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vous disease, and consequently she is no longer insane. it results from the distinctions which we have just established, that insanity is a privation of man's free agency, in consequence of a disorder of the understanding. It is important to remark, that the free agency represents, at the same time, the integrity of the conscience and of the will. Up to the present time these two elements have not been sufficiently distinguished, namely, the disorder of the understanding, and the loss of the free agency.

For example, Esquirol defined insanity, as an apy

racterised by disorders of the intelligence, of the sensibility, and of the will. Georget, one of the most distinguished pupils of Esquirol, particularly insists on the essential character of insanity being the lesion of these faculties; it even seems, according to him, that these lesions alone were sufficient to constitute all the species of insanity.

I have recently read the account of a voyage, in which the author,not thinking, perhaps, of defining insanity by its strongest pathognomic character, says, “madness is a misfortune which ignores itself," now nothing can be more true, and in my opinion, it is a very good definition, science might adopt it, with the exception of the word "misfortune," which not being medical, must be replaced by another word more appropriate. In the mean time, let us keep to this point, that the lesion of the intelligence, and the loss of the conscious-retic disease, ordinarily of long duration, and chaness of this lesion, are two very distinct facts, and that both are necessary to constitute a true mental alienation. We Te can, it is true, make an objection, and say that there are patients, who, having a perfect knowledge of their condition, are still not the less insane. This is true of those persons, subject to what are called motiveless impulses; they are indeed impelled in spite of the knowledge, or the consciousness of their affection, to acts of violence against themselves and against others, by impassioned movements which they recognize, which they disapprove of, and which they would repress, but to which they yield, notwithstanding all the obstacles opposed to their execution; in other words, the will is powerless, it is vanquished, and the subject rests so thoroughly conscious of his disease, that it is upon it that he throws the blame, having no power whatever over those actions to which he is impelled, he says, in spite of himself.

In the former case, we have seen that insanity proceeds from the loss of the consciousness of lesions of the intelligence, here it proceeds from the impotence of the will. But these instinctive impulses are not sufficient of themselves to constitute insanity, and I shall relate to you, in a subsequent lecture, the history of a man struggling for twenty years against the impulse to murder a tenderly beloved mother. This man left his own country in order to escape the danger which threatened him, and it was only after twenty years that this impulse succeeded in overcoming the efforts of the will. The patient perceived himself vanquished, and desired to be confined; from that moment he became insane; but up to that moment, though with the voluntary faculties very much weakened, yet he was not insane.

Thus lesions of the intelligence, and of the will, are so distinct from insanity, or alienation, that they may exist, as in the above cases, without there being either insanity or alienation.

But these lesions, these disorders of the faculties, which are, so to say, the material of insanity, do not constitute it, since they are compatible with the existence of the conscience and the free will. It is not possible that man should be mad and responsible which would be the case, if the definition of Georget was at all correct. Let us repeat, then, that the first character on which a definition of insanity should be founded, is the loss of conscience, and the impotence of the voluntary power of the subject.

Setting out from this, as from a fixed point, I may add, that I am of the opinion, that the word insanity (folie) ought not to be applied to particular diseases, either of the understanding or of the will, as long as they are such only; that is to say, so long as they are not associated with any general disorder of the reason, in short, whilst there is a rational discernment and domination of the reason, there is no insanity. This point fixed, we will pass to another.

Authors have, moreover, divided alienation into partial and general; but you will see that this division accords ill with the ideas I have just laid before you. Can it be, that insanity, as we have just defined it, is capable of existing in a greater or a less degree? Can any one be more or the less insane,—half mad,—more mad than another madman? No, gentlemen, we are mad, or we are not mad,-as we are free or are not free, as we have consciousness or we have it not, as we govern our actions or we do not govern them. If insanity consisted only in the lesion, or the disorder of the intellectual or voluntary faculties, it would be right to divide it into general and partial; for these lesions may be confined to any one, or may comprehend them altogether: but we have pronounced against such a conception of insanity, and we persist in our opinion, that insanity is an entity, or it does not exist.

