A manual of psychological medicine : containing the history, nosology, description, statistics, diagnosis, pathology, and treatment of insanity ; with an appendix of cases

Front matter

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A MANUAL

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Preface

The Authors of the following pages have long felt the want of a systematic treatise on Insanity, adapted to the use of students and practitioners in Medicine. Numerous monographs and works on limited portions of Psychological Medicine have appeared of late years. They are of great value to the specialist physician, but they do not meet the oft-repeated enquiry of the student and practitioner, — “ To what systematic treatise on Insanity can I refer ? ” Dr. Prichard's excellent “ Treatise on Insanity ”■ has undoubtedly been the one which hitherto has most nearly afforded the desired information ; but it was written a* quarter of a century ago, at a time when the Treatment of Insanity bore an aspect entirely different to its present one ; and, moreover, it is now out of print.

A knowledge of the nature and treatment of insanity is now expected of every well-educated medical man. The India Board require it of all persons to whom medical appointments are given under their new system of competitive examination. It is reasonable to expect that the good example thus set will be followed in other quarters ; and a desire to obtain a competent knowledge of this important branch of medical practice has become far more general in the profession than it ever before has been.

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PREFACE.

The Authors are aware that no amount of reading can render it safe to dispense with a clinical knowledge of mental disease. Their aim has been, to supply a text-book which may serve as a guide in the acquisition of such knowledge, sufficiently elementary to be adapted to the wants of the student, and sufficiently modern in its views and explicit in. its teaching to suffice the demands of the practitioner.

How far the Authors have succeeded in their purpose, it remains for their readers to determine ; of their shortcomings none can be more sensible than they are themselves.

It only remains to add respecting this Work, that the Chapters on the History, Nosology, Description, and Statistics, namely, that portion of the Work from the commencement to page 268, are written by Dr. Tuke ; and that the Chapters on the Diagnosis, Pathology, and Treatment of Insanity, and the Appendix of Cases, from page 268 to the end of the Work, are written by Dr. Bucknill.

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Chapter I. Page

Historical Sketch of Insanity among the Nations of Antiquity, MAINLY IN REGARD TO ITS EXTENT ... ... ... 1

1. Inference to be drawn from the Condition of tbe Ancients in regard

to Civilization.

The Egyptians — Greeks — and Romans ; their Civilization considerably advanced, but defective, and probably less calculated than our own to favour Mental Disease (1 — 5).

2. Examples in Ancient History, of Persons who were Insane, or who

feigned Insanity ; including References made to the Disease by Medical and other Writers.

Feigned Madness of Ulysses, and David — Madness of Saul — Ajax — Orestes — Cassandra — Plato’s Opinion of the Oracles — Power of Bacchus td induce Madness — Lycurgus, King of the Edones —

The Daughters of Prsetus — Athamas, King of Thebes — Medea — Question of Demoniacal Possession — Cambyses — Cleomenes,

King of Sparta — Allusions to Insanity made by Pythagoras — Hippocrates — Diodes — Asclepiades — and the Roman Poets, Horace, Persius, Juvenal, &c. (5 — 18).

CHAPTER II. Opinions of Ancient Medical Writers on the Treatment of

Treatment of Saul — Treatment pursued by Hippocrates — Aristotle Diodes — Asclepiades, the Founder of the Methodici — His Disciples, Titus and Themison — Celsus — Soranus — Coelius Aurelianus — Aretaeus — Galen (19 — 31).

IV

CONTENTS.

Chapter III. Page

Modern Civilization in its Bearing upon Insanity ... ... 31

Observations on the Numbers of Insane, and on the Fallacies connected with the Enquiry (31).

Number of Insane in England, &c., at the Present Time (33).

Impossible to compare this satisfactorily with Previous Statistics (34).

Attempt to decide the Question, Does Civilization favour the Generation of Insanity ? by an Enquiry whether the Chief Causes of Mental Disease are present in greater force in Civilized than in Uncivilized Society — Excess of Study — Emotional Sensibility —

Grief, Anxiety, &c. — Political Excitement — Occupation, Agricultural and Manufacturing — Intoxicating Liquors — Uterine Disease (34 — 46).

