A treatise on insanity and other disorders affecting the mind

Front matter

DEPOSITED BY

THE ESSEX SOUTH DISTRICT MEDICAL SOCIETY

J* m <Ju

Chapter II

PHENOMENA OF INSANITY DESCRIBED AS THEY ARE MANIFESTED IN THE DIFFERENT FORMS OF THE DISEASE.

Nect. I. — Moral insanity.

Description of moral insanity.

State of the temper and affections, 21.

State of the understanding, 21.

Examples given by M. Pinel, 22. 1»

Remarks on this disease by M. Esquirol, 22.

Remarks of M. Georget, 23.

Varieties of moral insanity, 24.

Melancholy and dejection, 24.

Morbid excitement, 25.

Disorder connected with religious feelings, whether of dejection or excitement, 26.

Malicious propensity — morbid irascibility, 26. Beine Tollhe.it; insane propensities, 27.

Destructive propensity, 27.

Propensity to theft, 28.

Erotomania, satyriasis, &c, 28.

Senile insanity, 29.

Prognosis in moral insanity, 29.

Sect. II. — Monomania or partial insanity of the understanding. Character of this disease; denominations, 30. Monomania and melancholia, 30.

Common notion erroneous, 31.

State of the affections in monomania, 31.

Succession of phenomena in the development of this disease, 32. Different forms of monomania. Demonomania — misanthropical and melancholy illusions, 33.

Sect. 111. — Cases exemplifying the description of moral insanity and that of monomania, and illustrating the relation between these forms of disease and the tiansition from one to another.

First case of moral insanity, terminating in monomania and suicide, 36.

Second case — of moral insanity degenerating into monomania, 37. Third case — of moral insanity, 38.

Fourth case — of moral insanity with excitement, 41. Fifth case — moral insanity displaying eccentricity of conduct, 42. Sixth case — of moral insanity degenerating into monomania, 43. Seventh case — of moral insanity, 44.

Communications from several physicians, 45.

Case of moral insanity, communicated by Dr. Syrr.onds, 45. Cases and Commentaries upon them, communicated by Mr. Hitch, 47.

S,ect, IV. — Mania or raving madness.

Characteristic of the disease, 61.

Description of mania, 61.

State of highest excitement described by Pinel, 63. Graphical description by Chiaruggi, 64.

Sect. V. — Of the phenomena of protracted insanity, or of the advanced and chronic stage of the disease.

Ultimate tendency, 66.

Opinion of M. Bayle, 67.

State of chronic disease in maniacs and monomaniacs, 67. Observations of M. Calmeil, 68.

Sect. VI.— Of incoherence, or dementia.

Incoherence, primary and secondary, 69.

Opinions of Pinel, Esquirol, and Calmeil, 70. Essential character of this disease, 71.

Description by Esquirol, 72.

Several degrees of incoherence, 72.

First degree of incoherence or dementia. Impaired memory — stage of forgetfulness, 73.

Cases exemplifying this stage, 74.

Second degree of incoherence — Loss of the reasoning power, 76.

Third degree of incoherence — Incomprehension, 78.

Fourth and last degree of incoherence — Loss of the instinctive faculties — Inappetency, 79.

Sect. VII.— Of general paralysis complicated with insanity.

Account of this disease first given by M. Esquirol, 80.

M. Calmeil's description, 82.

Paralysis in the first degree, 82.

Second degree of general paralysis, 82.

Third degree of general paralysis, 83.

Accessory diseases complicated with general paralysis, 84.

1. Congestions in the brain, 84.

2. Hemorrhages in the cerebral substance, 84.

3. Simple hemorrhages between the lamina; of the arachnoid, 85.

4. Ramollissement, 85.

5. Erosions of the cerebral surfaces, 85.

Duration of general paralysis.

Opinion of M. Royer Collard and M. Esquirol as to the ultimate prognosis, 85.

Occurrence of this disease in English lunatic hospitals, 86.

Modification of paralysis more frequent in England, 88. Sect. VIII. — Observations on the state of the sensorial and intellectual functions in cases of insanity.

