PSYCHOLOGICAL STUDY OP CERTAIN PHASES OP INSANITY …
Transcript of PSYCHOLOGICAL STUDY OP CERTAIN PHASES OP INSANITY …
PSYCHOLOGICAL STUDY
OP
CERTAIN PHASES OP INSANITY
WITH
SPECIAL REFERENCE TO MELANCHOLIA.
BY
MATHEW A. REASONER.
THESIS.
POR THE DEGREE OP BACHELOR OP SCIENCE.
UNIVERSITY OP ILLINOIS
45
B I B L I O G R A P H Y .
Practica l Lessons in Psychology, W. 0 , Krohn.
Sanity and Insanity, Mercier.
Dictionary of Physiological Medicine, Tuke.
Dictionary of Practica l Medicine, Powler.
Body and Mind, Maudsley,
Journal of Nervous and Mental Diseases,'92 to *96.
Reports from:Kankakee Hospital,Anna,Bryce,Ala., Pontiac,Mich.,
Norris town,Penn., Conneticut Hospital, and Central
Indiana Hospital.
Hospitals and Asylums o f the World, Burdette.
Handbook of Mental Diseases, Regis.
Reports o f Cases personal H istories e t c . , obtained at Kankakee
Suicide, M orselli.
Dictionary of S ta t is t ics , Mulhall,
Century Magazine,June 1896.
Nervous Diseases, Hammond.
THESIS.
A STUDY OP CERTAIN PATHOLOGICAL MENTAL CONDITIONS.
Throughout the history of education and o f medicine, no
question has so engaged the attention of the scientists and physi
cian as the influences exerted upon the human organism by environing
nt and hereditary. These influences upon our physical being repeat
ed through successive generations resolve themselves f in a l ly into
law, a law as unalterable as those o f the Medes and Persians, a
law founded upon fundamental truths and ve r i f ied in the experiments
of physiological science.
The aim o f education and medical science is one, so that
the physiologist joins hands with the pyscholo^ist in the en
deavor to restore health to the mind and to prevent degeneration,
and acknowledging the bodily transmission o f the sins o f the father
to the third and fourth generation; would fain seek in the springs
of l i f e i t s e l f the secret and cause o f insanity, and this w ill be
discovered i f ever i t is discovered only through a more thorough
investigation o f insanity i t s e l f , as manifested in a ll i t s foras
and phases.
In the broadest sense we speak o f mental alienation as
including al 1 the disorders o f the mind; defining i t we may say
"Mental alienation is the to ta l o f the pathological conditions es
sen tia lly characterized by disorders of the in te lligence", or as
implied in the disorders of the adjustment o f the individual to his
2surrouhdings or of the organism to its environment in cases due
to no fau lt o f the peripheral organism.
According to the international nomenclature adopted at
Paris in 1889 the mental alienation is c lass if ied in the following
manner, ( I ) Mania, (2) Melancholia, (3) Periodical Insanity, (C ir
cular Insanity), (4) Progressive Systematized Insanity, (5) Vesanic
Dementia, ( 6) Organic Dementia, (7) Paralytic Insanity, (8 ) Neurotic
Insanity (Hypochondria,Hysteria, Epilepsy), (9) Toxic Insanity,
( 10 ) Moral and Impulsive Insanity, ( I I ) Idiocy . The c la s s if ic a t
ions are either ( I ) Physiological,according to the nature o f the
disorder, (2) Symptomatic, or(3) Depending, upon the Anatomical
character of the lesions. The c lass ifica t ion evolved by Regis, which
is one of the most practical and suggestive yet presented is here
with given.
I , Functional A lienations,( Insanities,Vesanias,Phychoses)
I . Generalized or Sijimptomatic Insanities
1 Mania
Sub acute (Maniacle excitation)
Acute,Hyperacute,Chronic,Remittent or Intermittent.
2 Melancholia or Lypemania
Subacute ( depression),Acute ( t y p ic a l ) ,Hyp eracute
(with stupor) , Chronic,Remittent or Intermittent.
3 Insanity o f double form
Continuous insanity of double form and Intermittent
insanity of double fom.
3
2, Part ia l or Essential Insanities.
1 Systematized progressive insanity
F irs t stage (Hyperchondriacle Insanity)
Second stage (Persecutory, relig ious, erotic )
Third stage (Ambitious insnity)/
I I , Constitutional Alienation (Degenerac ies,Mental In firm ities )
1 Degeneracies of evolution( vices o f organization)
Disharmonies,
Defect o f equilibrium,eccentricity,
2 Neurasthenias,
, Fixed ideas, impulsions,
3 Phrenasthenias
Delusional (multiple delusions)
Reasoning (reasoning insani ty ,moral insanity)
Instinctive Insanity.
4 Monstrosities
Imbecility
Idiocy#
Cretin ism,myxoedema.
2 Degeneracies o f involution (disorganizations)
I Dementia
The ntimber o f c lass ifica tions vary about the same as the
number o f writ rs upon th subject,yet they a ll contain substan
t ia l l y the same thing arranged in various ways.
4Of these divisions the subject chosen for special study,
is a functional generalized derangement, one o f the most interest
ing of the series, that o f melancholia. I t is defined as a dis
order, characterized by f eel ings of depression and misery which is
in excess of what is ju s t i f ie d by the circumstances under iriaicfe the
individual is placed. There is frequently a tendency to brood over
a single subject and occasionally paroxysms o f insanity.
The subject w ill now be considered under three heads,
X a general view o f Melancholia including a careful presentation
of the symptoms, causes and cure,2 Reports o f cases, including react
ion times obtained and experimental work performed upon melanchol
iacs ,3 Legal responsib ility o f melancholiacs.
In slight cases the melancholia amounts only to; a fe l l in g
of d issatis faction , o f distrust in their own powers and a generalQ
vague unhappiness, but in acute cases i t is one o f the most dreg
fu l diseases which can a f f l i c t a human being. In such cases the
patient by his attitude and gesture fu lly evidences his aliment.
Question him and he does no t answer, urge him and he groans m hm
distress, s t i l l urge him and he crys and says in a feeble monotone
that he is the most miserable and wicked of men, that he xs accurs
ed of God and man, that he has committed the unpardonable sin and
is no longer f i t to l iv e . A universal gloom pervades his mind and
a distaste for a ll previous avocations and interests manifests i t
s e l f , he shows a fee lin g o f indifference toward a l l exlercises and
recreations, and indeed the Bntire external world. Nature presents
5him with no delight and whatever there be o f beauty or ga iety or
happiness around but serves to emphasize his gloom as he fee ls
their want o f kinship to his nature. But in comparing the relation
of the expression to the amoiant o f misery f e l t , another point
should be taken into consideration. The training o f man is so much
directed toward the suppression of the play o f emotions, that in
the early stages o f Melancholia where control is but l i t t l e impair
ed the actual amount o f emotion can only be fa u lt i ly estimated by
means o f the expression. On the other hand when misery has long
been severly f e l t and fre e ly expressed,a hab it ,o f complaining has
grown up, which continues a fte r a l l real intensity o f feeling has
passed away and thus in the la t te r stages o f the malady, the ex
pression may not be a true index of theemotions fe lt ,o u t neverthe
less is an important factor in the diagnosis o f the disease.
The cardinal symptom o f Melancholia is indicated by the
defin ition ; i t is the expression o f misery for which there is no
ju s t i f ia b le foundation, the two other groups o f symptoms are, de
fects o f nutrition and of other bodily processes, and defects o f
conduct with occasionally the expression o f delusion. The feeling
of misery is expressed in several d ifferen t ways, ( I ) by the face,
(2) by the attitude, ( 3 ) by gesture, (4) by verbal expression The
'expressfc & o f the face is especia lly characteristic, the jaws are
not firmly closed although the lips remain together,giving the face
an elongated appearance. The forhead exhibits several transverse
rinkles, extending up ward in the center are several ve rt ica l rinkles
6The inner edges of the eyebrows are drawn upward and together caus
ing the opening of the eyes to assume a triangular appearance,the
corners o f the mouth point downward and the lower l ip protrudes.