Comparison of Number of Insane in Civilized and Uncivilized Countries at the Present Day (46).

Snmmary of Conclusions (50).

Chapter IV

Amelioration of the Condition of the Insane in Modern Times,

Especially in regard to Mechanical Restraints ... ... 52

Injurious Effect of Celsus’ Teaching extended to Modern Times (52).

Condition of Insane in England formerly — Foundation of Bethlem Hospital and St. Luke’s — Interest in Insanity indicated by Works published in the 18th Century — Perfect — Arnold — Pargeter, &c. — Treatment of Insane as described by Dr. Browne — Establishment of the Retreat at York — Condition of the York Asylum — Evidence before the Committee of the House of Commons in 1815 — Subsequent Improvement in Asylums in consequence of Exposure at York and Bethlem Hospitals — Abolition of Instrumental Restraint at Lincoln — Dr. Conolly at Hanwell —

Report of Commissioners, 1844 — Many Asylums still Unreformed — Subsequent History — Report of Commissioners on Instrumental Restraint in 1854 (53 — 71).

Review of Legal Enactments in England in reference to the Insane, from 1744 to the Present Time (71 — 75).

CONTENTS.

V

Chapter V. Page

Of the Definition of Insanity, and of Classification ... ... 76

Difficulties of Attempting it — Illustrations — Locke’s Definition —

Cullen — Dr. Combe — Spurzheim — Lelut — Dr. Conolly — Dr. Guislain — M. Morel — Essentials of a Definition of Insanity — Concluding Remarks on the Subject (76 — 80).

2. On Classification.

Various Classifications from the Earliest Period of the Cultivation of Medicine — Hippocrates — Celsus — Cicero’s Strictures — Roman Law — Aretseus — Cselius Aurelianus — Galen (80 — 81).

Modern Nosology — Sauvages — V ogel — Linnaeus — Cullen — Arnold — Mason Good — Pinel — Esquirol — Guislain — Conolly — Parchappe — Baillarger — Prichard — Bucknill — Noble — Monro (81—86).

Remarks on Classification — Arrangement adopted in this Work (86—91).

CHAPTER VI. Of the various Forms of Mental Disease

Of Idiocy, Cretinism, and Imbecility (92). Of Dementia (113).

Of Delusional Insanity (123).

Of Melancholia (147).

Of Emotional Insanity

Of Mania (220).

Of Puerperal Insanity (236).

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CHAPTER VII. Moral Insanity (178).~ Homicidal Mania (191)

Suicidal Mania (201).

Kleptomania (207).

Erotomania (212).

Pyromania (214).

Dinsomn.m'fl, (91 R).

The Statistics of Insanity ... ... ... ... ... ... 241

Of the Causes of Insanity (241).

Predisposing : Hereditary Predisposition— Sex— Age— Seasons and Climate — Town and Country Life — Occupation — Marriage (241—258).

VI

CONTENTS.

PAGE

Exciting , Moral and Physical : Domestic Troubles or Grief — Religious Anxiety or Excitement — Disappointed Affections — Political and other Excitement — Fear and Fright — Excess of Study, &c.

— Intemperance — Epilepsy — Uterine Disorders — Other Diseases — Vicious Indulgences — Affections of the Head and Spine (258 — 262). See also Chapter III. pp. 34 — 45, and Chapter IX. p. 449 et 'passim.

Proportion of Recoveries and Relapses (263).

Mortality of the Insane (267).

Proportion of Insane to Population in Various Countries (See pp. 31 — 34, and 46 — 50).

CHAPTER VIII. Difficulties of Inquiry (271)

Diagnostic Value of Hereditary Tendency (272).

Of Previous Attacks (273).

Of Change of Habits and Disposition (273).

Manner of Examination (277).

Peculiarities of Residence and Dress (279).

Bodily Condition (282).

Gesture (283).

The Physiognomy of Insanity (285).

Demeanour towards the Patient (292).

Diagnosis of Dementia — Mania — Eccentricity — Melancholia — Monomania — Moral Insanity of Prichard — General Paralysis (293—335).

The Detection of Feigned Insanity (335).

