CHAPTER XV.INSANITY.

It is not the object of this chapter to treat at large of insanity. It is my intention to speak, as briefly as possible, of some points in regard to its causes and its treatment, which ought to be understood by the community.

The causes of insanity may be divided into two classes—those which act upon the mind, and those which act upon the body.

The mental causes of insanity do not produce the disease directly through their influence upon the mind. But this influence extends to the organization with which the mind is connected; and the insane manifestations or symptoms are entirely the result of the reaction of the affected organization upon the mind. As this point has been somewhat fully elucidated in the chapter onthe Mutual Influence of Mind and Body in Disease, it is not necessary to dwell upon it here.

The physical causes of insanity may be subdivided into three classes; those which act upon the great central organ of the mind, the brain; those which produce disease in other organs, affecting the brain sympathetically; and those which have a more general influence upon the system as awhole, or as a congeries of organs. In an individual predisposed to insanity by the peculiar cast of his nervous system, this malady may be induced by some local disease of some of the organs, or by an impaired state of the general health.

There is commonly too much disposition to look to some one thing, as the cause of the insanity in each individual case. And this disposition is encouraged by the tables of causes, which appear in some of the reports which are issued from our Insane Hospitals. These tables cannot be made up with any degree of correctness. They are therefore of little, if any, use; and they are even calculated to lead to error, if any great reliance be placed upon them. In the great majority of cases of insanity, the disease is the result of a concurrence of causes, and not of one cause alone. Perhaps it will be said, that in constructing these tables thepredominantcause is sought for in each case. If it be, it is by no means always easy to find it. In very many cases there must be much doubt in regard to it; and in no small proportion of them candor would lead to the confession, that we are entirely in the dark on this question. In the classification of causes, the class ofdoubtfulorunknownshould be much more numerous than it usually is in the annual reports of Institutions for the Insane.

One of the mistakes which are committed by the community, and sometimes even by physicians, in regard to the causes of insanity, deserves a passing notice. Theformof the derangement is often considered as indicative of the nature of its cause. It is by no means necessarily so. For example, an individual, who in his derangement talks mostly on the subject of religion, cannot as a matter of course be considered as having become insane through religious excitement. It may have been so, but the bare fact, thatreligion furnishes the subjects of his insane ideas and feelings, is no absolute proof that it is so. As well might it be said, that a patient who thinks that he has no stomach, of course became insane through abuse of that organ. A very common cause of insanity of a religious character is an impaired state of the general health; and the insane ideas run in that particular channel very often from the influence of merely collateral, or adventitious circumstances.

Neither can the form of the derangement furnish any conclusive evidence as to the character of the patient. Persons of the purest minds, and of the deepest reverence for the Deity, are sometimes in their insanity exceedingly profane and obscene.

It is important that the public should be informed in relation to thecausesof insanity, in order that these causes may as far as possible, be avoided. I will therefore notice some of them very briefly.

One of the causes of insanity is an indulgence of the passions. I take as an example the passion of pride. When this passion has obtained a monstrous growth from long indulgence, a severe mortification of it, especially if it be repeated or continued, will produce insanity in those who are predisposed to this disease, and sometimes in those who have no marked predisposition of this character. Many cases of this kind may be found in our Retreats.

In this connection I mention, as another source of insanity, the wrong views of life, the false principles, and the sickly sentimentalism, which are infused insensibly into the mind by a very large proportion of the fictitious literature of the world. This influence is a more prolific source of insanity than is commonly supposed. Not only is it exerted upon the reader as an individual, but it affects through themultitude of readers the general tone of thought and feeling, and thus acts widely, not merely as a particular, but as a general cause of insanity.

Anything which causes an undue excitement in the mind has a tendency to produce insanity. A too exclusive and prolonged attention to one subject has this effect. It is in this way in part that ultraism acts as a cause of this disease. The brain becomes wearied out and weakened by one kind of effort, just as the muscles of the school boy’s arm are tired out, when, as a punishment, he is compelled to hold with outstretched arm any heavy article for some considerable length of time. A wearied and weakened brain, when the infliction which produces this result, is frequent and long continued, is apt to become diseased; and one of the diseases to which it is thus made liable is insanity.

It is said that insanity is hardly known among the savage and uncivilized. There are two reasons for this. They are the intellectual torpor, and the physical vigor, which result from the habits of the savage. Wild passion, it is true, sometimes lashes his mind into fury, but it easily subsides into its usual repose, and the firm fibres of the brain and nerves suffer no injury from the shock. So also in countries which are ruled by despotic governments, the mental torpor which prevails makes insanity a rare disease.

As the intellectual torpor and the physical vigor of savage life prevent the occurrence of insanity; so on the other hand, the intellectual activity and the physical debility of civilized life conduce to its existence. Mental excitement combined with luxury and effeminacy is a prolific source of this disease. In this age, and especially in this nation, the mental activities in every department of effort are so lively,and have so little intervals of relaxation, that the wear and tear of brain in all this conflict produce an unusual amount of insanity, greater as is shown by statistics, than in any other country in the world.