Conditions of the mind and the nervous system in moral insanity, 88.

Opinion of Broussais, 89.

State of the mental and sensorial faculties in other varieties of insanity, 89.

State of consciousness — Of sensation and perception, 90.

Observations of Cullen, of Jacobi, Guislain, Esquirol, 91.

Hallucinations — Hypochondriacal illusions, 91.

Disturbance of the Understanding — Opinions of La Roniiguiere and Guislain, on the judgment and reasoning power, 92.

Observations on the influence of the will in intellectual processes, 94.

Of attention — Opinion of Hoffbauer, 95.

Sect. IX. — Disorders in the state of the physical functions attendant upon madness.

Questions which is the primary disorder, 96.

State of the physical functions, 96.

State in chronic cases, 96.

State in acute cases, 97.

Chapter III. Of The Terminations Of Insanity

Sect. I. — General remarks on the duration and terminations of insanity.

Various periods of duration, 98.

Three terminations, 98.

Sect. II. — Of recoveries from insanity, and, first, of the various circumstances which have an influence on their proportional number.

Article 1. Of the complication of insanity with other cerebral disorders, 99.

Complication with general paralysis, 99. with epilepsy, 99.

2. Of the forms of the disease — What varieties of madness

are most curable, 100.

3. The period of the disease, 100.

Great probability of cure in the early periods — Fact from Willis, Tuke, Pinel, Esquirol — Instances of recovery after long duration of insanity — Facts, 101.

7. Circumstances of the constitution, 106.

Sect. III. — Of the proportional number of recoveries which take place in insanity generally.

Report of Dr. Burrows, 107.

of Dr. Maximilian Jacobi, 107.

Researches of M. Esquirol at Bicetre, the Salpetriere, and at Charenton, 108.

English lunatic asylums, 108.

Report of Bethlem hospital, 110.

Of provincial hospitals, 111.

Of Lancaster County Asylum, 111.

Of Gloucester County Asylum, 112.

Of the Retreat near York, 113.

General Conclusion, 113.

Sect. IV. — Of the termination of insanity in death.

Modes by which insanity induces death, 114.

Mortality in different form3 of derangement, 117. Sect. V. — Of Relapses, and of recurrent insanity.

Liability to relapses — Proportion in which madness is recurrent,

Chapter IV. Of The Causes Of Insanity

Sect. I. — Nature of the causes of insanity.

Distribution under different heads, 120.

Sect. II. — Predisposing causes of insanity.

Article 1 . Of constitutional predisposition, whether hereditary or original, 121.

2. Of sex : Facts collected from various countries as to

the different proportions of lunatics in the two sexes 124.

3. Of age : Facts illustrative of the difference of predis-

position in different ages, 126.

4. Of temperament: Peculiarities of complexion and of

form which are supposed to denote predisposition to insanity in general, or to particular forms of the disease, 129.

5. Previous attacks of insanity and other diseases of the

brain, 130.

6. Of education, 131.

Sect. HI. — Of the productive causes of insanity — Moral and physical causes, 132.

Opinions of Heinroih, Guislain, Georget, 133. Statements of Pinel, 135.

Several statements by Esquirol, 137.

Sect. IV. — Of particular moral causes.

Article 1. Care and anxiety, 130.

2. Passions and emotions, 140.

Different proportions of unmarried and married person? — Jacobl's statement, 141.

3. Apprehensions relating to a future state, 142.

Of insanity connected with religious impressions — Facts relating to religious madness, so termed, in general, 143.

Comparison of Catholics and Protestants in this respect — Statements of Hallaran, Guislain, and Jacobi, 146.

Observations by Mr. Tuke on cases of this description and on the causes of insanity in general, 151. Sect. V. — Physical causes of insanity, 153. 1. Injuries of the head, 153.

Singular phenomena reported to be the remote consequences of injuries of the head, 153.

2. Insolations and exposure to heat, 154.

3. Metastasis, 154.

4. Intoxicating liquors and other stimulants, 154.

5. Sensuality, 155.

6. Intestinal irritation, 156.

7. Causes depending on states of the uterine system, 156. Dysmenorrhreal affections, 156.

Suppressions of the catamenia. 157.