Diagnosis of Concealed Insanity (346).

CHAPTER IX. Preliminary Observations (349)

Physiological Basis of Mental Pathology (350).

Mode of Production of Insanity (353).

CONTENTS.

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PAGE.

Causation of Insanity in its Pathological Relations (360).

Insanity conditioned by Disturbances of Cerebral Circulation which produce Serous Exudations (372).

Metaphysical Theory of Insanity considered (382).

Atrophy of the Brain (385), Its various Causes (387).

Insanity by Sympathy (393).

Pathology of Monomania ; Apparent Health of Organism, in connection with Functional Perversion, due to the establishment of a Habit of Cell-Growth in the Mould impressed by a previous State of Diseased Action (398 — 9).

Account of Special Pathological Changes — Cranium — Dura Mater — Arachnoid — Pia Mater — Cerebral Substance — Lesions of the Pectoral and Abdominal Viscera (402 — 452).

Humoral Pathology of Insanity (452).

Pathology of General Paralysis (455).

CHAPTER X. Tbeatment of Insanity 460

General Observations (460 — 470).

The Medicinal Treatment : Bleeding — Tartrate of Antimony — Calomel — Opium — Stimulants — Purgatives and Aperients — Counter-Irritation and Derivation — Tonics — Baths — Principles to follow in the Use of Active Remedies — Remedies in Chronic Insanity (470 — 506).

The Moral Treatment, including Remarks on Mechanical Restraint and Seclusion (506 — 528).

Appendix

Gases illustrated by the Portraits in the Frontispiece.

Acute Mania — Monomania of Pride — Congenital Imbecility — General Paralysis — Acute Suicidal Melancholia — Primary Dementia— Secondary Dementia (529 — 533).

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CONTENTS.

Some Cases illustrating Treatment.

PAGE.

Mania with Violence ; Disuse of Restraint— Sthenic Mania ; Recovery under the Use of Antimony — Acute Mania, subsiding into Melancholia ; Recovery — Mania from Debility ; Recovery under the Use of Quinine and Good Food — Mania with limited Delusions; Opiate Treatment — Suicidal Melancholia, changing to Mania; Treatment for Cerebral Hypereemia — Suicidal Mania, with Chorea ; relieved by Opiates — Mania relieved by preventing Dissolute Habits — Mania ; Recovery under Emenagogue Treatment— Mania ; Recovery after removal of Leucorrhoea — Mania, inclining to Dementia ; Recovery after removal of Foreign Body from Vagina; Mania, resembling Delirium Tremens; Opiate Treatment — Acute Melancholia from Moral Causes; not improved by Treatment ; Quiet Melancholia ; cured by Opium and Aether — Melancholia with Hallucination ; Recovery without Medicine — Melancholia without Delusion ; Recovery from Good Food — Melancholia from Chagrin ; Recovery without Medicine — Melancholia from Remorse ; Recovery without Medicine — Mania from G rief ; Recovery under Opiates — The same — Dementia following Brain-Fever ; Recovery under Tonics and Moral Treatment — Acute Dementia from Suppressio Mensium ; Emenagogue Treatment — Acute Mania, becoming Chronic under Treatment (528—547).

Some Cases illustrating Causation and Pathology.

Monomania, with Religious Exaltation; Death from Perforating Ulcer of Intestines — Acute Nymphomania, with Suicidal Impulse ; Death — Chronic Mania ; Death from Suicide — Mania, with Delusions ; Death from Chronic Gastritis — Mania from Dissipation and Intemperance — General Paralysis, followed by Apoplexy — Homicidal Monomania; Death from Pneumonia — Partial Recovery after Acute Mania ; Death from a Convulsive Attack — Acute Melancholia from Fear (547 — 556).

ERRATU M.

Page 460. Transpose the lines 19, 20, 21, 22, and read:

“It emanates from, and is consistent with, this hypothesis ; whose most recent exponent is no less eminent a person than the President of the Royal College of Physicians. But it is Dr. Leuret, a French physician, who, with the hardihood of logic, ” &c.

Chapter I

HISTORICAL SKETCH OF INSANITY AMONG THE NATIONS OF ANTIQUITY, MAINLY IN REGARD TO ITS EXTENT.

