A treatise on those disorders of the brain and nervous system, which are usually considered and called mental

Chapter I. Preliminary Nosology, Phrenology

AND NOMENCLATURE.

Circumstanced as is the author of the present treatise in reference to cases of mental aberration, having constantly under his care every grade and every shape of deranged intellect ; now being called to visit in the Asylum to which he is professionally attached, the horrible convulsions constituting an epileptic paroxysm, now the circumstances and consequences of an apoplectic seizure ; on this day being required to investigate a malady, the features of which may scarcely be visible without painful scrutiny ; on another day being placed almost in personal danger by the sufficiently palpable and violent ebullitions of maniacal fury ; at one moment having to trace the oftentimes faint line of demarcation between inflammation of the brain, and states simulating it, at the next to aim at ascertaining whether visceral or vascular conditions are the sources, or only the incidents of derangement ; being, moreover, in many cases, called on (and sometimes for judicial purposes) to decide the very difficult, but very momentous question, whether acts have been the result of controulable impulse or delusive excitation ; it may not be charged upon an individual thus engaged, that he is incompetent to write on insanity, on the ground that what he writes must rather be the closet coinage of his own brain, than the fruits of actual and practical observation.

So far indeed as opinions and deductions may differ from others, such sentiments and inferences are open to free canvass and fair criticism ; but that he speculates without the materials for speculation, or deduces without sufficient data, cannot surely be said of a physician whose official duties — to say nothing of private opportunities — comprise such superintendence as that just alluded to.

I am not desirous of putting forth any boastful pretensions beyond the warranty of truth; I wish not to conceal that the medical management of the house to which I am physician, is mainly in the hands of a resident and intelligent practitioner ;* and that we moreover receive assistance from a visiting surgeon.f Many of our inmates also have passed through their probationary state, and have been sent to us as incurables ; so that little more can be effected for these than the insurance of as much well-being as their situation admits. It is among

* Mr. Middleton, now of Fore-street, a very efficient officer and excellent man, has but recently left us. He is succeeded by one who promises to be as was Mr. M., every thing desirable. The name of this last gentleman is Norris.

f Mr. Manico, who resides in Peckham, at no great distance from the establishment, and who is highly respected and beloved by all who know him.

PHKENOLOGV, AND NOMENCLATURE. 3

the fresh subjects that the chief interest of our vocation consists ; it is among them that we are principally called on to witness the vast modifications of wandering intellect, and it is the having to do with them which more especially furnishes materials out of which to construct a treatise on nervous disorders, or on those ailments that are illogically deemed and erroneously designated manifestations of" an unsound mind."

My plan is first to trace out the subject by a broad and general outline ; then to present in substance and detail what shall thus Irave been indicated. This detail will comprehend the essentials of insanity, its prominent manifestations, its sources, exterior and internal, the particulars which present a prospect of recovery, or, on the other hand, menace permanence ; appearances found after death ; treatment, medical, moral, and domestic ; and as resulting from, or rather as constituting portions of this detail, the subjects of confinement, and coercion, and classification will fall under remark, with some other points on which a criminal inattention and cruelty on the one hand, and much abstract reasoning and Utopian feeling on the other, have been too conspicuous ; but out of all which much good has already, and will continue to be extracted by those who devote themselves without intimidation and without prejudice, to the important matter of mental alienation, and who constantly think and act under the consciousness that to be honest, moderate, manly, and really humane, whether good report

b 2 or evil report attend their endeavours, is to pursue the only justifiable policy, and eventually to insure the happiest results.

What is a nervous disorder? In one sense, as well remarked by Dr. Beddoes, all maladies are necessarily and essentially nervous ; the very term disease implying pain, and pain not being producible in any other way than through the medium of the nervous organization.

