Mental Maladies

MENTAL ALIENATION (part 6)

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.

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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

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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

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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

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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.

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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.]

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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

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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-

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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.

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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.

MENTAL ALIENATION (part 7)

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

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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.

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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

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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

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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

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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.

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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

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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-

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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

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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.

MENTAL ALIENATION (part 8)

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-

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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

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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

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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,

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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

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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

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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

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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.

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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-

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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-

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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-

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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-

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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

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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.

CLIMATES, SEASONS, AGES AND SEX, CONSIDERED AS (part 2)

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.

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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.

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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

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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

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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-

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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

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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

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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

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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

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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

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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.

CLIMATES, SEASONS, AGES AND SEX, CONSIDERED AS (part 3)

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

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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.

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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.

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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

REASONING MONOMANIA (part 2)

* 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

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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.

REASONING MONOMANIA (part 3)

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-

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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

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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

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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

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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.

REASONING MONOMANIA (part 4)

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-

MALADIES TO WHICH THOSE WHO ARE IN A STATE OF DE-

MENTIA SUCCUMB, AND THE RESULT OF CADAVERIC EX-

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 ;

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