It is not strange that the excitement which is created in the mind by the stirring motives presented by religion, should sometimes occasion mental derangement. The struggle which it often awakens against the passions, and propensities, and errors, which have accumulated in amount and force by long indulgence in sin, must render persons of considerable nervous susceptibility liable to this disease. But in such cases religion acts only as the exciting cause, while the predisposing causes have been exerting their influence through a long series of years. And it is to be remembered, that though, even when it is properly taught and enforced, it may occasionally act as the exciting cause of insanity, its general influence tends to remove the predisposing causes to which I have alluded, and its universal prevalence would be attended by their entire removal. It is also to be remembered, that of all those cases which are charged to religion by an indiscriminating public, and by the enemies of Christianity, in very few of them is the insanity produced by the proper presentation of religious truth, while in the great majority of them it owes its origin to the wild vagaries and the rash measures of the errorist, the ultraist, and the fanatic.

A fruitful source of insanity is to be found in a general debilitated condition of the system, which may be induced by a great variety of causes. Such a condition is commonly characterized by a morbid nervous irritability, which, with the aid of concurring causes, often produces mental derangement. A very large proportion of the inmates of our Insane Retreats present this condition of system. Theirphysical and mental energies have both been exhausted by incessant toil, and care, and anxiety from year to year, and long continued ill-health has at length resulted in insanity. I may remark that we see, in the loss of physical vigor as a cause of insanity, the chief reason why there are more females than males among the insane.

As intemperance combines so many of the agencies which tend to produce insanity, it is justly considered as one of the most prolific sources of this disease. Strong drink exerts its destructive influence upon the whole man, mental, moral, and physical. It dethrones the reason, and inflaming the passions, gives them the supremacy. It creates a morbid excitement throughout the whole nervous system, and especially in the brain, the great central organ of this system, and the instrument of the mind. It affects other organs also, and particularly the stomach, which sympathizes so readily with the brain, that its disorders, as is known to every one, have a great influence upon that organ. Strong drink, therefore, acting in these different ways upon the system, not only expends the vital power rapidly, bringing on premature old age, but it makes its deposites of disease here and there in the various organs, which seriously embarrass them in the performance of their functions. With such an impaired and diseased state of the system, and with the constant excitement to which both body and mind are subjected, it is no wonder that the intemperate are peculiarly liable to insanity.

In looking at the causes of insanity we readily discover the reason why children are so seldom insane, though, from the liveliness of their sympathies, they are much more apt to betemporarilyderanged by disease than adults are, as we see in the paroxysms of fever. The brain and nervous system require a long series of influences to bring theminto such a state, as renders them liable to that class of diseases, which we include under the name of insanity. This state is an accumulated result of the action of predisposing causes, continued for some length of time, perhaps during all the previous life of the patient. But the derangement of the child ceases with the temporary disease which causes it. Its organs, not being incumbered with any accumulations of disease, return readily to the performance of their healthy functions; and its nervous system not having been shattered with repeated attacks of sickness, and not having experienced the wear and tear of trouble and toil, resumes at once its usual free and easy and buoyant condition.

But, though insanity is not a common disease in the early years of life, the foundations are often laid for it in this forming period. The intellectual is often cultivated at the expense of the physical, thus inducing that debilitated, and at the same time irritable state of system, which you have seen is one of the prominent causes of insanity. The passions, instead of being curbed by reasonable restraints, are left to run riot. False views of life are permitted, with all the bewitching fascinations which genius and fancy and wit can furnish, to stamp their impress upon the mind, and through it upon the brain during the impressible period of its growth. Luxury too pampers the appetites, and gives to them a supremacy, which debases and impairs alike the physical and the mental powers. When the child therefore becomes the man, it is not strange that the predisposition, thus formed within him by this moral and physical training, should become more and more developed amid the stirring and troublous scenes of active life, till at length, through the agency of some exciting cause, insanity appears as the accumulated result of all these evil influences. Educationthen, using the word in its widest sense, has much to do with the production of insanity when it is directed by wrong principles; and, on the other hand, it can be made under proper management, to exert a powerful influence in the prevention of this disease.

Let me now call the attention of the reader to a few considerations in regard to the forms and the signs of insanity.

In some cases the symptoms of this disease are from the first of so marked a character that no one can mistake the nature of the malady. But in other cases its signs are for a long time indistinct, and no period can be accurately fixed upon as marking the commencement of the disease. Such cases are apt to be very obstinate, and the longer they continue without proper treatment, the more difficult is it to effect a cure. And delay is so common on the part of friends in relation to such cases, that many of them, in which an early adoption of the proper course would have resulted in an entire restoration to health, become incurable before anything effectual is done. In order that cases of this character should not be thus neglected, the community need to be enlightened in regard to them.

