatiable  relish  which  they  have,  for  romances  and  the  toilette,  for  frivo- 
lities, etc.,  together  with  the  misery  and  privations  of  the  lower  classes,  we 
shall  no  longer  be  astonished  at  the  disorder  of  public  and  private  morals,  nor 
any  longer  have  a  right  to  complain,  if  nervous  disorders,  and  particularly  in- 
sanity, multiply  in  France ;  so  true  is  it,  that  whatever  relates  to  the  moral 
well-being  of  man,  has  always  a  most  intimate  connection  with  his  physical 
well-being  and  the  preservation  of  his  health. 

We  believe  also  with  Pinel,  that  an  undue  severity, — that  reproaches  for  the 
slightest  faults,  that  harshness  exercised  with  passion,  that  threats  and  blows, 
exasperate  children,  irritate  youth,  destroy  the  influence  of  parents,  produce 
perverse  inclinations,  and  even  insanity  ;  especially,  if  this  severity  is  the  re- 
sult of  the  caprices  and  immorality  of  fathers. 

This  system  of  severity,  is  less  to  be  feared  at  this  day,  than  that  of  which 
we  have  spoken  above,  particularly  among  those  in  easy  circumstances,  and 
the  wealthy. 

The  depravations  of  both  minds  and  morals,  which  are  effected  by  the  vices 
of  our  education,  by  disdain  for  religious  beliefs,  and  by  the  faultiness  of  pub- 
lic morals,  exercises  its  influence,  upon  all  classes  of  society. 

But  how  happens  it,  that  we  never  cease  to  declaim  against  the  higher  class, 
and  to  extol  the  virtues  of  the  people  ? 

These  philosophical  decl aimers,  lived  with  the  great  whom  they  calumniat- 
ed, and  knew  not  the  people.  If  they  had  studied  the  morals  of  their  coun- 
try, they  would  have  been  convinced,  that  the  corruption  is  most  general, 
greatest,  most  hideous,  among  the  lower  class ;  that  it  gives  birth  to  almost  all 
the  evils  of  society  ;  that  it  produces  much  insanity,  and  at  the  same  time 
much  more  of  crime  than  in  the  higher  classes. 

The  vices  of  education  in  the  higher  classes,  and  the  want  of  it  in  the  low- 
er,  explain  these  differences.  Education,  supplies  the  place  of  morals  among 
the  former  ;   while  no  motive  suspends  the  arm  of  the  mob. 

If  the  form  of  government  influences  the  passions  and  morals  of  nations, 
we  must  not  be  surprised,  that  it  exercises  some  influence,  on  the  production 
and  character  of  insanity. 

Scott,  the  companion  of  Lord  Macarthney,  saw  but  very  few  insane  persons 
in  China. 

All  travelers  assure  us,  that  there  are  less  than  elsewhere,  in  Turkey,  Spain 
and  Mexico. 

It  is,  say  the  English,  because  those  countries  groan  under  a  des]x>tism, 
which  stifles  the  intellect,  and  represses  the  passions. 

On  the  other  hand,  a  republican  or  representative  government,  in  giving 
more  play  to  all  the  passions,  ought,  other  things  being  equal,  to  be  more  fa- 
vorable to  the  production  of  insanity. 


44  INSANITY. 

The  laws  which  confiscated  the  property  of  the  condemned,  under  the  Ro- 
man Emperors,  multiplied  suicides.  It  was  the  same  in  France,  during  the 
reign  of  terror. 

A  notary  of  Paris,  enquires  of  one  of  his  friends,  if  the  father  of  a  family, 
by  taking  his  own  life,  would  preserve  his  fortune  for  his  wife  and  children. 
On  receiving  an  affirmative  reply,  he  drowned  himself 

A  military  government  which  inspires  contempt  for  life,  multiplies  suicides, 
because  the  people  attach  a  greater  value  to  some  other  good  ;  being  ready, 
every  day,  to  sacrifice  themselves  to  their  ambition. 

The  law  of  conscription  increased  insanity  in  France,  and  at  each  period  of 
departure,  we  observed  an  increase  of  insanity,  either  because  the  conscripts 
themselves  became  insane,  or  their  parents  or  friends. 

Political  commotions,  by  arousing  to  greater  activity  all  the  intellectual 
faculties,  by  rendering  more  intense,  the  depressing  and  vindictive  passions, 
fomenting  the  spirit  of  ambition  and  revenge,  overturning  public  and  private 
fortunes,  and  changing  the  circumstances  of  all  men,  produce  a  vast  amount 
of  insanity. 

This  is  what  took  place  in  Peru  after  its  conquest  by  the  Europeans  ;  also 
in  England,  more  than  a  century  since.  The  same  occurred  in  America  after 
the  war  of  independence,  and  in  France  during  our  revolutions,  with  this  dif- 
ference between  us  and  the  English,  that  in  England,  according  to  Mead,  it 
was  those,  who  had  recently  acquired  fortunes,  that  became  insane,  whilst  in 
France  almost  all  who  had  escaped  the  sythe  of  the  revolution  were  seized 
with  mental  alienation. 

The  influence  of  our  political  misfortunes  has  been  so  great,  that  I  could 
give  the  history  of  our  revolution  from  the  taking  of  the  Bastile  to  the  last 
appearance  of  Bonaparte,  from  that  of  certain  insane  persons,  whose  insanity 
connects  itself  with  the  events  which  have  signalized  this  long  period  of  our 
history.* 

Here  the  question,  so  often  propounded  for  forty  years,  presents  itself;  Is 
there  now  more  insanity  than  existed  previous  to  the  revolution  ?  I  am  going 
to  hazard  my  opinion  with  respect  to  it. 

Political  commotions,  like  prevailing  ideas,  are  not  the  predisposing,  but  the 
exciting  causes  of  insanity.  They  call  into  action  this  or  that  cause,  and  im- 
press this  or  that  character  upon  the  insanity  ;  but  this  influence  although 
general,  is  momentary. 

At  the  destruction  of  the  ancient  monarchy,  many  individuals  became  in- 
sane, through  fear,  and  the  loss  of  fortune. 

When  the  pope  visited  France,  the  religious  forms  of  insanity  were  more 
numerous.  When  Bonaparte  made  kings,  there  were  many  Q,ueens  and  Kings 
in  Houses  for  the  Insane. 

At  the  epoch  of  the  invasions  of  France,  terror  produced  much  insanity, 
particularly  in  the  country.  The  Germans  had  made  the  same  observations, 
at  the  time  of  our  irruptions  into  their  country.  The  individual,  who  now 
becomes  insane  by  the  loss  of  his  fortune  and  rank,  would  have  become  so 
fifty  years  before,  in  consequence  of  the  loss  of  his  fortune  at  sea,  or  after  a 
disgrace  at  court :  that,  whom  the  terrors  of  the  revolution  rendered  insane, 
would  have  become  so,  two  centuries  ago,  through  fear  of  sorcerers  and  the 
devil. 

But  why  do  we  see  so  many,  insane  at  the  present  day  ?  Why  has  their 
number  doubled  at  Paris  within  thirty  years  1  Why  in  1786,  were  there  at 
Parte,  but  one  thousand  and  nine  insane  persons,  whilst  in  1813,  there  were 

*  I  could  conthiiie  this  comparative  history  even  to  our  own  time.  A  magistrate  be- 
lieved himself  accused  of  the  wicked  attempt  of  Fieschi,  and  two  young  men  believed 
themselves  the  accomplices  of  Alibaud. 


INSANITY.  45 

two  thousand  ;  and  about  four  thousand  in  1836  ?  We  must  conclude  from 
this  progressive  augmentation  of  the  insane  at  Paris,  that  their  number  must 
have  doubled  elsewhere.  It  has  doubled  and  indeed  tripled  at  Paris,  because, 
since  the  impulse  given  by  Pinel,  they  have  multiplied  the  means  of  relief  at 
the  capital ;  the  asylums  open  to  the  insane  are  increased  in  size,  and  improv- 
ed in  their  condition  ;  the  physicians  devote  themselves  to  this  service  more 
especially  ;  better  care  is  taken  of  the  sick,  and  a  greater  number  are  cured. 
We  speak  of  them  with  more  interest  and  hope ;  they  are  more  in  evidence ; 
and  their  life  is  prolonged.  From  a  record  kept  for  ten  years  at  the  Salpetri- 
ere,  it  is  shown  that  one  third  of  the  women,  admitted  into  the  class  of  the 
insane  of  this  hospital,  are  very  aged,  paralytic,  and  in  senile  dementia.  The 
same  is  true  at  Charenton  and  at  the  Bicetre.  These  intirm  patients  would 
have  remained  formerly,  in  their  families  ;  but  the  hope  of  a  cure,  causes 
them  to  be  brought,  at  this  day,  into  establishments  where  they  are  submitted 
to  remedial  treatment. 

People  avail  themselves  of  an  easy  means  of  relieving  themselves  from  the 
burthen  of  their  support. 

This  fact,  furnishes  the  reason  for  the  frightful  increase  of  the  inmates  of 
the  hospitals  of  France  ;  where  they  receive  as  insane,  all  those  individuals 
who  are  presented,  with  no  other  condition,  than  that  they  are  in  a  state  of 
delirium. 

In  those  cities  where  they  have  augmented  the  size,  and  improved  that  por- 
tion of  their  hospitals  devoted  to  the  insane,  as  at  Limoges,  Orleans,  Tou- 
louse, etc.,  in  cities  where  they  have  erected  establishments,  especially  design- 
ed for  this  class,  as  at  Bordeaux,  Rouen,  Caen,  Nantes,  Lyons,  Mans,  etc.,  the 
number  of  the  insane  has  wonderfully  increased. 

It  is  remarkable,  that  this  increase  has  no  where  taken  place,  except  where 
the  erection  of  buildings,  and  improvements  in  their  treatment  have  begun. 

Formerly,  the  insane  were  admitted  into  certain  convents  and  religious 
houses,  where  they  were  subjected  to  the  supervision  of  the  police.* 

From  all  these  considerations,  we  may  conclude,  that  if  the  number  of  the 
insane  has  increased  since  the  revolution,  this  augmentation  is  more  apparent 
than  real ;  that  it  is  far  less  considerable  than  we  are  accustomed  to  suppose  ; 
that  this  increase  is  less  due  to  the  storms  of  the  revolution,  which  were  tran- 
sient, than  to  the  profound  change  which  it  has  effected  in  our  morals,  whose 
influence  is  more  durable.  Let  us  not  seek,  by  exaggerating  them,  to  thicken 
the  evils  which,  for  so  many  years  have  weighed  down  our  unhappy  country. 

7.  Passions. — During  the  last  century,  we  gave  great  importance  to  the 
study  of  the  intellectual  and  moral  man.  Cabanis,  embellished  his  researches 
with  the  most  seductive  diction,  and  reduced  almost  to  a  demonstration,  the 
reciprocal  influence  of  the  moral  upon  the  physical. 

Crichton  has  made  a  more  direct  application  of  the  study  of  the  passions, 
to  the  causes  of  mental  alienation.  Pinel,  in  the  second  edition  of  the  Trea- 
tise on  Gladness,  has  adopted  the  division  of  the  passions  proposed  by  Moreau 
de  la  Sarthe.     This  division,  is  based  upon  pathological  views. 

Thus  Moreau  and  Pinel  regard  the  passions  as  spasmodic  agents,  debilitat- 
ing or  exciting,  which  produce  insanity. 

Is  this  division,  which  ought  to  be  especially  agreeable  to  physicians,  of 
general  application  in  the  study  of  mental  alienation  ? 

In  my  Dissertation  on  the  passions,  considered  as  causes,  symptoms  and  cu- 
rative means  of  mental  alienation,  I  have  principally  considered  them^  ant  the 
most  essential  symptoms,  and  the  most  powerful  therapeutic  agents  in  insanity 

The  first  wants  of  man,  limiting  themselves  to  those  connected  with   his 

*  I  discussed  this  question  in  a  memoir,  entitled,  ^^  Are  there  more  insane  persons  now 
than  formerly"  ? 


46  INSANITY. 

preservation  and  reproduction,  provoke  the  determinations  of  instinct ;  an  in- 
ternal impulse  leads  us  to  gratify  them. 

The  secondary  wants,  attach  themselves  to  the  first,  and  the  desires  which 
they  excite,  acquire  as  much  more  energy,  as  we  have  means  of  satisfying 
them.  They  produce  the  primitive  passions  ;  in  fine,  they  are  the  wants 
which  are  connected  with  our  preservation  ;  and  are  the  fruit  of  our  increas- 
ed intelligence  and  civilization.  They  engender  the  factitious  passions, — 
those  passitms  which  cause  the  greatest  injury  to  man,  especially  in  the  higher 
walks  of  life. 

Infancy,  exempt  from  the  influence  of  the  passions,  is  almost  a  stranger  to 
insanity  ;  but  at  the  epoch  of  puberty,  the  sentiments,  unknown  until  this  pe- 
riod, cause  new  wants  to  arise.  Insanity  then  appears,  to  trouble  the  first  mo- 
ments of  the  moral  existence  of  man. 

At  mature  age,  the  relations  become  extended,  social  wants  multiply,  and 
the  passions  take  a  new  character.  In  proportion  as  the  amorous  passions  be- 
come enfeebled,  those  of  a  factitious  nature  grow  strong.  Personal  interest, 
ambition,  love  of  distinction,  and  avarice,  replace  the  charms  of  love  and  de- 
lights of  paternity. 

At  this  period  of  life  also,  mental  alienation  appears  ;  insanity  is  more  ob- 
stinate, and  more  concentrated.  It  passes  more  readily  into  a  chronic  state  ; 
and  is  more  dependent  upon  abdominal  lesions. 

A  sense  of  his  weakness,  renders  the  old  man  more  calm  ;  and  while  medi- 
tating upon  the  errors  to  which  the  passions  lead,  he  isolates  himself,  and  be- 
comes an  egotist. 

Insanity  from  a  moral  cause,  rarely  exists  with  him,  and  when  he  loses  his 
reason,  it  is  because  his  organs  are  fatigued  and  exhausted.  Hence,  it  is  nei- 
ther mania  nor  monomania  which  is  developed,  at  this  period,  but  senile  de- 
mentia. 

Of  all  moral  causes,  those  which  most  frequently  produce  insanity,  are 
pride,  fear,  fright,  ambition,  reverses  of  fortune,  and  domestic  trouble.  This 
last  should  have  been  placed,  relative  to  its  great  influence,  at  the  head  of 
moral  causes,  if  it  be  limited  to  a  simple  idea ;  but  by  domestic  troubles,  I 
express  all  the  pains,  all  the  griefs,  all  oppositions,  misfortunes  and  dissen- 
sions, that  grow  out  of  the  family  state. 

One  can  scarcely  imagine  how  strongly  this  cause  operates  upon  the  minds 
of  the  people,  especially  females.  Forgetful  of  all  principle,  habits  of  immo- 
rality the  most  vile,  and  often  the  most  criminal,  render  prostitutes  the  victims 
of  the  most  ferocious  brutality. 

The  gay  and  enlivening  emotions,  are  rarely  the  cause  of  this  malady.  It 
is  singular,  that  the  excess  of  joy  which  destroys  life,  never  takes  away  the 
reason,  while  anxiety  and  chagrin  so  often  cause  its  loss.  Some  authors  how- 
ever, are  of  the  opinion,  that  this  class  of  emotions  have  caused  insanity. 

Mead  assures  us,  that  fortunes  rapidly  acquired,  produce  insanity  in  Eng- 
land. 

But  are  they  not  seized  with  this  disorder,  in  consequence  of  laying  aside 
their  former  habits,  of  living  in  idleness,  of  committing  every  variety  of  error 
in  regimen,  and  because  their  newly  acquired  wealth,  being  the  fruit  of  spoli- 
ations and  intrigues,  fills  them  with  disquietude,  not  being  in  the  habit  of  en- 
joying it. 

In  examining  with  care,  the  causes  of  certain  cases  of  insanity  which  have 
been  attributed  to  joy,  I  have  assured  myself  that  it  was  a  mistake. 

A  minister  informs  his  relative  of  his  nomination  to  an  important  place. 
The  latter,  stricken  as  with  a  blow  at  the  epigastrium,  falls  suddenly  into  hypo- 
chondriacal lypemania.  Joy  had  no  effect  in  bringing  about  this  malady,  as 
was  universally  supposed,  but  rather  despair  at  quitting  a  mistress. 

A  young  man  gains  a  prize  in  a  lottery  ;  some  days  after  he  is  seized  with 


INSANITY.  47 

insanity  ;  it  is  reported  that  excessive  joy  has  produced  this  affectino-  result. 
It  is  not  joy,  however,  but  the  fear  of  being  robbed,  and  losinor  his  treasure 

One  of  the  moral  causes  pointed  out  by  Pinel,  and  which  is  frequently  met 
with  in  practice,  is  the  conflict  which  arises  between  the  principles  of  religion, 
morality,  education  and  the  passions. 

This  internal  wrestling,  continues  for  an  indefinite  period  of  time,  and  ends 
by  producing  insanity,  and  even  characterizing  certain  forms  of  lypemania. 

Religious  fanaticism  which  caused  so  much  insanity  formerly,  has  now 
lost  all  its  influence,  and  very  rarely  produces  this  disorder. 

Among  more  than  six  hundred  insane  persons,  eight  only  became  so  in  con- 
sequence of  religious  terrors. 

I  have  never  known  insanity  to  be  produced  by  ascetic  exaggeration  but 
in  a  single  instance,  among  3:37  individuals  admitted  into  my  establishment. 
Love,  which  so  often  causes  erotomania,  and  even  nymphomania  in  warm 
countries,  has  lost  its  empire  in  France.  Indifference  has  taken  possession  of 
the  mind,  and  the  amorous  passions,  have  neither  the  exaltation  nor  the  purity, 
which  would  engender  erotic  insanity. 

Moral  causes  act  sometimes  individually  :  at  others,  several  combine  to 
overthrow  the  same  individual.  A  young  man  is  stricken  with  mania.  The 
conscription  has  just  taken  from  him  both  his  place  and  liberty. 

A  young  man  pays  his  addresses  to  a  lady  whose  parents  refuse  to  permit 
their  union.  He  is  sorrowful  and  dejected.  Some  months  after,  on  beino- 
informed  that  she  whom  he  adores,  is  married,  he  betakes  himself  to  the 
place  where  the  nuptials  are  celebrated,  and  there  blows  out  his  brains. 

A  young  lady  is  married  in  obedience  to  the  wishes  of  her  parents.  She  ap- 
peared happy,  though  often  sad.  A  year  after,  her  husband  is  ruined.  She 
supports  this  new  trial,  but  loses  her  reason,  on  learning  that  he  is  unfaithful 
also. 

Moral  causes  unite  ordinarily  with  physical,  particularly  among  women. 

A  young  person  during  the  catamenial  effcirt,  is  frightened  by  a  sudden  clap 
of  thunder,  and  her  menses  are  suppressed.  She  becomes  insane,  and  reason 
is  established  only  after  the  restoration  of  this  accustomed  discharge. 

A  young  woman  is  confined  happily.  On  the  seventh  day,  her  father  re- 
proaches her  violently,  and  unexpectedly.  Both  the  lochia  and  milk  are  sup- 
pressed. The  lady  becomes  a  maniac,  and  falls  into  a  state  of  dementia  after 
a  month  of  intense  excitement,  and  is  cured  at  the  end  of  six  months. 

This  combination  of  physical  and  moral  causes,  is  much  more  frequent  in 
the  production  of  insanity,  than  the  isolated  action  of  either  of  them. 

TABLE  OF  MORAL  CAUSES.     No.  VI. 
Salpetrierc  during  the  years  1811  and  1813.  My  Establishment. 

-  :il 

-  31 
1 
8 

14 

0 

7     Reverses  of  fortune    14 

-  16 
12 

-  13 
-            -  2 

Total      -  -     167 


Domestic  troubles 

-     105 

Disappointed  aifection 

46 

Political  events 

-       14 

Fanaticism         -             -             _ 

8 

Fright         ... 

-      38 

Jealousy             -             .             . 

18 

Anger         -             .             - 

-       16 

Misery,  and  reverses  of  fortune 

i  1 

Wounded  self-love 

1 

Disappointed  ambition 

0 

Excessive  study 

0 

Misanthropy 

0 

Total 

-    323 

48  INSANITY. 

Moral  causes  are  much  more  frequent  than  physical  A  comparison  of  the 
record  of  moral  causes,  kept  at  my  establishment  and  at  the  Salpetriere, 
proves  this,  and  the  reports  which  I  have  since  made  at  the  same  hospital,  and 
at  Charenton,  confirm  it. 

The  Memoir,  read  by  Pinel  at  the  Institute,  in  1807,  also  demonstrates  the 
same  fact. 

A  report,  made  in  Pennsylvania  in  1812,  gives  the  same  result,  since  among 
fifty  insane  persons  from  whom  their  account  was  made  up,  thirty-four  had 
become  so,  as   a  result  of  moral   affections,  and  sixteen  from  physical  causes. 

Experience  has  demonstrated  the  same  thing  to  Mr.  Tuke,  founder  and  di- 
rector of  the  Retreat  near  York  ;  and  in  fine,  the  same  has  been  every  where 
observed,  because  man  is  every  where  the  same. 

In  comparing  the  two  reports,  relative  to  fortune  and  rank  in  society,  we 
may  conclude,  that  moral  causes  are  more  numerous  among  the  rich,  since 
the  first  column  embraces  six  hundred  insane  poor,  and  the  second  three  hun- 
dred and  thirty-seven. 

Physical  causes  act  more  frequently  upon  women  than  men ;  and  we  shall 
readily  perceive  that  this  must  be  so,  if  we  call  to  mind  the  numerous  acci- 
dents to  which  women  are  liable,  during  the  period  of  menstruation,  pregna- 
cy  and  lactation.  These  causes  produce  a  powerful  influence  upon  the  lower 
classes.     The  form  of  insanity  which  they  produce,   is  ordinarily  dementia. 

In  like  manner,  there  exist  certain  atmospheric  conditions,  which,  at  some 
seasons,  render  maladies  epidemic  or  contagious.  In  minds  also,  there  exist 
certain  general  dispositions,  which  cause  mental  alienation  to  extend,  and 
communicate  itself  to  a  great   many  individuals,  by  a  sort  of  moral  contagion. 

It  is  what  we  have  observed  at  all  times,  and  in  all  countries.  The  example 
of  the  daughter  of  Proetus  was  contagious.  The  women  of  Lyons  fell  into 
suicidal  lypemania,  in  imitation  one  of  another. 

Demoniacal  possessions,  which  have  afflicted  different  countries  of  Europe, 
even  to  the  commencement  of  the  last  century,  establish  in  a  satisfactory  man- 
ner, the  existence  of  this  influence,  which  besides,  allies  itself  to  all  the  phe- 
nomena of  sensibility.  Examples  will  multiply,  when  I  speak  of  monomania 
and  suicide. 

The  causes  of  which  we  have  spoken  heretofore,  and  which  we  may  call 
general,  differ  from  the  following,  in  this  respect,  that  the  latter  are  more  in- 
dividual. They  act  more  immediately  upon  the  organism.  Their  action  is 
more  appreciable,  and  can,  to  a  certain  extent  be  prevented.  The  means  pro- 
per to  combat  their  results,  ought  to  be  added  to  the  list  of  pharmaceutic 
agents. 

Such  are  the  causes,  which  we  have  called  more  particularly  physical,  while 
the  preceding  have  been  hygienic,  intellectual  or  moral. 


11 

- 

4 

-  11 

- 

. 

2 

55 

- 

19 

-   52 

- 

. 

21 

27 

- 

11 

-   60 

. 

. 

4 

12 

- 

4 

-   14 

- 

. 

4 

13 

- 

12 

8 

- 

- 

1 

14 

- 

18 

-   24 

- 

. 

4 

60 

- 

10 

-  466 

Total      - 

264 

INSANITY.  49 

PHYSICAL  CAUSES.     No.  VII. 

Salpetrierc.  My  KstabUshmcnt. 

Hereditary  -  -  -     105       -  -  -       150 

Convulsions  of  the  mother  during 

testation       ... 
Epilepsy 

Menstrual  disorder 
Results  of  confinement 
Critical  period 
Progress  of  age 

Insolation         ... 
Blows  or  falls  upon  the  head 
Fevers  ... 

Syphilis 

Mercury  -  -  . 

Intestinal  worms 
Apoplexy  ... 

Total 

Hereditary  predisposition  is  the  most  common,  among  the  remote  causes  of 
insanity,  particularly  among  the  rich ;  and  is  in  the  proportion  of  one  sixteenth 
among  the  poor.  I  believe,  nevertheless,  that  the  proportion  is  greater,  even 
amoncr  the  latter. 

If,  from  my  records  of  the  Salpetriere,  this  cause  appears  feeble,  it  is  in 
consequence  of  the  difficulty  which  attends  the  making  up' of  correct  returns, 
among  women  who  are  often  ignorant,  even  of  the  name  of  their  parents. 
Mason  Cox  attributes  great  influence  to  this  predisposition.  Little  however, 
is  accorded  to  it  in  Pennsylvania,  by  Rush. 

It  is  rxsmarkable  in  England,  especially  among  the  Catholics,  who  always 
ally  themselves  in  marriage,  with  those  of  their  own  denomination.  The 
same  may  be  said  of  the  great  lords  of  France,  who  are  almost  all  parents. 
What  a  lesson  for  fathers,  who  in  the  marriage  of  their  children,  consult  ra- 
ther their  ambition,  than  the  health  of  their  descendants. 

Insanity  is  rather  transmissible  by  mothers,  than  fathers.* 

Children  who  are  born  before  their  parents  have  become  insane,  are  less 
liable  to  mental  alienation,  than  those  whose  births  take  place  afterwards. 

The  same  is  true  of  those  who  are  born  of  parents,  who  are  insane  only 
upon  the  paternal  or  maternal  side,  compared  with  those,  both  of  whose  pa- 
rents are  insane,  or  who  have  progenitors  on  both  sides  in  this  condition. 

Burton  assures  us,  that  those  begotten  of  aged  parents,  are  predisposed  to 
melancholy. 

This  fatal  inheritance  is  pictured  upon  the  physiognomy,  and  external 
forms ;  as  well  as  the  ideas,  passions,  habits  and  inclinations  of  those  who  are 
destined  to  become  the  victims  to  it.  Attracted  by  some  one  of  these  signs, 
I  have  sometimes  foretold  an  attack  of  insanity,  many  years  before  it  made  its 
appearance. 

Hereditary  mania  manifests  itself  among  parents  and  children,  often  at  the 
same  period  of  life.  It  is  provoked  by  the  same  causes,  and  assumes  the  same 
character. 

A  Swiss  merchant  saw  his  two  sons  die  insane,  at  the  age  of  nineteen  years. 

*  I  have  in  charge  at  the  present  time,  many  children  whose  parents  were  under  my 
care,  during  the  first  years  of  my  medical  practice. 

7 


50  INSANITY. 

A  lady  became  insane  at  twenty-five  years  of  age,  after  confinement.  Her 
daucrhter  becomes  so,  at  the  same  age,  and  from  the  same  cause.  In  the 
same  family,  both  father,  son  and  grandson,  commit  suicide  at  about  the  fif- 
tieth year  of  their  ages  respectively. 

We  have  had  at  the  Salpetriere  a  prostitute,  who  has  thrice  thrown  herself 
into  the  river  after  her  frantic  revels.  Her  sister  drowned  herself  in  a  state 
of  intoxication.  There  lives  in  the  environs  of  Nantes,  a  family  of  whom 
seven  brothers  and  sisters  are  in  a  state  of  dementia.  A  gentleman,  shocked 
at  the  earlier  events  of  the  revolution,  remains  during  ten  years,  shut  up  in 
his  apartment.  His  daughter  at  about  the  same  age,  falls  into  a  similar  state, 
and  refuses  to  leave  her  apartment. 

This  predisposition,  which  manifests  itself  by  the  external  conformation,  by 
the  moral  and  intellectual  character  of  individuals,  is  not  more  surprising  with 
reference  to  insanity,  than  to  gout,  phthisis  pulmonalis,  etc.  It  is  noticeable, 
even  from  infancy.  It  will  explain  a  multitude  of  whims,  irregularities,  and 
anomalies  of  character,  which  should  betimes,  have  put  the  parents  on  their 
guard. 

It  may  prove  a  useful  hint,  to  those  who  preside  over  the  education  of  chil- 
dren born  of  insane  parents.  It  will  be  proper  to  give  to  these  children  a  pe- 
culiar education,  to  exercise  them  much  in  gymnastics,  to  inure  them  to  ex- 
ternal impressions  ;  in  fine,  to  place  them  in  a  condition  different  from  that  of 
the  authors  of  their  being,  according  to  the  precept  of  Hippocrates  ;  who  re- 
commends that  the  constitution  of  the  individual  should  be  changed,  to  pre- 
vent those  maladies,  to  which,  by  hereditary  descent,  it  is  liable. 

What  has  been  said  with  respect  to  physical  education,  I  would  also  say 
with  respect  to  the  moral  and  intellectual.  We  must  be  on  our  guard,  against 
whatever  may  unduly  excite  the  brain. 

Sometimes  it  is  to  the  maternal  womb,  that  we  are  to  look  for  the  first  cause 
of  insanity  ;  not  only  idiocy,  but  the  other  forms  of  mental  alienation.  I 
know  not  why  this  circumstance  has  escaped  the  notice  of  observers. 

At  others,  it  is  during  the  period  of  nursing,  or  the  first  dentition,  that  the 
elements  of  the  malady  take  root  in  the  system,  which  is  at  a  later  period  to 
appear.  According  to  Van  Swieten,  almost  all  the  insane  have  had  convul- 
sions during  their  infancy.  I  have,  however,  observed  several  insane  young 
persons,  who,  during  their  infancy,  and  at  puberty,  had  escaped  cerebral 
fevers. 

Sometimes,  strong  impressions,  received  in  early  life,  are  also  the  remote 
cause  of  insanity.  Many  women,  who  were  pregnant  at  various  periods  of 
the  revolution,  have  become  the  mothers  of  children,  whom  the  slightest  cause 
has  rendered  insane.  A  female  of  the  lower  orders  is  pregnant ;  and  her  hus- 
band, under  the  influence  of  wine,  threatens  to  beat  her.  She  is  frightened, 
and  sometime  after  is  confined,  with  a  child  of  exceedingly  delicate  health, 
who  is  subject  to  panic  terrors,  and  who,  at  the  age  of  about  eighteen  years, 
becomes  insane.  A  lady,  while  pregnant,  exposes  her  life  a  thousand  times, 
to  save  that  of  her  husband.  She  has  convulsions,  and  is  confined.  Her 
daughter,  born  feeble,  and  subject  to  terrors,  is  married,  and  becomes  the 
mother  of  four  children.  At  twenty-three  years  of  age,  frightful  thoughts  of 
assassination  and  murder,  alone  occupy  her  mind,  and  render  her  furious. 

A  young  child,  three  years  of  age,  who  was  brought  to  the  Bicetre,  is 
frightened  at  the  bears  exhibited  there,  as  a  curiosity.  From  that  time,  he 
was  subject  to  frightful  dreams,  and  at  seventeen  years  of  age,  was  seized 
with  mania. 

A  girl,  six  years  of  age,  sees  her  father  massacred,  and  has  since  been  sub- 
ject to  panic  terrors.  At  fourteen,  her  menses  were  imperfectly  established, 
and  she  becomes  a  maniac.     She  wishes  to  rush  upon  every  body.     The  sight 


INSANITY.  51 

of  a  knife  or  weapon,  or  of  many  men  assembled,  excites  her  to  the  most  vio- 
lent fury. 

Falls  upon  the  head,  even  in  earliest  infancy,  predispose  to  insanity,  and 
are  sometimes  the  exciting  cause  of  it.  These  falls,  or  blows  upon  the  head, 
precede  by  many  years,  the  explosion  of  delirium. 

A  child  of  three  years  of  age,  fiills  upon  his  head.  He  complains  from  that 
time  of  headache.  At  puberty,  the  pain  in  the  head  increases,  and  mania 
manifests  itself  at  the  age  of  seventeen  years.  A  lady,  returning  from  a  ride 
on  horseback,  strikes  against  a  gate,  and  is  thrown  from  her  horse.  Some 
months  after,  she  becomes  insane,  is  cured  in  about  three  months,  and  dies 
two  years  afterwards  in  consequence  of  a  cerebral  fever. 

Rush  relates  several  analogous  cases. 

Masturbation,  of  which  we  have  spoken  under  another  head,  is  signalized 
in  all  countries,  as  one  of  the  frequent  causes  of  insanity. 

Sometimes  it  is  the  prelude  of  mania,  of  dementia,  and  even  of  senile  de- 
mentia.    Its  effects  are  more  deplorable  upon  men,  than  women. 

It  is  a  great  obstacle  to  the  cure  of  those,  who  give  themselves  up  to  the 
frequent  practice  of  this  vice,  during  the  course  of  their  disease. 

Cretins,  idiots,  and  individuals  in  a  state  of  dementia,  abandon  themselves 
to  it,  with  a  sort  of  fury.  Continence,  although  rarely,  sometimes  causes 
insanity. 

Buffon  has  borrowed  at  Espion  (turc)  a  very  remarkable  fact,  since  exten- 
sively copied,  viz.,  that  mania  has  been  caused  by  continence. 

Is  widowhood,  which  we  have  elsewhere  considered  under  the  head  of  mo- 
rals, a  cause  of  mental  alienation  ?  It  is  not  easy  to  ascertain  the  effect  of 
this  influence  upon  the  women  at  the  Salpetriere,  as  their  mode  of  life,  both 
before  and  after  marriage,  renders  continence  impossible. 

Among  the  wealthy  belonging  to  this  class,  whose  morals  are  generally  cor- 
rect, I  have  found,  among  one  hundred  and  forty-four  individuals,  admitted 
into  my  establishment,  forty-four  single  women,  eighty  who  were  married,  and 
twenty  widows. 

The  proportion  of  single  persons  is  much  greater  among  the  men,  since  of 
one  hundred  and  ninety-two,  sixty-one  were  not  married,  and  eight  only 
were  widowers. 

I  have  seen  some  young  women  who,  having  been  violated,  have  lost  their 
reason.     Shame  and  mortification  were  the  cause  of  their  malady. 

I  have  had  charge  of  a  lady  who  was  seized  with  an  attack  of  mania  on 
the  first  night  of  her  marriage.  Her  modesty  was  shocked,  at  being  obliged 
to  lodge  with  a  man. 

An  extremely  nervous  young  woman,  was  so  painfully  affected  by  the  first 
approaches  of  her  husband,  that  her  reason  forsook  her  immediately. 

Menstruation,  which  performs  so  important  a  part  in  the  economy  of  wo- 
man, cannot  be  a  stranger  to  the  production  of  mental  alienation.  It  even 
occupies  the  sixth  place  among  physical  causes. 

The  first  menstrual  effort,  sometimes  produces  insanity.  This  observation 
did  not  escape  Hippocrates. 

Disorders  of  menstruation,  provoked  by  physical  or  moral  accidents,  or  by 
the  progress  of  age,  multiply  the  conditions,  favorable  to  mental  alienation. 

Now,  the  menses  are  suppressed  suddenly,  and  insanity  speedily  ensues. 
Now,  they  present  remarkable  anomalies,  either  as  it  respects  the  period  of 
their  return,  or  the  quantity  and  quality  of  the  discharge,  before  insanity  de- 
clares itself 

Sometimes  the  menses  are  very  abundant,  and  appear  at  brief  intervals,  for 
a  short  time  before  the  invasion  of  insanity. 

In  fine,  there  are  cases,  where  insanity  manifests  itself,  without  the  least 
menstrual  disorder. 


52  INSANITY. 

The  period  of  the  menstrual  returns,  is  always  one  of  excitement  among  in- 
sane women,  even  with  those  whose  menses  are  not  deranged. 

LeucorrhcEa,  which  is  often  supplementary  to  the  menses,  to  which  pros- 
titutes, and  women  who  lead  a  sedentary  life  are  so  subject ;  when  suppressed, 
also  causes  insanity.  I  add  that  this  cause  is  more  frequent  than  is  generally 
supposed,  and  that  the  knowledge  of  this  fact,  may  become  a  very  valuable 
therapeutic  indication. 

The  suppression  of  hemorrhoidal  discharges,  is  almost  as  fatal  to  men,  as 
that  of  the  menses  is,  to  women  ;  but  its  influence,  being  exerted  at  a  more 
advanced  age,  most  frequently  produces  melancholy  and  dementia. 

Is  pregnancy  the  cause  of  insanity,  and  is  it  complicated  with  this  disease 
in  any  case  ?  I  speak  not  of  the  longings  of  pregnant  women,  nor  of  the 
moral  perversions  observed  among  them. 

Writers  on  legal  medicine,  report  several  cases  of  it.  I  have  seen  a  very 
nervous  young  woman,  who  had  an  attack  of  mania,  on  the  first  night  of  her 
marriage,  and  a  second  on  the  first  day  of  conception.  The  same  was  true  at 
her  second  pregnancy.  These  attacks  lasted  but  about  fifteen  days.  We  have 
seen  at  the  Salpetriere,  many  women  become  insane  during  pregnancy.  If 
this  ought  to  be  ranked  among  physical  causes  in  some  cases,  there  are  others 
where  it  is  set  in  action  by  moral  ones. 

Shame,  chagrin,  and  fear,  are  then  the  true  causes  of  the  malady. 

A  lady,  on  the  second  day  of  her  confinement,  leaves  her  bed,  and  sprinkles 
a  large  quantity  of  Cologne  water  over  her  garments,  and  about  her  apart- 
ments. The  next  day  she  is  a  maniac.  A  lady  experiences  a  moral  affection 
on  the  seventh  day  of  her  confinement.  The  lochia  are  suppressed  as  well  as 
the  milk  ;   and  she  becomes  furious. 

But  insanity  takes  place  more  frequently  after  confinement  and  during  lac- 
tation, than  during  pregnancy.  According  to  a  report  made  at  the  Salpetri- 
ere, of  six  hundred  insane  women,  52  had  lost  their  reason  after  confinement 
or  lactation.  Of  144  insane  women  belonging  to  the  wealthy  class,  21  were 
taken  sick,  as  the  result  of  their  confinement,  or  whilst  they  were  nursing. 
This  last  influence,  is  therefore  more  active  still,  among  the  latter,  than  wo- 
men of  the  lower  classes. 

Haslam  enumerates  84  women  who  became  insane  as  the  result  of  confine- 
ment, out  of  1664  admitted  at  Bethlem.  Rush  found  5,  out  of  70  received 
at  Pennsylvania.  At  Charenton,  those  who  became  insane  in  consequence  of 
confinement,  are  very  rare. 

We  have  had,  at  the  Salpetriere,  women  who  became  deranged  after  each 
confinement,  and  one  among  them,  after  every  second  confinement. 

A  lady  who  had  an  hereditary  predisposition,  became  insane  at  the  third 
month  of  lactation. 

Hippocrates  said  that  the  blood,  which  mounts  to  the  breasts  of  nurses,  pre- 
sages mania. 

Planchon  cites  a  case  of  it.  But  is  the  suppression  of  milk  a  cause  or 
effect  of  delirium  ?  It  has  been  pretended,  that  it  is  always  the  result  of  the 
cerebral  affection  ;  but  this  has  not  been  demonstrated  in  every  case.  There 
are  ca.ses  in  which  insanity  appears,  while  the  milk  is  not  suppressed ;  but  this 
suppression,  most  frequently  precedes  alienation.  Sometimes  delirium  in- 
creases, in  proportion  as  the  milk  diminishes  ;  while  it  ceases,  on  the  re-estab- 
lishment of  this  secretion.  These  cases  of  alienation,  of  which  we  shall  not 
attribute  the  cause  to  ecstasy,  or  to  the  accumulation  of  milk  in  the  cranial 
cavity,  are  cured  even  in  a  few  days,  but  more  frequently  after  five  and  six 
months,  or  a  year.* 


nurses. 


Vide  hereafter :  Concerning  the  mental  alienation  of  the  newly  confined,  and  of 


INSANITY.  53 

The  first  dentition,  by  causing  convulsions  in  children,  predisposes  to  insa- 
nity ;  while  the  tardy  appearance  of  the  teeth,  has  sometimes  provoked  this 
malady. 

The  suppression  of  the  transpiration,  which  is  determined  by  the  moral  af- 
fections, ought  to  stand  conspicuous  among  the  causes  of  mental  alienation. 
It  is  by  its  suppression,  that  atmospheric  vicissitudes,  the  humidity  of  the  soil, 
errors  of  regimen,  excessive  study,  and  the  passions,  produce  insanity. 

A  man  about  forty-six  years  of  age,  was  accustomed  to  perspire  copiously 
from  his  head.  He  was  advised  to  bathe  it  with  cold  water.  The  perspira- 
tion was  suppressed  by  degrees,  and  dementia  established. 

A  young  man  in  a  state  of  perspiration,  crosses  a  streamlet.  He  retires 
with  a  chill,  and  immediately  becomes  a  maniac. 

Fevers  of  a  grave  character,  leave  after  them  a  chronic  delirium  which  must 
not  be  confounded  with  mental  alienation  ;  nor  must  we  confound  continued, 
or  intermittent  ataxic  fevers,  with  insanity,  at  its  first  appearance  ;  a  point  of 
practice  well  worthy  the  attention  of  the  physician, — inasnmch  as,  mental 
alienation  at  its  invasion,  often  presents  almost  all  the  characters  of  ataxic  fe- 
ver, or  inflammation  of  the  meninges  of  the  brain,  and  reciprocally. 

These  fevers,  and  inflammations  of  the  meninges  and  encephalon,  by  en- 
feebling the  cerebral  system,  predispose  to  insanity,  which  appears  after  some 
months,  sometimes  years. 

We  often  meet  with  young  men  of  eighteen,  twenty,  and  twenty-five  years, 
who  are  suddenly  seized  with  mania,  without  other  appreciable  cause,  than  an 
acute  cerebral  affection,  which  had  taken  place  before,  or  at  the  period  of  pu- 
berty. 

The  presence  of  various  substances  in  the  first  passages  has  produced,  by 
sympathy,  mental  alienation. 

Mucous,  bilious,  and  depraved  masses  in  the  stomach,  worms  in  the  intesti- 
nal canal,  tceniiE,  lumbricoides  and  strongyli,  have  produced  insanity. 

I  speak  not  of  the  effect  of  poisons,  although  their  mode  of  action  upon  the 
cerebral  functions,  merits  the  greatest  attention  on  the  part  of  one  who  would 
thoroughly  understand  the  lesions  of  the  intellectual  faculties.  Poisons  pro- 
duce a  consecutive  effect,  which,  in  altering  the  sensibility,  causes  a  secondary 
insanity,  whose  cure  is  very  diflicult. 

A  great  number  of  chronic  affections,  either  in  consequence  of  their  incon- 
siderate suppression,  or  by  their  metastasis,  produce  insanity. 

Hippocrates  said,  that  the  checking  of  expectoration,  in  cases  of  phthisis, 
occasions  wandering  of  the  intellect.  It  is  certain  that  phthisis  causes,  or  at 
least  precedes  mental  alienation,  and  alternates  with  it. 

Epilepsy,  sooner  or  later,  leads  to  insanity,  either  in  infancy,  or  at  a  more 
advanced  age.  Of  the  three  hundred  epileptics  who  reside  at  the  Salpetriere, 
more  than  one  half  are  insane.  The  same  is  true  of  those  at  the  Bicetre  and 
at  Charenton.  Some  are  idiots  or  imbeciles,  others  in  a  state  of  dementia, 
and  others  still,  maniacs,  and  even  furious. 

The  fury  of  epileptics,  has  a  character  of  ferocity  which  nothing  subdues  ; 
and  it  is  this  circumstance  that  renders  it  so  formidable  in  all  hospitals  for  the 
insane. 

Hysteria  and  hypochondria  degenerate,  and  often  pass  into  insanity,  and  in 
many  cases  are  only  the  first  degree  of  it.  This  has  caused  these  maladies  to 
be  confounded  with  mental  alienation,  by  a  great  number  of  authors,  as  well 
ancient  as  modern. 

Apoplexy  often  terminates  in  dementia,  which  is  complicated  with  paralysis. 
The  suppression  of  a  nasal  discharge,  of  blennorrhao-ia,  of  an  ulcer  or  issue, 
has  produced  insanity,  as  well  as  the  retrocession  of  psora,  tetter,  gout  or  rheu- 
matism. The  suppression  of  these  affections,  is  not  always  the  cause  of  in- 
sanity, but  usually  precedes  its  invasion.     The  abuse  and  even  the  use  of 


54  INSANITY. 

medicines  which  act  powerfully  upon  the  nervous  system,  have  caused  insanity 
among  those  who  were  predisposed  to  it.  It  is  not  rare  that  persons  become 
insane,  during  a  mercurial  treatment.  We  can  say  as  much  of  the  abuse  of 
opium,  and  other  narcotics. 

We  have  already  seen,  that  those  occupations  which  expose  the  person  to 
the  fumes  of  charcoal,  predispose  to  insanity.  We  ought  to  add,  that  as- 
phyxia by  carbon,  is  very  liable  to  cause  dementia,  and  that  too  in  its  incura- 
ble form. 


III.     COURSE  OF  INSANITY. 

In  this  section,  after  having  traced  in  a  general  manner,  the  course  of  insa- 
nity, I  shall  give  some  details  respecting  its  terminations  ;  and  close  by  con- 
siderations concerning  the  cure,  and  mortality  of  the  insane. 

The  causes  of  mental  alienation,  do  not  always  act  directly  upon  the  brain, 
but  upon  organs  more  or  less  removed  therefrom. 

Now,  the  extremities  of  the  nervous  system,  and  the  foci  of  sensibility  situ- 
ated in  different  regions  ;  now,  the  sanguine  and  lymphatic  systems  ;  now,  the 
digestive  apparatus ;  the  liver  and  its  dependencies,  or  the  organs  of  reproduc- 
tion, are  each,  respectively,  the  point  of  departure,  of  the  malady. 

Here  airange  themselves  naturally,  the  considerations  respecting  the  in- 
fluence of  different  organs,  in  their  physiological,  or  pathological  states,  upon 
the  sensations,  ideas,  understanding,  and  will  ;  as  well  as  upon  the  passions 
and  determinations  of  man  ;  so  thoroughly  understood  by  Cabanis,  Cogan, 
Crichton,  and  Moreau  de  la  Sarthe.* 

Predisposing  causes  sometimes  act  with  so  much  energy,  as  to  produce  in- 
sanity, without  any  apparently  exciting  cause,  and  reciprocally  ;  so  that  the 
causes  of  mental  alienation,  cannot  be  rigorously  classed,  according  to  their 
degree  of  influence. 

Proximate  or  exciting  causes,  whether  physical  or  moral,  act  promptly. 

Generally,  their  effect  upon  the  system  is  slow,  especially  in  the  production 
of  dementia,  and  even  lypemania. 

I  am  convinced  that  these  causes  act  promptly,  only  in  cases  strongly  pre- 
disposed to  insanity.  Almost  all  the  insane,  presented  before  their  sickness, 
certain  functional  changes,  which  extended  back  many  years,  even  to  earliest 
infancy.  The  greater  part  had  suffered  from  acute  encephalic  inflammations, 
convulsions,  pains  in  the  head,  colics,  cramps,  constipation  and  menstrual 
irregularities. 

Many  were  endowed  with  great  activity  of  the  intellectual  faculties,  and  had 
been  the  sport  of  the  most  impetuous,  and  angry  passions.  Others  still  had 
been  peculiar  in  their  ideas,  affections  and  actions. 

Some,  led  away  by  a  disordered  imagination,  would  have  been  incapable  of 
a  systematic  course  of  study  ;  others,  obstinate  to  excess,  could  live,  only  in  a 
very  limited  circle  of  ideas  and  affections  ;  whilst  many,  without  intellectual 
and  moral  energy,  were  timid,  fearful,  irresolute,  and  indifferent  about  every 
thing.  With  these  dispositions,  an  accidental  cause  only  is  wanting,  to  pro- 
duce an  attack  of  insanity. 

But  insanity,  like  all  other  maladies,  has  its  period  of  incubation,  its  pre- 
monitory indications,  and  often  in  the  history  given  by  friends,  it  is  discover- 
ed that  the  first  act  of  insanity  which  frightened  them,  had  been  preceded  by 
many  symptoms,  which  escaped  all  observation.  Sometimes,  the  early  phe- 
nomena of  the  disease,  are  regarded  as  the  cause  of  the  malady. 

The  insane  often  combat  their  false  ideas  and  unusual  determinations,  be- 

*  Mental  diseases  ;  Encyclopedia  methodical. 


INSANITY.  55 

fore  any  one  perceives  the  disorder  of  their  reason,  and  the  internal  struggle 
which  precedes  the  outbreak  of  insanity. 

A  long  time  before  an  individual  may  be  regarded  as  insane,  his  habits, 
tastes  and  passions,  change.  One  surrenders  himself  to  wild  speculations, 
which  do  not  succeed ;  and  the  consequent  reverses  are  not  the  cause,  but  the 
first  effect  of  the  malady. 

Another,  all  at  once  engages  in  the  loftiest  acts  of  devotion,  and  is  present 
at  the  delivery  of  a  sermon,  from  which  he  goes  away  stricken  with  fear,  be- 
lieving himself  damned.  The  sermon  would  not  have  produced  this  effect,  if 
the  malady  had  not  previously  existed. 

A  young  lord,  without  any  motive,  undertakes  a  voyage  of  many  years'  du- 
ration, eight  days  before  the  confinement  of  his  wife.  He  experiences  some 
opposition  during  the  voyage,  and  after  six  months,  his  mental  alienation  be- 
comes manifest.  Was  not  this  voyage  the  first  act  of  his  insanity  ?  It  often 
happens  also,  that  the  evil  exists,  at  a  time  when  it  is  not  suspected. 

M.  ***,  about  sixty-four  years  of  age,  of  a  dry  and  nervous  temperament, 
who  had  led  a  very  quiet,  moral  life,  suddenly  leaves  his  house,  under  the  pre- 
text of  taking  a  walk. 

His  wife,  suspecting  something,  ordered  his  valet  to  follow  him.  He  sees 
his  master  enter  a  most  disreputable  place.  Upon  the  slightest  allusion  to  it, 
the  old  man  has  a  furious  paroxysm  of  anger,  which,  after  five  days,  termi- 
nates in  dementia. 

Insanity  is  continued,  remittent  or  intermittent. 

Continued  insanity  has  a  regular  course,  a  space  of  time  that  it  is  to  run, 
and  three  distinctly  marked  periods.  A  first  period  acute,  with  concomitant 
sypmtoms  ;  a  second,  chronic,  almost  always  exempt  from  symptoms  foreign 
to  the  delirium.     The  third  and  last  period,  is  that  of  the  decline  and  cure. 

But  this  course  is  easy  to  recognize,  only  in  acute  or  accidental  cases  of  in- 
sanity ;  or  in  attacks  of  intermittent  insanity.  It  is  never  observed  in  idiocy, 
nor  in  dementia. 

Remittent  insanity  offers  very  remarkable  anomalies,  either  as  it  respects  its 
character,  or  the  duration  of  the  remission. 

This,  in  some  cases,  is  but  the  passage  from  one  form  of  delirium  to  another. 

Thus,  an  insane  person  passes  three  months  in  lypemania,  the  three  follow- 
ing in  a  state  of  mania,  and  finally,  four  months,  more  or  less,  in  dementia  ; 
and  thus  successively  ;  now  with  great  regularity,  and  now  with  striking  va- 
riations. 

A  lady,  aged  fifty-two  years,  is  one  year  a  lypemaniac,  and  one,  maniacal 
and  hysterical.  In  other  circumstances,  the  remittence  presents  only  a  sensi- 
ble diminution  of  the  symptoms  of  the  same  species  of  insanity. 

Thus,  there  are  maniacs,  who  are  agitated,  violent  and  passionate,  only  at 
certain  periods  of  the  day,  at  certain  hours,  and  at  certain  seasons ;  whilst 
their  delirium  is  calm  and  peaceful  the  rest  of  the  time. 

There  are  those,  whose  lypemania  becomes  more  profound  and  oppressive 
at  irregular  intervals  ;  while  it  usually  offers  all  the  characteristics  of  a  fixed 
delirium,  combined  with  the  gay  and  jjleasurable  emotions.  The  seasons,  and 
also  menstruation,  produce  a  recurrence  of  the  same  symptoms,  and  delirium ; 
the  same  exaltation  and  oppression. 

Intermittent  insanity  is  quotidian,  tertian,  quartan,  monthly  and  aimual. 
In  fact,  attacks  recur  after  an  interval  of  many  years.  It  is  now  regular  ;  now 
irregular.  In  the  first  case,  the  same  season  and  period  of  the  year ;  the 
same  physical  and  moral  causes,  bring  back  a  malady,  having  the  same  cha- 
racter, crises  and  duration.  More  generally,  the  attacks  return  at  very  variable 
intervals.  They  are  provoked  by  new  causes,  and  do  not  present  the  same 
form  of  delirium.  Their  duration  and  crises  are  different ;  and  the  attack 
breaks  forth,  sometimes  suddenly,  but  is  more  frequently  announced  by  various 


56  INSANITY. 

signs,  which  are  ordinarily,  the  same  with  those  which  have  preceded  the  first 
attack. 

Among  the  insane,  some  suffer  from  cephalalgia,  insomnia  or  somnolence. 
They  lose  their  appetite  or  eat  voraciously.  They  suffer  also,  from  constipa- 
tion, abdominal  pains,  intestinal  heat,  etc.  Others  have  presentiments,  dreams, 
and  strange  ideas.  We  see  those,  whose  attack  is  always  preceded  by  great 
loquacity,  by  an  unusual  inclination  to  the  pleasures  of  love,  by  an  irresistible 
desire  to  move  about,  and  to  whistle.  There  are  others  whose  character  and 
affections,  tastes  and  habits,  are  changed.  They  become  irritable,  querulous, 
suspicious,  and  choleric  ;  or  taciturn,  gloomy  and  melancholic.  Finally,  after 
some  months,  weeks,  days  or  moments,  the  attack  bursts  forth,  runs  its  course, 
and  terminates  by  crises  more  or  less  complete.  Not  unfrequently,  the  attack 
ceases  abruptly,  without  any  precursory  indication  of  its  approaching  termina- 
tion. 

We  have  just  seen,  that  insanity,  in  some  sort  transforms  itself,  and  that  the 
different  forms  of  delirium,  replace,  and  succeed  each  other. 

We  ought  to  add,  that  by  their  complication,  binary  or  ternary  compounds 
are  formed. 

Lypemania  complicates  itself  with  mania ;  dementia,  with  mania  and  mono- 
mania. I  have  seen  an  imbecile  yield  to  an  attack  of  chagrin.  In  fine,  we 
have  seen  the  insane,  who  had  fallen  into  a  state  of  dementia,  preserve  the 
primitive  character  of  their  delirium,  and  have  at  intervals,  attacks  of  mania 
and  even  fury.  Many  observations,  detailed  farther  on,  will  demonstrate  these 
combinations. 

Insanity  is  very  often  complicated  with  cerebral  lesions,  such  as  chronic  in- 
flammation of  the  meninges,  paralysis,  convulsions,  epilepsy,  hypochondria 
and  hysteria.  It  is  complicated  with  affections  of  the  lungs,  of  the  heart  and 
intestines,  and  of  the  skin  ;  either  because  these  latter  maladies  have  preceded 
insanity,  and  ceased  at  its  incursion,  or  proceed  simultaneously,  or  alternate 
with  it. 

The  insane  are  not  secure  against  intercurrent  maladies,  and  epidemics. 
The  latter,  often  have  an  influence,  more  or  less  marked,  upon  insanity  :  either 
suspending  its  march,  causing  it  to  cease,  or  terminating  the  life  of  the  insane. 

Why  is  not  the  doctrine  of  crises,  applicable  to  mental  alienation  ?  Has 
not  insanity  its  causes,  symptoms,  and  a  course  which  is  proper  to  it  ?  Why 
should  it  not  terminate  like  other  maladies  ?  The  cure  is  certain,  only  when 
it  has  been  marked,  by  some  sensible  crisis.  When  insanity  ceases  suddenly, 
without  our  being  able  to  assign  any  critical  cause,  we  ought  to  fear,  lest  we 
have  to  do  with  its  intermittent  form.  If  insanity  pass  so  often  into  a  chronic 
state,  it  is  because  the  critical  efforts  are  rarely  perfect,  and  often  abortive, 
for  the  following  reasons  ;  1,  because  the  malady  attacks  enfeebled  subjects; 
2,  because  its  most  common  causes  are  debilitating ;  3,  because  the  suscepti- 
bility of  individuals,  and  the  ataxia  of  the  symptoms,  interfere  with  the  course 
of  nature.  Hippocrates,  Celsus,  Ccelius,  Boerhaave  and  Pinel,  have  pointed 
out  many  crises  of  insanity,  as  well  as  all  the  physicians  who  have  written  re- 
specting it.  These  crises  are  physical  or  moral.  They  are  observed  only 
in  monomania,  lypemania,  mania,  and  acute  dementia.  They  do  not  occur  in 
imbecility,  or  in  chronic  or  senile  dementia. 

Insanity  terminates  by  resolution.  Paleness  of  the  face,  which  was  of  a 
lively  red,  or  earthy  brown  ;  the  composure  of  the  features ;  a  sense  of  gene- 
ral lassitude,  sleep,  suppleness  of  the  skin,  freeness  of  the  excretions,  and  the 
return  of  moral  sensibility,  presage  a  cure  as  near  at  hand.  This  is  perfect, 
if  at  the  same  time  that  the  patient  is  restored  to  reason,  the  habitual  evacua- 
tions are  reestablished,  and  the  convalescent  returns  to  his  former  habits  and 
character. 

But  if  sleep,  the  appetite  and  excretions,  return  to  their  usual  state,  and 


INSANITY.  57 

delirium  does  not  lessen,  or  moral  sensibility  does  not  manifest  itself  in  the 
same  proportion ;  monomania  and  mania,  pass  into  the  chronic  state,  or  dege- 
nerate into  dementia. 

Sometimes  insanity  terminates,  by  the  predominance  of  the  absorbent  sys- 
tem. The  patients  gain  in  flesh,  and  delirium  is  dissipated  in  proportion  as 
obesity  increases.  Obesity  continues  for  several  months  after  the  perfect  re- 
establishment  of  reason  ;  whilst  it  is  a  sign  of  dementia,  if  the  delirium  per- 
sists. In  the  opposite  class  of  cases,  the  patient  is  cured  only  after  having 
reached  the  last  degree  of  emaciation  ;  and  only  returns  to  life  and  reason, 
after  having  stood  at  the  portals  of  death.  For  thirty  years,  this  last  critical 
termination  was  denied  ;  it  being  affirmed,  that  emaciation  was  the  effect  of 
insanity,  and  not  its  critical  termination.  However,  there  are  many  cases  of 
intermittent  insanity,  whose  course  renders  this  mode  of  termination  evident. 

Mad'e  ***,  fifty-one  years  of  age,  has  had  several  attacks  of  insanity,  as  a 
result  of  severe  afflictions.  Each  attack  ceases,  so  soon  as  the  patient  be- 
comes lean  in  flesh. 

The  intermission  continues  two  years,  during  which  she  increases  much  in 
size,  and  when  she  seems  to  have  attained  the  maximum  of  health,  delirium 
suddenly  bursts  forth,  is  prolonged  for  many  months,  and  its  intensity  lessens. 
only  when  emaciation  begins.  It  ceases,  only  when  she  becomes  very  lean. 
I  have  often  observed  similar  facts. 

M.  ***j  fifty-four  years  of  age,  has  had  a  great  number  of  attacks  of  mania 
with  fury  ;  each  attack  lasts  from  fifteen  to  twenty  days,  and  its  termination 
announces  itself  by  a  great  and  rapid  emaciation,  while  the  return  of  the  at- 
tacks occurs  only  when  he  has  recovered  a  good  degree  of  flesh. 

Galen  cites  a  case  of  insanity,  which  was  terminated  by  a  quartan  fever. 
Belgarric  states  a  similar  fact,  in  a  thesis  sustained  at  the  school  of  Montpe- 
lier  with  this  title:  "  An  in  ?iio7-bis  chronicis,  frhris  sit  rxcitancla"  ?  I  have 
known  in  several  instances,  iusanity  terminated  by  fevers,  either  continued  or 
intermittent. 

Hippocrates,  Celsus,  Boerhaave  and  Lacutus,  assure  us,  that  insanity  is 
terminated  by  hemorrhoids.  Frederic  Hofmann  advised  cups  to  the  funda- 
ment to  provoke  them.  Epistaxis  also,  has  cured  it.  The  first  menstrual 
eruption  is  sometimes  critical,  while  the  cessation  of  the  menses  is  a  time, 
truly  critical  with  some  insane  women.  I  have  known  many,  who  have  en- 
tirely recovered  the  use  of  their  reason,  on  ceasing  to  menstruate.  The  re- 
establishment  of  the  menses,  very  often  terminates  insanity.  Uterine  hemor- 
rhages, leucorrhcca  and  blermorrhagia,  have  also  produced  it.  Coition  and 
the  spermatic  excretion,  have  been  critical.  So  have  gestation  and  lactation; 
but  I  think  it  unwise,  to  advise  marriage  for  the  cure  of  insanity. 

This  means  does  not  succeed  so  often  as  is  supposed ;  and  sometimes  aug- 
ments the  evil. 

I  have  known  a  great  number  of  monomaniacs,  and  those  afllicted  with  ma- 
nia, whose  mental  state  was  not  improved  by  pregnancy,  parturition  nor  lacta- 
tion. 

Cutaneous  aflfections  merit  our  attention  the  more,  from  the  fact  that  their 
suppression  causes  insanity  ;  and  because  the  insane  are  very  subject  to  them. 
I  shall  refer  elsewhere  to  the  course  of  the  pelagra,  and  its  peculiar  influence 
upon  suicide.  Sometimes  insanity  re-appears,  at  the  same  time  that  tetters 
appear;  whilst  more 'frequently,  it  ceases  only  when  the  tetter  disappears; 
and  the  cure  is  not  permanent,  except  when  this  form  of  eruption  is  fixed  upon 
some  part. 

Hippocrates  was  of  opinion  that  psora  terminates  insanity,  and  all  those 
who  have  seen  much  of  this  disease,  coincide  with  him  in  opinion.  I  endea- 
vored to  communicate  it  to  a  soldier,  paralytic  and  in  a  state  of  dementia,  in 

8 


58  INSANITY. 

consequence  of  a  repercussion  of  this  disorder,  but  succeeded  neither  in  cur- 
ing him,  nor  in  communicating  the  disease. 

Gardanne  pretended,  that  we  could  cure  insanity,  by  the  inoculation  of  the 
small  pox.  Turuncles,  which  produce  a  suppuration  more  or  less  abundant, 
often  terminate  insanity  ;  whilst  eschars,  and  enormous,  but  atonic  suppura- 
tions, never  bring  it  to  a  favorable  issue.  Ulcers,  whose  suppression  causes 
insanity,  cure  it,  by  being  reestablished  ;  as  art  cures,  by  recalling  habitual 
evacuations,  that  have  been  suppressed. 

Perfect  and  Pinel,  mention  the  cure  of  a  maniac,  after  the  engorgement  of 
a  parotid.  In  1812,  there  was  at  the  Salpetriere  a  woman  forty  years  of  age, 
who,  frightened  by  a  thunder-clap,  became  a  maniac.  The  mania  ceased  in 
consequence  of  an  enormous  engorgement  of  the  submaxillary  glands.  This 
patient  fell  into  a  profound  stupor,  which  was  dissipated,  in  proportion  as  the 
engorgement  of  the  glands  disappeared. 

Lafontaine  read  to  the  society  of  Gottingen,  the  history  of  an  insane  per- 
son, who  was  cured,  after  many  years,  by  the  extirpation  of  a  cancer  of  the 
breast. 

Salivation  is  a  very  frequent  symptom  with  the  insane.  Many  make  efforts, 
as  if  desirous  to  spit,  but  without  success. 

This  symptom  depends  upon  constriction  of  the  throat,  or  spasm  of  the 
salivary  glands.  It  happens,  however,  that  salivation  is  critical,  as  Perfect  and 
Rolfinck  have  observed,  as  w^ell  as  Pinel  and  myself 

The  discharge  of  tears  offers  also  the  same  characters.  Many  insane  per- 
sons appear  to  weep  without  shedding  a  tear.  The  paroxysms  often  cease,  by 
the  shedding  of  tears,  which  in  some  cases,  are  critical.  The  return  of  trans- 
piration, terminates  insanity  much  more  frequently  than  is  supposed.  It  is 
this,  Avhich  renders  the  spring  favorable  to  the  cure  of  this  malady  ;  and  the 
tepid  baths  so  useful  in  the  treatment  of  the  insane,  whose  skin  is  in  a  state 
of  remarkable  erethysm. 

The  vomiting  of  mucous,  yellow,  black  or  pitchy  matters,  and  alvine  de- 
jections of  the  same  nature,  often  terminate  insanity,  especially  lypemania. 
Hippocrates,  Lorry  and  Pinel,  have  pointed  out  these  terminations,  as  well  as 
Mead,  Selle,  and  Van  Swieten,  who  have,  besides,  recorded  cures  which  had 
taken  place  after  the  expulsion  of  worms.  During  the  year  1811,  we  had  at 
the  Salpetriere  several  maniacs,  who  were  cured  by  the  expulsion  of  worms. 

However,  I  am  far  from  attributing  to  the  presence  of  worms,  that  impor- 
tance in  the  production  of  insanity,  which  Prost  gives  to  it.* 

The  same  is  true  of  the  influence  which  this  physician  accords  to  the  mu- 
cous membrane  of  the  alimentary  canal.  To  conclude  from  the  fact  that  in- 
sanity is  terminated  by  alvine  evacuations,  that  it  has  its  seat  in  the  intestines, 
is  strangely  to  deceive  ones-self 

To  conclude  also,  from  the  fact  that  the  mucous  membrane  of  the  intes- 
tines is  phlogosed  and  ulcerated,  that  insanity  has  its  seat  in  the  intestinal 
mucous  membrane,  is  equally  to  deceive  ones-self  It  is  to  confound  effects 
with  causes.  Intestinal  evacuations  are  critical,  in  a  great  immber  of  affec- 
tions, which  evidently  have  their  seat  elsewhere  than  in  the  mucous  mem- 
brane of  the  intestines. 

In  hypochondria,  whose  seat  is  so  often  in  the  abdominal  viscera,  we  avoid 
purgatives.  We  prescribe  them  in  insanity,  to  provoke  a  new  centre  of  irri- 
tation, to  excite  the  abdominal  viscera  now  fallen  into  alony,  and  to  expel  the 
accumulated  matters  from  the  alimentary  canal.  The  administration  of  pur- 
gatives is  not  always  followed  by  a  cure ;  indeed,  it  is  often  prejudicial. 

Phlogosis,  and  ulcerations  of  the  mucous  membrane  of  the  alimentary  ca- 

**  A  glance  at  insanity,  Paris,  1807;  in  8vo. 


INSANITY.  59 

nal,  prove  no  more  that  it  is  the  point  of  departure  in  insanity,  than  that  it  is 
the  seat  of  phthisis. 

The  insane  become  enfeebled  progressively ;  and  tolerant  also,  of  every 
variety  of  chronic  inflammation.  They  are  scorbutic,  and  phthisical.  A 
great  many  of  them  succumb  to  marasmus,  after  having  had  serous,  sangui- 
neous, and  purulent  evacuations. 

How  often,  on  opening  a  dead  body,  do  we  find  the  mucous  membrane  of 
the  intestines  injected,  thickened  and  disorganized  ? 

We  ought  to  have  observed  a  great  number  of  the  insane,  to  have  followed 
throughout  their  course,  the  maladies  to  which  they  yielded,  and  to  have  com- 
pared the  results  of  autopsies,  with  the  symtoms  which  had  characterized  the 
insanity  and  last  malady,  before  drawing  general  conclusions. 

The  different  forms  of  insanity  terminate  in  each  other.  Thus,  mania  ter- 
minates in  dementia,  or  lypemania ;  and  mania  with  fury,  terminates  critical- 
ly by  dementia,  when  the  latter  is  the  product  of  too  active  medication,  at  the 
commencement  of  mania  or  monomania.  All  forms  of  insanity  degenerate 
into  dementia,  after  a  more  or  less  brief  period  of  time. 

There  are  individuals  who,  after  being  cured  of  insanity,  are  hypochon- 
driacs and  hysterical.  I  have  never  known  epilepsy  cause  insanity  to  cease. 
In  some  cases,  it  unexpectedly  succeeds  convulsions,  which  resemble  epilepsy  ; 
but  these  convulsions,  far  from  being  critical,  announce  an  intracranial  lesion, 
which  aggravates  the  evil,  and  presages  the  approaching  end  of  the  patient. 

I  speak  not  of  accidental  crises,  which  can  furnish  no  therapeutic  indica- 
tion, such  as  falls  upon  the  head,  poisoning,  cutting  the  hair,  castration  and 
the  operation  for  cataract,  which  have  sometimes  brought  insanity  to  a  favora- 
ble close. 

Cannot  moral  affections,  by  reacting  upon  the  sensibility,  by  modifying  the 
sensations,  ideas,  passions  and  determinations  of  the  insane,  become  critical 
in  insanity,  of  which  they  are  so  often  the  cause  ?  Have  not  an  unforeseen 
enjoyment,  or  an  unexpected  success,  caused  the  gravest  maladies  to  cease  ? 
Has  it  never  happened,  that  a  sudden  fright,  or  violent  mortification,  has  ter- 
minated maladies,  supposed  incurable  ?  Do  not  these  troubles,  which  entirely 
overcome  the  moral  man,  resemble  in  any  respect  those  tumultuous  move- 
ments, which  precede  physical  crises  ? 

A  young  lady  is  plunged  into  the  profoundest  melancholy,  because  she  can- 
not be  immediately  married  to  her  lover  ;  she  refuses  every  kind  of  nourish- 
ment, and  falls  into  marasmus.  After  some  months,  her  lover  presents  him- 
self to  her  with  an  assurance  of  their  speedy  marriage.  The  patient  is  re- 
stored. 

An  insane  person  refuses  every  variety  of  nourishment.  A  sense  of  honor 
forbids  him  to  eat.  After  many  days,  vainly  employed  in  persuading  him  of 
his  error  ;  to  overcome  his  resolution,  they  presented  to  him  a  fal^c  patent, 
signed  Napoleon,  which  commands  him  to  eat,  and  acquits  him  of  a  breach  of 
honor,  if  he  obeys.  The  patient  takes  the  ordinance,  and  reads  it  several 
times.  A  moral  conflict  arises  between  his  convictions,  and  the  order  which 
he  has  received.  After  a  struggle  of  many  hours,  he  yields  with  a  groan ; 
eats,  and  is  restored  to  health. 

A  young  man,  in  despair  that  general  Moreau  had  been  condemned  to  ex- 
ile, persuades  himself,  that  he  is  destined  to  avenge  this  injury,  done  to  the 
French  nation,  in  the  person  of  its  first  general. 

At  Cadiz,  whither  commercial  affairs  had  called  him,  he  indulges  in  ma- 
niacal acts,  wanders  about  the  city  armed,  requiring  himself  to  be  recog- 
nized as  the  chief  of  the  French  nation.  He  is  arrested  and  sent  back  to 
France.  During  the  long  voyage,  M.  *  takes  for  a  guard  of  honor,  the  sol- 
diers who  accompany  him.  He  arrives  at  Paris.  Besides  his  pretensions,  the 
patient  persuades  himself  that  one  of  his  relatives, — his  most  intimate  friend. 


60  INSANITY. 

— has  become  his  most  cruel  enemy,  and  is  opposed  to  his  elevation  and  de- 
signs. Some  months  pass  in  retirement,  and  the  use  of  an  appropriate  regi- 
men. At  length,  after  six  months,  this  friend,  the  object  of  such  intense  an- 
ger, presents  himself  He  is  assailed  with  abuse  and  threats,  which  do  not 
prevent  him,  however,  from  throwing  himself  into  the  arms  of  his  sick  ac- 
quaintance. They  remain  in  each  others'  embrace  for  some  minutes.  Tears 
flow,  the  patient  turns  pale,  falls,  unable  to  sustain  himself,  and  is  restored 
to  reason,  which  has  ever  since  maintained  its  supremacy. 

A  man  of  letters  goes  to  drown  himself,  and  is  met  by  robbers.  He  suc- 
cessfully defends  his  purse,  and  returns  home,  perfectly  cured.  Do  not  these 
facts  present  the  character  of  a  crisis  from  a  violent  effort,  and  a  radical 
change  in  the  sensibility  ? 

But  shall  we  admit  the  existence  of  this  moral  influence,  when  insanity  de- 
pends upon  the  alteration  of  the  humors,  or  a  disorder  of  every  other  system 
but  that  on  which  innervation  depends  ? 

Why  not,  when  there  are  no  grave  lesions  in  the  organs  1  Moral  impres- 
sions determine  a  movement,  a  kind  of  shock  in  the  fibres ;  the  forces  are 
modified  ;  and  the  organs  acquire  an  activity,  adequate  to  the  solution  of  the 
maladies. 

Fear  and  dread,  cause  involuntary  evacuations,  both  of  the  rectum  and  blad- 
der ;  anger  provokes  hemorrhages,  and  a  bilious  flux ;  rage  augments  the  sali- 
vary secretions  ;  joy  awakens  the  tender  emotions  of  the  heart ;  mortification 
causes  the  tears  to  flow. 

Why  refuse  to  moral  affections  an  influence,  in  the  solution  of  insanity, 
when  we  accord  to  it,  one  so  powerful,  in  the  preservation  of  health,  and  in 
the  production  of  disease,  particularly  cerebral  disorders  ? 

A  lady  nineteen  years  of  age,  of  a  sanguine  temperament,  having  never  ex- 
perienced the  slightest  contradiction,  was  very  choleric  and  of  an  extreme  sus- 
ceptibility. Although  apparently  well,  her  menses  were  irregular.  At  the  ap- 
proach of  her  menstrual  periods,  or  when  she  experienced  some  opposition  to 
her  desires,  which  were  always  imperious,  she  became  peevish,  difficult,  and 
reserved.  She  complained  of  head-ache,  and  of  weakness  in  her  limbs.  On 
the  slightest  provocation  she  became  irritated,  and  vexed  ;  giving  herself  up 
to  the  blindest  acts  of  ano-er.  She  abused  her  mother  and  friends,  threatens 
their  lives  and  her  own.  After  each  attack  of  furious  anger,  Madame  *,  fell 
into  a  state  of  prostration,  but  was,  at  length,  restored  to  a  calm  state,  both  of 
body  and  mind. 

If  she  sought  to  control  herself,  and  to  restrain  the  explosion  of  her  anger, 
she  suffered  dreadfully  in  all  her  members.  Her  head  was  puffed  up,  her  face 
injected,  and  her  eyes  gorged  with  blood  ;  and  this  condition  was  relieved, 
only  by  the  occurrence  of  a  paroxysm. 

Does  not  this  observation,  whose  details  will  find  a  place  elsewhere,  strength- 
en our  opinion,  respecting  the  moral  crises  of  insanity  ?  This  opinion  is  con- 
firmed, by  the  salutary  effects  which  are  obtained  from  moral  agencies,  in  the 
treatment  of  mental  alienation.  Here,  as  in  the  physical  treatment,  the  phy- 
sician can  only  imitate  nature,  and  second  its  tendency,  towards  this  or  that 
solution. 

The  study  of  the  critical  terminations  of  mania,  conduct  us  naturally  to 
considerations  respecting  the  curability  and  mortality  of  this  malady. 


INSANITY. 


61 


TABLE  OF  CURES.     No.  VIII. 


England. 

Bedlam  hospital,  from  1748  to  1794, 

in   1813, 
St.  Luke's  hospital,  from  1751  to  1801, 
York  hospital. 
Retreat  near  York,  from  1801  to  1814, 

Totals, 


Admissions. 

Cures. 

8874     .     . 

.     .     2557 

422     .     . 

.     .       204 

6458     .     . 

.     .     2811 

599     .     . 

.     .       286 

163     .     . 

.     .         60 

16516 

5918 

France 


Charenton,  from  22d  Nov.  1798,  to  22d 

July,  1800,                                                       97     .     . 

.     .         33 

Do.  in  1803,                                                       499     .     . 

.     .       161 

Salpetriere,  1801  to  1805,                                1002     .     . 

.     .       407 

Do.  1804  to  1813,                                           2005     .     . 

.     .     1218 

My  own  Establishment  from  1801  to  1813,     335     .     . 

173 

Totals, 


39;38 


1992 


TABLE  OF  CURES  OBTAINED  AT  THE  SALPETRIERE  DUR- 
ING TEN  YEARS. 

-o  5S  lears. 

1 1       , ^ . 

<^  1804   1805  1806  1807  1808  1809  1810  1811  1812  1813  1814 

209  64       47         7         4         3         2         0         1  1         0         0 

212  —       73       54         4         2         2         1         0  0         0         1 

206  —       —       78       49       10         3         1         1  i         0         0 

204  —       —       —       60       55       11         1         0  2         0         0 

188  —       —       —       —       64       57         4         2  1         0         2 

209  —       —       —       —       —       48       64         9  4         1         3 

190  —       —       —       —       —       —       48       51  7         1         3 

163  —       —       —       —       —       —       —       44  30         8         3 

208  —       —       —       —       —       —       —       —  75       41        11 

216  —       —       —       —       —       —       —       —  —       50       49 


a 


129 
137 
143 
129 
130 
129 
110 

85 
127 

99 


2005 


1218 


From  the  reports  made  in  different  establishments  or  hospitals  for  the  in- 
sane, we  conclude  :  1,  that  the  absolute  cures  of  the  insane  are  about  one 
third.*  2,  that  the  number  of  cures  varies  from  a  fourth  to  a  half  This 
difference  depends  upon  the  peculiar  circumstances,  of  locality,  maladies,  and 
treatment.  3,  that  the  cures  are  more  numerous  in  France  than  in  England, 
(they  are  much  more  rare  in  Germany  and  in  Prussia).  Thus,  whatever  dis- 
play the  English  may  make  of  their  success  in  the  treatment  of  the  insane, 
we  can  oppose  to  it  still  greater  success  in  France. 

*  In  the  establishment  of  Ivry,  we  enumerate  among  529  insane  of  the  two  sexes,  not 
paralytic,  263  cures=l  to  2.01. 


\ 


U 


•O. 


62  INSANITY. 

A  word  of  information  this  to  such  of  my  countrymen,  as  think  that  the 
better,  must  be  always  among  strangers. 

It  is  not  sufficient  to  determine  the  number  of  cures.  It  is  of  importance 
moreover,  to  ascertain  the  duration  of  mental  alienation,  or  of  its  treatment. 
It  is  with  this  view,  that  I  have  arranged  the  second  table,  embracing  a  list  of 
cures  during  ten  years. 

The  first  column  presents  the  number  of  admissions,  a  deduction  being 
made  of  the  incurables ;  the  horizontal  lines,  indicate  the  cures  of  each  year ; 
the  second  vertical  column  indicates  the  total  number  of  cures. 

I  have  constantly  observed,  that  in  the  course  of  the  first  month  of  the  dis- 
ease, a  strikingly  marked  remission  takes  place.  The  insanity,  which,  up  to 
that  period,  had  an  acute  and  violent  course,  seems  to  have  reached  its  close  ; 
and  it  is,  at  this  time,  that  it  seems  to  pass  into  a  chronic  state,  because  the 
crisis  is  incomplete. 

Ought  this  remission,  which  I  have  observed  with  the  greatest  care,  to  be 
attributed  also  to  the  symptoms  which  complicate  insanity  at  its  commence- 
ment ?  It  is  often  during  the  first  month,  that  we  obtain  the  greatest  number 
of  cures,  when  compared  with  the  following  ;  a  fact  which  confirms  the  cor- 
rectness of  the  Memoir,  read  by  Pinel  before  the  Institute  in  1806. 

The  mean^erm  of  the  duration  of  insanity  has  been  fixed  in  this  memoir, 
at  between  five  and  six  months.  M.  Pinel  has  excluded  from  the  estimates 
which  led  to  this  result,  all  those  who  had  been  elsewhere  subjected  to  treat- 
ment, as  well  as  those  whose  insanity  was  of  long  standing.  Mr.  Tuke  gives 
a  greater  extension  to  the  duration  of  insanity,  in  the  account  which  he  ren- 
ders, of  the  Retreat  near  York.  Our  data  oblige  us  to  range  ourselves  in 
opinion  with  the  latter.  I  was  led  to  this  conclusion,  by  making  up  the  report 
of  the  insane  women,  admitted  at  the  Salpetriere,  during  ten  years.  This  re- 
port extends  from  1804  to  1813.  There  were  received,  during  this  period, 
two  thousand  eight  hundred  insane  women.  Seven  hundred  and  ninety-five 
were  regarded  as  incurables,  in  consequence  of  their  age,  or  because  they 
were  imberiles,  epileptic  or  paralytic. 

Two  thousand  and  five  were  put  under  treatment,  without  reference  to  the 
duration,  or  character  of  their  insanity.  Of  this  number,  six  hundred  and  four 
were  cured  during  the  first  year,  five  hundred  and  two  the  second,  eighty-six 
the  third,  and  forty-one  in  the  seven  following  years ;  whence  we  may  con- 
clude, 1st,  that  we  obtain  the  greatest  number  of  cures  during  the  first  two 
years ;  2d,  that  the  mean  term  of  cures,  is  a  little  less  than  one  year ;  3d,  that 
after  the  third  year  the  probability  of  a  cure  is  only  as  one  to  thirty.  There 
are  however  examples,  which  prove  that  we  ought  never  to  despair  of  the  cure 
of  the  insane. 

Pinel,  after  Baumes,  cites  the  memorable  example  of  a  lady,  who  had  pass- 
ed twenty-five  years  in  a  state  of  mania,  as  was  known  to  a  whole  province, 
and  who  suddenly  recovered  her  reason.  I  knew  a  girl  who,  for  ten  years, 
was  in  a  state  of  dementia,  with  suppression  of  her  menses.  One  day  on  ris- 
ing, she  runs  to  embrace  her  mother  ;  saying,  "  oh  !  mamma,  I  am  cured"  ! 
Her  menses  had  just  commenced  flowing  spontaneously,  and  reason  was  im- 
mediately established.     But  these  cases  are  rare. 

They  prove,  that  when  there  are  no  marked  indications  of  incurability,  or 
when  no  physical  disorder  exists,  we  may  hope,  that  at  length,  insanity  will 
cease.  I  have  seen  it  twice  terminate  at  the  critical  period,  with  two  women, 
who  had  been  insane,  and  even  in  maniacal  dementia  from  their  earliest  youth. 
There  was  at  the  Salpetriere,  while  I  was  physician  at  that  hospital,  a  woman 
who  had  become  insane  at  her  first  menstrual  period,  and  who  was  cured  at 
forty-two  years  of  age,  at  the  disappearance  of  the  menses. 

The  greater  number  of  cures  are  obtained  in  spring  and  autumn. 


INSANITY.  (33 

The  age  most  favorable  for  cure,  is  from  twenty  to  thirty  years.  Passed 
fifty  years  the  cures  are  rare. 

Mania  and  monomania,  are  much  more  frequently  cured  than  lypemania. 
We  never  cure  idiocy  nor  senile  dementia.  Chronic  dementia  is  rarely  cured. 
Mania  is  cured  more  promptly  than  lypemania.  There  are  many  insane  per- 
sons, who  can  be  restored  only  to  a  certain  point. 

Those  individuals  retain  such  a  degree  of  susceptibility,  that  the  sliirhtest 
causes  provoke  relapses,  and  they  preserve  their  reason  only  by  being  remov- 
ed from  society,  to  a  place  where  no  moral  shock,  no  disquietude,  no  event 
exposes  them  to  relapse  into  their  former  condition.  There  are  others,  whose 
brain,  and  consequently  the  reason,  has  experienced  such  a  shock,  that  they 
can  no  more  act  the  part  which  they  were  formerly  accustomed  to  perform  iii 
society. 

They  are  very  rational,  but  do  not  retain  mind  enough  to  be  military  cha- 
racters, to  conduct  their  commercial  affairs,  or  to  control  successfully  their 
private  business.  We  may  estimate  these  individuals,  at  one  twentieth  of  the 
number,  who  recover  their  reason. 

The  greater  part  of  the  insane  retain  a  painful  recollection  of  their  malady. 
They  are  often  ungrateful  for  the  attentions  which  they  have  received,  be- 
cause they  imagine  that  they  are  despised  on  account  of  their  malady,  and 
that  they  have  been  removed  from  society,  isolated,  and  treated  at  an  impro- 
per time.  This  phenomenon,  which  has  been  noticed  by  the  ancients,  and 
which  is  usually  very  marked  during  the  earlier  periods  of  convalescence,  is 
dissipated  by  degrees,  and  disappears  at  length,  when  the  individuals  have 
recovered  their  full  measure  of  health. 

Almost  all  the  insane,  even  maniacs,  have  a  recollection  of  their  ideas,  illu- 
sions, false  judgments,  and  affections,  whatever  may  have  been  the  disorder  of 
their  intellicrence. 

When  they  become  convalescent,  they  render  a  very  good  account  of  their 
illusions  and  hallucinations ;  of  their  repugnances,  and  aversions ;  of  their 
preferences,  and  obstinacy  ;  in  fine,  of  the  motives  of  their  determinations 
and  acts. 

They  determine  with  great  accuracy  the  epoch  of  the  cessation  of  the  de- 
lirium. They  indicate  the  causes  that  have  produced  it,  or  the  symptoms  that 
have  signalized  it.  They  appreciate  the  attentions  that  have  been  paid  them, 
the  good  or  the  evil  that  they  have  done,  and  the  errors  or  faults,  -which  they 
have  committed  during  the  existence  of  their  malady.  Insanity  is  not,  there- 
fore, attended  by  loss  of  consciousness,  for  the  insane  man  often  preserves  the 
recollection  of  his  condition. 

Many  melancholies  and  even  maniacs,  have  a  perfect  knowledge  of  all  their 
discourses,  and  of  all  their  actions,  and  after  their  cure,  they  relate  with  sur- 
prising exactitude,  what  they  have  done,  said,  or  thought.  Many,  in  conse- 
quence of  the  recollection  which  they  preserve  of  these  things,  dare  not  ap- 
pear in  public,  to  renew  their  former  relaticms,  fearing  that  in  entering  into 
the  world,  they  shall  become  objects  of  curiosity,  of  commisseration  and  dis- 
trust, which  wounds  their  self-love  and  humbles  them.* 

*I  have  reported,  in  the  "Annals  of  public  hygiene  and  legal  medicine,"  1636,  t. 
XVIth,  page  197,  the  psychological  condition  of  a  hypochondriacal  lady,  from  extracts  of 
letters  which  were  addressed  to  me  by  the  patient.  All  the  symptoms  which  this  lady 
experienced,  were  set  forth,  and  analyzed  by  her,  with  remarkable  correctness. 

In  the  same  volume  of  the  Annals,  may  be  found  a  memoir  of  Doctor  Bergmann, 
where  are  recorded  the  reflections  of  a  person  who,  having  been  afflicted  with  mania, 
relates  all  that  he  experienced  during  his  sickness. 

M.  Leuret,  in  his  "  Psychological  Fragments  on  Insanity,'"  Paris,  1834,  in  8vo.  p.  25. 
has  published  the  history  of  a  maniac  whom  he  saw  at  Ivry  ;  a  maniac,  who  could  re- 


64  INSANITY. 

It  is  not  uncommon,  that  individuals  who  are  regarded  as  cured  by  their 
relatives  and  even  physician,  are  not  entirely  so. 

They  reason  perfectly  well,  have  returned  to  their  former  habits  and  mode 
of  living,  and  even  discharge  important  duties,  whilst  there  still  remains  some- 
thing peculiar,  strange  and  unnatural. 

A  gentleman,  whose  malady  had  been  characterized  by  hallucinations  of 
hearing,  although  perfectly  restored  to  reason,  experienced  still  the  same  hal- 
lucinations. But  this  symptom  was  fugacious,  and  the  convalescent  very  well 
understood  the  cause  of  it.     It  persisted  for  four  months. 

M.  N.  had  been  cured  of  lypemaniacal  mania,  had  returned  to  his  family, 
and  been  appointed  to  distinguished  trusts,  the  duties  of  which  he  fulfilled  in 
a  remarkable  manner. 

For  a  year,  he  was  unwilling  to  turn  his  attention  to  an  estate,  in  which  he 
was  much  interested,  to  correspond  with  reference  to  it,  to  admit  of  conversa- 
tion on  the  subject,  or  to  permit  his  wife  and  children  to  visit  it.  It  was  on 
this  estate,  that  his  delirium  had  first  burst  forth,  with  the  greatest  violence. 

A  lady,  cured  apparently  of  an  attack  of  suicidal  lypemania,  with  parox- 
ysms of  mania,  passes  a  month  in  Paris,  to  divert  her  mind,  and  confirm 
her  convalescence.  She  then  returns  to  her  family,  and  all  her  former  habits. 
Every  one  is  convinced  of  her  perfect  restoration  to  health. 

A  year  after,  her  husband  was  seized  Avith  an  alarming  attack  of  apoplexy. 
The  grief  she  experienced  in  consequence  of  it,  produced  a  profound  impres- 
sion upon  her  mind,  which  resulted  in  her  cure.  Up  to  this  period,  she  had 
led  a  very  retired  life,  with  irrational  notions,  from  which,  the  care  she  had 
taken  of  her  children,  to  prevent  the  effect,  which  their  untimely  death  would 
have  produced  upon  the  mind  of  their  father,  alone  relieved  her. 

Mad'e  N.,  after  having  been  distres.sed  for  many  months,  by  a  gloomy  and 
insane  jealousy,  which  had  impelled  her  even  to  wish  to  destroy  her  children, 
was  unwilling  to  see  them  for  eight  months  after  her  apparent  cure,  although 
enjoying  the  perfect  use  of  her  reason,  and  restored  to  society,  where  she  was 
distinguished,  as  well  by  her  wit,  as  her  extraordinary  personal  charms. 

The  cases  which  I  have  above  reported,  prove  to  a  demonstration,  that  we 
cure  a  greater  number  of  the  insane  than  formerly.  But  the  relapses  !  the  re- 
lapses are  so  frequent !   is  repeated  on  all  sides. 

So  true  is  it,  that  it  is  as  difficult  to  dissipate  apprehension  from  the  mind 
of  man,  as  to  establish  hope  in  his  breast.  We  must  not  confound  relapses, 
with  new  attacks  of  insanity. 

Of  two  thousand  eight  hundred  and  four  insane  persons,  treated  at  the  Sal- 
petriere,  two  hundred  and  ninety-two  were  there,  for  a  second  or  third  attack. 
We  may  thus  conclude,  that  one  tenth  of  the  cases  are  relapses.  Among  the 
wealthy,  relapses  are  less  fretpient ;  without  doubt,  because  they  have  more 
means  at  their  control,  and  a  greater  desire  to  avoid  the  causes  of  a  relapse, 
while  the  misery  and  indifference  of  the  poor,  expose  them  to  the  action  of 
every  malign  influence. 

Physicians  know  well,  that  those  who  have  had  fevers,  the  phlegmasia?,  etc. 
are,  more  than  others,  exposed  to  a  recurrence  of  the  same  maladies ;  because 
an  organ,  once  affected,  is,  from  this  circumstance,  more  disposed  than  an- 
other, to  be  affected  anew  in  the  same  manner. 

We  give  not  the  title  of  relapse,  to  a  recurrence  of  these  maladies.  Why 
give  it  to  a  new  attack  of  insanity  ?  Do  not  all  hospital  physicians  see 
frequently  returning  to  their  wards,  the  same  individuals,  and  for  the  same 
causes  ? 

call,  two  days  after  he  had  uttered  them,  words  altogether  incolierent,  and  wliich  a  man, 
enjoying  the  use  of  his  reason,  unless  endowed  with  an  extraordinary  memory,  would 
have  foimd  great  difficulty  in  recollecting. 


INSANITY.  65 

They  consider  themselves  as  about  to  treat  a  new  malady,  and  not  a  pre- 
ceding one,  that  had  been  cured. 



I  do  not  deny,  that  the  insane  are  subject  to  relapses.  They  are  perahps 
more  exposed  than  other  classes  of  patients ;  because  the  exciting  causes  of 
insanity  are  numerous,  and  appear  every  where,  and  in  all  the  circumstances 
of  life  ;  because  the  crises  of  this  malady  are  less  complete  ;  and  because 
individuals  who  have  been  cured,  are  less  cautious  in  guarding  themselves 
against  accidents,  which  have  produced  their  former  attacks. 

But  because  men  are  imprudent,  ought  we  to  censure  the  impotence  of 
medicine  1  I  add,  that  relapses  are  often  foretold  ;  and  that  they  might,  fre- 
(juently,  have  been  prevented. 

Greding,  Monro,  and  Crichton,  are  of  opinion,  that  the  insane  are  not  long 
lived,  even  those  who  have  recovered  the  use  of  their  reason.  To  a  certain 
extent,  I  participate  in  this  opinion  ;  but  I  do  not  go  beyond  them,  as  Doctor 
Andre  has  done  in  a  German  Journal. 

In  opposition  to  this  afflictive  decision,  experience  proves,  that  many  insane 
persons  lead  a  long  life.  It  is  not  rare  to  find  in  hospitals,  insane  persons 
who  have  lived  there  twenty,  thirty  and  forty  years. 

The  mortality  of  the  insane  presents  several  interesting  considerations,  al- 
though neglected  hitherto.  It  ought  to  be  studied  with  reference  to  the 
number  of  the  insane,  to  the  season,  age,  sex,  and  form  of  insanity  ;  to  the 
malady  under  which  the  patients  succumb,  and  to  the  appearances  presented 
on  dissecticMi. 

The  mortality  of  the  insane,  like  their  cure,  depends  upon  many  local  cir- 
cumstances. 

Both  jone  and  the  other  are  modified  by  the  position,  and  general  arrange- 
ments of  the  place  in  which  they  are  treated  ;  by  the  direction,  supervision, 
and  regimen  ;  as  well  as  by  the  variety  of  patients  received  at  the  establish- 
ment. The  mortality  must  be  more  considerable,  and  the  cures  less  frequent, 
when  we  have  to  treat  every  form  of  insanity.  Thus,  the  tables  of  mortality, 
published  by  the  physicians  of  London  and  York,  are  the  more  favorable,  be- 
cause they  receive  at  those  hospitals  those  individuals  only,  who  offer  the  most 
favorable  indications  for  a  cure,  and  consequently,  most  widely  removed  from 
mortality  :  whilst  at  the  Salpetriere,  Bicetre,  and  Charenton,  more  than  one 
third  of  the  insane  admitted,  come  to  terminate  their  existence  at  these  hos- 
pitals. We  must  also  take  notice  of  the  accidental  circumstances  which  mo- 
dify the  mortality.  Thus,  we  have  observed  at  the  Hotel-Dieu  of  Paris,  that 
when  the  small  pox  was  epidemic,  a  greater  number  of  the  insane  died. 

In  1793,  scarcity  augmented  the  mortality  among  the  insane  at  the  Bice- 
tre (Pinel).* 

The  mortality  is  greater  in  autumn  and  winter,  as  the  following  table  (page 
68)  proves  ;  whilst  in  spring  and  summer  it  is  less.  In  the  latter  seasons,  the 
means  of  preserving  life,  concur  in  warding  off  dangers.  The  insane  are  less 
confined  than  in  winter  ;  they  take  more  exercise  ;  partake  of  fresh  vegetables  ; 
and  are  more  cheerful  and  gay. 

Thus,  spring  is  doubly  favorable  to  the  insane  ;  since  a  greater  number  are 
cured,  and  less  die  than  at  other  seasons ;  a  consideration,  which  furnishes  a 
valuable  indication  for  the  direction  of  the  insane,  and  a  strong  objection  to 
debilitating  treatment. 

We  have  seen  that  the  age  most  favorable  to  the  production  of  insanity,  is 
from  twenty-five  to  thirty-five  years,  for  both  sexes.  The  same  is  not  true  of 
their  mortality. 

*  In  1832,  the  cholera  having  invaded  the  division  of  the  insane  at  the  BicdTtrp  and 
Salpetriere,  the  mortality  among  this  class,  at  the  two  hospitals,  was  more  considerable 
than  usual.     This  scourge  spared  the  hospital  at  Charenton. 

9 


66  INSANITY. 

This  is  highest  for  the  two  sexes  from  thirty  to  forty  years,  while  that  of 
women  is  highest  from  forty  to  fifty  years  ;  and  that  of  men  from  thirty  to 
forty.  It  is  higher  among  women  than  men,  from  sixty  years  and  upwards. 
It  results,  therefore,  from  the  table  above  referred  to,  that  the  mortality  of  the 
insane  takes  place  at  an  earlier  period  among  men,  and  is  far  greater  at  an 
advanced  period  of  life,  among  women. 

We  ought  also  to  take  notice  of  the  treatment,  in  order  correctly  to  appre- 
ciate its  effects.  The  mode  of  treatment  adopted  at  the  Hotel-Dieu,  rendered 
the  mortality  of  this  hospital  greater  than  it  is  at  present,  at  the  Bicetre  and 
Salpetriere. 

At  Marseilles,  Raymond  found  the  mortality  of  the  insane  to  be  as  one  to 

fourteen. 

Tenon,  at  Paris,  in  1786,  fixed  it  at  one  to  eleven. 

Pinel,  setting  aside  cases  of  senile  dementia,  estimates  it  at  one  to  twenty 
or  twenty-three. 

I  believe  that  it  is  higher.     It  is  as  one  to  six  or  eight. 

But  to  have  more  precise  ideas  on  the  subject,  we  must  consider  it,  with 
reference  to  the  various  forms  of  insanity. 

My  records  furnish  the  following : 

Mortality  in  mania,  one  to  twenty-five. 
Mortality  in  monomania,  one  to  sixteen. 
Mortality  in  lypemania,  one  to  twelve. 
Mortality  in  dementia,  one  to  three. 

Imbeciles  and  idiots  are  never  cured,  but  some  of  them  live  a  long  time. 
It  is  rare,  however,  that  they  survive  their  thirtieth  or  fortieth  year. 

Accidental  acute  mania  is  rarely  fatal ;  simple  lypemania,  even  that  which 
is  characterized  by  an  impulse  to  suicide,  is  mortal  only  when  it  depends 
upon  an  organic  lesion,  or  is  complicated  with  scrofula,  phthisis  and  paralysis. 
The  patients  then  fall  into  marasmus,  (tabes  melancholica  of  Lorry),  and  die. 

Dementia,  being  the  termination  of  all  forms  of  mental  alienation,  is  most 
commonly  fatal.  It  is  often  complicated  with  paralysis  ;  and  it  is  this  com- 
plication, which  renders  the  mortality  of  the  Bicetre  and  Salpetriere,  so  much 
greater,  as  they  are  the  receptacles  of  every  form  of  insanity.  The  mortality 
of  the  insane  is  greater  during  the  first  two  years  after  the  invasion  of  the 
malady,  than  the  following.  It  is  greatest  during  the  first  year  after  their 
admission,  among  our  women  at  the  Salpetriere. 

These  considerations  lead  us  to  the  study  of  those  maladies  to  which  the 
insane  succumb. 

Those  which  most  frequently  terminate  the  existence  of  the  insane,  are  in- 
flammation of  the  meninges,  cerebral  fever,  apoplexy,  organic  lesions  of  the 
brain,  and  of  the  thorax  or  abdomen. 

We  may  estimate  two  eighths  of  encephalic  affections,  (excepting  epilepsy 
and  paralysis  from  the  number  of  maladies  which  destroy  the  insane),  two 
eicrhths  of  disorders  of  the  thorax  ;  and  three  eighths  of  abdominal  complaints, 
colnprising  among  them,  colliquative  diarrhoea ;  and  marasmus  without  orga- 
nic lesion. 

Monro,  on  the  authority  of  the  aphorisms  of  Greding,  assures  us  that  ma- 
rasmus and  dropsy  of  the  chest  occasion  the  greatest  amount  of  mortality 
among  the  insane.  The  examination  of  about  six  hundred  bodies  of  the  in- 
sane, has  not  led  me  to  this  conclusion.  On  the  contrary,  diseases  of  the  tho- 
rax are  less  numerous  than  those  of  the  abdomen. 

Does  this  difference  depend  upon  climate  and  mode  of  living,  or  upon  the 
mode  of  treatment  employed  to  combat  the  disease  ? 

A  slow,  nervous  fever,  often  terminates  lypemania.  Some  lypemaniacs  re- 
fuse all  motion.  At  one  time  they  are  unwilling  to  leave  their  bed;  at  another, 
they  insist  upon  sitting  on  the  ground.     Some  obstinately  refuse  every  kind  of 


INSANITY.  "  61 

aliment ;  others  eat  with  frightful  voracity.  They  seem  to  take  a  pleasure,  in 
braving  whatever  can  destroy  their  organization.  They  waste  away.  Their 
skin  becomes  earthy.  They  fall  into  a  state  of  extreme  debility.  A  parox- 
ysm of  fever  returns  at  every  evening.  A  diarrhoea  often  supervenes,  and 
hastens  their  doom. 

Phthisis,  which  complicates  insanity,  and  more  particularly  lypemania,  has 
been  observed  by  Mead  and  Lorry.* 

In  a  great  many  cases  of  insanity,  I  have  known  lypemania  and  even  mania, 
preceded  by  many  months,  by  phthisis,  or  appear  at  the  same  time  with  it. 
These  cases  of  phthisis,  escape  the  notice  of  the  most  careful  observers. 
Th«  patients  become  more  and  more  feeble  ;  fall  into  marasmus,  and  a  slow 
fever  ;  attended  sometimes  with  cough,  and  diarrhoea.  At  length  they  die. 
The  delirium,  far  from  ceasing,  augments,  even  to  the  end. 

At  the  opening  of  the  bodies,  we  find  the  lungs  tuberculous,  suppurating, 
and  sometimes  with  vomices.  Melanosis  of  the  lunss  is  not  rare.  The 
intestines,  almost  always,  present  traces  of  inflammation  and  gangrene  ;  as 
well  as  suppuration  of  the  crypts  of  the  mucous  membrane. 

It  might  be  supposed  that  organic  lesions  of  the  lung  existed,  because  the 
insane  cry  and  use  this  organ  in  their  vociferations.  It  is  not  so ;  since 
phthisis  is  generally  observed  only  among  lypemaniacs,  who  never  vociferate. 

Hippocrates  informs  us  in  the  Coacs,  that  the  phrensy  which  supervenes 
upon  pleurisy,  is  fatal.  Sometimes  also,  insanity  alternates  with  phthisis,  and 
while  the  delirium  lasts,  even  in  its  most  violent  form,  the  symptoms  of  phthisis 
cease  to  appear. 

Scurvy  is  still  one  of  the  most  frequent  complications  of  mental  alienation. 
It  is  often  a  result  of  insanity,  of  the  insalubrity  of  the  habitations,  of  the 
want  of  exercise,  and  the  bad  regimen  of  the  insane. 

The  scorbutic  belonging  to  this  class  are  either  lypemaniacs,  or  in  a  state 
of  dementia,  and  very  often  paralytic.  It  manifests  itself  by  yellow,  brown, 
or  black  spots  upon  the  members,  and  the  gums  are  fungous.  These  patients 
are  seized  with  a  serous  and  sometimes  sancjuinolent  diarrhoea ;  the  extremi- 
ties  become  oedematous  ;  pains  and  spasms  of  the  stomach  supervene  ;  and 
the  face  is  pale,  and  swollen. 

Eschars  upon  the  sacrum,  heels,  the  malleoli,  trochanters,  and  elbows,  invo- 
luntary and  serous  dejections,  and  syncopes,  presage  approaching  death. 

On  opening  the  bodies,  we  find  serous  eftusions  in  the  head,  and  the  brain 
is  infiltrated.  The  heart  is  flaccid,  and  often  the  capacity  of  the  pulmonary 
ventricle,  and  particularly  that  of  the  right  auricle,  is  augmented.  The  gall 
bladder  is  full  of  black  and  viscid  bile.  The  spleen,  more  or  less  voluminous, 
is  reduced  to  a  condition  resembling  the  lees  of  wine.  The  mucous  mem- 
brane  of  the  intestines  is  injected,  and  coated  with  a  brown,  sanguinolent  mu- 
cosity.     The  muscles,  pale  and  discolored,  are  torn  with  the  greatest  facility. 

Half  of  the  insane,  whatever  may  be  the  character  of  the  delirium,  but 
more  particularly  monomaniacs  who  die,  are  paralytic. 

These  individuals  suffer  more  or  less  embarrassment,  in  the  articulation  of 
sounds  ;  though  their  minds  are  sometimes  but  slightly  deranged,  at  the  com- 
mencement of  the  malady.  After  some  months  or  a  year,  if  they  have  not  gain- 
ed in  flesh,  they  become  very  lean,  grow  feeble,  walk  with  difficulty,  and  incline 
ordinarily  to  the  left  side.  The  dejections  become  involuntary,  without  being 
more  liquid.  There  is  incontinence  of  urine  ;  embarrassment  of  speech  in- 
creases ;  and  the  vital  forces  diminish,  although  they  may  take  exercise,  and 
the  appetite  be  voracious. 

From  the  time  that  they  take  their  bed,  gangrenous  eschars  form  at  the  coc- 
cyx, or  the  trochanters,  heels  and  elbows.  This  humid  gangrene  makes  ra- 
pid progress,  and  the  bones  are  soon  denuded.     Fever    sets   in.     Epileptiform 

*  De  melancholia  et  morbis  melancholisis,  Parisiis,  1763,  t.  I.  p.  385. 


68 


INSANITY. 


convulsions  supervene ;  the  members  are  livid,  and  very  cold  ;  the  pulse  is  no 
longer  perceptible,  and  the  patients  die. 

I  have  pointed  out  these  two  terminations,  because  I  have  very  often  observ- 
ed them. 

Apoplexy  is  still  one  of  the  maladies  which  terminates  the  life  of  the  in- 
sane. Of  two  hundred  and  seventy-six  individuals,  thirty-seven  died  apoplec- 
tic. Pinel  the  elder,  has  noticed  this  variety  of  sudden  death,  by  which  some 
maniacs  and  monomaniacs  are  overwhelmed,  particularly  during  the  winter. 
Aged  persons  are  more  exposed  to  it  than  the  young.  Suddenly,  the  most 
violent  fury,  and  the  wildest  delirium  cease ;  and  in  a  few  moments  the  patient 
dies.  It  would  seem  that  all  the  vital  forces  had  been  exhausted,  by  the  .ex- 
cess of  maniacal  excitement. 

I  had  in  charge  an  old  man  seventy-two  years  of  age,  dry  and  lean,  who, 
for  three  months,  was  in  a  constant  state  of  agitation  and  delirium.  He  comes 
out  of  this  state,  and  in  the  calmest  tone,  asks  his  servant  for  his  snuff  box, 
takes  from  it  a  pinch  of  snuff,  and  expires. 

Putrefaction  of  the  body  speedily  ensued,  and  the  interior  of  the  cranium 
presented  no  alteration.  M.  ***",  forty-three  years  of  age,  of  a  dry  tempera- 
ment, suffered  for  a  month,  from  an  attack  of  delirium,  with  fury.  On  the 
thirty-first  day,  we  noticed  that  he  was  pale.  He  asks  to  sit  down,  and  ex- 
pires. I  found  in  the  duplicature  of  the  falciform  fold  of  the  dura  mater,  an 
osseous,  pisiform  substance  about  three  lines  in  diameter,  depressing  the  cor- 
responding convolution  of  the  brain.     In  other  cases  I  have  found  nothing. 


TABLES  RELATING  TO  THE  MORTALITY  OF  THE  INSANE. 

No.  1.     Mortality  relative  to  admissions. 


Admissions 
Bicetre,  from  the  year  1784  to  1794,  1405 

Salpetriere  (Pinel),  from  1801  to  1805,  1002 

Charenton,  during  the  year  1803,  499 

Salpetriere,  from  1804  to  1814,  2804 


Deaths. 
685 
250 
82 
790* 


No.  2.     Mortality  relative  to  Seasons. 

During  the  ten  years,  from  1804  to  1814,  the  790  deaths  at  the  Salpe- 
triere, presented  the  following  proportions,  relative  to  seasons : 

March,  April,  May,                .             .             ,             .  .       175 

June,  July,  August,         -             -             -             -             -  174 
September,  October,  November,       ....       234 

December,  January,  February,                  ...  207 


790 


Mortality  with  respect  to  Age. 

I  have  here  compared   the   mortality  of  men  with  that  of  women,  relative 
to  age,  during  an  equal  number  of  years,  and  from  a  nearly  equal   number  of 
deaths,  of  the  two  sexes. 
Bicetre ;  Men,  from  1784  to  1794.      Salpetriere ;  Women,  from  1804  to  1814. 


20 

years, 

30 

40 

50 

60 

70 

and  above, 


-  25 
176 

-  215 
134 

-  90 
45 


58 
83 
143 
173 
123 
210 


685  790 

*  The  790  deaths  at  the  Salpetriere,  from  1804  to  1814,  relative  to  admissions,  took 


INSANITY.                             •  69 

TABLE  OF  MORTALITY 

At  the  Salpetriere,  during  ten  years. 

No.  of  ad-                                                    Years.  i^ 

missions       r- ^ — • ->,  §■ 

each  year.     1804  1805  180G  1807  1808  1809  1810  1811   1812  1818  ^ 

271             46       21       15         8         1         6         2         1         1  1  102 

301             —       48       29       16         7         2         4         1         0  2  109 

292             _      _       49       22         9         2         1         4         2  1  90 

297  ___       64       25         3         2         2         4  1  101 
252            _      _      _      _      35      23        8         I         3  1  71 

299             _____       35       31         7         3  1  77 

260             ______       30       22         9  3  64 

233             _______       26       20  9  55 

301             ________       23  10  33 

298  _________  26  26 


2804  728 

Those  who  died  during  this  period,  but  who  were  admitted  before  1804,      52 


Total,         ......         r         ..  .         780 

List  of  Diseases,  which  terminated  the  existence  of  the  Insane. 

Adynamic  fever           -             -             -             -             -  -       32 

Ataxic  fever,         -             -             -             -             -             -  14 

Cerebral  fever,             -             -             -             -             -  -       28 

Slow  nervous  fever,           -----  25 

Pleurisy,         -             -             -             -             -'           -  -       12 

Phthisis,                 ....--  28 

Latent  Peritonitis,       -             -             -             -             -  -       13 

Colliquative  diarrhoea.  Scurvy,       -             -             -             -  38 

Hydropericonditis,      -              -              -              -              -  -11 

Scirrus  of  the  pylorus,      -----  4 

Organic  lesions  of  the  liver,                 -             -             -  -       35 

Apoplexies,            __----  33 

Epilepsies,      -------4 


Total  ------  277 

We  are  now  naturally  conducted  to  the  post  mortem  examinations  of  the 
insane. 

From  this  announcement,  every  one  doubtless  expects,  that  we  are  about  to 
point  out  the  seat  of  insanity,  and  to  make  known  the  nature  and  seat  of  the 
organic  lesion,  of  which  insanity  is  the  expression. 

This  we  are  by  no  means  to  accomplish.  The  examinations  of  the  dead 
have,  to  the  present  period,  been  barren  of  practical  information. 

The  facts  observed  by  Willis,  Manget,  Bonet,  Morgagni,  Gunz,  Meckel, 
Greding,  Vicq-d'Azyr,  Camper,  Chaussier,  Gall,  etc.,  have  produced  only  ne- 
gative, or  contradictory  results. 

These  distinguished  observers  had  but  few  subjects  submitted  to  their  re- 
searches. 

All  the  labor  that  has  been  expended  upon  the  anatomy  of  the  brain,  has 
produced  no  other  result,  than  a  more  exact  description  of  this  organ,  and  the 

place  in  the  following  proportion  ;  382,  during  the  first  year,  227,  the  second,  and  181, 
during  the  seven  following  years. 


70  INSANITY. 

despairing  certainty,  of  our  beinoj  forever  unable  to  assign  to  its  parts,  the 
uses  from  whence  we  may  derive  information,  with  reference  to  tlie  exercise 
of  the  thinking  faculty,  whether  in  health  or  disease. 

Before  drawing  any  conclusions,  from  those  organic  lesions  observed  among 
the  insane,  will  it  not  be  well  to  acquaint  ourselves  with  all  the  varieties,  both 
of  the  cranium  and  brain,  which  are  compatible  with  the  integrity  of  the  fa- 
culties of  the  understanding  ? 

Would  not  this  be  the  true  point  of  departure,  for  all  our  pathological  re- 
searches ? 

Now,  says  the  learned  Chaussier,  there  is  no  organ  in  which  we  find  greater 
varieties,  with  respect  to  volume,  weight,  density,  and  in  its  respective  propor- 
tions, than  in  the  brain.* 

Have  we  carefully  distinguished  the  results  of  concomitant  maladies,  or 
those  diseases  which  terminate  the  life  of  the  insane,  from  those  which  belong 
to  mental  alienation  ? 

Organic  lesions  of  the  brain  reveal  themselves  by  other  signs  than  insanity. 
Thus,  chronic  inflammation  of  the  meninges  produces  compression,  which 
reveals  itself  by  paralysis  ;  cerebral  hemorrhage  is  also  manifested  by  paraly- 
sis. Tubercles,  cancers,  and  softening  of  the  brain,  present  peculiar  charac- 
ters, which  cannot  be  confounded  with  mental  alienation. 

Have  we  reflected  on  the  sudden  and  instantaneous  cures  of  insanity  ?  It 
is  in  consequence  of  having  neglected  these  considerations,  that  we  reason  so 
erroneously  respecting  the  seat  of  this  malady.  The  minute  and  detailed  de- 
scription of  the  alterations,  and  organic  lesions,  observed  in  the  post-mortem 
examinations  of  the  insane,  would  be  too  long,  and  the  less  necessary,  as  they 
offer  nothing  of  a  satisfactory  nature. 

In  treating  upon  mania,  monomania,  etc.,  I  shall  speak  of  the  examinations 
made  upon  the  bodies  of  those  who  have  died  while  suffering  from  these  vari- 
ous forms  of  insanity. 

I  shall  in  this  place  content  myself  with  giving  the  conclusions  which  I 
have  been  able  to  draw,  from  post-mortem  examinations  hitherto  made. 

I  do  not  pretend,  that  they  are  mathematically  exact ;  but  that  they  are  in 
the  main  correct,  with  respect  to  the  facts  observed. 

1.  Vices  of  conformation  in  the  cranium,  are  met  with,  only  among  imbe- 
ciles, idiots,  and  cretins. 

2.  Organic  lesions  of  the  encephalon  and  its  envelopes,  have  been  observed 
only  among  those  whose  insanity  was  complicated  with  paralysis,  convulsions 
and  epilepsy  ;  or  rather,  these  lesions  appertain  to  the  malady  which  has 
caused  the  death  of  the  patients. 

3.  The  sanguine  or  serous  effusions  ;  the  injections,  or  infiltrations,  which 
we  meet  Avith  in  the  cranial  cavity  ;  the  thickening  of  the  meninges  ;  their 
adhesions  among  themselves,  with  the  cranium  and  the  gray  substance  ;  the 
partial  or  general  softening  of  the  brain  ;  the  density  of  this  organ ;  the 
fibrous,  knotty,  and  cancerous  tumors,  observed  within  the  cranium  ;  all  these 
alterations  indicate  either  the  causes,  or  effects  of  insanity  ;  or  rather  the 
effects  of  a  complication,  to  which  the  patients  have  yielded. 

4.  The  alterations  within  the  thorax,  abdomen  and  pelvic  cavity,  are  evi- 
dently independent  of  insanity.  These  alterations  may,  nevertheless,  indicate 
the  source  of  mental  alienation,  by  showing  the  organ  primitively  affected, 
which  has  reacted  upon  the  brain. 

5.  All  the  ororanic  lesions  observed  among  the  insane,  are  found  to  exist 
among  those,  who  have  never  suffered  from  chronic  delirium. 

6.  Many  post-mortem  examinations  of  the  insane,  have  revealed  no  altera- 
tion, although  the  insanity  may  have  persisted  for  a  great  number  of  years. 

*  A  brief  exposition  of  the  structure  and  parts  of  the  encephalon.    Paris,  1807,  in  8  fig. 


INSANITY.  71 

7.  Pathological  anatomy,  shows  us  every  part  of  the  eacephalon,  altered,  in 
a  state  of  suppuration,  and  destroyed,  without  chronic  lesion  of  the  under- 
standing. 

8.  From  the  above  data,  we  may  conclude,  that  there  are  cases  of  insanity, 
whose  immediate  cause  escapes  our  means  of  investigation  ;  that  insanity  de- 
pends upon  an  unknown  modification  of  the  brain  ;  that  it  has  not  always  its 
point  of  departure  in  the  brain,  but  rather  in  the  foci  of  sensibility,  situated 
in  different  regions  of  the  body;  as  disorders  of  the  circulation  do  not  always 
depend  upon  lesions  of  the  heart,  but  upon  those  of  some  other  portion  oi'  the 
vascular  system. 

This  conclusion  will  be  opposed  to  those  who  pretend,  by  the  character  of 
the  delirium,  to  be  able  to  point  out  that  portion  of  the  brain  which  is  disturb- 
ed :  it  will  be  opposed  to  those  who  believe  that  there  is  an  ideal  insanitt/,  a 
form,  which  I  nuist  confess  my  inability  to  comprehend  ;  as  well  as  those  to 
which  they  give  the  appellation  ;  intellectual   insanity  ;  insanity  of  the  mind. 

I  am  not  more  fortunate,  in  understanding  the  various  systems  that  have 
been  devised,  for  explaining  the  delirium,  and  the  symptoms  of  mental  aliena- 
tion. 

Happily,  this  information  is  not  indispensable  to  the  cure  of  the  insane. 

Let   us  study  the  causes,  character,  course,  and  terminations  of  insanity  : 
let  us  endeavor  rightly  to  appreciate  the  influence  of  physical,  moral   and  in 
tellectual   agents,  over  this   disorder,  and  we  shall  discover  the  means,  suited 
to  combat  it. 

To  cure  insanity,  it  is  no  more  necessary  to  understand  the  nature  of  it, 
than  it  is  to  know  the  nature  of  pain,  to  employ  successfully,  calming  and  se- 
dative remedies. 


IV.     PROGNOSIS  OF  INSANITY. 

In  establishing  the  prognosis  of  insanity,  it  will  be  necessary  to  keep  before 
the  mind,  the  signification  which  I  have  given  to  the  five  forms  into  which  I 
have  divided  it.  Otherwise,  I  shall  be  found  opposed  to  those  with  whom  I 
concur  in  sentiment.  ^^^^      ^/ 

Imbecility  and  idiotism  are  never  cured.  ^  ^ 

Monomania  and  lypemania  are  cured,  when  they  are  recent,  accidental,  and 
do  not  depend  upon  an  organic  lesion. 

Mania  is  cured  more  frequently  than  monomania  and  lypemania.  >* 

Acute  dementia  is  sometimes  cured  ;  chronic  dementia  very  rarely  ;  senile 
dementia,  never.  j 

Hereditary  insanity  is  cured  ;  but  relapses  are  more  to  be  feared,  than  in 
accidental  insanity. 

Chronic  insanity  is  cured  with  difficulty,  especially  after  the  second  year. 
This  difficulty  is  proportioned  to  the  time  that  the  predisposing  causes  have 
been  operating  on  the  system,  prior  to  the  outbreak  of  delirium. 

Whatever  may  be  its  duration,  we  may  hope  for  the  cure  of  mental  aliena- 
tion, so  long  as  marked,  yet  curable  derangements  exist,  in  the  functions  of 
nutrition. 

Moral  causes,  which  have  acted  suddenly,  constitute  a  circumstance  in  favor 
of  a  cure  ;  but  if  their  operation  has  been  slow,  a  cure  is  effected  with  diffi- 
culty. 

Excessive  study,  when  it  produces  insanity,  may  well  occasion  doubts  re- 
specting a  cure ;  especially  when  with  these  excesses  are  connected  errors  of 
regimen. 

Insanity,  which  is  caused  or  continued  by  religious  notions,  or  by  pride,  is 
rarely  cured. 


72  INSANITY. 

Insanity,  maintained  by  hallucinations,  is  cured  with  great  difficulty. 

That  form  of  insanity  in  which  the  patients  are  aware  of  their  situation, 
presents  many  difficulties,  if  not  promptly  cured. 

When  the  insane  have  recovered  the  integrity  of  the  assimilative  functions, 
appetite,  sleep,  flesh,  etc.,  without  any  diminution  of  the  delirium,  we  have 
little  reason  to  expect  a  cure. 

When  the  sensibility  of  the  insane  is  so  much  enfeebled,  that  the  presence 
of  the  sun  does  not  affect  them  ;  that  they  lose  the  senses  of  taste  and  smell ; 
and  remain  unaffected  by  excesses  of  whatever  kind,  they  can  never  be  cured. 

Insanity  is  incurable,  when  it  is  the  result  of  scurvy  or  of  epilepsy.  Its 
complication  with  these  maladies  and  with  paralysis,  leads  to  inevitable  death. 


V.     TREATMENT  OF  INSANITY. 

It  is,  doubtless,  less  difficult  to  establish  systems,  and  to  imagine  brilliant 
hypotheses  respecting  mental  alienation,  than  to  observe  the  insane,  and  put 
up  with  the  disgusting  circumstances  of  whatever  kind,  to  which  those  are 
exposed,  who  would,  by  observation,  study  the  history  of  this  most  serious  in- 
firmity. 

The  difficulty  of  catching  the  varied  and  fugitive  forms  of  insanity,  the 
savage  rudeness  of  certain  monomaniacs,  the  obstinate  silence  of  some,  the 
scorn  and  abuse  of  others,  the  threats  and  blows  of  maniacs,  the  diswustinw 
filthiness  of  imbeciles,  together  with  the  prejudices  which  aggravate  the  lot  of 
these  unfortunates,  have  discouraged  those  who  wished  to  cultivate  this 
branch  of  the  healinw  art. 

They  shun  the  maniacs.     They  fear  them,  and  leave  them  in  their  chains. 

Monomaniacs  are  a  little  less  neglected.  They  submit  more  readily  to  ob- 
servation.    Their  delirium  is  more  amenable  to  theories  and  explanations. 

But  we  must  live  with  the  insane,  in  order  to  obtain  exact  notions  respect- 
ing the  causes,  symptoms,  course,  crises,  and  terminations  of  their  malady. 
We  must  live  with  them,  in  order  to  appreciate  the  infinite  cares  and  number- 
less detoils,  which  their  treatment  requires.  How  great  the  good  which  the 
patient  d  rives  from  friendly  and  frequent  intercourse  with  his  physician  ! 
How  valuable  the  lesson,  which  the  latter  acquires,  relative  to  the  influence 
of  the  physical  over  the  moral  man,  and  reciprocally  ! 

In  the  gestures,  movements,  looks,  and  general  aspect ;  in  his  proposals,  ac- 
tions, and  shades  of  conduct  which  are  imperceptible  to  others,  the  physician 
often  derives  his  first  thought,  respecting  the  treatment  which  is  suited  to  each 
patient  committed  to  his  care. 

Mental  alienation  offers  three  orders  of  phenomena,  whether  we  study  the 
causes  which  produce  it,  or  the  symptoms  which  characterize  it. 

We  have  seen  physical  as  well  as  intellectual  and  moral  causes,  acting  upon 
the  brain,  sometimes  individually,  sometimes  collectively,  produce  insanity. 
These  causes  have,  now  a  general,  now  a  local  action  ;  now  primitive  and 
immediate  ;  now  secondary  and  sympathetic.  Their  action  varies  with  the 
individual  cases,  and  their  effects  are  diverse,  and  even  opposite. 

We  have  seen  physical  disorders  as  well  as  moral  and  intellectual,  marking 
all  the  periods  of  the  malady,  in  degrees,  more  or  less  intense.  We  have 
sometimes  seen  nature  herself,  bear  the  whole  burthen  of  a  cure,  and  restore 
the  patient  to  health,  by  means  that  had  escaped  the  most  practiced  observers. 
Generally,  mental  alienation  is  terminated  by  sensible  crises.  It  is  not  rare 
to  witness  surprising  cures,  which  are  produced  by  moral  influences,  either 
accidental,  or  otherwise. 

Thus,  in  a  general  view  of  the  treatment  of  the  insane,  we  should  propose 


INSANITY.  73 

to  ourselves,  the  removal  of  physical  disorder,  the  aberrations  of  the  under- 
standing and  the  disturbance  of  the  passions. 

We  must,  therefore,  skillfully  control  the  mind  and  passions,  and  make  a 
suitable  use  of  the  physical  means,  which  ought  to  be  employed  in  the  treat- 
ment of  the  insane.  We  must  never  lose  sight  of  the  causes  which  have  pre- 
disposed to,  and  provoked  insanity  ;  nor  by  any  means  forget  the  habits  of 
the  patient,  and  the  sickness  which  existed,  previous  to  the  appearance  of 
mental  alienation,  and  which  ceased  a  little  before,  or  at  the  moment  of  the 
attack. 

Among  the  ancients,  the  treatment  of  insanity  was  made  to  consist  in  the 
use  of  hellebore.* 

An  accident  was  the  means  of  proposing  the  bath  of  surprise.  The  dis- 
covery of  the  circulation  of  the  blood,  caused  physicians  to  bleed  largely. 
The  humorists  returned  to  the  use  of  purgatives.  The  English  vigorously 
employed  the  precepts  which  Areteus  and  Coelius  had  suggested,  and  of 
which  Erasistratus  and  Gallienus  had  made  a  most  happy  application.  They 
made  a  secret  of  them  ;  but  Pinel  made  himself  master  of  it,  and  changed 
the  lot  of  the  insane.  The  chains  were  broken, f  the  insane  were  treated 
with  humanity,  hope  gained  hearts,  and  a  more  rational  system  of  thera- 
peutics, directed  the  treatment. 

It  will  often  be  necessary  to  vary,  combine  and  modify  the  means  employ- 
ed ;   for  there  is  no  specific  treatment  of  insanity. 

As  this  malady  is  not  identical  in  every  case  ;  as  in  every  instance  it  de- 
pends upon  difterent  causes,  and  presents  varied  characteristics,  and  requires 
new  combinations  ;  a  new  problem  is  to  be  solved,  for  every  patient  whom 
we  are  called  to  treat. 

I  will  limit  myself  to  general  considerations,  which  are  adapted  to  all ;  and 
will  set  a  due  value  upon  certain  medicaments,  denominated  heroic. 

In  the  study  of  symptoms,  we  have  seen  that  the  lesions  of  sensations,  to- 
gether with  that  of  the  association  of  ideas,  and  of  the  will,  caused  by  defec- 
tive attention,  produced,  and  kept  up  the  delirium,  as  well  as  the  perversion 
of  the  passions. 

Whatever  can  act  upon  the  brain,  either  directly  or  indirectly,  and  modify 
the  principle  of  thought ;  whatever  can  control  and  direct  the  passions,  should 
be  the  object  of  moral  treatment. 

The  first  question  that  presents  itself,  is  relative  to  isolation.  Ought  every 
insane  person  to  be  removed  from  all  familiar  scenes,  his  mode  of  life  changed 
— separated  from  those  with  whom  he  has  always  lived, — placed  in  a  situation 
altogether  new,  and  committed  to  the  care  of  strangers  1 

The  English,  French,  and  German  physicians,  agree  with  respect  to  the 
necessity  and  utility  of  isolation. 

Willis,  who  was  so  long  known,  and  sought  for,  in  consequence  of  his  suc- 
cess in  the  treatment  of  insanity,  was  accustomed  to  remark,  that  foreigners 
were  with  more  certainty  cured,  than  the  English.  The  same  is  true  in 
France. 

The  cures  are  more  frequent  among  those  patients  who  visit  Paris  from 
abroad,  than  those  who  reside  at  the  capital.  The  latter  are  not  sufficiently 
isolated. 

The  first  effect  of  isolation  is,  to  produce  new  sensations,  to  change  and 
break  up  the  chain  of  ideas,  from  which  the  patient  could  not  free  himself. 

New  and  unexpected  impressions  strike,  arrest,  and  excite  his  attention,  and 

*  Article  Hellebore;  Encyclop.  Method,  by  Ph.  Pinel. 

t  Bicetre  in  1792,  or  the  abolishment  of  chains  (Memoirs  of  the  Royal  Academy  of 
Medicine,  Paris,  1836,  t.  v.  pag.  31.) 

10 


74  INSANITY. 

render  him  more  accessible  to  those  councils,  that  ought  to  bring  him  back  to 

reason. 

Besides,  from  the  moment  that  an  insane  man  is  shut  out  from  the  world, 
surprised,  astonished,  and  disconcerted,  he  always  experiences  a  remission,  of 
great  value  to  the  physician,  who  then,  finding  the  patient  without  preposses- 
sions, can  more  readily  acquire  his  confidence. 

Isolation  is  not  less  useful,  in  combating  the  disorder  of  the  moral  affections 
of  the  insane.  The  disturbance  unexpectedly  occurring  in  the  nervous  sys- 
tem, changes  the  nature  of  the  sensations,  and  often  renders  them  pamful. 
The  natural  relations  with  the  external  world  are  no  longer  the  same.  Ex- 
ternally, every  thing  seems  to  be  thrown  into  confusion.  The  patient  who 
believes  not  that  the  cause  of  these  phenomena  is  within  himself,  is  at  va- 
riance with  all  that  he  either  sees  or  hears  ;  a  circumstance  which  excites  his 
mind,  and  places  him  in  opposition  to  others  and  himself  He  persuades  him- 
self that  his  friends  wish  to  oppose  him,  since  tihey  disapprove  of  his  errors 
and  excesses.  Not  comprehending  fully  what  is  said  to  him,  he  most  fre- 
quently misinterprets  the  language  which  is  addressed  to  him  :--proofs  of  the 
tenderest  affection  are  regarded  as  injuries,  or  as  enigmas  which  he  cannot 
solve  : — the  most  devoted  attentions  are  vexations  : — his  heart,  ere  long,  nour- 
ishes only  distrust. 

The  insane  man  becomes  timid  and  suspicious.  He  fears  every  one  that  he 
approaches  ;  and  his  suspicions  extend  to  those  who  were  most  dear  to  him. 
The  conviction  that  every  one  is  endeavoring  to  torment  and  slander  him,  to 
render  him  miserable,  and  to  ruin  him,  in  body  and  estate,  put  the  finishing 
stroke  to  this  moral  perversion. 

Hence  that  symptomatic  suspicion,  which  often  grows  up  without  motive ; 
sometimes,  in  consequence  of  necessary  opposition,  which  increases  by  rea- 
son of  the  alteration  of  the  intellectual  faculties,  and  which  is  depicted  so 
strikingly  upon  the  physiognomy  of  the  insane. 

With  such  moral  dispositions,  leave  an  insane  person  in  the  bosom  of  his 
family,  and  immediately  this  tender  son,  whose  happiness  once  consisted  m 
residing  at  home,  will  desert  the  paternal  mansion.  The  despairing  lover 
hopes,  by  his  counsels,  to  bring  back  the  wandering  reason  of  her  whom  he 
adores.     Her  unfortunate  condition  renders  the  blow  only  the  more  severe. 

She  who  once  loved  him  so  tenderly,  will  now  see  in  him  only  a  wretch, 
who  offers  his  attentions,  only  the  better  to  betray. 

This  friend,  whose  heart  is  weighed  down  with  grief,  hopes,  by  his  affec- 
tionate attentions,  to  restore  that  sensibility  and  reason,  which  had  been  the 
source  of  his  attachment  and  happiness. 

But  soon,  unhappy  one,  thou  wilt  be  embraced  in  the  general  proscription  ; 
and  thy  cares  for  thy  suffering  friend,  will  be  but  proofs,  that  thou  also  hast 
yielded  to  the  corrupting  influences  of  his  enemies. 

What  are  we  to  hope  for,  if  we  change  not  the  moral  condition  of  that  un- 
fortunate class,  whose  prejudices  are  so  strongly  excited  ? 

Who  of  us  has  not  experienced  the  difference  which  exists,  between  being 
deceived,  thwarted  and  betrayed,  by  his  neighbors  and  friends,  and  by  those 
who  are  strangers  to  him  1 

This  unfortunate  man,  suddenly  becomes  master  of  the  world,  gives  out  his 
sovereign  orders,  to  all  who  surround  him.  He  pretends  to  be  blindly  obeyed, 
by  those  who  had  ever  yielded  to  his  wishes,  through  respect  or  affection. 
His  wife,  children,  friends  and  domestics,  are  his  subjects.  They  have  always 
obeyed  ;  will  they  now  dare  to  be  disobedient  ?  He  is  in  his  dominions,  and 
commands,  a  despot ;  aird  he  is  ready  to  punish  with  the  greatest  seventy 
whoever  shall  dare  to  make  the  least  remonstrance.  What  he  wills  is  impos- 
sible ;  suppose  it  is,  he  wills  it ;  and  shall  the  will  of  the  great  be  met  by 
insurmountable  obstacles  ?     The  affliction  of  his  family,  the  regrets  of  his 


INSANITY. 


75 


friends,  the  agitation  of  all,  their  deference  for  his  wishes  and  caprices  ;  the 
repugnance  of  every  one  to  oppose  him  through  fear  of  exasperating  his  mad- 
ness °  do  not  all  these  serve  to  confirm  this  wretched  man  in  his  notions  of 
power  and  domination  ?  Remove  him  from  the  seat  of  his  pretensions  :— 
take  him  from  his  home.  Stripped  of  his  empire  and  subjects,  he  will  collect 
his  thoughts,  direct  his  attention  to  the  study  of  himself  in  this  new  world, 
and  to  the  establishment  of  relations  with  those  around  him. 

The  cause  of  mental  alienation  often  exists  within  the  family  circle.  The 
malady  originates  from  chagrins,  domestic  dissensions,  reverses  of  fortune, 
privations  ;  and  the  presence  of  the  parents  and  friends  of  the  patient,  exas- 
perates the  evil.     Sometimes,  an  excess  of  tenderness  keeps  up  the  disease. 

A  husband  persuades  himself  that  he  cannot  secure  the  happiness  of  his 
wife ;  and  resolves  to  fly  from  her,  or  to  terminate  his  existence,  as  the  only 
means  by  which  he  can  render  her  happy.  The  tears  of  his  wife,  and  her  sad 
countenance,  are  only  new  motives  for  inducing  him  to  commit  the  act. 

Has  the  first  commotion  amid  the  intellectual  and  moral  faculties,  originated 
in  the  house  of  the  insane  man,  and  in  the  midst  of  his  neighbors  ?  The 
sight  of  this  house  and  his  acquaintances,  will  constantly  revive  in  the  mind 
of  the  insane  person,  his  peculiar  ideas  and  sensations.  The  only  means  by 
which  we  can  break  up  this  fatal  association,  must  consist  in  preventing  a  re- 
newal of  the  impression ;  and,  in  order  to  effect  this,  the  patient  must  be  re- 
moved from  the  causes  that  produce  it. 

We  would  remark  generally,  that  the  insane  conceive  a  dislike  and  aversion 
to  certain  individuals,'w'ithout  any  motive,  and  nothing  induces  them  to  change 
their  views.  The  object  of  their  hatred  is  usually  the  person  who,  before 
their  illness,  enjoyed  their  love.  It  is  this  circumstance,  which  renders  this 
class  of  persons  so  indifferent,  and  sometimes  so  dangerous  to  their  friends  ; 
whilst  strangers  are  agreeable  to  them,  and  suspend  their  delirium  ;  either  be- 
cause noveky  with  respect  to  persons  and  things  is  always  useful,  or  because 
they  have  no  recollection,  no  painful  back  thought,  to  attach  to  the  person  of 
a  stranger  ;  or  because,  through  a  secret  sentiment  of  self-love,  they  wish  to 

conceal  their  condition. 

I  have  seen  patients  appear  very  calm  before  their  physician  and  strangers, 
at  the  same  time  that  they  would  abuse  in  a  low  voice,  their  relatives  or 
friends  ;  and  conceal  themselves,  in  order  to  pinch,  prick,  or  scratch  them. 
Such  are  the  obstacles  and  inconveniences,  which  present  themselves  in  view 
of  the  sojourn  of  the  insane  in  their  families,  when  we  desire  to  subject  them 
to  medical  treatment.  Let  us  now  look  at  the  advantages  which  patients  will 
derive,  from  treatment  in  an  establishment  especially  devoted  to  their  use  ; 
where'  placed  in  circumstances  quite  unusual,  and  committed  to  the  care  of 
strancrers,  they  will  receive  new  impressions. 

Where  shall  we  isolate  the  patient  1  We  have  already  said  that  the  insane 
man  should  be  placed  in  an  institution  devoted  to  the  treatment  of  mental 
diseases.  We  prefer  a  house  of  this  kind  to  a  private  one,  where  our  object 
is  effected  at  great  expense.  Partial  isolation  rarely  succeeds.  It  presents 
many  inconveniences,  which  we  would  wish  to  shun,  by  withdrawing  the  in- 
sane from  their  accustomed  places  of  abode  ;  and  offers  very  few  of  the  ad- 
vantages of  a  house  in  which  many  patients  are  assembled.  -jc 

The  strongest  objection  that  can  be  urged  against  establishments  devoted 
to  this  kind  of  treatment,  is  founded  upon  the  frightful  effects  that  may  result 
from  mingling  with  companions  in  misfortune.  I  reply,  that,  generally,  it  does 
not  injure  them,— that  it  is  not  an  obstacle  to  a  cure— that  it  is  a  valuable 
means  of  treatment,  because  it  obliges  the  insane  to  reflect  upon  their  condi- 
tion, because  that,  common  objects  no  longer  making  an  impression  upon  their 
minds,  they  are  diverted  from  themselves,  by  the  extravagances  of  their  com- 
panions.    They  are  obliged  to  live,  out  of  themselves,  and  to  occupy  their 


76  INSANITY. 

thoughts  with  what  is  going  on  around  them, — to  forget  themselves,  as  it  were, 
which  is,  in  itself,  a  means  of  cure.  The  desire  of  being  free,  and  the  need 
of  seeing  parents  and  friends,  grow  out  of  the  privation  of  these  privileges, 
and  replace  imaginary  and  unreasonable  wants  and  desires. 

Ennui  exercises,  in  its  way,  a  favorable  influence  upon  the  ideas  and  affec- 
tions of  the  insane.  The  presence  and  conduct  of  their  companions,  serves 
as  a  text  to  the  physician,  who  wishes  to  address  himself  to  the  imagination. 
However,  there  are  cases  in  which  isolation,  like  all  other  remedies,  even  the 
most  useful,  may  prove  injurious  ;  when  it  is  not  modified  by  the  susceptibility 
of  the  insane,  and  the  character  of  the  delirium  ;  and  with  a  reference  also, 
to  their  passions,  habits,  and  mode  of  life.  We  should  never  be  absolute  in 
practice.  Art  consists,  in  happily  distinguishing  the  indications  which  ought 
to  lead  to  a  modification  of  principles,  however  great  the  efficacy  that  expe- 
rience may  attribute  to  them. 

In  an  Establishment  devoted  to  the  treatment  of  the  insane,  the  arrano-e- 
ments  are  better  adapted  to  their  wants  than  in  a  private  house.  With  less 
suffering  to  the  patient,  he  is  more  faithfully  attended  to.  What  can  be  done 
with  a  furious  patient  in  an  apartment  of  a  private  house,  however  large  ?  A 
suitable  regard  for  his  security,  will  render  it  necessary  that  he  should  be 
bound,  and  confined  to  his  bed  ;  a  painful  condition,  which  augments  the  de- 
lirium and  fury  ;  while,  in  a  suitable  house,  he  could  be  indulged  in  his  pro- 
pensities, with  less  danger  to  himself  and  his  attendants.  In  a  house  of  this 
kind,  his  wants  are  better  understood,  and  the  domestics  better  instructed. 
The  distribution  of  buildings  permit  the  patients  to  be  removed,  from  one 
habitation  to  another,  as  his  condition,  his  disposition  to  injure  himself,  or  his 
progress  towards  recovery  may  render  expedient.  These  truths,  useful  in  the 
management  of  the  rich  who  are  insane,  are  of  rigorous  application  in  the 
treatment  of  the  poor. 

An  Establishment  for  the  insane  must  be  governed  by  regulations,  to  which 
all  must  submit.  This  will  serve  as  a  response  to  all  objections,  and  aid  in 
surmounting  all  repugnance,  at  the  same  time  that  it  furnishes  motives  to  obe- 
dience, less  unpleasant,  than  the  will  or  caprice  of  a  principal. 

There  is,  in  a  house  of  this  kind,  a  movement,  an  activity,  a  vortex,  into 
which  by  degrees,  all  enter.  The  most  infatuated  and  jealous  lypemaniac 
finds  himself,  almost  without  knowing  it,  forced  to  live  out  of  himself;  car- 
ried along  by  the  general  movement,  by  the  example,  and  by  the  impressions, 
ofi;en  strange,  which  are  perpetually  striking  his  senses.  The  maniac  himself, 
attracted  by  the  harmony,  order  and  regularity  of  the  house,  defends  himself 
better  against  his  impulses,  and  abandons  himself  less  to  his  eccentric  actions. 

In  an  Establishment  for  the  insane,  there  must  be  a  Head,  and  a  single 
Head,  from  whom  all  authority  should  emanate.  Reil,  and  those  who,  after 
him,  have  desired  that  a  hospital  for  the  insane  should  be  directed  by  a  physi- 
cian, a  psychologist  and  moralist,  had  no  practical  experience,  and  did  not  ap- 
preciate the  inconveniences  attending  a  division  of  powers.  When  there  are 
several  coordinate  powers,  and  the  mind  of  the  insane  knows  not  upon  whom 
to  repose,  it  wanders  in  doubt ;  confidence  is  not  established.  Now,  without 
confidence,  there  is  no  cure.  A  spirit  of  independence  evades  obedience, 
when  authority  is  divided.  It  is  to  prevent  this  double  inconvenience,  that  we 
admit  with  caution,  of  interviews  between  the  insane  and  their  friends.  The 
insane  are  but  grown  up  children,  children  too,  who  have  received  false  no- 
tions, and  a  wrong  direction.  So  many  points  of  resemblance  do  they  bear 
to  children  and  young  persons,  that  it  will  not  be  surprising,  if  both  one  and 
the  other  should  be  governed  on  similar  principles. 

The  physician  who,  in  an  establishment  of  this  kind,  gives  an  impulse  to 
every  thing  ;  to  whom  is  referred  whatever  interests  each  individual ; — sees  his 
patients  more  frequently  than  he  would  otherwise  do, — is  more  frequently  in- 


INSANITY.  77 

formed  of  whatever  affects  them, — interferes  in  their  dissensions  and  quarrels, 
— governs  them  by  principles  more  clear  and  positive, — controls  their  actions, 
and  causes  them  to  be  attended  by  people  who  are  accustomed  to  the  care  of 
the  insane.  Attendants  should  set  an  example  of  deference  and  obedience  to 
the  regulations,  and  head  of  the  house.  By  their  numbers,  they  present  an 
array  of  force,  which  renders  its  employment  unnecessary  ;  they  persuade 
those  most  excited,  that  all  resistance  would  be  vain  ;  in  fine,  living  among 
the  sick,  the  latter  are  not  alone,  nor  always  surrounded  by  irrational  persons. 
Example,  which  exerts  such  power  over  the  determinations  of  man,  has  also 
great  influence  with  the  insane.  We  must  not  forget  what  has  been  said  re- 
specting the  sagacity  of  the  insane,  in  comprehending  what  is  passing  around 
them.  The  restoration  and  discharge  of  a  patient  inspires  confidence  in  the 
hearts  of  others.  It  establishes  in  their  minds  the  hope  of  a  cure,  and  the 
certainty  of  being  set  at  liberty.  The  convalescent,  by  their  contentment, 
their  advice  and  counsels,  console  and  encourage  the  sick,  and  are,  in  this 
way,  of  great  service  to  them.  Thus,  the  inmates  of  a  house  of  this  kind, 
produce  a  happy  influence,  one  upon  another,  and  every  thing  concurs  to  fa- 
vor the  success  of  treatment.  The  arrangements  also,  are  such  that  the  sick 
can  neither  injure  themselves  nor  their  companions  ni  misfortune,  nor  triose 
who  serve  them. 

The  quietude  which  the  insane  enjoy,  far  from  tumult  and  noise ;  the  mora 
repose  which  their  withdrawal  from  their  former  habits,  their  business,  and 
domestic  cares  procure,  are  very  favorable  to  their  restoration.  Subjected  to 
a  regular  life,  to  discipline,  and  a  well  ordered  regimen,  they  are  constrained 
to  rertect  upon  the  change  in  their  situation.  The  necessity  of  restraining 
and  composing  themselves  with  strangers,  and  the  dwelling  together  with  com- 
panions in  misfortune,  are  powerful   auxiliaries  in  restoring  their  lost  reason. 

The  attentions  which  an  insane  person  receives  in  his  family,  pass  for  no- 
thing, though  all  around  him  be  eager  in  offering  them.  But  away  from  home, 
the  care  that  is  bestowed  upon  him  is  appreciated,  because  it  is  new,  and  is 
not  strictly  due.  Civilities,  attentions  and  mildness,  will  produce  an  effect, 
because  he  has  little  right  to  expect  them  at  the  hands  of  those  with  whom 
he  is  not  acquainted.  Let  a  man,  practiced  and  skillful,  profit  by  this  dispo- 
sition ;  let  him  command  confidence  and  esteem,  and  the  insane  will  shortly 
find  in  the  unknown,  a  person  whom  they  must  control,  or  to  whose  kindness 
submit.  The  necessity  of  a  dependence  from  which  they  cannot  escape,  hope, 
fear,  ennui  even,  will  begin  to  make  them  suspicious  that  they  are  sick.  Hav- 
ing acquired  this  conviction,  the  cure  is  not  far  distant. 

Sometimes  the  insane,  when  placed  in  a  new  situation,  think  themselves 
abandoned  by  their  relatives  and  friends.  But  let  those  to  whom  they  are 
brought,  be  prodigal  of  consolations  and  regards,  let  them  promise  to  assist 
in  renewing  the  connection  which  binds  these  unhappy  people  to  moral  ex- 
istence, and  they  pass  from  a  state  of  despair  to  that  of  hope.  This  contrast 
of  sentiments,  springing  from  their  presumed  abandonment,  and  the  tender 
cares  and  sympathy  bestowed  upon  them  by  strangers,  provoke  an  internal 
struggle,  from  which  reason  sometimes  comes  off  victorious.  Others  imagine 
that  they  have  been  brought  to  this  new  abode,  only  to  be  given  up  to  their 
enemies  or  to  punishment.  If  these  fears  are  overcome  by  civil  and  affable 
conduct,  on  the  part  of  those  by  whom  they  are  surrounded,  a  cure  will  soon 
be  effected. 

Thus,  reason  comes  to  the  support  of  experience,  to  strengthen  the  doctrine 
of  isolation,  as  a  preliminary  condition  to  all  rational  treatment  of  mental 
alienation. 

But,  says  an  objector,  it  may  happen,  that  by  dwelling  together,  the  insane 
may  injure  each  other.  The  soundest  mind  would  be  disturbed,  were  its  ha- 
bits  abruptly  changed,  and   brought  into  contact  only  with  the   insane.     Be- 


/ 


78  INSANITY. 

sides,  after  a  cure  has  been  effected,  how  can  we  conceal  from  the  patient  the 
condition  in  which  he  has  been  ?  Why  tear  away  from  the  seat  of  all  his  affec- 
tions, a  miserable  man,  whom  misfortunes  have  overcome?  Why  shut  up  a 
man  who,  above  all  things,  dreads  a  prison. — But,  how  many  objections  have 
already  been  made  ?  How  many  may  not  still  be  offered  ?  These  objections 
however,  do  not  do  away  with  the  inconveniences  and  advantages  that  we 
have  pointed  out  above,  and  to  which  experience  returns  a  favoring  response. 

But,  it  may  be  said,  that  there  are  insane  persons  who  are  cured  at  home. 
This  is  true.  These  cures  however,  are  rare,  and  cannot  impair  the  general 
rule.  They  prove  only,  that  isolation,  like  all  other  curative  means,  ought 
always  to  be  prescribed  by  a  physician.  I  will  say  more, — that  isolation  has 
been  fatal  to  some  insane  persons.  And  what  shall  we  conclude  from  this  1 
That  we  should  recommend  it  with  caution  ;  especially  when  it  is  to  be  pro- 
longed ;  and  also,  that  it  is  the  nature  of  the  best  and  most  useful  things,  not 
to  be  always  exempt  from  inconveniences.  To  the  wise,  judicious  and  ex- 
perienced physician  does  it  belong,  to  foresee  and  prevent  them. 

It  is  not  easy  to  determine  the  period  at  which  isolation  should  cease.  To 
prevent  abuse,  extreme  caution  and  tact  are  requisite.  Here,  experience  is 
slow  to  decide.  I  recommend  nothing  positive  with  respect  to  it,  except  that 
when  isolation  has  had  no  effect,  the  visits  of  relatives  and  friends  .should  be 
encouraged,  exercising  much  discretion  in  the  choice  of  the  first  persons  who 
may  be  admitted.  Visits,  in  the.se  cases,  should  be  sudden  and  unexpected, 
in  order  to  produce  a  strong  impression  upon  the  patient.  With  respect  to 
convalescents,  visits  are  to  be  allowed  with  great  caution.  Experience  shows, 
that  isolation  unduly  prolonged,  is  attended  with  consequences  less  injurious 
than  its  premature  cessation. 

We  should  ever  bear  in  mind,  that  at  the  commencement  of  insanity,  this 
affection  strongly  resembles  febrile  delirium — that  a  mistake  is  easily  made, 
and  that  unseasonable  isolation  may  compromise  the  cure  of  the  patient,  and 
the  moral  responsibility  of  the  physician.  In  doubtful  and  difficult  cases,  we 
should  delay  a  few  days,  in  order  that  the  characteristics  of  mental  alienation 
may  become  evident. 

In  dementia  and  idiocy,  isolation  is  only  indicated,  to  prevent  accidents  which 
may  be  grave,  and  to  maintain  order  and  security.  Some  lypemaniacs  are 
injured  by  confinement,  in  consequence  of  their  excessive  sensibility.  Mono- 
maniacs and  maniacs  must  of  necessity  be  isolated.  Confinement  is  indis- 
pensable for  the  insane  poor,  because  they  are  deprived  of  necessary  attentions 
at  home,  and  can,  in  a  thousand  ways,  compromise  their  own,  and  the  exist- 
ence of  their  friends. 

Isolation  is  not  always  effected  in  the  same  manner.  It  is  partial,  when  the 
patient  remains  at  home,  and  is  only  separated  from  the  members  of  his  fa- 
mily, and  persons  with  whom  he  has  habitually  lived.  We  isolate  an  insane 
man,  by  causing  him  to  travel  with  his  near  connections,  friends,  or  strangers. 
We  isolate  him,  by  placing  him  alone  in  a  habitation  unknown  to  him,  as  well 
as  those  who  serve  him.  In  fine,  he  is  isolated  in  a  public  or  private  estab- 
lishment, devoted  to  the  reception  of  many  people,  affected  with  mental  alien- 
ation. 

■   Isolation   acts  directly  upon  the  brain,  and  forces  this  organ  to  repose,  by 
■  withdrawing  the  insane  man   from  irritating  impressions, — by  repressing  the 
/  vivacity  and  mobility  of   impressions, — by  moderating    the   exaltation  of  the 
'      ideas  and   affections.     By  reducing  the  maniac  to  the  smallest  possible  num- 
ber of  sensations,  we  are  enabled  to  fix  his  attention,  by  unexpected  and  oft- 
re'peated   impressions.     We  must,  on  the  contrary,  use  strong  measures  with 
the  monomaniac  and  lypemaniac,  to  draw  them    away  from  their  concentrated 
ideas,  and  force  them  to  direct  their  attention   upon  objects,  foreign  to  their 
meditations,  disquietudes,   and  delirious  pretensions.      We  must  excite  the 


INSANITY.  79 

enfeebled  attention  of  him  who  is  in  a  state  of  dementia ;  but  the  happy  ef- 
fects which  we  may  propose  to  ourselves  are  obtained  only  by  means  of 
strong  mental  impressions,  unexpected  events,  lively,  animated,  and  brief 
conversations  ;  for  it  is  not  by  long  arguments  that  we  are  to  expect  to  be- 
jiefit  the  insane.  We  should  ever  speak  with  truth  and  sincerity  to  the  in- 
sane, and  only  employ  the  language  of  reason  and  kindness.  To  expect  how-1 
ever,  to  cure  the  insane  by  syllogisms  and  reasoning,  indicates  little  know- 
ledge of  the  clinical  history  of  mental  alienation.  "  1  understand  you  per- 
fectly "  said  a  young  lypemaniac,  "  and  if  I  were  convinced,  I  should  be 
cured."  Said  another,  ^'' I  knoin  what  I  ought  to  do,  I  would  do  it ;  hut  give 
me  the  pmoer,  the  ability  rchich  is  wanting,  and  you  will  have  cured  me." 

It  is  here  that  we  must  employ  a  perturbing  mode  of  treatment  ; — breaking 
up  one  spasm  by  another,  by  provoking  moral  shocks,  which  may  dissipate  the 
clouds  which  obscure  the  reason, — rend  the  veil  which  interposes  between 
man  and  the  external  world, — break  the  vicious  chain  of  ideas, — bring  to  an 
end  injurious  associations, — destroy  their  despairing  concentration  of  thought, 
and  break  the  chain  which  paralyzes  all  the  active  powers  of  the  insane.  We 
effect  this  object  by  arousing  the  attention  of  the  insane,  now  by  presenting 
to  them  new  objects,  now  by  causing  them  to  witness  new  and  surprising  phe- 
nomena ;  now,  by  putting  them  in  opposition  to  themselves ;  and  sometimes, 
by  taking  up  their  ideas,  caressing  and  flattering  them.  By  complying  with 
their  desires,  we  secure  their  confidence, — a  sure  test  of  an  approaching  cure. 
We  must  bring  into  subjection  the  whole  character  of  some  patients,  con(iuer 
their  pretensions,  control  their  freaks  of  passion,  break  down  their  pride  ; 
while  we  must  arouse  and  encourage  others. 

We  repress  the  passionate  transports  of  the  maniac,  and  sustain  the  broken 
spirit  of  the  lypemaniac.  We  oppose  the  passions  of  the  one  to  those  of  the 
other,  and  from  this  struorgle,  reason  sometimes  comes  off  victorious.  Fear  is 
a  depressing  passion,  which  exercises  such  an  influence  over  the  economy,  as 
to  suspend,  and  even  extinguish  vital  actions. 

Can  we  hope  to  cure  those  whom  fear  pursues  and  devours,  if  we  do  not 
inspire  them  with  confidence  ?  Many  insane  persons  sleep  not ;  aroused  by 
panic  terrors.  Encourage  them,  by  causing  some  one  to  sleep  in  their  cham- 
ber, or  by  allowing  them  a  light  during  the  night.  It  is  above  all,  important 
to  substitute  a  real  for  an  imaginary  passion.  This  monomaniac  becomes 
dissatisfied,  although  using  every  thing  with  an  unsparing  hand.  Cut  him  off 
from  this  habit,  and  impose  upon  him  real  privations  ;  then  will  satiety,  found- 
ed on  reason,  prove  a  powerful  means  of  cure.  A  lypemaniac  believes  that 
he  is  abandoned  by  his  friends.  Deprive  him  of  those  proofs  of  affection 
which  he  forgets  ;  then  will  he  regret  their  loss,  and  desire  them  ;  and  this 
natural  uneasiness,  these  reasonable  desires,  will  prove  a  means  of  cure. 

To  combat  the  self-love  and  vanity  of  some  insane  persons,  certain  allusions 
may  be  made  to  the  superiority  of  others,  and  to  the  embarrassments  of  their 
own  position.  Sometimes  displeasure  opportunely  manifested,  has  been  use- 
ful. Great  experience  however,  is  necessary,  to  control  these  passions.  The 
exciting  passions  of  love  and  ambition,  have  been  called  in,  to  aid  in  the 
treatment  of  the  insane.  A  melancholic  is  in  despair.  A  law  suit  is  suppos- 
ed to  be  instituted  against  him.  The  desire  to  defend  his  interests  restores 
his  intellectual  energy.  A  soldier  becomes  a  maniac.  After  some  months, 
he  is  told  that  a  campaign  is  about  to  commence.  He  demands  permission 
to  rejoin  his  general,  returns  to  the  army,  and  arrives  there  in  good  health. 

Pinel  oflfers  some  remarkable  observations,  on  the  art  of  directing  the  intel- 
ligence  and  passions  of  the  insane. 

I  have  published  several  in  my  dissertation  on  the  passions,  and  proved  by 
facts,  how  valuable  is  moral  treatment,  whether  we  desire  to  prevent  the  out- 
break of  an  attack  of  insanity,  or  are  called  to  treat  the  malady,  or  propose 


80  INSANITY. 

to  confirm  a  convalescence.  This  treatment  besides,  is  not  confined  exclu- 
sively to  mental  maladies  :  it  is  applicable  to  all  others.  It  is  not  enough  to 
say  to  the  sick,  courage,  courage,  you  tcill  be  better.  A  feeling  heart  must 
dictate  these  consoling  words,  that  they  may  reach  the  mind  and  heart  of  him 
who  suffers.  How  happens  it,  that  in  an  age  in  which  we  have  so  triumph- 
antly established  the  influence  of  the  moral  over  the  physical  man,  that  the.se 
researches  upon  man  in  a  state  of  disease,  have  not  been  extended  ?  Gaubi- 
us  complains  of  the  negligence  of  physicians  in  this  respect. 

The  ancients  attached  great  importance  to  moral  therapeutics,  which  are 
so  much  neglected  by  the  moderns.  From  the  highest  antiquity,  the  art  of 
healing  was  committed  to  the  ministers  of  the  altar.  There  were  temples 
celebrated  for  the  cures  they  had  wrought.  A  long  voyage,  a  new  climate, 
the  salubrity  of  holy  places,  the  change  of  habits  and  modes  of  life,  purifica- 
tions, processional  marches,  the  use  of  thermal  waters,  and  diet,  prepared  the 
way  for  the  moral  influence  which  their  ceremonies  and  mysterious  practices 
were  to  produce  upon  the  sick.  The  Egyptians,  Greeks  and  Romans,  had 
their  ^sculapii,  whose  priests  preserved  a  medical  liturgy,  and  to  whom  they 
were  accustomed  to  come,  seeking  health.  The  moderns  made  their  pilgrim- 
ages to  the  revered  remains  of  some  saint.  In  some  cities,  festivals  were  cele- 
brated, to  which  were  conducted  with  pomp,  both  epileptics  and  the  insane, 
who  were  sometimes  cured.*  In  our  day  we  have  found  a  great  physician. 
His  name,  his  consolations,  his  councils,  are  often  more  useful  than  his  reme- 
dies, because  his  reputation  commands  confidence,  and  permits  us  not  to  doubt 
respecting  a  cure. 

The  means  and  resources  proper  for  the  moral  treatment,  and  the  opportu- 
nity for  its  employment,  are  indicated  by  circumstances.  Examples  of  its 
employment  are  found  in  all  books.  I  have  published  many  of  them,  which 
may  be  found  in  the  different  essays  of  which  this  collection  is  composed. 

The  ancients  have  boasted  of  the  wonderful  effects  of  music.  Herodotus 
and  Pausanias  assure  us,  that  most  legislators  were  musicians, — that  music 
was  employed  to  civilize  men.  The  phrygian  measure  excited  to  fury, — the 
lydian,  soothed  to  melancholy — the  eolian  was  devoted  to  the  amorous  pas- 
sions. Each  passion  had  a  rhythm  which  was  proper  to  it ;  while  the  moderns 
have  sacrificed  every  thing  to  harmony.  The  Jews,  Greeks,  and  Romans 
were  all  equally  aware  of  the  power  of  music. 

Every  body  knows  the  effect  which  the  "  ranz  des  vaches"  produced  upon 
the  Swiss.  Music  acts  upon  the  physical  system,  by  producing  gentle  shocks 
upon  the  nerves,  by  quickening  the  circulation,  as  Gretiy  observed  in  his  own 
person.  It  acts  upon  our  moral  nature,  or  the  mind,  in  fixing  the  attention 
by  mild  impressions,  and  in  exciting  the  imagination  and  even  the  passions, 
by  agreeable  recollections.  Did  they  wish  success  in  the  treatment  of  the  in- 
sane, they  would  make  choice  of  a  small  number  of  instruments, — place  the 
musicians  out  of  sight  of  the  patient,  and  execute  airs  familiar  to  his  infancy, 
or  which  were  agreeable  to  him  before  his  illness.  I  have  often  employed 
music,  but  have  rarely  been  successful  with  it.  It  brings  peace  and  compo- 
sure of  mind,  but  does  not  cure.  I  have  seen  those  whom  music  rendered 
furious ;  one,  because  all  the  tones  appeared  false ;  another,  because  he 
thought  it  dreadful  that  people  should  amuse  themselves  near  a  wretch  like 
him.  Finally,  I  believe  that  the  ancients  have  exaggerated  the  effects  of  mu- 
sic, as  well  as  many  other  things.  The  facts,  reported  by  the  moderns,  are 
not  sufficiently  numerous  to  enable  us  to  determine  the  circumstances  in 
which  music  may  be  useful.  However,  it  is  a  valuable  remedial  agent,  parti- 
cularly in  convalescence.  It  ought  not  to  be  neglected,  however  indetermi- 
nate may  be  the  principles  of  its  application,  or  uncertain  its  efficacy. 

*  Lecture  II.     Note  respecting  die  village  of  Glieel. 


INSANITY.  81 

The  means  of  diverting  the  mind  are,  nevertheless,  after  labor,  the  most 
efficacious  agents  in  the  cure  of  the  insane,  but  we  cannot  rely  upon  the  suc- 
cess of  those  which  exalt  the  imagination  and  passions. 

The  lypemaniac,  always  suspicious,  appropriates  to  himself  whatever  strikes 
his  senses,  and  makes  it  serve  as  aliment  to  his  delirium.  Tlie  maniac  be- 
comes still  more  excited  by  the  representation  of  the  passions,  by  the  vivacity 
of  the  dialogue,  and  the  playing  of  the  actors,  if  he  is  present  at  a  theatrical 
representation.  Our  opinion  respecting  amusements  of  this  kind  is  support- 
ed by  the  example  of  the  Egyptians  and  Greeks.  But  witli  them  these  exhi- 
bitions partook  of  a  religious  character,  adapted  to  calm  the  passions,  and  to 
impose  upon  the  imagination,  at  the  same  time  that  the  mind  was  diverted  by 
the  pomp  of  the  ceremonies.  A  mind  at  all  accustomed  to  reflection,  is  asto- 
nished that  theatrical  representations  should  formerly  have  been  permitted  at 
Charenton  ;  and  a  German  author  regards  the  multiplication  of  theatres  as 
one  of  the  causes  of  the  great  number  of  insane  people  in  Germany.  The 
maniacs  could  never  be  present  at  the  theatrical  representations  of  Charenton, 
the  monomaniacs  rarely, — and  imbeciles  could  not  be  benefited  by  them. 
Those  to  whom  the  spectacle  could  be  useful,  were  already  cured,  and  it  would 
have  been  more  profitable  to  restore  them  to  liberty  than  to  shut  them  up  for 
three  hours  in  a  place,  confined,  heated  and  noisy,  where  every  thing  tended 
to  produce  cephalalgia.  Thus  there  were  few  representations  that  were  not 
signalized  by  some  violent  explosion  of  delirium,  or  by  some  relapse.  This 
mode  of  amusement,  by  which  the  public  were  imposed  upon  by  being  inform- 
ed that  the  insane  themselves  played  comedies,  never  obtained  the  approbation 
of  the  Physician  in  chief  of  the  Establishment.  Royer-Collard  exerted  him- 
self vigorously  against  it,  and  was  ultimately  successful  in  bringing  it  to  an 
end.  I  once  accompanied  a  young  convalescent  to  a  Comic  Opera.  He 
every  where  saw  his  wife  conversing  with  men.  Another,  after  the  space  of 
a  quarter  of  an  hour,  felt  the  heat  in  his  head  increasing — and  says,  let  us  go 
out,  or  I  shall  relapse.  A  young  lady,  being  at  the  Opera,  and  seeing  the  ac- 
tors armed  with  sabres,  believed  that  they  were  going  to  assail  her.  All  this 
happened,  notwithstanding  1  had  selected  both  the  individuals  I  was  to  accom- 
pany, and  the  pieces  that  were  to  be  acted.  A  theatrical  spectacle  can  never 
be  suited  to  the  condition  of  the  insane,  and  I  much  fear,  not  even  to  that  of 
convalescents. 

Seneca  says,  that  traveling  is  of  little  benefit  in  moral  aflfections.  He  cites 
on  this  subject,  the  reply  of  Socrates  to  a  melancholic,  who  was  complaining 
that  he  had  derived  little  advantage  from  his  travels.  "/«m  not  siirj)ri.sr(l ; 
do  you  not  travel  with  yourself  7"  However,  the  ancients  prescribed  traveling, 
and  sent  their  patients  to  take  the  hellebore  of  Antycira,  or  to  make  the  leap  at 
Leucates.  The  English  now  send  their  melancholies  into  the  southern  pro- 
vinces of  France,  into  Italy,  and  even  into  the  colonies.  I  have  always  ob- 
served that  the  insane  are  relieved  by  a  long  voyage,  especially  if  they  have 
visited  distant  countries,  whose  situation  and  aspect  took  strong  hold  of  their 
imagination  ;  and  if  they  experienced  difficulties,  opposition,  disappointments, 
and  the  fatigues  incident  to  travel.  Traveling  acts  moreover,  by  exciting  all 
the  assimilative  functions.  It  promotes  sleep,  the  appetite  and  secretions. 
Convalescents,  who  fear  to  re-enter  the  world,  where  they  will  be  called  upon 
to  speak  of  their  complaint,  are  less  uneasy,  after  a  journey  which  may  be 
made  the  subject  of  conversation  with  their  friends.  Such  are  the  agents 
which  exercise  a  direct  influence  over  the  brain,  and  consequently  over  the 
intellectual  and  moral  disorders  of  the  insane ;  and  such  are  the  o-eneral  views 
of  their  application,  which  I  would  suggest.  They  have  for  their  object,  to 
restrain  the  mental  operations  of  the  maniac,  and  to  draw  out  and  fix  upon 
external  objects  the  mind  and  thoughts  of  the  monomaniac.  The  prin- 
ciples of  physical   treatment  cannot  be  reduced  to  propositions  so  general. 

11 


82  INSANITY. 

No  one  doubts  the  necessity  of  acting  upon  the  brain,  in  combating  the  causes 
which  have  produced  and  keep  up  insanity  ;  but  the  nature  of  tliese  causes 
often  escapes  us.  The  brain  is  not  always  the  primitive  seat  of  their  action, 
and  this,  moreover,  does  not  produce  the  same  eifect  in  every  case.  The 
physical  means,  therefore,  adapted  to  avoid  the  fatal  effects  of  these  causes, 
must  be  varied.     They  are  hygienic,  or  pharmaceutic. 

The  constitution  of  the  insane  becomes  rapidly  enfeebled.  They  contract 
affections  of  the  skin,  lymphatic  engorgements  and  scurvy ;  a  circumstance 
which  shows  the  importance  of  a  suitable  site,  as  well  as  mode  of  construction 
of  their  habitations.  In  building  a  house  for  the  insane,  we  should  select  a 
site,  in  our  country,  with  a  southeastern  exposure  ;  with  an  exposure  to  the 
west  in  warm  countries ;  and  to  the  south,  at  the  north.  The  soil  should  be 
dry,  and  light.  The  lodging  rooms  should  be  protected  against  humidity 
and  cold  ;  and  favorably  disposed  for  ventilation.  It  is  a  grave  error  to  sup- 
pose that  the  insane  are  insensible  to  atmospheric  influences.  The  greater 
part  of  them  avoid  cold,  and  desire  warmth. 

The  ancients  recommended  that  maniacs  should  be  placed  in  a  situation 
cool  and  obscure.  This  precept  is  excellent  during  the  acute  period  of  the 
malady  ;  but  when  it  has  passed  into  the  chronic  state,  Pinel  advises  that 
they  be  left  to  all  the  activity  of  their  movements,  and  in  the  open  air.  Situ- 
ations well  lighted,  cheerful  and  picturesque,  are  suited  to  lypemaniacs. 
Those  who  have  become  insane  in  warm  climates,  will  be  more  likely  to  re- 
cover their  reason  by  returning  to  a  cold  one  ;  and  reciprocally.  Those  af- 
flicted with  nostalgia  will  be  restored  only  by  returning  to  their  country,  the 
places  where  they  were  born,  and  where  their  infancy  was  passed. 

The  clothing,  especially  that  of  the  lypemaniac,  should  be  warm.  The  use 
of  woolen  garments  next  the  skin,  and  of  dry  frictions,  will  be  found  of  ser- 
vice. The  bedding  may  consist  of  a  matress  and  hair-quilt,  together  with  a 
bolster  and  pillow  of  horse-hair.  The  patient  should  repose  upon  a  bed  of 
horse-hair.  The  covering  should  be  light,  and  the  head  usually  uncovered. 
Alimentation  should  be  varied  according  to  the  nature  and  period  of  the  ma- 
lady,— the  individual  circumstances  and  complications.  At  its  commence- 
ment we  prescribe  the  diet  to  which  most  patients  are  subjected  during  the 
early  stage  of  other  acute  disorders  ;  at  a  later  period  the  quantity  and  quality 
of  aliments  are  modified.  They  should  always  be  simple,  prepared  without 
spices,  and  easy  of  digestion.  During  convalescence,  the  aliment  should  be 
more  substantial  than  previously,  without  ever  being  excitant,  and  in  some 
very  rare  cases  should  be  more  abundant.  The  food  should  be  distributed 
with  discretion.  We  should  avoid  furnishing  at  once  a  day's  supply,  as  is 
done  in  some  hospitals.  It  results,  from  a  neglect  of  this  precaution,  that  the 
patients  devour  or  destroy  a  day's  provision  at  once ;  and,  tormented  by  hun- 
ger during  the  remainder  of  it,  they  become  more  furious  or  sorrowful,  sup- 
posing that  they  are  maliciously  refused  a  supply  of  their  wants,  or  that  the 
design  of  starving  them  to  death,  is  entertained  by  those  who  have  the  charge 
of  them.  The  greater  part  of  maniacs  and  monomaniacs  are  distressed  by 
thirst.  We  must  satisfy  this  desire  by  placing  appropriate  drinks  at  their 
doors,  or  by  distributing  them  at  certain  hours  during  the  day. 

Those  aliments  and  drinks  which  excite  the  patient,  should  be  proscribed 
during  every  period  of  the  malady.  Nevertheless,  they  may  be  adapted  to 
some  cases  of  dementia,  or  monomania,  and  to  the  period  of  convalescence, 
as  I  have  just  remarked.  Both  the  secretions  and  excretions  should  be  favor- 
ed in  every  possible  manner.  We  should  watch  with  care,  the  condition  of 
the  bowels  ;  for  constipation  is  a  frequent  symptom,  and  one  which  exaspe- 
rates the  delirium. 

Corporeal  exercises,  riding  on  horseback,  the  game  of  tennis,  fencing,  swim- 
ming and  traveling,  especially  in  melancholy,  should  be  employed,  in  aid  of 

V 


INSANITY.  S3 

other  means  of  treatment.  The  culture  of  the  earth,  with  a  certain  class  of 
the  insane,  may  be  advantageously  substituted  for  all  other  exercises.  We 
know  the  result  to  which  a  Scotch  farmer  arrived,  by  the  use  of  labor.  He 
rendered  himself  celebrated  by  the  cure  of  certain  insane  persons,  whom  he 
obliged  to  labor  in  his  fields. 

Bourgoin,  in  his  Travels  in  Spain,  remarks,  that  the  rich  at  the  Hospitrd  for      ,  - 
the  insane  at  Saragossa,  are  not  restored,  because  they  are  not  obliged  to  labor  ;    j  " 
whilst  the  poor  work  and  are  cured.     Pinel  recommends  that  an  Establishment 
for  the  insane  should  have  a   farm  connected  with  it,  on  which  the  patients        \ 
can  labor.     The  cultivation  of  the  garden   has  succeeded  happily  in  the  cure         \ 
of  some  insane  persons.     At  the  Salpetriere,  the  best  results  follow  the  inari 
nual  labor  of  the  women   in  that  Hospital.     They  are  assembled   in  a  large 
working  room,  w-here  some  engage  in  sewing  or  knitting  ;  while  others  per- 
form the  service  of  the  house,  and  cultivate  the  garden.     This  precious  re- 
source is  wanting  in  the  treatment  of  the  rich  of  either  sex.     An   imperfect 
substitute  is  furnished,  in  walks,  nmsic,  reading,  assemblages,  etc.     The  ha- 
bit of  idleness  among  the  wealthy,  counterbalances  all  the  other  advantages 
which  this  class  enjoy  for  obtaining  a  cure. 

To  establish  the  basis  of  a  certain  therapeutic  treatment  of  mental  aliena- 
tion, it  would  be  necessary  to  understand  all  the  general  and  individual  causes 
of  tins  malady  ;  to  distinguish  by  certain  signs,  the  source  from  whence  all 
disorders  spring  ;  to  determine  whether  the  physical  reacts  upon  the  moral,  or 
the  moral  upon  the  physical  ;  to  establish  the  varieties  of  insanity  that  are 
cured  .spontaneously  ;  those  which  call  for  moral  aids  ;  those  which  require 
medication  ;  and  finally,  those  which  yield  only  to  a  mixed  treatment.  What 
accidents  have  bef<dlen,  wlxat  obstacles  opposed  those  physicians,  who  have 
been  unwilling  to  see  but  one  disorder,  in  all  the  forms  of  insanity  that 
they  have  been  called  to  treat !  They  inferred  that  delirium  being  symp- 
tomatic of  almost  all  maladies  at  the  approach  of  their  fatal  termination,  in- 
sanity might  also  be  symptomatic.  They  were  not  ignorant  that  there  were 
forms  of  insanity  evidently  sympathetic  :  they  knew  that  a  thousand  predispos- 
ing and  exciting  causes  lead  to  insanity  ;  but  having  regard  only  to  the  most 
apparent  symptoms,  they  have  permitted  themselves  to  be  diverted  by  the  im- 
petuosity, violence,  and  changefulness  of  the  symptoms,  and  neglected  the 
study  of  the  causes  of  insanity,  and  the  relations  which  they  bear  to  the  symp- 
toms. Drawn  away  by  theories,  some  have  seen  nothing  but  inflannnation  ; 
have  charged  upon  the  blood  the  production  of  insanity,  and  employed  bleed- 
inor  to  excess.  Others  believed  that  the  bile  was  the  source  of  irritation,  and 
that  it  restrained  and  interfered  with  the  due  performance  of  organic  func- 
tions. They  were  prodigal  of  emetics  and  drastic  purgatives.  Others  still 
have  taken  account  only  of  tlie  nervous  influence,  and  employed  antispasmo- 
dics in  excess.  All  have  forgotten,  that  if  the  practitioner  ought  always  to 
have  before  his  mind  great  generid  truths, — systematic  views,  which  are  to 
predominate,  and  which  constitute  medical  science  ;  art  should  confine  itself 
to  the  most  careful  study  of  the  circumstances  and  symptoms,  which  will  best  ■ 
acquaint  us  with  the  causes  and  seat ;  in  a  word,  with  the  nature  of  the  mala- 
dy which  we  are  to  combat. 

When  called  to  visit  an  insane  person,  after  having  acquired  a  knowledge 
of  his  history,  together  with  the  predisposing  and  exciting  causes  of  his  at- 
tack, we  should  inquire  if  there  are  no  urgent  indications  to  fulfil.  To  ascer- 
tain the  cause  of  the  malady,  will,  in  general,  furnish  a  clue  to  the  best  mode 
of  treatment.  To  recall  the  menses  when  suppressed,  to  reestablish  old  ul- 
cers, to  provoke  cutaneous  affections,  and  to  insert  issues,  if  the  patient  had 
formerly  been  accustomed  to  them,  will  be  peculiarly  proper.  If  there  is 
active  excitement  attended  with  plethora,  these  symptoms  must  be  controlled 
by  sanguine  evacuations,  tepid  baths  and  emollients  long  continued  ;  together 
with  cooling  and  laxative  drinks.     Sometimes  it  will  be  necessary  to  apply  to 


84 


1 1\  S  A  N  I  T  Y  . 


/ 


\ 


the  skin  rubefacient  derivatives.  At  the  same  time,  the  strictest  attention 
should  be  paid  to  the  diet  and  regimen  of  the  patient.  Treated  as  an  acute 
disorder,  almost  always  at  the  expiration  of  8,  15,  21,  or  30  days,  there  is  a 
remission,  and  sometimes  a  very  marked  intermission.  Then,  in  connection 
with  those  moral  means  appropriate  to  the  character  of  the  delirium,  we  must 
set  ourselves  to  combating  those  material  causes,  whether  hygienic  or  patho- 
logical, which  had  preceded  and  induced  the  malady  ;  in  every  case,  following 
the  individual  indications.  Let  it  suffice,  to  point  out  a  few  of  these  indica- 
tions. A  man  becomes  insane,  who  has  been  subject  to  hemorrhages  which 
no  longer  exist.  The  physician  succeeds  in  establishing  this  evacuation,  and 
at  the  same  time  in  restoring  reason  to  his  patient.  A  cutaneous  affection 
disappears  ;  an  ulcer  dries  up,  and  mania  or  monomania  bursts  forth.  On  re- 
calling the  disorder  of  the  skin,  and  reopening  the  ulcer,  it  is  almost  certain 
that  the  insanity  will  cease. 

When  we  have  attacked  and  overcome  the  general  derangements,  the  pain- 
ful effects  of  particular  causes,  if  the  insanity  is  not  cured,  we  may  have  re- 
course to  an  empirical  treatment.  We  may  here  vary  without  ceasing,  those 
measures  which  experience  suggests.  We  shall  point  them  out,  when  speak- 
ing of  the  different  forms  of  insanity.  We  shall  content  ourselves  for  the 
present,  by  stating  our  opinion  respecting  the  mode  of  action  of  certain  reme- 
dies denominated  heroic,  in  the  treatment  of  this  disease. 

Water  by  all  methods,  and  at  every  temperature,  has  been  administered  to 
the  insane.  Tepid  baths,  from  20'^  to  25°  Reaumur,  are  the  most  useful.  We 
may  even  prolong  their  use  for  several  hours  in  succession,  among  lean,  ner- 
vous and  very  irritable  subjects.  When  there  is  a  strong  determination  of 
blood  to  the  head,  we  find  it  advantageous  to  apply  bladders  filled  with  very 
cold  water,  or  cloths  saturated  with  the  same  to  the  head,  during  the  continu- 
ance of  the  bath.  The  cold  bath  is  adapted  to  young,  strong,  and  robust 
subjects,  who  are  devoured  by  heat.  The  cold  acts  by  removing  to  some 
extent,  the  excess  of  heat,  or  by  exciting  the  tonic  action  of  the  skin.  Some 
authors  have  advised  hot  baths.  Prosper  Alpin  advises  them  ;  perhaps  we 
neglect  them  too  much.  The  baths  are  rendered  more  active  by  mingling 
with  the  water  divers  kinds  of  substances,  more  or  less  medicinal. 

The  bath  of  immersion  consists  in  plunging  the  patient  into  cold  water, 
and  withdrawing  him  immediately.  This  may  be  repeated  three,  four,  five 
and  six  times.  The  bath  of  affusion,  following  the  method  of  Currie,  is  ad- 
ministered by  placing  the  patient  in  an  empty  bathing  tub,  and  pouring  upon 
his  head  cold  water,  whose  temperature  is  reduced  at  each  bath.  The  baths 
of  immersion  and  affusion  are  particularly  useful  to  subjects  enfeebled  by 
masturbation,  or  by  long  grief,  and  in  whose  cases  we  wish  to  produce  a  re- 
action, by  withdrawing  from  the  centre,  nervous  power,  and  calling  it  to  the 
circumference.  These  baths  differ  from  the  bath  of  surprise.  The  latter  con- 
sists in  plunging  the  patient  into  the  water  when  he  least  expects  it.  We  ad- 
minister it,  by  precipitating  him  into  a  reservoir,  a  river,  or  the  sea.  It  is  the 
frio-ht  which  renders  this  means  efficacious  in  overcoming  sensibility.  We 
can  conceive  the  vivid  impression  that  a  })atient  experiences,  who  falls  unex- 
pectedly into  the  water,  with  the  fear  of  being  drowned. 

Van  Helmont  recommends  that  the  patient  be  kept  under  the  water,  till 
loss  of  consciousness  takes  place.  Van  Swieten,  commenting  upon  Boer- 
haave,  insists  upon  this  means,  which  was  almost  the  only  one,  in  connection 
with  blood-letting,  employed  during  the  last  century.  However,  we  have  no 
facts  illustrating  the  effects  of  this  practice.  Pinel  proscribed  the  bath  of 
surprise.  I  have  never  made  use  of  it,  but  am  certain  that  it  has  been  fatal. 
When  I  hear  of  its  being  prescribed,  I  should  prefer  rather,  that  they  advised 
to  precipitate  the  patient  from  the  third  story,  because  we  have  known  some 
insane  persons  cured  by  falling  upon  the  head.     The  douche  consists  in  pour- 


INSANITY, 


85 


ing  water  upon  the  head  from  a  greater  or  less  height.     It  was  known  to  the 

ancients ;  and  is  administered  in  different  ways.     At  Avignon,  the  tube  of  the 

douche,  with  a  flute-like  termination,  is  placed  about  a  foot  above  the  head  of 

the  patient.     At  Bordeaux,  it  terminates  in  a  head  like  that  of  a  watering  pot. 

At  the  Salpetriere,  the  douches  terminate  in  tubes  of  four,  six  and  twelve  lines 

in  diameter,  and  the  water  falls  from  different  heights.     The  water  is  usually 

at  the  atmospheric   temperature.     It  has  been  proposed  to  employ  hot  water 

in   some  cases  of  dementia.     The  patient  receives  the  douche,  seated  in  an  / 

arm  chair ;  or  better,  plunged  into  a  bath  of  tepid  or  cold  water.  I.^^m'XA^ 

The  douche  produces  its  effects,  both  by  the  action  of  the  cold,  and  the  \  ^ 
percussion.  It  exercises  a  sympathetic  influence  upon  the  region  of  the  epi- 
gastrium. It  causes  cardialgia,  and  desires  to  vomit.  After  its  action  ceases, 
the  patients  are  pale,  and  sometimes  sallow.  It  acts  also  morally,  as  a  means 
of  repression ;  a  douche  often  sufficing  to  calm  a  raging  excitement,  to  break 
up  dangerous  resolutions,  or  force  a  patient  to  obedience.  It  is  that  class  of 
the  insane  who  are  young,  strong  and  active,  who  require  the  douche.  They 
experience  after  having  received  it,  a  sensation  of  coolness  about  the  head, 
which  is  very  agreeable  to  them,  and  often  very  useful.  It  is  especially  pro- 
per in  cases  attended  with  cephalagia.  The  douche  ought  to  be  employed 
with  discretion,  and  never  immediately  after  a  repast.  It  is  necessary  to  ob- 
viate constipation  before  employing  it.  Its  employment  ought  to  be  continued 
but  a  few  minutes  at  a  time,  and  its  administration  never  to  be  left  to  servants. 
They  may  abuse  it,  and  we  ought  not  to  be  ignorant  that  the  douche  is  not 
exempt  from  grave  accidents.  Ice  has  been  applied  to  the  head.  Its  long 
continued  application  calms  the  cephalagia  and  fury  which  resists  blood-let- 
ting, general  baths,  and  the  douche,  especially  at  the  commencement  of  ma- 
nia"; when  there  is  redness  and  heat  of  face,  threatening  cerebral  congestion. 
This  application  succeeds  much  better  when  the  feet  of  the  patient  are 
plunged  into  very  warm  water,  or  enveloped  in  an  irritating  cataplasm. 

Revulsive  pediluvia,  produce  a  remote  irritation,  which  is  often  salutary. 
We  render  them  irritant,  by  the  elevated  temperature  of  the  water,  by  the  ad- 
dition of  the  muriates  of  soda,  ammonia,  and  powdered  mustard.  We  ought 
to  remember,  that  if  the  water  is  too  warm  at  first,  it  causes  pain,  which  re- 
acts upon  the  brain.  By  plunging  the  legs  into  an  emollient  decoction,  slight- 
ly warmed,  and  allowing  them  to  remain  there  for  a  considerable  period,  we 
relieve  the  patient  of  cramps.  We  moreover  make  use  of  water  by  jets,  fre- 
quently repeated ;  throwing  it  upon  the  faces  of  some,  who  are  laboring  under 
a  stupor.  These  slight  excitements,  frequent  and  unexpected,  have  sometimes 
aroused  patients  from  their  lethargy.  Water  has  been  prescribed  by  injec- 
tions ;  sometimes  pure,  sometimes  combined  with  purgative,  and  soothing  or 
antispasmodic  remedies,  as  the  indications  required.  The  douche  by  the  rec- 
tum has  also  been  advised,  to  overcome  obstinate  constipation, — to  unload 
the  large  intestines,  and  to  relieve  the  spasm  of  the  alimentary  canal ;  some-  I  -' 

times  to  give  tone  to  this  tract,  or  to  provoke  a  derivative  irritation.  ,  rHA-^ 

Avenbrugger  recommended  the  internal  use  of  cold  water,  drank  in  large  [/b      •    — 
quantities,  at  the  rate  of  a  tumbler  every  hour.     Hufeland  regards  this  means       akA^ 
as  of  service  in  mania.     Leroi  d'Anvers    has  published   an   account  of  the  y-'^-''^'^  (^  ^ 
advantages  of  cold  water,   as  a  preventive   of  suicide.     Many  facts  seem  to  ^i^^- 
justify  this  practice.     The  most   interesting  is  that  of  Theden,  a  very  distin-' 
guished  Prussian  surgeon,  who  having  been  hypochondriacal  in  his  youth,  at 
length  became  melancholic,  with  a  disposition  to  commit  suicide.     The  copi- 
ous use  of  cold  water  restored  him  to  health.     He  drank  of  it   from  twenty- 
four  to  thirty  pints  a  day.     From  a  favorable  opinion  of  its  utility,  as  well  as 
from  the  force  of  habit,  Theden  has  reported,  that  at  the  age  of  eighty  years, 
he  drank  every  day,  several   pints  of    cold  water.     Hufeland  confirms  this 


v/ 


86  INSANITY. 

fact  by  two  cases  which  he  has  collected.     This  means  has  been  particularly 
advised,  as  a  preventive  of  suicide. 

Evacuants  have  been  celebrated  from  the  highest  antiquity,  and  for  a  long 
time  formed  the  basis  of  treatment  in  insanity,  particularly  lypemania.  Far 
from  being  adapted  to  all  cases,  they  may  augment  the  evil.  The  moderns 
have  advised  emetics,  which  ought  to  hold  a  high  place  in  the  treatment  of 
some  forms  of  monomania,  and  lypemania  with  stupor.  Emetics  are  suited 
to  those  cases  in  which  the  sensibility  is  blunted,  where  the  patient  seems 
stricken  with  atony,  whilst  they  would  be  injurious,  did  irritation  exist.  Ma- 
son Cox  places  emetics  in  the  front  rank  of  remedies,  in  every  stage  of  in- 
sanity. Rush  believes  emetics  most  useful  in  hypochondriacal  melancholy. 
They  repeat  them  many  days  in  succession.  Besides  the  sensible  evacuations 
which  they  provoke,  they  excite  the  transpiration,  and  cause  succussions  use- 
ful in  relieving  spasms  of  the  abdominal  viscera.  Purgatives  are  also  praised. 
The  choice  of  purgatives  is  not  a  matter  of  indifference.  In  some  cases,  we 
prefer  those  which  have  a  special  action  upon  the  hepatic  system,  the  hemor- 
rhoidal vessels,  upon  intestinal  worms,  etc. '  Purgatives  often  cause  irritation, 
thereby  suspending  the  activity  of  the  skhi.  To  prevent  these  accidents,  or 
consecutive  effects,  we  alternate  them  with  the  tepid  bath.  Many  insane  per- 
sons think  themselves  very  well,  and  refuse  all  medication.  We  may  triumph 
over  this  repugnance  by  causing  them  to  take  without  their  knowledge,  some 
substance  which,  by  irritating  the  stomach  or  intestines,  provokes  pains,  and 
even  evacuations.  These  accidents,  by  causing  uneasiness  in  the  mind  of 
the  patient  respecting  his  health,  render  him  docile.  Hellebore,  gamboge, 
bryony,  aloes,  submuriate  of  mercury,  and  especially  the  tartrate  of  antimony 
and  potassa,  together  with  purgative  mineral  waters,  are  the  therapeutic 
agents,  which  we  may  at  such  times  employ  with  advantage. 

M.  Chrestien,  a  celebrated  practitioner  of  Montpellier,  proposes  colocynth, 
administered  by  friction  upon  the  abdomen,  as  a  sure  purgative.  He  goes  so 
far  as  to  recommend  this  substance  as  a  specific  in  insanity.  I  have  repeated 
the  experiments  of  M.  Chrestien,  upon  twenty  insane  persons,  but  have  not 
been  equally  successful  with  himself.  The  colocynth  not  only  failed  to  effect 
a  cure,  but  did  not  purge,  except  in  two  instances  after  confinement. 

On  the  discovery  of  the  circulation  of  the  blood,  it  was  believed  that  we 
had  discovered  the  cause  of  every  disorder,  and  a  remedy  for  all  ills.  Blood 
was  shed  abundantly.  The  blood  of  the  insane  was  the  more  freely  shed,  as 
by  bleeding  them  to  faintness,  it  was  believed  that  they  were  cured.  This 
treatment  was  extended  to  all  the  insane.  In  every  hospital,  there  was  estab- 
lished what  was  called,  the  treatment  of  the  insane  on  this  principle;  that  the 
blood  being  too  abundant  and  too  much  heated,  ouorht  to  be  evacuated  and 
cooled.  Besides,  in  the  hospitals  of  France,  where  some  attention  was  paid 
to  the  insane,  in  spring  and  autumn,  they  bled  them  once  or  twice,  and  bathed 
them  in  cold  water  ;  or  cast  them,  bound  hand  and  foot,  into  a  river  or  reser- 
voir. If  a  {e\v  victims  of  such  gross  mismanagement  escaped,  they  cried  out, 
a  miracle  !  Such  was  the  prejudice  not  long  since  even  at  Paris,  in  favor  of 
bleeding,  that  we  were  accustomed  to  receive  pregnant  women,  who  were  bled 
by  way  of  precaution,  before  being  sent  to  a  house  where  bleeding  was  pro- 
scribed. Excess  in  this  respect  has  sometimes  been  so  great,  that  I  have  had 
in  charge  an  insane  man,  who  had  been  bled  thirteen  times  in  forty-eight 
hours.  Pinel  set  himself  against  this  abuse,  and  cites  examples  which  ought 
to  be  presented  to  the  observation  of  all  physicians.  I  can  add,  that  I  have 
many  times  seen  insanity  increase  after  abundant  menstrual  flows,  after  hemor- 
rhages, and  after  one,  two  and  even  three  bleedings.  I  have  seen  a  state  of 
sadness  pass  into  mania  and  fury,  immediately  after  bleeding  ;  and  dementia 
to  replace,  reciprocally,  the  condition  of  mania.     I  do  not  believe  it  necessary 


J     ^ 


INSANITY.  87 

to  proscribe  blood-letting  in  the  treatment  of  insanity.  It  is  indispensable  in 
plethoric  subjects,  when  the  head  is  strongly  congested,  and  hemorrhages,  or 
habitual  sanguine  evacuations  have  been  suppressed.  At  the  commencement 
of  insanity,  if  there  is  plethora,  if  the  blood  rushes  violently  to  the  head,  if 
some  habitual  hemorrhage  is  suppressed,  we  bleed  largely,  once,  twice,  or 
thrice ;  apply  leeches  to  the  jugular  veins  and  temporal  arteries,  and 
cups  to  the  base  of  the  brain.  At  a  later  period,  sanguine  evacuations  are 
local,  and  employed  as  revulsives,  or  as  supplementary  to  suppressed  evacua- 
tions, etc.  The  use  of  energetic  tonics  and  antispasmodics,  ought  also  to  be  , 
appreciated.  Camphor,  musk,  iron,  quinine  and  antimony,  have  been  employ-  '' 
ed  in  very  large  doses,  as  specifics  in  insanity.  These  medicines  are  useful, 
but  of  individual  utility.  They  succeed  surprisingly  well,  when  one  is  suffi- 
ciently happy  to  seize  the  proper  indication  for  their  use,  which  the  disease 
presents  ;  but  are  hurtful  and  dangerous  if  employed  indiscriminately.  i 

Some  insane  persons  sleep  little;  passing  weeks  and  months  without  repose.  .,    ' 

Narcotics  are  employed  to  produce  sleep.     These  medicines  are  rather  hurt-  ")/V*^ 
ful  than  salutary,  especially  when  there  is  plethora,  or  congestion  of  the  head. 
For  a  long  time,  Valsalva  and  Morgagni  proscribed  opiates,  and  daily  prac-  » 

lice  confirms  the  judgment  of  these  great  masters.     Regimen,  labor  and  ex-     A      },Kk/ 
ercise,  are  the  true  remedies   for   insomnia.     Tepid   or  cool   baths  provoke    {  r^ 
sleep,  are  truly  efficacious,  and  are  in  no  way  dangerous.     Setons,  moxas,  the 
actual  cautery,  cups,  vesicatories,  irritating  and  mercurial  frictions  have  been  .. 

employed.     These  means  are  excellent  auxiliaries  to  provoke  a  revulsion,  to     -  ' 

bring  back  a  cutaneous  eruption  which  has  been  suppressed,  to  arouse  the 
sensibility  of  the  skin,  which  is  often  in  a  state  of  atony,  to  excite  a  general 
reaction,  etc.,  etc.  It  has  been  proposed  to  envelope  the  head  with  epispas- 
tics,  or  some  other  irritating  compositions  ;  and  to  employ  a  saturated  solution 
of  tartrate  of  antimony  and  potassa,  in  water.  I  must  confess,  that  I  have 
never  seen  those  means  succeed,  which  augment  irritation, — torment  and  dis- 
turb the  sick,  and  persuade  them  that  we  wish  to  punish  them.  It  is  almost 
always  among  monomaniacs,  or  persons  in  a  state  of  dementia,  that  we  pre- 
scribe a  course  of  medication,  so  active  and  perturbating.  I  do  not  deny,  that 
in  some  cases,  success  may  have  followed  this  treatment ;  but  I  believe  that 
those  cases  are  very  rare,  and  the  indications  very  difficult  to  appreciate. 

I  cannot  omit  making  some  remarks  respecting  the  use  of  fire  and  moxa, 
applied  to  the  top  of  the  head,  and  over  the  occiput  or  neck  in  mania.     Doc-  jp 

tor    L.  Valentin    has  published    some    valuable    observations   concerning  the  ^  Jl«J\ 
cure  of  mania   by  the   application  of  fire.*     I  have  many  times   applied  the    1*^      r"^ 
iron   at  a  red   heat  to   the  neck,  in  mania  complicated  with  fury,  and  some-     //" 
times  with  success.     I  made  very  many  attempts,  which  always  proved  fruit- 
less, when  I  addressed  myself  to  subjects  which  presented  symptoms  of  para- 
lysis.    The  seton  in  the  neck,  has  succeeded  better  in  my  hands,  except  when 
I  have  applied  it  to  individuals  who  did  not  experience  the  same  complica- 
tions,  and  who  were   in   that   stage  of  dementia  which   is   confounded  with 
idiocy.  | 

Gmelin  and  Perfect  affirm,  that  they  have  effected  cures  by  electricity.  At 
the  Salpetriere,  during  two  summers,  those  of  1823  and  1824,  I  submitted  to  ^ 
the  influence  of  electricity  a  large  number  of  our  insane  women.  One  only  - 
was  cured,  in  the  cour.se  of  my  experiments.  This  was  a  young  and  very 
strong  girl,  who  had  become  a  maniac  in  consequence  of  a  fright,  which 
suppressed  her  menses.  She  had  been  insane  for  a  month,  and  was  electrized 
for  fifteen  days.     At   the  menstrual   period,  the  discharge  appeared,  and  she 

*  An  Essay  and  Observations  concerning  the  good  effects  of  the  actual  cautery,  apphed 
to  the  head  in  various  disorders.     Nancy,  1815,  in  8vo. 


88  INSANITY. 

was  immediately  restored.  Wennolt  tried  galvanism.  I  also  employed  it,  in 
connection  with  Professor  Aldini,  in  1812.  Twice  the  menses  were  restored, 
but  the  delirium  persisted.  Experiments  have  been  made  with  magnetism, 
particularly  in  Germany.  The  facts  reported  in  France,  in  relation  to  it,  are 
neither  exact,  nor  well  observed.  In  1813  and  1816,  I  made  experiments 
with  the  late  M.  Faria,  upon  eleven  insane  women,  maniacs  or  monomaniacs. 
One  only,  who  was  remarkably  hysterical,  yielded  to  the  "magnetic  influence  ; 
but  her  delirium  underwent  no  change.  Magnetism  produced  no  effect  upon 
ten  other  insane  persons.  These  experiments  were  made  in  presence  of  M. 
Desportes,  governor  of  the  hospitals,  and  others,  besides  several  physicians.  I 
repeated  the  same  trials,  several  times,  with  divers  magnetizers,  with  no  better 
success.* 

I  ought  to  say  a  word  respecting  the  machine  of  Darwin.  This  instrument 
which,  nearly  enough,  resembles  a  circular  swing,  has  passed  from  the  arts, 
to  be  employed  in  medicine.  Mason  Cox  made  much  use  of  it.  Hufeland 
and  Horn  employed  it  at  Berlin.  One  of  them  remains  at  Geneva,  which 
furnished  Odier  an  opportunity  to  observe  its  eflects.  Poctor  Martin,  physi- 
cian of  the  hospital  at  Antiquaille,  where  to  this  day  the  insane  of  Lyons  are 
treated,  has  informed  me  that  he  had  been  frightened  at  the  accidents  which 
the  insane  had  met  with,  who  had  been  submitted  to  the  influence  of  this  ma- 
chine. They  fell  into  a  state  of  syncope,  and  had  also  copious  evacuations 
both  by  vomiting  and  purging,  which  prostrated  them  extremely.  This  mode 
of  treatment,  employed  with  prudence,  may  be  useful  to  such  insane  persons 
as  refuse  all  kinds  of  medicine,  and  who  present  symptoms  of  gastric  de- 
rangement.+ 

We  should  not  complete  all  that  relates  to  the  treatment  of  insanity,  did 
(V  we  neglect  to  speak  of  the  modes  of  preventing  it.  Prophylactic  mea- 
\^'  sures  have  for  their  object  the  preventing  of  the  disorder,  or  the  return  of  an 
|n1  attack.  These  measures  are  either  general  or  particular.  They  have  been 
already  indicated,  by  an  exposition  of  the  causes  of  insanity.  We  should 
avoid  marriages  with  persons  descended  from  insane  parents.  The  education 
of  man  begins  in  infancy,  and  we  should  guard  against  the  recital  of  such 
stories  and  fables  to  children,  as  disturb  the  brain,  or  painfully  excite  the 
imaorination.  While  cultivating  the  mind,  we  should  at  the  same  time  form 
the  heart,  and  never  lose  sight  of  the  fact  that  education  consists  less  in 
what  we  learn,  than  in  correct  habits  of  mind,  feeling  and  action.  If 
education  is  neither  religious  nor  moral  ;  if  the  child  meets  with  no  opposition 
to  his  wishes  or  caprices  ;  if  every  one  yields  to  his  desire  ;  how  will  he  fami- 
liarize himself  to  the  difticulties  with  which  life  abounds  1  We  should  not 
force  the  principles  of  feeling  and  intelligence,  by  early  fatiguing  the  brain 
with  lessons  of  inordinate  length.  We  should  avoid  errors  of  regimen,  which 
often,  at  the  tenderest  age,  predispose  to  insanity.  We  should  control,  and 
direct  the  passions  of  the  young. 

The  education  of  those  who  are  born  of  parents  already  insane,  should  be 
less  devoted  to  the  cultivation  of  the  mind,  than  the  strengthening  of  the 
physical  powers.  The  preceptor,  informed  beforehand  of  the  mental  state 
of  their  parents,  and  the  wanderings  of  their  passions,  will  educate  his  pupils 
with  reference  to  this  knowledge, — will  moderate  their  undue  ardor  of  mind, 

*  Georget  has  given  an  account  of  the  experiments  in  magnetism,  which  he  made  at 
the  Salpetriere,  in  a  work  entitled  :  "  Physiology  of  the  JVervoiis  System.''  Paris,  1821, 
tome  I.  Page  267,  and  tome  II.  p.  404.  M.  Dechambre,  who  repeated  the  experiments 
which  )ie  performed,  is  convinced  that  Georget  was  the  dupe  of  his  pretended  somnam- 
bulist. See  Medical  Gazette,  year  1835,  for  a  very  witty  account  of  the  experiments 
made  by  M.  Dechambre 

t  Since  the  first  edition  of  this  article  was  published,  the  rotary  machine  has  been 
every  where  abandoned. 


INSANITY.  89 

— check  their  wayward  propensities,  and  fortify  them  against  the  seductive 
influence  of  the  passions  ;  whilst  the  physician,  aware  of  the  physical  causes 
which  have  provoked  the  disease  in  the  persons  of  their  parents,  will  prevent 
the  development  of  these  causes,  or  diminish  their  deplorable  effects,  by  reori- 
men  and  medicines  adapted  to  the  wants  of  their  children. 

How  can  we  assure  ourselves  of  his  convalescence,  and  prevent  relapses,  if 
the  patient  is  not  submitted  during  a  period,  more  or  less  protracted,  to  a 
mode  of  life  appropriate  to  his  constitution,  and  to  the  causes  and  character 
of  the  malady  from  which  he  has  just  been  restored  ?  if  he  avoid  not  the  pre- 
disposing, physical  and  moral  causes, — if  he  is  not  watchful  against  errors  of 
regimen,  excess  of  study,  and  transports  of  passion  1  Experience  has  taught 
us  that  relapses  often  take  place,  in  consequence  of  the  simultaneous  develop- 
ment of  physical  and  moral  causes.  We  must  attack  with  energy,  these 
causes,  from  the  moment  that  they  manifest  themselves,  without  awaiting  the 
explosion  of  the  delirium.  An  emetic,  and  purgatives  given  in  season,  may 
arrest  an  attack  of  insanity.  The  application  of  leeches,  and  blood-letting, 
in  cases  of  slight  menstrual  disorder,  prevent  attacks,  which  might  otherwise 
have  taken  place.  The  disappearance  of  a  cutaneous  eruption,  of  the  gout, 
or  rheumatism,  or  an  habitual  evacuation,  has  preceded  a  first  attack  of  in- 
sanity. We  mu^t  be  ever  watchful  of  these  metastases  and  suppressions. 
What  has  been  said  respecting  the  precautions  which  the  physical  state  of 
those  who  have  been  insane,  demands,  is  equally  true  with  respect  to  the 
moral.  One  man  is  choleric ;  he  will  relapse  unless  he  exercise  all  his 
strength  to  overcome  this  passion.  Another  has  lost  his  reason  in  conse- 
quence of  domestic  trials.  He  ought  from  henceforth  to  be  spared  from 
these  afflictions.  A  third  remains  in  imminent  danger  of  a  relapse,  if  he 
does  not  reform  his  conduct,  and  abandon  the  excesses  that  have  preceded  his 
first  attack.  It  is  for  want  of  foresight  that  insanity  is  so  often  hereditary  ; 
and  in  consequence  of  imprudences,  that  persons  who  have  had  one  attack  of 
insanity  are  subject  to  a  recurrence  of  the  same  malady. 

[In  the  moral  treatment,  and  general  regimen,  recommended  by  our  author  for  the  in- 
sane, we  heartily  concur.  It  is  precisely  what  at  this  day  is  universally  admitted  and 
employed.  His  remarks  however,  with  respect  to  tfte  use  of  tonics,  and  narcotic  and 
sedative  agents,  are  not  in  accordance  with  the  practice  in  this  country. 

In  our  Institutions,  either  singly  or  in  combination,  they  form  in  a  majority  of  cases 
requiring  it,  the  basis  of  treatment,  and  are  indeed  of  very  general  application.  It  is 
proper  however  to  state,  that  some  of  the  Medical  Superintendents  of  Institutions  for 
the  insane,  whose  opinions  are  entitled  to  high  consideration,  while  they  admit  of  tonic 
and  corroborant  treatment  in  all  tho  forms  of  insanity,  regard  with  no  little  distrust,  if 
not  with  decided  disapprobation,  the  use  of  narcotics  and  sedatives. 

The  reported  results  of  treatment  on  the  part  both  of  the  advocates  and  opposers  of 
these  agents,  furnish  nothing  that  can  with  propriety  be  regarded  as  decisive  on  the  sub- 
ject ;  nor  will  the  latter  perhaps  admit,  that  their  preferences  have  been,  either  by  them- 
selves or  others,  submitted  to  the  test  of  an  extended  experience. 

In  cases  of  extreme  nervous  irritability  and  excitement,  attended  with  much  mental 
agitation,  as  well  as  when  the  mind  is  weighed  down  with  fearful  apprehensions  of  im- 
pending calamities,  or  a  settled  propensity  to  suicide  exists — conditions,  both  of  the  body 
and  mind  which  are  constantly  to  be  found  in  Institutions  for  the  insane, — narcotics  with 
their  soothing  influences  come  in  to  sustain  the  exhausted  nervous  system,  and  raise  the 
sinking  spirits,  to  a  degree  which,  aside  from  their  curative  effects,  renders  their  employ- 
ment decidedly  advantageous.  We  have  however,  in  my  own  opinion,  no  legitimate 
right  to  regard  any  agent  which  brings  even  temporary  relief  to  the  desponding  mind — 

12 


90  INSANITY, 

even  though  this  relief  result  from  an  absence  of  thougnt,  rather  than  from  the  exercise 
of  emotions  positively  pleasing — as  altogether  destitute  of  remedial  powers. 

To  furnish  repose,  and  to  kindle  even  for  a  few  moments,  the  flame  of  hope  in  a  mind 
over  which  the  demon  of  darkness  has  long  brooded,  may,  and  does  oftentimes,  bring 
comfort  which  no  language  can  adequately  describe,  and  encourages  the  unhappy  sufferer 
to  make  one  more  effort  to  escape  his  dreadful  thraldom.  His  own,  in  connection  with 
the  exertions  of  those  to  whose  enlightened  sympathy  and  care  he  has  been  committed, 
often  result  in  ultimate  and  complete  restoration  to  reason,  and  sound  bodily  health. 

In  cases  attended  with  a  full  habit,  and  considerable  arterial  reaction,  narcotic  and  se- 
dative agents,  when  deemed  appropriate,  are  for  a  time,  conjoined  with  nitre,  ipecacu- 
anha, or  the  antimonials  ;  and  cooling  laxatives  together  with  a  restricted  diet,  are  prefer- 
red to  more  direct  depletion. 

It  is  hardly  necessary  to  add,  that,  while  great  caution  is  required  in  the  use  of  depress- 
ing agents,  inflammatory  action  is  in  every  instance  to  be  promptly  met  b3'  the  use  of 
active  and  efficient  depletion,  both  topical  and  general,  commensurate  with  the  severity 
of  the  case.  The  most  intense  nervous  excitement  however,  which  is  sometimes  mis- 
taken for  cerebral  inflammation,  can  never  require  this  treatment.  It  is  in  view  of  errors 
of  this  sort,  that  the  general  practitioner  is  recommended  to  guard  against  depletion  and 
its  too  often  disastrous  consequences. 

Of  the  medicines  employed,  the  preparations  of  Iron,  (usually  the  precipitated  carbo- 
nate), and  the  sulphate  of  Quinine  ;  Laudanum,  the  salts  of  Morphia,  Conium,  Hyoscy- 
amus.  Camphor  and  Stramonium,  are  the  principal. 

Conium,  though  largely  employed  in  many  Institutions,  is  at  others  regarded  as  inert, 
and  therefore  laid  aside.  We  state  the  fact  without  assigning  the  reasons  for  such  con- 
tradictory views  ;  having  seen  none  other  offered,  than  such  as  grow  out  of  an  opposite 
experience  in  the  use  of  this  agent.  With  respect  to  Hyoscyamus,  Stramonium  and 
Camphor,  little  dependence  is  placed  upon  them,  though  they  are  sometimes  employed. 
Valerian,  in  some  of  its  forms  is  considerably  used,  and  Asafoetida,  or  some  .Ethereal 
preparation  occasionally. 

Depraved  or  sluggish  secretions,  with  torpor  of  the  bowels,  require  the  use  of  alterative 
medicine  and  laxatives.  On  no  point  are  the  profession  more  united,  than  in  their  op- 
position to  prolonged  purgation.  Iron  with  Conium  is,  in  many  Institutions,  very  freely 
employed,  sometimes  in  pills,  but  more  generally  in  a  liquid  form. 

The  following  combination  has  always  been  a  favorite  remedy  with  some,  and  is  large- 
ly employed,  with  slight  modifications,  in  several  Institutions  ; 

R 

Carb.  Ferri  Precipitat.  5xxx 

Ext.  Conii  3xv 

Syr.  Bals.  Tolu.  §vi 

Ol.  Cinnamom. 

Oi.  Limon.  aa  ^r^xii 

Alcohol  §ii 

Aquae  Oi 

Spt.  Gallici  Aut.  Vin.  Madei.  Oss 
Sacchari  §iv 

Mix. 

Of  this  mixture,  from  half  an  ounce  to  an  ounce  and  a  half,  is  to^  be  given  three 
or  four  times  a  day.  In  every  case,  it  is  proper  to  begin  with  moderate  doses  of  what- 
ever agent  or  combination  is  employed,  and  increase  it  gradually,  watching  its  effects. 
So  insusceptible  are  many  insane  persons  to  the  influence  of  narcotic  and  sedative  agents, 
that  they  bear  enormous  doses  of  them,  not  only  without  injury,  but  sometimes  with  the 
most  happy  results.     We  have  however,  no  means  of  ascertaining  beforehand,  who  are, 


INSANITY.  91 

and  who  are  not  easily  affected  by  articles  of  this  class.     Hence  the  necessity  of  cau- 
tion. 

In  addition  to  what  has  been  said  in  regard  to  treatment,  and  the  respective  merits  of 
remedial  agents,  it  is  our  duty  to  state  distinctly  our  belief,  that  not  a  few  of  those  who 
are  presented  and  received  as  persons  requiring  the  benefits  of  an  Institution  for  the  in- 
sane, need,  for  their  complete  restoration,  little  else  than  the  moral  and  restraining  in- 
fluences of  these  Establishments.  They  have  no  febrile  symptoms  to  subdue,  no  special 
degree  of  prostration  requiring  support,  no  marked  functional  derangement  of  any  organ 
or  part  to  regulate  ;  in  a  word,  present  no  indications  requiring  the  use  of  medicinal 
agents.  They  are  nevertheless  insane,  and  require  treatment ; — the  peculiar  treatment 
just  referred  to, — without  which,  the  teachings  of  experience  conduct  to  the  inference, 
that  they  would,  in  most  cases,  never  recover.] 


X* 


HALLUCINATIONS. 


Definition  of,  by  Esquirol,  Sauvages,  Sagar,  Darwin  and  other  English  physicians. — Illus- 
trative cases,  with  treatment. — Post-mortem  examinations. — Farther  remarks  on  hallu- 
cinations.— How  accounted  for. — Distinction  between  hallucination,  somnambulism, 
and  ecstasy. — The  convictions  of  the  minds  of  the  hallucinated  entire,  and  their  acts 
in  accordance  with  them. — Case  of  a  Jewess ;  post-mortem  examination  of. — Seat  of 
hallucinations. — Darwin's  and  Foville's  opinions  respecting.- — Subjects  to  which  hallu- 
cinations usually  relate. — Very  common  in  insanity. — By  some  regarded  as  synony- 
mous with  vision. — How  it  differs  therefrom. — Remarks  on  general  treatment. 


b"- 


A  PERSON  is  said  to  labor  under  a  hallucination,  or  to  be  a  visionary,  who 
has  a  thorough  conviction  of  the  perception  of  a  sensation,  when  no  external 
object,  suited  to  excite  this  sensation,  has  impressed  the  senses. 

Sauvages  has  given  the  name  of  hallucination  to  those  errors  which  result 
from  a  lesion  of  one  of  the  senses ;  and  when  the  sensations  fail  to  produce 
that  effect  upon  the  mind,  which  they  were  accustomed  to  do  before  this  lesion 
took  place.  Double  vision,  imperfect  sight,  ringing  in  the  ears,  are  ranked 
by  this  nosologist  in  the  first  order  of  his  division  of  the  insane.  But  such 
errors  and  illusions  as  the  other  senses  and  the  understanding  are  capable  of 
correcting,  should  not  be  confounded  with  delirium. 

Sagar  denominates  hallucinations,  false  perceptions,  which  form  the  first 
order  of  the  Vesanise,  of  his  Nosology.  Linnaeus  places  them  in  the  order  of 
diseases  of  the  imagination.     Cullen  ranks  them  among  local  maladies. 

Darwin,  and  after  him  the  English  physicians,  have  given  the  name  of  hallu- 
cination to  the  partial  delirium  which  affects  but  a  single  sense;  yet  the/ 
employ  it  indifferently,  as  a  synonym  with  delirium. 

This  symptom  of  delirium  has  been  confounded  by  all  authors  with  local 
lesions  of  the  senses,  with  the  vicious  association  of  ideas,  and  in  fine,  with 
the  influence  of  the  imagination.  It  has  been  studie  d  onlywhen  it  related  to 
ideas,  which  seemed  to  belong  to  the  sense  of  sight ;  never,  when  it  repro- 
duced those  appertaining  to  other  senses.  Nevertheless,  considered  in  all  its 
varieties,  and  to  whatever  sense  it  may  relate,  this  symptom  is  very  frequent. 
It  is  one  of  the  elements  of  insanity,  and  may  be  met  with  in  all  the  forms  of 
this  malady.  The  austere  writings  of  every  people,  the  history  of  magic  and 
sorcery  in  every  age,  together  with  the  annals  of  mental  medicine,  furnish  nu- 
merous facts  in  relation  to  the  subject  of  hallucinations.  I  have  collected  and 
published  a  great  many  of  them.  The  following  observations  will  exhibit  hal- 
lucinations, as  distinct  as  possible,  from  other  symptoms  of  insanity. 

M.  N.,  aged  51  years,  of  a  bilious   sanguine  temperament,  having  a  large 


94  HALLUCINATIONS. 

head,  short  neck  and  flushed  face,  was,  in  1812,  prefect  of  a  large  city  of  Ger- 
many, the  inhabitants  of  which  rose  upon  the  rear-guard  of  the  French  army, 
in  its  retreat.  The  disorder  which  resuUed  from  these  events,  and  the  respon- 
sibility which  rested  upon  the  prefect,  deprived  him  of  the  use  of  his  reason. 
He  considered  himself  accused  of  high  treason,  and  consequently  disgraced. 
In  this  state  of  mind  he  cut  his  throat  with  a  razor.  As  soon  as  he  had  re- 
covered his  senses,  he  hears  voices  that  accuse  him.  Cured  of  his  wound, 
he  hears  the  same  voices,  and  persuades  himself  that  he  is  surrounded  with 
spies.  He  believes  even  that  his  domestics  denounce  him.  These  voices 
are  continually  repeating  in  his  ear  that  he  has  betrayed  his  trust, — that  he  is 
dishonored,  and  that  he  can  do  nothing  better  than  destroy  himself  They 
employ  in  turn,  all  the  languages  of  Europe,  with  which  the  sick  man  is  con- 
versant. A  single  one  of  these  voices  is  understood  less  distinctly,  because  it 
borrows  the  Russian  idiom,  which  M.  N.  employs  with  less  facility  than  the 
others.  Among  these  different  voices,  he  hears  very  clearly  that  of  a  lady, 
who  calls  upon  him  to  take  courage,  and  entertain  confidence.  He  goes  aside 
often,  the  better  to  hear  and  understand.  He  questions  and  replies,  provokes, 
challenges,  and  becomes  angry,  while  addressing  those  persons  who  he  be- 
lieves are  speaking  to  him.  He  is  convinced  that  his  enemies,  by  various 
means,  can  divine  his  most  secret  thoughts,  and  cause  to  befall  him  all  the 
evils  implied  in  the  threats,  reproaches  and  sinister  opinions,  with  which  they 
are  overwhelming  him.  Aside  from  this,  he  reasons  with  perfect  propriety, 
and  all  his  intellectual  faculties  preserve  their  wonted  integrity.  He  partici- 
pates in  conversation  with  the  same  degree  of  spirit,  intelligence  and  readi- 
ness, as  before  his  sickness. 

Having  retired  to  the  country,  M.  N.  passes  the  summer  of  1812  at  a 
Chateau,  where  he  receives  much  company.  If  the  conversation  interests  him, 
he  no  longer  hears  voices.  If  it  languishes,  he  hears  them  imperfectly,  quits 
society,  and  turns  aside,  the  better  to  understand  the  sentiments  which  these 
perfidious  voices  express.  He  then  becomes  restless  and  gloomy.  The  fol- 
lowing autumn  he  comes  to  Paris.  The  same  symptoms  beset  him  during 
his  route,  and  are  exasperated  after  his  arrival.  The  same  voices  repeat ;  Slay 
thyself;  thou  canst  not  survive  thy  disgrace.  No,  no  !  replies  the  unfortu- 
nate man,  I  will  not  terminate  my  existence  until  I  have  been  justified.  I  will 
not  bequeath  a  dishonored  memory  to  my  daughter.  He  goes  to  the  minister 
of  police,  who  receives  him  with  kindness,  and  endeavors  to  encourage  him  ; 
but  scarcely  does  he  enter  the  street,  before  the  voices  assail  him  anew.  I 
was  invited  to  visit  him,  and  found  him  walking  with  his  only  daughter  in  the 
court  of  the  hotel  where  he  lodged.  His  countenance  was  of  a  sallow  hue, 
its  expression  restless,  and  his  eyes  haggard.  I  was  received  with  politeness, 
but  to  all  my  questions  received  no  other  response  than  this;  "  I  am  not  sick." 
On  the  following  day  my  reception  was  the  same.  He  said  to  me,  "  I  need  nei- 
ther a  physician  nor  a  spy."  He  was  agitated  the  remainder  of  the  day,  and 
conducted  his  daughter,  15  years  of  age,  to  the  house  of  one  of  his  friends. 
That  night  his  disquietude  was  very  great,  attended  with  excitement,  sleepless- 
ness, thirst  and  constipation.  The  following  day,  M.  N.  went  early  to  the 
prefecture  of  the  police,  where  he  declared  that  he  had  just  settled  a  pension 
upon  his  daughter, — that  he  would  not  yield  to  his  enraged  enemies,  who  were 
endeavoring  to  persuade  him  to  take  his  life,  before  he  had  fully  justified  him- 
self,— that  he  had  just  made  himself  a  prisoner,  and  must  be  judged  forthwith. 
The  same  day  he  is  committed  to  my  care. 

For  more  than  a  month,  M.  N.  does  not  leave  his  apartment ;  sleeping  none, 
eating  very  little,  unwilling  to  receive  any  one,  and  walking  with  rapid  strides, 
like  a  gloomy  and  restless  man.  Do  we  propose  the  use  of  remedies,  he  re- 
plies with  an  ironical  smile.  His  politeness  in  other  respects  is  perfect.  His 
conversation  is  connected,  very  witty  and  sometimes  gay  ;  but  he  never  be- 


HALLUCINATIONS.  95 

trays  his  secret — appears  very  much  engrossed  in  thought,  and  particularly 
suspicious  of  those  who  serve  him.  During  conversation,  he  is  absent  mind- 
ed, and  sometimes  stops  to  hear,  and  replies  briefly,  with  temper  and  even  pas- 
sion, to  the  pretended  voices.  After  nearly  two  months,  he  appeared  to  wish 
that  I  should  prolong  my  visits.  It  occurred  to  me  to  call  the  voices  which 
pursue  him,  babblers.  This  word  succeeds,  and  at  my  return  he  employs  it, 
to  express  their  dreadful  importunity.  I  venture  to  speak  to  him  respecting 
his  disorder,  and  of  the  causes  of  its  continuance.  He  relates  much  in  de- 
tail what  he  has  for  a  long  time  experienced,  is  a  little  more  ready  to  listen 
to  my  reasoning,  and  discuss  my  objections.  He  refutes  my  opinion  respect- 
ing the  causes  of  these  voices,  and  calls  my  attention  to  the  fact  that  they 
were  exhibiting  at  Paris,  a  woman  said  to  be  invisible,  to  whom  they  were 
accustomed  to  speak,  and  who  replied  at  a  distance.  Such  advances,  said  he, 
have  been  made  in  physics,  that  by  the  aid  of  instruments  the  voice  may  be 
transmitted  very  far.  You  have  traveled,  said  I,  a  hundred  leagues  by  post, 
and  upon  pavement,  and  the  noise  of  your  carriage  would  have  prevented  your 
babblers  from  being  heard.  Yes,  doubtless,  he  replied,  but  by  means  of  their 
instruments  I  heard  them  very  distinctly. 

The  new  political  views,  and  the  approach  of  foreign  armies  upon  Paris, 
appeared  to  him  fables,  invented  to  get  the  better  of  his  opinions.  Suddenly, 
in  the  midst  of  one  of  our  interviews,  he  said  to  me,  raising  his  voice,  and  in 
a  solemn  tone ;  "  Since  it  is  your  wish,  listen  to  my  profession  of  faith.  The 
emperor  has  overwhelmed  me  with  favors.  I  have  served  him  with  zeal  and 
devotion.  I  have  been  wanting  neither  in  duty  nor  honor.  This  I  swear.  Let 
him  do  with  me  what  he  pleases."  Towards  the  end  of  March,  1814,  after  a 
long  conversation,  I  invite  M.  N.  to  pay  me  a  visit,  in  order  to  satisfy  himself 
by  examining  my  library,  whether  I  was  a  physician.  He»declines;  but  three 
days  after,  thinking  that  he  had  taken  me  at  unawares,  he  proposes  to  visit  my 
study  immediately.  I  accept  the  proposal.  After  having  examined  the  books 
for  a  considerable  time,  he  says ;  "  If  these  books  were  not  placed  here  ex- 
pressly for  me,  this  library  is  that  of  a  physician."  Some  days  afterwards, 
the  siege  of  Paris  takes  place,  but  the  patient  remains  convinced  that  it  is  not 
a  battle,  but  merely  an  exercise  with  fire-arms.  The  king  is  proclaimed,  and 
I  send  him  the  journals  with  the  arms  of  France ;  he  reads  and  returns 
them,  adding  ;  "  these  journals  were  printed  expressly  for  me."  I  reply,  that 
this  would  not  only  be  very  expensive,  but  very  dangerous  also.  This  argu- 
ment does  not  change  his  mind.  I  propose,  in  order  to  convince  him,  to  walk 
with  him  about  the  city,  but  he  declines.  On  the  15th  of  April,  "  Let  us  go 
abroad,"  said  he  to  me  promptly,  and  without  any  suggestion  on  my  part.  In 
a  moment  we  directed  our  steps  to  the  Garden  of  Plants,  where  we  found  a 
large  body  of  soldiers  wearing  the  uniform  of  all  nations.  We  had  scarcely 
walked  a  hundred  steps,  when  M.  N.  presses  my  arm  violently,  saying ;  Let 
us  return,  I  have  seen  enough,  you  have  not  deceived  me ;  I  was  sick,  but  am 
now  cured.  From  that  moment  the  babblers  were  silent,  or  were  heard  only 
in  the  morning,  immediately  after  rising.  My  convalescent  turned  his  atten- 
tion from  them,  with  the  aid  of  the  shortest  conversation,  by  the  perusal  of  a 
book  for  a  few  moments,  or  by  a  walk.  At  this  time  also,  he  regarded  this 
symptom  as  I  did  myself.  He  looked  upon  it  as  a  nervous  phenomenon,  and 
expressed  his  surprise  at  having  so  long  been  the  dupe  of  it.  He  permitted 
the  application  of  some  leeches,  employed  the  foot-bath,  and  drank  some  tum- 
blers of  purgative  mineral  water. 

In  the  month  of  May,  he  goes  into  the  country,  where  he  enjoys  perfect 
health  notwithstanding  the  mortifications  he  experiences,  and  the  affliction 
which  the  death  of  his  only  daughter  occasioned.  M.  N.  returns  to  his  coun- 
try in  1815,  where  he  is  again  called  to  office. 

This  case  offers  the  most  striking  example  of  uncomplicated  hallucination 


X 


96  HALLUCINATIONS. 

of  hearing,  that  I  have  witnessed.  Hallucination  alone,  characterized  the 
cerebral  afiection  of  the  patient.  His  disquietudes,  suspicions  and  fears,  were 
only  the  consequence  of  this  phenomenon,  which  persisted  for  more  than  two 
months,  although  the  convalescent  had  entirely  recovered  the  free  exercise 
of  the  understanding.  Was  this  persistence  occasioned  by  the  force  of  ha- 
bit ?* 

M.  P.,  sixty  years  of  age,  belongs  to  a  family  distinguished  in  science,  and 
was  a  very  noted  officer  of  the  marine.  He  is  of  medium  size,  with  a  pro- 
jecting forehead,  and  a  largely  developed  occipital  region.  His  hair  is  of  a 
chesnut  color,  his  eyes  black,  countenance  pale,  mind  highly  cultivated,  dis- 
position mild.  In  his  youth,  he  indulged  in  masturbation,  and  one  of  his  bro- 
thers committed  suicide. 

M.  P.  at  the  age  of  30  years,  made  the  campaign  of  1807  in  Prussia,  in  the 
capacity  of  an  officer  of  marine.  He  remained  for  a  long  period  in  a  can- 
tonment that  was  extremely  humid,  and  in  consequence  was  seized  with  inter- 
mittent fever,  attended  by  delirium.  At  the  age  of  31  years,  while  on  leave 
of  absence  on  account  of  his  health,  he  was  married  to  a  charming  lady,  and 
introduced  to  a  family  in  which  he  was  treated  as  a  son.  Shortly  after,  he  is 
seized  with  delirium,  and  attempts  to  commit  suicide.  Committed  to  my  care, 
he  is  restored  in  three  months.  On  his  return  to  his  family,  he  is  the  happiest 
of  men.  He  returns  to  the  army,  with  the  rank  of  Lieutenant  of  the  marine 
guard,  and  makes  the  campaigns  of  1810  and  1811.  In  July  of  the  latter 
year,  in  consequence  of  an  excitement  resulting  from  an  act  of  injustice,  he 
suffers  from  a  return  of  delirium,  which  terminates  with  the  year.  In  the 
campaign  of  1814,  M.  P.  is  named  chief  of  the  squadron  of  the  marine  guard. 
Soon  after,  a  new  attack  is  provoked  by  the  abdication  of  Bonaparte.  In 
1815  he  returns  to  duty  during  the  hundred  days,  in  opposition  to  the  advice 
of  the  fimiily  of  his  wife.  After  the  second  abdication,  M.  P.,  seized  anew, 
takes  up  a  frightful  aversion  to  his  wife  and  her  family,  who  were  previously 
the  objects  of  his  strongest  regard.  Nothing  removes  this  dislike.  He  de- 
serts his  adopted  family,  and  makes  the  journey  to  Rom.e,  afoot  and  alone, 
impelled  by  religious  considerations.  Scarcely  has  he  set  foot  upon  the  soil 
of  Italy,  than,  one  day,  overcome  by  fatigue,  he  sits  down  upon  a  rock,  and 
experiences  an  extraordinary  visitation.  God  appears  to  him,  and  he  has  a 
vision  for  the  first  time.  From  henceforth,  he  believes  that  he  is  followed  by 
his  father-in-law,  who  throws  in  his  way  every  possible  obstacle  tp  the  accom- 
plishment of  his  journey.  He  sees,  hears,  and  contends  with  him.  Never- 
theless, he  reaches  his  place  of  destination.  Having  returned  to  France,  he 
is  placed  in  the  hospital  at  Avignon,  where  he  permits  his  beard  to  grow,  neg- 
lects the  most  ordinary  attentions  which  propriety  requires,  imposes  fasts 
upon  himself,  engages  in  no  occupation,  and  employs  no  means  of  diverting 
his  mind. 

\  I  visited   this   hospital   in    1821.     M.  P.  remembers   and  accosts   me  with 

much  satisfaction.  He  makes  many  enquiries  about  my  health,  and  respect- 
ing several  persons  whom  he  knew  when  under  my  care,  eleven  years  before. 


<? 


^I"-         On   being   brought  again  to  Paris,  M.  P.  enters  at  Charenton,  in  1825.     His 
■^  delirium  is  religious  and  mystical.     A  thousand  hallucinations   and  illusions 

of  the  senses   make  lio-ht  of  his  reason,  and  he  believes  also,  that  he  has  im- 



mediate  communications  with  God.  The  Son  of  God  sometimes  appears  to 
him  ;  and  he  sees  him  borne  upon  clouds,  surrounded  by  his  angels,  with  a 
cup  in  his  hand.  JJe  communicates  Ms  orders  to  his  humble  servant  P.,  not 
by  uiords,  but  by  signs  which  appear  in  the  air.  He  attempts  nothing,  with- 
out consulting  the  God  of  Heaven.     He  repeats  passages  of  the  Bible,  from 

*  This  case  was  previously  referred  to,  but  the  details  of  it,  which  we  have  recorded,  ap- 
peared to  me  of  so  much  interest,  that  I  could  not  pass  it  over  in  silence. 


HALLUCINATIONS.  97 

the  gospels,  which  he  opposes  to  the  observations  which  are  made  to  him  with 
respect  to  his  hallucinations  and  illusions.  God  expresses  himself  thus  in  the 
Holij  Scriptures,  says  he,  citing  the  verse.  Having  unduly  prolonged  the 
fast,  during  the  season  of  Lent,  in  1827,  M.  P.  was  taken  sick.  I  ordered  his 
food  to  be  increased  ;  but  he  obeyed  not,  until  he  had  weighed  the  matter 
carefully  in  his  mind,  had  consulted  God,  and  received  orders  from  above,  to 
comply  with  my  request.  He  often  said  to  me,  in  our  interviews  ;  "  Former- 
ly I  believed  not  in  God;  I  was  in  darkness  ;  but  since  I  have  exercised  faith, 
God  has  given  me  light."  He  is  constantly  in  the  gardens,  contemplating  the 
heavens  and  the  clouds,  with  a  blank  book  and  crayon  in  his  hand.  He 
traces  the  symbolical  figures,  which  he  sees  in  the  sky.  These  are,  at  one 
time,  geometrical  figures  ;  at  others,  animals,  household  utensils,  flowers,  in- 
struments of  music,  and  agricultural  implements.  Again,  they  are  strange 
figures  which  resemble  nothincr.  These  signs  are,  moreover,  for  the  instruc- 
tion  of  men  ;  for  the  scripture  saith,  there  shall  be  signs  in  heaven.  He  has 
seen  all  things  created,  and  understands  the  creation,  and  the  signs  which  he 
beholds.  He  wishes  also  to  explain  them,  and  in  his  explications,  religion 
and  politics  are  constantly  blended.  He  designs  all  his  visions,  and  writes 
out  their  explanations.  Usually  M.  P.  is  calm,  polite  and  amiable.  If  he 
speaks  of  his  visions,  a  smile  is  upon  his  lips,  and  his  language  is  mild.  He 
expresses  himself  without  excitement,  and  his  terms  are  very  well  chosen. 
If  we  persist  in  opposing  him  at  any  time,  his  eyes  become  animated,  his  look 
is  upward  upon  the  clouds,  and  his  face  flushed,  but  never  connected  with 
uncontrollable  excitement.  He  wears  the  appearance  of  a  person  in  the 
higher  walks  of  life  ;  in  person  is  moderately  full,  and  his  hair  is  white  ;  his 
appetite  and  rest  are  good.  He  lives  retired,  and  has  habitually  a  pompous 
air  ;  says  little,  and  never  disputes.  I  have  often  spoken  to  him  of  his  wife 
and  family,  in  order  to  recall  his  former  aflections.  They  wished  me,  says 
he,  to  deny  the  faith.  They  are  the  enemies  of  God,  and  I  renounce  them. 
His  costume  is  strange,  in  consequence  of  the  variety  of  its  colors. 

We  shall  not  read  without  interest,  an  account  of  the  peculiar  hallucina- 
tions of  a  distinguished  officer  of  marine,  who  has  been  at  Charenton  for 
eleven  or  twelve  years.  His  religious  monomania  is  carried  to  excess.  At 
the  age  of  fifty  he  is  controlled  by  ideas  of  a  mystical  and  punitive  character. 
He  desires  to  fast,  goes  about  with  naked  feet,  divests  himself  of  his  clothing, 
and  prostrates  himself  upon  the  floor  of  his  chamber.  Though  usually  tran- 
quil, he  has  had  several  attacks  of  madness,  which  have  been  caused  by  re- 
fusing him  permission  to  go  to  Brest,  to  rejoin  the  service.  In  the  spring  of 
1836,  M.  H.  sent  to  me  several  detached  sheets,  upon  which  he  had  written 
down  his  hallucinations.  The  following  are  certain  passages  taken  from 
them. 

First  sheet :  "  In  the  name  of  the  Father,  of  the  Son,  and  of  the  Holy 
Ghost. 

"  Signs  of  visions,  which  foretell  the  reign  of  God  and  the  coming  of 
N.  S.  J.  C. 

"  For  many  years,  extraordinary  events  have  been  taking  place  in  heaven 
and  upon  earth.  The  reign  of  God  and  the  coming  of  N.  S.  J.  C.  are  near. 
God  has  favored  me  with  many  visions  which  prove  it.  It  is  more  particular- 
ly within  the  last  years,  that  I  have  enjoyed  the  privilege  of  seeing  God,  and 
many  of  those  dwelling  in  Heaven. 

"  How  much  do  I  know  ! 

"  At  Orient,  in  Oct.  1821,  about  midnight,  I  heard  a  loud  voice  proceeding 
from  heaven,  which  uttered  words  which  I  cannot  repeat,  for  I  did  not  com- 
prehend them.  A  little  after,  I  heard  a  loud  cry,  and  saw  demons,  who  were 
suffering  the  chastisements  of  God.  On  hearing  this  voice  I  arose  hastily  and 
prayed.     The  next  day  I  gave  my  money  to  the  poor.     Some  days  after,  be- 

13 


98  HALLUCINATIONS. 

fore  sun-rising,  I  saw  in  the  east,  the  triangle,  emblematic  of  its  divinities.  I 
spoke  of  it  to  many  persons,  but  my  conduct  was  not  at  that  time  sufficiently 
religious,  to  secure  credence  to  my  report.  I  should  have  prayed  and  repent- 
ed, but  I  did  it  not.  It  was  not  until  many  years  afterwards,  that  I  began  to 
instruct  myself  in  matters  of  religion.  I  attended  mass  but  little,  from  shame. 
I  have  now  overcome  this  diffidence,  and  have  repented."  T.  H. 

Second  sheet  :  "  In  the  name  of  the  Father,  etc. 

"  Signs  and  visions,  etc.,  in  1829. 

"  At  the  close  of  the  month  of  June,  during  the  night,  a  man  appeared 
over  France  ;  the  presence  of  God  was  very  striking,  and  I  heard  some  one 
say,  is  this  the  end  of  the  world  1  it  seems  that  it  may  be  so.  Men  had  fears, 
and  many  were  troubled.  At  day-light,  the  most  perfect  calm  prevailed.  A 
few  days  afterwards  I  saw  persons  who  hastened  over  one  portion  of  the  sky, 
with  armed  men.  Their  march  was  rapid,  and  this  circuit  appeared  to  be 
made  for  the  purpose  of  warning  men  both  in  heaven  and  on  earth,  for  I  saw 
them  in  different  regions,  and  in  many  places.  During  the  whole  summer  I 
saw  angels  and  saints,  in  many  of  the  abodes  in  the  heavens.  I  saw  God  the 
Father  on  several  occasions,  who  condescended  to  speak  to  me.  The  first 
time,  he  was  surrounded  with  great  power,  and  the  heavens  were  clothed  in 
brightness.  I  saw  surrounding  him,  the  light  of  worlds,  which  before  appear- 
ed shrouded  in  darkness.  He  afterwards  enters  divers  hells,  where  he  slew 
several  monstrous  beasts,  and  filled  up  those  places,  from  which  I  believed 
false  oracles  emanated.  His  power  was  every  where  present,  and  the  heavens 
were  shaken  by  it.  Many  times  I  saw  John  the  Baptist  in  heaven,  in  a  cha- 
riot drawn  by  seven  horses,  from  whence  I  believe  he  was  preparing  with 
angels,  the  events  that  are  to  precede  the  coming  of  Christ.  I  pray  you  to 
believe  that  my  visions  are  true." 

Here  follows  the  signature,  T.  H. 

I  suppress  the  other  sheets.  Sometimes  the  ideas  contained  in  them  are 
not  more  connected  nor  more  rational  than  those  which  are  to  be  found  above. 
For  example,  he  closes  one  sheet  with  this  reflection  :  "  I  believe  that  Js.  Ch. 
will  come,  because  he  has  several  times  been  tempted.  I  pray  all  the  faithful 
to  intercede  in  my  behalf" 

Madame  de  S.,  of  medium  size,  of  spare  habit,  having  chesnut  colored  hair 
and  blue  eyes,  is  endowed  with  remarkable  susceptibility,  and  with  a  lively 
•*  and  very  amiable  disposition.  She  menstruated  for  the  first  time  at  14  years 
of  age.  She  has  always  enjoyed  delicate  health,  but  has  been  exempt  from 
grave  maladies.  Married  at  twenty-one  years  of  age,  she  became  pregnant 
at  twenty-three,  and  was  happily  confined.  She  did  not  nurse.  Three  months 
after  her  confinement  she  had  an  intestinal  affection,  which  persisted  notwith- 
standing a  hemorrhoidal  discharge.  At  thirty-one  years  of  age, a  second  preg- 
nancy occurs,  during  which  her  disposition  becomes  sour  and  capricious. 
She  is  confined  at  term,  and  without  accident ;  nurses  her  infant,  and  is  re- 
stored to  her  former  agreeable  disposition.  Lactation  debilitated  Mad'e  S.,  and 
the  abdominal  affection  became  grave.  At  thirty-eight  years  of  age,  her 
devotional  feelings  became  exalted.  She  indulged  in  mystical  notions,  and 
persuaded  herself  that  she  ought  to  live  with  her  husband,  with  the  view 
only  of  training  up  her  family  according  to  the  commands  of  God,  and  charg- 
ing him  with  being  too  worldly  in  his  views.  Nevertheless  she  became  preg- 
nant the  third  time,  and  was  happily  delivered.  Some  months  after  its  birth, 
the  child  died.  She  had  lavished  upon  it  the  attentions  which  excessive 
tenderness  inspired,  because,  said  she,  this  child  was  born  after  holy  visions. 
To  the  most  poignant  grief,  succeeded  calmness  and  tranquillity.  Her  mys- 
tical views  were  dissipated,  and  from  the  age  of  forty  years  she  enjoyed  per- 
fect health  until  forty-six,  when  she  lost  her  eldest  daughter,  who  had  re- 
cently married.     Although  filled  with  despair  at  this  misfortune,  she  put  on 


V 


HALLUCINATIONS.  99 

an  air  of  much  resignation,  in  order  to  sustain  the  spirits  of  her  husband,  who 
was  overwhehned  by  this  affliction.  She  returns  to  her  religious  readings 
with  more  ardor  than  ever.  She  read  also  several  of  those  pretended  politi- 
cal prophecies,  which  were  abroad  in  the  world.  These  diverse  readings, 
made  a  strong  impression  upon  her  mind.  She  lost  both  her  appetite  and 
rest ;  and  after  the  month  of  January,  1817,  often  spoke  of  the  events  fore- 
told with  respect  to  France.  At  length,  in  the  beginning  of  March  fol- 
lowing, she  was  present  at  the  anniversary  service  of  the  death  of  her  daugh- 
ter. She  remains  sad,  dejected  and  silent ;  without  appetite  or  sleep.  Sud- 
denly, on  the  fifth  of  March,  amidst  cries,  complaints,  convulsions  and  loqua- 
city, she  speaks  without  ceasing  of  God,  who  announces  to  her  extraordi- 
nary events. 

Heaven  had  been  opened  to  her  view.  She  had  seen  her  daughter  there, 
who  had  informed  her  that  France  was  about  to  become  subject  to  a  reign  of 
grace  and  justice, — that  a  Messiah  was  about  to  appear,  to  put  himself  at  the 
head  of  his  church  and  government,  and  that  all  the  world  would  hereafter  be 
happy.  This  state  of  mind  persisted  for  seven  hours,  and  when  restored  to 
the  use  of  her  reason,  it  was  proposed  to  her  to  visit  Paris  for  her  health. 
This  she  obstinately  refused  to  do.  As  soon  however  as  she  was  told  that  God 
commanded  it,  she  immediately  descended  from  her  apartment,  entered  her 
carriage  without  opposition,  and  arrived  on  the  sixth,  at  Paris.  On  the  seventh 
of  March,  a  new  crisis  occurred,  attended  by  cries,  convulsions  and  halluci- 
nations, together  with  efforts  to  escape  from  her  husband  and  female  atten- 
dant. She  repulses  them,  both  by  her  menaces  and  language  ;  and  beats  them 
both,  regarding  them  as  devils.  Isolation  renders  her  more  tranquil,  but  not 
more  rational.  She  is  in  despair  that  the  devil  should  assume  the  form  and 
appearance  of  her  husband,  the  person  whom  she  loves  better  than  all  others. 
She  goes  readily  to  the  house  of  M.  Pinel,  because  this  celebrated  man  ought 
to  be  as  well  informed  as  herself  with  respect  to  whatever  is  to  happen.  She  is 
committed  to  my  care.  From  the  first,  the  new  habitation,  and  the  strange  per- 
sons who  surrounded  the  patient,  impressed  her  to  such  a  degree,  that  she  did 
not  for  a  moment,  betray  the  thoughts,  which  had  preoccupied  her  mind. 
She  manifested  no  anxiety  at  the  absence  of  her  husband,  nor  any  uneasiness 
on  findincr  herself  anions  strangers.  This  change  of  situation,  is  the  fulfil- 
ment  of  the  command  of  God. 

The  next  day,  the  eighth,  Mad'e  S.  expresses  a  degree  of  confidence  in  me, 
and  I  endeavor  to  make  her  comprehend  how  contrary  to  the  truth  her  convic- 
tions are,  and  to  impress  upon  her  mind  the  true  object  of  her  stay  in  Paris. 
She  smiles  at  my  error,  and  with  much  kind  feeling,  recommends  me  to  pre- 
pare for  great  events.  Otherwise,  she  is  tranquil,  says  little,  never  speaks 
foolishly,  but  sometimes  laughs  without  cause.  She  also  makes  one  at  a 
game  of  cards  in  the  evening.  She  refuses  all  medicine.  On  the  tenth,  after 
a  long  conversation,  in  which  for  the  first  time,  she  relates  all  that  she  has 
seen  or  heard,  as  well  as  what  she  has  discovered  in  the  Holy  Scriptures ; 
after  a  discussion  of  sufficient  length,  she  consents  to  make  with  me,  the  fol- 
lowing treaty,  which  I  record,  and  which  is  signed  by  both  of  us.  By  the 
terms  of  this  agreement,  the  patient  consents  to  be  regarded  as  insane,  and  to 
submit  to  the  treatment  that  is  prescribed  for  her,  if  the  Messiah  does  not  ap- 
pear before  or  upon  the  twenty-fifth  of  March,  and  great  events  do  not  take 
place  at  this  period.  From  that  day,  she  is  not  only  calm,  but  gay;  converses 
voluntarily,  speaks  to  no  one  respecting  what  is  passing  in  her  mind,  and  sus- 
tains conversation  with  spirit,  and  upon  every  variety  of  subject.  With  myself 
only  does  she  sometimes  hazard  a  few  words  upon  her  prophesies,  and  then 
only,  from  her  interest  in  my  future  well  being.  The  twenty-fifth  of  March 
passes  by.  On  the  day  following,  I  require  the  execution  of  the  agreement. 
she    submits  with  the  best  grace,  and   testifies  a  strong  desire  to  see  her  hus- 


y 


100  HALLUCINATIONS. 

band  once  more.  She  sees  him  on  the  following  day,  and  appears  to  us  all  so 
rational,  that  she  is  permitted  to  return  immediately  to  her  province.  The 
convictions  of  this  lady  are  not  entirely  removed,  but  very  much  weakened. 
Having  reached  home,  she  resumes  her  former  habits  of  life,  as  well  in  lier 
family  as  abroad.  No  one  would  have  supposed  that  she  had  been  sick,  and 
in  a  very  short  period  the  last  traces  of  her  malady  are  completely  effaced. 

Madame  R.  a  seamstress,  aged  forty-four  years,  is  tall,  and  of  a  spare  habit; 
has  chesnut  colored  hair,  eyes  hazel  and  lively,  face  flushed.     Her  tempera- 
ment   is    sanguine,    she    enjoys  very  good  health,  and  is  of  an   animated  dis- 
position ;   but  obstinate  and  choleric.     At  nineteen  years  of  age,  menstruation 
takes  place,  preceded  by  violent  attacks  of  cholic.     At  twenty-two  she  is  mar- 
ried, is  seven  times  pregnant,  and  has  three  abortions.     At  thirty  years  of  age, 
/-     while  nursing,  she  engages  in  a  dispute,  and  has  a  fit  of  anger.     The   secre- 
^^  tion  of  milk  is  checked,  and   a  tranquil   delirium  follows,  which  persists  for 
^      eighteen  months;   after  which  she  once  more  enjoyed  good   health.     At  forty- 
{       one  years  of  age,  whilst  walking  in  the  street,  during  the  period  of  menstrua- 
te" tion,  she  is  thoroughly  wet  by  a  pot  of  warm  lye.     A  suppression  of  the  men- 
^     ,.      ses  immediately  took   place,  which   did   not   afterwards   appear.      From  this 
-/      time,  she  suffers  from  headaches,  increases  her  expenses,  purchases  articles  of 
little  use  in  her  family,  disputes  and  quarrels  on  the  subject  of  politics.     Her 
disposition  also  becomes  more  irritable  and  passionate. 

At  forty-four  years  of  age,  she  has  a  dispute,  which  is  attended  by  an  at- 
tack of  ancrer.  From  that  evenincr  she  suffers  from  nervous  agitation  and  de- 
lirium.  She  breaks  the  windows  of  her  neighbors,  is  arrested  and  sent  to  the 
police  office,  where  she  is  condemned  to  pay  for  the  glass  she  has  broken. 
A  new  attack  of  anger  supervenes,  attended  with  violent  delirium,  extreme  agi- 
tation and  loquacity  ;  she  cries,  sings,  dances,  etc.  She  is  brought  to  Charenton, 
and  remains  there  for  five  months,  in  a  state  of  acute  mania.  Transferred  to 
the  Salpetriere  on  the  19th  Nov.  1816,  the  patient  is  not  habitually  irrational, 
but  in  a  state  of  constant  agitation,  talks  incessantly,  tears  her  clothing,  and 
torments  her  companions.  Though  generally  gay,  she  sometimes  weeps. 
She  suffers  from  insomnia,  and  constipation.  She  dresses  herself  in  a  pecu- 
liar manner,  and  mentions  to  any  one  who  wishes  to  hear  her,  with  the  most 
perfect  coolness,  and  in  a  tone  of  the  deepest  conviction,  that  there  is  at  Cha- 
renton a  boarder  whom  Je.?us  Christ  has  come  to  visit,  and  who  pays  3000 
francs  for  her  board.  Whilst  our  patient  was  in  this  hospital,  she  also  saw 
Jesus  Christ.  His  stature  was  tall,  and  his  hair  brown  ;  a  singular  fact,  she 
adds,  as  he  is  represented  in  paintings  as  having  flaxen  hair,  but  perhaps  it  was 
so  in  his  infancy.  Jesus  Christ  has  a  fine  figure,  a  pretty  mouth,  and  hand- 
some teeth, — his  voice  and  language  are  mild.  He  has  announced  to  our  pa- 
tient, that  there  is  to  be  no  cold  during  the  winter, — that  he  will  punish  the 
Jacobins,  by  inundating  their  houses.  He  appeared  to  her  as  a  spirit,  that 
others  might  not  see  him.  He  was  accustomed  to  come  and  take  her  by  the 
arm  and  conduct  her  to  a  yellow  chapel  situated  in  the  garden.  He  has  many 
times  stated  to  her  that  there  would  be  no  more  wars,  nor  misfortunes,  the  peo- 
ple being  converted.  Since  she  has  been  at  the  Salpetriere,  Jesus  Christ  has 
visited  her  every  evening,  and  has  promised  that  there  should  be  an  early  and 
abundant  harvest,  the  rents  of  which  shall  be  her  own.  He  has  addressed  to 
her  several  letters,  (which  she  has  in  her  possession  but  will  show  them  to  no 
one).  He  sends  into  her  cell  the  sweetest  odors  of  jasmine  and  orange — 
upon  its  walls,  he  has  caused  to  be  painted  landscapes  and  distant  views,  and 
illuminates  it  every  evening,  with  the  most  brilliant  stars.  Our  patient  alone 
has  the  privilege,  either  to  see,  or  appreciate  these  delightful  things. 

Mad'lle  C.  tall  and  of  a  slender  form,  with  black  hair  and  large  black  eyes, 
skin  dark  and  swarthy,  bilious-nervous  temperament,  and  delicate  lungs,  is  en- 
dowed with  a  lively  disposition,  and   an  ardent  imagination.     At  the  close  of 


HALLUCINATIONS.  101 

her  first  year,  she  had  variola.  At  twelve  years  of  age,  menstruation  took 
place,  preceding  by  three  months  an  attack  of  chlorosis :  since  which,  the 
menses  have  been  both  scanty  and  irregular.  At  fourteen  years  of  acre  she 
became  enamored  of  a  young  man  with  whom  she  had  been  brought  up.  He 
dies;  and  Mad'Ue  C,  who  was  at  this  time  sixteen  years  old,  becomes  melan- 
cholic, refuses  food,  and  passes  several  days,  at  various  periods,  without  takino- 
the  least  nourishment.  She  has  since  been  subject  to  headaches,  pains  in  the 
stomach,  sleeps  little,  and  is  often  awoke  by  nightmare.  She  has  convulsions 
and  syncopes  on  the  slightest  opposition,  especially  after  her  meals.  When 
seventeen  )'ears  of  age,  the  passion  of  love  was  again  revived  in  her  heart ; 
and  melancholy,  together  with  her  other  nervous  symptoms,  disappeared.  Her 
health  appeared  to  be  excellent.  At  eighteen  years  of  age  she  loses  her  pa- 
rents, and  is  left  without  either  resources  or  a  guide.  To  this  misfortune,  loss 
of  appetite  succeeds,  and  the  menses  become  more  irregular.  Melancholy 
returns,  attended  with  a  desire  for  death,  and  joy  at  the  thought  that  she  shall 
very  soon  rejoin  her  parents.  At  length  delirium  supervenes,  continuing  from 
five  to  seven  hours  every  day.  In  the  intervals,  she  refuses  to  eat,  emaciation 
takes  place,  attended  by  a  pulmonary  catarrh,  to  which  leucorrhoea  succeeds, 
and  an  intermittent  fever,  at  first  tertian,  then  quartan,  and  afterwards  quoti- 
dian, with  delirium  during  the  attacks.  The  patient  sees  her  deceased  parents 
at  her  side,  which  produces  the  deepest  despair.  Some  friends,  in  the  hope 
of  consoling  her,  offer  her  religious  advice,  which  she  puts  in  practice.  But 
at  twenty-one  years  of  age,  thwarted  in  her  inclinations,  she  relapses  into  her 
former  grief  and  despondency,  feels  herself  overwhelmed  by  the  loss  of  her 
parents  and  her  excessive  misery.  It  was  at  this  time,  that  being  at  church, 
the  Holy  virgin  appeared  to  our  patient,  sitting  near  to  God,  offering  her  con- 
solation, and  assuring  her  that  she  should  take  her  under  her  own  protection. 
The  same  apparition  appeared  every  day  during  the  delirium  of  the  intermit- 
tent fever,  and  persisted  for  more  than  a  year. 

At  the  age  of  twenty-three  years,  perceiving  the  interest  of  her  lover 
lessening,  she  is  seized  with  grief ;  wishes  to  die,  and  refuses  nour- 
ishment. After  fifteen  days'  abstinence,  she  falls  into  a  state  which  she  can- 
not describe.  Nevertheless,  she  with  great  difficulty  gets  to  the  church,  and 
while  engaged  in  prayer,  notwithstanding  her  bodily  infirmities,  and  the  tu- 
mult of  her  passions  and  ideas,  God  appears  to  her,  and  demands  of  her,  in  a 
piercing  tone,  her  motive  for  self-destruction.  "  Because  I  am  overivhelmed 
with  sorrow,"  she  replied.  After  a  long  interview,  God  commands  her  to 
live,  notwithstanding  all  the  sufferings  which  yet  await  her.  He  requires  of 
her  an  oath,  that  she  will  not  endeavor  to  destroy  herself  She  takes  this 
oath ;  and  it  is  remarkable  that  though  she  has  since  experienced  many  rever- 
ses and  mortifications,  together  with  two  attacks  of  lypemania,  attended  with 
a  suicidal  impulse,  our  patient  has  ever  strictly  regarded  it.  When  twenty- 
five  and  a  half  years  old  she  leaves  her  province,  comes  to  Paris,  and  gives 
herself  up  to  libertinism,  with  all  the  passion  of  one  possessed  of  an  ardent 
temperament  and  vivid  imagination.  Soon  after,  she  becomes  pregnant,  and 
grieves  much.  During  her  pregnancy  she  has  fainting  turns  every  day,  and 
becomes  dropsical.  Nevertheless  her  confinement  is  fortunate.  From  that 
period,  she  enjoyed  miserable  health,  and  believed  she  was  going  to  die.  Be- 
sides, she  desires  death  as  an  end  to  her  sufferings.  At  twenty-nine  years  she 
becomes  pregnant  a  second  time.  During  her  pregnancy  she  suffers  greatly, 
has  violent  paroxysms  of  cholic,  but  a  happy  confinement.  She  leaves  the 
Maternite  ten  days  afterwards.  Having  returned  to  her  house,  alone,  forsak- 
en, and  without  resources,  she  was  plunged  into  the  most  profound  misery. 
Suffering,  and  overwhelmed  with  mortification,  she  labors  night  and  day,  to 
obtain  a  subsistence.  But  her  feeble  and  suffering  condition,  prevented  her 
from  procuring  wherewith  to  live.     She  betakes  herself  to  the  church,  and 


102  HALLUCINATIONS. 

there  for  three  hours  prays  to  God,  promising  to  go  forth,  confess  herself, 
and  be  converted.  She  leaves  the  church  with  more  courage  and  resolution, 
and  sets  herself  to  work  with  increased  ardor.  A  few  days  after  she  was 
seized  with  a  fever,  and  for  several  days  took  no  food.  She  then,  as  she  had 
formerly  done,  sees  God,  who  appeared  to  her  at  eight  o'clock  in  the  morning. 
She  is  transported  to  the  sixth  heaven ;  sees  things  more  beautiful  than  she 
can  describe,  and  the  recollection  of  which  still  fills  her  soul  with  inexpressi- 
ble delight.  This  rapturous  frame  continues  for  more  than  nine  hours.  God 
appeared  to  her  at  several  other  periods.  Jesus  Christ  visits  her  more  fre- 
quently, gives  her  advice,  and  commands  her  to  address  the  people.  She 
passes  several  days  without  eating,  because,  being  in  communication  with 
God,  she  thinks  herself  able  to  do  so.  She  wishes  to  labor,  but  is  unable  to 
effect  her  purpose  in  this  respect,  notwithstanding  her  great  necessity. 

She  has  the  same  visions  for  three  successive  weeks.     On  the  28th  of  April 
she  becomes  very  much  agitated.     On  the  30th,  she  sings  at  the  window  of 
her  chamber,  and  in  the  evening,  declaims,  announcing  woes  to  the  people  ; 
speaking  in  turn  of  the  impropriety  of  her  past  conduct,   and  of  her  present 
virtue  and  penitence.     She  arms  herself  with  whatever  comes  to  hand,  threat- 
ening to  exterminate  those  who  approach  her,  and  whom  she  treats  as  profane 
persons.     Turning  against  her  acquaintances  who  press  around  her,  anxious 
to  lend   their    assistance,  she  repulses  them  with  horror.     Her  own  sister  is 
repelled  with  contempt  and  rage.     On  the   1st  of  May,   a  physician  having 
come  to  visit  her,  she  commands  him  to  announce,  in  the  name  of  God,  the 
evils  that  threaten  France.     Her  agitation  and  the  perversion  of  her  ideas  are 
at  their  height.      On    the  3d  of   May  she  is  sent   to  the  Hotel-Dieu,  from 
whence  she  is  transferred  to  the  Salpetriere.     At  the  period  of  her  arrival,  the 
5th  of  May,  she  sings  and  talks  incessantly,  and  holds  religious  discourses, 
.      mingled  with  some  degree  of  obscenity.     She  is  emaciated,  her  complexion 
/      sallow,  her  skin  hot,  and  tongue  red.     She  is  anxious  to  perform  miracles  and 
/       to  cure  all  that  are  sick.     Tepid  baths,  diluent  drinks,  pediluvia,  etc.,  are  pre- 
scribed.    On  the  15th  there  is  general  delirium,  agitation,  loquacity,  cries  and 
f  songs.     On  the   17th,   all  the  symptoms  are  exasperated,  the  menstrual  flow 

takes  place,  and  the  discharge  is  abundant.  On  the  30th  of  May,  there  is  an 
alternation  of  agitation  and  repose.  God  has  commanded  her  to  warn  the 
Emperor, — she  knows  those  who  are  to  betray  him,  and  will  denounce  them. 
She  is  acquainted  also  with  the  expenditures  of  the  State,  and  those  who 
are  to  ruin  it.  She  speaks  with  haughtiness  and  pride,  and  in  threatening  lan- 
guage. Her  countenance  is  very  much  flushed,  she  is  greatly  agitated,  walks 
about  rapidly,  spits  often,  and  suffers  from  constipation  and  insomnia.  At  the 
end  of  June  the  menses  return  ;  in  July  the  same.  Continuation  of  tepid  baths, 
cold  lotions  to  the  head,  and  cooling  drinks.  August :  calm  and  patient ;  replies 
correctly  to  questions  that  are  addressed  to  her.  September  :  sleeps  ;  return  of 
reason,  convalescence,  cephalalgia.  December  :  health  perfect,  and  she  gives 
an  account  of  her  delirium.  God  appeared  to  her  very  often  during  her  last 
attack,  spoke  to  her,  and  unfolded  to  her  the  future.  He  had  the  form  of  a 
venerable  old  man,  clad  in  a  long,  white  robe.  During  the  following  winter 
her  health  continues  good,  and  she  leaves  the  hospital  April  13th,  1815. 

Scarcely  has  she  departed,  when,  finding  herself  in  the  same  state  of  abandon- 
ment and  destitution  as  formerly,  the  same  emotions  and  ideas  also  return.     Our 
patient  is  seized  with  the  desire  of  announcing  to  Napoleon,  what  God  had 
_  commanded  her  to  say.     She  attempted  oflen  to  penetrate  even  to  the  inte- 

)C<  rior  of  the  Tuileries.     Not  succeeding  in  this,  she  wrote  a  letter  which  she 

addresses  to  the  Emperor,  and  another  to  the  high  chancellor,  demanding  of 
him  the  means  of  enabling  her  to  reach  Napoleon.  I  have  still  in  my  pos- 
session the  reply  of  the  high  chancellor,  but  the  patient  dared  not  execute 
the  instructions  therein  contained.     At  the  review  which  precedes  the  de- 


HALLUCINATIONS.  103 

parture  for  Waterloo,  she  forces  the  ranks,  and  commits  with  dignity  to  the 
hands  of  an  officer  a,  packet  of  letters,  to  the  address  of  Bonaparte.  Sup- 
posing that  at  length  her  counsels  have  succeeded,  she  believes  that  she  has 
saved  France.  She  is  composed  for  some  time.  But  calamity  pursues  her 
at  every  step ;  and  finding  no  occupation,  she  relapses  again  into  lypemania. 
She  desires  to  destroy  herself,  and  many  times  goes  to  the  river  for  this  pur- 
pose. But  the  recollection  of  the  oath  vv'hich  she  took  at  the  age  of  twenty- 
three,  restrains  her.  She  reenters  the  Salpetriere  on  the  21st  of  June, 
1815,  in  a  most  deplorable  state,  especially  with  respect  to  her  physical  con- 
dition. Milk,  together  with  sufficient  nourishment,  tepid  baths,  and  cooling 
drinks  with  gentle  laxatives,  promptly  restore  the  vital  forces.  In  the  month 
of  August  the  patient  is  better  and  begins  to  labor.  In  the  month  of  Sep- 
tember the  menses  are  reestablished,  the  delirium  has  ceased,  and  cheerful- 
ness is  restored.  During  the  winter  she  is  affected  with  cephalalgia  and 
scurvy.  For  one  year  this  woman,  aged  thirty-three  years,  was  employed  in 
the  service  of  the  division  for  the  insane,  and  enjoyed  her  reason  perfectly. 
But  her  disposition  is  very  irritable,  and  she  is  capricious  and  erotic.  She 
remains  so  fully  convinced  of  the  truth  of  what  was  announced  to  her,  that 
she  said  to  me  one  day,  (1817)  ;  "  I  shall  be  insane  for  two  years  more,  until 
time  has  proved  that  all  that  has  been  predicted  to  me  is  only  insanity  and 
error."  In  1819,  she  wrote  with  her  own  hand  a  long  history  of  her  physical, 
intellectual  and  moral  infirmities,  from  which  the  extract  I  have  just  given 
was  taken. 

M.  D.,  doctor  in  medicine,  tall,  of  a  strong  constitution  and  sanguine  tem- 
perament, having  a  voluminious  head,  forehead  very  bare,  projecting  more  on 
one  side  than  the  other,  with  blue  eyes,  flushed  face,  and  having  a  violent 
and  obstinate  disposition  ;  is  an  ultra  partisan  of  the  doctrine  called  physiolo- 
gical. He  does  not  content  himself  with  spreading  abroad  this  doctrine  by 
his  opinions  and  writings,  but  wishes  to  advance  it  also  by  his  example.  He 
bleeds  himself  from  time  to  time,  subjects  himself  to  an  abstemious  diet, 
and  bathes  frequently.  He  had  challenged  to  a  duel  his  associates,  who,  in 
consultation  did  not  partake  of  his  medical  opinions.  Thirty-six  years  of 
age  (Aug.  1822)  :  paralysis  of  one  eye,  and  of  one  of  the  commissures  of 
the  lips,  with  transient  delirium.  Thirty-eight  years  of  age  (Sept.  1824)  : 
after  a  violent  contest,  which  took  place  at  a  consultation,  he  was  suddenly 
seized  with  delirium  and  a  nervous  agitation.  Having  returned  home,  M.  D. 
is  desirous  to  bleed  his  wife,  children  and  domestics,  and  takes  from  himself 
several  pounds  of  blood.  From  this  time,  he  suffers  from  inappetence,  sleep- 
lessness, extreme  turbulence,  entire  incoherence  of  ideas,  and  hallucinations. 
Eight  days  afterwards,  he  is  brought  to  Charenton.  At  the  time  of  his 
arrival  his  agitation  is  very  great,  and  his  loquacity  continual.  The  patient 
pretends  to  recognize  every  one,  and  treats  the  attendants  haughtily  and  in  a 
passionate  manner.  He  experiences  hallucinations  of  hearing  and  of  sight, 
— has  a  consciousness  of  his  condition,  and  reasons  justly.  Towards  the  end 
of  the  month  he  becomes  furious,  and  threatens  to  slay  all  who  approach  him. 
Forty  years  of  age  (Oct.  1826)  :  M.  D.  believes  he  sees  a  patient  of  the 
house  insult  and  violate  his  wife.  In  a  furious  passion  he  throws  himself 
upon  the  innocent  object  of  his  wrath,  and  injures  him  most  seriously.  Forty- 
one  years  of  age  (April,  1827).  He  has  had  several  attacks  of  intermittent 
fever,  which  seem  to  compose  him  without  lessening  the  delirium. 

When  the  medical  service  of  the  maison  royale  at  Charenton  devolved  on 
me,  the  condition  of  M.  D.  had  not  changed.  His  physical  condition  was 
good.  On  seeing  him  for  the  first  time  he  appeared  contented,  and  testified 
much  confidence  in  me ;  but  although  he  always  expressed  the  same  senti- 
ments towards  me,  and  pretended  to  feel  great  deference  for  me,  I  could 
never  induce  him  to  pursue  a  regimen   and  to  take  remedies    appropriate 


104  HALLUCINATIONS. 

to  his  condition.  I  earnestly  desired  to  contribute  to  his  cure,  and  paid  him 
particular  attention.  Nothing  however  could  induce  Jiim  to  lay  aside  his 
hallucinations,  nor  could  any  thing  control  his  medical  exaggerations.  He 
often  requested  me  to  order  him  to  be  bled.  My  refusals,  the  motives  to 
which  I  endeavored  to  explain,  did  not  discourage  him.  His  entreaties  were 
most  urgent  during  the  summer  of  1827.  At  length,  after  many  evasive  re- 
plies, I  yielded,  hoping  to  strengthen  the  confidence  of  the  patient,  and  to 
make  myself  master  of  his  reason.  It  was  agreed  between  us  that  we  should 
employ  a  small  bleeding  by  way  of  experiment.  It  was  performed  one  day 
during  the  month  of  October.  Scarcely  had  the  pupil  who  performed  the 
duty  retired,  than  our  enthusiast  removed  the  bandage,  and  fills  with  blood  a 
chamber  pot,  a  tin  wash  hand  basin,  bleeds  a  large  quantity  upon  the  floor  of 
his  chamber,  and  feeling  enfeebled,  reclines  upon  his  bed,  where  he  loses  still 
more.  Attracted  by  a  slight  plaintive  noise,  the  attendant  hastens  thither  and 
finds  him  extended  upon  his  bed,  and  almost  without  life.  The  pupils,  on  be- 
ing informed,  find  in  turn  the  patient  w^ithout  pulse  or  respiration  ;  his  face 
pale,  eyes  glazed,  limbs  flaccid,  and  regard  him  as  dead.  Nevertheless,  they 
employ  frictions,  at  first  dry,  then  of  aromatics  and  alcohol.  They  employ 
irritant  frictions  on  different  regions  of  the  body.  The  patient  is  also  enve- 
loped in  wool.  After  long  and  painful  efforts,  the  respiration  becomes  dis- 
cernible, the  pulse  perceptible,  and  a  few  drops  of  liquid  are  conveyed  to  the 
stomach.  After  some  hours  spent  in  attentions  of  this  nature,  the  patient 
seems  to  revive  ;  pronounces  some  words,  but  is  voiceless.  By  degrees,  the 
vital  forces  are  reestablished,  the  voice  returns,  and  the  senses  resume  their 
functions,  excepting  that  of  sight.  The  patient  remains  blind.  As  soon  as 
he  could  describe  his  feelings,  (which  was  only  after  the  expiration  of  several 
days),  he  declares  himself  well,  with  the  exception  of  a  slight  weakness.  He 
manifests  no  regret  at  his  loss  of  sight,  assuring  us  that  it  will  return.  Not- 
withstanding  his  anaemic  condition,  which  continues  for  several  months,  and 
the  privation  of  sight,  the  delirium  undergoes  no  change.  His  hallucinations 
are  equally  intense  and  coherent.  Their  character  also  remains  the  same, 
and  he  is  incessantly  excited  by  those  of  sight  and  hearing.  The  patient 
is  perpetually  in  conversation  with  persons  whom  he  sees  and  hears.  Habitu- 
ally contented  and  happy,  he  often  laughs  aloud,  applauds  and  claps  his  hands. 
He  never  complains  of  his  situation.  He  remains  exceedingly  irritable,  ready 
to  fall  into  a  passion  on  the  least  contradiction.  All  the  functions  of  nutri- 
tion are  well  performed  ;  yet  he  sleeps  little,  and  takes  little  exercise  ;  doubt- 
less in  consequence  of  his  recent  infirmity.  This  state  persists  with  little  va- 
riation for  several  years. 

Forty-two  years  of  age  (1828)  :  Intestinal  catarrh,  attended  with  a  very 
abundant  discharge  of  mucus,  which  much  enfeebles  the  patient.  Forty-nine 
years  of  age  (June,  1835)  :  During  the  night,  cerebral  congestion  takes 
place.  At  my  visit  on  the  following  day,  the  lips  are  found  to  deviate  towards 
the  left,  and  the  sensibility  is  obtuse.  It  is  necessary  to  pinch  the  skin  vio- 
lently to  produce  pain,  and  the  hearing  is  very  much  enfeebled.  We  notice 
many  breaks  in  the  pronunciation  of  words.  The  face  is  pale,  the  eyes  be- 
dewed with  tears,  the  pulse  strong,  frequent  and  regular.  The  skin  is  warm, 
and  the  patient  somnolent.  He  expectorates  copiously,  and  is  constipated. 
This  condition  is  not  of  long  duration.  From  this  period,  intelligence  is  en- 
feebled, the  patient  is  less  gay,  and  his  gayety  is  of  a  less  blustering  charac- 
ter. He  both  hears  and  understands  with  more  difficulty,  and  does  not  so 
readily  recognize  by  the  voice  the  persons  who  approach  him.  He  lies  most 
of  the  time  upon  his  bed,  and  has  no  regard  to  propriety.  He  has  little  ap- 
petite, and  sometimes  refuses  nourishment.  Digestion  also  is  imperfectly  per- 
formed. He  becomes  emaciated,  and  is  affected  with  a  diarrhoea,  but  the 
hallucinations  and  delirium  persist.     Fifty  years  of  age  (16th  March,  1836)  : 


HALLUCINATIONS.  105 

After  several  days  of  prostration  of  the  vital  forces,  and  diarrhoea,  the  dejections 
become  involuntary.  He  remains  drawn  up  in  bed,  is  no  longer  heard  to 
speak, — becomes  speechless  and  dies. 

Seventeenth  March,  1836  :  Autopsy.  The  cranium  is  found  to  be  spongy, 
and  a  serous  discharge  takes  place  on  opening  the  arachnoid  membrane.  A  few 
lines  from  the  apophysis  of  the  crista  galli,  an  ossification  presents  itself.  It 
is  of  a  conoidal  form,  oval,  two  lines  in  thickness,  and  an  inch  and  a  half  in 
circumference.  It  adheres  by  its  base,  to  that  portion  of  the  dura-mater, 
which  forms  the  fold  of  the  great  falx.  The  arachnoid  is  infiltrated,  thicken- 
ed, and  opake  in  some  points.  There  are  also  points  of  adherence  between 
the  pia-mater  and  the  cortical  substance  of  the  brain.  These  adhesions, 
which  are  very  numerous  at  the  base  of  the  brain,  are  of  greater  extent  at  the 
superior  region  of  the  hemispheres,  especially  in  front.  On  removing  these 
adhesions,  the  cortical  substance  has  an  ulcerated  appearance.  It  is  also  red. 
In  those  portions  where  the  dura-mater  has  not  formed  adhesions,  the  cortical 
substance  presents  a  silvery-grey  aspect.  If  we  scrape  it  with  the  back  of 
the  scalpel,  it  breaks  into  numerous  fragments,  and  that  portion  which  re- 
mains adherent  to  the  grey  substance,  seems  to  be  ulcerated,  as  I  remarked 
above.  The  origin  of  the  seventh  pair  of  nerves,  presents  nothing  special. 
The  optic  nerves  are  greyish,  and  present  the  color  and  transparency  of  wet 
parchment.  They  are  flattened  and  atrophied.  Stripped  of  the  neurilema, 
they  are  firm,  consistent  and  greyish.  This  color  and  consistence  extends 
even  to  their  connection  with  the  optic  thalami.  These,  when  laid  open,  pre- 
sent nothing  remarkable.  The  white  substance  of  the  brain  presents  nume- 
rous vessels,  from  which  escape  drops  of  serous  blood.  The  color  of  this  or- 
gan is  dull,  slightly  shaded,  violet  colored  in  some  portions,  and  its  consistence 
is  generally  more  firm  than  in  the  natural  state.  The  grey  substance  of  the 
interior  of  the  brain  is  of  a  rose  color.  The  cerebellum,  cerebral  pedun- 
cles, tuber  annulare,  the  medulla  oblongata  and  spinalis  appear  in  their  nor- 
mal state. 

From  these  facts,  and  from  all  that  we  can  gather  from  the  annals  of  the 
infirmities  and  diseases  of  the  human  mind,  we  may  conclude  that  there  ex- 
ists a  certain  form  of  delirium  in  which  individuals  believe  that  they  per- 
ceive, sometimes  by  one  sense,  sometimes  by  another,  and  sometimes  by  seve- 
ral at  once,  while  no  external  object  is  present  to  excite  any  sensation  what- 
ever. Thus,  a  man  in  a  state  of  delirium  hears  persons  address  him,  asks 
questions,  replies,  holds  a  continued  conversation ;  distinguishes  very  clearly 
reproaches,  abuse,  threats  and  commands  which  are  addressed  to  him, — dis- 
cusses questions,  is  vexed,  and  falls  into  a  passion.  He  hears  also  celestial 
harmonies  ;  the  songs  of  birds,  a  concert  of  voices,  and  this,  when  no  voice 
is  near,  and  a  profound  silence  reigns  around.  Another  sees  pictures  most 
varied  in  character,  and  most  animated  in  expression.  Heaven  opens,  and 
he  contemplates  God  face  to  face,  takes  part  in  exercises  of  the  Sabbath,  and 
rejoices  at  the  sight  of  a  beautiful  painting,  of  a  fine  exhibition,  and  on  be- 
holding a  friend.  He  is  frightened  at  the  sight  of  a  precipice,  of  flames  ready 
to  consume  him,  of  enemies  armed  to  assassinate  him,  and  of  serpents  who 
would  devour  him.  Yet  this  wretched  man  is  in  the  deepest  darkness.  He 
is  deprived  of  sight. 

One  insane  person  thinks  he  sees  a  shining  chariot,  which  is  going  to  con- 
vey him  to  heaven.  He  opens  his  window,  advances  gravely  to  enter  it,  and 
falls  to  the  ground.  Darwin  relates  the  case  of  a  student  at  Berlin,  who,  pre- 
vious to  the  period  referred  to,  had  enjoyed  good  health.  This  young  man 
entered  his  house  in  an  extreme  fright,  his  countenance  pale,  his  eyes  wander- 
ing, and  assuring  his  companions  at  the  same  time  that  he  should  die  in 
thirty-six  hours.  He  retires  to  bed,  orders  a  minister  to  be  sent  for  to  recon- 
cile him  to  his  God,  and  makes  his  will.     His  symptoms,  in  appearance  grave, 

14 


106  HALLUCINATIONS. 

alarm  his  comrades.  Hufeland  visits  the  patient,  but  his  reasonings  do  not 
convince  him.  This  celebrated  physician  orders  a  dose  of  opium,  which  pro-* 
duces  a  profound  sleep,  which  is  prolonged  much  beyond  the  thirty-six  hours. 
On  waking,  they  succeed  in  proving  to  the  patient  that  he  has  been  the  sport 
of  his  imagination.  When  fully  convinced,  composure  returns  to  his  mind, 
his  fears  are  entirely  dissipated,  his  usual  cheerfulness  returns,  and  he  con- 
fesses, that  having  gone  out  of  the  city  at  the  dusk  of  evening,  he  saw  a  death's 
head,  and  heard  a  voice  saying ;   "  Thou  shalt  die  in  thirty-six  hours." 

One  laboring  under  a  hallucination,  desires  that  certain  odors  which  annoy 
him  should  be  removed,  or  else  he  smells  those  of  the  sweetest  character,  while 
there  is  not  at  hand  any  odoriferous  body.  Before  his  sickness  he  was  de- 
prived of  the  sense  of  smell.  Another  believes  that  he  chews  bloody  flesh, 
grinds  arsenic,  and  devours  earth  :  sulphur  and  flame  set  his  mouth  on  fire. 
He  also  quaffs  nectar  and  ambrosia.  A  melancholic  sees  bees  constantly 
issuing  from  his  mouth.  A  maniac,  hearing  the  roar  of  thunder,  exclaimed; 
"a  thunderbolt  has  fallen  upon  my  head,  without  injuring  me."  He  believed 
that  he  slept  with  several  women  successively ;  conversed  as  if  they  had  been 
present,  praising  one  for  her  promptitude,  chiding  another  for  her  delay,  and 
addressing  each  in  a  manner  suited  to  her  character.  Now  he  was  gay ;  of- 
ten jealous,  sometimes  choleric.  While  walking  in  the  garden,  this  patient 
was  accustomed  to  believe  that  he  was  present  at  a  feast,  and  was  in  raptures 
at  the  delicacy  and  variety  of  the  dishes  that  he  smelled.  It  is  the  halluci- 
nated who  experience  asperities,  points,  and  arms  which  wound  and  lacerate 
them,  whilst  lying  upon  a  soft  bed.  They  are  carried  far  away,  and  think 
that  they  hold  in  their  hands  bodies  which  are  not  in  their  possession.  Some 
monomaniacs  and  epileptics,  at  the  commencement  of  their  attacks,  believe 
that  they  are  struck  and  beaten.  They  display  their  bodies  which  they  be- 
lieve have  been  greatly  injured  by  the  cruel  blows  which  they  have  received. 
A  general  believed  that  he  had  hold  of  a  robber,  and  shook  his  arms  violently, 
as  if  he  had  hold  of  some  one  whom  he  wished  to  throw  upon  the  ground. 

In  general,  these  individuals  believe  that  both  persons  and  things  are  present 
with  them,  which  can  have  no  real  existence,  except  in  their  own  imagina- 
tions ;  at  least,  so  far  as  they  are  concerned.  The  evidence  of  the  senses, 
passes  for  nothing  in  this  form  of  delirium.  This  class  of  patients  have  to 
contest  every  thing  with  the  external  world.  They  are  in  a  state  of  halluci- 
nation. Such  are  the  hallucinated.  The  phenomena  of  hallucination  are 
not  like  those  which  result  from  delirium.  In  the  latter,  sensations  become 
modified  and  changed,  so  that  the  perceptions  of  the  patient  are  no  longer 
what  they  were  before  his  illness,  nor  like  those  of  other  men.  Notions  rela- 
tive to  the  qualities  and  properties  of  things,  and  of  persons,  are  imperfectly 
perceived,  and  the  judgment  in  respect  to  them  consequently  incorrect.  The 
insane  man  mistakes  a  windmill  for  a  man ;  a  hole  for  a  precipice ;  and  clouds 
for  a  body  of  cavalry.  In  the  last  case  the  perceptions  are  incomplete  ;  hence 
an  error.  The  ideas  and  actual  sensations  are  but  imperfectly  connected. 
In  hallucinations,  sensation  and  perception  no  more  exist  than  in  reveries  and 
somnambulism,  since  external  objects  do  not  act  upon  the  senses.  A  thou- 
sand hallucinations  sport  with  and  mislead  the  mind.  In  fact,  hallucination 
is  a  cerebral  or  mental  phenomenon,  which  is  produced  independently  of  the 
senses.  It  persists,  although  delirium  may  have  ceased,  and  reciprocally. 
The  history  of  many  celebrated  men  confirms  this  view,  and  proves  that  a 
man  may  be  subject  to  hallucinations  without  delirium.  The  first  observation 
furnishes  a  very  remarkable  example  in  illustration  of  this  opinion.*  » 

The  most  rational   man,  if  he  will   observe  carefully  the  operations  of  his 

*  M.Lelut  reports  several  cases  of  hallucination  witliout  delirium,  in  his  work  :  "  Tht 
Demon  of  Socrates." 


