none psychopathology*** copyright (c) by lidija rangelovska. please see the corresponding rtf file for this ebook. rtf is rich text format, and is readable in nearly any modern word processing program. a study of association in insanity by grace helen kent, a.m. and a.j. rosanoff, m.d. kings park state hospital, n.y. table of contents. part i. association in normal subjects. § . method of investigation § . the normal standard § . the frequency tables § . normal associational tendencies § . practical considerations § . an empirical principle of normal association part ii. association in insane subjects. § . general survey of pathological material § . classification of reactions § . non-specific reactions; doubtful reactions § . individual reactions; explanation of groups and methods of application normal reactions pathological reactions derivatives of stimulus words partial dissociation non-specific reactions sound reactions word complements particles of speech complete dissociation perseveration neologisms unclassified reactions normal reactions circumstantial reactions distraction incoherent reactions § . order of preference § . errors involved in the use of arbitrary objective standards § . analysis of pathological material dementia præcox paranoic conditions epilepsy general paresis manic-depressive insanity involutional melancholia; alcoholic dementia; senile dementia § . pathological reactions from normal subjects § . number of different words given as reactions § . co-operation of the subject § . summary acknowledgments index to frequency tables and appendix the frequency tables appendix to the frequency tables part i. association in normal subjects. among the most striking and commonly observed manifestations of insanity are certain disorders of the flow of utterance which appear to be dependent upon a derangement of the psychical processes commonly termed association of ideas. these disorders have to some extent been made the subject of psychological experimentation, and the object of this investigation is to continue and extend the study of these phenomena by an application of the experimental method known as the association test. § . method of investigation. in this investigation we have followed a modified form of the method developed by sommer,[ ] the essential feature of which is the statistical treatment of results obtained by uniform technique from a large number of cases. [footnote : diagnostik der geisteskrankheiten, p. .] the stimulus consists of a series of one hundred spoken words, to each of which the subject is directed to react by the first word which it makes him think of. in the selection of the stimulus words, sixty-six of which were taken from the list suggested by sommer, we have taken care to avoid such words as are especially liable to call up personal experiences, and have so arranged the words as to separate any two which bear an obviously close relation to one another. after much preliminary experimentation we adopted the following list of words: table dark music sickness man deep soft eating mountain house black mutton comfort hand short fruit butterfly smooth command chair sweet whistle woman cold slow wish river white beautiful window rough citizen foot spider needle red sleep anger carpet girl high working sour earth trouble soldier cabbage hard eagle stomach no attempt is made to secure uniformity of external conditions for the test; the aim has been rather to make it so simple as to render strictly experimental conditions unnecessary. the test may be made in any room that is reasonably free from distracting influences; the subject is seated with his back toward the experimenter, so that he cannot see the record; he is requested to respond to each stimulus word by one word, the first word that occurs to him other than the stimulus word itself, and on no account more than one word. if an untrained subject reacts by a sentence or phrase, a compound word, or a different grammatical form of the stimulus word, the reaction is left unrecorded, and the stimulus word is repeated at the close of the test. in this investigation no account is taken of the reaction time. the reasons for this will be explained later. the general plan has been first to apply the test to normal persons, so as to derive empirically a normal standard and to determine, if possible, the nature and limits of normal variation; and then to apply it to cases of various forms of insanity and to compare the results with the normal standard, with a view to determining the nature of pathological variation. § . the normal standard. in order to establish a standard which should fairly represent at least all the common types of association and which should show the extent of such variation as might be due to differences in sex, temperament, education, and environment, we have applied the test to over one thousand normal subjects. among these subjects were persons of both sexes and of ages ranging from eight years to over eighty years, persons following different occupations, possessing various degrees of mental capacity and education, and living in widely separated localities. many were from ireland, and some of these had but recently arrived in this country; others were from different parts of europe, but all were able to speak english with at least fair fluency. over two hundred of the subjects, including a few university professors and other highly practiced observers, were professional men and women or college students. about five hundred were employed in one or another of the new york state hospitals for the insane, either as nurses and attendants or as workers at various trades; the majority of these were persons of common school education, but the group includes also, on the one hand, a considerable number of high school graduates; and on the other hand, a few laborers who were almost or wholly illiterate. nearly one hundred and fifty of the subjects were boys and girls of high school age, pupils of the ethical culture school, new york city. the remaining subjects form a miscellaneous group, consisting largely of clerks and farmers. § . the frequency tables. from the records obtained from these normal subjects, including in all , reactions, we have compiled a series of tables, one for each stimulus word, showing all the different reactions given by one thousand subjects in response to that stimulus word, and the frequency with which each reaction has occurred. [ ] these tables will be found at the end of this paper. [footnote : a similar method of treating associations has been used by cattell (mind, vol. xii, p. ; vol. xiv, p. ), and more recently by reinhold (zeitschr. f. psychol., vol. liv, p. ), but for other purposes.] with the exception of a few distinctive proper names, which are indicated by initials, we have followed the plan of introducing each word into the table exactly as it was found in the record. in the arrangement of the words in each table, we have placed together all the derivatives of a single root, regardless of the strict alphabetical order.[ ] [footnote : it should be mentioned that we have discovered a few errors in these tables. some of these were made in compiling them from the records, and were evidently due to the assistant's difficulty of reading a strange handwriting. other errors have been found in the records themselves. each of the stimulus words _butter_, _tobacco_ and _king_ appears from the tables to have been repeated by a subject as a reaction; such a reaction, had it occurred, would not have been accepted, and it is plain that the experimenter wrote the stimulus word in the space where the reaction word should have been written. still other errors were due to the experimenter's failure to speak with sufficient distinctness when reading off the stimulus words; thus, the reaction _barks_ in response to _dark_ indicates that the stimulus word was probably understood as _dog_; and the reactions _blue_ and _color_ in response to _bread_ indicate that the stimulus word was understood as _red_.] the total number of different words elicited in response to any stimulus word is limited, varying from two hundred and eighty words in response to _anger_ to seventy-two words in response to _needle_. furthermore, for the great majority of subjects the limits are still narrower; to take a striking instance, in response to _dark_ eight hundred subjects gave one or another of the following seven words: _light, night, black, color, room, bright, gloomy;_ while only two hundred gave reactions other than these words; and only seventy subjects, out of the total number of one thousand, gave reactions which were not given by any other subject. if any record obtained by this method be examined by referring to the frequency tables, the reactions contained in it will fall into two classes: the _common_ reactions, those which are to be found in the tables, and the _individual_ reactions, those which are not to be found in the tables. for the sake of accuracy, any reaction word which is not found in the table in its identical form, but which is a grammatical variant of a word found there, may be classed as _doubtful_. the value of any reaction may be expressed by the figure representing the percentage of subjects who gave it. thus the reaction, _table--chair_, which was given by two hundred and sixty-seven out of the total of our one thousand subjects, possesses a value of . per cent. the significance of this value from the clinical standpoint will be discussed later. § . normal associational tendencies the normal subjects gave, on the average. . per cent of individual reactions, . per cent of doubtful ones, and . cent of common ones. the range of variation was rather wide, a considerable number of subjects giving no individual reactions at all, while a few gave over per cent.[ ] [footnote : in the study of the reactions furnished by our normal subjects it was possible to analyze the record of any subject only by removing it from the mass of material which forms our tables, and using as the standard of comparison the reactions of the remaining subjects.] in order to determine the influence of age, sex, and education upon the tendency to give reactions of various values, we have selected three groups of subjects for special study: ( ) one hundred persons of collegiate or professional education; ( ) one hundred persons of common school education, employed in one of the state hospitals as attendants, but not as trained nurses; and ( ) seventy-eight children under sixteen years of age. the reactions given by these subjects have been classified according to frequency of occurrence into seven groups: (a) individual reactions (value ); (b) doubtful reactions (value ±); (c) reactions given by one other person (value . per cent); (d) those given by from two to five others (value . -- . per cent); (e) those given by from six to fifteen others (value . - . per cent); (f) those given by from sixteen to one hundred others (value . -- . per cent); and (g) those given by more than one hundred others (value over . per cent). the averages obtained from these groups of subjects are shown in table , and the figures for men and women are given separately. table i value of reaction ± . . - . . - . . - > sex number % % % % % % % of cases persons of m.. . . . . . . . collegiate f... . . . . . . . education both . . . . . . . persons of m.. . . . . . . . common school f.. . . . . . . . education both . . . . . . . school children m... . . . . . . . under jr. f.. . . . . . . . years of age both . . . . . . . general average. both. . . it will be observed that the proportion of individual reactions given by the subjects of collegiate education is slightly above the general average for all subjects, while that of each of the other classes is below the general average. in view, however, of the wide limits of variation, among the thousand subjects, these deviations from the general average are no larger than might quite possibly occur by chance, and the number of cases in each group is so small that the conclusion that education tends to increase the number of individual reactions would hardly be justified. it will be observed also that this comparative study does not show any considerable differences corresponding to age or sex. with regard to the type of reaction, it is possible to select groups of records which present more or less consistently one of the following special tendencies: ( ) the tendency to react by contrasts; ( ) the tendency to react by synonyms or other defining terms; and ( ) the tendency to react by qualifying or specifying terms. how clearly the selected groups show these tendencies is indicated by table ii. the majority of records, however, present no such tendency in a consistent way; nor is there any evidence to show that these tendencies, when they occur, are to be regarded as manifestations of permanent mental characteristics, since they might quite possibly be due to a more or less accidental and transient associational direction. no further study has as yet been made of these tendencies, for the reason that they do not appear to possess any pathological significance. table ii. special group values. _____________________________________ stimulus reaction general contrasting defining specifying word. word. value. group group group | subjects subjects subjects |----- % no. % no. % no. % chair........... . . . . . table....{ furniture....... . . . round........... . . . wood............ . . . . cotton.......... . . . easy............ . . . feathers........ . . . . soft.....{ hard............ . . . . silk............ . . sponge.......... . . cloth........... . . . color........... . . . . black...{ dress........... . . . . ink............. . . . white........... . . . . desire.......... . . . . . wish....{ longing......... . . . . money........... . . . flowers......... . . . girl............ . . . beau- homely.......... . . tiful..{ lovely.......... . . . . pleasing........ . . sky............. . . ugly............ . . . court........... . . . . . justice.{ injustice....... . . . right........... . . . . comfort......... . . . disease......... . . . . health..{ good............ . . . . sickness........ . . . . strength........ . . . . arrow........... . . fast............ . . . horse........... . . . . . swift...{ quick........... . . . . run............. . . runner.......... . . slow............ . . . . speed........... . . . disagreeable.... . . distasteful..... . . gall............ . . . . bitter..{ medicine........ . . quinine......... . . sweet........... . . . . taste........... . . . . bread........... . . . . eatable......... . . . butter..{ food............ . . . . sweet........... . . yellow.......... . . gladness........ . . . grief........... . . . joy.....{ pleasure........ . . . . sadness......... . . sorrow.......... . . . . § . practical considerations. this method is so simple that it requires but little training on the part of the experimenter, and but little co-operation on the part of the subject. it is not to be assumed that every reaction obtained by it is a true and immediate association to the corresponding stimulus word; but we have found it sufficient for the purpose of the test if the subject can be induced to give, in response to each stimulus word, any one word other than the stimulus word itself. no attempt is made to determine the exact degree of co-operation in any case. in the early stages of this investigation the reaction time was regularly recorded. the results showed remarkable variations, among both normal and insane subjects. in a series of twenty-five tests, made more recently upon normal subjects, ninety reactions occupied more than ten seconds, and fifty-four of the stimulus words elicited a ten-second response from at least one subject.[ ] [footnote : these tests were made by dr. f. lyman wells, of the mclean hospital, waverley, mass., and he has kindly furnished these data.] it is noteworthy that these extremely long intervals occur in connection with reactions of widely differing values. that they are by no means limited to individual reactions is shown in table iii. by a group of selected reactions, all given by normal subjects. table iii. word combination reaction time value of in seconds. reaction. comfort--happiness . % short--long . % smooth--plane . % woman--lady . % hard--iron . % justice--judge . % memory--thought . % joy--pleasure . % it is apparent, even from a superficial examination of the material, that the factors which cause variations of reaction time, both in the normal state and in pathological states, are numerous and complex. it has been the purpose of this study to establish as far as possible strictly objective criteria for distinguishing normal from abnormal associations, and for this reason we have made no attempt to determine by means of introspection the causes of variations of reaction time. it would seem that the importance and magnitude of the problem of association time are such as to demand not merely a crude measurement of the gross reaction time in a large number of cases, but rather a special investigation by such exact methods as have been used by cattell [ ] and others in the analysis of the complex reaction. it would be impracticable for us to employ such methods in a study so extensive as this. [footnote : mind, vol. xi, .] in view of these considerations we discontinued the recording of the reaction time. if the association test is to be useful in the study of pathological conditions, it is of great importance to have a reliable measure of the associational value of a pair of ideas. many attempts have been made to modify and amplify the classical grouping of associations according to similarity, contrast, contiguity, and sequence, so as to make it serviceable in differentiating between normal and abnormal associations. in this study we attempted to apply aschaffenburg's [ ] classification of reactions, but without success. our failure to utilize this system of classification is assigned to the following considerations: ( ) distinctions between associations according to logical relations are extremely difficult to define; in many cases there is room for difference of opinion as to the proper place for an association, and thus the application of a logical scheme depends largely upon the personal equation of the observer; that even experienced observers cannot, in all cases, agree in placing an association is shown by aschaffenburg's criticisms of the opinions of other observers on this point.[ ] ( ) logical distinctions do not bring out clearly the differences between the reactions of normal subjects and those of insane subjects; logically, the reaction _bath--ink_, which was given by a patient, might be placed in the class with the reaction _bath--water_, although there is an obvious difference between the two reactions. ( ) many of the reactions given by insane subjects possess no obvious logical value whatever; but since any combination of ideas may represent a relationship, either real or imagined, it would be arbitrary to characterize such a reaction as incoherent. [footnote : experimentelle studien uber association. psychologische arbeiten, vol. i, p. ; vol. ii, p. ; vol. iv, p. .] [footnote : loc. cit, vol. , pp. - .] the criterion of values which is used in this study is an empirical one. as has already been explained (p. ), every word contained in the frequency tables possesses a value of at least . per cent, and other words have a zero value. with the aid of our method the difficulty of classifying the reactions quoted above is obviated, as it is necessary only to refer to the table to find their proper values: the value of the reaction _bath--water_ is . per cent, while that of the reaction _bath--ink_ is . logically the combination _health--wealth_ may be placed in any one of four classes, as follows: / intrinsic / causal dependence health--wealth / \ coordination \ \ extrinsic / speech reminiscence \ sound similarity but since our table shows this association to have an empirical value of . per cent, it becomes immaterial which of its logical relations is to be considered the strongest. it is mainly important, from our point of view, to separate reactions possessing an empirical value from those whose value is zero. § . an empirical principle of normal association. on a general survey of the whole mass of material which forms the basis of the first part of this study, we are led to observe that _the one tendency which appears to be almost universal among normal persons is the tendency to give in response to any stimulus word one or another of a small group of common reactions_. it appears from the pathological material now on hand that this tendency is greatly weakened in some cases of mental disease. many patients have given more than per cent of individual reactions. it should be mentioned that occasionally a presumably normal subject has given a record very similar to those obtained from patients, in respect to both the number and the nature of the individual reactions. a few subjects who gave peculiar reactions were known to possess significant eccentricities, and for this reason we excluded their records from the thousand records which furnished the basis for the frequency tables; we excluded also a few peculiar records obtained from subjects of whom nothing was known, on the ground that such records would serve only to make the tables more cumbersome, without adding anything to their practical value. the total number of records thus excluded was seventeen. it will be apparent to anyone who examines the frequency tables that the reactions obtained from one thousand persons fall short of exhausting the normal associational possibilities of these stimulus words. the tables, however, have been found to be sufficiently inclusive for the practical purpose which they were intended to serve. common reactions, whether given by a sane or an insane subject, may, in the vast majority of instances, safely be regarded as normal. as to individual reactions, they cannot all be regarded as abnormal, but they include nearly all those reactions which are worthy of special analysis in view of their possible pathological significance. what can be said further of individual reactions, whether normal or abnormal, will appear in the second part of this contribution. part ii. association in insane subjects. § . general survey of pathological material. the pathological material which forms the basis of the present part of our study consists mainly of two hundred and forty-seven test records obtained for the most part from patients at the kings park state hospital. the different groups from which the cases were selected, together with the number from each group, are shown in table i. table i. dementia præcox cases. paranoic conditions " epilepsy " general paresis " manic-depressive insanity " involuntary melancholia " alcoholic psychoses " senile dementia " a comparison of our pathological with our normal material _en masse_ reveals in the former evidence of a weakening of the normal tendency to respond by common reactions. this is shown in table ii. table ii. common doubtful individual reactions. reactions. reactions. , normal subject . % . % . % insane subjects . % . % . % it seems evident from this that pathological significance attaches mainly to individual reactions, so that our study resolves itself largely into ( ) an analysis and classification of individual reactions and ( ) an attempt to determine what relationship, if any, exists between the different types of reactions and the different clinical forms of mental disease. § . classification of reactions. those who have attempted to use the association test in the study of insanity have felt the need of a practical classification of reactions, and have at the same time encountered the difficulty of establishing definite criteria for distinguishing the different groups from one another. it is a comparatively simple matter to make these distinctions in a general way and even to formulate a more or less comprehensive theoretical classification, but there still remains much difficulty in practice. we have made repeated attempts to utilize various systems of classification which involve free play of personal equation in their application. although for us the matter is greatly simplified by the elimination of all the common reactions with the aid of the frequency tables, we have nevertheless met with no success. the distinctions made by either of us have on no occasion fully satisfied, at the second reading, either the one who made them or the other, while a comparison of the distinctions made by each of us independently has shown a disagreement to the extent of - per cent. we sought, therefore, to formulate a classification in which the various groups should be so defined as to obviate the interference of personal equation in the work of applying it, hoping thus to achieve greater accuracy. in this we can lay claim to only partial success; for, in the first place, having satisfactorily defined a number of groups, we found it necessary in the end to provide a special group for unclassified reactions, into which falls more than one-third of the total number of individual reactions; and, in the second place, in at least two of our groups the play of personal equation has not been entirely eliminated, so that there is still a possibility of error to the extent of five per cent of individual reactions, which means approximately one per cent of the total number of reactions. we have found, however, that in spite of these shortcomings the classification here proposed is more serviceable than others which, though more comprehensive, are at the same time lacking in definiteness. our classification consists of the following classes, groups and subdivisions: i. _common reactions._ . specific reactions. . non-specific reactions. ii. _doubtful reactions._ iii. _individual reactions._ . normal reactions. . pathological reactions: a. derivatives of stimulus words. b. partial dissociation: (a) non-specific reactions. (b) sound reactions: a. words. b. neologisms. (c) word complements. (d) particles of speech. c. complete dissociation: (a) perseveration: a. association to preceding stimulus. b. association to preceding reaction. c. repetition of preceding stimulus. d. repetition of previous stimulus. e. repetition of preceding reaction. f. repetition of previous reaction. g. reaction repeated five times (stereotypy). (b) neologisms without sound relation. . unclassified. § . non-specific reactions; doubtful reactions. *non-specific reactions.*--it has already been intimated that common reactions are in the vast majority of instances to be regarded as normal. from amongst them, however, a fairly definite group can be separated out which seems to possess some pathological significance, namely, the group which we have termed non-specific. in this group are placed words which are so widely applicable as to serve as more or less appropriate reactions to almost any of our stimulus words. that such reactions are in value inferior to the remaining group of common reactions, which we have termed, in contradistinction, _specific reactions_, is perhaps sufficiently obvious; we shall speak later, however, of their occurrence in both normal and insane cases. it is not always easy to judge whether or not a given reaction should be classed as non-specific. a study of our material made with special reference to this type of reactions has enabled us to select the following list of words, any of which, occurring in response to any stimulus word, is classed as a non-specific reaction: article, articles bad beautiful, beauty fine good, goodness great happiness, happy large man necessary, necessity nice object (noun) people person pleasant, pleasantness, pleasing, pleasure pretty small thinking, thought, thoughts unnecessary unpleasant use, used, useful, usefulness, useless, uselessness, uses, using woman work it should be mentioned that some of these words occur as reactions to one or several stimulus words with such frequency (_citizen--man_, value . per cent; _health--good_, value . per cent) as to acquire in such instances a value as high as that of strictly specific reactions. *doubtful reactions* have already been defined (p. ): any reaction word which is not found in the table in its identical form, but which is a grammatical variant or derivative of a word found there, is placed in this group. § . individual reactions; explanation of groups and methods of application. *normal reactions.*--inasmuch as the frequency tables do not exhaust all normal possibilities of reaction, a certain number of reactions which are essentially normal are to be found among the individual reactions. in order to separate these from the pathological reactions, we have compiled an appendix to the frequency tables, consisting mainly of specific definitions of groups of words to be included under each stimulus word in our list. this appendix will be found at the end of this paper. a word of explanation is perhaps due as to the manner in which the appendix has been compiled. it was developed in a purely empirical way, the basis being such individual reactions, given by both normal and insane subjects, as seemed in our judgment to be obviously normal. it must be acknowledged that the appendix falls short of all that might be desired. in the first place, its use involves to some slight extent the play of personal equation, and it therefore constitutes a source of error; in the second place, it is in some respects too inclusive while in other respects it is not sufficiently so. however, the error due to personal equation is slight; the inclusion of certain "far-fetched" or even frankly pathological reactions may be discounted by bearing in mind that the general value of this group is not equal to that of the group of common reactions; and the number of strictly normal reactions which are not included is after all small. our experience has shown us that the appendix constitutes an important aid in the analysis of individual reactions. *pathological reactions. derivatives of stimulus words.*--we place here any reaction which is a grammatical variant or derivative of a stimulus word. the tendency to give such reactions seems to be dependent upon a suspension or inhibition of the normal process by which the stimulus word excites the production of a new concept, for we have here not a production of a new concept but a mere change in the form of the stimulus word. as examples of such reactions may be mentioned: _eating--eatables_, _short--shortness_, _sweet--sweetened_, _quiet--quietness_. *partial dissociation.*--we have employed the term dissociation to indicate a rupture of that bond--whatever be its nature-which may be supposed to exist normally between stimulus and reaction and which causes normal persons to respond in the majority of instances by common reactions. and we speak of partial dissociation where there is still an obvious, though weak and superficial, connection. under this heading we can differentiate four types: *non-specific reactions* have already been defined; we distinguish those in this class from those in the class of common reactions by means of the frequency tables. *sound reactions.*--this type requires no explanation; the main difficulty is to decide what degree of sound similarity between stimulus and reaction should be deemed sufficient for placing a reaction under this heading. the total number of different sounds used in language articulation is, of course, small, so that any two words are liable to present considerable chance similarity. some time ago we estimated the average degree of sound similarity between stimulus words and reaction words in a series of one hundred test records obtained from normal persons; we found that on the average . per cent of the sounds of the stimulus words were reproduced, in the same order, in the reaction word. our experience finally led us to adopt the following general rule: a reaction is to be placed under this heading when fifty per cent of the sounds of the shorter word of the pair are identical with sounds of the longer word and are ranged in the same order. among sound reactions we occasionally find *neologisms*; for these a separate heading is provided. possibly their occurrence may be taken as an indication of an exaggerated tendency to respond by sound reactions. *word compliments.*--here we include any reaction which, added to the stimulus word, forms a word, a proper name, or a compound word in common use. *particles of speech.*--under this heading we include articles, numerals, pronouns, auxiliary verbs, adverbs of time, place and degree, conjunctions, prepositions, and interjections. *complete dissociation.*--here are included reactions which appear to be entirely unrelated to the corresponding stimulus words; in the case of such reactions the stimulus words seem to act, as aschaffenburg has pointed out, merely as signals for discharge. this subdivision contains several types of reactions which seem to be dependent upon the phenomenon of perseveration; it contains also the rather important type of neologisms. the phenomenon of *preservation* occurs in cases in which one may observe an abnormal immobility of attention. to react normally to a series of stimulus words requires on the part of the subject, in the first place, a certain alertness in order that he may grasp quickly and clearly the meaning of each word, and, in the second place, a prompt shifting of the mind from one reaction to the next. when such mental mobility is lacking the subject is liable to react not by a response adjusted to the stimulus word, but either by repeating a previous stimulus or reaction, or by giving a word associated to the preceding stimulus or reaction. the names of the different types of reactions included under the heading of perseveration are sufficiently descriptive; we shall here refer only to those which require further definition. *association to preceding stimulus.*--here is placed any reaction that is shown by the frequency tables to be related to the stimulus preceding the one in question. seeming or even obvious relationship, if not established by reference to the frequency tables, is disregarded. in the tables, however, the combination may not exist in direct order but only in reverse order, in which case the reaction is included here. the following examples may serve as illustrations: _thief--night_ _lion--pocket-book_ _lion--pocket-book_ is not found in the frequency tables, and is, therefore, an individual reaction; _thief--pocket-book_, however, is found there; _pocket-book_ is, therefore, classed in this case as an association to preceding stimulus. _table--fork_ _dark--mutton_ _dark--mutton_ is not found in the frequency tables; _table--mutton_ is also not found there in the direct order, but is found in the reverse order, viz.: _mutton--table; mutton_ is, therefore, classed in this case as an association to preceding stimulus. *association to preceding reaction.*--if either the reaction in question or the preceding reaction happens to be one of the stimulus words in our list, and a relationship between the two be found to exist by reference to the frequency tables--whether in direct or in reverse order--the reaction in question is classed as an association to preceding reaction. this is illustrated by the following examples: _eating--table_ _mountain--floor_ _mountain--floor_ is an individual reaction; _table--floor_ is found in the frequency tables; _floor_ is, therefore, classed as an association to preceding reaction. _beautiful--flowers_ _window--red_ _window--red_ is an individual reaction; _red--flowers_ is found in the frequency tables; therefore, _red_ is classed as an association to preceding reaction. in cases in which neither the reaction in question nor the preceding reaction happens to be one of our stimulus words, but a relationship between them may be judged to exist without considerable doubt, the reaction in question is also classed here. example: _priest--father_ _ocean--mother_ _ocean--mother_ is an individual reaction; neither the word _father_ nor the word _mother_ is among our stimulus words; but the association between the words _father_ and _mother_ may be judged to exist without considerable doubt; therefore, in this case _mother_ is classed as an association to preceding reaction. in such cases as this personal equation must necessarily come into play; comparative uniformity of judgment may, however, be attained by systematically excluding any reaction the relationship of which to the preceding reaction is subject to any considerable doubt and by placing any such reaction in the unclassified group. *repetition of previous stimulus.*--here we place any reaction which is a repetition of any previous stimulus from amongst the ten next preceding, at the same time placing *repetition of preceding stimulus* under a separate heading. *neologisms.*--here we place the newly coined words, so commonly given by the insane, excepting such as possess a sound relationship to the stimulus word, for which, as already stated, a special place in the classification has been provided. neologisms might be divided into three types, as follows: ( ) those which arise from ignorance of language (_comfort--uncomfort, short--diminiature_); ( ) distortions of actual words, apparently of pathological origin and not due to ignorance (_hungry--foodation, thief--dissteal_); and ( ) those which seem to be without any meaning whatever (_scack, gehimper, hanrow, dicut_). it is, however, impossible to draw clear-cut distinctions between these types, and for this reason we have made no provision in our classification for such division. *unclassified reactions.