The conversation and the conduct of such patients often exhibit no signs of aberration of mind, which would strike the common observer, even when the disease has existed for some length of time. And when physicians assert that they are insane, some of their friends are apt to doubt in regard to it, and sometimes they even controvert the assertion. Of many cases of this character which have come under my observation, I will allude to but two. One of them is the case of a lady, whose insanity, which had taken the form of religious ultraism, had been coming on very gradually for a long time. Though it was of so deep a characteras to be absolutely incurable, many even very sensible persons among her acquaintances expressed their doubt of the necessity of taking her to an Insane Hospital, and probably would have cast blame upon me for so doing, had she not at one time summoned her friends around her, and after giving some singular directions and parting counsels, retired to her chamber and laid herself down to die. Such palpable acts as this, are often the first evidence that convinces the friends of a patient of the reality of his insanity. Though it may have existed for weeks or months, they perhaps have thought him to be nervous and ‘in a strange way,’ as it is expressed, but they have not really supposed him to be insane.

The other case which I will mention is one which was brought to the consideration of the civil authority of the town. I was called upon to testify in relation to it. The proofs of this gentleman’s insanity, which I adduced, were even made the subject of ridicule by a portion of that wise body of men, and yet his insanity very soon became so decided that he might be seen from day to day in our streets picking up rags and strings and bits of wood and coal.

The delusions of some patients are confined to some particular subjects. Upon these their insanity will appear in their conversation, while upon all other subjects they are perfectly rational. A man, who conversed with the utmost propriety on all other topics, on being asked if he believed in Jesus Christ, said at once, ‘I am Jesus Christ.’ A lady, who had very ambitious desires in relation to her husband’s standing in society, became insane upon this point alone, and while she was as rational as ever on all other subjects, she constantly poured a storm of reproach and abuse upon him, because he was not as great a man as she wished and expected he would be. A lady, who had been much fatiguedin preparing for house-keeping, upon going into her new abode contracted a feeling in regard to the house, which was something more than a mere dislike—it was a horror. She could not bear to be in it, especially if she were alone. She had an impression, ill-defined but unconquerable and ever present, that something dreadful would happen to her if she remained there. She said that she had rather live anywhere else, even in the poorest shanty. Her friends thought that it was a foolish notion, which she could overcome if she would make the effort. But they were mistaken. She was really insane on that one point. I recommended that she should be permitted to stay away from her house so long as she desired it, and that her mind should be diverted by journeying and visiting. A few weeks sufficed to remove the delusion. I once knew a similar case in which the patient was not removed, and her misery finally drove her to the commission of suicide.

It may be remarked of these cases of monomania, as it is termed, that they do not ordinarily retain the same definite and exclusive character which they at first have. If the insanity continue for some length of time, other delusions are apt to be added to the original one.

Moralinsanity is a form of the disease which is scarcely believed to exist by the community at large, and our courts of justice are very reluctant to recognise it, and will not do so without the most indisputable and abundant evidence. And yet this form of insanity is by no means rare. Many cases of it are found in our Retreats; and the outrages, which such patients commit, are occasionally made the subject of investigation before our legal tribunals. It is an insanity of the moral sense, affecting the intellect little if at all. Dr. Bell in speaking of it says, “There is insanity ofconduct, but not ofconversation; the persons afflicted arecapable of reasoning with correctness and energy upon premises not only false, but which they know to be false, and frequently display the greatest ingenuity in giving reasons for and explaining away their eccentric and unjustifiable conduct, and accounting for the change which, they will admit, has occurred in the whole tone and temper of their dispositions and propensities.

“It is a form of disease in which, perhaps more than in any other, acts which, in a rational and responsible being would be crimes, are committed. It occurs, at times, as the sequel of violent attacks of mania,—it passes into decided mania or demency,—it alternates with intellectual derangements; all which circumstances afford an adequate presumption of its being a genuine form of insanity.”[40]

“Sometimes” says Professor Smith of New York, in a very excellent description of this form of insanity, “it shows itself in the abandonment of ordinary habits and pursuits; in carelessness of one’s own affairs with random indulgence in follies and gross sensualities. Sometimes it is seen in the form of ardent devotion to a succession of projects, each suddenly conceived and embraced, with, it is believed the certain prospect of rapidly amassing wealth, or advancing in honor and happiness—and each as suddenly given up in disgust. In some cases there is an uncontrollable disposition to merriment, boisterous hilarity, and sportive and mischievous conduct towards others. Occasionally the more striking phenomena are inflated pride, exquisite vanity, and contempt of ordinary things. Frequently it assumes the character of melancholy or deep gloom, attended with fondness for solitude, and forebodings of evil when all around and in prospect is inviting and joyous. A form not uncommon displays itself in an unaccountable partiality for particularpersons, and a dislike of the nearest and dearest friends, with a disposition to revile and injure them. The more serious varieties are those in which there is a suicidal propensity, or a feeling of necessity to commit some dreadful crime—for example, to destroy a certain individual, perhaps a relative, as a tender and beloved child—an act, the execution of which, the reasoning power strongly opposes, and the conscience prevents by awakening the feeling of horror. These restraining forces, however, are not always sufficient to curb the strong propensity. Sometimes, as if urged irresistibly by some demoniac influence, the fatal deed is perpetrated; and instant relief from the burning passion is obtained; the homicide feels that a part of his destiny is fulfilled, and hence an emotion of satisfaction spreads over his mind. But such relief is not always durable; regret and remorse may succeed, and rankle long and deep in the soul.”[41]

I will pass on now to a few remarks upon thetreatmentof insanity.