Section I. — Inference to be drawn from the Condition of the Ancients in regard to Civilization.

What is the effect of the progress of civilization upon mental disease? How far did the civilization of the most civilized periods of ancient history extend ? These are inquiries which at once suggest themselves when we endeavour to estimate the probable extent of insanity among the nations of antiquity.

In the statistical chapter we shall enter fully into the consideration of the first question, namely, whether or not civilization favours the generation of insanity. It is sufficient for our present purpose, therefore, to state the general result of that inquiry, which is this — our conviction that, other things being equal , civilization does, on the whole, tend to render men more liable to mental disease. Hence, it only remains for us to inquire here, into the extent to which the great bulk of the people among the ancients were civilized ; especially as compared with modern society.

We believe it will be found that the Egyptians, the Greeks, and the Romans, however highly civilized in certain directions, will not, as a whole, bear comparison with the present Anglo- Saxon race. “ What were the people of Egypt/' asks a late eloquent writer, “ at the time when the learning of the Egyptians was the envy and wonder of the world ; when even wise men from Greece resorted thither to accomplish their studies, and qualify themselves to be teachers at home ? Methinks it is sufficiently evident, from the uniform character of B immensity stamped upon all the mins of temples, palaces, and cities, as well as from the more perfect specimens of pyramids, obelisks, and statues, yet extant in the land of Nile, that a number comparatively small of master minds supplied the ideas, which myriads of labourers were perpetually employed to embody ; and that the learning of Egypt was nearly, if not wholly, confined to the priesthood and the superior classes. The marvellous relics of Memphian grandeur, of which new discoveries are made by every successive traveller into the desert, or up the river, are melancholy proofs that the vaunted learning of Egypt, when it existed, was as much locked up from the comprehension of the vulgar, as it is at this day from the curiosity of the learned, in their undecipherable hieroglyphics, wherein it may be said to be embalmed/'

In other countries, no less than in Egypt, it is sufficiently obvious that the state of society, how much soever it is now enveloped in obscurity, must have been essentially different from that which it has assumed in modern times. Extreme simplicity marked the patriarchal age ; refinement and luxury were then almost unknown ; and notwithstanding the Father of the Faithful possessed “ flocks and herds, silver and gold, men-servants and maidservants, camels and asses," his manners were simple, and his habits and pursuits altogether favourable to mental tranquillity ; they belonged to rural, pastoral life. The destined wife of Isaac was found with her pitcher on her shoulder, about to draw water. Other similar illustrations of eastern simplicity and nomadic life will occur to the reader.

Passing to the early, and therefore more or less legendary period of Grecian history, abundant examples of the same condition of society are not wanting. In the Iliad, Paris is incidentally mentioned as at least assisting in the construction of his own dwelling :

“ Himself the mansion raised, from every part Assembling architects of matchless art.”

Ulysses, also, made his own house :

“ Around this tree I built, with massy stones Cemented close, my chamber, roofed it o’er,

And hung the glutinated portals on.”*

* Cowper’s Odyssey, Book xviii. v. 440.

AMONG THE NATIONS OF ANTIQUITY.

And from the following passage, the inference is fair that he practised mowing, as well as ploughing :

“ Were we matched

In work against each other, thou and I,

Mowing in spring time when the days are long,

I with my well bent sickle in my hand —

Or if again it were our task to drive,

Yok’d oxen of the noblest breed, sleek pair’d Big limb’d, both fatten’d to the full with grass,

Their age and aptitude for work the same,

Not soon to be fatigued ; and were the field In size four acres, with a glebe through which The share might smoothly slide, then shouldst thou see How straight my furrow should be cut and true.”* * * §