We often, however, meet with cases in which the perceptions are deranged, without any obvious or demonstrable cause. A physician, for example, shall be called to a female invalid, who, when well, was conspicuously alive to all the duties and delights of maternal relationship; she is now listless, and unsusceptible of either pleasurable or painful emotion. In common parlance she is in a nervous state. If she is told to be " up and active" — if she be appealed to as a wife and mother — if vivid representations are placed before her, respecting the injury she is inflicting both on herself and all about her ; she may subscribe to the abstract truth of your truisms, but she goes no further. Her belief does not influence her conduct. But let one of her infants be suddenly snatched from the domestic circle by the grasp of disease, and laid probably on the bed of death, and what a change will be instantaneously operated ! All the anxieties and alarms of a mother are now called forth from their hidinoplaces ; motives and actions are changed. The disorder has disappeared ; and thus has incident instantaneously effected what months of prosing and prescribing might in vain have endeavoured to accomplish.

Here let me take occasion to remark, that our nervous invalid, previously to conversion, was equally insane as to essence, — whatever the difference in degree, — with the confirmed, and solitary, and obstinate melancholic, who, amidst crowds of fellow lunatics, each calculated to excite attention and sympathy, is apparently buried in himself, and busied only in his own cogitations ; no more regardful of the painful interest spread out before him than would a blind man be delighted by the rich verdure of a British meadow, with all its delicious freshness, or one totally deaf be susceptible of painful excitation by the most unharmonious combination of musical sounds.

That thus in measure, more than in kind, do nervous derangements differ, is, in my judgment, an important principle for regulating practical inference ; and as, in the course of these pages, it will be my endeavour to substantiate and illustrate this principle, I have, in this preliminary chapter, adverted to it ; desirous as I am it should be understood, that while contending for its rectitude, I am not influenced by any wish to broach extravagant doctrine, or support untenable assumption. My object is merely to simplify in accordance with truth and nature, to show that nosological distinctions and nomenclatural designations are often worse than useless, inasmuch as they are occasionally conceived in, I was about to say, wanton defiance of good sense and straight-forward observation ; and being thus totally unnatural, they are not only unmeaning, but absolutely insusceptible of any proper bearing upon pathological or practical pursuit.

Erroneous conception, I shall afterwards have occasion to prove, constitutes the main ingredient of positive madness : this misconception, however, may be considered as always more or less engendered out of false perception, so that it is the feeling rather than the conceit which constitutes the radix of the whole. Now this feeling sometimes takes entire possession of the frame, every thing then being regulated by the insane ideas ; at other times the individual is both bodily and mentally well— or rather being bodily is mentally well — so far as we can refer health to any given standard ; while to one impression only does his understanding give way. To take one out of numerous examples. I have had an interview with a "young gentleman of first rate accomplishments, and full of intellectual vigour and propriety, who, immediately you mention the word elephant, whether by design or accident, whether in combination or by itself, is suddenly seized with a species of horrific spasm ; and while the impression lasts, is, to all intents and purposes, a madman.*

* When I was first introduced to this young gentleman, my friend asked him whether he came to town that day by the Elephant and Castle, and the immediate alteration in his countenance was striking to a painful degree ; he, however, by a great effort of his will, overcame the effect, and rejoined the conversation ; when the word was again announced, he rushed out

Now this instance would be named, in the schools, Monomania, and the term is well enough as an expression of occurrence ; but to suppose this or any other word capable of being stretched out into theory, or of embodying an abstraction, is to proceed upon assumptions altogether vain and visionary — it is to endeavour at giving essence and being to what is a mere circumstantial quality ; and that practitioner would be quite as philosophical in his nomenclature as these nosological classifiers, who should say of individuals in the same house, labouring under fever, that one had got " a Jack, and the other a Tom fever."

Monomaniacal misconception will be again adverted to, when we shall be considering the circumstances and treatment of insanity more in detail ; I now proceed to remark, that a question of much interest and nicety protrudes itself on the very outset of disquisitions respecting the nature of the malady, especially when our notions are limited to erroneous conceit as its essential characteristic. It will often be the duty of a medical counsellor to determine whether an act committed in a perturbed state of nerve and brain have been the absolute of the room, as if this second sounding was beyond his endurance, and we saw him no more.