Puerperal madness, 157. ,

Chapter V

RESULTS OF NKCROSCOPICAL RESEARCHES INTO THE CHANGES OF STRUC- TURE CONNECTED WITH INSANITY.

Sect. I. — Morbid phenomena discovered in the head : Researches of Morgagni, Greding, Haslam, Pinel, Esquirol, Georget, Bajle, Calmeil, Foville.

Observations of Morgagni, 158. of Greding, 158.

— of Haslam, 159.

-- of Georget, 159.

- of Pinel, 160.

10 ANALYSIS OF THE CONTENT8.

Observations of Esquirol, 160.

of Bayle, 161.

Abstract of M. Calmeil's observations, 162.

Abstract of M. Foville's observations, 164.

Sect. II. — Of morbid appearances in the thoracic viscera.

1. Diseases in the lungs, 170.

2. in the heart, 190.

Observations of Nasse, Romberg, and Foville, 170. Sect. III. — Of diseases in the abdomen discovered in cases of insanity. Observations of MM. Scipion, Pinel and Esquirol, on disorders of the intestinal canal in madness, 172.

Chapter VI. Theory Or Pathology Of Mental Derangement

Sect. I — General remarks on opinions maintained by different writers — Opinions of Heinroth and others that insanity is a disease of the mind properly so termed, 174.

Jacobi's refutation of the opinion of Professor Heinroth, 176.

Sect. II. — Of the, opinions of MM. Georget, Foville, and others that Insanity is an idiopathic disease of the brain, 177.

Sect. III. — Of the opinion of Pinel, that the cerebral disease is sympathetic, 178.

Sect. IV. — Survey of the preceding theories, and general conclusions as to the nature of insanity, 180.

Chapter VII. Treatment Of Insanity

Sect. I. — Therapeutical treatment of insanity, 185.

Article 1. First practical indication in the medical treatment of insanity, 185.

Of the propriety of bleeding.

Opinions of Cullen, 186.

Pinel, 187.

Esquirol, 187.

Haslam, 188.

Rush, 188.

Arguments of Foville on this subject, 189.

Concluding observations, 190.

Of abstraction of heat from the head — regulation of

temperature — bathing, 193.

Of counter-iiritation, 194.

Of purgatives, 195.

Of emetics, 195.

Of digitalis, 197.

Of the use of opium, 197.

— hyoscyamus, 199.

camphor, 199.

mercury, 200.

rotatory motion, 200.

2. Second practical indication in the medical treatment of insanity, 201.

ANALYSIS OF THE CONTENTS. H

Sect. II. — Moral treatment of insanity, 204.

Article 1. Of the propriety of secluding the insane, and separating them from their friends and society, 205.

Opinions of MM. Esquirol, Pinel, and others on this subject, and general conclusions, 205.

2. Of other means of abstracting lunatics from the morbid

impressions and associations which foster their mental diseases, 213.

3. Of the moral discipline and personal control under

which lunatics ought to be placed, 217.

4. Of the treatment of the understanding of lunatics, in

relation to their illusions and the morbid impressions on their minds, 219.

5. On the arrangement and management of lunatic asylums,

Chapter VIII. Of Puerperal Madness

Sect. I. Description and general account of the disease, 222. Sect. II. Terminations of puerperal madness, 224. Sect. HI. Causes and pathology of puerperal madness, 225. Sect. IV. Treatment of puerperal madness, 227.

CHAPTER IX. OF idiotism and mental deficiency

Sect. I. General description of idiotism and mental deficiency, 230.

Of cretinism, 230.

Of ordinary idiotism, 232.

Of imbecility, 234.

Sect. II. Causes of idiotism, 235.

CHAPTER X. T STATISTICS of insanity

Sect. I. Statistical history of insanity in Britain, 236. Sect. II. Statistical history of insanity in France, 242. Sect. III. Statistics of insanity in other countries : General observations, 246.

Number and condition of lunatics in Belgium and Holland, 246.

In the Prussian states, 247.