Grote observes, when speaking of the office and station of a king in the heroic times of Greece, that “Even the more homely varieties of manual acquirement are an addition to his character ; such as the craft of the carpenter or shipwright, the straight furrowing of the ploughman, or the indefatigable persistence of the mower, without repose or refreshment throughout the longest day.”"f* Moreover, at this early period, the general servitude J — the absence of individual action or thought, beyond the narrow limits of daily necessities — in regard to the population at large, is an important fact in relation to the exercise of the mental faculties, and their derangement ; thus it is concluded by the historian of Greece, that, in the society depicted in the old Greek poets, the mass of the people was politically passive and of little account. People were congregated in comparatively small companies, their wants were few, and they were not unlike modern agricultural populations, among whom the clergyman and the squire, the apothecary and the blacksmith, are the all-important personages ; these being represented in the Grecian village by the prophet, the leech, the bard, the carpenter, the smith, and the leather dresser. § Not less indicative of the habits and social condition of this period was the employment of the women, that is to say, the women of the

* Cowper’s Odyssey, Book xxiii. v. 225.

| It is computed that, in Attica, out of a population of 528,000, 400,000 were in a state of slavery.

§ See on this subject, Grote, Op. cit. vol. ii. p. 130.

highest families. “ Spinning and weaving/' observes Grote, “ were their constant occupation, whether free or slave, of every rank and station ; all the garments worn, whether by men or women, were fashioned at home ; and Helen, as well as Penelope, is expert and assiduous at the occupation. The daughters of Keleos and Eleusis go to the well with their basins for water ; and Nausikaa, daughter of Alcinous, joins her female slaves in the business of washing her garments in the river/'*

And even in the subsequent periods of Grecian history, although comparatively civilized, and although the arts flourished to a remarkable degree, scarcely more than the elements of the civilization of modern Europe were present. “That the body of the Athenians," remarks Montgomery, “under the tyrant Pisistratus, who is said to have first collected the scattered songs of Homer, and down even to the days of Pericles, (that munificent patron of the fine arts,) were little skilled in reading and writing, is the almost inevitable conclusion to be drawn from the state of literature in reference to the means of diffusing it in ancient times. Before the invention of printing, the slow production, the consequent scarcity, and the enormous value of books, when all were manuscripts, placed the possession of them beyond the reach of the poor ; and where libraries existed, few but the learned and the great could have access to them." It is stated by Hr. Vaughan,-)* that there is no reason to suppose one in a hundred could read, out of the myriads who peopled the great cities of Asia ; and that a very limited oral system of instruction existed to supply this want. “Down to the generation preceding Socrates," observes Grote, “ the poets continued to be the grand leaders of the Greek mind ; until then nothing was taught to youth except to read, to remember, to recite musically and rhythmically, and to comprehend poetical composition."! In the very zenith of the civilization of Greece, we believe it would be found, while poets and philosophers stood with great prominence as indeed giants of intellectual power, that what we understand by the great mass of the people, were wanting in mental cultivation ; and did not use their brains so much, and what is also of much importance in relation to this subject, were

* Op. cit. vol. ii. p. 133. f Age of Great Cities, p. 21.

| Op. cit. vol. iv. p. 130.

AMONG THE NATIONS OF ANTIQUITY.

not exposed to the same moral struggles, religious perplexities, or mental anxiety, as are the men and women of our own age. As regards the latter, there is a complete revolution. The Mrs. Somervilles of antiquity were few in number, if they existed at all. And if this were the place to enter into it, it were easy to show that the education of the women of England has, for the most part, run counter to the laws upon which the integrity of the cerebral functions depends.

Nor is it probable that, among the Romans, notwithstanding the character and the influence of the poets and philosophers whose names have been handed down to our times, there were many given to intense and enduring intellectual labour. We believe the writer to be correct, who says, that they laboured under the same disadvantages in acquiring and communicating knowledge as the Greeks ; and “they laboured under many more from the rough fierce manners of the plebeians, and the unquenchable thirst for martial glory that distinguished the patricians.”

From all these considerations, we think it probable that there did not exist among the nations of antiquity that form, or that extent of civilization, which is now to be found among the yet more highly civilized nations of modern Europe, and which, as we believe, tends in some degree, to exhaust or derange the mental powers. That insanity was, however, by no means unknown to them, we shall see, first, — by the instances of persons who had lost their reason, whose names have been handed down to us ; and secondly, — by the reference made by early writers to the disease.

Section II. — Examples in Ancient History of Persons who were Insane , or who feigned Insanity; including References made to the Disease by Medical and other Writers.