HALLUCINATIONS.  107 

mind,  will  sometimes  perceive  images  and  ideas  the  most  extravagant,  or  as- 
sociated in  the  strangest  manner.  The  ordinary  occupations  of  life,  the  la- 
bors of  the  mind  and  reason,  divert  the  attention  from  those  ideas,  images 
and  phantoms.  But  he  who  labors  under  a  delirium, — who  raves  ;  unable  to 
command  his  attention,  can  neither  direct  it  nor  turn  it  aside  from  these  ima- 
ginary objects.  He  remains  the  slave  of  his  hallucinations  and  reveries.  The 
habit  of  always  associating  the  sensation  with  the  external  object  that  solicits 
and  usually  calls  it  into  exercise,  lends  a  reality  to  the  productions  of  the  im- 
agination or  memory,  and  persuades  the  subject  of  hallucinations  that  what 
he  actually  experiences  could  never  occur,  without  the  presence  of  external 
bodies.  The  pretended  sensations  of  the  hallucinated,  are  the  images  and 
ideas  reproduced  by  the  memory,  associated  by  the  imagination, — and  person- 
ified by  habit.  Man  then  gives  a  form  to  the  offspring  of  his  mind.  He 
dreams,  while  fully  awake.  In  a  case  of  revery,  the  ideas  of  the  waking  hours 
continue  during  sleep;  whilst  he  who  is  in  a  complete  delirium  is  in  a  revery, 
though  awake.  Reveries,  like  hallucinations,  always  reproduce  former  sensa- 
tions and  ideas.  As  in  a  revery,  the  series  of  images  and  ideas  in  hallucina- 
tions is  sometimes  regular ;  but  more  frequently  they  are  reproduced  in  the 
greatest  confusion  and  present  the  strangest  associations.  The  hallucinated 
are  sometimes  conscious,  as  is  the  case  also  in  a  revery,  that  they  are  in  a  deli- 
rium, without  the  power  to  disengage  the  mind.  He  who  is  in  a  revery,  as 
well  as  he  who  has  hallucinations,  is  never  astonished  nor  surprised  at  the  ideas 
or  images  which  occupy  his  mind,  whilst  they  would  have  excited  the  greatest 
wonder  had  the  patient  been  fully  aroused,  or  had  he  not  been  delirious.  This 
phenomenon,  in  either  case,  is  caused  by  the  absence  of  every  accessory  idea, 
and  every  foreign  impression,  with  which  he  who  labors  under  either  of  these 
forms  of  disease  can  compare  the  objects  of  his  revery  or  delirium.  The 
thinking  faculty  is  altogether  absorbed  by  these  objects.  The  difference  be- 
tween the  hallucinated  and  somnambulists  consists  in  this  ;  that  in  the  greater 
number  of  cases  the  former  recall  whatever  has  preoccupied  or  troubled  their 
mind,  while  the  latter  remember  nothing.  Hallucinations  differ  from  ecstasy 
in  this  only,  that  the  latter  condition  is  always  produced  by  a  powerful  effort 
of  the  attention,  fixed  upon  a  single  object,  towards  which  the  imagination  of 
the  person  affected  constantly  tends.  In  ecstasy,  the  concentration  of  inner- 
vation is  so  strong,  that  it  absorbs  all  the  powers  of  life,  and  the  exercise  of 
all  the  functions  is  suspended,  except  that  of  the  imagination. 

In  hallucinations,  on  the  contrary,  for  the  augmented  action  of  the  centre  of 
sensibility,  a  violent  effort  of  attention  is  not  necessary.  All  the  functions  are 
performed  with  more  or  less  freedom ;  the  man  lives  amid  his  hallucinations 
as  he  would  have  done  in  a  world  of  realities.  The  conviction  of  the  hallu- 
cinated is  so  entire  and  sincere,  that  they  reason,  judge  and  decide  with  re- 
ference to  their  hallucinations.  They  also  arrange,  with  reference  to  this  psy- 
chological phenomenon,  their  thoughts,  desires,  will  and  actions.  At  a  time 
when  it  was  customary  to  burn  sorcerers,  and  those  possessed  of  demons,  they 
have  been  seen  to  throw  themselves  upon  their  funeral  pile,  rather  than  deny 
that  they  had  engaged  in  religious  exercises.  I  have  known  persons  who  had 
been  cured  of  their  hallucinations,  who  were  accustomed  to  remark,  "  I  saw 
and  heard,  when  laboring  under  this  delusion,  as  distinctly  as  you  see  and  hear." 
Many  give  an  account  of  their  visions,  with  a  coolness  that  belongs  only  to  the 
most  entire  conviction.  Hence  results  the  most  singular  language  and  ac- 
tions; for  hallucinations,  like  actual  sensations,  produce  among  the  insane 
eil^her  pleasure  or  pain,  love  or  hatred.  Thus,  one  rejoices,  laughs  aloud,  and 
finds  himself  the  happiest  of  men.  Soothed  by  so  lively  and  distinct  an  im- 
pression of  good  fortune  is  he,  that,  incapable  of  indulging  in  any  foreign 
thought,  he  sees  no  limit  to  his  felicity,  and  believes  that  it  can  never  end. 
Another  grieves,  laments,  and  is  in  a  state  of  complete  despair ;  overcome  by 


108  HALLUCINATIONS. 

the  frightful  hallucinations  that  press  upon  him.  It  is  the  more  profound,  as 
he  finds  himself  confined  to  a  dreadful  condition,  which  is  overwhelmino- 
him,  and  from  which  there  is  no  relief  He  can  see  no  compensation  nor 
any  limit  to  his  sufferings.  Lypemaniacs  also,  believe  that  nothing  can  chano-e 
their  lot,  neither  to  deprive  them  of  the  prosperity  which  intoxicates  them,  nor 
to  withdraw  them  from  the  trying  condition  in  which  they  groan  nio-ht  and 
day.  Many  believe  that  they  shall  never  die.  We  have  at  the  Salpetriere  a 
woman  who  demands  that  she  may  be  cut  in  pieces,  because  she  knows  not 
what  will  become  of  her  when,  every  body  being  dead,  she  shall  remain 
alone  upon  the  earth. 

But  hallucinations  have  not  always  the  character  of  a  fixed  idea,  or  of  a 
prevailing  passion.  Sometimes  they  extend  successively  to  the  recollections 
of  objects,  which  have  made  impressions  upon  the  senses,  and  give  to  the  de- 
lirium a  character  of  versatility,  which  is  remarked  both  in  their  sentiments 
and  actions.  This  happens  in  certain  forms  of  mania  and  febrile  delirium. 
Thus,  there  are  patients  whose  hallucinations  from  time  to  time  are  found  to 
change  their  object. 

Hallucinations  are  therefore  neither  false  sensations,  nor  illusions  of  the 
senses  ;  neither  erroneous  perceptions,  nor  errors  resulting  from  organic  sen- 
sibility, as  is  the  case  in  hypochondria.  We  may  confound  hallucinations 
with  illusions  of  the  senses,  or  with  the  false  perceptions  of  hypochondriacs. 
The  latter  believe  in  the  presence  of  external  objects,  or  in  a  lesion  of  the 
sentient  extremities ;  whilst  in  hallucinations,  not  only  are  there  no  external 
objects  really  acting  upon  the  senses,  but  sometimes  the  senses  no  longer  per- 
form their  functions.  I  once  had  in  charge  an  aged  merchant,  who,  after  a 
very  active  life,  was  seized  with  amaurosis  at  about  forty-one  years  of  age. 
Some  years  afterwards  he  became  a  maniac.  He  was  very  much  agitated, 
and  spoke  in  a  loud  voice  with  persons  whom  he  believed  he  both  saw  and 
heard.  He  beheld  the  most  singular  objects,  and  his  visions  often  threw  him 
into  a  complete  state  of  enchantment.  There  was  at  the  Salpetriere  in  1816, 
a  Jewess,  thirty-three  years  of  age.  She  was  blind,  and  also  a  maniac.  Ne- 
vertheless she  saw  the  strangest  sights.  Her  death  took  place  suddenly.  I 
found  both  the  optic  nerves  atrophied  from  their  decussation  to  their  entrance 
into  the  globe  of  the  eye.  In  this  case  certainly,  the  transmission  of  impres- 
sions was  impossible.  The  same  is  true  with  deaf  persons,  who  believe  that 
they  hear  people  speaking.  We  have  at  this  moment  at  the  Salpetriere,  two 
women  perfectly  deaf,  who  have  no  other  delirium  than  that  of  hearing  divers 
persons,  with  v^^hom  they  are  disputing  both  night  and  day.  They  often,  in- 
deed, become  furious.  This  frequently  happens  during  sleep,  with  this  diffe- 
rence, that  at  this  time  the  senses  are  shut,  and  are  not  impressed  by  external 
objects ;  whilst  in  delirium,  the  senses,  although  open  to  impressions,  not  be- 
ing attentive,  are,  as  it  were,  inaccessible  to  them,  and  even,  in  some  sort,  re- 
pulse them.     But  in  both  cases  the  effects  are  the  same. 

The  seat  of  hallucinations  not  being  at  the  extremities  of  sensitive  organs, 
must  be  at  the  centre  of  sensibility.  In  fact,  we  cannot  conceive  of  the  ex- 
istence of  this  symptom,  but  in  supposing  the  brain  to  be  acted  upon  by  some 
cause.  The  brain  may  be  set  in  action  by  a  sudden  and  violent  commotion, 
by  a  strong  mental  conflict,  or  by  vehement  passion.  It  is  wrought  upon  also 
sympathetically,  in  consequence  of  the  peculiar  condition  of  certain  organs 
more  or  less  remote  from  it.  This  takes  place  in  the  sympathetic  forms  of 
insanity,  in  fevers,  in  the  phlegmasia?,  or  by  the  ingestion  of  certain  poisons. 
Darwin  says,  that  hallucinations  proceed,  probably,  from  the  origin  of  tjjie 
nerve  of  sensation,  which  is  the  most  susceptible  to  attacks  of  inflammation.* 

*  Doctor  Foville,  in  the  excellent  articles  on  insanity  witfi  wliich  he  has  enriclied  the 
"  Dictionary  of  Practical.  Medicine  and  Surgery,"  says  "  that  lie  has  discovered  lesions  of 
the  nerves  in  hallucinations."     Might  not  this  be  a  simple  coincidence  ? 


HALLUCINATIONS.  109 

The  brain  is  called  into  action  by  a  violent  impression  which  excites  it  strong- 
ly. This  excitement  may  cause  either  a  state  of  ecstasy  in  this  organ,  which 
produces  a  fixedness  of  ideas,  or  a  convulsive  condition  of  the  brain,  which 
gives  rise  to  incoherence  of  ideas,  and  determinations  most  varied  and  fugi- 
tive. 

Hallucinations  relate  usually  to  the  occupations,  whether  mental  or  physical, 
to  which  the  person  suffering  from  them  has  been  accustomed,  or  else  they 
ally  themselves  to  the  nature  of  the  cause  that  has  kindled  up  the  excitement 
of  the  brain.  A  woman  has  read  the  history  of  sorceries,  and  is  wholly  en- 
grossed with  those  religious  duties  in  which  she  is  to  take  part.  She  sees  her- 
self transported  thither,  and  participating  in  all  those  rites  by  which  her 
mind  is  fascinated.  A  lady  reads  in  a  journal  an  account  of  the  condemna- 
tion of  a  criminal.  She  sees  every  where  the  bloody  head  separated  from 
the  body,  and  covered  with  black  crape.  This  head  projects  over  her  left 
eye,  and  inspires  her  with  such  inexpressible  horror  as  to  cause  her  to  make 
several  attempts  upon  her  life. 

Hallucinations  may  result  moreover,  from  the  repetition,  either  voluntary  or 
otherwise,  of  the  same  cerebral  movements.  These  may  be  frequently  repeat- 
ed, in  order  to  acquire  a  certain  kind  of  information,  or  to  examine  some  sub- 
ject ;  many  examples  of  which  we  find  in  the  lives  of  contemplative  men. 
Habit  renders  these  movements  easy,  and  even  involuntary,  as  it  does  certain 
organic  actions.  The  action  of  the  brain  prevails  over  those  of  the  senses, 
destroys  the  effect  of  present  impressions,  and  causes  him  who  labors  under 
hallucinations,  to  regard  the  effects  of  memory  as  actual  sensations.  From 
this  time  the  moraf  state  is  perverted,  and  there  is  delirium.  We  notice 
among  the  hallucinated  a  sort  of  eccentricity,  as  we  do  among  the  most  ra- 
tional men,  who  are  absorbed  in  some  profound  meditation. 

The  man  whose  delirium  has  for  its  object  an  exalted  passion,  no  longer 
perceives  any  thing.  He  sees  and  hears,  but  these  impressions  do  not  reach 
the  centre  of  sensibility.  The  mind  does  not  react  upon  them.  The  man 
who  is  subjected  to  the  influence  of  a  controlling  passion  is  altogether  en- 
grossed thereby  ;  is  drawn  away  by  it  ;  is  beside  himself  Whatever  does  not 
appertain  to  the  series  of  ideas  and  affections  which  characterize  his  passion, 
is  nothing  to  him  ;  whilst  every  thing  proper  to  it  is  ever  present  to  his  mind. 
Here  is  a"  passion  which  controls  the  reason,  modifies  the  ideas,  and  provokes 
the  determinations.  And  as,  of  all  the  passions  love  and  religion  are  those 
which  hold  the  most  absolute  empire  over  man,  since  they  affect  at  the  same 
time  both  his  mind  and  heart,  it  is  not  astonishing  that  religious  and  erotic 
monomania  should  be  signalized  by  hallucinations  the  most  strange  and  fre- 
quent. 

Hallucinations  take  place  among  men  who  have  never  had  dehrmm,  but 
they  constitute  one  of  the  elements  of  delirium  which  are  most  frequently 
found  in  mania,  lypemania,  monomania,  ecstasy,  catalepsy,  hysteria  and  febrile 
delirium.  Among  a  hundred  insane  persons,  eighty  at  least  have  hallucina- 
tions. Sometimes  this  symptom  appears  a  long  time  before  delirium  be- 
comes apparent  to  those  who  reside  with  the  patients.  They  often  struggle 
against  their  hallucinations  before  manifesting  or  complaining  of  them,  and 
before  committing  any  impropriety  either  of  speech  or  act.  Sometimes  at 
the  commencement  of  the  disorder,  the  hallucinations  are  fugitive  and  confus- 
ed. With  the  progress  of  it,  they  become  as  distinct  and  complete  as  the 
actual  sensations,  and  are  continued  and  permanent.  They  not  unfrequently 
persist,  though  the  delirium  may  have  ceased.  During  the  most  general  de- 
lirium, or  a  very  animated  conversation,  the  insane  man  suddenly  checks  him- 
self, to  contemplate  an  object  which  he  believes  strikes  his  eye,  or  to  listen 
and  reply  to  persons  whom  he  thinks  he  hears.  This  symptom  may  be  ob- 
served amono-  almost  all  those  who  have  delirium.     Nevertheless  individuals, 


110  HALLUCINATIONS. 

who,  before  their  ilhiess  were  controlled  by  a  passion,  or  subject  to  strong 
conflicts  of  mind,  are  more  exposed  to  it  than  others,  especially  if  they  have 
previously  applied  themselves  to  speculative  and  abstract  studies.  If  halluci- 
nations are  most  frequently  the  lot  of  feeble  minds,  men  the  most  remarkable 
for  their  strength  of  understanding,  the  depth  of  their  reason,  and  their  vigor 
of  thought,  are  not  always  free  from  this  symptom. 

At  one  time,  the  hallucinations  seem  to  depend  upon  the  functional  lesion 
of  a  single  sense, — the  hallucinated  believing  only  that  they  hear.  At  an- 
other, they  seem  to  depend  upon  that  of  two  and  even  three  senses, — the 
patient  believing  that  he  hears,  sees,  or  touches.  Sometimes  indeed,  all  the 
senses  seem  to  concur  in  producing  and  continuing  the  delirium.  Certain 
facts  prove  that  hallucinations  characterize  only  a  particular  state  of  deli- 
rium,— a  circumstance  which  has  caused  some  to  regard  the  hallucinated  as 
inspired  ;  but  on  continued  observation,  these  individuals  immediately  betray 
the  true  cause  of  their  condition.  In  Germany,  we  find  still  among  this  class 
of  the  insane  those  whom  they  call  seers.  In  the  East,  and  in  India,  we 
meet  with  pretended  prophets,  who  are  only  hallucinated. 

Hallucinations  depending  upon  impressions  perceived  by  the  senses  of  taste 
and  smell,  are  reproduced,  particularly  at  the  commencement  of  insanity. 
But  those  which  appertain  to  sight  and  hearing,  are  more  frequent  during  all 
periods  of  the  malady.  Hallucinations  of  sight,  reproducing  objects  which 
occasion  the  most  general  interest,  and  make  the  strongest  impression  upon 
the  multitude,  have  been  denominated  visions.  This  name  is  suited  to  a  sin- 
gle form  of  hallucination.  Who  would  dare  to  say,  visions  of  hearing,  visions 
of  taste,  visions  of  smell  ?  and  yet,  the  images,  ideas  and  notions,  which  seem 
to  belong  to  the  functional  alteration  of  these  three  senses,  present  to  the 
mind  the  same  characters,  have  the  same  seat,  that  is  to  say,  the  brain,  are 
produced  by  the  same  causes,  and  are  manifest  in  the  same  maladies  as  hallu- 
cinations of  sight, — as  visions.  A  generic  term  is  wanting.  I  have  proposed 
the  word  hallucination,  as  having  no  determinate  signification,  and  as  adapted 
consequently,  to  all  the  varieties  of  delirium  which  suppose  the  presence  of 
an  object  proper  to  excite  one  of  the  senses,  although  these  objects  may  be 
beyond  their  reach.  Hallucinations  are  an  indication  little  favorable  to  a 
cure  in  the  vesanife.  As  they  are  only  a  symptom  of  delirium,  and  may 
exist  in  many  diseases  of  the  mind,  either  acute  or  chronic,  they  do  not  re- 
quire a  particular  treatment.  They  ought  nevertheless,  to  have  great  weight 
in  the  intellectual  and  moral  management  of  the  insane,  and  the  therapeutic 
views  which  the  physician  may  propose. 


ILLUSIONS  OF  THE  INSANE. 


Preliminary  remarks.— Illusions,  by  some  authors  confounded  with  hallucinations.— Dis- 
tinction pointed  out.— Illusions  not  uncommon  when  in  a  state  of  health.— Examples. 
—Hypochondriacs  suffer  from  them.— Three  conditions  necessary  for  the  correct  per- 
ception of  a  sensation.— Remarks  on  the  causes  of  illusions.- Divided  into  ganglionic 
illusions  and  illusions  of  the  senses.- 1.  Examples  of  the  former  class.— Post-mortem 
examinations.— II.  Examples  of  the  latter  class.— Proof  that  illusions  depend  upon 
the  anormal  action  of  the  extremities  of  nerves.— Cases.— Inflammation  or  other  lesion 
of  the  nervous  center  or  its  membranes,  often  give  rise  indirectly,  to  illusions.— Con- 
clusion. 

The  insane  believe  that  they  see,  hear,  feel,  taste  and  touch,  whilst  the  ex- 
ternal objects,  answering  to  these  sensations  respectively,  are  not  within  reach 
of  their  senses,  and  cannot  actually  impress  them.     This  symptom  is  an  mtel- 
lectual  and  cerebral  phenomenon,  and  the  senses  are  not  concerned  m  its  pro- 
duction.    It  occurs,  although  the  senses  do  not  perform  their  functions,  and 
even  though  they  no  longer  exist.     Thus,  there  are  deaf  persons  who  think 
they  hear  ;  and  blind,  who  believe  they  see.     The  ancients  had  observed  this 
symptom  only  in  connection  with  recollections  of  the  sensations  of  sight,  and 
had  (riven  to  it  the  appellation  of  vision.     But  the  analysis  of  thought  among  the 
insane,  (for  the  insane  think  and  reason),  proves  that  the  same  phenomenon 
takes  place  relative  to  sensations  formerly  perceived  by  the  sense  of  smell,  and 
those  of  taste  and  touch,  as  well  as  by  that  of  sight ;  a  circumstance  that  has 
led  me  to  give  to  it  the  generic  name  of  hallucination.     In  the  essay  on  hallu- 
cinations, I  particularly  noticed  this  psychological  phenomenon,  and  stated  facts 
which  demonstrated  that  hallucinations  sometimes  existed  without  delirium, 
and  characterized  one  variety  of  monomania.     The  ancients  did  not^  distin- 
guish visions  from  illusions  of  the  senses.     Some  moderns  adopting  the  term 
which  I  proposed  as  a  substitute  for  visions,  have  confounded  hallucinations 
with  illusions;  dividing  them,  indeed,  into  mental  hallucinations  (visions),  and 
sensorial  hallucinations  {iUusioiis  of  the  senses).     Their  authors  have  not  dis- 
tinguished with  sufficient  clearness,  the  essential  difterence  which  exists  be- 
tween these  two  orders  of  phenomena.     In  hallucinations  every  thing  goes  on 
in  the  brain.     Visionaries,  and  those   in  a  state  of  ecstasy,  are  hallucinated. 
They  are  in   a  revery,  though  quite  awake.     The  activity  of  the  brain   is  so 
energetic,  that  the  visionary  or  the  hallucinated,  gives  a  body  and  reality  to  the 
images   and  ideas  that  memory  reproduces,  without  the  intervention  of  the 
sens'es.     In  illusions,  on  the  contrary,  the  sensibility  of  the  nervous  extremi- 
ties is  altered  :  it  is  exalted,  enfeebled,  or  perverted.     The  senses  are  active, 


112       .  ILLUSIONS      OF      THE      INSANE. 

and  the  actual  impressions  solicit  the  reaction  of  the  brain.  The  effects  of 
this  reaction  being  submitted  to  the  influence  of  the  ideas  and  passions  which 
control  the  reason  of  the  insane,  they  deceive  themselves  in  respect  both  to 
the  nature  and  cause  of  their  actual  sensations. 

Illusions  are  not  rare  in  a  state  of  health,  but  reason  dissipates  them.  A 
square  tower,  seen  from  a  distance,  appears  round  ;  but  if  we  approach  it,  the 
error  is  rectified.  When  we  travel  among  mountains,  we  often  take  them  for 
clouds.  Attention  immediately  corrects  this  error.  To  one  in  a  boat,  the 
shore  appears  to  move.  Reflection  immediately  corrects  this  illusion.  Hypo- 
chondriacs have  illusions,  which  spring  from  internal  .sensations.  These  per- 
sons deceive  themselves,  and  have  an  illusion  respecting  the  intensity  of  their 
sufferings,  and  the  danger  of  losing  their  life.  But  they  never  attribute  their 
misfortunes  to  causes  that  are  repugnant  to  reason.  They  always  exercise 
sound  reason,  unless  lypemania  {melancholy)  is  complicated  with  hypochon- 
dria. Then  delirium  is  present;  and  lypemaniacal  hypochondriacs  have  illu- 
sions, and  reason  incorrectly  respecting  the  nature,  causes  and  symptoms  of 
their  malady.  Illusions,  so  frequent  among  the  insane,  deceive  them  respect- 
ing the  qualities,  relations  and  causes  of  the  impressions  actually  received, 
and  cause  them  to  form  false  judgments  respecting  their  internal  and  external 
sensations.  Reason  does  not  rectify  the  error.  Three  conditions  are  neces- 
sary for  the  perception  of  a  sensation.  The  integrity  of  the  organ  which  re- 
ceives the  impression,  the  integrity  of  the  nerve  that  transmits  it,  and  the  in- 
tegrity of  the  instrument  which  reacts  upon  this  impression.  Illusions  of  the 
senses  depend  also  upon  three  causes :  alteration  of  the  organs  of  sense,  a 
lesion  of  the  nerves  of  transmission,  or  an  anormal  condition  of  the  brain.  If 
the  sensibility  and  activity  of  the  senses  are  aftected,  it  is  evident  that  the 
impression  made  upon  them  by  external  objects  is  modified.  If  the  nerves  of 
transmission  are  disordered,  and  if  at  the  same  time  the  brain  is  in  a  patholo- 
gical state,  it  cannot  rectify  the  error  of  the  senses :  hence  illusions.  If  the 
fugitive  and  brief  attention  of  maniacs  does  not  permit  the  senses  to  delay 
long  enough  upon  external  objects  to  make  a  distinct  impression,  the  percep- 
tion is  incomplete,  and  the  qualities  and  relations  of  objects  which  impress 
them  will  be  imperfectly  perceived.  In  monomania,  on  the  contrary,  the  at- 
tention being  too  concentrated,  cannot  transfer  itself  successively  to  objects 
external  and  foreign  to  the  intellectual  or  affective  preoccupations,  which 
control  the  patient.     Hence  illusions,  which  reason  does  not  remove. 

The  passions,  the  source  of  so  many  illusions  among  men  of  sound  minds, 
modifying  also  the  impressions,  and  giving  a  wrong  direction  to  the  reaction 
of  the  brain,  are  the  cause  of  a  thousand  illusions  among  the  insane.  The 
understanding  and  the  passions  concur  with  the  senses  in  the  illusions  of  the 
insane;  and  the  sentient  extremities  are  the  true  points  of  departure  of  the 
illusions.  There  is  always  an  actual  impression  upon  the  senses  of  external 
objects.  Let  us  now  see  what  facts  report.  They  inform  us  that  illusions 
spring  from  internal  and  external  sensations.  I  would  distinguish  them  into 
ganglionic  illusions,  and  illusions  of  the  senses. 

<5)  I.  Perturbations  of  organic  sensibility,  internal  sensations,  often  produce 
the  illusions  of  the  insane. 

The  skin  of  some  insane  persons  is  hot,  dry,  arid  and  cadaverous,  and  im- 
perfectly performs  its  functions.  These  patients  are  indifferent  to  the  ex- 
tremes of  temperature.  Pinel  speaks  of  a  maniac  who  was  accustomed  to 
gather  up  handfuls  of  snow  and  rub  it  upon  his  chest  with  delight.  Others 
experience  such  a  degree  of  irritation  of  the  skin,  that  they  think  they  are  to 
be  smitten  and  murdered  by  the  slightest  contact.  They  also  persuade  them- 
selves that  we  throw  at  them  substances,  or  poisons  which  burn  and  greatly 
injure  them.     We  have  at  Charenton   an  insane  woman,  who  cries  aloud  the 


ILLUSIONS      OF      THE      INSANE.  113 

moment  we   touch   her  with  the  end   of  the  finger  :  "  You  hurt  me !  Don't 
strike  me,  don't  strike  me,"  she  cries. 

An   officer  of  ordnance,  twenty-seven   years  of   age,  strong   and  tall,  was 
taken  with   intermittent  fever   during  the  campaign   in  Prussia.      He  was  re- 
quired to  drink  a  large  tumbler  of  brandy,  with  which  they  had  mingled  the 
powder  of  two  cartridges.     M.  ***  immediately  became   a  maniac.     There 
was  general   delirium,  loquacity,  cries,  rage.     He  destroyed  every  thing  that 
came  within   his  reach,  linen,  clothing  and   bedding.     Force    had  been  em- 
ployed to  cause  him  to  sleep  upon  straw.     Being  pricked  by  it,  he  disposed 
the  straw  in  a  circle,  leaving  in  the  centre  a  void  space,  in  which  he  placed 
himself     He  turned  his  head  in  all  directions,  blowing  incessantly  upon  the 
straw  that  surrounded  him,  and  from  time  to  time  uttering  cries,  as  if  to  re- 
pulse threatening  objects.     This   symptom   persisted   both  night  and  day  for 
more  than  three  weeks.     It  was  known  that  the  patient  regarded  each  blade 
of  straw  as  the  beak  of  a  bird  of  prey  which  was  wounding  him.     He  blew 
and  uttered  cries,  to  frighten   and  drive  away  these  mischievous  animals.     At 
a  later  period,  this  same  patient  had  new  illusions.     Scarcely  had  he  retired 
at  night  than  he  destroyed  his  bed,  and  passed  by  handfuls  the  straw  of  which 
it  was  made,  through  the  window  of  his  chamber,  which  was  closed  by  blinds, 
and  spoke  from   time  to  time  as  if  he  was  addressing  horses.     The  sound  of 
the  footsteps  of  persons  whom  he  heard  walking,  was  taken   by  him   for  those 
of  horses,  who  had   come  to   his  window  as  to  a  rack.     The  care  that  was 
taken  to  remove  the  straw  so  soon   as  he  threw  it  out,  kept  up  the  illusion. 
He  believed  that  the  horses  had  eaten  it.     This  patient  often  looked  upon  the 
clouds  as  a  body  of  armed  men,  and  supposed  that  this  army  was  going  into 
Germany  when  the  clouds  were  blown  towards  the  north,  and  were  marching 
towards  England  when  their  direction  was  towards  the  west.     Those  pains  in 
different  regions  of  the  body  which  the  insane  experience,  are  also  the  cause 
of  illusions  amonw  them. 

Mad'lle ,  eighteen  years  of  age,  enjoyed  good  health,  although  she  was 

not  regular  with  respect,  to  the  catamenia.  She  experienced  at  the  close  of 
the  events  of  1815,  a  fixed  pain  in  the  top  of  the  head,  and  immediately  per- 
suaded herself  that  she  had  a  worm  in  her  head  that  was  devouring  the  brain. 
The  sight  of  copper  caused  a  sensation  of  faintness,  and  her  parents  were  ob- 
liged to  have  all  the  gildings  of  the  apartment  removed.  She  consented  to 
walk  only  with  the  greatest  reluctance,  because  the  dust  that  was  raised  by 
those  who  were  walking,  was  loaded  with  the  oxyd  of  copper.  Nothing  could 
induce  her  to  touch  an  article  of  copper,  a  gilded  candlestick,  or  the  cock  of 
a  fountain.  Several  months'  treatment  having  proved  of  little  benefit,  I  was 
called  to  visit  her.  She  was  emaciated,  slightly  pale,  and  very  irritable.  She 
sometimes  refused  to  eat,  slept  poorly,  and  was  constipated.  She  spoke  of  her 
peculiar  repugnance  to  certain  things,  now  with  vivacity,  now  with  anger,  and 
now  with  tears.  I  endeavored  to  gain  the  confidence  of  my  young  patient, 
and  at  first  humored  her  notions,  assuring  her  that  I  would  destroy  the  worm, 
the  cause  of  her  sufferings,  if  she  had  the  courage  to  submit  to  a  slightly 
painful  operation.  I  had  so  well  succeeded  in  persuading  her,  that  after  one 
of  my  visits,  during  which  1  had  spoken  to  her  of  cures  obtained  by  a  means 
which  I  pointed  out  to  her,  she  raised  her  head,  and  with  a  knife  made  an 
incision  through  the  scalp.  Scarcely  does  she  see  her  blood  flowing  when 
she  finds  herself  ill.  I  was  immediately  sent  for,  and  repaired  to  the  patient. 
She  had  recovered  her  consciousness,  and  was  very  desirous  that  the  opera- 
tion should  be  performed,  about  which  I  had  been  conversing  with  her  for 
some  time.  Her  courage  sustains  that  of  her  parents,  who  consent  to  the 
employment  of  the  means  which  1  had  proposed.  M.  Bigot,  usually  the  phy- 
sician of  the  family,  makes  a  crucial  incision  of  more  than  two  inches  in  ex- 
tent, over  the  painful  point,  and  permits  the  blood  to  flow.     We  showed  to 

15 


114  ILLUSIONS   OF   THE   INSANE. 

the  patient  a  portion  of  the  fibrine,  which  we  assure  her  is  the  worm  which 
has  cost  her  so  much  suffering.  An  issue  was  established  in  the  centre  of 
the  incision,  and  kept  open  for  three  months,  after  which  the  fixed  pain,  illu- 
sions, and  her  fears  of  vcrdigri.-^,  disappear. 

Some  years  subsequently,  while  I  was  giving  my  clinical  lectures  on  men- 
tal diseases  at  the  Salpetriere,  a  similar  case  presented  itself  in  the  person  of 
a  country  woman,  who  had  been  admitted  into  the  division  for  the  insane. 
She  complained  of  fixed  and  very  acute  pains  at  the  top  of  the  head,  which 
she  attributed  to  the  presence  of  an  animal ;  a  circumstance  that  had  thrown 
her  into  lypemania  with  a  disposition  to  suicide.  I  made  a  crucial  incision 
over  the  painful  point.  I  was  careful  to  show  to  the  patient  a  fragment  of  an 
earth  worm,  assuring  her  that  this  was  the  cause  of  her  sufferings.  After  the 
operation,  this  woman  showed  to  her  associates  the  animal  from  which  she  had 
been  relieved,  expressing  her  joy  at  being  cured.  But  thirty-six  hours  after- 
wards, the  companions  of  this  unfortunate  woman  began  to  ridicule  her,  and 
to  say  that  I  was  imposing  upon  her  credulity.  She  tore  away  at  once  the 
issue  that  had  been  established,  her  former  pains  returned,  and  with  them 
her  illusions. 

A  general  of  division,  fifty  years  of  age  and  upward,  had  become  rheuma- 
tic during  the  war,  and  was  taken  with  mania  accompanied  by  rage,  in  con- 
sequence of  a  moral  affection.  His  teeth  were  poor,  and  he  often  suffered 
from  them.  He  accused  the  sun  of  being  the  cause  of  the  sufferings  which 
he  experienced,  and  when  his  pains  were  exceedingly  severe,  would  utter 
frip-htful  cries  and  imprecations  against  this  luminary,  and  threaten  to  go  and 
exterminate  it  with  his  brave  division.  Sometimes  the  pains  were  seated  in 
one  of  his  knees  ;  the  patient  would  then  seize  with  one  hand  the  painful  part, 
and  with  the  other  closed,  smite  his  knee  with  heavy  blows,  repeating :  "  Ah! 
villain,  thou  shall  not  escape  !  ah  !  villain!"  He  thought  he  had  a  robber  in 
this  knee. 

A  lady  thirty  years  of  age,  and  of  a  strong  constitution,  having  become 
hypochondriacal  after  severe  grief  which  had  occasioned  loss  of  rest,  persuad- 
ed herself  that  her  brain  was  petrified.  At  a  later  period,  having  felt  the  beat- 
ing of  the  temporal  artery,  when  lying  upon  the  right  side,  she  concluded 
that  her  brain  was  liquified,  and  that  it  was  running  like  a  torrent.  This  illu- 
sion was  the  more  remarkable,  as  she  very  well  knew  that  such  a  condition  of 
the  brain  was  impossible. 

Gastric  and  intestinal  pains,  borborygmi,  and  troubles  respecting  the  alvine 
evacuations,  are  also  symptoms  upon  which  the  insane  often  found  an  illusion, 
formino-  judgments  as  false  as  diverse,  respecting  the  nature  and  causes  of 
these  symptoms.  Facts  on  this  point  are  very  numerous,  and  are  found  in 
every  author. 

Ambrose  Pare  cured  a  hypochondriac  who  believed  that  he  had  frogs  in  his 
stomach,  by  administering  a  purgative  which  procured  abundant  stools,  and 
taking  the  precaution  to  introduce  secretly  small  frogs  in  the  vessel  which 
was  to  receive  the  rejected  matters. 

I  opened  the  body  of  a  lypemaniac  at  the  Salpetriere,  who  had  believed  for 
many  years  that  there  was  an  animal  in  her  stomach.  She  had  a  cancer  of 
this  ororan.  There  is  in  the  division  for  the  insane  at  the  Salpetriere,  a  wo- 
man who  has  for  many  years  suffered  from  abdominal  pains.  She  assures  us 
that  she  has  in  her  bowels  a  whole  regiment.  When  the  pains  are  exasperat- 
ed she  becomes  excited,  cries  aloud,  and  affirms  that  she  feels  the  blows  which 
the  soldiers  give  each  other  in  their  contests,  and  that  they  wound  her  with 
their  arms. 

A  woman,  about  58  years  of  age,  of  a  strong  constitution  and  sanguine 
temperament,  had  become  a  mother  by  M.  R.,  at  whose  house  she  lived  as 
door-tender.     This  was  a  source  of  deep  mortification  to  her.     She  afterwards 


ILLUSIONS      OF      THE      INSANE.  115 

experienced  gastro-intestinal  affections,  and  became  a  bigot.  The  events  of 
the  revolution,  concurred,  with  the  cessation  of  the  catamenia,  to  produce  an 
attack  of  mania.  She  was  brought  to  the  Salpetriere  where  she  passed  many 
years.  In  stature  she  was  small,  her  neck  thick  and  short,  her  mind  strong, 
and  she  was  of  a  very  full  habit.  There  was  something  mysterious  in  the 
expression  of  her  countenance,  and  she  complained  of  pains  at  the  epigastrium, 
which  was  sensitive  to  the  touch.  She  had  copious  eructations,  and  was  often 
affected  with  dysmenorrhcea.  Habitually  calm,  she  occupied  herself  in  sew- 
ing. They  called  her  in  the  hospital  the  3Iother  of  the  Church,  because  she 
was  constantly  talking  on  the  subject  of  religion.  She  attributes  her  suffer- 
ings to  the  wickedness  of  Pontius  Pilate,  (the  father  of  her  child).  This  in- 
famous wretch  has  taken  up  his  abode  in  her  bowels.  She  sees  him  there,  and 
every  time  that  she  meets  me,  she  beseeches  me  to  expel  him.  She  believes 
also,  that  she  has  in  her  belly  all  the  personages  named  in  the  New  Testament, 
and  sometimes  even  those  of  the  whole  Bible.  She  often  says  to  me;  '^  I  can 
hold  out  710  longer  ;  when  will  the  peace  of  the  church  come!"  If  her  pains 
are  exasperated,  she  repeats  to  me  with  imperturbable  coolness;  "  To-day  the 
crucifx'wn  of  Jesus  Christ  takes  place ;  1  hear  the  blows  of  the  hammer  with 
which  the  nails  are  driven."  She  believes  that  the  popes  hold  their  council  in 
her  bowels.  Nothing  can  dissipate  illusions  so  strange.  At  the  post-mortem 
examination  of  this  woman,  who  died  March  Cth,  181G,  the  body  was  in  good 
case.  I  found  at  the  middle  and  superior  part  of  the  occipital  region,  a  de- 
pression, which  would  admit  the  extremity  of  the  little  finger,  but  did  not  ex- 
tend to  the  internal  table.  The  brain  was  slightly  injected,  and  the  ventricles 
contained  a  small  quantity  of  serum.  The  ventricles  of  the  heart  were  full  of 
coagulated  blood.  The  abdominal  viscera  adhered  together,  and  to  the  abdo- 
minal parietes,  by  means  of  the  peritoneal  membrane,  which  was  much  thick- 
ened. It  was  impossible  to  separate  the  intestines  from  each  other.  So  strong 
were  the  adhesions,  that  they  formed  a  solid,  inseparable  mass.  The  liver  was 
exceedingly  voluminous,  extending  to  the  left  hypochondrium,  where  it  adhered 
to  the  spleen. 

I  found  the  same  alteration,  although  the  adhesions  were  less  strong  and  ge- 
neral, in  the  case  of  a  demonomaniac,  who  believed  that  she  had  several  devils 
in  her  belly,  who  were  rending  her  vitals,  and  constantly  tempting  her  to  de- 
stroy herself  This  woman  was  in  a  state  of  extreme  emaciation,  her  skin  had 
become  embrowned  as  if  tanned,  and  deprived  of  all  sensibility.  I  sometimes 
pierced  it  with  large  pins  without  producing  the  least  pain.  Seeing  herself  so 
insensible,  this  lypemaniac  became  persuaded  that  her  skin  was  changed  into 
that  of  the  devil.  Irritations,  pains,  and  lesions  of  the  organs  of  generation, 
are,  among  the  insane,  and  particularly  with  women,  the  frequent  cause  of 
illusions.  They  have  sometimes  induced  the  insane  to  mutilate  themselves. 
Erotic  female  monomaniacs,  experience  all  the  phenomena  of  a  union  of  the 
sexes.  They  think  themselves  in  the  arms  of  a  lover  or  ravisher.  An  hyste- 
rical female  monomaniac  believed  that  the  devil,  serpents  and  animals,  intro- 
duced themselves  into  her  body,  by  the  external  organs  of  reproduction.  Can- 
cers, and  ulcers  of  the  uterus,  are  not  uncommon  among  this  class  of  patients. 
The  hysterical  insane  are  disposed  to  attribute,  and  do  sometimes  attribute, 
to  enemies,  to  the  jealous,  and  to  the  devil,  the  pains  and  constrictions  of  the 
throat  which  suffocate  them.  The  flying  pains  which  they  experience  in  the 
limbs,  give  rise  to  the  most  painful  illusions. 

We  have  at  Charenton  a  monomaniac,  thirty  years  of  age,  who  is  persuad- 
ed that  he  is  conducted  every  night  into  thej  vaults  of  the  opera.  There, 
and  even  sometimes  without  leaving  his  chamber,  they  pierce  him  with  knives, 
plunge  poniards  into  his  back  and  breast,  and  take  off  now  an  arm,  now  a 
thigh.  They  even  cut  off  his  head.  When  it  is  remarked  to  this  unfortunate 
man  that   his  head  is  upon  his  shoulders,  that  he  preserves  his  members,  and 


116  ILLUSIONS      OF      THE      INSANE. 

that  his  body  presents  no  wound  nor  cicatrix,  he  replies  with  animation : 
"  These  are  the  wretches,  the  magnetizers  and  freemasons,  who  have  the  secret 
of  readjusting  the  limbs,  so  that  no  evidence  of  their  amputations  shall  ap- 
pear." If  we  insist;  "You  have  an  understanding,  he  replies,  with  these 
monsters  and  brigands."  "  Slay  me,  slay  me!  I  cannot  resist  the  sufferings 
which  they  cause  me  to  endure,  nor  their  cruelty."  The  father  of  this  mono- 
maniac, and  his  former  partner,  are  especially  accused  by  him  as  the  chiefs  of 
all  the  villians  who  nightly  torture  him. 

§  11.  After  a  recital  of  facts  which  indicate  the  part  which  the  internal  sen- 
sations perform,  in  illusions,  let  us  pass  to  those  which  take  their  origin  in  the 
external  senses.  The  perturbations  of  animal  sensibility,  and  the  impressions 
which  come  from  without, — external  sensations  are,  we  remarked  in  commenc- 
ing, the  causes  of  numerous  illusions.  Illusions  of  the  external  senses  are 
not  rare  with  man  in  a  state  of  health,  and  are  frequent  among  the  insane. 
Reason  immediately  rectifies  the  errors  of  the  former,  while  there  is  none  to 
combat  the  illusions  of  the  latter.  Does  the  maniac  hear  a  sound,  he  believes 
that  some  one  is  speaking  to  him,  and  replies  accordingly.  Does  he  hear  se- 
veral persons  speak  ?  He  believes  that  they  are  friends  who  are  hastening  to 
deliver  him,  or  subjects  who  have  come  to  raise  him  upon  a  broad  shield,  and 
proclaim  him  king.  He  who  suffers  from  panophobia,  believes  on  the  con- 
trary that  they  address  him  with  reproaches  and  threats.  An  unmeaning 
phrase  he  construes  into  the  expression  of  a  concerted  plot  against  him.  He 
thinks  he  hears  enemies,  agents  of  police  and  murderers,  making  arrangements 
to  arrest  and  conduct  him  to  prison,  or  the  scaffold.  Does  a  door  open  ?  he 
believes  himself  lost,  and  ready  to  become  the  prey  of  those  who  desire  his 
destruction. 

A  servant,  thirty-one  years  of  age,  had  lost  his  employment,  by  which  he 
supported  his  family,  and  had  come  to  want.  He  starts  for  Paris.  Suddenly 
he  jumps  from  the  carriage,  and  insults  his  traveling  companions,  who  have, 
he  says,  made  remarks  disreputable  to  him,  and  treated  lightly  his  destitution. 
All  of  them  were,  indeed,  unknown  to  him.  Having  arrived  at  Paris,  he  took 
lodgings  in  the  street  Bourgogne,  but  dared  not  go  out  of  the  house,  seeing 
in  every  one  he  met,  spies  and  agents  of  police,  ready  to  arrest  him.  This 
young  man  was,  moreover,  very  calm  and  rational  on  every  other  subject. 
One  day  he  hears  the  footsteps  of  several  persons  who  are  ascending  the  stair- 
way of  the  house  in  which  he  resided.  Convinced  that  they  have  come  to  ar- 
rest him,  he  seizes  one  of  his  razors  and  makes  with  it  several  superficial 
wounds  in  his  neck.  His  sister,  who  was  in  the  chamber,  threw  herself  upon 
him,  when  he  laid  aside  the  razor,  but  endeavored  to  throw  himself  from  the 
window,  dragging  her  with  him.  The  neighbors  hastened  to  them,  and  placed 
the  sick  man  in  bed.  He  had  concealed  a  pen-knife,  with  which  he  inflicted 
several  wounds  upon  the  chest,  but  without  penetrating  the  cavity.  One  hour 
after,  having  had  his  wounds  dressed  and  been  bled,  he  confessed  to  me  that  he 
had  sought  to  take  his  life,  only  to  secure  himself  from  arrest  and  the  infamy 
of  the  scaffold,  for  which  they  came  to  take  him. 

I  once  had  in  charge  a  lady,  whom  the  slightest  noise  filled  with  terror, 
especially  during  the  obscurity  of  the  night.  The  steps  of  a  person  walking 
lightly,  made  her  shudder,  and  the  wind  caused  her  to  tremble.  The  noise 
which  she  herself  made  while  in  bed,  frightened  her,  and  obliged  her  to  rise, 
and  utter  cries  of  terror.  I  enabled  this  panophobist  to  rest  at  night,  by  keep- 
ing a  light  in  her  chamber,  and  placing  a  woman  with  her,  who  watched  dur- 
ing the'vvhole  night.  Sight  is  the  sense  which  provokes  the  most  illusions 
in°a  state  of  health,  because  it  is,  more  frequently  than  the  others,  in  relation 
with  external  objects.  Illusions  of  sight  also,  are  very  frequent  among  the 
insane.  They  call  up  resemblances  which  provoke  indignation,  fear,  remorse 
and  fury,  and  almost  always  augment  delirium.     Thus  one  sees  in  a  relative 


ILLUSIONS      OF      THE      INSANE.  117 

or  friend,  an  unknown  person,  or  an  enemy,  against  whom  he  has  formerly 
had  cause  of  complaint. 

A  lady,  twenty-three  years  of  age,  affected  with  hysterical  mania,  was  ac- 
customed to  remain  constantly  at  the  windows  of  her  apartment.  It  was  dur- 
ing the  summer.  Whenever  she  saw  a  beautiful  cloud,  isolated  in  the  air, 
she  would  call  with  a  loud  voice,  "  Garnerin,  Garnerin,  come  and  seek  ?ne," 
and  repeat  the  same  invitation  until  the  cloud  had  disappeared.  She  regard- 
ed the  clouds  as  the  balloons  sent  up  by  Garnerin. 

An  officer  of  cavalry,  on  seeing  clouds,  regarded  them  as  a  body  of  armed 
men,  whom  Bonaparte  was  conducting  to  the  invasion  of  England.  The  in- 
sane often  collect  stones  and  fragments  of  glass,  which  they  look  upon  as  pre- 
cious stones,  diamonds,  antiques,  and  specimens  in  natural  history,  which  they 
preserve  with  the  greatest  care.  We  have  at  Charenton  an  aged  professor, 
who  preserves  in  his  chimney  an  enormous  quantity  of  small  stones,  to  which 
he  attaches  great  value.  He  distributes  them  as  rewards  of  great  price,  and 
is  grieved  and  angry  when  they  are  taken  from  him.  He  believes  that  they 
are  characters  for  printing,  of  which  he  is  unwilling  to  be  deprived.  Another 
patient  collects  stones,  snails,  broken  pieces  of  glass,  and  pottery,  to  make  of 
them,  he  says,  a  rich  collection  in  natural  history.  He  accuses  of  ignorance, 
those  who  do  not  concur  with  him  in  opinion  respecting  the  beauty  and  rare- 
ness of  his  specimens. 

Mad'e  de  C,  having  reached  the  critical  period  of  life,  was  taken  with 
hysterical  monomania.  After  some  years  her  delirium  changed  its  character. 
She  composed  verses,  and  wrote  comedies,  which  she  wished  to  submit  to  the 
judgment  of  the  academicians  ;  causing  them  to  be  read  to  all  those  whom 
she  met,  and  applauding  herself  the  beauties  which  her  compositions  present- 
ed. During  the  last  six  years  of  her  life  she  no  longer  wrote,  but  collected 
pebbles,  filling  the  drawers  of  her  furniture  with  them.  From  time  to  time 
'she  entrusted  one,  or  several,  with  me  ;  boasted  of  their  size  and  price,  and 
advised  me  to  cause  them  to  be  sent  to  the  king,  in  order  to  reestablish  the 
finances  of  the  state.  The  effects  of  light,  reflected  upon  the  walls  of  the 
apartment  occupied  by  the  insane,  or  modified  by  articles  of  furniture,  are 
frequent  occasions  of  illusion. 

A  gentleman  attacked  with  hypochondriacal  lypemania,  was  in  the  habit  of 
striking  continually  with  his  cane  upon  the  furniture  of  his  apartment,  and 
even  of  the  saloon  where  several  persons  were  assembled.  The  more  rapidly 
he  walked  the  more  he  struck.  I  discovered  at  length  that  the  shadow,  pro- 
jected upon  the  inlaid  floor  by  the  furniture,  was  mistaken  by  him  for  rats. 
The  shadow  of  the  patient  passing  between  the  furniture  and  the  light,  caused 
him  to  think  that  the  rats  were  very  numerous,  and  he  then  struck  to  frighten 
them.  The  more  speedily  he  moved,  the  more  rapid  were  the  flickerings  of 
the  light,  and  the  more  firmly  did  the  patient  believe  that  the  number  of  rats 
had  increased. 

I  had  in  charge  at  one  period  a  young  lady  who  was  occupied  much  in  art 
and  literature.  Her  imagination  was  very  active.  She  was  a  maniac,  and 
passed  the  night  without  sleep,  ravished  with  the  beautiful  pictures  which  she 
saw  designed  upon  the  curtains  of  her  bed  and  windows.  She  expressed  aloud 
her  rapturous  delight.  I  enabled  her  to  rest,  by  depriving  her  of  light  during 
the  night. 

A  young  lady,  laboring  under  a  second  attack  of  mania,  very  often  refused 
the  food  with  which  she  was  served.  On  enquiring  the  reason,  she  replied 
that  it  sometimes  bristled  with  pins  and  needles. 

The  insane  are  often  unable  either  to  read  or  write  ;  nor  can  we  always  at- 
tribute it  to  weakness  of  the  brain,  or  feebleness  of  the  reason.  In  some  in- 
stances it  happens  that  when  the  patient  attempts  to  read  or  write,  the  letters 
mingle  together  confusedly,  or  rather  move  about,  as  if  they  were  springing 
from  the  paper.     It  is  this  circumstance  evidently,  that  prevents  them  froni 


118  ILLUSIONS      OF      THE      INSANE. 

either  reading  or  writing.  But  are  these  illusions  the  result  of  the  anormal 
action  of  the  eyes,  an  action  which  the  cerebral  reaction  does  not  rectify  1 
The  two  following  facts  furnish  a  sufficient  reply  to  this  question.  Reil  re- 
lates that  an  insane  lady  had  attacks  of  excitement  and  even  fury.  Her  wait- 
ing woman,  wishing  on  one  occasion  to  restrain  her  mistress,  placed  her  hands 
over  her  eyes.  The  patient  immediately  came  to  herself,  and  was  perfectly 
calm,  saying  that  she  no  longer  saw  any  thing.  The  physician,  instructed  by 
this  phenomenon,  tested  it  himself,  and  was  convinced  that  the  agitation  of 
this  patient  was  produced  by  disorder  of  sight,  which  represented  frightful 
objects  to  her  vision. 

I  once  had  charge  of  a  young  soldier,  allied  to  the  family  of  Bonaparte. 
After  many  errors  of  regimen  and  reverses  of  fortune,  he  became  a  maniac 
and  was  committed  to  my  care.  He  saw  in  every  one  around  him  a  member 
of  the  imperial  family.  He  was  excited  and  indeed  enraged,  when  he  saw 
the  domestics  fulfilling  any  servile  duty.  He  prostrated  himself  at  the  feet  of 
one  of  them  whom  he  took  for  the  emperor,  and  demanded  favor  and  pro- 
tection. It  occurred  to  me  one  day  to  bandage  his  eyes  with  a  handkerchief 
From  that  moment  the  patient  was  calm  and  tranquil,  and  spoke  rationally  of 
his  illusions.  I  repeated  the  same  experiment  several  times,  and  with  the 
same  success.  On  one  occasion  among  others,  I  kept  the  bandage  for  twelve 
hours  over  his  eyes,  nor  did  he  speak  irrationally  during  the  whole  period. 
So  soon  however  as  he  could  see,  the  delirium  commenced  again. 

The  sense  of  smell,  like  the  other  senses,  deceives  the  insane.  This  class 
of  patients  are  very  suspicious,  and  refuse  their  food,  because  they  find  it  of 
a  disagreeable  odor.  They  in  general  smell  of  both  the  food  and  drink 
which  are  offered  them,  before  tasting,  and  sometimes  dash  them  away  with 
fury,  believing  that  they  discover  the  presence  of  poison.  Many  insane  per- 
sons, on  smelling  the  gases  diffused  in  the  air,  regard  them  as  unwholesome, 
and  suited  to  poison  them.  One  of  our  patients  who  suffers  at  times  from 
dyspnoea,  often  remarks  to  me  :  "  /  knmv  not  tvhctt  there  is  in  the  air,  but  I 
cannot  breathe.  It  contains  a  mephitical  qualiti/,  which  takes  aivay  my  respi- 
ration. I  am  dreadfully  emaciated,  and  shall  die  on  account  of  this  condition 
of  the  atmosphere." 

I  have  seen  the  insane,  when  very  much  agitated  and  restless,  composed  by 
agreeable  odors  diffused  around  their  apartments.  Almost  always  at  the  com- 
mencement, and  sometimes  in  the  course  of  mental  disorders,  the  digestive 
functions  are  primitively  or  secondarily  affected,  and  the  insane  find  an  un- 
pleasant taste  in  all  the  food  which  is  presented  them  ;  whence  they  conclude 
that  their  aliment  is  poisoned,  and  reject  it  with  fury  or  with  dread.  This 
phenomenon  provokes  moreover,  among  these  patients,  an  aversion  to  those 
who  have  the  care  of  them  ;  and  this  is  the  more  violent,  in  proportion  as 
those  persons  were  more  dear  and  devoted  to  them.  Is  there  any  thing  more 
dreadful  than  the  fear  of  being  poisoned  by  those  we  love  1  This  dread  and 
refusal  of  food  ceases  after  a  few  days,  either  by  change  of  diet  or  after  eva- 
cuations, by  which  the  gastric  embarrassment  or  irritation  of  the  stomach  is 
dissipated.  This  symptom,  so  trying  to  those  who  are  not  in  the  habit  of  ob- 
serving the  insane,  is  not  one  of  serious  import.  It  is  not  alarming  like  the 
obstinate  refusal  of  some  monomaniacs,  who  do  not  eat,  either  in  obedience 
to  a  fixed  idea  which  controls  them, — such  as  an  expiation,  the  fear  of  failing 
to  fulfill  a  religious  precept,  or  in  consequence  of  some  principle  of  honor,  or 
to  terminate  their  existence.  It  happens  also,  that  the  dryness  and  aridity  of 
the  mucous  membrane  of  the  tongue  and  mouth,  persuade  some  insane  per- 
sons, that  earth  has  been  mingled  with  their  aliments,  and  that  it  is  desired 
that  they  should  eat  of  tainted  food  ;  whilst  in  other  cases,  particularly  in  de- 
mentia, the  sense  of  taste  being  destroyed,  the  patients  eat  the  most  disgust- 
ing and  foetid  substances. 

The  sense  of  touch,  so  often  appealed  to  by  the  reason,  to  dissipate  the 


ILLUSIONS      OF      THE      INSANE.  119 

errors  of  the  other  senses,  sometimes  deceives  the  insane.  I  have  already 
cited  several  facts,  which  demonstrate  that  the  perversion  of  the  sensibility  of 
the  skin  causes  numerous  illusions  respecting  the  qualities  of  bodies  surround- 
ing or  placed  in  contact  with  the  cutaneous  surface.  When  inflammation, 
or  some  other  lesion  takes  place  in  the  meninges  of  the  brain,  or  in  the  organ 
itself,  then  the  members  become  sometimes  tremulous,  and  the  extremities  of 
the  fingers  lose  their  natural  sensibility.  The  attention  no  longer  directs  the 
application  of  the  organs  of  touch,  and  the  memory  is  unfaithful.  Hence 
spring  illusions  from  the  tactile  impressions  of  bodies.  These  patients  are 
awkward,  grasp  feebly,  and  do  not  retain  what  they  lay  hold  of  They  break, 
or  permit  to  fall,  the  objects  they  have  taken  up.  They  judge  incorrectly  of 
the  form,  extent,  solidity  and  weight  of  bodies  ;  the  pathological  condition  of 
the  brain  not  permitting  them  to  rectify  these  illusions. 

A  lady  very  much  enfeebled  by  her  confinement,  and  by  sanguine  evacua- 
tions, performed  in  order  to  combat  an  attack  of  mania,  suffered  from  obsti- 
nate constipation.  I  prescribed  enemata  ;  and  notwithstanding  her  agitation, 
she  wished  to  administer  them  herself  Scarcely  had  they  put  the  syringe  into 
her  hands,  than  she  threw  it  aside  with  horror.  The  same  thing  is  repeated 
several  times.  This  lady  has  since  assured  me,  that  the  syringe  appeared  to 
her  so  heavy,  that  she  thought  it  was  filled  with  mercury,  and  persuaded  her- 
self, that  we  wished  to  make  a  barometer  of  her  body. 

Conclusion. — From  what  precedes,  I  think  we  may  conclude  : 

1.  That  illusions  are  produced  by  external  and  internal  sensations. 

2.  That  illusions  are  the  result  of  the  action  of  the  sentient  extremities, 
and  the  reaction  of  the  nervous  centre. 

3.  That  illusions  are  as  often  provoked  by  excitement  of  the  internal,  as  by 
that  of  the  external  senses. 

4.  That  illusions  should  not  be  confounded  with  hallucinations,  (visions), 
since  in  the  latter  the  brain  alone  is  excited. 

5.  That  illusions  mislead  the  judgment  respecting  the  nature  and  cause  of 
the  impressions  actually  received,  and  impel  the  insane  to  the  commission  of 
acts,  dangerous  to  themselves  and  to  others. 

C.  That  the  sex,  education,  profession  and  habits,  by  modifying  the  cere- 
bral reaction,  modify  the  character  of  the  illusions. 

7.  That  the  illusions  take  the  character  of  the  passions  and  ideas  which 
control  the  insane. 

8.  That  reason  dissipates  the  illusions  of  a  man  sound  in  mind,  whilst  it  is 
impotent  in  destroying  the  illusions  of  the  insane. 

This  essay  will  not  be  without  interest,  if,  by  observation,  I  have  proved  the 
existence  of  a  psychological  phenomenon  imperfectly  understood,  although 
frequent  in  delirium  ;  if  the  facts  which  I  have  related,  throw  some  light  upon 
the  history,  still  obscure,  of  the  aberrations  of  the  understanding  ;  and  if 
these  facts  furnish  therapeutic  views,  applicable  to  the  treatment  of  mental 
diseases. 

[The  general  principles  of  treatment  both  in  Illusions  and  Hallucinations,  are  the 
same.  Active  remedies  are  rarely  necessary.  Abundant  exercise  in  the  open  air,  a  nu- 
tritious diet  easy  of  digestion,  the  warm  bath,  and  counter  irritation  in  many  cases,  to- 
gether with  cheerful,  and  if  possible  engrossing  occupations,  will  meet  most  successfully 
the  indications  of  treatment.  Great  tact  and  ingenuity,  as  well  as  promptitude  in  deci- 
sion and  action,  are  often  necessary  in  the  management  of  those  suffering  from  this  form 
of  insanity,  nor  can  detailed  directions  be  given,  which,  in  all  respects  will  be  adapted 
to  the  circumstances  of  any  two  cases.  Still  the  leading  principles  of  treatment  being 
fully  understood,  a  discerning  mind  will  find  little  difficulty  in  their  application.] 


FURY. 


Definition. — Causes  hemorrhages,  convulsions,  apoplexy  and  death. — Aspect  of  counte- 
nance in  a  state  of  fury. — Confounded  with  mania  by  the  ancients. — Rage,  definition 
of. — Fury  appears  in  all  forms  of  mental  alienation,  and  even  dementia. — Sanguine 
and  bilious-nervous  temperaments  predispose  to  fury. — By  what  caused. — Not  in  gene- 
ral automatic. — Usually  intermittent. — Fury  sometimes  terminates  in  dementia,  and 
sometimes  is  the  last  link  in  the  chain  of  circumstances  that  affect  its  cure. — Fury 
renders  the  prognosis  in  mental  alienation  more  favorable  than  its  opposite. — It  may 
be  so  intense  as  to  create  danger. — Treatment,  with  important  remarks. 

Fury  is  a  violent  excitement,  caused  by  an  error  of  mind  or  heart.  We 
call  that  man  furious,  who,  transported  by  delirium,  or  some  passion,  exhausts 
himself  by  talk,  by  threats  and  actions;  seeking  at  the  same  time  to  injure 
others  and  himself. 

Fury  expresses  the  highest  degree  of  exaltation  of  the   vehement  passions. 
We  love  or  hate  with  fury.     We  denominate  fury,  a  violent  attack  of  anger. 
Religious  fanaticism  as  well  as  political  excitement  and  enthusiasm,  are  some- 
times converted  into  uncomplicated  fury.     This  extreme  state  of  the  passions, 
which  deprives  a  man  of  reason,  and  conducts  him  to  the  most  fearful  resolu- 
tions, leads,  often  enough,  to  mental  alienation.     It  causes  hemorrhages,  con- 
vulsions, apoplexy   and  death.     In  fury  the  face  is  flushed,  or  very  pale,  and 
always  spasmodically  aftected ;  the  eye  flashes,  the  expression  of  the  counte- 
nance is  ferocious,  the  voice  loud  and  hesitating,  the  tone  threatening,  and 
the  whole  body  convulsively  agitated.     Fury  is  in  most  cases  expansive,  though 
.   sometimes,  sullen  and  concentrated.     It  is  always  succeeded  by  lassitude,  and 
/    extreme  prostration  of  the  vital  forces. 
Vf  Fury  is  an  accident,  a  symptom  ; — it  is  the  anger  of  delirium.     It  was  con- 

X.  founded  with  mania  by  the  ancients,  and  by  many  moderns,  just  as  hydropho- 
f  bia  was  confounded  with  rage,  which  is  an  extreme  degree  of  fury.  Mania 
>  consists  in  a  general  chronic  delirium,  without  fever,  with  exaltation  of  the 
sensibility  and  motive  powers,  in  opposition  to  dementia,  which  is  a  general 
chronic  delirium  with  diminution  of  power.  But  all  maniacs  are  not  furious; 
nor  are  all  those  suffering  from  hydrophobia  enraged.  Fury  however,  appears 
in  all  forms  of  delirium,  even  in  febrile  delirium.  It  appears  in  all  forms  of 
mental  alienation,  and  even  in  dementia.  It  bursts  forth  also  in  many  diseases, 
which  we  cannot  confound  with  mania,  such  as  meningitis,  hysteria  and  hy- 
drophobia. It  appears  in  drunkenness,  after  the  use  of  certain  poisons,  etc. 
Fury  is  therefore,  a  symptom,  very  distinct  from  mania.  It  may  well  appertain 
to  a  variety  of  mania,  but  not  furnish  it  with  a  specific  character ;  since  we 

16 


122  FURY. 

observe  it  in  many  varieties  of  monomania,  lypemania,  dementia  and  idiocy. 
The  sanguine,  and  particularly  the  bilious-nervous  temperament,  both  being 
exceedingly  irritable,  predispose  to  fury.  The  scorching  heat  of  the  air,  cer- 
tain atmospheric  constitutions,  and  certain  winds,  render  more  imminent  the 
explosions  of  fury,  as  well  as  all  those  circumstances  that  augment  the  impulse 
of  blood  towards  the  head,  or  excite  the  cerebral  nervous  system. 

Fury  is  caused  by  the  use,  or  rather  the  abu.se  of  various  substances  intro- 
duced into  the  stomach.  Wine,  alcoholic  liquors,  opium,  etc.,  produce  fury. 
The  same  is  true  of  meningitis,  hydrophobia  and  hysteria.  In  all  these  cases, 
the  hallucinations,  illusions  of  the  senses,  and  the  perversion  of  the  moral 
affections  which  overthrow  the  reason,  render  the  patient  furious.  If  maniacs 
are  more  frequently  furious  than  other  insane  persons,  it  must  be  attributed  to 
their  temperament,  their  extreme  susceptibility,  and  the  exaltation  of  all  their 
faculties ;  circumstances  which  render  them  exceedingly  impressible,  and  con- 
sequently, very  irritable  and  choleric.  Man  in  a  state  of  dementia  is  rarely 
furious,  because  innervation,  in  his  case,  is  without  energy,  sensibility  almost 
extinct,  and  impressions  almost  null.  Fury  is  no  more  automatic  than  are  all 
the  other  determinations  of  delirium,  inasnmch  as  the  furious  do  not  give 
themselves  up,  without  motive,  to  their  transports  of  excitement.  It  is  to 
shun  some  danger  with  which  they  believe  themselves  menaced,  to  resist  ob- 
stacles real  or  imaginary,  or  in  fine,  to  take  vengeance  upon  those  whom  they 
regard  as  their  enemies,  that  the  insane  become  furious.  I  shall  have  to  no- 
tice, however,  some  exceptions,  in  speaking  of  homicidal  monomania.* 

Fury  is  rarely  continued.  It  is  intermittent,  like  the  action  of  the  causes 
that  produce  it.  If  continued,  it  cannot  be  of  long  duration.  It  is  always  a 
distressing  symptom  in  fever,  or  in  the  phlegmasiae.  It  is  not  thus  in  mental 
alienation,  and  is  critical  in  consecutive  dementia.  When,  after  a  too  debili- 
tating treatment,  the  insane  have  fallen  into  dementia,  if  they  recover  their 
vital  forces,  mania  and  even  fury,  put  an  end  to  the  delirium.  This  was  ob- 
served by  Pinel,  among  the  insane,  who,  after  having  been  submitted  to  treat- 
ment at  the  Hotel  Dieu,  were  sent  to  the  Bicetre  in  profound  dementia.  We 
also  see  fury  terminate  in  incurable  dementia,  and  sometimes  a  single  day  suf- 
fices to  produce  this  result.  The  fury  which  occasions  so  much  terror  and 
disquietude,  among  those  who  are  not  accustomed  to  the  insane,  far  from  ren- 
dering the  prognosis  in  mental  alienation  less  favorable,  furnishes  stronger 
hope  of  cure.  Furious  maniacs  and  monomaniacs,  are  cured  more  frequently 
than  the  insane  who  are  composed  and  mild.  With  the  latter,  there  is  less 
vital  force,  less  energy,  less  reaction,  and  cures  are  more  difficult.  It  is  not 
unusual,  that  after  an  attack  of  fury,  the  insane  become  more  calm  and  ra- 
tional. But  if  the  fury  is  continued,  if  the  delirium  is  general,  and  so  intense 
that  it  takes  from  the  furious  person  the  sentiment  of  his  own  existence,  we 
may  fear  that  the  patient  will  not  resist  the  excess  of  excitement,  and  that 
death  will  promptly  supervene.  If  the  insane  in  their  fury,  commit  acts  of 
atrocity,  it  is  to  be  feared  that  they  will  not  recover.  (I  have  never  seen  an 
insane  person  cured  who  had  taken  the  life  of  his  children,  relatives  or 
friends.)  They  are  not  incurable  however,  when  they  have  compromised 
only  their  own  existence. 

[A  female  aged  24  years,  was  placed  at  the  Retreat  for  the  Insane  at  Hartford,  Conn., 
during  the  autumn  of  1840,  who  had  just  taken  the  life  of  one  of  her  children,  and  made 
an  attempt  upon  that  of  another.  She  was  small,  slender,  and  quite  delicate.  Her  fea- 
tures were  small — their  expression  vacant,  yet  tinged  with  melancholy.  She  refused  to 
speak,  and  disregarded  any  request  that  was  made.  Such  was  her  condition  for  several 
weeks.     At  the  expiration  of  this  period,  I  was  informed  one  morning  by  her  nurse,  that 

*  See  note  on  Homicidal  Monomania. 


FUKY.  123 

a  change   had    taken  place  in  Mrs. .     On  repairing  to  her  apartment,  I   found  her 

bathed  in  tears.  The  expression  of  her  countenance  was  changed,  and  she  seemed  to 
have  awoke  to  the  realities  of  her  condition.  She  replied  in  monosyllables  to  such 
questions  as  were  put  to  her,  but  with  manifest  reluctance. 

Suffice  it  to  say,  that  after  a  long  and  tedious  convalescence,  during  which  she  suffer- 
ed greatly  from  palpitations  of  the  heart  and  other  nervous  symptoms,  she  recovered  per- 
fectly, and  has  continued  well  until  the  present  time.  This  case  may  be  found  reported 
at  some  length  in  the  Eighteenth  Annual  Report  of  the  Retreat,  Hartford.] 

Fury,  being  one  of  the  most  alarming  symptoms  of  insanity,  ought  to  at- 
tract particular  attention,  though  it  does  not  require  spegial  treatment.  Its 
treatment  should  be  merged  in  that  of  the  maladies  of  which  it  is  a  symp- 
tom;  nevertheless,  it  requires  special  hygienic  attentions.  It  is  because  fury 
has  been  taken  for  insanity  itself,  and  great  therapeutic  importance  has  been 
attached  to  this  symptom,  that  so  many  grave  errors  have  been  committed  in 
the  treatment  of  the  furiously  insane.  They  were  bled  to  excess,  with  the 
intention  of  abating  their  vital  force,  and  it  was  not  perceived  that  the  loss 
of  blood  augmented  the  evil,  and  that  it  composed  the  sick  only  by  depriving 
them  of  the  power  of  reaction,  necessary  for  the  solution  of  the  disorder. 

This  symptom  has  been  the  cause  of  the  most  general,  as  well  as  fatal 
errors  in  the  treatment  of  the  insane.  Seeing  among  them  only  the  furious, 
all  the  insane  have  been  treated  like  dangerous  and  mischievous  animals,  ready 
to  destroy  and  exterminate  every  thing  ;  against  whom  it  was  necessary  to  pro- 
tect society.  Hence  dungeons,  cells,  grates,  chains  and  blows  ;  means  which, 
by  exasperating  the  delirium,  were  a  principal  obstacle  to  its  cure.  Ever 
since  these  unfortunate  people  have  been  treated  with  kindness,  the  number  of 
the  furious  has  diminished  to  such  a  degree  that,  in  hospitals  well  kept,  and 
properly  arranged,  among  many  hundred  insane  people,  not  one  can  be  found 
in  a  state  of  fury. 


MENTAL  ALIENATION 

OF  THOSE  RECENTLY  CONFINED,  AND  OF  NURSING  WOMEN. 


Preliminary  remarks. — Subject  divided  into  two  parts.— Pari  First. — Temporary  deliri- 
um of  early  confinement  briefly  noticed. — Nearly  one  twelfth  of  the  women  at  the 
Salpetriere  became  insane  after  confinement. — More  among  the  wealthy  insane  after 
confinement ,  among  the  poor  after  weaning. — History  of  this  form  of  insanity. — Pe- 
riod of  the  first  appearance  of  insanity  in  92  cases,  succeeded  by  several  important 
deductions. — Symptoms  accompanying  an  attack. — Form  of  insanity  affecting  92  cases. 
— Age  during  which  women  are  most  subject  to  this  malady. — Illustrative  cases. — Is 
the  suppression  of  the  milk  the  cause  or  eff'ect  of  insanity  .''  Does  the  milk  act  as  a 
foreign  body  in  those  accidents  which  follow  confinement  or  lactation  ?  Opinions  of 
both  ancients  and  moderns  on  these  questions. — This  class  of  cases  generally  cured, 
unless  the  predisposition  is  too  energetic. — How  produced. — Duration  of  attacks. — 
Relapses. — Mortality. — Remarks  on  post-mortem  examinations. — General  treatment. 
— Part  Second. — Cases,  with  treatment  in  detail ;  together  with  an  account  of  certain 
post-mortem  examinations. 

Although  much  has  been  written  respecting  the  diseases  to  which  those  re- 
cently confined  are  exposed,  and  the  ravages  which  the  milk  commits  in  the 
economy,  when  diverted  from  its  secretory  organs  ;  accoucheurs  and  physi- 
cians, who  have  treated  of  the  diseases  of  women,  have  little  to  say  re.specting 
those  forms  of  mental  alienation  which  burst  forth  after  confinement,  and 
during  or  after  lactation.  It  is  this  circumstance  which  has  determined  me  in 
making  choice  of  this  subject ;  with  the  hope  of  spreading  abroad  some  light 
in  a  department  of  practice,  of  the  more  importance,  as  it  interests  a  great 
portion  of  the  female  sex. 

This  essay  is  divided  into  two  parts  :  the  one  is  limited  to  considerations 
deduced  from  my  private  practice,  and  the  division  of  the  insane  at  the  Sal- 
petriere :  the  other  embraces  observations  or  cases,  which  serve  as  a  basis  to 
the  general  considerations  expressed  in  the  first  part.  I  had  at  first,  distri- 
buted the  observations  in  the  first  part,  but  it  appeared  to  me,  that  they  divert- 
ed the  attention  too  much,  and  interrupted  the  chain  of  general  ideas,  which 
I  have  endeavored  to  render  as  brief  as  possible. 

PART  FIRST. 

I  will  not  speak  of  the  transient  delirium  which  takes  place  after  confine- 
ment, and  sometimes  during  the  milk  fever.     This  delirium  is  speedily  dissi- 


126  MENTAL      ALIENATION 

pated,  either  by  the  occurrence  of  the  lochial  discharge,  or  by  its  diminution 
when  too  abundant ;  by  the  lacteal  secretion,  the  cessation  of  the  fever,  or  the 
return  of  strength.  Mauriceau  and  other  accoucheurs  have  witnessed  delirium 
on  the  second  day  of  confinement,  and  seen  it  disappear  on  the  fourth.  Neither 
will  I  speak  of  the  delirium  of  those  who,  in  their  phrensy,  destroy  the  chil- 
dren to  whom  they  have  just  given  birth.  False  shame,  perplexity,  fear,  mise- 
ry and  crime,  do  not  always  lead  to  infanticide.  Delirium  however,  by  dis- 
turbing the  reason  of  the  recently  confined,  sometimes  also,  directs  their  sac- 
rilegious hands.  A  maiden  becomes  pregnant,  does  not  conceal  the  fact,  and 
causes  the  linen  proper  for  her  confinement  to  be  prepared,  and  announces  the 
expected  event  to  all.  She  is  confined  during  the  night.  On  the  following  day, 
she  is  found  in  her  bed  and  the  child  in  the  privy  ;  mutilated  by  twenty-one 
wounds  with  an  instrument,  which  is  supposed  to  be  a  pair  of  scissors.  She 
is  arrested  some  hours  after,  and  carried  upon  a  litter,  a  distance  of  two 
leaorues  from  the  house  where  she  was  confined.  She  endeavors  to  conceal 
herself  from  the  gaze  of  her  indignant  country  women.  While  on  the  way, 
rising  with  difficulty,  she  frequently  says  to  those  who  bear  and  conduct  her  : 
"  They  will  do  me  no  harm;  they  will  do  nothing  to  me;  will  they?  I  have 
done  no  injury  ;  they  can  do  nothing  to  me."  Some  days  after  she  is  interro- 
gated, and  avows  her  crime  ;  does  not  defend  herself,  manifests  not  the  least 
regret,  but  refuses  to  eat.  Has  not  this  young  woman  suffered  from  an  attack 
of  delirium  ?  Finally,  this  and  other  facts  of  similar  import,  belong  to  legal 
medicine,  and  ought  not  to  occupy  me  here. 

The  number  of  women  who  become  insane  after  confinement,  and  during 
or  after  lactation,  is  much  more  considerable  than  is  commonly  supposed.  In 
fact,  at  the  Salpetriere,  almost  one  twelfth  of  the  women  received,  have  be- 
come insane  under  these  circumstances.  There  are  years  in  which  this  pro- 
portion is  one  tenth  ;  thus,  of  eleven  hundred  and  nineteen  women  admitted 
into  the  division  of  the  insane,  during  the  years  1811,  1812,  1813,  and  1814, 
ninety-two  became  insane  after  confinement,  during,  or  immediately  after  lac- 
tation ;  and  of  these  ninety-two  women,  sixty  belonged  to  the  years  1812  and 
1813,  durinff  which  there  were  six  hundred  admissions.  And  if  of  the  whole 
number  of  insane  women  received  during  these  four  years,  we  deduct  at  least 
one  third,  who  have  passed  the  age  of  fifty  years,  beyond  which  period,  wo- 
men are  not  exposed  to  the  influences  of  confinement  and  lactation,  we  shall 
be  led  to  conclude,  that  mental  alienation  as  a  result  of  confinements,  during, 
and  after  lactation,  is  more  frequent  than  I  at  first  intimated.  This  is  true, 
particularly  among  the  wealthy.  The  number  in  this  class,  according  to  the 
result  of  my  private  practice  is  almost  one  seventh.  Astruc  also,  had  observ- 
ed that  deposits,  and  engorgements  of  milk,  are  more  frequent  among  the 
higher  than  the  lower  classes  of  society.  But  it  is  certain  also,  that  mental 
alienation  after  weaning,  is  rare  among  the  rich,  whilst  it  is  frequent  among 
the  poor,  who  either  from  necessity  or  voluntarily  wean  their  children. 

The  precautions  which  the  wealthy  do,  and  are  able  to  take,  after  weaning, 
account  for  this  difference.  Nothing  can,  however,  relieve  them  of  their  ex- 
treme susceptibility,  immediately  after  confinement,  or  whilst  nursing.  The 
epoch  of  the  invasion  of  the  malady,  with  reference  to  the  time  of  delivery 
and  lactation,  it  is  not  a  matter  of  indifference  to  determine,  since  it  fur- 
nishes indications  useful  in  practice.  Hippocrates,  in  the  third  book  of  Epi- 
demics, relates  several  cases  of  grave  affections,  attended  with  delirium,  super- 
vening upon  confinement,  during  the  epidemic  of  which  he  gives  the  description. 
They  are,  for  the  most  part,  fevers.  Perhaps  case  fourteenth,  is  one  of  acute 
mania.  It  is  that  of  the  wife  of  Epicrates,  who,  having  been  confined  with 
twins,  was  delirious  from  the  first  day  of  confinement,  and  died  phrenetic  on 
the  twenty-first.  Levret  informs  us,  that  insanity  is  to  be  feared  after  confine- 
ment, if  the  lochia  are  scanty,  or  are  suppressed ;  especially  if  the  breasts  do 


OF      THl      RECKNTLY      CONFINED.  127 

not  fill,  or  fall  away.     Zimmennann,*  mentions  some  examples  of  mania  and 
melancholy,  preceded  by  suppression  of  the  lochia.     He  cites,  among  others, 
that  of  a  woman,  who  was  cured,  only  at  the  expiration  of  six  months.     There 
was  published  at  Gottengen  in  1745,  a  thesis,  sustained  by  Doct.  Berger,  bear- 
ing the  following  title :  De  puerperarum  Mania  et  Melancolid.     I  have  never 
been  able  to  procure  it.     Doublet!  says,  that  the  lacteal  irritation,  sometimes 
falls  upon  the  brain,  either  immediately  after  confinement,  or  at  the  period  of 
the  lacteal  revolution.     Some  who  have  been  confined,  adds  this  author,  have 
a  fixed  pain  in  the  head ;  others  are  in  a  stupor,  have  a  dull  expression,  and 
reason  falsely.     Of  our  ninety-two  women,  sixteen   became  insane,  from  the 
first,    to  the  fourth  day  of   confinement.     We    read  in  Puzos, |   that  lacteal 
deposits  are  sometimes  made  in  the  brain,  and  that  they  produce  insanity  by 
compressing  this  viscns,  or  rather,  by  distending  its  fibres.     These  deposits, 
according  to  this  author,  take  place  like  others,  from  the  tenth,  to  the  twelfth 
day  after  confinement.     He  reports  three  cases  on  this  subject.     Among  our 
ninety-two  women,  twenty-one  became  insane  from  the  fifth,  to  the  fifteenth 
day  after  confinement.     Seventeen   became  insane  between  the  fifteenth  and 
sixtieth  day  after  confinement,  the  extreme    limit  of  the   lochial   discharge. 
Nineteen  women  lost  their  reason,  between  the  second  month  or  the  following 
one.  and  the  twelfth,  durino-  lactation.     Nineteen   were  seized  with   mental 
alienation,  immediately  after  a  forced  or  voluntary  weaning.     We  may  there- 
fore conclude :   1,  that  alienation  of  mind,  is  not  more  frequent  among  the  re- 
cently confined,  than  among  nursing  women :  2,  that  the  danger  of  losing  the 
reason,  diminishes,  in  proportion  as  the  female  is  removed  from  the  epoch  of 
confinement :  3,  that  nursing  women,  especially  poor  ones,  are  much  more  lia- 
ble to  become  insane  after  weaning,  than  during  the  period  of  lactation. 

Mental  alienation  after  confinement,  is  sometimes  announced  by  sinister  pre- 
sentiments, even  during  pregnancy.     Sadness  and  disquietudes,  exaggerated 
or  without  foundation,  are  a  prelude  also,  to  the  explosion  of  delirium.     Some- 
times the  irruption  of  insanity  takes  place  suddenly.     At  first,  this  class  of 
insane  persons  appear  to  be  in  a  febrile  state.     The  skin  is  warm,  pliant  and 
moist.     It  is  also  pale,  the  tongue  white,  the  breasts  flaccid  ;   and  the  abdomen 
neither  tender  nor  painful.     Sometimes,  there  is  a  very  acute  pain  in  the  head 
or  uterus,  the  pulse  is  small,  feeble  and  concentrated,  and  at  the  same  time, 
there    is    uncomplicated  delirium    or   monomania,    more    frequently,  mania, 
rarely  dementia.     Sometimes  also,  the  most  profound  stupor  presages  phrensy, 
with  which  it  is  easy  to  confound  mania.     But  the  pain   in  the  head,  the  red- 
ness of  the  eyes,  the  dryness  of  the  skin,  ringing  in  the  ears,  the  anomalies 
of   the  pulse,  subsultus  tendinum,   ataxy   of  the   symptoms,    and  their   rapid 
increase,  furnish  distinguishing  evidence  of  the  latter  malady.     Phrensy  ter- 
minates fatally  on  the  third  or  fourth  day,  rarely  passing  the  seventh ;  whilst 
the  duration  of  mania  after  confinement,  is  prolonged,  and  persists  for  several 
weeks  or  months,  and  sometimes  even  more.     Mental  alienation  which  makes  its 
appearance  during,  or  after  lactation,  presents  little  difference,  as  it  respects  its 
character  and  progress,  from  insanity  which  breaks  forth  under  any  other  cir- 
cumstances.    Notwithstanding,  there  is  something  peculiar  in  its  aspect,  which 
causes  it  to  be  recognized  by  one  who  is  accustomed  to  the  care  of  the  in- 
sane. 

In  comparing  the  diff'erent  forms  of  mental   alienation  of  the  nine-two  wo- 
men who  constitute  the  subject  of  this  essay,  I  find  the  numbers  following  : 
Dementia  -  -  -  -  -  -  -8 

Lypemania  (melancholy)  and  monomania    -  -  -  35 

Mania  -  -  -  -  -  -  -     49 

*  Treatise  on  Experience. 

t  Memoirs  of  the  Royal  Society  of  Medicine,  ann.  1786,  t,  viii.  p.  179. 

t  Memoir  on  Lacteal  Deposits. 


128 


MENTAL      ALIENATION 


It  may  perhaps  be  asked,  if  the  recently  confined  and  nurses  never  sink 
into  idiocy  ?  By  no  means  ;  since  idiocy  is  a  cerebral  alteration,  appertain- 
ing to  earliest  infancy. 

Before  passing  to  the  causes  which  produce  insanity  among  the  newly  con- 
fined and  nurses,  I  ought  to  determine  the  age,  during  which  they  are  most 
subject  to  this  malady.     Of  our  ninety-two  women  : 

22  are  from  20  to  25  years  of  age. 

41         "         25  "    30      " 

16         "         30  "    35      " 

11         "         35  "   40     " 
2         "  43      " 

The  age  at  which  nursing  women,  as  well  as  those  recently  confined,  are 
most  subject  to  mental  alienation,  is  from  25  to  30  years.  It  is  also  the  age 
of  the  greatest  fruitful ness.  The  causes  which  especially  predispose  the  re- 
cently confined  and  nurses  to  this  malady  are,  hereditary  predisposition,  an 
extreme  susceptibility,  attacks  of  insanity  anterior  to  pregnancy,  and  attacks 
consequent  upon  preceding  confinements,  or  during  lactation.  In  some  cases, 
the  predisposing  causes  suffice,  not  only  to  produce  a  transient  delirium,  but 
also  to  excite  an  actual  attack  of  insanity.  Such  are  the  severe  labor  of  con- 
finement ;  and  the  return,  simply,  of  confinement  or  lactation ;  the  same  phy- 
sical circumstances  bringing  back  the  same  functional  alterations  of  the  brain, 
together  with  the  same  intellectual,  and  moral  disorders.  It  is  singular,  that 
women  have  been  known  to  become  insane  after  giving  birth  to  a  male  child, 
while  they  were  exempt  from  this  accident  after  confinement  with  a  daughter. 
We  have  seen  women,  whose  delirium  manifested  itself  only  after  every  se- 
cond confinement ;  also  those  who  fell  into  the  same  condition,  on  the  third 
or  fifth  month  of  each  period  of  lactation,  without  any  assignable  exciting 
cause.  The  exciting  causes  which  provoke  insanity  among  the  recently  con- 
fined and  nurses,  are  errors  in  resimen  and  the  moral  affections.  Coolness  ; 
the  impression  of  cold,  in  whatever  way  it  may  be  made,  is  of  all  errors,  most 
to  be  dreaded. 

Exposure  to  cool  air,  or  the  application  of  cold  water,  by  suppressing  the 
lochia,  provoke  insanity  ; — and  this,  whether  the  person  in  child-bed,  exposes 
herself  to  currents  of  cold  air,  or  walks  abroad  ;  whether  she,  or  her  who 
nurses,  plunges  her  limbs  in  cold  water,  cuts  the  hair,  or  employs  in  excess, 
heating  remedies.  Among  our  ninety-two  insane  women,  fourteen  times  was 
mental  alienation  provoked  by  physical  causes,  and  among  these  fourteen  cases 
in  ten  instances,  the  impression  of  cold  was  the  cause  of  the  malady.  Hasty 
weaning,  whether  voluntary  or  forced,  becomes  the  cause  of  insanity,  when 
nursing  women,  at  this  period,  neglect  those  precautions  which  prudence  and 
experience  enjoin.  We  have  already  seen  also,  that  nineteen,  out  of  ninety- 
two  women,  became  insane  a  few  days  or  immediately  after  weaning,  in  con- 
sequence of  imprudences  or  negligence.  We  have  already  remarked  that  in- 
sanity after  weaning,  is  rare  among  the  higher  classes,  because  the  women 
belonging  to  this  class  are  extremely  cautious  at  this  period. 

Moral  affections  are  the  most  frequent  cause  of  mental  alienation  among 
those  recently  confined,  and  nursing  women.  They  are  to  physical  influences, 
in  respect  to  frequency,  as  one  to  four.  The  fatal,  as  well  as  general  in- 
fluence of  these  causes,  has  been  understood  in  all  times.  At  Rome,  a  crown 
was  suspended  over  the  entrance  of  the  house  of  those  recently  confined,  to 
give  notice,  that  it  was  a  sacred  asylum.  There  exists  at  Harlem  a  law, 
which  requires  that  a  sign  be  placed  upon  the  house  of  lying-in  women. 
This  sign  serves  as  a  safe-guard  against  the  intrusion  of  bailiffs,  and  agents  of 
police,  who  might  otherwise  present  themselves  in  virtue  of  their  office.     Van- 


OF      THE      RECENTLY      CONFINED.  129 

Swieteii  assures  us,  that  women  in  confinement,  are  often  afflicted  with  incu- 
rable mania,  in  consequence  of  some  corroding  grief  What  happens  in  con- 
sequence of  confinements  occurs  also,  during  and  after  lactation,  but  is  attend- 
ed with  much  less  danger.  Of  our  ninety-two  women,  forty-six  became  in- 
sane, after  suffering  from  some  moral  affection.  The  fear  of  again  falling  sick, 
after  having  had  an  attack  of  insanity,  the  despair  caused  by  the  loss  of  a 
child,  or  the  abandonment  of  the  father,  anger,  fright,  mortification,  and  do- 
mestic dissensions,  are  also  exciting  causes. 

The  effects  of  fright  were  remarkable  during  the  year  1814,  since,  of  thir- 
teen women  who  had  become  insane  after  confinement,  in  consequence  of 
moral  affections,  and  who  were  admitted  into  our  hospital  during  that  year, 
(1814),  eleven  became  insane  in  consequence  of  fright.  I  made  the  same 
observation  in  eighteen  hundred  and  fifteen.  The  predisposing  prepare  the 
recently  confined,  and  those  vvho  are  nursing,  in  some  sort,  for  the  action  of 
exciting  causes.  Both  the  one  and  the  other  act  with  the  more  energy,  in 
proportion  as  confinement  and  lactation,  exalt  the  susceptibility  and  mobi- 
lity of  lying-in  and  nursing  women,  and  render  them  more  accessible  to  acci- 
dental influences.  These  latter,  and  among  them,  especially  moral  affections, 
are  the  more  fatal,  in  proportion  to  the  promptness  with  which  they  act. 

A  lady  is  happily  confined,  and  on  the  following  day  perfumes  her  bed  with 
odoriferous  fluids.  The  lochia  are  suppressed,  and  the  milk  is  not  secreted. 
Mania  bursts  forth  on  the  same  day,  and  she  is  cured  only  at  the  expiration  of 
ten  months,  after  a  catarrhal  fever.  A  husband  throws  a  bucket  of  water 
upon  his  wife,  who  was  confined  the  night  before.  The  unfortunate  woman 
immediately  becomes  a  maniac,  and  never  recovers.  A  young  woman  eighteen 
years  of  age,  evades  the  watchfulness  of  her  parents,  dissembles  her  pregnan- 
cy, is  confined  in  a  garret,  at  a  very  cold  season,  and  passes  down  the  stairs 
in  order  to  regain  her  chamber.  The  lochia  are  suppressed,  and  an  irruption 
of  mania  takes  place,  from  which  she  recovers  at  the  end  of  a  year,  when  the 
menses  are  reestablished.  A  woman,  while  nursing,  is  overtaken  by  a  .storm. 
She  had  become  warm  by  walking  rapidly,  and  passes  through  a  stream,  the 
water  of  which  reaches  her  knees.  The  milk  ceases  to  flow,  and  she  be- 
comes a  lypemaniac.  Another  is  frightened  by  a  thunder-clap.  The  milk  is 
suppressed,  and  she  loses  her  reason. 

When  physical  or  moral  causes,  isolated  or  united,  exert  their  action  upon 
the  recently  confined,  the  lochia  are  diminished  or  disappear, — the  milk  no 
longer  comes  to  the  breasts,  or  they  become  flaccid,  and  mental  alienation 
breaks  forth.  Things  do  not  always  proceed  thus.  It  happens  that  insanity 
manifests  itself,  although  there  be  no  suppression;  though  the  lochia  flow  im- 
perfectly and  scantily.  There  are  cases,  though  they  must  be  admitted  to  be 
very  rare,  in  which  the  lochial  discharge  is  natural,  and  partakes  even  of  a 
hemorrhagic  character,  (case  first),  and  nevertheless,  the  reason  of  the  patient 
wanders.  The  same  is  true  of  the  milk.  Now  it  is  wholly  suppressed ;  and 
now  there  is  not  suppression,  but  the  secretion  is  less  abundant.  It  does  not 
possess  its  nutritive  qualities,  and  the  child  refuses  the  breast.  Moreover, 
mental  alienation  occurs,  although  no  suppression  nor  diminution  may  have 
taken  place,  and  lactation  continues,  suited  to  the  wants  of  the  child.  Here 
are  very  naturally  presented,  two  interesting  questions,  which  for  a  long  time 
furnished  matter  for  debate. 

1.  Is  the  suppression  or  diminution  of  the  milk,  the  cause  or  effect  of  men- 
tal alienation  ? 

We  may  reply,  that  insanity  manifests  itself  most  frequently,  among  women 
who  do  not  nurse.  Of  our  ninety-two  insane  women,  twenty-nine  were  single, 
and  sixty-three  married.  Now  single  women  rarely  nurse.  The  greatest  num- 
ber of  facts,  prove,  that  the  milk  diminishes,  is  suppressed,  or  loses  its  dis- 
tinctive qualities,  before  the  explosion  of  delirium ;  but  there  are  observations 

17 


130  MENTAL      ALIENATION 

also,  which  furnish  undeniable  proof,  that  the  suppression  or  diminution  of 
milk,  takes  place  only  after  the  explosion  of  insanity. 

2.  Does  the  milk  act  as  a  foreign  body,  in  those  accidents  which  follow  con- 
finement or  lactation  1 

The  ancients  believed,  that  the  milk  was  conveyed  to  the  brain,  just  as  they 
thought  that  it  was  sent  to  other  organs ;  and  attributed  to  metastasis,  all  the 
accidents  which  followed  its  diminution  or  suppression.  Sennert  believed, 
that  the  delirium,  under  these  circumstances,  is  the  effect  of  the  vapors,  which 
pass  from  the  uterus  to  the  head.  Levret  assures  us,  that  milk  has  been  found 
within  the  cranium.  Boerhaave  opposed  the  treatment  of  the  different  patho- 
logical phenomena  which  appear  after  confinement,  as  different  maladies; 
but  rather  as  the  same  malady,  appertaining  to  the  same  cause,  and  conse- 
quently identical,  but  manifesting  itself  under  various  forms.  Almost  all  ac- 
coucheurs have  attributed  the  different  accidents  which  follow  confinement 
and  nursing,  to  lacteal  metastasis.  This  opinion  is  popular,  and  consoles  some 
unfortunate  people  for  the  ills,  from  which  there  is  no  release.  Nevertheless, 
the  experiments  of  the  moderns,  particularly  those  of  Chaussier  and  Bichat, 
demonstrate  that  no  milk  is  to  be  found  in  the  abdomen  of  those  recently 
confined,  who  have  died  of  peritonitis.  Nor  does  it  exist  in  the  cranial  cavity 
of  those  who  have  died  insane  after  confinement. 

The  moderns  believe  with  reason,  that  after  confinement,  and  during  lacta- 
tion, there  exists  a  lacteal  diathesis,  which  modifies  all  the  secretions  of  the 
female,  and  impresses  upon  them  its  own  character  ;  that  the  susceptibility  of 
the  recently  confined  and  of  nursing  women  renders  them  more  dependent 
upon  external  infiuences  ;  that  these  influences  act  upon  this  or  that  organ, 
and  cause  the  development  of  accidents  which  characterize  the  diseases  pro- 
per to  these  organs  ;  accidents,  which  are  modified  by  the  general  diathesis, 
that  is,  the  lacteal.  Hippocrates,  (book  v,  aph.  40,)  says  that  women  whose 
blood  escapes  by  the  nipples,  are  threatened  with  mania.  However,  we  see 
women,  who  experience  a  diversion  of  the  menstrual  secretion  to  the  nipples, 
without  any  other  accident.  Planchon  assures  us,  that  Doctor  Pieters  of 
Louvain,  had  seen  a  nursing  woman,  who  passed  blood  instead  of  milk  by  the 
nipples,  and  who  did  not  become  insane.  Doublet  has  many  times  observed 
at  the  hospital  of  Vaugirard,  nursing  women  whose  engorged  breasts  discharg- 
ed blood,  without  any  serious  results. 

Mental  alienation,  following  confinement,  is  generally  cured,  if  the  predis- 
position is  not  too  energetic.  More  than  one  half  are  restored.  Among  our 
ninety-two  women,  fifty-five  were  cured  ;  constituting  one  seventh  of  the  total 
number  of  cures  obtained  at  the  Salpetriere,  during  the  four  years  referred  to 
above.  The  mental  alienation  of  this  class,  is  terminated  by  the  reestablish- 
ment  of  the  lochia,  by  the  secretion  and  evacuation  of  milk,  by  an  abundant 
leucorrhoea,  by  mucous  and  sometimes  sanguinolent  alvine  dejections,  by  the 
return  of  the  menses  that  have  been  suppressed  ever  since  the  beginning 
of  pregnancy,  and  by  subcutaneous  suppurations  ;  very  rarely  by  pregnancy. 
The  duration  of  the  attacks  is  variable.     Of  fifty-five  cures, 

4   took   place  during  the  1st    month  ; 
7  "  "         2d 

6 
7 
5 
9 

15  during  the  following  months ; 
2  after  two  years. 

Therefore,  thirty-eight,  or  rather  two  thirds  of  the  cures,  took  place  within 
the  first  six  months  after  the  attack  of  mental  alienation. 


(( 

(t 

3d 

<( 

It 

a 

4th 

(I 

f( 

(( 

5th 

(( 

(< 

(( 

fith 

i< 

OF      THE      RECENTLY      CONFINED.  131 

If  the  cures  of  the  recently  confined  are  frequent,  we  must  admit  that  these 
patients  are  disposed  to  relapses,  when  a  strong  predisposition  has  preceded 
the  first  attack.  We  may  prevent  this  disposition  to  periodicity,  by  avoiding 
the  circumstances  which,  having  produced  the  first,  may  occasion  the  return 
of  new  attacks  of  insanity.     They  are  prevented  by  avoiding  pregnancy. 

I  was  not  a  little  surprised,  whilst  arranging  the  notes  which  I  have  made 
respecting  our  ninety-two  women,  to  find  but  six  deaths. 

1  after  six  months  from  confinement ; 

1  after  a  year  ; 

2  after  eighteen  months  : 
1  after  three  years  ; 

1  afl;er  five  years  ; 

Therefore,  the  mortality  is  only  one  eighteenth,  among  women,  insane  in 
consequence  of  confinement,  during,  or  after  lactation.  It  is  only  one  fifty- 
third,  with  respect  to  the  mortality  of  the  whole  division  of  the  insane  con- 
nected with  our  hospital.  How  happens  it,  that  the  abdominal  affections 
Avhich  occur  after  confinement,  are  so  often  mortal,  whilst  the  cerebral  mala- 
dies, which  take  place  at  the  same  period  rarely  prove  fatal  ?  This  sketch  is 
not  perhaps  useless,  with  respect  to  the  physiology  of  the  brain,  and  the  ap- 
preciation of  the  influence  of  this  organ  upon  organic  life.  The  opening  of 
the  bodies  of  those  who  have  been  confined  or  nursed,  and  have  died  after 
having  been  insane  a  longer  or  shorter  period  of  time,  offers,  strictly  speaking, 
nothing  in  particular  ;  nothing  which  enables  us  to  recognize  the  material 
cause  of  this  form  of  alienation,  or  to  discover  its  seat.  Selle,  in  his  collec- 
tion of  observations,  states  that  he  found,  poured  out  into  the  brain,  a  great 
quantity  of  pus,  in  the  case  of  a  woman  who  had  died  after  a  second  confine- 
ment, and  had  suffered  from  an  attack  of  mania,  in  consequence  of  a  preced- 
ing one.  I  found  serum  amono-  the  folds  of  the  arachnoid  membrane,  as  in 
other  cases  of  insanity,  but  never  any  thing  that  resembled  milk.  These  are 
the  albuminous  effusions,  which  have  been  mistaken  by  some  authors. 

Finally,  it  would  be  as  strange  to  find  milk  in  the  brain  after  confinement 
or  lactation,  when  there  was  suppression  of  this  secretion,  as  to  find  menstrual 
blood  in  the  cavity  of  the  cranium,  in  females  who  have  become  insane  after 
the  suppression  of  the  menses.  When  insanity  is  complicated  with  puerperal 
peritonitis,  we  find  effusions,  and  false  membranes,  in  the  peritoneal  cavity. 
The  treatment  of  mental  alienation,  which  occurs  as  a  consequence  of  confine- 
ments, during  or  after  lactation,  has  undergone  many  changes.  Most  authors, 
frightened  undoubtedly  by  the  violence  of  the  symptoms  which  these  cases 
present,  have  regarded  them  as  incurable.  Puzos  admits  that  he  partook  of 
this  error,  after  several  fruitless  efforts  to  overcome  it.  However,  he  at  length 
persuaded  himself,  that  by  the  use  of  powerful  evacuations,  both  by  bleeding 
and  purging,  we  could  change  this  disordered  condition  of  the  brain  ;  but  that 
the  greatest  efforts  of  art,  were  for  a  long  time  necessary.  Deceived  by  the 
gravity  of  the  symptoms,  practitioners  have,  almost  always,  carried  to  excess, 
the  means  which  they  employed.  They  bled  to  the  utmost,  and  suppression 
of  the  lochia  fortified  them  in  the  belief  of  the  correctness  of  the  practice. 
Yet  a  too  copious  lochial  discharge  causes  insanity.  Haller  states,  that  a  wo- 
man was  deprived  of  the  faculty  of  thought,  in  consequence  of  a  too  abundant 
lochial  discharge. 

I  relate,  in  the  second  part  of  this  memoir,  a  case  of  mania,  which  occurred 
in  the  person  of  one  recently  confined,  who  had  had  a  uterine  hemorrhage, 
for  eight  days.       Boerhaave  and  Van-Swieten*  inform  us,  that  blood-letting 

*  Comm.  in  H.  Boerhaave  Aphorismos,  Paris,  1769,  aph.  1332. 


132  MENTAL      ALIENATION 

ought  not  to  be  employed,  except  in  case  of  the  utmost  necessity,  not  even 
when  the  lochia  are  suppressed.  By  debilitating,  say  these  authors,  blood- 
letting injures,  rather  than  benefits  the  patients.  Without  doubt,  this  is  the 
result  of  the  indirect  force.  The  lassitude  and  exhaustion  which  follow  con- 
finement, should  have  caused  them  to  beware  of  appearances.  They  were  in 
the  habit  of  prescribing  for  a  time,  the  most  energetic  purgatives,  drastics 
and  neutral  salts.  At  a  later  period,  they  preferred  the  milder  purgatives. 
In  cases  attended  with  suppression  of  the  milk,  they  endeavored  to  bring  it 
back  to  the  breasts,  by  the  application  of  cupping  glasses,  and  by  suction,  or  else 
they  purged.  If  the  disorder  proved  rebellious,  they  recommend  a  new  preg- 
nancy and  nursing,  and  because  it  has  sometimes  happened  that  this  advice 
has  proved  useful,  they  have  made  of  it  a  general  precept.  I  am  confident 
that  it  succeeds,  only  when  alienation  is  accidental,  and  does  not  depend  upon 
a  serious  prior,  or  predisposing  cause.  Bleedings  ought  to  be  employed  cau- 
tiously during  the  first  stage.  When  the  sanguine  temperament  predominates, 
and  there  are  signs  of  plethora  or  congestion  of  the  brain,  leeches  to  the  vulva 
or  thighs,  are  useful.  The  cups,  vesicatories  and  sinapisms,  applied,  now  to 
the  legs  or  thighs,  and  now  to  the  neck,  in  connection  with  a  ptisan  slightly 
sudorific  or  purgative,  following  the  tendency  of  nature,  will  be  preferred  to 
means  called  heroic. 

Some  persons  recently  confined,  have  been  cured  by  the  employment  of 
purgative  enemata.  I  have  prescribed  with  success,  immediately  after  con- 
finement, enemata,  prepared  with  four  ounces  of  sugar,  and  a  sufficient  quan- 
tity of  milk.  I  recommended  three  of  them  a  day,  the  patients  observing,  at 
the  same  time,  a  strict  regimen  in  every  respect.  An  emetic,  repeated  several 
times  in  succession,  has  also  been  success-ful  among  subjects  remarkably  lym- 
phatic. It  sometimes  happens,  that  vesicatories,  which  have  not  succeeded  at 
the  commencement  of  the  malady,  and  during  its  period  of  irritation,  produce 
the  best  effects,  when  renewed,  sometime  after  the  invasion  of  the  disorder. 
Tepid  baths,  especially  the  hip-bath,  and  sometimes  hot  baths,  second  won- 
derfully the  other  curative  means,  when  the  patient  has  passed  to  the  chronic 
state.  Cool  or  cold  baths  are  dangerous.  When  the  malady  persists,  especial- 
ly among  nursing  women,  if  the  menses  are  not  reestablished  alter  the  use  of 
evacuants,  we  shall  find  advantage  from  applying  leeches  to  the  vulva,  and 
cupping-glasses  to  the  thighs ;  employing  emmenagogues,  and  other  reme- 
dies, suited  to  recall  the  menstrual  tlux. 

It  is  unnecessary  to  remark,  that  women  who  have  become  insane  in 
consequence  of  confinement  and  lactation,  ought  to  be  submitted  to  the  same 
creneral  principles  of  treatment,  with  other  insane  persons  ;  that  isolation,  the 
aids  of  hygiene,  and  moral  means,  ought  not  to  be  neglected,  and  that  these 
alone  have  sufficed  to  effect  a  cure,  although  more  rarely,  than  in  other  forms 
of  mental  alienation. 

PART  SECOND. 

Case  I. — P.  Y.  E ,  fifty-three  years  of  age,  belongs  to  a  family,  many 

of  which  are  insane.     One  of  her  cousins  became  insane  in  consequence  of 

her  confinement.     E begins  to  menstruate  at  the  age  of  sixteen  without 

accident.  Soon  after,  she  grows  tall  rapidly,  and  at  each  menstrual  period 
experiences  colic  pains.  Her  disposition  is  mild,  yielding  and  diffident,  and 
she  resides  in  the  country. 

Married  at  twenty  years  of  age,  she  becomes  the  mother  of  five  chil- 
dren. On  the  fourth  month  of  the  fifth  pregnancy,  she  is  frightened  by  a  man 
who  runs  through  the  street  with  a  drawn  sabre.  From  this  time  she  has  pre- 
sentiments. She  fears  that  her  confinement  will  not  be  fortunate,  and  is  per- 
suaded that  she  shall  become  insane. 


OF      THERECENTLY      CONFINED.  133 

Thirty  years  of  age:  she  is  happily  confined  on  the  15th  of  April,  1811. 
Three  days  subsequently,  she  is  seized  with  uterine  hemorrhage,  which  occa- 
sions  fears   for  her  life,  and  ceases  only  at  the  expiration  of  eight  days      At 

this  time,  E is  active,  and  excited,  but  free  from  delirium.     A  tonic  reai- 

men  is  prescribed,  and  the  secretion  of  milk  takes  place.  She  nurses  her 
infant,  but  on  the  twenty-ninth  day  becomes  delirious,  commits  a  thousand 
extravagances,  and  wishes  to  destroy  herself  She  strikes  and  abuses  those 
about  her,  and  for  fifteen  days,  obstinately  refuses  to  eat  or  to  drink.  On  the 
forty-fourth  day  after  her  confinement,  vesicatories  to  the  limbs  and  a  full  diet 
are  prescribed.  She  continues  to  nurse  her  child,  although  she  has  little  milk. 
Sixtieth  day.  The  milk  has  become  abundant,  and  the  patient  eats  well  ; 
nevertheless  mania  continues.  Some  days  after,  she  is  brought  to  the  Salpe- 
triere,  July  25th,  1811.  She  is  sad,  and  does  not  speak.  The  abdomen  is 
distended.     The  infant  is  removed,  and  on  the  following  day  there  is  fury. 

July  27th.  A  laxative  drink  is  prescribed,  a  vesicatory  to  the  neck,  and 
camphorated  liniment  is  applied  to  the  breasts,  which  are  distended  with  milk. 
A  whitish  mucous  discharge  takes  place  from  the  vulva,  the  vesicatory  dis- 
charges very  abundantly,  and  the  alvine  evacuations  are  free. 

Aug.  20th.  The  vesicatory  has  ceased  discharging,  and  the  patient  speaks 
and  walks  more  readily.  She  eats  little,  digestion  is  easy,  and  the  breasts  no 
longer  contain  milk. 

Sept.  6th.  She  is  better,  although  sad.  She  replies  correctly,  labors,  and 
we  consider  her  convalescent. 

Oct.  1st.  She  is  profoundly  melancholy,  refuses  to  speak,  to  take  nourish- 
ment, or  to  e.xercise. 

Oct.  3d.  A  vesicatory  is  applied  between  the  shoulders,  and  followed  by  a 
febrile  movement,  which  persists  for  fifteen  days. 

19th.  Cessation  of  the  febrile  symptoms.  During  the  continuance  of  the 
fever,  there  is  a  progressive  return  of  reason. 

22d.  Her  health  is  improved,  and  is  so  understood  by  the  patient,  who 
speaks  without  repugnance,  and  gives  an  account  of  what  she  has  experienced. 
{A  laxative  drink). 

Nov.  10th.  E has  seen  her  relatives,  and  appeared  very  well  at  the  in- 
terview. There  is  a  return  of  vital  energy,  and  a  moderately  full  habit  of 
body.      ( Tepid  baths,  and  aromatic  drinks).     The  menses  return. 

December.     Vesicatory  ceases  to  discharge,  and  convalescence  is  confirmed. 

Dec.  10th.  This  woman  is  discharged  eight  months  after  her  confinement, 
seven  after  the  invasion  of  the  delirium,  and  four  and  a  half  after  her  admis- 
sion into  the  hospital. 

Case  II. — T.  J.  M» ,  fifty-one  years  of  age,  is  admitted  at  the  Salpetri- 

ere  June  30th,  1812.  She  has  a  sister  who,  after  her  confinement,  became 
insane,  and  still  remains  deaf.  Our  patient  is  tall,  having  chestnut  colored 
hair  mingled  with  white.  Her  eyes  are  large  and  dark,  face  flushed,  skin 
brown,  physiognomy  changeful,  abdomen  voluminous.  When  a  year  old,  she 
had  variola.  At  ten  years  of  age,  she  had  a  severe  illness,  during  which,  a 
uterine  hemorrhage  took  place.  Eleven  years  of  age,  menstruation  abundant, 
and  followed  by  colic  pains  after  each  menstrual  period.  In  youth  her  health  is 
feeble,  and  she  suffers  from  hemicrania  of  the  left  side,  which  persists  for 
twenty-four  hours.     She  is  afflicted  also,  with  epigastraloria. 

Twenty-five  years  of  age.  M.  marries,  and  is  better  since  her  marriage,  at 
least  in  appearance.  Twenty-six.'  First  confinement.  Mania  and  fury,  which 
persist  up  to  the  period  of  the  second  pregnancy.  Her  second  confinement 
terminated  happily.  Since  that  period,  she  has  been  confined  twelve  times, 
her  confinements  in  each  instance  being  laborious,  and  followed  by  mental 
alienation  of  a  month  or  six  weeks'  duration.     Thirty-nine.     Apoplexy,  follow- 


134  MENTAL      ALIENATION 

ed  by  hemiplegia.  Forty-seven  years.  After  a  severe  fever,  she  suffered  from 
mania  and  fury,  which  lasted  for  five  months,  since  which  she  has  had  irre- 
aularities  of  menstruation,  and  cephalalgia.  A  cessation  of  the  menses  takes 
place  at  the  age  of  forty-nine,  without  accident.  Fifty  years.  A  grave  attack 
of  fever  occurs,  followed  by  a  return  of  the  menses,  which  recur  at  intervals 
of  a  month,  for  the  space  of  a  year.  Fifty-one  years.  M.  loses  her  husband 
and  is  imprisoned.  She  is  immediately  seized  with  mania.  When  brought 
to  the  hospital,  June  30th,  1812,  she  is  in  a  state  of  mania.  There  is  general 
delirium,  agitation,  and  at  intervals,  panic  terrors,  tears,  constipation,  etc. 
Auo-.  12th,  1812.  She  is  calm,  knows  her  condition,  weeps  in  view  of  her 
situation,  and  the  loss  of  her  husband.  She  reasons  justly,  but  her  mind  is 
feeble.  December,  M.  is  well.  The  menses,  which  ceased  at  the  first  of  the 
previous  month,  did  not  again  appear.  At  the  time  of  leaving  the  hospital 
she  was  unusually  timid,  but  enjoying  the  perfect  use  of  her  reason. 

Case  III. — S.  J.,  forty  years  of  age,  was  admitted  at  the  Salpetriere  April 
22d,  1812.  She  is  tall,  her  face  covered  with  pimples,  her  hair  is  chestnut 
colored,  her  eyes  of  the  same  color  and  lively,  and  her  complexion  light.  She 
is  of  a  moderately  full  habit.  Twelve  years  of  age,  she  has  cephalalgia  and 
nasal  hemorrhages.  Thirteen  years  of  age.  The  menses  first  appear,  suc- 
ceeded by  a  cessation  of  the  hemorrhages.  Since  that  period,  her  menses 
have  been  regular,  but  scanty.  Eighteen  years  of  age.  The  benefactor  of 
this  woman  is  beheaded.  She  is  immediately  seized  with  a  general  tremor, 
and  her  mind  wanders  for  some  days.  Twenty-six  years  of  age.  J.  marries, 
and  becomes  the  mother  of  three  children,  whom  she  nurses.  Thirty  years  of 
awe.  She  is  confined  with  her  fourth  child,  nurses  it,  and  weans  it  incautious- 
ly.  Two  days  after,  she  is  taken  with  general  delirium,  attended  by  a  pre- 
dominance of  religious  ideas.  She  is  brought  to  the  hospital,  from  which  she 
is  discharged  cured,  after  four  months'  treatment.  Thirty-six.  A  new  attack 
caused  by  the  absence  of  her  husband.  She  is  admitted  a  second  time,  at 
the  hospital,  May  28th,  1810,  from  which  she  is  discharged  June  21st,  1811, 
at  the  end  of  thirteen  months.  Thirty-nine.  Fifth  confinement  ;  seven 
months  after  which,  she  weans  her  child.  The  day  but  one  afterwards,  she  is 
seized  with  delirium,  attended  with  imaginary  fears.  She  is  taken  to  a  pri- 
vate hospital,  where  an  eruption  takes  place  over  her  whole  body,  which,  at 
length  occupies  only  the  face.  At  the  expiration  of  twenty  months,  this  pa- 
tient is  brought  to  the  hospital,  April  22d,  1812.  She  is  sad,  melancholy, 
and  in  despair.  She  has  also  religious  terrors.  May  24th,  1812.  A  dis- 
charge from  the  left  ear.  Since  that  period  she  is  more  rational,  judges  cor- 
rectly of  her  disease,  eats  and  sleeps  well.  June.  Tepid  baths,  pimples  upon 
the  face,  eyelids  red,  vesicatory  upon  the  arm.  Frojii  this  period,  conva- 
lescence. This  woman  was  discharged,  Aug.  11th,  1812,  enjoying  the  use  of 
her  reason.  All  the  attacks  were  announced  by  sadness,  uneasiness,  and  in- 
aptitude for  her  ordinary  occupations.  By  degrees,  the  mind  became  lost. 
During  the  attacks,  she  experienced  a  burning  and  confused  state  of  the 
brain. 

Case  IV. — D S.  D.,  forty-one  years  of  age,  was  admitted  at  the  Salpe- 
triere, June  19th,  1812.  She  is  of  medium  stature,  her  hair  is  of  a  chestnut 
color,  her  eyes  blue,  her  complexion  light,  her  physiognomy  mobile,  and  her 
habit  of  body  moderately  full.  This  woman  has  an  uncle  and  an  aunt  who 
are  insane.  She  met  with  a  fall  upon  her  forehead,  when  nine  years  of  age. 
Traces  of  the  cicatrix  are  still  distinct.  When  fourteen  years  of  age  she  is 
aflSicted  with  Psora.  Sixteen  years  of  age.  The  menses  appear,  preceded 
by  headache.  They  are  both  scanty  and  irregular.  At  twenty-six  she  mar- 
ries.    The  menses  from  this  period  are  more  abundant.     Leucorrhoea  also 


OF      THE      RECENTLY      CONFINED.  135 

exists.  The  pain  in  the  head  is  more  severe.  At  the  age  of  twenty-seven 
years,  during  her  first  pregnancy,  she  meets  with  domestic  trials.  Her  hus- 
band having  undergone  an  operation  unknown  to  her,  she  is  frightened,  on 
being  apprised  of  it.  Her  mind  wanders,  and  she  becomes  furious.  She  is 
now  thirty-three  years  of  age.  She  is  treated  at  Charenton,  and  the  attack 
lasts  five  months,  the  understanding  remaining  slightly  enfeebled.  She  is 
again  confined  at  thirty-five  years  of  age.  At  the  age  of  thirty-seven  years, 
on  the  third  day  of  her  third  confinement,  slight  opposition  was  followed  by 
delirium  and  fury.  Six  days  after,  she  was  admitted  at  the  hospital,  from 
whence  she  was  discharged  at  the  expiration  of  ten  months,  the  attack  having 
lasted  for  six  months.  Forty-one  years.  Domestic  troubles  together  with 
slight  opposition,  bring  on  a  new  attack  of  fury,  which  continues  for  a  few- 
days.  She  was  brought  to  the  hospital  June  19th,  1812,  and  after  some  days 
became  calm,  but  irrational.  Aug.,  1812.  She  converses  much,  and  for  a 
long  time ;  she  relates  all  that  she  ever  knew,  saw  or  heard,  and  with  great 
incoherence,  both  of  ideas  and  language.  She  enjoys,  however,  long  intervals 
of  reason.  October.  She  is  calm  and  labors,  but  is,  at  brief  intervals,  irra- 
tional.    December.     This  third  attack  terminates  in  dementia. 

Case  V. — L ,  the  offspring  of  an  insane  mother  (her  daughter  is  in- 
sane, and  her  grand-daughter  died  a  maniac),  is  of  medium  stature,  her  hair 
of  a  chestnut  color,  her  eyes  and  skin  brown,  and  her  physiognomy  mobile. 
At  the  age  of  fourteen  or  fifteen  years,  the  menses  merely  make  their  appear- 
ance, and  are  suppressed  for  a  year  afterwards,  with  chlorosis  and  fever.  At 
the  age  of  sixteen  years  the  menses  return,  since  which,  she  has  had  thirteen 
children.  At  the  age  of  twenty-three  years,  she  first  becomes  a  mother. 
From  that  period,  the  menstrual  flow  is  irregular  and  scanty.  Twenty-nine 
years.  Her  infant  having  died  some  days  after  her  fourth  confinement,  she 
becomes  a  maniac  from  excessive  grief.  She  is  treated  at  the  Hotel-Dieu. 
The  menses  are  suppressed  for  a  year,  and  a  cure  takes  place  after  eighteen 
months.  Since  this  period,  at  each  confinement,  immediately  after  the  secre- 
tion of  milk  takes  place,  she  is  seized  with  mania  :  now,  with  suppression  of 
the  lochia  and  menses ;  now  without  suppression.  The  attacks  last,  usually, 
one  year.  Each  attack  is  announced  by  abdominal  pains,  which  extend  to  the 
uterus,  and  are  attended  with  the  sensation  of  a  foreign  body  resting  upon  the 
rectum.     The  attack  makes  its  irruption  by  cries  and  convulsions. 

At  length,  the  fear  of  becoming  insane  produces  delirium.  She  becomes 
agitated,  and  cannot  refrain  from  speaking  and  walking  about.  A  thousand 
hallucinations  augment  her  delirium.  She  hears  persons  speaking  whom  she 
does  not  behold,  and  sees  .strange  objects  which  frighten  her.  She  suffers 
from  insomnia,  palpitations  and  constipation.  During  the  attack,  she  no  lon- 
ger suffers  from  leucorrhoea,  and  the  oz^na  is  not  observable.  Forty-five 
years.  Last  confinement.  Attack  mora  violent  than  the  preceding  ones. 
Forty-nine  years.  She  now  suffers  from  flatulence,  which  painfully  distends 
the  abdomen,  and  embarrasses  the  respiration,  especially  when  she  has  eaten. 
She  then  suffers  more  than  at  any  other  period.  About  the  age  of  fifty  years, 
the  menses  cease  flowing,  without  an  outbreak  of  delirium.  Fifty-three  years 
of  age.  Her  husband  joins  the  army,  and  she  has  a  new  attack.  She  suffers 
from  winds  that  stifle  her,  and  which  ascend  to  her  head.  Then  reason  wan- 
ders, and  she  has  a  thousand  hallucinations  of  hearing  and  sight.  She  has, 
also,  convulsions.  The  paroxysms  are  renewed,  ordinarily,  every  two  days, 
and  are  announced,  like  the  attacks,  by  cries.  This  state  persists  for  six 
months.  Since  this  attack,  she  has  enjoyed  her  reason  perfectly,  but  in  spring 
and  autumn,  experiences,  for  some  days,  a  convulsive  trembling  of  the  limbs. 

At  the  age  of  fifty-nine  years,  Dec.  1811,  she  is  severely  frightened.  Nine 
days  subsequently,  she  is  suddenly  seized  with  abdominal  pains,  extending  to 


136  MENTAL      ALIENATION 

the  uterus,  and  convulsions  ;  terror,  delirium,  a  desire  to  walk  about  and  to 
run.  Hallucinations  are  present.  She  is  aware  of  her  condition,  and  de- 
mands that  she  be  conducted  to  the  Salpetriere.  Admitted  at  the  Hotel-Dieu, 
every  thing  appears  changed,  and  in  the  utmost  confusion.  She  hears  one 
utter  a  cry,  on  seeing  a  surgeon  making  a  vaginal  examination  and  displaying 
his  hand  tinged  with  blood.  L.  believes  that  she  every  where  beholds  intes- 
tines floating  about,  and  the  smoking  of  blood.  She  is  in  the  greatest  fright, 
nor  can  she  dissipate  these  phantoms,  although  she  knows  that  she  is  deceived. 
Foot-baths  are  administered,  and  she  is  bled  from  the  arm.  All  the  symptoms 
are  aggravated,  and  her  delirium  no  longer  permits  her  to  recognize  any  thing. 
Her  intelligence  is  overturned,  and  she  has  no  longer  a  sense  of  her  delirium. 
After  two  months,  she  is  brought  to  the  Salpetriere.  March  25th,  1812.  The 
abdomen  is  distended,  habit  of  body  moderately  full,  skin  brown,  physiogno- 
my mobile,  and  expressive  of  fear.  There  is  delirium,  constant  desire  to 
move  about,  constipation,  and  sometimes  convulsions,  particularly  during  the 
night.  We  bathe  the  patient,  and  administer  cooling  drinks.  She  gradually 
becomes  calm.  In  July  and  Aug.  she  becomes  tranquil,  walks  about  less, 
and  labors  a  little  while  at  a  time.  September.  The  patient  awakes  to  a 
consciousness  of  her  condition,  and  feels  herself  sufficiently  strong,  to  dissi- 
pate her  hallucinations  and  vain  fears.  Moreover,  she  is  very  calm,  and. rea- 
sons correctly.  On  the  12th  Sept.  1812,  she  leaves  the  hospital  well  ;  cured 
of  her  eleventh  attack  of  mania.  Since  that  period,  she  has  fallen  into  de- 
mentia, attended  with  trembling  of  the  limbs. 

Case  VT. — R.,  thirty-four  years  of  age,  was  admitted  at  the  hospital,  Nov. 
10th,  1813.  She  has  a  mild,  but  lively  disposition.  She  is  tall,  with  chestnut 
colored  hair,  large  hazel  eyes,  a  dark  complexion,  a  mobile  physiognomy,  and 
a  tolerably  full  habit  of  body.  At  si.xteen  years  of  age  the  menses  are  spon- 
taneously established,  and  at  the  age  of  twenty-four,  she  marries.  Twenty- 
six  years.  On  the  third  day  after  her  first  confinement,  a  lady,  having  musk 
about  her  person,  calls  upon  her.  She  is  immediately  seized  with  delirium, 
but  continues,  nevertheless,  to  nurse  her  child,  who  dies  at  the  age  of  three 
years.  This  first  attack  was  characterized  by  mania  with  fury,  and  last- 
ed but  two  months.  It  ceased  suddenly,  after  a  severe  fright.  Since  the 
first  attack,  she  has  remained  exceedingly  susceptible.  Every  spring  she  has 
excitement  without  delirium,  which  is  dissipated  by  the  use  of  antispasmodics. 
Thirty  years.  Whilst  weaning  her  child,  aged  one  year,  she  descends  to  the 
shop  of  her  husband,  in  which  there  was  some  paint.  The  odor  immediately 
excites  delirium,  which  increases  for  five  days,  and  is  followed  by  mania  with 
fury.  Aug.  4th,  1809,  she  was  admitted  at  the  Salpetriere.  September.  A 
very  marked  remission.  R.  is  calm,  and  appears  rational.  Her  husband 
solicits  her  discharge,  and  obtains  it  on  the  12th  of  Oct.  following.  From 
the  second  day  of  her  discharge,  there  is  a  return  of  the  delirium  and  fury, 
accompanied  with  a  suppression  of  the  menses,  and  a  distended  abdomen. 
Readmitted  at  the  hospital,  the  patient  becomes  calm  at  the  approach  of  win- 
ter. In  December,  the  menses  are  established,  and  R.  is  discharged  June 
24th,  1811.  Thirty-four  years.  Nov.  1st,  1813.  An  abortion  at  two  months, 
attended  with  colic  pains,  uterine  hemorrhage,  and  from  the  following  day 
with  loquacity.  Nov.  3d.  Mania  and  fury  (tepid  baths  and  leeches  to  the 
malleoU),  without  remission.  The  patient  is  brought  again  to  the  hospital. 
At  her  arrival,  her  eyes  are  haggard,  face  pale,  features  of  the  countenance 
shnniken,  general  delirium,  mania,  fury.  Three  days  after,  she  is  calm,  and 
becomes  aware  that  she  is  in  the  hospital.  16th.  Menses  are  wanting.  22d. 
Patient  sees  her  husband  with  satisfaction.  She  is  sad,  but  her  replies  are  cor- 
rect. [Tepid  baths).  28th.  Fever,  attended  with  gastric  embarrassment. 
{Emetic,  repeated  twice).     Abundant  dejections,  since  which  her  ideas  are 


OF      THE      RECENTLY      CONFINED.  137 

connected.  She  is  calm,  and  labors.  Return  to  reason  progressive.  Dec. 
21st.  R.  leaves  the  hospital,  perfectly  restored  to  the  use  of  her  reason,  al- 
though the  menses  are  not  reestablished. 

Case  VII. — M.,  (admitted  at  the  Salpetriere  April  29th,  1814,  at  the  age 
of  twenty-four  years),  was  the  offspring  of  a  mother  who  died  insane.  She  is 
tall,  with  chestnut  colored  hair,  and  an  expressive  eye.  Her  complexion  is 
sallow,  skin  brown,  physiognomy  mobile,  and  her  disposition  gay.  She  has 
fits  of  anger,  which  are  dissipated  by  tears ;  is  indolent  and  of  great  suscepti- 
bility. From  infancy,  she  has  been  subject  to  ophthalmia,  and  has  suffered 
from  headache  during  her  whole  life.  Six  years  of  age.  Psora  and  frequent 
nasal  hemorrhages.  When  eleven  years  old,  she  has  the  small  pox  in  its  se- 
verest form.  She  is  affected  with  ozaena,  and  the  nasal  hemorrhages  have 
ceased.  Fifteen  years  of  age.  The  menses  appear  spontaneously ;  since 
which  period  her  health  has  been  good,  and  the  ozsena  has  disappeared.  At 
each  menstrual  epoch,  sometimes  before,  and  sometimes  after  it,  she  suffers  from 
headache,  which  is  dissipated  by  vomiting.  This  woman  marries  at  the  age 
of  twenty-three  years.  At  twenty-four,  being  pregnant,  she  meets  with  a  fall, 
and  sprains  one  of  her  feet.  At  the  fifth  month  of  her  pregnancy,  the  events 
caused  by  the  approach  of  the  allied  armies,  give  her  great  uneasiness,  and 
the  more,  as  she  is  unable  to  walk,  and  remains  at  home  alone.  At  the  ninth 
month  of  her  pregnancy,  a  Cosack  threatens  her  life.  She  loses  her  appetite, 
and  suffers  from  nervous  twitchings.  April  21st.  On  the  eve  of  her  confine- 
ment, she  is  frightened  anew.  22d.  She  is  confined,  and  has  convulsions  for 
twenty-four  hours.  23d.  Continuation  of  the  convulsions.  At  their  cessa- 
tion, she  laughs  continually,  and  is  delirious.  24th.  General  delirium,  agi- 
tation, fury, — refuses  to  take  nourishment.  The  patient  is  unwilling  to  drink 
any  thing  but  cold  water.  Symptoms  are  exasperated  during  the  night.  Ne- 
vertheless, the  lochia  continue  to  flow,  though  the  secretion  of  milk  does  not 
take  place.  {Sinapisms  to  the  feet).  The  pain  caused  by  the  sinapisms,  caus- 
es the  patient  to  believe  that  we  wish  to  burn  her  feet.  During  her  convul- 
sions, she  bites  her  tongue,  and  the  pains  which  result  from  it,  seem  to  her  to 
be  caused  by  fire. 

She  is  brought  to  the  hospital  April  29th.  On  her  admission,  her  complex- 
ion is  sallow  and  discolored,  her  eyes  constantly  in  motion,  tongue  white, 
breasts  flaccid,  and  her  delirium  gay.  The  patient  recognizes  neither  the  per- 
sons nor  objects  that  surround  her.  She  considers  herself  an  empress,  and  is 
constantly  affirming  that  her  husband  is  Louis  XVIII,  and  that  all  the  furniture 
is  of  silver,  or  some  other  precious  metal.  She  grants  favors  to  every  body. 
Her  step  is  haughty,  her  tone  imperious,  and  her  ideas  of  grandeur  predomi- 
nant, notwithstanding  the  most  complete  incoherence.  Her  actions  present 
the  same  disorder,  and  a  similar  exaggeration.  Appetite  voracious.  April 
30th. — (  Vesicatories  to  both  limbs,  and  laxative  drinks).  Lochia,  mingled  with 
a  whitish  mucus.  May  8th.  Discharge  of  matters,  at  first  white.  She  is 
more  calm,  though  the  -delirium  preserves  the  same  character.  12th.  Con- 
tinuation of  the  lochia.  [Same  medicines).  Vesicatory  discharges  freely, — 
dejections  brownish,  mingled  with  mucous  matters.  Less  disorder  of  the 
ideas.  15th.  She  sees  her  husband,  and  recognizes  him.  It  seemed  to  him, 
that  for  a  moment  she  recollected  herself,  and,  as  it  were,  came  out  of  a  reve- 
ry.  This  period  however,  is  very  brief,  and  the  delirium  continues,  but  she 
no  longer  entertains  ideas  of  grandeur.  22d.  Cessation  of  the  lochia, — the 
vesicatory  dries  up, — there  is  more  connection  in  her  ideas,  and  her  compo- 
sure is  perfect.  The  sight  of  her  husband  affords  our  patient  pleasure.  24th. 
Convalescence.  She  renders  a  complete  account  of  the  motives  of  her 
actions  during  her  delirium.     The  vesicatory  has  ceased  to  discharge.     25th. 

18 


138  MENTAL,      ALIENATION 

She  experiences  a  sensation  as  if  stunned,  which  enfeebles  both  her  body  and 
mind.     Aside  from  this,  she  is  rational,  and  obtains  her  discharge. 

Case  VIII  — L    forty-one   years  of  age,  is  admitted   into  the  hospital  Nov. 
28th  ^1811.     At  the  age  of  eighteen,  a  fright  suppresses  her  menses   and  she 
is  melancholic  for  eighteen  months;   after  which,  she  enjoys  comfortable  health, 
her  menses  being  reestablished.     She  is  confined  at  the  age  of  thirty-six  years 
After  the  fourth  day,  the  mid-wife  having  left  her,  she  becomes  alarmed    and 
is  much  chagrined.     The  milk  is  suppressed,  she  is  unwilling  to  eat,  and  be- 
comes furious.     Her  tongue  is  paralized.     The  menses  reappear  at  the  expi- 
ration  of  two  months,  and  the  patient  sinks  into  a  profound  melancholy,  wish- 
in<T  to  remain  constantly  in  bed.     If  she  rises,  she  remains  en  chemise,  without 
Clothincr      She  eats  reluctantly,  sometimes  cries  out,  and  becomes  angry  with- 
out cau°se,  and  when  she  is  desired  to  change  her  linen,  or  to  eat ;  to  lie  down, 
or  to  rise  up ;  flies  into  a  passion  and  strikes.     Nothing  can  induce  her  to 
speak  when  she  does  not  choose  to.     She  sometimes  comes  to  a  sense  ot  her 
condition,  and  exceedingly  regrets  her  extravagances.     The  menses  have  been 
at  all  times  reaular  and  abundant ;  constipation  obstinate.     At  the  time  of  her 
admission  at  the  hospital,  the  melancholy  having  persisted  for  five  years,  her 
complexion  was  pale,  her  features  shrunken,  her  hair  and  eyes  black.     She 
has  also  strabismus.     She  leaves  her  bed  with  great  reluctance.     She  passes 
several   days  also  without  eating.     Her  hair,  which  had  not  been  combed  for 
five  months,  was  tangled,  as  if  matted  and  felted,  and  presented  no  traces  of 
vermin  nor  their  eggs.     It  was  very  clean,  and  a  quantity    amounting  to  fif- 
teen ounces,  was  cut  off.     Care  was  taken  to  cover  the  head  with  wool.     Dec 
5th      To-day  apoplectic  symptoms  were   present.     {Sinajnsm,  vesicatory,  and 
a  strengthening  potioi^.     6th.     She  has  spoken  some  words  m  a  low  tone^ 
There  is  prostration  of  the  vital  forces,  and  paralysis  of  the  left  limbs,  with 
diminution   of  sensibility.      8th.     ( Vcsicatories   to   the  thighs).      Dejections 
which  have  persisted  for  many  days.     The  patient  offers  some  appearance  of 
reason      {Arnica).     24th.     Same   state,  obstinately  refuses  food.     Jan.  12th 
181-'>   '  Unnatural   freedom  of  the  bowels  ceases.     The  patient  refuses  food 
for   about  eight  days,  or  rather,  takes  but  a  few  spoonfuls  of  sugared  wme. 
The  vital  forces  became  progressively  extinct,  and  death  takes  place,  January 

"^^^Autop^V  iwenty-four  hours  after  death.     Hair  black;    cranium  hardened 
and  unequally  thick;  median  fine  distorted ;  vessels  of  the  pia-mater  inject- 
ed •  brain  soft ;  white  substance  injected ;  depression  of   the  convolutions  o 
the'  brain,  corresponding  with  the  suture  formed  by  the  junction  of  the  coronal 
and  parietal  bones  of  the  right  side,  near  the  median  line      In  this  place,  the 
nia-mater  was  much  thickened,  and  contained  serum.      The  lateral  ventricles 
are  contracted  on  every  side ;  their  membrane  adheres  posteriorly  to  a  great  ex- 
tent, contains  serum,  and  is  injected,  as  well   as  the  ch(>roid  membrane.     The 
heart  is  enlarged,  flaccid   and  full  of  black  blood.     The  liver  is  granulated 
and  brown,  and  the  gall  bladder  distended  with  bile  of  a  deep  brown  color 
and  very  thick.     The  left  extremity  of  the  transverse  colon  has  descended 
into  the  pelvic  cavity.     The  omentum  is  very  fat,  the  stomach  very  much  re- 
tracted and  interspersed  with  deep  folds.     The  intestines  also,  are  contracted 
in  some  parts,  and  the  mucous  membrane  is  red,  brown,   and  sphacelated. 
We  observe  some  fibro-cartilaginous  parts  in  the  proper  membrane  of  the  ute- 
rus, and  the  bladder  is  contracted,  very  much  thickened,  and  its  mucous  mem- 
brane very  red. 

Case  IX  —Those  pupils  who  attended  my  clinical  lectures  on  mental  alien- 
ation,\aw  at  the  Salpetriere,  a  young  woman  who  was  confined  Sept.  25th, 


OF      THE      RECENTLY      CONFINED.  139 

1818,  and  who  experienced  so  serious  a  disappointment,  at  not  having  given 
birth  to  a  boy,  that  she  was  taken  with  delirium  on  the  first  day  of  her  con- 
finement, and  became  a  maniac  on  the  third.  The  delirium  and  fijry  persist- 
ed fijr  six  weeks,  aft;er  which,  she  was  alternately,  calm  and  excited.  This 
woman  was  brought  to  the  hospital,  Dec.  7th.  On  the  11th  an  enormous  de- 
posit took  place  in  the  right  groin.  The  delirium  persisted,  but  the  calm  was 
perfect.  The  abscess  opened  spontaneously,  towards  the  end  of  the  month. 
The  delirium  immediately  began  to  decrease.  The  patient  began  to  conva- 
lesce Jan.  15th,  and  was  restored  to  her  family  on  the  8th  Feb.  following,  four 
months  and  a  half  after  her  confinement 

Case  X. — L.,  nineteen  years  of  age,  is  happily  confined  Jan.  19th,  1819. 
She  exposes  herself  to  the  cold  air,  and  becomes  delirious  on  the  first  day 
after  confinement.  The  infant  cannot  nurse,  because  the  nipple  is  not  form- 
ed ;  notwithstanding  the  milk  is  very  abundant.  The  delirium  increases. 
The  patient  strikes  her  breasts  and  is  unwilling  to  be  clothed.  The  third  day 
the  lochia  are  suppressed,  and  on  the  day  following,  leeches  are  applied  to  the 
vulva.  Overcome  by  the  heat,  she  rises  from  her  bed,  washes  her  hands,  and 
drinks  cool  water.  The  delirium  is  violent,  and  the  breasts  very  much  dis- 
tended with  milk.  They  apply  leeches  behind  the  ears,  sinapisms  to  the  feet, 
and  prescribe  an  ethereal  potion.  One  month  after  her  confinement,  this 
woman  was  brought  to  La  Charite,  from  whence  four  days  subsequently,  she 
was  transferred  to  the  Salpetriere,  March  1st,  1819.  At  the  period  of  her 
admission,  the  patient  presents  the  following  symptoms  ;  face  flushed,  features 
shrunken,  the  breasts  voluminous,  resistent,  and  painful, — general  delirium. 
She  refuses  to  be  clothed,  has  a  feeling  of  fear,  cries  aloud,  is  abusive  in  her 
languaore,  and  suffers  from  nervous  agitation.  March  loth,  the  right  breast 
is  enormously  distended,  the  skin  livid  and  violaceous,  and  fluctuation  is  per- 
ceptible. It  is  impossible  to  keep  upon  it  the  least  covering.  Some  days 
after,  the  surgeon-in-chief  of  the  hospital  opens  the  abscess.  From  that  mo- 
ment, the  patient  more  readily  admits  the  application  of  dressings.  She  is 
more  composed,  and  is  more  attentive  to  what  is  passing  around  her.  The 
delirium,  however,  persists,  and  suppuration  is  very  abundant.  At  the  begin- 
ning of  the  month  of  May,  a  laxative  potion,  continued  for  some  days,  pro- 
vokes copious  dejections.  ISth.  Although  there  is  still  delirium,  the  patient 
sees  her  husband.  From  this  time  the  progress  towards  reason  was  percepti- 
ble. The  wounds  cicatrize,  which  are  successively  formed,  upon  the  right 
breast.  We  regarded  her  convalescence  as  confirmed  from  the  20th  of  the 
month  of  May,  and  on  the  27th  she  was  restored  to  her  family,  enjoying  per- 
fectly the  use  of  her  reason,  four  months  after  her  confinement. 

Case  XI. — Mad'lle  M.,  of  medium  height  and  nervous  temperament,  having 
black  eyes,  and  a  dark  complexion,  was  still  at  that  age  when  young  people 
know  of  love,  only  by  what  they  read  of  it  in  romances,  when  her  mother  ac- 
companied her  to  a  ball.  A  voung  man,  with  whom  she  was  unac([uainted, 
pays  his  respects  to  her.  She  immediately  experiences  a  singular  and  painful 
internal  commotion.  Some  days  afterwards,  she  experiences  the  same  impres- 
sion. Notwithstanding,  this  young  man  is  respectable,  and  unites  in  himself 
all  those  qualities  that  can  flatter  a  young  person,  Vvhose  affections  are  not 
already  engaged.  He  speaks  of  marriage,  but  she  experiences  an  insuperable 
aversion  to  this  proposition,  without  being  able  to  offer  a  reason  for  her  repug- 
nance. Her  parents  insist,  and  she  consents.  But  every  time  that  she  sees 
him  to  whom  she  is  betrothed,  she  feels  a  painful  internal  sensation,  whilst, 
during  his  absence,  she  believes  she  loves  him,  whose  presence  produces  upon 
her  an  effect  so  strange.  At  length  she  marries.  The  first  months  of  mar- 
ried  life  are  the  occasion  of  great  suffering  to  her,  without  exciting  any  sus- 


140  MENTAL      ALIENATION 

picion  of  the  fact  on  the  part  of  her  husband.  She  loves  him,  yet  his  pre- 
sence makes  her  ill.  She  becomes  the  mother  of  two  children,  whom  she 
nurses,  and  cares  for,  with  the  utmost  maternal  tenderness.  She  weaned  the 
second,  during  the  absence  of  her  husband  on  a  voyage.  She  becomes  un- 
easy on  account  of  his  absence,  and  weans  her  child  without  the  least  precau- 
tion. From  uneasiness,  she  passes  to  melancholy  and  sadness.  Her  friends 
desire  to  soothe  her,  and  direct  her  mind  to  the  consolations  of  religion.  Her 
tender  and  devoted  spirit  imposes  upon  itself  privations,  and  she  offers  prayers, 
which  are  prolonged  into  the  night.  She  abandons  her  ordinary  occupations, 
refuses  every  kind  of  exercise,  and  eats  nothing.  At  length,  delirium  ap- 
pears. She  looks  upon  her  children  without  satisfaction.  She  is  often 
tempted  to  destroy  them,  in  order  to  preserve  them  from  the  extreme  misfortune 
into  which  she  believes  they  have  been  plunged  by  the  abandonment  of  her  hus- 
band. She  has  lost  much  flesh,  and  her  complexion  becomes  sallow.  There 
is  loss  of  rest  and  constipation,  but  the  menses  recur  at  regular  intervals. 

After  six  months'  absence,  she  receives  her  husband  with  coldness.  The 
lypemania  increases.  She  many  times  recommends  that  they  withdraw  her 
children,  and  that  they  do  not  bring  them  to  her  without  some  special  purpose. 
The  voice  of  her  children,  or  their  noise  in  an  adjoining  room,  produces  a 
state  of  suffering  and  agony,  which  is  clearly  depicted  upon  her  countenance. 
Her  husband  on  one  occasion,  brings  her  children  into  her  presence.  She 
becomes  pale,  shudders,  and  comes  near  falling  into  a  swoon.  Another  time, 
she  pretends  to  embrace,  with  a  view  to  stifle  them.  At  the  expirajion  of  a 
year,  she  is  committed  to  my  care.  She  is  very  much  emaciated,  has  a  sal- 
low tincre,  and  her  eyes  are  fixed  and  convulsive,  as  well  as  the  features  of 
her  countenance.  The  skin  is  dry  and  arid,  and  of  a  burning  heat.  The 
pulse  is  feeble  and  frequent.  She  refuses  nourishment,  and  respiration  is  dif- 
ficult. She  is  sad,  refusing  all  kinds  of  exercise,  and  every  mode  of  diver- 
sion. She  does  not  speak,  but  weeps  much.  She  is  often  impatient  when 
any  one  discourses  with  her  respecting  her  condition,  especially  when  offered 
any  hope  of  a  cure,  which  she  regards  as  impossible.  She  demands  to  be 
shut  up  in  a  hospital,  and  takes  all  the  remedies  that  are  prescribed  for  her. 
After  eight  months  of  isolation,  during  which,  nothing  could  withdraw  the 
patient  from  her  despair,  nor  cause  a  thought  for  her  husband  or  children  to 
spring  up  in  her  breast,  after  having  exhausted  means  the  most  varied,  I  order 
a  vesicatory  to  be  applied  to  her  left  arm.  Until  this  period,  I  had  not  thought 
its  employment  advisable,  in  consequence  of  the  emaciation  and  irritability  of 
the  patient.  On  the  following  day,  the  vesicatory  assumes  an  erysipelatous 
aspect.  The  arm  swells,  and  discharges  a  thick  and  whitish  fluid,  very  abun- 
dant and  fcetid.  At  the  end  of  a  month,  she  is  less  sad,  and  less  averse  to 
consolations  and  diversions.  On  first  seeing  her  husband,  she  seemed  to  be 
indifferent,  but  shortly  manifested  pleasure  ;  and  was  at  length  restored  to  her 
family,  after  an  illness  of  two  years.  She  hears  her  children  spoken  of  with- 
out dread,  but  is  still  unwilling  to  see  them,  distrusting  herself,  she  says. 
But  she  oversees  her  household  affairs,  goes  into  society,  occupies  herself,  and 
continues  to  improve.  It  is  not  until  the  expiration  of  six  months  more,  that 
she  desires  to  have  her  children  with  her,  and  to  direct  their  education  ; — a 
duty,  of  which  she  acquits  herself,  with  all  the  tenderness,  that  she  had  la- 
vished upon  them  previous  to  her  illness. 

Case  XH. — C.  was  born  in  the  country,  labored  in  the  fields,  and  married 
a  brutal  husband.  At  twenty-six  years  of  age,  she  becomes  pregnant.  She 
is  attacked  with  psora,  and  her  husband  causes  her  every  species  of  mortifica- 
tion. Nevertheless,  she  is  confined  ;  but  two  hours  thereafter  is  beaten  and 
mal-treated  by  her  husband,  who  throws  a  bucketful  of  cold  water  upon  her 
body.     The  same  day  mania  bursts  forth,  attended  with  fury.     The  lochia 


OF      THE      RECENTLY      CONFINED.  141 

are  suppressed,  and  the  menses  do  not  appear.  All  the  means  employed  for 
the  cure  of  this  unhappy  person  prove  fruitless.  A  maniac  and  furious  for 
four  years,  she  is  at  this  time  in  a  state  of  dementia. 

Case  XIII.— Mad'lle  B.,  twenty-five  years  of  age,  (descended  from  a  father, 
subject  to  cephalalgia,  which  he  was   accustomed  to  relieve  by  the  applica- 
tion of  ice  to  the  head),  is  endowed  with  a  peculiarly  nervous  temperament,  a 
crlowin<T  imagination,  and  a  lively  and  sensitive  disposition.     The  culture  of 
fetters  and  the  arts,  which  constituted  the   basis  of  her  education,  by  accord- 
ing with  her  native  tendencies,  contributed  to  the  irregularity  of  her  passions. 
At  the  acre  of  twenty-four  years,  she  formed  a  prudential  matrimonial  connec- 
tion.    Her  husband  entered  the  army.     Mad'lle  B.  committed  certain  impro- 
prieties, and  is  severely  censured  by  her  relatives  and  friends.     A  young  man, 
of  an  agreeable  exterior,  was  prodigal  of  his  attentions  to  her.     She  becomes 
enamored,  and  after  a  struggle  of  some  weeks,  deserts  the  house  of  her  hus- 
band, and  retires  to  that  of  her  lover,  where  she  experiences  mortifications  of 
every  kind.     She  becomes  pregnant.     Her  pregnancy  is  disturbed  by  disquiet- 
udes, by  jealousy,  by  the  desire  to  please  her  lover,  by  the  fear  of  a  severe  ill- 
ness,' in  fine,  by  the  most  painful  regrets.     Nevertheless  her  confinement  is  a 
happy  one.  '  On  the  day  but  one  succeeding  this  event,  she  sprinkles  her  bed 
and  chamber  with  odoriferous  waters,  and  walks  about  on  her  naked  feet,  not- 
withstanding the  cold.     From  the  third  day  her  actions  were  irrational.     On 
the  eighth,  she  has  affectionate  interviews  with  her  lover.     On  the  nmth,  she 
overturns  every  thing  in  the  house,  and  sports  with  her  lover  as  if  he  were  a 
child.     Little  milk  is  secreted  for  her  infant.     On  the  fourteenth  day  after  her 
confinement,  she  is  brought  to  a  hospital, — a  circumstance  that  makes  a  very 
stroncT   impression   upon  her  mind.     Her  reason   is  altogether  lost.     She  de- 
stroys every  thing,  and  becomes  furious.     The  constant  attentions  which  she 
pays  her  child,  are  more  injurious  than  useful,  both  to  the  one  and  the  other. 
She  passes  twenty-fours  hours  perfectly  naked,  concealed  under  a  stair-case. 
On  the  twentieth  day  of  her  illness,  March  11th,  1800,  the  patient  is  com- 
mitted to  my  care.     Her  countenance  is  pale,  eyes  haggard,  the  tone  of  her 
voice  harsh  and  elevated,  breath  fetid,  breasts  flaccid,  and  her  agitation  con- 
tinual     Her  desires  are  strange.     She  is  loquacious,  makes  obscene  remarks, 
and  has  an  irresistible   propensity  to  tear.     She  is  slightly  warm  and  moist, 
and  has  no  uneasiness  respecting  her  child. 

On  the  twenty-first  day  after  her  confinement  and  sickness,  she  takes  a  bath, 
a  purcrative  enema,  and  a  soothing  drink.     On  the  twenty-second  day,  she  has 
a  shiv^ering  fit,  agitation,  hatred  of  certain  persons,  cries,  complaints,  an  habi- 
tual state  of  opposition,  painful  reveries,  fear,  panic  terrors,  dread  ot  poison 
and  of  death.     She  has  also,  no  connected  ideas.     On  the  twenty-third  day, 
the  child  dies,  without  occasioning  any  grief  on  the  part  of  the  patient.      1  he 
lochia  do  not  cease.     On  the  twenty-eighth  day,  the  menses  appear  and  con- 
tinue until  the  thirty-third.     Since  then,  there  has  been  composure  with  sleep, 
but  delirium.     On  the  thirty-ninth  day,  there  is  a  return  of  reason.     Her  lover 
visits  her,  and  she  is  agitated  from  that  day  forward.     On  the  forty-eighth  day 
of  the  attack  of  the  malady,  she  is  composed,  and  is  again  visited  by  her  lover. 
This  is  followed   by  agitation,   and  insomnia.     The  patient  experiences  the 
greatest  excitement.     The  delirium  is  at  its  height.     She  converses  with  her 
lover  though  he  is  absent.     She  thinks  he  is  in  the  walls,  in  her  chamber,  and 
even 'in  her  bed.     Often,  during  the  day,  she  takes  the  clouds  for  balloons,  and 
calls  aloud  upon  Garnerin  the  feronaut,  to  make  with  her  a  journey  to  the 
moon.     She  calls  for  her  husband,  father  and  mother,— tears  every  thing,  and 
is  often  naked.     She  is  loquacious,  laughs  loudly,  and  does  not  rest.     During 
this  period,  she  takes  the  whey  of  Weiss  every  day,  which  is  followed  by  mo- 


142  MENTAL      ALIENATION 

derate  evacuations.  On  the  sixty-first  day  her  menses  return  again,  but  cease  on 
the  followiag  day.  On  the  sixty-seventh  day,  she  takes  a  cold  bath  and  douche. 
From  the  former  she  makes  violent  efforts  to  esca^je,  and  on  leaving  it, 
suffers  from  extreme  prostration,  a  general  trembling,  and  an  enfeebled  voice. 
A  half-hour  afterwards,  the  patient  desires  to  leave  her  bed,  and  take  food. 
The  same  treatment  is  continued  until  May  third,  when  the  bath  is  suspended, 
in  consequence  of  the  appearance  of  the  menses. 

On  the  seventy-fourth  day,  May  10th,  the  menses  cease.  On  the  seventy- 
fifth  day,  there  is  composure,  unmeaning  gestures,  and  taciturnity.  Seventy- 
sixth  day,  the  tepid  bath  and  douche.  Seventy-seventh  day,  composure,  sleep. 
Eightieth  day,  the  douche  again  employed.  She  obstinately  refuses  to  dress 
herself  Eighty-second  day,  she  enjoys  some  hours  of  reason.  Eighty-third 
day,  some  stains  of  a  hemorrhoidal  flux.  From  the  eighty-fourth  to  the  nine- 
ty-fourth day,  composure,  but  little  sleep.  On  the  ninety-sixth  day  of  the  dis- 
ease, June  2d,  a  hemorrhoidal  flux.  3d.  Agitation,  extreme  mobility,  ob- 
scene discourse,  cries,  declamation.  5th.  Douche  repeated.  9th.  Vora- 
cious appetite.  11th.  Menses  appear,  during  which,  the  patient  is  extremely 
agitated,  is  passionate,  and  contradicts  every  thing.  16th.  Cessation  of  the 
menses.  19th.  Tears  ;  she  becomes  conscious  of  her  condition,  and  is  desi- 
rous to  be  restored.  39th.  Composure,  tears,  sleep.  On  the  one  hundred 
and  twenty-fifth  day,  July  1st,  she  suffers  from  hysterical  syncope.  4th.  Calm, 
and  rational  ;  nevertheless  the  patient  destroys  every  thing  within  her  reach, 
and  abuses  those  who  serve  her.  tJth.  Progressive  return  of  reason,  hysteri- 
cal syncopes.  Visit  of  her  lover.  8th.  Syncope;  febrile  movement,  pre- 
ceded by  rigors,  l^th.  Fever  continued,  presenting  the  symptoms  of  ca- 
tarrhal fever,  with  evening  paroxysms,  and  frequent  attacks  of  hysterical  syn- 
copes,— progressive  return  of  reason.  13th.  Appearance  of  the  menses, 
which  flow  abundantly,  and  cease  on  the  15th.  Fever  continues.  Notwith- 
standing, the  patient  is  not  irrational,  tears  nothing,  and  eats  moderately.  We 
converse  with  her  about  her  affairs,  and  her  situation  with  respect  to  her  hus- 
band- 21st.  Returns  to  the  house  of  her  lover,  where  she  has  an  attack  of 
colic,  and  faints.  24th.  Urine  abundant — depositing  a  whitish  sediment. 
From  the  8th,  the  period  of  the  invasion  of  the  fever,  we  had  recourse  to  a 
strencrtheninw  reoimen,  light  tonics  and  exercise.  26th.  The  fever  which 
presented  all  the  characteristics  of  a  continued  catarrhal  fever,  became  a  ter- 
tian intermittent,  and  persisted  all  the  autumn,  and  a  part  of  the  winter.  In 
the  spring  following,  the  fever  ceases,  the  patient  gains  flesh  rapidly,  and  re- 
covers her  gayety  and  ordinary  vivacity.  Since  that  period,  she  has  obtained 
a  divorce,  married  her  lover,  and  become  the  mother  of  two  children,  whom 
she  has  nourished  and  educated  with  the  greatest  care.  She  subsequently 
met  with  the  greatest  misfortunes,  and  experienced  domestic  trials,  without 
suffering  in  the  least  from  aberration  of  mind. 

Case  XIV. — N.,  thirty-one  years  of  age,  having  always  enjoyed  excellent 
health,  two  months  after  her  confinement,  experienced  a  most  trying  mortifi- 
cation, in  consequence  of  which,  she  became  insane.  At  the  moment  of  her 
admission  at  the  Salpetriere,  her  countenance  is  animated,  her  eyes  sparkling, 
her  skin  moist.  The  patient  passes  alternately,  from  cries  and  vociferations, 
from  extreme  agitation  and  loquacity,  to  repose  and  the  most  obstinate  silence. 
She  walks  about  at  a  rapid  pace,  pouring  forth  abuse,  when  suddenly  she  stops, 
becomes  motionless,  her  eyes  fixed,  absorbed  and  indifferent  to  surrounding 
objects.  Thus  she  passes  her  days  and  nights,  without  sleep  or  repose.  This 
delirium  continues  for  five  months.  She  speaks  simply  in  a  low  voice,  and 
makes  mysterious  signs.  Suddenly  she  utters  a  piercing  cry,  thinking  that 
she  recognizes  the  persons  who  surround  her,  and  becomes  furious  towards 


OF      THE      RECENTLY      CONFINED.  143 

them.  Not  far  from  the  middle  of  the  fifth  month,  her  countenance  becomes 
sallow,  brown,  and  afterwards  of  an  earthy  hue.  Her  death  takes  place  Oct. 
6th,  1815,  six  months  after  her  confinement. 

Autopsy.  Cranium  thick  and  hardened;  meninges  and  brain  healthy. 
Thoracic  viscera  in  their  normal  state.  Sero-purulent  liquid  in  the  peritoneal 
cavity.  Peritoneum  thickened,  greyish  through  its  whole  extent,  and  coated 
with  a  yellowish,  albuminous  covering.  Mucous  membrane  of  the  alimen- 
tary canal,  healthy  and  coated  with  a  yellowish  mucus.  Liver  soft,  and  easily 
torn. 

Case  XV.— M.  J.  B.,  twenty-eight  years  of  age,  is  the  off'spring  of  a  mo- 
ther, who,  when  forty-eight  years  of  age,  suffered  from  a  slight  attack  of  apo- 
plexy. When  nine  years  old,  she  has  the  small  pox.  From  seventeen  to 
eighteen  years  of  age,  she  is  subject  to  violent  attacks  of  cephalalgia,  which 
disappear  after  the  first  appearance  of  the  menses.  At  twenty-eight  years  of 
age,  she  is  happily  confined.  She  experiences  many  trials,  and  her  lover 
abandons  her.  Six  days  after  her  confinement,  delirium  bursts  forth.  On 
the  ninth  day,  she  is  admitted  at  the  Salpetriere.  At  the  time  of  her  arrival, 
she  is  very  much  agitated,  has  hallucinations  of  hearing,  mysterious  voices 
commanding  her  to  injure  persons  by  whom  she  is  surrounded.  She  believes 
herself  in  society,  and  affirms  that  she  has  never  suffered  from  head-aches, 
but  experiences  acute  pains  in  the  limbs.  No  lochia.  A  large  vesicatory  is 
applied  to  the  back,  prolonged  tepid  baths  are  administered,  and  at  first  cool- 
ing, then  laxative  drinks.  After  some  days,  the  delirium  diminishes,  and 
the'menses  are  established.  Convalescence  is  protracted.  The  patient  her- 
self demands  that  the  vesicatory  should  be  continued.  Reason  is  soon  estab- 
lished, and  she  goes  from  the  hospital  restored,  after  the  second  return  of  the 
menses. 


EPILEPSY. 


Synonyms  and  symptoms. — Medium  duration  and  frequency  of  attacks. — Lunar  influ 
ences. — Notices  of  the  leading  mental  peculiarities  in  339  cases  of  Epilepsy. — Verti- 
goes epileptic,  their  effect  upon  the  mind. — Pathognomonic  characteristics  of  Epilepsy. 
— Causes. — Organs  upon  which  they  primarily  act. — Analysis  of  post-mortem  examina- 
tions.— Diagnosis. — Divisions  and  subdivisions. — Feigned  epilepsy. — Prognosis. — Re- 
marks preliminary  to  the  details  of  treatment. — Attacks  often  lessened  temporarily  in 
frequency  by  a  change  of  remedies. — Treatment,  with  a  notice  of  numerous  remedies 
employed  in  ancient  and  modern  practice,  with  their  effects. — Fear  as  a  curative  agent. 
— Hygienic  influences. — Traveling. — Music. — Moral  influences. 

The  symptoms  of  epilepsy  are  so  extraordinary,  so  entirely  beyond  the 
reach  of  any  physiological  explanation,  and  its  organic  causes  so  entirely  un- 
known, that  the  ancients  believed  it  to  depend  upon  the  wrath  of  the  gods. 
Although  Hippocrates  may  have  combated  this  prejudice,  he  has  preserved 
for  it  the  appellation  of  the  sacred  disease.  Areteus  calls  it  3Ial  d'Hercule. 
It  is  the  7uorbus  comitialis  of  Pliny  ;  the  morbus  sacer  ct  major  of  Celsus  ;  the 
morbus  sonticus  of  Aldus  Gelliits  ;  and  the  morbus  caducus  of  Paracelsus. 
The  sacred  writers  denominate  those  who  suffer  from  this  malady,  lunatics. 
Epilepsy,  which  is  confounded  with  eclampsia  by  many  moderns,  is  designat- 
ed in  France,  by  the  names,  mal-caduc,  haut-mcd,  mat  de  terre,  mal  de  saint 
Jean,  mal  des  enfans.  In  the  west  of  France,  epileptics  are  called  tombeurs. 
The  first  intimation  of  an  epileptic  attack,  is  usually  a  cry  from  the  patient, 
who  immediately  falls  and  suffers  from  convulsions  of  every  grade  of  intensi- 
ty, from  slight  convulsive  movements,  to  those  of  the  most  violent  and  terrific 
character.  Consciousness  is  entirely  suspended.  The  hair  stands  on  end, 
the  brow  is  knit,  the  eye-brows  are  depressed  and  drawn  nearer  together,  the 
eyes  project,  and  are  haggard  or  crossed.  The  eyelids  sometimes  open  and 
shut  very  rapidly  for  some  minutes,  leaving  exposed  and  fixed,  the  inferior 
portion  of  the  globe  of  the  eye.  In  other  cases,  the  eyelids  remain  open,  and 
the  eyes,  strongly  injected,  seem  to  start  from  the  orbit,  and  move  convulsive- 
ly. The  face  is  bloated  and  flushed,  livid  and  ecchymosed.  The  muscles  of 
the  face  produce  hideous  grimaces,  the  lips  are  prolonged,  project  or  extend 
towards  the  ears,  and  are  covered  with  a  frothy  saliva.  The  lower  jaw  is  fix- 
ed in  contact  with  the  superior  one,  or  is  extended  even  to  luxation.  The 
tongue  is  lengthened,  swollen,  and  projects  from  the  mouth  ;  is  seized,  bruised, 
torn,  and  cut  between  the  teeth,  the  grinding  of  which  is  so  violent,  that  they 
are  sometimes  broken  with  a  loud  noise.  The  voice  consists  merely  of  groans 
and  sighs,  similar  to  that  of  a  person  strangling.     Sometimes  epileptics  utter 

19 


146  EPILEPSY. 

howls,  more  or  less  prolonged  and  frightful.  There  are  some,  who  utter 
words  without  connection,  extravagant  and  strange,  which  knaves  have  caus- 
ed to  pass,  and  simple  people  have  taken,  for  the  inspirations  of  demons. 

The  vessels  of  the  head  are  so  much  distended,  and  the  carotids  beat  with 
such  force,  that  they  seem  ready  to  burst.  The  whole  head  executes  rotatory 
movements,  is  carried  to  the  right  or  left,  or  from  before  backward.  Some- 
times it  is  fixed  in  one  or  the  other  of  these  attitudes,  or  is  thrown  backward. 
The  neck  is  rigid,  and  this  fixedness  or  rigidity,  cannot  be  surmounted  by  the 
greatest  efforts.  The  trunk  suddenly  prostrated,  now  upon  the  back,  and  now 
upon  the  abdomen,  raises  itself  only  to  fall  again.  It  turns  itself  in  various 
directions,  bends  itself,  rolls  upon  the  ground,  or  reposes  in  a  true  tetanic 
condition.  The  arms,  hands  and  fingers,  the  thighs,  legs,  feet  and  toes,  par- 
ticipate in  this  state.  The  flexure  of  the  thumb  is  so  common,  that  it  has 
been  regarded  as  a  sign  of  epilepsy. 

The  muscles  of  organic  life  are  not  indifferent  to  this  scene  of  sufTerinff 
and  terror.  The  pulse,  at  first  small,  is  developed,  becomes  frequent,  hard, 
unequal,  and  sometimes  stops.  Respiration  is  slow  or  hurried,  convulsive  or 
stertorous.  Eructations,  borborygmi  and  vomiting,  the  involuntary  emission 
of  urine,  semen  and  feces,  the  perspiration  which  bursts  from  every  pore,  the 
blood,  which  starts  from  the  nose,  eyes  and  ears,  all  indicate  the  violent  state 
of  the  organism.  Sensibility  seems  extinct,  so  utterly  impossible  is  it  to 
arouse  the  patient  by  whatever  means  we  employ.  But  when  the  vital  princi- 
ple seems  to  be  yielding  to  so  much  violence,  and  the  patient  about  to  suffo- 
cate, the  muscles  relax,  respiration  becomes  more  easy,  the  pulse  slackens  or 
is  developed,  sensibility  is  restored,  the  convulsions  diminish,  the  physiogno- 
my assumes  its  ordinary  appearance,  the  mind  begins  to  return,  the  eyes  that 
have  been  weighed  down,  open,  and  the  look  is  one  of  astonishment.  The 
limbs,  fatigued  and  painful,  need  repose.  Some  epileptics  after  a  sleep  of 
longer  or  shorter  duration,  recover  their  energy.  Others,  after  a  long,  coma- 
tose sleep,  awake,  and  remain  pale,  languid  and  feeble  for  some  hours,  and 
even  days.  Immediately  after  the  attack,  and  before  recovering  their  senses, 
both  the  one  class  and  the  other,  are  affected  with  carphologia.  The  exercise 
of  thought  is  immediately  established  with  the  former  ;  with  the  latter,  it  be- 
comes free,  only  after  some  hours,  or  days. 

No  epileptic  preserves  a  recollection  of  what  he  has  experienced,  nor  has 
the  least  knowledge  of  it.  All  are  sad  after  the  attack,  as  if  ashamed,  and 
are  exceedingly  susceptible.  Epileptic  attacks  are  not  always  so  formidable. 
The  convulsions  are  not  always  general.  There  are  persons  who  have  only 
the  premonitory  symptoms  of  an  attack.  Others,  experience  only  the  earlier 
symptoms,  which  cease  promptly.  Sometimes,  it  is  only  a  stunning  sensation, 
a  general  shivering,  followed  by  rigidity,  or  rather,  a  simple  convulsive  move- 
ment of  a  limb,  the  head  or  lips,  with  a  momentary  privation  of  thought.  I 
have  been  consulted  in  behalf  of  a  young  lady,  whose  father  is  epileptic,  who 
is  seized  with  her  attacks,  in  the  midst  of  a  company,  while  walking,  or  on 
horseback.  She  does  not  fall,  but  her  eyes  are  convulsed,  and  her  looks 
fixed.  The  attack  lasts  but  a  few  seconds,  and  the  patient  resumes  the  con- 
versation at  the  phrase  where  she  left  off"  speaking,  without  suspecting  that 
any  thing  has  happened  to  her,  and  unless  she  had  uttered  a  cry,  no  one 
would  have  observed  what  had  passed.  With  the  progress  of  age,  the  attacks 
become  more  complete.  Poupart*  cites  a  similar  case.  Some  epileptics 
merely  shake  the  head,  arms  or  legs;  others  only  close  the  hands;  some 
run,  and  others  turn  round  and  round. 

Doctor  Esparron  recognized  an  attack  of  epilepsy,  by  a  simple  convulsive 
movement  of  the  lips.     The  convulsions  merely,  of  the  eyes  and  thorax  ena- 

*  Memoirs  of  the  Royal  Academy  of  Sciences ;  1705. 


EPILEPSY.  147 

bled  Pechlin  to  ascertain  the  same  fact.  These  attacks,  which  may  be  mista- 
ken, serve  as  a  prelude  to  those,  which  by  degrees,  or  with  age,  become  com- 
plete, or  rather  intercalate  with  complete  attacks,  which  leave  no  doubt  re- 
specting the  nature  both  of  the  one  and  the  other.  This  is  epileptic  vertigo. 
Among  infants,  the  attacks  are  less  violent,  and  may  be  confounded  with  or- 
dinary convulsions.  Children  have  vertigoes,  and  their  limbs  totter.  Perspi- 
ration breaks  out  upon  the  face,  which  becomes  red  and  bluish  ;  the  eyes 
converge,  and  are  fixed  towards  the  root  of  the  nose  ;  the  convulsions  are 
general  or  partial,  and  the  jaws  are  set,  or  the  lips  covered  with  froth.  When 
the  attack  has  been  light,  children  retain  a  stupid  expression,  are  somnolent, 
complain  of  the  head,  and  lift  the  hand  to  it.  They  are  unwilling  to  nurse. 
If  the  attack  has  been  violent,  they  fall  into  a  profound  sleep,  from  which 
they  awake  in  a  stupid  condition.  There  are  cases,  in  which  attacks  occur 
suddenly  and  without  any  premonition,  particularly  in  constitutional    epilepsy. 

There  are  others,  which  are  announced  by  divers  accidental  circumstances, 
especially  in  sympathetic  epilepsy.  They  are  almost  always  foreseen,  before 
the  loss  of  consciousness  takes  place.  Epileptic  persons  experience  convul- 
sive movements  and  acute  pains.  They  experience  a  sensation  of  cold,  a 
vapor  [aura  cpileptica),  in  the  head  or  face  ;  in  one  of  the  arms  or  hands  ; 
in  the  thighs,  legs  or  toes ;  in  the  chest,  stomach  or  uterus.  These  various 
sensations  are  propagated  like  a  vapor,  along  the  limbs,  trunk  and  neck,  to- 
wards the  head,  and  when  it  reaches  the  brain,  the  attack  bursts  forth.  Epi- 
leptics profit  by  these  presentiments,  in  order  to  guard  themselves  against 
grave  accidents,  which  might  result  from  a  fall.  It  is  at  this  time  that  liga- 
tures are  to  be  applied,  that  some  physicians  have  advised  the  extension  of  the 
limbs,  walking  about,  and  the  inhalation  of  some  substances,  strongly  aroma- 
tic or  stimulant.  The  redness  at  the  root  of  the  nose,  the  turgescence  of  the 
veins  of  the  neck,  the  throbbing  of  the  temporal  arteries,  the  discoloration  of 
the  face,  vertigoes,  supineness,  ringing  in  the  ears,  frightful  reveries,  palpita- 
tions and  the  flow  of  tears,  are  the  precursory  signs  of  angiotenic  or  plethoric 
epilepsy.  Some,  previous  to  the  attacks,  smell  disagreeable  odors  ;  others 
have  a  repugnance  to  food,  which,  together  with  vomitings,  borborygmi  and 
involuntary  dejections,  presage  gastric  epilepsy.  Some  are  more  irritable  and 
choleric,  and  in  other  cases,  the  intellectual  faculties  are  exalted  on  the  day 
previous  to,  as  well  as  on  that  of  the  attack.  Immediately  before  the  attack, 
says  Areteus,  some  epileptics  think  they  see  a  shining  light,  of  a  purple  or 
dark  color  ;  others  hear  a  sound,  as  if  some  one  was  striking  a  resisting  body 
with  a  stone  or  club.  There  are  those  who  have  hallucinations.  We  have  at 
the  Salpetriere  one  epileptic,  who  turns  round  and  round  for  some  minutes, 
and  another,  who  runs  with  all  her  might  until  she  falls.  Nothing  can  stop 
them. 

The  condition  of  an  epileptic,  forewarned  by  internal  sensations,  of  an  at- 
tack more  or  less  immediate,  is  so  painful  and  trying  to  many  of  this  class, 
that  they  anxiously  desire  that  it  should  occur  ;  seeking  for  those  influences 
which  experience  has  taught  them,  were  favorable  to  its  invasion.  Some, 
with  this  intention  drink  wine  and  liquors  ;  others  excite  anger,  by  seeking  a 
quarrel  with  the  first  person  they  meet.  The  duration  of  the  attacks  is  very  va- 
riable. Some  last  but  a  few  seconds  ;  others,  for  some  minutes.  The  medium 
period,  is  from  five  to  fifteen  minutes.  The  frequency  of  the  attacks  is  not 
more  determinate.  They  recur  annually,  every  six  months,  monthly,  every 
fifteen  days,  every  eight  days,  on  alternate  days,  daily,  and  several  times  a  day. 
There  are  epileptics  who  have  complete  and  very  violent  attacks,  at  very  long 
intervals.  During  these  intervals,  they  suffer  from  vertigo.  The  attacks  of 
some  have  a  fixed  season  of  return,  and  recur  at  very  determinate  periods. 
In   some  cases,  particularly  among  women,  they  recur  on  fixed  days.     Some- 


148  EPILEPSY, 

times  the  attacks  alternate  with  respect  to  intensity.  There  are  violent  and 
feeble  attacks.  These  are  the  forms,  which  they  denominate  in  hospitals,  le 
grand  ct  petit  mal.  More  rarely,  the  attacks  reappear  at  indeterminate  pe- 
riods, and  the  epileptic  then  has  several  in  succession,  and  at  brief  intervals. 
In  some  instances,  the  attacks  occur  during  the  day  ;  in  others  during  the 
night ;  and  in  others  still,  during  sleep.  I  have  had  under  my  charge  a  young 
man,  who  became  apprised  of  his  attacks,  only  by  the  fatigue  and  dullness 
which  he  experienced  on  waking.  Several  times  we  succeeded  in  concealing 
from  him  the  fact,  that  he  had  had  an  attack, 

I  have  in  charge,  a  man  thirty-two  years  of  age,  whose  epilepsy  is  compli- 
cated with  fury  and  dementia.  His  attacks  occur  only  during  sleep.  If  it 
happens,  (which  is  very  rare),  that  he  has  attacks  during  the  day,  he  has  slept 
immediately  before  its  occurrence.  If  we  prevent  sleep,  or  awake  him  in  time, 
the  attack  is  avoided.  I  have  advised  the  patient  not  to  retire  to  bed,  but  to 
resist  sleep  by  diversion.  The  attack  passes  by,  but  the  sleep  of  the  following 
day  recalls  it.  There  is  no  disease,  which  has  been  regarded  as  more  depen- 
dent on  the  course  of  the  moon,  in  consequence  of  its  periodicity.  Never- 
theless, the  coincidence  of  the  attacks  with  the  lunar  phases,  is  neither  so  con- 
stant nor  so  regular  as  has  been  supposed.  Among  large  assemblages  of  epilep- 
tics, I  have  not  observed  that  the  attacks  were  more  frequent,  at  certain  pha- 
ses of  the  moon  than  at  others. 

Authors  relate,  that  epilepsy  has  ceased  after  the  reestablishment  of  sup- 
pressed hemorrhages,  or  repelled  cutaneous  eruptions  ;  after  pains  in  the  thighs, 
ulcers  in  the  throat,  or  upon  the  legs;  after  engorgements  of  the  breasts  or 
testes,  and  after  blindness.  This  last  crisis,  is  not  very  rare.  Epilepsy  is  a 
malady  not  only  formidable  by  the  violence  of  its  symptoms,  and  a  cause  of 
despair  in  consequence  of  its  incurability  ;  but  is  still  more  so,  by  its  fatal 
effects  upon  both  the  body  and  mind  of  those  who  are  affected  by  it.  The  latter 
are  the  necessary  consequences  of  the  repetition  of  the  attacks.  The  former 
are  accidental,  and  may  be  prevented.  The  accidental  effects  of  epilepsy, 
which  I  call  local,  and  which  may  be  prevented,  depend  upon  the  disasters 
which  take  place,  at  the  commencement  of  an  attack.  An  epileptic  person 
may  fall  into  the  lire  or  into  the  water,  or  be  precipitated  from  a  window,  etc. 
By  falling,  he  may  be  wounded,  or  bruised  ;  he  may  disfigure  his  countenance, 
fracture  a  limb,  or  be  drowned.  These  accidents  are  sufficiently  frequent 
and  grave,  to  furnish  important  indications  in  the  arrangements  of  a  hospital 
destined  to  be  occupied  by  a  great  number  of  epileptic  patients.  The  violent 
and  oft-repeated  perturbations  of  the  nervous  system,  which  take  place  in  epi- 
lepsy, produce  necessarily,  in  time,  lesions  in  the  organs  of  nutritive  life,  as 
well  as  alterations  in  the  brain  and  its  functions.  The  features  of  the  coun- 
tenance enlarge,  the  lower  eyelids  puff  up,  the  lips  become  thickened,  and 
the  handsomest  countenances  ugly.  There  is  something  uncertain  in  the 
look ;  the  eyes  wander,  and  the  pupils  are  dilated.  We  observe  convulsive 
movements  of  certain  muscles  of  the  face.  Epileptics  have  also  a  peculiar 
wait.  Their  slender  arms  and  legs  are  no  longer  in  relation  with  the  size  of 
the  rest  of  the  body.  They  become  deformed  and  paralytic.  The  legs 
of  an  epileptic  at  the  Salpetriere,  after  a  violent  attack,  became  flexed  upon 
the  thighs,  so  that  she  could  not  walk.  A  year  after,  during  an  attack,  the 
limbs  were  extended  and  flexed  alternately.  The  person  who  was  by  the 
patient  at  this  time,  succeeded  by  some  effort,  in  maintaining  the  extension  of 
them,  and  by  this  happy  expedient,  this  epileptic  is  again  enabled  to  walk. 

The  functions  of  organic  life  are  altered  and  languish.  Epileptics  are  sub- 
ject to  cardialgia,  flatulence,  spontaneous  lassitude,  and  trembling.  They 
take  little  exercise,  and  become  either  corpulent  or  lean.  They  are  strongly 
inclined  to  the  pleasures  of  love  and  onanism.     Perhaps  the  excesses  to  which 


f.- 


EPILEPSY.  149 


they  yield  themselves,  produce  the  organic  lesions  and  disorders,  which  are 
manifest  when  the  malady  has  persisted  for  a  long  time.  In  general,  epilep- 
tics do  not  reach  extreme  old  age.  The  cerebral  functions  and  intellectual 
faculties,  by  degrees  become  greatly  impaired.  Areteus,  who  has  so  well  de- 
scribed the  symptoms  of  epilepsy,  has  not  omitted  to  speak  of  the  influence  of 
this  malady  upon  the  functions  of  the  brain.  Van-Swieten  in  his  Commen- 
taries upon  Boerhaave,  remarks,  that  he  has  seen  many  unhappy  persons  who 
had  been  weak-minded  from  infancy,  and  that  all  of  them  with  whose  history 
he  had  become  acquainted,  had  suffered  from  attacks  of  epilepsy.  The  un- 
derstanding is  altered,  and  gradually  enfeebled ;  the  sensations  no  longer  pos- 
sess their  former  vivacity ;  memory  is  lost ;  imagination  becomes  extinct ;  and 
the  epileptic  sinks  into  incurable  dementia.  These  fatal  effects  are  the  more 
to  be  feared,  in  proportion  as  the  attacks  are  more  violent  and  frequent. 

Assisted  by  M.  Calmeil,  medical  inspector  of  the  hospital  at  Charenton, 
and  at  that  time  a  pupil  at  the  Salpetriere,  I  have  collected  with  the  utmost 
care,  the  history  of  those  women  who  occupy  the  epileptic  ward,  to  the  num- 
ber of  three  hundred  and  eighty-five.  Of  these,  forty-six  are  hysterical.  So 
analogous  are  the  symptoms,  that  hysteria  has  sometimes  been  confounded 
with  epilepsy.  There  are  hysterical  persons,  who  are  at  the  same  time,  epi- 
leptic. But  in  those  cases,  a  little  experience  enables  us  to  decide,  to  which 
of  the  two  disorders  the  convulsions  to  which  the  patient  is  subject,  belong. 
Hysterical  patients  have  attacks  of  mania,  and  almost  all  are  hypochondriacs, 
but  they  do  not  fall  into  dementia.  I  have  therefore,  to  give  an  account  of 
only  three  hundred  and  thirty-nine  epileptics, — subtracting  the  forty-six  hyste- 
rical patients.  Of  this  number  twelve  are  monomaniacs.  Thirty  are  maniacs, 
among  whom,  some  have  a  disposition  to  commit  suicide,  and  have  made  seve- 
ral attempts  upon  their  lives.  Thirty-four  are  furious,  with  three  of  whom, 
there  is  an  irruption  of  fury,  only  after  an  attack.  One  hundred  and  forty- 
five  are  in  a  state  of  dementia,  sixteen  are  constantly  in  this  state,  the  rest, 
only  after  an  attack.  Two  have  paroxysms  of  fury.  Eight  are  idiots.  One 
of  them  has  been  epileptic  only  from  seven  to  eight  months,  and  has  had  but 
five  attacks.  Fifty  are  habitually  rational,  but  suffer  from  absent-mind- 
edness more  or  less  frequently  ;  or  else  from  exaltation  of  the  faculties.  Some 
have  a  temporary  delirium,  and  all  a  tendency  to  dementia.  Sixty  have  no 
aberration  of  the  understanding,  but  are  exceedingly  susceptible,  irascible, 
head-strong,  difficult  about  their  living,  capricious,  strange ;  all  possess  some 
peculiarities  of  character.  Therefore,  two  hundred  and  sixty-nine  of  our 
three  hundred  and  thirty-nine  epileptics,  that  is  to  say,  four  fifths  of  them,  are 
more  or  less  insane;  one  fifth  only  retaining  the  use  of  their  reason,  but  in 
what  a  condition  !  Some  epileptics  experience  internal  sensations,  from  which 
spring  presentiments,  which  warn  them  of  an  approaching  paroxysm ;  and 
that,  although  they  may  have  just  had  one,  another  attack  will  immediately 
ensue. 

Many,  previous  to  the  entire  suspension  of  sensibility,  have  hallucinations 
the  most  varied.  They  think  that  they  see  luminous  bodies,  by  which,  they 
fear  that  they  may  be  embraced.  They  also  believe  that  they  see  dark  bodies, 
extended  and  immense,  which  threaten  to  shroud  them  in  thick  darkness. 
They  hear  sounds  like  the  bursting  of  a  thunderbolt,  the  roll  of  drums, 
the  clash  of  arms  in  the  din  of  combats.  They  smell  odors  the  most  fetid. 
It  seems  to  them  that  they  are  struck,  and  unmercifully  beaten.  All  these 
hallucinations  inspire  them  with  the  greatest  terror.  Perhaps  it  is  this  senti- 
ment, which  impresses  upon  the  physiognomy  of  most  epileptics,  that  expression 
of  fright  or  indignation,  which  is  peculiar  to  these  patients  during  the  attack. 
Almost  all  epileptics,  on  reviving  from  the  somnolence  which  follows  a  com- 
plete attack,  or  after  vertigo,  are  in  a  state  of  dementia,  which  gradually  dis- 


150  EPILEPSY. 

appears.  The  reestablishment  of  organic  sensibility,  always  precedes  that  of 
reason.  Many  epileptics  suffer  from  a  kind  of  carphologia,  and  make  bundles 
of  linen  or  other  materials  which  they  meet  with ;  or  else  move  their  hands 
about  blindly,  as  if  seeking  to  collect  and  bind  together  something;  when,  in 
fact,  there  is  nothing  within  their  reach.  The  fury  of  epileptics  bursts  forth 
after  the  attacks,  rarely  before,  and  is  dangerous,  blind,  and  in  some  sort, 
automatic.  Nothing  can  subdue  it,  neither  the  appearance  of  force,  nor  mo- 
ral influence,  which  succeeds  so  well  with  other  furious  maniacs.  This  fury 
is  so  formidable,  and  so  much  dreaded,  that  I  have  seen  in  a  hospital  of  the 
south,  all  the  epileptics  chained  every  night  to  their  beds,  in  consequence  of 
the  fear  which  they  inspired.  I  am  unable  to  determine  whether  the  mania 
of  epileptics,  has  any  connection  with  the  frequency  of  the  attacks,  or  with 
the  vertigoes.  It  bursts  forth  among  those  already  in  a  state  of  dementia,  and 
even  among  subjects  who  enjoy  habitually  the  use  of  their  reason.  Dementia 
is  that  form  of  mental  alienation,  which  most  generally  threatens  epileptics. 

A  young  man,  twenty-six  years  of  age,  having  become  epileptic  in  conse- 
quence of  having  given  himself  up  to  the  practice  of  onanism,  was  exceed- 
ingly irritable  after  his  attacks.  The  slightest  opposition  produced  fury.  He 
had  conceived  a  strong  aversion  to  his  parents.  To  these  symptom.s,  is  joined 
a  orloomy  melancholy,  attended  with  a  disposition  to  commit  suicide.  Neither 
tonics,  cold  baths,  nor  indeed  any  thing  can  prevent  his  sinking  into  dementia, 
of  which  he  already  manifests  some  symptoms. 

A  lady,  now  thirty-four  years  of  age,  has  been  epileptic  from  infancy.  Her 
mind  is  feeble,  and  at  the  age  of  puberty,  she  became  a  maniac.  She  is 
married,  and  has  one  child.  Some  domestic  troubles  produced  fury,  and  the 
attack  lasted  about  a  year.  Since  this  period,  that  is,  since  the  age  of  twenty- 
four  years,  this  lady  has  often  had  delirium,  and  sometimes  fury.  The  at- 
tacks of  epilepsy  take  place  during  the  night,  and  it  is  before  the  attacks  that 
fury  bursts  forth.  Dementia  is  imminent.  With  respect  to  its  duration,  the 
mental  alienation  of  epileptics  is  now  ephemeral,  and  takes  place,  only  after 
the  attacks,  particularly  mania  accompanied  with  fury,  and  an  inclination  to 
suicide.  Nevertheless,  its  duration  extends  from  a  few  minutes  or  hours,  to 
several  days.  Now  it  is  permanent ;  particularly  dementia.  It  is  independent 
of  the  return  of  the  attacks,  and  persists  from  one  to  another. 

Whatever  may  be  the  form  and  duration  of  the  mental  alienation  of  epilep- 
tics, it  takes  place,  sometimes  at  the  first,  or  among  the  earliest  attacks,  par- 
ticularly in  infancy.  In  the  case  of  some  epileptic  children,  reason  is  not 
developed;  they  are  idiots.  With  others,  it  is  developed,  but  is  speedily  lost. 
When  epilepsy  appears  after  puberty,  and  especially  adult  age,  reason  yields 
more  slowly ;  but  each  attack  adds  to  the  feebleness  of  the  intelligence,  be- 
fore dementia  is  complete.  The  progress  towards  dementia,  is  in  proportion 
to  the  number  of  years  that  have  elapsed,  since  the  invasion  of  the  first  attack. 
It  is  more  to  be  feared,  and  is  more  rapid,  when  the  attacks  occur,  at  inter- 
vals increasing  in  frequency ;  whilst  reason  is  preserved,  when  the  attacks  are 
rare,  when  they  are  not  many  times  repeated  on  the  same  day,  and  when  there 
are  not  vertigoes.  This  tendency  to  dementia  is  more  directly  allied  to  the 
frequency  of  the  vertigoes,  than  to  that  of  the  epileptic  attacks.  Vertigoes 
have  a  more  active  and  energetic  effect  upon  the  brain,  than  what  is  called, 
le  grand  mal,  or  the  complete  attack.  Vertigoes  destroy  the  intelligence,  both 
more  speedily,  and  with  more  certainty  than  the  attacks,  although  they  may 
have  scarcely  an  appreciable  duration.  There  are  indeed,  individuals  who 
have  vertigoes,  in  presence  of  persons  who  can  no  more  perceive  them,  than  if 
they  did  not  occur.  When  epilepsy  ceases,  or  when  it  is  suspended  for  a 
longer  or  shorter  period  of  time,  (and  it  ceases  sometimes  for  years),  or  the 
interval  between  the  attacks  increases,  though  the  malady  does  not  cease,  the 


EPILEPSY.  151 

understanding  is  progressively  recovered,  and  the  dispositions  of  the  subjects 
of  it  are  ameliorated.  They  are  less  irritable,  more  mild,  more  sociable  ;  but 
I  have  never  seen  one,  who  did  not  preserve  a  very  marked  physical  and  moral 
susceptibility.  How  happens  it  that  vertigoes,  whose  duration  is  so  brief,  and 
where  convulsions  are  scarcely  perceptible,  produce  a  more  fatal  effect  upon  the 
brain,  and  destroy  more  promptly  the  understanding,  than  complete  attacks  of 
epilepsy,  whose  convulsions  are  more  violent  and  lasting?  How  happens  it 
that  hysterical  convulsions,  which  are  so  intense,  and  which  persist  durinor 
many  hours  and  even  days,  do  not  produce  dementia,  like  epileptic  seizures, 
and  more  especially  vertigoes?  Does  not  this  last  observation  serve  to  confirm 
the  opinion  of  those,  who  pretend  that  both  hysteria  and  epilepsy,  have  their 
primitive  seat  in  the  brain?  Such  is  the  general  course  of  this  terrible  dis- 
ease. 

Amidst  so  many,  and  such  varied  symptoms,  by  what  signs  shall  we  recog- 
nize epilepsy  ?  The  confusion,  and  fall  at  the  commencement,  or  during  the 
attack,  takes  place  in  syncope,  asphyxia,  and  apoplexy.  The  convulsions, 
which  are  now  general,  now  partial,  now  extremely  violent,  and  now  scarcely 
appreciable,  are  not  constant,  and  appertain  to  other  neuroses.  The  same  is 
true  of  the  frothing  at  the  mouth,  which  exists  sometimes  in  apoplexy,  as- 
phyxia and  hysteria.  The  involuntary  emission  of  urine  and  semen,  is  not  a 
symptom  confined  to  epilepsy.  The  strong  contraction  of  the  thumb,  and  its 
occlusion,  are  not  constant.  The  pathognomonic  character  of  epilepsy,  consists 
in  convulsions,  the  entire  suspension  of  sensibility,  and  loss  of  consciousness. 
Epilepsy  is  therefore  a  convulsive  or  clonic  malady,  with  loss  of  conscious- 
ness. Epilepsy  differs  from  apoplexy.  In  the  latter,  respiration  is  stertorous, 
there  are  few  if  any  convulsions,  and  the  pulse  is  scarcely  altered.  It  is  usu- 
ally fatal  on  the  second  or  third  attack.  We  cannot  confound  epilepsy  with 
syncope,  from  which  it  is  sufficiently  distinguished,  by  the  flushed  counte- 
nance, the  freedom  of  the  pulse,  the  relaxation  of  the  muscles,  and  the  recol- 
lection of  the  state  which  he  escapes  who  has  had  syncope. 

Hysteria  has  been  often  mistaken  for  epilepsy,  and  reciprocally.  Hysteria 
however,  only  appears  at  puberty  or  subsequently.  The  attack  docs  not  burst 
forth  suddenly,  and  is  preceded  or  accompanied  by  globus  hystericus,  or  con- 
striction of  the  throat.  In  epilepsy,  the  convulsions  are  concentrated,  and 
seem  to  tend  towards  the  axis  of  the  trunk,  and  are  more  violent  on  one  side 
of  the  body  than  the  other,  or  in  one  member  than  in  the  others.  In  hysteria 
the  convulsions  are,  so  to  speak,  expansive.  The  members  extend  and  pro- 
ject themselves  as  far  as  possible,  are  more  fully  developed,  and  the  convul- 
sions are  more  uniform.  The  features  also,  are  less  altered,  and  the  counte- 
nance is  less  hideous  and  injected.  In  hysteria  the  abdomen  is  distended, 
there  are  borborygmi,  the  patient  does  not  lose  his  consciousness,  nor  does  he 
fall  into  a  comatose  state  after  convulsions,  but  preserves  a  recollection  of 
what  he  has  just  experienced,  and  there  is  less  prostration  after  the  attack. 
In  the  intervals,  some  hysterical  symptom  always  betrays  the  nature  of  the 
malady.  Hysteria,  even  when  prolonged,  never  destroys  the  intellectual  facul- 
ties. The  causes  of  epilepsy  are  general  or  special,  remote  or  proximate. 
Certain  authors  assure  us  that  epilepsy  is  endemic  in  some  countries.  Is  it 
not  most  frequent  in  mountainous  countries  ?  Hippocrates  classes  it  among 
the  maladies  of  spring.  Is  epilepsy  contagious  ?  Yes,  by  the  fright  which 
an  attack  inspires.  Powerful  moral  impressions,  received  by  the  mother  dur- 
ing pregnancy,  communicate  it  to  the  foetus,  and  those  which  the  nurse  re- 
ceives, by  changing  the  quality  of  the  milk,  have  also  caused  epilepsy.  Are 
children  who  have  been  conceived  during  the  menstrual  period,  more  exposed, 
on  this  account,  to  the  malady  ? 

Epilepsy  attacks  persons  of  every  age.  However,  it  is  so  common  in  infan- 
cy, and  so  rare  at  adult  age,  particularly  in  advanced  life,  that  it  has  been  call- 


152  EPILEPSY. 

ed,  mal  chs  cnfans.  The  readiness  with  which  it  is  contracted,  is  in  an  in 
verse  ratio  to  the  age  ;  but  we  must  add,  that  if  this  malady  is  more  common 
at  the  earlier  periods  of  life,  it  is  also  more  easily  cured.  The  extreme  sus- 
ceptibility of  the  nervous  system,  the  presence  of  meconium,  intestinal 
worms,  the  labor  of  dentition,  the  bad  quality  of  the  milk  of  nurses  who  give 
themselves  up  to  errors  of  regimen  or  to  their  passions,  are  also  circumstances, 
which  more  particularly  expose  children  to  epilepsy.  Falls,  and  ligatures  with 
which  the  bodies  or  heads  of  infants  have  been  too  tightly  compressed,  have 
often  caused  this  malady. 

Women  and  children,  being  more  feeble,  susceptible  and  impressible  than 
men,  are  more  subject  to  epileptic  seizures.  This  predisposition  with  respect 
to  sex,  is  not  perceivable  from  birth  until  the  age  of  seven  years.  At  this 
period,  the  character  of  either  sex  is  delineated,  becomes  marked,  and  distin- 
guishes itself;  and  it  is  then,  that  the  number  of  epileptic  women  predomi- 
nates. By  comparing  the  number  of  epileptics  at  the  Salpetriere,  with  the 
men  suffering  from  the  same  malady,  who  have  been  admitted  at  the  Bicetre, 
we  find  the  number  of  epileptic  women  the  greater  by  one  third.  There  are 
at  the  Bicetre,  one  hundred  and  sixty-two  epileptics,  and  three  hundred  eighty- 
nine  at  the  Salpetriere.  Melancholic  temperaments,  enfeebled,  scrofulous, 
and  cachectic  constitutions,  predispose  to  epilepsy,  as  well  as  scurvy,  rachitis 
•and  syphilis.  Errors  of  regimen,  onanism,  insolation,  blows  and  falls  upon  the 
head,  the  abuse  of  alcoholic  drinks  and  poisons,  are  the  exciting  causes  of 
epilepsy. 

M.  C.,  a  native  of  Boston,  aged  nineteen  years,  made  a  voyage  to  France. 
Whilst  sailing  under  the  line,  he  lays  down  upon  the  deck  and  falls  asleep. 
Shortly  after,  he  is  awoke  by  a  dreadful  headache,  and  an  inflammation  of  the 
face  and  scalp.  The  whole  head  becomes  enormously  swollen,  the  patient 
has  delirium,  and  they  believe  him  lost.  However,  he  is  several  times  bled 
copiously,  the  inflammation  diminishes,  and  ceases  on  the  ninth  day  :  but  im- 
mediately after,  epileptic  attacks  appear.  The  young  patient  is  put  on  shore 
at  L'Orient,  where  he  is  treated  for  six  months  ;  after  which,  he  is  sent  to  Pa- 
ris, and  committed  to  my  care.  The  following  is  the  condition  in  which  I 
first  saw  him.  In  stature,  he  is  of  middle  size,  his  hair  is  light  colored,  his 
eyes  blue  and  very  lively,  physiognomy  mobile,  and  his  habit  moderately  full. 
There  is  an  habitual  cephalalgia,  and  obstinate  constipation.  The  epileptic 
attacks  recur  every  seven  or  eight  days.  They  commence  with  a  maniacal 
state.  The  patient  suddenly  begins  to  walk  his  chamber,  soon  after  he  leaps 
about,  and  overturns  whatever  comes  in  his  way.  He  throws  himself  with  a 
kind  of  fury  upon  those  that  surround  him,  and  after  a  few  moments'  strug- 
gle, utters  a  cry.  Convulsions  of  the  face,  eyes  and  limbs,  together  with  loss 
of  consciousness,  complete  the  attack,  which  lasts  six  or  seven  minutes,  and 
which  is  followed  by  a  comatose  state,  of  half  an  hour's  duration,  from  which 
the  patient  comes  forth,  with  his  full  measure  of  intelligence,  and  a  very  acute 
pain  in  the  head.  All  the  remedies  advised  as  a  cure  for  epilepsy,  had  failed 
at  L'Orient.  Having  reference  to  the  cephalalgia,  which  was  frequently  re- 
newed during  the  course  of  the  day,  and  to  the  obstinate  constipation,  which 
always  announced  a  coming  attack,  after  having  prescribed  an  appropriate 
alimentary  regimen,  and  abundant  exercise,  I  put  the  patient  upon  the  use  of 
pills,  prepared  with  the  Ext.  Colocynth,  Asafoetida,  and  Calomel.  At  the 
same  time,  the  young  patient  exposes  his  head  occasionally  to  the  flow  of  cold 
water  from  the  spout  of  a  pump.  This  impression  of  cold,  repeated  many 
times  a  day,  by  diminishing  the  cephalalgia,  renders  the  attacks  at  first  less 
violent,  and  terminates  them  in  the  course  of  three  months,  by  removing  both 
the  headache  and  the  attacks.  This  young  man  spent  some  months  after 
this  period  at  Paris,  and  finally,  took  passage  for  Boston,  where  he  arrived  in 
very  good  health,  and  from  whence  I  have  learned  that  he  continued  well. 


EPILEPSY.  1 53 

The  metastasis  of  a  chronic  cutaneous  eruption,  the  suppression  of  an  nicer, 
the  cessation  of  an  habitual  evacuation,  are  also  causes  of  epilepsy.  Military 
physicians  have  had  occasion  to  observe,  that  the  suppression  of  transpiration, 
sometimes  renders  soldiers  epileptic.  A  woman  seventy  years  of  age,  says 
Zacutus,  had,  for  eighteen  years,  an  ulcer  upon  the  wing  of  the  nose.  A 
charlatan  cures  it  by  an  external  application.  Twenty-four  hours  after  this 
was  effected,  she  had  a  first  attack  of  epilepsy,  and  several  afterwards,  until 
two  issues  were  established  upon  the  legs.  A  man  thirty  years  of  ao-e,  re- 
ceives a  blow  upon  the  head.  A  year  after,  the  wound  heals,  and  epilepsy 
bursts  forth.  The  wound  is  opened  again  with  the  cautery,  and  the  epilepsy 
ceases.  An  imprudent  surgeon  induces  cicatrization  ;  the  attacks  are  renew- 
ed, and  again  cease  on  a  new  application  of  the  caustic. 

Doctor  Maisonneuve*  speaks  of  a  young  man,  nineteen  years  of  age,  who, 
at  the  age  of  eight  years,  having  washed  his  head  repeatedly  with  cold  water, 
in  order  to  cure  tinea  capitis,  succeeded  in  removing  it.  Some  days  after, 
he  was  seized  with  epilepsy.  The  attacks  were  least  frequent  during  the 
summer.  Cartheuser  had  remarked,  that  the  improper  practice  of  repellino- 
tinea  capitis  with  cold  lotions,  which  was  established  in  Sweden,  had  render- 
ed epilepsy  frequent  in  that  country.  Epilepsy  is  caused  by  syphilis.  Omo- 
bon,  Pison  and  Scardona,  relate  examples  of  it.  Cullerier  published  in  the 
General  Journal  of  Medicine,  (t.  xiv,  p.  '271),  two  cases  of  epilepsy,  caused 
by  syphilis,  and  cured  by  an  anti-venereal  treatment.  In  these  two  cases, 
and  in  a  third,  related  by  M.  Maisonneuve,  the  intervals  between  the  attacks 
were  marked  by  sufferings,  which  betrayed  the  presence  of  an  ever-acting 
morbid  cause.  Tissot  assures  us,  that  epilepsy  has  been  caused  by  the  sudden 
suppression  of  the  salivation,  produced  by  the  use  of  mercury.  Hoffmann 
speaks  of  mercury,  as  capable  of  causing  epilepsy  among  feeble  persons.  M. 
Landre-Beauvais  has  often  noticed  it,  as  a  result  of  the  mercurial  treatment. 
Epilepsy  is  symptomatic  and  transient,  among  children  suffering  from  variola, 
rubeola  and  scarlatina.  It  occurs,  when  these  eruptions  do  not  appear  at  a 
proper  time,  or  are  suddenly  suppressed.  Accoucheurs  have  regarded  as  epi- 
leptic, the  convulsions  which  complicate  the  labor  of  confinement. 

Violent  moral  commotions,  the  violent  passions,  such  as  chagrin,  anger,  and 
above  all,  fear,  are  the  most  frequent  causes  of  epilepsy.  This  malady  is 
caused,  also,  by  strong  mental  conflicts,  associated  with  an  improper  regimen. 
The  sight  of  an  epileptic  seizure,  and  the  habit  of  feigning  epilepsy,  have 
provoked  this  malady.  A  mason,  twenty-one  years  of  age,  strong  and  robust, 
is  frightened  during  a  dream,  and  becomes  epileptic.  A  servant  untying  a 
leathern  strmg,  tied  in  three  knots,  imagines  that  these  knots  are  the  work  of 
a  witch.  She  is  frightened,  and  is  taken  with  an  attack  of  epilepsy.  A  wo- 
man is  frightened  by  an  insane  person,  and  becomes  epileptic.  A  girl,  nine 
years  of  age,  amuses  herself  with  looking  at  the  sun.  After  some  minutes, 
she  believes  that  she  sees  in  the  midst  of  it,  a  huge  black  head.  She  is 
frightened,  and  on  the  same  evening,  whilst  relating  to  her  mother  \vhat  she 
has  seen,  is  seized  with  a  first  attack.  The  same  physical  and  moral  pheno- 
mena which  have  induced  the  first  attack  of  epilepsy,  become  the  cause  of 
succeeding  ones,  although  they  may  act  with  less  intensity.  A  woman  meets 
with  a  severe  mortification,  and  becomes  epileptic  in  consequence  of  it.  Af- 
terwards, the  slightest  chagrin  produces  an  attack. 

A  child  is  frightened  by  a  dog,  and  becomes  epileptic.  He  afterwards  has 
an  attack  every  time  he  hears  the  barking  of  a  doo-.  Another  becomes  epi- 
leptic after  a  fit  of  anger.  The  slightest  contradiction,  afterwards  produces 
an  attack.  A  little  girl  ten  years  old,  is  at  play  with  her  companions,  who 
tickle  the  soles  of  her  feet.     She  becomes  epileptic.     An  attack  occurs  every 

**  Researches  and  Observations  on  Epilepsy,  Paris,  1803,  in  8vo. 

20 


154  EPILEPSY. 

time  they  threaten  to  tickle  her.  Impressions  made  upon  the  senses,  an  un- 
expected noise,  certain  colors  or  odors,  sometimes  produce  attacks.  The  heat 
of  an  apartment,  the  movement  of  a  large  assemblage  of  persons,  the  slight- 
est error  of  regimen,  atmospheric  vicissitudes,  watchings,  etc. ;  in  a  word, 
whatever  may  have  provoked  the  first  attack,  may  become  the  cause  of  suc- 
ceeding ones.  A  soldier  rushes  to  the  assault,  a  bomb  bursts  near  him,  and 
he  is  seized  with  epilepsy,  from  which  he  is  restored,  in  the  space  of  a  year. 

Twenty  years  after,  the  sight  of  the  same  ramparts,  produces  an  attack. 
From  the  facility  with  which  the  attacks  are  reproduced  from  the  slightest 
exciting  causes,  it  seems  proper  to  infer,  that  there  remains  in  the  organism 
after  the  first  attack,  as  well  as  in  the  nervous  system,  a  special  disposition, 
which,  from  the  least  cause,  is  set  in  action,  and  occasions  new  attacks.  This 
disposition,  which  Tissot  denominates  proegumene,  merits  the  greatest  atten- 
tion in  the  prophylactic  treatment,  but  is  no  more  easy  to  explain,  than  the 
periodicity  of  epilepsy.  We  no  more  find  the  traces  of  it  in  the  organism, 
than  we  find  in  the  organs,  lesions,  proper  to  acquaint  us  with  the  seat  of 
epilepsy. 

After  having  pointed  out  the  causes  of  epilepsy,  I  will  indicate  the  organs 
upon  which  they  seem  to  act  primitively,  in  order  to  produce  this  malady. 
At  one  time,  they  exercise  their  influence  upon  some  organ,  more  or  less  re- 
mote from  the  brain,  and  produce  sympathetic  epilepsy  ;  at  another,  they  act 
directly  upon  the  brain,  to  produce  its  idiopathic  form.  In  sympathetic  epi- 
lepsy, the  causes  act  primarily  upon  the  organs  of  nutritive  life,  or  rather 
upon  those  of  the  life  of  relation.  Is  the  digestive  apparatus  the  seat  of  epi- 
lepsy ;  the  attacks  burst  forth  when  there  exists  an  active  gastric  irritation,  or 
when  there  is  accumulated  in  the  stomach  or  intestines,  particularly  among 
children,  mucous  matters,  acid  or  otherwise  ;  or  when  there  has  been  intro- 
duced into  this  viscus,  irritating  or  deleterious  substances.  These  patients  ex- 
perience pains  in  the  stomach,  and  tension  in  the  epigastric  region,  with  all  the 
signs  of  gastric  embarrassment.  They  are  also  fastidious.  A  little  before  the 
attacks,  they  have  fainting  turns,  pains  about  the  heart,  nausea  and  vomitings, 
which  are  renewed  during  the  attack.  When  epilepsy  is  caused  by  worms, 
the  patients  offer  all  the  signs  which  announce  their  presence.  That  epilepsy 
which,  I  shall  call  intestinal,  is  announced  by  certain  signs.  Children  who, 
without  a  fall  or  fright,  become  epileptic  ;  who,  at  the  same  time,  have  a  pale" 
countenance,  swollen  cheeks,  the  eyes  dull,  and  pupils  dilated,  the  dejections 
greyish,  abdomen  voluminous,  the  gait  dull  and  lifeless,  and  whose  attacks 
are  announced  by  borborygmi,  leave  no  doubt  as  to  the  true  seat  of  the  evil. 
When  the  liver  is  primarily  affected,  respiration  is  interrupted,  the  diaphragm 
is  painfully  moved,  the  abdominal  muscles  are  convulsively  exercised,  the  pa- 
tient loses  his  consciousness,  and  some  moments  after,  eructations  and  bor- 
borygmi take  place.  The  jaundice,  which  appears  before,  or  after  the  attack, 
slowly  disappears  ;  the  patient  complains  of  a  pain  in  the  region  of  the  liver, 
and  vomits  yellow  matters.  Hippocrates  has  referred  to  the  bile  as  a  cause  of 
epilepsy  :  Fabricius  has  attributed  it  to  biliary  concretions. 

It  was  only  after  numerous  observations,  that  Hippocrates,  and  all  who  have 
succeeded  him,  regarded  sanguine  plethora,  as  one  of  the  causes  of  epilepsy, 
especially  in  youth.  The  sanguine  temperament,  the  approach  of  puberty, 
the  delay  or  suppression  of  the  menses,  the  cessation  of  some  habitual  hemor- 
rhage, such  as  bleeding  at  the  nose,  or  hemorrhoids  ;  whatever  can  give  the 
blood  a  tendency  to  the  head,  insolation,  violent  exercises,  the  abuse  of  alco- 
holic drinks,  are  circumstances  that  provoke  sanguine  or  plethoric  epilepsy. 
The  patient  suddenly  loses  his  consciousness,  the  countenance  becomes  tu- 
mid, is  very  red  and  covered  with  perspiration ;  the  eyes  gleam,  the  respira- 
tion is  blowing,  the  convulsions  are  not  very  violent,  and  last  but  for  a  short 
time.     After  the  attack,  the  patient  passes  hours,  and  sometimes  days  in  a 


EPILEPSY.  155 

comatose  statef,  rom  which  he  recovers  but  slowly,  and  to  which  succeeds 
delirium,  and  sometimes  fury  or  paralysis  of  some  member.  The  attacks  are 
less  frequent  than  in  the  other  varieties,  recurring,  ordinarily,  but  once  a  month. 
In  the  interval,  between  one  attack  and  another,  the  patients  have  vertigoes, 
and  torpor  of  the  faculties.  On  opening  the  bodies,  we  find  the  vessels  of 
the  head  dilated,  and  gorged  with  blood,  and  the  cerebral  substance  strongly 
injected. 

The  suppression  of  the  menses  more  frequently  produces  epilepsy,  than  that 
of  hemorrhoids ;  because  the  menses  are  a  physiological  phenomenon,  whilst 
hemorrhoids  are  an  indication  of  deranged  health.  The  organs  of  reproduc- 
tion are  also  the  seat  upon  which  the  epileptic  cause  primarily  acts,  and  from 
whence,  as  by  irradiation,  depart  the  first  phenomena  of  the  attack.  This 
variety  which  we  may  call  genital,  is  most  frequent  among  women,  and  dif- 
fers, as  we  have  already  said,  from  hysteria.  There  is  so  strong  an  analogy 
between  a  slight  epileptic  attack,  and  the  spasmodic  orgasm  which  accompa- 
nies the  act  of  reproduction,  that  the  ancients  have  defined  coition  to  be  epi- 
lepsia hrevis.  This  act  is  sometimes  followed  by  epilepsy.  Sauvages  speaks 
of  a  person,  in  whose  case,  coition  was  always  followed  by  an  attack.  G. 
Cole  cites  the  example  of  a  woman,  who,  three  days  after  her  marriage,  be- 
came epileptic.  Onanism  predisposes  to  this  terrible  malady,  and  becomes  the 
exciting  cause  of  it,  even  in  childhood.  Zimmermann  knew  a  young  man 
who  had  an  attack  whenever  he  committed  the  act  of  onanism.  A  young 
man,  from  twelve  to  thirteen  years  of  age,  gave  himself  up  to  masturbation. 
Although  strong  and  robust,  he  becomes  extremely  susceptible,  and  at  the  age 
of  fifteen  years,  is  seized  with  an  attack  of  epilepsy.  The  attacks  coin- 
cide with  the  first  quarter  and  full  of  the  moon,  and  burst  forth  suddenly. 
The  patient  is  prostrated  and  utters  a  cry,  convulsions  are  general ;  the  eyes, 
open  and  fixed,  are  injected,  and  the  pupils  are  very  much  dilated.  After  the 
attack,  which  lasts  from  three  to  four  minutes,  the  patient  remains  very 
much  fatigued  during  the  whole  day.  Vertigoes  are  r.ire  between  the  attacks. 
He  is  habitually  extremely  susceptible,  and  is  mortified  and  grieved  on  the 
slightest  cause.  Tonics,  peruvian  bark,  valerian,  river  baths,  swimming  and 
corporeal  exercise,  together  with  a  very  active  life,  contribute  after  six  months, 
to  diminish  the  frequency  of  his  attacks.  After  the  lapse  of  a  year,  they  are 
no  longer  renewed,  and  the  patient  is  regarded  as  cured.  The  pleasure  of 
again  seeing  his  mother,  from  whom  he  had  been  separated  for  two  years, 
recalled  the  attacks,  but  they  were  more  mild.  At  length,  after  six  months 
more  of  the  same  treatment,  he  was  restored  to  perfect  health,  since  which 
period  he  has  been  engaged  in  commerce,  and  traveled  much.  His  health 
was  invigorated  by  it.  He  married  at  twenty-seven  years  of  age,  and  is  now 
remarkably  well.  I  analyze  only  this  case,  which  we  may  say  in  passing, 
proves  better  than  any  reasoning,  the  efficncy  of  regimen  and  corporeal  exer- 
cises, in  triumphing  over  a  malady,  at  once  so  grave  and  rebellious.  Conti- 
nence has  sometimes  produced  epilepsy ;  but  excess  in  this  respect  is  less  to 
be  feared  than  the  opposite  abuse.  With  respect  to  the  marriage  relation,  I 
owe  to  the  kindness  of  Doctor  Hebreard,  physician  at  the  Bicetre,  the  follow- 
ing note  :  Of  one  hundred  and  sixty-two  epileptic  men,  residing  at  the  Bice- 
tre, one  hundred  and  nineteen  are  single,  thirty-three  are  married,  seven  are 
widowers,  and  one  is  divorced. 

The  delay,  suppression  and  derangement  of  the  menses,  pregnancy,  and 
the  labor  of  confinement,  have  caused  epilepsy.  M.  Maisonneuve  speaks  of  a 
young  woman,  twenty-two  years  of  age,  who  became  epileptic,  in  conse- 
quence of  the  derangement  of  the  menses,  and  was  cured  by  their  reestab- 
lishrnent.  Another  young  woman,  twenty-three  years  of  age,  had  attacks  at 
each  menstrual  period,  except  when  the  discharge  was  abundant.  The  same 
author  cites  the  example  of  a  widow,  thirty-one  years  of  age,  whose  turns 


156  EPILEPSY. 

were  suppressed  by  a  strong  impression,  and  who  became  epileptic.  Fernel 
and  Schenckius,  have  seen  women,  whose  attacks  were  renewed  only  during 
the  period  of  pregnancy.  Horstius  speaks  of  a  woman  thirty-two  years  of 
age,  whose  menses  were  scanty,  and  who  became  epileptic.  The  attacks  re- 
curred every  fifteen  days.  Having  married  nine  months  after,  she  became 
pregnant  and  was  cured,  I  have  seen  some  epileptics  become  pregnant,  with- 
out having  remarked  the  least  modification  in  the  intensity  or  frequency  of 
the  attacks.  Lamotte  speaks  of  a  woman,  who  had,  in  eight  pregnancies, 
five  daughters  and  three  sons.  She  had  several  attacks  of  epilepsy,  every 
time  she  was  pregnant  with  a  son,  but  never  during  the  pregnancies  with  her 
daughters.     Mauriceau  has  seen  epilepsy  take  place  after  confinement. 

If  epilepsy  has  its  seat  in  the  digestive  apparatus,  in  the  circulatory  system, 
or  in  the  organs  of  reproduction,  there  are  causes  which  act  primarily  upon 
organs  placed  at  the  surface.  I  will  sum  up,  what  has  been  said  on  this 
point.  Fernel  has  seen  the  precursory  symptoms,  and  the  first  symptoms  of 
the  attack,  experienced  at  the  crown  of  the  head,  and  renewed,  every  time 
thBt  the  head  was  pressed.  Doctor  Vigne,  a  distinguished  physician  of 
Rouen,  was  consulted  by  a  young  man,  eighteen  years  of  age,  who  had  be- 
come epileptic  in  consequence  of  a  psoric  affection.  The  patient  experienced 
an  icy  coldness  at  the  middle  of  the  forehead,  by  which  he  was  forewarned  of 
an  attack.  For  three  years,  Doct.  Vigne  applied  himself  to  recall  the  erup- 
tion to  the  surface.  He  succeeded,  and  the  patient  was  restored.  Brunner 
eflfected  a  cure,  by  applying  a  moxa  to  the  neck,  at  the  point  where  the  first 
symptoms  were  experienced.  Fabrice  met  with  the  same  success,  by  extract- 
ing a  glass  ball,  whose  introduction  into  the  ear  had  caused  epilepsy.  Donat 
had  charge  of  a  nun,  who  experienced  at  the  commencement  of  the  attacks, 
a  pain  in  the  right  breast,  from  whence  the  aura  ascended  to  the  brain.  If 
the  breast  ulcerated,  the  attack  was  prevented.  Hollier  says,  that  in  the  case 
of  one  young  man,  the  attack  began  at  the  shoulder,  the  arm  was  seized  with 
trembling,  the  jaws  were  locked,  and  the  attack  took  place.  In  another  case, 
numbness  of  the  right  hand  was  the  first  symptom,  the  three  first  fingers  were 
firmly  contracted,  the  arm  also  was  twisted,  the  body  bent,  and  the  patient 
fell.  The  attack  of  another,  began  in  the  little  finger  of  the  left  hand.  Tis- 
sot  gives  the  example  of  a  man  who  prevented  an  attack,  by  applying  to  the 
arm  a  tourniquet,  which  he  tightened,  so  soon  as  he  experienced  pain  in  the 
left  hand.  M.  Maisonneuve  knew  a  man,  in  whose  case  the  attack  made  its 
irruption,  by  convulsions  of  the  arm  and  eyelids  of  the  right  side.  If  at  the 
commencement  of  these  convulsions,  the  arm  was  violently  pulled,  the  attack 
was  prevented.  The  effect  was  the  same,  if  the  patient  ran.  This  circum- 
stance recalls  to  mind  another  patient,  who  prevented  the  attacks  by  throwing 
the  head  back,  as  far  as  possible.  Professor  Alibert  relates,  that  an  epileptic 
was  accustomed  to  lessen  the  gravity  of  the  attacks,  and  preserve  his  con- 
sciousness, by  causing  a  gun  to  be  fired  near  him  several  times,  on  the  day  of 
the  attack. 

In  other  cases,  the  attack  commences  in  the  leg,  from  whence  there  arises 
a  vapor,  like  a  cold  wind,  along  the  thigh,  the  back  and  the  neck,  to  the  head, 
when  the  attack  bursts  forth  ;  or  rather  the  attack  announces  itself  by  a  pain 
in  the  top  of  the  foot,  from  whence  arises  a  cold  current  of  air  towards  the 
head.  A  man  who  has  an  ulcer  on  the  leg,  causes  it  to  cicatrize.  Epilepsy 
follows  ;  and  each  attack  begins  with  a  cold  wind,  which  proceeds  from  the 
cicatrix.  A  ligature  above  the  knees,  checks  the  attack.  A  lady,  who  had 
employed  many  remedies,  was  cured  by  the  amputation  of  the  first  phalanx 
of  the  great  toe,  from  whence  the  epileptic  aura,  proceeded. 

A  child  of  eleven  years  of  age,  had  suffered  from  two  or  three  attacks  a 
week,  from  the  age  of  two  years.  Each  was  announced  by  a  feeling  of  un- 
easiness and  cold,  proceeding  from  the  right  side.     Doctor  Carron  discovered 


EPILEPSY.  157 

on  the  thumb  of  an  epileptic  person,  a  small  indolent  tumor  He  made  an 
incision  into  it,  and  removed  small  hard  bodies,  of  the  size  of  a  millet  seed, 
of  a  sebaceous  nature.  The  child  was  cured.  Doctor  Pontier  cured  an  epi- 
leptic by  cauterizing  the  saphena  nerve  of  either  leg.  These  two  last  cases 
are  found  in  the  General  Journal  of  Medicine  of  Paris,  tom.  xiii,  p.  242,  and 
tom.  xvi,  p.  261. 

We  must  therefore,  discover  the  causes  of  epilepsy,  which  act,  at  first,  upon 
the  internal  organs,  or  those  situated  externally,  before  exercising  their  action 
upon  the  brain.  However  inexplicable  may  be  these  phenomena,  however  few 
the  relations  which  subsist  between  these  local  impressions,  and  a  complete 
attack  of  epilepsy,  it  cannot  be  denied  that  the  first  cause  of  the  evil  acts  pri- 
marily elsewhere  than  upon  the  brain.  Willis,  Pison  and  Demoore,  pretend 
that  epilepsy  ever  has  its  primitive  seat  in  the  brain. 

Is  not  the  contrary  demonstrated  by  the  cases  of  sympathetic  epilepsy  col- 
lected by  all  authors  ?  Is  it  not  established  by  the  cures  that  take  place  after 
the  evacuation  of  the  meconium,  of  the  mucous,  acrid,  yellow  and  black  mat- 
ters ;  of  worms,  and  biliary  concretions,  in  gastric  epilepsy  ?  The  cures 
which  take  place  after  the  first  menstrual  discharge,  after  the  reestablishment 
of  the  menses,  after  marriage,  and  after  pregnancy  in  uterine  epilepsies ;  the 
cure  by  blood-letting,  and  sanguine  evacuations  in  plethoric  epilepsies  ;  the 
cure,  by  the  extraction  of  foreign  bodies,  by  cauterization  and  amputation  j 
by  the  reestablishment  of  an  ulcer;  the  averting  of  the  attacks,  by  the  liga- 
ture of  the  member  from  whence  the  epileptic  aura  proceeds,  and  by  the  ex- 
tension of  the  limbs ;  are  not  these,  numerous  and  incontestable  proofs,  that 
epilepsy  has  not  always  its  primitive  seat  in  the  brain,  or  its  first  point  of  de- 
parture from  it  ? 

Idiopathic  epilepsy  commences  almost  with  life,  it  has  characters  peculiar 
to  it,  and  is  the  despair  of  physicians.  The  first  invasion  takes  place  in  ear- 
liest infancy,  and  its  attacks  are,  at  first,  incomplete.  They  occur  without  pre- 
cursory signs,  the  convulsions  are  slight  and  most  marked  in  the  countenance. 
Their  duration  is  short,  and  their  return  irregular,  but  at  brief  intervals. 
Sometimes  the  attacks  cease  for  a  long  time,  to  appear  again  after  many  years. 
According  to  Hippocrates,  they  disappear  at  puberty.  They  may  however 
persist  even  to  old  age,  and  do  not  seem  to  shorten  life.  The  cessation  of  the 
menses,  now  augments,  and  now  diminishes,  the  frequency  and  gravity  of  the 
attacks. 

Hereditary  predisposition,  strong  impressions  made  upon  the  mind  of  the 
mother  during  pregnancy,  epileptic  attacks  during  confinement,  and  vivid 
moral  commotions  on  the  part  of  the  nurse,  are  the  most  common  predispos- 
ing causes  in  idiopathic  epilepsy,  although  denied  by  some  authors.  Tissot, 
in  his  "  Treatise  on  Epilepsy,"  at  first  admits  an  hereditary  influence,  but 
afterwards,  rejects  it.  Doussin  Dubreuil,  decides  against  hereditary  influence. 
Other  observers  believe  that  epilepsy  can  be  transmitted  hereditarily,  and 
cite  facts  in  support  of  their  opinion.  Saillant,*  Maisonneuve,  and  Hoffmann, 
cite  numerous  examples,  as  interesting  as  conclusive,  in  favor  of  the  heredi- 
tary nature  of  epilepsy.  From  the  examples  which  I  have  gathered  from  our 
epileptic  women  at  the  Salpetriere,  epilepsy  is  more  frequently  transmitted  by 
the  father  than  the  mother,  while  the  contrary  is  true  with  respect  to  mania. 
When  the  eyes  of  children  are  convulsive,  when  they  have  tumors  upon  the  neck, 
and  a  shrill  voice ;  when  they  are  affected  with  a  dry  and  obstinate  cough  ; 
when,  on  becoming  larger,  they  experience  abdominal  pains,  unattended  with 
diarrhoea  ;  when  there  supervene  swellings  of  the  testes  ;  when  one  hand  be- 
comes emaciated,  an  arm  impotent,  or  when  the  legs  are  weak,  without  an  as- 
signable cause  ;  when  children  are  seized  with  fear  without  cause  ;  when  they 

*  Memoirs  of  the  Royal  Society  of  Medicine,  t.  iii,  p.  305,  and  t.  v,  {).  89. 


158  EPILEPSY. 

cry  aloud,  weep,  yawn,  and  continually  rub  the  forehead  ;  when  their  sleep  is 
interrupted  by  reveries  ;  if  they  have  convulsions,  we  ought  to  suspect  the 
existence  of  epilepsy,  especially  if  the  father  and  mother  are  affected  with  the 
same  malady.  If  convulsions  supervene  at  a  more  advanced  age,  these  com- 
memorative signs  aid  us  in  recognizing  essential  epilepsy.  They  will  enable 
us  to  appreciate  the  influence  of  symptoms,  which  we  regard  as  the  proximate 
cause  of  epilepsy  ;  such  as  gastric  embarrassment,  worms,  suppression  of  the 
menses,  etc.  Are  not  these  disorders,  the  eft'ect  of  preexisting  epilepsy,  or 
that  of  the  circumstances,  which  have  favored  the  development  of  the  mala- 
dy ?  If  so,  what  opinion  ought  we  to  entertain  respecting  medicines,  proper 
to  evacuate  the  bowels,  reestablish  the  menstrual  flow,  and  expel  worms  ? 
Hebreard*  proves,  that  the  expulsion  of  worms  is  not  sufficient  to  remove  epi- 
lepsy ;  their  presence  often  being  only  a  complication.  Medicines  have  been 
increased  in  quantity,  and  the  attacks  have  increased  in  frequency,  because 
we  did  not  reach  the  true  source  of  the  evil. 

To  these  causes  of  essential  epilepsy,  a  great  number  have  been  added. 
We  remarked  above,  that  sanguine  plethora  has  been  admitted  by  all  authors. 
Hippocrates  admits  the  superabundance  o{  phlegm,  as  one  of  the  causes  of 
idiopathic  epilepsy.  Moral  affections,  by  acting  upon  the  brain,  produce 
essential  epilepsy.  That  which  is  caused  by  anger,  is  less  permanent.  Fright 
and  chagrin  make  more  profound  and  powerful  impressions,  the  effects  of 
which  are  more  difficult  to  cure.  We  place  also,  among  the  causes  of  idio- 
pathic epilepsy,  vices  of  conformation  in  the  cranium,  and  lesions  of  the 
meninges  and  brain.  A  rapid  analysis  of  what  has  been  observed  at  the  post- 
mortem examinations  of  those  who  were  afflicted  with  epilepsy,  will  be  the 
means  of  determining,  if  it  be  possible  to  do  so,  the  seat  of  idiopathic  or 
essential  epilepsy. 

Leduc  remarked,  that  the  heads  of  epileptics  are  very  large,  the  bones  of 
the  cranium  very  thick,  and  the  sutures  effaced.  Lorry  has  confirmed  this 
observation.  Bontius  found  the  cranium  deformed,  and  Morgagni  observed 
the  same  in  a  great  number  of  subjects.  The  celebrated  Dumas  measured 
the  facial  angle  of  many  epileptics,  and  concludes  from  his  researches,  that 
children  are  exposed  to  epilepsy,  in  proportion  as  their  facial  angle  approaches 
seventy  degrees.  Bontius  found  in  one  case,  the  occipital  bone  nine  lines  in 
thickness,  and  Zacchias  found  the  internal  table  of  the  same  bone,  destroyed 
by  caries.  Bontius  saw  an  infant  of  six  weeks,  who  was  rendered  epileptic 
by  the  pressure  of  the  folds  of  its  cap,  and  who  was  cured  by  removing  this 
covering.  The  same  author  relates  the  case  of  a  young  man  who,  having  re- 
ceived in  infancy  blows  upon  the  head,  became  epileptic.  Bonet  cites  similar 
facts.  We  have  often  met  with  osseous  concretions,  developed  upon  the  falci- 
form process  of  the  dura-mater.  These  concretions  are  now  round,  now 
lengthened  and  sharp.  In  making  the  post-mortem  examination  of  an  epi- 
leptic, twenty-three  years  of  age,  who  died  during  an  attack,  I  found  adher- 
ing to  the  internal  face  of  the  dura-mater,  an  ovoid,  osseous  tumor,  eight 
lines  in  diameter,  depressing  the  superior  convolutions  of  the  brain. 

Are  not  the  various  eff'usions  observed,  between  the  meninges  and  the  cra- 
nium, and  in  the  arachnoid  cavity,  rather  the  effects,  than  the  cause  of  the 
malady  T  We  have  often  found  the  vessels  of  the  meninges  dilated,  engorged, 
and  varicose,  containing  fibrous  and  osseous  concretions.  What  inference  are 
we  to  draw  from  tliese  alterations  of  the  brain  ?  Morgagni  says,  that  in 
the  case  of  a  woman,  epileptic  for  two  years,  the  anterior  third  of  the  lefl; 
lobe  of  the  brain,  very  much  depressed,  was  reduced  to  an  extreme  softness, 
and  in  that  of  a  young  man,  the  bed  of  the  optic  nerve  of  the  right  side  re- 
sembled brownish  colored  pap.     The  brain  of  eight  epileptics,  appeared  to 


Medical  Library. 


EPILEPSY.  159 

Greding*  to  be  softened.  Morgagni,  Greding,  Meckel  and  Boerhaave,  found 
the  brain  of  epileptics  hard,  and  even  callous.  The  size  of  the  ventricles  of 
the  brain,  the  presence  of  a  fluid  more  or  less  abundant  in  them,  and  the  se- 
rous cysts,  developed  in  the  tissue  of  the  choroid  plexuses,  offer  varieties 
without  number,  yet  furnish  no  positive  data.  There  have  been  found,  within 
the  cranium  of  persons  who  have  died  of  epilepsy,  scirrus,  tuberculous,  fibrous 
and  osseous  tumors,  developed  in  the  ventricles,  and  in  the  substance  even,  of 
the  brain. 

Bauhin  and  Borrichius,  have  seen  abscesses  in  the  white  substance.  Bar- 
tholin removed  a  portion  of  a  sword  from  the  cavity  of  the  brain.  Didier  ex- 
tracted a  musket  ball  from  the  anterior  part  of  this  organ.  The  pineal  gland 
so  often  contains  osseous  concretions,  that  this  alteration  proves  nothing. 
Baillie  and  Soemmerring,  found  this  gland  very  hard,  while  Greding  found  it 
soft  in  twenty-five  cases  of  epilepsy.  He  also  assures  us,  that  among  twenty 
epileptics,  ten  had  the  pineal  gland  surrounded  with  serum.  The  pituitary 
body  has  been  the  special  object  of  the  researches  of  Wenzel.  This  author 
has  pointed  out  many  alterations  in  the  osseous  portion  which  forms  the  sella 
turcica,  and  the  apophyses  which  surmount  it.  At  one  time,  there  are  defects 
of  conformation,  at  another,  caries.  Among  twenty  epileptics,  Wenzel  found 
in  seven  cases,  the  pituitary  body  enlarged  ;  in  ten,  he  found  in  its  interior,  a 
yellow,  solid,  pulverulent  matter;  in  five,  instead  of  this  solid  substance,  there 
was  a  thick,  viscous  fluid.  This  body  often  presented  to  him  traces  of  in- 
flammation, when  there  was  no  alteration  of  the  brain  or  its  meninges.  Wen- 
zel indeed,  constantly  observed  some  alteration  in  the  pineal  gland  ;  but,  asks 
this  writer,  are  these  lesions,  the  cause  or  effect  of  epilepsy  1 

Neither  the  alterations  of  the  cranium,  nor  the  lesions  of  the  intra-cranial 
organs,  teach  us  what  is  the  seat,  or  what  are  the  organic  lesions,  of  which 
this  malady  is  the  expression.  Authors  have  neglected  to  mention,  in  their 
autopsies,  the  state  of  the  spinal  marrow  and  its  membranes.  Assisted  by  M. 
Amussat,  then  a  pupil  at  the  Salpetriere,  and  who  now  stands  so  high  in  pub- 
lic estimation,  I  endeavored  to  repair  this  omission.  In  order  to  lay  open  and 
remove  the  marrow,  M.  Amussat  invented  the  instrument  called  the  rachitoine, 
which  enables  us  to  ascertain  the  condition  of  the  spinal  marrow,  in  fatal 
cases  of  epilepsy.  In  the  case  of  twelve  epileptic  women,  ten  of  whom 
died  between  the  first  of  February  and  the  first  of  June  following,  we  found 
the  meninges  injected  in  one  case,  and  in  two  of  a  greyish  aspect.  In  nine 
cases,  there  were  concretions,  more  or  less  numerous,  disseminated  through- 
out the  whole  extent  of  the  external  face  of  the  arachnoid  covering  of  the 
spinal  marrow.  These  concretions,  which  were  of  a  lenticular  form,  were 
from  one  to  three  lines  in  diameter,  and  one  line  in  thickness.  Most  were 
cartilaginous,  the  remainder,  osseous.  We  found,  in  four  cases,  the  substance 
of  the  rachidian  prolongation,  altered  and  softened  ;  particularly  the  lumbar 
portion,  and  the  arachnoid  membrane,  contained,  in  one  case,  a  great  number 
of  hydatids.  Thus,  ten  examinations  of  epileptics,  indiscriminately  made, 
presented  in  nine  instances,  lesions  of  the  medulla  spinalis,  or  its  membranes. 
M.  Mitivie,  a  pupil  at  the  "  Children's  Hospital,"  found  the  same  concretions, 
in  two  children  who  died  epileptic.  Who  might  not  be  tempted  to  conclude, 
that  the  organs  contained  in  the  vertebral  canal,  were  the  seat  of  epilepsy, 
since  twelve  poRt-mortem  examinations  of  those  who  died  epileptic  had  pre- 
sented some  lesion  of  these  parts  ? 

A  woman,  fifty-three  years  of  age,  is  frightened.  She  has  convulsions,  and 
remains  epileptic.     The  attacks  return  every  second  or  third   day,  and   are 

*  Ludwig.  Adversaria  Medico-Practica.  LipsisB,  1769 — 1772,  3  vol.  in  8vo.  .It  is  in 
this  collection  that  J.  C.  Greding,  has  published  his  numerous  observations  on  the  em- 
ployment of  different  medicines  in  epilepsy.  * 


160  EPILEPSY. 

very  violent.  For  some  months,  the  attacks  become  more  and  more  frequent. 
She  dies  at  the  age  of  fifty-six,  after  an  attack  which  left  her  for  five  days  in 
a  comatose  state.  Post-mortem  examination. — We  found  hydatids  of  various 
sizes,  collected  about  the  medulla  oblongata,  from  whence  they  are  propagat- 
ed, in  great  numbers,  to  the  coxal  extremity  of  the  spinal  canal,  and  contain- 
ed in  the  sac,  formed  by  the  arachnoid  membrane.  There  is  softening  of  the 
lumbar  portion  cf  the  medullary  substance.  The  pituitary  body,  contains  a 
cyst,  filled  with  a  reddish  brown  fluid. 

A  child  has  had  convulsions,  from  the  time  of  its  first  dentition,  which,  at 
length,  degenerate  into  epileptic  attacks.  At  four  years  of  age,  they  become 
more  frequent.  At  the  age  of  five  years  and  a  half,  he  has  four  or  five  attacks 
daily,  and  becomes  paralytic  ;  dying  at  the  age  of  six  and  a  half  years.  At 
the  post-mortem  examination,  the  arachnoid  membrane  of  the  medulla  spinalis 
was  found  to  be  injected.  There  was  softening  of  the  medullary  substance 
near  the  sixth  and  twelfth  dorsal  vertebrae.  The  softened  substance  appeared 
slightly  yellow. 

Musel,  in  dissecting  two  epileptics,  found  the  spinal  vessels  varicose,  and 
engorged  with  blood.  Bonet  has  seen  the  spinal  canal  full  of  serum.  From 
all  these  researches,  particularly  from  those  of  Bonet,  Morgagni,  Baillie,  Gre- 
ding,  Meckel  and  Wenzel,  what  shall  we  conclude  1  Nothing.  Wepfer  and 
Lorry  have  drawn  this  sad  conclusion.  We  confess  frankly,  that  pathological 
anatomy,  has  up  to  this  period,  shed  little  light  upon  the  immediate  seat  of 
epilepsy.  However,  we  must  not  be  discouraged.  Nature  will  not  always 
prove  rebellious  against  the  efforts  of  her  investigators. 

What  shall  I  say  of  the  numberless  reveries  that  have  been  put  forth,  re- 
specting the  itnmediate  cause  of  epilepsy  ?  The  ancients  attributed  it  to  the 
influence  of  the  moon,  to  the  vengeance  of  the  celestials,  and  to  enchantments. 
Have  the  moderns  succeeded  better  with  their  systems  ?  Where  is  the  sub- 
stance that  produces  this  nervous  irritation  ?  Who  has  beheld  the  animal 
spirits  ?  Who  has  measured  the  force  of  their  elasticity  1  They  have  attri- 
buted epilepsy  to  the  Archeus,  to  a  tumultuous  and  confused  movement  of  the 
vital  principle,  or  rational  soul.  Hoffmann,  attributes  it  to  the  derangement 
of  the  course  of  the  humors,  which  prevents  the  distribution  of  their  spiritual 
part.  Some  are  of  the  opinion,  that  the  contraction  of  the  dura-mater  and 
envelopes  of  the  brain  and  nerves,  causes  epilepsy.  It  is  unnecessary  to  re- 
gard these  reveries  of  the  imagination.  Let  us  pass  to  the  diagnosis.  From 
the  analysis  of  the  symptoms  which  characterize  epilepsy,  from  the  knowledge 
of  the  causes  that  produce  it,  from  the  lesion  of  the  organs  upon  which  these 
causes  are  supposed  primarily  to  act,  we  may  establish  the  following  varieties. 
We  attach  moreover,  to  this  classification  no  other  importance  than  that  of 
enabling  us  to  present  within  a  small  compass,  the  therapeutic  indications. 

Epilepsy  is  divided  into  essential,  sympathetic,  and  symptomatic.  Essential 
or  idiopathic  epilepsy,  has  its  seat  in  the  brain  or  its  dependencies.  It  may 
be  divided  into  three  varieties. 

1.  Idiopathic  epilepsy,  produced  by  external  causes,  such  as  too  great  a 
degree  of  compression  upon  the  cranium,  contusions,  fractures,  insolation. 

2.  Idiopathic  epilepsy,  which  depends  upon  a  defect  in  the  structure  of 
the  cranium,  or  upon  a  lesion  of  the  meninges,  or  the  brain  ;  upon  serous  or 
sanguine  effusions  into  the  cranial  cavity. 

8.  Idiopathic  epilepsy,  which  we  may  call  nervous,  is  produced  by  moral 
affections,  either  on  the  part  of  the  mother  or  nurse,  or  on  that  of  the  patient 
himself.  Among  these  moral  causes,  anger,  fear  and  imitation,  are  most  to 
be  dreaded. 

Sympathetic  epilepsy  presents  five  varieties,  clearly  defined. 

1.  Sympathetic  epilepsy,  whose  seat  is  in  the  digestive  apparatus.  It  is 
caused  by  the  meconium,  by  matters  accumulated  in  the  stomach  or  intes- 


EPILEPSY.  161 

tines,  by  intestinal  worms,  by  the  indigestion  of  food,  or  substances  of  an  irri- 
tating nature. 

2.  Sympathetic  angiotenic  epilepsy,  which  has  its  seat  in  the  sanguine  sys- 
tem. Epilepsia  plcthorica  of  Bonet ;  Epilepsia  polyposa  of  F.  Hoffmann. 
The  suppression  of  the  menses,  of  hemorrhoids,  and  of  habitual  evacuations,  as 
well  as  errors  of  regimen  and  abuse  of  liquors,  provoke  it. 

3.  Sympathetic  epilepsy,  which  has  its  seat  in  the  lymphatic  system  ;  epi- 
lepsia humoralis,  metastatiea,  of  authors  ;  epilepsia  cachcetica,  of  F.  Hoff- 
mann ;  epilepsia  serosa,  of  Charles  Pison  ;  epilepsia  scorbutiea,  syphilitica,  of 
Bonet.  Pale,  chlorotic,  rachitic  and  scrofulous  subjects,  are  predisposed  to  it. 
The  retrocession  of  tinea  capitis,  psora,  of  an  ulcer,  of  syphilis  or  the  gout, 
produce  this  variety. 

4.  Sympathetic  epilepsy,  which  has  its  seat  in  the  organs  of  reproduction  ; 
epilepsia  genitalis,  epilepsia  ttterina,  of  Sennert ;  epilepsia  ab  utero,  of  Jon- 
ston.  The  abuse  of  venereal  pleasures,  onanism,  continence,  pregnancy,  and 
confinement,  are  the  remote  or  proximate  causes  of  it. 

5.  Sympathetic  epilepsy,  which  has  its  seat  in  the  external  organs  ;  epilep- 
sia sympathica,  of  authors.  Every  cause,  whether  apparent  or  concealed,  which 
irritates  any  one  of  the  external  parts,  and  whose  secondary  effect  irradiates 
towards  the  brain,  produces  this  variety  of  epilepsy. 

Epilepsy  is  symptomatic  of  the  cutaneous  phlegmasife,  of  retarded  denti- 
tion, of  the  eruption  of  variola,  rubeola,  scarlatina,  etc.,  or  of  the  sudden  dis- 
appearance of  these  eruptions.  With  respect  to  that  form  of  epilepsy,  which 
is  simulated  or  feigned,  it  may  be  caused  by  various  motives  ;  for  example, 
that  of  obtaining  a  thing  ardently  desired  ;  as  was  the  case  with  the  girl  who, 
having  heard  that  marriage  was  recommended  for  epileptics,  feigned  the  dis- 
ease to  obtain  the  remedy.  Epilepsy  is  feigned,  to  avoid  a  thing  which  may 
be  repugnant.  Our  young  conscripts  had  recourse  to  this  means.  I  knew  an 
old  officer,  who  had  been  brought  before  the  revolutionary  tril)unal,  who  feign- 
ed an  attack  of  epilepsy  and  was  saved.  School-children,  in  order  to  avoid 
attending  school,  have  also  deceived  their  parents  ;  but  a  physician  will  not 
long  be  mistaken,  if  he  be  attentive. 

I  have  spoken  above  of  the  crises  of  epilepsy.  We  must  say  something 
of  the  prognosis,  which  is  not  altogether  so  unfavorable  as'  is  generally  sup- 
posed. Epilepsy  is  a  long  and  dangerous  malady,  but  is  rarely  fatal  at  its  first 
attack.  When  it  is  hereditary  and  fixed,  it  is  not  cured.  Sympathetic  epi- 
lepsy is  cured  more  easily  than  the  essential  form,  although  the  latter  may  not 
always  be  incurable.  Epilepsy  rarely  affects  children  who  have  sores  upon 
the  head.  Sometimes  epilepsy  disappears  for  several  years,  to  reappear,  with- 
out any  new  appreciable  cause.  Those  who  are  attacked  soon  after  birth,  are 
rarely  cured.  If  not  restored  at  puberty,  they  remain  incurable.  Those  who 
become  epileptic  between  the  age  of  three,  four,  and  ten  years,  are  restored, 
if  treated  in  time.  Those  who  are  seized  with  epilepsy,  a  little  before  the 
age  of  puberty,  are  cured  when  this  crisis  is  complete.  Those  who  become 
epileptic  after  the  age  of  puberty,  are  sometimes  cured,  though  Hippocrates 
may  have  thought  otherwise.  Marriage  only  cures  genital  epilepsy.  It  aug- 
ments the  other  forms.  A  pregnant  woman  who  becomes  epileptic,  runs  a 
great  risk.  When  the  attacks  increase  in  frequency,  and  acquire  intensity, 
we  oucfht  to  fear  death.  Death  takes  place,  not  durinor  the  horror  of  the  con- 
vulsions,  but  during  the  period  of  prostration  which  succeeds. 

Epilepsy,  complicated  with  mental  alienation,  is  never  cured.  The  physi- 
cian, says  Hippocrates,  who  knows  by  regimen,  how  to  change  the  tempera- 
ment, to  render  it  cold  or  warm,  dry  or  humid,  will  succeed  in  curing  epi- 
lepsy. However,  there  are  few  maladies,  for  which  a  greater  number  of  me- 
dicaments have  been  proposed,  or  those  more  absurd.     Some  regarded  only 

21 

*.  ■ .  • 


162  EPILEPSY. 

the  condition  of  the  alimentary  canal,  and  prescribed  evacuants ;  others  have 
bled  ;  the  former  desired  to  calm  the  fury  of  the  attacks,  the  latter  endeavor- 
ed to  ffive  steadiness  to  the  inordinately  impressible  nerves.  In  fine,  tonics  of 
the  most  energetic  kind  have  been  prodigally  employed.  Unable  to  discover 
a  rational  tre°atment,  they  have  sought  for  specifics,  which  have  been  multi- 
plied without  end.  The  best  minds,  disappointed  by  medicine  the  most  cele- 
brated, have  regarded  epilepsy  as  beyond  the  resources  of  medicine,  and  de- 
clared' it  incurlible  to  the  great  detriment  of  the  sick.  Epileptics  have  be- 
come the  prey  of  charlatans.  If  physicians  had  accorded  to  hygienic  aids 
the  importance  which  they  merit,  and  had  not  preferred  the  exclusive  use  of 
medicines  and  drugs,  they  would  have  met  with  better  success. 

Before  entering  upon  the  details  of  treatment,  I  will  state  what  I  have  ob- 
served with  respect  to  this  disease  at  the  Salpetriere,  in  the  division  of  the 
epileptics,  in  whose  service  I  was  employed  for  ten   years.     I  had  charge  of 
three  hundred  and  eighty-five  women,  or  girls,  of  every  age  passed  puberty, 
belonging  to  the  class  of  paupers.     Among  this  number,  forty-six  were  hyste-' 
ricalj'and   three  hundred   and   thirty-nine  epileptic.     The  greater  part,  as   I 
remarked  page  149,  were   more  or   less  habitually  insane.     I  was   no   better 
satisfied  with^'the  description  that  authors  have  given  of  epilepsy,  and  with  the 
results  of  post-mortem  examinations  which  they  have  published,  than  with  the 
success  of  the  medicines  which   they  have  proposed,  to  combat  this   almost 
always   rebellious   malady.     I  wished   to   submit  to  my  own  observation,  the 
efficacy  of  the  most  varied  remedies.     I  employed  successively,  sanguine  eva- 
cuations and  purgatives,  baths  of  every  temperature,  issues,  the  cautery,  fire, 
and  antispasmodics,  vegetable  and  mineral.     I  confined  myself  to  hydrocy- 
anic  acid.     I  procured   and  purchased   secret   remedies.     Every  spring   and 
autumn,  I  chose  thirty  epileptic  women,  with  the  history  of  whose  malady  I 
was  best  acquainted  ;   its  causes   and  symptoms.     The  women  were  prepared 
in  advance,  by  repeated  promises  of  a  certain  cure.     I  was  very  much  assist- 
ed by  the  watchfulness  of  the  pupils. 

A  new  medicine  invariably  suspended  the  attacks  with  some,  for  fifteen 
days  ;  for  a  month,  two  months,  and  even  for  three  months,  with  others.  Af- 
ter this  period,  they  returned,  presenting  in  every  case  the  same  characters  that 
they  had  done  in  preceding  years.  Several  of  our  epileptics  submitted  them- 
selves to  my  treatment  for  several  years  ;  but,  shall  I  confess  it !  I  did  not 
obtain  a  single  cure.  In  my  private  practice,  I  was  scarcely  more  happy.  If 
the  attacks  were  suspended,  it  was  less  by  the  action  of  medicines,  than  the 
effect  of  the  confidence  which  determines  a  patient  to  consult  a  new  physi- 
cian. Is  not  this  remission  or  suspension,  generally  observed  by  physicians 
who  are  called  to  treat  chronic  diseases,  particularly  those  called  nervous  ? 

Ere  long  I  perceived  that  epilepsy  is  rarely  curable.  It  has  happened  that 
cures  of  hysteria  have  been  published,  which  were  supposed  to  be  epilepsy. 
The  mistake  is  easy,  so  greatly  does  the  latter  malady  resemble  epileptiform 
hysteria.  Authors  have  also  taken  for  a  cure,  the  spontaneous  suspension  of 
the  attacks,  as  well  as  their  suspension  from  every  new  mode  of  medication. 
This  error  is  the  more  readily  committed,  as  the  patients  are  lost  sight  of,  by 
the  physician,  who  is  not  consulted  on  the  return  of  the  attack.  The  follow- 
ing case  will  justify  my  suspicions  respecting  the  cure  of  epilepsy,  and  put  us 
on  our  guard  against  precipitancy  in  our  judgment. 

When  I  assumed  the  duties  of  a  medical  officer  at  the  Salpetriere,  Doctor 
Landre-Beauvais,  who  had  preceded  me  in  charge  of  this  department,  handed 
me  notes  of  those  cases  which  he  had  submitted  to  a  particular  treatment. 
At  this  period,  the  strongest  confidence  was  placed  in  the  efficacy  of  the  ni- 
trate of  silver.  My  colleague  had  made  trial  of  it,  and  remitted  to  me  the 
following  note  respecting  N.     She  has  employed  the  Nitrate  of  Silver,  for  a 


EPILEPSY.  163 

long  time,  and  has  had  no  attack  for  six  months.  Her  menses,  which  uiere 
suppressed,  are  reestablished.  Six  months  pass  away,  and  N.  demands  a  dis- 
charge from  the  hospital,  because  she  has  been  restored  for  a  year  and  is  now 
very  well.  Before  making  out  a  certificate  of  discharge,  required  by  the 
regulations  of  the  hospital,  I  addressed  several  questions  to  her  respecting  the 
causes  of  her  malady  and  cure.  In  her  reply,  she  made  the  following  disclo- 
sures. "  Jealousy  and  mortification  suppressed  the  menstrual  discharge,  and 
I  was  immediately  seized  with  an  attack.  I  was  admitted  into  the  hospital, 
and  many  remedies  were  employed.  M.  Landre-Beauvais  ordered  me  pills  of 
silver,  and  I  took  them  for  several  weeks.  Finding  myself  no  better,  I  laid 
them  aside.  I  said  nothing  about  it,  through  fear  of  grieving  M.  Beauvais, 
who  was  very  kind  to  us.  Sometime  after,  a  woman  in  the  hospital  gave  me 
a  very  strong  ptisan,  in  order  to  bring  about  a  return  of  the  menses.  She 
succeeded.  The  attacks  of  epilepsy  have  not  appeared  for  a  year.  My  "pe- 
riods" are  regular  and  abundant.  I  no  longer  have  attacks  nor  vertisfoes.  I 
am  quite  well,  and  am  going  to  return  to  the  house  of  my  master."  Two 
months  after  her  discharge,  she  comes  to  solicit  a  readrnission  to  the  hospital 
as  the  attacks  had  reappeared.  The  nitrate  had  not  cured  the  patient.  Thus 
my  confrere,  an  equally  good  observer  and  judicious  practitioner,  contented 
himself  with  recording  in  his  notes  ;  "  N.  has  made  use  of  the  nitrate  of 
silver,  and  her  menses  have  been  restored  for  six  months,  since  which  period 
she  has  had  no  attacks,"     He  does  not  add,   "  N.  is  cured." 

This  fact  among  a  thousand,  proves  how  distrustful  we  should  be,  respect- 
ing the  administration  and  effects  of  medicines ;  and  with  how  much  reserve 
we  should  proclaim  the  cure  of  a  malady,  especially  of  a  malady  of  the  ner- 
vous system.  To  treat  epilepsy,  we  must  not  only  attack  the  cause,  but  re- 
move the  disposition  to  a  return  of  the  attacks.  We  must  prevent  the  attacks 
when  they  announce  themselves  by  precursory  signs,  and  avoid  the  accidental 
causes  which  may  provoke  them.  The  best  practitioners  are  of  the  opinion 
that  nothing  is  to  be  done  during  the  attack,  but  precautions  must  be  taken, 
lest  the  patient  injure  himself  If  we  have  given  some  attention  to  the  symp- 
toms calculated  to  reveal  the  cause  of  epilepsy,  and  the  organ  upon  which  this 
cause  primarily  acts,  we  shall  have  presented  to  us  the  principles  of  treatment, 
which  are  suited,  not  to  epilepsy  in  general,  but  to  each  species  or  variety  in 
particular. 

Thus,  epilepsy  which  has  its  seat  in  the  digestive  system,  should  be  treated, 
if  there  is  gastric  embarrassment,  by  emetics  and  purgatives,  selected  from 
among  those  which  do  not  debilitate.  Galen  employed  the  oxymel  of  squills 
with  the  greatest  success.  If  there  is  irritation,  we  prescribe  sanguine  evacu- 
ations and  sedatives.  The  Artemesia  Santonica  and  Calomel,  are  employed 
when  worms  infest  the  alimentary  canal.  The  mineral  waters  of  Balaruc,  of 
Spa  and  of  Pyrmont  have  been  found  useful.*  The  patient  should  avoid 
every  thing  that  can  surcharge  the  stomach,  such  as  greasy  substances,  butter, 
and  salted  food.  If  we  suspect  some  engorgement  of  the  liver,  whey  with 
cream  of  tartar,  the  mineral  acids,  particularly  the  sulphuric,  are  recommend- 
ed, as  well  as  the  Cichorium  Intybus  [Succory),  Saponaria  officinalis,  and  tepid 
baths  These  means,  which  the  discretion  of  the  physician  must  modify,  should 
be  combined  with  tonics,  Peruvian  bark.  Valerian,  etc. 

Epilepsy,  which  has  its  seat  in  the  sanguine  system,  ought  to  be  combated 
on  other  therapeutic  principles.  If  there  is  plethora,  attended  with  cerebral 
congestion,  general  blood-letting,  repeated  if  necessary,  cups,  and  leeches  ap- 
plied to  the  temples  or  behind  the  ears,  particularly  among  children,  are  use- 
ful. We  recall  suppressed  sanguine  evacuations,  whether  normal  or  patholo- 
gical.    If  puberty,  or  the  first  appearance  of  the  menses  does  not  remove  the 

*  See  Hooper's  Med.  Dictionary,  article  Mineral  Waters. 


164  EPILEPSY. 

disease,  it  should  be  treated  like  essential  epilepsy.  If  menstrual  disorders 
are  the  effect  of  epilepsy,  we  should  fear  exasperating  the  evil  by  the  persever- 
ing administration  of  cmmenagogues.  We  shall  avoid  error,  if,  returning  to 
earliest  infancy,  we  discover  the  first  indications  of  epilepsy,  that  is,  convul- 
sions, or  incomplete  attacks.  As  it  respects  regimen,  we  insist  upon  the 
means  proper  to  moderate  the  activity  of  the  circulation ;  to  prevent  its  too 
strong  impulse  towards  the  head,  and  to  render  sanguification  less  active. 
Insolation,  large  assemblies  in  warm  and  imperfectly  ventilated  apartments, 
violent  exercises,  liquors,  and  the  violent  passions,  should  be  avoided,  and  also 
constipation.  Epilepsy,  which  has  its  seat  in  the  lymphatic  and  absorbent  sys- 
tem, and  which  is  produced  by  the  suppression  of  the  transpiration,  or  an 
ulcer,  the  retrocession  of  psora,  herpes  or  the  gout,  requires  a  treatment 
adapted  to  reestablish  these  various  affections.  It  is  with  this  view,  that  it  has 
been  recommended  to  dwell  in  cow  stables,  in  cases  of  epilepsy  that  have  been 
produced  by  the  suppression  of  the  transpiration.  M.  Landre-Beauvais,  with 
reference  to  this  suggestion,  directed  the  following  experiment  to  be  made  at 
the  hospital  of  the  Salpetriere.  Four  beds  were  placed  in  the  stable,  in  which 
four  cows  were  kept.  Four  young  epileptics  occupied  this  stable  for  several 
months,  and  were  replaced  by  others.     The  result  was  absolutely  null. 

Does  difference  of^  climate  and  regimen,  explain  why  this  means  has  suc- 
ceeded elsewhere,  while  it  has  been  unsuccessful  with  us  ?  Finally,  we  un- 
derstand that  a  treatment,  suited  to  reestablish  tlie  transpiration,  would  be 
favorable  in  that  form  of  epilepsy,  which  is  caused  by  the  suppression  of  this 
function.  Thus,  tepid  baths,  frictions,  moderate  exercise  in  the  open  air,  etc., 
would  be  useful.  Issues  have  succeeded,  when  we  have  wished  to  produce  a 
derivative  irritation,  or  have  desired  to  replace  a  cutaneous  affection,  an  ulcer, 
tinea  capitis,  or  tetter.  Exutories  upon  a  large  surface,  ought  to  be  continued 
for  a  long  time,  even  after  a  cure  has  been  effected.  Epilepsy,  which  has  its 
seat  in  the  organs  of  reproduction,  offers  numerous  considerations  which  ought 
to  control  our  treatment.  If  epilepsy  is  produced  by  the  constitutional  effort 
that  takes  place  at  the  age  of  puberty,  the  patient  requires  a  good  regimen 
and  exercise ;  gymnastics  and  the  cold  bath,  are  not  to  be  neglected.  If  it  is 
suppression  of  the  menses,  or  menstrual  disorder  which  has  produced  epilepsy, 
we  must  reestablish  or  regulate  this  evacuation,  and  if  the  constitution  of  the 
patient  is  strong,  and  we  have  reason  to  suppose  that  atony  of  the  organs  of 
reproduction  exists,  marriage  may  be  advised.  By  reestablishing  an  equilibrium 
in  the  distribution  of  the  vital  forces,  epilepsy  will  cease.  But  we  must  not 
lose  sight  of  the  fact,  that  often,  the  suppression  of  the  menses  is  not  the 
cause  of  epilepsy ;  tliat  the  true  cause  acts  sometimes  from  earliest  infancy, 
especially  in  hereditary,  or  constitutional  epilepsy,  and  in  the  case  of  children 
committed  to  the  care  of  mercenary  nurses  or  strangers.  If  onanism  has 
been  the  cause  of  this  frightful  malady,  we  must  have  recourse  to  all  those 
means  which  can,  so  to  speak,  renew  the  temperament.  Bark,  valerian,  the 
martial  preparations,  asses'  milk,  a  diet  of  white  meats,  and  analeptics  gene- 
rally, are  serviceable.  Corporeal  exercises,  on  horseback,  by  fencing,  dancing, 
cold  baths,  river  baths,  swimming  and  affusions,  often  so  useful,  would  be 
dangerous,  if  there  existed  engorgements,  or  suppuration  in  the  viscera. 

The  different  examples  which  we  have  given  above,  furnish  to  the  practi- 
tioner some  special  indications.  If  the  cause,  which  acts  primarily  upon  an 
oro-an,  is  easily  removed  or  destroyed,  we  eradicate  it.  We  apply  fire,  caus- 
tics, setons  or  cupping  glasses,  over  the  part  from  whence  the  aura  cpileptica 
proceeds.  It  has  been  proposed  even  to  divide  the  nerves.  Antispasmodics 
and  reorimen,  ought  to  second  the  local  means.  Can  idiopathic  epilepsy  be 
cured,  if  it  depend  upon  an  organic  lesion,  or  upon  a  vice  of  conformation? 
What  are  we  to  expect  from  medicines?     The  physician  who  is  a  wise  obser- 


EPILEPSY.  165 

ver,  avoids  the  use  of  them,  and  confines  himself  to  regulating  the  regimen, 
and  shunning  those  circumstances  which  are  calculated  to  produce  a  return 
of  the  attacks.  The  cautery,  moxa,  and  the  trephine  have  been  recommend- 
ed, when  the  recollection,  and  a  fixed  pain  in  the  head,  lead  us  to  hope  to 
reach  the  cause  of  the  evil,  or  when  the  symptoms  indicate  infiltration  of  the 
brain  or  its  meninges,  by  serum,  or,  as  the   ancients  would  say,  by  phlegm. 

The  prince  of  ,  epileptic  from  his  earliest  youth,  would  permit  no  one 

to  approach  him,  notwithstanding  the  entreaties  of  his  family.  With  the  pro- 
gress of  age,  the  attacks  became  more  frequent ;  and  at  fifty-seven  years  of 
age,  he  is  taken  with  an  attack  and  falls  headlong  into  the  fire.  After  havino- 
burned  through  the  scalp,  the  fire  penetrates  even  to  the  external  table  of  the 
parietal  bone.  An  abundant  suppuration  is  established,  and  the  wound  is  kept 
open  by  a  portion  of  necrosed  bone.  The  sick  man,  having  become  impa- 
tient, demands  the  service  of  a  surgeon,  who  removes  the  bony  fragment,  and 
cicatrization  advances  rapidly.  It  is  complete  in  the  space  of  forty-two  days. 
During  all  this  period,  the  patient  had  no  attack ;  but  they  immediately  re- 
turned after  the  cure  of  the  wound.  One  of  them  is  followed  by  mania  with 
fury.  Two  large  bleedings  control  the  delirium.  At  a  numerous  consulta- 
tion, I  proposed  to  open  the  woimd  with  the  actual  cautery.  Those  composino- 
the  consultation,  preferred  two  issues  in  the  neck.  These  produced  no  effect. 
I  have  ever  since  regretted,  that  my  advice  in  the  case  had  not  been  reo-ard- 
ed.  Valentin  cites  the  cases  of  epileptics,  who  have  been  cured,  by  the  ac- 
tual cautery  applied  to  the  head. 

[As  illustrative  of  the  efl'cct  of  powerful  and  long  continued  counter-irritation  in  the 
treatment  of  Epilepsy,  I  would  state  the  following  case  :  A.  W.  S.,  a  young  man,  now  19 
years  of  age,  has  been  subject  to  epileptic  paroxysms,  gradually  increasing  in  frequen- 
cy ever  since  his  tenth  year.  His  first  attack  occurred  within  an  hour  after  eating,  ad 
libitum,  of  almonds  and  raisins.  It  was  on  an  anniversary  occasion,  when  the  largest 
liberty  is  usually  extended  to  children,  and  the  energies  of  both  mind  and  body  are  taxed  to 
the  utmost.  Being  the  only  member  of  a  large  family  who  had  ever  been  seriously 
ill,  this  dreadful  occurrence  excited  the  liveliest  sympathy.  The  attacks  continued  to  re- 
cur, notwithstanding  every  effort  that  a  father's  tenderness  and  the  skill  of  the  most  able 
physicians,  could  suggest.  So  trying  to  the  feelings  of  the  iemale  members  of  the  family 
were  his  paroxysms,  and  such  their  efi'ect  upon  the  mind  of  the  patient,  that  he  was  at 
length  placed  at  the  Retreat  at  Hartford,  Conn.  In  this  Institution,  during  a  period  of 
nearly  four  years,  he  was  submitted  to  every  variety  of  treatment,  both  moral  and  medi- 
cal, that  offered  the  smallest  prospect  of  relief,  but  without  success.  In  the  month  of 
December,  1843,  his  attendant  rose  as  usual  at  an  early  hour  in  the  morning,  built  a  fire 
in  his  stove — the  pipe  of  which  was  carried  up  a  few  feet,  then  returned,  and  after  being 
brought  near  the  floor,  by  an  angle  conveyed  into  the  flue — and  left  the  room  for  a  few 
moments  to  procure  a  pitcher  of  water.  During  his  absence  the  patient  arose,  went  to 
the  stove,  and, — feeling  an  unpleasant  sensation  in  his  head, — leaned  forward  over  the 
pipe,  to  bathe  it  in  a  basin  of  water  which  stood  on  the  other  side.  At  that  moment  he 
was  seized  with  a  paroxysm,  and  fell  with  his  abdomen  directly  across  the  heated  pipe, 
from  which  it  was  protected  only  by  a  thin  surface  of  cotton  cloth.  He  was  heard  to 
fall  by  a  person  occupying  the  room  beneath,  who  immediately  ran  to  his  assistance,  but 
not  before  a  frightful  burn  had  taken  place.  A  deep,  suppurating  wound,  embracing 
nearly  the  entire  surface  of  the  abdomen,  confined  him  to  his  bed  for  several  months, 
reducing  the  system  excessively,  and  for  many  weeks  threatening  his  life.  He  at  length 
however  recovered,  and  has  never  had  an  attack,  (now  almost  eleven  months),  since 
that  connected  with  the  injury  just  described.  He  is  still  cautious  with  respect  to  regi- 
men, avoiding  sources  of  much  excitement,  and  confining  himself  mainly  to  farinaceous 


166  EPILEPSY. 

and  vegetable  food.     He  reads  however,  studies,  and  submits  himself  often  to  influences 
which  formerly  resulted  uniformly  in  a  fit. 

How  long  this  reprieve  will  last, — if  it  be  a  reprieve  merely, — time  alone  will  show. 
Though  perhaps  practically  of  little  utility — as  this  agent,  to  a  similar  extent  will  never 
be  resorted  to  as  a  remedy — it  furnishes  still  further  evidence  that  the  causes  of  epilepsy 
are  deeply  seated,  and  that  the  severest  shock  to  the  whole  system,  compatible  with  life, 
can  alone  be  expected  to  be  attended  with  salutary  and  permanent  results.  It  may  be 
proper  to  add,  that  this  patient  was  bled  several  limes  during  the  early  part  of  his  treat- 
ment, took  purgatives  at  brief  intervals,  had  a  seton  open  for  many  months  in  his  neck, 
was  put  upon  a  rigidly  abstemious  diet,  avoiding  meats,  stimulants,  and  indigestible  food, 
and  had  recourse  to  gentle  exercise.  By  one  physician,  with  whom  he  spent  a  conside- 
rable period,  the  Nitrate  of  Silver  was  employed  freely.  After  his  admission  at  the  Re- 
treat, the  seton  was  continued  for  a  time,  and  a  restricted  regimen  enjoined.  Part  of  the 
time,  exercise  in  the  country  was  permitted  ;  and  at  other  periods,  in  order  to  avoid 
mental  excitement,  he  was  confined  to  his  room.  At  his  own  urgent  solicitation,  he  was 
kept  in  his  room  for  three  successive  months,  and  limited  to  a  tea-cupful  of  mush  and 
milk  three  times  a  day,  during  the  whole  period.  During  this  time,  his  mind  was  in  a 
calm  and  cheerful  frame,  and  an  interval  of  seven  weeks  elapsed  between  the  parox- 
ysms. The  records  show  that  he  took  Hydrocyanic  Acid  for  about  three  months — from 
one  to  three  drops  at  a  dose — thrice  a  day.  The  shower  bath  was  administered  twice  a 
week  for  many  months.  He  was  put  upon  full  doses  of  the  Sulphate  and  Oxyd  of  Zinc, 
the  Exts.  of  Strammonium  and  Belladonna, — took  Valerian  and  Ammoniated  Copper — 
his  bowels  being  kept  free,  sometimes  by  salines,  sometimes  by  drastics,  and  at  others  by 
laxatives.  From  none  of  these  agents  was  any  benefit  received,  and  but  brief  and  tem- 
porary amelioration  of  any  of  the  symptoms.  A  very  abstemious  diet  rendered  the  inter- 
vals between  the  fits  longer  than  anything  else,  and  also  made  him  more  pleasant.  It 
has  always  been  observed,  that  if  he  ate  heartily,  or  partook  of  fruit,  or  of  a  variety  of 
food,  it  made  him  worse.  Medicine  was  suspended  and  renewed  at  intervals,  but  with 
little  benefit;  and  at  the  time  of  his  accident,  no  expectation  of  his  recovery  was  enter- 
tained. He  now  takes  Quinise  Sulphat  gr.  1,  Morphia?  Sulphat  gr.  1-8  in  Camphor  mix- 
ture, three  times  a  day.  Diet  limited  to  vegetable  and  farinaceous  food,  in  moderate 
quantity.]* 

Henricus  ab  Heers,  cites  the  example  of  a  girl  who,  near  the  time  of  her 
marriage,  was  frightened  by  two  men  in  a  state  of  intoxication,  who  endeavor- 
ed to  violate  her.  Muriate  of  Antimony,  applied  to  the  great  toe  of  either 
foot,  until  the  bone  was  denuded,  terminated  the  attacks.  When  our  eloquent 
and  learned  Pariset,  then  physician  at  the  Bicetre,  was  sent  to  Cadiz,  to  inves- 
tigate the  yellow  fever,  I  was  charged  with  the  service  of  the  insane  and  epi- 
leptics in  that  ho.spital.  I  found  twenty  epileptics  submitted  to  the  experi- 
ments of  my  professional  brother.  Moxas,  to  the  number  of  two  and  even 
three,  had  been  burned  upon  the  most  elevated  part  of  the  head,  and  the  ustipn 
had  penetrated  even  to  the  external  table  of  the  bones.  The  wounds  were 
kept  open  with  the  greatest  care.  I  could  not  furnish  undeniable  proof  of  a 
single  cure.  There  was  brought  to  the  Salpetriere,  a  young  epileptic  whose 
attacks  began  in  the  great  toe.  On  the  faith  of  authors,  I  believed  the  cure 
certain.  The  toe  was  cauterized  to  the  bone.  Far  from  having  cured  my 
young  patient,  the  attacks  were  no  longer  announced  by  pain  in  the  great  toe ; 
there  was  no  longer  an  epileptic  aura;  but  they  were  both  more  frequent  and 
violent.     Finally,  essential  epilepsy  ought  to  call  into  exercise  all  the  attention 

*  This  patient,  I  have  just  learned,  returned  to  his  father's  family  a  little  more  than  a 
year  after  liis  last  attack  at  the  Retreat,  but  was  seized  with  a  fit  about  four  days  after 
his  return. 


EPILEPSY.  167 

of  the  practitioner.  It  is  against  this  form,  as  it  occurs  among  children,  that 
we  have  sometimes  employed  with  success,  valerian,  bark,  iron,  the  misletoe 
of  the  oak,  (Viscum  album)  musk,  opium,  camphor,  assafcetida,  mercury,  etc. 
Let  us  examine  briefly,  the  importance  of  these  substances,  and  fix  the  degree 
of  confidence  which  they  respectively  merit. 

Valerian  is  one  of  the  medicines,  whose  reputation  is  most  generally  ad- 
mitted. There  is  no  practitioner  who  has  not  congratulated  himself  upon  the 
use  of  it.  Its  decoction  is  feeble  and  unpleasant  to  the  taste.  We  give  it  in 
substance,  in  the  dose  of  from  one  to  two  ounces  a  day,  in  powder  or  extract. 

[The  quantity  of  Valerian  here  recommended,  greatly  exceeds  the   dose  usually  em 
ployed.     From   one  half  a  drachm,  to  a  drachm  three   or   four  times  a  day,  would  gene- 
rally be  regarded  as  a  full  dose,  and  as  much  as  could  well  be  borne.] 

The  peony,  (Paeonia  ofiicinalis),  is  worthy  of  no  confidence.  The  misletoe 
of  the  oak,  has  been  employed  by  those  entertaining  superstitious  views,  with 
more  benefit.  It  is  now  abandoned.  Musk,  so  useful  in  certain  ataxic  fevers 
and  convulsions,  has  been  useful,  but  would  be  injurious  in  plethoric  epilepsy. 
The  same  is  true  of  opium,  whose  employment  requires  much  prudence,  al- 
though it  may  have  succeeded  in  essential  epilepsy,  caused  by  moral  affec- 
tions ;  in  epilepsy  sympathetic  of  very  violent  local  pains,  and  in  nocturnal 
epilepsy.  Bark,  and  the  leaves  of  the  orange-tree  in  substance,  are  useful ; 
camphor  and  assafcetida  have  had  their  admirers.  Iron  is  preferable  to  bark, 
in  debilitated  and  chlorotic  cases,  when  it  is  particularly  desirable  to  stimu- 
late the  circulation.  Mercurial  frictions  have  been  proposed,  to  combat  epi- 
lepsy consecutive  to  syphilis.  Calomel  is  recommended,  not  to  combat  a 
particular  infection,  but  to  change  the  general  action  of  organs,  and  to  in- 
crease the  activity  of  the  functions  of  the  lymphatic  system.  Thouret  and 
Andry*  assure  us,  that  they  have  sometimes  obtained  happy  effects  from  the 
application  of  artificial  magnets.  In  England,  they  have  tried  the  inhalation 
of  a  mixture  of  oxygen  gas  and  atmospheric  air.  Their  success  has  been 
more  than  uncertain.  These  various  experiments,  merit  the  careful  attention 
of  observers.  I  hesitate  about  saying  so  much  respecting  electricity  and  gal- 
vanism. 

Shall  we  give  the  name  of  medicines  to  those  substances,  whose  employ- 
ment would  appear  incredible  to  those  who  know  not  to  what  degree  of  de- 
gradation man  can  descend,  when  given  over  to  ignorance  and  prejudice  ? 
Will  it  be  believed  that  physicians  have  prescribed  earth  worms,  siccdloioed 
fasting;  the  powder  of  an  elk's  foot,  the  heel  of  a  hare,  the  after-birth  of  a 
first  horn  dried;  the  scrapings  of  a  human  skull,  and  the  vertebrae;  besides 
the  dried  brain  of  a  man  and  raven  1  They  have  prescribed  human  blood 
warm,  the  little  bones  of  the  ear  of  a  calf,  the  back  bone  of  a  lizard  stripped 
of  its  flesh  hy  ants,  the  heart  and  liver  of  a  mole,  of  a  frog,  and  of  many  other 
substances,  more  or  less  disffU-stinff  and  absurd.  Will  it  be  believed,  that  in 
our  day,  it  has  been  proposed  to  insert  an  amethyst  beneath  the  skin  of  the 
arm  or  some  other  member,  as  an  infallible  specific?  Without  wishing  to 
rank  the  metallic  salts  in  this  revolting  enumeration,  I  think  that  they  ought  to 
be  proscribed.  Is  their  use  serviceable  1  The  perturbation  which  they  pro- 
duce in  the  organism,  and  upon  which  is  founded  the  hope  of  cure,  is  too 
hazardous  and  often  too  serious,  especially  if  employed  by  rash  or  unskillful 
hands.     Thus  we  reject  as  dangerous,  the  salts  of  copper  and  jiitrate  of  silver, 

*  A.  Portal,  in  his  work  (Observations  on  the  Kature  and  Treatment  of  Epilepsy,  Paris, 
1827,  in  8  vo.),  has  gone  largely  into  details,  respecting  the  various  medicines  proposed 
for  the  cure  of  epilepsy. 


168  EPILEPSY. 

how  many  miracles  soever  may  be  attributed  to  their  use.  We  can  say  as 
much  of  fear,  which  is  recommended  by  some  rash  persons.  But  who  can 
calculate  the  effects  of  fear,  and  consequently,  who  would  dare  to  make  use 
of  it  as  a  curative  ao-ent ! 

It  is  essentially  to  hygienic  influences,  that  we  must  have  recourse  m  com- 
bating epilepsy.  They  are  of  indispensable  application,  to  renew,  in  some  sort, 
the  constitution  of  the  sick.  By  these  means  they  will  be  permitted  to  engage 
in  the  cultivation  of  the  soil,  in  exercise  on  horseback,  and  in  gymnastics, 
dancing,  swimming  and  fencing.  Hippocrates  recommends  change  of  coun- 
try. Van-Swieten  has  seen  many  epileptics,  who  had  no  attacks  during  their 
residence  in  the  East  Indies.  Marin  cites  the  example  of  a  girl,  who  prevent- 
ed the  attacks  by  music.  I  knew  one  whose  attacks  occurred  during  her  first 
sleep,  and  who  often  prevented  them,  by  retiring  at  a  late  hour,  and  by  yield- 
ing herself  to  gentle  and  agreeable  diversions,  before  retiring  for  the  night. 

These  latter  considerations,  call  to  mind  what  has  been  said  about  prevent- 
ing the  attacks.  In  sympathetic  epilepsy,  we  sometimes  prevent  the  attacks, 
by  causing  the  patient  to  walk  about  rapidly,  the  moment  the  first  symptoms 
manifest  themselves,  by  extending,  powerfully,  the  limb  from  whence  the  first 
sensation  of  an  approaching  attack,  or  the  epileptic  aura  proceeds,  by  applying 
ligatures  above  the  part  primitively  affected,  and  by  removing  all  physical  and 
moral  causes,  which  provoke  the  return  of  an  attack.  Pinel  employed  the 
inhalation  of  ammonia,  as  soon  as  the  epileptic  experienced  the  first  indica- 
tions of  a  seizure.  It  remains  for  me  to  say  a  word  respecting  the  precautions 
which  it  is  proper  to  take,  to  prevent  the  unpleasant  consequences  of  epilepsy. 
The  prostration  of  the  physical  energies,  requires,  in  general,  strengthening 
regimen.  We  must  dispel  the  false  shame  which  grieves  and  discourages  epi- 
leptics, and  remove  the  prejudices  vyhich  cause  them  to  be  regarded  with  a 
sort  of  dread.  The  habitual  sadness  in  which  many  of  them  live,  aggravates 
their  condition.  We  should  watch  over  their  actions  and  conduct.  Strongly 
inclined  to  the  pleasures  of  love,  they  give  themselves  up  to  the  practice  of 
solitary  vices,  which  are  more  injurious  than  the  evil  itself  We  shall  avoid 
the  consequences  of  falls,  by  selecting  habitations  on  a  level  with  the  ground, 
by  providing  the  epileptics  with  attendants,  who  will  hold  them  up  when  about 
to  fall,  and  lay  them  down  upon  a  bed  or  the  ground,  guarding  their  heads 
from  hard  substances,  against  which  they  might  otherwise  injure  themselves 
durincr  the  convulsions.  In  their  various  movements,  we  must  be  careful  not 
to  restrain  them,  by  confining  the  members  tightly.  In  order  to  avoid  cuttmg 
the  tongue,  or  breaking  the  teeth,  some  of  these  patients  exercise  the  precau- 
tion of  placing  a  roll  of  linen  between  the  teeth;  and  I  knew  one  lady  who 
never  retired  to  bed  without  taking  this  precaution.  If  the  attack  takes  place 
during  the  night,  we  may  wad  the  bed,  giving  it  the  form  of  a  box,  to  avoid 
falls.  Where  many  epileptics  are  assembled  together,  we  shall  avoid  many 
accidents,  by  placing  them  in  dormitories,  on  a  planked  ground  floor,  and  in 
employing  very  low  beds.  They  ought  not  to  live  together  in  the  same  wards 
with  the  insane,  as  is  practiced  in  most  hospitals  where  they  receive  both  these 
classes  of  patients.  The  sight  of  an  epileptic  seizure,  is  sufficient  to  render 
a  well  person  epileptic.  How  much  greater  is  the  danger,  in  the  cure  of  an 
insane  person,  often  so  impressible !  What  shall  we  think  of  the  indifference 
with  which  these  unfortunates,  whom  we  meet  in  the  public  way,  are  permit- 
ted to  wander  about,  who  never  fail  to  draw  around  them  a  crowd  of  the  curi- 
ous, embracing  both  women  and  children  ?  Nevertheless,  the  sight  of  an  epi- 
leptic seizure,  is*  sufficient  to  produce  epilepsy.  These  unhappy  people,  muti- 
lated, often  covered  with  blood,  and  always  indigent,  excite  commiseration, 
and  obtain  charity  from  all  beholders ;  and  there  is  no  doubt,  that  rogues  have 
recourse  to  this  means  of  obtaining  money  from  the  passers  by.     It  is  well  to 


EPILEPSY.  169 

point  out  this  abuse,  so  much  the  more  reprehensible,  as  it  serves  as  a  pretext  for 
rocruery,  by  compromising  the  health  of  citizens.  I  remarked  in  commencing 
this  article,  that  at  the  onset  of  the  attacks,  epileptics  are  thrown  either  upon 
the  back  or  abdomen.  In  the  latter  case,  they  bruise  themselves  and  disfigure 
the  countenance.  We  see  some  of  them  whose  faces  are  marred  by  the  cica- 
trices of  burns  which  have  been  produced  by  falling  into  the  fire.  Worse  re- 
sults may  happen.  When  the  attacks  take  place  during  sleep  at  night,  some 
epileptics  turn  upon  the  face  in  bed,  and  if  not  succored,  when  the  collapse 
takes  place,  the  face  presses  upon  the  bolsters  or  pillows,  and  asphyxia  termi- 
nates the  existence  of  the  patient.  We  cannot  guard  with  too  much  care, 
those  epileptics  who  have  nocturnal  attacks,  especially  those  who,  during  the 
convulsions,  are  thrown  upon  the  face. 

The  case  which  I  am  about  to  relate,  and  with  which  I  shall  finish  what  I 
have  to  say  respecting  epilepsy,  is  calculated  to  give  us  an  idea  of  the  epileptic 
state.  The  subject  is  a  patient  who  has,  in  all  his  habits  of  body,  an  impress 
of  the  malady  to  which  he  is  a  victim.  It  was  obtained  by  M.  Leuret,  physi- 
cian of  the  hospital  of  the  Bicetre. 

"  Joseph  B ,  now  an  epileptic,  and  deformed  by  the  contractions  of  his 

limbs,  was  formerly  a  drummer  in  a  regiment  of  the  line.  Like  many  sol- 
diers, he  became  intoxicated,  whenever  opportunity  offered.  On  those  occa- 
sions, he  was  in  the  habit  of  quarreling,  and  it  was  after  a  quarrel  which  took 
place  during  a  fit  of  intoxication,  that  he  experienced  his  first  attack.  He 
does  not  know  whether  any  member  of  his  family  was  ever  affected  by  this 
malady,  or  any  other  nervous  affection.  He  is  now  forty-seven  years  of  age, 
and  was  twenty-eight  when  seized  with  his  first  attack.  He  has  therefore  suf- 
fered from  this  malady  nineteen  years.  Without  fortune,  and  unable  by  his 
labor  either  to  satisfy  his  necessary  wants,  or  to  secure  proper  care,  he  is  ad- 
mitted at  the  Bicetre.  For  a  long  time,  his  attacks  were  quite  slight,  and  per- 
mitted him  to  render  himself  serviceable  in  the  hospital.  He  was  employed 
as  a  glazier.  Eight  years  after  his  admission,  whilst  laboring  at  his  vocation 
in  the  fifth  story,  the  cord  which  sustained  the  scaffold  upon  which  he  was  sit- 
ting, broke,  and  the  unfortunate  Joseph  B.  fell  upon  the  pavement,  and  was 
wounded  in  the  head.  From  this  moment,  his  attacks,  which  were  previously 
very  frequent,  became  more  so,  and  his  body  was  reduced  to  a  state  of  gene- 
ral and  permanent  contraction.  He  almost  always  lies  upon  his  back,  his  feet 
rigid  and  inflexible,  the  legs  drawn  up  towards  the  thighs,  the  hands  flexed 
upon  the  fore-arms,  and  the  latter  upon  the  arms ;  in  a  word,  the  members 
are  so  stiffened,  especially  those  of  the  right  side,  as  to  be  scarcely  capable  of 
executing  any  voluntary  movement.  Sensibility  is  changed  in  an  analogous 
manner.  The  left  side  still  feels.  Touch  is  still  exercised  there  in  a  slight 
degree,  and  it  transmits,  although  feebly,  the  impression  of  cold  or  heat.  On 
the  right  side,  sensibility  is  almost  gone.  We  touch  the  arm  or  thigh  of  this 
side,  but  the  patient  does  not  perceive  it.  We  pinch  him,  without  producing 
any  pain.  In  front,  upon  the  trunk,  the  line  of  demarkation  between  the  two 
sides,  is  well  drawn.  Insensibility  ceases  at  the  linea  alba  on  the  abdomen, 
and  at  the  median  line  on  the  chest.  Posteriorly,  it  is  along  the  middle  of  the 
back.  The  head  is  usually  drawn  back,  and  the  muscles  of  his  person,  even 
when  in  a  state  of  repose,  (which  rarely  occurs),  leave  upon  the  features  a 
convulsive  expression. 