The attitude o f Melancholia is one o f general flex ion , the figure
is never erect, and the head is generally bowed, one o f the minor
symptoms is a tendency o f the thumb to l i e para lle l with the fing
ers. The most prominent gesture is that o f weeping, not loud but
low sobbing, accompanied with ringing of the hands,nodding, o f the
head, sighing and groaning, or rocking a? the body back and forth.
The verbal expressions o f misery are few and may be considered main
ly as verbal gestures whose pecu liarity is their frequent repeti
tion and in this form o f usage are no more to be considered than as
groans. In one case recorded by Dr. Savage, the patient never
opened his lips but to repeat the words,"dead and dammed". He spoke
only that one phrase as i f in i t he,did his soul outpour.
t So far we have spoken only o f the general external mani
festations o f Melancholia. There are other and important factors
which may be used in a diagnosis but are essentia lly pathological
conditions upon which the abnormal mental states dependj We w ill
consider them as taken up in the following elassification,under
Causes o f Insanity. The f i r s t d ivision from which results by fa r
the largest proportion of insanity is that o f I— Direct Physical
Causes. They a ffec t mental processes by direct action on the brain,
- through violence, from increase or diminution in the. blood supply
through deleterious substances carried in the blood, or through
altered nervous sensations,(a) diseases of the nervous system as
epilepsy, chorea,syphilis,apoplexy, tumors,or other disease a ffec t-
ing brain and spine tissue, (b) prolonged draft on v i ta l i ty ,o v e r
exertion,over-study, rapid child-birth,prolonged lactation, (c) 111
health- tuberculosis,cancer,Bright's disease ect. (d) Causes incid
ent to pregnancy and parturition-abortion,pregnancy,puerperal.
(e) Traumatic causes- bodily injury and in juries to the head, sun
stroke etc.
2. Indirect physical and emotional causes which produce
their e ffec t by an indirect action a-afi^n upon the brain, For con
venience they may be divided as follows: (a) Grief, care and anxiety
abuse, cruelty and neglect, (b) Want and privation, (c) Business
reverses and prep lex ities (d) Feigning insanity. { e) Religious ex
citement.
3 . The third division includes vicious habits o f a l l
kinds- Intemperance, opium, chloral, cocaine habits,sexual excess,
self-abuse, and a ll habits o f l i f e which d irec t ly undermine the
physical constitution and thus a ffe c t the brain. They are indeed
direct causes, since they act through a dire% poisoning of the
brain or by a sapping v i t a l i t y and producing a constitutional break
down. The real proportion o f insanity produced by vicious habits
is somewhat smaller than a f i r s t glance would seem to show, since
the natural constitution o f the individual has much to do with the
practice o f such habits and the preservation of mental in tegr ity .
Thosewho through hereditary are constitutionally disposed toward
8vicious habits, are generally o f a weal nervous constitution and
are affected much more seriously by such habits than the normal in
dividual, so that in cases o f resulting insanity the vicious habits
are to be considered as the strain which prematurely shattered the
already weakened and hered ita rily predisposed nervous system.
4 . Under Constitutional and Evolutional Causes are con
sidered three causes which point to an innate defect in the consti
tution or development o f the individual. To a greater extent titan
any o-ther one cause does heredity either d irec tly or ind irectly
affect the mind. The individual may be endowed with a nervous,a
susceptable or weak constitution, which at some cr is is in develop
ment needs but a t r i f l i n g cause to produce a breakdown. Under this
head the causes may be grouped as follows, (a) Congenital and In
fan t ile - , ante-natal influences and those producing an arrest in
development, (b) evolutional and developmental-including those per
taining to the pubescent, adolescent, climacteric and senile periods.
In a more exhaustive review o f the causes above stated,
epilepsy w i l l f i r s t be mentioned. I t is a disease especia lly de
pendent upon congenital causes for its existence, and o f its real
nature scarcely anything is known. Frequently i t is found alternat
ing with Melancholia and other forms of insanity in successive
generations, but is not so important as others in producing Melanch
o l ia . Another very p r o l i f i c cause is Syphilis. I t may produce men
ta l disorder by causing loss or destruction of nerve tissues;such
as organic dementia; i t may cause sensory troubles leading to
9mental disorder,or i t may cause disorder o f nutrition and function
which may lead to ordinary insanity such as Melancholia or epilep
sy. The way in which syphilis affects the individual,depends much
upon personal idiocyncracies. I t more generally a ffect the ner
vous system o f those who by age, habit or inheritence are nervous
ly weak, and in many such cases i t seems to avoid the tissues more
affected in others, such as the skin and mucus membrahB. I t is hard
to make a true estimate o f the number o f insane to whom syphilis
has been either an exciting or predisposing cause, but of the mel
ancholiacs the number in whom syphilis is either acquired or heredx
tary is large. Melancholis may arise from syphilis ind irectly ; as
in gastric ulceration, where owing to the close relationship exis
ting between the nervous centers and the digestive tract,from dis
order in one a disturbance is generally induced in the other. In
regard to the condition of the blood much of importance has been
obtained. The blood is generally much deteriorated in Melancholia.
In forty two cases (sixteen males,twenty six females) deficiency in
the red blood corpuscles was observed in f i f t y per cent. In women
the subnormal corpuscular percentages were absolutely ten per cent
lower than in men. The richness o f the blood in the haemoglobin
was a l i t t l e lower than normal in the majority o f cases and the
average p ercentages were 93 fo r men, and 85 for women. In several
instances the blood was de fic ien t in haemoglobin but contained a
normal number of haemacytes.
No special mention needs bejnade o f the e f fe c t induced by
prolonged draft upon the v i t a l i t y from over exertion, over-study
and prolonged lactation, save as to the general symptom* The con
ditions induced resemble anaemia,there is a lack o f in it ia t iv e ,a
loss of self-confidence, and ^exhausted condition of the nerve cen
ters and in an organism in any way unstable, the mental processes
may be affected.
Under general i l l health, Tuberculosis is by fa r the most
active in producing Melancholia. From another standpoint we may
say that the concurrence and co-existence o f phthisis and insanity,
indicates an imperfectly developed or unstable organism with a
m ateria lly lessened power o f resistencej and this hereditary or ac
quired in s ta b il ity or vu lnerability would manifest i t s e l f in the
lungs o f one individual making him under proper environment l ia b le
to the development ofphthisi,s(while in another the in s ta b il i ty being
in the nervous system, the tendency would be to develop insanity,
especia lly Melancholia."Phthisis and insanity are equally potent
factors in the hereditary production o f brain in s tab il ity , " says
Tomlinson,one o f the most noted American A lien is ts . Out o f 69 5
admittances to the St. Peter 's Hospital,St. Peter, Minn., 70 had a
h istory o f phthisis in the family,and o f the general insctigr 22/
are a ffected with consumption, which is about three times the per
cent o f the normal population affected. Of 104 cases o f Melanchol
iacs upon whom autopsies were held by Blackburn in the Government
Hospital at Washington, 37 or 35/,were found to be suffering from
I Ituberculosis, which was the d irect or indirect causeof death. In
a tabulated^or the causes of m ortality in 98 American asylumns,G2
of them had a death rate o f from 15 to 65/£,a.n& these figures are
liab le to be underestimated owing to the lack o f thoroughness in
post mortem examinations. The hereditary relationship between in
sanity and phthisis was observed by Van der Kolk, who says, " I t is
remarkable that in the same family some of the children suffer from
mania or Melancholia, and the brothers and s is ters who. ,remain free
from this disease die o f phth isis". The key to the solution o f
this question is undoubtedly in the close relationship existing
between the brain and the badily nutrition. Recent investi gations
point to the fact that every severe disturbance o f brain function
of whatever kind, is accompanied by lowering or disturbance o f its
trophic energising, and that such trophic lowering means sooner or
la ter , structural or functional change in the peripheral organs and
tissues (especia lly connective tissues) o f the body.
