OF

ASYLUMS AND HOSPITALS FOR THE INSANE.

AT the Annual Meeting held at the County Asylum, Michaelover, near Derby, on the 1st of August, under the Presidency of Dr. Hitchman, the following Office-bearers were appointed for the year 1856-7 :—

President-DR. HITCHMAN, Medical Superintendent, County Asylum, Derby. President Elect-DR. FORBES WINSLOW, D.C.L., Cavendish Square, London. Ex-President—DR. THURNAM, Medical Superintendent, County Asylum, Wilts. Treasurer-W. LEY, ESQ., Medical Superintendent, County Asylum, Oxfordsh. Auditors-DR. CAMPBELL, Medical Superintendent, County Asylum, Essex; DR. PRICHARD, Abingdon Abbey, Northampton.

Hon. Secretary (General)—DR. LOCKHART ROBERTSON, Charles-street, Berkeley-square, London.

Hon. Secretary for Ireland-DR. STEWART, Medical Superintendent, District Asylum, Belfast.

Hon. Secretary for Scotland-DR. BROWNE, Medical Superintendent, Royal Crichton Asylum, Dumfries.

Editor of Journal-DR. BUCKNILL, Medical Superintendent, County Asylum, Devon.

The following Members were duly elected in accordance with the terms of Rules III. and VI. :

Honorary:

SIR BENJAMIN C. BRODIE, BART., D.C.L.

SIR HENRY HOLLAND, BART., M.D., D.C.L.

JAMES WILKES, Esq., Her Majesty's Commissioner in Lunacy. THOMAS PEACH, Esq., M.D., Justice of the Peace for the County of Derby. J. R. HUME, Esq., M.D., Her Majesty's Commissioner in Lunacy.

Ordinary :-

DR. HELPS; DR. FAYRER; DR. BAKEWILL; F. W. CASSON, Esq.; J. S. ALDERSON, ESQ.; J. G. ROBERTSON, ESQ.; DR. WILLETT; DR. HEDGER; T. ALLEN, ESQ.; J. BUSH, Esq.; DR. ARMSTRONG; DR. STEWART; DR. MACREIGHT; DR. BLOUNT; DR. CHEWNER; DR. BOISRAGON; DR. HERVEY; G. BODINGTON, ESQ.; DR. LAWLOR.

Members are reminded that by Rule IV., "the Annual Subscription of £1 1s. is due in advance on the 1st of July in each year."

It is particularly desired that the arrears for 1855-6 may be paid up without further delay.

All Subscriptions to be paid to the Treasurer, William Ley, Esq., Medical Superintendent, County Asylum, Oxford.

C. LOCKHART ROBERTSON, M.B. CANTAB.

1, Charles Street, Berkeley Square,

September, 1856.

Honorary Secretary.

OF

PSYCHOLOGICAL MEDICINE

AND

MENTAL PATHOLOGY.

OCTOBER 1, 1856.

Part First.

Original Communications.

ART. I.-ON MONOMANIA.

IT is related that Pinel, on one occasion, took a lady to look over the arrangements of the Salpétrière. Having passed through several wards, the lady suddenly stopped, and asked where the insane people were, and if she might not be allowed to see them. By this she meant the violent insane; and after visiting them, she would doubtless leave the hospital with the full conviction that there were two perfectly distinct forms of insanity at least -an opinion which the most cursory glance at the inmates of any such establishment would tend to corroborate.

This man was yesterday perhaps a man of science, of genius, of extended philanthropy, piety, and benevolence. Look at him, and listen to him now, his irregular and disorderly actions, his incoherent, perhaps blasphemous words, in which you may nevertheless trace the partial mechanical reproduction of vanishing ideas,—his indiscriminate, aimless violence-all betray a mind utterly overthrown, at war with itself and with the world. This woman was yesterday gentle, modest, affectionate, and fulfilled all the relations of life with prudence and propriety. See the contrast: "her timidity is changed into boldness, her gentleness to ferocity, her conversation consists of abuse, obscenity, and blasphemy; she respects neither the laws of decency nor of humanity; her nudity braves all spectators; and in her blind delirium she menaces her father, strikes her husband, or strangles her child."* A little while, and this will have passed away, but to * Esquirol.

leave the unhappy victim a wreck, a caricature upon intelligent life. Pass on to another ward, and enter into conversation with that handsome, intelligent-looking grave gentleman in black. He evinces a mind well stored with ancient and modern lore; he can illustrate any subject upon which you enter with the riches of information and fancy; he discusses the current topics of the day-politics, art, or science, with considerable insight into their principles. Perhaps you detect no disorder of mind, until the close of an interesting interview, when, as a secret, he tells you of visions and special revelations from above, relating to some trivial matter of daily life; or he communicates, under strict injunctions not to betray him, his imperial rank, of which his enemies have deprived him; or his superhuman power, which he only refrains from using because of his love for his fellow-creatures. He is Socrates, and can give you most convincing arguments that he is entitled to be alive now; he is Jesus Christ, and is again subjected to the malice of the world; he is Mahomet; he is Napoleon Bonaparte, escaped forty years ago from St. Helena, and has been living here incognito ever since, for fear of re-banishment,-perhaps he retains his youth after all this, because he has discovered the elixir vitæ. Or he has squared the circle, and is imprisoned for envy by men of science; or he has the philosopher's stone, and is confined because of the political and social influence he might exert through its

means.