He  is  incapable  of  making  a  regular  and  complete  movement,  and  if  he 
wishes  to  lay  hold  of  any  thing  with  his  left  hand,  which  is  the  better  of  the 
two,  he  never  succeeds  at  the  first  effort,  nor  without  fatigue.  If  he  desires 
to  speak,  the  tongue  stammers ;  he  pronounces  one  or  two  syllables,  and  una- 
ble to  finish,  seeks  an  equivalent  for  the  word  which  his  tongue  refuses  to  ar- 
ticulate, This  defect  gives  to  his  speech  a  great  resemblance  to  that  of  a 
drunken  man.     Rarely  are  his  muscles  in  a  state  of  complete  repose.     If  their 

oo 


170  EPILEPSY. 

contractions  are  too  feeble  to  execute  certain  movements  of  those  parts  which 
it  is  their  office  to  move,  by  applying  the  hand  upon  any  part  of  the  surface 
of  the  body,  we  feel  that  it  is  agitated  by  a  kind  of  vermicular  movement,  very 
analogous  to  what  occurs  in  ataxic  fevers,  and  which  are  called  snbsultus 
tendinum.  If  he  closes  his  eyelids,  we  observe  that  they  tremble.  For  more 
than  seven  years,  that  is,  after  the  disappearance  of  the  immediate  symptoms 
caused  by  his  fall,  he  has  daily  from  three  to  six  epileptic  attacks.  A  little 
less  than  a  minute  before  the  attack,  he  is  apprised  of  its  approach  hy  some- 
thing tohich  takes  place  in  his  head;  utters  a  cry,  mutters  certain  words,  and 
loses  his  consciousness,  at  the  same  time  that  he  experiences  epileptic  contrac- 
tions. It  is  rare  that  saliva  issues  from  his  mouth.  The  attack  lasts  for  a 
short  time,  and  the  patient  promptly  recovers  his  senses. 

Notwithstanding  the  long  duration  of  his  malady  (nineteen  years),  and  the 
frequency  of  the  attacks,  the  understanding  of  the  patient  preserves  its  origi- 
nal integrity.  His  words  are  not  always  intelligible ;  indeed,  they  lack  much 
of  it.  His  phrases  are  never  complete,  nor  is  the  expression  of  his  features 
ever  in  relation  with  what  he  is  saying;  but  it  is  easy  to  see,  that  all  this  de- 
pends upon  the  instrument  which  executes  his  will.  That  sentence,  which  a 
convulsive  movement  does  not  prevent  him  from  expressing,  denotes  a  just 
thought,  and  a  healthy  judgment.  With  respect  to  his  moral  manifestations, 
he  is  superior  to  the  greater  part  of  his  companions  in  misfortune,  who  are 
otherwise  less  afflicted  than  himself  Epilepsy  changes  the  character,  and  dis- 
poses the  unfortunate  subject  of  it,  to  bickerings  and  freaks  of  violent  anger. 
Joseph  B.,  however,  is  very  mild,  taking  notice  of  the  attentions  that  are  paid 
him,  and  when  any  one  approaches  him,  he  sees  that  he  is  always  disposed  to 
smile,  or  to  utter  expressions  of  thankfulness.  The  functions  of  nutritive  life 
are  healthfully  executed ;  the  appetite  is  good,  alvine  evacuations  take  place 
daily,  and  the  urine  is  excreted  as  in  a  state  of  health.  The  pupils  contract 
properly ;  and  the  respiration  and  pulse  offer  nothing  anormal.  There  are 
doubtless,  few  examples  of  a  malady  as  long,  and  of  attacks  as  numerous  and 
frequent,  in  which  the  intelligence  has  remained  so  sound,  as  in  the  case  of 
Joseph  B.  It  is  the  only  case  that  I  have  ever  met  with,  among  more  than 
six  hundred  epileptics." 

[Witli  respect  to  the  pathology  of  Epilepsy,  the  views  of  our  author  correspond  with 
those  of  the  profession  who  liave  most  carefully  investigated  the  subject  in  this  country 
and  in  Europe.  We  can  add  nothing  to  what  lias  been  stated  respecting  tlie  Idiopathic 
form  of  this  malady,  and  shall  content  ourselves  with  a  few  remarks  in  reference  to  his 
other  division,  or  Sympathetic  Epilepsy. 

Wiiile  we  frankly  admit  that  we  have  little  confidence  in  the  efficacy  of  remedies  in 
this  disease,  we  cannot  find  it  in  our  hearts  to  recommend  an  entire  disuse  of  them.  We 
believe  that  wlien  judiciously  employed,  tiiey  may  aid  the  Vis  Medicatrix  in  its  efforts  to 
repel  those  morbid  influences  that  so  seriously  disturb  the  functions  of  organic  life.  It 
becomes  us  to  study  with  care  the  pathology  of  every  case  that  is  presented  to  our  no- 
tice, and  to  relieve,  so  far  as  practicable,  every  disordered  action.  To  overcome  nervous 
irritability,  to  equalize  the  circulation,  to  regulate  the  secretory  functions,  and  to  secure 
a  calm  and  hopeful  frame  of  mind,  will  clearly  constitute  a  part,  and  that  not  an  unim- 
portant one,  of  our  duty.  Certain  agents  belonging  to  the  class  of  Sedatives,  combined 
with  those  which  are  known  to  exercise  a  tonic  influence,  may  be  employed,  with  a 
view  to  their  supposed  specific  influence,  the  quantity  of  their  respective  ingredients 
varying,  to  meet  the  indications  which  are  from  time  to  time  presented.  Tlic  prepara- 
tions of  Copper  and  the  Witrate  of  Silver,  are  those  articles  of  ilie  latter  class  upon 
which  reliance  may  be  placed  ;  and  Camphor,  the  Extract  of  Belladonna,  and  Strammo- 
nium  in  some  of  its  forms,  of  the  former.  To  these.  Valerian  and  Assafcetida  may  per- 
haps be  occasionally  added,  with  advantage.     We  notice  these  remedies,  among  many 


EPILEPSY.  171 

that  occur  to  us,  not  so  much  because  we  entertain  a  greater  degree  of  confidence  in 
them,  but  rather  because  they  are  at  present  the  more  popuhu".  Every  source  of  irrita- 
tion which  may  originate  in  the  use  of  indigestible  food,  from  intestinal  torpor,  or  from 
an  inordinate  amount  of  alimentary  matter  in  itself  proper,  all  mental  agitation,  whether 
from  the  exercise  of  pleasing  or  depressing  emotions,  and  such  corporeal  exercises  or 
occupations  as  are  sedentary,  or  require  for  their  performance  a  stooping  posture,  are  to 
be  scrupulously  avoided.  In  a  word,  all  the  means  employed  should  have  for  their  ulti- 
mate purpose  the  restoration  of  every  disordered  function,  and  the  preservation  of  the 
integrity  of  every  portion  of  the  system.] 


CRITICAL  TEEMINATIONS  OP  INSANITY. 


General  remarks  on  the  doctrine  of  crises. — No  cure  without  a  crisis. — Causes  of  incom- 
pleteness of  crises. — The  physician  the  minister  of  nature. — Remarks  on  relapses. — 
A  marked  remission  usually  during  the  first  month. — Its  cause. — Insanity  terminates 
by  resolution. — Principle  of  cure  illustrated  by  cases. — Terminates  by  the  predomi- 
nance of  activity  in  the  absorbent  system. — Terminates  by  great  prostration  and  ema- 
ciation.— Example. — A  febrile  movement  often  serviceable. — Examples. — Hemor- 
rhages sometimes  effect  a  cure. — Examples. — Herpetic  eruptions  sometimes  cure  insa- 
nity.— Examples. — Furuncles  sometimes  critical  in  insanity. — Examples. — Abundant 
suppurations,  whether  spontaneous  or  provoked,  sometimes  terminate  insanity. — A 
variety  of  illustrations  and  examples. — Influence  of  coition  and  continence. — Exam- 
ples.— Pregnancy  and  confinement  sometimes  terminate  insanity. — Examples. — Preg- 
nancy and  confinement,  when  they  effect  a  cure,  act  rather  as  exceptions  than  in  ac- 
cordance with  a  general  rule. — Dentition  as  a  cause  of  insanity. — Examples. — Crises 
of  insanity  arranged  in  their  order. 

I  SHALL  not  discuss  all  that  has  been  said  respecting  crises,  nor  sit,  a  self- 
appointed  judge,  upon  the  respective  merits  of  Galen  and  Asclepiades.  It  is 
sufficient  for  me  to  remember  that  the  doctrine  of  crises  is  as  ancient  as  ob- 
servation in  medicine  ;  and  that,  divested  of  pythagorean  notions,  and  the 
subtilties  of  dogmatists,  it  has  been  sanctioned  by  the  experience  of  all  ages. 
I  propose  to  demonstrate  that  this  doctrine  is,  in  all  respects,  applicable  to 
mental  diseases.  This  application  would  be  far  more  fruitful  with  respect  to 
therapeutics,  should  I  extend  it  to  each  order  of  the  vesanise.  But  the  crises 
of  insanity  having  been  imperfectly  understood,  or  neglected  by  the  greater 
part  of  authors,  I  have  desired  to  point  them  out  in  this  essay,  as  furnishing 
useful  hints  for  the  treatment  of  this  malady. 

Mental  alienation,  which  the  ancients  regarded  as  an  inspiration  or  punish- 
ment of  the  gods ;  which  was  afterwards  regarded  as  a  demoniacal  possession, 
and  which,  in  other  times,  passed  for  the  work  of  magic;  mental  alienation, 
in  all  its  forms,  and  varieties  innumerable,  differs  in  no  respect  from  other 
diseases.  Like  them,  it  has  its  premonitory  symptoms,  which  enable  us  to 
foresee  it,  symptoms  which  characterize  it,  a  course  which  is  proper  to  it, 
periods  of  increase  and  decline,  a  duration  peculiar  to  it,  and  at  length,  the 
united  efforts  of  the  whole  system,  tending  to  terminate  it,  either  by  a  cure, 
or  by  death.  Like  all  maladies,  insanity  is  sporadic  or  epidemic,  hereditary 
or  accidental,  idiopathic  or  symptomatic.  It  is  simple  or  complicated ;  con- 
tinued, remittent,  or  intermittent ;  acute  or  chronic.     Why  should  not  insa- 


174  CRITICAL     TERMINATIONS     OF     INSANITY. 

nity  terminate  by  crises  1  Hippocrates,  and  all  good  observers  assure  us,  that 
the  cure  of  diseases  never  takes  place  without  critical  phenomena.  In  fact, 
where  is  the  physician  who,  having  prescribed  for  a  patient,  would  believe  him 
to  be  effectually  cured,  unless  lie  could  refer,  in  his  own  mind,  to  crises  which 
terminated  the  disease  1  Doubtless,  there  are  forms  of  disease,  in  which  cri- 
ses are  especially  frequent,  and  easily  perceived.  Such  are  acute  diseases. 
It  is  very  unusual,  that  in  grave  forms  of  fever,  and  in  the  phlegmasiae,  we 
do  not  observe  critical  phenomena.  Now,  insanity  presents  the  most  striking 
analogy  to  these  disorders.  The  points  of  resemblance  are  so  numerous,  that 
often,  at  the  period  of  attack,  the  most  skillful  eye  can  scarcely  distinguish 
them.  This  analogy  becomes  still  more  surprising,  when  we  compare  certain 
insane  persons  with  the  dying.  We  notice  among  them,  almost  all  the  signs 
of  death  described  by  Hippocrates  ; — the  eyes  fixed  and  glaring,  with  a  look 
still  more  terrible,  which  seems  to  discover  from  afar,  some  frightful  object ; 
a  sinister  and  mysterious  air  ;  convulsions  of  the  hands,  or  carphologia,  altera- 
tion of  the  voice,  a  sardonic  laugh,  involuntary  dejections,  etc.  With  rela- 
tions so  striking  between  insanity  and  those  maladies  which  terminate  most 
frequently  by  sensible  crises,  why  should  not  the  former  itself  terminate  by 
crises  1 

1  have  always  observed,  that  the  cure  of  mental  maladies  is  only  deceitful 
or  temporary,  when  it  is  not  determined  by  some  critical  phenomena.  At- 
tacks of  intermittent  insanity  terminate,  almost  invariably,  promptly  and  sud- 
denly, without  enabling  the  physician  to  perceive  the  critical  cause  of  the 
cessation  of  the  symptoms.  I  say  almost  always;  because  it  happens  that  the 
attacks,  especially  when  their  return  is  regular,  terminate  by  crises  as  constant 
and  regular,  as  the  epoch  of  the  return  of  the  attacks  themselves.  In  chronic 
insanity,  the  crises  are  less  apparent,  because  the  symptoms  are  less  energetic, 
and  more  tardy,  because  the  symptoms  proceed  slowly.  They  are  more  sud- 
den and  marked,  in  accidental  and  acute  attacks  of  insanity,  which  seize, 
with  violence,  young,  strong,  and  robust  subjects.  The  crises  are  incomplete. 
Hence  the  reason  why  mental  alienation  is,  in  these  cases,  often  chronic. 
When  we  reflect  that  causes  the  most  debilitating,  both  physical  and  moral, 
are  those  which,  in  a  great  majority  of  cases,  predispose  to  this  malady,  and  pro- 
voke it ;  it  furnishes  a  very  satisfactory  explanation,  of  the  defective  reaction, 
the  incompleteness  of  the  crises,  and  the  transition  of  insanity  to  the  chronic 
state.  Those  whom  insanity  attacks,  are  debilitated  by  excessive  study  and 
watchfulness,  by  the  abuse  of  pleasures,  by  long  continued  griefs  ;  by  every 
variety  of  error  in  regimen,  by  acute  disease,  by  habitual  evacuations.  If  the 
early  symptoms  indicate  a  good  degree  of  constitutional  vigor,  this  energy  is 
only  apparent  and  deceptive,  and  becomes  the  source  of  many  errors  in  treat- 
ment. 

Another  cause  of  the  incompleteness  of  crises,  and  consequently  of  the 
chronic  nature  of  insanity  is,  that  it  is  a  malady,  in  which  the  critical  efforts 
are  especially  affected  by  nervous  anomalies,  and  by  the  excessive  sensibility 
of  the  patients  ;  circumstances  which,  by  interfering  with  the  regularity  of 
the  vital  movements,  powerfully  oppose  the  completeness  of  the  crises.  Nor 
must  we  lose  sight  of  the  fatal  effects  of  the  treatment  employed  at  the  com- 
mencement of  insanity.  Frightened  by  the  first  symptoms,  they  almost  de- 
stroy the  patient,  by  copious  and  repeated  bleedings  ;  and  thus  deprive  nature 
of  that  vital  energy,  which  is  necessary  to  bring  the  malady  to  a  successful 
termination.  These  agitators  are  ignorant  of  the  fact,  that  the  physician  does 
not  cure  ;  that  he  is  only  the  minister  of  nature,  that  his  office  is,  to  remove 
the  obstacles  that  might  otherwise  turn  her  aside  from  her  proper  path,  and  to 
prepare  the  patient  for  the  successive  development  of  the  symptoms  of  the 
disease,  so  that  he  may  prove  equal  to  the  critical  efforts  that  are  to  terminate 
it.     Meanwhile,  Hippocrates  advises  us  to  be  watchful   at  the  beginning  of 


CRITICAL     TERMINATIONS     OF     INSANITY.  175 

disease ;  and  warns  us  not  to  be  frightened  by  the  grave  symptoms,  whicli 
precede  and  accompany  crises. 

What  shall  we  think  of  those  physicians,  who  always  wish  to  have  a  share 
in  whatever  nature  does,  who  are  armed  at  all  points,  to  combat  one  after  the 
other,  and,  as  it  were,  hand  to  hand,  the  symptoms  that  occur  during  an  at- 
tack of  disease  1  Let  them  call  to  mind  this  fearful  sentiment  of  Baglivi  ; 
Quanto  pliires  remedionun  usus  necat,  qudm  vis  et  impetus  morhi.  [De  crisi  et 
diebus  c?-iticis).  A  comparison  of  the  existing  method  of  treating  the  insane, 
with  that  employed  by  the  ancients,  proves  this.  Desiring  to  abate  the  acti- 
vity of  the  vital  forces,  they  deprived  the  maniacs  of  that  energy  which  was 
necessary  for  delirium.  Hence,  sudden  deaths,  paralysis,  and  dementia. 
Hence,  temporary  cures,  followed  immediately  by  relapses,  when  reaction  per- 
mitted the  development  of  the  first  symptoms.  Thanks  to  the  principles  set 
forth  by  Pinel,  we  find  at  this  day,  a  wise  custom  prevailing,  which  watches 
the  efforts  of  nature,  in  order  to  second,  not  to  prevent  them. 

It  is  also  certain,  that  in  our  days,  we  cure  a  greater  number  of  the  insane, 
and  that  relapses  are  less  frequent  than  formerly.  We  should  carefully  guard 
against  confounding  relapses  with  new  attacks  of  insanity.  All  physicians 
know,  that  individuals  who  have  suflered  from  intermittent  fevers,  from  inflam- 
mations of  the  brain,  of  the  lungs,  stomach,  etc.,  are,  more  than  others,  ex- 
posed to  contract  again  these  same  affections  ;  since  an  organ,  that  has  once 
been  affected,  is,  from  this  circumstance,  disposed,  more  than  another,  to  be 
aflfected  anew.  We  do  not  give  the  name  of  relapse,  to  the  returns  of  other 
diseases,  and  why  should  we  to  a  new  attack  of  insanity  1  I  do  not  pretend  to 
deny,  that  those  who  have  been  insane,  are  exposed  to  relapses.  They  nmst 
be  more  exposed  thereto  than  other  patients,  because  as  I  have  already  remark- 
ed, the  crises  of  insanity  are  often  incomplete,  and  convalescents,  for  a  very  con- 
siderable period,  are  exceedingly  susceptible.  Physicians  who  have  had  charge 
of  the  insane  have  doubtless  remarked,  how  many  persons  who  are  cured,  com- 
mit imprudences,  and  are  not  careful  to  avoid  the  causes,  which  first  occasion- 
ed their  illness.  But  I  am  wandering  from  my  subject,  and  return  to  the  cri- 
ses of  mental  alienation. 

I  think  that  I  have  demonstrated  by  analogy,  that  mental  alienation  ter- 
minates by  crises.  Let  us  see  what  observation  and  experience  teach.  I 
could  relate  facts,  found  in  the  writings  of  Hippocrates,  Celsus,  Coclius  Aure- 
lianus,  Boerhaave  and  Pinel,  who  have  pointed  out  many  crises  of  insanity, 
but  I  shall  confine  myself  to  observations  which  I  have  made  in  my  own  prac- 
tice, and  which  will  justify  my  opinion  respecting  the  doctrine  of  crises. 
Can  any  one  seize  upon  the  order  and  succession  of  all  the  phenomena, 
which  appear  in  the  course  of  an  attack  of  insanity  !  Can  he  point  out  the 
signs  which  are  to  inform  us,  by  what  organ  the  crises  are  to  operate,  and  de- 
termine the  kind  of  crisis  which  belongs  to  this  or  that  variety  !  Can  he  de- 
termine the  precise  epoch  of  the  crises  !  I  have  been  unable  to  attain  this  re- 
sult. I  have  generally  observed,  that  in  the  course  of  the  first  month  after  the 
invasion  of  an  attack,  a  very  marked  remission  takes  place,  after  which,  the 
delirium  returns  with  greater  intensity.  At  this  period,  the  malady,  which 
previously  had  an  acute  and  violent  course,  seems  to  have  reached  its  ter- 
mination ;  yet  it  passes  into  a  chronic  state,  because  the  crisis  has  been  in- 
complete. This  first  remission,  which  I  have  studied  with  the  greatest  care, 
ought  also  to  be  attributed  to  the  cessation  of  the  symptoms,  which  compli- 
cate insanity  at  its  commencement.  If  the  crisis  is  complete,  the  malady 
ceases.  Thus,  during  the  fir.st  month  of  the  invasion  of  insanity,  a  greater 
number  of  the  insane  are  cured,  compared  with  the  whole  number  of  cures 
effected,  than  during  the  succeeding  ones. 

Mental  alienation  terminates  by  resolution.  This  termination,  which  is  very 
rare  in  chronic  insanity,  is  announced  by  a  general  sense  of  feebleness,  of 


176  CRITICAL     TERMINATIONS     OF     INSANITY. 

lassitude  and  fatigue ;  by  paleness  of  the  countenance,  and  the  diminution  of 
muscular  activity ;  by  the  return  of  sleep  and  appetite,  or  the  cessation  of  vo- 
racity ;  by  the  reestablishment  of  the  secretions,  or  by  their  diminution  when 
too  abundant.  All  these  circumstances,  coinciding  with  the  progressive  ces- 
sation of  the  delirium,  and  with  the  manifestation  of  moral  sensibility,  an- 
nounce an  approaching  cure.  The  cure  is  effected  if  the  patient  returns  to 
his  former  views,  affections,  habits,  and  character.  If  we  observe  farther,  we 
are  assured  that  this  individual  who,  during  his  delirium,  could  not  shed  a 
tear,  now  weeps  readily;  that  another,  subject  to  a  cough,  expectoration  and 
perspiration,  and  to  pains  in  different  regions  of  the  body,  has  recovered  from 
all  these  slight  infirmities  which  are  the  safeguards  of  his  good  health  :  for,  to 
the  observing  physician,  resolution  itself  is  not  merely  the  normal  and  suc- 
cessive return  of  all  the  functions ;  as  he  always  notices  some  slight  critical 
phenomenon.  If  we  add  the  following  signs  to  those  which  I  have  just  point- 
ed out,  we  shall  then  have  the  characters  of  a  perfect  cure.  The  patient  should 
retain  no  painful  recollection  of  his  malady,  and  he  ought  to  speak  of  it  with 
indifference ;  to  meet  again,  without  repugnance,  those  who  have  had  charge 
of  him,  and  to  revisit  without  reluctance,  those  places  in  which  he  was  treated. 
And  he  should  not  be  unduly  fearful  with  respect  to  the  future,  and  adopt, 
without  pusillanimity,  the  advice  which  is  given  him  for  the  preservation  of 
his  health.  These  last  characteristics  are  so  essential,  that  if  they  are  want- 
incr,  I  always  distrust  the  cure  of  an  insane  person.  I  have  seen  individuals 
restored  to  reason,  who  dared  not  visit  me  on  their  first  return  to  society,  but 
who  came  with  pleasure,  some  months  subsequently ;  having  at  that  time  a  dis- 
tinct recollection  of  their  malady,  but  with  it  a  sense  of  reestablished  health. 
I  have  seen  others,  who  could  not  surmount  the  mortification  and  shame  of 
having  been  insane,  remain  melancholic,  and  soon  after,  yield  to  a  new  attack. 

A  young  man,  twenty-one  years  of  age,  of  a  sanguine  temperament,  strong 
and  robust,  spoiled  by  the  kindness  and  continual  flatteries  of  his  relatives, 
of  an  obstinate  and  proud  disposition,  applies  himself  much  to  study,  in  order 
to  render  himself  distinguished  among  his  comrades.  He  was  delirious  for 
some  days,  during  the  winter  of  1805,  and  suspends  his  studies  for  a  brief 
period ;  returning  to  them  afterwards  with  renewed  ardor.  Experiencing 
some  slight  opposition,  he  is  seized  with  an  attack  of  mania,  near  the  close  of 
the  month  of  December.  He  requires  attentions  from  every  one,  complains 
of  both  his  parents,  wishes  to  manage  the  affairs  of  the  family,  and  to  direct 
them  according  to  his  fancy.  He  is  quarrelsome  and  passionate  in  his  inter- 
course with  his  father  and  mother,  his  friends  and  associates.  His  delirium 
extends  to  every  variety  of  subject,  but  sentiments  of  ambition  predominate. 

M.  B.  is  committed  to  our  care,  Jan.  11th,  1806.  In  stature  he  is  tall, 
his  hair  is  black,  his  complexion  ruddy,  his  mobility  extreme.  He  gives  him- 
self the  airs  of  a  man  of  consequence,  eats  much,  and  drinks  in  proportion. 
Any  resistance  to  his  inordinate  desires  throws  him  into  fury,  and  he  breaks 
every  thing.  Thus  he  passes  three  months,  alternating  between  calmness,  de- 
lirium and  fury.  If,  for  a  brief  period,  he  seems  rational,  it  is  only  to  grieve, 
and  fall  into  a  sort  of  despair.  Tepid  and  shower  baths,  acidulated  drinks 
and  isolation,  effect  a  cure  in  four  months,  but  my  convalescent  is  sad,  gloomy, 
melancholic,  and  uncontrollably  idle.  He  travels  several  months,  by  which 
means  his  sadness  is  dissipated,  but  nothing  enables  him  to  triumph  over  the 
shame  of  having  been  insane.  Restored  to  his  family,  and  enjoying  the  per- 
fect use  of  his  reason,  he  engages  in  the  exercise  of  the  chase.  After  six 
months,  when  his  parents  feel  satisfied  and  perfectly  secure,  M.  B.  is  found 
dead  in  the  midst  of  a  forest,  by  the  side  of  his  gun. 

I  have  noticed  convalescents  who,  for  a  longer  or  shorter  period,  experi- 
enced vexation  in  consequence  of  having  been  sick,  and  expressed  it  by  com- 
plaints, prejudices,  and  reproaches  without  motive.     I  have  seen  some  who 


CRITICAL     TERMINATIONS     OF     INSANITY.  177 

Still  had  pains  in  the  head,  and  cardialgia  ;  others  believed  that  they  still  heard 
voices,  which  addressed  them,  even  internal  voices ;  while  others  still,  enter- 
tained strange  ideas,  and  acted  singularly  ;  sure  signs  that  the  cure  was  not 
perfect.  If  with  the  normal  reestablishment  of  all  the  functions,  with  the 
return  of  appetite,  of  sleep,  of  a  moderate  fullness  of  habit  and  regularity  of 
the  secretions,  the  delirium  does  not  proportionately  diminish,  insanity  per- 
sists, and  becomes,  so  to  speak,  constitutional,  or  passes  into  dementia.  Some- 
times, mental  maladies  terminate  by  the  predominance  of  activity  in  the  absor- 
bent system.  At  the  conclusion  of  almost  all  maladies,  the  subjects  of  them, 
during  convalescence,  gain  flesh  to  a  greater  or  less  extent.  This  happens 
also,  in  insanity.  There  are  individuals  however,  particularly  those  of  a  tem- 
perament remarkably  lymphatic,  whose  absorbent  system  acquires  so  great 
activity,  that  they  become  very  fat,  attain  an  inordinate  fullness  of  habit,  and 
remarkable  obesity.  This  condition  augments  progressively  for  several  months, 
and  at  the  same  time,  the  intellectual  and  moral  faculties  recover  their  activity. 
It  continues  to  augment,  after  the  perfect  reestablishment  of  reason,  for  seve- 
ral months,  but  finally  diminishes  to  the  point  to  which  the  patient  was  accus- 
tomed, previous  to  his  illness.  This  termination  is  sufficiently  frequent  to 
merit  notice. 

A  lady,  twenty-three  years  of  age,  of  a  lymphatic  temperament,  and  of  a 
mild  and  timid  disposition,  whose  father  was  subject  to  violent  cephalalgia,  had 
suffered  from  several  grave  aifections,  and  even  delirium,  at  the  epoch  of  her 
first  menstruation.  Married  at  the  age  of  twenty-one  years,  to  one  of  the 
most  distinguished  generals,  she  immediately  becomes  pregnant.  Whilst  in 
this  state,  she  leads  a  sad  and  monotonous  life,  has  presentiments  respecting 
the  result  of  her  confinement,  and  ardently  desires  the  return  of  her  husband, 
who  is  in  the  army.  Mad'e  D.  is  happily  confined.  On  the  seventh  day  fol- 
lowing, she  experiences  a  severe  moral  impression  ;  the  lochia  are  suppressed, 
she  is  seized  with  delirium,  and  becomes  furious.  Some  days  afterwards,  the 
lochia  reappear,  and  composure  returns  with  reason.  On  the  twenty-fifth  day 
after  her  confinement,  she  imprudently  sits  down  upon  the  grass.  New  dis- 
quietude succeeded.  The  lochia  were  suppressed,  and  she  experiences  a  sort 
of  syncope.  Delirium  and  fury  reappear  with  more  violence  than  at  first. 
She  is  bled  and  bathed.  They  have  recourse  to  soothing  remedies  and  anti- 
spasmodic drinks,  but  the  delirium  increases.  They  hope  that  the  presence  of 
her  husband  will  change  this  condition.  He  returns  from  the  army,  sees  his 
wife,  and  is  prodigal  of  his  attentions  ;  but  in  vain.  They  are  both  sent  into 
the  country.  The  husband  soon  becomes  the  object  of  his  wife's  fury,  and 
his  presence  occasions  violent  fits  of  anger.  At  length,  after  three  months, 
the  patient  is  committed  to  my  care.  Her  countenance  is  pale,  skin  earthy, 
eyes  fixed,  breath  fetid,  and  there  were  convulsive  movements  of  the  muscles 
of  the  face.  There  is  general  delirium,  continual  muttering,  resistance  to 
whatever  may  be  proposed  to  her,  inappetence,  constipation  and  insomnia. 
Tepid  baths,  laxative  drinks,  and  exercise  in  the  open  air,  are  prescribed. 
After  three  weeks  the  fury  ceases,  but  the  delirium  persists,  and  at  times,  she 
strikes.  On  the  second  month,  and  the  fifth  of  the  malady,  we  apply  a  large 
blister  to  the  neck,  which  discharges  very  abundantly,  and  laxatives  are  con- 
tinued for  several  days  in  succession.  At  the  sixth  month,  the  sleep,  as  well 
as  the  appetite,  begins  to  improve.  At  the  seventh  month,  the  patient  eats  vo- 
raciously, and  sometimes  replies  correctly  to  questions  that  are  addressed  to  her. 
At  the  eighth  month,  the  vesicatory  is  suppressed,  and  she  takes  an  infusion  of 
saffron,  foot  baths,  exercise  and  carriage  rides.  The  menses  reappear,  and 
the  patient  begins  to  gain  flesh.  Her  complexion  and  skin  become  more  clear, 
and  reason  progressively  returns.  At  the  close  of  the  eighth  month,  her  obe- 
sity is  so  great,  that  the  young  lady  becomes  solicitous  respecting  it.  I  tran- 
quiiize  her  mind,  by  assurances  that  it  is  altogether  factitious,  and  will  be  dis- 

23 


178  CRITICAL     TERMINATIONS     OF     INSANITY. 

sipated,  in  proportion  as  her  health  improves.  On  the  ninth  month,  being 
perfectly  convalescent, — after  several  days'  preparation, — I  announced  to  her 
the  death  of  her  husband  who  was  killed  in  the  army.  She  experiences  con- 
vulsive movements,  which  give  me  uneasiness.  I  console  and  tranquilize  her, 
I  surround  her  with  amusements,  and  she  sees  her  family.  Her  convalescence 
is  not  interrupted.  The  obesity  continued  for  several  months  more,  and  was 
dissipated  only  at  the  expiration  of  two  years,  although  her  health  was  perfect. 
I  could  cite  many  similar  facts,  particularly  the  example  of  a  young  person, 
eighteen  years  of  age,  who,  in  consequence  of  a  panic  terror,  becomes  a  mani- 
ac. After  six  montlis  of  delirium  and  fury,  the  obesity  became  so  considera- 
ble, that  I  thought  it  necessary  to  apply  a  vesicatory ;  the  patient  already  expe- 
riencing constraint  in  her  respiration,  and  a  sort  of  dementia. 

It  happens  that,  (without  our  being  able  to  assign  the  cause  of  it),  some 
individuals  become  excited,  quarrelsome,  subject  to  fits  of  anger,  and  won- 
derfully emaciated,  many  months  before  an  attack  of  insanity.  Almost  all  the 
insane  orow  lean  during  an  attack,  except  those  who  are  threatened  with  de- 
mentia. We  have  just  seen  obesity  terminate  insanity  ;  the  contrary  some- 
times happens.  The  patient  is  reduced  to  the  lowest  degree  of  emaciation, 
and  insanity  is  terminated  by  the  most  alarming  phenomena.  The  skin  be- 
comes brown,  black,  and  cadaverous.  Feebleness  is  extreme.  The  patients 
have  no  longer  the  physical  energy  necessary  for  the  manifestation  of  deli- 
rium, still  less  to  be  furious.  They  are  almost  voiceless.  At  the  moment 
when  we  believe  them  ready  to  succumb  ;  when  they  seem  to  have  reached 
the  utmost  limits  of  existence,  they  return  from  the  portals  of  the  tomb,  to 
life  and  reason.  Sometimes,  this  condition  is  aggravated,  by  swellings  of  the 
extremities,  gangrenous  eschars,  and  by  a  relaxed  condition  of  the  bowels. 
If  there  is  no  organic  lesion,  if  the  patient  is  well  nourished,  if  they  strength- 
en him,  and  ward  off  too  violent  moral  impressions,  the  disease  terminates  in 
health. 

A  Jewess,  nineteen  years  of  age,  of  a  lymphatic  and  nervous  temperament, 
of  a  good  constitution,  but  menstruating  irregularly,  is  deceived  and  abandon- 
ed by  her  lover.     She  leaves  the  house  where  she  is  at  service,  and  runs  about 
the  streets,  scarcely  knowing  where  she  goes.     On  returning,  she  hangs  her- 
self.    They  have  only  time  to  lend  her  the  most  pressing  attentions.     She  be- 
comes  furious,  and  on   the  next  day  is  conducted  to  the  Salpetriere.     This 
patient  is  of  middle  size,  with  black  hair  and  eyes,  a  dejected  expression,  a 
countenance  alternately  very  red  or  pale,  a  fetid  breath,  and  livid  lips.      She 
refuses  every  kind  of  food,  and  becomes  furious  when  they  offer  her  any  nour- 
ishment.    She  desires  to  remain  naked   in  her  cell.     The  moment  any  one 
enters  her  apartment,  fear   is  depicted  upon  her  countenance   and  her  whole 
person.     She  supplicates  them  to  wait  until  the  next  day,  persuading  herself 
that  they  are  about  to  seize  and  conduct   her  to  punishment.     She  believes 
that  a  flag-stone  that  covers  a  gutter,  conceals  a  frightful  precipice,  filled  with 
all  mann.er  of  filth,  serpents  and  venomous  beasts,  and  that  it  is  into  this,  that 
they  desire  to  precipitate  her.     She  eats  not,  because  they  wdsh  to  poison  her, 
or  deduce  a  reason   from  what  she  shall  eat,  in   favor  of  her  condemnation. 
She  often  makes  vain  efforts  to  weep.     Sometimes  she  cries  during  the  night, 
and  remains  upon  the  pavement  of  her  cell   covered  only  with  her  chemise. 
Notwithstanding  the  rigors  of  winter,  they  find  her  squatting  naked,  in  a  cor- 
ner, upon  the  stone.     Throughout  the  summer,  she  exposes  herself  almost  na- 
ked, to  the  heat  of  the  sun.     During  eight  months  of  delirium  and  imaginary 
terrors,  of  crroans  and  anguish,  the  patient  loses  flesh,  and  her  skin  becomes 
perfectly  brown,  like  that  of  a  mulatto.     This  young  girl  scarce  breathes  when 
conducted  to  the  infirmary.     They  administer  a  tonic  potion.     On  the  follow- 
ing day,  a  serous  and  abundant  diarrhcea  comes  on.     The  vital  forces  give  way. 
In  vain  do  they  prescribe  remedies  to  moderate  it ;  the  patient  is  unwilling  to 


CRITICAL  TERMINATIONS  OF  INSANITY.         179 

take  any  thing.  The  diarrhoea  ceases  only  at  the  expiration  of  a  month,  when 
N.  is  thought  to  be  near  her  end.  They  cause  her  by  force,  to  swallow  a  few 
drops  of  wine  and  broth.  Some  days  subsequently,  a  more  abundant  nour- 
ishment is  taken  with  less  repugnance.  By  degrees,  the  forces  rally,  reason 
returns  progressively,  and  disquietude  only  remains.  On  the  eleventh  month 
of  the  malady,  the  menses  return,  and  on  the  succeeding  one,  are  abundant. 
The  epidermis  falls  off  in  scales,  and  the  skin  recovers  the  hue  of  health. 
Reason  is  established,  and  our  convalescent  is  employed  in  the  service  of  the 
house,  in  order  to  assure  us  of  the  restoration  of  her  health. 

There  are  few  chronic  maladies,  that  have  not  been  cured  by  the  develop- 
ment of  an  unexpected  fever.  All  practitioners  cease  not  to  express  regret  at 
not  having  it  in  their  power  to  induce  it.  Many  have  endeavored  to  accom- 
plish this  purpose.  The  physician  having  charge  of  the  hospital  for  the  in- 
sensates  at  Tubingen  in  Wurtemburg,  causes  the  insane  under  his  control  to 
take  calomel  in  repeated  doses,  in  order  to  kindle  up  a  febrile  movement.  In 
this,  he  sometimes  succeeds.  Cold  baths  and  affusions,  produce  the  same 
result.  What  art  cannot  always  accomplish,  nature  performs  for  some  indi- 
viduals, and  it  is  not  unusual  for  symptomatic  and  essential  fevers  to  termi- 
nate insanity.     I  saw  it  once  brought  to  a  close,  by  an  inflammatory  fever. 

A  young  man,  a  native  of  Caen,  twenty-three  years  of  age,  of  a  lymphatic 
temperament,  nervous  constitution,  and  a  lively,  sensitive  disposition,  had  been 
much  troubled  with  hemorrhoids.     After  the  early  storms  of  the  revolution 
had  passed  away,  he  devoted  himself  with  great  assiduity  to  commerce.     At 
the  age  of  twenty-one  years,  he  conceived  a  most  violent  passion  for  a  young 
person,  who  did  not  regard  him  with  indifference.     One  of  his  friends  reveal- 
ed to  him  a  purpose  which  he  entertained,  of  marrying  this  lady.     From  that 
moment  M.  B.  conceals  his  attachment,  and  continues  to  live  with  his   friend 
and  her  whom  he  loves,  without  betraying,  his  sentiments.     He  gradually  how- 
ever, became  sad,  gloomy  and  retired.     Meanwhile,  his  mother  dies,  and  he 
experiences  in  consequence  of  it,  the  profoundest  grief     He  conceives  a  dis- 
like to  his  occupations,  forms  the  resolution  of  abandoning  commercial  pur- 
suits, of   quitting  his  family  and   the  place  where   he  was  born.     He  rejects 
those  pleasures  which  are  especially  interesting  to  those  of  his  age,  and  only 
enters  society  when  propriety  requires.     He  passes  the  following  winter,  in 
this  state  of  melancholy,  suffering  at  one  time   from  constipation,  at  another, 
from  relaxation  of  the  bowels,  and   complains  of  frightful   pains   in  the  head. 
On  one  of  the  earliest  days  of  spring,  he  is  unduly  heated,  and   becomes  ex- 
cited in  a  numerous  and  noisy  assembly.     In  the  middle  of  the  evening,  whilst 
dancing  with   his  beloved  friend,   he  is   seized  with   convulsive  movements. 
The  most  violent  delirium  bursts  forth,  the  patient  betrays  his  secret,  reveals 
his   love,  and  reproaches  himself,  calling  incessantly  upon  the  object  of  his 
passion.     He   forgets   his  relatives   and   friends,   and    refuses   all    assistance. 
This  condition  persists  for  four  days,  and  several  men  are  scarcely  sufficient 
to  confine  him   in  bed.     The  convulsions  cease,  but  the  delirium   increases. 
The  patient  refuses  the  remedies  that  are  presented  to  him,  and  pretends  that 
he  alone  can  cure  himself     One  of  his  friends  however,  induces  him  to  sub- 
mit to  be  bled  in  the  foot,  and  to  take  some  cooling  and  sedative  drinks.     Less 
agitation  succeeds,  but  the  incoherence  of  ideas  and  actions  is  the  same.     He 
experiences  an  irresistible  desire  to  walk  about,  and  has  recourse  to  a  strata- 
gem, to  relieve  himself  of  the  watchfulness  of  his  relatives  and  friends.     He 
threatens  and  strikes  even,  those  who  oppose  his  wishes,  or  who  accompany  him 
in  his  walks.     Such  are  the  features  which  characterize  this  malady,  during 
the  first  two  months,  after  which  the  patient  is  committed  to  my  care,  about 
the  middle  of  the  month  of  April  following.     On  his   arrival,  he  descends 
from  the  carriage  without  noticing   any  one,  ascends  the  stairs,  and  descends, 
and  ascends  again,  with  extreme  promptitude.     On  seeing  me,  he  touches  my 


180  CRITICAL     TERMINATIONS     OF     INSANITY. 

hand  :  "  You  are  Bonaparte,  I  know  you,  I  have  seen  you  ;  how  much  plea- 
sure it  gives  me  !  are  you  not  him  1  embrace  me  ;  I  am  your  secretary."  I 
endeavor  to  remove  this  illusion  ;  the  patient  insists,  and  becomes  threatening  : 
"  You  have  done  well,  ^ays  he,  and  I  am  not  mistaken."  He  runs  about, 
goes  out  and  returns,  unable  to  remain  an  instant  in  a  place. 

A  friend  who  accompanies  him,  assures  him  that  he  is  at  the  house  of  a 
physician, — "  Bah  !  bah  !  you  toill  not  deceive  me."  We  sit  down  at  the  ta- 
ble, and  he  devours  the  provisions  set  before  us.  Joy  is  depicted  upon  his 
countenance,  his  face  is  flushed,  his  eyes  gleam,  and  his  movements  are  hasty 
and  abrupt,  as  well  as  his  speech.  He  retires,  and  rises  during  the  night.  At 
break  of  day,  he  is  with  me.  He  lays  hold  of  all  the  bocks  that  come  in  his 
way,  puts  them  in  place,  takes  them  down  again,  returns  them,  or  turns  them 
over  and  over.  He  wishes  to  write,  takes  up  the  pen,  and  lays  it  down  again. 
He  rises  up  and  sits  down,  goes  out  and  returns  to  me,  and  prays  me  to  write 
a  letter  to  his  beloved  friend.  I  decline ;  he  traces  himself  certain  insignfi- 
cant  words,  gives  me  the  paper  to  subscribe,  and  wishes  me  to  sign  a  fictitious 
name,  I  bring  to  his  recollection  the  danger  there  would  be  in  my  signing  a 
false  one.  Fear  nothing  he  says,  I  am  answerable  for  the  vt'hole.  I  still  re- 
fuse, and  he  insists.  Finally  he  seems  to  yield,  but  immediately  pretends  that 
I  am  a  female  in  disguise.  He  goes  out  hastily,  and  runs  about  the  court  and 
gardens.  He  leaps  over  all  obstacles,  even  a  barrier  eight  feet  high.  He  be- 
lieves himself  possessed  of  supernatural  power,  which  enables  him  to  sur- 
mount all  dangers.  I  place  near  my  patient,  a  strong  and  robust  attendant, 
who  follows  him  wherever  he  goes,  without  opposing  his  movements  in  any 
respect.  His  presence  resulted  in  imposing  some  restraint  upon  the  patient, 
whilst  I  exert  myself  to  gain  his  confidence.  After  the  second  day,  M.  B. 
wishes  to  make  to  me  a  certain  revelation,  but  the  ideas  which  are  to  express 
it,  fiiil  him.  He  collects  all  the  little  stones  in  the  gardens,  which  he  regards 
as  gold  or  diamonds,  and  of  which  he  makes  a  collection  in  his  chamber. 
Upon  paper,  the  walls,  gates,  the  enclosure,  and  the  sand,  he  v/rites  lines, 
which  he  calls  verses.  He  traces  insignificant  phrases,  and  always  the  name 
of  his  beloved.  His  countenance  is  uniformly  very  red,  his  eyes  shining  and 
very  changeful,  his  pulse  full,  hard  and  frequent;  constipation  and  insomnia 
obstinate.  His  appetite  is  voracious,  his  loquacity  continual,  and  his  mobility 
incoercible.  Nevertheless,  w^e  sometimes  find  him  sad  and  thoughtful  ;  his 
eyes  bedewed  with  tears,  without  his  being  able  or  willing,  to  assign  the  cause 
of  his  emotion. 

During  the  first  eight  days,  nauseating  drinks  are  prescribed.  From  the 
eighth  to  the  twentieth  of  May,  his  muscular  activity  is  very  great,  and  he 
seems  to  feel  a  sort  of  necessity  to  destroy  whatever  comes  w'ithin  his  reach  : 
the  locks,  bed,  curtains,  and  linen,  a  flute  and  pipe,  all  are  torn  or  broken. 
He  believes  that  he  recognizes  every  one  whom  he  meets,  and  endeavors  to 
console  them,  thinking  them  very  unfortunate.  He  lays  hold  of  whatever  he 
finds.  At  one  moment  he  runs  with  extreme  swiftness  ;  then  suddenly  stops, 
panting  and  perspiring  with  fatigue.  For  a  brief  period,  he  appears  to  be  in 
a  revery,  but  sets  off  again  at  a  rapid  pace,  so  soon  as  any  one  approaches 
him.  While  in  this  state,  if  I  desire  to  restrain  him  by  laying  hold  of  his 
arms,  so  long  as  I  hold  him,  the  muscles  of  his  face  are  convulsed,  and  he 
beats  the  ground,  not  with  anger,  but  from  impatience,  and  is  constantly  mov- 
ing his  limbs  and  head,  not  in  a  menacing  manner,  but  from  his  internal  de- 
sire to  run.  If  during  his  intervals  of  repose,  I  question  him,  he  makes  no 
reply.  If  I  offer  him  advice,  he  does  not  appear  to  comprehend  me.  His 
whole  being  seems  to  be  agitated  with  an  irresistible  necessity  for  motion.  I 
yield  to  this  impulse,  and  already  the  patient  is  far  from  me. 

May  20th.  About  this  time,  M.  B.  becomes  more  disposed  to  ask  ques- 
tions, and  converses  more.  His  movements  are  less  active,  his  eyes  less  lively, 
his  countenance  less  flushed.     He  sheds  tears,  and  sometimes  seems  to  realize 


CRITICAL     TERMINATIONS     OF     INSANITY.  181 

his  condition,  and  testifies  much  confidence.  He  Avishes  to  write  to  his  rela- 
tives, but  his  letter  is  destitute  of  meaning.  After  a  remission  of  three  days, 
the  patient  has  a  new  paroxysm,  which  continues  for  three  weeks. 

June  10th.  Shivering,  cephalalgia,  and  flashes  of  heat  occur  ;  his  counte- 
nance is  sullen,  his  eyes  gleam,  and  his  pulse  is  hard,  full  and  strong.  He 
suffers  from  nausea,  and  his  tongue  is  covered  with  a  yellowish  coat.  The 
patient  feels  the  need  of  confining  himself  to  bed,  and  converses  rationally. 

June  11th.  An  emetic  causes  him  to  vomit  abundantly,  and  also  produces 
several  alvine  evacuations.  In  the  evening  he  perspires.  June  r2th.  The 
gastric  symptoms  disappear,  but  there  is  cephalalgia,  attended  with  a  hard  and 
full  pulse,  flashes  of  heat,  and  a  feeling  of  general  lassitude,  with  thirst. 

June  13th.  He  is  bled  from  the  arm,  and  during  the  night  followinor,  the 
secretions  of  perspiration  and  urine  are  abundant,  as  well  as  on  the  three  suc- 
ceeding days.  June  18th.  Apyrexia — countenance  pale.  The  patient  ima- 
gines that  he  has  just  awoke  from  a  long  dream.  There  is  no  lesion  of  the 
understanding,  but  great  feebleness  of  memory.  June  26th.  Convalescence, 
and  a  return  of  the  vital  forces.  Although  the  patient  seemed  to  have  lost 
his  memory  during  the  delirium,  he  preserves,  at  his  convalescence,  a  recollec- 
tion of  the  least  important  circumstances  connected  with  his  malady,  testifies 
the  most  entire  confidence  in  me,  and  desires  to  resume  his  former  occupa- 
tions. He  sees  his  friends  again.  I  multiply  around  him,  so  far  as  possible, 
the  means  of  diversion.     Tepid  baths  are  prescribed  on  alternate  days. 

July  7th.  Indications  of  gastric  embarrassment.  Nauseating  drinks  are 
prescribed  for  three  days.     Reason  perfect.     Alvine  dejections  abundant. 

July  21st.  This  young  man  returns  to  society  perfectly  cured,  not  only  of 
his  delirium,  but  of  his  love.  One  year  after,  he  is  present  at  the  marriage 
of  her  who  had  been  the  object  of  his  passion,  and  the  cause  of  his  disease. 
Four  years  subsequently,  he  marries  himself  Since  that  period,  he  has  be- 
come the  head  of  an  immense  establishment,  which  he  manages  most  suc- 
cessfully. 

I  have  seen  insanity  terminate  by  gastric  fever.  A  military  officer,  (his 
brother  died  insane  at  the  age  of  twenty  years),  forty-one  years  of  age,  com- 
manded a  frontier  post,  and  after  having  supported  all  the  fatigues  of  the  war, 
and  escaped  the  consequences  of  a  rupture  of  the  crural  artery,  becomes  in- 
sane, through  despair  at  not  having  received  the  cross  of  the  Legion  of  Ho- 
nor. After  the  victory  of  Austerlitz,  he  prepares  a  discourse  in  praise  of  the 
victor,  commands  the  garrison  to  take  arms,  and  orders  them  to  kneel,  while 
listening  to  this  discourse  This  conduct  of  commandant  C,  gave  rise  to  re- 
marks, which  came  to  his  ears.  On  the  followmg  day  he  is  delirious,  and  has 
attacks  of  fury.  His  brother  comes,  and  removes  him  to  his  family,  where  they 
both  bleed  and  bathe  him.  M.  C.  is  gloomy,  and  regardless  of  his  wife  and 
children,  desiring  to  fly  from  both  them  and  his  country.  After  some  months, 
he  escapes,  and  proceeds  to  Paris,  to  another  brother,  who  receives  him  with 
tenderness.  After  some  days,  new  signs  of  insanity  appear  ;  even  jealousy,  dis- 
trust and  excitement ;  and  the  patient  is  committed  to  my  care  April  1st, 
1806.  His  eyes  gleam,  and  are  very  changeable.  His  countenance  is  also 
very  much  flushed  and  convulsive.  The  patient  prostrates  himself  upon  the 
earth,  and  adores  the  sun,  which  he  regards  as  the  father  of  nature.  Does 
he  walk  in  the  gardens,  he  thinks  himself  in  the  Champs-Elysees,  He  looks 
upon  a  patient  and  the  gardener  as  Nereids,  as  they  are  occupied  in  drawing 
water,  another  is  taken  for  Rhadamanthus,  himself  for  Minos,  etc.  At  the 
end  of  fifteen  days,  having  become  more  calm,  M.  C.  no  longer  prostrates 
himself,  converses  more  willingly,  but  still  believes  himself  to  be  the  great 
priest  of  the  sun,  son  of  Zoroaster  ;  now  defying  Christ,  and  now  consider- 
ing himself  to  be  Jesus  Christ,  destined  to  reform  the  world,  and  to  improve 
the  moral  condition  of  men.     At  times,  he  utters  frightful  cries,  in  conse- 


182  CRITICAL     TERMINATIONS     OF     INSANITY. 

quence  of  agonizing  pains;  imagining  that  a  fiery  serpent  has  escaped  from 
the  sun,  and  entered  his  stomach.  We  apply  leeches  to  the  anus,  administer 
baths,  douches,  and  acidulated  laxative  drinks.  Near  the  close  of  the  month 
of  August,  the  patient  is  seized  with  gastric  fever.  After  five  days,  it  takes 
the  character  of  a  tertian  intermittent.  I  prescribe  no  remedy,  and  leave  the 
case  to  the  efforts  of  nature.  After  the  seventh  attack,  this  soldier  had  en- 
tirely recovered  his  health. 

M.  L.,  a  student  in  surgery,  of  a  slender  constitution,  and  a  gloomy,  melan- 
choly disposition,  had  experienced  some  domestic  troubles  before  coming  to 
Paris,  where  he  devoted  himself  with  the  greatest  ardor  to  the  study  of  ana- 
tomy ;  sustaining  himself  upon  slightly  nutritious  food.     From  spring-time  he 
sleeps  less,  becomes  querulous  among  his  comrades,  and  imagines  that  they 
make  sport  of  him.     Near  the  close  of  the  month  of  June,  while  present  at  a 
lecture  of  professor   Boyer,  he  utters  a  loud  cry ;  saying,  "  I  am  lost,  I  am 
damned,  I  must  die."     They  bleed  him  in  the  foot,  and   in  the  jugular  vein, 
and  administer  sedative  and  cooling  drinks.     Every  attention  is  lavished  upon 
him.     The  patient  repulses  those  about  him  with  violence,  utters  cries,  calls 
them  by  opprobrious  epithets,  spits  in  their  faces,  is  unwilling  to  drink,  and 
becomes  much  emaciated  in   a  few  days.     July  28th.     The  patient  is  com- 
mitted to  my  care.     His  countenance   is  alternately  pale  and  red,  his  features 
wan,  his  eyes  shining  and  fixed  ;  his  breath  fetid,  and    his  pulse  extremely  fre- 
quent.    The  delirium  is  general,  with  a  predominance  of  religious  terrors. 
He  breaks,  mars  and  rends  every  thing,  and  endeavors  to  injure   himself     If 
we  offer  him  any  remedy  or  nourishment,  he  becomes  furious.     Several  atten- 
dants find  it  difficult  to  restrain  him.     His  fury  is  sometimes  spontaneous,  his 
thirst  urgent,  and  his  dejections  involuntary.     July  31st.     A  new  and  instan- 
taneous paroxysm  of  fury,  followed   by  a  comatose  state,  which  we  believe 
feigned.     Towards  evening  his  face   becomes    very  much  flushed,  skin  hot, 
pupils  dilated,  and  his  right  arm  very  painful,  when  he  attempts  to  extend  it. 
Pulse  frequent,   delirium   continued.     At  evening,  the  urine  is  tinged  with 
blood.     Acidulated   and  nitrous  drinks   are  prescribed,  the  tepid  bath,   cold 
water  to  the  head,  etc.     Aug.  1st.     The  right  arm  is  covered  with  an  erysipe- 
latous eruption,  the  urine  sanguinolent,  and    the  pulse  very   frequent.     '2d. 
Same  as  at  evening.     5th.   Symptoms  all  exasperated,  pulse  very  frequent,  and 
subsultus  tendinum.     A  drachm  of  camphor  and  nitre  are  taken  during  the 
twenty-four  hours  ;  wine  whey,  and  vesicatories  to  the  limbs.     6th.  Frequency 
of  the  pulse  diminishes,  perspiration  abundant.     7th.  Apyrexia,  continuation 
of  delirium.     8th.    Paroxysm   of   fury,   apyrexia.     9th.     Delirium   and   fury. 
10th.   Slight  paroxysm,  delirium,  general  sense  of  feebleness,  paleness  of  the 
countenance.      12th.  The  patient  rises  ;  incoherence.     Camphorated  Peruvian 
bark.     16th.  Eruptions  over  the  whole  body.     18th.  The  pimples  grow  white  ; 
at  times  delirium.     Vinous  water,  as  a  drink.     2'2d.     Progressive  return  of 
the  vital  forces,  and  the  patient,  rather  restless  than  delirious.     28th.  Conva- 
lescent.    He  is  now  put  upon  the  use  of  analeptics,  milk,  and  exercise.     He 
sees  his  parents  with  composure,  and  at  length,  after  some  days  of  painful  re- 
veries, returns  to  the  bosom  of  his  family,  where,  after  a  long  and  trying  con- 
valescence his  health  is  perfectly  restored.     It  is  many  months   before  he  is 
able  to  resume  his  studies,  his  brain  remaining  very  feeble.     After  an  interval 
of  a  year,  he  returns  to  Paris,  and  resumes  his  medical  studies  with  the  great- 
est success. 

We  had  at  the  Salpetriere,  a  woman  who  had  an  attack  of  mania,  on  three 
successive  years,  and  which  terminated  by  an  ataxic  adynamic  fever.  I  pre- 
vented the  fourth  attack,  which  she  would  otherwise  have  had  on  the  following 
year,  and  this  year  (1815),  she  has  not  even  had  the  premonitory  symptoms.* 

**  (jalen  reports  the  cure  of  one  case  of  mania,  by  a  quartan  fever. 


CRITICAL     TERMINATIONS     OF     INSANITY.  183 

Hemorrhages,  whose  suppression  often  causes  insanity,  sometimes  terminate 
it.  A  young  man,  nineteen  years  of  age,  while  attending  the  school  at  Fon- 
tainebleau,  is  seized  with  an  attack  of  mania,  which  renders  the  most  energetic 
treatment  necessary.  He  is  bled  largely.  After  fifteen  days,  his  agitation 
ceases,  and  the  patient  becomes,  as  it  were,  stupid  ;  wallowing  upon  the 
ground,  devouring  substances  the  most  filthy,  speaking  not,  and  disposed  to 
strike  on  the  slightest  opposition ;  yielding  sometimes  to  spontaneous  acts  of 
fury.  His  face  is  flushed,  his  eyes  rendered  dim  by  a  discharge,  and  his  nose 
and  mouth  are  constantly  full  of  a  mucous  matter,  which  runs  out  upon  his 
garments.  The  patient  often  attempts  to  beat  his  own  head.  After  many 
months  of  useless  attentions,  I  resolve  to  employ  sternutatories.  He  bled  at 
the  nose  at  times  for  several  days,  and  reason  began  to  return.  Convalescence 
soon  followed. 

During  the  war  of  Vendee,  M.  G.,  the  father  of  a  family,  about  thirty-eight 
years  of  age,  large  and  strong,  being  in  the  habit  of  losing  blood  every  year 
to  remove  a  sore  throat  which  made  him  apprehensive  of  suffocation,  neglected 
this  precaution.  In  the  summer  of  1800,  he  is  often  obliged  during  the  night, 
to  sit  up  in  bed,  feeling  as  if  he  were  about  to  suffocate.  At  the  approach  of 
winter,  these  symptoms  disappear,  but  the  patient  becomes  uneasy,  jealous, 
timid  and  gloomy,  with  respect  to  certain  matters  of  importance.  At  the  be- 
ginning of  April  1801,  it  is  observed  that  he  is  absent  minded,  and  indifferent 
about  his  family  and  business.  He  goes  out  and  comes  in  without  a  motive, 
censures  himself  for  his  faults  before  every  one  he  sees,  and  asks  pardon  for 
them.  On  the  day  following  a  sleepless  night,  he  suffers  from  agitation  and 
delirium.  An  emetic  is  given  him.  Twelve  leeches  applied  to  the  feet,  re- 
lieve him.  He  is  confined  to  his  bed,  and  some  days  subsequently,  leeches  are 
applied  to  the  anus,  and  a  tepid  bath  given.  Health  is  restored.  Two  months 
pass ;  but  towards  the  end  of  June,  a  new  paroxysm  occurs,  accompanied  by 
a  chill  and  fever,  and  a  refusal  to  employ  any  remedy.  Six  men  with  difli- 
culty  confine  the  patient  to  a  cold  bath ;  on  leaving  which,  he  is  more  rational. 
The  same  baths  are  employed  on  the  following  days,  with  equal  success. 
This  paroxysm  lasts  eight  days,  and  since  that  period,  is  renewed  almost  every 
month.  We  have  successively  bled,  purged  and  bathed  the  patient.  To- 
wards the  end  of  autumn,  the  paroxysms  are  irregular.  The  patient  talks 
irrationally,  and  is  at  times,  turbulent  and  passionate.  He  is,  ordinarily,  ra- 
ther gay  than  sad.  In  his  lucid  intervals,  there  remains  an  air  of  assurance, 
an  imperious  tone,  and  a  kind  of  laugh,  foreign  to  his  natural  habit. 

After  a  year's  treatment,  the  patient  was  sent  to  Paris,  and  committed  to  my 
care,  Feb.  25th,  180!2.  M.  G.  has  light  hair,  bright  eyes,  a  countenance 
very  much  flushed,  and  the  external  appearance  of  a  strong  man,  in  the  enjoy- 
ment of  excellent  health.  He  is  troubled  about  nothing.  He  goes  and 
comes,  playing  tricks  upon  every  body,  laughing  till  his  sides  ache,  at  the 
merest  trifle,  and  sometimes  at  nothing.  No  idea,  no  recollection,  could  fix 
his  attention  for  a  moment.  Content  with  himself,  he  is  the  friend  of  all,  and 
has  not  a  thought  for  his  family.  Suddenly,  his  face  becomes  more  flushed, 
his  eyes  are  red  and  glistening,  and  there  is  heat  in  the  abdomen.  Afterwards, 
the  most  general  delirium  seizes  the  patient.  He  threatens  and  strikes.  A 
great  array  of  force  does  not  impress  him.  This  state  persists  for  seven  or 
eight  days,  and  terminates  by  a  general  sense  of  fatigue,  with  a  desire  to  sleep. 
It  is  renewed  several  times.  The  intervals  between  one  paroxysm  and  another, 
do  not  leave  the  patient  exempt  from  the  full  force  of  the  delirium.  He  is 
proud  and  haughty.  He  insults  every  one,  and  is  constantly  laughing  convul- 
sively. During  the  paroxysm,  the  patient  experiences  heat  in  the  head,  and  a 
burning  sensation  in  the  stomach  and  intestines.  Acidulous  and  nitrous  drinks 
are  exhibited,  tepid  baths,  douches,  lotions  of  oxycrate  to  the  head,  leeches  to  the 
anus,  pediluvia,  acidulated  drinks  and  laxatives.     During  the  first  two  months. 


184  CRITICAL     TERMINATIONS     OF     INSANITY. 

composure  and  excitement  alternate.  Cold  baths  and  douches  are  demanded 
by  the  patient. 

August.  Peruvian  bark  during  the  remission ;  leeches  to  the  anus  daily, 
for  fifteen  days ;  tepid  baths,  with  cold  water  to  the  head,  exercise,  and  diver- 
sion by  the  culture  of  the  garden.  A  hemorrhoidal  flux  comes  on,  which  is 
so  copious  for  several  days,  that  I  become  alarmed.  The  patient  is  pale, 
thoughtful,  gloomy  and  timid ;  desiring  to  return  to  his  family,  and  reason- 
ing very  properly.  September.  A  return  of  the  hemorrhoids,  and  a  continu- 
ance of  health.  Towards  the  end  of  the  month,  the  patient  still  laughs  at 
times,  without  cause.  On  the  following  month,  the  hemorrhoids  again  appear. 
Composure  and  correctness  of  thought,  are  more  marked.  Tired  of  a  life  of 
inactivity,  our  patient  returns  home  on  the  twenty-first  of  October.  In  the 
spring  following,  his  relatives  and  friends  fear  a  relapse.  I  advise  the  applica- 
tion of  leeches  to  the  anus,  foot  baths,  lotions  of  vinegar  to  the  head,  acidulat- 
ed drinks,  and  aloetic  purgatives.  The  hemorrhoids  discharge,  and  all  unea- 
siness is  dissipated.  Five  years  subsequently,  he  sees  one  of  his  children  sus- 
pended from  the  casement  of  the  garret  window,  ready  to  fall,  and  many  peo- 
ple hastening  thither.  Almost  motionless  from  fright,  he  runs  and  saves  his 
son.  To  this  violent  emotion,  succeed  all  the  signs  of  a  new  attack.  They 
make  repeated  applications  of  leeches,  and  administer  baths,  with  cold  water 
to  the  head,  together  with  cool  and  laxative  drinks.  In  this  instance  again, 
the  symptoms  only  appear.* 

.  I  never  knew,  from  my  personal  observation,  insanity  to  be  terminated  by 
the  rupture  of  varices,  but  was  acquainted  with  one  person  who  was  insane, 
and  who,  at  this  time,  is  advanced  in  life,  and  has  varicose  limbs. t  Suppres- 
sion of  the  menses  is  a  frequent  cause  of  insanity,  whether  it  may  have  been 
produced  by  a  strong  moral  affection,  or  some  error  of  regimen.  Insanity, 
depending  upon  this  cause,  terminates  by  the  reestablishment  of  the  menstrual 
flux.  However,  when  hereditary  disposition,  or  a  vice  of  conformation  pre- 
disposes to  insanity,  which  occurs  from  an  accidental  cause,  at  the  commence- 
ment of  the  malady,  the  menses  are  suppressed.  But  though  promptly  re- 
stored, they  do  not  relieve  the  patient  from  the  malady.  When  the  menses 
flow  freely  without  a  return  to  health,  we  may  then  fear,  lest  the  patient  be- 
come incurable ;  but  so  long  as  they  are  not  established,  it  is  proper  to  enter- 
tain some  hope  of  cure,  especially  in  early  life. 

Mad'e  C,  twenty-nine  years  of  age,  and  the  mother  of  two  children,  having 
had  distant  connections  affected  with  mental  alienation,  was  of  an  extremely 
jealous  disposition.  Scarcely  is  she  married,  than  her  jealousy  is  called  forth 
with  respect  to  her  husband,  who  however,  furnishes  no  occasion  for  the  exer- 
cise of  it.  Without  any  assignable  cause,  she  experiences  a  violent  attack  of 
jealousy,  followed  by  the  suppression  of  the  menses,  and  a  maniacal  delirium. 
After  some  months  of  fruitless  treatment  at  home,  she  is  committed  to  my 
care.  Her  hair  and  eyebrows  are  black,  her  brow  wrinkled,  her  eye  bright 
and  concealed  beneath  the  eyebrows,  her  look  asquint,  tongue  white,  and  the 
body  loaded  with  flesh.  The  patient  believes  that  she  hears  her  husband,  and 
supposes  that  he  is  near  her,  but  concealed  and  retained  by  his  mistres.ses. 
The  women  who  surround  and  serve  her,  excite  her  jealousy.  She  hears  them 
speaking  in  abusive  terms,  in  a  low  and  cowardly  tone.  Now,  she  remains 
whole  hours  without  moving ;  now  springs  with  the  speed  of  an  arrow,  takes 
a  hundred  steps  and  stops.  She  has  heard  her  husband,  who  is  absent.  At 
other  times,  her  step  is  slow  and  tortuous..  She  makes  the  day  to  consist  of 
forty-eight  hours  ;  breakfasts  and  dines  on  the  first,  but  does  not  retire  to  bed. 
On  the  following  day,  she  takes  luncheon  and  sups ;   and  the  day  being  finish- 

*  ZacHtus-Lusitanus  relates  a  similar  case. 

t  Decaballis,  Phenomena  Medici,  says  that  mania  terminates  by  the  rupture  of  vari- 
ces.    Hipp.,  aph.  21,  sect.  6.     Boerhallve,  aph.  124. 


CRITICAL     TERMINATIONS     OF     INSANITY.  185 

ed,  she  retires.  It  was  several  months  before  she  could  decide  to  retire  vo- 
luntarily on  the  intermediate  day,  or  change  her  mode  of  measurino-  time. 
She  persuades  herself,  that  those  about  her  are  constantly  occupied  in  acts 
disobliging  to  her,  which  provokes,  on  her  part,  outbreaks  of  fury.  The  ab- 
domen is  voluminous,  hard,  and  often  affected  with  colic  pains.  Constipation 
is  obstinate,  and  persists  from  fifteen  to  eighteen  days.  In  vain  do  they  de- 
sire to  administer  an  enemata,  and  apply  leeches.  She  believes  that  they  wish 
to  violate  her  person,  because,  says  she,  men  must  have  several  women.  Six 
months  pass  in  this  state,  and  she  makes  less  resistance  to  the  use  of  the  bath. 
At  length,  they  oblige  her  to  take  hip-baths  daily,  and  to  drink  a  laxative 
ptisan.  The  patient  appears  a  little  more  calm,  although  her  face  is  very 
much  flushed.  She  complains  of  colic  pains,  and  is  more  ready  to  do  what  is 
prescribed  for  her.  However,  her  notions  and  infatuations  are  the  same. 
She  does  not  recognize  the  hand-writing  of  her  husband,  and  is  unwilling  to 
hear  her  children  spoken  of,  though  her  condition  may  be  somewhat  improved. 
I  resolve  to  send  her  abroad  in  a  carriage  on  the  three  days  of  the  carnival. 
She  enters  it  on  compulsion,  and  rides  for  four  or  five  hours  each  day.  On 
returning  at  evening,  she  appears  less  gloomy  and  dissatisfied.  On  Monday, 
the  menses  make  their  appearance,  and  flow  abundantly  on  Tuesday.  From 
this  period  all  her  views  are  correct,  all  her  prejudices  are  dissipated,  her  hal- 
lucinations cease,  the  excretions  are  reestablished,  and  at  the  end  of  a  month, 
she  is  in  a  condition  to  return  to  her  family. 

Mad'lle  E.,  thirty  years  of  age,  of  a  nervous  temperament  and  delicate 
constitution,  a  vigorous  imagination,  a  mild  and  sensitive  disposition,  is  aban- 
doned by  her  lover,  by  whom  she  had  become  a  mother.  She  becomes  sad, 
and  grows  lean  rapidly.  The  menstrual  flow  is  imperfect,  irregular  and  scan- 
ty. She  suffers  from  constipation  and  colic  pains.  Some  months  after  this 
period,  the  fruit  of  her  labor  and  economy  is  stolen  from  her.  The  menses 
are  suppressed,  and  her  child  dies.  Her  grief  is  at  its  height.  The  menses 
do  not  appear,  and  at  the  expiration  of  ten  days,  the  most  violent  fury  bursts 
forth.  The  patient  is  delirious  on  all  subjects,  and  is  brought  to  the  Salpe- 
triere  Oct.  i;3th,  1801.  She  has  black  hair,  a  dark  complexion,  haggard 
eyes,  a  countenance  very  much  flushed,  though  sometimes  pale,  a  fetid  breath, 
and  livid  lips.  She  suffers  from  extreme  agitation,  utters  cries,  indulges  fear, 
employs  menacing  language,  and  at  intervals,  breaks  out  into  convulsive  laugh- 
ter. She  swears,  strikes,  and  does  not  recognize  her  relatives  and  friends. 
Notwithstanding  the  disorder  of  her  ideas,  she  is  disconcerted  on  finding  her- 
self in  a  hospital,  and  is  more  composed.  At  night  her  agitation  returns. 
Constipation  obstinate.  Fifteenth  and  sixteenth.  Tepid  baths  with  cold  wa- 
ter to  the  head.  There  is  composure,  occasional  colic  pains,  transient  chills, 
and  momentary  paleness  of  the  face.  Eighteenth.  The  patient  listens  to 
suggestions  and  advice  ;  testifies  some  degree  of  confidence,  and  is  less  deli- 
rious. The  alvine  dejections  are  effected  with  pain,  and  the  sleep  is  light. 
The  menses  appear.  Nineteenth.  A  very  marked  remission.  She  walks 
with  naked  feet,  which  is  followed  by  a  suspension  of  the  menses,  flushing  of 
the  face,  and  gleaming  of  the  eyes.  There  is  general  uneasiness  and  disquie- 
tude, distrust  and  transient  delirium.  Foot-baths  and  aromatic  drinks.  Sleep 
follows,  and  a  return  of  the  menses,  which  flow  abundantly.  On  the  follow- 
ing days  the  patient  experiences  every  evening  a  slight  febrile  heat,  succeeded 
by  a  copious  perspiration.  On  the  following  month,  the  menses  appear  with- 
out effort  or  excitement,  and  she  is  restored  to  her  family,  some  days  after  the 
menstrual  period,  yet  experiencing  violent  attacks  of  hysteria. 

Affections  of  the  skin  merit  special  attention  in  the  study  of  insanity.  The 
repercussion  of  herpes  has  often  caused  this  malady.  Sometimes  insanity 
appears  so  dependent  upon  the  development  of  a  psoric  affection,  that  it  ap- 
pears at  the  same  time  that  the  herpetic  eruption  becomes  manifest. 

24 


186  CRITICAL     TERMINATIONS     OF     INSANITY. 

A  young  man,  seventeen  years  of  age,  being  at  the  lyceum  in  the  province, 
is  suddenly  seized  with  an  attack  of  mania.  He  is  committed  to  my  charge. 
I  prescribe  tepid  baths  and  a  cooling  drink.  There  is  manifest  upon  his 
countenance,  a  herpetic  eruption,  which  gradually  becomes  extinct,  and  at  the 
same  time  that  the  delirium  disappears.  A  month  after,  his  father  brings  him 
to  Paris  to  pass  the  carnival  there.  He  becomes  greatly  fatigued.  On  Shrove 
Tuesday  he  got  tipsy,  and  his  father  brought  him  back  again  to  me,  worse 
than  at  his  first  attack.  Herpes  covered  his  whole  cheek,  but  after  the  use  of 
tepid  baths,  of  bitter  and  sudorific  ptisans,  together  with  much  exercise,  it 
disappeared  along  with  the  delirium.  During  the  following  autumn,  after  a 
frantic  revel,  delirium  returns,  in  connection  with  the  herpetic  eruption.  For 
two  years,  it  appeared  in  spring  and  autumn.  For  the  last  four  years,  this 
young  man,  having  submitted  to  healthful  regimen,  and  led  a  very  active  life, 
has  enjoyed  excellent  health,  and  for  two  years  engaged  in  the  war. 

A  young  Englishwoman,  while  residing  at  Rouen,  becomes  furious,  and  is 
brouo-ht  to  me,  covered  with  a  herpetic  eruption.  She  is  cured  after  four 
months,  of  the  attack.  I  apply  a  vesicatory,  and  advise  a  mild  regimen  and 
baths.  Every  thing  is  neglected.  In  the  spring  of  the  following  year,  she 
has  a  new  attack.  The  body  is  covered  with  herpes.  After  the  cure  of  this 
second  attack,  I  apply  a  vesicatory,  and  the  use  of  the  baths  is  continued. 
The  blister  is  replaced  by  a  cautery.  Since  the  epoch  of  the  return  of  the 
malady  is  passed,  certain  red  spots  appear  upon  the  person,  unattended  by 
cerebral  symptoms  ;  but  violent  colics,  hysterical  syncopes  and  vertigoes,  coin- 
cide with  a  greater  eruption  upon  the  surface,  yet  without  delirium.  Baths, 
depuratory  drinks,  and  an  active  life,  dissipate  all  these  symptoms.  This 
young  woman  enjoys  perfect  health  for  five  years,  and  has  returned  to  her 
native  country,  where  she  has  met  with  many  causes  of  chagrin,  and  changed 
her  regimen  and  mode  of  life,  without  being  sick. 

If  herpes  causes  insanity,  if  it  sometimes  proceeds  in  company  with  it, 
without  doubt  it   sometimes  terminates  it.     I  have  observed  this  termination. 

A  young  man  twenty  years  of  age,  very  strong  and  robust,  had,  at  the  age 
of  seventeen  years,  an  herpetic  eruption  which  occupied  the  whole  of  the  right 
side  of  the  chest.  By  the  use  of  appropriate  remedies,  he  was  cured,  and  gave 
himself  up  to  study,  and  particularly  to  pleasures.  The  disquietudes  connect- 
ed with  the  conscription,  caused  him  to  lose  his  reason.  He  is  much  agitat- 
ed, and  commits  a  thousand  extravagances.  At  the  expiration  of  a  month,  he 
is  committed  to  my  charge.  I  leave  the  patient  to  his  fancies.  He  bathes 
and  takes  a  laxative  ptisan.  A  month  has  scarcely  elapsed,  when  a  herpetic 
eruption  appears  upon  the  left  foot.  His  ideas  immediately  become  more  just, 
his  conversation  is  connected,  and  a  few  days  subsequently,  this  young  man 
enjoys  the  fnll  measure  of  his  reason,  and  in  less  than  six  weeks  is  restored 
to  his  family. 

It  is  the  consequence  of  psora  as  well  as  of  herpes.  During  the  last  cam- 
paign in  Prussia,  they  brought  into  the  military  hospital  a  horseman,  present- 
ing all  the  symptoms  of  an  ataxic  fever.  After  some  days'  observation.  Doc- 
tor Roux, — now  principal  physician  to  the  army,  believed  that  he  recognized 
a  veritable  mania.  He  prescribes  tepid  baths.  From  the  time  at  which  the 
first  bath  was  given,  he  notices  the  eruption  of  psora.  The  baths  are  contin- 
ued. This  eruption  extends  over  the  whole  body,  and  the  delirium  lessens  in 
proportion  as  the  psora  progresses.  After  fifteen  days  the  patient  is  restored 
to  reason,  but  the  body  is  covered  by  this  cutaneous  affection.  The  mildest 
measures  are  employed.  It  is  removed,  and  at  the  close  of  the  second  month, 
this  soldier  resumes  his  duties. 

M.  de  S.,  twenty-seven  years  of  age,  of  a  nervous  temperament,  descended 
from  a  father  whose  imagination  was  singularly  disordered,  having  had  also  an 
uncle  and  sister  insane,  and  possessing  a  very  strange  and  inconstant  disposi- 


CRITICAL     TERMINATIONS     OF     INSANITY.  187 

tion,  had  been  attacked  with  psora  while  in  the  army.  This  affection  was 
treated,  and  disappeared  in  a  few  days.  Four  years  afterwards,  having  left 
the  service,  he  abandoned  himself  to  the  grossest  irregularities,  committing 
every  variety  of  excess  in  regimen.  He  experiences  some  opposition,  becomes 
sad,  complains  of  constipation  and  pains  in  the  head,  and  loses  much  flesh. 
After  two  months,  he  suddenly  becomes  furious,  and  knows  not  the  voices  of 
his  relatives  and  friends,  whom  he  strikes  indifferently.  He  believes  that 
every  one  deceives  him,  that  he  is  going  to  be  given  up  to  justice,  and  that 
his  mistress  will  be  sacrificed.  He  converses  little,  refuses  nourishment,  or 
eats  voraciously.  After  some  days,  he  is  committed  to  my  care,  Jan.  24th, 
1808.  He  has  light  hair,  eyes  blue  and  fixed,  face  pale,  breath  fetid.  There 
was  a  general  trembling  of  the  body,  attended  with  an  expression  of  fear,  so 
soon  as  any  one  approached  him.  His  lips  were  in  continual  motion,  and  he 
obstinately  refused  either  to  speak  or  move.  At  other  times,  the  patient  moves 
about  and  converses  much.  Several  times,  he  endeavors  to  dash  his  head 
against  the  walls.  At  these  seasons  his  face  is  extremely  red,  and  his  eyes 
gleam.  There  are  moments  when  he  gives  himself  up  to  the  commission  of 
the  blindest  acts  of  fury,  employing  whatever  comes  to  hand,  to  assail  any  in- 
dividual who  may  approach  him.  This  patient  has  since  infomed  me,  that 
he  distinctly  heard  a  voice,  which  counselled  him  neither  to  speak,  walk  or 
eat ;  and  which  assured  him,  that  he  must  slay  some  one,  in  order  to  be  saved 
and  free.  This  voice  kept  him  awake,  threatening  him  with  dangers  the  most 
terrible.     Application  of  leeches,  acidulated  drinks,  and  tepid  baths. 

May.  Nauseating  drinks  for  many  days  together ;  provoking  abundant  de- 
jections, and  a  slight  eruption  upon  the  skin.  June.  Bitter  drinks,  tepid 
baths,  and  the  application  of  leeches  to  the  temples.  The  patient  converses 
more  willingly,  sleeps  a  little,  and  trembles  less.  There  is  a  manifest  remission. 
July.  Leeches  applied  anew  to  the  head,  cold  baths,  douches.  A  marked 
amelioration.  August.  An  aloetic  purgative,  tepid  baths,  and  a  blister  to  the 
neck.  A  more  marked  advance  towards  reason  succeeds.  Pimples  are  more 
numerous  upon  the  body.  September.  Convalescence  perfect.  The  patient 
is  restored  to  his  family  during  the  month  of  October ;  his  dejection,  irreso- 
lution and  sadness  continuing,  or  giving  place  to  a  disordered  gayety.  Nov. 
He  gives  himself  up  anew  to  some  errors  of  regimen,  and  resumes  his  former 
disposition  ;  at  the  same  time  informing  me  that  his  cutaneous  disorder  has 
returned.  In  fact,  I  examine  him,  and  find  his  body,  particularly  the  arms, 
covered  with  pimples,  attended  with  an  insupportable  itching.  I  was  unable 
to  induce  him  to  take  care  of  this  new  affection,  which  tormented  him  for 
more  than  a  year.  There  has  been  no  cutaneous  affection  for  four  years,  nor 
has  his  reason  been  affected. 

M.  de  X.,  a  general  and  inspector  of  reviews,  thirty-eight  years  of  age,  of 
a  sanguine  temperament,  tall,  with  black  hair,  a  lively  and  glowing  imagina- 
tion, gave  himself  up  to  excessive  masturbation,  although  very  devoted  to 
study,  and  leading  a  very  active  life.  He  experienced,  two  years  since,  ex- 
cessive mortifications,  which  rendered  him  sad.  He  is  sent  to  Italy,  takes  the 
itch,  and  treats  himself  In  eight  days,  the  eruption  disappeared.  He  now 
experiences  some  opposition,  called  forth  by  the  uprightness  of  his  conduct, 
and  the  severity  of  his  inspection.  His  disposition  is  soured,  and  he  becomes 
irritable  and  passionate.  They  impeach  him,  and  he  goes  to  Paris  to  justify 
himself  Certain  indications  of  delirium  are  noticed  in  his  conversation. 
One  of  his  friends  is  so  imprudent  as  to  say  to  him,  that  he  had  been  im- 
peached because  he  was  insane.  He  then  becomes  so  in  reality;  is  furious, 
and  threatens  the  lives  of  all  those  who  surround  him,  even  that  of  his  wife. 
They  bleed  him  several  times,  bathe  him  with  cold  water,  and  administer  the 
bath  of  surprise.  He  sinks  into  dementia,  complicated  with  general  paralysis. 
Suffering  from  involuntary  dejections,  momentary  attacks  of  fury,  fright,  when- 


188  CRITICAL     TERMINATIONS     OF     INSANITY. 

ever  any  one  approaches  him,  voracity,  insomnia,  and  constant  cries,  he  is 
committed  to  my  care  in  the  spring  of  1805,  Baths,  whey,  aloetics,  and  Pe- 
ruvian bark  are  successively  administered,  and  the  severest  watchfulness  is 
exercised  to  prevent  masturbation.  Exercise,  both  by  walking  in  the  open  air, 
and  by  riding,  is  taken ;  yet  nothing  changes  the  condition  of  the  patient. 
But  though  extremely  fearful,  he  becomes  affectionate,  extending  his  hand, 
and  smiling,  to  all  those  who  approach  him.  Hoping  that  if  I  could  again 
communicate  to  him  the  itch,  I  should  cure  him,  I  employed  tepid  baths,  and 
friction  morning  and  evening.  He  takes  tonics  internally,  and  sleeps  in  the 
shirts  of  those  affected  with  this  disorder  for  fifteen  nights.  Professor  Alibert 
provides  me  with  the  virus  of  psora.  I  make  about  the  articulations  of  the 
limbs,  more  than  eighty  punctures,  with  no  better  success.  I  cause  the  pa- 
tient to  sleep  anew  in  infected  shirts,  with  no  better  success.* 

[The  immediate  cause  of  psora  being  now  well  understood,  the  want  of  success  in  in- 
oculating with  the  matter  of  the  vesicle  is  not  surprising.  Not  only  is  tliere  nothing 
specific  in  this  matter,  but  the  insect  (jlcariis  TScahei),  by  whose  irritation  it  is  produced, 
is  not  found  in  the  vesicle  itself,  but  distant  from  it  usually  two  lines  in  extent.] 

Chilblains  have  also  some  influence  upon  the  progress  of  insanity. 

I  had  charge  of  a  young  man  eighteen  years  of  age,  who,  from  the  age  of 
thirteen  years,  had  been  in  a  state  of  mania,  which  alternated  with  dementia. 
The  delirium  lessened,  and  reason  resumed  its  seat  for  many  months,  while 
he  was  tormented  with  chilblains  on  his  heels  and  the  fingers  of  his  hands. 
The  sores  discharged  abundantly.  Several  issues  were  established,  after  the 
suppression  of  the  chilblains.  This  young  man  continues  in  a  state  of  de- 
mentia, accompanied  by  fury,  which  has  assumed  an  erotic  character  since 
the  age  of  puberty. 

Furuncles  often  make  their  appearance  among<the  insane,  and  become  cri- 
tical in  some  cases,  especially  when  the  suppuration  is  very  abundant.  I  have 
observed  this  critical  termination,  particularly  in  the  case  of  two  individuals, 
both  of  whom  were  exceedingly  fleshy,  and  had  what  is  called  a  humoral  con- 
stitution. 

M.  de  T.,  an  old  soldier  forty-seven  years  of  age,  descended  from  a  father 
and  uncle  who  were  insane,  of  a  sanguine  temperament,  subject  for  a  long 
series  of  years  to  a  trembling  of  the  hands,  was  of  a  mild  disposition,  indiffe- 
rent, irresolute,  of  limited  mental  capacity,  and  poorly  adapted  for  study.  Al- 
though destitute  of  passion,  he  was  very  fond  of  women,  and  by  no  means 
difficult  in  his  choice.  His  education  was  neglected,  and  his  fortune  impaired, 
both  by  the  injustice  of  his  relatives,  and  the  consequences  of  the  revolution. 
His  wife  having  had  eleven  abortions,  he  was  greatly  afflicted,  in  consequence 
of  not  having  children  to  whom  he  could  leave  his  name  and  fortune.  For 
some  time  past,  the  trembling  of  the  hands  having  diminished,  the  patient  has 
been  troubled  with  hemorrhoids,  and  has  become  gloomy.  During  the  year 
1801,  he  became  sad,  taciturn,  indifferent  about  his  affairs,  his  wife  and 
friends ;  indulging  also  in  many  liberties  with  the  ladies.  Eating  much,  and 
taking  little  exercise,  he  becomes  corpulent.  Spring  of  1802.  Impairment 
of  the  intellectual  faculties,  especially  of  the  memory.  The  patient  leaves 
his  house  without  a  purpose,  and  returns  thither  without  a  motive,  and  at  all 
hours.  Twice,  on  the  same  day,  he  goes  on  foot  to  the  residences  of  a  lady 
and  a  cousin,  to  demand  their  hand.  At  another  time  he  wishes  to  drown 
himself     Finally,  he  sometimes  leaves  his  hotel,  and  not  returning,  is  found 

*  Gardane  assures  us,  that  mania  can  be  cured  by  inoculation.  Fischer  and  Riedlin 
make  the  same  observation.  Decostes  mentions  a  case  of  mania,  which  was  cured  by 
the  itch. 


CRITICAL     TERMINATIONS     OF     INSANITY.  189 

on  foot,  many  leagues  distant,  upon  the  public  road,  not  knowing  whither  he 
is  going.  May  1st,  1802.  The  patient  is  brought  to  Paris,  and  committed 
to  the  care  of  Pinel  and  myself  His  face  is  pale,  features  relaxed,  his  eyes 
fixed,  his  hands  tremble.  He  totters  upon  his  legs,  has  a  voracious  appetite, 
thirst,  and  difficulty  and  pain  in  urinating.  His  memory  is  enfeebled,  and 
intermediate  ideas  are  wanting,  to  carry  on  a  process  of  reasoning.  Some- 
times, he  becomes  violent,  and  his  delirium  then  takes  the  form  of  excitement. 
His  face  is  flushed,  his  eyes  glisten,  and  his  movements  are  free  and  constant. 
He  cries,  breaks,  rends,  displaces  and  gathers  together  every  thing  that  he 
meets  with.  Leeches  are  applied  to  the  anus,  which  occasion  an  abundant  dis- 
charge, and  laxative  drinks  produce  dry  and  black  dejections.  His  sleep  is 
troubled  by  frightful  dreams. 

June.  Baths  at  22'^  (Reaumur) ;  douches,  with  no  effect.  Blister  to  the 
neck,  followed  by  a  remission.  Some  days  afterwards,  he  has  a  rigor,  with  a 
tendency  to  stupor.  There  is  a  return  of  delirium,  attended  with  agitation, 
fury,  and  a  desire  to  destroy.  Leeches  are  applied  to  the  anus.  19th.  A  he- 
morrhoidal flux,  followed  by  still  greater  exasperation  of  the  symptoms.  He 
indulges  in  obscene  proposals,  and  makes  up  a  matrimonial  project.  He  has 
an  irresistible  desire  to  walk  about,  and  employ  his  hands  in  doing  mischief. 
Baths,  with  lotions  of  cold  water  to  the  head.  29th.  Suddenly,  amidst  fright- 
ful cries  and  howls,  he  calls  upon  his  son,  (though  he  has  no  child),  and  per- 
sists in  remaining  naked.  His  face  is  at  this  time  exceedingly  red,  his  skin 
hot,  and  fury  bursts  forth  on  the  slightest  opposition.  These  symptoms  in- 
crease during  the  night.  We  multiply  lotions  of  oxycrate  upon  the  head,  and 
several  tumblers  of  an  emulsion  are  drank  with  avidity.  We  permit  the  pa- 
tient to  walk  about  naked  in  the  open  air,  and  spunge  him  with  cold  water, 
but  nothing  soothes  him.  At  two  o'clock  at  night,  the  patient  who  was  asleep 
in  bed,  overcome  by  fatigue,  is  awoke  by  a  frightful  dream.  He  thinks  that  he 
is  surrounded  by  robbers,  and  places  with  difficulty  his  bed  against  the  win- 
dow to  prevent  their  entrance.  At  the  same  time,  he  utters  frightful  cries, 
and  strikes,  with  redoubled  blows,  against  the  walls  and  door  of  his  cham- 
ber. I  hasten  to  the  patient.  Neither  my  exhortations,  nor  the  presence  of 
several  attendants  could  reassure  him,  or  cause  him  to  cease  his  vociferations. 
His  face  is  very  much  flushed,  the  blood-vessels  of  the  neck  and  head  greatly 
enlarged,  the  skin  hot,  and  his  fury  extreme.  I  threaten  the  patient  with 
the  douche.  He  desires,  and  receives  it ;  becoming  coinposed,  while  the  wa- 
ter is  falling  upon  his  head.  He  thanks  us  for  the  favor  we  have  done  him, 
retires  to  bed,  drinks  several  glasses  of  very  cool  emulsion,  and  sleeps  finely 
the  rest  of  the  night.  30th.  Calm.  There  is  however,  a  wildness  of  action, 
which  seems  to  be  aroused  by  the  genius  of  destruction.  Whilst  tearing  up 
his  linen,  he  assures  me,  that  he  is  making  shirts,  sheets  and  mattres.ses. 
The  vesicatory  discharges,  although  it  was  often  plucked  off.  A  bitter  and 
laxative  ptisan. 

July  1  St.  Return  of  his  cries,  agitation  and  fury.  Lotions  of  vinegar  and 
water  applied  to  the  head  and  the  whole  body,  are  followed  by  sleep.  3d.  Fu- 
runcles upon  the  back  and  arm  ;  composure,  sadness,  tears  ;  less  delirium, 
but  the  same  desire  to  use  and  exercise  his  hands;  diarrhcea.  5th.  Symptoms 
again  exasperated.  They  are  temporary,  and  during  their  continuance,  his 
face  is  very  red.  8th.  Application  of  leeches  to  the  anus.  The  vesicatory 
and  several  boils  dry  up,  from  the  impossibility  of  employing  dressings  upon 
them.  9th.  Composure  and  agitation  alternate.  He  destroys  every  thing ; 
demolishing,  he  says,  to  build  again.  He  breaks,  in  order  to  make  new  ob- 
jects. He  roots  out  the  trees,  in  order  to  quicken  vegetation.  He  tears  up 
his  linen,  in  order  to  increase  the  quantity  of  it.  He  marries  himself  to  se- 
ven or  eight  women,  and  is  noisy  during  the  night.  At  times,  he  howls. 
10th.  At  one  o'clock  at  night,  he  throws  against  his  door,  the  wood-work  of 


190  CRITICAL     TERMINATIONS     OF     INSANITY. 

his  bed,  which  is  of  great  weight.  We  come  to  the  patient,  and  find  him 
pale,  trembling  and  frightened.  He  thought  he  had  seen  four  robbers,  who 
wished  to  enter  his  chamber.  We  encourage  him,  wet  his  head  and  spunge  his 
whole  body  with  very  cold  vinegar  and  water.  He  then  goes  to  bed,  and  sleeps 
perfectly  well  the  rest  of  the  night.  12th.  Tepid  baths,  douches  every  other 
day  ;  composure,  lucid  moments,  and  sleep.  Towards  the  end  of  the  month 
his  agitation  returns,  always  preceded  by  palor,  and  accompanied  by  redness 
of  the  face,  heat  and  thirst.  The  blister  has  dried  up,  and  the  boils  ceased 
to  suppurate.  The  diarrhoea  has  also  ceased.  30th.  Lucid  moments,  walks 
abroad.  The  patient  tears  less,  remains  clad,  eats  with  propriety,  but  at  break 
of  day,  overturns  every  thing  in  his  chamber.  Tepid  baths,  aloes,  and  pow- 
dered rhubarb,  mingled  with  pulverized  orange  leaves. 

Aug.  20th.  Several  boils  appear ;  same  treatment ;  bitter  drink.  27th. 
Manifest  progress  towards  the  use  of  the  reason  ;  patient  writes  to  his  wife. 
30th.  Abundant  suppuration  of  the  boils,  and  sleep.  The  patient  no  longer 
tears,  but  every  morning  his  bed  is  overturned. 

Sept.  4th.  Redness  of  face,  agitation,  delirium,  impatience.  The  boils 
discharge  a  little  ;  return  of  strength.  13th.  New  boils,  composure,  scarcely 
any  delirium.  21st.  Abundant  suppuration  of  the  boils.  The  patient  enjoys 
the  perfect  use  of  his  reason,  desires  to  see  his  wife,  and  speaks  of  returning 
home.  29th.  Agitation,  tears,  extravagant  notions,  abundant  stools.  Laxa- 
tives in  combination  with  bitters,  and  alternating  with  tepid  baths. 

Oct.  11th.  Reason  perfect,  memory  somewhat  enfeebled;  face  flushed  at 
times  ;  slight  embarrassment  in  speech  ;  step  slow  and  uncertain.  The  boils 
begin  to  dry  up.  Takes  exercise  both  by  walking  and  in  a  carriage.  Peru- 
vian bark  and  sack.     Issue  upon  the  arm. 

Nov.  Reestablishment  of  the  vital  forces,  muscular  movements  easy,  gay- 
ety,  and  social  civilities.  25th.  Arrival  of  his  wife.  He  was  more  sad  and 
thoughtful  on  the  following  days.  Every  evening  his  eyes  are  red,  and  his 
head  aches.  28th.  Slight  paralysis  of  the  tongue  ;  dissipated  by  exercise  and 
labor  in  the  garden.  Foot  baths,  rendered  stimulating  by  mustard,  employed 
for  several  days  in  succession  ;  purgative  enemata.  Leeches  to  the  anus  on 
the  29th. 

Dec.  Vesicatory  to  the  neck,  which  has  discharged  for  some  days.  Infu- 
sion of  arnica.  Health  perfect.  The  patient  leaves  for  the  country  on  the 
following  month,  during  a  very  cold  period.  His  carriage  is  overturned,  and 
falls  many  feet  without  his  reason  being  in  the  least  affected  by  this  violent 
shock.  Five  years  afterwards,  M.  de  T.,  whose  hemorrhoids  discharged  abun- 
dantly, and  who  enjoyed  excellent  health,  died  suddenly,  from  a  cerebral  he- 
morrhage. 

A  lady,  twenty-seven  years  of  age,  of  a  lymphatic  temperament,  having 
light  hair,  and  a  mild,  though  decided  disposition,  the  issue  of  a  mother  whose 
ideas  and  schemes  had  always  been  exaggerated,  has  been  nursing  for  three 
months.  Her  husband  is  obliged  to  be  absent.  From  that  evening,  she  wor- 
ries and  torments  herself  respecting  him.  Now,  she  fears  that  he  is  slain  ; 
now,  that  he  is  going  to  abandon  her.  On  the  following  day,  her  friends, 
wishing  to  divert  her,  write  for  her  to  visit  them.  Scarcely  has  she  complied 
with  this  invitation,  before  she  begins  to  seek  her  husband  every  where,  and 
suffers  from  the  most  violent  delirium,  which  his  arrival  does  not  dissipate. 
After  a  delirium  of  three  months'  duration,  which  is  often  attended  with  fury, 
the  patient  is  committed  to  my  care.  She  is  in  a  state  of  religious  melancho- 
ly, having  a  pale  face,  convulsive  features,  and  rarely  speaking.  She  eats 
little,  and  with  difficulty.  Constipation  is  obstinate.  The  patient  is  unwil- 
ling to  take  any  remedy,  but  desires  to  die,  and  invokes  death.  I  order  a  ve- 
sicatory to  the  neck,  which  she  supports  but  a  few  days.  We  have  recourse 
to  mild  purgatives.     After  three  months,  reason  is  restored,  but  the  patient 


CBITICAL     TERMINATIONS     OF     INSANITY.  191 

remains  gloomy,  sad,  diffident,  jealous  and  choleric.  Nevertheless,  she  re- 
turns to  her  family.  After  some  days,  an  enormous  furuncle  appears  upon  the 
perinaeum.  Suppuration  is  very  abundant  for  fifteen  days,  and  from  that  time, 
her  health  is  perfect. 

Abundant  suppurations,  whether  spontaneous  or  provoked  ;  the  reopening 
of  ulcers  and  issues,  have  also,  sometimes  terminated  insanity.* 

M.  C,  an  officer  of  the  guard,  twenty-five  years  of  age,  very  tall,  of  a  fee- 
ble constitution  and  nervous  temperament,  of  a  melancholy  disposition,  unac- 
quainted with  every  thing  but  the  service,  flying  society,  and  giving  himself 
up  to  solitary  pleasures,  had  seen  his  brother  perish  in  Egypt,  in  consequence 
of  traumatic  tetanus.  From  the  time  of  his  return  to  France,  he  remains 
attached  to  the  military  service.  The  death  of  his  father,  together  with  some 
domestic  trials,  render  him  more  gloomy  for  a  year.  About  the  month  of 
March,  1801,  whilst  exercising,  he  experiences  a  peculiar  disturbance  in  his 
stomach,  and  since  that  period,  he  has  never  ceased  to  complain  of  the  epi- 
gastric region.  He  grows  lean,  and  becomes  feeble.  He  believes  that  his 
lungs  are  affected,  and  employs  several  remedies. 

July  27th.  Being  at  the  military  hospital,  he  remains  for  twenty-four  hours, 
sitting  upon  his  hams  in  bed,  unwilling  to  leave  it.  At  six  o'clock  on  the  fol- 
lowing morning,  he  deceives  the  overseers  and  sentinels  of  the  hospital,  and, 
clothed  with  a  single  garment  runs  through  the  streets,  drinks  a  glass  of  bran- 
dy, betakes  himself  to  the  house  of  a  cousin,  and  is  there  very  delirious. 
Two  days  afterwards,  feeling  very  thirsty,  he  drinks  ten  bottles  of  wine,  in 
which  he  dissolves  several  pounds  of  sugar.  He  vomits  abundantly,  but  still 
drinks.  His  servant  tries  to  prevent  it,  but  this  is  not  done  without  danger. 
In  the  evening,  he  experiences  great  prostration,  and  during  the  night  suffers 
from  convulsions,  when  his  urine  is  discharged  involuntarily.  His  thirst  is 
most  urgent.  On  the  following  day,  the  delirium  is  continued  and  general. 
He  spits  at  every  one,  often  becomes  furious,  and  thinks  that  every  thing  of- 
fered him  is  poisoned. 

Aug.  20th.  I  visit  the  patient,  who  is  at  the  Guard  hospital.  I  find  him 
bound  to  his  bed,  surrounded  by  his  comrades,  pale,  extremely  emaciated,  his 
eyes  glazed,  the  muscles  of  his  face  wan,  and  his  breath  exhaling  a  fetid  odor. 
I  cause  him  to  be  unbound,  and  he  consents  to  enter  a  carriage  with  me  alone. 
The  open  air  composes  him,  and  he  is  rational.  Having  been  introduced  to 
his  new  habitation,  he  sleeps  for  several  hours.  On  waking,  there  is  redness 
of  the  cheeks,  his  eyes  are  fixed,  and  his  physiognomy  sad.  "  I  could  die 
for  him ;  I  must  see  him ;  if  he  sees  me,  every  thing  is  saved ;  he  is  God,  my 
father ;  my  mother  !  he  has  chosen  my  mother  for  his  wife.  In  the  name  of 
the  Father  and  of  the  Son  and  of  the  Holy  Ghost.  So  may  it  be."  These 
phrases  are  blended  together,  during  seasons  of  repose,  when  the  patient  seeks 
for  words,  and  repeats  them  very  rapidly,  as  if  after  a  great  effort  of  memory. 
He  often  makes  the  sign  of  the  cross,  pronouncing  the  words,  "/«  the  nume^ 
etc.,  in  a  slow  and  solemn  manner.  The  pupils  are  dilated,  and  the  urine 
flows  involuntarily.  Perspiration  is  general,  limbs  rigid,  pulse  feeble  and  sub- 
sultus  tendinum.  Lotions  of  cold  water  to  the  head,  and  sinapisms.  21st. 
A  remission,  attended  with  a  general  sense  of  feebleness.  He  seeks  every 
where  for  his  father  and  mother.  There  is  tetanic  rigidity.  Signs  of  the 
cross  are  constant,  and  he  entertains  solicitude  respecting  his  life.  At  evening 
he  has  an  appetite,  and  a  remission  of  his  malady.  The  patient  sees  20,000 
men  pass,  on  horseback,  borne  upon  clouds,  to  the  conquest  of  England. 
During  the  night,  there  is  tetanic  rigidity,  and  an  expression  of  alarm  upon 
his  countenance.  The  patient  believes  that  he  sees  devils,  from  which  he 
tries  to  rid  himself  by  signs  of  the  cross,  and  blows  of  his  fists  which  he 

*  Sibbern.  in  Collect.  Soc.  Med.     Havn.  I,  no.  11. 


192  CRITICAL     TERMINATIONS     OF     INSANITY. 

makes  in  the  air.  23d.  From  seven  o'clock  in  the  morning,  there  is  tetanic 
rigidity ;  his  eyes  are  fixed,  and  the  pupils  dilated.  There  is  perspiration, 
slow  pulse,  and  insensibility  when  the  skin  is  pinched.  The  visit  of  a  com- 
rade causes  the  tears  to  flow.  Alcoholic  frictions  are  employed,  a  blister  to 
the  neck,  and  sinapisms  to  the  feet.  24th.  Same  delirium,  complaints  of 
the  patient  as  to  what  he  is  caused  to  suffer  ;  tetanic  rigidity  diminished.  Ve- 
sicatory discharges  abundantly.  25th.  Bath,  followed  by  sleep.  The  sight 
of  his  sister  afforded  him  the  sincerest  pleasure,  but  after  his  first  greetings, 
he  sinks  into  a  profound  sleep.  All  the  articulations  of  the  fingers,  upon 
which  blisters  were  formed  day  before  yesterday,  are  in  a  state  of  suppuration. 
27th.  The  patient  is  stronger,  and  desires  to  be  left  to  take  care  of  himself. 
28th.  He  affronts  his  sister,  and  is  at  times  delirious.  Gayety  and  sadness 
alternate.     Sleep. 

Sept.  4th.  We  open  a  blister  under  the  heel,  formed  by  the  sinapism  on 
the  2;3d  of  Aug. ;  an  operation  which  the  patient  was  unwilling  to  permit. 
The  serum  which  is  poured  forth,  exhales  an  exceedingly  fetid  odor.  A  few 
drops  of  it  fell  upon  one  of  my  fingers,  causing  a  whitlow,  which  it  was  ne- 
cessary to  open  with  an  instrument.  5th.  A  complete  remission,  together 
with  a  bath.  6th.  Abundant  stools,  bleeding  at  the  nose,  and  perspiration. 
The  wound  upon  the  heel  is  of  an  unhealthy  character.  New  blisters  form 
upon  all  the  fingers.  17th.  Same  state  continues;  severe  and  continued 
pains  at  the  epigastrium.  27th.  The  blisters  of  the  fingers  dry  up  succes- 
sively.    The  wound  beneath  the  heel  improves.     Milk,  chocolate,  tonics. 

Oct.  2d.  Cicatrization  of  the  wound  of  the  heel.  Since  this  period,  al- 
though the  patient  makes  a  visit  to  his  relatives  and  friends,  and  walks  much, 
he  becomes  sad,  uneasy,  impatient.  Nothing  diverts  him,  and  he  says  he 
suffers  greatly.  11th.  His  emotions  are  variable.  There  is  alternately,  gay- 
ety and  sadness,  discouragement  and  bitter  complaints.  We  apply  a  blister 
to  the  arm,  and  administer  purgative  drinks  during  several  days.  Stools  abun- 
dant. 13th.  Restoration  to  health.  It  is  remarkable,  that  during  the  sup- 
puration of  the  vesicatory,  the  patient  improved  daily.  23d.  This  young 
officer  leaves  for  his  family  in  the  country,  and  a  few  days  afterwards,  there 
was  a  suppression  of  the  vesicatory.  His  health  immediately  suffers,  and  an 
issue  is  established.  M.  C.  at  length  returns  to  his  service,  from  which  he  re- 
tires a  year  subsequently,  at  the  solicitation  of  his  relatives,  in  the  enjoyment 
of  ofood  health. 

A  lady,  forty  years  of  age,  becomes  a  maniac,  and  remained  so  for  a  year. 
After  an  intermission,  she  had  another  attack,  which  persisted  for  a  year  ; 
and  so  on,  for  twenty  years.  At  the  time  of  the  cessation  of  the  menses,  a 
cancer  appears  on  the  right  breast,  and  at  the  age  of  sixty  years  the  tumor 
is  extirpated.  An  attack  recurs,  without  affecting  the  tendency  of  the  wound 
towards  cicatrization,  which  took  place  six  weeks  after  the  operation.  When 
the  wound  had  cicatrized,  the  attack  which  usually  lasted  a  year,  ceased  en- 
tirely, and  very  speedily,  having  continued  only  six  months  ;  and  has  not 
again  returned.     For  seven  years,  this  woman  has  enjoyed  perfect  health.* 

Mary  Ann  Frances  F.,  nineteen  years  of  age,  of  a  nervous  temperament, 
medium  stature,  light  hair,  black  eyes,  light  complexion,  and  a  moderately  full 
habit,  was  born  of  an  insane  mother.  At  seven  years  of  age,  she  has  variola, 
at  twelve  tinea  capitis,  at  thirteen  psora,  at  fourteen,  the  menses,  preceded  by 
an  eruption  on  the  head.  Since  the  turns  have  been  abundant,  she  has  had 
frequent  attacks  of  headache.  At  the  age  of  sixteen  years,  she  imagined 
that  every  one  was  watching  her  movements,  but  this  painful  idea  was  prompt- 
ly dissipated.  Married  at  the  age  of  eighteen,  she  had  at  nineteen  a  happy 
confinement.     She  desired  to  nurse  her  infant,  but   at  the  earliest  period  of 

*  Lafontaine. 


CRITICAL     TERMINATIONS     OF     INSANITY.  193 

lactation,  committed  errors  in  regimen.  She  was  unwilling  to  remain  cover- 
ed, saying,  she  was  too  warm,  etc.  The  conformation  of  the  nipples  not  be- 
ing favorable  for  nursing,  she  experienced  much  pain  whilst  the  child  was  at 
the  breast,  which  occasioned  great  disorder  of  thought.  On  the  fourth  day, 
she  ceases  to  nurse,  and  her  breasts  are  excessively  distended  with  milk.  On 
the  fifth,  she  drinks  cold  water,  and  washes  herself  in  it.  The  lochia  cease, 
and  the  delirium  increases.  She  complains  of  an  insupportable  heat.  They 
cannot  bleed  her.  She  pinches  and  bruises  her  breasts  without  appearing  to 
suffer.  On  the  fourteenth  day,  leeches  are  applied  to  the  vulva,  mustard  to 
the  thighs,  and  two  blisters  to  the  legs.  On  the  sixteenth  day,  leeches  are 
applied  behind  the  ears,  sinapisms  anew,  ethereal  potions,  etc.  All  these 
means  were  employed  without  success.  On  the  25th  Feb.,  she  is  brought  to 
La  Charite,  and  after  remaining  there  four  days,  is  transferred  to  the  Salpe- 
triere.  On  her  arrival,  the  delirium  is  general,  the  breasts  are  very  hard,  and 
the  patient  refuses  to  remain  covered.  She  is,  without  cause,  tormented  with 
fear,  mistaking  persons  who  approach  her,  for  gentlemen  of  her  acquaintance. 
March  5th,  a  milk  abscess  forms  in  the  right  breast,  which  was  previously 
very  hard  and  of  a  violet  color.  An  abundant  discharge  of  sanious  matter 
takes  place,  yet  the  delirium  continues,  and  the  patient  will  allow  no  apparel 
to  be  put  upon  her.  April  10th,  the  opening  in  the  breast  tends  to  cicatriza- 
tion, the  delirium  lessens,  and  the  patient  regards  the  advice  that  is  given  her. 
Laxative  drinks.  May  1st.  Progressive  return  of  the  vital  forces,  and  rea- 
son. Sees  her  husband  and  parents  :  is  more  calm  and  rational.  May  12th. 
Entire  convalescence,  and  complete  cicatrization  of  the  abscess.  15th,  rea- 
son is  wholly  restored.     On  the  27th,  our  convalescent  is  discharged  cured. 

We  have  had  at  the  Salpetriere  a  woman,  thirty-five  years  of  age,  who  was 
affected  with  a  monomaniacal  delirium,  attended  with  excessive  mobility.  She 
had  a  cancer  in  a  state  of  ulceration  on  the  left  breast,  showed  it  to  every  one, 
and  would  wear  no  apparel.  The  surgeon-in-chief  of  the  hospital.  Professor 
Lallemand,  extirpated  the  breast ;  an  operation  which  the  patient  bore  with 
great  fortitude.  From  that  moment,  she  was  more  composed,  and  willingly 
submitted  to  the  employment  of  dressings.  Although  enormous,  the  wound 
healed  rapidly  ;  and  cicatrization  and  the  reestablishment  of  reason  were 
simultaneous. 

A  woman  forty-five  years  of  age,  had  for  three  years,  an  ulcer  upon  the 
leg.  They  heal  the  sore,  and  she  immediately  becomes  a  maniac,  and  suffers 
somewhat  from  difficulty  of  articulation.  She  is  brought  to  the  Salpetriere. 
The  ulcer  is  reopened,  and  reason  restored.  Similar  facts  have  been  present- 
ed to  my  notice,  seven  or  eight  times  at  least,  in  the  course  of  my  practice. 
We  have  in  the  division  for  the  insane  at  the  Salpetriere,  a  woman  forty-six 
years  of  age,  affected  with  an  attack  of  mania  without  fury,  which  was  induced 
by  a  thunder-clap.  This  attack  terminated  in  an  engorgement  of  the  sub- 
maxillary glands  of  the  right  side.  The  patient  then  fell  into  a  stupor,  attend- 
ed with  an  inability  to  articulate  sounds.  The  use  of  mercury  internally,  and 
friction  to  the  tumor,  dissipated  the  engorgement.  This  woman  recovered 
her  reason,  in  proportion  as  the  glands  were  emptied,  and  at  length,  became 
sane.  But  scarcely  had  she  returned  home,  than  she  experienced  domestic 
mortifications  and  distress,  and  relapsed  into  a  state  of  stupor  and  paralysis. 
The  glands  were  engorged  anew,  and  since  they  have  been  relieved  a  second 
time,  the  patient  is  better. 

Elizabeth  C,  sixty-four  years  of  age,  of  much  constitutional  vigor,  and  very 
active  for  one  of  her  age,  has  always  enjoyed  excellent  health.  She  never 
experienced  any  menstrual  disorder,  and  had  four  fortunate  confinements. 
One  of  her  sons  went  to  Spain  during  the  last  war.  Having  received  no  in- 
telligence respecting  him,  she  thought  she  recognized  him  one  day  among  a 
company  of  soldiers,  and  followed  this  company  from  the  suburb  St.  Antoine, 

25 


194  CKITICAL     TERMINATIONS     OF     INSANITY. 

to  the  environs  of  the  barrier  Fontainebleau.  We  know  not  precisely  what 
happened  on  the  way,  but  she  was  taken  by  the  police,  on  the  following  day, 
running  naked  through  the  streets  and  public  places.  She  is  brought  to  the 
Salpetriere,  in  a  state  of  agitation  extraordinary  for  a  person  of  her  age. 
This  condition  lasts  for  six  weeks  without  any  remission  ;  when  at  length,  the 
parotid  of  the  left  side  becomes  developed.  The  delirium  is  immediately  as- 
suaged. The  repeated  application  of  leeches  to  the  tumor,  reduced  its  in- 
flammation. However,  an  abscess  forms,  which  is  opened  and  cured  in  the 
course  of  about  three  weeks.  Ever  since  the  enlargement  of  the  parotid  com- 
menced, the  delirium  has  gradually  lessened,  and  finally  disappeared  before 
the  cicatrization  of  the  wound,  formed  by  the  opening  of  the  abscess.  At  this 
time,  June  24th,  the  patient  leaves  the  hospital  perfectly  restored. 

Sputation  is  a  very  remarkable  symptom  among  the  insane.  It  often  an- 
nounces the  explosion  of  an  attack,  and  sometimes  persists  during  the  whole 
period  of  the  malady.  There  are  insane  persons  who  make  all  the  efforts  and 
movements  of  one  who  desires  to  spit,  though  they  are  unable  to  accomplish 
the  act.  This  desire  seems  to  result  from  an  obstruction  of  the  throat,  or  a 
constriction  of  the  salivary  glands.  Salivation  is  sometimes  very  abundant, 
even  among  very  meagre  subjects.  Certain  German  authors  assert,  that  this 
symptom  is  the  sign  of  an  affection  of  the  liver  ;  but  I  have  never  been  able 
to  demonstrate  this  fact.  Salivation  is  the  effect  of  atony  and  paralysis  in  the 
case  of  individuals  who  are  in  a  state  of  dementia,  and  who  allow  a  great 
amount  of  mucus  to  flow  from  the  mouth,  unperceived  by  them.  Abundant 
salivation  sometimes  terminates  insanity.  When  the  insane  are  phthisical,  if 
spitting  is  suppressed,  the  delirium  increases,  and  excitement  or  sadness  is 
more  considerable.  When  the  spitting  is  abundant,  there  is  a  remission  of 
insanity.  The  skin  performs  its  functions  imperfectly  in  insanity,  and  there- 
fore, the  reestablishment  of  the  transpiration  concurs,  more  frequently  than  is 
supposed,  in  the  cure  of  the  insane.  Is  it  not  to  this  cause  that  we  are  to  at- 
tribute many  cures  in  spring,  and  the  good  effects  of  tepid  and  vapor  baths, 
together  with  mucilaginous  drinks  ?  Perspiration  sometimes  terminates  insa- 
nity. This  termination  is  more  rarely  observed,  on  account  of  the  agitation 
of  the  patient,  but  is  frequent.  Do  not  the  heats  of  summer,  by  provoking 
abundant  sweats,  favor  the  cures  of  autumn  ?  By  means  of  these,  in  connec- 
tion with  the  vapor  bath,  I  have  cured  some  insane  persons.  Tears,  which 
perform  an  important  part  in  the  ncrvotis  disorders  of  women,  also  terminate 
insanity. 

A  lady,  thirty-four  years  of  age,  of  a  lymphatic  temperament  and  nervous 
constitution,  and  of  a  mild  and  timid  disposition,  has  always  enjoyed  good 
health,  although  the  menstrual  flux  is  not  regular.  For  some  months  she 
takes  care  of  a  lady  whom  she  tenderly  loves.  She  labors  day  and  night,  and 
watches  for  fifteen  nights  in  succession.  Whilst  greatly  and  constantly  trou- 
bled, through  fear  of  seeing  her  friend  perish,  she  learns  that  her  lover  has 
fought  a  duel,  and  been  wounded.  After  concealing  her  despair  for  some 
hours,  she  becomes  delirious,  and  reveals  her  secret.  They  bleed  her,  and 
prescribe  foot-baths  and  diluent  drinks.  After  fifteen  days,  the  violence  and 
agitation  are  subdued.  The  patient  is  conscious  that  during  her  delirium, 
she  has  revealed  the  secrets  of  her  heart.  From  this  period,  she  believes  her- 
self despised  by  every  one,  detested  by  her  husband,  and  destined  to  some 
punishment.  She  desires  to  die.  Five  days  are  spent  in  vain  solicitations  to 
induce  her  to  take  some  aliment,  and  for  eight  days,  she  takes  but  a  few  swal- 
lows of  broth.  She  is  committed  to  my  care.  The  countenance  of  the  pa- 
tient is  pale,  the  lips  brownish,  eyes  dull,  the  physiognomy  expressive  of  pain, 
and  the  movements  slow.  At  times,  she  heaves  a  profound  sigh,  her  breath 
is  fetid,  and  she  sufters  from  constipation.  On  the  day  after  her  admission, 
I  place  with  the  patient,  beside  the  women  who  serve  her,  a  young  lady  of  an 


CRITICAL     TERMINATIONS     OF     INSANITY.  195 

agreeable  exterior,  mild  and  engaging,  who  converses  at  first,  with  an  air  of 
indifference,  then  with  an  accent  of  benevolence  and  friendship,  and  at  length, 
commits  to  her  certain  confidential  matters,  and  invites  our  patient  to  unfold 
her  feelings.  After  twenty -four  hours  of  gentle  and  adroit  perseverance,  the 
patient  takes  the  hand  of  her  new  friend,  sheds  a  torrent  of  tears,  and  then 
reveals  all  the  secrets  of  her  heart ;  pointing  out  the  cause  of  her  delirium, 
the  motive  that  induced  her  to  resolve  to  eat  no  more,  in  fine,  the  fears  that 
harass  her.  She  decides  also,  to  take  some  nourishment.  On  the  day  fol- 
lowinor,  there  is  a  new  struggle  against  her  notions,  resolutions  and  fears ;  a 
new  crisis,  a  new  effusion  of  tears,  and  progress  towards  convalescence.  Af- 
ter three  weeks  the  cure  is  completed,  on  my  assuring  the  patient  that  no- 
thing that  she  had  said  was  believed,  but  had   been  attributed  to  her  delirium. 

This  crisis,  which  we  often  observe  in  hysteria,  is  more  frequent  among 
melancholies  than  maniacs.  I  remarked,  page  58,  that  insanity  is  terminated 
by  the  spontaneous  vomiting  of  mucous  matters,  yellow  and  brownish.  These 
terminations  are  so  frequent,  and  so  commonly  useful,  that  they  have  served 
as  a  guide  to  practitioners  who,  wishing  to  imitate  nature,  and  follow  her  ten- 
dencies, have,  at  all  times,  made  use  of  emetics.  I  have  averted,  so  to  speak, 
attacks  of  insanity,  by  giving  emetics,  and  prevented  threatening  relapses,  by 
the  administration  of  even  drastic  purgatives.  These  therapeutic  agents  are 
not  always  employed  to  unload  the  alimentary  canal.  Their  action  is  some- 
times perturbating.  It  overcomes  the  spasm  of  the  intestines,  or  determines 
a  revulsive  irritation,  which  is  in  some  cases  salutary.  Insanity  is  sometimes 
terminated  by  coition,  and  even  onanism  ;  although  these  two  causes  often 
produce  this  malady,  which  then  passes  speedily  into  dementia.  Every  body 
knows  the  history  of  M.  Bl.,  rector  of  Reole,  related  by  himself  This  pa- 
tient, who  was  strong,  robust,  and  in  the  flower  of  his  age,  consecrated  both 
by  occupation  and  principle  to  the  severest  continence,  becomes  a  maniac, 
and  is  cured  at  the  expiration  of  six  months,  after  a  very  abundant  and  spon- 
taneous spermatic  evacuation.* 

We  have  often  seen  girls,  and  young  widows,  cured  by  marriage.  Alexan- 
der Benoit  states,  that  a  maniac,  escaping  from  her  house,  entered  a  lodging 
room,  where  she  was  subjected  to  the  brutality  of  15  individuals.  Her  men- 
ses, which  had  been  suppressed,  were  reestablished,  and  the  patient  was  cured. 
I  understand,  from  a  physician  who  has  charge  of  the  insane  at  Stockholm, 
that  a  young  maniac,  having  escaped  from  his  cell,  enters  the  habitation  of  a 
young  woman  who  is  insane ;  and  that,  after  having  given  themselves  up  dur- 
ing the  night,  to  the  wildest  venereal  transports,  the  former  was  found  on  the 
following  morning  dead,  and  the  latter  cured.  I  have  never  had  occasion  to 
observe  similar  crises  in  mania;  but  have  sometimes  known  marriage  to  cure 
hysterical  melancholy  I  have  had  charge  of  three  girls  who,  after  attacks  of 
mania,  remained  a  long  time  sad,  gloomy  and  inactive ;  and  who  recovered 
the  plenitude  of  their  health  only  after  marriage.  We  must  also  take  notice 
of  moral  influences.  Pregnancy,  confinement  and  nursing,  are  means  which 
nature  sometimes  employs,  to  terminate  insanity.  I  believe  these  terminations 
are  rare.  I  have  often  noticed,  that  pregnancy  and  confinements  changed  the 
delirium  in  no  respect,  but  rendered  maniacs  more  composed.  I  have  also 
known  one  lady  who,  during  five  consecutive  pregnancies,  became  insane,  and 
was  cured  in  every  instance  by  confinement.!  Notwithstanding  these  exam- 
ples, and  many  others  cited  by  numerous  authors,  and  the  opinion  of  many 
physicians,  I  regard  as  exceptions,  the  cures  of  insanity  by  marriage,  preg- 

*  Euffon.  Hist,  of  Man. — Ch.  Londe,  art.  Satyriasis,  of  the  Die.  of  Practical  Medi- 
cine and  Surgery,  t.  xiv,  p.  527. — Leuret,  Psyc.  Fragments  on  Insanity  :  art.  Passive  In- 
spiration, p.  282. 

i  An  ephemeris  of  curious  things  in  nature. 


196  CRITICAL     TERMINATIONS     OF     INSANITY. 

nancy  and  confinement ;  so  often  have  I  seen  it  persist,  and  even  aggravated, 
by  these  means.  Let  one  visit  the  Salpetriere,  and  he  will  there  find  more 
than  one  hundred  insane  women,  although  they  have  been  married,  pregnant 
and  confined. 

As  the  natural  secretions  may  become  the  causes  and  crises  of  insanity,  so 
those  of  a  morbid  character,  may  both  produce  and  terminate  this  malady. 

M.  de  F.,  seventeen  years  of  age,  of  a  robust  constitution  and  great 
strength,  of  a  yielding  disposition,  and  addicted  to  the  pleasures  of  his  age, 
contracts  a  gonorrhcsa,  and  is  treated  with  the  liquor  of  Van-Swieten.  One 
night,  being  tormented  by  thirst  and  want  of  sleep,  he  takes  a  bottle  of  the 
pure  liquor  that  was  standing  upon  his  table,  drinks  of  it,  and  persuades  him- 
self that  they  wish  to  poison  him.  He  becomes  furious,  is  cured  at  the  expi- 
ration of  three  months,  and  becomes  a  soldier.  Being  in  the  army  during  the 
campaign  in  Prussia,  (then  twenty-four  years  of  age),  he  gives  himself  up  to 
all  the  excesses  to  which  his  new  condition  exposes  him.  He  contracts  a  go- 
norrhoja,  and  his  comrades  advise  him,  in  order  to  cure  it,  to  drink  a  large 
tumbler  of  brandy,  in  which  they  had  steeped  the  powder  of  three  cartridges. 
The  gonorrhoea  disappeared.  The  patient  however  begins  to  be  delirious, 
yields  himself  to  new  excesses,  and  arrives  in  France  with  his  regiment.  The 
fury  and  delirium  augment.  Not  recognizing  his  superiors  and  comrades,  he 
commits  all  sorts  of  extravagances  at  his  quarters,  and  is  committed  to  my 
care  in  the  month  of  May,  1807.  This  young  officer  is  tall,  his  hair  black, 
harsh  and  abundant,  his  breath  fetid,  and  his  tongue  very  white.  His  features 
are  shrunken,  face  pale,  and  the  cheeks  flushed.  His  eyes  glisten,  emaciation 
is  considerable,  and  there  is  fury,  attended  with  a  desire  to  rend.  His  deliri- 
um is  general.  Now,  the  patient  believes  he  sees  in  the  clouds  a  body  of  40 
or  50,000  men,  which  the  emperor  reviews;  now,  he  thinks  himself  in  an  en- 
chanted place,  and  destined  to  figure  in  great  events ;  becoming  proud  and 
arrogant.  He  often  sees,  through  a  little  opening  in  the  ceiling  of  his  cham- 
ber, immense  regions  inhabited  by  beings  who  are  extremely  happy,  and  who 
come  and  arrange  themselves  around  it,  to  pay  court  to  him.  He  regards  his 
attendant  as  the  god  of  the  infernal  regions ;  and  whenever  he  sees  him  shut 
a  door,  he  thinks  that  the  gates  of  Erebus  are  forever  closed  upon  him. 
Another  is  his  guardian  angel,  who  is  often  overcome  by  the  god  of  hell.  His 
sleep  is  a  long  time  troubled  by  the  sight  of  a  skeleton,  which  rises  from  the 
floor  to  the  ceiling  of  his  chamber,  and  upon  which  my  patient  throws  himself 
with  fury,  uttering  loud  cries,  to  rid  himself  of  this  unwelcome  visitor.  He 
tears  the  coverings  of  his  bed,  his  mattress  and  straw  bed.  He  sometimes 
happens  to  sleep  quite  naked  upon  the  straw,  and  on  being  pricked  by  it,  ima- 
gines that  the  extremity  of  every  stalk  is  the  beak  of  an  eagle  which  is  going 
to  devour  him.  He  then  makes  upon  the  floor  a  clean,  circular  place,  around 
which  he  arranges  the  straw,  and  the  remains  of  whatever  he  has  torn  in  pieces 
or  broken;  places  himself  in  the  centre  of  this  circle,  and  moving  his  head, 
with  extreme  rapidity  from  right  to  left,  passes  the  whole  night  in  blowing,  to 
protect  himself  from  the  attacks  of  these  eagles.  This  insomnia,  together 
with  the  apprehensions  which  maintain  it,  persists  for  fifteen  nights.  After 
having  passed  six  months,  in  a  state  of  fury  which  nothing  can  calm,  either 
night  or  day,  he  gives  himself  up  to  the  practice  of  masturbation,  to  a  fright- 
ful extent,  for  fifteen  days.  Representations  of  its  effects,  and  threats,  are  of 
no  avail.  At  length,  the  patient  becomes  frightened  at  the  dangers  that  may 
happen  from  a  continuance  of  these  ruinous  practices.  He  is  more  composed, 
yet  we  observe  that  his  linen  is  still  soiled.  The  gonorrhoea  has  reappeared, 
and  I  favor  this  discharge  by  all  possible  means.  By  slow  degrees,  the  patient 
becomes  more  calm  and  tranquil,  and  more  accessible  to  the  councils  of  rea- 
son. It  is  at  about  the  eighth  month,  that  we  began  to  regard  him  as  fairly 
convalescent.     There  still  remains  some  confusion  of  ideas,  uneasiness,  preju- 


CRITICAL.     TERMINATIONS     OF     INSANITY.  197 

dices,  and  an  apathy  difficult  to  overcome.  I  oblige  him  to  occupy  his  mind, 
and  to  go  abroad  with  a  convalescent  like  himself.  He  is  immediately  seized 
with  another  attack  of  gonorrhcEa,  which  lasted  more  than  three  months. 
Since  that  time,  he  has  been  well.  Two  years  afterwards,  he  suffers  from  a 
third  attack  of  gonorrhcEa,  which  he  suppresses,  and  the  inguinal  glands  be- 
come engorged.  He  loses  his  reason,  and  throws  himself  from  a  third  story, 
not  for  the  purpose  of  destroying  himself,  but  under  the  influence  of  an  illu- 
sion. The  noise  which  he  makes,  draws  together  a  crowd  of  people  in  the 
court  of  the  hotel,  where  he  stops.  Persuading  himself  that  it  is  a  body  of 
the  enemy,  he  mounts  his  horse  upon  the  balcony  of  his  chamber,  and  exclaims 
with  the  tone  of  a  commander ;  charge,  forward.  He  advances  suddenly, 
falls  upon  the  pavement,  and  escapes  with  some  contusions.  The  glands  sup- 
purate abundantly,  and  after  a  month,  during  which  the  delirium  progressively 
diminishes,  M.  de  F.  is  quite  rational. 

Physicians  have  observed  that  the  pain  of  the  first  dentition,  causes  St. 
Vitus'  dance.  Among  subjects  of  a  lymphatic  and  nervous  temperament,  it 
sometimes  becomes  also,  the  cause  of  insanity.  The  appearance  of  the  teeth 
through  the  gums,  causes  all  the  symptoms  to  cease.  I  have  observed  this,  in 
the  case  of  three  young  women.  They  have  convulsions,  bloating  of  the  face, 
discharge  much  saliva,  and  often  raise  their  hands  to  the  mouth.  They  com- 
plain of  great  pain  in  the  head  and  jaw.  I  could  not  be  deceived  respecting 
the  cause  of  this  malady,  in  the  first  of  the  three  patients.  The  delirium 
ceases  at  the  expiration  of  a  month ;  and  two  teeth  had  pierced  their  enve- 
lopes. Fifteen  days  afterwards,  mania  reappeared  with  the  same  intensity. 
The  gums  of  the  late  teeth  were  swollen  and  very  red.  The  attack  lasted 
several  months  and  ceased  only  on  the  appearance  of  the  teeth. 

[I  cannot  refrain  from  referring  in  this  place  to  the  remarks  of  Doctor  Marshall  Hall 
on  this  important  subject  (dentition),  and  quoting  from  the  Lancet  of  May  18th,  1844, 
a  paragraph  from  his  pen.  Though  they  refer  especially  to  children,  the  cases  before  us 
show,  that  they  are,  sometimes  at  least,  applicable  to  those  who  are  rapidly  approaching, 
if  they  have  not  already  reached  the  period  of  maturity.  "  Like  other  physiological  pro- 
cesses," he  observes,  "it  is  apt  to  become,  from  its  very  character  of  energy,  patholo- 
gical, or  of  morbid  activity.  It  is  obviously  then,  attended  with  extreme  suffering  to  the 
patient;  the  brain  is  irritable,  and  the  child  is  restless  and  cross;  the  gums  are  tumid 
and  heated ;  there  is  fever,  an  afiection  of  the  general  vascular  system,  and  there  are  too 
frequently,  convulsions  of  various  degrees  and  kinds,  manifested  in  the  muscles  that 
move  the  eyeball,  the  thumb  and  finger,  the  toes;  the  larynx,  the  parietes  of  the  respi- 
ratory cavities ;  and  the  limbs  and  frame  in  general,  affections  of  the  excito-motor  part 
of  the  nervous  system,  and  of  the  secretions  of  the  liver,  kidneys  and  intestines,  affec- 
tions of  the  ganglionic  division  of  that  system."] 

Perhaps  I  ought  to  have  incised  them,  although  this  would  have  been  by  no 
means  easy  ;  the  patient  being  very  much  agitated,  and  believing  that  we  wish- 
ed to  assassinate  her. 

[The  reason  assigned  by  our  author  for  not  performing  immediately  the  operation 
strongly  urged  by  Dr.  Hall,  viz.,  incising  the  gums,  repeatedly  if  necessary,  is  one  that 
strikes  us  as  puerile,  unless  perhaps,  it  may  be  attributed  to  extreme  sensibility  and  be- 
nevolence of  heart.  I  should  not  however,  have  referred  to  this  point,  had  I  not  else- 
where observed  a  want  of  the  same  qualities  of  firmness  and  resolution  in  administering 
food,  at  times  when  the  patient  stood  in  imminent  danger  of  complete  and  fatal  exhaus- 
tion. God  forbid  that  I  should  recommend  a  measure,  however  trifling  its  character, 
that  would  cause  a  patient  alarm,  or  indeed  any  degree  of  apprehension,  without  a  cor- 
responding or  far  greater  good.     Yet  to  permit  him  to  starve,  or  a  paroxysm  of  mania  to 


198  CRITICAL     TERMINATIONS     OF     INSANITY. 

continue  for  months,  when  the  use  of  the  stomach  pump  in  the  one  case,  and  the  gum 
lancet  in  the  other,  might  liave  prevented  these  grave  issues,  is  not  humanity,  but  a 
cliildish  wealiness.] 

I  shall  close  this  article  with  the  following  case,  extracted  from  the  Giornale 
delle  Scienze  Medicalc  cli  Napoli,  by  M.  de  Renzi.  A  maniac,  thirty-three 
years  of  age,  of  a  bilious  temperament  and  strong  constitution,  had  an  enor- 
mous tumor  on  the  nates  of  the  left  side,  extending  even  to  the  anus.  It  was 
opened  with  a  sharp  instrument,  and  discharged  a  great  quantity  of  fetid  mat- 
ter. The  wound  was  dressed  with  cerate  and  an  emollient  cataplasm.  Gan- 
grene appeared,  and  the  dressing  was  made  with  storax.  The  patient  was  put 
upon  the  use  of  lemonade.  During  the  suppuration,  the  attacks  of  fury  were 
less  frequent,  and  some  signs  of  returning  reason  were  observed.  When  the 
eschar  was  removed,  a  fistula  in  ano  was  found  to  exist,  and  was  treated  me- 
thodically. In  proportion  as  the  ulcer  cicatrized,  the  reason  of  the  patient 
improved.  The  cicatrization  of  the  fistula  was  complete  in  forty-five  days 
after  the  operation.  Reason  was  reestablished  March  2d,  1835.  This  pa- 
tient was  admitted  into  the  hospital  for  the  insane  at  Palermo,  Dec.  19th, 
1834. 

Such  is  an  enumeration  of  the  most  remarkable  physical  crises  of  insanity. 
I  could  have  multiplied  the  details,  have  added  a  greater  number  of  examples, 
and  hazarded  some  explanations  ;  but  I  have  limited  myself  to  unfolding  those 
practical  results  which  are  justified  by  the  testimony  of  authors.  We  may 
arrange  the  crises  of  insanity  in  the  following  order  ;  fevers,  hemorrhages, 
gastric  phlegmasia?,  cutaneous  affections,  and  those  of  the  lymphatic  system. 
It  is  the  duty  of  the  practitioner,  to  distinguish  the  different  tendencies  of  na- 
ture, and  to  second  them  according  to  the  precept  of  Hippocrates.  We  have 
seen  insanity  terminated  after  a  fall  upon  the  head,  by  poisoning,  by  the  cut- 
ting of  the  hair,  by  the  operation  for  cataract,  and  by  castration.  Doctor 
Ziitzin,  a  physician  at  Bamberg,  observed  that  three  attacks  of  mania  were 
terminated  by  plica ;  and  by  appropriate  treatment,  prevented  for  seven  years, 
the  return  of  the  attacks.  These  however,  are  facts  rather  curious  than  use- 
ful, which  are  isolated,  and  can  never  furnish  any  therapeutic  view,  nor  guide 
the  physician  in  the  treatment  of  mental  alienation. 


LYPEMANIA  OR  MELANCHOLY. 


Definition  of  terra,  both  ancient  and  modern,  with  remarlvs. — No  advancement  in  science 
or  the  arts,  which  has  not  served  as  a  cause  of  mental  disease. — Monomania  has  its 
seat  in  the  heart  of  man. — A  disease  especially  of  civilization. — Modified  by  state  of 
society. — Illustrations. — Tristimania  of  Rush,  lypemania  or  melancholy  of  Esquirol. — 
Views  of  the  ancients  respecting  melancholy. — Symptoms  of  lypemania  or  melancho- 
ly.— Description  of  the  person  of  a  lypemaniac. — Cases. — Great  torpor  of  the  secre- 
tions.— Aversion  to  food. — Loss  of  rest  in  consequence  of  hallucinations  and  illusions. 
— Dreams  terrify  many. — Secretions  become  greatly  disordered. — Urine. — General 
description  of  the  emotions  of  the  lypemaniac. — Modifying  influence  of  the  passions 
on  the  mind. — Causes  of  lypemania. — Seasons  and  climates. — Spring  and  summer 
produce  the  greatest  number  of  lypemaniacs. —  Table  illustrative. — Spring  most  favora- 
ble to  the  cure  of  lypemania. — Age. — Childhood. — Adolescence. — Maturity. — Old  age. 
—  Table  of  ages.  Sex. — Temperaments. — Professions  and  mode  of  life. —  Table  of 
causes. — Lypemania  is  continued,  remittent,  or  intermittent. — Remittent  form  most 
common. — Crises  very  numerous. — Diseases  which  cause  the  death  of  lypemaniacs. — 
Post-mortem  examinations. — Most  frequent  termination,  phthisis  pulmonalis. — Patho- 
logical anatomy  has  taught  us  nothing  positive,  respecting  the  seat  of  melancholy. — 
Table  of  diseases  totvhich  lypemaniacs  succuvib. — Displacement  of  the  transverse  colon 
frequent. — Interesting  case  and  post-mortem  examination. — Other  cases  with  autop- 
sies.—  Table  of  the -pathological  lesions  found  in  the  post-mortem  examination  of  one 
hundred  and  sixty-eight  cases  of  hjpemania. — Treatment  of  lypemania. — It  may  be 
hygienic,  moral  or  pharmaceutic. — Influence  of  atmosphere  on  health  and  disease. — 
Case,  reported  in  the  language  of  the  sufferer,  together  with  the  advice  given. — Cloth- 
ing.— Food. — Exercise  both  of  body  and  mind  recommended  and  enforced. — Isolation. 
— Tepid  baths. — Continence  and  sexual  intercourse. — The  passions. — Fear. — Supersti- 
tion.— Love. — Means  used  to  break  the  chain  of  morbid  feelings. — Examples. — Music. 
— Physical  treatment. — Laxatives,  and  at  the  commencement  of  an  attack,  emetics 
and  emeto-cathartics. — ^Tartrate  of  Antimony  and  Potassa  with  drastics,  to  be  employ- 
ed under  certain  circumstances. — The  rotatory  machine. — Blood-letting,  local  and  gene- 
ral.— Baths  ;  tepid,  vapor  and  cold. — Affusions. — Douche. — Internal  exhibition  of  cold 
water. — Opium. — Magnetism. — Closing  remarks. — {Farther  remarks  on  treatment.) 

Writers,  since  the  time  of  Hippocrates,  have  denominated  that  form  of 
delirium  which  is  characterized  by  moroseness,  fear,  and  prolonged  sadness, 
Melancholy.  The  appellation,  melancholy,  has  been  aiven  to  this  variety  of 
insanity,  according  to  Galen,  because  the  depressing  moral  affections  depend 
upon  a  depraved  condition  of  the  bile,  which,  having  become  black,  obscures 


200  LYPEMANIA     OR     MELANCHOLY. 

the  animal  spirits  and  produces  delirium.  Some  moderns  have  given  a  more 
extended  signification  to  the  word  melancholy,  and  have  called  melancholic, 
every  form  o^  partial  delirium,  when  chronic,  and  unattended  by  fever.  It 
is  certain  that  the  word  melancholy,  even  according  to  the  acceptation  of  it 
among  the  ancients,  often  presents  to  the  mind  a  felse  idea ;  for  melancholy 
does  not  always  depend  upon  the  bile.  Nor  would  this  signification  be  suited 
to  it,  as  the  moderns  define  it.  This  double  consideration,  has  caused  me  to 
propose  the  word  monomania;  (derived  from  novo;,  alone,  and  fjnpia,  mania;) 
a  term  which  expresses  the  essential  character  of  that  form  of  insanity,  in 
which  the  delirium  is  partial,  permanent,  gay  or  sad.  This  generally  received 
definition  is  now  adopted  by  the  greater  number  of  physicians,  and  is  estab- 
lished in  our  language.*  The  word  melancholy,  employed  in  the  language 
of  common  life  to  express  that  habitual  state  of  sadness  from  which  some 
people  suffer,  should  be  left  exclusively  to  moralists  and  poets,  who,  in  their 
expressions,  are  not  obliged  to  employ  so  much  precision  as  physicians.  Its 
signification  should  be  limited  to  the  temperament  in  which  the  hepatic  sys- 
tem predominates,  and  to  designate  the  disposition  to  a  fixedness  of  ideas,  and 
sadness  ;  while  the  word  monomania,  expresses  an  anormal  condition  of  the 
physical  or  moral  sensibility,  with  a  circumscribed  and  fixed  delirium. 

Monomania  is  of  all  maladies,  that  which  presents  to  the  observer,  pheno- 
mena the  most  strange  and  varied,  and  which  offers,  for  our  consideration, 
subjects  the  most  numerous  and  profound.  It  embraces  all  the  mysterious 
anomalies  of  sensibility,  all  the  phenomena  of  the  human  understanding,  all 
the  consequences  of  the  perversion  of  our  natural  inclinations,  and  all  the 
errors  of  our  passions.  He  who  is  profoundly  versed  in  whatever  relates  to 
monomania,  cannot  be  a  stranger  to  that  knowledge  which  relates  to  the  pro- 
gress and  course  of  the  human  mind.  It  is  also,  in  direct  relation  in  point  of 
frequency,  with  the  development  of  the  intellectual  faculties.  The  more  the 
understanding  is  developed,  and  the  more  active  the  brain  becomes,  the  more 
is  monomania  to  be  feared.  There  has  been  no  advancement  in  the  sciences, 
no  invention  in  the  arts,  nor  any  important  innovation,  which  has  not  served 
as  a  cause  of  monomania,  or  lent  to  it,  its  peculiar  character.  The  same  is 
true  of  the  prevailing  notions,  general  errors,  and  universal  convictions,  whe- 
ther true  or  false,  which  impress  a  peculiar  feature  upon  each  period  of  social 
life.  Monomania  is  essentially  a  disease  of  the  sensibility.  It  reposes  alto- 
gether upon  the  affections,  and  its  study  is  inseparable  from  a  knowledge  of 
the  passions.  Its  seat  is  in  the  heart  of  man,  and  it  is  there  that  we  must 
search  for  it,  in  order  to  possess  ourselves  of  all  its  peculiarities.  How  many 
are  the  cases  of  monomania,  caused  by  thwarted  love,  by  fear,  vanity,  wound- 
ed self-love,  or  disappointed  ambition  !  This  malady  presents  all  the  signs 
which  characterize  the  passions.  The  delirium  of  monomaniacs  is  exclusive, 
fixed  and  permanent,  like  the  ideas  of  a  passionate  man.  Like  the  passions, 
monomania  now  manifests  itself  by  joy,  contentment,  gayety,  exaltation  of  the 
faculties,  boldness,  and  transports  of  feeling  ;  now,  it  is  concentrated,  sad, 
silent,  timid  and  fearful  ;  but  always  exclusive  and  obstinate. 

It  has  long  been  said,  that  insanity  is  a  disease  of  civilization  ;  it  would 
have  been  more  correct  to  have  said  this  respecting  monomania.  Monoma- 
nia is  indeed  frequent  in  proportion  to  the  advancement  of  civilization.  It 
borrows  its  chararter,  and  finds  again  the  causes  which  produce  it,  in  the  dif- 
ferent periods  of  society.  It  is  superstitious  and  erotic  in  the  infancy  of 
society,  as  it  is  also,  in  the  countries  and  regions  where  civilization  and  its 
excesses  have  made  little  progress  ;  whilst  in  an  advanced  state  of  society, 
its  cause  and  character  manifest  themselves  in,  and  depend  upon,  pride,  scep- 

**  This  word  has  been  admitted  into  the  Dictionary  of  the  French  Academy,  edition 
of  183.5. 


LYPEMANIA     OR     MELANCHOLY.  210 

ticism,  ambition,  the  passion  for  gaming,  despair  and  suicide.  There  has 
been  no  social  epoch,  which  has  not  been  remarkable,  in  consequence  of 
some  indications  which  monomania  furnishes,  of  the  intellectual  and  moral 
character  of  each. 

The  state  of  modern  society  has  modified  the  causes  and  character  of  mo- 
nomania, and  this  malady  now  reveals  itself  under  new  forms.  With  the 
weakening  of  religious  convictions,  demonomania,  and  forms  of  insanity  de- 
pending upon  superstition,  have  also  disappeared.  The  influence  of  religion 
over  the  conduct  of  people  being  lessened,  governments,  in  order  to  maintain 
authority  over  men,  have  had  recourse  to  a  police.  Since  that  period,  it  is  the 
police  that  troubles  feeble  imaginations,  and  establishments  for  the  insane  are 
peopled  with  monomaniacs  who,  fearing  this  authority,  are  delirious  respecting 
the  influence  which  it  exercises,  and  by  which  they  think  themselves  pursued. 
This  monomaniac,  who  would  formerly  have  been  delirious  with  respect  to 
magic,  sorcery  and  the  infernal  regions ;  is  now  delirious,  thinking  himself 
threatened,  pursued,  and  ready  to  be  incarcerated  by  the  agents  of  the  police. 
Our  political  convulsions,  in  France,  have  been  the  occasion  of  much  mono- 
mania, which  has  been  provoked  and  characterized  by  events  which  have 
signalized  each  epoch  of  our  revolution. 

To  the  facts  stated  at  page  17, 1  will  add  the  following  :  In  1791 ,  there  were 
at  Versailles,  a  prodigious  number  of  suicides.  Pinel  states,  that  an  admirer 
of  Danton,  having  heard  him  accused,  became  insane,  and  was  sent  to  the 
Bicetre.  At  the  death  of  the  king  and  his  unfortunate  family,  much  mono- 
mania immediately  made  its  appearance.  The  trial  of  Moreau,  and  the  death 
of  the  duke  d'Enghien,  produced  much  of  it.  When  the  pope  visited  France, 
this  great  event  awoke  anew  religious  ideas,  and  there  was  then  much  super- 
stitious monomania,  which  disappeared  immediately.  At  that  epoch,  when  the 
emperor  peopled  Europe  with  new  kings,  there  were  in  France  many  mono- 
maniacs who  thought  themselves  emperors  or  kings,  empresses  or  queens. 
The  Spanish  war,  the  conscription,  our  conquests  and  reverses,  produced  also, 
their  mental  maladies.  How  many  persons,  stricken  with  terror  at  the  time 
of  the  two  invasions,  remained  monomaniacs!  Indeed,  we  now  find  in  mad- 
houses, many  persons  who  consider  themselves  dauphins  of  France,  and  des- 
tined to  the  throne.  Many  cases,  which  we  may  read  in  this  work,  will  con- 
firm this  general  truth ;  that  the  state  of  society  exercises  a  striking  influence 
over  the  production  and  character  of  monomania.  The  profound  study  of 
this  disease,  allies  itself  to  an  acquaintance  with  the  morals  and  habits  of 
every  people.  The  gymnosophists  destroyed  themselves  in  consequence  of 
their  contempt  of  death ;  the  stoics  through  pride,  and  the  Japanese  through 
love  of  virtue.  Monomania  took  the  form  of  superstition  among  the  Jews  as 
it  exists  at  this  day  in  Spain,  and  in  every  country  in  Europe  where  indiffe- 
rence and  incredulity  with  respect  to  ancient  forms  of  belief,  left  minds  to 
the  influence  of  the  religious  sentiment ;  from  whence  spring  ideas  the  most 
strange  and  absurd.  We  observe  the  same  in  England  and  Germany,  among 
the  jealous  members  of  the  various  sects,  which  are  multiplying  almost  to  infi- 
nity. This  observation  has  been  made  by  all  English  and  German  physicians, 
who  have  written  upon  mental  diseases.  Monomania  was  erotic  in  Greece, 
as  it  now  is  in  Italy.  The  habit  of  being  always  on  horseback,  rendering  the 
Scythians  impotent,  they  thought  that  their  sex  had  been  changed.  In  some 
countries  they  fear  the  black  devil ;  in  others  the  white.  There,  monomaniacs 
consider  themselves  bewitched,  or  wolf-men ;  here  they  fear  magicians  and 
sorcerers.  On  the  sea-coast,  they  fear  shipwrecks  and  tempests.  These 
forms  of  insanity  still  exist,  among  certain  people  in  the  extreme  north. 

Such  are  the  general  considerations  which  appertain  to  every  variety  of  mo- 
nomania, and  to  all  the  forms  of  partial  delirium  that  are  permanent,  and  un- 
attended by  fever.     But  this  malady  presents  itself  under  two  opposite  forms. 

26 


^02  LYPEMANIA     OR     MELANCHOLY. 

The  ancients,  who  had  adduced  as  characteristics  of  melancholy,  sadness  and 
fear;  were  obliged  to  rank  among  melancholies  certain  cases  of  partial  deli- 
rium, which  were  maintained  by  an  extreme  exaltation  of  the  imagination,  or 
by  passions  of  a  gay  and  sprightly  character.  Lorry,  who  has  so  well  de- 
scribed melancholy,  although  his  definition  of  it  accords  with  the  view  enter- 
tained by  the  ancients,  admits  a  variety  of  melancholy  complicated  with  ma- 
nia, which  is  indicated  by  a  partial  delirium,  attended  by  exaltation  of  the 
imagination,  or  an  exciting  passion.  Rush*  divides  melancholy  into  two 
forms ;  that  in  which  sadness  predominates,  which  he  calls  tristimania ;  and 
that  in  which  the  opposite  emotion  prevails,  which  he  denominates,  amenomania ; 
thus  confirming  the  results  of  an  observation  which  every  one  may  make. 
Monomania,  characterized  by  a  passion  either  gay  or  sad,  exciting  or  depress- 
ing, and  producing  a  fixed  and  permanent  delirium,  attended  also  by  desires 
and  determinations  depending  upon  the  character  of  the  prevailing  passion, 
is  naturally  divided  into  monomania  properly  so  called,  which  is  indicated  by 
a  partial  delirium,  and  a  gay  or  exciting  passion ;  and  into  monomania  which 
is  signalized  by  a  partial  delirium,  attended  by  a  sad  or  depressing  passion. 
The  first  of  these  affections  corresponds  with  maniacal  melancholy,  maniacal 
fury,  or  with  melancholy  complicated  with  mania;  in  fine,  with  amenomania. 
I  give  to  it  the  name  of  monomania,  and  shall  speak  of  it  hereafter.  The 
second  corresponds  with  the  melancholy  of  the  ancients,  the  tristimania  of 
Rush,  and  the  melancholy  with  delirium,  of  Pinel.  Notwithstanding  the  fear 
of  being  accused  of  neologism,  I  give  it  the  name  of  lypemania,  a  word 
formed  from  Ivnetx)  tristitiam  infei'o,  anxium  reddo,  and  fnivia^  mania.  We 
shall  treat  of  lypemania  in  this  article,  employing  indiflferently,  the  words  me- 
lancholy or  lypemania,  believing  that  custom  has  consecrated  the  latter  appel- 
lation. 

Hippocrates  designates,  as  the  characters  of  melancholy,  sadness,  or  pro- 
longed fear,  without  speaking  of  delirium.  Areteus  gives  to  mania  the  appel- 
lation of  melancholy,  so  soon  as  fury  is  present.  Galen  adopts  and  enlarges 
upon  this  point,  as  well  as  upon  many  other  ideas  of  Hippocrates.  Coelius 
Aurelianus  does  not  distinguish  melancholy  from  hypochondria,  and  relates 
several  very  interesting  cases  of  partial  delirium.  Almost  all  authors  who 
have  succeeded  them,  have  only  copied,  or  arranged  in  their  own  way,  the 
ideas  advanced  by  Galen.  Rhazes  pretends,  that  the  black  bile,  flowing  from 
the  spleen  into  the  stomach,  produces  melancholy.  Michaelis  of  Hereda, 
and  Forestus,  believe  that  ideas  of  a  depressing  character,  and  fear,  unite  with 
partial  delirium,  to  form  the  distinctive  character  of  melancholy.  Sennert 
admits  an  occult,  or  obscure  condition  of  the  animal  spirits,  in  melancholy  : 
Sydenham  confounds  hysteria  with  hypochondria,  and  the  latter  with  melan- 
choly. Ettmuller  distinguishes  delirium  from  melancholy ;  the  former,  in  his 
opinion,  succeeding  the  affection  of  melancholy.  Frederic  Hoffmann  and 
Boerhaave,  regard  melancholy  as  the  first  degree  of  mania.  Sauvages  defines 
melancholy  to  be  an  exclusive  delirium,  without  fury,  and  complicated  with  a 
chronic  disease.  Lorry  adopts  the  definition  and  theories  of  the  ancients,  but 
divides  melancholy  into  three  varieties ;  one  depending  upon  a  material  cause, 
one  having  no  such  dependence,  and  a  third  mixed.  Cullen  very  clearly  dis- 
tinguishes melancholy  from  hypochondria.  Li  the  latter,  dyspepsia  is  present, 
and  the  delirium  relates  to  the  health  of  the  patient.  Pinel  characterizes 
melancholy,  by  sadness  and  fear,  with  partial  delirium  concentrated  upon  a 
single  object,  or  a  particular  series  of  objects.  Moreau  de  la  Sarthe  confines 
himself  to  the  definition  of  the  ancients,  and  designates  this  form  of  madness 
by  the  title  of  melancholy  with  delirium.     My  honorable  friend.  Dr.  Louyer- 

*Med.  Enquiries  and  Observations  upon  the  Diseases  of  the  Mind.  Philadelphia, 
1812,  inSvo. 


LYPEMANIA     OR     MELANCHOLY.  203 

Villermay,*  has  most  clearly  pointed  out  the  difference  which  ouo-ht  ever  to 
distinguish  hypochondria  from  melancholy.  Melancholy  consists  in  the  per- 
manent and  exclusive  impression  of  any  object  whatever,  pursued  with  ardor 
and  almost  always  accompanied  with  fear,  suspicion,  etc.  Such  is  the  defini- 
tion of  melancholy  which  we  read  in  the  Treatise  on  Dclirutm  of  the  respecta- 
ble professor  Fodere.  The  same  author  gives  the  name  of  mania  to  melan- 
choly, when  the  latter  passes  into  the  state  of  excitement  or  fury. 

This  hasty  exposition,  indicates  the  fluctuation  and  uncertainty  of  opinions 
respecting  the  characteristics  and  nature  of  this  malady.  We  consider  it  well 
defined,  by  saying  that  melancholy  with  delirium,  or  lypemania,  is  a  cerebral 
malady,  characterized  by  partial,  chronic  delirium,  without  fever,  and  sus- 
tained by  a  passion  of  a  sad,  debilitating  or  oppressive  character.  Lypema- 
nia should  not  be  confounded  with  mania,  of  which  the  delirium  is  oeneral, 
with  exaltation  of  the  sensibility  and  intellectual  faculties  ;  nor  with  monoma- 
nia, whose  characteristic  is,  exclusiveness  of  ideas,  with  a  gay  and  expansive 
passion.  It  should  not  also,  be  confounded  with  dementia,  in  which  incohe- 
rence and  confusion  of  ideas  are  the  effect  of  weakness;  nor  with  idiocy,  for 
the  idiot  can  never  reason. 

Lypemania  has  been  so  often  taken  for  hypochondria,  that  I  cannot  forbear 
presenting,  in  few  words,  the  differences  which  exist  between  these  two  mala- 
dies. Lypemania  is  more  frequently  hereditary.  Lypemaniacs  are  born  with 
a  peculiar  temperament,  the  melancholic,  which  disposes  them  to  lypemania. 
This  disposition  is  strengthened  by  vices  of  education,  and  by  causes  which 
act  more  directly  upon  the  brain,  the  sensibility  and  intelligence.  The  causes 
which  produce  it,  are  usually  moral  ;  whilst  hypochondria  is  generally  the  ef- 
fect of  physical  causes,  which  modify  the  action  of  the  stomach,  and  disturb 
the  digestive  functions.  In  lypemania,  ideas  contrary  to  reason,  are  fixed 
and  sustained  by  a  depressing  passion,  as  well  as  a  vicious  association  of  ideas. 
In  hypochondria  on  the  contrary,  there  is  no  delirium,  but  the  patient  exagge- 
rates his  sufferings.  He  is  constantly  preoccupied  and  frightened  at  the  dan- 
gers which  he  believes  threaten  his  life  :  dyspepsia  also,  is  present. 

As  in  the  other  forms  of  insanity,  I  shall  consider,  with  respect  to  lypemania 
or  melancholy,  the  causes  that  produce  it,  the  symptoms  which  characterize 
it,  the  course  which  is  proper  to  it,  its  terminations  and  treatment. 


SYMPTOMS  OF  LYPEMANIA  OR  MELANCHOLY. 

In  person,  the  lypemaniac  is  lean  and  slender,  his  hair  is  black,  and  the 
hue  of  his  countenance  pale  and  sallow.  The  surface  over  the  cheek  bones, 
is  sometimes  flushed,  and  the  skin,  brown,  blackish,  dry  and  scaly  ;  whilst 
the  nose  is  of  a  deep  red  color.  The  physiognomy  is  fixed  and  changeless ; 
but  the  muscles  of  the  face  are  in  a  state  of  convulsive  tension,  and  express 
sadness,  fear  or  terror  ;  the  eyes  are  motionless,  and  directed  either  towards 
the  earth  or  to  some  distant  point,  and  the  look  is  askance,  uneasy  and  suspi- 
cious. If  the  hands  are  not  dried  up,  brown  and  earthy  in  their  hue,  they  are 
swollen  and  livid. 

Mad'lle  C,  twenty-three  years  of  age,  is  brought  to  the  Salpetriere  June 
8th,  1812.  In  stature  she  is  of  medium  size,  her  hair  and  eyes  are  black,  the 
eyebrows  very  thick,  and  approximate  closely  at  the  root  of  the  nose  ;  her  look 
is  fixed  upon  the  ground,  her  physiognomy  expressive  of  fear,  her  habit  of 
body  lean,  and  her  skin  brown.  We  observe  some  scorbutic  spots  on  the 
lower  extremities.  The  hands  and  feet,  always  very  cold,  are  of  a  purplish 
red  ;  the  pulse  is  slow,  and  very  feeble :  constipation,  which  is  ordinarily  very 

*  Treatise  on  Nervous  Maladies  or  Vapors.     Paris,  1816,  2  Vol.,  in  8vo, 


204  LYPE MANIA     OR     MELANCHOLY. 

obstinate,  is  sometimes  replaced  by  a  diarrhoea ;  secretion  of  urine  scanty. 
She  utters  not  a  word,  refuses  every  kind  of  movement,  and  persists  obstinate- 
ly in  confining  herself  to  bed.  We  have  recourse  to  various  means,  to  induce 
her  to  take  nourishment.  Affusions  of  cold  water  triumph  over  this  repug- 
nance, and  she  eats  more  readily.  However,  she  manifests  at  times,  her  un- 
willingness to  take  nourishment,  though  with  less  obstinacy.  For  the  four 
years  that  this  woman  has  been  in  the  house,  but  few  words  have  escaped  her, 
which,  however,  have  indicated  to  us,  that  fear  absorbed  all  her  faculties. 
She  formerly  lived  in  the  country,  and  had  been  excessively  frightened  by  sol- 
diers. We  have  to  oblige  her  to  leave  her  bed,  when,  so  soon  as  dressed,  she 
sits  down  upon  a  bench,  always  in  the  same  place,  her  attitude  remaining  the 
same  ;  her  head  inclined  to  the  left  side  of  the  chest,  the  arms  crossed,  rest- 
ing upon  the  knees,  and  her  eyes  turned  fixedly  towards  the  sun.  She  remains 
thus,  without  moving,  or  uttering  a  word  during  the  whole  day.  At  meal 
time,  she  does  not  go  for  her  food,  but  it  is  necessary  to  bring  it  to  her,  and 
press  her  to  partake  of  it.  She  never  changes  her  position  to  do  this,  and 
uses  only  the  arm  and  hand  of  the  right  side.  If  any  one  approaches  the  pa- 
tient, or  speaks  to  her  ;  if  they  interrogate  or  exhort  her  ;  her  countenance  be- 
comes slightly  flushed,  and  sometimes  she  turns  her  eyes  aside,  but  never 
speaks.  It  is  necessary  to  inform  her  when  it  is  time  to  retire ;  when  she  un- 
dresses, gathers  herself  up  in  bed,  and  envelopes  her  person  entirely  in  the 
coverings.  Menstruation  is  irregular  and  scanty  ;  and  is  suppressed  for  six 
months.  We  never  succeeded  in  overcoming  the  silence  of  this  female,  nor 
her  aversion  to  motion.  She  never  had  an  attack  of  fury,  and  died  of  phthisis 
at  the  age  of  twenty-nine  years. 

The  following  presents  to  us  lypemania  with  different  characters  from  those 
Avhich  we  observed  in  the  preceding  case.  In  the  latter,  the  lypemaniac  seems 
to  be  overcome  by  the  weight  of  the  emotions  that  oppress  her,  whilst  in  the 
following  case,  the  patient  reveals  by  her  look  and  attitude,  the  activity  and 
fixedness  of  her  mind  and  affections.  Mad'lle  W.,  tall,  and  of  a  remarkably 
strong  constitution,  had  spent  her  infancy  in  the  chateau  of  Chantilly,  and 
had  often  sported  with  the  duke  d'Enghien,  himself  a  child.  At  the  period  of 
the  emigration,  she  was  committed  to  a  lady,  who  was  charged  to  watch  over 
her  education.  Political  events  became  more  serious.  She  experienced  mis- 
fortunes, and  her  education  was  neoflected.  At  the  death  of  the  duke  d'Eng- 
hien,  she  falls  into  the  most  profound  lypemania,  and  though  only  sixteen  or 
seventeen  years  of  age,  her  hair  becomes  almost  immediately  gray.  She  was 
sent  to  the  Salpetriere,  where  she  survived  many  years.  She  was  very  tall  and 
slender,  her  hair  very  abundant  and  gray,  and  her  large  blue  eyes,  motionless. 
She  was  pale,  and  clad  simply  in  her  chemise,  with  uncovered  head  ;  sat 
constantly  upon  the  bolster  of  her  bed,  the  thighs  flexed  upon  the  abdomen, 
and  the  legs  upon  the  thighs.  The  elbows  rested  upon  the  knees,  and  the 
head,  always  elevated  and  turned  to  the  right,  was  sustained  by  the  right  hand. 
During  the  night,  the  position  of  the  patient  is  the  same,  but  she  sits  upon 
the  mattress,  supporting  her  back  against  the  bolster,  and  collecting  the  cover- 
ings about  her  chest.  She  never  speaks,  but  from  time  to  time  murmurs  in 
a  very  lov/  tone,  a  few  monosyllables,  which  lead  us  to  believe  that  she  sees 
and  regards  some  one.  She  responds  to  no  question,  but  repulses  by  a  move- 
ment of  the  body,  the  person  who  interrogates  her.  She  eats  little,  and  con- 
stipation is  obstinate.  She  moves  about  upon  the  nates,  after  the  manner  of 
cripples ;  raising  her  body  by  the  aid  of  her  hands.  Her  eyes  and  attention 
are  never  turned  from  a  window  which  is  near  her  bed,  and  through  which, 
she  seems  to  see  or  hear  some  one,  who  fixes  her  attention.  The  thighs  and 
legs,  by  their  long  continued  fixed  condition,  are  contracted,  and  some  at- 
tempts that  have  been  made  to  extend  them,  have  proved  ineffectual. 

Oneness  of  affection  and  thought,  renders  the  actions  of  the  melancholic 


(5 


LYPE MANIA  OR  MELANCHOLY.  205 

■uniform  and  slow.  He  refuses  indeed,  all  motion,  and  passes  his  days  in  so- 
litude and  idleness.  He  habitually  sits  with  his  hands  crossed,  or  stands  in- 
active, with  them  hanging  by  his  side.  If  he  walks,  it  is  slowly,  and  with 
apprehension,  as  if  he  had  some  danger  to  shun  ;  or  with  haste,  and  always 
in  the  same  direction,  as  if  his  mind  was  profoundly  occupied.  Some,  lace- 
rate their  hands  and  the  ends  of  the  fingers,  and  destroy  the  nails.  Torment- 
ed with  grici  or  tear,  the  eye  and  ear  are  incessantly  on  the  watch.  For  the 
lypemaniac,  day  is  without  repose,  and  the  night  without  sleep.  The  secre- 
tions are  no  longer  performed.  Some  melancholies  obstinately  refuse  all  nou- 
rishment. We  have  seen  them  pass  several  days  without  food,  although  hun- 
gry ;  being  restrained  by  hallucinations  or  illusions,  which  give  birth  to  chi- 
merical fears.  One,  fears  poison,  another,  dishonor  ;  the  latter  wishes  to  do 
penance,  the  former  believes  that  if  he  eats,  he  shall  compromise  his  relatives 
or  friends  ;  in  fine,  there  are  those,  who  hope  to  rid  themselves  of  life  and  its 
torments,  by  abstinence  from  all  nourishment.  We  have  seen  some  of  them 
sustain  an  abstinence  of  thirteen,  twenty  and  more  days'  continuance.  When 
we  triumph  over  the  repugnance  of  these  patients  to  taking  food,  the  greater 
part  of  them  are  less  gloomy  and  sad.  See  Suicide.  The  pulse  is  ordinarily 
slow,  feeble,  and  concentrated  ;  sometimes  it  is  very  hard,  and  we  feel  under 
the  fingers  a  sort  of  trembling  of  the  artery.  The  skin  is  arid,  and  attended 
with  a  dry  and  burning  heat.  Transpiration  has  ceased,  while  the  extremities 
of  the  limbs  are  bathed  in  sweat. 

Lypemaniacs  sleep  little  ;  inquietude  and  fear,  terror,  jealousy  and  halluci- 
nations, keep  them  awake.  If  they  grow  drowsy,  no  sooner  do  their  eyes 
close,  than  they  see  a  thousand  pliantoms  which  terrify  them.  If  they  sleep, 
their  rest  is  interrupted,  and  agitated  by  dreams  of  an  inauspicious  character. 
They  are  often  aroused  from  sleep  by  the  nightmare,  or  dreams  which  repre- 
sent to  them  the  objects  which  have  caused,  or  continue  their  delirium.  Some, 
after  a  favorable  night,  are  more  sad  and  uneasy.  Others,  think  that  they 
shall  never  reach  the  close  of  the  day,  and  are  better  when  night  begins,  per- 
suaded that  they  cannot  then  be  apprehended.  Others  still,  think  that  their 
uneasiness  augments  at  the  approach  of  night.  They  dread  obscurity,  soli- 
tude, insomnia,  the  terrors  of  sleep,  etc.  The  secretions  also,  present  re- 
markable disorders  among  lypemaniacs.  In  some  cases,  the  urine  is  abun- 
dant, clear,  and  limpid  ;  in  others,  scanty,  thick  and  turbid.  There  are  me- 
lancholies who,  from  various  motives,  retain  their  urine  for  many  days  in  suc- 
cession. We  know  the  history  of  one  patient,  who  was  unwilling  to  urinate, 
through  fear  of  inundating  the  world  ;  and  who  decided  to  do  so,  only  after 
he  had  been  persuaded  that  it  was  by  this  means  alone,  that  a  great  conflagra- 
tion, which  had  just  broken  out,  could  be  extinguished, 

Melancholy  with  delirium,  or  lypemania,  presents  in  its  symptoms  when 
taken  together,  two  striking  differences.  Those  suffering  from  this  calamity, 
now  exhibit  a  remarkable  susceptibility,  attended  with  extreme  mobility. 
Every  thing  produces  a  strong  impression  ;  the  slightest  cause  produces  the 
most  painful  effects.  Events,  the  most  simple  and  common,  appear  to  them 
to  be  new  and  singular  phenomena,  prepared  expressly  to  torment  and  injure 
them.  Cold,  heat,  rain  and  wind,  cause  them  to  shudder  with  pain  and  fear. 
Noise  impresses  them  painfully,  and  strikes  them  with  terror.  Silence  causes 
them  to  start,  and  frightens  them.  If  any  thing  displeases  them,  they  repulse 
it  with  rudeness  and  obstinacy.  If  their  food  is  not  agreeable  to  them,  their 
repugnance  to  it  is  so  great,  as  to  produce  nausea  and  vomiting.  Have  they 
any  ground  for  fear,  they  are  terrified ;  have  they  any  regrets,  they  are  in  de- 
spair ;  do  they  experience  any  reverses,  they  believe  that  all  is  lost.  Every  thing 
is  forced  and  exaggerated  in  their  mode  of  feeling,  thinking  and  acting.  This 
excessive  susceptibility  causes  them  to  be  constantly  meeting,  in  external  ob- 
ects,  with  new  causes  of  pain.     Both  day  and  night  their  ear  is  open  for  hear- 


206  LYPEMANIA  OR  MELANCHOLY. 

ing  and  their  eye  for  seeing.  They  are  constantly  in  motion,  in  search  of 
their  enemies,  and  the  causes  of  their  sufferings.  They  relate  without  ceasing, 
and  to  every  one,  the  story  of  their  ills,  their  fears,  and  despair.  Again,  the 
sensibility  concentrated  upon  a  single  object,  seems  to  have  abandoned  all  the 
organs ;  the  body  is  indifferent  to  every  impression,  while  the  mind  no  longer 
engages  itself,  except  upon  a  single  object,  which  absorbs  all  the  attention, 
and  suspends  the  exercise  of  all  the  intellectual  functions.  The  immobility 
of  the  body,  and  the  fixedness  of  the  features,  together  with  an  obstinate  si- 
lence, betray  the  painful  conflict  between  the  understanding  and  affections. 
It  is  no  longer  a  pain  that  agitates  the  mind,  that  causes  complaints,  cries  and 
tears  ;  but  an  emotion  which  rather  produces  silence,  shuts  the  fountain  of  tears, 
and  is  incapable  of  suffering.  In  this  state  of  painful  exaltation  of  the  sensi- 
bility, not  only  are  lypemaniacs  inaccessible  to  every  impression  foreign  to  the 
object  of  their  delusion,  but  they  are  also  beyond  the  influence  of  reason,  be- 
cause they  but  imperfectly  perceive  impressions.  An  abyss,  say  they,  separates 
them  from  the  external  world.  I  hear,  I  see,  I  feel,  say  many  lypemaniacs,  but 
I  am  not  as  I  formerly  icas.  Objects  do  not  come  to  me,  do  not  idrntify  them- 
selves with  my  being  ;  a  thick  cloud,  a  veil,  changes  the  hie  and  aspect  of  bodies. 
The  most  polished  substances  appear  to  me  to  be  bristling  loith  asperities. 
External  objects,  no  longer  sustaining  their  natural  relations,  grieve,  astonish, 
and  frio-hten  them.  They  have  illusions  of  the  senses,  and  hallucinations. 
They  associate  ideas  the  most  strange  and  unlike;  from  all  which  spring  con- 
victions more  or  less  opposed  to  common  sense,  unjust  prejudices,  fear,  fright, 
dread,  awe  and  terror. 

The  passions  modify  the  ideas  belief  and  determinations  of  the  most  ra- 
tional man.  The  depressing  passions  produce  also  a  partial  lesion  of  the  un- 
derstanding. The  intellectual  life  of  him  whom  a  melancholic  delirium  con- 
trols, is  altogether  imbued  with  the  character  of  his  passion.  The  mountain- 
eer cannot  support  a  lengthened  absence  from  the  place  of  his  nativity,  ceases 
not  to  mourn,  and  at  length  pines  away  and  dies,  if  he  does  not  revisit  the 
paternal  roof  He  who  fears  the  police,  or  the  pursuits  of  the  tribunals,  is 
filled  with  alarm  and  dread,  and  is  in  constant  apprehension  of  an  arrest.  He 
sees  every  where  agents  of  police,  and  servants  of  the  magistracy,  and  that  too, 
among  his  friends  and  relatives. 

Antiochus  dies,  in  despair  of  obtaining  from  Seleucus  his  father,  the  wo- 
man whom  he  adores.  Ovid  and  Tasso,  pass  days  and  nights,  in  incessant 
agitation  both  of  mind  and  heart,  in  consequence  of  the  absence  of  the  objects 
of  their  love.  Fear,  with  all  its  shadows,  whether  the  cause  of  it  be  real  or 
imaorinary,  exercises  the  most  general  influence  over  melancholies.  One  M'ho 
is  superstitious,  dreading  the  wrath  of  heaven,  and  the  vengeance  of  the  gods, 
is  pursued  by  furies,  thinks  himself  in  the  power  of  the  devil,  devoured  by  the 
flames  of  hell,  and  doomed  to  eternal  punishment.  Another,  frightened  by 
the  injustice  of  governments,  apprehends  falling  into  the  hands  of  the  officers 
of  the  State,  and  of  being  conducted  to  the  scaffold.  He  accuses  himself  of 
havino-  committed  the  greatest  crimes,  for  which  he  seeks  to  justify  himself. 
He  now  prefers  death  to  the  agony  of  uncertainty,  whilst  at  other  times,  he 
supplicates  a  delay  in  the  execution  of  the  punishment,  from  which  nothing, 
in  his  opinion,  can  protect  him.  The  latter,  fears  the  treachery  of  men,  and 
thinks  that  his  secret  enemies,  the  envious  and  wicked,  tlireaten  his  fortune, 
his  honor,  his  affections,  and  even  life  itself  The  slightest  noise  or  move- 
ment, the  most  insignificant  sign,  or  trifling  expression,  cause  him  to  start  with 
fear,  and  persuade  him  that  he  is  going  to  die  by  the  machinations  of  his  ene- 
mies. If  a  more  substantial  and  liberal  education  sets  a  man  above  these  su- 
perstitious terrors,  or  fears  of  a  similar  import ;  ingenious  in  self-torment,  he 
finds  the  elements  of  grief  and  terror  in  his  instructions  and  knowledge ;  and 
his  disquietudes  originate  in  matters  pertaining  to  science.     This  lypemaniac 


LYPEMANIA     OR     MELANCHOLY.  207 

thinks  that  he  is  subjected  to  the  deadly  influence  of  electricity  or  magnetism, 
and  persuades  himself  that  by  means  of  chemical  agents  he  may  be  poisoned ; 
or  by  certain  occult  instruments,  physical  science  is  preparing  for  him  a  thou- 
sand ills,  hears  whatever  he  utters,  however  great  the  distance,  or  even  divines 
his  thoughts.  The  remorse  which  sometimes  succeeds  to  crimes  of  o-reat 
magnitude,  throws  the  guilty  into  a  state  of  melancholy  and  characterizes 
their  delirium.  Orestes  is  pursued  by  furies.  Pausanias  the  Lacedemonian, 
having  slain  a  young  female  slave  that  had  been  presented  to  him,  is  tormented 
even  to  the  day  of  his  death,  by  a  spirit  which  pursues  him  wherever  he  goes, 
and  which  resembles  his  victim.  Theodoric,  having  caused  the  decapitation  of 
Symmacus,  believes  that  he  sees  the  head  of  his  victim  in  that  of  a  fish  which 
is  served  upon  his  table.  The  too  noted  Santerre,  expects  every  instant  to  be 
seized  by  soldiers,  who  are  to  conduct  him  to  punishment.  Lypemaniacs 
frighten  themselves,  from  motives  the  most  strange  and  imaginary.  Alexander 
de  Tralles  says,  that  he  once  saw  a  woman  who  dared  not  bend  her  thumb, 
lest  the  world  should  come  to  an  end.  Montanus  speaks  of  a  man,  who  ima- 
gined that  the  earth  was  covered  with  a  shell  of  glass,  under  which  were  ser- 
pents, and  he  dared  not  walk,  through  fear  of  breaking  the  glass,  and  being 
devoured  by  them. 

A  general  whom  I  had  in  charge,  dared  not   go  into  the  street,  believing 
that  all  the  passers-by,  addressed  him  in  terms  of  abuse  or  reproach. 

Some  lypemaniacs  are  constantly  laboring  under  fear,  and  consume  their 
lives,  in  constantly  recurring  solicitudes  ;  whilst  others  are  terrified  by  a  vague 
sentiment,  without  any  motive.  I  fear,  say  these  patients,  I  fear  ;  but  where- 
fore? I  know  not,  i/et  I  fear.  Their  external  appearance,  their  physiogno- 
my, their  actions  and  discourse,  all  indicate  fear  the  most  profound  and  poig- 
nant, from  which  they  can  neither  relieve  themselves,  nor  secure  the  ascen- 
dency. The  delirium  takes  the  character  of  the  moral  affection  which  en- 
gaged the  mind  of  the  patient  before  the  outbreak  of  the  disease,  or  preserves 
that  of  the  cause  that  produced  it ;  a  fact  which  is  especially  noticeable  when 
this  cause  acts  promptly,  and  with  great  energy.  A  woman,  in  the  course  of 
a  dispute  is  called  a  thief;  she  immediately  persuades  herself  that  every  one 
accuses  her  of  the  same  thing,  and  that  all  the  agents  of  justice  are  in  pursuit 
of  her,  to  hand  her  over  to  the  tribunals.  A  lady  is  frightened  by  robbers, 
who  break  into  her  house ;  from  this  time  she  never  ceases  to  exclaim,  the 
robber !  Every  man  she  sees,  not  excepting  her  own  son,  are  brigands  who 
are  come  to  rob  and  assassinate  her.  On  the  slightest  noise,  she  cries  out,  the 
robber  !  thinking  that  they  are  breaking  open  the  door  of  her  house.  A  mer- 
chant meets  with  some  small  losses.  He  immediately  thinks  himself  ruined, 
reduced  to  the  most  complete  indigence,  and  refuses  to  eat,  because  he  has 
not  wherewith  to  pay  for  his  food.  A  statement  of  his  affairs  is  presented 
him,  which  shows  that  he  is  in  very  prosperous  circumstances.  He  examines, 
discusses  it,  and  seems  to  be  convinced  of  his  error ;  but  on  the  whole,  con- 
cludes that  he  is  ruined.  Two  brothers  have  a  discussion  respecting  certain 
pecuniary  affairs  ;  when  the  one  persuades  himself  that  the  other  wishes  to 
kill  him,  in  order  to  enjoy  his  property.  A  soldier  loses  his  grade,  and  be- 
comes sad  and  thoughtful.  He  immediately  considers  himself  disgraced,  and 
persuades  himself  that  his  companions  have  impeached  him ;  and  is  perpetu- 
ally occupied  in  justifying  his  conduct,  which  has  always  been  highly  honora- 
ble. A  woman  sees  her  child  thrown  from  a  horse ;  after  which  no  reasoning, 
and  not  even  the  sight  of  the  child,  who  is  well,  can  convince  her  that  he  is 
living. 

In  thus  analysing  all  the  ideas  that  torment  lypemaniacs,  we  can  readily 
refer  them  to  some  sad  and  debilitating  passion.  Could  we  not  establish  a 
good  classification  of  lypemania,  by  taking  as  a  basis,  the  different  passions 
that  modify  and  subjugate  the  understanding  1     Sometimes  the  moral  senti- 


208  LYPEMANIA  OR  MELANCHOLY. 

ments  of  lypemaniacs  not  only  preserve  all  their  energy,  but  are  exalted  to 
the  highest  degree,  although  the  patients  themselves  are  lamenting  the  want 
of  them,  and  are  suffering  from  the  profoundest  sorrow.  The  principles  of 
filial  piety,  love,  friendship  and  gratitude,  are  sometimes  carried  to  excess, 
and  augment  the  disquietude  and  fears  of  the  melancholic,  and  impel  him  to 
such  acts  as  ilow  from  despair.  Thus  a  mother  believes  she  is  abandoned  by 
her  husband,  and  desires  to  slay  her  children  to  preserve  them  from  a  like 
misfortune.  A  vine-dresser  slays  his  children,  in  order  to  send  them  to  heaven. 
The  languor,  and  monotonous  repetition  of  the  movements,  actions  and  words 
of  the  lypemauiac,  and  the  state  of  despondency  into  which  he  is  plunged, 
would  impose  upon  us,  if  we  believed  that  his  mind  was  inactive,  like  his 
body.  The  attention  of  the  melancholic  is  of  very  great  activity,  and  direct- 
ed to  a  particular  object  with  a  degree  of  intenseness,  that  is  almost  insur- 
mountable. Wholly  engrossed  by  the  object  that  affects  him,  the  patient  can- 
not turn  aside  his  attention,  nor  fix  it  upon  other  objects  foreign  to  his  affec- 
tion. The  mind,  like  the  brain  is,  if  I  may  be  allowed  the  expression,  in  a 
tetanic  state,  and  a  strong  physical  or  moral  commotion  can  alone  cause  this 
spasm  to  cease.  There  being  no  lesion  of  the  reason,  except  on  a  single 
point,  it  seems  as  if  lypemaniacs  called  into  vigorous  exercise  all  their  intel- 
lectual power,  to  fortify  themselves  in  their  delirium.  It  is  scarcely  possible 
to  imao-ine  the  full  force  and  subtilty  of  their  reasonings  in  sustaining  their 
prejudices,  disquietudes  and  fears.  Rarely  do  we  succeed  in  convincing,  and 
never  in  persuading  them.  1  understand  tvell  tchat  you  say  to  me,  (says  a 
melancholic),  you  spcnh  reasonably ,  hut  I  cannot  believe  you.  Sometimes,  on 
the  contrary,  the  mind  of  melancholies  is  in  a  cataleptic  state.  They  seize 
upon  with  energy,  and  preserve  with  more  or  less  tenacity,  the  suggestions 
that  are  made  to  them,  and  we  can  in  such  cases,  cause  them  to  change  their 
notions  almost  willingly,  provided  that  the  new  ideas  have  some  relation  with 
the  prevailing  passion.  A  lady  gets  the  idea  that  her  husband  wishes  to  shoot 
her,  escapes  from  her  chateau,  and  throws  herself  into  a  well.  She  was  told, 
that  if  she  wished  to  destroy  herself,  poison  would  be  an  easier  means  of 
effectinor  this  purpose.  She  immediately  becomes  afraid  of  it,  and  refuses 
every  kind  of  food.  A  melancholic  conceives  that  he  is  disgraced.  After 
havincr  in  vain  sought  to  reassure  him,  they  offer  him  religious  consolation, 
when  he  at  once  believes  that  he  is  damned. 

Some  lypemaniacs  possess  a  knowledge  of  their  condition,  have  a  conscious- 
ness of  its  falsity,  and  of  the  absurdity  of  the  fears  with  which  they  are  tor- 
mented. They  perceive  clearly  that  they  are  irrational,  and  often  confess  it, 
with  grief  and  even  despair.  They  are  however,  brought  back  by  the  pas- 
sion that  controls  them,  to  the  same  ideas,  fears,  disquietudes  and  delirium. 
It  is  impossible  for  them  to  think,  will  or  act  against  it.  Many  assure  us,  that 
a  resistless  power  has  taken  from  them  their  reason,  and  that  this  power  is  God, 
the  devil,  fate  ;  and  that  they  no  more  possess  the  ability  to  direct  it,  than  that 
of  controlling  their  will.  Is  not  this  rf«somn§"  lypemania  ?  The  will  of  most 
lypemaniacs  is  inflexible.  Nothing  can  subdue  it,  neither  reasoning,  nor  the 
solicitations  of  the  most  active  tenderness,  nor  threats.  Nothing  can  triumph 
over  their  errors,  their  alarms  or  fears.  Nothing  can  remove  their  prejudices, 
their  repugnances  or  aversions.  Nothing  can  divert  them  from  the  engrossing 
thoucrhts  that  occupy  their  mind  and  heart,  but  strong  and  unexpected  shocks, 
sufficient  to  attract  their  attention.  Some  lypemaniacs  no  longer  possess  the 
power  of  volition,  or  if  they  will,  they  are  wholly  incapable  of  executing  their 
purposes.  After  having  struggled  and  combated  a  desire  which  presses  them, 
they  remain  inactive. 

An  aged  magistrate,  very  much  distinguished  for  his  wisdom  and  eloquence, 
in  consequence  of  troubles,  is  seized  with  an  attack  of  monomania,  attended 
with  ao-itation,  and  even  violence.     After  some  months  the  delirium  ceases, 


LYPEMANIA  OR  MELANCHOLY.  209 

but  the  patient  retains  unfounded  prejudices.  At  length,  he  recovers  the  en- 
tire use  of  his  reason,  but  remains  unwilling  to  return  to  society,  although  he 
knows  that  he  is  in  the  wrong.  He  is  also  unwilling  to  occupy  himself,  or  to 
think  about  his  affairs,  although  he  knows  very  well,  that  they  are  suffering 
from  his  caprice.  His  conversation  is  both  rational  and  intellectual.  Does 
one  speak  to  him  of  traveling  or  of  attending  to  his  affairs,  he  replies ;  /  hioio 
that  I  ought  and  am  able  to  do  it,  your  advice  is  very  good,  I  would  follow 
yoxir  counsels,  I  am  convinced ;  hut  make  me  able  to  will,  by  means  of  this  tvill, 
which  determines  and  executes.  It  is  certain,  said  he  to  me  one  day,  that  I 
only  have  the  ability  not  to  will,  for  1  have  my  reason  entirely,  1  know  what  I 
ought  to  do,  but  strength  abandons  me,  when  the  time  for  action  comes. 

Lypemaniacs  are  never  unreasonable,  not  even  in  that  sphere  of  thought 
which  characterizes  their  delirium.  They  proceed  upon  a  falpe  idea,  as  well 
as  wrong  principles ;  but  all  their  reasonings  and  deductions  are  conformable 
to  the  severest  logic.  To  one  who  is  a  stranger  to  their  delirium,  they  differ 
in  nothing  from  others  ; — correctly  appreciating  whatever  is  brought  under 
their  observation, — judging  well  of  persons  and  facts,  and  reasoning  as  justly 
as  before  their  illness.  But  the  character  and  affections,  the  habits  and  mode 
of  life  of  the  melancholic,  have  changed,  as  always  happens  in  delirium,  be- 
cause delirium  changes  the  natural  relations  between  the  patient  and  the  exter- 
nal world.  He  who  was  prodigal,  is  now  avaricious  ; — the  warrior  is  timid  and 
even  pusillanimous ; — the  laborious  man  no  longer  wishes  to  labor  ; — liber- 
tines with  grief  reproach  themselves,  and  repent ; — he  who  was  the  least  ex- 
acting, cries  out  treachery  ; — all  are  diffident  and  suspicious,  and  on  their 
guard  with  respect  to  whatever  they  say  or  do.  They  speak  little,  uttering 
only  a  few  monosyllables  ;  having  but  a  single  thought,  they  repeat  incessant- 
ly the  same  words.  A  few  only  are  loquacious,  who  utter  complaints  and  re- 
criminations, expressions  of  fear  and  despair. 


CAUSES  OF  LYPEMANIA. 

The  causes  of  melancholy  are  numerous,  and  are  common  to  other  forms 
of  insanity.  We  shall  speak  in  this  place  of  those  only,  which  have  a  more 
immediate  influence  on  the  frequency  and  character  of  melancholy. 

Seasons  and  climates. — Climates  and  seasons  have  a  special  influence  on 
the  production  of  this  malady.  The  inhabitants  of  mountainous  regions,  who 
are  partially  civilized,  are  seized  with  nostalgia  on  leaving  their  country  ; 
whilst  the  inhabitants  of  the  plains  who  are  advanced  in  civilization,  are  little 
disposed  to  suffer  from  this  malady.  The  neighborhood  of  marshes,  or  a  fog- 
gy and  humid  atmosphere,  by  relaxingt  he  solids,  predisposes  to  lypemania. 
Dry  and  warm  countries,  where  certain  winds  prevail,  also  predispose  to  it. 
All  know  the  effects  of  the  sirocco  upon  the  Italians,  in  producing  melancho- 
ly ;  of  the  solano,  upon  the  Spanish,  and  the  kamsim  upon  the  Egyptians. 
In  regions  where  the  atmosphere  is  hot  and  dry,  sensibility  is  most  exalted, 
the  passions  are  most  vehement,  and  melancholies  most  numerous.  Such 
were  Greece  and  Egypt,  according  to  the  testimony  of  Areteus,  of  Bontius, 
Prosper  Alpin  and  Avicenna.  This  report  is  confirmed  by  the  statement  of 
modern  travelers,  who  assure  us  that  melancholic  affections  are  frequent  in 
Asia  Minor,  in  Upper  Egypt,  Bengal,  and  on  the  African  coasts.  Hippocra- 
tes, and  all  authors  who  have  succeeded  him,  assure  us  that  autumn  is  the 
season  which  produces  the  greatest  number  of  melancholies.  This  season, 
according  to  Cabanis,  is  fruitful  in  maladies  of  this  kind,  in  proportion  as  the 
summer  has  been  hot  and  dry.  This  remark  is  confirmed  by  my  own  obser- 
vations, made  in  the  autumn  of  1818.     AH  physicians  noticed  that  melancho- 

27 


210 


LYPE MANIA     OR     MELANCHOLY. 


ly  was  more  frequent  this  year,  during  the  months  of  October  and  November, 
than  in  preceding  years.  We  received  at  the  Salpetriere,  during  these  two 
months,  a  much  greater  number  of  melancholies,  and  particularly  of  suicides, 
than  we  usually  admitted.  Notwithstanding  the  general  opinion,  I  shall  be 
compelled  to  believe  that  spring  and  sunnner  produce,  at  least  in  our  tempe- 
rate regions,  more  melancholies  than  other  seasons.  This  difference  may 
perhaps  depend  upon  difference  of  climate.  It  is  certain  that  the  reports, 
made  during  four  years  at  the  Salpetriere,  justify  this  opinion,  which  will  ap- 
pear perhaps  a  paradox,  but  which  I  think  worthy  the  attention  of  observers, 
especially  as  it  is  confirmed  by  my  later  observations.  It  is  with  this  hope, 
that  I  hazard  my  doubts  without  farther  discussion. 

Finally,  the  most  favorable  season  for  the  cure  of  lypemaniacs,  is  spring; 
whilst  lypemania  is  ordinarily  exasperated  during  autumn  and  winter. 

TABLE  OF  LYPEMANIACS  WITH  RESPECT  TO  SEASONS. 


Report  of  the  Salpetriere. 

Months. 
January 

1811 

1812 

1813 

1814 

Totals. 

3 

3 

9 

5 

20 

February 

5 

3 

7 

4 

19 

March 

10 

5 

9 

5 

29 

April 

4 

9 

4 

4 

21 

May 

11 

19 

12 

4 

46 

June 

1 

11 

10 

6 

34 

July 

9 

1(3 

12 

8 

45 

August 

.     B 

10 

11 

15 

44 

September 

14 

4 

12 

9 

39 

October 

G 

8 

IG 

5 

35 

November 

8 

8 

6 

4 

26 

December 

12 

5 

10 

7 

34 

According  to  the  preceding  table,  it  is  certain  that  during  four  years,  the 
admission  of  lypemaniacs  has  been  more  numerous  at  the  Salpetriere,  during 
the  months  of  May,  June,  July  and  August,  than  the  other  months  of  the 
year. 

Age. — The  mobility  of  infancy,  as  it  secures  the  child  from  strong  and  du- 
rable impressions,  would  entirely  protect  it  from  lypemania,  were  it  exempt 
from  all  passion.  But  jealousy  sometimes  poisons  the  sweet  enjoyments  of 
early  life,  and  produces  a  true  melancholy  with  delirium.  Some  children, 
jealous  of  the  tenderness  and  caresses  of  their  mother,  become  pale  and  ema- 
ciated, fall  into  a  state  of  marasmus,  and  die.  Children  are  also  exposed, 
though  less  frequently,  to  nostalgia.  At  the  epoch  of  puberty,  the  develop- 
ment of  new  organs  exciting  new  wants  and  sentiments,  the  young  adolescent 
feels  the  influence  of  new  passions,  and  his  days  pass  happily  and  peacefully 
away,  without  regrets  for  the  past,  or  solicitudes  respecting  the  future.  But 
if  the  primitive  passions  exercise  over  him  complete  sway,  and  exalt  his  imagi- 
nation ;  vexations,  the  torments  of  love,  and  erotomania,  come  in  to  mar  his 
earliest  enjoyments.  The  struggle  of  the  amorous  passions  with  religious 
principles,  vi'hich  are  the  fruit  of  early  education,  exposes  the  young  man  to 
religious  lypemania;  and  if  onanism,  or  premature  enjoyments;  if  the  abuse 
of  pleasure  and  excessive  study,  have  been  substituted  for  the  pure  and  varied 
pleasures  of  this  age,  we  ought  then  to  fear  an  incurable  melancholy.     At 


LYPEMANIA     OR     MELANCHOLY. 


211 


adult  age,  the  sensibility  is  less  excitable,  the  imagination  less  active,  and  the 
other  faculties  of  the  mind  act  with  greater  energy.  Factitious  passions  re- 
place the  passion  of  love ;  relations  with  loved  objects  become  relaxed,  whilst 
family  cares,  personal  interest,  love  of  glory  and  ambition,  assume  a  more 
complete  empire  over  the  soul..  If  troublesome  predispositions  exist,  and  if 
moderation  places  no  check  upon  the  factitious  or  social  passions,  at  the  least 
shock  or  reverse,  man  becomes  gloomy,  sad,  suspicious,  and  in  fine,  melancho- 
lic. It  is  also,  towards  the  termination  of  this  period,  that  the  disturbances 
connected  with  the  cessation  of  the  menses,  and  the  abandonment  of  the  world 
and  its  pleasures,  expose  women  to  a  thousand  varied  ills,  and  among  them,  to 
melancholy ;  particularly  those,  who  have  made  society  and  coquetry,  the  only 
occupation  of  their  frivolous  life.  A  sense  of  his  weakness,  renders  the  old 
man  more  composed.  His  thoughts  and  desires  have  lost  their  energy,  the 
imagination  is  at  rest,  the  passions  are  extinct;  and  can  melancholy  take  pos- 
session of  minds  destitute  of  passion?  This  malady  is  very  uncommon  in  old 
age,  except  that  form  which  is  denominated  senile  melancholy ;  a  state,  in 
which  the  old  man,  after  a  stormy  and  dissipated  life,  meditating  upon  the 
errors  into  which  his  passions  have  drawn  him,  isolates  himself,  becomes  sad, 
uneasy,  hard  to  please,  avaricious,  suspicious  and  egotistical ;  often  unjust 
towards  his  friends,  his  own  children  and  society  at  large. 

The  following  abstract,  made  at  the  Salpetriere,  proves  that  lypemania  is 
very  frequent  in  early  life,  that  is  to  say,  between  the  age  of  twenty-five  and 
thirty-five  years;  and  that  it  constantly  diminishes  after  this  period,  and  rarely 
appears  after  the  age  of  fifty-five  years.  The  report,  made  up  from  the  higher 
and  wealthy  classes  of  society,  gives  the  same  results.  ^ 


TABLE  OF  AGES. 


Ages. 

Years. 

20 

25 

30 

35 

40 

45 

50 

55 

60 

1811 

7 

19 

16 

13 

13 

10 

9 

1 

6 

1812 

8 

23 

16 

9 

15 

9 

12 

3 

6 

1813 

8 

14 

18 

15 

17 

11 

3 

9 

1814 

4 

8 

12 

10 

7 

6 

4 

8 

Totals. 

27 

64 

62 

47 

52 

48 

38 

11 

29 

Sex. — Women,  in  consequence  of  their  constitutional  gentleness,  and  the 
mobility  of  their  sensations  and  desires,  as  well  as  by  the  little  application  which 
they  make  with  reference  to  any  matter,  seem  to  \)&  less  subject  than  men,  to 
melancholy.  Such  was  the  opinion  of  Areteus,  of  Coelius  Aurelianus  and 
the  ancients.  But,  are  not  the  extreme  susceptibility  and  sedentary  life  of 
our  women,  their  peculiarities  even,  the  predisposing  causes  of  this  malady  ? 
Are  not  women  under  the  control  of  influences  to  which  men  are  strangers ; 
such  as  menstruation,  pregnancy,  confinement  and  nursing?  The  amorous 
passions,  which  among  them  are  so  active ;  religion,  which  is  a  veritable  pas- 
sion with  many,  when  love  does  not  exclusively  occupy  their  heart  and  mind, 
jealousy,  fear,  do  not  these  act  more  energetically  upon  the  minds  of  women 
than  men  ?  Religious  melancholy  is  also  very  frequent  among  them,  especially 
in  the  lower  classes  of  society,  and  in  countries  where  ignorance  generally 
prevails.  Girls,  widows,  and  sometimes  women  at  the  critical  period  of  life, 
are  a  prey  to  erotic  melancholy.  Men,  says  Zimmermann,  are  insane  from 
pride,  girls  from  love,  and  women  from  jealousy. 


212  LTPKMANIA  OR  MELANCHOLY. 

Temperaments. — The  melancholic  temperament  of  the  ancients,  and  the 
bilious-nervous  of  Halle,  predispose  to  lypemania.  Persons  of  this  tempera- 
ment are  tall  and  slender,  and  the  muscles  small,  but  well  defined.  The  chest 
is  narrow  and  confined,  the  skin  brown  or  sallow,  the  hair  black,  and  the  eyes 
are  sunken  and  full  of  fire.  The  physiognomy  is  sad  and  uneasy,  the  look 
timid  or  fixed,  sensibility  is  exquisite,  and  all  the  passions  are  extreme.  These 
individuals  love  or  hate  intensely,  and  with  obstinacy.  Thoughtful,  taciturn, 
jealous  and  suspicious,  they  concentrate  their  affections.  Society  calls  upon 
them  importunately,  but  they  fly  from  it ;  preferring  solitude,  in  which  their  ima- 
ffination  and  affection  can  exercise  themselves  without  disturbance.  They  are 
well  calculated  for  the  cultivation  of  the  arts  and  sciences.  They  have  little 
memory,  but  their  ideas  are  strong,  their  conceptions  vast.  They  are  capable 
of  profound  meditation.  Often,  exclusively  devoted  to  the  objects  of  their  study, 
it  seems  as  if  they  had  no  thought  or  interest,  except  in  a  single  definite  ob- 
ject, to  which  they  devote  themselves  with  the  utmost  ardor.  These  persons 
are  especially  predisposed  to  lypemania.  It  was  said  by  Aristotle,  that  men 
of  genius,  and  great  statesmen,  are  ordinarily  melancholies.  Mahomet,  Lu- 
ther, Tasso,  Cato,  Pascal,  Chatterton,  J.  J.  Rousseau,  Gilbert,  Alfieri,  Zim- 
mermann,  etc.,  confirm  the  opinion  of  Aristotle,  which  was  justified  by  his 
own  individual  example.  This  temperament  does  not  belong  exclusively  to 
that  variety  of  genius,  which  engages  itself  in  thinking,  speaking,  and  doing 
well;  but  is  the  temperament  also,  of  some  great  villains,  and  very  wicked 
persons.  Those  evil  geniuses,  who  are  sent  into  the  world  to  be  the  terror  of 
it,  and  to  tyrannize  over  their  fellow  citizens,  are  not  always  exempt  from  the 
torments  of  the  blackest  melancholy.  Their  harsh  and  repulsive  physiognomy 
wears  the  impress  of  their  hateful  and  malevolent  passions.  Their  aversion 
to  men,  causes  them  to  seek  solitude,  and  to  fly  the  presence  of  their  fellow 
creatures.  Acquired  constitutions  of  temperaments,  in  which  the  hepatic  or 
hemorrhoidal  system  predominates,  also  predispose  to  lypemania. 

Professions  and  mode  of  life. — Corporeal  labor  maintains  the  physical  forces, 
at  the  same  time  that  it  distributes  them  uniformly  among  all  the  organs.  It 
is  the  best  check  upon  the  passions,  which  it  moderates,  at  the  same  time  that 
it  prevents  the  imagination  from  blending  itself  with  our  pleasures  and  cor- 
rupting them.  An  idle  and  inactive  life,  the  transition  from  a  very  active  to  a 
slucrwish  and  indolent  one,  abounding  in  leisure ;  excessive  nicrht-watchinor,  by 
exhausting  the  physical  energies,  and  sleep  unduly  prolonged,  by  depressing 
the  powers  both  of  body  and  mind;  occasion  moroseness  and  mental  torpor. 
Excessive  study  exhausts  man,  says  Celsus,  more  than  labor  of  the  body,  if  it 
encroaches  upon  time,  which  properly  belongs  to  repose  and  exercise.  If  it 
is  concentrated  upon  a  single  object,  and  this  is  abstract,  mystical  or  romantic, 
then  the  man  is  in  constant  danger  of  becoming  a  lypemaniac.  Melancholy 
is  still  more  to  be  dreaded,  if,  to  excessive  study,  are  joined  errors  of  regimen, 
dissipated  and  dissolute  conduct,  or  a  too  decided  taste  for  a  solitary  life. 
Zimmermann  relates  many  examples  of  melancholy,  produced  from  this  last 
cause.*  There  are  certain  professions,  which  more  particularly  predispose  to 
this  malady,  because  they  exalt  the  imagination  and  passions,  and  expose  those 
who  practice  them,  to  errors  of  regimen  of  every  kind :  such  are  musicians, 
poets,  actors,  and  merchants  who  are  engaged  in  hazardous  speculations.  I 
could  name  more  than  twenty  actors,  in  behalf  of  whom  I  have  been  con- 
sulted. 

The  physical  causes,  which  we  may  call  pathological,  in  general  act  by  en- 
feebling the  constitution,  or  by  impressing  upon  the  fluids,  a  morbid  character. 
Prolonged  fasting  and  hunger,  have  been  referred  to  by  several  authors,  par- 

"  SJohtude,  trans,  by  A.  J.  L.  Jouidan,  Paris,  1825,  in  8vo. 


LYPEMANIA     OR     MELANCHOLY.  213 

ticularly  Santacnix,  as  calculated  to  produce  melancholy.  This  influence  is 
even  consecrated  in  popular  language,  and  the  habit  of  surcharging  the  sto- 
mach with  aliment,  difficult  of  digestion,  especially  among  men  who  take  little 
exercise,  disposes  to  the  same  malady.  Some  physicians  have  pretended,  that 
the  habitual  use  of  milk  renders  one  sad,  and  is  hurtful  to  melancholies.  It 
is  certain  that  the  use  of  this  article  produces  head-aches  among  persons  of  a 
bilious-nervous  temperament.  The  abuse  of  opium,  of  hot  drinks,  and  alco- 
holic liquors,  often  causes  lypemania,  and  leads  melancholies  to  suicide.  Per- 
haps we  ought  to  attribute  to  the  abuse  of  hot  drinks  and  alcohol,  the  great 
number  of  suicides  which  we  observe  in  England.  This  is  indeed  the  opinion 
of  many  English  physicians.  Women  are  often  brought  to  our  hospital  who, 
while  in  a  state  of  intoxication,  or  during  the  delirium  that  succeeds  it,  fall 
into  a  state  of  lypemania,  with  an  inclination  even  to  suicide.  Onanism  and 
continence  after  marriage,  sometimes  produce  melancholy.  The  suppression 
of  an  habitual  evacuation,  of  the  transpiration,  of  a  hemorrhoidal  flux,  and 
obstinate  constipation,  occasion  melancholy.  Sanctorius  has  observed,  that  a 
defect  of  transpiration  renders  a  person  sad,  and  Voltaire  remarked,  that  con- 
stipation influenced  to  a  frightful  extent,  the  determinations  of  the  oreat. 
The  retrocession,  or  sudden  cessation  of  any  morbid  affection  whatever,  may 
cause  lypemania  where  there  is  a  predisposition  to  the  malady.  The  same 
effect  may  be  produced,  by  the  suppression  of  an  issue,  herpes  or  psora.  We 
see  lypemania  replace  phthisis  pulmonalis,  hysteria,  hypochondria,  epilepsy, 
mania  and  monomania,  or  alternate  with  these  diseases.  It  is  not  rare  that, 
on  the  cessation  of  the  general  delirium  and  excitement  which  characterize 
mania,  those  so  afflicted  fall  into  a  state  of  profound  melancholy,  with  an  indi- 
cation even  to  suicide.  Some  are  controlled  by  a  painful  sentiment,  with  which 
the  recollection  of  their  delirium  inspires  them,  a  sentiment  unfortunately 
strengthened  by  prejudice.  Others  are  impressed  with  the  idea  that  they  are 
no  longer  of  any  service  in  society,  and  persuade  themselves  that  they  are  use- 
less, or  a  charge  to  their  relatives  and  friends,  or  objects  of  contempt  among 
their  fellow  citizens. 

M.  W.,  forty-eight  years  of  age,  and  of  a  very  strong  constitution,  having 
taken  an  active  part  during  the  reign  of  terror,  is  removed  by  the  directory, 
and  sent  on  an  embassy.  The  first  Consul  recalls  him  and  names  him  a  pre- 
fect. Not  being  appointed  to  a  post  corresponding  with  that  which  he  had  just 
left,  nor  by  any  means  with  the  aspirations  of  his  ambition,  he  gave  himself 
up  to  a  thousand  exaggerations  and  extravagances,  in  his  conversation  and 
actions.  He  soon  persuades  himself  that  he  is  king,  and  abandons  himself  to 
all  the  pretensions  with  which  such  a  conviction  inspires  him.  He  requires 
that  every  one  should  prostrate  himself  before  him,  is  constantly  making  and 
unmaking  ministers,  and  prodigal  of  favors,  honors  and  wealth.  His  step  is 
proud  and  imposing.  He  sleeps  little,  eats  much,  and  suffers  from  constipa- 
tion. He  is  committed  to  my  care,  and  after  some  months  recovers  his  rea- 
son, takes  a  very  correct  view  of  his  condition,  and  we  consider  him  cured. 
Soon  after  however,  he  falls  into  a  profound  melancholy  with  delirium,  accom- 
panied with  sadness  and  imaginary  fears,  which  follow  him  to  the  close  of  life. 
He  dies,  from  a  frightful  cerebral  hemorrhage,  five  months  after  the  attack  of 
melancholy.  At  the  post-mortem  examination,  the  cerebral  substance  was 
found  to  be  very  much  injected,  softened,  and  as  it  were,  triturated,  around 
the  effused  blood.  All  the  viscera  were  healthy.  The  o-emini  muscles  re- 
sembled smoked  bacon,  having  the  color  and  density  of  it.  Their  normal 
texture,  together  with  the  muscular  fibres,  had  disappeared.  During  the  last 
two  months  of  his  life,  he  remained  standing  motionless,  or  walked,  slowly 
placing  the  feet  one  before  the  other,  at  every  step.  From  the  commencement 
of  this  disease,  he  had  manifested  some  slight  symptoms  of  a  paralysis  of  the 
tongue,  and  had  acquired  much  flesh. 


214  LYPEMANIA  OR  MELANCHOLY. 

The  passions  constitute  a  true  form  of  insanity,  but  one  which  is  of  tem- 
porary duration.  They  take  possession  of  the  intellectual  faculties,  and  so 
completely  absorb  them,  that  the  individual  is  incapable  of  directing  his 
thoughts  to  any  thing  other  than  the  object  of  his  passion.  Whether  the  mo- 
ral affections  and  the  passions  have  their  seat  in  the  heart,  in  the  phrenic  cen- 
tre, in  the  solar  plexus,  in  the  trisplanchnic  nerve,  in  the  ganglions,  in  the 
brain,  or  are  only  the  effects  of  a  reaction  of  the  soul  or  vital  principle,  it 
is  ever  true,  that  they  exercise  a  powerful  influence  over  the  functions  of  or- 
ganic life,  as  well  as  the  understanding.  If  the  passions  have  an  influence 
over  all  our  functions  in  a  state  of  health,  how  much  more  energetic  will  this 
influence  be  in  a  malady,  in  which  disorder  of  the  passions  forms  the  principal 
characteristic  !  The  moral  affections  are  the  most  frequent  cause  of  lypema- 
nia ;  their  disorder  is  the  most  prominent  symptom  of  it,  and  in  the  hands  of 
a  skillful  physician,  are  a  powerful  means  of  cure.  Disappointed  affection, 
jealousy,  fear, — which  is  the  perception  of  a  future  ill,  or  one  which  threatens 
us, — and  fright, — which  is  the  perception  of  a  present  ill, — are  the  passions 
which  produce  the  greatest  number  of  lypemaniacs,  particularly  in  youth, 
among  women,  and  in  the  lower  classes  of  society  ;  whilst  ambition,  avarice, 
wounded  self-love,  reverses  of  fortune,  and  gaming,  are  the  most  frequent 
cause  of  insanity  among  adults,  and  men  of  mature  age,  in  the  higher  classes 
of  society,  and  in  those  countries  whose  customs  and  institutions  foster  all 
the  social  passions.  The  depressing  passions  are,  most  generally,  the  cause 
of  melancholy  with  delirium.  At  one  time,  they  act  slowly,  and  by  repeated 
attacks,  progressively  fatigue  the  organs,  and  steel,  so  to  speak,  the  sensibility. 
The  enfeebled  mind  then  supports  with  difticulty  any  opposition,  and  man  be- 
comes fearful,  because  he  is  feeble,  and  very  sensitive.  At  another,  the  mo- 
ral affections,  lively  and  abrupt,  suddenly  overwhelm  the  sensibility,  and  at 
once  sink  the  patient  into  melancholy.  The  following  tables  indicate  the 
differences,  with  respect  to  frequency,  which  the  causes  of  lypemania  present. 

TABLE  OF  CAUSES. 

Hereditary  predisposition              .             .             ,  .110 

Suppression  of  the  menses      .              .              .             ,  25 

Critical  period         .          .              .              .              .  .40 

Consequences  of  confinements            ...  35 

Fall  upon  the  head            .              .              .              .  .10 

Masturbation               .....  6 

Libertinism           .              .              .              .              .  .30 

Abuse  of  wine            .....  19 

Domestic  troubles             .             .             .             .  .60 

Reverses  of  fortune  and  consequent  misery                 .  48 

Disappointed  affection      .             .             .             .  .42 

Jealousy         ......  8 

Fright      .......       19 

Wounded  self-love      .....  12 

Anger      .             .             .             .             .             .  .18 


o 


Total  .....  482 

The  causes  of  lypemania,  like  those  of  other  mental  diseases,  do  not  always 
act  immediately  upon  the  brain  ;  that  is  to  say,  there  are  cases  of  sympathetic 
melancholy.  Now,  different  foci  of  sensibility  react  upon  the  brain,  to  pro- 
duce the  delirium  of  melancholy  ;  and  now,  the  predominance  and  lesion  of 
an  organic  apparatus,  occasion  the  same  reaction.     All  the  symptoms  appear 


LYPEMANIA     OR     MELANCHOLY.  215 

to  depend  upon  the  disorder  of  some  viscus,  more  or  less  remote  from  the 
centre  of  sensibility.  How  numerous  are  the  cases  of  melancholy,  that  have 
succeeded  hypochondria  !  How  many  melancholies  are  there,  who  recognize, 
in  particular,  lesions  of  the  abdominal  viscera,  as  the  causes  of  chronic  mala- 
dies !  Hence,  we  give  to  these  affections  the  appellation  of  hypochondriacal 
lypemania.  I  have  seen  a  merchant  who,  having  fallen  into  a  profound  me- 
lancholy, attended  with  a  refusal  to  take  nourishment,  and  attempts  upon  his 
life,  assured  us,  that  a  foreign  body  had  been  arrested  in  his  throat,  which 
entirely  prevented  his  swallowing.  His  friends  were  certain  that  he  had  taken 
nothing  that  could  cause  an  inflammation  of  the  cesophagus,  and  an  inspection 
of  the  part,  removed  all  disquietude  with  respect  to  it.  The  patient,  in  the 
deepest  distress,  was  constantly  demanding  the  removal  of  this  foreign  body. 
Three  months  afterwards,  he  fell  into  a  marasmus  and  died. 

At  the  post-mortem  examinatioH,  I  found  an  ulcer  of  a  syphilitic  aspect, 
occupying  the  superior  third  of  the  cesophagus.  Bonet  speaks  of  a  country- 
man, who  assured  him  that  he  had  a  toad  in  his  stomach,  that  he  heard  his 
noise,  and  felt  him  hopping  about,  etc.  At  his  death,  they  found  a  cancer  of 
that  organ.  I  have  many  times  seen  hypochondriacal  lypemaniacs,  who  affirm- 
ed that  they  had  devils  in  their  stomachs,  and  believed  that  the  abdomen 
was  full  of  unclean  animals.  They  were  also  convinced  that,  by  the  aid  of 
electricity  and  magnetism,  the  most  acute  pains  were  produced  in  their  intes- 
tines. In  these  cases,  the  opening  of  the  bodies  revealed  chronic  peritonitis, 
a  cancer  of  the  stomach,  and  gangrene  of  the  transverse  colon.  One  patient 
thought  he  had  birds  in  his  belly,  and  was  afraid  to  go  to  the  water-closet, 
through  fear  that  these  birds  escaping,  we  should  become  apprised  of  his  in- 
firmity. Many  times,  he  begged  me  to  listen  to  the  noise  of  these  birds. 
What  he  experienced,  resulted  from  flatus,  and  borborygmi. 

The  causes  of  lypemania,  like  those  of  all  other  maladies,  are  predisposing 
or  remote,  proximate  or  exciting ;  but  these  distinctions  cannot  be  rigorously 
applied  to  this  or  that  cause,  for  it  often  happens,  that  those  causes  which  we 
call  predisposing,  are  exciting  ;  and  reciprocally.  The  exciting  causes  alone, 
seem  to  have  been  sufficient  to  provoke  the  malady.  Usually  however,  there 
is  a  concurrence  of  the  two  orders  of  causes.  A  first  event,  disposes  to  the 
disease  ;  a  second,  causes  it  to  break  forth. 

M.  B.,  twenty-three  years  of  age,  is  on  the  eve  of  marriage  to  the  lady  whom 
he  adores.  Insurmountable  obstacles  interfere,  to  break  up  their  designs. 
He  becomes  sad,  morose,  uneasy,  flies  society,  and  in  a  word,  is  melancholic. 
At  the  expiration  of  six  months,  he  fails  to  obtain  in  the  service,  the  advance- 
ment which  he  expects,  and  immediately  falls  into  the  deepest  despair.  He 
accuses  all  men  of  injustice,  and  believes  himself  to  be  the  object  of  their 
hatred  and  persecutions.  In  the  street,  while  walking,  and  in  traveling,  he 
often  thought  that  they  were  mocking  him,  and  demanded  satisfaction  of  them. 
He  once  fought  a  duel  with  a  soldier  whom  he  had  never  before  seen,  Avith 
whom  he  met  by  accident,  and  by  whom  he  persuaded  himself  that  he  had 
been  insulted.  At  length,  he  made  several  attempts  to  commit  suicide,  but 
was  cured  after  the  lapse  of  a  year. 

A  merchant  forty-five  years  of  age,  is  interested  in  a  bankruptcy,  which  for 
a  brief  period  embarrasses  him,  without  impairing  his  fortune.  On  the  day 
of  this  reverse,  his  character  changes.  He  becomes  more  gay  than  usual,  and 
laughs  at  this  mischance ;  felicitating  himself  in  having  thereby  acquired  a 
more  thorough  knowledge  of  men.  He  forms  projects  incompatible  with  his 
fortune  and  unsuited  to  the  condition  of  his  affairs.  Eight  days  pass  in  this 
state  of  joy,  satisfaction  and  activity,  which  occasions  apprehension  of  a  grave 
disease,  of  which  he  has  himself  a  presentiment.  After  this  epoch,  political 
events  wholly  foreign  to  his  interests,  but  which  oppose  his  views,  plunge  him 
into  a  melancholy  delirium  from  which  nothing  relieves  him. 


216  LTPEMANIA  OR  MELANCHOLY. 

It  is  not  rare,  to  see  lypemania  burst  forth  without  any  assignable  cause. 
Nevertheless,  by  observing  the  patient  with  special  care,  by  informing  our- 
selves of  his  mode  of  livino-  and  habits,  we  discover  the  true  origin  of  the 
evil,  which  is  often  some  concealed  moral  affection.  Hippocrates,  Erasistra- 
tus,  Galen,  and  Ferrand  in  his  Treatise  on  Love,  cite  memorable  examples  of 
their  sagacity  in  discovering  the  feigned  or  concealed  causes  of  lypemania. 
I  have  often  been  able  to  foretell  that  onanism  was  the  real  but  concealed 
cause  of  the  disease.  It  also  happens,  that  the  exciting  causes,  whether  phy- 
sical or  moral,  act  so  suddenly,  that  the  delirium  appears  at  once,  especially 
when  the  predisposing  influences  are  numerous  or  strong;  Lypemania  is 
continued,  remittent  or  intermittent.  The  remittent  form  is  most  frequent, 
and  there  are  few  lypemaniacs  whose  delirium  is  not  exasperated  on  alternate 
days.  Many  experience  a  very  marked  remission  at  evening  and  after  dinner  ; 
whilst  others  suffer  most  on  waking,  and  during  the  early  part  of  the  day. 
With  the  latter,  this  exasperation  of  the  symptoms,  depends,  now  upon  the 
pain  which  they  experience  at  the  thought  of  being  obliged  to  drag  out  a 
miserable  existence  for  another  day,  whose  interminable  length  frightens  them, 
and  now,  from  fear  that  their  enemies  will  profit  by  the  occasion,  to  execute 
their  dreadful  purposes.  Certain  persons,  who  suffer  from  panophobia,  are 
afraid  at  the  approach  of  night  and  darkness.  The  shades  of  night  arouse 
their  apprehensions  ;  robbers  can  more  readily  introduce  themselves  ;  insom- 
nia and  dreams  terrify  them  in  advance.  Intermittent  melancholy  presents  no- 
thing in  particular  ;  nothing  that  we  can  add  to  what  has  been  said  respect- 
ing intermittent  insanity. 

Continued  lypemania  has,  in  general,  a  very  slow  course  ;  and  besides  the 
partial  delirium  which  characterizes  it,  is  complicated  with  a  multitude  of 
symptoms,  whose  exasperation  coincides  with  that  of  the  delirium,  or  provokes 
it.  It  is  usually  in  the  spring  that  it  terminates  in  health  ;  but  can  we  rely 
upon  an  effectual  cure,  if  it  is  not  preceded  by  some  commotion  or  by  some 
crisis,  either  physical  or  moral  ?  I  am  always  doubtful  respecting  a  cure, 
when  I  have  been  unable  to  observe  any  previous  crisis.  As  in  other  forms 
of  insanity,  so  in  this,  crises  are  very  numerous.  Now,  they  occur  by  the 
skin,  in  the  reestablishment  of  the  transpiration,  in  abundant  sweats,  exanthe- 
mata and  furuncles.  We  find  examples  of  them  in  every  author  ;  now,  by 
habitual  hemorrhages  which  were  suppressed,  and  by  the  menses  ;  and  now, 
by  mucous,  bilious,  brown,  blackish  and  even  sanguineous  evacuations,  which 
take  place,  either  by  vomiting  or  alvine  dejections.  These  critical  evacua- 
tions are  observed  more  frequently  than  others  ;  are  referred  to  by  all  authors, 
and  are  the  crises  which  art  may  provoke  with  the  greatest  success.  Hippo- 
crates tells  us  that  Adamentus  was  cured  by  vomiting  a  great  quantity  of 
black  matter.  Lorry  and  Halle*  relate  similar  examples.  Pinel  speaks  of 
the  cure  of  two  melancholies  ;  one,  by  the  development  of  one  of  the  paro- 
tids ;  the  other,  by  a  jaundice.  Lypemania  is  also  terminated  by  moral  shocks. 
A  violent  passion  suddenly  provoked,  by  producing  a  diversion  of  the  thoughts, 
which  have  been  previously  fixed,  effects  a  cure.  The  malady  ceases  from 
the  effect  of  fright  or  fear,  and  by  the  effect  of  a  stratagem  well  concerted, 
and  managed  according  to  the  character  of  the  malady  and  that  of  the  pa- 
tient. The  return  to  reason  also  takes  place,  when  by  his  attentions  and  dis- 
courses, a  skillful  physician  knows  how  to  possess  himself  of  the  confidence  of 
the  patient.  This  first  step  taken,  the  cure  is  easy.  In  some  cases,  we  effect 
a  cure  by  satisfying  the  desires  of  the  patient,  and  granting  to  him  the  ob- 
ject of  the  passion  which  has  provoked  the  delirium.  Melancholy  is  also  ter- 
minated by  the  e.\plosion  of  maniacal  delirium.  This  termination  is  rare ; 
and  we  might  anticipate,  that  the  transition  from  tranquil  lypemania  to  fury, 

*  Memoirs  of  the  Medical  Society  of  Emulation,  t.  iii,  p.  348. 


CRITICAL     TERMINATIONS     OF     INSANITY.  217 

would  be  succeeded  by  fatal  accidents,  and  the  prelude  to  a  speedy  death, 
either  natural  or  provoked.  Lypemania  sometimes  passes  into  mania.  It  is 
doubtless  this  transformation,  which  has  caused  melancholy  to  be  confounded 
with  m?.nia.  It  degenerates  not  unfrequently,  into  dementia.  In  this  condi- 
tion, the  prevailing  ideas  still  remain  ;  but  they  are  incoherent,  without  con- 
nection, order  or  harmony  with  the  actions  ;  whilst  before,  the  ideas  and  con- 
victions were  strong,  and  the  reasonings,  desires  and  determinations,  the  just 
and  immediate  consequences  of  the  ideas  which  characterized  the  delirium. 


DISEASES  TO  WHICH  LYPEMANIACS  SUCCUMB. 

POST-MORTEM    EXAMINATIONS. 

Melancholy  terminates  in  death.  Lorry  and  Mead  assure  us,  that  phthisis 
pulmonalis  is  its  most  frequent  termination.  The  English  believe,  that  it 
often  terminates  in  dropsy  of  the  chest.  The  great  number  of  post-mortem 
examinations  that  I  have  made,  confirm  the  observation  of  the  first  named 
writers.  I  have  also  seen  many  abdominal  affections  put  an  end  to  the  exist- 
ence of  melancholies.  Scurvy  and  consecutive  gangrene,  cause  the  death  of 
a  large  number  of  lyperaaniacs.  The  want  of  exercise,  and  bad  regimen  of 
these  patients,  and  the  chagrin  which  pursues  them,  by  enfeebling,  exposes 
them  to  chronic  inflammations  of  different  organs.  I  ouo-ht  not  to  forget  ona- 
nism  as  calculated  to  produce  the  most  fiital  effects  upon  the  health  and  life 
of  these  unfortunate  people.  It  is  one  of  those  errors  to  which  they  yield 
themselves,  and  to  which  it  is  important  to  call  the  attention  of  those  who 
have  to  direct  and  watch  over  the  insane. 

Pathological  anatomy  has  taught  us  nothing  positive  respecting  the  seat  of 
melancholy.  It  is  not  that  the  examination  of  bodies  is  wanting,  but  observa- 
tions are  incomplete.  We  cannot  distinguish  what  is  proper  to  lypemania, 
from  vyhat  appertains  to  hypochondria  or  mania,  with  which  it  has  been  con- 
founded. In  the  post-mortem  examinations  of  the  insane,  and  consequently 
in  those  of  melancholies,  they  have  too  frequently  neglected  to  notice  the  dis- 
eases that  caused  their  death.  I  have  taken  great  pains  to  ascertain  these 
diseases.     The  following  are  my  observations  with  respect  to  this  subject. 

TABLE  OF  DISEASES  TO  WHICH  LYPEMANIACS  SUCCUMB. 

Adynamic  fever                 .              .              .              .  .10 

Marasmus,  and  slow  fever       ....  24 

Phthisis  pulmonalis,  and  chronic  pleurisies            .  .       62 

Diseases  of  the  heart               ....  16 

Chronic  phlegmasise  of  the  abdomen        .              .  .32 

Scurvy             ......  26 

Apoplexy  ......         6 

Total      ......  176 

From  this  report,  it  appears  that  melancholies  die  most  frequently,  in  con- 
sequence of  chronic  diseases,  particularly  from  affections  of  the  chest.  Ma- 
rasmus, and  a  slow  nervous  fever,  present  all  the  characteristics  of  the  tahes 
melancolica  described  by  Lorry.  These  patients  complain,  some  of  them  of 
cardialgia,  others  of  colics.  They  eat  little,  though  in  some  cases  the  appe- 
tite is  voracious.  Nevertheless,  they  become  gradually  emaciated  and  enfee- 
bled. Constipation  is  at  first  obstinate,  and  they  suffer  from  irregular  febrile 
paroxysms,  which  occur  most  frequently  at  eveninor.     The  pulse  is  feeble  and 

28 


218  CRITICAL     TERMINATIONS     OF     INSANITY. 

concentrated,  and  the  heat  of  the  skin  pungent.  The  skin  is  sometimes  co- 
vered with  a  viscous  perspiration,  but  is  most  generally  dry,  and  of  an  earthy 
aspect.  The  patients  fall  into  a  state  of  extreme  feebleness,  and  no  longer 
leave  their  bed.  They  lose  both  voice  and  appetite  ;  their  features  change, 
and  at  length  life  becomes  extinct,  without  a  struggle  or  pain.  Some  lype- 
maniacs  are  for  a  longer  or  shorter  period  before  death,  troubled  with  a  serous 
and  sometimes  a  sanguineous  diarrhoea,  which  is  symptomatic  of  phthisis, 
scurvy  and  chronic  enteritis.  The  ancients  ascribed  melancholy  to  accumu- 
lations of  black  and  thick  bile,  and  to  corroding  humors,  which,  arising  to 
the  brain,  obscured  as  with  a  veil,  the  organ  of  thought,  and  thus  impressed 
a  sad,  sombre  and  timid  character  upon  the  delirium  of  melancholies.  Some 
authors  have  pretended  to  find  these  humors  in  the  brain.  The  advancement 
which  pathological  anatomy  has  made  in  our  days,  permits  us  to  offer  a  reason 
for  this  phenomenon.  It  is  very  true,  that  we  find  in  the  brain  of  some  me- 
lancholies, a  reddish,  yellow  fluid  ;  but  every  one  now  knows,  that  this  is  not 
bile,  but  the  residue  of  a  sanguine  effusion,  or  of  a  softened  portion  of  the 
brain.  This  matter  is  now  contained  in  a  cyst ;  and  now  effused  in  a  loose 
net-work,  formed  by  the  cerebral  substance.  This  alteration  we  observe  in 
the  brain  of  individuals,  who  have  never  been  insane.  It  coincides  with  me- 
lancholy, but  is  neither  the  cause  nor  effect  of  this  malady. 

Bonet,  in  the  Sepulchretum,  says  that  the  vessels  of  the  encephalon  are  dis- 
tended and  engorged  with  blood,  and  that  there  are  effusions  into  the  sinuses  of 
the  brain.  He  refers  especially,  to  lesions  of  the  thorax  and  abdomen  among 
melancholies.  Boerhaave  says  that  the  brain  is  hard,  friable,  and  of  a  yel- 
lowish white,  and  that  the  vessels  of  this  organ  are  gorged  with  coagulated 
black  blood.  We  can  conclude  nothing  from  these  facts,  since  the  authors 
who  report  them,  confound  melancholy  with  mania.  Some  moderns  assure 
us,  that  among  melancholies  the  gall-bladder  contains  concretions,  but  this  is 
by  no  means  constant.  The  heart  has  sometimes  appeared  destitute  of  blood, 
or  else  its  ventricles  have  been  found  full  of  concretions,  called  polypi.  Gall 
assures  us,  that  the  cranium  of  suicides  is  thick  and  hard.  I  have  in  my 
possession,  the  crania  of  several  insane  persons  who  have  committed  suicide, 
which  are  very  soft.  One  of  the  alterations  which  I  have  frequently  met  with 
amoncr  melancholies,  is  the  displacement  of  the  transverse  colon.  I  have  re- 
ported several  cases  in  proof  of  it.  The  transverse  position  of  the  colon  be- 
comes oblique,  and  even  perpendicular  ;  its  extreme  left  is  situated  near  the 
pubes,  and  is  sometimes  concealed  behind  the  symphisis.  The  following  case 
will  interest  those  who  are  fond  of  political  phenomena,  and  who  seek  for  ex- 
traordinary facts  in  medicine, 

Teroenne  or  Theroigne  de  Mericour,  was  a  celebrated  courtesan,  born  in  the 
city  of  Luxemburgh.  She  was  of  medium  height,  had  chestnut  colored  hair, 
large  blue  eyes,  a  changeful  physiognomy,  and  a  sprightly,  free,  and  even  ele- 
gant carriage.  This  girl,  in  the  opinion  of  some,  of  honorable  birth,  and  in 
that  of  others,  springing  from  the  rank  of  courtesans,  acted  a  truly  deplorable 
part,  during  the  first  years  of  the  revolution.  She  was  then  from  twenty- 
eight  to  thirty  years  of  age.  She  devoted  herself  to  the  various  chiefs  of  the 
popular  party,  to  whom  she  was  of  service  in  most  of  the  riotous  disturbances, 
and  contributed,  especially  on  the  /Sth  and  Gth  Oct.  1789,  to  corrupt  the  regi- 
ment of  Flanders,  by  leading  into  its  ranks,  women  of  ill  fame,  and  by  distri- 
buting money  among  the  soldiers.  In  1790,  she  was  sent  into  the  city  of  Liege, 
to  arouse  the  people.  She  there  took  a  military  rank.  She  made  herself 
remarkable  among  this  unbridled  populace,  which  was  sent  to  Versailles  on 
the  5th  and  Gth  of  Oct.,  1790.  The  Austrians  arrested  her  in  the  month  of 
January  1791.  She  was  conducted  to  Vienna,  and  confined  in  a  fortress. 
The  Emperor  Leopold  saw  her,  conversed  with  her,  and  caused  her  to  be  set 
^t  liberty  in  Dec.  of  the  same  year.     She  returns  to  Paris,  and  once  more  ap- 


CRITICAL     TERMINATIONS     OF     INSANITY.  219 

pears  upon  the  stage  during  the  period  of  the  revolution.  She  then  made 
herself  conspicuous  upon  the  terraces  of  the  Tuileries,  and  on  the  rostrum, 
haranguing  the  people  with  boldness,  in  order  to  bring  them  back  to  modera- 
tion, and  the  Constitution.  This  course  cannot  suit  her  long.  The  Jacobins 
shortly  repair  to  Teroenne,  and  we  immediately  see  her  appear,  a  red  bonnet 
upon  her  head,  a  sword  by  her  side,  and  a  pike  in  her  hand,  commandinor  an 
army  of  women.  She  took  an  active  part  in  the  events  of  September,  1792. 
Although  it  may  not  be  proved  that  she  participated  in  the  massacres,  it  is 
said,  nevertheless,  that  she  entered  the  court  of  the  abbey,  and  with  her  sword 
cut  off  the  head  of  an  unfortunate  man,  whom  they  were  conducting  to  the 
tribunal  of  this  prison.     We  are  assured  that  it  was  a  former  lover. 

When  the  Directory  was  established,  and  popular  associations  ceased,  Te- 
roenne lost  her  reason.  She  was  conducted  to  a  house  in  the  suburb  St. 
Marceau.  They  found  in  the  papers  of  St.  Just,  a  letter  from  her,  dated  July 
26th,  1794,  in  which  signs  of  a  wandering  intellect  are  shown.  In  Nov., 
1800,  she  was  sent  to  the  Salpetriere  and  on  the  following  month  was  trans- 
ferred to  the  Petites-Maisons,  where  she  remained  seven  years.  When  the 
Administration  of  hospitals  caused  the  insane  to  be  removed  from  the  Petites- 
Maisons,  Teroenne  returned  to  the  Salpetriere  Sept.  1807.  She  was  then 
about  forty-seven  years  of  age.  At  the  time  of  her  admission,  she  was  very 
much  agitated,  reviling  and  threatening  every  body,  speaking  only  of  liberty, 
of  committees  of  public  safety,  revolutionary  committees ;  and  accusing  all 
who  approached  her  of  being  moderates  and  royalists.  In  1808,  a  distinguish- 
ed personage,  who  had  figured  as  chief  of  a  party,  visits  the  Salpetriere. 
Teroenne  recognized  him,  and  raised  herself  from  the  bed  of  straw  upon 
which  she  was  lying,  and  overwhelmed  the  visiter  with  abusive  language ; 
accusing  him  of  having  abandoned  the  popular  party,  and  of  being  a  moderate, 
to  whom  a  decree  of  the  committee  of  public  safety  would  soon  do  justice.  In 
1810,  she  becomes  more  composed,  and  falls  into  a  state  of  dementia,  which 
enabled  us  to  observe  traces  of  her  early  prevailing  ideas.  Teroenne  was  un- 
willing to  wear  any  clothing,  even  a  chemise.  Every  day,  both  morning  and 
evening,  and  many  times  a  day,  she  waters  her  bed,  or  rather  the  straw  of  it, 
with  several  buckets  of  water,  lies  down,  and  covers  herself  with  her  sheet 
only,  in  summer,  and  with  both  sheet  and  coverlid,  in  winter.  She  amuses 
herself  in  walking  with  naked  feet,  in  her  cell  flagged  with  stone,  and  inun- 
dated with  water.  Severe  cold  causes  her  to  chano-e  this  regimen  in  no  re- 
spect.  Never  have  they  succeeded  in  inducing  her  to  sleep  in  a  chemise,  nor 
to  employ  a  second  covering.  During  the  last  three  years  of  her  life,  she  was 
provided  with  a  very  large  morning  gown,  which  however,  she  rarely  put  on. 
When  it  froze,  and  she  had  not  water  in  abundance,  she  was  accustomed  to 
break  the  ice,  and  take  the  water  which  she  obtained  from  it  and  wet  her 
body,  particularly  her  feet. 

Although  in  a  small  and  gloomy  cell,  very  damp  and  without  furniture,  she 
enjoys  good  health,  and  pretends  to  be  occupied  with  very  important  matters. 
She  smiles  to  persons  who  accost  her,  and  sometimes  replies  hastily,  /  know 
you  not,  and  conceals  herself  under  her  covering.  It  is  rare  that  she  replies 
correctly.  She  often  says  ;  /  do  not  know  ;  I  have  forgotten.  If  they  insist, 
she  becomes  impatient,  and  talks  to  herself  in  a  low  voice.  She  articulates 
phrases,  interspersed  with  the  words,  fortune,  liberty,  committee,  revolution, 
rascal,  warrant,  decree,  etc.  She  applies  many  of  them  to  the  moderates. 
She  is  angry  and  transported  with  passion,  when  opposed ;  especially  when 
they  desire  to  prevent  her  from  taking  water.  She  once  bit  a  companion  with 
so  much  fury,  as  to  take  out  a  piece  of  flesh.  The  disposition  of  this  woman 
had  therefore  outlived  her  understanding.  She  rarely  leaves  her  cell,  gene- 
rally remaining  there  in  bed.  If  she  goes  out,  it  is  in  a  state  of  nudity,  or 
covered  only  with  her  chemise.     She  takes  but  few  steps,  most  frequently  prp- 


220  CRITICAL     TERMINATIONS     OF     INSANITY. 

ceeding  upon  all  fours,  and  extends  herself  upon  the  ground.  With  a  fixed 
eye,  she  collects  all  the  oftal  she  finds  upon  the  pavement,  and  eats  it.  I  have 
seen  her  devour  straw,  feathers,  dried  leaves,  and  morsels  of  meat  lying  in  the 
dirt.  She  drinks  cistern  water,  whilst  they  wash  the  courts,  although  it  may 
be  dirty,  and  charged  with  filthy  matters ;  preferring  this  drink  to  every  other. 
I  endeavored  to  induce  her  to  write.  She  traced  a  few  words,  but  was  never 
able  to  complete  a  sentence.  She  never  gave  any  indication  of  hysteria. 
Every  sentiment  of  shame  seems  to  be  extinct,  and  she  is  habitually  naked 
without  blushing,  in  the  presence  of  men.  Wishing  to  obtain  her  portrait  in 
181G,  she  willingly  sat  for  it,  but  appeared  to  attach  no  importance  to  the  work 
of  the  painter.  Notwithstanding  the  regimen  to  which  she  subjected  herself 
for  ten  years,  the  menses  were  perfectly  natural.  Her  appetite  was  good,  she 
was  not  sick,  nor  did  she  contract  any  disorder.  Some  days  before  entering 
the  infirmary,  an  eruption  appeared  over  the  whole  body.  She  washed  how- 
ever, as  usual  with  cold  water,  and  lay  upon  her  wet  bed.  The  eruption  dis- 
appeared, and  from  that  period  she  remained  in  bed,  eating  nothing,  but 
drinking  water. 

May  1st,  1817.  Teroenne  enters  the  infirmary,  in  a  state  of  extreme  feeble- 
ness, refusing  all  nourishment,  drinking  water,  remaining  in  bed,  and  often 
talking  with  herself,  but  in  a  very  low  tone.  15th.  Emaciation,  extreme 
paleness  of  the  face,  eyes  glazed  and  fixed,  some  convulsive  movements  of  the 
face,  pulse  very  feeble,  slight  swelling  of  the  hands,  and  oedema  of  the  feet. 
At  length,  on  the  ninth  of  June,  she  dies,  at  the  age  of  fifty-seven  years, 
without  seeming  to  be  restored,  for  a  moment,  to  the  use  of  her  reason. 

Autopsy  at  10  o'clock,  A.  M.  Dara-mater  adherent  to  the  cranium,  which 
is  thick  posteriorly,  and  the  median  line  much  warped.  The  brain  was  very 
soft  and  discolored,  and  the  membrane  which  invests  the  ventricles,  thickened. 
The  subjacent  cerebral  substance,  for  the  thickness  of  a  line,  is  of  a  vitreous 
aspect,  and  a  greyish  white.  The  plexus  choroides  was  discolored,  presenting 
small  serous  cysts.  The  internal  carotid  arteries  which  pass  along  the  caver- 
nous sinuses,  have  acquired  the  diameter  of  a  very  large  quill.  The  pituitary 
gland  contains  a  brownish  fluid.  There  is  serum  in  the  plurae,  as  well  as  in 
the  pericardium.  The  heart  is  flaccid.  The  stomach  is  distended  with  a 
greenish  fluid.  The  transverse  colon  is  precipitated  perpendicularly,  behind 
the  pubes.  The  liver  is  small,  and  greenish  in  color;  its  tissue  very  soft;  and 
its  proper  tunic  detached  with  the  greatest  ease.  The  gall  bladder  is  distend- 
ed with  black,  thick  and  clotted  bile.  The  spleen  is  soft  and  green,  like  the 
liver.  The  bladder  is  very  much  contracted,  and  its  walls  thickened.  The 
envelope  of  the  ovaries  is  thick,  and  even  cartilaginous  at  several  points.  In 
the  case  of  Teroenne,  as  in  those  which  follow,  the  transverse  colon  had 
changed  its  direction,  and  descended  behind  the  pubes. 

Jane,  fifty-eight  years  of  age,  is  admitted  at  the  Salpetriere  Oct.  5th,  1811, 
having  always  enjoyed  good  health.  Her  father  became  insane  after  having 
been  trepanned,  and  one  of  her  daughters  had  thrown  herself  into  the  river 
after  her  confinement.  By  occupation  she  was  a  seamstress,  was  married  at 
the  age  of  twenty-six  years,  and  became  the  mother  of  eight  children.  At 
forty-five  years  of  age,  the  menses  ceased  without  accident.  When  fifty-four 
years  of  age  her  son  enters  the  army.  Sadness,  tears,  melancholy  and  deli- 
rium succeed  this  event.  She  is  several  times  bled,  and  is  cured.  Fifty-eight 
years  of  age.  Suddenly,  and  without  cause,  she  has  a  new  attack  of  delirium, 
attended  with  sadness  and  weeping.  This  happened  May  19th,  1811.  On 
the  2 1st,  they  brought,  her  to  Charenton,  from  whence  at  the  expiration  of  five 
months,  she  is  sent  to  the  Salpetriere.  Fifty-eight  and  a  half  years  of  age. 
At  the  period  of  her  admission  into  the  hospital,  Oct.  5th,  1811,  she  is  extreme- 
ly emaciated,  her  physiognomy  expressive  of  disquietude  and  trouble,  and  her 
skin  dry  and  brown.     She  is  always  ready  to  go  away.     During  the  night  she 


CRITICAL     TERMINATIONS     OF     INSANITY.  221 

leaves  her  bed,  with  a  view  to  take  her  departure.  She  is  constantly  repeat- 
ing ;  my  God,  my  God  !  and  demanding  her  children.  She  prays  us  to  con- 
ceal them,  goes  and  comes,  and  worries  herself — supplicating  and  often  weep- 
ing. She  is  forgetful,  not  knowing  even  how  to  find  her  bed.  She  eats  little  ; 
and  her  dejections  are  frequent,  involuntary,  and  of  a  mucous  character. 
Oct.  26th.  Jane  enters  the  infirmary,  in  consequence  of  her  feebleness  and 
bowel  affection.  Besides,  there  are  the  same  moral  disquietudes  and  agita- 
tion ;  nor  does  the  sight  of  her  relatives  bring  composure.  Insomnia.  Jan. 
1812.  The  feebleness  augments,  the  diarrhoea  persists,  and  the  patient  can 
no  lonorer  leave  her  bed.  Towards  the  end  of  the  month,  the  tongue  becomes 
black,  the  lips  brownish,  and  the  pulse  very  feeble  and  frequent.  All  the  ady- 
namic symptoms  are  clearly  marked.  In  February,  eschars  form  on  both  tro- 
chanters and  the  coccyx,  and  death  takes  place  on  the  11th  of  the  month. 

Autopsy,  the  12th.  Marasmus  ;  cranium  soft  and  injected ;  the  median 
line  dividing  the  brain  into  two  unequal  parts.  Serum  at  the  base  of  the  cra- 
nium ;  cerebellum  soft,  and  cerebrum  dense.  The  arachnoid  is  injected,  and 
the  plexus  choroides  presents  small  serous  cysts.  The  lateral  ventricles  are 
reduced  on  every  side,  with  very  extended  adhesions  at  the  posterior  part. 
The  transverse  colon  has  fallen  almost  perpendicularly  into  the  pelvic  cavity, 
carrying  with  it  a  great  part  of  the  descending  portion.  The  stomach  is  con- 
tracted with  deep  folds,  and  its  mucous  membrane  presents  traces  of  inflam- 
mation. The  intestines  contain  little  else  than  a  greenish  mucus,  with  slight 
traces  of  inflammation.  The  gall-bladder  is  very  much  distended  with  a  fluid, 
yellow  bile,  mingled  with  many  small,  yellow  concretions.  The  spleen  is 
small.     The  muscles  are  pale,  and  easily  torn. 

Barbe,  a  Benedictine  widow,  a  native  of  Martinique,  and  a  negress,  thirty- 
seven  years  of  age,  was  admitted  at  the  hospital  July  14th,  1812,  without  our 
being  able  to  obtain  the  least  information  respecting  her  previous  condition, 
mode  of  life,  or  the  causes  and  duration  of  her  malady.  At  the  period  of  her 
admission,  Barbe  is  emaciated,  her  eyes  are  large,  haggard,  and  sometimes 
threatening.  On  her  arrival,  she  was  placed  in  bed,  was  feeble,  and  her  skin 
dry  and  hot.  She  drank  much,  but  was  unwilling  to  eat,  assuring  us  that 
they  wished  to  poison  her.  She  appeared  to  tremble  with  fear,  so  soon  as 
any  one  approached  her.  Her  look  at  length  became  indirect  and  uneasy. 
She  drove  persons  from  her,  threatened  them,  called  them  villains,  rascals, 
and  poisoners.  She  seemed  to  recognize  in  us  the  objects  of  her  hatred,  her 
fears  and  her  fury.  She  constantly  refused  to  take  any  thing  but  water,  al- 
though she  consented  to  drink  a  little  weak  wine  with  it.  July  29th,  1812. 
Frequent  cough,  especially  at  evening,  oppression  and  fever.  Blisters  to  the 
legs.  Aug.  8th.  Spitting  of  blood  ;  pulse  feeble,  and  a  well  marked  parox- 
ysm :  at  evening  cough.  Barbe  demands  with  temper,  remedies  Avhich  she 
does  not  take.  12th.  Prostration,  and  still  greater  oppression  ;  blisters  do 
not  discharge.  14th.  Diarrhoea,  limbs  swollen.  ICth.  Saliva  greenish,  and 
very  fetid,  dyspnoea.  17th.  Shivering  fits,  and  disappearance  of  the  swell- 
ing.    18th.     Death  took  place  at  six  o'clock  in  the  morning. 

Autopsy  on  the  morning  of  the  19th.  She  is  tall,  emaciated,  and  there  is 
a  general  discoloration  of  the  skin,  which  is  of  a  dull  black  color.  The  cra- 
nium is  very  thick,  and  of  small  size.  The  dura-mater  is  very  thick,  and  ad- 
herent to  the  cranium  ;  vessels  of  the  arachnoid  and  pia-mater  are  injected ; 
the  convolutions  of  the  brain  are  small  and  close.  The  brain  is  soft,  and 
there  is  serum  at  the  base  of  the  cranium,  and  in  the  two  lateral  ventricles. 
Adhesions  of  the  walls  of  the  ventricles  are  very  strong,  posteriorly  ;  there 
are  slight  adhesions  with  the  striated  bodies ;  the  capacity  of  the  ventricles  is 
very  much  diminished,  and  the  vessels  of  the  membrane  that  invests  them  are 
injected.  The  white  substance  is  injected — the  grey  substance  slightly  color- 
ed, and  the  cerebellum  soft.     The  left  pleura  is  adherent  throughout  a  great 


222  CRITICAL     TERMINATIONS     OF     INSANITY. 

portion  of  its  extent,  and  a  mud-like  serum  effused  through  the  rest  of  the  ca- 
vity. The  lung  is  infiltrated  and  in  a  state  of  suppuration,  with  numerous 
tubercles  in  the  same  condition.  The  right  pleura  presents  only  certain  ad- 
hesions, but  the  superior  portion  of  the  lung  is  tuberculous,  with  some  points 
of  suppuration.  There  is  an  abundance  of  serum  in  the  pericardium.  The 
liver  is  soft,  the  gall-bladder  containing  bile.  The  urinary  bladder  is  greatly 
contracted,  and  its  walls  very  thick.  The  uterus  is  voluminous  but  healthy  ; 
and  the  vagina  presents  traces  of  leucorrhcea.  The  mucous  membrane  of  the 
stomach  is  slightly  phlogosed,  and  coated  with  a  greyish  mucus.  The  trans- 
verse colon  is  precipitated  behind  the  pubes. 

Manceau,  a  single  woman  and  a  seamstress.  At  thirty  years  of  age  she  is 
married  and  meets  with  trials,  from  which  mania  and  melancholy  ensue.  Se- 
veral times  in  the  course  of  the  year,  she  suffers  from  nervous  agitation.  At 
thirty-six  years  of  age,  fury  is  almost  continual,  and  provoked  by  the  slightest 
opposition.  At  a  later  period,  she  was  accustomed  to  run  through  the  fields 
with  a  devotional  book  in  her  hand.  She  was  not  mischievous.  Thirty-seven 
years  of  age.  Admitted  into  the  hospital  June  10th,  1806.  She  is  much  ema- 
ciated, very  wild  and  furious.  Her  menses  are  regular,  and  her  eyes  haggard 
and  threatening.  She  remains  habitually  upon  the  bed,  yet  never  using  the 
coverings  of  it.  During  the  warmest  weather,  she  rises  and  remains  seated 
upon  her  heels,  always  in  the  same  place.  She  remains  by  herself,  speaks  to 
no  one,  but  provokes  all  by  her  abuse.  She  is  very  mischievous,  and  strikes 
with  the  intention  of  doing  much  injury.  She  then  becomes  pale,  and  her 
eyes  gleam.  Slie  is  uncontrollable,  and  still  threatens,  though  surrounded  by 
a  great  array  of  force.  She  is  unwilling  to  labor,  but  demands  permission  to 
return  home,  because  she  is  very  rich.  She  is  insolent,  and  prodigal  of  the 
appellations  of  robber,  rascal,  etc.  At  night  she  is  tranquil.  She  is  very 
neat.  She  eats,  but  her  appetite  is  capricious.  Forty-two  years  of  age,  Oct. 
1811.  For  some  months  her  menses  have  been  irregular.  She  is  sick,  but 
refuses  aid.  December.  Very  copious  uterine  hemorrhage.  Since  this  time 
she  often  remarks  that  she  is  sick,  and  falls  into  marasmus,  without  any  dimi- 
nution of  her  fury.  March  6th,  1812.  Fever.  8th.  Involuntary  dejections, 
adynamic  symptoms  and  fever.  9th.  Admitted  into  the  infirmary,  where  it 
was  necessary  to  restrain  her.  Tongue  and  teeth  black,  fever,  involuntary 
dejections,  thirst.  10th.  Respiration  frequent,  prostration.  11th.  Death 
took  place  at  eleven  o'clock  in  the  morning. 

Autopsy,  12th.  Marasmus,  hair  grey.  Skin  brown  and  sunburnt ;  oedema 
of  the  feet,  and  scurvy  spots.  Cranium  irregularly  thickened,  median  line 
turned  to  one  side,  parietal  protuberances  very  much  enlarged,  fosscB  at  the  base 
of  the  cranium,  unequal.  A  mass  of  membraniform  blood,  over  the  whole  in- 
ternal face  of  the  arachnoid.  Falx  reticulated.  Vessels  of  the  external  lami- 
na of  the  pia-mater  injected,  more  particularly  at  the  left.  Serum  between 
the  two  lamina;  of  the  pia-mater.  Serum  at  the  base  of  the  cranium.  Pineal 
gland  presents  osseous  concretions.  The  ventricles  adhere  anteriorly  to  the 
striated  bodies.  Plexuses  discolored.  Grey  substance  discolored.  Cerebel- 
lum very  soft.  Left  lung  hepatized,  presenting  some  tubercles,  two  or  three 
of  which  are  in  a  state  of  suppuration.  Hydropericardium.  Transverse 
colon  depressed  even  to  the  pubes.  The  stomach  contracted ;  its  folds  pre 
senting  traces  of  inflammation,  and  the  mucous  surface  coated  with  a  greyish 
mucus.  Intestines  inflamed  at  various  points,  and  of  a  dark  color.  Matrix 
scirrous. 

Buel  was  twenty-eight  years  of  age  at  the  time  of  her  admission  into  the 
hospital  of  the  Salpetriere,  Dec.  11th,  1808,  in  consequence  of  religious  me- 
lancholy. The  patient  still  menstruated,  but  the  discharge  was  scanty.  This 
woman  had  almost  nightly,  drjluxions  from  the  head,  and  an  habitual  cepha- 
lalgia.    She  ate  little,  and  remained  much  of  the  time  in  bed.     Her  delirium 


CRITICAL     TERMINATIONS     OF     INSANITY.  223 

was  founded  on  religious  notions,  and  she  was  in  the  habit  of  saying  that  she 
was  retained  in  the  house  by  villians.  She  treated  her  companions  with  con- 
tempt, nor  did  she  associate  with  them,  and  lived  aside  and  alone.  When 
thirty-one,  she  no  longer  complained  of  cephalalgia,  nor  did  she  suffer  from 
defluxions ;  but  became  more  feeble,  and  lost  flesh,  although  her  appetite  was 
very  good.  She  often  coughed.  Her  complaints  were  accompanied  with  me- 
naces, cries  and  abuse.  July,  1812.  Thirty-two  years  of  age  ;  defluxion  from 
the  head,  cough,  time  in  bed  prolonged,  extreme  feebleness.  July  14th,  ad- 
mitted into  the  infirmary.  Phthisis,  fever.  Aug.  6th.  Cough,  dyspnoea,  and 
febrile  paroxysms  every  evening.  19th.  Purulent  expectoration,  diarrhoea, 
and  oedema  of  the  feet.  21st.  Cessation  of  the  diarrhoea,  oedema  of  the 
hands  and  feet,  dyspnoea,  delirium.  23d.  Death  at  9  o'clock  in  the  morning. 
24th.  Post-mortem  examination.  She  was  tall,  hair  light,  eyes  blue,  skin 
white;  thoracic  members  emaciated;  abdominal,  infiltrated;  submaxillary 
glands  enlarged.  Cranium  thin  and  hardened,  the  dura-mater  is  adherent  to 
the  cranium,  and  that  portion  which  lines  the  middle  fossae  of  the  base  of  the 
cranium  is  reticulated.  There  is  serum  between  the  pia-mater  and  the  arach- 
noid. The  convolutions  of  the  brain  are  close,  and  of  little  depth.  The 
grey  substance  is  discolored,  and  a  reddish  serum  is  found  in  the  lateral  ventri- 
cles, whose  capacity  is  very  much  diminished,  by  the  adherence  of  their  pos- 
terior walls.  Serum  containing  flocculi,  is  met  with  in  both  pleurae,  which 
adhere  closely  to  the  lungs.  The  latter  present  tubercles,  of  which  some  are 
in  a  state  of  suppuration.  There  is  serum  also,  in  the  pericardium  and  abdo- 
men. The  liver  is  granulated  in  its  aspect,  and  the  gall-bladder  distended 
with  fluid  bile,  of  an  orange  color.  The  alimentary  canal  is  distended  by 
gases,  the  transverse  colon  extending  even  to  the  pubes.  There  are  certain 
reddish  and  even  ulcerated  points  of  the  mucous  membrane  of  the  stomach 
and  intestines ;  the  mesenteric  glands  are  enlarged. 

A  widow  St.  D.  was  thirty-six  years  of  age  when  she  entered  the  Salpetri- 
ere,  Jan.  5th,  1807,  in  consequence  of  melancholy,  with  attempts  to  commit 
suicide.  Having  lost  her  husband  at  the  age  of  twenty-eight  years,  she  griev- 
ed excessively,  and  sunk  into  great  mental  depression.  Though  the  mother 
of  several  children,  she  immediately  became  sad  and  gloomy,  and  a  prey  to 
imaginary  terrors.  Pursued  by  her  fears,  she  threw  herself  from  a  window, 
with  one  of  her  children  in  her  arms.  Though  treated  at  the  Hotel  Dieu, 
and  by  several  physicians,  nothing  could  compose  her  terrified  imagination. 
At  the  age  of  thirty-six  years,  when  admitted  into  the  hospital,  she  was  very 
much  emaciated,  remained  much  in  bed,  menstruated  regularly,  ate  much, 
accused  herself  of  divers  crimes,  and  wished  to  be  crucified.  She  made  seve- 
ral attempts  to  destroy  herself  We  soon  perceived,  that  she  had  given  herself 
up  to  the  practice  of  masturbation.  Every  winter,  she  suffered  from  very  se- 
vere catarrhal  affections,  for  which  she  passed  several  months  in  the  infirmary. 
Thirty-nine  years  of  age.  She  appeared  to  be  relieved  of  her  religious  terror, 
and  spoke  of  holy  things  without  dread.  There  was  more  connection  in  her 
reasonings,  but  her  disposition  became  insupportable.  She  complained  of, 
and  was  dissatisfied  with  every  thing,  accusing  the  persons  who  served  her, 
with  negligence  or  unkind  treatment.  She  abused  every  one,  vexed  her  asso- 
ciates, and  gave  them  bad  advice.  Forty  years.  During  the  winter  the  men- 
ses cease.  Since  that  period,  she  has  had  a  continual  couorh,  and  has  sensibly 
grown  worse.  She  frequently  suffers  also,  from  a  diarrhoea.  Forty-one  years 
of  age.  Oct.,  1811,  enters  the  infirmary.  There  is  emaciation,  cough,  ex- 
pectoration, fever,  and  capriciousness  with  respect  to  her  mode  of  living, 
feebleness  and  night  sweats.  This  woman  is  not  irrational,  but  sad,  taciturn, 
and  very  irritable.  Jan.  5th,  1812.  Serous  and  fetid  diarrhoea,  purulent  ex- 
pectoration, a  very  painful  cough,  and  oedema  of  the  feet.  15th.  Extreme 
feebleness,  and  alteration  of  the  features  of  the  face  :  paroxysms  every  evening. 


224  CRITICAL     TERMINATION S     OF     INSANITY. 

18th.  Incapable  of  taking  solid  aliment,  the  vital  forces  are  sustained  with  a 
little  broth  and  wine.  Expectoration  and  alvine  dejections  very  abundant  and 
fetid.  24th.  Cessation  of  the  diarrhoea,  suppression  of  the  expectoration  and 
dyspnoea.  At  evening  she  feels  that  her  last  hour  is  approaching,  wishes  her 
waiting  maid  good  nicrht,  and  dies.  25th.  Post-mortem  examination.  Hair 
black,  emaciation,  cranium  thin  and  hardened ;  the  median  line  dividing  the 
head  into  two  unequal  parts.  Meninges  very  much  injected,  serum  between 
the  pia-mater  and  arachnoid  membrane ;  a  reddish  serum  at  the  base  of  the 
cranium,  as  well  as  in  the  lateral  ventricles,  whose  walls  adhere  posteriorly. 
The  lungs  adhere  to  the  costal  pleurae,  and  contain  tubercles,  of  which  a  great 
portion  are  in  a  state  of  suppuration.  The  mesenteric  glands  are  enlarged, 
and  several  of  them  are  reduced  to  a  puriform  substance.  The  transverse 
colon  extends  towards  the  pubes.  The  liver  is  soft  and  fat,  and  the  gall  blad- 
der contains  very  brown  bile.  The  spleen  adheres  to  the  diaphragm.  There 
are  several  ulcerated   points  upon  the  mucous  membrane  of  the  intestines. 

M.,  forty-three  years  of  age,  of  an  athletic  figure,  and  sanguine  tempera- 
ment, had  yielded  himself,  from  his  earliest  youth,  to  the  control  of  an  unbri- 
dled ambition.  He  had  held  trusts  of  great  importance ;  but  for  sonietinie, 
had  filled  a  station  of  but  secondary  consequence.  This  disappointment  ren- 
dered him  sad,  without  lessening  his  pretensions.  His  disposition  changed, 
and  he  became  choleric  and  difficult  in  his  intercourse  with  societv.  He  com- 
mitted errors  of  conduct,  the  publicity  of  which  exposed  him.  He  became 
irritated  at  the  counsels  of  his  relatives  and  friends,  until,  at  length,  his  con- 
duct was  that  of  a  maniac,  although  there  was  no  wildness  in  his  conversation. 
The  moment  they  manifest  a  desire  to  oppose  this  conduct,  he  becomes  furi- 
ous, and  dangerous  to  all  who  approach  him,  even  to  his  family.  He  was 
committed  to  my  care.  He  is  tall,  his  face  flushed,  eyes  injected  and  shining. 
He  is  also  loquacious,  utters  cries,  menaces  those  about  him,  and  uses  abusive 
language.  He  calls  himself  a  king,  and  requires  the  attentions  due  to  royalty  ; 
treating  with  disdain  all  those  whom  he  meets.  These  wild  pretensions  be- 
came every  instant  the  cause  of  new  irritations,  opposition  and  outbreaks  of 
fury.  He  suffers  from  insomnia,  thirst,  and  constipation.  It  is  easy  to  per- 
ceive, that  at  times,  the  patient  with  difficulty  utters  articulate  sounds.  Leeches 
to  the  anus  and  temples  renewed ;  acidulated  drinks ;  prolonged  tepid  baths. 
After  two  months  we  employ  douches  of  cold  water  to  the  head,  while  the 
body  of  the  patient  is  immersed  in  tepid  water.  Composure  is  gradually  es- 
tablished. He  has  lucid  intervals  ;  but  the  conviction  that  he  is  a  great  per- 
sonage ever  remains.  At  the  expiration  of  five  months,  the  patient  becomes 
fleshy,  and  the  paralysis  of  the  tongue  more  apparent.  He  is  perfectly  calm  ; 
his  appetite  and  sleep  are  excellent,  but  his  notions  of  grandeur  persist.  The 
patient  gradually  becomes  exceedingly  fleshy.  He  walks  with  difficulty;  and 
it  is  with  no  little  inconvenience  that  he  makes  himself  understood.  His  me- 
mory is  enfeebled,  especially  that  for  things  present.  We  apply  at  first,  a 
large  blister  to  the  neck ;  then  a  seton.  Valerian,  bark  and  drastics  are  em- 
ployed alternately.  At  the  expiration  of  fifteen  months'  illness,  a  frightful 
attack  of  apoplexy  terminates  the  existence  of  the  patient.  The  cellular  tissue 
is  surcharged  with  fat.  The  integuments  of  the  head  are  very  much  injected, 
as  well  as  the  membranes  of  the  brain,  which  is  dense.  The  liver  is  fatty, 
and  voluminous.  The  intestines  are  distended  with  gases ;  trichurides  are 
found  in  the  coecum.  The  transverse  colon  having  become  perpendicular, 
is  concealed  behind  the  pubes  by  its  splenic  extremity. 

The  facts  related  above,  present  a  pathological  phenomenon,  which  has  not 
yet  been  particularly  referred  to.  Both  the  ancients  and  moderns  who  have 
treated  of  mental  alienation,  and  particularly  of  melancholy,  have  all  spoken 
of  lesions  of  the  abdominal  viscera ;  but  no  one,  of  the  displacement  of  the 
transverse  colon.     However,  we  often  find  this  intestine  displaced,  in  our  post- 


LYPEMANIA  OR  MELANCHOLY.  225 

mortem  examinations  of  the  insane.  Its  direction  is  now  oblique,  now  per- 
pendicular, so  that  its  left  extremity  is  brought  behind  the  pubes.  Sometimes 
the  transverse  colon  descends  in  the  form  of  an  arc,  below  the  pubes,  and 
within  the  pelvic  cavity.  This  displacement  cannot  depend  upon  a  mechani- 
cal action,  resulting  from  a  thickening  of  the  walls  of  the  colon,  or  from  the 
accumulation  of  matters  within  it ;  for  in  the  greater  number  of  subjects  that 
I  have  examined,  the  colon  was  empty,  and  all  the  membranes  composing  it, 
healthy.  The  same  is  true  of  the  ascending  and  descending  portions  of  the 
colon,  which  by  their  traction  might  draw  down  the  transverse  portion.  This 
displacement  is  not  the  effect  of  the  last  and  fatal  disease  of  the  patient ;  for 
this  phenomenon  is  observed  among  individuals  who  have  fallen  victims  to 
different  maladies.  The  insane,  and  particularly  melancholies,  among  whom 
we  observe  this  displacement  of  the  transverse  colon,  often  complain  of  epi- 
gastric pains.  They  remark,  that  they  experience  a  pain  similar  to  that  which 
a  band  would  produce,  girded  about  the  hypochondria.  The  dejections  are 
generally  morbid.  Do  not  these  symptoms  furnish  an  explanation  of  the  dis- 
placement of  the  colon  ?  Had  not  the  ancients  by  giving  hellebore,  and  the 
moderns,  in  prescribing  emetics  and  drastics  in  the  treatment  of  mental  alien- 
ation, and  especially  in  melancholy,  both  by  means  of  evacuants,  had  for  their 
object,  to  restore  the  tone  of  all  the  abdominal  viscera  ?  Are  not  laxatives 
regarded  as  injurious,  because  they  augment  the  relaxation  1  and  are  we  not 
always  exceedingly  careful  to  combine  them  with  tonics  ?  Do  not  sea-voyao-es 
in  fine,  and  exercise  on  horseback,  so  useful  in  melancholy,  produce  their  be- 
neficial effect  by  strengthening  the  abdominal  viscera  ? 

The  knowledge  of  these  facts  has  appeared  to  me  interesting;  1st,  because 
displacement  of  the  colon  is  frequent  among  the  insane,  particularly  melan- 
cholies ;  2d,  because  this  information  may  render  more  sure  and  rational, 
the  treatment  of  some  cases  of  disease.  The  post-mortem  examination  of 
one  hundred  and  sixty-eight  lypemaniacs,  has  revealed  the  following  lesions. 
It  proves  that  a  great  many  melancholies  succumb  to  phthisis  pulmonalis  ;  and 
that  alterations  of  the  abdominal  viscera  are  also  very  frequent ;  whilst  orga- 
nic changes  of  the  brain  are  rare ;  for  we  should  not  attribute  melancholy  to 
the  effusions  which  we  observe  in  the  sinuses  and  meninges  of  the  brain. 
We  say  the  same  with  respect  to  the  osseous  concretions,  so  frequent  in  the 
conarium,  (pineal  gland). 

Table  of  Pathological  Lesions  found  in  the  bodies  of  Lypemaniacs. 

Thickening  of  the  meninges  .  .  .2 

Organic  lesions  of  the  brain  ...  4 

Cranium.  <(  Points  of  ossification  adhering  to  the  falx        .  .       3 

I  Sanguine  effusions  into  the  sinuses  or  substance  of  the 

(^      brain     ......  5 

C  Organic  lesions  of  the  lungs  .  .  .65 

T%orax. -^  Lesions  of  the  heart  .  .  .  .11 

(^  Serum  in  the  cavities  of  the  chest       .  .  ,6 

^  Colon  displaced                  ....  33 

Adhesion,  and  suppuration  of  the  peritoneum  .       5 

Ulceration  of  the  stomach  or  pylorus         .              .  6 

"              "       intestines  or  rectum              .  .       7 

Abdomen,  -l  Intestinal  worms                 ....  5 

Tenia              .              .             ,             .              .  ,1 

Organic  lesions  of  the  liver           ...  2 

Biliary  concretions      .             .            ..             .  .7 

Ulceration  of  the  uterus                 ...  6 


Total 168 

29 


226  LYPEMANIA  OR  MELANCHOLY. 

In  comparing  the  maladies  which  terminate  the  lives  of  lypemaniacs,  with 
those  by  which  the  existence  of  those  suffering  from  other  forms  of  mental 
alienation  is  brought  to  a  close ;  by  comparing  also  the  results  of  cadaveric 
examinations  of  melancholies,  with  those  which  we  observe  in  the  cadavera 
of  those  who  have  been  affected  by  other  forms  of  insanity  ;  one  is  struck 
with  the  predominance  of  pulmonary  maladies  among  melancholies,  as  well 
as  with  the  frequency  of  the  abdominal  changes.  Lypemaniacs  however,  like 
other  insane  persons,  rarely  fall  victims  to  acute  maladies,  but  in  general,  to 
diseases  of  a  chronic  character. 


TREATMENT  OF  LYPEMANIA. 

The  treatment  of  melancholy  with  delirium,  like  that  of  other  forms  of 
mental  alienation,  ouaht  not  to  be  limited  to  the  administration  of  certain 
medicines.  We  must,  before  commencing  the  use  of  medicine,  be  thorough- 
ly convinced,  that  this  is  a  malady  obstinate  and  difficult  to  cure  ;  and  that 
moral  medicine,  which  seeks  in  the  heart  for  the  cause  of  the  evil,  which 
sympathizes  and  weeps,  which  consoles,  and  divides  with  the  unfortunate 
their  sufferings,  and  which  revives  hope  in  their  breast,  is  often  preferable  to 
all  other.  We  must  be  well  informed  of  the  remote  and  proximate  causes  of 
the  disease,  and  its  treatment  may  be  either  hygienic,  moral  or  pharmaceutic. 
Hippocrates  and  the  ancients,  the  Arabians  and  the  moderns,  have  all  observ- 
ed, that  the  state  of  the  atmosphere  exercises  a  remarkable  influence  over  the 
intellectual  and  moral  faculties  of  man.  A  dry  and  temperate  climate,  a  clear 
sky,  a  pleasant  temperature,  an  agreeable  situation  with  varied  scenery,  are 
well  adapted  to  melancholies.  English  physicians  are  careful  to  send  their 
melancholic  patients  into  the  southern  provinces  of  France  and  Italy,  thus 
protecting  them  against  the  moist  and  oppressive  air  of  England. 

M.,  a  native  of  Belgium,  forty-two  years  of  age,  of  a  strong  constitution, 
and  transacting  a  very  large  business,  consults  me  at  the  close  of  the  winter 
of  1825.  Observe  the  account  which  is  given  me  by  him.  "  I  have  always 
enjoyed  good  health,  am  happy  in  my  family, — having  an  affectionate  wife 
and  charming  children.  My  affairs  are  also  in  excellent  condition.  Three 
years  since,  I  experienced  a  trifling  vexation.  It  was  at  the  beginning  of 
autumn,  and  I  became  sad,  gloomy  and  susceptible.  By  degrees  I  neglected 
my  business,  and  deserted  my  house  to  avoid  my  uneasiness.  I  felt  feeble, 
and  drank  beer  and  liquors.  Soon  I  became  irritable.  Every  thing  opposed 
my  wishes,  disturbed  me,  and  rendered  me  insupportable,  and  even  dangerous 
to  my  family.  My  affairs  suffered  from  this  state.  I  suffered  also  from  in- 
somnia and  inappetence.  Neither  the  advice  nor  tender  counsels  of  my  wife, 
nor  that  of  my  family,  had  any  more  influence  over  me.  At  length,  I  fell  into 
a  profound  apathy,  incapable  of  every  thing,  except  drinking  and  grieving. 
At  the  approach  of  spring  I  felt  my  affections  revive.  I  recovered  all  my  in- 
tellectual activity,  and  all  my  ardor  for  business.  I  was  very  well  all  the  en- 
suing summer,  but  from  the  commencement  of  the  damp  and  cold  weather  of 
autumn,  there  was  a  return  of  sadness,  uneasiness,  and  a  desire  to  drink,  to 
dissipate  my  sadness.  There  was  also  a  return  of  irascibility  and  transports 
of  passion.  During  the  last  autumn  and  present  winter,  I  have  experienced 
for  the  third  time  the  same  phenomena,  which  have  been  more  grievous  than 
formerly.  My  fortune  has  suffered,  and  my  wife  has  not  been  free  from  dan- 
ger. I  have  now  come  to  submit  myself  to  you,  sir,  and  to  obey  your  direc- 
tions in  every  thing." 

After  many  questions,  I  offered  the  following  advice.  A  hospital  will  not 
benefit,  but  on  the  contrary,  injure  you.  I  will  refer  you  to  a  physician  who, 
during  the  whole  summer  will  watch  over  your  regimen,  and  accompany  you 
in  your  excursions  to  the  environs  of  Paris.  You  should  bathe  often,  and 
from  time  to  time,  drink  of  the  Sedlitz  water.     Your  food  should  be  of  a  ve- 


LYPEMANIA     OK     MELANCHOLY.  227 

getable  character.  In  the  month  of  September,  you  should  go  to  Languedoc, 
and  must  be  in  Italy  before  the  close  of  October,  from  whence  you  must  not 
return  until  the  month  of  May.  This  counsel  was  closely  followed.  At  the 
close  of  December  he  was  at  Rome.  He  felt  the  impression  of  the  cold,  and 
the  beginnings  of  a  desire  to  drink  were  manifest,  but  shortly  disappeared. 
He  escaped  a  fourth  attack,  by  withdrawing  himself  from  the  coldness  and 
moisture  of  autumn.  He  returns  to  Paris  in  the  month  of  May,  in  the  enjoy- 
ment of  excellent  health.     I  could  relate  many  similar  facts. 

The  clothing  should  be  warm,  and  often  changed,  particularly  the  stock- 
inors ;  melancholies  being  particularly  subject  to  cold  feet.  They  ought  to 
proscribe  salted,  spiced,  irritating  and  fatty  articles  of  food,  and  all  others 
that  are  difficult  of  digestion.  Fresh  meats,  roasted,  and  chosen  from  among 
those  of  young  animals,  together  with  vegetable  food,  are  adapted  to  this  class 
of  patients.  They  should  abstain  from  farinaceous  vegetables,  giving  the  pre- 
ference to  herbaceous  legumina  and  fruits,  especially  those  that  contain  in 
the  greatest  abundance,  a  mucilaginous  and  saccharine  principle.  Such  are 
the  red  fruits  of  summer,  grapes,  oranges,  pomegranates,  etc.  Fernel,  Van- 
Swieten  and  Lorry,  cite  examples  of  melancholies,  who  were  cured  by  the 
use  of  the  fruits  of  summer  ;  they  might  have  added,  by  the  very  abundant 
use  of  the  grape.  Exercise,  in  whatever  manner  it  may  be  taken,  is,  without 
contradiction,  one  of  our  great  resources,  in  combating  lypemania.  Tra- 
veling, which  acts  upon  the  brain  by  the  impressions  which  it  produces,  caus- 
ino-  as  it  were,  a  multitude  of  ideas  and  images,  which  are  constantly  renew- 
ed, to  pass  through  the  mind  ;  necessarily  destroys  that  fixedness  of  the 
thoughts  and  concentration  of  the  attention,  which  are  so  trying.  Patients 
who  cannot  travel,  ought  to  take  exercise,  and  seek  for  diversions  by  excur- 
sions on  foot  and  by  carriage-rides,  by  corporeal  exercises,  by  the  cultivation 
of  the  earth,  by  taking  charge  of  a  garden,  by  family  occupations  and  the 
practice  of  some  profession.  Equitation  excites  the  activity  of  the  abdominal 
viscera ;  favors  transpiration  ;  reposes  and  diverts  the  attention.  We  some- 
times obtain  happy  results  from  setting  patients  to  carriage-driving.  The 
Englishman  struggles  against  the  spleen,  by  taking  the  place  of  the  coachman, 
and  driving  through  the  streets  of  London.  The  celebrated  Alfieri  rendered 
his  deep  melancholy  supportable,  by  this  means.  The  chase  may  be  made  to 
fulfil  the  same  indications  ;  but  we  should  be  cautious  how  we  entrust  arms 
to  those  who  entertain  any  disposition  to  commit  suicide.  Pinel  expresses  the 
wish  that  all  hospitals  for  the  insane  should  have  connected  with  them  a  farm, 
on  which  the  inmates  may  labor.  Doctor  Langermann  had  almost  effected 
this  purpose  at  the  hospital  of  Bareuth,  of  which  he  was  physician.* 

Dr.  Horn  has  provided  the  insane  of  the  hospital  of  Berlin,  with  all  the 
means  of  exercise,  compatible  with  their  security,  and  he  derives  from  it 
great  advantages.  At  the  Salpetriere,  a  good  number  of  our  insane  women 
occupy  themselves  in  sewing,  knitting,  and  other  manual  exercises.  Some 
engage  in  the  cultivation  of  the  garden,  and  many  are  occupied  in  the  service 
of  the  hospital.  These  active  occupations  contribute  to  the  number  of  cures 
obtained  at  this  House.  It  is  not  so  easy  to  furnish  men  with  the  implements 
of  labor,  because  they  may  abuse  them.  Individuals  who  are  not  accustomed 
to  any  occupation,  when  there  are  insuperable  difficulties  in  the  way  of  their 
traveling,  riding  on  horseback,  or  by  carriage,  ought  to  exercise  themselves  at 
games,  which  repose  the  mind  and  fatigue  the  body.  Such  are  the  shuttle- 
cock, tennis,  the  foot-ball,  billiards,  etc.  But,  to  exercises  of  the  body,  we 
should  join  those  of  the  mind.     Study  contributes  to  the  cure  of  melancho- 

*  For  more  than  thirty  years,  we  advised  labor,  and  labor  upon  the  soil  particularly. 
At  this  day,  the  precept  is  every  where  invoked,  and  put  in  practice  in  Germany,  Eng- 
land and  France. 


228  LyPE  MANIA  OR  MELANCHOLY. 

lies,  provided  that  they  do  not  apply  themselves  io  objects  calculated  to  exalt 
the  imagination.  Sometimes  also,  we  favor  melancholy  ideas,  by  what  we 
hope  may  cure. 

M.  Charpentier,  in  his  excellent  thesis  on  melancholy,  tells  us  that  an  eccle- 
siastic, who  had  become  melancholic,  with  a  disposition  to  suicide,  in  conse- 
quence of  the  misfortunes  of  the  revolution,  was  relieved  of  this  condition, 
by  means  of  his  active  efforts  in  defending  the  concordat,  which  was  favora- 
ble to  the  independence  of  the  clergy.  A  man  persuades  himself  that  his 
enemies  have  stripped  him  of  his  whole  fortune.  He  becomes  sad,  morose, 
and  refuses  to  eat,  because  he  has  nothing  wherewith  to  purchase  food.  He 
is  sent  to  Paris.  After  the  lapse  of  several  months,  I  advise  one  of  his  friends 
to  feign  a  suit,  and  persuade  the  patient  to  consult  an  advocate.  The  latter, 
understanding  our  object,  demands  a  written  memorial,  in  order  the  better  to 
understand  the  situation  of  his  client's  aftairs.  After  hesitating  for  some  days, 
he  commences  a  long  account,  which  requires  many  excursions,  and  even  short 
journeys.  A  month  had  scarcely  elapsed,  and  even  before  the  memorial  was 
completed,  when  it  became  evident  that  the  disease  began  to  improve,  the 
cure  of  which  was  speedily  accomplished.     Alibert  relates  an  analogous  case. 

Isolation  is  ordinarily  favorable,  even  when  it  is  absolute.  Solitude  exer- 
cises a  mysterious  power,  which  reestablishes  the  moral  forces  that  have  been 
exhausted  by  the  passions.  Tepid  baths  prolonged,  are  of  evident  benefit,  in 
reestablishing  the  transpiration;  and  all  physicians,  from  the  time  of  Galen  to 
our  own  day,  have  boasted  of  their  utility,  and  diligently  recommended  their 
use.  The  excretions  seem  to  be  almost  altogether  suspended  in  lypemania ; 
transpiration  no  longer  takes  place ;  and  the  urine  is  retained  sometimes  for 
one,  two,  and  even  five  days.  Constipation  is  obstinate,  and  persists  for  weeks 
and  months.  Forestus  speaks  of  an  old  man,  who  was  for  three  months  with- 
out an  alvine  evacuation.  Such  a  degree  of  constipation  is  not  always  free 
from  dancrer,  as  it  sometimes  occasions  intestinal  inflammation.  We  must  over- 
come  it,  by  means  of  the  quality  of  the  aliments  and  drinks  ;  by  the  use  of  ene- 
mata,  fomentations  to  the  abdomen,  hip  baths,  etc.  Although  continence  may, 
in  rare  instances,  be  a  cause  of  melancholy  ;  it  is  not  less  true,  that  in  some  cir- 
cumstances, the  spermatic  evacuation  has  effected  its  cure.  It  may  be  how- 
ever, that  the  moral  impression  has  been  more  favorable  than  the  evacuation 
itself  It  is  not  easy  to  establish  the  degree  of  influence  which,  in  this  act, 
belongs,  respectively,  to  the  physical  and  moral  impression.  Aetius  has 
spoken  too  strongly  of  the  advantages  of  coition,  which  he  prescribes  as  a 
specific.  I  can  oppose  many  contrary  facts,  to  the  few  rare  examples  that  are 
offered  in  favor  of  this  view. 

In  examining  the  various  hygienic  means  of  relief,  I  have  pointed  out  most 
of  the  important  rules  that  are  to  be  observed  in  the  treatment  of  melancholy. 
It  remains  for  me  to  speak  of  the  employment  of  the  passions,  in  the  cure  of 
this  class  of  cases.  Nothing  is  more  difficult  than  to  control  the  passions  of 
man  in  health.  How  greatly  augmented  is  the  difficulty,  when  we  wish  to 
direct  those  of  the  insane !  A  certain  address  is  necessary,  and  great  skill  in 
seizing  upon  the  infinitely  diversified  shades,  which  the  application  of  the 
moral  treatment  presents,  and  to  determine  upon  a  fitting  opportunity  for  this 
application.  Now,  we  must  oppose,  and  conquer  the  most  obstinate  resolu- 
tions, inspiring  the  patient  with  a  passion,  stronger  than  that  which  controls 
his  reason,  by  substituting  a  real  for  an  imaginary  fear ;  now,  secure  his  con- 
fidence, and  raise  his  fallen  courage  by  awaking  hope  in  his  breast.  Each 
melancholic  should  be  treated  on  principles  resulting  from  a  thorough  acquain- 
tance with  the  tendency  of  his  mind,  his  character  and  habits,  in  order  to 
subjugate  the  passion  which,  controlling  his  thoughts,  maintains  his  delirium. 
Melancholies  who  are  under  the  dominion  of  superstition,  ought  to  avoid  read- 
ing and  conversation  on  subjects  veiled  in  mystery.     It  is  rare  that  we  can 


LTPEMANIA  OR  MELANCHOLY. 