Cancer has not produced a very large proportion of insaa
and then mainly in utjbine or cerebral cancerous affections in fan-
ales.
Among females, disorders o f the reproductive organs fr e
quently produces insanities o f d ifferen t types,Melancholia predomin
ating. We may state these causes as follows; pregnancy,parturit-ion
abortion,amenncfrhea,etc. The insanities o f pregnancy may be indue
ed by hereditary tendencies, through neurose s,advanced stage at
who are nervously degenerate),pregnancy, (especia l ly in those
12previous nervous illness ,the sex o f the child, blood poisoning,or
moral influences. Esquirol has said that the derangements o f men
struation form one sixth o f the physical causes o f insanity,and
Morel agrees with him. The following general conclusions are ob
tained from the study o f f iv e hundred lunatics. - I . That in idiocy
and cretinism,puberty is usually delayed or absent. 2. That Mel
ancholiacs in great number suffer from amenorrhoea, 3. That very
rarely catamenia reappears in aged insane women a fter a prolonged
cessation. 4, That maniacle exacerbations usually occur at the
menstrual flow.
In Melancholia the general conditions o f ssem anaemia
may produce amenorrhoea and hence asthenic Melancholia,but amenorr
hoea T3 also sometimes the result o f a p lethoric condition o f the
system.
The growth and development o f the brain in marked by many
dangers. Since i t is the hereditary impulses that have produced
these a c t iv it ie s , i t is easy to see how any hereditary taint or mis
directed impulse,will abnormally influence them,but the development
into insanity only occurs a fter the adolescent period is welx on.
And then may not ensue with out an adequate exciting cause,possib-
l y delaying un til the senile period for i ts appearance.
Under the tem Traumatic factor may r igh tly be included
giP 1 ? injuries produced by external violence aiiecting the nervous
system so as to become factors in the production o f mental disorder
or defect. A blow on the head may produce a ja r ,a shake, or a
13violent vibration o f the brain or spinal chord, the practica l re
sult o f which is the suspension to a greater or less degree o f
fewer or more of the functions o f tfce brain or chord. Next there
may follow the molecular alterations and the perversions o f funct
ions, exibited as psycho-neuroses or neurasthenias, and f in a l ly
there may be sub-acute or chronic organic diseases of the brain
and sometimes of other parts o f the system. The age of 'the pat
ient has some influence on the type of traumatic insanity resulting
I t shows a tendency to assume the form most common at that time o f
l i f e . This tendency to the production o f insanity by injury is
greatly increased in neurotic subjects. External violence may a f f
ect the embryo or foetus in utero. Frequently when severe shocks
have been sustained by the pregnant mother, and p a r t ia l ly conveyed
to the womb, they have wroiight v i ta l disaster to the nervous and
mental development to the coming child. The injuries sometimes sus
tained during birth may establish a neurosis or degenerative dia
thesis which frequently ends in Melancholia. Mental alienation when
induced by bodily injury apart from the head is more an indirect
than a direct result.
An important cause of the re la t iv e ly large amount o f Mel
ancholia existing is the e f fe c t produced on the brain by indirect
physical and emotional causes. These causes have already been
stated. When the means o f subsistence fa l ls so low as to verge on
starvation the nerve centers become very poorly nourished, and the
14signs o f alienation resulting from the d irect stress o f imperfect
nutrition, unlike business reverses,which a ffec t the. unstable
mind through the suddenness and unexpectedness of the shock,begin
to show themselves, Quite commonly certain symptoms which the pat-
lent displays in the period of emotional disturbances which goes
before the complete loss o f se lf eontrol are wrongly understood
as exciting causes when they are only incident to the insanity.
This is notable true of relig ious excitment. In the depressed
periods o f Melancholia the subject is restless and low sp irited,
introspectiveand d issa tis fied with himself. In this state of mind
his thoughts are apt to turn upon his spiritual na lure,and he; a t to
nds church a tten tive ly in the hope that through sp iritual exalta
tio&, he may obtain r e l i e f from his overwhelming depression. His
thoughts become centered upon relig ious subjects, his restlessness
increases, he becomes sleepless and loses his appetite and la te r
becomes deranged. The re lig ious excitment had to do with the
production o f insanity, but back o f that lay i l l health, business
worries, overexertion, excesses o f some kind, or possibly an here
ditary defective nervous organization.
The causes given under the th ird division,which were
somewhat fu l ly treated,are either d irectly or ind irectly responsi
ble for about 25 % o f insanity.
Of the forth division heredity is by fa r the most impor-Tr
tant cause. By heredity we mean a reproduction in progeny or o f f
spring, by transmission or descent, o f the salient mental and phy-
—
sica l characteristics o f the ancestral type. Race a fte r race,in
dividual a fte r individual,have endowed their progeny with a synop
sis o f the sum tota l o f their objective and subjective experiences,
plus the similar experiences o f their predecessor whether man or
animal. In a more or less varying line there has been transmitted
down the ages an impetus, a gemule, a gem plasm, or whatever this
po ten tia lity may be termed,which has passed from being to being
added unto and strengthened in one generation,depending upnn envir
onmental resistence. Thus i t is seen that the poten tia lity which
insures that " like w il l produce l ik e " , when i t reaches the indiv
idual may be increased or decreased in various ways, depending
up cn the conditions ender which the organism is placed. As 4 rule
the characteristics o f the immediately preceeding generation o f
ancesters, are impressed most strongly. "Ift terse terms an indiv
idual may start a neurosis or degenerative diathesis «■** in his
own l i f e ' s h istory, or add to one originated by his parent, or
modify an ancestoral a tav is tic vice o f development," Also the
prepttence o f one or the other parent may determine whether the o f f*
€
spring acquire the f in a l ly appointed armamentarium o f the genus
or the coarse amature o f the criminal. When the degenerative
element approaches a great degree o f morbidity, i t soon reaches a
stage in the family history when the line becomes extinct, thus ex
plaining the frequent s t e r i l i t y and barrenness o f the defective and
delinquent classes, or the degenerative developmental impulse may
be so misspent or dissipated, as to render a proper development
16impossible, or the individual reaches maturity with a damaged and
over susceptable organism. The other causes have been treated
rather fu l ly and w ill not be taken up further.
Melancholia is c lass if ied as acute,hyperacute,
subacute, chronic, remitt ent and intermittent. These forms w il l now
be considered. In the prognosis of Melancholia the more acute
and recent^St ack is ,the more favorable are the prospects, and f o l
lowing from this the longer the period o f incubation aad the; more
lingering the progress ,fina lly the existences o f hallucinations are
a l l indices o f threatening incurability . In regard to correspond
ing mental lesions, there is some dispute as yet. When narrowed
down to the functional alienations or true insanities,the question
becomes yet harder to answer. I t appears that in the great major
i ty of cases no traces are l e f t by the acute insanities. We may
suppose that maniacle conditions or too se of excitement correspond
to a hyperaemia and Melancholia or depressed state, to an ischaemia
of certain regions of the brain and indeed with some reason,yet
these purely functional disorders usually disappear at the autopsy,
so,they cannot always be v e r if ied . I t has been prop used to make
cerebral oddema the characteristic o f one particular form o f mental
d isease ,- ’'Melancholia with stupor;' The outward manifestations o f
these conditions are very p len t i fu l. Hallucinations o f hearing
sight and the other senses are frquently noticable. Every subject
o f such auditory ha llu c ina tions is a dangerous patient. What was
at f i r s t to them confused and inarticulate hallucinations,becomes
17la te r organized,and to use an expression of the patient "becomes a
vo ice". What i t w i l l say and impel them to do, depends especially
on the character o f the insanity ani tfce former l i f e o f the patient.