In Norway and other countries in the north, 248.

In the United States of America, 249.

In Italy and the South of Europe, 250.

In barbarous countries, 250.

Chapter XI. Of Unsoundness Of Mind In Relation To Jurisprudence

Sect. I. General observations : Three sources of Unsoundness, 252 Different course pursued in the English and Roman law, 253.

Sect. II. Of mental deficiency in its different modifications and degrees: Hoffbauer's stages of silliness and stupidity, 256.

Sect. III. Of disorders of the mind considered in relation to jurisprudence, 264.

Sect. IV. Of moral insanity, in its relation to criminal and civil law ; Observations on the criterion of insanity according to English physicians and lawyers. Statement of a different opinion, 271.

Sect. V. General observations on homicidal madness, 273.

Sect. VI. Continuation of the same subject. Allusion to some remarkable cases exemplifying homicidal madness and the character of moral insanity, 279.

Sect. VII. Of suicide, 284.

Sect. VIII. Of other modifications of moral insanity, 285.

CHAPTER XII. OF ecstatic affections

Sect. I. General account : Ordinary phenomena, 287.

Of dreaming and somnambulism, 288.

Sect. II. Of artificial somnambulism.

History of animal magnetism, 290.

Sect. III. Of the phenomena of animal magnetism, 298.

Kluge's account of the six stages of animal magnetism, 299. Sect. IV. Theory of animal magnetism, 303.

Dr. Stieglitz's account of the different theories of animal magnetism, 305.

Sect. V. Phenomena of real somnambulism. Ordinary and cataleptic somnambulism, or ecstasis. Comparison of the phenomena of somnambulism with those of the state induced by animal magnetism, 306.

Article 2. Ecstasis, or cataleptic somnambulism, 314. Sect. VI. Of maniacal ecstasy, or ecstatic madness, 319. Sect. VII. Of ecstatic visions, or traces, 320.

Remarkable case communicated by Dr. Arnould, 321. Sect. VIII. Further observations on the pathology of ecstatic affections, 323.

Supplementary note on peculiar configurations of the skull connected with mental derangement, with observations on the evidence of phrenology and on opinions respecting the functions of the brain, 325,

Of the form of the skull in lunatics, 325,

Of the form of the skull in idiots, 326.

Survey of the doctrine of the phrenologists, 326.

Later researches into the functions of the brain, 334.

Opinions of Dr. Fqville, 336.

TREATISE ON INSANITY

OTHER DISORDERS OF THE MIND.

INTRODUCTORY CHAPTER.

PRELIMINARY REMARKS ON THE DEFINITION OF INSANITY: NO- SOGRAPHY OF THE DISEASE : ITS DIFFERENT FORMS.

Writers on disorders of the mind have frequently remarked that it is difficult to furnish a definition of insanity, which may enable us at once to recognise it when it exists, and to distinguish it from all other conditions whether of health or disease. So great, indeed, has this difficulty appeared to some authors, that by them it has been thought better to lay aside such an attempt. It is, however, requisite, at the commencement of a treatise on any subject of extensive relations, that the writer should make known to his readers in as clear and definite a manner as possible what is the precise nature of the objects to which their attention is to be directed. On this consideration I find it to be incumbent upon me to take some notice of the attempts which have been made to define or characterise insanity ; and if these attempts should be found, on examination, unsuccessful, to supply the defect if not by a new definition, at least by some brief description that may answer the same purpose.

It has been said, with perfect accuracy, that insanity is a disorder of the system by which the sound and healthy exercise of the mental faculties is impeded or disturbed. The definitions adopted by several modern writers have nearly this meaning, though expressed in various terms.* Yet this statement cannot be considered as a