229 


swerve  with  impunity  from  this  precept.  It  ia  generally,  after  having  read 
books  calculated  to  exalt  the  imagination,  after  having  given  up  the  mind  to 
exaggerated  religious  practices,  and  listened  to  sermons  which  lead  astray  the 
religious  sentiment,  that  the  delirium  of  melancholy  assumes  its  most  fatal 
character.  The  cures  that  are  reported,  and  attributed  to  religious  influence, 
need  proof  I  have  made  many  attempts  to  establish  their  correctness.  I 
have  called  to  my  aid  many  and  very  respectable  ecclesiastics,  but  rarely  with 
success.  A  man  is  in  despair  in  consequence  of  not  having  obtained  a  cer- 
tain place,  and  considers  both  himself  and  family  dishonored.  Religious  in- 
fluences might  effect  a  cure  in  this  case,  by  producing  a  diversion  in  the 
prevailing  ideas,  and  impressing  him  with  a  sense  of  the  vanity  of  earthly 
things.  A  demonomaniac  however,  does  not  regard  the  advice  of  an  ecclesi- 
astic. I  have  seen  insane  persons,  who  were  far  from  religion  before  their 
sickness,  become,  after  their  cure,  sincere  believers,  fulfilling,  with  great  re- 
gularity, the  duties  of  religion.  They  were  convalescent,  when  they  openly 
embraced  a  religious  life.  One  of  these  individuals,  a  man  of  great  worth, 
and  who  for  a  long  time  discharged  important  public  duties,  was  brought  to 
entertain  a  religious  belief,  to  which  he  had  before  been  a  stranger,  by  the  re- 
eollection  of  what  he  had  experienced  during  his  delirium.  When  love  is  the 
prevailing  passion,  it  is  often  the  case  that  nothing  less  than  the  object  be- 
loved will  eflfect  a  cure;  amore  medico  sanatur  amor,  (Ovid).  Every  one  is 
acquainted  with  the  cure  wrought  by  Erasistratus,  who  restored  the  son  of 
Seleucus,  by  inducing  this  prince  to  sacrifice  to  his  son,  his  love  for  Strato- 
nice.  Areteus  speaks  of  one  Crotoniatus  who  was  cured,  only  by  the  posses- 
sion of  the  object  beloved.  If  there  are  insurmountable  obstacles  to  this 
mode  of  relief,  some  physicians  have  not  feared  to  recommend  the  counsel 
of  Ovid.  A  sudden,  strong,  and  unexpected  emotion,  a  surprise,  fear  and  ter- 
ror, have  sometimes  been  successful.  Spasmo  spasmus  solvitur,  says  Lorry. 
Means,  more  or  less  ingenious,  have  been  devised  to  remove  convictions,  and 
to  break  the  chain  of  strange  ideas.  A  thousand  circumstances  may  furnish 
the  physician,  or  bring  to  mind  indications  for  intellectual  and  moral  therapeu- 
tics. The  following  facts  may  furnish  useful  hints.  We  find  them  in  every 
collection  of  cases,  and  in  various  parts  of  this  work.  Alexander  of  Tralles, 
cures  a  woman  who  thinks  she  has  swallowed  a  serpent,  by  throwing  one  into 
a  vessel  in  which  she  was  vomiting.  Zacutus  tells  us,  that  a  young  man  who 
believed  that  he  was  damned,  was  cured,  by  introducing  into  his  apartment,  a 
man  disguised  so  as  to  represent  an  angel,  who  announced  to  him  the  pardon 
of  his  sins.  Ambrose  Pare  cures  a  patient  who  thought  he  had  frogs  in  his 
abdomen,  by  purging  him,  and  putting  frogs,  by  stealth,  into  his  night  vessel. 
A  demonomaniac  refuses  every  kind  of  nourishment,  because  he  thinks  him- 
self dead.  Forestus  succeeds  in  inducing  him  to  eat,  by  presenting  to  him 
another  dead  man,  who  assured  him  that  people  of  the  other  world  eat  very 
well.  Alexander  of  Tralles  informs  us,  that  Philotinus  undeceived  a  man 
who  thought  he  had  no  head,  by  causing  him  to  wear  a  bonnet  of  lead,  whose 
weight  finally  informed  him  of  his  error.  A  melancholic  believes  that  he  can 
never  again  urinate,  without  subjecting  the  world  to  the  risk  of  a  new  deluge. 
They  inform  him  that  a  fire  threatens  the  destruction  of  the  city,  and  that 
unless  he  consents  to  urinate,  all  is  lost.  He  decides  to  comply  with  their 
request,  and  is  cured. 

A  young  man  is  unwilling  to  eat,  because  his  friends  and  relatives  will  be 
dishonored  thereby.  One  of  his  friends  arrives,  all  out  of  breath,  and  brings 
a  declaration  of  the  government,  which  frees  him  from  all  dishonor.  The 
patient,  who  had  passed  thirteen  days  without  food,  on  receiving  this  intima- 
tion, eats  immediately.  Pinel  relates,  that  while  physician  at  the  Bicetre,  he 
made  up  a  mock, court,  which  tried  a  melancholic,  who  thought  himself  guilty. 
This  stratagem  succeeded,  but  its  success  was  short,  in  consequence  of  the 


230  LYPEMANIA  OR  MELANCHOLY. 

imprudence  of  one  of  those  who  were  in  the  secret,  who  informed  the  man 
that  we  had  made  sport  of  him.  The  same  author  relates  in  his  Treatise  on 
Mania,  many  examples  of  monomaniacs,  whose  imaginary  fears  and  obstinate 
repugnances  had  yielded  to  a  real  fear,  caused  by  the  appearance  of  a  great 
degree  of  constraint.  Pain  has  also  triumphed  over  the  obstinacy  of  some 
patients. 

A  lady  was  committed  to  my  care,  who  thought  that  she  was  damned,  and 
had  the  devil  in  her,  and  was  cured,  through  fear  of  cold  baths,  which  she 
dreaded  beyond  measure,  and  with  which  she  was  threatened,  every  time  that 
she  abandoned  herself  to  her  peculiar  notions  and  chimerical  fears.  We  suc- 
ceed also,  by  persuading  lypemaniacs  that  they  have  no  possibility  of  accom- 
plishing their  design.  Thus,  a  young  person,  who  had  been  disappointed  in 
a  love  affair,  having,  for  seventeen  days,  refused  to  take  food,  in  order  to  ter- 
minate her  existence,  was  restored  to  health,  after  being  obliged  to  take  food 
by  means  of  the  tube,  and  had  become  satisfied,  that  in  spite  of  all  her 
efforts,  they  could  nourish  her,  and  prevent  her  dying  of  hunger. 

I  have  seen  the  substitution  of  one  passion  for  another  cure  lypemania,  by 
addressing  itself  to  the  self-love  of  the  individual,  arousingf  and  exaltinor  it. 
I  have  silenced  imaginary  terrors  thereby,  and  have  seen  love  take  the  place 
of  delirium  depending  on  melancholy,  in  the  case  of  two  or  three  young  lype- 
maniacs of  the  Salpetriere.  We  should  be  cautious  in  the  employment  of 
fear,  and  especially  terror;  as  these  passions  produce  a  sedative  action,  which 
may  occasion  the  gravest  consequences.  The  effects  of  music,  to  which  the 
ancients  have  attributed  so  many  miracles,  is  more  beneficial  in  melancholy 
than  in  other  forms  of  mental  alienation.  Galen  assures  us,  that  ^sculapius 
was  accustomed  to  cure  diseases  of  the  mind,  by  songs  and  harmony.  We 
read  in  the  history  of  music,  and  in  the  writings  of  physicians,  examples  of 
cures  effected  by  this  means.  In  order  to  render  it  efficacious,  we  must  em- 
ploy a  small  number  of  instruments,  and  select  airs  adapted  to  the  condition 
of  the  patient.  The  treatment  which  applies  itself  directly  to  the  organic 
sensibility,  and  which  we  call  physical  treatment,  when  it  is  seconded  by  hy- 
giene, and  is  not  directed  by  empiricism,  but  by  systematic  views,  certainly 
contributes  to  the  cure  of  lypemania  :  for  if  this  malady  is  often  produced  by 
the  moral  affections,  it  is  also,  by  physical  derangements.  It  is  the  result  of 
observation,  that  all  forms  of  mental  alienation,  and  melancholy  in  particular, 
offer  the  best  chance  of  cure,  when  the  physician  can  perceive  some  disorder 
in  the  functions  of  assimilative  life. 

Let  us  suppose  the  nature  of  the  pathological  causes  which  have  produced 
melancholy,  to  be  fully  understood ;  our  therapeutic  views  will  be  directed  in 
accordance  with  this  information.  If  there  be  suppression  of  the  menses,  or 
hemorrhoids,  we  must  reestablish  these  evacuations;  if  the  retrocession  of 
herpes,  we  act  upon  the  skin,  etc.  It  would  be  superfluous  to  enter  into  de- 
tails, as  physicians  are  aware  that  they  often  have  to  do  with  melancholy  de- 
pending upon  similar  causes.  It  is  not  always  easy  to  go  back  to  causes  so 
evident ;  and  lypemania  is  treated  conformably  to  the  theories  and  systems 
that  have  prevailed,  at  different  epochs  of  medicine.  The  ancients,  regarding 
this  malady  as  produced  by  bile,  black  bile,  or  a  corroding  humor,  employed 
evacuants,  especially  purgatives.  Hellebore  was  the  remedy  preferred  to  all 
others,  in  melancholy,  and  its  use  has  passed  into  a  proverb.  That  of  Anty- 
cira  was  preferred  to  any  other.  Celsus  recommends  the  white  hellebore  in 
gay  or  cheerful  monomania,  while  he  prescribes  the  black  in  lypemania,  or 
melancholy  with  sadness.  Some  moderns  have  desired  to  return  to  the  use  of 
hellebore.  They  propose  to  purge  with  it:  but  we  do  not  want  for  other  me- 
dicines, better  known,  more  sure  and  less  dangerous ;  for  practitioners  who 
extol  extravagantly  the  use  of  this  root,  by  no  means  accord  to  it  a  specific 
virtue.     Pinel  confines  himself  to  gentle  laxatives,  or  mild  purgatives.     The 


LYPEMANIA  OR  MELANCHOLY.  23 1 

chicoria,  and  saponaceous  plants,  combined  with  certain  neutral  salts,  are 
sufficient  to  obviate  constipation,  whether  it  announces  an  attack  or  paroxysm, 
or  complicates  the  melancholy.  At  the  commencement  of  lypemania,  emetics 
and  emeto-cathartics  are  very  useful.  We  find  it  well  also,  to  maintain  an 
artificial  diarrhoea,  when  the  strength  will  permit  it,  thus  imitating  nature  in 
one  of  her  means  of  cure.  Enemata,  more  or  less  irritating,  also  produce 
some  benefit.  Evacuants  are  adapted  chiefly  to  that  form  of  melancholy 
which  is  characterized  by  supineness,  an  aversion  to  action,  and  torpor  of  the 
functions. 

We  administer  the  Tartrate  of  Antimony  and  Potassa,  in  small  and  repeat- 
ed doses,  either  for  the  purpose  of  relieving  irritation,  or  to  act  upon  the  ima- 
gination of  patients  who  think  themselves  well.  The  gastric  or  intestinal 
pains  which  they  experience,  attract  their  attention,  persuade  them  that  they 
are  sick,  and  determine  them  to  employ  suitable  remedies.  With  some  me- 
lancholies who  refuse  every  kind  of  medicine,  we  employ  energetic  substances 
in  a  small  volume,  and  cause  them  to  be  taken  without  the  knowledge  of  the 
patient,  mingled  with  his  food  or  drinks.  Such  are  gamboge,  scammony, 
jalap,  aloes,  calomel,  etc.  Darwin  has  lately  added  to  our  list  of  remedial 
agents,  a  machine,  which  he  denominates  a  rotatory  machine,  the  effect  of 
which  is  to  produce  abundant  evacuations,  both  by  the  mouth  and  bowels. 
Some  English  physicians,  among  whom  are  Mason  Cox,  and  Haslam,  boast 
greatly  of  the  happy  effects  produced  by  this  machine,  of  which  I  first  caused 
a  model  to  be  made  in  France.  Some  physicians  have  feared  lest  the  use  of 
it  might  be  more  injurious  than  useful.  It  provokes  epistaxis,  occasions  fears 
of  apoplexy,  prostrates  the  patient  exceedingly,  produces  syncope,  and  exposes 
to  other  accidents,  more  or  less  alarming  in  their  character,  which  have  caus- 
ed it  to  be  rejected. 

Pursuing  the  atrabile  into  the  circulation,  the  humorists  deduce  from  blood- 
letting a  general  precept  against  melancholy.  Areteus  alone  among  the  an- 
cients, expressly  defends  it  in  the  major  part  of  cases.  He  permits  it  how- 
ever, only  among  young  subjects,  in  the  spring,  and  in  small  quantities.  Cul- 
len  says,  that  blood-letting  is  rarely  useful.  Pinel  employs  it  very  little.  Ne- 
vertheless, we  may  have  recourse  to  local  sanguine  evacuations  ;  now  at  the 
epigastrium,  when  the  stomach  is  the  seat  of  an  active  irritation  ;  now,  to  the 
vulva,  when  we  wish  to  reestablish  the  menstrual  flux ;  or  to  the  anus,  when 
we  desire  to  renew  a  hemorrhoidal  discharge  ;  and  finally  to  the  head,  when 
there  are  signs  of  cerebral  congestion.  I  have  sometimes  applied  leeches 
with  success  to  the  side  of  the  head,  when  lypemaniacs  complained  of  a  fixed 
pain  in  the  part.  Lypemania  does  not  always  present  itself  in  connection 
with  symptoms,  which  indicate  a  predominance  of  the  abdominal  system,  or 
turgescence  of  the  sanguine  system.  Sometimes  the  nervous  system  appears 
to  be  alone  the  cause  of  all  the  difficulty  ;  and  Lorry  first  correctly  viewed 
and  admirably  described  the  character  of  this  form  of  melancholy,  which  he 
most  clearly  distinguishes  from  that  depending  upon  physical  causes.  In  this 
form  of  melancholy,  vulgarly  called  nervous,  but  by  Lorry,  melancholy  not 
depending  upon  a  physical  agency,  evacuants  augment  the  evil.  The  physi- 
cian should  endeavor  to  modify  the  .sensibility,  and  to  calm  the  nervous  ex- 
citement by  hygienic  measures  already  indicated  ;  by  soothing  drinks,  by  nar- 
cotics, by  opium,  by  the  use  of  water  in  vapor,  in  douches,  by  baths  and  affu- 
sions. The  tepid  bath  is  more  or  less  prolonged,  sometimes  for  several  hours. 
The  bath,  by  immersion  in  cold  water,  is  useful  when  melancholy  depends 
upon  onanism.  Affusions  of  cold  water,  by  determining  a  nervous  reaction 
to  the  surface,  causes  the  internal  spasm  to  cease,  and  brings  about  a  happy 
termination  of  the  malady.  The  douche  acts  in  a  similar  manner,  besides 
that,  in  the  hands  of  an  experienced  physician,  it  may  have  a  moral  influence 
over  the  patient,  and  oblige  him  to  renounce  resolutions,  both  dangerous  and 


232  LYPEMANIA     OR     MELANCHOLY. 

fatal.  Some  physicians,  and  particularly  Teden  and  Leroi  d'Anvers,  have 
recommended  the  internal  use  of  very  large  doses  of  cold  water.  They  re- 
gard it  as  an  almost  infallible  remedy  against  the  disposition  to  suicide. 
The  ancients  made  a  very  free  use  of  narcotics.  Lazare  Riviere  boasts  of  the 
good  effects  of  opiates.  Odier*  states,  that  he  cured  a  case  of  melancholy  by 
the  use  of  opium,  gradually  carried  to  the  extent  of  thirty  grains,  and  com- 
bined with  an  equal  quantity  of  musk.  We  should  not  employ  this  article 
among  plethoric  individuals,  or  those  disposed  to  sanguine  congestions. 
Some  enthusiasts  have  employed  magnetism  in  the  treatment  of  melancholy  ; 
and  what  have  they  obtained  1  Results  slightly  advantageous,  if  not  altogether 
doubtful.  I  have  also  made  experiments  with  it,  but  have  not  obtained  a  sin- 
gle cure. 

After  having  rapidly  unfolded  the  general  considerations,  which  the  study 
of  lypemania,  or  melancholy  with  delirium  presents,  we  ought  to  indicate  the 
varied  forms  which  the  delirium  of  melancholy  assumes  ;  but  who  could  point 
out  all  these  varieties  ?  Are  they  not  as  numerous  as  the  modifications  that 
the  sensibility  can  experience  1  Do  they  not  borrow  their  characters  from 
some  one  or  other  passion,  unduly  excited  by  the  imagination  ?  Although  the 
cause  of  the  disease  remains  always  the  same,  the  features  which  characterize 
each  case  of  the  affection,  change  and  diversify  themselves  to  infinity.  I  shall 
speak  of  a  very  small  number  of  varieties  only,  which  give  rise  to  considera- 
tions of  the  hiofhest  interest. 


o 


[The  treatment  of  tliis  form  of  mental  disease  recommended  by  our  author,  will  be 
found  to  correspond  for  the  most  part  with  that  pursued  by  the  profession  in  this  coun 
try,,  and  is  quite  at  variance  with  the  expectant  plan,  so  popular  with  French  practition 
ers  The  hygienic  course  which  he  advocates,  is  proved,  both  by  examples  given  by  him- 
self, as  well  as  by  a  sufficient  amo.unt  of  evidence  elsewhere  furnished,  to  be  of  incalcu- 
lable value  to  the  lypemaniac.  In  his  remarks  on  "  Moral  Influences,"  we  regard  his 
veiws  as  particularly  happy.  In  his  graphic  description  of  the  mental  condition  of  this 
unfortunate  class,  he  touchingly  appeals  in  their  behalf,  to  that  sympathy  and  forbear- 
ance in  our  intercourse  with  them,  which  under  all  circumstances  of  affliction  are  so 
welcome,  and  the  more,  when  a  diseased  and  debilitated  frame,  is  coupled  with  the  de- 
pressing emotions.  No  apprehensions  are  more  real,  no  fears  more  intense,  no  belief 
more  honest,  no  convictions  more  strong,  than  those  which  torture  the  victim  of  melan- 
choly. Ilis  imaginary  notions,  are  to  him  awful  realities  ;  and  I  am  safe  in  saying  that 
no  other  form  of  suftering  can  for  a  moment  compare  with  this.  Would  all  the  morti- 
fication and  regrets  incident  to  ruinous  reverses,  induce  the  tender  mother  to  raise  the 
weapon  of  death  over  the  head  of  her  innocent  offspring.''  Would  she  not  rather  bless 
God  that  this  precious  treasure  was  still  spared  to  her  .■'  Yet  the  perverted  maternal 
sentiment,  leads  but  too  frequently  to  the  commission  of  acts,  which  the  mind  shudders 
to  contemplate.  Now  the  early  symptoms  of  the  malady  which  result  in  a  catastrophe 
60  deplorable,  are  known  by  the  common  name  of  "hypo,"  and  are  regarded  as  an  in- 
firmity which  the  unhappy  suflierer  may  at  any  time  sliake  off.  Hence  that  indifference, 
the  cold  look,  and  not  unfrequently,  the  harsh  and  unfeeling  expression,  which  aug- 
ment the  agony  which  he  now  endures.  From  the  first,  the  tenderest  sympathy,  those 
hygienic  influences  and  medicinal  agents,  which  are  best  adapted  to  restore  the  exhaust- 
ed energies,  and  overcome  disordered  organic  functions,  are  demanded  ;  and  if  we  fail 
in  giving  to  each  and  every  one  of  them  its  full  measure  of  influence  at  an  early  day, 
we  may  see  our  unhappy  friends  doomed  to  a  life  of  suff'ering  which  no  pen  can  describe. 
The  table  which  furnishes  an  account  of  the  pathological  lesions,  found  after  death  in 
one  hundred  and  sixty-eight  cases,  is  probably  the  most  valuable  of  any,  in  this  depart- 

*  British  Library,  Geneva,  1816. 


LYPEMANIA  OR  MELANCHOLY.  233 

nient  on  record;  both  as  furnishing  a  more  satisfactory  statement  of  the  pathology  of 
lypemania  than  any  other,  and  as  a  consequence,  the  most  appropriate  mode  of  treat- 
ment. The  number  of  post-mortem  examinations  made  in  the  hospitals  for  the  treat- 
ment of  insanity  in  this  country,  are  very  few,  and  of  this  number  fewer  still  are  ever 
published.  The  cause  is  evident,  and  is  not  likely  very  soon  to  be  obviated  ;  a  circum- 
stance which  gives  additional  interest  and  value  to  the  table  referred  to.  With  respect 
to  the  medical  treatment,  it  may  be  proper  to  remark,  that  drastic  purgatives  are  very 
rarely  requisite,  and  general  blood-letting  still  less  so ;  while  to  obviate  local  conges- 
tions, topical  depletion  may  sometimes  be  proper.] 


30 


DEMONOMANIA. 


Origin,  history  and  signification  of  term. — Origin  of  religious  melancholy. — Stellar  and 
lunar  influence. — Influence  of  the  doctrine  of  the  Platonists  on  mental  alienation. — 
Origin  of  conjurations,  sorcery,  magic,  witchcraft  and  astrology. — Influence  of  Chris- 
tianity on  the  form  and  treatment  of  insanity. — The  eflTect  of  the  reformation  of  Lu- 
ther and  Calvin. — Mode  of  dissipating  the  errors  which  led  to  this  form  of  insanity. — 
Analysis  of  symptoms  of  this  malady,  compared  with  those  that  attend  other  forms  of 
melancholy. — Case. — Post-mortem  examination.- — Cases. — Sometimes  epidemic. — Ex- 
amples.— Demoniacal  possession  rarely  occurs  before  puberty. — Women  more  subject 
to  this  disease  than  men. — Causes,  physical  and  moral. — Its  access  generally  sudden. 
— Demonomaniacs  usually  emaciated,  etc. — Exhale  a  strong  odor. — Ecstasies  common, 
and  modified  by  various  circumstances. — Demonomaniacs  suffer  from  hallucinations 
and  illusions. — Case. — Tenacious  of  their  delusions. — Examples. — Tests  of  demonia- 
cal possession. — Death  often  hailed  with  joy  by  the  possessed. — Convulsions  not  un- 
common.— Important  conclusions. — Suicide  much  to  be  feared  in  this  form  of  insanity. 
— Of  all  insane  persons,  lypemaniacs  are  the  most  cruel. — Treatment. — Medical. — 
Moral. — Zoanthropy. — Lycanthropy. — Fatalists,  or  believers  in  destiny. — Several 
strange  views  referred  to. — Examples,  with  a  post-mortem  examination. 

The  word  demon  among  the  ancients,  was  not  understood  in  a  bad  sense. 
It  signified  the  Divinity,  a  tutelary  Genius,  a  guardian  Spirit ;  dulftoviov^  is 
derived  from  dul/non'^  sapiens,  sciens.  Plato  assigned  this  name  to  that  Spirit 
with  whom  the  Supreme  Being  intrusted  the  government  of  the  world.  The 
Jews,  after  the  Chaldeans,  attributed  almost  all  diseases  to  the  agency  of 
spirits  or  demons.  Saul  is  troubled  by  an  evil  spirit ;  Job  is  the  sport  of  a 
demon.  The  dysentery  which  smote  Joram,  was  referred  to  the  same  cause. 
Nebuchadonosor  is  seized  with  lycanthropy  by  the  command  of  God.  Is  it 
astonishing  that  hysteria,  epilepsy  and  melancholy  are  called  sacred?  The 
Greeks  also,  charged  the  spirits  with  being  the  cause  of  the  major  part  of 
their  diseases.  Herodotus  affirms,  that  Cleomenes  did  not  become  furious 
in  consequence  of  the  presence  of  demons,  but  because  he  was  intoxicated 
with  the  Scythians.  Aristophanes  denominates  the  most  intense  degree  of 
fury,  not  /navlu^  but  xuxodul/iovlu.  By  preserving  the  primitive  signification 
of  this  word,  we  should  have  given  the  name  of  demonoraania  to  religious 
melancholy.  The  first  variety  of  this  form  of  insanity  would  have  designated 
that  class  of  the  insane,  who  believe  that  they  are  God,  who  imagine  that  they 
have  conversations  and  intimate  communications  with  the  Holy  Spirit,  angels 
and  saints,  and  who  pretend  to  be  inspired,  and  to  have  received  a  commission 
from  heaven  to  convert  men.  This  species  would  have  been  denominated 
theomania ;  while  the  second  would  have  been  called  cacodcmonomania,  and 


236  DEMONOMANIA. 

would  have  embraced  all  those  unfortunate  beings  who  fancied  that  they  were 
possessed  by  the  devil,  and  in  his  power ;  who  were  convinced  that  they  had 
been  present  at  the  imaginary  assemblies  of  evil  spirits,  or  who  feared  damna- 
tion, and  the  misery  of  eternal  fire.  This  classification  would  present,  in  a 
single  variety,  all  those  forms  of  delirium  which  have  reference  to  religious 
beliefs.  It  would  place  in  opposition  all  the  varieties  of  religious  melancholy  ; 
while  the  religious,  gay  and  bold  forms  of  delirium,  attended  with  pride  and 
exaltation  of  the  faculties,  would  be,  so  to  speak,  placed  in  comparison  with 
the  sad  and  timid  forms,  attended  by  despondency  and  terror.  But  the  word 
demonomania  is  appropriated;  and  the  public  would  charge  me  with  neolo- 
gism, were  I  to  restore  it  to  its  etymological  signification. 

Man,  dependent  by  his  organization  upon  external  influences,  and  passing 
alternately  from  well-being  to  sorrow,  from  pain  to  pleasure,  and  from  fear  to 
hope,  was  naturally  led  to  reflect  upon  the  nature  and  relations  of  good  and 
evil.  He  soon  admitted  the  existence  of  a  good  being,  and  a  malevolent  spirit, 
which  presided  over  his  good  or  ill  fortune.  A  step  more  only,  and  a  system 
of  theology  was  formed.  Religion  was  now,  gentle  and  full  of  consolation ; 
now,  she  assumed  a  severe  and  threatening  tone.  But  sorrow  having  pervad- 
ed almost  the  entire  existence  of  man,  and  pain  being  more  extensively  pre- 
valent in  the  world,  ideas  of  a  depressing  character  predominated.  From  sad- 
ness, to  fear  and  terror,  there  was  but  a  step.  These  sentiments  inspired  in 
the  earliest  period  of  the  world,  a  sort  of  religious  melancholy,  depending 
upon  those  fearful  terrors  that  had  their  origin  with  the  birth  of  the  world. 
Religious  melancholy  was,  therefore,  of  all  forms  of  mental  alienation,  the 
most  general  and  extended.  The  sacred  books  of  every  people  present  ex- 
amples of  it.  When  man,  abandoning  the  worship  of  the  true  God,  fell  into 
idolatry,  the  first  objects  of  his  adoration  were  the  stars.  (Newton,  chronol.) 
These  most  strongly  impressed  his  senses,  and  exercised  over  him  the  most 
active  and  long-continued  influence.  Religious  melancholy  was  regarded  as 
dependent  upon  the  course  of  the  stars,  and  its  periodicity  strengthened  this 
belief  The  insane  were  called  maniacs,  a  word  derived  from  «'/»''?,  luna, 
lune,  from  which  the  Greeks  made  maniacs,  moon-struck,  and  the  Latins  luna- 
tics ;  an  appellation  which  is  still  maintained  in  England,  and  also  in  France, 
in  the  language  of  common  life.  When  the  doctrine  of  spirits,  taught  by  the 
Platonists,  at  length  complicates  their  theological  notions,  nervous  maladies, 
and  particularly  mental  alienation,  being  sacred  diseases,  were  attributed  to 
the  agency  of  spirits  and  demons.  Among  the  insane,  some  were  gay,  bold  and 
rash,  regarding  themselves  as  inspired.  They  believed  themselves  fortunate, 
and  the  friends  of  the  gods ;  and  presented  themselves,  or  were  presented  to 
the  people,  as  those  sent  from  heaven.  They  also  uttered  oracles  on  their 
own,  and  on  account  of  the  priests.  Others,  on  the  contrary,  sad,  timid,  pu- 
sillanimous, fearful,  and  pursued  by  imaginary  terrors,  pronounced  themselves 
condemned  forever.  They  were  treated  as  objects  of  celestial  wrath,  and  re- 
garded themselves  as  devoted  to  the  powers  of  hell.  Meleager,  CEdipus  and 
Orestes,  and  many  other  illustrious  subjects  of  divine  wrath,  were  pursued  by 
furies.     These  were  true  lypemaniacs. 

Disquietude,  fear  or  fright,  modified  or  changed  the  nature  of  all.  They 
deemed  it  necessary  to  deliver  themselves  from  some  extraordinary  evil,  or  to 
turn  aside  the  vengeance  of  the  gods.  They  desired  also  to  read  in  the  future, 
what  they  were  to  fear  or  to  hope  for.  They  evoked  the  souls  of  the  dead, 
after  having  consulted  the  oracles  and  stars.  The  followers  of  Orpheus  gave 
birth  to  the  science  of  conjurations,  sorcery,  and  many  other  mysterious  prac- 
tices. Magic  and  witchcraft  formed  a  part  of  their  religious  worship.  Sove- 
reigns, legislators  and  philosophers,  were  initiated  into  the  mysteries  ;  some, 
to  extend  the  sphere  of  their  knowledge,  and  others,  from  motives  as  shameful 
as  criminal.     Astrology,  magic  and  witchcraft,  all  children  of  fear,  so  enchain- 


DEMONOMANIA.  237 

ed  the  imagination  of  men,  that  we  need  not  be  astonished,  says  Pliny,  that 
their  influence  lasts  so  long,  and  has  extended  to  all  ages,  regions  and  people. 
Christianity,  by  recalling  religious  views  to  the  unity  of  God,  by  causing  ora- 
cles to  cease,  and  by  enlightening  men,  rendered  sacred  the  opinions  of  Plato 
and  Socrates,  respecting  the  existence  of  demons,  and  wrought  a  great  revo- 
lution in  the  sentiments  of  men.  They  exaggerated  the  power  of  spirits  over 
matter,  and  the  fear  of  yielding  to  the  instigations  of  the  devil,  created  dread. 
They  believed  that  from  the  commencement  of  this  life,  they  were  in  the 
power  of  demons,  and  the  number  of  demonomaniacs  multiplied.  This,  the 
institution  of  exorcisms  in  the  primitive  church  establishes.  They  had  re- 
course to  ceremonies  and  prayers  to  deliver  the  possessed,  but  did  not  burn 
them.  They  established,  in  several  cities,  solemn  feasts  for  the  cure  of  the 
possessed.  They  were  accustomed  to  assemble  in  a  church  all  the  insane  of 
a  country,  whither  they  came  from  the  most  remote  regions.  The  concourse 
of  people,  assembled  from  every  quarter,  the  presence  of  the  bishop,  the  pomp 
and  solemn  display,  the  confidence  which  took  possession  of  the  sick,  and 
every  thing  that  could  control  their  imagination,  contributed  to  the  cure  of 
some  of  these  unfortunate  beings.  They  proclaim  it  a  miracle,  and  this  per- 
suasion prepared  new  cures  for  succeeding  years.  These  solemnities,  which, 
in  some  cities  of  France  were  still  celebrated  so  late  as  the  middle  of  the  last 
century,  must  not  be  confounded  with  what  they  called  the  feast  of  mod-peo- 
ple, a  strange  saturnal,  which  took  place  in  certain  chapters,  during  the  four- 
teenth and  fifteenth  centuries. 

When  the  impetuous  Luther,  on  pretext  of  removing  abuses,  attempted  to 
revolutionize  the  church  in  order  to  avenge  his  quarrels,  religious  discussions 
became  the  subject  of  all  conversations,  of  all  sermons,  and  even  of  all  poli- 
tical reports.  The  diverse  parties,  reciprocally  menaced  each  other  with  eter- 
nal damnation.  Fanaticism  was  aroused,  and  religious  melancholy  added  to 
all  those  ills  that  innovations  had  provoked.  Calvin  augmented  them  still 
more.  We  see  none  but  the  excommunicated,  the  condemned  and  wizards. 
The  public  were  alarmed,  created  tribunals,  the  devil  was  summoned  to  ap- 
pear, the  possessed  were  brought  to  judgment.  They  erected  scaffolds,  and 
kindled  funeral  piles.  Demonomaniacs,  under  the  name  of  sorcerers  and 
possessed,  victims  in  a  double  sense  of  the  prevailing  errors,  were  burnt,  after 
having  been  put  to  the  torture  in  order  to  induce  them  to  renounce  their  pre- 
tended compact  with  the  devil.  In  these  unhappy  times,  such  was  the  mania 
for  attributing  every  thing  to  the  agency  of  the  devil,  that  Pierre  de  I'Ancre, 
not  being  able  to  comprehend  how  a  rock,  situated  near  a  village  of  Asia, 
called  Arpasa,  of  which  Pliny  speaks,  and  which,  like  the  rock  of  Cydobre 
among  the  Albigenses,  moves  when  one  touches  it  with  the  end  of  the  finger, 
while  the  most  powerful  efforts  failed  in  producing  this  result,  attributes  this 
phenomenon  to  the  power  of  a  demon.  G.  E.  Stahl*  relates  cases  of  grave 
maladies,  which  were  reorarded  as  the  work  of  the  devil. 

Were  this  the  place  for  it,  I  could  prove  that  the  insane  had  been  employed 
to  utter  oracles,  and  that  the  priests  knew  how  to  inspire  themselves  with  a 
holy  delirium.  I  shall  show  farther  on,  that  demoniacal  possession  is  a  true 
monomania.  Demons  became  mute  from  the  time  that  Christianity  shed  its 
benign  influences  abroad  over  the  worldt.  They  ceased  to  plague  men,  so 
soon  as  men  ceased  to  fear.  They  no  sooner  ceased  to  burn  sorcerers  and 
magicians,  than  the  imagination  became  composed,  and  no  longer  gave  birth 
to  either  of  them.  Many  now  fear  the  police,  as  they  would  formerly  have 
done  the  stars  and  demons.  This  fear  is  so  much  the  more  intense  and  fatal, 
as  the  police  acquires  more  influence  in  times  of  trouble  and  civil  dissensions  j 

*  Collegium  causale  sic  dictum  minus.     Swidnita,  1734,  in  4to. 
t  Fontenelle,  History  of  Oracles,  in  12mo. 


238  DEMONOMANIA. 

and  we  shall  no  longer  be  surprised,  if  in  hospitals  for  the  insane,  demonoma- 
niacs  are  replaced  by  a  class  which  fears  the  police,  prison  and  punishment. 
It  is  ever  the  weakness  of  the  human  mind,  pusillanimity,  disquietude  and 
fear,  which  acts  upon  these  unfortunate  beings,  producing  such  results  as  were 
formerly  regarded  as  demoniacal  possession.  That  man  is  now  in  a  mad- 
house, because  he  fears  the  police,  who  would  formerly  have  been  burnt  be- 
cause he  feared  the  devil. 

Physicians,  and  some  men  of  superior  wisdom,  have,  in  all  times,  combat- 
ted  the  prejudices  which  caused  the  true  sources  of  nervous  maladies  and 
mental  alienation  to  be  overlooked.  Hippocrates  or  his  disciples,  in  the  trea- 
tise "  On  the  Sacred  Disease,"  assures  us,  that  there  can  be  no  maladies 
caused  by  the  gods.  Areteus  expresses  the  same  sentiment.  De  causis  morb. 
diut,  lib.  I.  The  report  of  Marescot,  Riolan  and  Duret,  respecting  the  pos- 
session of  Martha  Brossier,  is  a  model  of  sound  reason  and  wisdom.  They 
reduce  their  opinion  to  these  memorable  terms  :  nihil  a  demons;  multa  Jicta, 
a  morho  pauca.  "  Nothing  from  the  devil ;  many  things  feigned  :  few  things 
from  disease."  Cardan,  Corneille  Looz,  Joseph  Duchene,  Bekker,  Pigray, 
Bayle,  Naude  and  Mead,  defended  these  unfortunate  beings  against  both  the 
prejudiced  and  the  Del-Rios,  Bodins,  Pierre  de  I'Ancres,  etc.  Malebranche, 
whose  opinion  should  not  be  suspected,  speaks  with  a  noble  boldness.*  Par- 
liaments, under  the  presidency  of  Seguier,  annulled  many  decrees,  which  con- 
demned to  the  flames  both  sorcerers  and  the  possessed.  All  have  read  that 
beautiful  passage  of  Aguesseau,  where  this  celebrated  magistrate  says  to  par- 
liament, that  in  order  to  cause  sorcery  to  cease,  all  that  is  necessary  is,  no 
longer  to  speak  of  sorcerers,  and  to  attribute  no  kind  of  importance  to  the 
matter,  but  to  commit,  without  noise,  to  the  physicians,  the  wizards,  who  were 
"  more  sinned  against,  than  sinning."  Both  sorcerers  and  the  possessed 
were,  in  fact,  often  the  victims  of  impostors,  who  made  traffic  of  the  igno- 
rance and  superstition  of  their  fellow  creatures.  They  were  imbeciles,  me- 
lancholies and  hysterical  persons,  who  were  believed  to  be  possessed,  because 
they  had  been  threatened  with  demons  and  wizards ;  and  judges  doomed  these 
unhappy  beings  to  the  flames.  A  jurisprudence  existed,  having  reference  to 
sorcery  and  magic,  as  laws  were  enacted  against  robbery  and  murder.  The 
people,  seeing  both  Church  and  prince  believe  in  the  reality  of  these  extra- 
vagances, remained  invincibly  persuaded.  The  more  they  pursued  sorcerers 
and  the  possessed,  and  the  more  ceremony  attended  their  punishment,  the 
more  was  the  number  of  these  persons  augmented,  by  exciting  the  imagina- 
tion, and  occupying  it  with  chimerical  fears.  A  better  education  and  the  pro- 
gress of  knowledge,  have  gradually  dissipated  these  fatal  errors,  more  success- 
fully than  funeral  piles,  or  legal  code  and  digest. 

Though  demonomania  may  be  unusual  at  this  day,  it  will  not  be  uninterest- 
ing to  point  out  and  determine  its  characters.  If  the  possessed  no  longer 
exist,  there  are  still  some  monomaniacs  who  consider  themselves  in  the  power 
of  the  devil.  I  have  collected  certain  facts  respecting  demonomania,  and  have 
compared  them  with  what  demonographers  have  related.  Their  resemblance 
has  satisfied  me  that  the  symptoms  that  I  observed  are  the  same,  with  the  signs 
of  possession  pointed  out  by  authors,  or  contained  in  the  accounts  of  the 
trials  of  sorcerers  and  those  possessed.  After  having  given  a  brief  history 
of  demonomania,  we  will  pass  on  to  an  analysis  and  comparison  of  the  symp- 
toms of  this  malady,  with  those  that  attend  other  forms  of  melancholy. 

A.  D.,  a  servant  woman  forty-six  years  of  age,  was  of  medium  size,  had 
chestnut  colored  hair,  small  hazel  eyes,  a  dark  complexion,  and  an  ordinary 
degree  of  fulness  of  habit.  Endowed  with  great  susceptibility,  she  has  much 
self-esteem,   and  was  religiously  educated.     Fourteen  years  of   age.     Fir.st 

"  Researches  Concerning  Truth;  Paris,  1762,  4  vol.  in  12mo. 


DEMONOMANIA.  239 

menstruation,  and  since  that  period  the  menses  have  been  scanty  and  irregular. 
Thirty  years.  She  becomes  attached  to  a  young  man,  whom  they  will  not 
permit  to  marry  her.  She  becomes  sad  and  melancholic,  believing  herself 
abandoned  by  every  body.  The  menses  cease,  not  to  appear  again.  She  en- 
gages with  extreme  ardor  in  devotional  exercises,  makes  a  vow  of  chastity, 
and  devotes  herself  to  Jesus  Christ.  Sometime  after  this,  she  fails  in  her  pro- 
mises, and  remorse  seizes  upon  her.  She  regards  herself  as  condemned,  given 
over  to  the  evil  one,  and  suffers  the  torments  of  hell.  Six  years  she  passes  in 
this  state  of  delirium  and  torments ;  after  which,  exercise,  dissipation  and  the 
influence  of  time,  restore  her  to  reason  and  her  ordinary  occupations.  Forty 
years  of  age.  Forsaken  by  a  new  lover,  D.  renews  her  vows  of  chastity,  and 
passes  her  time  in  prayer.  One  day,  while  on  her  knees  reading  the  imita- 
tion of  Jesus  Christ,  a  young  man  enters  her  chamber,  says  that  he  is  Jesus 
Christ,  that  he  has  come  to  console  her,  and  that  if  she  will  but  trust  in  him, 
she  will  have  no  longer  occasion  to  fear  the  devil.  She  yields.  For  the  se- 
cond time  she  considers  herself  in  the  power  of  the  devil,  and  experiences  all 
the  torments  of  hell  and  despair.  Sent  to  the  Salpetriere,  she  spends  most  of 
her  time  in  bed,  groaning  night  and  day,  eating  little,  continually  complaining, 
and  relating  her  misfortunes  to  all.  Forty-six  years  of  age,  March  16th, 
1813.  This  woman  is  transferred  to  the  infirmary  for  the  insane.  Her  ema- 
ciation is  extreme,  skin  earthy,  face  pale  and  convulsive,  the  eyes  dull  and 
fixed ;  the  breath  fetid,  the  tongue  dry,  rough,  and  interspersed  with  whitish 
points.  She  refuses  nourishment,  although  she  says  that  she  is  tormented  by 
liunger  and  thirst.  There  is  insomnia,  together  with  a  small  and  feeble  pulse, 
head  heavy,  with  a  burning  sensation  internally,  and  a  feeling  as  if  bound 
with  a  cord  externally.  There  is  a  painful  constriction  of  the  throat,  and  she 
is  constantly  rolling  up  the  skin  of  her  neck  with  her  fingers,  and  crowding  it 
behind  the  sternum ;  assuring  us  that  the  devil  draws  it,  and  that  he  strangles 
and  prevents  her  from  swallowing  any  thing.  There  is  considerable  tension 
of  the  muscles  of  the  abdomen,  attended  by  constipation ;  and  upon  the  back 
of  the  right  hand  and  left  foot,  are  scrofulous  tumors.  The  devil  has  extend- 
ed a  cord  from  the  sternum  to  the  pubes,  which  prevents  the  patient  from 
standing  up.  He  is  in  her  body,  burning  and  pinching  it.  He  also  gnaws 
her  heart,  and  rends  her  entrails.  She  is  surrounded  by  flames,  and  in  the 
midst  of  the  fires  of  hell,  though  we  see  them  not.  No  one  may  credit  it,  but 
her  ills  are  unprecedented,  frightful,  eternal.  She  is  damned.  Heaven  can 
have  no  compassion  upon  her. 

April,  1813,  diminution  of  the  vital  forces.  The  patient  sees  no  one  who 
approaches  her.  Day  appears  to  her  a  light,  in  the  midst  of  which  wander 
spectres  and  demons,  which  reproach  her  for  her  conduct,  threaten  and  mal- 
treat her.  She  refuses  all  consolation,  and  becomes  irritated  if  we  persist  in 
offering  it.  The  assistance  of  the  ministers  of  religion  is  useless,  and  the 
aid  of  medicine  rejected.  This  malady  being  never  seen,  men  can  do  no- 
thing; a  supernatural  power  is  necessary.  She  curses  the  devil,  who  burns 
and  tortures  her,  and  God,  who  has  cast  her  into  hell.  May  1813;  marasmus, 
abdominal  members  retracted  upon  the  abdomen ;  decline  of  the  vital  forces, 
though  the  patient  often  says  that  she  can  never  die.  May  25th;  tongue 
brown,  burning  heat,  difficult  respiration,  thirst,  pulse  small  and  contracted. 
May  30th  :  feet  swollen,  chills  at  irregular  intervals,  though  she  has  at  the  same 
time  sensations  of  heat.  Mournful  groans.  June  6th.  A  serous  diarrhoea, 
feet  swollen  at  times,  the  cheeks  very  much  flushed,  the  tongue  black,  the 
skin  earthy,  pulse  very  small  and  frequent.  June  15th :  prostration,  eschar 
over  the  coccyx,  delirium  the  same.  June  21st :  aphonia,  respiration  fre- 
quent, pulse  scarcely  perceptible ;  the  same  groans,  the  same  delirium,  and 
conviction  that  she  should  not  die.  June  22d.  Death  took  place  at  seven 
o'clock  in  the  evening ;  for  two  days  previous  to  this  event,  she  could  execute 
no  movement,  and  swallowed  nothing. 


240  DEMONO  MANIA. 

June  24th.  Post-mortem  examination  :  marasmus,  feet  edematous,  lower 
extremities  retracted,  eschars  on  the  coccyx  and  sacrum.  Cranium  thickened 
anteriorly,  diploe  injected.  Falciform  fold  of  the  dura-mater  reticulated,  and 
torn  anteriorly.  Serum  at  the  base  of  the  cranium.  Some  points  of  ossifica- 
tion in  the  Pineal  gland.  Cerebrum  and  cerebellum  softened,  grey  substance 
pale.  Serum  abundant  in  the  two  lateral  and  third  ventricles;  plexus  chor- 
rides  discolored,  having  many  small,  serous  cysts.  Very  extended  adhesions 
of  the  posterior  portions  of  the  two  ventricles.  Lungs  tuberculous,  and  adhe- 
rent throughout  their  whole  extent  to  the  pleurje.  A  small  quantity  of  serum 
in  the  pericardium,  to  which  the  right  auricle  and  point  of  the  heart  adhere. 
Epiploon  atrophied,  and  interspersed  with  small  black  points,  as  was  also  the 
peritoneum  throughout  its  whole  extent.  All  the  abdominal  viscera,  adhering 
closely  together,  form  but  a  single  mass  of  a  brownish  aspect ;  mesenteric 
glands  very  much  developed,  and  some  of  them,  as  large  as  hazel  nuts,  are 
converted  into  adipocere.  The  gall-bladder  contains  little  bile,  the  spleen  is 
reduced  to  the  consistence  of  pap  and  the  color  of  lees  of  wine ;  the  mucous 
membrane  of  the  intestines  is  ulcerated  in  several  points,  and  that  of  the  uri- 
nary bladder  reddish.  The  forehead  is  retreating,  and  very  narrow  from  tem- 
ple to  temple.  The  excessive  flattening  of  the  coronal  region,  gives  to  this 
profile  one  of  the  characters  which  have  been  pointed  out  as  proper  to 
idiocy. 

M.,  now  forty-nine  years  of  age,  living  in  the  country,  and  a  wool-spinner 
by  occupation,  had  often  heard  accounts  of  sorcerers.  At  fifteen  years  of  age, 
the  menses  appear  spontaneously.  Thirty-seven.  When  on  the  point  of  mar- 
riage, she  learns  that  her  pretended  lover  is  deceiving  her.  She  will  no  longer 
listen  to  him,  and  a  year  after  marries  another  person.  He  whom  she  has  for- 
saken, threatens  her  with  vengeance,  and  dooms  her  to  the  dwelling  place  of 
devils.  A  man  in  the  village  where  she  resides,  who  passes  for  a  sorcerer, 
gives  his  body,  without  the  least  doubt  on  her  part,  to  the  devil.  At  forty 
years  of  age  the  menses  cease.  At  this  period  her  ideas  become  deranged, 
but  in  a  manner  imperceptible  to  strangers,  and  she  suffers  from  cephalalgia. 
Forty-two  years.  Returning  from  a  long  excursion,  she  is  fatigued,  and  lies 
down  upon  the  earth  to  refresh  herself  Shortly  after,  she  experiences  in  her 
head  a  motion  and  noise  like  that  of  a  spinning  wheel.  She  is  frightened, 
but  nevertheless  resumes  her  course,  and  on  the  way,  is  raised  from  the  earth, 
to  the  height  of  more  than  seven  feet.  Having  reached  her  place  of  resi- 
dence, she  can  neither  eat  nor  drink.  She  calls  to  mind  the  threat  that  had 
been  made  with  reference  to  her,  four  years  previously,  and  no  longer  doubts 
that  she  is  bewitched.  Many  remedies  are  administered,  and  she  makes  pray- 
ers, performs  devotions  of  nine  days'  duration,  and  also  pilgrimages.  She 
wears  a  stole,  which  had  been  presented  her  by  a  priest.  But  all  in  vain. 
The  devil  and  his  torments  no  longer  leave  her,  and  three  years  afterwards, 
she  is  brought  to  the  Salpetriere. 

At  the  time  of  her  arrival  at  the  hospital  she  is  extremely  emaciated,  her 
skin  is  sun-burnt,  earthy,  and  hot ;  the  pulse  it  feeble  and  small,  the  head  is 
bowed  down,  the  face  bloated,  and  the  forehead  wrinkled.  The  eye-brows,  at 
times  mingling  with  the  folds  of  the  forehead,  are  lost  in  the  hair  :  the  abdo- 
men is  hard  and  voluminous,  and  the  patient  has  her  hand  constantly  upon  it. 
She  assures  us  that  she  has,  in  her  uterus,  an  evil  spirit,  in  the  form  of  a  ser- 
pent, which  leaves  her  neither  day  nor  night,  although  her  organs  of  genera- 
tion are  not  like  those  of  other  women.  She  complains  of  a  great  degree  of 
constriction  about  the  throat,  and  experiences  a  necessity  to  walk  about,  and 
suffers  much  more  acutely  if  prevented  from  doing  so.  She  walks  slowly, 
speaking  in  a  low  tone  of  her  condition,  which  she  deplores.  She  conceals 
herself  when  she  eats  and  drinks,  as  well  as  when  called  to  evacuate  the  blad- 
der and  bowels,  in  order  the  better  to  persuade  us  that  she  is  not  a  body,  but 
merely  a  spectre  and  imaginary  being. 


DEMONOMANIA.  24 1 

"  The  devil  has  taken  from  me  my  body,  and  I  have  no  lono-er  a  human 
shape.  There  is  nothing  so  dreadful  as  to  appear  to  live  and  yet  not  to  be  of 
this  world.  I  burn,  sulphur  exhales  with  my  breath.  I  neither  eat  or  drink 
because  the  -devil  has  no  need  either  of  food  or  drink.  I  feel  nothino-  and 
should  I  be  placed  in  a  terrestrial  fire,  I  should  not  burn.  I  shall  live  mil- 
lions of  years ;  that  which  is  upon  the  earth  not  being  able  to  die.  Were 
it  not  so,  despair  would  have  caused  me,  long  since,  to  terminate  my  exist- 
ence." 

Nothing  undeceives  her,  and  she  is  abusive  in  her  language  to  those  who 
seem  to  doubt  the  truth  of  what  she  affirms.  Those  who  contradict  her,  she 
calls  sorcerers  and  demons.  If  they  insist  upon  the  correctness  of  their  opin- 
ion respecting  her,  she  becomes  irritated,  her  eyes  project,  and  are  red  and 
haggard.  Look  then,  she  says,  at  this  beautiful  figure  ;  is  it  that  of  a  woman 
or  a  devil  ?  She  strikes  herself  violently  with  her  fist  upon  her  chest.  She 
pretends  also,  to  be  insensible,  and  to  prove  it,  pinches  her  skin  with  all  her 
might,  and  strikes  her  chest  with  a  wooden  shoe.  I  have  myself  pinched  her, 
pricked  her  often  with  a  pin,  and  transfixed  the  skin  of  her  arm,  without  her 
testifying  the  least  suffering.  Still  she  manifested  pain  when  not  forewarned. 
This  woman  is  tranquil,  is  not  mischievous,  and  speaks  rationally  upon  every 
other  subject,  when  we  can  divert  her  thoughts.  On  pretext  of  deliverino- 
her  out  of  the  power  of  the  devil,  and  unbewitching  her,  she  was  thrice  mag- 
netized, but  without  my  being  able  to  witness  any  magnetic  effect. 

H.,  fifty-one  years  of  age,  and  a  pedler  by  occupation,  menstruated  only 
after  the  age  of  twenty-four  years.  She  is  subject  to  a  headache  and  colic 
pains,  and  is  the  mother  of  three  children.  At  the  age  of  thirty-six  years, 
and  during  her  last  pregnancy,  she  was  accustomed  to  read  the  Apocalypse, 
and  books  which  treated  of  ghosts  and  wizards.  She  was  often  frightened  by 
these  readings.  Her  last  confinement  was  laborious,  and  she  afterwards  had 
several  fainting  turns.  From  time  to  time,  she  seemed  to  see  flames.  When 
thirty-seven  years  old,  she  borrows  some  money  to  oblige  a  relative.  The  cre- 
ditor harasses  and  threatens  her.  Distressed  by  this  debt,  and  while  walking 
in  the  garden  connected  with  her  residence,  the  devil  appears  to  her,  proposes 
to  her  to  sign  a  paper  with  blood  drawn  from  the  little  finger  of  her  left  hand, 
and  promises  her  the  sum  of  money  she  owes.  After  a  long  debate,  she 
writes  out  her  renunciation  of  God,  and  her  voluntary  sacrifice  to  the  devil. 
No  sooner  has  she  committed  this  act,  than  the  earth  trembles  beneath  her 
feet  and  around  her.  Her  house  also,  is  encompassed  by  a  whirlwind,  which 
shakes  and  injures  its  roof  At  this  instant,  the  evil  spirit  disappears,  carry- 
ing away  with  him  her  real  body,  leaving  only  a  phantom.  All  her  neighbors 
were  the  terrified  witnesses  of  these  phenomena.  Her  real  body  being  with 
the  devil,  its  image  is  tempted  to  throw  itself  into  the  water,  and  to  strangle 
itself.  The  devil  incites  her  to  divers  crimes.  Feeling  that  she  was  devour- 
ed by  the  fires  of  hell,  she  threw  herself  into  a  pond,  and  suffers  more  since 
than  before.  She  has  no  blood,  and  is  absolutely  insensible.  I  pierced 
through  the  skin  of  her  arm  with  a  pin,  but  she  appeared  to  experience  no 
pain  in  consequence  of  it.  I  shall  remain  upon  the  earth,  says  she,  until  wise 
men  have  discovered  a  means  of  obliging  the  devil  to  bring  back  to  the  earth 
my  natural  body.  All  that  I  say  was  taught  me  by  the  body  which  no  longer 
exists,  but  which,  before  my  misfortune,  was  upon  the  earth. 

This  woman  is  very  much  emaciated,  her  skin  very  brown  and  sun-burnt. 
Grief  and  despair  are  depicted  upon  her  countenance,  which  is  wrinkled  and 
contracted.  She  walks  about  quietly,  knitting,  and  avoids  her  companions. 
She  does  not  regard  herself  as  sick,  but  groans  about  her  miserable  condition, 
which  nothing  can  change.  She  is  tranquil,  supports  opposition,  and  has  a 
great  desire  to  be  relieved  of  her  infirmity.  Cherishing  this  hope,  she  has 
four  times  consented  to  be  magnetized,  without  however,  deriving  the  least 

31 


242  DEMONOMANIA. 

possible  effect  from  the  operation.  With  the  expectation  that  her  portrait 
would  be  carried  to  the  archbishop,  she  places  herself  in  a  very  proper  atti- 
tude to  have  it  taken.  Such  was  the  condition  of  this  unfortunate  woman  for 
twelve  years.  During  eleven  of  them,  she  performed  laborious  services,  ful- 
filling her  duties  very"  satisfactorily.  For  one  year  only,  did  age  and  wretch- 
edness compel  her  to  enter  the  Salpetriere. 

L.  is  fifty  seven  years  of  age,  a  laundress,  and  has  been  very  devout  from 
infancy.  Menstruation  commences  at  the  age  of  fifteen  years.  At  the  age 
of  seventeen  she  is  married,  and  becomes  the  mother  of  fifteen  children. 
When  forty-six  years  of  age,  she  loses  her  husband  and  one  of  her  children, 
which  expires  in  her  arms  ;  since  which  period,  there  have  been  anomalies 
with  respect  to  menstruation.  Near  this  time,  she  indulges  in  religious  scru- 
ples ;  accuses  herself  of  having  partaken  of  the  sacrament  unworthily  ;  takes 
an  exaggerated  view  of  religious  exercises  ;  neglects  her  occupations  ;  and 
passes  her  time  in  the  church.  There  is  insomnia.  She  groans,  and  stands 
in  fear  of  hell.  Fifty-two  years  of  age.  Cessation  of  the  menses.  Her  fears 
are  converted  into  religious  terror,  and  she  believes  herself  to  be  in  the  power 
of  the  devil.  Fifty-four  years  of  age  ;  fever  and  delirium.  She  throws  her- 
self from  the  window,  and  is  sent  to  the  Hotel-Dieu,  from  whence,  after  five 
months,  she  is  transferred  to  the  Salpetriere.  Extreme  emaciation,  skin  sun- 
burnt, earthy,  and  complexion  sallow.  Expression  of  countenance  restless. 
The  whole  body  is  in  a  sort  or  vacillation  and  continual  balancing.  She  is 
constantly  walking  about,  seeking  to  do  mischief;  to  strike,  to  kill. 

"  For  a  million  of  years  I  have  been  the  wife  of  the  devil.  I  know  that 
I  am  with  him ;  for  he  lodges  with  me,  and  ceases  not  to  say  to  me,  that  he  is 
the  father  of  my  children.  I  suffer  from  uterine  pains.  My  body  is  a  sac, 
made  of  the  skin  of  the  devil,  and  is  full  of  toads,  serpents,  and  other  unclean 
beasts,  which  spring  from  devils.  I  have  no  occasion  to  eat  (though  she  eats 
largely).  All  that  is  given  me  is  poison.  I  should  long  since  have  been  dead, 
were  I  not  the  devil.  For  more  than  twenty  years  I  have  had  no  alvine  eva- 
cuation. I  have  committed  every  kind  of  crime  ;  have  slain  and  robbed. 
The  devil  is  continually  telling  me  to  slay,  and  even  to  strangle  my  children. 
In  one  minute,  I  commit  more  crimes  than  all  rogues  have  committed  in  a 
hundred  years.  Hence  I  am  not  sorry  to  wear  a  strait  waistcoat ;  for  without 
this  precaution,  I  should  be  dangerous.  In  giving  myself  away  to  the  devil, 
I  have  been  constrained  to  devote  my  children  to  him.  But  in  return,  I  have 
required  the  devil  to  bring  low,  him  that  sits  on  high  ;  to  slay  God,  and  the 
Viro-in.  When  I  was  accustomed  to  receive  the  sacrament,  I  treated  with 
contempt  the  good  God  of  the  Church.  I  no  longer  believe  in  him  ;  it  is  no 
longer  necessary  for  me  to  do  so.  It  is  no  longer  necessary  to  make  confes- 
sion, the  devil  forbids." 

L.  remains  aside,  avoids  her  companions,  fears  lest  she.shall  do  them  harm, 
talks  to  herself,  sees  the  devil  on  every  side,  and  often  disputes  with  him. 
This  uuhappy  being  presents  an  example  of  demonomania,  complicated  with 
dementia  and  fury.  The  strangest  illusions  and  hallucinations  maintain  her 
delirium,  and  provoke  acts  of  the  blindest  fury. 

S.,  forty-eight  years  of  age,  is  devoured  by  two  demons  who  have  taken  up 
their' abode  in  her  haunches,  and  come  forth  through  her  ears.  Devils  have 
made  several  marks  upon  her  person,  and  her  heart  is  daily  displaced.  She 
shall  never  die,  though  the  devil  may  tell  her  to  go  and  drown  herself  She 
has  seen  the  two  devils  by  which  she  is  possessed.  They  are  cats  ;  one  of 
which  is  yellow  and  white,  and  the  other  black.  She  puts  tobacco,  whie,  and 
particularly  grease,  upon  her  head  and  in  her  ears,  to  exorcise  the  devil.  She 
walks  constantly  with  naked  feet  in  fair  and  rainy  weather,  and  while  walking, 
picks  Up  whatever  comes  in  her  way.  She  mislays  her  clothing,  eats  largely, 
and  the  dejections  are  involuntary.     She  sleeps  not,  is  filthy,  emaciated,  and 


DEMONO  MANIA.  243 

her  skin  very  much  sun-burnt.  There  is  no  coherence,  even  in  the  system  of 
ideas  that  constantly  occupy  her  mind.  She  articulates  sounds  with  the  great- 
est difficulty.  This  is  a  striking  case  of  demonomania,  which  has  deo-enerated 
into  dementia,  complicated  with  paralysis. 

I  may  be  censured  for  having  multiplied  cases.  However,  even  in  their 
abridgment,  they  have  appeared  to  me  to  offer  the  more  interest,  as  the  first 
three  furnish  us  an  example  of  simple  demonomania,  and  the  two  latter,  that 
of  this  malady  complicated  with  dementia ;  the  one  attended  with  fury,  the 
other  with  paralysis.  Besides,  the  whole  five  present  features  which  charac- 
terize demoniacal  possession.  I  pass  to  the  analysis  and  appreciation  of  the 
symptoms  of  this  malady,  compared  with  the  signs  of  possession,  pointed  out 
by  writers  on  demonology.  Demonomania  is  sometimes  epidemic.  Like  all 
nervous  maladies,  it  propagates  itself  by  a  kind  of  moral  contagion,  and  by 
the  power  of  imitation.  The  mal  des  andous,  which  afflicted  Holland,  Bel- 
gium and  Germany,  in  the  fourteenth  century,  was  a  kind  of  demonomania. 
In  1552  or  54,  there  was  at  Rome  an  epidemic  of  the  possessed,  which  affect- 
ed eighty-four  persons.  A  franciscan  monk  exorcised  them  in  vain.  The 
devils  accused  the  Jews.  The  major  part  of  those  possessed  were  Jewish  wo- 
men who  had  been  baptized.  About  the  same  period,  in  the  monastery  of 
Kerndrop  in  Germany,  all  the  nuns  were  possessed.  The  devils  designated 
the  cook  of  the  convent,  who  confessed  that  she  was  a  sorceress,  and  was 
burnt,  together  with  her  mother.  The  neighboring  villages  were  also  infect- 
ed. The  example  of  the  possessed  at  Loudun,  indicated  most  clearly,  the 
power  of  the  imagination  and  imitation.  This  epidemic  having  pervaded  cer- 
tain neighboring  cities,  threatened  the  Cevennes  and  all  Upper  Languedoc  ; 
when  the  prudent  policy  of  a  bishop  checked  the  progress  of  the  evil,  by  di- 
vesting it  of  whatever  pertained  to  the  marvelous,  with  which  the  imagination 
had  furnished  it.  The  convulsionists  of  St.  Medard,  deservedly  figure  among 
the  victims  of  moral  contagion.  This  happily,  is  the  last  scene  of  the  kind 
that  has  afflicted  our  country. 

We  have  elsewhere  seen,  that  delirium  ordinarily  takes  the  character  of  the 
ideas  prevailing  at  the  epoch  when  the  insanity  bursts  forth.  So  demonoma- 
nia is  most  frequent  when  religious  ideas  occupy  the  mind,  and  are  the  sub- 
ject of  all  discussions,  whether  public  or  private,  civil  or  political.  The  his- 
tory of  Christianity,  the  irruption  of  the  religion  of  Mahomet,  and  the  esta- 
blishment of  Lutheranism  and  Calvinism  prove  this.  In  our  day,  the  delirium 
of  many  insane  persons  runs  upon  politics.  Mental  alienation  is  strikingly 
hereditary.  Why  should  not  demonomania  be  so  also  ?  Should  we  be  sur- 
prised, if  writers  on  demonology  tell  us,  that  from  generation  to  generation, 
the  members  of  the  same  family  were  devoted  to  the  devil,  or  were  sorcerers? 

Very  rarely  were  they  accustomed  to  see  cases  of  demoniacal  possession, 
previous  to  the  age  of  puberty.  Although  a  father  and  mother  might  have 
devoted  their  children  to  the  devil,  before  or  soon  after  their  birth,  they  were 
initiated  or  admitted  to  the  assembly  of  witches  only  after  the  age  of  puberty. 
Before  this  period  of  life,  there  was  neither  mania  nor  melancholy.  The  age 
most  favorable  for  possession  is  from  forty  to  fifty  years.  Old  persons  are 
little  exposed  to  it.  Thus,  all  authors  observe  that  old  men  are  no  better 
adapted  to  utter  oracles  than  for  sorcery.  An  enfeebled  imagination  no 
longer  lends  itself  to  these  miserable  illusions.  The  appellation  of  old  sorce- 
ress, confirms  this  result  of  general  observation.  One  of  the  influences  of  this 
old  sorceress  is  shown  by  a  dry,  emaciated,  wrinkled  and  decrepit  exterior,  in 
the  case  of  demonomaniacs  who,  in  consequence  of  the  moral  tortures  which 
they  experience,  and  the  physical  evils  and  privations  they  endure,  grow  old, 
long  before  the  usual  decay  of  nature.  Women  are  more  subject  to  this  dis- 
ease than  men.  Pliny  assures  us,  that  women  are  to  be  preferred  to  men,  in 
magic.     Quintilian   is  of  the  same  opinion.     Saul  goes   to  consult  witches. 


244  DEMONOMANIA. 

Those  are  witches  whom  the  Jewish  records  recommend  us  to  guard  against. 
They  were  priestesses,  pythonissfe  and  sybils,  who  uttered  oracles.  Bodin 
maintains  that  at  the  most,  we  find  but  one  sorcerer  to  fifty  sorceresses.  Paul 
Zacchias  establishes  a  still  greater  difference.  Woman  is  more  decidedly  ner- 
vous ;  she  is  more  dependent  upon  her  imagination,  more  submissive  to  the 
effects  of  fear  and  fright,  more  accessible  to  religious  notions,  more  given  to 
the  marvelous,  more  subject  to  melancholy  than  man.  Having  reached  the 
critical  period,  forsaken  by  the  world,  and  passing  from  ennui  to  sadness,  wo- 
man sinks  into  lypemania,  often  into  its  religious  form.  If  hysteria  be  blend- 
ed with  it,  the  conflict  of  the  senses  with  the  religious  principles,  plunges  her 
into  demonomania,  when  mental  weakness,  ignorance  and  prejudices  have,  so 
to  speak,  ftishioned  the  mind  in  advance,  for  a  similar  disease. 

The  melancholic  temperament,  as  that  most  favorable  for  the  production  of 
lypemania,  is  that  of  the  greater  part  of  demonomaniacs.  A  nervous  habit, 
an  imagination  easily  excited,  and  a  pusillanimous  disposition,  essentially  pre- 
dispose to  this  disease.  It  would  be  difficult  to  point  out  the  conditions  of 
life  most  favorable  to  the  development  of  lypemania.  It  embraces  among  its 
victims,  sovereigns,  legislators,  philosophers,  the  learned ;  but  more  particular- 
ly the  ignorant;  men,  whose  infancy  has  been  spent  in  listening  to  the  histo- 
ries of  wizards,  demons,  ghosts,  and  all  those  influences  that  are  calculated 
to  keep  the  mind  restless,  tormented,  and  disposed  to  the  strangest  impressions 
of  alarm  and  fear.  (Mallebranche).  A  bad  education,  religious  fanaticism, 
an  ascetic  life,  false  and  exaggerated  notions  of  divine  justice,  damnation  and 
hell,  are  also  causes,  more  or  less  remote,  of  this  disease  ;  just  as  the  perusal 
of  romances  disposes  to  erotic  melancholy,  and  the  reading  of  mystical  books, 
or  those  relating  to  sorcery,  to  demonomania.  For  a  long  period,  demonoma- 
nia has  been  scarcely  observed,  and  attacks  only  the  feeble-minded  and  credu- 
lous. Since  the  reign  of  Henry  HI,  Q^rodius  remarks  that  sorcery  has  been 
the  portion  only  of  the  ignorant  and  peasantry.  Among  more  than  twenty 
thousand  insane  persons  who  have  passed  under  my  observation,  I  have 
scarcely  seen  one  among  a  thousand,  stricken  with  this  fatal  disease.  They 
are,  almost  invariably,  persons  belonging  to  the  lowest  class  of  society  ;  rarely 
men  occupying  rank  in  the  world  by  their  birth,  education  and  fortune. 
There  are  besides,  certain  worthless  knaves,  who  abuse  the  simplicity  and  ig- 
norance of  the  inhabitants  of  the  country,  by  causing  them  to  believe  that  they 
possess  a  diabolical  power ;  that  they  can  destroy  the  virile  power ;  make 
children  sick  ;  and  throw  a  spell  over  the  flocks.  Certain  phenomena  imper- 
fectly observed,  fortify  the  belief  of  these  timid,  simple  and  credulous  people, 
and  sorcery  still  maintains  certain  obscure  and  contemptible  relics  of  its  an- 
cient power.  We  still  find  in  Germany,  certain  traces  of  this  leprosy  of  the 
human  mind,  which,  with  this  exception,  is  banished  into  the  extreme  north  of 
Europe;  and  into  the  country  of  the  Malaquais,  Siamese,  Indians,  and  other 
people  enveloped  in  the  thick  darkness  of  ignorance. 

The  individual  and  proximate  causes  of  demonomania,  are  the  same  with 
those  of  lypemania;  but  this  variety  recognizes  causes  which  may  be  regard- 
ed as  specific.  They  are  either  physical  or  moral.  A  feeble  mind,  a  vicious 
education,  the  reading  of  works  on  sorcery,  magic,  etc. ;  false  religious  notions 
and  prejudices,  predispose  to  demonomania.  An  intense  moral  commotion,  a 
fright,  an  unusual  or  threatening  proposal  or  look,  an  exciting  sermon,  the 
force  of  imitation,  suffice  to  produce  an  attack.  Widowhood,  the  critical  pe- 
riod, frictions  upon  the  body,  suppositories  prepared  from  certain  substances, 
drinks  composed  of  enervating  and  narcotic  substances ;  such  are  the  physi- 
cal causes  of  this  malady.  Gassendi  tells  us,  that  a  provincial  shepherd  was 
accustomed  to  provide  himself  with  a  suppository  of  Stramonium  when  he  re- 
tired at  night,  and  on  waking  would  relate  all  that  he  had  seen  at  the  witch- 
meeting.     Certain  sorcerers  in  order  to  gain  access  to  these  assemblages,  were 


DEMONOMANIA.  245 

accustomed  to  anoint  their  bodies  with  fat,  which  had  been  prepared  with  irri- 
tating, or  narcotic  substances.  These  applications  produce  their  effects  in  two 
ways  :  1st,  upon  the  imagination;  by  exciting  and  fixing  it  upon  events,  pro- 
mised and  desired ;  2d,  by  irritating  the  brain,  they  provoked  dreams,  which 
were  almost  alwa3's  predicated  upon  the  ideas,  desires  or  fears  of  the  sleep- 
er. This  mode  of  enchantment  is  very  ancient,  since  the  Greeks  denominat- 
ed sorcerers  and  magicians  cpuQi)«y.ld&g.  They  also  gave  them  this  name  per- 
haps because  the  use  of  plants  was  connected  with  their  enchantments. 

Demoniacal  possession  has  often  been  caused  by  the  look  merely,  of  a  sor- 
cerer. The  influence  of  an  amorous  look  upon  a  young  person,  the  effects  of  a 
choleric  or  threatening  expression  upon  a  timid  or  prejudiced  mind  ;  will  they  not 
account  for  the  consequences  of  enchantment  by  the  look  !  without  the  neces- 
sity of  having  recourse  to  a  supernatural  and  diabolical  power  ?  The  attack 
of  demonomania  bursts  forth,  in  general,  suddenly.  Its  invasion  is  prompt,  its 
duration  variable,  and  its  cure  doubtful.  Demonomania  terminates  in  demen- 
tia. Convulsions,  marasmus,  scurvy,  phthisis  or  a  slow  fever,  bring  to  a  close 
the  life  of  this  unfortunate  class  of  our  fellow  beings.  Demonomaniacs  are 
emaciated,  their  complexion  is  sallow  and  sun-burnt,  their  physiognomy  indi- 
cates disquietude,  the  look  is  suspicious,  and  the  features  of  the  face  shrunken. 
They  do  not  sleep,  eat  little,  and  often  secretly.  They  walk  much,  and  suffer 
from  constipation.  They  are  fond  of  solitude,  experience  pains  in  the  head, 
chest,  abdomen  and  limbs,  and  accuse  the  devil  of  it.  They  feel  an  internal 
fire  which  consumes  them,  and  believe  that  they  are  in  the  flames  of  hell  which 
they  alone  perceived.  Their  breath  seems  to  be  on  fire.  With  groans  they 
lament  their  fate,  but  never  weep.  They  strive  to  injure  those  who  surround 
them,  and  suffer  from  a  thousand  hallucinations,  and  even  fury.  The  possess- 
ed exhale  a  very  strong  odor,  which  betrays,  say  they,  the  presence  of  the 
devil.  This  phenomenon  is  not  rare  in  nervous  maladies,  either  because  the 
breath  has  become  fetid,  or  because  the  transpiration  has  acquired  an  odor 
very  much  increased  by  the  morbid  character  of  the  fluids.  Does  the  fetor  of 
the  breath  announce  a  threatening  attack  of  convulsions,  mania  or  hysteria? 
Women  in  a  state  of  demonomania,  experience  a  thousand  hysterical  symp- 
toms. They  believe  that  they  are  transported  to  the  midnight  assemblies  of 
wizards,  where  they  are  witnesses  of  the  strangest  extravagances.  They  have 
intimate  communications  with  the  devil  or  his  subordinates  ;  after  which,  a 
collapse  bringing  an  end  to  the  attack,  they  find  themselves  again  in  the  same 
place,  from  whence  they  believed  they  had  been  taken.  Who  does  not  see  in 
this,  the  last  stage  of  an  attack  of  hysteria?  Amidst  the  obscenities  of  these 
meetings,  which  we  shall  be  cautious  about  describing, — who  does  not  recog- 
nize the  turpitude  of  an  imagination,  polluted  by  the  vilest,  most  obscene  and 
disgusting  debauchery  ?  who  does  not  recognize  a  description  of  the  most  ex- 
travagant, shameful  and  ribald  dreams?  The  frequent  ecstasies  which  take 
place  in  nervous  affections,  partake  of  a  sublime  and  contemplative  character,  if, 
during  its  waking  hours,  the  soul  is  elevated  to  the  contemplation  of  noble  and 
divine  objects.  They  are  erotic,  if  the  mind  and  heart  lull  themselves  in  reve- 
ries of  love.  They  are  obscene,  if,  when  awake,  one  indulges  in  lascivious 
thoughts,  and  if  the  uterus,  irritated  and  excited,  gives  place  to  illusions, 
which  are  regarded  as  diabolical  practices. 

The  cases  reported  in  the  different  articles  of  this  work,  establish  the  cor- 
rectness of  this  view.  Besides,  they  strikingly  resemble  the  case  of  Angele 
de  Soligny,  reported  by  Martin  Del-Rio.  Did  not  this  female  present  all  the 
features  of  nymphomania,  provoked  by  widowhood,  and  a  contemplative  life 
carried  to  an  extreme,  and  combated  by  religious  principles?  In  the  descrip- 
tion of  the  nightly  meetings  of  the  witches,  are  united  all  those  circumstances 
which  are  proper  to  excite  the  imagination.  Assemblies,  devoted  to  mysteri- 
ous rites,  have  at  all  times  been  holden   during  the  night.     Night  is  most  fa- 


246  DEMONOMANIA. 

vorable  to  illusions  and  to  fear.  It  presides  over  dreams.  An  uninhabited 
island,  a  rugged  rock,  a  cavern  surrounded  by  an  ancient  forest,  an  old  and 
abandoned  chateau,  a  cemetery,  etc.,  such  were  the  places  of  rendezvous.  The 
adoration  of  the  he-goat,  dates  back  to  the  earliest  period.  It  appertains  to 
an  ancient  religious  custom  of  the  Egyptians,  who  offered,  in  Mendes,  an  infa- 
mous worship  to  the  he-goat  Hazazel.  The  ancients  were  in  the  habit  of 
joining  to  prayers  and  invocations,  the  preparation  of  certain  plants,  and  the 
immolation  of  certain  animals,  devoted  to  the  infernal  powers.  Children  also, 
were  sacrificed.  From  the  time  o^the  introduction  of  Christianity,  sorcery 
allied  itself  to  those  notions  of  spirituality  that  prevailed.  It  borrowed  from 
the  christian  worship,  crosses,  prayers  and  consecrated  wafers ;  and  profaned 
these  sacred  objects  in  a  manner  most  revolting,  in  order  to  avenge  the  devil 
for  his  defeat.  The  sorcerers  of  Ireland,  always  recite  the  Ave  Maria  in  their 
practices  of  sorcery.  In  Livonia,  the  grand  talisman  against  sorcery  consists 
in  the  following  words  ;  Two  eyes  have  regarded  thee  ;  three  others  can  cast 
upon  thee  a  favorable  look,  in  the   name  of  the  Father,  So7i  and  Holy  Ghost. 

Like  all  lypemaniacs,  demonomaniacs  suffer  from  hallucinations  and  illusions 
of  the  senses.  Some  think  that  they  are  the  devil,  others  persuade  themselves 
that  they  have  the  devil  within  them,  who  pinches,  bites,  rends  and  burns 
them.  Some  hear  him  speak,  and  his  voice  proceeds  from  the  stomach,  bow- 
els or  uterus.  They  converse  with  him,  the  devil  recommending  to  them  the 
commission  of  crimes,  murders,  acts  of  incendiarism  and  suicide.  He  pro- 
vokes them  to  the  most  disgusting  obscenities,  and  to  blasphemies  the  most 
impious.  He  threatens  and  even  strikes  them,  if  they  do  not  obey  his  orders. 
Many,  who  were  retained  in  prison  on  account  of  their  possession,  assured 
those  about  them,  that  the  devil  had  come  thither  to  find  them.  Do  we  not 
see  maniacs  and  melancholies,  who  converse  with  imaginary  beings,  who,  they 
persuade  themselves,  are  at  their  side,  and  were  introduced  by  the  chimney 
and  window?  The  illusions  of  sight  and  touch,  are  here  the  same  as  with 
demonomaniacs.  Some  of  the  possessed  or  sorcerers,  as  a  conveyance  to 
their  nightly  assemblages,  bestrode  a  broom.  Others  were  mounted  upon  a 
he-goat,  an  ass,  dog,  etc.  The  latter,  anointed  the  body  with  an  ointment. 
The  former  had  need  only  of  their  imagination.  All,  without  passing  up  the 
chimney,  leaving  their  habitation,  or  even  getting  out  of  bed,  reached  the 
place  of  meeting,  where  they  saw  the  devil ;  now,  in  the  shape  of  a  he-goat, 
a  satyr  or  black  cat;  now,  in  that  of  a  man,  either  black  or  white.  Such  are 
the  disgustiiiff  reveries  that  have  given  rise  to  the  belief  in  the  existence  of 
incubi  and  succubi.  Some  women,  mostly  hysterical,  have  seen  the  devil  un- 
der the  form  of  a  young  man,  handsome,  and  well  made.  Doubtless  libertines, 
abusincr  the  weakness  of  some  women,  have  borrowed  from  the  devil  his  form 
and  power.  I  once  had  in  charge  a  maniac,  who  every  night  believed  that  he 
went  to  bed  with  his  mistresses,  and  was  accustomed  to  converse  with  them, 
assuming  a  different  tone  with  each,  and  having  reference  to  their  respective 
dispositions  and  humor.  There  are  many  erotic  lypemaniacs,  who  are  con- 
vinced that  they  have  had  intimate  relations  with  men,  to  whom  they  have 
scarcely  addressed  a  word,  but  by  whom  their  imagination  has  been  taken. 

Mad'lle  de  S.,  aged  thirty-one  years,  of  medium  size,  having  black  hair  and 
eyebrows,  a  slender  habit  of  body,  and  nervous  temperament,  together  with  a 
disposition  disposed  to  melancholy,  in  company  with  her  mother  attends  the 
botanical  course  of  a  celebrated  professor.  After  a  few  lectures  she  persuades 
herself  that  she  is  pregnant  by  the  professor,  who  is  advanced  in  life,  and  to 
whom  she  has  never  spoken.  Nothing  dissuades  her  from  this  belief  She 
becomes  much  emaciated,  loses  her  appetite,  and  is  invincibly  opposed  to  lis- 
tening again  to  him  who  has  made  her  a  mother.  The  menses  are  suppressed, 
which  is  a  new  proof  of  pregnancy.  The  counsels  of  a  tender  and  beloved 
mother,  physicians  and  medicines,  are  all  repulsed  with  obstinacy.     She  spends 


UEMONOMANIA.  247 

the  eighth  month  in  preparing  child-bed  linen.  The  ninth  and  tenth  month 
pass  without  confinement.  It  does  not  take  place,  says  the  patient,  because 
there  are  not  colics  and  necessary  pains.  She  stands  much  with  naked  feet, 
in  order  to  provoke  pains.  She  hears  the  father  of  her  child,  who  exhorts  her 
to  patience,  and  encourages  her  to  support  the  throes  favorable  to  parturition. 
She  sometimes  utters  cries,  which  are  common  to  women  at  this  period.  In 
other  respects,  she  is  perfectly  rational.  I  know  well  that  I  am  like  an  insane 
person,  she  sometimes  says,  but  it  is  certain  that  I  am  pregnant.  She  is  com- 
mitted to  my  care  after  suffering  from  this  malady  for  eighteen  months.  She 
is  very  much  emaciated  and  feeble,  pulse  frequent  and  small,  skin  dry  and  hot. 
She  is  sad,  neither  speaking  nor  moving ;  wishing  neither  to  sit  down  during 
the  day,  nor  to  retire  during  the  night.  She  also  refuses  all  nourishment.  I 
was  enabled  to  overcome  her  unwillingness  to  take  food,  by  effusions  of  cold 
water.  But  nothing  triumphed  over  the  convictions  of  this  patient,  who,  some 
months  after,  went  into  the  country  to  terminate  her  earthly  pilgrimage. 

The  continual  muttering  of  some  of  the  possessed,  has  given  rise  to  the 
belief  that  these  unfortunate  beings  conversed  with  the  devil  in  an  unintelli- 
gible  maimer.  We  find  this  symptom  existing  in  a  great  many  melancholies, 
especially  among  those  who  have  fallen  into  a  state  of  dementia,  and  who  stam- 
mer, in  a  low  voice,  words  having  no  connection.  The  possessed,  like  all  me- 
lancholies, beset  by  their  own  ideas,  neglected  their  relatives,  friends  and  in- 
terests. They  were  miserable  and  unfortunate ;  never  improving,  in  a  pecu- 
niary respect,  the  condition  of  their  family.  They  could  no  more  do  it,  than 
deliver  themselves  from  the  demons  and  judges  who  were  going  to  burn  them. 
Improvidence,  and  incapacity  for  every  kind  of  occupation,  are  the  character- 
istics, not  only  of  lypemania,  but  also  of  most  of  those  passions  which  are 
intimately  connected  with  it.  The  possessed  were  very  obstinate  in  their  be- 
lief, rarely  betraying  their  adherence  to  it.  Notwithstanding  the  severest  pun- 
ishments, in  spite  of  the  rack,  which  was  most  inhuman,  the  greater  part  re- 
mained attached  to  their  notions,  and  obstinately  refused  to  renounce  their 
compact.  The  demon  gave  them  this  power  and  obstinacy.  They  were  aban- 
doned of  God,  who  detested  their  abominations.  This  infatuation  is  charac- 
teristic of  melancholy.  Neither  reasoning,  privations,  nor  pain,  can  convince 
the  lypemaniac.  The  stronger  the  efforts  made  to  persuade  him,  the  greater 
is  his  resistance,  and  the  more  powerfully  does  he  \vithstand.  Suspicion, 
fear  and  self-love  fortify  his  convictions,  which  punishments  only  increase. 
I  had  in  charge  a  young  man  who,  deceived  by  an  exaggerated  notion  of 
honor,  refused  all  nourishment.  After  having  exhausted  all  known  means 
to  overcome  this  resolution,  I  applied  with  much  preparation,  red  hot  irons 
upon  different  parts  of  his  body,  without  overcoming  his  purpose.  A  surprise 
succeeds  better.  What  can  man  not  support,  when  sustained  by  a  strongly 
excited  imagination !  The  children  of  Sparta,  lacerated  by  whips  upon  the 
altar  of  Diana,  expired  without  uttering  a  complaint.  A  child  at  Lacedemon, 
having  stolen  a  fox,  concealed  him  beneath  his  tunic,  and  permitted  his  abdo- 
men to  be  mangled  by  the  teeth  and  claws  of  this  animal,  without  manifest- 
ing the  least  pain,  through  fear  of  being  discovered.  To  how  great  an  ex- 
tent does  insensibility  proceed  in  hysteria  and  convulsions ! 

The  princess  B.,  twenty  seven-years  of  age,  of  a  nervous  temperament,  a 
very  lively  imagination,  a  gay  and  mild  disposition,  had  received  a  very  excel- 
lent and  liberal  education,  too  strictly  intellectual  for  a  woman.  Married 
when  very  young,  she  meets  with  great  domestic  trials,  which  repress  her  na- 
tural gayety,  and  render  her  melancholic.  Missionaries  go  to  St.  Petersburg, 
and  obtain  permission  to  preach.  Their  sermons  produce  a  strong  impression 
upon  the  minds  of  the  great  ladies  of  that  country.  The  imagination  of  the 
princess  is  not  the  last  to  become  excited.  See  her  now,  an  enthusiast,  and 
uncertain  whether  she  shall  abandon  the  prevailing  mode  of  worship.     The 


248  DEMONOMANIA. 

sovereign,  at  first,  expresses  his  dissatisfaction,  and  afterwards  sends  back  the 
missionaries.  Every  one  fears  to  incur  the  displeasure  of  a  sovereign  whom 
he  loves.  The  princess,  enfeebled  by  her  sorrow,  is  easily  subjugated  by  reli- 
gious terrors,  and  the  apprehension  of  a  persecution.  She  becomes  a  lypema- 
niac,  accuses  herself  of  having  committed  crimes,  and  expresses  a  dread  of 
being  exposed  to  suffer  martyrdom.  Her  aberration  of  mind  increases,  and 
one  day,  either  to  punish  herself,  or  to  test  her  courage,  she  places  the  middle 
finger  of  the  right  hand  in  the  flame  of  a  wax  candle,  and  allows  it  to  remain 
there  so  long,  that  it  was  necessary  to  remove  its  three  phalanges,  so  deep  had 
been  the  burn.  At  the  expiration  of  four  years,  alternating  between  agitation 
and  fury,  composure  and  sadness,  excitement  and  depression,  the  princess 
is  brought  to  Paris  and  committed  to  my  care.  She  was  in  a  state  of  demen- 
tia complicated  with  paralysis,  and  attended  with  a  disposition  to  transports  of 
passion,  and  to  strike  when  opposed.  What  could  I  do  to  overcome  a  disease 
like  this  ?     Her  physical  condition  is  improved,  but  reason  was  forever  lost. 

Punishments,  invented  by  the  most  refined  cruelty,  could  not  draw  tears 
from  the  eyes  of  the  possessed  when  put  to  the  torture.  The  demon,  said 
they,  dried  up  their  source.  Almost  all  lypemaniacs  experience  a  desire  to 
weep,  without  the  ability  to  shed  a  tear,  by  whatever  effort  they  may  make. 
The  sleep,  into  which  some  fell  during  the  tortures  of  the  rack,  was  the 
strongest  proof  of  possession.  They  did  not  then  know,  that  excessive  pain 
produces  an  uncontrollable  desire  to  sleep.  They  were  accustomed  to  bind 
the  limbs  of  the  possessed  before  casting  them  into  the  water  ;  and  if  they 
then  swam  upon  it,  they  were  regarded  as  possessed.  Some  hysterical  women 
could  not  submerge  themselves  in  the  water,  and  floated  when  plunged  into 
it.  Those  in  favor  of  the  punishment  of  the  possessed,  recommended  that 
these  unfortunates  be  interrogated,  immediately  after  their  arrest ;  because,  so 
soon  as  they  are  taken,  they  think  that  they  are  forsaken  by  the  devil,  and 
confess  every  thing  ;  whilst,  if  we  allow  them  time  to  reflect,  the  devil  comes 
and  gives  them  instruction,  (Del-Rio,  Bodin,  de  I'Ancre).  Who  can  forget 
the  effects  of  a  lively  and  vigorous  impression,  which  always  suspends  the  de- 
lirium for  some  moments,  only  to  resume  its  power,  so  soon  as  the  first  effect 
of  this  moral  commotion  has  ceased  1  Upon  this  phenomenon,  reposes  the 
most  important  therapeutic  precept,  for  the  treatment  of  the  insane.  Some  of 
the  possessed,  unable  to  support  the  miseries  they  experienced,  and  incapable 
of  resisting  the  varied  solicitations  which  the  devil  made  to  them,  pursued  by 
remorse  for  crimes  which  they  had  committed,  or  with  which  they  charged 
themselves,  tormented  by  their  thoughts,  and  tortured  in  a  thousand  ways, 
solicited  death,  prayed  that  the  time  of  punishment  might  be  hastened,  threat- 
ened to  destroy  themselves,  and  marched  gayly  to  the  scaffold.  Is  not  this 
symptom  common  to  many  melancholies,  who  prefer  death  a  thousand  times, 
to  the  disquietudes  and  anguish  that  torment,  and  the  moral  suffering  which 
overwhelms  them  ;  an  agony  more  intolerable  than  all  the  physical  pains  ima- 
ginable ?  Others  on  the  contrary,  persuaded  that  they  could  not  die,  (the 
devil  having  given  them  an  assurance  of  it),  went  to  their  punishment  with 
composure  and  tranquillity  ;  sometimes  with  disdain.  This  sense  of  security, 
which  depended  upon  an  illusion,  a  deceitful  hope,  was  regarded  as  an  incon- 
testable proof  of  the  pre.sence  of  a  demon.  I  have  reported  the  cases  of 
lypemaniacs,  who  were  fully  convinced  that  they  could  not  die,  and  who  were 
accustomed  to  enquire  of  me,  what  they  should  do,  when  left  alone  upon  the 
earth.  Convulsions  existed  in  all  times,  because  they  depended  upon  the 
state  of  the  organism,  as  well  as  the  imagination.  They  complicate  all  the 
forms  of  mental  alienation.  Priestesses,  sybils  and  pythonissae  fell  into  con- 
vulsions when  the  prophetic  spirit  took  possession  of  them.  The  possessed 
were  seized  with  convulsions  when  the  delirium  was  very  intense,  and  some 
became  maniacs,  enraged,  and  died.     This  termination,  which  is  not  rare  in 


D  E  M  O  N  O  M  A  N  I  A  .  249 

convulsive  diseases,  was  regarded  as  the  last  effort  of  the  devil,  constrained  to 
leave  the  body  of  the  possessed  person ;  and  knaves  took  advantage  of  it,  the 
better  to  deceive  the  ignorant.  In  reading  the  histories,  reported  by  writers 
on  demonology,  as  preserved  in  the  accounts  of  the  trials  of  the  possessed,  we 
learn  that  those  contortions,  convulsions,  and  great  muscular  contractions, 
referred  to  as  efforts  of  the  devil,  are  nothing  more  than  those  nervous  symp- 
toms, to  which  hysterical  persons,  hypochondriacs  and  epileptics,  are  all  ex- 
posed. These  convulsions  did  not  deceive  Pigrai  when  appointed  to  pro- 
nounce upon  fourteen  unfortunate  persons,  who  had  been  condemned  to  the 
flames.  He  decided  that  hellebore  should  be  given  them.  They  did  not 
triumph  over  the  learned  men  who  saw  them  at  St.  Medard,  nor  over  the 
magistrate  who  caused  them  to  cease  at  his  will ;  notwithstanding  the  mur- 
mur of  certain  rogues,  who  desired  longer  to  abuse  the  public  credulity. 
From  what  precedes,  we  conclude  : 

1.  That  demonomania  is  a  variety  of  religious  melancholy. 

2.  That  it  recognizes  as  its  remote  cause,  ignorance,  prejudices  and  the 
feebleness  and  pusillanimity  of  the  human  mind. 

3.  That  disquietude,  fear  and  dread  provoke  it. 

4.  That  the  delirium,  determinations  and  actions  of  demonomaniacs,  de- 
pend upon,  as  their  principal  cause,  false  notions  of  religion,  and  a  frightful 
depravation  of  morals. 

5.  That  this  disease  has  become  more  rare,  since  religious  knowledge,  a 
better  education,  and  more  general  instruction,  have  more  uniformly  enlight- 
ened all  classes  of  society. 

We  must  signalize  as  one  of  the  varieties  of  demonomania,  that  state  in 
which  some  insane  persons,  stricken  by  the  terrors  of  hell,  believe  that  they 
are  damned.  These  are  persons  whose  minds  are  feeble,  timid  and  fearful ; 
whose  hearts  are  upright  and  pure  ;  whose  convictions  are  profound,  and  who 
think  that  they  have  committed  errors  and  crimes  whose  chastisement  they 
cannot  shun.  Such  are  in  a  state  of  despair.  They  are  not,  like  demono- 
maniacs, actually  in  the  power  of  the  devil.  They  neither  see  nor  feel  the 
sulphureous  flames  which  devour  them.  Still  they  dread  damnation,  and  are 
convinced  that  their  career  will  terminate  in  hell.  They  impose  upon  them- 
selves mortifications  more  or  less  extreme,  as  well  as  singular,  in  order  to 
avoid  their  destiny.  The  history  of  all  religions  presents  the  cases  of  men 
who,  fearful  of  the  future,  submit  both  their  bodies  and  minds  to  the  most 
cruel  and  inconceivable  tortures  ;  now,  to  secure  the  favors  of  heaven  ;  and 
now,  to  disarm  the  celestial  anger.  A  pusillanimous  disposition,  exaggera- 
tion, ignorance  of  the  true  principles  of  religion ;  the  reading  of  books  calcu- 
lated to  enslave  the  mind,  the  critical  period,  masturbation,  and  reverses  of 
fortune ;  are  the  most  frequent  causes  of  this  variety,  which,  in  our  day,  is  not 
so  rare  as  demonomania,  and  does  not  spare,  like  it,  the  higher  ranks  of  so- 
ciety. Demonomania  furnishes  the  most  striking  proof  of  the  strange  oppo- 
sition which  exists  between  the  ideas  and  determinations.  The  impulse  to 
murder  and  suicide  is  very  much  to  be  feared  among  individuals,  who  stand 
in  fear  of  eternal  damnation.  Sauvages,  Forestus  and  Pinel,  mention  several 
cases  of  them.  It  is  neither  the  spleen,  nor  disgust  of  life,  which  urges  them 
on  to  suicide.  It  is  neither  the  fright,  which,  depriving  rnan  of  the  faculty  of 
reasoning,  precipitates  him  upon  the  evil  which  he  most  fears.  How  happens 
it,  said  I  to  a  young  man,  that  you  fear  being  damned,  and  yet  wish,  by  tak- 
ing your  own  life,  to  hasten  on  the  period  of  eternal  punishment,  the  very 
thought  of  which  fills  you  with  despair  1  This  simple  mode  of  reasoning  he 
could  not  comprehend.  Fear  is  a  sentiment  which  is  surmounted  by  a  still 
stronger  one.  Persons  who  fear  eternal  damnation,  are  indescribably  misera- 
ble. Solely  occupied  by  their  sufferings  and  actual  torments,  imagination 
represents  this  state  of  anguish  as  the  greatest  of  evils ;  as  greater  than  death 
32 


250  DEMONOMANIA. 

itself.  The  evils  which  they  dread,  but  do  not  feel,  necessarily  produce  less 
effect  upon  them,  than  those  which  they  endure.  Future  ills  can  be  but  ima- 
ginary, whilst  actual  ones  are  realities.  Their  intolerable  position  is  frightful, 
and  must  be  changed.  Not  having  the  courage  to  suffer,  how  should  they 
have  to  hope  ?  All  is  despair.  This  state  of  things  must  cease,  cost  what  it 
may.  The  surest  means  of  effecting  it,  is  to  cease  to  live.  The  resolution  is 
taken, — reason  wanders, — the  future — and  the  punishments  of  hell ,  vanish.  De- 
lirium and  despair  direct  the  steel  of  the  monomaniac,  who  commits  self-murder. 

Of  all  insane  persons  lypemaniacs  are  the  most  cruel.  Not  only  do  these 
wretched  beings  attempt  their  own  destruction  ;  but  direct  their  deadly  blows 
at  the  persons  of  their  friends,  relatives  and  children.  A  miserable  being, 
after  listening  to  a  sermon,  believing  himself  damned,  goes  home  and  destroys 
his  children  to  preserve  them  from  the  same  dreadful  doom  (Pinel).  A  young 
woman  experiences  certain  domestic  trials.  She  immediately  persuades  her- 
self that  she  is  lost,  and  for  more  than  six  months  is  haunted  with  the  desire 
to  destroy  her  children,  to  preserve  them  from  the  sufferings  of  a  future  state. 
When  suffering  from  this  frightful  form  of  insanity,  and,  yielding  to  their 
blind  fury,  these  wretched  beings  have  executed  their  horrible  purposes,  they 
are  never  restored.  Such  is  my  experience.  We  are  of  the  opinion  that  re- 
turnincr  reason,  bringing  with  it  but  too  just  reproaches,  induces  moral  suffer- 
ing, and  gives  rise  to  the  most  poignant  regrets,  which  are  shortly  succeeded 
by  the  same  torments  and  delirium.  The  treatment  of  demonomania  is  the 
same  with  that  of  lypemania,  or  melancholy  with  delirium.  The  pharmaceu- 
tic treatment,  as  well  as  the  regimen,  depend  upon  the  knowledge  of  its  causes. 
Albrecht  tells  us,  that  he  cured  a  robust  man,  who  for  some  years  was  regard- 
ed as  possessed,  by  causing  him  to  take  wine,  impregnated  with  emetic  quali- 
ties, during  alternate  periods  of  fourteen  days  ;  at  the  fourth  period  his  patient 
was  cured.* 

The  moral  means  do  not  differ  from  those  which  are  adapted  to  lypemania 
in  general.  The  assistance  of  ministers  of  religion  has  rarely  been  followed 
with  permanent  success.  A  lady  believed  herself  damned,  and  had  recourse 
to  several  priests.  A  prelate,  as  respectable  by  his  age  as  his  virtues,  went 
to  her  residence  arrayed  in  his  pontifical  robes,  received  her  confession,  and 
lavished  upon  her  religious  consolations.  The  patient  recovered  her  reason 
perfectly  for  a  few  hours  ;  but  on  the  following  day,  she  relapsed  into  a  state 
worse  than  her  former  one  had  been.  However,  I  by  no  means  think  that 
such  aid  ought  to  be  neglected.  The  consolations  of  religion,  the  presence 
and  encouragements  of  a  minister  of  the  altar,  by  calling  into  exercise  a  de- 
gree of  confidence  on  the  part  of  the  patient,  may  cause  hope  to  spring  up  in 
his  breast,  and  prove  the  commencement  of  a  cure.  We  find  several  exam- 
ples of  cures  among  authors.  Zacutus  relates,  that  he  restored  to  health  a 
demonomaniac,  by  introducing  into  his  chamber  during  the  night,  an  indivi- 
dual in  the  guise  of  an  angel,  who  announced  to  the  patient  that  God  had 
pardoned  him.  We  can  imagine,  that  success  might  attend  the  like  efforts 
in  similar  cases.  If  the  disease  is  not  of  long  standing,  if  it  is  not  compli- 
cated with  organic  lesions,  with  paralysis  or  scurvy,  we  may  hope  for  a  degree 
of  success.  Reil  suggests  a  great  number  of  means,  but  reduces  all  to  this 
general  principle  :  to  make  a  vivid  impre.ssion  upon  the  imagination  of  the 
insane,  in  order  to  subjugate  it,  and  afterwards  to  gain  possession  of  their 
confidence  and  mind  ;  or  to  combat  a  passion  by  a  passion.  To  do  this,  an 
observing  mind  is  necessary,  and  a  thorough  acquaintance  with  the  manage- 
ment of  the  understanding  and  passions  of  men. 

Connected  with  demonomania  as  a  sub-variety,  is  Zoanthropy  ;  a  deplorable 
aberration  of  the  mind,  which  perverts  the  instinct  even,  and  persuades  the 

*  Philosopical  Decade,  year  iv. 


DEMONOMANIA.  251 

lypemaniac  that  he  is  changed  into  a  brute.  This  strange  form  of  insanity 
has  been  observed  from  the  highest  antiquity  ;  and  was  connected  with  the 
worship  of  the  ancient  pagans  who  sacrificed  animals  to  their  gods.  Lycan- 
thropy  was  described  by  /Etius  and  the  Arabians.  It  has  been  known  since 
the  fifteenth  century,  and  they  have  given  in  France,  to  those  afflicted  with 
this  disease,  the  appellation  of  wolf-men.  These  wretched  beings  fly  from 
their  fellow  men,  live  in  the  woods,  church-yards  and  ancient  ruins,  and  wan- 
der, howling,  about  the  country  at  night.  They  permit  their  beard  and  nails 
to  grow,  and  thus  become  confirmed  in  their  deplorable  conviction,  by  seeing 
themselves  covered  with  long  hair,  and  armed  with  claws.  Impelled  by  ne- 
cessity or  a  cruel  ferocity,  they  fall  upon  children,  tear,  slay  and  devour  them. 
Roulet,  at  the  end  of  the  sixteenth  century,  was  arrested  as  a  wolf-man,  and 
confessed,  that  with  his  brother  and  cousin,  after  having  rubbed  the  body  with 
an  ointment,  they  were  changed  into  wolves,  and  that  they  then  ran  about  the 
fields,  and  devoured  children.  Justice,  more  enlightened  than  in  the  pre- 
ceding ages  of  the  world,  sent  these  unfortunate  men  to  a  hospital  for  the 
insane. 

There  have  been  lycanthropes  who  believed  that  they  were  transformed  into 
dogs.  These  are  called  cynanthropes.  A  distinguished  lord  of  the  court  of 
Louis  XIV.  experienced,  at  times,  a  disposition  to  bark,  and  was  accustomed 
to  put  his  head  out  of  the  window  to  satisfy  this  desire.  Don  Calmet  tells  us 
that  in  a  convent  of  Germany,  the  nuns  believed  that  they  were  changed  into 
cats,  and  that,  at  a  certain  hour  of  the  day,  they  were  accustomed  to  run  all 
about  the  convent,  striving  to  outdo  each  other  in  mewing.  We  find,  even  in 
our  days,  insane  persons  who,  no  longer  believing  in  the  power  of  the  devil 
over  matter,  still  believe  in  destiny ;  and  persuade  themselves  that  it  imposes 
upon  them  all  the  pains  they  suffer  ;  that  they  are  objects  of  horror,  and  ought 
to  be  removed  from  the  world.  This  unfortunate  caprice  manifests  itself  in 
the  country.  We  have  at  Charenton  a  young  man  from  the  mountains  of 
Limousin,  of  a  bilious-sanguine  temperament,  slender  and  emaciated  in  his 
habit,  with  black  hair  and  eyes,  and  a  pale  complexion,  who  has  a  dracq 
in  his  abdomen.  The  dracq,  or  destiny,  sometimes  enters  his  head,  tortures 
him  in  a  thousand  ways  during  the  day,  and  particularly  in  the  night,  ad- 
dresses and  threatens  him.  If  I  ask  this  unfortunate  young  man  what  this 
dracq  may  be,  "  I  know  nothing  about  it,"  he  replies,  "  but  it  is  a  destiny 
that  has  been  imposed  upon  me,  and  every  thing  has  been  done  to  deliver  me 
from  it,  but  without  success."  Other  lypemaniacs  are  convinced  that  they 
have  no  head,  that  they  have  one  of  glass  or  of  a  bird,  that  an  enormous  ex- 
crescence depends  from  the  nose,  and  that  their  body  is  of  butter,  their  limbs  of 
wax  or  of  glass.  We  must  also  speak  again  of  that  singular  perversion,  which 
persuades  a  young  woman  at  Charenton  that  she  no  longer  has  a  body,  and 
who  is  constantly  going  about,  like  a  person  who  has  lost  his  way,  seeking 
for  her  body.  She  calls  upon  us  for  it,  during  a  visit,  and  repeats  incessantly, 
"  I  have  no  longer  a  body, — what  will  become  of  me!  give  me  my  body." 
Hippocrates  understood  the  cause  of  the  disease  of  the  Scythians,  which 
sometimes  appears  in  our  days,  from  different  influences. 

Mad'e  M.,  a  widow,  experienced,  after  the  death  of  her  husband,  very  great 
trials,  together  with  the  loss  of  her  fortune.  She  has  an  attack  of  mania, 
makes  attempts  to  commit  suicide,  and  is  sent  to  the  Salpetriere.  She  was 
small  in  stature,  very  much  emaciated,  much  agitated,  constantly  talking,  as- 
suring us  and  repeating  with  transports  of  emotion,  that  she  was  not  a  woman, 
but  a  man.  If  any  one,  in  speaking  to  her,  addresses  her  with  the  appellation 
of  Madame,  she  immediately  becomes  more  agitated,  utters  abusive  language, 
or  gives  herself  up  to  acts  of  violence.  M.  Pussin,  then  inspector  in  the  di- 
rection of  that  department  of  the  hospital  devoted  to  insane  women,  engaged 
with  M.  Pinel  to  procure  the  dress  of  a  man  for  this  female.     She  attired 


25-2  DEMONOMANIA. 

herself  in  it  with  transports  of  joy,  and  walked  about  among  her  companions 
with  a  sort  of  ostentation.  She  was  more  composed  and  tranquil,  and  talked 
much  less,  but  was  excited  to  fury,  if  not  addressed  by  the  title  of  Monsieur 
instead  of  Madame.  Her  strength  gradually  gave  way,  and  she  entered  the 
infirmary  in  the  month  of  November,  1802,  having  a  copious  diarrhoea,  and 
being  exceedingly  weak.  She  rejected  baths,  ptisans,  and  the  potions  that 
were  prescribed  for  her.  At  length,  she  became  unwilling  to  take  any  thing, 
and  died,  aged  sixty-eight  years,  her  delirium  remaining  unchanged  to  tlie 
last  days  of  her  life. 

At  the  post-mortem  examination,  I  found  the  external  vessels  of  the  crani- 
um gorged  with  blood.  The  cerebral  substance  presented  nothing  remarka- 
ble, except  rmmerous  bloody  points  when  it  was  divided  by  slices.  The  late- 
ral ventricles  contained  each  about  two  ounces  of  serum.  The  mucous  mem- 
brane of  the  stomach,  in  its  small  curvature,  presented  an  ulcer  of  about  four 
inches  in  circumference,  its  surface  being  covered  with  granulations,  and  of 
a  crrayish  aspect.  Near  the  pylorus,  there  vvas  a  species  of  polypus,  extremely 
soft,  and  large  at  its  base,  projecting  about  an  inch,  and  having  a  brown  color. 
Traces  of  inflammation  were  noticed  upon  the  mucous  membrane  of  the 
stomach,  cecum,  colon  and  rectum  ;  and  at  some  points  this  membrane  was 
destroyed.  The  gall  bladder  contained  bile  of  a  deep  green  color,  inspissated, 
and  mingled  with  small  concretions. 

I  had  in  charge,  many  years  since,  a  man  twenty-six  years  of  age,  of  a 
noble  stature,  large  size,  and  genteel  figure,  who,  in  his  earliest  youth,  was 
very  fond  of  dressing  himself  in  women's  clothes.  Admitted  into  the  highest 
circles,  if  a  comedy  was  performed,  he  always  chose  the  part  of  a  female. 
At  length,  in  consequence  of  a  trifling  opposition,  he  persuaded  himself  that 
he  was  a  woman,  and  sought  to  convince  every  body  of  it,  even  the  members 
of  his  family.  Several  times  did  he,  while  at  home,  divest  himself  of  all  his 
clothes,  array  himself  with  the  head-dress  and  costume  of  a  nymph,  and,  thus 
attired,  wished  to  walk  abroad  in  the  streets.  When  committed  to  my  care, 
aside  from  this  notion,  he  was  not  irrational.  He  was  however,  constantly 
occupied  in  curling  his  hair,  in  admiring  himself  in  the  glass,  and  with  his 
dressing  gowns,  used  every  effort  to  render  his  costume  as  similar  as  possible 
to  that  of  a  woman.  He  was  accustomed,  also,  to  imitate  their  step  when 
walking.  One  day  while  walking  with  him  in  the  garden,  I  raised  the  lappet 
of  his  riding  coat,  which  he  had  carefully  arranged,  when  immediately  he 
takes  one  step  backward,  and  treats  me  in  an  impertinent  and  lewd  manner. 
No  reasoning,  attention  nor  regimen,  were  successful  in  restoring  this  unfor- 
tunate man  to  the  use  of  his  reason. 


SUICIDE. 


Origin  of  term. — Ancient  philosophers  not  agreed  with  respect  to  the  appreciation  of  this 
act. — Legislation  with  respect  to  it. — A  variety  of  circumstances  lead  man  to  termi- 
nate his  existence. — The  impulse  of  lofly  sentiments, — false  popular  views, — national 
usages, — passions, — febrile  delirium  and  mania, — hypochondria  and  lypemania. — Sui- 
cide provoked  BY  THE  PASSIONS. — When  strongly  excited,  always  produce  disturbance 
in  the  organism  or  understanding  of  man. — Acute  and  chronic. — Examples  of  acute  sui- 
cide, with  remarks. — Chronic  suicide. — Remarkable  examples. — Suicide  preceded  by 
HOMICIDE. — Mental  condition  previous  to,  and  after  an  act  of  homicide  described. — 
Form  which  precedes  homicide,  usually  acute,  sometimes  chronic. — Examples,  and 
development  of  important  principles. — Reciprocal  suicide. — Examples. — Disposition 
sometimes  feigned. — Examples  and  treatment. — Climates,  seasons,  age  and  sex,  con- 
sidered AS  causes  of  suicide. — Climates  one  of  the  proximate  causes,  but  less  active 
than  morals,  civilization,  etc. — Table  of  quarterly  admissions  at  the  Salpetriere  of  those 
who  had  attempted  suicide. — Most  frequent  during  the  warm  seasons. — Hereditary. — 
Examples. — Most  frequent  when. — See  table. — Children  sometimes  victims  of  suicide, 
from  vicious  education. — Old  age  rarely  exposed  to  suicide. — Examples. — Less  fre- 
quent among  women  than  men. — Data  establishing  proportion  of  suicides  between 
men  and  women. — Exceptions. — Sometimes  epidemic. — Cause. — Preventive. — The 
reading  of  immoral  and  licentious  books  tends  to  suicide. — Description  of  chronic 
suicide  only  given. — Attempts  usually  voluntary. — Often  great  insensibility. — Exam- 
ples.— Instruments  which  suicides  employ. — Great  precaution  used  by  some,  to  render 
their  attempts  eifective. — Several  cases  with  treatment. — Vanity,  and  a  spirit  of  re- 
venge sometimes  manifested  in  this  act. — Illustrations. — Various  considerations  pre- 
vent those  who  desire  death,  from  the  commission  of  suicide. — Case  illustrative. — A 
frightful  perseverance  manifested  in  some  cases. — Suicide  is  acute  or  chronic  ;  contiuned 
or  intermittent. — Examples. — Pathological  lesions  observed  among  suicides. — 
Opinions  of  Gall,  Home,  Recamier,  Loder  and  others. — Post-mortem  examinations. — 
Note  from  31.  Leuret. — Query  respecting  the  influence  of  the  organs  of  digestion  in 
the  production  of  suicide. — Treatment  of  suicide  :  means  of  preventing  it. — Moral 
influences,  with  examples. — A  specific  treatment  recommended  by  some. — Bleeding. 
— Tonic. — Bark  in  combination  with  a  narcotic  or  sedative  agent. — Cold  bath. — Copi- 
ous draughts  of  cold  water  and  an  issue  over  the  liver. — Abundant  corporeal  and 
pleasant  mental  exercises. — {Farther  remarks  on  treatment.) — Constant  watchfulness 
on  the  part  of  those  who  have  the  charge  of  persons  sufliering  from  a  suicidal  propen- 
sity, indispensable. — Restraining  apparatus  not  to  be  relied  upon. — Should  sleep  in 
public  halls  under  the  constant  watch  of  an  attendant. — {Remarks  on.) — Success  of 
this  measure  at  the  Salpetriere. — Mode  of  dissipating  a  repugnance  to  food  in  the  early 


254  SUICIDE. 

stages  of  insanity. — Fear  sometimes  employed  as  a  restraining  agent. — Is  suicide  a 
criminal  act  ?  Can  it  be  prevented  or  lessened  by  legislation  ?  Remarks,  etc.,  on  the 
writings  of  Doct.  Burrows. — Suicides  greatly  increased  within  the  last  half  century. — 
Relative  proportion  of  suicides  in  Paris  and  Berlin  compared. — Proportion  of  men  and 
women. — Proportion  of  either  sex  who  have  availed  themselves  of  certain  modes  of 
committing  suicide. — Researches  of  M.  Guerry  on  suicide. — Summer  produces  more 
suicides  than  autumn. — Greatest  number  committed  between  the  hours  of  four  and  six, 
and  least,  between  two  and  four,  in  the  morning. 

In  no  language,  was  there  formerly  a  term  to  express  that  act,  by  which 
man  terminates  his  existence.  The  term  which  was  wanting  to  express  an 
act  which  has  unhappily  become  so  frequent,  was  originated,  during  the  last 
century,  by  the  celebrated  Desfontaines.  It  is  suicidum,  autochiria,  melancolia 
anglica  of  Sauvages,  suicide  of  Pinel.  Morals  and  religious  beliefs,  as  well  as 
the  laws,  have  singularly  contributed  to  modify  the  opinion  of  people  respect- 
ing self-murder,  and  to  render  it  more  or  less  frequent.  The  ancient  philoso- 
phers were  not  agreed  with  respect  to  the  appreciation  of  this  act.  Some, 
with  Demetrius  and  Zeno  at  their  head,  have  not  only  approved  of  suicide, 
but  justified  it  by  their  example.  Certain  others,  as  Plato  and  Cicero,  have 
entertained  doubtful  opinions,  while  the  greater  number,  with  Pythagoras  and 
Socrates,  condemn  it.  Legislation  also,  has  varied  among  different  people, 
and  even  in  the  same  country.  There,  suicide  is  authorized  by  law  :  here,  it 
is  tolerated  only  under  certain  determinate  circumstances :  elsewhere,  it  is 
condemned  as  a  crime.  All  the  laws  of  modern  and  civilized  Europe,  and 
even  the  Coran,  condemn  and  brand  with  infamy,  the  act  of  self-murder. 
However,  a  general  opinion,  which  regards  suicide,  either  as  a  matter  of  indif- 
ference, or  as  the  effect  of  disease  or  delirium,  seems  to  have  prevailed  in  our 
days,  though  contrary  to  the  civil  and  religious  codes.  It  does  not  belong  to 
my  subject  to  treat  of  suicide  in  its  legal  relations,  nor,  consequently,  of  its 
criminality.  I  must  limit  myself  to  showing  it  to  be  one  of  the  most  impor- 
tant subjects  of  clinical  medicine.  Self-murder  takes  place  under  circum- 
stances so  opposite,  and  is  determined  by  motives  so  diverse,  that  it  cannot  be 
limited  to  any  single  denomination.  However  varied  may  be  the  motives  and 
circumstances,  which  cause  men  to  expose  their  lives,  and  to  brave  death, 
they  almost  always  exalt  the  imagination,  either  on  account  of  a  good,  more 
precious  than  life,  or  an  evil  more  formidable  than  death. 

Before  tracing  the  history  of  suicide,  it  may  be  well  perhaps,  to  point  out 
the  principal  circumstances  which  lead  man  to  terminate  his  own  existence. 
From  these  preliminary  considerations,  Ave  will  pass  to  an  exposition  of  the 
symptoms,  to  an  enquiry  into  the  causes,  and  to  the  post-mortem  examination 
of  bodies.  We  will  finally  close,  with  some  general  views  respecting  the 
means  proper  to  prevent  suicide,  and  to  combat  the  fatal  impulse  which  urges 
man  to  the  commission  of  self-murder.  Man  destroys  himself,  or  exposes  his 
life  to  certain  destruction,  under  the  impulse  of  the  loftiest  sentiments.  The 
act  is  then  worthy  of  admiration,  and  excludes  all  blame.  The  victims  of 
false,  but  popular  views ;  of  barbarous,  but  national  usages ;  not  only  are  indi- 
viduals, but  whole  sects,  doomed  to  a  voluntary  death.  All  the  passions  have 
their  seasons  of  fury.  In  their  excesses,  there  is  nothing  that  they  do  not  sa- 
crifice ;  and  man,  while  a  prey  to  a  passion,  spares  not  his  own  life.  In  febrile 
delirium  and  mania,  more  lives  are  taken  than  is  usually  supposed.  Hypo- 
chondria and  lypemania  are  most  frequently  the  true  cause  of  that  abhorrence 
and  utter  weariness  of  life,  which  so  often  give  birth  to  that  form  of  suicide, 
which  we  call  voluntary.  He  who  wishes  to  terminate  his  existence,  moved 
by  diverse  motives,  does  not  always  lay  violent  hands  upon  himself,  but  be- 
comes a  homicide.     It  is  not  unusual  for  two  individuals,  led  away,  either  by 


SUICIDE.  255 

blind  passion,  or  by  wretchedness,  to  resolve  to  die,  and  reciprocally  to  take 
each  other's  life. 

Finally,  suicide  is  sometimes  feigned.  From  what  precedes,  we  already 
perceive,  that  suicide  is,  with  respect  to  our  knowledge,  only  a  phenomenon, 
consecutive  to  a  great  number  of  diverse  causes ;  that  it  presents  itself  under 
very  different  characters ;  and  that  this  phenomenon  is  not  exclusively  con- 
fined to  any  one  malady.  It  is  in  consequence  of  having  made  suicide  a 
malady  sui  generis,  that  they  have  established  general  propositions,  which  ex- 
perience disproves.  He  is  not  the  homicide  of  himself,  who,  listening  to  the 
dictates  of  noble  and  generous  sentiments,  places  himself  in  certain  peril, 
exposes  himself  to  inevitable  death,  and  makes  a  voluntary  sacrifice  of  life  in 
obedience  to  the  laws,  and  to  guard  the  faith,  plighted  for  the  salvation  of  his 
country.  Such  were  the  Decii,  who  sought  death  in  the  camp  of  the  enemy, 
to  fulfil  an  oracle,  which,  at  this  price,  had  furnished  victory  to  the  Athenians. 
Such  also,  was  Curtius,  who  precipitated  himself  armed,  into  an  abyss,  to  as- 
sure victory  to  the  Romans.  Assas  was  another,  who  hesitated  not  to  sacrifice 
his  life  to  save  the  regiment  of  Auvergne,  which  would  have  been  surprised, 
had  it  not  been  for  the  heroic  devotion  of  this  officer.  The  generous  inhabi- 
tants of  Calais  and  Rouen,  were  of  this  number ;  who  made  an  oftering  of 
their  lives,  to  save  their  fellow  citizens  who  were  ready  to  perish  by  the  sword 
of  the  enemy,  or  by  famine.  Were  Socrates  and  Regulus  self-murderers ; 
the  one,  for  having  refused  to  avoid  the  execution  of  the  laws  which  condemn- 
ed him  to  death ;  the  other,  for  being  unwilling  to  forfeit  his  word?  Shall 
we  denominate  suicides,  those  wretched  beings  who,  victims  to  religious  be- 
liefs, and  the  usages  of  their  country,  think,  that  by  devoting  themselves  to 
death,  they  perform  a  duty,  and  an  act  at  once  memorable,  and  worthy  of  re- 
compense? This  hope,  embraced  with  ardor,  has  resulted  in  the  sacrifice  of 
life,  not  only  on  the  part  of  a  few  individuals,  but  of  colonies,  and  entire  na- 
tions. Such  were  the  Thracians,  Germans  and  Arabians ;  and  such,  at  this 
day,  are  the  Indians. 

The  Gymnosophists,  living  in  forests,  learned  to  despise  life.  Meditating 
constantly  upon  death,  they  came  to  regard  it  as  the  supreme  good.  Diseases, 
infirmities,  and  old  age,  were  regarded  among  them  as  an  opprobrium,  and 
the  deepest  disgrace  was  attached  to  a  natural  death.  Thus,  so  soon  as  they 
were  sick,  old  or  infirm,  they  threw  themselves  upon  the  funeral  pile.  In  the 
capital  of  the  island  of  Ceos,  the  country  of  Simonides,  old  people  were  never 
seen.  The  usage  of  society  called  for  their  sacrifice,  and  the  laws  permitted 
those  who  had  arrived  at  the  age  of  sixty  years,  and  were  no  longer  capable 
of  serving  the  republic,  to  commit  the  act  of  self-murder.  It  was  a  disgrace, 
to  live  for  one's-self  only.  He  who  was  to  die,  assembled  his  relatives,  and 
after  being  crowned  with  flowers,  as  on  a  feast  day,  took  a  cup  of  the  decoc- 
tion of  the  poppy,  or  of  hemlock.  The  ancient  inhabitants  of  the  Canary 
islands,  in  order  to  honor  their  gods,  were  accustomed  to  throw  themselves 
into  an  abyss,  hoping  to  enjoy  the  felicity  which  was  promised  to  a  death  so 
imposing.  The  Japanese  drown  themselves,  the  better  to  celebrate  the  divini- 
ty Amidas ;  or  shut  themselves  up  in  a  tomb,  walled  on  all  sides,  leaving  only 
a  small  opening  for  the  passage  of  air.  Buried  while  living,  they  call  without 
ceasing,  Amidas,  Amidas,  until  they  die  from  hunger  and  exhaustion.  The 
Gauls  were  accustomed  to  betake  themselves  to  the  other  world,  in  order  to 
close  up  their  affairs.  They  lent  money,  on  condition  that  it  should  be  re- 
paid in  the  other  world.  They  were  accustomed  to  throw  themselves  upon 
the  funeral  pile  of  their  relatives  and  friends,  to  indicate  their  extreme  reluc- 
tance at  parting  with  them.  The  widow  of  Malabar,  mounts  the  funeral  pile 
which  is  to  consume  the  remains  of  her  husband,  in  obedience  to  an  ancient 
custom ;  unwilling  to  survive,  to  meet  the  disgrace  which  she  encounters,  in 


256  SUICIDE. 

not  sacrificing  herself  to  his  manes.     The  feast  of  the  Ticonal  never  takes 
place  in  Bengal,  without  being  the  occasion  of  numerous  deaths. 

It  is  difficult,  says  Dr.  Deville,  who  has  witnessed  it,  and  who  has  kindly 
communicated  to  me  the  following  description,  to  form  an  idea  of  this  cruel, 
yet  brilliant  feast,  which  draws  together  devotees  and  the  curious,  from  the 
most  remote  parts  of  India.  After  ten  days'  preparation,  the  procession,  or 
rather  the  career  of  the  car  begins.  It  consists  of  three  immense  socles, 
placed  one  above  another,  and  supported  by  axle-trees,  mounted  upon  wheels. 
Upon  the  highest  socle,  is  a  canopy,  beneath  which  is  placed  the  niche,  which 
encloses  the  idol.  The  ornaments  which  decorate  the  car,  are  magnificent. 
They  employ  for  this  purpose,  the  richest  stuffs,  and  the  most  precious  jewels. 
They  burn  the  most  exquisite  perfumes,  in  vases  placed  around  the  idol,  and 
troops  of  musicians  are  seated  upon  the  steps  of  the  car.  Bayaders  dance 
and  sing  hymns,  and  the  brahmins,  standing  before  the  idol,  fan  the  god  with 
the  punkah,  (fans).  They  attach  cords  to  the  car,  of  such  length,  that  the 
thousands  of  Indians  who  lay  hold  of  them,  may  draw  it.  While  on  its  course, 
which  is  one  of  about  twenty  miles,  the  devotees  precipitate  themselves  before 
it,  and  are  crushed  (to  the  number  of  from  four  to  five  hundred),  beneath  the 
wheels  of  the  car,  while  nothing  impedes  its  progress.  Others  make  inci- 
sions in  their  arms,  upon  their  legs  or  over  the  whole  body,  and,  dripping  with 
blood,  brave  the  intense  heat  of  the  sun,  together  with  their  pain,  and  follow 
the  procession,  uttering  cries  of  joy. 

Political  leaders  have  sometimes  borrowed  their  supports  from  religious 
ideas,  in  order  the  better  to  cherish  a  contempt  for  death,  in  the  hearts  of 
people  exposed  to  frequent  wars,  or  who  have  become  conquerors.  Odin, 
being  conscious  that  his  end  was  approaching,  transfixed  himself  with  an  ar- 
row, in  presence  of  his  friends  and  lieutenants,  saying  to  them  that  he  was 
going  to  Scythia,  to  precede  them  at  the  banquet  of  the  gods.  The  Scandi- 
navians were  accustomed  to  throw  themselves  from  the  top  of  a  rock,  in  order 
to  free  themselves  from  the  infirmities  of  old  age  ;  persuaded  that  if  they  de- 
voted themselves  to  death,  they  should  occupy  a  more  distinguished  place  in 
the  Valhalla.  The  same  was  true  among  the  Abyssinians.  These  victims  of 
ignorance  and  of  errors,  both  religious  and  political,  were  not,  certainly,  sui- 
cides. They  all  yielded  to  the  beliefs,  usages,  prejudices  and  customs  of  their 
respective  countries,  which  are  often  more  powerful  than  even  the  instinct  of 
self-preservation.  Christianity,  by  dissipating  pagan  errors,  removed,  wherever 
it  penetrated,  the  opinion  that  it  is  lawful  to  take  one's  own  life  in  honor  of 
the  divinity,  and  proscribed  this  custom  ;  causing,  at  the  same  time,  to  cease, 
the  offering  of  human  sacrifices,  which  defiled  the  worship  of  the  gods. 


SUICIDE  PROVOKED  BY  THE  PASSIONS. 

A  few  words  will  satisfy  the  most  incredulous,  that  the  passions,  when 
strongly  excited,  ever  produce  disturbance,  either  in  the  organism  or  under- 
standing of  man.  When  the  soul  is  strongly  moved,  by  a  violent  and  unexpect- 
ed affection,  organic  functions  are  perverted,  the  reason  is  disturbed,  the  indivi- 
dual loses  his  self-consciousness,  is  in  a  true  delirium,  and  commits  acts  the 
most  thoughtless  ;  those  most  opposed  to  his  instinct,  to  his  affections  and  in- 
terests. Thus,  terror  often  takes  away  the  thought  of  flight,  and  urges  its  vic- 
tim into  perils,  greater  than  the  danger  he  would  shun.  Love  deprives  him 
who  is  powerfully  impressed  by  it,  of  all  those  qualities  proper  for  the  ac- 
complishment of  his  desires  ;  while  anger  and  jealousy,  lead  the  man  who  is 
endowed  with  the  mildest  disposition,  to  imbrue  his  hands  in  the  blood  of  his 
best  friend.     A  sudden   and  unexpected  trial,  love  betrayed,  ambition  disap. 


SUICIDE.  257 

pointed,  honor  compromised,  the  loss  of  fortune,  by  overthrowing  the  reason, 
deprive  man  of  the  power  of  reflection.  Does  the  delirium  of  the  passions 
permit  man  to  reflect  ?  Do  not  all  laws  acquit  him  who  has  committed,  dur- 
ing the  first  transports  of  a  violent  passion,  an  act,  which  would  have  been 
criminal  had  it  not  been  for  this  circumstance  ?  The  actions  of  a  man, 
transported  by  a  sudden  passion,  are  regarded  as  performed  without  free 
agency  ;  and  are  judged  of,  as  the  effect  of  a  temporary  delirium.  Strong 
men,  of  a  sanguine  temperament,  of  great  susceptibility,  and  of  an  irascible 
disposition,  are  impelled  to  suicide  by  an  impulse  so  much  the  more  strong, 
as  the  impression  has  been  unexpected  ;  and  the  passion  a  social  one,  sudden- 
ly called  into  exercise.  But  the  acute  delirium  provoked  by  the  passions,  is 
temporary,  and  the  suicide  which  it  provokes  is  promptly  executed.  If  not 
consummated,  the  impulse  is  not,  ordinarily,  renewed.  The  fruitless  attempt 
seems  to  have  been  the  crisis  of  the  moral  affection.  The  involuntary  and 
acute  form  of  suicide  is  very  different  from  that  which  is  chronic,  and  the 
result  of  premeditation.  Examples  of  acute  suicide  produced  by  disorder  of 
the  passions  are  so  frequent,  that  it  will  be  sufficient  for  me  to  point  out  a 
small  number  of  them.  The  trustee  of  the  fortunes  of  his  fellow-citizens, 
loses  at  play  the  money  that  has  been  committed  to  his  care.  His  honor  is 
lost,  and  he  blows  out  his  brains. 

A  merchant  meets  with  a  considerable  loss.  Fearing  that  he  shall  not  be 
able  to  fulfil  his  engagements,  he  goes  and  drowns  himself  A  shoemaker, 
forty-five  yearg  of  age,  dwelling  near  the  Place  du  Louvre,  enjoying  good 
health,  and  doing  a  very  prosperous  business,  had  passed  the  day  with  his 
family.  Very  early  on  the  following  morning,  he  opens  his  shop,  and  goes  to 
drink,  as  was  his  custom,  a  glass  of  brandy  at  the  store  of  the  grocer,  his 
neighbor.  He  returns,  and  about  ten  minutes  afterwards,  his  workmen,  on 
coming  in  to  their  labor,  find  this  unhappy  man  prostrate  in  his  back  shop. 
He  had  laid  open  his  abdomen  with  a  shoe  knife,  and  the  intestines  had  fallen 
from  this  cavity.  We  were  informed  that  he  had  lost,  two  or  three  days  pre- 
viously, a  considerable  sum,  and  that  he  had  nothing  left  wherevvith  to  fulfil 
the  engagements  which  he  had  contracted  for  the  day  on  which  he  destroyed 
himself,  which  was  the  last  of  the  month,  1820 

Mad'e  G.,  who  had  just  married  a  young  man  to  whom  she  was  attached, 
has  a  violent  altercation  with  her  mother  respecting  her  husband.  She  went 
out  hastily.  Not  seeing  her  return,  her  sister  was  sent  to  look  after  her.  On 
passing  near  the  Rhone,  the  child  saw  the  garments  of  her  sister,  floating  on 
the  surface  of  the  river.  Her  mother,  who  had  followed  at  no  great  distance, 
at  this  sight,  escapes  from  those  who  were  called  together  by  her  cries,  and  at 
once  follows   her   unhappy  daughter.     (Vide  Matthey  Diseases  of  the  Mind). 

Mad'e  S.,  about  thirty-two  years  of  age,  surprises  her  husband  in  company 
with  her  sister.  The  latter  deliberately  insults  her.  She  immediately  declares 
to  her  husband  that  he  shall  no  longer  have  a  wife,  and  throws  herself  from 
a  very  low  window.  It  only  caused  certain  slight  contusions.  They  hasten 
to  her  assistance.  While  they  are  carrying  her  to  her  bed,  she  groans,  and 
expresses  much  regret  that  she  has  not  accomplished  her  designs,  and  repeat- 
edly assures  them  that  the  attentions  they  are  lavishing  upon  her  are  of  no 
avail.  They  offer  her  drink,  but  she  refuses  it,  as  well  as  the  nourishment 
which  is  brought  to  her.  She  replies  to  no  question.  Her  husband  testifies 
the  most  sincere  regret  and  affiection.  Far  from  yielding  to  his  solicitations, 
whenever  he  approaches  her  bed,  or  speaks  to  her,  her  appearance  changes, 
and  she  becomes  convulsed.  She  passes  six  days  in  this  condition,  nor  does 
any  thing  succeed  in  overcoming  her  resolution  to  take  no  nourishment.  I 
was  called  on  the  sixteenth  day.  The  patient  was  very  much  enfeebled,  her 
eyes  were  haggard,  the  pulse  feeble,  frequent  and  intermittent,  and  the  skin 
hot.     The  patient  complained  of  no  pain,  but  sighed  profoundly.     She  replied 

33 


258  SUICIDE. 

to  my  questions  by  nods.  I  induce  her  to  swallow  three  spoonfuls  of  sugared 
water,  which  she  does  with  great  difficulty.  After  this  she  is  unwilling  to  take 
any  thing.  The  next  day  she  expires,  after  a  general  perspiration  of  some 
hours.  Lucretia  cannot  survive  the  outrage  which  Sextus  has  committed,  and 
sheathes  a  poniard  in  her  breast.  The  Roman  generals,  in  their  civil  wars, 
were  accustomed  to  take  their  own  lives  after  the  loss  of  a  battle ;  ashamed 
of  their  defeat,  and  unwilling  to  submit  to  the  authority  of  the  victor. 

But  the  most  violent  passions  do  not   always  impel  the  passionate  man   sud- 
denly to  the  commission  of  acts  of  fury.     When  the  passion  is  primitive,  or 
the  moral   impression  has   been   foreseen,  its   action   is   less   rapid,  especially 
when   it  operates  upon  enfeebled    subjects,  or  those  of  a  lymphatic  tempera- 
ment.    The  secret  prey  of  hatred  and  jealousy,  and  of  miscalculations  with 
respect  to  schemes  of  ambition  and  fortune,  man   arrives  slowly,  and  by  suc- 
cessive paroxysms,  to  the  most  fatal  resolutions.     Although  acting  slowly,  the 
passions  do  not  less  enfeeble  the  organs,  nor   less  disturb  the  reason.     They 
are  not  less  likely  to  destroy  life,  and  when   time  is   still  afforded  to  relieve 
these  wretched  beings  from  their  peculiar  fury,  they  present  all  the  features 
of  despair,  as  well   as  the  characteristics  of  lypemania.     Many  have  made  at- 
tempts upon  their  lives,  without   knowing  what  they  were  doing  ;   and  many 
have  assured  me,  that  they  recollected  nothing  that  they  had  done.     Many 
also,  had  singular  hallucinations.     This,  though  voluntary  suicide,  is  chronic. 
It  is  to  this  variety,  that  we  are  to  refer  that  form  of  suicide  which  is  resolved 
upon  through  hatred  or  weariness  of  life  ;  which  last,  appears  to  me  to  offer 
important  considerations.     Chronic  suicide  has,  more  particularly,  given  rise 
to  discussions   respecting  the  criminality  of  self-murder,  because  it  presents 
the  characteristics  of  a  premeditated   act.     It  is   not,  perhaps,  so  much  with 
respect  to  the  act,  in   itself  considered,  that  this  dissidence  exists  ;  for  it  is 
certain,  that  up  to  the  moment  of  its  execution,  he  who  attempts  his  own  life, 
almost  always  resembles  a  man  in  a  state  of  despair,  connected  with  delirium. 
Physical  suffering,  which  often   leads  to  lypemania  and   hypochondria,   also 
causes  suicide.     It  changes  the  sensations,  concentrates  the  attention,  impairs 
the  courage,  and  destroys  the  reason,  by  modifying  the  sensibility  so  as  to  ac- 
cord with  the  prevailing  passions.     Its  action  however,  is  slower  than  that  of 
moral  suffering,  and  rarely  provokes  self-murder.     The  man  to  whom  physical 
suffering  leaves   no  moment  of  relief,  who  perceives  not   the  limit  of  a  long 
and  cruel  malady,  after  having  at  first  supported  his  ills  with  resignation,  at 
length   becomes   impatient.     Overcome  by  sufferings  which   have  for   a  long 
time  enfeebled  him,  he  takes  his  life,  to  put  an  end  to  these  intolerable  evils. 
He  considers  that  the  pain  of  dying  is  but  temporary,  and  yields  to  premedi- 
tated despair.     It  is  the  same  moral  condition,  that  determines  the  suicide  of 
hypochondriacs ;  all  of  whom  are  persuaded   that  their  sufferings  are  greater 
than  one  can  conceive,  and  are  never  to  terminate  ;  partly,  on  account  of  their 
extraordinary  nature,  and  in  part,  in  consequence  of  the  impotence  of  art,  or 
the  ignorance  of  physicians.     There  is  no  condition  which  inspires  more  fear 
of  death,  and  stronger  desires  to  be  relieved  from  present  sufferings,  than  hy- 
pochondria.    Hypochondriacs  fear    to  die,  from  pusillanimity  ;  they  dread  to 
live,   from   weakness.      Finally,    hypochondriacs    converse    much    respecting 
death.     They  often   demand   it,  at  the   hands  of  those  who  are  about  them. 
They  make  attempts,  but  rarely  do  they  accomplish  their  purposes  ;  the  slight- 
est motives,  the  least  pretext,  causing  them  to  delay,  or   abandon  their  pur- 
poses.    They  resemble  poltroons  who  talk  loudly,  in  order  that  they  may  be 
regarded   as  men  of  courage.     The  father  of  Licinius  Ca;cinius,  of  pretorian 
rank,  overcome  by  the  pain  and  weariness  attending  a  long  sickness,  takes  a 
large  dose  of  opium.     Haslam   mentions  the  case  of  a  man  who  took  his  own 
life,  being  no  longer  able  to  endure  the  sufferings  of  the  gout. 

A  girl,  sixteen  years  of  age,  when  on  the  point  of  being  violated  by  her 


SUICIDE.  259 

own  father,  experienced  such  a  degree  of  horror  at  the  thought,  that  she  had 
violent  convulsions.  The  next  day  but  one,  she  took  at  once,  an  opiate  po- 
tion, prepared  for  several  days.  The  symptoms  that  supervened  were  very 
serious,  and  she  remained  subject  to  nervous  attacks,  very  frequent  and  vio- 
lent in  their  character.  Two  years  afterwards,  tired  of  this  condition,  she 
swallowed  fifteen  grains  of  tartar  emetic.  She  vomited  much,  and  the  con- 
vulsions were  auo-mented.  She  was  sent  to  Paris  when  nineteen  years  of  ao-e. 
She  was  tall,  of  a  pretty  full  habit,  and  of  a  rosy  complexion.  However,  she 
experienced  almost  constant  sufferings,  and  convulsions  the  most  varied  and 
peculiar.  She  was  successively  blind,  deaf  or  dumb,  and  incapable  of  walking 
or  swallowing.  This  state  persisted,  sometimes  for  some  hours,  at  others,  for  a 
day,  and  even  two  days  in  succession.  Sometimes  her  tongue  projected  two 
inches  from  her  mouth,  and  was  tumefied.  At  other  times,  the  patient  could  not 
swallow,  whatever  efforts  she  might  make.  In  one  instance,  she  passed  seven 
days  without  being  able  to  take  any  thing.  I  have  seen  her  fall  at  full  length 
upon  the  floor  ;  now  upon  her  back,  and  now  her  face.  I  have  seen  her  turn 
round  and  round  for  an  hour,  without  its  being  possible  for  four  persons  to 
prevent  it.  I  had  applied  a  blister  to  the  left  leg,  and  when  she  became  blind, 
deaf,  mute,  or  incapable  of  motion,  the  application  of  a  single  drop  of  vinegar 
upon  the  blistered  surface,  suddenly  restored  her  sight,  hearing,  speech  and 
power  of  motion.  After  fifteen  days,  this  measure  ceased  to  be  of  use.  All 
concluded  that  this  patient  was  hysterical.  So  often  was  she  told  of  the  bene- 
fits that  matrimony  would  produce,  that  at  length  she  permitted  herself  to 
be  drawn  into  it,  solely  for  the  sake  of  being  cured  thereby.  After  seven  or 
eight  months,  seeing  no  chancre  in  her  condition,  she  swallowed  twelve  grains 
of  tartar  emetic.  She  made  the  most  violent  vomitive  efforts,  and  rai.sed  a 
little  blood.  However,  she  recovered  from  the  consecutive  symptoms,  but  not 
from  her  nervous  troubles.  In  a  state  of  despair,  she  disappeared.  Her  rela- 
tives and  friends  believed  that  she  had  drowned  herself  Four  months  after- 
wards, while  passing  near  St.  Martin's  gate,  I  felt  myself  seized  by  the  collar 
of  my  coat,  and  made  a  strong  effort  to  disengage  myself:  "  You  shall  not 
escape  me,"  said  a  voice  which  I  recognized ;  I  turn,  and  exclaim  ;  "  what 
are  you  doing.  Mademoiselle?  "I  am  cured.  Have  I  not  done  every  thing  for 
my  restoration  to  health  ;  and  endeavored  in  vain  to  terminate  my  deplorable 
existence  ?  Has  not  every  one  frequently  afiirmed,  yourself  among  others, 
that  marriage  would  cure  me,  whoever  might  be  willing  to  form  that  connec- 
tion with  me  ?  Well,  if  the  horrible  remedy  which  I  am  now  employing  does 
not  cure  me,  I  will  throw  myself  into  the  river."  This  wretched  being  was 
clad  in  the  tattered  garments  of  the  most  abject  prostitution,  was  reduced  to 
the  greatest  misery,  and  often  without  the  means  of  satisfying  the  most  press- 
ing wants  of  nature.  Six  months  afterwards,  she  had  an  abortion,  and  her 
nervous  difficulties,  the  convulsions  and  phenomena  described  above,  were, 
after  this  event,  less  intense  and  frequent.  A  year  subsequently,  that  is  to 
say,  twenty-two  months  after  she  began  the  life  of  a  prostitute,  she  was  con- 
fined. From  that  period,  almost  all  the  symptoms  disappeared.  She  retired 
to  the  house  of  a  female  domestic  who  had  served  her,  and  on  her  arrival  at 
Paris,  was  perfectly  restored.  She  begged  permission  to  return  to  her  family, 
was  sometime  afterwards  married,  and  became  the  mother  of  four  children. 

When  maniacs  commit  self-murder,  they  do  it  without  reflection.  They 
usually  throw  themselves  from  a  height ;  a  circumstance  which  proves  that 
they  obey  a  blind  impulse,  by  the  employment  of  a  means  the  most  easy  and 
accessible.  Maniacs  are  affected  by  illusions;  perceive  imperfectly  the  rela- 
tions of  things,  and  are  often  pursued  by  panic  terrors.  They  are  the  sport 
of  their  sensations,  or  of  the  hallucinations  which  constantly  deceive  them. 
One,  wishing  to  descend  the  stairs,  and  believing  that  he  is  opening  the  door 
of  his  apartment,  opens  the  window,  and  precipitates  himself  to  the  ground. 


260  SUICIDE. 

Another,  estimating  distances  imperfectly,  and  believing  that  he  is  on  the 
ground  floor,  throws  himself  out  of  the  window.  This  latter  person,  wishes 
to  do  violence  to  a  woman  who  waits  upon  him,  and  throws  himself  from  the 
stair-way  of  the  third  story,  hoping  to  arrive  at  the  bottom  before  she  escapes 
his  pursuit.  A  maniac,  impelled  by  hunger,  was  accustomed  to  eat  whatever 
came  in  his  way.  He  dies  suddenly,  and  on  examining  his  body,  they  find  a 
spunge  that  he  had  devoured,  and  which  rested  in  the  oesophagus.  Some  ma- 
niacs destroy  themselves  while  endeavoring  to  perform  feats  of  strength  and 
address.  There  are  maniacs  who  suffer  from  a  violent  cephalalgia,  and  who, 
by  striking  their  heads  against  the  walls,  experience  relief  Others  believe 
that  they  have  some  foreign  body  in  the  cranium,  and  hope  to  remove  it  by 
opening  the  head.  We  have  seen  them  destroy  life  by  smiting  themselves  for 
this  purpose.  Maniacs  also  destroy  themselves  at  the  commencement  of  the 
disease,  driven  to  despair  by  the  moral  affection  which  has  caused  the  deliri- 
um, or  coincided  with  its  explosion ;  the  recollection  of  this  affection,  not  be- 
ing destroyed  by  the  delirium,  which  has  not  yet  invaded  the  entire  understand- 
ing. This  class  of  patients  also  take  their  lives,  because  they  have  a  know- 
ledge of  the  disease  which  is  commencing,  and  which  plunges  them  into  des- 
pair. There  are  those  who  destroy  themselves  during  convalescence  from 
mania,  rendered  desperate  by  the  excesses  they  have  committed,  or  ashamed 
of  having  been  insane.  Finally,  (we  must  confess  it),  there  are  those  who 
destroy  life  while  making  efforts  to  disengage  themselves  from  means  of  re- 
straint, unskilfully  applied,  or  to  escape  from  places  in  which  they  had  been 
confined.  Those  who  are  suffering  from  a  fever,  in  their  delirium  destroy 
themselves,  like  maniacs. 

Every  case  of  monomania  may  lead  to  self-murder ;  whether  the  monoma- 
niac obey  his  illusions  or  hallucinations,  or  fall  a  victim  to  a  delirious  passion. 
A  monomaniac  hears  an  internal  voice,  which  is  constantly  repeating ;  slay 
thyself,  slay  thyself;  and  he  takes  his  life,  in  obedience  to  a  superior  power, 
whose  mandate  he  cannot  disobey.  A  man,  whose  brain  was  deranged  by 
some  obscure  and  mystical  notions,  believed  that  he  was  in  communication 
with  God.  He  hears  a  celestial  voice  which  says  to  him  :  My  son,  come  and 
sit  dmvn  at  my  side.  He  springs  from  the  window,  and  fractures  a  leg. 
Whilst  they  are  raising  him  up,  he  expresses  much  astonishment  at  his  fall, 
and  particularly  on  finding  himself  wounded.  A  soldier  hears  an  organized 
hurdy-gurdy.  He  thinks  he  is  listening  to  celestial  music,  and  at  the  same 
time  sees  a  luminous  chariot,  which  is  coming  to  bear  him  away  to  heaven. 
He  very  seriously  opens  the  window,  extends  a  leg  to  enter  the  car,  and  falls 
to  the  ground. 

M.  A.,  of  a  bilious-sanguine  temperament,  was  addicted  to  onanism  from 
childhood,  though  it  did  not  impair  the  development  of  his  physical  and  intel- 
lectual faculties.  He  was  endowed  with  a  very  active  imagination,  followed 
Bonaparte  into  Egypt,  and  held  there  an  important  office.  At  about  the  age 
of  thirty-two,  some  years  after  his  return  to  France,  he  was  stricken  with  apo- 
plexy, the  effects  of  which  were  dissipated  by  abundant  bleedings.  Some 
years  later,  he  fell  from  a  horse,  wounding  his  head  severely.  This  was  fol- 
lowed by  a  furious  delirium,  of  six  weeks'  duration.  From  that  period,  he 
manifests  a  slight  degree  of  aberration  of  mind,  and  becomes  difficult,  queru- 
lous, and  subject  to  transports  of  anger.  After  two  years,  he  suddenly  resigns 
a  very  important  post,  on  pretext  of  devoting  himself  entirely  to  a  project 
which  he  had  long  before  conceived,  and  which  consisted  in  uniting  all  people 
under  the  government  of  the  Emperor.  From  that  period,  either  from  regret, 
or  from  want  of  occupation,  the  ideas  became  more  disturbed,  and  he  sets 
himself  to  tracing  upon  paper,  the  plan  of  an  edifice,  which  shall  have  as  ma- 
ny compartments  as  there  are  different  tribes  of  men ;  with  a  centre,  for  the 
chief  of  all  the  assembled  people.     This  plan  was  made  and  re-made,  drawn 


SUICIDE.  261 

and  drawn  again,  several  times,  with  the  addition  of  innumerable  and  very 
inexact  calculations.  Two  years  pass  away,  in  the  most  persevering  occupa- 
tion, in  order  to  finish  the  plans,  and  to  submit  them  to  new  calculations.  He 
now  experiences  a  keen  moral  affection.  He  is  anxious  to  execute  his  pre- 
tended project,  and  begins,  by  causing  his  chateau  to  be  pulled  down,  and  mak- 
ing a  smooth  place,  in  order  to  construct  the  foundations  of  the  new  edifice. 
Every  representation  which  is  made  with  respect  to  his  project,  excites  his 
anger.  After  several  acts  of  violence,  always  provoked  by  the  obstacles  which 
he  experiences  in  the  execution  of  his  design,  he  is  brought  back  to  Paris, 
half  pleased  and  half  sad,  at  the  idea  of  entirely  abandoning  his  preparations 
He  then  persuades  himself  that  he  ought  to  perform  some  brilliant  act.  In 
order  to  prove  that  he  has  received  a  special  mission,  and  to  control  public 
opinion,  he  assembles  together  the  poor,  seats  them  at  table,  and  serves  them 
as  a  domestic.  He  throws  himself  into  the  Seine  from  the  Pont  Neuf,  and 
regains  the  shore  without  accident.  This  first  proof  confirms  him  in  his 
opinion.  The  next  day  he  goes  into  the  streets,  throwing  himself  beneath 
the  wheels  of  the  heaviest  carriages,  assuring  all  that  he  cannot  be  wounded. 
The  day  following,  they  prevent  him,  when  about  to  jump  from  the  window  of 
his  chamber.  Whilst  they  bear  him  to  his  bed,  he  bitterly  deplores  the  ill 
success  of  his  efforts,  and  complains  that  they  do  not  understand  him,  and  of 
the  obstacles  which  they  oppose  to  his  designs.  He  is  placed  in  a  house  devot- 
ed to  the  insane.  He  several  times  endeavored  to  perform  extraordinary  feats, 
which  would  compromise  his  life,  and  always,  to  prove  his  mission.  At  length 
he  was  convinced  that  they  would  permit  him  to  make  no  further  attempts. 
Well,  said  he  one  day,  since  they  prevent  me,  I  will  do  nu  more.  He  engages 
in  writing  out  upon  the  walls,  and  on  paper,  his  project  for  the  reunion  of  all 
people.  By  degrees,  his  sentences,  even  upon  this  subject,  indicate  less  con- 
nection and  coherence  of  thought.  Five  years  after  his  first  attempts  at  sui- 
cide, he  writes  words,  whose  letters,  instead  of  being  placed  horizontally,  are 
written  one  above  the  other  ;  or  else  he  makes  figures  without  order,  to  which 
he  gives  strange  appellations.  He  is  however  rational,  when  he  speaks  of 
things  foreign  to  his  delirium.  He  is  so  entirely  occupied  in  writing  his  let- 
ters, words,  lines  and  figures,  which  he  calls  his  work,  that  he  rises  at  earliest 
dawn,  and  sometimes  refuses  to  eat;  pretends  to  be  more  entirely  engrossed 
than  any  other  man,  retires  reluctantly,  and  speaks  of  his  labor  as  a  man  de- 
voted to  study,  or  to  a  most  important  undertaking,  would  do.  During  the 
heats  of  summer,  he  suffers  from  nervous  agitation,  when  he  cries  both  night 
and  day ;  speaks  of  his  undertaking,  and  complains  of  not  being  able  to  exe- 
cute it.  He  has  not  again  made  the  slightest  attempt  to  establish  his  mission. 
Dr.  Marc  has  made  us  acquainted  with  the  following  case,*  published  by  Dr. 
Ruggieri,  an  apothecary  at  Venice.  It  indicates  the  influence  of  lypemania, 
over  the  determination  to  self-murder,  and  the  obstinacy  of  those  patients  who 
are  subjected  to  it.  Matthew  Lovat,  a  shoemaker  of  Venice,  who  was  con- 
trolled by  certain  mystical  notions,  castrated  himself,  and  threw  the  genitals 
out  of  the  window.  He  had  prepared  himself  beforehand,  with  every  thing 
necessary  to  dress  the  wound,  and  experienced  no  serious  consequences  from 
it.  Some  time  afterwards,  he  persuaded  himself  that  God  had  commanded 
him  to  suffer  death  upon  the  cross.  He  reflected  two  years  upon  the  mode  of 
executing  his  project,  and  occupied  himself  in  preparing  instruments  lor  his 
sacrifice.  At  length,  the  day  arrives.  Lovat  crowns  himself  with  thorns, 
three  or  four  of  which  penetrate  the  skin  of  his  brow.  A  white  handkerchief, 
tied  tightly  around  the  flanks  and  thighs,  conceals  the  mutilated  parts.  The 
rest  of  the  body  is  naked.  He  takes  his  seat  upon  the  middle  of  the  cross, 
which  he  has  made,  and  adjusts  his  feet  upon  a  bracket,  which  was  attached 

*  Medical  Library,  Sept.,  1811. 


262  SUICIDE. 

to  the  inferior  branch  of  it.  The  right  foot  reposes  upon  the  left,  and  he 
transfixes  them  both,  with  a  nail  five  inches  in  length,  which  he  drives,  with  a 
hammer,  to  a  considerable  depth  into  the  wood.  He  then  transfixes  succes- 
sively, both  his  hands,  with  long  and  very  sharp  nails,  by  striking  the  heads  of 
them  against  the  side  of  his  chamber.  He  then  raises  his  hands  thus  pierced, 
and  brings  them  in  contact  with  those  which  he  had  previously  placed  at  the 
extremity  of  the  two  arms  of  the  cross,  in  order  to  cause  the  nails,  there 
placed,  to  penetrate  his  hands.  Before  nailing  the  right  hand,  he  avails  him- 
self of  it,  to  make,  with  a  sharp  shoemaker's  knife,  a  large  wound  in  the  left 
side  of  his  chest.  This  done,  with  the  assistance  of  cords  previously  prepar- 
ed, and  slight  movements  of  the  body,  he  causes  the  cross  to  slip,  which  falls 
outside  of  the  window,  and  Lovat  remained  suspended  in  front  of  the  house. 
On  the  follov/ing  day,  he  was  still  there.  The  rigrht  hand,  alone,  was  detached 
from  the  cross,  and  hung  by  his  side.  They  removed  the  wretched  man  from 
this  terrible  situation,  and  brought  him  immediately  to  the  Imperial  clinical 
college.  M.  Ruggieri  perceived  that  no  wound  was  mortal.  Lovat  recovered 
from  his  wounds,  but  not  from  his  delirium.  It  was  observed  that  durino-  the 
exasperation  of  the  delirium,  he  did  not  complain,  whilst  he  suffered  dread- 
fully, during  his  lucid  intervals.  He  was  transferred  to  the  hospital  for  imbe- 
ciles, where  he  exhausted  himself  by  voluntary  fasts,  and  died  phthisical,  April 
8th,  1806. 

Nostalgia  leads  to  suicide  The  ranz  des  vaches,  and  the  notes  of  the  bag- 
pipe, through  the  influence  which  actual  sensations  have  over  the  ideas  and 
recollections,  produce  regret  at  being  no  longer  in  the  country  of  their  birth  ; 
and  grief,  at  being  removed  from  the  objects  of  their  earliest  attachments. 
Hence,  springs  up  a  violent  desire  to  revisit  the  places  where  they  were  born. 
The  emotions  thus  awakened,  together  with  their  despair  at  being  separated 
from  those  objects  which  call  them  into  exercise,  rise  superior  to  all  other  feelings, 
and  both  Swiss  and  Scotch  soldiers  destroy  themselves,  if  they  cannot  desert. 
How  many  lypemaniacs,  who  believe  themselves  pursued  by  robbers,  or  agents 
of  government,  destroy  themselves,  in  order  to  avoid  falling  into  their  hands  ! 
Some  make  no  estimate  of  the  danger  they  run,  in  order  to  effect  their  es- 
cape ;  while  others  prefer  certain  death,  to  the  torture  and  disgrace  which  are 
preparing  for  them.  How  many,  who  believe  that  they  are  betrayed  by  for- 
tune and  their  friends,  destroy  themselves,  after  a  strugwle  of  longer  or  shorter 
duration !  They  take  their  lives  as  do  men,  whom  a  passion  urges  slowly,  to 
the  commission  of  self-murder. 

M.  B.,  about  forty-three  years  of  age,  after  having  become  exhausted  in  the 
discharge  of  public  duties,  which  are  committed  to  him,  falls  a  victim  to  an 
act  of  injustice,  and  soon  becomes  insane.  They  conduct  him,  contrary  to 
his  wishes,  to  an  estate.  He  then  persuades  himself  that  his  wife  has  de- 
nounced him,  and  that  he  is  ruined  by  the  government.  On  the  following 
day  he  shuts  himself  up  in  his  study,  places  the  barrel  of  a  fowling-piece  in 
his  mouth,  and  with  a  horseman's  pistol  springs  the  trigger.  Fortunately  the 
direction  of  the  gun  is  changed,  and  the  charge  passes  through  the  cheek, 
throwing  him  down.  His  relatives  hasten  to  him,  but  he  refuses  all  assist- 
ance. However,  they  bleed  him,  and  bind  up  his  wounds;  and  although  he 
submits  reluctantly  to  the  attentions  that  they  bestow  upon  him,  the  wound 
is  disposed  to  heal.  The  patient  testifies  the  most  violent  hatred  towards  his 
wife  ;  a  circumstance  which,  joined  to  his  delirium  and  threats  to  take  his  own 
life,  determines  his  family  to  send  him  to  Paris.  At  his  arrival,  the  wound  is 
not  cicatrized,  and  the  patient  is  sad  and  thoughtful.  He  converses  little, 
walks  about  like  a  man  absorbed  in  thouoht,  and  often  raises  his  hands  to  his 
head.  His  face  is  sometimes  flushed,  his  complexion  sallow,  constipation  is 
obstinate,  and  there  is  insomnia.  However,  he  assures  us  that  he  is  not  un- 
well, rejects  every  remedy,  and  receives  the  physicians  with  reluctance.     He 


SUICIDE.  263 

is  apparently  very  composed,  reasons  with  remarkable  correctness,  but  threat- 
ens, from  time  to  time,  to  throw  himself  from  the  window,  especially  when 
spoken  to  respecting  his  health.  At  the  expiration  of  fifteen  days,  notwith- 
standing the  most  careful  attention,  he  escapes  from  his  hotel,  and  they  find 
him  hastening  towards  the  quays  remote  from  the  centre  of  the  city,  in  order 
to  throw  himself  into  the  Seine.  He  is  then  committed  to  my  care.  After 
five  months'  retirement,  and  apparent  composure,  he  experiences  pains  in  his 
bowels,  and  cephalalgia,  which  are  exasperated  on  alternate  days.  He 
refuses  every  remedy,  never  leaves  his  apartment;  takes  no  part  in  ordinary 
affairs,  and  diverts  his  mind  neither  by  reading,  nor  any  manual  occupation. 
Notwithstanding,  he  receives  me  kindly  enough,  and  converses  willingly  on 
every  variety  of  subject,  excepting  his  own  disorder,  his  wife,  and  a  cousin 
who  had  prevented  him  from  throwing  himself  into  the  river.  No  sooner 
do  I  touch  upon  either  of  these  three  topics,  than  his  eyes  kindle,  his  face 
flushes,  he  quits  his  arm-chair,  and  walks  about  at  a  rapid  pace,  irritated, 
and  ready  to  give  way  to  his  anger.  During  the  course  of  the  fifth  month  of 
his  retirement,  and  the  sixth  of  his  disease,  he  appeared  to  me  more  accessible 
to  means  employed  for  his  diversion.  He  had  consented  to  play  a  game  at 
draughts  in  his  apartment,  and  to  take  a  laxative  drink.  I  invited  his  wife  to 
pay  him  a  visit  with  his  children ;  informing  her  distinctly  at  the  same  time, 
that  his  prejudices  against  her  had  not  ceased,  and  that  his  reception  of  her 
would  be  perhaps,  exceedingly  painful  ;  but  that  a  moral  commotion  would  be 
very  serviceable  to  him.  On  the  day  appointed,  Mad'e  B.  and  her  children, 
without  being  announced,  present  themselves  to  the  patient.  The  latter  im- 
mediately exclaims,  with  a  threatening  gesture;  "Retire,  Madam,  retire." 
The  courage  of  this  lady,  so  devoted  to  her  husband,  does  not  sustain  her. 
She  finds  herself  feeling  unwell,  and  it  is  necessary  to  assist  her  to  withdraw 
from  the  apartment.  Her  husband  retains  part  of  the  children,  speaks  to 
them  in  harsh  terms  of  their  mother,  and  shortly  after  sends  them  from  his 
apartment.  I  remain  alone  with  the  patient,  who  walks  at  a  rapid  rate,  like  a 
furious  man  who  has  not  a  word  to  utter.  After  some  minutes,  he  approach- 
es me,  who  had  remained  motionless,  seized  me  by  the  collar,  and  says  several 
times :  "  What  are  you  doing  there  like  a  post,  do  you  feel  nothing  ?  How 
can  I  fail  to  be  moved  by  this  circumstance,  of  which  I  have  just  been  a 
witness?" 

His  hasty  walk  begins  again ;  and  after  the  lapse  of  half  an  hour,  he  lies 
down  upon  his  bed,  and  I  leave  him  alone.  An  hour  afterwards,  he  is  sitting 
up  when  I  come  in  :  "  Well  said  I,  approaching  him,  you  are  more  composed, 
will  you  listen  to  the  truth  ?  Is  it  possible  that  you  could  thus  treat  the  wife  who 
adores  you  ?  She  is  in  an  alarming  condition ;  and  is  this  the  price  of  the 
consolation  that  she  has  been  accustomed  to  offer  you  ?  How  poignant  should 
be  your  regrets !"  The  patient  preserves  a  sullen  silence,  but  is  profoundly 
moved.  In  the  evening,  I  inform  him  that  I  have  conducted  his  wife  to  her 
residence,  and  left  her  in  an  exceedingly  trying  condition.  Same  silence. 
Two  days  after  this,  he  sees  his  children,  and  speaks  to  them  unkindly  re- 
specting their  mother.  On  the  same  day,  I  inform  him  that  his  wife  is  very 
ill  and  that  her  condition  is  the  result  of  the  reception  that  he  had  given  her. 
On  the  fifth  day  he  sees  his  children,  but  says  nothing  respecting  their  mother. 
During  the  day,  he  asks  permission  to  go  and  see  his  wife.  "  You  shall  not 
see  her,  sir,  said  I.  Would  you  still  aggravate  the  frighttul  condition  which 
you  have  caused  1"  These  words  are  uttered  in  a  decided  tone.  On  the  sixth 
day,  he  receives  a  visit  from  his  children,  and  is  more  affected.  He  enquires 
also,  after  his  wife.  In  the  evening,  I  inform  him  that  the  health  of  his  wife 
has  improved. 

On  the  seventh  day,  he  manifests  some  regret  at  what  has  transpired,  and 
we  converse  in  a  tone  of  confidence.     He  asks  permission  to  visit  his  wife, 


264  SUICIDE. 

which  I  grant.  At  the  hour  for  dinner,  he  says  that  he  will  dine  at  hoine, 
and  sends  me  a  note  of  invitation.  During  the  hours  preceding  and  following 
dinner,  he  conversed  with  his  wife  and  children,  on  general  subjects  and  mat- 
ters of  no  special  interest.  From  time  to  time,  however,  he  addressed  his 
wife  in  terms  of  reproach,  and  with  insolence  ;  but  in  a  voice  so  low,  and  with 
such  precautions  that  his  children  did  not  hear  his  remarks.  At  ten  o'clock, 
I  go  to  his  residence.  He  appears  gay,  receives  me  with  an  appearance  of 
satisfaction,  and  we  retire  together.  Two  days  after  this,  he  returns  to  his 
family,  where,  for  some  days,  he  is  very  irascible,  unkind  to  his  wife,  but  very 
affectionate  towards  his  children,  relatives  and  friends,  who  visit  him.  A  few 
months  later,  he  was  called  upon  to  perform  certain  very  important  duties. 
He  supports  the  disquietudes,  fatigues  and  menaces,  to  which  certain  public 
functionaries  were  exposed,  during  the  earliest  period  of  the  invasion  of  1814. 
However  excellent  might  be  his  health,  and  however  important  the  duties 
which  he  had  to  fulfil,  he  could  hear  no  one  speak  of  the  estate  where  he 
first  attempted  suicide.  He  would  not  permit  his  wife  or  children  to  go  thi- 
ther ;  and  it  was  a  year  after  his  cure  was  regarded  as  complete,  that  having 
sent  his  wife  and  children  before  him,  he  returned  to  his  province. 

An  ecclesiastic  thoughtlessly  swallows  the  seal  of  a  letter  that  he  has  just 
received.  One  of  his  friends  smilingly  said,  you  have  sealed  up  your  boioels. 
This  idea  takes  possession  of  the  mind  of  the  ecclesiastic,  and  after  two  days, 
he  refuses  all  nourishment,  convinced  that  it  cannot  pass.  They  administered 
to  the  patient,  says  Darwin,  purgatives  which  acted  powerfully,  without  effect- 
ing a  cure.  They  succeed  at  length,  with  difficulty,  in  causing  him  to  drink 
a  little  broth.  He  soon  refuses  to  swallow,  and  shortly  dies.  Was  this  an 
error  of  volition,  as  Darwin  pretends  1  Would  not  Barclay  have  said,  that 
there  was  a  vicious  association  of  ideas,  which  led  to  a  fatal  determination  1 
Weariness  of  life,  has  not  been  sufficiently  distinguished  from  hatred  of  it, 
when  writers  have  enquired  into  the  determining  motives  to  self-murder.  Not- 
withstanding, these  two  conditions  of  the  mind  are  very  different.  Hatred  of 
life  is  an  active  state,  and  supposes  a  sort  of  irritation  and  exaltation  of  the 
sensibility.  Weariness  of  life  is  a  passive  state,  the  effect  of  atony  of  the 
sensibility.  Hatred  of  life  is  frequent,  because  a  thousand  circumstances 
provoke  it.  It  spares  no  class  of  society,  and  most  frequently  attacks  men 
abounding  in  wealth  and  dignity,  because  they  possess  more  passions,  which 
are  called  into  active  exercise.  A  prey  to  vexations,  either  real  or  imaginary, 
or  to  a  chronic  passion,  man,  at  first  disgusted  with  life,  ends  by  hating  it, 
and  destroying  himself  I  ought  finally  to  state,  that  words  here  but  imper- 
fectly express  the  ideas  which  they  are  designed  to  convey,  and  that  from 
this  circumstance,  discussions  have  sprung  up  respecting  hatred  of  life  and 
desire  of  death.  In  fact,  they  have  no  aversion  to  life,  but  hate  the  sufferings 
which  traverse  it,  and  have  a  horror  of  their  uneasiness.  They  do  not  desire 
death  ;  but  wish  to  be  delivered  from  pains,  oppositions  and  vexations,  and 
have  recourse  to  death  as  the  most  certain  means.  Suicide,  determined  by 
hatred  of  life,  forms  one  of  the  distinctions  which  we  have  already  establish- 
ed. It  appertains  to  lypemaniacal  suicide,  or  to  suicide  produced  by  a  chro- 
nic passion  ;  according  as  the  causes  which  occasion  hatred  of  life,  are  real  . 
or  imaginary. 

Weariness  of  life,  the  tfcdium  vita;,  leads  to  self-murder.  Although  weari- 
ness may  be  a  passive  condition,  it  is,  in  some  instances,  not  the  less  a  motive 
of  action.  Such  has  been  the  opinion  of  many  philosophers,  and  I  have  ob- 
served, that  weariness  determined  certain  monomaniacs  to  do  what  had  ap- 
peared most  repugnant  to  them,  and  that  they  were  cured  by  efforts  made 
upon  themselves,  from  excessive  ennui.  Ennui,  at  the  epoch  of  puberty,  ori- 
ginates in  a  vague  desire,  the  object  of  which  is  unknown  to  him  who  ex- 
periences it ;   and  this  want  gives  rise  to  an  inquietude,  which  occasions  sad- 


SUICIDE.  265 

ness,  terminating  in  weariness.  The  most  common  effects  of  this  tediousness 
are,  decay,  feebleness,  and  vsometimes  suicide  :  a  phenomenon  noticed  by  Hip- 
pocrates among  young  girls,  who  either  have  not,  or  but  imperfectly,  menstru- 
ated. Ennui  recognizes  moreover  as  a  cause,  the  cessation  of  engrossing  oc- 
cupations ;  the  transition  from  a  very  active  life  to  one  of  repose  and  idle- 
ness, when  no  occupation  for  the  mind  or  affections  of  the  heart  have  been 
previously  formed.  Weariness  is  also  the  effect  of  the  abandonment,  either 
forced  or  voluntary,  of  the  fashionable  world,  and  frivolous  pleasures  ;  when 
the  individual  remains  isolated,  and  without  any  interest  whatever.  It  is  .so 
much  the  more  fatal,  when,  having  no  aptitude  for  the  arts  and  sciences,  one 
is  deprived  of  the  resource  of  pleasures,  in  consequence  of  having  abused 
them. 

Man  must  have  desires,  or  he  falls  into  a  state  of  painful  weariness.  But 
if  he  has  exhausted  his  sensibility  by  the  excessive  exercise  of  the  emotions 
and  the  abuse  of  pleasures  ;  if,  having  exhausted  all  the  sources  of  happiness, 
there  is  nothing  more  that  can  cause  him  to  feel  that  he  still  lives,  and  all 
external  objects  are  indifferent  to  him  ;  if,  the  more  means  of  self-satisfaction 
he  has  enjoyed,  the  less  numerous  are  the  new  objects  which  he  meets  with 
that  are  calculated  to  awaken  his  interest ;  man  then  occupies  a  frightful  void. 
He  sinks  into  a  state  of  satiety ;  a  terrible  weariness,  which  conducts  to  sui- 
cide. To  quit  life,  is  to  him  an  act  as  indifferent  as  that  of  leaving  a  splen- 
didly furnished  table,  when  he  no  longer  desires  food,  or  to  abandon  a  woman 
whom  he  formerly  adored,  but  whom  he  no  longer  loves.  That  form  of  sui- 
cide which  is  called  splenic,  is  chronic.  It  is  executed  with  coolness  and 
composure.  Nothing  announces  either  violence  or  effort,  like  other  forms  of 
suicide.  Finally,  those  who  suffer  from  the  spleen,  present  all  the  characte- 
ristics of  melancholy.  The  mo.st  frequent  causes  of  spleen  are  debilitating, 
and  act  upon  the  nervous  system.  Such  are  the  abuse  of  pleasures,  onanism, 
and  the  immoderate  use  of  alcoholic  drinks.  There  is  the  same  change  of 
disposition  and  habits ;  the  same  indifference  towards  the  dearest  objects ;  the 
same  physical  symptoms  ;  loss  of  appetite,  insomnia,  constipation,  emaciation 
or  oedema ;  the  same  concentration  of  the  attention  upon  a  single  idea  ;  the 
same  integrity  of  the  understanding  upon  every  other  subject ;  the  same  per- 
verseness  ;  and  the  same  dissimulation  in  the  execution  of  the  determinations 
in  the  former  as  in  the  latter. 

I  have  strong  reasons  for  believing  that  the  spleen  is  a  very  rare  disease, 
even  in  England.  We  too  often  attribute  the  suicides  of  the  English  to  weari- 
ness of  life,  because  England  is  the  country  in  which  most  frequently  the  peo- 
ple have  recourse  to  it.  The  English  without  doubt,  suffer  most  from  this 
distressing  weariness  ;  still  many  other  motives  than  this  give  rise  to  suicide 
among  them.  I  have  had  charge,  as  well  in  establishments  for  the  insane  as 
in  my  private  practice,  of  a  great  many  individuals,  who  have  either  attempt- 
ed, or  taken  their  lives.  I  have  seen  no  one  who  was  driven  to  suicide  in 
consequence  merely  of  weariness  of  life.  All  had  determinate  motives,  real 
or  imaginary  vexations,  which  led  them  to  loathe  existence.  I  have  even  been 
deceived  sometimes  in  this  respect.  A  man  in  the  enjoyment  of  a  splendid 
fortune,  had  given  himself  up  to  the  practice  of  masturbation.  Nevertheless 
he  was  strong  and  in  good  health,  and  with  no  other  cause  of  grief  than  the 
recollection  of  the  horrors  of  the  revolution,  whose  principles,  besides,  he  ap- 
proved. He  made  several  attempts  to  commit  suicide,  and  often  called  for 
pistols,  wishing  to  die  by  means  of  them.  During  the  two  years  that  I  had 
charge  of  him,  he  was  not  for  a  moment  irrational.  He  was  gay,  agreeable  and 
very  well  informed,  saying  to  me  sometimes  ;  give  me  apisfoL  Why  do  you 
wish  to  destroy  yourself?  I  am  weary  of  life.  It  was  only  after  the  lapse  of 
two  years,  that  he  acknowledged  to  me  that  he  had  hallucinations  of  hearing 
and  sight.     He  believed  that  he  was  pursued  by  agents  of  the  police.     He 

34 


266  SUICIDE. 

both  heard  and  saw  them  through  the  walls  of  his  apartment,  which,  he  add- 
ed, are  lined  with  planks  having  slides,  in  order  that  they  might  both  hear  and 
see,  what  he  said  and  did. 

I  have  often  met  with  a  variety  of  suicide,  of  which  authors  have  not  spo- 
ken ;  and  which  is  in  many  respects  analogous  to  the  spleen.  There  are  per- 
sons who,  in  consequence  of  physical  causes,  or  variable  morals,  fall  into  a 
state  of  physical  prostration  and  moral  discouragement.  They  have  little 
appetite,  a  dull  and  deep-seated  pain  in  the  head,  heat  in  the  bowels,  bor- 
borygmi  and  constipation.  Nevertheless,  their  external  appearance  indicates 
no  grave  disorder  of  the  health.  Among  women,  the  menses  are  sometimes 
suppressed.  At  a  later  period,  the  features  of  the  countenance  with  this 
class  of  patients  are  shrunken,  the  look  fixed  and  uneasy,  and  the  complexion 
pale  and  sallow.  They  complain  of  a  racking  pain  at  the  epigastrium;  of  a 
heaviness  of  the  head,  which  prevents  thought,  and  of  a  torpor  and  general 
lassitude,  which  render  effort  impossible.  They  move  not,  but  prefer  remain- 
ing in  bed,  or  sitting  quietly,  and  are  impatient  when  we  desire  them  to  take 
exercise.  They  abandon  their  ordinary  occupations,  neglect  their  domestic 
duties,  and  are  indifferent  to  the  objects  of  their  former  affections.  They  no 
longer  engage  in  business,  and  are  unwilling  either  to  converse,  study,  read 
or  write.  They  dread  society,  and  especially  the  importunities  to  which  this 
malady  exposes  them.  Weighed  down  by  a  sense  of  their  condition,  they 
entertain  gloomy  meditations  ;  and  at  length,  in  despair  on  account  of  their 
real  or  pretended  worthlessness,  which  they  believe  can  never  be  surmounted, 
they  desire  death,  call  for  it,  and  sometimes  devote  themselves  to  it ;  wishing 
to  die,  since  they  believe  that  they  can  no  more  fulfil  their  duties  towards  their 
families  or  society.  These  patients  do  not  reason  irrationally.  Their  impulse 
to  suicide  is  stronger  in  proportion  as  their  occupations  have  been  more  steady, 
and  their  duties  numerous.  I  have  seen  this  malady  continue  for  a  few  months, 
and  also  to  persist  for  two  years.  I  have  seen  it  alternate  with  mania,  and 
with  perfect  health.  Some  patients  were  for  six  months  either  maniacs  or  in 
the  enjoyment  of  good  health  ;  and  for  an  equal  period,  overcome  by  a  sense 
of  their  physical  as  well  as  intellectual  and  moral  weakness,  which  caused 
them  to  desire  death. 

M.,  thirty-two  years  of  age,  tall,  and  of  a  strong  constitution,  having  never 
been  sick  ;  the  descendant  of  a  father  who,  after  having  acquired  a  large  for- 
tune, died  in  possession  of  little  property,  had  received  a  thorough  education 
with  a  view  to  carry  on  to  its  greatest  extent,  the  trade  of  a  locksmith.  He 
is  married  at  the  age  of  twenty-seven  years,  to  a  woman  whom  he  adores. 
He  has  engaged  in  several  undertakings,  which  have  not  succeeded  ;  a  circum- 
stance which  has  too  severely  afflicted  him  ;  discouraging  and  rendering  him 
slothful,  without  however  impairing  his  health.  Although  depressed  in  mind, 
he  engaged  in  enterprises  which  promised  great  and  favorable  results.  He 
begins  his  labors  with  zeal  ;  but  at  the  expiration  of  a  month,  on  meeting  with 
slight  difficulties,  he  is  unduly  affected  by  them.  He  is  discouraged  ;  believes 
he  is  ruined  ;  incapable  of  accomplishing  any  thing ;  and  is  unwilling  to  leave 
his  bed  to  oversee  his  workmen,  or  to  direct  their  labors  ;  thinking  that  he  is 
destitute  of  those  qualities  and  the  vigor  necessary  to  bring  his  enterprises 
to  a  favorable  issue.  He  suffered  at  times  from  vertigo,  from  heat  in  the 
bowels,  and  constipation.  His  affection  for  his  wife  and  children,  together 
with  the  care  of  his  interests,  were  of  no  avail  in  relieving  his  depression  of 
mind.  He  was  impatient  even,  when  his  wife  repeated  her  advice.  He  took 
a  very  correct  view  of  his  situation,  but  made  no  effort  for  his  relief  Eight 
days  passed  thus.  Suddenly  he  was  well  ;  manifested  all  his  activity  in  his 
business,  and  all  his  aftection  for  his  family.  Relapses  occurred  ten  or  twelve 
times  at  irregular  intervals,  and  were  provoked  ordinarily  by  some  slight  oppo- 
sition, or  by  difficulties  which  would  not  have  occasioned  them  in  any  other 


SUICIDE.  267 

state  of  health.  Whilst  these  paroxysms  lasted,  the  patient  felt  dull,  and  his 
mind  was  embarrassed.  He  suffered  from  epigastric  pains  ;  remained  in  bed, 
ate  little,  and  wished  to  see  no  one.  Despair,  in  consequence  of  his  inapti- 
tude, of  being  a  burthen  to  his  family  and  of  not  being  cured,  often  urged 
him  to  suicide. 

L.,  thirty-four  years  of  age,  was   admitted  into  the  Salpetriere  Sept.  23d, 
1819.     She  was  the  offspring  of  healthy  parents,  and  had  the  small  pox  when 
eight  years  old.     She  menstruated  at  the  age  of  fifteen,  married   at   twenty, 
and   had  a  child  when  twenty-one.     After  her  confinement,  she  had   an  ulcer 
on   the  foot,  which  was  cured  at  the  expiration  of  about  six  months.     From 
that  period  she  suffered  from  cardialgia ;   at  first,  fugacious  and  slight,  then 
constant  and  very  intense  ;  attended  with  vomiting  of  food.     After  her  second 
pregnancy,  which  occurred  at  the  age  of  twenty-seven,  the  symptoms  became 
more  grave.     She  believed  that  she  had  a  cancer  of  the  stomach,  and  worried 
much  on  account  of  it.     When  about  thirty-three  years  of  age,  she  becomes 
undecided  in  her  ideas  and  actions ;    no  longer  wishing  what   she  formerly 
ardently  desired.     Her  thoughts  were  at  times  incoherent,  though  her  husband 
did  not  notice  it.     Nevertheless   the  menstrual  flow  was  natural.     After  six 
months  there  was  insomnia,  and  a  painful  sense  of  constriction  at  the  root  of 
the  nose,  paleness  of  the  face,  and  a  change  in  its  features.     Her  look  is  fixed 
and  sometimes  haggard.     She  suffers  from  pain   at  the  stomach,  and  a  sense 
of  constraint  and  obstruction  at  the  epigastrium,  which  prevents  motion.     She 
abandons  her  ordinary  occupations  and  the  cares  of  her  household.     There  is 
sadness,  tears,  voracity  or  want  of  appetite,  a  desire  and  temptation  to  sui- 
cide, produced  by  the  regret  of  being  no  longer  of  any  service  in  society,  and 
of  feeling  no  longer  any  affection  for  her  famdy.     Such  was  the  condition  of 
the  patient  at  the  time  of  her  admission  into  the  hospital.     She  was   put  upon 
the  use  of  acidulated   diluent  drinks   and  tepid   baths.     Three  months  after 
this  her  mind  was  more  composed,  and  the  patient  called  for  occupation.     She 
gives  a  more  favorable  account  of  her  situation,  but  always  complains  of  a 
fullness  and  racking  pain  in  her  abdomen,  of  menstrual   suppression,  and  ob- 
stinate insomnia.     I  prescribed  the  whey  of  Weiss,  and  a  blister  to  the  neck. 
The  irritation  produced  by  the  latter,  obliged  us  to  place  it  upon  the  left  arm. 
The  dejections,  at   first   consistent,  became  abundant ;  sleep   improved  ;   and 
hope  again  revived  in  the  breast  of  the  patient,  who  labored  with  satisfaction. 
In  February,  1820,  her  complexion  had  become  clear,  her  physiognomy  com- 
posed, and  her  ideas  more  distinct  and  ready.     On  the  twenty-third  of  March, 
she  was  restored  to  her  family,  although  the  menses  had  not  reappeared,  but 
fully  resolved   to   renew  her  usual  occupations.     She  kept   her  word.     The 
menses  were  established  during  the  month  of  April.     From  the  time  of  their 
appearance,  she  was  a  little  more  active  than  natural ;  was  more  loquacious, 
and  moved  about  more  freely ;  sought  again  the  toilet,  and  was  less  sedentary. 
In   the  month  of  Sept.  1820,  she  became  fearful  of  a  relapse,  and  experienced 
a  feeling  as  if  a  bar  extended  across  the  epigastrium,  from  one  hypochondrium 
to  the  other.     The  features  of  the  countenance  change,  and  there  is  insomnia. 
These  premonitory  symptoms  of  a  relapse  persist  for  two  months,  in  spite  of 
all  the  efforts  made  by  the  patient  in  her  own  behalf,  and  the  medicines  that 
I  advised.     In  the  month  of  December,  the  same  apathy  that  formerly  existed, 
the  same  despair   of  ever  being  able  to  accomplish  any  thing,  and  of  being 
past  cure,  lead  to  gloomy  thoughts,  and  awaken  a  desire  to  terminate  a  life, 
whose  duties  she  can  never  fulfil. 

There  are  persons  who,  amidst  fortune,  grandeur  and  pleasures,  and  enjoy- 
ing the  perfect  use  of  their  reason ;  after  having  embraced  their  relations  and 
friends,  set  their  affairs  in  order,  and  written  excellent  letters,  clip  the  thread 
of  life.  Do  they  yield  to  a  delirious  resolution?  Yes,  unquestionably.  Is  it 
not  true  that  monomaniacs   appear  rational,  until  an  external  or  internal  im- 


268  SUICIDE. 

pression  comes  in  suddenly  to  awaken  their  delirium?  Do  they  not  know 
how  to  repress  the  expression  of  their  delirium,  and  to  dissemble  the  disorder 
of  their  understanding,  so  as  to  deceive  the  most  skilful,  as  well  as  persons 
who  live  with  them  on  terms  of  intimacy  ?  The  same  is  true  of  some  indi- 
viduals, over  whom  the  purpose  to  commit  suicide  holds  complete  sway.  A 
physical  pain,  an  unexpected  impression,  a  moral  affection,  a  recollection,  an 
indiscreet  proposal,  the  perusal  of  a  book,  kindle  up  anew  the  dominant 
thought,  and  instantaneously  provoke  determinations  the  most  fatal,  in  the 
breast  of  an  unfortunate  being  who,  an  instant  previous,  was  perfectly  com- 
posed. That  then  happens,  which  took  place  in  the  case  of  the  maniac  de- 
tained at  the  Bicetre,  of  whom  Pinel  says,  that  the  revolutionists  set  him  at 
liberty,  because  he  appeared  to  them  perfectly  sane.  They  led  him  forth  in 
triumph,  as  a  victim  of  tyranny,  when  being  excited  by  the  vociferations  and 
the  sight  of  the  arms  of  his  liberators,  he  suddenly  fell  upon  them,  sabre  in 
hand. 

Does  not  the  fury  of  the  homicidal  monomaniac  burst  forth  instantaneously, 
so  that  no  antecedent  circumstance  may  have  forewarned  the  victim  ?  We 
cannot  deny  that  there  are  individuals  M'hom  a  fatal  inclination  leads  to  sui- 
cide, by  a  sort  of  resistless  charm.  I  have  never  seen  such  persons  ;  and  I 
dare  say  that  if  those  cases  had  been  more  carefully  studied,  in  which  they 
pretend  that  the  patients  obeyed  an  insurmountable  impulse,  it  would  have 
unfolded  the  motives  which  led  to  their  determination.  There  are  suicides 
as  well  as  other  insane  persons,  of  whom  we  s-peak,  as  of  unfortunate  beings, 
who  are  obeying  a  blind  destiny.  I  believe  that  many  persons  have  learned 
to  read  the  thoughts  of  these  patients,  and  proved  that  their  determinations 
are,  almost  always,  the  result  of  motives  and  the  logical  consequence  of  a 
principle,  though  it  may  be,  in  truth,  a  false  one.  There  are  persons,  how- 
ever, who,  in  the  midst  of  good  fortune,  destroy  themselves.  Voltaire,  sustain- 
ed by  certain  striking  examples,  pretends  that  it  is  those  who  are  distinguish- 
ed for  their  good  fortune  who  voluntarily  terminate  their  existence,  and  not  the 
man  who  is  the  victim  of  want,  and  compelled  to  labor  for  his  subsistence. 
This  proposition  is  false.  Misery  leads  to  suicide,  and  self-murder  is  most 
frequent  during  years  signalized  by  calamities.  Amidst  ruin  and  fiimine,  sui- 
cides are  frequent.  During  the  horrors  of  a  siege,  the  besieged  destroy  them- 
selves. Amidst  defeats,  soldiers  take  their  own  lives.  Self-murder  takes 
place  during  great  political  convulsions.  The  fortunate  of  the  age  destroy 
themselves;  but  good  fortune,  says  Jean  Jacques,  has  no  external  sign. 
To  judge  of  it,  we  must  read  the  heart  of  the  man  who  appears  to  be  happy. 

W.,  thirty  years  of  age,  and  enjoying  excellent  health,  solicits  the  hand  of 
a  young  lady  who  is  to  secure  his  happiness.  A  few  days  after  marriage,  he 
destroys  himself  It  was  neither  errors  of  regimen,  nor  good  fortune  which 
led  him  to  commit  this  act,  but  the  disappointment  of  not  having  found  his 
wife  such  as  he  had  flattered  himself  she  was. 

A  man  twenty-seven  years  of  age,  like  the  former,  married  to  a  charming 
girl,  at  the  expiration  of  six  months  after  marriage,  makes  a  thousand  at- 
tempts upon  his  life.  Because  his  wife  is  of  a  sedate  and  quiet  disposition, 
this  unfortunate  man  persuades  himself  that  she  is  unhappy,  that  he  is  the 
cause  of  her  unhappiness,  and  that  she  can  never  enjoy  herself  with  him. 
He  was  wealthy,  and  a  man  who  was  held  in  the  highest  estimation  ;  had  a 
charming  wife,  and  all  in  the  province  regarded  him  as  at  the  summit  of  hap- 
piness. Thus  the  individual  whom  we  believe  happy,  is  racked  with  inward 
griefs,  and  tortured  by  some  passion.  The  splendor  by  which  he  is  surround- 
ed, does  not  permit  us  to  see  the  anguish  of  his  soul.  A  man  who  should 
destroy  himself,  and  who  should  be  at  the  same  time  truly  happy,  would  be  a 
phenomenon  of  which  human  reason  cannot  conceive.  When  it  is  said  that 
men  most  eminent  by  their  rank,  fortune,  and  the  consideration  which  they 


SUICIDE.  269 

enjoy ;  in  fine,  that  men  in  appearance  the  most  happy,  destroy  themselves,  it 
is  true;  because  they,  more  than  others,  are  influenced  by  a  great  variety  of 
causes  which  impel  them  to  this  fatal  decision. 


SUICIDE  PRECEDED  BY  HOMICIDE. 

Who  will  ever  reveal  that  disorder  of  the  organism,  which  urges  on  the 
madman  who  desires  his  own  destruction,  to  acts  the  most  atrocious,  before 
executing  his  deplorable  resolve  ?  I  will  not  attempt  a  task  so  difficult.  The 
facts  which  acquaint  us  with  the  motives  which  determine  the  greater  part  of 
these  wretched  beings,  arc  not  few.  It  is  remarkable,  that  all  the  cases  of  sui- 
cidal monomania  which  have  been  published  previous  to  this  period,  present 
striking  analogies  one  with  another ;  and  that  they  offer  indications  of  mental 
alienation,  particularly  of  lypemania.  Almost  all  homicidal  suicides  are  lype- 
maniacs,  controlled  by  a  passion  carried  even  to  delirium  ;  but  aside  from  this, 
enjoying  the  use  of  their  reason.  Certain  motives,  more  or  less  plausible  to 
their  minds,  determine  them,  and  they  select  for  their  victims  the  objects  of 
their  strongest  attachment.  They  commit  the  homicide  with  composure,  at 
least  in  appearance.  After  having  consummated  their  purpose,  they  are  not 
disturbed,  nor  uneasy.  They  are  more  composed  after  having  committed  it 
than  before,  and  sometimes  appear  content.  Some  make  a  declaration  of 
their  crime  to  the  police  and  tribunals,  or  speak  of  it  to  those  they  meet.  Far 
from  concealing  themselves,  they  await  the  period  of  arrest,  and  demand  that 
they  may  suffer  capital  punishment.  The  form  of  suicide  which  succeeds  an 
act  of  homicide  is  usually  acute ;  sometimes  however,  it  is  chronic,  and  offers 
all  the  characteristics  of  a  reflected  and  voluntary  act.  I  have  seen  monoma- 
niacs take  their  own,  after  having  taken  or  attempted  to  take,  the  life  of  an- 
other. 

M.  H.,  twenty-seven  years  of  age,  is  for  several  days  in  a  state  of  acute 
mania.  He  falls  to  beating  with  a  chair,  a  woman  whom  they  place  near  him, 
and  whom  he  thinks  they  desire  to  make  a  substitute  for  his  mistress.  He 
wounds  her,  and  is  so  excessively  frightened  at  the  sight  of  blood,  that  he  pre- 
cipitates himself  from  the  window  of  the  fourth  story. 

A  lady,  during  an  attack  of  lypemania,  which  caused  her  to  fear  being  ar- 
rested, condemned,  and  conducted  to  the  scaftbld ;  rendered  desperate  by  the 
o-rief  which  she  thinks  she  shall  cause  her  husband,  endeavors  to  take  his  life, 
by  beating  him  on  the  head  with  a  stone,  before  destroying  her  own. 

The  Journals  reported  the  case  of  a  Belgian  lady  in  1815,  who,  after  hav- 
ing thrown  four  of  her  children  into  a  well,  precipitated  herself  into  it  after 
them.  She  would  have  subjected  a  fifth  to  the  same  fate,  had  he  not  escaped 
her.     She  had  also  sent  a  poisoned  cake  to  a  sixth,  who  was  abroad  at  school. 

Mad'e  R.,  thirty-two  years  of  age,  the  offspring  of  a  melancholic  father,  of 
a  bilious-sanguine  temperament,  at  the  age  of  eight  years  meets  with  a  fall 
upon  her  head,  from  which  she  suffered  for  a  long  time.  Her  mother  feeling 
for  her  little  attachment,  she  was  boarded  away  from  home  until  near  the  time 
of  her  marriage.  Having  menstruated  at  the  age  of  fifteen,  she  married  at 
sixteen.  At  nineteen,  a  second  pregnancy  was  succeeded  by  melancholy,  with 
some  thoughts  of  suicide.  This  condition  was  dissipated  by  a  third  pregnan- 
cy. When  thirty -one  years  of  age,  during  a  fourth  pregnancy,  she  preserved 
her  gayety,  and  enjoyed  very  good  health.  Her  confinement  was  a  happy  one, 
and  she  nursed  her  infant.  She  exhausts  herself  however,  and  becomes  ema- 
ciated. At  the  eighth  month  of  lactation,  she  becomes  sad,  impatient  and 
irritable  towards  her  husband.  She  was  heard  to  complain  that  she  had  chil- 
dren. She  is  impetuous  in  her  treatment  of  her  nursing  child.  Several  times, 
she  was  observed  to  press  it,  as  if  with  a  view  to  stifle  it.     In  one  instance, 


270  SUICIDE. 

during  the  absence  of  her  husband,  she  threw  it  out  of  the  window.  From 
that  time,  they  permitted  her  to  have  charge  of  her  child  only  while  nursing. 
Some  days  subsequently,  there  was  sadness,  insomnia  and  inappetence.  She 
was  apathetic,  and  knew  not  how  to  behave.  She  felt  incapable  of  doing  any 
thing,  deplored  her  own  and  the  misfortune  of  her  children  ;  persuaded,  that 
both  herself  and  husband  were  ruined.  She  saw  her  children  clothed  in  rags, 
running  about  the  streets,  holding  out  their  hands  for  charity.  This  thought 
filled  her  with  despair,  and  led  her  to  form  the  resolution  to  destroy  them,  and 
afterwards  herself.  However,  maternal  tenderness  maintained  its  sway.  If 
she  would  caress  her  children,  or  if  indeed  she  approached  them,  she  shud- 
dered, and  the  purpose  of  slaying  them  immediately  recurred  to  her  mind. 
A  moment  afterwards,  she  deplored  her  situation,  formed  the  resolution  to  re- 
sist these  horrible  designs,  and  responded,  by  promises,  to  the  exhortations  of 
her  family. 

After  several  months,  she  desired  to  change  her  residence :  saying,  that  if 
removed,  she  should  not  injure  her  children.  She  was  accordingly  sent  into 
the  country  among  her  friends.  She  appeared  more  composed,  and  manifested 
a  desire  to  return  to  her  children.  Her  wish  was  gratified ;  but,  a  few  days 
afi;erwards,  the  same  thoughts  awoke  again  in  her  breast,  and  she  was  sent 
back  into  the  country.  I  was  consulted  in  the  month  of  December,  and  advis- 
ed her  husband  to  keep  her  until  spring.  During  the  three  winter  months, 
she  went  and  came;  had  alternate  seasons  of  composure  and  excitement; 
was  much  emaciated  ;  and  her  complexion  was  pale.  She  swallowed  some  of 
the  oxyd  of  copper,  that  she  had  collected  by  scouring  utensils  of  this  metal, 
and  made  several  efforts  to  throw  herself  into  the  water.  One  day,  when  most 
sad,  her  mother  proposed  to  her  to  go  into  the  country  ;  "  Let  us  go  immedi- 
ately," said  she  smiling.  On  the  way,  she  was  in  very  good  spirits,  hoping  to 
find  the  rat's-bane  which  she  knew  had  been  sprinkled  about  the  house ;  but 
her  mother,  having  penetrated  the  cause  of  her  contentment,  had  sent  to  pre- 
vent it.  On  arriving  at  her  residence  in  the  country,  she  hastens  all  over  the 
garrets,  but  finds  only  a  morsel  of  the  paste  which  had  escaped  the  search  of 
the  domestics.  This  she  swallows,  without  however  suffering  any  inconve- 
nience. 

She  is  committed  to  my  care  April  10th,  1816.  Her  complexion  is  sallow, 
her  cheeks  flushed,  her  eyes  haggard.  There  is  emaciation,  a  burning  skin, 
headache,  pains  at  the  epigastrium,  obstinate  constipation,  and  pains  in  the  re- 
gion of  the  urinary  organs.  She  remains  sad  and  silent ;  and  is  tranquil  until 
nine  o'clock  at  night,  when  she  becomes  agitated,  swears,  reproaches  and  abus- 
es her  absent  husband,  and  complains  of  having  been  sent  to  Paris.  During 
this  time  her  countenance  is  very  much  flushed,  she  walks  about  rapidly  and 
with  naked  feet,  threatens  those  persons  who  surround  her,  and  howls.  No- 
thing can,  for  an  instant,  divert  her  attention,  nor  produce  composure  of  mind. 
At  five  o'clock  in  the  morning  the  paroxysm  ceases,  and  is  followed  by  an 
abundant  flow  of  tears.  At  my  visit,  she  demands  her  liberty.  "  Can  you 
have  forgotten  your  vociferations,  and  the  transports  of  the  night?"  No,  no, 
sir,  but  I  have  to  complain  of  the  ill  treatment  of  my  relatives,  and  of  my  pre- 
sent confinement,  which  is  unjust,  since  I  am  not  insane.  The  paroxysms  are 
renewed  almost  every  night,  and  at  nearly  the  same  hour ;  rarely  taking  place 
during  the  day.  They  are  announced  by  redness  of  the  face,  and  characte- 
rized by  frightful  oaths,  liorrible  cries,  and  reproaches  against  her  family  ;  by 
insults  and  threats  towards  those  who  surround  her,  and  by  pelvic  pains,  which 
exasperate  her.  I  ordered  a  laxative  drink,  and  a  vapor  bath,  daily.  From 
the  commencement  of  the  month  of  May,  I  order  a  tepid  bath  on  alternate 
days,  a  douche  during  the  bath,  and  the  vapor  bath  every  evening,  with  cold 
water  to  the  head. 

May  2.5th,  at  four  o'clock  in  the  morning,  she  has  a  paroxysm,  which  proves 


SUICIDE.  271 

to  be  the  last.  At  half  past  seven,  the  housekeeper,  to  whom  I  had  given  my 
instructions,  enters  her  apartment,  and  with  a  iirm  and  assured  tone  rebukes 
her,  and  assures  her  that  she  shall  no  longer  remain  in  her  house ;  and  finally, 
if  she  does  continue,  she  shall  spend  the  remainder  of  her  life,  and  that,  with 
the  approbation  of  all  her  friends.  The  patient  is  struck  dumb,  on  hearing 
such  language  from  a  lady  who  had  heretofore  treated  her  with  much  civility, 
and  in  whom  she  had  testified  great  confidence  during  her  lucid  intervals. 
After  some  moments  of  thoughtful  silence,  she  promises  to  make  an  effort  to 
control  herself  On  the  same  day,  she  asks  permission  to  visit  the  housekeep- 
er, but  is  refused.  The  domestics  had  been  ordered  to  observe  the  most  per- 
fect silence.  This  privation  was  continued  for  three  days,  during  which,  calm 
and  thoughtful,  she  was  accustomed  to  walk  in  the  garden,  and  was  admitted 
to  the  table  of  convalescents.  The  trial  having  passed,  on  the  28th  of  May 
I  permit  her  to  see  the  housekeeper.  On  meeting,  these  ladies  embrace,  and 
Mad'e  R.  thanks  the  matron  for  her  firmness,  and  weeps  with  her,  in  view  of 
the  dreadful  nature  of  her  disease. 

From  this  epoch,  I  observed  a  most  favorable  change.  The  patient  can 
comprehend  the  language  of  friendship  and  attachment.  She  accepted  those 
means  of  diversion  that  were  proposed,  and  I  begin  to  encourage  her,  in  op- 
position to  that  fear  which  she  entertained,  that  she  should  never  recover. 
The  Seidlitz  waters  not  relieving  the  constipation,  I  had  recourse  to  Ol.  ri- 
cini,  which  provoked  abundant  dejections.  About  the  middle  of  June,  she 
became  decidedly  convalescent.  She  was  more  cheerful,  her  sleep  was  better, 
and  the  pelvic  pains  had  ceased.  She  does  justice  to  the  tenderness  of  her 
husband,  and  the  affection  of  her  relatives,  and  desires  to  return  to  the  bosom 
of  her  family ;  yet  without  manifesting  impatience  or  obstinacy.  She  takes  a 
very  correct  view  of  her  past  condition,  and  was  grieved  in  consequence  of  it, 
but  did  not  despair.  On  taking  leave  of  us,  she  went  to  reside  among  her 
relatives ;  and  the  sight  of  her  mother  was  most  sratifyino-  to  her.  On  the 
14th  of  September,  she  was  restored  to  her  family,  and  passed  another  month 
at  Paris,  in  diversions  constantly  renewed ;  after  which  she  returned  to  her 
husband  and  family,  whom  she  regarded  with  the  same  affection  as  before  her 
illness.  One  year  subsequently,  the  husband  of  Mad'e  R.  died.  Excessive 
grief,  occupations  foreign  to  her  habits,  affairs  of  interest  which  it  was  neces- 
sary to  arrange,  together  with  the  diminution  of  the  means  of  subsistence, 
far  from  impairing  her  health,  confirmed  it  :  for  until  then,  she  felt  that  some- 
thing was  wanting,  of  the  plenitude  and  activity  of  her  faculties.  Such  is 
the  confession  which,  ten  years  afterwards,  this  lady  made  to  me,  having  had 
another  attack,  attended  with  different  symptoms,  and  continuing  longer  than 
the  preceding. 

A  lady,  thirty-six  years  of  age,  and  the  mother  of  a  family,  nursed  her  infant. 
In  consequence  of  certain  moral  affections,  she  was  seized  with  a  desire  to 
die.  But  said  she,  /  have  not  the  courage  to  take  my  own  life ;  and  in  order 
to  cause  the  law  to  reqtiire  it,  I  must  take  the  life  of  some  one  ;  and  in  fact  she 
attempted  to  slay  both  her  mother  and  children.  When  brought  to  our  hos- 
pital she  was  very  much  emaciated,  sad,  spoke  not,  refused  to  eat,  and  wished 
to  take  no  remedy.  She  presented  all  the  characterestics  of  profound  melan- 
choly. The  threat  that  she  should  otherwise  be  covered  with  vesicatories, 
induced  her  to  take  some  of  the  whey  of  Weiss,  which  relaxed  her  bowels. 
The  extract  of  bark  and  musk  were  given  for  more  than  a  month,  when 
we  returned  to  the  use  of  purgatives.  The  patient  was  less  sad,  but  often 
repeated;  "  I  must  slay  some  one,  in  order  that  I  may  die."  She  was  bathed 
during  the  intense  heats  of  summer,  and  received  the  douche  several  times 
during  the  month  of  September,  and  a  second  vesicatory  is  also  applied. 
She  appeared  at  this  time,  manifestly  better,  and  her  relatives  desired  to  re- 
move her  during  the  month  of  October.     She  was  then  emaciated,  but  her 


272  SUICIDE. 

complexion  was  clearer,  and  the  features  of  her  face  less  shrunken ;  she  took 
exercise  more  willingly,  ate  and  slept  well,  and  spoke  no  more  of  taking  the 
life  of  any  one.  Nevertheless,  the  menses  had  not  reappeared.  I  have  un- 
derstood, that  on  being  restored  to  her  family,  this  woman  had  resumed  her 
former  habits  and  enjoyed  very  good  health. 

Crichton*  cites  several  examples  of  homicidal  suicide,  taken  from  German 
authors.  Those  unfortunate  beings  who  constitute  the  subjects  of  his  obser- 
vations, being  unable  to  resolve  to  destroy  themselves,  have  taken  the  lives  of 
others,  hoping  thereby  to  be  condemned  to  death.  Examples  of  those  who, 
during  a  paroxysm  of  jealousy,  of  anger  or  revenge,  have  slain  the  object  of 
their  passion,  and  then  themselves,  are  not  rare.  We  had  at  the  Salpetriere, 
a  woman  who  desired  to  hang  herself  Her  brother,  having  become  enamor- 
ed of  his  own  sister,  on  learning  that  she  was  about  to  be  married,  stabbed 
her,  and  threw  himself  from  the  window.  A  shoemaker,  for  ten  years  a  me- 
lancholic, imagines  that  the  purchase  of  a  house  that  he  has  made,  has  been 
the  cause  of  his  own  misfortune,  and  that  of  his  wife.  During  a  fit  of  de- 
spair, he  slays  his  wife,  three  of  his  children,  and  would  have  slain  the  fourth 
had  he  not  escaped  his  rage.  After  this  horrible  sacrifice  he  lays  open  his 
own  abdomen,  and  the  stroke  not  being  mortal,  he  drew  again  the  instrument, 
and  transfixed  his  heart.  This  man  enjoyed  a  good  reputation,  and  was  of  a 
mild  disposition.  , 

Thus,  among  those  wretched  beings  who  destroy  others,  before  taking  their 
own  lives,  some  obey  those  vehement  passions  which  lead  them  quickly  to 
this  double  homicide.  Others  are  aroused  by  passions  whose  effects  are  slow 
in  manifesting  themselves.  There  are  those  who  are  unwilling  to  destroy 
themselves,  through  fear  of  eternal  condemnation  ;  knowing  that  suicide  is  a 
great  crime,  for  which  they  could  not  obtain  pardon.  They  are  however, 
certain  of  being  condemned  to  death  after  taking  the  life  of  a  fellow-beino". 
and  hope  to  have  time,  before  their  punishment,  to  reconcile  themselves  to 
God,  and  to  prepare  for  a  happy  death.  There  are  those  who  slay  the  dearest 
objects  of  their  affection,  in  order  to  preserve  them  from  the  trials  of  life  and 
the  dangers  of  condemnation.  Finally,  we  have  seen  those  who  slew  the  ob- 
jects of  their  tenderest  attachment,  being  unwilling  to  be  separated  from 
them,  and  believing  that  they  should  be  reunited  after  death.  Is  it  possible 
to  believe  that  such  a  violation  of  the  fundamental  laws  of  nature  ;  such  exal- 
tation of  the  imagination  ;  such  perversion  of  the  sensibility  ;  can  be  compa- 
tible with  the  enjoyment  of  sound  health  and  the  integrity  of  reason  ?  Must 
he  not,  on  the  contrary,  have  reached  the  extreme  limit  of  delirium,  who  re- 
solves to  take  the  life  of  the  wife  whom  he  tenderly  loves,  and  the  children 
whom  he  adores  1  Does  he  not  abandon  himself  at  once,  to  acts  most  op- 
posed to  natural  laws,  and  the  instinct  of  self-preservation?  Notwithstanding, 
many  facts  prove  that  these  unfortunate  beings,  aside  from  this  act,  both  be- 
fore and  after  its  accomplishment,  are  composed  and  rational.  Do  we  not 
observe  this  composure  and  reason  among  those  maniacs  who,  from  the 
slightest  motives,  from  the  most  trifling  opposition,  give  themselves  up  to  the 
commission  of  acts  indicative  of  the  blindest  fury  ?  It  is  not  the  si^ns  of 
delirium  on  the  part  of  those  who  commit  suicide,  that  are  wanting ;  but  ob- 
servers who  are  at  hand  to  see  all,  and  to  see  correctly. 

Reciprocal  suicide  is  that  act  by  which  two  individuals  slay,  one  the  other. 
It  is  generally  the  delirium  of  some  passion,  and  sometimes  extreme  wretched- 
ness, which  lead  those  who  are  their  victims,  to  devote  themselves  to  death. 
The  same  passion,  leading  to  the  same  determination,  finds  a  certain  charm 
in  dying  by  the  hand  it  adores.     Examples  of  this  form  of  fury  are  not  rare, 

*  An  Inquiry  on  tlie  Nature  and  Origin  of  Mental  Derangement,  London,  1798,  2  vol. 
in  8vo. 


SUICIDE.  273 

and  we  can  trace  them  back  to  the  remotest  antiquity.  The  most  memorable 
is  that  of  Arria  and  Poetus.  The  latter  was  condemned  to  suffer  death  for 
having  conspired  against  Claudius.  Arria  his  wife,  not  wishing  to  survive 
her  husband,  plunges  a  poniard  into  her  breast.  She  withdraws  it,  and  pre- 
sents it  to  her  husband,  saying :  take  it,  Pectus,  it  gives  no  pain.  Their 
daughter  was  desirous  of  imitating  her  mother,  under  similar  circumstances. 
She  opens  the  veins,  but  her  husband  who  was  condemned  to  punishment, 
entreats  her,  and  obtains  her  consent  to  survive  him  for  the  sake  of  their 
children. 

Richard  Smith,  in  1726,  presented  a  strange  spectacle  to  the  world.  He 
had  been  rich,  but  was  now  poor  and  infirm.  He  had  a  wife  and  an  infant 
child,  with  whom  he  could  share  nothing  but  misery.  Richard  Smith  and 
Bridget  Smith,  by  common  consent,  after  having  tenderly  embraced  and  given 
a  last  kiss  to  their  child,  and  slain  it,  hung  themselves  from  the  posts  of  their 
bed.  A  letter  was  found  written  by  their  own  hand  :  "  Tf  e  believe  that  God 
will  pardon  us.  We  have  resigned  our  life  because  we  icere  miserable,  and  with- 
out resources.  We  have  also  rendered  to  our  only  son  the  service  of  slaying 
him,  for  fear  that  he  might  become  as  lorctched  as  ourselves."  It  is  remarkable 
that  these  mad  people,  who  had  destroyed  their  only  child,  should  write  to  a 
friend,  to  commend  to  his  care  their  dog  and  cat ! 

In  1770,  a  young  citizen  of  Lyons,  handsome,  having  a  fine  figure,  amiable, 
and  possessed  of  superior  talents,  becomes  enamored  of  a  young  lady,  whose 
parents  are  unwilling  to  betroth  to  him.  Her  lover  ruptures  a  blood  vessel  in 
making  some  undue  effort ;  the  physicians  declare  that  no  hope  of  recovery 
remains,  and  his  mistress  provides  him  a  temporary  abode.  She  is  armed 
with  two  pistols  and  as  many  poniards.  They  embrace  for  the  last  time, — the 
triggers  of  the  two  pistols  are  attached  to  ribbons.  The  lover  holds  that 
which  is  to  kill  his  mistress,  while  the  latter  holds  the  ribbon  of  the  pistol 
which  is  to  take  the  life  of  her  lover.  Both  pull  at  a  given  signal,  and  both 
fall  at  the  same  instant.  This  example  having  become  but  too  celebrated, 
has  had,  unhappily,  many  imitators. 

Some  years  since,  the  son  of  a  justice  of  the  peace,  employed  in  one  of  the 
bureaux  of  the  Legion  of  Honor,  became  attached  to  a  young  lady,  the  daugh- 
ter of  a  wealthy  merchant.  The  parents  of  the  latter  refuse  their  consent  to 
the  marriage,  on  account  of  the  youth  of  the  suitor.  They  repair  to  the 
forest  of  St.  Germain  ;  where  the  lover,  having  blown  out  the  brains  of  his 
mistress  who  had  not  the  courage  to  destroy  herself,  suspends  himself  from  a 
tree  by  the  shawl  of  her  Avho  had  just  consented  to  die  for  him,  and  by  his 
hand. 

Madame  de  Stael,  who,  during  the  excitement  of  youth,  seemed  to  approve 
of  suicide,  condemned  it  at  a  later  period,  and  reproached  herself  for  this 
error.  In  an  essay,  or  fragment  on  suicide,  which  this  celebrated  woman  at- 
tributes to  the  pain  of  living,  we  read  the  following  example:  In  1811,  M. 
and  Mad'e  left  their  residence  and  went  to  the  inn  at  Postdam.  After  having 
sung  pieces  suited  to  the  occasion,  M.  blew  out  the  brains  of  Mad'e,  and 
destroyed  himself  immediately  after.  The  lady  had  a  father,  husband,  and 
one  daughter;  while  the  gentleman  was  an  esteemed  scholar  and  a  distinguish- 
ed officer. 

A  disposition  to  suicide  is  sometimes  feigned  ;  or,  to  speak  more  correctly, 
there  are  individuals  who  threaten  to  take  their  own  lives,  without  the  least 
intention  to  do  so.  We  sometimes  notice  this  in  society,  among  a  class  of 
people  whose  imperious  desires  lead  them  to  utter  all  sorts  of  menaces,  in 
order  to  overcome  the  resistance  which  is  opposed  to  their  wishes.  The  in- 
sane, and  more  particularly  monomaniacs,  animated  by  various  motives  ;  now, 
to  obtain  what  they  desire  ;  now,  to  afflict  their  friends ;  and  now,  from  ca- 

35 


274  SUICIDE. 

price  ;  pretend  to  desire  to  commit  self-murder.  They  are  however,  very 
careful  to  be  seen,  so  that  some  one  may  come  to  their  rescue  ;  or  so  well  ar- 
range matters,  as  to  suffer  no  harm  in  their  attempt. 

A  lady  twenty-seven  years  of  age,  among  a  thousand  extravagances,  which 
had  for  their  object  to  afflict  and  grievously  alarm  her  husband  who  loved  her 
much,  made  several  feigned  attempts  to  commit  suicide.  After  some  months 
she  was  committed  to  my  care.  Slie  wore  the  dress  of  a  man,  the  only  cloth- 
ing that  for  six  months  she  had  been  willing  to  put  on.  After  she  had  retired 
to  bed,  the  male  attire  which  she  wore  was  removed,  and  the  dress  of  a  female 
substituted  for  it.  On  the  following  morning,  she  begs  for  the  dress  she  has 
been  accustomed  to  wear,  which  was  refused  her.  She  then  springs  from  her 
bed,  threatens  the  persons  who  serve  her,  howls,  rolls  upoji,  and  strikes  her 
head  against  the  floor  of  her  chamber.  I  hasten  in  the  direction  from  which 
the  noise  proceeds.  On  seeing  me,  she  strikes  her  head  rudely,  repeating  ; 
"  I IV  ant  to  kill  myself ."  Very  well,  kill  yourself;  this  must  be  a  bad  head, 
at  least,  and  your  husband  will  be  relieved  from  a  great  source  of  annoyance. 
As  it  respects  myself,  it  is  a  matter  of  the  most  perfect  indifference.  Scarce- 
ly had  I  pronounced  these  words  in  a  threatening  tone,  when  she  rises,  and 
dresses  herself;  and,  since  that  time,  though  she  may  have  remained  as  it 
respects  her  reason,  an  insane  person,  she  has  not  once  threatened  to  destroy 
herself 

A  young  woman  was  constantly  speaking  of  destroying  herself,  and  made  a 
thousand  attempts  without  accomplishing  her  pretended  purpose.  An  old 
uncle  with  whom  she  lived,  wearied  by  her  oft-repeated  threats,  proposed  to 
her  a  walk  into  the  country,  and  conducts  her  to  the  border  of  a  pond,  and 
pretends  that  he  is  about  to  undress  himself  "  Come,  my  niece,"  said  he  to 
her,  "  throw  yourself  into  the  water,  I  will  follow  you.  Your  hatred  of  life 
is  so  great,  that  you  had  better  bring  it  to  a  close."  He  presses,  and  urges 
her  even.  After  a  long  struggle,  she  declares  that  she  does  not  wish  to  drown 
herself,  and  that  she  will  talk  no  more  about  self-murder.  She  kept  her  word. 
This  uncle,  at  the  age  of  seventy-seven  years,  became  a  maniac,  and  died  of 
apoplexy. 

Finally,  a  case  of  supposed  suicide  may  become  the  subject  of  grave  ques- 
tions in  legal  medicine.  Murderers,  in  order  to  conceal  their  crime,  have 
endeavored  to  make  it  appear  that  their  victims  had  committed  suicide.  The 
student  of  legal  medicine  ought  to  be  acquainted  with  the  signs  which  dis- 
tinguish the  dead  body  of  a  suicide  from  that  of  a  man  who  has  been  assas- 
sinated. Louis  has  written  on  this  subject.  We  read  in  his  essay,  that  a  son, 
having  robbed  his  father  of  a  sum  of  money,  strangled  him,  and  afterwards 
suspended  the  corpse  with  the  same  halter  that  he  had  employed  to  commit 
the  parricide.  Such  are  the  diverse  circumstances  which  precede,  determine 
and  signalize,  all  those  acts  by  which  man  takes  his  own  life,  whether  volunta- 
rily or  involuntarily.  They  prove  how  faulty  are  all  the  reports  that  have 
been  published  respecting  suicide,  even  those  which  have  been  drawn  up  from 
the  verbal  processes,  deposited  in  the  registers  of  the  public  authority. 
These  reports  are  of  little  service  in  elucidating  the  history  of  the  suicide  ; 
because  they  in  general  are  wanting  in  those  statements  that  are  necessary  to 
establish  the  true  cause  of  it,  and  the  motive  which  led  to  the  suicide  ;  because 
they  rarely  notice  the  physical  and  moral  state  of  individuals  who  have  de- 
stroyed themselves;  because  they  do  not  ascertain  whether  a  man,  who  is 
found  dead,  was  insane,  or  whether  he  fell  a  victim  to  a  sudden  impulse  of 
despair,  or  by  a  reflected  resolution  ;  and  because,  finally,  it  is  not  known  but 
the  subject  of  the  report  may  be  the  victim  of  an  assassin.  These  suggestions 
may  give  a  right  direction,  if  I  am  not  mistaken,  to  the  enquiries  of  a  physi- 
cian who  may  be  required  to  make  a  judicial  report,  with  respect  to  the  dead 


SUICIDE.  275 

body  of  a  man  who  is  said  to  have  committed  self-murder.  In  fine,  they  may 
be  useful  to  the  physician  who  is  charged  with  the  direction  of  an  establish- 
ment for  the  insane. 

What  precedes,  will  justify  the  remark  which  was  made  at  the  commence- 
ment of  this  article,  to  wit :  that  self-murder  is  only  a  phenomenon,  consecu- 
tive to  very  different  causes ;  that  it  cannot  be  regarded  as  a  malady  sui  gene- 
ris ;  and  that  it  is,  almost  invariably,  a  symptom  of  mental  alienation.  The 
greater  part  of  those  unfortunate  beings  who  have  made  attempts  upon  their 
own  lives,  or  who  have  committed  suicide,  belong  to  families,  some  of  whose 
members  have  been  affected  with  mental  alienation.  Most  of  those  who  have 
failed  in  accomplishing  their  designs,  remain  insane  for  a  longer  or  shorter 
period  of  time,  or  become  so  afterwards.  A  large  proportion  of  them  have 
manifested,  before  committing  the  fatal  deed,  all  the  symptoms  of  lypemania. 
Some  have  destroyed  themselves,  after  having  had  an  attack  of  mania,  subse- 
quently to  which  they  have  remained  sad  and  morose. 


CLIMATES,    SEASONS,  AGES   AND    SEX,  CONSIDERED    AS 

CAUSES  OF  SUICIDE. 

Climate,  it  is  constantly  remarked,  exercises  a  remarkable  influence  in  the 
production  of  suicide;  in  proof  of  which,  its  frequency  in  England  is  noticed; 
caused,  it  is  supposed,  by  an  atmosphere  surcharged  with  humidity,  and  by 
fogs.  But  have  they  reflected  upon  the  fact,  that  suicide  was  unknown  in 
Great  Britain  at  the  time  of  its  conquest  by  the  Romans,  whilst  it  was,  at 
that  epoch,  frequent  in  Italy  ?  Climates  have  remained  the  same  ;  but  mo- 
rals, civilization  and  opinions,  have  changed;  and  these  are  the  causes  which 
powerfully  affect  the  frequency  of  mental  maladies.  Do  not  the  Dutch  live 
in  a  climate  still  more  humid,  and  as  foggy  as  that  of  England  ?  Notwith- 
standing, suicide  is  less  frequent  in  Holland  than  elsewhere.  The  climate  of 
Copenhagen  has  not  changed  ;  yet  suicides  have  progressively  doubled  within 
forty  years.  At  Berlin,  the  suicides  within  a  century  have  augmented  in  a 
deplorable  proportion.  Are  not  suicides  more  frequent  during  certain  years 
and  seasons,  in  the  same  country  and  city,  though  the  climate  has  not  chang- 
ed ?  In  the  spring  of  1811,  there  were  many  suicides  in  Paris.  Dr.  Rech* 
of  Montpellier,  has  written  me,  that  during  the  year  1820  more  suicides  oc- 
curred in  that  city  than  in  the  preceding  twenty  years.  I  am  not  disposed  to 
deny,  that  a  cloudy  and  sombre  sky  disposes  to  sad  and  melancholy  thoughts, 
and  may,  with  propriety,  be  ranked  among  the  causes  which  give  rise  to  su- 
icide. But  I  believe  that  the  authority  of  Montesquieu  has  given  to  it  undue 
importance,  and  that  his  assertion  has  been  repeated  without  sufficient  consi- 
deration. It  has  also  been  frequently  said,  that  suicide  was  more  frequent  in 
autumn  than  at  any  other  season.  Cheyne,  in  England,  adopts  this  opinion, 
and  Professor  Osiander  participates  in  it,  with  respect  to  the  north  of  Germa- 
ny. Have  they  not  been  led  to  entertain  this  opinion  through  the  influence  of 
the  humoral  theories,  or  in  consequence  of  the  analogy  of  autumn  with  bru- 
mal climates  ?  The  physicians  of  Vienna  are  of  opinion  that  suicide  is  most 
frequent,  before  and  after  the  equinoxes.  Fodere  and  M.  Duglas  observed  at 
Marseilles,  that  siiicides  were  most  frequent  when  the  thermometer  rose  to 
twenty-two  degrees  (Reaumur).  During  the  month  of  August,  1822,  Dupuy- 
tren  remarked  at  his  clinic,  that  within  two  months,  the  suicides  brought  to 
the  Hotel-Dieu  were  much  more  numerous  than  during  the  preceding  years. 
The  summer  was  extremely  warm. 

*  Since  that  period,  Dr.  Rech,  Professor  of  the  Faculty  of  Montpellier,  and  having 
charge  of  the  liospital  for  the  insane,  has  issued  several  very  interesting  publications, 
respecting  the  establishment  of  which  he  is  physician,  and  upon  mental  diseases. 


276  SUICIDE. 

Ill  a  report  of  those  admitted  during  a  period  of  six  years,  into  the  division 
of  the  insane  at  the  SaJpetriere,  after  having  attempted  to  commit  suicide,  I 
find  that  these  attempts  were  most  frequent  during  the  warmest  seasons  and  in 
spring ;  and  least  so,  during  the  three  months  of  autumn.  Does  not  mental 
alienation  make  its  irruption  more  frequently  in  summer  than  at  other  sea- 
sons ?     Witness  the  followinor  statement : 

During  the  three  months  succeeding  December,  42  were  admitted. 

March,         58 
June,  (31 

September,  31 


K 
(( 


Cabanis  observed,  that  after  a  very  dry  summer,  succeeded  by  a  rainy  au- 
tumn, that  suicides  were  most  frequent  during  the  latter  season.  I  made  the 
same  observation  in  1818.  We  received  during  that  year  into  our  hospital,  a 
much  greater  number  of  suicides  than  we  had  received  in  previous  years,  or 
have  since  admitted.  In  my  private  practice  also,  I  had  at  the  same  period  a 
greater  number  of  suicides  to  treat.  Is  not  the  transition  from  a  dry  summer 
to  a  humid  autumn,  especially  favorable  to  the  development  of  abdominal  af- 
fections, upon  which  suicide  so  often  depends  1  We  do  not  charge  external 
causes  alone  with  producing  suicide.  There  are  certainly  individual  predis- 
positions, a  certain  physical  state,  which  modifies,  exalts  or  enfeebles  the  sen- 
sibility. 

The  difierence  in  the  mood  of  mind,  causes  one  man  to  laugh  at  the  most 
afflictive  events,  while  another  is  excessively  agitated,  or  filled  with  despair. 
The  latter  destroys  himself;  while  the  former  becomes  insane.  Is  not  this 
predisposition  rendered  evident  by  the  hereditary  nature  of  suicide  ?  We 
have  knov/n  entire  families  destroy  themselves,  just  as  we  have  known  whole 
families  become  insane.  Voltaire  states,  that  a  man  of  a  grave  profession,  of 
mature  age,  and  of  regular  habits,  committed  suicide  Oct.  17th,  1769,  and  left 
to  the  council  of  the  city  where  he  was  born,  a  written  defence  of  his  death. 
His  father  and  brother  had  destroyed  themselves,  at  the  same  age  with  himself. 
Is  there  not  a  certain  disease  which  develops  itself  at  the  same  age,  in  all 
the  members  of  a  family  ?  A  man,  whose  father  and  grand-father  had  taken 
their  own  lives  at  the  age  of  fifty-three  years,  began  at  the  age  of  fifty  to  be 
tempted  to  suicide,  and  was  persuaded  that  he  should  die  as  his  relatives  had 
done.  We  have  at  the  Salpetriere  a  woman  aged  sixty-three  years,  who  has 
had  a  great  number  of  attacks  of  suicidal  lypemania.  Her  daughter  has  had 
several  attacks  of  mania ;  and  her  errand-daughter,  from  the  age  of  fifteen 
years,  was  subject  to  the  same  attacks,  and  entertained  thoughts  of  suicide. 

Rush  relates  the  following  case.*  Captains  C.  L.  and  J.  L.  were  twins,  and 
so  nearly  resembled  each  other  that  it  was  impossible  to  distinguish  them. 
They  served  in  the  war  of  American  independence.  They  were  equally  re- 
markable, and  both  attained  the  same  military  rank.  They  were  gay  in  their 
dispositions,  and  happy  in  their  fiimily  alliances  and  fortune.  Capt.  C.  L.  re- 
sided at  Greenfield,  two  hundred  miles  from  the  house  of  his  brother,  who  had 
removed  to  Vermont  some  years  before.  Captain  J.  L.,  when  returning  from 
the  General  Assembly  of  Vermont,  shot  himself  with  a  pistol.  He  had  been 
sad  and  taciturn  for  some  days  previous.  About  the  same  time,  Capt.  C.  L. 
became  melancholic,  and  spoke  of  suicide.  Some  days  afterwards,  he  rises 
very  early  in  the  morning,  and  proposes  to  his  wife  a  ride  on  horseback.  He 
shaves ;  after  which,  he  passes  into  an  adjoining  chamber  and  cuts  his  throat. 
The  mother  of  these  two  brothers,  adds  Rush,  is  insane,  and  two  of  the  sis- 
ters have  been,  for  several  years,  harassed  with  the  thought  of  self-murder. 

*  Medical  Enquiries  and  Observations  upon  Diseases  of  the  Mind.  Philadelphia,  1812, 
in  8vo,  page  47. 


SUICIDE.  277 

G.,  a  proprietary,  leaves  seven  children,  with  a  fortune  of  two  millions. 
They  reside  at  Paris  or  its  environs,  and  preserve  their  respective  portions  of 
the  paternal  estate.  Some  increase  theirs  ;  while  no  one  experiences  any  seri- 
ous misfortune.  All  enjoy  excellent  health,  lead  honorable  lives,  and  are  held 
in  high  and  general  estimation.  The  entire  seven  brothers,  when  between 
the  ages  of  thirty  and  forty  years,  commit  suicide.*  Gall,  who  relates  this 
fact,  knew  a  family,  the  grand-mother  of  which,  a  sister,  and  the  mother, 
committed  suicide.  The  daughter  of  the  latter  was  on  the  point  of  hanging 
herself,  and  the  son  effected  his  death  by  this  means. 

We  have  at  the  Salpetriere  many  insane  persons,  whose  fathers,  mothers, 
brothers  or  sisters,  have  committed  suicide.  A  rich  merchant,  of  a  violent 
disposition,  is  the  father  of  six  children.  As  they  complete  their  education, 
he  gives  each  of  them  a  large  sum  of  money,  and  sends  them  away  from 
home.  The  youngest,  aged  twenty-six  or  seven  years,  becomes  melancholic,  and 
precipitates  himself  from  the  roof  of  his  house.  A  second  brother,  who  had 
charge  of  him,  reproaches  himself  on  account  of  his  brother's  death,  makes 
several  attempts  to  commit  suicide,  and  dies  a  year  afterwards,  in  consequence 
of  prolonged,  and  repeated  abstinence.  During  the  following  year,  another 
brother  has  an  attack  of  mania,  of  which  he  is  cured.  A  fourth  brother,  a 
physician,  who  two  years  before,  had  told  me,  with  looks  indicative  of  despair, 
that  he  should  not  escape  his  destiny,  destroys  himself  Two  or  three  years 
later,  a  sister  becomes  at  first  a  maniac,  and  afterwards  makes  numerous  at- 
tempts upon  her  life.  The  sixth  brother  is  at  the  head  of  a  great  commercial 
establishment,  and  would  have  terminated  his  existence  as  his  brothers  had 
done,  had  not  his  life  been  preserved,  through  the  influence  of  his  children 
and  wife,  who  was  to  him  a  guardian  angel,  both  by  her  care  and  tenderness.t 
Suicide  is  most  frequent  between  the  ages  of  twenty  and  thirty  years. 
This  is  demonstrated  by  the  report,  founded  on  the  admissions  of  women  at 
the  Salpetriere,  before,  or  after  having  made  attempts  to  commit  this  act. 

Before  the  age  of  15  years,     2 

From  15  to  20  "  16 

"  20  to  25  "  29 

"  25  to  30  "  27 

"  30  to  35  '•  27 

"  35  to  40  "  27 

"  40  to  45  "  25 

"  45  to  50  "  22 

"  50  to  55  "  7 

"  55  to  60  "  6 

"  60  to  65  "  7 

"  65  to  70  "  I 

"  70  to  75  "  2 

198 

This  makes  the  number  198,  (out  of  1898  admissions),  of  insane  women, 
received  during  six  years  at  the  hospital  of  the  Salpetriere,  who  had  made 
attempts  to  commit  suicide.     It  is  a  little  more  than  one  tenth. 

Although  suicide  manifests  itself  as  a  form  of  mental  alienation,  only  after 
the  age  of  puberty,  we  have  seen  nevertheless,  in  our  days,  school-children 
terminating  their  existence,  the  victims  of  a  vicious  education,  which  teaches 
that  a  state  of  nothingness  lies  beyond  the  limits  of  this  life,  and  that  it  is 
lawful  for  a  man  to  deprive  himself  of  his  existence,  whenever  it  becomes 

*F.  G.  Gall,  on  the  Functions  of  the  Brain.     Paris,  1825,  6  vol.  in  8vo. 

t  Some  years  after  I  first  wrote  these  lines,  this  wretched  being  destroyed  himself. 


278  SUICIDE. 

disagreeable  to  him.     We  had   at  the  Salpetriere  a  female,  who  threw  herself 
into  the  river  at  the  age  of  nine  years,  and  repeated  the  act  at  the  age  of  forty. 

Old  age,  which  inspires  man  with  the  desire  of  living,  because  his  life  is,  at 
this  period,  of  necessity  so  short,  is  rarely  exposed  to  suicide.  However,  in 
ancient  times,  when  the  stoic  philosophers  felt  themselves  growing  old,  or  sink- 
ing into  the  infirmities  of  advanced  age,  they  avoided,  by  a  voluntary  death, 
the  shame,  or  the  infirmities  of  caducity.  We  still  meet  with  some  old  men 
who,  less  desirous  of  life  than  the  generality  of  mankind,  destroy  themselves, 
or  rather,  permit  themselves  to  die. 

A  physician  of  Paris,  eighty-four  years  of  age,  experiences  a  slight  indispo- 
sition, from  which  he  is  promptly  relieved.  Some  months  afterwards,  he  finds 
himself  ao-ain  sick.  Nothing  can  induce  him,  either  to  take  care  of  his  health, 
or  make  use  of  the  least  nourishment.  By  following  your  advice,  he  was  ac- 
customed to  say  to  his  friends,  and  only  daughter,  I  can  prolong  my  days  a 
little,  but  I  must  of  necessity  soon  die.  After  an  abstinence  of  five  days'  con- 
tinuance, he  consents  to  take  the  yolk  of  an  egg,  and  a  few  moments  after 
expires.  His  daughter  becomes  insane  at  the  age  of  thirty  years.  Pomponius 
Atticus  being  sick,  subjected  himself  to  the  most  rigid  abstinence.  His  pains 
cease,  but  he  refuses  all  aliments.  He  permits  himself  to  pine  away,  saying, 
that  in  this  way  he  was  prepared  to  die  easily.  The  father  of  the  celebrated 
Barthez  allowed  himself  to  die  of  hunger  at  the  age  of  ninety  years,  in  de- 
spair at  the  loss  of  his  second  wife. 

Although  women  may  be  more  exposed  to  mental  diseases  than  men,  sui- 
cide is,  nevertheless,  less  frequent  among  them.  Observers  in  all  countries 
are  agreed  on  this  point.  The  exaltation  of  their  sensibility  ;  the  transports 
of  their  imagination;  the  exaggeration  of  their  tenderness  and  their  religious 
aifections,  produce  maladies  opposed  to  suicide,  from  which  they  are  in  a 
still  farther  degree  removed,  by  the  gentleness  of  their  disposition,  and  their 
natural  timidity.  They  suffer  from  the  vapors  and  other  nervous  diseases, 
and  become  insane.  They  take  their  own  lives,  as  has  been  remarked,  less 
frequently  than  men,  and  it  is  usually  love,  or  lypemania,  that  urges  them  to 
the  commission  of  this  act.  Hippocra,es  remarks,  that  girls  who  have  never 
menstruated,  and  young  women  with  whom  this  function  is  performed  imper- 
fectly, fall  into  a  state  of  prostration,  and  commit  suicide.  Brorson,  who  has 
written  a  treatise  on  suicide,  establishes  the  proportion  of  men  to  women,  as 
five  to  one.  According  to  a  report  made  at  the  March  of  Brandebourg,  it 
appears  that  there  are  forty-five  suicides  per  annum  ;  to  wit,  thirty-two  men 
and  thirteen  women.  A  report  made  at  Paris  during  the  years  1805-C  and 
'7,  gives  two  hundred  and  eighty-two  men,  and  one  hundred  and  thirteen  wo- 
men. A  later  report,  shows  that  there  were  during  the  first  three  months  of 
the  year  1817,  thirty-nine  suicides  of  men,  and  ten  of  women,  besides  twenty- 
five  persons  whose  sex  was  not  ascertained.  In  my  own  establishment,  there 
have  been  admitted  fifty  persons  who  had  made  attempts  to  commit  suicide ; 
thirty-five  men  and  fifteen  women.  From  these  and  many  other  reports,  we 
may  conclude  that  the  proportion  of  suicides  among  men  and  women,  is  as 
three  of  the  former,  to  one  of  the  latter. 

[From  a  list  of  suicides  miule  up  from  data  furnished  in  the  United  States,  during  the 
year  1843-4,  it  was  found  that  of  one  hundred  and  eighty-Tour  suicides  committed,  one 
hundred  and  fifty-four  were  men;  the  remaining  thirty,  women.] 

But  these  conclusions  are  subject  to  accidental  exceptions.  In  fact,  au- 
thors speak  of  epidemics  of  suicide,  which  have  been  confined  to  women. 
The  character  of  these  epidemics  confirms  what  we  have  said ;  that  suicide 
is  only  a  consecutive  symptom.  The  appearance  of  an  epidemic  form  of  sui- 
cide  is  most  singular.     Does  it  depend  upon  a  latent  condition  of  the  atmos- 


SUICIDE.  279 

phere  ;  upon  imitation,  so  powerful  in  its  influence  over  the  determinations 
of  men;  upon  those  circumstances  which  produce  a  revolution,  in  a  country; 
in  fine,  upon  any  governing  sentiment?  It  is  certain,  that  these  sudden  and 
temporary  epidemics  are  the  effect  of  different  causes,  and  confirms  what  we 
have  already  said  ; — that  suicide  is  not  a  malady  sui  generis.  The  philoso- 
pher Hegesias,  an  admirer  of  stoicism,  preaches  in  Egypt,  during  the  reign  of 
Ptolemy,  contempt  of  life  and  the  pleasures  of  death.  Suicides  soon  become 
very  frequent.  Plutarch  tells  us,  that  suicide  prevailed  as  an  epidemic  at  Mi- 
letus, and  that  young  women  and  girls  hung  themselves,  in  emulation  of  one 
another,  because  war  kept  the  other  sex  abroad.  Primerose  assures  us,  that 
in  his  time,  the  women  of  Lyons,  disgusted  with  life,  precipitated  themselves 
in  crowds  into  the  Rhone,  without  assigning  any  cause  for  so  doing.  An  an- 
cient historian  of  Marseilles  says,  that  the  girls  of  that  city  were  accustomed 
to  destroy  themselves,  in  consequence  of  the  inconstancy  of  their  lovers. 
Sydenham  tells  us,  that  in  1G97,  there  were  many  monomaniacs  and  suicides 
in  the  city  of  Mansfeld  during  the  month  of  June,  which  was  extremely  warm. 
The  same  thing,  we  just  remarked,  was  observed  at  Stuttgard,  during  the  sum- 
mer of  1811.  In  1806,  there  were  a  great  many  suicides  at  Rouen.  Atmos- 
pheric heat,  in  connection  with  reverses  of  fortune,  seemed  to  be  the  cause  of 
it.  Doctor  Desloges,  physician  at  St.  Maurice  in  the  Valais,  witnessed  an 
epidemic  of  suicide  in  1813,  in  the  village  of  St.  Pierre  Montjeau. 

A  woman  hung  herself,  and  other  women  felt  themselves  impelled  to  follow 
her  example.  Some  years  since,  in  the  environs  of  Etampes,  a  priest  hung 
himself,  and  in  a  few  days  after  it  two  others  in  the  environs  also  destroyed 
themselves,  and  some  other  persons  imitated  them.  I  have  heard  this  case 
related  by  Pinel,  whose  estate  was  in  the  neighborhood  of  Etampes.  When 
nostalgia  prevails  epidemically  in  an  army  ;  when  mountaineers  take  up  their 
abode  in  our  cities;  when  monomania  is  rife  among  a  population,  particularly 
superstitious  monomania  ;  then  are  suicides  most  frequent. 

Education,  the  reading  of  works  that  extol  suicide,  the  power  of  imitation, 
contempt  for  religious  opinions,  the  excesses  of  civilization,  a  military  spirit, 
political  revolutions,  the  depravation  of  morals,  gaming,  onanism,  the  abuse 
of  fermented  liquors,  physical  pain,  pelagra,  are  also  causes  that  lead  man  to 
commit  suicide.  If  by  education,  the  mind  of  man  is  not  fortified  by  a  reli- 
gious belief,  by  moral  precepts,  by  habits  of  order,  and  a  regular  course  of 
life  ;  if  he  is  not  taught  to  respect  the  laws,  to  fulfil  his  duties  towards  society, 
and  to  support  the  vicissitudes  of  life  ;  if  he  has  learned  to  despise  his  equals, 
to  treat  with  disdain  the  authors  of  his  being,  and  to  be  imperious  and  capri- 
cious in  his  desires ;  then  unquestionably,  cseteris  paribus,  he  will  be  most 
disposed  to  terminate  his  existence  by  a  voluntary  act,  so  soon  as  he  shall  ex- 
perience any  serious  vexations  or  reverses.  Man  needs  a  controlling  authority, 
which  shall  direct  his  passions  and  govern  his  acts.  Given  over  to  the  guid- 
ance of  his  own  native  v/eakness,  he  falls  into  indifference,  and  from  that  into 
scepticism.  Nothing  now  sustains  his  courage.  H.e  meets  unarmed,  the  con- 
flicts of  life,  the  anguish  of  the  heart,  the  vicissitudes  of  fortune,  and  the  way- 
ward impulses  of  the  passions.  A  student,  educated  in  religious  principles, 
becomes  melancholic,  and  finally  speaks  of  death.  He  often  enquires  of  one 
of  his  companions  if  man  has  a  soul.  The  latter  replies  that  he  has  not. 
After  a  painful  struggle  between  the  principles  of  his  childhood  and  the  errors 
of  youth,  this  unfortunate  young  man  terminates  his  career  by  suicide.  A 
young  man,  before  destroying  himself,  in  a  writino-  which  he  leaves,  censures 
his  parents  for  the  education  they  have  given  him.  Another  utters  blasphe- 
mies against  God  and  imprecations  upon  society.  A  third,  destroys  himself 
because  he  has  not  air  enough  to  breathe  at  his  ease.  Two  students,  at  the 
age  of  twenty-one,  asphyxiate  themselves,  because  a  play  which  they  had  pre- 
pared together,  did  not  succeed.     A  child,  thirteen  years  old,  hangs  himself, 


280  SUICIDE. 

and  leaves  a  note  which  begins  thus  :  /  bequeath  my  soul  to  Rousseau,  my 
body  to  the  earth  !  !  When  a  great  intellectual  and  moral  change  is  brought 
about  in  society,  it  influences  the  progress  of  thought,  and  the  conditions  of 
existence. 

Recklessness  of  mind  reveals  itself  not  only  in  useless  writings  and  ro- 
mances, but  also  in  productions  of  a  more  elevated  character.  When  the 
theatre  presents  only  the  triumphs  of  crime,  and  the  misfortunes  of  virtue ; 
when  books,  placed  by  their  cheapness  within  the  reach  of  all,  contain  only 
declarations  in  opposition  to  creeds,  family  ties,  and  the  duties  which  all  owe 
to  society  ;  they  inspire  a  contempt  for  life,  and  suicides  multiply.  Death  is 
regarded  as  a  safe  asylum  against  physical  pains  and  moral  sufferings.  The 
reading  of  books  which  extol  suicide  is  so  fatal,  that  Madame  de  Stael  assures 
us,  that  the  reading  of  the  Wcrthci'  of  Goethe  has  produced  more  suicides 
in  Germany,  than  all  the  women  of  that  country.  Suicide  has  become  more 
frequent  in  England,  since  the  apology  that  has  been  made  for  it  by  the 
Dovvnes,  Blounts,  Gildons,  etc.  The  same  is  true  of  it  in  France,  since  they 
began  to  write  in  favor  of  self-murder,  and  have  held  it  up  before  the  public 
as  an  act  of  our  free  will  and  courage.  The  suicide  of  Richard  Smith  and 
his  wife  ;  that  of  Philip  Mordant,  who  destroyed  himself,  saying  that  when 
one  is  dissatisfied  with  his  house,  he  should  leave  it ;  were  the  signal  for  a 
great  number  of  suicides  in  England. 

What  precedes,  establishes  the  fact  that  there  are  epochs  in  society,  more  fa- 
vorable than  others  to  suicide,  in  consequence  of  the  general  exaltation  of  mind. 
The  more  excited  the  brain  is,  and  the  more  active  the  susceptibility,  the  more 
do  the  wants  augment ;  the  more  imperious  become  the  desires ;  the  more  do 
the  causes  of  chagrin  multiply ;  and  the  more  frequent  become  mental  aliena- 
tion and  suicide.  Any  person  may  satisfy  himself  of  this,  by  comparing  the 
number  of  suicides  in  cities,  particularly  capital  cities,  with  those  that  take 
place  in  the  country.  The  same  fact  will  appear  by  comparing  the  number 
of  suicides  in  Russia  with  those  that  occur  in  France,  and  particularly  Eng- 
land. If  one  now  compares  the  actual  state  of  Europe  with  that  of  Italy, 
during  the  time  of  the  emperors,  will  he  be  astonished  that  epochs  so  similar, 
as  it  respects  morals  and  the  splendor  of  civilization,  are  equally  fruitful  in 
suicides?  During  the  ninth  and  tenth  centuries,  the  epoch  of  confusion  in 
opinions  and  doctrines,  the  donatists,  seized  with  a  suicidal  frenzy,  devoted 
themselves  to  death,  or  gave  themselves  up  to  it  for  money.  Men,  women 
and  children  hung  themselves,  or  threw  themselves  from  precipices,  or  upon 
funeral  piles.  The  gnostics  permitted  themselves  to  die  of  hunger,  through 
fear  of  wounding  a  creature  which  was  a  part  of  the  Deity. 

A  military  spirit,  which  inspires  indifference  to  life,  which  attaches  little 
importance  to  a  good  which  one  is  ready  to  sacrifice  to  the  ambition  of  a  mas- 
ter, is  favorable  to  suicide.  At  Rome,  during  their  civil  wars,  the  conquered 
generals  destroyed  themselves,  that  they  might  not  fall  beneath  the  yoke  of 
the  victor.  The  vessel  which  carried  Vitellius  and  his  cohort,  was  taken  by 
the  fleet  of  Pompey,  among  the  sands  of  the  Illyrian  sea.  After  having  fought 
valiantly,  fatigued  with  the  carnage,  Vitellius  exhorted  his  surviving  soldiers 
to  prevent,  by  a  death  of  their  own  choosing,  the  disgrace  of  falling  into  the 
hands  of  the  victors,  Animated  by  his  discourse,  his  soldiers  slew  each  other 
upon  the  deck. 

Great  calamities  also  lead  to  suicide.  It  prevailed  extensively  during  the 
existence  of  the  black  plague  that  ravaged  Europe,  towards  the  middle  of  the 
fourteenth  century.  Historians  assure^  us  that  the  Peruvians  and  Mexicans, 
in  despair  at  the  destruction  of  their  worship,  usages  and  laws,  destroyed 
themselves  in  great  numbers  ;  and  that  more  fell  by  their  own  hands  than  by 
the  fire  and  sword  of  their  barbarous  conquerors.  Ross  Cox,  in  his  account 
of  a  voyage  in  the  waters  of  Columbia,  published  in  London  in  the  year  1831, 


SUICIDE.  281 

relates,  that  at  the  close  of  the  last  century  the  small  pox  committed  horrible 
ravages  in  India,  and  that  thousands  of  Indians  hung  themselves  to  trees, 
believing  that  the  Great  Spirit  had  delivered  them  over,  to  be  punished  by 
evil  ones.  Montaigne  states,  that  during  the  wars  of  the  Milanese,  this  peo- 
ple, impatient  of  so  many  changes  of  fortune,  so  fully  determined  to  die,  that 
I  have  heard  it  stated  to  my  f either  that  they  heid  taken  an  aeeount  of  eit  least 
twenty-jive  heads  of  families,  tvho  destroyed  themselves  in  a  single  week. 

In  1320,  five  hundred  Jews,  pursued  by  the  peasantry  of  the  country,  took 
refuge  in  the  chateau  of  Verdun,  upon  the  Garonne.  Besieged  by  their  im- 
placable enemies,  and  driven  to  despair,  after  having  thrown  their  infants  over 
the  walls  to  their  besiegers,  they  cut  their  own  throats.  The  Jews,  at  the 
time  of  the  siege  and  taking  of  Jerusalem  by  Titus,  in  order  to  put  an  end 
to  their  sufferings,  threw  themselves  from  the  top  of  the  ramparts,  or  set  fire 
to  their  houses,  in  order  to  become  a  prey  to  the  flames. 

Onanism  is  referred  to  by  Tissot,  as  one  of  the  causes  of  suicide.  I  have 
very  often  seen  suicide  preceded  by  the  practice  of  masturbation.  The  same 
is  true  with  respect  to  the  abuse  of  alcoholic  drinks.  These  two  causes  ex- 
haust the  sensibility,  producing  languor  or  despair.  They  produce  also  much 
insanity.  Individuals  thus  enfeebled  sink  into  lypemania,  and  form  no  other 
purpose  than  that  of  ridding  themselves  of  life,  which  they  have  no  lono-er 
the  capacity  to  endure.  We  have  had  at  the  Salpetriere  two  sisters,  who  were 
prostitutes  ;  one  of  whom  drowned  herself  after  a  revel.  The  other,  twice 
threw  herself  into  the  Seine  while  intoxicated,  and  made  a  third  attempt, 
when  she  was  rescued  and  brought  to  the  hospital.  We  had  one  woman, 
thirty  years  of  age,  who,  whenever  she  met  with  any  vexation,  sought  to  drown 
her  troubles  in  wine  ;  and  when  intoxicated,  made  a  thousand  attempts  upon 
her  life.  Another  woman  of  the  town,  whenever  she  is  overcome  by  wine, 
endeavors  to  hang  or  strangle  herself  When  asked  what  impels  her  to  such 
attempts,  she  replies  vaguely,  that  she  does  not  know,  and  is  not  conscious  of 
what  she  does.  M.  Dannecy  had  occasion  to  notice,  at  the  Hotel-Dieu,  a 
shoemaker,  who  had  the  same  inclination  for  drink,  and  the  same  impulse  to 
suicide  whenever  he  was  intoxicated.  An  advocate  of  Paris,  unable  to  pre- 
vent the  excesses  to  which  intoxication  led  him,  was  so  overcome  with  de- 
spair on  account  of  it,  that  he  opened  the  veins  of  both  arms,  and  died  in  the 
month  of  December,  1810. 

The  pelagra  produces  a  great  number  of  suicides,  particularly  in  Lombar- 
dy  ;  and  Professor  Thomassini  has  assured  me  that  one  third  at  least  of  the 
pelagrous  destroy  themselves.  Since  the  first  publication  of  this  article,  in 
1821,  I  have  seen  this  disease  in  Upper  Italy,  and  particularly  in  Lombardy. 
The  pelagra  is  primitively  a  disease  of  the  digestive  apparatus,  which  is  com- 
plicated secondarily,  with  a  cerebral  and  cutaneous  affection.  Frapolli  recog- 
nizes in  it  three  stages  ;  in  the  first,  little  beside  gastric  symptoms  appear. 
The  skin  of  the  extremities  of  the  limbs  however,  becomes  discolored  and 
detaches  itself  in  scales.  During  the  second  stage,  the  cerebral  symptoms 
appear,  and  the  skin  becomes  rugose,  thick  and  cleft.  There  is  acute  deli- 
rium and  insanity  in  all  its  varieties,  particularly  suicidal  lypemania.  Some 
Italian  writers  think  that  one  third  of  the  pelagrous  destroy  themselves. 
Others,  estimate  this  number  as  high  as  one  half*  Among  a  great  number 
of  lypemaniacs,  we  observe  in  France,  an  analogous  phenomenon  ;  these  pa- 
tients experiencing,  without  doubt,  an  irritation  of  the  skin  at  the  extremities 
of  the  fingers,  which  they  tear  and  lacerate  with  the  nails.  This  symptom 
diminishes  and  disappears  when  lypemania  tends  to  a  cure,  or  when  it  has 
ceased  entirely. 

I  will  not  enlarge  more  upon  the  causes  of  suicide,  but  will  confine  myself 

*  On  the  Pelagrous  Form  of  Insanity,  by  Doctor  Brierre  de  Boismont,  1834. 
36 


282  SUICIDE. 

to  the  indication  of  those,  which  seem  to  produce  it  most  frequently.  If  I 
have  not  spoken  of  the  passions  which  often  occasion  suicide,  either  acute  or 
chronic,  it  is  because  I  have  noticed  them  sufficiently,  while  analyzing  the 
circumstances  which  almost  invariably  precede  it.  The  phenomena  which 
accompany  or  succeed  the  disposition  to  suicide,  oft'er  the  most  striking  ana- 
logy to  those  of  mental  maladies.  We  say  in  general,  that  persons  of  a  me- 
lancholic temperament  and  a  bilious  constitution,  are  very  prone  to  suicide. 
They  have  a  sallow  complexion,  and  the  features  of  the  countenance  are 
shrunken.  They  suffer  also  from  abdominal  constrictions  and  embarrassments. 
We  see  individuals  however,  endowed  with  a  sanguine  temperament,  and  offer- 
ing all  the  signs  of  plethora,  who  terminate  their  own  existence.  This  ple- 
thora is  particularly  manifest  among  women,  who  usually  destroy  themselves, 
or  attempt  to  do  so,  during  the  menstrual  period.  Those  who  are  known  to 
suffer  from  suicidal  impulses,  should  be  carefully  watched  at  these  seasons. 
A  scrofulous  habit  is  also  very  often  met  with  in  persons  who  have  been  driven 
to  commit  suicide.  It  disposes  to  discouragement,  apathy,  indifference,  and 
consequently,  to  ennui.  As  it  respects  the  moral  character  of  the  suicidal, 
from  which  an  effort  has  been  made,  to  deduce  something  ennobling  in  the 
act  of  self-murder,  there  is  nothing  constant.  Courage  is  manifested,  it  is 
said,  in  committing  suicide.  But  poltroons  and  warriors,  women  and  men, 
master  and  slave,  rich  and  poor,  the  criminal  and  honest  man,  all  destroy 
themselves ;  offering  no  other  differences,  than  those  which  spring  from  causes 
foreign  to  the  character  of  each. 

It  would  be  exceedingly  difficult  to  describe  the  acute  form  of  suicide,  since 
it  is  executed  so  soon  as  resolved  upon,  and  as  the  greater  part  of  the  pheno- 
mena which  accompany  and  succeed  it,  are  observed  only  in  its  chronic  form. 
I  shall  confine  myself  to  a  description  of  the  latter.  At  the  commencement 
of  this  affection,  those  who  entertain  a  purpose  to  destroy  themselves,  or  who 
feel  inclined  to  suicide,  experience  many  symptoms  of  hypochondria  or  me- 
lancholy. They  complain  of  dyspepsia,  of  disturbance  in  the  abdominal  vis- 
cera, of  flatulence  and  constipation.  Their  complexion  changes.  Sad, 
thoughtful  and  reserved,  they  become  emaciated  or  (Edematous.  These 
wretched  beings  experience  pains  in  the  bowels,  bloatings  and  heats  which 
distend  the  intestines,  and  provoke  cephalalgia.  They  suffer  also,  from  throb- 
bings  within  the  cranium,  constrictions  at  the  root  of  the  nose,  and  spasms  at 
the  epigastrium,  together  with  a  general  uneasiness,  more  trying  than  severe 
local  pain.  They  renounce  their  former  habits,  and  no  longer  have  a  taste 
for  any  thing ;  since  the  world,  at  length  disenchanted,  no  longer  possesses 
either  beauty  or  interest.  They  behold  things  readily  enough,  but  no  longer 
feel  as  they  were  formerly  accustomed  to  do,  with  reference  to  them.  They 
express  a  desire  to  die,  and  speak  with  approbation  of  those  who  have  put  an 
end  to  their  own  existence.  They  speak  of  death  with  earnestness,  or  an 
affected  indifference,  and  complain  of  not  enjoying  favorable  opportunities  for 
the  accomplishment  of  their  purposes.  Soon,  they  imagine  that  they  are  neg- 
lected and  despised, — fly  tlie  world,  seek  solitude,  become  pusillanimous,  sus- 
picious, and  scarcely  persuade  themselves  to  live.  At  length,  the  idea  of  de- 
stroying themselves  becomes  fixed,  and  constantly  engages  their  thoughts, 
from  which  they  cannot  divert  their  minds.  Their  thoughts  are  concentrated 
upon  this  subject,  with  all  the  obstinacy  that  is  noticed  among  other  mono- 
maniacs. If  the  fatigue  of  watching  causes  them  to  sleep,  they  are  troubled 
with  frightful  dreams.  Thus,  neither  night  nor  day,  can  these  unfortunate 
beings  shake  off  the  thought  of  death  ;  no  more  than  other  monomaniacs  the 
idea  that  they  are  ruined,  disgraced  or  condemned. 

There  is  not  an  individual  belonging  to  this  class,  who  has  not  ideas  of  sui- 
cide, and  a  desire  even,  to  precipitate  himself  therefrom,  whenever  he  finds 
himself  upon  an  elevation,  or  near  a  window;  or  of  drowning  himself  when 


SUICIDE.  283 

passing  over  a  bridge.  These,  like  all  possible  ideas,  which  are  constantly 
renewed,  and  succeed  each  other  by  crowds  in  the  mind^  are  represented  in 
turn.  They  usually  leave  no  traces  in  the  mind,  more  than  other  thoughts. 
But  if  a  man  actually  experiences  a  violent  vexation ;  if  the  idea  of  self-de- 
struction presents  itself,  in  connection  with  a  thousand  other  thoughts,  to  his 
mind ;  this  one  thought  of  suicide  associates  itself  strongly  to  the  moral  state 
which  is  present  together  with  the  vexation,  and  the  desire  of  freeing  himself 
from  it.  Hence  arises  the  determination  to  self-murder,  as  an  infallible  means 
of  terminating  his  misfortunes.  The  impulse  to  suicide  is  more  or  less  vio- 
lent and  sudden,  and  depends  upon  numerous  causes ;  upon  the  age,  sex, 
temperament,  habits,  profession  and  irritability  of  the  individual,  and  a  thou- 
sand other  circumstances  that  escape  our  observation.  Does  not  this  obsti- 
nate association  of  ideas  occur  fortuitously  in  a  state  of  health,  while  we  are 
engrossed  with  a  given  subject?  It  is  durable,  in  proportion  as  the  false  ideas 
are  associated  together,  in  a  manner  calculated  to  absorb  the  understanding, 
and  to  concentrate  the  attention  and  sensibility.  These  ideas,  closely  con- 
nected, and  varying  with  individual  cases,  lead  men  to  form  erroneous  judg- 
ments; and  to  determinations,  sometimes  sudden,  and  sometimes  long  reflect- 
ed, in  connection  with  the  prejudices  and  exclusive  reasonings  which  charac- 
terize monomania. 

A  nobleman  calls  upon  M.  Anson  his  friend,  and  says  to  him,  I  am  tired 
of  the  insipidity  of  life,  and  my  intention  is,  to  quit  ii  to-morrow.  After  a 
long  conversation,  M.  Anson  being  obliged  to  be  absent,  obtains  the  promise 
of  this  nobleman  to  await  his  return,  which  is  fixed  at  four  o'clock  precisely, 
some  days  afterwards.  M.  A.  was  unable  to  arrive  on  the  day  appointed, 
before  the  hour  of  five.     His  friend  had  shot  himself  at  four. 

But  it  is  said,  that  suicides  obey  irresistible  impulses.  I  have  questioned 
several  hypochondriacs,  and  a  great  many  lypemaniacs,  who  had  made  attempts 
upon  their  lives,  on  this  point.  All  assured  me  that  the  attempt  at  self-de- 
struction was  voluntary,  and  that  they  dwelt  upon  the  thought  of  it,  even  with 
satisfaction.  But  all  added,  that  they  were  in  a  state,  either  physical  or  moral, 
than  which  nothing  could  be  more  dreadful ;  that  they  believed  its  continu- 
ance must  be  eternal ;  and  that  death  presented  itself  to  them  as  the  only 
mode  of  deliverance  from  it.  It  was  this  circumstance  which  rendered  it  de- 
sirable. Those  who  experience  no  farther  pleasure  from  life,  and  yield  to  the 
spleen,  have  no  longer  sensations  or  desires.  They  have  exhausted  the  re- 
sources of  life.  They  experience  a  frightful  void,  and  are  in  a  state  of  com- 
plete isolation  from  the  world.  This  produces  a  state  to  which  they  prefer 
death,  which  has  no  terrors  for  them  :  the  transient  pain  of  dying,  appearing 
preferable  to  a  never-ending  ennui.  Much  is  said  about  persons  who  destroy 
themselves  without  effort  or  repugnance.  No  notice  however,  is  taken  of 
those  who  destroy  themselves  after  painful  and  unknown  suflTerings.  I  have 
heard  it  remarked  by  a  woman  who,  after  having  thrown  herself  into  the  Seine, 
was  brought  to  the  Salpetriere,  that  before  effecting  her  fatal  purpose,  she  had 
walked  for  twenty-four  hours,  at  a  rapid  pace,  upon  the  bank  of  the  river, 
and  that  during  this  whole  period  her  sufferings  were  indescribable.  We 
have  also  at  the  Salpetriere  another  woman,  who  threw  herself  into  the  river. 
Since  this  accident,  she  has  been  melancholic,  and  suffers  much  when  bathed, 
or  when  she  passes  near  a  river.  They  cause  her  to  do  whatever  they  desire, 
by  threatening  to  throw  her  into  the  water. 

A  maiden  learns  that  her  lover  is  drowned.  She  rises  very  early  in  the 
morning  and  goes  to  the  banks  of  the  Seine  to  drown  herself.  She  sits  down 
upon  the  brink  of  the  water,  and  delays  until  the  next  day,  the  execution  of 
her  design.  On  the  following  day,  the  same  resolution  calls  her  back  to  the 
same  place.  The  horror  of  death  causes  her  to  return  to  the  house  of  her 
parents.     On  the  third  day,  constantly  beset  by  this  idea,  she  was  upon  the 


284  SUICIDE. 

bank  of  the  river  deliberating,  when  some  one,  passing  along  on  the  foot-path, 
perceived  her.  He  calls  to  her,  and  threatens  to  go  for  the  guard.  This 
threat  causes  her  to  lose  her  reason,  and  she  at  once  plunges  into  the  river. 
She  is  immediately  taken  out  of  the  water.  Her  menses  were  flowing  at  the 
time,  and  were  suppressed.     She  has  since  been  epileptic. 

What  miscivings  characterize  the  conduct  of  those  who  meditate  suicide  ! 
What  conflicts  before  determining  upon  it !  What  efforts  to  reconcile  them- 
selves to  it,  hidden  and  concealed  from  the  public,  to  secure  to  this  senseless 
act,  the  external  aspect  of  courage  and  fortitude!  It  is  self-love  still,  that  in- 
vests suicide  with  its  mantle.  How  many  self-murderers  would  yet  live,  were 
some  friend  able  to  unite  again  the  thread  of  life  which  they  have  severed  ! 
How  many  are  there,  who  regret,  in  quitting  life,  the  destiny  which  they  found 
too  unhappy !  With  what  avidity  do  they  seize  again  upoi?  life,  by  every 
means  that  are  offered  them !  A  man  throws  himself  into  a  well.  He  makes 
every  effort  to  get  out  of  it,  and  points  out  the  means  of  effecting  this  purpose. 
Pauline,  the  wife  of  Seneca,  both  young  and  beautiful,  wished  to  die  with  her 
husband.  She  opens  certain  blood  vessels.  Nero,  on  being  informed  of  this 
act,  orders  the  bleeding  wounds  to  be  stanched.  Snatched  from  the  portals  of 
the  tomb,  she  thinks  no  more  of  death.  The  struffwles  of  suicides,  against 
the  desire  which  leads  them  to  the  commission  of  self-murder,  are  either  ex- 
ceedingly painful,  or  they  contemplate  their  destruction  with  a  kind  of  joy. 
They  have  paroxysms,  now  regular,  and  now  irregular;  deferring  the  execu- 
tion of  their  design,  now,  from  one  motive,  and  now  from  another.  Often 
do  they  wear  upon  their  persons,  or  conceal  in  a  safe  place,  the  instruments 
or  means  of  destruction ;  uncertain  with  respect  to  the  time,  place  or  occa- 
sion, most  favorable  for  the  accomplishment  of  their  purpose.  We  can  also, 
with  some  experience,  prevent  the  effects  of  these  exasperations,  which  impress 
upon  the  physiognomy  a  sinister  expression,  in  consequence  of  the  return  of 
the  physical  and  moral  symptoms,  previously  indicated.  The  physical  symp- 
toms are  then  most  grave,  the  moral  sufferings  most  intense,  and  life  most  in- 
supportable. 

Finally,  after  having  engaged  for  months  and  years,  in  an  internal  struggle, 
with  alternate  remissions,  a  prey  to  the  most  frightful  passions,  or  else  indiffer- 
ent and  insensible  to  every  thing ;  experiencing  neither  the  blessings  nor  pain 
of  living ;  led  on  slowly,  to  the  last  degree  of  physical  and  moral  insensibility, 
which  deprives  man  of  the  conservative  instinct  of  his  own  proper  existence ; 
they  quit  life,  to  avoid  intolerable  sufferings,  or  a  most  trying  weariness  of  it. 
Their  eyes  are  haggard,  the  countenance  is  flushed,  or  very  pale,  the  respira- 
tion is  hurried,  and  the  mind  perplexed.  They  are  no  longer  masters  of  their 
actions.  The  sentiments  which  some  of  them  leave  behind  ;  do  not  these 
prove  the  exaltation  and  derangement  of  their  reason?  If  some  write  to  their 
relatives  and  friends,  letters  which  express  the  composure  of  reason,  do  they 
not  dissemble  their  moral  condition,  as  so  often  happens  in  the  case  of  mono- 
maniacs ? 

This  destruction  of  all  physical  sensibility  is  not  rare  among  monomaniacs, 
as  we  have  known  them  to  mutilate  and  burn  themselves,  and  amputate  the 
limbs,  without  appearing  to  suffer  any  pain  in  consequence  of  it ;  so  com- 
pletely had  the  exaltation  and  fixedness  of  their  emotions  blunted  their  sensi- 
bility, and  driven  it  from  its  true  seat. 

Many  suicides,  after  having  most  seriously  wounded  themselves,  do  not 
complain  of  the  pain  of  their  wounds.  This  state  of  organic  insensibility 
indicates  that  the  delirium  has  not  ceased,  and  that  the  patients  ought  to  be 
watched  with  care.  Porcia,  filled  with  despair  on  account  of  the  death  of  her 
husband,  swallows  burning  coals.  Haslam  speaks  of  a  woman  who,  having 
champed  some  glass  in  her  mouth  for  a  half-hour,  assured  him  that  it  did  not 
occasion  the  least  suffering.  I  have  applied  blisters,  setons,  moxas  and  the 
actual  cautery,  to  persons  strongly  inclined  to  suicide,  and  lypemaniacs,  in 


SUICIDE 


285 


order  to  interrogate  their  sensibility,  without  producing  pain.  Some,  after 
their  restoration  to  health,  have  assured  me  that  they  did  not  suffer  in  the  least 
from  these  applications.  A  young  man,  twenty-seven  years  of  age,  in  a  fit  of 
maniacal  despair,  throws  himself  from  the  fourth  story ;  protests  that  it  has 
done  him  no  harm,  and  ascends  immediately  to  his  apartment.  The  fibula 
was  fractured.  A  soldier  fractured  one  of  his  thighs,  by  throwing  himself 
from  the  second  story.  He  constantly  repeated,  it  is  nothing,  I  am  not  in 
pain.  I  do  not  insist  upon  this  point  of  analogy  between  suicides  and  the  in- 
sane.    We  shall  see  other  examples  of  it,  in  the  course  of  this  article. 

Among  those  who  destroy  themselves,  there  are  some  who  choose  neither  the 
kind  of  death,  nor  the  instrument,  nor  the  means  of  their  destruction,  but 
employ  whatever  may  offer ;  availing  themselves  of  all  the  circumstances  fa- 
vorable to  their  design,  so  soon  as  their  resolution  is  formed.  This  is  espe- 
cially true  with  respect  to  acute  suicide,  maniacs,  those  laboring  under  febrile 
diseases,  and  such  as  the  delirium  of  the  passions  attacks.  One  permits  him- 
self to  die  of  hunger  ;  another  watches  his  opportunity  to  throw  himself  from 
a  height.  One  escapes  to  go  and  drown  himself,  while  another  hides  and 
shuts  himself  up  with  the  view  of  hanging  himself  The  pistol  and  poniard 
are  also  instruments  which  men  employ.  Women  rarely  have  recourse  to 
these  means.  They  hang,  drown,  asphyxiate  themselves,  or  die  of  hunger. 
Usually  the  instruments  which  these  wretched  beings  employ,  have  reference 
to  their  professions  ;  a  circumstance  which  furnishes  a  proof  of  the  sponta- 
neity of  their  determination.  Soldiers  and  sportsmen  blow  out  their  brains  ; 
shoemakers  open  the  abdomen  with  a  cutting  knife ;  engravers  with  the  graver  ; 
laundresses  poison  themselves  with  potassa,  prussian  blue,  or  asphyxiate  them- 
selves by  means  of  carbon. 

In  the  following  report  will  be  found  the  means  by  which  198  women  at- 
tempted to  end  their  days. 

Suspension  or  strangulation,      .  .  .  .  .49 

Throwing  themselves  from  a  height,  ...  45 

Fire  arms,         .  .  .  .  .  •  .2 

Cuttincr  instruments,  .  .  .  •  18 

Poison,  .  .  .  .  •  .  '        * 

Asphyxia,     .....••  5 

Abstinence,       .  .  .  .  •  •  .48 

Immersion,  ......  31 

205* 

In  chronic  suicide,  in  lypemania  with  a  tendency  to  suicide,  and  in  the 
spleen,  patients  sometimes  choose  the  instrument  which  is  to  terminate  their 
existence,  and  are  unwilling  to  employ  another,  after  having  deliberated  upon 
the  different  kinds  of  death,  and  having  rejected  them  through  various  and 
often  strange  motives.  However,  there  are  cases  in  which  they  employ  suc- 
cessively all  those  means  which  they  regard  as  suited  to  accomplish  their  reso- 
lution. 

It  has  been  pretended  that  suicides  preferred  that  kind  of  death  which  had 
the  most  intimate  relation  with  their  physical  being.  Experience  daily  proves 
this  opinion  to  be  false.  It  is  rather  the  habit,  profession  or  example,  which 
determine  the  choice  of  the  kind  of  death,  and  the  means  of  destruction. 
There  are  persons  who  employ  the  utmost  precaution   against  surviving  the 

*  Seven  women  had  recourse  to  two  different  modes  of  committing  suicide  ;  a  circum- 
stance which  explains  the  difference  of  the  sum  total  in  the  latter  case,  with  the  number 
of  women  who  constituted  the  basis  of  our  calculation. 


286  SUICIDE. 

attempts  which  they  make  upon  their  lives,  in  order  to  avoid  the  struggle 
against  that  horror  which  the  earlier  fatal  convulsions  may  inspire.  There  are 
some  also  who,  before  throwing  themselves  into  the  river,  fill  their  pockets 
with  heavy  bodies,  and  tie  their  hands  or  legs.  Others,  placing  themselves  so 
as  to  fall  immediately  into  a  river,  shoot  themselves  with  a  pistol,  or  pierce 
their  vitals  with  a  poniard.  Others  still,  confine  themselves  to  their  houses  or 
apartment ;  or  else  remove  every  person,  so  as  to  render  succor  impossible. 

[About  two  years  since,  a  palient  was  brought  to  the  Retreat  at  Hartford,  Ct.,  who  had 
repeatedly  attempted  suicide.  One  of  his  attempts  was  as  follows.  Being  a  farmer,  he 
went  to  his  barn,  took  a  rope  of  considerable  length,  which  was  at  hand,  and  threw  one 
end  of  it  over  the  "  high  beams,"  to  which  he  made  it  fast.  He  tlien  took  a  barrel,  upon 
one  end  of  wliich' he  placed  himself,  tied  the  rope  snugly  about  his  neck,  and  witii  the 
slack,  fastened  his  hands  behind  him.  As  he  was  on  the  point  of  swinging  off,  a  mem- 
ber of  his  family  discovered  him,  and  frustrated  his  fatal  purpose.  When  admitted,  his 
countenance  was  haggard,  his  eyes  dull,  and  his  frame  emaciated.  His  countenance 
however  did  not  indicate  a  great  degree  of  mental  suffering,  nor  was  he  disposed  to  refer 
to  any  subject  of  a  painful  character.  He  answered  questions  readily,  intelligently,  and 
in  a  tone  of  voice  by  no  means  desponding.  Nothing  indicative  of  mental  alienation 
appeared  at  our  first  interview,  nor  indeed  at  any  subsequent  period.  An  attendant  slept 
in  the  same  bed  with  the  patient,  whose  rest  was  for  several  nights  much  disturbed,  as  it 
had  been  previously  for  several  weeks.  He  was  closely  watched  for  some  time,  and  at 
length  recovered.  After  his  recovery  an  opportunity  was  taken  to  ascertain  from  his 
own  lips,  the  condition  of  our  patient's  mind  previous  to  his  admission,  as  well  as  during 
the  earlier  period  of  his  residence  at  the  Hospital.  To  my  surprise,  I  found  that  the  pe- 
riod previous  to  his  admission,  during  which  the  attempt  just  referred  to  was  made,  and 
also  near  one  week  after  he  came  to  the  Retreat,  icere  a  perfect  blank.  He  was  an  ho- 
nest, respectable  man,  and  his  statement  worthy  of  entire  credence.] 

A  person  throws  himself  into  a  river,  from  whence  he  is  immediately  with- 
drawn. Some  days  afterwards,  he  precipitates  himself  from  the  top  of  a  stee- 
ple upon  a  pile  of  stones,  fractures  the  body  of  one  of  the  dorsal  vertebrae,  but 
does  not  die.  He  now  resolves  not  to  eat;  but  by  great  effort  they  surmount 
this  resolution,  which  is  still  renewed  from  time  to  time.  He  dies  a  year 
after,  from  chronic  inflammation  of  the  mucous  membrane  of  the  alimentary 
canal. 

Mad'e  X.,  a  cousin  of  the  patient  of  whom  I  have  just  spoken,  was  en- 
dowed with  the  richest  gifts  of  nature,  and  received  an  education  every 
way  suited  to  develop  her  naturally  remarkable  understanding,  and  exalt  a 
brilliant  imagination.  The  daughter  of  a  wealthy  banker,  she  married  a  no- 
bleman of  high  rank.  The  revolution  bore  heavily  upon  her  own  and  the 
family  of  her  husband.  Though  very  young,  she  was  committed  to  prison, 
and  did  not  recover  her  liberty  imtil  after  the  9th  Thermidor  (July).  Her 
nervous  susceptibility  acquires  a  remarkable  degree  of  development ;  and  the 
imagination  becomes  still  more  ardent.  On  enterincr  the  world  again,  she  en- 
joys  the  society  of  men  most  distinguished  for  their  attainments  in  the  sciences, 
literature  and  the  fine  arts.  Whatever  was  great,  noble  or  generous,  made  a 
profound  impression  upon  her  mind.  Some  years  after  the  restoration,  which 
she  hailed  with  enthusiasm,  she  permitted  herself  to  be  drawn  away  by  an  at- 
tachment, which  was  by  no  means  happy.  From  that  period,  her  family  no- 
ticed a  change  of  disposition.  She  became  sad,  solitary,  and  complained  of 
nervous  derangement.  She  traveled  a  long  time  without  benefiting  her  health. 
She  imagined  that  she  carried  in  her  system  the  virus  of  the  plague,  which 
would  injure  those  that  approached  her,  particularly  the  members  of  her  fami- 


SUICIDE.  287 

ly,  and  isolated  herself  completely  from  the  world  ;  shutting  herself  up  in  a 
little  apartment,  into  which  a  servant  woman  only  was  permitted,  and  that  very 
rarely,  to  enter.  She  also  was  subsequently  excluded,  and  the  food,  and  other 
things  which  the  wants  of  the  patient  required,  were  placed  in  an  ante-cham- 
ber. This  state  persists  for  more  than  a  year,  and  she  becomes  much  emaci- 
ated, loses  her  sleep  and  appetite,  the  features  of  her  countenance  change,  and 
the  desire  for  death  comes  in,  to  aggravate  this  condition.  Notwithstanding, 
menstruation  was  very  regular,  though  she  suffered  from  obstinate  constipa- 
tion. After  some  years,  she  persuades  herself  that  she  has  enemies  who  de- 
sire to  get  possession  of  her  person.  She  has  hallucinations  of  hearing  and 
of  vision ;  and  at  length,  suicide  becomes  a  predominant  idea.  Being  in  the 
country,  she  throws  herself  into  a  river,  from  which  they  withdraw  her.  On 
the  following  day  she  refuses  to  eat,  makes  numerous  efforts  to  strangle  her- 
self, and  is  brought  to  Paris.  On  the  way,  she  endeavors  by  artifice  as  well 
as  force,  to  throw  herself  from  the  carriage.  After  her  arrival,  she  endeavors 
to  strangle  herself,  refuses  to  eat,  and  for  several  months,  swallows  only  from 
compulsion  the  liquid  aliment  which  is  introduced  into  her  mouth.  She  seizes 
upon  every  variety  of  cord  or  band,  for  the  purpose  of  strangling  herself  with 
it, — handkerchiefs,  neck-cloths,  garters,  and  the  bandages  which  retain  a 
cautery.  She  dashes  her  head  against  the  walls  and  the  corners  of  the  chim- 
neys ;  tries  to  throw  herself  from  the  windows,  and  the  top  of  the  furniture  ; 
and  depresses  the  head  to  a  level  with  the  floor,  while  the  feet  remain  upon 
the  bed.  She  provides  herself  with  small  pieces  of  glass,  to  open  the  arteries, 
and  endeavors  to  swallow  feathers,  crayons,  and  bits  of  wood.  She  makes, 
with  little  pieces  of  paper  and  wood,  secretly  taken  from  her  mattress,  balls  to 
suffocate  herself  with,  by  swallowing  them.  She  takes  to  pieces  an  article  of 
furniture,  in  order  to  make  the  same  use  of  the  nails.  One  day,  while  walk- 
ing in  her  garden,  having  on  a  camisole,  and  accompanied  by  a  female  com- 
panion and  two  servant  women,  she  manages  to  conceal  a  pebble  in  her  shoe, 
and  desires  to  return  to  her  apartment.  They  remove  the  camisole,  when  she 
immediately  swallows  the  pebble,  which  was  too  large  to  pass  the  cesophagus 
without  great  difficulty.  While  efforts  are  making  to  urge  it  Ibrward  into  the 
stomach,  she  rejoices,  and  when  at  length  it  has  been  forced  into  this  organ,  she 
consoles  herself  with  the  reflection  that  it  will  hasten  the  disorganization  of 
the  intestines. 

One  day  whilst  walking  in  the  country,  although  followed  by  three  persons, 
she  throws  herself  upon  the  sword  of  a  soldier.  At  another  time,  seeing  two 
soldiers  armed  with  muskets,  she  throws  herself  upon  her  knees  and  beseeches 
them  to  shoot  her.  The  patient  lodges  on  the  basement  floor,  and  her  bed 
and  chimney  are  wadded.  They  withdraw  from  her  apartment  whatever  can 
awaken  ideas  of  suicide,  or  serve  for  its  execution  ; — such  as  scissors,  pins 
and  knives.  Two  women  watch  her  during  the  day,  and  two  during  the  night. 
She  has  a  conviction  that  another  revolution  is  at  hand,  and  that  not  a  single 
noble  will  escape  it.  With  this  exception,  she  enjoys  her  reason  perfectly,  in 
connection  with  a  vigor  of  thought  and  soundness  of  judgment  far  superior 
to  most  women ;  but  she  is  unwilling  to  see  any  one,  not  even  her  relatives. 
"  I  have  a  horror  of  myself,  says  she,  and  I  am  unwilling  to  be  seen  in  this 
condition  ;  besides,  I  should  communicate  the  plague." 

I  employ  baths,  cold  lotions  to  the  head,  purgatives,  bark  and  musk.  All 
the  means  suggested  by  experience,  are  in  turn  employed  for  several  month.s 
with  the  greatest  care.  Following  the  method  of  Avenbrugger,  I  order  a 
seton  over  the  region  of  the  liver,  and  cause  her  to  drink  several  pints  of  fresh 
water  daily,  without  producing  any  other  effect  than  the  abandonment  of  her 
attempts  to  commit  suicide.  Her  disquietudes,  fears  and  hallucinations  are 
the  same,  and  the  desire  of  death  persists.  I  close  my  treatment  by  confin- 
ing myself  to  whey,  tepid  baths,  sedative  enemata,  and  to  frequent  conversa- 


288  SUICIDE. 

tions,  which  always  divert  the  patient.  At  the  age  of  forty-five  years,  anoma- 
lies of  menstruation  do  not  modify  her  health.  Emaciation  increases,  and  the 
feet,  and  sometimes  the  face  are  infiltrated.  The  patient  always  experiences 
the  same  repugnance  to  taking  food.  Some  months  subsequently,  I  invite  her 
mother  to  pay  her  a  visit.  This  first  interview,  after  a  long  absence,  makes 
a  strong  impression  upon  the  patient,  causes  her  to  forget  her  disquietudes 
and  fears,  and  to  converse  willingly.  After  a  quarter  of  an  hour  however, 
she  requests  her  mother  to  retire.  The  visits  are  repeated,  and  she  expe- 
riences great  pleasure  in  receiving  successively,  the  other  members  of  the 
family.  I  present  her  with  crayons,  pencils,  knives,  pen-knives,  and  every 
article  of  furniture  necessary  for  her  use.  All  the  precautions  that  had  been 
so  imperiously  necessary  for  eighteen  months  to  prevent  suicide,  are  now  su- 
perfluous. She  retires  into  the  country,  with  her  physical  health  much  im- 
proved, though  the  oedema  of  the  feet  and  face  return  from  time  to  time. 
Her  alimentary  regimen  continues  to  be  bad.  Nevertheless,  she  walks 
abroad,  and  engages  in  reading,  drawing  and  painting.  She  also  consents  to 
receive  a  small  number  of  persons  into  her  family,  excluding  all  strangers. 
Her  menses  cease  without  aggravating  her  disease,  and  she  lives  ten  years 
after  this  period,  always  entertaining  the  same  prepossessions  and  disquietudes, 
with  the  same  unwillingness  to  receive  society.  Her  toilet  is  peculiar,  and 
made  with  little  care  ;  and  her  mode  of  nourishing  herself  consists  in  taking, 
with  repugnance,  meat  or  vegetable  soups 

A  magistrate,  forty-five  years  of  age,  having  many  insane  relatives,  but  re- 
garded by  the  world  as  happy ;  being  rich,  the  father  of  a  family,  and  occu- 
pying a  highly  respectable  situation,  has  been  for  several  years  harassed  by 
the  thought  of  self-murder.  When  about  the  age  of  forty-two  years,  while 
fortune  seemed  to  be  smiling  upon  him,  he  avails  himself  of  the  absence  of 
his  wife  and  children,  who  are  in  the  country,  to  cut  his  throat  in  several 
places  with  a  razor,  but  without  causing  death.  He  is  heard  to  rush  into  his 
apartment,  repeating  these  words  :  "  How  much  it  costs  to  die  !"  The  neigh- 
bors hasten  in,  and  find  the  wretched  man  extended  upon  the  floor.  He  had 
died  after  stabbing  himself  several  times  with  a  knife,  in  the  chest. 

The  obstinacy  manifested  in  the  resolution  to  commit  suicide,  and  persever- 
ance in  the  execution  of  this  design,  surpass  all  belief;  especially  among  lype- 
maniacs.  When  this  class  of  persons,  controlled  by  a  fixed  idea,  have  resolv- 
ed to  terminate  their  existence,  they  resist,  not  merely  the  councils  of  reason, 
of  friendship  and  tenderness,  and  those  material  obstacles  that  oppose  their 
designs ;  but  support  unheard  of  sufferings,  whilst  preserving  a  composure 
and  resignation  which  contrast  singularly  with  the  convulsive  and  painful 
expression  of  their  countenance.  In  vain  do  they  tell  us  that  they  do  not  suf- 
fer, whilst  every  thing  betrays  the  keenest  mental  agony. 