These distinctions teach us, that insanity has two sources: the one which consists in the loss of the consciousness of the lesions of the intelligence; the other, in the want of power to govern certain impulses. Now, whether insanity comes from one or other of these sources, the result will be the same to the patient; for, in either case, he is deprived of his free The most that I can admit is, that insanity may be agency; as madness and liberty are two terms which complete or incomplete: understanding by the word mutually exclude each other. Hence, the lunatic be- complete, the total overthrow of the reason; and by the comes incapable of governing himself, incapable of word incomplete, that state of vagueness, or of momanaging his affairs, incapable of the acts of personal mentary interruption of the reason, which constitutes responsibility, and therefore he falls under an especial something analogous to the mental situation of him legislation, the regulations of which we will some day who dreams while half-asleep, and who yields for the study. moment to illusions and to disordered impulses, but We have now prepared a definition of insanity; for soon resumes the empire over himself.

This is all that I can concede, but let us repeat it again, insanity has two distinct elements: first, the lesion of the intelligence; and then, the loss of the consciousness of that lesion, or the impotence of the will. I need scarcely tell you, which of these two is the most important to the physician,—it is the lesion; for when you have cured that, you have almost cured your patient.

The same may be said of hallucination; for, after having been for a greater or less length of time recognised by the subject as an error of the senses, it terminates by vanquishing the reason, and destroying the consciousness. Here also, if you can cure the hallucination, you may hope that the conscience and the reason will return to their integrity.

But the lesion of the intelligence is not the most important element for the magistrate; for him, the question is the loss of the conscience, or of the power of self-control. It is, indeed, the failure of the free agency, or of the responsibility, that places the insane under a different jurisdiction than that which governs the sane.

The questions for the magistrate and for the physician are then very different; but these two create a general point of view, which should at least be kept in sight in giving a veritable definition of insanity. Gentlemen, you now see how I understand insanity, and how it seems to me it ought to be understood; and now we will consider the value of the terms which are commonly used in the study of mental alienation.

The word delirium (delire) which is found in all authors is generally used as synonymous with insanity (folie), but with this difference, that it is more particularly applied to perturbations of the intelligence connected with acute affections of the brain. It will be easy for you to make the distinction in the cases where this word is used in science generally, or in mental alienation.

he a valid personality? In both these acceptations, the word alienation conveniently expresses that which was intended, and the term mental alienation is preferable in this respect to the word insanity.

I now come to the plan of instruction that I propose to follow in this course of lectures, for it seems to me that you will understand better, when you know how we are to proceed with our subject.

Up to the present time, and I appeal to the memory of those among you who have read the general treatises of our authors, the study of insanity has been made under the two titles of general history, and of particular history, or the history of the different forms of mental alienation. With most authors, the scientific importance is all given to the general history, to the prejudice of the more practical history of particular forms. Thus, in the treatise of Georget, we find contained in less than twenty pages, the entire description of idiotcy, mania, monomania, melancholia, stupidity, and dementia. Look at the articles on insanity in the more recent dictionaries of medicine, and you will find the same predominance of general history, with the same negligence of the practical history of the various forms of insanity.

Such a method is subject to great objections. How trace the general history of alienation without being exposed to all sorts of contradictions which change the general homogeniety? Thus you will read in the same author, that insanity has for a symptom, a great exaltation of the faculties, and a profound depression of the same faculties, that it is characterized by very limited and very extended disorders of the intelligence. In regard to the progress of the disease, you will read in the same treatise, that insanity is essentially continued, intermittent, remittant, periodic, etc., and in truth the general history of insanity is only the union of contradictory characters, because the most different indications are observed in it.

Thus there is discordance throughout, and nowhere any homogeneous conception. This follows from the nature of the subject, and from insanity being considered as a pathological entity, whilst in reality it is the union of very different morbid forms, having, however, among them points of contact. It is assuredly possible to study the vesania in a general manner, and this study will not be without important results; but it is necessary to know, how to restrict it to certain points, among which, I shall give as an example, the influence of hereditary tendency.

The expression mental alienation is also synonymous with insanity, yet it has a wider significance, since it includes idiotcy, which is not included in the term insanity. Idiotcy being, as you know, the congenital privation of the intelligence. Idiots are not mad, we may even say, they are not diseased, in the sense that having possessed nothing they have lost nothing, and are, in respect to the understanding, as he who, in respect to the body, comes into the world with a member or an organ the less. More extensive in its signification than the word insanity, from including idiotcy, mental alienation has also the advan- We must then distinguish alienation conceived in tage of pointing out the foundation of the disease. an abstract or general manner, as we should expect The word alienari, which is its etymological root, sig-philosophers and magistrates to define it, from the nifies to cease to be master of something, to cease to govern it. Such is the case with our patients; we have seen, in the definition of insanity, that they cease to direct their intellectual faculties, and to govern as masters their voluntary acts; they are ruled, instead of ruling; passive, instead of active. Therefore it is that the word alienation should be taken by us in its absolute passive sense.

