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three weeks from his admission had the pleasure of discharging him "recovered."
Whilst this gentleman was under my own immediate care, I had frequent conversations with him concerning previous circumstances, and the views which he took of his own mental condition. He all along insisted that there had been no insanity: he allowed that over-fatigue and bad nights whilst excursioning had produced some undoubted nervous excitement; but he maintained that it had been most unjust to treat him as a lunatic. When hints were delicately thrown out regarding the acts and the words going very much to prove the contrary, there was manifested a somewhat convenient memory as to occurrences, which doubtless it was unpleasant to him to recollect, and he would slur them over in his own way, and with his own particular purpose. Above all, he was most intolerant of the least suggestion that his admitted nervousness or excitability was the result of the physical injury sustained by the head. Naturally of the most kind-hearted and placable disposition, he yet brooded incessantly upon the wrong which he considered to have been done him. He was greatly irritated, and even indignant, when his old friend and family surgeon paid him a visit; so much so, that the patient's wife, after having had an interview with him, insisted that neither professional nor any other considerations should authorise its repetition. Again, there was the patient's legal adviser, his own near relative, and one in whose success he had greatly interested himself; towards this gentleman he was equally embittered. A much respected friend, his own clergyman indeed, who had been a party to the stratagem by which his removal from home had been effected, was placed under ban. After leaving the asylum, the sole residuum that shewed itself of his morbid state, was a perpetual brooding over the supposed wrong which he had sustained, and an incessant iteration and reiteration of his story to all who would listen to the tedious details. He repeatedly expressed his delight that his wife had been no party to the transaction, observing that had it been otherwise he should never more have been as husband to her. It was hoped that little pleasure-trips and sojourn with various friends in different parts of the country, would have scattered this train of thought. But no, the theme was constant; so much so, that I advised a continental tour of some months duration to be made, in company with a judicious member of the family. I feared indeed, that if this dangerous mental monotone was not broken, some new
form of insanity would be the consequence. As I write, this tour is in progress, and so far as can be ascertained from correspondence, I should say with success.
The third and last case which I shall detail, presents the same essential features as the foregoing ones. It exhibits, moreover, circumstances of perilous relapse, apparently as a consequence of the patient's brooding over supposed injustice done to him.
Mr. E. F., a gentleman of talent and education, and about thirty years of age at the period of the events about to be related, was always of a vain, captious, and jealous disposition. Very soon after his marriage, without the slightest cause, he began to entertain the most preposterous suspicions of his wife's fidelity; but for several years this circumstance had no other result than that of producing the usual degree of domestic unhappiness, not however obvious in any way to the world. But jealousy led to its customary issue-unjust suspicion; and this became ludicrously displayed, and largely extended in its objects. He became singularly tenacious, moreover, of his own dignity, absurdly imagining that almost every one was either slighting or conspiring against him. In well-known sequence of such phenomena, and coincidently with disturbance of the digestive organs, unmistakeable delusions arose, corresponding very much in character with the morbid feeling out of which they sprung. I need say nothing of the particular form which they assumed, as this is a circumstance which does not connect
itself with my present purpose. I may go on to state, however, that violent conduct supervening upon the mental state, removal of the patient to an asylum was resolved upon, and he was removed accordingly. Under these circumstances he became my patient. There was little in his appearance, and less in his conversation, apart from the topics connected with his malady, to suggest that he was a madman. He was naturally cunning, and this character, with other (the worst) parts of his character, became so intensified that only when an attack was skilfully conducted could he be made to commit himself. Ordinarily, he was quite unrecognisable as a person mentally deranged. He had been brought to the
asylum by his father, who had in conversation with him assigned his violence as the reason for the proceeding, and thus it was well known to the patient by whose authority he was placed in confinement. I may here state that the patient had always, in an especial manner, been attached to his father, and had had unlimited confidence in him. During
the sojourn in the asylum, there was no display of maniacal violence, and he was always calm and self-sustained when visited by any of his relatives. He was taken from the establishment somewhat earlier than I was prepared to recommend, under the impression which his father had that he was quite cured. I had myself, however, the apprehension that the ashes still smouldered. He would never, in my various conferences with him, admit for a moment that he was or had been insane, or in any way whatever disordered in the head; and he would refer with sorrow, rather than anger, to the conduct pursued towards him by his father. Yet this said father, who had himself retired from a business which for some time had been the son's exclusively, devoted himself faithfully and assiduously to its management, in the absence of its proper principal, and in every way exhibited himself deeply solicitous for his welfare. On leaving the asylum, this gentleman received the fullest explanation of matters from his father, who moreover