M.  de  B.,  having  insane  relatives,  and  a  strong  constitution,  was  tall,  his 
hair  and  eyes  black.  His  mind  was  well  cultivated  and  his  habits  regular. 
Drafted  at  a  mass  levying,  he  was  unwilling  to  serve,  not  in  consequence  of 
cowardice,  but  of  his  opposition  to  the  revolution.  He  gave  himself  up  to 
the  practice  of  onanism,  in  order  to  make  himself  sick,  and  thereby  obtain 
his  discharge.  Unfortunately,  he  succeeded  but  too  well.  His  health  was  se- 
riously impaired,  and  the  vital  forces  weakened  to  such  a  degree,  that  he  could 
scarcely  walk,  and  lost  his  voice  entirely.  His  emaciation  is  extreme,  and  he 
is  believed  to  suffer  from  phthisis.  Satisfied  with  being  relieved  from  military 
service,  he  consents  to  take  care  of  his  health,  which  remains  feeble,  and  ex- 
tremely susceptible.  Though  naturally  gay,  he  is  often  sad,  and  somewhat 
melancholic.  An  event  of  little  importance  produces  lypemania.  He  con- 
ceives that  his  actions  are  watched,  with  a  view  to  injure  his  family  and 
friends.  He  refuses  to  leave  his  house,  becomes  morose  and  sad,  and  from 
time  to  time  passes  two,  three  and  five  days,  without  eating.     After  the  dis- 


SUICIDE.  289 

ease  had  continued  for  several  months,  they  discover  that  his  reason  for  refus- 
ing food  is,  that  by  eating,  he  compromises  the  character  of  his  family  and 
friends :  honor  forbids  that  he  should  eat.  The  patient  persists  in  this  course 
for  more  than  a  year,  when  a  physician  orders  two  large  bleedings  from  the 
foot.  From  the  time  that  the  frequency  of  his  fasts  began  to  increase,  he  con- 
ceived an  aversion  towards  his  friends.  The  more  they  exert  themselves  to 
arouse  him  from  his  disquietude,  and  to  engage  him  to  eat,  the  more  irksome  their 
presence  becomes.  At  length  he  desires  to  be  removed  from  his  house.  He 
is  isolated,  and  committed  to  my  care.  Regarding  himself  in  a  house  of  safe- 
ty, he  once  more  eats,  and  recovers  his  strength ;  and  although  always  uneasy, 
speaks  and  converses  very  agreeably  upon  every  other  subject,  especially  lite- 
rature, which  he  has  cultivated  with  success.  Six  months  pass  thus,  and  it  is 
spring.  The  patient  begins  it,  by  prolonging  his  seasons  of  abstinence.  He 
assures  me  that  he  is  anxious  to  go  as  long  as  possible  without  food,  so  as  to 
compromise  no  one.  At  other  times,  he  affirms  that  he  wishes  to  terminate 
his  existence ;  his  condition  being  intolerable.  Douches,  baths,  enemata  and 
frictions,  produce  no  effect. 

After  three  successive  refusals  to  take  food,  he  endures  an  abstinence  of 
eight  days'  continuance.  Frightened  by  this  resolution,  the  thought  occurred 
to  me,  that  by  introducing  through  the  nares,  into  the  fauces,  a  gum  elastic 
tube,  and  injecting  by  this  means  some  liquid  aliment  into  his  stomach,  we 
should  convince  the  patient  that  he  could  be  forced  to  live,  in  spite  of  him- 
self M.  Murat  takes  charge  of  this  operation.  It  succeeds ;  but  after  tak- 
ing his  food  for  four  days  voluntarily  and  rationally,  he  renews  his  attempts. 
Eight  days  pass  thus.  They  set  in  the  chamber  of  the  patient,  although  he 
touches  it  not,  such  food  as  he  preferred  when  well.  At  this  he  becomes 
furious,  pretending  that  we  wish  to  tempt  him  to  betray  his  honor.  Durinop 
the  night  he  is  sleepless ;  while  he  is  walking,  at  a  rapid  pace,  throughout  the 
day.  On  the  ninth  day,  we  endeavor  in  vain  to  overcome  his  resolution,  by 
producing  acute  pains  with  a  flexible  red  hot  iron,  lightly  applied  to  the  skin. 
To  this  he  manifests  a  stoical  indifference.  On  the  following  day,  his  mother 
and  family  visit  him,  with  the  intention  of  remaining  with  him.  Each  makes 
his  individual  efforts  to  triumph  over  his  resolution.  They  eat  in  his  apart- 
ment, in  order  to  incite  him,  by  their  example.  One  of  his  intimate  friends, 
joins  his  own,  to  the  efforts  of  the  relatives  of  the  patient. 

An  ecclesiastic,  in  whom  he  has  much  confidence,  is  not  more  successful. 
All  is  useless.  On  the  twelfth  day,  he  offers  his  arm  to  his  mother,  to  walk 
with  her  in  the  garden.  His  limbs  tremble,  and  he  is  very  pale.  After  a 
quarter  of  an  hour,  he  experiences  a  slight  syncope.  During  this  walk,  we 
concert  with  his  friend,  a  stratagem.  When  he  has  recovered  from  his  syn- 
cope, we  present  to  him  a  declaration,  legalized  by  the  seal  of  the  state,  and 
in  appearance  official,  authorizing  him  to  eat,  and  discharging  him  from  all 
responsibility  with  respect  to  it.  One  of  his  friends,  who  was  concerned  in 
the  stratagem,  urges  and  encourages  him ;  and  as  the  patient  still  hesitated, 
his  friend  said  to  him  ;  Think  you  that  I  deceive  you  ;  that  I  would  counter- 
feit the  stamp  of  the  state  1  At  the  close  of  this  sentence,  which  was  spoken 
with  earnestness,  as  if  waking  from  a  dream,  come  mother,  exclaims  the  pa- 
tient, let  us  go  up,  and  he  ascends  two  stories  hastily.  His  friends  cannot 
prevent  him  from  devouring  the  half  of  a  fowl  contained  in  a  pie,  as  well  as 
half  the  crust  of  it.  He  also  drinks  freely  of  water,  assuring  us  that  his 
thirst  has  cost  him  more  suffering  than  his  long  abstinence  from  food.  Scarce- 
ly has  he  finished  his  repast,  when  symptoms  of  intoxication,  carried  even  to 
delirium,  appear.  Three  hours  afterwards  he  retires  to  bed,  complaining  of 
cardialgia.  Emollient  enemata,  and  flannels  wrung  in  hot  water,  applied  over 
the  abdomen,  diminish  his  sufferings.     The  patient  does  not  sleep.     Never- 

37 


290  SUICIDE. 

theless,  on  the  morning  following  this  painful  night,  he  is  comfortable.  On 
the  same  evening  he  enters  his  apartment,  and  resumes  his  ordinary  dress, 
complaining  only  of  feebleness.  One  month  after  this,  without  any  known 
cause,  he  shuts  himself  up  in  his  apartment,  strips  himself  naked,  and  de- 
clares that  he  will  never  open  his  door  to  any  one,  and  will  eat  no  more.  The 
efforts  of  his  mother  and  family  are  altogether  useless.  I  go  to  the  chamber 
of  the  patient,  fearing  lest  the  smallest  noise  in  opening  his  door,  would  cause 
him  to  throw  himself  from  the  window. 

Satisfied  that  a  surprise  would  prevent  this  misfortune,  I  send  for  a  strong 
lock-smith,  who,  with  a  large  anvil  hammer,  with  a  single  blow  bursts  open 
the  door.  The  patient  is  struck  with  amazement,  and  permits  himself  to  be 
dressed,  but  refuses  to  eat.  You  have  done  well  to  surprise  me,  said  he,  other- 
wise  I  should  have  escaped  through  the  ivindow.  (This  was  in  the  third  story). 
We  tried  music,  of  which  the  patient  was  very  fond.  For  three  days,  the 
best  musicians  executed  the  choicest  pieces  of  music  near  his  apartment.  On 
each  occasion  however,  the  patient  becomes  furious.  He  has  since  assured 
me  that  his  fury  resulted  from  his  indignation  that  they  should  be  amusing 
themselves,  while  he  was  in  a  situation  so  deplorable.  On  the  fifth  day  of  his 
renewed  abstinence,  M.  Dubois  introduced  a  tube  through  the  nares,  and  con- 
veyed into  the  stomach  some  broth  with  a  little  wine,  assuring  the  patient, 
that  unless  he  ate  at  evening,  it  would  be  renewed  on  the  following  morning. 
So  much  resistance  does  he  experience  in  his  attempt  to  introduce  the  instru- 
ment, that  he  dares  not  surmount  it.  The  patient  begins  to  laugh.  I  had 
used,  said  he  to  us,  all  my  efforts  during  the  night,  to  contract  the  muscles  of 
the  pharynx,  in  order  to  prevent  the  introduction  of  the  tube.  On  the  seventh 
day,  every  thing  having  failed,  I  resolve  to  roll  up  a  handkerchief  upon  itself, 
and  strike  the  patient  with  it  upon  the  legs,  saying  in  an  ironical  tone ;  since 
you  make  a  child  of  yourself,  we  will  treat  you  like  a  school-boy,  so  long  as 
you  refuse  to  eat.  His  pride  is  wounded  by  this  treatment,  and  he  asks  to  be 
permitted  to  eat.  For  four  months  since  that  period,  he  has  eaten  but  twelve 
eggs  prepared  in  water,  without  drink,  and  has  been  opposed  to  taking  even 
this.  He  sits  all  this  time  upon  a  carpet,  urinates  very  rarely,  and  goes  to  the 
water  closet,  not  oftener  than  once  in  eight  days.  He  does  not  allow  himself 
to  be  shaved,  wipes  his  nose  and  mouth  with  his  fingers,  and  changes  his  linen 
only  once  a  week.  Although  surrounded  by  his  family,  he  is  habitually  sad ; 
but  converses  with  spirit,  and  sometimes  gayety.  I  persuade  the  friends  of 
the  patient  to  commit  him  to  the  care  of  that  friend,  of  whom  I  have  spoken 
above,  who  had  acquired  a  great  ascendency  over  him,  and  who,  by  threaten- 
ing to  beat  him,  had  induced  him  to  take  a  long  journey  into  Switzerland. 
After  a  year,  the  patient  revisits  Paris,  and  is  no  longer  irrational.  He  re- 
mains however,  whimsical  and  singular,  and  after  some  years  his  family  are 
constrained  to  seclude  him. 

A  woman  of  the  town,  reduced  to  extreme  wretchedness,  was  the  mother  of 
a  child  eleven  years  of  age,  who  lived  with  her.  She  commands  this  child  to 
do  whatever  she  shall  order  him,  and  not  to  leave  the  chamber  before  the  fol- 
lovvincr  morning.  This  miserable  woman  locks  herself  up,  removes  all  the 
coverings  from  her  bed,  lies  down  upon  a  matress,  ties  her  feet  together,  and 
causes  her  child  to  bind  her  hands.  She  then  requires  him  to  cover  her  with 
her  matresses,  sheets  and  bed-coverings,  and  to  place  over  these,  all  her  wear- 
ing apparel  and  furniture,  even  to  the  flower  pots.  The  child  obeys.  After 
the  lapse  of  half  an  hour,  he  hears  his  mother  sigh.  He  approaches  the  bed, 
and  enquires  if  she  wishes  any  thing.  She  replies  with  harshness ;  the  child 
frightened,  retires.  After  about  an  hour,  he  ceases  to  hear  any  thing,  and 
remains  until  the  next  morning  without  going  abroad,  seated  against  the  door, 
as  his  mother  had  commanded  him.     Not  hearing  his  mother  move,  he  re- 


SUICIDE.  291 

moves  every  thing  that  he  has  placed  upon  her,  and  finds  her  dead.  In  de- 
spair, this  wretched  child,  no  longer  having  a  mother,  goes  to  drown  himself. 
He  is  taken  out  of  the  river,  and  relates  what  has  just  been  stated. 

I  know  nothing  more  deplorable  than  the  following  case,  reported  by  Hufe.- 
land  in  his  Journal  of  Practical  Medicine;  the  No.  for  March  1819.  A  mer- 
chant, thirty-two  years  of  age,  having  lost  his  fortune,  and  receiving  no  assis- 
tance from  his  relatives,  determines  to  die  of  hunger.  This  wretched  man 
was  ill  from  six  to  seven  weeks.  While  bearing  a  heavy  burthen,  he  had  met 
with  a  fall,  and  had,  at  the  time,  felt  something  give  way  in  his  bowels,  near 
the  umbilicus;  since  which,  he  had  experienced  constant  pains  in  the  abdo- 
men. From  the  12th  to  the  15th  Sept.  1818,  he  wanders  in  the  country,  and 
stops  in  a  lonely  forest.  On  the  15th,  he  digs  a  trench,  and  there  fixes  the 
place  of  his  death,  and  remains  here  until  the  third  of  October,  the  day  on 
which  he  was  found  by  an  inn-keeper.  After  an  abstinence  of  eighteen  days, 
he  still  breathed,  but  was  without  consciousness ;  and  expired  not  long  after 
the  inn-keeper  had  caused  him  to  swallow,  with  great  difficulty,  a  cup  of  broth, 
containing  the  yolk  of  an  egg.  They  found  upon  the  person  of  this  unhappy 
man,  a  journal  written  in  crayon,  with  his  own  hand.  The  following  is  an 
abstract  of  it : 

"  The  generous  philanthropist  who  shall  discover  me  after  my  death,  is  re- 
quested to  inter  me,  and  retain,  as  a  recompense  for  this  service,  my  clothing, 
purse,  knife  and  port-folio.  I  am  not  a  suicide,  but  die  of  hunger,  because  wick- 
ed men  have  deprived  me  of  a  considerable  fortune,  and  I  am  unwilling  to  be  a 
charge  to  my  friends.  It  is  unnecessary  to  open  my  body,  since,  as  I  have 
just  said,  I  die  of  hunger  :  Sept.  IGth.  Sept.  17th  :  What  a  night  have  I 
passed !  I  have  been  drenched  with  rain,  and  been  very  cold.  18th  :  The 
rain  and  cold  have  obliged  me  to  walk  about.  Walking  was  painful  to  me. 
Thirst  has  compelled  me  to  lick  up  the  water  which  remained  upon  the  mush- 
rooms. But  how  unpleasant  was  this  water !  19th  :  The  cold,  the  length 
of  the  nights,  and  the  thinness  of  my  garments,  which  cause  me  the  more 
keenly  to  feel  the  severity  of  the  cold,  occasion  me  much  suffering.  20th  : 
There  is  in  my  stomach  a  terrible  commotion.  Hunger,  and  especially 
thirst,  become  more  and  more  dreadful.  For  three  days  it  has  not  rained : 
would  that  I  could  lick  water  from  the  mushrooms!  21st:  Not  being  able 
longer  to  endure  my  thirst,  I  crawl  away  slowly  and  with  much  difficulty,  to 
buy  a  bottle  of  beer,  which  has  not  quenched  my  thirst.  In  the  evening,  I  go 
for  water  to  a  pump,  which  is  near  the  inn  where  I  purchased  the  beer. 
Yesterday  (the  22d),  I  could  scarcely  move,  much  less  conduct  the  pencil. 
Thirst  compelled  me  to  go  to  the  pump.  The  water  was  icy,  and  I  vomited 
it.  I  had  convulsions  until  evening  ;  nevertheless  I  returned  to  the  pump  : 
23d.  My  legs  seem  to  be  dead.  For  three  days,  I  have  been  unable  to 
visit  the  pump.  Thirst  increases.  My  weakness  is  so  great,  that  I  have  only 
been  able  to  write  these  lines  to  day  :  26th.  I  have  been  unable  to  change 
my  place.  It  has  rained,  and  my  clothing  is  wet.  No  one  would  believe  how 
much  I  suffer.  Whilst  it  rained,  a  few  drops  fell  into  my  mouth,  which  has 
not  however,  appeased  my  thirst.  Yesterday,  at  ten  steps'  distance,  I  saw  a 
shepherd.  I  saluted  him,  and  he  returned  my  salutation.  I  die  with  the 
greatest  regret.  Wretchedness  has  imperiously  driven  me  to  it.  Neverthe- 
less, I  pray  that  death  may  speedily  come.  My  father,  pardon  him,  for  he 
knows  not  what  he  does.  Weakness  and  convulsions  prevent  me  from  writing 
more,  and  I  feel  that  it  is  for  the  last  time  :  Sept.  29th,  1818." 

Some  suicides  desire  to  conceal  every  trace  of  their  death,  whilst  others  de- 
stroy themselves  with  much  ceremony.  A  woman  resolves  to  drown  herself, 
and  throws  herself  into  the  Seine  below  St.  Cloud,  in  order  that  her  body 
may  not  be  found.     Many  bury  themselves  in  the  depths  of  forests  for  the 


292  SUICIDE. 

same  purpose.  The  English  furnish  numerous  examples  of  suicides,  executed 
with  much  ceremony,  and  attended  with  many  singular  circumstances.  Va- 
nity is  present,  even  amidst  the  agonies  of  suicide.  They  prepare  for  death 
as  for  a  feast  day.  Witness  this  enthusiast,  who  orders  a  high  mass  to  be 
composed  in  music  ;  causes  it  to  be  executed,  and  blows  out  his  brains  amidst 
the  musicians,  whilst  they  sing  the  last  requiescat  in  pace.  This  peculiarity 
is  very  uncommon  among  us ;  at  least,  suicides  do  not  wish,  by  the  ceremony 
attending  their  death,  to  take  a  sort  of  revenge  upon  those  who  have  impelled 
them  to  this  act  of  despair.  A  lady  who  is  the  mother  of  several  children, 
but  addicted  to  pleasures,  is  guilty  of  certain  improprieties  of  conduct.  Her 
relatives  consult  with  respect  to  her.  She  runs  to  all  the  armorers  in  the  city, 
one  of  whom  provides  her  with  a  loaded  pistol,  with  which  she  shoots  her- 
self at  the  door  of  the  hall  in  which  her  relatives  were  deliberating  upon  her 
fate.     (Mathey). 

A  young  man  is  attached  to  a  lady,  and  on  learning  that  she  is  married, 
goes  to  the  house  of  the  person  who  provides  the  marriage  supper,  and  when 
the  party  have  all  assembled,  blows  out  his  brains. 

There  are  persons  impelled  to  suicide,  who  possess  a  degree  of  cunning  and 
address,  capable  of  baffling  the  attentions  of  the  most  carefully  conducted 
watchfulness,  and  of  disconcerting  the  most  skillful.  They  bring  about,  or 
seize  upon  occasions  with  a  degree  of  premeditation  and  craftiness,  which  one 
could  by  no  means  have  anticipated.  We  must  not  allow  ourselves  to  be  im- 
posed upon  by  composure  or  joy  ;  by  promises  or  oaths ;  for  these  persons  de- 
stroy themselves  when  we  least  expect  it,  and  often  after  having  given  the  fair- 
est assurances. 

A  young  lady  had  previous  to  her  marriage,  when  about  the  age  of  eighteen, 
a  first  attack  of  lypemania  with  a  tendency  to  suicide.  She  marries  at  twenty, 
and  appears  happy.  Five  or  six  years  afterwards,  she  meets  with  some  slight 
difficulties.  The  menses  flow  sparingly,  her  countenance  has  a  frowning  ex- 
pression, and  she  suffers  from  headache.  She  is  anxious  to  recover  from  a  con- 
dition, which  appears  to  her  the  more  dreadful,  as  she  is  no  longer  of  any  use 
in  the  management  of  her  household,  and  a  charge  upon  her  husband  and 
relatives.  I  offer  her  some  advice,  which  the  patient  finds  of  service  ;  but 
after  the  lapse  of  three  weeks,  she  comes  again  to  consult  me.  She  expresses 
a  strong  desire  to  leave  her  home,  in  order,  she  says,  to  recover  more  speedi- 
ly ;  besides,  she  shall  never  recover  at  home,  nor  among  her  relatives.  Ac- 
companied by  her  mother,  she  goes  to  a  private  hospital,  to  which  I  had  refer- 
red them.  I  forewarned  them  to  be  on  their  guard  ;  suspecting  the  inten- 
tions of  the  patient,  in  consequence  of  the  earnestness  which  she  manifested 
about  being  admitted  into  a  strange  establishment.  She  embraces  her  rela- 
tives and  appears  contented.  The  mistress  of  the  house  remains  with  the 
patient,  who  converses  with  composure  and  rationally  respecting  her  condi- 
tion ;  of  the  course  she  has  pursued,  and  the  resolutions  she  has  formed,  to 
do  whatever  should  be  prescribed  for  her.  It  was  necessary  however,  that 
this  young  woman  should  be  left  alone  but  a  few  moments,  to  hang  herself  be- 
hind the  door  of  her  chamber,  by  attaching  a  noose  to  the  hinge. 

I  have  heard  my  colleague  Blegnie  state,  that  whilst  making  the  rounds  at 
Charenton  with  Royer  Collard,  these  gentlemen  stopped  before  the  door  of  a 
lypemaniac,  who  had  a  disposition  to  commit  suicide.  Doctor  Blegnie,  who 
was  nearest  to  the  door,  perceives  it  close,  and  suddenly  opens  it.  This  mo- 
tion of  it  had  been  produced  by  the  body  of  the  lypemaniac,  who  had  just 
hung  himself  while  these  gentlemen  were  conversing  at  his  door. 

A  gentleman  visits  Paris,  with  his  wife,  daughter  and  two  servants,  to  be 
treated  for  lypemania,  attended  with  a  disposition  to  suicide.  I  am  consulted 
on  the  evening  of  their  arrival,,  and  forewarn  his  family  to  exercise  over  the 


V 


SUICIDE.  293 

patient  the  strictest  watchfulness,  assuring  them  that  they  have  every  thing  to 
fear  from  the  slightest  neglect.  On  the  following  morning,  his  wife  and 
daughter  are  obliged  to  go  out,  and  leave  the  patient,  attended  by  the  two 
domestics.  One  of  them  leaves  the  apartment  for  a  moment,  and  the  patient 
orders  the  other  to  look  for  something  for  him.  The  latter  forgets  the  orders 
that  have  been  given  him,  and  had  not  descended  two  steps,  when  his  master 
threw  himself  from  the  third  story  of  the  same  stairway. 

M.  A.,  thirty  years  of  age,  was  for  two  years  in  love  with  a  young  and 
beautiful  lady,  and  at  length  obtains  her  hand.  Behold  both  himself  and  wife, 
at  the  summit  of  human  happiness.  A  month  of  married  life  has  not  passed, 
when  the  husband  becomes  sad  and  thoughtful  ;  and  is  constantly  repeating 
that  he  is  unhappy,  and  experiences  a  weariness  of  life.  Aside  from  this,  he 
is  not  irrational.  He  consents  to  visit  Paris,  in  company  with  one  of  his  bro- 
thers. On  his  arrival,  he  is  extremely  anxious  to  consult  me.  He  is  of  me- 
dium size,  of  a  moderately  full  habit,  his  complexion  sallow,  and  his  look  ab- 
stracted. He  explains  very  satisfactorily  the  causes  of  his  malady,  and  the 
motives  which  render  life  insupportable.  He  is  jealous.  I  endeavor  to  dis- 
suade him  from  entertaining  this  idea,  and  to  reassure  him.  He  appears  to 
be  persuaded,  and  consents  to  spend  some  days  in  Paris  for  the  sake  of  repose 
and  amusement.  In  the  evening,  he  visits  the  theatre,  retires  to  bed  in  the 
same  chamber  with  his  brother,  and  goes  to  sleep.  At  five  o'clock  in  the 
morning,  he  rises  and  goes  out  with  little  noise.  He  returns  at  six,  and  in- 
forms his  brother  that  he  wishes  to  depart  immediately  for  Rouen,  in  order  to 
leave  his  country.  The  latter  wishes  to  make  a  remark,  but  the  patient,  who 
had  just  supplied  himself  with  two  pistols,  places  the  muzzle  of  one  of  them 
upon  the  forehead  of  his  brother,  saying  :  if  you  do  not  ivish  to  go,  I — .  The 
unhappy  brother  falls  fainting  into  an  arm  chair,  the  patient  leaves  the  hotel, 
and  blows  out  his  brains  in  the  forest  of  Bondi. 

A  lady,  forty-eight  years  of  age,  of  a  lymphatic  constitution,  had  made 
several  attempts  to  commit  suicide.  She  had  tried  to  hang  and  to  poison  her- 
self; she  had  also  thrown  herself  into  a  well.  I  am  called  to  attend  upon 
her,  and  after  some  months  she  appears  very  well.  Several  circumstances 
seem  to  confirm  the  opinion  that  I  have  formed  respecting  her  restoration. 
At  the  close  of  a  long  conversation  with  this  lady,  after  she  had  decided  to 
employ  a  cooling  drink,  which  she  had  refused  previously,  I  come  to  the  con- 
clusion that  I  can  confide  in  her.  The  better  to  convince  her  that  I  thought 
her  cured,  I  open  one  of  the  windows  of  her  apartment,  which  were  closed. 
She  seemed  to  be  delighted,  and  I  leave  her  reading  a  journal,  leaving  with 
her  a  waiting  maid,  who  was  working  embroidery,  with  her  back  turned  a  lit- 
tle towards  the  open  window.  I  had  not  left  the  ante-chamber,  before  this 
lady  had  thrown  herself  out  of  the  window.  The  first  words  she  uttered, 
when  they  came  to  her  aid  were  ;  do  not  mention  it  to  the  doctor. 

M.  N.,  disposed  to  lypemania  with  a  tendency  to  suicrde,  was  sad  and 
thoughtful.  After  some  months,  he  declares  to  his  family  that  he  is  cured  of 
his  fatal  thoughts;  becomes  gay,  and  converses  freely.  Some  days  afterwards, 
he  embraces  his  wife  and  children  with  a  degree  of  affection  which  was  not 
then  noticed,  and  hastens  to  throw  himself  into  a  river. 

General  A.  enjoyed  a  large  fortune  before  the  revolution,  and  was  an  officer 
in  the  military  establishment  of  the  king.  When  twenty-five  years  of  age,  he 
becomes  melancholic,  and  consults  Bouvard,  who  says  to  him  abruptly,  when 
men  are  in  your  condition  they  blow  out  their  brains.  Struck  with  this  opin- 
ion, given  by  a  celebrated  physician,  young  A.  with  difficulty  refrained  from 
putting  it  into  execution.  Ever  since,  the  thought  of  suicide  has  been  present 
to  his  mind,  even  on  the  day  of  battle  at  the  head  of  his  division.  He  died  at 
the  age  of  eighty-six  years,  and  to  the  last,  had  constantly  to  struggle  against 
this  deplorable  impulse. 


294  SUICIDE. 

All  those  who  entertain  thoughts  of  suicide  have  not  the  same  perseverance, 
nor  an  equal  share  of  address.  There  are  among  them,  and  these  are  the 
most  numerous,  hypochondriacs,  who  often  speak  of  a  distaste  of  life,  and  a 
desire  of  suicide.  They  make  attempts,  but  are  wanting  in  resolution.  Some 
have  such  fear  of  death,  that  they  request  their  relatives  and  friends  to  watch 
them  carefully,  and  prevent  them  from  fulfilling  their  designs.  These  patients 
manifest  the  characteristics  of  hypochondria.  They  are  timid,  fearful,  irreso- 
lute, and  very  different  from  the  lypemaniacs  of  whom  we  have  just  spoken. 
They  are  restrained  by  various  motives.  They  do  not  destroy  themselves, 
through  horror  of  death ;  the  fear  of  suffering,  if,  after  their  attempts  they  are 
severely  wounded ;  and  by  the  penalties  with  which  religion  menaces  suicides. 
Others  are  preserved  in  being,  through  their  affection  for  some  relative  or 
friend,  or  by  a  sentiment  of  honor  ;  wishing  to  justify  themselves  for  pretend- 
ed wrongs,  that  they  believe  the  public  reproach  them  with.  Finally,  there 
are  those  who  think  that  by  not  destroying  themselves,  they  shall  prevent  the 
joy,  and  destroy  the  hopes  of  their  real  or  supposed  enemies. 

M.  A.,  remarkably  hypochondriacal,  has  assured  me  that  religious  ideas  had 
alone  prevented  him  from  committing  suicide,  to  which  he  had  many  times 
been  tempted  during  the  e.\istence  of  his  disease.  He  had  however,  never 
made  any  attempts.  A  moral  and  religious  education,  in  connection  with 
noble  and  generous  sentiments,  have  preserved  him  to  life  and  his  friends. 
Similar  examples  are  not  very  rare,  although  religious  motives  are  not  always 
sufficient  to  arrest  the  arm  of  the  suicide. 

M.  L.,  had  cut  his  throat,  and  suffered  from  hallucinations  of  hearing,  which 
led  him  to  attempt  suicide.  But  he  was  restrained  from  repeating  it,  through 
the  necessity  of  justifying  himself  against  a  pretended  accusation,  which  had 
determined  his  first  attempt  to  commit  suicide. 

I  have  seen  persons  fully  resolved  to  destroy  themselves,  and  who  resisted 
the  impulse  ;  restrained  by  their  word  of  honor.  General  M.,  tall,  with  chest- 
nut-colored hair  and  eyes,  was  of  a  melancholy  disposition.  One  of  his  cou- 
sins had  committed  suicide.  In  the  army,  the  General  associated  little  with 
his  comrades,  took  little  e.xercise,  and  appeared  to  possess  little  activity,  ex- 
cept on  the  day  of  battle.  Ambitious  and  distrustful,  he  apprehended  that 
they  did  not  do  him  justice,  although  advancement  had  not  been  wanting,  in 
view  of  his  talents  and  bravery.  At  the  fall  of  Bonaparte  he  retired  into  his 
province,  and  there  married  a  young  woman,  beautiful,  amiable,  and  endowed 
with  excellent  qualities.  During  the  hundred  days,  the  General,  notwithstand- 
ing the  opposition  of  his  family,  resumes  his  duties,  wishing  to  do  as  his  asso- 
ciates had  done,  and  was  present  at  the  battle  of  Waterloo.  He  is  disbanded 
with  the  army,  and  returns  to  his  family,  who  receive  him  rather  coolly,  as 
well  as  the  inhabitants  of  his  county.  This  reception  affects  him  deeply,  and 
increases  his  natural  disposition  to  melancholy  and  distrust.  The  General 
becomes  sad,  more  sedentary  in  his  habits,  no  longer  goes  out  of  his  house, 
takes  very  little  exercise,  neglects  his  friends,  and  refuses  all  diversion.  In 
1815  he  returns  to  active  service  ;  but  it  is  for  so  short  a  period,  as  not  to 
counterbalance  the  bad  effects  of  his  previously  sedentary  life.  During  the 
summer  of  1816,  one  of  the  intimate  friends  of  the  General  comes  to  spend 
a  season  with  him,  and  is  most  cordially  received.  Shortly,  however,  the 
presence  of  this  friend,  who,  by  the  confession  of  the  General  himself,  had 
done  nothing  to  occasion  offence  on  his  part,  excites  sentiments  of  jealousy, 
which  cease  not  to  make  progress,  and  which  at  length  degenerate  into  sui- 
cidal lypemania,  attended  with  hallucinations. 

The  General,  until  this  period  so  good,  so  affectionate,  so  anxious  to  serve 
his  friends,  becomes  sad,  morose,  irritable,  querulous ;  insulting  his  wife  by 
his  jealous  remarks.  His  friend,  lamenting  this  condition,  hopes  to  put  an 
end  to  it  by  leaving  him.     His  departure  however,  only  exasperates  the  Gene- 


SUICIDE.  295 

ral.  He  no  longer  leaves  his  apartment ;  a  thousand  suspicions  harass  him; 
his  jealousy  increases.  He  is  passionate,  and  from  abusive  remarks  proceeds 
to  ill  treatment.  This  conduct  embroils  him  with  the  family  of  his  wife, 
who,  not  believing  that  he  is  ill,  accuse  him  of  a  perverse  disposition,  and 
decide  upon  visiting  his  house  no  more.  Solitude  becomes  more  complete. 
He  engages  in  no  occupation  whatever,  and  his  jealousy  is  exasperated.  Dur- 
ing the  inspection  of  1816,  which  lasts  two  months,  the  patient  is  overwhelmed 
by  the  anguish  of  his  jealousy,  and  obtains  no  sleep.  On  reaching  his  family 
again,  he  is  gay,  and  the  kindness  of  his  natural  disposition  is  nearly  restored. 
But  these  days  of  happiness  are  of  short  duration,  and  jealousy  soon  resumes 
its  empire.  The  General  every  where  witnesses  proofs  that  his  friend  has  be- 
come his  rival.  He  believes  him  in  bed  with  his  wife,  while  he  is  himself  by 
her  side.  He  springs  from  it,  arms  himself  with  his  sword,  and  seeks,  first 
in  his  own  chamber,  and  then  throughout  the  Chateau,  for  the  object  of  his 
jealousy  ;  uttering  imprecations  and  threats  against  his  invisible  rival,  and 
despairing  wife.  At  a  later  period,  the  General  believes  that  the  family  of  his 
wife,  particularly  his  brother-in-law,  favor  these  odious  intrigues.  The  voices 
of  those  who  speak  or  sing,  the  singing  of  birds,  and  the  rustling  of  leaves, 
are  also  warnings.  Often,  notwithstanding  the  most  profound  silence  prevails, 
he  hears  voices  that  insult  and  mock  him.  Unable  to  seize  these  infamous 
enemies,  (for  his  rival  has  accomplices),  the  General  calls  upon  them,  defies 
and  provokes  them,  runs  about  like  a  madman,  pursuing  them  every  where, 
armed  with  his  sword.  Having  returned  to  his  wife,  he  pours  out  upon  her  de- 
voted head,  his  anger  and  despair.  Nevertheless,  he  cannot  refuse  to  do  jus- 
tice to  the  virtue  of  his  wife. 

Nothing  can  persuade  the  General  that  he  is  sick,  that  he  needs  attentions, 
and  that  all  his  disquietude  is  chimerical.  At  length,  neither  himself  nor  his 
wife  wishing  to  remain  there  longer,  he  determines  to  come  to  Paris,  where 
he  arrives  about  the  middle  of  July,  1817.  The  change  of  place  and  objects, 
together  with  the  attention  which  he  gives  to  the  furniture  of  his  apartment, 
divert  and  compose  him.  After  some  days,  he  relapses  into  his  fever  of  jea- 
lousy. The  cries  which  he  hears  in  the  streets,  are  also  insults  addressed  to 
him  by  his  enemies,  through  the  instrumentality  of  his  rival.  They  accuse  of 
cowardice,  him  who  has  fought  so  well.  He  follows  his  wife  at  every  step, 
who  cannot  pass  alone  from  one  portion  of  her  apartment  to  another.  His 
eyes  are  incessantly  fixed  upon  her,  and  a  glance,  gesture  or  movement,  and 
even  complete  repose,  are  also  indications  of  an  understanding  with  his  enemy. 
If  she  weeps,  he  believes  that  she  desires  to  have  him  understand  that  she  is 
unhappy.  If  she  smiles,  it  is  a  proof  of  friendship  for  his  enemies.  If  she 
assumes  a  tone  of  firmness,  it  is  because  she  believes  that  she  shall  be  sustain- 
ed by  them.  These  wicked  beings  both  see  and  hear  through  the  walls  and 
ceilings,  all  that  is  done  and  said  in  his  apartment.  Near  the  close  of  the 
month  of  July,  sabre  in  hand,  the  General  visits  every  part  of  the  hotel  where 
he  is  residing,  and  enters  the  apartments  of  all  his  fellow-lodgers,  seeking  his 
rival.  It  is  with  much  difficulty  that  they  prevent  him  from  going  into  the 
street,  as  he  desires  to  fall  upon  his  rival,  whom  he  has  seen.  On  the  follow- 
ing day,  he  manifests  the  same  feelings  towards  the  passers-by,  and  especially 
the  shop-keepers,  who  exclaim  ;  coward,  coward.  Unable  to  accomplish  more, 
and  giving  himself  up  to  his  jealous  frenzy,  the  General  desires  to  put  an  end 
to  his  existence.  One  of  his  friends,  a  master  commissary,  who  is  prodi- 
gal of  the  warmest  attentions,  can  effect  nothing  with  respect  to  this  errone- 
ous sentiment,  though  the  patient  is  irrational  upon  no  other  subject.  He 
requires  his  friend  to  give  him  a  potion,  containing  sufficient  opium  to  cause 
him  to  sleep  forever.  To  all  the  objections  that  friendship  urges,  the  patient 
replies,  by  threatening  to  have  recourse  to  means  the  most  extreme  and  infal- 


296  sure  IDE. 

lible.  At  length,  his  friend  appears  to  yield,  and  promises  the  potion  at  even- 
ing. The  day  is  a  quiet  one.  The  General  writes  down  his  last  wishes,  and 
makes  his  will.  The  potion  is  brought  to  him.  The  patient  swallows  it 
with  avidity,  and  retires  to  bed,  awaiting  patiently  his  last  hour.  Experiencing 
no  decided  symptom,  he  suspects  that  he  has  been  deceived  ;  reproaches  his 
friend  for  his  weakness ;  accuses  him  of  having  covered  him  with  shame,  and 
of  having  despised  him  to  the  degree  of  believing  that  he  did  not  know  how 
to  die. 

Having  become  almost  furious,  he  is  comn)itted  to  my  care  Aug.  1st,  1817, 
and  placed  in  a  room  on  the  ground  floor,  where  he  remains  without  light, 
from  seven  until  eleven  o'clock  at  night.  I  then  visit  the  patient.  Despair 
is  depicted  upon  every  feature  of  his  countenance ;  his  complexion  is  of  a 
livid  paleness ;  his  eyes  are  injected ;  the  skin  is  hot ;  and  the  pulse  very  fre- 
quent. I  endeavor  to  persuade  the  General  that  I  am  a  physician ;  but  he 
persists  in  regarding  me  as  a  painter,  brought  to  him  to  take  his  portrait, 
which  is  to  be  placed  in  public  and  sold,  as  we  sell  that  of  a  criminal.  Af- 
ter an  hour's  conversation,  we  become  silent,  during  which,  my  eyes  remain 
fixed  upon  those  of  the  patient.  After  some  minutes;  "General,  say  I,  you 
wish  to  destroy  yourself,  and  for  want  of  some  other  means  of  effecting  your 
purpose,  you  wish  to  keep  your  cravat.  You  shall  not  take  your  life.  I  will 
restore  you  to  health,  and  return  you  to  your  family  and  happiness.  To  hap- 
piness !  cried  he,  there  is  no  more  happiness  for  me.  Pardon  me.  General,  I 
will  restore  you  to  happiness,  and  I  wish  to  assure  myself  that  you  will  make 
no  attempt  upon  your  life.  Four  attendants  are  going  to  remain  in  your 
chamber,  and  watch  you,  unless  you  pledge  me  your  word  of  honor  that  you 
will  make  no  attempt  to  destroy  yourself  Take  your  choice,  though  I  prefer 
your  word.  I  give  it  you,  he  replied  in  a  feeble  tone.  You  must  give  me 
your  word  frankly,  and  like  a  soldier.  After  hesitating  for  some  minutes ; 
"  Well  sir,  I  pledge  you  my  honor  as  a  soldier."  I  retire,  leaving  the  pa- 
tient his  cravat.  On  the  following  day  I  visit  him,  and  congratulate  him  on 
havincr  resisted  his  fatal  design.  I  encourage  him,  and  strive  to  gain  his  con- 
fidence. In  the  course  of  our  conversation,  the  patient  informed  me  that  he 
had,  more  than  twenty  times,  taken  his  cravat  to  strangle  himself,  but  that  his 
word  of  honor  had  restrained  him.*  I  order  leeches  to  the  anus,  and  foot 
baths,  rendered  stimulant  by  mustard. 

Aug.  i3d.  Sadness,  same  ideas,  same  conviction  that  his  enemies  are  pur- 
suing him;  but  the  consolations  which  I  lavish  upon  the  patient,  kindle  a  lit- 
tle hope  in  his  breast.  He  acquaints  me  with  the  cause  and  duration  of  his 
disease,  which  he  attributes  to  the  sedentary  life  which  he  led,  after  the  active 
duties  of  the  field.  Aug.  4th.  Sensible  amelioration.  Although  depressed 
and  uneasy,  the  patient  no  longer  entertains  the  idea  of  self-destruction.  His 
appetite  is  good  and  his  sleep  tranquil.  Aug.  5th.  He  consents  to  walk  in 
the  garden,  and  experiences  the  most  delightful  emotions,  regarding  nature 
with  a  degree  of  pleasure  which  he  had  not  for  a  long  time  enjoyed.  If  I 
speak  of  his  wife,  his  eyes  moisten  with  tears,  which  he  endeavors  to  conceal. 
On  the  eighth  day,  I  propose  to  him  to  breakfast  at  St.  Cloud.  The  weather 
was  delightful.  On  the  way,  the  patient  says  little,  but  seems  to  enjoy  a  new 
existence,  and  expresses  his  satisfaction.  Never  had  the  face  of  nature  ap- 
peared to  him  more  beautiful.  From  time  to  time  his  countenance  lowers, 
and  he  is  silent ;  believing  that  he  hears  his  enemies  in  the  mid.st  of  the  park 
of  St.  Cloud.  He  suddenly  stops;  his  eyes  gleam;  and  his  face  becomes 
animated.     Do  you  hear  them,  says  he,  the  wretches?     No,  I  reply.     Not 

*  This  case  has  been  reported  in  the  thesis  of  Dr.  Anceaume,  to  whom  I  related  it. 
On  Melancholy,  Paris,  1818,  in  4to. 


SUICIDE.  297 

daring  to  show  themselves,  they  hurl  their  abuse  from  above  the  trees.  The 
murmur  of  the  breeze  among  the  trees,  was  the  cause  of  his  illusions.  He 
heard  the  words,  coward,  coward.  I  express  my  astonishment,  and  in  a  few 
moments  dissipate  this  unfortunate  illusion.  The  remainder  of  the  day  passes 
very  pleasantly,  and  on  his  return,  the  patient  was  placed  in  an  apartment 
appropriate  to  the  improved  state  of  his  health.  This  unexpected  change 
occasions  a  sort  of  intoxication,  which  confirms  the  good  resolves  of  the  day. 
I  feel  as  if  I  were  born  again,  he  several  times  repeated.  On  the  following 
day,  the  General  is  gay,  engages  in  various  games,  hears  not  the  importunate 
voices,  and  no  longer  misinterprets  the  sound  which  is  made  around  him. 

Aug.  19th.  The  General  receives  an  unexpected  visit  from  hi.s  father,  to 
whom  he  seems  to  be  restored.  He  takes  him  to  lodge  at  the  hotel,  where 
his  wife  had  arrived.  His  cure  seemed  to  be  perfected.  The  patient  believ- 
ed himself  happy.  But  from  the  following  morning,  he  is  less  gay,  his  jeal- 
ousy kindles  again  ;  and  hallucinations  of  hearing  are  noticed.  The  General 
thinks  he  sees  his  rival  in  the  street,  who  provokes  him.  However,  ideas  of 
suicide  no  more  return,  and  the  patient  treats  both  his  father  and  wife  with 
kindness.  He  regrets,  nevertheless,  his  not  being  with  myself  At  my  visit, 
I  divert  him  from  the  thought  of  isolation,  and  assure  him  that  he  wants  agree- 
able occupation  to  remove  the  remainder  of  the  melancholy  that  broods  over 
his  mind.  Early  in  the  month  of  September,  I  propose  to  him  to  accompany 
me  on  a  journey  to  Belgium.  He  accepts  the  proposal  joyfully.  He  often 
speaks  of  it,  but  delays  his  preparations.  The  difficulties  which  he  experi- 
ences in  obtaining  a  passport,  causes  him  to  believe  that  his  enemies  oppose 
his  journey ;  but  so  soon  as  it  is  secured,  he  is  satisfied,  and  applauds  himself 
for  having  obtained  the  victory  over  his  pretended  enemies.  On  the  eve  of 
departure,  the  choice  of  a  carriage  not  being  yet  fixed  upon,  he  supposes, 
from  the  new  obstacles  which  are  offered  to  this  arrangement,  that  his  ene- 
mies will  prevent  him  from  fulfilling  it.  Nevertheless,  we  commence  our  jour- 
ney on  the  15th  of  Sept.,  and  the  patient  is  almost  overcome  by  his  pleasura- 
ble emotions.  But  before  arriving  at  the  third  post,  he  takes  the  passengers 
in  a  carriage  which  meets  our  own,  for  the  agents  of  his  enemies,  and  relapses 
into  sadness. 

On  the  following  day,  he  wishes  to  visit  one  of  his  friends,  who  lives  at 
some  distance  from  the  city,  where  we  passed  the  night.  He  experiences 
some  delay  while  on  the  way,  which  he  attributes  to  the  manoeuvres  of  his 
enemies.  However,  he  reaches  the  residence  of  his  friend,  and  writes  me  the 
next  day,  that,  at  length,  he  had  found  happiness  ;  that  he  was  with  his  friend  ; 
and  desires  me  to  take  every  possible  precaution  to  conceal  the  place  of  his 
retreat.  For  three  weeks,  the  General  enjoys  most  perfect  health,  and  believes 
that  he  is  delivered  from  his  rival  and  enemies.  He  writes  his  wife  and  rela- 
tives letters,  full  of  expressions  of  tenderness,  and  of  the  pleasure  he  enjoyed. 
After  the  lapse  of  this  period,  he  no  longer  finds  himself  in  security  where  he 
is,  and  is  suspicious  of  his  friend,  his  wife  and  domestics.  He  barricades 
himself  nightly,  in  his  chamber.  At  length,  he  deserts  thejhouse,  unknown 
to  every  one,  returns  to  Paris,  and  comes  to  see  me  again  on  the  21st  of  Oct. 
I  was  still  absent,  and  the  patient  persuades  himself  that  they  are  deceiving 
him.  * 

A  few  days  afterwards,  my  return  causes  hope  to  spring  up  again  in  his 
breast ;  and  he  consents  once  more  to  separate  himself  from  his  family.  I 
order  leeches  frequently,  to  the  anus.  Frequent  and  abundant  epistaxis  dissi- 
pates the  cephalalgia  ;  drives  away  melancholy  thoughts,  and  renders  the  pa- 
tient more  disposed  to  diversions.  At  the  expiration  of  a  month,  the  brother- 
in-law  of  the  patient,  whom  the  latter  had  always  regarded  as  one  of  his  worst 
enemies,  comes  to  visit  him ;  is  cordially  received,  and  finds  in  the  General, 

38 


298  SUICIDE. 

the  same  friendship  and  confidence  as  formerly.  By  proofs  of  attaclnnent, 
and  diversions,  the  brother-in-law  sncceeds  in  dissipating  every  indication  of 
disease.  This  happy  change :  continues  but  for  three  weeks  ;  at  the  end  of 
which,  suspicion  revives,  and  with  it  hallucinations.  The  patient  receives  the 
visit  of  his  wife  and  one  of  his  relatives ;  appears  gratified,  happy,  and  per- 
fectly composed  for  some  days,  and  then  relapses  into  his  unhappy  delusions. 
He  joins  his  family,  and  passes  three  months  in  Paris  with  his  wife,  her  mo- 
ther and  brother.  He  treats  them  at  first  extremely  well ;  but  is  then  over- 
come by  his  jealous  suspicions.  Always  manifesting  great  confidence  in  me, 
as  well  as  friendship,  he  is  pleased  to  see  me ;  hears  my  advice,  and  employs 
some  of  my  prescriptions.  After  ithe  lapse  of  three  months,  passed  in  alter- 
nate states  of  well-being  and  of  grief,  the  General  returns  to  his  own  estate, 
designing  to  make  certain  tasteful  improvements,  and  to  engage  in  exercise. 
On  his  arrival,  he  finds  himself'  well,  but  is  not  slow  to  resume  his  solitary 
course  of  life,  and  again  becomes  suspicious.  Paroxysms  of  jealousy  return 
from  time  to  time.  At  lenetli,  after  some  months,  his  wife  is  obliged  to  leave 
him  and  return  to  her  family.  The  General  remains  alone,  a  prey  to  his  jea- 
lous griefs  and  suspicions ;  now  well,  and  now  ill ;  but  having  made  no  far- 
ther attempts  at  suicide.  Several  years  elapse,  before  it  ife  possible  again  to 
bring  together  the  General  and  his  wife ;  nothiiig  successfully  overcoming  his 
jealous  passion.*  .  ■  ■•.:   . 

Those  who  endeavor  to  destroy  themselves,  do  not ^al ways  succeed  in  effect- 
ing their  purpose.  Amcwog  a  hundred  individuals  who  make  the  attempt,  not 
one  half  succeed.  Those  who  have  escaped  their  awn  proper  fury,  present 
very  different  moral  and  intellectual  dispositions.  Now,  having  thrown  them- 
selves into  a  river,  they  swim  fco  gain  the  shore  and  call  for  aid.  After  having 
thrown  them.selves  into  a  well,  they  employ  every  means  to  escape,  and  point 
out  the  precautions  which  are  necessary  to  effect  their  rescue.  They  congra- 
tulate themselves  on  account  of  their  failure.  They  complain  of  pains  from 
which  they  have  long  suffered,  or  of  recent  ones  caused  by  wounds  and  con- 
tusions, which  they  have  themselves  produced.  They  reveal  the  motives 
which  have  led  them  to  attempt  self-murder,  and  manifest  for  tiie  first  time, 
disorder  in  their  ideas.  They  are  mortified,  and  express  regret  at  having  been 
driven  to  this  excess.  The  fear  of  death,  seen  but  too  neary  together  with 
the  physical  and  moral  shock  which  they  have  experienced,  has  cured  them. 
Now,  suicides  who  have  been  rescued  in  time,  pursue  their  designs  with  new 
fury  ;  lament   their  unskillfulness,  and-  repel   the   attentions   that   are  offered 

them.  .:;:      :■   .  :,;  : 

A  person  throws  himself  into  the  Seine,  and  the  sailors  draw  him  out  by 
his  feet.  When  his  head  reaches  the  surface  of  the  water,  he  makes  the 
greatest  efforts  to  plunge  in  again.  A  woman  had  thrown  herself  into  a  well, 
and  allows  herself  to  fall  back  three  times  successively,  when  near  the  top  of 
it ;  so  that  it  was  necessiiry  to  bind  her,  in  order  to  withdraw  her.  Many  of 
these  wretched  beings,  remove  the  bandages  placed  upon  the  wounds  that  they 
have  made,  ajid  enlarge  them  with  their  fingers:.  They  also  make  use  of 
pieces  of  the  a|)paratus  or  clothing  employed  torestrain  them,  for  the  pur- 
pose of  strangling  themselves.  I  have  seen  them  retain  in  their  fauces,  the 
food  and  drinks  that  were  given  them,  hopnig  to  asphyxiate  themselves. 
These  wretched  beings  are  insensible  to  physical  suffering.  iAll  sensibility  is 
annihilated.  Nothing  can  snatch  them  from  their  fatal  purpose.  In  these 
cases,  the  disease  persists  in  allits  intensity,  and  the  patient  requires  the  most 

*  This  case,  as  well  as  snvpral  other?,  which  may  ho  loiind  in  the  chapter  on  Suicide, 
were  published  in  1820,  in  the  suppk^nientai  journal  of  the  medical  sciences,  by  one  of  my 
pupils;  as  errors  of  more  than  one  ivind  found  tlieir  way  into  it  at  that  time,  I  republish 
tlie  facts,  as  1  collected  them. 


SUICIDE.  299 

careful  and  constant  attention.  Thus  it  is,"ttmong  persons  who  liave  attempt- 
ed to  destroy  themselves.  With  some,  the  attempts  have  been  succeeded  l)y 
a  remission  and  even  cessation  of  the  malady.  -With  others,  they  appear  to 
aggravate  the  evil. 

Suicide,  like  all  those  diseases  of  which  it  is  a  symptom,  is  acute  or  chro- 
nic ;  continued  or  intermittent.  M.  Alibert  had  charge  of  a  lady  who,  during 
the  process  of  digestion,  could  not  prevent  herself  from  entertaining  a  desire 
for  self-destruction.  She  was  many  tiiiies  surprised  after  dinner,  passing  a 
cord  about  her  neck.  It  was  then  necessary  to  watch  her  very  closely.  I 
have  had  charge  of  several  women  who,  during  pregnancy^  were  tormented 
with  the  same  desire.  It  is  frequently  the  case  that  we  3ee  women  who,  dur- 
ing the  menstrual  discharge,  desire  intensely  to  destroy  themselves,  and  make 
attempts  to  effect  this  purpose  ;  but  who  cease  to  entertain  this  desire  so  soon 
as  the  menstrual  period  is  closed,  or  the  change  of  life  has  taken  place. 

M.,  very  tall,  and  of  a  vigorous  constitution,  lived  for  some  time  in  the  Ca- 
ribbee  Islands.  He  escapes  the  yellow  fever,  returns  to  France,  and  expe- 
riences rheumatic  pains,  which  are  exasperated  during  the  winter.  At  the 
age  of  thirty-six  years,  he  breakfasts  with  his  family,  takes  a  cup  of  chocolate 
which  his  wife  presents  him,  and  shdrtly  after  experiences  colic  pains.  This 
unfortunate  man  immediately  persuades  himself  that  the  family  of  his  wife 
are  anxious  to  destroy  him,  and  that  his  wife  has  been  constrained  to  offer 
him  chocolate  containing  poison.  Ill  despair,  he  cuts  his  throat  with  a  razor, 
and  remains  voiceless.  On  the  succeeding  year,  in  the  month  of  Fel)ruary, 
there  are  the  same  pains,  and  the  same  sentiments.  He  attempts  to  strangle 
his  wife,  and  gives  himself  several  strokes  with  a  knife,  upon  the  left  temple 
and  forehead.  The  same  attempts  are  renewed  on  the  two  succeeding  years. 
For  several  years,  the  disorder  extends  so  that  the  mind  embraces  many  erro- 
neous views,  and  the  understanding  is  weakened.  He  often  disputes  with 
distinguished  personages,  particularly  M.  Talleyrand,  and  indulges  in  the 
most  abusive  threats,  but  makes  no  farther  attempts  upon  his-  own  life,  or  the 
lives  of  others.  ' 

A  young  man  from  the  south- ^  aged  twenty-five  years,  of  a  remarkably  ner- 
vous temperament,  at  the  approach  of  winter,  for  three  successive  years,  is 
seized  with  a  violent  excitement.  H6'is  then  very  active,  and  always  in  mo- 
tion ;  converses  much  ;  thinks  himself  possessed  of  a  remarkable  mind  ;  lays 
out  a  thousand  projects  ;  gives  away  much  money  ;  purchases  and  borrows, 
without  troubling  himself  much  with  respect  to' payments.  He  is  very  irrita- 
ble. Every  thing  offends  him,  and  excites  transports  oif  ■  anger.  He  no  longer 
regards  the  friendship  of  his  relatives,  nor  does  he  recognize  even  the  voice 
of  his  father.  So  soon  as  the  intiuence  of  spring  begins  to  be  felt,  he  be- 
comes more  composed,  and  by  degrees  less  active,  less  talkative,  and  less  sus- 
ceptible. In  proportion  as  the  temperature  rises,  the  physical  and  intellectual 
forces  grow  weak.  He  falls  into  a  state  of  inactivity  and  torpor  ;  reproaches 
himself  for  all  the  extravagances  to  which  he  has  yielded  himself  during  the 
period  of  excitement ;  and  at  length  becomes  a  lypemaniac  ;  first  desiring,  and 
finally  attempting  to  destroy  himself 

A  lady,  forty-eight  years  of  age,  regretting  the  loss  of  society,  sinks  into 
lypemania.  She  suffered  from  hallucinations  of -hearing,  and  believed  also, 
that  she  smelt  the  grease  with  which  the  axletrees  of  carriages  were  lubricat- 
ed (coom).  Whenever  she  was  disturbed  by  this  odor, — although  she  might 
not  be  near  any  thing  that  could  produce  it,  she  became  sad,  and  was  dispo.s- 
ed  to  injure  herself  The  paroxysm  usually  occurred  in  the  evening.  The 
remainder  of  the  day  she  was  very  well,  and  even  gay. 

Mad'e  de  B.  had  several  attacks  of  a  suicidal  propensity,  always  produced 
by  hallucinations  of  sight,  and  religious  scruples.     On  one  occasion,  she  saw 


300  SUICIDE. 

a  bloody  head  separated  from  the  body,  and  covered  with  black  crape.  On 
another,  it  was  an  entire  skeleton  in  steel.  She  saw  and  heard  also,  a  proces- 
sion. These  images  were  fixed  in  the  left  temple,  above  the  eye ;  pursued 
her  every  where,  and  wearied  her  as  well  during  the  night  as  the  day.  The 
attack  lasted  from  one  to  three  months.  At  each  of  them,  the  hallucination 
changed  its  object.  The  patient  avouM  always  choose  opium,  hoping  to  die 
without  pain.  At  the  age  of  sixty-eight  years,  she  took  a  strong  dose  of  it, 
and  experienced  for  many  hours  before  her  death,  the  most  frightful  pains. 
The  lady  whose  deplorable  end  I  have  just  noticed,  formerly  had  a  cousin 
who,  sad  and  taciturn  for  a  considerable  period,  had  often  manifested  a  suici- 
dal disposition.  A  journey  is  reconmiended,  to  which  she  gives  her  assent, 
and  makes  preparations,  which  seem  to  divert  her.  The  horses  were  attach- 
ed to  the  carriage,  and  the  moment  when  her  son,  who  was  to  accompany  his 
mother,  offers  her  his  hand  to  assist  her  into  the  carriage,  she  remarks  that 
she  has  forgotten  something,  returns  hastily  to  her  apartment,  and  does  not 
come  down.  He,  after  waiting  some  minutes,  goes  to  assist  her  down,  when 
he  finds  her  expiring.  She  had  just  poisoned  herself.  This  same  son,  after 
having  been  cured  of  a  monomania,  and  enjoyed  good  health  for  twelve  years, 
blows  out  his  brains,  despairing  of  the  fall  of  Bonaparte,  whom  he  had  desired 
to  overthrow  while  a  monomaniac. 

R.  V.  B.,  sixty-nine  years  of  age,  is  the  offspring  of  a  very  passionate  mo- 
ther. She  is  also  rickety,  and  of  extreme  susceptibility.  When  thirty-four 
years  of  age,  a  moral  affection  determines  her  to  throw  herself  into  the  Seine. 
At  the  age  of  thirty-six  years,  when  two  months  advanced  in  pregnancy,  her 
husband  dies.  A  second  attack  follows,  which  does  not  terminate  until  after 
her  confinement.  At  the  age  of  thirty-seven,  she  meets  with  trials,  attended 
by  a  suppression  of  the  menses  for  a  year.  A  new  attack  succeeds,  which  is 
dissipated  only  after  the  return  of  the  menses.  At  forty-one,  a  fourth  attack, 
caused  by  the  events  of  the  revolution  and  disquietudes  respecting  her  chil- 
dren. At  forty-eight,  an  attack  which  is  induced  by  no  known  cau.se.  At 
fifty-four,  cessation  of  the  menses,  preceded  by  a  very  abundant  uterine  he- 
morrhage. At  sixty-one,  a  sixth  attack  ;  trifling,  and  caused  by  slight  vexa- 
tions. At  sixty-three,  the  attack  is  provoked  by  troubles  ;  persists  for  several 
months,  and  is  very  violent ;  since  which  time,  cephalalgia  is  violent,  and 
there  is  an  intermission  of  only  four  months.  At  sixty-four,  an  eighth  attack  ; 
and  the  patient  made  the  most  powerful  efforts  to  strangle  herself.  She  also 
swallowed  pins.  At  sixty-seven,  an  attack  like  the  preceding  ones.  At  sixty- 
eight,  an  attack  of  trifling  severity,  but  the  period  of  prostration  was  of  con- 
siderable duration.  Ever  since  the  first  attack  on  each  year,  during  the  heats 
of  summer,  the  p.itient  experiences  slight  turns  of  sadness,  attended  with  a 
desire  to  destroy  herself,  which  are  dissipated  by  pediluvia  and  diversions. 

The  attacks  always  take  place  in  summer,  and  are  variable  with  respect  to 
intensity  and  duration.  Their  approach  is  announced  by  insomnia  and  flashes 
of  heat,  which  ascend  to  the  head.  The  face  is  flushed,  and  the  sensibility 
is  exalted.  When  in  this  state,  the  most  trifling  contrariety, — a  source  of 
vexation  of  no  consequence  at  any  other  time, — determines  the  explosion  of 
the  delirium.  At  the  commencement  of  the  attack,  the  patient  experiences 
febrile  symptoms.  She  recognizes  every  one,  but  talks  incessantly,  utters 
abusive  language,  and  makes  obscene  remarks.  She  seeks  all  means,  and 
makes  the  most  violent  efforts  to  destroy  herself  She  then  seems  furious. 
Although  her  appetite  is  good,  she  becomes  emaciated.  Constipation  is  obsti- 
nate, and  after  a  period  of  agitation,  her  limbs  feel  as  if  bruised.  She  is  over- 
come. She  does  not  even  stir.  She  sometimes  talks  to  herself  in  a  low 
voice  ;  suffers  from  cardialgia,  but  gains  flesh.  Sleep  returns,  and  with  it 
strength,  though  she  eats  less.     In  the  intervals,  she  is  perfectly  rational,  gives 


SUICIDE.  301 

a  good  account  of  her  condition,  and  remembers  whatever  she  has  done.  She 
is  also  very  much  mortified  and  grieved,  in  consequence  of  it.  She  feels  the 
need  of  exercise  and  occupation.  After  the  age  of  sixty-four  years,  the  inter- 
missions are  shorter, — of  not  more  than  tu'o  months'  duration,  and  the  period 
of  prostration  longer. 

I  have  elsewhere  mentioned,  that  her  daughter  has  had  several  attacks  of 
mania,  and  that  her  grand-daughter  had  a  first  attack  at  the  age  of  fourteen 
years,  attended  with  efforts  to  destroy  herself.  The  daughter  of  this  patient 
is  at  Charenton,  in  a  state  of  mania,  bordering  on  dementia  ;  and  her  grand- 
daughter died  at  the  age  of  twenty-one,  a  lypemaniac,  and  phthisical. 


PATHOLOGICAL  LESIONS  OBSERVED  AMONG  SUICIDES. 

All  that  I  have  said  hitherto,  together  with  the  facts  which  I  have  related, 
prove  that  suicide  offers  all  the  characteristics  of  mental  alienation,  of  which 
it  is,  in  reality,  a  symptom  :  that  we  must  not  look  for  a  single  and  peculiar 
sign  of  suicide,  since  we  observe  it  under  circumstances  the  most  opposite, 
and  since  it  is  symptomatic  or  secondary,  either  in  acute  or  febrile  delirium, 
or  in  chronic  delirium.  Finally,  the  opening  of  the  dead  bodies  of  suicides, 
has  shed  little  light  on  this  subject.  M.  Gall  believes,  that  the  cranium  of 
suicides  is  thick  and  dense.  I  have  in  my  collection  many  crania,  which  dis- 
prove this  opinion.  With  the  crania  of  several  suicides,  I  have  sought  to 
ascertain  whether  the  proportions  of  their  different  diameters  could  be  reduced 
to  a  mean  ;  but  did  not  succeed  in  obtaining  this  result.  I  possess  the  crania 
of  suicides  whose  antero-posterior  diameter  is  very  great,  whilst  that  of  some 
others  is  scarcely  equal  to  the  lateral  one  ;  so  that  in  the  former,  the  crania  are 
very  much  elongated,  whilst  in  the  latter  they  are  almost  spherical.  I  may, 
one  day,  publish  a  draught  of  these  crania,  and  the  examinations  which  I  have 
made  with  respect  to  their  thickness,  density,  diameters,  capacity,  etc. 

Home  has  seen  the  vessels  of  the  dura-mater  very  much  dilated.  I  have 
also  observed  it ;  but  it  is  not  constant,  nor  peculiar  to  individuals  who  have 
terminated  their  own  existence.  Freteau  mentions  two  cases  of  suicide, 
which  he  attributes  to  the  stagnation  of  a  thick  and  poisonous  blood  in  the 
interior  of  the  cranium.  M.  Recamier  found,  in  the  case  of  a  man  who  died 
four  days  after  poisoning  himself,  at  the  anterior  portion  of  the  left  hemis- 
phere of  the  brain,  an  ossification  of  the  dura-mater,  of  a  circular  form,  and 
an  inch  in  diameter.  The  arachnoid  membrane  was  opake  and  thickened. 
This  alteration  was  met  with  in  two  persons  who  had  made  no  attempt  upon 
their  lives.  Loder  found  the  corpus  callosum  very  soft,  and  M.  Gall  affirms 
that  it  is  disorganized.  We  read  in  Hufeland's  Journal  of  Medicine,  (1812 
and  181.3),  that  there  was  found  in  a  cyst,  above  the  right  ventricle  of  the 
brain,  an  osseous  concretion,  an  inch  in  length,  and  three  lines  in  breadth. 
Cabanis  pretended,  that  the  brain  of  the  insane  and  of  suicides  contains  more 
phosphorus  than  that  of  other  men.  M.  M.  Desgenettes  and  Calliere,  speak 
of  a  soldier  who,  obstinately  refusing  to  eat,  died,  after  refusing  and  accept- 
ing food  alternately,  for  several  months.  On  opening  the  body,  the  brain 
was  found  consistent,  but  not  injected ;  the  cerebellum  was  healthy ;  the 
transverse  colon  perpendicular ;  and  the  gall  bladder  contained  black,  thick 
and  viscid  bile.  This  displacement  of  the  colon  is  frequent  in  lypemania,  and 
I  have  given  several  examples  of  it,  on  page  168  and  the  following,  and  have 
observed  it  also  among  the  insane  who  had  an  inclination  to  suicide.  Four- 
croy,  and  several  physicians,  think  that  we  usually  find  concretions  in  the 
gall  bladder.  This  alteration  is  however  rare.  The  same  is  true  of  organic 
lesions  of  the  liver,  which  authors  have  often  regarded  as  the  cause  of  melan- 


302  SUICIDE. 

choly  and  suicide.  However,  Fodere  relates  the  following  case.  The  niece 
of  a  curate  to  whom  I  was  physician,  intelligent  and  virtuous,  grew  old  in  a 
state  of  celibacy.  She  conceived,  on  account  of  it,  an  extreme  weariness  of 
life,  and  resolved  several  times  to  destroy  herself,  by  taking  various  very  ac- 
tive articles  ;  such  as  tartar  emetic  and  others,  whose  fatal  effects  we  succeed- 
ed in  obviating.  The  mischief  however,  was  already  accomplished.  Ana- 
sarca of  the  inferior  extremities  appeared,  and  at  the  same  time  the  disposi- 
tion to  suicide  ceased,  and  reason  insensibly  returned.  On  being  consulted 
in  this  case,  continues  the  learned  professor,  I  foimd  the  liver  painful,  of  a 
scirrous  hardness,  and  after  a  suppurative  fever,  and  other  symptoms,  I  could 
not  doubt  that  there  might  be,  in  this  viscus  or  its  neighborhood,  one  or  more 
seats  of  suppuration.  M.  Osiander  regards  lesions  of  the  heart  and  inflam- 
mations of  the  abdominal  viscera,  as  the  cause  of  suicide. 

Doctor  Alberts  of  Gottengen,  believes  that  lesions  of  the  heart  are  frequent 
among  suicides.  Corvisart  entertained  the  same  opinion.  It  acquires  much 
more  weight,  if  we  remember  that  palpitations  are  frequent,  and  if  we  com- 
pare the  post-mortem  examinations  of  suicides,  with  the  symptoms  of  which 
they  complain,  before  attempting  to  terminate  their  existence.  Sometimes 
we  find  no  injuries,  other  than  those  which  are  the  effects  of  attempts  to  com- 
mit suicide.  Joseph  Frank  opened  a  body,  in  which  he  found  no  alteration, 
at  least  none  perceptible  to  the  senses.  I  have  examined  the  bodies  of  some 
suicides,  without  finding  any  primitive  lesion..  The  post-mortem  examinations 
which  I  have  made  in  person,  or  caused  to  be  made  under  my  own  observa- 
tion, having  presented  nothing  constant,  I  shall  content  myself  with  relating  a 
small  number  of  them. 

M.  C,  the  son  of  a  very  passionate  father,  has  lost  three  brothers,  all  of 
whom  connnitted  suicide.  A  fourth  has  had  several  attacks  of  mania,  and  a 
maniacal  sister  has  several  times  endeavored  to  destroy  herself  He  is  about 
thirty  years  of  age,  of  medium  size,  has  blond  hair,  blue  eyes,  an  ordinary  de- 
gree of  fullness  of  habit,  and  is  endowed  with  a  great  degree  of  susceptibility. 
He  paid  every  attention  that  fraternal  affection  could  suggest,  to  one  of  his 
brothers  who  had  attempted  to  destroy  himself  The  latter  ascends  into  a 
garret;  M.  C.  pursues  him,  and  at  the  moment  when  he  was  about  to  reach 
him,  the  patient  throws  himself  from  it,  exclaiming;  follmo  me.  Most  deeply 
affected,  he  believes  himself  guilty  of  the  suicide  of  his  brother,  and  accuses 
himself  of  having  been  wanting  in  watchfulne.ss.  He  immediately  persuades 
himself  that  his  family  will  demand  of  him  an  account  of  this  suicide.  The 
thought  fills  him  with  despair,  and  he  wishes  to  destroy  himself  A  month  af- 
terwards, he  makes  several  attempts,  and  is  committed  to  my  care.  I  quickly 
succeed  in  reassuring  him,  and  fifteen  days  had  scarcely  elapsed,  when  I  en- 
gage one  of  his  brothers,  who  was  a  physician,  to  travel  with  the  patient. 
The  two  brothers  set  off  on  their  journey.  From  the  third  day,  the  same  dis- 
quietudes revive,  the  same  impulses  are  manifest,  many  attempts  at  suicide  are 
made,  and  the  patient  is  committed  again  to  my  charge.  By  means  of  the 
most  careful  attentions,  I  once  rhore  succeed  in  awakenincr  in  his  breast  a  de- 
sire  for  life;  but  on  this  occasion,  I  do  not  hasten  his  removal.  He  remains 
sad,  morose  and  uneasy;  at  times  his  disquietudes  return  again,  and  he  passes, 
at  different  intervals,  several  days  without  eating.  Constipation  is  obstinate, 
and  almost  insurmountable.  The  sight  of  his  brother  augments  his  grief,  be- 
cause,  says  he,  my  brother  cannot  pardon  me.  He  sees  his  other  relatives, 
but  with  dread. 

After  a  period  of  eight  months,  he  appeared  better.  Hope  revives  in  his 
breast.  He  also  converses  and  takes  exercise,  and  forms  with  his  brother, 
projects  for  the  future.  Two  months  pass  thus,  when  suddenly,  and  without 
any  known  motive,  he  refuses  every  kind  of  aliment.     For  twenty-one  days 


SUICIDE.  303 

he  takes  nothing.  From  the  twelfth  day  of  his  abstinence,  he  ceases  to  leave 
his  bed,  and  his  emaciation  is  very  great.  The  secretions  are  suspended,  and 
his  feebleness  is  extreme.  We  often  hear  the  patient  repeating  ;  How  much  it 
costs  to  die!  Every  means  employed  to  surmount  his  resolution,  is  fruitless. 
On  the  nineteenth  day,  he  manifests  an  adynamic  condition.  He  then  desires 
to  eat,  but  swallows  with  difficulty,  a  few  drops  of  liquids.  Tormented  by 
thirst,  he  is  no  longer  able  to  drink.  His  body  is  drawn  together,  his  limbs 
rigid;  his  legs  of  a  purple  color,  and  very  qold.  On  the  twenty-first  day,  he 
becomes  speechless,  smiles  convulsively,  and  dies  on  the  twenty-eighth  day. 
On  opening  the  body,  I  found  the  brain  hard  and  violaceous,  as  if  it  had  been 
injected  with  violet-colored  wax.  The  sinuses  of  the  brain  were  atrophied, 
and  the  transverse  colon  almost  perpendicular. 

F.,  thirty-three  years  of  age,  is  brought  to  the  Salpetriere  in  a  state  of  fury. 
Admitted  on  the  10th  of  June,  on  the  13th  at  four  o'clock  in  the  morning, 
she  is  found  strangled.  She  had  tied  the  sheets  of  her  bed  around  her  neck, 
and  fixed  the  extremities  of  them  to  its  foot-posts.  She  had  then  slipped  un- 
der the  bed ;  and  had  probably  strangled  herself  by  making'  efforts,  as  if  she 
intended  to  conceal  herself  beneath  the  couch.  On  the  evening  previous,  she 
had  been  walking  about,  and  nothing  had  occurred  to  inspire  the  least  disqui- 
etude. On  the  following  day  (the  15th),  we  make  an  examination  at  ten  in 
the  morning.  The  face  was  purple.  Traces  of  compression  were  remarked 
on  the  anterior  and  lateral  regions  of  the  neck,  by  means  of  the  ecchymosis. 
The  abdomen  was  voluminous,  and  distended  with  gas.  The  integuments  of 
the  cranium  were  very  much  injected,  and  the  cranium  itself  was  very  much 
depressed  towards  the  right  temple.  The  sinuses  of  the  dura-mater  were  en- 
gorged with  blood,  as  well  as  the  vessels  of  the  arachnoid,  pia-mater  and  cho- 
roid plexuses.  The  capacity  of  the  ventricles  of  the  brain  was,  in  every  re- 
spect, very  much  diminished.  The  pineal  gland  presented  small  concretions; 
and  the  pituitary  body  enclosed  a  reddish  serum.  The  lungs,  slightly  en- 
gorged with  blood,  adhered  slightly  to  the  pleura  costalis. 

Permit  me  here  to  relate  the  deplorable  end  of  a  young  physician,  of  the 
highest  promise,  twenty-five  years  of  age ;  a  native  of  one  of  the  southern 
provinces,  and  descended  from  a  family,  of  which  several  members  have  been, 
or  still  are,  insane.  •  This  young  man,  who  was  of  a  nervous-sanguine  tempe- 
rament, of  great  susceptibility,  and  of  a  very  lively  disposition,  devoted  him- 
self with  interest,  to  the  study  of  mental' diseases.  His  researches  on  melan- 
choly were  published.*  Certain  trifling  criticisms,  and  still  more,  the  little 
interest  which  certain  friends  manifested  in  commending  his  book,  which  is 
in  truth  a  valuable  work,  affected  him  keenly.  He  often  spoke  to  me  of  the 
criticisms,  and  more  frequently  still,  of  the  remarks  that  had  been  made  upon 
his  book  in  learned  societies.  Indignant,  or  perhaps  dissatisfied  with  the 
world,  which  had  treated  him  with  so  much  injustice,  he  conceived  a  disgust 
for  life.  He  was  sensible  of  his  condition^  for  he  went  to  pass  some  time  in 
the  country.  On  his  return,  he  took  eighteen  grains  of'  opium.  He  was 
scarcely  incommoded  by  it,  and  related  this  event  as  a  matter  of  indifference. 
He  suddenly  disappeared  from  Paris,  and  some  time  after,  I  learn  that  this  un- 
happy man  had  gone  into  Touraine,  and  that  there,  in  a  public  house,  had 
strangled  himself.  He  tied  a  cravat  about  his  neck,  and  to  this  fastened  seve- 
ral napkins,  attaching  them  to  the  foot  of  his  bed.  Extending  himself  on  the 
floor  on  his  back,  he  placed  his  feet  against  the  bed,  which  served  him  as  a 
fixed  point,  for  eflfecting  the  strangulation. 

Mad'e,  thirty-three  years  of  age,  experienced  domestic  trials,  made  several 
attempts  upon  her  life,  and  was  sent  to  the  hospital.     She  was  tall,  very  much 

" Medico-Philosophical  Researches  on  Melancholy;  by^Luce  Roiibeau.     Paris,  1817, in 
12mo. 


304  SUICIDE. 

emaciated,  and  of  a  gentle  disposition.  She,  at  first,  made  several  attempts  to 
strangle  herself,  but  not  succeeding,  refused  to  eat.  After  two  months  she 
appeared  more  composed.  Nevertheless,  during  the  month  of  August,  she 
swallowed  a  thimble  and  piece  of  money,  as  well  as  sewing  needles.  She 
often  said  ;  Let  me  go  home.  Aside  from  this,  she  was  not  irrational  ;  but  was 
sad,  sought  retirement,  walked  about  with  a  slow  step,  and  did  not  speak. 
She  could  never  be  induced  to  work.  She  often  wept,  was  constipated,  and 
slept  little.  On  the  eighth  of  September,  without  any  thing  occurring  which 
caused  us  to  fear  that  she  would  injure  herself,  though  she  still  entertained  a 
desire  to  die  ;  she  slipped  herself  through  a  ventilator,  in  an  old  dormitory, 
which  had  been  for  some  time  abandoned,  and  there  suspended  herself  with  a 
very  small  cord,  attached  to  a  nail  which  she  found  in  one  of  the  walls.  She 
had  stood  upon  two  rough  stones.  She  was  found  with  her  back  against 
the  wall,  the  face  livid,  but  no  froth  issuing  from  the  mouth.  The  arms  hung 
by  the  side  of  the  body,  the  hands  of  a  violet  hue,  the  feet  extended,  and  of 
the  same  color.  One  of  the  stones  was  beneath  her  feet ;  the  other,  a  few 
inches  distant  from  them.  On  opening  the  body,  we  found  the  impression  of 
the  cord  passing  obliquely  around  the  neck,  directed  behind  the  ears  and 
without  ecchymosis.  The  skin  which  covered  the  depression  was  of  a  brown 
color,  depressed  and  dry  ;  and  beneath,  the  compressed  cellular  tissue,  formed 
a  shining  white  band  a  line  in  breadth,  without  any  infiltration  of  blood,  either 
above  or  below  the  depression.  The  coronal  portion  of  the  cranium  was  re- 
treating, and  the  parietal  protuberances  prominent.  No  alteration  in  the 
brain  nor  in  its  envelopes,  which  were  injected.  The  right  lung  was  engorged 
with  blood  in  its  posterior  and  inferior  portion.  Liver  voluminous  and  red- 
dish. The  transverse  colon  was  directed  towards  the  pubes,  and  the  large 
intestines  distended  with  eras.  We  did  not  find  those  foreign  bodies  that  were 
swallowed  two  months  before  her  death. 

A  person  named  L.,  thirty-three  years  of  age,  of  a  lean  and  slender  habit, 
and  of  a  nervous-lymphatic  temperament,  has  always  enjoyed  excellent  health 
and  perfect  tranquillity  of  mind.  She  had  during  her  youth,  no  grave  mala- 
dy. At  the  age  of  thirteen  and  a  half  years  the  menses  appeared,  and  she 
seemed  to  her  parents  to  be  very  well.  In  1814,  frightened  by  the  dangers 
of  the  siege  with  which  Paris  is  threatened,  and  more  still  by  the  presence 
of  the  enemy,  she  experiences  so  great  a  degree  of  disquietude,  that  she  is 
suddenly  seized  with  hemiplegia,  and  this  paralysis  was  not  preceded,  accord- 
ing to  the  statement  of  her  parents,  by  any  symptom  of  cerebral  hemorrhage. 
She  enters  the  Hospital  St.  Louis,  from  which  she  is  discharged  some  time 
after,  almost  cured.  But  her  disposition,  it  is  remarked  by  her  friends,  is 
entirely  changed.  To  her  ordinary  gayety,  has  succeeded  a  profound  sad- 
ness. She  is  no  longer  fond  of  society,  which  she  was  formerly  accustomed 
to  seek,  and  wishes  to  be  alone.  She  coughs  and  expectorates  freely,  yet 
without  experiencing  any  local  pain.  Suddenly  she  breaks  her  habitual  si- 
lence. From  being  sad  and  thoughtful,  she  becomes  agitated,  and  is  torment- 
ed by  remorse  for  crimes  which  she  believes  she  has  committed,  and  seeks 
every  means  of  putting  an  end  to  her  existence.  Heaven,  she  affirms,  abhors 
her.  In  this  condition  she  was  brought  to  the  Salpetriere.  I  cause  her  to 
be  placed  in  the  infirmary.  She  walks  with  crutches,  is  sad,  and  often  speaks 
of  self-destruction.  Eight  days  afterwards,  she  throws  away  her  crutches, 
walks  with  rapidity  in  the  hall,  and  goes  to  a  window  of  a  very  lofty  second 
story,  and  after  some  hesitation,  precipitates  herself  from  it.  She  fell  upon 
her  right  side,  the  whole  of  which  was  frightfully  mutilated  by  the  fall.  How- 
ever, she  makes  no  complaint  of  the  pain  which  she  must  experience.  The 
fall  augmented  the  excitement  of  her  mind.  She  displays  her  arms  all  covered 
with  the  blood  which  she  says  she  has  shed,  and  sees  in  those  who  are  lavish- 


SUICIDE.  305 

ing  their  attentions  upon  her,  only  the  executioners,  who  are  to  lead  her  to 
punishment.  Every  time  we  approach  her,  she  is  frightened,  her  features  are 
contracted,  and  she  conjures  us  not  to  cause  her  to  be  conducted  to  the  guillo- 
tine. This  scene  of  horror  lasts  for  about  two  days  ;  when  she  dies,  a  prey  to 
her  heart-rending  terrors. 

The  post-mortem  examination  was  made  by  Doctor  Amussat,  then  house 
pupil  at  the  hospital  Salpetriere.  Head. — No  apparent  lesion  in  the  brain, 
its  membrane,  or  in  the  spinal  marrow.  Thorax  and  abdomen. — Several  ribs  of 
the  right  side  are  fractured.  The  left  lung  is  healthy.  The  right  encloses  a 
cyst  filled  with  hydatids,  situated  precisely  over  a  similar  one  with  which  it 
communicates,  occupying  almost  the  whole  of  the  liver,  which  adheres  to  the 
diaphragm,  which  is  itself  pierced  to  permit  the  two  cysts  to  communicate. 
The  medium  of  communication  between  the  liver  and  lung  is  very  narrow. 
We  find  a  similar  case  in  Bonnet. 

M.,  the  victim  of  onanism,  was  in  a  state  of  monomania  complicated  with 
dementia.  He  was  found  suspended  from  his  bed.  Nothing  had  caused  the 
least  fear  of  this  event ;  no  previous  attempt  having  been  known  to  take  place. 
With  a  band  which  contained  the  apparatus  of  an  exutory,  he  had  formed  a 
handle  two  feet  in  circumference,  and  had  connected  it  to  the  ring  of  his  bed. 
His  head  was  passed  through  the  support  thus  fastened,  and  the  body  left  to 
its  own  weight.  The  anterior  part  of  the  neck  reposes  upon  this  support. 
The  arms  are  pendant ;  the  legs  crossed  and  slightly  flexed  ;  and  the  feet  re- 
pose entirely  upon  the  bed,  the  surface  of  which  is  only  four  and  a  half  feet 
distant  from  the  ring  through  which  the  handle  has  been  passed.  The  face 
was  tumefied  and  of  a  purple  color ;  the  eyes  were  widely  opened  and  glisten- 
inor  •  and  there  was  a  little  sano-uineous  mucus  around  the  mouth.  The  fore- 
arms  and  hands,  the  legs  and  feet,  were  rigid  and  violet-colored  ;  the  veins 
were  large  and  engorged  with  blood  ;  and  the  penis,  partially  erected,  pre- 
sented a  drop  of  fluid  at  its  orifice.  Some  stains  of  the  same  fluid  were  no- 
ticed upon  the  thighs.  The  scrotum  was  of  a  purple  color,  and  the  abdomen 
swollen,  distended,  and  filled  with  gas.  The  body  was  examined  on  the  fol- 
lowing day,  thirty  hours  after  his  supposed  death.  There  was  an  oblique  de- 
pression of  the  skin  of  the  neck,  extending  from  the  thyroid  cartilage,  beneath 
the  mastoidean  apophyses,  towards  the  occipital  protuberance,  of  the  breadth 
of  three  lines,  more  distinctly  marked  on  the  right.  The  depressed  skin  was  of 
a  yellowish  brown,  hardened,  and  as  it  were,  burned.  Towards  the  occiput, 
the  skin  was  less  dry  and  brown  ;  and  above  the  depression  an  effiision  was 
formed.  The  subjacent  parts  presented  nothing  remarkable,  except  a  slight 
sanguineous  infiltration  some  lines  in  breadth,  upon  the  external  face  of  the 
thyroid,  and  into  the  substance  of  the  superficial  muscle.  The  left  jugular 
vein,  for  the  extent  of  three  lines  beneath  the  depression,  was  of  a  dark  gray, 
and  a  little  above,  its  internal  coat  seemed  to  be  broken,  and  its  cellular  tunic 
presented  a  vesicle  formed  from  the  blood,  which  had  escaped  by  the  rupture 
of  the  internal  one.  The  cranium  was  thickened,  the  blood-vessels  and  sinu- 
ses of  the  brain  were  gorged  with  blood,  and  the  cerebral  substance  was  soft. 
The  abdomen  was  distended  by  intestinal  gases.  The  stomach  contained 
aliments  partially  digested,  and  its  mucous  membrane  was  interspersed  with 
rose-colored  and  brownish  spots.  The  mucous  membrane  of  the  small  intes- 
tines, near  the  caecum,  for  an  extent  of  six  inches,  was  red. 

A  woman  whom  we  had  long  since  placed  in  the  division  of  the  insane,  in 
the  interior  of  the  hospital,  suffered  from  time  to  time,  it  was  said  by  her  com- 
panions, from  attacks  of  mental  depression.  Nevertheless,  she  was  accustom- 
ed to  bestow  certain  attentions  upon  some  little  children.  She  was  opposed 
in  this  matter,  threw  herself  from  the  fourth  story,  fell  upon  the  flag-stone, 
and   died  some  minutes   after.     The  cranium  was  broken  into  several  frag- 

39 


306  SUICIDE. 

ments,  which  were  retained  by  the  hairy  scalp  and  the  pericranium,  particu- 
larly the  right  parietal  and  coronal  of  the  same  side.  The  cranium  was  very 
much  injected,  as  well  as  the  meninges  and  brain.  The  vessels  of  the  me- 
ninges were  very  much  distended.  All  the  bones  were  fractured,  even  the 
bod'y  of  the  sphenoid  and  the  vertebrae  of  the  neck.  The  liver  was  ruptured 
in  several  places,  as  well  as  the  spleen,  whose  form  we  with  difficulty  recog- 
nize. 

Some  years  since,  a  woman  threw  herself  from  a  first  story  which  was  very 
high.  She  fell  upon  her  head  and  died  immediately.  The  bones  of  the  cra- 
nium were  broken  into  a  great  number  of  fragments,  even  the  body  of  the 
sphenoid.  The  brain  had  lost  a  third  of  its  volume.  It  was  very  dense,  and 
the  space  which  it  might  formerly  have  occupied  in  the  cranium  was  filled 
with  black  and  fluid  blood.  We  read  in  the  Memoirs  of  the  R,oyal  Society, 
that  in  the  case  of  a  hysterical  girl  who  had  hung  herself,  one  of  the  ovaries 
was  found  broken,  as  if  it  had  been  burst  by  a  fluid  which  it  contained. 

M.  L.,  forty-one  years  of  age,  and  of  a  strong  constitution,  participated  in 
the  war  of  la  Vendee,  and  supported  the  fatigues,  reverses  and  frauds,  which 
followed  this  fatal  war.  The  times  having  become  more  quiet,  he  lives  in 
the  country,  experiences  some  trifling  difficulties  and  acts  of  injustice,  be- 
comes sad,  gloomy,  suspicious,  and  believes  that  his  enemies  will  take  his  life 
by  poison.  He  loses  his  sleep,  appetite,  etc.  After  some  months,  he  becomes 
unwilling  to  go  abroad,  to  see  his  friends  or  connections,  and  refuses  nourish- 
ment. If  it  is  nisisted  upon,  he  flies  into  a  passion,  and  becomes  dangerous. 
In  this  condition  he  is  committed  to  my  care.  Change  of  place,  the  sight  of 
new  objects,  the  devoted  attentions  of  strange  persons,  make  upon  the  mind 
of  the  patient  a  favorable  impression.  He  is  less  solitary,  walks  about,  con- 
verses more  willingly,  takes  his  food  regularly,  and  consents  even  to  employ 
some  remedies.  After  the  lapse  of  fifteen  days,  when  the  condition  of  the  pa- 
tient seemed  to  be  ameliorated,  he  suddenly  refuses  food,  and  confines  himself 
to  his  bed.  His  physiognomy  is  expressive  of  gloom,  his  complexion  is  more 
sallow,  and  his  eyes  injected.  Four  days  after  this  he  vomits  mucous  matter ; 
repulses  every  one,  and  rejects  all  the  attentions,  remedies,  and  every  variety 
of  aliment  that  is  offered  ;  constantly  repeating  that  he  has  been  poisoned. 
On  the  sixth  day,  he  vomits  mucous  matter  mingled  with  very  black  blood. 
On  the  seventh  day,  the  prostration  of  the  vital  forces  is  extreme  ;  the  patient 
can  scarcely  reply  to  questions  that  are  put  to  him,  and  the  pulse  is  very  fre- 
quent and  feeble.  He  several  times  vomits  blackish  and  very  fetid  matters. 
On  the  eighth,  he  consents  to  drink  some  gum-water,  but  refuses  all  medi- 
cine, and  dies  on  the  twelfth  day. 

On  opening  the  body,  I  find  the  meninges  of  the  brain  in  a  normal  state, 
and  the  ventricles  containing  serum.  The  stomach  and  duodenum  present 
no  alterations,  but  the  whole  of  the  mucous  membrane  of  the  transverse  colon 
is  contracted  into  deep  folds,  thickened  and  soft.  It  is  covered  with  a  red- 
dish mucus,  like  lees  of  wine,  which  being  removed,  reveals  a  surface  of  a 
violet  red  color,  sphacelated  at  several  points.  The  same  lesion  extends  to 
the  superior  portion  of  the  descending  colon.  The  remainder  of  the  intesti- 
nal tract  is  healthy.  Several  polygonal  calculi,  formed  of  a  yellow  and  black- 
ish substance,  fill  the  gall  bladder.     The  liver  presents  a  greasy  aspect. 

A  man,  thirty  years  of  age,  and  who  was  married  at  nineteen,  six  years 
afterwards  is  devoured  by  jealousy.  He  destroys  his  wife,  is  put  in  prison 
April  15th,  1831,  and  dies  June  17th,  after  an  abstinence  of  sixty-one  days  ; 
the  wretched  man  having  taken,  during  this  long  space  of  time,  only  water 
and  a  few  spoonsful  of  broth.  On  opening  the  body,  it  was  found  extremely 
emaciated,  and  its  weight  66  kil.  (132  pounds).  The  cranium  is  thickened, 
and  the  white  substance  of  the  brain  is  dense,  particularly  at  its  base.     There 


SUICIDE.  307 

is  unusual  density  of  the  cerebellum  and  of  the  spinal  prolongation.  The  heart 
is  pale,  flaccid,  and  easily  torn,  as  well  as  other  muscles.  The  stomach  con- 
tains six  outices  of  a  greenish  liquid,  and  its  mucous  membrane,  though  very 
resistant  at  its  cardiac  extremity,  is  more  and  more  soft  towards  the  pylorus. 
The  alimentary  canal  is  atrophied,  and  the  small  intestines  somewhat  contract- 
ed ;  its  mucous  membrane,  at  the  extremity  of  the  ilium  a  little  red,  and  the 
transverse  colon  oblique  towards  the  pubes.  The  liver  is  dense,  red  and  gra- 
nulated ;  and  the  gall  bladder  distended  with  thick,  blackish  and  clotted  bile. 
The  spleen  is  dense.  The  thigh  being  sawn  through,  the  marrow  of  the  me- 
dullary canal  was  found  in  its  normal  condition.  This  case,  which  was  drawn 
up  by  M.  Desbareaux-Bernard,  may  be  read,  with  all  its  details,  in  a  memoir 
published  at  Toulouse,  in  1831. 

From  the  cases  related  by  authors,  and  from  those  which  precede,  what  con- 
sequences can  we  deduce,  so  as  to  determine  those  organic  lesions  which  will 
enable  us  to  fix  upon  the  seat  of  suicide  ?  In  this  respect,  we  experience  the 
same  difficulty  as  in  assigning  the  seat  and  organic  lesions,  of  whose  exis- 
tence the  delirium  of  mental  maladies  informs  us.*  Nevertheless,  if  we  con- 
sider that  in  the  various  cases  of  suicide,  accompanied  by  post-mortem  exami- 
nations, lesions  of  the  brain  are  rarely  discovered,  and  that  we  meet  with  fre- 
quent changes  in  the  organs  of  digestion,  particularly  of  the  alimentary  canal ; 
may  we  not  believe  that  organic  changes  of  this  tract,  are  especially  connect- 
ed with  the  resolutions  of  suicides,  who  determine  to  permit  themselves  to  die 
of  hunger  ? 


TREATMENT  OF  SUICIDE  :  MEANS  OF  PREVENTING  IT. 

Suicide  being  an  act  consecutive  to  the  delirium  of  the  passions  or  insani- 
ty, I  ought  to  have  little  to  say  respecting  the  treatment  of  a  symptom ;  a 
treatment  which  belongs  to  the  therapeutics  of  mental  diseases,  and  reposes 
essentially  upon  the  appreciation  of  the  causes  and  determining  motives  of 
suicide.  Therefore,  it  is  to  the  treatment  adapted  to  each  variety  of  insanity 
that  we  must  have  recourse,  in  treating  an  individual  urged  on  to  his  own  de- 
struction ;  just  as  it  is  necessary  to  go  back  to  the  councils  of  religion  and 
public  morals,  when  we  would  prevent  the  numerous  suicides  that  are  provok- 
ed by  a  general  error  of  opinion,  and  the  exaltation  of  the  passions.  I  would 
have  limited  myself  to  these  general  remarks,  were  not  suicide  so  grave  a 
symptom  as  to  render  it  important  that  we  should  avail  ourselves  of  all  possi- 
ble means  of  combating  and  preventing  it.  Suicide  is  sometimes  cured  spon- 
taneously, like  mental  diseases ;  through  the  influence  of  hygienic  agents,  by 
some  physical  or  moral  crisis ;  or  by  the  aid  of  medicines.  Pinel  speaks  of  a 
certain  scholar  who,  being  in  London  for  the  purpose  of  dissipating  a  melan- 
cholic affection,  was  going  to  drown  liimself  in  the  Thames,  when  he  was  at- 
tacked by  robbers.  He  defended  himself  against  these  ruffians,  and  forgot 
the  purpose  which  had  led  him  from  home.  This  gentleman  died  at  the  age 
of  eighty-four  years ;  and  although  often  reduced  to  the  necessity  of  receiving 
aid  from  his  friends,  he  did  not  again  experience  a  desire  to  destroy  himself 

A  young  man  wishes  to  take  his  life,  and  goes  out  to  purchase  a  pair  of  pis- 

*  M.  Leuret,  in  the  article  Suicide,  in  the  Dictionary  of  Practical  Medicine,  has  given 
us  a  summary  of  sixteen  post-mortem  examinations  of  suicides,  and  his  conclusion  is  as 
follows:  In  seven  of  the  bodies,  there  were  no  other  lesions  than  those  produced  by  the 
character  of  the  death  ;  and  in  the  nine  remaining  ones,  the  changes  were  so  varied, 
that  we  could  infer  nothing  from  them,  relative  to  the  nature  and  seat  of  suicide.  M. 
Leuret  adds,  that  all  those  individuals  with  whom  he  was  concerned,  were  very  clearly 
insane,  before  committing  the  fatal  deed.     See  Dictionary  cited,  t.  xv.  p.  85. 


308  SUICIDE. 

tols.  The  gun-smith  demands  an  exorbitant  price ;  he  becomes  irritated,  dis- 
putes with  the  dealer,  and  forgets  that  he  wanted  to  purchase  arms  wherewith 
to  destroy  himself.  How  many  people  are  there  who,  after  an  ineffectual  at- 
tempt to  take  their  own  lives,  no  longer  entertain  a  thought  of  it;  because 
they  have  been  frightened  by  the  risk  that  they  run,  or  saw  death  so  near  at 
hand,  as  to  desire  no  more  immediate  intercourse.  A  lady  desires  to  die  of 
hunger,  because  she  has  openly  betrayed  the  secrets  of  her  heart.  Attentions 
and  consolations,  the  assurance  that  no  one  credits  what  she  has  said,  and  the 
hope  of  seeing  her  lover  whom  she  supposed  dead  ;  cause  her  to  entertain 
once  more  a  desire  for  life,  and  she  decides,  not  only  to  take  nourishment,  but 
to  do  whatever  is  recommended,  with  a  view  to  her  entire  cure. 

An  ecclesiastic   twice  threw  himself  into  a  well,  after  having  fallen  into  the 
most  profound  lypemania,   in  consequence  of  the  horrors  of  the  revolution. 
At  the  time  of  the  publication  of  the  first  concordat,  he  is  angry  and  indig- 
nant :   and  sets  to  writing  against  a  compact,  which  he  considers  derogatory 
to  religion ;   and  is  in  a  little  time  cured   of  his  melancholy  and  disposition  to 
suicide.     Moreau  de  la   Sarthe  relates  an  analogous  case,  in  the  second  vol- 
ume of  the  Memoirs  of  the  Medical  Society  of  Emulation.     A  woman  loses 
a  part  of  her  fortune,  becomes  depressed  in  mind,  and  desires  to  destroy  her- 
self    Still  greater  misfortunes  ruin  her.     The  exercise  and  labor  called  forth 
by  this  new  position,  suffice  to  cure  the  patient,     A  lady,  in  consequence  of 
certain  trials,  suffers  from  a  suppression  of  the  menses.     She  has  pains  in  her 
head,  and  desires  to  terminate  her  existence.     After  the  lapse  of  four  months, 
she  leaves  her  house,  and  places  a  letter  upon  her  secretary  informing  her  hus- 
band, that  weary  of  the  troubles  of  life,  she  is  going  to  drown  herself.     She 
proceeds   to   St.   Cloud  to  execute  her  purpose;    being  unwilling  that  they 
should  discover  her  body.     On  the  way  her  menses  appear.     She  immediately 
feels  very  well,  and  returns  home.     She  goes  to  the  commissioner  of  her  ward, 
and  relates  to  him  the  above  account,  to  which  the  public  seals  were  affixed. 
How  many  women  come  to  us  at  the  Salpetriere,  whom  wretchedness  and  do- 
mestic trials  have  decided  to  terminate  their  existence,  and  who  are  restored 
by  affectionate  attentions  and  consolations ;   by  the  hope  of  a  more  propitious 
fortune,  and  good  nourishment !     Many  of  these  wretched  beings   renounce 
their  fatal  design,  when  removed  from  all  the  means  of  destroying  themselves, 
and  convinced  that  we  shall  cause  them  to  live,  in  spite  of  their  resistance. 
Who  does  not  perceive  in  all  these  facts,  the  same  phenomena  which  are  ob- 
served among  the  insane,  whatever  be  the  character  of  their  delirium? 

Some  physicians  have  proposed  a  specific  treatment  for  suicide.  Persuaded 
that  the  liver  is  the  seat  of  the  evil,  and  that  the  bile  is  the  prime  cause  of  it ; 
some  recommend  what  are  called  hepatic  purgatives.  Others  believe  that  we 
should  bleed,  so  as  to  unload  the  great  vessels  of  the  brain.  The  latter  hold- 
ing that  the  tendency  to  suicide,  is  the  effect  of  the  weakness  or  oppression  of 
the  vital  principle,  have  recommended  tonics  in  large  doses.  I  can  say  that 
bark,  in  combination  with  opium,  hyoscyamus  and  musk,  has  sometimes  suc- 
ceeded in  modifying  the  sensibility  of  this  class  of  patients,  and  in  procuring 
sleep.  These  means  however,  would  not  be  applicable  to  all  cases.  Subjects 
enfeebled  by  onanism,  are  much  benefited  by  the  cold  bath,  and  even  asper- 
sions of  cold  water.  Avenbrugger  proposed  an  exutory  over  the  region  of 
the  liver,  and  copious  draughts  of  water.  The  celebrated  Theden,  and  more 
recently.  Dr.  Leroy,  physician  at  Anvers,  have  insisted  upon  the  very  abun- 
dant use  of  cold  water  as  a  specific.  Theden  states  that  he  made  a  most  suc- 
cessful trial  of  it  upon  himself,  and  relates  some  cases  in  support  of  the  effica- 
cy of  this  method.  Dr.  Chevrey  cites  several  cases  establishing  the  fact,  that 
the  cure  of  the  disposition  to  suicide,  has  been  effected  by  the  method  of 


SUICIDE.  309 

Avenbrugger.*  I  have  submitted  to  this  treatment  several  patients  who  had 
made  divers  attempts  to  commit  suicide,  but  with  little  success.  In  three  ca- 
ses, treated  at  the  Salpetriere,  I  ordered,  for  two  of  them,  a  seton  over  the 
right  hypochondrium,  and  a  blister  for  the  third.  I  also  prescribed  a  great 
quantity  of  water.  I  related  above  the  case  of  a  lady,  in  which  I  had  caused 
a  larcre  seton  to  be  inserted  over  the  region  of  the  liver.  At  Charenton,  I 
caused  blisters  to  be  placed  over  the  same  region.  Setons  and  blisters  con- 
tinued for  several  months,  effected  no  amelioration. 

Suicides,  like  all  lypemaniacs,  think  too  much.  We  must  either  prevent 
them  from  thinking,  or  oblige  them  to  think  differently  from  what  they  are  in 
the  habit  of  doino;.  Reasoning  effects  little ;  moral  commotions  are  of  more 
service.  Celsus  advises  that  individuals  who  entertain  a  desire  for  suicide, 
should  go  abroad ;  and  physicians,  in  all  times,  have  recommended  corporeal 
exercises,  gymnastics,  riding  on  horseback,  the  cultivation  of  the  soil,  journey- 
ing, etc. 

[In  our  author's  treatment  of  suicide,  there  are  two  points  which  merit  special  notice 
and  approbation.  Of  these  one  is  the  moral  treatment,  which  embraces,  among  other 
things,  those  kind  and  cheering  attentions  which  are  ever  welcome  in  whatever  form  af- 
fliction may  come,  but  particularly  so,  when  despair  has  taken  possession  of  the  mind. 
Like  other  useful  agencies,  they  are  recommended  as  adjuvants,  rather  than  the  principal 
means  of  cure.  Neither  argument  nor  sympathy,  individually  or  united,  ever  yet  cured 
a  case  of  suicidal  insanity,  or  ever  caused  a  patient  fully  to  appreciate  the  considerations 
offered  for  his  relief,  however  well  suited  to  his  condition  ;  yet  the  fact,  that  they  furnish 
evidence  that  he  is  not  quite  forgotten,  and  that  his  friends  do  not  regard  his  state  as  alto- 
gether hopeless,  lessens  for  a  brief  space,  the  overwhelming  burthen  which  rests  upon 
his  mind.  The  daily  expressions  of  sympathy  and  hope,  in  connection  with  the  assidu- 
ous attentions  of  devoted  and  affectionate  attendants,  doubtless  give  to  the  agents  of  a 
medicinal  character  which  may  be  employed,  a  degree  of  efficacy  which  they  would 
not  otherwise  manifest.  The  employment  of  tonic,  in  connection  with  narcotic  and  se- 
dative agents,  constituted  the  second  point  of  interest  in  the  treatment.  The  victims  to 
this  fearful  propensity,  are  usually  much  debilitated,  not  only  in  consequence  of  the  ex- 
hausting nature  of  their  mental  disease,  but  from  their  vigils  and  abstinence.  They  nei- 
ther sleep  nor  eat,  voluntarily.  Under  these  circumstances,  as  remedial  agents  of  spe- 
cial utility,  are  the  class  of  remedies  referred  to.  To  the  other  therapeutic  agents  men- 
tioned,— with  the  limitations  and  explanations  offered, — no  valid  objection  can  be  made, 
while  some  are  of  unquestionable  utility.  However,  the  great  principle  of  treatment 
our  author  has  clearly  presented,  in  the  opening  sentence  of  this  part  of  our  subject,  viz. : 
that  the  remedies  employed,  of  whatever  kind,  must  be  administered  with  reference  to 
the  physical  derangement,  which  a  careful  examination  of  the  case  unfolds.] 

I  have  nothing  to  remark  respecting  the  treatment  which  the  symptoms, 
following  attempts  at  suicide,  may  demand.  Cerebral  congestions,  asphyxia, 
whether  produced  by  immersion  or  strangulations,  wounds,  bruises,  the  symp- 
toms of  poisoning  and  the  effects  of  abstinence,  present  various  indications  of 
which  we  cannot  here  speak.  Persons  who  have  a  propensity  to  suicide, 
should  occupy  apartments  on  the  ground  floor  of  a  building,  cheerful,  and 
pleasantly  located.  They  should  be  guarded  night  and  day  by  attendants, 
vigilant,  and  having  experience  to  meet  the  wiles  of  suicides,  usually  ex- 
ceedingly skillful   in  baffling  the  watchfulness  of  the  most  active.     If  it   be 

•  Medical  Essay  on  Suicide.     Paris,  1816,  in  4to. 


310  SUICIDE. 

necessary  at  any  time,  to  have  recourse  to  the  camisole,  this  should  not  ope- 
rate as  a  motive  to  security,  for  patients  have  made  use  of  it  to  strangle  them- 
selves. A  woman  at  the  Salpetriere  had  been  fastened  upon  her  bed,  by 
means  of  this  garment.  During  the  night  she  threw  herself  from  it,  and  her 
body,  resting  with  all  its  weight  upon  the  waistcoat,  compressed  the  trachea, 
and  the  patient  was  asphyxiated.  A  patient,  confined  to  his  bed,  succeeds  in 
throwing  from  his  couch  every  portion  of  his  bedding,  and  is  suspended  and 
strangulated  by  the  camisole.  In  public  establishments,  individuals  who  are 
disposed  to  suicide,  demand  the  utmost  attention.  These  patients  should  not 
be  placed  in  isolated  cells,  but  in  public  halls,  where  they  may  be  better 
watched,  both  by  their  fellow  patients,  and  the  attendants.  They  should 
never  be  out  of  sight.  It  is  to  this  attention,  and  to  the  advantage  of  having 
all  the  apartments  of  this  class  of  patients  upon  the  ground  floor,  that  we  are 
indebted,  at  the  Salpetriere,  for  having  scarcely  any  suicides  ;  since,  among 
eleven  or  twelve  hundred  insane  persons,  of  whom  one  hundred  at  least  have 
made  attempts  upon  their  lives  in  the  course  of  ten  years,  only  four  suicides 
have  been  committed  ;  whilst,  every  where  else,  the  number  is  far  more  con- 
siderable. I  congratulate  myself,  on  having  first  laid  down  a  general  rule  for 
the  government  of  suicides,  even  with  respect  to  their  sleeping  arrangements  ; 
a  precept  that  has  not  been  lost  in  other  establishments,  where  they  have 
made  use  of  it,  and  in  which  many  individuals  are  disposed  to  suicide. 

[In  the  measures  suggested  for  the  prevention  of  suicide  is  one  deservedly  occupying 
a  prominent  place,  but  which,  so  far  as  is  known,  has  not  been  employed,  except  in  indi- 
vidual cases,  in  this  country.  I  refer  to  the  sleeping  apartments  of  suicidal  patients, 
which  our  author  recommends  should  be  sufficiently  large,  to  lodge  comfortably  all  tiie 
patients  belonging  to  this  class.  An  attendant  is  to  watch  with  them  every  night,  for 
the  purpose  of  preventing  them,  if  disposed  to  do  themselves  harm.  This  would  restrain 
some  from  making  the  attempt  who  might  otherwise  do  so  ;  enable  the  attendant  to  pre- 
vent injury  should  an  attempt  in  any  case  be  made,  and  possibly  furnish  to  some  who  are 
impelled  to  this  act  by  vague  and  imaginary  fears,  a  sense  of  security  which  might  result 
in  quiet  and  refreshing  repose.  In  our  larger  Institutions  and  probably  in  all,  this,  or 
some  similar  arrangement  might  at  any  time  be  adopted.  In  all  cases  of  this  sort,  a 
ceaseless  watch,  secure  it  as  we  may,  is  the  patient's  principal  security.  There  is  an 
impulsive  form  of  this  disease,  to  which  the  principle  just  stated  is  admitted  to  be  appli- 
cable, but  which  it  is  exceedingly  difficult  to  apply,  from  the  circumstance  that  a  necessity 
for  its  exercise,  is  only  occasionally  manifested.  Moreover,  while  the  disposition  is 
known  to  friends,  and  a  degree  of  watchfulness  regarded  by  them  as  necessary,  they  are 
sometimes  unable,  and  perhaps  as  often  unwilling,  from  not  appreciating  its  importance, 
to  meet  the  additional  charge  for  attendance  which  the  case  may  require.  Hence  suicides 
in  our  public  institutions  sometimes  occur,  notwithstanding  the  most  diligent  attentions 
of  the  resident  officers.  The  night  arrangement  suggested  above,  together  with  a  classi- 
fication which  will  permit  a  constant  oversight  during  the  day  of  all  those  who  are  sup- 
posed to  be  inclined  to  suicide,  would  doubtless  prove  a  satisfactory  and  economical  means 
of  effecting  this  important  purpose.] 

From  the  commencement  of  my  studies  on  mental  alienation,  I  was  strong- 
ly impressed  by  the  obstinacy  of  certain  insane  persons,  in  repulsing  every 
variety  of  nourishment,  and  profoundly  affected  by  the  anguish  which  preced- 
ed their  long  agonies.  I  have  already  stated,  that  at  the  commencement  of 
almost  all  forms  of  insanity,  the  insane  refuse  food ;  now,  because  it  appears 
to  them  to  have  an  unpleasant  taste,  in  consequence  of  the  condition  of  their 


SUICIDE.  311 

stomachs  ;  now,  because  they  think  that  they  are  provided  with  human  flesh 
and  even  that  of  their  children,  to  eat ;  now,  they  imagine  that  they  see  poi- 
son, filthy  matters,  pins,  needles,  etc.,  upon  the  food  that  is  offered  them  ;  and 
finally,  they  believe  that  it  is  intended  to  poison  them,  although  they  see  no 
poisonous  substances.  We  must  not  permit  ourselves  to  be  frightened  by 
this  repugnance,  as  it  is  dissipated  when  the  irritation  of  the  stomach  or  gas- 
tric embarrassment  has  ceased.  We  combat  it  by  immediate  medication 
when  it  depends  upon  a  change  in  the  digestive  apparatus ;  by  the  applica- 
tion of  leeches  to  the  epigastrium,  and  by  means  adapted  to  unload  the  bow- 
els, or  by  derivatives;  such  as  irritating  pediluvia,  cataplasms  rendered  stimu- 
lant by  mustard,  or  even  blisters  to  the  inferior  extremities. 

Does  the  refusal  to  take  nourishment,  depend  upon  the  moral  cause  of  lyp- 
emania,  attended  with  a  desire  for  self-destruction  ?  we  must  act  promptly  and 
energetically.  We  have  recourse  to  persuasion,  and  excite  the  sensibility  by 
proofs  of  tenderness  and  affection  on  the  part  of  those  who  are  dear  to  the  suffer- 
er. It  has  been  reccommended, — and  Pinel  among  others  has  advised  it, — to 
strike  the  imagination  of  this  class  of  patients,  by  some  appearance  calculated 
to  frighten  them,  and  to  cause  them  to  fear  an  evil  greater  than  the  moral  one 
they  already  experience.  The  douche  and  cold  baths,  have  sometimes  over- 
come resistance.  If  all  these  means  fail,  if  the  refusal  of  food  persists,  if  the 
patient  has  made  up  his  mind  to  die  of  hunger,  we  must  have  recourse  to  the 
forced  introduction  of  alimentary  substances  into  the  stomach.  Several  me- 
chanical means  have  been  devised,  to  force  patients  to  open  the  mouth. 
These  measures  are  violent,  and  do  not  always  succeed.  The  use  of  a  gum 
elastic  tube,  introduced  through  the  nostrils  into  the  oesophagus,  for  the  pur- 
pose of  conveying  nutritive  liquids  into  the  stomach,  ordinarily  succeeds,  if 
we  have  recourse  to  it  before  abstinence  has  given  rise  to  inflammation  of  the 
stomach  and  intestines.  The  introduction  of  food  after  a  loner  abstinence, 
would  not  prevent  death.  I  first  made  use  of  the  tube  in  these  circumstances, 
but  its  employment  requires  precautions.  The  oesophagean  tube,  which  I 
first  employed,  was  of  too  large  a  calibre,  and  introduced  with  difficulty. 
We  have  since  adopted  an  ordinary  tube  of  a  smaller  calibre,  as  well  as  short- 
er. It  sometimes  happens  that  the  extremity  of  the  tube  coils  upon  itself 
before  entering  the  cesophagus,  and  then  the  liquid  returns  by  the  nostrils  and 
mouth.  M.  Baillarge,  a  house  pupil  at  Charenton,  has  provided  the  tube  with 
a  stiffener  of  whalebone,  by  which  the  accident  of  which  I  have  just  spoken, 
has  been  prevented.  It  may  happen,  that  the  resistance  will  be  such,  that 
even  with  much  experience  we  shall  open  a  false  passage  with  the  tube. 
This  accident,  though  extremely  grave,  is  very  rare,  for  I  have  known  it  to 
occur  but  once.  The  tube,  though  introduced  by  a  practiced  and  skillful 
hand,  took  a  false  direction,  and  provoked  an  inflammation,  which  terminated 
mortally  in  a  few  days.  I  repeat  it,  that  this  was  the  only  instance  in  which 
I  observed  a  similar  accident.  This  method  is  usually  unattended  with  dan- 
ger, and  has  been  the  means  of  preserving  the  lives  of  numerous  patients 
whom  I  have  had  in  charge,  either  in  public  establishments,  or  in  my  private 
practice. 

Mad'lle  R.,  the  daughter  of  a  very  nervous  mother,  aged  twenty-five  years, 
very  tall,  although  rickety,  having  black  hair  and  eyes,  together  with  a  very 
lively  imagination,  was  on  the  eve  of  marriage,  when  she  met  the  person  to 
whom  she  was  engaged,  in  company  with  another  young  lady.  Both  her 
pride  and  affection  were  most  seriously  wounded.  She  becomes  agitated,  flies 
into  a  rage,  and  is  frantic  with  despair.  A  few  days  subsequently,  she  comes 
to  the  conclusion  that  she  is  forsaken.  From  that  moment  she  has  no  desire 
to  live,  and  resolves  to  die  of  hunger.  Maternal  tenderness  cannot  overcome 
this  determination,  and   chagrin,  insomnia,  and   the  refusal  of  food,  produce 


312  SUICIDE. 

great  debility.  '  Gall  is  called,  but  effects  nothing  in  opposition  to  the  pur- 
pose of  the  patient.  Emaciation  is  extreme,  and  the  prostration  very  great. 
I  am  invited  to  a  consultation.  The  eyes  of  the  patient  were  sunken  and 
hacrgard  ;  the  cheeks  of  an  earthy  paleness ;  the  portion  over  the  protube- 
rances of  the  cheek  bones  much  flushed,  and  the  skin  had  a  dry,  pungent 
heat.  The  few  words  which  she  uttered,  were  no  longer  heard  ;  she  was  al- 
most voiceless.  It  is  decided  to  employ  the  tube,  which  we  do,  notwithstand- 
ino-  the  resistance  of  the  patient.  We  administer  some  weak  broth,  and  a 
few  spoonsful  of  sugared  water.  Emollient  fomentations  are  placed  upon  the 
abdomen,  and  heat  of  the  lower  extremities  is  induced  by  cataplasms,  render- 
ed slightly  stimulant  by  mustard,  and  frequently  renewed.  The  same  treat- 
ment is  pursued  on  the  succeeding  days.  Broth  is  given  four  times  a  day. 
On  the  fourth,  a  gelatinous  bath  of  half  an  hour's  duration  is  administered, 
and  on  the  eighth,  prolonged  baths.  The  alvine  dejections  are  less  dry,  more 
frequent,  and  voided  with  less  difficulty.  On  the  tenth  day,  as  she  resides  in 
a  very  noisy  street,  she  was  able  to  be  conveyed  to  a  quarter,  retired,  and  in 
the  neitrhborhood  of  extended  walks.  Sleep  is  reestablished,  emaciation  has 
lessened,  the  complexion  has  cleared  up,  the  voice  is  more  sonorous,  the  skin 
is  cooler,  and  the  pulse  more  developed.  She  is  however,  too  weak  to  walk, 
remains  sad,  silent,  and  is  unwilling  to  take  food.  After  the  lapse  of  six 
weeks,  the  baths  are  given  but  three  times  a  week ;  and  after  two  months, 
meat  soups  are  substituted  for  vegetable  broths.  When  the  tube  arrives,  she 
places  herself  in  an  arm-chair  that  its  introduction  may  be  easier.  It  is  only 
at  the  expiration  of  five  months,  after  some  walks,  and  after  having  recovered 
her  vital  strength  and  usual  fulness  of  habit,  that  she  begins  to  converse  vol- 
untarily, to  eat  like  other  people,  and  resumes  her  usual  manner  of  living. 

I  might  here  close  what  I  have  to  say  upon  the  subject  of  suicide.  It  is,  how- 
ever, a  malady  so  deplorable  and  frequent,  it  propagates  itself  in  a  manner  so 
frio-htful  to  families  and  society,  and  suggests  questions  of  so  much  impor- 
tance, that  I  cannot  refrain  from  saying  a  word  upon  these  points.  And  in 
the  first  place,  is  suicide  a  criminal  act  which  may  be  punished  by  the  laws? 
Has  the  legislator  the  means  of  preventing  it?  Since  suicide  is  almost  al- 
ways the  effect  of  disease,  it  cannot  be  punished  ;  the  law  inflicting  penalties, 
only  upon  acts  voluntarily  committed,  in  the  full  enjoyment  of  reason.  Now 
I  believe  that  I  have  shown,  that  man  only  makes  attempts  upon  his  life,  when 
in  a  state  of  delirium,  and  that  suicides  are  insane  persons.  Fodere  is  of  the 
same  opinion.  In  1777,  the  parliament  of  Paris  examined  this  question,  but 
without  deciding  it.  But,  in  view  of  the  interest  of  humanity  and  society, 
can  the  legislator  have  recourse  to  means  adapted  to  prevent  an  act,  which  out- 
rages equally,  natural  laws,  the  laws  of  religion  and  of  society,  and  which  is 
so  frequent  also,  that  in  France  for  example,  there  are  annually  committed, 
three  times  as  many  suicides  as  assassinations?  Experience  shows,  that  com- 
minatory  enactments  have  sufliiced  to  prevent  suicide.  When  the  declama- 
tions of  Agesias  rendered  suicide  frequent  in  Egypt,  a  law  of  Ptolemy,  which 
forbad  any  one,  on  pain  of  death,  from  teaching  the  philosophy  of  Zeno,  put 
an  end  to  this  dreadful  practice.  W^hen  the  daughters  of  Miletus  hung  them- 
selves in  emulation  one  of  another,  the  senate  passed  a  decree,  that  the  bodies 
of  suicides  should  be  exposed  in  some  public  place,  and  the  contagion  ceased. 
The  netrroes  who  were  transported  to  America,  were  accustomed  to  destroy 
themselves,  in  the  hope  of  returning  to  Africa  after  death.  An  Englishman 
caused  this  impulse  to  cease,  by  ordering  the  hands  of  those  negroes  who 
committed  suicide  to  be  cut  off,  and  exposed  to  the  observation  of  their  com- 
panions. Penal  enactments  were  passed  by  certain  ancient  nations  with  a 
view  to  prevent  suicide.  The  laws  of  Athens  prosecuted  this  crime  even  be- 
yond the  limits  of  life ;  requiring  that  the  hand  of  the  offender  should  be 


SUICIDE.  -  313 

burned  separately  from  the  body.  A  law  of  the  elder  Tarquin,  deprived  of 
the  right  of  sepulture,  the  body  of  any  citizen,  who  voluntarily  destroyed  him- 
self The  senate  of  the  republic  of  Marseilles,  which  tolerated  suicide,  con- 
demned him  who  took  his  own  life  without  a  legitimate  cause.  At  an  earlier 
period,  the  Roman  laws  favorable  to  suicide,  annulled  the  testament  of  him, 
who  destroyed  himself,  in  order  to  escape  an  ignominious  punishment,  and 
forbade  mourning  for  it.  Soldiers  were  disgraced,  if  they  made  an  attempt 
upon  their  own  lives.  At  Thebes,  the  dead  body  of  a  suicide,  was  burnt  in 
disgrace. 

The  laws  of  Christian  countries,  which  condemn  all  murder,  have  pro- 
nounced self-murder  to  be  the  greatest  crime,  because  it  leaves  no  room  for 
repentance.  They  refuse  to  the  dead  bodies  of  suicides,  a  Christian  burial. 
All  modern  legislation,  to  which  the  laws  of  the  church  have  served  as  a 
basis,  have  branded  suicide  with  infamy.  In  England,  the  corpses  of  suicides 
were  formerly  thrown  out  into  the  highway.  More  recently,  they  have  been 
interred  in  the  country,  where  three  roads  meet.  In  France,  during  the  time 
of  St.  Louis,  the  household  goods  of  the  suicide  were  confiscated  for  the 
benefit  of  the  proprietor  of  the  soil  on  which  the  crime  was  committed.  At  a 
later  period,  the  dead  bodies  of  suicides  were  drawn  through  the  streets  upon 
a  hurdle.  AH  these  laws  have  fallen  into  desuetude,  particularly  in  France. 
In  England,  they  evade  their  application,  by  obtaining  the  certificate  of  a 
physician,  who  testifies  that  the  person  who  has  committed  the  act  of  self- 
murder  was  insane.  At  this  day  in  France,  and  in  the  greater  portion  of  Eu- 
rope, they  would  look  upon  the  punishment  of  suicide,  as  an  act  of  barbarism. 
Beccaria  opposes  the  penalties  enacted  against  suicide,  on  the  ground  that  they 
are  inflicted  only  upon  a  dead  body,  and  produce  no  impression  upon  the  liv- 
ing ;  whilst,  at  the  same  time,  by  causing  the  relatives  to  suffer,  the  innocent 
are  punished,  which  is  unjust.  If  it  be  affirmed  in  opposition,  says  this  writer, 
that  the  disgrace  and  penalties  attending  this  act,  and  the  fear  of  infamy,  will 
prevent  the  most  resolute  man  from  the  commission  of  it ;  I  reply  that  he 
whom  the  horror  of  death,  and  the  threats  of  eternal  punishment  do  not  re- 
strain, will  not  be  deterred,  by  considerations  far  less  weighty. 

Are  not  the  fundamental  laws  of  our  being,  and  the  warnings  of  religion, 
daily  sacrificed  to  the  force  of  prejudice,  to  passions  and  social  interests? 
Did  we  not  say,  that  the  punishments  inflicted  upon  sorcerers  and  the  possess- 
ed, far  from  diminishing  their  number,  augmented  it?  Will  it  not  be  the 
same,  with  respect  to  the  penalties  enacted  against  suicide?  With  reference 
to  the  former,  the  penalties  inflicted  upon  sorcerers  and  the  possessed,  were 
enacted  in  accordance  with  a  popular  error.  The  more  severe  the  enactments, 
the  more  thoroughly  persuaded  were  the  public  of  the  existence  of  sorcerers 
and  the  possessed,  of  which,  the  laws  sanctioned  the  belief.  The  number  of 
these  deluded  people  began  to  lessen,  so  soon  as  they  ceased  to  believe  in  the 
existence  of  sorcerers,  and  to  fortify  the  public  mind  in  this  belief,  by  the  zeal 
which  was  manifested,  not  in  destroying  error,  but  in  punishing  it. 

Popular  opinion  is  not  favorable  to  suicide,  nor  is  it  exercised  with  a  view 
to  combat  an  error,  but  to  prevent  an  act,  whatever,  aside  from  this,  its  moral 
or  legal  character  may  be.  Argument  merely,  should  not  prevail  against  the 
authority  of  experience.  Comminatory  laws  caused  suicides  to  cease  in  Egypt, 
Miletus  and  America.  Suicide  is  more  frequent,  since  the  laws  which  con- 
demn it,  have  lost  their  force.  Hence,  for  the  welfare  of  society,  the  legisla- 
ture should  establish  laws,  not  attaching  penalties  to  the  dead  body  of  the  suicide, 
and  still  less  against  his  relatives  ;  but  with  a  view  to  prevent  the  commission 
of  suicide.  It  does  not  belong  to  me  to  say  what  these  laws  shall  be,  but,  in 
my  opinion,  they  should  vary  to  suit  the  dispositions,  morals,  and  even  the  pre- 
judices of  the  people  inhabiting  different  countries ;  and  should  be  designed 
40 


314  SUICIDE. 

to  meet  the  social  causes,  which  are  calculated  to  develope  a  tendency  to  sui- 
cide. For  example,  in  our  day,  the  king  of  Saxony  has  enacted  a  law,  that 
the  bodies  of  suicides,  should  be  placed  in  public  amphitheatres  for  dissec- 
tion. 

Until  wise  legislation  apply  some  remedy  to  this  social  evil,  the  friends  of 
humanity  should  desire  that  education  may  repose  upon  the  solid  basis  of  mo- 
ral and  religious  principles.  They  should  protest  against  the  publication  of 
works  which  inspire  a  contempt  for  life,  and  laud  the  advantages  connected 
with  a  voluntary  death.  They  should  point  out  to  the  government,  the  dan- 
gers which  result  from  making  public  the  infirmities  to  which  man  is  exposed. 
They  should  loudly  demand,  that  the  journals  be  forbidden  to  publish  suicides, 
and  from  relatino;  the  motives  and  triflinw  circumstances  connected  with  the 
commission  of  the  act.  These  frequent  accounts  familiarize  the  mind  to  the 
idea  of  death,  and  cause  it  to  be  regarded  with  indifference.  The  examples 
daily  presented  for  imitation,  are  contagious  and  fatal ;  and  that  person,  who 
is  now  harassed  by  reverses  or  vexations,  would  not  have  destroyed  himself 
had  he  not  read  in  a  journal,  the  history  of  the  .suicide  of  a  friend  or  an  ac- 
quaintance. The  freedom  of  the  press  should  not  prevail  over  the  true*inte- 
rests  of  humanity. 

When  speaking  of  the  particular  causes  of  suicide,  I  demonstrated  that  the 
present  age  was  fruitful  in  causes  adapted  to  produce  it.*  As  when  in  times 
of  ignorance,  and  at  periods  when  religious  discussions  prevail,  and  religious 
monomania  abounds,  we  meet  with  magicians,  sorcerers  and  the  possessed ; 
so  suicides  prevail,  when  the  excesses  of  civilization  threaten  the  destruction 
of  empires.  During  the  prosperous  periods  of  the  Roman  Republic,  suicide 
was  rare.  But  it  became  frequent,  when  the  philosophy  of  the  stoics  found 
partisans  in  the  patrician  order  ;  when  two  soothsayers  could  no  longer  regard 
each  other  without  a  smile ;  when  luxury  and  wealth  had  corrupted  the  morals 
of  the  people  ;   and  political  agitations  had  shaken  the  Republic  to  its  centre. 

The  same  has  been  true  in  England,  since  Richard  Smith,  and  particularly 
Mordan,  set  an  example  which  became  contagious.  Moreover,  since  the  writ- 
ings of  Donne,  Blount  and  Gildon  have  found  readers ;  since  certain  philo- 
sophers in  France  have  revived  and  given  credit  to  the  doctrine  of  Zeno ; 
since  certain  others  have  taken  up  the  defence  of  self-murder  ;  and  revolu- 
tions have  given  a  new  impulse  to  all  the  passions,  suicide  has  become  more 
frequent,  tinder  all  these  circumstances,  the  natural  motives  which  inspire  a 
horror  of  death,  and  especially  of  self-murder,  are  not  strengthened  by  consi- 
derations drawn  from  morals,  religion  and  the  laws.  If  suicide  is  constantly 
represented  in  books  and  upon  the  stage,  not  merely  as  an  indifferent  act,  but 
as  one  indicative  of  courage,  from  which  men  the  most  grave,  and  often  the 
most  eminent  in  society  do  not  recoil ;  the  public  mind  will  doubtless  be  more 
disposed  to  suicide ;  and  this  disposition  will  be  fortified  by  the  force  of  imi- 
tation, if  examples  are  daily  presented  in  the  public  prints.  But  from  the  cir- 
cumstance that  suicide  is  more  frequent  in  our  times,  I  shall  not  conclude 
with  Doctor  Burrows,  however  great  may  be  my  esteem  for  this  physician  and 
his  writings,  that  the  number  of  the  insane  has  increased  in  France.  Doctor 
Burrowst  complains  of  the  fact,  that  Lorry  pretends  that  melancholy  is  ende- 
mic in  England.  He  accuses  those  foreigners  of  injustice,  who  affirm  that 
there  is  more  insanity  in  England  than  elsewhere,  and  also  accuses  Montes- 
quieu of  having  given  authority  to  this  prejudice.  But  Doct.  Burrows  should 
accuse  English  historians,  and  particularly  Smollet  and  I.  Delarrey,  who  deno- 

*  See  also,  Considerations  on  the  Suicides  of  our  Epoch,  by  Doctor  Brouc.  {Jinnals  of 
Public  Hygiene,  1836,  t.  xvi,  page  224.) 

t  Jin  Inquiry  into  certain  Errors  relative  to  Insanity,  London,  1820,  in  8vo.  Commen- 
taries on  the  Causes,  Symptoms  and  Treatment  of  Insanity,  London,  1828,  in  8vo. 


SUICIDE .  315 

minate  England  the  natal  soil  of  suicide.  He  should  take  to  task,  those  Eng- 
lish physicians  who  assure  us,  that  the  insane  are  more  numerous  in  their 
country,  than  upon  the  continent.  Was  not  this  truth  loudly  proclaimed  in 
the  British  parliament  in  1815  1 

See  how  M.  Burrows  reasons,  to  prove  that  insanity  is  more  frequent  in 
France  than  in  England.  "  It  is  at  this  day  generally  admitted,  that  suicide 
is  a  mental  disease.  If  suicide  is  most  frequent  in  a  city,  mental  alienation 
is  most  frequent  there.  London  presents  far  more  numerous  points  of  resem- 
blance to  Paris,  than  any  other  city.  The  mortality  of  London  is  much  great- 
er than  that  of  the  whole  department  of  the  Seine,  which  embraces  Paris  :  it 
being  as  10  to  7.  The  number  of  suicides  found  in  the  tables  of  mortality 
at  London,  averages  about  40  a  year.  It  is  true  that  those  who  have  made 
way  with  themselves  are  declared  insane,  and  are  enrolled  as  such  on  the 
bills  of  mortality.  It  is  moreover  true,  that  it  is  difficult  to  decide,  as  to  whe- 
ther death  is,  or  is  not  voluntary,  on  the  part  of  all  those  who,  having  destroy- 
ed themselves,  are  found  drowned.  But  supposing,  continues  the  author,  that 
the  number  of  persons  who  voluntarily  destroy  themselves,  and  who  have  been 
declared  insane,  may  be  120.  Supposing  moreover,  that  there  may  be  40 
upon  whose  cases  no  judgment  is  passed,  the  total  number  of  voluntary  sui- 
cides in  London  is  200,  whilst  the  mean  number  of  suicides  at  Paris,  is  300  a 
year.  Therefore  the  number  of  suicides  in  London,  is  to  that  at  Paris,  as  2 
to  3.  But  suicides  are  insane  persons.  Therefore  there  are  one  third  more 
insane  persons  in  the  department  of  the  Seine  than  at  London,  and  therefore, 
mental  alienation  is  more  frequent  in  France  than  in  England." 

I  will  in  the  first  place  remark,  that  Doct.  Burrows  makes  up  the  number 
of  200  suicides  at  London,  only  by  means  of  a  series  of  suppositions ;  and 
that  he  embraces  in  this  amount  only  those  cases  of  suicide  supposed  to  be 
voluntary  ;  whilst  in  the  Paris  reports,  are  embraced  not  only  those  who  have 
destroyed  themselves,  whether  voluntarily  or  not ;  but  also  those  who  have 
been  found  dead  by  the  police,  without  its  being  always  possible  to  determine 
whether  they  have  committed  self-murder,  have  been  assassinated,  or  have 
come  to  their  end  by  some  accidental  means.  M.  Burrows  assures  us,  that 
more  persons  drown  themselves  at  Paris  than  London,  although  accidents  of 
this  nature  ought  to  be  more  frequent  in  the  latter  city,  in  consequence  of 
the  activity  of  its  business  on  the  river.  I  am  not  able  to  verify  this  fact ; 
but  I  suspect,  that  if  it  is  established  by  the  reports  of  the  public  registers, 
this  difference  is  owing  in  part  to  this  circumstance ;  that  the  Thames  carries 
all  the  dead  bodies  into  the  sea,  whilst  those  which  the  Seine  contains,  are 
arrested  by  the  nets  at  St.  Cloud,  and  carried  to  the  Dead  House ;  and  in 
part,  to  the  solicitude  of  the  English  to  inter  the  dead,  which  causes  them  to 
reclaim  those  who  have  been  found  in  the  water,  and  to  state  the  proof  of 
the  death  in  the  parish  registers.  This  author  assures  us,  that  in  1817,  there 
were  at  Paris  many  more  suicides  than  at  London.  This  proves  at  most,  as 
we  have  elsewhere  stated,  and  as  we  have  just  repeated,  that  there  are  years, 
in  which  suicides  are  more  frequent  than  usual,  since  we  have  known  it  to 
prevail  epidemically,  in  different  countries.  But  to  desire  to  establish  it  as  a 
mean,  because  the  number  of  suicides  at  Paris  in  1817,  amounted  to  300, 
would  be  strangely  to  deceive  ourselves.  I  have  elsewhere  expressed  the  rea- 
sons which  render  me  suspicious  of  the  fidelity  and  exactness  of  the  reports 
drawn  up  from  the  public  registers. 

M.  Balbi,  in  a  table,  comparative  of  France  with  the  principal  states  of  the 
globe,  establishes  the  number  of  suicides,  relative  to  the  population,  in  the 
following  proportions.* 

*Thc  French  Monarchy  corn-pared  with  the  Principal  States  of  tlie  Globe.     Sheet  in  Fol. 


316  SUICIDE. 

f 

France,  (1827)  1  suicide  to  20,740  inhabitants. 


Prussia,       " 

14,404 

Austria,      " 

49,182 

New  York  " 

7,797 

Boston,       " 

12,500 

Baltimore,  " 

13,656 

Philadelphia, 

15,875 

Doctor  Casper,  who  has  published  the  result  of  very  extensive  researches 
on  the  subject  of  suicide,  has  somewhat  altered  the  proportions,  by  comparing 
the  number  of  suicides  with  the  population.* 

Copenhagen,  100  suicides  to  1,000  inhabitants. 
Paris,                 49  "  2,040 

Hamburg,         45  "  2,222 

Berlin,  34  "  2,741 

London,  20  "  5,000 

Elberfeld,         20  "  5,000 

The  increase  of  suicides  within  the  last  half  century,  has  been  frightful. 
At  Berlin,  from  1788  to  1797,  sixty-two  suicides,  according  to  Doct.  Casper, 
took  place  ;  and  from  1813  to  1822,  the  number  of  suicides  increased  to  544. 
In  Paris  from  1817  to  1821,  the  number  of  suicides  amounted  on  an  average, 
to  346,  and  in  1834  there  were  574.  We  should  doubtless  take  into  view  the 
increase  of  the  population,  and  the  care  that  is  taken,  to  ascertain  with  exact- 
ness whatever  relates  to  this  subject ;  but  we  cannot  conceal  the  fact,  that 
this  increase  in  the  number  of  suicides,  reveals  a  remarkable  change  in  so- 
ciety. The  general  returns  of  the  criminal  courts  in  France,  present  from 
the  year  1827  to  1831  inclusive,  an  average  of  1808  suicides,  legally  made  up 
from  the  whole  kingdom.  Those  suicides  that  have  not  been  announced  to 
the  authority,  are  not  embraced  in  this  estimate.  Notwithstanding,  suicides 
are  thrice  as  numerous  in  France,  as  homicides.  In  Berlin,  suicides  are  to 
murders  or  homicides,  as  1  to  5 ! 

M.  Q,uetelet,  in  his  work  replete  with  the  most  valuable  researches  and 
deductions,  respecting  the  development  of  the  faculties  of  man,t  assures  us 
that  in  the  department  of  the  Seine,  the  mean  number  of  suicides  is  350,  out 
of  800,000  inhabitants  ;  that  is,  one  suicide  to  3,900  of  the  population  ;  a 
proportion  far  less  than  that  which  had  been  pointed  out  by  Doctor  Casper. 

If  we  compare  the  data  published  by  this  physician,  with  the  results  to 
which  M.  Q,uetelet  has  arrived,  we  shall  observe  a  very  remarkable  difference 
as  it  respects  suicide,  between  Paris  and  Berlin.  The  number  of  suicides  is 
much  more  considerable  at  Berlin  than  at  Paris.  It  is  as  20  to  12  according 
to  M.  Balbi,  and  as  20  to  29,  according  to  Casper.  At  Berlin  the  number 
of  suicides  among  men,  is  to  that  among  women,  as  5  to  1,  whilst  at  Paris, 
the  difference  is  as  3  to  1.  At  Paris,  strangulation  as  a  means  of  suicide,  oc- 
curs in  one  case  in  ten,  whilst  it  amounts  to  one  half  in  Berlin.  Fire- 
arms are  employed  in  1  case  in  7  at  Paris,  and  1  in  3  at  Berlin  ;  whilst 
submersion  embraces  a  little  more  than  one  third  at  Paris,  and  one  eighth  at 
Berlin.  Upon  what  do  differences  so  remarkable,  depend  ?  Are  the  locali- 
ties or  morals  of  these  places,  concerned  in  effecting  them  ? 

M.  Guerry,  an  advocate  of  the  Royal  Court  at  Paris,  in  consequence  of 

*  Beitrage  ziir  Medicin  Statistil<  und  Staats  arzneizunde,  Berlin,  1825,  in  8vo. 
t  On   Man,   and  the  Development  of  his  Faculties;    or  an  Essay  on  Social  Physics. 
Paris,  1835,2  Vols,  in  8vo. 


SUICIDE.  317 

being  placed  in  peculiar  circumstances,  was  led  to  make  some  very  extended 
researches  on  the  subject  of  suicides.  Those  portions  already  published,  have 
produced  an  intense  desire  that  the  author  may  complete  this  work.*  M. 
Guerry  has  concluded,  from  his  statistical  data,  that  in  the  north  of  France, — 
divided  by  him  into  five  regions, — there  are  51  suicides,  whilst  there  are  11  in 
the  south,  and  9  in  the  central  portion :  that  in  the  north,  the  number  of 
suicides,  in  proportion  to  the  population,  is  as  1  to  9,855,  and  in  the  south  as 
1  to  30,875 ;  that  the  department  of  the  Seine  produces  one  sixteenth  of  the 
suicides  that  are  committed  throughout  all  France  ;  that  the  number  of  sui- 
cides increases  progressively,  in  proportion  as  we  approach  the  Capital,  and 
that  a  like  progression  takes  place  with  reference  to  Marseilles,  relative  to  the 
departments  which  surround  that  city.  M.  Guerry  has  also  shown,  that  sum- 
mer produces  more  suicides  than  autumn,  as  I  also  stated,  when  speaking  of 
the  influence  of  the  seasons  on  the  production  of  suicides ;  that  the  greater 
number  of  suicides  are  committed  from  four  to  six  o'clock,  and  the  least, 
from  two  to  four  in  the  morning  ;  that  age  has  an  influence  upon  the  choice 
of  the  means  employed  by  suicides,  etc.  It  has  not  been  demonstrated,  that 
suicides  are  more  frequent  in  France  than  in  England ;  but  were  this  estab- 
lished by  incontestable  facts,  it  would  not  prove,  that  the  insane  are  more  nu- 
merous with  us,  than  in  England. 

If  the  number  of  suicides  be  greater  at  this  day  in  France,  several  forms  of 
mental  alienation  have  almost  entirely  disappeared  :  for  example,  religious  in- 
sanity, which  is  still  very  prevalent  in  England.  The  acts  of  the  British  Par- 
liament attest,  that  in  1815  there  were  7000  insane  persons  in  London  and 
its  environs ;  whilst  there  were  never  in  the  department  of  the  Seine,  whither 
there  is  an  influx  from  all  the  provinces,  a  number  amounting  to  thirty-five 
hundred. 

*  An  Essay  on  the  Moral  Statistics  of  France,  Paris,  1833,  in  4to. 


MONOMANIA. 


Distinctive    characteristics  of  monomania  and   lypemania. — Intellectual  monomania. — 
Reasoning  mania  of  authors,  affective  monomania  of  Esquirol. — Monomania  without 
delirium,  or  instinctive   monomania. — The  physiognomy  and  leading  mental  qualities 
of  the  monomaniac  and  lypemaniac  described  and  contrasted. — Course  of  monomania 
more    acute,  and  its   termination    usually  more   favorable   than  lypemania. — Theoma- 
niacs. — Melancholica  enthusiastica. — Delusions  of  monomaniacs. — Case  in  detail,  with 
post-mortem   examination. — Case   in  which   hypochondria    first,  then    lypemania,  and 
lastly  monomania  were   successively   developed. — Cases   illustrating  certain    mental 
peculiarities. — Case  of  Mad'e   de    R.,  with    post-mortem  examination. — Monomania 
sometimes  epidemic. — A  modern  example. — Predisposing  and  exciting  causes. — Remit- 
tent or  intermittent. — Progress  sometimes  rapid   and  violent. — Terminates    suddenly 
and  unexpectedly. — Sometimes   passes   into   mania,  or  alternates  with   lypemania. — 
When  prolonged,  degenerates  into  dementia. — Intermediate  state. — General  treatment. 
— Farther  remarks  on  treatment. — Erotic    monomania. — Erotomania    defined. — Dis- 
tinguished   from    nymphomania    and  satyriasis. — Case   illustrating  the   uncomplicated 
characteristics  of  erotic  delirium,  with  treatment. — Mode  of  detecting  it   in  its  earliest 
stage. — Cases  illustrative  of  its  sudden  and   fatal    termination. — Suicide  one  of  its 
terminations. —  Amorous  lypemania   complicated   with    mania. — Examples. — Erotoma- 
nia may  degenerate. — Cannot  be  confounded   with  hysterical  madness. — Has  existed 
among  all  people. — Causes  of  erotomania   the  same  with   monomania  in  general. — 
Is  the    cerebrum   or  cerebellum    the    part  affected    in   erotomania .'' — In   some  cases, 
marriage   almost    the   only   remedy. — Reasoning    monomania. — General    description, 
succeeded    by   numerous   examples. — Has    an    acute   and  chronic  course. — Three  pe- 
riods recognized  in   it. — Remittent  or  intermittent. — No  therapeutic  indication  diffe- 
rent from  what  is  found   applicable  in  other  forms  of  monomania. — Peculiar  manage- 
ment  of  the   mind  requisite. — Reasons   offered  for  studying  it  with   care. — Monoma- 
nia FROM  DRUNKENNESS. — Fermented  drinks  common  to  all  people. — Use  and  abuse. 
— Their  effects. — Intemperance   sometimes    hereditary. — Sometimes  produced  at    the 
critical    period    in   women. — Examples. — Cologne   water  preferred  in   some   cases   to 
other  stimuli. — Paroxysmal. — Reasons  assigned  for  the  formation  of  this  habit. — To- 
nics proposed  for  some  cases,  oil   of  turpentine  for  others. — Incendiarv  monomania. 
— (Pyromania  of  Marc). — Causes  which   lead  to  it. — Examples. — An  instinctive  im- 
pulse   independent  of  the  will    sometimes    leads  to  incendiarism. — Inferences   from 
foregoing  cases. — Farther  remarks,  with   respect  to  causes. — Relative   proportion   of 
male  and   female    incendiaries. — Hygienic  influences   relating  to  sexual  development 
in  France  and  Germany  described. — Enquiries  respecting  the  age  and  sex  of  incendia- 


320  MONOMANIA. 

ries. — Homicidal  monomania. — Synonyms. — Causes  which  lead  to  it. — Mania  with- 
out delirium. — Maniacal  fury. — Further  exciting  causes. — Examples. — All  periods  of 
life  subject  to  attacks. — Usually  periodical. — Treatment  like  that  of  other  forms  of 
monomania. — Cases,  with  treatment  and  observations. — Cases  of  three  little  girls,  with 
remarks. 

After  having  set  forth  the  characteristics  of  lypemania,  (melancholy  with 
delirium),  it  becomes  my  duty  to  describe  that  form  of  partial  delirium,  to 
which  I  have  given  the  name  of  monomania ;  but  first,  I  will  endeavor  to 
point  out  the  distinctive  characteristics  of  those  two  forms  of  delirium.  Mo- 
nomania and  lypemania,  are  chronic  cerebral  affections,  unattended  by  fever, 
and  characterized  by  a  partial  lesion  of  the  intelligence,  affections  or  will. 
At  one  time,  the  intellectual  disorder  is  confined  to  a  single  object,  or  a  limited 
number  of  objects.  The  patients  seize  upon  a  false  principle,  which  they 
pursue  without  deviating  from  logical  reasonings,  and  from  which  they  deduce 
leo-itimate  consequences,  which  modify  their  affections,  and  the  acts  of  their 
will.  Aside  from  this  partial  delirium,  they  think,  reason  and  act,  like  other 
men.  Illusions,  hallucinations,  vicious  associations  of  ideas,  false  and  strange 
convictions,  are  the  basis  of  this  delirium,  which  I  would  denominate,  intel- 
lectual monomania.  At  another ;  monomaniacs  are  not  deprived  of  the  use  of 
their  reason,  but  their  affections  and  dispositions  are  perverted.  By  plausible 
motives,  by  very  reasonable  explanations,  they  justify  the  actual  condition  of 
their  sentiments,  and  excuse  the  strangeness  and  inconsistency  of  their  con- 
duct. It  is  this,  which  authors  have  called  reasoning  mania,  but  which  I 
would  name  affective  monomania. 

In  a  third  class  of  cases,  a  lesion  of  the  will  exists.  The  patient  is  drawn 
away  from  his  accustomed  course,  to  the  commission  of  acts,  to  which  neither 
reason  nor  sentiment  determine,  which  conscience  rebukes,  and  which  the 
will  has  no  longer  the  power  to  re.strain.  The  actions  are  involuntary,  instinc- 
tive, irresistible.  This  is  monomania  without  delirium,  or,  instinctive  monoma- 
nia. 

Such  are  the  general  phenomena,  which  partial  delirium  -or  monomania, 
presents.  But  according  as  the  delirium  is  expansive  or  concentrated,  gay  or 
sorrowful,  there  exist  differences,  which  it  is  necessary  to  notice.  In  lypema- 
nia, the  sensibility  is  painfully  excited  or  disturbed ;  the  sorrowful  and  de- 
pressing passions  modify  the  intelligence  and  the  will.  The  lypemaniac  fas- 
tens upon  himself  all  his  thoughts,  all  his  affections;  is  egotistical,  and  lives 
within  himself  In  monomania  on  the  contrary,  the  sensibility  is  agreeably 
excited.  The  gay  and  expansive  passions  react  upon  the  understanding  and 
the  will.  The  monomaniac  lives  tvithout  himself,  and  diffuses  among  others 
the  excess  of  his  emotions.  The  physiognomy  of  the  monomaniac  is  animat- 
ed, changeful,  pleasant ;  the  eyes  are  lively  and  brilliant.  The  complexion 
of  the  lypemaniac  is  sallow,  pale,  and  even  bronzed ;  the  features  of  the  face 
are  contracted,  changeless  and  shriveled ;  the  eyes  are  sunken,  and  fixed  ; 
the  look  is  uneasy  and  suspicious. 

The  monomaniac  is  gay,  petulant,  rash,  audacious.  The  lypemaniac  is  sor- 
rowful, calm,  diffident,  fearful.  The  former  exercises  much,  is  talkative,  blus- 
tering, pertinacious,  and  easily  irritated  :  nothing  would  appear  to  oppose  the 
free  exercise  of  all  his  functions.  The  latter  opposes  every  movement,  dis- 
sembles, excuses  or  accu  ses  himself;  the  functions  are  accomplished  painfully 
and  with  slowness.  The  course  of  monomania  is  more  acute,  its  duration 
shorter,  and  its  termination  more  favorable,  unless  there  are  complications. 
The  contrary  holds  true  in  lypemania.  In  this,  the  delirium  seems  to  depend 
more  particularly  upon  some  abdominal  lesion ;  while  in  the  other,  it  appears 
to  be  caused  more  immediately,  by  the  anormal  condition  of  the  brain.     Such 


MONOMANIA.  321 

are  the  essential  difterences  between  lypemania  and  monomania;  so  clearly 
pointed  out,  that  we  need  not  confound  these  two  pathological  conditions,  nor 
impose  upon  them  the  same  name,  if  we  desire  precision  in  medical  lano-uao-e. 
It  is  in  consequence  of  not  having  distinguished  these  two  maladies,  that  au- 
thors have  noticed  only  the  intellectual  disorders,  and  neglected  the  other 
symptoms.  They  have  not  observed  the  difference  between  monomania  and 
mania,  because  of  the  excitement,  susceptibility  and  fury  of  some  monomani- 
acs. They  have  confounded  monomania  with  melancholy,  because  that  in 
both  one  and  the  other,  the  delirium  is  fixed  and  partial.  They  deny  that 
there  are  monomaniacs.  There  are  not,  say  they,  insane  persons,  whose  rea- 
son is  sound  except  on  a  single  subject.  These  patients  always  offer  some 
disorder  of  sentiment  and  will.  But  if  it  were  not  thus,  monomaniacs  would 
not  be  insane.  I  would  ask,  if  maniacs  always  reason  incorrectly,  and  upon 
every  variety  of  subject ;  if  all  their  intellectual  faculties  are  invariably  per- 
verted? M.  Foville,  in  his  excellent  article  on  Mental  Alienation  in  the  Dic- 
tionary of  Practical  Medicine  and  Surgery ;  says  that  he  has  seen  but  two  or 
three  monomaniacs,  either  at  the  Salpetriere  or  St.  Yon  (Rouen).  Was  it 
because  he  found  no  difference  between  the  insane  man  who  believed  himself 
a  King,  Grand  Seignior,  inspired  of  Heaven,  prophet ;  and  he  who,  at  the 
same  time,  has  illusions,  hallucinations,  imperfectly  distinguishes  the  qualities 
and  relations  of  external  objects,  is  unpleasantly  affected  by  whatever  impress- 
es him,  confounds  times,  places,  things  and  persons;  is,  in  fine,  the  sport  of 
his  perverted  faculties?  Shall  we  adopt  the  same  therapeutic  views,  in  the 
treatment  of  those  insane  persons  who  are  a  prey  to  a  delirium  so  varied  in 
form?  In  the  above  cases,  shall  the  intellectual  and  moral  hygienic  treatment 
be  the  same  ? 

M.  Foville  enquires,  if  the  different  forms  of  delirium  which  we  call  mania 
and  monomania,  may  not  be  the  expression,  proper  to  the  character  of  those 
persons  respectively,  who  are  thus  affected  ?  If  it  is  thus,  concludes  this  au- 
thor, the  limits  and  extent  of  the  delirium  are  of  little  importance.  Partial 
delirium  is  a  phenomenon  so  remarkable,  that  the  more  we  observe  it,  the 
more  are  we  astonished,  that  a  man  who  feels,  reasons  and  acts,  like  the  rest 
of  the  world,  should  feel,  reason  and  act  no  more  like  other  men,  upon  a  sin- 
gle point?  Can  monomania  without  delirium,  the  reasoning  monomania  of 
authors,  be  confounded  with  mania  ?  In  this,  the  understanding  is  overthrown. 
In  the  other,  it  is  sound,  intact,  and  sometimes  even  more  active  and  clear 
than  natural.  In  mania,  the  whole  intellectual  and  moral  being  is  perverted, 
all  the  actions  are  disordered ;  while  in  monomania,  the  perversion  with  re- 
spect to  the  acts,  is  partial  and  limited,  like  the  wandering  of  the  reason.  But, 
says  Dr.  Prichard,*  the  word  monomania,  applied  to  moral  and  instinctive  in- 
sanity, without  lesion  of  the  reasoning  powers,  does  not  correspond,  in  our 
acceptation  of  it,  with  the  word  mania,  which  presents  to  the  mind  the  idea 
of  ititellectual  disorder.  But  in  the  moral  insanity  of  this  author,  in  the  rea- 
soning mania  of  Pinel,  in  mania  toithout  delirium,  the  understanding  is  more 
or  less  affected.  Were  it  not  thus,  the  insane  would  permit  tiiemselves  to  be 
controlled  by  their  understanding,  and  would  discover  that  their  views  are 
false,  and  their  actions,  unusual  and  strange.  Their  understanding  is  more  or 
less  at  fault;  it  has  lost  its  influence  over  the  will,  and  is  no  longer  in  harmo- 
ny with  the  other  faculties.  Among  the  insane,  who,  without  motive,  are 
drawn  away  instinctively  to  the  commission  of  reprehensible  acts,  which  would 
be  criminal  if  they  enjoyed  the  use  of  their  reason,  intellectual  action  is  sus- 
pended. In  these  cases,  there  is  strictly  a  lesion  of  the  understanding  ;  but 
this  is  not  the  controling  cause  of  their  acts.  There  is  hence,  delirium,  insa- 
nity, monomania.     I  shall  be  pardoned  for  this  long  discussion,  on  what  I  un- 

*  Treatise  on  Insanity  and  other  disorders  affecting  the  ftfind.    London,  1835,  in  8vo. 
41 


322  MONOMANIA. 

derstand  by  the  word  monomania,  if  my  reader  will  call  to  mind,  that  Paschal 
recommends  the  employment  of  no  term,  of  which  we  cannot  give  a  clear  and 
distinct  definition.  M.  Laromiguiere*  is  equally  explicit,  on  the  necessity  of 
obtaining  exact  ideas,  and  appreciating  the  value  of  words. 

Among  monomaniacs,  the  passions  are  gay   and   expansive.      Enjoying  a 
sense  of  perfect  health,  of  augmented  muscular  power,  and  of  a  general  well- 
being,  this  class  of  patients  seize  upon  the  cheerful   side  of  every  thing.     Sa- 
tisfied with  themselves,  they  are  content  with  others.     They  are  happy,  joyous 
and  communicative.     They  sing,  laugh,  dance.     Controled  by  pride,  vanity 
and  self-love,  they  delight  in  their  vain-glorious  convictions,  in  their  thoughts 
of  grandeur,  power  and  wealth.     They  are  active,  petulant,  inexhaustible  in 
their  loquacity,  and  speaking  constantly  of  their  felicity.     They  are  suscepti- 
ble and  irritable.     Their  impressions  are  vivid,  their  affections  energetic,  their 
determinations  violent.     Disliking  opposition  and  constraint,  they  easily  be- 
come  anory,  and  even  furious.     Among  monomaniacs,  some  believe  them- 
selves to  be  gods;  pretend  to  be  in  communication  with  heaven;   assure  us 
that  they  have  a  divine  mission ;  and  present  themselves  as  prophets  and  sooth- 
sayers.    We  call  them  theomaniacs.     Plato  admitted   a  form  of  insanity  pro- 
duced by   inspiration,   and  regarded  it   as  a  gift  of  the   gods.     The   divine 
breath  animated  both  prophetesses  and  sibyls,  and  inspired  them  with  a  know- 
ledo-e   of  the  future.     Areteus  and  Coelius-Aurelianus  also  admitted   a  holy 
delirium.     The   monomania  of   enthusiasm   (melancholica   enthusiastica)    of 
Paul  d'Egine,  belongs  to  the  same  variety  of  delirium.     This  class  of  mono- 
maniacs  think  themselves  excited,  agitated  and  enlightened,  by  a  supernatu- 
ral power.     From   ancient  times,  enthusiasts  and  inspired  persons  have  not 
been  wanting.     Paracelsus  believed  that  he  carried   his  familiar  in  the  hilt  of 
his  sword.     The  enthusiasts  of  the  Cevennes  believed  in  the  declarations  of 
some  who  pretended  to  be  inspired,  who  boasted  of  their  power  to  predict  fu- 
ture events,  and  of  being  acquainted  with  the  profoundest  mysteries.     Those 
persons  had  convulsions.      We  have  seen  at  different  times,  men  making  simi- 
lar pretensions  seduce  persons,  by  no  means  prepossessed  in  their  favor,  and 
least   susceptible  of  vain  credulity.     Examples  of  a  like  error   are  not  rare. 
The  individuals  of  whom  historians  speak,  are  either  theomaniacs,  rogues,  or 
the  agents  of  some  adroit  intriguer.     The  insane  man  of  the  Pyreus,  who  has 
so  often  been  cited  as  an  example  ;   and  that  other  demented  person,  who  en- 
tered the  theatre,  and  applauded  as  if  the  play  had  been  going  on,  were  also 
monomaniacs.     Fodere  gives  an   account  of  a  porter  thirty-five  years  of  age, 
who  persuaded  himself,  that  in  consequence  of  the  peace  with  England,  coffers 
full  of  gold   and  silver  had  arrived  for  him  from  America.     So  strong  was  this 
persuasion,  that  he  refused  longer  to  labor   in  his  vocation.     We  had   at  the 
Salpetriere,  a  girl  who  had  received  some  instruction,  and  who  believed  that 
she  controled  the  sun,  moon  and  clouds.     Uneasy  at  her  sojourn  in  the  hospi- 
tal, she  threatened  us ;  now  with  rain,  and  now,  with  some  painful  solar  influ- 
ence.    I  have  seen  at  the  same  hospital  many  women,  who  thought  themselves 
empresses,  etc.     Some  monomaniacs  consider  themselves  kings,  princes  and 
lords ;  wish  to  command  the  world,  and  give,  with  dignity  and  condescension, 
their  commands  to  those  around  them.     Others  consider  themselves  savans, 
distinguished  by  their  discoveries  and   inventions ;  poets  and  orators,  whose 
verses  and  orations  it  is  necessary  to  listen  to,  on  pain  of  their  displeasure. 
Others  still,  rolling  in  wealth,  distribute  their  favors  and  fortunes  among  all 
those  whom  they  meet.     There  are  those  who,  under  the  influence  of  the  pas- 
sion of  love,  are  constantly  engaged  in  matters  pertaining  to  it ;  flatter  them- 
selves with  the  merest  illusions,  and  think  that  their  dwelling  place  is  among 
sylphs  and  houris. 

*  Discourses  on  Piiilosophy. 


MONOMANIA.  323 

M.  de  R.,  63  years  of  age,  tall,  of  a  strong  constitution,  and  sanguine  tem- 
perament, endowed  with  much  intelligence,  which  had  been  improved  by  a 
good  education,  was  curate  of  a  parish  of  Paris.  When  about  50  years  of 
age,  he  experienced  long,  but  trifling  difficulties.  He  troubled  himself  much 
on  account  of  them,  had  pains  in  the  head,  and  became  slightly  deaf  Some 
time  after,  at  the  termination  of  an  absorbing  discussion,  reason  wandered ; 
but  four  months  of  treatment  sufficed  to  effect  a  cure.  The  deafness  how- 
ever, still  increased.  He  returned  to  the  discharge  of  his  duties,  and  continu- 
ed to  enjoy  good  health  for  two  years.  He  then  experienced  a  new  truuble. 
Insomnia  became  urgent ;  the  pains  in  the  head  were  severe  and  almost  con- 
stant ;  and  the  deafness  was  complete.  Some  days  after,  the  patient  had  hal- 
lucinations of  hearing,  and  from  that  time  he  hears  voices  which  justify  his 
conduct,  and  condemn  those  who  are  opposed  to  it.  When  committed  to  my 
care,  he  believed  himself  in  communication  with  God  and  angels,  who  con- 
versed with  him  both  night  and  day.  He  is  impatient,  and  commands  with 
pride,  and  in  the  name  of  God.  He  no  longer  reads  his  breviary,  and  re- 
nounces the  most  common  practices  of  religion.  If  he  speaks,  the  voice  of 
an  angel  informs  him  beforehand,  what  he  .shall  utter.  If  he  reads,  the  same 
voice  is  heard,  before  he  pronounces  the  words,  and  if  he  writes,  voices  dic- 
tate to  him.  He  is  but  the  echo  of  what  he  hears,  whether  he  speaks  or 
writes.  He  is  con.stantly  demanding  his  liberty ;  calling  for  clothing  or  an 
improved  diet.  If  refused,  he  repeats  many  times  in  succession ;  in  the  name 
of  God,  you  are  accursed.  God,  by  my  mouth  commands  you.  If  you  obey 
not,  I  pronounce  you  accursed.  Do  they  persist  in  their  refusal,  M.  de  R. 
writes;  you  are  a  heretic,  a  perverse  person;  God  will  condemn  ycu.  If 
they  laugh  at  his  threats,  he  becomes  irritated,  his  figure  is  animated,  his  eyes 
gleam,  and  in  a  transport  of  passion  he  exclaims,  Accursed !  accursed !  or 
retiring,  in  a  rage,  he  says  ;  Accursed,  you  are  condemned  !  When  admitted 
at  Charenton  in  1831,  his  condition  remained  the  same.  He  is  inoffensive, 
goes  and  comes  to  the  house,  reiterates  his  demands,  complaints,  threats  and 
curses,  but  is  not  habitually  sorrowful.  He  often  visits  the  house  of  one  of 
the  officers,  whom  he  anathematizes  as  well  as  the  others ;  although  he  often 
plays  with  him,  and  has  presented  him  a  volume,  in  prose  and  verse,  written 
since  he  became  an  inmate  of  the  establishment.  This  volume,  and  a  second 
which  he  gave  to  Dr.  Calmeil,  are  remarkable  for  their  justness  and  coherence 
of  thought,  and  energy  of  expression.  Nothing  is  altered  in  the  writing, 
which  is  very  neat  and  correct.  In  1832,  he  is  seized  with  chronic  catarrh, 
and  his  health  becomes  enfeebled.  He  often  complains  of  dyspnoea ;  his 
limbs  swell ;  and  at  length  he  dies  suddenly,  Oct.  15th,  1833,  after  an  attack 
of  pulmonary  hemorrhage. 

At  an  examination,  made  twenty-four  hours  after  death,  nothing  remarkable 
was  noticed  externally.  The  mouth  is  still  full  of  blood.  The  bones  of  the 
cranium  are  thin ;  its  antero-posterior  diameter  six  inches,  and  the  transverse 
five  and  a  half  The  dura-mater  is  of  a  violet  color  externally,  and  of  an  un- 
natural thickness.  There  was  separated  from  it  a  rough,  false  membrane,  one 
line  in  thickness,  and  composed  of  several  plates  or  folds.  The  dura-mater 
thus  exposed,  is  healthy,  and  still  covered  with  the  arachnoid  tujiic.  The 
other  face  of  the  false  membrane,  in  contact  with  the  arachnoid,  is  reddened 
in  plates,  and  a  fine  membrane  is  separated  from  it,  which  is  the  seat  of  the 
injection,  which  extends  over  nearly  the  whole  surface  of  the  meninges,  except 
above  the  orbits.  The  false  membrane  extends  over  the  whole  convexity  of 
the  brain,  where  it  presents  the  greatest  thickness;  from  whence  it  extends  on 
either  side,  becoming  more  and  more  thin,  as  it  proceeds  to  the  base  of  the 
cranium.  The  injection  seems  to  be  confined  to  the  sub-arachnoid  cellular 
tissue.  But  the  extremely  thin  membrane,  which  is  the  seat  of  injection,  may 
be  removed;  for  the  arachnoidean  plate,  when  washed,  presents  no  longer  red- 


324  MONOMANIA. 

ness,  while  the  cerebral  plate  of  the  same  membrane  is  healthy.  The  pia- 
mater  is  injected,  red,  and  easily  removed.  Its  numerous  convolutions  pre- 
sent on  their  surface,  little  points  of  blood.  The  grey  substance  is  not  color- 
ed, but  is  here  and  there  of  a  yellow  hue.  The  white  substance  is  injected, 
but  there  is  no  serum  in  the  ventricles.  Nothing  anormal  is  noticed  in  the 
remainder  of  the  cerebro-spinal  system.  The  two  lungs  contain  at  their  sum- 
mits, and  the  right  throughout  the  greater  portion  of  the  superior  lobe,  a  mass 
of  tubercular  matter,  and  presents  small  caverns,  filled  with  a  softened  tuber- 
cular deposit.  The  remaining  portions  of  the  two  lungs  are  engorged  with 
blood,  still  contained  in  its  vessels.  The  bronchia^  are  filled  with  frothy,  red 
blood,  similar  to  that  which  is  vomited  before  death.  The  heart  is  small  and 
its  substance  firm  ;  its  cavities  are  small,  and  its  walls  thick. 

M.,  thirty-six  years  of  age,  is  tall,  of  a  bilious-sanguine  temperament,  with 
black  hair  and  eyes.  The  features  of  his  countenance  are  distinctly  marked. 
He  has  a  cousin-german  on  the  mother's  side,  who  is  insane.  In  infancy,  his 
health  was  feeble ;  but  became  firm  at  puberty.  In  disposition,  he  is  obsti- 
nate and  proud.  Becoming  his  own  master  at  an  early  period,  he  traveled 
much,  and  led  a  very  dissipated  and  irregular  life.  At  twenty  years  of  age, 
he  endeavored  to  recover  by  speculations,  his  fortune,  which  the  revolution 
had  destroyed.  At  the  age  of  twenty-seven  years,  he  was  married  to  a  beau- 
tiful woman,  both  amiable  and  wealthy.  He  gave  himself  up,  with  more  vigor 
than  ever  to  business,  and  with  all  the  fire  of  his  ambition.  At  the  same 
time,  he  is  jealous.  During  the  second  year  of  his  marriage,  tumors  appear 
upon  his  body,  which  are  more  distinct  in  the  following.  He  employs,  and 
every  where  enquires  for  remedies  ;  thinks  much  about  his  health,  respecting 
which  he  is  more  troubled  in  winter,  than  summer.  He  is,  in  a  word,  a  hy- 
pochondriac.  Notwithstanding  vicissitudes  in  business,  his  fortune  increased. 
In  1815,  he  stakes  it  all  in  the  public  funds,  and  in  a  single  day  is  ruined. 
From  that  moment,  a  change  in  his  character  is  perceptible.  He  is  quarrel- 
some, too  exacting,  overbearing,  uneasy,  restless,  and  unjust  towards  his  rela- 
tives, whom  he  accuses  of  not  coming  to  his  support.  He  ceases  not  to  com- 
plain of  them,  notwithstanding  their  many  proofs  of  regard.  When  thirty-six 
years  of  age,  two  years  after  his  reverse  of  fortune,  he  became  gloomy  and 
thoughtful.  He  attributes  his  indisposition,  to  derangement  of  the  nervous 
system  and  stomach.  Shortly  after,  he  conceived  an  opinion,  that  the  food  at 
the  eating  house  at  which  he  was  accustomed  to  dine,  had  been  poisoned. 
He  indulged  in  violent  fits  of  passion  against  his  father-in-law,  who  lavished 
upon  him  every  attention,  but  refused  to  commit  to  his  keeping  the  funds  as 
he  had  once  before  done.  He  quarreled  with  his  wife,  notwithstanding  the 
affection  she  entertained  for  him.  He  visits  the  houses  of  his  acquaintances 
and  friends,  complaining  that  he  is  poisoned  in  the  family  of  his  father-in-law, 
but  immediately  makes  the  same  complaint,  when  living  with  them.  Often, 
after  his  repasts,  he  goes  abroad  for  milk  to  drink ;  and  not  unfrequently,  after 
water  for  his  own  use. 

After  a  month  of  inquietude,  agitation  and  domestic  quarrels,  provoked  by 
his  unjust  suspicions  and  reproaches,  he  demands  a  passport,  wishing  to  leave 
France.  Some  days  after,  he  throws  himself  into  the  hands  of  the  police, 
lodges  an  accusation  against  his  father-in-law,  and  accuses  his  wife  of  exercis- 
ing an  undue  influence  over  him.  It  was  under  these  circumstances  that  the 
patient  was  committed  to  my  care,  December  30th,  1817.  He  walks  at  a  ra- 
pid pace,  eats  little,  and  his  bowels  are  constipated.  He  is  impatient,  replies 
hastily,  and  with  pride.  However,  after  several  interviews,  I  began  to  obtain 
his  confidence,  and  convinced  him  of  the  falsity  of  his  peculiar  notions.  He 
appeared  well  from  the  sixteenth  day,  but  is  exceedingly  anxious  to  recover 
his  liberty  and  visit  his  wife.  I  promised  that  he  should  see  her  shortly,  and 
that,  if  he  continued  rational,  he  should  return  to  his  family  in  eight  days. 


MONOMANIA.  325 

This  positive  assurance,  together  with  the  expectation  of  once  more  seeing 
his  wife  and  children,  seemed  to  put  an  end  to  his  fears  and  absurd  preju- 
dices. Nevertheless,  three  days  before  leaving  me,  he  persuades  himself  that, 
during  the  night,  we  had  sprinkled  ashes  about  his  chamber.  This  halluci- 
nation awakens  his  apprehension,  but  he  conceals  it  carefully,  and  restrains 
himself,  in  order  once  more  to  visit  his  wife  and  father-in-law.  That  he  might 
not  betray  himself,  he  returns  to  his  own  house.  The  same  day  however,  he 
manifests  uneasiness  while  at  dinner  ;  repels  whatever  is  said  to  undeceive 
him,  and  refuses  all  advice,  attentions  and  remedies.  On  the  following  days 
he  overheats  himself  in  running,  and  expresses  a  desire  to  assume  the  manage- 
ment of  his  affairs.  At  the  expiration  of  a  month,  he  appeared  more  agitated 
and  troubled  ;  the  alarms  of  his  family  increase  ;  and  at  length,  on  going  out 
of  a  coffee  house,  where  he  had  been  reading  a  journal,  in  which  there  was  a 
question  respecting  the  pretended  dauphin,  he  at  once  conceives  the  idea  that 
he  is  himself  the  son  of  Louis  XVI ;  presents  himself  at  the  Tuileries,  and 
penetrates  even  to  the  apartments  of  the  king,  in  order  to  claim  his  rights. 
He  is  arrested,  replies  with  composure,  politeness  and  dignity,  to  the  officer 
who  interrogates  him,  and  allows  himself  to  be  conducted  home,  without  re- 
sistance or  complaint. 

Committed  anew  to  my  care,  Feb.  20th,  1818,  he  presented  during  his  stay, 
the  following  symptoms.  His  physiognomy  is  changeful,  his  eyes  red  and 
projecting,  and  his  step  haughty.  He  is  polite  towards  all,  familiar  with  none. 
He  protests  that  he  is  not  sick  ;  that  he  is  the  dauphin  ;  that  his  arrest  is  ar- 
bitrary ;  and  that  he  will  one  day  have  revenge  ;  often  and  loudly  renewing 
his  protestation.  His  confidence  is  sometimes  shaken,  but  a  moment  after,  his 
conviction  is  entire  ;  and  he  abandons  himself  to  all  the  errors  it  suggests. 
He  issues  proclamations  to  the  French  people,  is  in  constant  activity,  endea- 
vors to  escape,  and  reviles  the  minister  of  police,  who  prevents  him  from  ful- 
filling his  high  destiny.  Nevertheless,  he  devotes  himself,  from  time  to  time, 
to  poetry  and  painting.  His  various  productions,  written  with  the  greatest 
facility,  want  neither  force  nor  beauty.  When  ridiculed  on  the  subject  of  his 
delirium,  he  becomes  irritated,  or  speedily  retires,  without  uttering  a  word. 
He  sleeps  little,  and  is  troubled  with  constipation.  Sometimes  he  eats  only 
bread,  persuaded  that  poisons  are  mingled  with  his  other  aliments.  Laxative 
drinks,  tepid  baths,  leeches  frequently  applied  to  the  anus,  isolation,  frequent 
and  friendly  conversations,  reading  and  walking,  are  the  means  employed  for 
his  relief.  After  many  months,  a  long  journey  into  Germany  is  recommended, 
and  undertaken  without  success.  I  cannot  close  this  account  without  remark- 
ing, that  from  being  a  hypochondriac  at  first,  then  a  lypemaniac,  fearing  pri- 
son, he  became  a  monomaniac,  immediately  after  reading  the  journal.  That 
sufficed  to  produce  a  permanent  impression.  He  believed  himself  the  dau- 
phin of  France. 

With  what  coherency  of  reasoning  the  patient  seeks  to  persuade  others  of 
the  correctness  of  this  acquired  conviction,  the  following  will  show  :  It  is  the 
patient  who  speaks.  "  My  pretended  father  was  attached  to  the  Tuileries 
(this  is  true).  On  the  tenth  of  August,  when  I  was  eight  years  of  age,  my 
pretended  father  preserved  me  from  a  brawl  ;  took  me  through  the  Tuileries ; 
caused  me  to  go  out  by  the  Pont-Tournant,  and  placed  me  at  a  house  in  the 
rue  Royale.  My  education  I  owe  to  him.  He  died.  When  Bonaparte  was 
proclaimed  Emperor,  I  was  presented,  by  his  order,  with  a  seal  which  was  that 
of  the  family  of  the  Bourbons,  and  which  had  been  taken  from  me  on  the 
tenth  of  August,  before  my  removal  from  the  Tuileries.  In  1814,  M.  D.  S., 
who  called  himself  my  uncle,  went  with  M.  Talleyrand  before  Louis  XVIII, 
that  he  might  recosnize  me.  In  a  long  conference  which  was  held  at  Saint- 
Ouen,  it  was  decided,  lest  the  public  tranquillity  should  be  compromised, 
and  to  prevent  collisions,  that  Louis  XVIII.  should  reign.     They  were  oblig- 


326 


MONOMANIA, 


ed  to  deny,  though   they  could   not   fail   to  know  me  ;   for  in  every  feature  I 
resembled  Louis  XVI." 

The  following  case  presents  to  our  notice  a  monomaniac,  harassed  by  ima- 
ginary terrors,  which  lead  him  to  the  commission  of  an  act  of  fury,  and  which 
passes  into  monomania,  whose  prominent  characteristic  is,  pride  or  vanity. 
During  his  whole  life,  this  patient  had  been  foolishly  vain,  and  a  prey  to  fear. 
M.,  thirty  years  of  age,  of  a  strong  constitution,  and  a  very  lively,  cheerful 
disposition,  has  never  been  controlled  from  earliest  infancy.  He  is  very  sen- 
sitive to  any  want  of  attention  which  may  be  his  due  in  society,  and  has  an 
ambition  to  pass  for  a  very  important  personage.  He  is  fond  of  violent  exer- 
cises, such  as  the  chase,  and  martial  engagements  ;  and  is  mortified  when  he 
cannot  make  a  display  of  luxury  and  splendor.  His  mother,  when  pregnant, 
experienced  a  serious  fright ;  and  when  six  months  old,  he  was  operated  upon, 
for  a  fistula  in  ano.  From  birth  until  his  fifth  year,  he  was  subject  to  convul- 
sions ;  and  at  six  years  of  age,  suffered  from  an  acute  cerebral  affection, 
which  was  cured  at  the  expiration  of  ten  days.  When  twelve  years  old,  an 
inguinal  hernia  made  its  appearance.  He  suffered  subsequently,  from  a  her- 
petic affection,  and  a  quinsy  attended  with  delirium.  During  his  infancy,  he 
was  exposed  to  causes  of  fright ;  living  at  that  time  amidst  the  scenes  of  la 
Vendee.  Since  this  period,  he  has  always  suffered  from  panic  terrors.  Arbi- 
trary and  violent  acts,  to  which  he  was  subjected  during  seasons  of  trouble, 
contributed  to  strengthen  his  tendency  to  fear.  However,  his  constitution  be- 
came more  robust  at  the  period  of  puberty.  After  being  fatigued  by  reading, 
and  even  during  the  night,  he  is  seized  with  a  passion  for  study,  and  at  the 
same  time  persuades  himself  that  his  enemies  are  about  to  make  an  attempt 
upon  his  life.  Already  does  he  experience  the  future  effects  of  the  poison. 
He  fears  all  who  approach  him,  excepting  his  relatives,  who  are  condemned 
to  submit  to  the  same  destiny  with  himself.  He  thinks  that  he  both  sees  and 
hears,  persons  armed  with  poniards  and  air-guns,  which  have  been  given  them 
for  the  purpose  of  destroying  him.  Does  he  walk  in  the  gardens,  he  imme- 
diately returns  ;  saying  that  a  ball  had  just  whistled  by  his  ears.  Sometimes 
he  indulges  in  immoderate  laughter,  and  when  asked  the  cause  of  it,  he  re- 
plies that  he  hears  sounds,  from  which  he  forms  words,  that  excite  his  mirth. 
He  endeavors  to  persuade  those  persons  who  are  about  him,  that  they  ought 
to  hear  the  same  sounds  that  he  does.  He  is  apprehensive  that  he  is  regarded 
as  a  madman.  He  constantly  hears  the  cry  of;  madman;  madman.  He  fre- 
quently enquires  of  his  friends,  if  his  eyes  are  not  fixed  or  haggard.  Often, 
after  eating,  he  is  irrational,  and  suffers  from  oppression. 

While  at  an  inn,  in  D.,  a  barber,  who  was  about  to  shave  him,  stoops  down 
to  pick  up  something.  Without  any  previous  altercation,  M.  fires  a  pistol  at 
him,  and  fractures  his  arm.  It  was  perfectly  apparent,  that  he  regarded  this 
unfortunate  man  as  an  assassin.  In  consequence  of  this  attack  of  fury,  he 
remains  for  five  days  without  eating,  drinking  or  sleeping.  At  the  expiration 
of  this  period,  sleep  is  again  reestablished,  and  M.  is  more  rational  and  com- 
posed. He  also  eats,  but  his  fears  never  desert  him.  When  committed  to 
my  care,  I  observe  that  the  physiognomy  of  the  patient  is  extremely  changeful 
and  animated  ;  his  step  proud  and  haughty.  During  the  first  days,  he  refuses 
every  variety  of  aliment,  and  is  unwilling  to  be  shaved.  He  does  not  sleep, 
and  constipation  is  obstinate,  notwithstanding  the  employment  of  prolonged 
tepid  baths.  As  it  respects  genius,  he  professes  to  be  the  first  man  in  the 
world  ;  and  attempts  are  made  to  take  his  life,  through  fear  that  he  will  con- 
trol the  world.  He  is  Apollo,  and  Caesar.  By  this  double  title  it  is,  that  he 
expects  and  requires  that  all  should  obey  him.  It  is  shameful,  that  the  high- 
est order  of  mind  should  be  confounded  with  insanity.  He  writes  to  all  those 
occupying  the  most  exalted  stations  ;  even  the  king  himself  He  is  constant- 
ly expecting  orders,  which  will  restore  him  to  freedom,  and  threatens    me 


MONOMANIA.  327 

with  the  full  weight  of  his  authority,  so  soon  as  he  shall  be  set  at  liberty. 
Meanwhile,  he  demands  an  advocate  and  bailiff.  He  alone  is  master ;  no  one 
has  authority  over  him.  He  replies  with  disdain,  and  often  not  at  all,  to  ques- 
tions that  are  put  to  him.  It  is  impossible  to  persuade  him,  that  he  is  the  sport 
of  his  disordered  imagination,  and  that  his  condition  requires  the  aid  of  me- 
dicine. We  wish,  he  says,  to  make  him  lose  his  reason,  by  the  use  of  reme- 
dies, but  his  mind  is  too  strong,  and  we  shall  not  succeed.  Mildness  and 
persuasion  are  of  no  avail.  Do  we  wish  him  to  take  a  bath,  or  to  apply  a 
blister  to  one  of  his  limbs  ;  it  is  necessary  to  employ  a  great  array  of  force, 
in  order  to  effect  our  purpose.  When  his  mind  is  divested  of  his  fears,  he 
converses  with  propriety,  is  amiable,  plays  at  different  games,  and  no  disturb- 
ance of  his  reason  is  apparent.  The  functions  of  organic  life,  offer  no 
disorder. 

M.  H.,  forty-five  years  of  age,  a  bachelor,  and  counsellor-at-law,  is  of  a 
medium  stature,  bilious-sanguine  temperament,  of  an  excellent  constitution, 
and  has  a  remarkably  voluminous  head.  His  forehead  is  uncovered  to  a  very 
considerable  e.\tent,  his  hair  black,  his  eyes  full  of  vivacity,  and  his  com- 
plexion swarthy.  He  has  always  led  a  regular  life,  and  conducted  his  affairs 
with  system  and  integrity.  He  resided  for  some  time  at  Guadeloupe,  was 
sick  for  a  year  after  a  struggle  with  the  climate,  in  connection  with  reverses 
of  fortune,  was  sent  back  to  Paris,  and  admitted  at  Charenton,  Nov.  20th, 
1832.  During  the  first  months  of  his  sojourn  at  this  establishment,  he  appears 
composed,  walking  in  the  garden,  reading  much,  and  conversing  with  spirit. 
He  would  have  been  regarded  as  rational,  if,  from  time  to  time,  his  delirium 
did  not  make  itself  manifest.  He  called  himself  the  son  of  Louis  XVI,  and 
was  accustomed  to  add,  that  an  attempt  had  been  made  to  poison  him,  for  a 
political  purpose.  After  some  months,  the  delirium  manifests  itself  more 
habitually,  and  at  length  reaches  a  state  of  fury.  He  is  king,  and  as  such, 
expects  to  command  and  to  be  obeyed.  Those  who  surround  him  are  his 
slaves,  and  their  riwht  to  life  and  death  is  vested  in  him.  Wo  to  the  man 
who  accosts  him,  without  recognizing  his  kingly  power.  A  doubt  on  this 
point,  is  high  treason.  The  domestics  who  serve  him,  know  full  well  the 
precautions  which  it  is  necessary  to  take,  in  presenting  themselves  to  him.  In 
several  instances,  his  threats  and  transports  of  passion,  on  my  endeavoring  to 
combat  his  error,  have  put  me  on  my  guard. 

In  his  case,  every  circumstance  comports  with  his  conviction.  His  lofty 
carriage,  his  attitude  and  look  ;  the  imperious  tone  of  his  voice  and  gestures, 
most  clearly  express  the  vain  prejudices  that  occupy  his  mind.  He  does  not 
adorn  himself  with  the  insignia  of  his  rank,  and  with  ribbons,  after  the  man- 
ner  of  monomaniac  Am^.s  with  whom  we  meet  amonor  assemblao;es  of  the  in- 
sane ;  but  the  walls  of  his  cell,  which  he  regards  as  a  dungeon,  present,  writ- 
ten in  large  characters,  both  words  and  phrases,  \yhich  disclose  his  mental 
condition.  Observe  some  of  the  inscriptions,  which  he  has  traced  in  the  form 
of  letters,  as  they  stand  upon  the  walls  : 

I  have — .  Tuesday — .  A  rabble  of  Frenchmen — .  Farther  on  :  Mortal 
hatred  to  the  French  Nation, — to  the  people,  to  the  Nobility — by  S.  A.  R., 
Prince  of  Bourbon,  etc.  April  1st,  1837  :  Son  of  Louis  XVI. — King.  Be- 
low :     I  am  not  a  Man — but  a  Prince — King — MONARCH. 

This  hatred  of  the  French,  and  these  titles  which  he  proclaims  with  pride, 
constitute  the  subject  of  all  his  letters  and  writings.  He  feels  indignant  at 
the  injustice  that  restrains  him  by  prison  bolts ;  so  great  and  powerful  as  he 
is.  He  pretends  that  they  have  taken  possession  of  him  by  supernatural 
means,  which  spies, — selected  from  the  most  degraded  of  the  French  people, 
— employ  ;  by  pouring  upon  his  majesty,  torrents  of  electricity,  in  order  to 
annihilate  him.  Sometimes  he  refuses  food,  not  wishincr  to  be  nourished  like 
the  clowns  of  his  corridor.     His  food  ought  to  be  prepared  in  royal  kitchens. 


328  MONOMANIA. 

His  grandeur  and  power  permit  him  to  recognize,  as  his  relatives  and  friends, 
none  other  than  the  Bourbons,  Ferdinands,  Nicholases,  etc.  For  some  months, 
the  physical  health  of  M.  H.  has  been  suffering.  He  has  an  obstinate  cough, 
loses  flesh,  sleeps  little,  and  takes  little  food.  His  tongue  seems  to  be  some- 
what embarrassed,  and  his  memory  enfeebled.  In  his  writings,  we  observe 
the  omission  of  letters  and  words ;  a  circumstance  which  did  not  occur  durino- 
the  first  years  of  his  residence  at  the  hospital.  The  ideas  and  words  also, 
which  express  his  delirium,  are  less  coherent. 

Monomaniacs,  like  other  insane  persons,  are  subject  to  illusions  and  hallu- 
cinations, which  often  alone  characterize  their  delirium,  and  are  the  cause  of 
the  perversion  of  their  affections,  and  the  disorder  of  their  actions.  Nume- 
rous facts  justify  this  statement.  Transported  by  enthusiasm,  by  religious  or 
political  fanaticism,  warmed  by  erotic  passions,  blinded  by  notions  of  an  im- 
aginary good  fortune,  flattered  by  sentiments  of  a  felicity  of  which  they  deem 
themselves  alone  worthy,  monomaniacs  entertain  little  affection  for  their  rela- 
tives and  friends,  or  their  tenderness  is  exaggerated.  They  often  disdain 
persons  whom  they  were  accustomed  to  love  most  tenderly,  and  feel  a  sort  of 
pity  for  them,  in  consequence  of  their  pretended  ignorance,  or  supposed 
poverty,  or  because  they  are  unworthy  of  understanding  the  good  fortune  of 
the  monomaniac,  or  of  participating  in  it.  Like  all  insane  persons,  these 
patients  neglect  their  own  interests  and  affairs,  and  treat  with  contempt  the 
usages  of  society.  There  are  insane  persons  educated  in  conformity  with  the 
strictest  principles,  remarkable  for  the  rectitude  of  their  understanding,  for 
the  delicacy  of  their  sentiments,  for  the  mildness  of  their  dispositions,  and  for 
a  uniformly  sober  and  moral  life  ;  who,  in  consequence  of  some  physical  or 
moral  causes,  change  their  disposition  and  habits  of  conduct,  become  turbu- 
lent and  unsociable,  and  perform  odd,  singular,  culpable,  and  sometimes  dan- 
gerous acts,  in  opposition  to  their  affections  and  interests.  A  partial  le- 
sion of  the  understanding  causes  these  changes,  and  perverts  the  sentiments 
and  actions  of  this  class  of  patients. 

Thus,  the  old  man,  who  believes  that  he  hears  the  voice  of  an  angel,  who 
commands  him  to  offer  up  his  son,  after  the  example  of  Abraham,  and  per- 
forms this  sacrifice,  is  a  monomaniac.  I  once  had  under  my  care,  says  Pinel, 
in  the  hospital  of  the  Bicetre,  an  insane  man,  whose  mania  was  periodical, 
and  whose  attacks  were  renewed  regularly,  after  several  months  of  compos- 
ure. The  invasion  of  the  attacks  were  announced  by  a  sensation  of  intense 
heat  in  the  abdomen,  afterwards  in  the  chest,  and  finally  in  the  face.  To 
this  succeeded  redness  of  the  cheeks,  a  sparkling  eye,  and  great  distension 
of  the  veins  and  arteries  of  the  head,  followed  by  a  raging  fury,  which  led 
him,  by  an  irresistible  impulse,  to  seize  an  instrument  or  weapon,  to  assault 
the  first  person  who  appeared.  A  kind  of  internal  contest,  he  was  accustom- 
ed to  say,  he  constantly  experienced,  between  the  ferocious  impulse  of  a  de- 
structive instinct,  and  the  profound  horror  Avith  which  the  idea  of  crime 
inspired  him.  There  was  no  indication  of  wandering  in  his  memory,  imagi- 
nation and  judgment. 

He  confessed  to  me  while  closely  confined,  that  his  inclination  was  abso- 
lutely irresistible  and  involuntary  ;  that  his  wife,  notwithstanding  his  tender- 
ness for  her,  had  just  escaped  falling  a  victim  to  it ;  and  that  time  only  was 
o-iven  him  to  warn  her  to  flee.  The  same  lucid  intervals  brinw  back  the 
same  reflections  and  expressions  of  remorse.  On  account  of  it,  he  had  con- 
ceived such  a  disgust  for  life,  that  he  had  several  times  sought  to  terminate 
his  existence.     This  was  a  striking  example  of  monomania.* 

The  following  case  is  remarkable,  for  the  alternate  recurrence  of  excite- 
ment  and  composure.     Mad'e  de   R.,  who  was  of  a  strong   constitution,   al- 

*  Pincl,  Medico-Philosophical  Treatise  on  Mental  Alienation. 


MONOMANIA.  329 

though  rickety,  of  a  sanguine  temperament  and  ardent  imagination,  suffered 
seriously,  in  consequence  of  the  revolution,  and  many  domestic  griefs.  Hav- 
ing been  left  a  widow  with  the  wreck  of  a  large  fortune,  she  shuts  herself  up 
on  an  estate,  in  order  to  live  more  economically,  and  to  superintend  the  edu- 
cation of  her  children.  When  about  fifty  years  of  age,  after  the  cessation  of 
the  menses,  she  passes  a  very  active  winter,  occupied  with  her  affairs,  enjoy- 
ing society,  seeking  the  world  once  more,  and  taking  much  exercise.  In  the 
spring,  and  during  the  summer,  she  is  composed,  more  sedentary  and  indolent 
living  alone,  taking  no  care  of  her  fortune,  and  deciding  upon  nothing.  In 
these  conditions  respectively,  which  are  renewed  alternately  for  several  years, 
she  fulfilled  the  duties  of  an  excellent  mother,  wanting  in  none  of  the  proprie- 
ties of  life.  It  was  necessary  to  live  on  terms  of  intimacy  with  her,  in  order 
to  perceive  the  change  in  her  manner  which  took  place  during  summer  and 
winter.  At  the  age  of  fifty-five  years,  she  is  deeply  afflicted  in  consequence 
of  the  departure  of  her  son  for  Ghent.  She  immediately  conceives,  that  the 
greatest  misfortunes  are  about  to  happen  to  Paris,  and  that  she  shall  be  more 
disastrously  affected  by  them,  than  any  other  person.  She  becomes  agitated, 
goes  abroad,  every  where  expressing  her  fears,  and  loses  her  sleep.  A  cerebral 
congestion  at  length  occurs,  and  thirty  leeches  are  applied  to  the  lower  ex- 
tremities, her  full  habit  not  allowing  general  blood-letting.  The  leech-bites 
provoke  an  eresypelas  on  each  limb.  This  accident  leads  the  patient  to  be- 
lieve that  poisonous  leeches  have  been  employed,  that  her  life  has  been  in  jeo- 
pardy, and  that  she  shall  die  in  consequence  of  their  use.  To  this  fear,  an 
attack  of  mania  succeeds,  of  which  she  is  promptly  cured,  and  leaves  for  the 
country.  In  1817,  she  has  another  attack,  which  persists  for  a  year.  For 
three  years  she  appears  to  be  restored,  beyond  the  danger  of  relapse,  when, 
in  the  month  of  Sept.  1820,  during  a  feast  which  she  was  in  the  habit  of  mak- 
ing for  her  friends,  and  the  tenants  on  her  estate,  some  sheaves,  belono-ino-  to 
a  farm  in  the  neighborhood  of  the  chateau,  are  set  on  fire.  She  immediately 
conceived  that  she  was  environed  by  flames,  and  surrounded  by  enemies  and 
soldiers. 

On  the  following  day  she  sets  out  for  Paris,  and  on  the  journey,  which  is 
one  of  a  hundred  leagues,  she  sees  soldiers  fighting,  and  the  flames  devour- 
ing the  harvests  and  dwelling  places  of  the  inhabitants.  She  is  in  a  frightful 
delirium,  and  ceases  not  to  utter  cries  of  terror.  She  is  committed  anew  to 
my  care,  and  after  some  days  of  repose,  baths,  in  connection  with  affusions  of 
cold  water  and  laxative  drinks,  reestablish  composure,  but  the  delirium  per- 
sists. She  is  incessantly  talking,  even  during  the  night.  She  converses  with 
princes  and  kings,  who  are  her  ancestors.  The  most  distinguished  monarchs 
pay  her  visits  ;  the  illustrious  dead  appear  to  her,  and  she  converses  with 
them ;  now,  with  transports  of  passion,  uttering  reproaches ;  now,  with  tran- 
qudlity,  offering  them  advice,  and  announcing  to  them  the  most  important 
events.  Mad'e  de  R.  regards  herself  as  a  sovereign,  moves  with  a  lofty  step, 
proclaims  her  power  and  strength,  and  issues  her  commands  with  pride.  A 
hundred  times  a  day,  however  cold  it  may  be,  she  opens  a  window  of  her 
apartment,  and  utters  to  the  winds,  accusations  or  justifications  ;  seeming  to 
hear  persons  who  address  her.  While  the  exasperation  of  her  symptoms  con- 
tinue, her  face  is  flushed,  and  her  complexion  more  than  usually  sallow.  In- 
somnia and  constipation  are  obstinate.  Winter  passes  in  this  state  of  excite- 
ment. Nevertheless,  she  distinguishes  persons  and  things,  converses  in  a  con- 
nected manner,  on  every  other  subject  than  that  of  her  grandeur,  her  ances- 
try, and  the  dangers  to  which  her  enemies  have  subjected  her. 

In  the  spring,  she  becomes  more  peaceful.  Whilst  preserving  her  ridicu- 
lously vain  delirium,  she  is  less  active,  walks  less,  and  says  little.  She  also 
sleeps  more,  and  can  engage  in  reading  the  journals,  and  books  of  travels. 
After  eight  years,  passed  in  alternate  seasons  of  excitement  and  repose,  she 

42 


330  MONOMANIA. 

becomes  habitually  more  peaceful;  often  speaking  in  a  low  voice,  and  some- 
times with  passion.  She  articulates  her  complaints  with  distinctness,  or  laughs 
convulsively,  and  is  always  disturbed  by  hallucinations  of  hearing.  Notwith- 
standing her  incoherence  of  thought  and  language,  which  has  become  habitual, 
she  retains  a  knowledge  of  external  objects,  and  is  kind  towards  those  who 
are  about  her.  At  the  age  of  sixty-eight  years,  she  had  become  very  corpu- 
lent, and  suffered  from  an  attack  of  cerebral  congestion,  which  was  immedi- 
ately removed,  by  applying  leeches  to  the  neck.  Whilst  the  attack  lasted 
(which  was  for  about  an  hour),  every  thing  appeared  to  the  patient  to  be  black, 
even  the  persons  who  addressed  her,  and  whose  voices  she  recognized.  Sub- 
sequently, the  abdomen  became  gradually  distended,  swollen  and  renitent, 
without  fluctuation.  At  the  age  of  seventy-two  years,  the  extremely  volumi- 
nous condition  of  her  abdomen  embarrassed  her  respiration  and  movements. 
She  often  suffered  from  somnolence  during  the  day,  complained  of  thirst,  and 
had  alternate  attacks  of  constipation  and  diarrhoea.  When  seventy-three 
years  of  age,  dyspncea  causing  us  to  fear  for  her  life,  we  tapped  her,  but  no- 
thino-  followed  the  puncture  but  a  gelatiniform  substance,  of  a  citrine  color ; 
nor  could  we  obtain  but  a  few  ounces  even,  of  this.  Six  weeks  after  this  ope- 
ration she  died. 

On  opening  the  body,  July  1st,  1834,  we  witness  a  general  emaciation,  the 
abdomen  considerably  distended,  and  without  fluctuation.  There  was  a  cur- 
vature of  the  spinal  column,  the  cranium  was  thick  and  dense  at  several 
points,  and  the  internal  table  perforated  by  granulations  springing  from  the 
dura-mater.  This  membrane  closely  adhered  to  the  cranium,  over  a  great 
extent ;  the  arachnoid  was  dense,  and  the  pia-mater  injected,  especially  on  the 
right  side,  and  separating  without  tearing,  from  the  cortical  substance.  The 
right  lobe  of  the  brain  was  injected,  and  the  lateral  ventricles  of  the  same 
side  slightly  developed.  The  left  lobe  was  pale,  when  compared  with  the  right 
one,  whose  ventricle  was  developed  one  third  more  than  that  of  the  opposite 
side.  The  cerebellum  and  spinal  marrow  are  in  a  normal  state.  The  capaci- 
ty of  the  chest  is  reduced  by  the  pressing  upward  of  the  abdominal  contents. 
The  lungs  are  healthy.  The  heart  is  voluminous,  and  there  are  some  points 
of  ossification  upon  its  valves.  The  walls  of  the  abdomen  are  thinner  than 
natural,  and  its  cavity  distended  by  a  tumor,  resulting  from  the  development 
of  the  left  ovarium.  The  interior  of  it  is  divided  by  incomplete  partitions, 
and  filled  with  a  gelatinous  fluid,  thick,  and  reddish  in  some  parts,  and  of  a 
yellowish  white  in  others.  From  it,  proceed  numerous  vessels,  which  ramify 
upon  the  partitions  which  divide  the  tumor,  and  are  finally  lost,  in  various 
parts  of  the  contained  fluid.  The  uterus  is  voluminous,  and  is  divided  by  a 
partition,  which  extends  even  to  its  neck.  The  stomach  is  atrophied,  and  its 
internal  surface  slightly  injected.  In  the  ccecum,  we  observe  an  appendix, 
formed  by  a  conical  and  fluctuating  tumor,  of  the  size  of  a  small  pear,  and 
containing  a  fluid  analogous  to  that  of  the  ovarian  cyst.  The  liver  is  small, 
the  gall  bladder  wasted  away,  and  containing  small,  blackish,  polyhedral  cal- 
culi. The  spleen  is  small,  easily  torn,  and  its  peritoneal  membrane  contains 
fine  cysts,  the  largest  of  which  has  the  volume  of  a  large  chestnut.  Each 
cyst  contains  a  fluid,  similar  to  that  contained  in  the  tumors  of  the  ovary  and 
ccECum. 

Monomania  is  sometimes  epidemic.  Was  not  that  strange  disease,  which 
desolated  Holland  and  the  province  of  the  Rhine  in  1373,  under  the  names  of 
mal  des  ardcns,  and  mal  de  Saint-Jenn,  an  epidemic  ?  Those  who  were  at- 
tacked with  it,  laid  aside  their  accustomed  habits,  crowned  themselves  with 
flowers,  and  carried  them  in  their  hands.  They  ran  about  the  streets  also, 
and  into  the  temples,  singing  and  dancing.  The  abdomen  was  so  greatly  dis- 
tended, that  many  would  have  died,  had  they  not  taken  care  to  swathe  it. 
The  writers  who  give  an  account  of  this  strange  disease,  inform  us,  that  the 


MONOMANIA.  331 

laboring  classes  abandoned  their  occupations.  They  add,  that  the  rich  took 
care  to  protect  themselves  by  their  domestics,  through  fear  of  doing  violence 
to  their  persons,  and  in  order  to  avoid  those  objects  which  might  injure  them. 
This  precaution  shows,  that  among  this  class  of  patients,  the  delirium  was 
partial. 

In  Don  Quixote,  we  find  an  admirable  description  of  monomania,  which 
prevailed  over  nearly  the  whole  of  Europe,  in  consequence  of  the  crusades : 
a  medley  of  amorous  extravagance,  and  chivalrous  bravery,  which  in  many 
cases  was  a  real  insanity. 

[Probably  no  event  in  modern  times  has  furnished  a  fairer  example  of  epidemic  mo- 
nomania, than  the  great  rally  in  behalf  of  what  is  now  known  by  the  appellation  of 
"  Millerism."  This  delusion  originated  in  the  readings,  reflections  and  dreams  of  one 
Wm.  Miller,  of  the  State  of  New  York,  who,  in  one  or  all  of  the  ways  specified,  came 
to  know  about  the  year  1840  at  what  time  "  the  Lord  was  to  appear  in  the  Heavens," 
and  the  end  of  all  things  to  come.  He  soon  found  adherents — as  will  the  author  of  any 
"  humbug"  however  palpable — who,  with  a  zeal  worthy  a  better  cause,  set  themselves 
to  proselyting.  They  went  abroad  preaching  their  doctrine  to  all  who  would  hear,  and 
publishing  their  views  to  the  world,  through  periodicals  and  newspapers,  which  owed 
their  origin  to  the  success  of  tlie  learned  author  and  abettors  of  this  new  creed  in  lead- 
ing astray  the  people.  At  the  outset,  they  pitched  not  only  upon  the  year,  but  tiie  day 
and  hour  on  which  the  "  Son  of  Man  should  come,  with  power  and  great  glory."  A 
doctrine  like  this,  solemn  and  momentous  beyond  expressipn, — spread  abroad  with  all 
the  rapidity  that  novelty  could  lend  to  it,  the  zeal  of  its  adherents  effect,  or  its  impor- 
tance inspire,  soon  collected  around  its  standard,  throngs  of  ignorant  men  and  silly  wo- 
men, who  hugged  the  delusion,  as  the  announcement  of  great  events,  and  the  supporter 
of  raptures  and  glorious  ecstasies.  The  beggarly  amount  of  intellect  with  which  its  de- 
luded followers  were  possessed,  soon  yielded  to  the  force  of  religious  excitement,  and 
long  before  "  the  time  drew  near  when  they  were  to  be  received  up,"  they  forsook  their 
respective  callings,  closed  their  shops  and  stores,  left  their  families  to  suffer,  or  to  the 
cold  charities  of  the  world,  attending  meetings  for  prayers  and  exhortations,  "  rendering 
night  hideous  by  their  screams,"  and  by  ceaseless  prayers  and  watchings,  intending  to 
open  in  "  the  great  day  of  the  Lord." 

The  excitement  of  which  the  above  brief  representation  furnishes,  by  no  means  an 
exaggerated  description,  soon  began  to  produce  its  eflfecls  upon  both  the  bodies  and  minds 
of  these  wretched  beings.  A  pale  and  haggard  countenance,  indicative  at  once  of  phy- 
sical exhaustion,  and  great  mental  solicitude,  strange  and  erroneous  views  in  reference 
to  their  worldly  relations  and  aff'airs,  together  with  their  conduct,  which  showed  that 
the  controlling  power  of  reason  was  swallowed  up  in  the  great  Majlstroom  of  Millerism, 
all  indicated  the  shock  which  had  been  produced  by  the  terrors  of  this  fearful  delusion. 
As  the  time  for  the  great  denouement  approached,  meetings  increased,  their  prayers  and 
praises  ascended  upward,  and  were  heard  far  and  wide  around,  converts  were  multiplied, 
baptisms  were  celebrated,  not  by  sprinkling,  but  by  immersions,  which  lasted  sometimes 
longer  than  life,  the  gift  of  tongues  was  vouchsafed,  ascension  robes  of  snowy  whiteness 
were  made  ready,  property  was  freely  given  up,— to  the  priests  instead  of  the  poor,— 
and  on  the  morning  of  "  the  great  day,"  with  hearts  prepared  and  decked  in  robes  of 
peerless  white,  they  go  forth  to  meet  the  "bridegroom."  Some,  not  content  to  meet 
him  upon  the  earth,  actually  ascended  trees,  in  order  first  to  greet  his  approach.  The 
day  first  announced  passed  oft'  quietly,  and  as  on  other  days,  the  world  and  the  world's 
people  jogged  on  in  their  accustomed  course  and  round  of  duties.  But  great  was  the 
disappointment  of  the  deluded  followers  of  the  doctrine  of  "  Miller."  Their  time,  for 
weeks  and  months  had  been  lost,  their  business  broken  up,  and  their  property  gone. 
Yet  to  exhibit,  as  it  were  still  more  forcibly,  the  strength  of  religious  fanaticism  operat- 


332  MONOMANIA, 

ing  upon  weak  minds,  they  still  clung  to  their  delusion  ;  again  "  searched  the  scrip- 
tures," and  happily  found  that  they  had  been  in  error.  It  was  on  a  certain  day  and 
hour  of  the  Jewish  year  1844,  on  which  their  calculations  should  have  been  based,  in- 
stead of  the  corresponding  year  of  our  calendar.  The  joyful  fact  was  spread  abroad 
throughout  the  realms  of  Millerdom,  and  at  it  they  went  with  greater  zeal  and  fervor, 
if  possible,  than  before. 

Our  Institutions  for  the  Insane  however,  were  daily  furnishing  new  proofs  of  the 
mental  ravages  it  was  producing  throughout  the  country.  Miller  maniacs  were  almost 
daily  brought  to  their  doors,  worn  out  and  exhausted  by  the  ceaseless  orgies  of  this  de- 
voted sect.  Some  were  already  in  heaven,  clothed  with  the  new  bodies  provided  for 
the  saints  ;  others  like  spectres  were  hastening  to  convert  to  the  same  faith  their  fellow- 
victims  to  disease  ;  while  a  third  class  refused  to  eat,  having  no  further  need  of  other 
"than  angels'  food."  So  strictly  did  many  of  the  "  believers"  adhere  to  cherished 
passages  of  the  Sacred  Scriptures,  that  they  declined  to  go  abroad  to  respond  to  the  calls 
of  nature  ;  because  forsooth,  we  were  commanded  "  to  become  as  little  children  ;"  and 
hence  soil  their  under-dresses.  None  slept,  or  slept  but  little  ;  all  were  waiting  ;  wait- 
ing in  obedience  to  a  divine  command,  though  sleep  alas  was  far,  far  from  their  eyes 
in  consequence  of  the  long-continued  watchfulness  which  had  been  imposed.  They 
had  passed  the  point  of  sleep  ;  some  of  them  the  rallying  point  of  exhausted  nature,  and 
sunk  to  rise  no  more.  Scores  of  the  victims  to  this  modern  delusion,  were  known  by 
all,  to  be  the  tenants  of  Mad  Houses,  and  it  was  promulgated  far  and  wide  by  the  most 
respected  authorities,  that  this  was  a  legitimate  result  of  their  misguided  views  and  acts  ; 
yet  it  fell  unheeded  upon  -the  ears  of  those  for  whom  in  kindness  it  was  designed. 
Meanwhile,  the  period  approached  when  the  correctnesrof  their  last  reckoning  was  to 
be  verified,  and  all  appointed  means  of  excitement  were  called  into  requisition.  If  pos- 
sible, a  more  firm  conviction  of  the  truth  of  Millerism  existed  in  the  minds  of  its  fol- 
lowers generally,  than  before  ;  converts  to  it  had  increased,  and  all  the  elements  of  a 
prodigious  and  extended  commotion  were  concentrating,  preparatory  to  this  great  event. 
The  scenes  which  were  enacted  in  view  of  the  fulfillment  of  this  second  interpretation, 
greatly  exceeded  the  first.  Like  the  first,  it  proved  to  be  the  "  baseless  fabric  of  a 
vision."  Rational  men  then  said  "  they  will  now  give  it  up,"  and  sane  men  were  all 
of  one  mind  on  the  subject.  The  "  Cry"  of  Nov.  22d,  1S44,  however,  announces  the 
fact,  that  "  our  brethren  and  sisters  are  not  only  strong,  but  much  stronger  than  ever. 
Our  brethren  are  all  standing  fast,  and  expecting  the  Lord  every  day."  For  centuries 
probably  has  no  excitement  been  fraught  with  more  deplorable  results,  both  to  the  bodies 
and  minds  of  men  than  this,  which  has  already  been  characterized  by  two  marked  and 
striking  crises.  Still  the  fever  rages,  notwithstanding  these  critical  periods,  which  usu- 
ally betoken  a  fatal  terminiation,  or  a  gradual  restoration  to  health.  Though  a  firm 
and  uncompromising  friend  to  the  doctrine  of  "  toleration"  in  all  matters  of  opinion, 
not  inconsistent  with  reason  and  the  interest  and  welfare  of  man,  I  am  here  in  favor 
of  restraint ;  nor  do  I  know  of  any  better  way  to  check  the  progress  of  this  piece  of 
modern  fanaticism,  than  to  let  it  rage  within  the  limits  of  the  law  ;  conveying  to  those 
receptacles  of  human  woe, — our  Insane  Hospitals, — those  whose  mental  condition  re- 
quires it,  appointing  guardians  for,  or  sending  to  work-houses,  such  as  refuse  to  provide 
for  themselves  or  families,  and  incarcerating  sucli  as  may  be  found,  seizing  with  unholy 
hands,  under  the  guise  of  religion,  the  miserable  pittance  of  deluded  men  and  women. 

I  have  gone  over  the  surface  of  this  subject,  I  allow.  I  did  not  approach  it  for  the 
sake  of  its  statistics;  to  inform  the  profession  or  others  particularly,  respecting  its  prin- 
ciples, or  to  compare  them  with  those  of  other  sects.  My  intention  has  been  to  glance 
at  its  leading  features  as  they  appeared  in  the  practices  of  its  believers  ;  showing  the 
tremendous  mental  commotion  they  were  calculated  to  produce  on  weak  and  excitable 
minds ;  and  state  in  general  its  results,  and  the  means,  so  far  as  practicable,  of  doing 
away  this  great  popular  evil.] 


MONOMANIA.  333 

The  functions  of  assimilative  life,  do  not  in  general  appear  to  suffer,  and 
are  performed  without  occasioning  any  fear  for  the  life  of  the  patient.  Ne- 
vertheless, the  pulse  of  this  class  of  patients  is  developed,  hard  and  strong; 
and  the  expression  animated.  The  heat  of  the  skin  is  considerable,  and  it  is 
sometimes  moist.  These  patients  eat  much,  and  sleep  little.  Their  rest  is 
disturbed  by  dreams,  now  painful,  and  now  of  a  pleasurable  character.  They 
often  suffer  from  abdominal  pains  and  heats,  and  sometimes  from  constipation. 
The  causes  which  predispose  and  produce  monomania,  are  the  same  with 
those  which  produce  insanity  in  general.  Sanguine  and  nervous-sanguine 
temperaments,  and  persons  endowed  with  a  brilliant,  warm  and  vivid  imagina- 
tion ;  minds  of  a  meditative  and  exclusive  cast,  which  seem  to  be  susceptible 
only  of  a  series  of  thoughts  and  emotions ;  individuals  who,  through  self-love, 
vanity,  pride  and  ambition,  abandon  themselves  to  their  reflections,  to  exagge- 
rated projects  and  unwarrantable  pretensions,  are  especially  disposed  to  mono- 
mania. It  is  remarkable,  that  these  individuals  almost  invariably  beguile 
themselves  with  the  hope  of  a  happy  fortune,  when,  stricken  by  some  reverse, 
or  disappointed  in  their  lofty  expectations,  they  fall  sick.  Thus,  a  man  who 
is  actually  happy,  and  moderate  in  his  desires,  and  who,  by  some  exciting 
cause,  becomes  insane,  will  not  be  a  monomaniac ;  whilst  an  ambitious,  proud, 
or  amorous  man,  who  shall  have  become  unfortunate,  or  have  lost  the  object 
of  his  affections,  will.  It  would  seem  as  if  monomania  were  only  an  exacro-e- 
ration  of  the  thoughts,  desires  and  illusions  with  respect  to  the  future,  with 
which  these  unfortunate  beings  amuse  their  fancy,  previous  to  their  illness. 

A  weak  understanding,  little  cultivated  or  developed  ;  and  the  want,  or  vices 
of  education,  also  predispose  to  monomania.     The  exciting  causes  are  ;  errors 
of  regimen,  strong  passions,  and  especially  reverses  of  fortune,  disappointed 
self-love,  or  ambition.     Religious  excitement  also,  ascetic  meditations  and  the 
reading  of  romances,  often  produce  this  disease  among   those  who  are  essen- 
tially controlled   by  pride  and  vanity.      By   uniting  the  physical   and  mental 
causes  of  mania,  particularly  those  which  suppose  strong,  energetic  and  ex- 
pansive passions,  with  the  predisposing  and  exciting  causes  of  lypemania,  one 
will  form  a  correct  idea  of  the  causes  of  monomania.     Monomania  is  remit- 
tent or  intermittent ;   and  the  symptoms   are  exasperated,  particularly  at  the 
menstrual  periods.     It  is  sometimes  preceded  by  melancholy  and  lypemania, 
and   is  complicated  with  epilepsy,  hysteria,  hypochondria,  and  very  frequently 
with  paralysis.     The  progress  of  monomania  is  rapid  and  violent.     Its  termi- 
nation is  often  unexpected,  and  is  effected  like  other  forms  of  mental   aliena- 
tion, by  crises,  more  or  less  sensible.     But  it  not  unfrequently  terminates  sud- 
denly, without  cause,  or  perceptible  crisis,  or  by  a  vivid  moral   impression. 
Monomania  sometimes  passes  into  mania,  and  sometimes  alternates  with  lype- 
mania.    When  prolonged,  it  degenerates  into  dementia;  but  there  exists  an 
intermediate  state,  which,  I  believe,  has  not  been  pointed  out,  although  con- 
stant.    In  the  acute  stage  of  monomania,  when  it  is  uncomplicated,  the  mo- 
nomaniac preserves  entire  the  integrity   of  his  understanding,  especially   in 
respect  to  whatever  is  beyond  the  sphere  of  his  delirium  ;   and,  admitting  his 
leading  idea  to  be  just,  he  reasons  and  decides  very  correctly.     But  when  the 
disease  degenerates  into  a  chronic  state,  the  monomaniac  is  not  only  irrational 
in  his   hypothesis,  but  his  reasonings,  affections  and  acts,  which  were  previ- 
ously, the  proper  consequences  of  the  idea  or  controlling  affection  of  his  mind, 
no  longer  maintain  their  logical    and  natural  connection.     The   insane   man 
cannot  now  control  his  reason,  in  that  sphere  of  thought  and  conviction,  what- 
ever  it  may  be,  which  is   generated  by,  and  characterizes  his  malady.      At 
length,  although  the  delirium  is  still  limited  to  a  determinate  subject,  we  ob- 
serve as  in  dementia,   incoherence  of  the  ideas,   affections  and  acts.     This 
remark  is  also  applicable  to  lypemania.     The  treatment  of  monomania  should, 
as  in   other  forms  of  mental  alienation,  be  directed  with  a  special  reference 


334  MONOMAKIA. 

to  the  predisposing  and  exciting  causes  of  the  disease,  and  to  the  physical  dis- 
orders. The  intellectual  and  moral  symptoms  should  have  great  weight  in 
the  therapeutic  views  of  the  physician.  In  this  malady,  which  is  character- 
ized by  a  peculiarly  nervous  condition  of  the  system,  antispasmodics  are  very 
useful.  While  we  may,  with  advantage,  have  recourse  to  hygienic  agents,  it 
is  proper  also,  to  hope  for  success  from  moral  treatment.  Here,  more  than  in 
other  forms  of  mental  disease,  and  with  better  hopes  of  success,  we  apply  to 
the  understanding  and  passions  of  the  patient,  with  a  view  to  effect  his  cure. 
We  have  recourse  to  surprises,  subterfuges,  and  oppositions,  ingeniously  ma- 
naged, as  circumstances  suggest,  the  genius  of  the  physician  gives  birth  to, 
and  as  experience  may  hit  upon,  and  appropriately  pursue. 

[There  is  perliaps  no  form  of  insanity  to  which  tlie  "moral  revulsion,"  so  highly  com- 
mended by  Leuret,  is  better,  if  as  well  adapted  as  that  of  monomania.  We  must  admit 
however,  that  if  the  principle  holds  good  in  this,  it  may  be  equally  well  suited,  though 
more  difficult  of  application,  to  all  the  others.  We  apply  it  instinctively,  in  the  treatment 
of  those  cases  of  mental  disease,  which  are  connected  with  depression  of  mind.  We 
cheer  up  the  desponding  in  heart ;  offer  encouragement  to  the  timid  and  doubting  ;  and  bid 
the  weak  be  strong.  So  rare  is  it,  in  any  of  the  forms  of  insanity  connected  with  depres- 
sion of  mind,  particularly  in  the  early  stages,  to  find  the  organic  functions  healthfully 
performed,  that  we  can  hardly  fail  to  entertain  a  sympathy  for  the  afflicted  sufferer,  which 
precludes  all  thought  of  the  moral  revulsion  of  Leuret.  A  man  whose  sentiments  of  hu- 
manity are  properly  cultivated,  would  almost  as  soon  think  of  moral  revulsion  in  the 
treatment  of  idiopathic  fever,  as  in  a  case  where,  in  connection  with  the  extreme  depres- 
sion of  lypemania,  he  observed  indications  of  serious  functional  disturbance  of  the  diges- 
tive apparatus,  or  other  important  portion  of  the  system.  In  monomania  on  the  con- 
trary, an  opposite  principle,  yet  with  the  same  intent,  is  often  quite  as  instinctively  called 
into  play. 

On  the  one  hand  is  a  king  who,  without  any  marked  indication  of  physical  infirmity, 
and  frequently  indeed  furnishing  satisfactory  evidence  of  good  bodily  health — except 
that  which  is  inferred  from  the  existence  of  intellectual  derangement, — demands  obei- 
sance, and  threatens  direful  punishments,  if  any  fail  to  obey.  On  the  other,  a  man  not 
worth  a  groat,  who  has  possibly  been  the  tenant  of  an  alms-house,  and  removed  to  an 
establishment  for  the  insane  from  motives  of  humanity,  is  strutting  about  in  his  soiled 
and  shabby  dress,  a  Crcosus  in  wealth,  and  dispensing  thousands  in  consideration  of  the 
smallest  favors,  and  even  ordinary  civilities.  In  such  cases,  the  promptings  of  the  natu- 
ral heart  suggest  the  "  leveling  system,"  and  the  king  soon  finds,  from  the  treatment 
which  he  receives,  that  distinctions  of  rank  are  decidedly  unpopular,  even  if  they  do  not 
subject  their  possessor  to  the  moral  revulsion  of  Leuret,  both  on  the  part  of  his  associates, 
as  well  as  that  of  the  resident  officers.  The  money-king  is  treated  with  equal  incivility; 
and  he  who  with  a  spoonful  of  ink  and  a  stump  of  a  pen,  dispenses  his  "checks"  for 
sums, — of  which  he  keeps  no  record, — and  which  fancy  suggested,  finds  it  exceedingly 
difficult,  if  not  quite  impossible,  to  raise  the  smallest  amount,  in  funds  available  for  the 
supply  of  a  want,  or  to  increase  his  stock  of  comforts.  Twenty  times  a  day  is  he  re- 
minded, in  a  manner  most  offensive  to  the  unperverted  feelings  of  man,  by  his  fellow- 
patients  who  recognize  his  infirmity,  of  his  poverty  and  utter  destitution.  His  own  senses 
corroborate  their  statements.  Yet  what  does  it  avail .'  To  employ  the  douche,  or  any 
other  agent  which  will  inspire  the  patient  with  fear  and  dread,  may  repress  the  expres- 
sion of  the  "one  idea"  wiiich  occupies  the  mind,  but  will  it  be  eradicated  thereby.' 
Will  it  of  itself  have  any  tendency  towards  effecting  this  result .'  Can  filling  the  mind 
with  perpetual  alarm,  exclude  this  "idea,"  so  that  eventually,  when  the  former  emotion 
is  removed  by  the  restoration  of  the  patient  to  liberty,  the  latter  will  not  return  .''  One 
of  the  great  advantages  resulting  from  fear  consists  in  this,  that  it  leads  the  patient  to 


MONOMANIA.  335 

exercise  self-control,  and  also,  in  many  cases,  secures  that  submission  which  induces  a 
ready  compliance  withthose  hygienic  measures  which  are  regarded  as  useful  in  restoring 
the  bodily  and  mental  health. 

I  have  known  patients  who  were  insufferably  insolent  and  abusive,  as  well  as  perverse 
and  obstinate,  reduced  to  a  state  of  quietude  and  ready  obedience  tiiat  could  not  have 
been  anticapted,  by  a  single  application  of  the  shower  bath.  A  mode  of  treatment  ana- 
logous to  that  of  Leuret,  was  once  employed  in  the  cure  of  a  man  who  regarded  himself, 
and  demanded  that  he  should  be  addressed,  as  the  "  Emperor  of  the  World."  In  the 
immediate  prospect  of  the  bath  however,  his  regal  dignity  would  forsake  him,  and  he 
was  most  willing  to  admit  that  he  had  never  been,  nor  was  at  that  time,  any  other 
than  Mr.  R.  W.  His  memory  always  proved  treacherous,  and  but  a  few  hours  would 
elapse,  before  the  submissive  Mr.  R.  W.  becomes  again  the  "  Emperor  of  the  World." 
This  gentleman  at  length  recovered,  and  in  view  of  his  absurd  pretensions,  all  of  which 
he  perfectly  well  remembered,  was  accustomed  to  exclaim,  "why  did  you  not  whip  me 
and  beat  this  nonsense  out  of  my  brain  .'  I  wonder  how  you  could  have  borne,  or  I 
have  been  guilty  of  such  contemptible  arrogance  and  obstinacy." 

There  is  little  reason  to  doubt, — though  gentleness  and  forbearance  be  the  order  of  the 
day, — that  those  practices,  which  result  from  a  sort  of  instinctive  impulse, — not  passion, 
nor  thoughtlessness,  but  a  principle  wrought  into  the  texture  of  our  being,  and  which  is 
the  origin  of  the  idea  of  Leuret, — have,  every  where,  more  or  less  influence  in  the  treat- 
ment of  the  insane.  This  doctrine  may  in  many  cases,  and  I  again  assert,  particularly  in 
monomania,  prove  highly  beneficial.  The  man  however  who  adopts  it  as  his  guide, 
needs  much  tact,  as  well  as  prudence  and  discrimination,  and  much  of  the  "  milk  of 
human  kindness"  in  his  nature,  cultivated  by  education,  to  carry  out  the  principle  of 
Leuret  in  such  a  manner  as  to  cause  no  offence  to  an  impartial  and  wise  observer,  com- 
petent to  decide  upon  the  propriety  of  the  measure,  as  a  remedial  agent,  and  the  frame 
of  mind  which  led  to  it.] 


EROTIC  MONOMANIA. 

Erotomania  is  not  that  languor,  which  prevades  the  heart  and  soul  of  him 
who  experiences  the  first  impulses  of  a  desire  to  love,  nor  that  soft  revery, 
which  has  such  charms  for  youth,  and  which  lead  him  who  has  once  felt  its 
influence,  to  seek  again  for  solitude,  the  better  to  taste  at  leisure,  the  luxury 
of  a  sentiment,  which  was  before  unknown  to  him.  This  is  not  a  disease  ;  it 
is  melancholy.  Erotomania  comes  within  the  province  of  medicine,  is  a  chro- 
nic cerebral  affection,  and  is  characterized  by  an  excessive  sexual  passion  ; 
now,  for  a  known  object ;  now,  for  one  unknown.  In  this  disorder,  there  is 
a  lesion  of  the  imagination  only.  There  is  likewise  an  error  of  the  under- 
standing. It  is  a  mental  affection,  in  which  the  amorous  sentiments  are  fixed 
and  dominant,  like  religious  ideas  in  theomania,  or  in  religious  lypemania. 
Erotomania  differs  essentially  from  nymphomania,  and  satyriasis.  In  the  lat- 
ter, the  evil  originates  in  the  organs  of  reproduction,  whose  irritation  reacts 
upon  the  brain.  In  erotomania,  the  sentiment  which  characterizes  it,  is  in 
the  head.  The  nymphomaniac,  as  well  as  the  victim  to  satyriasis,  is  the  sub- 
ject of  a  physical  disorder.  The  erotomaniac  is,  on  the  contrary,  the  sport  of 
his  imagination.  Erotomania  is  to  nymphomania  and  satyriasis,  what  the 
ardent  affections  of  the  heart,  when  chaste  and  honorable  are,  in  comparison 
with  frightful  libertinism  ;  while  proposals  the  most  obscene,  and  actions  the 
most  shameful  and   humiliating,  betray  both  nymphomania   and  satyriasis.* 

*  See  article  Satyriasis,  by  Doctor  Chas.  Londe,  in  the  Dictionary  of  Practical  Medi- 
cine and  Surgery,  t.  .xiv,  p.  517. 


336  MONOMANIA. 

The  erotomaniac  neither  desires,  nor  dreams  even,  of  the  favors  to  which  he 
might  aspire  from  the  object  of  his  insane  tenderness  ;  his  love,  sometimes, 
having  for  its  object,  things  inanimate.  Alcidias  of  Rhodes,  is  seized  with 
an  erotic  delirium  for  the  Cupid  of  Praxiteles.  Variola  relates  the  same  fact, 
respecting  an  inhabitant  of  Aries  who  lived  in  his  time.  In  erotomania,  the 
eyes  are  lively  and  animated,  the  look  passionate,  the  discourse  tender,  and 
the  actions  expansive  ;  but  the  subjects  of  it  never  pass  the  limits  of  proprie- 
ty. They,  in  some  sort,  forget  themselves  ;  vow  a  pure,  and  often  secret  de- 
votion to  the  object  of  their  love  ;  make  themselves"  slaves  to  it ;  execute  its 
orders  with  a  fidelity  often  puerile  ;  and  obey  also  the  caprices  that  are  con- 
nected with  it.  While  contemplating  its  often  imaginary  perfections,  they 
are  thrown  into  ecstasies.  Despairing  in  its  absence,  the  look  of  this  class  of 
patients  is  dejected  ;  their  complexion  becomes  pale  ;  their  features  change  ; 
sleep  and  appetite  are  lost.  They  are  restless,  thoughtful,  greatly  depressed 
in  mind,  agitated,  irritable  and  passionate.  The  return  of  the  object  beloved, 
intoxicates  them  with  joy.  Their  extreme  happiness  is  apparent  throughout 
their  whole  frame,  and  spreads  to  every  thing  that  surrounds  them.  Their 
augmented  muscular  activity  is  convulsive  in  its  character.  These  patients 
are  ordinarily  exceedingly  loquacious,  and  always  speaking  of  their  love. 
During  sleep,  they  have  dreams  which  give  birth  to  succubi  and  incuhi. 

Like  all  monomaniacs,  those  suffering  from  erotomania,  are  pursued  both 
night  and  day,  by  the  same  thoughts  and  affections,  which  are  the  more  disor- 
dered as  they  are  concentrated  or  exasperated  by  opposition.  Fear,  hope, 
jealousy,  joy  and  fury,  seem  unitedly  to  concur,  or  in  turn,  to  render  more 
cruel  the  torment  of  these  wretched  beings.  They  neglect,  abandon,  and 
then  fly  both  their  relatives  and  friends.  They  disdain  fortune,  and  despising 
social  customs,  are  capable  of  the  most  extraordinary,  difficult,  painful  and 
strange  actions. 

The  following  case  is  the  more  interesting,  as  it  presents  the  characteristics 
of  erotic  delirium  without  complication.  A  lady  thirty-two  years  of  age,  tall, 
of  a  strong  constitution  and  nervous  temperament,  having  blue  eyes,  a  light 
complexion,  and  chestnut  colored  hair,  had  received  her  education  at  a  school, 
in  which  the  most  brilliant  future,  and  the  highest  pretensions  were  present- 
ed in  perspective,  to  those  young  persons  who  went  from  this  institution. 
Some  time  after  her  marriage,  she  saw  a  young  man  of  a  higher  rank  than 
her  husband,  and  immediately  becomes  strongly  impressed  in  his  favor,  though 
she  had  never  spoken  to  him.  She  begins  by  complaining  of  her  position, 
and  speaking  with  contempt  of  her  husband.  She  murmurs  at  being  obliged 
to  live  with  him,  and  at  length  conceives  an  aversion  for  him,  as  well  as  her 
nearest  relatives,  who  endeavor,  in  vain,  to  recall  her  from  her  error.  The 
evil  increases,  and  it  becomes  necessary  to  separate  her  from  her  husband. 
She  goes  into  the  family  of  her  father,  discourses  constantly  of  the  object  of 
her  passion,  and  becomes  difficult,  capricious  and  choleric.  She  also  suffers 
from  nervous  pains.  She  escapes  from  the  house  of  her  relatives  to  pursue 
him.  She  sees  him  every  where,  and  addresses  him  in  passionate  songs.  He 
is  the  handsomest,  the  greatest,  the  most  humorous,  amiable  and  perfect  of 
men.  She  never  had  any  other  husband.  It  is  him  who  lives  in  her  heart, 
controls  its  pulsations,  governs  her  thoughts  and  actions,  animates  and  adorns 
her  existence.  She  is  sometimes  surprised  in  a  kind  of  ecstasy,  and  ravished 
with  delight.  She  is  then  motionless ;  her  look  is  fixed,  and  a  smile  is  upon 
her  lips.  She  frequently  writes  letters  and  verses,  copying  them  several  times, 
with  much  care  ;  and  though  they  express  the  most  vehement  passion,  are 
proof  of  the  most  virtuous  sentiments.  When  she  walks,  she  moves  with 
sprightliness,  and  with  the  air  of  one  engrossed  in  thought ;  or  else  her  step 
is  slow  and  haughty.  She  avoids  men  whom  she  disdains,  and  places  far  be- 
low her  idol.     However,  she  is  not  always  indifferent  to  those  marks  of  interest 


MONOMANIA.  337 

that  are  shown  her  ;  while  every  expression,  that  is  not  altocrether  respectful, 
offends  her.  To  proofs  of  affection  and  devotion,  she  opposes  the  name, 
merit,  and  perfections  of  him  whom  she  adores. 

During  both  day  and  night,  she  often  converses  by  herself;  now,  in  a  hio-h, 
and  now,  in  a  low  tone.  She  is  now,  gay  and  full  of  laughter  ;  now,  melan- 
cholic, and  weeps  ;  and  is  now  angry,  in  her  solitary  conversations.  If  any 
one  refers  to  these,  she  assures  him  that  she  is  constrained  to  speak.  Most 
frequently  it  is  her  lover  who  converses  with  her,  by  means  known  to  hhnsclf 
alone.  She  sometimes  believes,  that  jealous  persons  endeavor  to  oppose  her 
good  fortune,  by  disturbing  their  conversation,  and  striking  her.  (I  have  seen 
her  ready  to  break  out  into  a  violent  paroxysm  of  fury,  after  having  uttered  a 
loud  cry,  assuring  me  that  she  has  just  been  struck).  Under  otlier  circum- 
stances, her  face  is  flushed,  and  her  eyes  sparkling.  She  rages  against  every 
one,  utters  cries,  and  no  longer  recognizes  the  persons  with  whom  she  lives. 
She  is  furious,  and  utters  the  most  threatening  language.  This  state,  which 
is  usually  temporary,  sometimes  persists  for  two  and  three  days,  after  which, 
the  patient  experiences  violent  pains  at  the  epigastrium  and  heart.  These 
pains,  which  are  confined  to  the  precordial  region,  and  which  she  could  nut  en- 
dure without  aid  furnished  by  her  lover,  are  caused  by  her  relatives  and 
friends,  although  they  may  be  several  leagues  distant  from  her,  or  by  persons 
who  are  about  her.  The  appearance  of  force,  and  words  spoken  with  decision, 
restrain  her.  She  then  grows  pale,  and  trembles  ;  tears  flow,  and  terminate 
the  paroxysm. 

This  lady,  who  is  rational  in  every  other  respect,  labors,  and  carefully  su- 
perintends the  objects,  which  are  adapted  to  her  convenience  and  use.  She 
does  justice  to  the  merit  of  her  husband,  and  the  tenderness  of  her  relatives, 
but  can  neither  see  the  former,  nor  live  with  the  latter.  The  menses  are  reoru- 
lar  and  abundant ;  the  paroxysms  of  excitement  ordinarily  taking  place  at 
the  menstrual  period,  though  not  always.  Her  appetite  is  capricious,  and  her 
actions,  like  her  language,  are  subordinate  to  the  whims  of  her  delirious  pas- 
sion. She  sleeps  little,  and  her  rest  is  troubled  by  dreams,  and  even  night- 
mare. She  has  long  seasons  of  watchfulness,  and  when  she  does  not  sleep, 
walks  about,  talking  to  herself  or  singing.  This  disease  was  of  several  years' 
duration,  when  she  was  committed  to  my  care.  A  systematic  treatment  for  a 
year,  isolation,  tepid,  cold  and  shower  baths,  antispasmodics  externally  and 
internally  employed,  none  of  them  succeed  in  restoring  to  the  use  of  her  rea- 
son, this  interesting  patient. 

M.,  thirty-six  years  of  age,  is  of  a  nervous  temperament,  a  melancholy  dis- 
position, and  small  stature.  His  hair  is  black,  and  his  physiognomy  but 
slightly  agreeable.  A  native  of  the  south,  he  occupies  a  common  position  in 
an  office  at  Bayonne.  Being  at  Toulouse,  he  had  a  quarrel  in  behalf  of  a 
woman,  by  whom  he  believed  he  was  beloved.  He  obtains  leave  of  absence, 
and  betakes  himself  to  Paris,  in  order  to  solicit  advancement.  He  goes  to 
the  theatre,  and  conceives  a  passion  for  one  of  the  most  beautiful  actresses  of 
Feydeau,  and  believes  that  his  sentiment  is  reciprocated.  From  this  period,  he 
makes  every  possible  attempt  to  reach  the  object  of  his  passion.  He  presents 
himself  at  the  residence  of  this  lady,  and  leaves  not  the  door  by  which  the 
actors  enter  the  theatre,  hoping  to  enter  with  them,  or  obtain  a  passing  look 
from  her  whom  he  adores.  The  actors,  and  the  husband  of  the  actress,  re- 
vile this  wretched  man  ;  repulse,  abuse,  and  maltreat  him.  Whenever  the 
object  of  his  passion  appears  upon  the  stage,  he  attends  the  theatre,  places 
himself  on  the  fourth  tier  of  seats  opposite  the  stage,  and  when  this  actress 
appears,  waves  a  white  handkerchief  to  attract  her  attention. 

Her  face  then  becomes  flushed,  her  eyes  injected  and  shining.  He  main- 
tains that  she  recognizes  him,  and  testifies  her  regard  for  him  by  the  play  of 
her  countenance,  the  tone  of  her  voice,  and  the  passionate  expression  of  her 

43 


338  MONOMANIA. 

song.  In  the  most  rigorous  weather,  he  takes  his  position  upon,  or  near  the 
steps  of  the  door  of  the  house  in  which  she  resides.  He  follows  her  footsteps, 
pursues  her  in  her  walks,  and  when  she  goes  into  the  country,  proceeds  after 
her  carriage  on  foot.  He  is,  at  length,  arrested  in  the  Tuileries,  for  having 
raised  with  his  cane,  the  dress  of  this  lady.  Sometimes,  and  even  during  the 
night,  he  takes  a  hackney  coach  at  a  suitable  hour,  stops  in  front  of  the  resi- 
dence of  this  lady,  and  mounts  the  roof  of  the  carriage,  hoping  to  see  the  ob- 
ject of  his  passion  through  the  windows.  Notwithstanding  the  insults  and 
blows  which  this  unhappy  man  receives  at  the  theatre  and  in  the  streets;  not- 
withstanding the  ill  treatment  of  every  kind  which  is  heaped  upon  him,  it 
fails  to  remove  his  illusion.  The  disdain,  and  refusals  of  the  young  actress 
to  speak  with  him,  are  precautions  employed,  the  better  to  conceal  her  love. 
The  blows  with  which  he  is  assaulted,  are  often  the  result  of  jealousy  on  the 
part  of  his  rivals.  After  a  very  violent  altercation  with  the  husband  of  this 
lady,  whom  M.  maintains  is  not  married,  he  is  brought  to  a  private  hospital, 
where  I  was  charged  with  the  duty  of  establishing  the  condition  of  his  mind. 
It  was  not  difficult  to  recognize  his  erotic  delirium.  On  every  other  subject, 
he  reasoned  very  correctly,  his  interests  were  regarded,  and  his  conversation 
was  coherent.  I  represented  to  him  that  he  ran  a  risk  of  losing  his  place, 
by  not  returning  promptly  to  Bayonne.  My  leave  of  absence,  he  replied,  has 
not  yet  expired.  But,  said  I,  how  could  you  attend  the  theatre,  with  an  income 
of  only  900  francs?  I  am  at  no  other  expense,  my  food  costing  me  almost 
nothing.  I  go  to  the  theatre  only  when  Mademoiselle  plays,  and  1  there  exer- 
cise the  utmost  economy.  How  could  you  believe  that  she  loves  you  ?  You 
have  nothing  engaging,  particularly  to  an  actress.  Your  person  is  not  hand- 
some, and  you  possess  neither  rank  nor  fortune.  All  that  is  true,  but  love 
does  not  reason,  and  I  have  seen  too  much  to  leave  me  to  doubt  that  I  am 
loved.  Some  weeks  subsequently,  on  seeing  him,  he  confessed  to  me,  that 
Mademoiselle  resided  in  the  house  ;  that  he  heard  her,  but  that,  in  consequence 
of  the  same  jealousy  that  had  previously  prevented  his  meeting  her,  she  had 
been  prevented  from  speaking  to  him. 

Erotomania  does  not  always  manifest  itself  by  the  same  symptoms  that  we 
have  just  described.  It  is  sometimes  the  more  violent,  in  proportion  as  it  is 
concentrated.  It  masks  itself  under  a  deceptive  exterior,  and  is  then  more 
fatal  still.  The  patients  are  not  irrational,  but  sad,  melancholic,  gloomy,  ta- 
citurn, lose  their  appetite,  become  rapidly  emaciated,  and  fall  into  a  fever, 
which  Lorry  denominates  an  erotic  fever.  It  has  a  course  more  or  less  acute 
and  fatal.  This  condition  may  be  readily  confounded  with  chlorosis.  But 
we  can  easily  avoid  an  error.  If,  after  having  obtained  all  possible  informa- 
tion respecting  antecedent  circumstances,  the  physician  is  attentive,  he  will 
observe,  that  the  countenance  of  this  class  of  patients  assumes  an  animated 
tone,  and  becomes  flushed ;  the  pulse  frequent,  stronger,  and  quick,  in  the 
presence  of  the  object  beloved,  or  even  on  hearing  the  name  pronounced,  or 
the  individual  alluded  to  in  conversation. 

A  young  female,  with  no  apparent  physical  disease,  without  any  known 
cause,  becomes  sad  and  thoughtful.  The  countenance  assumes  a  pale  hue, 
the  eyes  sink  in  their  sockets,  and  the  tears  flow  involuntarily.  The  sufferer 
experiences  turns  of  prostration,  without  previous  exertion ;  groans  and  sighs. 
Nothing  diverts  her,  or  engages  her  attention.  On  the  contrary,  every  thing 
wearies  her.  She  avoids  her  relatives  and  friends ;  and  neither  speaks  nor 
replies  to  any  one.  Her  appetite  is  feeble,  and  capricious.  She  does  not 
sleep ;  or  if  she  does,  her  rest  is  disturbed,  and  she  becomes  emaciated.  Her 
relatives  expect,  by  marriage,  to  restore  her  from  this  condition,  which  fills 
their  minds  with  disquietude.  She  accepts,  at  first  with  indifference,  the  va- 
rious proposals  that  are  made  to  her.  Shortly  after  however,  she  refuses  them 
all  with  obstinacy.     The  malady  continues  to  increase,  and  fever  ensues.     The 


MONOMANIA.  339 

pulse  is  irregular,  disordered,  and  sometimes  slow.  Certain  convulsive  move- 
ments are  observed,  some  thoughts  irrationally  expressed,  and  particularly  cer- 
tain strange  actions.  She  finally  sinks  into  marasmus,  and  dies.  Death  re- 
vealed the  secret.  Diffidence,  an  imperfect  religious  education,  and  the  fear 
of  displeasing  her  relatives,  have  determined  her  to  conceal  the  emotions  of 
her  heart,  and  the  true  cause  of  her  malady. 

Jonadab  does  not  permit  himself  to  be  deceived  by  the  sadness,  languor  and 
declining  health  of  Ammon,  the  second  son  of  David,  who  had  become  en- 
amored of  his  sister  Tamar.  Hippocrates  discovers  the  love  of  Perdicax, 
son  of  Amyntas,  king  of  Macedonia,  for  Phyla,  a  concubine  of  his  father;  a 
passion  which  occasioned  a  hectic  fever.  From  the  state  of  the  pulse  and 
the  redness  of  the  countenance,  Plutarch  relates  that  Erasistratus  recognized 
the  cause  of  the  disease  of  Antiochus  Soter,  who  was  dying  with  love  for  his 
mother-in-law  Stratonice.  Galen  gave  an  opinion  equally  correct,  respecting 
the  condition  of  Justine,  who  had  become  enamored  of  the  actor  Piladcs.  J. 
Ferrand*  states  that  he  discovered  the  disease  of  a  young  man  who  died  of 
love,  by  the  flush  upon  his  countenance,  and  the  acceleration  of  his  pulse,  at  the 
sight  of  a  girl  who  was  accustomed  to  bring  a  light  into  his  chamber. 

This  variety  of  erotomania  is  not  rare.  There  are  few  physicians  who  have 
not  had  occasion  to  observe  and  propose  a  remedy  for  it ;  which  is  sometimes 
too  late,  when  the  disease  has  a  very  acute  course.  A  young  lady  of  Lyons 
falls  in  love  with  one  of  her  relatives,  to  whom  she  was  promised  in  marriao-e. 
Circumstances  oppose  the  fulfillment  of  promises  made  to  the  two  lovers,  and 
the  father  requires  the  removal  of  the  young  man.  He  has  scarcely  gone, 
when  this  young  lady  falls  into  a  state  of  profound  sadness,  says  nothing,  con- 
fines herself  to  her  bed,  refuses  all  nourishment,  and  the  secretions  become 
suppressed.  She  repulses  all  the  advice,  prayers  and  consolations  of  her  rela- 
tives and  friends.  After  five  days,  vainly  employed  in  endeavors  to  overcome 
her  resolution,  they  decide  on  recalling  her  lover ;  but  it  was  now  too  late. 
She  sinks,  and  dies  in  his  arms  on  the  sixth  day.  I  was  struck  with  the  rapid 
progress  of  this  malady,  in  the  case  of  a  woman  who  died  in  seven  days,  after 
having  established  in  her  mind  a  conviction  of  the  indifference  of  her  husband. 

When  erotomania  has  not  a  termination  so  sudden  and  deplorable,  it  pre- 
sents the  features  of  the  most  vehement  of  the  passions ;  of  which  it  seems  to 
be  but  an  exaggeration,  and  the  extreme  limit.  It  resembles  mania  with  fury. 
It  leads  to  suicide,  through  despair  of  not  being  able  to  obtain  the  object  be- 
loved. Sappho,  unable  to  soften  the  severity  of  Phaon,  precipitates  herself 
from  the  Leucadian  rock,  which  has  since  become  so  celebrated.  The  an- 
cients were  accustomed  to  send  to  Leucadia,  those  lovers  who  could  neither 
support  nor  conquer  their  passion.  The  cures  attributed  to  the  leap  at  Leu- 
cadia, prove  that  the  ancients  regarded  erotomania  as  a  true  nervous  affection, 
which  might  be  cured  by  a  strong  moral  shock.  Facts  related  by  the  ancients, 
as  well  as  those  which  are  daily  observed,  prove,  that  in  all  times,  suicide  has 
been  one  of  the  terminations  of  erotomania.  Amorous  lypemania  is  compli- 
cated with  mania,  and  sometimes  preceded  by  it.  The  following  cases  justify 
these  propositions. 

A  young  man  twenty-three  years  of  age,  becomes  enamored  of  a  young  wo- 
man, and  conceals  his  passion  for  more  than  a  year.  Having  danced  with  his 
friend  on  a  certain  occasion,  he  is  seized  with  convulsions,  which  recur,  at 
brief  intervals,  for  three  days.  During  the  period  of  their  remission,  he  is 
slightly  delirious.  After  the  convulsions  had  ceased,  he  became  a  maniac, 
violent,  choleric,  agitated ;  constantly  endeavoring  to  escape.  At  the  expira- 
tion of  two  months,  the  patient  is  committed  to  my  care.  Although  his  deli- 
rium was  general,  and  his  agitation  extreme,  he  was  accustomed  to  trace  upon 

*  The  Disease  of  Love,  or  Erotic  Melancholy,  Paris,  1623,  in  8vo. 


340  MONOMANIA. 

the  pavement  and  walls,  the  name  of  her  who  was  the  object  of  his  every 
thought,  and  constantly  walking  about  in  the  hope  of  finding  her.  On  the 
sixth  month  of  the  malady,  he  was  seized  with  a  fever,  which  terminated  the 
erotic  mania. 

Madeleine,  at  the  age  of  fifteen  years,  is  taken  from  the  Foundling  hospital, 
to  the  family  of  a  country  woman  who,  supposing  that  her  only  son  had  died 
in  the  army,  adopts  her  as  her  daughter.  Two  years  afterwards,  her  son  re- 
turns. Soon,  the  pleasing  person  and  cheerful  disposition  of  Madeleine  at- 
tract Jean-Pierre.  On  her  part,  she  loves  him  with  all  her  heart,  she  com- 
plies with  his  desires,  and  would  have  regarded  herself  as  ungrateful,  in  refus- 
ing any  thing  to  the  son  of  her  mother  by  adoption.  Three  years  pass  in 
this  tender  intimacy,  and  with  the  expectation,  on  her  part,  of  marrying  Jean- 
Pierre.  But  he  forsakes  Madeleine,  and  marries  another.  The  poor  girl,  in 
despair,  loses  her  reason,  wanders  about  the  fields,  and  throws  herself  into  the 
river,  from  whence  she  is  taken,  and  sent  to  the  Hotel-Dieu.  At  the  expira- 
tion of  six  weeks,  she  is  transferred  to  the  Salpetriere,  early  in  September. 
During  the  first  year  of  her  residence  in  the  hospital,  she  suffers  from  erotic 
mania  and  fury,  committing  acts  of  violence  upon  her  companions  and  herself. 
To  this  condition  monomania  succeeds,  whose  only  object  is  Jean-Pierre, 
whom  Madeleine  loves,  notwithstanding  his  infidelity.  At  her  menstrual  pe- 
riods, her  agitation  is  renewed,  when  this  unhappy  being  is  intractable,  irasci- 
ble and  choleric.  She  is  unceasingly  calling  for  Jean-Pierre,  often  repeats  his 
name,  and  says  that  no  one  is  comparable  with  him.  A  calm,  attended  by  a 
painful  sadness,  returns  again,  so  soon  as  the  menses  cease  to  flow.  Made- 
leine is  habitually  reserved  and  thoughtful,  meditating  upon  her  infidel  lover. 
She  performs  some  trifling  services  in  the  division  for  the  insane,  and  if  any 
thing  is  said  to  her  respecting  young  men,  she  regards  it  with  disdain.  She 
sings,  and  sometimes  laughs  and  is  very  gay  ;  at  others,  she  weeps.  She  will 
ever  love  Jean-Pierre.     Those  who  love  sincerely,  always  love. 

A  lady  eighty  years  of  age,  who,  in  her  youth,  had  lived  amidst  the  illu- 
sions of  the  great,  being  reduced  in  her  circumstances,  to  the  income  of  a 
moderate  fortune,  spent  her  time  in  the  country,  and  enjoyed  excellent  health, 
notwithstanding  her  advanced  age.  In  consequence  of  the  events  of  1830, 
this  lady  is  taken  with  erotomania.  The  object  of  her  love  is  a  young  man, 
who  has  taken  an  active  part  in  the  aftairs  of  this  period.  She  believes  that 
she  is  beloved,  assures  herself  that  her  menses  are  again  established,  makes 
her  toilet  with  much  display,  awaits  her  lover  at  the  rendezvous,  causes  food 
to  be  prepared  which  she  herself  carries  to  the  field,  persuaded  that  the  ob- 
ject of  her  attachment  will  come  to  partake  of  it  with  her.  She  hears  him 
address  her,  she  converses  with  him,  sees  him,  and  seeks  for  him  everywhere. 
After  some  months,  her  brain  becomes  progressively  enfeebled ;  and  in  one 
year  after  the  manifestation  of  delirium,  she  sinks  into  dementia.  She  con- 
verses alone,  and  in  a  low  tone  ;  often  proiwuncing  the  name  of  the  object  of 
her  delirium. 

Mad'e  de  L.,  of  a  nervous-sanguine  temperament,  a  very  vivid  imagination, 
and  educated  on  philosophical  principles  ;  having  a  decided  taste  for  the  read- 
ing of  medical  writings  and  romances,  enjoyed  excellent  health,  although  very 
nervous  and  impressible.  Reduced  almost  to  penury  by  the  revolution,  which 
cost  her  husband  his  life  upon  the  scaffold,  she  was  constrained  to  form  an 
establishment,  to  complete  her  means  of  subsistence,  and  secure  a  livelihood 
for  her  son,  who  only  knew  how  to  write  bad  verses. 

She  receives  into  her  house  a  student  of  medicine,  twenty-three  years  of 
age.  She  is  at  first  well  disposed  towards  this  young  man,  but  soon  becomes 
prodigal  of  her  attentions  to  him,  and  her  civilities  are  exaggerated.  At  a 
later  period,  her  carriage,  her  agitation,  her  impatience,  her  gayety  and  sad- 
ness, her  thoughtless  complaints,  and  ridiculous  expenditures,  betray  the  mo- 


MONOMANIA.  341 

ral  disorder  under  which  this  lady  now  labors,  at  the  age  of  sixty-four  years. 
This  young  man, — though  he  little  merits  it, — is  ever  the  subject  of  her  praise. 
She  contemplates  his  future  prospects,  his  successes  and  disappointments, 
more  than  her  own  affairs.  The  crosses  and  rude  conduct ;  the  evident 
causes  of  jealousy,  and  the  indifference  of  the  young  student,  who  ridicules 
the  attachment  of  this  superannuated  female  ;  the  warnings  and  advice  of  her 
devoted  friends  ;  the  railery  of  persons  who  dwell  in  the  house,  and  the  coarse 
pleasantries  of  the  domestics  ;  all  fail  to  bring  back  her  lost  reason,  though, 
in  every  other  respect,  she  enjoys  the  respect  of  society,  and  performs  with 
spirit  and  propriety  the  honors  of  her  house.  However,  she  does  not  sleep ; 
her  appetite  is  poor  ;  and  she  becomes  emaciated.  Never  did  she  entertain 
the  thought  of  seeking  happiness  from  the  pleasures  of  sense.  At  the  expi- 
ration of  two  years,  this  student  deserts  the  house  ;  but  this  does  not  unde- 
ceive her.  She  not  only  excuses  his  clandestine  flight,  but  the  serious  wrongs 
and  baseness  which  it  reveals.  She  loves  still.  She  remains  for  several 
months,  very  much  depressed  in  mind,  and  at  length  falls  into  a  state  of  com- 
plete wretchedness,  and  dies  eight  years  subsequently,  from  a  cancer  of  the 
uterus. 

This  case  presents  a  remarkable  feature  ;  since,  at  the  age  of  sixty-four 
years,  when  the  erotic  affection  burst  forth,  the  patient  menstruated  regularly 
and  abundantly  for  two  years  ;  experiencing  no  interruption  of  the  menses, 
but  from  the  grief  which  she  suffered,  in  consequence  of  the  departure  of  the 
student.  Was  the  cancer  of  the  uterus,  the  effect  of  the  cessation  of  this  late 
menstruation  ;  or  rather,  was  the  nervous  irritation  of  the  uterus,  which  so 
often  precedes  organic  lesions,  the  prime  cause  of  the  erotic  delirium '? 

We  have  just  related  cases,  which  prove  that  if  erotomania  is  most  frequent 
among  the  wealthy  classes,  and  the  inhabitants  of  cities,  whose  education  and 
mode  of  life  exalt  the  imagination,  it  spares  not  the  poor,  nor  the  inhabitants 
of  the  country.  Moreover,  if  this  form  of  madness  is  most  frequently  observ- 
ed among  the  young ;  the  cases  which  precede,  demonstrate  that  it  affects 
also,  persons  of  an  advanced  age. 

Erotomania,  like  all  forms  of  monomania,  may  degenerate.  The  delirium 
may  extend  to  a  greater  number  of  ideas.  It  may  become  general  ;  and  with 
the  progress  of  age,  terminate  in  dementia  ;  in  which  we  again  discover  the 
first  elements  of  the  intellectual  and  moral  disorder,  which  characterized  the 
commencement  of  the  disease.  We  have  often  observed  this  in  the  hospitals 
of  the  Salpetriere  and  Charenton,  among  women  who  had  been  affected  pri- 
marily with  chronic  erotomania,  but  are  now  in  a  state  of  incurable  dementia. 
Erotomania  cannot  be  confounded  with  hysterical  madness.  In  the  latter 
form,  the  amorous  ideas  extend  to  whatever  objects  are  calculated  to  excite 
the  nervous  system  ;  whilst  in  erotic  mania,  the  affections  take  the  character 
of  monomania  ;  that  is  to  say,  they  are  fixed  and  concentrated  upon  a  single 
object.  Erotomania  has  been  particularly  noticed  among  all  people.  The 
ancients,  who  deified  love,  regarded  this  disease  as  one  of  the  forms  of  re- 
venge, which  Cupid  and  his  mother  were  accustomed  to  take.  Galen  affirms, 
that  love  is  the  cause  of  the  greatest  physical  and  moral  disorders.  Both 
philosophers  and  poets  have  described  them,  and  physicians  of  every  age 
have  made  them  conspicuous.  Erotic  delirium  spares  no  one  ;  neither  the 
wise  nor  foolish.  Aristotle  burns  incense  to  his  wife.  Lucretia,  made  amo- 
rous by  a  philter,  destroys  herself  Tasso  breathes  forth  his  love  and  despair 
for  fourteen  years.  Cervantes  has  given  the  most  varied  description  of  this 
disease,  which  prevailed  almost  as  an  epidemic  in  his  time,  and  was  modified 
by  the  chivalrous  manners  of  the  fourteenth  century.  In  the  case  of  Heloise 
and  Abailard,  the  erotomania  associates  itself  with  the  religious  sentiments 
which  prevail   at  the  period  during  which  they  lived  ;  whilst  in  Nina,  eroto- 


342  MONOMANIA. 

mania  is  represented  in  dull,  spiritless  colors,  in  conformity  with  the  relaxed 
manners  of  modern  times. 

The  causes  of  erotomania  are  the  same  with  monomania  in  general.  Al- 
though this  disease  appears  even  in  advanced  age,  nevertheless,  it  most  fre- 
quently affects  young  people,  especially  those  of  a  nervous  temperament,  a 
lively  and  ardent  imagination,  and  who  are  led  away  by  the  allurements  of 
pleasures.  It  affects  those  also,  who  lead  a  life  of  indolence,  and  exalt  the 
imagination  by  reading  romances,  and  have  received  a  voluptuous  and  effemi- 
nate education.  Masturbation,  by  increasing  the  susceptibility  of  the  nervous 
system  ;  and  continence,  by  provoking  its  inordinate  activity,  also  predispose 
to  erotic  delirium.  Where  is  the  seat  of  erotomania  ?  We  have  already  said, 
that  it  is  in  the  head.  Is  the  cerebrum  or  cerebellum  the  part  affected  1  On 
this  point,  we  admit  our  ignorance ;  we  know  nothing  respecting  it.  It  is  suf- 
ficient for  us,  having  learned  that  this  disease  constitutes  a  true  alteration  of 
the  sensibility  and  thinking  principle,  to  conclude  that  there  is  a  lesion  of 
the  encephalon.  We  know  nothing  beyond  this.  In  what  does  this  lesion 
consist  1     We  do  not  know. 

Erotomania,  being  a  disease  essentially  cerebral,  should  be  treated  like 
other  cerebral  affections.  When  amorous  sentiments  affect  the  nutritive  func- 
tions, and  threaten  the  life  of  the  patient,  marriage  is  almost  the  only  effica- 
cious remedy.  It  is  in  this,  as  in  nostalgia  ;  it  is  only  the  accomplishment  of 
the  desires  of  the  patient,  that  can  cure  him.  When  erotic  fever  declares  it- 
self, when  sadness  is  extreme,  when  the  cause  of  his  pining  away  is  conceal- 
ed, skill  and  address  are  necessary  to  discover  it;  for,  once  known,  an  im- 
portant step  towards  a  cure  is  attained.  If  a  way  still  remains  accessible  to 
the  heart  of  the  patient,  we  should  place  near  him  a  person  whose  qualities 
and  attentions  weaken  the  impressions  made  by  the  object  beloved.  A  new 
impression  may  destroy  the  first.  When  the  object  of  the  passion  is  imagina- 
ry, and  marriage  is  impossible,  we  have  recourse  to  means  adapted  to  modify 
the  susceptibility.  Prolonged  tepid  baths,  diluent  drinks,  whey  in  combina- 
tion with  nitre,  ass'  milk,  succory,  (cichorium  intybus),  together  with  a  vege- 
table regimen,  are  preferable  to  antispasmodics,  which  often  increase  the  flame, 
rather  than  extinguish  it.  In  some  cases,  tonics  are  useful,  if  debilitating 
causes  have  predisposed  to  the  malady,  or  provoked  it.  We  must  not  fail  to 
combat  the  pathological  causes,  nor  lose  sight  of  the  fact,  that  in  an  erotic 
fever,  as  Lorry  remarked,  there  is  always  a  sort  of  erethysm  of  the  organs  of 
generation.  Hence,  cold  baths,  the  sitting  baths,  cold  enemata,  etc.,  will  be 
useful.  Isolation,  diversions,  journeys,  exercise  and  manual  labor,  powerfully 
concur  in  the  success  of  the  treatment.  Moral  shocks,  as  the  success  attend- 
ing the  leap  at  Leucadia  demonstrates,  produce  a  general  impression,  which  is 
useful  in  erotomania,  as  well  as  in  other  varieties  of  monomania. 


REASONING  MONOMANIA, 

I  have  already  remarked,  that  there  are  monomaniacs  who  are  not  irrational, 
whose  ideas  maintain  their  natural  connection,  whose  reasonings  are  logical, 
and  whose  discourses  are  connected,  often  spirited  and  intellectual.  But  the 
actions  of  these  patients  are  contrary  to  their  natural  affections,  to  their  inte- 
rests, and  to  social  usages.  They  are  irrational  in  this  sense  ;  that  they  are 
in  opposition  to  their  own,  and  the  habits  of  those  with  whom  they  live. 
However  disordered  their  actions  may  be,  these  demonomaniacs  have  always 
motives  more  or  less  plausible  to  justify  themselves,  so  that  we  can  say  of  them, 
that  they  are  reasonable  madmen. 

In  reasoning  monomania,  the  patients  are  active,  and  constantly  in  motion  ; 


MONOMANIA.  343 

converse  much,  and  with  vivacity.  They  were  amiable,  frank,  generous;  they 
have  become  peevish,  deceitful,  wicked.  They  were  full  of  affection  and  ten- 
derness towards  their  relatives  ;  they  are  now  discontented,  and  speak  evil  of 
those  they  once  loved,  and  fly  from  them.  They  were  provident ;  they  are 
now  profuse.  Their  actions  were  regular  ;  they  are  now  inconsiderate,  adven- 
turous, and  even  reprehensible.  Their  conduct  was  suited  to  their  state  and 
social  condition  ;  it  is  now  irregular,  and  in  no  respect  suited  to  their  position 
and  fortune.  Motives  always  determine  them.  By  their  deportment  and  con- 
versation, these  persons  impose  upon  those  who  were  not  acquainted  with  them 
previous  to  their  illness,  or  who  see  them  for  a  brief  period  only  ;  so  well  do 
they  know  how  to  restrain  themselves  and  to  deceive. 

Pinel*  relates  the  following  case  :  "  Profound  ignorance,  as  well  as  an  ill- 
directed  education,  or  a  perverse  and  ungovernable  nature,  may  produce  the 
lighter  shades  of  this  form  of  mental  alienation.  An  only  son,  reared  under 
the  eye  of  a  feeble  and  indulgent  mother,  becomes  accustomed  to  yield  to  all 
his  caprices,  and  all  the  inclinations  of  a  fiery  and  lawless  nature.  The 
impetuosity  of  his  desires  increase,  and  become  fortified  by  age  ;  while  mo- 
ney, which  is  lavishly  furnished,  seems  to  remove  every  obstacle  to  the  supre- 
macy of  his  will.  Does  any  one  resist  him,  his  temper  becomes  exasperated ; 
he  assaults  with  boldness,  and  seeks  to  rule  by  force.  He  lives  amidst  conti- 
nual conflicts  and  strife.  If  any  animal,  a  sheep,  dog  or  horse,  vex  him  ;  he 
kills  it  at  once.  Is  he  at  a  meeting  of  any  sort,  or  a  festival,  he  flies  into  a 
passion,  gives  and  receives  blows,  and  goes  away  covered  with  blood.  On 
the  other  hand,  the  possessor  at  adult  age,  of  a  large  fortune,  he  manages  it 
in  a  proper  manner,  discharges  his  other  duties  towards  society,  and  renders 
himself  conspicuous  even,  by  acts  of  beneficence.  He  falls  into  a  passion 
one  day,  with  a  woman  who  insulted  him,  and  throws  her  into  a  well." 

Mad'e,  twenty-three  years  of  age,  married  four  years  since,  of  a  nervous- 
sanguine  temperament,  of  great  susceptibility,  and  a  lively,  cheerful  disposi- 
tion, experiences  some  slight  difiiculties.  Her  imagination  becomes  excited, 
and  she,  who  was  mild,  good,  faithful  to  her  husband,  devoted  to  her  child, 
and  very  watchful  over  her  household,  becomes  irritable  ;  and  a  word  arouses 
her  passion,  or  melts  her  to  tears.  She  neglects  her  husband,  because  he  op- 
poses her  ;  and  forsakes  her  infant,  because  business  of  importance  calls  her 
abroad.  In  her  house,  she  throws  every  thing  into  confusion,  because  it  is 
foul  and  disordered,  and  it  is  time  that  order  and  neatnesss  should  prevail. 
She  speaks  to  the  first  that  enters,  against  her  husband,  and  accuses  him  of 
a  thousand  faults  of  which  he  is  not  guilty.  Thoughtless  in  her  discourse, 
she  reveals  secrets,  which  a  woman  usually  keeps  concealed.  Imprudent  in 
her  movements,  she  exposes  herself  to  unwarrantable  suspicions,  and  if  her 
husband  or  relatives  desire  to  make  any  representations  to  her,  she  gets  angry 
and  pretends  that  they  calumniate  her.  She  suffers  from  frequent  pains  in  her 
head,  insomnia  and  constipation.  The  menses  are  scanty,  and  habitual  colics 
are  more  severe  at  the  menstrual  periods,  and  some  hysterical  symptoms  also 
complicate  this  condition. 

She  is  committed  to  my  care,  and  is,  at  first,  very  much  composed  and  ra- 
tional, complaining  little  of  her  family,  who  persist  in  believing  her  ill.  But 
when  the  first  impression  of  isolation  has  ceased,  and  she  has  become  familiar 
with  her  new  habitation  and  associates,  her  diseased  activity  is  renewed.  She 
puts  every  thing  in  her  apartment  in  disorder,  and  is  constantly  displacing  the 
articles  which  furnish  it.  She  is  dissatisfied,  complains  of  every  thing,  and 
relates  to  one  and  another,  a  thousand  falsehoods  and  calumnies;  seeking  to 
disseminate  feelings  of  discontent,  misunderstanding  and  disorder.  It  would 
seem  as  if  the  demon  of  evil  inspired  the  words  and  acts  of  this  patient.     Do 

*  MedicO' Philosophical  Treatise  on  Mental  Alienation,  Paris,  1809,  in  8vo.  p.  150. 


344  MONOMANIA. 

we  demonstrate  to  her  that  she  is  in  an  error,  that  what  she  says  is  false,  and 
that  what  she  does  is  not  right;  she  tries  to  justify  herself,  and  is  silent  or 
angry.  If,  however,  she  is  in  society,  she  fashions  her  looks  with  so  much 
care,  that  the  best  informed  would  regard  her  as  very  well.  She  takes  part 
in  the  conversation,  flatters,  and  makes  friendly  remarks  to  those  concerning 
whom  she  had  spoken  unkindly  in  the  morning  or  evening  previous.  She 
promises  no  more  to  disarrange  her  furniture,  and  to  put  in  order  those  arti- 
cles of  her  toilet  which  she  uses.  On  the  following  morninw,  the  same  scenes, 
conversations  and  disorders,  are  renewed.  Tepid  baths  prolonged,  laxatives, 
and  a  little  before  the  menstrual  periods,  sitting  baths,  with  the  infusion  of 
camomile,  and  some  leeches,  to  make  up  for  the  deficient  menstrual  flux,  are 
the  remedies  employed.  After  the  expiration  of  three  months,  during  which 
we  employ  a  few  baths  of  repression,  the  menses  flow  abundantly.  Sleep  is 
better,  and  she  is  more  composed.  The  same  attentions  continued,  together 
with  a  severe  repression,  renewed  if  necessary,  when  the  actions  of  the  pa- 
tient are  too  eccentric,  and  her  discourse  highly  improper  ;  at  length  effect  a 
cure,  after  six  months'  treatment. 

Mad'e  C,  tall,  of  a  nervous  temperament  and  warm  imagination,  has  al- 
ways enjoyed  excellent  health.  A  tender  wife  and  excellent  mother,  she  is 
much  engrossed  with  her  household  and  commercial  affairs.  When  forty-one 
years  of  age,  she  loses  one  of  her  children,  is  profoundly  affected  by  it,  and 
some  days  afterwards,  to  sadness  succeeds  agitation,  her  imagination  becomes 
excited,  her  susceptibility  more  acute,  and  her  affections,  tastes  and  habits, 
change.  Soon  after,  she  becomes  more  active,  thinks  she  possesses  a  superior 
understanding,  and  is  a  victim  to  the  ignorance  of  her  husband  ;  who,  know- 
ing nothing  of  business,  would  have  been  ruined  without  her.  She  opposes 
her  husband,  insults  him,  and  at  length  conceives  an  aversion  for  him.  She 
neglects  her  affairs,  her  children  and  household.  She  is  running  about  every 
where,  wearying  all,  by  her  loquacity  and  pretensions.  She  repeats  her  com- 
plaints, even  to  strangers ;  as  well  as  her  projects  and  expectations.  Dissatis- 
fied with  every  thing,  she  wishes  to  make  a  clean  house,  and  displaces  all  her 
furniture,  makes  extravagant,  and  even  ridiculous  expenditures,  entertains  an 
increasing  dislike  towards  her  husband,  and  wishes  to  desert  the  conjugal 
mansion. 

She  is  committed  to  my  care  in  June,  1822.  Mad'e  C.  is  constantly  in 
motion  ;  constantly  speaking  of  herself,  of  her  mind  and  capacity.  She  re- 
criminates all  others,  and  particularly  her  husband.  Every  thing  displeases 
her,  both  persons  and  inanimate  objects.  Her  vanity,  and  the  perversion  of 
her  affections,  the  change  of  her  disposition  and  habits,  are  allied  to  a  sem- 
blance of  reason,  which  imposes  upon  those  who  see  and  hear  her  for  the  first 
time,  and  for  a  few  moments  only  ;  as  she  has  ever  motives  more  or  less  spe- 
cious, to  justify  her  sentiments,  conversation  and  acts.  She  does  not  sleep, 
eats  little,  suffers  from  constipation,  and  complains  of  no  pain.  There  is 
something  convulsive  in  her  physiognomy,  and  the  aspect  of  her  countenance. 
Convinced  that  she  enjoys  perfect  health,  she  refuses  all  medicine,  isolation 
and  the  baths;  and  counsel,  imperfectly  appreciated,  and  unkindly  received, 
has  alone  been  employed.  After  the  lapse  of  two  months,  she  becomes  more 
composed,  sees  her  husband  with  gratification,  and,  although  still  more  active 
than  in  a  state  of  health,  returns  to  her  family,  and  resumes  her  former  ha- 
bits. Since  this  period,  every  year,  about  the  vernal  equinox,  her  excitement 
is  renewed,  and  sometimes  isolation  is  necessary. 

At  the  age  of  forty-nine  years,  she  is  brought  to  Charenton  in  the  month  of 
July,  1830.  At  the  time  of  her  admission,  her  activity  is  excessive,  and  her 
loquacity  exhaustless.  She  fatigues,  by  her  pretensions  to  superiority  of  un- 
derstanding, and  capacity.  She  treats  the  inmates  with  disdain,  as  well  as  the 
officers,  domestics  and  servants  of  the  house.     She  complains  of  all.     She 


MONOMANIA.  345 

accuses  her  husband  of  possessing  a  narrow  understanding,  and  boasts  of 
having  predicted  his  ruin.  Certain  hysterical  notions,  and  jealousy,  blend 
with  these  reproaches.  Drawn  away  by  the  necessity  of  speaking  ill,  she  sup- 
poses wrongs,  evil  designs  and  faults,  and  relates  them  to  one  and  another. 
She  perverts  whatever  comes  to  her  knowledge,  in  order  to  indispose,  irritate, 
and  embroil  among  themselves,  the  people  of  the  house.  Does  she  speak  of 
her  husband,  it  is  with  contempt ;  affecting,  for  his  sake,  a  disdainful  pity. 
She  is  also  indifferent  towards  her  children.  Dissatisfied  with  her  apartment, 
she  often  demands  permission  to  change  it;  displaces  all  the  articles  which 
she  employs,  neglects  attentions  with  respect  to  cleanliness,  and  makes  her 
toilet  imperfectly,  accusing  the  maid-servants  of  negligence.  In  her  insolent 
discourse,  she  spares  no  one,  unless  they  treat  her  with  severity,  and  are  pre- 
pared to  punish  her  errors.  At  the  termination  of  her  attack,  the  patient  is 
peaceful,  renders  justice  to  all  those  whom  she  has  calumniated  during  its 
continuance,  recovers  her  affections,  and  resumes  her  regular  habits,  both  with 
respect  to  conduct  and  language. 

In  the  month  of  June,  1835,  when  fifty-four  years  of  age,  she  is  again  ad- 
mitted at  Charenton.  At  the  commencement  of  this  attack,  she  abandons 
herself  to  graver  errors  than  in  the  preceding  ones.  She  is  less  agitated  than 
during  her  first  residence  in  the  establishment,  but  is  more  deceitful,  in  the 
hope  of  more  promptly  securing  her  liberty.  She  writes  to  the  prefect  of 
police,  to  magistrates  and  lawyers,  letters  so  methodically  drawn  up,  as  to 
deceive  the  persons  to  whom  they  were  addressed  ;  a  circumstance  which  im- 
poses upon  me  the  necessity  of  making  out  certificates,  giving  an  account  of  the 
mental  condition  of  this  lady,  and  the  change  in  her  affections  and  disposi- 
tion, in  addition  to  the  disorder  with  respect  to  her  language  and  actions. 
Anomalies  of  menstruation  have  in  no  way  modified  her  physical  health, 
which  is  good,  excepting  an  abundant  leucorrhoea  and  insomnia.  The  cha- 
racter of  the  delirium  is  similar,  in  all  respects,  to  the  symptoms  observed 
during  the  previous  attacks. 

During  her  seizures,  she  restrains  herself  in  the  presence  of  strangers,  and 
persons  whom  she  wishes  to  convince  of  her  sound  intellectual  and  moral 
health.  She  never  utters  a  word  before  them,  respecting  the  articles  she  has 
displaced,  nor  any  thing  unbecoming.  All  her  conversation  and  actions  are 
under  the  control  of  motives.  She  overwhelms  with  taunts  and  disdain,  those 
whom  she  regards  as  feeble ;  but  yields,  so  soon  as  they  offer  an  energetic  re- 
sistance. She  dissembles,  and  has  recourse  to  falsehood,  the  better  to  deceive, 
and  more  securely  accomplish  her  purposes.  She  spreads  abroad  discontent, 
insubordination  and  disorder.  She  has  been  a  real  scourge,  in  the  various 
establishments  in  which  she  has  been  placed,  since  her  first  attack.  The 
functions  of  organic  life  have  never  been  appreciably  changed,  and  after  each 
attack,  on  recovering  her  natural  condition,  she  renews  her  excellent  senti- 
ments, and  resumes  her  habit  of  composure,  order,  and  regularity  of  conduct. 

M.  W.,  a  corn-merchant  and  baker,  had  a  mild  and  retiring  disposition, 
was  apt  in  business,  honest,  religious,  regular  in  his  conduct,  and  obliging  to 
every  one.  The  worthy  father  of  a  family,  he  cherished  with  extreme  fond- 
ness, both  his  wife  and  children.  Although  of  a  delicate  constitution,  he  was 
never  sick,  but  avoided  very  violent  exercise,  thinking  that  he  could  not  sup- 
port it.  When  forty-five  years  of  age,  he  met  with  considerable  losses,  which 
affected  him  deeply,  and  permitted  himself  to  sink  into  discouragement  and 
dejection,  at  the  same  time  that  he  makes  strenuous  efforts  to  triumph  over 
this  misfortune,  and  recover  his  former  position.  After  some  time,  he  obtains 
a  recompense  for  his  labors.  It  was  not  long  after  this  period,  that  his  friends 
remarked,  that  his  spirits  were  unusually  elevated.  He  extended  the  circle 
of  his  business,  for  which  he  manifests  a  greater  capacity  than  formerly.     He 

44 


346  MONOMANIA. 

exercised  greater  skill  in  his  purchases  and  sales,  and  never  permitted  an  op- 
portunity for  a  lucrative  operation  to  escape  him.  He  made  longer  and  more 
frequent  journeys,  and  neglected  the  religious  duties  of  the  Sabbath.  The 
effort,  both  of  body  and  mind,  to  which  he  subjected  himself,  alarmed  his 
friends. 

Some  months  subsequent  to  this  change  in  his  habits,  his  relatives  desired 
to  represent  to  him,  that  his  long  journeys,  made  with  reference  to  uncertain 
enterprises,  prevented  him  from  occuj)ying  himself  with  his  affairs  at  home, 
which  were  more  sure,  and  more  advantageous.  He  assumed  an  imperious 
tone,  and  expressed  sentiments  which  he  had  never  before  entertained.  Still 
there  was  no  lesion  of  his  understanding.  In  vain  do  they  repeat,  that  he 
exposes  himself  to  the  danger  of  compromising  his  fortune  a  second  time,  and 
of  impairing  his  health.  His  disposition  has  become  irascible  and  imperious ; 
and  he  can  no  longer  endure  the  slightest  contradiction.  The  smallest  obsta- 
cle to  the  accomplishment  of  his  projects,  irritates  him.  Nevertheless,  he  con- 
tinues the  same  way  of  life  for  ten  months,  when  a  great  change  takes  place 
in  his  sentiments  towards  his  family.  He  no  longer  remains  with  his  wife  and 
children ;  eulogizes  whatever  he  sees  elsewhere,  and  finds  fault  with  whatever 
transpires  in  his  own  house.  His  own,  are  less  intellectual  than  the  children 
of  his  neighbors,  and  his  wife  is  less  orderly  in  her  household  arrangements, 
than  other  women.  He  begins  to  partake  of  strong  drinks,  contrary  to  his 
habits ;  offering  as  an  apology,  his  engrossing  occupations  and  fatigues.  He 
associates  with  strange  women,  which  provokes  a  violent  crisis,  on  his  wife's 
venturing  certain  expostulations.  He  becomes  irritated,  and  defends  himself 
with  much  warmth;  utters  very  serious  menaces,  quits  his  house,  abandons 
his  family  and  business,  and  goes  into  the  country ;  sleeping  during  the  day, 
and  doing  scarcely  any  thing. 

Committed  to  the  care  of  Doctor  Hitch,  this  physician  observed,  that  his 
countenance  was  animated,  his  eyes  lively  and  changeful,  his  look  uncertain 
and  restless;  head  hot,  and  hair  harsh;  tongue  loaded;  stools  unfrequent ; 
the  extremities  of  the  limbs  cold  ;  the  skin  of  the  hands  of  a  softness,  -pecu- 
liar to  nervous  persons  ;  pulse  full  and  tense.  The  patient  was  very  active, 
often  changed  his  place,  and  disturbed  the  furniture  of  his  apartment ;  formed 
projects;  speculated;  and  purposed  to  make  long  journeys.  He  was  inces- 
santly talking,  yet  his  conversation  was  rational,  nor  did  he  employ  any  male- 
volent expression,  not  even  against  his  relatives  or  friends.  However,  he  ap- 
peared more  than  usually  agitated,  when  the  conversation  turned  upon  his  wife 
and  children.  He  was  well  aware  that  he  was  in  a  hospital,  knew  the  cause 
of  it,  and  manifested  a  dislike  towards  no  one.  He  felt  that  within  some 
months,  a  great  change  had  taken  place  in  him,  but  that  his  physical  health 
had  improved.  He  admitted  the  strangeness  of  his  conduct  towards  his  fami- 
ly and  relatives,  without  either  approving  or  censuring  it.  He  was  accustom- 
ed to  speak  with  much  good  sense,  of  his  business;  but  if  at  liberty,  would 
have  expended  his  money,  for  at  least  useless  acquisitions.  Did  he  converse 
with  any  one,  he  gave  the  most  minute  account  of  his  actions,  without  mistak- 
ing with  respect  to  dates  ;  but,  by  himself,  both  his  language  and  conduct  were 
absurd. 

This  case,  which  was  reported  by  Dr.  Prichard,  is  remarkable  for  the  pro- 
gressive change,  first  of  the  habits,  and  afterwards  of  the  affections  of  the  pa- 
tient. After  his  restoration  to  health,  he  remarked  to  his  physician,  that  the 
idea  of  his  insanity  presented  itself  to  his  mind,  the  moment  he  entered  the 
establishment,  under  the  direction  of  Doctor  Hitch. 

One  of  my  friends,  of  a  sanguine  temperament,  says  Dr.  Hitch,  possessed 
a  lively  imagination,  great  sensibility,  and  very  elevated  sentiments.  He  was 
distinguished  at  the  bar,  but  was  exceedingly  impatient,  often  fell  into  a  pas- 


MONOMANIA.  347 

sion  during  a  discussion,  and  became  violent  when  opposed.  He  received  a 
public  affront,  from  persons  who  were  greatly  indebted  to  him ;  an  event 
which  embittered  the  remainder  of  his  existence.  Although  of  a  mild  and 
generous  disposition,  he  always  retained  a  resentment  against  the  persons  who 
had  injured  him;  sought  every  opportunity  to  thwart  their  plans,  and  to  beset 
their  path  with  difficulties.  Did  he  meet  them  in  society,  their  name  alone 
was  sufficient  to  make  him  redden.  He  frowned,  and  his  physiognomy  ex- 
pressed the  agitation  of  his  mind.  Two  years  afterwards,  he  had  not  succeed- 
ed in  controlling  these  sentiments,  and  died  of  an  apoplectic  attack.  Durino- 
the  two  years  that  this  disorder  lasted,  the  patient  suffered  from  sudden  attacks 
of  headache,  succeeded  by  convulsions.  There  was  never  any  lesion  of  the 
understanding,  and  he  was  accustomed  to  admit,  that  the  feelings  of  aversion 
which  controlled  him,  were  entirely  opposed  to  his  religious  principles,  but 
that  he  could  not  surmount  them. 

An  intelligent  and  prudent  merchant,  enjoyed  the  perfect  use  of  his  reason, 
until  the  age  of  forty-six  years.  He  had,  at  this  period,  amassed  a  considera- 
ble fortune ;  the  fruit  of  his  own  industry.  He  loves  his  wife,  and  becomes 
progressively  so  avaricious,  as  to  deny  himself  articles  the  most  necessary  to 
the  maintenance  of  life,  and  falls  sick  for  want  of  sufficient  nourishment.  He 
was  frightfully  emaciated,  and  his  body  covered  with  an  eruption.  The  sick 
man  dwelt  in  a  filthy  and  miserable  chamber,  permitting  himself  to  want  for 
every  thing.  Before  leaving  this  chamber,  from  which  he  had  not  gone  for  a 
long  time,  this  wretched  being  fixed  his  eyes  upon  an  old  coffer,  which  occu- 
pied a  corner  of  his  lodgings,  in  which  were  found  bank  notes  for  a  conside- 
rable sum.  This  patient,  was  rapidly  restored  in  a  hospital,  where  he  breathed 
a  pure  air,  was  well  nourished,  and  took  exercise.  A  few  days  after  being  set 
at  liberty,  he  married.  After  a  few  months  however,  his  new  wife  was  unable 
to  endure  the  caprices  of  her  husband,  who,  it  was  perceived,  was  afflicted 
with  mental  alienation.  In  fact,  his  understanding  had  undergone  a  complete 
change.  This  patient,  at  first  manifested  only  a  change  in  his  moral  habits, 
characterized  by  such  a  degree  of  avarice,  that  he  refused  himself  the  neces- 
saries of  life.  At  a  later  period,  the  severity  of  the  disease  increased ;  the 
symptoms  no  longer  permitting  an  intellectual  form  of  insanity  to  be  mis- 
tciken. 