Hallucinations o f the other senses are not so frequently met with
in the acute form. The humility, contrition,apprehension, cares and
anxieties,are merely preversions o f the ego istic fee lin g vihich is
evidenced in the refusal o f food and the constant tendency to sui
cide peculiar to Melancholia, Winslow records a statement of a
patient as fo llow s,-" For six months I have never had the idea o f
suicide night or day from my mind. Whereever I go an unseen demon
pursues me,impelling me to s e l f destruction. My w ife,fr iends, and
children,observe my lis tlessnes and perceive ray despondency byt
they know nothing o f the worm that is gnawing within*! Among the
physical disorders,one o f the most prominent is the insomnia indue
ed in acute attack^. Tactile^h ich w i l l be considered la te r is
much impaired, explaining the indifference to pain which so many of
the alienated show. There is frequently a loss or diminisrinent o f
the muscular sense, which possibly explains the prolonged attitude
and catileptiform immobolity o f seme anong them, who at times
seem to have changed to vertib le statues.
In K, K, the above symptoms(were especially evident.
Female sex,aged 24,not married,height f iv e feet three,weight 130
pounds,pulse slow ,d istinctive melancholiac attitudes, says very
l i t t l e , wall not always answer questions, sometimes repeats the last
few words o f the question asked, has no special delusions or at
18least says nothing o f them. Was observed going along the ha ll with
the arms outstreAched,apparently in a catileptiform condition. She
was requested to play on the piano,and there the same thing was
evidenced only in a d ifferen t way. She only desisted when taken
away and during the playing through several changes,kept up the
same monotonous performance.
Of respiration and circulation in Melancholia no defin ite and
conclusive statement can be made, since they may vary either way
between extreme ranges. The nutrition until .the chronic stage is
reached is very poor indeed, as a result the subject is generally
in a much emaciated condition. The secretions are altered,indeed
i t is partly owing to the respiration (anidrosis) that the skin and
hair assume their special characteristics. The temperature is low
ered in a l l depressed or apathetic forms. Priam the good e ffec ts
frequently obtained by washing out the st omachs o f Melancholiacs,
i t seems log ica l to assume that the result produced may come thr
ough auto-intoxi cat ion.
The f i r s t period o f Melancholia is that o f invasion
which may begin with gastro-in testinal disorders,insomnia,depress
ion, ennui; but outside o f these there seems to be no special sym
ptoms. This stage does not last for any great length o f time and
sooner or la te r gives way to the fu l le r development o f the disease.
In culmination the principal symptom;-, is a painful concentration
of the mind upon some characteristis delusion or hallucination. The
ideas are variable between rather narrow lim its . They are ordinar-
19i ly ideas o f ruin, impo tence, damnation, persecution, disgrace, and
especially o f cu lpability and imaginary crimes. Mr. K. was a good
example o f the la tte r , 50 years old, rather short stature, fa i r nut
rition,occupation book-keeper, not very temperate, duration o f in
sanity four years, doubtful hereditary, had attempted suicide, and
since that time has been mentally unbalanced, believes that he has
robbed his employer o f a large amount o f money,nothing can change
his delusion, he believes that he is the meanest man on the face
of the earth, is going to be dammed, he thinks he ought to be shot,
and would not make the s ligh test resistence in such event , he does
not know what tie did with the money, (his employers obtained an ex
pert accountaint to go over the book and a ll was discovered straight
) but s t i l l he knew that he had taken the money and was consequent
ly the worst sinner outside o f H e ll. Hid is a case o f chronic Mel
ancholia with delusions o f crime and again we are reminded of the
perverted ego istic impulse so frequently seen and the constant
teridency to re fe r a ll e v i l to s e l f . Corresponding with these de
lusions are special symptoms o f speech. They talk very l i t t l e , and
then in a slow doleful tone as i f the,words were forced out. In
acute Melancholia hallucinations are nearly constant, several
senses may be involved,but hearing is most frequently a fi ’acted.
They hear voices threatening and reproaching them and see a ll man
ner o f disagreeable sights. In Mrs. M.,aged 44 , white, f iv e feet two
inches high,weight 98 pounds,Teutonic,very anaemic,hair sandy,harsh
and scanty,skin dry,heredity bad,and nutrition very poor. Hallucin
= g e --------- -— ■— — — —— -------— — =— ------------ --------------— — ------at ions that voices come to her in the nightand t e l l her she is not
f i t to l iv e , that she is in the road,and is eating what belongs to
others. She would eat only when fed but made no very determined
efforts to comr.it suicide, again exibiting two of the typ ica l phas
es of Melancholia; The tendency to cormiit suicide is nearly con
stant but under characteristic conditions is never carried out,
since the patient lacks a su ffic ien t amount o f in it ia t iv e as well
as the consequent w i l l power necessary to carry out any very deter
mined e f fo r t at s e l f destruction and the only endeavors made are
ridiculous in the ir f u t i l i t y . In Melancholia the patient frequent
ly declares that he fee ls no hunger or fo r some other assigned
cause refuses to take any nourishment whatever. But has not a suffi
f ic ien t anount of w ill power to prevent himself receiving food,when
he only needs to he the passive agent. The causes fo r such perver
sions are found freepiently in abnormal conditions,of the intestines
as cancer,ulcers,gastric dilation,dyspepsia,gastritis,dysentery,
e n te r i t is ,c y s t i t is etc. The functional systems not less important
and numerous are saburral conditions,fetor o f the breath,regurgi-
tat ion, with pyrosis, vomi ting, gas trorrAa£gi a, and enterorrhagia, intes
tinal colic,meteorism, tympanitis, constipatior^particularly diarrhoea
and incontinence of urine and faeces. These symptoms may be seen in
all forms o f insanity but are more especial to Melancholia,many of
whose symptoms are d irec tly traceable to such pathological condi
tions, Acute Melancholia does not ordinarily have as a basis,ad
vanced stages of the above mentioned conditions. And for this
--------------- ------------ ---------------- . — ■— ---------- ------------------------ ----------------------------------- -— “ — = —
reason presents more p o ss ib i l i t ie s for cure under proper hygenic
treatment.
Sub-acute Melancholia, the melancholia o f depression, is
very common in the female, i t may be either delusional or non-de-
lmsional* A rather fu ll personal history o f J, B. flras obtained.
Kis ailment had o r ig in a lly been acute Melancholia and a history o f
its progress through sub-acute Melancholia is herewith presented.
J. B, male, admitted July 13 189,marrie d, white,
born in Germany,age at time o f admittence 39,Teutonic,business l i v
ery keeper, common school education, temperate,Homan Catholic,used
tobacco,duration o f insanity short,not sexua l,f irs t attack,paternal
hereditary none,riiaternal heredity ^-father suicided,two brothers
unbalanced, cause unknown. No bruises,much headache,goo (^nutrition,r
f iv e fee t seven and one ha lf inches tall,mouth and tongue clear,
appetite fair,bowels a irregular,sleep poor. Special sanses - sight
and pupils normal,hearing good. Skin dry,s ligh t general insensibi
l i t y on right dide, reflexes s l igh t ly diminished on figh t side,ap
parently chronic bronchitis. Heart normal, respiration 16 and regu
lar, palse 84 weak regular,genito-urinary system noamal. Delusions
o f persecution, suicidal tendencies but no homocidal, inhibition
poor. Patient suspicious,fears that he is going to receive sane
bodily injury, he is rather depressed but talks fre e ly and answers
questions,has no pecu lia r it ies o f speech. His parents were born
in Gemany,no relationship existed between than. His father was
r ^ r ------- -— ---------— - — ■— - — ■— =— ■— — ---------- -— ■— —— ■— ----------aged 37,his mother 39 at his b irth. His mother died o f consumption
and rheumatism. J. B. was an industrious worker, temperate,uniform
disposition, rather successful in business, chewed tobacco and out
side o f this had no vicious habits. The assigned causes are hard
work,business compl i cat ions, and the worry consequent to the care of
a sick child with whom he staid up nightly during the previous May.