The feigned madness of Ulysses, immediately prior to the Trojan war, should be regarded as the earliest reference in antiquity to the existence of mental disease, if we adopt the view that such an event actually occurred at least a century before Homer flourished. Otherwise, the madness of Saul claims priority, he having probably died a short period before

HISTOKICAL SKETCH OF INSANITY

Homer lived. But the Homeric age, or legendary epoch of Grecian history, is enveloped in much obscurity. The same observations apply to the madness, real or supposed, of Ajax, who must not be overlooked in our illustrations of the madmen of antiquity. But first, in reference to Ulysses, it may be remarked, that the test applied by Palamedes, to discover his condition of mind, proceeded upon the fallacious idea, hut too common even in our own times, that because an individual is mad upon one point, he is necessarily so upon all. The wish and the endeavour to save the life of his son Telemachus were consistent with genuine mania. King David feigned dementia with better success.

After the dispute between Ajax and Ulysses, respecting the arms of the dead Achilles, which ended in their being awarded to the latter, Ajax was seized with madness, and slaughtered sheep and oxen, under the illusion that they were the sons of Atreus who had favoured his rival. Afterwards, when Ulysses hesitated to see him at the instance of Minerva, who was fabled to have inflicted this disorder, she responds, according to the poet, — who, as has been well said, “ sang and showed in grand dramatic rhythm and melody, not a fable, but a fact/' —

Dost thou then fear To see a madman ?

To which the son of Laertes replies :

Were his senses sound I should not fear him.

And when the madman's wife, Tecmessa, is asked “ how this sudden ill began," she answers :

The night was far advanced ; the evening lamps No longer blazed ; when, grasping in his hand His dreadful sword, he bent his eager steps Towards the passes, from all haunt now clear.

* * * * ^ iSSued forth alone.

What then befell I know not ; he returned Driving in bonds the bulls, the herdsman’s dogs,

And lowing herds ; some by his sword were slain,

And hewn in pieces ; some like captives bound,

Kaging against the flocks, he scourged as men.

At length he issued from the tent, and held Long converse with some shadow ; of the sons Of Atreus much, and of Ulysses much,

AMONG THE NATIONS OF ANTIQUITY.

He spoke, and laughed aloud, how their base deeds He in this sally amply had revenged.

Entering the tent again, his sense at length Slow he regained’; but when he saw the ground With carnage covered thus, he smote his head,

And raised a mournful cry ; then prostrate lay,

Stretched midst the havoc of the slaughtered flocks,

Rending with violence his hair. Long time He lay, nor uttered word ; with rigorous threats Then bade me tell him every circumstance Of what had passed, and whence the carnage asked That lay around him ; struck with fear, my friends,

Distinct I told him all that had been done,

Far as I knew it ; straight with mournful cries Loud he lamented ; such from him before I never heard.

The madness of Orestes is thus graphically described, by his sister Electra :

* * * * on his bed

He lies ; his mother’s blood to frenzy whirls His tortured sense ; the avenging powers that haunt His soul with terrors thus, I dare not name.

The sixth day this, since, on the hallowed pile,

My slaughtered mother purged her stains away.

No food hath passed his lips ; no bath refreshed His limbs ; but in his garments covered close,

When his severe disease abates a little,

He melts in tears ; and sometimes from his couch Starts furious, like the colt burst from his yoke.

The scene in which Electra ministers to her sick brother, is described with still greater force and accuracy of detail :

Elect. — Alas, my brother ! wildly roll thine eyes ;

So quickly changed, — the frantic fit returns.

Orest. — Ah, my mother ! do not set thy furies on me.

See how their fiery eyeballs roll in blood,

And wreathed snakes hiss in their horrid hair !

There, there they stand ! ready to leap upon me.

Elect. — Rest thee, poor brother ; rest thee on thy bed ;

Thou seest them not, — ’tis fancy’s coinage all.

Orest. — Oh, Phoebus ! they will kill me ; those dire forms,

These Gorgon-visaged ministers of hell !

Elect. — Thus will I hold thee, round thee throw mine arms,

And check the unhappy force of thy wild starts.