M.,  the  son  of  a  merchant,  received  a  good  education,  and  was  regarded  as 
a  highly  respectable  scholar.  He  had,  however,  so  great  a  distrust  of  himself, 
that  he  feared  to  recite  his  lessons ;  believing  that  he  did  not  know  them. 
His  education  completed,  he  commenced  business  with  his  father,  who  assign- 
ed him  a  handsome  allowance.  He  seemed  to  enjoy  himself,  when  he  unex- 
pectedly announced  to  his  father  that  he  no  longer  wished  to  deceive  him  ; 
that  he  felt  that  he  had  not  the  capacity  necessary  to  fulfil  his  duties,  and  that 
he  was  injuring  the  business.  The  contrary  however,  was  true.  The  rela- 
tives of  this  young  man  exerted  themselves  to  inspire  him  with  confidence ; 
but  he  was  accustomed  to  reply ;  "  My  brother  has  more  talent  than  myself. 
I  shall  never  fulfil,  in  a  proper  manner,  the  engagements  connected  with  my 
employment."  His  father,  who  was  a  man  of  judgment,  proposed  to  his  son 
a  change  of  residence  and  occupation;  and  sent  him  to  Manchester  to  make 
some  large  purchases.  The  latter  fulfilled  his  mission  most  successfully.  He 
soon  however  relapses  into  his  former  self-distrust,  and  complains  anew  of  his 
incapacity,  on  resuming  his  former  occupations.  The  same  fears  of  injurino- 
the  business  of  his  father  revived ;  he  renounced  the  advantages  of  home,  and 
departed  secretly  for  Liverpool,  with  the  intention  of  embarking  for  America. 
Unable  to  accomplish  his  purpose,  he  was  compelled  to  return  to  his  family. 
Soon  after,  he  made  a  new  attempt  at  evasion.  On  being  reinstated  in  his  fa- 
ther's house,  he  poisoned  himself     At  length,  on  being  committed  to  the  care 


348  MONOMANIA. 

of  Dr.  Hitch,  the  latter  recognized  in  the  patient,  a  man  well  adapted  for 
business,  intelligent,  active,  prudent;  acquainted  with  merchandise,  a  good 
accountant,  and  possessing  an  excellent  judgment.  Three  months  suffice  to 
restore  this  young  man  to  such  a  measure  of  health,  as  to  enable  him  to  return 
to  his  family ;  where,  for  a  year,  he  engaged  in  business  in  a  very  satisfactory 
manner.  He  then,  once  more  lost  all  confidence  in  his  capacity,  and  left  his 
relatives ;  since  which  period,  he  has  several  times  absented  himself  from 
home.  They  permitted  him  to  gratify  his  caprices,  with  respect  to  changes 
of  place,  when  suddenly,  his  feelings  became  materially  altered.  He  avoided 
his  father,  addressed  him  hastily,  and  conversed  with  him  only  in  an  angry 
manner.     He  was  also  suspicious  of  the  other  members  of  his  family. 

The  four  preceding  cases  are  borrowed  from  the  work  of  Doctor  Prichard, 
who  reports  them  as  examples  of  moral  insanity.  This  learned  coadjutor, 
who  published  in  1822  an  excellent  work  on  diseases  of  the  nervous  system,* 
has  since  enriched  science,  with  the  most  complete  work  we  now  possess  on 
mental  diseases. t  This  skillful  physician,  by  means  of  a  series  of  very  inte- 
resting observations,  has  unfolded  the  signs  of  that  variety  of  partial  delirium, 
in  which  the  disposition,  habits  and  affections  of  the  sick,  undergo  a  change, 
without  being  attended  by  any  lesion  of  the  understanding.  Doct.  Prichard 
has  not,  perhaps,  sufficiently  distinguished  moral  insanity^  from  another  varie- 
ty, which  is  also  exempt  from  disorder  of  the  understanding,  and  which  Pinel 
denominates  mania  without  delirium,  and  of  which  I  shall  speak  in  the  suc- 
ceeding chapters. 

Mad'lle  F.,  thirty-four  years  of  age,  is  tall,  with  auburn  hair,  blue  eyes, 
flushed  face,  and  sanguine  temperament.  She  is  of  a  gay  disposition,  and 
mild  temper.  Trained  to  a  knowledge  of  commercial  affairs  from  her  earliest 
youth,  she  feared  to  wrong  others.  At  a  later  period,  whenever  she  made  out 
an  account,  she  feared  lest  she  might  be  deceived,  to  the  prejudice  of  those, 
with  reference  to  whom  the  account  was  made.  She  was  accustomed  to 
make  frequent  visits  at  the  house  of  her  aunt,  without  her  hat,  and  with  an 
apron  which  she  was  accustomed  habitually  to  wear.  One  day,  at  the  age  of 
eighteen,  without  any  known  cause,  on  going  out  of  the  house  of  her  aunt, 
she  is  seized  with  disquietude,  lest  she  might  unintentionally  carry  away  in  her 
apron,  something  belonging  to  her  relative.  From  henceforth,  she  makes  her 
visits,  without  wearing  her  apron.  At  a  later  period,  she  spends  much  time 
in  completing  the  accounts  and  invoices,  being  apprehensive  of  committing 
some  error  ;  of  substituting  one  figure  for  another  ;  and  consequently,  of 
wronging  purchasers.  Later  still,  she  fears  that  by  handling  money,  she  shall 
retain  something  of  value  in  her  fingers.  In  vain  do  they  object,  that  she  can- 
not retain  a  piece  of  money  without  perceiving  it,  and  that  the  contact  of  her 
fingers  cannot  alter  the  value  of  the  money  which  she  touches.  That  is  true, 
she  replies,  my  disquietude  is  absurd  and  ridiculous,  but  I  cannot  prevent  it. 
I  must  lay  aside  business.  Her  apprehensions  gradually  augment,  and  be- 
come general.  When  she  places  her  hands  upon  any  thing,  her  disquietudes 
are  renewed,  and  she  washes  her  hands  in  much  water.  When  her  garments 
rub  acrainst  any  object  whatever,  she  is  disquieted  and  tormented.  Is  she 
abroad  ?  Her  whole  .attention  is  engrossed  in  her  endeavors  to  touch  nothing, 
either  with  her  hands  or  her  clothing.  She  also  contracts  a  singular  habit. 
Whenever  she  touches  any  thing  ;  whenever  her  garments  have  been  in  con- 
tact with  a  piece  of  furniture,  or  any  other  object ;  when  any  one  enters  her 
apartment,  or  she  herself  makes  a  visit ;  she  shakes  her  hands  rapidly ;  and 

*  A  Treatise  on  Diseases  of  the  Xenons  System,  London,  1822,  in  8vo. 

t  Treatise  on  Insanity,  and  other  Disorders  affecting  the  Mind,  London,  1835,  in  8vo. 


MONOMANIA.  349 

rubs  the  fingers  of  either  hand  with  each  other,  as  if  endeavoring  to  remove 
some  very  subtle  substance  from  beneath  the  nails.  This  singular  movement 
is  renewed  every  moment  of  the  day,  and  on  all  occasions.  Does  she  wish  to 
pass  from  one  apartment  to  another?  She  hesitates,  and  while  hesitating,  takes 
every  possible  precaution  to  prevent  her  dress  from  touching  either  the  doors, 
walls  or  furniture.  She  is  extremely  cautious  with  respect  to  opening  doors, 
windows,  ward-robes,  etc :  something  valuable  might  be  attached  to  the  keys, 
or  knobs  which  serve  to  open  them,  and  remain  upon  her  hands.  Before  sit- 
ting down,  she  examines  her  seat  with  the  greatest  care,  and  shakes  it  even, 
if  it  be  movable,  to  be  certain  that  nothing  precious  attaches  itself  to  her 
garments.  She  cuts  off  the  hems  of  her  linen  and  dresses,  for  fear  that  some- 
thing might  be  concealed  in  them.  Her  shoes  are  so  tight,  that  the  skin  ex- 
tends beyond  the  border  of  them,  and  her  feet  swell  and  cause  her  much  suf- 
fering. Her  motive  for  inflicting  this  torture  is,  to  prevent  any  thing  from 
entering  her  shoe.  Her  disquietudes  are  sometimes  during  the  paroxysms 
carried  so  far,  that  she  dares  touch  nothing,  not  even  her  food.  Her  waiting- 
maid  is  obliged  to  carry  her  food  to  her  mouth.  After  many  periods  of  remis- 
sion and  exasperation,  continued  many  ye.ars  ;  after  having  tested  the  inade- 
quacy of  the  advice  of  her  relatives  and  friends,  as  well  as  her  own  reason, 
she  decides  to  come  to  Paris  in  Nov.,  1830.  Isolation,  the  care  of  strangers, 
and  the  efforts  which  she  makes  to  conceal  her  disease,  sensibly  ameliorate 
her  condition,  but  her  sorrow  in  consequence  of  having  left  her  relatives,  and 
her  desire  to  see  them,  determine  her  at  the  expiration  of  two  months  to  re- 
turn to  her  family.  There,  by  degrees,  all  her  disquietude  and  madness  re- 
turn. After  some  months,  she  voluntarily  leaves  the  residence  of  her  parents, 
to  reside  in  the  family  of  a  skillful  physician.  Her  apprehensions  again,  for 
the  most  part  leave  her,  and  also  her  strange  habits.  A  year  has  hardly  pass- 
ed, when  the  same  disquietudes  are  renewed,  as  well  as  the  same  precautions. 
The  paroxysm  lasts  for  eighteen  months.  After  a  year's  remission,  another 
paroxysm  recurs,  and  she  comes  to  commit  herself  to  my  care  at  the  close 
of  the  year  1834.  During  eighteen  months,  scarcely  were  the  movements  of 
her  hands  or  fingers  perceived,  nor  any  of  those  other  precautions  which  she 
had  been  accustomed  to  take.  For  the  last  six  months  however,  (June,  1837), 
the  phenomena  have  returned  with  still  greater  intensity,  and  increased  from 
day  to  day. 

In  order  to  render  this  singular  aberration  more  perfectly  understood,  I  will 
trace  her  manner  of  life  for  a  day.  She  rises  at  six  o'clock,  as  well  summer 
as  winter.  Her  toilet  usually  occupies  her  an  hour  and  a  half,  and  more  than 
three  hours  during  the  period  of  excitement.  Before  leaving  her  bed,  she 
rubs  her  feet  for  ten  minutes,  in  order  to  remove  whatever  may  have  insinu- 
ated itself  between  the  toes  or  beneath  the  nails.  She  afterwards  turns  and 
re-turns  her  slippers,  shakes  them,  and  hands  them  to  her  chamber-maid,  in 
order  that  she,  after  having  carefully  examined  them,  may  assure  her  that  they 
conceal  nothing  of  value.  The  comb  is  passed  through  the  hair  a  great  num- 
ber of  times,  with  the  same  intent.  Every  article  of  her  apparel  is  examined 
successively,  a  great  number  of  times,  inspected  in  every  way,  in  all  the  folds 
and  wrinkles,  and  rigorously  shaken.  After  all  these  precautions,  the  hands 
are  powerfully  shaken  in  turn,  and  the  fingers  of  either  hand  rubbed  by  each 
other.  This  rubbing  of  the  fingers  is  performed  with  extreme  rapidity,  and 
repeated  until  the  number  of  rubbings,  which  is  enumerated  in  a  loud  voice, 
is  sufficient  to  convince  her,  that  nothing  remains  upon  them.  The  close  at- 
tention and  uneasiness  of  the  patient  are  such,  during  this  minute  exploration, 
that  she  perspires,  and  is  almost  exhausted  by  the  fatigue  of  it.  If,  from  any 
cause,  these  precautions  are  not  taken,  she  is  restless  during  the  whole  day. 
Her  chamber-maid,  who  never  leaves  her,  assists  at  this  long  toilet,  to  aid  the 


350  MONOMANIA. 

patient  in  convincing  herself,  that  no  object  of  value  adheres  either  to  her 
clothing  or  fingers.  The  affirmations  of  this  woman  abridge  the  precautions 
as  well  as  the  toilet.  If  they  threaten  to  send  in  a  second  woman,  the  toilet 
is  hastened,  but  the  patient  is  uneasy  during  the  whole  day. 

She  breakfasts  at  ten  o'clock.  Before  commencing  her  repast,  she  examines 
and  shakes  the  napkins,  plates,  tumblers,  decanters  and  knives.  She  also 
shakes  and  rubs  her  fingers,  after  touching  the  various  articles  of  her  service. 
It  IS  the  same  at  dinner.  The  presence  of  strangers  does  not  restrain  her. 
She  eats  with  a  kind  of  eagerness.  Before  retiring  at  night,  she  goes  through 
the  same  precautions,  and  her  evening  toilet  lasts  more  than  an  hour.  During 
the  day,  she  reads,  or  devotes  herself  to  sewing  ;  but  is  very  careful  to  shake 
the  books  and  the  work  before  making  use  of  them  ;  and  also,  to  shake  her 
hands  and  rub  her  fingers,  every  time  she  touches  these  various  articles.  If 
she  happen  to  pass  her  hands  through  her  hair,  over  her  person  or  garments, 
or  place  them  upon  any  object  that  is  near  her,  she  shakes  and  rubs  her 
fingers,  as  I  have  related  above.  She  writes  to  her  family,  to  give  them  an 
account  of  her  condition,  of  what  she  is  doing,  of  her  plans,  and  expectations 
of  a  cure.  Before  commencing  however,  she  shakes  the  paper,  pens  and  ink- 
horn  ;  never  sealing  her  letters  until  her  maid-servant  has  assured  her  that 
there  is  nothing  in  the  folds  of  the  paper.  She  never  unseals  the  letter  which 
she  receives.  During  the  paroxysms,  she  neither  reads,  labors  or  writes,  but 
in  presence  of  her  waiting-woman  ;  and  if  accidentally  alone,  even  in  her 
apartment,  she  does  not  sit  down,  until  the  servant  comes  in,  and  assures  her 
that  there  is  nothing  upon  the  seat,  to  prevent  it. 

She  pays  visits,  but  on  entering,  scrupulously  avoids  touching  any  thing, 
balances  herself  about  her  seat,  examines  and  shakes  it,  accomplishing  all 
this  with  so  much  address,  that  she  is  not  at  first  observed.  Does  she  receive 
visits,  she  approaclies  an  arm-chair,  but  immediately  shakes  and  rubs  her  fin- 
gers. She  makes  journeys  to  her  native  city ;  but  so  arranges  them,  as  to 
arrive  at  a  very  early  hour  in  the  morning,  in  order  to  have  time  to  change  her 
linen  and  other  clothing,  as  well  as  to  wash  herself,  before  embracing  her  rela- 
tives  when  they  rise.  She  is  never  irrational  ;  is  aware  of  her  condition  ;  per- 
ceives the  ridiculous  nature  of  her  apprehensions,  and  the  absurdity  of  her 
precautions  ;  and  laughs  at  and  makes  sport  of  them.  She  also  laments,  and 
sometimes  weeps  in  view  of  them.  She  not  only  makes  efforts  to  conquer 
herself,  but  also  points  out  means,  and  even  very  unpleasant  ones,  which  she 
considers  as  adapted  to  assist  her,  in  overcoming  her  apprehensions  and  pre- 
cautions. She  makes  her  toilet  with  care,  but  without  taste  ;  purchases,  but 
her  waiting-maid  pays  ;  and  she  afterwards  settles  the  account  with  her,  and 
requires  her  to  place  her  money  in  her  secretary  without  touching  it  herself. 
She  is  fond  of  amusement ;  goes  to  the  theatre,  and  visits  public  walks.  She 
makes  parties  for  the  country,  and  every  evening  joins  a  social  assemblage. 
Her  conversation  is  gay,  humorous,  and  sometimes  mischievous.  If  however 
she  changes  her  seat ;  if  she  puts  her  hand  to  her  head,  her  person  or  dress  ; 
upon  her  own,  or  the  chair  of  another  ;  she  shakes  and  rubs  her  fingers  vigo- 
rously. She  does  the  same,  if  any  one  enters  or  leaves  the  drawincr-room. 
She  enjoys,  besides,  excellent  health.  Her  appetite  and  sleep  are  good.  She 
sometimes  suffers  from  pain  in  the  head,  and  her  f;\ce  becomes  flushed  on  the 
slightest  emotion.  She  attends  to  all  the  medical  suggestions  that  are  propos- 
ed to  her,  but  is  opposed  to  baths,  in  consequence  of  the  precautions  which 
she  is  obliged  to  take,  before  entering  the  water,  and  on  coming  out  of  it.  It 
would  be  impossible  at  any  time,  to  discover  the  least  disorder  in  the  sensa- 
tions, reasoning  faculties  or  affections,  of  this  interesting  patient. 

I  shall   doubtless  be  accused  of  having  multiplied  cases;   but  it  was  my  de- 
sire to  make  this  variety  of  insanity,  which  Pinel  has  denominated  reasoning 


MONOMANIA.  351 

madness,  and  Dr.  Prichard  moraZ  insanity,  but  which  is  a  veritable  monomania, 
more  clearly  understood.  Patients,  affected  with  this  variety  of  insanity,  have 
in  truth,  a  partial  delirium.  They  perform  acts,  and  hold  odd,  strange  and 
absurd  conversations,  which  they  regard  as  such,  and  for  which  they  censure 
themselves.  Among  them,  some  are  turbulent,  unsociable,  and  commit  ridi- 
culous and  blame-worthy  acts,  contrary  to  their  former  affections  and  true  in- 
terests. They  find  themselves  uneasy  everywhere,  and  are  constantly  chang- 
incr  their  place.  They  both  speak  and  do  ill,  through  malice,  from  a  want  of 
employment,  and  from  wickedness.  Incapable  of  application,  and  averse  to 
labor,  they  overturn,  break  and  destroy.  The  perversion  of  their  disposition 
renders  them  exceedingly  troublesome  to  their  families,  and  in  those  establish- 
ments, to  which  they  are  brought.  At  the  Salpetriere  and  Charenton,  the 
admission  of  this  class  of  monomaniacs  is  always  dreaded ;  since,  by  their 
example  and  counsels,  they  destroy  discipline  and  subordination,  so  necessary 
in  institutions  of  this  kind.  Others  are  perfectly  aware  of  their  situation, 
discourse  upon  it  pertinently,  and  desire  relief  They  are  dangerous,  neither 
by  their  conversation  nor  acts ;  and  are  only  hurtful  to  themselves.  They 
abandon  the  objects  of  their  affections;  leave  their  families  and  business,  and 
compromise  their  true  interests ;  always  actuated  by  motives,  more  or  less 
plausible. 

The  signs  of  reasoning  monomania,  consist  in  the  change  and  perversion 
of  the  habits,  disposition  and  affections.  In  that  form  of  monomania,  of 
which  I  spoke  at  the  commencement  of  the  chapter,  it  is  evident  that  the  un- 
derstandincr  is  disturbed,  and  that  this  lesion  brings  about  the  disorder  of  the 
affections  and  actions.  In  reasoning  monomania,  with  which  I  am  now  occu- 
pied, the  understanding  is  not  essentially  disordered,  since  it  assists  in  the 
acts  of  the  insane  person,  and  the  patient  is  always  ready  to  justify  his  senti- 
ments and  conduct.  Reasoning  monomania  has  an  acute  and  chronic  course. 
We  distinguish  three  periods  in  it.  In  the  first,  the  disposition  and  habits  are 
changed  ;  in  the  second,  the  affections  are  perverted ;  and  at  length,  in  the 
third,  a  maniacal  excitement  appears,  or  else  a  weakening  of  the  faculties 
more  or  less  rapid,  leads  the  monomaniac  to  dementia.  This  form  of  mono- 
mania is  remittent  or  intermittent.  It  is  subject  to  relapses,  and  is  complicat- 
ed with  lypemania,  hypochondria,  hysteria,  and  especially  paralysis.  The 
treatment  claims  no  therapeutic  indication,  differing  from  those  which  were 
pointed  out,  when  speaking  of  monomania  in  general.  But  the  management 
of  the  mind  requires  special  attention,  particularly  with  respect  to  isolation, 
which  is  not  to  be  lightly  prescribed.  It  is  well  to  be  apprised  beforehand, 
that  the  vexations,  and  even  the  caution  and  advice  which  is  given  at  the  out- 
set of  the  malady,  hasten  the  second  stage.  Great  prudence  and  experience 
also,  are  necessary,  to  control  individuals  affected  with  reasoning  monomania. 

Reasoning  monomania  ought  to  be  studied  with  the  more  care,  since  those 
suffering  from  it  know  how  to  deceive  the  most  skillful  physicians ;  because 
they  dissemble  their  condition,  in  presence  of  those  who  notice  them,  and  have 
authority  to  decide  on  the  question  of  their  isolation ;  because  they  impose 
upon  judicial  magistrates  in  their  legal  capacity,  when  about  to  administer 
upon  their  persons  or  fortune ;  and  finally,  because  they  are  often  the  subjects 
of  medico-legal  questions,  which  it  is  very  difficult  to  resolve.  I  trust  that 
for  these  reasons,  I  shall  be  excused  for  the  length  of  the  chapter  on  mono- 
mania. 


352  MONOMANIA. 


MONOMANIA  RESULTING  FROM  DRUNKENNESS. 

In  all  times  and  places,  men  have  made  use  of  fermented  drinks,  and  have 
abused  them  to  a  greater  or  less  degree.  Every  people  have  their  peculiar 
beverage,  which  they  prefer  to  all  others,  and  prepare  from  the  productions 
of  the  soil  where  they  dwell.  In  Europe,  we  drink  cider,  beer,  wine  and 
brandy.  We  also  abuse  these  drinks.  Their  moderate  use  agreeably  excites 
the  moral  and  physical  powers.  Their  abuse  provokes  delirium,  then  coma, 
sleep  and  stupor.  These  effects  vary  with  a  thousand  individual  circum- 
stances, and  with  the  quantity  and  quality  of  the  drinks  that  are  abused.  The 
abuse  of  fermented  drinks  is  more  common  at  the  north  than  in  the  south. 
In  Russia,  Sweden  and  Denmark  ;  in  cold  and  damp  countries  like  Holland 
and  England,  they  need  excitement,  to  resist  the  influences  of  the  climate. 
In  North  America,  there  die  annually,  says  a  public  officer,  37,000  inebriates. 
In  that  country,  intemperance  produces  three  fourths  of  the  crime  and  mental 
alienation  ;  and  we  can  say  the  same,  with  respect  to  the  north  of  Europe. 
Children,  women  and  old  persons,  are  less  exposed  than  adults  of  the  male 
sex  to  the  abuse  of  fermented  drinks,  and  consequently,  to  their  deplorable 
effects.  The  fatal  propensity  to  drunkenness  is  sometimes  hereditary.  Gall 
relates,  that  in  a  Russian  family,  both  the  father  and  grandfather,  early  fell 
victims  to  their  fondness  for  fermented  drinks,  and  the  grandson,  from  the 
age  of  five  years,  manifested  a  decided  taste  for  strong  liquors.  Drunkenness, 
by  disturbing  the  brain,  impairs  by  degrees  the  understanding ;  enfeebles  the 
organs  of  motion  ;  leads  to  insanity  ;  to  delirium  tremens*  and  paralysis,  which 
destroys  so  large  a  number  of  the  insane.     It  leads  also  to  suicide. 

Whilst  I  was  at  the  Salpetriere,  we  had  a  servant,  who  had  been  a  maniac, 
and  was  afterwards  attached  to  the  service  of  the  division  of  the  insane  at  this 
hospital.  On  the  slightest  opposition,  this  girl  began  to  drink,  and  had  re- 
course to  a  thousand  expedients  to  procure  wine,  and  could  be  prevented  from 
obtaining  it,  only  by  seclusion.  If  she  was  not  taken  care  of  betimes,  she 
became  furious,  or  made  attempts  upon  her  life.  Gall  saw  in  the  prisons  at 
Bamberg,  a  woman  who,  so  soon  as  she  had  drank,  experienced  a  strong  de- 
sire to  set  fire  to  some  building.  Scarcely  had  this  irritation  subsided,  when 
she  conceived  a  horror  for  herself  Nevertheless,  she  had  been  the  cause  of 
fourteen  conflagrations  before  she  was  imprisoned. 

But  I  am  not  to  occupy  myself  in  this  place,  with  the  abuse  of  fermented 
drinks,  nor  with  its  pathological  effects.  I  have  to  prove,  that  if  the  abuse  of 
alcoholic  liquors  is  an  effect  of  the  degradation  of  the  mind,  of  vices  of  edu- 
cation, and  of  bad  examples,  there  is  sometimes  also  a  disordered  condition 
of  the  system,  which  leads  certain  individuals  to  the  abuse  of  fermented  drinks. 
There  are  cases,  in  which  drunkenness  is  the  effect  of  the  accidental  distur- 
bances of  the  physical  and  moral  sensibility  ;  which  no  longer  leaves  to  man, 
liberty  of  action.  The  sick,  who  are  thus  affected,  had  formerly  gentle  man- 
ners, and  habits  of  sobriety,  but  have  suddenly  changed.  Some  physical  or 
moral  cause  has  provoked  this  change ;  certain  precursory  signs  have  an- 
nounced it.  When  the  attack  has  terminated,  the  patients  return  to  their  for- 
mer temperate  habits.  Relapses  are  frequent ;  are  provoked  by  the  same 
causes,  and  announced  by  the  same  phenomena.  They  sometimes  recur  at 
fixed  periods.  It  is  not  unusual  that,  at  the  epoch  of  the  cessation  of  the 
menses,  women,  feeling  debilitated,  desire  to  give  tone  to  the  system  by  drink- 

*  See  on  tliis  important  subject,  P.  Rayer,  Essay  on  Dclirivm  Tremens,  Paris,  1819,  in 
8vo. — Leveille,  Essay  on  the  Insanity  of  Drunkards,  or  on  the  Trembling  Delirium.  (Me- 
moirs of  the  Royal  Academy  of  Medicine,  t.  i.  Paris,  1828,  in  4to,  p.  181). 


MONOMANIA.  353 

ing  strong  liquors,  and  end  with  intemperance  and  its  consequences.  A  mer- 
chant, for  three  years  in  succession,  at  the  beginning  of  autumn,  becomes  sad, 
uneasy  and  morose.  He  neglects  his  commercial  affairs,  and  is  difficult 
and  impatient,  with  respect  to  his  domestic  matters.  In  order  to  dissipate  his 
moroseness,  he  at  first  drinks  beer,  and  afterwards  becomes  intoxicated  daily. 
He  is  then  dangerous  to  his  family.  His  wife  is  insecure  with  him,  and  his 
fortune  is  no  longer  safe  in  his  hands.  On  the  first  approach  of  spring,  he 
suddenly  loses  his  desire  for  drink,  which  has  tormented  him  during  the  whole 
winter,  resumes  his  habits  of  sobriety,  repairs  by  his  activity  the  losses  which 
he  has  sustained  in  his  business,  and  endeavors,  by  his  devotedness,  to  indem- 
nify his  wife,  for  the  mortification  he  has  occasioned  her. 

Mad'e  has  always  been  sober  and  regular  in  her  habits.  At  the  age  of 
forty-two  years,  she  experiences  the  first  anomalies  of  menstruation,  suffers 
from  pains  in  her  stomach,  and  spontaneous  lassitude.  With  the  hope  of 
strengthening  her  system,  she  drinks  wine,  and  feels  at  first  relieved.  She 
augments  the  quantity  by  degrees,  and  finally  drinks  without  the  knowledge 
of  her  husband  and  family.  At  a  later  period,  she  procures  brandy,  and  drinks 
to  intoxication,  which  compels  her  to  remain  in  bed  most  of  the  time.  She 
then  abandons  her  usual  occupations,  no  longer  entertains  any  affection  for 
her  family,  and  becomes  irritated  and  angry,  if  any  one  opposes  her.  This 
depraved  habit  existed  for  six  years.  The  menses  at  length  ceased  to  flow  ; 
and  soon  after,  she  recovers  her  health ;  conceives  an  aversion  for  strong 
liquors,  and  even  wine ;  has  resumed  her  habits  of  sobriety,  and  at  the  age  of 
seventy-two  years,  enjoys  excellent  health.  The  daughter  of  this  lady  be- 
came insane  at  the  age  of  thirty-two  years.  Her  delirium  is  gloomy  and  sad 
in  its  character  ;  and  she  is  unwilling  to  eat  any  thing  but  bread,  or  drink 
any  other  fluid  than  water,  in  order  to  be  able  to  succor  the  indigent. 

Mad'e  P.,  tall,  of  a  nervous  temperament,  and  agreeable  exterior,  with  a 
gay,  but  foolishly  vain  disposition,  has  always  enjoyed  excellent  health.  The 
mother  of  a  family,  and  in  moderate  circumstances,  at  the  age  of  thirty-four 
years  she  enters,  with  her  husband,  an  establishment,  in  order  to  superintend 
its  aff'airs.  On  reaching  the  critical  period,  she  begins  to  partake  of  alcoholic 
liquors,  to  combat  the  pains  in  her  stomach.  At  a  later  period,  she  has  re- 
course to  brandy,  and  appears  more  active,  intellectual  and  irascible.  In  the 
sequel,  the  abuse  of  liquors  and  brandy  becoming  habitual,  she  is  almost  con- 
stantly in  a  state  of  intoxication,  and  her  faculties  become  enfeebled.  At  the 
age  of  forty-six,  she  retires  into  the  country.  Numerous  occupations  divert 
her  from  her  deplorable  inclination.  A  year  subsequently  however,  she  re- 
sumes her  habit  of  drinking,  giving  brandy  the  preference,  and  is  no  longer 
fond  of  wine.  She  at  length  becomes  sottish,  and  is  persuaded  to  go  and 
reside  with  her  friends,  whose  position  imposes  some  restraint  upon  her.  She 
continues  sober  for  six  months,  and  recovers  a  good  degree  of  fullness  of 
habit  and  freshness  of  complexion.  At  the  expiration  of  this  period,  renew- 
ing her  former  habits,  she  dies  in  two  or  three  days,  in  a  state  of  adynamia, 
without  complaining  of  any  pain,  or  her  physician  being  able  to  discover  the 
least  derangement  in  any  of  the  organs. 

•til' 

The  wife  of  a  merchant,  about  fifty  years  of  age,  very  temperate  m  her  habits 
previously  to  this  period,  began,  at  first,  to  drink  wine,  then  liquors,  and  lastly 
brandy.  Every  evening,  she  was  in  a  state  of  complete  intoxication.  Her 
taste  led  her,  at  length,  to  prefer  Cologne  water,  and  she  was  accustomed  to 
drink  from  five  to  seven  decanters  of  it,  daily.  After  the  lapse  of  a  year,  she 
became  leucophlegmatic, — was  frightened,  in  view  of  this  condition, — suddenly 
laid  aside  the  use  of  all  fermented  drinks,  and  died  eight  days  after  having 
taken  this  step. 

Mad'e  B.,  forty-two  years  of  age,  the  mother  of  a  family,  of  a  nervous  tem- 
45 


354  MONOMANIA. 

perament,  and  enjoying  good  health,  when  at  the  age  of  twenty-eight  years, 
lost  a  daughter.  Her  thoughts  become  disturbed,  she  is  sad,  uneasy,  and 
frightened  at  every  thing.  After  some  weeks,  her  health  is  reestablished. 
When  thirty-six  years  of  age,  without  any  determinate  exciting  cause,  there  is 
a  return  of  the  delirium,  which  presents  peculiar  characteristics.  There  is 
sadness  at  its  commencement,  a  trembling  and  languor  at  the  stomach,  moral 
discouragement,  and  an  incapacity  to  devote  herself  to  the  least  exercise  or 
occupation.  At  the  expiration  of  six  weeks,  there  is  suddenly  a  general  ex- 
citement, attended  by  insomnia.  Agitation,  and  disordered  movements,  a 
desire  to  drink  wine  to  excess,  disturbance  of  the  ideas,  and  perversion  of  the 
affections,  characterize  this  state.  After  two  months,  the  symptoms  disappear, 
and  the  patient  recovers,  with  reason,  composure  and  sobriety.  Since  then, 
she  has  annually  a  similar  attack.  During  the  last  year,  1836,  she  was  bled 
three  times  at  the  commencement  of  the  attack,  which  persisted,  nevertheless, 
as  long  as  the  preceding  ones,  and  terminated  in  the  month  of  June.  In  the 
month  of  October  following,  she  suffers  from  convulsions,  and  in  the  month  of 
December  there  is  a  suppression  of  the  menses,  refusal  to  eat,  and  languor  of 
the  stomach.  After  some  weeks,  she  makes  an  inordinate  use  of  drinks,  and 
suffers  from  insomnia,  hallucinations,  and  a  conviction  that  her  enemies  are 
exercising  their  hatred  towards  her.  After  the  lapse  of  a  month,  there  is  a 
remission,  but  a  return  of  all  the  symptoms  immediately  follows.  On  being 
sent  to  Charenton,  April  24th,  there  is  a  cessation  of  the  attacks  towards  the 
close  of  the  month  of  May,  preceded  by  a  return  of  the  menses.  She  con- 
jures us  to  point  out  a  means,  by  which  the  recurrence  of  an  attack  may  be 
prevented,  of  which  she  entertains  an  equal  degree  of  mortification  and 
horror. 

M.  G.,  an  advocate,  aged  forty-one  years,  is  of  medium  stature,  of  a  san- 
guine temperament,  and  has  black  hair  and  eyes.  He  has  always  enjoyed 
good  health.  For  a  few  years  past,  he  has  been  troubled  with  a  cutaneous 
affection,  which  has  spread  over  the  entire  surface,  and  gives  to  his  hands  the 
appearance  of  elephantiasis.  His  disposition  is  gentle,  easy,  and  even  puerile. 
In  his  youth,  he  had  a  fondness  for  alcoholic  drinks,  but  never  exposed  him- 
self to  the  habit  of  drunkenness.  At  a  later  period,  he  made  an  inordinate 
use  of  alcoholic  liquors,  and  sometimes  became  intoxicated.  Holding  the 
office  of  summoner,  he  lost,  on  account  of  his  habits,  public  confidence,  and 
was  obliged  to  sell  his  office.  Having  no  longer  any  occupation,  he  spent  his 
time  and  money  in  drinking  to  such  a  degree,  that  in  the  account  which  was 
made  out  respecting  him,  it  is  stated,  that  in  one  day  he  swallowed  J71  glasses 
of  brandy.  For  the  year  past,  he  has  been  accustomed  to  visit  every  evening, 
tippling  houses  of  the  lowest  class,  where  he  passed  the  night  in  company 
with  the  most  abject  beings.  He  was  there  arrested,  and  placed  in  charge  of 
the  prefecture  of  police,  from  whom  he  was  taken,  at  the  expiration  of  three 
months,  on  the  demand  of  one  of  his  aunts,  who  took  pity  on  his  condition, 
clothed  him,  made  him  promise  never  again  to  be  guilty  of  similar  excesses, 
and  sent  him  into  the  country.  He  was  not  slow  to  renew  his  fatal  habits, 
sold  his  effects,  and  disappeared.  For  some  days,  the  family  with  whom  he 
resided  were  extremely  anxious  respecting  him,  not  knowing  in  what  condition 
or  place  he  could  be.  At  length,  he  returned  to  the  house  of  the  same  aunt 
who  had  previously  sent  him  into  the  country,  where,  after  having  received 
both  reproaches,  and  wise  counsels,  he  resolved  to  come  to  Charenton  ;  pro- 
mising to  conduct  himself  there  in  a  proper  manner.  He  was  admitted,  Jan. 
4th,  183G,  He  is  composed  and  polite.  His  manners  are  agreeable,  his  con- 
versation interesting,  and  he  occupies  himself  with  literature.  Do  we  refer 
to  the  consequences  of  his  excesses,  he  blushes,  seems  to  be  mortified,  excuses 
himself,  promises  repentance,  and  to  resist  his  fatal  inclination.     He  affirms. 


MONOMANIA.  355 

with  the  accent  of  despair,  that  he  is  drawn  away  in  spite  of  himself,  the  mo- 
ment he  sees  a  possibility  of  gratifying  his  taste  for  alcoholic  beverages. 

If  I  converse  with  him,  after  having  represented  to  him  how  humiliating 
and  dreadful  his  conduct  is,  for  a  man  who  has  a  good  education,  together 
with  a  wife  and  children ;  and  convince  him  that  his  health  has  become  im- 
paired, and  his  understanding  enfeebled ;  he  appreciates  the  justness  of  my 
observations;  thanks  me  for  the  expression  of  my  good  will  towards  him; 
weeps  for  shame  and  mortification ;  forms  the  strongest  resolutions,  and  pro- 
mises never  again  to  go  out  of  the  house  if  he  hereafter  relapses  into  the  same 
excesses.  Notwithstanding  his  excellent  sentiments  and  fair  protestations; 
notwithstanding  his  promises,  every  time  that  we  permit  him  to  go  out  of  the 
establishment,  he  restrains  himself  for  three  or  four  days  only  ;  after  which,  he 
drinks,  and  relapses  into  a  state  of  complete  drunkenness.  If,  after  one  of 
these  excesses,  he  is  restrained  for  some  weeks,  his  conduct  becomes  regular 
ao-ain,  and  his  reason  perfect.  He  does  not  ask  to  go  out,  but  after  long  pri- 
vation, experiences  anew  a  strong  excitement,  and  there  is  no  promise  nor 
stratao-em  that  he  will  not  employ  to  obtain  his  liberty.  He  has  recourse  even 
to  threats.  Is  there  a  power  stronger  than  reason  and  the  will  of  this  wretch- 
ed man,  which  leads  him  to  the  commission  of  excesses,  for  which  he  experi- 
ences the  keenest  mortification,  whose  frightful  effects  he  deplores,  and  from 
which  he  promises  to  reform?  All  our  efforts  for  the  last  eighteen  months  to 
assist  this  patient  in  gaining  the  mastery  over  this  fatal  inclination,  have  thus 
far  been  unavailing. 

A  lady  still  young,  has  been  brought  several  times  to  Charenton,  in  conse- 
quence of  the  abuse  of  wine,  and  liquors  which  produce  intoxication,  the 
effects  of  which  persist  for  several  days.  When  the  attack  has  ended,  and 
she  has  recovered  the  use  of  her  reason,  she  is  ashamed,  hides  herself,  and 
calls  loudly  for  permission  to  return  to  her  family.  Hoping  to  assist  in  over- 
coming the  inclination  that  controls  her,  we  have  administered  the  douche, 
have  refused  her  permission  to  go  out  for  several  months,  and  have  threatened 
to  retain  her  all  her  life,  if  she  exposes  herself  to  be  brought  again  to  the 
establishment.  She  makes  the  fairest  promises,  and  the  firmest  resolutions ; 
but  so  soon  as  she  is  free,  nothing  can  prevent  the  attacks. 

From  the  facts  which  precede,  who  can  deny  that  there  exists  a  mental  dis- 
ease, whose  principal  characteristic  is,  an  irresistible  desire  for  fermented 
drinks?  Observed  with  care,  all  the  characteristic  features  of  partial  insanity 
and  of  monomania,  will  there  be  found.  Whenever  delirium  or  insanity  are 
preceded  by  the  abuse  of  fermented  drinks,  and  especially  drunkenness,  we 
are  disposed  to  charge  this  abuse  with  being  the  primitive  cause  of  the  cere- 
bral disorders,  though  in  many  cases  it  is  only  the  first,  and  sometimes  the 
characteristic  symptom  of  a  commencing  monomania.  At  one  time,  at  the 
commencement  of  mental  alienation,  the  stomach  is  in  a  peculiar  condition, 
which  causes  the  patient  to  suffer  an  excessively  painful  degree  of  physical 
prostration.  It  is  then  that  this  organ  demands  strong  drinks.  It  is  a  disor- 
dered appetite;  a  real  longing.  At  another,  from  the  time  of  the  invasion  of 
insanity,  the  moral  principle  is  prostrated,  the  patient  is  destitute  of  energy, 
incapable  of  thinking  or  acting ;  is  overwhelmed  by  a  sense  of  weariness  and 
irritability  of  temper,  and  drinks,  at  first  to  excite,  then  to  divert  the  feelings, 
and  at  length  reaches  intoxication.  In  both  cases,  the  desire  for  drink  is 
instinctive,  imperious,  irresistible.  The  patient  seizes  upon  every  variety  of 
stroncr  drink,  and  becomes  irritated  and  even  dangerous,  if  not  gratified. 
This°phenomenon  is  also  a  prelude  to  dementia. 

This  desire  for  alcoholic  drinks  persists  during  the  whole  paroxysm  ;  after 
which,  the  convalescent  becomes  again  sober,  and  resumes  all  the  habits  of  a 
life  of  temperance.  I  have  seen  persons  who,  in  the  intervals  of  the  parox- 
ysms, felt  a  great  repugnance  to  all  fermented  drinks,  and  partook  only  of 


356  MONOMANIA. 

water.  A  young  merchant,  who  was  a  native  of  Holland,  whom  I  had  in 
charge  during  an  attack  of  mania,  succeeding  repeated  excesses  in  the  use  of 
strong  drinks ;  ten  years  subsequently  stated  to  me,  that  since  the  attack  from 
which  he  had  then  suffered,  he  had  never  been  able  to  drink  either  wine  or 
liquors.  I  have  seen  persons  who,  filled  with  despair  in  view  of  the  state  of 
degradation  from  which  they  had  been  raised,  and  into  which  they  feared, 
lest  they  might  again  fall,  demanded  our  services  anew,  to  prevent,  they  said, 
this  horrible  malady. 

I  have  elsewhere  cited  the  example  of  an  advocate  who,  unable  to  triumph 
over  this  fatal  inclination,  terminated  his  life  by  a  violent  death.  Those  who 
are  afflicted  with  this  form  of  monomania,  yield  to  an  influence  which  they 
have  not  the  power  to  resist : — an  influence  which  is  the  more  imperious,  in 
proportion  as  it  has  degenerated  into  a  habit.  Motives  the  most  powerful ; 
resolutions  the  most  determined  ;  promises  the  most  solemn ;  the  disgrace  and 
danger  to  which  they  expose  themselves ;  the  physical  pains  which  attend 
them  ;  the  chastisements  with  which  they  are  threatened  if  they  do  not  con- 
trol themselves  ;  the  prayers  and  supplications  of  friendship  ;  the  tenderness  of 
fathers,  mothers  and  children  ;  none  of  these,  can  divert  these  wretched  beings 
from  this  deplorable  propensity.  What  is  the  mode  of  action  of  the  causes 
which,  modifying  the  sensibility  of  the  stomach,  provoke  an  appetite  for  fer- 
mented drinks,  among  persons  who  had  previously  been  sober  and  temperate  ? 
The  modification  of  the  sensibility  of  the  stomach  is  evident,  since  the  desire 
to  partake  of  strong  drinks  ceases  to  be  perceived,  so  soon  as  these  causes  no 
longer  act. 

In  one  of  the  cases  reported  in  detail,  the  desire  for  fermented  drinks  is 
renewed  for  three  years,  on  each  successive  autumn,  and  no  longer  return, 
when  the  patient  is  withdrawn  from  the  influence  of  cold  and  moisture,  by 
retiring  to  Italy,  at  the  close  of  summer.  In  one  of  the  preceding  cases,  the 
appetite  for  wine  appears,  with  the  first  anomalies  connected  with  the  cessa- 
tion of  the  menses,  and  is  no  longer  perceived  when  menstruation  has  ceased, 
to  return  no  more.  A  sort  of  moral  reaction  may  also  triumph  over  this  fatal 
impulse.  It  is  certain,  that  in  many  cases,  the  depraved  taste  of  patients  is 
induced  by  a  general  sentiment  of  debility,  and  tremors  of  the  stomach. 
Might  not  a  bitter,  or  some  other  tonic,  be  substituted  for  the  wine,  which, 
by  changing  the  morbid  action  of  the  stomach,  would  put  an  end  to  the 
disease  ?  It  has  been  recommended,  to  mingle  some  nauseous  substance  with 
the  wine,  whose  unpleasant  taste  might  induce  an  aversion  to  the  latter.  For 
this  purpose,  the  oil  of  turpentine  has  been  proposed.  The  Spartans  were 
in  the  habit  of  intoxicating  their  slaves,  in  order  that  the  spectacle  of  degra- 
dation and  brutishness,  into  which  drunkenness  had  plunged  them,  might  in- 
spire the  citizens  with  a  horror  of  it.  It  is  long  since  this  means  has  lost  its 
efficacy.  Isolation  has  appeared  to  me,  to  be  the  only  truly  valuable  precau- 
tion. It  is  necessary,  by  long  habits  of  sobriety,  to  overcome  the  disposition 
to  intemperance  ;  and  this  triumph  cannot  be  effected  unless  its  victim  fly  the 
opportunities,  and  indeed,  render  it  impossible  to  gratify  it.  Now,  isolation 
alone  fulfills  these  conditions.  Instructions  and  religious  precepts,  the  coun- 
sels of  philosophy,  the  reading  of  treatises  on  temperance,  the  fear  of  physical 
and  intellectual  infirmities,  the  inevitable  consequence  of  drunkenness,  will  be 
auxiliaries  to  isolation. 


MONOMANIA.  357 


INCENDIARY  MONOMANIA.     {Pyromayiia  of  Marc). 

Not  having  had  an  opportunity  to  observe  particular  facts  respecting  this 
form  of  monomania,  I  borrow  what  follows,  from  an  essay  on  this  subject, 
published  by  Doctor  Marc* 

Man,  the  sport  of  his  passions,  becomes  an  incendiary  through  jealousy, 
and  from  a  spirit  of  revenge.  M.  Marc  states  the  case  of  a  woman,  who  sets 
fire  to  a  house  near  her  own,  through  jealousy  of  another  woman,  with  whom 
her  own  husband  was  accustomed  to  live,  and  in  order  to  take  vengeance  on 
the  proprietors  of  the  house,  who  favored  this  misconduct.  Two  girls,  one 
twelve  and  the  other  fourteen  years  of  age,  both  servants,  and  dissatisfied  with 
their  condition,  committed  acts  of  incendiarism,  in  order  to  be  relieved  from 
service.  Two  girls,  who  were  cow-tenders,  one  twelve  and  a  half,  and  the 
other  sixteen  years  of  age,  become  incendiaries  in  order  to  obtain  a  release 
from  an  occupation  which  had  been  the  means  of  loading  them  with  reproaches, 
and  which  they  likewise  detested.  Criminals  commit  acts  of  incendiarism,  to 
conceal  the  traces  of  their  crimes,  or  from  some  other  motive. 

The  insane,  in  consequence  of  delirium,  to  procure  their  liberty,  or  to  satis- 
fy their  vengeance,  set  fire  to  the  house  in  which  they  dwell.  I  had  charge 
of  a  maniac,  who  threw  a  burning  fire-brand  into  his  own  bed,  hoping  to  re- 
cover his  liberty,  amidst  the  confusion  which  it  would  produce.  Monoma- 
niacs obey  hallucinations,  illusions  and  fixed  ideas,  which  determine  them  to 
commit  acts  of  incendiarism,  as  others  are  determined  to  destroy  their  fellow- 
creatures  or  themselves.  An  insane  man  had  placed  himself  upon  some 
fagots,  and  was  Eroinw  to  set  fire  to  them,  believing  himself  invested  with  divine 
power,  and  was  convinced,  that  at  his  command,  the  flames  would  at  once  be 
extinguished.  A  young  man  had  undertaken,  during  the  heats  of  summer, 
a  journey  on  horseback.  His  mind  wanders  ;  people  press  around  him,  and 
he  thinks  that  he  has  fallen  into  the  hands  of  robbers.  He  sets  fire  to  the 
house  into  which  he  has  been  kindly  received,  in  order  to  escape  from  what 
he  considers  to  be  a  den  of  malefactors.  A  gentleman,  forty  years  of  age, 
thinks  that  he  has  enraged  enemies,  and  fears,  lest  he  shall  be  assaulted  in 
his  own  house.  He  surrounds  his  apartment  with  a  train  of  powder,  resolved 
to  set  fire  to  it,  so  soon  as  his  pretended  enemies  shall  present  themselves. 
Schlegel,  in  his  work  on  political  medicine  (1819),  relates  that  a  woman, 
affected  with  religious  melancholy,  sought  to  commit  suicide,  by  burning  her- 
self upon  her  bed.  She  manifested  no  intellectual  disorder,  with  the  excep- 
tion of  a  distaste  of  life,  and  religious  exaltation, 

Jonathan  Martin  was  brought  i3efore  the  grand  jury  of  the  county,  for  hav- 
ing attempted  to  set  fire  to  the  cathedral  of  York.  When  brought  into  court, 
Jonathan,  whose  appearance  is  cheerful,  commences  a  conversation  with  those 
persons  who  surround  him.  Are  you  sorry  for  what  you  have  done?  a  lady 
enquires.  Not  at  all ;  if  it  were  designed  that  I  should  do  it,  I  should  exe- 
cute it  still.  It  was  very  necessary  to  purify  the  house  of  the  Lord,  from  the 
unworthy  ministers,  who  are  far  removed  from  that  purity,  which  is  enjoined 
in  the  Gospel.  But  this  is  not  the  way  to  correct  the  priests.  Martin 
smiled,  and  says,  after  a  few  moments'  silence  ;  "  Pardon  me,  this  will  cause 
them  to  reflect.  They  will  perceive,  that  it  is  the  finger  of  God  that  directs 
my  arm.  Christians,  who  are  thoroughly  converted  to  the  true  religion,  will 
find  that  I  have  done  well.  The  Lord  works  mysteriously,  and  it  is  his  will, 
that  accomplishes  whatever  comes  to  pass,  in  heaven  or  on  earth."  The  drums 
announce  the  arrival  of  the  Chief  Judge  ;  "  This  is  curious,"  says  Martin,  "  one 

*  Annals  of  Public  Hygiene  and  Legal  Medicine,  Paris,  1833,  t.  x,  p.  357. — Memoirs 
of  the  Royal  Academy  of  Medicine,  t.  iii,  p.  29. 


358  MONOMANIA. 

might  imagine,  that  he  heard  the  trumpets  of  the  last  judgment."  In  the 
court  of  audience,  the  solicitor-general  declared,  that  he  should  withdraw 
another  important  accusation,  which  was  joined  to  that  of  incendiarism.  Jo- 
nathan was  accused  of  having  carried  away  the  fringes  of  gold,  and  other 
precious  things,  which  surrounded  the  pulpit.  "  You  do  well  to  withdraw  the 
accusation  of  robbery,  it  is  contrary  to  common  sense.  I  had  no  intention  of 
taking  any  thing,  but  an  angel  from  God  having  commanded  me  to  set  fire  to 
the  church,  it  was  necessary  to  strengthen  myself  by  proofs,  that  I  alone  per- 
formed this  act,  that  another  might  not  be  punished  for  it ;  or  if  you  prefer  it, 
might  not  suffer  in  consequence  of  it." 

A  servant  girl,  fifteen  years  of  age,  and  suffering  from  nostalgia,  twice  com- 
mitted the  act  of  incendiarism,  in  order  to  leave  her  masters.  She  affirmed 
that  from  the  moment  of  entering  upon  service,  she  was  beset  with  the  de- 
sire of  setting  something  on  fire.  It  seemed  to  her  that  a  shade,  constantly 
by  her  side,  impelled  her  to  this  act.  This  girl  suffered  from  violent  pains 
in  the  head,  and  her  menses  were  tardy.  Henke,  in  the  7th  vol.  of  his  Annals, 
among  many  other  examples,  relates  that  of  a  girl  twelve  years  of  age,  who 
thrice  set  fire  to  buildings,  and  purposely  suffocated  her  infant. 

A  little  girl  twelve  years  of  age,  had  suffered  for  some  time  previously  from 
a  cerebral  fever,  which  had  enfeebled  her  intellectual  faculties.  Notwith- 
standing, she  entered  the  service  of  a  farmer  at  Barkingside,  near  London  ; 
set  fire  to  a  bed  in  the  house  where  she  was  at  service,  and  informed  the  fa- 
mily, who  promptly  extinguished  the  fire.  This  child,  on  being  interrogated 
by  the  magistrate,  made  the  following  responses  to  the  questions  that  were 
addressed  to  her  :  "  I  did  not  think  that  I  was  doing  mischief;  I  wished  to 
see,  if  by  bringing  a  lighted  candle  near  the  bed  curtain  I  should  set  it  on 
fire.  I  was  curious  to  witness  the  effect  of  the  flame,  and  supposed  that  it 
would  be  more  beautiful  than  coals  of  fire,  or  a  fagot  burning  in  the  fire- 
place. I  entertain  no  dislike  towards  my  master,  and  enjoyed  myself  very 
well,  while  at  his  house.  I  did  not  think  that  I  was  doing  him  an  injury,  by 
burning  a  worthless  bed  ;  he  is  rich  enough  to  purchase  another.  I  did  not 
reflect  that  I  committed  a  great  crime  by  setting  fire  to  the  property  of  ano- 
ther person,  and  wished  only  to  make  a  bonfire.  Had  I  known  that  I  should 
be  hung  for  having  kindled  a  bonfire,  I  should  not  have  done  it." 

E.  Platner*  states,  that  the  female  servant  of  a  peasant,  had  twice  commit- 
ted incendiary  acts,  incited  by  an  internal  voice,  by  which  she  was  constantly 
harassed,  and  which  commanded  her  to  burn  something,  and  then  destroy  her- 
self. This  girl  afTirmed,  that  she  had  regarded  with  composure  and  satisfac- 
tion, her  first  incendiary  act.  The  second  time,  she  hastened  to  give  the 
alarm,  and  endeavored  to  hang  herself  No  other  intellectual  disorder  was 
observed  in  the  case  of  this  girl.  From  the  age  of  four  years  however,  she 
had  suffered  from  spasms,  which  degenerated  into  epilepsy.  A  violent  epilep- 
tic seizure  had  preceded  by  several  days,  the  second  act.  No  obscure  insin- 
uation, no  opposition  nor  mortification,  had  provoked  this  determination. 
She  had  hesitated  for  some  days. 

Persons  who  have  fallen  into  a  state  of  dementia,  as  well  as  idiots,  in  the 
absence  of  discernment,  or  through  carelessness,  sometimes  become  incendia- 
ries. Malefactors  often  abuse  the  weak  understanding  of  idiots,  and  employ 
these  miserable  beings  to  accomplish  their  fatal  designs.  Persons  in  a  state 
of  dementia,  allow  their  clothing  and  furniture  to  take  fire,  before  perceiving 
the  danger  which  they  incur,  and  the  conflagration  that  menaces  their  habita- 
tion. The  cases  which  precede,  embrace  all  that  class  of  persons,  who  are 
led  away  by  some  controling  passion,  or  by  disorder  or  feebleness  of  the  in- 
tellectual faculties.     Among  the  incendiaries  who  are  insane,  or  whose  minds 

*  QujEstioncs  JMcdiciiiEe  Forensis,  Lipsite,  1824,  in  8vo. 


MONOMANIA.  359 

have  become  weakened,  some  have  hallucinations  ;  the  greater  part  obeying 
an  impulse  of  greater  or  less  intensity,  and  led  away  by  motives  more  or  less 
plausible  in  their  character.  These  patients  however,  are  not  deprived  of  the 
faculty  of  reasoning,  and  their  insanity  may  be  classed  among  the  forms  of 
reasoning  monomania.  There  are  facts  which  demonstrate,  that  some  incen- 
diaries are  moved  by  an  instinctive  impulse,  independent  of  their  will.  This 
circumstance  ought  to  bring  this  variety  into  the  division  which  Pinel  has 
denominated  mania  without  delirium,  and  which  I  call  monomania  without  de- 
lirium ;  because  the  act  of  incendiarism  is,  in  these  cases,  the  result  neither 
of  a  passion,  of  a  delirium,  nor  of  a  want  of  reason. 

In  the  7th  vol.  of  the  Annals  of  Henke,  it  is  stated  that  a  female  servant, 
on  returning  from  a  dance  where  she  had  been  much  heated,  was  suddenly 
seized  with  an  incendiary  impulse.  She  experienced  great  anxiety  during  the 
three  days  of  irresolution,  which  preceded  the  act  of  incendiarism.  She  de- 
clared that  she  felt,  on  seeing  the  fire,  a  joy,  the  like  of  which,  she  had  never 
before  experienced. 

A  young  woman  twenty-two  years  of  age,  was  disturbed  by  an  internal  agi- 
tation, which  urged  her  to  the  commission  of  some  incendiary  act,  although 
she  discharged  her  appropriate  duties  in  a  perfectly  acceptable  manner,  ac- 
cording to  the  statement  of  her  employers.  This  agitation  increased  greatly, 
if  she  passed  any  considerable  time  without  seeing  her  lover,  by  whom  she 
had  had  a  child. 

A  girl,  by  name  Choleau,  was  brought  before  the  court  of  assizes  of  Seine- 
et-Marne,  on  suspicion  of  belonging  to  a  band  of  incendiaries  who,  in  1830 
desolated  several  departments  of  France.  This  girl,  at  the  age  of  seventeen 
years,  says  her  advocate,  poor,  and  an  orphan,  who,  from  the  age  of  six  years 
had  procured  her  own  livelihood,  seduced  because  advice  and  support  was 
wanting  in  her  weakness,  and  pregnant  for  seven  or  eight  months  ;  affirms 
with  an  accent  of  sincerity  which  leaves  no  room  for  doubt,  that  she  lias  twice 
committed  an  incendiary  act  from  the  influence  of  instinct,  and  an  irresistible 
necessity  ;  the  victim  of  suggestions,  to  which  her  state  of  pregnancy  expos- 
ed her,  together  with  the  accounts  of  incendiarism,  the  alarms,  and  incendi- 
ary scenes,  which  filled  the  whole  country  around  her  with  fear,  and  excited 
her  disordered  brain.* 

An  apprentice  to  the  business  of  a  wheelwright,  eighteen  years  of  age,  and 
living  in  the  country,  committed  sixteen  incendiary  acts,  in  the  course  of  four 
months.  He  always  carried  with  him  a  sponge,  and  a  thread  saturated  with 
sulphur  ;  and  although,  to  satisfy  his  gluttony  and  pleasures,  he  might  already 
have  learned  to  steal,  and  was  destitute  of  money,  he  always  refrained  from 
robbery  during  the  conflagrations  which  he  had  kindled.  He  was  not  excited 
by  any  passion,  but  on  the  breaking  out  of  the  flames  was  greatly  pleased, 
and  his  pleasure  was  increased  by  the  sound  of  the  bells,  the  lamentations, 
clamors,  cries  and  confusion  of  the  population.  So  soon  as  the  bells  an- 
nounced the  existence  of  a  fire,  he  was  obliged  to  leave  his  work,  so  violent- 
ly were  both  body  and  mind  agitated. 

These  cases  demonstrate  :  1st,  that  mental  alienation,  whatever  may  be  the 
character  of  the  delirium,  leads  some  insane  persons  to  the  commission  of  in- 
cendiary acts ;  2d,  that  there  is  a  variety  of  monomania  without  delirium,  cha- 
racterized by  an  instinctive  desire  to  burn.  These  two  propositions  need  no 
demonstration.     Here  are  the  facts,  which  are  sufficient  to  establish  them. 

[Enquiries  have  been  instituted,  and  the  experience  of  men  of  age  and  careful  ob- 
servation has, been  put  in  requisition,  to  establish  if  possible,  by  some  further  proof 
the  existence  of  that  form  of  insanity  which  is  now  under  consideration.     A  number  of 

*  Tribunitial  Gazette,  No.  18, 


360  MONOMANIA. 

cases,  the  histories  of  which  were  well  known,  have  been  furnished  ;  the  mental  condi- 
tion of  each  individual  for  a  considerable  period  previous  to  the  commission  of  the  in- 
cendiary act — at  about  the  time  of  its  commission — and  subsequently,  having  been  given. 
In  one  case  only,  was  it  possible  to  ascertain  the  leading  mental  traits  of  either  parent. 
In  seven  cases  of  persons  who  had  been  guilty  of  the  act  of  incendiarism,  their  average 
age  did  not  equal  eighteen  years  :   the  extremes  being  eight  and  twenty-eight  years. 

The  mind  in  each  of  the  cases  referred  to,  was  peculiarly  constituted  ;  a  deep  and 
abiding  spirit  of  revenge  being  one  of  its  marked  features.  In  one  case,  a  "  diabolical 
love  of  excitement"  was  the  cause  assigned;  yet  subsequent  manifestations  of  the  above 
characteristic,  led  to  the  belief  that  it  might  safely  be  substituted  for  the  cause  assigned. 
In  a  second,  repeated  punishments  were  invariably  followed  by  a  prompt  act  of  incendi- 
arism. In  a  third  instance,  a  reprimand  was  followed  by  an  incendiary  act.  In  a  fourth 
case,  a  mind  reckless  of  consequences  and  regardless  of  all  moral  considerations,  which 
was  characterized  by  a  haughty  defiance  of  all  punitive  treatment,  and  which  gloried  in 
braving  the  severest  dispensations  of  justice,  led  its  unhappy  possessor,  thrice  to  perpe- 
trate the  act  of  incendiarism.  In  one  at  least  of  the  remaining  cases,  revenge  was  the 
dread  agent  in  the  production  of  this  act.  One  of  the  remaining  two,  seemed  to  have 
become  the  willing  slave  of  his  wayward  propensities,  which  an  unwise  training  had 
rather  cherished  than  subjected  to  a  wholesome  control.  Their  wretched  victim  has  been 
led  on  from  the  commission  of  one  act  of  incendiarism  to  another,  and  is  now,  as  he 
has  long  been,  the  degraded  and  ruined  inmate  of  a  state  prison. 

Two  only  of  the  subjects  referred  to  were  girls  ;  one  of  whom  was  fourteen  and  the 
other  eleven  or  twelve  years  of  age,  at  the  time  of  committing  the  act  with  which  they 
were  charged.  The  elder  was  an  orphan,  and  had  been  educated  wholly  or  in  part,  at 
an  asylum  for  this  interesting  and  bereaved  class  of  children.  Respecting  her  parentage 
nothing  was  known.  The  younger  was  the  daughter  of  a  very  dissolute  and  wicked 
woman,  who  had  no  settled  abode  ;  her  perverse  disposition  preventing  her  from  obtain- 
ing a  support  where  known.  Inheriting  a  similar  disposition,  rendered  if  possible  more 
perverse  by  the  example  and  treatment  of  her  cruel  mother,  this  little  girl  thought  only 
how  to  wreak  her  vengeance  upon  any  one  who  thwarted  her  designs,  or  subjected  her 
to  salutary  restraints. 

In  both  these  cases  however,  judicious  management,  uniting  great  kindness  and  for- 
bearance with  incentives  to  obedience,  to  the  exercise  of  prompt  and  decisive  modes  of 
discipline,  has  led  to  the  belief,  on  the  part  of  those  who  have  long  known  tliem,  after 
years  of  observation  with  respect  to  their  mental  operations  and  conduct,  that  a  health- 
ful balance  has  been  secured  to  their  minds,  and  that  it  is  now  safe  to  permit  them  to 
mingle  in  society,  subject  to  the  trials  and  privations  incident  to  poverty  and  comparative 
ignorance. 

The  facts  above  stated,  I  have  been  at  some  pains  to  collect  from  authentic  sources  ; 
and  which,  as  the  expressions  of  the  opinions  of  men  whose  minds  were  unfettered  by 
prejudices  or  peculiar  theoretical  views,  are  of  much  interest,  and  on  this  account  I  add 
them.] 

From  the  facts  which  have  been  cited,  one  is  surprised  at  the  great  number 
and  age  of  the  incendiaries  belonging  to  the  female  sex,  compared  with  the 
number  and  age  of  men,  who  are  guilty  of  this  act.  This  double  result  is 
true,  with  respect  to  the  north  of  Germany,  according  to  the  observations 
published  by  German  phy.sicians.  The  same,  however,  is  not  true  of  France. 
M.  Marc  has  collected,  and  compared  the  charges  of  incendiarism,  report- 
ed in  the  Tribunitial  Gazette,  from  1825  to  1832,  and  has  found  that  in 
France,  the  number  of  male  incendiaries  is  greatear  than  that  of  women,  and 
that  adults  are,  among  us,  more  frequently  incendiaries  than  persons  below 
the  age  of  twenty  years. 


MONOMANIA.  361 

Nervous  affections,  says  our  co-laborer,  are  more  frequent  and  peculiar, 
among  German  than  French  women  ;  particularly  the  neuroses ;  which  are 
connected  with  the  first  menstrual  efforts.  This  results  from  the  difference 
of  climate,  morals  and  habits,  especially  among  the  inhabitants  of  the  coun- 
try. See  how  M.  Marc  develops  his  views.  "  The  physical  education  of  the 
German  peasant  girl,  and  the  peasant  girl  of  France,  is  far  from  being  the 
same.  In  the  latter  country,  the  peasant  women  live  beneath  a  milder  sky, 
and  are  habituated,  from  their  earliest  years  to  occupy,  during  the  winter 
abodes  whose  temperature  is  slightly  elevated,  but  not  hot ;  their  nourishment 
is  simple,  rarely  rendered  stimulant  by  spices,  and  few  are  acquainted  with 
heating  drinks.  Nothing  therefore,  diverts  them  from  a  distinctly  marked 
course  of  life,  or  interferes  with  the  sexual  development,  whose  most  essential 
sign,  menstruation,  manifests  itself  in  a  normal  manner,  assisted  moreover,  by 
the  salutary  influence  of  the  climate.  It  is  not  thus  in  Germany,  especially 
in  its  northern  portions.  The  dwellings  of  the  Germans  are  warmed  by  fires, 
which  are  kindled  in  stoves  of  immense  size,  upon  and  behind  which,  are 
sometimes,  the  lodgings  of  a  part  of  the  family.  The  heat  is  so  excessive, 
during  at  least  six  months  of  the  year,  as  to  incommode  whoever  may 
visit  an  abode  of  this  kind,  without  being  habituated  to  the  action  of  an  at- 
mosphere, at  the  same  time,  both  hot  and  humid  :  for  usually,  the  water, 
which  serves  for  domestic  purposes,  and  for  cooking  the  roots  destined  for  the 
nourishment  of  cattle  and  other  animals,  is  heated  to  ebullition  in  vessels 
made  of  iron  or  brass,  and  fitted  into  the  walls  of  the  stove,  the  vapor  of 
which,  destroys  the  elasticity  of  the  ambient  air.  Let  us  add  to  this  cause  of 
insalubrity,  the  frequent  use  of  hot  spiced  drinks ;  as,  for  example,  a  stimu- 
lant soup,  rendered  aromatic  with  cumin  or  coriander;  the  employment  of  tea, 
weak  it  is  true,  but  taken  in  large  quantities  ;  the  custom  finally,  of  sleepino- 
upon  beds,  as  well  as  beneath  coverings  of  feathers ;  and  we  can  explain  how 
these  influences,  alternating  promptly  with  the  action  of  intense  cold,  often 
prolonged,  excite,  and  in  turn  enfeeble  the  system ;  thus  giving  rise  to  ner- 
vous affections." 

The  German  physicians  have  proved*  that  acts  of  incendiarism  were 
more  frequently  committed  by  young  girls,  from  nine,  to  twelve,  fifteen  and 
eighteen  years,  than  by  those  of  a  more  advanced  age.  (I  have  already  re- 
marked, that  this  is  not  true  in  France).  They  have  tried  to  explain  this 
singular  result  of  their  observations.  Henke  attributes  this  disposition,  to  the 
arrest  and  disturbance,  connected  with  the  development  of  the  organs,  and, 
as  a  consequence,  to  the  arrest  and  disordered  development  of  the  physical 
and  moral  phenomena  of  puberty.  The  affections  which  are  unfolded  at  this 
period  of  life,  are  common  to  the  two  sexes  ;  but  are  far  more  frequent  and 
marked,  among  girls  than  boys.  They  have  their  seat  in  the  centre  of  sensi- 
bility, in  the  extremities,  or  in  the  different  foci  of  the  nervous  system.  They 
reveal  themselves,  now  by  spasms  and  convulsions ;  now  by  mental  diseases. 
During  youth,  and  the  effort  connected  with  the  establishment  of  puberty ; 
somnambulism,  ecstasy,  lypemania,  nostalgia  and  suicide,  are  also  observed. 
But  it  is  not  always  easy  to  refer  to  this  arrest,  or  trouble  connected  with  the 
developments,  the  affections  which  depend  upon  them.  It  often  happens  also, 
that  the  physician  imperfectly  understands  the  source  of  these  disordered  and 
critical  movements ;  that  he  regards  them  as  morbid  phenomena,  and  combats 
them,  by  a  too  energetic  medication.  They  also  interfere  with  nature  in  her 
operations.  If  we  connect  these  considerations,  with  those  which  result  from 
circumstances,  amidst  which,  puberty  is  developed  among  the  country  girls 

*  Researches,  based  upon  the  actual  State,  in  Germany,  of  medico-legal  doctrines,  tcith 
respect  to  mental  alienation,  by  Taufflieb.  {Annals  of  public  Hygiene  and  of  legal  Medi- 
cine ;  Paris,  1835,  t.  xiv.  p.  1^4  J 

46 


362  MONOMANIA. 

of  the  north  of  Germany,  we  shall  clearly  perceive,  why  the  young  women 
of  that  country  are,  during  the  early  period  of  adolescence,  more  subject  to 
pyromania  than  young  men. 


HOMICIDAL  MONOMANIA. 

Homicidal  monomania,  mania  without  delirium,  reasoning  mania  of  Pinel, 
maniacal  fury  of  Fodere.  Crime  and  the  passions,  nerve  the  arm  of  the 
homicide.  The  arrangement  of  the  facts,  however,  which  appertain  to  this 
subject,  constitute  no  part  of  my  design.  The  insane  attempt  to  take  the 
lives  of  their  fellow-beings.  Some,  having  become  exceedingly  susceptible, 
as  well  as  very  irritable,  in  a  fit  of  anger,  smite,  and  slay  those  who  resist 
them,  or  by  whom  they  think  themselves  opposed.  They  destroy  persons 
whom  they  regard,  either  rightfully  or  otherwise,  as  their  enemies ;  from 
whom  they  deem  it  necessary  to  defend  themselves,  or  on  whom  they  must  take 
vengeance.  Others,  deceived  by  the  illusions  of  the  senses,  or  by  hallucina- 
tions, obey  the  impulse  of  their  delirium.  Some  destroy,  and  relate  the  mo- 
tive for  their  frightful  determinations  ;  assign  a  reason  for  their  actions ;  and 
possess  a  consciousness  of  the  harm  they  commit.  Others,  are  the  blind 
instruments  of  an  involuntary,  and  instinctive  impulse,  which  impels  them  to 
the  commission  of  murder.  Finally,  we  notice  idiots  who,  for  want  of  a  de- 
velopment of  the  understanding,  and  ignorant  equally,  of  evil  and  of  good, 
destroy  from  imitation. 

We  have  classed  among  maniacs,  persons  who  appear  to  enjoy  the  use  of 
their  reason ;  and  whose  affective  functions  alone,  seem  to  be  in  the  wrong. 
These  maniacs  perceive,  compare  and  judge  correctly ;  but  they  are  drawn 
aside,  from  the  slightest  cause,  and  even  without  an  object,  to  the  commission 
of  acts  of  violence  and  fury.  They  are  irresistibly  impelled,  they  assure  us, 
to  lacerate  and  injure  themselves,  and  destroy  their  fellow-beings.  These 
wretched  persons  have  a  consciousness  of  their  condition,  deplore  their  situa- 
tion, warn  their  friends  to  protect  themselves  against  their  fury,  or  place  them 
where  they  can  do  no  harm.  Pinel,  more  than  any  other  physician,  has  called 
the  attention  of  observers  to  this  fearful  malady,  which,  in  hospitals,  they  call 
reasoning  insanity,  and  to  which  our  illustrious  master  has  given  the  appella- 
tion of  mania  unthant  delirium.  Fodere  admits  this  variety,  which  he  calls 
maniacal  fury  * 

But  does  a  form  of  mania  really  exist,  in  which  those  who  are  affected  by 
it,  preserve  the  integrity  of  their  reason,  whilst  they  abandon  themselves  to 
the  commission  of  acts  the  most  reprehensible  ?  Is  that  a  pathological  condi- 
tion, in  which  man  is  irresistibly  led  on,  to  the  commission  of  an  act  which 
his  conscience  condemns  ?  I  think  it  is.  I  have  seen  a  great  many 
insane  persons,  who  appeared  to  enjoy  the  use  of  their  understanding,  and  who 
deplored  the  determinations,  towards  the  execution  of  which,  they  were  pow- 
erfully drawn  ;  but  all  affirmed,  that  they  experienced  certain  internal  sensa- 
tions, of  which  they  could  give  no  account ;  that  the  brain  was  embarrassed  ; 
that  they  experienced  an  inexpressible  inconvenience  in  the  exercise  of  their 
minds,  and  that  this  precursory  trouble,  was  itself  announced  by  physical 
symptoms,  of  which  they  preserved  a  distinct  recollection.  They  experienced, 
the  one,  a  consuming  heat,  rising  from  the  lower  part  of  the  abdomen,  even 
to  the  head  ;  another,  a  burning  sensation,  attended  by  throbbings  in  the  head; 
others  still,  afhrm  that  an  illusion,  a  hallucination,  or  a  process  of  false  rea- 
soning determined  them.     I  will   explain   myself  by  examples.     One  insane 

*  .i  Treatise  on  Delirium,  ^'Ipplied  to  Medicine,  Morals  and  Legislation.     Paris,  1817, 
2  vol.  in  8vo. 


MONOMANIA.  363 

man,  suddenly  becomes  very  much  flushed,  and  hears  a  voice,  which  says  to 
him  :  slay,  slay  ;  this  is  thine  enemy  ;  slay  him,  and  thou  shall  he  free.  An- 
other is  persuaded  that  his  wife  betrays  him.  Her  conduct,  and  the  circum- 
stances of  the  case,  ought  to  remove  his  suspicions.  But  jealousy  nerves  his 
arm,  and  he  attempts  to  smite  her.  The  weapon  falls  from  his  hand,  he 
throws  himself  at  the  feet  of  her  whom  he  was  a  moment  before  about  to  sacri- 
fice, deplores  his  jealous  fury,  makes  the  strongest  promises,  and  the  firmest 
resolutions  to  conquer  himself.  An  instant  afterwards  however,  his  excite- 
'ment  is  renewed.  The  mother  of  a  family  considers  herself  ruined  :  her  situ- 
ation is  frightful,  nothing  can  change  it,  and  she  is  convinced  that  her  chil- 
dren are  destined  to  beg  in  the  streets.  Despair  seizes  upon  her  ;  she  resolves 
to  destroy  them,  and  prepares  herself  to  accomplish  her  design.  At  the  mo- 
ment of  executing  them,  (maternal  tenderness  crying  more  loudly  than  des- 
pair), she  exclaims;  my  children,  retire.  The  examples  related  by  Pinel,  sus- 
tain those  which  I  have  just  related.* 

Nearly  all  the  facts  relating  to  mania  toithout  delirium,  which  have  been 
reported  by  authors,  appertain  to  monomania  or  lypemania ;  to  that  form  of 
insanity  Avhich  is  characterized  by  a  fixed  and  exclusive  delirium.  The  irre- 
sistible impulses,  present  all  the  signs  of  a  passion  which  has  attained  to  deli- 
rium. The  sick,  whether  furious  or  not,  drawn  away  irresistibly ,  to  the  com- 
mission of  acts  which  they  disclaim,  are  sensible  of  their  condition,  reason 
respecting  it  as  well  as  others,  and  form  a  correct  judgment  of  it.  They  de- 
plore the  acts  which  they  have  committed,  and  strive  to  control  themselves. 
At  such  times,  do  they  not  enjoy  a  lucid  interval  ?  Shortly  after,  a  paroxysm 
succeeds  to  the  remission.  Once  more,  a  prey  to  their  delirium,  these  mono- 
maniacs are  hurried  away.  They  yield,  but  reason  no  longer  governs  their 
actions.  In  obeying  the  impulse  which  impels  them,  they  forget  the  motives 
which,  a  moment  before,  restrained  them.  They  now  notice  nothing,  save  the 
object  of  their  fury  ;  like  men  who  are  the  victims  of  a  strong  moral  affection, 
and  see  nothing  but  the  object  of  their  passion.  In  the  language  of  common 
life,  we  call  this  extreme  state  of  the  passions,  delirium;  and  shall  we  say, 
that  a  like  condition,  in  a  state  of  mania,  is  free  from  delirium  ?  I  say  that  this 
opposition  of  the  ideas,  of  the  judgment  and  affections,  to  the  actions,  in  this 
form  of  madness,  is  explained  by  the  changefulness  of  the  ideas  and  affections, 
which  induce  the  mobility,  which  itself  characterizes  the  maniacal  impulses. 
The  will  vacillates  successively  between  these  two  impressions.  Those  who 
are  thus  affected,  are  actually  drawn  away  to  the  commission  of  an  irrational 
act,  and  one  which  is  revolting  to  nature,  because  they  do  not  enjoy  the  use 
of  their  reason,  and  are  in  a  state  of  delirium.  Man  no  longer  has  the  faculty 
of  directing  his  actions,  because  he  has  lost  the  unity  of  his  mind.  He  is  the 
homo  duplex  of  St.  Paul  and  of  Buffon ;  impelled  to  evil  by  one  motive,  and 
restrained  by  another.  This  lesion  of  the  will,  may  be,  with  much  propriety, 
compared  with  an  oversight,  and  can  be  conceived  of,  as  resulting  from  the 
duplicity  of  the  brain,  whose  two  halves,  not  being  equally  excited,  do  not  act 
simultaneously.  But  it  is  invariably  true,  that  what  has  been  called  reasoning 
insanity,  mania  without  delirium,  and  maniacal  fury,  belong  rather  to  mono- 
mania or  to  lypemania,  and  that  the  acts  of  fury  and  destruction,  to  which  the 
insane  yield  themselves,  are  always  the  result  of  delirium,  however  brief  we 
may  suppose  it  to  be. 

Such  was  in  1818,  when  I  wrote  the  article  31ania,  for  the  Dictionary  of 
the  Medical  Sciences,  my  mode  of  interpreting  the  facts,  relating  to  homicidal 
mania,  published  by  Pinel,  in  his  immortal  Treatise  on  3Iania.  Since  that 
epoch,  I  have  observed  cases  of  insanity  without  delirium,  and  have  submitted 

*A  Medico-Philosophical  Treatise  on  Mental  Alienation,  2d  Edition,  Paris,,  in  8yo. 
p.  139. 


364  •  MONOMANIA. 

to  the  authority  of  facts ;  as  my  essay  on  homicidal  monomania,  inserted  in 
the  translation  of  J.  C.  Hoffbauer,*  attests.  The  cases  which  succeed,  those 
which  we  may  read  in  various  chapters  of  this  work,t  and  those  which  have 
been  collected  by  French  and  German  authors,  who  have  written  on  mental 
diseases,  and  on  legal  medicine,^  demonstrate,  that  if  the  insane,  deceived  by 
their  delirium,  hallucinations  or  illusions,  destroy  life ;  that  if,  victims  to  rea- 
soning 7nania,  they  take  life,  after  having  premeditated  and  reflected  upon  the 
homicide  that  they  are  about  to  commit ;  there  are  other  monomaniacs,  who 
slay  from  an  instinctive  impulse.  These  last,  act  without  consciousness,  with- 
out passion,  delirium  or  motive.  They  destroy,  in  consequence  of  a  blind 
and  momentary  disposition,  independently  of  the  will.  They  have  an  attack 
of  monomania  without  delirium.  Observation  demonstrates,  that  the  insane 
who  suffer  from  homicidal  monomania,  are,  now  of  a  gloomy,  melancholic, 
capricious  and  passionate  disposition ;  and  now,  remarkable  for  the  mildness 
and  excellency  of  their  morals  and  habits.  The  state  of  the  atmosphere,  cer- 
tain disorders  of  the  organs  of  nutritive  life,  over-excitement  of  the  nervous 
sensibility,  vices  of  education,  exaltation  of  the  religious  sentiment,  the  power 
of  imitation,  mortifications,  and  lastly,  extreme  misery,  are  the  exciting  causes 
of  this  malady.  To  justify  these  general  propositions,  it  will  be  sufficient  to 
present  the  following  facts,  which  I  have  taken  the  precaution  to  abridge. 
When  the  terrible  Klamsin  blows,  the  Indian,  armed  with  the  homicidal  steel, 
precipitates  himself  upon  whatever  he  meets.  The  despair,  into  which  a 
siege,  long  continued ;  a  fatal  epidemic,  or  a  shipwreck  without  hope  of  suc- 
cor, plunge  men ;  makes  homicides  of  friends,  associates  and  fellow  citizens 
who,  a  little  before,  lived  in  the  most  perfect  harmony.  A  little  girl  three 
years  of  age,  was  often  heard  to  curse  the  second  wife  of  her  father.  At  a 
later  period,  she  desires  the  death  of  her  step-mother ;  and  when  five  years 
and  three  months  old,  makes  her  first  attempts  to  destroy  the  wife  of  her  fa- 
ther. A  lady,  of  an  imagination  the  more  ardent,  in  consequence  of  her  hav- 
ing, in  very  early  life  contracted  the  habit  of  novel-reading,  and  excessively 
unhappy,  on  account  of  the  prolonged  absence  of  her  husband,  desires  to  de- 
stroy her  children,  in  order  that  they  may  not  one  day,  experience  a  like  mis- 
fortune. 

A  father  immolates  his  son  upon  a  funeral  pile,  in  obedience  to  the  voice 
of  an  angel,  who  commands  him  to  imitate  the  sacrifice  of  Abraham.  An 
officer,  whose  case  I  have  already  reported,  and  a  vine-dresser,  of  whom  Pinel 
speaks,  wish  to  regenerate  the  world  by  blood.  A  mother  slays  her  infant,  in 
order  to  make  it  an  angel.  An  unhappy  father,  a  leader  of  the  sect  of  the 
Momiers  in  Switzerland,  assisted  by  the  members  of  his  family,  causes  his 
fanatical  daughter,  to  submit  to  all  the  anguish  and  pains  of  crucifiction. 
Prohaska  slays  his  wife  and  two  children,  because  he  believes  that  an  officer 
pays  his  addresses  to  the  former.  A  saddler,  before  committing  suicide,  de- 
sires to  slay  his  wife,  in  order  that  she  may  never  belong  to  another.     A  girl 

*  Legal  Medicine  Relating  to  the  Insane,  and  to  Mutes ;  translated  from  the  German,  by 
A.  M.  Chambeyron,  with  notes  by  MM.  Esquirol  and  Itard,  Paris,  1827,  in  8vo. 

t  Suicide,  and  Homicidal  Monomania. 

X  Hufeland  und  Osann,  Journal  der  pratischen  heilkunde. — Henke,  Zeitchrift  fur  die 
staatsarznekunde. — Taufflieb,  Annals  of  public  Hygiene,  1835,  t.  iv.  p.  124. — Gall,  On 
the  Functions  of  the  Brain,  Paris,  1825,  in  8vo. — Georget,  Medical  Investigation  of  the 
Criminal  Trials  of  Legcr,  Fletmann,  Lecouffc,  Popavoine,  etc.,  Paris,  1825,  in  8vo.  Ji 
Discussion,  Together  With  a  JVew  Medico-Legal  Discussion  on  Insanity,  Paris,  1826-1828, 
2d  part,  in  8vo.  Marc,  Medico- Legal  Consultation,  With  Respect  to  the  Girl  H.  Cornier  ; 
Paris,  1826,  in  8vo.  Jinnals  of  PiiMic  Hi/giene,  and  Legal  Medicine,  t.  ii.  p.  351 ;  t. 
iv.  p.  383;  t.  x.  p.  357. — A  Bricre  :de  'Qoxsmeni,  Medico-Legal  Observations  on  Homi- 
cidal Monomania,  Paris,  1826,  in  8vo. — Cazauvieilh,  On  Homicidal  Monomania,  An- 
nals of  Public  Hygiene,  t.  xvi.  p.  121. — F.  Leuret,  Psychological  Fragments  on  Insanity, 
Paris,  1834,  in  8vo. 


MONOMANIA.  365 

named  Sthrum,  slays  her  best  friend,  to  prepare  herself  for  a  happy  death. 
A  mother  believes  herself  ruined,  and  desires  to  destroy  her  nursing  child,  in 
order  that  it  may  escape  both  disgrace  and  misery.  An  instructor  at  Edin- 
burgh, destroys  his  wife  and  five  children,  but  spares  two  pupils,  who  had 
been  committed  to  his  care.  A  similar  event  took  place  at  Amsterdam.* 
All  those  monomaniacs  of  whom  I  have  just  spoken,  suffered  from  a  partial 
delirium  ;  all  were  impelled  to  homicide  by  a  motive,  confessed  and  reflected 
upon  ;  and  the  affections  of  all,  were  perverted  or  enfeebled.  Such  was  not 
the  case  with  those  insane  persons,  who  are  the  subjects  of  the  following 
observations. 

A  woman  who  had  been  confined  ten  days  previously,  finds  herself  sudden- 
ly, and  without  motive,  agitated  by  a  desire  to  strangle  her  infant.  The  mo- 
ther of  four  children,  is  impelled  involuntarily  to  destroy  them,  and  escapes 
this  calamity,  only  by  deserting  her  house.  A  female  servant,  every  time 
that  she  undresses  for  bed,  an  infant  committed  to  her  care,  is  seized  with  an 
irresistible  desire  to  eviscerate  it.  A  mother  is  impelled  to  decapitate  that 
one  of  her  children,  whom  she  loves  with  the  greatest  tenderness.  A  woman, 
at  the  period  of  menstruation,  experiences  a  desire  to  destroy  her  husband  and 
children.  This  desire  is  most  active,  when  she  sees  them  asleep.  A  gentle- 
man reads  a  journal,  in  which  are  reported  the  details  of  the  murder  of  an 
infant.  On  the  following  night,  he  suddenly  starts  out  of  sleep,  with  a  desire 
to  slay  his  wife.  A  woman  cuts  off  the  head  of  a  child  whom  she  scarcely 
knew,  and  is  brought  to  trial  for  it.  The  trial  is  very  extensively  published, 
and  produces,  from  the  effect  of  imitation,  many  cases  of  homicidal  monoma- 
nia without  delirium.  In  this  last  series  of  facts,  the  understanding,  moral 
affections  and  will,  exercise  no  influence.  What  therefore,  is  this  formidable 
malady,  which,  sporting  with  the  tenderest  emotions  of  the  soul,  urges  man  to 
the  violation  of  the  most  sacred  of  nature's  laws,  and  leads  him  to  slay  his 
fellow  man,  and  those  who  are  most  dear  to  him  ?  These  wretched  beings  are 
not  irrational  before  committing  murder,  and  when  they  do  take  life,  are 
moved  by  no  passion  nor  motive  ;  they  are  drawn  away  instinctively.  But  if 
they  do  not  reason  incorrectly,  can  it  be  said  that  they  are  rational  ?  Can 
we  reconcile  reason  with  the  murder  of  that  being  who  is  most  dear  ?  A 
husband  slays  the  wife  whom  he  adores  ;  a  father,  the  son  in  whom  he  delights  ; 
a  mother  her  nursing  child,  and  that  one  of  her  offspring  whom  she  loves  with 
the  greatest  tenderness.  We  can  understand  this  phenomenon,  only  by 
admitting  the  suspension,  temporarily,  of  all  understanding ;  all  moral  sen- 
sibility and  volition.  The  following  fact  enables  me  more  clearly  to  under- 
stand it. 

A  man,  thirty-two  years  of  age,  tall,  of  a  spare  habit  of  body,  a  nervous 
temperament  and  mild  disposition,  has  been  carefully  educated,  and  is  a  cul- 
tivator of  the  arts.  He  had  suffered  from  a  cerebral  affection,  of  which  he 
had  been  cured  for  several  months.  He  has  been  in  Paris  for  two  months, 
and  leads  a  perfectly  regular  life.  He  enters  one  day,  the  Palais  de  Justice, 
gains  access  to  the  hall  of  the  Pas  Perdus,  throws  himself  upon  an  advocate, 
and  seizes  him  by  the  throat.  He  is  arrested,  conducted  to  prison,  and  com- 
mitted to  my  care  on  the  same  day  with  this  event.  At  my  first  visit,  which 
was  made  on  the  following  morning,  he  was  calm,  tranquil,  without  anger  or 
resentment,  and  had  slept  the  whole  night.  On  the  same  day,  he  designs  a 
landscape.  He  remembers  very  well  what  took  place,  on  the  previous  even- 
ing in  the  Palais  de  Justice,  and  speaks  of  it  with  indifference.  He  has  how- 
ever, no  recollection,  either  of  the  motives  or  circumstances  attending  the  act, 
and  entertains  no  regret  on  account  of  it.  He  replies  politely  to  my  questions, 
without  dissimulation,  and  with  the  accent  of  truth.     "  I  went  to  the  Palais  de 

*  Gall,  Functions  of  the  Brain. 


866  MONOMANIA. 

Justice,  as  I  would  have  gone  any  where  else,  to  the  Palais  Royale  or  the 
Tuileries,  like  an  idler  who  was  walking  before  me,  without  any  intention  or 
special  purpose.  Not  only  had  I  no  ill  will  towards  this  advocate,  but  he 
was  entirely  unknown  to  me  ;  nor  have  I  ever  had  any  interview  or  business 
with  any  advocate  whatever.  I  do  not  understand  how  I  could  have  met  with 
a  disaster  of  this  kind.  It  might  have  taken  place  any  where  else,  and  I 
might  have  been  directed  to  any  other  person."  On  my  remarking  to  him, 
that  nothing  but  an  instantaneous  attack  of  disease  could  explain  this  act  ; 
"  you  can  explain  it  as  you  please,"  he  says,  "  as  for  myself,  I  do  not  feel 
sick,  and  I  am  unable  to  say  how  this  incident  happened  to  me."  During  the 
three  months  that  M.  was  subject  to  my  observation,  he  was  never  for  a  mo- 
ment inconsistent  with  himself,  never  delirious,  and  never  committed  an  un- 
becoming act.  He  was  polite  and  obliging  to  all ;  amusing  himself  in  sketch- 
ing, or  reading  serious  books.  He  preferred  solitude,  but  without  affecta- 
tion. 

Sometimes,  homicidal  monomaniacs  are  agitated  by  an  internal  struggle 
between  the  impulse  to  murder,  and  the  sentiments  and  motives  that  dissuade 
them  from  it.  The  violence  of  this  struggle,  consists  in  the  strength  of  the 
impulse  on  the  one  hand,  and  the  remaining  intelligence  and  sensibility  on  the 
other.  This  is  so  true,  that  the  insane  often,  whatever  may  be  the  character 
of  the  delirium,  entertain  feeble  desires  to  commit  murder,  which  are  not 
sufficiently  active  to  require  obedience  to  them.  In  other  cases,  the  desire  to 
destroy  is  powerful,  and  is  often  renewed,  and  combated  by  the  patient. 
With  some,  the  impulse  is  more  energetic  still.  An  internal  struggle  arises, 
which  troubles  and  agitates  the  sick  person,  and  occasions  frightful  anguish. 
Finally,  with  a  small  number,  the  impulse  is  so  violent  and  instantaneous, 
that  there  is  no  struggle ;  the  act  immediately  following  the  impulse.  This 
agitation,  this  struggle,  and  these  agonies,  which  so  often  precede  homicide, 
are  the  more  energetic,  in  proportion  to  the  degree  of  intelligence  and  sensi- 
bility that  the  patient  preserves ;  as  we  have  observed,  while  studying  with 
care,  all  these  cases  of  monomania. 

Much  more  frequently  than  is  supposed,  even  by  physicians;  the  affective 
faculties  of  the  insane  are  perverted,  and  indeed,  entirely  suspended.  Men 
the  most  moral,  possessing  the  mildest  dispositions  and  the  gentlest  manners, 
and  who  were  perfectly  regular  in  their  conduct,  have  confessed  to  me,  that 
ideas  of  homicide  had  tormented  them  during  their  delirium,  particularly  at 
the  commencement  of  their  disorder.  These  deplorable  impulses  are  provok- 
ed, neither  by  hatred  nor  anger,  as  with  furious  maniacs.  They  are  on  the 
contrary,  spontaneous,  fugacious,  and  foreign  even,  to  the  habitual  delirium. 
They  are  not  produced  from  without,  either  by  conversations  or  acts.  A  for- 
mer magistrate  has  often  remarked  to  me,  that  nothing  in  the  world  would 
induce  him  to  sit  in  a  criminal  court,  after  what  he  had  himself  experienced 
during  an  attack  of  insanity.  The  same  confession  has  been  made  to  me  by 
a  young  man,  whose  social  position  requires  him  sometimes,  to  sit  in  a  court 
of  justice.  Its  persistence  and  obstinacy,  as  well  as  the  manifestation  of 
these  fatal  impulses,  sometimes  characterize  homicidal  monomania  without 
delirium. 

Homicidal  monomania  spares  no  age,  since  children  from  eight  to  ten  years 
old,  are  not  exempt  from  it.  It  is  ordinarily  periodical,  and  the  paroxysm  or 
attack,  is  preceded  by  symptoms,  which  indicate  a  general  excitement.  This 
class  of  patients  experience  colic  pains,  and  a  sensation  of  heat  in  the  bow- 
els and  chest,  attended  with  pain  in  the  head.  They  suffer  from  insomnia  \ 
the  face  becomes  red  or  very  pale,  the  skin  swarthy,  the  pulse  hard  and 
full,  and  the  body  affected  with  convulsive  tremors.  The  patient  usual- 
ly makes  an  assault,  when  no  external  occurrence  gives  rise  to  the  excess  to 
which  he  yields  himself     The  act  accomplished,  it  seems  that  the  attack  is 


MONOMANIA.  367 

over  ;  and  some  homicidal  monomaniacs,  seem  to  be  relieved  of  a  state  of 
agitation  and  anguish,  which  was  exceedingly  painful  to  them.  They  are 
composed,  and  free  from  regret,  remorse  or  fear.  They  contemplate  their 
victim  with  indifference ;  and  some  even  experience  and  manifest  a  kind  of 
satisfaction.  The  greater  part,  far  from  flying,  remain  near  the  dead  body,  or 
concur  with  the  magistrates,  by  denouncing  the  act  which  they  have  just 
committed.  A  small  number  however,  retire,  conceal  the  instrument  and 
hide  the  traces  of  the  murder.  But  very  soon,  they  betray  themselves;  or,  if 
not  seized  by  the  police,  hasten  to  reveal  the  act ;  to  relate  its  most  minute 
details,  as  well  as  the  motives  of  their  flight. 

Homicidal  monomania  should  be  treated  like  other  forms  of  monomania. 
In  those  cases  which  I  have  related,  some  patients  were  cured,  by  means 
which  acted  on  the  abdominal  organs.  With  them,  the  use  of  laxatives  and 
purgatives,  appeared  to  be  more  especially  indicated.  Monomaniacs  who 
have  accomplished  their  purpose,  are  rarely  restored  to  health.  I  have  never 
seen  one  who  had  perpetrated  a  homicide,  that  recovered  the  use  of  his  rea- 
son. In  their  treatment,  it  is  necessary  to  take  suitable  precautions,  to  pre- 
vent the  consequences  of  the  deadly  dispositions  by  which  they  are  actuated, 
both  with  respect  to  themselves  and  others. 

Mad'e  L.  has  an  uncle  who  became  insane  in  consequence  of  the  excessive 
use  of  alcoholic  drinks.  The  widow  of  a  first  husband,  who  was  a  surgeon, 
she  married  a  few  years  afterwards,  at  the  age  of  thirty-one,  and  was  admit- 
ted at  Charenton,  Feb.  26th  1837.  In  stature,  she  is  above  the  medium  size, 
her  constitution  is  strong,  and  her  head  remarkable  for  its  rotundity,  and  the 
smallness  of  its  size.  Her  hair  is  of  a  chestnut  color,  her  brows  slightly 
marked,  her  eyes,  gray  and  small,  are  fixed  and  sparkling  ;  and  her  neck,  on 
which  creep  projecting  veins,  is  short  and  large.  She  has  always  enjoyed 
excellent  health,  although  treated  for  several  syphilitic  affections  with  mercury. 

Her  conduct  has  been  very  irregular  and  disorderly;  although  reverses  of 
fortune,  and  the  abuse  of  fermented  drinks,  are  the  exciting  causes  of  her 
actual  malady,  which  began  in  a  manner  perceptible  to  all,  in  the  month  of 
June  1836.  She  has  always,  however,  had  a  proud  and  intractable  disposi- 
tion ;  an  aversion  to  labor  ;  a  relish,  from  early  life,  for  blood,  and  for  meat, 
which  she  sometimes  eats  raw.  Long  since,  she  felt  herself  irresistibly  inclin- 
ed to  homicide,  in  order  to  shed  blood.  She  has  been  seen  to  cut  in  pieces, 
with  an  expression  of  joy,  birds  or  other  animals  which  fell  into  her  hands. 
Marriage  did  not  modify  this  horrible  instinct.  She  abandoned  her  first  hus- 
band, to  run  away  with  a  young  man,  and  at  a  later  period  gave  herself  up  to 
the  first  comer. 

She  began  to  furnish  evident  indications  of  delirium  one  year  since.  Four 
months  subsequently,  the  most  furious  mania  burst  forth,  and  she  broke  and 
tore  in  pieces,  every  thing  within  her  reach,  and  gave  herself  up  to  the  com- 
mission of  acts  of  violence,  particularly  against  her  neighbors.  After  having 
spent  the  months  of  December  and  January,  in  the  hospital  of  Montreuil, 
Chalons-sur-Marne,  her  condition  not  improving,  they  brought  her  to  the 
residence  of  her  mother,  with  the  hope  that  the  tender  cares  of  her  relatives, 
would  modify  this  mortal  perversion.  The  first  days  pass  off"  without  a  storm. 
A  new  position,  the  civilities,  and  proofs  of  tenderness  and  devotion  which 
were  displayed,  seemed  to  have  soothed  her  delirium.  But  exigences  increas- 
ing, which  could  not  be  met,  she  soon  became  an  object  of  terror  to  her  mo- 
ther and  neighbors,  whom  she  overwhelms  with  insults  and  threats.  Since  her 
seizure,  she  has  had  several  paroxysms,  during  which,  she  is  noisy  and  furious  ; 
breaks  every  thing  in  pieces,  and  permits  herself  to  be  accosted  by  no  one. 
Her  looks,  gestures  and  menaces,  inspire  fear.  She  repeats  that  a  crime  must 
be  committed  ;  and  that  she  must  slay  her  mother,  and  all  who  approach  her. 
The  human  race  must  die,  and  the  earth  be  inundated  with  blood.     She  has 


368  MONOMANIA. 

hallucinations  of  sight  and  hearing  ;  she  sees  blood  running,  which  excites 
her  ;  she  hears  voices  that  applaud  her  furious  conduct,  and  this  arouses  her 
to  crime.  When  composed,  if  any  one  converses  with  her  respecting  her  un- 
fortunate propensities  ;  far  from  denying  them,  or  being  affected  or  irritated 
on  account  of  them  ;  she  replies  in  a  firm  tone,  and  with  words  energetically 
articulated  ;  raising  her  hand  at  the  same  time  to  her  brow  ;  "  Such  as  this 
head  is,  good  or  bad,  you  will  not  alter  it.  Such  is  my  organization  ;  never, 
never  will  you  make  me,  other  than  I  am  ;  in  no  respect  more  rational. 
Whatever  your  power  ;  neither  your  cells,  your  quieting  chairs,  nor  your 
douches  will  modify  my  will.  Besides,  I  am  content  with  my  mode  of  ex- 
istence." She  enjoys  excellent  physical  health  ;  but  has  sometimes  a  little 
pain  in  the  head,  and  heat  in  the  occipital  region  ;  is  awoke  out  of  sleep  by 
surprise,  and  with  a  desire  to  run  about.  Menstruation  is  regular ;  but 
each  menstrual  epoch  is  marked  by  an  exasperation  of  all  the  symptoms. 
Cooling  and  laxative  drinks,  tepid  baths  long  continued,  cold  water  to  the 
head,  and  a  purgative  from  time  to  time,  are  highly  proper  ;  entire  separation 
also,  from  all  her  relatives,  the  patient  sometimes  requires.  Such  are  the 
means  employed  to  combat  this  terrible  malady,  which  impels  this  wretched 
woman  to  commit  murders,  even  the  murder  of  those  whom  she  most  tenderly 
loves. 

M.  P.,  thirty-two  years  of  age,  single,  educated  as  a  pharmaceutist,  is  of 
medium  size,  of  a  strong  constitution,  and  sanguine  temperament.  His  hair 
is  chestnut  colored,  eyes  blue,  head  large,  neck  short  and  large,  and  the 
shoulders  broad.  Whilst  a  student,  he  was  remarkable  for  his  intelligence, 
and  for  the  variableness  of  his  disposition.  Now,  he  wished  to  be  a  soldier  ; 
now,  a  seminarist ;  and  now,  he  aspired  to  the  chief  places  in  society.  He 
was  fond  of  reading  philosophical  treatises  ;  and  particularly,  theological  writ- 
ings. On  leaving  college,  he  was  placed  with  a  pharmaceutist,  where  his 
conduct  was  without  reproach,  and  his  labors  diligent.  Shortly  after,  without 
any  known  cause,  certain  irregularities  in  his  character  were  observed.  He 
abused  the  confidence  that  had  been  reposed  in  him,  became  disgusted  with 
his  profession,  and  manifested  a  desire  to  become  an  ecclesiastic.  Indifferent 
and  disgusted  with  every  thing,  he  abandoned  himself  to  idleness.  At  length 
he  left  Paris,  for  the  purpose  of  visiting  his  relatives,  but  instead  of  going  to 
them,  he  ran  about,  here  and  there,  in  the  country,  without  any  object,  and 
in  such  a  state  of  excitement,  that  he  was  arrested  and  sent  to  the  Bicetre ; 
where  he  passed  several  days,  and  was,  at  length,  transferred  to  Charenton. 
During  the  first  months  of  his  residence  in  that  establishment,  he  is  composed, 
and  his  conversation  scarcely  betrays  the  disorder  that  pervades  his  thoughts. 

After  this  time,  agitation  supervened  ;  and  certain  emotions  indicative  of 
pride,  manifested  themselves.  He  is  a  grand  seignior,  prince,  etc, ;  he  also 
boasts  of  his  excellencies.  At  a  later  period,  he  becomes  the  prey  of  various 
hallucinations.  During  the  night,  there  once  appeared  to  him,  a  colossal 
angel  ;  who,  after  having  taken  from  Napoleon  his  crown,  advances  majesti- 
cally, and  places  it  upon  his  head.  At  a  later  period  still,  he  has  intercourse 
with  heaven.  He  affirms  that  he  is  a  new  Christ,  and  pretends,  in  order  to 
establish  his  divine  power,  that  he  possesses  the  ability  to  perform  miracles, 
and  often  exercises  it.  He  controls  the  thunder,  and  holds  the  guardianship 
of  the  weather.  He  is  superior  to  the  physical  wants  of  humanity,  and  can 
live  for  an  indefinite  period  without  food.  He  tells  us,  from  time  to  time,  that 
he  must  be  crucified,  and  that  he  shall  fast  for  forty  days  ;  and  with  this 
conviction,  he  has  more  than  once,  obstinately  refused  food,  and  we  have 
been  obliged  to  have  recourse  to  the  oesophagean  tube  ;  to  the  introduction  of 
which,  he  yields  without  resistance.  For  several  months  past,  he  has  ex- 
perienced a  very  strong  inclination  to  suicide  and  homicide  ;  and  for  this 
double  reason,  requires  the  most  careful  supervision. 


MONOMANIA.  369 

Twice  he  has  been  discovered  in  a  dying  state,  having  hung  himself  by 
means  of  his  cravat ;  and  violent  impulses  to  suicide  are  constantly  operating 
upon  ftis  mind.  The  physicians  of  the  establishment,  in  particular  the  physi- 
cian-in-chief, must  be  his  victims,  and  he  has  thrown  himself  upon  them,  on 
four  different  occasions,  with  a  precipitation  and  fury,  difficult  to  oppose.  If 
I  ask  the  reason  for  these  acts  of  violence,  he  replies  in  a  calm  and  affected 
tone,  that  they  compel  him  to  smite  them  ;  and  that  I  myself,  have  for  two 
years  past,  provoked  him  to  fall  upon  and  destroy  me.  Sometimes  he  adds, 
that  we  shall,  and  must  release  him,  and  that  it  is  necessary  for  him  to  slay 
some  one,  in  order  that  he  may  be  slain  in  turn.  Previous  to  this  period,  his 
impulses  to  murder,  were  not  directed  against  the  other  patients  nor  the  ser- 
vants. He  does  not  constantly  experience  this  cruel  impulse,  and  his  physi- 
ognomy is  calm  and  tranquil.  He  often  smiles  ;  but  his  smile  is  a  bitter  one. 
He  testifies  some  regret ;  but  announces,  that  at  a  determinate  epoch,  he  must 
administer  the  cup ;  must  smite  M.  Esquirol ;  and  close  the  scene  with  the 
sacrifice  of  his  own  person.  He  writes  much,  but  his  writings  are  a  confused 
succession  of  sentences,  religious,  philosophical  and  political  ;  the  sentiments 
of  each  of  which,  are  properly  connected.  With  these  sententious  phrases 
are  blended,  and  often  recur,  the  following  words;  "/«?«  man,  God,  Napo- 
leon, Kohespierre  altogether. — I  am  Robespierre,  a  monster,  I  must  be  slain;" 
and  elsewhere  ;  I  know  not  in  fact,  why  God  desires  me,  by  all  means,  to 
exterminate  every  body. 

In  the  midst  of  these  terrible  thoughts,  he  sometimes  maintains  an  appear- 
ance of  reason,  which  is  calculated  to  deceive.  He  converses  even,  in  a  con- 
nected manner,  and  amuses  himself  in  reading  and  writing ;  but  his  look 
betrays  a  want  of  confidence,  and  his  lips  quiver.  His  smile  is  sardonic,  and 
he  demands  his  liberty,  in  a  tone  which  manifests  his  deplorable  inclinations. 
Finally  ;  the  functions  of  assimilative  life  are  executed  in  a  proper  manner  ; 
his  habit  is  quite  full ;  his  sleep  is  usually  peaceful ;  and  he  eats  with  a 
relish,  when  some  odd  notion  does  not  determine  him  to  abstain  from  all  food. 
Baths,  douches,  purgatives  and  leeches  ;  employed  methodically,  and  at  diffe- 
rent intervals,  have  in  no  respect  modified  this  malady.  We  have  not  been 
more  successful  with  gentleness,  kindness,  and  all  our  interest,  in  overcoming 
the  fatal  dispositions  of  this  wretched  being,  who  was  admitted  at  Charenton, 
June  9th,  1835.  We  perceive,  in  the  two  cases  we  have  just  been  reading, 
two  individuals  of  difterent  sexes,  born  with  perverse  inclinations,  and  a  de- 
praved nature.  These  dispositions,  and  this  character,  not  having  been  im- 
proved by  education,  have,  at  the  age  when  the  passions  first  unfold  them- 
selves, gained  the  mastery  over  the  understanding,  and  led  astray  the  reason 
and  conduct,  to  homicidal  monomania. 

A  little  girl  is  sent  to  nurse  for  thirteen  months,  in  the  country,  two  leagues 
from  Paris.  She  is  afterwards  placed  in  charge  of  her  grandmother,  an  aged 
woman,  respectable  and  religious.  At  the  age  of  seven  years  and  a  half,  she 
is  brought  back  to  Paris,  and  spends  some  months  with  her  father  and  mother. 
This  child  is  very  sad  ;  never  plays,  laughs  nor  weeps  ;  but  always  sits  in  a 
chair,  her  hands  crossed,  and  if  the  eye  of  her  mother  is  turned  from  her, 
abuses  her  own  person.  She  is  taught  to  read,  sew  and  knit ;  but  attends 
reluctantly,  to  instruction  relating  to  them.  Her  stature  is  three  feet  five 
inches  ;  her  hair  is  a  light  chestnut  color  ;  her  eyes  black  and  lively,  and  she 
has  a  snub  nose.  Her  mouth  is  small ;  her  cheeks  are  plump  and  rosy  ;  and 
her  physiognomy  agreeable  and  intellectual.  From  the  age  of  four  years,  this 
child  was  accustomed  to  indulge  in  the  practice  of  onanism,  with  little  boys 
from  ten  to  twelve  years  of  age  ;  and  her  removal  from  these  boys^  is  the 
cause  of  her  sadness.  Unless  they  maintain  a  constant  watch  over  her,  she 
indulges  alone,  in  the  same  practices.     The  attentions  of  her  mother,  reli- 

47 


370  MONOMANIA. 

gious  instruction,  and  the  advice  of  a  physician,  do  not  succeed  in  overcom- 
ing this  fatal  habit.  Her  mother  falls  sick  in  consequence  of  her  grief,  and 
this  unfortunate  little  girl  expresses  regret,  only  because  she  is  not  dead?  Had 
her  mother  died,  she  would  have  inherited  her  wearing  apparel  ;  would  have 
refitted  it  to  her  own  person,  and  thus  have  gone  abroad  in  pursuit  of  men. 
If  she  had  not  destroyed  her  mother  during  her  illness,  it  was  because  a 
watch  had  been  set  to  prevent  her  from  doing  it.  But,  said  her  mother  to 
her,  if  I  should  die  to-day,  I  should  rise  again  to-morrow.  Our  Lord  rose 
from  the  dead. — I  know  full  well,  replied  the  child,  that  when  one  dies,  he 
returns  no  more.  Our  Lord  was  raised  from  the  dead,  because  he  was  the 
great  God.  My  little  sister  and  brother  have  never  come  back  from  the  grave. 
— But  how  would  you  take  my  life,  asks  her  mother. — If  I  were  in  a  wood,  I 
would  secrete  myself;  cause  you  to  fall  by  means  of  your  dress,  and  then 
bury  a  poniard  in  your  breast.  Do  you  know  what  a  poniard  is  ?  A  gentle- 
man left  a  book,  in  which  it  was  related,  that  a  woman  sheathed  a  poniard  in 
the  heart  of  a  man.  This  book  had  actually,  by  mistake,  been  left  in  the 
house.  But  if  you  should  kill  me,  says  her  mother  to  her,  what  I  have, 
would  belong  to  your  father. — I  am  well  aware  of  that,  and  my  father  would 
cause  me  to  be  put  in  prison  ;  but  I  wish  to  take  his  life  also.  This  little 
girl  has  often  said  since,  that  she  loved  neither  her  father  nor  mother,  nor  her 
grandmother  who  brought  her  up. 

Some  months  subsequently,  on  the  occasion  of  the  murder  of  a  child,  the 
little  girl  says  to  her  mother  ;  if  I  should  kill  you  with  a  knife,  I  should 
have  blood  upon  my  garments,  and  it  would  be  seen  ;  but  I  should  be  care- 
ful to  undress  myself  before  committing  this  act.  Eight  days  afterwards,  she 
says  that  she  had  thought,  in  order  that  she  might  have  no  blood  upon  her 
clothing,  she  should  employ,  to  kill  her  mother,  the  same  poison  that  they 
were  accustomed  to  scatter  upon  the  grain  in  the  fields.  A  neighbor,  wishinor 
to  test  the  feelings  of  this  wretched  child,  puts  a  paste  formed  from  the  finest 
flour  in  wine,  saying  that  it  was  arsenic,  and  offers  it  to  the  child,  who  ex- 
claims ;  I  should  like  very  much  to  give  it  to  my  mother,  but  do  not  wish 
to  take  it  myself  She  shuts  her  teeth  and  lips  closely,  when  they  endeavored 
to  make  her  swallow  it.  Such  was  the  moral  state  of  this  little  girl,  at  the 
age  of  eight  years,  when  she  was  brought  before  a  justice  of  the  peace,  who 
questioned  her,  in  the  absence,  as  well  as  in  the  presence  of  her  mother. 
Some  months  later,  she  was  interrogated  a  second  time. 

Our  learned  and  respectable  associate,  Doctor  Parent-Duchatelet,  a  victim 
to  his  zeal  in  behalf  of  humanity,  and  too  soon  removed  for  the  welfare  of 
science  and  the  happiness  of  his  friends ;  reports  this  case  with  all  its  details,* 
and  wrote  the  following  note  respecting  it.  "  This  little  girl  was  placed  in 
a  convent,  through  the  instrumentality,  and  at  the  expense  of  the  administra- 
tion. Some  months  after  her  admission,  she  suffered  from  a  pedicular  disease. 
She  was  brought  to  her  mother,  and  when  cured,  entered  again  the  house,  in 
which  the  public  authority  had  placed  her.  She  was  a  second  time  removed, 
in  consequence  of  extreme  prostration,  which  it  was  believed,  presented  the 
symptoms  of  scurvy.  Admitted  anew  to  the  convent,  she  received  a  sort  of 
education,  which  consisted  in  labor  with  the  hands ;  there  first  partook  of  the 
communion,  and  was  discharged,  at  the  expiration  of  several  years.  This 
girl  has  now,  December,  1831,  at  the  age  of  fourteen  years,  been  placed  as 
an  apprentice,  with  a  polisher  of  jewels.  She  is  adroit  in  the  use  of  her 
hands,  but  knows  not  how  to  read  or  write.  She  visits  her  mother  every  Sab- 
bath, and  spends  the  evening  with  her  ;  conducts  tolerably  well,  is  very  sub- 
missive, and  never  speaks  of  her  previous  life.     She  is  however,  at  all  times, 

*   Annals  of    Public    Hygiene  and  Legal  Medicine,    Paris,  1332,  t.    vii.   p.   173   and 
following. 


MONOMANIA.  371 

sad  and  taciturn,  and  never  plays  or  amuses  herself.  She  complains  of  the 
rude  manner  in  which  she  was  treated  at  the  convent ;  and  her  mother  is  of 
the  opinion  that  she  still  persists  in  the  habit  of  onanism." 

On  the  7th  June,  1835,  I  was  consulted  in  behalf  of  a  little  girl,  seven  and 
a  half  years  of  age,  of  ordinary  stature,  having  a  pale  skin,  an  abundant  and 
thick  growth  of  hair,  of  a  blond  color,  her  eyes  of  a  deep  blue,  and  the  upper 
lip  slightly  tumefied,  but  presenting  no  symptom  of  scurvy.  Her  physiog- 
nomy has  an  expression  of  deceit ;  and  her  eyes  are  often  turned  towards  the 
internal  angle  of  the  orbit,  which  gives  to  her  countenance,  otherwise  pale,  a 
convulsive  aspect.  Her  understanding  is  well  developed,  and  although  the 
daughter  of  a  laborer,  she  has  learned  to  read  and  write.  She  was  trying  to 
read  the  title  of  a  book,  lying  upon  my  desk,  while  her  mother-in-law  was  giv- 
ing me  the  following  account ;  for  at  first,  the  little  one  would  neither  speak 
to  me,  nor  reply  to  my  questions.  She  listened  to  the  statement  of  her  mo- 
ther with  the  most  perfect  indifference ;  as  if  it  had  reference  to  another  indi- 
vidual. "  I  married  my  husband  as  his  second  wife,  when  this  little  girl  was 
two  years  of  age.  We  sent  her  to  live  with  her  grand-parents,  who  were 
much  displeased  at  my  marriage  with  their  son,  and  often  expressed  their  dis- 
satisfaction in  presence  of  their  grand-daughter.  The  child  was  five  years 
old,  when  my  husband  and  myself  went  to  visit  his  parents.  They  received 
me  kindly ;  but  the  child,  who  testified  great  satisfaction  on  seeing  her  father, 
almost  refused  my  caresses,  and  would  not  embrace  me.  Nevertheless,  she 
returned  with  us  to  Paris.  Every  time  an  opportunity  offered  however,  she 
was  accustomed  to  scratch  and  strike  me,  saying ;  I  hope  you  will  die.  When 
she  was  five  years  and  three  months  old,  I  was  pregnant,  and  she  kicked  me 
in  the  abdomen  ;  at  the  same  time  expressing  a  like  wish.  We  sent  her  back 
to  her  grand-parents,  where  she  remained  for  two  years  more.  On  returning 
to  us,  at  the  age  of  seven  years  and  four  months,  she  began  again  to  abuse 
me,  and  is  incessantly  repeating,  that  she  heartily  wishes  that  I  may  die,  as 
well  as  her  little  brother,  who  was  nursed  abroad,  and  whom  she  had  never 
seen.  Not  a  day  passes,  on  which  she  does  not  strike  me.  If  I  stoop  down 
before  the  fire  place,  she  strikes  me  in  the  back,  in  order  to  cause  me  to  fall 
into  the  fire.  She  beats  me  with  her  fist,  sometimes  seizes  the  scissors, 
knives,  or  other  instrument  that  may  fall  in  her  way,  always  accompanying 
her  abusive  treatment  with  the  same  remark ;  I  wish  I  could  kill  you.  Her 
father  has  often  corrected  her,  and  I  have  not  unfrequently  opposed  him,  but 
the  child  has  never  expressed  a  willingness  to  abandon  her  design.  Her 
father  once  threatened  to  have  her  imprisoned.  That,  she  replied,  will 
not  save  my  mother  and  little  brother  from  death,  nor  prevent  me  from 
destroying  them.  After  this  account,  which  the  child  heard  with  coldness, 
I  addressed  her  the  following  questions.  Her  replies  were  made  without  bit- 
terness or  anger ;  and  with  composure  and  indifference.  Why  do  you  wish 
to  kill  your  mother  ?  Because  I  do  not  love  her.  Why  do  you  not  love  her  ? 
I  do  not  know.  Has  she  treated  you  ill  ?  No.  Is  she  kind  to  you  ?  Does 
she  take  care  of  you '?  Yes.  Why  do  you  beat  her?  In  order  to  kill  her. 
How  !  In  order  to  kill  her  ?  Yes,  I  desire  that  she  may  die.  Your  blows 
cannot  kill  her  ;  you  are  too  young  for  that.  I  know  it.  One  must  suffer,  to 
die.  I  wish  to  make  her  sick,  so  that  she  may  suffer  and  die,  as  I  am  too 
small  to  kill  her  at  a  blow.  When  she  is  dead,  who  will  take  care  of  you? 
I  do  not  know.  You  will  be  poorly  taken  care  of,  and  poorly  clothed,  unhap- 
py child  !  That  is  all  one  with  me  ;  I  will  kill  her ;  I  wish  her  dead.  If  you 
were  large  enough,  would  you  kill  your  mother?  Yes.  Would  you  kill  your 
grand-mother,  (she  is  the  mother  of  the  young  woman,  and  is  present  at  the 
consultation)  ?  No.  And  why  would  you  not  kill  her  ?  I  do  not  know. 
Do  you  love  your  father  ?  Yes.  Do  you  wish  to  kill  him  ?  No.  Notwith- 
standing he  punishes  you  ?     That  is  all  the  same,  I  will  not  kill  him.     Al- 


372  MONOMANIA. 

though  your  father  scolds  and  beats  you,  will  you  still  love  him  ?  Yes.  Have 
you  a  little  brother  ?  Yes.  He  has  been  sent  abroad  to  nurse,  have  you  ever 
seen  him  ?  Yes.  Do  you  love  him  ?  No.  Do  you  wish  that  he  may  die  ? 
Yes.  Do  you  want  to  kill  him  ?  Yes.  I  have  asked  father  to  bring  him 
home  from  his  nurse,  in  order  to  kill  him.  Why  do  you  not  love  your  mother  I 
I  know  nothing  about  it.  I  hope  she  will  die.  Where  did  you  get  such 
dreadful  thoughts?  My  grand-parents  and  aunt,  were  accustomed  often  to 
say,  that  my  mother  and  little  brother  must  die.  But  is  that  possible  ?  Yes, 
Yes.  I  wish  to  say  no  more  about  my  plans.  I  will  take  care  of  them,  until 
I  am  grown  up. 

This  conversation  lasted  an  hour  and  a  half  The  coolness,  composure  and 
inditference  of  the  child,  excited  in  my  mind  the  most  painful  emotions.  The 
step-mother  of  this  little  girl  is  young,  her  physiognomy  mild,  and  her  tone 
and  manners  are  agreeable.  She  dwells  in  the  neicrhborhood  of  the  Garden 
of  Plants,  and  enjoys  a  good  reputation,  as  well  as  her  husband.  By  my  ad- 
vice, this  child  was  sent  into  the  country,  to  the  residence  of  some  nuns, 
where  she  passed  three  months.     Her  grand-parents  have  again  taken  her. 

This  case  is  remarkable  in  more  than  one  respect. 

1.  For  the  fixedness  of  the  desire  to  destroy  her  step-mother,  on  the  part 
of  a  little  girl,  eight  years  of  age,  who  had  nothing  to  complain  of,  according 
to  her  own  confession. 

2.  On  account  of  the  age,  at  which  this  deplorable  disposition  was  devel- 
oped. The  grand-parents  of  this  little  girl,  dissatisfied  with  the  marriage  of 
their  son,  express  their  displeasure  by  violent  language,  without  foreseeing 
the  effect,  which  these  sentiments  may  produce  upon  the  mind  of  a  little 
child,  from  two  to  five  years  old.  What  a  lesson  to  parents,  who  know  not 
how  to  restrain  themselves,  either  in  their  language  or  actions,  in  the  presence 
of  their  children,  whose  minds  and  hearts  they  corrupt  from  their  earliest  in- 
fancy. 

On  the  15th  of  June,  1834,  in  the  little  village  of  Bellesme,  the  dead  body 
of  a  little  child  is  taken  from  a  well.  Two  days  subsequently,  they  take  from 
the  same  well,  a  child  of  two  years  and  a  half.  A  girl  eleven  years  of  age, 
known  in  the  country  by  her  very  bad  habits,  never  met  children  younger 
than  herself,  without  beating  them,  or  tormenting  them  in  a  thousand  cruel 
ways.  This  little  girl  had  enticed  these  two  infants  successively  to  the  well, 
and  pushed  them  in.  These  three  cases  are  pregnant  with  meaning.  Was 
it  not  the  want  of  a  due  degree  of  moral  and  intellectual  development,  and 
the  vicious  education  of  these  three  little  girls,  that  deprived  them  of  the  dis- 
cernment necessary  to  appreciate  the  horrid  nature  of  the  acts  which  they 
committed?  Did  not  the  habit  of  onanism,  contracted  at  the  age  of  four  years, 
impair  their  developments  in  the  case  of  the  first?  Did  not  the  inconsider- 
ate conversation  of  the  grand-parents  make  a  profound  and  fatal  impression 
upon  the  mind  and  heart  of  the  subject  of  the  second  case?  As  for  the 
third,  nothing  corrected  the  habits  of  wickedness,  contracted  in  infancy. 

A  vine-dresser,  thirty-five  years  of  age,  formerly  a  gunner,  tall  and  slender, 
of  a  bilious-nervous  temperament  and  a  melancholy  disposition,  is  subject  to 
frequent  attacks  of  epistaxis,  and  loses  much  blood  in  consequence  of  it. 
Exposed  to  the  heat  of  a  summer's  sun,  the  nasal  hemorrhages  are  suppressed. 
Since  that  period,  for  about  a  month,  he  has  suffered  from  cephalalgia,  and 
sadness ;  and  abandoned  his  labor.  At  a  later  period,  the  patient  thinks 
that  he  has  been  accused  of  committing  crimes ;  is  filled  with  despair, 
and  tries  to  hang  himself  He  is  bled  from  the  foot  and  arm.  He  afterwards 
becomes  furious  ;  and  during  his  delirium,  endangers  the  lives  of  several 
members  of  his  family.  He  renews  his  attempts  to  destroy  himself  on  several 
occasions,  and  is  brought  to  Charenton  June  7th,  1837.  At  the  time  of  his 
arrival,  the  patient  is  suffering  from  a  general  delirium.     His  physiognomy  is 


MONOMANIA.  373 

expressive  of  terror  ;  his  agitation  continual  ;  and  during  the  intervals  of 
composure,  the  patient  is  sad,  gloomy  and  silent.  All  at  once,  he  thinks  he 
sees  enemies  in  those  persons  who  surround  him,  and  hears  a  voice  which  is 
frequently  saying  to  him  ;  "  Deliver  thyself  from  these  enemies."  His  coun- 
tenance was  then  very  much  flushed,  and  his  eyes  injected.  Suddenly,  and 
without  any  provocation,  he  gives  his  neighbor  several  blows  with  his  night 
vessel ;  throws  himself  upon  him  ;  and  would  have  killed  him,  had  not  the 
attendants  ran  to  his  relief  The  patient  immediately  becomes  composed, 
and  replies  to  the  reproaches  which  they  utter,  that  his  two  brothers  appear- 
ed to  him,  and  told  him  to  get  clear  of  this  neighbor,  who  wished  to  injure 
him.  On  the  day  after  this  attack,  he  remembered  nothing  of  what  had  pass- 
ed the  evening  previous.  He  makes  several  attempts  to  murder  different  at- 
tendants, during  his  stay  in  the  establishment.  In  the  intervals  of  the  parox- 
ysms of  panophobia  and  fury,  he  was  peaceful,  gave  an  account  of  his  condi- 
tion, and  the  motives  of  these  fatal  impulses.  He  sometimes  demanded  that 
they  should  put  upon  him  the  camisole,  in  order  to  prevent  the  calamities  he 
might  cause,  although  it  would  greatly  irritate  him  to  be  thus  confined.  I 
learn  from  the  patient,  that  he  has  been  subject  to  epistaxis,  and  that  it  was 
suppressed  before  his  illness.  I  ordered  the  application  of  leeches  to  the  en- 
trance of  either  nostril,  without  discontinuing  the  use  of  baths,  cold  lotions 
to  the  head,  and  laxative  drinks.  The  application  of  leeches,  repeated  for 
twelve  days,  provoked  on  the  thirteenth  a  nasal  hemorrhage.  On  the  four- 
teenth day,  he  had  a  very  abundant  epistaxis,  which  was  renewed  the  same 
and  the  following  days.  The  patient,  who  felt  before  these  hemorrhages,  a 
painful  constriction  at  the  root  of  the  nose,  found  himself  relieved  of  this 
symptom,  free  from  the  head-ache,  and  restored,  almost  spontaneously,  to  the 
use  of  his  reason. 

M.  de  L.,  a  captain  of  infantry,  thirty-four  years  of  age,  has  a  very  strong 
constitution.  His  stature  is  above  the  medium  size  ;  his  hair  and  eyes  are 
black ;  his  complexion  slightly  sallow,  and  his  face  flushed.  He  has  an 
extremely  kind  disposition,  and  is  very  friendly  towards  his  inferiors.  His 
manners  are  mdd  and  his  conduct  regular.  In  consequence  of  a  thwarted 
inclination,  he  becomes  sad,  and  more  solitary.  After  the  lapse  of  some 
weeks,  he  suffers  from  delirium,  is  furious,  and  at  a  later  period,  thinks  that 
he  has  received  from  heaven,  a  commission  to  convert  men.  During  an 
attack  of  fury,  which  bursts  forth  spontaneously,  he  strikes  upon  the  head,  the 
physician  of  the  military  hospital,  where  he  is  at  first  treated.  After  the  dis- 
ease had  continued  for  six  months,  he  was  sent  to  Charenton.  At  the  time  of 
his  admission,  he  appears  slightly  excited,  his  countenance  is  very  much 
flushed,  and  his  eyes  injected.  After  some  days  however,  the  patient  becomes 
agitated,  and  pretends  to  be  endowed  with  prodigious  strength  :  he  is  Achil- 
les ;  breathing  forth  strength  and  courage.  Some  days  subsequently,  before 
any  thing  had  betrayed  his  disposition  to  fury,  he  leaves  his  bed  during  the 
night,  and  cries  with  a  stentorian  voice  ;  "  This  is  the  day  of  vengeance." 
He  arms  himself  with  a  pewter  pot,  and  strikes  the  attendant  who  was  near 
him,  three  blows  with  it  upon  the  head,  and  would  have  killed  him  at  that 
instant,  if  they  had  not  run  to  his  aid.  As  it  was,  he  died  a  few  days  after, 
from  the  injury  he  had  received.  From  that  moment,  his  agitation,  and  ef- 
forts to  free  himself  from  the  restraints  that  had  become  necessary  ;  his 
cries,  threats  and  fury,  successively  increase.  He  believes  that  he  has  been 
called  of  God  to  regenerate  the  human  race,  by  the  baptism  of  blood.  Al- 
ready he  has  slain  twenty  millions  of  persons,  whom  he  has  regenerated. 

Belphigos  is  the  celestial  being  under  whose  influence  he  acts.  At  each 
visit  he  repulses  the  questions  relative  to  his  health  ;  assuring  us  that  he  was 
never  better,  and  that  he  has  no  need  either  of  a  physician,  or  of  remedies. 
He  often  invites  me  with  composure,  and  with  the  accent  of  kindness,  to  ap- 


374  MONOMANIA. 

proach  hira.  "  Approach  that  I  may  cut  off  your  head ;  it  is  the  way  to  in- 
sure your  future  well-being."  What  he  said  to  me,  he  was  accustomed  to 
say  to  my  colleagues,  as  well  as  to  the  attendants.  This  wretched  man  had, 
at  times,  a  sentiment  of  his  state,  and  deplored  his  av/ful  condition.  These 
ideas,  althougli  dominant  and  habitual,  were  not  so  exclusive,  as  to  prevent 
his  manifesting,  for  brief  periods,  some  traces  of  maniacal  incoherence.  At 
times,  he  utters  frightful  howls ;  seeking  to  tear  in  pieces,  and  to  bite  what- 
ever may  be  within  his  reach  Sometimes  also,  he  weeps.  There  were 
intervals  of  several  hours  duration,  when  he  was  composed  and  rational.  Al- 
though supporting  with  the  greatest  impatience  the  camisole,  which  had  been 
rendered  necessary,  to  prevent  the  effects  of  his  fatal  impulses  ;  and  although 
lie  made  violent  efforts  to  free  himself  from  it ;  he  felt  the  necessity  for  its 
employment,  and  was  sometimes  reconciled  to  it.  Derivatives  acting  upon  the 
intestinal  canal,  in  conjunction  with  baths,  and  sanguine  evacuations,  were 
the  basis  of  treatment.  Several  times,  the  diarrhoea  which  tbllowed  the  ad- 
ministration of  purgatives,  obliged  us  to  suspend  their  employment.  Not- 
withstanding the  most  anxious  cares,  and  the  most  active  treatment,  the  pa- 
tient lost  flesh  with  frightful  rapidity.  He  suffered  from  a  degree  of  debility, 
for  which  we  were  unable  to  account.  During  the  last  days  of  his  life,  very 
abundant  mucous  evacuations  took  place,  which  it  was  impossible  to  arrest ; 
yet  the  delirium  did  not  change  its  character.  The  v.hole  body,  suddenly 
assumed  an  icteric  hue.  Two  days  in  succession,  in  the  morning,  he  suffer- 
ed from  a  chill,  which  was  succeeded  by  an  abundant  perspiration.  The 
tongue  and  teeth  were  coated  with  fuliginous  matter ;  the  nostrils  were  cover- 
ed with  a  fine  powder  ;  the  respiration  was  laborious  ;  and  the  patient  died, 
Nov.  26th,  1827,  about  one  year  after  the  invasion  of  the  malady. 

Necroscopy .  The  serous  fluid  contained  in  the  arachnoid  cavity,  in  the 
lateral  ventricles,  and  the  medullary  substance  of  the  brain  itself,  presents, 
with  varying  shades,  the  sallow  hue  of  the  integument.  The  gray  substance 
is  slightly  injected.  The  serous  membrane  of  the  ventricles  is  sensibly  granu- 
lated. The  right  lung  is,  to  a  great  extent,  hepatized.  There  exist  cellular 
adhesions,  between  the  pleura;  costalis  and  pulmonalis.  The  left  lung  and  its 
membranes  are  perfectly  healthy.  The  liver  is  voluminous  and  yellow.  The 
gall  bladder  contains  a  black,  viscous  and  thickened  fluid,  and  encloses  seve- 
ral jagged  calculi  of  moderate  size.  The  intestines  appear  externally,  reddish 
and  injected.     The  spine  is  in  its  normal  state. 

M.  D.,  thirty  years  of  age,  is  small  in  stature,  with  blond  hair,  blue  eyes, 
and  an  ordinary  fullness  of  habit.  At  the  age  of  sixteen,  he  was  suddenly 
seized  with  religious  lypemania,  and  sent  immediately  to  Senegal,  where  he 
was  cured,  at  the  expiration  of  six  months.  When  nineteen,  he  had  a  second 
attack,  which  persisted  for  a  year,  when  he  returns  to  France.  At  twenty-two 
he  marries,  and  is  excessively  jealous,  even  of  his  father-in-law;  reproaching 
his  wife,  for  preferring  her  father  to  her  husband.  Nevertheless,  he  continues 
his  trade  as  a  saddler,  and  enjoys  good  health,  until  thirty  years  of  age.  At 
this  epoch,  he  has  a  third  attack  of  lypemania,  characterized  by  a  fear  of  eter- 
nal condemnation,  by  extreme  jealousy,  and  by  several  attempts  to  commit  sui- 
cide. The  patient  is  sent  to  Charenton,  refuses  to  speak  or  to  move,  and  re- 
jects every  variety  of  food.  After  a  sanguine  evacuation,  a  sinapism  to  the 
feet  is  ordered.  The  patient  manifests  no  pain,  yet  when  we  remove  the  plas- 
ter, the  epidermis  of  the  superior  surface  of  both  feet  is  removed.  The  deli- 
rium ceases  almost  spontaneously.  The  patient  speaks  willingly,  and  submits 
to  the  regimen  and  prescriptions  that  are  ordered  for  him.  In  thirty  days,  he 
is  in  a  condition  to  enter  upon  the  discharge  of  his  accustomed  duties,  and 
resumes  his  usual  labors.  After  some  weeks,  he  becomes  melancholic,  and 
believes  that  he  is  lost.  Notwithstanding,  he  labors  vigorously.  He  frequent- 
ly stops  work,  throws  himself  upon  his  knees,  offers  some  prayers,  composes 


MONOMANIA.  375 

himself,  and  again  commences  his  labor.  Sometimes,  tormented  by  his  dis- 
quietudes, he  runs  to  the  neighboring  church,  confesses,  and  returns  again, 
feeling  perfectly  secure  and  tranquil.  At  other  times,  convinced  that  he  can- 
not escape  the  destiny  that  threatens  him,  he  cries  out  to  his  wife  to  save  her- 
self, because  he  feels  impelled  to  destroy  her.  After  this  warning,  he  throws 
himself  upon  a  seat  or  bed,  like  a  person  terrified.  His  wife  cannot  approach 
him ;  her  husband  constantly  desiring  her  to  retire  from  him.  He  commands 
those  at  hand  to  bind  him,  and  go  after  the  guard,  in  order  to  prevent  him 
from  committing  some  great  crime.  The  attack  ended,  this  wretched  man 
asks  pardon  of  his  wife.  God,  he  says,  has  doomed  me  to  eternal  punishment, 
in  consequence  of  the  grief  which  I  occasion  you.  He  then  submits  to  the 
treatment  which  is  prescribed  for  him,  although  God  alone  can  reverse  the 
sentence  of  condemnation.  If  he  desires  to  slay  his  wife,  it  is  because  he 
sees  death  ready  to  seize  upon  him,  and  does  not  wish  her  to  survive  him,  to 
become  the  wife  of  another  person.  A  cautery,  applied  to  the  neck  ;  tepid 
baths,  and  gentle  purgatives ;  have  improved  the  health  of  this  patient,  whose 
paroxysms  are  less  frequent  and  intense.  The  right  portion  of  the  coronal 
region,  and  the  left  of  the  occipital,  are  most  salient.  The  head,  measured 
from  the  cast  which  was  taken  after  death,  presents  : 

Antero-posterior  diameter    ....  7.40  in. 

Transverse  diameter       ....  6.37  " 

Circumference         .....  26.37  " 

Bi-temporal  curvature     ....  11.41   " 

Fronto-occipital  curvature    .              .              .              .  11.61   " 

Mad'e  T.,  forty  years  of  age,  the  wife  of  a  nursery-man,  has  a  brother  who 
has  been  insane.  This  woman  is  tall,  stout,  and  has  a  sallow  complexion. 
At  the  age  of  sixteen,  she  has  a  slight  attack  of  melancholy.  At  seventeen, 
she  menstruates  for  the  first  time.  At  the  age  of  seventeen  and  a  half  years 
she  is  married,  and  subsequently  became  the  mother  of  five  children.  Her 
first  child  was  born,  when  she  was  twenty  years  of  age.  At  the  age  of  twen- 
ty-one years  and  nine  months,  she  is  confined  a  second  time.  She  now  as- 
sumes the  duties  of  nurse,  with  the  expectation  thereby,  of  augmenting  the 
means  of  subsistence  for  her  family.  During  lactation,  she  is  depressed  in 
mind,  and  contemplates  the  destruction  of  her  child.  Still  she  continues  to 
nurse  it,  for  the  space  of  two  years,  notwithstanding  her  fear,  and  dread  of 
yielding  to  her  fatal  thoughts.  Since  this  period,  she  experiences  at  times,  a 
crackling  sensation  in  her  head,  and  often  suffers  from  melancholy.  Her  dis- 
position is  reserved,  uneasy,  ambitious  and  avaricious.  She  occupies  herself 
much,  in  the  management  of  her  household  affairs,  and  goes  abroad  but  little. 
When  obliged  to  make  a  few  visits,  she  cannot  conceal  the  utter  weariness 
which  it  occasions  ; — a  circumstance  which  has  often  led  to  unpleasant  feelings 
on  the  part  of  those  whom  she  visited.  When  she  converses  with  her  hus- 
band, she  speaks  only  of  calculations,  and  matters  which  relate  to  the  increase 
of  their  property.  At  the  age  of  twenty-nine  years,  she  experiences  an  in- 
tense desire,  and  a  strong  impulse,  to  destroy  one  of  her  daughters,  on  seeing 
her  asleep ;  the  girl  is  now  eleven  years  of  age. 

The  transition  from  a  state  of  habitual  health,  to  that  of  disease,  takes 
place  insensibly.  Two  moral  causes  appear  to  have  provoked  an  actual  per- 
version of  mind.  The  first  was,  the  opposition  of  her  eldest  son,  who  wished 
to  become  a  butcher,  contrary  to  the  intention  of  his  mother.  Three  years 
afterwards,  on  seeing  him  persist  in  his  resolution,  she  goes  to  a  fortune-teller, 
in  order  to  ascertain  the  future  destiny  of  her  son.  Presages  of  misfortune 
impress  upon  her  thoughts  a  more  melancholy  character.  She  becomes  more 
gloomy  ;  more  susceptible ;  more  irritable  :  yet   is  not  irrational.     After  the 


376  MONOMANIA. 

lapse  of  fifteen  months  she  becomes  pregnant,  and  is  grieved  at  its  occur- 
rence, after  an  interval  of  eleven  years,  and  at  her  advanced  age.  She  is 
informed  also,  that  they  had  jested  with  her  grown  up  children  on  the  precr- 
nancy  of  their  mother.  She  at  once  begins  to  feel  uneasy  respecting  her 
unborn  infant,  fearins  lest  she  shall  not  be  able  to  take  care  of  it  conve- 
niently.  Immediately  after  her  confinement,  although  she  experiences  great 
pleasure  at  the  kind  reception  which  the  new  comer  receives  at  the  hands  of 
her  other  children,  she  entertains  ideas  of  infanticide,  which  persist,  and  are 
afterwards  renewed  with  more  or  less  intensity  ;  and  it  is  to  prevent  a  crime, 
that  she  wishes  to  destroy  herself.  Several  times  does  she  seek  to  put  an  end 
to  her  days,  pursued  by  the  fear  of  destroying  her  child.  She  put  it  out  to 
nurse  when  two  months  old ;  but  not  being  able  to  refrain  from  seeing  it,  she 
is  constantly  visiting  it,  to  take  care  of  it,  and  to  seek  after  its  welfare.  At 
length,  at  the  expiration  of  a  month,  she  takes  it  home  again.  A  month  has 
scarcely  elapsed,  when  it  becomes  necessary  to  put  out  the  child  once  more 
to  nurse.  Unable  to  see  it,  the  patient  often  desires  to  hear  of  its  welfare  ; 
and  reproaches  herself  for  not  having  kept  it  at  home,  and  taken  care  of  it 
there.  Agitated  by  the  thought  and  fear  of  slaying  her  child,  she  says ;  "  It 
is  better  that  I  should  die,  than  this  dear  innocent."  So  intense  was  her  dis- 
quietude, that  she  several  times  left  the  house  of  her  husband,  with  the  inten- 
tion of  terminating  her  existence.  One  month  afterwards,  she  was  found  in 
her  chamber,  asphyxiated  by  the  fumes  of  burning  charcoal.  "  My  child  is, 
notwithstanding,  a  beautiful  and  lovely  being.  I  adore  it ;  but  its  caresses 
produce  a  strange  feeling  within  me,  and  I  start,  without  knowing  why,  when- 
ever I  approach  it.  I  have  an  excellent  husband,  and  ought  to  be  happy. 
But  now  I  reproach  myself,  with  having  abandoned  my  household  and  its 
duties,  which  formerly  occupied  and  diverted  me.  I  have  offered  prayers, 
but  have  not  been  heard  with  favor.  Would  that  I  could  persuade  myself 
that  I  were  sick  ;  but  I  cannot  :  I  am  a  wretched  mother." 

Whenever,  in  conversing  with  this  patient,  and  assuring  her  positively,  that 
her  fears  with  respect  to  slaying  her  son,  are  the  result  of  disease,  we  succeed 
in  convincing  her;  her  countenance  then  becomes  composed,  and  she  renders 
a  complete  account  of  her  sensations,  and  mental  sufferings.  It  often  happens, 
that  she  reproaches  herself,  in  consequence  of  the  food  she  has  eaten.  If  she 
endeavors  to  eat ;  after  taking  a  few  mouthfuls,  she  abstains,  and  her  mouth  is 
habitually  very  dry.  She  experiences  epigastric  pains,  and  spasms  in  the 
throat ;  sleeps  very  little,  and  suffers  from  very  severe  colic  pains ;  when  her 
fears  and  despair  are  exa.sperated.  I  prescribed  the  whey  of  Weiss,  and  tepid 
baths,  from  which  treatment  there  result  abundant  evacuations.  Feeling  very 
well,  she  wished  to  return  home,  contrary  to  ray  advice ;  but  scarcely  had  she 
entered  her  house,  when  her  torments  respecting  infanticide  and  suicide  are 
renewed,  and  it  was  necessary  for  her  again  to  enter  the  establishment,  from 
whence  she  is  discharged  in  good  health,  after  a  farther  treatment  of  two 
months. 

At  the  same  time,  during  the  summer  of  1836,  we  had  at  Charenton,  a  wo- 
man from  the  country ;  a  most  excellent  mother,  but  who  had  been  harassed 
for  some  time,  with  ideas  of  infanticide,  and  who,  moreover,  like  the  patient 
of  whom  I  have  just  spoken,  was  not  irrational. 


MANIA. 


Description  of  the  maniac,  and  his  end  unless  restored. — Definition  of  Mania. — Mania 
briefly  contrasted  with  Monomania  and  Lypemania. — Views  of  Heinroth  and  Prichard 
with  respect  to  the  connection  between  mania  and  fury. — Most  frequent  causes  of 
mania. — Table  of  ages. — Table  of  professions. — Causes. — Tables  of  physical  and  moral 
causes. — Incursion  of  mania. — Symptoms. — Hallucinations. — Sensations  perverted. — 
Case  in  detail  with  treatment. — Other  cases. — Mania  usually  chronic. — Continued,  re- 
mittent or  intermittent. — Sometimes  alternates  with  other  diseases. — Examples. — Criti- 
cal terminations. — Table  of  cures. — Table  of  cures  relative  to  Seasons. — Table  of  the 
periods  of  mortality. — Remarks. — Post-mortem  examinations. — Remarks  upon. — Treat- 
ment.— Three  periods  characterize  mania  ;  treatment  of  each. — Restraint. — Food. — 
Pinel's  cases  with  treatment. — Intercourse  of  physician  with  patient. — Visits  of  friends. 
— Convalescents. — Views  and  feelings  of  convalescents. — Their  treatment. — Remarks 
on  medication. — Medicines  appropriate  to  the  first  stage. — Pinel's  remarks  on  blood- 
letting.— Baths. — Cold  to  head. — Laxative  drinks. — Enemata. — Exercise. — Diet. — Cri- 
tical efforts  to  be  managed  cautiously. — Case  illustrative. — Classification,  its  import- 
ance.— Q,uinine  in  intermittent  mania. — Reasons  for  its  occasional  failure. — Treatment 
adapted  to  cases  which  result  from  the  suppression  of  habitual  evacuations. —  Case. — 
Benefit  of  cold  aff"usions,  with  cases. — Purgatives. — Camphor. — Opium. — Digitalis. — 
Bath  of  Surprise. — Submersion. — Rotatory  machine. — Moxas. — Actual  cautery. —  Cases 
illustrating  its  effects. — Cups. — (Farther  remarks.) 

What  a  change  has  it  effected  in  that  man  who,  yesterday,  to-day,  and  even 
a  few  moments  since,  engaged  in  the  profoundest  meditations,  was  accustomed 
to  submit  to  his  estimates  the  laws  which  govern  the  universe ;  who,  in  his 
vast  conceptions  balanced  the  destinies  of  empires ;  by  wise  combinations 
opened  to  his  country  new  sources  of  prosperity;  by  his  genius  enriched  the 
arts  by  so  many  master-pieces  ;  and  through  the  generosity  of  his  sentiments 
perceives  only  the  happiness  of  his  fellow-beings  1  All  at  once  he  fails  to  re- 
cognize surrounding  objects,  and  losing  his  own  identity,  lives  only  a  chaotic 
existence.  His  disordered  and  menacing  discourses  betray  the  disturbance  of 
his  reason.  His  actions  are  mischievous ;  and  he  desires  to  overthrow  and 
destroy  every  thing.  He  is  at  war  with  ievery  body  ;  and  hates  all  that  he 
was  formerly  accustomed  to  love.  He  is  the  very  genius  of  evil,  who  delights 
in  the  confusion,  disorder  and  fear  which  he  spreads  around.  This  woman, 
the  image  of  candor  and  virtue,  equally  amiable  and  modest,  whose  lips  were 
never  opened  but  to  utter  mild  and  generous  sentiments,  who  was  a  beloved 
daughter,  a  faithful  wife  and  affectionate  mother,  suddenly  becomes  insane. 
48 


378  MANIA. 

Her  timidity  now  becomes  audacity;  her  mildness  is  converted  into  ferocity. 
She  utters  nothing  but  abuse,  obscenity  and  blasphemy.  She  no  longer  re- 
spects either  the  laws  of  propriety  or  humanity.  Her  nakedness  braves  all 
eyes,  and,  in  the  blindness  of  her  delirium  she  threatens  her  father,  beats  her 
husband,  and  strangles  her  children,  if  neither  a  cure  nor  death  put  an  end  to 
such  excesses.  To  a  state  so  deplorable,  yet  a  positive  indication  of  life, — if 
the  patient  is  not  cured, — succeeds  a  calm,  a  thousand  times  more  afflictive. 
The  maniac  sinks  into  an  apathetic  condition.  There  is  no  longer  a  conflict 
of  mind  ;  no  more  threatening.  All  recollections  of  the  past  are  forever  lost ; 
all,  at  length,  is  merged  in  dementia,  the  tomb  of  human  reason.  This 
wretched  being  becomes  an  object  of  pity  and  disgust  to  his  fellow-beings, 
who,  in  this  deplorable  condition,  no  longer  recognize  the  man,  because  they 
no  more  perceive  the  exercise  of  reason.  He  stupidly  drags  out  the  remain- 
der of  his  material  existence,  without  thought,  desires  or  regrets  ;  sinking 
gradually  into  the  grave. 

Mania  is  a  chronic  cerebral  affection,  ordinarily  unattended  by  fever,  and 
characterized  by  perturbation  and  exaltation  of  the  sensibility,  of  the  under- 
standing and  will.  I  say  usually  without  fever,  because,  at  its  commencement, 
and  sometimes  during  the  progress  of  the  attack,  febrile  symptoms  are  observ- 
ed which  may  deceive  us,  and  render  a  diagnosis  difficult.  The  countenance 
of  maniacs  is  flushed,  sullen  or  pale.  It  is  shrivelled,  the  hair  is  crisped,  and 
the  eyes  are  injected,  shining  and  haggard.  This  class  of  patients  fly  the 
light,  and  have  a  horror  of  certain  colors.  They  suffer  from  a  humming 
sound,  and  a  tingling  in  the  ears,  which  are  sometimes  very  red  ;  and  the 
slightest  noise  disturbs  them.  Monomaniacs  suffer  from  cephalalgia,  and  from 
heat  within  the  cranium.  They  are  also  affected  with  anorexia,  or  a  voracious 
appetite.  Consumed  by  an  internal  heat,  they  are  tormented  by  a  burning 
thirst  for  cold  drinks.  They  suffer  also  from  heat  in  the  bowels ;  from  consti- 
pation and  insomnia.  If  they  sleep,  frightful  dreams  trouble  their  repose,  or 
they  start  suddenly  out  of  their  slumbers.  Maniacs  are  remarkable  for  their 
false  sensations,  illusions  and  hallucinations,  and  for  their  vicious  association 
of  ideas,  which  are  reproduced,  with  extreme  rapidity,  without  order  or  con- 
nection. They  are  also  remarkable  for  their  errors  of  judgment ;  the  perturba- 
tion of  their  affections  ;  and  in  fine,  for  their  freaks  of  volition.  This  class  of 
patients  possess  great  nervous  excitability,  their  delirium  is  general,  and  all  the 
faculties  of  the  understandinor  are  exalted  and  overthrown.  Whatever  makes 
an  impression,  whether  physical  or  moral,  even  the  empty  products  of  their 
imagination,  excite  them,  and  become  the  subject  of  delirium. 

Mania  should  not  be  confounded  with  lypemania,  (melancholy  without  de- 
lirium), nor  with  monomania.  In  the  latter,  the  delirium,  whether  sad  or  gay, 
concentrated  or  expansive,  is  partial,  or  circumscribed  to  a  small  number  of 
ideas  and  affections.  In  lypemania  and  monomania,  the  symptoms  are  the 
expression  of  the  disorder  of  the  affections  ;  whilst  in  mania,  the  phenomena 
are  the  result  of  the  confusion  of  all  the  elements  of  the  understanding.  In 
mania,  the  multiplicity,  rapidity,  and  incoherence  of  the  ideas,  together  with 
the  defect  in  the  power  of  attention,  exalt  the  passions  of  the  maniac,  occa- 
sion errors  of  judgment,  corrupt  his  desires,  and  impel  him  to  determinations 
more  or  less  strange,  unusual  or  violent.  The  disturbance  of  the  understand- 
ing provokes  the  excesses  of  the  maniac,  as  its  immediate  consequence.  In 
lypemania,  on  the  contrary,  the  source  of  the  evil  is  in  the  passions.  The 
sensations,  ideas,  desires  and  determinations  of  the  monomaniac,  are  under 
the  influence  of  a  controlling  passion,  which  absorbs  all  the  power  of  thought. 
If  maniacal  delirium  presents  some  degree  of  analogy  to  the  erratic  flights  of 
genius  ;  lypemaniacal  delirium  offers  all  the  features  of  the  passion  in  its 
physiological  state.  Is  not  this  influence  of  the  understanding  upon  the  pas- 
sions, an  incontestable  truth  ?     Before  desiring,  it  is  necessary  to  know.     The 


MANIA.  379 

influence  also  of  the  passions  upon  the  understanding,  is  a  truth  as  evident  as 
the  preceding.  Who  would  dare  deny  this  reciprocal  influence  of  the  under- 
standing upon  the  passions,  and  of  the  passions  upon  the  understanding  ! 
All  authors,  especially  the  ancients,  apply  the  name  of  maniac  to  all  those 
insane  persons  who  are  led  by  their  delirium,  to  the  commission  of  any  act 
of  violence  or  fury  ;  a  circumstance  which  causes  us  to  confound,  even  in  our 
days,  mania  with  melancholy.  Fury,  however,  is  the  anger  of  a  man  in  deli- 
rium. Fury  bursts  forth  in  all  forms  of  mental  alienation,  and  even  in  idiocy, 
when  the  subject  of  it  is  violently  opposed.  It  often  manifests  itself  in  an 
atrocious  manner,  both  in  lypemania  and  monomania. 

Professor  Heinroth,  who  has  enriched  with  some  very  interesting  notes,  the 
German  translation  of  my  principal  essays  on  insanity,  by  Doct.  Hille,*  cen- 
sures me  for  considering  fury  as  a  symptom  merely.  He  is  of  the  opinion 
that  fury  is  a  pathognomonic  sign  of  mania  ;  because,  says  this  author,  it  is 
constant  and  lasting  in  mania,  which,  without  fury,  is  a  contradiction.  Doct. 
Prichardt  coincides  in  opinion,  with  the  celebrated  Professor  of  Dantzick. 
Without  doubt,  maniacs,  in  consequence  of  their  extreme  susceptibility,  are 
very  irritable  when  in  a  state  bordering  on  that  of  fury  ;  but  they  are  not  at 
all  times  furious.  In  dementia,  there  is  a  weakening  of  all  the  faculties  ; 
and  the  delirium,  affections  and  acts,  disclose  the  feebleness  of  the  organs  ;  a 
circumstance,  which  distinguishes  mania  from  dementia.  An  idiot  is  never 
mistaken  for  a  maniac.  In  idiocy,  the  faculties  have  never  existed,  or  have 
never  been  sufficiently  developed. 

The  details  into  which  we  entered,  in  the  article  Insanity,  permit  us  to 
abridge  vvhatwe  have  to  say  respecting  the  causes,  symptoms,  progress,  termi- 
nation and  treatment  of  mania.  What  are  the  most  frequent  causes  of  ma- 
nia ?  With  respect  to  the  seasons,  it  is  evident  that  mania  ought  to  appear  in 
the  spring,  and  during  the  heats  of  summer.  In  the  reports  of  the  maniacs 
admitted  during  four  years  at  the  hospital  Salpetriere,  from  the  month  of 
March  to  that  of  August  inclusive,  I  find,  not  only  that  the  admissions  are 
most  numerous,  but  also  that  the  admissions  of  maniacs  are  the  greater,  com- 
pared with  those  afflicted  with  other  forms  of  insanity.  The  admissions  of 
maniacs  into  my  establishment,  are  more  than  doubled  during  the  same  six 
months  of  the  year,  when  compared  with  the  admissions  during  the  other  six. 
During  the  six  months  of  spring  and  summer,  those  of  June,  July  and  August, 
are  the  months,  during  which  mania  appears  most  frequently.  This  influence 
of  an  elevated  atmospheric  temperature,  on  the  production  of  mania,  is  equal- 
ly felt  in  warm  countries,  where  mania  is  more  frequent  than  in  temperate  and 
cold  climates.  The  influence  of  heat  also  modifies  the  progress  of  the  disor- 
der ;  that  of  summer  ordinarily  exasperating  it.  Maniacs,  under  these  cir- 
cumstances, are  more  agitated,  more  irritable,  more  disposed  to  fury  ;  and 
this  state  is  greatly  protracted  ;  whilst  a  sudden  cold,  attended  by  a  dry  at- 
mosphere, at  first  agitates,  but  soon  composes  them. 

That  period  of  life,  in  which  the  vital  forces  act  with  the  greatest  energy, 
when  certain  passions  exercise  the  most  complete  mastery  over  man,  when  the 
intellectual  faculties  possess  their  greatest  activity,  may  be  regarded  as  that 
especially  appropriate  to  the  development  of  mania.  The  delusions  of  the 
imagination,  and  the  seductions  of  love,  conspire  to  render  mania  most  fre- 
quent in  youth.  The  table  of  ages  shows  us,  that  the  number  of  cases  of  ma- 
nia are  very  considerable  from  twenty  to  twenty -five  years  of  age,  and  still 
greater,  from  twenty-five  to  thirty.  The  proportion  increases  from  fifteen  to 
thirty,  while  it  decreases  from  thirty  to  sixty  years,  and  above.  This  is  not 
true  with  respect  to  the  general  report  of  ages,  published  near  the  commence- 

*  Pathologic  und  Therapie  der  Seelensta.rungen,  Leipsig,  1827,  in  8vo. 

t  Treatise  on  Insanity  and  other  Disorders  affecting  the  Mind,  London,  1635. 


380 


MANIA. 


ment  of  this  work.  The  absolute  number  of  insane  persons,  augments  much 
from  the  age  of  fifteen  to  thirty  years,  and  decreases  essentially,  from  this  lat- 
ter period  to  the  close  of  life.  4t  the  age  of  forty,  however,  the  number  of 
the  insane  is  a  little  the  most  numerous.  By  comparing  the  table  of  ages  in 
dementia,  the  difference  is  still  more  remarkable.  In  fact,  from  the  acre  of 
fifteen  years  to  that  of  forty,  the  number  of  individuals  in  a  state  of  demelitia, 
IS  one  half  less  than  from  forty  to  eighty  years.  Many,  afflicted  with  demen- 
tia, have  passed  the  age  of  fifty  and  si.xty  years,  whilst  few  cases  of  mania  are 
found.  If  an  irruption  of  mania  takes  place,  after  the  age  of  sixty  years,  it 
appears  only  in  the  persons  of  those  who  are  strong,  robust,  and  in  the  enjoy- 
ment of  good  health.  If  it  has  not  then  an  acute  course,  and  a  speedy  termi- 
nation, it  immediately  degenerates  into  a  state  of  dementia,  or  becomes  com- 
plicated with  paralysis. 

TABLE  OF  AGES. 


Ages. 

Report  of  the  Salpetriere 
for  four  years. 

Report  of  7ny  establishment 
during  several  years. 

15 

20 
25 
30 
35 
40 
45 
50 
55 
60 
65 

.     .     17     .     . 
.     .     56     .     . 

.     51     .     . 

.     55     .     . 

.     56     .     . 

.     31     .     . 

.     27     .     . 

.     16     .     . 

.     13     .     . 

•       5     .     .     . 

.       0     .     .     . 

MEN. 

.     .  10     . 

-     .   14     . 

.  15     . 

.     7     . 
.     9     . 
.     7     . 
.     6    . 
.     3     .     . 
.     3     . 
.     0     . 
.  10     . 

WOMEN. 

.       7     . 

.     10     . 

21     . 

6     . 

3     . 

1  . 

2  . 

3  .     . 
0     . 

2     .     . 
0     .     . 

•  327     .     .     . 

.  84     .     . 

55     .     . 

By  comparing  the  number  of  maniacs  of  either  sex,  we  shall  learn  that 
mania  is  more  frequent  among  men  than  women.  With  men,  it  manifests  a 
more  violent  and  impetuous  character.  A  sense  of  supernatural  strength, 
which  some  maniacs  experience,  joined  to  the  habit  of  exercising  command^ 
renders  men  particularly  violent,  audacious,  passionate  and  furfous.  They 
are  also  more  dangerous,  as  well  as  more  difficult  to  control  and  restrain. 
Women  in  a  state  of  mania  are  boisterous  ;  talk  and  clamor  much  ;  are  de- 
ceitful, and  yield  their  confidence  very  reluctantly.  A  sanguine  and  nervous 
temperament ;  and  a  plethoric,  strong  and  robust  constitution  ;  most  frequent- 
ly predispose  to  mania.  Many  whom  I  have  seen  suffering  from  this  form  of 
insanity,  were  persons  of  very  great  susceptibility,  of  a  lively,  irritable  and  cho- 
leric disposition,  and  endowed  with  an  ardent  and  glowing  imagination.  They 
undertake  with  enthusiasm,  the  wildest  projects,  and  engage  in  the  most 
hazardous  speculations.  Some  among  them  had  been  subje'ct  to  hemorrha- 
ges and  cephalalgia;  to  dreams,  and  somnambulism.  Others  had  suffered  from 
nervous  affections,  hysterical  symptoms,  convulsions,  attacks  of  epilepsy,  and 
cutaneous  affections. 

Professions,  considered  as  the  predisposing  causes  of  mania,  present  no- 
thing of  special  interest,  when  compared  with  professions  considered  as  causes 
of  insanity  in  general.  However,  I  have  deemed  it  proper  to  place  before 
the  eye  of  the  reader  such  as  I  have  met  with,  during  four  years,  in  the  hos- 
pital Salpetriere,  and  during  several  years  in  my  own  establishment. 


MANIA. 


381 


TABLE  OF  PROFESSIONS. 


Report  of  the 

Salpetriere. 

Report  of  my  Establishment. 

Field  laborers 

.     30 

Husbandmen     ...       2 

Domestics 

26 

Merchants    ...          14 

Seamstresses 

.     83 

Soldiers              ...     16 

Cooks 

9 

Students       ...          15 

Laundresses 

.     11 

Employers  and  servants     .       7 

Tradesmen 

15 

Chemists  and  glass-makers       3 

Peddlers 

.       7 

Physicians          ...        1 

Varuishers 

5 

Artists,  literary  men,  and 

Public  women 

.     44 

men  devoted  to  study     .       5 

Householders 

45 

Education  improperly  direct- 
ed         ....     10 
Misconduct            .         .            3 

Total 

Householders    .         .         .63 
Total     ....     139 

...     275 

The  causes  of  mania,  which  may  be  denominated,  in  some  sort,  individual, 
or  rather  specific  causes,  are  physical  or  moral.  The  table  of  causes,  which 
I  shall  subjoin,  presents  hereditary  predisposition  as  a  remote  cause,  doubtless, 
but  as  the  most  frequent.  Amonsr  women  of  all  classes,  menstruation,  either 
because  it  has  been  with  difficulty  established,  or  has  been  suppressed,  or  in 
consequence  of  its  final  cessation,  is  one  of  the  most  common  causes  of  ma- 
nia. It  may  with  truth  be  said,  that  this  cause  extends  its  influence  over  the 
whole  period  of  life  during  which  females  are  in  the  most  favorable  condi- 
tion for  the  development  of  mania.  The  cause  most  to  be  feared,  after  that 
of  menstruation,  is  confinement  and  lactation  ;  either  because,  after  confine- 
ment the  milk  does  not  enter  the  breasts,  or  is  suppressed  during  the  period  of 
nursing ;  or  finally,  because,  at  tlie  time  of  weaning,  the  mother  has  neglect- 
ed suitable  precautions.  Insolation,  and  exposure  to  the  fire,  often  cause 
mania ;  a  circumstance  which  presents  a  striking  analogy  to  the  influence  of 
the  warm  season,  relative  to  the  frequency  of  this  malady.  In  fact  we  stated 
above,  that  warm  climates,  and  the  heat  of  summer  are  favorable  to  the  de- 
velopment of  this  form  of  madness. 

Herpetic  affections,  either  in  consequence  of  their  repercussion,  or  of 
their  long  continuance,  sometimes  produce  mania.  This  cause  acts  most 
frequently  between  the  age  of  thirty  and  forty  years,  and  with  women,  during 
the  anomalies  of  the  last  menstruation,  or  at  some  period  subsequent  to  the 
cessation  of  the  menses.  Rarely  do  we  fail  of  deriving  good  effects  from 
counter-irritants  which  excite  the  skin,  and  determine  there  a  point  of  irrita- 
tion, or  become  the  seat  of  a  salutary  evacuation.  I  have  sometimes  seen 
the  application  of  a  simple  vesicatory  to  the  arm,  give  rise  to  a  herpetic  form 
of  erysipelas,  which  has  put  an  end  to  inveterate  cases  of  mania. 

Epilepsy,  which  is  so  often  the  cause  of  idiocy  and  dementia,  also  produces 
mania ;  that  is  to  say,  after  the  attack  of  epilepsy,  the  patients  thus  afflicted 
remain  in  a  state  of  mania,  often  attended  with  fury.  Of  the  four  hundred 
epileptics  that  we  now  have  at  the  Salpetriere,  fifty  at  least,  are  maniacs  after 
every  attack.  The  fury  of  epileptics  is  blind,  terrible,  and  dangerous  in  the 
extreme ;  and  is  most  to  be  dreaded,  in  asylums  for  the  insane.  The  mania 
of  epileptics,  is  not  of  long  duration.  It  sometimes  terminates  in  a  few 
hours;  at  others,  in  three,  four,  and  eight  days.  It  is  very  unusual  for  an 
attack  to  take  place,  before  the  epileptic  seizure.     Melancholy  and  hypochon- 


382 


MANIA. 


dria  have,  in  all  times,  been  signalized,  as  predisposing  causes  of  mania. 
Several  distinguished  masters,  Alexander  de  Tralles,  and  Boerhaave  himself, 
were  of  the  opinion,  that  melancholy  (lypemania),  was  only  the  first  degree' 
of  mania.  This  is  in  some  cases  true.  There  are  in  fact,  some  persons, 
who,  before  becoming  maniacs,  are  sad,  morose,  uneasy,  diffident  and  sus- 
picious. Some  suffer  from  a  partial  delirium,  attended  with  excitement. 
Others,  feel  that  they  are  sick,  suffer  from  cephalalgia  and  soreness  of  the 
hmbs,  and  have  a  presentiment,  that  they  are  threatened  with  a  grave  malady, 
and  even  entertain  a  fear  of  becoming  insane.  They  are  restless,  and  dis- 
turbed in  mind  ;  demand  remedies,  and  take  many  of  them.  In  these  cases, 
melancholic  and  hypochondriacal  symptoms  are  the  precursors  of  mania. 
This  is  the  period  of  incubation.  These  symptoms  cannot  deceive  a  man  of 
experience.  They  are  the  index  of  an  approaching  attack  of  mania.  The 
moral  causes  of  mania  are  far  more  numerous  than  those  of  a  physical  na- 
ture. They  are  more  considerable  among  women  than  men,  and  the  dispro- 
portion is  still  greater,  when  we  compare  the  causes  of  mania  with  those  of 
dementia.  One  readily  perceives  the  reason  for  these  differences,  when  he 
refers  to  the  temperament,  age,  and  disposition  of  those  who  are  usually  af- 
fected with  mania.  Women,  with  whom  love  is  the  most  important  business 
of  life,  sustain,  with  far  greater  difficulty  than  men,  the  effects  of  disappoint- 
ed affection. 

It  is  a  matter  of  no  less  interest,  to  compare  the  number  of  moral  causes, 
in  the  inferior  and  higher  classes  of  society.  The  brain  of  the  rich  man  is 
more  frequently  called  into  action  ;  the  intellectual  faculties  are  more  devel- 
oped ;  the  social  passions  more  frequently  called  into  exercise,  and  more  en- 
ergetic. More  dependent  upon  the  caprices  of  fortune  and  of  men,  both  the 
great  and  rich  remain  more  exposed  than  the  poor,  to  the  fatal  effects  of 
wounded  self-love,  ambition,  and  the  loss  of  fortune.  The  predisposing  or 
proximate  moral  and  physical  causes,  rarely  act  alone.  They  unite  and°be- 
come  complicated,  in  order  to  produce  mania.  A  fright  occasions  the  sup- 
pression of  the  menses,  which  becomes  the  causeof  mania ;  the  latter  ceasing, 
with  the  return  of  the  menstrual  evacuations.  A  woman  during  her  confine- 
ment, experiences  a  severe  mortification  ;  the  lochia  are  suppressed,  and  an 
irruption  of  mania  takes  place.  We  may  with  truth  affirm,  that  mania  rarely 
takes  place,  without  the  concurrence  of  both  physical  and  moral  causes. 
Sometimes  this  malady  appears,  from  no  other  appreciable  cause,  than  errors 
of  regimen.  It  must,  however,  be  understood,  that  these  errors  are,  in  some 
cases,  the  first  indications  of  commencing  disease.  We  have  seen  mania 
supervene  upon  grave  forms  of  fever,  intermittent  fevers,  and  particularly  the 
quartan  type,  according  to  Sydenham,  who  first  made  this  observation.  It 
has  been  known  to  appear  after  sudden  relief  from  rheumatic  attacks,  gout 
and  hemorrhoids  ;  from  erysipelas,  an  habitual  evacuation,  cutaneous  affec- 
tions, leucorrhcea,  and  Menorrhagia. 


MANIA. 


383 


PHYSICAL  CAUSES. 


Salpetriere. 

My  Establishment. 

A 

MEN.              WOMEN. 

Hereditary       .... 

88 

38 

37 

Masturbation       .         .         . 

8 

6 

2 

Menstruation 

27 

0 

11 

In  consequence  of  confinement 

38 

0 

19 

Critical  period     . 

12 

0 

8 

Abuse  of  wine 

14 

4 

0 

Insolation 

2 

3 

0 

Exposure  to  fire 

12 

2 

0 

Falls  or  blows     . 

8 

1 

2 

Mercury           .... 

2 

2 

1 

Cessation  of  psora 

3 

1 

0 

Cessation  of  herpes 

2 

2 

6 

A  suppressed  ulcer 

1 

0 

0 

Fever           .... 

3 

4 

1 

Apoplexy         .... 

0 

1 

1 

Epilepsy      .... 

0 

0 

0 

Total       .         .         .         . 

132 

26 

51 

MORAL  CAUSES. 


Salpetriere. 

My  Establishment. 

A 

— ■^     r 

MEN. 

1 

WOMEN. 

Domestic  trials 

.     62 

9 

20 

Reverses  of  fortune     . 

6 

13 

6 

Want      .... 

.     19 

0 

0 

Disappointed  affection 

53 

4 

14 

Jealousy 

.       4 

1 

8 

Wounded  self-love 

1 

15 

7 

Fright     .... 

.     36 

1 

6 

Anger 

o 

•                         1^ 

1 

1 

Excessive  study 

0 

10 

0 

Total 

.       183 

54 

63 

Mania  rarely  makes  its  incursion  suddenly.  Usually  certain  signs,  more  or 
less  apparent,  precede  it,  which  often  escape  the  attention  of  the  relatives  and 
friends  of  the  sick.  Still,  of  all  the  forms  of  mental  alienation,  mania  is  that, 
whose  invasion  is  most  frequently  sudden  and  spontaneous.  At  one  time, 
nothing  occurs  from  which  we  can  anticipate  its  approach  ;  yet  a  strong  mo- 
ral impression,  or  an  error  of  regimen  suffices  suddenly  to  develop  it,  and 
the  maniac  reaches  the  highest  degree  of  intellectual  and  moral  disorder. 
From  its  commencement,  the  delirium  is  general,  and  the  fury  extreme. 
Then  it  is,  that  maniacs  destroy  themselves,  either  in  consequence  of  the 
wandering  of  the  reason,  not  knowing  what  they  do ;  or  by  accident,  in 
consequence  of  imprudences ;  or  through  despair,  having   a  consciousness  of 


384  MANIA. 

their  condition.  Commonly,  the  invasion  of  mania  is  progressive  and  gradu- 
al. At  first,  trifling  irregularities  in  the  affections  are  noticed,  in  the  con- 
duct of  one,  whom  the  first  symptoms  of  the  malady  begin  to  disturb. 
The  maniac  is,  at  the  commencement  of  the  malady,  either  sad  or  gay  ;  ac- 
tive or  indolent ;  indifferent  or  eager.  He  becomes  impatient,  irritable  and 
choleric.  He  soon  neglects  his  family,  forsakes  his  business  and  household 
affairs,  deserts  his  home  and  yields  himself  to  acts,  the  more  afflictive,  as  they 
contrast  more  strikingly  with  his  ordinary  mode  of  life.  To  alternations 
of  delirium  and  reason  ;  of  composure  and  agitation  ;  succeed  acts  the  most 
strange  and  extravagant ;  entirely  contrary  to  the  well-being  and  interests  of 
the  patient.  The  alarm  and  disquietude;,  the  warnings  and  advice  of  friend- 
ship, paternal  tenderness  and  love;  oppose,  irritate  and  provoke  the  patient; 
exciting  him  by  slow  degrees,  to  the  highest  pitch  of  mania.  There  are 
persons  who  are  hypochondriacal,  and  buried  in  a  profound  melancholy  for 
some  hours,  days,  and  even  months,  before  the  explosion  of  mania  ;  while 
others  sink  into  a  deep  stupor,  appearing  to  be  deprived  of  every  thought  and 
idea.  They  move  not,  but  remain  where  they  are  placed.  They  must  be 
dressed,  and  food  must  be  conveyed  to  their  mouths.  The  features  of  the 
face  are  contracted  ;  and  the  eyes  red  and  gleaming.  Suddenly,  mania  bursts 
forth,  in  all  the  strength  of  its  delirium  and  agitation. 

Many  persons,  subject  to  habitual  indisposition,  which  has  suddenly  disap- 
peared, experience  a  sense  of  perfect  well-being,  and  believe  that  they  have 
attained  the  enjoyment  of  sound  health.  They  possess  a  sense  of  inexpressible 
power  and  happiness.  To  their  eye,  all  nature  is  clothed  with  beauty. 
Everything  appears  not  only  possible,  but  easy.  They  know  no  obstacles  to 
their  desires.  Contentment  and  joy  are  impressed  upon  their  physiognomies. 
Insomnia,  constipation  and  agitation,  progressively  increase;  the  ideas  become 
confounded,  and  the  patient  gayly  commences  the  most  frightful  of  maladies. 
Most  frequently,  mania  bursts  forth  without  any  febrile  indication;  but  its  in- 
vasion is  sometimes  characterized  by  the  most  alarming  symptoms.  At  one 
time,  it  is  a  cerebral  congestion,  attended  by  epileptiform  convulsions;  at 
another,  a  gastric  or  typhoid  fever ;  at  another,  a  phlegmasia.  Many  maniacs, 
immediately  before  the  attack,  experience  a  sense  of  heat  in  the  bowels,  which 
is  propagated  from  the  abdomen  to  the  epigastrium  and  head.  Some  suffer 
from  a  very  painful  cephalalgia,  and  have  confessed  to  me,  that  they  had 
sought  to  smite  themselves  upon  the  head,  with  the  hope  of  relieving  them- 
selves from  an  insupportable  evil.  Finally,  I  have  seen  mania  begin  with  con- 
vulsions. 

Where  is  the  man,  who  would  dare  flatter  himself  that  he  had  observed, 
and  could  describe  all  the  symptoms  of  mania,  even  in  a  single  case  ?  The 
maniac  is  a  Proteus  who,  assuming  all  forms,  escapes  the  observation,  of  the 
most  practised  and  watchful  eye ;  differing  widely  from  the  melancholic,  who 
appears  ever  the  same ;  presenting  few  peculiarities,  and  those  easily  grasped. 
No  one  has  better  described  than  Pinel,  the  disordered  activity,  and  the  tu- 
multuous and  frantic  movements  of  the  maniac.  This  great  observer  pos- 
sessed the  art  of  describing  with  remarkable  vividness,  all  the  symptoms  that 
he  beheld.  In  mania,  it  is  not  easy,  as  it  is  in  melancholy,  to  reduce  the  deli- 
rium to  a  primitive  type,  nor  to  define  with  precision,  what  faculty  of  the  un- 
derstanding is  essentially  disturbed.  Every  thing  indicates,  however,  effort, 
violence,  enerory.  Extreme  agitation  is  most  manifest,  and  a  defect  in  the  har- 
mony  of  the  mental  powers,  is  most  prominent  in  tlie  delirium  of  maniacs. 
The  attention  is  especially  disturbed,  and  the  patients  lose  the  power,  either 
of  controlling,  or  fixing  it.  Let  one,  however,  produce  a  strong  impression 
upon  the  mind  of  a  maniac,  or  an  unexpected  event  arrest  his  attention ;  be- 
hold him  suddenly  becoming  rational,  and  reason  sustaining  itself,  so  long  as 
the  actual  impression  maintains  sufficient  power  to  sustain  his  attention.     Be- 


MANIA.  385 

ing  no  longer  in  relation  with  the  activity  of  the  other  faculties,  the  attention 
is,  in  some  sort,  subdued  by  them,  instead  of  directing  them,  and  lending  force 
to  their  action.  We  shall  see,  in  examining  the  details,  that  all  intellectual 
disturbances  may  be  reduced  to  a  want  of  harmony  between  the  attention  and 
actual  sensations ;  the  ideas  and  recollections.  The  maniac  presents  the 
image  of  chaos,  whose  elements,  when  set  in  motion,  dash  against,  and  oppose 
each  other,  to  augment  the  confusion,  disorder  and  error.  He  lives  isolated 
from  the  physical  and  intellectual  world,  as  if  he  were  shut  up  in  an  obscure 
chamber.  Sensations,  ideas  and  images,  present  themselves  to  his  mind,  with- 
out order  or  connection;  leaving  no  traces  after  them.  Led  away  unceasingly, 
by  impressions  constantly  renewed,  he  cannot  fix  his  attention  upon  external  ob- 
jects, which  produce  an  impression  too  vivid,  and  succeed  each  other  too  rapidly. 
He  can  no  longer  distinguish  the  qualities  of  bodies,  by  seizing  upon  their 
relations.  He  brings  together  places  the  most  remote,  and  persons  who  are 
entire  strangers.  He  associates  ideas  the  most  unlike  ;  forms  images  the  most 
whimsical ;  holds  conversations  the  most  strange  ;  and  gives  himself  up  to  the 
commission  of  acts  the  most  ridiculous.  The  equilibrium  between  actual  im- 
pressions and  recollections,  is  broken,  and  the  vivacity  of  the  images  which 
memory  reproduces,  is  often  such,  that  the  maniac  believes  those  objects  to  be 
present  and  real,  which  his  excited  imagination  calls  up  to  his  view.  A  thou- 
sand hallucinations  sport  with  his  reason.  He  sees  what  does  not  exist.  He 
converses  with  invisible  interlocutors ;  questions  and  replies  to  them  ;  com- 
mands them ;  promises  obedience,  and  often  becomes  excited  to  anger  against 
them.  It  is  no  unusual  occurrence,  to  see  the  hallucinated  aroused  to  the 
most  violent  fury,  against  beings,  whom  they  believe  they  both  hear  and  see. 
Those  who  are  excited  and  agitated  by  maniacal  delirium,  are  also  irritated  in 
mind,  because  they  form  incorrect  opinions  respecting  the  internal  and  exter- 
nal impressions  which  they  actually  experience.  A  young  maniac  is  troubled 
with  pains  in  his  limbs,  and  becomes  furious ;  assuring  us,  that  he  is  pierced 
with  a  thousand  nails.  How  many  maniacs  are  furious,  after  having  tasted  of 
aliments  that  they  find  unpleasant,  and  believe  to  be  poisoned !  A  lady  per- 
suades herself,  that  clouds  suspended  in  the  air,  are  balloons,  and  calls  aloud 
to  Garnerin,  for  permission  to  enter  his  car.  Almost  all  those  maniacs  who 
are  excited  to  fury,  become  so,  in  consequence  of  the  false  judgments  which 
they  form,  respecting  persons  or  things.  One  strikes  an  individual  unknown 
to  him,  thinking  that  he  is  taking  vengeance  upon  an  enemy.  Another  dis- 
covers a  rival  in  a  person  whom  he  never  before  saw.  A  young  maniac  became 
furious  every  time  he  saw  a  woman  in  company  with  a  man  ;  persuaded  that  his 
wife  was  with  a  lover.  The  monomaniac  whose  susceptibility  is  exalted  or 
perverted,  lives  in  error  and  acts  at  random.  Error,  having  corrupted  his 
desires  and  depraved  his  affections,  he  becomes  suspicious  and  diflident. 
Hence  spring  all  his  disorders.  He  is  uneasy,  and  seeks  with  anxiety  for  a 
good  which  he  no  longer  finds.  Placed  in  a  false  position,  his  relations  with 
surrounding  objects  are  of  a  painful  character.  He  becomes  vexed  with 
whatever  approaches  him  ;  is  angry  and  furious.  His  fury  expends  itself  with 
so  much  the  more  violence,  as  his  desires  are  intense.  Does  he  meet  with  an 
obstacle  ;  he  does  not  amuse  himself  in  removing  it,  but  breaks  or  leaps  over 
it.  Are  his  desires  opposed ;  all  the  means  proper  to  gratify  them  seem  to 
him  right.  He  is  incapable  of  choosing,  since  he  is  unable  to  appreciate 
either  dangers  or  advantages.  Does  he  wish  to  come  down  from  his  apart- 
ment ;  he  throws  himself  from  the  window,  or  sets  fire  to  the  house  in  which 
he  is  restrained.  He  slays  his  friend,  as  his  only  reply  to  the  counsels  of 
friendship.  Is  he  opposed  ;  he  commits  the  greatest  excesses,  and  is  now  only 
the  subject  of  dread  and  danger  to  his  fellow-beings  and  to  society. 

The  maniac,  constantly  diverted,  both  by  external  objects  and  his  own  ima- 
gination ;  drawn  away  to  matters  having  no  connection  with  himself;  forget- 
49 


386  MANIA. 

ting  every  thing  that  surrounds  him,  and  ignorant  of  his  own  existence,  seems 
deprived  of  consciousness.  Notwithstanding,  there  is  no  absolute  cessation  of 
the  perception  of  external  objects ;  the  sense  of  personal  identity  is  not  lost, 
and  perception  still  exists;  for  the  maniac  recalls,  after  his  restoration  to 
health,  those  objects  of  which  he  appeared  to  take  no  notice  during  his  deli- 
rium. Having  become  composed  and  rational,  he  gives  an  account  of  what 
he  has  seen  and  heard,  as  well  as  of  what  he  has  felt,  and  the  motives  which 
gave  rise  to  his  determinations.  His  recollections  of  the  past,  do  not  usuarlly 
become  distinct  for  some  time,  even  many  months  after  his  cure";  and  until  a 
perfect  measure  of  health  has  returned.  The  overthrow  of  the  reason  and 
affections,  necessarily  destroys  the  sentiment  of  justice  and  injustice.  The 
maniac  seems  to  have  abjured  all  idea  of  religion,  every  sentiment  of  shame, 
and  every  principle  of  probity.  This  dutiful  son,  this  faithful  parent,  or  affec- 
tionate husband,  forgets  those  most  dear  to  his  heart,  and  repulses  them  with 
harshness,  and  in  a  transport  of  passion.  Their  presence,  advice,  and  the 
opposition  which  the  condition  of  the  patient  renders  necessary,  agitate  and 
irritate  him,  more  than  if  they  were  strangers. 

Language,  bestowed  upon  man  to  express  his  thoughts  and  affections,  dis- 
closes the  disturbance  which  exists  in  the  understandinor  of  the  maniac.  As 
thoughts  present  themselves  in  a  crowd  to  his  mind,  pressing  upon,  and  crowd- 
ing each  other  with  confused  violence;  so,  words  and  phrases  escape  his  lips, 
with  no  coherency  or  order,  and  with  an  extreme  volubility.  Some  maniacs, 
full  of  confidence  in  themselves,  speak  and  write  with  facility,  and  render 
themselves  remarkable,  by  the  brilliancy  of  their  expressions,  the  profundity 
of  their  thoughts,  and  the  association  of  the  most  ingenious  ideas.  They 
pass,  with  the  greatest  rapidity,  from  the  most  obliging  expressions,  to  threats 
and  abuse.  They  utter  words  and  incoherent  phrases,  which  have  no  connec- 
tion with  their  ideas  or  actions.  They  will  sometimes  also  repeat  for  several 
hours,  the  same  word,  phrase,  and  even  the  same  passage  of  music,  without 
appearing  to  attach  the  least  meaning  to  it.  There  are  those,  who  invent  a 
language  exceedingly  singular ;  while  others,  in  speaking  of  themselves,  ad- 
dress only  a  third  person.  Sometimes,  the  maniac  assumes  a  tone  of  boasting 
and  vanity,  and  remains  by  himself  Nothing  possessing  the  power  to  control 
his  attention,  and  yielding  to  the  fleeting  desire  of  the  moment,  he  departs, 
directing  his  mind  to  a  purpose,  which  he  fails  to  accomplish.  Diverted  in 
his  progjress,  though  rapid  and  precipitate,  he  suddenly  stops,  pensive  and 
thoughtful ;  and  seems  engrossed  in  some  design.  Suddenly  he  starts  again, 
runs  with  rapidity ;  sings  and  cries  aloud.  Again  he  stops ;  and  his  counte- 
nance assumes  an  expression  of  admiration  and  joy.  He  weeps,  laughs, 
dances,  and  speaks  in  a  variable  tone  of  voice.  In  connection  with  this  uncon- 
trollable activity,  his  movements  are  quick,  abrupt  and  uncertain.  The  move- 
ments and  gestures  of  maniacs,  both  of  which  appear  most  insignificant  and 
ridiculous,  are  the  expression  of  the  exaltation,  and  disorder  of  the  ideas  and 
affections  of  this  class  of  patients. 

In  general,  maniacs  become  emaciated;  the  features  of  the  face  change ; 
their  countenance  assumes  a  peculiar  appearance ;  which  contrasts  with  their 
physiognomy  while  in  a  state  of  health.  The  head  is  usually  elevated,  and 
the  hair  rough.  The  face  is  now  flushed,  particularly  that  portion  which 
covers  the  prominences  of  the  cheek  bones.  The  eyes  are  red,  sparkling, 
projecting  and  haggard  ;  fixed  upon  the  sky,  and  braving  the  beams  of  the 
sun.  Now  it  is  pale  ;  the  features  are  contracted,  and  often  drawn  towards 
the  roots  of  the  nose ;  the  look  is  vague,  uncertain  and  wandering.  During 
a  paroxysm  of  fury,  all  the  features  Jaecome  animated;  the  neck  swells;  the 
face  becomes  flushed ;  the  eyes  sparkle ;  and  all  the  movements  are  quick  and 
threatening.  To  so  many  phenomena,  which  appertain  to  the  convulsive  en- 
ergy of  the  organs  of  the  life  of  relation,  are  associated  symptoms,  which 


MANIA.  387 

prove  that  the  functions  of  nutritive  life  participate  in  this  violent  excitement. 
With  the  progress  of  the  malady,  the  features  become  more  changed.  The 
face  is  sallow,  brown  or  earthy,  the  physiognomy  is  convulsive,  and  the  mani- 
ac is  scarcely  recognized.  The  development  of  the  muscular  powers,  is  in 
some  cases  extraordinary.  We  have  seen  them  support  the  heaviest  weights ; 
break  the  strongest  cords,  and  prostrate  several  men  who  sought  to  restrain 
them.  That  which  renders  furious  maniacs  so  formidable  is,  that  the  idea  of 
their  augmented  powers,  is  submitted  to  the  deductions  of  reason  ;  and  that 
many  entertain  a  conviction,  that  their  powers  are  supernatural  and  uncon- 
trollable. When  they  employ  them  also,  they  are  the  more  dangerous  ;  either 
because  an  idea  of  superiority  controls  them,  or  their  understanding  has  be- 
come greatly  impaired.  Epileptics  are,  of  all  maniacs,  those  whose  fury  is 
most  to  be  feared ;  because,  while  deprived  of  their  understanding,  nothing 
restrains  them.  There  are  those,  on  the  contrary,  who,  laboring  under  other 
forms  of  mania,  are  timid,  fearful  and  diffident,  and  submit,  when  a  great 
array  of  force  is  brought  against  them,  which  they  believe  they  cannot  suc- 
cessfully oppose.  This  circumstance  furnishes  a  first  datum  for  the  moral  di- 
rection of  these  patients.  Is  a  maniac  furious,  he  will  become  still  more  so,  if 
one  or  two  persons  only  attempt  to  restrain  him ;  but  will  compose  himself,  on 
the  contrary,  if  several  surround  him,  to  oppose  themselves  to  his  excesses. 

It  is  very  frequently  stated  that  maniacs,  devoured  by  an  internal  heat,  can 
support  the  severest  cold.  This  observation,  understood  in  a  sense  too  gene- 
ral, has  been  exceedingly  fatal  to  the  insane.  Undoubtedly,  in  numerous  at- 
tacks of  mania,  a  very  intense,  internal  heat  is  developed.  The  patients  expe- 
rience a  burning  heat;  at  one  time  in  the  head,  at  another  in  the  abdomen, 
and  again  in  the  skin,  which  is  dry  and  arid.  Some  have  remarked,  that  it 
seemed  as  if  a  burning  fluid  was  circulating  in  their  veins.  Many  also,  con- 
sider it  a  punishment  to  be  shut  up  in  a  close  and  heated  apartment ;  or  to  be 
confined  to  their  bed,  enveloped  in  coverings.  Is  it  astonishing  that  they  pre- 
fer to  lie  upon  the  floor  or  even  upon  stone  ?  We  have  seen  those  who,  tor- 
mented by  a  devouring  heat,  cannot  endure  the  .slightest  covering  ;  and  who, 
though  naked,  seek  still  for  cold.  We  have  seen  them  take  the  snow  by 
handfuls,  and  allow  it,  with  extreme  delight,  to  melt  upon  their  bodies ;  and 
break  the  ice  of  a  pond  or  river,  for  the  purpose  of  plunging  into  it.  It  is 
not  unusual  in  hospitals,  to  see  men,  and  even  women,  throw  themselves  nak- 
ed into  cold  water,  and  expose  the  body,  particularly  the  head,  to  the  water, 
as  it  escapes  from  the  fountains.  Some  demand  of  us  to  apply  the  douche  of 
cold  water,  directly  to  the  head. 

A  maniac  becomes  furious  during  the  night,  and  utters  frightful  howls.  At 
two  o'clock  in  the  morning,  I  order  the  douche,  and  whilst  the  cold  water  is 
falling  upon  his  head,  and  inundating  his  body,  he  appears  to  be  greatly  pleas- 
ed, and  thanks  us  for  the  kindness  we  have  shown  him ;  becomes  composed  ; 
and  sleeps  remarkably  well  the  rest  of  the  night.  Notwithstanding,  we  must 
guard  against  the  conclusion,  that  all  maniacs  are  equally  insensible  to  cold. 
In  truth,  they  support  a  low  temperature  more  readily  than  other  men,  because 
they  are  more  active,  and  thus  disengage  a  greater  amount  of  caloric.  It  is 
certain  however,  that  a  very  intense  degree  of  cold  agitates  them ;  and  that, 
during  the  winter,  especially  at  the  close  of  an  attack,  patients  suffer  and  die, 
if  care  be  not  taken  to  protect  them  from  tlie  rio-ors  of  the  season.  Maniacs, 
say  they,  moreover,  can  support  for  a  long  time,  both  hunger  and  thirst. 
However,  the  greater  part  of  them  eat  much,  and  with  voracity ;  and  are  tor- 
mented and  irritated  by  a  burning  thirst.  The  physical  and  moral  irritation, 
which  results  from  too  long  privation  from  aliments,  torments  them ;  and  is 
succeeded  by  weakness,  fainting,  and  even  death.  Many  cases  of  mania 
terminate  in  dementia;  which  proves  that  maniacs  become  enfeebled,  impair 
their  strength,  and  need  nourishment,  in  order  to  repair  their  exhausted  pow- 


388  MANIA. 

ers.  Pinel  has  established  the  fact,  that  the  want  of  nourishment,  and  its  im- 
proper distribution,  exasperates  and  prolongs  the  evil.  Some  maniacs  suffer 
from  a  degree  of  delirium  so  intense,  that  they  appear  to  have  a  sense,  neither 
of  their  existence  nor  wants  ;  and  refuse,  at  such  times,  their  nourishment, 
not  knowing  what  is  presented  to  them.  It  also  happens,  that  disturbance  of 
the  stomach,  made  manifest  by  the  foul  state  of  the  tongue,  and  the  fetid  odor 
of  the  mouth,  cause  the  maniac  to  repulse  food  when  offered  him  ;  and  some- 
times, this  condition  of  the  stomach  gives  rise  to  vague  ideas  of  poison ; 
whence  spring  new  motives  to  repugnance.  In  such  circumstances,  the  refu- 
sal of  food  does  not  persist,  and  ceases,  when  the  delirium  abates,  or  when 
the  gastric  symptoms  are  dissipated.  I  have  never  known  a  fatal  accident 
supervene  in  a  case  of  mania,  upon  the  obstinate  refusal  of  nourishment ; 
while  monomaniacs  and  lypemaniacs^  resist  hunger  with  a  fearful,  and  even 
mortal  obstinacy. 

Maniacs  are  subject  to  insomnia,  which  persists  for  several  days,  weeks,  and 
even  months.  Sleep  is  painful,  and  often  troubled  by  dreams  and  night-mare. 
These  patients  usually  suffer  from  constipation,  which  is  generally  of  an  obsti- 
nate character.  Some  have  liquid  and  abundant  stools ;  a  symptom  more 
fatal  than  constipation,  especially  when  it  occurs  early  in  the  attack,  and  often 
returns  during  the  course  of  the  malady.  I  remarked,  when  speaking  of  the 
causes  of  insanity,  that  onanism  was  often  the  occasion  of  mental  alienation  ; 
but  it  produces  less  of  mania  than  other  forms  of  insanity.  Maniacs,  during 
the  existence  of  their  attacks,  rarely  yield  themselves  to  this  fatal  habit. 
However,  we  meet  with  some  cases  of  masturbation  among  them.  If  they  are 
less  subject  to  masturbation,  they  manifest  no  sense  of  shame  in  the  mode  of 
wearing  their  apparel ;  and  do  not  refrain  from  conversation  the  most  disgust- 
ing and  obscene.  Persons  most  respectable  for  their  religious  principles  and 
morals,  are  not  exempt  from  these  failings.  Onanism  among  maniacs  is  a 
fatal  symptom.  If  it  does  not  cease  promptly,  it  furnishes  an  insurmountable 
obstacle  to  the  cure.  Hastening  the  giving  out  of  the  vital  forces,  it  plunges 
these  patients  into  a  state  of  brutish  stupidity,  phthisis,  marasmus  and  death. 

Such  are  the  general  symptoms  of  mania.  They  j)resent  all  the  characte- 
ristics of  excitement,  and  a  want  of  harmony  in  the  exercise  of  the  faculties. 
There  is  a  variety  of  mania,  which  does  not  present  the  same  manifestations 
of  force,  energy,  and  disposition  to  fury  ;  although  we  may  always  recognize 
in  it  the  same  incoherence  of  ideas  ;  the  same  disorder  both  of  words  and  ac- 
tions ;  the  same  activity  ;  the  same  mobility  in  the  exercise,  both  of  the  intel- 
lectual and  moral  faculties  ;  and  the  same  want  of  harmony  between  them. 
Every  thing  excites  those  who  are  a  prey  to  this  variety  of  maniacal  delirium ; 
every  thing  opposes  and  irritates  them.  Their  susceptibility  is  extreme  ;  no- 
thing checks  their  mobility  ;  and  their  activity  is  uncontrollable.  They  are 
cunning,  deceitful,  imprudent,  quarrelsome,  and  dissatisfied  with  every  thing, 
even  the  most  affectionate  attentions.  They  are  incessantly  complaining,  both 
of  persons  and  things.  Their  loquacity  is  exhaustless.  They  are  constantly 
speaking,  and  their  voice  is  deafening.  They  are  every  moment  changing 
their  tone,  thought  and  language.  They  apprehend  every  thing  in  its  wrong 
sense.  They  are  not  ashamed  to  utter  or  to  do  the  most  shameful  things. 
They  abuse,  calumniate,  and  please  themselves,  with  perverting  the  best  in- 
tentions, and  in  inventing  evil.  They  also  rend  in  pieces,  and  destroy.  The 
more  numerous  their  acts  of  malice,  the  more  gay,  contented  and  satisfied 
are  they.  They  laugh  at  the  mischief  they  do,  as  well  as  at  that  which  they 
see  done.  Finally,  they  grieve,  experience  transports  of  anger,  and  cry 
aloud  ;   are  timid  and  cowardly  ;   but  are  rarely  excited  to  fury. 

However  numerous  the  anomalies  which  the  symptoms  of  mania  present ; 
and  however  long  its  duration  ;  the  eye  of  an  observer  detects  in  this,  as  in 
all  other  diseases,  a  regular  progress.     Mania  has  its  premonitory  symptoms 


MANIA.  389 

and  precursory  signs.  We  distinguish  in  it,  three  periods.  In  the  first,  the 
patients  complain  of  a  general  and  unaccountable  uneasiness  ;  of  cephalalgia ; 
heat  in  the  cranium,  and  a  burning  in  the  bowels ;  epigastric  pains ;  a  distaste 
for  food,  attended  with  thirst  and  constipation.  They  suffer  from  internal 
agitations,  vague  disquietude,  insomnia,  dreams,  presentiments,  alternations 
of  gayety  and  sadness,  and  sometimes  a  temporary  delirium.  They  still  how- 
ever retain  their  affection  for  their  relatives  and  friends.  The  symptoms 
augment,  the  delirium  becomes  general  and  constant,  and  the  mofal  affections 
are  perverted.  The  transition  to  this  second  period  is  signalized  by  certain 
acts  of  violence  or  of  fury,  either  spontaneous  or  provoked.  After  a  period, 
usually  of  considerable  duration,  the  maniac  becomes  more  composed ;  less 
turbulent ;  and  less  disposed  to  fury.  He  is  more  attentive  to  foreign  impres- 
sions, and  more  submissive  to  the  counsels  that  are  given  him.  At  length, 
the  moral  affections  awake,  the  features  of  the  countenance  are  less  convul- 
sive, emaciation  diminishes,  sleep  is  prolonged,  and  the  patient  becomes  aware 
of  his  condition.  Ordinarily,  in  proportion  as  the  functions  of  nutritive  life, 
and  those  of  the  life  of  relation  become  established,  a  crisis,  more  or  less 
complete,  takes  place.  But  if  the  functions  of  the  life  of  nutrition  are  rees- 
tablished without  a  corresponding  diminution  in  the  delirium,  we  may  then 
fear,  lest  the  mania  pass  into  a  chronic  state,  and  degenerate  at  last  into  de- 
mentia.    The  following  observation  happily  illustrates  this  regular  course. 

A.,  a  field  laborer,  is  tall,  her  hair  of  a  flaxen  color,  her  eyes  blue  and  live- 
ly. Her  physiognomy  is  changeful ;  her  disposition  petulant,  irascible  and 
choleric.  At  the  age  of  six  years,  she  has  variola.  Twenty  years  of  age  ; 
menses  very  irregular  ;  usually  preceded,  and  often  replaced  by  leucorrhoea. 
Twenty-eight  years  ;  married  ;  domestic  trials.  Six  months  subsequently,  a 
suppression  of  the  menses  takes  place,  which  continues  for  eighteen  months. 
Twenty-nine  and  a  half  years  ;  mania,  which  ceased,  only  after  the  occur- 
rence of  a  diarrhoea,  which  persisted  for  eighteen  months.  Thirty  years  ; 
restoration  to  health  ;  separation  from  her  husband.  Thirty-six  years  ;  incu- 
bation. Moral  affections  succeeded  by  general  uneasiness,  syncope,  inappe- 
tence,  pains  in  the  limbs,  weakness. 

First  period : — June  2d,  1813;  Insomnia,  nausea,  white  or  yellow  tongue, 
forebodings.  June  17th.  Emetic.  The  act  of  vomiting  occasions  great  suf- 
fering. She  believes  that  those  around  desire  to  poison  her.  She  cries 
aloud,  and  is  agitated.  Her  friends  press  eagerly  around  her,  and  assure  her 
that  she  is  insane  ; — a  remark  which  affects  her  most  keenly.  She  becomes 
delirious,  and  is  removed  from  home. 

Second  period: — Her  ideas  are  all  exceedingly  disordered,  and  every  thing 
frightens  the  patient.  Her  arrival  at  Paris,  and  especially  her  stay  at  the  Pre- 
fecture, render  her  perfectly  insane  ;  every  thing  appears  of  a  dark  hue,  and 
she  no  longer  recognizes  any  one.  June  29th.  At  the  period  of  her  admis- 
sion into  the  hospital  Salpetriere,  Mad'e  A.  is  extremely  emaciated,  her  skin 
brown,  her  loquacity  continual,  and  her  delirium  extends  to  every  thing.  She 
has  numerous  hallucinations,  utters  abusive  and  threatening  language,  and 
deals  blows  upon  all  around  her.  The  patient  breaks  every  thing  within  her 
reach,  tears  her  clothing,  goes  naked,  rolls  upon  the  ground,  sings,  dances, 
vociferates,  and  rejects  the  aliments  that  are  offered  her.  Insomnia  and  con- 
stipation are  obstinate.  The  emaciation,  the  swarthy  hue  of  the  skin,  the 
contraction  of  the  muscles  of  the  countenance,  the  knit  brow,  the  commis- 
sures of  the  lips  convulsively  raised,  the  eyes  sunken,  often  injected  and  hag- 
gard, and  the  animated,  although  doubtful  look,  give  to  the  physiognomy  of 
this  maniac,  a  character  which  perfectly  expresses  the  disorder  and  exaltation 
of  her  ideas  and  affections.  July,  same  condition.  Baths,  tepid  and  prolong- 
ed. August.  Cold  douches,  while  the  patient  is  in  a  tepid  bath.  Sometimes 
sleep  follows  the  employment  of  the  bath,  but  during  the  night  she  indulges 


390 


MANIA, 


in  cries  and  songs.  Constipation  continues.  Sept.  Tepid  baths.  Boils 
appear  upon  various  regions  of  the  body.  There  is  a  slight  degree  of  compo- 
sure, and  on  the  27th  of  September  a  cessation  of  the  furuncles,  and  a  return 
of  agitation.  October.  We  commence  with  two,  and  afterwards  employ  four, 
six,  and  eight  grains  of  opium  daily.  We  administer  Hyoscyamus  in  the  same 
dose,  without  obtaining  any  effect.  November.  The  menses  appear,  but  are 
scanty.  Leeches  are  applied  to  the  vulva,  and  there  is  a  slight  remission  ; 
but  on  the  following  day,  delirium  and  agitation  return,  with  the  same  inten- 
sity. Tepid  baths  daily.  She  passes  the  months  of  December,  January  and 
February,  in  the  same  state  of  delirium  and  excitement.  We  content  our- 
selves with  furnishing  the  patient  with  food,  and  protecting  her  from  the  cold. 
March,  1S14.  A  serous  diarrhosa,  so  abundant,  that  after  fifteen  days  the  pa- 
tient is  scarcely  able  to  walk.  The  mental  disturbance  does  not  diminish,  but 
fury  no  longer  exists. 

Third  period  : — April.  The  diarrhoea  persists.  LeucorrhcEa  also  appears, 
and  there  are  some  slight  manifestations  of  reason.  The  patient  takes  the  pti- 
sans and  aliments  that  are  offered  her,  and  desires  to  recover  once  more  the  use  of 
her  faculties.  May.  We  prescribe  chocolate,  and  mucilaginous  drinks.  Her 
appetite  is  good,  her  rest  better,  and  she  recognizes  those  who  approach  her. 
She  listens  to  the  advice  that  is  given  her,  but  often  manifests  incoherence  in 
her  ideas.  May  27th. — The  diarrhoea  has  ceased  for  some  days,  and  the  pa- 
tient is  slightly  irrational ;  but  preserves  a  very  great  mobility,  and  a  never- 
ceasing  loquacity.  She  passes  into  the  ranks  of  convalescents  ;  but  her  look 
is  one  of  astonishment,  and  her  laugh  convulsive.  She  is  delirious  only  for 
very  brief  periods,  and  attends  to  what  is  said  to  her.  June.  Her  mobility 
is  extreme,  and  it  is  impossible  to  fix  her  mind  upon  work.  Tepid  baths,  and 
antispasmodic  drinks  are  employed,  and  there  is  a  progressive  and  rapid  re- 
turn to  her  usual  fulness  of  habit  and  reason.  July  1st.  She  has  a  copious 
leucorrhoea,  which  continued  for  six  days.  Her  habit  continues  moderately 
full,  and  her  physiognomy  composed.  No  undue  vivacity  of  expression  longer 
remains,  and  all  the  functions  are  reestablished.  Convalescence  is  perfect. 
July  lltli.  Discharged;  since  which  period,  she  has  never  failed  to  enjoy 
excellent  health.  This  observation,  which  is  interesting  on  various  accounts, 
presents  to  our  notice,  the  three  stages  of  mania,  in  a  case  whose  progress  has 
been  perfectly  regular.  The  operation  of  new  causes,  made  the  first  pass  into 
the  second  stage  of  the  malady,  and  a  long,  and  even  harassing  critical  eva- 
cuation, preceded  the  third. 

In  the  following  case,  we  see  a  girl,  twenty-one  years  of  age,  and  habitual- 
ly melancholic,  whose  mania  is  preceded  by  an  attempt  at  suicide.  The 
progress  of  this  case  is  less  regular,  is  modified  by  menstruation,  and  its  du- 
ration much  longer  than  the  preceding.  N.,  twenty-one  years  of  age,  a  ser- 
vant girl,  the  offspring  of  a  father  who  committed  suicide,  and  brought  up  by 
an  epileptic  aunt,  is  of  a  stature  above  the  medium  size,  and  her  habit  is  mode- 
rately full ;  her  hair  flaxen,  eyes  blue,  and  disposition  gloomy.  She  is  silent, 
and  very  industrious  and  regular  in  her  conduct.  From  infancy,  her  health 
was  delicate,  and  she  had  variola  at  the  age  of  six  years.  When  fourteen, 
she  was  subject  to  pains  in  the  head,  cardialgia  and  leucorrhoea.  At  fifteen, 
menstruation  was  established,  and  since  that  period,  has  been  both  regular 
and  abundant.  Her  health  became  firm,  but  if  the  menses  were  at  any  time 
scanty,  cephalalgia  supervened,  attended  with  sadness  and  insomnia.  At  the 
age  of  twenty  and  a  half  years,  N.,  becomes  more  sedentary  and  gloomy. 
When  twenty-one,  she  devotes  herself  to  the  care  of  her  aunt,  who  is  sick  ; 
and  is  greatly  grieved,  as  well  as  fatigued  by  her  efforts.  The  menses  are 
suppressed.  She  suffers  from  insomnia  and  an  increased  degree  of  sadness ; 
often  from  panic  terrors  and  thoughts  of  suicide. 

In   the   month  of  Feb.   1813,  she   is  thrice    bled   in   the  feet,  without   any 


MANIA.  391 

improvement  of  her  health.  She  was  afterwards  brought  to  the  residence  of 
her  mother,  where  her  symptoms  became  exasperated.  A  few  days  subse- 
quently, April  5th,  whilst  her  menses  are  flowing,  she  throws  herself  into  the 
river.  When  taken  from  the  water,  she  does  not  speak,  and  maintains  an 
obstinate  silence  during  the  succeeding  days  ;  her  appetite  is  capricious,  she 
moves  not,  nor  sleeps.  On  the  1st,  of  June  1813,  she  is  admitted  at  the 
Salpetriere.  She  is  in  a  state  of  stupor,  attended  with  convulsive  movements 
of  the  face,  and  the  levator  muscles  of  the  shoulders.  She  refuses  to  speak, 
to  take  nourishment,  or  to  v/alk.  She  remains  in  bed,  or  sits  wherever  she 
may  be  placed.  The  dejections  are  involuntary.  Tepid  baths  are  prescribed, 
and  vesicatories  applied  to  different  regions  of  the  skin.  Leeches  also  are 
applied  to  the  vulva.  The  menses  do  not  again  appear  until  the  month  of 
September.  There  is  a  slight  show  in  October  and  November.  Decem- 
ber loth,  the  menstrual  flow  is  abundant.  Sleep  then  returns  ;  the  patient 
converses  more,  and  her  appetite  is  improved.  On  the  23d,  she  converses 
and  desires  to  render  herself  useful  in  the  house.  She  sleeps,  but  her  appe- 
tite is  capricious.  She  also  conducts  with  propriety,  but  it  is  necessary  to 
provide  for  her  wants.  Feb.  12th,  1814,  delirium,  attended  with  certain  fe- 
brile symptoms,  such  as  the  following  ;  dry  and  parched  lips ;  brown  tongue ; 
pulse  full,  hard  and  frequent.  Thirst.  During  the  month  of  March  follow- 
ing, all  the  febrile  symptoms  disappear,  but  mania  bursts  forth,  with  all  its 
agitation,  violence  and  incoherence  of  thought.  The  face  is  deeply  flushed, 
and  expresses  indignation;  the  delirium  is  general,  her  loquacity  continual, 
sentences  brief,  and  her  movements  prompt.  The  patient  is  greatly  agitated, 
and  will  wear  no  clothinff.  She  swears,  threatens  and  strikes.  Believino- 
that  she  sees  persons  approaching  her,  she  becomes  irritated,  because  they 
do  not  address  her.  She  tears,  strikes,  bites,  cries  aloud,  dances  and  laughs, 
alternately. 

During  the  months  of  September,  October,  and  November,  the  same  agita- 
tion and  incoherence  of  thought  continue.  Her  loquacity  also,  her  disposi- 
tion to  fury,  insomnia  and  constipation ;  as  well  as  the  suspension  of  the 
menses,  continue  the  same.  Notwithstanding  the  cold,  she  remains  naked, 
refuses  to  wear  any  covering  upon  her  feet,  and  walks  thus,  about  the  courts. 
She  vociferates,  holds  obscene  conversation,  overturns  and  destroys.  Tepid 
baths  prolonged,  and  the  douche  which  she  dreads,  in  no  respect  modify  her 
condition.  During  her  convalescence  however,  she  confessed  that  she  dread- 
ed the  douche,  which  notwithstanding  benefited  her,  although  exceedingly 
painful.  In  January,  1815,  there  is  a  copious  menstrual  flow,  and  from  that 
period  she  is  more  composed.  The  patient  sleeps  a  little,  and  seeks  to  occu- 
py herself,  although  always  delirious.  During  the  month  of  February,  she  is 
more  tranquil  and  rational,  both  in  her  conversation  and  acts.  In  February, 
the  menstruation  is  more  abundant,  the  appetite  more  regular,  sleep  better, 
and  there  is  no  longer  cephalalgia.  The  features  of  the  countenance  are  not 
now  convulsive,  and  the  complexion  is  becoming  more  clear.  She  labors 
much  in  the  house,  and  by  slow  degrees  attains  a  moderately  full  habit. 
Tepid  baths  are  continued,  and  an  aromatic  infusion  is  prescribed  for  a  drink. 
During  the  month  of  March  she  becomes  convalescent,  reasons  correctly, 
remembers  her  condition,  and  gives  a  complete  account  of  it.  It  was  her 
opinion,  during  her  delirium,  that  the  persons  who  surrounded  her  wished 
to  slay  her.  She  was  discharged  restored,  June  19th,  1815.  Since  that 
period  she  has  enjoyed  excellent  health,  and  resumed  her  ordinary  occupa- 
tions.    Six  years  afterwards,  June  5th,  1821,  she  died  of  phthisis. 

The  progress  of  mania  is  not  always  so  regular,  as  in  the  first  of  the  pre- 
ceding cases.  We  have  already  seen,  that  this  is  a  disease  which  varies  in 
its  mode  of  attack.  It  varies  also,  in  the  succession  of  its  symptoms,  in 
their  duration  and  termination.     In  one  case,  from  its  commencement,  the 


392  MANIA. 

mania  manifests  its  highest  degree  of  excitement,  and  thus  persists  to  the 
end  of  the  attack,  which  ceases  suddenly.  The  patient  then  appears,  as  it 
were,  to  come  out  of  a  dream  ;  and  it  seems  to  him  that  the  medium  which 
isolates  him  from  the  rest  of  the  world,  was  rent,  or  had  fallen  from  his  eyes. 
In  another,  the  progressive  diminution  of  the  number  and  intensity  of  the 
symptoms,  enables  us  to  foresee  the  most  distant  termination  of  the  malady. 
Again,  it  is  only  after  alternate  remissions,  more  or  less  long  and  marked, 
that  the  maniac  reaches  convalescence.  A  point,  to  which  1  cannot  too  care- 
fully direct  your  attention,  is  the  remission,  which  is  observed  during  the  course 
of  the  first  month  after  an  attack  of  mania.  It  is  constant.  Does  it  mark 
the  termination  of  the  period  of  irritation?  Mania  is  a  disease  emphatically 
chronic  ;  nevertheless,  its  duration  is  sometimes  very  brief  We  have  known 
attacks  to  last  only  twenty-four  hours;  a  few  days  or  weeks.  But  in  such 
cases,  we  may  well  fear  a  new  attack,  at  no  distant  period.  We  cannot  be 
too  much  on  our  guard,  however  slight  and  temporary  may  have  been  the 
first  manifest  action  of  cerebral  disturbance,  as  the  patients  remain  in  con- 
stant danger  of  new  cerebral  symptoms.  Mania  persists  for  several  months, 
a  year,  and  for  many  years.  Like  all  maladies,  mania  is  remittent  or  inter- 
mittent. We  have  just  described  the  progress  of  continued  mania.  Remit- 
tent mania  differs  from  the  continued  form,  in  this  respect  only  ;  that  the 
disturbance  of  the  thoughts  and  actions  present  remissions  more  or  less 
marked  and  regular.  There  are  some  maniacs  who  sleep  very  quietly,  and 
become  agitated  so  soon  as  they  awake.  Others  do  not  sleep  ;  are  agitated 
during  the  night,  and  composed  after  a  night  of  insomnia.  Finally,  some 
are,  both  morning  and  evening,  more  composed,  and  accessible  to  foreign 
impressions.  The  remission  is  often  so  regular  on  alternate  days,  that  we  are 
tempted  to  believe  that  it  is  an  intermission. 

Intermittent  mania,  succeeding  attacks,  now  regular,  and  now  irregular,  is 
very  frequent.  It  maybe  said  to  embrace  one  third,  among  great  assemblages 
of  maniacs.  Like  intermittent  forms  of  fever,  intermittent  mania  assumes  the 
quotidian,  tertian  or  quartan  type.  Its  attacks  also  recur  every  eight  days, 
every  month,  every  three  months ;  twice  a  year,  annually,  every  two,  three 
and  four  years.  Attacks  burst  forth  spontaneously,  and  without  other  known 
causes  than  the  epoch,  season  or  year,  on  which  previous  attacks  took  place ; 
or  else  they  are  provoked,  now,  by  the  same  causes  that  produced  the  first 
attacks,  and  now,  by  different  ones.  Attacks  are  induced  by  moral  affections, 
and  by  physical  derangements ;  such  as  gastric  embarrassments,  constipation, 
cephalalgia,  or  accidental  diseases.  I  have  seen  a  soldier  suffer  from  three 
attacks  of  mania,  each  of  which  immediately  succeeded  the  venereal  disease. 
A  woman  had  two  attacks,  succeeding  the  same  infection.  With  some  wo- 
men the  attack  bursts  forth  at  each  menstrual  period  ;  at  every  pregnancy 
and  confinement.  There  are  women,  who  become  maniacs  every  time  they 
nurse  or  wean  their  children.  I  have  had  in  charge  a  young  man  who  had 
suffered  from  three  attacks  of  mania,  at  the  opening  of  spring.  Before  the 
explosion  of  the  delirium,  his  face  was  covered  with  a  herpetic  eruption, 
which  ceased  with  the  attack.  Intoxication  very  frequently  induces  an  attack. 
A  lady  is  seized  with  mania  every  year ;  each  attack  being  preceded  by  symp- 
toms of  metritis.  We  have,  at  the  Salpetriere,  a  girl  whose  attacks  are  an- 
nounced by  all  the  signs  of  phthisis  pulmonalis.  Epilepsy  provokes  the  re- 
turn of  the  attacks.  Sometimes  attacks  of  mania  are  very  regular,  both  as  it 
respects  the  epoch  of  their  return,  the  nature  of  the  symptoms,  crises  and 
duration.  The  precursory  signs  of  attacks  are  sometimes  constant.  Some 
maniacs  before  an  attack,  are  chatty  or  serious  ;  others  walk  about  much, 
feel  remarkably  well,  and  are  very  happy.  Some  sing  or  whistle ;  others  are 
melancholic,  sad,  uneasy,  pusillanimous  ;  refuse  to  eat,  and  sleep  little.  Some 
have  a  presentiment  of  the  returning  attack,  and  experience  all  the  premonitory 


MANIA.  393 

symptoms  of  it.  In  general,  the  attacks  terminate  suddenly,  and  sometimes 
without  a  crisis.  Usually,  during  the  remission,  the  return  of"  the  thoughts, 
affections  and  habits  of  health,  is  complete.  However,  symptoms  sometimes 
remain,  which  prove  that  the  attack  is  not  entirely  resolved. 

I  have  seen  persons  who,  during  an  attack  of  mania,  reach  a  degree  of  ema- 
ciation bordering  upon  marasmus ;  and  whose  attacks  cease,  only  when  they 
have  sunk  into  a  state  of  extreme  feebleness.  The  seizure  having  termi- 
nated, more  or  less  time  is  required  to  restore  to  the  patient  his  full  measure 
of  thought  and  usual  fullness  of  habit ;  and  scarcely  has  he  attained  to  sound 
physical  and  moral  health,  when  he  relapses  into  a  new  attack.  Intermissions 
are  more  frequent  in  mania,  than  in  other  forms  of  insanity.  It  is  not  rare  to 
see  mania  alternate,  with  extreme  regularity,  with  phthisis,  hypochondria  and 
lypemania.  Mad'e  de  M.,of  a  delicate  constitution,  nervous  temperament,  and 
great  susceptibility,  having  experienced  the  unmitigated  severities  of  the 
revolution,  was  obliged  to  emigrate  with  her  family.  Along  with  the  priva- 
tions necessarily  connected  with  emigration,  she  experienced  domestic  trials, 
and  became  a  maniac.  She  was  then  twenty-four  years  of  age.  An  attack 
occurred  every  year.  Having  returned  to  France,  the  attacks  were  renewed 
for  two  years  in  succession.  When  committed  to  my  care,  she  was,  for  the 
third  time  since  her  return,  in  a  state  of  mania  complicated  with  hysteria.  I 
prescribed  one  drachm  of  camphor,  dissolved  in  two  ounces  of  pure  vinegar, 
to  be  taken  during  the  day,  by  table  spoonfuls,  in  four  ounces  of  water.  On 
the  following  day,  the  attack  was  lessened,  and  ceased  almost  immediately  ; 
whilst  the  preceding  attacks  had  lasted  from  ten  to  eleven  months.  During 
the  succeeding  year,  the  attack  was  renewed.  She  experienced  at  first,  all 
the  symptoms  of  metritis.  She  has  epigastralgia,  violent  pains  in  the  uterus, 
heat  and  paucity  of  urine  ;  nausea,  threatening  syncope,  especially  when  she 
places  her  feet  upon  the  ground  ;  burning  heat  of  skin,  pulse  frequent,  hard 
and  small ;  thirst  and  disquietude.  On  the  seventh  day,  the  symptoms  of 
metritis  cease,  and  an  instantaneous  explosion  of  maniacal  delirium  ensues. 
She  is  exceedingly  susceptible.  Everything  vexes  and  irritates  her.  She  is 
greatly  agitated,  is  continually  speaking,  and  her  thoughts  are  incoherent. 
Her  remarks  are  vulgar,  ribald  and  obscene  ;  which  last  symptom  is  the  more 
remarkable,  as  she  had  been  educated  with  the  utmost  care.  An  aunt  of  the 
patient  caused  her  to  take  the  same  medicine,  which  a  year  before  had  suc- 
ceeded so  well.  At  this  time,  however,  to  render  its  effect  more  durable,  they 
administer  the  mixture  of  camphor  and  vinegar  in  one  dose,  and  without  dilut- 
ing it  with  any  vehicle.  The  result  of  it  was  an  actual  poisoning,  which  com- 
promised the  life  of  the  patient.  Consecutive  gastralgia  permits  nothing  to 
be  introduced  into  the  stomach ;  and  for  several  weeks,  she  can  take  but  a 
few  spoonfuls  of  rice  water,  oatmeal  gruel,  or  milk  and  water.  The  attack 
of  mania,  however,  was  cut  short  by  it.  She  enjoyed  a  perfect  intermission 
for  two  years ;  since  which  period,  that  is  to  say,  for  twenty  years,  the  attacks 
recur  almost  annually;  continuing  however,  only  for  one  or  two  months. 

Mad'e  de  S.,  of  a  strong  constitution,  has  long  resided  in  the  Indies.  Mar- 
ried at  twenty,  she  was  confined  at  twenty-one.  Six  days  after  her  confine- 
ment her  bed  caught  fire,  she  became  alarmed,  uttered  a  loud  cry,  and  both 
the  milk  and  lochia  were  suppressed.  A  quarter  of  an  hour  afterwards,  she 
was  seized  with  mania  and  fury,  which  lasted  three  months,  and  was  succeed- 
ed by  melancholy,  which  continued  for  two  more.  She  was  immediately  bled 
several  times  in  the  foot,  and  cold  baths  were  administered.  She  was  then 
in  the  Isle  of  France.  When  twenty-nine  years  of  age,  she  had  a  second  at- 
tack, caused  by  the  grief  which  the  capture  of  Batavia,  where  her  husband 
was  garrisoned,  occasioned  her.  A  furious  attack  suddenly  burst  forth,  per- 
sisted for  two  months,  and  was  succeeded  like  the  preceding  attack,  by  me- 
lancholy.    It  lasted  for  four  months.     At  thirty-five  years  of  age,  she  had  a 

50 


394  MANIA. 

new  attack,  caused  by  the  disquietude  connected  with  a  painful  voyage,  and 
despair  at  the  imprisonment  of  her  husband.  The  attack  was  less  violent 
than  the  previous  ones,  and  lasted  but  three  months,  comprising  the  period 
of  melancholy.  During  the  month  of  November,  1815,  she  has  a  fourth  at- 
tack, produced  by  the  removal  of  her  husband  from  office,  and  the  death  of 
an  intimate  friend.  The  attack  commenced  on  the  third,  and  she  was  com- 
mitted to  my  care  on  the  fourth  of  November.  The  mania  persisted  for  two 
months,  and  was  succeeded  by  melancholy.  The  period  of  melancholy  was 
prolonged  to  a  greater  extent,  than  in  her  previous  attacks. 

When  forty  years  of  age,  she  sails  with  her  husband  for  Senegal,  and  ex- 
periences all  the  horrors  of  the  shipwreck  of  the  Medusa; — a  shipwreck,  un- 
happily so  well  known.  Nor  does  it  occasion  the  loss  of  her  reason.  On  the 
following  year,  she  experiences  a  fifth  attack,  similar  in  all  respects  to  those 
which  have  preceded  it.  She  reaches  France  in  a  state  of  sadness,  and  suf- 
fering from  prostration  and  tremors  at  the  stomach.  These  symptoms  are 
dissipated,  only  at  the  expiration  of  some  months.  At  the  age  of  forty-five, 
she  has  a  sixth  attack.  All  the  different  attacks  have  presented  the  same 
characteristics  ; — a  sudden  invasion,  provoked  by  some  moral  aftection  ;  a 
period  of  mania  lasting  from  two  to  three  months ;  succeeded  by  one  of  me- 
lancholy, which,  at  first,  continued  for  two  or  three  months  only ;  and  persist- 
ed for  a  much  longer  period,  during  the  last  two  attacks.  During  the  mani- 
acal period,  she  conceives  an  aversion  to  her  husband  and  daughter,  who  are 
the  objects  of  her  tenderest  affection  when  in  health.  During  that  of  melan- 
choly, it  seems  to  the  patient  that  her  head  is  empty,  and  she  considers  her- 
self incapable  either  of  thinking  or  acting.  While  the  attack  lasts,  she  be- 
comes much  emaciated  ;  and  so  soon  as  the  emaciation  is  extreme,  the  cessa- 
tion of  the  attack  takes  place. 

Sometimes  at  its  commencement,  mania  presents  all  the  symptoms  of  grave 
forms  of  fever.  The  diagnosis  also,  at  this  period  of  the  malady,  is  not  always 
easy.  This  error  may  be  followed  by  the  most  fatal  consequences,  should  an 
ataxic  fever  or  cerebral  phlegmasia,  be  mistaken  for  mania.  Complications 
with  cutaneous  affections  are  frequent.  It  is  rare  among  young  women,  that 
mania  is  not  complicated  with  certain  hysterical  symptoms.  The  same  is 
true  of  hypochondria  among  men.  Mania  is  often  complicated  with  epilepsy ; 
more  frequently  still  with  paralysis  and  scurvy.  It  is  also  complicated  with 
other  forms  of  insanity  ;  a  circumstance  that  has  given  rise  to  many  diverse 
opinions  respecting  the  character  and  classification  of  different  forms  of  men- 
tal alienation.  Mania  being  produced  by  causes  which  are  peculiar  to  it,  and 
having  symptoms  which  characterize  it,  a  course  also,  more  or  less  regular, 
like  all  other  maladies,  terminates  by  crises.  Like  them,  it  has  its  critical  ter- 
minations, and  its  transformations  into  other  diseases.  If  the  crises  of  mania 
have  not  been  well  observed,  it  is  not  because  they  are  wanting,  but  because 
the  observation  of  them  is  difficult,  in  consequence  of  the  fear  and  estrange- 
ment which  maniacs  inspire,  and  of  the  general  abandonment  of  this  class  of 
patients,  even  to  our  own  times.  This  disease  terminates  by  evacuations  of 
every  kind,  mucous  or  sanguine,  vomiting,  ptyalism,  alvine  dejections,  leucor- 
rhcea,  bleimorrhagia,  epistaxis,  menses,  hemorrhoids,  varices.  It  terminates  by 
cutaneous  phlegmasiae  and  erysipelas.  I  have  seen  enormous  furuncles,  fol- 
lowed by  abundant  suppuration,  put  an  end  to  mania.  Finally,  mania  is  ter- 
minated by  continued  and  intermittent  fevers.  It  is  converted  into  a  true  me- 
lancholy, or  degenerates  and  passes  into  dementia,  which  is,  as  1  have  else- 
where said,  a  termination  of  all  forms  of  insanity.  We  must  not  confound 
this  form  of  dementia  with  that  condition  of  certain  maniacs,  which  succeeds 
the  agitation  and  delirium.  The  convalescents  are  prostrate,  exhausted,  and 
little  disposed  to  exertion.  They  say  little,  but  are  no  longer  irrational,  either 
in  their  conversation  or  actions.     To  those  cases  illustrating  the  critical  ter- 


MANIA.  395 

minations  of  insanity,  which  I  have  previously  reported,  I  will  add  the  two 
following.     They  are  cases  of  mania,  terminated  by  critical  deposits. 

Mad'e  A.  F.  G.,  nineteen  years  of  age,  of  a  nervous  temperament,  and  me- 
dium stature  ;  having  flaxen  hair,  black  eyes,  and  a  light  complexion,  is  the 
offspring  of  an  insane  mother.  She  had  variola  at  the  age  of  nine  years, 
tinea  capitis  at  twelve,  psora  at  thirteen,  and  menstruated  spontaneously  at  the 
age  of  fourteen.  Since  her  menses  have  been  abundant,  she  has  been  subject 
to  frequent  attacks  of  cephalalgia.  When  sixteen,  she  imagines  that  every 
one  is  watching  her  movements.  Married  at  eighteen,  at  nineteen  she  is  hap- 
pily confined.  She  desires  to  nurse  her  child  ;  but  immediately  begins  to 
commit  errors  of  regimen,  and  is  unwilling  to  remain  covered  in  bed,  saying 
she  is  too  warm,  etc.,  etc.  She  experiences  many  pains  during  the  act  of 
nursing,  and  these  provoke  confusion  of  ideas.  On  the  fourth  day,  she  ceases 
to  nurse  her  infant,  and  her  breasts  become  excessively  engorged  with  milk. 
On  the  fifth,  she  drinks,  and  washes  herself  in  cold  water,  in  consequence  of 
which  the  lochia  no  longer  flow.  She  complains  of  an  insupportable  heat ; 
and  they  desire  to  bleed  her,  but  to  no  purpose.  On  the  fourteenth  day, 
leeches  are  applied  to  the  vulva,  sinapisms  to  the  thighs,  and  blisters  to  the 
limbs.  On  the  sixteenth,  leeches  are  employed  behind  the  ears,  new  sina- 
pisms and  an  ethereal  potion,  but  all  without  success.  On  the  25th  of  Feb. 
the  patient  is  brought  to  La  Charite,  remains  there  four  days,  and  is  trans- 
ferred to  the  Salpetriere.  At  the  time  of  her  admission,  her  delirium  is 
general,  and  her  breasts  very  hard.  The  patient  refuses  to  remain  covered, 
suffers  from  panic  terrors,  and  regards  those  who  approach  her  as  acquain- 
tances. March  5th,  a  deposit  is  formed  in  the  right  breast.  An  abundant 
discharge  of  sanious  matter  is  established,  and  the  delirium  is  lessened.  Not- 
withstanding, the  patient  is  unwilling  to  wear  any  apparel.  April  10th  ;  the 
wound  of  the  breast  tends  to  cicatrization.  The  delirium  diminishes,  and  the 
patient  becomes  more  accessible  to  the  advice  that  is  given  her.  Until  the 
first  of  May,  there  is  a  progressive  return  of  the  vital  forces  and  reason  ;  and 
she  sees  her  husband  and  relatives.  May  12th,  her  convalescence  is  entire, 
and  there  is  a  complete  cicatrization  of  the  abscess.  May  15th,  reason  is 
perfect.     May  27th,  she  leaves  the  hospital,  in  the  enjoyment  of  good  health. 

Elizabeth  C,  sixty-four  years  of  age,  of  a  good  constitution,  and  very  ac- 
tive for  one  of  her  age,  has  always  enjoyed  excellent  health.  She  has  never 
experienced  any  menstrual  disorder,  and  has  been  four  times  happily  confined. 
One  of  her  sons  was  engaged  in  the  Spanish  war,  and  having  no  news  from 
him,  she  is  greatly  afflicted.  One  day  she  believed  that  she  recognized  him 
in  the  midst  of  a  company  of  soldiers,  and  follows  them,  from  the  faubourg 
Saint-Antoine,  to  the  barrier  Fontainebleu.  It  is  not  certainly  ascertained 
what  she  does  on  the  way,  but  she  was  taken  on  the  following  day,  running 
naked  through  the  street.  When  brought  to  the  Salpetriere,  she  is  in  a  state 
of  fury,  which  persists  for  six  weeks ;  after  which,  the  parotid  of  the  left  side 
becomes  enlarged.  The  delirium  immediately  ceases,  and  the  repeated  appli- 
cation of  leeches  to  the  tumor,  diminishes  the  inflammation.  An  abscess  how- 
ever forms,  which  opens,  and  is  cured  in  the  course  of  six  weeks.  Since  the 
appearance  of  the  tumor  of  the  parotid,  the  delirium  has  gradually  diminish- 
ed, and  completely  disappeared,  before  the  cicatrization  of  the  opening  in  the 
wound. 

It  is  consoling  to  think,  that  the  malady,  most  deplorable  as  it  respects  the 
nature  and  violence  of  its  symptoms,  offers  the  readiest  chance  of  cure.  Ma- 
nia is,  in  fact,  of  all  forms  of  mental  alienation,  most  certainly  cured,  if  it  is 
simple,  and  if  the  predispositions  to  it  are  not  too  numerous,  and  their  influ- 
ence too  energetic.  Of  two  hundred  and  sixty-nine  maniacs  who  have  been 
cured,  and  of  whom  I  can  give  an  exact  and  detailed  account ;  one  hundred 
and  thirty-two  were  suffering  from  their  first  attack,  seventy-seven  from  the 


396  MANIA. 

second,  thirty-two  from  the  third,  and  eighteen  from  the  fourth ;  ten,  had  had 
a  still  greater  number  of  attacks.  They  occur  at  briefer  intervals,  either  be- 
cause they  are  prolonged  and  multiplied ;  or  because  their  intermission  is 
shorter,  less  distinct  and  clear,  and  the  mania  continued.  The  duration  of 
the  malady  is  also  shorter  than  that  of  other  forms  of  insanity;  a  fact  of  which 
we  can  assure  ourselves,  by  casting  a  glance  over  the  following  table  ;  which 
proves  that  almost  all  maniacs  are  cured  during  the  first  year  ;  and  that  after 
this  period,  the  number  restored  to  health  is  very  limited. 

Table  of  cures.— 'Cnxes  obtained  during  the  first  month,  27  ;  second  month, 
32 ;  third  month,  18 ;  fourth  month,  30 ;  fifth  month,  24 ;  sixth  month,  20 ; 
seventh  month,  20 ;  eighth  month,  19 ;  ninth  month,  12 ;  tenth  month,  13 ; 
twelfth  month,  23;  during  the  second  year,  18;  in  the  following  years,  13; 
total,  269.  The  seasons  most  favorable  for  effecting  a  cure,  are,  beyond  con- 
tradiction autumn  and  summer ;  the  most  unfavorable,  winter.  Summer 
being  the  season  for  accidental  mania,  it  is  not  surprising  that  maniacs  are 
cured  durina  the  three  months  of  summer. 

o 

Table  of  cures,  relative  to  the  seasons. — During  the  three  months  of  Sept., 
Oct.  and  Nov.,  83;  Dec,  Jan.,  Feb.,  48  ;  March,  April,  May,  61 ;  June, 
July,  Aug.,  77  ;  total,  269.  If  mania  is  cured  more  frequently  than  other 
forms  of  insanity,  it  is  more  rarely  the  cause  of  death ;  supposing  all  neces- 
sary precautions  to  be  taken,  to  prevent  the  numerous  accidents  to  which  the 
delirium  of  maniacs  exposes  them.  It  is  proper,  in  forming  this  favorable 
opinion,  to  take  into  the  account  the  influence  of  the  regimen  and  treatment 
to  which  maniacs  are  submitted,  and  to  have  reference  to  the  complications 
and  duration  of  the  disease.  For  if  mania  has  persisted  for  several  years,  the 
constitution  of  the  maniac  is,  in  some  sort,  identified  with  the  malady,  or  the 
latter  has  degenerated.  If  it  is  complicated  with  epilepsy,  paralysis,  or  some 
organic  lesion,  then  certainly  the  mania  is  mortal ;  less,  in  itself  considered, 
than  by  its  complications.  Among  more  than  twelve  hundred  insane  women, 
admitted  into  the  Salpetriere  during  four,  and  into  my  establishment  for  seve- 
ral years,  scarcely  thirty  died  from  simple  mania.  Twenty-five  died  during 
the  first  attack,  and  four  during  the  second.  These  maniacs  died  in  the  course 
of  six  years ;  two-thirds  of  them  during  the  first  year,  as  the  following  table 
proves : 

Table  of  the  periods  of  mortality . — Months.  First,  3;  second,  3;  third,  0; 
fourth,  5 ;  fifth,  0 ;  sixth,  4 ;  seventh,  2 ;  eighth,  1 ;  ninth,  2 ;  tenth,  0 ; 
twelfth,  1.  Years. — Second,  3  ;  third,  2;  fourth,  2  ;  si.xth,  3.  Simple  mania 
is  rarely  fatal.  Maniacs  do  not  die  from  the  cerebral  affection,  but  from 
typhoid,  and  cerebral  ataxic  fever,  phthisis  pulmonalis,  and  epileptiform  con- 
vulsions. They  die  suddenly,  as  if  the  sensibility,  being  exhausted,  nothing 
remained  to  sustain  the  vital  principle.  We  had  at  the  Salpetriere,  in  1814, 
a  young  woman  twenty-four  years  of  age,  who  was  in  a  state  of  recent  and 
furious  mania,  free  from  complications.  Her  life  was  taken  by  one  of  her 
companions.  The  pupils  who  assisted  at  the  post-mortem  examination  were 
surprised,  as  well  as  myself,  on  finding  no  lesion  of  the  brain  or  its  meninges. 
At  the  necropsy  of  the  maniac,  of  whom  I  spoke  elsewhere,  who  also  died 
suddenly,  I  found  no  cerebral  lesion.  It  sometimes  happens,  that  the  brain 
and  its  meninges  suffer  from  no  lesion,  although  the  maniac  may  have  lived 
several  years.  The  nature,  extent  and  seat  of  lesions,  are  not  in  relation 
with  the  violence  and  duration  of  the  delirium.  When  authors  have  met  with 
lesions  of  the  brain  or  its  membranes,  proof  of  the  fact  had  been  manifested 
during  life,  by  embarrassment  in  the  movements,  paralysis,  or  convulsions. 
If  we  follow  with  attention  the  progress  of  the  malady,  we  can,  by  the  symp- 
toms which  complicate  it,  assign  the  epoch  at  which  the  lesion  commences. 
On  the  other  hand,  how  many  organic  lesions  of  the  brain  or  its  meninges 
have  escaped  the  most  attentive  observation  !     When  mania  persists  for  a  long 


MANIA.  397 

time,  in  the  last  days  of  maniacs,  does  not  the  general  weakness  dispose  to 
local  inflammations?  Do  not  the  symptoms  of  meningitis,  of  sanguine  con- 
gestions, of  cephalitis,  and  the  encephalic  lesions  which  we  observe  in  examin- 
ing the  dead,  belong  to  the  epipha^nomena  which  precede  death?  -Has  due 
care  been  exercised  in  distinguishing  simple  from  complicated  mania  ?  It  is 
certain  that  mania  has  existed,  in  which  no  cerebral  lesion  could  be  detected. 
Maniacs  are  sometimes  very  suddenly  cured ;  while  cases  occur,  in  which 
they  live  10,-20,  30  years,  notwithstanding  the  lesion  of  an  organ,  whose  in- 
fluence is  intimately  connected  with  all  those  which  are  essential  to  life.  At- 
tacks of  intermittent  mania  cease  spontaneously. 

What  conclusion  shall  we  draw  from  the  preceding  remarks?  That  patho- 
logical anatomy,  notwithstanding  the  very  important  labors  of  MM.  Foville, 
Calmeil,  Bayle  and  Guislain,  has  not  yet  made  us  acquainted  with  the  organic 
cause  of  mania.  Thirty  years  ago,  I  would  willingly  have  written  on  the  pa- 
thological cause  of  insanity.  I  will  not  now  attempt  a  labor  so  difficult;  so 
much  uncertainty  is  there,  and  so  contradictory  are  the  results  of  post-mor- 
tem examinations  of  the  insane,  that  are  made,  even  at  the  present  day.  I 
will  add  however,  that  modern  researches  permit  us  to  hope  for  views  more 
positive,  clear  and  satisfactory. 

Maniacs  sometimes  die  from  exhaustion  of  the  sensibility.  They  reach 
this  condition  in  consequence  of  their  excessive  agitation,  and  the  exaltation 
of  the  delirium.  They  are  much  emaciated,  and  enfeebled  even  to  syncope. 
They  sink  into  a  state  of  insensibility,  and  remain  gathered  up  in  their  bed, 
without  making  the  least  motion :  the  pulse  is  depressed  and  feeble,  the 
extremities  are  cold,  and  sometimes  violaceous.  In  the  course  of  a  few  days 
they  die,  especially  if  exposed  to  cold,  or  are  not  protected  from  its  rigors ;  if 
care  is  not  taken  to  warm  them  aorain,  if  cold,  and  to  administer  some  inviffo- 
rating  potion,  good  wine,  and  succulent  nourishment.  It  sometimes  happens, 
and  in  cold  seasons  particularly,  that  maniacs  are  stricken  with  instantaneous 
and  unexpected  death.  These  are  maniacs  who  are  most  agitated  and  vio- 
lent ;  the  wandering  of  whose  reason,  extends  even  to  the  loss  of  a  sense  of 
their  own  existence.  They  are  usually  emaciated,  pale,  of  a  nervous  tempe- 
rament, very  irritable,  and  suffer  from  convulsive  movements  of  the  features. 
Do  these  individuals  die  of  a  nervous  apople.xy?  Post-mortem  examinations 
have  taught  me  nothing  with  respect  to  it ;  no  lesion  revealing  the  cause  of 
death.  Rarely  are  maniacs  overwhelmed  by  cerebral  hemorrhage,  but  they 
suffer  from  cerebral  congestions,  and  partial  softening  of  the  brain,  which  pro- 
voke epileptiform  convulsions,  and  destroy  the  patient  in  a  few  days.  Slight 
symptoms  of  paralysis  usually  terminate  thus,  or  indicate  the  near  approach 
of  mania  to  dementia. 

Experience  has  proved  that  mania  is  not  incurable,  according  to  the  pre- 
possessions and  expressed  opinions  of  some  men.  This  prejudice  has  been 
exceedingly  fatal  to  maniacs,  to  whom  have  been  refused,  not  only  those 
means  that  were  best  calculated  to  restore  them  to  reason,  as  well  as  that 
sympathy  and  interest  which  their  malady  required  ;  but  also  many  things 
necessary  to  their  very  existence.  Maniacs  were  formerly  almost  every  where, 
and  are  still  in  many  countries,  deprived  of  things  indispensable  to  the  pre- 
servation of  life ;  constantly  confined,  tied,  and  even  chained.  The  negli- 
gence and  abandonment  in  which  these  wretched  beino-s  are  allowed  to  drag 
out  a  miserable  existence,  clearly  indicate  the  indifference  of  the  dispensers  of 
public  charity,  and  every  where  claim  the  active  solicitude  of  governments. 

Treatment. — We  must  never  lose  sight  of  the  fact  that  three  periods  sig- 
nalize the  march  of  mania,  and  that  each  one  of  these  calls  for  a  peculiar 
management.  What  resources  does  not  hygiene  present,  by  its  physical  as 
well  as  intellectual  and  moral  agents,  for  the  treatment  of  mania !  Some 
physicians  have  confidence  only  in  hygiene.     However,  pharmaceutic  agents 


398  MANIA. 

have  their  utility,  particularly  at  the  commencement  of  the  malady.  But  first, 
what  application  can  we  make  of  hygiene  1  At  the  commencement  of  the 
attack,  and  during  the  first  period,  the  patient  is  placed  upon  the  ground  floor, 
in  a  retired  apartment,  which  is  ventilated,  and  a  reduced  temperature  main- 
tained ;  cooled  when  too  warm,  and  heated  when  the  season  is  cold.  If  the 
violence  of  the  patient  is  extreme,  we  confine  him  to  his  bed,  and  control  his 
movements  with  the  camisole.  He  is  restricted  to  a  very  low  diet.  Cold 
nitrous  drinks  are  given  him,  pure  water,  the  decoction  of  dog-grass,  (  Triticum 
Repens),  or  of  barley,  whey,  almond  emulsion,  orange-sherbet,  cherry  and 
currant  water,  etc.  The  patient  is  left  alone  in  his  apartment,  persons  ready 
to  serve  him  being  near  at  hand.  The  presence  of  relatives  and  the  visits 
of  friends  are  interdicted,  in  order  to  reduce  him  to  the  smallest  number  pos- 
sible, of  impressions  and  sources  of  excitement.  These  measures  are  appli- 
cable only  during  the  first  period,  after  which  the  patient  should  be  subject- 
ed to  a  different  regimen.  This  class  of  patients  ought  not  to  be  confined  to 
their  apartments  ;  still  less  to  their  beds.  Exercise  is  with  them  an  instinc- 
tive want.  If  they  are  only  boisterous,  we  should  permit  them  in  the  open  air 
to  surrender  themselves  to  all  their  susceptibility  of  motion,  abandon  them- 
selves to  all  their  vociferations  and  extravagances,  in  order  to  remove  and 
exhaust  their  fury.  We  should  have  recourse  to  means  of  restraint,  only 
when  they  run  some  risk  of  life,  in  consequence  of  their  imprudence,  or  com- 
promise that  of  others,  by  their  freaks  of  excitement.  Even  then,  restraint 
should  be  temporary.  It  ought  to  be  prescribed  by  the  physician,  and  carried 
into  effect  immediately  after  some  out-break  on  the  part  of  the  patient,  and 
should  cease  so  soon  as  composure  is  established.  Without  this  attention, 
and  many  others  which  experience  alone  can  teach,  maniacs  will  regard 
themselves  as  the  victims  of  the  injustice  or  caprice  of  those  who  serve  them. 
As  for  those  who,  during  the  night,  are  unwilling  to  remain  in  bed,  if  they 
are  not  disposed  to  do  mischief,  it  is  better  to  permit  them  to  go  free,  than  to 
restrain  them. 

I  have  elsewhere  unfolded  the  motives  for  this  precept.  Since  the  custom 
of  keeping  maniacs  in  close  confinement  has  been  laid  aside,  and  instead  of  it, 
all  that  liberty  which  is  compatible  with  their  security  allowed,  the  number  of 
furious  maniacs  has  greatly  diminished.  How  many  have  become  paralytic, 
in  consequence  of  being  confined  for  too  long  a  period,  to  their  bed  or  chair  ! 
Some  maniacs  will  not,  without  resistance,  bear  clothing  of  any  kind  ;  but  can 
be  kept  clad  by  the  aid  of  the  camisole,  particularly  in  winter,  and  at  the  ter- 
mination of  their  attacks.  The  aliments  should  be  sufficiently  abundant,  and 
so  distributed,  that  hunger  and  thirst  shall  not  augment  the  causes  of  irrita- 
tion and  discontent.  We  should  prefer  as  alimentary  substances,  articles  easy 
of  digestion  ;  such  as  white  meats,  fresh  vegetables  and  fruits.  Some  maniacs, 
at  the  commencement  of  their  attacks,  refuse  every  variety  of  aliment ;  but  it 
is  rare,  that  this  repugnance  does  not  cease  after  some  days.  It  sometimes  de- 
pends upon  gastric  embarrassments,  which  diet  dissipates,  or  which  it  is  proper 
to  combat  by  appropriate  means.  Sometimes,  also,  it  happens  that  this  repug- 
nance is  caused  by  the  excess  of  delirium,  which  deprives  the  patient  of  a 
sense  of  his  wants.  A  blister  applied  to  each  leg,  by  distributing  the  sen- 
sibility more  uniformly,  or  by  provoking  a  derivative  pain,  has  sufficed  in  such 
cases  to  overcome  this  refusal.  Moreover,  I  do  not  approve,  for  maniacs,  the 
coercive  measures  that  are  useful  in  some  cases  of  lypemania. 

It  has  been  supposed  that  the  moral  treatment  applicable  to  maniacs,  con- 
sisted in  reasoning  and  arguments.  This  is  a  chimera.  Maniacs  cannot  suffi- 
ciently  control  their  attention,  to  hear  and  follow  the  reasonings  that  are  offer- 
ed them.  The  moral  treatment  consists  in  seizing  their  attention,  controlling 
their  understanding,  and  in  gaining  their  confidence.  Though  these  patients 
may  be  audacious  and  rash,  they  are  easily  intimidated.     Fear  exercises  over 


MANIA.  399 

them  an  empire  so  complete,  that  they  become  timid,  tremble,  and  are  sub- 
missive to  those  who  know  how  to  exercise  a  control  over  them.  Fear,  by  its 
debilitating  influence,  moderates  the  excess  of  their  irritability,  and  thus  dis- 
poses them  to  hear  and  follow  the  advice  that  is  tendered  them.  It  is  unne- 
cessary however,  that  this  sentiment  be  carried  so  far  as  to  occasion  terror. 
Without  doubt,  some  maniacs  have  been  cured  by  an  extreme  fright,  but  we 
do  not  say  how  many  of  them  have  been  rendered  incuraljle,  in  consequence 
of  having  been  reduced,  by  injudicious  treatment,  to  a  continual  state  of  alarm. 
We  inspire  fear  in  a  thousand  different  ways ;  but  the  employment  of  these 
means  must  not  be  abandoned  to  rude  and  ignorant  men.  They  would  abuse 
it.  It  is  not  given  to  every  one  to  manage  skillfully  this  instrument  of  cure, 
and  its  application  is  not  adapted  to  all  maniacs.  We  succeed  also,  in  arrest- 
ing the  attention  of  maniacs,  by  exciting  their  admiration  and  surprise.  An 
imposing  and  unexpected  phenomenon,  which  vividly  strikes  their  senses,  may 
bring  them  back  to  reason.  Let  a  person  present  himself  to  a  maniac  with 
assurance,  and  a  steady  look,  and  we  see  this  furious  man,  just  now  so  lavish 
of  threatenings,  disconcerted,  and  becoming  calm  and  tractable.  The  effect 
is  the  same  if,  by  an  imposing  exterior,  and  by  words,  grave  and  energetically 
uttered,  we  inspire  hini  with  astonishment,  confidence  and  respect.  These 
effects  last  as  long  as  the  impressions  received  persist.  The  outward  charac- 
ter, the  physical  as  well  as  the  intellectual  and  moral  qualities  of  those  who 
approach,  or  have  the  care  of  maniacs,  exercise  great  power  over  them.  As 
physical  shocks,  and  energetic,  perturbating  medicines,  cure  maniacs ;  so 
moral  shocks,  vivid  and  unexpected  impressions,  also  contribute  to  their  cure. 
Oppose  a  great  array  of  force  to  fury,  and  preparations  suited  to  convince  the 
maniac  that  all  resistance  is  useless,  and  it  will  render  him  docile,  if  you  are 
constrained  at  any  time  to  employ  it.  Never  allow  him  to  be  subjected  to  im- 
proper treatment.  It  will  abase,  degrade,  or  provoke  him  to  anger  ;  and 
the  anger  of  the  maniac  is  fury.  Have  special  reference  to  the  susceptibility 
of  all  insane  persons  ;  particularly  that  of  maniacs  who  were  accustomed  to 
the  polished  manners  of  large  cities,  and  to  the  higher  classes  of  society.  Ar- 
bitrary punishments,  prolonged  seclusion,  irons,  blows,  rude  remarks  and 
menaces,  irritate,  rather  than  compose  them.  If  repression  is  necessary,  ex- 
ercise it  without  passion  and  brutality ;  otherwise,  the  maniac  will  see  only 
anger  in  your  conduct.  Facts  will  prove,  better  than  mere  reasoning,  the 
happy  results  of  a  moderate  and  intelligent  degree  of  repression,  on  maniacs. 
Pinel  relates  certain  cases,  which  establish  the  results  that  may  be  de- 
rived from  this  influence.  General  V.,  forty-five  years  of  age,  of  a  lymphatic- 
sanguine  temperament,  of  a  very  full  habit,  an  understanding  well  developed, 
and  a  very  vivid  imagination,  had  obtained  the  entire  confidence  of  Bonaparte. 
He  was  charged  with  the  direction  and  care  of  the  immense  collection  of 
artillery  in  the  camp  of  Boulogne.  He  became  greatly  fatigued,  not  only  in 
the  exercise  of  his  duties,  but  also  in  making  experiments  in  gunnery,  in  the 
open  air,  and  exposed  to  the  heat  of  a  summer's  sun.  Suddenly  the  General 
quits  the  army,  enters  a  carriage  with  an  aid-de-camp,  causes  it  to  be  covered 
with  branches  of  trees,  and  announces  along  the  whole  route  that  he  is  going 
to  Paris,  to  carry  a  treaty  of  peace  which  he  has  just  signed  with  England. 
On  completing  half  the  distance,  he  obliges  his  aid-de-camp  to  leave  him,  and 
permits  no  one  to  enter  the  carriage.  He  pays  the  postillions  largely,  and  is 
angry  because  they  do  not  proceed  with  sufficient  rapidity.     He  gives  himself 

no  time  to  eat,  arrives  at  the  Place  du  Carrousel,  meets  General  in  his 

carriage,  stops  him,  and  begs  permission  to  take  the  carriage  of  the  latter,  in 
order  to  reach  St.  Cloud  as  soon  as  possible,  (the  news  of  the  treaty  of  peace 
having  already  spread  throughout  Paris,  and  the  public  funds  risen.)  The  sick 
man  prevails  with  his  companion  in  arms,  who  gives  up  to  him  his  carriage. 
General  V.,  with  his  dress  in  great  disorder,  penetrates  even  to  the  apartments 


400  MANIA. 

of  the  Emperor,  and  announces  to  him  that  a  treaty  of  peace  has  just  been 
formed,  and  that  he  had  hastened  to  communicate  to  him  the  news.  The  pa- 
tient is  brought  back  to  Paris,  and  treated  by  Corvisart  and  Pinel.  At  this 
epoch,  the  malady  presented  all  the  symptoms  of  a  gastric  affection,  and  a  ma- 
nia with  fury.  Attended  by  his  relatives,  and  surrounded  by  domestics,  the 
General  manifests  a  wish  to  escape  through  the  windows.  They  confine  him 
to  his  bed,  and  he  becomes  still  more  exasperated.  They  tighten  his  bonds, 
and  he  becomes  composed.  On  gaining  a  greater  degree  of  liberty,  he  disen- 
cumbers himself,  and  falls  upon  those  who  serve  him.  One  of  them  is  wound- 
ed, and  they  bind  him  anew.  Averse  to  restraint,  he  looses  his  bonds  and 
severely  wounds  another  domestic.  Fifteen  days  pass  in  a  state  of  maniacal 
delirium,  alternating  between  fury  and  affected  composure.  The  patient  is 
committed  to  my  care  under  the  direction  of  Pinel.  He  was  much  emaciated, 
his  tongue  thick  and  white,  agitation  extreme,  and  delirium  continual.  His 
ideas  were  incoherent,  and  at  times,  he  indulged  in  cries,  menaces  and  abuse. 
He  also  suffered  from  thirst,  constipation  and  insomnia.  On  the  following 
day  a  bath  is  ordered,  and  the  patient  assures  me  that  he  will  not  take  it.  I 
send  to  him  twelve  attendants,  with  a  supervisor  at  their  head.  The  latter  in- 
forms the  General  that  the  bath  awaits  him.  The  patient  becomes  angry, 
threatens  him,  and  declares  that  he  will  not  bathe  On  his  refusal,  the  super- 
visor informed  him  that  he  had  received  orders  to  take  him  to  the  bath,  if  he 
did  not  go  readily.  The  General  raises  himself  proudly  :  Wretches,  says  he, 
loill  you  dare  lay  a  hand  on  me  7  Yes,  General,  this  is  our  order;  and  at  the 
same  time  the  attendants  approach.  The  General  looks  at  them  with  pride, 
and  starts,  saying  :  Do  not  approach  me.  Whilst  he  is  in  the  bath,  I  visit  the 
patient,  who  is,  at  first,  very  much  irritated,  but  gradually  becomes  tranquil.  I 
endeavor  to  persuade  him  that  nothing  will  be  required  of  him,  but  by  my 
order,  and  for  the  benefit  of  his  health.  From  that  time  he  becomes  perfectly 
tractable. 

Notwithstanding,  the  delirium  persi.sts  during  the  whole  summer,  with  cer- 
tain intervals  of  remission,  during  which  the  patient  writes  comedies  and  bal- 
lads, which  display  tbe  incoherence  of  his  thoughts.  During  the  paroxysm, 
he  is  very  irritable,  and  spontaneously  excited.  He  leaves  his  apartment, 
uttering  furious  cries  ;  makes  several  turns  in  the  garden,  becomes  composed, 
and  returns  tranquil,  after  the  lapse  of  a  few  minutes.  This  exasperation  is 
renewed  twenty  or  thirty  times  a  day.  Notwithstanding  the  wandering  of  his 
thoughts,  the  General  conceives  the  design  of  perfecting  a  certain  weapon, 
and  makes  a  drawincr  of  it.  He  manifests  a  desire  to  execute  a  model  of  it. 
After  having  long  avoided  making  any  reply,  I  yield  to  his  demand  ;  he  giv- 
ing me  his  word  of  honor  that  he  will  go  merely  to  the  founder,  and  return 
peacefully.  One  attendant  accompanies  him,  and  two  others  follow  at  a  dis- 
tance. The  General  makes  his  toilet,  which  has  been  very  much  neglected 
since  his  illness.  He  goes  to  the  founder,  presents  his  drawing,  engages  him 
to  cast  his  model,  and  says,  when  leaving  him,  that  he  will  return  in  eight 
days.  He  passes  an  hour  with  the  founder,  without  the  latter  suspecting  that 
he  is  doing  business  with  a  maniac.  The  General  has  scarcely  reached  home, 
when  agitation,  delirium,  and  a  disposition  to  fury  return.  Eight  days  subse- 
quently, I  permit  hini  to  make  a  second  visit  to  the  founder.  The  model  is 
executed,  and  an  order  to  found  fifty  thousand  of  them  is  given.  This  order 
was  the  only  act  of  delirium  which  revealed  to  the  founder  the  malady  of  the 
General.     At  a  later  period,  this  weapon  was  adopted  in  the  service. 

During  the  autumn,  the  delirium  progressively  diminished,  and  the  General 
recovered  entirely  the  use  of  his  reason.  On  returning  home,  he  experienced 
very  serious  trials.  He  had  been  placed  at  the  retreat  in  the  month  of  Sep- 
tember, two  months  after  his  attack.  His  reason  was  not  disturbed,  and  he 
for  a  long  period   solicited  a  commission,  by  means  of  which  he  could  again 


MANIA*  401 

engage  in  the  active  duties  of  lifci  He  was  unsuccessful,  however,  although 
the  relative  of  a  distinguished  personage  at  that  epoch.  Chagrin  takes  pos- 
session of  his  mind,  and  during  the  autumn  following,  on  a  day  when  he  had 
been  relating  to  me  his  trials,  and  after  having  been  conversing  on  matters  of 
business  with  M.  Laffitte,  to  whose  residence  he  had  sent  his  carriage,  instead 
of  returning  home,  the  General  wanders  about  for  thirty-six  hours.  Exhausted 
doubtless  by  fatigue  and  hunger,  he  enquires  the  name  of  the  place  in  which 
he  finds  himself  He  is  informed  that  it  is  Etampes.  In  a  moment,  he  reco- 
vers his  understanding,  and  is  painfully  affected,  on  reflecting  on  the  disqui- 
etude of  his  family  in  consequence  of  his  long  absence ;  orders  himself  to  be 
brought  back  to  Paris,  and  sends,  desiring  me  to  see  him.  The  General  had 
no  recollection  of  what  he  had  done  during  these  thirty-six  hours.  He  ex- 
pressed his  condition  by  saying  ;  I  have  had  an  apoplexy,  which  has  spared 
the  organs  of  motion.  He  complained  of  great  fatigue  ;  and  his  limbs  were 
very  much  engorged  and  lacerated.  From  this  moment  he  manifested  signs 
of  paralysis  of  the  tongue,  and  his  memory  became  enfeebled.  A  month  sub- 
sequently, a  delirium  supervened,  of  which  the  patient  had  a  presentiment,  and 
employed  all  those  means  that  were  proposed  for  his  cure.  Upwards  of 
twelve  moxas  were  successively  applied  to  the  base  of  the  cranium  and  nape 
of  the  neck.  Nothing  could  arrest  the  constant  progress  of  the  paralysis, 
nor  the  weakening  of  the  understanding.  At  length,  after  an  interval  of  ten 
months,  a  serous  diarrhcea  occurred,  an  enormous  eschar  formed  on  the  coccyx, 
and  epileptiform   convulsions  were  repeated   for  two  days.     The  patient  died. 

On  opening  the  body,  which  was  done  twenty-four  hours  after  death,  the 
cranium  was  found  thin  and  injected  ;  the  meninges  thick  and  containing 
serum.  The  ventricles  also,  and  cerebral  substance  were  injected.  At  the 
inferior  and  posterior  part  of  the  right  hemisphere,  adhering  to  the  dura-ma- 
ter, I  discovered  a  tumor,  about  the  size  of  a  cherry  and  encysted.  It  was 
filled  with  limpid  serum,  and  compressed  the  convolutions  of  the  brain,  for  its 
lodorment.  The  white  substance  surrounding  the  tumor  was  dense.  The 
bronchial  passages  were  engorged  with  mucus,  and  the  aortic  valves  ossi- 
fied. There  was  serum  in  the  peritoneal  cavity,  and  the  mucous  membrane 
of  the  large  intestines  was  slightly  reddened.  Worms  were  found  in  large 
numbers,  in  the  ccecum  and  rectum. 

M.,  twenty-seven  years  of  age,  and  of  a  lymphatic-nervous  temperament, 
after  an  attack  of  fury,  which  had  lasted  six  months,  remained  in  a  state  of 
melancholy.  In  the  following  spring,  the  period  at  which  the  attack  of  fury 
had  burst  forth  in  the  preceding  year,  this  young  man  presents  all  the  indi- 
cations of  a  new  attack  :  redness  of  the  face,  changefulness  of  the  eyes,  dimi- 
nution of  the  appetite,  a  fetid  breath,  constipation,  hasty  movements,  and 
brief  replies.  At  length,  after  eight  days,  the  attack  manifests  itself  by  cries, 
provocations,  threats  and  abuse.  He  breaks  and  destroys  every  thing  for  the 
sake  of  freedom.  He  repulses  me,  and  treats  my  advice  with  disdain.  Dur- 
ing the  night,  he  yields  himself  to  all  the  excesses  of  fury.  At  break  of  day, 
I  order  him  to  be  permitted  the  liberty  of  the  garden.  He  runs  about,  sing- 
ing, crying  and  swearing.  Seeing  himself  free,  he  attempts  to  root  up  a  tree, 
wherewith  to  exterminate  his  enemies.  His  attendant  tells  him  that  he  should 
destroy  nothing.  This  advice  is  unkindly  received,  and,  the  attendant  insist- 
ing, the  furious  patient  springs  to  strike  him.  This  movement  had  been  an- 
ticipated. Other  attendants,  who  had  been  stationed  at  a  little  distance,  lay 
hold  of  him  and  convey  him  to  a  chamber  deprived  of  light.  I  immediately 
present  myself  before  the  patient,  reprove  him  for  his  transport  of  passion, 
point  out  to  him  the  wrong  that  he  has  done  in  striking,  and  leave  him  to  his 
reflections.  Two  hours  afterwards,  not  a  trace  of  fury  remains,  and  M.  be- 
gins to  appear  rational. 

A  lady  forty-eight  years  of  age,  of  a  lymphatic  temperament,  and  a  peculiar 
51 


402  MANIA. 

disposition,  becomes  a  maniac  in  consequence  of  the  misfortunes  of  the  revo- 
lution. In  consequence  of  the  disorder  of  her  ideas,  she  indulges  an  intole- 
rable pride,  and  is  always  ready  to  strike.  It  was  enough  to  place  upon  her 
twice,  for  an  hour  only,  the  camisole,  and  to  cause  her  to  experience  the  mor- 
tifying effect  of  this  treatment.  From  this  time,  she  becomes  perfectly  docile, 
and  far  from  retaining  any  resentment  against  me,  she  boasts  of  my  firmness, 
and  treats  me  with  friendship,  though  she  has  not  recovered  the  entire  use  of 
her  reason. 

A  furious  man  injures  and  destroys  whatever  comes  within  his  reach.  He 
beats  his  attendant,  enters  his  apartment,  barricades  it,  and  then  tries  to  de- 
molish it.  I  order  several  attendants  to  approach  his  apartment,  who  are  told 
to  make  a  loud  noise,  and  say  to  the  patient,  that  he  will  repent  if  he  does 
not  open  the  door,  and  they  are  obliged  to  force  it.  He  laughs  at  these 
threats.  The  door  is  broken  open,  and  the  attendants  enter  precipitately  in 
a  crowd.  He  becomes  disconcerted,  and  is  filled  with  fear  ;  throws  himself 
upon  his  knees,  asks  pardon,  promises  to  be  tranquil,  and  keeps  his  word. 

A  justice  of  the  peace,  in  1804,  having  become  a  maniac,  gave  his  deci- 
sions on  certain  occasions  in  a  very  loud  and  threatening  tone,  and  pleased 
himself,  by  pronouncing  the  doom  of  several  of  his  compatriots.  This  furious 
explosion  was  repeated  several  times  in  the  course  of  the  day.  A  monoma- 
niac, after  having  concerted  his  measures  with  me,  on  a  certain  day  says  ; 
"  Sir,  retire,  for  I  also  am  ill,  and  feel  that  I  am  going  to  become  furious, 
when  I  am  terrible,  and  capable  of  slaying  every  body."  This  decisive  and 
repeated  threat  put  an  end  to  the  oratorical  transports  of  the  maniac. 

A  young  man,  twenty  years  of   age,  surgeon  of   a   battalion  cantoned   at 
Ostend,  of   a    sanguine  temperament,   of  a  haughty  disposition,    quick  and 
passionate,  and  very  devoted  to  study,  experiences  certain   difficulties.     He 
loses  his  reason,  and  regards  himself  as  destined  for  great  exploits.     His  de- 
lirium is  general,  but  vain  thoughts  predominate,  and  he  exacts  various  atten- 
tions.    He  treats  his  comrades  with  contempt,  yields  himself  up  to  acts  of  fury, 
because  the  figure  of  persons  whom  he  meets  is  disagreeable  to  him,  and  be- 
cause he  gives  a  wrong  interpretation  to  what  is   said  to  him.     He  proceeds 
so  far   as   to  provoke  his  Colonel  to  a  duel.     His   father,  who  had  hastened 
from  the  country,  is  not  recognized,  is  regarded  with  hatred,  and  threatened 
with  a  thrust  of  his  sword.     This  young  man  is  committed  to  my  care.     His 
hair   is  black   and  crisped,  his  eyes  bright,  his  look  proud  and   threatening. 
The  prominences  of  the  cheeks  are  flushed  ;  the  face  pale,  with  a  slightly  sal- 
low hue.     His  delirium  is  general,  and  his  loquacity  contiimal.     His  conver- 
sation is  imperious,  and  his  movements  brusk,  and  hesitating.     He  repulses 
food  with  disdain.     After  an  hour's  isolation,  and  great  agitation,  I  approach 
the  patient  alone,  seize  him  firmly  by  the  arm,  and  oblige  him  to  remain  near 
me.     After  regarding  him  intently  :  "  Young  man,  said  I,  you  are  to  remain 
here  some  days  ;  if  you  desire  to  be  comfortable,  be  obliging  and   kind.     If 
you  choose  to  act  like  one  deprived  of  the  use  of  his  reason,  we  shall  treat 
you  as  we  do  the  insane.     You  see  these  attendants ;  they  are  ordered  to  pro- 
cure   for    you  whatever    you  may  ask    for  with  composure   and    politeness. 
Otherwise,  they  are  to  obey  no  one  but  myself"     At  the  close  of  my  remarks, 
which  were  listened  to  with  impatient  composure,  I  let  go  the  arm  of  the  pa- 
tient, who  continues  to  walk  about  at  a  rapid  pace,  but  without  noise.     When- 
ever M.  R.  becomes  agitated  and  cries,  I  have  only  to  appear,  or  make  myself 
heard  by  him,  and  composure  is  restored.     Tepid  baths,  cold  lotions,  acidu-. 
lated  and  laxative  drinks,  administered  from  time  to  time,  together  with  abun- 
dant exercise,  progressively  effect  a  cure  in  the  course  of  three  mouths.     This 
young  man  has  assured  me,  that  notwithstanding  his  delirium,  the  words  that 
were  addressed  to  him  on  his  admission,  were  always  present  to  his  mind. 

Mad'e ,  at  the  age  of  fifty-four  years,  suffered  from  a  first  attack  of 


MANIA.  403 

mania,  after  the  cessation  of  the  menstrual  flow.  Six  years  subsequently,  she 
feels  the  approaches  of  a  second  seizure,  arranges  her  household  affairs,  and 
desires  to  be  conducted  to  a  private  hospital  so  soon  as  the  attack  shall  burst 
forth.  It  declares  itself  by  a  sudden  and  general  delirium,  attended  by  great 
agitation  and  fury.  Desiring  to  escape  from  her  house,  she  throws  down  and 
beats  all  who  oppose  her.  After  the  lapse  of  some  days,  the  patient  is  com- 
mitted to  my  care.  She  spends  the  whole  of  the  first  day  in  relating  the  his- 
tory of  her  malady,  and  commiserating  us  for  having  to  do  with  a  woman  so 
wicked,  and  capable  of  every  species  of  depravity.  Early  in  the  evening,  she 
experiences  a  feeling  of  universal  chilliness,  which  is  succeeded  by  cephalal- 
gia. The  face  is  flushed,  and  the  thirst  ardent.  Some  hours  subsequently, 
her  loquacity  becomes  incessant,  her  conversation  obscene,  and  she  indulges 
in  the  use  of  insulting  language,  menaces  and  cries.  They  tell  me  to  set 
fire  to  the  house,  to  kill  every  body,  to  throw  myself  down,  etc.,  etc.  I  arrive 
speedily,  censure  her  conduct  with  much  severity,  and  complain  loudly  of  so 
much  noise  and  disturbance.  "  What  they  say  to  you  is  not  true.  Do  not 
try  to  hear.  There  is  no  one  near.  You  have  nothing  to  fear.  I  am  here 
to  rebuke  the  foul  spirit  that  inspires  you.  Fear  nothing  and  retire."  These 
words  spoken  with  energy,  and  in  a  grave  tone,  satisfy  the  patient.  She  re- 
turns to  her  bed,  and  is  tranquil  the  remainder  of  the  night.  On  her  reco- 
very, she  told  me  that  my  words  had  reassured  her,  against  the  suggestions 
of  a  malevolent  spirit,  who  was  accustomed  to  take  possession  of  her  during 
the  existence  of  her  malady. 

The  cases  which  I  have  just  reported,  demonstrate,  some  of  them,  the  good 
effects  of  moral  influence  on  maniacs,  especially  during  the  early  period  of 
isolation.  Others,  the  desirable  direction  that  it  is  capable  of  giving,  to  the 
minds  of  those  patients  when  the  delirium  and  disposition  to  fury  persists. 
These  facts  may  serve  as  a  guide,  in  circumstances  analogous  to  those  in 
which  I  found  myself  It  must  not  be  forgotten,  that  to  succeed,  the  impres- 
sion must  be  vivid  and  energetic.  I  have  seen  maniacs  cured  instantaneously, 
by  the  impression  they  experience  on  entering  a  hospital  or  establishment  for 
the  insane. 

M.,  who  was  of  a  quick,  passionate  disposition,  and  very  vain,  survives  a 
cerebral  fever,  and  remains  a  maniac.  His  delirium  is  so  violent,  that  he 
rushes  furiously  upon  his  wife  and  children ;  and  is,  at  length,  committed  to 
my  care.  Placed  upon  the  basement  floor,  in  a  gloomy  apartment,  with  no 
other  furniture  than  a  bed,  this  patient,  who,  for  a  month  previously,  had  been 
in  a  state  of  general  delirium,  furious  and  sleepless,  from  the  first  night  of  his 
isolation,  is  composed  and  sleeps.  On  the  following  day,  the  fury  does  not 
return,  and  there  remains  only  a  kind  of  revery,  which  he  dissembles,  through 
fear  of  being  regarded  insane.  At  intervals,  there  is  some  degree  of  agitation, 
which  the  patient  restrains.  From  the  third  day,  he  is  restored  to  heaJth,  and 
occupies  himself  much  with  the  quality  of  the  aliments  with  which  they 
will  serve  him.  On  the  fourth  day,  he  calls  for  his  wife  and  children.  On 
the  ninth,  he  receives  a  visit  from  his  wife,  leaves  with  her  for  the  country, 
remains  there  forty-eight  hours,  and  resumes  his  usual  occupation.  He  how- 
ever retains  a  grudge  against  his  physician, — an  old  friend, — because  he  be- 
lieved him  insane,  and  tore  him  from  his  family.  By  time,  this  prejudice  is 
dissipated,  and  M.  has  told  me  since  his  convalescence,  that  on  the  first  night, 
he  had  felt  the  delirium  vanish  like  a  dream. 

The  physician  who  treats  a  maniac,  should  never  seek  to  inspire  him  with 
fear,  but  should  have,  subject  to  his  order,  a  person,  who  shall  charge  himself 
with  the  painful  task,  who  may  act  as  circumstances  require ;  and  oppose  him- 
self, when  necessary,  to  the  wildness,  impetuosity  and  violence  of  the  patient. 
The  physician  should  be,  among  the  patients,  a  messenger  of  consolation. 


404  MANIA. 


He  must  manage  with  address  on  those  occasions  in  which  he  acts  the  nart  of 
a  protector  and  benefactor.     He  should  maintain  a  tone,  obligina,  yet  J-rave  • 
and  ally  goodness  with  decision,  so  as  to  command  esteem.     He  vvill  thu"  gairi 
their  confidence,  without  which  no  cure  can  be  effected.     His  countenance 
look  and  words;  his  tone  of  voice,  his  gestures  and  silence  even,  produce  an 
effect  upon  the  m.nd  or  heart  of  the  maniac.     The  physician  must  decide 
upon  the  visits  of  relatives;  indicate  rewards;   and  prescribe  punishments 
It  IS  for  him  to  direct  all  who  approach  the  patient,  and  those  who  serve  him 
Un  the  subject  of  interviews,  it  is  necessary,  in  general,  to  be  extremely  cau- 
tious •    since  the  visit  of  a  relative  or  friend,  often  awakens  thoughts   with 
which  recollections  are  connected,  which  continue,  or   revive  the  delirium 
We  are  of  the  opinion,  that  the  management  of  maniacs  during  convalescence 
should   be  various.     The   greater  part  of  them  however,  need  consolations 
encouragement     agreeable   conversation,  gentle   emotions,   walks   and  varied 
exercises      Before  submitting  them   to  their  former  habits,  and  the  influence 
of  their  friends,  a  time  of  trial,  of  greater  or  less  duration  is  necessary  dur- 
ing which,  the  patient  should  not  remain  in  that  habitation   in  which  he  sees 
objects  of  a  painful  character,  and  where  he  has  yielded  himself  to  his  most 
violent  transports.     The  convalescence  of  maniacs  is  often  lono-  and  difficult 
feometimes  however,  it  is  prompt;  in  which  case,  you  may  well  fear  an  inter- 
mit ent  mania.     In  sonie  instances,  convalescents,  on  being  restored  to  socie- 
ty, to  their  families  and  former  habits;  acquire  a  full  measure  of  health   onlv 
at  the  expiration  of  several  months,  and  sometimes  even  longer.     An  extreme 
sensibility  still  continues,  which  renders  them  very  impressible,  very  suscepti- 
ble, and  accessible  to  depressing  emotions.     Some  are  mortified  in  view  of  the 
condition  from  which  they  have  just  obtained  relief,  and  dread  their  first  inter- 
view with  their  relatives  and  friends;  especially  when,  in  their  delirium   they 
have   committed    strange   and    blameworthy  acts,   the   recollection  of  ^Vhich 
wounds  their  self-love,  or  afflicts  their  hearts.     Some  consent  to  speak  of  their 
malady,  and  to  see  again   the  persons  who  have  had  them  in  charge      Manv 
retain  an  aversion  towards  those  who  have  been  engaged  about  then?,  and  have 
had  the  care  of  them.     If  this  aversion,  or  those  prejudices,  are  inordinately 
strong,  they  engender  a  true  melancholy ;   a  disposition  to  suicide,  or  a  new 
attack  of  mania.     I  recommend  journeyings  and   a  residence  in  the  country 
to   hese  convalescents,  before  returning  to  their  families,  or  placing  themselves 
m  those  circumstances   to  which  they  have  been  accustomed,  or   in  presence 
of  those  persons  who  were  witnesses  of  the  invasion  of  their  malady 
crefid  r.ZT''^''Z?^  medicines,  properly  so  regarded,  calls  for  the  most 
careful  reflection.     When  one  would  combat  mania,  he  must  guard  against  the 
spirit  ot    system,  and  suspect  exclusive  modes  of  medication  :  so  easy  is  it 
tor  us  to  permit  ourselves  to  be  imposed   upon,  by  the   violence  of  symptoms 
1  he  same  medicines   should  not  be  ordered   indiscriminately  to  all   maniacs' 
and  during  all  periods  of  the  malady.     Independently  of  the  general  conside- 
rations relating  to  season,  age,  seX  and  temperament,  it  is  necessary  to  modify 
our  therapeutic  views,  in  accordance  with  the  condition  of  each  individuaJ 
We  must,  in  the  first  place,  assure  ourselves  as  to  whether  the  mania  depends 
upon   some  pathological   cause,   and   treat  it  in   accordance  with   this  view 
Many  maniacs  have  been  rendered  incurable,  because  notice  was  taken   only 
o   the  effervescence  of  the  delirium,  and  the  violence  of  the  fury  ;  and  because 
all  maniacs  were  treated  in  the  same   manner.      When,   from  the  indications 
which  have  been  collected  respecting  the  causes  of  the  malady,  and  from  ob- 
servation, we  are  unable  to  reach  the  source  of  the  evil,  it  is  preferable  to 
limit  ourselves  to  a  judicious  expectation.     At  the  outset  of  mania,  durino-  its 
hrst  period,  if  gastric  symptoms  are  present,  we  endeavor  by  mild  meas°ures 
to  relieve  the  first  passages.     For  this  purpose,  we  may  employ  one  or  two 


MANIA.  405 

emetics;  the  tartrate  of  antimony  and  potassa,  diffused  in  a  large  amomit 
of  orange  water,  whey,  etc.  If  indications  of  plethora  are  present,  we  em- 
ploy and  repeat  blood-letting.  We  apply  leeches  behind  the  ears,  or  upon 
the  temples  ;  cupping  glasses  to  the  back  of  the  neck  ;  and  frequently  a  small 
number  of  leeches  to  the  anus.  The  redness  of  the  face  and  eyes,  the  ring- 
ing and  buzzing  sound  in  the  ears,  together  with  a  pulsative  pain  in  the  tem- 
ples, or  within  the  cavity  of  the  cranium,  reveal  a  tendency  to  cerebral  con- 
gestion. We  must  be  cautious  respecting  sanguine  evacuations.  By  enfee- 
bling maniacs  we  run  the  risk  of  throwing  them  into  dementia.  "  Bleeding, 
says  Pinel,  is  an  unusual  evacuation,  and  one  which  constitutes  an  epoch  in 
the  hospital  for  the  insane  (Salpetriere).  How  numerous  are  the  maniacs 
who  have  never  lost  blood,  and  been  cured  ;  how  many  have  been  bled,  and 
still  remain  incurable !" 

We  employ  tepid  baths,  and  continue  them  for  two,  three  and  four  hours  ; 
repeating  them  two  and  three  times  a  day,  by  giving  a  bath  every  time  that 
the  delirium  and  fury  is  renewed,  if  the  subject  is  of  a  dry  and  irritable  tem- 
perament. While  the  patient  is  in  the  bath,  we  apply  cold  water  constantly 
to  the  head  ;  now  by  pouring  the  water  ;  now  by  keeping  upon  the  head  a  cloth 
or  spunge  saturated  with  it.  We  insist  upon  the  use  of  cold,  diluent  and 
slightly  laxative  drinks.  Lastly,  we  unload  the  large  intestine  by  enemata,  at 
first  emollient,  then  purgative.  The  diet  should  be  cautiously  restricted. 
When  the  violence  of  the  symptoms  has  abated,  we  allow  the  patient  to 
expend  his  fury  in  the  open  air,  and  employ  his  activity,  by  extending  to  him 
greater  liberty.  We  allow  a  more  abundant  diet.  If  there  are  intervals  of 
reason,  we  redouble  our  proofs  of  interest  and  good  will.  If  crises  appear, 
we  notice,  and  second  them  by  a  more  nutritious  regimen,  and  some  light 
tonics.  The  following  case  illustrates  the  danger  that  flows  from  interfering 
with  the  efforts  of  nature. 

A  woman,  about  thirty-six  years  of  age,  was  admitted  at  the  Salpetriere 
January  18th,  1818.  She  was  both  maniacal  and  furious,  as  well  as  much 
emaciated,  and  very  irritable.  The  delirium  persisted  with  the  same  violence, 
until  the  beginning  of  August,  and  psora  then  appeared,  and  made  rapid 
progress.  The  delirium  diminished,  and  at  the  close  of  the  same  month,  had 
almost  entirely  ceased.  Wishing  to  relieve  her  from  this  troublesome  affec- 
tion, which  was  a  source  of  much  discomfort  to  her,  I  ordered  sulphur 
baths,  and  a  bitter  ptisan.  After  the  fourth  bath,  the  psoric  affection  began 
to  diminish,  and  the  delirium  and  agitation  reappeared.  The  baths  were  sus- 
pended ;  but  a  few  days  subsequently,  (September  13th,)  the  patient,  who 
was  very  feeble,  died.  The  opening  of  the  body  presented  no  notable  lesion 
within  the  cranium,  though  the  lungs  were  diseased.  It  is  probable  that  if  I 
had  been  content  to  sustain  the  vital  forces  in  this  case,  the  psora  would  not 
have  disappeared,  the  crisis  would  have  been  completed,  convalescence  would 
have  had  a  regular  progress,  and  the  patient  have  been  cured.  My  readers 
will  pardon  this  confession.  I  desired  to  point  out,  by  a  striking  example, 
the  importance  of  respecting  critical  efforts. 

Finally,  when  composure  is  reestablished,  and  maniacs  begin  to  realize 
their  condition,  although  delirium  still  continues,  and  the  affections  may  not 
be  fully  aroused ;  their  situation  must  be  changed  ;  they  must  be  withdrawn 
from  those  places  in  which  they  have  yielded  themselves  to  their  extrava- 
gances, and  surrounded  by  objects,  both  new,  and  suited  to  divert  them. 
We  induce  them  to  labor  and  exercise  ;  and  prescribe  for  them  a  strengthening 
regimen.  The  same  course  should  be  pursued  in  each  attack  of  intermittent 
mania.  During  the  intermission,  we  administer  remedies  suited  to  combat 
the  periodicity,  duiniue,  which  is  so  useful  in  intermittent  fevers,  when 
judiciously  administered,   sometimes   succeeds  in   intermittent   mania.     This 


406  MANIA. 

agent  however,  often  falls  ;  perhaps,  because  it  is  not  given  in  doses  sufficient- 
ly large,  because  it  is  ordered  when  the  malady  is  inveterate,  and  when  all 
other  medicines  have  proved  ineffectual.  I  have  seen  it  succeed,  in  some  re- 
cent cases  of  intermittent  mania,  whose  attacks  were  renewed  every  three 
weeks,  or  monthly.  But  the  treatment  of  mania  would  cease  to  be  rational, 
if  every  period  of  the  disease,  and  all  maniacs  were  treated  in  a  similar  man- 
ner. When  mania  has  passed  into  a  chronic  state,  therapeutic  measures  vary, 
according  to  circumstances.  If  mania  has  burst  forth,  after  the  suppression 
of  the  menses,  hemorrhoids,  or  a  habitual  hemorrhage,  we  practice  general 
blood-letting,  local  bleedings  renewed  from  time  to  time,  and  in  small  quanti- 
ty, and  other  means  adapted  to  reestablish  these  evacuations.  If  mania  re- 
sults from  confinement,  or  after  a  sudden  suppression  of  the  milk ;  laxatives, 
purgative  enemata,  blisters  and  setons  are  usually  sufficient  to  terminate  it. 