* See MM. Heinroth, Fodere, Georget, Guislain, Broussais, Jacobi. April, 1837. 2

14 DEFINITIONS OF INSANITY.

sufficient definition of insanity, for while it probably comprises every form of that disorder, it includes also many other morbid affections. Among the latter may be mentioned the varieties of delirium which occur in phrenitis, typhus, and other febrile and inflammatory diseases, and which ought not to be confounded with insanity, though they are comprehended within the definition above proposed. On this account it becomes necessary to introduce some express limitations. For a similar reason it appears requisite to exclude the disordered state of the mental faculties, consisting chiefly in stupor and diminished capability of sensation and perception, which accompanies lethargy, apoplexy, and other comatose diseases. There are some other morbid conditions of the brain and of the faculties dependent for their exercise on the functions of that organ, which must in like manner be excluded by particular restrictions. Such are congenital idiotism and the mental weakness of old age. Now it is obvious that a definition loses all its utility, when it is fpund necessary to encumber it with so many additional circumstances. Thus the endeavour to define insanity in the most simple and obvious terms which suggest themselves, is found to afford no satisfactory result, and a like disappointment has ensued on every similar attempt.

It appears that the practical advantages of a definition can, in this instance, only be attained by stating what are in reality those disturbances which the mental operations sustain in cases of insanity. These disturbances, however, present very different phenomena in different forms of the disease, and we cannot attempt to enumerate them or describe them in a collective statement, till we have taken notice of their principal varieties.

It has generally been supposed that the chief, if not the sole disorder of persons labouring under insanity consists in some particular false conviction, or in some erroneous notion indelibly impressed upon the belief. Mr. Locke made a remark which has often been cited, that " madmen do not appear to have lost the faculty of reasoning ; but having joined together some ideas very wrongly, they mistake them for truths, and they err, as men do that argue right from wrong principles." From Mr. Locke's time it has been customary to observe that insane persons reason correctly from erroneous premises; and some instance of illusion, or some particular erroneous impression has been looked for as the characteristic of the disease, or an essential circumstance in it. Dr. Cullen seems to have had Mr. Locke's observation in his mind when he laid down the definition of insanity, which occurs in his ' First Lines.' He describes this disease to be," in a person awake, a false or mistaken judgment of those relations of things which, as occurring most frequently in life, are those about which the generality of men form the same judgment, and particularly when the judgment is very different from what the person himself had before usually formed." Cullen attempted to draw even this description within narrower limits, by observing that " there is generally some false perception

DIFFERENT FORMS OF INSANITY. 15

of external objects, and that such false perception necessarily occasions a delirium or erroneous judgment, which is to be considered as the disease." That this is by far too limited an account of insanity, and only comprises one among various forms of mental derangement, every person must be aware who has had opportunities of extensive observation.

An attentive consideration of the phenomena which present themselves in different cases of insanity, enables us to observe several forms of varieties, which are distinguishable from each other by well-marked lines. To one division of cases, — namely, to those which are referrible to the form of madness termed melancholia, monomania, or partial insanity, — the preceding remarks of Mr. Locke and Dr. Cullen are alone applicable. These are instances in which the illusion of the understanding is connected with some particular subject, and leaves the judgment comparatively clear in other respects. The phenomena of such cases are very different from those of mania or raving madness, in which the mind is totally deranged, and the individual affected talks nonsense, or expresses himself wildly and absurdly on every subject. There is, in the third place, a class of persons generally reckoned among lunatics, but consisting chiefly, though not entirely, of individuals whose disorder has already reached an advanced or protracted stage. In these the condition of the faculties is such as to preclude the possibility of any mental effort or voluntary direction of thought. The most striking characteristics in this state are the rapid succession of ideas, and the unconnected manner in which they enter into the mind, without order or coherence, or, at least, without following their ordinary and natural arrangement and association. Incoherence is the characteristic of this morbid condition.