Orest. — Oh, let me go ! I know thee, who thou art ;

One of the furies ; and thou grapplest with me,

To whirl me into Tartarus ; avaunt !

The “ heaven-inspired Cassandra ” was regarded by the Trojans as insane, and was said to have been confined. Plato, in the Timaeus, makes some most interesting observations on the connection between divination and insanity : “A sufficiently clear proof/' says he, “ that the Deity assigned prophetic power to human madness , is found in the fact that, no one in his right senses has any concern with divinely inspired and true prophecy, which takes place only when the reasoning power is fettered by sleep, or alienated by disease or by enthusiasm." He then goes on to say, that such do not themselves know the meaning of what they give forth ; “it being by no means," he observes, “ the office of one who either has been or is still madf to judge respecting things seen or spoken by himself ; * * *

whence, indeed, the law directs that the race of prophets (or interpreters) should preside as judges over divine predictions."* In fact, the Greek word fiavrla, a soothsayer, which is here used by Plato, and is also employed in regard to Cassandra, is derived from /jlcuvo/jlcu, to rave, from which our term mania is likewise derived.

In the Phsedrus, also, Plato observes, “ the greatest blessings we have, spring from madness, when granted by divine bounty. For the prophetess at Delphi, and the priestesses at Dodona, have, when mad, done many and noble services for Greece, both privately and publicly ; but in their sober senses little or nothing. And if we were to speak of the Sybil, and others, who, employing prophetic inspiration, have correctly predicted many things to many persons, respecting the future, we should be too prolix in relating what is known to everyone. This, however, deserves to be adduced by way of testimony, that such of the ancients as gave names to things did not consider madness as disgraceful, or a cause of reproach ; for they would not have attached this very name to that most noble art by which the future is discerned, and have called it a mad art ; but considering it noble when it happens by the divine decree, they gave it this name. But the men of the present day, by ignorantly inserting the letter t have called it the prophetic art."*!*

Mr. Colquhoun, in his Isis Revelata , maintains that the oracular responses were associated with a magnetic condition of

* Plato, translated by Davis, vol. ii. p. 283.

f Plato, translated by Cary, vol. i. p. 319, 320.

the system. “ The miracles of the magicians, the Delphic and other oracles, the prophetic inscriptions of the Sybils, the temple sleep, the cures wrought by the Asclepiadae, these were the triumphs of animal magnetism in those ages/'

But whatever may have been due to animal magnetism, or to positive madness, there is reason to suppose that something must be attributed to the use of an intoxicating gas, as the nitrous oxide. Dr. A. T. Thompson suggests sulphurous acid gas.

In his Timseus, Plato makes several other allusions to madness. Thus, after speaking of bodily disease, he goes on to say, “ In the above manner are the diseases of the body produced ; but the diseases of the soul, resulting from the habit of the body, are as follows. We must admit that the disease of the soul is folly, or a privation of intellect ; and that there are two kinds of folly, the one madness, the other ignorance. Whatever passion, therefore, a person experiences, that induces either of them, must be called a disease. Excessive pleasures and pains, however, are what we should deem the greatest diseases of the soul ; for when a man is over elevated with joy, or unduly depressed with grief, and so hastens immoderately either to retain the one, or fly from the other, he can neither perceive nor hear anything properly, but is agitated with fury, and very little capable of exercising the reasoning power." Plato then goes on to enunciate a doctrine totally repugnant to all sound psychology ; indeed he confounds crime and insanity together, to an extent which would shock the stoutest supporter of the doctrine of irresponsibility in criminal cases. He says : “ And indeed it may almost be asserted, that all intemperance in any kind of pleasure, and all disgraceful conduct, is not properly blamed as the consequence of voluntary guilt. For no one is voluntarily bad; but he who is depraved becomes so through a certain bad habit of body, and an ill-governed education." “All the vicious are vicious through two most involuntary causes, which we shall always ascribe rather to the planters, than the things planted ; and to the trainers, rather than those trained."* In the same remarkable production, Plato observes, “ There are two kinds of madness ; one arising from human diseases, the other from an inspired deviation from established custom. "j*