The past history of the treatment of this disease is to a great extent a history of tyranny and cruelty. The errors and abuses which have generally marked the management of the insane, till within a few years, are numerous and truly horrible. But these errors and abuses are fast passing away. Ever since the wise and humane physician, Pinel, entered in 1792 the Bedlam of France, in whose cells three hundred maniacs were chained, and in the short space of a few days knocked off the chains from fifty-three of them with none but happy results, the management of the insane has been becoming steadily more wise and merciful fromyear to year.[42]In producing this change throughout the community, the public institutions for the insane have had a great agency. I will therefore pass at once to the consideration of the usefulness of these institutions, as the best mode which I can adopt for developing the principles to be observed in the treatment of insanity.

The advantages of Retreats, or Hospitals for the Insane, may be summed up under three heads, which I will notice separately.

1. In sending a patient to a Retreat you take him away from all those mental associations under which his insanity originated. These associations are so manypoints of attachment, by which his malady is fastened upon him; and it is therefore almost asine qua nonin the cure to release him from their influence. The power of these associations is most strikingly shown in the renewal of the insanity, in those who are returned to their homes before their restorationis fairly confirmed. Change of scene, as is known to every one, has a good effect upon invalids generally; but it is especially true of those invalids whose disease is insanity. Accordingly a very important part of the treatment of the insane in a Retreat, consists in such a management of their occupations and amusements, as will best divert their minds from those channels of thought and feeling, in which they have previously run.

2. The insane are ordinarily subjected to a more judiciousmedicaltreatment in a Hospital than they are among their friends. It is the testimony of all who have had charge of the insane, that their restoration depends mostly upon regimen, or the regulation of their occupations and amusements, bodily and mental, and very little indeed upon medicine. It is undoubtedly true, that the deranged are very often injured by too much positive medication prior to their admission to a Retreat. They are first dosed by their friends, and the physician who is called in, having had perhaps but a limited experience in insanity, places too high an estimate on the curative power of remedies in this malady, and gives the patient altogether too much medicine. It was once very common to bleed the insane. But it is now settled by the accumulated experience of the profession, that very few of them require this measure, and that most of them would certainly be injured by a reducing practice.

3. In sending a patient to a Retreat, you place him under a better moral and mental management than he can have among his friends. There is a peculiar tact requisite for the proper management of the insane, which some seem to possess naturally, and which is much improved by actual practice. In the selection of attendants in our Retreats special regard is of course had to the possession of this qualification. The attendants are therefore skilful in managingthe insane mind. They are free from those errors which are so common in the community in relation to the treatment of insanity, and which often do so much harm to the insane while they continue under the care of their friends at their homes. Some of these errors it will be profitable to notice briefly in this connection.

It is very common for the friends of the insane to attempt toreasonthem out of their delusions. If the derangement be of a religious type, the clergyman, or some excellent friend, endeavors by argument to convince the patient of his error. This is in vain, and worse than in vain.It uniformly does harm.It does nothing but strengthen the patient’s confidence in his notions, and make him more earnest and obstinate in their defence.

It is quite common still, though not so much so as it once was, to practice deception upon the insane. This ruinous error I comment upon in the chapter onVeracity in our Intercourse with the Sick, to which I refer the reader.

Another error which is frequently committed, is to pursue a timid course at one time and a violent one at another, instead of one which is both mild and firm throughout. This error has been the cause of the practice of much unnecessary cruelty in the domestic treatment of the insane.

These and other errors are for the most part avoided by the attendants in our Hospitals. They have no needless collisions with the patients in regard to their notions and delusions. They practice no deception upon them, but win their confidence by an open and candid intercourse. Their conduct towards them is marked with mildness, and they make use of no more restraint than is absolutely necessary, and that with calm firmness, instead of impetuous and noisy violence.

It is a common observation that the deranged are apt to look upon their most intimate friends as their enemies; while, on the other hand, they are ordinarily much attached to their attendants and physicians. The reasons of this I will briefly notice. In every family, however warm may be its attachments, and however strong may be the control of principle in its members, there must be differences of taste and feeling and opinion, and a mutual yielding on these points is absolutely essential to the maintenance of harmony and peace. Now if one of the members of that family become deranged, his self-restraint is gone, and he no longer does his part of the yielding. He becomes unreasonable, obstinate, opinionative. There is no more agreeing to differ on his part. All the points of difference between him and his friends become now to him so many battle grounds; and those whom he fights he is apt to hate. The injudicious discussions and disputes, which friends are disposed to hold with the insane, add to the difficulty. Then too the deceptions, which most persons feel themselves authorized to practice in such cases are certain to confirm the enmity, by destroying the confidence of the insane in their candor and honesty. I need not stop to show, that there is an absence of all these circumstances in the intercourse between the insane and their attendants in a Retreat.