In June he became nervous and excitable, he aaid sane one was going
to take his property from him and was going to jump into the canal.
He was treated by sedatives which induced soitae constipation . He
seemed to get better until July 4th, when he jumped from the upper
story window,sustaining a rupture o f the inguinal regions but which
was however readily reduced. He was now very weak physically
and made only one attempt at suicide afterward when he again jumped
from a window. I t was only necessary to restrain him during the
last two or three days before taking him to the County j a i l . During
this time he was watched and held down by neighbors. July I3th,'89
present condition feeble,emaciated. Pulse normal, pupils equally
dilat ed, voice unnatural, stammering and hesitating,hands sweaty,
appetite poor,sleep induced only by means o f narcotics,digestion
bad. There were no signs o f paralysis un til a fte r his fa l l vshen
symptoms o f concussion of his brain and spine appeared in the par
alysis of the lower extremities which lasted about eight hours.
This was removed by means of counter ir r itan ts . He talks about his
debts and family, but is occasionally observed talking to himself.
Sept.22nd, he has no delusions,he wants to work,and appeared cheer-
23fu l when informed thathe was to be sent home soon. He was sent home
but was returned in a few days as he had become v io len t. Feb .l9 th,
his wife died and i t was thought advisable to take him to the funer
a l. On arris ing that morning on which he was to leave he said that
i t seemed to him as i f something awful had happened. Upon his re
turn he seemed to fe e l the death o f his wife very much and appeared
more quiet. He continued in the same state for sane time verging
toward chronicity. Oct,6th ,*90, Appetite fa ir ,b od ily health good,
sleep very disturbed,habits very cleanly,he is s t i l l w ill ing to
work, takes care o f the supervisor's o f f ic e , seems always depressed
and crys for the least cause. Nov, I l th , becomes very much g r ie f
stricken,he talks much o f his family and o f his desire to see them.
June I 6th, begins to talk o f himself,he remains stationary until
July 15th when he seems to improve some since he does not cry so
much. Aug,2nd, he s t i l l continues neat and tidy but is constantly
depressed and talks o f h@me. Aug. 22nd, appetite fa i r ,bodily healtK
good, sleeps well, talks much. Sept. 22nd, he seems to have no real
ization of his condition but crys continually,wants to go home to
his children. Stationary un til Dec. 22nd,talks o f home and children
and crys. Stationary until March 23rd,health good, wants to go
home, s t i l l worse. May 20th, he said today that he thought he was
well enough to go home, June 20th,it is d i f f ic u l t fo r him to com
prehend,he wonfiss a gi*eat deal,works very fa ith fu lly . July 22nd,
worries constantly and crys,writes home once or twice a week. Sept.
I 2th, his health and appetite are both good,he talks much of the
24time when he shall go home, Jan, I2th, *91, he is afraid o f some
ham which may befa ll him and erys constantly, assigning fo r a reas
on his desire to go home and see his children, Stationary, April
27th, nervous at times. March 23rd,His appetite poor, sleeps well,
talks much o f his brother George and s is te r Lucy, Stationary. Appe
t i t e good,becomes delusional at time^and may be disturbed or qpiet.
The rest o f his h istory has been the regular progress into chronic
Melancholia,he now works very l i t t l e and talks 1 css , al thoigh most
of his bodily functions are in very good order. He s its and sobs ,
rocking back and forth and at times no amount of questioning w ill
induce him to reply. At this stage o f the disease the patient
avoids a l l labor,a ll a c t iv it ie s and social l i f e ,h e isolates him
s e l f and incapable of making any e f fo r t or wish,remains fo r months
at a time in a position o f absolute passiveness. A designation for
this phase o f insanity sometimes used,is Melancholia with reasonings
The subject fee ls and comprehends his condition and is sometimes
capable o f resisting his pathologicallj$hhmocidal or suicidal impul
ses. Subacute Melancholia generally manifests i t s e l i i^ more or
less sudden attacks, l iab le to termination at any time, so ordinarily
recovery takes place with the p oss ib i l ity o f relapse. The prognosis
is more grave than that o f acute Melancholia,
The third d ivision o f Melancholia to be considered is the
Hyperacute or Melancholia with stupor. From a psychic^ we'lnay d if fe r
entiate between cases where there is simple stupor without delus
ions i . e . passive,and those wherein the stupor is only peripheral
25and the mental a c t iv it ie s are exceedingly active. In the la t t e r the
patient may become the subject o f the most fr igh t fu l delusions and
hallucinations and indeed when Melancholia is invested with these
characteristics, i t is a fearfu l disease. Frequently they remain in
one position fo r whole months, as lying in bed,sitting down,or doub
led upon themselves with the immobility o f a statue. Occasionally
tender the influence of a sudden impulse they drop a ll at once their
torpor,have a period o f agitation or commit some act o f violence,
then relapse into their former impassibility. For instance Mrs. G.
who had long been in a Melancholiac stupor, suddenly a r^ed herself
to say, "Cut my throat and le t me die". The at ten dent questioned
her upon the reason for this request. She answered,-"Because I am
so shocked", then relapsed into her former condition, from which she
recovered atthe end o f some months. Hyperacute Melancholia is sus-
ceptable o f cure,but when prolonged results in physical degenerati
on, I t is considered as a phenomenon o f arrest. The anotomieal a l
terations may be either oedematous conditions of the brain,which is
not constant or an atrophy o f the convolutions.
Chronic Melancholia is merely one o f the modes o f termin
ation o f the, other forms. The physical symptoms may improve but the
psychical symptoms become somewhat attenuated,gaining in intensity
as they lose in quantity. Ideas o f persecution ot o f relig ious dela
sions delusions predominate , frequently accompanied with multiple
hallucinations and d if fe r ing from the progressive systematized de
lusions by the etio logy and the existence o f a degree of depression
with Melancholiac paroxysms and a tendency towards suicide. In chr
onic Melancholia consequent to the anxious forms, the most absurd,
hypo chon dr ic 16 conceptions are frequently present. Mrs. Y. upon,
being questioned as to her name,responded,-" I have no name,I am no
one,I have no body,no head,no limbs, I an a vo ice ,I an an echo",or
the man who so frequently called attention to the resonant quali
ties and the beautiful polish Qf the hollow stee l ball which he
possessed in place o f a head. Many o f these delusions lead to the
formation o f a double personality. Chronic Melancholia is incurablq
I t may continue in de fin ite ly and f in a l ly merge into Melancholia
dementia. The last form to be considered is that o f Remittent and
Intermittent Melancholia. Remittent Melancholia is a continuous
form in which between the regularly returning crises or paroxysms,
there are periods o f attenuations or remissions. Intermittent Melan
cholia d i f fe rs from remittent in that the attacks are; not separated
by simple periods of ameliorations or remissions, but by intervals
of complete returns to the normal conditions. When in i t s heighten
ed fom , the insanity is generall y acute or sub-acute. Intermitt
ent and Remittent melancholia are in no ways var ie t ies from a
sYmptomological point o f view,but are distinguished by the fo llow
ing points. ( I I The attacks are reproduced in a more or less re
gular fashion. (2) That they are usually identical with each other,
( 3 ) That they begin and end as a rule suddenly, (4) That they are
always separated by remissions or intermissions, ( 5l That the dur
ation o f the alternation is indefin ite and ceases only when chron-
"27ic i t y has appeared. These forms as well as the insanities o f dou
ble form are more special to the degenerated and congenitally dis
posed, The general treatment used irjMelancholia consists in a
special oversight of the patient, Russian and Turkish baths, f r i c t i
onal e le c t r ic i ty , in acuste forms nervous sedatives,purgation and
douches and d iffe ren t forms of tonics. The following table is con
densed from a large amount of s ta t is t ic s .
