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.