accompanied him to a watering-place, as a proceeding intermediate to his resumption of the business. Notwithstanding the kindness and consideration so obviously showed him, it was plain that he continued to nurture a sense of injury. When once at liberty he became sullen with his father, insinuating that he had had his reasons for so carefully attending to the business, and obscurely hinting that there were other and darker motives for the incarceration to which he had been subjected. Before the period fixed for their return home, in less than three weeks from leaving the asylum, the miserable fellow boldly and angrily charged his aged parent, upwards of sixty years of age, with having got him out of the way that he (the father) might have incestuous communication with his own daughter-in-law; and, immediately upon this preposterous accusation the patient attempted parricide with a knife; but, happily, there was no injury received beyond an insignificant flesh-wound. Other unmistakeable signs of dangerous insanity ensued, and he was again placed in confinement. As he upon this occasion went to an asylum with which I have no connection, I was called upon to certify in the case, and found him in a decidedly. worse condition than any in which I had before seen him. After some months he was again liberated; and since his return home, some three years ago, I believe there has been no renewed outbreak, at least none of any serious character. But to this day, I understand, he maintains a reserved and even morose demeanour towards both his parents. He has
never exhibited cordial feeling towards any of his family, excepting his children. His wife sometimes is with him and sometimes not, according to the humour of the time. He has changed his medical attendants, and to myself he will not vouchsafe so much as a look of recognition. But his ordinary deportment is that of a sane man; and he conducts his business affairs with industry, consistency, and skill.
I do not know that I need occupy much space in commenting on the class of facts now exemplified; the inferences and practical conclusions, I think, suggest themselves. It is clearly of considerable moment, that the residual prejudices forming the subject of this paper should be guarded against, and if possible prevented; for not only do they in some instances give rise to social inconveniences and domestic mischief, but they operate injuriously upon the recovery of mental tone, and tend, moreover, to bring about relapse. It is obvious, therefore, that whenever there is good reason for believing that an imputation of insanity will be resented, and the justice of such imputation be impeached, persons who have intimate relations of any kind with patients should, ostensibly at least, be as little as possible mixed up with the measures that may be adopted. A contrary proceeding will often embarrass, even if it do not close, all future connection of a friendly character. "It was most injudicious and absurd, even if I had been insane," said a patient, whose case is the second I have recorded, "that my own nephew, my attorney, and my own doctor, should have been the persons to take me, and thus have made themselves the active instruments in the deception practised upon me. Why that of itself was an additional blunder." And he was right, I think. Under such circumstances, the proper course to pursue is plainly for indifferent persons and strangers to have the management of such matters, so far as practicable. Of course, the plan to be acted upon in particular instances cannot a priori be indicated as the facts of a case and the facilities of operation vary, so will the steps to be taken. I am uncertain how far more extended experience may confirm my diagnosis, as to the examples that will demand that especial circumspection which I suggest. I certainly do not propose the views here offered in this respect as having dogmatic significance. I have given expression to them in order that they may receive that sort of trial by which alone their value can be estimated. The unmistakeable evils that arise from the combination of circumstances which it has been my aim to illustrate must, I apprehend, be matter of experience to all psychological
physicians engaged in private practice. And it is at least well to point them out with distinctness, as a measure necessarily conducive to the selection of just methods of preventive anticipation.
Addressing my medical brethren through the pages of a medical periodical, I may probably without impropriety suggest that, in addition to all the foregoing considerations, they should have regard to their business interests in dealing with this class of cases; and accordingly, that they should leave to strangers as much as possible the duty of professional action in the event of removal to an asylum, when the necessity arises in private practice.
On the Various Forms of Mental Disorder, (being the Substance of Lectures delivered at the York School of Medicine.) By DANIEL H. TUKE, M.D., Visiting Medical Officer to the York Retreat.
(Concluded from page 364.)
Passing from the consideration of the several so-called monomanias, or diseased manifestations of somewhat isolated propensities, we may next consider a more general affection, viz.:
This, perhaps, the most interesting and best recognised form of mental disease, has been usually treated of by writers, as essentially a disorder of the reasoning faculties. Dr. Prichard classed it under intellectual insanity. We are disposed, however, to regard it as belonging primarily to the affective or emotional group. It is, as has been before remarked, the object of the classification here adopted to refer every form of disease to that class of the mental functions which the disease necessarily, though not exclusively, involves in its course. Thus delusional insanity necessarily involves the intellectual faculties. The same is true of dementia, idiocy, and imbecility, although these in general destroy the integrity of the moral feelings also. The animal propensities are, however, so far from sympathising with the condition of the intellect, that they may be in a state of vigorous action. Mania implies an excitement which so