Recovered Died Relieved Chronic
M, Simple 61.7 14. 13.4 10,6
M, Acute 54.9 23. 5 5.8 15.6
M. Delusional 55. 5 14. 14.3 1 6 .
M, Recurrent 50, 12.5 12 . 5 25.
M. Hyperacute 63. 6 9. 27.2
Prom this i t is seen that Melancholia. is susceptable to
cure in a much greater degree than most of the other forms.
The ;following are some of the results obtained from the
autopsies of 104 melancholiacs at the Government Hospital at Wash
ington. In almost every case where the disease had existed some
time, decided atrophic changes were found in the convolutions and
nearly always most noticable over the f^onte—parieta l convexity and
the anterior porti ons o f the median surfaces. The dura mater was
adherent to the skull in many cases especially to e lderly subjects.
Shrinkage or atrophy o f the convolutions was observed in the major
ity o f cases. The average weight o f 88 male brains was 44,005 02.
28Of the female brains seven in number,the average weight was 43.62
oz. The facts can be appreciated when i t is known that the normal
brain is from 45 to 50 oz. in weight. The average weight o f the
brain in 7 5 males in whan the disease had existed over a year was
46,64 oz. General reduction of consistence,odema,and enlargement of
the perivascular spaces were found in various degrees in nearly
a l l the chronic cases and frequently in a minor degree in the acute
forms , Lesions o f the cerebellum,pons and medulla,were not common
and the spinal chords were generally found to be normal. The mic
roscopic examinations added but l i t t l e to the knowledge already
obtained. Generally in the acute cases no structural a lteration
could be discovered,though some showed decided degeneration in the
nerve c e l ls and vess'^g/S, these were no doubt c losely connected with
the mental symptoms. Of the diseases o f the other organs,tuber
culosis o f the lungs was found in th irty f iv e cases. The disease
was found accompanied by tuberculor affections of other organs and
was in many cases the direct or indirect cause o f death. The heart
showed valvular disease accompanied by hypertrophy and dilation in
at least eight cases and chronic disease of the valves,as well as
six cases of atrophy of the heart were found, usually in connection
with phthisis. The diseases of the kidneys were usually chronic in
character. In th irty f iv e cases they showed a degree o f contraction
deemed of pathological importance,shown by adhesion o f capsules,
by the granularsurfaces, the cortica l atrophy and the reduction in
weight. There were sixteen cases of lesser contraction and eight
29of other a ffections. The urine which must necessarily be affected
w il l be considered la te r . Five malignant tumors were found,all o f
whichrijwere carcinomata, in one case the prostrate gland was the
seat of the tumor.
Two regular autopsy reports are here given,
Acute Melancholia
No,36,(Head not examined). Heart,weight 7 3/4 oz, calcareous
deposits at the base of aortic valves. Lungs,- right adherent at
apex and upper lo b e , le f t free . On section both hypostatic at bases
posteriorly,most marked at r ight. Areas of pneumonic consolidation
in right lung lobular in character, one focus only in l e f t lung.
Kidneys,- Weight o f l e f t 4 1/2 oz., right 3 3/4 oz. Capsules ad-• $>•herent, surfaces granular. On section chronic in te r s t i t ia l nephrite
Uterus,- Fibroids of Fundus u ter i, small cyst o f l e f t broad l ig a
ment, Mesentric Glands enlarged.
Chronic Melancholia,
( Head not examined) Heart,- weight 8 3/4 oz. Pericardial walls
very thick; the sack contains a few drams of clear yellow flu id .
The epicardium markedly fa tty . M itra lis s l igh t ly thickened;orifice
admits of three fingers. Slight thickening along the attached
borders of the aortic valves. Muscle pale,flabby,on section fa t ty
degeneration exhibited. Lungs,- l e f t very adherent throughout; on
section well f i l l e d with large and small tubercular deposits,a
large cavity occupies the apex and a number of smaller ones scatter
ed through the lings contain purulent f lu id and caseous material.
30Right also firm ly adherent through out,one small cavity at the apex
containing purulent f lu id and caseous material,lung f i l l e d with
hard nodular masses composed o f aggregations o f tubercular deposits
L iv e r , -weight 29 I/ i oz, Peripheries of acini fa tty . Superficial
blood vessles very d is tinct. Gall Bladder,- Cholelithaisis (19 dark
stones each the sixe of a pea,also a quantity of dark f lu id b i le ) .
Spleen,- weight 31/4 oz,very dark and fr ia b le . Kidneys,-weight o f
l e f t 3 1/2 oz, right 3 1/4 oz. Capsules strip readily ,leaving the
surfaces irregular and granular,covered with a number o f cysts from
the size of a pea to that of a almond,containing clear yellow flu id
On section fa tty degeneration and chronic in t e r s t i t ia l changes ex
hibited. In testines,- in ileum and ileo-caceal valve,numerous small
ulcers averaging a pea in s ize, ch ie fly situated opposite mesentric
attachment. Uterus,- very much atrophied, some erosion o f cervix.
Since so many o f these conditions are peculiar to Melan
cholia as compared with other forms of insan ity ,it must be admitted
that a very close relation exists between physical and. psychical
health. And that frequently they may be used interchangeably the
one as an index of the other#
That insanity may as one o f i ts e ffec ts render
a person not responsible for his actions,is recognized by the stat
ute law as well as by the common law of most countries. The gu ilt
or innocence of the accused is determined and secondly in the event
o f the verdict being against the accused, the question o f his sanity
31i f brought up is determined and i f he is deemed not responsible for
his actions,he is treated as are other insane. Thus in the case o f
the defendant who is found by a jury at his t r ia l to have been
gu ilty o f the offense charged against and yet to have been insane,
every care is taken to protect the public from any possible depre-
dations by him in the future, whilst the prisoner himself receives
at once such care and treatment as his insane condition may require
Regarded from this point of view the question becomes somewhat more
simple as well as more practica l. I t is a less complicated problem
to determine in a given case whether a prisoner shall he treated
as a criminal lunatic or as an ordinary prisoner, than i t is to de
fine in the abstract the exact degree o f mental defeet or derange
ment which renders a person insane, so as not to be according to
the law responsible for his actions. The question o f insanity is
always one o f degree and the degree of aberation varies in the same
person at d ifferen t times. The point that determines the degree o f
aberration, that is pronounced insanity, is usually such a^state o f
character and conduct that the person has reached or is liab le to
reach, that renders him or w i l l render him highly objectionable,
troublesome or dangerous to others. The peace safety and wellfare
of others and o f the person himself usually determine the question,
whether he shall be called insane or not. In delusional forms o f
insanity and manicle forms, there is l i t t l e d i f f ic u lty in determin
ing whether the individual is or is not responsible for actions
committed by him. But in such forms as Melancholia whereas as
been said and excessive amoQnt of g r ie f or misery exists compared
to the exciting causes i t is d iffe ren t. This fee ling may have ex
isted for a long time and the individual being su ff ic ien t ly adapt
able to restrain himself so that differences, i f any, noticed in
his behavior were only s ligh t. Suddenly without the s ligh test warn
ing we find that he has committed suicide or has murdered his iam-
i ly . He possible knows that he has done wrong, but thinks that he
has taken the only step out of the dilemma. From the fa.ct brought
out before, i t is therefore evident that in many cases the melanch
oliac is responsible for his actions.