It is curious that he connects some kind of allusion to himself, whenever he hears this shibboleth uttered. He was once standing in a stationer's shop, when a lady came in and asked for some elephant paper ; he immediately took up a parcel from the counter, and hurled it at her, as an assailant of his peace.

consequence of an uncontrollable impulse, or one which the due exercise of mental power might have checked in purpose, and prevented in perpetration. Writers on madness have been puzzled, even perhaps beyond their own consciousness, in attempts at definition of the insane state, from the source of difficulty now referred to, and as will more clearly appear when I am treating on definition, a sort of provisionary or gratuitous clause has been appended to their account of essentials. Now part of this difficulty is founded on the fact of our almost necessary ignorance respecting the motives actuating another individual, and the internal workings of another's mind. It is easy, for instance, to condemn suicide as a deed of criminality or cowardice, but before we can substantiate our charge thus sweepingly brought, we must be sure of the precise condition of nerve at the time of perpetration of the deed. On this head, likewise, I shall have again to dwell afterwards somewhat more at large, and I here merely advert to, by way of illustrating the exceeding nicety attending all disquisitions on the subject of insanity, when delusion, and delusion alone, is allowed to be its constituent. Passion is certainly not madness, if misconception only is ; and yet, to distinguish the impulse of misconception from the impulse of fury is often to prove ourselves in a degree mad, by manifesting that we judge by mistake. A part of this difficulty may be met by recognizing those extremely rapid changes of feeling and belief which run through the maniac's mind. "Avoid me, or I shall do you an injury," says the insane sometimes to those about him ; but why not perform the purpose without giving the warning ? Because the individual is now only excited. Under the subsequent delusion he commits some enormity, and then contrition rushes as speedily among his feelings, as did the previous delusion. This hurry of changes is forcibly pourtrayed, in a late work on insanity by Dr. Conolly; it may, and probably has been compared to the circle of light which is formed by a revolving spark, and which light, though only of course actually present at one point, seems to our perception to be in the whole circle at the same instant.

There are, indeed, many instances in which a fixed, determined purpose is, day after day, and year after year, contemplated by the maniac, he only awaitino- a favourable time for the execution of the same ; such an instance we have in that forcibly pourtrayed account of Norris, in Bedlam, given by Dr. Haslam ; but in these cases the revenge and its consequences are evidently grounded in mistake, otherwise a prison, and not a mad-house, would be the proper security of the patient. But if madness be crime, and crime madness, there is an end of the matter. It is not, however, so ; there must, I repeat, be some mistake or misconception mixed up with the emotions of the mind in mental disorder, otherwise, as I have elsewhere remarked, we go a considerable way towards demolishing all the landmarks which stand between virtue and vice ; we commiserate moral ill precisely as we do mental alienation ; since, then, criminality in all its extent resolves itself into organic necessity, and the hand of the assassin is urged by the same impulse as that which directs the wild beast of the forest in springing upon its prey, or the foaming cataract in rushing down the mountain steep !

We shall afterwards, as above intimated, have occasion to notice that much of practical and judicial importance attaches itself to the problem, whether actual madness may be predicated without positive delusion ; here the topic is only introduced in a preliminary or introductory manner ; but even here it may be permitted me to remark, that if motive be thus the measure of insanity, and if nervous disorders, in all their grades, are the same in essence, a vast field spreads itself out before us, in reference both to individual responsibility, and the due appreciation of preventive circumstance. Only for a moment let us turn our thoughts to the difference produced in the feelings and conduct of a person after he shall have taken a few glasses of wine, or a single grain of opium. Then let us extend our contemplation over the whole range of various excitation, to which we are all exposed necessarily, or to which we voluntarily subject ourselves; and the surprize will be, that so many do so well as is found to be the case; and it will, moreover, be made, one should think, sufficiently evident, that to graduate disorder by the scale of nosology, and to separate into so many distinct abstractions, as some attempt, is a vain attempt. Nay, the endeavour implies a violation of all rectitude. Mental, or rather nervous, like all other malady, is circumstantial, not abstract.