M.  R.  J.  B.,  twenty-eight  years  of  age,  is  the  offspring  of  a  mother  who 
experienced  a  slight  attack  of  apoplexy,  at  the  age  of  forty-eight  years.  One 
of  her  sisters  became  insane  at  a  later  period.  She  had  variola  when  nine 
years  of  age.  Between  the  age  of  seventeen  and  eighteen  years,  she  suffered 
from  violent  cephalalgia.  When  eighteen  years  old,  the  menses  were  estab- 
lished, and  the  cephalalgia  disappeared.  On  the  14th  of  March,  1819,  she 
was  happily  confined.  She  experiences  many  trials,  and  on  the  sixth  day  de- 
lirium bursts  forth.  On  the  2t>d,  she  is  brought  to  the  Salpetriere  ;  and  at  the 
time  of  her  admission,  thinks  that  she  hears  many  voices,  which  induce  her  to 
injure  those  around  her.  She  considers  herself  bewitched ;  experiences  vio- 
lent pains  in  the  limbs;  and  refuses  all  kinds  of  internal  medicine.  I  then 
order  a  large  blister  to  the  back,  and  at  the  same  time  administer  tepid  baths, 
affusions  of  cold  water  to  the  head,  and  diluent  drinks,  succeeded  by  purga- 
tives. The  delirium  diminishes,  and  the  menses  re-appear.  The  patient  finds 
herself  so  much  benefited  by  the  blister,  that  she  calls  for  its  renewal.  Her 
reason  being  shortly  altogether  reestablished,  she  leaves  the  hospital.  She  af- 
terwards married,  and  fifteen  years  subsequently,  falls  into  a  state  of  hypochon- 
driacal lypemania,  and  comes  to  consult  me ;  enquiring  if  she  can  employ  a 
blister,  in  which  she  has  the  utmost  confidence,  from  her  recollection  of  the 
good  effect  of  that  which  I  had  formerly  ordered.  In  the  same  circumstances, 
I  have  derived  much  benefit  from  the  use  of  the  whey  of  Weiss,  continued 
for  several  successive  days,  in  connection  with  a  diluent  drink.  This  whey 
usually  purges  in  a  dose  of  twelve  ounces,  without  producing  colic  pains.  I 
have  prescribed,  in  that  form  of  mania  which  bursts  forth  after  confinement, 
three  laxative  enemata  daily,  for  one  or  two  weeks,  and  the  patient  is  put  upon 
a  strict  diet.  I  could  relate  several  examples  of  the  good  effects  of  this  last 
remedy.     The  enemata  are  composed  of  milk  and  four  ounces  of  sugar. 

If  mania  is  produced  by  the  retrocession  of  gout,  by  the  disappearance  of  a 
herpetic  affection,  by  the  sudden  cessation  of  psora,  or  by  the  suppression  of 
an  ulcer,  we  employ  such  means  as  are  calculated  to  recall  these  disorders  re- 
spectively ;  and  sometimes  by  an  exutory,  furnish  a  substitute  to  those  affec- 
tions which  have  disappeared.  It  was  thus,  that  during  the  last  year,  we  cured, 
as  if  by  enchantment,  by  establishing  a  seton  in  the  neck,  a  young  person  who 
had  become  a  maniac  immediately  after  the  cicatrization  of  an  ulcer,  seated 
upon  the  prominence  of  the  cheek  bone  of  the  right  side,  from  which  she  had 
long  suffered.  If  mania  is  the  effect  of  the  presence  of  worms  in  the  alimen- 
tary canal,  we  shall  find  benefit  from  the  use  of  calomel  combined  with  jalap, 
aloetics,  gamboge,  etc.  If  mania  supervenes  upon  a  grave  disease,  an  inter- 
mittent fever,  onanism,  or  a  feebleness,  depending  upon  a  too  rapid  growth ; 
we  combine  a  corroborating  regimen,  ass'  milk,  bark,  bitters,  and  tepid  baths, 
which  compose  the  nervous  irritation  of  feeble  persons.  We  then  pass  to 
river  and  sea  bathing.     Affusions  of  cold  water  have  first  composed,  and  at 


MANIA.  407 

length  cured,  furious  maniacs  of  a  nervous  temperament,  whose  idiopathic 
mania  depended  upon  disorder  of  the  nervous  sensibility.  The  following  facts 
will  prove  that  the  action  of  this  agent  is  not  always  physical. 

Mary  Margaret  L.,  twenty-five  years  of  age,  of  a  sanguine  temperament, 
tall,  of  the  ordinary  fullness  of  habit,  of  an  extremely  changeful  physiognomy, 
and  remarkable  susceptibility,  at  the  age  of  seven  years  suffered  from  a  severe 
illness,  and  had  variola  when  eight  years  old.  At  fifteen,  the  menses  were 
established  spontaneously,  and  were  afterwards  regular.  She  is  subject  to 
cephalalgia,  and  frequent  attacks  of  epistaxis.  When  twenty-four  years  of 
age,  her  lover  was  enlisted  into  the  army,  and  she  became  sad  and  gloomy. 
Her  younger  sister  married ;  which  afflicted  her  the  more,  as  the  female  com- 
panions of  the  former  were  very  agreeable  to  herself.  A  new  lover  presented 
himself,  to  whom  she  became  attached.  He  however  soon  after  married  another 
woman.  This  occurrence  was  to  her  the  cause  of  new  trials.  They  fastened 
horrible  things  upon  her  door.  On  the  2oth  of  July,  1811,  when  twenty-five  years 
of  age,  being  at  a  ball,  L.  is  placed  opposite  her  perjured  lover.  She  suddenly 
faints,  and  falls  backward.  The  syncope  passed,  she  is  seized  with  delirium. 
For  three  days  she  performs  a  thousand  extravagances,  leaping  and  dancino-, 
but  not  uttering  a  word.  On  the  28th,  she  is  composed,  and  her  reason  re- 
stored. Eight  days  subsequently,  one  of  her  companions  indulged  in  abusive 
language  towards  her.  The  delirium  reappeared,  in  connection  with  attempts 
at  suicide.  The  menses  being  suppressed,  she  is  bled,  and  leeches  are  applied  to 
the  vulva,  but  with  no  marked  effect.  A  month  afterwards  she  was  admitted 
at  the  Salpetriere.  At  the  time  of  her  admission,  L.  was  in  a  state  of  hysteri- 
cal mania.  For  three  months  her  menses  did  not  appear  ;  and  when  they 
were  reestablished,  there  was  no  amelioration  of  the  delirium.  In  the  month  of 
December,  she  suffered  from  convulsions  and  hysterical  suffocations,  which 
were  composed  by  tepid  baths.  In  the  month  of  January,  1812,  there  was 
uterine  fury.  We  administered  antispasmodics,  assafoetida,  etc.  In  June  and 
July,  the  delirium  was  the  same,  but  her  composure  greater ;  the  menses  also 
flow.  In  the  month  of  August,  reason  and  delirium  alternate.  Autumn 
passes  in  the  same  state,  notwithstanding  the  use  of  prolonged  and  frequent 
baths.  In  January,  1813,  there  was  the  same  agitation,  the  same  incoherence 
of  thought  and  loquacity.  She  walks  much,  talks  incessantly,  and  commits  a 
thousand  extravagances.  She  embroiders  upon  the  thick  linen  cloth  of  her 
garments,  strange  and  shapeless  designs ;  cuts  them  into  fragments,  and  makes 
presents  of  them.  She  persuades  herself  that  men  come  to  find  her  while  in 
bed ;  and  treats  with  affection,  now  one,  and  now  another,  in  order  to  form  an 
estimate  of  them  by  their  discourses.  She  addresses  one  as  if  she  were  jea- 
lous; another,  as  if  she  were  satisfied  with  him.  The  sight  of  her  relatives 
does  not  modify  the  malady.  May  :  she  suffers  from  emaciation  and  extreme 
agitation.  In  the  month  of  June,  I  order  affusions  of  cold  water.  The  first 
is  given  with  water  at  fourteen  degrees,  (Reaumur.)  This  is  succeeded  by  a 
chill,  which  lasts  during  the  whole  day.  On  the  day  following,  she  is  com- 
posed ;  delirium  the  same.  Three  days  after,  new  affusions  ;  followed  by 
composure,  more  distinctly  marked.  On  the  following  days,  the  affusions 
are  continued,  and  the  patient  is  each  day  more  rational,  and  remains  more 
willingly  in  place.  August :  she  reasons  correctly,  and  labors,  but  remains 
hysterical.  She  is,  at  length,  discharged,  during  the  month  of  September, 
perfectly  cured,  after  a  malady  of  twenty-two  months'  duration. 

Mad'lle  Florence  Angelica  M.,  eighteen  years  of  age,  of  a  delicate  constitu- 
tion, nervous  temperament,  and  subject  to  cephalalo-ia,  is  of  an  obstinate  and 
violent  disposition.  She  had  variola  during  her  first  year.  At  eight  years  of 
age,  she  was  admitted  into  the  Maison  Royale  de  la  rue  Barbette,  where  she 
remained  until  she  was  seventeen.     During  her  residence  here,  she  distin- 


408  MANIA. 

guished  herself  by  her  aptitude  and  devotion  to  labor.  She  meets  with  a  fall 
upon  her  head,  when  seventeen  and  a  half  years  of  age.  She  suffered  habi- 
tually from  cold  feet,  and  her  hands  were  of  a  purple  color.  The  menses  were 
established  at  the  age  of  eighteen  without  accident.  They  were  regular,  but 
scanty.  During  the  months  of  January  and  February,  she  devoted  herself 
night  and  day  to  labor,  preparing  to  submit  the  proofs  necessary  to  obtain  a 
certificate  from  the  governess.  On  the  14th  of  March,  having  eaten  flesh 
during  lent,  she  went  twice  to  confession.  After  the  first,  she  reproached  her- 
self with  having  offended  God.  After  the  second  one,  notwithstanding  the 
consolations  that  the  confessor  had  offered  her,  she  was  surprised  weeping 
and  sobbing  ;  pretending  that  she  had  been  threatened  to  a  frightful  extent. 
She  was  bled  and  bathed  without  any  special  effect.  April  2d,  she  was 
brought  to  the  Saltpetriere.  At  the  time  of  her  admission,  she  is  weeping ; 
calling  for  her  mother  ;  wishing  to  go  out ;  worrying  and  talking  much,  and 
very  incoherently.  On  the  third  day,  she  was  greatly  agitated,  and  made  in- 
coherent and  obscene  remarks.  On  the  10th  of  April,  after  her  admission  at 
the  Saltpetriere,  she  suffered  from  extreme  agitation  and  fury,  and  goes  about 
almost  naked.  A  douche  composes  her.  On  the  15th,  and  following  days, 
her  agitation  remains  the  same.  Tepid  baths  are  administered.  I  also  order 
affusions  of  cold  water  at  the  temperature  of  fourteen  degrees,  (Reaumur.) 
The  first  produced  no  appreciable  effect.  Two  days  afterwards,  we  conduct 
the  young  patient  into  the  bathing  rooms,  in  order  to  administer  new  affusions. 
She  employed  all  her  power  of  resistance  to  prevent  it.  Her  efforts  were  use- 
less. After  fifteen  minutes,  she  was  taken  with  a  chill,  her  teeth  chattered 
forcibly,  the  limbs  were  incapable  of  supporting  the  weight  of  the  body,  and 
the  pulse  was  small,  slow  and  concentrated.  She  was  carried  to  her  bed,  and 
immediately  fell  asleep.  The  sleep  lasted  four  hours,  during  which  a  copious 
perspiration  was  established.  On  awaking,  her  reason  was  perfect ;  since 
which,  she  has  not  had  a  moment's  delirium.  Placed  on  the  following  day,  in 
the  division  of  the  convalescents,  she  conducts  in  the  most  rational  and  proper 
manner.  She  manifested  a  strong  desire  to  see  her  family  once  more.  After 
a  trial  of  some  days'  continuance,  an  interview  with  her  relatives  was  permit- 
ted, and  followed  by  no  unpleasant  consequences,  notwithstanding  the  excite- 
ment of  the  mother  of  our  convalescent.  At  length,  after  the  enjoyment  qf 
good  health  for  two  months,  she  was  restored  to  her  family. 

M.  F.  L.,  twenty-four  years  of  age,  a  laundress,  of  a  sanguine  temperament, 
of  a  lively,  passionate  disposition,  and  very  choleric,  was  admitted  at  the  Sal- 
petriere,  Feb.  19th,  1812.  At  the  age  of  five  years  she  had  variola ;  at  six, 
psora;  at  seven  she  was  violated,  and  had  syphilis;  and  at  fourteen,  the 
menses  made  their  appearance  spontaneously,  and  have  since  been  regular. 
She  was  confined  Feb.  9th,  1812,  and  six  days  after  her  confinement,  went 
to  washing  in  cold  water.  On  her  return,  she  was  seized  with  a  chill,  a  cir- 
cumstance which  did  not  prevent  her  from  going  to  see  two  women,  who  were 
fastened  by  an  iron  collar  to  a  post.  She  returns  from  this  hideous  spectacle 
in  a  state  of  delirium.  On  the  19th,  ten  days  after  her  confinement,  she  is 
admitted  at  the  hospital.  At  my  visit,  on  the  following  morning,  I  found  this 
woman  very  much  agitated,  and  very  delirious;  crying  and  talking  incessantly. 
Her  breasts  were  hard  and  engorged.  Camphorated  liniments  are  applied  to 
them,  and  on  the  24th,  the  engorgement  had  subsided.  Convulsions  super- 
vene, which  are  daily  renewed  at  different  hours,  and  preceded  by  cries.  The 
eyes  are  convulsively  raised,  and  the  face  strongly  injected.  White  and  frothy 
saliva  flows  from  the  mouth.  After  this  discharge,  the  patient  talks  much. 
March  2d,  there  is  general  delirium,  loquacity,  and  extreme  agitation.  She 
no  longer  knows  those  who  surround  her,  and  often  pronounces  the  name  of 
the  same  individual.     May;  delirium  the  same.     June;   a  little  more  compos- 


MANIA.  409 

ed  in  her  movements;  while  her  incoherence  and  loquacity  have  not  dimi- 
nished. July;  same  condition.  Tepid  baths  and  laxative  drinks  produce  no 
amelioration.  Aug. ;  a  blister  is  applied  between  the  shoulders,  without  any 
appreciable  effect,  Dec.  ;  appearance  of  the  menses,  without  diminution  of 
the  delirium  and  agitation.  Winter  occasions  no  change  in  this  condition. 
In  the  month  of  June,  1813,  I  subject  the  patient  to  affusions  of  cold  water, 
which  are  repeated  for  several  successive  days.  There  is  a  febrile  reaction 
after  each  affusion,  and  the  delirium  is  lessened.  We  observe  manifest  im- 
provement daily,  and  her  restoration  is  complete  by  the  close  of  July.  The 
menses  are  restored  and  regular.  At  length  she  returns  to  her  family.  Since 
leaving  the  hospital,  she  has  had  three  favorable  confinements,  without  suffer- 
ing any  derangement  of  health  in  consequence  of  them. 

J.,  fifteen  years  of  age,  was  admitted  at  Charenton,  Aug.  13th,  1836.  He 
was  then  in  a  state  of  dementia,  bordering  on  insensibility,  in  consequence  of 
onanism.  The  skin  of  this  young  patient  was  discolored,  his  large  blue  eyes 
were  dull  and  puffed  up,  and  his  step  unsteady;  though  he  walked  a  little. 
He  spoke  not,  and  scarcely  replied  in  monosyllables;  not  seeming  to  compre- 
hend the  questions  that  were  put  to  him.  I  subject  him  to  affusions  at  a  tem- 
perature of  14'^  (Reaumur).  The  rigor  was  well  marked ;  and  it  was 
several  hours  before  the  patient  recovered  his  natural  warmth.  After  the  se- 
cond affusion,  I  ordered  frictions  with  woolen  cloth,  along  the  spine,  and  upon 
the  inferior  extremities.  After  the  sixth  affusion,  the  countenance  of  the 
patient  became  animated,  and  it  seemed  to  himself  that  he  had  just  awoke. 
By  slow  degrees,  the  vital  forces  were  reestablished.  He  walked  with  more 
assurance,  and  replied  more  willingly  and  correctly  to  such  questions  as  were 
put  to  him,  and  called  for  a  larger  quantity  of  food.  Fifteen  affusions  proved 
sufficient  to  effect  his  cure. 

During  the  summer  of  1813,  I  submit  four  maniacs  to  affusions  of  cold 
water.  One  of  the  four  women  could  not  recover  the  vital  heat  within  twelve 
hours.  She  then  slept,  and  was  well,  on  waking.  Reaction  was  slight  in  the 
cases  of  the  three  others,  but  the  activity  of  the  delirium  was  lessened,  and 
they  were  cured  a  few  days  after,  without  the  employment  of  any  farther  affu- 
sions. They  have  often  succeeded,  either  by  arousing  and  exciting  the  dor- 
mant forces,  or  by  recalling  to  the  surface  the  too  concentrated  innervation. 
It  is  however  very  certain,  that  this  powerful  therapeutic  agent  does  not 
act  in  the  same  manner,  upon  all  subjects.  Young  J.,  exhausted  by  onanism, 
was  pale,  anasarcous,  and  in  a  state  of  dementia ;  and  affusions  had  a  tonic 
action  ;  while  the  other  insane  persons  were  maniacs.  It  is  evident,  that  with 
them  the  affusions  produced  a  salutary  febrile  reaction.  In  the  case  of  the 
fourth,  the  cure  was  effected,  less  by  the  physical  action  of  the  cold  water, 
than  by  the  moral  influence  of  this  species  of  medication.  Douches  of  cold 
water  upon  the  head  have,  even  to  our  day,  been  regarded  as  a  specific  in 
mania.  They  produce  a  sedative  physical  action,  in  consequence  of  the  cold, 
and  a  moral  action,  as  a  means  of  repression.  The  greater  part  of  conva- 
lescents say,  in  general,  that  they  have  derived  benefit  from  them.  Some 
maniacs  demand  the  use  of  this  agent,  but  we  must  be  careful  not  to  abuse  it. 

If  mania  is  complicated  with  excitement  of  the  reproductive  organs,  we 
compose  them,  by  means  of  tepid  and  demi-baths,  by  enemata,  cold  or  pre- 
pared with  opiates,  hyoscyamus,  assafoetida,  water  of  the  lauro-cerasus,  etc. 
We  have,  in  these  cases,  recommended  the  use  of  the  acetate  of  lead  inter- 
nally, and  camphor  combined  with  vinegar.  There  are  however,  forms  of 
mania,  which  resist  a  treatment  directed  according  to  the  most  approved  the- 
rapeutic views.  We  must  then  have  recourse  to  a  perturbating  plan  of  treat- 
ment, and  to  empiricism  even,  when  a  wise  and  experienced  physician  con- 
trols its  application.     When  a  maniac  is  young,  strong,  robust,  well  nourished 

52 


410  MANIA. 

and  plethoric,  we  may  repeat  blood-letting.  I  have  found  benefit  from  the 
application  of  three  or  four  leeches  to  the  anus,  renewed  every  eight  or  fifteen 
days,  according  to  the  state  of  the  vital  forces.  I  encourage  a  flux  towards 
the  hemorrhoidal  vessels,  by  hip  baths  or  aloes.  To  diminish  the  impulse  of 
blood  towards  the  brain,  we  apply  ice  to  the  head.  We  maintain,  by  means 
of  a  spunge  or  linen  cloth,  cold  water,  or  water  and  vinegar,  in  contact  with 
the  head  of  the  maniac,  whilst  he  is  in  a  warm  bath,  or  his  feet  in  hot  water. 
Use  has  been  made  of  drastics,  and  other  purgative  medicine.  They  succeed, 
by  occasioning  a  strong  irritation  upon  the  alimentary  canal,  which  thus  re- 
lieves the  brain.  Drastics  provoke  the  evacuation  of  brown,  pitchy,  mucous 
matters  ;  the  presence  of  which  continue  the  delirium.  When  maniacs  refuse 
all  medicines,  and  we  wish  to  act  on  the  alimentary  canal,  we  may  mingle  a 
purgative  with  their  food,  and  prescribe  an  emetic  drink  ;  we  employ  frictions 
of  croton  oil  upon  the  abdomen,  have  recourse  to  enemata,  and  even  the 
douche  ascend  ante. 

It  must  not  be  forgotten,  that  in  mania,  constipation  is  as  fatal  as  liquid 
and  abundant  dejections.  In  ordering  purgatives,  we  should  be  cautious  that 
the  extremely  suspicious  maniacs  do  not  get  an  impression  that  we  are  ad- 
ministering substances,  suited  to  poison  them.  In  the  employment  of  drastics, 
and  even  purgatives,  it  will  be  found  advantageous  to  alternate  them  with  tepid 
baths.  Baths  moderate  the  general  irritation,  caused  by  evacuants.  Areteus 
made  great  use  of  distilled  vinegar.  Locher  also  boasts  of  its  use,  and  Chi- 
aruggi  has  combined  it  with  camphor  in  the  following  formula  : 

R 

G.  Camphora^      .         .         .         .         .         .         .     3i     a.     3ii 

Aceti  distillat f  §ii    a  f  §iv 

Mix. 

Of  this  mixture,  a  table  spoonful  is  to  be  taken,  diff'used  in  some  vehicle. 

A  young  woman  who  was  insane,  and  had  been  cured,  after  having  swallow- 
ed an  ointment  containing  not  less  than  twenty  grains  of  opium,  the  attention 
of  practitioners  was  directed  particularly  to  the  effect  of  narcotics.  These 
medicines  are  not  suited  to  cases  of  plethora.  Valsalva  and  Morgagni  pro- 
scribed opium ;  though  the  former  states  that  he  has  cured  several  maniacs, 
by  putting  them  upon  the  use  of  an  infusion  of  poppy.  Doctors  Sutton  and 
Pery  have  cured,  with  opium,  maniacs  who  were  tormented  with  thirst  and 
insomnia.  M.  Pery  assures  us,  that  he  has  employed  it,  in  the  quantity  of 
sixty-four  grains  a  day.  Several  English  physicians,  and  particularly  Doctor 
Locher,  who  has  long  been  at  the  head  of  the  hospital  for  the  insane  at 
Vienna,  speak  in  the  highest  terms  of  the  digitalis  purpurea.  He  was  in 
the  habit  of  employing  it  in  substance,  in  the  dose  of  from  one,  to  twenty  and 
thirty  grains,  twice  a  day.  The  English  prescribe  its  tincture,  in  doses  of 
from  twenty  to  fifty  drops  twice  or  thrice  a  day.  I  have  elsewhere  said,  that 
we  should  regard  the  bath  of  surprise,  as  a  perturbating  and  empirical  reme- 
dy. Van  Helmont  was  accustomed  to  submerge  maniacs ;  a  barbarous  mea- 
sure, by  means  of  which,  they  formerly  believed  themselves  able,  successfully 
to  combat  epilepsy.  This  author  recommended,  that  the  submersion  should 
be  prolonged  until  a  state  bordering  upon  death  was  induced,  in  order,  he  was 
accustomed  to  say,  to  annihilate  the  last  traces  of  their  maniacal  extrava- 
gances. In  accordance  with  this  view,  establishments  for  the  treatment  of  the 
insane  were  erected  near  rivers,  into  which  they  threw  their  patients,  bound 
hand  and  foot.  Boerhaave  and  Van-Swieten  gave  the  same  advice.  Cullen 
proposes  immersion  in  cold  water,  in  order  to  provoke  a  chill,  and  its  conse- 
quent reaction. 


MANIA.  411 

Many  facts  which  have  been  observed  in  England,  by  Doctors  Mason  Cox, 
Haslam  and  Fox  ;  and  the  experiments  made  at  Berlin,  by  Doctors  Hufeland 
and  Horn  ;  seemed  to  favor  the  employment  of  the  rotatory  machine.  Why  do 
men  so  skillful,  attempt  to  introduce  into  practice  an  agent  so  dangerous ! 
The  rotatory  machine  is  now  every  where  abandoned.  The  moxa,  applied  to 
the  crown  of  the  head,  has  been  proposed.  I  confess  that  I  have  never  em- 
ployed it  in  mania ;  though  I  have  often  tried  it  without  benefit  in  dementia 
complicated  with  paralysis.  Is  it  not  to  be  feared  that  the  application  of  fire, 
by  destroying  the  hairy-scalp,  will  determine  consecutively,  inflammation 
within  the  cranium  ?  Such  was  the  opinion  of  professor  Chaussier.  Doctor 
Valentin  of  Nancy,  has  announced  the  good  effects  of  the  actual  cautery, 
applied  to  the  neck.  I  can  affirm  that  this  means  has  sometimes  succeeded 
in  my  hands,  in  the  most  furious  mania,  and  even  upon  subjects  very  much 
emaciated,  and  extremely  irritable.  It  may  moreover,  have  a  frightful  moral 
influence;  and  I  have  seen  women  at  the  Salpetriere,  who,  incapable  of  un- 
derstanding this  act,  cried  out  on  seeing  the  red-hot  iron,  and  proclaimed 
their  innocence  of  crimes  which  deserved  the  mark,  (a  brand  to  which  cer- 
tain criminals  are  condemned).  This  measure,  like  all  perturbating  agents, 
aside  from  its  physical  action,  produces  a  moral  effect,  as  the  following  facts 
show.  In  a  case  of  mania  attended  with  fury,  which  occurred  in  the  person  of 
a  young  female,  I  wished  to  apply  the  iron  at  a  red  heat  whilst  she  was  in  the 
bath.  It  merely  reddened  the  skin  ;  but  the  patient  immediately  came  to  her- 
self, and  soon  recovered  the  use  of  her  reason.  This  girl,  whom  fear  cured, 
ha.s  since  remained  in  the  house  in  the  capacity  of  a  domestic. 

V.  V.  P.,  twenty-six  years  of  age,  and  of  a  lymphatic  temperament,  becomes 
a  maniac  during  the  month  of  April,  1823.  She  is  bled  and  bathed  at  home, 
but  without  success.  She  is  admitted  at  the  Saltpetriere  on  the  2Cth  day  of 
May  following,  in  a  state  of  mania,  attended  with  a  degree  of  agitation  and 
fury,  which  nothing  composes.  In  the  month  of  October,  I  apply  the  actual 
cautery  to  the  neck.  The  preparations  for  this  operation  disturb  her  much. 
Scarcely  has  the  red  hot  iron  been  applied  to  her  neck,  when,  to  her  cries  and 
agitation,  succeeds  a  moment  of  silence.  She  then  sheds  a  torrent  of  tears, 
and  afterwards  makes  regular  progress  towards  recovery,  which  is  perfected  at 
the  expiration  of  two  weeks.  She  still  remained  for  some  time  in  the  division 
of  convalescents,  and  returned  to  her  family,  November  19th,  of  the  same 
year. 

A  girl,  twenty  years  of  age,  tall,  and  of  a  robust  constitution,  is  brought  to 
the  Salpetriere  in  a  state  of  very  violent  mania.  The  means  usually  employ- 
ed, do  not  change  her  state,  and  I  decide  upon  applying  the  actual  cautery  to 
the  neck.  All  the  preparations  being  made,  we  employ  force  to  hold  the  pa- 
tient. She  is  so  much  frightened,  on  seeing  the  hot  iron,  that  she  redoubles 
her  eflforts  to  avoid  it.  She  is  restrained  by  force,  but  so  soon  as  she  feels  the 
iron  approach,  she  repeats  her  eflforts,  frees  herself  from  the  hands  of  the  assist- 
ants, and  remains  for  five  minutes  in  the  enjoyment  of  perfect  reason.  She 
inquires  with  composure  what  they  wish  to  do  with  her,  and  earnestly  entreats 
that  she  may  be  spared.  I  consent  to  defer  the  application  of  the  iron,  on 
condition  that  the  patient  will  from  henceforth  remain  rational  and  tranquil. 
She  promises,  and  keeps  her  word. 

In  two  days,  she  is  transferred  to  the  division  of  the  convalescents,  and  is  soon 
perfectly  restored.  She  declared  that  the  fright  she  had  experienced,  at  sight  of 
the  hot  iron,  had  contributed  to  her  cure.  Iron  heated  in  boiling  water,  may 
be  substituted  for  that  which  is  heated  in  the  fire.  It  is  an  agent  less  fright- 
ful to  patients,  and  less  energetic ;  but  which  composes  maniacs,  especially 
when  the  integuments  of  the  head  appear  gorged  with  blood.  I  will  speak  of 
the  application  of  cups  to  the  neck.     In  order  to  do  this,  we  shave  the  hair 


412 


MANIA, 


from  the  posterior  region  of  the  head,  and  apply  a  number  of  them  to  the  nape, 
the  neck,  and  shoulders ;  scarify  to  a  greater  or  less  depth,  and  then  apply 
cold  lotions  to  the  head. 

Such  are  the  remedial  agents  which  have  been  signalized  as  suited  to  com- 
bat mania.  We  cannot  deny  that  the  successes  attributed  to  heroic  remedies, 
are  far  less  numerous  than  the  cures  obtained  by  a  suitable  direction  given  to 
the  maniacs  themselves,  and  those  who  serve  them,  by  a  proper  regimen,  and 
wise  expectation  ;  and  that  it  is  better  to  trust  to  time  and  the  efforts  of  na- 
ture, than  to  the  employment  of  remedies,  often  hazardous,  rarely  useful,  and 
sometimes  dangerous.  Finally,  in  enumerating  the  principal  medicines  pro- 
posed, to  overcome  one  of  the  most  formidable  of  maladies,  it  will  not  be  sup- 
posed that  I  advise  the  employment  of  them  all,  even  successively,  in  each 
case  of  mania.  I  am  to  suppose  that  the  well  educated  physician  will  here 
expect  only  the  general  indications,  respecting  the  employment  of  the  thera- 
peutic agents  already  tested.  Each  must  make  that  application  of  them  to  in- 
dividual cases,  which  his  wisdom,  experience  and  discernment  may  suggest. 

[There  are  several  points  connected  with  the  treatment  of  mania  to  which  it  may  be 
proper  to  refer ;  not  because  they  are  new,  or  supposed  to  furnish  the  basis  of  novel 
views ;  but  rather  because  mankind  are  prone  to  forget,  or  fail  to  practice  much  that  is  of 
vital  consequence  to  their  welfare  and  happiness.  Our  author  in  this  chapter  describes 
that  form  of  insanity  which  has  probably  led  to  more  cold-blooded  cruelty  and  abuse  ; 
and  to  a  greater  amount  of  inappropriate  medical  and  moral  treatment,  than  all  the 
others  united.  It  was  upon  the  chafed  and  abraded  limbs  of  the  maniac,  that  was  once 
heard  the  clanking  of  chains  ;  upon  his  lacerated  flesh  that  was  once  seen  the  marks  of 
the  scourge  ;  and  upon  his  features  the  impress  of  that  rage,  which  unkindness  had  en- 
gendered. It  was  the  maniac  too,  for  whom  the  dungeon  was  prepared  ;  whose  bed  was 
straw,  and  who,  partly  from  fear  we  may  in  charity  suppose— and  partly  also  from  in- 
difference on  the  part  of  those  in  charge  of  him,  was  permitted,  month  after  month,  to 
roll  in  his  nakedness  amid  his  own  ordure.  Such  was,  until  too  recently,  the  condition 
of  the  maniac  who,  previous  to  his  attack,  might  have  occupied  the  most  intimate  rela- 
tions towards  those  by  whom  he  was  surrounded. 

From   the  statement  of  our  author,  as  well  as  from  those  which  every  year  appear 
in  the   published    reports  of  our  Institutions  for   the  treatment  of  Insanity,  we  learn 
that  this  fearful  form  of  mental  derangement  is  that  which,  in  its  earlier  stage,  admits 
most  readily  of  cure.     Would  that  the  public  understood  this  inexpressibly  important 
truth  !     Would  that  physicians  generally,  were  fully  alive  to  the  magnitude  of  the  evil, 
and  the  certainty,  if  promptly  and  judiciously  treated,  of  its  cure  !     We  might  then   hope 
that   mania,  with   all  its  terrible  consequences,  would  less   frequently  prove  the   lot  of 
man.     This  very  class  of  the  insane,  above  all  others,  need  the  peculiar  privileges  of 
these  Institutions.     For   the  maniac  were  they  constructed;  not  exclusively,  but  with 
special  reference  to  their  wants  ;  and  provided  with  all   the  appliances  requisite  for  their 
comfort  and  successful  management.     A  distrust  of  the  efficacy  of  treatment  on  the  one 
hand— growing  out  of  a  belief,  it  may  be,  that  nothing  can  be  done  for  one  in  this  un- 
happy condition— and  on  the  other,  a  false  notion  that  these  Institutions  are  money- 
making    Establishments,   doubtless   deter   many  uninformed  persons  from   applying   to 
them  for  aid,  in  behalf  of  their  suffering  relatives.     The  fact  is,  they  owe  their  origin  to 
the  exercise  of  the  largest  philanthropy  ;  and  a  benevolence  that  spurns  reward,  has 
ever  actuated  their  generous  guardians  and  supporters.     Let  them  then  become  the 
recipients  of  all  whom  this  terrible  visitation  afflicts,  both   because  of  the  manifold 
comforts  which  they  afford,  the  cures  which  in  a  large  majority  of  cases  we  may  confi- 
dently anticipate  as  the  result  of  their  treatment,  and  the  great  economy  connected  with 
this  practice. 


MANIA. 


413 


I  am  induced  to  add  the  following  tables,  illustrative  of  the  latter  consideration. 
Their  accuracy  has  been  corroborated  by  similar  investigations,  at  several  different  In- 
stitutions. They  were  prepared  at  the  request  of  a  Committee  of  the  Legislature  of 
Connecticut,  in  the  spring  of  1843. 


TABLE  I. 

Showing  the  expense,  etc.  of  supporting  twenty  Chronic  cases  of  Insanity  now 

in  the  Retreat  at  Hartford,  Conn. 


Time 

No. 

Present  Age. 

at  Expense. 

Total  Expense. 

1 

45  years. 

19  years. 

$3,458 

2 

43 

18 

3,776 

3 

39 

13 

2,366 

4 

32 

11 

2,062 

5 

31 

10 

1,820 

6 

29 

9 

1,638 

7 

33 

9 

1,638 

8 

41 

9 

1,638 

9 

27 

7 

1,274 

10 

28 

1^ 

1,274 

11 

44 

19 

3,458 

12 

61 

18 

3,276 

13 

39 

15 

2,730 

14 

47 

14 

2,548 

15 

35 

14 

2,548 

16 

30 

14 

2,548 

17 

45 

13 

2,366 

18 

57 

11 

2,002 

19 

53 

11 

1,002 

20 

33 

10 

1,820 

Aggregate. 

792  years. 

241  years. 

$44,782 

Average. 

39.6 

12.05 

12,239  10  cts. 

414 


MANIA. 


TABLE  II 


SJioiving  the   expense  of  supporting  twenty  recent  cases  of  Insanity,  last  dis- 
charged from  the  same  Instittition,  cured. 


No. 

Present  Age. 

Time  at  Expense. 

Total  Exp. 

1 

19  years. 

3  m.  0  w.  0  d. 

145  00 

2 

54 

3       1       4 

50  00 

3 

17 

3       7       6 

73  00 

4 

34 

3       0       3 

47  00 

5 

45 

3      6      2 

67  50 

6 

47 

6       0       1 

91  50 

7 

35 

3       0       5 

48  50 

8 

32 

3       0       0 

45  50 

9 

37 

8       0       0 

121  00 

10 

40 

3       0       4 

47  50 

11 

21 

6      2       1 

98  50 

12 

60 

3       0       0 

45  00 

13 

45 

2       1       3 

45  50 

t 

14 

30 

2       0       4 

45  50 

15 

47 

3       1       0 

49  00 

16 

21 

3       3       0 

56  00 

17 

59 

3       0       0 

45  00 

18 

26 

14       3       0 

202  50 

19 

30 

2       2       4 

37  00 

20 

44 

1       1       2 

45  50 

Aggregate. 

733  years. 

7y.  Im.  0w.4d. 

$1,308  30 

Average. 

36.65 

119.2  d. 

$65  80 

TABLE  III. 

Aggregates  and  Averages  of  Chronic  and  Recent  Cases  compared. 


Aggregates. 

Ages. 

Time  at  Expense. 

— > 

Total  Expenses. 

Chronic  cases. 
Recent  cases. 

792  years. 
733 

39.6  years. 
36.65 

241  years. 

7y.  1  m.  Ow.  4  d. 

12.05  years. 
119.2  days. 

$44,782  00 
1,308  00 

2,239  10 

65  80 

Averages. 

Chronic  cases. 
Recent  cases. 

The  tables  contain  a  list  of  twenty  chronic  and  twenty  recent  cases  of  in- 
sanity, the  former  embracing  those  who  have  been  longest  resident  at  the  Re- 
treat for  the  Insane ;  the  latter  those  who  have  recently  been  discharged  cured, 
in  their  order. 


MANIA.  415 

The  average  age  of  those  who  have  been  found  to  be  incurable  is  39.6 
years, — average  time  spent  at  the  Retreat  12.5  years,  and  the  average  expense 
incurred,  $2,239  10. 

Their  aggregate  ages  are  792  years, — the  whole  period  spent  at  the  Institu- 
tion 241  years,  and  the  sum  total  of  their  expenses,  exclusive  of  clothing, 
$44,782. 

All  are  enjoying  a  comfortable  measure  of  bodily  health,  and  will  probably 
live,  most  of  them,  materially  to  increase  the  enormous  expense  which  their 
deplorable  malady  has  already  rendered  necessary. 

Of  the  recent  cases  it  appears  that  the  average  age  is  36.65  years, — the 
average  time  spent  at  the  Retreat  119.2  days,  or  a  little  less  than  four  months, 
and  the  average  expense  $65  80. 

The  aggregate  ages  of  all  those  contained  in  this  list  are  733  years, — the 
aggregate  amount  of  time  spent  by  them  at  the  Institution,  seven  years  one 
month  and  four  days,  and  their  whole  expense  exclusive  of  clothing,  $1,308. 

These  two  truths, — than  which  none  are  more  thoroughly  established, — that  the  ma- 
niac is,  in  a  large  majority  of  cases  restored  to  health,  if  submitted  early  to  appropriate 
treatment,  and  that  a  large,  and  in  many  instances  a  ruinous  expense,  is  in  this  way 
avoided, — aside  from  other  momentous  considerations — it  is  hoped,  will  result  in  ex- 
tending the  benefits  of  our  Institutions  for  the  Insane,  to  all  who  may  need  their  aid. 
I  cannot  refrain  from  noticing  with  commendation  the  remarks,  and  cases  illustrative  of 
the  moral  treatment  of  this  class  of  the  insane.  From  the  period  when  the  immortal 
Pinel  first  made  the  experiment  of  unloosing  the  fetters  of  the  maniac,  and  leaving  him 
free,  to  move  at  will  about  the  wards  and  courts  appropriated  to  his  use,  until  the 
present  day,  there  has  been  a  constantly  increasing  amelioration  of  the  treatment  of 
this  unfortunate  class.  Indeed,  a  sort  of  generous  rivalry  has  come  to  exist  in  our  pub- 
lic Institutions,  as  to  which  exercises  the  least  degree  of  physical  restraint.  A  good 
practice  however  may  be  carried  to  an  extreme.  Every  true  philanthropist,  who  is  at 
all  acquainted  with  this  class  of  the  insane,  must  know,  that  at  times,  both  humanity 
and  benevolence  call  aloud  for  the  personal  restraint  of  the  maniac.  The  character  of 
this  restraint  must  vary,  as  well  as  the  time  for  which  it  is  required.  It  is  hoped  that 
this  principle  will  be  admitted  to  prevail  in  all  our  Institutions,  and  that  a  limited  and 
peculiar  "  definition"  of  the  term,  may  not  lead  the  public  to  an  incorrect  conclusion 
in  regard  to  it.  With  respect  to  opium,  it  may  be  proper  to  remark  once  more,  that  in 
the  opinion  of  several  superintendents  of  public  Institutions,  in  connection  with  tonics, 
it  is  regarded  as  the  sheet-anchor  in  this  form  of  insanity.  In  general,  an  intense  de- 
gree of  nervous  excitement, — a  degree  which  utterly  precludes  sleep,  except  as  the  result 
of  exhaustion, — and  which  leads  to  unremitted  activity, — characterizes  mania.  It  is  to 
curb  this  excitement,  to  soothe  this  irritability,  and  induce  repose,  that  this  remedy  is 
proposed.  In  numerous  instances,  its  employment  is  unquestionably  advantageous.  It 
ought  however  in  every  case  to  be  used,  subject  to  such  restrictions  as  were  suggested  in 
the  chapter  on  Insanity.  Digitalis,  while  it  is  not  excluded  from  the  list  of  remedies 
employed  in  public  Institutions,  is  far  from  being  a  common  remedy.  In  a  single  case 
of  continued  mania,  where  it  was  believed  that  its  use  might  be  attended  with  favorable 
results,  it  was  employed  for  a  considerable  period,  its  constitutional  impression  produced, 
and  continued  for  some  time,  but  without  success.  Moxas  and  the  potential  cautery 
have,  for  the  most  part  been  abandoned.  The  milder  forms  of  counter-irritation  are  now 
preferred,  and  generally,  the  tartar  emetic  ointment  and  seton  are  the  most  potent  agents 
of  this  class  now  in  use.] 


DEMENTIA. 


Definition  of  term. — Description  of  the  mental  manifestations  of  a  demented  person. — 
Physical  characteristics.— Paralytic  complications.— Dementia,  acute  or  chronic,  sim- 
ple or  complicated  ;  continued,  remittent  or  intermittent.— Compared  with  mania  and 
monomania. — Cases  illustrative  of  the  decline  from  mania  and  monomania,  to  demen- 
tia.—Distinction  between  dementia  and  imbecility  and  idiotism.— Signification  of  term 
insensate.— Its  causes,  complications,  terminations  and  changes  which  post-mortem 
examinationsreveal.— Influence  of  age.— Table  of  ages.— Exciting  causes  of  demen- 
tia.—Table  OF  CAUSES.— Physical  and  moral  causes.— Remarks  on  the  causes  of  demen- 
tia.—Varieties  and  complications  of  dementia.— Maladies  to  which  the  demented  suc- 
cumb, etc.— Table  of  the  principal  organic  lesions.— Extended  description  of  the  con- 
dition of  the  contents  of  the  great  cavities,  as  revealed  by  post-mortem  examinations. 
—Illustrative  cases.— Remarks  with  reference  to  the  above  cases.— Acute  dementia. — 
Causes.— Invasion.— Treatment.-Termination.-Illustrative  case.— Chronic  demen- 
tia.—Causes.— Course.— Treatment  and  termination.— Third  variety.— Senile  demen- 
tia—Cause.— Progress. — Treatment  and  termination.— Complicated  varieties. — Com- 
plications.—Incurable.— Invasion  gradual.- Extreme  limits  of  this  disease,  usually 
from  one  to  three  years.— Phenomena  of  the  last  period  of  life.— Cases.— Compa- 
rative frequency  of  paralysis  connected  with  dementia  in  different  countries.— Seve- 
ral authors  cited  on  this  point,  German,  Italian  and  EnglisJi.— Pathology  and  periods, 
as  indicated  by  Bayle.  Symptoms  of  paralysis  usually,  indicative  of  a  fatal  termi- 
nation.—Sometimes  existing  very  early  in  an  attack  of  insanity.— Cases.— Delirium 
sometimes  ceases,  while  the  paralysis  persists.— Case.— Practical  considerations.— 
(Brief  extracts  from  other  writers  with  reference  to  the  paralysis  sometimes  connected 
with  dementia.) 

Dementia  is  a  cerebral  affection,  usually  chronic  and  unattended  by  fever, 
and  characterized  by  a  weakening  of  the  sensibility,  understanding  and  will. 
Incoherence  of  ideas,  and  a  want  of  intellectual  and  moral  spontaneity,  are 
the  signs  of  this  affection.  Man  in  a  state  of  dementia,  has  lost  the  faculty 
of  perceiving  objects  correctly,  of  seizing  upon  their  relations,  comparing 
them,  and  producing  a  distinct  remembrance  of  them.  Hence  results  the 
impossibility  of  reasoning  correctly.  In  dementia,  impressions  are  unnatural- 
ly feeble,  either  because  the  sensibility  of  the  organs  of  sensation  is  enfee- 
bled ;  or  because  the  organs  of  transmission  have  lost  their  activity  ;  or  be- 
cause, finally,  the  brain  itself  no  longer  possesses  the  power  to  perceive,  and  re- 


418  DEMENTIA. 

tail!  the  impression  which  is  transmitted  to  it : — from  whence  it  results,  that 
sensations  are  feeble,  obscure  and  incomplete.  Individuals  in  a  state  of  de- 
mentia, are  incapable  of  concentrating  their  attention  sufficiently  ;  and  beinp- 
incapable  of  forming  a  clear  and  correct  notion  of  objects,  they  can  neither 
compare  nor  associate  ideas  ;  nor  have  they  the  power  of  abstraction.  The  or- 
gan of  thought  has  not  sufficient  energy,  and  is  deprived  of  the  tonic  force,  re- 
quisite for  the  integrity  of  its  functions.  Hence  ideas,  the  most  unlike,  succeed, 
independently  one  of  another  ;  and  follow  without  either  connection  or  mo- 
tive. Their  conversation  is  incoherent,  and  the  patients  repeat  words  and 
entire  sentences,  without  attaching  to  them  any  precise  signification.  They 
speak  as  they  reason,  without  a  consciousness  of  what  they  are  saying.  It 
seems  that  they  have  sentiments  treasured  up  in  their  minds,  which  they  re- 
peat in  obedience  to  the  force  of  former  habits,  or  yielding  to  fortuitous  con- 
crruities. 

Many  of  those  who  are  in  a  state  of  dementia,  have  lost  their  memory,  even 
of  those  things  which  are  most  intimately  connected  with  their  existence. 
But  it  is  especially  the  faculty  of  recalling  impressions  recently  made,  which 
is  essentially  changed.  They  possess  only  the  memory  of  old  persons.  They 
forget  in  a  moment,  what  they  have  just  seen,  heard,  said  or  done.  It  is  the 
memory  of  things  present  which  is  wanting  to  them  ;  or  rather,  memory  does 
not  betray  them,  because  the  sensations  being  very  feeble,  as  well  as  the  per- 
ceptions, scarcely  a  trace  is  left  after  them.  Many  also  are  irrational,  only 
because  the  intermediate  ideas  do  not  connect  those  which  precede  and  fol- 
low. We  clearly  perceive  breaks,  which  it  would  be  necessary  to  fill  up,  in 
order  to  give  to  their  discourses  the  arrangement,  filiation  and  perfection, 
which  belongs  to  a  connected  and  complete  process  of  reasoning.  The  ener- 
gy of  the  sensibility  and  intellectual  faculties,  which  is  always  in  proportion 
to  the  activity  of  the  passions,  being  almost  extinct,  the  latter  are  null,  or 
almost  so,  in  dementia.  The  insane,  in  a  state  of  dementia,  have  neither  de- 
sires nor  aversions  ;  neither  hatred  nor  tenderness.  They  entertain  the  most 
perfect  indifference  towards  objects  that  were  once  most  dear.  They  see  their 
relatives  and  friends  without  pleasure,  and  leave  them  without  regret.  They 
are  not  uneasy  in  consequence  of  the  privations  that  are  imposed  upon  them, 
and  rejoice  little  at  the  pleasures  which  are  procured  for  them.  What  is  pass- 
ing around  them,  no  longer  awakens  interest ;  and  the  events  of  life  are  of 
little  account,  because  they  can  connect  themselves  with  no  remembrances,  nor 
any  hope.  Indifferent  to  every  thing,  nothing  affects  them.  They  sport  and 
play,  when  others  are  in  affliction.  They  shed  tears  and  utter  complaints, 
when  every  body  else  is  happy,  and  when  they  ought  to  be  so  themselves.  If 
their  position  is  unpleasant,  they  do  nothing  to  change  it.  The  brain  being 
in  a  state  of  atony,  and  no  longer  furnishing  sensations  for  the  production  of 
ideas  upon  which  to  reason,  nor  data  upon  -which  to  form  a  judgment,  the  de- 
terminations are  vague,  uncertain,  variable,  without  aim,  and  passionless. 
Those  who  are  in  a  state  of  dementia,  are  destitute  of  spontaneity.  They  no 
longer  determine,  but  abandon  themselves ;  yielding  implicitly  to  the  will  of 
others.  Their  obedience  however  is  passive,  and  they  have  not  sufficient 
energy  to  be  intractable.  They  are  often  also  the  sport  of  those  who  wish 
to  take  advantage  of  this  dreadful  condition.  Notwithstanding,  they  are  iras- 
cible, like  all  feeble  beings,  and  those  whose  intellectual  faculties  are  weak 
or  limited.  Their  anger  however,  is  only^of  a  moment's  duration.  It  has  no 
permanence  like  that  of  maniacs,  and  particularly  those  suffering  from  lype- 
mania.  They  are  so  feeble  that  their  fury  must  necessarily  be  of  short  dura- 
tion, and  they  can  but  for  a  brief  period,  sustain  so  great  an  effort. 

Almost  all  who  have  fallen  into  a  state  of  dementia,  have  some  sort  of 
ridiculous  habit  or  passion.  Some  are  constantly  walking  about,  as  if  seeking 
something  that  they  do  not  find.     The  gait  of  others  is  slow,  and  they  walk 


DEMENTIA.  419 

with  difficulty.  Otliers  still,  pass  days,  months  and  years,  seated  in  the  same 
place,  drawn  up  in  bed,  or  extended  upon  the  ground.  This  one  is  constant- 
ly writing,  but  his  sentiments  have  no  connection  or  coherency.  Words  suc- 
ceed words  :  relating  sometimes  to  his  former  habits  and  affections.  We  can 
sometimes  recognize  amidst  the  incoherence  and  confusion  of  what  they  write, 
a  word  or  phrase  which  they  repeat,  and  which  is  the  result  of  memory. 
They  are  the  fixed  ideas  which  characterize  their  delirium,  when  monomania 
has  preceded  dementia.  Their  writing  is  always  changed,  bad,  and  not  easily 
recognized.  There  are  some  patients  who  cannot  trace  a  letter,  or  select 
those  which  could  form  the  shortest,  and  most  familiar  word.  These  wretch- 
ed beings  are  equally  unskillful  in  all  the  useful  arts  or  accomplishments 
which  they  cultivated  with  success  before  their  illness.  One,  in  an  interminable 
babble,  speaks  in  a  loud  voice,  constantly  repeating  the  same  words.  Ano- 
ther, with  a  sort  of  continued  murmur,  utters  in  a  very  low  tone,  certain  im- 
perfectly articulated  sounds  ;  commencing  a  phrase  without  being  able  to 
finish  it.  The  latter  does  not  speak  ;  while  the  former  beats  with  his  hands, 
both  night  and  day  ;  his  neighbor  at  the  same  time,  balancing  his  body  in 
the  same  direction,  with  a  degree  of  monotony,  very  fatiguing  even  to  an 
observer.  One  murmurs,  rejoices,  weeps  and  laughs  at  the  same  time  ;  ano- 
ther sings,  whistles  and  dances  during  the  whole  day.  Many  clothe  them- 
selves in  a  ridiculous  manner,  and  take  possession  of  whatever  they  meet  with, 
in  order  to  fit  them  to  their  ordinarily  filthy  garment,  affecting  a  singular  cos- 
tume which  is  always  disordered  and  strange. 

To  this  disturbance  of  the  soundness  of  the  understanding,  are  united  the 
following  symptoms.  The  face  is  pale,  the  eyes  dull,  and  moistened  with  tears, 
the  pupils  dilated,  the  look  uncertain,  and  the  physiognomy  without  expres- 
sion. The  body  is  now  emaciated  and  slender  ;  and  now  loaded  with  tlesh  ; 
the  face  full,  the  conjunctivtE  injected,  and  the  neck  short.  The  functions  of 
organic  life  maintain  their  integrity.  Sleep,  ordinarily  profound  and  prolong- 
ed, is  daily  renewed,  the  appetite  becomes  voracious,  and  the  alvine  evacua- 
tions are  consistent,  and  sometimes  liquid.  In  very  many  cases,  the  lymphatic 
system  predominates,  and  such  persons  acquire  much  flesh.  It  often  happens, 
that  when  mania  or  monomania  tends  to  dementia,  this  frightful  termination 
is  announced  by  obesity.  When  paralysis  complicates  dementia,  the  para- 
lytic symptoms  are  manifested  successively.  At  first,  articulation  is  endjar- 
rassed  ;  shortly  after,  locomotion  is  executed  with  difficulty ;  and  the  arms  are 
moved  but  with  pain.  Finally,  the  dejections  become  involuntary.  None  of 
these  epiphenomena  ought  to  be  regarded  as  symptoms  of  dementia,  more  than 
the  signs  of  scurvy,  which  often  complicates  this  malady.  Dementia  is  acute 
or  chronic  ;  simple  or  complicated  ;  continued,  remittent,  or  intermittent. 
Dementia  differs  essentially  from  mania,  and  particularly  monomania.  In 
these  latter,  the  faculties  are  especially  disturbed.  Maniacs  are  irrational,  in 
consequence  of  excitement.  There  is  a  wandering  and  exaltation  of  the  un- 
derstanding, and  their  delirium  depends  upon  a  convulsive  condition  of  the 
nervous  and  cerebral  system.  In  monomania,  there  is  also  an  exaltation,  as 
well  as  fixedness  and  tension  of  the  sensibility.  Maniacs  and  monomaniacs 
are  drawn  away  by  errors  of  sensation,  by  false  perceptions,  hallucinations, 
and  the  abundance  and  fixedness  of  the  ideas  and  affections.  He  who  is 
in  a  state  of  dementia  imagines  not,  nor  indulcres  in  thought.  He  has  few  or 
no  ideas.  He  neither  wills  nor  determines,  but  yields ;  the  brain  being  in  a 
weakened  state.  Whilst  in  the  case  of  the  maniac  and  melancholic,  every 
thing  indicates  strength,  power  and  effort ;  with  the  person  in  dementia,  every 
thing  betrays  weakness,  relaxation  and  feebleness.  Dementia  can  no  longer 
with  propriety  be  confounded  with  monomania,  to  which,  in  some  cases,  it 
presents  resemblances.     It  will  not  prove  useless  to  observe  with  care,  the  pro- 


420  DEMENTIA. 

gress  from  mania  and  monomania  to  dementia ;  and  with  the  view  to  illustrate 
this  point,  I  relate  the  two  following  cases. 

P.  J.  D.,  a  merchant  twenty-nine  years  of  age,  of  a  gay  and  very  active  disposi- 
tion, has  taken  a  great  amount  of  mercury,  to  remove  two  successive  attacks 
of  blennorrhagia.  When  twenty-eight  years  of  age,  he  meets  with  serious 
losses  in  business,  which  are  succeeded  by  depression  of  mind.  Some  months 
subsequently,  he  manifests  indifference  about  his  affairs,  which  he  neglects  ; 
and  prejudices  against  his  family,  particularly  his  mother.  He  suffers  from  in- 
appetence,  does  not  sleep,  and  refuses  to  take  food,  through  fear  of  poison  ; 
and  is  ever  employed  in  discovering  and  baffling  the  designs  of  his  pretended 
enemies.  Previous  to  this  period,  the  change  in  his  disposition,  the  perver- 
sion of  his  affections,  the  abandonment  of  his  business,  and  the  fear  of  poison, 
characterize  the  delirium,  to  which  succeed  gay  and  ambitious  notions.  The 
patient  indulges  in  every  variety  of  error  in  regimen.  At  the  expiration  of 
four  months,  he  suddenly,  during  the  month  of  May,  1836,  complains  of  a  vio- 
lent cephalalgia,  and  condemns  himself  to  repose,  silence,  and  the  most  abstemi- 
ous diet.  His  tongue,  at  this  time,  appeared  embarrassed.  On  the  8th  of  June, 
1836,  he  is  admitted  at  Charenton  ;  does  not  walk,  is  emaciated,  and  remains 
standing  near  his  bed,  with  his  head  inclined,  his  arms  hanging  by  his  side, 
his  look  and  physiognomy  changeless.  He  seems  a  stranger  to  all  who  sur- 
round him  ;  replies  not  to  the  questions  that  are  addressed  to  him,  nor  to  those 
proofs  of  kindness  that  are  shown  him.  He  perseveringly  refuses  food,  and 
constipation  is  obstinate.  Two  purgative  enemata  provoke  the  evacuation  of 
brown,  hard  and  dry  matter.  On  the  9th  of  June,  the  patient  is  carried  to  the 
bath,  notwithstanding  his  efforts  to  the  contrary ;  remains  there  two  hours, 
and  eats  with  an  appetite,  soon  after  leaving  it.  His  face  is  animated,  and  his 
physiognomy  changeful.  On  the  following  day, — the  10th, — he  is  agitated, 
complains  of  his  relatives,  and  particularly  of  his  mother  ;  demands  his  liberty, 
talks  incessantly,  cries,  walks  about  with  spirit,  overturns  whatever  he  meets 
with,  and  expresses  in  abusive  terms,  his  resentment  towards  his  family,  who 
wish  him  to  die  by  a  slow  fire.  Is  he  in  the  court,  he  indulges  in  loud  laugh- 
ter, walks  at  a  rapid  pace,  cries,  howls,  etc.,  etc.  If  he  is  checked,  and  efforts 
made  to  fix  his  attention,  he  affirms  that  his  enemies  are  tormenting  him.  He 
sees  and  hears  them  every  where,  both  night  and  day  ;  and  it  is  his  mother  in 
particular,  who  reproaches  him.  By  degrees,  the  patient  becomes  more  com- 
posed, and  after  some  days,  we  grant  him  more  liberty ;  and  at  a  later  period, 
he  passes  into  the  division  of  convalescents.  He  no  longer  suffers  from  hallu- 
cinations, nor  entertains  prejudices.  His  conversation  is  connected,  but  he 
remains  isolated,  engages  in  no  diversions,  and  performs  strange  acts.  Ad- 
mitted to  the  table  of  convalescents,  he  eats  with  voracity,  or  not  at  all ;  and 
contents  himself  with  drinking  at  a  draught,  the  wine  that  is  served  out  to  him. 
He  laughs  loudly,  or  appears  to  be  absorbed  by  some  thought  which  engages 
him.  At  the  close  of  August,  the  agitation  returned.  He  runs,  sings  and 
laughs  ;  clapping  his  hands,  holding  the  most  incoherent  conversation,  and  ac- 
cusing anew,  both  his  mother  and  family.  He  does  not  eat,  but  drinks  a  large 
quantity  of  water.  From  excitement,  the  patient  passes  without  transition 
into  a  state  entirely  opposite.  His  head  is  inclined,  his  eyes  fixed  and  dull, 
and  his  insensibility  to  external  objects  complete.  On  rising,  he  must  be  dress- 
ed, and  remains  wherever  he  is  placed. 

An  abundance  of  mucus  discharges  from  his  mouth  and  nose;  constipation 
is  obstinate;  the  urine  involuntary  ;  and  he  refuses  food.  He  closes  his  jaws 
whenever  an  attempt  is  made  to  administer  liquids  of  any  kind.  It  is  neces- 
sary to  undress  him  for  bed  ;  and  he  remains  in  just  the  position,  in  which 
the  attendants  place  him.  He  maintains  a  profound  silence  which  nothing 
overcomes.     His  emaciation  is  rapid,  and  very  manifest.     Aspersions  of  cold 


DEMENTIA.  421 

water  upon  the  face,  made  unexpectedly,  seem  to  awake  the  patient  again. 
His  complexion  is  fresh ;  his  eyes  and  physiognomy  animated.  He  calls  for 
food,  which  he  eats  voraciously.  This  measure  however,  ultimately  fails,  as 
well  as  the  douche,  which  was  administered  at  a  later  period.  At  last,  he 
sinks  again  into  a  stupor,  from  which  nothing  arouses  him. 

Thus  was  manifested  alternately,  a  state  of  maniacal  lypemania,  and  pro- 
found stupor.  Sometimes  we  succeed  in  causing  the  patient  to  eat,  by  accost- 
ing and  inviting  him  in  a  brusk  manner,  to  take  food.  If  he  refuses  at  first, 
every  new  attempt  is  vain.  Sometimes  also,  if  we  approach  him  he  extends 
his  hand,  utters  a  few  words,  and  ceases  to  reply  ;  especially  if  we  refer  to 
his  position.  During  his  lucid  intervals,  which  are  of  short  duration,  he  con- 
verses readily  and  with  cheerfulness.  Is  he  interrogated  as  to  what  passes  in 
his  mind  during  these  seasons  of  stupor  ?  "  In  this  state,  he  replies,  my  un- 
derstanding is  null.  I  do  not  speak,  nor  do  I  see  or  hear  anything.  If  I  see 
or  comprehend  any  thing,  I  maintain  silence,  not  having  the  courage  to  reply. 
This  want  of  activity  depends  upon  the  fact,  that  my  sensations  are  too  feeble 
to  act  upon  my  will."  A  remarkable  feature  in  the  case  of  this  patient  was, 
his  excessive  repugnance  to  speak  of  his  malady.  If  questioned  upon  this 
point,  he  avoids  making  any  reply  ;  or,  if  he  replies,"  it  is  very  briefly,  and 
turns  the  conversation.  If  enquiries  are  still  made,  he  becomes  silent,  bows 
his  head,  and  relapses  into  a  stupor,  or  leaves  the  querist  without  making  any 
reply.  This  patient  passed  the  winter  and  a  part  of  the  spring,  in  this  state  of 
alternate  agitation  and  stupor.  He  was  returned  to  his  family,  when,  after 
a  two  months'  trial,  they  were  obliged  to  bring  him  back  again  to  Charenton, 
where  he  was  admitted  August  9th,  1837,  in  a  state  of  complete  stupor. 
This  was  not  a  case  of  simple  dementia,  for  the  patient,  although  apparently 
insensible  to  what  was  passing  around  him,  was  not  however,  deprived  of 
understanding,  and  possessed  great  strength  of  will.  We  observe  in  his  physi- 
ognomy the  expression  of  certain  sentiments,  which  do  not  exist  in  complete 
dementia.  He  was  capable  of  resisting  obstinately,  what  was  desired  of  him. 
I  have  seen  several  insane  persons  who,  in  a  similar  condition,  were  very  dan- 
gerous. It  was  necessary  to  watch  them  with  great  care  ;  since,  when  reliev- 
ed at  intervals,  of  their  habitual  stupor,  they  attempted  the  most  fatal  acts. 

P.  L.  Fr.,  of  Swiss  origin,  twenty-seven  years  of  age,  of  medium  size  and 
a  bilious-sanguine  temperament,  has  a  swarthy  and  sallow  complexion,  auburn 
hair,  blue  eyes,  a  voluminous  and  almost  spherical  head,  and  a  forehead  large- 
ly developed  and  wrinkled.  There  is  a  circular  depression,  on  a  line  with 
the  superior  angle  of  the  occipital  bone.  In  consequence  of  an  altercation 
with  his  officers,  he  lost  his  rank  of  quarter-master.  Wounded  in  his  interests 
and  self-love,  he  becomes  sad,  brusk  and  absent-minded  ;  and  after  some  weeks, 
is  seized  with  general  delirium.  He  talks  incessantly,  and  gives  himself  up 
to  the  commission  of  disorderly  acts,  rending  and  breaking  whatever  comes 
within  his  reach.  Conducted  to  the  hospital  of  the  guard,  he  is  treated  for 
six  weeks,  and  is  sent  from  thence  to  Charenton,  November  5th,  1827,  in  a 
state  of  mania  attended  with  fury.  In  the  month  of  February,  1828,  ulcers 
form  upon  the  limbs,  which  he  is  constantly  lacerating.  It  is  found  necessary 
to  confine  him  to  an  arm-chair,  to  prevent  his  walking,  and  to  keep  his  hands 
from  the  sores.  Besides  the  incoherence  of  his  ideas,  his  agitation  and  lo- 
quacity,  a  slight  difficulty  in  pronunciation  is  observed.  By  degrees,  the 
fury  ceases;  composure  is  induced,  and  the  difficulty  of  articulating  sounds 
becomes  more  marked,  and  his  ideas  more  incoherent  and  less  energetic. 
For  eight  years,  he  has  been  in  the  first  stage  of  dementia,  preserving  some 
slight  traces  of  mania,  which  appears  from  time  to  time.  The  functions  of 
organic  life  are  healthfully  executed,  the  appetite  is  voracious,  and  the  sleep 
ordinarily  good.  Notwithstanding,  the  lower  extremities  are  edematous. 
He  is  indifferent  with  respect  to  his  position,  and  his  conversation  is  incohe- 


422  DEMENTIA. 

rent.  He  utters  words  without  connection  or  energy,  or  else  maintains  a  per- 
fect silence.  Rarely  does  he  reply  ;  and  when  he  does,  his  responses  are  in 
no  way  connected  with  the  questions  that  are  addressed  to  him.  They  are 
returned  slowly,  and  sometimes  instead  of  replying,  he  utters  abuse.  Some- 
times also,  he  seems  to  have  hallucinations  of  hearing,  and  talks  to  the  walls. 
He  passes  much  of  the  day,  sitting  upon  his  heels  on  an  arm-chair;  his  head 
reclining  upon  his  chest,  and  his  eyes  dull  and  fixed.  Does  any  one  endeavor 
to  attract  his  attention,  he  sometimes  replies  to  questions  relative  to  his  na- 
tive country,  and  his  lodging  room,  but  does  not  recognize  those  persons  who 
come  to  see  him.  He  never  speaks  of  his  family,  and  continues  to  entertain 
the  most  perfect  indifference  respecting  his  position. 

Dementia  must  not  be  confounded  with  imbecility  or  idiotism.  In  imbeci- 
lity, neither  the  understanding  nor  sensibility  have  been  sufficiently  developed. 
He  who  is  in  a  state  of  dementia,  has  lost  these  faculties  to  a  very  considera- 
ble degree.  The  former  can  neither  look  backward,  nor  into  the  future ;  the 
latter  has  recollections  and  reminiscences.  Imbeciles  are  remarkable  by  their 
conversation  and  acts ;  which  greatly  resemble  infancy.  The  conversation 
and  manners  of  the  insensate,  bear  the  impress  of  their  former  state.  Idiots 
and  cretins  have  never  possessed  either  memory  or  judgment.  Scarcely  do 
they  present  the  features  of  animal  instinct ;  and  their  external  conformation 
indicates  clearly  enough,  that  they  are  not  organized  for  thought.  There 
exists  therefore,  a  form  of  mental  alienation  which  is  very  distinct,  in  which 
the  disorder  of  the  ideas,  affections  and  determinations,  is  characterized  by 
feebleness,  and  by  the  abolition,  more  or  less  marked,  of  all  the  sensitive, 
intellectual  and  voluntary  faculties.  This  is  dementia.  If,  as  I  hope,  I  have 
clearly  fixed  the  signification  of  this  word,  it  will  no  longer  be  confounded 
Avith  mania,  monomania  and  imbecility,  as  is  daily  done  ;  while  the  word  insen- 
sate, beinii  reserved  for  individuals  who  are  in  a  state  of  dementia,  will  no 
lono-er  designate  maniacs,  imbeciles  or  monomaniacs. 

After  having  unfolded  the  signs  of  dementia,  and  the  characters  which 
cause  it  to  be  distinguished  from  other  forms  of  mental  alienation,  I  will 
hastily  point  out  the  causes  which  produce  it ;  the  diseases  that  complicate  it ; 
those  which  terminate  it ;  and  the  principal  changes  which  the  post-mortem 
examinations  of  those  who  die  in  this  condition  reveal.  I  will  close,  by  stat- 
ing my  opinion  respecting  the  paralysis,  which  so  often  complicates  this  mala- 
dy. The  tables  upon  which  the  following  considerations  repose,  embrace  two 
hundred  and  thirty-five  persons,  who  are  affected  with  dementia.  They  are 
placed  in  two  columns.  One  contains  a  report  of  those  women  in  a  state  of 
dementia,  whose  cases  were  taken  at  the  Salpetriere,  during  the  years  1811 
and  1812.  The  other  is  made  up  from  the  insane  of  both  sexes  who  are  in 
a  similar  state,  belonging  to  the  wealthy,  and  higher  classes  of  society,  who 
were,  during  several  years,  admitted  into  my  establishment. 


INFLUENCE  OF  AGE.— TABLE  OF  AGES. 

Number  of  Individuals. 


Aces.  1st  Column.  2d  Column. 


lo 


2      .  .  .         1 

20  .  .  4  .  . 

30  .  .  14  .  . 

oo       •  •  •         y       •  •  • 

40  .  .  13  .  . 


Ages. 
45 
50 
55 
60 
65 
70 
75 
87 


DEMENTIA. 

1st  Column. 

2d  Column. 

16      . 

.       12\ 

20 

15/ 

16       . 

41 

16 
10       . 

}>     138 

11 

1\ 

13       . 

l\ 

1 

0/ 

423 


154 


81 


235 


In  casting  a  glance  over  the  above  table,  we  see  that  dementia  is  most  fre- 
quent from  forty  to  eighty  years  of  age  ;  for  we  have  but  ninety-seven  persons, 
that  is  to  say,  a  little  more  than  one  third,  from  birth  to  the  age  of  forty  years ; 
while  there  remains  one  hundred  and  thirty-eight,  or  near  two  thirds,  from  the 
age  of  forty  years  and  above.  The  age  during  which  dementia  is  numerically 
most  frequent,  is  from  forty  to  fifty  years ;  but,  in  comparison  with  the  popu- 
lation, the  frequency  of  this  malady,  is  in  a  direct  relation  with  the  progress  of 
age.  The  comparison  of  numbers  in  the  two  columns,  presents  to  our  notice, 
two  very  marked  differences.  First ;  the  number  of  persons  in  a  state  of  de- 
mentia, above  the  age  of  forty  years  in  the  second  column,  is  much  less  than 
that  in  the  first,  because  the  report  was  made  up  from  an  establishment  into 
which  cases  of  senile  insanity  are  never  admitted ;  whilst  at  the  Salpetriere, 
all  insane  persons  who  present  themselves,  are  indiscriminately  received. 
Second  ;  the  number  of  cases  of  dementia  under  the  age  of  forty  years,  is 
much  greater  in  column  second,  relatively,  than  in  column  first,  because  those 
persons  in  a  state  of  dementia,  who  constitute  column  second,  belono-  to  the 
higher  classes  of  society,  in  which  the  abuse  of  pleasures,  inordinate  passions, 
and  errors  of  regimen,  destroy  man,  wear  out  the  brain  from  early  youth,  dis- 
pose him  to  dementia,  and  urge  him  into  a  premature  old  age. 


EXCITING  CAUSES  OF  DEMENTIA.— TABLE  OF  CAUSES. 


Physical  Causes. 


Menstrual  disorders 

.       15 

Critical  period 

35 

Consequences  of  confinement 

8 

Falls  upon  the  head 

3 

Progress  of-  age_ 

.      49 

Ataxic  fever 

3 

Suppression  of  hemorrhoids 

2 

Mania 

18 

Monomania 

.       15 

Paralysis 

5 

Apoplexy 

2 

Syphilis,  and  abuse  of  mercury 

3 

Errors  of  regimen 

6 

Abuse  of  wine 

6 

Masturbation 

a                                      • 

11 

Moral  C 

'auses. 

Disappointed  affection 


^'^^  DEMENTIA 


Friohts           ,              ,  ^ 

Political  shocks    .....  c 

Disappointed  ambition            .              .              .        "  3 

Want        .              ,                                  '              '  '                 _ 

Domestic  trials           .             ,  jo 


Unknown  causes  .  .  .  _  .14 


Total  .  .  .  .  ,  235 

Like  all  forms  of  insanity,  dementia  depends  upon  a  great  variety  of  causes 
feome  are  physical ;  others  moral.     These  two  orders  of  causes  are  sometimes 
complicated.     A  severe  trial  occurs,  a  few  days  after  confinement;  the  lochia 
are  suppressed,  and  dementia  declares  itself.     A  fright  causes  the  menses  to 
disappear,  suppresses  a  cutaneous  disease,  and  gives  rise  to  a  retrocession  of 
gout;   and  dementia  appears.     Moral   causes  give  rise  to  dementia   more  fre- 
quently among  women  than  men ;   and  more  readily  among  person's  already 
affected  with  mental  alienation,  than  those  who  enjoy  the  plenitude  of  their 
understanding.     They  are  indeed  so  few,  that  I  take  an  account  of  them,  only 
for  the  purpose  of  showing  how  small  is  their  proportion  relatively  to  the'other 
varieties  of  insanity.     They  act  with  more  energy  in  the  higher  c'l asses  of  so- 
ciety than  the  lower.     The  disorders   and  cessation  of  the  menses,  cerebral 
levers,  chronic  inflammations  of  the  brain  and  its  meninges,  together  with  con- 
gestions, are  the  most  frequent  causes  of  dementia,  especially  in  advanced  life 
Ihe   abuse  of  mercury,  errors  of  regimen,  onanism,  epilepsy,   syphilis   and 
blows  upon  the   head,  succeed  them.     I  have  known  dementia  occasioned  by 
dwelling  in  a  house  recently  built,  in  the  case  of  a  rheumatic  person  ;  by  lotions 
ol  cold  water  upon  the  head,  in  the  case  of  a  man  who  perspired  copiously 
and  habitually  from  this  part ;  by  the  suppression  of  an  abscess,  followino-  va- 
riola; the  checking  of  a  coryza;  by  the  retrocession  of  gout,  and  the   reper- 
cussion of  herpes.     Epilepsy  often  causes  dementia.     Thus  in  the  hospital  of 
the  fealpetriere,   among  two  hundred  and  eighty-nine  epileptics,  more  than 
thirty  are  in  a  habitual  state  of  dementia. 

Lypemania,    and   particularly  monomania   and   mania,   whether    acute  or 
chronic,  very  often  degenerate  into  dementia.     Of  two  hundred  and  thirty-five 
individuals  in  a  state  of  dementia,  I  find  that  there  are  thirty-three  who  were 
maniacs  or  monomaniacs.     Dementia  is  often  produced  by  a  too  active  and 
debilitating  treatment,  and   by  profuse  bleedings  often  at  the  commencement 
ot  mama  and  monomania.     It  then  sometimes  terminates  by  the  revival  of  the 
vital  forces,  which  provoke  an  attack  of  mania.     At  the  termination  of  a  very 
acute  mama  and  ataxic  cerebral  fevers,  (phlegmasia^  of  the  meninges),  conva- 
lescents remain  in  a  delirium,  tranquil,  taciturn  and  sad.     Their  ideas  are  in- 
coherent, and  without  strength  or  energy.     This  state  constitutes  the  transi- 
tion from  mama,  or  a  cerebral  phlegmasia,  to  convalescence  ;  and  must  not 
be  confounded  with  dementia,  properly  so  called.     In  a  malady  which  is  often 
the   termination  of  a  great  many  others,  which  is,  so  to  speak,  the   constitu- 
tional condition  of  old  age,  it   is   not  easy  to  determine   the   temperament  of 
those  who  are  affected  by  it.     However,  we  are   confident  that  the   lymphatic 
temperament,  the   hemorrhoidal   and    apoplectic    constitution,    predispose  to 
dementia.     Those  persons  who  have  fallen   into  a   constitutional   feebleness 
either  in  consequence  of  excessive  study,  or  from  errors  of  regimen,  or  from' 
passions  too  long  excited ;  those  who  possess  a  bashful,  irresolute  and  timid 
disposition,  and  have  long  acted  under  constraint ;  and  those  whose  intellec- 
tual  faculties  have  never  reached  that  degree  of  energy  and  activity  which 
could  alone  place  them  in  perfect  harmony  with  those  who  would  otherwise 
have  been  equals ;  are  in  a  situation  favorable  for  the  development  of  dementia. 


D  E  M  E  N  T  r  A 


425 


VARIETIES  AND  COMPLICATIONS  OF  DEMENTIA. 


Tabic  of  Varieties. 


Number  of  Individuals. 


Simple  Varieties. 

1st  Column 

Dementia  acute 
"          chronic 
"         senile     . 
"         intermittent 

10 

43 

.       35 

7 

Complicated  varieties. 

Dementia  monomaniacal    . 
"         maniacal 
"         convulsive 
"         epileptic, 

.       34 

21 

4 

30  GUI 

2d  Column. 

11 

32 

2 
o 


.       20 

8 
6 

30  out  of  289  cases  of  epilepsy. 

A  glance  merely  at  this  table,  shows  us  that  acute  dementia  is  rare,  and  that 
continued  dementia  is  more  frequent  than  the  intermittent  form.  When  it  is  in- 
termittent, the  attack  returns  in  spring  and  autumn  ;  but  after  a  certain  number 
of  attacks,  it  becomes  continued.  When  it  alternates  with  mania,  the  latter 
bursts  forth  at  certain  epochs  ;  at  the  equinoxes  and  solstices.  The  return  of 
the  menses  announces  the  periods  of  mania,  and  should  put  us  on  our  guard 
against  its  effects. 

Paralysis  very  often  complicates  dementia.  Of  two  hundred  and  thirty-five 
cases  of  dementia,  more  than  one  half  present  certain  symptoms  of  paralysis. 
A  scorbutic  complication,  is  endemic  in  all  hospitals  where  the  insane  are 
received,  but  I  have  made  no  account  of  it  in  my  reports,  because  this  compli- 
cation extends  to  all  the  varieties  of  insanity.  This,  at  least,  is  what  I  have 
observed,  in  visiting  both  French  and  foreign  hospitals.  The  complication  of 
paralysis  and  scurvy,  so  frequent  in  dementia,  is  more  rare  in  mania.  It  is 
as  much  the  effect  of  the  malady  as  of  hygienic  circumstances,  which,  in  al- 
most all  hospitals,  seem  to  conspire  to  aggravate  the  lot  of  the  unfortunate 
insane. 


MALADIES  TO  WHICH  THOSE  WHO  ARE  IN  A  STATE  OF  DE- 
MENTIA SUCCUMB,  AND  THE  RESULT  OF  CADAVERIC  EX- 
AMINATIONS. 

The  mortality  is  far  greater  in  dementia  than  in  melancholy,  and  espe- 
cially mania  ;  since  nearly  half  of  those  in  a  state  of  dementia,  die.  The 
maladies  which  terminate  the  existence  of  those  in  dementia,  are  generally 
organic,  but  rarely  inflammatory,  unless  the  inflammations  are  of  a  passive 
character. 


Table  of  the  Principal  Organic  Lesions. 


Cadaveric  lesions. 

Crania  with  thin  diploe 

"       solidified 

"       injected    . 
Crania  with  thick  diploe 

"       solidified 

"       injected 
54 


No.  of  persons. 

7 

5 

3 

12 

.       10 

29 


426  DEMENTIA. 

Crania,  irregular  with  respect  to  the  different  diameters,  and 

the  capacity  of  the  two  halves  of  the  osseous  case  29 

Meninges  thickened         .  .  .  .  .11 

"  injected     .....  19 

Basilar  arteries  ossified     .  .  .  .  .5 

Cerebrum  dense        .....  15 

"          softened           .             .             .             .  .29 

Cerebellum  dense      .....  12 

"             softened         .             .             .             .  .17 

Substance  gray  thickened      ....  5 

"              "     discolored             .              .              .  .15 

"           white  injected        ....  19 

Adhesion  of  the  membrane  that  invests  the  ventricles  .       54 

Organic  lesions  of  the  heart  ...  5 

lungs        .  .  .  .13 

"  "        liver  ...  2 

Biliary  concretions  .  .  .  .  .8 

Chronic  and  organic  lesions  of  the  alimentary  canal  24 

Organic  lesions  of  the  vagina  and  uterus  .  .3 

At  the  autopsy,  the  cranium  presents  irregular  dimensions,  but  they  are  not 
constant.     Very  frequently,  the  median  line   is  diverted  to  one  side  or   the 
other,  so  that  the  fossae  of  the  base  are  not  equal,  and  the  two  halves  of  the 
cranium  have  not  the  same  capacity.     The  cranium  is  sometimes  depressed 
laterally,  towards  the  fronto-parietal  sutures.     It  is  thick ;  now  hardened  like 
ivory,  and  now  spungy ;  and  injected,   particularly  when  thick   and  spungy. 
It  is  thin,  and  even  then  injected.     Its  thickness  is  variable  in  different  re- 
gions, and  results  from  the  thickening  of  the  meninges,  and  not   from  the 
swelling  of  the  convolutions.     The  cranium  of  an  old  person  is  thickest  and 
most  compact.     The  capacity  of  the  frontal   sinuses  is  increased,  in  conse- 
quence of  the  greater  separation  of  the  two  frontal  tables.     We  find  also,  on 
the  external  aspect  of  the  cranium,  depressions  proceeding  from  before  back- 
ward, which  render  salient,  the  longitudinal  suture  of  the  parietal  bones.     In 
this  case,  the  depression  of  the  external  table   does  not  bring  the  internal  one 
upon  the  brain.     This  latter  is,  so  to  speak,  glued  to  the  external  table,  by  the 
absorption  of  the  diploic  substance,  which  ordinarily  separates  them.     The 
dura-mater  is  often   adherent,  either  to  the   arch  or  base  of  the   cranium, 
and  sometimes  thickened.     Its  internal  face  is  covered  with  an  effusion,  which 
seems  formed  by  the  blood,  exhaled,  or  poured  out  into  the  cavity  of  this  mem- 
brane.    The  arachnoid  is  more  dense,  and  less  transparent  than  natural.     It 
is  infiltrated,  and  contains  in  its  cavity,  serous,  and  even  sanguine  effusions. 
At  the  base  of  the  brain,  we  also  meet  with  serous  effusions,  which  are  almost 
always  found  in   the  ventricles.     Are  not  these  the  effects  of  the  last  malady, 
or  of  death  ?     The  pia-mater,  thickened   and  infiltrated,  has  lost  its  transpa- 
rency, and  adheres  to  the  cortical  substance.     The  arteries  which  ramify  upon 
the  base  of  the  brain,  are  cartilaginous,  and  even  osseous,  particularly  in  senile 
dementia.     The  caliber  of  the  veins  is  augmented,  and  they  are  gorged  with 
blood.     The  convolutions  of  the  brain  are  atrophied,  separated  from   one  ano- 
ther, shallow  or  flattened,  compressed   and  small,  especially  in  the  frontal  re- 
gion.    It  is  not  uncommon,  that  one  or  two  convolutions  of  the  convexity  of 
the  brain  are  depressed,  atrophied,  and  almost  destroyed,  and  the  empty  space 
filled  with  serum.     The  cortical  substance  is  very  red,  or  highly  colored,  and 
sometimes  yellowish ;  very  dense  on  its  cranial  face,  and  softened  throughout 
the  remainder  of  its  thickness.     It  frequently  adheres  to  the  pia-mater,  and  is 


DEMENTIA.  427 

torn  when  we  attempt  to  separate  this  membrane  from  it.     Tliis  is  rarely  want- 
ing, when  paralysis  is  complicated  with  dementia. 

The  white  substance  loses  its  natural  hue.  It  is  of  a  duller  color,  more 
dense  and  consistent ;  and  we  discover  within  it,  traces  of  former  affections  ; 
now  in  one  hemisphere,  and  now  in  both.  There  are  cicatrices,  around  which 
the  white  substance  is  indurated,  and  cysts  also,  containing  yellowish  fibrous 
shreds,  the  remains  of  a  sanguine  effusion,  or  surrounded  and  filled  with  se- 
rum. I  have  twice  seen  a  brain  which  presented  the  aspect,  and  nearly  the 
color  and  density  of  Swiss  cheese,  in  the  case  of  women  who  died  paralytic 
and  demented.  We  also  find  certain  portions  of  the  brain  softened,  and  others 
hardened ;  and  finally,  traces  of  former  hemorrhages.  The  adhesions  of  the 
membrane  that  lines  the  lateral  ventricles,  are  constant.  They  are  rare  in  the 
other  ventricles,  and  obliterate  the  appendix,  known  by  the  name  of  the  digital 
cavity.  This  appendix  is  almost  always  separated  from  the  remainder  of  the 
ventricle,  by  adhesions,  which  permit,  now  one  issue,  and  now  two,  to  commu- 
nicate with  the  ventricle  at  the  posterior  extremity.  This  membrane  often 
adheres  to  the  portion  which  covers  the  striated  body.  These  adhesions 
which  are  more  or  less  extended,  cause  the  ventricles  to  lose  their  true  cha- 
racter. They  are  observed,  finally,  in  a  great  number  of  subjects  who  are  not 
insane  ;  and  establish  the  identity  of  this  with  the  serous  membrane  of  the  other 
splanchnic  cavities.  Do  not  these  explain  the  cause  of  chronic  cephalalgia, 
just  as  adhesions  of  the  pleurae,  explain  those  thoracic  pains,  which  q^re  regard- 
ed as  rheumatic  ?  The  choroid  plexuses,  now  injected,  and  now  discolored, 
usually  present  serous  cysts ;  in  number  and  volume  however,  very  variable. 
In  one  instance,  these  cysts  contain  a  serous  substance  ;  in  another,  an  osse- 
ous. I  have  twice  found  in  each  ventricle,  a  hydatid  as  large  as  a  small  hen's 
egg.  The  pineal  gland  among  the  insensate,  as  well  as  other  insane  persons, 
and  those  afflicted  with  some  other  malady,  usually  presents  some  points  of 
ossification,  (Scarpa.)  I  once  found  it  as  small  as  the  head  of  a  pin,  and  at 
another,  it  seemed  to  be  entirely  wanting. 

The  post-mortem  examinations  of  those  who  have  died  in  a  state  of  demen- 
tia, often  disclose  a  tuberculous  state  of  the  lungs.  Hypertrophy  of  the  ven- 
tricles of  the  heart,  and  ossifications  of  the  aorta,  are  not  rare.  The  attention 
of  certain  German  authors,  who  have  very  recently  written  on  mental  diseases, 
has  been  fixed  upon  lesions  of  the  heart.  These  alterations  ought  to  be  ob- 
served with  care,  and  studied  in  connection  with  insanity  in  general  ;  and 
more  particularly  with  dementia.  The  numerous  changes  in  the  alimentary 
canal,  which  have  been  observed  in  dementia,  are  almost  invariably  either 
symptomatic  or  secondary,  and  are  also  essentially  chronic.  These  general 
results  of  cadaveric  examinations,  made  upon  the  persons  of  those  who  have 
died  in  a  state  of  dementia,  offer  a  greater  number  of  cerebral  lesions,  than 
are  found  in  the  other  varieties  of  insanity.  We  learn  that  in  dementia,  which 
is  the  termination  of  all  intellectual  and  moral  disorders,  which  results  from  the 
progress  of  age,  and  which  is  so  often  complicated  with  paralysis  and  convul- 
sions ;  the  cranium,  the  meninges  and  the  brain,  may  have  undergone  a  great 
number  of  changes,  which  account  for  the  weakening  of  the  understanding 
and  sensibility. 

To  these  general  results,  I  will  add  certain  facts,  which  my  practice  has 
furnished.  Although  they  may  shed  no  additional  light  upon  the  immediate 
seat  of  dementia  and  its  treatment,  they  will  be  interesting  at  least,  from  the 
nature  of  the  organic  lesions. 

R.  had  enjoyed  during  her  youth,  excellent  health.  When  about  thirty- 
seven  years  of  age,  her  circumstances  become  reduced,  and  she  suffers  from 
mental  depression.  She  marries  at  thirty-eight,  but  has  no  children.  She 
meets  with  many  mortifications  and  domestic  trials ;  her  husband  being  an  in- 
temperate man.      She  ceases   to  menstruate  at  the  age  of  forty-two  years. 


428  DEMENTIA. 

Since  that  period,  her  health  has  changed.  At  fifty-two  she  suffers  from  a 
torpor  or  numbness  of  the  senses  ;  and  the  death  of  her  husband  leaves  her  in 
the  most  profound  wretchedness.  She  suffers  from  lancinating  pains  in  the 
left  arm,  her  ideas  are  confused,  her  memory  enfeebled,  and  her  conversation 
is  without  coherence.  She  goes  and  comes  without  an  object,  and  no  longer 
knows  what  she  does.  At  length  she  sinks  into  profound  dementia.  On  the 
15th  of  April,  1812,  she  is  brought  from  the  Hotel  Dieu,  to  the  Salpetriere. 
At  the  time  of  her  admission,  she  is  very  much  emaciated  and  paraplegiac  ; 
moving  her  superior  extremities  with  much  difficulty.  She  repeats  certain 
words  and  phrases,  which  she  understands  ;  but  appears  to  have  no  notion, 
either  of  her  condition,  or  of  the  place  to  which  she  has  been  brought.  Both 
nicrht  and  day,  she  utters  piercing  cries,  without  being  able  to  mention,  or 
even  to  indicate,  what  can  be  the  cause  of  them.  She  dies  twelve  days  after 
her  admission,  April  27th,  1812,  aged  fifty-six  years. 

Post-morte77i  examination. — Both  the  meninges  and  the  bram,  appear 
healthy.  On  raising  the  latter,  I  found  a  spheroidal  tumor  of  the  size  of  a 
walnut,  enveloped  in  a  proper  tunic,  obstructing  almost  entirelj^,  the  occipital 
foramen,  and  fixed,  by  a  peduncle  of  some  lines  in  length,  to  the  membrane 
which  lines  the  vertebral  canal.  This  tumor  was  dense  and  fibrous  ;  com- 
pressing inferiorly,  the  cerebellum,  particularly  the  left  lobe.  The  rachidian 
prolongation  was  atrophied  and  flattened  ;  being  only  four  lines  in  breadth, 
and  t\v°o  in  thickness.  It  surrounded  the  peduncle  of  the  tumor,  to  penetrate 
the  vertebral  canal ;  and  resumed  its  normal  figure  some  lines  below  the  oc- 
cipital opening,  though  more  thin  than  in  its  ordinary  condition.  The  left 
lobe  of  the  cerebellum,  more  compressed  than  the  right,  lodged  the  greater 
portion  of  the  tumor.  The  brain  appeared  to  me  healthy.  The  pleurae  pre- 
sented traces  of  recent  inflammation,  and  old  adhesions.* 

Mad'e  F.,  fifty  years  of  age,  is  brought  to  the  Salpetriere,  without  any  pre- 
vious intimation.  Her  countenance  is  pale,  her  look  that  of  astonishment, 
her  eyes  are  but  half  opened,  and  her  thoughts  incoherent.  She  manifests  the 
most  perfect  indifference  respecting  her  new  situation.  She  makes  no  reply 
to  the  questions  that  are  put  to  her,  and  expresses,  from  time  to  tune,  her 
fear  of  falling  into  the  water.  She  coughs  and  expectorates  abundantly. 
This  state  persists  for  eleven  months;  when  a  diarrhoea  commences,  she 
becomes  enfeebled,  and  no  longer  leaves  her  bed.     An  enormous  eschar  forms 

upon  the  sacrum,  and  she  dies.  ■-,■,■,      r         , 

On  opening  the  body,  I  found  the  cranium  thm,  particularly  the  trontal 
protuberances',  which  were  no  more  than  a  line  in  thickness.  The  lungs  were 
tuberculous.  The  mucous  membrane  of  the  transverse  colon  was  ulcerated 
at  some  points.  The  left  ovarium  much  enlarged,  enclosed  a  cyst,  with  its 
proper  membrane,  which  contained  a  soft,  tenacious,  yellowish  substance,  m 
the  midst  of  which  was  found  entangled  some  flaxen  colored  hair.t  This 
hair  seemed  to  be  implanted  in  a  body,  of  the  color  and  consistence  of  suet ; 
in  the  centre  of  which,  I  found  an  osseous  point,  of  one  or  two  lines  in  extent, 
and  irregular  in   form;  together   with   several  other  bony   fragments,  which 

were  much  smaller.  ^        ,  ■         c 

A  woman  forty-eight  years  of  age,  and  tall,  some  time  after  the  cessation  ot 
the  menses,  perceived  a  small  tumor  above  the  left  ear.  It  provoked  an  in- 
convenient 'pruritus,  and  the  patient  often  lacerated  it  by  scratching.  The 
tumor  rapidly  increased  in  size,  and  projected  considerably  ;  occupying  the 
temporal  region.     In  proportion  to  the  growth  of  the  tumor,  did  her  faculties 

*  This  case  was  published  by  M.  Scipio  Pinel,  to  whom  I  communicated   it,  for  his 

inaugural  thesis.  ^  ,        ,    ,        -i    j  u     at    /-■         -i 

t  Many  cases  of  pilous  ovarian  cysts  have  been  figured  and  described  by  M.  Cruveil- 
hier  in  his  splendid  work :  Pathological  Jinatomy  of  the  Human  Body,  folio,  fig.  colored. 


DEMENTIA.  429 

decay ;  her  memory  becoming  enfeebled,  and  her  thoughts  losing  their  ener- 
gy. The  patient  becomes  less  impressible,  and  loses  sleep.  At  a  later  period, 
she  experienced  difficulty  in  uttering  articulate  sounds.  She  replied  cor- 
rectly to  ordinary  questions  ;  but  they  did  not  appear  either  to  arouse  her,  or 
to  give  rise  in  her  mind  to  new  ideas.  She  said  little,  moved  slowly,  com- 
plained of  no  pain,  and  suffered  only  in  moving  her  head.  At  the  expiration 
of  three  months  she  was  brought  to  the  Salpetriere.  She  was  slightly  ema- 
ciated, and  her  complexion  pale.  The  tumor  situated  above  the  ear  of  the 
left  side,  extended  over  a  portion  of  the  temporal  region,  and  behind  the  ear. 
It  was  two  inches  in  length,  from  before  backward,  an  inch  and  a  half  in 
breadth,  and  projected  from  the  head  eight  lines.  Pulsations,  though  percep- 
tible, were  very  obscure.  It  was  adherent  throughout  its  whole  extent ;  had  no 
apex,  but  was  covered  with  protuberances,  and  the  skin  did  not  appear  to  be 
changed.  This  tumor  continued  to  increase  in  size,  during  her  stay  in  the 
hospital.  The  understanding  became  more  enfeebled  ;  the  patient  compre- 
hended nothing  ;  spoke  no  more  ;  and  appeared  to  be  deaf  Notwithstanding, 
she  walked  three  days  before  her  death.  She  passed  two  days  in  bed,  in  a 
comatose  state,  from  which  she  could  be  aroused,  by  violently  pinching  the 
skin  upon  the  limbs. 

On  opening  the  body,  I  discovered  a  tumor  projecting  within  the  cranium, 
as  well  as  externally  ;  and  occupying  the  temporal  region.  It  presented  inter- 
nally, all  the  characteristics  of  an  erectile  tumor,  and  was  gorged  with  blood. 
It  had  its  proper  tunic,  and  after  having  destroyed  a  portion  of  the  temporal, 
occipital  and  parietal  bones,  together  with  a  little  of  the  left  wing  of  the 
sphenoid,  it  was  reflected  upon  the  dura-mater,  and  consequently  compressed 
the  brain  laterally.  The  opening,  formed  by  the  destruction  of  the  bones, 
was  nearly  circular,  and  two  and  a  half  inches  in  diameter.  The  dura-mater 
was  in  other  respects  healthy,  and  the  brain  very  dense,  particularly  the  left 
hemisphere,  whose  lateral  convolutions,  compressed  by  the  tumor,  were  flat- 
tened and  atrophied.  The  ventricles  contained  a  little  serum;  the  other  or- 
gans were  healthy.* 

M.  P.,  fifty  years  of  age,  born  in  London,  very  tall,  of  a  sanguine  tempera- 
ment and  strong  constitution,  had  lost,  to  some  extent,  the  use  of  his  hearing. 
He  had  command  of  a  battalion  in  the  service  of  France.  He  was  admitted 
'at  Charenton,  March  3d,  1880.  At  the  time  of  his  admission,  he  said  little, 
demanded  his  liberty,  complained  of  the  injustice  exercised  towards  him,  and 
appeared  absent-minded,  and  indifferent  to  the  new  objects  that  surrounded 
him.  Sometimes,  a  season  of  excitement  unexpectedly  occurred,  and  then 
the  patient  addressed  every  one  ;  stating  that  he  had  just  come  in  possession 
of  more  than  a  hundred  thousand  francs.  His  ideas  were  then  sufficiently 
connected,  as  well  as  his  conversation,  to  give  to  his  statement  the  appear- 
ance of  truth.  Captain  P.  was,  moreover,  kind  and  affectionate,  and  his  con- 
duct considerate  and  proper.  It  was  deemed  advisable,  to  permit  him  to 
enjoy  the  liberty  and  diversions  which  were  granted  to  the  most  rational  pa- 
tients. There  was  however,  something  disjointed  about  his  acts,  his  memory 
was  treacherous,  and  the  patient  often  repeated  the  same  things.  His  readi- 
ness in  permitting  himself  to  be  controlled,  was  remarkable.  Slight  signs  of 
paralysis  were  recognized,  in  consequence  of  his  hesitation  in  pronouncing 
certain  words.  He  was  accustomed  to  eat  much,  and  with  avidity  ;  and  suf- 
fered several  times  from  violent  congestions,  which  were  accompanied  by  se- 
vere convulsions,  in  one,  or  both  sides  of  the  body.  In  consequence  of  the 
congestions,  there  remained  a  feebleness,  now  in  the  right,  and  now  in  the  left 
side  ;  and  at  length,  the  patient  inclined  to  one  side.     Four  years  subsequent- 

*  This  case  should  have  been  reported  icith  that  which  I  related  in  a  previous  part  of  the 
work. 


430  DEMENTIA. 

ly  (1834),  the  understanding  becomes  enfeebled,  and  the  incoherence  of  ideas 
more  marked ;  the  patient  is  more  violent,  is  silly,  and  weeps  without  cause. 
His  pronunciation  is  such,  that  it  is  with  difficulty,  that  he  is  understood  ;  and 
his  gait  is  feeble  and  tottering.  His  toilet  has  become  foul,  and  neglected, 
and  it  is  no  longer  possible  to  admit  the  patient  to  the  common  table,  in  con- 
sequence of  his  slovenliness  and  gluttony.  He  suffers  from  time  to  time,  from 
seasons  of  excitement ;  during  which  he  utters  cries,  goes  and  comes  with- 
out motive  or  aim,  walks,  inclining  much  to  one  side,  complains  of  those 
with  whom  he  lives,  and  seems  no  longer  to  comprehend  what  he  is  doing. 

In  Nov.  1834,  he  refuses  several  times  to  eat,  or  merely  eats  a  little  broth, 
after  having  a  long  time  declined  it.  He  afterwards  experiences  very  singular 
illusions ;  every  thing  seeming  to  him  to  be  wet ;  both  the  bread  which  is 
offered  him,  the  clothing  which  he  wears,  and  the  bed  in  which  he  sleeps.  In 
conformity  with  this  illusion,  he  throws  away  his  bread,  is  constantly  putting 
off  his  garments,  nor  can  he  be  induced  to  remain  iu  bed.  His  feebleness 
augments,  and  his  physical  health  changes.  Retention  of  urine  supervenes, 
which  renders  it  necessary  to  have  recourse  to  the  catheter  for  several  days. 
The  patient  appears  no  longer  to  connect  his  ideas,  replies  to  no  questions  that 
are  addressed  to  him,  and  at  length,  on  the  9th  of  Dec,  a  fever,  attended  with 
agitation  and  incoherent  loquacity,  begins.  We  apply  leeches  behind  the 
ears,  call  into  requisition  sinapisms,  and  administer  purgative  enemata.  On 
the  following  day,  adynamic  symptoms  supervene,  attended  by  a  very  abundant 
haemoptysis,  and  he  dies  on  the  10th  Dec.  1834. 

Post-mortem  examination. — The  bones  of  the  cranium  are  thickened,  and 
the  dura-mater  adheres  to  the  cranium  for  a  considerable  extent.  The  cere- 
bral surface  of  the  arachnoid  membrane  is  thickened,  and  is  of  a  dull  white, 
particularly  on  the  convexity  of  the  hemispheres.  The  pia-mater,  slightly  in- 
filtrated, adheres  to  the  cortical  substance,  which  is  torn  when  this  membrane 
is  raised.  It  presents,  here  and  there,  circumscribed  rents,  whose  depth  is 
unequal,  which  are  red,  and  slightly  rose-colored.  The  convolutions  are 
small.  The  white  substance  is  slightly  rose-colored.  In  the  anterior  region 
of  the  striated  body,  a  depression  is  observed.  In  cutting  upon  this  point,  we 
discover  below,  traces  of  hemorrhage,  the  matter  of  which,  not  being  entirely 
absorbed,  presents  a  rusty  aspect.  The  ventricles  contain  a  small  quantity  of 
serum.  The  cerebellum,  and  the  annular  protuberance,  are  more  highly- 
colored  than  the  cerebrum.  The  medulla  spinalis  is  atrophied,  and  has  lost 
one  fourth  of  its  normal  volume,  although  otherwise  healthy.  Both  lungs  are 
hepatized,  and  fluid  blood  flows  from  them.  The  right  pleura  presents  certain 
false  membranes.  The  heart  is  small,  in  proportion  to  the  stature  of  the  sub- 
ject. The  urinary  bladder  is  small,  its  walls  thickened,  and  its  mucous  mem- 
brane reddened. 

M.  C,  thirty-seven  years  of  age,  of  medium  stature,  and  a  sanguine  tempe- 
rament; having  a  large  head,  a  well  formed  cranium,  and  well  developed 
muscular  system,  after  having  been  clerk  to  a  wine  merchant,  had  acquired 
by  his  excellent  conduct  and  activity,  a  handsome  fortune,  and  traded  in  wines. 
He  experienced  certain  losses,  (which  however,  it  was  easy  for  him  to  repair), 
as  well  as  difficulties  and  domestic  trials.  It  was  observed,  that  he  was  addict- 
ed to  the  use  of  strong  drink,  and  had  become  exceedingly  irascible. 

At  length,  during  the  spring  of  1832,  he  was  seized  with  maniacal  delirium, 
attended  with  fury.  After  several  bleedings,  which  did  not  compose  the  pa- 
tient, he  was  brought  to  Paris  in  a  state  of  general  delirium,  in  which  ideas 
relating  to  a  fortune  far  greater  than  his  own,  predominated,  and  a  slight  em- 
barrassment in  pronunciation  was  noticed.  Always  in  motion,  he  rent  his 
clothing,  walked  incessantly ;  striking,  on  meeting  the  slightest  obstacle,  and 
at  the  most  trifling  opposition ;  crying,  singing,  distributing  money,  and  de- 
siring to  make  a  fortune  for  every  body.     Insomnia  was  obstinate,  the  dejec- 


DEMENTIA.  431 

tions  easy,  and  the  appetite  sustained.  He  manifested  however,  a  complete 
indifference  respecting  his  new  situation,  his  interests  and  the  objects  of  his 
affection.  Cups  to  the  neck,  baths,  douches,  affusions  of  cold  water,  and  dras- 
tics, administered  successively  for  more  than  fifteen  months,  have  modified  in 
no  respect,  either  the  susceptibility  of  the  patient,  or  the  incoherence  and  vio- 
lence of  his  delirium,  his  fury  or  insomnia.  During  the  summer  of  1832, 
there  appeared  upon  the  scalp  an  active  irritation,  which  led  the  patient  to  re- 
move the  hair,  although  very  short,  and  to  scratch  the  part  to  such  a  degree,  as 
to  produce  sores  of  considerable  severity.  He  removed  also  the  integuments 
of  the  face,  so  that  the  inferior  part  of  it  formed  a  single  wound,  and  render- 
ed the  use  of  the  camisole  necessary,  to  produce  cicatrization.  When  brought 
to  Charenton,  October  2d,  1832,  the  patient  retains  his  fullness  of  habit,  and 
much  physical  strength  ;  but,  although  he  walks  with  an  elastic  step,  we  no- 
tice certain  indications  of  a  paralysis  of  the  abdominal  members.  The  embar- 
rassment of  the  tongue  is  clearly  marked. 

During  winter,  the  symptoms  of  dementia  augment ;  he  neither  speaks  nor 
makes  any  request.  Ordinarily,  when  interrogated,  he  makes  no  reply  ;  but  if 
urged,  and  he  replies,  he  contents  himself  with  saying  ;  Leave,  me  alone.  He  is 
neglectful  of  his  person.  Whatever  the  hour,  he  is  without  either  coat  or  cra- 
vat. In  the  spring  of  1834,  he  suffered  from  several  attacks  of  congestion, 
which  paralyzed,  but  for  a  few  hours  only,  one  of  his  arms.  He  had,  for  se- 
veral months,  a  spasmodic,  and  almost  habitual  movement  of  the  jaws  ;  which, 
rubbing  one  against  the  other,  produced  a  sound  like  that  of  grinding  the 
teeth.  The  congestions,  which  were  often  renewed,  presented  the  following 
symptoms  :  he  maintained  himself  "with  difficulty  in  a  standing  posture,  nor 
could  he  serve  himself  longer  with  one  of  his  arms,  nor  indeed  speak.  The 
features  of  the  countenance  were  also  changed.  Sometimes  convulsive  shocks 
occurred  in  the  side  opposite  the  paralysis.  Bleeding  caused  these  symptoms 
to  terminate  in  a  few  hours.  More  frequently  however,  he  remained  until  thfe 
following  morning,  in  a  comatose  state.  The  arm  was  then  benumbed.  In 
November,  1834,  after  an  attack  of  congestion,  the  right  arm  became  paralyz- 
ed, and  did  not  again  recover  its  power  of  motion.  The  patient  lost  his 
strength,  refused  to  eat,  and  sunk  into  extreme  mental  torpor. 

On-  the  17th  of  December,  vomiting  supervened,  attended  by  a  fever  and 
rigors ;  and  the  patient  kept  his  bed.  He  was  put  upon  an  appropriate  diet, 
but  soon  deglutition  became  difficult,  and  the  rigors  more  marked  :  thouo-h 
sensibility  persisted  on  both  sides  of  the  body.  On  the  22d,  there  were  slight 
contractions,  followed  by  convulsions  of  little  intensity  in  the  right  arm. 
During  the  day,  there  were  rigors  and  vomitings.  The  eyelids  fell,  and  the 
pupils  were  motionless.  We  apply  the  scarifying  cups  to  the  neck,  after  a 
general  bleeding.  On  the  23d,  same  state,  and  a  like  bleeding.  On  the  24th, 
a  comatose  state,  alternating  with  general  and  more  marked  convulsions  of 
the  abdominal  muscles.  The  pupils  are  very  much  dilated,  while  the  pulse  is 
very  much  concentrated,  small  and  frequent.  Death  takes  place  during  the 
afternoon. 

Examination. — The  cranium  is  thick  and  dense.  In  sawing  it  through,  the 
meninges  of  the  left  side  were  cut,  from  whence  flowed  from  five  to  six 
ounces  of  a  thick  and  bloody  liquid.  In  the  cavity  of  the  arachnoid,  a  cyst 
was  formed,  as  well  as  in  the  case  following.  The  internal  coat  of  the  arach- 
noid was  lined  by  a  membrane,  which  extended  from  within  half  an  inch  of 
the  falciform  fold  on  the  floor  of  the  orbit  and  the  temporal  fossa,  to  the  pe- 
trous portion  of  the  temporal  bone  and  ethmoidal  fossne.  The  interior  of 
this  membrane  contained  effused  blood,  and  was  of  a  reddish  hue.  There 
were  also  membraniform  clots,  which  were  adherent  to  it.  The  dura-mater 
of  the  right  side  had  a  brownish  aspect  like  that  of  the  left,  and  the  cavity  of 
the  arachnoid  of  the  same  side  contained  a  cyst,  filled  with  a  thick  and  sani- 


432  DEMENTIA. 

ous  fluid.  The  membrane  of  the  cyst  clothed  the  arachnoid  to  the  same  ex- 
tent with  that  of  the  opposite  side  ;  but  it  was  thicker,  and  more  unequal, 
than  the  false  membrane  of  the  left  side.  The  arachnoid  itself  appeared  nei- 
ther thicker,  nor  more  highly  colored,  than  in  its  ordinary  state.  The  pia- 
mater  was  healthy.  The  two  lobes  of  the  cerebrum  were  so  compressed,  that 
they  formed  a  point  at  their  frontal  extremity.  The  cortical  substance  was 
rose-colored  at  certain  points,  and  the  white  substance  presented  no  alteration. 
The  tubercula  quadrigemina  were  injected.  The  membrane  of  the  lateral 
ventricles  was  adherent  to  itself  at  several  points. 

M.,  forty  years  of  age,  admitted  at  the  Salpetriere  Aug.  9th,  1817,  was  a 
seamstress,  and  lived  in  the  country.  Her  husband  died  in  a  state  of  senile 
dementia.  When  a  girl,  she  was  exceedingly  passionate.  She  was  tall,  with 
black  eyes,  chestnut-colored  hair,  a  fair  skin,  and  moderately  full  habit  of 
body.  When  seven  years  of  age,  she  had  variola  ;  at  eleven,  psora  ;  at  thir- 
teen, menstruated  spontaneously,  since  which  period  the  menses  have  been 
regular  and  abundant.  When  eighteen,  she  had  a  fever,  in  consequence  of 
the  kick  of  a  horse.  At  twenty-four,  she  was  married.  She  had  no  children, 
but  became  very  industrious  after  her  marriage. 

In  April,  1816,  when  thirty-nine  years  of  age,  after  many  domestic  trials, 
she  was  reduced  to  poverty,  and  made  an  inordinate  use  of  wine  and  brandy. 
Being  unable  to  pay  her  rent,  she  was  severely  tried  by  the  reproaches  and  threats 
of  her  landlord.  The  menses,  which  were  flowing  at  this  moment,  became 
very  abundant,  and  menorrhagia  continued  for  three  weeks.  On  its  ceasing, 
she  had  a  slight  attack  of  apoplexy.  Leeches  were  applied,  she  was  vomited, 
and  twice  purged.  The  tongue  however,  remained  embarrassed,  the  memory 
enfeebled,  the  ideas  confused,  and  locomotion  difficult. 

Towards  the  close  of  the  month  of  May,  she  was  able  to  resume  her  house- 
hold duties.     She   remained  however,  much   excited,  was  always  wishing   to 
leave  her  house,  pretending  that  she  had  business  of  importance.     She  became 
rapidly  emaciated ;  and  obstinately  refused  to  cover  her  head,  when  subjected 
to  the  solar  rays.     On  the  2d  of  June,  she  abandoned   her  ordinary  occupa- 
tions, spoke  incessantly  of  her  husband,  and  manifested  decided  mental  alien- 
ation.    On  the  4th  of  June,  she  entered  the  hospital.     Her   step  was   tremu- 
lous, memory  feeble,  and  she  indulged  in  loud  cries.     On  alternate  days,  there 
was  a  very  marked  remission.     A  vesicatory  was  applied   to  the  neck  a  few 
days  subsequently,  peruvian  bark  was  administered,  and  later  still,  a  purgative. 
Her  condition   appeared   improved,  her   ideas  were  more  connected,  and  she 
walked  more  readily.     There  still  however,  remained  some  difficulty  in  utter- 
ing articulate  sounds,  and  she  left  the  hospital   on   the  19th  of  July.     Having 
returned  home,  she  renews  her  former  habits,  and  the  paralysis  continues  to 
progress  until  the  following  year.     On  the  9th  of  Aug.  1817,  the  paralysis  was 
general,  and  the  patient  could  not  walk.     It  was  necessary  to  carry  her  to  the 
infirmary,  and   she  was   with   difficulty  able  to   articulate  sounds.     She  cried 
much,  and  complained  of  suffering,  particularly  iri  the  back.     Loss  of  memory 
is  now  noticed,  attended  with  dementia,  and  involuntary  dejections.     Her  appe- 
tite is  voracious.     During   the  month  of  December,  her   feebleness   becomes 
extreme,  and  an  eschar  forms  on  the  sacrum.     In  January,  aphonia  and  ady- 
namia occur.     On  the  24th  of  the  same  month,  she  refused  food,  was  coma- 
tose, and  died  at  3  o'clock,  P.  M.,  January  27th,  1818. 

Autopsy  on  the  following  day,  at  9  o'clock,  A.  M.  Exterior. — Moderate 
fullness  of  habit,  together  with  a  superficial  eschar  on  the  sacrum.  Head. — 
Cranial  bone  thick,  and  the  dura-mater  of  a  brownish  color,  throughout  that 
portion  corresponding  with  the  left  hemisphere.  In  the  cavity  of  the  arach- 
noid, was  found  a  considerable  eff"usion  of  a  brownish  sanious  and  flocculent 
liquid,  exhaling  a  fetid  odor.  This  fluid  had  flattened  and  compressed  the 
left  hemisphere  of  the  cerebrum,  to  such  a  degree  as  to  occasion  the  belief, 


DEMENTIA.  433 

that  the  subjacent  convolutions  were  effaced.  The  internal  face  of  the  arach- 
noid was  lined  by  a  brownish  membrane,  which  formed  a  cyst,  in  which  was 
contained  the  effused  fluid. ,  The  membrane  which  formed  the  cyst,  was  floc- 
culent  on  its  internal  surface,  and  extended  from  the  left  supra  orbitar  arch 
and  the  falciform  fold,  to  the  lateral  sinus  of  the  same  side,  and  the  whole  of 
the  left  parietal  bone ;  extending  to  the  occipital  and  the  tentorium  cerebelli. 
The  convolutions  were  very  much  flattened.  The  right  hemisphere  of  the 
cerebrum  had  suffered  no  change,  though  there  was  an  effusion  of  serum  in 
the  arachnoid  membrane  of  this  side.  The  vertebral  canal  also  contained 
serum,  and  at  some  points,  which  were  evidently  thickened,  the  vertebral 
arachnoid  adhered  to  the  pia-mater.  These  two  membranes  were  injected 
•throughout  their  inferior  half  The  medulla  spinalis  appeared  to  be  slightly 
softened.  The  uterus,  voluminous  and  soft,  presented  near  its  neck  certain 
small  vesicles,  developed  in  its  tissue,  and  containing  a  thin  colorless  fluid. 

What  conclusion  shall  we  draw  from  these,  and  many  similar  facts?  That 
the  changes  observed  in  the  brain  and  its  membranes,  are  found  in  subjects 
who  have  given  no  indication  of  delirium;  that  organic  lesions  of  the  encepha- 
lon  appertain  to  paralysis  and  convulsions,  rather  than  dementia ;  and  that 
the  character  and  intensity  of  the  delirium,  are  not  in  proportion  to  the  extent 
of  the  organic  lesion.  What  shall  we  conclude  ?  That  the  examinations  of 
the  bodies  of  the  dead,  which  have  so  often  furnished  important  information 
respecting  the  seat  of  diseases,  present  no  result  which  is  satisfactory,  respect- 
ing the  source  and  immediate  cause  of  the  delirium  of  those  who  are  in  a  state 
of  dementia.  Every  thing  indicates  in  this  disease,  a  compression,  sinking  and 
collapse  of  the  encephalon.  Is  this  state  caused  by  the  engorgement  of  the 
vascular  system,  or  by  the  lessening  of  the  cerebral  circulation?  Do  not  the 
arteries,  having  lost  their  elasticity,  or  being  ossified,  propel  with  sufficient 
energy,  the  blood  which  flows  languidly  in  veins  already  too  greatly  dilated? 
Does  not  the  inflammation  of  the  meninges,  by  thickening  the  membranes,  or 
by  provoking  a  too  abundant  serous  exhalation,  induce  the  compression  ? 
Does  not  the  contracting  of  the  cranial  cavity,  by  the  separation  of  the  inter- 
nal table,  particularly  of  the  coronal  portion,  contribute  to  compress  the  brain? 
The  post-mortem  examination  of  bodies  teaches  us  little  in  this  respect ;  all 
the  organic  alterations  of  the  brain  or  its  dependencies,  appertaining  less  to  the 
delirium  than  its  complications. 

I  have  in  my  possession  a  great  number  of  specimens  in  pathological  anato- 
my, which,  compared  with  the  history  of  the  malady,  prove  that  dementia 
, existed  previous  to  any  organic  lesion  of  the  encephalon ;  and  that  when  the 
organic  lesion  took  place,  it  was  revealed,  either  by  convulsions  or  paralysis. 
What  we  have  unfolded  relative  to  the  symptoms,  causes  and  complications  of 
dementia,  justifies  the  division  of  this  condition  into  three  varieties ;  such  as 
we  have  previously  established,  as  well  by  their  terminations  as  treatment. 

Fiist  variety. — Acute  Dementia. — This  variety  results  from  temporary 
errors  of  regimen,  from  a  fever,  hemorrhage,  metastasis,  the  suppression  of  a 
habitual  evacuation,  or  from  the  debilitating  treatment  of  mania.  Its  invasion 
is  sudden ;  it  is  exempt  from  any  lesion  of  motion ;  and  is  easily  cured  by  the 
combined  agency  of  regimen  and  tonic  treatment.  Frictions,  exercise  on 
horseback,  river  baths,  peruvian  bark,  musk,  valerian,  etc.,  are  generally  use- 
ful. It  is  cured  by  restoring  suppressed  evacuations,  and  recalling  to  its  pri- 
mitive seat  the  affection  that  has  been  displaced.  It  sometimes  terminates 
happily  by  an  explosion  of  acute  mania,  which  is  then  critical,  as  the  following 
case  proves, 

M.,  twenty  years  of  age,  of  medium  stature,  having  chestnut  colored  hair, 
blue  eyes,  a  pale  complexion,  and  a  changeful  physiognomy  ;  was  the  offspring 

55 


434  DEMENTIA. 

of  a  father  ■'who  suffered  from  a  herpetic  affection.     She  was  a  seamstress. 
When  eight  months  old,  she  had  convulsions,  which  ceased  at  the  close  of 
the  first  dentition.     At  ten  years  of  age  she  had  variola  ;   and  from  this  peri- 
od  her  disposition  was  gloomy,  and  she  was  exceedingly  susceptible,  and  irri- 
table.    At  seventeen,  the  menses  were  with  difficulty  established,  and  were 
preceded  by  cephalalgia.     They  have   since  been   regular,  but   scanty ;   and 
preceded  on  each  recurrence  by  cephalalgia.     She  had  a  strong  propensity  to 
sleep,  and  fell  into  a  slumber  so  soon  as  she  ceased  exercise.     Although  de- 
vout, she  was  a  reader  of  romances.     When  twenty  years  of  age,  she  suffer- 
ed for  three  months  with  a  violent  pain  in  her  head,  and  had  during  the  month 
of  July,  1819,  a  very  serious  difficulty  with  one  of  her  associates.     She  suf- 
fered from  insomnia  for   four  days,  and  afterwards   from  delirium  ;  wishes  tor 
die,  says  she  is  dead,  and  in  the  mean  time  her  face   becomes   flushed.     At 
intervals,  she  utters  cries,  weeps,  her  countenance  is  convulsed,  and  the  pa- 
tient assures   us  that   she   suffers  dreadfully.     Four   days  subsequently  (July 
22d,  1819),  she  is  brought  to  the  Salpetriere  in  a  state  of  mania,  which  per- 
sisted until  the  month  of  September.     At  this  epoch,  the  patient  sunk  into 
a   state  of  complete  dementia.     She   appeared  insensible  to  every  thing   that 
was  passing  around  her,  did  not  change   her  place  ;  spoke  not ;   and  did   not 
reply  even  to  such  questions   as  were  addressed  to  her.     This  state  continued 
until  the  month  of  December,  when  I  applied  the  actual  cautery  to  the  neck. 
This  application  provoked  a  general  irritation,  and  a  maniacal  delirium,  which 
persisted  for  several   days.     In  the  month  of  January,  the  menses  were  rees- 
tablished.    The  patient  became  convalescent,  and  her  tastes,  habit  of  thought, 
and  mode  of  living,  such   as   they  were  previous  to  her  illness.     Pinel  cites 
in  his  Treatise  on  Mania  the  spontaneous  cure  of  a  case  of  dementia,  by  the 
explosion  of  maniacal  delirium.     What  nature  effected  in  the  case  of  which 
this  celebrated  teacher  speaks,  did  not  art  accomplish  for  the  patient  of  whom 
I  have  just  given  an  account? 

Second  variety. — Chronic  Dementia. — Dementia  is  produced  by  onanism, 
errors  of  regimen,  drunkenness,  the  abuse  of  pleasures,  and  excessive  study. 
It  is  consecutive  to  hypochondria,  lypemania,  mania,  epilepsy  and  apoplexy. 
This  variety  is  very  rarely  cured.  When  it  results  from  excesses  and  errors 
of  regimen,  it  is  slowly  established.  Whether  it  terminates  monomania  or 
mania,  it  appears  during  the  existence  of  these  last  affections  ;  and  even  from 
their  commencement,  there  are  certain  symptoms  which  foretell  this  fatal 
termination.  We  most  frequently  notice  this  in  monomania  characterized  by 
pride,  which  is  ordinarily  complicated  with  paralysis.  Dementia  which  succeeds 
monomania  or  mania,  preserves  some  traces  of  the  primitive  delirium.  Thus, 
some  persons  have  from  time  to  time  seasons  of  excitement,  which  arouse 
again  their  faculties.  In  other  cases,  amidst  the  incoherence  of  their  ideas, 
they  discover  that  which  was  prominent  during  the  existence  of  monomania. 
The  dementia  which  succeeds  apoplexy  is  ordinarily  incqrable.  That  which 
is  produced  by  drunkenness,  presents  a  feature  which  is  quite  peculiar,  to 
wit :  trembling  of  the  limbs,  which  has  given  rise  to  the  appellation  of  deli- 
rium tremens.  Its  duration  is  short,  for  after  some  days  it  is  spontaneously 
cured.  To  combat  chronic  dementia,  blisters,  setons,  moxas,  fire,  irritating 
frictions,  sea-bathing,  electricity,  etc.,  are  recommended.  All  these  measures 
have  unhappily  resulted  in  very  rare,  and  often  ephemeral  success. 

Third  variety. — S^iiJLE  Dementia. — Senile  dementia  results  from  the  pro- 
gress of  age.  Man,  passing  insensibly  into  the  vale  of  years,  loses  his  sensi- 
bility, along  with  the  free  exercise  of  his  understanding,  before  reaching  the 
extreme  of  decrepitude.     This  form  of  mental  disease  is  gradually  establish- 


DEMENTIA.  435 

ed.  It  commences  with  a  weakening  of  the  memory,  especially  with  respect 
to  recent  impressions.  Sensations  are  feeble.  Attention,  which  is  at  first  fa- 
tiguing, at  length  becomes  impossible.  Volition  is  uncertain,  and  without 
impulse ;  and  the  movements  are  slow,  or  impracticable.  However,  senile 
dementia  begins  not  unfrequently  with  a  general  excitement,  which  persists 
for  an  indefinite  period ;  and  is  revealed,  now,  by  the  increased  activity  of  one 
function,  and  now,  by  that  of  another.  This  function  is  exercised  with  a 
new  and  unusual  energy,  which  deceives  the  aged  subject  of  it,  and  imposes 
upon  those  around  him.  Thus,  there  are  persons  who,  before  sinking  into 
dementia,  become  exceedingly  susceptible,  and  are  irritated  by  the  most  tri- 
fling matters.  They  are  exceedingly  active ;  desiring  to  understand  and  do, 
everything.  Others  experience  venereal  desires,  which  have  long  been  ex- 
tinct, and  which  urge  them  to  acts  which  are  contrary  to  their  habits  of  con- 
tinence. Others  still,  who  are  naturally  temperate,  experience  an  irreo-ular 
desire  for  spiced  and  highly  seasoned  food ;  for  wine  and  liquors.  To  this 
inordinate  excitement,  dementia  is  not  slow  to  succeed.  These  symptoms  of 
general  excitement  indeed,  are  the  first  indications  of  senile  dementia.  The 
transition  from  excitement  to  dementia  is  sudden,  especially  when  the  awed 
are  opposed  in  their  unreasonable  desires,  or  placed  where  it  is  impossible  to 
gratify  them.  We  shall  not  confound  this  excitement  with  the  mania  which 
bursts  forth  at  a  very  advanced  age,  in  strong,  robust,  and  well  sustained  per- 
sons. Mania,  attended  even  with  fury,  bursts  forth  after  the  age  of  eighty; 
and  is  sometimes  cured.  The  study  of  illustrative  cases  ought  to  suffice,  to 
render  our  diagnosis  sure.  Country  air,  moderate  exercise,  and  a  tonic  regi- 
men, may  retard  the  progress  of  senile  dementia,  and  suspend,  to  some  extent, 
its  termination. 

Complicated  varieties. — It  will  be  proper  to  annex  to  the  three  precedino- 
varieties,  that  of  complicated  dementia.  It  exists  in  connection  with  lypema- 
nia,  mania,  epilepsy,  convulsions,  scurvy,  and  especially  paralysis.  Compli- 
cated dementia  is  incurable.  Hippocrates  has  set  down  as  a  mortal  symptom 
in  acute  maladies,  the  complication  of  delirium  with  any  variety  of  convul- 
sions. What  the  father  of  medicine  has  said  respecting  acute^  diseases,  is 
applicable  to  insanity,  and  particularly  to  dementia.  The  complication  of 
mental  diseases  with  lesions  of  motion,  resists  every  curative  measure,  and 
leaves  no  hope  of  a  protracted  existence. 

The  facts  which  I  have  just  related,  those  which  may  be  read  in  the  works 
of  MM.  Calmeil,*  Baylet  and  Guislain,|:  but  too  fully  confirm  this  sad  truth. 
In  1805,  I  first  called  attention  to  this  phenomenon,  and  established  by  proof, 
the  incurability  of  insanity  complicated  with  paralysis. ||  This  form  of  para- 
lysis is  often  the  sign  of  chronic  inflammation  of  the  meninges,  and  should 
not  be  confounded  with  paralysis  which  is  consecutive  to  cerebral  hemorrha- 
ges, cancers,  tubercles,  and  softenings  of  the  brain.  It  appears,  now,  with 
the  first  symptoms  of  delirium,  during  the  period  of  acuity,  so  remarkable  at 
the  commencement  of  almost  all  forms  of  insanity ;  now,  it  precedes  the  deli- 
rium ;  and  now,  joins  itself  in  some  sort  to  it.  Finally,  whatever  may  be  the 
epoch  at  which  paralysis  appears,  its  invasion  sometimes  takes  place  without 
grave  phenomena;  and  sometimes,  it  is  the  result  of  congestions,  cerebral 

*  Paralysis  considered  with  reference  to  the  Insane,  Paris,  1826,  in  8vo. 

t  A  Treatise  on  Diseases  of  the  Brain  and  its  Membranes,  Paris,  1826,  in  Bvo. 

\  A  Treatise  on  Diseases  of  the  Brain  ;  or  a  new  Doctrine  respecting  Mental  Diseases, 
Brussels,  1833,  in  8vo. 

11  The  Passions,  considered  as  the  Causes,  Symptoms  and  Curative  Means  of  Mentai 
Alienation,  Paris,  1805,  in  4to. 


436  DEMENTIA. 

fevers,  epileptiform  convulsions,  etc.  At  first,  it  is  partial ;  it  then  invades  a 
greater  number  of  muscles,  and  becomes  general.  Its  progress  is  regular  ;  it 
goes  on  constantly  increasing,  while  the  understanding  grows  weak.  What- 
ever may  be  the  character  of  the  delirium,  it  indicates  a  speedy  transition 
from  insanity  to  chronic  dementia.  It  is  rare  that  insane  paralytics  live  more 
than  from  one  to  three  years ;  and  among  them,  the  strongest  and  most 
robust  die  most  suddenly.  Generally,  the  last  moments  of  life  with  these 
patients  are  marked  by  convulsions,  cerebral  congestions,  visceral  phlegmasiae, 
and  gangrene,  which  embraces  all  that  portion  of  the  body  which  is  deprived 
of  the  power  of  motion,  and  upon  which  its  weight  reposes. 

Permit  me  to  relate  certain  cases,  which  will  render  more  intelligible  the 
progress  of  this  fatal  complication.  How  deplorable  the  spectacle  presented 
by  this  young  monomaniac,  who,  strong,  robust,  full  of  life,  and  destined  to  a 
brilliant  future,  at  the  age  of  thirty  years,  in  consequence  of  some  trifling  dis- 
cussions respecting  matters  which  were  to  him  of  some  interest,  persuades 
himself  that  he  is  the  possessor  of  an  immense  fortune,  which  he  inconside- 
rately spends,  and  believes  to  be  an  object  of  desire  with  all.  He  purchases, 
unnecessarily,  and  without  reason,  every  thing  that  offers ;  furniture,  horses, 
carriages,  pictures,  etc.  etc.,  and  yields  himself  at  the  same  time  to  all  the  ex- 
cesses of  the  most  fashionable  life.  The  counsels  of  his  relatives  and  friends 
fail  to  bring  him  back  to  the  path  of  moderation  in  his  thoughts,  desires,  or 
conduct  ;  which  a  little  before  they  admired.  Becoming  excessively  sus- 
ceptible, he  is  irritated,  and  thrown  into  a  transport  of  passion  by  the  slightest 
observation.  He  refuses  all  medicine  ;  assuring  those  around  him  that  he 
was  never  so  well  or  so  happy.  He  was  brought  to  Paris  by  Doct.  K.,  a  phy- 
sician equally  skillful  and  estimable.  "  I  commit  to  your  care,"  says  my  con- 
frere, "  a  very  interesting  patient,  who  is  but  slightly  excited,  and  whom  I 
have  withdrawn  from  scenes  calculated  to  augment  this  excitement,  which  you 
will  speedily  cure."  I  converse  with  the  patient,  who  speaks  to  me  of  his  for- 
tune, of  his  projects  of  happiness  for  himself  and  his  friends,  of  the  numerous 
acqnisitions  which  he  is  to  make  in  Paris,  etc.  etc.  After  half  an  hour's  con- 
versation, "  what  think  you  ?"  says  my  learned  friend.  "  I  think  that  your  pa- 
tient is  incurable ;  that  he  will  not  recover,  nor  survive  a  year.  Remain  in 
Paris,  and  you  will  see,  as  the  malady  is  making  rapid  progress."  In  convers- 
ing with  the  patient,  I  had  remarked  some  hesitation  in  the  pronunciation  of 
certain  words,  and  the  undue  readiness  with  which  he  had  consented  to  remain  in 
a  private  hospital.  More  extensive  observation  enabled  me  to  obtain  a  glimpse 
of  certain  slight  defects  of  memory,  and  a  forgetfulness  of  the  projects  of  the  even- 
ing previous.  I  was  struck  by  the  indifference  and  the  air  of  contentment  which 
the  patient  manifested,  though  deprived  of  his  liberty,  and  incapable  of  gratify- 
ing his  caprices.  He  deferred  daily  until  the  morrow,  the  accomplishment  of 
projects,  which  at  first  he  wished  to  execute  instantly.  At  the  expiration  of 
fifteen  days  the  embarrassment  of  the  tongue  had  increased  ;  loss  of  memory 
is  more  frequently  made  manifest ;  and  before  the  close  of  the  month,  his  step 
is  less  easy,  and  he  grows  lean,  although  eating  largely.  Leeches  are  repeat- 
edly employed ;  a  seton  is  inserted  in  tl^  neck,  and  valerian  is  prescribed  as 
well  as  laxatives,  to  prevent  constipation.  Nothing  succeeded  in  staying  the 
progress  of  the  inflammation  of  the  meninges,  and  consequently  that  of  the 
paralysis.  At  the  expiration  of  three  months  his  ideas  were  almost  extinct ; 
he  no  longer  remembered  any  thing ;  and  merely  uttered  words  without  any 
connection  ;  repeating  often,  million,  horses,  chateau,  carriage,  etc.  etc.  He 
conducts  like  a  child ;  totters  in  his  gait;  and  sometimes  discharges  his  urine 
involuntarily.  By  slow  degrees,  he  becomes  more  feeble ;  no  longer  speaks 
but  in  a  low  voice  ;  and  never  leaves  his  arm  chair,  unless  he  is  induced  to 
walk,  and  sustained  beneath  both  arms.     His  appetite  is  at  all  times  voracious. 


DEMENTIA.  437 

At  the  fifth  month,  the  patient  scarcely  articulates,  and  can  no  longer  be  un- 
derstood. The  dejections  are  involuntary,  although  the  matters  are  solid,  and 
the  urine  is  discharged  unconsciously,  both  day  and  night.  Finally,  at  the 
commencement  of  the  sixth  month,  he  confined  himself  to  bed ;  suffered  for 
two  days  from  epileptiform  convulsions,  and  at  the  expiration  of  seven  months 
sunk  under  a  disease,  which,  at  its  commencement,  appeared  so  trifling  that 
the  experience  of  a  distinguished  physician  failed  to  detect  it. 

M.  C,  an  advocate,  thirty-five  years  of  age,  has  a  paternal  uncle  who  is  in- 
sane. He  is  tall,  has  chestnut-colored  hair,  and  in  his  youth  was  very  irregu- 
lar in  his  habits.  Married  at  twenty-three,  he  learned  how  to  ally  pleasures 
with  study,  and  the  labors  of  the  closet.  He  was  greatly  esteemed  by  the  cir- 
cle in  which  he  moved.  In  the  month  of  April,  1836,  he  publicly  made  re- 
marks, which  led  to  his  arrest.  He  was  sentenced  to  fifteen  days  imprison- 
ment, and  interdicted,  temporarily,  his  professional  labors.  While  his  case 
was  on  trial,  he  suffered  from  cerebral  congestion,  and  was  bled.  After  sen- 
tence was  pronounced,  he  manifested  a  child-like  gayety,  and  jested  respecting 
this  event  and  its  consequences.  From  henceforth,  he  entertained  certain  no- 
tions of  grandeur,  and  in  the  month  of  Aug.,  while  pleading,  stopped  suddenly, 
and  excused  himself,  on  the  ground  that  he  could  speak  no  more.  From  that 
day  he  hesitated  in  speech,  and  his  ideas  were  incoherent.  He  was  bled,  and 
taken  to  a  private  hospital,  from  which,  at  the  expiration  of  two  months,  he 
was  transferred  to  Charenton,  Oct.  17th,  1836.  At  the  time  of  his  arrival,  he 
was  emaciated,  his  complexion  pale,  the  embarrassment  in  his  pronunciation 
very  marked,  his  memory  very  much  enfeebled,  and  his  thoughts  incoherent. 
The  patient  speaks  of  his  talents,  which  are  the  admiration  of  all ;  of  his  for- 
tune, which  is  immense ;  and  of  his  ^advancement,  for  which  he  is  to  be  pre- 
sented to  the  king;  his  carriages  also  await  him.  He  desires  to  leave  the 
house,  in  order  to  make  a  plea ;  being  charged  with  the  defence  of  all  his  fel- 
low-citizens. He  is  happy,  and  boasts  of  his  good  fortune.  He  walks  much, 
and  moves  like  one  who  is  seeking  something  ;  talking  incessantly,  in  disdain- 
ful, but  not  threatening  language.  If  he  insists  upon  leaving  the  house,  it  is 
because  he  is  charged  with  a  great  amount  of  business ;  or  because  some  one 
is  awaiting  him.  If  he  meets  with  a  direct  refusal,  he  is  grieved,  but  imme- 
diately composes  himself;  not  having  moral  force  enough  to  insist.  He  weeps, 
but  never  manifests  attachment  or  regrets,  either  with  respect  to  his  family  or 
friends. 

At  each  visit,  his  incoherent  discourse  is  the  same  ;  his  demands  the  same, 
and  the  feebleness  of  volition  the  same.  Does  he  call  for  any  thing,  it  is  suffi- 
cient to  promise  him  that  before  the  close  of  the  day,  or  on  the  day  following, 
he  shall  have  what  he  desires,  and  that  he  can,  meanwhile,  go  wherever  he 
may  choose.  Much  engaged  with  his  food,  he  is  made  very  contented  by  the 
promise  that  his  desires  on  this  point  shall  be  regarded.  By  degrees,  yet 
with  frightful  rapidity,  the  patient  ceases  to  speak  of  his  profession,  and  de- 
mentia and  paralysis  progress.  His  pronunciation  becomes  more  difficult,  his 
step  more  tottering,  and  in  the  month  of  February,  1837,  all  the  symptoms 
are  aggravated.  His  toilet,  which  was  so  complete,  is  neglected ;  his  garments 
are  torn  and  soiled ;  and  the  urine  passes  involuntarily.  Towards  the  close  of 
winter,  the  patient  seems  to  have  merely  fleeting  thoughts.  He  is  deprived  of 
moral  sentiment,  has  no  memory,  lays  no  plans  for  the  future,  and  lives  a 
merely  physical  existence.  A  few  months  were  sufficient  to  bring  M.  C.  to 
this  last  degree  of  intellectual  and  moral  existence.  The  whole  constitution 
gives  way ;  the  organs  perish  ;  and  this  man,  so  young,  and  recently  so  bril- 
liant, and  so  distinguished  for  his  intelligence,  is  now  a  mere  automaton. 

M.  L.  D.,  thirty-eight  yeacs  of  age,  had  participated  in  the  last  campaigns 
of  the  empire^  and  was  elevated  to  the  rank  of  Colonel,  after  the  restoration  ; 


438 


DEMENTIA 


uniting  to  every  physical  and  intellectual  quality  all  the  advantages  of  a  lofty 
position  in  society,  and  a  large  fortune.  He  was  of  the  opinion  that  he  had 
experienced  injustice  on  the  part  of  the  government.  His  self-love  was  deeply 
wounded,  and  after  many  days  of  insomnia,  he  gave  himself  several  thrusts 
with  a  knife,  in  the  region  of  the  heart.  He  was  promptly  succored,  and  his 
services  were,  but  for  a  brief  period,  discontinued.  From  this  time,  he  ex- 
pressed with  bitterness  his  dissatisfaction  ;  but  was  in  no  respect  less  exact  in 
fulfilling  his  duties  as  a  commanding  officer.  Two  years  subsequently,  he 
has  an  attack  of  cerebral  congestion,  for  which  he  is  largely  bled.  Two  days 
later,  he  has  a  second  attack,  more  severe  than  the  first.  He  remains  excited, 
talks  much,  is  agitated,  irritable  and  exacting.  He  does  not  sleep,  and  after  a 
third  attack,  a  true  mania  is  developed.  The  delirium  is  general,  attended 
v/ith  agitation  and  notions  of  grandeur  and  fortune.  He  commits  a  thousand 
extravagances;  remains  almost  naked  ;  talks  incessantly ;  cries  aloud  ;  orders  a 
thousand  things  at  once  ;  is  impatient ;  rends  ;  and  commits  strange  and  impru- 
dent acts,  which  compromise  his  life,  though  he  entertains  no  idea  of  suicide. 
Several  physicians  are  called  in  consultation  ;  and  the  maniacal  state  of  the 
patient  cannot  be  denied.  His  age,  however,  and  the  brief  duration  of  the 
disease,  offer  to  the  counsellors  expectations  of  a  cure.  I  affirm  that  the  pa- 
tient will  never  recover:  1st,  because  three  severe  attacks  of  cerebral  conges- 
tion had  preceded  the  maniacal  state,  and  that  consequently  there  was  some 
degree  of  cerebral  lesion  ;  2d,  because,  notwithstanding  his  incessant  loqua- 
city, certain  words  are  imperfectly  pronounced  ;  and  because  his  gait,  although 
lively  and  active,  is  uncertain.  I  added,  that  active  medication  would  hasten 
the  progress  of  the  disease  ;  that  the  country,  exercise,  a  severe  regimen,  and 
the  repeated  application  of  leeches,  to  prevent  new  congestions,  appeared  to 
me  to  be  the  only  proper  course.  One  of  the  consulting  physicians  did  not 
concur  with  me  in  my  unfavorable  prognosis,  and  proposed  certain  tentative 
measures.  After  a  month  spent  in  fruitless  attempts,  we  were  obliged  to  re- 
nounce all  hope  of  cure.  Paralysis  had  progressed,  and  dementia  was  con- 
firmed ;  the  patient  retaining  incoherent  notions  of  grandeur,  which  persisted 
for  more  than  two  years.  He  regarded  himself  as  the  possessor  of  several 
provinces  and  kingdoms ;  distributed  places,  and  gave  away  millions ;  and 
commanded,  also,  an  army  of  giants.  His  cavalry  was  mounted  upon  horses 
of  gigantic  size  ;  he  possessed  palaces  of  diamond  ;  and  his  stature  was  20, 
30,  and  40  cubits  in  height.  He  talked,  both  night  and  day  ;  now,  in  a  low 
tone;  now,  loudly.  He  also  uttered  loud  cries.  Beset  by  hallucinations  of 
hearing,  he  listened  to  the  voices  of  imaginary  beings,  and  replied  to  them  ; 
boasting  of  his  person,  disputing  with,  and  even  abusing  them.  He  recog- 
nized the  members  of  his  family,  and  addressed  them  with  amiability  and 
politeness  ;  but  after  a  brief  interval  however,  resumed  his  habit  of  constant 
conversation.  He  was  sent  into  the  country.  Although  in  a  state  of  com- 
plete dementia,  frequently  experiencing  vertigoes,  and  epileptiform  convulsions; 
although  he  walked  with  difficulty ;  sometimes  inclining  very  much  toward 
one  side,  and  scarcely  able  to  articulate  a  word;  he  lived  for  twelve  years;  at 
the  close  of  which  period,  there  still  remained  some  traces  of  his  former  po- 
liteness, together  with  those  amiable  and  affectionate  manners,  for  which  he 
was  distinguished  before  his  illness.  This  patient  owed  his  prolonged  exist- 
ence to  the  .severe  regimen  to  which  he  was  subjected ;  to  abundant  daily  ex- 
ercise ;  to  the  repeated  application  of  leeches  to  the  anus ;  and  the  frequent 
employment  of  gentle  laxatives. 

Paralysis  is  more  frequent  among  insane  men  than  women.  Eighteen  years 
ago,  when  charged  with  the  service  of  the  division  of  the  insane  at  the  Bicetre, 
during  the  absence  of  M.  Pariset,  who  was  sent  to  Cadiz  to  study  the  yellow 
fever  which  was  prevailing  there  ;  I  was  struck,  in  comparing  the  number  of  men. 


DEMENTIA.  439 

insane  and  paralytic,  at  the  Bicetre,  and  the  number  of  paralytic  women  at  the 
Salpetriere.  The  same  observation  may  be  made  in  every  establishment  into 
which  both  sexes  are  admitted.  It  has  not  escaped  the  notice  of  Doct.  Foville, 
j)hysician-in-chief,  at  St.  Yon,  Rouen.  According  to  this  physician,  they 
amount  to  one  eleventh  at  the  Institution  over  which  he  presides.  Among 
334  insane  persons  who  were  examined  by  him,  31  were  paralytic,  to  wit :  22 
men  and  9  women.*  At  Charenton,  the  proportion  of  paralytics  is  still  more 
considerable.  They  constitute  one  sixth  of  the  whole  number  of  admissions. 
In  truth,  of  619  insane  persons  who  were   admitted   during  the   three  years 

1826,  1827  and  1828,  109  were  paralytics.  But  the  proportion  of  men  is 
enormous,  compared  with  that  of  women.  Of  366  insane  men  admitted  into 
the  house,  95  were  paralytics  ;  while  of  153  women,  14  only  were  aifected 
with  paralysis.  This  complication  is  most  frequently  observed  among  that 
class  of  insane  persons  who  have  yielded  to  venereal  excesses,  or  have  been 
addicted  to  the  use  of  alcoholic  drinks ;  among  those  also,  who  have  made  an 
inordinate  use  of  mercury,  as  well  as  those  who,  exercising  the  brain  too  vigo- 
rously, in  mental  strife,  have,  at  the  same  time,  abandoned  themselves  to  errors 
of  regimen. 

Do  not  these  circumstances  explain  sufficiently  well,  how  it  happens  that 
there  are  more  men  insane  and  paralytic  than  women  1  They  also  account  for 
the  fact,  that  in  proportion  to  the  number  of  insane  men,  there  are  more  para- 
lytics at  Charenton  than  at  the  Bicetre.  The  insane  who  are  admitted  at  the 
latter  hospital  are  poor.  They  lead  a  very  laborious  life,  and  react  more  en- 
ergetically against  the  causes  which  we  have  just  pointed  out,  as  capable  of 
producing  paralysis.  These  causes  exercise  the  less  intiuence,  because  the 
laborer,  engaged  in  manual  occupations,  exercises  his  understanding  but  little ; 
thereby  fatiguing,  to  a  trifling  extent  only,  the  brain.  The  insane  who  are  ad- 
mitted into  the  establishment  at  Charenton,  enjoy  an  honorable  ease,  are  fur- 
nished with  more  means  for  the  gratification  of  their  passions,  and  exercise 
professions  which  excite  the  brain.  Their  material  life  is  less  active,  and  con- 
sequently the  same  causes  ought  to  produce  cerebral  disturbances  more  fre- 
quently, and  those  of  a  graver  character.  It  is  true,  that  there  are  more  insane 
persons  who  are  paralytic,  among  the  wealthy  and  elevated,  than  the  other 
classes  of  society.  The  paralysis,  which  is  now  under  consideration,  is  more 
rare  in  the  south  than  in  the  north  of  France.  It  is  still  less  frequent  in  Italy, 
and  warm  climates.  Doct.  Delaye  has  met  with  it  at  the  hospital  of  Toulouse, 
but  in  five  instances  among  one  hundred  and  eleven  insane  persons  ;  three 
men  and  two  women.  Doct.  Rech  assures  me  that  he  met  with  no  paralytics, 
among  one  hundred  and  thirty-two  insane  persons  residing  in,  or  admitted, 
from  1822  to  1825,  into  the  ward  for  the  insane,  in  the  general  hospital  at  Mont- 
pellier.t  Professor  Vulpes,  physician-in-chief  des  maisons  d'Aversa,  in  the 
kingdom  of  Naples,  stated  to  me  repeatedly,  during  his  residence  in  Paris,  in 

1827,  that  he  could  scarcely  mention  three  paralytics  among  five  hundred  in- 
sane persons  of  both  sexes,  who  were  confined  and  treated  in  the  three  build- 
ings, of  which  the  establisment  of  Aversa  is  composed,  and  of  which  he  has 
the  charge.  Whilst  residing  in  Italy,  in  1834,  I  established  the  fact  that 
there  were  not  only  a  small  number  of  insane  paralytics  in  the  establishment 
at  Aversa;  but  in  all  those  of  a  similar  character  in  southern  Italy,  and  the 
Lombard-Venetian  territory. 

Doct.  Burrows,  whilst  admitting  that  in  English  establishments  they  take 
no  account,  either  of  the  complications  of  insanity,  or  of  those  maladies  which 
terminate  the  existence  of  the  insane  ;  believes  that  the  number  of  insane  para- 

*  Dictionary  of  Practical  Medicine  and  Surgery,  art.  Mental  Alienation,  t.  i.  p.  504. 
t  Medical  Ephemeris  of  Montpcllier,  1827. 


440  DEMENTIA. 

lytics  is  less  in  England  than  in  France.  He  adds,  that  m  his  private  practice, 
he  did  not  see  a  paralytic  among  twenty  insane  persons.  This  estimable  au- 
thor attributes  the  frequency  of  paralysis  among  us,  to  a  bad  regimen,  and  to 
a  want  of  precautions  suited  to  secure  the  insane  from  atmospheric  changes, 
whilst  in  England,  this  class  is  very  well  cared  for.  In  Germany  they  censure 
our  mode  of  treatment.  Certain  French  physicians  have  published  the  opinion, 
that  this  complication  was  provoked  by  some  defect  of  locality,  or  by  errors  of 
hygiene. 

I  am  well  aware  of  the  importance  which  we  should  attach  to  hygienic 
causes  in  the  production  of  diseases.  I  know  well  that  the  insane  are  more 
exposed  than  individuals  in  the  enjoyment  of  good  health,  to  sink  under  the 
depressing  influence  of  insalubrious  localities.  But  I  will  remark,  that  in 
treating  of  the  paralysis  of  the  insane,  I  speak  of  that  which  is  developed 
before  their  admission  into  localities  devoted  to  this  class  of  patients ;  and 
also,  that  the  insane  and  paralytic  women,  whom  I  observed  at  the  Salpetriere  ; 
the  insane  and  paralytic  men,  at  the  Bicetre  ;  and  those  of  both  sexes  suffer- 
ing from  the  same  complication  at  Charenton ;  none  of  them  sunk  into  this 
slate  during  their  stay  at  those  establishments,  but  were  paralytic  before  their 
admission.  I  am  convinced,  that  when  they  have  learned  better  to  distinguish 
the  symptoms  of  paralysis  which  complicates  insanity ;  they  will  find  in  Eng- 
land, and  particularly  at  London,  as  many  insane  paralytics  as  at  Paris.  Doc- 
tor Burrows  seems  to  think  that  I  regard  paralysis  of  the  insane  as  the  effect 
and  not  the  cause  of  insanity.*  I  have  said  nothing  like  this.  I  am  satisfied 
to  signalize  paralysis  as  a  frequent  complication  of  insanity,  and  as  rendering 
our  prognosis  less  favorable.  I  believe,  that  in  this  double  aspect,  the  dura- 
tion calls  for  all  the  attention  of  practitioners  and  physicians,  whose  research- 
es in  pathological  anatomy  relate  to  mental  diseases.  M.  A.  L.  Baylet  de- 
sires to  prove,  that  the  paralysis  and  monomania  of  the  rich  and  great  are 
the  signs  of  chronic  meningitis ;  and  that  this  inflammation  presents  three 
w^ell  marked  periods :  1st,  the  period  of  ambitious  monomania,  with  certain 
traces  of  complete  paralysis  ;  2d,  the  period  of  mania ;  3d,  the  period  of  de- 
mentia with  general  paralysis. 

Great  as  has  been  the  number  of  the  insane  which  I  have  seen,  the  monoma- 
nia of  the  great  has  not  presented  to  me  a  march  so  regular  ;  I  have  seen  it 
preceded  by  attacks  of  mania,  by  monomania  and  lypemania.  Paralysis  com- 
plicates all  forms  of  insanity,  whatever  may  be  the  character  of  the  delirium. 
It  complicates  mania  and  lypemania,  as  well  as  ambitious  monomania,  but 
more  frequently  the  latter.  It  almost  invariably  complicates  dementia.  If  in 
observing  mania  at  its  commencement,  we  discover  symptoms,  however  trifling, 
of  paralysis  ;  we  may  boldly  affirm  that  dementia  will  succeed  the  former. 
It  is  equally  true  with  monomania,  whatever  may  be  the  character  of  the  de- 
lirium ;  and  we  may  add  moreover,  that  death  will,  at  no  distant  day,  termi- 
nate the  disease.  Neither  maniacs  nor  monomaniacs  possess,  in  these  cases, 
the  same  energy  of  attention,  the  same  vigor  in  the  association  of  ideas, 
the  same  strength  of  will,  the  same  tenacity  of  purpose,  the  same  obstinacy 
in  resistance,  as  formerly.  They  are  agitated  and  transported  by  passion, 
but  obey  and  yield ;  indicating  by  their  acts  a  weakened  state  of  the  brain. 
It  has  happened  to  me  to  express  an  assurance,  that  a  furious  maniac  was 
already  paralytic,  and  could  not  recover,  notwithstanding  the  opinion  of  se- 
veral physicians  to  the  contrary,  who  were  worthy  the  highest  esteem ;  but 
who,  having  less  experience  with  the  insane,  had  overlooked  the  symptoms 
of  paralysis,  which  were  in  truth,  very  marked. 

*  Communications  on  the  causes,  forms,  symptoms  and  treatment,  moral  and  medical, 
of  Insanity.     London,  1828,  in  Bvo. 

t  A  treatise  on  diseases  of  the  brain  and  its  membranes,  Paris,  1826,  in  8vo. 


DEMENTIA.  441 

Called  to  take  charge  of  an  officer,  who  was  suffering  from  ambitious  mono- 
mania attended  with  fury,  although  the  patient  was  in  other  respects  strong 
and  robust,  I  declared  that  he  would  not  recover;  and  that  soon,  they  would 
clearly  perceive  the  existence  of  paralysis.  My  prognosis  was  founded  on  the 
two  following  phenomena  :  1st,  in  the  middle  of  a  sentence,  the  patient  articu- 
lated certain  words  more  slowly  than  others ;  2d,  it  was  sufficient  to  make 
him  a  promise,  to  compose  him,  and  cause  him  to  renounce  those  projects  to 
which  he  was  strongly  inclined.  A  slight  strabismus  enabled  me  to  form  a 
similar  conclusion  respecting  a  monomaniac  who  was,  at  the  time,  fulfilling 
the  duties  of  captain  of  a  regiment. 

If  the  diagnostic  signs  of  chronic  meningitis,  were  monomania,  resultinor 
from  exaggerated  notions  of  greatness,  attended  by  paralysis ;  this  #»rm  of 
monomania  would  never  occur  without  paralysis.  Observation  establishes  the 
contrary.  Insane  women  are  rarely  paralytic.  Insane  men  and  women,  in 
warm  climates,  in  the  south  of  France  and  Italy,  are  rarely  paralytic.  How- 
ever, ambitious  monomania  bursts  forth  at  Paris,  among  insane  women ;  nor 
is  it  unfrequent  in  the  south  of  France,  and  in  Italy,  among  the  insane  of 
both  sexes.  Monomania,  attended  by  pride,  exists  therefore,  without  paraly- 
sis; and  on  the  other  hand,  paralysis  exists  without  delirium.  How  then  can 
we  admit  that  this  form  of  monomania  and  paralysis,  are  pathognomonic  signs 
of  chronic  meningitis?  There  are  cases  of  paralysis,  attended  by  exclusive 
delirium,  and  by  the  monomania  of  pride  and  ambition,  in  which  the  delirium 
ceases,  and  the  paralysis  persists.  1  observed,  near  the  close  of  the  year 
1827,  a  fact  of  this  kind. 

An  officer,  connected  with  a  company  of  horse  belonging  to  the  kino-'s 
household,  is  suddenly  seized  with  an  attack  of  monomania  ;  the  patient  be- 
lieving that  he  is  a  distinguished  personage,  and  exceedingly  wealthy.  He 
commits  numerous  extravagances,  and  at  the  same  time,  experiences  difficulty 
in  uttering  articulate  sounds.  At  the  expiration  of  five  weeks  the  monomania 
ceases,  but  the  paralysis  persists,  and  soon  invades  the  muscles  of  the  limbs ; 
the  patient  suffering  from  frequent  cerebral  congestions,  which  provoke  epi- 
leptiform convulsions,  though  delirium  no  longer  exists.  This  soldier  distin- 
guishes clearly  between  the  state  in  which  he  now  is,  and  that  in  which  he 
has  been  ;  demanding  for  the  former,  the  aids  of  medicine. 

When  we  examine  the  bodies  of  the  paralytic  insane,  and  even  monomaniacs, 
we  do  not  always  meet  with  indications  of  inflammation  of  the  meninges; 
whilst  on  the  contrary,  we  sometimes  meet  with  inflammations  of  the  menin- 
ges, though  there  has  been  no  delirium  connected  with  notions  of  greatness. 

Doctor  Calmeil,*  who  has  derived  his  information  from  the  same  sources 
with  M.  Bayle,  that  is  to  say ;  from  observations  collected  at  Charenton  ;  has 
manifested  a  marked  reserve  with  respect  to  his  conclusion  from  the  facts 
which  he  has  reported  in  his  work,  which  is  in  all  respects  so  remarkable. 
Our  learned  confrere,  and  my  collaborator  in  the  duties  which  I  was  appoint- 
ed to  discharge  towards  the  insane  at  Charenton,  was  satisfied  to  establish  by 
numerous  facts,  that  chronic  inflammation  of  the  meninges,  produced  general 
paralysis,  peculiar  to  the  insane ;  but  was  never  of  the  opinion  that  he  had 
discovered  the  immediate  cause  of  that  form  of  delirium  which  was  ever  con- 
nected with  ideas  of  grandeur  and  wealth.  Paralysis  of  the  organs  of  speech, 
depends  upon  a  lesion  of  the  anterior  lobules  of  the  brain,  says  M.  Bouillaud.t 
It  is  one  of  the  most  incontestable  of  facts,  adds  this  skillful  professor ;  never- 
theless, observation  does  not  always  justify  this  proposition.    Nature  perseveres 

*  Paralysis,  considered  witli  reference  to  llie  Insane.     Paris,  1826,  in  8vo. 
t  A  Clinical  and  Physiological  Treatise  on  Encephalitis,  or  Inflammation  of  the  Brain. 
Paris,  1825,  in  8vo. 

56 


442  DEMENTIA. 

in  maintaining  her  secret,  notwithstanding  the  constant  researches  of  physi- 
cians, in  all  ages. 

I  will  close  my  remarks  on  the  paralysis  of  the  insane,  with  a  few  practical 
considerations.  The  paralytic  insane  eat  gluttonously,  and  collect  their  food 
in  the  back  of  the  mouth,  in  some  instances,  to  such  a  degree  as  to  prevent 
swallowing.  This  accident  also  happens  when  the  paralysis,  having  reached 
the  muscles  of  deglutition,  renders  the  performance  of  this  function  almost 
impossible.  Then  the  solid  aliment,  being  no  longer  propelled  into  the  sto- 
mach, is  retained  in  the  oesophagus,  and  compresses  the  larynx.  In  these 
cases,  asphyxia  is  imminent ;  and  the  person  who,  a  moment  ago,  was  dying, 
is  restored  again  to  life,  by  relieving  the  throat  and  mouth  of  those  substances 
which  Jaave  not  been  conveyed  into  the  stomach  by  deglutition.  I  once  wit- 
nessed a  very  singular  case,  which  eventually  proved  fatal  to  the  patient, 
who  is  the  subject  of  the  following  observation. 

M.,  about  forty  years  of  age,  after  a  long  attack  of  mania,  had  fallen  into 
a  state  of  dementia.  The  desire  for  food  was  so  strong,  and  the  taste  so  per- 
verted, that  the  patient  was  accustomed  to  devour  the  most  disgusting  sub- 
stances, and  ate  all  the  insects  he  could  catch  during  his  walks  in  a  very  large 
garden  ;  such  as  spiders,  snails,  worms,  butterflies,  etc.  He  was  one  day 
served  at  dinner  with  a  portion  of  a  calf's  head.  He  ate  the  whole  of  it  with 
avidity,  and  soon  after  fell  prostrate,  in  a  state  of  unconsciousness.  His  face 
was  of  a  purple  color.  His  attendant,  suspecting  the  cause  of  this  accident, 
introduced  a  foreign  body  into  the  oesophagus,  and  propelled  the  food  into  the 
stomach.  Some  weeks  subsequently,  calf's  head  was  again  served  to  the 
same  patient ;  but  in  this  instance,  fearing  his  gluttony,  they  took  care  to  cut 
into  morsels  the  food  which  was  presented  to  him.  Scarcely  had  he  intro- 
duced a  little  into  the  oesophagus,  than  the  accident  referred  to  above,  was  re- 
newed. The  use  of  this  variety  of  meat  was  strictly  forbidden.  Six  months 
afterwards,  either  through  forgetfulness  or  ignorance,  they  again  served  the 
calf's  head  to  this  patient.  In  this  instance,  he  had  swallowed  too  large  a 
morsel,  from  which  it  was  impossible  to  relieve  the  oesophagus,  and  he  speedily 
died.  On  opening  the  body,  the  oesophagus  was  found  greatly  distended 'with 
a  morsel  of  the  meat,  which  he  had  attempted  to  swallow.  The  brain  was 
very  red,  the  meninges  thickened  and  injected,  and  the  lungs  engorged  with 
blood. 

Constipation  is  also  a  frequent  symptom  among  insane  paralytics.  The  rec- 
tum being  paralyzed,  defecation  is  almost  impossible.  Here,  fecal  matters  re- 
main for  a  longer  or  shorter  period;  sometimes  even  for  twenty  or  thirty  days, 
before  the  patient  begins  to  complain.  If  not  carefully  attended  to,  by  those 
whose  duty  it  is  to  serve  them,  and  this  inconvenience  obviated,  the  intestines 
become  inflamed,  and  at  length,  gangrenous.  Purgatives  produce  no  effect, 
frictions  upon  the  abdomen  succeed  no  better,  and  the  patients  die.  Some- 
times the  accumulation  is  so  great,  and  so  hardened,  that  mechanical  means 
are  necessary  to  unload  the  rectum.  The  retention  of  urine,  also  demands 
special  attention.  It  is  sometimes  necessary  to  have  recourse  to  the  catheter ; 
but  more  frequently,  insane  paralytics  are  subject  to  incontinence  of  urine,  or 
else  it  is  discharged  by  overflowing.  During  the  day,  they  soil  their  clothing, 
and  at  night  inundate  the  bed,  if,  in  consequence  of  their  feebleness,  they  are 
permitted  to  remain  there.  The  urine  is  not  slow  in  forming  eschars,  which 
destroy  the  integuments  down  to  the  bone.  These  patients  ought  to  be  lodg- 
ed upon  a  bed  of  a  peculiar  construction,  their  linen  frequently  changed,  and 
washed  with  an  infusion  strongly  aromatic,  or  even  with  alcohol  diffused  in  - 
water.  Insane  paralytics  are  also  exposed,  in  consequence  of  their  extreme 
feebleness,  to  a  grave  accident  which  compromises  their  existence.  If  pre- 
cautions are  not  taken,  on  sitting  down  before  a  fire,  they  will  permit  them- 


DEMENTIA.  443 

selves  to  be  burned,  without  making  any  complaint,  so  severely  as  to  endanger 
life.  If,  while  in  bed,  they  attempt  to  change  their  position,  having  no  longer 
sufficient  strength  to  control  the  impulse  which  they  give  their  bodies ;  or  in 
consequence  of  not  possessing  sufficient  understanding  to  measure  distances ; 
they  permit  themselves  to  fall,  ordinarily  upon  their  head,  and  die  a  few  days 
afterwards.  I  have  several  times  shown,  that  the  ecchymosis  of  the  dura-ma- 
ter, being  propagated  to  the  subjacent  portion  of  the  arachnoid  ;  or  else  a  cir- 
cumscribed sanguine  effusion,  membraniform,  and  extended  over  the  external 
lamina  of  the  arachnoid,  was  the  first  result  of  the  fall  of  these  patients  from 
the  height  of  their  heads  ;  a  result  which  hastened  their  death.  It  happens  but 
too  frequently,  that  we  confine  either  to  a  bed  or  quieting  chair,  the  furious- 
ly insane,  and  insane  paralytics ;  the  former,  to  prevent  their  yielding  to  the 
impulses  of  their  fury;  the  latter,  to  avoid  the  falls  to  which  they  are  liable 
while  walking.  We  should  fear  abusing  a  measure  of  this  nature,  since  the 
want  of  motion  and  exercise  favors  the  progress  of  paralysis;  and  since  it  is 
often  induced  among  furious  maniacs,  in  consequence  of  the  prolonged  repose 
to  which  they  are  forcibly  subjected.  It  is  the  dread  of  this  result,  which  has 
led  to  the  introduction,  in  the  insane  establishments  of  Spain,  of  a  long  chain, 
fastened  to  the  bed,  and  attached  to  one  of  the  feet.  They  thus  protect  them- 
selves against  the  fury  of  maniacs ;  allowing,  at  the  same  time  to  the  latter, 
perfect  freedom  of  motion. 

[A  class  of  cases  terminating  in  the  disease  under  consideration, — and  which  may  be 
found  in  the  latter  part  of  this  chapter, — may  appear  peculiar,  and  perhaps  quite  new  to 
some  of  the  readers  of  this  work.  It  forms  a  variety,  which,  if  it  has  existed,  has  been 
little  noticed  so  far  as  I  can  learn,  by  writers  on  insanity  in  this  country.  The  only 
source  from  which  I  have  been  able  to  obtain  information  on  this  interesting  form  of 
disease, — not  having  had  an  opportunity  to  witness  a  case  of  it, — has  been  the  last  An- 
nual Report  of  Doct.  Bell,  Superintendent  of  the  McLean  Asylum,  Charlestown,  Mass. 
I  take  the  liberty  to  transcribe  what  he  says  in  reference  to  it,  and  also  Doct.  Conolly's 
description  of  it,  which  is  found  in  the  same  Report.  "  I  have  regarded  it  (says  Doct. 
B.),  as  a  somewhat  curious  fact,  that  it  is  only  within  the  last  three  years  that  this  disease 
has  been  admitted  to  this  institution.  As  late  as  my  visit  to  Europe  in  1840,  it  was  un- 
known within  our  walls.  Nor  after  seeing  it  so  often  manifested  there,  can  I  recall  any 
case  in  our  register,  which  would  at  all  meet  its  characteristics,  rendering  it  certain  that 
it  was  not  overlooked.  Since  that  period,  however,  we  have  had  abundant  evidence 
that  it*  is  not  a  form  of  disease  peculiar  to  other  countries.  I  find  that  not  less  than 
twelve  or  fifteen  well  marked  cases  have  been  received,  coinciding  exactly  in  mental 
and  physical  manifestations  with  those  I  saw,  and  which  are  so  graphically  described 
by  many  English  and  continental  authors."  Dr.  C.'s  description  comprises  the  essential 
characteristics  of  general  paralysis,  and  is  as  follows  :  "  Men  in  the  prime  of  life,  intel- 
ligent and  of  active  habits,  have  perhaps  sustained  a  single  attack  of  paralysis  ;  a  slight 
impairment  of  the  mind,  a  slight  faltering  in  the  speech,  and  a  little  infirmity  in  the 
gait,  only  discovered  by  those  who  look  for  it,  are  the  most  prominent  symptoms.  Yet 
in  all  these  cases  the  death-blow  is  struck  from  the  first.  When  the  previous  history  of 
those  cases  can  be  obtained,  it  is  usually  found  that  certain  changes  of  character  and 
disposition  preceded  the  paralytic  attack.  The  individual  who  was  before  prudent  in 
his  conduct,  has  become  extravagant  and  speculative  ;  or  after  being  lively  and  attentive 
to  propriety  of  dress  and  behavior,  has  become  dull,  slovenly,  and  occasionally  forgetful 
of  decorum.  These  changes  have  gradually  appeared  for  a  year  or  two,  before  disease 
has  declared  itself.  After  a  little  ebullition  of  discontent  on  being  removed  from  their 
homes,  they  often  become  contented  and  full  of  exciting  hopes.  Sometimes  they  are 
fretful,  because  they  cannot  carry  into  effect  some  project  or  speculation  connected  with 


444  DEMENTIA. 

their  former  pursuits.  But  a  vague  kind  of  happiness  soon  succeeds  to  this  state.  Their 
liealtli,  they  say,  was  never  so  good,  their  mind  never  so  clear,  their  prosperity  never  so 
secure.  Fits  of  a  convulsive  character,  sometimes  decidedly  epileptic,  often  supervene 
on  this  state  ;  and  each  attack  leaves  the  mind  and  body  weaker,  until  a  paroxysm  more 
severe  than  common,  proves  fatal.  When  this  is  not  the  course  of  the  disease,  the  men- 
tal excitement  becomes  more  extreme,  and  after  some  continuance,  ends  in  an  oblitera- 
tion of  almost  every  faculty,  in  which  state  the  patients'  life  may  be  prolonged  for  a  con- 
siderable period."  Thus  far  Doct.  Conolly.  Doct.  Bell  in  conclusion  says :  "  The 
cases  under  my  care  have  uniformly,  with  a  single  exception,  been  of  the  male  sex,  and 
in  almost  every  instance  in  those,  who  have  borne  the  long  continued  pressure  of  un- 
usual business  anxieties,  either  with  or  without  reverses.  The  form  of  delusions  has 
almost  always  borne  reference  to  immense  amounts  of  money,  great  power  or  some  simi- 
lar exaltation.     No  recovery  has  occurred  among  them." 


IDIOCY 


Brief  account  of  the  views  of  authors  in  regard  to  idiocy. — Synonyms. — Origin  and  sig- 
nification of  term. — Commences  with  life. — Idiots  never  reach  an  advanced  age. — 
Vices  of  conformation  almost  invariably  discoverable  in  brain. — Dementia  and  idiocy 
contrasted. — Illustrative  cases. — Idiots  classed  in  two  divisions,  viz.,  imbeciles  and 
idiots. — Contrasted. — First  variety. — Imbecilitv. — General  description  of  imbeciles. 
— Cases,  together  with  admeasurements  of  the  head. — Remarks  respecting  habits  and 
mode  of  life  of  imbeciles. — A  few  whose  minds  are  capable  of  partial  development. — 
Their  gayety,  piquant  repartees,  jovial  manners,  etc.,  have  been  the  means  of  their 
introduction  to  the  great. — At  Court  even  is  there  the  post  o?  fool. — Origin  of  custom. 
— Employed  by  rogues  for  culpable  purposes. — Acts  to  which  puberty  gives  rise. — 
Second  variety. — Idiocy. — Idiots  incapable  of  speech. — Case  of  Queneau,  with  post- 
mortem examination. — Other  cases,  describing  the  figure,  admeasurements  of  the  head, 
habits,  and  peculiar  characteristics  of  idiots. — Moral  and  physical  condition  of  the 
mothers  of  idiots,  while  pregnant  with  them. — Account  of  cases  representing  the  ex- 
treme limit  of  idiocy  from  Pinel,  Gall,  and  the  records  of  the  Salpetriere. — Idiots 
nearly  or  quite  deaf  as  well  as  mutes. — The  senses  null  or  exceedingly  obtuse. — Com- 
parative view  of  the  condition  of  the  blind  and  dumb,  and  idiots. — Remarkable  apti- 
tude of  many  idiots  for  the  acquisition  of  music,  and  their  fondness  for  musical  sounds- 
— Deductions  from  the  above  cases. — A  number  of  the  physical  and  predisposing 
causes  noticed. — Exciting  causes  of  idiocy. — -Volume  and  form  of  the  heads  of  idiots. 
— Gall's  limits  of  intelligence. — Researches  of  Foville,  Parchappe  and  others,  respect- 
ing the  vices  of  conformation  in  the  cranium  of  the  idiot,  and  its  development  com- 
pared with  that  of  the  healthy  subject. —  Table  of  mean  results  of  certain  cranial  ad- 
measurements.— Remarks  of  Morgagni  and  Meckel  respecting  the  cerebral  substance  in 
idiocy. — Maiacarne,  on  the  convolusions,  etc.,  of  the  brain  in  idiocy. — Remarks  of  La- 
vater  and  Camper  respecting  physiognomy  of  idiots. — Remarks  on  treatment. — (Brief 
account  of  some  recent  attempts  to  improve  the  condition  of  idiots). — Cretins,  Cagots 
and  Albinos. — Cretinism. — Origin  and  definition  of  term. — History  of  Cretinism. — The 
person  of  the  cretin  described. — Like  idiots,  cretins  may  be  divided  into  three  classes. 
— Description  of  first  class. — The  first,  the  most  numerous  class. — Description  of  se- 
cond class. — Of  third  class. — Cretins  not  necessarily  born  such. — Organism  develops 
very  slowly. — Relative  proportion  of  cretins  and  idiots. — Examination  of  the  crania 
of  idiots  obtained  with  great  difficulty. — (Description  of  one  belonging  to  Dr.  H.  A. 


446  IDIOCY. 

Grant,  of  Hartford,  Conn.) — Opinions  of  authors  respecting  the  causes  of  cretinism  va- 
rious.— Views  of  several  authors  noticed. — Opinion  of  M.  Bayle  in  respect  to  the  in- 
fluence of  water  in  the  production  of  cretinism. — Opinion  of  M.  Vyn. — Immediate 
cause  as  obscure  as  the  predisposing  and  remote. — Opinions  of  authors  respecting. — 
Probable  cause,  the  influence  to  which  infants  are  subjected. — Do  cretinism  and  goitre 
depend  upon  the  same  cause  .' — Cretinism  diminishing. — Causes  assigned. — Albinos. — 
Definition  of  term,  and  description  of  the  person  of  albinos. — Usually  found  in  con- 
nection with  the  goitrous  and  idiotic. — Born  of  parents  of  every  variety  of  complex- 
ion.— Intellectual  and  physical  characteristics. — Natives  of  all  countries. —  Synonyms. 
— Testimony  of  ancients  respecting  albinos. — Characteristics,  physical  and  intellectual, 
of  the  parents  of  albinos. — History  of  Roche. — Cagots. — Signification  of  term. — Pro- 
vincial appellations  of. — Degradation  of  those  wretched  beings  for  centuries,  extreme. 
— Considerations  with  respect  to  savage  races  of  men. — Conclusion. — Cases  in  illustra- 
tion of  the  history  of  idiocy,  giving  an  account  of  the  mental  and  physical  condition 
of  idiots,  together  with  a  description  of  their  physiognomy,  and  daily  habits. — Seve- 
ral autopsies. 

Much  confusion  pervades  the  writings  of  all  those  authors,  vi'ho  have  treated 
the  subject  of  mental  alienation,  relative  to  idiocy,  (idiotism).  Confining 
themselves  to  appearances,  they  have  confounded  idiots  with  persons  in  a  state 
of  dementia,  and  reciprocally ;  sometimes  even,  with  monomanics.  Because  the 
latter,  absorbed  by  a  few  fixed  ideas,  seem  to  be  plunged  into  a  state  of  stupor, 
or  because  the  understanding  of  others  seems  to  be  obliterated,  they  have  con- 
cluded that  all  were  idiots.  Sauvages,  Sagar,  and  Vogel,  have  denominated 
idiocy  amentia,  imhecillitas,  ingenii,  fatuitas,  and  Linnaeus  has  called  it  moro- 
sis.  Cullen  and  Fordere,  innate  dementia.  Dufour  and  Pinel  have  consti- 
tuted it  a  variety  of  insanity,  which  they  designate  by  the  appellation  of  idiot- 
ism. Notwithstanding,  our  celebrated  Professor  distinguishes  idiocy  from 
dementia,  only  by  the  degree  of  change  in  the  understanding,  and  defines  de- 
mentia, the  abolition  of  thought;  and  idiocy,  the  obliteration  of  the  intellectual 
and  affective  faculties.  He  often  speaks  of  the  latter,  as  of  the  most  advanced 
degree  of  dementia ;  and  relates  facts,  from  which  it  appears  evident  that  he 
entertained  no  very  clear  notions  respecting  these  two  infirmities  of  the  mind. 
Finally,  he  admits  an  acquired,  and  also  a  connate  form  of  idiocy.  The  word 
Idlog^  privatus,  solitarius,  expresses  the  condition  of  a  man,  who,  deprived  of 
reason,  is  isolated  in  some  sort,  from  the  rest  of  creation.  From  the  word 
idiota,  idiot,  idiotism  has  been  deduced  ;  but  as  the  latter  word  has  already  a 
grammatical  signification,  it  has  seemed  to  me  advisable,  to  substitute  for  it, 
the  word  idiocy,  and  devote  it  to  the  language  of  medicine.  Idiocy  is  not  a 
disease,  but  a  condition  in  which  the  intellectual  faculties  are  never  manifested  ; 
or  have  never  been  developed  sufficiently  to  enable  the  idiot  to  acquire  such 
an  amount  of  knowledge,  as  persons  of  his  own  age,  and  placed  in  similar  cir- 
cumstances with  himself,  are  capable  of  receiving.  Idiocy  commences  with 
life,  or  at  that  age  which  precedes  the  development  of  the  intellectual  and 
affective  faculties  ;  which  are,  from  the  first,  what  they  are  doomed  to  be,  dur- 
ing the  whole  period  of  existence.  Every  thing  about  the  idiot  betrays  an  or- 
ganization imperfect,  or  arrested  in  progress  of  development.  We  can  con- 
ceive of  no  possibility  of  changing  this  state.  Nothing  teaches  us  how  to 
impart,  for  a  few  moments  even,  to  the  wretched  idiot,  an  increase  of  reason 
or  intelligence.  He  never  reaches  an  advanced  age, — rarely  surviving  more 
than  thirty  years, — and  on  laying  open  the  brain,  we  almost  invariably  dis- 
cover vices  of  conformation. 

Dementia  and  idiocy  differ  essentially ;  otherwise,  the  principles  of  every 
classification  are  illusory.  Like  mania  and  monomania,  dementia  only  com- 
mences with  puberty ;  and  has  a  period  of  increase  which  is  more  or  less 


IDIOCY.  447 

rapid.  Both  chronic  and  senile  dementia,  increase  from  year  to  year,  by  the 
decay  of  the  organs,  and  the  successive  loss  of  some  faculty.  Every  symp- 
tom betrays  physical  weakness ;  all  the  features  are  relaxed,  and  the  eyes  are 
dull,  and  downcast.  If  the  demented  person  desires  to  act,  it  is  because  he 
is  impelled  by  a  fixed  idea,  which  has  survived  the  general  loss  of  intelli- 
gence. We  can  cure  dementia,  and  conceive  the  possibility  of  suspending  its 
symptoms.  There  is  indeed,  a  diminution  and  privation  of  the  energy  requi- 
site for  the  exercise  of  the  faculties,  but  those  faculties  exist  still.  Moral 
shocks,  as  well  as  certain  medicaments  may  revive,  and  excite  sufficient 
strength  to  produce  the  manifestation  of  certain  ideas  and  affections.  Other 
means  also,  may  remove  the  obstacles  which  prevent  this  manifestation.  If  a 
person,  who  has  fallen  into  a  state  of  dementia  does  not  die  immediately,  he 
may  live  a  long  time,  and  reach  a  very  advanced  age.  On  examining  the 
body,  we  sometimes  meet  with  organic  lesions,  but  they  are  accidental ;  for 
the  thickening  of  the  bones  of  the  cranium,  and  the  separation  of  their  ta- 
bles, coinciding  with  senile  dementia,  do  not  characterize  vices  of  conforma- 
tion. It  is  the  same  with  the  alterations  and  changes,  which  the  cerebral  sub- 
stance undergoes  in  the  progress  of  age. 

A  man  in  a  state  of  dementia  is  deprived  of  advantages  which  he  formerly 
enjoyed ;  he  was  a  rich  man,  who  has  become  poor.  The  idiot,  on  the  con- 
trary, has  always  been  in  a  state  of  want  and  misery.  The  condition  of  a 
man  in  a  state  of  dementia  may  change ;  that  of  the  idiot  is  ever  the  same. 
The  latter  retains  many  of  the  features  of  infancy  :  while  the  former  pre- 
serves much  of  the  physiognomy  of  the  adult  man.  In  the  case  of  both,  the 
sensations  are  null,  or  nearly  so.  The  man  who  is  in  a  state  of  dementia 
however,  indicates  in  his  organization,  and  even  in  his  intelligence,  something 
of  his  past  perfection  ;  while  the  idiot  is,  what  he  always  was ;  and  is  all  that 
he  can  be,  so  Jong  as  his  organization  remains  unchanged. 

From  this  comparison,  have  we  not  a  right  to  conclude  that  an  affection, 
the  epoch  of  whose  invasion  is  constant  (infancy),  which  presents  special 
symptoms,  the  prognosis  of  which  is  always  unfavorable,  and  which  presents 
organic  changes  which  are  peculiar  to  it,  offers  a  collection  of  features,  suffi- 
cient to  distinguish  it  from  every  other  malady? 

But  there  are  persons,  who  appear  to  be  deprived  of  sensibility  and  under- 
standing ;  who  are  destitute  of  ideas,  words,  and  the  power  of  motion  ;  who 
remain  where  they  are  placed ;  whom  it  is  necessary  to  dress,  and  feed  with  a 
spoon.  Are  not  these  idiots?  Not  necessarily.  These  are  not  the  actual 
symptoms ;  and  it  is  not  one  epoch  only  of  a  disease,  which  can  furnish  an 
abstract  idea  of  it.  On  the  contrary,  it  is  necessary  to  study  this  malady  dur- 
ing all  its  periods,  each  of  them  being  capable  of  furnishing  certain  diagnos- 
tic indications.  I  once  made  a  drawing,  and  gave  the  history  of  a  girl,  who 
presented  all  the  symptoms  which  are  ordinarily  regarded  as  the  signs  of  idi- 
ocy.    She  was  terrified,  and  fear   enchained  the  exercise  of  all  her  faculties. 

I  once  had  in  charge  a  young  man,  twenty-seven  years  of  age,  who,  deceived 
by  a  woman,  and  having  been  unable  to  obtain  a  situation  which  he  desired, 
after  an  attack  of  mania,  fell  into  a  state  of  apparent  idiocy.  The  face  of  this 
patient  was  flushed,  and  his  eyes  fixed  or  vague  in  their  expression.  It  was 
necessary  to  dress  and  undress  him,  and  to  put  him  in  bed.  He' ate,  only 
when  food  was  conveyed  to  his  mouth.  His  arms  hung  by  his  side,  and  his 
hands  were  tumefied.  Though  always  standing,  he  walked  only  when  obliged 
to,  and  appeared  to  possess  neither  sensation  nor  thought.  Leeches  applied 
to  the  temples,  tepid  baths,  cold  douches  upon  the  head,  and  particularly,  a 
general  eruption  over  the  surface,  cured  him.  After  his  cure,  he  informed 
me  that  an  internal  voice  said  to  him  :  stir,  and  you  are  last;  fear  rendered 
him  motionless. 


448  IDIOCY. 

The  sensibility  and  intelligence  are  not  therefore  extinct ; — the  manifesta- 
tion of  these  faculties  being  prevented  by  various  motives, — of  which  the  pa- 
tient gives  an  account  when  cured.  Whilst  giving  my  clinical  course  in  1822, 
we  had  at  the  Salpetriere,  a  Mad'e  B.,  who  seemed  to  be  in  a  profound  stupor, 
and  completely  insensible.  She  remained  motionless  near  her  bed,  and  never 
spoke.  I  often  pinched  and  pricked  her,  without  her  manifesting  the  least 
degree  of  pain.  I  ordered  a  seton  to  be  inserted  in  the  nape,  and  several 
blisters  were  applied  on  various  parts  of  the  body  ;  the  same  insensibility  be- 
ing always  manifested,  the  same  obstinate  silence,  and  the  same  unwillingness 
to  walk.  On  one  occasion,  this  girl  did  not  appear  at  our  visit ;  after  which 
period,  we  were  unable  to  persuade  her  to  remain  in  the  dormitory  at  the  hour 
of  the  clinic.  When  cured,  she  informed  me  that  a  pupil  had  pinched  her. 
She  was  offended  by  this  impertinence,  which  was  allowable  in  me,  but  im- 
proper on  the  part  of  the  pupils  ;  and  resolved  not  to  permit  it  to  be  again  re- 
peated. Certain  monomaniacs,  controlled  by  erotic  or  religious  ideas,  present 
the  same  symptoms.  In  all  these  cases,  the  sensitive  and  intellectual  faculties 
are  clearly  and  energetically  exercised, — appearances  deceiving  us, — as  there 
is  no  idiocy.  From  the  man  who  enjoys  the  use  of  his  sensitive  and  intellec- 
tual faculties,  but  who,  in  consequence  of  a  feeble  organization,  is  placed  in 
the  lowest  rank  of  social  and  intellectual  life,  to  that  of  idiocy,  there  are  de- 
grees innumerable.  Who  could  point  out  and  describe  every  shade  in  the  de- 
scent, from  the  man  who  thinks  to  the  idiot  who  is  destitute,  even  of  the  in- 
stincts of  our  nature  1  Nevertheless,  in  studying  facts,  we  may  class  idiots 
in  two  series,  in  which  they  may  all  be  included.  The  former  embraces  im- 
beciles ;  the  latter,  idiots  properly  so  called.  In  the  first  class,  the  organiza- 
tion is  more  or  less  perfect ;  the  sensitive  and  intellectual  faculties  are  some- 
what developed  ;  sensations,  ideas  and  memory,  as  well  as  the  affections, 
passions,  and  even  inclinations  exist;  but  only  in  a  slight  degree.  They  feel, 
think,  speak,  and  are  capable  of  acquiring  a  certain  amount  of  education. 

In  the  second  series,  the  organization  is  incomplete;  the  senses  are  scarcely 
developed ;  and  sensibility,  attention  and  memory  are  nul,  or  nearly  so. 
Idiots  have  a  very  small  number  of  limited  ideas,  beside  their  passions  for  the 
supply  of  instinctive  wants ;  which  are  expressed  by  certain  gestures,  words, 
monosyllables  or  cries.  Reason  does  not  control  their  actions ;  which  are 
kw,  and  repeated,  either  from  habit  or  the  force  of  imitation. 

JFHrst  variety. — Imbecility. — Imbeciles  are  generally  well  formed,  and  their 
organization  is  nearly  normal.  They  enjoy  the  use  of  the  intellectual  and 
affective  faculties,  but  in  a  less  degree  than  the  perfect  man,  and  they  can  be 
developed  only  to  a  certain  extent.  Whatever  education  they  may  receive, 
imbeciles  never  reach  the  degree  of  reason,  nor  the  extent  and  solidity  of 
knowledge,  to  which  their  age,  education  and  social  relations,  would  other- 
wise enable  them  to  attain.  Placed  in  the  same  circumstances  with  other 
men,  they  do  not  make  a  like  use  of  their  understanding.  M.,  thirty-seven 
years  of  age,  belongs  to  a  family,  who  enjoy  an  immense  fortune.  His  mo- 
ther, during  her  pregnancy  with  him,  experienced  long  seasons  of  disquietude, 
and  keen  moral  sufferings.  His  head  presents  nothing  remarkable.  His  hair 
is  abundant,  and  his  eyes  small  and  without  expression.  In  his  physiognomy, 
there  is  something  vague,  uncertain  and  sad.  The  organic  developments  took 
place  at  a  later  period  than  is  usual  with  children.  He  scarcely  walked  at  the 
acre  of  four  years.  At  five,  he  pronounced  a  few  words ;  and  at  six,  could 
talk.  Incapable  of  attention,  his  petulence  was  extreme.  It  was  long  before 
he  learned  to  read  and  write ;  nor  could  he  ever  read  connectedly,  nor  write 
a  letter,  however  short,  nor  remember  what  he  read.  They  attempted,  but  in 
vain,  to  teach  him  one  of  the  mechanic  arts.     He  learned  a  little  music,  and 


IDIOCY.  449 

sang  certain  airs ;  but  his  stock  of  knowledge  was  exceedingly  limited.  He 
was  excessively  timid,  and  until  the  age  of  eighteen  years,  dared  not  leave, 
alone,  the  paternal  mansion.  After  that  period,  he  was  accustomed  to  run 
about  at  random  in  the  fields,  to  talk  much,  and  even  became  a  babbler  ; 
always  speaking  irrelevantly  with  respect  to  the  subject  of  conversation.  He 
frequently  employed  one  word  for  another.  Always  cheerful,  he  was  accus- 
tomed to  laugh  without  a  motive,  and  sometimes  by  himself.  He  passed  a 
portion  of  the  day,  either  sitting  or  lying  down ;  and  it  was  only  by  conside- 
rable effort  that  he  set  himself  in  motion ;  but  once  started,  he  knew  not  when 
to  stop.  He  was  never  able  to  combine  other  ideas  than  those  which  are  in 
constant  use.  He  never  formed  a  project,  merely  living  from  day  to  day.  He 
was  incapable  of  managing  his  business,  or  of  directing  an  enterprise.  At 
the  age  of  thirty-seven  years,  his  intelligence  was  certainly  inferior  to  that  of 
a  child  of  ten  years,  notwithstanding  the  care  that  had  been  taken  to  develop 
it.  At  puberty,  he  manifested  none  of  the  passion  proper  to  that  age.  He 
lived  alone  in  the  country,  not  thinking  that  his  mode  of  life  could  be  diffe- 
rent and  more  agreeable.  The  extent  of  his  intelligence  will  be  understood 
from  the  following  fact.  His  physician  told  him  he  must  mount  a  horse. 
Accordingly  he  daily  spends  an  hour  in  mounting  and  dismounting  one  of  his 
father's  horses ;  not  suspecting  that  it  was  a  ride  on  horse-back  that  had  been 
ordered.     Chance  discovered  this  mode  of  obeying  the  doctor's  command. 

Whilst  in  charge  of  the  ward  for  the  insane  at  the  Bicetre,  in  1821,  a 
rachitic  imbecile  died,  who  was  of  a  very  diminutive  stature,  and  whose  cra- 
nium was  very  small  and  narrow ;  while  the  face  was  largely  developed.  His 
physiognomy  was  very  changeful,  and  even  intellectual.  His  countenance 
wore  the  expression  of  a  cynical  smile,  and  resembled  much  that  of  the  most 
celebrated  personage  of  the  last  century,  as  it  respected  the  fecundity  and 
cynical  character  of  his  mind.  This  imbecile,  at  the  time  of  his  death,  was 
thirty-four  years  of  age,  and  had  been  an  inmate  of  the  Bicetre  for  quite  a 
number  of  years.  He  spent  his  life  in  doing  and  saying  malicious  things,  and 
in  playing  tricks  on  those  about  him.  He  yielded  himself,  in  a  horrible  de- 
gree, to  the  practice  of  masturbation.  On  the  very  evening  of  his  death,  he 
was  surprised  on  his  bed,  endeavoring  to  gratify  this  fatal  inclination.  He 
had  never  learned  either  to  read  or  write,  or  any  trade.  He  was  very  chatty, 
and  his  repartees  were  the  more  surprising,  as  he  was  habitually  accustomed 
to  speak  incoherently,  incessantly,  without  any  connection  of  ideas,  and 
always  irrationally.  He  walked  much,  ate  voraciously,  was  filthy  in  his  habits, 
and  careless  of  his  clothing.  A  cast  in  plaster,  of  the  head  of  this  imbecile, 
taken  after  death,  presented  the  following  admeasurements. 

Circumference  .....       10.73  in. 

From   the  root  of  the  nose  to  the  tuberosity  of  the  occi- 
pital bone         .....  12.00    " 
Antero-posterior  diameter       .              .              .              .         6.65    " 
Bi-temporal  diameter      .              .              .              .  5.14    " 


Total  .....        40.52 

R.  was  eleven  years  of  age  at  the  time  of  her  admission  at  the  Salpetriere, 
and  nineteen  when  I  committed  her  case  to  writing.  Her  head  is  remarkably 
regular ;  the  forehead  is  high  and  large ;  the  frontal  protuberances  are  well 
developed ;  the  facial  line  approaches  ninety  degrees ;  the  hair  is  thick  and 
black  ;  the  eyes  large  and  blue ;  the  nose  slightly  flattened ;  and  the  teeth 
handsome  and  regular.  The  cheeks  are  plump,  the  physiognomy  mild,  some- 
what expressive,  and  the  skin  white  and  supple.  The  limbs  also  are  well 
developed.     Admeasurement  of  the  head,  taken  while  living : 

57 


450 


IDIOCY 


Circumference  .....       19.56 

From  the  root  of  the  nose  to  the  occipital  protuberance  14.28 
Antero-posterior  diameter       .  .  .  .7.12 

Bi-temporal  diameter        ....  5.74 


m. 


Total  .....        46.70 

R.  usually  sits  with  her  knees  crossed,  her  hands  beneath  her  apron,  and  is 
almost  constantly  raising  or  depressing  her  shoulders.  Her  physical  health  is 
good,  and  she  has  a  good  appetite.  She  is  a  gourmand,  worrying  herself 
much  about  what  she  shall  have  to  eat  at  her  meals ;  and  if  she  sees  one  of 
her  companions  eating,  cries,  and  calls  for  something  for  herself  Whilst  with 
her  parents,  she  was  accustomed  to  escape  and  run  to  the  shop  of  a  pastry- 
cook who  lived  near,  and  devour  the  first  pie  that  she  saw.  She  was  also  in 
the  habit  of  entering  a  grocer's  shop,  seizing  upon  the  bottles  of  liquor,  and  if 
they  attempted  to  prevent  her  from  drinking,  dashed  them  upon  the  ground. 
Her  step  is  slow,  and  if  any  one  approaches  her,  she  raises  her  head  awk- 
wardly, and  turns  her  eyes  to  see  who  is  coming. 

She  understands  every  thing  that  is  said  to  her.  She  has  a  little  memory, 
and  relates  certain  facts  which  she  heard  while  at  home.  She  replies  correctly 
and  slowly,  in  a  lisping  and  stifled  tone  of  voice.  She  asks  few  questions  ; 
but  demands  her  repasts,  articles  for  the  toilet,  dolls,  etc.  She  sings  certain 
airs,  is  acquainted  with  the  value  of  money,  counts  it,  and  preserves  it  to  buy 
dainties  and  toys.  She  is  cheerful  when  her  mother  pays  her  a  visit,  and  is 
regarded  by  strangers  as  a  domestic.  She  is  fond  of  dolls,  with  which  she 
amuses  herself,  but  does  not  preserve  them ;  leaving  them  wherever  she  hap- 
pens to  go.  She  is  timorous  and  frightened  at  the  least  noise.  She  is  also 
mild  and  diffident ;  and  if  dressed  in  a  manner  more  than  usually  tidy,  is  delight- 
ed, and  displays  herself  to  every  one.  Full  of  vanity,  she  is  very  sensible  to  flat- 
tery, and  smiles  with  complacency  when  her  person  is  commended.  She  is 
cunning  and  conceited.  On  wetting  her  bed,  as  she  sometimes  does,  she  de- 
fends herself,  and  accuses  the  servant  girls  of  it.  She  detests  her  room-mate, 
who  is  a  mute,  and  poorly  clad.  She  has  been  caught  thrusting  needles  into  a 
blistered  surface,  which  had  been  made  upon  the  person  of  her  wretched  com- 
panion. She  knew  her  letters  and  could  read  a  few  words.  On  seeing  one 
write,  she  takes  the  pen,  as  if  desirous  of  making  the  attempt.  Her  mother 
could  never  learn  her  to  sew,  knit,  or  take  charge  of  household  matters ;  still 
less  to  read  connectedly,  or  write.  Though  she  dresses  herself  alone,  she  calls 
for  the  assistance  of  a  servant  girl  to  adjust  her  garments  in  a  proper  manner. 
She  is  fond  of  men,  smiles  in  their  presence,  and  runs  after  them.  Notwithstand- 
ing she  is  nineteen  years  of  age,  she  has  never  menstruated.  Her  mother,  while 
pregnant,  had  been  dreadfully  frightened.  The  child  was  born  feeble,  but 
grew  until  two  years  of  age,  when  an  arrest  took  place  in  the  development  of 
the  organs.  She  did  not  walk  until  four  years  of  age  ;  her  understanding  was 
developed  at  a  still  later  period ;  and  she  did  not  talk  until  she  was  seven 
years  old.  With  respect  to  her  reason,  this  imbecile  resembles  a  child  of 
seven  or  eight  years.  It  is  probable  that  in  a  more  favorable  condition,  she 
would  have  acquired  an  amount  of  instruction  which  would  have  permitted 
her,  with  some  degree  of  watchfulness  on  the  part  of  her  friends,  to  live  in 
society. 

P.,  twenty-two  years  of  age,  was  admitted  at  the  Salpetriere,  Aug.  27th, 
1812.  Her  mother  while  pregnant,  experienced  certain  severe  trials.  P.  had 
a  feeble  and  sickly  infancy,  and  learns  to  walk  at  a  very  late  period.  When 
five  years  of  age,  she  suffered  from  a  severe  illness,  resulting,  it  was  supposed, 
from  a  fright.  Since  this  period,  the  progress  of  intelligence  has  ceased,  al- 
though the  organs  are  well  developed.     Her  stature  is  above  the  medium  size, 


IDIOCY.  *  451 

her  step  easy,  slow,  and  somewhat  haughty ;  her  hair  of  a  chestnut  color,  and 
her  forehead  lofty.  Her  eyes  are  blue,  face  flushed,  chin  small  and  sharp, 
teeth  white,  and  well  arranged,  the  occipital  region  well  developed,  the  physi- 
ognomy mild  and  friendly,  skin  fair,  and  the  limbs  well  formed.  The  ad- 
measurements of  the  head,  taken  during  life,  are  as  follows  : 

Circumference 33.66  in. 

Antero-posterior  diameter  .....      7.87  " 

Bi-temporal  diameter      ......  6.10  " 

From  the  curve  at  the  root  of  the  nose,  to  the  occipital 

tuberosity 14.29  " 


Total 61.92  " 

The  menses  appeared  at  thirteen,  and  were  abundant  and  regular  at  fourteen 
years  of  age.  After  that  period,  her  disposition  became  less  amiable,  and  she 
refused  to  labor.  The  sight  of  men  caused  the  color  to  mount  into  her  cheeks, 
and  she  was  accustomed  to  escape  from  the  house  of  her  parents,  to  run  about 
and  play  with  little  boys.  The  intellectual  capacity  of  this  imbecile  is 
considerable.  She  attends  both  to  what  she  sees  and  hears.  She  has  some 
memory,  forms  a  sufficiently  accurate  judgment  respecting  the  most  common 
things,  and  replies  correctly,  but  in  a  hesitating  tone,  to  such  questions  as  are 
addressed  to  her.  In  vain  do  they  endeavor  to  teach  her  to  read  and  labor. 
She  knows  a  few  letters,  and  that  is  all.  She  has  learned  how  to  arrange 
dolls,  and  amuse  herself  with  them.  She  dresses  herself,  combs  her  hair, 
washes  herself,  makes  her  bed,  and  calls  for  a  change  of  linen.  She  goes  for 
her  food,  but  is  unwilling  to  receive  it,  except  in  the  dishes  appropriated  to 
her  use.  Very  haughty,  she  disdains  her  companions  ;  and  notwithstanding 
she  is  habitually  mild,  opposition  irritates  her.  She  is  then  perverse,  abusive 
in  her  language,  and  when  angry,  strikes.  If  any  one  strikes  her,  she  returns 
their  blows  with  interest.  She  is  excessively  obstinate,  and  never  yields.  She 
has  neither  fear  nor  jealousy.  She  walks  much,  and  sports  with  her  com- 
panions. She  is  very  fond  of  her  mother,  caresses  her,  and  if  the  latter  is  long 
absent,  she  becomes  sad.  She  accuses  her  father-in-law,  whom  she  dislikes, 
of  treating  his  other  children  better  than  herself;  and  particularly  of  supply- 
ing them  with  handsomer  clothing.  She  is  observant  of  the  attentions  that 
are  paid  her.  The  sight  of  men  produces  a  strong  impression,  and  she  is  on 
the  watch  for  the  workmen,  when  permitted  to  enter  the  courts  of  the  hos- 
pital. Never  has  she  become  habituated  to  continued  labor.  Her  physiogno- 
my expresses  her  joy,  on  receiving  a  new  dress,  and  she  hastens  to  display 
herself  to  her  companions  and  the  domestics  of  the  house.  When  I  caused 
her  portrait  to  be  taken,  in  consequence  of  the  regularity  in  the  form  of  her 
head,  and  the  harmony  of  the  features  of  her  countenance,  which  contrasted 
with  the  feebleness  of  her  understanding,  she  seemed  to  be  transported  with 
joy.  Nevertheless,  I  found  much  difficulty  in  inducing  her  to  keep  her  seat, 
which  she  was  constantly  disposed  to  leave.  I  was  never  able  to  take  a  cast  of 
her  face ;  for  so  soon  as  she  felt  the  softened  plaster  over  her  eyes,  she  would 
open  them.  She  has  often  essayed  in  vain,  to  keep  her  eyelids  closed,  and 
often  wept  with  mortification  at  her  inability  to  submit  successfully  to  the 
operation. 

Imbeciles  are  incapable  of  attention  ;  their  sensations  are  feeble  and  fuga- 
cious ;  their  memory  dull  and  inaccurate  ;  and  their  will  without  energy. 
They  can  combine  and  compare,  but  are  unable  to  rise  to  general  and  abstract 
notions.  They  are  not,  in  general,  deprived  of  the  power  of  speech  ;  and  if  a 
few  of  them  are  mutes,  they  very  readily  express,  by  the  play  of  their  counte- 
nance and  gestures,  their  thoughts,  desires,  and  wants.     They  learn  to  read 


452  •  IDIOCY. 

and  write,  and  also  music.  They  exercise  the  mechanic  arts,  but  perform  im- 
perfectly every  thing  that  they  attempt.  They  live  in  their  respective  families 
like  strangers  or  great  children.  If  not  directed  in  what  they  do,  in  the  dis- 
charge of  social  usages  and  duties,  and  in  the  administration  of  their  affairs, 
they  become  the  victims  of  their  incapacity  and  improvidence.  Possessing 
little  sensibility,  although  irritable,  they  part  with  their  relatives  without  regret, 
as  well  as  those  who  take  charge  of  them.  Some,  however,  are  very  grateful, 
and  susceptible  of  love  or  hatred  ;  but  their  affections  are  not  durable.  They 
seek  for  sexual  commerce,  often  with  transports.  The  function  of  nutri- 
tion is  well  executed.  To  this  extent  do  imbeciles  possess  aptitudes,  inclina- 
tions and  dispositions,  which  contrast  with  the  feebleness  of  their  organization, 
sensibility  and  intelligence. 

Imbeciles  are  nothing  of  themselves.  They  produce  nothing  ;  and  all  their 
movements,  both  intellectual  and  moral,  are  aroused  only  by  foreign  impulses. 
They  neither  think  nor  act,  but  through  others.  Their  will  is  without  energy. 
They  will  and  do  not  will.  They  cannot  follow  a  conversation,  still  less  a  dis- 
cussion ;  and  know  not  how  to  conduct  a  project  to  its  close.  They  regard  as 
serious,  things  the  most  gay  ;  and  laugh  at  those  that  are  most  sad.  Does 
something  interest  them  ;  their  eyes  are  fixed,  but  they  do  not  see.  They  hear, 
but  do  not  comprehend  ;  although  they  affect  to  have  both  seen  and  under- 
stood. They  reply  correctly  ;  but  you  must  not  ask  them  many  questions,  nor 
require  from  them  responses  which  demand  reflection,  or  are  contrary  to  their 
habits.  Usually  self-satisfied,  they  speak  of  themselves  in  a  tone  indicative  of 
such  a  frame  of  mind ;  or  seek  for  expressions  to  which  their  physiognomy 
does  not  respond.  Their  gestures  and  position  are  odd,  and  rarely  in  harmony 
with  what  they  think  or  say.  Their  management  betrays  them,  as  well  as  their 
development,  which  indicates  a  want  of  capacity,  and  a  determinate  end. 
They  are  deceitful,  mischievous,  liars,  quarrelsome  and  irascible,  but  pol- 
troons. Puffed  up  by  pretensions ;  easily  led  and  controlled ;  incapable  of 
application  and  labor ;  they  are  parasitic  beings ;  of  no  use,  either  to  them- 
selves or  their  fellow-creatures.  If  they  work,  it  is  necessary  to  direct  and 
excite  them  incessantly,  since  they  are  excessively  indolent.  In  hospitals,  these 
imbeciles  are  the  servants  or  laughing-stock  of  every  body.  They  are  the  good 
people  of  the  house,  and  are  called,  more  especially,  imbeciles.  This  variety  is 
denominated  by  authors,  fatuity.  Imbeciles  of  this  character,  present  some 
points  of  resemblance  with  maniacs  without  fury,  in  the  mobility  and  versati- 
lity of  their  ideas,  sentiments,  desires  and  actions. 

There  are  other  imbeciles  however,  who  possess  a  small  number  only  of 
sensations  and  ideas,  and  have  little  memory.  Their  language  also  is  limited. 
They  distinguish  those  with  whom  they  live,  love  their  relatives,  and  are 
mindful  of  the  cares  that  are  extended  to  them.  They  are  passionate, 
thievish,  obstinate  and  peevish.  The  sight  of  a  person  of  the  opposite  sex 
agitates  and  disturbs  them.  They  are  capable  of  receiving  a  trifling  amount 
of  education,  and  it  is  possible,  by  dint  of  effort,  to  develop  that  portion  of 
sensibility  and  understanding  which  they  possess.  Still,  this  education  is 
limited  to  the  ordinary  matters  of  life.  Habit,  and  the  force  of  imitation, 
produce  a  great  effect  upon  their  ideas,  affections  and  acts ;  impressing  upon 
their  mode  of  life  a  kind  of  regularity,  which  it  would  be  wrong  to  regard  as 
the  effect  of  reasoning.  They  provide  for  their  wants,  know  how  to  clothe 
themselves,  procure  nourishment,  and  are  capable  of  performing  ordinary 
household  labors. 

Finally,  there  are  imbeciles,  the  faculties  of  some  of  whom  are  more 
energetic  than  those  of  others,  and  whose  understandings  are  capable  of 
partial  development.  They  have  an  aptitude  only  for  certain  things,  for 
which  they  have  a  decided  taste  and  a  marked  inclination.  They  possess  an 
understanding  for  whatever  relates  to  their  inclinations  and  aptitudes,  and 


IDIOCY.  453 

judge  of  them  very  correctly  ;  but  are  incapable  of  every  thing  else.  They 
sometimes  learn  a  trade,  but  nothing  more.  They  also  learn  to  read,  but 
cannot  write.  They  understand  music  in  some  instances,  and  play  upon  an 
instrument,  but  can  neither  read  nor  write.  You  can  oblige  them,  neither 
to  remember,  reflect  nor  foresee.  They  produce  nothing,  invent  nothing, 
perfect  nothing.     Such  are  partial  imbeciles. 

The  innocence  and  jovial  manners  ;  the  gayety  and  piquant  repartees ; 
the  pleasant  and  sometimes  very  judicious  sallies  of  some  imbeciles  ;  have 
caused  them  to  be  admitted  into  the  presence  of  the  great,  and  even  that  of 
kings,  to  divert  them  from  their  distressing  ennui,  and  to  afford  them  recrea- 
tion. There  is,  in  courts  even,  the  post  of  fool.  All  those  who  discharged 
the  duties  of  this  office  were  not  imbeciles,  some  of  them  being  adroit  rogues. 
If  Triboulet  was  a  witty  imbecile,  Angely  and  Brusquet  were  adroit  knaves, 
who  gave  proof  of  their  intelligence,  by  amassing  immense  fortunes. 

The  custom  of  having  fools  to  entertain  the  great,  reaches  back  into  remote 
antiquity.  History  tells  us  that  Lucius  Junius  Brutus,  simulated  folly  so 
well  that  Aruns  and  Titus,  sons  of  Tarquin,  having  been  sent  to  Delphos 
to  consult  the  oracle,  brought  him  back,  to  make  sport  for  them.  This  ridi- 
culous abuse  was  handed  down  even  to  our  own  time,  and  was  so  general  in 
the  middle  ages,  that  a  council,  held  at  Paris  in  1212,  defended  the  bishops  for 
having  about  their  persons,  fools  to  make  them  laugh.  Charles  V.,  says  Le 
Sage,  caused  a  letter  to  be  written  to  the  mayor  and  magistracy  of  the  city  of 
Troyes,  to  have  them,  as  was  customary,  provide  him  with  a  fool,  Thcvenin, 
his  own  fool  being  dead.  If  the  great  had  their  fools,  the  people  indemnified 
themselves,  by  celebrating  in  different  cities,  what  was  called  the  feast  of  fools. 
Potemkin,  had  for  his  fool,  one  Mosse  who,  according  to  M.  de  Segur,  did 
not  conceal  the  truth  from  his  master. 

Imbeciles  are  usually  timid,  cowardly  and  obedient.  Evil-doers  but  too 
frequently  abuse  their  unfortunate  dispositions,  and  employ  these  wretched 
beings  to  set  fire  to  buldings,  or  commit  some  culpable  act,  by  intimidating 
or  seducing  them,  by  the  allurement  of  a  recompense,  which  flatters  their 
senses  or  appetites.  Since  imbeciles  are  not  deprived  of  all  intelligence,  they 
possess  desires  and  passions  proportioned  to  the  development  of  their  sensi- 
tive and  intellectual  faculties.  They  have  inclinations  more  or  less  imperious, 
and  sometimes  perverse  ones.  They  rob  to  satisfy  their  gluttony ;  to  pro- 
cure articles  for  the  toilet ;  or  from  some  other  motive.  We  saw,  in  the 
chapter  on  Monomania,  the  cases  of  incendiary  imbeciles  described.  At  the 
epoch  of  puberty,  the  instinct  of  reproduction  becomes  developed,  and  imbe- 
ciles become  amorous  ;  yielding  themselves  to  the  practice  of  onanism,  to  a 
degree  the  more  frightful,  as  they  are  ignorant  of  the  evils  to  which  this 
dreadful  habit  exposes  them.  Men  seek  for  women,  girls  become  coquettes, 
and  those  are  often  brought  to  hospitals  between  the  ages  of  fourteen  and 
eighteen  years,  who,  having  attained  to  puberty,  pursue  men,  are  intracta- 
ble, and  regardless  of  the  commands  of  their  parents.  There  was  once  at 
the  Salpetriere  an  imbecile,  who  fulfilled  the  severest  labors  of  the  house,  for 
a  very  trifling  consideration.  In  several  instances,  after  having  obtained  a  few 
sous,  she  carried  them  to  a  working  man,  and  abandoned  herself  to  his  lust ; 
returning  to  him  no  more,  after  she  became  pregnant.  The  following  case 
shows  that  imbeciles  are  not  always  deprived  of  moral  sensibility,  and  are 
capable  of  becoming  melancholies. 

A  girl  whose  name  was  V.,  tall,  with  chestnut-colored  hair,  blue  eyes, 
flushed  face,  a  changeless  physiognomy, — though  sometimes  indulging  in  a 
stupid  laugh, — was  admitted  at  the  Salpetriere  May  27th,  1811,  aged  twenty- 
two  years.  From  early  life,  it  was  observed  that  her  understanding  was  not 
developed  in  proportion  to  the  organic  growth.  She  remained  incapable  of 
articulating  distinctly,  and  could  acquire  nothing.     When  fourteen  she  men- 


454  '  iDiocy. 

struated.  She  grew  tall  rapidly,  and  suffered  from  convulsions,  particularly 
at  the  menstrual  periods,  notwithstanding  the  flow  was  abundant.  At  the 
time  of  her  admission  into  the  hospital,  she  had  the  appearance  of  a  person 
in  the  enjoyment  of  perfect  health,  but  could  not  reply  to  the  most  simple  and 
ordinary  questions,  though  she  endeavored  to  do  so ;  making  a  sign  that  she 
comprehended  them.  She  uttered  cries,  and  often  continued  to  cry  for  a 
quarter  of  an  hour.  Her  appetite  was  good,  and  her  sleep  equally  so.  Her 
dejections  were  often  involuntary.  She  knew  not  how  to  dress  herself,  but 
displaced  nothing,  and  was  mild  and  obedient.  From  the  movements  going 
on  around  her,  she  was  accustomed  to  judge  as  to  the  time  of  rising,  retir- 
ing, or  taking  her  meals.  She  very  readily  found  her  ward  on  returning  from 
her  walk.  In  a  word,  she  had  an  understanding  of  the  primary  wants  of 
existence,  but  nothing  farther.  Though  never  passionate,  she  was  suscepti- 
ble of  ennui.  During  the  month  of  July,  1812,  she  was  struck  by  one  of  her 
companions,  and  was  so  deeply  grieved  in  consequence  of  it,  that  she  was  no 
longer  willing  to  partake  of  any  thing  but  water.  Profound  sighs  often 
escaped  her  ;  she  became  emaciated  ;  scorbutic  patches  appeared  ;  she  grew 
feeble  ;  and  in  the  month  of  September  was  confined  to  her  bed,  and  vomited 
blood.  Refusing  all  nourishment  and  every  remedy,  she  was  seized  with  a 
slow  fever,  and  died  October  31st,  1812. 

At  the  post-mortem  examination,  which  was  made  on  the  1st  of  Nov.,  I 
found  the  cranium  voluminous  and  thickened,  and  the  brow  very  projecting. 
The  facial  angle  measured  more  than  70'~',  the  median  line  of  the  cranial  cavi- 
ty was  warped,  the  dura-mater  very  adherent  to  the  cranium,  the  external 
lamina  of  the  arachnoid  covered  with  a  false  membrane,  resembling  the  fibrine 
of»blood,  a  serous  effusion  into  the  cavity  of  the  arachnoid  which  was  slightly 
injected,  and  serum  at  the  base  of  the  cranium.  The  brain  was  very  dense, 
the  grey  substance  discolored,  and  the  white  injected.  The  membrane  which 
lines  the  lateral  ventricles  had  formed  adhesions  at  several  points ;  a  circum- 
stance which  lessened  their  capacity.  There  were  serous  cysts  in  the  tissue 
of  the  choroid  plexuses.  The  peduncles  of  the  cerebellum,  very  near  the 
annular  protuberance,  were  disorganized ;  their  substance  in  this  portion  was 
greyish  and  puriform  to  the  extent  of  two  or  three  lines  in  breadth,  and  six  or 
seven  in  depth;  the  pineal  gland  appeared  to  be  cartilaginous,  and  the  cere- 
bellum was  very  dense.  The  peritoneum,  particularly  in  the  pelvic  cavity, 
was  dotted  with  small  black  points.  The  ascending  colon  and  ccecum  were 
reddish  externally,  whilst  their  mucous  membrane  was  brown.  The  gall  blad- 
der contained  bile,  inspissated,  grained,  and  very  brown.  The  hymen  closed 
the  entrance  to  the  vagina,  and  the  ovaries  were  very  much  injected. 

Imbeciles  possess  therefore  sensibility,  a  certain  degree  of  intelligence,  and 
a  weak  memory.  They  comprehend  what  is  said  to  them,  make  use  of  speech, 
or  if  mute,  express  themselves  by  signs.  They  are  capable  of  acquiring  a 
certain  amount  of  education,  and  possess  moral  affections :  but  given  up  to 
their  own  control,  they  very  easily  become  degraded.  Imperfectly  nourished, 
and  poorly  protected  from  the  effects  of  the  weather ;  filthy  in  their  habits, 
and  giving  themselves  up  to  errors  of  regimen  ;  their  health  becomes  impair- 
ed ;  the  little  intelligence  with  which  they  were  originally  endowed,  enfeebled ; 
and  at  length,  the  imbecile,  who  is  brought  to  a  hospital,  presents  all  the  cha- 
racteristics of  idiocy. 

Second  variety. — Idiocy. — We  have,  at  last,  reached  the  utmost  limit  of 
human  degradation.  Here,  the  intellectual  and  moral  faculties  are  almost 
null ;  not  that  they  have  been  destroyed,  but  never  developed.  Among  idiots, 
the  want  of  intelligence  and  sensibility,  is  often  in  proportion  to  the  vices  of 
organization.  There  are  merely  the  rudiments  of  intelligence,  and  instinct 
controls  all  the  faculties.     The  power  of  speech  even,  does  not  exist.     In  rare 


IDIOCY.  455 

instances,  we  find  certain  faculties  developed,  and  a  natural  aptitude  for  the 
exercise  of  certain  talents. 

Q,uenau  was  admitted  at  the  Salpetriere  in  1781,  at  the  age  of  ten  years. 
She  had  a  good  constitution,  and  an  ordinary  fulness  of  habit.  The  face  was 
more  fully  developed  than  the  cranium.  The  top  of  the  head  was  depressed, 
the  occipital  portion  small,  the  forehead  flattened  and  receding.  The  follow- 
ing admeasurement  was  taken  during  life  : 

Circumference  .....  20.07  in. 

From  the  curve  at  the  root  of  the  nose,  to  the 

tuberosity  of  the  occipital  bone         .  .  11.33    " 

Antero-posterior  diameter      ....         6.92 
Bi-temporal  diameter        ....  5.63 


li 


Total  .....       43.95 

Her  physiognomy  is  stupid ;  expressing  sufficiently  well  her  disposition  to 
beg.  She  is  constantly  exposed  to  the  air,  whatever  the  weather ;  extending 
her  hand  to  every  one  for  a  few  pieces  of  money,  with  which  she  purchases 
food,  as  she  has  a  craving  appetite.  It  is  necessary  to  dress  her.  When  she 
attempts  to  speak,  she  utters  a  hoarse  cry,  or  a  sort  of  articulate,  jerking 
grunt,  which  she  continues,  until  she  is  understood.  She  comprehends  by  a 
gesture,  what  is  intended  to  be  communicated  to  her ;  provided  it  has  reference 
to  nothing  beyond  the  most  common  wants  of  life.  She  is  grateful  to  the 
nurse  who  attends  upon  her ;  and  to  those  who  give  her  money,  or  food  ;  and 
expresses  her  thankfulness,  by  kissing  her  fingers,  and  raising  her  eyes  up- 
wards. She  understands,  when  spoken  to  slowly,  and  in  a  loud  tone  of  voice. 
Though  habitually  gentle,  she  becomes  angry  when  she  cannot  satisfy  her 
gluttony,  and  tears  all  her  clothing  except  her  chemise,  which  she  preserves 
from  a  sense  of  shame ;  taking  care  to  cover  her  throat  with  her  hands.  She 
has  never  been  able  to  learn  a  trade. 

This  imbecile  is,  notwithstanding,  a  musician.  Does  she  witness  dancing, 
she  leaps  in  time ;  or  does  she  hear  singing,  she  repeats  in  a  rough  voice,  not 
the  words,  but  the  airs,  of  which  she  has  learned  a  great  many.  A  pupil  at 
the  Salpetriere  plays  upon  the  violin  ;  Quenau  follows  the  sound,  and  with  a 
curious  attention,  seeks  from  whence  it  comes,  and  gradually  approaches  the 
musician.  M.  Guerry  improvises  an  air.  She  follows  him ;  retaining  and  re- 
peating it,  when  requested.  He  commences  an  air,  and  she  follows  him  quite 
to  the  close.  M.  Despres,  an  interne  of  the  hospital,  sings  a  complicated  air; 
Quenau  redoubles  her  attention,  fixes  her  eyes  upon  the  pupil,  contracts  her 
features,  and  endeavors  to  put  herself  in  unison  with  the  singer.  Fruits,  of 
which  she  is  extravagantly  fond,  are  placed  at  her  door ;  and  she  manifests, 
both  by  her  looks  and  gestures,  her  desire  to  take  them  ;  but  at  the  moment 
when  she  is  ready  to  lay  hold  of  them,  M.  Despres  beats  time  and  sings.  She 
immediately  begins  to  beat  time  also,  and  abandons  the  fruits,  which  she  seizes 
upon  with  avidity,  so  soon  as  the  singing  ceases.  Does  one  play  upon  the 
flute,  Q,uenau  is  all  ear.     So  attentive  is  she,  as  to  repeat  the  airs  played. 

On  the  25th  of  August,  1833,  M.  Litz,  at  the  invitation  of  M.  Leuret,  with 
pleasure  assisted  in  the  following  experiments,  which  were  made  in  presence 
of  Doct.  Mitivie,  in  the  study  of  M.  Pariset,  physician  of  the  division  of  the 
insane  at  the  Salpetriere.*  M.  Litz  improvises  several  airs.  Q,uenau  takes 
them  up,  but  experiencing  difficulty  in  repeating  them, — her  voice  being  inca- 
pable of  reaching  the  pitch   in  which  this   celebrated   musician   sang ; — her 

*  M.  Leuret  published  a  detailed  account  of  this  experiment,  with  the  phrenological 
history  of  Quenau  in  the  Medical  Gazette,  for  the  year  1836. 


456  IDIOCY. 

features  express  both  the  effort  and  inconvenience.  M.  Litz  touches  the  pia- 
no :  duenau  is  motionless ;  her  eyes  watching  the  fingers  of  the  great  per- 
former ;  or  else  she  commences  a  sort  of  convulsive  movement ;  turning  her- 
self in  various  directions ;  biting  her  fists  ;  stamping  with  her  foot ;  raising 
her  eyes  upward  ;  and  using  every  effort  to  put  herself  in  unison.  The  tran- 
sition from  a  grave  to  an  acute  sound,  provokes  a  sudden  contraction  of  all 
the  muscles,  as  if  she  was  agitated  by  an  electrical  discharge.  This  last  expe- 
riment was  repeated  more  than  twenty  times,  and  always  with  the  same  result. 
Doct.  Leuret  induces  her  to  leave  the  study,  and  shows  her  some  apricots. 
As  soon,  however,  as  M.  Litz  touches  the  piano,  she  returns,  and  while  the 
instrument  is  to  be  heard,  her  eye  is  fixed  upon  the  musician,  and  she  returns 
to  the  apricots  only  when  the  music  ceases.  Notwithstanding  this  singular 
musical  capacity,  her  cranium  does  not  offer  the  protuberance  pointed  out  by 
Gall,  as  indicating  the  organ  of  music.  On  the  15th  of  January,  1837,  Q,ue- 
nau,  at  the  age  of  sixty-six  years,  died  of  acute  pneumonia.  At  the  post-mor- 
tem examination,  which  was  made  by  M.  Mitivie,  physician  to  the  division  of 
the  insane  at  the  Salpetriere  ;  it  was  shown  that  the  scalp  was  somewhat  thick- 
er on  the  left  than  the  right  side,  that  the  median  line  inclined  to  the  right, 
that  the  pia-mater  was  slightly  infiltrated,  and  that  the  brain,  which  was  some- 
what soft,  presented  no  remarkable  lesion.  The  lung  presented  changes, 
characteristic  of  the  disease  of  which  she  had  died. 

G.  is  admitted  at  the  Salpetriere  in  1813,  at  the  age  of  nineteen  years.  She 
is  of  small  stature,  and  moderately  full  habit.  Her  head  is  very  voluminous, 
and  its  conformation  irregular.  The  forehead  is  remarkably  high,  large  and 
projecting ;  and  the  frontal  protuberances  are  very  prominent,  particularly  the 
left.  The  facial  angle  is  more  than  ninety  degrees.  Her  hair  is  a  blond, 
the  eyes  small,  of  a  chestnut  color,  and  concealed  beneath  her  arching  eye- 
brows. She  is  cross-eyed  ;  her  mouth  is  large,  teeth  white,  and  her  complexion 
swarthy  and  sun-burnt.  Her  physiognomy  is  convulsive,  and  habitually  ex- 
presses mildness  and  joy.  The  following  dimensions  were  taken  while  the 
subject  was  still  living : 

Circumference  of  head            .....  20.63  in. 
From  the  curve  at  the  root  of  the  nose,  to  the  occipi- 
tal tuberosity 12.91  " 

Antero-posterior  diameter       .....  7.28  " 

Bi-temporal  diameter          ..:...  5.90  " 


Total 46.72 

She  eats  gluttonously,  and  without  discretion ;  crowding  forward  with  her 
fingers,  the  food  which  she  has  accumulated  in  her  mouth ;  still  not  possessing 
sufficient  intelligence  to  go  for  it,  at  the  hours  of  distribution.  The  dejections 
are  involuntary,  and  the  menses  abundant  and  regular.  She  walks  little;  all 
her  movements  being  convulsive.  She  draws  along  the  left  side  of  the  body, 
and  uses  her  left  arm  with  difficulty.  It  is  necessary  to  dress  her  when  she 
wets  up,  and  to  put  her  to  bed  like  a  child.  She  is  insensible,  and  protects 
herself  neither  from  the  heat,  cold  nor  rain.  She  recognizes  the  nurse  who 
attends  upon  her,  often  embraces  her,  expresses  her  joy  and  recognition  of  her 
by  kissing  her  hand,  smiling,  and  shaking  her  head.  Her  disposition  is  ex- 
tremely mild  and  good.  If  a  disturbance  occurs  at  any  time,  she  goes  and 
informs  the  person  in  charge.  She  is  obedient,  as  well  as  very  obstinate. 
She  takes  care  to  cover  her  throat  whilst  being  dressed,  and  if  a  wish  seems  to 
be  manifested  to  raise  her  garments,  she  removes  the  offending  hand.  Never- 
theless, she  does  not  blush ;  showing  that  she  does  not  possess  the  sentiment  of 
shame  ;  and  the  indications  of  decency  which  she  manifests,  are  the  result  of 


IDIOCY.  457 

habits  contracted  in  infancy.  She  articulates  the  following  syllables  only  ; 
pa-pa,  ma-ma,  which  she  repeats  on  every  occasion,  as  well  to  express  her 
anger,  as  to  testify  her  joy.  She  constantly  carries  in  her  right  hand  some 
rags  rolled  up  into  the  staape  of  a  doll ;  and  to  testify  her  satisfaction  or  resent- 
ment, she  strikes  it  violently,  several  times  in  succession,  upon  the  right  tem- 
ple. She  has  retained  a  fragment  of  a  popular  air,  which  she  sings  often,  over 
and  over  again,  with  an  expression  of  satisfaction.  The  condition  of  this  fe- 
male remained  a  long  time  stationary ;  but  within  four  years  she  has  made 
some  slight  intellectual  advancement.  She  now  goes  after  her  own  food,  calls 
for  it  if  forgotten,  and  rejects  what  does  not  suit  her.  Her  dejections  are  in- 
voluntary (*ly  during  the  night.  In  the  day-time  she  goes  to  the  privy.  She 
articulates,  though  imperfectly,  certain  words,  which  she  employs  to  express 
her  desires.  She  exerts  herself  to  repeat  what  she  hears,  without  being  able 
to  effect  her  purpose.  She  makes  numerous  grimaces ;  seeming  to  attach  to 
them  ideas,  which  she  (»nnot  otherwise  express- 

M.  v.,  is  the  offspring  of "  a  mother  who,  during  pregnancy,  remained  in  a 
state  of  stupor.  Notwithstanding  the  cares  lavished  upon  his  infancy,  his 
health  was  very  feeble,  and  it  was  not  until  he  was  six  years  of  age  that,  one 
day  while  playing,  he  suddenly  pronounced  the  word  papa.  When  seven 
years  of  age,  he  had  a  very  severe  attack  of  cerebral  fever,  which,  however, 
did  not  prevent  the  development  of  the  organs,  but  was  followed  by  a  serious 
disturbance  of  the  intellectual  and  affective  faculties,  and  arrested  their  devel- 
opment, already  so  feeble  and  backward.  After  this  period  he  becomes  irrita- 
ble and  turbulent.  He  tears,  breaks,  strikes  and  spits  upon  those  who  ap- 
proach him,  and  utters,  both  night  and  day,  piercing  and  plaintive  cries.  He 
is  easily  frightened  ;  noise,  the  sight  of  animals,  etc.,  producing  this  effect. 
Some  one  having  called  him  a  hog,  he  remembers,  and  still  frequently  repeats 
the  word ;  employing  it  on  every  occasion.  When  ten  years  of  age,  he  was 
placed  at  the  Institution  for  the  deaf  and  dumb  at  Paris,  without  results  favo- 
rable to  the  development  of  his  understanding.  At  a  later  period,  he  was 
placed  at  a  private  hospital,  and  at  length  committed,  several  years  since,  to 
a  lady  who  lives  in  the  country,  and  who  takes  the  utmost  care  of  this  wretch- 
ed child.  When  seventeen  years  of  age,  his  stature  is  27.75  inches.  The 
vertebral  column  is  slightly  curved  in  the  dorsal  region.  The  top  of  the 
head  is  slightly  depressed ;  the  hair  of  a  deep  chestnut  color,  abundant,  harsh 
and  bristling  ; — a  circumstance  which  prevents  one  from  judging  of  the  flatten- 
ing of  the  vertex.  The  eyes  are  blue,  the  look  mild,  the  mouth  largely  cleft, 
and  the  lower  lip  thick.  The  physiognomy,  though  habitually  convulsive,  is 
not  wanting  in  expression,  and  is  sometimes  sad  and  melancholy.  The  coun- 
tenance is  wrinkled,  in  consequence  of  his  habitual  grimaces.  The  following 
are  the  admeasurements  of  the  head  taken  from  the  living  subject  : 

Circumference        ,             .             .             .             ,  21.53  in. 
From  the  curve  at  the  root  of  the  nose  to  the  occi- 
pital tuberosity          ....  12.99    " 
Occipito-frontal  diameter  ....         7.08    " 
Bi-temporal  diameter                 .              .              .  5.99    " 


Total         .  .  .  .  .       47.-59 

His  limbs  are  well  developed,  and  his  skin  white.  He  often  suffers  from 
furuncles  on  different  regions,  and  from  aphthm  in  the  mouth.  His  appetite 
is  not  strong,  and  he  prefers  vegetables  to  meats.  He  likes  to  be  properly 
served,  though  he  conducts  with  little  propriety  himself;  as  he  is  constantly 
spitting  about  him  during  his  repast,  even  upon  his  plate  cover.     If  a  new 

58 


458  IDIOCY. 

dish  is  served  up  to  him,  he  carries  his  fingers  to  his  mouth,  to  indicate  that 
they  may  give  it  him  to  taste.  He  does  so,  and  if  it  is  not  acceptable, 
pushes  it  aside.  On  the  contrary,  he  testifies  great  impatience  to  have  it,  if 
it  is  to  his  taste.  His  sleep  is  often  interrupted  by  cries,  and  lasts  only  from 
one  to  three  hours.  This  young  man  was  never  able  to  learn,  either  to  read, 
write,  or  speak.  Notwithstanding,  some  of  the  intellectual  faculties  acted  to 
a  certain  extent.  He  recognizes  very  readily,  both  persons  and  places.  He 
combines  certain  ideas,  and  though  he  does  not  speak,  articulates,  in  his  own 
way,  certain  sounds,  of  which  he  forms  words,  to  which  he  attaches  a  signifi- 
cation. Thus  he  says  pa  pa  paa,  ma  ma  maa,  and  applies  these  syllables  to  the 
lady,  who  has  charge  of  him.  He  says  also  ho  ho  jour,  me  me,  ont  taking  the 
hand  of  those  persons  who  approach  him,  and  whom  he  knows.  He  is  exces- 
sively mobile,  being  constantly  in  motion,  and  suffering  from  a  tremulous 
movement  in  all  his  limbs.  He  is  perpetually  in  mischief;  spitting  upon 
those  around  him,  pinching,  patting,  kicking,  and  th»)wing  them  down  ;  and 
afterwards  laughing.  When  he  wishes  to  play  a  trick  upon  any  one,  he 
assumes  a  mild  and  friendly  tone,  in  order  to  induce  them  to  approach  him. 
While  walking  in  the  country,  he  approaches  near  to  those  whom  he  meets  ; 
spits  upon  them,  and  escapes,  laughing  and  uttering  a  cry,  M  hi  hi.  On 
returning  from  his  walk,  he  hastens  to  reach  home  first,  and  conceals  himself, 
in  order  to  impose  upon  some  of  the  people  of  the  house.  Every  object  and 
person  that  he  has  not  seen  before,  interest  him.  If  a  stranger  enters  the 
house  in  which  he  lives,  he  cries  and  struggrles,  until  he  has  been  recognized 
by  some  one  of  his  associates.  Before  passing  from  one  place  to  another,  he 
looks  attentively,  as  if  to  reassure  himself  by  this  exploration. 

He  is  sensible  of  the  good  that  is  done  him,  and  becomes  irritated  by  im- 
proper proceedings.  "  He  is  mild,  diffident,  and  timid.  If  opposed,  he  carries 
his  complaints  to  the  lady  who  has  charge  of  him;  repeating  at  the  same  time, 
the  monosyllables  ma  ma  ma.  A  female  servant  having  struck  him  upon  the 
arm,  he  remains  irritated  during  the  whole  day ;  crying  every  moment  ma  ma 
ma;  pointing  by  turns,  to  the  arm  that  had  been  struck,  and  also  to  the  ser- 
vant who  inflicted  the  blow;  and  becoming  composed,  only  when  the  latter, 
after  a  rebuke,  manifested  regret.  On  hearing  a  carriage,  he  says  brrr,  wish- 
ing doubtless  to  imitate  the  sound  of  wheels.  He  once  pronounced  the  name 
of  his  father,  whom  he  had  not  for  a  long  time  seen.  He  was  formerly  afraid 
of  animals,  but  no  longer  fears  them  ;  caressing  the  horses,  and  playing  with 
the  house  dog.  He  is  at  all  times  agitated,  and  disposed  to  lacerate  his  per- 
son, although  he  fears  the  injury.  Within  a  year  particularly,  he  has  torn  his 
lips  ;  dashed  his  head  against  the  walls  and  furniture  ;  and  struck  himself  with 
his  fists  in  his  eyes.  He  would  be  disposed  to  onanism  were  he  not  watched ; 
and  makes  attempts  to  touch  both  men  and  women. 

M.  de  G.,  is  another  idiot,  thirty-six  years  of  age,  who  was  admitted  at  Cha- 
renton  Aug.  6th,  1825.  Whilst  pregnant,  his  mother  experienced  a  severe 
moral  affection.  His  stature  is  a  little  above  the  medium  size ;  he  is  of  ordi- 
nary fulness  of  habit,  his  head  of  a  beautiful  conformation,  his  hair  of  a  chest- 
nut color,  and  his  eyes  grey :  his  forehead  is  large,  high  and  open..  His  phy- 
siognomy is  gentle,  and  vague ;  yet  more  expressive  than  the  extent  of  his 
understanding  would  seem  to  indicate. 

Great  circumference 
Antero-posterior  curve 
Transverse  curve 
Antero-posterior  diameter 
Transverse  diameter 

Total  ....  64.07 


22.44 

13.89 

13.38 

7.87 

6.49 

IDIOCY.  459 

The  limbs  are  well  formed,  and  his  head  is  habitually  inclined  toward  the  earth. 
The  trunk  inclines  slightly  forward,  the  fore-arms  are  flexed,  and  the  fingers  con- 
stantly bent ;  the  thumb  of  the  left  hand  alone  being  extended.  The  hands,  also 
closed,  are  affected  with  a  kind  of  convulsive  tremblincr.  When  he  walks,  he 
approaches  walls  or  trees,  in  order  to  rub  his  garments  against  them.  When 
he  descends  a  stair-way,  or  a  sloping  ground,  he  walks  slowly,  and  endeavors 
to  support  himself,  throwing  his  body  backward  and  his  arms  in  front.  The 
motion  of  his  fingers  and  arms,  the  balancing  of  his  head  and  trunk  from  be- 
fore backward,  give  to  his  attitude  something  altogether  peculiar.  His  health 
is  good,  the  functions  of  nutritive  life  are  satisfactorily  executed,  and  his  appe- 
tite is  excellent.  He  eats  his  soup  with  a  spoon,  but  if  his  bread  and  other 
food  are  not  cut  into  morsels,  he  becomes  impatient,  goes  around  the  table, 
takes  the  meat  in  his  fingers,  looks  at  it,  puts  it  again  upon  his  plate,  takes  it 
up  again,  carries  it  to  his  mouth,  and  after  making  certain  vain  efforts  to  divide 
it,  throws  it  upon  the  floor.  If  his  food  is  cut  in  pieces,  he  takes  it  with  a 
spoon,  not  knowing  how  to  use  a  fork. 

It  was  with  much  difficulty  that  they  accustomed  him  to  wear  a  cap,  and 
take  care  of  his  shoes,  stockings  and  gloves.  Some  years  sioce,  while  making 
his  toilet,  he  was  wounded  at  the  end  of  one  of  his  fingers ;  since  which,  he 
conceals  his  fingers,  whenever  any  one  attempts  to  touch  them.  It  is  to  him  a 
great  trial  to  have  his  nails  pared,  and  his  feet  washed.  It  is  necessary  to  con- 
fine his  gloves  to  his  wrists,  which  makes  him  sad.  He  looks  steadily  at  his 
hands,  and  makes  great  efforts  to  free  himself  from  this  appendage.  Incapable 
of  unbuttoning  his  clothes,  if  he  has  a  want  to  satisfy,  he  goes  to  his  own,  or 
some  other  attendant,  (never  to  the  patients),  asks,  by  signs,  their  assistance, 
and  goes  with  them  to  the  privy.  If  there  is  no  domestic  at  hand,  he  goes 
out  alone,  but  being  unable  to  undo  his  clothing,  soils  himself;  when  he  dares 
not  again  go  out,  until  some  one  comes  to  cleanse  and  bring  him  in.  He  rises 
from  his  bed  at  night,  evacuates  the  bowels  or  bladder  upon  the  middle  of  the 
floor  of  his  chamber,  and  again  retires.  He  sleeps  well  ;  retiring  and  rising 
at  fixed  hours.  When  the  hour  for  getting  up  arrives,  he  informs  his  atten- 
dant by  striking  together  his  teeth.  If  the  servant  delays,  he  leaps  from  his 
bed,  and  walks  about  in  his  shirt.  If  desired  to  remain  in  bed,  he  becomes 
impatient.  When  he  retires,  he  takes  the  bolster  in  his  arms,  turns  upon  his 
face,  laughs  aloud  several  times,  and  goes  to  sleep.  He  was  never  able  either 
to  read  or  write,  or  to  articulate  the  least  sound ;  although  he  was  not  deaf 
He  distinguishes  both  persons  and  things,  of  which  he  has  daily  observation. 
He  recognizes  his  attendant  without  difficulty,  as  well  as  those  persons  who 
manifest  an  interest  in  him ;  looks  for  them  again,  and  smiles  at  their  ap- 
proach ;  while  he  flies  from  others,  and  looks  sad  when  they  come  near  him. 
He  is  very  submissive,  both  to  the  gestures  and  voice  of  his  attendant,  whom 
he  servilely  obeys.  Until  the  age  of  twenty-one  years,  he  was  accustomed  to 
sing  incessantly,  without  articulating  any  sound.  At  this  epoch  however,  he 
ceased  to  sing,  after  an  attack  of  acute  articular  rheumatism.  Notwithstand- 
ing, music  still  produces  a  powerful  impression,  and  strongly  excites  him. 
The  excitement  is  proportionate  to  the  number  and  noise  of  the  instruments. 
On  endeavoring  to  make  him  hear  the  sound  of  a  flute,  he  seemed  to  be 
scarcely  sensible  of  it.  When,  on  the  contrary,  he  hears  loud-sounding  music, 
he  bursts  into  a  fit  of  laughter,  and  dances  or  leaps  almost  in  time.  Since  the 
period  of  puberty,  the  presence  of  women  exercises  upon  him  a  remarkable 
influence,  though  less  energetic  than  music.  On  being  embraced  one  day,  by 
a  lady  who  paid  him  certain  special  attentions,  his  joy  and  excitement  were 
not  augmented,  although  his  countenance  was  expressive  of  "satisfaction.  He 
is  an  onanist.  He  refrains  during  the  day,  because  he  is  watched ;  but  when 
in  bed,  if  left  alone,  he  abandons  himself  to  this  fatal  practice ;  ceasing  so 
soon  as  he  is  spoken  to,  or  perceives  that  he  is  observed.     It  has  been  noticed. 


460  IDIOCY. 

that  on  being  put  upon  his  bed  without  any  covering,  he  abstains.  Is  it  fear 
or  shame  that  restrains  him?  This  is  not  his  only  vicious  inclination.  He 
robs  the  sick  of  their  wine,  and  is  very  careful  to  conceal  himself  both  from 
them  and  the  attendants. 

E.,  aged  twenty-three  years,  is  of  small  stature,  but  large,  thick  set,  and 
provided  with  much  fatty  cellular  tissue.  The  forehead,  rising  at  a  right  angle, 
is  flattened.  The  temporal  regions  are  prominent.  Her  hair  is  abundant,  of 
a  chestnut  color,  and  harsh.  Her  eyes  are  dark,  small,  crossed,  and  almost 
constantly  convulsed ;  which  causes  them  to  be  directed  upward.  Her  physi- 
ognomy is  mild,  and  somewhat  expressive.  The  arms  are  short,  slightly 
rigid,  and  move  convulsively.  She  is  unable  to  open  her  hands  completely. 
The  fingers  are  almost  invariably  flexed,  and,  as  it  were,  contracted;  being 
capable  of  extension,  only  one  by  one,  and  then  slowly,  and  with  effect. 
Ordinarily  the  index  only  remains  extended.  The  head  rises  rounding  to  its 
summit,  and  is  flattened  from  before  backward ;  so  that  the  fronto-occipital 
diameter  is  less  than  the  bi-temporal ;  as  the  admeasurements  of  the  head, 
taken  upon  the  living  subject,  indicate. 

Circumference        .  .  .  ._       .     .  20.00  in. 

From  the  curvature  at  the  root  of  the  nose  to  the  • 

occipital  tuberosity  ....  11.81    " 

Antero-posterior  diameter  .  .  .  6.10    " 

Bi-temporal  diameter    ....  6.33   " 


Total  .....       44.24 

She  is  well  nourished,   though  she  eats    sparingly.      Her  dejections  are 
easy,  and  her  menses  regular.     Her  gait  is  painful ;  waddling  and   hesitating. 
She  moves  with  little  assurance,  and  remains  habitually  in  a  sitting  posture. 
Her  sensations  are  fugacious,  and  she  has  little  memory.      She  recognizes 
persons  whom  she  often   sees,  and  knows   how  to  count  as  far  as  twenty  and 
beyond.     If  one   asks  for  a  certain  number,  she  shows,  in  her  way,  as  many 
fingers  as  there  are  units  in  the  number  demanded.     She  knows  the  value  of 
certain  pieces  of  coin,  and  distinguishes  the  utensils  that   she  is  asked   for,  if 
they  are  at  hand.     She  is  fond,  both  of  flowers  and  fruits.     She  does  not  speak  ; 
but  understands,  and  goes  to  seek   the  object,  the  name  of  which  has  been 
mentioned  to  her.     She  never  learned   to  talk.     She  expresses  her  thoughts 
and  affections  by  two  sounds,  the  one  prolonged,  hihihiii ;  the  other,  hehehee, 
which  she  forms  by  hastening  the  respiration,    and  modulates  variously,  ac- 
cording to  what  she  desires  to  express.     The  affective  qualities  predominate 
in  this  case.     She   is  very  affectionate,   and   attaches  herself  to  those   with 
whom   she   resides,  especially  to  those  who  have  the  care  of  her.     She  came 
from  the  Orphan's  Hospital  with  an  imbecile,  with  whom  she  is  pleased,  and 
shares  her  food,  with  whatever  else  is  given  her.     If  any  one  of  her   compan- 
ions commits   an  act   which  leads  to  enquiries,  she    interests  herself  in   it. 
She  is  timid,  very  modest  and   always  decently  clad.     She  testifies  her  affec- 
tion  after   the   manner   of  certain    animals :    by   approaching  those  who  are 
the  objects  of   it,  rubbing  herself  against  them,  panting,  and  making  many 
gestures. 

Aba  is  an  idiot  of  the  Bicetre,  about  thirty  years  of  age.  His  stature  is 
below  the  medium  size,  his  limbs  well  formed,  his  head  large  enough,  but 
flattened  posteriorly  ;  the  forehead  is  low,  the  nose  broad  and  flat,  the  mouth 
laro-e,  and  the  physiognomy  vague,  uncertain,  and  without  expression.  He 
sometimes  seems  to  meditate.  Sometimes,  his  physiognomy  expresses  a 
slight  smile,  and  a  malicious  aspect,  particularly  when  he  beholds  strangers. 
His  head,  on  being  measured,  presents  the  following  proportions  : 


20.98 

in 

7.20 

(< 

6.10 

a 

12.59 

a 

IDIOCY.  461 


Circumference        ..... 
Occipito-frontal  diameter 

Bi-temporal  diameter  .... 

From  the  curve  at  the  root  of  the  nose  to  the  occi- 
pital protuberance 

Total         .....       46.87 

His  physical  health  is  good  ;  his  movements  are  free  ;  he  eats  slowly,  and 
often  stops  in  the  attitude  of  a  man  who  thinks,  fears,  is  astonished,  and 
curious  ;  which  emotions  however,  soon  cease.  He  soils  his  bed.  The  sen- 
sibility and  understanding  of  this  idiot  were  arrested,  so  to  speak,  in  their 
rudimentary  state.  His  sensations  are  slight  and  temporary.  Attention  is 
very  feeble,  and  can  be  brought  to  bear  but  upon  a  small  number  of  objects ; 
and  the  memory  is  almost  null.  He  comprehends  somethings  that  are  said  to 
him ;  for  instance  ;  to  wash  himself,  and  to  go  to  bed.  He  occasionally 
makes  some  noise  by  rubbing  the  teeth  together,  and  seems  to  be  pleased  by 
it.  He  knows  the  attendant  who  has  charge  of  him,  but  does  not  speak. 
He  merely  pronounces  in  a  low  tone,  the  syllables  ba,  ha,  ha,  which  he  repeats 
on  every  occasion.  He  has  contracted  certain  habits  like  the  following  :  he 
dresses  himself;  goes  after  his  food,  and  retires  to  answer  to  the  calls  of  na- 
ture. He  collects  all  the  little  motes  which  settle  upon  his  arm,  or  which 
he  finds  upon  the  garments  of  others.  I  presented  to  him,  says  M.  Leuret, 
physician  to  the  division  of  the  insane  at  the  Bicetre,  who  communicated 
this  case  to  me,  a  piece  of  money.  He  smiled  on  receiving  it,  looked  at  it, 
turned  it  over  and  over,  put  it  to  his  mouth,  and  then  handed  it  back  to  me. 
I  show  him  apples,  and  he  takes  them  with  manifest  pleasure.  He  nibbles 
one  of  them,  at  first  round  and  round,  but  finally  swallows  it,  even  to  the 
seeds.  I  extend  my  hand,  in  order  that  he  may  give  me  one  of  them,  and  he 
understands  ;  presenting  me  the  apple  which  he  is  eating,  but  without  letting 
go  of  it.  I  repeat  the  act ;  he  presents  me  a  piece,  and  retires  smiling.  An 
attendant  takes  one  of  them  from  him,  and  leaves  the  chamber  in  which  we 
were.  Aba  follows  him  with  his  eyes;  but  having  lost  sight  of  him,  appears 
to  have  no  farther  recollection  of  him.  After  some  minutes  the  servant 
re-enters,  and  Aba  extends  to  him  his  hand  for  his  apple. 

Aba  is  an  onanist  as  well  as  a  thief;  robbing,  even  with  address,  particular- 
ly articles  of  food  ;  and  the  vice  is  carried  in  his  case,  to  a  very  considerable 
extent.  He  had  one  day  robbed  a  companion  of  his  food,  who,  in  order  to 
punish  him,  endeavored  in  the  contest  to  plunge  his  head  in  a  bucket  of  cold 
water.  Aba  was  thrown  down,  and  one  of  his  arms  fractured.  During  the 
efforts  at  reduction,  he  manifested  no  pain,  and  even  seemed  to  smile.  Did 
he  suffer  ?  He  often  showed  me  the  injured  arm,  while  the  apparatus  was 
upon  it,  and  some  time  indeed,  after  its  removal. 

Matteau,  at  the  age  of  ten  years,  was  admitted  at  the  Salpetriere,  May  7th, 
1836,  and  the  following  observations  made  in  1837.  She  is  both  rachitic  and 
epileptic.  Though  she  was  the  offspring  of  a  bandy-legged  father,  her  mother 
had  given  birth,  both  before  and  after  her  confinement  with  M.,  to  healthy, 
and  well  formed  children.  The  stature  of  this  idiot  is  51.02  inches.  Her 
hair  is  of  a  light  chestnut  color,  her  eyes  blue,  eyebrows  blond,  and  her  look 
fixed,  and  without  expression.  Her  eyelids,  usually  in  motion,  are  sometimes 
closed,  as  if  she  slept.  The  forehead  is  low,  and  the  supra-orbital  protube- 
rances, salient.  She  has  a  rounded  snub-nose.  The  inferior  lip  is  large  and 
pendant,  and  the  physiognomy,  ordinarily  stupid,  becomes  animated,  only 
when  expressing  pain.     The  admeasurements  of  the  head,  are  as  follows  : 


19.13 

in 

10.63 

a 

6.85 

11 

4.68 

a 

462  IDIOCY. 


Circuinference  .... 

Frontooccipital  curve      .... 
Antero-posterior  diameter 
Bi-temporal  diameter        .... 

Total        .....  41.29 

We  notice,  in  the  case  of  this  idiot,  a  deviation  of  the  spine  to  the  left ;  an 
ulcer  about  the  size  of  a  twenty-five  cent  piece,  occupying  the  middle  of  the 
back,  and  a  vast  cicatrix,  extending  over  a  great  portion  of  the  left  posterior 
region  of  the  trunk,  the  neck  and  superior  extremity,  and  over  the  posterior 
and  superior  part  of  the  thigh  of  the  same  side.  This  ulcer,  and  these  cica- 
trices, are  the  result  of  a  fall  into  the  fire  during  an  epileptic  seizure,  to 
which  she  has  been  subject,  from  the  age  of  seven  years.  When  eighteen 
months  old,  this  girl  suffered  from  convulsions,  which  arrested  her  physical  and 
intellectual  development. 

On  her  arrival  at  the  hospital,  she  refused  all  nourishment,  and  passed  nei- 
ther urine  nor  fecal  matter,  for  three  days ;  after  which  variola  made  its  ap- 
pearance. The  course  and  termination  of  the  latter  affection,  were  regular. 
After  that  period,  the  epileptic  attacks  occurred  daily,  and  were  sometimes, 
five  or  six  in  number,  during  the  twenty-four  hours.  She  is  habitually  motion- 
less; her  head  inclined  to  the  right,  or  resting  upon  the  breast,  and  the  fore- 
head reposing  upon  the  knees.  One  of  her  arms  hangs  by  her  side ;  the  hand 
strongly  flexed  upon  the  forearm,  and  the  fingers  upon  the  hand.  The  other 
is  usually  in  the  mouth;  the  lips  performing  the  action  of  suction,  either  upon 
the  hand,  or  the  arm  of  the  chair  in  which  she  is  fastened.  If  permitted  to 
stand  up,  she  totters,  and  sits  down  awkwardly  upon  the  ground.  However, 
she  sometimes  leaves  her  seat,  and  takes  a  few  steps.  If  touched  at  any  time, 
she  utters  piercing  cries,  opening  widely  her  mouth,  and  knitting  the  eye- 
brows. She  often  cries  during  the  night.  A  stranger  to  the  noise  which  she 
makes,  she  is  not  disturbed  either  by  singing,  cries  or  noise.  She  knows 
those  who  have  charge  of  her,  and  caresses  them.  Is  she  shown  the  door, 
and,  at  the  same  time,  informed  that  her  brother  has  arrived ;  she  turns  her 
eyes  slightly  in  the  direction  indicated.  She  only  pronounces  the  words  pa 
pa,  ma  ma,  and  sometimes  the  syllables  coc  coc,  at  the  same  time,  regarding 
the  sun.  She  is  incapable  of  putting  on  her  clothes,  and  of  entertaining  any 
notions  of  propriety,  or  any  consciousness  of  her  wants.  When  she  witnesses 
the  distribution  of  food  among  her  companions,  she  opens  her  mouth,  and  ex- 
tends her  hand,  as  if  to  demand  her  share.  Finally,  she  eats  much,  voracious- 
ly, and  without  discernment.  Her  dejections  are  involuntary,  and  she  yields 
herself  to  the  practice  of  onanism. 

Before  analysing  the  cases  which  precede,  in  order  to  deduce  from  them 
general  views  respecting  idiocy,  ought  we  not,  by  new  facts,  to  reach  that  de- 
gree of  idiocy,  which  is  the  extreme  limit  of  human  degradation,  in  which 
even  instinct  no  longer  exists ;  that  limit  at  which  man,  deprived  of  every 
attribute,  is  no  longer  any  thing  more  than  a  monster  which  vegetates  ?  Pinel 
has  published  the  history,*  together  with  a  design  of  the  cranium  of  an  idiot, 
who  was  at  the  Salpetriere  in  1805.  It  resembled  the  sheep,  both  in  its  tastes, 
its  mode  of  life,  and  the  form  of  its  head.  She  had  an  aversion  to  meat,  and 
eat,  with  avidity,  both  fruits  and  roots ;  drinking  nothing  but  water.  Her 
demonstrations  of  sensibility,  of  joy  or  grief,  were  limited  to  the  repeating  of 
the  words,  imperfectly  articulated ;  be,  ma  tate.     She  would  alternately  flex 

*  A  Treatise  on  Mental  Alienation,  Paris,  1809,  in  8vo.  p.  179. 


IDIOCY.  463 

and  extend  the  head,  and  rub  it  against  the  breast  of  her  nurse.  If  she  de- 
sired to  resist,  or  express  her  dissatisfaction,  she  sought  to  strike,  with  the 
crown  of  the  head  inclined.  She  was  extremely  choleric,  and  many  times, 
I  saw  her  in  the  bath,  making  efforts  to  get  out,  and  repeating  in  an  acute 
tone,  be,  he,  he.  The  back,  loins  and  shoulders  were  covered  with  flexible  and 
black  hair,  from  one  to  two  inches  in  length.  She  could  never  be  induced  to 
sit  in  a  chair,  or  upon  a  bench,  even  to  take  her  food.  No  sooner  was  she 
seated,  than  she  slipped  down  upon  the  earth,  and  was  accustomed  to  sleep 
with  her  extremities  closely  gathered  about  her,  after  the  manner  of  animals. 
Pinel  examined  this  case,  and  furnished  us  with  the  dimensions  of  the  head 
of  this  idiot,  compared  with  those  of  the  cranium  of  a  little  girl  of  seven 
years : 

Idiot  of  11  years.         Girl  of  seven  years. 

Length  of  cranium  .  .  .       5.11  in.         .         7.08  in. 

Breadth  ....  3.53  "  .         5.11  " 

Depth  .  .  .  .       5.11   "  .         6.29 


<< 


'Gall  has  in  his  collection,  and  exhibited  at  his  lectures,  a  plaster  cast  of  the 
head  of  an  idiot,  resembling  in  every  particular,  that  published  by  Pinel.* 

The  state  of  degradation  of  some  idiots  is  such,  that  they  are  deprived  of 
certain  of  the  senses,  do  not  possess  the  instinct  of  self-preservation,  and  lead 
a  life  which  is  altogether  negative.  We  had  at  the  Salpetriere  in  1812,  an 
idiot  who  was  found  lying  by  the  dead  body  of  her  mother,  who  was  supposed 
to  have  been  dead  for  three  days.  On  being  sent  to  the  hospital,  June  20th, 
by  order  of  the  police,  this  idiot,  who  was  twenty-seven  years  of  age,  very 
much  emaciated,  very  pale,  rachitic,  blind,  and  deaf  and  dumb,  uttered,  from 
time  to  time,  an  acute,  although  inarticulate  and  stifled  cry.  Her  limbs  were 
atrophied,  and,  being  drawn  up  under  the  thighs, — she  could  not  walk.  It  was 
necessary  to  convey  liquid  aliments  into  the  mouth,  and  even  so  far  as  the 
(Esophagus.  She  knew  neither  how  to  chew  nor  swkllow.  She  was  nourished 
with  broth  and  wine,  and  died  at  the  expiration  of  a  few  days.  The  weight  of 
the  dead  body  was  forty-three  pounds  ;  the  bones  of  the  cranium  spungy,  and 
very  thin;  being  only  from  .11  to  .15  of  an  inch  in  thickness.  The  brain, 
which  was  atrophied,  did  not  possess  half  its  original  weight,  and  the  convolu- 
tions were  narrow,  close  and  shallow.  The  cortical  substance  was  discolored, 
and  the  white  very  dense,  and  yellowish.  The  lateral  ventricles,  very  slightly 
developed,  were  destitute  of  serum.  I  was  unable  to  preserve  the  skeleton  ; 
the  bones  being  destroyed  by  maceration. 

In  1817,  there  died  at  the  same  hospital,  an  idiot  twenty-five  years  of  age, 
who  was  deaf,  dumb,  blind  and  rachitic.  She  could  not  rest  upon  the  back, 
in  consequence  of  the  vicious  conformation  of  the  trunk ;  and  not  having  the 
instinct  to  change  her  position,  it  was  necessary  to  turn  her  from  time  to  time, 
now  upon  one  side,  and  now  upon  the  other.  If  placed  in  a  sitting  posture, 
she  had  not  the  strength  requisite  to  maintain  it,  and  allowed  herself  to  fall 
down  again.  When  food  was  conveyed  to  her  mouth,  her  lips  and  head  were 
slightly  moved,  as  if  to  withdraw  them  from  the  article  which  was  presented 
her.  By  crowding  the  spoon  into  her  mouth,  the  jaws  separated,  but  it  was 
necessary  to  carry  it  quite  to  the  oesophagus,  in  order  that  the  food  might  reach 
the  stomach.  Always  sitting  upon  the  haunches  in  bed,  she  loved  to  be  cover- 
ed, even  in  summer.  If  the  coverings  were  removed,  she  uttered  a  harsh  cry, 
and  endeavored  to  replace  them  with  her  hand;  but  if  they  were  not  near,  she 
ceased  her  efforts,  and  remained  gathered  up  in  bed.     She  was  accustomed  to 

*  Functions  of  the  Brain. 


464  IDIOCY. 

pronounce  very  imperfectly,  rarely,  and  without  motive,  the  syllables  md,  md, 
especially  when  touched.  If  she  perceived  any  one  approaching  her,  she  ut- 
tered a  cry  similar  to  that  of  a  cross  dog,  which  she  once  repeated,  whenever 
they  commenced  feeding  her.  She  died  four  months  after  her  admission  into 
the  hospital.  The  following  is  the  result  of  a  post-mortem  examination.  The 
head,  at  first  sight,  does  not  appear  very  irregular,  but  is  small,  and  the  occi- 
pital region  compressed.  The  forehead,  slightly  elevated,  and  depressed  late- 
rally, retreats  immediately  above  the  superciliary  arches.  The  two  eyeballs, 
present  no  trace  of  organization,  and  the  crystalline  lens  is  very  small,  hard, 
opake,  and  of  a  dull  white  color.  The  two  superior  conoidal  teeth  are  double, 
and  fixed,  the  one  before  the  other.  The  bones  of  the  cranium  are  thin  and 
spungy,  and  very  easily  cut.  On  exposing  the  dura-mater,  the  convolutions 
are  not  apparent,  and  a  fluctuation  is  experienced  beneath  the  meninges. 
The  latter  being  cut,  a  large  quantity  of  serum  flows  forth,  contained  in  the 
lateral  ventricles,  which  were  dilated,  at  the  expense  of  nearly  the  entire  cere- 
bral substance.  The  pia-mater  is,  in  some  sort,  invested  by  a  stratum  of  cere 
bral  substance,  of  not  more  than  25  or  30  millimetres  (.98  or  1.18  inches)  in 
thickness.  The  folds  of  cerebral  substance  which  separate  the  two  ventricles, 
the  cornua  Ammonis,  and  the  corpora  striata  are  destroyed.  The  corpus  cal- 
losum  is  very  dense  and  slightly  yellow,  the  optic  thalami  are  atrophied,  and 
their  gray  substance  of  an  ash  color.  The  optic  nerves  are  reduced  to  the 
neurilema  merely.  The  lungs  are  contracted  and  atrophied,  although  crepi- 
tating. The  heart,  which  is  small,  and  its  muscular  substance  pale,  is  easily 
torn.  The  skeleton,  which  I  have  preserved  in  my  collection,  is  very  remarka- 
ble.    The  cranium,  on  being  measured,  furnishes  the  following  proportions : 

Entire  height  of  the  skeleton  .  .  .       41.73  in. 


Circumference  of  the  cranium  .  .  18.89  in. 

From  the  curvature  at  the  root  of  the  nose  to  the  occi- 
pital tuberosity  .....        10.43    " 
Antero-posterior  diameter         .  .  .  6.18    " 

Bi-temporal  diameter  ....         5.35    " 


Total,  embracing  only  the  four  last  numbers     .  40.85  in. 

The  spine  presents  a  curvature,  which  is  concave  towards  the  left,  and  ex- 
tends from  the  eleventh  to  the  twenty-first  vertebra.  A  second  curvature  in 
the  opposite  direction,  is  formed  by  the  lumbar  vertebrte,  whose  apophyses  are 
firmly  united.  The  ribs  of  the  left  side,  proceed  directly  forward  from  their 
angular  points,  and  those  of  the  right  instead  of  being  convex  externally, 
project,  by  their  convexity,  into  the  thoracic  cavity.  The  sternum  projects 
almost  horizontally,  and  its  abdominal  apophyses  is  wanting.  The  pelvic 
bones  have  not  the  normal  form.  The  iliac  portions  are  convex  towards  the 
pelvic  cavity,  and  separated  anteriorly,  to  the  extent  only  of  1.57  of  an  inch. 
The  pubic  portions,  projected  anteriorly,  approach  each  other  so  nearly,  that 
they  touch  at  some  points ;  whence  it  results,  that  the  pelvic  basin  is  almost 
obliterated.  The  lower  extremities  are  slender,  and  all  the  bones  present  nodo- 
sities, numerous  false  unions,  and  defects  of  ossification.  The  left  thigh  is 
larger  and  shorter  than  the  right,  and  slightly  twisted  towards  its  inferior 
extremity.  The  heads  of  the  thigh  bones  are  atrophied,  and  that  of  the  right 
is  only  .39  of  an  inch  in  extent.  The  corresponding  cotyloid  cavity  does  not 
exist.  The  humerus,  as  well  as  the  radius  and  ulna,  present  several  swellings 
and  adhesions.  The  lower  jaw,  ribs,  scapulae,  the  metacarpal  bones,  and  cer- 
tain of  the  phalanges  of  the  left  side ;  together  with  the  bones  of  the  metatar- 


IDIOCY.  465 

sus,  present  numerous  vices  of  conformation,  resembling  consolidated  frac- 
tures. The  skeleton  is  very  light ;  the  bones  have  lost  their  polish,  are 
rough,  fatty  and  yellowish.  The  bones  of  the  cranium  are  spungy  and  thin ; 
being  only  from  4  to  6  millimetres  (.15  to  .23  of  an  inch)  in  thickness. 

During  the  same  year,  there  was  brought  into  the  division  of  the  insane  at 
the  Salpetriere,  an  idiot  who  had  been  found  in  one  of  the  bateaux,  which  de- 
scend from  the  Bourgogne  to  Paris.  She  appeared  to  be  about  twenty  years 
of  age,  and  was  both  deaf  and  dumb.  The  abdomen  was  greatly  distended 
with  serum.  Her  head  was  small,  inclining  to  the  right.  The  eyes,  which 
were  blue,  remained  open  and  fixed,  the  dilated  pupils  not  contracting.  The 
eye-lids  did  not  close  on  the  approach  of  light.  Nevertheless,  this  idiot  seem- 
ed to  look,  as  children  are  accustomed  to  do,  when  they  begin  to  see.  She 
manifested  besides,  no  sign  of  sensibility,  whether  she  was  touched  or  pinched, 
or  the  coverings  by  which  she  was  surrounded,  were  removed.  The  dejec- 
tions were  serous,  frequent  and  involuntary.  When  liquid  aliment  was  pre- 
sented in  a  spoon  to  her  lips,  she  was  accustomed  to  open  wide  her  mouth, 
and  keep  it  open,  so  long  as  fluids  were  poured  into  it,  which  it  was  necessary 
to  convey  to  the  fauces,  in  order  that  they  might  pass  into  the  stomach.  She 
did  not  shut  her  lips,  until  two  or  three  minutes  after  they  had  ceased  to  feed 
her.  The  body  reposed  upon  the  left  hip,  in  such  a  way  that  she  could  not 
extend  herself  upon  the  bed,  but  remained  there  slightly  inclined,  sustained  by 
pillows,  and  maintained  this  position,  having  neither  instinct,  nor  the  power  to 
change.  She  died  at  the  expiration  of  a  month,  without  serious  suffering,  and 
on  opening  the  body,  we  found  the  left  ventricle  of  the  brain  distended  with 
serum,  which  had  taken  the  place  of  the  cerebral  lobe  of  the  same  side,  which 
no  longer  existed.  The  convolutions  of  the  right  lobe  were  extremely  small, 
shallow,  and  much  compressed  ;  the  right  ventricle  being  almost  obliterated. 
The  cerebral  substance,  which  was  very  dense,  and  stretching  rather  than 
tearing,  was  of  a  dirty  white.  The  cerebellum  was  small,  and  remarkably 
hard,  particularly  the  gray  substance,  which  was  almost  friable,  at  the  surface 
of  this  organ.  The  arachnoid  was  infiltrated  and  thickened,  without  adhe- 
sions. The  gray  substance  of  the  remaining  portions  of  the  organ,  was  pale. 
The  lungs  were  atrophied,  and  compressed  into  the  superior  portion  of  the 
chest;  and  the  pleurae  contained  serum,  as  well  as  the  peritoneal  cavity.  The 
heart  was  small  and  very  soft.     The  muscles  were  pale,  and  easily  torn. 

The  skeleton  of  this  idiot,  which  makes  a  part  of  my  collection,  is  remarka- 
ble for  its  lightness,  and  the  enormous  curvature  of  the  vertebral  column,  as 
well  as  the  peculiar  direction  of  the  pelvis,  and  the  narrowness  of  the  left 
cavity  of  the  thorax.  The  head  is  small,  a  little  inclined  to  the  right,  and 
more  developed  in  the  direction  of  its  depth  than  breadth.  The  cranium  is 
flattened  at  the  sides,  and  a  little  depressed  anteriorly.  The  forehead  is  nar- 
row, retreating  rapidly,  and  presents  at  its  middle  portion  an  unequal  swel- 
ling, circumscribed  by  a  circular  depression.  The  coronal  suture  is  not  en- 
tirely closed.  The  thickness  of  the  bones  of  the  cranium, — of  which  I  shall 
furnish  the  admeasurements, — is  only  from  three  to  four  millimetres  (.11  to 
.15  of  an  inch.) 

Measure  of  the  cranium. 
Circumference           .....  17.32  in. 
From  the  curvature  at  the  root  of  the  nose,  to  the  pos- 
terior margin  of  the  occipital  foramen               .  10.03  " 
Antero-posterior  diameter      ....  5.98  " 
Bi-temporal  diameter        .             ...             .  4.60  " 


Total  .....       37.93 

59 


466  IDIOCY. 

The  cervical  portion  of  the  vertebral  canal,  is  nearly  straight,  but  twisted 
in  some  sort  upon  itself;  whence  it  happens,  that  the  bodies  of  the  superior 
vertebree  are  turned  to  a  trifling  extent  to  the  right,  which  occasions  the  devi- 
ation of  the  head  to  the  same  side.  The  inferior  half  of  the  spine,  describes 
an  arc  whose  chord  is  3.14  inches.  The  convexity  of  the  curvature  projects 
downward  and  to  the  left,  while  the  concavity  is  upward  and  to  the  right. 
The  bodies  of  the  vertebras,  are  therefore  turned  almost  entirely  to  the  left. 
The  pelvic  cavity  is  so  far  changed  from  its  usual  position,  that  its  superior 
opening  is  directed  downward  and  to  the  left,  whilst  the  inferior  one  is  directed 
backward,  and  to  the  right.  The  pelvis  has  been  rotated  laterally,  placing  it 
horizontally  beneath  the  base  of  the  chest ;  the  iliac  portion  of  the  right  coxal 
bone,  the  cotyloid  cavity,  and  the  anterior  border  of  the  left  iliac,  almost 
touching  the  ribs.  The  trunk,  during  life,  reposed  upon  this  margin,  which 
Ijad  undoubtedly  caused  the  swelling  and  erosion  of  the  left  anterior  and  infe- 
rior iliac  spine.  The  heads  of  the  thigh  bones  are  very  small,  and  the  cotyloid 
cavities  shallow,  and  irregular  in  their  circumference.  The  left  margin  of  the 
sacrum  looks  downward,  and  the  right  upward ;  so  that  the  position  of  this 
bone  is  almost  horizontal.  The  thorax,  which  is  thrown  to  the  right,  is  form- 
ed almost  wholly  of  the  right  cavity,  which  is  5.90  inches  in  diameter,  whilst 
the  left  is  only  .98  of  an  inch.  The  ribs  of  the  left  side,  on  reaching  their 
angles  respectively,  project  abruptly  before  the  spinal  column.  The  sternum 
is  thrown  to  the  left. 

Idiots  are  rachitic,  scrofulous,  epileptic  or  paralytic.  The  head,  either  too 
large  or  small,  is  badly  formed;  and  the  occipital  region  flattened  and  small, 
in  proportion  to  the  face.  The  features  are  irregular;  the  forehead  is  low, 
narrow,  and  almost  pointed ;  retreating  greatly,  and  more  salient  on  the  right 
than  the  left  side.  The  eyes  are  convulsive,  crossed,  and  of  an  unequal  size, 
and  the  lips  are  thick.  The  mouth  is  large,  and  when  open,  permits  the  saliva 
to  escape.  The  gums  are  fungous,  and  the  teeth  decayed.  The  defective 
conformation,  or  want  of  symmetry  in  the  organs  of  sensation,  indicates 
clearly  enough,  that  the  action  of  the  senses  is  imperfect.  Idiots  are  partially 
or  entirely  deaf,  or  hear  imperfectly.  They  are  mutes,  or  articulate  with  diffi- 
culty, certain  monosyllables.  Their  incapacity  to  speak,  depends  upon  their 
deafness,  on  the  imperfect  conformation  of  the  organs  of  speech,  and  upon  the 
circumstance,  that  they  are  incapable  of  imitating  the  movements,  adapted  to 
the  articulation  of  sounds.  Some  utter  cries  more  or  less  acute,  suppressed 
or  harsh.  Deprived  of  an  eye,  they  see  imperfectly,  or  are  blind.  Taste  and 
smell  are  equally  imperfect;  for  these  wretched  beings  do  not  distinguish  the 
qualities  of  sapid  or  odorous  bodies.  They  roll  themselves  amidst  the  most 
filthy  and  fetid  ordure,  and  devour  the  most  disgusting  substances;  eating 
herbs,  straw,  linen,  wool,  tobacco  and  fecal  matters.  They  drink  either  urine, 
or  spring  water.  I  have  found  in  the  stomach  of  an  idiot,  fragments  of  linen, 
which  had  once  constituted  a  portion  of  his  dress ;  in  another  case,  the  cecum 
was  filled  with  straw,  which  had  led  to  an  inflammation  and  gangrene  of  the 
intestinal  membranes.     They  devour  indeed,  whatever  comes  in  their  way. 

An  idiot  to  whom  I  had  given  some  apricots,  at  first  put  them  in  her  mouth 
and  ate  the  pulp  ;  being  unable  to  bite  through  the  stones,  she  swallowed 
them,  as  she  had  already  done  the  pulp  of  the  fruit.  She  thus  ate  nine  apri- 
cots in  succession,  and  would  have  eaten  more  had  I  not  feared  that  she 
would  have  been  sick.  The  touch,  far  from  rectifying  the  other  senses,  or 
proving  a  substitute  for  them,  is  not  sure.  The  arms  of  idiots  are  of  un- 
equal length,  contracted  and  atrophied  ;  the  hands  are  deformed,  distorted 
and  small ;  the  fingers  are  slender,  crooked,  maimed,  or  deprived  of  motion ; 
and  the  skin  is  thick,  rugose  and  insensible.  Idiots  extend  the  arms  and 
hands  in  a  vague  and  convulsive  manner ;  lay  hold  of  bodies  awkwardly ;  are 


IDIOCY.  467 

unable  to  retain  them,  and  permit  them  to  escape  from  theij  hands.  They 
walk  awkwardly  ;  waddling,  or  advancing  by  successive  jerks  ;  and  are  easily 
thrown  to  the  earth.  Some  of  them  remain  wherever  they  are  placed. 
Those  who  walk,  march  about  without  an  object,  or  without  its  being  possible 
to  guess  what  they  propose  to  themselves. 

The  senses  of  idiots  therefore,  being  scarcely  developed,  and  the  sensations 
imperfectly  perceived,  the  understanding  can  make  no  greater  proportion- 
ate advance,  since  its  instruments  are  defective.  Their  senses,  strangers 
to  the  external  world,  are  incapable  of  exercising  a  corrective  influence  over 
each  other ;  nor  can  education  prove  a  substitute  to  so  many  disadvantages, 
as  in  the  case  of  the  blind  and  deaf  and  dumb,  in  whom  the  senses  which 
remain,  supply  to  a  certain  extent,  those  of  which  they  are  deprived.  The 
ideas  which  man  acquires  by  those  senses,  of  which  the  blind  and  dumb  are 
deprived,  are  doubtless  wanting  to  them ;  but  the  understanding  remaining 
unimpaired,  although  deprived  of  certain  of  its  instruments,  exercises  itself 
altogether,  in  acquiring  general  notions  and  abstract  ideas.  The  blind  also, 
as  well  as  mutes,  whose  powers  of  attention  may  be  called  forth  by  various 
means,  so  well  pointed  out  by  Doct.  Itard,  and  so  successfully  applied  to  the 
education  of  the  Savage  of  Aveyron,*  are  capable  of  receiving  an  education, 
while  idiots  are  not. 

Incapable  of  attention,  idiots  cannot  control  their  senses.  They  hear,  but 
do  not  understand ;  they  see  but  do  not  regard.  Having  no  ideas,  and  think- 
ing not,  they  have  nothing  to  desire ;  therefore  have  no  need  of  signs,  or  of 
speech.  It  is  indeed  useless,  to  him  who  neither  thinks  nor  desires.  More- 
over, we  can  judge  of  the  degree  of  understanding  which  idiots  possess,  by 
the  extent  of  their  vocabulary.  They  utter  certain  imperfectly  articulated 
sounds  and  cries,  or  prolonged  bellowings,  which  they  interrupt  in  order  to 
separate  the  lips,  as  if  they  desired  to  laugh.  If  they  do  articulate  certain 
words,  they  attach  to  them  little  sense.  Some  have  only  a  cry,  indicative  of 
pain  and  pleasure.  However,  there  are  those  who,  like  children,  form  by 
imitation  and  habit,  a  language  of  action,  and  even  an  articulate  one ;  which 
is  understood  only  by  those  who  live  with,  and  have  charge  of  them.  It 
expresses  merely  the  first  wants  of  life,  and  those  instinctive  appetites  which 
they  are,  unaided,  incapable  of  gratifying.  Of  what  utility  would  language 
be  to  him  who  cannot  think,  and  has  nothing  to  communicate  to  his  fellow 
beings  ?  Idiots  are  mutes,  because  they  have  nothing  to  say.  Those  who 
have  a  language  of  action,  employ  only  a  small  number  of  gestures,  as  signs 
of  their  instinctive  wants.  Do  they  act,  every  thing  is  wrongly  done.  We 
perceive  the  disorder,  awkwardness,  and  slowness  of  their  acts.  The  under- 
standing remains  as  at  birth,  or  at  the  period  when  the  arrest  of  development 
took  place.  The  digestive  functions  of  idiots  are  usually  very  well  accom- 
plished ;  and  they  eat  much  and  with  voracity.  With  the  female  sex,  men- 
struation is  regular,  and  abundant.  These  wretched  beings  do  not  always 
testify  a  desire  to  eat ;  not  seeming  to  be  apprised  of  hunger,  until  they  per- 
ceive food.  Sometimes,  in  order  to  nourish  them,  it  is  necessary  to  convey 
the  food  to  their  mouth,  and  sometimes  even  to  the  fauces.  Their  secretions 
are  involuntary,  and  are  passed  everywhere,  and  without  shame. 

Idiots  do  not  always  possess  the  instinctive  faculties.  They  are  below  the 
brute ;  for  animals  possess  the  instinct  of  self-preservation  and  reproduction. 
Idiots  do  not  possess  this  instinct,  and  have  no  sense  of  their  existence. 
They  have  neither  pain  nor  pleasure  ;  hatred  nor  love.  They  are  untimely 
births.     They  are  monsters,  and  doomed,  in  consequence,  to  an  immediate 

*  Tlie  Education  of  a  Savage,  Paris,  1807,  in  8vo. — An  account  of  the  new  developments 
of  the  Savage  of  Aveyron,  Paris.  1807,  in  8vo. 


468  IDIOCY. 

death,  unless  the  tenderness  of  parents,  or  public  commiseration  preserve 
them.  Yet,  who  would  not  be  surprised  at  the  facility  which  the  major  part 
of  idiots  possess,  of  singing,  and  remembering  a  variety  of  airs?  Beside 
the  examples  which  I  have  above  related,  I  ought  here  to  remark,  that  nearly 
all  the  idiot  children,  for  whom  I  have  been  consulted,  sing  some  certain  air 
with  more  or  less  correctness ;  or  at  least,  certain  passages  of  music,  although 
deprived  of  speech. 

The  habitudes  of  some  idiots  are  very  singular.  They  seem  to  be  ma- 
chines, set  in  motion  in  order  to  produce  invariably  the  same  movements. 
With  them,  habit  takes  the  place  of  intelligence.  An  idiot  who  was  twenty- 
three  years  of  age  when  I  saw  him,  of  the  usual  stature,  a  slender  person,  fore- 
head flattened,  the  complexion  pale,  the  eyes  crossed,  articulation  scarcely 
possible,  and  the  dejections  involuntary,  was  always  accustomed  to  walk  to 
the  same  place ;  sometimes  enlivening  his  walk  by  bowing  and  rapidly  rais- 
ing the  body  ;  or  by  shaking  one  of  his  arms,  and  laughing  loudly.  If  any 
one  placed  an  obstacle  across  the  path  to  which  he  was  partial,  he  was  both 
grieved  and  angry,  until  it  had  been  removed.  Never  did  he  remove  it  him- 
self 

Among  the  idiots  of  the  Salpetriere,  there  are  several  who  are  incapable  of 
either  dressing  or  feeding  themselves.  Their  dejections  are  involuntary,  and 
they  remain  almost  naked;  indifferent  to  the  rain,  cold,  or  heat  of  the  sun. 
There  is  one  who,  as  soon  as  she  rises  in  the  morning,  sits  down  upon  the  end 
of  the  same  bench,  and  there  balances  herself  backwards  and  forwards;  strik- 
ing her  shoulders  violently  against  the  wall.  This  balancing  is  continued  and 
regular ;  being  sometimes  more  rapid  and  vigorous  than  at  others,  and  she 
then  utters  a  stifled  cry.  Thus  she  passes  her  days  and  life ;  exposed  to  every 
atmospheric  vicissitude,  and  a  stranger  to  all  external  impressions.  I  found 
twenty  years  ago,  in  the  hospital  of  Poitiers,  extended  upon  the  straw  in  the 
same  apartment,  two  little  idiots,  one  of  whom  constantly  laughed,  and  the 
other  wept.  Idiots  are  strongly  inclined  to  masturbation,  and  yield  themselves 
to  the  excessive  practice  of  it  in  the  presence  of  any  one,  without  either  mod- 
esty or  shame. 

I  once  saw  an  idiot  thirteen  years  of  age,  who  had,  ever   since  the  age  of 
seven,  possessed  all  the  signs  of  virility ;  the  penis  being  very  large,  and  the 
pubes  covered  with  hair.     He  seemed  to  live,  only  to  masturbate.     Doct.  Hain- 
dorf, — who  published  in  German,  twenty-five  years  ago,  an  excellent  treatise 
on  mental  alienation, — relates  a  remarkable  example  of  obstinacy,  which  dis- 
played itself  in  the  person  of  an  idiot.     Born  in  the  mountains  of  Rawn,   he 
was  deprived  of  the  power  of  speech,  and  brought  to  the  hospital  of  St.  Julien, 
Wurtzburg.     He  was  permitted  to  wander  about  in  the  garden  of  this  estab- 
lishment, where  he  was  seen,  covered  only  with  a  linen  garment.     He  was  ac- 
customed to  amuse  himself,  in  moving  about  in   a  circle,  from  within  which, 
he  would  pluck  up  the  grass,  and  collect  stones,  which  he  placed  in  a  pile,  and 
afterwards  threw  away.     Thus  he  occupied  himself,  without  either  purpose  or 
design  ;   and   during  this  exercise  his  muscles  were  convulsively  contracted. 
If  prevented  from  moving  about,  and  piling  up  stones,  he  would  begin  to  pull 
different  parts  of  his  body,  and  to  scoop  up  the  earth  with  his  feet,  which  were 
naked,  and  covered  with  callosities.     If  put  in  a  place  of  confinement,  he  be- 
came furious,  and  endeavored  to  set   himself  at  liberty.     So  soon  as  he  had 
obtained  his  freedom,  he  commenced  his  circular  movements,  and  collecting 
stones.     He  ate  and  drank  whatever  was  given   him,  and  always  returned  to 
the  same  place,  for  his  food  and  sleep.     He  was  often  accustomed  to  gnaw  a 
bit  of  wood,  and  swallow  what  he  could  obtain  in  this  way;  but  so  soon  as  a 
word  was  spoken  to  him,  in  connection  with  a  fixed  look,  he  fled  to  conceal 
himself     The  slightest  noise  terrified,  and  caused  him  to  retire ;  but  he  would 


IDIOCY.  469 

soon  return,  to  resume  his  habitual  exercise.  He  gave  no  indication  of  prac- 
ticing onanism.  All  his  acts  were  similar,  and  repeated  at  fixed  periods  of 
the  day.  The  features  of  his  countenance  were  disordered,  the  lips  project- 
ing, the  teeth  of  a  dirty  white,  and  the  eye,  half  concealed  beneath  the  lid,  did 
not  permit  the  pupil  to  be  seen.  The  outline  of  his  mouth,  was  towards  the 
eyes.  The  physiognomy  was  destitute  of  expression,  and  the  head,  which  was 
very  small,  presented  a  remarkable  flattening  of  the  vertex. 

The  insensibility  of  idiots  is  sometimes  most  remarkable,  although  enjoying 
the  use  of  their  senses.  We  have  seen  these  wretched  beings  bite  and  lace- 
rate themselves,  and  also  tear  out  their  hair.  I  have  seen  an  idiot  who,  with 
her  fingers  and  nails,  had  pierced  through  her  cheek,  play  with  a  finger  placed 
in  the  opening,  and  end  by  tearing  it  to  the  very  commissure  of  the  lips,  with- 
out seeming  to  suffer.  Some  of  them  have  had  their  feet  frozen,  without  pay- 
ing the  least  attention  to  it.  An  idiot,  having  become  pregnant,  is  confined 
without  the  slightest  suspicion  of  what  has  taken  place  ;  and  desires  to  leave 
her  bed,  saying  she  is  not  sick.  These  wretched  beings  are  reduced  to  such 
a  degree  of  insensibility  and  brutishness,  that  they  do  not  understand  the  cause 
of  their  pain,  nor  distinguish,  whether  it  is  internal  or  external.  Their  con- 
sciousness of  self-existence  is  so  slight,  that  they  are  not  aware  that  a  disor- 
dered portion  of  the  system,  at  any  time  appertains  to  themselves,  and  many 
even  mutilate  themselves.  When  sick,  they  do  not  complain,  but  remain 
gathered  up  in  bed,  without  manifesting  the  least  suffering,  or  without  being 
able  to  divine  the  cause  or  seat  of  the  affection.  They  die  even,  without  the 
power  .of  aiding  themselves.  Their  moral  degradation,  is  in  relation  with  their 
privation  of  physical  sensibility. 