Hale,who wrote in 1670,says there is a tota l insanity
and a partia l form.'The person a ffected with the total insanity
is not responsible fo r any of acts and the responsib ility of the
p a r t ia l ly insane must be determined by the circumstances o f the
case!J BlacHstone considers that i f a man be insane, he should not
be tried and i f he becomes insane afterward,sentence should neither
be pronounced nor judgment executed. In response to the statement
that a man to be irresponsiblepSrskine says, no such madman ever
existed in the world, ( This does not include some cases o f imbec
i l i t y or senile insanity). The other importent point upon which
Lord Erskine insisted and the most important was contained in the
following passage of his speech:- "When a man is laboring under a
de lus ion ,if you are sa t is f ied *hat the delusion existed at the time
of the committal of the offense,and that the act was done under its
influence,then the accused cannot be considered as gu ilty o f any
33crime. The summing up by the judge was as follows: " To be sure i f
a man is in a deranged state at the time,he is not criminally re
sponsible for his acts but the material part o f the case is whether
at the very time the act was committed the man's mind was sane,"
farther he stated that i t was.neessary for the prosecution to show
the sanity o f the defendent. This was during the t r ia l o f James
Hadfield fo r the attempted murder of the King,which occured in 1800
In the case o f Edward Oxford charged with fir in g a loaded p is to l
at the Queen in 1840,- the attorney General said in the course of
his speech that to make the defense o f insanity effec tive,council
for the defense must show that at other times the party in whose
behalf the plea was set up had exhibited marks o f insanity and also
that at the time the act was committed he was in an insane condi
tion and that he was unable to distinguish between r igh t and wrong
At another time Lord Lyndhurst in a speech before the House o f
Lords said as follows: " The question to be determined is whether
at the time the act in question was committed the prisoner had or
had not the use of his understanding so as to know that he was
doing a wrong or wicked act. I f the jurors shall be o f opinion that
the prisoner was not sensible at the tine he committed tire ac t,
that he was v io lating the law, then he would be en tit led to a verd it
in his favor,l?ut i f they are o f the opinion that when he committed,
the act,he wasin a sound state of mind, then their verdict must be
against him," In this case also the defendant was acquitted. A set
of f i v e questions was submitted by the House o f Lords by the Eng-
34lish judges and in reply, the answers following were received,
1, What is the law respecting alledged crimes committed by
persons a f f l ic t e d with insane delusions or partia l insanity, when
the accused knew he was acting in v io la tion to law but did the act
under an insane delusion with the intention of redressing or re
venging some supposed grievence or injury or of producing some sup
pased public benefit?
Ans.- I f the person knew he was acting in vio lation to the law
of the land whatever his intention,he shall not be exempt from pun-
mi shment,
2, What are the proper questions to be submitted to the jury
when a person with insane delusions is charged with some crime?
3, In what terns ought the questions be l e f t to the jury as
to the prisoner's state o f mind at the time when the affense was
committed?
Ans.- To acquit the accused, i t is necessary that the defense
establish the fact c learly that at the time the offense was com
mitted the accused was laboring under such a defect o f reason as
not to know the nature o f the act he was doing. The usual course is
to leave the question with the jury,as to whether the defendant had
a su ff ic ien t degree o f reason to know that he was doing an act that
was wrong.
4, I f a person under an insane delusion as to existing facts
commits an offense in consequence thereof,is he thereby excused?
Ans.- Here i t would depend upon the character o f the delusion
as to the defendant's responsib ility .? For instance i f he k i l le d a
man under the delusion that that man was attempting to take his
l i fe ,th en w ill he not be held responsible. I f on the other hand he
k i l l s him in order to g ra t i fy some supposed spite that he has con
ceived against that person,then is he to be held responsible and
liab le to jjunishinent.
5, Gan a medical man merely from facts gained at the t r ia l ,
be re lied upon to give a true statement of the degree of insanity
of the accused and the condition o f the defendant’ s mind at the
time of the commission o f the ctime?
Ans.- The la tte r is especially more a matter for the jury to
decide but for a correct decision the physician's opinion is re
quired.
At present there is nothing more d i f f ic u l t thaii the appli
cation of the law in insane subjects. The knowledge oi r igh t and
wrong in its broadest sense involves a capacity to reason and draw
conclusions from facts, this of course implies a sound mind. In a
general sense a person may be said to be insane so as not to be
liab le to lega l punishment: l* when his mental condition is such as
to render him un fit for penal d iscip line. 2- When in the words o,
Lord Blackstone "disease o f the mind was the cause of the crime" or
when in. the words of Mr Justice Stephen," The accused was deprived
by disease a ffecting the mind, o f the power of passing a rational
judgment on the moral character of the act which he ment to do."But
i t may be said that the law o f the present day is about a hundred
36years behind the times since no recognition is made of the fact
that disease may a ffec t the w ill power and render a person unable
to restrain their criminal propensities even though knowing that
such acts are in direct v io la tion to the law. In such cases i t
seems hardly right to hold the individual d irectly responsible for
his acts.
Mental Alienation and. Especially Melancholia as Examined
by Experimental Pyschological Methods.
The relations existing between the mental conditions and
the nervous a c t iv it ie s are very intimate, in fact they are one and
the same thing in so far as their relations to health and disease
are concerned. In normal man we may speal o f the amount o f in te lle
ctual capacity,but this can never be stated accurately since i t can
not be measured or obtained concretely, however an index may be
found in the various results obtained as time reactions and from
the temperature and heart pulsations of the subject. The simple
reaction time which is the basis of a l l other measurements of psy-
cho-physical operations has been the subject of inquiry at the
hands of numerous observers with respect to the normal reaction
time to acoustic, v isua l, tactual or gustatory stimuli as well as the
variations observed under diverse physiological and pathological
conditions and alterations in the intensity ar nature of the stim
ulus applied.
Simple as the mechanism is(whieh w ill be described la ter )
37i t is absolutely necessary in dealing with normal and much more so
with insane subjects,to observe certain percautions: F irs t as re
gards the patient,he should be told before hand exactly what is ex
pected o f him and what he may expect and should be given a few pre
liminary t r ia ls . Instruct him to keep his finger on the contact
breaker at s ligh t tension so that no time w il l be lost in breaking
c ircu it . In certain subjects i t is necessary to insist upon keeping
the attention upon the be ll and responding as quickly as possible.
The room where the experiments are carried on, should be as quiet
as possible and nothing allowed in the room which may distract the
subject's attention. So vagrant becomes the attention - o f many
from visual impressions, that i t is often necessary to blindfold the
eyes when testing the reaction to acoustic stimuli and in testing
the reaction to visual stimuli the most absolute silence should be
maintained. Each case must be treated on its own merits and aare
must be taken not to arrouse by any stray remark the s ligh test emo
tional disturbance. Even with a. normal subject such interruptions
are very distracting but are much more so with the insane. A fter
a series o f preliminary tr ia ls when i t is obvious our subject has
accustomed himself to respond properly a series of test tr ia ls
should be taken. We never exceed twenty tr ia ls with these subjects,
since beyond this number a large proportion of cases betray some
exhaustion from the sustained attention requisite; an average is
struck from their total and the maximum and minimum delay also re
corded.
38The simplest reaction may be defined as a signaling by a
predesignated movement that an expected stimilus has been received.
We are informed that a bell is about to strike and that as soon as
the sound is heard we are to press a key, the time intervening be
tween the striking of the be ll and the pressure of the key is a
simple reaction time. In this process we distinguish as physiologi
cal fac tors ,(a ) the impression of the sense organ, (b) the passage
o f the impulse along jja£f'erent nerves (and i t may be the spinal chord
together with delays whenever the impulse enters ce l ls ) to the
bra in ,(c ) the passage of the return efferent impulse from the brain
to the spinal chord and the nerves and muscles and (d)the contrac
tion o f the muscles. The factor thus unaccounted for,the transfor
mation o f the sensory into the motor impulse,is a center or pyscho-
log ica l factor of which we have regretably^knowledge. I t is however
the variations o f this factor and the influences by which its time
relations are favorably or un favorably affected that interests us
more especia lly . That sense organs have a certain in e r t ia , is shownb
by the fusion o f rapidly succeeding images or stimulations «**a. of
through experimentation,‘ftfay be easily elimated by further
research. The rate of the nervous impulse may be considered as a
result o f many experiments to be about HO fee t per second for
both sensory and motor nerve. The latent time o f the muscle and
time of its contraction have been determined and form a s ligh t ana
constant factor. With these facts in view, i t has been extimated
that in a reaction from eye to hand involving 150<r , the central ||
39process and the remaining processes occupy about equal times. So
in tests o f abnormal sub jects ,it is neces sary to take into con
sideration the pathological conditions both physical and mental,
which exist in the patient. Other conditions a ffecting reaction
times in both normal and abnormal subjects a re (I ) the number o f dis
tinctions and choices, (2) specific nature of the impression and
the reaction, (3) the foreknowledge o f the subject, (4) the associa
tion o f stimulus with motion, (5) a frequent overlapping o f mental
processes.