The reader cannot have failed to see in the course of my remarks, that it is very important that the insane should early come under proper treatment. The first indications of insanity should be noticed, and measures should at once be taken to convey the patient to some Retreat. The delay which is so apt to occur in relation to those, in whom the malady comes on slowly and imperceptibly, is one great reason why so many of them are incurable. If these could all in the very beginning be removed away from the influences,which have produced and are maturing their insanity and be placed under proper treatment, many more of them would undoubtedly recover than now do.

Among the most helpless and pitiable of the miserable in this world are the insane poor. Ordinary sickness requires only ordinary care. But insanity is a malady, which not only often requires more care than other sickness, but a care which is, as you have seen, of a peculiar character—such as the comfortless home, the want, and the ignorance of the poor are unfit to supply. It is the duty of society therefore to make systematic and ample provision for the proper care of this class of the insane. In many of the states some provision has been made for them, but it is very inadequate. The provision in Connecticut is an annual appropriation placed in the hands of the Governor to be dispensed by him to applicants till the whole sum is expended. In this way a large number of the insane poor have secured to them a residence for a suitable period in the Retreat at Hartford. This is well so far as it goes, but it is not sufficient.Allthe insane poor in the State should be provided for. And the expense need not be very great if a proper plan be adopted. A portion of the expense, one third or one half, should be defrayed in each case by the town where the patient resides. In this way any improper use of the public benefaction would be guarded against, for the local authorities would, in behalf of the towns, secure a suitable examination of the pecuniary circumstances of the patients. Such a plan would be a truly economical one. For many, who, with the scanty and irregular provision which is now made, are left to become hopelessly insane, and to be therefore lasting burdens to the towns in which they reside, would under a better plan be restored and become able to support themselves.

This chapter is already so long, that I must devote less space than I originally intended to thelegal relationsof insanity. A few points only can be briefly noticed.

The legal relations of insanity are very imperfectly understood, even by those who are concerned in the administration of justice. The lawyer at the bar, and the judge on the bench, often exhibit great ignorance on this subject. The history of the legal definitions of insanity, given by learned judges, is almost from beginning to end a history of profound blunders. And yet these definitions have been the guide in trials in which insanity has been alleged, except when they have been set aside by the plain common sense of the jury, as has sometimes very fortunately been the case. In speaking of the inconsistencies and absurdities of the English law in relation to insanity, Dr. Bell, in his valuable report to which I have before had occasion to refer, remarks, that “from the test of Judge Tracey, that to exempt from criminal responsibility, the patient should know absolutely nothing, to that of a later tribunal, where ability to repeat the multiplication table was gravely considered as the exact point in a civil case, the doctrines and decisions have been amusingly strange and inconsistent. Even cunning, foresight, calculation, all possessed occasionally in a wonderful degree by the most insane patients of every hospital, have been regularly decided by the highest English tribunals, to contraindicate the existence of that degree of alienation which implies criminal irresponsibility!”

The course which is adopted by our courts, to decide whether a man accused of any crime is insane and therefore irresponsible, is a very objectionable one. In France they are far in advance of us on this subject. The course there is to place the accused, if suspected of insanity, underthe examination of a commission composed of men who are practically qualified to decide such a question. “Upon them,” says Dr. Bell, “rests the awful responsibility of determining the state of the mind of the accused, as to the one fact of insanity; they approach him at all times, they watch his actions in his presence and without his knowledge; his habits, his sleeping and waking hours, his physical condition, everything in fact which can throw light upon the momentous question, passes under slow, persevering, scientific investigation. Under the responsibility of reputations as precious to them as those of the highest court, and under the sanction of an oath, they arrive at conclusions, and present their reasons for such conclusions, which form one, not the exclusive, element for a court and jury to arrive at a just judgment.

How are the facts, elucidating the state of a prisoner’s mind after a doubtful act, ascertained with us? The functions devolved in France upon the bright professional luminaries such as I have named, here fall upon the gaoler, the constables, and the turnkeys.Expertsmay on the day of final trial be summoned in, to give their opinions on testimony, derived from such sources as this! No provision exists for any investigation beyond thevolunteeraid, which such an ungracious task will rarely secure. The moment for investigating the perhaps fleeting manifestations and evidences of disease passes, before the law makes the least advances for the prisoner’s protection. I have even known the instance of a professional man whose life was spent among the insane, and who, moved solely by humane feeling, had visited in prison a friendless wretch whose homicidal act was feared from circumstances to be the result of insanity, being held up and vilified to a jury by a governmentfunctionary, for hisofficiousintermeddling in matters in which he had no concern!”