*--this group is important, in the first place, because it is numerically a large one, and in the second place, because it contains certain fairly definite types of reactions which are placed here for the sole reason that we have not been able to find strictly objective criteria for their differentiation from other types. it has already been stated that the frequency tables, even together with the appendix, fail to exhaust all normal possibilities of association, so that a certain small number of perfectly normal reactions must fall into the unclassified group. we submit the following examples: _music--listen_ _smooth--suave_ _sour--curdled_ _earth--mound_ another type of reactions found in the unclassified group, though also normal, yet not obviously so until explained by the subject, is represented by those which originate from purely personal experiences, such as the following, given by normal subjects: _blossom--t....._ _hammer--j....._ the first of these reactions is explained by the subject's acquaintance with a young lady, miss t...., who has been nick-named "blossom," and the second is explained by the subject's having among her pupils at school a boy by the name of j.... hammer. it would be difficult to estimate the proportion of such reactions in the unclassified group, but we have gained the general impression that it is small. an attempt to place them in a separate group could be made only with the aid of explanations from the subjects; such aid in the case of insane subjects is generally unreliable. moreover, to class these reactions as strictly normal would perhaps be going too far, since their general value is obviously inferior to that of the common reactions; and in any case in which they are given in unusually large numbers they must be regarded as manifestation of a tendency to depart from the normal to the extent to which they displace common reactions. the next type of reactions met with in the unclassified group is characterized by a peculiarly superficial, or non-essential, or purely _circumstantial_ relationship to the stimulus. such reactions, though occasionally given by normal subjects, are more often given by insane ones, and seem to be somewhat characteristic of states of mental deterioration which are clinically rather loosely described as puerilism. we offer the following examples, given by normal subjects: _music--town_ _sickness--summer_ _child--unknown_ _house--enter_ still another type of reactions to be considered in this connection consists of words which are in no way related to the corresponding stimulus words, but which arise from _distraction_ of the subject by surrounding objects, sounds, and the like. in some cases the experimenter may be able to judge from the direction of the subject's gaze, from a listening attitude, and so on, that certain reactions are due to distraction. in other cases, particularly in cases of normal subjects, the fact that certain reactions are due to distraction may be determined by questioning the subject on this point immediately after making the test; in work with insane subjects, as we have several times had occasion to point out, such aid is generally not available. the group of unclassified reactions includes also one more type of reactions which are of great importance both numerically and otherwise. these are the *incoherent reactions*, that is to say, reactions which are determined neither by the stimulus words, nor by the agency of perseveration, nor by distraction. although the occurrence of incoherent reactions is hardly subject to doubt, yet in no instance is it possible to establish with certainty that a given reaction is of this type, for in no instance can a remote, or an imagined, or a merely symbolic relationship between stimulus and reaction be positively excluded. some, indeed, would assert that some such relationship must necessarily exist in every instance, at least in the domain of the subconscious. this circumstance necessitates the placing of this type of reactions in the unclassified group. in practice it may be found advisable in some cases to analyze the unclassified reactions with a view to ascertaining to what extent each of the various types is represented among them. but one here treads on slippery ground, and one must be continually warned against the danger of erroneous conclusions. § . order of preference. after having developed the classification here proposed we found that there was still considerable room for difference of opinion in the placing of many reactions, owing to the circumstance that in many cases a reaction presents features which render it assignable under any one of two or more headings. to leave the matter of preference in grouping: to be decided in each case according to the best judgment of the experimenter would mean introducing again the play of personal equation, and would thus court failure of all our efforts to accomplish a standardization of the association test. therefore, the necessity of establishing a proper order of preference for guidance in the application of the classification became to us quite apparent. in the arrangement of the order of preference we were guided mainly by two principles, namely: (i) as between two groups of unequal definition, the one which is more clearly defined and which, therefore, leaves less play for personal equation is to be preferred; ( ) as between two groups of equal definition, the one which possesses the greater pathological significance is to be preferred. in accordance with these principles we have adopted the order of preference shown in table iii., placing every reaction under the highest heading on the list under which it may be properly classed. table iii . non-specific (common). . doubtful reactions. individual reactions. . sound reactions (neologisms). . neologisms without sound relation. . repetition of preceding reaction. . reaction repeated five times. . repetition of preceding stimulus. . derivatives. . non-specific reactions. . sound reactions (words). . word complements. . particles of speech. . association to preceding stimulus. . association to preceding reaction (by frequency tables). . repetition of previous reaction. . repetition of previous stimulus. . normal (by appendix). . association to preceding reaction (without frequency tables). . unclassified. § . errors involved in the use of arbitrary objective standards. it may readily be seen that such definiteness and uniformity as this classification possesses results from the introduction of more or less arbitrary criteria for the differentiation of the various types of reactions. the question might arise, to what extent do the distinctions thus made correspond to reality? to consider, for instance, our rule for the placing of sound reactions ( per cent of the sounds of the shorter word to be present, in the same order, in the other word): when a given reaction (_man--minstrel_) is in accordance with the rule assigned under the heading of sound reactions, can it be assumed that sound similarity and not some other relationship is the determining factor of the association in question? or when in, a given instance (_cabbage--cobweb_) the sound similarity falls somewhat short of the standard required by the rule, can it be assumed that sound similarity is not, after all, the determining factor? similar questions may, of course, arise in connection with other subdivisions. it must, indeed, be conceded that objective methods can reveal but indirectly and with uncertainty the inner mechanism which produces any association and that in any given instance it would be impossible to establish the correctness of grouping in accordance with such methods. however, to decide that question for any given reaction is really not necessary in practice, since an error made through wrongly placing one, two, or three reactions tinder any heading is of no significance; the types acquire importance only when represented by large numbers in a record under consideration; and when many reactions fall tinder a single heading the likelihood of error, as affecting the record as a whole, is by that fact alone greatly reduced. the whole question might more profitably be approached from another point of view: to what extent are the distinctions of this classification useful? an answer to this question can be found only in the results. § . analysis of pathological material we present in table iv, the results of a statistical examination of the records obtained from certain groups of normal subjects and from some groups of insane subjects. the normal groups have been studied for the purpose of determining the frequency and manner of occurrence among normal subjects of the various of abnormal reactions. it seemed best for this purpose to consider separately the records of those subjects who gave an unusually large number of individual reactions. fifty-three records containing fifteen or more individual reactions were found after a fairly diligent search among our normal test records. in the other groups of subjects--persons of common school education, persons of collegiate education, and children--we included no records containing more than ten individual reactions. the more striking departures from average normal figures are indicated in the table by the use of heavy type. this table reveals associational tendencies as occurring in connection with the psychoses studied. a better insight into the nature of these tendencies can be gained by a special analysis of the test of each clinical group. dementia prÆcox in this psychosis we find the number of individual reactions far exceeding not only that of the normal but that of any other psychosis which we studied. to a corresponding extent we find the number of the highest type of normal reactions--the common specific reactions--reduced. table iv. types of reaction a b c d e f g h i j k l m n o p q r s t u v w x y z aa +--+----+----+--+----+----+--+----+----+--+----+----+---+----+----+--+----+----+--+----+----+---+----+----+---+----+----+ _common reactions:_ | | | | | | | | | | | | | | | | | | | | | | | | | | | | specific reactions................| | . |....| | . |....| | . |....| | . |....| / | . |....| | . |....| | . |....| | . |....| | . |....| non-specific reactions............| | . |....| | . |....| | . |....| | . |....| | . |....| | . |....| | . |....| / | . |....| / | . |....| | | | | | | | | | | | | | | | | | | | | | | | | | | | | _doubtful reactions_................| | . |....| | . |....| | . |....| | . |....| | . |....| | . |....| | . |....| | . |....| | . |....| | | | | | | | | | | | | | | | | | | | | | | | | | | | | _individual reactions:_ | | | | | | | | | | | | | | | | | | | | | | | | | | | | normal reactions..................| | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | / | . | . | | . | . | / | . | . | derivatives of stimulus words.....| | . | . | | . | . | | | | | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | non-specific reactions............| | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | sound reactions (words)...........| | . | . | | . | . | | | | | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | sound reactions (neologisms)......| | . | . | | . | . | | | | | | | | . | . | | . | . | | . | . | | . | . | | . | . | word complements..................| | . | . | | . | . | | | | | . | . | | . | . | | . | . | | | | | . | . | | . | . | particles of speech...............| | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | association to preceding stimulus.| | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | association to preceding reaction.| | | | | | | | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | repetition of preceding stimulus..| | | | | . | . | | | | | | | | . | . | | | | | . | . | | | | | | | repetition of previous stimulus...| | | | | . | . | | | | | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | repetition of preceding reaction..| | | | | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | repetition of previous reaction...| | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | reaction repeated five times......| | | | | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | neologisms without sound relation.| | | | | | | | . | . | | | | | . | . | | . | . | | . | . | | . | . | | . | . | unclassified......................| | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | | . | . | +--+----+----+--+----+----+--+----+----+--+----+----+---+----+----+--+----+----+--+----+----+---+----+----+---+----+----+ total individual reactions | | . |....| | . |....| | . |....| | . |....| / | . |....| | . |....| | . |....| / | . |....| / | . |....| +--+----+----+--+----+----+--+----+----+--+----+----+---+----+----+--+----+----+--+----+----+---+----+----+---+----+----+ normal subjects, common school education; records containing not over individual reactions. a. median per cent of all reactions. b. average per cent of all reactions. c. average per cent of individual reactions. normal subjects, collegiate education; records containing not over individual reactions. d. median per cent of all reactions. e. average per cent of all reactions. f. average per cent of individual reactions. normal subjects, school children; records containing not over individual reactions. g. median per cent of all reactions. h. average per cent of all reactions. i. average per cent of individual reactions. normal subjects; records containing not under individual reactions. j. median per cent of all reactions. k. average per cent of all reactions. l. average per cent of individual reactions. cases of dementia præcox. m. median per cent of all reactions. n. average per cent of all reactions. o. average per cent of individual reactions. cases of paranoic conditions. p. median per cent of all reactions. q. average per cent of all reactions. r. average per cent of individual reactions. cases of epilepsy. s. median per cent of all reactions. t. average per cent of all reactions. u. average per cent of individual reactions. cases of general paresis. v. median per cent of all reactions. w. average per cent of all reactions. x. average per cent of individual reactions. cases of manic-depressive insanity. y. median per cent of all reactions. z. average per cent of all reactions. aa. average per cent of individual reactions. while almost every type of individual reactions shows here an increase over the normal averages, the most striking increases are shown by the table to be in the groups of unclassified reactions, neologisms, sound reactions, and some types of perseveration. a further examination of the individual test records shows that there is no uniformity of associational tendencies in this clinical group, but that several tendencies are more or less frequently met with either alone or in various combinations. yet some of these tendencies, when appearing at all prominently, are so highly characteristic of dementia præcox as to be almost pathognomonic. among these may be mentioned: ( ) the tendency to give _neologisms_, particularly those of the senseless type; ( ) the tendency to give unclassified reactions largely of the _incoherent_ type; and ( ) the tendency toward _stereotypy_ manifested chiefly by abnormally frequent repetitions of the same reaction. fairly characteristic also is the occasional tendency to give sound reactions. again, occasionally one encounters pronounced _perseveration_, and at least two of our subjects gave a good many unclassified reactions obviously due to _distraction_. it must be noted that not infrequently cases of dementia præcox give test records that cannot be distinguished from normal. it seems that the pathological associational tendencies constitute merely a special group of symptoms, some of which may be expected to be manifest in cases which have reached a state of advanced mental deterioration, but may not necessarily be present in the early stages of the disease. on the other hand there is evidence to show that these tendencies may in some cases appear among the earliest manifestations. this matter will be referred to again. thus the test records of dementia præcox depart from the normal not sharply but by a gradual shading off. we find similar gradual transitions between dementia præcox and other psychoses. for this work we selected cases in which the diagnoses were established with reasonable certainty. whether or not in cases of doubtful clinical classification this association test may be of aid in determining the diagnosis, is a question that must for the present remain open. we submit herewith copies of test records. the numbers which appear after the reactions indicate in each case the reaction type, in accordance with table iii. (p. ); common specific reactions are not numbered. case no. .--h.j. neologisms; some unclassified reactions, mostly incoherent. table--meadow......... dark--black........... music--sweet.......... sickness--dead........ man--manion........... deep--near............ soft--sooner.......... eating--formble....... mountain--gair........ house--temble......... black--benched........ mutton--ranched....... comfort--bumble....... hand--semble.......... short--simber......... fruit--narrow......... butterfly--ben........ smooth--gum........... command--bramble...... chair--low............ sweet--temper......... whistle--bensid....... woman--hummery........ cold--gunst........... slow--bemper.......... wish--tip............. river--gumper......... white--andes.......... beautiful--giinper.... window--hummer........ rough--geep........... citizen--humper....... foot--zuper........... spider--gumper........ needle--himper........ red--gumper........... sleep--moop........... anger--rumble......... carpet--slamper....... girl--mnker........... high--bumper.......... working--gumpip....... sour--imper........... earth--gumper......... trouble--humper....... soldier--guipper...... cabbage--phar......... hard--her............. eagle--damnornott..... stomach--dumper....... stem--gumper.......... lamp--huntenit........ dream--hungnot........ yellow--bampir........ bread--gumper......... justice--sidnerber.... boy--eeper............ light--huntznit....... health--geeper........ bible--himpier........ memory--hummer........ sheep--hunner......... bath--bemnitper....... cottage--gumper....... swift--dumper......... blue--dipper.......... hungry--hummer........ priest--rump.......... ocean--himmer......... head--hiniper......... stove--gamper......... long--humble.......... religion--gumper...... whiskey--numper....... child--himmer......... bitter--gehimper...... hammer--gueep......... thirsty--humper....... city--deeper.......... square--bummer........ butter--bimper........ doctor--harner........ loud--harner.......... thief--himmer......... lion--humor........... joy--gumpier.......... bed--hoomer........... heavy--doomer......... tobacco--per.......... baby--hoomer.......... moon--gumper.......... scissors--gumper...... quiet--humper......... green--gueet.......... salt--rummer.......... street--numper........ king--himper.......... cheese--guinter....... blossom--yunger....... afraid--yunger........ case no. .--g. d. neologisms; numerous unclassified reactions, mostly incoherent; some sound neologisms. table--muss........... dark--gone............ music--caffa.......... sickness--monk........ man--boy.............. deep--lesson.......... soft--ness............ eating--pie............ mountain--gus......... house--muss........... black--court.......... mutton--beef.......... comfort--ness......... hand--koy............. short--ness........... fruit--dalb........... butterfly--flack...... smooth--mess.......... command--cork......... chair--ness........... sweet--bess........... whistle--toy.......... woman--girl........... cold--cork............ slow--mass............ wish--veil............ river--mouth.......... white--cast........... beautiful--ness....... window--crow.......... rough--ratter......... citizen--zide......... foot--malloy.......... spider--straw......... needle--cast.......... red--roman............ sleep--scack.......... anger--gois........... carpet--noise......... girl--call............ high--hort............ working--kaffir....... sour--romerscotters... earth--bell........... trouble--tramine...... soldier--gas.......... cabbage--cor.......... hard--kalbas.......... eagle--bell........... stomach--chenic....... stem--trackstar....... lamp--loss............ dream--melso.......... yellow--ormondo....... bread--life........... justice--quartz....... boy--nellan........... light--cor............ health--hallenbee..... bible--book........... memory--bike.......... sheep--armen.......... bath--cor............. cottage--callan....... swift--swar........... blue--blacksen........ hungry--scatterbuck... priest--canon......... ocean--men............ head--will............ stove--somen.......... long--lass............ religion--cor......... whiskey--hanrow....... child--vand........... bitter--bike.......... hammer--hemmel........ thirsty--cass......... city--cor............. square--malice........ butter--back.......... doctor--ness.......... loud--arman........... thief--cast........... lion--loss............ joy--kaffir........... bed--banrow........... heavy--cast........... tobacco--colrow....... baby--boil............ moon--padoc........... scissors--kantow...... quiet--kilroe......... green--graft.......... salt--semen........... street--pess.......... king--guess........... cheese--tiffer........ blossom--cad.......... afraid--mellows....... case no. .--d.v. considerable number of neologisms; stereotypy manifested partly in a tendency toward frequent repetition of certain reactions but mainly in a persistent tendency to make use of the grammatical form of present participle, giving rise to numerous doubtful reactions. table--stand.......... dark--lonesome........ music--playing........ sickness--disease..... man--hiding........... deep--unreckless...... soft--beginning....... eating--plenty........ mountain--high........ house--standing....... black--grivelling..... mutton--plenty........ comfort--laying....... hand--disease......... short--writing........ fruit--coming......... butterfly--flying..... smooth--glimming...... command--master....... chair--standing....... sweet--sugar.......... whistle--blowing...... woman--loving......... cold--cellar.......... slow--coming.......... wish--dreaming........ river--divided........ white--wall........... beautiful--pleasant... window--breaking...... rough--tumble......... citizen--gentleman.... foot--sweating........ spider--biting........ needle--stinging...... red--coloring......... sleep--dreaming....... anger--widing......... carpet--cleaning...... girl--pretty.......... high--degrace......... working--nobody....... sour--holling......... earth--disgrace....... trouble--plenty....... soldier--shooting..... cabbage--welldebell... hard--earning......... eagle--setting........ stomach--degrivel..... stem--biting.......... lamp--burning......... dream--walking........ yellow--blowing....... bread--making......... justice--unpossible... boy--growing.......... light--stand.......... health--raising....... bible--teaching....... memory--together...... sheep--weeding........ bath--held............ cottage--standing..... swift--incuriossable.. blue--smooven......... hungry--uncareless.... priest--going......... ocean--moving......... head--setting......... stove--warm........... long--slowly.......... religion--everything.. whiskey--burning...... child--born........... bitter--taking........ hammer--hitting....... thirsty--drinking..... city--welldebell...... square--taking........ butter--soft.......... doctor--instrument.... loud--speaking........ thief--gitting........ lion--scared.......... joy--playing.......... bed--laying........... heavy--raisen......... tobacco--eating....... baby--born............ moon--shining......... scissors--cutting..... quiet--hitting........ green--landed......... salt--throwing........ street--walking....... king--tension......... cheese--eating........ blossom--growing...... afraid--nobody........ case no. .--c.j. unclassified reactions, mostly incoherent. table--tablecloth..... dark--forward......... music--instrument..... sickness--fluid....... man--hemale........... deep--steep........... soft--hard............ eating--mountain...... mountain--raven....... house--shutter........ black--blue........... mutton--beef.......... comfort--discomfort... hand--wrist........... short--tall........... fruit--vegetable...... butterfly--bee........ smooth--rough......... command--orders....... chair--sofa........... sweet--sour........... whistle--fife......... woman--girl........... cold--warm............ slow--faster.......... wish--not............. river--neck........... white--blue........... beautiful--homely..... window--sill.......... rough--paint.......... citizen--pedestrian... foot--rose............ spider--towel......... needle--lifter........ red--dove............. sleep--coat........... anger--smile.......... carpet--gas........... girl--kite............ high--cow............. working--candy........ sour--peach........... earth--balloon........ trouble--grass........ soldier--brass........ cabbage--flea......... hard--cat............. eagle--negro.......... stomach--winter....... stem--leaf............ lamp--cloth........... dream--slumber........ yellow--pink.......... bread--glass.......... justice--coal......... boy--maid............. light--shine.......... health--pale.......... bible--leaf........... memory--grief......... sheep--giraffe........ bath--soap............ cottage--scene........ swift--slow........... blue--piece........... hungry--food.......... priest--minister...... ocean--waves.......... head--black........... stove--lid............ long--short........... religion--christian... whiskey--malt......... child--baby........... bitter--sweet......... hammer--nail.......... thirsty--water........ city--steeple......... square--marble........ butter--bread......... doctor--aster......... loud--fog............. thief--mary........... lion--tiger........... joy--glad............. bed--sheet............ heavy--light.......... tobacco--smoke........ baby--powder.......... moon--sky............. scissors--handle...... quiet--sing........... green--pink........... salt--chimney......... street--block......... king--crown........... cheese--tea........... blossom--leaves....... afraid--frighten...... case no. .--r.t. unclassified reactions, mostly incoherent. table--full........... dark--coldness........ music--aeronaut....... sickness--better...... man--extension........ deep--electrician..... soft--harden.......... eating--stomach....... mountain--lord........ house--roof........... black--darkness....... mutton--working....... comfort--ahead........ hand--mercury......... short--have........... fruit--flavor......... butterfly--plant...... smooth--level......... command--obedient..... chair--rest........... sweet--polish......... whistle--note......... woman--comfort........ cold--pleasant........ slow--move............ wish--wealth.......... river--shell.......... white--change......... beautiful--sat........ window--temperature... rough--shell.......... citizen--soldier...... foot--travel.......... spider--web........... needle--point......... red--temperature...... sleep--rest........... anger--temper......... carpet--court......... girl--birth........... high--dirt............ working--ease......... sour--bait............ earth--vexation....... trouble--business..... soldier--obedient..... cabbage--fell......... hard--solid........... eagle--government..... stomach--chest........ stem--wish............ lamp--brilliancy...... dream--unso........... yellow--color......... bread--crust.......... justice--truth........ boy--obedient......... light--heart.......... health--feeling....... bible--scripture...... memory--saying........ sheep--wool........... bath--get............. cottage--morrell...... swift--good........... blue--look............ hungry--have.......... priest--scripture..... ocean--supply......... head--manager......... stove--shake.......... long--journey......... religion--thought..... whiskey--lusk......... child--wish........... bitter--enmalseladiga. hammer--efface........ thirsty--want......... city--comforts........ square--crown......... butter--flavor........ doctor--dram.......... loud--temper.......... thief--catched........ lion--crown........... joy--pleasure......... bed--comforts......... heavy--thoughts....... tobacco--changes...... baby--pleasure........ moon--brilliancy...... scissors--edge........ quiet--baptism........ green--autumn......... salt--gather.......... street--thoroughfare.. king--crown........... cheese--flavor........ blossom--wood......... afraid--downhearted... case no. .--g.f. unclassified reactions, mostly incoherent; slight tendency to respond by sound reactions. table--desk........... dark--blue............ music--stars.......... sickness--trees....... man--menace........... deep--soap............ soft--excited......... eating--spelling...... mountain--marbles..... house--train.......... black--bed............ mutton--button........ comfort--steak........ hand--flexible........ short--umbrella....... fruit--blanket........ butterfly--grass...... smooth--sheet......... command--carpet....... chair--store.......... sweet--flower......... whistle--linen........ woman--water.......... cold--coal............ slow--ferry........... wish--sample.......... river--shades......... whiter--blue.......... beautiful--suspender.. window--wood.......... rough--chisel......... citizen--ruler........ foot--snake........... spider--fly........... needle--bird.......... red--green............ sleep--opening........ anger--angry.......... carpet--stitching..... girl--madam........... high--ceiling......... working--easy......... sour--warm............ earth--heaven......... trouble--astonished... soldier--man.......... cabbage--carrot....... hard--softness........ eagle--parrot......... stomach--mind......... stem--stable.......... lamp--oil............. dream--awake.......... yellow--darkness...... bread--rough.......... justice--male......... boy--buoy............. light--standing....... health--very.......... bible--ashamed........ memory--staring....... sheep--stock.......... bath--sponge.......... cottage--house........ swift--mouse.......... blue--fall............ hungry--appetite...... priest--pastor........ ocean--waves.......... head--hat............. stove--blackening..... long--garden.......... religion--goodness.... whiskey--kummell...... child--woman.......... bitter--coughing...... hammer--sofa.......... thirsty--pillow....... city--united.......... square--oblong........ butter--lard.......... doctor--physician..... loud--easy............ thief--burglar........ lion--tiger........... joy--healthy.......... bed--thread........... heavy--gloves......... tobacco--cigar........ baby--hood............ moon--stars........... scissors--knife....... quiet--recollect...... green--ring........... salt--pencil.......... street--bushes........ king--germany......... cheese--rice.......... blossom--pepper....... afraid--allspice...... case no. .--o.m. unclassified reactions, mostly incoherent. table--vote........... dark--plenty.......... music--health......... sickness--fright...... man--manager.......... deep--slow............ soft--pepper.......... eating--vanity........ mountains--slept...... house--courage........ black--funeral........ mutton--age........... comfort--slide........ hand--credit.......... short--simpson........ fruit--physician...... butterfly--torment.... smooth--button........ command--scarf........ chair--rage........... sweet--cider.......... whistle--lace......... woman--debt........... cold--powderly........ slow--telephone....... wish--regret.......... river--herald......... white--black.......... beautiful--jolly...... window--pane.......... rough--duty........... citizen--ward......... foot--minister........ spider--handsome...... needle--pin........... red--white............ sleep--apple.......... anger--sour........... carpet--wood.......... girl--boy............. high--low............. working--height....... sour--pitcher......... earth--clam........... trouble--necessity.... soldier--marine....... cabbage--watermelon... hard--cracker......... eagle--bright......... stomach--back......... stem--stimulant....... lamp--hair............ dream--knees.......... yellow--amen.......... bread--general........ justice--no........... boy--grass............ light--thought........ health--depression.... bible--judger......... memory--stomach....... sheep--crusade........ bath--labor........... cottage--cotton....... swift--depth.......... blue--crimson......... hungry--alloyed....... priest--politicians... ocean--sea............ head--cranium......... stove--soft........... long--biles........... religion--bunion...... whiskey--vinegar...... child--edge........... bitter--born.......... hammer--wood.......... thirsty--cradle....... city--flames.......... square--eating........ butter--dirt.......... doctor--malefactor.... loud--quinine......... thief--joy............ lion--sage............ joy--thorn............ bed--draper........... heavy--close.......... tobacco--weed......... baby--stop............ moon--starch.......... scissors--crepe....... quiet--bustle......... green--color.......... salt--throw........... street--ferment....... king--jaunce.......... cheese--tepid......... blossom--woman........ afraid--shame......... case no. .--e.h. unclassified reactions, mostly incoherent. table--cent........... dark--sweet........... music--delighted...... sickness--pop......... man--change........... deep--pass............ soft--drop............ eating--fair.......... mountains--heavy...... house--fate........... black--right.......... mutton--with.......... comfort--indeed....... hand--span............ short--stop........... fruit--dip............ butterfly--home....... smooth--days.......... command--stop......... chair--pledge......... sweet--right.......... whistle--home......... woman--louisa......... cold--chair........... slow--aid............. wish--book............ river--shoes.......... white--ouch........... beautiful--not........ window--papers........ rough--lettuce........ citizen--money........ foot--stand........... spider--socks......... needle--drops......... red--glass............ sleep--suits.......... anger--suits.......... carpet--hat........... girl--president....... high--pass............ working--knock....... sour--cake............ earth--home........... trouble--news......... soldier--name......... cabbage--rule......... hard--rope............ eagle--in............. stomach--potato....... stem--pick............ lamp--berry........... dream--book........... yellow--lettuce....... bread--chews.......... justice--night........ boy--bat.............. light--rasp........... health--off........... bible--comforter...... memory--candy......... sheep--eat............ bath--sweet........... cottage--walk......... swift--reason......... blue--dot............. hungry--swift......... priest--birth......... ocean--stop........... head--strap........... stove--pot............ long--name............ religion--day......... whiskey--take......... child--jaw............ bitter--licorice...... hammer--sound......... thirsty--cards........ city--dice............ square--muff.......... butter--stick......... doctor--perfect....... loud--walk............ thief--jail........... lion--cow............. joy--nail............. bed--new.............. heavy--down........... tobacco--prize........ baby--new............. moon--new............. scissors--teach....... quiet--man............ green--water.......... salt--money........... street--right......... king--girl............ cheese--house......... blossom--work......... afraid--jars.......... case m.f. (from hudson river state hospital).--unclassified reactions, mostly incoherent. table--heat........... dark--succeed......... music--benefit........ sickness--steep....... man--dicut............ deep--rectify......... soft--bed............. eating--dozy.......... mountain--tulu........ house--sails.......... black--sunrise........ mutton--tuition....... comfort--blasphemous.. hand--doing........... short--pest........... fruit--charm.......... butterfly--doctor..... smooth--border........ command--right........ chair--distill........ sweet--noticed........ whistle--stead........ woman--splice......... cold--strap........... slow--chief........... wish--shame........... river--word........... white--color.......... beautiful--better..... window--dull.......... rough--bright......... citizen--chum......... foot--relax........... spider--float......... needle--action........ red--stout............ sleep--lazy........... anger--anguish........ carpet--knowledge..... girl--first........... high--hand............ working--power........ sour--mud............. earth--sky............ trouble--sorrow....... soldier--manhood...... cabbage--righteous.... hard--beaten.......... eagle--dog............ stomach--paste........ stem--dust............ lamp--fall............ dream--idle........... yellow--zone.......... bread--pan............ justice--tricks....... boy--barrel........... light--powers......... health--kindness...... bible--story.......... memory--pillow........ sheep--veil........... bath--ink............. cottage--paper........ swift--arrow.......... blue--cold............ hungry--dyes.......... priest--cloak......... ocean--pilot.......... head--tin............. stove--plate.......... long--trouble......... religion--soap........ whiskey--starch....... child--night.......... bitter--contentment... hammer--shortness..... thirsty--knife........ city--mind............ square--truth......... butter--biscuit....... doctor--piles......... loud--distrust........ thief--babies......... lion--hair............ joy--eyesight......... bed--dievos........... heavy--determined..... tobacco--health....... baby--wood............ moon--heat............ scissors--squeeze..... quiet--tears.......... green--fall........... salt--soft............ street--wait.......... king--inches.......... cheese--doctor........ blossom--fades........ afraid--hearts........ case no. .--e.j.d. unclassified reactions, mostly incoherent. table--unicorn.......... dark--african........... music--love............. sickness--slumber....... man--minstrel........... deep--river............. soft--highwayman........ eating--england......... mountain--pleasure...... house--christianity..... black--directory........ mutton--capers.......... comfort--mankind........ hand--surface........... short--court............ fruit--pleasure......... butterfly--dispatcher... smooth--navigation...... command--administration. chair--time............. sweet--office........... whistle--foreign........ woman--usefulness....... cold--frigid............ slow--vocation.......... wish--longing........... river--tributary........ white--island........... beautiful--unseen....... window--frugal.......... rough--nautical......... citizen--pedestrian..... foot--laugh............. spider--jungle.......... needle--man............. red--monde.............. sleep--resustication.... anger--uncared.......... carpet--foreign......... girl--celt.............. high--wine.............. working--prayer......... sour--flower............ earth--tariff........... trouble--ledger......... soldier--work........... cabbage--ancient........ hard--provender......... eagle--school........... stomach--bowels......... stem--tide.............. lamp--scientific........ dream--somno............. yellow--pain............ bread--populous......... justice--thwart......... boy--globe.............. light--female........... health--linen........... bible--divine........... memory--current......... sheep--water............ bath--rain.............. cottage--journal........ swift--yacht............ blue--novel............. hungry--viand........... priest--pedestrian...... ocean--commotion........ head--sugar............. stove--writer........... long--mingle............ religion--tent.......... whiskey--copulency...... child--editor........... bitter--backward........ hammer--youth........... thirsty--salt........... city--gentler........... square--angelus......... butter--pastry.......... doctor--veterinary...... loud--muslin............ chief--grocer........... lion--trip.............. joy--penance............ bed--granite............ heavy--note............. tobacco--vanese......... baby--school............ moon--element........... scissors--elderly....... quiet--trinity.......... green--commissioner..... salt--strength.......... street--voyager......... king--sorrow............ cheese--holiday......... blossom--parks.......... afraid--stamina......... case no. .--c.l. pronounced stereotypy. following note on test record: "many attempts were made to secure a reaction other than 'cat,' but usually without success; the reaction _cold--warm_ was given spontaneously and with apparent interest; most reactions were given only in response to much urging, or else mechanically, without attention." table--cat............ dark--rat............. music--shoe........... sickness--cat......... man--boy.............. deep--cat............. soft--hat............. eating--cat........... mountain--hit......... house--gold........... black--woman.......... mutton--get........... comfort--cousin....... hand--jesus........... short--hat............ fruit--hand........... butterfly--going...... smooth--hat........... command--boy.......... chair--hat............ sweet--cat............ whistle--boy.......... woman--cat............ cold--warm............ slow--button.......... wish--cat............. river--cat............ white--rat............ beautiful--good....... window--wheel......... rough--good........... citizen--candy........ foot--cat............. spider--dog........... needle--cat........... red--button........... sleep--cat............ anger--go............. carpet--cat........... girl--in.............. high--little.......... working--cold......... sour--cat............. earth--tag............ trouble--cat.......... soldier--cat.......... cabbage--cat.......... hard--cat............. eagle--cat............ stomach--cat.......... stem--hat............. lamp--cat............. dream--cat............ yellow--cat........... bread--cat............ justice--cat.......... boy--cat.............. light--cat............ health--cat........... bible--cat............ memory--cat........... sheep--cat............ bath--cat............. cottage--cat.......... swift--cat............ blue--cat............. hungry--cat........... priest--cat........... ocean--cat............ head--cat............. stove--cat............ long--cat............. religion--cat......... whiskey--cat.......... child--cat............ bitter--cat........... hammer--cat........... thirsty--cat.......... city--cat............. square--cat........... butter--cat........... doctor--cat........... loud--cat............. thief--cat............ lion--cat............. joy--cat.............. bed--cat.............. heavy--cat............ tobacco--cat.......... baby--cat............. moon--cat............. scissors--cat......... quiet--cat............ green--cat............ salt--cat............. street--cat........... king--cat............. cheese--cat........... blossom--cat.......... afraid--cat........... case no. .--e.t.s. stereotypy table--eat............ dark--unkindness...... music--beautiful...... sickness--suffering... man--good............. deep--unkindness...... soft--unkindness...... eating--digesting..... mountain--low......... house--small.......... black--darkness....... mutton--good.......... comfort--home......... hand--useful.......... short--useful......... fruit--healthy........ butterfly--beautiful.. smooth--unkindness.... command--great........ chair--useful......... sweet--healthy........ whistle--beautiful.... woman--good........... cold--unhealthy....... slow--good............ wish--always.......... river--needed......... white--pretty......... beautiful--trees...... window--needed........ rough--unneeded....... citizen--needed....... foot--needed.......... spider--needed........ needle--needed........ red--beautiful........ sleep--beautiful...... anger--needed......... carpet--needed........ girl--needed.......... high--height.......... working--needed....... sour--needed.......... earth--needed......... trouble--trust........ soldier--needed....... cabbage--needed....... hard--trouble......... eagle--beautiful...... stomach--trouble...... stem--shoot........... lamp--light........... dream--pleasant....... yellow--pretty........ bread--good........... justice--needed....... boy--needed........... light--pretty......... health--needed........ bible--needed......... memory--needed........ sheep--needed......... bath--needed.......... cottage--needed....... swift--needed......... blue--pretty.......... hungry--food.......... priest--father........ ocean--fresh.......... head--unhealthy....... stove--warmth......... long--length.......... religion--needed...... whiskey--needed....... child--needed......... bitter--needed........ hammer--needed........ thirsty--water........ city--pretty.......... square--honest........ butter--good.......... doctor--needed........ loud--needed.......... thieft--trust......... lion--love............ joy--laughter......... bed--comfortable...... heavy--sleepiness..... tobacco--needed....... baby--needed.......... moon--needed.......... scissors--needed...... quiet--pleasure....... green--me............. salt--needed.......... street--needed........ king--needed.......... cheese--needed........ blossom--needed....... afraid--nervous....... case no. .--c.m. perseveration: numerous instances of association to preceding reaction; unclassified reactions, mostly incoherent. table--tree........... dark--night........... music--instrument..... sickness--smoke....... man--woman............ deep--water........... soft--tide............ eating--potato........ mountain--milk........ house--clay........... black--polish......... mutton--goat.......... comfort--cream........ hand--hay............. short--meat........... fruit--pears.......... butterfly--flower..... smooth--smell......... command--drink........ chair--wine........... sweet--honey.......... whistle--wind......... woman--whiskey........ cold--fire............ slow--speed........... wish--go.............. river--boat........... white--stem........... beautiful--cloak...... window--drift......... rough--storm.......... citizen--citron....... foot--feed............ spider--web........... needle--thread........ red--sew.............. sleep--rest........... anger--health......... carpet--carrots....... girl--eat............. high--horse........... working--hay.......... sour--cut............. earth--machine........ trouble--repair....... soldier--mow.......... cabbage--plant........ hard--seed............ eagle--bird........... stomach--egg.......... stem--join............ lamp--oil............. dream--burn........... yellow--gas........... bread--flour.......... justices--drink....... boy--girl............. light--man............ health--woman......... bible--baby........... memory--want.......... sheep--lamb........... bath--water........... cottage--hay.......... swift--corn........... blue--eat............. hungry--ham........... priest--pickle........ ocean--turnip......... head--hair............ stove--coal........... long--wood............ religion--lemon....... whiskey--wheat........ child--rye............ bitter--medicine...... hammer--nail.......... thirsty--beer......... city--cake............ square--pie........... butter--cream......... doctor--herb.......... loud--duck............ thief--feathers....... lion--animal.......... joy--peace............ bed--sleep............ heavy--rest........... tobacco--chew......... baby--chair........... moon--sun............. scissors--cut......... quiet--hair........... green--grapes......... salt--bag............. street--stone......... king--cement.......... cheese--money......... blossom--flower....... afraid--fast.......... case no. .--e.d. numerous repetitions of reactions previously given; unclassified reactions, mostly incoherent; neologisms. table--eating......... dark--night........... music--piano.......... sickness--stoppery.... man--manly............ deep--knowing......... soft--undoable........ eating--oblong........ mountain--guide....... house--residing....... black--dress.......... mutton--aiding........ comfort--escorted..... hand--escorted........ short--unescorted..... fruit--eating......... butterfly--interfere.. smooth--knowing....... command--unerrorer.... chair--seated......... sweet--durable........ whistle--treated...... woman--help........... cold--stoppery........ slow--unknowing....... wish--treated......... river--boats.......... white--treasurer...... beautiful--form....... window--outlook....... rough--unescorted..... citizen--residing..... foot--travel.......... spider--stoppery...... needle--clothing...... red--color............ sleep--stoppery....... anger--unguarded...... carpet--residence..... girl--help............ high--escorted........ working--man.......... sour--form............ earth--platformer..... trouble--unguarded.... soldier--sentinel..... cabbage--dinners...... hard--escorted........ eagle--newspaper...... stomach--health....... stem--winding......... lamp--reading......... dream--guarded........ yellow--aged.......... bread--knowing........ justice--bar.......... boy--help............. light--advice......... health--doableness.... bible--church......... memory--knowing....... sheep--aided.......... bath--stoppery........ cottage--seashore..... swift--business....... blue--help............ hungry--unadded....... priest--rome.......... ocean--help........... head--knowing......... stove--cooking........ long--bank............ religion--church...... whiskey--drink........ child--help........... bitter--error......... hammer--builder....... thirsty--drink........ city--building........ square--unerrorer..... butter--eating........ doctor--destroyer..... loud--notoriety....... thief--error.......... lion--lord............ joy--escorted......... bed--unescorted....... heavy--unescorted..... tobacco--chewing...... baby--help............ moon--knowing......... scissors--tailor...... quiet--form........... green--moneyed........ salt--eating.......... street--city.......... king--adds............ cheese--eating........ blossom--escorted..... afraid--unguarded..... case no. .--a.f. unclassified reactions, mostly incoherent; perseveration: instances of association to preceding reaction and to preceding stimulus. table--stove.......... dark--clear........... music--calm........... sickness--exact....... man--particular....... deep--personal........ soft--frank........... eating--determined.... mountain--idea........ house--street......... black--water.......... mutton--ground........ comfort--country...... hand--fire............ short--straight....... fruit--flowers........ butterfly--horn....... smooth--farm.......... command--forbidden.... chair--bed............ sweet--sugar.......... whistle--noise........ woman--boy............ cold--house........... slow--store........... wish--work............ river--sound.......... white--blue........... beautiful--fair....... window--door.......... rough--glass.......... citizen--dress........ foot--exact........... spider--fly........... needle--pins.......... red--person........... sleep--nervous........ anger--determined..... carpet--floor......... girl--man............. high--fruit........... working--wear......... sour--sweet........... earth--early.......... trouble--state........ soldier--girl......... cabbage--woman........ hard--heart........... eagle--bird........... stomach--friend....... stem--tree............ lamp--couch........... dream--desk........... yellow--table......... bread--chair.......... justice--truth........ boy--honor............ light--tails.......... health--care.......... bible--book........... memory--remembrance... sheep--free........... bath--court........... cottage--pitcher...... swift--strong......... blue--delicate........ hungry--bread......... priest--church........ ocean--ship........... head--height.......... stove--people......... long--heart........... religion--catholic.... whiskey--brooklyn..... child--new york....... bitter--frost......... hammer--summer........ thirsty--fall......... city--autumn.......... square--winter........ butter--daily......... doctor--midnight...... loud--forenoon........ thief--afternoon...... lion--evening......... joy--sorrow........... bed--obstinate........ heavy--indifferent.... tobacco--pipe......... baby--mother.......... moon--daughter........ scissors--son......... quiet--sister......... queen--brother........ salt--forward......... street--proper........ king--vulgar.......... cheese--personal...... blossom--tree......... afraid--fear.......... case no. .--g.b. sound reactions; unclassified reactions, mostly incoherent table--tablet......... dark--dot............. music--lizzie......... sickness--josh........ man--mcmahon.......... deep--deaf (deef)..... soft--sulphur......... eating--itching....... mountain--mouth....... house--horse.......... black--back........... mutton--button........ comfort--community.... hand--hat............. short--shore.......... fruit--freehoff....... butterfly--busty...... smooth--small......... command--cummings..... chair--cherries....... sweet--sweeten........ whistle--walters...... woman--wayman......... cold--laboratory...... slow--slaw............ wish--wishbone........ river--ontario........ white--william........ beautiful--bureau..... window--weldon........ rough--saw............ citizen--sendow....... foot--hoof............ spider--web........... needle--shoe.......... red--book............. sleep--sitting........ anger--freeman........ carpet--longing....... girl--gone............ high--law............. working--back......... sour--clock........... earth--flower......... trouble--sensibility.. soldier--sodder....... cabbage--cabot........ hard--done............ eagle--time........... stomach--mat.......... stem--water........... lamp--florist......... dream--conners........ yellow--flower........ bread--water.......... justice--gaynor....... boy--passion.......... light--life........... health--wealth........ bible--gone........... memory--hans.......... sheep--pasture........ bath--rogan........... cottage--house........ swift--swim........... blue--thompson........ hungry--memory........ priest--golden........ green--hat............ head--broom........... stove--fan............ long--time............ religion--yukon....... whiskey--freeman...... child--hopkins........ bitter--brown......... hammer--hands......... thirsty--thirty....... city--sure............ square--squire........ butter--tam o'shanter. doctor--dorsan........ loud--law............. thief--child.......... lion--dirty........... joy--commerce......... bed--strike........... heavy--walden......... tobacco--alice........ baby--water........... moon--handsome........ scissors--comet....... quiet--tiger.......... green--tree........... salt--salary.......... street--prunes........ king--kind............ cheese--handsome...... blossom--pretty....... afraid--africa........ case no. .--m.h. sound reactions; unclassified reactions, mostly incoherent. table--token.......... dark--dye............. music--meat........... sickness--sorrow...... man--mother........... jeep--dark............ soft--silk............ eating--elephant...... mountain--many........ house--home........... black--brown.......... mutton--men........... comfort--cat.......... hand--hat............. short--shift.......... fruit--free........... butterfly--baby....... smooth--soft.......... command--cat.......... chair--comfort........ sweet--sugar.......... whistle--wine......... woman--when........... cold--cat............. slow--short........... wish--when............ river--rhine.......... white--when........... beautiful--baby....... window--wide.......... rough--red............ citizen--company...... foot--feeling......... spider--speck......... needle--nothing....... red--rose............. sleep--should......... anger--after.......... carpet--cat........... girl--god............. high--heaven.......... working--will......... sour--sweet........... earth--eaten.......... trouble--tea.......... soldier--sailor....... cabbage--cobweb....... hard--haven't......... eagle--eaten.......... stomach--sat.......... stem--should.......... lamp--little.......... dream--did............ yellow--you........... bread--butter......... justice--jesus........ boy--baby............. light--love........... health--heaven........ bible--bitch.......... memory--man........... sheep--shepherd....... bath--both............ cottage--cat.......... swift--said........... blue--bad............. hungry--haven't....... priest--pope.......... ocean--open........... head--heart........... stove--steel.......... long--little.......... religion--right....... whiskey--when......... child--chimney........ bitter--both.......... hammer--heart......... thirsty--think........ city--church.......... square--swift......... butter--bread......... doctor--debtor........ loud--loaf............ thief--theatre........ lion--liar............ joy--jam.............. bed--broom............ heavy--hard........... tobacco--tom.......... baby--brother......... moon--men............. scissors--shift....... quiet--quilt.......... green--grass.......... salt--said............ street--stevens....... king--kite............ cheese--cat........... blossom--bad.......... afraid--anger......... case no. .--j.b. unclassified reactions, many of which are probably due to distraction; some stereotypy. note on test record states: "influenced by sensory impressions, but gave good attention to each stimulus word. had some difficulty in limiting his response to one word, but made all possible effort to comply with every request. on one occasion he was asked to react with his eyes closed, but was unable, under the unnatural conditions, to respond with one word." table--floor.......... dark--light........... music--shoe........... sickness--well........ man--boy.............. deep--sea............. soft--soap............ eating--tea........... mountain--forest...... house--horse.......... black--sill........... mutton--tablecloth.... comfort--black........ hand--fingers......... short--wrist.......... fruit--soup........... butterfly--grape...... smooth--coat.......... command--vest......... chair--pillow......... sweet--brick.......... whistle--knuckles..... woman--wall........... cold--eating.......... slow--swift........... wish--knob............ river--pad............ white--book........... beautiful--shadow..... window--stockings..... bough--stand.......... citizen--blue......... foot--brass........... spider--shoelace...... needle--name.......... red--sunlight......... sleep--flag........... anger--slant.......... carpet--rip........... girl--lady............ high--stripe.......... working--steam........ sour--handkerchief.... earth--ground......... trouble--insect....... soldier--army......... cabbage--sill......... hard--washstand....... eagle--blue........... stomach--tap.......... stem--sill............ lamp--back............ dream--shadow......... yellow--blanket....... bread--horizontal..... justice--ink.......... boy--taste............ light--yellow......... health--book.......... bible--joseph......... memory--joe........... sheep--pillow......... bath--mott............ cottage--globe........ swift--continue....... blue--notice.......... hungry--josephine..... priest--sixteen....... ocean--flag........... head--cabbage......... stove--rivet.......... long--floor........... religion--priest...... whiskey--tin.......... child--shadow......... bitter--black......... hammer--buttons....... thirsty--shadow....... city--back............ square--oval.......... butter--table......... doctor--doorway....... loud--shadow.......... thief--butter......... lion--difference...... joy--ink.............. bed--butter........... heavy--shadow......... tobacco--wood......... baby--wall............ moon--lightning....... scissors--book........ quiet--yellow......... green--sole........... salt--ink............. street--sides......... king--stripes......... cheese--butter........ blossom--trees........ afraid--boy........... case no. .--j.f. perseveration; some stereotypy; sound reactions; unclassified reactions many of which are probably due to distraction. note on test record states: "understood what was expected, but could not be induced to give much attention to the stimulus words; sat facing a window, and showed a strong tendency to merely name objects in sight. reaction time very short, in some cases so short that it is doubtful if he recognized the stimulus word at all." table--god............ dark--angel........... music--bird........... sickness--woman....... man--male............. deep--dove............ soft--dog............. eating--horse......... mountain--mule........ house--dog............ black--rabbit......... mutton--hen........... comfort--dog.......... hand--clock........... short--myself......... fruit--post........... butterfly--bricks..... smooth--glass......... command--sand......... chair--leaf........... sweet--wood........... whistle--earth........ woman--grass.......... cold--mustard......... slow--kale............ wish--lampsquob....... river--ten............ white--rock........... beautiful--water...... window--scene......... rough--been........... citizen--house........ foot--stable.......... spider--horse......... needle--pin........... red--cushion.......... sleep--black.......... anger--white.......... carpet--vingency...... girl--noodles......... high--macaroni........ working--tomatoes..... sour--asparagus....... earth--oakry.......... trouble--peas......... soldier--beans........ cabbage--greens....... hard--cow............. eagle--robin.......... stomach--hawk......... stem--fishes.......... lamp--whale........... dream--shark.......... yellow--crabs......... bread--red............ justice--jam.......... boy--be............... light--girl........... health--filth......... bible--book........... memory--bad........... sheep--dat............ bath--oval............ cottage--nurse........ swift--begin.......... blue--joy............. hungry--wonder........ priest--apostle....... ocean--preacher....... head--dead............ stove--store.......... long--lone............ religion--world....... whiskey--whisper...... child--gule........... bitter--rugby......... hammer--ball.......... thirsty--sun.......... city--christ.......... square--jesus......... butter--joe........... doctor--john.......... loud--luke............ thief--st. matthew.... lion--lie............. joy--george........... bed--beth............. heavy--tither......... tobacco--iron......... baby--blade........... moon--stars........... scissors--sun......... quiet--wired.......... green--mean........... salt--lou............. street--vault......... king--sepulchre....... cheese--presbyterian.. blossom--baptist...... afraid--methodist..... case no. .--a.l. sound reactions; particles; unclassified reactions, mostly incoherent. table--ammitting...... dark--cat............. music--hello.......... sickness--spelling.... man--then............. deep--heap............ soft--deep............ eating--people........ mountain--striking.... house--pat............ black--and............ mutton--it............ comfort--herself...... hand--self............ short--length......... fruit--long........... butterfly--quick...... smooth--edges......... command--first........ chair--exact.......... sweet--nicest......... whistle--thistle...... woman--pins........... cold--waving.......... slow--swift........... wish--choice.......... river--never.......... white--black.......... beautiful--much....... window--such.......... rough--exact.......... citizen--just......... foot--root............ spider--diving........ needle--hercules...... red--green............ sleep--deep........... anger--grief.......... carpet--cheap......... girl--ink............. high--i............... working--loafing...... sour--hour............ earth--hurt........... trouble--bubble....... soldier--yes.......... cabbage--garbage...... hard--hitting......... eagle--fitting........ stomach--pitting...... stem--condemned....... lamp--stamp........... dream--stained........ yellow--purple........ bread--pimple......... justice--suit......... boy--ahoy............. light--night.......... health--wealth........ bible--indeed......... memory--remembering... sheep--cow............ bath--sponge.......... cottage--people....... swift--left........... blue--shift........... hungry--property...... priest--judge......... ocean--river.......... head--sea............. stove--venus.......... long--hog............. religion--pigeon...... whiskey--gin.......... child--thing.......... bitter--better........ hammer--happy......... thirsty--whiskey...... city--fitting......... square--round......... butter--shut.......... doctor--exercise...... loud--accounts........ thief--endless........ lion--tiger........... joy--fast............. bed--grass............ heavy--heaving........ tobacco--queen........ baby--water........... moon--room............ scissors--pants....... quiet--razor.......... green--steel.......... salt--sharp........... street--fence......... king--bring........... cheese--eggs.......... blossom--see.......... afraid--awaiting...... case no. .--c.d. some stereotypy; particles; unclassified reactions, mostly incoherent. table--doctor......... dark--nigger.......... music--violin......... sickness--whores...... man--mulcane.......... deep--deaf............ soft--hearing......... eating--pillow........ mountain--sight....... house--pure........... black--nigger......... mutton--plenty........ comfort--middle....... hand--left............ short--one............ fruit--up............. butterfly--bird....... smooth--never......... command--commodore.... chair--seat........... sweet--sugar.......... whistle--highest...... woman--constance...... cold--temperature..... slow--walk............ wish--wishbone........ river--love........... white--dr. white...... beautiful--pretty..... window--dove.......... rough--fine........... citizen--united states foot--left............ spider--web........... needle--ether......... red--pot.............. sleep--wake........... anger--mad............ carpet--pretty........ girl--boy............. high--heidel.......... working--never........ sour--sweet........... earth--bride.......... trouble--mischief..... soldier--war.......... cabbage--head......... hard--never........... eagle--fly............ stomach--go........... stem--study........... lamp--light........... dream--behave......... yellow--false......... bread--plenty......... justice--just......... boy--come............. light--davie.......... health--wealth........ bible--constance...... memory--fine.......... sheep--plenty......... bath--bother.......... cottage--mansion...... swift--hurry.......... blue--flowers......... hungry--never......... priest--highest....... ocean--land........... head--millionaire..... stove--twenty-five.... long--thirty-four..... religion--churches.... whiskey--plenty....... child--baby........... bitter--sorrow........ hammer--court......... thirsty--blood........ city--this............ square--i............. butter--plenty........ doctor--millionaire... loud--tell............ thief--rich........... lion--west............ joy--ever............. bed--constance........ heavy--fine........... tobacco--back......... baby--millionaire..... moon--always.......... scissors--large....... quiet--stay........... green--flowers........ salt--perfume......... street--floor......... king--haaken.......... cheese--kiss.......... blossom--flower....... afraid--never......... case no. .--p.d. test record somewhat approaching the normal: individual reactions, of which are unclassified, mostly "far fetched" and not strictly incoherent. patient is a well-marked case of dementia præcox but only moderately deteriorated; works well at the hospital. table--oak.............. dark--brown............. music--falsetto......... sickness--typhoid....... man--gender............. deep--feet.............. soft--feeling........... eating--partaking....... mountain--hunter........ house--dwelling......... black--color............ mutton--sheep........... comfort--coziness....... hand--anatomy........... short--stature.......... fruit--apples........... butterfly--insect....... smooth--plain........... command--order.......... chair--furniture........ sweet--sugar............ whistle--steam.......... woman--sex.............. cold--degree............ slow--speedless......... wish--expression........ river--amazon........... white--pulp............. beautiful--description.. window--opaque.......... rough--uncouth.......... citizen--qualification.. foot--anatomy........... spider--bug............. needle--steel........... red--color.............. sleep--slumber.......... anger--aroused.......... carpet--texture......... girl--female............ high--up................ working--doing.......... sour--lemon............. earth--dirt............. trouble--distress....... soldier--uniform........ cabbage--crop........... hard--metal............. eagle--bird............. stomach--anatomy........ stem--pipe.............. lamp--glass............. dream--atmosphere....... yellow--color........... bread--flour............ justice--equality....... boy--male............... light--sun.............. health--color........... bible--nonsense......... memory--retentiveness... sheep--quadruped........ bath--water............. cottage--stories........ swift--speed............ blue--navy.............. hungry--appetite........ priest--uniform......... ocean--atlantic......... head--stature........... stove--iron............. long--inches............ religion--creed......... whiskey--hops........... child--neuter........... bitter--horehound....... hammer--steel........... thirsty--degree......... city--population........ square--sides........... butter--cream........... doctor--physician....... loud--noise............. thief--characterization. lion--menagerie......... joy--openness........... bed--furniture.......... heavy--weight........... tobacco--plant.......... baby--egg............... moon--astronomy......... scissors--blades........ quiet--noiseless........ green--paris............ salt--crystal........... street--lane............ king--usurper........... cheese--milk............ blossom--bud............ afraid--scared.......... case no. .--j.h. test record approaching the normal: individual reactions, classed as normal, non-specific, unclassified, mostly "far fetched" but not strictly incoherent. well-marked dementia præcox, but of recent origin and but slight deterioration. table--eat............ dark--night........... music--pleasure....... sickness--suffering... man--farmer........... deep--low............. soft--hard............ eating--life.......... mountain--earth....... house--dwelling....... black--color.......... mutton--food.......... comfort--rest......... hand--limb............ short--small.......... fruit--nourishing..... butterfly--flower..... smooth--straight...... command--obey......... chair--furniture...... sweet--palate......... whistle--noise........ woman--marriage....... cold--indisposed...... slow--weary........... wish--work............ river--tug............ white--sheets......... beautiful--rare....... window--ventilation... rough--uneven......... citizen--public....... foot--walk............ spider--web........... needle--sew........... red--marine........... sleep--repose......... anger--assault........ carpet--cloth......... girl--sister.......... high--above........... working--labor........ sour--bitter.......... earth--farm........... trouble--fight........ soldier--duty......... cabbage--vegetable.... hard--stone........... eagle--large.......... stomach--body......... stem--leaf............ lamp--light........... dream--unconsciousness yellow--flag.......... bread--hunger......... justice--freedom...... boy--school........... light--electricity.... health--business...... bible--religion....... memory--brain......... sheep--pasture........ bath--clean........... cottage--property..... swift--current........ blue--uniform......... hungry--appetite...... priest--church........ ocean--commerce....... head--thought......... stove--iron........... long--distance........ religion--belief...... whiskey--alcohol...... child--parent......... bitter--taste......... hammer--trade......... thirsty--beverage..... city--position........ square--block......... butter--yellow........ doctor--profession.... loud--fiddle.......... thief--police......... lion--africa.......... joy--sensation........ bed--rest............. heavy--burden......... tobacco--store........ baby--care............ moon--atmosphere...... scissors--dressmaker.. quiet--lonesome....... green--color.......... salt--house........... street--neighborhood.. king--beast........... cheese--merchant...... blossom--flowers...... afraid--train......... case no. .--l.l. test record not distinguishable from normal. case of recent onset, with little, if any deterioration. table--chair.......... dark--light........... music--note........... sickness--health...... man--woman............ deep--shallow......... soft--hard............ eating--breakfast..... mountain--rock........ house--chimney........ black--white.......... mutton--animal........ comfort--chair........ hand--foot............ short--long........... fruit--ripe........... butterfly--fields..... smooth--hard.......... command--army......... chair--straw.......... sweet--bitter......... whistle--engine....... woman--man............ cold--hot............. slow--fast............ wish--desire.......... river--brook.......... white--black.......... beautiful--girl....... window--glass......... rough--smooth......... citizen--city......... foot--ankle........... spider--web........... needle--cotton........ red--brick............ sleep--night.......... anger--joy............ carpet--cloth......... girl--mouth........... high--low............. working--idle......... sour--vinegar......... earth--round.......... trouble--sickness..... soldier--gun.......... cabbage--garden....... hard--rock............ eagle--fly............ stomach--man.......... stem--watch........... lamp--oil............. dream--sleep.......... yellow--sunflower..... bread--butter......... justice--peace........ boy--girl............. light--window......... health--man........... bible--god............ memory--mind.......... sheep--pasture........ bath--water........... cottage--trees........ swift--engine......... blue--sky............. hungry--bread......... priest--church........ ocean--ships.......... head--mind............ stove--chimney........ long--wind............ religion--god......... whiskey--alcohol...... child--mother......... bitter--fruit......... hammer--nails......... thirsty--water........ city--cars............ square--angles........ butter--cow........... doctor--sickness...... loud--noise........... thief--sinner......... lion--jungle.......... joy--gladness......... bed--pillow........... heavy--iron........... tobacco--leaf......... baby--mother.......... moon--stars........... scissors--thread...... quiet--room........... green--grass.......... salt--ocean........... street--men........... king--queen........... cheese--butter........ blossom--bud.......... afraid--coward........ case no. .--b.b. test record not distinguishable from normal. case of several years standing, but showing almost complete remission of all symptoms. table--chair.......... dark--day............. music--instrument..... sickness--health...... man--woman............ deep--thoughts........ soft--apple........... eating--food.......... mountain--rock........ house--building....... black--dark........... mutton--meat.......... comfort--home......... hand--from............ short--stout.......... fruit--eating......... butterfly--bird....... smooth--glossy........ command--general...... chair--floor.......... sweet--taste.......... whistle--tune......... woman--man............ cold--chilly.......... slow--fast............ wish--something....... river--water.......... white--black.......... beautiful--pretty..... window--pane.......... rough--ugly........... citizen--papers....... foot--shoe............ spider--bug........... needle--thread........ red--white............ sleep--slumber........ anger--kindness....... carpet--mat........... girl--boy............. high--short........... working--idle......... sour--sweet........... earth--land........... trouble--sorrow....... soldier--hero......... cabbage--turnip....... hard--soft............ eagle--owl............ stomach--head......... stem--pipe............ lamp--cover........... dream--sleep.......... yellow--brown......... bread--biscuit........ justice--peaceful..... boy--girl............. light--dark........... health--well.......... bible--book........... memory--lost.......... sheep--animal......... bath--wash............ cottage--house........ swift--movements...... blue--red............. hungry--thirst........ priest--minister...... ocean--sea............ head--body............ stove--iron........... long--length.......... religion--too......... whiskey--drink........ child--baby........... bitter--taste......... hammer--nails......... thirsty--drink........ city--town............ square--man........... butter--bread......... doctor--patient....... loud--howl............ thief--steal.......... lion--bear............ joy--happiness........ bed--blanket.......... heavy--weight......... tobacco--smoke........ baby--cradle.......... moon--sun............. scissors--thimble..... quiet--stillness...... green--plaid.......... salt--pepper.......... street--sidewalk...... king--queen........... cheese--crackers...... blossom--leaf......... afraid--frightened.... paranoic conditions. the clinical group of psychoses included under the designation paranoic conditions is far from being homogeneous. we have here cases that are more or less closely allied to the paranoid form of dementia præcox, other cases that are apparently dependent upon involutional changes (kraepelin's _praeseniler beeinträchtigungswah_), still other cases that are characterized by absence or at least delay of mental deterioration, etc. in some of these cases disturbance of the flow of utterance is not observed, and the test records obtained from them present no striking abnormalities. distinctly pathological records are obtained mainly from those cases which clinically resemble dementia præcox; in these records the nature of the pathological reactions would seem to indicate that the diagnosis of dementia præcox would be more justifiable than that of paranoic condition. the following test records will serve to illustrate the types of reactions met with in this group of psychoses: case no. .--f.a. normal record. table--purpose........ dark--obscure......... music--pleasant....... sickness--confinement. man--twenty-one....... deep--down............ soft--smooth.......... eating--nourishment... mountain--high........ house--living......... black--dark........... mutton--eating........ comfort--pleasant..... hand--limb............ short--low............ fruit--eat............ butterfly--miller..... smooth--soft.......... command--obey......... chair--sitting........ sweet--tasting........ whistle--noise........ woman--female......... cold--unpleasant...... slow--easy............ wish--want............ river--water.......... white--colorless...... beautiful--handsome... window--glass......... rough--unpleasant..... citizen--vote......... foot--limb............ spider--insect........ needle--sewing........ red--color............ sleep--bed............ anger--cross.......... carpet--floor......... girl--young........... high--up.............. working--labor........ sour--unpleasant...... earth--dirt........... trouble--worriment.... soldier--fight........ cabbage--vegetable.... hard--tough........... eagle--bird........... stomach--anatomy...... stem--growth.......... lamp--burn............ dream--restlessness... yellow--color......... bread--eat............ justice--right........ boy--young............ light--see............ health--well.......... bible--religion....... memory--thoughtful.... sheep--animal......... bath--wash............ cottage--house........ swift--fast........... blue--color........... hungry--appetite...... priest--christian..... ocean--large.......... head--trunk........... stove--fire........... long--distance........ religion--christianity whiskey--drinkable.... child--young.......... bitter--bad........... hammer--knock......... thirsty--dry.......... city--government...... square--block......... butter--eat........... doctor--cure.......... loud--noisy........... thief--steal.......... lion--animal.......... joy--pleasant......... bed--laying........... heavy--weighty........ tobacco--smoking...... baby--new-born........ moon--planet.......... scissors--cutting..... quiet--easy........... green--color.......... salt--preservative.... street--lane.......... king--monarch......... cheese--eatable....... blossom--budding...... afraid--fear.......... case no. .--d.e.d. slight tendency to give sound reactions. table--tree........... dark--bright.......... music--song........... sickness--health...... man--woman............ deep--shallow......... soft--hard............ eating--digesting..... mountain--hill........ house--horse.......... black--red............ mutton--tallow........ comfort--wealth....... hand--arm............. short--long........... fruit--plate.......... butterfly--net........ smooth--surface....... command--obey......... chair--table.......... sweet--sour........... whistle--call......... woman--lady........... cold--lukewarm........ slow--not............. wish--receive......... river--lake........... white--black.......... beautiful--graceful... window--door.......... rough--smooth......... citizen--city......... foot--leg............. spider--soap.......... needle--pin........... red--yellow........... sleep--slumber........ anger--amiable........ carpet--mat........... girl--boy............. high--hill............ working--playing...... sour--sweet........... earth--land........... trouble--tranquillity. soldier--boy.......... cabbage--plant........ hard--easy............ eagle--bird........... stomach--bowels....... stem--head............ lamp--chimney......... dream--myth........... yellow--blue.......... bread--biscuit........ justice--balance...... boy--girl............. light--gray........... health--wealth........ bible--prayerbook..... memory--understanding. sheep--lamb........... bath--swim............ cottage--house........ swift--slow........... blue--yellow.......... hungry--eat........... priest--bishop........ ocean--river.......... head--neck............ stove--covers......... long--short........... religion--optional.... whiskey--wine......... child--baby........... bitter--sweet......... hammer--gimlet........ thirsty--drink........ city--town............ square--compass....... butter--butterfly..... doctor--lawyer........ loud--lord............ thief--beggar......... lion--lioness......... joy--sorrow........... bed--couch............ heavy--light.......... tobacco--cigarette.... baby--child........... moon--stars........... scissors--knife....... quiet--quilt.......... green--envy........... salt--sewing.......... street--lane.......... king--queen........... cheese--cracker....... blossom--flower....... afraid--courageous.... case no. .--m.f. unclassified reactions, mostly "far fetched" or incoherent; perseveration. table--eat............ dark--night........... music--sing........... sickness--sadness..... man--home............. deep--light........... soft--sleep........... eating--drink......... mountain--hills....... house--home........... black--stove.......... mutton--lamb.......... comfort--pleasure..... hand--write........... short--short-cake..... fruit--grapes......... butterfly--butter..... smooth--ironing....... command--correct...... chair--see............ sweet--apples......... whistle--happiness.... woman--girl........... cold--warm............ slow--fast............ wish--like............ river--water.......... white--blue........... beautiful--red........ window--light......... rough--easy........... citizen--spring....... foot--run............. spider--fly........... needle--carrie........ red--pink............. sleep--awake.......... anger--jolly.......... carpet--curtains...... girl--yellow.......... high--green........... working--bed.......... sour--dishes.......... earth--grapes......... trouble--work......... soldier--sing......... cabbage--potatoes..... hard--sewing.......... eagle--daisy.......... stomach--flowers...... stem--vine............ lamp--flatiron........ dream--sleep.......... yellow--awake......... bread--children....... justice--dresses...... boy--mother........... light--dark........... health--wealth........ bible--commands....... memory--black......... sheep--chickens....... bath--carpet.......... cottage--worsted...... swift--silk........... blue--cotton.......... hungry--chair......... priest--church........ ocean--spring......... head--canary.......... stove--board.......... long--dishes.......... religion--piano....... whiskey--home......... child--baby........... bitter--shoes......... hammer--tacks......... thirsty--longing...... city--flushing........ square--store......... butter--butcher....... doctor--hat........... loud--chair........... thief--picture........ lion--house........... joy--gladness......... bed--sleep............ heavy--sick........... tobacco--album........ baby--basket.......... moon--stars........... scissors--knife....... quiet--spoon.......... green--scar........... salt--pepper.......... street--sugar......... king--blacking........ cheese--meat.......... blossom--flowers...... afraid--red........... case no. .--l.k. marked stereotypy; unclassified reactions, mostly incoherent. table--fruit.......... dark--light........... music--pleasure....... sickness--illness..... man--parent........... deep--verse........... soft--fruit........... eating--illness....... mountain--parent...... house--privilege...... black--colors......... mutton--parent........ comfort--family....... hand--comfort......... short--parent......... fruit--parent......... butterfly--insect..... smooth--surface....... command--privilege.... chair--house.......... sweet--dairy.......... whistle--nature....... woman--parent......... cold--house........... slow--light........... wish--desire.......... river--house.......... white--suspicion...... beautiful--house...... window--light......... rough--surface........ citizen--parent....... foot--house........... spider--insect........ needle--house......... red--colors........... sleep--god............ anger--god............ carpet--house......... girl--god............. high--house........... working--parent....... sour--desire.......... earth--god............ trouble--god.......... soldier--house........ cabbage--desire....... hard--vegetable....... eagle--animal......... stomach--doctor....... stem--growth.......... lamp--house........... dream--god............ yellow--color......... bread--god............ justice--fright....... boy--parent........... light--god............ health--god........... bible--teachings...... memory--teaching...... sheep--god............ bath--cleanness....... cottage--home......... swift--fear........... blue--color........... hungry--appetite...... priest--servant....... ocean--god............ head--servant......... stove--house.......... long--god............. religion--servant..... whiskey--doctor....... child--house.......... bitter--taste......... hammer--household..... thirsty--drink........ city--god............. square--touch......... butter--taste......... doctor--servant....... loud--thought......... thief--slave.......... lion--animal.......... joy--pleasure......... bed--household........ heavy--weight......... tobacco--doctor....... baby--care............ moon--heavens......... scissors--household... quiet--nerve.......... green--substance...... salt--taste........... street--heavens....... king--servant......... cheese--taste......... blossom--sight........ afraid--fear.......... case no. .--l.e. remarkably persistent tendency to give sound reactions; numerous sound neologisms; no reactions given in response to some of the stimulus words on the ground that she had "no word to match." table--witchhazel..... dark--frog............ music--lessons........ sickness--badness..... man--wife............. deep--seef............ soft--shoft........... eating--feeding....... mountain--sounding.... house--shmouse........ black--fake........... mutton--shutton....... comfort--somfort...... hand--land............ short--court.......... fruit--shrewd......... butterfly--shuddergy.. smooth--slude......... command--noman........ chair--sash........... sweet--leaf........... whistle--noshissel.... woman--lemon.......... cold--shoal........... slow--snow............ wish--dish............ river--liberty........ white--size........... beautiful--........... window--hilda......... rough--shoff.......... citizen--shiffizen.... foot--shoot........... spider--shider........ needle--dreedle....... red--shred............ sleep--seef........... anger--............... carpet--shloppet...... girl--shirl........... high--fie............. working--shlirking.... sour--bower........... earth--world.......... trouble--shuttle...... soldier--polster...... cabbage--sheffies..... hard--shward.......... eagle--............... stomach--............. stem--lamp............ lamp--sant............ dream--leam........... yellow--cherry........ bread--dread.......... justice--chestnuts.... boy--................. light--shwife......... health--felt.......... bible--............... memory--.............. sheep--sheet.......... bath--scab............ cottage--foppach...... swift--shift.......... blue--shoe............ hungry--angry......... priest--sheaf......... ocean--notion......... head--shred........... stove--shove.......... long--song............ religion--switching... whiskey--chiston...... child--kile........... bitter--shitter....... hammer--lemon......... thirsty--flrsten...... city--................ square--birds......... butter--shudder....... doctor--shoctor....... loud--souse........... thief--sheaf.......... lion--zion............ joy--bloy............. bed--wading........... heavy--shleavy........ tobacco--confecker.... baby--savey........... moon--shoon........... scissors--............ quiet--shiet.......... green--sheel.......... salt--shawlt.......... street--freet......... king--sing............ cheese--seefs......... blossom--pleasant..... afraid--shraid........ case no. .--f.w. neologisms; some particles; many unclassified reactions, mostly incoherent. table--pleasure....... dark--air............. music--walking........ sickness--gloves...... man--fields........... deep--courtesy........ soft--spoons.......... eating--oranges....... mountain--ice......... house--paintings...... black--blue........... mutton--hemisphere.... comfort--flowers...... hand--sawdust......... short--peanuts........ fruit--autoharp....... butterfly--disease.... smooth--ice........... command--botheration.. chair--tea............ sweet--arrangement.... whistle--steadfast.... woman--flowers........ cold--grandeur........ slow--present......... wish--mania........... river--courtesy....... white--ink............ beautiful--flowers.... window--air........... rough--enjoyment...... citizen--queer........ foot--hatred.......... spider--carousy....... needle--pleasant...... red--permit........... sleep--indeed......... anger--benevolence.... carpet--disorder...... girl--caterer......... high--aside........... working--among........ sour--destroy......... earth--confusion...... trouble--frivolous.... soldier--air.......... cabbage--temptation... hard--among........... eagle--quality........ stomach--debasteaur... stem--counteract...... lamp--testament....... dream--connexus....... yellow--division...... bread--atherey........ justice--anger........ boy--quality.......... light--among.......... health--frivolous..... bible--permit......... memory--usual......... sheep--astray......... bath--conscientious... cottage--texalous..... swift--patience....... blue--community....... hungry--confusion..... priest--second........ ocean--apology........ head--trinity......... stove--compartment.... long--terminal........ religion--abundant.... whiskey--approvement.. child--anger.......... bitter--courageous.... hammer--correction.... thirsty--afterwards... city--cataract........ square--plenty........ butter--accost........ doctor--southern...... loud--triangular...... thief--cannery........ lion--practice........ joy--summons.......... bed--avron............ heavy--olenthegolis... tobacco--abundant..... baby--parenthus....... moon--otherwise....... scissors--cartridge... quiet--outside........ green--abounty........ salt--calonry......... street--abyss......... king--cavenry......... cheese--perplex....... blossom--cartridge.... afraid--stubborn...... epilepsy. most of the cases of epilepsy in our collection show advanced dementia and in some the clinical history would indicate also original mental inferiority, that is to say, imbecility or feeble-mindedness. in these cases the dominant characteristic, so far as shown in the test records, seems to be a narrowing of the mental horizon manifested firstly by a tendency to repeat many times one or another word, and secondly by an abnormally pronounced tendency to make use of non-specific reactions or particles of speech. occasionally other abnormalities are noted, such as perseveration or distraction. we submit here copies of some test records. case no. .--w.t.k. repetition of words previously given; nonspecific reactions. table--article........ dark--light........... music--tone........... sickness--ill......... man--person........... deep--distant......... soft--condition....... eating--chew.......... mountain--high........ house--abode.......... black--color.......... mutton--meat.......... comfort--peace........ hand--limb............ short--distance....... fruit--result......... butterfly--animal..... smooth--plain......... command--order........ chair--seat........... sweet--pleasant....... whistle--sound........ woman--female......... cold--chilly.......... slow--pace............ wish--desire.......... river--body........... white--clear.......... beautiful--grand...... window--place......... rough--unsmooth....... citizen--member....... foot--member.......... spider--animal........ needle--article....... bed--color............ sleep--rest........... anger--condition...... carpet--covering...... girl--female.......... high--distance........ working--occupation... sour--condition....... earth--planet......... trouble--condition.... soldier--member....... cabbage--vegetable.... hard--condition....... eagle--animal......... stomach--member....... stem--branch.......... lamp--article......... dream--thinking....... yellow--shade......... bread--article........ justice--position..... boy--male............. light--clear.......... health--condition..... bible--book........... memory--condition..... sheep--animal......... bath--position........ cottage--house........ swift--fast........... blue--color........... hungry--condition..... priest--office........ ocean--body........... head--member.......... stove--article........ long--distance........ religion--profession.. whiskey--liquid....... child--person......... bitter--condition..... hammer--article....... thirsty--condition.... city--place........... square--honest........ butter--article....... doctor--profession.... loud--sound........... thief--position....... lion--animal.......... joy--pleasant......... bed--article.......... heavy--weight......... tobacco--plant........ baby--person.......... moon--planet.......... scissors--article..... quiet--peaceful....... green--shade.......... salt--article......... street--place......... king--ruler........... cheese--article....... blossom--plant........ afraid--fear.......... case no. .--j.a. repetition of words previously given; non-specific reactions. table--wood........... dark--chairs.......... music--wood........... sickness--dropsy...... man--body............. deep--well............ soft--lady............ eating--man........... mountain--hills....... house--barns.......... black--horse.......... mutton--sheep......... comfort--poison....... hand--man............. short--people......... fruit--trees.......... butterfly--tree....... smooth--people........ command--general...... chair--hands.......... sweet--fruit.......... whistle--man.......... woman--people......... cold--ice............. slow--people.......... wish--dead............ river--lakes.......... white--foam........... beautiful--man........ window--glass......... rough--people......... citizen--man.......... foot--people.......... spider--barn.......... needle--clothes....... red--blood............ sleep--bed............ anger--angry.......... carpet--stores........ girl--ladies.......... high--mountain........ working--people....... sour--fruit........... earth--clay........... trouble--bad.......... soldier--man.......... cabbage--field........ hard--case............ eagle--bird........... stomach--man.......... stem--pipe............ lamp--fire............ dream--bad............ yellow--chair......... bread--rye............ justice--right........ boy--bad.............. light--ship........... health--pig........... bible--man............ memory--mind.......... sheep--mutton......... bath--water........... cottage--house........ swift--ship........... blue--lines........... hungry--people........ priest--man........... ocean--deep........... head--bad............. stove--wood........... long--trees........... religion--form........ whiskey--apples....... child--people......... bitter--apples........ hammer--axe........... thirsty--drink........ city--towns........... square--measurement... butter--cows.......... doctor--person........ loud--people.......... thief--person......... lion--animal.......... joy--person........... bed--man.............. heavy--mountain....... tobacco--growing...... baby--person.......... moon--people.......... scissors--cutting..... quiet--mind........... green--cloud.......... salt--planting........ street--walk.......... king--human........... cheese--milk.......... blossom--flowers...... afraid--human......... case no. .--e.m. repetition of words previously given; non-specific reactions. table--tablecloth..... dark--dog............. music--figure......... sickness--drink....... man--people........... deep--pull............ soft--light........... eating--think......... mountain--well........ house--plumber........ black--horse.......... mutton--park.......... comfort--nice......... hand--use............. short--long........... fruit--figs........... butterfly--cloth...... smooth--nice.......... command--pleasant..... chair--wash........... sweet--sour........... whistle--mug.......... woman--pear........... cold--warm............ slow--quickness....... wish--nice............ river--pleasant....... white--use............ beautiful--comfort.... window--looks......... rough--pleasant....... citizen--comfort...... foot--help............ spider--wake.......... needle--use........... red--look............. sleep--good........... anger--no............. carpet--make.......... girl--happy........... high--nice............ working--pleasant..... sour--bag............. earth--ground......... trouble--good......... soldier--clothes...... cabbage--eat.......... hard--good............ eagle--pleasant....... stomach--hurt......... stem--use............. lamp--lighted......... dream--pleasant....... yellow--wake.......... bread--making......... justice--help......... boy--pleasant......... light--big............ health--nice.......... bible--use............ memory--no............ sheep--pleasant....... bath--good............ cottage--useful....... swift--quick.......... blue--good............ hungry--sour.......... priest--good.......... ocean--useful......... head--nice............ stove--lighted........ long--lake............ religion--pleasant.... whiskey--use.......... child--help........... bitter--sour.......... hammer--stick......... thirsty--drink........ city--handy........... square--pleasant...... butter--useful........ doctor--help.......... loud--make............ thief--punish......... lion--bad............. joy--happy............ bed--pleasant......... heavy--light.......... tobacco--pleasant..... baby--help............ moon--sun............. scissors--pleasant.... quiet--sleep.......... green--beans.......... salt--handy........... street--make.......... king--nice............ cheese--good.......... blossom--pleasant..... afraid--will.......... case no. .--c.h. repetition of words previously given; non-specific reactions; particles. table--work........... dark--true............ music--pleasant....... sickness--well........ man--absent........... deep--together........ soft--plenty.......... eating--good.......... mountain--together.... house--one............ black--america........ mutton--vegetable..... comfort--sleep........ hand--nothing......... short--never.......... fruit--vegetable...... butterfly--bird....... smooth--large......... command--willing...... chair--good........... sweet--always......... whistle--music........ woman--one............ cold--medium.......... slow--quick........... wish--hope............ river--lake........... white--always......... beautiful--medium..... window--open.......... rough--smooth......... citizen--american..... foot--two............. spider--butterfly..... needle--steel......... red--color............ sleep--plenty......... anger--never.......... carpet--floor......... girl--five............ high--medium.......... working--always....... sour--never........... earth--cultivate...... trouble--none......... soldier--willing...... cabbage--vegetable.... hard--seldom.......... eagle--american....... stomach--no........... stem--one............. lamp--burning......... dream--always......... yellow--sometimes..... bread--soft........... justice--always....... boy--two.............. light--plenty......... health--plenty........ bible--catholic....... memory--good.......... sheep--wool........... bath--good............ cottage--plenty....... swift--medium......... blue--never........... hungry--seldom........ priest--good.......... ocean--three.......... head--good............ stove--burning........ long--medium.......... religion--willing..... whiskey--some......... child--good........... bitter--never......... hammer--tool.......... thirsty--seldom....... city--new york........ square--always........ better--good.......... doctor--good.......... loud--medium.......... thief--none........... lion--animal.......... joy--plenty........... bed--good............. heavy--medium......... tobacco--yes.......... baby--more............ moon--bright.......... scissors--sharp....... quiet--plenty......... green--good........... salt--little.......... street--lots.......... king--none............ cheese--seldom........ blossom--always....... afraid--sometimes..... case no. .--c.c. distraction table--eat............ dark--lock............ music--fiddle......... sickness--doctors..... man--woman............ deep--water........... soft--snow............ eating--oats.......... mountain--spray....... house--building....... black--red............ mutton--meat.......... comfort--red.......... hand--people.......... short--world.......... fruit--age............ butterfly--bird....... smooth--eggs.......... command--cake......... chair--world.......... sweet--cherries....... whistle--peaches...... woman--children....... cold--summer.......... slow--brother......... wish--pear............ river--orange......... white--black.......... beautiful--red........ window--door.......... rough--table.......... citizen--couch........ foot--arm............. spider--fly........... needle--scissors...... red--blue............. sleep--pink........... anger--box............ carpet--rug........... girl--boy............. high--play............ working--cup.......... sour--bread........... earth--picture........ trouble--soap......... soldier--towel........ cabbage--turnip....... hard--tree............ eagle--clock.......... stomach--eat.......... stem--soap............ lamp--oil............. dream--glass.......... yellow--bottle........ bread--soap........... justice--pencil....... boy--picture.......... light--darkness....... health--washstand..... bible--book........... memory--saucer........ sheep--chair.......... bath--bureau.......... cottage--pan.......... swift--towel.......... blue--wash............ hungry--eat........... priest--church........ ocean--beans.......... head--prunes.......... stove--cook........... long--fig............. religion--church...... whiskey--tea.......... child--people......... bitter--stomach....... hammer--tack.......... thirsty--peach........ city--box............. square--soap.......... butter--lard.......... doctor--sick.......... loud--head............ thief--cup............ lion--bottle.......... joy--pitcher.......... bed--sheet............ heavy--blanket........ tobacco--mustard...... baby--pepper.......... moon--heater.......... scissors--string...... quiet--lace........... green--red............ salt--soda............ street--soldier....... king--box............. cheese--cake.......... blossom--shell........ afraid--blotter....... case no. .--l.t. some neologisms, all possessing obvious meaning. table--stand.......... dark--light........... music--instrument..... sickness--health...... man--female........... deep--detableness..... soft--hard............ eating--starving...... mountain--isthmus..... house--building....... black--white.......... mutton--beef.......... comfort--patient...... hand--leg............. short--long........... fruit--vegetable...... butterfly--spider..... smooth--coarse........ command--thought...... chair--utensil........ sweet--sour........... whistle--trumpet...... woman--man............ cold--warm............ slow--quick........... wish--command......... river--lake........... white--black.......... beautiful--pretty..... window--door.......... rough--straight....... citizen--tramp........ foot--arm............. spider--fly........... needle--pin........... red--blue............. sleep--awake.......... anger--patient........ carpet--rug........... girl--servant......... high--low............. working--laziness..... sour--sweet........... earth--hemisphere..... trouble--goodness..... soldier--merchant..... cabbage--pumpkin...... hard--tight........... eagle--hawk........... stomach--abdomen...... stem--leaf............ lamp--lantern......... dream--nightmare...... yellow--lavender...... bread--pastry......... justice--badness...... boy--child............ light--darkness....... health--sickness...... bible--testament...... memory--remember...... sheep--lamb........... bath--dirtiness....... cottage--building..... swift--quickly........ blue--redness......... hungry--starving...... priest--minister...... ocean--sea............ head--topness......... stove--cooking........ long--shorter......... religion--wickedness.. whiskey--medicine..... child--daughter....... bitter--sweetness..... hammer--pickaxe....... thirsty--drinkness.... city--village......... square--strightness... butter--syrup......... doctor--queen......... loud--low............. thief--burglar........ lion--tiger........... joy--enjoyable........ bed--bedstead......... heavy--lightness...... tobacco--sweetness.... baby--infant.......... moon--sun............. scissors--shears...... quite--noiseness...... green--greenbill...... salt--sugar........... street--island........ king--nephew.......... cheese--curdness...... blossom--bud.......... afraid--knowledgeable. general paresis. cases presenting no considerable dementia or confusion and cases in a state of remission are apt to give normal test records. as we proceed from the records of such cases to those of cases showing mental deterioration we observe a gradual reduction in the values of reactions, contraction of the mental horizon,[ ] and the appearance of the phenomenon of perseveration. we submit the following test records for illustration: [footnote : what we mean by contraction of the mental horizon has already been described in connection with epilepsy, page .] case no. .--c.a.f. almost complete remission of all mental symptoms. normal record. table--dish........... dark--light........... music--sound.......... sickness--disease..... man--woman............ deep--fathomless...... soft--sweet........... eating--food.......... mountain--high........ house--barn........... black--color.......... mutton--meat.......... comfort--ease......... hand--foot............ short--long........... fruit--sweet.......... butterfly--moth....... smooth--rough......... command--order........ chair--leg............ sweet--pleasant....... whistle--sound........ woman--female......... cold--ice............. slow--languid......... wish--desire.......... river--long........... white--color.......... beautiful--fair....... window--glass......... rough--smooth......... citizen--voter........ foot--toe............. spider--fly........... needle--sharp......... red--color............ sleep--slumber........ anger--rage........... carpet--sweep......... girl--maiden.......... high--lofty........... working--toiling...... sour--distasteful..... earth--ground......... trouble--sorrow....... soldier--fighter...... cabbage--leaf......... hard--easy............ eagle--fly............ stomach--food......... stem--petal........... lamp--light........... dream--slumber........ yellow--color......... bread--eat............ justice--judgment..... boy--youth............ light--lamp........... health--nature........ bible--holy........... memory--remember...... sheep--lamb........... bath--water........... cottage--house........ swift--fast........... blue--color........... hungry--famished...... priest--holy.......... ocean--sea............ head--top............. stove--fire........... long--short........... religion--holy........ whiskey--drink........ child--infant......... bitter--sour.......... hammer--knock......... thirsty--drink........ city--town............ square--round......... butter--eat........... doctor--physician..... loud--knock........... thief--steal.......... lion--tiger........... joy--happiness........ bed--sleep............ heavy--weigh.......... tobacco--smoke........ baby--child........... moon--stars........... scissors--cut......... quiet--soft........... green--color.......... salt--food............ street--lane.......... king--queen........... cheese--eat........... blossom--flower....... afraid--fear.......... case no. .--f.f. repetition of words previously given; non-specific reactions; unclassified reactions some of which are "circumstantial" (see page ). table--bureau......... dark--boats........... music--piano.......... sickness--doctor...... man--sober............ deep--cellar.......... soft--easy............ eating--chewing....... mountain--climb....... house--tenants........ black--color.......... mutton--meat.......... comfort--easy......... hand--use............. short--stump.......... fruit--nice........... butterfly--like....... smooth--clean......... command--faithful..... chair--easy........... sweet--like........... whistle--good......... woman--like........... cold--medicine........ slow--i............... wish--like............ river--boats.......... white--sheet.......... beautiful--flowers.... window--red........... rough--streets........ citizen--honest....... foot--walking......... spider--kill.......... needle--sew........... red--nice............. sleep--rest........... anger--cross.......... carpet--good.......... girl--nice............ high--good............ working--well......... sour--bitter.......... earth--property....... trouble--fighting..... soldier--good......... cabbage--eat.......... hard--sorry........... eagle--good........... stomach--good......... stem--fair............ lamp--use............. dream--now............ yellow--color......... bread--good........... justice--fine......... boy--good............. light--good........... health--right......... bible--home........... memory--good.......... sheep--like........... bath--good............ cottage--fine......... swift--go............. blue--nice............ hungry--bad........... priest--father........ ocean--boats.......... head--brains.......... stove--heat........... long--streets......... religion--catholic.... whiskey--bad.......... child--good........... bitter--sorrow........ hammer--use........... thirsty--drink........ city--brooklyn........ squares--park......... butter--ice........... doctor--cure.......... loud--holler.......... thief--no............. lion--no.............. joy--hope............. bed--rest............. heavy--loud........... tobacco--good......... baby--good............ moon--light........... scissors--use......... quiet--good........... green--nice........... salt--use............. street--nice.......... king--right........... cheese--nice.......... blossom--grow......... afraid--no............ case no. .--r.n. numerous particles of speech; some unclassified reaction, chiefly "circumstantial" (see page ). table--eat............ dark--cloudy.......... music--fond........... sickness--well........ man--human............ deep--ocean........... soft--fine............ eating--yes........... mountain--yes......... house--yes............ black--yes............ mutton--yes........... comfort--yes.......... hand--finger.......... short--yes............ fruit--yes............ butterfly--yes........ smooth--even.......... command--obey......... chair--settle......... sweet--bitter......... whistle--can't........ woman--lady........... cold--ice............. slow--fast............ wish--give............ river--enjoyment...... white--black.......... beautiful--yes........ window--pane.......... rough--smooth......... citizen--yes.......... foot--one............. spider--yes........... needle--sewing........ red--blue............. sleep--nap............ anger--willing........ carpet--yes........... girl--nature.......... high--low............. working--artist....... sour--sweet........... earth--world.......... trouble--peaceful..... soldier--no........... cabbage--vegetable.... hard--soft............ eagle--american....... stomach--condition.... stem--post............ lamp--light........... dream--thinking....... yellow--green......... bread--loaf........... justice--yes.......... boy--human............ light--heaven......... health--wealth........ bible--yes............ memory--yes........... sheep--animal......... bath--yes............. cottage--yes.......... swift--fast........... blue--gray............ hungry--no............ priest--yes........... ocean--water.......... head--human........... stove--coal........... long--short........... religion--yes......... whiskey--no........... child--baby........... bitter--sweet......... hammer--pincher....... thirsty--drinking..... city--population...... square--circle........ butter--lard.......... doctor--physician..... loud--low............. thief--penalty........ lion--liar............ joy--welcome.......... bed--sleep............ heavy--light.......... tobacco--yes.......... baby--human........... moon--natural......... scissors--no.......... quiet--yes............ green--shade.......... salt--eat............. street--town.......... king--ruler........... cheese--eat........... blossom--blooming..... afraid--scared........ case no. .--c.z. perseveration shown by numerous instances of association to preceding reaction. table--horse.......... dark--wren............ music--lark........... sickness--cold........ man--woman............ deep--sea............. soft--hard............ eating--drinking...... mountain--fountain.... house--barn........... black--stable......... mutton--cow........... comfort--horse........ hand--lamb............ short--calf........... fruit--apples......... butterfly--oranges.... smooth--peaches....... command--plums........ chair--bench.......... sweet--sugar.......... whistle--drum......... woman--man............ cold--hot............. slow--fast............ wish--who............. river--water.......... white--blue........... beautiful--splendid... window--sashes........ rough--ready.......... citizen--brooklyn..... foot--shoe............ spider--web........... needle--pin........... red--blue............. sleep--awake.......... anger--bad............ carpet--sweeper....... girl--boy............. high--low............. working--playing...... sour--sweet........... earth--ground......... trouble--wheelbarrow.. soldier--mexican...... cabbage--potatoes..... hard--beets........... eagle--carrots........ stomach--peas......... stem--peas............ lamp--burning......... dream--happy.......... yellow--blue.......... bread--green.......... justice--freedom...... boy--girl............. light--burning........ health--strength...... bible--prayerbook..... memory--thoughts...... sheep--lamb........... bath--water........... cottage--house........ swift--whist.......... blue--red............. hungry--eating........ priest--father........ ocean--mother......... head--brother......... stove--sister......... long--freedom......... religion--smart....... whiskey--wine......... child--lamb........... bitter--goat.......... hammer--nails......... thirsty--dry.......... city--talking......... square--inches........ butter--cheese........ doctor--bread......... loud--oranges......... thief--almonds........ lion--apples.......... joy--grapes........... bed--peaches.......... heavy--cranberries.... tobacco--grapes....... baby--watermelon...... moon--muskmelons...... scissors--citrons..... quiet--squashes....... green--pumpkins....... salt--cucumbers....... street--tomatoes...... kings--pears.......... cheese--apples........ blossom--cherries..... afraid--gooseberries.. case no. .--b.w. perseveration; record almost entirely made up of instances of association to preceding reaction. table--san francisco... dark--comprehensible... music--sinking......... sickness--brooklyn..... man--woman............. deep--amazing.......... soft--pleasant......... eating--digesting...... mountain--gulf......... house--peninsula....... black--constantinople.. mutton--bermuda........ comfort--los angeles... hand--cuba............. short--cities.......... fruit--iowa............ butterfly--england..... smooth--russia......... command--turkey........ chair--manila.......... sweet--porto rico...... whistle--washington.... woman--cincinnati...... cold--pittsburg........ slow--philadelphia..... wish--milwaukee........ river--st. louis....... white--japan........... beautiful--china....... window--berlin......... rough--glasgow......... citizen--london........ foot--dublin........... spider--sacramento..... needle--texas.......... red--north carolina.... sleep--florida......... anger--seattle......... carpet--nevada......... girl--iowa............. high--virginia......... working--louisiana..... sour--hawaii........... earth--connecticut..... trouble--rhode island.. soldier--vermont....... cabbage--massachusetts. hard--hudson........... eagle--east river...... stomach--staten island. stem--kings park....... lamp--fort lee......... dream--long island..... yellow--greenport...... bread--southold........ justice--northport..... boy--new jersey........ light--rome............ health--italy.......... bible--episcopal....... memory--methodist...... sheep--congregational.. bath--baptist.......... cottage--minister...... swift--physician....... blue--horse............ hungry--cow............ priest--catholics....... ocean--lake............. head--bay............... stove--sound............ long--island............ religion--boston........ whiskey--harvard........ child--yale............. bitter--columbia........ hammer--library......... thirsty--carnegie....... city--rockefeller....... square--harriman........ butter--leggitt......... doctor--lincoln......... loud--roosevelt......... thief--taft............. lion--gaynor............ joy--slocum............. bed--grant.............. heavy--mcclellan........ tobacco--spain.......... baby--new london........ moon--newburgh.......... scissors--troy.......... quiet--schenectady...... green--lake george...... salt--vienna............ street--alsace lorraine. king--garfield.......... cheese--mckinley........ blossom--bryan.......... afraid--blaine.......... manic-depressive insanity. in this disorder the departures from the normal seem to be less pronounced than in the psychoses considered above. the number of individual reactions is in most cases not greatly above the normal average; and, so far as their character is concerned, we find that many of them are classed as normal, in accordance with the appendix to the frequency tables; among the unclassified reactions, which are quite frequent here, we find mostly either obviously normal ones, or some of the type to which we have already referred as "far-fetched," while others among them are "circumstantial" (see p. ); further we find that most of the remaining individual reactions fall into the general group of partial dissociation: non-specific reactions, sound reactions, word complements, and particles. in some cases the only abnormality that is found is that of an undue tendency to respond by non-specific reactions, most of them being common and there being no excessive number of individual reactions. it would seem legitimate to assume that this tendency is here to be regarded as a manifestation of the phenomenon which is clinically described as _dearth of ideas_. it is significant that this tendency is observed not only in depressive phases of the psychosis, but also in manic phases and even in the normal intervals of recurrent cases or after apparent recovery in acute cases; this will be seen from some of the test records which are here reproduced. occasionally cases are met with which give a large number of unclassified reactions, seemingly incoherent. there can be no doubt that at least some of these cases are clinically perfectly typical ones of manic-depressive insanity, yet the test records strongly resemble, in some respects, those of dementia præcox. since clinically the distinction between typical cases of these psychoses can be so clearly made on the basis of the disorders of the flow of thought respectively characterizing them, it could hardly be assumed that the associational disturbances in these two groups of cases are truly related, although there may be an apparent resemblance; it must be acknowledged that we are here confronted with one of the most serious shortcomings of the association test, or at least of the present method of applying it. case no. .--m.b. depressive attack. normal record. table--eat............ dark--night........... music--play........... sickness--death....... man--health........... deep--depth........... soft--hard............ eating--chewing....... mountain--high........ house--living......... black--color.......... mutton--sheep......... comfort--kind......... hand--body............ short--small.......... fruit--garden......... butterfly--spring..... smooth--rough......... command--obey......... chair--sit............ sweet--apple.......... whistle--music........ woman--land........... cold--chilly.......... slow--easy............ wish--want............ river--water.......... white--color.......... beautiful--grand...... window--light......... rough--smooth......... citizen--man.......... foot--body............ spider--animal........ needle--sew........... red--color............ sleep--rest........... anger--badness........ carpet--floor......... girl--young........... high--low............. working--busy......... sour--sweet........... earth--live........... trouble--grief........ soldier--army......... cabbage--garden....... hard--stone........... eagle--bird........... stomach--body......... stem--plant........... lamp--light........... dream--sleep.......... yellow--color......... bread--eat............ justice--kind......... boy--young............ light--day............ health--strength...... bible--christ......... memory--think......... sheep--mutton......... bath--clean........... cottage--live......... swift--run............ blue--color........... hungry--food.......... priest--clergy........ ocean--water.......... head--body............ stove--fire........... long--tall............ religion--teaching.... whiskey--drink........ child--young.......... bitter--sweet......... hammer--nail.......... thirsty--drink........ city--town............ square--four.......... butter--eat........... doctor--medicine...... loud--noise........... thief--steal.......... lion--beast........... joy--kind............. bed--sleep............ heavy--weight......... tobacco--smoke........ baby--mother.......... moon--light........... scissors--cut......... quiet--kind........... green--grass.......... salt--table........... street--walk.......... king--government...... cheese--eat........... blossom--tree......... afraid--coward........ case no. .--m.l. maniacal attack. fifteen individual reactions, of which are classed as normal in accordance with the appendix to the frequency tables. table--chair............ dark--light............. music--chorus........... sickness--health........ man--woman.............. deep--around............ soft--light............. eating--food............ mountain--valley........ house--flat............. black--white............ mutton--beef............ comfort--disease........ hand--legs.............. short--tall............. fruit--grapes........... butterfly--birds........ smooth--rough........... command--president...... chair--assemblyman...... sweet--bitter........... whistle--birds.......... woman--man.............. cold--warm.............. slow--fast.............. wish--well.............. river--mountain......... white--red.............. beautiful--heaven....... window--door............ rough--smooth........... citizen--naturalization. foot--hand.............. spider--bug............. needle--doctor.......... red--white.............. sleep--well............. anger--passion.......... carpet--cloth........... girl--boy............... high--low............... working--pleasure....... sour--sweet............. earth--heaven........... trouble--anger.......... soldier--mine........... cabbage--steak.......... hard--soft.............. eagle--parrot........... stomach--pelvis......... stem--flowers........... lamp--light............. dream--empty............ yellow--black........... bread--brown............ justice--done........... boy--baby............... light--heaven........... health--wealth.......... bible--love............. memory--remembrance..... sheep--goat............. bath--water............. cottage--house.......... swift--slow............. blue--green............. hungry--i............... priest--minister........ ocean--sea.............. head--neck.............. stove--electricity...... long--broad............. religion--presbyterian.. whiskey--medicinal...... child--boy.............. bitter--sweet........... hammer--saw............. thirsty--water.......... city--middletown........ square--madison......... butter--bread........... doctor--love............ loud--soft.............. thief--burglar.......... lion--animal............ joy--ecstasy............ bed--couch.............. heavy--lead............. tobacco--smoke.......... baby--boy............... moon--stars............. scissors--cotton........ quiet--noisy............ green--yellow........... salt--pepper............ street--dean............ king--god............... cheese--roquefort....... blossom--apple.......... afraid--never........... case no. .--j.n. depressive attack. only two individual reactions, both classed as normal; undue tendency to give non-specific reactions. table--cup............ dark--light........... music--song........... sickness--pain........ man--child............ deep--high............ soft--hard............ eating--tasting....... mountain--valley...... house--room........... black--white.......... mutton--lamb.......... comfort--peace........ hand--foot............ short--long........... fruit--apple.......... butterfly--moth....... smooth--rough......... command--obey......... chair--table.......... sweet--sour........... whistle--song......... woman--love........... cold--warm............ slow--fast............ wish--well............ river--water.......... white--black.......... beautiful--grand...... window--glass......... rough--smooth......... citizen--man.......... foot--hand............ spider--fly........... needle--thread........ red--blue............. sleep--rest........... anger--passion........ carpet--rug........... girl--child........... high--low............. working--labor........ sour--sweet........... earth--ground......... trouble--overcome..... soldier--brave........ cabbage--lettuce...... hard--soft............ eagle--bird........... stomach--heart........ stem--tree............ lamp--light........... dream--sleep.......... yellow--red........... bread--roll........... justice--peace........ boy--child............ light--sun............ health--wealth........ bible--good........... memory--good.......... sheep--lamb........... bath--water........... cottage--house........ swift--fast........... blue--white........... hungry--eat........... priest--man........... ocean--water.......... head--arm............. stove--warm........... long--short........... religion--good........ whiskey--none......... child--good........... bitter--sour.......... hammer--noise......... thirsty--water........ city--country......... square--round......... butter--salt.......... doctor--good.......... loud--noise........... thief--man............ lion--beast........... joy--good............. bed--good............. heavy--weight......... tobacco--smoke........ baby--child........... moon--sun............. scissors--knife....... quiet--rest........... green--red............ salt--water........... street--city.......... king--man............. cheese--butter........ blossom--flower....... afraid--fear.......... case no. .--w.h. recurrent attacks, mixed in character; at time of test patient was in a normal interval. individual reactions, of which is classed as normal, as a derivative, as non-specific, and as a sound reaction; undue tendency to give non-specific (common) reactions. table--comfort........ dark--darknew......... music--pleasure....... sickness--sorrow...... map--manners.......... deep--thought......... soft--comfort......... eating--pleasure...... mountain--height...... house--comfort........ black--darkness....... mutton--eating........ comfort--pleasure..... hand--useful.......... short--stumpy......... fruit--eating......... butterfly--handsome... smooth--plane......... command--ordering..... chair--easy........... sweet--candy.......... whistle--noise........ woman--love........... cold--freezing........ slow--laziness........ wish--good............ river--water.......... white--clearness...... beautiful--handsome... window--scene......... rough--harshness...... citizen--voting....... foot--stepping........ spider--poison........ needle--sharpness..... red--blood............ sleep--comfort........ anger--passion........ carpet--walking....... girl--lovely.......... high--height.......... working--business..... sour--tart............ earth--planting....... trouble--sorrow....... soldier--fighting..... cabbage--eating....... hard--harshness....... eagle--flying......... stomach--eating....... stem--vine............ lamp--lighting........ dream--pleasure....... yellow--color......... bread--eating......... justice--suing........ boy--children......... light--seeing......... health--pleasure...... bible--thinking....... memory--recollections. sheep--wool........... bath--pleasure........ cottage--living....... swift--quickness...... blue--sky............. hungry--pleasure...... priest--holiness...... ocean--sailing........ head--thinking........ stove--warmth......... long--length.......... religion--holiness.... whiskey--badness...... child--pleasure....... bitter--sourness...... hammer--pounding...... thirsty--drinking..... city--town............ square--measure....... butter--greasy........ doctor--medicine...... loud--hearing......... thief--stealing....... lion--fierceness...... joy--pleasure......... bed--sleeping......... heavy--solid.......... tobacco--pleasure..... baby--loveliness...... moon--bright.......... scissors--sharpness.... quiet--pleasure....... green--color.......... salt--taste........... street--walking....... king--majestic......... cheese--eating........ blossom--handsome..... afraid--fear.......... case no. .--a.f. maniacal attack; at time of test patient had improved, though not recovered. non-specific reactions; particles. (patient does not speak english with perfect fluency.) table--board.......... dark--night........... music--piano.......... sickness--appendicitis man--husband.......... deep--hole............ soft--hard............ eating--vegetable..... mountain--country..... house--comfort........ black--cotton......... mutton--lamb.......... comfort--rest......... hand--arm............. short--journey........ fruit--apples......... butterfly--love....... smooth--nice.......... command--order........ chair--down........... sweet--sugar.......... whistle--blow......... woman--good........... cold--ice............. slow--lazy............ wish--home............ river--boat........... white--milk........... beautiful--flowers.... window--corner........ rough--man............ citizen--not.......... foot--short........... spider--don't......... needle--steel......... red--rose............. sleep--well........... anger--not............ carpet--beauty........ girl--love............ high--reason.......... working--dress........ sour--vinegar......... earth--ground......... trouble--much......... soldier--blue......... cabbage--sour......... hard--no.............. eagle--paper.......... stomach--well......... stem--flower.......... lamp--light........... dream--awful.......... yellow--flower........ bread--rye............ justice--court........ boy--little........... light--room........... health--love.......... bible--no............. memory--good.......... sheep--lot............ bath--cold............ cottage--little....... swift--kick........... blue--no.............. hungry--no............ priest--love.......... ocean--grove.......... head--black........... stove--shine.......... long--square.......... religion--no.......... whiskey--champagne.... child--my............. bitter--pepper........ hammer--knock......... thirsty--no........... city--new york........ square--table......... butter--good.......... doctor--s............. loud--talk............ thief--night.......... lion--yes............. joy--good............. bed--comfort.......... heavy--iron........... tobacco--strong....... baby--love............ moon--shine........... scissors--cut........ quiet--well........... green--bow............ salt--hitter.......... street--hinsdale...... king--franz joseph.... cheese--swiss......... blossom--nice......... afraid--no............ case no. .--e.m. circular insanity of over twenty years' standing; at time of test patient was in a manic phase. non-specific reactions; doubtful reactions; neologisms, all possessing obvious meaning. table--using.......... dark--unbright........ music--songs.......... sickness--catching.... man--masculine........ deep--high............ soft--chew............ eating--sometimes..... mountain--highlands... house--live........... black--color.......... mutton--meat.......... comfort--easy......... hand--body............ short--unlongly....... fruit--plants......... butterfly--insects.... smooth--feeling....... command--do........... chair--use............ sweet--taste.......... whistle--act.......... woman--female......... cold--acting.......... slow--gradually....... wish--desire.......... river--water.......... white--color.......... beautiful--niceness... window--built......... rough--treatment...... citizen--country...... foot--body............ spider--insect........ needle--article....... red--color............ sleep--tiredness...... anger--scolding....... carpet--article....... girl--female.......... high--low............. working--do........... sour--tasting......... earth--surface........ trouble--worriment.... soldier--man.......... cabbage--vegetable.... hard--difficult....... eagle--bird........... stomach--body......... stem--article......... lamp--article......... dream--untruly........ yellow--color......... bread--food........... justice--unfairly..... boy--masculine........ light--easy........... health--sickness...... bible--commandments... memory--remember...... sheep--animal......... bath--cleanness....... cottage--country...... swift--quickly........ blue--color........... hungry--food.......... priest--masculine..... ocean--water.......... head--body............ stove--article........ long--shortly......... religion--bible....... whiskey--drinking..... child--disremembering. bitter--taste......... hammer--using......... thirsty--drinking..... city--acting.......... square--measuring..... butter--food.......... doctor--helping....... loud--hearing......... thief--untrue......... lion--animal.......... joy--gladness......... bed--lying............ heavy--unlightly...... tobacco--using........ baby--borning......... moon--sending......... scissors--using....... quiet--acting......... green--color.......... salt--food............ street--walking....... king--person.......... cheese--food.......... blossom--plant........ afraid--frightened.... case no. .--a.b. maniacal attack. individual reactions, of which are classed as normal, are sound reactions ( sound neologisms), word complement, particles, and unclassified reactions most of which are either obviously normal or "far fetched" but not strictly incoherent. table--mahogany....... dark--green........... music--masonic........ sickness--seasickness. man--maternity........ deep--well............ soft--silk............ eating--cleanliness... mountain--gibraltar... house--bungalow....... black--light.......... mutton--lamb.......... comfort--linen........ hand--left............ short--shorthand...... fruit--pears.......... butterfly--canary..... smooth--linen......... command--pilot........ chair--round.......... sweet--sugar.......... whistle--mother....... woman--twenty-one..... cold--ice............. slow--music........... wish--girl............ river--hudson......... white--plaster........ beautiful--nature..... window--st. patrick's. rough--blankets....... citizen--twenty-one... foot--six............. spider--fly........... needle--tailor........ red--herald........... sleep--seven.......... anger--angoria........ carpet--green......... girl--eighteen........ high--school.......... working--ten.......... sour--kraut........... earth--round.......... trouble--son.......... soldier--navy......... cabbage--curly........ hard--stone........... eagle--almanac........ stomach--stomjack..... stem--maple........... lamp--new.....york.... dream--husband........ yellow--cards......... bread--rye............ justice--liberty...... boy--joe.............. light--white.......... health--death......... bible--holy........... memory--seven......... sheep--lamb........... bath--cleanliness..... cottage--gray......... swift--ball........... blue--balloon......... hungry--yes........... priest--doctor........ ocean--niagara........ head--rest............ stove--stationary..... long--poems........... religion--catholic.... whiskey--hunter....... child--jesus.......... bitter--gall.......... hammer--steel......... thirsty--water........ city--new york........ square--union......... butter--sweet......... doctor--s............. loud--discreet........ thief--night.......... lion--bostock......... joy--joy line......... bed--ostermoor........ heavy--iron........... tobacco--durham....... baby--rose............ moon--half............ scissors--steel....... quiet--nursing........ green--grass.......... salt--rock............ street--liberty....... king--alphonso........ cheese--swiss......... blossom--apple........ afraid--dark.......... case no. .--u.b. maniacal attack. persistent use of particles _oh, me, i, none,_ etc. table--none........... dark--red............. music--stock.......... sickness--rose........ man--frank............ deep--blue............ soft--pillow.......... eating--no............ mountain--oyster...... house--mercy.......... black--mother......... mutton--me............ comfort--home......... hand--mother.......... short--me............. fruit--me............. butterfly--it......... smooth--oh............ command--none......... chair--none........... sweet--for............ whistle--bird......... woman--i.............. cold--i............... slow--me.............. wish--none............ river--are............ white--wife........... beautiful--alma....... window--stephen....... rough--rudolphia...... citizen--father....... foot--anthon.......... spider--reverend...... needle--pine.......... red--brother.......... sleep--adam........... anger--i.............. carpet--home.......... girl--agatha.......... high--niece........... working--i............ sour--i............... earth--i.............. trouble--i............ soldier--father....... cabbage--hail......... hard--me.............. eagle--i.............. stomach--i............ stem--life............ lamp--lambert......... dream--i.............. yellow--i............. bread--i.............. justice--i............ boy--just............. light--picture........ health--cook.......... bible--beads.......... memory--dick.......... sheep--to............. bath--none............ cottage--home......... swift--lazy........... blue--nell............ hungry--i............. priest--i............. ocean--i.............. head--home............ stove--home........... long--short........... religion--none........ whiskey--none......... child--sylvester...... bitter--i............. hammer--my............ thirsty--no........... city--no.............. square--ben........... butter--i............. doctor--i............. loud--bell............ thief--iron........... lion--i............... joy--i................ bed--i................ heavy--i.............. tobacco--i............ baby--i............... moon--will............ scissors--beads....... quiet--nerves......... green--i.............. salt--i............... street--peter......... king--i............... cheese--i............. blossom--i............ afraid--no............ case no. .--a.r. maniacal attack. unusual number of doubtful reactions; individual reactions of which are classed as normal; are unclassified, some seemingly incoherent. table--chicago........ dark--montreal........ music--mississippi.... sickness--flowers..... man--ocean............ deep--medicines....... soft--accidental...... eating--vaccination... mountain--evergreens.. house--caves.......... black--station........ mutton--operations.... comfort--money........ hand--bandages........ short--soldiers....... fruit--dictionary..... butterfly--storehouse. smooth--vegetables.... command--bible........ chair--histories...... sweet--farewells...... whistle--ammunition... woman--foreign........ cold--armory.......... slow--st. petersburg.. wish--wealth.......... river--revenue........ white--purity......... beautiful--colonial... window--shutters...... rough--planes......... citizen--naturalization foot--carriage........ spider--remedies...... needle--canoe......... red--refreshments..... sleep--restfulness.... anger--usefulness..... carpet--coach......... girl--finery.......... high--fortifications.. working--materials.... sour--pickles......... earth--gravitation.... trouble--graphophone.. soldier--guns......... cabbage--children..... hard--inheritance..... eagle--feathers....... stomach--envelope..... stem--roots........... lamp--oil............. dream--fairies........ yellow--lemons........ bread--jams........... justice--repentance... boy--clothes.......... light--lanterns....... health--joys.......... bible--heaven......... memory--head.......... sheep--pastures....... bath--cleanliness..... cottage--home......... swift--rapids......... blue--truth........... hungry--appetite...... priest--saintliness... ocean--ships.......... head--intelligence.... stove--woods.......... long--trains.......... religion--godliness... whiskey--drunkenness.. child--joyfulness..... bitter--olives........ hammer--nuts.......... thirsty--water........ city--shopping........ square--monuments..... butter--crackers...... doctor--medicines..... loud--music........... thief--detectives..... lion--cages........... joy--home............. bed--restfulness...... heavy--expressage..... tobacco--cigars....... baby--carriage........ moon--light........... scissors--goods....... quiet--peacefulness... green--vegetables..... salt--water........... street--stones........ king--crown........... cheese--knife......... blossom--plants....... afraid--enemies....... case no. .--c.g. depressive attack. individual reactions of which are classed as normal and as unclassified; among the latter several seem to be incoherent table--fish........... dark--boat............ music--water.......... sickness--tank........ man--horse............ deep--ocean........... soft--egg............. eating--beans......... mountain--grass....... house--roof........... black--bath........... mutton--butcher....... comfort--cigar........ hand--shoes........... short--baseball....... fruit--orange......... butterfly--elephant... smooth--glass......... command--general...... chair--kitchen........ sweet--cake........... whistle--bird......... woman--door........... cold--ice............. slow--cat............. wish--bed............. river--trout.......... white--paint.......... beautiful--monkey..... window--bars.......... rough--rowdy.......... citizen--policeman.... foot--fine............ spider--insect........ needle--sewing........ red--man.............. sleep--pond........... anger--hatred......... carpet--tacks......... girl--floor........... high--mountain........ working--dog.......... sour--milk............ earth--mud............ trouble--radiator..... soldier--cannon....... cabbage--vegetable.... hard--wood............ eagle--quick.......... stomach--flesh........ stem--pipe............ lamp--burn............ dream--thinking....... yellow--mice.......... bread--baker.......... justice--equality..... boy--young............ light--green.......... health--art........... bible--preacher....... memory--return........ sheep--fold........... bath--water........... cottage--house........ swift--fleeting....... blue--dark............ hungry--thirst........ priest--elephant...... ocean--briny.......... head--hard............ stove--black.......... long--grass........... religion--thinking.... whiskey--kentucky..... child--carriage....... bitter--pickles....... hammer--nails......... thirsty--wanting...... city--new york........ square--base.......... butter--cow........... doctor--carriage...... loud--hall............ thief--prison......... lion--cage............ joy--automobile....... bed--iron............. heavy--lead........... tobacco--weed......... baby--rocker.......... moon--sky............. scissors--laundry..... quiet--peaceful....... green--engine......... salt--grocer.......... street--lincoln....... king--spain........... cheese--baker......... blossom--flower....... afraid--going......... involutional melancholia; alcoholic dementia; senile dementia. there are so few cases of these psychoses in our series that we can say but little concerning their associational disorders. in table v. we show all the types of reactions given by each subject. we have not observed in our cases of _involutional melancholia_ any undue tendency to give individual reactions. the records are either perfectly normal or slightly abnormal in that they show an increase of the non-specific (common) reactions. in this respect they resemble strongly the records obtained from some cases of manic-depressive insanity. this similarity is of interest in connection with other evidence, recently brought to light, [ ] showing that involutional melancholia is closely related to manic-depressive insanity, if not identical with it. [footnote : g. l. dreyfus. die melancholic ein zustandsbild des manisch-depressiven irreseins. .] table v. +-----------------------+-----------------+-----------+ | involutional | alcoholic | senile | | melancholia | dementia | dementia | +--+--+--+--+--+--+--+--+--+--+--+--+--+--+--+--+--+--+ | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | case no.--| | | | | | | | | | | | | | | | | | | types of reaction | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | +--+--+--+--+--+--+--+--+--+--+--+--+--+--+--+--+--+--+ _common reactions:_ | | | | | | | | | | | | | | | | | | | specific reactions................| | | | | | | | | | | | | | | | | | | non-specific reactions............| | | | | | | | | | | | | | | | |..| | | | | | | | | | | | | | | | | | | | | _doubtful reactions_................| | | | | | | | | | | | | | |..| |..|..| | | | | | | | | | | | | | | | | | | | _individual reactions:_ | | | | | | | | | | | | | | | | | | | normal reactions..................|..| | | |..| | | | | | | | | | | | | | derivatives of stimulus words.....|..|..|..|..|..|..|..|..|..|..|..|..|..|..|..| | |..| non-specific reactions............|..|..|..|..|..|..| |..|..|..|..|..|..|..| | |..|..| sound reactions (words)...........|..|..|..| |..| |..|..|..|..|..|..|..|..|..|..|..|..| sound reactions (neologisms)......|..|..|..|..|..|..|..|..|..|..|..|..|..|..|..|..|..|..| word complements..................|..|..|..|..|..|..| |..|..|..|..|..|..|..|..|..|..|..| particles of speech...............|..|..|..|..|..|..| | |..|..|..|..|..| | | |..| | association to preceding stimulus.|..|..|..|..| |..| |..|..|..| |..|..|..|..| |..|..| association to preceding reaction.|..|..|..|..|..|..|..|..|..|..|..|..|..|..|..|..|..| | repetition of preceding stimulus..|..|..|..|..|..|..|..|..|..|..|..|..|..|..|..|..|..| | repetition of previous stimulus...|..|..|..|..|..|..| |..|..|..|..|..| |..|..|..|..|..| repetition of preceding reaction..|..|..|..| |..|..|..|..|..|..|..|..|..| |..|..|..| | repetition of previous reaction...|..|..|..|..| |..| |..| |..|..|..| | | | | | | reaction repeated five times......|..|..|..|..| |..|..|..|..| | | |..| |..|..|..| | neologisms without sound relation.|..|..|..|..|..| | |..|..|..|..|..|..|..|..|..|..|..| unclassified......................|..| | |..| | | | |..| | | | | | | | | | +--+--+--+--+--+--+--+--+--+--+--+--+--+--+--+--+--+--+ total individual reactions case no. .--s.m. normal record. table--wood............. dark--black............. music--noise............ sickness--illness....... man--being.............. deep--depth............. soft--mushy............. eating--devouring....... mountain--hill.......... house--residence........ black--color............ mutton--meat............ comfort--luxury......... hand--body.............. short--abrupt........... fruit--oranges.......... butterfly--insect....... smooth--even............ command--order.......... chair--article.......... sweet--taste............ whistle--noise.......... woman--sex.............. cold--temperature....... slow--dull.............. wish--desire............ river--water............ white--color............ beautiful--sky.......... window--glass........... rough--uneven........... citizen--representative. foot--end............... spider--insect.......... needle--instrument...... red--color.............. sleep--repose........... anger--temper........... carpet--rug............. girl--sex............... high--elevation......... working--employment..... sour--bitter............ earth--clay............. trouble--anxiety........ soldier--military....... cabbage--vegetable...... hard--substance......... eagle--bird............. stomach--body........... stem--flower............ lamp--light............. dream--imagination...... yellow--color........... bread--wheat............ justice--credit......... boy--child.............. light--sun.............. health--condition....... bible--book............. memory--remembrance..... sheep--lamb............. bath--bathing........... cottage--house.......... swift--rapid............ blue--color............. hungry--desire.......... priest--minister........ ocean--water............ head--body.............. stove--fire............. long--distance.......... religion--creed......... whiskey--liquor......... child--infant........... bitter--sour............ hammer--tool............ thirsty--dry............ city--town.............. square--block........... butter--food............ doctor--physician....... loud--noisy............. thief--burglar.......... lion--animal............ joy--happiness.......... bed--cot................ heavy--weight........... tobacco--weed........... baby--infant............ moon--light............. scissors--instrument.... quiet--noiseless........ green--color............ salt--seasoning......... street--block........... king--ruler............. cheese--food............ blossom--flower......... afraid--fear............ case no. .--t.s. no individual reactions; non-specific reactions. table--furniture...... dark--color........... music--fiddle......... sickness--bed......... man--person........... deep--water........... soft--pliable......... eating--cake.......... mountain--high........ house--bricks......... black--color.......... mutton--meat.......... comfort--easy......... hand--limb............ short--small.......... fruit--vegetable...... butterfly--insect..... smooth--level......... command--control...... chair--sit............ sweet--nice........... whistle--noise........ woman--person......... cold--atmosphere...... slow--easy............ wish--something....... river--stream......... white--color.......... beautiful--nice....... window--glass......... rough--unpleasant..... citizen--person....... foot--limb............ spider--insect........ needle--instrument.... red--color............ sleep--bed............ anger--irritable...... carpet--rug........... girl--person.......... high--elevation....... working--try.......... sour--bitter.......... earth--sand........... trouble--anxiety...... soldier--person....... cabbage--plant........ hard--stone........... eagle--bird........... stomach--person....... stem--apple........... lamp--light........... dream--sleep.......... yellow--color......... bread--flour.......... justice--equal........ boy--child............ light--gas............ health--doctor........ bible--scripture...... memory--thought....... sheep--animal......... bath--water........... cottage--house........ swift--quick.......... blue--color........... hungry--want.......... priest--preach........ ocean--water.......... head--person.......... stove--heat........... long--length.......... religion--belief...... whiskey--drink........ child--person......... bitter--sour.......... hammer--tool.......... thirsty--dry.......... city--place........... square--shape......... butter--eat........... doctor--physician..... loud--hear............ thief--steal.......... lion--animal.......... joy--glad............. bed--sleep............ heavy--weight......... tobacco--plant........ baby--child........... moon--light........... scissors--tool........ quiet--rest........... green--color.......... salt--spice........... street--place......... king--ruler........... cheese--eat........... blossom--flower....... afraid--hide.......... case no. .--a.w.s. individual reactions; non-specific reactions. table--stand.......... dark--color........... music--happy.......... sickness--ill......... man--human............ deep--thought......... soft--touch........... eating--appetite...... mountain--ground...... house--shelter........ black--color.......... mutton--lamb.......... comfort--warm......... hand--touch........... short--small.......... fruit--taste.......... butterfly--beauty..... smooth--level......... command--obey......... chair--rest........... sweet--good........... whistle--noise........ woman--female......... cold--chilled......... slow--move............ wish--think........... river--water.......... white--color.......... beautiful--nice....... window--glass......... rough--push........... citizen--man.......... foot--body............ spider--insect........ needle--pointed....... red--blood............ sleep--rest........... anger--riled.......... carpet--covering...... girl--child........... high--air............. working--ambitious.... sour--taste........... earth--ground......... trouble--thought...... soldier--command...... cabbage--vegetable.... hard--blow............ eagle--bird........... stomach--body......... stem--pipe............ lamp--light........... dream--thought........ yellow--purple........ bread--food........... justice--law.......... boy--male............. light--lamp........... health--soul.......... bible--scriptures..... memory--thought....... sheep--lamb........... bath--cleanness....... cottage--house........ swift--quick.......... blue--color........... hungry--appetite...... priest--scholar....... ocean--water.......... head--brains.......... stove--heat........... long--measurement..... religion--good........ whiskey--alcohol...... child--baby........... bitter--taste......... hammer--knock......... thirsty--water........ city--new york........ square--box........... butter--milk.......... doctor--help.......... loud--noise........... thief--burglar........ lion--animal.......... joy--well............. bed--rest............. heavy--load........... tobacco--nicotine..... baby--joy............. moon--light........... scissors--cutting..... quiet--rest........... green--color.......... salt--sand............ street--crossing...... king--ruler........... cheese--luxury........ blossom--flower....... afraid--fright........ case no. . j.d. individual reactions, of which are classed as normal, particle, unclassified, mostly obviously normal. table--eating......... dark--night........... music--amusement...... sickness--distress.... man--working.......... deep--sorrow.......... soft--easy............ eating--supper........ mountain--pleasure.... house--home........... black--grief.......... mutton--butchers...... comfort--home......... hand--shake........... short--baseball....... fruit--eating......... butterfly--field...... smooth--soft.......... command--oblige....... chair--seat........... sweet--flowers........ whistle--fire......... woman--home........... cold--winter.......... slow--easy............ wish--home............ river--dock........... whiter--day........... beautiful--handsome... window--glass......... rough--wagon.......... citizen--voter........ foot--walking......... spider--web........... needle--sticking...... red--danger........... sleep--rest........... anger--right.......... carpet--house......... girl--out............. high--air............. working--labor........ sour--bitter.......... earth--ground......... trouble--worry........ soldier--man.......... cabbage--farmer....... hard--bath............ eagle--birds.......... stomach--body......... stem--pipe............ lamp--burn............ dream--thinking....... yellow--color......... bread--eating......... justice--peace........ boy--soldier.......... light--day............ health--happy......... bible--books.......... memory--good.......... sheep--lamb........... bath--washing......... cottage--house........ swift--quick.......... blue--color........... hungry--eating........ priest--church........ ocean--bathing........ head--mind............ stove--fire........... long--hours........... religion--church...... whiskey--drinking..... child--home........... bitter--sour.......... hammer--working....... thirsty--dry.......... city--new york........ square--block......... butter--cow........... doctor--hospital...... loud--speaking........ thief--sentence....... lion--animal.......... joy--pleasure......... bed--sleeping......... heavy--weight......... tobacco--smoking...... baby--home............ moon--night........... scissors--cutting..... quiet--alone.......... green--color.......... salt--eating.......... street--walking....... king--william......... cheese--milk.......... blossom--flower....... afraid--fright........ our cases of _alcoholic_ dementia are clinically without evidences of disturbance of flow of thought. the dementia consists mainly in impairment or loss of the power of retention, with resulting amnesia for recent occurrences, and temporal disorientation. the records are either normal or show but slight departures from normal. case no. .--j.s. slight deterioration. table--eat............ dark--night........... music--enjoyment...... sickness--sadness..... man--work............. deep--hole............ soft--feathers........ eating--appetite...... mountain--hill........ house--live........... black--dark........... mutton--eat........... comfort--pleasant..... hand--work............ short--story.......... fruit--eat............ butterfly--annoyance.. smooth--iron.......... command--officer...... chair--sit............ sweet--nice........... whistle--pleasure..... woman--pleasure....... cold--annoyance....... slow--car............. wish--like............ river--water.......... white--sack........... beautiful--house...... window--look.......... rough--unpleasant..... citizen--man.......... foot--walk............ spider--annoyance..... needle--sticking...... red--color............ sleep--happy.......... anger--annoyance...... carpet--walk.......... girl--school.......... high--skies........... working--labor........ sour--lemon........... earth--walk........... trouble--annoyance.... soldier--army......... cabbage--eat.......... hard--stone........... eagle--fly............ stomach--victuals..... stem--pipe............ lamp--burn............ dream--sleep.......... yellow--orange........ bread--eat............ justice--person....... boy--school........... light--see............ health--comfort....... bible--read........... memory--recollection.. sheep--eat............ bath--cleanness....... cottage--live......... swift--go............. blue--color........... hungry--eat........... priest--confession.... ocean--vessels........ head--knowledge....... stove--burn........... long--time............ religion--faith....... whiskey--drink........ child--infant......... bitter--unkind........ hammer--nail.......... thirsty--dry.......... city--inhabitants..... square--brick......... butter--eat........... doctor--cure.......... loud--noise........... thief--steal.......... lion--animal.......... joy--happiness........ bed--lay.............. heavy--feeling........ tobacco--chew......... baby--nurse........... moon--bright.......... scissors--cut......... quiet--ease........... green--flower......... salt--taste........... street--walking....... king--control......... cheese--eat........... blossom--flower....... afraid--nervousness... case no. .--j.r. marked deterioration. table--mahogany....... dark--dawn............ music--harp........... sickness--none........ man--white............ deep--unfathomable.... soft--silken.......... eating--good.......... mountain--high........ house--place.......... black--color.......... mutton--cooked........ comfort--rest......... hand--clasp........... short--small.......... fruit--apples......... butterfly--buttercups. smooth--iron.......... command--home......... chair--ebony.......... sweet--potatoes....... whistle--song......... woman--pretty......... cold--depressed....... slow--process......... wish--home............ river--mississippi.... white--wings.......... beautiful--palace..... window--clear......... rough--no............. citizen--patriot...... foot--heath........... spider--none.......... needle--darning....... red--apples........... sleep--plenty......... anger--mistake........ carpet--floor......... girl--pretty.......... high--ordinary........ working--eight........ sour--nonsense........ earth--fruits......... trouble--little....... soldier--patriot...... cabbage--garden....... hard--wood............ eagle--high........... stomach--leave........ stem--stalk........... lamp--kerosene........ dream--happy.......... yellow--aster......... bread--white.......... justice--right........ boy--white............ light--white.......... health--good.......... bible--puzzled........ memory--bad........... sheep--cheviot........ bath--marble.......... cottage--story........ swift--fast........... blue--waist........... hungry--not........... priest--confessor..... ocean--pacific........ head--oval............ stove--polish......... long--forever......... religion--protestant.. whiskey--none......... child--none........... bitter--sweet......... hammer--no............ thirsty--no........... city--new york........ square--compass....... butter--sweet......... doctor--cure.......... loud--quietly......... thief--jail........... lion--brave,.......... joy--peacefulness..... bed--good............. heavy--no............. tobacco--yes.......... baby--none............ moon--shines.......... scissors--uncut....... quiet--peaceful....... green--grass.......... salt--water........... street--queen......... king--unknown......... cheese--stilton....... blossom--cherry....... afraid--not........... we reproduce in full the record obtained from one of our cases of _senile dementia._ case no. .--e.s. table--cat............ dark--night........... music--cat............ sickness--cat......... man--mouse............ deep--well............ soft--sack............ eating--well.......... mountain--hill........ house--castle......... black--dog............ mutton--sheep......... comfort--lamb......... hand--chicken......... short--light.......... fruit--apple.......... butterfly--fly........ smooth--iron.......... command--obey......... chair--stool.......... sweet--sugar.......... whistle--lump......... woman--man............ cold--shiver.......... slow--cold............ wish--push............ river--pond........... white--cat............ beautiful--cat........ window--glass......... rough--fight.......... citizen--tough........ foot--shoe............ spider--clock......... needle--pin........... red--white............ sleep--eyes........... anger--mad............ carpet--cloth......... girl--boy............. high--low............. working--sewing....... sour--sweet........... earth--clay........... trouble--child........ soldier--man.......... cabbage--spinach...... hard--cat............. eagle--bird........... stomach--belly........ stem--pike............ lamp--globe........... dream--eyes........... yellow--flower........ bread--flour.......... justice--fight........ boy--cat.............. light--lamp........... health--cough......... bible--book........... memory--mind.......... sheep--lamb........... bath--water........... cottage--house........ swift--quick.......... blue--color........... hungry--eat........... priest--clergyman..... ocean--river.......... head--life............ stove--fire........... long--short........... religion--catholic.... whiskey--drink........ child--boy............ bitter--sweet......... hammer--noise......... thirsty--drink........ city--new york........ square--marion........ butter--cow........... doctor--w............. loud--noise........... thief--steals......... lion--heart........... joy--happy............ bed--mattress......... heavy--lead........... tobacco--smoke........ baby--boy............. moon--shine........... scissors--cut......... quiet--noisy.......... green--color.......... salt--bitter.......... street--place......... king--rule............ cheese--taste......... blossom--flower....... afraid--trouble....... § . pathological reactions from normal subjects. mental disorders do not always so manifest themselves as to incapacitate the subject for his work or to necessitate his sequestration in a hospital for the insane. it is, therefore, not surprising that in applying the association test to over a thousand subjects selected at random we have obtained a small number of test records which show various types of abnormal reactions. among the subjects who furnished such records some are described as eccentric, taciturn, or dull, while others are apparently normal but come of neuropathic stock. a few of them are persons wholly unknown to us. we reproduce in full from the normal series, containing abnormal reactions. consecutive no. .--state hospital attendant efficient in his work but is generally regarded to have married very foolishly. sound reactions; numerous unclassified reactions. table--brought........ dark--some............ music--leaf........... sickness--water....... man--book............. deep--desk............ soft--ground.......... eating--bark.......... mountain--tree........ house--paper.......... black--light.......... mutton--horse......... comfort--hat.......... hand--sick............ short--swallow........ fruit--mass........... butterfly--leaf....... smooth--wing.......... command--man.......... chair--left........... sweet--sick........... whistle--whirl........ woman--where.......... cold--coal............ slow--some............ wish--whirl........... river--rice........... white--waist.......... beautiful--brought.... window--women......... rough--row............ citizen--sir.......... foot--fall............ spider--spice......... needle--knee.......... red--roam............. sleep--sorrow......... anger--august......... carpet--covered....... girl--great........... high--his............. working--map.......... sour--slur............ earth--eat............ trouble--through...... soldier--solder....... cabbage--cart......... hard--him............. eagle--earth.......... stomach--stall........ stem--stair........... lamp--left............ dream--dread.......... yellow--waist......... bread--book........... justice--gem.......... boy--bird............. light--left........... health--heart......... bible--base........... memory--moth.......... sheep--shrill......... bath--bend............ cottage--cart......... swift--swell.......... blue--beard........... hungry--heart......... priest--path.......... ocean--oar............ head--him............. stove--still.......... long--left............ religion--rest........ whiskey--whirl........ child--charge......... bitter--bought........ hammer--hemp.......... thirsty--thursday..... city--salt............ square--squirrel...... butter--bread......... doctor--daisy......... loud--lark............ thief--twist.......... lion--lesson.......... joy--jar.............. bed--beard............ heavy--health......... tobacco--toboggan..... baby--bird............ moon--mill............ scissors--setters..... quiet--quart.......... green--great.......... salt--sorrow.......... street--stem.......... king--cart............ cheese--chart......... blossom--bed.......... afraid--frill......... consecutive no. --laundryman in state hospital. nothing abnormal has ever been observed in his case. numerous perseverations. table--house.......... dark--range........... music--eats........... sickness--dog......... man--barn............. deep--hollow.......... soft--apple........... eating--cranberry..... mountain--water....... house--pig............ black--rats........... mutton--mice.......... comfort--sheep........ hand--lamb............ short--birds.......... fruit--peach.......... butterfly--pears...... smooth--grapes........ command--nut.......... chair--bureau......... sweet--broom.......... whistle--violin....... woman--man............ cold--child........... slow--infant.......... wish--night........... river--dark........... white--steamboat...... beautiful--tugboat.... window--yacht......... rough--ferry.......... citizen--water........ foot--egg............. spider--fly........... needle--thread........ red--spool............ sleep--machine........ anger--picture........ carpet--bed........... girl--bureau.......... high--oilcloth........ working--pen.......... sour--ink............. earth--paper.......... trouble--chair........ soldier--table........ cabbage--beet......... hard--cauliflower..... eagle--potatoes....... stomach--beans........ stem--plum............ lamp--wick............ dream--oil............ yellow--stick......... bread--stone.......... justice--dirt......... boy--street........... light--match.......... health--sickness...... bible--book........... memory--leaf.......... sheep--wool........... bath--water........... cottage--people....... swift--fast........... blue--residence....... hungry--beef.......... priest--clergyman..... ocean--rice........... head--eyes............ stove--nose........... long--mouth........... religion--legs........ whiskey--arms......... child--elbows......... bitter--day........... hammer--nails......... thirsty--saw.......... city--plane........... square--chisel........ butter--file.......... doctor--duck.......... loud--goose........... thief--robber......... lion--tiger........... joy--bear............. bed--leopard.......... heavy--tiger.......... tobacco--smoke........ baby--pipe............ moon--star............ scissors--sharp....... quiet--noisy.......... green--blue........... salt--yellow.......... street--green......... king--purple.......... cheese--axe........... blossom--handle....... afraid--barn.......... consecutive no. .--state hospital attendant. efficient, but unusually taciturn and seclusive. sound reactions. table--linen.......... dark--sunshine........ music--song........... sickness--saturday.... man--manager.......... deep--dark............ soft--sorrowful....... eating--eighty........ mountain--miner....... house--heart.......... black--blue........... mutton--mountain...... comfort--company...... hand--happy........... short--slow........... fruit--froth.......... butterfly--butter..... smooth--smoke......... command--company...... chair--chap........... sweet--slow........... whistle--whip......... woman--worried........ cold--cow............. slow--slap............ wish--water........... river--rubbed......... white--wash........... beautiful--bounty..... window--light......... rough--roguish........ citizen--sight-seeing. foot--fool............ spider--span.......... needle--work.......... red--robe............. sleep--soap........... anger--angel.......... carpet--carriage...... girl--guide........... high--heart........... working--worthy....... sour--satchel......... earth--early.......... trouble--trout........ soldier--socket....... cabbage--currant...... hard--harmful......... eagle--early.......... stomach--stable....... stem--stand........... lamp--light........... dream--drunk.......... yellow--lustre........ bread--brand.......... justice--judgment..... boy--butter........... light--love........... health--help.......... bible--book........... memory--mental........ sheep--shop........... bath--bandage......... cottage--cot.......... swift--swan........... blue--black........... hungry--height........ priest--house......... ocean--apple.......... head--heart........... stove--strap.......... long--love............ religion--belief...... whiskey--whisk broom.. child--chap........... bitter--butter........ hammer--habit......... thirsty--thirty....... city--soap............ square--squirrel...... butter--bank.......... doctor--dentist....... loud--laugh........... thief--thump.......... lion--lump............ joy--jump............. bed--bank............. heavy--happy.......... tobacco--tub.......... baby--bundle.......... moon--mantle.......... scissors--saturday.... quiet--quarter........ green--drought........ salt--saturday........ street--straight...... king--cattle.......... cheese--captain....... blossom--bandage...... afraid--flattered..... consecutive no. .--nothing abnormal has ever been suspected in the case of this subject; mother eccentric; sister insane. sound reactions. table--stable......... dark--dreary.......... music--joy............ sickness--silliness... man--manner........... deep--dreary.......... soft--sooth........... eating--evening....... mountain--morning..... house--help........... black--dark........... mutton--mitten........ comfort--come......... hand--handsome........ short--small.......... fruit--first.......... butterfly--butter..... smooth--sooth......... command--come......... chair--air............ sweet--good........... whistle--music........ woman--wonder......... cold--freezing........ slow--snow............ wish--wind............ river--riffle......... white--wait........... beautiful--handsome... window--light......... rough--harsh.......... citizen--city......... foot--walk............ spider--creep......... needle--needless...... red--color............ sleep--sleet.......... anger--rough.......... carpet--carpenter..... girl--going........... high--air............. working--toiling...... sour--shower.......... earth--eating......... trouble--loneliness... soldier--solid........ cabbage--carrying..... hard--hardly.......... eagle--eating......... stomach--starch....... stem--step............ lamp--glass........... dream--dreary......... yellow--yonder........ bread--bed............ justice--juice........ boy--ball............. light--likeness....... health--help.......... bible--book........... memory--memorial...... sheep--sleep.......... bath--battle.......... cottage--cotton....... swift--fast........... blue--blind........... hungry--hurry......... priest--prince........ ocean--over........... head--large........... stove--stone.......... long--heavy........... religion--goodness.... whiskey--strong....... child--small.......... bitter--butter........ hammer--hard.......... thirsty--thrifty...... city--seeing.......... square--squirrel...... butter--bitter........ doctor--dark.......... loud--noisy........... thief--stealing....... lion--eating.......... joy--joyous........... bed--sleep............ heavy--weightful...... tobacco--cocoa........ baby--boys............ moon--moo............. scissors--successors.. quiet--easy........... green--grass.......... salt--simmer.......... street--steep......... king--kingdom......... cheese--squeeze....... blossom--blooming..... afraid--africa........ consecutive no. l .--school teacher. efficient; described as very silent. unclassified reactions, due mostly to distraction. table--cat............ dark--no.............. music--will........... sickness--chair....... man--table............ deep--floor........... soft--paper........... eating--wood.......... mountain--chair....... house--window......... black--wall........... mutton--sky........... comfort--air.......... hand--table........... short--paper.......... fruit--sweeping....... butterfly--room....... smooth--working....... command--stone........ chair--machine........ sweet--radiator....... whistle--clock........ woman--cane........... cold--flower.......... slow--cord............ wish--marriage........ river--chimney........ white--wheel.......... beautiful--cane....... window--pot........... rough--grass.......... citizen--paper........ foot--closet.......... spider--awning........ needle--good.......... red--bad.............. sleep--hinge.......... anger--will........... carpet--paper......... girl--chair........... high--table........... working--cane......... sour--floor........... earth--ceiling........ trouble--chain........ soldier--desk......... cabbage--paper........ hard--table........... eagle--flower......... stomach--match........ stem--match........... lamp--table........... dream--chair.......... yellow--cane.......... bread--flour.......... justice--peace........ boy--window........... light--wall........... health--floor......... bible--house.......... memory--paper......... sheep--dress.......... bath--clothes......... cottage--earth........ swift--sky............ blue--trees........... hungry--leaves........ priest--bark.......... ocean--boat........... head--hat............. stove--ashes.......... long--short........... religion--peace....... whiskey--bottle....... child--dress.......... bitter--sour.......... hammer--teeth......... thirsty--dry.......... city--good............ square--wood.......... butter--best.......... doctor--shoes......... loud--music........... thief--notes.......... lion--strings......... joy--happy............ bed--wish............. heavy--lead........... tobacco--plant........ baby--good............ moon--paper........... scissors--straw....... quiet--hoop........... green--rope........... salt--dish............ street--dirt.......... king--bucket.......... cheese--plate......... blossom--plant........ afraid--sweeping...... consecutive no. .--state hospital attendant. incompetent, dull. numerous non-specific reactions. table--rolling........ dark--swim............ music--playing........ sickness--riding...... man--walk............. deep--singing......... soft--light........... eating--sleep......... mountain--low......... house--small.......... black--dark........... mutton--lean.......... comfort--good......... hand--small........... short--small.......... fruit--taste.......... butterfly--beautiful.. smooth--long.......... command--immediate.... chair--small.......... sweet--clear.......... whistle--long......... woman--small.......... cold--long............ slow--write........... wish--quick........... river--long........... white--clean.......... beautiful--nice....... window--big........... rough--bad............ citizen--short........ foot--small........... spider--small......... needle--small......... red--dark............. sleep--easy........... anger--bad............ carpet--small......... girl--short........... high--long............ working--good......... sour--bad............. earth--large.......... trouble--bad.......... soldier--good......... cabbage--small........ hard--apples.......... eagle--small.......... stomach--good......... stem--short........... lamp--bright.......... dream--good........... yellow--light......... bread--good........... justice--good......... boy--small............ light--clear.......... health--good.......... bible--true........... memory--good.......... sheep--many........... bath--good............ cottage--large........ swift--fast........... blue--dark............ hungry--long.......... priest--true.......... ocean--wide........... head--large........... stove--black.......... long--wide............ religion--good........ whiskey--strong....... child--small.......... bitter--bad........... hammer--small......... thirsty--bad.......... city--big............. square--long.......... butter--good.......... doctor--good.......... loud--hearty.......... thief--bad............ lion--bad............. joy--happy............ bed--easy............. heavy--stone.......... tobacco--strong....... baby--small........... moon--large........... scissors--sharp....... quiet--baby........... green--dark........... salt--strong.......... street--wide.......... king--high............ cheese--good.......... blossom--apples....... afraid--he............ consecutive no. .--school boy. non-specific reactions. table--board.......... dark--night........... music--sound.......... sickness--pleasantness man--people........... deep--river........... soft--cat............. eating--pleasantness.. mountain--high........ house--home........... black--dark........... mutton--good.......... comfort--pleasure..... hand--foot............ short--little......... fruit--good........... butterfly--pretty..... smooth--soft.......... command--go........... chair--sit............ sweet--good........... whistle--noise........ woman--pretty......... cold--bad............. slow--quick........... wish--good............ river--deep........... white--snow........... beautiful--pretty..... window--look.......... rough--even........... citizen--good......... foot--hand............ spider--bite.......... needle--sharp......... red--crimson.......... sleep--wake........... anger--mad............ carpet--floor......... girl--good............ high--tall............ working--sleep........ sour--bad............. earth--ground......... trouble--bad.......... soldier--good......... cabbage--bad.......... hard--soft............ eagle--bird........... stomach--ache......... stem--slender......... lamp--light........... dream--good........... yellow--pretty........ bread--good........... justice--good......... boy--fun.............. light--see............ health--happiness..... bible--good........... memory--good.......... sheep--pretty......... bath--good............ cottage--pretty....... swift--quick.......... blue--yellow.......... hungry--eat........... priest--good.......... ocean--big............ head--little.......... stove--hot............ long--distance........ religion--good........ whiskey--bad.......... child--cute........... bitter--good.......... hammer--hard.......... thirsty--hard......... city--good............ square--round......... butter--soft.......... doctor--good.......... loud--noisy........... thief--good........... lion--big............. joy--good............. bed--comfortable...... heavy--light.......... tobacco--bad.......... baby--pretty.......... moon--cute............ scissors--sharp....... quiet--loud........... green--pretty......... salt--good............ street--narrow........ king--good............ cheese--good.......... blossom--pretty....... afraid--scared........ consecutive no. .--school boy. non-specific reactions. table--chair.......... dark--cold............ music--sweet.......... sickness--hard........ man--wise............. deep--dark............ soft--sweet........... eating--drinking...... mountain--snow........ house--great.......... black--horse.......... mutton--good.......... comfort--health....... hand--foot............ short--fat............ fruit--good........... butterfly--pretty..... smooth--hard.......... command--general...... chair--soft........... sweet--good........... whistle--loud......... woman--large.......... cold--dreary.......... slow--hard............ wish--fairy........... river--large.......... white--snow........... beautiful--woman...... window--large......... rough--hard........... citizen--good......... foot--small........... spider--ugly.......... needle--thick......... red--cow.............. sleep--dreams......... anger--very........... carpet--pretty........ girl--small........... high--tree............ working--hard......... sour--bitter.......... earth--great.......... trouble--hard......... soldier--brave........ cabbage--good......... hard--stone........... eagle--great.......... stomach--weak......... stem--watch........... lamp--pretty.......... dream--sweet.......... yellow--buttercup..... bread--flour.......... justice--man.......... boy--gun.............. light--bright......... health--care.......... bible--holy........... memory--poor.......... sheep--pretty......... bath--nice............ cottage--low.......... swift--stream......... blue--bluebird........ hungry--tired......... priest--church........ ocean--water.......... head--large........... stove--fire........... long--snake........... religion--jesus....... whiskey--temperance... child--healthy........ bitter--apple......... hammer--nail.......... thirsty--water........ city--houses.......... square--desk.......... butter--yellow........ doctor--medicine...... loud--harse........... thief--wicked......... lion--fierce.......... joy--happiness........ bed--rest............. heavy--stone.......... tobacco--dirty........ baby--small........... moon--sky............. scissors--sharp....... quiet--lonely......... green--sour........... salt--cows............ street--people........ king--rich............ cheese--yellow........ blossom--pretty....... afraid--fear.......... consecutive no. .--lawyer. individual reactions, of which are classed as normal; are unclassified, most of which are also obviously normal. table--chair............. dark--candle............ music--girl.............. sickness--doctor......... man--woman............... deep--swimming........... soft--hand............... eating--reisenweber...... mountain--kipling........ house--mortgage.......... black--spectrum.......... mutton--pig.............. comfort--chair........... hand--ring............... short--tall.............. fruit--banana............ butterfly--color......... smooth--sphere........... command--soldier......... chair--teacher........... sweet--apple............. whistle--policeman....... woman--hat............... cold--thermometer........ slow--invalid............ wish--million............ river--hudson............ white--broadway.......... beautiful--girl.......... window--school........... rough--ball.............. citizen--justice......... foot--shoe............... spider--insect........... needle--tailor........... red--flannel............. sleep--potassium bromide. anger--teacher........... carpet--tack............. girl--belt............... high--pole............... working--laborer......... sour--apple.............. earth--columbus.......... trouble--lawyer.......... soldier--gun............. cabbage--plantation...... hard--brick.............. eagle--feathers.......... stomach--juice........... stem--leaf............... lamp--light.............. dream--pillow............ yellow--lemon............ bread--crust............. justice--judge........... boy--pants............... light--gas............... health--medicine......... bible--jacob............. memory--brain............ sheep--wool.............. bath--soap............... cottage--rod............. swift--ball.............. blue--sky................ hungry--i................ priest--surplice......... ocean--ship.............. head--hair............... stove--shovel............ long--pole............... religion--abraham........ whiskey--kentucky........ child--baby.............. bitter--pepper........... hammer--nail............. thirsty--lemonade........ city--manhattan.......... square--washington....... butter--salt............. doctor--nurse............ loud--hammer............. thief--jewelry........... lion--androcles.......... joy--automobile.......... bed--shoes............... heavy--flannigan......... tobacco--pipe............ baby--wife............... moon--man................ scissors--cut............ quiet--demure............ green--eyes.............. salt--cellar............. street--wall............. king--edward............. cheese--roquefort........ blossom--field........... afraid--burglar.......... § . number of different words given as reactions. it has been suggested by fuhrmann [ ] that the number of different words given in response to one hundred selected stimulus words may be used as "a fairly reliable measure of the intelligence and degree of education of a patient." the test according to fuhrmann is applied twice in every case, the interval between the two sittings being at least four weeks. "in very intelligent and well educated persons every stimulus words almost always evokes in the first test - different associations; in the less intelligent and in the feeble-minded the same associations are more frequently repeated. in the second test with the same stimulus words--which is really much more important than the first, since even persons or inferior intelligence may reach higher numbers in the first test--the difference in the wealth of the stock of representations becomes plainly evident: the man of intelligence will not need to draw on the associations which he gave in the first test, but will produce new ones; the feeble-minded subject will, on the contrary, repeat to a greater or lesser extent the associations of the first test." "in general the associational capacity of an adult person may be taken to be from per cent to per cent. should the number sink below per cent the suspicion of a pathological condition must then arise; and the higher the subject's degree of education the stronger is this suspicion. in the case of an associational capacity of per cent or less no doubt of its pathological significance can remain any longer." [footnote : diagnostik und prognostik der geisteskrankheiten, p. . leipzig, .] our results are not strictly comparable with fuhrmann's, because we have obtained but one test record from each subject; it may be said, however, that the results of a single test in each case do not show any considerable differences, corresponding to education or age, in the variety of responses. further, dementing psychoses, with the exception of epilepsy, show on the whole no diminution in the number of different reactions, although in individual cases this number falls considerably below the general average; and in such cases the diminution may be dependent upon stereotypy or perseveration, and not necessarily upon reduction in the stock of representations. it would appear from our results that pathological mental states are apt to manifest themselves by a tendency to give reactions belonging to types of inferior values rather than by diminished variety of responses. we show in table vi. the numbers of different responses given by our groups of normal and insane subjects, expressed in figures giving for each group the median and the average. table vi. med. av. normal subjects, common school education; records containing not over individual reactions........ . normal subjects, collegiate education; records containing not over individual reactions........ . normal subjects, school children; records containing not over individual reactions........ . normal subjects; records containing not under individual reactions............................... . cases of dementia præcox............................. . cases of paranoic conditions......................... . cases of epilepsy.................................... / . cases of general paresis............................. / . cases of manic-depressive insanity................... . § . co-operation of the subject. in our work with insane subjects we encountered many cases in which we were unable to obtain satisfactory test records owing to lack of proper co-operation. some subjects seemed to be either too confused or too demented to be capable of understanding and following the instructions given them. others were for one reason or another unwilling to co-operate. it is important to distinguish inability from unwillingness to co-operate, since the former indicates in itself an abnormal state of the mind, while the latter is quite often shown by normal persons. a subject may co-operate to the extent of giving a single word in response to each stimulus word, and yet fail to co-operate in some other particulars. he may, instead of giving the first word suggested to him by the stimulus, suppress the first word more or less systematically, and give some other word which may seem to him more appropriate. this probably occurs very often, but does not seem to render the results less serviceable for our purpose. further, a subject may react by words related not to the stimulus words, but to each other, thus simulating perseveration; or he may react by naming objects within reach of the senses, thus appearing to be distracted; or he may give only sound reactions. there is, in fact, no type of pathological reactions which a normal person may not be able to produce more or less readily at will, though in the case of incoherent reactions considerable mental effort may be required, and the end may be attained only by regularly rejecting the first and some subsequent words which are suggested by the stimulus. in view of these considerations we are led to conclude that the association test, as applied by our method, could not be relied upon as a means of detecting simulation of insanity in malingerers, criminals, and the like. § . summary. the normal range of reaction in response to any of our stimulus words is largely confined within narrow limits. the frequency tables compiled from test records given by one thousand normal subjects comprise over ninety per cent of the normal range in the average case. with the aid of the frequency tables and the appendix normal reactions, with a very few exceptions, can be sharply distinguished from pathological ones. the separation of pathological reactions from normal ones simplifies the task of their analysis, and makes possible the application of a classification based on objective criteria. by the application of the association test, according to the method here proposed, no sharp distinction can be drawn between mental health and mental disease; a large collection of material shows a gradual and not an abrupt transition from the normal state to pathological states. in dementia præcox, some paranoic conditions, manic-depressive insanity, general paresis, and epileptic dementia the test reveals some characteristic, though not pathognomonic, associational tendencies. acknowledgments. it is with pleasure that we acknowledge our indebtedness to the many persons who have assisted us in collecting the data for this work. about two hundred tests upon normal subjects were made for us by the following persons: dr. frederic lyman wells, dr. jennie a. dean, miss lillian rosanoff, and miss madeleine wehle. dr. o. m. dewing, the late superintendent of the long island state hospital, and dr. chas. w. pilgrim, superintendent of the hudson river state hospital, have assisted the work by kindly permitting the test to be made upon employees of these institutions, and we are especially indebted to dr. f. w. parsons for personal assistance in securing the co-operation of many subjects. professor r. s. woodworth, of columbia university, extended to us the courtesy of the psychological laboratory during several weeks of the summer session of , and gave us much assistance in obtaining interviews with students; we received assistance also from several of the instructors of teachers' college, especially mr. wm. h. noyes. we are indebted to mr. f.c. lewis and mr. w.e. stark, of the ethical culture school, new york, for permitting us to make the test upon the pupils of that school. in the work of compiling the tables we have been assisted by dr. n. w. bartram, dr. jennie a. dean, mrs. h. m. kent, and others. we wish, finally, to express our thanks to dr. wm. austin macy, superintendent of this hospital, to whom we are indebted for the opportunity of undertaking this work. the frequency tables. . table accommodation article articles basket bench board book books boy bread breakfast broad brown butter cards celery center chair chairs chemical cloth cockroaches comfort cover cutlery desk dine dining dinner dish dishes dissection dog eat eatables eating ferns fête flat floor food fork form furniture glass hard hat home house ink kitchen lamp large leaf leaves library leg legs linen long low mabel mahogany mat meal meals meat mess nails napkin number oak object old operating ornament parlor pitcher plate plates plateau polished refreshments rest room round school serviceable set shiny sit sitting slab smooth soup spiritualism spoon spread square stable stand stool straight strong supper tablecloth tea timber top typewriter use useful utensil victuals wagon whist white wire wood wooden work working write writing . dark afraid baby bad barks black blackness blank blind blindness blue board boat bright brightness brown candle cart cat cell cellar close closet cloud clouds cloudy cold color colored colorless coon curly day daylight dead denseness dim dimness dingy dismal dog door dreary dress dungeon dusk dusky evening eye eyes fair fear fearful fearsome fright ghost ghosts gloom gloomy gray green ground hair hall hell hole horse house illumination invisible lamp lantern light lonely lonesome lonesomeness mahogany man mice midnight moon moonlight mysterious nice night oblivion obscure parlor prison red rest room scare shades shadow shadows sky sleep sleeping space starry stars stillness storm stumbling subject sunlight thunder tree twilight unseen walk weather white woods . music accordion air amuse amusement art 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sheets sing singer singing soft softness solemn song songs soothing sound sounds stool strain strains string study sweet sweetness symphony talent teacher teaching thought time tone town tune violin voice wagner wavy window words worship yankee doodle . sickness affliction age ailing ailment air anxiety appendicitis aunt baby bad bed bertha better body business calamity care child cold condition consumption contagious convalescence convalescing cure danger death dietary diphtheria disability disabled discomfort disease distress doctor dread dreariness enjoyed ether exhaustion family father fear feeble feel feeling fever fevers fracture fright gloom gravel grief grunting hard hatefulness headache health healthy home horrible hospital ill illness incompetence inconvenience indisposition infirmary insanity invalid k. low lying malady man measles medication medicine melancholy mine misery misfortune mother nervousness neuralgis nurse nursing operation oranges pain painful pale patient patients people person physician pill pills plague pleasantness pneumonia poverty quiet quietness recovery relapsing rheumatism room sad sadness serious severe sigh sore sorrow sorry stomach strength suffer suffering summer sympathy terror together trouble trying typhoid uncomfortable unhappiness unhappy unhealthy unpleasant unpleasantness unwell want weak weakness weariness weary well white worried worriment . man adult affection age alive animal animals animate appearance baby bad beard beast being biped blond body boy brain bright brightness brother brotherhood brute bum business cane certain charles child children christian clergyman clothes clothing coat comfort companion company coon crank creature cross devil doctor dress educator existence fakir false family father female flesh form fraud fred friend gentle gentleman girl glacier good greatness grown growth hair hat help home homely horrible horse house human humanity husband individual insane institution intellectual intelligent janitor joe labor laborer lady large life light limb living lord love machine maiden male mammal manhood mankind manliness manly marriage married masculine mason mind might minister minor misery money monkey mr. d. mr. h. mr. n. mr. s. muscular n. nature ned nice noble nuisance out papa passion people person pleasure policeman politician power professor prosperity provider roosevelt ruler self sex shirt shoes short smoking stern stout street strength strong sweetheart taft tall thought trousers true unfeminine use v. voter walk wedding whiskers wife wise woman work works worker working young . deep abyss altitude around below beneath black blue bottom bottomless bowl breath broad brooding brook cave cayuga chair chasm cellar classic clear cliff danger dangerous dark darkness dense depth depths diameter dig distance ditch doleful down dread earth extension fall falling far fathomless fear full gloomy good gorge great ground heavy height high hole hollow large length level light long low measure mighty mind mine narrow ocean organ philosophy pit pond pool precipice profound ravine reaching river rocks safety scare sea sewer shade shady shallow sharp ship short sincere sink sleep smooth sorrow sound space spacious steep story strong study sunken surface swimming thick thickness thin thinking thought thoughts tranquil trench under valley vast wading water well wet wide width . soft apple baby ball beautiful bed boiled brain bread breeze butter cake candy care carpet cat cement clay clean cloth clothes coal cold color comfort comfortable comply consistency cotton crabs cream creeping cushion dark dough down dress drink earth ease easy egg eggs eyes feather feathers feathery feel feeling felt fine firm flabby fleece flesh flexible floor fluffy food foolish form fruit fun fur gentle girl glove good grasp grass ground gum hair hand hands hard harsh hazy head idiot jelly kitten large light lightly liquid loose loud low maple marshes medium mellow membrane mild moist moss mud mush mushing mushy music nice palatable peach pear pillow pillows pliable plush pudding putty quality quiet rubber sand satisfactory seat silk skin slow slushy smooth snap snow soap soup sponge sponges spongy squash sticky strong substance sweet sweetness tender texture timid tomatoes touch velvet voice wadding warm water watery wax wet white wool woolen yielding . eating abstain abstinence action appetite apple apples assimilation biting bread breakfast butter cake candy chacona's chew chewing chicken coffee commons consuming cooking cream devour devouring diet diets digest digesting digestion dine dining dinner drink drinking dyspepsia enjoyable enjoying enjoyment enough etiquette fast fasting fattening feasting feed feeding filling finishing fish flavor flesh food fork forks fruit full gluttonish good gormandizer gratifying habit health healthful heartily hearty hot house hunger hungry ice-cream indigestion knives lemons life live living lobster lobsters lunch masticate masticating mastication matter meal meals meat meeting mild milk more motion mouth movement much myself necessary necessity nice nourish nourishing nourishment olives oranges palatable people pie pleasant pleasantness pleasure plenty poor potato potatoes provisions pudding quick quickly refreshing refreshment reisenweber relief relish resting room sandwich satisfaction satisfied satisfy satisfying sick sit sitting sleep sleeping slow slowly soup starving steak stomach strawberries strength substance sufficient sugar surfeiting sustaining sustenance swallow swallowing table talking taste tasting teeth thinking throat tongue use utensils vegetable vegetables victuals want water watermelon well work . mountain abrasion adirondacks air alleghany alps altitude attractive automobile bald beautiful beauty big blanc bluff breckenridge camping catskills cliff cliffs clifton climb climbing close clouds cone country crevice descend descending desert dirt distance ditch earth elevation fear field flashman foliage fountain galeton geography grand grandeur granite grass great green ground heath height heights high highlands highness hill hills hilltop hilltops hilly himalaya hollow holyoke home horse hudson huge impressive incline island kipling knoll lake land landscape large level lofty low lowland monodonack mound mount ivy mount kearsarge mount mckinley mount pleasant mount shasta mount wilson object owl's head peak peaks pictures pike's peak pines plain plateaus pleasure pointed railway range ranges river rock rockies rocks rocky rough scene scenery sea seas seashore shadows shooting size sky slope snow steep steepness stone stones stream summit switzerland tall terrace top tree trees up vale valley valleys vermont view volcano washington white wood woods . house abode alley apartment background barn bay ridge beautiful belknap big blinds boards boat box brick bricks brown build building bungalow cabin camp carpenter carpet castle cattle cellar chair chamber chicken chimney church city clean closed college comfort comforts comfortable contractor corridor cottage cover covering dark den dog domestic domicile door doors dwell dwelling enclosure erection family fancy farm farmer fence field fire floor form foundation frame friends furnace furnishing furniture garden grandmother great green ground grounds habitable habitation happiness height high hill home homeless hospital hot hotel hovel hut inhabitant inhabited inmates into joy land lake large lawn lemon leonia life live living lot lots lumber man mansion material mine mortgage mountain house mouse new object old ours palace painting pasadena people piazza picture place pleasant pretty property protection red refuge residence resident restful road roof room rooms sage school sea shanty shed shelter sky small spacious square stable star steps stone stoop store street structure tabernacle table tall telescope tenant tenement tent timber top town tree trees tumbler villa village walls warm wealth well white whittier wide willow window windows wood wooden workman worship yard . black agreeable blue board book bright buggy cat chair charcoal cloth clothes cloud clouds cloudy coal coat color colored colorless crepe curtain dark darkness death dense desolate dirty disagreeable disklike dog domino dress dye earth ebony face fear figure flecked floor funeral gloomy gown gray green hair hat heavy hog horror horse impenetrable ink lack light mammy man mrs. b. mournful mourning mud negro negroes nigger night nothing obscure orange paint paper pen pink pipe pit radiator red ribbon robe sad sadness sack shady sheep shoe shoes sign skirt sky somber soot sorrow space spectrum stocking stockings suit table tar terror tie umbrella velvet wall water white wonder wood yellow . mutton animal animals appetite australia baa beef bony breakfast broth brown butcher calf cattle cheap chop chops cow delicious dinner disagreeable dish dislike disliked eat eatable eating fat field flesh flock food fork fowl goat good grass grease greasy ham hate head horrid indigestion knife lamb lambs leg mary meat mouse muttonhead nice old pastures peas pig pork rare roast sauce sheep smell soft soup stale steak stew strong table tallow tender thinking tough uncle veal vegetables vegetarian wool . comfort agony annoyance bad bed blanket book books canoe care chair cheer children cloth comfortable comforter consolation console consoling content contentment convenience cozy couch cover covering cushion cushions davenport death delightful desirable discomfort disease displeasure distress driving ease easiness easy eating enjoying enjoyment feather feeling fireplace fireside friends god good goodness great grief hammock happiness happy hard hardship healing health help home house household i idleness ill joy justice kindness lamp laziness lazy leisure less life like living loneliness lounge luxurious luxury man mansion miserable misery money mother neatness nice none nurse pain palace patient peace people pillow pipe playing pleasant please pleasure plentiness plenty polly post quiet quietness quilt rain relief rest restful restfulness resting rich rocker safety salary satisfaction satisfied security settled sick sickness sit sitting sleep slippers slumber smoke smoking sofa soft solace solid solitude soothing sorrow speak spirit spread suffering sweet swing table taken tea thankfulness tired trials trouble uncomfort uncomfortable uneasiness uneasy unrest unwell warm warmth wealth well well-being wine wish woman wool work ye . hand anatomy arm arms ball beautiful black bleeding body bone bones busy cards clean clock convenience cradle cunning dexterity diligence dissecting do doing dog ear elbow extremity face fat feel feeling feet fellowship finger fingers fist flesh foot form formation friend friendship fruit give glove gloves good grasp greeting grip handle handy hard head heart help helper helping hold holding human instrument jewel kindness knife knitting labor large 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juicy knife lemon liked love luscious luxury meat medicine melon milk nourishing nourishment nice nutritious nuts orange oranges orchard outcome palatable peach peaches pears picking pie pineapple plant plants pleasant pleasure plenty plum produce prune raspberries raspberry red result ripe ripeness salad seed sickness sour south spring stalk stand stems store strawberries strawberry summer swallow sweet sweets table taste tree trees vegetable vegetables watermelon wine . butterfly air airiness airy animal animals ant beast beautiful beauty bee bees beetle bird birds black blossom blue bread bright brilliant brown bush butter buttercup bug bugs bumblebee cabbage caterpillar caterpillars chase chrysalis cocoon cocoons collection color colors colored country cricket daisy dish dove dress dust eagle ease ephemeral fairy field fields firefly flies flight flippant flittering flitting flits flower flowers flutter fluttering fly flying gaudy gauze gay girl gnat golden good grace graceful grass grasshopper grasshoppers grub handsome happy high horse human idler insect insects japanese kite lady lepidoptera light lightness lilies little meadows metamorphosis miller monarch mosquito motion moth moths mountains mourning cloak nature net nets nice orange outdoors pancake pig pigeon plumage powder pretty red small snakes snare soul sparrow speckled spider spotted spring summer sun sunshine swallow sweet swift temporary tree two useless vanity variegated wasp white wind wing wings word worm worms yellow . smooth apple ball basin bed board butter calm carpet character cheek chip circus clean clear cloth clothes coarse coat country course cream cube deceitful deep desk done dry ease easy even evenness face fair feeling fine finished flat flexible floor folded fur glass glassy glazed glide gliding glossy good goods grand grass grease ground hair hand hard harmonious harsh ice iron ironing ivory kind lake lawn lens level lightly lovely machinery mahogany marble mercury mild mirror molasses narrow nice nicely oyster paint paper paste pat path pebble person piano placid plain plane planed pleasant pleasing plum polished pressed quality queer river river road roads roof rough round rubber rugged rule running sailing sandpaper satin sea shape sharp shave shiny silk silken skin sleek slick slippery snail snake soft softness sphere stone straight street stroke surface table thin thought tidy tomato tongue touch tranquil uneven velvet velvety very wall walls water wave window wood work worm wrinkled wrinkles . command ability act acting anger answer anything appeal appearance army arrogance ask asking athletics attention authority baseball bible bid boss boy captain charge chief church combine combined come commander commandment company compel control cross dare demand demanding desire determined dictate dictatorial dignity direct disability discipline dislike do doing domineer domineering done don't door drill driver duty earnestness easy eat effort employ employees enforce entreat entreaty exclamation exertion experience father firm forbid force forced foreman gain general gentleness gently germany give go god god's good govern grand halt harsh harshly haughty head him holy honorable horse i immediately imperative imperious independent insist instant institution instruct instruction intelligence judge knowing labor language law laziness lead leader lieutenant listen loud love madam man master masterful military mind mother move must noble nuisance obedience obedient obey obeyed officer only order ordering orders parents peace people peremptory perfect person plead policeman power powerful praise proper question quick refuse regiment reply reprimand request respect respond retreat right rule ruling running say saying school severe shalt ship soldier soldiers something speak spoken stamina statement stern strength strict strong stubborn superintend superior supervisor surly surrender talk teach teacher teachers teaching tell telling temper temperament thee them think thinking thoughtfulness threat told uncomfortable upright voice vow wagon wife will willing words work wrong you . chair arm article back beauty bed bench book boy broken brown bureau cane caning careful carpet cart color comfort comfortable convenience couch crooked cushion cushions desk ease easy fatigue floor feet foot footstool form furniture governor winthrop hair hard hickory high home house idleness implement joiner large leg legs lounge low lunch mahogany massive mission morris myself necessity oak object occupy office people person place placed plant platform pleasant pleasure posture reading rest resting rocker rocking room rounds rubber rung seat seated seating settee sit sitting size sofa soft spooning stand stool stoop study support table tables talk teacher timber tool upholstered upholstery use useful white wood wooden . sweet agreeable appetizing apple apples beautiful bitter black breath candies candy cherries child chocolate chocolates clean confectionery cream cunning delicious dessert dinner dog dreams e. eat elegant eyes face flavor flower flowers food fresh fruit gentle girl good harsh honey hunger huyler's insipidity kiss limited lovely loving low mary mellow melody milk molasses mouth music musty name nausea nice orange oranges palatable peach peaches perfume pie plausible pleasant pleasing pleasurable pleasure plum preserves quality saccharine salt salty sharp sickish sixteen soft soothing sour stuff sugar syrup taste tasteful tasting tasty tea toothsome ugly unpleasant very voice wholesome . whistle act action air alarm annoyance