The word alienation has been also derived from the adjective alienus-foreign—and it is correct even in this sense. Is not the alienated a foreigner to himself? Does he know what passes in himself? Has

alienation which is given to the physician to observe, to consider, and to submit to a particular treatment. In a word, to wish to make a history of insanity in general, with all the signs and types that characterize its various forms, would be to expose oneself to all the contradictions which we have noticed in authors; and then, after all, we should lose our great object, namely, practical utility.

The general notion and definition of insanity, such as we have given it, is what ought to be given, and is no more than what is required in commencing a course of lectures founded on clinical study as ours is, stamped

above all things by utility, which is the aim and end ing an amount of research worthy of the Society of of all instruction. The course, in consequence, will be Antiquaries. It does not contain a philosophical disdivided into two parts: the first relative to general, quisition on the principles of optics, adapted for the the other to special pathology; which latter, I need study of gentlemen who are preparing for honours not tell you, will merit on your part an especial study. at Cambridge. It does not contain an account of 1st. In the general pathology, we shall study what the construction and manufacture of the microscope; are called the elementary lesions, those which, united neither does it pursue and describe the capabilities of among themselves, are found at the bottom of the the instrument in botany, geology, mineralogy, etc. different forms of insanity. This is the manner in Lastly, it does not contain a number of large gaudily which we proceed in the study of all classes of disease. colored prints, representing the tissues of the body as The general pathology of mental alienation includes they appeared to the imagination of some observer, the study of pathological physiology. It is as necessary unfortunately too small to serve as diagrams in a to understand the manner in which the morbid phe- lecture room. nomena produce themselves in the lesions of the faculties, as in the organic lesions; and this work is preparatory, otherwise it would be necessary to make a digression before each patient, and in relation to each disease, if we have not taken the precaution to do this in advance. The general pathology will include the physiology of delirium, and all other generalities, which precede in a methodic instruction the study of particular diseases; thus, for example, we must study the pathological physiology of hallucination before examining any patient subject to that phenomenon.

2nd. In the special pathology, I need not tell you, is ranged the description of the different forms of mental alienation.

The Microscope, and its Application to Clinical Medicine, by LIONEL BEALE, M.B., LOND., Professor of Physiology and Morbid Anatomy in King's College. London: Highley. 8vo. pp. 303.

This book, one of Mr. Highley's Library of Science and Art, is by far the best adapted for the medical practitioner which has yet appeared on the subject. We will mention two or three of the things which it does not contain.

It does not contain a series of elaborate steel plates of various forms and modifications of microscope stands, adapted for the entertainment of those who are curious in the subtleties of mechanics. It does not contain a minute description of all the bad microscopes which ever were invented in past ages, display

Mr. Highley has just published

It is not written in a manner to bewilder or mislead; and, in truth, it has evidently been written for the use and instruction of that busy and practical race, who value the instrument as a ditcher values his spade, hoping by its means to delve deeper and deeper still into the secrets of disease.

It will, perhaps, be fair now to state what the book does contain. It contains 232 well executed woodcuts, mostly "copied from drawings taken by the author from objects actually under observation." It contains 303 pages, in which it would be difficult to point to a paragraph which the most utilitarian reader would condemn as superfluous; and it describes, in an agreeable and simple style, the whole art and science of medical microscopy. We know it as a fact, that many men who have been perplexed by their microscopes, and still more by former books of instructions, have made rapid progress by the aid of this excellent treatise.

We hoped to have given extracts on the examination of the brain and nerves, but want of space forbids: and we are the more reconciled to the omission as most of our readers will probably get the book.


In consequence of Dr. Wingett having withdrawn, DR. MANLEY, late Assistant Medical Officer of the Devon County Lunatic Asylum, has been appointed Medical Superintendent to the HANTS COUNTY LUNATIC ASYLUM.