The greater number o f observers give .19 sec. or even
less as the normal reaction time to visual stimuli and from .14 to
,15 sec, to auditory stimuli. Taking .19 as the standard in health
we find notable delay in those cases o f paralysis and stuperous
Melancholia in whom, the visual reaction times were tested. No ef-*
forts were made to discover the relations existing between tne
various senses as regards their l ia b l i t y to diminition in sense-
tivness in the various mental a ffections.
The tests made were as fo l lo w s , ( I ) Auditory reaction
time, (2) Visual reaction time, (3) Sphygmographic tracings, (4)
Pressure sense, (5) Temperature. Following are the details o f the
processes with further on a tabulated l i s t o f results.
I . - As shown in photograph number I ,th e apparatus used was
sin improved chronometer measuring to .01 seconds accurately with
the necessary e le c tr ica l connections and an e lec tr ic b e l l . I t was
so arranged that upon the operator closing the e le c tr ic c ircu it , the
40be ll would ring and the chronometer would start the subject was
instructed that as quickly as possible upon heraing the b e ll he
should break the c ircu it with his c ircu it breaker, whi ch was obtaiit-
ed with s ligh t pressure, simultaneously with this the chronometer
ceased running and the reaction time was noted down-, the averages of
a number of experiments are given below in conjunction with those
of visual stimuli.
The reaction time to visual stimuli was obtained by
means of the apparatus and e le c tr ica l connections as exhibited in
photograph number 2, The apparatus used was a shutter behind which
was concealed an object, the shutter was so arranged that i t could
be dropped and at the time the object came into view, the shutter
struck a c ircu it closer,establishing the c ircu it and setting the
chronometer into operation, the subject then broke the c ircu it au
the moment when he was able to speak the name p f the object, A ser
ies of tests were made upon d ifferen t persons and are presented far
tfcer on in connection with the other reports,
3, In the various conditions o f insanity the influence of
the nervous system upon the heart and circulation is such that in
nearly every case the sphygmographic character o f the pulse is a l
tered ,in some way from the normal, and for purposes o f diagnosis as
well as prognosis the instrument is frequently of valuable service.
Prom the nature o f the apparatus obtainable i t was impossible to
take any tracings except from the carotid* artery, Further on w ill*
be found tracings su ffic ien t to exhibit the special character is tics
f
41of f i r s t the normal pulse,second the Melancholiac pulsation,third
the epleptic circulation,and fourth exhibits characteristics o f ciur
onic Melancholia. Number I is a gooA sample of normal tracing,the
descent is marked by several undulations, the point is sharp and
the ascent abrupt, the pulse is about seventy f iv e per minute and
the heart's action strong and the arteries well f i l l e d . Number 2
exhibits the characteristics of Melancholia, the pulse excepting in
acyute cases is slower than usual and from the tracings and imper
fe c t f i l l i n g o f the vessles and an imperfect cardiac systole is in
dicated. The upstroke is short and slanting and the down stroke
prolonged and undulating. The tension is very low so that i f much
pressure is used the pulsations are en tire ly lo s t . Number 4 exhib
its the phases o f chronic Melancholia especia lly well. The heart s
action as evidenced by the tracing, is much stronger than that o±
No,2 and in short is what we might expect in the return o f bodily
health which ensues in chronic Melancholia, The manner o f using
the apparatus is shown in the accompanying photographs,but possibly
its construction is well enough know not to need farther descrip
tion.
4. Testing for sen s ib il ity to presure is performed as f o l
lows: any portion o f the body selected is denuded of hairs and rub
bed with o i l . A series o f cork weights from .01 milligram up to
several milligrams are obtained and beginning,a very l igh t one is
gently placed upon the skin, i f possible so as not to be f e l t , i f sue
c e s s fu l ,weights are added until f e l t . At some o f the more sensitive
42portions o f the body mere contact o f any perceptable weight suf
fices to produce a sensation and in such cases the skin sensibility
is tested either by the variation in weight which the subject is
able to distinguish or by obtaining the least distance at which the
subject is able to distinguish between two points o f contact upon
the skin. The sen s ib il ity of the skin varies greatly on d ifferen t
portions o f the body.
The following are some of the reaction times obtained in
normal subjects and Melancholiacs. The f i r s t f iv e are normal.
Se lfR. K.I . H. R. L . D. A.R. W.M. L.S. W.J. w. G. A. J. W.
Simple Melancholia - - - - ■ Simple Melancholia - - - - ■ Climacteric Melancholia - ■ Hypochondriacle Melancholia Delusional Melancholia - - ■ Depressed Melancholia - - ■
Auditory .13 .15 .16 .13 .16 .29 .22 .29
- .23 .20 .23
Visual.16.17.13.21.21.30.25.29.24.26.24
(reaction times for comparison)
The average reaction times follows:General Paralysis
for a few fonns o f Auditory
.19
insanity are as Visual
.23
43Alcoholic Insanity- Epileptic Insanity Chronia Mania
Auditory. 2 1.23
- .25
V i sual.25.26.275
None of the patients examined suffered from any very ser
ious degree of Melancholia such as would have prevented them from
entering fu l ly into the interest of the t r ia l . And franco titer obser
vation on normal subjects the lim it o f va r iab il ity for acoustis
stimuli has been found to be from .12 to .18 of a second and for
visual stimuli from ,15 to ,22 of a second. In the insane the fo r
mer is only exceptionally below ,20 and the la t te r rises i riem .24
to .30. The prolongation of the reaction times in Melancholia a-
r ises from the general defect in nutrition throughout the whole
body and this defect is always of the nature o f a slackening, weak
ening dimunition of the a c t iv ity in the proeess of nutrition. In
a ll the parts of the body that are open to observation, nu trit ive
defect shows i t s e l f conspicuously in the pathological conditions.
In the normal subject,weights of .02 gr. can be d istin
guished on the forehead and of .03 gr, on the abdomen. In melanch
oliacs the sens ib ility is never so acute as normal,frequently a
frram weight cannot be distinguished on these portions. On the palm
or d ig its normally .02 gV. can be distinguished. The figures follow
ing show the susceplability for variation as shown by normal sub-
j ects,
"For I g r . , .32 gr. can be distinguished as a variation For 5 g r . , .96 gr. can be distinguished as a variation For 10 g r . , 1.4 gr. variation can be distinguished For 20 gr, 2.4 gr. variation can be distinguished For 100 g r . , 7.4 gr. variation can be distinguished'
44In these there is shown a constantly decreasing ra tio , -Frequent!./
in Melancholiacs the pressure spots are deadened and no variation
in pressure earn, be distinguished. The method for testing"loca l sign
gives in many abnormal cases very exaggerated results. A ver^ pec
u liar and unexpected fact in the study of the temperature is, that
i t is generally about a ha lf degree above the normal average,frequ
ently i t rises to 101 degrees.
Concluding we may say that advanced researhh upon the
lines suggested here has given much that is o f value to science
and especially to medicine and inthe fuUute w ill be the means by
which much more of importance both to the physician and the unfor
tunate sufferer w ill be gained.