Such having been the opinions and practices of our courts of justice, it is not strange that the rights of the insane have often been trampled upon and thateven life has been sometimes sacrificed under all the solemn formalities of law, for acts committed in the irresponsible condition of insanity. I could citemanysad cases in illustration, but I will merely advert to one of a recent date, which the efforts of one individual prevented from being added to the long list of cases, in which the robe of justice has been stained by the blood of irresponsible maniacs. I refer to the trial of the poor negro Freeman, who killed the Van Nest family, consisting of four persons. In this case a verdict of guilty was given, and the community who came near resorting to Lynch law before the trial, were eager to have the sentence executed. Governor Seward, who, to his praise be it spoken, as a volunteer nobly stemmed the raging torrent of popular excitement, defended the prisoner. He succeeded in obtaining a grant for a new trial. This trial never took place. The judge, before whom he was to be tried, visited the prisoner in his cell, and becoming satisfied of his insanity, refused to try him. In a few short months the prisoner died, leaving no doubt upon the mind of any one acquainted with the case that he was truly insane.

It is true that the plea of insanity, just like any other plea, is often set up when there is very little ground for it. But there is good reason to believe, that it is very seldom established and made the basis of an acquittal, when it ought not to be. Dr. Bell remarked upon this point in 1844, that “it may be a consolation and an encouragement to juries, in faithfully following out their own sincere convictions upon the law and evidence in such cases, to know,that in a pretty diligent inquiry as to the event of every case of homicide in New England, where the accused has had the defence of insanity ‘set up’ for him, and been acquitted on that ground, it has been found thatnot a single instance has occurred, where the progress of time has not abundantly verified the soundness of the defence.” And he has recently informed me that this assertion holds true up to the present time.

While it is important that justice should be secured to the insane, when placed under trial for acts which they have committed, it is of still greater importance that such acts should, if possible, be prevented. If, when a man in an irresponsible condition destroys the life of a fellow-man, we prevent his innocent blood from being shed, we do well: but if we recognise the existence of that condition, and the danger to others which attends it, sufficiently early, to take measures to prevent his destroying the life of his fellow-man,we do better.

This point of prevention should be made an especial object of legislation. But in this country the laws which aim at this object are exceedingly defective. In Connecticut it is the duty of the civil authority and select men to order “any lunatic, who is dangerous and unfit to be without restraint to be confined in some suitable place.” If they fail to attend to the complaint, in three days it may be brought before any justice of the peace, and he can issue such an order. In Massachusetts the judges of Probate may commit to the hospital any lunatic “who in their opinion is so furiously mad, as to render it manifestly dangerous to the peace and safety of the community, that he should be at large.” The objectionable points in these provisions are two. 1. Those are made the judges of the fact of insanity, and of the danger to the peace and safety ofthe community attendant upon it, who are not competent to pass such judgment. When we say that judges of probate, selectmen, and justices of the peace are not thus competent, we say nothing to their discredit. Insanity is a subject which they have no opportunity of understanding with any definiteness or to any extent. 2. The terms in which these provisions are couched show, that only great and manifest danger is contemplated by them. Some outrage or attempt at outrage is commonly therefore to be proved, in order to authorize in the view of the law the confinement of the person complained of.

With such defects in the provisions of the law, it is no wonder that the community is occasionally shocked with outrageous, even fatal acts by insane persons, who through neglect have been permitted to go at large. Indeed, in some cases there has been no apprehension of danger up to the time of the commission of such acts; and yet if these cases had been submitted to the examination of those who have knowledge and skill on the subject of insanity, the danger would, generally, at least, have been foreseen, and the acts would therefore have been prevented. To secure such an examination a standing commission of lunacy should be appointed, composed of physicians who are properly qualified to decide the important questions which would come before them. Every case of suspected insanity should be subjected to their examination, and it should be their duty to prescribe what measures shall be adopted in regard to each case. Such a commission would not only prevent the peace and safety of the community in many cases from being violated, and save many valuable lives, but it would also secure a recovery in many cases of insanity in which now neglect renders such a result impossible.

Many other points in regard to the legal relations ofinsanity might be noticed with profit and interest to the general reader, but this chapter is already sufficiently long. In conclusion I cannot but express the hope that our lawyers and judges will give more attention to this part of medical jurisprudence; and that the abuses which exist may be speedily removed, so that the pretender to insanity may be sure to be detected and punished, and the truly insane may as surely be secured in their rights.