Notice to Correspondents. W. A., Esq.-We reviewed Dr. Maddock's book on its own merits, without any knowledge of the

HIGHLEY'S LIBRARY OF SCIENCE & ART author. A more honest plan, we think, than that of reviewing

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a book according to its author; though, as it appears, not without certain inconveniences.

DEVON COUNTY ASYLUM. WANTED, an Experienced COOK, capable of £20 a year. Apply to Dr. Bucknill at the Asylum.

All communications for the forthcoming Number should be addressed to the Editor, DR. BUCKNILL, Devon County Lunatic Asylum, near Exeter, before the 1st day of August next.

Published by SAMUEL HIGHLEY, of 32, Fleet Street, in the Parish of Saint Dunstan-in-the-West, in the City of London, at No. 32, Fleet Street aforesaid; and Printed by WILLIAM AND HENRY POLLARD, of No. 86, North Street, in the Parish of Saint Kerrian, in the City of Exeter. Saturday, July 1, 1854.

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be employed but can never be of use, and therefore

The Employment of Mechanical Restraints in the can never be correctly said to be in abuse.

Treatment of the Insane.

There is this difference between that which is in principle good and that which is evil: the former may by abuse or misuse be converted into evil, while the latter can by no conversion become other than it is by nature from the beginning. One evil may mask or master a lesser one, but that which is bad in principle can never become good in practice.

That however which is good in principle constantly becomes bad in practice. Generosity terminates in reckless extravagance, prudence makes the miser, courage the brawler and peacebreaker, and even religion engenders the fanatic. The use of food begets gluttony, the use of clothing ends in dandyism, profligacy and debauchery originate in the strongest and most necessary instincts of our nature.

"So little knows

"Any but God alone, to value right

"The good before him; but perverts best things "To worst abuse or to their meanest use." The gentleman, whose letter will be found at p. 111 of our present number, maintains that the principle of mechanical restraint in the treatment of the insane, is in itself good; that like the virtues, the social affections, food, clothing, and other good things, all that can be objected to it is, that it is capable of abuse. We differ from him entirely, and believe that the principle of mechanical restraint is bad, and that its practice is always unnecessary and mischievous; that it may

Dr. Simpson observes that, "the greatest boons to mankind have not unfrequently been converted into the greatest curses through their abuse," &c. And he compares mechanical restraints to that medicine which of all others has in skilful hands proved the most generally useful in combatting the diseases of mankind; because the latter when unskilfully employed has been productive of evil. He might with equal justice have compared it to bread and meat, because these in aldermanic constitutions cause gout and surfeits and apoplexies.

The following passage from Dr. Simpson's recently published Report will more fully explain his meaning: "That the abuse of that which is in its nature good should to a greater or less extent detract from and injure the good itself, is a truism applicable not only to restraint, but to all science and to every human system and creed; and of the truth of which a moment's reflection will suggest multiplied illustrations. Nevertheless, granting the vast evil of its abuse, we cannot regard this as inseparable from or as constituting an essential element of the principle itself; neither can it be admitted as detracting from its intrinsic efficacy and value when referred to peculiar and rarely exceptional cases; but should serve to remind us not only of the great caution and judgment required in its use; but more especially of the necessity of exercising a watchful supervision of those more immediately entrusted with its application."—p. 7.

If in the York asylum the immediate application of

restraints is entrusted to servants, Dr. Simpson may with confidence expect, that notwithstanding the most watchful supervision, he will not need to wait long for an opportunity of observing gross abuses (as he will call them) of this boon to suffering humanity.

ment of the insane is bad, it is as bad now as it was forty years ago; and as bad under the spencer of Mr. Hill as under the chains of Bethlem. To use another illustration; not many years ago the discipline of the British army was maintained by the unsparing employment of the cat-o-nine-tails, and every one believed that its use was essential to the welfare of that class of our fellow subjects who wear red coats: that in fact it was quite a “boon" to military human

Hounslow, the public was induced to ask itself, whether discipline might not possibly be maintained without lacerating the dorsal region of our heroes with leather thongs. And through Mr. Wakley's exertions a parliamentary limitation of flogging powers was provided. Since that time the use of the lash has been abolished in one regiment after another, until at present the non-flogging regiments comprise a large proportion of the entire army, and the opinion prevails pretty extensively that the existence of flogging marks the commanding officer of any regiment as negligent, or brutal, and unfit for his duties. Few people can

fillip us back again a few paces towards barbarism, flogging regiments will soon become as rare as restraint asylums.