The modifications of insanity already mentioned are affections of the understanding or rational powers, but there is likewise a form of mental derangement in which the intellectual faculties appear to have sustained little or no injury, while the disorder is manifested principally or alone, in the state of the feelings, temper, or habits. In cases of this description the moral and active principles of the mind are strangely perverted and depraved ; the power of self-government is lost or greatly impaired; and the individual is found to be incapable, not of talking or reasoning upon any subject proposed to him, for this he will often do with great shrewdness and volubility, but of conducting himself with decency and propriety in the business of life. His wishes and inclinations, his attachments, his likings and disli kings, have all undergone a morbid change, and this change appears to be the originating cause, or to lie at the foundation of any disturbance which the understanding itself may seem to' have sustained, and even in some instances to form throughout the sole manifestation of the disease. The older nosologists, Sauvages, Sagar, and Linnaeus, were not wholly unaware of these distinctions, for in their distributions of mental disorders, we find, besides an order of Vesanise or Hallucinationes, in which errone-

16 NOSOGRAPHY OF INSANITY.

ous impressions were supposed to affect the understanding, another department, styled Morositates, or Morbi Pathetici, consisting of depraved appetites and other morbid changes in the feelings and propensities. The disordered states, however, which are classed under these heads, are not, all of them at least, strictly forms of insanity ; and Pinel appears to have been the first writer who, with a clear conception of the subject, distinguished a class of mental disorders under the term of " madness without delirium." Pinel, who was an acute and original observer, and whose opinions carry much weight on account of his extensive opportunities of investigating the history of madness, has made the following remark in reference to the sentiments of Mr. Locke : — " We may justly admire," he says, " the writings of this philosopher, without admitting his authority upon subjects not necessarily connected with his inquiries. On resuming, at Bicetre, my researches into this disorder, I thought, with the above author, that it was inseparable from delirium or delusion, and I was not a little surprised to find many maniacs who at no period gave evidence of any lesion of the understanding, but who were under the dominion of instinctive and abstract fury, as if the active faculties alone had sustained injury."

The examples given by Pinel in illustration of this remark were not fortunately chosen, and they are all of one kind, namely, of that in which the principal manifestations of insanity were violent fits of anger or rage. The general observation which the author has so clearly expressed, that insanity consists, in certain cases, in a morbid perversion of the affections and moral feelings exclusively, and without any perceptible lesion of the intellectual faculties, is a fact of the highest importance, pathologically and practically, and the opinion of the author above cited, in this particular, deserves the most attentive consideration. In the following pages I hope to confirm this opinion, and to show that the facts which I shall adduce are sufficient to authorise a more general statement than the particular instances hitherto related would lead us to adopt.

If the preceding observations are well founded, we shall be enabled to distinguish the principal forms or varieties of insanity under the following terms: —

1. Moral Insanity, or madness consisting in a morbid perversion of the natural feelings, affections, inclinations, temper, habits, moral dispositions, and natural impulses, without any remarkable disorder or defect of the intellect or knowing and reasoning faculties, and particularly without any insane illusion or hallucination.

The three following modifications of the disease may be termed Intellectual Insanity in contradistinction to the preceding form. They are severally : —

2. Monomania, or partial insanity, in which the understanding is partially disordered or under the influence of some particular illusion, referring to one subject, and involving one train of ideas, while the intellectual powers appear, when exercised on other subjects, to be in a great measure unimpaired.

NOSOGRAPHY OF INSANITY. 17

3. Mania, or raving madness, in which the understanding is generally deranged ; the reasoning faculty, if not lost, is confused and disturbed in its exercise ; the mind is in a state of morbid excitement, and the individual talks absurdly on every subject to which his thoughts are momentarily directed.

4. Incoherence, or dementia. By some persons it may be thought scarcely correct to term this a form of insanity, as it has been generally considered as a result and sequel of that disease. In some instances, however, mental derangement has nearly this character from the commencement, or 'at least assumes it at a very early period. I am therefore justified in stating it, after Pinel, to be a fourth and distinct form of madness. It is thus characterised by that justly celebrated writer : — " Rapid succession or uninterrupted alternation of insulated ideas, and evanescent and unconnected emotions ; continually repeated acts of extravagance ; complete forgetfulness of every previous state ; diminished sensibility to external impressions ; abolition of the faculty of judgment; perpetual activity."