But what, it will be asked, is the condition of nerve and brain, when disorder becomes confirmed and conspicuous ? To this question the reply is not easy. When discoursing on the pathology of nervous derangement, we shall have to adduce several conditions of the organization implicated, some more and some less demonstrative and satisfactory, in the way of explication ; change, indeed, of external shewing cannot well be conceived without change of internal state ; but who shall pronounce upon the precise nature of that change in the sentient organization, when unexpected intelligence instantaneously destroys a keen appetite ? when madness occurs as the immediate result of some heart-rending disappointment? when the whole man is thoroughly, and in a moment, revolutionized by a change of scene and circumstance? or when faith in a physician at once breaks down the strong holds of hitherto confirmed disease?

Under slower and successive operation of excitants, visible and appreciable alteration, as will afterwards be noticed, manifests itself in connexion with, if not as a source of, deranged consciousness ; and I may here briefly cite the case of Jurieu, as mentioned by Beddoes. This poor man locked himself in his study, for the purpose of scanning thoroughly the meaning of St. John's Revelation. The confinement, exclusion from fresh air, and anxiety which the determination brought with it, came at length so to derange his feelings and secretions as to occasion spasms, and pains, and flatulence. The concomitant or result of all this perturbation was a conceit that the Beast of blasphemy with ten heads, and ten horns, and ten crowns on his horns, had made good his lodgment within him, and was rending and gnawing his vitals.

Now, in these, and such like cases, the visceral disorder aggravates, to say the least, the brain and nerve sickness; but it must also be confessed, that on the one hand the heights and depths of the former (visceral affection) are often developed, though without any consequent or antecedent misconception; and on the other, the conceptions will not seldom maintain their wonted integrity, in spite of chylopoietic disturbance, be it great or little. Clouds upon the feelings are, in many cases, much more dependant upon clouds and electric changes in the atmosphere, than they are upon what is going on in the digestive apparatus: it was prettily said, by Van Helmont I believe, that the archer, though shooting at the head, often takes his stand on the stomach ; but he, at least, quite as often sends his arrows, winged with electric impulse immediately from the ethereal matter that is about us, and is himself almost as aerial and unsubstantial as any of the sylphs and gnomes of which Pope sings so sweetly in his delightful poem, the Rape of the Lock. But of this more in another place.

As on all hands, and by all theorists, it is admitted that the brain and nerves are in some mode or other the media of perception and consciousness, writers on madness have evinced an anxiety to acquire a knowledge of the laws by which these organs and their functions are regulated, on this ground ; that, could we ascertain the precise circumstances of mental health, we should be better qualified to mark out and map those manifold deviations from it, to which all are obnoxious. But philosophers and physiologists, in their researches on this head, have all egregiously failed. The vov <tt&> has ever eluded the research of the metaphysician, so much so, that the reader of these pages would be but ill repaid for his trouble, were I to attempt any thing like a detail of successive doctrines : — and, if metaphysicians have been bad — medico-metaphysicians have been still worse. " All medical doctrines," says Dr. James Gregory, in his blunt and forcible manner, " are stark staring nonsense ;" and it cannot be denied, that the disputations of the schools afford considerable justification to this sweeping condemnation of pathological theory. Thought, says one writer, is a secretion from the brain, as bile is from the liver. Ideas, says another, are vibrations and vibratiuncles. A third calls them configurations of the organs of sense. These are all modern — very modern conceits — and the individuals who have broached them are men of high intellect, and of moral worth. In what, however, do the conceits themselves differ from, but in their being more vague and unphilosophical than the phantasms of Plato, the Pineal gland of Descartes, and the Archseus of Helmont ?

Whence all this nothingness of abstract speculation? Why it is because the inquiries have been abstract, that they Lave so lamentably failed. The essential distinction has been lost sight of between final and efficient cause. A point has been assumed, where matter ends, and mind begins ; analogies have been eagerly sought for, while it has not been duly considered that the very terms mind and matter are gratuitous, and in no wise expressive of essence. Thus philosophy has been made a species of poetry — to " airy nothings" have been given " habitations and names" — and the whole fabric of medico-metaphysical speculation comes out to be merely formed of " the stuff which dreams are made of."