Dr. Simpson has chosen his simile to illustrate the blessings and the abuses of restraint from medical science. We will select what we consider a more appropriate one from that of surgery. When monarchs first began to employ "that vil-ity. But a soldier having been flogged to death at lainous saltpetre" in their martial amusements, the army surgeons who before that time had been accus tomed to treat wounds made by glaives and bills in a cleanly and gentlemanly fashion, found that the new sort of wounds almost invariably underwent some degree of sloughing; this they attributed to the parts having been burned by the ball or to their having been poisoned by the powder; and in order to obviate these inconveniences, they, on principles since rendered scientific by the great Hannehman, were in the habit of pouring boiling oil into them. This employment of boiling oil in the treatment of gunshot wounds was in our opinion an exact counterpart of the employment | doubt, that if the savagery and license of war does not of mechanical restraints in the treatment of insanity; both of them being unnecessary and unmitigated evils, both of them adding fuel to fire, and increasing the mischief they pretended to alleviate. Flogging the soldier and straight-waistcoating the We doubt not that a vigorous controversy was lunatic have indeed many points in common. The carried on by our surgical forefathers before this prac-most pernicious quality of both exists not so much in tice was finally abandoned; that first there was a the suffering they occasion, as in the degradation of Charlesworth to conceive and a Conolly to exemplify humanity which they exhibit. When a soldier is subthe possibility of treating such wounds without the use jected to the lash like a recreant cur or a bit of proof the ardent fat; and that long after the barber sur-prietary human flesh, every man in the regiment geons and leeches of the period had adopted milder necessarily feels himself degraded. In the Clifton or practices, there was a Dr. Simpson to maintain that York asylum, a patient is put under mechanical realthough it was barbarous to pour from the cauldron straint, in order, says Dr. Simpson, that "he may with an unsparing hand, that boiling oil was notwith-associate with the inoffensive, the industrious, and the standing “a boon to mankind,” and “that the abuse cheerful of his companions." Is it possible that these of that which is in its nature good" should not be per- companions can avoid the most painful sense of abasemitted 66 to detract from and injure the good itself." ment at such a sight? Seeing a fellow patient tied But medical journalism existed not when that con-up like a ferocious dog, will not each one with deep troversy took place, and so alas for human fame, the shame reflect that his turn may come next? Whether name of this stout partizan has not been transmitted in regiments or asylums, the old system of control was made by appeals to the lowest and basest of the motives of human action: by fear of the lash, fear of the bond. Under a better system lunatics at least are controlled by appeal to higher motives, motives, however, which it is impossible to evoke, until the brand of shame and degradation, the use of mechanical restraint is removed absolutely and for ever.

to us.


The last public asylum in this country, where the patients will be accustomed to the enjoyment of mechanical restraints, will very likely be within sight of York Minster; but who was the man who last poured boiling oil into the living track of a musket ball? Alas! his name is lost for ever.



Dr. Simpson is right in maintaining, that if me- Dr. Simpson restrains his patients by means of the chanically restraining the insane is right in principle,|muff and the spenser. We called the spenser the "mass of abuse" to which the principle has led should not cause us to lose sight of the "element of good" it contains. Principles and theories embodying them are alone worth fighting for, and we do not number ourselves among those who on the question of slavery can be ardent abolitionists in America, and contemplate without repugnance the Circassian beauty and the Ethiopian eunuch standing at price in the markets of Stamboul, or the Russian serf doomed to remain for ever an agricultural chattel. If the principle of slavery is bad, it is bad in the west and the east. If the principle of using mechanical restraint in the treat

euphonious name for the straight waistcoat:" in this it appears we were mistaken. We must plead ignorance of any new fashioned methods of mechanical restraint, an ignorance of which we are not ashamed. If restraints are to be used at all we quite agree with the physicians who gave evidence before the Parliamentary committee on this subject, that the simple handcuff is much to be preferred to all sorts of waistcoats. Like many other things which have got a bad name, the straight-waistcoat has gone through several changes of appellation. Its first change was into a vest, then it became a camisole, (we presume from the French

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