attention automobile bad bell bird birds blast blew blow blowing blows boat boy boys breath bright brother buzzing call calling cars cent chain children clean clear come conductor crow cry cuckoo dance dear disagreeable distant dog drink dumb ear echo effort engine factory fife fingers fire flute fly franklin fun funny galton girl habit happiness harmony harsh holler 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figure fine freedom friend genteel gentle gentleness girl girls goddess good goodness gown grace graceful grand grandmother great hair handsome hat hats helper helpmate her home honor house housekeeper housewife human humanity inexplicable individual intellect interesting kind kindness labor lady large leader liar living lovable love loveliness lovely loving mabel maid majesty man mankind marriage married mate modesty mother mrs. s. myself nature necessity nice noble nurse old palmist parasol people perfection person petticoats pleasure pretty purity rib sex short sister skirt skirts slender small softness spiritual stout style suffrage sweet sweetness sweetheart talk tall teacher temporary truth uneasy use virtue waist walks weak weakness wife will womanhood work you young . cold activity agreeable air arctic atmosphere autumn bad bitter bracing breezy brisk bum chill chilly clothes clothing coal coat comfort comfortable comfortless cool cough cure damp dark darkness day death degree disagreeable discomfort dreary feel feeling feet finland fire fold freeze freezing frigid frost frozen fuel furs grippe gloomy ham hands hard head hearted heat hot ice ice-cream irritating january latitude lemonade light man medicine misery mushroom nature naughty near never night numb numbness overcoat pain peary penetrating pleasant pressure quiet raw refrigerator rhinitis room running rough sensation severe sharp shiver shivering shivers shivery shrivel shudder sick sickness skating sleighing slow sneezing snow snuffles stone storm stove temperate temperature thermometer touch uncomfortable unpleasant warm warmth water weather well white wind windy winter wraps zero . slow action age anger animal ant anxiety association automobile awful baby backward backwards bad bear beggar behind better bill boat boring boy breakdown camel canal boat car cars careful carpenter cart catch caterpillar caution child climb clock coach conversation cow crawl creep creeping dead decrease delay deliberate dilatory distance dizzy donkey drag dragging dreary dressing drive driver drone dr. r. dull ease easy erie fast feeble fine fire fly foot funeral gait gin going hard haste hasty heavy horse hot hurry impatience inactive inanition incessant indecision insect invalid irritating laggard lagging lassitude late laziness lazy lecture leisure lingering long man march market me medium mice mind mode moderate molasses monotonous moon motion motionless move movement moving mr. t. mule music myself nasty nature obstacle old ox oxen pace papa person philadelphia poke poky poughkeepsie pupil quality quick quickly quickness quiet rain rapid rhythmic river rose run sharp short sick sickness slack sloth slowly sluggish smart smooth snail snails snake softly speech speed speedless starting step still stop stubborn stupid subway sure swift swing talk tardy team tedious terrapin thought thoughtful tide time tired tiresome tortoise train trains trolley turtle unpleasant unsatisfactory vehicle 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lonesome long longing love luck make marry million mind money moon morning music myself news nice no obey object obtain offer one opportunity opposition orange order perhaps person pick picture pie plan play pleasant pleasure plenty position possess possession present promise quiet reality receive remembrance renown repeat request rest rich riches ring sail satisfactory satisfied satisfy satisfying say secret sincere sleep some something sorrow sorry speak special star stars strong success suggest summer sweetheart swim think thinking thought toy trip trouble true try unattainable uncertain unfulfilled unlawful unsatisfied vacation want wants wanted wanting waste watch water wealth well will wisdom wise wishbone wonder would wouldn't yes you . river amazon androscoggin bank banks barrow bathing bay beautiful beauty bend blue boat boats boating body bridge broad brook bubbling calumet camping canal canoe canoeing chignagnette cliffs commerce connecticut creek current dangerous deep 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dresses easy evening face feathers flag flower garment ghost glare good gray green hall handkerchief hands hard horse house innocence lady lawn lead lemon lie light linen lovely man marble milk mountain mountains muslin napkin nearly nice paint pale paper pencil person pigeon pink pleasing powder pretty pure purity race red restful retired ribbon rightness rose sand sarah shade sheet shoes shroud silvery simple skirt sky snow snowflake snowy soft soul space spread still summer sunlight swan tablecloth tent tile trees trousers waist wall wash wedding yellow . beautiful admirable admiring aesthetic all ancient appearance art article artistic attractive baby bird birds brilliant building butterfly carpet carving charming child city classic clear clouds color colors comely common complexion conceited country curtain dainty day delicious delightful description desire divine dress earth elegant enjoyed ethereal eunice evelyn everything exquisite eye eyes face fair falls fancy fascinating 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casing children church clean cleaner clear colored cool curtain curtains danger dirty door doors doorway draught eyes few frame garden glass glasses hole home house joyful landscape large lattice ledge light look looking low newcastle object open opened opening outdoors outlook pane panes picture porch rain rock room sash scene scenery school screen screens seat see shade shades shed shining sight sightly sill sky skylight small square stained stop street structure sun sunshine thing translucent transom transparent trees useful vast ventilation ventilator view viewing visible vision wall wash wide winter wood . rough bad bag ball basket bear blisters blow board boards boisterous bold boy boys bristle brush brutal brutality bumpy calm careless carpet chaps cloth coarse coarseness cobblestones cold country crooked cross cruel desert difficult dirt disagreeable discomfort discouraging dog dress dry dull earth easy even land face fast file fine floor football forest gambler genteel gentle girl granite granular grater grating gravel ground hairy hall hand hard hardness harsh harshness haste hill hills hilly horrid house porcupine ice impertinent injurious iron irregular jagged knife late level lurk lump man manner manners material me mean mild mountain mountains nice noisy obstetricians ocean orange paper pavement peasant pebbles person picture pineapple plane plank play poor stern push stone quality quiet quite radiator ragged railway rasp ready refined rider riders river road roads rock rocks rocky rowdy ruddy rude rudeness rug rugged ruggedness russian rut sand sandpaper savage sea sedate scratch shock sliver slow smooth smoothness soft sponge west sticky wind stones stony storm stormy straight street surface table tempestuous tongue touch tough towel tramp trouble tumble turbulent ugly uncomfortable uncouth uneasy uneven unfairness unfinished unpleasant unsatisfactory untaught voices voyage vulgar walk wall washing water waves weary weather wild winds wood woodsman work world wrong . citizen alien america american americans army arrived belong belonging beloved beneficial bird born brooklyn brother business c. candidate capital cat cistern citizeness city civies civilian civilized clothes club commander community comrade conspirators constitution cosmopolitan countrified country countryman criticise democrat duties duty dweller dwelling ear election eligible emigrant emigration f. faithful farm farmer fellow fellowship fine five fool foreign foreigner free freeman friend friendship gardener gentleman german good government green helper home honest honor honorable human i immigrant independence indian individual inhabit inhabitant invader italian justice k. king large law laws lawyer leader leading legislature lincoln little live lives loyal male man manhood mayor me member men merry moral mr. a. mr. c. mr. s. municipal myself name nationality native natural naturalization naturalized navy near neighbor newspaper new york noble nobleman nonsense obedient obey occupant office officer old orderly outlaw paper papers patrician patriot patriotic peasant people person plebeian policeman politician politicians politics poor president proud relative republic republican residence resident respectable revolution righteousness roman roosevelt ruler season ship soldier state statesman stationed straight subject suburban suffrage suffragette taft tammany taxes teddy thoughtful tough town townsman undesirable unit united states useful village vote voting voter washington woman work years . foot anatomy animal ankle appendage arm baby's base bicycle big black body bone bones boot bottom broken brown careful comfort corn corns dainty difficult distance expansive extremity finger firm flat flesh football foundation gear girls going good ground hand hands head heel help helper horse house human humility hurt inch inches kick knee labor lame large leg legs length limb long man measure member mine miss f. movement music nail naked necessity needful organ pain painful part pavement pedal pedant pedestal pedestrian person plaster quadruped rheumatism right rubber rule ruler run shape shoe shoes short size skin slipper small sole sore speed stability stand standing standard step stepping stocking stone strength strong stumps support swiftness three tired toe toes travel trod twelve two useful velocity walk walking warm yard . spider abhorrence afraid animal annoyance ant arachnida arachnoid awful bee bees beetle big bird bite black breakfast bug bugs butterfly camp caterpillar centipede chills climb cobweb cobwebs country crawl crawls crawling crawly creature creep creeps creeping creepiness creepy cricket cringe cross crow cunning daddy-long-legs danger dangerous dark dirty disagreeable displeasure dread evil fear fish flies fly fright fry frying grass harlequin harmful horrible horrid horror industry insect jumping large leg legs loathsome long miss muffet mosquito moth movements nasty nest net nuisance objectionable obnoxious octopus pain pan pest poison poisonous pretty rats robert bruce roach room shivers shudder sinister small snake snakes sparrow sting stings stung study tarantula thing thread tortoise treachery tree ugly undesirable unpleasant venomous vermin walk wall wasp watching weaves weaving web webs wiggly worm young . needle article blood book broken button buttons camel cloth clothes coat cotton crocheting cut darning diligence dressmaker embroidery eye fine handy help hole home housewife hurt hypodermic implement industry instrument knitting labor long magnetic material mending metal nail ornament patching pin pins pincushion point pointed prick pricks pricking sew sews sewing sharp sharpness shiny slippers small steel sting stitching surgeon tailor thick thimble thin thread tool use using useful weapon wire woman work . red aggravating anarchist anger apple apples ball banner barn beauty becoming black blood bloody blossom blue book bravery brick bricks bright brightness brilliant brook brown building bull cap cape carpet ceiling cheeks cheer cherries closet cloth clouds coat color colors colored coloring comfortable cornell cow crimson curtain danger dark dashy dislike dress eat ed fiery fire flag flannel flashy fright flower flowers flushing garment garnet gaudy glaring glass globe glow grass green hair handsome hat head healthy heat hereford holly hood horse hot house indian ink iron jacket lavender light lips maroon mars mixture moon object objectionable offensive orange paint paper passion pencil pink plush poinsettia pretty purple ribbon riding robin rose rosy rug scarlet shoe sky smooth soldier spots story sun sunset sweater tablecloth thread tie tomatoes turkey vivid war warm warmth whiskey white wool world yarn yellow . sleep awake awaking awaken awakening baby beautiful bed bedstead calm chance child children coma comfort dead death deep desire desperate dope dormitory dose doze dream dreams drowsy drowsiness dullness ease easy eat enjoyable enjoyment enough experiment eyes fast fatigue fine forgetfulness gentle girl go good habit happiness health heavy home insomnia lady leisure lain lie living luxurious luxury mesmerism midnight myself natural necessary need needful nice night peace peaceful peacefulness perfect pillow pleasant plenty poorly potassium profound quiet quietness quietude rage recline reclining refreshing refreshment relax repose rest resting restful restless restore restorer retiring rise rising senses shakespeare sheet shut silence sleeplessness sleepy slumber slumbering snore soft solace song soothing sound soundly still sweet thinking tired tiresome unconscious unconsciousness wake wakefulness wakened wakening waking walk wanting watchful weariness weary well woman . anger abuse aggravated aggravation agony amiability amiable angry anguish annoyance annoyed appearance aroused awful bad bitter bitterness blow blows blush boy breathing calm calmness cat catching cause character cheer child children choler cold command compose control cool cranky crazy cross crossness covetous cruel cry danger deliberation despise devil disagreeable disappointed disappointment discomfort dishonor dislike disobedience disobedient displeased displeasure disturbance disturbed dog downhearted duel emotion enemy energy enmity excitability excited excitement exclamation face father fear feeling ferocity fierce fiery fight fighting fist flush foolish foolishness force forgive forgiveness frenzy fret fright frown frowning fun furious fury gentle gentleness giant girl glad gladness good great grief grieve grouchy happiness happy harsh haste hasty hate hateful hatred headache horrid horror hot hot-headed house humor hunger hysteria ill impatience impatient indian indignant indignation insanity insult insulted intense intensity intoxication ire irritable jealousy jimmy joy joyful judgement kind kindness laughter light lion little loud love low mad maddest madness malice man mean meekness mild mind mirth myself name nature nerves nervous never nice noise noisy none nonsense not noticeable obey out outrage pain passion passionate patience peace peaceful peevish person placid pleasant pleasure provocation provoke provoked provoking quarrel quarreling quarrelsome quick quickness quiet quietness quite rage rarely rashly rashness raving reason red remorse resentment resistive rest restless revenge riled rough roughness rude sad scold scolding scowl sedative selfishness sharp shorn sick sin slow smooth sober soft soldier sometimes soothing sorrow spite spiteful storm strike strong suffering sulky swear sweetness sword talking teacher tears temper temperament terrible terror thought torment trouble turbulent turmoil ugliness ugly unbecoming uncomfortable unhealthy unpleasant very vexation vexed vicious violence violent voice war wicked wickedness wish woman words wrath wrathful wroth wrong yelling . carpet appearance article beat beating beater beautiful beautifying beauty bedroom blue bright broom brown brush brushes brussels chair chairs clean cleaning cleaner cloth color colors comfort comfortable cotton cover covering curtains dark design designer dirt down drag dullness dust duster ease electric expense fancy figure flat floor flooring foot fur furnishing furniture germs good goods grain gray green hall heavy home house ingrain lay loom lot luxury mat material matting mattress microbes moss nail neatness nice none oilcloth oriental ornament parlor pattern pennant pleasant plush pretty protection quick rag rags ragged red reddish refinement rich room rough rug rugs shoes small smooth soft softness stairs stove straw sweep sweeping sweeper table tack tacks tapestry textile thread tread use useful velvet walk walking wall wanamaker warm warmth weaver weaving wear white wide wood wool woolen worsted woven . girl ankles annie associate baby beatrice beautiful beauty being belt big biped blonde blooming book boy boys braids bright changeable cheerful child children childhood childish choice class classmate clever clothes clothing coleen college companion cook cunning curls cute dainty damsel dance dancing daughter delight diabolo domestic doris dorothy dream dress dresses effle ethel eyes fair fellow female feminine flesh flirtation frances friend futurity garden gay gentility gentle gertrude good grace hair hand handsome happiness harmlessness has hat head here hood hoop human humanity immature infant innocence innocent intelligent irene jealousy jolly joy kid lady large lassie learning little lively lizzie love loving lovely maid maiden maidenhood malt man men meek mischievious miss miss s. modesty mother myself neat necessity nice niece noise pelar person petticoats play pleasure pretty pupil quick rarely running saucy school servant sex shirk silly sister sixteen skirts slender slight slim small smart smartness student studious study stylish summer sweet sweetness sweetheart talks tall thoughtless ugly useful vanity virgin walk water weak white wife woman young youngster youth . high above air alps altitude ascend bank beam beanstalk big bridge building buildings cathedral ceiling chair church cliff climb climbing clouds deep depth dimension distance distant dizzy elevated elevation erect exalted extended fall falling far fast fear feet fence first giant great hat heaven heavens heavenward height hill hills hot house houses ideal ideas immense jump kite ladder large length lighthouse lofty long low magnificent man mast measure medium metropolitan mind monument mount mountain mountains myself notion peak pine pinnacle play pole power precipice reach rich rocky roof room see shallow short skies sky skyscraper small soft spire staff stand steep steeple stick stone summit swing tall temperature temple top tower tree trees up upward valley vision wall waves wind woman . working accomplish accomplishment active activity always ambition ambitious anxious apron attendant bent book boy broom business busy carpenter class comfort complication content continually continuous cooking day difficult digging diligence discomfort do doing done drawing driving drudge dusting duties duty earning ease easiness easy eating effort employed employers employment energetic energy engaged english essay exercise exercising exertion factory fair faithfully farm fast father fatigue fatigued field flowers foundry function girl good hammer hands happiness hard health healthy hoeing horse hour house idle idleness idling inconvenience indolent industrious industry intelligent interest italian job keeping labor laboring labors laborer lack ladies late laziness lazy leisure lillie little live livelihood living loaf loafing loafer lounging machine machinery machinist making man men model money morning motion movement moving mowing myself necessary necessity neighbor never night noble nothing nursing obstetrics occupation occupied occupy order paid patients people person perspiration play playing pleasant pleasure plow plowing policy position possession prosperous quick railroad reading recreation rest resting result rowing running salary satisfaction saving school scrubbing servant setting sewing shirking shop shorthand sickness singing sitting slave slavery slaving sleep sleeping slow smart starving steady stenographer strenuous struggle study studying sweep sweeping swift table task thinking thought time tired tiresome tiring to-day toil toiling tools treadmill trouble trying typewriter unemployed useful wages walking washerwoman washing weariness willing woman work workman world writing . sour acetic acid acrid anger angry apple apples astringent bad beer bitter bitterness cherries cider cross crowd currants dangerous death delight disagreeable dislike disposition distasteful drink face flavor fruit gall good goodness grape grapes grapefruit green hate hurts juice kraut lemon lemons lime man milk nasty naturally nice no nourishing odor orange painful persimmon pickle pickles pleasant plum plums pucker quince rancid repulsive rhubarb rough salt salty sauerkraut sear sharp soft song spoiled stomach sugar sweet tart taste tasting tasteless teeth turned twinge ugly unhappy unpalatable unpleasant unpleasantness unsweetened vinegar wholesome wine . earth agriculture air ashes ball beautiful big black body broken brown building cemetery clay climate cloud coffin cold color columbus continent corn country cover creation crunching crushed crust damp dark delve depth dig digging dirt dirty dogs dry dust farm farming fence fertile fertilized field fields flag floor flower flowers foot foundation fresh fruitful fuller's garden geranium globe grain grand grass grave gravel gravity great green greenhouse ground growth habitation hard heaven heavens heavy hell hemisphere home house huge inhabitable land large level live living loam lot low man map mars mass material matter metal mine mineral moist moon mother mould mouldy mountain mountains mud nature object ocean one orange paradise place planet plant plants planting pleasure potential productive put rain rampart rest revolution rich river road rock rocks round roundness sand sky smelly smooth sod soft soil solid solidity space sphere star stone stones street substance sun surface travel tree trees unfertile universe vastness vegetable walk water wide wood world worm worms . trouble accident affliction aggravation anger angry anguish annoy annoyed annoyance anxiety avoid bad begins black borrowed borrows bother bothered bothersome brains brewing broke burden burdens business busy calm calmness care cares careless children college comfort comforts comfortable coming consequences contented contentment court cry crying danger darkness day death deep despair difficult difficulties difficulty disagreeable disagreement disappoint disaster discomfort discontent disease dislike disobedience displeased displeasing displeasure dissatisfactory distress disturbed doctor dogs ease easiness easy ended enemies enemy error everywhere exams excited excitement family father fear feeling few fight fighting flunking fret friends fun funeral fuss girl gossip great grief handkerchief happiness happy hard hardship harm health heart heaviness hemorrhage home horror horse hurried husband idea illness imaginary inconvenience joy kindness kinds labor laugh lawyer lessons life little lonesome loss lots mad madness man many marriage me mind minded mischief miserable misery misfortune misunderstanding money monotony mother mrs. wiggs much nervousness no noise none nuisance pain patience patient patients peace peaceful people perplexed perplexity person pity pleasure plenty poor poverty psychologist quarrel quarreling quiet quietness release relief remorse rest reverses romeo ruffled sad sadness school scrape sea seldom sereneness shadow ship shooting sickness simple sin sleep sometimes sorrow sorrows sorrowful sport squabble study suffer suffering sweetener sympathy table task tears teasing temper temptation thought thoughts torment travel trial trials troublesome ugly unavoidable uncertainty uncomfortable uneasiness uneasy unfortunate unhappiness unhappy unlucky unnecessary unpleasant unpleasantness unrest unsafe unsatisfactory unsettled upset want war weak weary weeping welfare woe woman women work worked working worried worries worry worrying worriment wrinkles wrong yesterday youth . soldier academy armlet army arms arnold artillery baseball battle bayonet blood blue boy boys brave braveness bravery brazilian brother buttons cadet camp cannon cap captain cavalry citizen civilian clothes colonel command commanding commander costume country courage danger defender defense discipline disliked double drill drums duty enemy england english erect fellow fight fights fighter fighting firearm fort fortune general germany glory good grant guard guardian guardsman gun guns helmet hero him hobo home hurt infantry jacky jim king lieutenant male man men manly march marching marine marshal mechanic military militia murder music musket n. nation national navy necessary nobility obedience obey officer officers order orderly patriot patriotic patriotism person philippines police policeman protection protector proud red redcoat regiment regular respectable richmond rifle sailor sailors salute sentry servant service show sick single smart sorrow stateliness store straight strength stremious strict strong sword tall tent tin training travel troop troops uniform united states upright uprightness valiant veteran volunteer war warfare warrior west point widow work . cabbage away bad beans beef beet beets boiled broth bud bunchy carrot carrots catsup cauliflower cigar cold-slaw cook cooking corn cucumbers cut decayed disagreeable dish dislike dinner eat eating eatable eatables farm farming field fields fine flower fond fruit garden german germans goat good green greens ground grow grows growing growth ham hard head heads healthy heavy herb home horrid indigestion kale kraut large leaf leaves letters lot meal meat mrs. wiggs mustard nice nothing odor onion onions paper parsley patch plant plants plantation planted planting plate pork potato potatoes purple quart rabbit red rose round salad sauerkraut slaw smell soapy solid soup sour spice spinach sprouts stalk stew stinking strong sustenance sweet taste tender tomato tomatoes turnip turnips unnecessary unwholesome valhalla vegetable vegetables vinegar virginia white . hard adamant apple apples bad ball baseball bed bench blackboard board boards bone bread break brick brittle bullet cabbage callous candy can't chair character coal coarse cold crystallized dense diamond difficult disagreeable do durability earth earthen easy egg eggs examination fare farmer faery feeling firm firmness fist flint floor formidable fruit glass glittering gold good granite ground hammer harsh heart hearted heavy hickory hurt ice immovable impenetrable indestructible individual indurated inflexible injustice icksome iron kind labor lead lesson lignum-vitae life low hick maple marble mathematics mean medium metal murder mush nail nails natural nut nuts oak opaque pavement perplexing physics piano principle pulpy quality questions raining resistance resistant rigid road rock rocks rocky rough saltpetre severe sidewalk smooth soft solid stale steel stick stingy stone stones stony stove strength strong stuff substance table tack thick tight touch tough tree trouble turnip unbreakable uncomfortable uneasy unimpressionable unpleasant unpliable unripe unyielding uselessness very walnuts water wisdom wood work working . eagle air altitude america american animal aspiring bald beak beast bill bird birds birdie black butterfly buzzard carnivorous carrion chickens claws clouds contour crag crow cruelty dollar dove eggs emblem eye eyed eyry falcon feathers fierce flag flies flight flint fly flying flyer fowl freedom glare glorious golden graceful gray great hawk height high insect insignium keen king large lark liberty lofty might mountain mountains nest owl paper parrot partridge peacock pigeon power prey quail quarry robin rock scarce sharp sight sky sly soar soars soaring solitude space sparrow sport spread strength strong sun swallow swan swift swiftness sword talon talons tern times turkey united states vulture wing wings young zoo . stomach abdomen ache anatomy animal appetite apples arm back bad bag basket beast beef belly belt biology body bowels brain bread breast cancer care careful cat cavity chart chest coil condition contain delicate diaphragm digest digesting digestion digestive digests dinner disease distress doctor dress duodenum dyspepsia eat eating empty engine excellent face fat feed feeding feet food foot flesh frame front full function gastric gertrude good grind grinding hand hands head health heart hog hunger hungry hurt hurts hygiene illness indigestion inside interior internal intestine intestines juice large leg limb liver living lung lungs machinery man meal meals member milk mortal mouth muscle nausea necessary necessity neck nuisance object oblong oesophagus organ organs overeating overloaded pain part person physiology picture poor portion pouch psychology pump punch receiver receptacle reservoir rest round self sick sickness skin small soft sore sour specimen strong suffer suffering sustenance system tender tenderness thought throat tongue trouble troubles troublesome trunk tube upset useful vessel want water weak weakness work . stem anything appendage apple apples base beginning blade blossom boat body brain branch branches broad broom bud bush butt cane cherry connection connects cord core end ending evolution fibre fibres finger flower flowers foundation fruit grass green growth handle hard head hold holding holder holes join leaf leaves leg length lettuce life light lily limb living long match necessity object offshoot organ part parts particle peach pear peduncle pencil petal pick piece pipe pit plant plow point poppy projection prop reed river rod root roots rose shank short slender small smoke soft stalk steps stern stick stiff stone stop storm straight support thin thorn tide tobacco top tree trees trunk twig valve violet vine watch water weed wind winding winder wood . lamp aladdin arc articles black blaze brass bright brightness burn burning burner burns candle chandelier cheer chimney convenience crockery dangers dark darkness daylight distance dull electric evening fire flame full furniture gas glaring glass globe high home hot house illumination kerosene lantern large library light lights lighted lighten lit match nickle night oil ornament petroleum post pretty reading red rochester room see shade shadow small smoke smokes smoking smoky stand stove student table tall useful vessel warmth wick wisdom . dream absence angel angels anger anything asleep awake awaking awaken awakening baby bad beautiful bed bliss book boy comfort consciousness conversation dangerous darkness days death delusion delusions disagreeable disappointment discontent disturbance disturbing doze dread dreary easy expectation experiment eyes falling fancy fantasy fear feeling feelings forgotten fortune funny girl good goodness grand grieving hallucination happiness heaven home hope horrible idea illusion image imaginary imagination imagine imaginings impression indigestion insanity inspiration kind land languid lie like love m. man mare meditate melancholy melody mesmeric mind money music nature never nice night nightmare no none nonsense object omen on opium paradise patients peace peaceful phantoms picture pillow play pleasant pleasure presentiment prophesy psychology purple queer quiet realization recollection relax remember repose reposing rest restless restlessness reverie sad sadness scene second semiconscious sensation sense shade shadows short sickness sight sights sleep sleeping sleeper sleeplessness sleepy slept slumber something somnambulist snore soliloquy stale startling story sweet talk terrible things think thinking thought thoughts tiring trouble true uncomfortable unconscious unconsciousness uneasiness uneasy unfortunate unpleasant unpleasantness unreal unrest unstable vacancy vagueness vision visions vivid wake waking wander wandering weird wonder woods work . yellow alive amber apple autumn banana beautiful beauty becoming bird black blossoms blue bright brightness brilliant brown buff butter buttercup buttercups butterfly canary cat china chinaman chinee chinese chrome chrysanthemum chrysanthemums cloth coarse color coloring common complexity corn cream crocus daffodil daffodils daisy dandelion dark delightful desert disagreeable dog door dream dress dresses dull ecru egg fade fancy fence fever flag flame flower flowers fruit g. garments gay glare gold golden goldenglow goldenrod goods gorgeous grass green hair house hue ink jasmine jaundice jealousy jonquil journal kid leaf leaves lemon light lily maize man marigolds matter mellow melon molasses nature nice obnoxious ochre orange paint pale pansy paper peach pears pillow pink plague poppy pretty primrose pumpkin pumpkins pure purple red ribbon rose satin school sear shade silk sky soft suit sulphur sun sunflower sunlight sunshine table tan tarnish tree ugly unharmonious violet wagon warm warmth wax wheat white . bread appetite bake baking baker bakery biscuit biscuits blue board box breakfast brown buns butter cake cheese children color common cookies corn crackers crumbs crust cut daily diet dinner dish dough doughnuts earn eat eating eatable eatables edible feed flour food fresh fruit good graham grain ham hand hard heavy holes home hot hunger hungry knife life light living loaf lunch making man meal meat milk mixing necessary necessity needful nourishment oatmeal pantry pastry plate pudding roll rolls rye salt salty satisfaction sister soft sour staff stale strengthen substance substantial sugar sustenance sweet table tea toast tough useful water wheat white wholesome wine winner yeast . justice action administered administration all always ask authority b. bad bed blind blindfolded body caught charity chastise chief clearness comfort command commanding conqueror constable court courts creator crime criminal cruelty dealing deeds defying delayed demand deserved dispute distribution do doing done dr. e. duty elusive emblem employer energy equal equality equally equity even exactness execution fair fairness favor fear fine freedom friendship gift give given god godliness good goodness govern government guilty happy harm hasty have heaven help him honest honesty honor impartial iniquity injury injustice innocent j. jail joy judge judged judgment jury just justified kindness lacking large law lawful lawyer lenient liberty lots love magistrate man merciful mercy merit mind moral mother never nobility noble none nonsense obey obtain oppression order pardon partiality peace perfect person picture plato police policeman politics popular power privilege purity reason reward right righteous righteousness rightly rightness rights ruler satisfaction satisfied satisfying scales severe severity sorrow square squareness squire statue story supreme sure tranquility true truth truthfulness unbias unfairness unhappiness unjust uprightness vengeance virtue well wicked willingness wisdom wise work wrong yes yield . boy action active activity agility animal athletic athletics baby bad ball barefoot baseball beautiful being ben body boisterous book bright brother busy cap careless charles chicken child children class clothes clothing companion cousin curls dead development dirty dog edward eighteen embryonic errand fair female fight flesh foolish football frank friend frolic fun funny games girl good grown growth gun handsome harry hat head hearty hero hood hoop human humanity imbecile imperfect incorrigible industrious infant inhabitant innocent jacket james jimmy joe joyful jump jumper juvenile kid lad large laugh legs life little lively maid male man manhood mankind manliness manly marbles masculine master meanness michael mischief mischievous mother muscles myself naughty ned nephew newspaper nice noise noisy nuisance obedient out pants paul person play plays playful playfulness pupil rough running runs scallywag scamp scholar school sex sharp shoes small smart smiles son spirit spoiled sport street strength strong suit sweetheart swimming tall terror think thomas top toys tracy trait tramp trouble useless water whistle whistles wicked wild wildness woman woods work working young youngster youth youthful . light agreeable air airy arc assistance awake beacon beautiful beautifying beauty biscuit black blue bread bright brightness brilliant brown burn burning candle cheer clear clearness coat color comfort complexion convenient cork dark darkness dawn day daylight daytime dimness distance dress dull early easy education electric electricity element emptiness enjoy evening eyes fair feather feathers fire flame fleshy forward fuel gas glare gleam good hair happiness health healthy hearted heat heaven heavy hills illuminate illumination joy kerosene knowledge laboratory lamp lamps life long look luminous match moon morning nice night necessity paper pathway peaceful pink pipe placid pleasant pleasure plenty rays red reflection right room see seeing seen shade shadow shadows shine shines shining sight sign sky soft sound space splendor steam sun sunlight sunshine swift transparent truth twilight ventilation vera vibration vision vivid waist warmth waves weak weight white whiteness window world yellow . health action activity air athletics bad baseball beautiful beauty better blessing blood board body boon boy broad buoyancy care careful cheer circulation cleanliness climate color comfort condition constitution consumption contentment convenience country desirable disease doctor eating enjoyment everything excellent excursion exercise existence face feel feeling fine food form fortune freedom fun gift girl gladness glow golf good goodness grand gymnasium gymnastics happiness happy haste healing healthful healthy heaven holiness hygiene ill illness joy life light live living luck luxury man me medicine merriment mother mountain moving necessary needed needful normal optimism pain perfect person physical physician physiology play pleasant pleasure plenty poor preserve proper prosperity quick red riches robust rose rosy round rugged self sick sickly sickness smiles sound spirit spirits state strength strengths strong sturdy success temper thankful trouble unhealthiness unhealthy useful valuable vigor virility walking want warm water weakness wealth well wholesome woman wonderful youth . bible academy all ancient beauty belief beneficial black book books catechism christ christian church class clean clergyman comfort command commandment commandments creed devotion directions drama duty encyclopedia excellent fable faith family genesis glass god good goodness gospel gospels grand guide heaven heavy help history holiness holy home hope hymns instructive jacob jesus knowledge koran large law leaf leaves lectern legend lie life light literature lord love message mine minister moses mother necessary noble obey open paper piety pious pray praying prayer prayers prayer-book preacher preaching prophet psalms rarely read reading reformation religion religious reverence righteous rot sacred saviour school scripture scriptures sermon shelf sour stones stories story strength studies study sunday table teach teacher teachings testament text tradition true truth truthfulness unnecessary useful verses weariness word words worship writ . memory absent acquire aid analysis ancient association attention aunt back bad beautiful bird blank book books brain brains brightness bucket catechism cause charming childhood clear concentration connection conscience consciousness dancing death debts defect defective desirable deterioration dictionary dim distant dream dreams dull easy educated effort elusive english europe events everything excellent experiment faces faculty failing fails fair fancy far farther fascination faulty feeling fine fleeting fond fool forget forgetful forgetfulness forgetting forgotten forty friends gone good gravestone great green happiness happy head hearing history home hopefulness idea image imagination impossible increase intellect intelligence interpret invisible joy keep know knowledge lack lacking language lasting learn learning lecture length lessons light long loss love magnificent man marvelous me memorandum memorizing mental mind mindful mnemonics mother mud my myself names necessary necessity needful noble none oblivion painful past patient pen perception person picture pictures pleasantness pleasure poem poems poetry poor power psychology quick reading reason recall recalling recognition recollect recollection recollections reflect remember remembering remembrance remind reminder reminiscence reminiscences reproductive result retain retaining retention retentive retrospect sadness scenes scholar school sensation sense senses short simple song sound splendid stanza storehouse story strengthen strong student study studying sure sweet swift swing teacher tender test thankful things think thinking thinks thought thoughts thoughtful thoughtfulness thoughtlessness time train training tree unconsciousness understand understanding unstable useful verses weak well will wit wonderful work youth . sheep animal animals astray awkward baa beast bed bethlehem black blind buffalo calf calm cattle cloth country cow cows death deer dirty dog dogs eat farm feed field fields fleece flesh flock flocks fold follow food foolish fowl fur gentle gentleness goad goat goats good grass graze grazing group hair harmless herd herder hill hillside horn horse humanity innocence innocent jump lamb lambs landscape large lecture lowing many meadows meat meekness mountain mutton nature oxen park pasture pastures peace peaceful pet picture pig plains play pretty quadruped raising ram rocks run running shear shearing shears shepherd simple sleep small soft spring stock stupidity tick trust wander water white wolf wool woolly . bath baby basin bathe bathing beneficial boat boy clean cleaning cleanliness cleanly cleanness cleanse cleansing cold comfort cool creal springs delight dirt dirty dry english every filth filthiness fine flowers fluid fresh good health healthful healthiness healthy hot house invigorates invigorating joy large luxury man massage morning nakedness neatness necessary nice none ocean often once pleasant pleasure plenty plunge porcelain refreshed refreshing refreshment river robe room salt sanitary scrub sensation shower sleeping soap soothing sponge spray springs swim swimming take taken toilet towel towels tub vapor vessel want warm wash washing water wet wood yesterday . cottage abode agreeable alone apartments barn beach beautiful box brick brook brown building bungalow cabin camp camping cape cod castle chair cheese city comfort contentment cottage country couple cozy cute distant door dwelling family far farm fence field fine flowers frame garden green habitable habitation hamlet hammock handsome happiness happy hill home homelike homestead hope hospital house houses