Has the new organology at all assisted our extrication from these " muddy depths of everlasting nonsense?" Have they sent physiological and pathological researches into the right path of pursuit? Have Gall or Spurzheim thrown out any intimations respecting mind, or rather its media, which may prove at last ad rem? or do these psycologists still bind us in those delusive tracks, which lead to that delightfully dread abode, the Castle of Doubt — " de. lightfully" — O, yes ! I wish, when thinking of it, to be young again, in order to enjoy its picturesque beauty, as magnificently pourtrayed by its great delineator, with the appendages of its grim ruler,

Giant Despair, and the restless, uxorious upbraiding of his anti -christian and anti-hopeful wife — but " tempora mutantur, and, alas ! nos mutamur."

In attempting a reply to the above questions, I expect it will be my fate not to satisfy either party. There is still, to my seeming, a great deal of mental circumstance quite inexplicable upon, if not in opposition to, the tenets of the phrenologists ; but at the same time I am of opinion, that to the ingenious theorists just named, physiology is much indebted.

The good that the science has already accomplished, consists in its having discarded imaginative reasoning, and sent it back to its proper province ; and in having taught us to regard every thing that concerns the living principle as futile and unsubstantial, beyond what can be made out upon the common principle of physics ; of the how and wherefore it does not profess to take cognizance.

Mind, it had hitherto been assumed, was a something connected with the thinking principle in the way of totality, and the especial faculties of perception, memory, abstraction, and imagination, were the result of its particular workings : but how, says the organologist, if this were the case, would we explain the superior and innate, or at least congenital adroitness of this individual in the computation of numbers, of that in the perception of sounds 1 Why is this man from his birth a philologist, that a mathematician? Were perception a distinct faculty, and were varieties merely varieties in the measure of mental power, how could the dull in physical pursuit be alive and alert in the investigation of moral science ? How could it come to pass that the youthful constructor of machinery should not be able to construct, with equal facility and readiness, the metrical number or the flowing sentence ?

That these objections are forcibly opposed to the doctrine of the faculties, as taught by the metaphysicians, all must admit; nor can the difficulty be done away with, by referring to the principle of early impression, or accidental association, since, of two children, brought up in the same nursery, and trained precisely under the same tuition, one shall show, from its infancy, a tendency to one thing, the other to another thing. One will be altogether careless how affairs are brought about, so that he has enjoyment in what is before him; the other has no pleasure, even in the most common toy, without desiring to look into its interior, and to ascertain the source and mode of its workings. Again, one reads and spells with avidity, and is already a verbal critic in miniature ; the other chops and carves fragments of wood into rude copies of things he has about him, and thus, by his very acts of infancy, calls upon papa early to initiate him into the principles and practice of mechanism.

The moral disposition also differs, even from the dawn of existence. This will show, by the first cry he utters, that he is about to be troublesome and wayward; that will manifest meekness and docility, through the same medium ; and as they grow up we shall find one to mix mercy even with its most wanton sports, while a sort of cruelty shall constitute the very essence of sport in the other.

To multiply instances, however, in proof of original diversity of character, were quite useless, as they must, by all, have been observed ; and the only question of interest that can connect itself with the admitted fact is, " how may these truths be philosophically or physiologically accounted for?"

We will suppose twenty individuals to be selected from others, as marked by conspicuous high-mindedness or self-esteem ; and each of these to have a particular fulness in the formation of the upper and back part of the head ; this being an index of brain development or fulness in that part, it might be fair, hypothetically, to suppose that such construction in the cerebral mass indicated always this particular temperament ; but the proof would not be complete unless you could select another twenty of different feeling and consciousness, and find in each and all of these last the formation referred to wanting. Were, however, this second series as uniform as the first, nothing short of unjustifiable scepticism would refuse to admit that such and such an exterior denotes, cateris paribus, such and such a disposition- In this way did Gall originally pursue his investigations ; and in this way was he brought to the inference, that the several innate or organic powers go together, to the formation of the sum total of character, the perfection of the character not consisting in the superabundance of this or that faculty, but in

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the proper balance and due adjustment of the whole; irregularities conducing to aberrations in the degree and measure of their existence.