An  idiot,  says  Doct.  Haindorf,  who  was  kept  in  the  hospital  of  Saltzburg, 
did  not  appear  susceptible  of  any  fear.  They  desired  to  make  the  trial, 
whether  he  would  not  be  impressed  by  the  sight  of  a  man  who,  having  simu- 
lated death,  should  rise  again.  With  this  intent,  an  attendant  laid  himself 
down  upon  a  bench,  enveloped  in  a  sheet,  and  the  idiot  was  ordered  to  watch 
the  dead  man.  Perceiving  that  he  moved,  the  idiot  advised  him  to  remain 
tranquil.  Notwithstanding  this  advice,  the  pretended  dead  man  arose  ;  when 
the  idiot  seizes  a  hatchet,  and  at  first,  cuts  off"  a  foot,  and  without  being  de- 
terred by  the  cries  of  the  unfortunate  person,  decapitates  him  at  a  second 
blow ;  after  which,  he  remains  composedly  by  the  dead  body.  When  re- 
proved for  his  conduct,  he  coldly  replied  :  if  the  dead  man  had  remained  tran- 
quil, I  should  have  done  nothing  to  him. 

A  lypemaniac  desired  to  die,  but  was  nevertheless  unwilling  to  commit  the 
act,  because  it  was  a  crime  ;  preferring  to  subject  herself  to  the  condemna- 
tion of  death,  by  the  commission  of  some  capital  offence.  Being  left  on  one 
occasion  with  an  idiot,  she  persuaded  the  latter  to  permit  her  to  cut  oflf  her 
head  ;  an  act  which  she  accordingly  performed.  The  means  employed  by  the 
lypemaniac  were  of  a  character  to  furnish  an  opportunity  for  repentance,  to 
any  one  but  an  idiot,  and  to  protect  herself  even  after  the  first  essays  had 
been  made  to  effect  this  frightful  design.  Gall  states,  that  an  idiot,  having 
slain  two  children  of  his  brother,  comes  smiling,  to  relate  to  the  wretched 
father  what  he  has  just  done.  Harder  says,  that  an  idiot  cut  the  throat  of  a 
man,  after  having  seen  the  same  act  performed  upon  a  hog. 

Each  of  the  cases  which  I  have  just  related,  would  furnish  matter  for  much 
comment.  From  them  all,  I  deduce  the  following  propositions :  Idiocy  pre- 
sents innumerable  varieties,  as  it  respects  sensibility,  and  the  intellectual  and 
moral  capacity.  Some  idiots  possess  aptitudes  and  inclinations ;  and  almost 
all,  even  those  who  are  deprived  of  the  power  of  speech,  sing,  and  retain  a 
recollection  of  tunes.  Though  no  constant  and  direct  relation  subsists,  be- 
tween the  vice  of  organization,  and  the  various  degrees  of  sensibility  and 
understanding  among  idiots ;  we  must  be  convinced,  that  the  more  considera- 


470  IDIOCY. 

ble  are  the  organic  deformities,  the  more  marked  are  the  imperfections  of  sen- 
sibility and  intelligence.  No  particular  volume  nor  form  of  the  head  are  pe- 
culiar to  idiocy ;  notwithstanding,  it  is  proper  to  observe,  that  the  smallest 
heads  appertain  to  the  most  degraded  class  of  idiots.  Although  we  meet  with 
idiots  havino;  large  heads,  the  forms  of  the  heads  are  not,  more  than  the 
volume,  a  rigorous  index  of  the  sensitive  and  intellectual  capacity.  Their 
capability  of  acquiring  an  education,  though  limited  to  the  power  of  imitation, 
and  the  primary  wants  of  instinctive  life,  is  not  a  sufficient  indication  to  cha- 
racterize the  principal  varieties  of  idiocy,  although  Dr.  F.  Voisin  may  be  of 
this  opinion.*  Speech,  that  essential  attribute  of  man,  which  has  been  given 
him  to  express  his  thoughts  ;  being  the  sign,  most  frequently  in  relation  with 
the  intellectual  capacity  of  idiots,  furnishes  the  character  of  the  principal  vari- 
eties of  idiocy. 

In  the  first  degree  of  imbecility,  speech  is  free  and  easy.  In  the  second,  it 
is  less  easy,  and  the  vocabulary  is  more  circumscribed.  In  the  first  degree 
of  idiocy,  properly  so  called,  the  idiot  uses  merely  words  and  short  phrases. 
Idiots  of  the  second  degree,  articulate  only  monosyllables,  or  certain  cries. 
Finally,  in  the  third  degree  of  idiocy,  there  is  neither  speech  nor  phrases ; 
words  nor  monosyllables. 

The  causes  of  idiocy,  which  are  almost  invariably  local  and  physical,  prevent 
the  development  of  the  organs,  and  render  them  unfit  for  the  manifestation  of 
intelligence ;  thus  differing  from  insanity,  whose  intellectual  and  moral  causes, 
ordinarily  super-excite  the  brain,  exalt  the  sensations,  and  occasion  permanent 
exhaustion.  To  the  number  of  the  physical  and  predisposing  causes  of  idi- 
ocy, we  must  add  the  influence  of  the  sun,  water  and  air ;  the  manner  of 
living  among  mothers;  hereditary  predisposition ;  certain  localities  favorable 
to  the  development  of  scrofula;  and  mountainous  countries,  such  as  Scotland 
and  Norway.  There  are  more  idiots  in  countries  than  cities.  It  is  not  unu- 
sual, that  there  are  several  idiots  belonging  to  the  same  family.  I  knew  two 
young  gentlemen,  sole  heirs  of  a  distinguished  family,  who  were  idiots.  We 
have  at  the  Salpetriere,  an  idiot  girl,  whose  mother  had  but  three  children ; 
two  daughters  and  a  son ;   all  of  whom  were  idiots. 

Sometimes  also,  in  the  same  family,  there  is  one  idiot,  and  other  children 
who  are  insane.  I  have  known  idiots  become  mothers,  but  have  never  known 
their  children  to  become  so.  The  exciting  causes  of  idiocy  are  numerous. 
Lively  moral  affections  on  the  part  of  mothers  during  gestation,  has  an  influ- 
ence upon  the  child  in  utero ;  and  improper  management  during  parturition  may 
produce  the  same  effect.  The  custom  pointed  out  by  Hippocrates,  which 
certain  matrons  have  of  kneading  in  some  sort,  the  heads  of  newly-born  chil- 
dren, by  wounding  the  brain,  may  occasion  idiocy  :  also  blows  upon  the  head, 
whether  from  falling  or  otherwise.  Convulsions,  whatever  may  be  their  cause, 
and  also  epilepsy,  provoke  this  affection.  Sometimes  a  single  convulsion,  or 
attack  of  epilepsy,  is  sufficient  to  arrest  the  development  of  the  organs,  and 
the  ulterior  progress  of  the  understanding,  in  a  child  who,  until  that  period, 
had  appeared  highly  intellectual.  Acute  and  chronic  hydrocephalus,  also  pro- 
duces fatal  effects ;  and  a  cerebral  fever  or  meningitis  which  occurred  in  in- 
fancy, has  occasioned  idiocy.  The  effects  of  these  causes  are  noticed  from  the 
period  of  birth,  and  produce  the  congenital  form  of  idiocy.  Children  belong- 
ing to  this  class,  have  heads,  either  very  small  or  large,  and  the  features  of  the 
countenance  are  imperfectly  delineated.  They  take  the  breast  with  difficulty, 
nurse  poorly,  do  not  gain  strength,  and  it  is  long  before  their  eyes,  (which  are 
crossed,)  follow  the  light.  They  are  lean,  pale,  and  do  not  walk  before  the  age 
of  from  five  to  seven  years,  and  sometimes,  not  before  puberty.     They  are  in- 

*  Application  of  tiie  Phyeiology  of  the  Brain,  to  the  study  of  children  who  require  a 
special  education  :  Paris,  1830,  in  8vo. 


IDIOCY.  471 

capable  of  learning  to  speak,  or  acquire  only  certain  words,  or  syllables,  and 
this,  at  a  comparatively  late  period  of  life. 

Children  are  sometimes  born  in  a  state  of  perfect  health,  and  grow,  at  the 
same  time  that  their  understanding  develops  itself;  but  possess  an  unusual  de- 
gree of  susceptibility ;  are  lively,  irritable,  choleric  ;  of  a  brilliant  imagina- 
tion, a  well  developed  understanding,  and  an  active  mind.  This  activity,  not 
being  in  relation  with  the  physical  forces,  they  exercise  and  speedily  exhaust 
themselves.  Their  understanding  remains  stationary ;  making  no  farther  ad- 
vances; and  the  hopes,  which  were  recently  raised  so  high,  are  dashed  for- 
ever. This  is  accidental,  or  acquired  idiocy.  Sometimes  also,  an  accidental 
cause  arrests  the  development  of  the  organs  and  intelligence. 

The  crania  of  idiots  ordinarily  present  vices  of  conformation.  Both  the 
volume  and  form  of  the  cranium  among  idiots,  offer  as  many  varieties,  as  do 
the  crania  of  sound  men.  There  is  indeed,  no  form  proper  to  idiocy.  A 
head  too  small  or  too  large,  in  proportion  to  the  height  of  the  body,  may  be 
that  of  an  imbecile  or  idiot.  The  same  is  true  of  a  regular,  as  well  as  of  a 
deformed  head.  The  numerous  researches  that  have  been  made  with  respect 
to  the  conformation  of  the  head,  had  for  their  object  its  volume,  the  form  of 
the  cranium,  and  the  features  of  the  countenance.  Hippocrates  had  pointed 
out  the  too  small  head, — which  he  calls  microcephalon, — as  one  of  the  causes 
of  idiocy.  Willis  has  described  the  brain  of  an  idiot,  which  had  not  half  the 
usual  volume.  Brown,  at  Amsterdam,  has  in  his  possession  a  similar  cere- 
brum, and  severd  crania  of  microcephala.  Pinel  has  given  an  account  of 
the  cranium  of  an  idiot,  which  was  remarkable  for  its  imperfect  conformation, 
and  also  that  of  one  who  could  scarcely  be  said  to  have  a  cranium,  while  the 
face  was  very  fully  developed.  M.  Richerand  in  his  physiology,  cites  seve- 
ral examples  of  crania,  which  were  very  slightly  developed.  Gall  has  figured* 
two  very  small  crania,  and  limits  intelligence  to  crania  which  are  only  from 
14  to  17  inches  in  circumference. 

Vesale  pretends  that  the  heads  of  the  Germans  are  flattened  posteriorly,  in 
consequence  of  a  custom  of  theirs  which  requires  that  their  children  should 
sleep  upon  the  back  ;  and  gives  a  sketch  of  the  cranium  of  an  idiot,  whose 
occiput  is  very  much  flattened.  Prochaska,  Malacarne  and  Ackerman,  have 
given  descriptions  of  the  crania  and  brains  of  idiots,  which  differ  much  from 
each  other. 

According  to  Cuvier,  the  relations  of  the  ctanium  to  the  face,  indicate  the 
degree  of  intelligence  among  both  animals  and  man.  A  small  cranium  and 
large  face,  are  indicative  of  an  inferior  degree  of  intelligence.  Pinel  has 
applied  the  calculations  of  geometry  to  the  appreciation  of  the  cranial  capa- 
city. He  has  pointed  out,  as  peculiar  to  idiots,  a  flattened  cranium,  and  a 
want  of  symmetry  between  the  right  and  left  portions  of  it.  In  the  case  of 
one  idiot,  the  height  of  the  head  was  only  one  tenth  part  of  the  structure  of 
the  individual.  May  not  these  vices  of  conformation,  this  defective  develop- 
ment of  the  cranium  be  attributed  with  propriety,  to  rachitis  and  scrofula,  so 
frequent  among  idiots  ? 

Those  suffering  from  hydrocephalus,  are  not  all  deprived  of  understanding; 
but  the  cases  which  I  have  related,  prove  that  idiots  are  often  hydrocephalic, 
although  their  crania  may  be  small.  These  idiots  are  rachitic,  and  their  limbs 
atrophied,  deformed  and  contracted.  I  have  a  large  number  of  the  busts  and 
heads  of  idiots,  cast  after  death.  In  general,  the  summit  of  the  cranium  is 
elliptical,  the  diameter  of  the  fronto-occipital  region  is  extended,  and  the 
parietal  flattened,  towards  the  temporal  suture.  This  circumstance,  which 
renders  the  foreheads  of  certain   idiots  almost  pointed,  the  flattening  of  the 

*  Anatomy  and  Physiology  of  the  JVervous  System. 


472 


IDIOCY. 


occipital  and  coronal  regions,  and  the  inequality  of  the  right  and  left  portions 
of  the  cranial  cavity,  are  phenomena  the  most  constant,  and  perhaps  most 
worthy  of  attention,  on  the  part  of  those  who  desire  explications. 

There  was  brought  to  the  Salpetriere  Dec.  15,  1815,  one  who  had  been  an 
imbecile  from  birth,  who  was  in  the  habit  of  becro-inor,  and  was  maltreated  and 
violated,  in  1813,  by  foreign  soldiers.  Though  of  medium  stature,  she  ap- 
peared small,  in  consequence  of  a  curvature  of  the  spine,  from  which  a  pro- 
tuberance projected  upon  the  left  haunch.  The  head  is  voluminous,  the  face 
long,  large,  and,  as  it  were,  flattened,  and  the  forehead  upright.  The  hair  is 
abundant,  and  of  a  chestnut  color  ;  the  eyes  of  a  chestnut  color,  and  some- 
times crossed ;  the  mouth  is  large,  and  seems  to  be  square  when  open  ;  the 
teeth  are  carious,  and  the  gums  fungous  ;  the  palatine  arch  forms  a  reenter- 
ing angle,  at  the  point  of  union  of  the  maxillary  bones,  and  the  velum  palati 
is  bifurcated.  The  head,  measured  upon  the  plaster  cast  taken  after  death, 
gives  the  following  proportions  : 

Circumference         .... 
Fronto-occipital  curvature 
Antero-posterior  diameter  » 

Bi-temporal  diameter     . 

Total  .....       46.71 


21.06 

in, 

12.71 

(( 

6.57 

(( 

6.37 

(( 

This  singular  head  exceeds  considerably  the  usual  size  of  well  formed 
heads.  The  face  is  6.10  inches  in  length,  and  the  antero-posterior  exceeds 
the  bi-temporal  diameter,  by  only  .19  of  an  inch.  The  forehead  is  2.75  inches 
high,  and  from  one  orbital  apophysis  to  the  other,  is  5.11  inches.  The  face 
is  flattened,  and  the  occipital  region  narrow,  compared  with  the  coronal. 
The  hands  of  this  imbecile,  as  well  as  her  feet,  present  an  extraordinary 
conformation,  with  respect  to  their  length.  The  fingers  approximate  at  their 
extremities,  and  are  united  by  the  skin.  The  nails  touch,  and  are  always  dis- 
tinct. We  distinguish  beneath  the  skin,  five  fingers  on  the  right,  and  six  on 
the  left  hand.  So  closely  are  they  confined  one  to  the  other,  that  they  cannot 
be  bent,  nor  separated.  The  feet  present  the  same  vice  of  conformation. 
Notwithstanding  this  faulty  condition,  she  can,  though  imperfectly,  spin,  han- 
dle the  needle,  fasten  a  pin,  and  untie  a  knot.  Though  of  a  very  limited  un- 
derstanding, she  recognizes  those  who  serve  her,  regards  the  calls  of  nature, 
eats  well,  sleeps,  and  her  menstruation  is  regular.  She  left  her  father  with 
indifference,  nor  does  she  ever  speak  of  him.  She  regards  men  with  satisfac- 
tion, has  no  sense  of  shame,  and  is  very  covetous.  By  showing  her  some  pieces 
of  money,  she  may  be  induced  to  do  whatever  any  one  desires.  She  often  calls 
for  jewelry  and  ear-rings ;  always  in  order  to  be  married  on  the  following  day. 
She  articulates  certain  words  with  difficulty,  but  vivacity ;  is  choleric,  but 
timid  ;  and  laughs  and  weeps,  at  the  slightest  occurrence.  She  died  one  year 
after  her  admission,  of  a  verminous  affection.  I  found  73  lumbricoid  worms 
in  the  digestive  canal,  and  even  in  the  oesophagus. 

M.  Foville,*  physician  to  the  Asylum  for  the  insane  at  Rouen,  in  an  essay 
full  of  interest,  points  out  a  vice  of  conformation  in  the  cranium,  which  he 
has  often  witnessed  in  that  hospital.  He  has  observed  a  circular  depression  of 
the  head,  which,  passing  from  the  forehead  over  the  temporal  regions,  extends 
around,  below  the  occipital  protuberance.  This  is  a  consequence  of  the  com- 
pression of  a  fillet,  placed  upon  the  forehead  of  children,  and  maintained  in 
its  position  by  strings,  which  confine  unduly,  this  portion  of  the  head.     Inter- 


*  Deformity  of  the  Cranium,  Paris,  1834,  in  8vo, 


IDIOCY. 


473 


fering  thus  with  the  regular  development  of  the  cranium,  it  deforms,  and  ren- 
ders very  prominent,  the  occipital  region,  while  the  forehead  is  very  much 
flattened.  This  defect  is  observed  in  the  south  of  France,  and  must  necessa- 
rily impair  the  development  of  the  understanding. 

In  the  interesting  researches  of  Dr.  Parchappe,* — physician  to  the  Asylum 
for  the  insane  at  Rouen, — he  compares  the  volume  and  form  of  the  cranium, 
modified  by  stature,  age,  sex,  the  physiological  and  pathological  condition  of 
the  understanding,  with  the  mass  and  volume  of  the  encephalon;  and  con- 
cludes that  if  there  exists  a  general  relation  between  these  two  terms,  facts  are 
wanting  to  deduce  rigorously  from  this  relation,  the  different  degrees  of  intel- 
lectual and  moral  capacity.  Dr.  Lelut,  physician  to  the  Salpetriere,  who  has 
published  such  interesting  essays,  respecting  mental  alienation,  has  also  made 
some  researches,  respecting  the  relative  volume  and  form  of  the  cranium,  in 
the  healthy  man  and  the  idiot.  He  is  of  the  opinion,  that  the  cranium  of  the 
latter  is  a  little  less  developed ;  but  that  this  difference  is  not  so  great  as  it  ap- 
pears, and  has  been  represented  to  be,  since  the  time  of  the  ancient  writers. 
According  to  this  author,  the  more  the  volume  of  the  cranium  lessens,  the 
nearer  do  we  reach  the  lowest  degree  of  idiocy.  The  frontal  portion  of  the 
cranium  of  idiots  is,  in  fact,  as  large  and  expansive  as  that  of  men  in  general  ; 
and  indeed,  the  dimensions  of  their  crania  are  as  great  as  those  of  other  men. 
How  much  labor  is  still  necessary,  and  what  careful  and  extended  research, 
before  we  shall  be  able  to  establish,  with  precision,  the  coincidence,  in  volume 
and  form  of  the  brain,  with  the  intellectual  capacity. 

With  each  case  of  idiocy  which  I  have  published  in  this  chapter,  I  have  also 
given  the  admeasurements  of  the  heaS,  taken  during  life.  By  bringing  them 
together,  we  may  compare  the  means,  with  the  results  obtained  by  my  young 
confreres  :  time  will  not  permit  me  to  do  it.  For  those  who  are  fond  of  this 
kind  of  investigations,  I  subjoin  a  table  of  the  mean  results  of  admeasure- 
ments of  the  head,  taken  from  women  in  the  enjoyment  of  good  health,  and 
from  plaster  casts,  taken  after  death,  in  the  case  of  36  insane  women,  17  imbe- 
ciles, and  17  idiots.  In  the  case  of  three  idiots,  whose  heads  were  very  small, 
the  admeasurements  were  taken  from  the  crania. 


TABLE  OF  CRANIAL  ADMEASUREMENTS. 


Circumfe- 
rence. 

Antero- 
posterior 
curvature. 

Antero- 
posterior 
diameter. 

Transverse 
diameter. 

Totals. 

Women  in  a 
state  of  health 

21.87  in. 

13.30  in. 

6.98  in. 

5.29  in. 

47.44  in, 

Insane 

20.82 

11.50 

6.96 

5.67 

44.95 

Imbeciles 

20.19 

11.49 

6.69 

5.63 

44. 

Idiots 

19.92 

11.26 

6.85 

5.39 

43.42 

Idiots  micro- 
cephalous. 

15.07 

7.51 

4.88 

4.17 

31.63 

From  this  table,  we  learn  1st ;  that  the  circumference  of  the  head,  accord- 
ng  to  admeasurements,  taken  from  among  women  enjoying  the  use  of  their 
reason;  from  insane  women,  imbeciles  and  idiots;  diminishes  in  an  almost 
equal  proportion,  from  the  woman  in  the  enjoyment  of  usual  health,  to  the 

*  Researches  on  the  Encephalon,  Paris,  1836,  in  8vo. 
60 


474  IDIOCY 

idiot  deprived  even  of  instinct.  2d.  That  the  fronto-occipital  curvature  di- 
minishes in  a  remarkable  degree,  from  the  woman  of  sound  mind,  to  the 
insane  female ;  whilst  no  variation  is  noticed  from  the  insane  person  to  the 
imbecile,  and  a  difference  of  but  six  millimetres  between  the  latter  and  idiocy. 
3d.  That  the  fronto-occipital  diameter  is  the  same  in  the  case  of  the  woman  en- 
joying the  use  of  her  reason,  and  the  insane  woman ;  and  that  there  is  a  dimi- 
nution of  but  six  millimetres,  between  the  insane  person  and  idiot ;  while  the 
difference  is  enormous,  on  passing  to  the  lowest  degree  of  idiocy.  4th.  That 
the  bi-temporal  diameter  is  more  considerable  in  the  case  of  the  insane  woman, 
and  even  the  imbecile  and  idiot,  than  in  that  of  the  woman  possessing  the  ordi- 
nary degree  of  intelligence.  5th.  That  if  we  suppose,  that  the  sum  of  these  four 
admeasurements,  express  the  volume  of  the  brain ;  it  follows  that  the  volume 
of  this  organ,  diminishing  in  the  same  proportion  with  the  intellectual  capa- 
city ;  that  of  the  cranium,  would  be  the  expression  of  this  capacity. 

Morgagni  found  the  brain  very  dense  :  Meckel  says  that  the  cerebral  substance 
of  idiots,  is  more  dry,  light  and  friable,  than  that  of  persons  in  the  enjoyment 
of  a  sound  mind.  Malacarne  assures  us,  that  the  convolutions  of  the  brain 
are  numerous,  in  proportion  to  the  intelligence,  and  that  the  plates  or  lamellae 
of  the  cerebellum,  are  least  numerous  among  those  who  are  deprived  of 
understanding.  The  convolutions  are  small,  atrophied,  compact  and  shallow. 
Perhaps  the  capacity  of  the  lateral  sinuses  of  the  cerebellum  have  been  neg- 
lected. I  have  found,  in  nearly  every  idiot  whose  body  I  have  examined,  the 
lateral  ventricles  much  confined,  and  of  very  limited  capacity.  The  physiog- 
nomy of  imbeciles  and  idiots  is  very  peculiar,  so  that  they  are  recognized  as 
soon  as  seen.  Lavater  says,  that  the  receding  forehead,  whose  curvature  is 
spheroidal ;  the  large,  prominent  and  open  lips,  whose  commissures  are  wide- 
ly separated  ;  and  the  chin  projecting  forward,  or  retreating,  indicate  idiocy. 
Camper,  who  sought  in  the  facial  angle  only  a  characteristic  of  the  beauty 
of  the  face,  fixes  at  ninety  degrees,  the  extreme  limit  of  this  angle.  There 
are,  however,  idiots,  whose  facial  angle  is  more  than  this ;  and  very  sensible 
persons,  in  whom  it  does  not  measure  eighty  degrees. 

It  will  be  observed,  that  I  have  nothing  to  say,  respecting  the  treatment  of 
a  constitutional  condition.  Nevertheless,  we  may,  to  a  certain  extent,  ame- 
liorate the  lot  of  imbeciles,  by  giving  a  proper  direction  to  their  habits  and 
actions ;  as  well  as  by  accustoming  them  to  some  labor,  that  shall  turn  to  the 
profit  of  the  poor,  or  serve  as  a  means  of  diversion  to  the  rich.  Idiots  re- 
quire very  careful  and  assiduous  domestic  attentions. 

[By  tlie  politeness  of  Lewis  Weld,  Esq.,  Principal  of  the  Asylum  for  the  deaf  and 
dumb,  at  Hartford,  Conn.,  who  has  recently  visited  several  of  the  Institutions  in  Europe 
designed  for  this  interesting  class  of  our  fellow-beings, — and  who  is  expected,  at  no  dis- 
tant day  to  make  a  report  of  this  visit, — I  have  been  favored  with  the  following  particu- 
lars respecting  a  class  of  imbeciles  and  idiots,  twelve  in  number,  who  are  enjoying  the 
philanthropic  instructions  of  M.  Saegert,  himself  the  superintendent  of  an  institution  for 
mutes,  at  Berlin,  Prussia.  At  the  commencement  of  their  pupilage,  says  Mr.  Weld,  a 
small  number  only  could  speak  intelligibly,  some  were  unable  to  walk,  few  were  capable 
of  attending  to  the  primary  necessities  of  life,  and  all  required  the  attentions  of  very 
young  children.  M.  Ssgert  has  had  one  of  these  wretched  beings  under  his  care  for  the 
space  of  two  years,  two  for  one  and  a  half  years  each, — both  of  whom  are  deaf  and  dumb, 
— the  period  during  which  the  remaining  ones  had  been  under  instruction,  varying  from 
five  months  to  two  weeks;  a  single  individual  having  been  admitted  at  the  last  named 
period.  Their  ages  varied  from  eight  to  twenty  years.  Their  improvement  has  been 
regarded  as  decidedly  encouraging.  They  are  now  able  to  dress  and  undress  themselves, 
wash  their  faces  and  hands,  walk  about,  partake  of  their  food  with  propriety,  etc.,  etc. 


IDIOCY.  475 

Their  occupations,  calculated  to  develop  and  exercise  the  mind,  are  principally  drawing, 
writing,  and  knitting.  Some  sing  a  little  ;  others  dance.  In  drawing,  they  not  unfre- 
quently  seem,  on  meeting  with  a  comparatively  difficult  point,  to  pause,  and  after  a  time 
proceed  with  their  work,  as  if  by  a  process  of  reasoning  they  had  been  enabled  to  sur- 
mount the  difficulty.  They  also  submit  understandingly,  to  restraint  and  the  discipline 
of  the  house.  Besides  the  physiognomy  characteristic  of  idiocy,  I  am  informed,  that 
with  most  of  them,  the  head  is  mal-formed.  The  hygienic  means  emplo3'ed  by  M. 
S.  are  limited  to  diet  and  exercise.  In  addition  to  his  own  observations  and  carefully 
formed  opinions,  he  has  consulted  every  author  of  authority  who  has  treated  of  the 
subject  of  idiocy,  and — I  am  happy  to  be  able  to  state — is  soon  to  publish  the  results  of 
his  experience.  M.  Guggenbuhl  of  Abendburg,  Switzerland,  has  a  school  for  cretins, 
and  employs  medical,  as  well  as  other  measures  ttf  relief  and  improvement.  He  has 
fourteen  or  fifteen  pupils  under  his  care,  and  receives  them  at  the  early  age  of  five  years. 
M.  Seguin,  of  Paris,  has  also  a  school  for  the  instruction  of  idiots.  Mr.  Weld  did  not 
however,  visit  either  of  the  latter  institutions.  Upon  the  statement  just  made,  which  is 
not  only  exceedingly  brief, — barely  sufficient  to  direct  the  minds  of  medical  men  to  the 
subject  to  which  it  refers, — but  containing  few  of  the  data  upon  which  an  intelligent 
opinion  could  be  formed,  it  might  seem  invidious  to  comment,  did  not  our  remarks  accord 
with  the  sentiments  expressed,  and  the  hopes  entertained  by  the  benevolent  men  who 
have  undertaken  this  work.  It  certainly  is  a  thankless  office,  and  would  indeed  seem  to 
be  the  offspring  of  a  disingenuous  and  uncharitable  spirit,  to  do  otherwise  than  bid  "  God 
speed"  to  efforts  which  have  for  their  object  the  amelioration  of  the  physical  condition, 
and  the  elevation  in  the  scale  of  intelligence,  of  any  class,  however  degraded,  of  our 
fellow  men.  We  have  however  learned  from  some  degree  of  observation,  and  in  com- 
mon with  others  from  personal  experience  also,  that  time,  talent  and  labor,  may  all  be 
so  expended,  as  virtually  to  be  thrown  away.  It  therefore  becomes  a  duty,  at  the  same 
time  that  we  witness  new  proofs  of  a  growing  benevolence,  and  find  the  active  charities 
of  man  opening  new  fields  of  philanthropic  effort,  to  enquire  what  fruits  may  be  fairly 
anticipated  as  a  reward;  scanning  with  the  eye  of  reason  as  well  as  philanthropy,  the 
means  pursued  as  well  as  the  ends  contemplated,  by  the  various  benevolent  schemes  and 
enterprises,  that  almost  daily  demand  our  notice  and  approval.  The  doctrine  of  perpet- 
ual motion  has  ever  found  advocates  and  believers,  notwithstanding  the  demonstrable 
impossibility  of  effecting  the  object  contemplated  thereby;  and  not  a  few  have  wasted 
months  and  years  of  their  lives,  and  not  a  little  bewildered  their  brains,  by  their  attempts 
to  compass  this  impossibility.  So  also,  the  navigating  the  air  by  means  of  balloons,  has 
been  attempted  by  misguided  men,  who,  having  made  clear  to  their  own  minds,  some 
one  of  the  many  elements  which  must  concur  to  secure  its  practicability,  have  engaged 
in  a  ruinous  enterprise,  for  want  of  a  clear  appreciation  of  all  the  conditions  of  the  pro- 
blem. With  reference  to  the  undertaking  more  particularly  before  us,  we  have  reason  to 
believe  that  the  gentlemen  who  are  experimenting  upon  the  mind  of  the  idiot,  are  pro- 
ceeding cautiously  and  intelligently  in  their  work  ;  are  making  it  collateral  to  other 
occupations  of  known  and  acknowledged  importance,  and  are  wasting  neither  their  talents 
nor  resources,  nor  in  any  respect  compromising  the  present  or  future  well-being  of  the 
unhappy  subjects  of  their  experiments.  For  these,  in  addition  to  other  considerations 
offered,  we  should  hesitate  before  expressing  an  opinion  with  regard  to  the  results  of 
their  labors,  and  leave  it  for  time  to  make  them  manifest.] 

Without  imitating  that  species  of  worship,  which  they  are  in  the  habit  of  pay- 
ing to  idiots  and  cretins  in  certain  countries,  where  it  is  regarded  as  a  special 
favor  of  heaven,  to  have  an  idiot  or  cretin  in  one's  family ;  we  should  treat 
with  much  care,  those  wretched  beings  who,  left  to  themselves,  are  exposed  to 
all  the  causes  of  destruction.     We  habituate  them,  in  time,  to  a  suitable  regi- 


476  IDIOCY. 

men  ;  but  their  indolence,  apathy,  and  resistance  to  every  movement  which 
only  augment  their  slovenliness,  together  with  their  propensity  to  onanism, 
require  an  enlightened,  and  very  active  watchfulness.  Nothing  could  have 
prevented  imbecility  and  idiocy  ;  but  authors  who  have  written  on  cretinism, 
particularly  Fodere,  offer  most  important  advice  respecting  the  propagation 
of  this  last  infirmity. 

Both  cretins,  cagots,  and  even  albinos,  have  been  classed  among  idiots. 
Cretinism  is  a  remarkable  variety  of  idiocy.  Cretins  are  idiots  of  the  moun- 
tains, though  they  are  sometimes  found  in  the  plains.  They  do  not  differ 
essentially  from  our  idiots,  with  respect  to  the  feebleness  of  their  sensibility 
and  intellectual  capacity ;  but  in  the  symptoms  and  circumstances  peculiar 
to  cretinism.  We  denominate  cretins,  those  idiots  and  imbeciles  who  ordi- 
narily inhabit  the  gorges  of  mountains.  This  name  is  derived,  it  is  said, 
from  the  word  chretien,  because  these  wretched  beings,  simple  and  inoffen- 
sive in  their  manners  and  habits,  were  venerated  as  holy  personages.  Permit 
me  to  hazard  an  hypothesis.  Did  not  the  appellation  cretin  come  from  the 
word  cretine,  which  in  an  earlier  age,  signified  alluvion?  Has  not  this  name 
been  transferred  to  individuals  who  have  become  enfeebled,  in  consequence  of 
living  in  the  midst  of  an  alluvial  region  ?  In  fact,  is  not  cretinism  endemic 
in  gorges  of  the  mountains,  which  are  more  or  less  marshy,  and  exposed  to  a 
moist  air  ?  M.  de  Maugiron,  of  the  Society  of  Sciences  at  Lyons,  is  the  first 
who  noticed  with  special  attention  this  unfortunate  class,  and  wrote  an  essay 
on  cretinism.  M.  de  Saussure,*  in  his  journey  to  the  Alps,  speaks  at  length 
of  cretins,  and  the  causes  of  their  infirmities. 

Richard  Clayton!  assures  us,  that  cretins  are  rarely  more  than  four  feet 
two  inches  in  height,  that  the  greater  part  of  them  are  deaf  and  dumb,  and  that 
they  become  old  at  a  comparatively  early  period  of  life.  Clayton,  doubtless 
speaks  only  of  cretins  who  are  reduced  to  the  lowest  degree  of  mental  and 
physical  degradation.  L.  Ramond|  has  described  the  cretins  of  the  Pyrenees, 
compared  them  with  those  of  the  Alps,  and  demonstrated  that  the  causes 
which  are  said  to  produce  cretinism  in  the  Alps,  do  not  exist  in  the  Pyrenees. 
William  Cox§  has  pointed  out  the  different  degrees  of  degradation  with 
respect  to  intelligence,  which  exist  among  cretins ;  from  that  which  borders 
upon  a  normal  state,  to  that  in  which  the  cretin  becomes  a  mere  organized 
being  that  vegetates.  Fodere|l  has  published  an  excellent  work  on  the  cre- 
tins of  the  Alps,  whom  he  had  long  seen,  and  carefully  observed.  Parr,  in 
his  researches  among  the  Americans,  remarks,  that  he  saw  many  cretins  and 
albinos  at  the  Isthmus  of  Panama.  Cretins  present  the  same  characteris- 
tics, the  same  varieties  of  intellectual  incapacity,  and  of  physicial  and  moral 
insensibility,  which  we  observe  among  idiots.  They  are  however,  distin- 
guished from  the  latter,  inasmuch  as  they  are  born  usually,  in  the  gorges  of 
mountains,  and  amidst  local  and  material  circumstances,  which  are  not  met 
with  elsewhere;  and  because  they  display  goitres  more  or  less  voluminous; 
and  are  all  remarkably  lymphatic  and  scrofulous. 

The  stature  of  cretins  is  small,  and  their  skin  pale,  wan,  livid,  flaccid  and 
wrinkled  Their  muscles  are  soft,  relaxed,  and  without  strength;  their  limbs 
large  and  thick.  The  abdomen  is  very  voluminous.  The  head  is  usually 
gross,  now  flattened  posteriorly,  and  now  depressed  at  the  top.  The  hair  is 
fine,  and  of  a  blond  color.     The  eyes  are  widely  separated,  and  concealed  be- 

*   Travels  among  the,  Mps. 

t  Memoirs  of  the  Literary  and  Philosophical  Society  of  Manchester. 
t  Journey  to  the  Pyrenees. 

§  Letters  on  the  Civil,  Political,  and  Natural  Condition  of  the  S%ciss.  Paris,  1782,  2 
vols,  in  8vo. 

II  A  Treatise  on  Goitre  and  Cretinism.     Paris,  year  viii.  in  8vo. 


IDIOCY.  477 

neath  bushy  eye-brows;  the  lids  are  red  and  weeping  ;  the  look  askance  and 
stupid ;  the  nose  is  flattened,  and  the  lips  are  thick.  The  tongue  is  pendant, 
and  the  mouth,  half  open,  overflows  with  mucus,  which  runs  down,  over  their 
garments.  The  lower  jaw  is  prolonged,  and  the  face  swollen,  which  causes  it  to 
appear  square  ;  and  the  physiognomy  without  expression,  is  stupid.  With 
some  cretins,  the  neck  is  short  and  thick  ;  while  in  other  cases,  it  is  lono-  and 
slender.  All  are  not  afflicted  with  goitre.  For  the  most  part,  the  lower  extre- 
mities are  unequal,  short,  and  infiltrated  ;  and  the  step  is  slow,  awkward  and 
insecure.  They  are  slovenly  in  the  extreme.  Furthermore,  the  digestive 
functions  are  well  executed.  Cretins  are  gluttons,  and  also  very  lascivious. 
Like  idiots,  they  may  be  distributed  into  three  classes.  Cretins  of  the  first 
class,  hold  the  head  properly,  have  an  animated  look,  and  an  easy  gait.  Their 
ideas  are  few,  and  incomplete;  but  they  distinguish  between  the  most  common 
affairs  of  life,  as  well  as  good  and  evil.  They  are  incapable  of  followino-  a 
process  of  reasoning,  ask  few  questions,  and  reply  correctly.  Their  speech 
however,  is  interrupted  by  grimaces,  and  convulsive  muscular  movements. 
This  constitutes  the  most  numerous  class  of  cretins. 

Cretins  of  the  second  class,  have  a  livid  skin,  deformed  features,  a  long 
neck,  soft  and  flaccid  flesh.  They  are  goitrous,  their  heads  imperfectly  formed, 
and  their  limbs  large  and  heavy.  They  express  themselves  by  gestures  only, 
or  by  convulsive  cries,  have  little  sensibility,  experience  and  express  merely 
their  physical  wants.  Their  understanding  goes  no  farther  than  a  gross  instinct, 
and  they  become  attached  to  no  one.  In  the  third  class,  the  cretins  are  mute, 
deaf,  or  blind  ;  the  look  indicating,  that  at  best,  they  see  imperfectly.  They  pos- 
sess no  sense  of  taste,  but  eat  whatever  is  put  into  their  mouth.  They  are  equally 
insensible,  to  good  or  bad  treatment.  It  is  necessary  to  carry  them  about,  as 
their  dullness  and  stupidity  are  most  profound.  All  infants  who  become  cretins, 
are  not  born  such.  It  is  only  about  the  second,  third  or  fourth  year,  that  the 
development  of  the  understanding  is  arrested.  However,  children  who  are  to 
become  cretins,  are  born  with  a  small  goitre,  nurse  with  difiiculty,  are  bloated 
and  always  drowsy.  They  neither  walk  nor  speak,  at  the  same  age  with 
other  children.  It  is  not  until  the  age  of  ten  or  twelve  years,  that  they  are 
able  to  walk,  speak  a  few  words,  and  convey  their  food  to  their  mouth.  Pu- 
berty is  late.  These  wretched  beings  are  found  seated,  ordinarily  before  their 
respective  habitations.  To  go  from  their  bed  to  the  common  fire-place  in  win- 
ter, and  outside  of  the  door  in  summer,  is,  for  them,  a  long  journey,  as  they 
walk  little.  It  would  be  desirable  to  be  able  to  compare  the  different  forms  of 
the  crania  of  cretins,  with  those  of  the  idiots  inhabiting  the  plains  and  cities. 
I  have  been  unable  to  obtain  more  than  a  single  specimen  of  the  crania  of 
cretins,  although  I  have  sought  for  them  in  the  Pyrenees  and  Alps,  and  seve- 
ral physicians  have  promised  them  to  me.  The  prejudices  of  the  country, 
have  doubtless  proved  an  insurmountable  obstacle  to  the  fulfillment  of  the 
promises  of  my  confreres. 

[I  have  recently  examined  the  skull  of  a  cretin,  belonging  to  my  friend,  Dr.  H.  A.  Grant, 
of  Hartford,  Ct.  The  Doctor  informs  me,  that  while  en  route  from  Martigny  to  Mont  St. 
Bernard,  he  accidentally  paused  in  the  neighborhood  of  a  church-yard.  He  entered  it, 
and  while  w^alking  about  among  the  tombs,  happened  to  glance  at  the  church  which  was 
a  little  way  off,  and  observed  in  a  niche,  something  resembling  the  skull  of  a  human 
being.  On  inquiring  of  his  conductor,  who  was  acquainted  in  those  parts,  what  it  was, 
and  why  it  had  been  placed  there,  he  was  told  that  it  was  the  skull  of  a  cretin  boy,  from 
eight  to  ten  years  of  age,  who,  in  consequence  of  his  perverse  disposition,  and  acts  of 
cruelty  and  murder — for  he  had  actually  killed  his  own  mother — had  been  decapitated 
after  death,  and  his  head  placed  where  it  then  was,  as  a  terror  to  all  evil  doers  belonging 


478  iDiocy. 

to  this  class.  A  plate  of  glass  once  stood  before  it,  but  this  had  long  since  been  broken, 
and  the  naked  skull  stood  bleaching  beneath  the  sun  and  winds  of  heaven.  Without 
expressing  much  interest  in  this  statement  at  the  time,  Doctor  G.  resolved,  if  possible,  to 
*  possess  himself  of  it.  On  his  return  a  few  days  subsequently,  he  halted  again  at  this 
sequestered  spot,  and  sending  his  servants  in  an  opposite  direction,  availed  himself  of 
the  opportunity  to  despoil  the  church  of  this  singular  relic.  So  long  had  it  been  expos- 
ed, that  the  sutures  easily  separated,  and  it  was  readily  deposited  beneath  the  folds  of 
his  cloak.  This  skull  is  of  the  usual  thickness  and  density.  The  bones  of  the  face  are 
unusually  small,  while  the  breadth  across  the  root  of  the  nose  from  the  internal  canthus 
of  one  eye  to  that  of  the  other,  is  nearly  two  inches.  The  head  is  singularly  shaped; 
the  anterior  portion  being  low  and  narrow,  while  its  breadth  across  from  one  parietal 
protuberance  to  the  other,  is,  in  contrast,  remarkably  large.  The  vertex  is  also  very 
flat;  rising  little  if  any,  above  the  low  forehead.  The  occipital  bone  has  unfortunately 
been  misplaced  or  lost.  In  other  respects  the  skull  is  entire.  In  proof  of  the  fact  that 
the  age  of  the  child  was  correctly  given,  it  will  be  proper  to  observe,  that  the  second 
teeth  had  not  all  been  cut  at  the  time  of  his  death  ;  several  now  being  exposed  to  view, 
by  the  decay  of  the  integument  and  alveolar  processes.  We  took  the  admeasurements 
of  the  skull,  with  a  view,  at  the  same  time  that  we  furnished  an  idea  of  its  size,  to  pre- 
sent also,  the  striking  contrast  which  exists  between  the  parietal  and  frontal  portions. 

Circumference  of  skull      .....  19.2-5  inches 

From  root  of  nose  to  occipital  protuberance,  about    .             .  10.00  " 
From  mastoid  process  of  one  side  to  the  same  on  the  other, 

over  parietal  protuberances    ....  l.'3.]2  " 
From  junction  of  frontal  with  parietal  bone,  from  side  to  side 

just  below  parietal  protuberances             .             .             .  12.87  " 

From  corresponding  points  over  frontal  bone       .             .  6.50  " 

A  family  of  the  Pyrenees  is  thus  described.  The  physiognomy  of  the  mo- 
ther contrasts  singularly  with  that  of  her  two  children ;  the  goitrous  enlarge- 
ments of  the  latter,  particularly  that  of  the  young  man,  being  much  less  volu- 
minous than  that  of  the  mother.  The  forehead  of  the  young  man  is  far  more 
retreating  than  that  of  his  sister.  The  eyes  of  both  are  concealed  beneath  the 
orbit,  and  the  chin  is  also  very  retreating.  The  lips  of  both,  and  particularly 
those  of  the  daughter,  project,  and  the  mouth  remains  partially  open.  Their 
physiognomy  is  expressive  of  the  most  perfect  stupidity.  They  do  not  speak, 
but  utter  a  sort  of  grunt.  They  walk  insecurely  and  slowly ;  help  themselves 
to  food ;  but  require  assistance  in  dressing.  They  employed  certain  signs  to 
express  their  desires,  which  were  limited  to  the  first  wants  of  life.  They  re- 
cognized their  mother,  and  loved  to  be  near  her.  Rarely  did  one  move  abroad 
without  the  other ;  and  in  the  house,  they  were  always  accustomed  to  sit  side 
by  side.  The  daughter  was  sent  to  the  hospital  at  Toulouse,  where  I  saw  her 
in  1828.  She  was  of  medium  stature ;  her  head  small,  and  flattened  at  its 
crown;  the  eyes  small,  and  concealed  beneath  the  orbit;  the  lips  thick,  the 
mouth  gaping,  and  filled  with  mucus.  Two  small  goitres  were  appended  to 
her  chin.  She  walked  awkwardly,  and  with  a  waddling  gait.  She  did  not 
speak,  but  uttered  a  grave,  deep  sound,  to  express  her  joy,  as  well  as  suffering. 
She  had  a  well  marked  taste  for  strong  substances,  and  seized  upon  tobacco 
with  avidity.  She  appeared  gratified  when  I  gave  it  to  her,  and  conveyed  it 
immediately  to  her  nose.  I  gave  her  some  pieces  of  money  ;  she  took  them 
in  her  hand,  looked  at  them  attentively,  and  expressed  her  recognition  of  them, 
by  uttering  certain  stifled  and  articulate  sounds.  She  has  since  died,  and  M. 
Delaye,  physician-in-chief  of  the  hospital  of  Toulouse,  sent  me  her  cranium, 


IDIOCY.  479 

the  dimensions  of  which  are  as  follows.     The  left  half  of  the  cranium  is  more 
prominent  than  the  right : 

Circumference           .....  20.07  in. 
Curvature  from  the  root  of  the  nose  to  the  occipital 

tuberosity        .              .              .              .              .  9.64    " 

Antero-posterior  diameter       ....  6.G1    " 

Bi-temporal  diameter      ....  5.70    " 


Total  .  .  .  ,  .        42.02 

I  have  remarked,  that  cretinism  is  endemic  in  the  gorges  of  mountains,  and 
in  certain  plains.  We  meet  with  cretins  among  the  Alps,  the  Pyrenees,  the 
Asturias,  in  Scotland,  among  the  Krapack  or  Carpathian  mountains,  in  Tar- 
tary,  among  the  Cordilleras,  etc.,  etc.  Cretins  are  far  more  numerous  in  coun- 
tries where  cretinism  is  endemic,  than  are  idiots  in  the  plains  and  cities. 
Cretins  are  so  numerous  in  these  countries,  that  in  the  department  of  the  Alps 
alone,  there  were  3,000  cretins  in  1812, — according  to  a  memorial  from  which 
I  shall  borrow  much, — while  idiocy  is  a  rare  phenomenon  among  us.  In  fact, 
in  hospitals  for  the  insane,  only  one  thirtieth  at  most,  are  idiots.  In  the  crene- 
ral  table  of  the  insane  admitted  at  the  Salpetriere,  during  four  years,  within 
three  months,  and  published  by  Pinel,  we  find  that  out  of  1,002  insane  women 
who  were  admitted,  only  36  were  idiots.  The  reports  of  the  same  hospital, 
from  the  year  1804  to  1814,  out  of  2,804  insane  women,  present  98  cases  of 
idiocy.*  The  same  is  true  at  the  Bicetre.  According  to  an  unpublished  me- 
morial of  Pussin,  as  well  as  the  reports  made  by  Doct.  Hebreard,  physician  to 
this  hospital,  and  the  reports  published  by  Count  Pastoret  in  1816,t  out  of 
2,154  insane  men  admitted  at  the  Bicetre  during  ten  years,  69  were  idiots. 

The  examination  of  these  reports,  justifies  what  I  remarked  above,  when 
announcing  that  idiocy  is  a  rare  phenomenon  among  us ;  since,  out  of  7,950 
insane  persons  of  both  sexes,  there  are  only  203  idiots.  Pinel  says,  that  one 
quarter  of  the  inmates  of  the  Bicetre  and  Salpetriere,  are  idiots.  This  is  evi- 
dently an  error  in  compiling,  since  the  statistical  tables  of  the  same  work 
show  the  contrary.  Reil,  and  others  who  have  written  since  the  celebrated 
French  professor,  have  repeated  the  same  error.  The  vague  acceptation  of  the 
word  idiotism,  explains  this  apparent  contradiction  between  what  has  been  ad- 
vanced by  these  distinguished  masters,  and  the  results  of  observation.  Those 
authors,  who  have  observed  cretins,  and  written  on  the  subject  of  cretinism 
have  expressed  different,  and  often  conflicting  opinions,  respecting  the  causes 
of  this  infirmity.  We  meet  with  cretins  in  low,  deep  and  narrow  valleys,  and 
in  gorges  surrounded  by  high  mountains. 

A  celebrated  Italian  traveler,  whose  name  has  escaped  me,  assures  us,  that 
cretins  are  far  less  numerous,  in  the  gorges  of  magnesian,  than  calcarious 
mountains.  Saussure  has  observed  that  there  are  no  cretins  found  above  an 
elevation  of  600  toises|  {3,600  feet).  He  does  not  concur  in  opinion,  with 
those  authors  who  believe  that  snow-water  or  melted  ice,  and  waters  contain- 
ing calcarious  sulphates,  are  the  cause  of  cretinism.  The  inhabitants  of 
high  mountains,  he  says,  drink  the  same  waters  and  are  not  goitrous.  This 
savant  attaches  little  importance  to  marshy  emanations,  to  bad  nourish- 
ment, to  drunkenness  and  debauchery,  as  a  cause  of  this  infirmity,  because 
the  effects  of  these  influences  are  not  perceived  among  the  inhabitants  of  the 
plains.     He   attributes   cretinism,   to  the   stagnant,  heated    and  vitiated   air, 

*  Report  to  the  general  Council  of  Hospitals.     Paris,  1816,  in  4to. 
t   Treatise  on  Mental  Alienation.     Paris,  1809,  in  8vo.  p.  186 
\  A  toise  is  two  yards. 


480  IDIOCY. 

which  tlie  inhabitants  of  the  valleys  respire  ;  for,  adds  he,  villages  having  a 
southern  exposure,  contain  the  largest  number  of  cretins.  The  cretins  of  the 
Pyrenees,  which  were  observed  by  Rainond,  inhabit  valleys  having  a  northern 
exposure,  respire  a  dry  and  temperate  air,  and  drink  pure  and  running  water. 
It  is  therefore  to  other  causes  than  those  indicated  by  Saussure,  that  we  are 
to  attribute  cretinism.  Sloth  and  supineness  can  with  no  more  propriety,  be 
charged  with  it.  The  inhabitants  of  Beam  and  Navarre,  though  very  active, 
are  nevertheless  subject  to  goitre  and  cretinism.  Can  we  however,  convince 
ourselves  with  Ramond,  that  misery,  and  the  state  of  abasement  and  con- 
tempt of  which  cretins  are  the  objects,  may  have  gradually  produced  the 
cretinism  of  the  inhabitants  of  the  Pyrenees  1  Certainly  not.  The  cretins 
of  the  Valais,  are  regarded  with  a  kind  of  consideration  in  addition  to  nu- 
merous affectionate  attentions,  and  are  not  miserable. 

Fodere  does  not  admit,  that  the  waters  which  are  drank  by  the  inhabitants 
of  the  valleys  of  the  Alps,  are  the  cause  of  cretinism,  the  inhabitants  of  high 
mountains  having  no  other  waters  to  drink.  This  learned  professor  is  of  opi- 
nion, that  cretinism  is  produced  by  the  warm,  humid,  concentrated  and  stag- 
nant air,  which  is  respired  in  the  gorges.  In  an  unpublished  memoir  which 
Count  Rambuteau  sent  to  the  minister  of  the  interior  in  1812, — a  memoir  which 
I  have  freely  laid  under  contribution, — the  aged  prefect  of  the  Simplon  ex- 
presses the  belief,  that  the  Rhone,  overflowing  at  the  period  when  the  snows 
melt,  leaves  in  the  plains  of  the  Valais,  marshy  waters,  which  exhale  impure 
vapors ;  and  that  the  waters,  in  descending  from  the  summits  of  the  moun- 
tains, are  charged  with  the  muriate  and  carbonate  of  lime,  which  render  them 
unhealthy.  These  are  not  the  only  circumstances  however,  which  contribute 
to  the  production  of  cretinism.  He  rejects  the  opinion  of  those  who  attribute 
it  to  waters,  produced  from  ice  and  melted  snows.  In  the  Valais  even,  says 
M.  Rambuteau,  the  habitations  which  are  situated  on  high  mountains,  where 
they  breathe  a  pure  and  free  air,  present  to  our  notice  a  robust  population. 

In  the  valley  of  the  Rhone,  many  of  the  more  extended  portions  of  it, 
are  exempt  from  goitres  and  cretinism,  where  the  air  is  well  agitated,  and 
throughout  the  greater  part  of  the  lateral  valleys,  where  they  receive  the  re- 
freshing winds  from  the  north  :  when  removed  from  marshes,  and  water  of  a 
good  quality  is  drank.  Cretins  on  the  contrary,  are  most  numerous  in  villages 
situated  in  valleys,  encompassed  by  high  mountains,  and  exposed,  during  four 
months,  to  the  rays  of  a  burning  sun.  The  heat,  reflected  from  the  naked 
and  scorching  rocks,  is  so  concentrated,  that  the  inhabitants  respire  only  a 
stifling  and  heated 'air,  and  the  south  wind,  especially  referred  to  by  Hippo- 
crates, for  its  depressing  effect  upon  the  process  of  innervation,  prevails  there 
constantly. 

It  is  remarkable,  that  the  valleys  in  which  goitrous  persons  only  are  found, 
border  on  those  in  which  cretins  reside  ;  and  that  in  approaching  the  latter, 
goitres  begin  to  appear  ;  at  first  rare,  then  more  frequent.  At  length,  we  see 
them  both  existing  together.  The  habitations  of  the  Valais  are  low,  narrow 
and  filthy.  The  air  in  them  is  not  renewed,  nor  does  the  light  penetrate  them. 
The  domestic  animals  live  there,  in  company  with  human  beings.  The  food 
of  the  latter  is  bad,  and  composed  of  salted  meats,  potatoes,  maize  and  chest- 
nuts. The  indolence,  sloth,  drunkenness  and  debauchery ;  the  insufficient 
attention  which  is  paid  to  new-born  children,  and  the  accidents  which  happen 
in  consequence  of  their  abandonment ;  are  all  secondary,  but  powerful  causes, 
which  augment  the  fatal  influences  of  the  sun,  water  and  air. 

To  all  these  denials  of  the  injurious  influence  of  the  waters,  Dr.  Bailly  op- 
poses the  contrary  results  of  his  observations.  Goitre  or  bronchocele  proceeds, 
says  this  physician,  from  uncleanly  and  hard  waters,  which  run,  sheltered  from 
the  sun,  and  the  action  of  the  air,  |s  do  those  which  flow  from  the  crevices  of 


IDIOCY.  481 

rocks,  from  mountains,  or  the  bowels  of  the  earth,  and  which  are  drank 
sliortly  after  they  appear.  It  is  true,  adds  our  confrere,  that  goitre  is  produced 
from  the  quality  of  the  water,  and  not  from  the  condition  of  the  atmosphere ; 
and  that  there  are  springs  in  the  Leman,  the  use  of  whose  waters  for  eight 
days  only,  produces  or  augments  this  tumor.  Those  persons  in  the  same  vil- 
lage, who  do  not  drink  of  the  water  of  these  springs,  are  in  no  respect  affect- 
ed with  goitre,  and  do  not  become  idiots,  although  living  within  gun-shot  of 
the  other  inhabitants.  M.  Vyn,  in  his  excellent  itinerary  in  Switzerland,  dis- 
cusses the  various  opinions  that  have  been  promulgated  respecting  the  causes 
of  cretinism,  and  expresses  his  dissatisfaction  with  them  all.  He  is  of  the 
opinion,  that  this  infirmity  is  produced  by  the  sudden  and  frequent  transition 
from  a  warm  to  a  cold  temperature.  This  is  produced  by  very  cold  currents 
of  air,  which  escape  from  narrow  gorges,  and  from  the  great  reduction  of  tem- 
perature after  sunset,  in  comparison  with  its  elevation  during  the  day. 

The  immediate  organic  causes  of  cretinism,  are  no  better  known  nor  deter- 
mined, than  are  the  predisposing  and  remote.  Thus,  one  attributes  it  to  the 
smallness  of  the  head  among  cretins,  and  the  flattening  of  the  vertex  and  occi- 
pital region.  Malacarne  contends,  that  the  small  size  of  the  cranium,  or 
rather  its  narrowness,  does  not  permit  the  brain  to  become  developed ;  and 
hence  it  is  incapable  of  fulfilling  its  functions.  Ackermann  concluded,  that  the 
flattening  of  the  occipital  region,  noticed  among  many  cretins,  by  displacing 
the  bundles  of  nerves  at  their  origin,  impaired  their  action,  and  consequently 
the  development  of  the  understanding.  Some  observers  have  found  the  brain 
very  dense,  and  others,  hydrocephalic.  Some  authors  attribute  cretinism  to 
the  compression  of  the  carotids,  produced  by  the  submaxillary  glands  which 
had  been  very  much  developed  by  scrofula.  Is  cretinism  the  result  of  a  con- 
genital vice  ?  Is  the  deformity  of  the  cranium  always  the  cause  of  this  infir- 
mity, or  rather  is  it  not  often  a  malady  acquired  after  birth  ?  Josias  Simler, 
— an  historian  of  the  Valais,  who  wrote  in  1574, —  pretends  that  the  midv/ives 
of  his  time,  knew,  at  the  moment  of  birth,  whether  the  infant  was  to  be  a  cre- 
tin. If  such  was  the  fact,  cretins  were  born  with  some  appreciable  vice  of 
conformation ;  after  which,  the  dwelling  in  valleys  which  were  humid  and 
warm,  the  state  of  the  atmosphere,  the  quality  of  the  waters,  and  bad'regimen, 
exercised  only  a  secondary  influence. 

But  M.  Rambuteau  assures  us,  that  it  is  very  rare  that  we  can  decide  at 
birth,  whether  the  infant  is  to  be  a  cretin  ;  and  besides,  how  are  we  to  explain 
the  improvement  which  the  inhabitants  of  the  valleys  experience,  on  changing 
their  residence  to  high  mountains,  or  the  marked  diminution  observed  for 
many  years  in  the  number  of  cretins?  It  is  the  more  probable  supposition, 
that  the  influences  to  which  infants  are  subjected,  are  the  producing  cause  of 
this  malady  ;  for,  as  we  have  already  said,  children  are  not  born  cretins,  nor 
do  they  become  so,  previous  to  the  second,  and  sometimes  the  fourth  or  fifth 
year.  Another  interesting  problem  to  solve  is  the  following  :  Do  cretinism  and 
goitre  depend  essentially  upon  the  same  causes?  Since  the  major  part  of  cre- 
tins are  goitrous,  some  observers  have  decided  the  question  in  the  affirmative. 
However,  there  are  facts  that  ought  to  inspire  doubts  respecting  this  identity 
of  origin.  Cretins  spring  from  goitrous  parents,  though  this  is  not  always  the 
case ;  and  it  is  not  unusual  to  see  in  the  same  family,  infant  cretins,  and  chil- 
dren whose  understandings  are  fully  developed,  though  they  are  the  offspring  of 
the  same  father  and  mother.  It  is  not  always  the  case,  that  cretins  are  found 
where  goitre  exists ;  and  reciprocally,  where  there  are  idiots,  cretins  are  not 
always  found.  Thus  goitre  does  not  necessarily  influence  the  development  of 
the  organs  and  intellectual  faculties,  but  is  complicated  with  idiocy  in  certain 
countries. 

It  is  a  constant  observation,  says  M.  Rambuteau,  that  cretins  who  are  mar- 
ried to  persons  exempt  from  cretinism,  give  birth  to  children,  sound  both  in 

61 


482  IDIOCY. 

body  and  mind;  while  individuals  who  are  well  formed  and  intelligent,  beget 
cretins.  We  cannot  say  what  would  be  the  result  of  a  marriage  between  two 
cretins,  as  such  unions  never  take  place.  It  is  notorious,  that  both  fathers  and 
mothers  who  stammer,  (a  very  common  occurrence  in  the  Valais),  often  give 
birth  to  idiots  ;  and  that  in  families  where  the  first  born  is  an  idiot,  the  younger 
children  are  equally  so.  It  has  also  been  observed,  that  the  Valaisannes,  who 
marry  French  or  Savoyard  refugees,  are  more  likely  to  produce  cretins,  than 
when  they  are  allied  to  the  people  of  the  country.  We  can  account  for  this 
phenomenon,  by  calling  to  mind  the  fact,  that  the  French  and  Savoyards  who 
take  refuge  in  the  Valais,  are  men  without  principle,  education  or  resources ; 
who  are  enervated  by  the  excessive  heat  of  the  valleys,  by  drunkenness  and 
debauchery ;  who  become  apathetic  and  besotted,  and  who, — marrying  before 
becoming  acclimated, — produce  feeble  and  scrofulous  children,  subject  to  the 
fatal  influences,  of  all  the  causes  which  favor  the  production  of  goitre  and  cre- 
tinism ;  whilst  the  Valaisannes,  who  are  connected  by  marriage  with  French- 
men belonging  to  the  higher  classes,  and  in  easy  circumstances,  give  birth,  as 
do  the  inhabitants  of  the  lofty  mountains,  to  strong  and  robust  children. 

Whatever  may  be  the  remote  and  proximate  causes  of  cretinism,  it  is  con- 
soling to  know,  that  the  number  of  cretins  has  been  diminishing  in  the  Alps 
and  Pyrenees  for  the  last  forty  years.  The  late  prefect  of  the  Simplon, 
attributed  this  diminution  to  the  dykes,  which  prevent  the  inundations  of  the 
Rhone ;  to  the  drying  up  of  the  marshes  ;  to  the  grubbing  up  of  the  soil ;  and 
finally,  to  the  improved  regimen  adopted  by  the  inhabitants  of  the  Alps,  who 
have  become  more  industrious,  and  less  addicted  to  crapulence  and  drunken- 
ness. Fodere  assures  us,  that  the  care  which  is  taken  to  rear  the  children 
upon  high  mountains,  that  industry,  commerce,  and  the  use  of  coffee,  have 
powerfully  contributed  to  lessen  the  number  of  this  unfortunate  class  of  our 
fellow-beings.  Ramond  agrees  in  sentiment  with  these  authors,  as  it  respects 
the  diminution  of  cretinism.  Perhaps  we  ought  also  to  attribute  something  to 
the  influence  of  the  light  that  has,  at  length,  penetrated  these  countries.  The 
prejudices  and  superstitious  regard  which  they  entertain  for  these  unhappy  be- 
ings, the  mistaken  attentions  which  they  lavished  upon  them,  contributed  to 
render  indolent,  apathetic  and  stupid — cretins  in  a  word — those  unfortunate 
beings  who,  at  this  day,  without  being  deprived  of  the  cares  which  are  due  to 
those  who  are  deformed  by  nature,  are  reared  with  a  greater  share  of  discre- 
tion. 

We  denominate  albinos,  those  persons  who,  accidentally,  and  in  conse- 
quence of  a  malady  ordinarily  congenital,  have  a  milk-white  skin,  the  hair  of 
the  head  and  person  of  a  shining  whiteness,  and  rose-colored  eyes.  The 
skin  of  albinos  is  pale,  of  a  milk-white  color,  and  covered  with  a  white 
down;  the  hair  of  the  head,  eyelids,  eyebrows,  beard,  and  that  of  the  other 
parts  of  the  body,  being  of  a  shining  white.  The  cornea,  deprived  of  the 
pigmentum,  leaves  exposed  to  view,  the  blood-vessels  which  traverse  the  eye- 
balls ;  a  circumstance  which  gives  to  the  eyes  their  rose  color.  A  continual 
winking  agitates  the  eyelids  ;  and  the  pupils  contract  and  dilate  frequently. 
They  fly  the  light,  the  shining  of  which  prevents  them  from  perceiving  ob- 
jects ;  nor  do  they  see  distinctly,  except  during  the  twilight,  and  when  the 
moon  illuminates  the  horizon.  This  condition  is  often  complicated  with 
imbecility  and  idiocy.  Wherever  we  meet  with  albinos,  there  we  also  find 
the  goitrous  and  idiots.  Albinos  do  not  constitute  a  distinct  race  of  men 
as  has  been  pretended.  The  birth  of  an  albino  is  an  accident.  He  springs 
from  parents,  black,  olive  or  copper  colored,  in  the  torrid  zone.  With  us,  he 
is  born  of  parents  whose  complexions  are  of  the  usual  whiteness,  and  whose 
remaining  children  resemble  their  father  and  mother.  The  constitution  of 
albinos  is  generally  debilitated,  and  their  intellectual  capacity  feeble. 

Do  albinos  reproduce  their  like?     We  do  not  know,  as  we  are  destitute 


IDIOCY.  483 

of  observations  on  this  point ;  still  it  is  certain,  that  when  united  with  healthy 
persons,  they  engender  a  healthy  offspring.  The  Kakrelaks  of  Asia  are 
regarded  as  fruitful.  That  worthy  missionary,  M.  Dubois,  who,  for  thirty 
years,  preached  Christianity  in  India,  baptized  the  infant  of  a  female  Kakre- 
lake  and  a  European  soldier.  This  infirmity  of  the  human  species  is  more 
frequent  within  the  tropics  than  in  Europe.  We  meet  with  albinos  in  the 
Island  of  Ceylon,  bearing  the  name  ofbcdas,  and  that  of  Kakrelaks  in  Ame- 
rica.    The  albinos  of  South  Africa  are  called  dandos. 

■  Albinos  were  known  among  the  ancients.  We  read  in  the  fragments  of 
Ctesias,  that  the  Indians  are  black  by  nature  and  not  from  the  influence  of  the 
sun.  I  have  seen  however,  says  this  author,  two  women  and  five  men  who 
were  white.  Pliny  relates  that  in  Albania,  at  the  foot  of  the  Caucasus,  we 
meet  with  individuals  whose  eyes  are  glaucous,  who  are  white  from  birth,  and 
who  see  better  at  night  than  during  the  day.  Fifty  years  ago,  they  were 
accustomed  to  display  at  Paris,  two  albinos,  who  were  born  in  the  mountains 
of  Auvergne.  M.  Blandin*  states,  that  a  friend  of  his  was  acquainted  with 
a  family  of  albinos  in  the  environs  of  Paris.  We  all  saw  at  Paris,  fifteen 
years  ago,  an  albino,  who,  it  was  said,  came  from  the  Black  Forest,  was  well 
formed,  although  of  small  size  and  low  stature,  spoke  several  languages,  was 
married,  and  had  two  children,  who  did  not  participate  in  the  infirmity  of 
their  father.     The  chaplain  of  the  hospital  of ,  is  an  albino. 

M.  D.,  who  is  not  far  from  fifty  years  of  age,  was  the  offspring  of  very 
healthy  parents,  but  is  an  albino.  His  developments  are  like  those  of  other 
children,  although  of  a  delicate  constitution,  and  endowed  with  the  usual 
share  of  intelligence.  His  disposition  is  very  mild  and  acquiescent,  though 
timid.  Until  the  age  of  seven  years,  he  did  not  see  during  the  day,  but  after 
that  period,  habituated  himself  gradually  to  the  impression  of  light,  until  he  was 
enabled  to  see,  and  to  distinguish  objects  which  were  at  hand.  He  is  myopic, 
and  obliged  to  bring  close  to  his  eyes  whatever  he  desires  to  see  or  to  read. 
He  received  a  most  carefully  conducted  education,  and  profited  by  it  to  some 
extent,  without  however  acquiring  a  remarkable  degree  of  intelligence. 
Until  his  appearance  in  society  when  about  eighteen  years  of  age,  he  permit- 
ted his  snow-white  locks  to  fall  freely  over  his  shoulders.  He  then  put  on  a 
wig  and  spectacles,  and  frequented  society,  in  which  he  always  appeared 
.somewhat  constrained.  He  is  now  married,  and  has  two  children  whose  com- 
plexions are  very  dark. 

Every  physician  has  visited  Roche,  an  albino,  who  has  been  for  a  great 
many  years  an  inmate  at  the  Bicetre.  He  was  about  thirty-four  years  of  age 
when  I  saw  him  in  1821.  He  is  of  medium  stature,  of  more  than  ordinary 
fullness  of  habit,  his  skin  delicate,  of  a  milky  whiteness,  with  a  slightly  rose- 
colored  tinge.  The  volume  of  his  head  is  proportioned  to  the  size  of  his 
body,  and  well  enough  formed  ;  although  the  forehead  is  flattened.  Measure 
of  the  head. 

Circumference        .  .  .  .  .21.65  in. 

Curvature  from  the  root  of  the  nose  to  the  occipital 

protuberance  ....  12.00    " 

Antero-posterior  diameter  ....         7.24    " 
Transverse  diameter      ....  6.10    " 


Total 46.99 

The  hair,  both  upon  the  head  and  person,  is  of  a  shining  whiteness ;  and 
his  eyelids   are  in   constant  motion.     If   the  twinkling  ceases,  they  remain 

*  Dictionary  of  Medicine  and  Practical  Surgery,  art.  Mhino,  p.  454. 


484  IDIOCY. 

Iialf  closed.  Tlie  ball  of  the  eye  is  rose  colored.  Roche  sees  illuminated 
objects  imperfectly,  his  vision  is  very  limited,  and  he  regards  objects,  like  one 
suffering  from  myopia.  He  sees  best  in  the  shade,  and  is  pleased  to  remain 
in  his  cell.  His  physiognomy  is  without  expression,  even  when  he  is  vexed. 
His  step  is  awkward  and  uncertain,  and  his  motions  quick.  He  walks  in  his 
shirt,  with  naked  feet ;  runs  about  without  stockings,  sings,  cries  aloud,  and 
breaks  whatever  comes  in  his  way.  His  voice  is  clamorous,  and  becomes  acute 
when  he  is  opposed.  This  albino 'has  no  connected  ideas,  and  articulates 
imperfectly  the  few  words  that  he  has  learned.  Indeed,  it  is  scarcely  possible 
to  understand  what  he  wishes  to  say.  He  understands,  when  addressed  re- 
specting his  habits,  and  the  ordinary  wants  of  life.  He  extends  his  hand  for 
tobacco,  and  raises  up  his  shirt,  to  which  he  has  doubtless  become  accustomed 
by  the  allurement  of  money,  which  the  curious  have  bestowed  upon  him. 
He  eats  largely,  collects  together  whatever  he  meets  with,  is  irritable  but  not 
perverse.  He  is  much  addicted  to  onanism.  Some  time  since,  he  lost  his 
hair,  and  now  remains  better  clad,  and  can  spend  his  time  in  a  dormitory. 

Cagots. — We  give  this  appellation  to  a  race  of  men  who,  plunged  in  the 
deepest  calamity,  pursued  by  contempt,  abuse  and  disgrace,  are  found  dis- 
persed along  the  sea-coast,  from  the  north,  to  the  south  of  France.  "  In  the 
solitudes  of  little  Brittanny,  says  Ramond,  they  are  known  to  have  been 
treated  with  barbarity.  Scarcely  have  they  been  permitted  in  the  most  highly 
civilized  periods,  to  engage  in  the  occupations  of  shoemakers  and  coopers. 
Theparliament  of  Rennes  was  obliged  to  interfere,  to  secure  to  them  the  rights 
of  sepulture.  We  find  them  at  that  time,  known  by  the  name  of  cacous  and 
cagneux,  and  the  dukes  of  Bretagne  had  commanded,  that  they  should  not  ap- 
pear in  pu'ulic  without  a  distinctive  mark.  Towards  Atheunis,  we  find  a  simi- 
lar class  concealed  in  the  Island  of  Maillezais.  La  Rochelle  is  peopled  with 
coliberts  or  slaves.  They  appear  again  under  the  name  of  cahcts  in  Guienne 
and  Gascon,  refugees  in  the  marshes,  lagunes  and  heaths  of  those  regions 
which  have  been  for  a  long  time  uninhabitable.  In  the  two  Navarres,  they 
are  sometimes  called  caffos.  They  were  thus  called  in  the  ancient  For, 
which  was  compiled  about  the  year  1074.  We  discover  them  finally,  in  the 
mountains  of  Beam,  Bigorre,  and  in  the  four  valleys  and  province  of 
Comminges.  It  was  these  cagots  or  capots  that,  in  the  eleventh  century,  we 
learn,  were  given  away,  bequeathed  and  sold  as  slaves ;  regarded  here,  as 
elsewhere,  as  infected  and  leprous  persons  ;  entering  the  church  only  through 
a  small  and  separate  door,  and  having  their  holy  water  and  seats  apart ;  that, 
in  many  places,  the  priests  were  unwilling  to  receive  to  confession,  and  to 
whom  the  ancient  For  of  Beam  was  thought  to  do  a  favor,  by  taking  seven 
witnesses  from  among  them,  as  evidence  ;  who  were,  in  1460,  the  objects  of  a 
claim,  on  the  part  of  the  states  of  Beam,  who  desired  that  they  should  be 
prevented  from  walking  with  naked  feet  in  the  streets,  through  fear  of  infec- 
tion ;  and  that  they  should  wear  upon  their  dress  their  former  distinctive  mark, 
the  foot  of  a  duck  or  goose. 

The  cagots  were  doomed  from  time  immemorial  to  wretchedness,  misery, 
iornominv  and  infirmities.  Infamous  and  accursed,  they  were  avoided  and  cast 
oif  by  the  population  generally  ;  banished  into  remote  places,  incapable  of  con- 
necting themselves  with  the  other  inhabitants,  or  of  engaging  in  any  other  oc- 
cupations, than  those  of  wood-cutters  or  carpenters.  They  were  also  obliged 
to  march  first  to  every  fire,  and  render  to  the  community  the  most  degrading 
services.  It  was  not  until  about  the  middle  of  the  last  century,  that  the  parlia- 
ment of  Bordeaux  passed  a  decree,  by  which  it  was  forbidden  to  treat  in  an 
abusive  manner,  any  pretended  descendant  of  the  race  of  Giezi,  and  to  treat 
them  as  agots,  ragots,  gahets  or  ladrcs.  They  require  also,  the  execution  of 
the  decrees  of  this  court,  of  the  9th  July,  1723,  and  the  22d  of  Nov.  1735,  on 
penalty  of  a  fine  of  200  livres.     The  same  decree  commands,  that  the  gahets 


IDIOCY.  485 

shall  be  admitted  to  all  general  and  special  assemblies  which  may  be  called  by 
the  inhabitants,  to  mtxnicipal  charges,  and  to  the  honors  of  the  church,  like 
other  persons.  The  parliament  of  Toulouse  passed  a  similar  decree,  July  11th 
1746,  in  confirmation  of  two  former  ones,  passed  during  the  month  of  August, 
1703,  and  on  the  11th  of  Aug.  1745.  Ramond  prepared  a  learned  disserta- 
tion on  the  origin  of  this  race  of  men,  who  presented  the  same  physical  cha- 
racteristics, and  the  same  intellectual  and  moral  stupidity,  in  the  different  pro- 
vinces. This  savant  has  been  able  to  offer,  however,  only  conjectures.  Are 
they  the  remains  of  those  ancient  people,  who  have  successively  made  incur- 
sions upon  Gaul  ?  Are  they  the  Sarrazins,  a  remnant  who  have  escaped  the 
sword  of  Charles  Martel  ?  Are  they  the  leprous,  who  have  been  banished  from 
society,  and  exiles  in  secluded  and  desert  places,  where  they  have  degenerated; 
not  daring  to  quit  their  retreat?  It  still  remains  to  be  explained,  how  beings 
so  base  and  degraded,  living  away  from  society  which  disdains  and  treats 
them  in  the  grossest  manner,  have  maintained  their  existence  for  so  many  cen- 
turies. Lastly,  since  the  beginning  of  the  last  century,  prejudices  having 
ceased  to  exist  against  these  wretched  beings ;  and  Nogues,  a  physician,  having 
raised  his  voice  in  their  favor,  and  declared  that  they  were  strong,  robust  and 
intelligent  men ;  the  authority  of  parliament  having  also  set  limits  to  their 
state  of  idiocy  ;  we  now  rarely  meet  with  one  of  this  unfortunate  class;  and 
I  have  only  spoken  of  them  here,  with  a  view  to  bring  to  mind  another  proof 
of  the  deplorable  effects  which  misery,  contempt  and  ignorance,  produce  upon 
the  human  understanding. 

In  this  place,  we  may  naturally  introduce  a  few  considerations  respecting 
savage  races  of  men.  Do  savages  exist?  If  we  understand  by  this  term,  men 
endowed  with  intelligence,  living  alone,  isolated,  strangers  to  all  civilization, 
without  education,  and  having  never  had  communication  with  others  of  their 
species,  doubtless  they  do  not  exist.  There  are  however,  people  who  lead  a 
wandering  life  in  the  woods,  upon  mountains,  and  on  the  banks  of  rivers;  who 
are  destitute  of  the  blessings  of  civilization,  and  whom  we  call  savages. 
They  have  few  ideas.  To  render  themselves  intelligible,  to  exchange  thoughts 
and  desires,  they  have  but  a  small  number  of  words.  They  have  sensations 
and  passions ;  they  compare  and  foresee ;  they  exercise  volition,  and  live  in 
society.  Doubtless  their  sensations  are  less  acute,  their  ideas  less,  and  their 
wants  less  than  our  own.  Their  foresight  also  is  less,  and  their  understanding 
is  less  cultivated.  They  are  less  civilized  than  men  who  inhabit  our  cities, 
and  dwell  in  our  capitals.  Savages  however,  are  endowed  with  the  same  fa- 
culties, and  there  is  no  difference  between  them  and  us,  but  that  which  exists 
between  a  man  who  has  been  educated,  and  one  who  has  not;  between  the 
ignorant  man,  and  him  who  has  been  instructed ;  between  the  man  without 
experience,  and  him  who  has  much  of  it ;  between  the  man  who  yields  himself 
to  the  sway  of  brutal  passions,  and  him  who  has  learned  to  control  them.  And 
these  men,  found  in  the  woods,  towards  whom  the  eloquence  of  the  philoso- 
phers of  the  last  century  awakened  the  interest  of  the  civilized  world;  v/hom 
they  exhibited,  with  a  degree  of  affectation,  to  public  curiosity,  as  perfect  men, 
superior  even  to  Newton  and  Bossuet ;  only  wanted  education.  Those  wretch- 
ed beings  were  not  savages,  but  idiots;  abandoned  and  fugitive  imbeciles; 
whom  the  instinct  of  self-preservation,  and  a  thousand  fortuitous  circumstances 
had  preserved  from  death. 

A  criminal  mother,  or  a  family  in  distress,  aband(wis  an  idiot  or  imbecile 
son  ;  an  imbecile  escapes  from  the  paternal  mansion,  and  wanders  in  the 
woods,  not  knowing  how  to  find  his  way  back.  Favoring  circumstances  pro- 
long his  existence ;  he  becomes  swift  of  foot,  in  order  to  avoid  danger ;  and 
climbs  trees  to  protect  himself  from  the  pursuit  of  certain  animals  which 
threaten  him.  Pressed  by  hunger,  he  nourishes  himself  with  whatever  comes 
to  hand.     He  is  timid,  because  he  has  been  frightened ;  and  is  obstinate,  be- 


486  IDIOCY. 

cause  his  understanding  is  feeble.  This  unfortunate  being  is  found  by  hunts- 
men, brought  into  a  city,  conducted  to  a  capital,  placed  in  a  national  school, 
and  committed  to  the  charge  of  the  most  celebrated  tutors.  Both  court  and 
city,  interest  themselves  in  his  past  condition  and  education.  Savans  write 
volumes  to  prove  that  this  is  a  savage,  who  will  become  a  Leibnitz  or  Buffon. 
The  observant  and  modest  physician  assures  them  that  he  is  an  idiot.  They 
appeal  from  this  decision,  and  commence  writing  and  discussing  the  subject 
anew.  The  most  approved  modes  of  instruction,  and  the  most  intelligent 
cares  are  bestowed  upon  the  education  of  this  pretended  savage. 

But  from  all  these  pretensions,  efforts,  promises  and  expectations,  what  is 
the  result?  That  the  observing  physician  had  judged  correctly.  The  pre- 
tended savage  was  only  an  idiot.  Such  was  the  judgment  of  Pinel  respecting 
the  savage  of  Aveyron.*  We  may  from  this  conclude,  that  men  who  are  de- 
prived of  understanding,  isolated,  and  found  in  the  mountains  and  forests,  are 
imbeciles,  or  idiots  who  have  wandered  away  from  their  homes,  or  have  been 
abandoned. 


CASES  IN  ILLUSTRATION  OF  THE  HISTORY  OF  IDIOCY. 

Dargent,  twenty-four  years  of  age,  admitted  at  the  Salpetriere  Sept.  8th, 
1820,  is  tail,  the  head  voluminous,  and  the  forehead  high.  The  frontal  protu- 
berance of  the  right  side  is  more  salient  than  that  of  the  left,  whilst  the  pro- 
jection of  the  occipital  region  is  more  Tnarked  on  the  left.  The  eyes  are  chest- 
nut colored,  her  look  vague,  teeth  handsome,  the  countenance  swollen  and 
flushed,  the  physiognomy  stupid,  the  limbs  well  formed,  and  the  skin  white. 
She  eats  alone,  but  knows  not  enough  to  go  for  her  food,  and  collects  every 
variety  of  disgusting  substance.  Her  dejections  are  involuntary.  She  does 
not  speak,  nor  does  she  engage  in  any  thing,  unless  it  be  to  play  with  rags 
rolled  up  into  the  shape  of  a  doll.  Of  a  gentle  disposition,  she  is  rarely  angry, 
and  testifies  by  her  caresses,  her  remembrance  of  persons  who  take  charge  of 
her.  In  the  month  of  March,  1824,  she  was  thrown  down  by  an  insane  per- 
son. She  was  menstruating  at  the  time,  but  by  this  accident,  the  menses  were 
suppressed.  For  some  days  she  refused  food,  but  soon  resumed  her  former 
habits.  The  menses  however  did  not  return.  On  the  18th  of  May,  a  con- 
tinued cough  was  developed,  attended  with  dyspncea.  On  the  20th,  her  face 
was  much  flushed,  the  respiration  difficult,  the  pulse  hard  and  frequent,  and 
the  abdomen  soft.  We  cannot  determine  the  amount  of  the  expectoration, 
which  is  swallowed.  She  was  bled,  gum  water,  and  loch  were  given  her ;  and 
on  the  21st  there  was  a  remission.  Leeches  to  the  anus.  On  the  22d,  as  the 
cough  persisted,  a  vesicatory  was  applied  to  the  arm.  On  the  24th,  the  op- 
pression was  very  considerable,  and  a  vesicatory  applied  to  the  chest.  On  the 
26th,  oil  was  given  to  counteract  the  constipation ;  27th,  alvine  dejections ; 
28th,  abdomen  painful,  and  fifteen  leeches  applied;  29th,  persistence  of  the 
pulmonary  symptoms,  attended  with  a  diarrhcea;  31st,  laborious  respiration, 
and  diarrhoea ;  on  the  2d  of  June,  she  died,  and  the  body  was  examined. 

Autojjsy. — Head  large,  and  the  ])ones  of  the  cranium  thickened  and  more 
dense  than  natural.  Arachnoid  slightly  injected  ;  convolutions  less  numerous 
than  usual,  and  shallow,  particularly  on  the  left  side  ;  lateral  ventricles  very 
much  shrunken,  particularly  that  on  the  right  side;  cerebellum  of  normal  con- 
sistence, and  less  dense  than  the  brain  ;  lungs  tuberculous  and  cavernous. 
There  was  serum  in  the  pericardium,  and  the  heart  was  small.  The  stomach 
contains  the  puriform  substance  which  was  thrown  from  the  lungs,  and  swal- 

*  Nothing  can  be  more  interesting,  than  the  two  reports  of  Dr.  Itard,  on  the  wonderful 
attention  which  our  confrere  lavished  upon  this  idiot,  to  develop  his  understanding. 


IDIOCY.  487 

lowed  during  life.     Mucous  membrane  of  the  intestines  reddened  at  certain 
points.     Proportions  of  the  plaster  cast  of  the  head  : 

Circumference         .....  21.37  in. 
Curvature  from  the  root  of  the  nose  to  the  occipital 

protuberance  ....  13.38  " 

Antero-posterior  diameter  .  .  .  7.20 

Bi-temporal  diameter     ....  5.59 


(( 


Total  .  .  .  .  .       47.54 

Delatre,  about  twenty-one  years  of  age,  is  the  daughter  of  an  imbecile  father. 
She  is  small  in  stature,  head  small,  and  forehead  low.  At  the  height  of  two 
fingers'  breadth  above  the  superciliary  arches,  the  cranium  is  flattened,  and  we 
observe  a  more  marked  depression  at  the  crown  of  the  head.  The  eyes  are 
red,  and  almost  fixed,  the  look  vague,  the  external  commissures  of  the  eyelids 
is  higher  than  the  internal,  and  the  pupil  dilated.  From  infancy,  she  is  par- 
tially deaf,  but  from  the  age  of  nineteen  years,  her  deafness  seems  to  have  di- 
minished. The  nose,  which  is  depressed  at  its  root,  terminates  in  a  point. 
The  upper  lip  is  thicker  than  the  lower,  by  several  lines.  The  chin  is  bifur- 
cated, and  tends  upward.  The  physiognomy  is  expressive  of  sadness.  Ad- 
measurements of  the  head  upon  the  living  subject : 

Circumference       .....       20.47  in. 
From  the  curvature  at  the  root  of  the  nose  to  the  oc- 
cipital protuberance               .              .             •.              12.28  " 
Antero-posterior  diameter                .              .              .         7.24  " 
Bi-temporal  diameter                  .              .              .                G.18  " 


Total      .....       46.17 

She  has  a  heavy,  sluggish  gait,  and  is  incapable  of  running.  She  does  not 
take  a  firm  hold  of  objects  with  her  hands,  nor  can  she  handle  a  broom.  She 
remains  isolated  from  her  companions ;  sitting  usually  upon  the  ground,  and 
raking  about  the  earth.  She  also  collects  together  rags,  and  unravels  them. 
She  has  a  habit  of  holding  a  cord  between  her  teeth,  and  with  one  of  her 
hands,  while  with  the  other,  she  causes  it  to  vibrate.  Does  any  one  approach 
her,  she  regards  them  with  a  savage  expression.  Does  she  see  signs  made  by 
any  one,  she  gazes  with  her  mouth  open.  She  dresses  and  undresses  herself 
without  assistance,  but  is  incapable  of  taking  any  farther  care  of  her  person, 
and  willingly  receives  such  things  as  are  given  her.  She  is  fond  of  chansfino- 
her  linen,  and  awaits,  with  pleasure,  the  arrival  of  the  Sabbath,  that  she  may 
be  clad  in  her  neatest  attire.  During  the  distribution  of  food,  she  becomes  an- 
gry if  required  to  wait,  and  is  not  served  before  the  rest.  She  smells  her  food, 
and  rejects  it  if  not  agreeable  to  her.  If  she  sees  any  thing  given  to  her  com- 
panions to  eat,  she  signifies  by  signs  that  she  would  not  be  forgotten. 
She  recognizes  her  father,  and  caresses  him.  She  is  grateful,  but  this 
sentiment  is  evanescent;  and  testifies  her  satisfaction  by  a  sort  of  grunt, 
which  is  peculiar  to  her.  She  robs,  retains,  and  defends  what  she  has  taken. 
She  never  gives  away  any  thing,  and  is  obstinate  only  in  preserving  either 
the  rags  which  she  has  collected,  her  food,  or  the  fruits  of  her  robberies.  Is 
she  opposed,  she  utters  a  cry,  but  articulates  no  sound.  At  certain  periods, 
particularly  those  of  menstruation,  she  becomes  irritable  and  choleric;  springs 
at  the  person,  and  tries  to  seize  hold  of,  and  strangle  those  who  displease  her. 
When  she  has  permitted  herself  to  commit  an  act  in  anger,  and  has  struck 
any  one,  she  immediately  flies.     She  is  destitute  of  the  sense  of  shame,  loves 


488  IDIOCY. 

to  remain  naked,  and  appears  to  be  occupied  in  considering  her  person. 
Very  much  given  to  masturbation,  the  presence  of  men  seems  to  produce  no 
effect  upon  her.     She  sleeps  well,  is  never  sick,  and  menstruates  regularly. 

Grous  is  nineteen  years  of  age.  Her  mother  while  nursing  her,  was 
frightened  by  a  mad  woman,  who  endeavored  to  take  this  child  by  force 
from  her  arms.  Her  understanding  did  not  unfold  in  proportion  to  the 
development  of  the  body,  and  when  eighteen  months  old,  she  suffered 
from  confluent  variola.  She  did  not  begin  to  walk,  until  two  years  of  age. 
When  three  years  old,  she  had  a  severe  attack  of  disease,  and  from  that  period, 
there  was  a  complete  arrest  in  the  development  of  the  understanding.  At 
the  age  of  seven  years,  the  physical  forces  were  reestablished,  and  at  fourteen, 
a  spontaneous  eruption  of  the  menses  took  place. 

She  is  tall;  her  head  is  small,  flattened,  and  slightly  developed.  The 
occipital  region  is  remarkably  small.  The  hair  and  eyebrows  are  of  a  chest- 
nut color ;  the  forehead  is  narrow ;  the  eyes  blue ;  and  the  lower  lip, 
which  is  the  larger,  is  projecting.  The  teeth  are  in  a  good  state  of  preserva- 
tion ;  the  skin  is  sun-burnt,  and  the  physiognomy  stupid.  Admeasurements 
of  the  head,  taken  during  life. 

Circumference        .....  19.84  in. 
Froin  curvature  at  the  root  of  the  nose  to  the  occi- 
pital protuberance      .              .              .              ,  11.14    " 
Occipito-frontal  diameter    ....  7.00    " 
Bi-temporal  diameter     ....  5.74    " 


Total  .....       43.72 

Her  limbs  are  well  formed,  though  her  gait  is  awkward,  slow  and  hesitat- 
ing. In  walking,  she  extends  her  liands,  like  an  infant  who  is  essaying  his 
powers.  Her  head  is  inclined  towards  the  earth,  and  her  body  is  very  prone. 
She  sits  habitually,  either  on  the  ground  or  upon  a  bench,  holding  in  her  hand 
a  doll,  with  which  she  plays ;  or  rolling  up  in  her  fingers,  her  clothing  and 
bonnet.  If  she  is  walking  and  is  stopped,  she  does  not  appear  either  angry 
or  impatient.  At  night,  she  leaves  her  bed,  and  runs  about,  without  a  motive, 
in  the  dormitory.  Since  the  age  of  fourteen  years,  the  epoch  of  her  first 
menstruation,  she  has  become  perverse,  especially  at  the  menstrual  periods, 
and  throws  down  her  companions  without  any  provocation.  If  vexed  at  one 
of  her  associates,  she  lacerates  her  own  skin,  and  accuses  the  person,  who 
has  in  one  way  or  another  opposed  her.  During  these  attacks  of  anger,  she 
throws  about  her  wooden  shoes.  She  is  extremely  obstinate  and  timid,  and 
conceals  herself  if  spoken  to  with  severity  ;  but  immediately  begins  again, 
what  had  provoked  the  language  of  censure.  She  has  never  been  able  to 
learn  any  thing,  nor  is  she  acquainted  with  those  things  which  relate  to  the 
first  wants  of  life,  nor  does  she  recognize  the  persons  who  have  the  constant 
care  of  her.  It  is  necessary  to  dress  her,  make  her  bed,  and  carry  to  her  her 
food,  upon  which  she  seizes  with  voracity.  She  can  only  articulate  monosyl- 
lables, and  that  with  difficulty  ;  thus  creating  a  jargon  which  the  children 
comprehend  better  than  her  mother.  Is  she  presented  with  any  thing  that 
pleases  her,  she  emits  from  the  trachea  the  articulate  sounds  he,  he,  heou,  and 
smiles.  Her  voice  is  infantile,  drawling  and  shrill.  She  retains  a  single  air, 
which  it  pleases  her  to  trill.  She  fixes  her  attention  upon  objects  that  sur- 
round her ;  but  has  no  memory  farther  than  to  recall  what  has  been  promised 
her.  If  any  one  puts  money  in  her  hand,  she  hastens  to  purchase  dainties 
with  it.  She  understands  its  value,  and  if  any  one  endeavors  to  deceive  her, 
she  is  vexed,  and  becomes  angry,  though  she  has  no  words  wherewith  to  ex- 
press this  sentiment.     Although  she  appears  to  be  incapable  of  chagrin  and 


IDIOCY.  489 

ennui,  and  since  the  time  of  her  admission  into  the  hospital,  has  testified  nei- 
ther regret  nor  surprise.  She  receives  her  mother  with  satisfaction,  when 
she  comes  to  visit  her.  She  recognizes  the  nurse  who  has  charge  of  her,  and 
sometimes  manifests  her  generosity  by  giving  to  her  some  of  the  articles  which 
her  mother  brings.  She  is  particularly  pleased  with  children.  Although  fond 
of  the  toilet,  she  is  unable  to  keep  a  garment  more  than  a  few  days  without 
tearing  it  in  pieces,  to  make  a  species  of  doll.  The  presence  of  men  agitates 
her  powerfully,  and  her  feelings  betray  themselves  by  a  smile,  a  reddening  of 
the  face,  and  by  actions  (by  no  means  equivocal),  which  she  does  not  dissem- 
ble, even  in  the  presence  of  several  persons.  Is  a  man  near  her,  she  pretends 
to  suffer  from  pain  in  her  bowels,  prostrates  herself  upon  the  earth  like  epi- 
leptics, and  imitates  their  convulsions.  So  soon  however  as  any  one  threatens 
her,  or  throws  water  in  her  face,  she  ceases  the  game.  The  functions  of 
nutritive  life  are  properly  executed,  and  her  menses  regular. 

Brikton,  aged  twenty  years,  is  the  offspring  of  a  healthy  mother,  and  a  father 
who  is  habitually  in  a  state  of  intoxication.  She  has  two  brothers,  who  were 
never  capable  of  learning  to  read.  She  came  into  the  world  in  a  pitiful  con- 
dition, and  it  was  only  after  two  years'  nursing,  that  she  learned  how  to  find 
the  breast  of  her  mother.  It  was  at  this  age  that  she  began  to  draw  herself 
about  upon  her  knees,  her  hands  and  limbs ;  and  pronounce  the  words  papa 
and  mamma.  She  had  convulsions  during  both  her  first  and  second  dentition. 
She  did  not  walk  previous  to  her  seventh  year,  and  at  twelve  was  very  small ; 
after  which  period  her  growth  was  rapid.  She  was  not  accustomed  to  play 
with  children  of  her  own  age,  but  knew  how  to  defend  herself  At  fifteen 
years  of  age,  the  menses  appeared,  but  were  shortly  after  suppressed  for  eight 
months  ;  since  which  period  they  have  been  both  regular  and  abundant.  She 
is  of  medium  stature  ;  of  a  very  full  habit ;  and  her  head  is  small  in  propor- 
tion to  the  size  of  the  face.  The  hair  is  of  a  brown  color,  and  abundant  in 
quantity  ;  the  forehead  narrow  and  low.  The  right  eye  is  blue,  and  the  left 
red  ;  the  nose  is  large,  and  flattened  at  its  root ;  the  mouth  large  ;  the  lips 
thick  and  projecting  ;  the  teeth  poor,  and  the  jaws  large.  The  chin  is  round, 
the  neck  short  and  large,  and  the  face  injected  and  sunburnt.  The  physiog- 
nomy is  composed,  but  without  expression.     Admeasurements  of  the  head  : 

Circumference        .  .  .  .  .19.13  in. 

From  the  curvature  at  the  root  of  the  nose  to  the  occi- 
pital protuberance    .  .  .  .  12.24    " 
Antero-posterior  diameter                .              .              .         7.08    " 
Transverse  diameter                 .             .             .  5.63   " 


Total  .....       44.08 

The  limbs  are ,  short  and  large,  and  the  breasts  developed.  She  moves 
slowly,  her  step  is  awkward,  and  she  extends  her  hands  when  walking.  She 
notices  what  is  passing  around  her,  and  appears  to  be  occupied  with  it.  Thus, 
on  seeing  one  of  her  companions  put  on  a  pair  of  shoes,  she  understands,  and 
says,  they  fit  well.  She  responds  accurately  enough,  to  such  questions  as  are 
addressed  to  her.  She  was  able  to  learn  but  a  few  of  the  letters;  and  never, 
either  to  read  or  write.  She  has  a  little  memory,  and  recalls  certain  events 
which  transpired  in  her  own  family,  of  which  she  was  a  witness  ;  but  confounds 
them  when  wishing  to  speak  of  them.  If  any  one  enquires  her  age,  she  re- 
plies ;  "  I  don  't  know,  but  mother  does."  She  is  acquainted  with  the  value  of 
certain  pieces  of  money,  and  makes  a  proper  use  of  it.  Although  she  knows 
the  name  of  the  street  in  which  her  parents  reside,  she  never  recognizes  it  a 
second  time.  It  was  with  much  difficulty  that  she  was  taught  to  dress  her- 
self    She  was  never  able  to  knit ;  but  goes  to  look  after  her  food.     She  some- 

62 


490  IDIOCY. 

times  discharges  the  severest  labors  of  the  hospital.  Her  disposition  is  mild. 
She  loves  her  mother,  and  those  who  have  the  charge  of  her.  She  becomes 
angry  when  provoked,  but  possesses  the  sentiment  of  shame  and  modesty. 
She  is  not  fond  of  play,  lives  isolated,  without  inquietude  or  ennui ;  often 
repeating  that  she  is  free  from  anxiety.     Her  physical  health  is  good. 

Barboulax,  twenty  years  of  age,  dismissed  from  the  hospital  for  incurable 
women,  at  the  age  of  fourteen  years,  is  of  the  ordinary  stature.  Her  head  is 
large,  and  the  forehead,  which  is  of  moderate  elevation,  is  flattened  at  the 
sides.  The  frontal  protuberances  are  slightly  marked,  and  separated  by  a 
trifling  depression.  The  hair,  eyebrows  and  eyelashes  are  very  black.  A 
few  white  hairs  are  noticed  on  the  forehead.  Her  eyes, — concealed  by  enor- 
mous cheeks, — of  a  chestnut  color,  and  moist,  open  languidly  and  without 
expression.  The  nose  is  large,  the  mouth  wide,  face  flushed,  the  physiognomy 
timid  and  infantine,  and  the  neck  short. 

Circumference  of  the  head             .             .             .  21.26  in. 
From  curvature  at   the  root  of  the  nose    to   the 

occipital  protuberance           .             .             .  12.71    " 

Antero-posterior  diameter               .             .             .  7.20    " 

Transverse  diameter     ....  5.90   " 


Total         .  .  .  .  .       47.07 

The  limbs  are  well  developed,  but  large,  and  the  movements  awkward  and 
heavy.  She  walks  but  little,  and  is  habitually  seated  upon  the  haunches,  in  a 
corner  of  the  dormitory,  without  an  idea  of  going  into  the  court.  When  any 
one  looks  at  her,  she  conceals  her  face  with  the  fore  arm,  and  with  the  hand 
of  the  other  arm  rapidly  rubs  her  clothing.  If  an  attempt  is  made  to  remove 
her  arm,  she  resists  ;  and  if  force  is  employed,  she  blushes,  weeps,  and  ap- 
pears like  one  in  ill  humor.  Though  habitually  tranquil,  she  gets  angry 
when  opposed,  bites,  kicks,  and  throws  her  wooden  shoes.  If  struck,  she 
remains  disconcerted,  and  says,  beaten.  She  is  sensible  both  to  praise  and 
censure ;  possesses  the  sentiment  of  shame  and  modesty,  and  easily  entertains 
feelings  of  jealousy.  Previous  to  her  admission  into  the  Salpetriere,  she 
threw  a  child  from  a  window,  whom  she  saw,  with  feelings  of  jealousy,  affec- 
tionately caressed,  and  manifested  no  regret  in  consequence  of  it.  She  knew 
no  sadness,  ennui  nor  coquetry.  She  expresses  her  thankfulness  to  the  servant 
girl  who  takes  care  of  her,  and  is  particularly  affectionate  to  one  of  her  com- 
panions. Her  vocabulary  is  limited  to  a  small  number  of  words.  She  says 
yes  and  no,  often  unseasonably ;  and  beaten,  when  she  is  struck.  She  knows 
how  to  dress  herself,  but  is  not  always  very  successful.  Some  one  is  obliged 
to  wash  her,  and  comb  her  hair.  She  does  not  know  how  to  look  after  her 
food,  and  if  it  is  not  brought  to  her,  will  not  call  for  it.  She  never  calls  for 
any  thing,  but  collects,  either  clean  or  filthy  rags,  for  the  purpose  of  making 
various  kinds  of  dolls.  Her  general  health  is  good,  and  the  menses  are  re- 
gular. 

Coulmin,  twenty  years  of  age,  is  small  and  rachitic,  of  a  slender  habit  of 
body,  skin  sunburnt,  the  left  temple  greatly  depressed,  the  forehead  high,  and 
the  vertex  slightly  flattened. 

Circumference       ..... 
From  curvature  at  the  root  of  the  nose  to  the  occi- 
pital tuberosity         .... 
Fronto-occipital  diameter 
Bi-temporal  diameter 


20.70 

in. 

12.20 

<i 

6.88 

<c 

5.78 

(( 

Total  .....       45.56 


/ 


IDIOCY.  491 

Her  hair  is  blond,  her  eyelids  are  inflamed  and  red,  her  eyes  small  and 
blue.  Her  nose  is  short,  lips  thick,  and  the  saliva  flows  from  the  mouth.  The 
chin  is  round,  and  the  pavilion  of  the  ears  very  large.  The  limbs  are  very 
slender,  the  head  is  inclined  forward,  and  the  back  much  arched.  Her  step 
is  insecure ;  one  foot  scarcely  touching  the  earth  before  it  is  taken  up,  and 
the  body  advances  hesitatingly.  Her  look  is  besotted.  When  laughing,  she 
opens  the  lips  so  much  as  to  expose  completely  the  teeth.  She  eats  largely, 
and  feeds  upon  the  filthiest  articles.  If  hungry,  she  stamps  with  her  feet ; 
and  calls  the  nurses  sluts,  when  they  are  tardy  in  bringing  her  food.  The 
dejections  are  involuntary,  and  her  turns  have  never  appeared.  She  is  quiet, 
and  sleeps  at  night,  but  soils  her  bed.  When  she  has  risen  and  is  dressed  in 
the  morning,  she  is  conducted  to  a  bench,  where  she  seats  herself  upon  the 
haunches,  the  chin  being  placed  upon  her  knees,  and  balances  herself  con- 
stantly from  before  backward.  She  rarely  walks.  She  knows  only  the  nurse 
who  has  charge  of  her.  It  is  necessary  to  get  her  up,  wash  and  dress  her, 
and  undress  her  before  retiring  at  night.  Attentions  to  cleanliness  vex  her, 
and  she  often  repeats  the  words  beast  and  hog,  to  express  either  her  dis- 
satisfaction or  anger ;  or  else  some  desire,  which  is  limited  always  to  a  craving 
for  food.  She  is  not  deaf,  and  the  striking  of  the  clock  apprises  her  of  the 
hour  for  the  distribution  of  food.  When  any  one  speaks  to  her  about  walk- 
ing, she  quits  her  bench  and  takes  a  few  steps.  She  tries  to  sing,  by  repeat- 
ing la  la  la  la  ;  and  when  she  utters  one  of  the  two  or  three  words  which 
form  her  vocabulary,  her  voice  is  harsh  ;  imitating  the  low  mewing  of  a  cat. 
Indifferent  to  everything,  she  seems  to  be  destitute  of  modesty.  She  laughs 
and  weeps,  is  obstinate  and  choleric.  Her  countenance  then  becomes  flushed, 
and  the  mucus  which  habitually  escapes  from  her  mouth,  becomes  augmented. 
She  spits  in  the  face,  and  bites  others  and  herself.  Nothing  seems  to  frighten 
her,  and  she  manifests  no  sentiment  of  recognition.  It  is  necessary  for  her  to 
wear  the  camisole,  to  prevent  her  from  washing  herself  with  her  urine,  from 
rolling  in  the  gutters,  and  even  the  privy,  and  also  from  collecting  the  filthiest 
ordure. 

Brault,  aged  twenty-six  years,  entered  the  Salpetriere  September  3d,  1812, 
at  the  age  of  sixteen  years.  She  is  of  medium  stature,  and  her  head  is  small, 
particularly  the  posterior  portion.  She  carries  her  head,  alternately,  on  the 
right  and  left  side.  Her  hair  is  chestnut  colored,  her  eyes  are  blue,  moving 
convulsively,  and  cannot  remain  a  long  time  fixed.  Her  forehead  is  flattened 
at  the  sides,  narrow,  and  almost  pointed.  The  lips  are  constantly  separated 
by  a  convulsive  laugh.  Two  of  her  incisor  teeth  are  very  large  and  project- 
ing ;  the  chin  also  is  very  voluminous,  forming  a  double  fold.  The  face  is 
gross  and  flushed.  The  physiognomy  is  without  expression,  the  limbs  large 
and  short,  the  fingers  small  and  slender.  This  last  peculiarity  is  frequently 
noticed  among  idiots.  Admeasurements  of  the  head,  taken  from  the  living 
subject : 

Circumference  ..... 

From  the  root  of  the  nose  to  the  occipital  tuberosity 
Antero-posterior  diameter 
Bi-temporal  diameter  .... 

Total 47.03 

It  is  necessary  to  get  her  up,  and  dress  her  in  the  morning,  and  to  undress 
her  at  night.  She  does  not  go  for  her  food  ;  yet  utters  the  word  pignon  when 
she  desires  food,  and  agnon,  when  she  wishes  drink.  She  seems  to  be  pleased, 
when  her  food  is  handed  her,  and  seizes  upon  it  gluttonously.  Her  appetite 
is  very  great,  and  her  dejections  involuntary.     She  passes  the  day,  seated  upon 


20.55 

in 

13.50 

(( 

6.88 

(( 

6.10 

(( 

492  IDIOCY. 

a  bench  or  the  ground.  She  often  has  a  needle  in  her  fingers,  which  she 
passes  awain  and  again,  through  some  rags.  When  she  retires  at  nicht,  she 
says  to  the  chamber-maid;  good  night,  nurse.  She  walks  awkwardly,  and 
moves  her  hands  convulsively  when  walking.  She  cannot  run,  and  if  it  rains, 
she  does  not  seek  a  shelter.  Although  her  intellectual  faculties  are  very  limit- 
ed, she  does  not  seem  to  be  an  entire  stranger  to  what  is  passing  around  her. 
She  recognizes  the  sound  of  the  clock  which  announces  the  hour  for  food. 
She  articulates,  more  or  less  imperfectly,  five  or  six  words,  and  the  sounds 
which  she  utters,  are  very  dull.  We  sometimes  hear  her  sing  the  four  follow- 
ing syllables :  la  la  la  la.  She  is  very  choleric,  particularly  at  the  menstrual 
periods,  or  when  provoked ;  throwing  her  clogs  at  the  head  of  the  person  who 
excites  her  anger.  She  is  also  very  obstinate.  It  is  but  three  months  since 
the  death  of  her  mother,  to  whom  she  no  longer  refers ;  though  she  was  ac- 
customed to  receive  her  with  pleasure,  and  to  caress  her  at  every  visit.  She 
recognizes  the  servant  girl,  but  manifests  no  gratitude  for  her  attentions.  If 
threatened,  she  weeps.  She  possesses  not  the  sentiment  of  modesty.  She 
knows  not  how  to  play,  but  keeps  some  rags  in  her  hand,  which  she  twists 
about  awkwardly  in  her  fingers. 

Laguette,  about  fifty  years  of  age,  is  of  the  ordinary  stature.  Her  head, 
which  is  greatly  inclined  forward,  is  small,  and  flattened  at  the  sides;  the  oc- 
ciput is  slightly  projecting,  and  the  forehead,  which  is  elevated,  retreating. 
The  frontal  protuberances  are  slightly  marked.  The  hair  is  of  a  brown  color, 
sprinkled  with  white ;  the  eye-brows  are  similar  in  color,  and  the  eyes  small, 
red  and  crossed.  The  nose  is  large  and  long,  the  mouth  of  medium  size,  and 
the  lips  are  pale,  thin  and  wrinkled.  The  incisor  teeth  are  wanting,  the  chin 
is  round  and  turned  up,  the  complexion  is  dark,  and  the  countenance  flattened 
and  wrinkled.  The  physiognomy  expresses  astonishment  and  stupidity.  The 
measure  of  the  head  furnishes  the  following  proportions  : 

Circumference            .....  20.11  in. 
From  the  curvature  of  the  nose  to  the  occipital  tubero- 
sity      .....  12.79  " 
Antero-posterior  diameter       ....  7.16  " 
Bi-temporal  diameter      ....  5.G7  " 


Total  .....       45.73 

She  applies  her  hands  to  her  person,  and  makes  sudden  motions  with  her 
head,  similar  to  those  which  we  see  in  sheep.  The  limbs  are  developed,  she 
walks  slowly  and  awkwardly,  turns  her  attention  to  what  is  going  on  around 
her,  distinguishes  objects,  and  understands  what  is  said  to  her.  She  repeats 
several  times  in  succession,  and  with  energy,  the  monosyllables  he,  he,  he, 
when  any  thing  strongly  interests  her.  She  knows  how  to  indicate  to  the 
nurse  where  her  shoes  should  be,  even  when  she  has  deposited  them  some  time 
since,  in  a  corner.  She  is  extremely  indolent,  and  is  sometimes  noisy  during 
the  night.  The  dejections  are  involuntary,  both  night  and  day.  She  flies, 
whenever  her  companions  manifest  a  disposition  to  strike  her,  but  attacks  no 
one.  When  angry,  she  hurls  her  clogs  against  the  walls,  overturns  the  house- 
hold utensils,  tears  her  clothing,  stockings  and  chemise  ;  after  which,  she 
betakes  herself  to  the  nurse,  and  requests  her  by  signs,  to  repair  what  she  has 
just  torn  in  pieces  ;  expressing  her  satisfaction,  when  her  garments  are  again  put 
in  order.  To  prevent  her  from  mischief,  they  are  obliged  to  confine  her  to 
her  bed  ;  which,  however,  does  not  prevent  her  from  destroying  with  her  teeth, 
the  camisole,  in  order  to  disembarrass  herself  She  experiences  a  sense  of 
hunger,  but  it  is  necessary  to  bring  to  her  her  food,  which,  before  touching, 
she  examines  with  care,  both  by  the  senses  of  sight  and  smell.     She  eats 


/ 


IDIOCY.  493 

much,  and  loves  to  smell  of  flowers.  It  is  necessary  both  to  dress  and  wash 
her,  though  I  have  endeavored  to  make  her  dress  herself.  She  has  succeeded, 
— either  well  or  ill — and  puts  on  the  camisole  without  repugnance.  If  she  is 
arrested  in  this  act  by  any  obstacle,  she  seeks  for  aid,  by  making  some  sign, 
by  bleating,  or  by  scratching  her  forehead  or  head  quickly,  and  several  times 
in  succession. 

She  expresses  her  thanks  when  clean  linen  is  given  her.  She  loves  to  see 
people  well  clad,  and  salutes,  and  even  does  reverence,  at  the  desire  of  the 
nurse,  to  persons  who  give  her  tobacco,  which  she  seizes  with  avidity,  and 
conveys  quickly  to  her  nose.  She  possesses  no  sense  of  modesty,  and  is  often 
naked ;  appearing  to  regard  herself  with  pleasure.  She  is  much  given  to 
onanism.  She  is  alive  to  reproaches,  and  weeps ;  but  her  regrets  are  mo- 
mentary, and  she  is  soon  guilty  of  the  fault,  which  has  just  cost  her  censure. 
This  idiot  learned  the  air,  Vive  Henri  IV.,  which  she  sings,  while  repeating 
he,  he,  be,  and  turning  round  and  round.  Her  menses  have  long  ceased,  nor 
has  she  seemed  to  experience,  in  consequence  of  this  occurrence,  the  least 
change  in  her  health,  which  is  excellent. 

Ferrandier,  twenty-two  years  of  age,  whose  stature  is  somewhat  above  the 
medium  size,  has  a  sunburnt,  though  pliant  and  soft  skin,  and  a  small  head, 
which  is  habitually  inclined  forward,  and  to  one  side.  The  cranium  is  but 
slightly  developed,  in  comparison  with  the  face  ;  the  forehead  is  narrow,  the 
occiput  flattened,  and  the  vertex  elevated.  The  hair  is  brown  and  abundant, 
the  eyes  blue,  the  eyelids  thickened,  and  slightly  opened,  and  the  look  am- 
bio-uous.  The  jaws  are  large,  the  nose  is  small,  the  lips  are  prominent,  inclin- 
ing upward,  and  partially  open.  She  conveys  into  her  mouth  with  the  tongue, 
the  mucus  which  is  constantly  discharging  from  her  nostrils.  Her  teeth  are 
white,  chin  round,  physiognomy  stupid,  neck  short  and  large,  breasts  volumi- 
nous and  pendant,  and  the  pelvis  large.  The  superior  extremities  are  small 
and  without  strength ;  the  lower  are  short,  and  infiltrated  during  winter,  and 
the  right  side  is  weaker  than  the  left.  The  measures  of  the  head  are  taken 
over  the  face. 

Circumference        .....  19.40  in. 
From  curvature  at  the  root  of  the  nose  to  the  occi- 
pital tuberosity          ....  11.61 
Antero-posterior  diameter                .              .              .  6.65    " 
Bi-temporal  diameter    .             .             .             .  5.31    " 

Total 42.97 

She  walks  very  slowly,  cannot  run,  nor  ascend  a  stairway  without  assis- 
tance. She  remains  seated  in  the  court  and  upon  the  earth,  usually  in  the 
same-  place.  She  is  epileptic,  and  the  attacks  return  every  seven  or  eight 
days.  The  dejections  are,  during  the  night,  involuntary.  She  understands 
what  is  said,  and  replies  to  the  questions  that  are  addressed  to  her.  She  is 
susceptible  of  attention  to  the  objects  that  are  presented  to  her,  and  to  what 
is  passing  around  her.  Still  she  is  incapable  of  doing  the  least  thing.  It  is 
necessary  to  dress,  comb  and  wash  her.  She  plays  with  dolls,  and,  excepting 
errors,  counts  a  hundred.  She  keeps  the  money  that  is  given  her,  and  saves 
it  to  purchase  dainties. 

She  trills  certain  airs  that  she  has  heard,  and  entertains  an  affection  for  one 
of  her  companions,  whom  she  embraces  tenderly  and  often.  It  was  observed 
that  she  had  a  falling  out  with  her  companion,  which  lasted  eight  days ;  dur- 
ing which  period,  she  no  longer  sought  for,  nor  embraced  her.  They  at 
length  became  at  one  again,  judging  from  their  embraces.  She  is  very 
grateful  for  the  attentions  that  are  paid  her,  but  is  obstinate,  and  easily  made 


494  IDIOCY. 

angry.  She  then  strikes,  bites  and  tears  every  thing  that  comes  within  he  rreach, 
and  it  becomes  necessary  to  restrain  her  with  the  camisole.  She  is  insensi- 
ble to  reproaches,  and  inaccessible  to  fear.  She  has  no  sense  of  modesty,  and 
is  pleased  in  being  near  to  men.  The  health  of  this  idiot  is  good,  and  her  men- 
struation regular. 

Gaudin,  admitted  at  the  Salpetriere  April  7th,  1824,  at  the  age  of  twenty 
years,  is  scrofulous  and  rachitic,  as  well  as  deaf  and  mute.  The  head  is 
small,  forehead  narrow,  and  the  temporal  regions  developed.  The  eyes  are 
small  and  blue,  the  look  is  crossed  and  fixed,  the  hair  of  a  chestnut  color 
and  the  teeth  handsome.  The  face  is  flushed,  and  the  physiognomy  without 
expression.  The  limbs  are  very  slender,  habitually  bent,  and  contracted  at 
the  left  side.  Deprived  of  all  sensation,  and  not  expressing,  even  by  gestures, 
the  first  wants  of  nutrition,  it  is  necessary  to  introduce  food  into  her  mouth 
when  she  swallows  it.  The  dejections  are  involuntary.  Passing  most  of  her 
time  in  bed,  she  remains  in  the  same  position,  and  if  uncovered,  her  limbs 
move  convulsively,  particularly  to  the  right,  and  she  manifests  impatience. 
Many  efforts  have  been  made  to  seat  her  in  a  chair,  but  she  slides  from  it, 
and  permits  herself  to  fall.  Her  sensibility  has  often  been  interrogated  by 
pinching ;  but  she  manifests  no  sign  of  pain.  She  has  never  been  regular. 
Since  her  admission  into  the  hospital,  her  health  has  suffered  daily.  She  has 
become  very  much  emaciated,  and  the  features  of  the  countenance  are  ex- 
pressive of  uneasiness.  In  vain  did  we  explore  the  different  cavities ;  in  vain 
did  we  watch  for  some  indication,  that  might  explain  her  progressive  and 
rapid  emaciation;  and  she  died  on  the  26th  of  June,  one  month  and  a  half 
after  her  admission  into  the  hospital. 

The  post-mortem  examination  was  made  on  the  day  following,  at  the  clinic. 
The  bones  are  slender,  and  friable  to  such  a  degree  as  to  be  destroyed  by 
maceration.  The  cranium  is  small,  the  dura-mater  healthy,  and  the  convolu- 
tions atrophied  and  very  compact.  The  arachnoid,  which  is  injected,  presents, 
at  the  level  of  the  frontal  protuberances,  two  osseous  points,  from  three  to 
four  lines  in  diameter,  and  adheres  to  the  cortical  substance,  throughout  a 
great  extent  of  the  hemispheres.  This  substance  is  red,  while  the  white  is 
injected,  and  a  little  soft.  The  corpora  striata  and  optic  thalami,  are  greatly 
injected.  The  capacity  of  the  ventricles  is  but  slight,  and  the  cerebellum 
equally  injected.  The  annular  protuberance  is  less  dense  than  usual,  the 
spinal  marrow  slightly  consistent,  the  lungs  are  hepatized,  the  heart  is  small 
and  flaccid,  and  the  mucous  membrane  of  the  stomach  is  soft  and  red.  Pro- 
portions of  the  plaster  cast  taken  after  death. 

Circumference  of  head 
Antero-posterior  curvature 
Occipito-frontal  diameter    . 
Bi-temporal  diameter 

Total  .....       43.09 

Audry,  twenty-three  years  of  age,  is  of  medium  stature.  The  head  is 
large,  the  occipital  region  developed,  and  the  forehead  narrow  and  flattened. 
The  eyes  are  very  black,  and  sometimes  crossed ;  and  the  lids  are  often,  and 
closely,  shut.  She  often  covers  them.  The  hair  is  very  black  and  crisped, 
the  complexion  of  the  face  is  of  an  olive  color,  while  that  of  the  person  is 
brown.  The  nose  is  large  and  flat,  lips  large,  teeth  beautiful,  ears  very  large, 
feet  large  and  flat,  the  breasts  hard,  and  the  physiognomy  stupid.  The  ad- 
measurements of  the  head  were  taken  from  the  living  person  : 


19.48  : 

in. 

11.41 

(C 

6.57 

(( 

5.63 

<( 

r 


22.44 

in 

12.51 

<( 

7.67 

(< 

5.94 

(( 

IDIOCY.  495 

Circumference        .  .       '     . 

Curvature  from  the  nose  to  the  occiput 
Antero-posterior  diameter 
Bi-temporal  diameter    .... 

Total  .....       48.56 

The  limbs  are  well  developed.  She  does  not  walk  however,  but  remains 
always  seated  upon  her  heels,  now  upon  the  ground,  and  now  upon  an  arm- 
chair ;  balancing  herself  backwards  and  forwards,  exposed  to  every  variation 
of  temperature,  with  no  other  clothing  than  a  chemise ;  looking  to  the  right 
and  left,  without  understanding  what  is  demanded  of  her,  and  probably  with- 
out comprehending  any  thing  that  is  going  on  around.  She  occupies  herself 
however,  much  of  the  time,  in  looking  at  her  hands,  which  she  brings  very 
near  her  eyes. 

The  instinct  of  this  idiot  is  almost  null.  She  only  knows  the  person  who 
is  in  the  habit  of  attending  upon  her,  or  giving  her  tobacco.  She  not  only 
does  not  speak,  but  merely  pronounces  the  following  syllable,  which  she 
repeats  incessantly,  and  with  the  more  vivacity,  whenever  any  thing  impresses 
her  in  an  agreeable  or  painful  manner.  Bron,  hrou,  is  her  only  language, 
which  she  is  almost  constantly  muttering ;  and  which  has  caused  her  to  re- 
ceive, in  the  hospital,  the  name  of  Bourdon.  It  is  necessary  to  dress  her, 
and  put  her  to  bed  like  a  child,  and  to  carry  to  her  her  food,  which  she  de- 
vours with  voracity,  after  having  smelled  of  it.  She  is  very  timid,  and  the  least 
noise  frightens  her.  She  expresses  her  fright,  by  gathering  her  whole  body, 
so  to  speak,  into  the  greatest  degree  of  compactness  possible.  Her  fright 
having  passed,  she  endeavors  to  laugh.  She  has  no  affection  for  any  one,  nor 
the  instinct  of  self-defence,  when  smitten.  She  has  an  excessive  fondness  for 
tobacco.  She  presents  not  her  hand,  but  her  arm,  to  every  person  who  passes 
near  her  ;  and  when  they  have  placed  some  tobacco  upon  it,  she  conveys  it 
with  a  sort  of  avidity  and  sensuality,  first  to  her  nose,  and  afterwards  to  her 
mouth.  She  licks,  both  her  chemise,  and  the  bench  on  which  she  has  been 
sitting,  if  the  smallest  quantity  of  tobacco  still  adheres  to  them.  When  she 
has  no  more,  she  expels  from  her  nose  what  she  has  just  snuffed  up,  in  order 
afterwards  to  swallow  it. 

An  effort  has  been  made,  to  cause  her  to  understand  that  she  must  dance, 
if  she  wishes  to  obtain  tobacco.  Then,  at  the  slightest  intimation,  and  espe- 
cially, when  she  is  shown  tobacco  or  a  snuff  box,  she  jumps  about,  her  feet  in 
motion  under  her,  and  her  arms  extended  upward.  Her  hearing  seems  to  be 
imperfect,  for  it  is  necessary  to  speak  several  times,  to  attract  her  attention  ; 
but  the  sight  of  tobacco  is  sufficient  to  arouse  her  solicitude.  Whilst  I  was 
getting  a  sketch  of  her,  I  was  accustomed  to  give  her  apricots,  the  pulp  of 
which  she  ate  ;  but  not  succeeding  in  biting  the  stone,  she  swallowed  it.  She 
possesses  not  the  sentiment  of  shame.  I  have  often  seen  her,  seated  upon  an 
arm-chair,  playing  with  her  breasts,  the  nipples  of  which  she  would  twist  round 
with  her  fingers.  I  have  also  seen  her  urinate,  and  notice  with  a  sort  of  cu- 
riosity, the  urine  as  it  passed  off  in  a  stream.  Her  other  necessities  were 
satisfied  involuntarily,  wherever  she  happened  to  find  herself.  In  other  respects, 
she  is  well ;  and  the  menses  are  very  regular  and  abundant.  She  gives  herself 
up  to  the  practice  of  onanism  to  a  frightful  extent,  in  open  day,  and  in  the 
presence  of  every  body.  Several  times  in  my  own,  and  the  presence  of  the 
draughtsman,  she  endeavored  to  gratify  this  inclination,  without  seeming  to 
suspect  that  she  was  in  the  presence  of  any  one.  Her  physical  insensibility  is 
such,  that  by  pinching  her,  or  drawing  a  feather  over  her  lips,  or  eyelids,  it 
was  impossible  for  me  to  produce  the  least  indication  of  sensibility.  Since 
the  time  of  her  admission,  which  was  six  years  since,  she  has  somewhat  im- 


496  IDIOCY. 

proved.  She  knows  how  to  intimate,  by  signs,  that  she  has  not  been  served 
to  her  food,  permits  herself  to  be  clothed,  and  assists  in  putting  on  her  cloth- 
incp;  she  puts  a  bonnet  on  her  head,  takes  the  same  chair,  which  is  pierced, 
draws  it  to  the  same  place,  puts  upon  it  a  night  vessel,  and  seats  herself  there- 
on. When  unable  to  obtain  tobacco,  either  by  gestures  or  murmurs,  she 
leaves  her  seat,  and  makes  mimic  efforts  to  effect  her  purpose.  In  1826,  Au- 
dry  was  seized  with  the  confluent  form  of  variola,  and  died  with  it  on  the 
sixth  day.  During  her  illness,  she  did  not  manifest  the  least  pain.  When 
food  was  brought,  she  testified  no  desire  either  to  eat  or  drink,  but  accepted 
whatever  was  conveyed  to  her  mouth. 


JEFFERSON  MEDICAL  COLLEGE. 

SESSION  OF  1846—7. 

The  regular  Course  of  Lectures  will  commence  on  Monday  the  2d  day  of  November,  and 
end  on  ihe  last  day  of  February. 

RoBLEY  DuNGi.isoN,  M.  D.,  Professor  of  Institutes  of  Medicine. 

KoBKUT  M.  HusTOJf,  M.  U.,  Professor  of  Materia  Medica  and  General  Therapeutics. 

Joseph  Pani;oast,  M.  D.,  Professor  of  General,  Descriptive  and  Surgical  Anatomy. 

John  K.  Mitchell,  M.D.,  Professor  of  Practice  of  Medicine. 

Thomas  D.  Muttek,  M.  U.,  Professor  of  Institutes  and  Practice  of  Surgery. 

Charles  D.  Meigs,  M,  D.,  Professor  of  Obstetrics  and  Diseases  of  Women  and  Children. 

Franklin  Bache,  M.  D.,  Professor  of  Chemistry. 

Every  Wednesday  and  Saturday  during  the  course.  Medical  and  Surgical  cases  are  investigated  and  pre- 
scribed for  belore  the  class  Duiing  the  past  year  not  fewer  than  1,000  cases  were  treated,  and  upwards  of  1*"2 
■were  operatfed  on.  The  Clinical  Lectures  are  so  arranged  as  to  permit  the  student,  should  he  desire  it,  to  attend 
the  Medical  and  Surgical  practice  and  lectures  at  the  Pennsylvania  Hospital. 

On  and  at'ter  the  1st  of  October,  the  dissecting  rooms  of  the  College  will  be  open  under  the  direction  of  the 
Professor  of  Anatomy  and  the  Oemonstrator. 

Owing  to  the  large  size  of  the  class,  which  numbered  409  during  the  last  session,  it  became  expedient  to 
make  extensive  and  imporlaiil  alterations  in  the  college  edifice.  These  will  be  completed  by  the  1st  of  Sep- 
tember. 

R.  M.  HUSTON,  M.  D.,  Dean  of  the  Faculty. 

No.  1  Girard  Street 

GEO.    W.    CARPENTER    8l    CO., 

Ko.  301  Blarket  Street. 

Have  always  on  hand  a  large  and  general  assortment  of  choice  Drugs  and  Medicines,  Surgical  Instruments, 
Anatomical  preparations.  Chemical  and  Philosophical  apparatus,  and  everything  appertaining  to  the  Profes- 
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will  extend  to  such  as  furnish  satisfactory  references  a  liberal  credit,  and  furnish  them  with  articles  of  the  best 
quality  at  as  low  prices  as  those  of  like  character  can  be  had  elsewhere  in  the  United  States. 

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m  12. 

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Encyclopaedia  Americana,  13  vols   Svo.     A  supple- 
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East's  Reports,  edited  by  G.  M.  Wharton,  in  8  vols, 
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Youatt  on  the  Dog,  with  plates,  preparing. 


TO   THE    IMEEDICAI.   FHOFESSIOIT. 

The  following  list  presents  nearly  all  the  works  on  Medical  Science  published,  at  press  and 
preparing  by  the  Subscribers.  They  will  be  found  to  be  executed  in  a  superior  style,  and  sold 
at  prices  as  low  as  can  be  afforded  consistent  with  correct  editions.  These  works  can  be  had 
in  all  the  principal  bookstores  throughout  the  Union;  from  which,  or  from  the  subscribers,  all  in- 
formation relative  to  prices,  &c.,  can  be  obtained,  on  application,  free  of  postage. 

L,EJl    K    BLi^jyCU.lRIt,  PhiladelphHu 


Anatomical  Atlas,  by  Smith  &  Horner,  imp.  8vo,  650  figs. 

Ariioti's  Elementsof  Physics, new  ed.l  vol.  Svo,  4S4pp. 

American  Medical  Journal,  quarterly  at  $5  a  year. 

Abercrorabie  on  the  Stomach,  1  vol.  8vo,  320  pages. 

Abercrombie  on  the  Brain,  new  ed  ,  1  vol.  8vo,  3'J4  pp. 

Alison's  Outlines  of  Pathology,  in  1  vol.  8vo,  420  pp. 

Ashwell  on  Females,  one  vol.  Svo,  520  pages. 

Andral  on  the  Blood,  120  pages,  Svo. 

Bird  on  Urinary  Deposits,  1  vol.  Svo,  223  pp. 

Bird's  Natural  Philosophy,  preparing. 

Burrovrs  on  Cerebral  Circulation,  preparing. 

Budd  on  the  Liver,  1  vol.  Svo,  392  pp. 

Buckland's  Geology  and  Mineralogy,  2  vols.  Svo,  with 

numerous  plates  and  maps. 
Berzelius  on  the  Kidneys  and  Urine,  1  vol.  Svo,  lEOpp. 
Bridgewater  Treatises,  with  numerous  illustrations,  7 

vols.  8vo,  3257  pp. 
Bartlett  on  Fevers,  &c.,  1  vol.  8vo.,  .394  pages. 
Bartlett's  Philosophy  of  Medicine,  1  vol.  8vo,  312  pp. 
Brigham  on  Mental  Excitement,  1  vol.  12mo.  204  pp. 
Billing's  Principles  of  Medicine,  1  vol  8vo,  304  pp. 
Brodie  on  Urinary  Organs,  1  vol.  Svo,  214  pp. 
Brodie  on  the  Joints,  1  vol.  Svo,  216  pp. 
Brodie's  Surgical  Lectures,  1  vol.  Svo,  350  pp. 
Benedict's  Compendium  of  Chapman's  Lectures,  1  vol. 

Svo,  258  pp. 
Chapman  on  Viscera,  1  vol.  Svo,  384  pages. 
Chapman  on  Fevers,  Gout,  &c.,  1  vol.  Svo.  450  pp. 
Chelius'  Surgery,  by  South  and  Norris.  at  press. 
Chitty's  Medical  Jurisprudence,  Svo,  510  pp. 
Clater  and  Skinner's  Farrier.  12itio,  cloth,  220  pp. 
Carpenter's  Principles  of  Human  Physiology,  1  vol. 

Svo,  644  pages,  with  cuts,  second  edition. 
Carpenter's  General  and  Comparative  Physiology,  1 

vol.  Svo,  preparing,  many  plates. 
Carpenter's  Vegetable  Physiology,  1  vol.  12mo,  vvith 

cuts,  300  pp. 
Carpenter's  Manual,  or  Elements  of  Physiology,  1  vol. 

Svo,  566  pages,  many  cuts. 
Carpenter's  Cyclopedia  of  Natural  Science,  preparing. 
Cooper,  Sir  Astley  on  Hernia,  imp.  Svo,  plates.  423  pp. 
Cooper  on  Dislocations,  1  vol.  Svo,  with  cuts,  500  pp. 
Cooper  on  ihe  Testis  and  Thymus  Gland,  1  vol.  impe- 
rial Svo,  many  plates. 
Cooperontlie  Anatomy  and  Diseasesof  the  Breast,  &c. 

&c.,  1  vol.  imperial  8vp.  splendid  lithographic  plates. 
Condie  on  Diseases  of  Children,  1  vol.  Svo,  0.52  pages. 
Churchill  on  Females,  3d  edition.  1  vol.  8vo,  572  pp. 
Churchill's  Midwifery,  1  vol.  Svo.  520  pp.,  many  cuts. 
Cyclopcedia  of  Practical   Medicine,  by   Forbes,  &c. 

Edited  by  Dunglison,  in  4  large  super-royal  vols., 

3154  double  columned  pages. 
Carson's  Medical  Formulary,  in  preparation. 
Dewees'  Midwifery,  with  plates,  lOtli  edit.,  660  pp. 
Dewees  on  Children,  Sth  edition,  548  pp. 
Dewees  on  Females,  with  plates,  t<th  edition.  5.32  pp. 
Durlacher  on  Corns,  Bunions,  &c..  1  vol.  12mo  ,  1.34  pp. 
Dunglison's  Physiology,  6th  edition,  2  vols.  Svo,  1350 

pages,  with  370  cuts. 
Dunglison's  Therapeutics  and  Materia  Medica,  a  new 

edition,  with  cuts,  2  vols.  Svo,  986  pages. 
Dnnglison's  Medical  Dictionary,  6ih  edition,  1  vol.  Svo, 

804  very  large  pages,  double  columns 
Dunglison  on  New  Remedies,  4th  edition,  616  pp. 
Dunglison  on^Human  Health,  in  1  vol  Svo,  464  pp. 
Dunglison's  Practice  oi  Medicine,  2d  edition,  2  vols. 

Svo,  1322  pp. 
Dunglison's  Medical  Student,  1  vol  12mo.  312  pp. 
Dniitt's  Surgery.  1  vol.  Svo.  534  pp.,  2d  ed.,  many  cuts. 
Ellis'  Medical  Formulary,  a  new  edition,  nearly  ready. 
EUiot.son's  Mesmeric  Cases,  Svo,  5G  pp. 
Esquirol  on  Insanity,  by  Hunt,  496  pp. 
Fownes'  Elementary  Chemistry,  1  vol.  royal  12mo,  460 

pages,  many  cuts. 
Fevers.  General  and  Special,  edited  by  Clymer,  1  vol. 

Svo,  600  pages. 


Fergusson's  Practical  Surgery,  1  vol.  Svo,  2d  ed  ,  640  pp. 

Graham's  Chemistry,  with  cms,  1  vol.  Svo,  750  pp. 

Griffith's  Chemistry  of  the  Four  Seasons,  1  vol.  12mo, 
•  with  cuts. 

Griffith's  Medical  Botany,  many  illustrations,  at  press. 

Guthrie  on  the  Bladder  and  Urethra,  1  vol.  bvo.  150  pp. 

Hoblyn's  Dictionary  of  Medical  Terms,  by  Hays,  1  vol. 
large  12mo,  402  pagdS. 

Harris  on  the  Maxillary  Sinus,  1  vol.  Svo,  166  pages. 

Horner's  Special  Anatomy,  2  vols.  &vo,  7ih  ed.,  cuts. 

Horner's  Mew  Dissector,  1  vol.  12nio,  with  many  cuts. 

Hasse's  Pathological  Anati  my,  nearly  ready. 

Hope  on  the  Heart.  1  vol  8yo,  with  plates,  a  new  ed. 

Harrison  on  the  Nervous  System,  1  vol.  Svo,  292  pp. 

Hughes  on  the  Lungs  and  Heart,  1  vol.  12nio,  270  pp. 

Jones'  (T.  Wharton)  Manual  of  Ophthalmic  Surgery, 
with  many  cuts,  at  press. 

Jones  and  Todd  on  the  Ear.  1  vol.,  preparing. 

Kirby  on  Animals,  many  plates,  1  vol  Svo.  520  pp. 

Kirby  and  Spence's  Entomology,  1  vol.  Svo,  600  pages, 
plates,  plain  or  colored. 

Lawrence  on  the  Eye,  a  new  ed.,  many  cuts,  1  vol.  Svo. 

Lawrence  on  Ruptures,  1  vol.  Svo,  4b0  pp. 

Liston's  Surgery,  by  Mutter,  1  vol.  Svo,  566  pp.,  many 
cuts. 

Miller's  Principles  of  Surgery,  1  vol.  Svo,  526  pp. 

Miller's  Practice  of  Surgery,  1  vol.  Svo,  496  pp. 

Maury's  Dental  Surgery,  with  plates,  1  vol.  Svo,  286 pp. 

Muller's  Physiology,  1  vol.  fevo.  886  pages. 

Medical  News  and  Library,  published  monthly. 

Meigs' Translation  of  Colombat  de  l'Is6re  on  the  Dis- 
eases of  Females.  1  vol.  Svo,  720  pp, 

Metcalf  on  Calorie,  in  one  large  vol  ,  Svo.  (at  press.) 

Ptout  on  the  Stomach,  1  vol.  Svo,  col'd  plates,  466  pp. 

Popular  Medicine,  by  Coales,  1  vol.  Svo.  614  pages. 

I  hilip  on  Protracted  Indigestion,  1  vol.,  240  pages. 

Phillips  on  Scrotula,  1  vol  Svo,  350  pages. 

Pereira's  Materia  Medica,  2  vols  Svo.  1580  very  large 
and  closely  printed  pages.     Second  Edition. 

Ro)  le's  Materia  Medica,  with  wood-cuts,  nearly  ready. 

Roget's  Animal  and  Vegetable  Physiology,  with  many 
cuts  2  vols.  Svo,  872  pages. 

Roget's  Outlines  of  Physiology,  1  vol.  Svo.  516  pages. 

Rigby's  System  of  Midwifery,  1  vol.  Svo.  492  pages. 

Ricord  on  Venereal,  new  edition,  1  vol.  Svo.  256  pages. 

Ricord's  large  work  on  Venereal  Diseases,  with  nume- 
rous plates  preparing 

Ramsboiham  on  Parturition,  with  many  plates,  1  vol 
imperial  bvo,  a  new  and  improved  ediiion,  520  pp. 

Robertson  on  the  Teeth,  1  vol.  Svo,  230  pages. 

Simon's  Chemistry  of  Man,  1  vol.  Svo,  730 pages. 

Taylor's  new  work  on  Medical  Jurisprudence,  by  Grif- 
fith, 1  vol  Svo,  540  pages. 

Traill's  Medical  Jurisprudence.  1  vol.  Svo,  234  pages. 

Trimmer's  Geology  and  Mineralogy,  1  vol.  Svo,  528  pp. 

Todd  &  Bowman's  Physiology,  publishing  in  the  Medi- 
cal News  and  Library,  many  cuts. 

Thomson  on  the  Sick  Room,  1  vol.  12mo.  360  pp  ,  cuts. 

Vogel's  Pathological  Anatomy,  with  plates,  preparing. 

VValshe  on  the  Diseases  of  the  Lungs,  1  vol.  12mo,  310 
pages. 

Watson's  Principles  and  Practice  of  Physic,  by  Con- 
die.  1  vol.  Svo,  1060  large  pages. 

Wilson's  Human  Anatomy,  with  cuts, 1vol.  Svo,  anew 
and  improved  edition.  60S  pages 

Wilson's  Dissector,  or  Practical  and  Surgical  Anato- 
my, by  Goddard,  with  cuts,  1  vol.  ]2mo,  444  pages. 

Wilson  on  the  Skin,  1  vol.  Svo,  .370  pages. 

Williams'  Pathology,  or  Principles  of  Medicine,  1  vol. 
Svo,  384  pages. 

Williams'  Lectures  on  the  Stomach,  &c.,  preparing. 

Williams  on  the  Respiratory  Organs,  by  Clymer,  1  vol, 
Svo,  500  pages. 

Youatt  on  the  Horse,  by  Skinner,  cut»,  448  pp.  1  vol.  8w). 

Youatt  and  Clater's  Cattle  Doctor,  1  vol.  12mo,  wilk 
cuts,  292  pages. 


♦♦♦  They  have  other  work?  in  pteparation  not  included  in  this  list 


LEA  &  BLANCHARD'S  PUBLICATIONS. 

No-w   Ready, 
CARPENTER'S    NEW    WORK. 


A  MANUAL,  OR 

ELEMENTS    OF    PHYSIOLOGY, 

INCLUDING  PHYSIOLOGICAL  ANATOMY. 

FOR  THE  USE  OF  THE  MEDICAL  STUDENT. 
BY  WILLIAM  B.  CARPENTER,  M.  D.,  F.  R.  S., 

FuUerian  Professor  of  Physiology  in  the  Royal  Institution  of  Great  Britain,  &c. 

With   One   Hundred   and  Eighty  Illustrations, 

IN  ONE  OCTAVO  VOLUME  OF  566  PAGES, 

Elegantly  printed  to  match  his  "  Principles  of  Human  Physiology." 
The  sheets  of  this  volume,  in  their  passage  through  the  press  have  been  carefully  examined  by 
Dr.  Meredith  Clymer,  the  editor  of  Dr.  Carpenter's  Principles  of  Physiology.  The  manner  in  which 
the  work  is  brought  up  to  the  day,  and  its  perfect  adaptation  to  its  purposes  as  an  elementary  text- 
book for  students  have  rendered  unnecessary  any  alterations  or  additions.  The  efforts  of  the  pub- 
lishers have  therefore  been  directed  to  obtaining  a  correct  reprint  of  the  London  edition. 

"Tlie  auiiior  has  shown  singular  skill  in  preserving  so  marked  a  liae  of  disiinction  between  the  present 
Manual  and  the  •  Principles  of  Physiology'  previously  publislied  by  hitn.  They  are  both  on  precisely  the  same 
subject;  but  the  one  is  neither  a  copy,  nor  an  abstract,  nor  an  alindginent  of  the  other.  In  one  thing,  how- 
ever, they  are  exactly  alike— in  their  general  excellence,  and  in  their  perfect  adaptation  to  their  respective 
purposes.  The  reputation  of  Dr.  Carpenter  as  a  pliysiologist  is  too  well  established  throughout  the  whole  medi- 
cal world  to  admit  of  increase  from  any  connneudaiion  ol  our.s;  but  we  should  be  doing  injustice  to  our  own 
feelings  if  we  did  not  here  express  our  admiration  of  his  great  intellectual  powers,  of  his  extensive  learning, 
of  the  comprehensiveness  of  his  views,  of  the  quickness  with  which  he  seizesthe  important  points  and  bearings 
of  each  subject,  of  the  logical  order  in  winch  he  arranges  his  lacls,  and  of  the  clearness  and  precision  with 
■which  he  explains,  and  exposes  his  doctrines.  Dr.  Carpenter's  various  treatises  are  in  tact  models  in  their 
respective  departments.  It  is  their  great  and  varied  excellence  which  accounts  for  their  unrivalled  popularity. 
AVe  can  pay  no  higher  compliment  to  the  work  before  us,  than  to  say,  that  it  is  equal  in  merit  to  the  Ibrmer 
productions  of  the  author.  This  is  equivalent  to  say  ing  that  it  i.«,  without  question,  the  best  manual  or  short 
treatise  on  physiology  extant.  Although  designed  for  the  student,  and  I'ramed  expressly  to  meet  his  wants ;  it  is 
a  work,  we  will  venture  to  say,  that  may  be  consulted  with  advantage  by  most  physicians  and  surgeons,  how- 
ever learned." — The  British  and  Foreign  Medical  Review. 


CARPENTER'S  HUMAN  PHYSIOLOGY. 

PRINCIPLES  OF  HUMAN  PHYSIOLOGY, 

WITH  THEIR  CHIEF  APPLICATIONS  TO 

PATHOLOGY,   HYGIENE,    AND    FORENSIC    MEDICINE. 
BY  WILLIAM  B.  CARPENTER,  M.D,,  F.  R.  S.,  &c. 

Second  American,  from  a  IVew  and  Revised  London  Edition. 

WITH  NOTES  AND  ADDITIONS, 

BY  MEREDITH  CLYMER,  M.D.,  «&:c. 
With  Two  Hundred  and  Sixteen   Wood-cut  and  other  Illustrationa, 

In  one  octavo  volume,  of  about  650  closely  and  beautifully  printed  pages. 

The  very  rapid  sale  of  a  large  impression  of  the  first  edition  is  an  evidence  of  the  merits  of  this  valuable  work 
and  that  it  has  beeu  duly  appreciated  by  the  profession  of  this  country.  The  publishers  hope  that  the  present 
edition  will  be  found  still  more  worthy  of  approbation,  not  only  from  tlie  additions  of  the  author  and  editor,  but 
also  from  its  superior  execution,  and  the  abundance  of  its  illustrations.  No  less  than  eighty-five  wood-cuts  and 
another  lithographic  plate  will  be  found  to  have  beeu  added,  affording  ihe  most  material  assistance  to  the  student. 

■'  We  have  much  satisfaction  in  declaring  our  opinion  that  this  work  is  the  best  systematic  treatise  on  physi- 
ology in  our  own  language,  and  the  best  adapted  for  the  student  existing  in  any  language.  ' — Medico- CMrurgi- 
cal  Review. 

•'The  work  as  it  now  stands  is  the  only  Treatise  on  Physiology  in  the  English  language  which  exhibits  a  clear 
and  connected,  and  comprehensive  view  of  the  present  condition  of  that  science  '''—London  and  Edinburgh 
Monthly  Journal. 

CARPENTER'S  POPULAR  TREATISE 
ON    VEGETABLE    PHYSIOLOGY. 

In  one  neat  duodecimo  volume,  extra  cloth,  with  numerous  illustrations. 

This  woik  forms  a  part  of  Carpenter's  Popular  Cyclopadia  of  Natural  Science,  the  remainder  of 
wliich  will  be  published  with  all  the  beautiful  illustrations. 


CARPENTER'S  PRINCIPLES  OF  GEiNERAL  AND  COxMPARATIVE 
PHYSIOLOGY,  AND  HIS  WORK  ON  ANIMAL  PHYSIOLOGY, 

WITH  ALL  THE  BEAUTIFUL  ILLUSTRATIONS,  ARE  NOW  PREPARLNO. 


LEA  &  BLANCH  A  RD'S  PUBLICATIONS.  7 

LISTON  AlwTllfTTEEiliRin^ 

A    BEAUTIFUL   VOLUME,    PROFUSELY    ILLUSTRATED. 

LECTURES  ON  THE~OPERATIONS  OF  SURGERY, 

AND  ON 

DISEASES  AND  ACCIDENTS  REQUIRING  OPERATIONS 

DELIVERED  AT  UNIVERSITY  COLLEGE,  LONDON, 

BY  ROBERT  LISTON,  ESQ.,  F.R.S.,  &c. 

EDITED,  WITH  NUMEROUS  ALTERATIONS  AND  ADDITIONS, 
BY   T.    D.    MUTTER,   M.D., 

PROFESSOR  OF  SURGERY  IN  THE  JEFFERSON  MEDICAL  COLLEGE,  PHILADELPHIA. 

IN  ONE  LARGE  AND  BEAUTIFULLY  PRINTED  OCTAVO   VOLUME. 
WITH  TWO  HUNDRED  AND  SIXTEEN  ILLUSTRATIONS  ON  WOOD. 
This  work  contains  much  original  matter  of  Professor  Miitter's,  amounting  to 
about  two  hundred  and  fifty  pages,  embodying  the  resuks  of  his  great  experience, 
and  adapting  the  whole  to  the  wants  of  the  American  Profession.    The  Lectures 
are  those  which  have  attracted  so  much  attention  as  published  in  the  Lancet 
They  are  here  reproduced  entire,  omitting  none  of  the  original  wood  engravings, 
and  introducing  many  new  and  valuable  ones,  rendering  this  altogether  one  of 
the  most  completely  illustrated  works  of  the  kind  that  has  for  some  time  been 
presented  to  the  medical  public.     Among  the  additions  of  Professor  Miitter  will 
be  found  full  and  elaborate  Treatises  on  Staphyloraphy,  the  different  Plastic  Ope- 
rations, Club-Foot,  Affections  of  the  Eye,  Deformities  from  Burns,  and  many 
other  important  subjects,  not  to  be  met  with  in  so  enlarged  a  form  in,  perhaps, 
'any  other  work  on  Surgery.     The  chapters  containing  them  are  fully  illustrated 
with  numerous  original  and  highly  curious  engravings. 

"This  )s  a  very  attractive  book,  both  in  respect  to  mechanical  execution  and  contents.  Printed  on  fine 
■white  paper,  with  a  fair  new  type,  and  embellished  with  more  than  200  well  execuied  wood  cuts,  it  presents 
altogether  as  beautiful  an  appearance  as  a  work  of  art  as  its  uiitter  is  interesting  and  important  to  tlie  prac- 
tical surgeon.  The  lecture  on  operations  on  the  eye  is  a  very  lucid  and  instructive  one,  but  we  can  only  refer 
to  it  in  the  most  cursory  manner.  The  editor  has  fully  supplied  everyttiing  that  was  wanting  to  render  the 
chapter  complete,  and  we  would  gladly  quote  his  remarks  on  the  operations  of  Strabismus  and  Staphyloma, 
did  our  limits  permit.  The  chapter  on  Cataract,  by  Dr.  Mutter,  extending  over  thirty  pages,  we  look  upon  as 
one  of  the  most  valuable  essays  on  the  subject  in  the  language.  It  is  clear  and  methodical,  sufficiently  full,  yet 
precise,  and  ahoandmg  in  practical  precepts  ot  tlie  highest  interest.  The  remarks  on  drforinities  of  the  nose 
are  evidently  the  result  of  much  experience  and  observation.  The  operations  for  hare-lip  and  cieft  palate  ara 
treated  at  considerable  length,  and  made  exceedingly  clear  by  means  of  the  accompanying  illustrations:  we 
can  recommend  these  sections  alone  as  worth  far  more  to  the  surgeon  than  many  times  the  price  of  the  whole 
work.  The  same  remark  will  apply  to  the  next  lecture,  on  the  Diseases  of  ihe  Antrum,  CariousTeelh,  Erected 
Tumours  of  the  Face,  and  Solid  and  Kncysteo  Tumors.  We  know  of  no  systematic  work  on  surgery  in  which 
the  anaplastic  operations  for  removal  or  remedying  deformities  of  the  face  are  so  fully  and  satisfactorily  de^ 
scribed  as  in  this.  But  we  have  already  exceeded  our  limits,  and  can  only  say  in  conclusion  that  l-ision's  Lec- 
tures, with  Miiiter's  additions,  should  be  in  every  surgeon's  library,  and  in  every  student's  hands,  who  wishes 
to  post  up  his  surgical  knowledge  to  the  present  moment,"— TAe  New  York  Journal  of  Medicine. 

"  The.se  lectures  will  be  found  eminently  practical,  a  point  of  no  small  moment  in  a  work 
on  Surgery.  Indeed,  we  have  no  hesitation  in  affirming,  that  it  is  a  compendium  of  the 
modern  practice  of  Surgery  as  complete  and  accurate  as  any  treatise  of  similar  dimensions 
in  the  English  language. —  The  Western  Lancet. 

Lately  Published,  a  New  and  Much  Improved  Edition  of 
DRUITT'S    SURGERY. 


THE  PRINCIPLES  AND  PRACTICE  OF  MODERN  SURGERY. 

By  ROBERT  DRUITT,  Surgeon. 
FROM    THE    THIRD    LONDON    EDITION. 

ILLUSTRATED  BY  ONE  HUNDRED  AND  FIFTY-THREE  WOOD  ENGRAVINGS. 

WITH  NOTES  AND  COM.MENTS, 

By  JOSHUA  B.  FLINT,  M.  M.,  S.  S. 

In  One  Volume,  Octavo. 

"An  unsurpassalDle  compendium  not  only  of  surgical  but  of  medicai'  practice." — Louden 
Medical  Gazette. 


8  LEA  &  BLANCHARD'S  PUBLICATIONS. 

BRODIE'S     SURGICAL    WORKS. 


NOW  READY, 

CLINICAL  LECTURES  ON  SURGERY, 

DELTVEP.ED   AT  ST.   GEORGE'S  HOSPITAL 

By  SIR  BENJAMIN  BRODIE,  Bart.,  V.  P.  R.S., 

SERJEANT  SUHGEON  TO  THE  QUEEN,  ETC.  ETC. 

IN  ONE  NEAT  OCTAVO  VOLUME. 

These  Lectures,  in  passing  through  the  columns  of  ''The  Medical  News/'  during  the 
last  year,  have  received  the  unanimous  approbation  of  the  profession  in  this  country  and 
will  no  doubt  be  eagerly  sought  for  in  their  complete  state.  ' 

"  Sir  Benjamin  Brodie  has  long  been  distinguished  as  a  surgeon,  even  among  those  in  the  front 
rank,  and  may  now  be  regarded  as  occupying  the  first  place  in  Great  Britain,  if  not  in  the  world. 
It  IS  not  as  a  mere  operator  that  he  is  distinguished — that,  it  must  be  conceded  by  all  right  thinking 
minds,  is  but  a  very  humble  part  of  the  qualifications  of  a  surgeon— but  as  a  profound  pathologist 
and  therapeutist.  We  may  be  prejudiced  or  mistaken,  but  in  these  higher  and  really  intellectual 
qualifications,  we  know  of  no  living  surgeon  that  approaches  him.  His  well  considered  opinions 
and  practical  instructions  are  conveyed,  too,  in  language  so  appropriate,  so  simple,  clear  and  chaste 
that  one  scarcely  knows  whether  most  to  admire  the  excellence  of  the  matter  or  the  beauty  of  the' 
style  in  which  it  is  clothed.  Theory  and  practice  go  hand  in  hand  throughout.  Rarely  is  a  pre- 
cept given  without  being  illustrated  by  some  apposite  case,  selected  from  his  vast  experience,  and 
always  in  the  fewest  and  most  expressive  words.  Nothing  more  than  is  necessary  to  enforce  the 
point  is  said,  and  nothing  that  is  necessary  is  left  untold." — The  Medical  Examiner. 

"  It  would  not  be  easy  to  find  in  the  same  compass  more  useful  matter  than  is  embraced  in  each 
of  these  discourses,  or  indeed  in  this  volume.  We  the  less  regret  the  limited  extracts  we  have  it 
in  our  power  to  make  from  it,  because  we  feel  sure  that  it  will  in  a  short  time  find  its  way  into  all 
the  medical  libraries  in  the  country.'— TAe  Western  Journal  of  Medicine  and  Surgery. 

"Sir  B.  Brodie  has  rendered  his  clinical  lectures— what  all  clinical  lectures  should  be — clear, 
impressive  and  practical  expositions  of  curative  measures,  in  which  all  the  most  important  features 
of  the  subject  are  plainly  set  forth,  without  being  unnecessarily  encumbered  with  details.  We 
attach  a  very  high  value  to  these  Lectures:  their  style  is  clear,  demonstrative  and  unaffected,  de- 
cided and  energetic ;  but  altogether  free  from  dogmatism  or  over-confidence.  They  are  strictly 
practical ;  and  much  of  the  information  which  they  contain  will  assuredly  do  the  reader  and  his 
patients  good  service  in  time  of  need." — Medical  Gazette. 

BRODIE  ON  URINARY  ORGANS. 


LECTIIRES 
ON  THE  DISEASES  OF  THE  URINARY  ORGANS. 

FROM   THE   THIRD  LONDON    EDITION. 

WITH  ALrER\TlO\S  AND  ADI)[TIOiVS. 

In  One  Small  Octavo  Volume,  Cloth 
This  work  has  been  entirely  revised  throughout,  some  ot  the  author's  views  have  been 
modified,  and  a  considerable  proportion  of  new  matter  has  been  added,  among  which  is 
a  lecture  on  the  Operation  of  Lithotomy. 

BRODIE   ON   THE   JOINTS. 


PATHOLOGICAL  A\D  MfKGICAL  OBSERVATIONS 

ON  THE  DISEASES  OF  THE  JOINTS. 

FR'»V1   'JHE   FOURTH    LONDON   EDITION. 

mnth  the  Author's  ^(trrfitions  uWO  mwtows. 

In  One  Small  Octavo  Volume,  Cloth. 

^  "To  both  the  practical  physician  and  the  student,  then,  this  little  volume  will  be  one  of  much 
service,  inasmuch  as  we  have  here  a  condensed  view  of  these  complicated  subjects  thoroughly 
investigated  by  the  aid  of  the  light  afforded  by  modern  Pathological  Surgery." — N.  Y.  Journal  of 
Medicine. 


LEA  &  BLANCHARD'S   PUBLICATIONS.  9 

THE  SIXTH  EDITION  OF  DUNGLISON'S  MEDICAL  DICTIONARY. 

To  1846. 

fflEDICAL~LEXICON. 


A    DICTIONARY 

OF 

MEDICAL    SCIENCE. 

CONTAINING 

A  CONCISE    ACCOUNT   OF   THE    VARIOUS  SUBJECTS  AND  TERMS  ;   WITH 
THE  FRENCH  AND  OTHER   SYNONYMES  ;   NOTICES  OF  CLIMATES 
AND    OF    CELEBRATED    MINERAL     WATERS;    FORMULA 
FOR  VARIOUS   OFFICINAL  AND  EMPIRICAL  PREPA- 
RATIONS, &c. 

BY  ROBLEY  DUNGLISON,  M.  D.,' 

Professor  of  the  Institutes  of  Medicine,  &c.  in  Jefferson  Medical  College,  Philadelphia. 

SIXTH  EDITION,  REVISED  AND  GREATLY  ENLARGED. 

In   one  Royal  Octavo    Volume   of  over  800   very   large  pages,  double   columns. 

Strongly  bound  in  the  best  leather,  raised  bands. 

It  is  not  necessary  for  the  author  to  say  more,  as  a  preface  to  this  sixth  edition  of  his  dictionary,  than  that  he 
has  be&towed  the  same  care  on  its  revision  and  improvement,  which  he  did  on  the  others.  luproof  of  this,  he 
may  remark,  that  the  present  edition  com\)rises  ne<ir\y  two  thousand  Jive,  hundred  suhiec.l^  aiid  terms  not  con- 
tained in  the  last.  Many  of  these  have  been  introduced  into  medical  terminology  in  consequence  of  the  pro- 
gress of  the  science  ;  and  others  had  escaped  him  in  previous  revisions. 

It  is  the  author's  anxious  wish  to  render  the  work  a  satisfactory  and  desirable — if  not  indispensable — Lexicon, 
in  which  the  student  may  search  without  disappointmentfor  every  term  that  has  been  legitimated  in  the  nomen- 
clature of  the  science.  This  desideratum  he  is  enabled  to  attempt  in  successive  editions,  by  reasonof  the  work 
not  being  stereotyped;  and  the  present  edition  certainly  offers  stronger  claims  to  the  attention  of  the  practi- 
tioner and  student  than  any  of  its  predecessors.— Prf/ace  to  Sixth.  Edition,  May  1S46. 


A  NEW  EDITION    OF 

THE    MEDICAL    STUDENT, 

OR  AIDS  TO  THE  STUDY  OF  MEDICINE. 

A  REVISED  AND  MODIFIED  EDITION. 

BY  ROBLEY  DUNGLISON,  M.  D., 
In  One  neat  12mo.  volume. 


HUMAN    HEALTH; 

OR,  THE   INFLUENCE  OF  ATMOSPHERE  AND  LOCALITY,  CHANGE  OF  AIR 
AND  CLIMATE,  SEASONS,  FOOD,  CLOTHING,  BATHING  AND  MINE- 
RAL SPRINGS,  EXERCISE,  SLEEP,  CORPOREAL  AND  INTEL- 
LECTUAL  PURSUITS,  &c.  &c.,  ON  HEALTHY  MAN: 
CONSTITUTING 
ELEMENTS    OF    HYGlf^NE. 

BY   ROBLEY   DU  N  G  L  I  S  0  N,  M.  D. 

A  New  Edition  with  many  Modifications  and  Additions.     In  One  Volume,  8vo. 


DUNGLISON  ON  NEW^ REMEDIES. 

NEW   RE"MEDIES, 

PHARMACEUTICALLY  AND  THERAPEUTICALLY  CONSIDERED. 

FOURTH  EDITION. 

WITH  EXTENSIVE  MODIFICATIONS  AND  ADDITIONS, 
BY  ROBLEY  DUNGLISON,  M.  D.,  &c. 

The  numerous  valuable  therapeutical  agents  which  have  of  late  years  been  introduced  into  the  Materia 
Medica,  render  it  a  difficult  matter  for  the  practitioner  to  keep  up  with  the  advancement  of  the  science,  espe- 
cially as  the  descriptions  ol  them  are  difficult  of  access,  being  scattered  so  widely  through  transactions  of 
learned  societies,  journals,  monographs,  &c.  &c.  To  obviate  this  difficulty,  and  to  place  within  reach  of  the 
profession  this  important  information  in  a  compendious  form,  is  the  object  of  the  present  volume,  and  the  num- 
ber of  editions  through  which  it  has  passed  show  that  its  utility  has  not  been  underrated. 

1X7=  Apothecaries  and  Physicians  may  rely  upon  having  a  late  edition  of  this  useful  work. 


10  LEA  &   BLANCHARD'S  PUBLICATIONS. 

PROFESSORnDUITOUSON^^ 


NOW  READY.— A  NEW  EDITION  OF 

DUNGLISON'S    PHYSIOLOGY, 

Brought  up  to  1846. 

HUMAN    P  HY  S  I  O  L  0  G  Y , 

WITH 

THREE  HUNDRED  AND  SEVENTif  ILLUSTRATIONS. 

BY  ROBLEY  DUNGLISON,  M.  D., 

PEOFESSOE  OF  THE  I.\STITUTES  OF  MEDICIJVE  IN  THE  JEFFEKSGN  MEDICAL  COLLEGE,  PHILADELPHIA, 

&C.    &C. 

S  I  X  T  H    E  D  I  T  I  O  N. 

GREATLY  IMPROVED. 
In  two  large  octavo  volumes,  containing  nearly  \25Q  pages. 

"  It  is  but  necesary  for  the  Author  to  say  that  all  the  cares  that  were  bestowed 
on  the  preparation  of  the  fifth  edition  have  been  extended  to  the  sixth,  and  even 
to  a  greater  amount.  Nothing  of  importance  that  has  been  recorded  since  its 
publication,  has,  he  believes,  escaped  his  attention.  Upwards  of  seventy  illustra- 
tions have  been  added ;  and  many  of  the  former  cuts  have  been  replaced  by  others. 
The  work,  he  trusts  will  be  found  entirely  on  a  level  with  the  existing  advanced 
state  of  physiological  science." 

In  mechanical  and  artistical  execution,  this  edition  is  far  in  advance  of  any  former  one.  The 
illustrations  liave  been  subjected  to  a  thorough  revision,  many  have  been  rejected  and  their  places 
supplied  with  superior  ones,  and  numerous  new  wood-cuts  have  been  added  vvlierever  perspicuity  or 
novelty  seemed  to  require  them. 


THE  PRACTICE  OF  MEDICINE, 

OR  A  TREATISE  ON 

SPECIAL  PATHOLOGY  AND  THERAPEUTICS. 

BY  ROBLET  DLOsTGLISON,  M.D. 

CONTAINING 
THE    DISEASES   OF    THE    ALIMENTARY    CANAL,   THE    DISEASES   OF   THE 
CIRCULATORY   APPARATUS,  DISEASES   OF    THE    GLANDULAR   OR- 
GANS, DISEASES  OF  THE  ORGANS  OF  THE  SENSES,  DISEASES 
OF  THE  RESPIRATORY  ORGANS,   DISEASES  OF  THE  GLAN- 
DIFORM  GANGLIONS,  DISEASES  OF  THE  NERVOUS  SYS- 
TEM,  DISEASES    OF    THE    ORGANS    OF   REPRODUC- 
TION, DISEASES  INVOLVING  VARIOUS   ORGANS, 

«!fec.  &c. 

In  Two  Volumes,  Octavo. 

This  work  has  been  introduced  as  a  text-book  in  many  of  the  Medical  Colleges, 
and  the  general  favor  with  which  it  has  been  received,  is  a  guarantee  of  its  value 
to  the  practitioner  and  student. 

"  In  the  volumes  before  us,  Dr.  Dunglisnn  lias  proved  that  his  acquaintance  with  the  present  facts 
and  doctrines,  wheresoever  originating,  is  most  extensive  and  intimate,  and  the  judgment,  skill, 
and  impartiality  with  which  the  materials  of  the  worli  have  been  collected,  weighed,  arranged,  and 
exposed,  are  strikingly  manifested  in  every  chapter.  Great  care  is  everywhere  taken  to  indicate 
the  source  of  information,  and  under  the  head  ol"  treatment,  formula  of  the  most  appropriate  reme- 
dies are  everywhere  introduced.  In  conclusion,  we  congratulate  the  students  and  junior  practi- 
tioners of  America  on  possessing  in  the  present  volumes  a  work  of  standard  merit,  to  which  they 
may  confidently  refer  in  their  doutsts  and  difficulties." — Brit,  and  For.  Med.  Rev.  for  July,  1842. 

"  Since  the  foregoing  observations  were  written,  we  have  received  a  second  edition  of  Dungli- 
son's  work,  a  sufficient  indication  of  the  high  character  it  has  already  attained  in  America,  and 
justly  attained." — Ibid,  for  October,  1844. 


LEA  &  BLANCHARD'S  PUBLICATIONS.  11 

NOW  READY, 

DUNGLISON'S    THERAPEUTICS. 

A  NEW  EDITION,  MUCH  IMPROVED,  TO  1S46. 


GENERAL  THERAPEUTICS  AND  MATERIA  MEDICA. 

WITH  ONE  HUNDRED  AND  TWENTY  ILLUSTRATIONS. 
ADAPTED  FOR  A  MEDICAL  TEXT-BOOK. 

BY    ROBLEY    DUNGLISON,   M.D., 

Professor  of  Institutes  of  Medicine,  etc.  in  Jefferson  Medical  College;  Late  Professor  of  Materia  Medica,  etc. 

in  the  Universities  of  Virginia  and  Maryland,  and  in  Jefferson  Medical  College. 

Third  Edition,  Revised  and  Improved,  in  Two  Octavo  Volumes,  well  hou-iLd. 

In  this  edition  much  improvement  will  be  found  over  the  former  ones.  The  author  has  stthjected 
it  to  a  thorough  revision,  and  has  endeavored  to  so  modify  the  work  as  to  make  it  a  more  complete 
and  exact  exponent  of  the  present  state  of  knowledge  on  the  important  .'subjects  of  which  it  treats. 
The  favor  with  which  the  former  editions  were  received,  demanded  that  the  present  should  be  ren- 
dered still  more  worthy  of  the  patronage  of  the  profession,  and  this  alteration  will  be  found  not 
only  in  the  matter  of  the  volumes,  but  also  in  the  numerous  illustrations  introduced,  and  the  gene- 
ral improvement  in  the  appearance  of  the  work. 

LIST  OF  ILLUSTRATIONS.— Vol.  L 

1.  Cepliaglis Ipecacuanha.  17.  Legume  and  leafletof  C  37.  Cetraria  Tslandica,  57.  I/ycopus  Virginiciis. 

2.  Brown  Ipecacuan.  root.  ohovata.  38.  Fucus  vesiculosus.  58.  Strychnos  Nax  Vomica. 

3.  Striated  ipecacuan.  root  IS.  Tinnevelly  Senna.  39  Inhaler.  59.  Rma  graveolt- ns. 

—  Undulated  Ipecacu-  19.  Cassia  Marilandica.        40.  Cantharides.  GO.  Secale  oornulum. 

anha  root.  20.  Podophyllum.  41.  Leoiitodon  Tarnxacum.fil.  Cinnntnoraum  Zeylani- 

4.  Tonidium  Ipecac,  root     21.  llpliradendroncarnbogi-42.  Erigerou    I'hiladelplii-  cum. 

5.  Gillenia  stipulacea.  o'ides.  cum.  62.  Cardamom. 

6.  Lobelia  inflata.  22.  Momordica  E!ateri«m.    43  Arbutus  Uva  ursi.  G3.  Cariopliylliisaromaticus 

7.  Sans;uinaria Canadensis  23.  Apocynum  cannaliinunr]44.  Kupatoriumpertbliatum.()4.  Fceniculum  vulgare. 

8.  Apocynum  Aadrosaemi-  24.  Convolvulus pai)(luralLis4.5.  Asclepia.*  tu!'wosa.         0.5.  Monarda  coceinea. 

folium.  25.  Chenopodium    Anlhel-   46.  Arum  triphyllum.  60.  Hedeoma  pulegioides. 

9.  Eryihronium   America-  mimiciim.  47.  Carthamus  linctorius.      67.  Myrislica  nioschata. 

num.  26.  Spigelia  Marilandica.     48.  Warm-bath.  63.. Nutmeg  in  ihe  shell  sur- 

10.  Euphorbia  corollata.  27.  N'^phrodium  Filix  max.  49.  Hip-bath.                                   rounded  by  the  mace. 

11.  Ficus  Carica.  23.  Pnnica  granatnm.            50  Fool-bath.  69.  Gaultheria  procuinbens. 

12.  Ricinis  communis.  29,  .30.  Inhaling  Bottles.         51.  Hyoscyamus  Niger.  70.  Juniperus  communis. 

13.  Rheum  palmatum.  31.  Balsamadend'n  Myrrha.  52.  Datura  Stramonium.  71.  Citrus  Auranlium. 

14.  Rheum  compaclum.  32.  Acacia  Arabica.              53.  Conium  maculatum.  72.  Laurus  camphora. 

15.  Aloe  Socotorina.  33.  Olea  Europa?a.                  54.  Hamulus  Lupnius.  73.  Drymis  Winleri. 

16.  Legume   and   leaflet  of34  Saccharum  officinarura.oo.   Dried    lupulinic    gTain74  Acorus  Ciilamus. 

Acute  leaved  Alexan-  35.  Linuin  usitatissimum.  with  its  hilum  magn:fi'd  75.  Piper  nigrum, 

drian  Senna.  36.  Astragalus  verus.  56.  Cannabis  sativa.  76.  Electrical  Apparatus  for 

Medical  purposes. 
VOL.    II. 

1.  Cocculus  palmatus.         13.  TTepatica  Americana.     26.  Abies  excelsa.  35.  Parlic's  of  Potato  starch 

(Male  plant.)  14.  Indigo.  27.  Ranunculus  acris.  seen  by  the  microscope. 

2.  Gentiana  Catesbsei.  15.  Cornus  Florida.  28.  Aralia  nudicaulis.  36.  Janipha  Manihot. 

3.  Frasera  Walteri.  16.  Liriodendron  tulipifera  29.  Solanum  dulcamara,       -37.  Panicles  of  Tapioca  as 

4.  Sabbatia  angularis.  17.  Dyospyros  Virginiana.  30.  Tacca  pinnanfida.  seen  by  the  microscope. 

5.  Coptis  trifolia.  13.  Heuchera  acerifolia.  31.  Particles  of  Tahiti   Ar-3S.  Sagus  Rumpliii. 

6.  Aletns  farinosa.  19.  SpirEea  tomenlosa.  row-root.  .39  Particles  of  Sago-meal. 

7.  AristolochiaserpentariaSO.  Stance  Caroliniana.  32.  Particles  of  white  East  40.  Particlesof  Potato  sago. 

8.  Asarura  Canadense.  21.  Colchiciim  autumnale.  India  Arrow-root.         41.  Cycas  revoluta    or  the 

9.  Anthemis  Cotula.  22.  Veratritm  Album.    Var  33.  Particles  of  West  India  Japan  Sago-tree. 

10.  IVIagnolia  glanca.  Albirtorum.  Arrow-root.  42.  Avena  Sativa. 

11.  JMagnoIia  macrophylla.  23.  Cm  cifiiga  racemosa-     34.  Particles  of  Tous-les-  43.  Parti's  of  Wheat  Starch 

12.  Geum  Virginianum.         24, 25.  Shower-bath.  mois. 

"Our  junior  brethren  in  America  will  find  in  these  volumes  of  Professor  Dunglison.  a  'Thesaueits  MsDiCJk- 
MiNUitt,'  more  valuable  than  a  large  purse  of  go\Ay—Mtdico-Chirurgical  Review/or  Jan,  1845. 

NEW    AND   IMPROVED   EDITION,   TO   JULY,  1846. 

THE     MED  fc  AL     FOR  M  U  L  A  R  Y : 

BEING  A  COLLECTION  OF  PRESCRIPTIONS,  DERIVED  FROM  THE  WRITINGS  AND  PRACTICE  OF  MANY  OF 
THE  MOST  EMINENT  PHYSICIANS  OF  AMERICA  AND  EUROPE. 

TO  WHICH  IS  ADDED  AN  APPENDIX, 

CONTAINING  THE  USUAL  DIETETIC  PREPARATIONS  AND  ANTIlJOTES  FOR  POISONS. 
THE  WHOLE  ACCOMPANIE.T   WITH  A  FEW    BRIEF  PHARMACEUTIC    AND   MEDICAL  OBSERVATIONS. 

BY    BENJAMIN    ELLIS,    M.D., 

Late  Professor  of  Materia  Medica  and  Pharmacy  in  tlie  Philadelphia  College  of  Pharmacy. 

EIGHTH  EDITION,  WITH  EXTENSIVE  ALTERATIONS  AND  ADDITIONS. 

BY  SAMUEL  GEORGE  MORTON,  M.  D. 

In  One  neat  Octavo  Volume. 

This  popular  work  has  been  too  extensively  and  favorably  known  to  the  profession  in  the  United  Slates  to 
require  any  remarks  in  introducing  a  new  edition,  except  to  state  that  the  improvements  in  it  will  be  found  to 
be  numerous  and  important.  Great  care  has  been  taken  in  its  passage  through  the  press  to  insure  the  utmost 
accuracy,  and  it  is  cojfidently  presented  as  worthy  the  increased  confidence  of  physicians  and  apothecaries. 


12  LEA   &   BLANCHARD'S   PUBLICATIONS. 

HAS  SE '  sTIraOLOGfCAL^^ 


AN  ANATOMICAL  DESCRIPTION 

OF  THE  DISEASES  OF  THE 

ORGANS  OF  CIRCULATION  AND  RESPIRATION. 

BY  CHARLES  EWALD  HASSE, 

Professor  of  Pathology  and  Clinical  Medicine  in  the  University  of  Zurich,  &c. 
TRANSLATED  AND  EDITED  BY 

W.   E.   S  W  AINE,   M.D.,   &c. 
In  one  octavo  volume, 

A  New  "Work,  Just  Ready.— July  1846. 
HOPE  ON  THE  HEART,— New  Edition. 

A  TREATISE  ON  THE  DISEASES 

OF    THE    HEART   AND  GREAT  VESSELS, 

AND  ON  THE  AFFECTIONS  WHICH  MAY  BE  MISTAKEN 

FOR  THEM. 

COMPRISING  THE  AUTHOR'S  VIEW  OF  THE  PHYSIOLOGY  OF  THE  HEART'S 

ACTION   AND    SOUNDS    AS    DEMONSTRATED   BY  HIS  EXPERIMENTS 

ON  THE  MOTIONS  AND  SOUNDS  IN  1S30,  AND  ON  THE 

SOUNDS    IN  1S34-5. 

BY  J.  HOP^,  M.D.,  F.R.S.,  &c.  &c, 

Second  American  from  the    Third   London  Edition. 
WITH  NOTES  AND  A  DETAIL  OF  RECENT  EXPERIMENTS. 

BY   C.  W.   PENNOCK,   M.D.,  &c. 

In  one  octavo  volume  of  nearly  600  pages,  with  lithographic  plates. 

HUGHES  ON  THE  LUNGS  AND  HEART, 

CLINICAL  INTRODUCTION  TO  THE  PRACTICE  OF  AUSCULTATION, 

AND  OTHER  MODES  OF  PHYSICAL  DIAGNOSIS. 
INTENDED  TO  SIMPLIFY  THE  STUDY  OF  THE  DISEASES  OF  THE  HEART 

AND  LUNGS. 
BY   H.    M.    HUGHES,   M.D.,   &e. 

In  One  Duodecimo  Volume,  with  a  plate. 

A  NEW  WORK.— PHILLIPS  ON  SCROFULA. 

jrUST  nEJlDW—JTuly  1846. 

SCR  O^  U  L  A, 

ITS  NATURE,  ITS  PREVALENCE,  ITS  CAUSES,  AND  THE  PRINCIPLES  OF 

ITS   TREATMENT. 

BY  BENJAMIN  PHILLIPS,  M.  D.,  F.  R.  S.,  &c. 

In  one  neat  octavo  volume,  with  a  plate. 

"There  can  be  no  doubt  that  there  was  ample  room  for  a  fresh  review  of  scrofula,  and  that  a  work  on  the 
subject,  from  a  writer  of  learning,  industry,  and  talent,  must  be  acceptable;  and  such,  after  a  careful  perusal, 
the  work  before  us  appears  to  be.  Very  uncommon  pains  seem  to  have  been  taken  in  collecting  information 
from  men  as  well  as  books.  Our  impression  of  this  work  is,  that  it  is  a  very  important  accession  to  our  profes- 
sionalliterature,  and  does  the  greatest  credit  to  the  industry,  research  and  talent  of  the  author.  Its  utility  is, 
we  think,  likely  to  extend  far  beyond  the  limits  of  professional  society."— TAeio/irfo/i  Medical  Gazette. 

This  work  is  just  published.  The  author  has  been  for  years  engaged  in  the  collection  of  materials  and  sta- 
tistics from  all  parts  of  the  world. 


SMALL  BOOKS  ON  GREAT  SUBJECTS. 


"The  Connection  between  Physiology  and  Intellectual  Science." 

Forming  No.  3  of  a  series  of  small  Avorks  now  issuing^  at  Tweuty-five  Cents  each. 

To  be  followed  shortly  by  "  Philosophical  Theories  and  Philosophical  Experience," — On  Man's 
Power  over  Himself  to  Prevent  or  Control  Insanity," — "An  Introduction  to  Practical  Organic  Che- 
mistry,"— "An  Introduction  to  Vegetable  Physiology,  with  References  to  the  Works  of  De  Can- 
dolle,  Lindley,  &c.,"  and  several  other  new  and  valuable  works.  Each  one  to  form  a  very  neat 
and  portable  volume, 

55"  These  works  have  acquired  great  popularity  in  England,  and  the  publishers  take  pleasure 
in  introducing  the  series  neatly  printed,  and  at  so  low  a  price. 


LEA  &   BLANCHARD'S   PUBLICATIONS.  13 

COMPENDIliroFcH^  LECTUEES. 

A  COMPENDIUM  OF  LECTURES 

ON  THE 

THEORY  AND  PRACTICE  OF   MEDICINE. 

DELIVERED   BY   PROFESSOR   CHAPMAN   IN   THE    UNIVERSITY   OF    PENN- 
SYLVANIA. 

PREPARED,  WITH  PERMISSION,  FROM  DR.  CHAPMAN'S  MANUSCRIPTS, 
AND  PUBLISHED  WITH  HIS  APPROBATION, 

BY  N.  D.  BENEDICT,  M.  D. 

IN    ONE    VERY    NEAT    OCTAVO    VOLUME. 

CONTENTS. 

Remarks  on  the  Classification  of  Diseases — Fever  in  General — Intermittent  Fever — Remittent  Fever 
— Continued  Fever,  (Mild,  Intermediate,  and  Extreme  Forms) — Yellow  Fever — Endemic  Pneu- 
monic, or  Spotted  Fever — Diseases  of  the  Heart  and  Blood-vessels,  (Inflammatory,  Organic,  and 
Nervous) — Acute  Carditis,  Pericarditis,  and  Endocarditis — Chronic  Carditis,  Pericarditis,  and  En- 
docarditis— Hypertrophy  of  the  Heart — Dilatation  of  the  Heart — Atrophy  of  the  Heart — Rupture 
of  the  Heart — Affections  of  the  Valves  of  the  Heart — Palpitations — Acute  Arteritis — Degenera- 
rations  of  Arteries — Aneurism  of  Arteries — Phlebitis — Acute  Inflammation  of  the  Throat — Chronic 
Inflammation  of  the  Throat — Dysphagia — Parotitis — Dysentery,  (Inflammatory) — Dysentery,  (Con- 
gestive)— Diarrhcea — Cholera  Morbus — Cholera  Infantum — Flatulent  Colic — Bilious  Colic — Colica 
Pictonum — Acute  Peritonitis — Chronic  Peritonitis — Acute  Catarrh — Catarrhus  iEstivus — Chronic 
Catarrh — Acute  Bronchitis — Chronic  Bronchitis — Catarrhus  Senilis — Acute  Infantile  Bronchitis — 
Chronic  Infantile  Bronchitis — Croup — Acute  Infantile  Asthma — Whooping-Cough — Acute  Laryn- 
gitis— Chronic  Laryngitis — Pleuropneumonia — Congestive  Pneumonia — Chronic  Pleurisy  and 
Pneumonia — Apoplexy — Palsy — Epilepsy — Hysteria — Chorea — Neuralgia — Diabetes. 
The  subjects  treated  of  in   this  volume  are  entirely  distinct  from  those  considered  in  Dr. 

Chapman's  two  works  on  "Thoracic  and  Abdominal  Viscera,"  and  on  "Eruptive  Fevers," 

«&c.     These  works  are  ail  printed  and  bound  to  match,  and  form  three  very  neal  octavo 

volumes. 


LECTURES  ON  THE  MORE  IMPORTANT  DISEASES 

OF  THE 

THORACIC  AND  ABDOMINAL  VISCERA. 

DELIVERED  IN  THE  UNIVERSITY  OF  PENNSYLVANIA. 
BY  N.  CHAPMAN,  M.  D. 

PHOFESSOR  OF  THE  THEORY  AND  PRACTICE  OF  MEDICINE,  ETC.  '  , 

In  One  Volume,  Octavo. 


CHAPMAN    ON    FEVERS,    &c. 

LECTURES  ON  THE  MORE  IMPORTANT 

ERUPTIVE  FEVERS,  HJIMORRHAGES  AND  DROPSIES, 

AND  ON  GOUT  AND  RHEUMATISM, 

DELIVERED  IN  THE  UNIVERSITY  OF  PENNSYLVANIA. 
By  N.  CHAPMAN,  M.D., 

PROFESSOR  OF  THE  THEORY  AND  PRACTICE  OF  MEDICINE,  ETC.  ETC. 

In  One  Neat  Octavo  Volume. 
"The  name  of  Chapman  stands  deservedly  high  in  the  annals  of  American  medical  science.  A  teacher  and 
a  lecturer  for  nearly  forty  years,  in  the  oldest  and,  we  believe,  the  first  medical  school  on  this  side  of  the  At- 
lantic, the  intimate  friend  and  companion  of  Rush,  Kuhn,  Physick,  Wislar,  Woodhouse,  Dewees,  and  a  host 
of  others,  scarcely  less  renowned.  Professor  Chapman  reflecisuponlhe  profession  of  this  generation  something 
of  the  genius  and  wisdom  of  that  which  has  passed;  he  stands  out  the  able  and  eloquent  champion  of  the  doc- 
trines and  principles  of  other  times,  when  Cullen's  "  first  lines"  formed  the  rule  of  faiih  for  all  tlie  Doctors  in 
Medicine  throughout  Christendom.  In  him  is  embodied  the  experience  of  threescore  and  ten,  strengthened 
by  reading,  and  enlightened  by  a  familiar  intercourse  with  many  of  the  ablest  medical  men  in  the  New  and 
Old  World.  In  conclusion,  we  njust  declare  our  belief  that  the  name  of  Chapman  will  survive  when  thai  of 
many  of  his  cotemporaries  shall  have  been  forgotten  ;  when  other  generations  shall  ireid  the  great  theatre  of 
human  affairs,  and  when  other  discoveries  yet  undisclosed,  shall  shed  a  brighter  light  upon  the  path  of  medi- 
cal science.  The  various  lectures  which  he  has  been  publishing,  containing,  as  they  do,  the  doctrines  that 
he  has  so  long  and  so  eloquently  taught  to  large  and  admiring  classes,  we  doubt  not  will  be  welcomed  with 
delight  by  his  numerous  pupils  throughout  the  Union."— iVeio  Orleans  Medical  Journal. 


14  LEA   &  BLANCHARD'S  PUBLICATIONS. 

horne¥^¥TnTtomy, 

NEW  EDITION— To  be  Ready  by  October. 


SPECIAL   ANATOMY 

AND 

HISTOLOGY. 

BY 

WILLIAM  E.  HORNER,  M,  D., 

PROFESSOR  OF  ANATOMY  IN  THE  UNIVERSITY  OF  PENNSYLVANIA,  &c.  &c. 

SEVENTH  EDITION, 

WITH  MANY  IMPROVEMENTS  AND  ADDITIONS. 
In  iiDO  Octavo  Volumes,  with  Illustrations  on  Wood. 
This  standard  work  has  been  so  long  before  the  profession,  and  has  been 
so  extensively  used,  that,  in  annoinicing  the  new  edition,  it  is  only  neces- 
sary to  state  that  it  will  undergo  a  most  careful  revision  ;  the  author  will 
introduce  many  illustrations  relating  to  Microscopical  Anatomy,  and  will 
add  a  large  amount  of  text  on  these  various  points  of  investigation  that 
are  rapidly  advancing  and  attracting  so  much  attention.  This  new  edi- 
tion will  be  arranged  to  refer  conveniently  to  the  illustrations  in  Smith 
and  Horner's  Anatomical  Atlas,  and  will  be  ready  for  the  Fall  Lectures. 

HORNER'S  DISSECTOR. 

THE  UNITED  STATES  DISSECTOR, 

BEING  A  NEW  EDITION,  WITH  EXTENSIVE  MODIFICATIONS,  AND 

ALMOST  REWRITTEN, 

OF 

"HORNER'S  PRACTICAL  ANATOMY." 

IN  ONE  VERY  NEAT  VOLUME, 
ROYAL  12mo. 
With  many  Illustrations  on  Wood. 
The  numerous  alterations  and  additions  which  this  work  has  under- 
gone, the  improvements  which   have  been  made  in  it,  and  the  numerous 
wood-cuts  which  have  been  introduced,  render  it  almost  a  new  work. 

It  is  the  standard  work  for  the  Students  in  the  University  of  Pennsyl- 
vania. 

BUDD  ON   THE   LIVER. 

ON    DISEASES    OF    THE    LIVER. 

BY  GEORGE  BUDD,  M.D.,  F.R.S., 

Professor  of  Medicine  in  King's  College,  London,  &c.  &c. 
With  colored  -plates,  and  numerous  uwod-cuts.    In  one  neat  octavo  volume. 
"  We  cannot  too  strongly  recommend  llie  dligent  siiidy  of  this  volume.    The  work  cannot  fail  to  rank  the 
name  of  its  author  amimg  the  most  enlightened  pathologists  and  soundest  practitioners  of  the  day."— ilfcdico- 
CAirurgical  Review. 

/ 


SMITH  &  HORNER'S  ANATOMICAL  ATLAS. 

Just  Published,  Price  Five  Dollars  in  Parts. 


AN 

ANATOMICAL    ATLAS 

lUUSTRATIVE  OF  THE  STKTJGTURE  OF  THE  HUMAN  EQBY. 

BY  HENRY  H.  SMITH,  M.D., 

Fellow  of  the  College  of  Phxjsiciam,  S^c 
UNDER  THE  SUPERVISION  OF 

WILLIAM  E.  HORNER,  M.  U., 

Professor  of  Anatomy  in  the  Univerdty  of  PennsylvMua, 

In  One  large  Volume,  Imperial  Octavo. 

This  work  is  but  just  completed,  having  been  delayed  over  the  time  intended  by  the  great  difficulty  in  giving 
to  the  illustrations  the  desired  finish  and  perfection.    It  consists  of  five  parts,  v^hose  contents  are  as  follow*: 

Part     I.  The  Bones  and  Ligaments,  witli  one  hundred  and  thirty  engravings. 

Part   II.  The  Muscular  and  Dermoid  Systems,  virith  ninet>'-one  engravings. 

jPart  III.  The  Organs  of  Digestion  and  Generation,  witli  one  hundred  and  ninety-one  engravings. 

Part  IV.  The  Organs  of  Respiration  and  Circulation,  with  ninety-eight  engravings. 

Part   V.  The  Nervous  System  and  the  Senses,  with  one  hundred  and  twenty-six  engravings. 
Forming  altogether  a  complete  System  of  Anatoiuical  Plates,  of  nearly 

SIX   HUNDRED   AND   FIFTY   FIGURES, 
executed  in  the  best  style  of  art,  and  making  one  large  imperial  octavo  volume.    Those  wlio  do  not  want  it  in 
parts  can  have  the  work  bound  in  extra  cloth  or  sheep  at  an  extra  cost. 

Tliis  work  possesses  novelty  both  in  the  design  and  the  execution.  It  is  the  first  attempt  to  apply  engraving 
on  wood,  on  a  large  scale,  to  the  illustration  of  human  anatomy,  and  the  beauty  of  the  parts  issued  induces  the 
publishers  to  flatter  themselves  with  the  hope  of  the  perfect  success  of  their  undertaking.  The  plan  of  the 
■work  is  at  once  novel  and  convenient.  Each  page  is  perfect  in  itself,  tlie  references  being  immediately  under 
the  figures,  so  that  the  eye  takes  in  the  whole  at  a  glance,  and  obviates  the  necessity  of  continual  reference 
backwards  and  forwards.  The  cuts  are  selected  from  the  best  and  most  accurate  sources ;  and,  where  neces- 
sary, original  drawings  have  been  made  I'rom  the  admirable  Anatomical  Collection  of  the  University  of  Penn- 
sylvania. It  embraces  all  the  late  beautiful  discoveries  arising  from  tlie  use  of  the  microscope  in  the  investi- 
gation of  the  minute  strucmre  of  the  tissues. 

In  the  getting  up  of  this  very  complete  work,  the  publishers  have  spared  neither  pains  nor  expense,  and  they 
now  present  it  to  the  profession,  with  the  full  confidence  that  it  will  be  deemed  all  that  is  wanted  in  a  scientific 
and  artistical  point  of  view,  while,  at  the  same  time,  its  very  low  price  places  it  within  the  reach  of  all. 

It  is  partindarly  adapted  to  supjily  the  place  of  skeletons  or  subjects,  as  the  profession  will  see  by  examining  the  list 
of  plates 


"  These  fi<Tires  are  well  selected,  and  present  a  complete  and  accurate  representation  of  that  wonderful  fabric, 
the  human  body.  The  plan  of  this  Atlas,  which  renders  it  so  peculiarly  convemenl  for  the  student,  and  us 
superb  artistical  execution,  have  been  already  pointed  out.  We  must  congratulate  the  student  upon  the 
completion  of  this  atlas,  as  it  is  the  most  convenient  work  of  the  kind  that  has  yet  appeared;  and,  we  must 
add,  the  very  beautiful  manner  in  which  it  is  'got  up'  is  so  creditable  to  the  country  as  to  be  flattering  to  our 
national  pride." — American  Medical  Journal.  .     ,       , 

"This  IS  an  exquisite  volume,  and  a  beautiful  specimen  of  art.  We  have  numerous  Anatomical  Atlases,! 
but  we  will  venture  to  say  that  none  equal  it  in  cheapness,  and  none  surpass  it  in  faithfulness  and  spirit.  We 
strongly  recommend  to  our  friends,  both  urban  and  suburljan,  the  purchase  of  this  excellent  work,  for  which 
both  editor  and  publisher  deserve  the  thanks  of  the  profession."— JVffrfscai  Exayniner. 

"We  would  strongly  re«ommend  it,  not  only  to  the  student,  but  also  to  the  working  practiti'oner,  who, 
although  grown  rusty  in  the  toils  of  his  harness,  still  has  the  desire,  and  often  the  necessity,  of  refreshing  his 
knowledge  in  this  fundamental  part  of  the  science  of  medicine."— iVew  York  Jo^irnal  of  Mrduine  and  Surg. 

"  The  plan  of  this  Atlas  is  admirable,  and  its  execution  superior  to  any  thing  ot  tlie  kind  before  published  in 
this  country.  It  is  a  real  labour-saving  affair,  and  we  regard  its  publication  as  the  greatest  boon  that  could  be 
conferred  on  the  student  of  anatomy.  It  will  be  equally  valuable  to  the  practitioner,  by  allording  hiin  an  easy 
means  of  recalling  the  details  learned  in  tlie  dissecting  room,  and  which  are  soon  forgotten."— .ilmenca/i  Medi- 
cal Journal.  •      i  i,       i       ■   ■ 

"  It  is  a  beautiful  as  well  as  particularly  useful  design,  which  should  be  extensively  patronized  by  physicians. 
Burgeons  and  medical  students." — Boston  Med.  and  Surg.  Journal. 

"  It  hits  been  the  aim  of  the  author  of  the  Atlas  to  comprise  in  it  ttie  valuable  points  of  all  previous  works,  to 
embrace  the  latest  microscopical  observations  on  tlie  anatomy  of  the  tissues,  and  by  placing  it  at  a  moderate 
price  to  enable  all  to  acquire  it  who  may  need  its  assistance  in  the  dissecting  or  operating  room,  or  other  field 
of  practice."— WM!<rn  Journal  of  Med.  and  Surgery. 

"These  numbers  complete  the  series  of  this  beautiful  work,  which  fully  merits  the  praise  bestowed  upon  the 
earlier  numbers.  AVe  regard  all  the  engravings  as  possessing  an  accuracy  only  equalled  by  their  beamy, 
and  cordially  recommend  the  work  to  all  engaged  in  the  study  of  anatomy."— A'ew  York  Journal  of  Medicine 

and  Surgery.  ,      ■   •  ,         t ,       , 

"A  more  elegant  work  than  the  one  before  us  could  not  easily  be  placed  by  a  physician  upon  the  table  of 
his  student.*"— Veitem  Journal  of  Medicine  and  Surgery. 

"We  were  much  pleased  with  Part  I,  but  the  Second  Part  gratifies  us  still  more,  both  as  regards  the  attract- 
ive nature  of  the  subject,  (The  Dermoid  and  Muscular  Systems.)  and  the  beautiful  artistical  execution  of  ihe 
Illustrations.  We  have  here  delineated  the  most  accurate  microscopic  views  of  some  of  the  tissues,  as.  for 
instance  the  cellular  and  adipose  tissues,  the  epidermis,  rete  mucosum  and  cutis  vera,  the  sebaceous  and 
perspiratory  or-ans  of  the  skin,  the  perspirator)'  glands  and  hairs  of  tiie  skin,  and  the  hair  and  nails.  Then 
follows  the  general  anatomy  of  the  muscles,  and,  lastly,  their  separate  delineations.  We  would  recomnicnd 
this  Anatomical  Atlas  to  our  readers  in  the  very  strongest  terms."— JVm/>  York  Journal  of  Medicine  and  Sur- 
gery. 


16  LEA  &  BLANCHARD'S  PUBLICATIONS. 

THERAPEUTICAL    LIBRARY. 


PEREIRA'S  MATERIA  MEDICA. 

WITH  NEARLY  THREE  HUNDRED  ENGRAVINGS  ON  WOOD. 
A  NEW  EDITION,  LATELY  PUBLISHED. 


THE  ELEMENTS  OF 

MATERIA  MEDICA  AND  THERAPEUTICS. 

COMPREHENDING   THE   NATURAL  HISTORY,  PREPARATION,  PROPERTIES,  COMPO- 
SITION, EFFECTS  AND  USES  OF  MEDICINES. 

BY  JONATHAN  PEREIRA,  M.  D.,  F.  R.  S.  and  L.  S., 

Member  of  the  Society  of  Pharmacy  of  Paris ;  Examiner  in  Materia  Medica  and  Pharmacy  of  the  University 
of  London;  Lecturer  on  Materia  Medica  at  the  London  Hospital,  &c.  &c. 

Second  American,  from  the  last  London  Edition,  enlarged  and  improved. 
WITH  NOTES  AND   ADDITIONS  BY  JOSEPH  CARSON,  M.D. 

In  Two  Volumes,  Octavo,  containing  Fifteen  Hundred  very  large  Pages,  illustrated  by- 
Two  Hundred  and  Seventy-five  Wood-cuts. 

Part  I.  contains  the  General  Action  and  Classification  of  Medicines  and  the  Mineral  Materia 
.Medica.  Part  II.,  the  Vegetable  and  Animal  Kingdoms,  including  diagrams  explanatory  of  the 
l>rocesses  of  the  Pharmacopoeias,  a  tabular  view  of  the  History  of  the  Materia  Medica,  from  the 
earliest  times  to  the  present  day,  with  the  Introduction  of  the  Processes  of  the  New  Edinburgh 
Pharmacoposia,  and  a  very  copious  index.  It  also  contains  additional  articles  on  Mental  Remedies, 
Light,  Heat,  Cold,  Electricity,  Magnetism,  Exercise,  Dietetics  and  Climate,  and  many  additional 
Wood-cuts,  illustrative  of  Pharmaceutical  Operations,  Crystallography,  Shape  and  Organization  of 
the  Feculas  of  Commerce,  and  the  Natural  History  of  the  Materia  Medica. 

In  passing  through  the  press  the  second  edition  of  this  standard  work,  the  opportunity  has  been 
taken  by  the  editor  to  correct  any  mistakes  or  inadvertencies  that  may  have  escaped  him  or  the 
autlior,  in  the  first  edition.  It  may  now  be  considered  as  entirely  worthy  of  the  confidence  of  the 
physician  and  pharmaceutist,  as  an  accurate  edition  of  the  most  complete  work  extant  on  the  subject. 

"An  Encyclopoedia  of  knowledge  in  that  department  of  medical  science — by  the  common  consent  of  the  pro- 
fession the  most  elaborate  and  scientific  Treatise  on  Materia  Medica  incur  language." — Western  Journal  of 

Medicine  and  Surgery. 


THE  STUDENT'S  TEXT-BOOK  OF  MATERIA  MEBICA. 

NCW   AT    PRESS, 

A  MANUAL  OF 
MATERIA  MEDICA  AND  THERAPEUTICS. 

By  J.  FORBES  ROYLE,  M.  D., 

PROFESSOK    IN     KING'S    COLLEGE,    LONDON. 

EDITED  BY 

J.  CARSON,  M.D., 

Professor  of  Materia  Medica  and  Pharmacy  in  tlie  Philadelphia  College  of  Pharmacy,  etc.  etc. 

In  One  Octavo  Volume,  with  Numerous  Splendid  Illustrations. 

This  work  will  contain  all  the  most  recent  information  and  investigations  in  the  various 
branches  connected  with  the  Materia  Medica,  and  under  the  supervision  of  its  able  editor, 
will  receive  whatever  alterations  and  additions  may  be  necessary  to  adapt  it  to  the  United 
States  Pharmacopoeia,  and  to  the  practice  of  this  country.  The  high  character  of  the  author 
will  attract  attention  to  the  work  as  a  text-book  for  the  next  session  of  the  various  colleges, 
if  ready.  The  numerous  and  beautiful  illustrations  will  far  surpass  anything  that  has  as 
yet  been  attempted  in  this  way.  This  volume  will  be  brought  out  in  a  style  to  match  Fer- 
guson's Surgery,  Wilson's  Anatomy,  &c.,  and  will  be  sold  at  a  low  price. 


LEA  &  BLANCHARD'S  PUBLICATIONS.  H 

THE  GREAT~MEDICAl7^^ 
THE  CYCLOP/EDIA  OF  PRACTICAL  MEDICiNE; 

COMPRISING  TREATISES  ON  THE 

NATURE  AND  TREATMENT  OF  DISEASES, 

MATERIA  MEDICA  k  THERAPEUTICS, 

DISEASES  OE  WOMEN  AND  CHILDREN, 

MEDICAL  JURISPRUDENCE,  &».  &c. 

EDITED  BY 

JOHN   FORBES,   M.  D.,  F.  R.  S., 
ALEXANDER    TWEEDIE,   M.D.,  F.R.S., 

AND 

JOHN    CONOLLY,    M.D. 

REVISED,  WITH  ADDITIONS, 

By  ROBLEY  DUNGLISON,  M.D. 


THIS   WORK   IS   NOW   COMPLETE,   AND    FORMS 

FOUR  LARGE  SUPER-ROYAL,  OCTAVO  VOLUMES, 

CONTAINING  THIRTY-TWO  HUNDRED  AND  FIFTY-FOUR 
UNUSUALLY  LARGE  PAGES  IN  DOUBLE  COLUMNS,^ 

PRINTED    ON    GOOD    PAPER,   WITH   A   NEW   AND   CLEAR  TYPE. 
THE   WHOLE  WELL   AND   STRONGLY   BOUND, 

WITH  RAISED  BANDS  AND   DOUBLE  TITLES. 
Or,  to  be  had  in  twenty-four  parts,  at  Fifty  Cents  each. 

For  a  list  of  Articles  and  Authors,  together  with  opinions  of  the  press,  see  Supplement  to  the  Nth 
vember  number  of  the  Medical  News  and  Library. 

This  work  having  been  completed  and  placed  before  the  profession,  has 
been- steadily  advancing  in  favor  with  all  classes  of  physicians.  The  nu- 
merous advantages  which  it  combines,  beyond  those  of  any  other  work  ; 
the  weight  which  each  article  carries  with  it,  as  being  the  production  of 
some  physician  of  acknowledged  reputation  who  has  devoted  himself 
especially  to  the  subject  confided  to  him,  the  great  diversity  of  topics 
treated  of;  the  compendiousness  with  which  everything  of  importance  is 
digested  into  a  comparatively  small  space ;  the  manner  in  which  it  has 
been  brought  up  to  the  day,  everything  necessary  to  the  American  prac- 
titioner having  been  added  by  Dr.  Dunglison  ;  the  neatness  of  its  mecha- 
nical execution,  and  the  extremely  low  price  at  which  it  is  afforded, 
combine  to  render  it  one  of  the  most  attractive  works  now  before  the  pro- 
fession. As  a  book  for  constant  and  reliable  reference,  it  presents  advan- 
tages which  are  shared  by  no  other  work  of  the  kind.  To  country  prac- 
titioners, especially,  it  is  absolutely  invaluable,  comprising  in  a  mode- 
rate space,  and  trifling  cost,  the  matter  for  which  they  would  have  to 
accumulate  libraries,  when  removed  from  public  collections.  The  steady 
and  increasing  demand  with  which  it  has  been  favored  since  its  completion, 
shows  that  its  merits  have  been  appreciated,  and  that  it  is  now  universally 
considered  as  the 

LIBRARY  FOR  CONSULTATION  AND  REFEiENGE. 


18  LEA  &  BLANCHARD'S  PUBLICATIONS. 

WORKS  BY  PROFESSORS  CHURCHILL,  MEIGS,  &c. 
CHUHCHII<Z.'S    l^IDWIPEHY. 

A  New  Edition,  Just  Published. 


ON  THE  THEORY  AND  PRACTICE  OF  MIDWIFERY, 

BY  FLEETWOOD  CHURCHILL,  M.D..  M.  11.1.  A., 

Licenliate  of  the  Colle-je  of  Physicians  in  Ireland;  Physician  to  the  Western  Lying-in  Hospital ;  Lecturer  on 
IVIidwifery,  &c.,  in  the  Richmond  Hospital  Medical  School.  &c.  &:c. 

WITH    NOTES    AND    ADDITIONS 
BY  ROBERT  M.  HUSTON,  M.  D., 

Professor  of  Materia  Medica  and  General  Therapeutics,  and  formerly  of  Obstetrics  and  the  Diseases  of  Wo- 
men and  Children  in  the  Jefferson  Medical  College  of  Philadelphia;  President  of  the  Philadelphia 

Medical  Society,  &;c.  &c. 

«         SECOND  AMERICAN  EDITION. 

WITH  ONE  HUNDRED  AND  TWENTY-EIGHT  ILIiUSTRATIONS, 

ENGRAVED  BY  GILBERT  FROM  DRAWINGS  BY  BAGG  AND  OTHERS. 

In  One  beautiful  Octavo  Volume. 
The  call  for  a  second  edition  of  Dr.  Churchill's  Midwifery,  within  so  short  a  time  after  the  ap- 
pearance of  the  first,  is  satisfactory  evidence  that  the  profession  in  this  country  appreciate  the  high 
value  of  the  work.  Both  as  a  text-book  for  the  student  and  as  a  manual  for  the  practitioner,  it  hag 
a  deservedly  great  reputation,  especially  for  the  fulness  and  clearness  with  which  the  physiological 
details  are  wrought  out  and  brought  to  illustrate  the  practical  part.  To  render  the  present  edition 
■worthy  of  a  continuance  of  the  favor  and  confidence  so  signally  manifested  towards  its  predecessor, 
the  editor  has  carefully  added  all  the  new  facts  and  observations  which  have  transpired  since  the 
publication  of  the  last  edition,  or  such  at  least  as  appeared  to  him  deserving  of  being  recorded. 
These  relate  to  some  of  the  most  important  points  in  physiology  and  obstetrical  practice.  Various 
new  illustrations  have  been  introduced,  and  the  whole  brought  up,  as  far  as  possible,  to  the  day  of 
publication. 


A  NEW  EDITION  OF  CHURCHILL  ON  FEMALES. 

THE   DISEASES   OF   FEMALES, 

INCLXTDING  THOSE   OF 

PREGNANCY    AND   CHILDBED. 
BY  FLEETWOOD  CHURCHILL,  M.D., 

Author  of  "  Theory  and  Practice  of  Midwifery,"  &c.  &c. 
THIRD  AMERICAN,  FROM  THE  SECOND  LONDON  EDITION,  WITH  ILLUSTRATIONS- 
EDITED,    WITH    NOTES, 
BY  ROBERT  M.  HUSTON,  M.  D.,  &c.  &c. 
In  One  Volume,  8vo, 

"  In  complying  with  the  demand  of  the  profession  in  this  country  for  a  third  edition,  the  Editor 
has  much  pleasure  in  the  opportunity  thus  afforded  of  presenting  the  work  in  its  more  perfect  form. 
All  the  additional  references  and  illustrations  contained  in  the  English  copy  are  retained  in  this." 

A  TREATISE  ON  THE  DISEASES  OF  FEMALES, 
AND  ON  THE  SPECIAL  HYGIENE  OF  THEIR  SEX. 

WITH  NUMEROUS  WOOD-CUTS. 

BY    COLO  MB  AT    DE    L'ISERE,    M.  D., 

Chevalier  of  the  Legion  of  Honor;  late  Surgeon  to  the  Hospital  of  the  Rue  de  Valois,  devoted  to  the  Diseases 

of  Females,  &c.  &c. 

TRANSLATED,  WITH  MANY  NOTES  AND  ADDITIONS, 

By   C.    D.   MEIGS,  M-D., 

Professor  of  Obstetrics  and  Diseases  of  Women  and  Children  in  the  Jefferson  Medical  College,  &c.  &c. 

In  One  Large  Volume,  8vo. 
"  We  are  satisfied  it  is  destined  to  take  the  front  rank  in  this  department  of  medical  science;  it  is 
beyond  all  comparison,  the  most  learned  Treatise  on  the  Diseases  of  Females  that  has  ever  been 
written,  there  being  more  than  one  thousand  distinct  authorities  quoted  and  collected  by  the  inde- 
fatigable author.  It  is  in  fact  a  complete  exposition  of  tiie  opinions  and  practical  methods  of  all 
the  celebrated  practitioners  of  ancient  and  modern  times.  The  Editor  and  Translator  has  per- 
formed his  part  in  a  manner  hardly  to  be  surpassed.  The  translation  is  faithful  to  the  original,  and 
yet  elegant.  More  tlian  one  hundred  pages  of  original  matter  have  been  incorporated  in  the  text, 
constituting  a  seventh  part  of  the  whole  volume." — JVet/;  York  Journal  of  Medicine. 


LEA   &   BLANCHARD'S   PUBLICATIONS.  19 

WORKS  BTlPROFlfSSOR^WrirDEWEES. 

NEW  EDITIONS. 


DEWEES'S  MIDWIFERY. 

A  COMPREHENSIVE  SYSTEM   OF    MIDWIFERY. 

CHIEFLY    DESIGNED   TO    FACILITATE  THE  INQUIRIES  OF  THOSE    WHO  MAY  BE  PUR- 
SUING THIS  BRANCH   OF  STUDY- 
ILLUSTRATED  BY  OCCASIONAL    CASES   AND  MANY  ENGRAVINGS. 
Tenth  Edition,  with  the  Author's  last  Improvements  and  Corrections. 

BY  WILLIAM  P.  DEWEES,  M.  D„ 

LATE  PROFESSOR  OF    MIDWIFERY  IN  THE  UNIVERSITY    OF    PENNSYLVANIA,  ETC. 

In  one  volume,  octavo. 
That  this  work,  notwithstanding  the  length  of  time  it  has  been  before  the  profession,  and  the 
numerous  treatises  that  have  appeared  since  it  was  written,  should  have  still  maintained  its  ground, 
and  passed  to  edition  after  edition,  is  sufficient  proof  that  in  it  the  great  practical  talents  of  the 
author  were  fully  placed  before  the  profession.  Of  the  hook  itself  it  would  be  superfluous  to 
speak,  having  been  so  long  and  so  favorably  known  throughout  the  country  as  to  have  become 
identified  with  American  Obstetrical  Science. 


DEWEES  ON  FEMALES. 

A  TREATISE  ON  THE  DISEASES  OE  FEMALES. 

BY  WILLIAM  P.  DEWEES,  M.  D.,  &c. 

LATE  PROFESSOR  OF  MIDWIFERY  IN  THE  UNIVERSITY  OF  PENNSYLVANIA,  ETC. 

EIGHTH    EDITION, 
With  the  Author's  last  Improvements  and  Corrections. 

In  one  octavo  volume,  with  plates. 


DEWEES    ON    CHILDREN. 

A  TREATISE  ON  THE 

PHYSICAL  AND  MEDICAL  TREATMENT  OF  CHILDREN, 

BY  WILLIAM  P.  DEWEES,  M.D., 

LATE  PROFESSOR  OF  MIDWIFERY  IN  THE  UNIVERSITY  OF  PENNSYLVANIA,  ETC.  ETC. 

EIGHTH    EDITION. 
In  one  volume,  octavo. 

This  edition  emboclies  the  notes  and  additions  prepared  by  Dr.  Dewees  before  his  death,  and  will  be  found 
much  improved. 

The  objects  of  this  work  are,  1st,  to  teach  those  whohavethe  charee  of  children,  eitheras  parent  orguardian, 
the  most  approved  methods  of  securing  and  improving  their  physical  powers.  This  is  attempted  by  pointing 
out  the  duties  which  the  parent  or  the  guardian  owes  for  this  purpose,  to  this  interestine  but  helpless  class  of 
beings,  and  the  manner  by  which  their  duties  shall  be  fulfilled.  And  2d,  to  render  available  a  long  experi- 
ence to  those  objects  of  our  affection  when  they  become  diseased.  In  attempting  this,  the  author  has  avoided 
as  much  as  possible,  "  technicality,"  and  has  siven,  if  he  does  not  flatter  himself  too  much,  to  each  disease  of 
which  he  treats,  its  appropriate  and  designating  characters,  with  a  fidelity  that  will  prevent  any  two  being  con- 
founded together,  with  the  best  mode  of  treating  them,  that  either  his  own  experience  or  that  of  others  has 
sugsested. 

Physicians  cannot  too  strongly  recommend  the  use  of  this  book  in  all  families. 


ASHWELL  ON  THE  DISEASES  OF  FEMALES. 

A  PRACTICAL  TREATISE  ON  THE 

DISEASES  PECULIAR  TO  WOMEN. 

U.LUSTRATED  BY  CASES 

DERIVED  FROM  HOSPITAL  AND  PRIVATE  PRACTICE. 

By  SAMUEL  ASHWELL,  M.  D., 

Member  of  the  Royal  College  of  Physicians ;  Obsieiric  Physician  and  Lecturer  to  Guy's  Hospital,  &c. 

Edited  by  PAUL  BECK  GODDARD,  M.  D. 

The  whole  complete  in  one  large  octavo  volume. 
"  The  most  able,  and  certainly  the  most  standard  and  practical  work  on  female  diseases  that  we 
have  yet  seen." — Medico-Chirurgical  Review. 


20  LEA  &  BLANCH ARD'S  PUBLICATIONS. 

LATELY  PUBLISHED, 
A  NEW  EDITION  OF 

WILSON^S    HUMAN    ANATOMY, 

MUCH     IMPROVED. 


A  SYSTEM   OF   HUMAN   ANATOMY, 

GENERAL    AND    SPECIAL. 

BY  ERASMUS  WILSON,  M.D., 

LECTURER  ON  ANATOMY,  LONDON. 

SECOND  AMERICAN  EDITION,  EDITED  BY 

PAUL  B.  GODDARD,  A.  M.,  M.  D., 

Professor  of  Anatomy  and  Histology  in  the  Franklin  Medical  College,  Philadelphia. 
WITH  OVER  TWO  HUNDRED  ILLUSTRATIONS. 

Beautifully  Printed  from  the  Second  London  Edition,  in  One  very  neat  Octavo  Volume. 

"  Mr.  Wilson,  before  the  publication  of  this  work,  was  very  favorably  known  to  the  profession  by  his  trea- 
tise on  Practical  and  Surgical  Anatomy:  and,  as  this  is  the  Second  American  Edition,  from  the  second  London 
Edition,  since  1840,  any  special  commendation  of  the  high  value  of  the  present  work,  on  our  part,  would  be 
mipererogatory.  Besides,  the  work  has  been  translated  at  Berlin,  and  overtures  were  repeatedly  made  to  the 
London  publisher  for  its  reproduction  in  France.  The  work  is,  undoubtedly,  a  complete  system  of  human 
anatomy,  brought  up  to  the  present  day.  The  illustrations  are  certainly  very  beautiful,  the  originals  having 
been  expressly  designed  and  executed  for  this  work  by  the  celebrated  Bagg  of  London;  and,  in  the  American 
edition  they  have  been  copied  in  a  masterly  and  spirited  manner.  As  a  text-book  in  the  various  colleges  we 
would  commend  it  in  the  highest  terms." — New  York  Journal  of  Medicine. 


WILSON'S    DISSECTOR. 


THE  DISSECTOR; 

OE,  PEACTICAL  AND  SURGICAL  ANATOMY. 

BY  ERASMUS  WILSON, 

Author  of  "A  System  of  Human  Anatomy,  &c. 

WITH  ONE  HUNDRED  AND  SIX  ILLUSTRATIONS. 

MODIFIED    AND    RE-ARRANGED    BY 

PAUL  B.  GODDARD,  M.  D., 

Professor  of  Anatomy  and  Histology  in  the  Franklin  Medical  College,  Philadelphia. 

In  One  Large  Royal  Duodecimo  Volume,  Sheep. 

"  It  strikes  us  as  being  all  that  a  "Dissector"  should  be.     The  wood-cuts  are  numerous  and  will 
afibrd  the  student  the  most  essential  aid  in  the  dissecting  room." — West.  Journ.  of  Med.  and  Surg. 


WILSON    ON    THE    SKIN. 


A  PRACTICAL  AND  THEORETICAL  TREATISE 

ON  THE 

DIAGNOSIS,  PATHOLOGY  AND  TREATMENT 

OF  DISEASES  OF  THE  SKIN; 

ARRANGED  ACCORDING  TO  A  NATURAL  SYSTEM  OF  CLASSIFICATION, 

AND  PRECEDED  BY 

AN  OUTLINE  OF  THE  ANATOMY  AND  PHYSIOLOGY  OF  THE  SKUV. 

BY  ERASMUS  WILSON, 

Lecturer  on  Anatomy  and  Physiology  in  the  Middlesex  Hospital  Medical  School,  &c.  &c. 
In  One  Neat  Octavo  Volume,  Cloth. 
"  It  is  a  sound  book  of  practice.  As  a  practical  guide  to  the  classification,  diagrnosis  and  treatment  of  the  dig 
eases  of  the  skin,  the  hook  is  complete.  We  know  nothing,  considered  iii  this  aspect,  better  in  our  language: 
it  is  a  safe  authority  in  all  the  matters  which,  in  this  range  of  diseases,  engage  the  practitioner's  attention,  and 
possesses  the  high  quality,  unknown,  we  believe,  to  every  older  manual,  o(  being  on  a  level  with  Science's  high 
waier  mank.— Medical  Times. 


LEA  &  BLANCHARD'S  PUBLICATIONS.  21 

A  NEW  AND  COMPLETE  WORK  ON  FEVERS. 


FE  YER  S; 


THEIR  DIAGNOSIS,  PATHOLOGY  &  TREATMENT. 

PREPARED  AND  EDITED  WITH  LARGE  ADDITIONS, 

FROM  THE  ESSAYS  ON  FEVER  IN 

TWEEDIE'S  LIBRARY  OF  PRACTICAL  MEDICINE, 

BY 
MEREDITH  CLYMER,   M.  D., 

Professor  of  the  Principles  and  Practice  of  Medicine  «i  Franklin  Medical  College,  Philadelphia; 
Consulting  Physician  to  the  Philadelphia  Hospital ;  Fellow  of  the  Col- 
lege of  Physicians,  fyc.  ^c. 

In  one  octavo  volume  of  600  pages. 

The  want  of  a  distinct  treatise  on  Fevers,  embodying  the  received  doctrines  of  their  pathology  and 
treatment  has  long  been  felt  and  generally  acknowledged.  To  supply  this  deficiency  in  medical 
literature  is  the  object  of  the  present  volume.  It  has  been  prepared  from  the  Essays  on  Fever 
contributed  by  Drs.  Christison,  Shapter,  Burrows,  Gregory  and  Locock,  to  Dr.  Tweedie's  "  Library 
of  Practical  Medicine,"  and  will  be  found  to  embrace  the  whole  class  of 

Idiopathic  Fevers,— Continued,  Periodical,  Eruptive,  and  Puerperal. 

The  additions  of  the  Editor,  amounting  to  about  one-half  of  the  volume,  have  been  chiefly  made 
with  reference  to  the  Fevers  of  this  country.  It  has  been  his  aim  to  render  the  work  as  complete  as 
possible,  and  to  adapt  it  particularly  to  the  necessities  of  the  American  Practitioner. 

WILLIAMS'    PATHOLOGY. 

COMPRISING 

GENERAL  PATHOLOGY  AND  THERAPEUTICS, 

AND  A  GENERAL  VIEW  OF 

ETIOLOGY.  NOSOLOGY,  SEMEIOLOGY,  DIAGNOSIS  AND  PROGNOSIS. 
BY  CHARLES  J.  B.  WILLIAMS,  M.  D.,  F.R.S., 

Fellow  of  the  Royal  College  of  Physicians,  &c. 
WITH   NOTKS  AND  AnDITIONS, 

BY  MEREDITH  CLYMER,  M.D.,  &c. 

In  one  volume,  8vo, 


WILLIAMS  AND  CLYMER  ON  THE  CHEST,  &c 

A  TREATISE  ON  THE 

DISEASES  OF  THE  RESPIRATORY  ORGANS, 

INCLTJDINO 

THE  TRACHEA,  LARYNX,  LUNGS,  AND  PLEURA. 

BY  CHARLES  J.  B.  WILLIAMS,  M.D., 
Ck)nsulting  Physician  to  the  Hospital  for  Consumption  and  Diseases  of  the  Chest  j  Author  of 

"Principles  of  Medicine,"  &c.  &c. 

WITH  NUMEROUS  ADDITIONS  AND  NOTES, 

BY  MEREDITH  CLYMER,  M.D,  &c. 

In  one  neat  octavo  volume,  with  cuts. 

This  work  recommends  itself  to  the  notice  of  the  profession  as  containing  a  more  particular  and 

detailed  account  of  the  affections  of  which  it  treats  than  perhaps  any  other  volume  before  the  public, 

"The  wood-cuts  illustrating  the  physical  exmination  of  the  che?t,  are  admirably  executed,  and  the  whole 
mechanical  execution  of  the  work  does  much  credit  to  the  publishers.  This  work  is  undoubtedly  destined  to 
take  precedence  of  all  others  yet  published  on  the  '  Respiratory  Organs,'  and  as  a  text-book  for  teachers  ami 
students,  no  better  in  the  present  slate  of  Ike  science  is  to  be  expected.'"— iVeio  York  Journal  ofMedieina. 


22  LEA  &  BLA    CHARD'S   PUBLICATIONS. 

KIRBY  &  SPENCEWS^  USE. 

AN  INTRODUCTION  TO  ENTOMOLOGY; 

OR,  ELEMENTS  OF  THE  NATURAL  HISTORY  OF  INSECTS  :  COMPRISING 

AN  ACCOUNT  OF  NOXIOUS  AND  USEFUL  INSECTS,  OF  THEIR 

METAMORPHOSES,  FOOD,  STRATAGEMS,  HABITATIONS, 

SOCIETIES,   MOTIONS,   NOISES,  HYBERNATION, 

INSTINCT,  &c.,  &c. 

With  Plates.     Plain  or  Colored. 

By  WILLIAM  KIRBY,  M.A.,  F.R.S.    And  WILLIAM  SPENCE,  Esq.,  F.R.S. 

FROM  THE  SIXTH  LONDON  EDITION. 

Which  was  Corrected  and  Considerably  Enlarged, 

In    One  Large    Octavo    Volume,    extra  doth. 

sZ^!LZl\u'^nnll''nn^TT  Stands,  is  acknowledged  to  be  the  best  extant  as  a  popular  introduclion  to  the 
r-reeabirm.rer"    f      "'         '"  T?"'  °^^"'^"1?^  =^"J   nuerestlng  information,  conveyed  in   a  simple  and 
fast  vo    ,ne^     shein!  J      '•  ''/V^'r  I'**' ^-l'^'""-  f'^™  which  tins  is  prnned,  the  authors  have  omitted   he  two 
^onof  tr^irineinles^nL  Jh''^*"  '°'"  P^P"'"/'^^- «'«!  arranged  it  as  it  now  is.  forming  a  complete  exposi 
uon  ot  the  principles  of  the  study,  unincumbered  with  Anatomical  or  scientific  details. 

has  iiot''m'',irhTe'ilr1'';^.'tt.l  """  physician  engaged  in  an  engros.itig  practice,  whether  in  town  or  country, 
whi  e  ih^few  Ire  ,h^.  perusal  Ot  hooks  unconnected  with  his  prot'ess.on;  but  we  know  just  as  well,  that 

tT,  o-ivP  tn  n  Jf.  =  I  >  "^'""^'^'1  il'  l'"S'"«s,  the  many  have  the  command  of  more  time  than  they  are  disposed 
KactT  an  vC, ,  h'  'T  "°T  "'^"^'  "■'  "'"  "°"''^  ^"^"^^'  '^>'  ""'^'>'  --^"y  >"""^  P^.vs'can,  waiting 
works  «  fhT,  ^r  ^  .?,  f  i^  ''°'"''  '^ecause  unoccupied  !  Why  not  spend  these  hours  in  the  study  of  such 
mav  find'mnt.erl«^n'=^'  ^'^.^P^nc^-f  herein  the  physiologist,  farmer,  horiiculturist.  philosopher,  and  moralist, 
may  bm\matteTtoinsiraclhm.— The  Western  Journal  of  Medicine  and  Surgery.         '^  ^       '  "^ 

r,olItruv^'^'^rr^TR  °,''*''  "^7^'  which  has  for  iriany  years  enjoyed  a  very  high  and  constantly  increasing 
and  amhen   .^  .       "■  f°?^'''^  ^  '^"""^"^  '^'^"^'^^  "P""  """"''^  ^'^i*^"'^^  '"  "^i^  Country.     It  is  a  free,  carefifi 

lhrn^^\n^urJf^u  1°''  ?  ''k  ''""i^  extensive  department  of  study,  of  which  it  treats,  and  has  done  mucli 
scienimr"  s  ,  de,  .fn^r""  Tu  ^.''^^'^h  which,  until  us  publication,  has  found  comparatively  little  favor  with  the 
scientihc  students  ot  Great  Bri  am.  The  treatise  of  Messrs.  Kirby  &  8i>e>ce  is  well  adapted,  not  only  by  its 
one  e'r°  Trf  '« l,f  ''y  "\^«>-'^<^."v'^  ^ty'^-  'o  uttroduce  the  subject  to  popular  tavor.  It  is  thrown  into  the  Ibrm 
=it,u  =?;.  1  a'"'°usl'  abounding  to  some  extent  in  scientific  terms,  it  is  divested  of  technicality  so  far  as  pos- 
verv"  n  IfrnJ,''  ^'''"y/?'"eeable  intermixture  of  anecdotes,  &c..  is  made  a  pleasant  and  entertaining,  as  well  as 
tpvLJh  J  H  "''.  important  work.     It  is  now  reprinted  from  the  sixlh  London  edition,  which  has  been 

^iven  «n„. , ?'"','"''"';  '  i'"  ^?™^  V?'  hanclsome  octavo  volume  of  about  GOO  pages.  Those  who  have  never 
rl-fuJ^L  \T  V°  ®  ^'ibJ'^ctof  which  It  treats,  will  find  embodied  in  it  an  immense  amount  of  very  iiue- 
restmgaad  useful  informatiou,  set  forth  in  an  agreeable  and  attractive  style."-iV.  Y.  Couritrand  Enquirer 


THE  CHEMISTRY 

OF  THE 

FOUR    SEASONS, 

BY  THOMAS  GRIFFITH, 

Lecturer  on  Chemistry  at  St.  Bartholomew's  Hospital,  &c.  &c. 
IN    ONE    VERY    NEAT    DUODECIMO    VOLUME. 
With  Numerous  Wood- cuts.    A  New  Work. 
The  object  of  this  little  book  is  to  show  in  a  popular  and  agreeable  manner  the  chemical  airency 
exerted  in  the  various  phenomena  of  nature.     It  forms  a  neat  volume  for  the  Centre  Table.    ° 


A  TEXT  BOOK  OF 

PRACTICAL   GEOLOGY  AND  MINERALOGY, 

WITH  INSTRUCTIONS  FOR  THE  QUALITATIVE  ANALYSIS  OF  MINERALS, 

BY  JOSHUA  TRIMMER,  F.  G.  S. 

WITH  TWO  HUNDRED  AND  TWELVE  WOOD-CUTS. 

A  handsome  octavo  volume,  bound  in  embossed  cloth. 

This  is  a  systematic  introduction  to  Mineralogy,  and  Geology,  admirably  calculated  to  instruct  the  student  in 
those  sciences.  The  organic  remains  of  the  various  formations  are  well  illustrated  by  numerous  figures,  which 
are  drawn  with  great  accuracy. 


LEA  &  BLANCHARD'S  PUBLICATIONS.  23 

GRAHAM'S    CHEMISTRY, 

THE  ELEMENTS  OF  CHEMISTRY. 

LNCLUDING  THE  APPLICATION  OF  THE  SCIENCE  TO  THE  ARTS. 

With  Numerous  Illustrations. 

BY  THOMAS  GRAHAM,  F.  R.  S.  L.  and  E.  D. 

Professor  of  Chemistry  in  University  College.  London,  &c.  (Sec. 
WITH  NOTES  AND  ADDITIONS, 

BY  ROBERT  BRIDGES,  M.  D.,  &c.  &c, 

In  One  Volume  Octavo. 

The  great  advancement  recently  made  in  all  branches  of  chemical  investigation,  renders  neces- 
sary an  enlarged  work  which  shall  clearly  elucidate  the  numerous  discoveries,  especially  in  the 
department  connected  with  organic  Chemistry  and  Physiology,  in  which  such  gigantic  strides 
have  been  made  during  the  last  few  years.  The  present  treatise  is  considered  by  eminent  judges 
to  fulfil  these  indications,  and  to  be  peculiarly  adapted  to  the  necessities  of  the  advanced  medical 
Btudent  and  practitioner.  In  adapting  it  to  the  wants  of  the  American  profession,  the  editor  has 
endeavored  to  render  his  portion  of  the  work  worthy  the  exalted  reputation  of  the  first  chemist  ot 
England.     It  is  already  introduced  in  many  of  the  Colleges,  and  has  universal  approbation. 


FOWNES'S  CHEMISTRY  FOR  STUDENTS. 

ELEMENTARY  CHEMISTRY 

THEORETICAL  AND  PRACTICAL. 


J 


By  GEORGE  FOWNES,  Ph.  D., 

Chemical  Lecturer  in  the  Middlesex  Hospital  Medical  School,  &c.  &c. 

With  Numerous  Illustrations.    Edited,  -with  Additions, 
By  ROBERT  BRIDGES,  M.  D., 

Professor  of  General  and  Pharmaceutical  Chemistry  in  the  Philadelphia  College  of  Pharmacy,  &c.&c. 
In  one  large  duodecimo  volume,  sheep  or  extra  cloth. 

The  character  of  this  work  is  such  as  to  recommend  it  to  all  colleges  in  want  of  an  elementary 
text-book,  and  to  all  practitioners  who  wish  to  place  a  compendious  manual  in  the  hands  of  their 
students.  It  is  fully  brought  up  to  the  day,  containing  all  the  late  views  and  discoveries  that  have 
so  entirely  changed  the  face  of  the  science,  and  it  is  completely  illustrated  with  very  numerous 
wood  engravings  explanatory  of  all  the  different  processes  and  forms  of  apparatus.  Though  strictly 
scientific,  it  is  written  with  great  clearness  and  simplicity  of  style,  rendering  it  easy  to  be  mastered 
by  those  commencing  the  study.     The  low  price  at  which  it  is  sold,  places  it  within  the  reach  of  all. 

Though  tfiis  work  has  been  so  recently  published,  it  has  already  been  adopted  as  a  text-book  by 
many  of  the  Medical  Institutions  throughout  the  country.  As  a  work  for  the  first  class  student,  and 
as  an  introduction  to  the  larger  systems  of  Chemistry,  such  as  Graham's,  there  has  been  but  one 
opinion  expressed  concerning  it,  and  it  may  now  he  considered  as 

THE  TEXT-BOOK  FOR  THE  CHEMICAL  STUDENT. 


SIMON'S   CHEMj^STRY  OF  MAN. 

ANIMAL    CHEMISTRY. 

WITH  REFERENCE  TO  THE  PHYSIOLOGY  &  PATHOLOGY  OF  MAN. 

BY  DR.  J.  FRANZ  SIMON. 

TRANSLATED    AND    EDITED    BY 
GEORGE  E.  DAY,  M.  A.  &  L.  M.  Cantab.,  &c. 

With  plates.    In  one  octavo  volume,  of  over  seven  hundred  pages ,  sheep,  or  in  two  parts,  boards. 
This  important  work  is  now  complete  and  may  be  had  in  one  large  octavo  volume.     Those  who 
obtained  the  first  part  can  procure  the  second  separate. 

•'  No  treatise  on  physiological  chemistry  approaches,  in  fulness  and  accuracy  of  detail,  the  work  which 
stands  at  the  head  of  this  article.  It  is  the  production  of  a  man  of  true  German  assiduity,  who  has  added  to  his 
own  researches  the  results  of  the  labors  of  nearly  every  other  inquirer  in  this  interesting!:  branch  of  science. — 
The  death  of  such  a  laborer,  which  is  mentioned  in  the  preface  to  the  work  as  having  occurred  prematurely  in 
1S12,  is  indeed  a  calamity  to  science.  He  had  hardly  reached  the  middle  term  of  life,  and  yet  had  made  himself 
known  all  over  Europe,  and  in  our  country,  where  his  name  has  been  tamiliar  for  several  years  as  among  the 

most  successful  of  the  cultivators  of  the  Chemistry  of  Man It  is  a  vast  repository  of  facts,  to  which  ite 

teacher  aud  student  may  refer  with  equal  satisfaction."— Ifte  Western  Journalof  Medicine  and  Surgeru- 


24  LEA  &  BLANCHARD'S  PUBLICATIONS. 

w  A  T  s  0  NVmFficFoFp  H  Y  S I  c. 

New  Edition  by  Condie. 

LECTURES  ON  THE 

PRINCIPLES  AND  PRACTICE  OF  PHYSIC. 

DELIVERED  AT  KINg's  COLLEGE,  LONDON. 

BY  THOMAS  WATSON,  M.  D.,  &c.  &c. 
Second  American,  from  the  Second  Londoii  Edition. 

REVISED,  WITH  ADDITIONS, 

BY  D.  FRANCIS  CONDIE,  M.  D., 
Author  of  a  work  on  the  "Diseases  of  Children,"  &c. 

In  one  Octavo  Volume, 

Of  nearly  ELEVEN  HUNDRED  Large  Pages,  strongly  hound  with  raised  bands. 

"  We  know  of  no  work  better  calculated,  for  being  placed  in  the  hands  of  the  student,  and  for  a 
text-book,  and  as  such  we  are  sure  it  will  be  very  extensively  adopted.  On  every  important  point 
the  author  seems  to  have  posted  up  his  knowledge  to  the  day." — American  Medical  Journal. 

The  rapid  sale  of  the  first  edition  of  this  work  is  an  evidence  of  its  merits,  and  of  its  general 
favor  with  the  American  practitioner.  To  commend  it  still  more  strongly  to  the  profession,  the 
publishers  have  gone  to  a  great  expense  in  preparing  this  edition  with  larger  type,  finer  paper,  and 
stronger  binding,  with  raised  bands.  It  is  edited  with  reference  particularly  to  American  practice, 
by  Dr.  Condie  ;  and  with  these  numerous  improvements,  the  price  is  still  kept  so  low  as  to  be  within 
the  reach  of  all,  and  to  render  it  among  the  cheapest  works  offered  to  the  profession.  It  has  been 
received  with  the  utmost  favor  by  the  medical  press,  both  of  this  country  and  of  England,  a  few  of 
the  notices  of  which,  together  with  a  letter  from  Professor  Chapman,  will  be  found  in  the  Supple- 
ment to  The  Medical  News  and  Library,  for  November,  1845, 


A  NEW  AND  IMPROVED  EDITION  OF 

RAMSBOTHAM'S  STANDARD  WORK  ON  PARTURITION. 

THE  PRINCIPLES  AND  PRACTICE  OF 

OBSTETRIC  MEDICINE  AND  SURGERY, 

IN  REFERENCE  TO 

THE  PROCESS  OF  PARTURITION. 

ILLUSTRATED  BY 

One  hundred  and  forty-eight  Large  Fig-ures  on  55  I^ithograpMc  Plates. 

BY  FRANCIS  H.  RAMSBOTHAM,  M.  D.,  &c. 

A  NEW  EDITION,  FROM  THE  ENLARGED  AND  REVISED  LONDON  EDITION. 
In  one  large  imperial  octavo  volume,  well  bound. 
The  present  edition  of  this  etandard  work  will  be  found  to  contain  numerous  and  important  improvemenis 
over  the  last.  Besides  much  additional  matter,  ihere  are  several  more  plates  and  wood-cuts,  and  those  which 
were  before  used  have  been  re-drawn.  This  book  has  long  been  known  lo  the  profession,  by  whom  it  has 
been  most  flatteringly  received.  A.  more  extended  advertisement,  with  a  recommendatory  letter  from  Professor 
Hodge  of  the  University  of  Pennsylvania,  may  be  seen  in  the  November  Supplement  lo  The  Medical  News. 


CONDIE    ON    CHILDREN. 

A  PRACTICAL  TREATISE  ON 

THE  'DISEASES    OF    CHILDREN, 

BY  D.  FRANCIS  CONDIE,  M.  D., 

Fellow  of  the  College  of  Physicians ;  Member  of  the  American  Philosophical  Society,  &c.  &c. 

IN  ONE  VOLUME,  OCTAVO. 
10="  The  Publishers  would  particularly  call  the  attention  of  the  Profession  to  an  examination  of  this  work. 
"Dr.  Condie,  from  the  very  groat  labor  which  he  has  evidently  bestowed  upon  this  book,  is  entitled  to  our 
respect  as  an  indefatigable  and  conscientious  student;  but  if  we  consider  the  results  of  his  labor,  we  cannot 
but  admit  his  claim  to  a  place  in  the  very  first  rank  of  eminent  writers  on  the  practice  of  medicine.     Retrard- 
iug  his  treatise  aa  a  whole,  it  is  more  complete  and  accurate  in  its  descriptions,  while  it  is  more  copious  and 
more  judicious  in  its  therapeutical  precepts  than  any  of  its  predecessors,  and  we  feel  persuaded  that  the  Ame- 
rican medical  profession  will  very  soon  regard  it,  not  only  as  a  very  good,  but  as  the  very  best  '  Praciica 
Tceatise  on  the  Diseasea  of  Children.'  "—-Am.  Med.  Journal. 


LEA   &  BLANCHARD'S  PUBLICATIONS.  25 

THE  SURGICAL  WORKS  OF  SIR  ASTLEY  COOPER. 

LEA  &  BLANCHARD  have  how  completed  the  last  volume  of  the  illustrated  works  of  Sir  Aslley  Cooper. 
They  form  an  elegant  series;  the  works  on  Hernia,  the  Testis,  the  Thymus  Gland  and  the  Breast,  being  printed, 
illustrated  and  bound  to  match,  in  imperial  octavo  with  numerous  LITHOGRAPHIC  PLATES,  while  the 
Treatise  on  Dislocations  is  in  a  neat  medium  octavo  form,  with  NUMEROUS  WOODCUTS  similar  to  the 
last  London  edition. 

SIR  ASTLEY  COOPER  OU  HERNIA, 

With  One  Hundred  and  Thirty  Figures  in  Liltiography» 

—  > 

THE  ANATOMY  AND  SURGICAL  TREATMENT  OF 

ABDOMINAL    HERNIA. 

By  Sir  ASTLEY  COOPER,  Bart. 

Edited  by  C.  Aston  Key,  Surgeon  to  Guy's  Hospital,  &c. 

This  important  work  of  Sir  Astley  is  printed  from  the  authorized  second  edition,  published  in  London,  in  large 
super-royal  folio,  and  edited  by  his  nephew,  Professor  Key.  It  contains  all  the  Plates  and  all  the  Letterpress- 
there  are  no  omissions,  mterfolaiioiis,  or  modifications— it   s  the  complete  work  in 

One  Liarge  Imperial  Octavo  "Volume. 
With  over  130  Figures  on  26  Plates,  and  over  400  Large  Pages  of  Letterpress. 
The  correctness  of  the  Plates  is  guaranteed  by  a  revision  and  close  examination  under  the  eye  of  a  distin- 
guished Surgeon  of  this  city. 

ANOTHER  VOLUME  OF  THE  SERIES  CONTAINS  HIS  TREATISE 

ON  THE  STRUCTURE  AND  DISEASES  6F  IM  TESTIS. 

Illustrated  by  uO  Figures.     From  the  Second  London  Edition. 
BY  BKANSBY  B.  cooper,  ESQ. 

AND  ALSO  ON  THE  ANATOMY  OF  THE  THYMUS  GLAND. 

Illustrated  by  57  Figures. 

The  two  works  together  in  one  beautiful  imperial  octavo  volume,  illustrated  with  twenty-nine  plates  in  the 
best  style  of  lithography,  and  printed  and  bound  to  match. 

The  Series  is  concluded  by 

COOPER  ON  THE 

ANATOMY  AND  DISEASES  OF  THE  BREAST,  &o., 

This  larcre  and  beautiful  volume  contains  THE  ANATOMY  OF  THE  BREAST; 

THE  COMPARATIYE  ANATOMY  OF  THE  MAMMARY  GLANDS; 

ILLUSTRATIONS  OF  THE  DISEASES  OF  THE  BREAST; 

'And  Twenty-five  Miscellaneous  Surgical  Papers,  now  first  published  in  a  collected  form. 

By  Sir  ASTLEY  COOPER,  Bart.,  F.R.  S.,  &c. 

The  whole  in  one  large  imperial  octave  volume,  illustrated  with  tw  i  hundred  and  fifty-two  figures  on 
thirty  six  Lithographic  Plates;  well  and  strongly  bound. 

COOPER  ON  FRACTURES  AND  DISLOCATIONS, 

WITH  NUMEROUS  WOOD-CUTS. 

A  TREATISE  ON  DISIOGATIQNS  AND  FRACTURES  OF  THE  JOINTS. 

By  Sir  ASTLEY  COOPER,  Bart.,  F.  R.  S.,  Sergeant  Surgeon  to  the  King,  &c. 

A  NEW  EDITION  MUCH  ENLARGED  ; 

Edited  by  BRANSBY  COOPER,  F.  R.  S.,  Surgeon  to  Guy's  Hospital. 

WITH  ADDITIONAL  OBSERVATIONS  FROM 

Professor  JOHN  C.  WARREN,  of  Boston. 
With  numerous  engravings  on  wood,  after  designs  by  Bagg,  a  memoir  and  a  splendid  portrait  of  Sir 

Astley.    Li  one  octavo  volume. 

The  peculiar  value  of  this,  as  of  all  "f  .^ir  Astljey  Cooper's  works,  consists  in  its  eminently  practical  charac- 
ter. His  nephew,  Bransby  B.  Cooper,  from  his  own  experience,  has  added  a  number  of  cases.  Besides  this, 
Sir' As' lev  left  behind  him  very  cimsiderable  additions  in  M.S.  for  the  express  purpose  of  being  introduced  into 
this  edition'  The  volume  is  embellished  with  ONE  HUNDRED  AND  THIKTY-THREE  WOODCUTS, 
and  contains  the  history  of  no  less  than  three  hundred  and  sixty-one  casf s,  thus  embodying  the  records  of  a 
lifeof  practice  of  the  Author  and  his  various  editors.  There  are  also  additinnal  Observations  from  notes  fur- 
Dished  by  John  C.  Warren,  M.  D.,  the  Professor  of  Anatomy  and  Surgery  in  Harvard  University. 

"  After  ihe  fiat  of  the  profession,  it  would  be  absurd  in  us  to  eulogize  Sir  Aslley  Cooper's  Work  on  Fractures 
and  Dislocations.  It  is  a  national  one,  and  will  probably  subsist  as  long  as  English  Surgery,' -Medico-Chi- 
rurs'cal  Review. 


y 


26  LEA  &  BLANCHARD'S  PUBLICATIONS. 

A  NEW  MEDICAL  DICTIONARY, 
In  one  Volume,  large  12mo.,  now  ready,  at  a  low  price. 

A  DICTIONARY  OF 

THE  TERMS  USED  IN  MEDICINE 

AND 

THE  COLLATERAL  SCIENCES; 
By   RICHARD   D.    HOBLYN,   A.M.,    Oxon. 

FIRST  AMERICAN,  FROM  THE  SECOND  LONDON    EDITION. 

REVISED,  WITH  NUMEROUS  ADDITIONS, 

By    ISAAC    HAYS,    M.D., 

Editor  of  the  American  Journal  of  the  Medical  Sciences. 

Believing  that  a  work  of  this  kind  would  be  useful  to  the  profession  in  this  country,  the  publishers 
have  issued  an  edition  in  a  neat  form  for  the  office  table,  at  a  low  price.  Its  object  is  to  serve  aa 
an  introduction  to  the  larger  and  more  elaborate  Dictionaries,  and  to  assist  J^he  student  commencing 
the  study  of  Medicine,  by  presenting  in  a  concise  form  an  explanation  of  the  terms  most  used  in 
Medicine  and  the  Collateral  Sciences,  by  giving  the  etymology  and  definition  in  a  manner  as  simple 
and  clear  as  possible,  without  going  into  details  ;  and  bringing  up  the  work  to  the  present  time  by 
including  the  numerous  terms  lately  introduced.  This  design  the  author  has  so  ably  .executed  as 
to  elicit  the  highest  encomiums  of  the  medical  press. 

It  has  been  edited  with  especial  reference  to  the  wants  of  the  American  practitioner,  the  native 
medicinal  plants  being  introduced,  with  the  formula;  for  the  various  officinal  preparations  :  and  the 
whole  being  made  to  conform  to  the  Pharmacopceia  of  the  United  States.  It  is  now  ready  in  one 
neat  royal  duodecimo  volume  of  four  hundred  pages  in  double  columns. 


TAYLOR'S  MEDICAL  JURISPRUDENCE. 

MEDICAL    JURISPRUDENCE. 

.  By  ALFRED  S.  TAYLOR, 

Lecturer  on  Medical  Jurisprudence  and  Chemistry  at  Guy's  Hospital,  &c. 
With  Numerous  Notes  and  Additions,  and  references  to  American  Practice  and  Law. 

Br  R.  E.  GRIFFITH,  M.  D. 
In  one  volume,  8vo. 

"  We  rpcommend  Mr.  Taylor's  work  as  the  ablest,  most  comprehensive,  and,  above  all,  the  m  'st  practically 
useful  book  which  exists  on  the  subject  of  lecal  medicine.  Any  man  of  sound  judgment,  who  has  mastered 
the  contents  of  Taylor's  '  Medical  Jurisprudence,'  may  go  into  a  courlof  law  with  the  most  perfect  confidence 
of  bein?  able  to  acquit  h\mse\{ creditably. "—Medico-Ckirurgical  Review. 

"  As  we  expected,  it  has  become  truly  the  manual  of  both  the  medical  and  legal  professions, 
and  is  regarded  by  all  as  the  standard  authority  on  the  subject;  the  autlior,  also,  as  we  find  from 
the  public  prints,  is  the  person  consulted,  almost  as  a  matter  of  course,  in  the  more  difficult  medico- 
legal cases. — The  British  and  Foreign  Medical  Review. 


LAWRENCE  ON  THE  EYE.    New  Edition— Now  Ready. 

A  TREATISE  ON  THE  DISEASES  OF  THE  EYE. 

BY  W.  LAWRENCE,  F.  R.  S., 

Surgeon  Extraordinary  to  the  Queen,  Surgeon  to  St.  Bartholomew's  Hospital,  &c.  &c. 

SECOND  AMERICAN,  FROM  THE  LAST  LONDON  EDITION, 

With  many  Modifications  and  Additions,  and  the  I/itnoduction  of  over  one  hundred  Illustrations, 

BY  ISAAC  HAYS,  M.D., 
Surgeon  to  Will's  Hospital,  Physician  to  the  Philadelphia  Orphan  Asylum,  &.c.  &c. 

IN  ONE  LARGE  OCTAVO  VOLUME. 

The  character  of  this  work  is  too  well  known  to  require  a  word  of  commendation.  It  is  justly  considered  the 
best  we  possess  on  the  subject.  In  this  ediiiou  will  be  found  many  important  alterations  and  improvements, 
bringing  the  work  up  to  the  level  of  the  present  state  of  knowledge  on  the  subjects  of  Ophthalmic  f^urgery  and 
Practice.  The  chapters  on  the  Anatomy  and  Physiology  of  the  Organ  have  received  especial  augmentations, 
and  many  new  cuts  have  been  introduced,  rendering  the  whole  clear  and  comprehensible. 


LEA   &  BLANCHARD'S   PUBLICATIONS.  27 

MILLER'S   SURGICAL  WORKS. 

THE  PRINCaPLES  OF  SURGERY. 

BY  JAMES  MILLER,  F.  R.  S.E.,  F.R.  C.S.E., 

Professor  of  Surgery  in  the  University  of  E'linburgh,  &c. 
In  one  neat  octavo  volume,  to  match  the  Author -s  volume  on  "  Practice.'" 

"  No  one  can  peruse  this  work  without  the  conviction  that  he  has  been  addressed  by  an  accom- 
plished surgeon,  endowed  with  no  mean  literary  skill  or  doubtful  good  sense,  and  who  knows  how 
to  grace  or  illumine  his  subjects  with  the  later  lights  of  our  rapidly  advancing  physiology.  The 
book  deserves  a  strong  recommendation,  and  must  secure  itself  a  general  perusal." — Medical  Times. 

"  We  feel  no  hesitation  in  expressing  our  opinion  that  it  presents  the  philosophy  of  the  science 
more  fully  and  clearly  than  any  other  work  in  the  language  with  which  we  are  acquainted." — Phi- 
ladelphia Medical  Examiner . 

"  To  the  student  who  wishes  to  acquire  a  useful  practical  knowledge  of  the  pathology  of  sur- 
gical diseases,  it  is  impossible  to  recommend  abetter  guide  than  the  present  treatise  by'^Mr.  Mil- 
ler."— Edinburgh  Medical  and  Surgical  Journal. 

"An  admirable  epitome  of  the  surgical  science  of  the  day.  Being  written  by  a  sound  practical 
surgeon  accustomed  to  the  public  teaching  of  his  science,  it  has  the  clearness  of  diction  and  ar- 
rangement which  renders  it  an  excellent  manual  for  the  students  as  well  as  that  amount  of  scien- 
tific and  practical  information  which  makes  it  a  safe  and  valuable  guide  to  the  practitioner."— TAe 
Lancet. 


JUST   PUBLISHED. 

THE  PRACTICE  OF  SURGERY. 

BY  JAMES  MILLER. 

Professor  of  Surgery  in  the  University  of  Edinburgh. 

In  one  neat  octavo  volume. 

This  work  is  printed  and  bound  to  match  the  "  Principles  of  Surgery,"  by  Professor  Miller  lately 
issued  by  L.  &  B.     Either  volume  may  be  had  separately.  ' 

"  This  work,  with  the  preceding  one,  forms  a  complete  text-book  of  surgery,  and  has  been  under- 
taken by  the  author  at  the  request  of  his  pupils.  Although,  as  we  are  modestly  informed  in  the 
preface,  it  is  not  put  forth  in  rivalry  of  the  excellent  works  on  practical  surgery  which  already  exist, 
we  think  we  may  take  upon  ourselves  to  say,  that  it  will  form  a  very  successful  and  formidable 
rival  to  most  of  them.  While  it  does  not  offer  the  same  attractive  illustrations,  with  which  some  of 
our  recent  text-books  have  been  embellished,  and  while  it  will  not,  as  indeed  is  not  its  design,  set 
aside  the  more  complete  and  elaborate  works  of  reference  which  the  profession  is  in  possession  of, 
we  have  no  hesitation  in  stating  that  the  two  volumes  form,  together,  a  more  complete  text-book 
of  surgery  than  any  one  that  has  been  heretofore  offered  to  the  student."— TAe  Northern  Journal 
qf  Medicine. 

"  Mr.  Miller  is  already  known  in  his  profession  as  an  able  writer  and  a  well  informed  surgeon, 
and  the  book  before  us  is  calculated  to  maintain  his  reputation.  We  recommend  it  to  those  who 
want  a  sound  guide,  or  wish  to  refresh  their  recollections.  The  characteristics  which  especially 
distinguish  the  work  are,  its  plain  good  sense,  or  the  selection  of  the  important  from  the  unimport- 
ant announcements  in  surgery  ;  the  sound  indications  of  the  judgment  to  be  exercised  in  the  treat- 
ment of  surgical  diseases." — The  Lancet. 

A  NEW  AND  IMPROVED  EDITION  OF 

FERGUSSON'S   OPERATIVE  SURGERY. 

A  SYSTEM  OF  PRACTICAL  SURGERY. 

BY  WILLIAM  FERGUSSON,  F.  R.  S.  E. 

SECOND  AMERICAN  EDITION,  REVISED  AND  IMPROVED. 
With  Two  Hundred  and  Fifty-two  Blustrations  from  Drawings  by  Bagg,  Engraved  by  Gilbert, 

With  Notes  and  Additional  Illustrations, 

BY   GEORGE    W.    N  ORRIS,   M.D.,&c. 

In  one  beautiful  octavo  volume  of  six  hundred  and  forty  large  pages. 

"If  we  were  to  say  that  this  volume  by  Mr.  Fergusson,  is  one  excellently  adapted  to  the  student,  and  the  yet 
inexperienced  practitioner  of  surgery,  we  should  restrict  unduly  its  range.  It  is  of  the  kind  which  every  medi- 
cal man  ought  lo  have  by  him  for  ready  reference,  as  a.  guide  to  the  prompt  treatment  of  many  accidents  and 
injuries,  which  whilst  he  hesitates,  may  be  followed  by  incurable  defects,  and  deformities  of  structure,  if  not  by 
death  itself.  In  drawing  to  a  close  our  notice  of  Mr.  Fergusson's  Practical  Surgery,  we  cannot  refrain  from 
again  adverting  to  ihe  numerous  and  beautiful  illustrations  by  wood-cuts,  which  contribute  so  admirably  to 
■elucidate  the  descriptions  in  the  text.  Dr.  Norris  has,  as  usual,  acquitted  himself  judiciously  in  ixis  otfice  of 
a.nnotator.    His  additions  are  strictly  practical  and  to  the  ^o\aV—Bulktin  of  Medical  Science. 


28  LEA  &  BLANCH ARD'S  PUBLICATIONS. 

LIBRARY    OF    SURGERY. 


CHELIUS'S  SYSTEM   OF  SURGERY. 

A  SYSTEM  OF  SURGEEY. 

By  J.  M.  CHELIUS, 

Doctor  in  Medicine  and  Surgery,  Public  Professor  of  General  and  Ophthalmic  Surgery,  etc.  etc.  in  the 

University  of  Heidelberg. 

TRANSLATED  FROM  THE  GERMAN, 
AND  ACCOMPANIED  WITH  ADDITIONAL  NOTES  AND  OBSERVATIONS, 

By  JOHN  F.  SOUTH, 

SURGEON    TO    ST.   THOMAS'S    HOSPITAL. 

EDITED,  WITH  REFERENCE  TO  AMERICAN  AUTHORITIES, 
By  GEORGE  W.  NORRIS,  M.D. 

Publishing  in  Numbers,  at  Fifty  Cents  eacH. 

Nine  Numbers  are  now  ready:  and  the  whole  is  expected  to  be  complete  by  September  next,  forming 

Three  Large  Octavo  Volumes. 

That  this  work  should  have  passed  to  six  editions  in  Germany,  and  have  been  tAnslated  into  no  less  than 
seven  languages,  is  sufficient  proof  of  its  value.  It  contains  what  is,  perhaps,  embraced  to  an  equal  extent 
by  no  other  work  on  the  subject  now  before  the  public— a  complete  System  of  Surgery,  both  in  its  principles 
and  practice.  The  additions  of  the  translator,  IVIr.  South,  are  very  numerous,  bringing  the  work  up  to  the  very 
day  of  publication,  and  embodying  whatever  may  have  been  omitted  by  the  author  respecting  English  Sur- 
gery; while  Dr.  Norris  will  lake  equal  care  in  representing  the  state  of  the  Science  in  America. 

'■Judging  from  a  single  number  only  of  this  work,  we  have  no  hesitation  in  saying  that,  if  the  remaining  por- 
tions correspond  at  all  with  the  first,  it  will  be  by  far  the  most  complete  and  scientific  System  of  Surgery  in  ths 
Knglish  language.  We  have,  indeed,  seen  no  work  which  so  nearly  comes  up  to  our  idea  of  what  such  a  pro- 
duction should  be,  both  as  a  practical  guide  and  as  a  work  of  reference,  as  this;  and  the  fact  that  it  has  passed 
through  six  editions  in  Germany,  and  been  translated  into  seven  languages,  is  sufficiently  convincing  proof  of 
its  value.  It  is  methodical  and  concise,  clear  and  accurate;  omiiting  all  minor  details  and  fruitless  speculations, 
it  gives  us  all  the  information  we  want  in  the  shortest  and  simplest  form  " —  The  New  York  Journal  of  MedicinA. 

"The  scope  of  Professor  Chelius's  Manual  is  indicated  by  its  title :  it  professes  to  treat,  systematically,  of  the 
science  and  art  of  Surgery,  but  within  such  compass  as  to  render  the  work  an  appropriate  introduction  and 
companion  to  his  lectures.  The  care,  however,  which  has  been  bestowed  upon  its  construction,  and  the  labor 
which  its  research  evinces,  would  be  ill  repaid  were  it  confined  to  this  sphere;  and  we  may  conscientiously 
say,  that  we  know  of  no  Manual  of  Surgery,  on  the  whole,  more  deserving  of  public  confidence,  or  more  vali*- 
able  as  a  guide  and  refresher  to  the  young  practitioner.  It  is  not  our  intention  at  present  critically  to  analyze 
Mr.  South's  labors;  but  we  should  be  guilty  of  an  injustice  to  him  and  to  our  readers  if  we  did  not  cordially 
recommend  his  work  as  having  fair  promise  of  forming,  what  it  is  the  translator's  ambition  it  should  be,  a  sound 
and  comprehensive  system  of  Practical  Surgery.  The  notes  and  text  are  so  intermingled  as  to  render  it  coit- 
tinuously  readable,  without  presenting  those  abrupt  transitions  which  are  so  disagreeable  in  many  viorks  simi- 
larly arranged.  The  faults  of  omission  &c.,  at  which  we  have  hinted  in  our  comments  on  the  first  chapter  of 
our  author's  work,  (viz.  that  on  'Inflammation')  have  been  amply  compensated  by  the  copious  and  excellent 
digest  of  his  translator  and  annotalor  who  is  justly  proud  of  availing  himself  of  the  labors  of  our  own  coun- 
trymen in  this  department  of  pathology,  while  he  gives  their  due  meed  of  notice  and  respect  to  the  contributions 
of  our  continental  brethren.  The  references  which  are  given  to  original  works  have  evidently  been  carefully 
collated,  and  will  be  found  of  great  value  lo  ihe  student  and  practitioner  who  may  wish  lor  more  copious  in- 
formation on  any  particular  branch  of  Surgery;  and  the  practical  remarks  and  illustrations  with  which  the 
work  abounds,  are  a  good  guarantee  of  the  translator's  ability  lo  do  justice  to  his  task,  at  the  same  time  that 
they  prove  that  Mr.  South  has  not  failed  to  avail  himself  industriously  of  the  large  opportunities  which  his  Hos- 
pital appointment  has  afforded  him." — T/te  British  and  Foreign  Medical  Review. 

"  We  will,  therefore,  content  ourselves  for  the  present  with  directing  the  attention  of  the  profession  to  it,  as 
being  the  most  complete  system  of  Surgery  in  any  language,  and  one  that  is  of  equal  utility  as  a  practical  guide 
and  as  a  work  of  reference.  The  fact  of  ils  having  reached  six  editions  in  Germany,  and  its  having  been  irsns- 
lated  into  seven  languages, .are  more  convincing  proofs  of  its  value  ilian  anything  that  we  can  say.  Mr.  South 
has  performed  his  task  with  much  judgment,  and  has  certainly  made  a  most  useful  addition  to  the  medical  lite- 
rature of  this  country  by  rendering  Chelius's  work  into  English  " — The  Lancet. 

"This  work  has  long  been  the  chief  texi-book  on  Surgery  in  the  principal  schools  of  Germany,  and  the  pub- 
lication of  five  editions  of  it  in  the  original  and  of  translations  into  no  less  than  eight  foreign  languages,  show 
the  high  estimation  in  which  it  is  held.  As  a  sysiemalic  work  on  Surgery  it  has  merits  of  a  high  order.  It  is 
methodical  and  concise— and  on  the  whole  clear  and  aeeurate.  The  most  necessary  information  is  conveyed 
in  the  shortest  and  simplest  form.  Minor  details  and  fruitless  speculations  are  avoided.  It  is,  in  fact,  essen- 
tially a  practical  book.  This  work  was  first  published  nearly  twenty  years  ago.  and  its  solid  and  permanent 
reputation  has  no  doubt  led  Mr.  S^outli  to  undertake  ihe  present  translation  of  the  latest  edition  of  it.  which,  w« 
are  informed,  is  still  passing  through  ihe  press  in  (lermany.  Wn  should  have  felt  at  a  loss  to  select  any  one 
better  qualified  for  the  task  than  the  translaior  of  Otto's  Compendium  of  Human  and  Comparative  Pathological 
Anatomy — a  surgeon  to  a  large  hospital,  whose  induisiry  and  opporiunities  have  enabled  him  to  keep  pace  with 
the  improvements  of  his  time." — The  Medico-Chirurgical  Recie^v. 

"Although  Great  Britain  can  boast  of  some  of  the  most  skilful  surgeons,  both  among  her  past  and  her  present 
professorsof  that  branch  of  medical  science,  no  vi'ork  professing  to  be  a  complete  system  of  Surgery  has  beea 
published  in  the  British  dominions  since  that  of  Benjamin  Bell,  now  more  than  half  a  century  old. 

"This  omission  in  English  medical  literature  is  fully  ami  saiisfactorily  .supplied  by  the  translation  of  Professor 
Chelius's  System  of  Surgery  by  a  gentleman  excellently  fitted  for  ihe  task,  both  by  his  extensive  reading,  and 
the  opportunities  of  practical  experience  which  he  has  enjoyed  for  years  as  surgeon-  to  one  of  our  largest  me- 
tropolitan hospitals.  The  fact  of  Professor  Chelius's  work  having  been  translated  into  seven  languages  is  suf- 
ficient proof  of  the  estimation  in  which  it  is  held  by  our  continental  brethren,  and  the  English  edition,  now  in 
•ourse  of  publication,  loses  none  of  the  value  of  ihe  original  from  the  treatment  received  at  the  hands  of  its 
translator.  The  notes  and  additions  of  Professor  South  are  numerous,  and  contain  the  opinions  resulting  from 
his  vast  experience,  and  from  that  of  his  colleague. 

"  We  are  free  to  confess,  prejudiced  though  perhaps  we  are,  in  favor  of  the  English  practice  of  surgery,  that 
ftis  work  is  one  of  great  value,  and  one  which  every  practitioner  and  advanced  student  should  possess." — The 
Medical  Tiines. 


W  O  R  K  S 


IN 


VARIOUS  DEPARTMENTS 


OF 


MEDICINE  AND  SURGERY, 

PUBLISHED 

BY  LEA  &  BLANCHARD. 


AMERICAN  JOURNAL  OF  THE  MEDICAL  SCIENCES,    Edited  by  Isaac  Hays,  M.  D. 

Published  quarterly  at  $5  00  per  annum. 

ANDRAL  ON  THE  BLOOD.  Pathological  Haematology  ;  an  Essay  on  the  Blood  in  Dis- 
ease.    Translated  by  J.  F.  Meigs  and  Alfred  Stille.     In  one  octavo  volume,  cloth. 

ARNOTT'S  PHYSICS.  The  Elements  of  Physics  in  plain  or  non-technical  language.  A 
New  Edition.     Edited  by  Isaac  Hays,  M.  D.     In  1  vol.  8vo.,  sheep,  with  176  wood-cuts. 

ABERCROMBIE  ON  THE  STOMACH.  Pathological  and  Practical  Researches  on  Dis- 
eases  of  the  Stomach,  Intestinal  Canal,  &c.     Fourth  Edition.     In  1  vol.  8vo.,  sheep. 

ABERCROMBIE  ON  THE  BRAIN.  Pathological  and  Practical  Researches  on  the  Dis- 
eases of  the  Brain  and  Spinal  Cord.     A  New  Edition.     In  one  octavo  volume,  sheep. 

ALISON'S  PATHOLOGY.  Outlines  of  Pathology  and  Practice  of  Medicine.  In  three 
parts,  containing  Preliminary  Observations,  Inflammatory  and  Febrile  Diseases,  and 
Chronic  or  Non-Febrile  Diseases.     In  one  neat  octavo  volume,  sheep. 

BIRD  ON  URINARY  DEPOSITS,  Urinary  Deposits,  their  Diagnosis,  Pathology  and  The- 
rapeutical Indications.     In  one  neat  octavo  volume,  cloth,  with  numerous  wood-cuts. 

BERZELIUS  ON  THE  KIDNEYS  AND  URINE,  in  1  vol.  8vo.,  cloth. 

BUCKLAND'S  GEOLOGY.  Geology  and  Mineralogy,  with  reference  to  Natural  Theology. 
A  Bridgewater  Treatise.     In  two  octavo  volumes,  with  numerous  maps,  plates,  &c. 

BRIDGEWATER  TREATISES.  The  whole  complete  in  7  vols.  8vo.,  containing  Roget's 
Animal  and  Vegetable  Physiology,  in  2  vols.,  with  many  cuts;  Kirby  on  the  History, 
Habits  and  Instinct  of  Animals,  1  vol.  with  plates ;  Prout  on  Chemistry  ;  Chalmers  on  the 
Moral  Condition  of  Man  ;  Whewell  on  Astronomy  ;  Bell  on  the  Hand  ;  Kidd  on  the  Phy- 
sical Condition  of  Man;  and  Buckland's  Geology,  3  vols.,  with  many  plates  and  maps. 

BARTLETT  ON  FEVERS  OF  U.  S.  The  History,  Diagnosis  and  Treatment  of  Typhus 
and  Typhoid  Fevers,  and  on  Bilious  Remittent  and  Yellow  Fever.  In  1  vol.  8vo.,  ex.  cloth. 

BARTLETT'S  PHILOSOPHY  OF  MEDICINE.  Essay  on  the  Philosophy  of  Medical 
Science.     In  two  Parts.     One  neat  octavo  volume,  extra  cloth. 

BRIGHAM  ON  MIND,  &c.  The  Influence  of  Mental  Excitement  and  Mental  Cultivation 
on  Health.     In  one  neat  12mo.  volume,  extra  cloth, 

BILLING'S  PRINCIPLES  OF  MEDICINE.  The  Fust  Principles  of  Medicine.  From  the 
Fourth  liondon  Edition.     In  one  octavo  volume,  cloth. 

CHITTY'S  MEDICAL  JURISPRUDENCE.  A  Practical  Treatise  on  Medical  Jurispru- 
dence.    With  Explanatory  Plates.     In  one  octavo  volume,  sheep. 

CLATER  AND  SKINNER'S  FARRIER.  Every  Man  his  own  Farrier.  Containing,  the 
Causes,  Symptoms,  and  most  approved  Methods  of  Cure  of  the  Diseases  of  Horses. — 
From  the  28th  London  Edition.     Edited  by  Skinner.     In  one  12mo.  volume,  cloth. 

CLATER  AND  YOUATT'S  CATTLE  DOCTOR.  Every  Man  his  own  Cattle  Doctor.— 
Containing  the  Diseases  of  Oxen,  Sheep,  Swine,  &c.  Edited  by  Youatt,  and  revised  by 
Skinner.     With  Wood-cuts.     In  one  volume  12mo. 

DURLACHER  ON  CORNS,  BUNIONS,  &c.  A  Treatise  on  Corns,  Bunions,  the  Dis- 
eases of  Nails,  and  the  General  Management  of  the  Feet.     In  one  12mo.  volume,  cloth. 

ELLIOTSON'S  MESMERIC  CASES.     In  one  octavo  pamphlet. 

ESQUIROL  ON  INSANITY.  Mental  Maladies,  Considered  in  Relation  to  Medicine,  Hy- 
giene and  Medical  Jurisprudence.     Translated  bv  E.  K.  Hunt,  M.  D.,  &c.     In  1  vol.  8vo. 

GUTHRIE  ON  THE  BLADDER,  &c.  The  Anatomy  of  the  Bladder  and  Urethra,  and 
the  Treatment  of  the  Obstructions  to  which  those  passages  are  liable.     In  I  vol.  8vo. 

HARRIS  ON  MAXILLARY  SINUS.  Dissertation  on  the  Diseases  of  the  Maxillary  Sinus. 
In  one  small  octavo  volume,  cloth. 

29 


30 


LEA   &  BLANCHARD'S   PUBLICATIONS. 


KIRBY  ON  ANIMALS.  The  History,  Habits  and  Instinct  of  Animals.  A  Bridgewater 
Treatise.     In  one  large  volume  8vo.  with  plates. 

HARRISON  ON  THE  NERVES.  An  Essay  towards  a  correct  Theory  of  the  Nervous 
System.     In  one  octavo  volume,  sheep. 

LAWRENCE  ON  RUPTURES.  A  Treatise  on  Ruptures,  from  the  fifth  London  Edition. 
In  one  octavo  volume,  sheep. 

MAURY'S  DENTAL  SURGERY.  A  Treatise  on  the  Dental  Art,  founded  on  Actual  Ex- 
perience.  Illustrated  by  241  Lithographic  Figures  and  54  Wood-cuts.  Translated  by 
J.  B.  Savier.     In  one  octavo  volume,  sheep. 

MULLER'S  PHYSIOLOGY.  Elements  of  Physiology,  Translated  by  Wm.  Baly,  M.D., 
and  edited  and  arranged  bv  John  Bell,  M.  D.     In  one  large  octavo  volume,  sheep. 

PROUT  ON  THE  STOMACH.  On  the  Nature  and  Treatment  of  Stomach  and  Renal 
Diseases.     In  one  octavo  volume,  sheep,  with  colored  plates. 

POPULAR  MEDICINE,  BY  COATES.     In  one  octavo  volume,  sheep,  with  Wood-cuts. 

PHILIP  ON  INDIGESTION.     A  Treatise  on  Protracted  Indigestion.     In  1  vol.  8vo. 

ROGET'S  PHYSIOLOGY.  A  Treatise  on  Animal  and  Vegetable  Physiology,  with  over 
400  illustrations  on  Wood.     In  two  octavo  volumes,  cloth.     A  Bridgewater  Treatise. 

ROGET'S  OUTLINES  OF  PHYSIOLOGY.  Outlines  of  Physiology  and  Phrenology.  In 
one  large  octavo  volume,  cloth. 

RIGBY'S  MIDVVIFERY.     A  System  of  Midwifery.     With  Wood-cuts.     In  1  vol.  8vo. 

KICORD  ON  VENEREAL.  A  Practical  Treatise  on  Venereal  Diseases;  with  a  Thera- 
peutical Summary,  and  a  Special  Formulary.     In  I  vol.  8vo.,  cloth. 

KOBER  rSON  ON  TEETH.  A  Practical  Treatise  on  the  Human  Teeth,  with  plates.  One 
small  volume  octavo,  cloth. 

TRAILL'S  MEDICAL  JURISPRUDENCE.  Outlines  of  a  Course  of  Lectures  on  Medi- 
cal  Jurisprudence.     Revised,  with   numerous  notes.     In  one  octavo  volume,  cloth. 

THOMSON'S  SICK  ROOM.  Domestic  Management  of  the  Sick  Room,  Necessary  in  Aid 
of  Medical  Treatment,  for  the  Cure  of  Diseases.  Edited  by  R.E.Griffith,  M.D.  In  one 
large  royal  12mo.  volume,  extra  cloth,  with  Wood-cuts. 

WALSHE  ON  THE  LUNGS.  Physical  Diagnosis  of  the  Diseases  of  the  Lungs.  In 
one  neat  12mo.  volume,  extra  cloth. 

YOUATT  ON  THE  HORSE.  The  Horse:  containing  a  full  account  of  the  Diseases  of 
the  Horse,  with  their  mode  of  Treatment;  his  Anatomy,  and  the  usual  Operations  per- 
formed on  him;  his  Breeding,  Breaking,  and  Management;  and  Hints  on  his  Sound- 
ness, and  Purchase  and  Sale.  Together  with  a  General  History  of  the  Horse  ;  a  Dis- 
sertation on  the  American  Trotting  Horse,  how  trained  and  jockeyed,  an  account  of  his 
remarkable  performances;  and  an  Essay  on  the  Ass  and  the  Mule.  By  J.  S.  Skinner, 
Assistant  Postmaster  General,  and  Editor  of  the  Turf  Register.  In  one  volume,  octavo, 
••with  numerous  Cuts. 


MSniC^l,   W^ORKS,  at  JPresa  and  Preparing: 


A  MANUAL  OF  MATERIA  MEDICA  AND 
Therapeutics.  By  J.  Forbes  Royle,  M.  D.,&c. 
Edited  by  J.  Carson,  M.  D.,  &c.  In  1  vol.  Svc, 
numerous  wood-cuts,  [nearly  ready). 

TODD  &  BOWMAN'S  PHYSIOLOGICAL  ANA- 
tomy  and  Physiology  ol'Man.  Many  wood-cuts, 
{publishing  in  the  Medical  News  and  Library). 

A  TREATISE  ON  OPHTHALMIC  MEDICINE 
and  Surgery.  By  T.  Wharton  Jones.  In  1  vol. 
beautifully  illustrated. 

PRINCIPLES  OF  GENERAL  AND  COMPA- 
rative  Physiology.  By  Wm.  B.  Carpenter, 
M.  D.,&c.  From  a  new  London  edition,  with 
numerous  improvements  and  additions.  In  1 
vol.  large  8vo.,  many  steel  plates. 

A  TREATISE  ON  ANIMAL  PHYSIOLOGY, 
with  very  numerous  illustrations.  By  Wm.  B. 
Carpenter. — To  be  tbllowed  by  his  other  works 
on  Natural  Science. 

A  NEW  AMERICAN  FORMULARY.  By  J. 
Carson,  M.  D.,  &c.  In  one  volume,  {preparing). 

A  SYSTEM  OF  SURGERY.  By  J.  M.CIielius. 
Translated  by  South,  and  Edited  by  Norris. — 
Publishing  in  numbers  at  50  cents  each.  To 
be  complete  in  three  octavo  volumes. 

HORNER'S  AMERICAN  DISSECTOR,  in  one 
large  12mo.  vol.,  with  many  cuts,  {nearly  ready.) 


AN  ANATOMICAL  DESCRIPTION  OF  THE 
Diseases  of  the  Organs  of  Circulation  and  Re- 
spiration. By  C.  E.  Hasse.  Translated  and 
Edited  by  W.  E.  Swaine,  M  D.,  &c.  In  1  vol. 
8vo.,  {nearly  ready). 

A  TREATISE  ON  AURAL  SURGERY.  In  1 
vol.  Svc,  many  illustrations. 

A  COMPLETE  MEDICAL  BOTANY,  especially 
adapted  to  the  United  States.  By  R.  E.  Grif- 
fith, M.  D.  In  1  vol.  large  8vo.,  with  many 
illustrations. 

LECTURES  ILLUSTRATIVE  OF  VARIOUS 
Subjects  in  Pathology  and  Surgery.  By  Sir  B. 
Brodie — completing  his  works. 

CALORIC,  its  Mechanical,  Chemical,  and  Vital 
Agencies  in  the  Phenomena  of  Nature.  By  S. 
L.  Metcalfe,  M.  D.,  &c.     In  1  large  8vo.  vol. 

GOLDING  BIRD'S  ELEMENTS  OF  NATU- 
RAL PHILOSOPHY.  With  numerous  wood- 
cuts. 

VOGEL'S  PATHOLOGICAL  ANATOMY.— 
Translated  and  Edited  by  G.  Day,  M.  D.,  &c. 
In  1  vol.  large  8vo.,  many  plates. 

BURROWS  ON  CEREBRAL  CIRCULATION, 
with  plates. 

Togcllur  with  other  yVew  n*ark8. 


LEA  &   BLANCHARD'S   PUBLICATIONS.  31 

(See  Page  33.) 

THE  yEDiCO-OHlRURGIGAL  REVIEW, 

EDINBURGH  MEDICAL  AND  SURGICAL  JOURNAL, 

AND   NUMEROUS  OTHERS. 

WHILE  FROM  FRANCE 

THE  GAZETTE   MEDICALE   DE  PAKIS— L'EXPERIENCE— BEVUE  MEDICALE 
—JOURNAL   DE   MEDECINE— JOUKNAL   DES    CONNAISSANCES 
MEDICO-CHIRURGICALES,   " 

AND  VARIOUS  OTHERS,  WITH  THE 

ZEITSCHRIFT  FUR  DIE  GESAMMTE  MEDICIN, 

WITH  SEVERAL  OTHERS  FROM  GERMANY, 

AND  THE  BIBLTOTHEK  FOR  L^GER,  OF   DENMARK, 

TOGETHER  WITH 

Alii  THS  ATflSERICAST  JOUHSJALS, 

ARE  PUT  IN  REQUISITION. 
It  will  thus  be  seen  that  the  material  for  a  full  Summary  of  all 

NEW  MATTERS  AND   LMPORTANT  DISCOVERIES 

is  full  and  ample,  while  the  exertions  of  the  Editor  and  the  time  of  publication  insure  a  fulness 

and  newness  to  this  department. 

ALL  THE  LATE  AND  IMPORTANT 

AIVIERICAN  IISSTELLIGEF^CE, 

is  fully  recorded — while 

TME   ]?I0.1JTIII.Y  rHEll^S 

furnishes  the  lighter  and  floating  information,  and  embraces  important  Books  for 

THE  LIBRARY  DEPART M.EHT. 


Among  those  works  already  published  in  the  Monthlrj  Library  and  News,  may  be  mentioned 

WATSON'S  LECTURES  ON  THE  PRAGTIGE  OF  PHYSIC, 

AS  ALSO 

BRODIE'S    LECTURES    ON    SURGERY, 

CONCLUDED  IN  MARCH  OF  THIS  YEAR,  (1846). 
The  work  for   the   year    184G   is  a  new   orie, 

TODD  &  BOWMAN'S 

PHYSIOLOGICAL  ANATOMY  &  PHYSIOLOGY  OF  MAN. 

NOW    PUBLISHING   IN  ENGLAND. 

This  work  has  already  earned  for  its  authors  a  high  reputation  in  Europe  and  this 
country.     It  will  be  reproduced  entire,  with  all  the  numerous  and  beautiful  wood-cuts. 
Each  Work  in  the  Library  is  regularly  paged  so  as  to  be  bound  separately. 

THE  TERIWS  ARE 

For  the  Medical  Journal  and  the  Medical  News,  if  paid  for  by 
the  firsl  of  February  of  each  Year,  and  the  amount  remitted 
free  of  cost  to  the  Publishers,       .         .         .         -         -     Five  Dollars. 

For  the  Journal  only,  when  ordered  without  funds,  or  paid  for 

after  the  first  of  February  of  each  year,  .         -         -     Five  Dollars. 

For  the  Medical  News  only,  to  be  paid  for  always  in  advance, 

and  free  of  postage,    --------  One  Dollar. 

i^  In  no  case  can  the  News  be  sent  without  pay  in  advance.  =^ 


32  TWO  MEDICAL  PERIODICALS  FOR   FIVE   DOLLARS   A   YEAR. 

rn   TT   "C* 

AMERICAN  JOURNAL  OF  THE  MEDICAL  SCIENCES, 

Edited  by  ISAAC  HAYS,  M.  D. 

SURGEON  TO  WILLS'  HOSPITAL,  ETC. 

Published  Quarterly  on  the  first  of  January,  April,  July  and  October  ;  each  Number  having  at  least 

264  large  and  closely  printed  pages. 

WHEN    NECESSARY,    CASES    ARE 
Fully  Illustrated  with  lilTHOGRAPHIC  PLATES  and  WOOD-CUTS. 

ALSO, 

Sl)e  illelrical  5Ieu)6  anJr  Cibrarg, 

Of  32  Large  Pages,  Published  Monthly,  is  given  Gratis  to  Subscribers 

to  The  Journal  who  pay,  by  the  first  of  February  of  each  year,  Five  Dollars  free  of  expense  to  the 

Publishers. 

Under  the  new  law  the  postage  on  the  Journal  is  reduced  to  about  13^  cents  per  number,  while 
the  News  and  Library  is  sent  through  the  mail  as  a  Newspaper. 

Persons  wishing  to  subscribe,  to  commence  with  the  January  number  for  1847,  should  advise  the 
publishers  at  once,  as  the  whole  quantity  for  the  present  and  two  past  years  was  taken  up  early 
in  the  year. 


The  publishers  do  not  deem  it  necessary  to  refer  to  the  past  course  of  the  Journal.  It  is  suffi- 
cient that  for  the  last  TWENTY-SEVEN  YEARS  it  has  received  the  approbation  of  the  profession 
at  home  and  abroad  ;  but  they  would  call  attention  to  the  extended  and  liberal  arrangement  exist- 
ing and  to  be  pursued  that  shall  embody  the  latest  intelligence  from  all  quarters. 

ITS  PAGES  WILL  BE  DEVOTED  FIRST  TO 

ORIGINAL    COMMUNICATIONS 

FROM  ALL  SECTIONS  OF  THE  UNION,  WITH 

REVIEWS  OF  ALL  NEW  WORKS 

OF  INTEREST,  AND 

While  its  QUARTERLY  SUMMARY  will  embrace  a  full  and  extended 

RETROSPECT  AND  ABSTRACT 

FROM  THE  VARIOUS 

FOREIGN  AND  DOMESTIC  JOURNALS. 

With  reference  to  this  department,  the  arrangements  of  the  publishers  are  very  extensive  and  em- 
brace for  the  gleanings  of  the  editor  the  various  Journals  from 

GREAT   BRITAIN,   FRANCE,   GERMANY, 
DENMARK,    ITALY, 

^JVn  OTIfER  SEC'TlOJ\'S  OF  THE   VV^ORLn. 

INCLUDING  AS  PROMINENT  AMONG  THE  ENGLISH, 

BRAITHWAITE'S   RETROSPECT, 

RANKING'S  HALF-YEARLY  ABSTRACT, 

THE   LONDON    MEDICAL  TIMES, 
THE    LONDON    MEDICAL    GAZETTE, 

FORBES'  BRITISH  AND  FOREIGN  QUARTERLY. 

(Continued  on  Page  31.) 

55"  This  paper  may  be  delivered  to  any  physician  if  declined  by  the  person  to  whom  it  is  ad- 
dressed, or  if  they  have  removed — and  Postmasters  and  others  will  particularly  oblige  the  publish- 
ers by  furnishing  a  list  of  the  Physicians  and  Lawyers  of  their  county  or  neighborhood.  InaTdition 
to  the  business  it  may  bring  to  the  office,  a  copy  of"  The  Complete  Florist,"  or  such  other  volume, 
will  be  sent  by  mail  gratis  for  any  ten  or  more  names  furnished  free  of  cost. 
Philadelphia,  July,  1846. 


1 


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