FOOTNOTES:[40]Annual Report of the McLean Asylum, 1843.[41]A Discourse on the Influence of Diseases on the Intellectual and Moral Powers, by Joseph M. Smith, M. D., Professor of the Theory and Practice of Physic, and Clinical Medicine.[42]The following very interesting account of this experiment is taken from an article on the treatment of lunatics, in the London Quarterly.It was during the reign of terror, and while all France labored under a new form of insanity, that the idea was first conceived of setting loose madmen from their bonds. The good and wise physician, Pinel, seems to have been struck with the injustice of keeping the patients chained in the dungeons of Bicetre, while so many hundreds of his countrymen, more mischievously distracted than many of them, were at large to work the bloody frolics of the revolutionary frenzy. There were at that time upwards of 300 maniacs chained in the loathsome cells of the horrible Bedlam of France. Pinel formed the resolution of setting them free from their strict restraint, and he entreated permission of the Commune to that effect. Struck with the novelty of the enterprise, at that time a sufficient recommendation before any assembly in France, the Commune listened to the proposal, and deputed one of their body, the notorious Couthon, to accompany the physician to the spot, and judge of the propriety of carrying his undertaking into effect. They were received by a confused noise—the yells and vociferations of some hundreds of madmen, mixed with the sounds of their clanking chains, echoing through the damp and dreary vaults of the prison. Couthon turned away with horror, but he permitted Pinel to pursue his enterprise. The philanthropist resolved speedily to liberate fifty of the number by way of experiment, and began by unchaining twelve of the most violent. The account of his proceeding has been recorded by his nephew, Sclyion Pinel, in a lively narrative, which was read before the Academy of Sciences. The first man set at liberty was an English captain. He had been forty years in chains, and his history was forgotten by himself and all the world. His keepers approached him with dread; he had killed one of their comrades by a blow with his manacles. Pinel entered his cell unattended, and accosted him in a kind and confiding manner, and told him that it was designed to give him the liberty of walking abroad, on condition that he would put on a waistcoat that might confine his arms. The madman appeared to disbelieve; but he obeyed. His chains were removed, and the door of the cell was left open. Many times he raised himself and fell back; his limbs gave way; they had been ironed forty years. At length he was able to stand and to stalk to the door of his dark cell, and to gaze, with exclamations of wonder and delight, at the beautiful sky. He spent the day in the enjoyment of his newly-acquired privilege; he was no more in bonds; and during the two years of his farther detention at Bicetre, assisted in managing the house. The next man liberated was a soldier, a private in the French guards, who had been ten years in chains, and was an object of general fear. His case had been one of acute mania, occasioned by intemperance—a disorder which often subsides in a short time under abstinence from intoxicating drinks unless kept up, as in this case, by improper treatment. When set at liberty, this man willingly assisted Pinel in breaking the chains of his fellow prisoners; he became immediately calm, and even kind and attentive, and was ever afterwards the devoted friend of his deliverer. In an adjoining cell there were three Prussian soldiers, who had been many years in chains and darkness; through grief and despair they had sunk into a state of stupor and fatuity, the frequent result of similar treatment; they refused to be removed. Near to them was an old priest, harmless and patient, who fancied himself to be the Savior of the world. When taunted by the keepers, who used to tell him that, if he was Christ, he could break the heavy chains that loaded his hands, he replied with solemn dignity,Frustra tentaris Dominum tuum. After his release he got rid of his illusion, and recovered the soundness of his mind. Within a few days Pinel liberated fifty-three maniacs from their imprisonment. The result was beyond his hopes. Tranquility and harmony succeeded to tumult and disorder, and even the most ferocious madmen became more tractable. This took place in 1792; and the example of Pinel was followed in various parts of France.

[40]Annual Report of the McLean Asylum, 1843.

[41]A Discourse on the Influence of Diseases on the Intellectual and Moral Powers, by Joseph M. Smith, M. D., Professor of the Theory and Practice of Physic, and Clinical Medicine.

[42]The following very interesting account of this experiment is taken from an article on the treatment of lunatics, in the London Quarterly.It was during the reign of terror, and while all France labored under a new form of insanity, that the idea was first conceived of setting loose madmen from their bonds. The good and wise physician, Pinel, seems to have been struck with the injustice of keeping the patients chained in the dungeons of Bicetre, while so many hundreds of his countrymen, more mischievously distracted than many of them, were at large to work the bloody frolics of the revolutionary frenzy. There were at that time upwards of 300 maniacs chained in the loathsome cells of the horrible Bedlam of France. Pinel formed the resolution of setting them free from their strict restraint, and he entreated permission of the Commune to that effect. Struck with the novelty of the enterprise, at that time a sufficient recommendation before any assembly in France, the Commune listened to the proposal, and deputed one of their body, the notorious Couthon, to accompany the physician to the spot, and judge of the propriety of carrying his undertaking into effect. They were received by a confused noise—the yells and vociferations of some hundreds of madmen, mixed with the sounds of their clanking chains, echoing through the damp and dreary vaults of the prison. Couthon turned away with horror, but he permitted Pinel to pursue his enterprise. The philanthropist resolved speedily to liberate fifty of the number by way of experiment, and began by unchaining twelve of the most violent. The account of his proceeding has been recorded by his nephew, Sclyion Pinel, in a lively narrative, which was read before the Academy of Sciences. The first man set at liberty was an English captain. He had been forty years in chains, and his history was forgotten by himself and all the world. His keepers approached him with dread; he had killed one of their comrades by a blow with his manacles. Pinel entered his cell unattended, and accosted him in a kind and confiding manner, and told him that it was designed to give him the liberty of walking abroad, on condition that he would put on a waistcoat that might confine his arms. The madman appeared to disbelieve; but he obeyed. His chains were removed, and the door of the cell was left open. Many times he raised himself and fell back; his limbs gave way; they had been ironed forty years. At length he was able to stand and to stalk to the door of his dark cell, and to gaze, with exclamations of wonder and delight, at the beautiful sky. He spent the day in the enjoyment of his newly-acquired privilege; he was no more in bonds; and during the two years of his farther detention at Bicetre, assisted in managing the house. The next man liberated was a soldier, a private in the French guards, who had been ten years in chains, and was an object of general fear. His case had been one of acute mania, occasioned by intemperance—a disorder which often subsides in a short time under abstinence from intoxicating drinks unless kept up, as in this case, by improper treatment. When set at liberty, this man willingly assisted Pinel in breaking the chains of his fellow prisoners; he became immediately calm, and even kind and attentive, and was ever afterwards the devoted friend of his deliverer. In an adjoining cell there were three Prussian soldiers, who had been many years in chains and darkness; through grief and despair they had sunk into a state of stupor and fatuity, the frequent result of similar treatment; they refused to be removed. Near to them was an old priest, harmless and patient, who fancied himself to be the Savior of the world. When taunted by the keepers, who used to tell him that, if he was Christ, he could break the heavy chains that loaded his hands, he replied with solemn dignity,Frustra tentaris Dominum tuum. After his release he got rid of his illusion, and recovered the soundness of his mind. Within a few days Pinel liberated fifty-three maniacs from their imprisonment. The result was beyond his hopes. Tranquility and harmony succeeded to tumult and disorder, and even the most ferocious madmen became more tractable. This took place in 1792; and the example of Pinel was followed in various parts of France.