To illustrate. If one of the twenty individuals, marked by nature with pride and self-conceit, be at the same time strong and full in those organs which are the media of mechanic skill, this individual will not only be himself satisfied that he has the capability of affecting much in the way of mechanism, but he actually is so capable. Now let both of these faculties be too much indulged, or unduly fostered by the extravagant praises of others, our proud mechanist will not be long in coming to estimate even his especial talent at, by far, too high a rate; scarcely any thing is too difficult, and he proceeds from step to step till he mounts up to the height of more than mortal prowess ; he feels that he is born to excel and to benefit his fellow men by prodigious exploits. From those around him he may now receive ridicule in place of their former flattery, a conflict of sentiment occupies his mind, and the result of the whole is a madhouse! " I intend,' said one of these high-minded madmen to another, " to throw bridges over the English Channel ; and I, said the other, am going to drain the Mediterranean, and plant it with apple-trees." A youth has been just with me whom I knew when an infant ; he has grown up with high perceptive and imaginative powers, and is, moreover, full and large in self-estimation. Scarcely yet more than a boy, he has sent problems and questions to different professors; he tells me nothing comes amiss to him, he knocks off poetry for his sister's musical compositions as an amusement ; he condescends, indeed, to scribble for the ephemeral publications of the day ; but he is ready to prepare any youth for any university! " What a fine instance," will the phrenologists say, " of the rectitude of our principles." But the opposers of phrenology will be ready to ask, how are reason, and good sense, and moral principle, and honour, and religion capable of preserving the mental adjustment and balance in sane individuals, while, by the organist's own showing, these very checks and preventives are the result of organization? To this objection it might be replied, we have nothing to do with consequences ; nor does the onus probandi of how things take place rest with us. For myself, however, I would venture to urge, (supposing I am a convert to the creed of the phrenologist,) that free will and counteracting motive are, and always have been, and always will be, unsolved problems. I would say further, that all doctrines suppose, nay, that all observation demonstrates natural and congenital differences, both of capacity and disposition : and I would, moreover, contend (whether consistently with phrenology or not, I do not care) that there is a perception of good and evil, which teaches all to war against natural bias ; and that this perception, confessedly more acute in some individuals than in others, and in the same person under varying circumstances, is only then thoroughly suspended or extinguished, when the physical has

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borne down and defeated the moral man : all short of this is but insanity in degree ; and the distinction between madness and crime is to be sought for in a modification of the principle to which we now advert, and about which I shall have more to say in another place.

I might be expected here to enlarge on the anatomical and physiological grounds of phrenological inference, but this investigation would lead me into too wide a field ; and I am, besides, anxious to avoid the imputation of partizanship; one especial circumstance ought, however, to be here alluded to, because, if fully established, it would absolutely prove the general rectitude of the science under remark ; and show, moreover, that a very important use may be made of it in the way of education, or in other words, of mental training and discipline. I might have longed, while looking at the young genius just mentioned, to have the power of scooping a little out of one portion of the cerebral mass, that another might more freely expand itself; now, that we may actually accomplish these organic changes, not indeed in the regular way of the trephine and scalpel, but in the more indirect mode of culture and pruning, the physiologists of the new school show you facts to prove. It has actually been made out that the shape or form of the skull are regulated by the pursuits of the man — aye — even of grown — adult, man ; and it therefore follows, that this or that propensity may be kept at bay, and finally vanquished, by calling the mind oft from indiligence, and by exercising those organs which are the media of opposing inclination. Mr. Deville showed me, among many other examples of this principle, one particular cast of the head of an individual, who commenced his career in life with very high promise of intellectual eminence and moral worth : for a time, this individual cultivated and improved his understanding during every successive day ; he then fell into habits of idleness and sensuality ; and lastly, in the way we are told of that great man, Dr. Paley, he roused himself into mental pursuits and practices, and shook off the old man, of mere carnality or worldly existence. The cast at each epoch answered exactly to the character. You would say of the first, " that is the head of a powerful, and intellectual individual ;" the one taken during the second stage was manifestly swelling out, in the animal portions of the brain ; while the reverse organization was as decided and impressive in the third and grandest period ; the bust looked indeed as if it were only waiting for animation to push up more and more the philosophical points, and bulge out into larger and larger expansion of moral thought and mental capacity.*