Look again at that decent mechanic: a few weeks ago he was recognised as a hard-working, honest, upright member of society; but one day he seized a fellow-workman by the throat and strangled him. He had no quarrel with him, and liked him very much, he will tell you; but "he was not humble before God, and the blessed Trinity suddenly appeared and told him to kill him."* Yet he is mild and amiable in character, and talks with perfect coherence upon all matters within the scope of his intelligence. His neighbour evinces no morbid propensity, save that of setting buildings, &c. on fire. The next has made frequent attempts at suicide, the reasons for which are utterly trivial and futile. That wretched-looking creature in the next room laid violent hands on a favourite child, and then delivered herself up to justice. She did not know why, but the temptation to kill it was irresistible, and she yielded; with the completion of the act her right mind returned, and she became conscious of the crime; no intellectual aberration can be traced.† Here is another, with a look of excitement and importance, who will overwhelm you with a volume of words without connexion; half-formed ideas, causeless and evanescent emotions struggle * "Correspondenzblatt," 1855.

Vid. Case of H. Cornier.

feebly for expression. He has forgotten the past, feels but imperfectly the present, and thinks not of the future. Lastly, crouching on the ground, or shuffling aimlessly along, is one whose mental development is below that of the beasts that perish. Some of his instincts alone remain, or perhaps these are gone, and nothing remains but vegetative life. Speak to him, and if you attract his attention, the only answer is a vacant stare, or an inarticulate chuckle or cry. Hunger, thirst, heat, or cold, are alike indifferent; the lichen or the sponge have almost as much vitality as he.

Many of these differences are obvious enough, and have been recognised from the earliest times in which mental diseases have been the subject of investigation. Two great forms of insanity have generally been admitted-one in which all the faculties were disordered, and one in which some remained virtually or apparently sound. The earliest classification was equivalent to a division into mania and melancholy;* by this latter term signifying a delirium or error, partial in its nature and extent. Pinel and Esquirol were the founders of the modern views as to the varieties of insanity. According to them, Idiocy and total Imbecility involve the original absence, or the utter loss of the intellect; Dementia signifies the loss of coherence in the thoughts, with general enfeeblement of the will, the sensibility, and the intelligence: Mania, complete perversion of these faculties, generally with exaltation in energy of function; whilst Monomania (here including both Lypomania and Chæromania) signifies a partial lesion of the intelligence, or the will, or the passions. Whilst there is but little difference of opinion on the existence of the first three forms of mental aberration, it is quite otherwise as to the last; and according to the diverse aspects in which the well-marked phenomena have been viewed, and also according to the different preconceived theories as to the absolute and essential constitution of the mind in relation to the unity or diversity of its faculties, widely different have been the opinions expressed upon the nature or existence of Monomania, especially that peculiar and important variety dependent upon lesion of the passions or instincts alone, and called manie raisonnante, moral insanity, and insanity without delirium. A dis

was,

* Wherever the word "melancholy" is made use of in ancient treatises or observations on insanity, and even in most modern ones, it must be observed that it differs entirely in signification from its social and conventional application. It and is yet frequently, used to signify a partial aberration of mind; in many instances, but by no means invariably, attended by depression of spirits. Its etymology is one of the very numerous relics of exploded theories, with which science in general, but ours especially, abounds. In fact, the terminology of mental science is rife with similar instances :-melancholy signifying black bile-folly, being derived from a word signifying a balloon full of wind-lunacy and mania both having reference to a lunar origin, &c. &c.

cussion on this subject, involving medico-legal principles of the very highest importance, has been carried on before the "Société Medico-Psychologique" during one entire year, in which the greatest authorities have taken part, in which the most diametrically opposed views have been promulgated, in which learning and candour have both been lavishly expended, yet in which, to use the words of M. Pinel (neveu) "Chacun est resté avec ses convictions, sans que les arguments et les raisons de ceux qui pensent différemment aient pu le faire changer de manière de voir." The conclusion of this long discussion (of which an abstract is contained in the last number of this journal), and the publication of a monograph by the above-named M. Pinel, marked by great ability and research, suggest to us the opportunity of inquiring into this subject (on which we in England are not more united in opinion than our continental brethren, and in reference to which our practice is perhaps still more undecided), and of illustrating it by a few cases on which judgments have recently been pronounced on the continent.

The question hinges upon what is called the "solidarity," the absolute mutual dependence of the faculties of the mind, the oneness of the mind itself. The supporters of the theory of monomania speak of the mind as compound, consisting of many distinct faculties or attributes, any one of which may be disordered or subverted independently of the others. The opponents of this theory say that the mind is one absolutely, and if deranged, is deranged as a whole; that there may be a prominent morbid idea, but that this is only a symptom of a universal morbid state. Thus melancholia-which includes melancholia proper, or partial depressive delirium, and chæromania or monomania proper, partial expansive delirium-is described by Pinel as "delirium exclusively on one subject, no propensity to acts of violence, independent of such as may be impressed by a predominant and chimerical idea-free exercise in other respects of all the faculties of the understanding.' Mania without delirium, "manie raisonnante," moral or instinctive insanity, which is essentially included in this question as hypothecating a derangement of one order only of faculties, the affective, is described by the same writer as involving "no sensible change in the functions of the understanding, but perversion of the active faculties, marked by abstract and sanguinary fury, with a blind propensity to acts of violence."* It is the existence of this form

*The opponents of this view either consider all acts of this nature as instances of ungoverned passion; or allowing the insanity, they consider it universal, violence being only the predominant, but not the exclusive morbid tendency. That many of the faculties of the mind are in what appears to be healthy action, is undeniable; but this fact is accounted for by saying that they are automatically performed.