[42]The following very interesting account of this experiment is taken from an article on the treatment of lunatics, in the London Quarterly.

It was during the reign of terror, and while all France labored under a new form of insanity, that the idea was first conceived of setting loose madmen from their bonds. The good and wise physician, Pinel, seems to have been struck with the injustice of keeping the patients chained in the dungeons of Bicetre, while so many hundreds of his countrymen, more mischievously distracted than many of them, were at large to work the bloody frolics of the revolutionary frenzy. There were at that time upwards of 300 maniacs chained in the loathsome cells of the horrible Bedlam of France. Pinel formed the resolution of setting them free from their strict restraint, and he entreated permission of the Commune to that effect. Struck with the novelty of the enterprise, at that time a sufficient recommendation before any assembly in France, the Commune listened to the proposal, and deputed one of their body, the notorious Couthon, to accompany the physician to the spot, and judge of the propriety of carrying his undertaking into effect. They were received by a confused noise—the yells and vociferations of some hundreds of madmen, mixed with the sounds of their clanking chains, echoing through the damp and dreary vaults of the prison. Couthon turned away with horror, but he permitted Pinel to pursue his enterprise. The philanthropist resolved speedily to liberate fifty of the number by way of experiment, and began by unchaining twelve of the most violent. The account of his proceeding has been recorded by his nephew, Sclyion Pinel, in a lively narrative, which was read before the Academy of Sciences. The first man set at liberty was an English captain. He had been forty years in chains, and his history was forgotten by himself and all the world. His keepers approached him with dread; he had killed one of their comrades by a blow with his manacles. Pinel entered his cell unattended, and accosted him in a kind and confiding manner, and told him that it was designed to give him the liberty of walking abroad, on condition that he would put on a waistcoat that might confine his arms. The madman appeared to disbelieve; but he obeyed. His chains were removed, and the door of the cell was left open. Many times he raised himself and fell back; his limbs gave way; they had been ironed forty years. At length he was able to stand and to stalk to the door of his dark cell, and to gaze, with exclamations of wonder and delight, at the beautiful sky. He spent the day in the enjoyment of his newly-acquired privilege; he was no more in bonds; and during the two years of his farther detention at Bicetre, assisted in managing the house. The next man liberated was a soldier, a private in the French guards, who had been ten years in chains, and was an object of general fear. His case had been one of acute mania, occasioned by intemperance—a disorder which often subsides in a short time under abstinence from intoxicating drinks unless kept up, as in this case, by improper treatment. When set at liberty, this man willingly assisted Pinel in breaking the chains of his fellow prisoners; he became immediately calm, and even kind and attentive, and was ever afterwards the devoted friend of his deliverer. In an adjoining cell there were three Prussian soldiers, who had been many years in chains and darkness; through grief and despair they had sunk into a state of stupor and fatuity, the frequent result of similar treatment; they refused to be removed. Near to them was an old priest, harmless and patient, who fancied himself to be the Savior of the world. When taunted by the keepers, who used to tell him that, if he was Christ, he could break the heavy chains that loaded his hands, he replied with solemn dignity,Frustra tentaris Dominum tuum. After his release he got rid of his illusion, and recovered the soundness of his mind. Within a few days Pinel liberated fifty-three maniacs from their imprisonment. The result was beyond his hopes. Tranquility and harmony succeeded to tumult and disorder, and even the most ferocious madmen became more tractable. This took place in 1792; and the example of Pinel was followed in various parts of France.

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