If I am correet in assuming that all the varieties of madness may find their place under one of the descriptions thus marked out, a short nosography of the disease, which will answer many of the purposes of a definition, will be furnished by summing up the characteristics of the different forms. We may, then, describe insanity as a chronic disease, manifested by deviations from the healthy and natural state of the mind, such deviations consisting either in a moral perversion, or a disorder of the feelings, affections, and habits of the individual, or in intellectual derangement, which last is sometimes partial, namely, in monomania, affecting the understanding only in particular trains of thought; or general, and accompanied with excitement, namely, in mania, or raving madness ; or, lastly, confounding or destroying the connections or associations of ideas, and producing a state of incoherence.

I shall now endeavour to draw an accurate and tolerably complete description of the phenomena of insanity, containing a statement generalized from a multitude of particular examples. In this description, while I avail myself of the aid afforded by the best practical writers of different countries, it will be my aim to avoid the admission of any circumstance or feature of disease which I have not in more or fewer instances actually observed. The reader will find, if I am not mistaken in the evidence of facts which I shall lay before him, enough to confirm and illustrate the preceding remarks, and to show how far the distinctions laid down are sufficient and complete.

NOTES ON THE PRECEDING CHAPTER.

The division of the forms of insanity pointed out in the preceding chapter is the most simple that is admissible, or adapted to the April, 1837. 3

18 PROFESSOR HEINROTH'S FORMS OF INSANITY.

existing varieties of the disease ; it is entirely practical, and founded on observation. A more extensive arrangement has been laid down by Professor Heinroth, in his celebrated Treatise on Derangement of the Mental Faculties, a work which, though singular and absurd in some of its fundamental principles, is, perhaps, of all treatises on disorders of the mind, the most elaborate and comprehensive. Heinroth's distribution is rather theoretical or speculative than the result of actual observation and experience ; yet it will be found worthy of consideration.

The disorders of the mind, according to this writer, are only limited in number and in kind by the diversities which exist in the operations of the mental faculties. The mental operations are of three distinct kinds, and are referred on the testimony of consciousness to three different departments in our inward nature, viz. to those of the feeling or sentiment (des gemiiths), the understanding, and the will. The emotions of joy, grief, pleasure and pain, the mental processes of reflection and contemplation, and the voluntary act of self-determination, are three kinds of mental phenomena, which, as they present themselves to our inward consciousness, are so clearly and strongly distinguished from each other, that it is impossible to confound them. " If the cause of derangement is in relation to one of these manifestations of mental existence — and to one or another it must belong, since the mind is ever occupied with phenomena related to one out of the three classes — we have only to inquire to which modification the disorder actually refers itself, or whether it affects the feelings, the understanding, or the will. Since one of these has possession of our consciousness, or is at least predominant at every point of time, whichever function of the mind happens to be that which is falling into disorder, by it the form of insanity is determined." Thus we have, continues Heinroth, three classes of mental diseases corresponding to the three departments of our minds. A second distinction is founded on the character of the disturbance which is experienced ; whether it is of the nature of exaltation or depression, of increased or diminished excitement.

It would be superfluous to follow Herr Heinroth closely through the particulars with which he has filled up the preceding outline. It appears, indeed, to me that he has inadvertently lost sight of his original principle of discrimination, and has confounded essentially separate forms of mental disorder, for which he had provided distinct places in his system. I shall simply enumerate the principal modifications of derangement of the mind, or of its diseases and defects, according to the principles of Heinroth's method.

First kind of mental disorder. — Disorders of the moral dispositions.

The first division consists, as above stated, in disorders of passion, feeling, or affection, of the gcmllth, or moral disposition. This has two forms.

First form : — Exaltation or excessive intensity. Undue vehemence of feeling.

Morbid violence of passions and emotions.

PROFESSOR HEINROTH'S FORMS OF INSANITY. 19

Second form : — Depression.

Simple melancholy, dejection without illusion of the understanding.

Second kind of mental disorders.

The second division consists of disorders affecting the understanding or the intellectual faculties.

First form : — Exaltation.

Undue intensity of the imagination, producing mental illusions.

To this head belong all the varieties of monomania. Second form : — Depression.

Feebleness of conception ; of ideas. Imbecility of the understanding.

Third kind of mental disorders.

The third division comprises disorders of the voluntary powers, or of propensities, and of will.

First form : — Fxaltation.

Violence of will and of propensities.