innocence ivy lake lane large lawn little live living log lonesomeness love low lumber maine mansion name neat newburgh nice one open orchard outing painted palace personage patient patients peace people picturesque place pleasantness pleasure pond porch prettiness pretty pudding reside residence resident resort rest river rod roof roomy roses rustic school sea seashore seaside shelter shingles shore simplicity sleep small snug stands structure summer sweet switzerland table tent thatched tower trees two unity vacation veranda villa village vine vines white window woman wood wooden woods yard . swift active aeroplane ahead antelope arrow automobile autos ball beauty better bicycle bird birds boat brisk brook bullet cat channel child choice clever creek current curve cutting deer degree doctor dog eagle easy engine fast fastness fear fish feet flight fly flying foot girl go going good grand greek heard hare haste hear high horse hurry hurrying indian kite launch lazy light lightening lively man marathon mercury messenger meteor more morning motion motoring movement moving muscles near niagara falls power quick quickly quickness quiet race rapid rapidity rapidly real riding river rivers road rocket run running runner rushing sail sharp shot sleigh slow slowly smart smartness smooth speed speedily speeding speedy spinchiled spy steam sting stone stream strong sure swallow swallows throw tide time train trains walking water wind work . blue air azure ball beautiful becoming bell binding bird black blood blossom blotter bluebird bluing blusey book bright brown cadet chemical clock cloth clothes clothing cloud could color colors coloring dainty dark deep depth dress dull ether eyes fair feeling fidelity flag flower forget-me-not gentian globe gloominess gloomy glum good grass gray green hat heaven heavens heavenly homesick hopeful horizon house hue indigo ink lake light lily lonesome melancholy monday navy necktie ocean paint pale paper pencil pink pleasant pleasing policeman pretty purity purple red restful ribbon river room sad sailor sea serge shade skies sky soft somber space stripes suit tie tint true truth turquoise unhappy unrest velvet violet violets washing water white wind yale yellow . hungry aching ambitious angry animal appeasing appetite appetizing baby bad bananas bear beggar biscuit boy bread breakfast butcher candy child children cold college country crackers crave craving cupboard dark desirable desire devil devour dinner disagreeable discomfort displeasure dissatisfaction dissatisfied distress dog dogs dry eat eating eatables emotion emptiness empty exhausted faint fainting famine famish famished famishing fascinating fast fasting fatigue fatigued fed feel feeling fill filled food form fulfilment full fruit gaunt gertrude girl gnawing good grub hardship henrietta hog horse hunger i ice-cream kitchen lack lion longing lunch man me meal meat milk miserable misery nausea necessary need needy never nice no noon nothing nourish now ocean often pain painful pallid pang peaches perishing person picnic pie plenty plow poor potatoes poverty present ravenous repletion sad sandwiches satiated satiety satisfied satisfy school sensation sharp ship sick sleepy slow sorrow starvation starve starved starving steak stomach suffering sufficiency sufficient supper table thirst thirsty thought tiger tired tiresome tramp traveling uncomfortable unhappiness unhappy unpleasant unsatisfied very viands victuals walk want wanting weak weakness wish wolf . priest altar authority belief bible bishop black blessing book boy brother cassock cathedral catholic catholics catholicism ceremony chancel chapel childhood church clean clergy clergyman cleric clerical cloister cloth clothes collar comforter command communion confession confessor conscientious console counsellor crucifix dignified discipline discontent dishonor dislike divine divinity doctor doing dominie dress dr. k. duty exalted faithful fakir fakirs fat father follower forgive forgiveness garb gentleman god good goodness gown heaven high holiness holy honor hood house humble hypocrite inspired instruction jew just justice kind knowledge layman leader lecture levi levite lord male man mass minister monastery monk moral noble nun office parson pastor people person piety pious pope power praise pray prays prayer prayers preach preaches preacher prelate priestess profession prophet pulpit purity rabbi religion religious representative repulsive reserved reverend righteous road robe robes ruler sacred sacrifice sanctity school sent serious sermon sermony servant service services shaven shoot sinner sister slim solemnity sometimes spookism stern student sunday surplice table teacher ugly vest vicar york . ocean afraid angry atlantic barge bathing bay beach beautiful big bigness billows blue boat boats body boisterous breadth breeze broad bryon cape cod coney island country crossing current dark deep deepness depth depths distance enormous europe expanse expansive float foam grand grandeur great greatness green grove gulfs hudson immense immensity infinity joy lake land large launch liquid maine mauretania might mighty motion power pretty quantity river roars rough sail sailing salt sand sandy hook sea seas seashore seething shining ship ships shore sky sound storm storms steamboat steamer steamers steamship stream swiftness swim swimming tide terrible traveling trip valley vast vastness vessel voyage waste water waters wave waves wavy wet white wide wonder wonderful . head above ache aches anatomy animal appearance arm arms asymmetrical baby's back bald ball beautiful beginning big black body bonehead boss brain brains branch bright brown cabbage captain cattle cavity chess chief chop clear comb combs consciousness cover covered cow cranium crown director donkey ear ears emptiness empty encephalon end extremity eye eyes face father feature features feet figure firm first food foot forehead front girl glasses good govern great hair hand hands handsome hard hat headless heart heels high highest hot house human individual intellect intelligence king knee knowledge large leadership leading life light limb limbs little long louse man man's masterpiece medium member memory mentality mind mouth nail nation neck nose organ pain part people person physiology planning pope power president pretty principal procession quarters rest round roundness ruler scalp sense senses sensible shape shaped shoulder shoulders skull small sore square statue stomach strong superintendent symmetry tail teeth thick think thinking thought thoughts tired top trunk useful whirl wit woman woman's work . stove article bake baking black blacking box breakfast bright burn burning chair chimney coal comfort cook cooking cooks cover dark dinner dirt dishes fire fireplace flame food franklin fry fuel furnace furniture furnitureness gas german good grate hard hardware heat heating heats heater heavy home hot house household icebox implement instrument iron isinglass kettle kitchen lamp large legs lid lifter light long metal oil oven painful pipe pipes poker polish radiator range receptacle red room round rusty shovel sink small smoke steel structure teakettle using utensil warm warmth water winter wood zinc . long age anxiety arm arms avenue away barn beach bench big blackboard board boat book boulevard bridge broad brooklyn bridge broomstick building cable chimney coat courage craving day days deep depth desirable dimensions distance distant dress duration elongated endless enough eternity extended extension extensive extent far feet fellow fence flagpole foot for giant girl glass grass great hair hall head height high hill hose hours house island journey labor lane lanky large lasting lecture legs length lengthy level life line linear live lusitania man measure medium meter mile miles mississippi much name narrow night nose oblong path person pin pipe plant plenty pole railroad railway rails reed ribbon ride river road rod room rope row rug rule ruler shape sharp shore short shovel slender slim slow small snake something space spacious spire square stay steamer steeple stick sticks story straight street streets strength stretch string stupid summer table tall test thin thread throw time tiresome tower track train tree trip vast very wait waiting walk walking walls way ways weary whale while wide winter wire wishing without worm yard year . religion abraham aesthetics aim all anything association atheism atheism baptist beauty belief beliefs believe believing believer belong belonging bible body books brain buddha catechism catholic ceremony china christ christian christianity christlike church churches churchman civilize clergyman comfort commandments conduct congregational conscience conversion creator creed custom deep denomination devotion different difficult dislike divine doctrine dogma doubt druids duties duty emotion episcopal episcopalian eternity ethics everyday fair faith fake fanaticism feeling fine foolish free gentle german god godly good goodness gospel government guide happiness harmony health heathen heaven hebrew helpful hereafter heresy history holiness holy honor house hypocrisy idea ideas ignorance indefinite indiscreet institutions irreligion irreligious jesus jew jews jewish just kind knowledge law learning life living lord lutheran man men mankind many mental methodism methodist minister modesty mohammed morals mystic nationality need no none nothing nun nuns obey opinion order orthodox paganism peace people perfect persecution person persuasion piety pious poor pope powerful practice pray praying prayer prayers prayer-book preacher preaching presbyterian priest profession professor protestant pulpit pure puzzle question race rector religious reverence right righteousness sacrament sacred sacredness saintly saints salvation scholastic science scripture sect sectarian self service sheeney society solace somewhat soul spirituality stability standby study superstition tabernacle table teaching temperament temple think thinking thought thoughtful � training true trust truth uncertain uncertainty unknowable virtuous vow want wickedness wide woman wonder wonderful work worship worshipping yankee . whiskey abomination alcohol ale amber appetizer apple awful bad barley barrel bed beer beverage biting bitter booze boston bottle brandy breath burn burning carrie nation cider closet color corn curse dangerous dark death degradation despised destruction devil deviltry dewar's disagreeable discontent disgust distillery distress dope dreadful drink drinks drinking drinkable drug drunk drunkard drunkards drunkenness evil fast fire flask fluid food full gin glass good grain hard headache hennessey's hops horror hot hotels hunter indulge indulgence inebriety insanity intemperance intoxicant intoxicants intoxicated intoxicating intoxication jag kentucky knock law liquid liquids liquor malt men medicine misery money moonshine narcotic nice none odor old pint place pleasant poison poor poorhouse powerful prohibition punch rarely red ruin ruination rum rye saloon saloons scotch seasickness sick sickness smell smuggle sorrow sour spirit spirits stimulant stimulants stimulating stimulation stomach straight strong stupidity suffering taste temperance temptation terrible thirst thirsty tipsy toddy toper trouble unhealthy unpleasantness warm water wine wrong . child adult angel babe baby bad beautiful beauty being bird birth blessing body born boy boys burden care carriage charm childhood childish christ clothes comfort coming companion cradle creep crib cries cry cross cunning cute darling daughter dear dearest delight disobedient dog doll dress dresses eleanor elizabeth embryonic expectation family fat father female frolicsome fun fussy future girl girls glass good goose greta growing growth habits hair happiness happy healthy helpless helplessness home hood hospital human humanity ill immature infancy infant injury innocence innocent interesting joy juvenile kid kindergarten labor lady large like little lonely loveable love loving lovely male mammal man maternity me mite mother motherhood naive naughty necessary nephew nice night-dress noise nuisance obedient offspring parent parents people person pet play playing playful pleasure plump precious pretty pupil purity rattle religious school screaming senses simple simplicity sister small smile son spoiled study sweet sweetness table tender three toys trouble weak woman young youngster youth youthful . bitter acid acrid agreeable ale almond almonds aloe aloes altogether alum anger apples apple apricot astringent bad banana beer berry biting boneset burdock candy cascara chastisement chickory chocolate cider cold cross cup deep disagreeable disappointment dislike distasteful dregs drink enemy feelings flag fruit gall good grape grapefruit grass grief grudge hatred herb herbs hops horrid horseradish icy ill irritating lemon lemons lemonade lessons life lines liquor love magen man mandrake medicine mirabar morphine nasty nice none nux offensive olives orange peach peel pepper persimmon pickle pickles pleasant plums poison puckering quassia quince quinine rank sadness salt salts sharp sorrow sound sour sourness spice strong strychnia strychnine suffering sweet sweeter tart taste tasteless tasting tea tears temper thoroughwort thought tonic tonics trouble turnip ugly unhealthy unpalatable unpleasant unpleasantness unsweetened unwholesome vegetables vinegar water weather wine word words wormwood wrong . hammer action annoyance anvil article awl axe bang beating blacksmith blow board bruiser building carpenter carpentering chisel claps claw club concussion convenience drive drives driving door easy effort finger force geology handle hard hatchet head heavy hit horseshoe hurt hurts implement instrument iron j. knife knock knocker knocking large lost mallet mark maul metal nail nails nailing noise nut nuts one pain picture picture plumber pound pounding pounds rap repairs revolver road rod round saw scissors shoemaker shop sledge small sound spade stay steel stone strength strike striking stroke tack tacks thor thread throw throwing thumb thump toe tongs tool tools turf use useful utensil weapon weight wood work working . thirsty all always animal appetite bar beer beverage bird boy brooks cattle child cold craving cream cup desert desire desiring dipper disagreeable discomfort dog drink drinking drought dry dryness emotion empty exhausted famished fatigue feeling fluid food fountain glass good hard haste heat horse hot hunger hungry labor lack lawn lemonade liquid longing man mouth nauseated oranges pain parched parching people person quench quenched refreshing satiated satisfied sensation soda spring stream suffering terrible throat tongue uncomfortable unpleasant very vichy walk want wanting warm water wench wet work . city albany beautiful big boston bridges brooklyn building buildings bulk burlington business busy bustle capital cars charming chicago child citizen civilization cleveland collection community complexity confusion congregation corporation country creal creal springs crowd crowded crowds density dirt distance earth excitement fine fun gaiety good government governor great greatness habitation heat hill home homes hot house houses immense incorporated incorporation industry inhabitant inhabitants inhabited joy land large largeness life live loathing location lots machinery majority manhattan manufacture many men metropolis mill mountain municipal municipality nation new york noise noisy park pavement people place pleasantness populated population populous poughkeepsie republic residence resting rich scene sea settlement shopping shops sights sin size slums small smoke space springfield state stores street streets tale ten thousand theatre theatres towers town towns township traffic traveling tumult turmoil village wagons welcome world . square accurate acre across active airy angle angles angular arithmetic association bed best big block board book box brick broad building business carpenter carpet cars center chatham checkers circle circular city common commons compass concert copley corner corners cornered correct correctness cover crackers crooked crowd cube cubic cubical curse curve deal dealing decoration desk dewey dice die door düsseldorf earth ease equal even evenness exact fair field figure file flat floor foot form four frame furlong garden geometry getty goods grass green grounds hand handkerchief harlem herald heavy honest honesty house houses inch inches instrument iron just justice junction kindergarten knob land large lawrence length level lines little long lot madison man mark marks masonry mathematics meal measure measurement measurements metal mile monument new york object oblong obtuse open oval paper parallel parallelogram park pavements people perfect picture pillow place plane plot proportion public quadrangle rectangle rectangular rhomboid right rittenhouse road room round rule ruler saddle seat shape sharp side sides sidewalk size sizing small smooth solid space stand steel straight street streets sugar surface surveyor table thoroughfare times tool tree trees triangle true uneven uniform union upright village walk walks wall washington wide window wood yard . butter bad bill biscuit bread breakfast butter butterine cheese churn color composition cooking cottolene country cup cow cows cream dairy dairying diet dinner dish dripping eat eatable eatables eating edible egg eggs emollient excellent farm farmer fat fatty fish flour fly food fresh fudge goat good grease greasy grocer healthful indifference ingredients jam jelly kerosene knife lard luxury meal meat melt melting milk molasses mush nourishment nut oil oily oleomargarine peaches plate pleasant plenty pound pure rancid salt salty salve smear smooth soft softness sour spoon spread square strong substance sugar supper sweet table tallow taste tea thin tub use vegetable yellow . doctor administer aid ailment apparatus attendant bad bag beard better bill bills bottle brains brother butcher c. c. care carriage case chief clergyman clever college convenient cure d. d. d. death dentist disease diseases divinity doctress dog driving dr. druggist education fakir false father friend g. g. gentleman good goodness great grip healer healing health help helper helpful helpfulness home hospital ill illness inquisitive intelligent interne invalid k. k. killer kind labor laboratory laborer lamp lawyer learned life m. mcc. mcm. magistrate male man mean medical medicine medicines merchant minister mister money murder n. n. necessity need needed needful nice nurse nurses o. office old one operation p. pain papa patient patients people person pharmacist physical physician pills practitioner priest profession professional quack relief relieved remedy s. satchel science scientist sick sickness smart student suffering supervisor surgeon surgical syringe tend treatment trouble trust useful useless w. w. w. well wise woman work . loud angry audible band bawl bell bells birds boisterous boy boys bright call called calliope calm cannon check child children city clear course color common confusion cornet deaf deafening din disagreeable discontent dislike drum ear easy explosion fast forte game gong graphophone gun guns hammer hard harsh haughty hear heard heavy high hog holler horn impatient knock laugh laughing lofty long low man masculine megaphone mellow mild mouth music noise noisy objectionable ocean organ owl pain painful people person phonograph piano piercing pistols power quiet quietness racket real report rough rude s. scream sharp shock shout shouting shriek shrill shrinking silent sing singer singing slow smart smooth socks soft softly song sound sounds speak speech spoken still stone strong subway sweet talk talking talker thunder tie tone trolley uncomfortable unpleasant voice voices vulgar whisper whistle wide wind yell yelling . thief absence abstractor anger arrest bad badness bandit bank beggar being betrayer boy burglar burglary careful catch caught caution chief clerk clothing court crime criminal crook cry culprit cute dangerous dark deceit detective devil dishonest dishonesty dishonor dislike distrustful dirt dog dumb enemy evil fear felon girl glove gold good harsh honest honesty house household ignorant injustice interest irish jail jewelry jewels judge jury justice killed kleptomaniac laugh law lawyer liar lock loss low man mask mcclure's mean meanness men mercenary merchant minister mischief misdemeanor mistake money murder murderer necessity neighbor newspaper night none noted object pencil person pickpocket play pocket pocketbook police policeman poor prison prisons prisoner punishment purse ran rascal reverses revolver rob robber robbery rogue roguish run running scare schemer school scoundrel shot silver silverware sin sing sing sinner sly snake sneak sneaking sneaky spoils steal stealing steals stole stolen stealer stealth stealthy take taking time tools tramp treasure troublesome trust ugly undesirable unjust unreliable vagrant valuables vice villain virtue want watch waywardness wicked wickedness window woman wretched wrong . lion africa androcles anger angry animal animals bear beast beautiful beauty big bird bite blood boisterous bold bostock's brave bravery bronx cage camel cat cave christian circus claws cow crouching cruel cub cubs danger dangerous death den desert devours disturber dog eat eats elephant enraged fear ferocious ferocity fierce fierceness forest fox fright frightened giraffe great growl hair hearted holler horse howl huge hungry hunter hunting hyena interested jealous jungle jungles king l. lamb large lioness lionized lookout majestic majesty mane menagerie mice mighty monkey mouse mule n. noble noise panther park paw picture power powerful prey rage raging revenge roar roars roaring roosevelt rough savage sea shaggy sharp sheep small stealth stealthy story strength strong sultan tame tamer tail teeth terrible tiger tigers ugly vicious walks wicked wild wildness wilderness wilds wolf woods wool wrath yellow zoo zoology . joy action amuse amusement anger angry anticipation arrival automobile ball bird birth birthday bitterness bless blessing bliss boy bright brightness buoyant cheer cheerful cheerfulness child children christmas comes comfort comfortable company complete concert contentment dance dancing delight delighted delightful despair ecstasy elated emotion engaged enjoyment excitement expression extreme exuberance fair family feel feeling felt festivity fine food forever friends fullness fun gaiety gay game gift girl girls glad gladness glee godliness good grand great grief hands happiness happy harmony health heard heart heaven holiday home hope inexpressible joking jubilant lady laugh laughing laughter leap letter life light like line lonely lots love loving lovely man marriage meeting merriment merry mirth money motherhood much music news nice noise outing pain passing peace picnic picnics pleasant pleased pleasure pride quality rapture rejoice rejoicing relief ride riding rider sad sadness sailing saturday seldom sensation shouting show sing singing smile smiling song sorrow sorry state suffering summer sunlight surprise sweet time triumph trouble unalloyed unattainable unhappiness unhappy vacation water wedding wetness wish wonderful work wrath youth . bed animal asleep baby bedding bedstead blanket blankets boat bowl brass bug chair clean cleanliness clothes clothing comfort comforts comfortable cot couch counterpane cover covers covering desired dormitory down dreamland ease easiness easy fatigue feathers flannels floor folding frame furniture go good hammock hard head home house iron joy large lay laziness lie lounge low lying make marriage mattress narrow negro night object pan patient peace pillow pillows pleasure post quilts recline recuperation refreshing repose respite rest resting restful robe room seat sheet sheets shoes sick sickness sleep sleeping sleepiness sleepy slumber sofa soft spread spring springs square stove structure table tick time tired twilight vassar want warm weariness white whiteness wide wood . heavy air animal anvil article automobile avoirdupois baby bad bat bed big body books boulders box boxes boy bread brick building bullet bundle burden burdensome cake cannon carpet carry carrying cement chair change cloth clothes cloudy coal coarse coat comfort cumbersome dark difficult dirt disappointment discomfort dope drag drill drowsiness drowsy dull effort elephant f. fall feel firmness full gold gorgeous grief grip hammer hard head heart hearted heft help horse house iron irons labor laden large lead lift lifting light lightness load loadsome loud machine man marble mountain much mud muscle myself no obliging opposing oppression oppressive package pail person piano ponderous pound pounds pressure quicksilver quiet rock rough safe sand satchel scales sharp ship short sickness sleep sleeping slothful slumber soft soggy solid sound steel stone stones stout stove strain strength strong study suit table thick things thoughtful tired tiresome ton tough trunk uncomfortable underwear very weak weariness weary weather weigh weighing weight weighted weighty wood work . tobacco amber anger bad bite bitter bob breath brown chew chewing cigar cigars cigarette cigarettes comfort curse death decay deviltry dirty disagreeable disgust disgusting drug durham elevate enjoyed enjoyment execrable exhilaration evil field fields filth filthiness filthy food garden good green grower growing habit habits hard herb herbs horrid horrors indian injurious intoxicate juice leaf leaves light liquor lungs luxury man men narcotic nasty nausea nicotine none not nuisance obnoxious odor odorous opium pipe pipes plant plants pleasant pleasure poison poor pouch plug refrain ruin scent sensation sin smell smoke smoking smoker snuff solace spit stalk stars stimulant stimulants strong substance suffocation sugar sweet tasty tobacco unclean unnecessary unpleasant unwholesome use used useful useless vegetable vice virginia weed weeds whiff whiskey wickedness yellow . baby animal beautiful beauty beginning being bib big birth blessing blue body bonnet born bottle boy bread buggy bundle cap care carriage cart child children childhood chubby clothes comfort cradle creation crib crooning cross cries cry crying cunning cute cuteness darling daughter delicate dirty doll dress embryonic eyes fair family fat father feet female flesh food friend future girl good goodness growth happiness happy harmless helpless helplessness home human infant infinitesimal innocence innocent joy jump kid lamb laugh laughing lawrence life light little lorenzo love loveliness lovely mama man mankind mary milk mother name nice noise noisy nuisance nurse offspring pacifier paper person pink play pleasant pleasure population powder pretty rattle rocker round ruth sex sick sickness simple simplicity sister sleep slight small smallest smiling soft softness squalls squeal squealing stout sunshine sweet sweetness syrup talk talks tiny trouble two walking weak weakness wee white wife woman yell young youngster youth . moon astronomer astronomy atmosphere ball beam beams beautiful beauty body bright brightness brilliant calm change cheese circle circular clear clouds cold coldness crescent cute dark delicate delightful dim distance dreaming earth eclipse equator evening fair fire firmament full girl globe glowing grand great guard half heaven heavens high illumination lady lake large light love loveliness lovely lunar man moonlight mountain mystery necessary new night object ocean one orbit pale planet planets pleasant quiet reflection rise rises rising round satellite sea see seeing l sentimental shine shines shining shiny silver silvery size sky solar sound splendid spoon spooning star stars starlight steamer stone struck sun sweet turkey valuable wan water white wish yellow . scissors apart article barber blade blades blunt cloth clothing cord crooked crossed cut cutting cutlery dress dressmaker dressmaking dull edge fate firecrackers flowers garments glistening goods grating grind handle handy implement instrument instruments knife knives lever linen lost machine material metal millinery mother nails necessity needle needles nickle nippers paper point pointed razor ruching sarah screw severing sew swing sharp sharpness sharpen shears shut silver skirt spool steel string tailor thimble thread tongs tool tools trousers useful usefulness utensil weapon woman work . quiet action alone always asleep baby beautiful beauty bed behave boisterous bore boy breeze brook butterfly calm cattle child children church color comfort comfortable composed contented country creal cricket cross dark darkness day death degree demure disposition docile dreary dull dumb ease easiness easy evening family feeling genteel gentle gentleman girl good green happy harmless harsh heaven home hour house hospital humble joy landscape laughing library life like loneliness lonely lonesome looks lovely l loud low man melancholy mind miss k. moon mountains music myself nature nice night noise noiseless noisiness noisy nook park peace peaceable peaceful peacefulness people person place pleasant pleasure quick quite rabbits refined relief repose reserved rest resting restful restless room rough sad sea serene sheep sickness silence silent sleep sleeping sleepy slow slowness slumber slumbers smart smooth sober soft softly softness solemn solitude soothing sound soundless speechless state steady still stillness study stupid subdued summer sunday sweet talk time times timid tomb tranquil tree twilight village violent voice walk water well wilton wish wood woods . green apple beautiful bird black bloomy blotter blue book bright brown butterfly cabbage calm carpet cheese cloth color colors comfort corn country covetous cucumber curtain dark dartmouth definite dress earth envy erin eyes farmer favorite field fields flag flower flowers foliage food foolishness forest fresh fruit gay glasses gold grand grapes grass gray grew grief ground hat hill horn horrid hue ireland irish jealousy landscape laurel lawn leaf leaves light meadow meadows mountain name nature ocean olive orange paint paper peaceful peas pink plant plants pleasant pleasing pretty purple quiet red restful ribbon ripe sea shade shamrock shutters sight silk sky slow small soft sour spinach spring stain summer tea tree trees unripe vegetable vegetables verdant verdure warning wearing white wood woods yellow young . salt acrid air apple apples article barre barren bath beef bitter bowl box bread brine bromide butter celery cellar chemical codfish condiment cook cooking cows cream deposit digestible dinner dirt disagreeable dish drink dry earth eat eatable eating eggs epileptics finish fish flavor flavoring food france fresh glass good halite ham hard horrid ice-cream ingredient kenilworth kitchen lake life lot mackerel marsh meat meats medicinal melt mine mines mineral mustard nacl necessary necessity needed needful nice ocean pantry paper pasture pepper petre physic pickles pork potassium potato potatoes powder preparation preservation preservatives preserving quotation refreshing relish rock rocks saline saltpetre salty sandwiches saratoga saving savor savory sea season seasoning shake shaker sharp sheep smart snapping sodium soup sour spice spill stickiness sugar sweet syracuse table tart taste tasting tasteful tasty tasteless temper thirst thirsty trees use useful uses using vegetable vegetables victuals vinegar water wet white . street air alley asphalt automobiles avenue avenues better bitter block boulevard bowery boy brick broad broadway brooklyn building business busy byway car cars carriage city clarkson clean cleaner colors confusion congestion corner country crooked cross crowd crowded dark devon direct directions dirt dirty distance drive driving driveway dry dust dusty dwellings earth eighty-sixth eleventh elm even fertile fifteenth fine flags forty-third garden going gravel gutter hard heat hester highway home horses hot house houses hustle land lane large length light live location lonely long main market maxfield motion mud musician name narrow new york nice noise noisy number numbers one-fifteenth one-sixteenth opening passage passageway passway path pathway pave paved pavement paving pebble pecan people place pleasant pleasure pretty racket residence road roads roadway see shopping short sidewalk sidewalks sixty-seventh sixty-third smooth space square stone stones straight sun sweep tenements terrace thoroughfare town tracks traffic travel tree trees trolley turmoil vehicles village wagon wagons walk walking walks wall washington way wet white wide width woodhull . king albert all alphonso antiquity arthur authority bad boss card cards chess chief command commanding commander conqueror country court courtier crown crowned daughter diamonds dignity dislike dog duke edward emperor empire england ermine family farce first fool foreign friend garment george glory good govern government governor great greatness hamlet happy head helmet henry high holland honorable horrible imperial inheritance italy john judgement kaiser king kingdom large law leader lion lord louis xvi. loyal majestic majesty male man master mean midas monarch monarchy nation nobility noble nobleman none officer old palace person picture pompous power powerful president princess prussia queen regal regent reign rich richard royal royalty rule rules ruler saxony scepter slave somebody sovereign spain stories subject supreme throne title town tyrant . cheese american bacteria bad beer biscuit bitter box bread brick butter buttermilk cake camembert casein chalk cheesecloth churn cloth cold color corn cow cows cracker crackers cream creamery crust curd curds cut cutter dairy delicatessen derby diet digestible digestion dinner dish dislike dutch eagle eat eating eaten eatable eatables edible eggs factory fat feast fine fondness food fresh fromage de brie good green grocer grocery ham hard head heap hole holes holey hoops hunger hungry indigestion jam kind knife limburger lump lunch macaroni maggot maggots meat mice microbes mild milk milky mixture moon mould mouldy mouse mustard nice nourishment nutrition odor odorous pickles pie plain plate poor poultry price product rarebit rat rats red resentment rich roquefort rough round sage salt sandwich sandwiches sauce scent switzer sharp skippers smell smells soft solid sour strengthening strong sugar supper sweet swiss switzerland taste tasty thin vegetable vegetables wafers white worms yellow . blossom apple apples art beautiful beauty beginning berries bloom blooming blow book bright bud buds bursting bush bushes buttercups cherries cherry clematis clover color colors country dainty daisy delicate eat fair falling falls field flower flowers foliage forth fragrance fragrant frail fruit garden gin girl green grow growth handsome happiness hepatica leaf leaves lilacs lily magnificent may mimosa nice odor orange orchard pansies pansy peacefulness peach petal petals picking pink plant pleasure plum pour pretty red rose roses scent seeds shrubberies small smell soft spring sprout stem summer sun sweet t. tree trees vine violet weeds white yellow youth . afraid accidents action alarm always anger angry animal animals anxiety automobile awful backwardness bad bashful battle bears blow bold boy brave bravery brother burglar burglars careful cat cheerfulness child children cold comfort comforted company confidence conscience courage courageous cow cows coward cowardice cowardly crowd crying danger dangerous dare dark darkness death deep depressed desire dislike do dog dogs don't doubt dread dreading dreadful dream emotion faith fear fearful fearless feeling fierce forward fright frighten frightened frightful frog gallant ghost ghosts girl go goblins god guilty happy harm heart heroism hide home hope horse hurt insect joy joyful licked lightning lion loneliness lonely lonesome loss man manner memory mild miss k. mice mouse need nerve nerves nervous nervousness never night no nobody noise noisy not nothing obsession opposition palpitation patient patients plucky police quiet rat rats retreat riot robbers rocks run running scare scared scary scream sensitive shiver shrinking shudder shy sickness sleep soldier somebody sore sorrow sorry spirit spiritual startled startling stay stillness strong suddenness suffering sure tempted terrified terror thief thought threaten thunder timid timidity to-night tremble trouble trust unable uncertain uneasy unhappiness unknown unprotected woman women worried worry appendix to the frequency tables general rules . any word combination which is to be found in the frequency tables, but only in the reverse order from that in which it occurs in a test record under consideration, is to be classed as a normal reaction. . any reaction word which is a synonym or an antonym of the corresponding stimulus word is to be classed as normal. . table any food or meal. any room or apartment any article of table linen, china, silver, or furnishings. word designating any special variety of tables. any word pertaining to appetite. . dark any source of illumination. any enclosure from which light is wholly or in a large measure excluded. word referring to physiological pigmentation of tissues exposed to view. any division of the diurnal cycle. any color or coloring material. anything which obscures light. . music any musical instrument. name of any composer or musician. special or general name of any musical composition. term designating rhythm, tempo, loudness, or pitch. name of any dance. term expressing subjective effect of music. . sickness term designating any disease, symptom, injury, or physiological function. any cause of disease. any means or measure of treatment of disease. any anatomical organ or region. word denoting mode of termination, results, consequences, or indirect effects of disease. any term of prognostic import. common or proper name of any person. . man word denoting or implying age of a person. any of the well-known male sexual characteristics. occupation or profession more or less peculiarly masculine. word pertaining to familial relationships or domestic organization. word pertaining to sexual relationships; any word denoting the opposite sex. the proper name of any male person. any article of male apparel. . deep any vessel or container. any natural or artificial body of water. any depression of surface. any object naturally situated or often artificially placed at a comparatively great distance below the surface. any act of progress from surface to depth. . soft any article of food. any fabric. . eating any article of table linen, china, or silver. any organ of digestion; any function of nutrition. any article of food; any meal. any private or public eating place. word denoting taste. . mountain name of any mountain, mountain range, or mountainous country. word pertaining to shape, geological composition, fauna, or flora of mountains or mountainous regions. any term of physical geography. . houses any place of house location. any part of a house. any material used in the construction of a house. any part of the process of construction of a house. laborer or mechanic having to do with the construction of a house. any commercial term pertaining to ownership, taxes, mortgages, sale, renting, or occupancy of a house. any article of furniture. . black any object or substance that is always or often black or dark in color. any color. word denoting limitation or obscuration of light. any word clearly related to the word black used as a proper name. . mutton any article of food; any meal. any animal, or class or group of animals, whose meat is used for human consumption as food. any article of table linen, china, silver; any cooking utensil. word designating any person engaged in the preparation of meats for consumption. word denoting any process employed in the preparation of meats for consumption. . comfort any agreeable or disagreeable subjective state. any object, act, or condition that contributes to comfort or produces discomfort. . hand any simple function of the hand; work requiring special manipulation. word denoting skill or any degree of skill. any part or any tissue of the body. . short any word involving the concept of duration. common or proper name of any person. any word denoting shape, relative or absolute dimension, or distance. any object in which characteristically one dimension exceeds any other. . fruit any article of food; any meal. any process employed in the cultivation of fruits or in their preparation for consumption. word designating any person engaged in the cultivation of fruits or in their preparation for consumption. any article of table linen, china, or silver. . butterfly any bird, worm, or insect any flower. any color. . smooth any object possessing a smooth surface as a characteristic feature. any fabric. . command word denoting any means of influence of one mind upon another intended to produce acquiescence. word denoting or implying acquiescence or lack of it. term applied to any commanding officer or to any person in authority. . chair any article of furniture. any room or apartment . sweet any substance having a sweet taste. common or proper name of a child' or woman. . whistle any instrument or any animal producing a shrill musical sound. . woman word denoting or implying age of a person. any of the well-known female sexual characteristics. occupation or profession more or less peculiarly feminine. word pertaining to familial relationships or domestic organization. word pertaining to sexual relationships; any word denoting the opposite sex. name of any female person. any article of female apparel. . cold name of any location characterized by low temperature. any illness or symptom which may be caused by exposure to cold. any division of the annual cycle. any food that is always or often served cold. any means or measure of protection against cold. any state of the natural elements causing a sensation of cold. word denoting subjective characterization of or reaction to cold. . slow any means or manner of locomotion. any word involving the concept of rate of progress with reference either to time or to intensity of action. common or proper name of any person. . wish word implying fulfillment of a wish either by achievement or through acquiescence. word implying non-fulfillment of a wish. word denoting any state of longing or anticipation. word denoting any state free from longing or anticipation. word denoting a prayer or request. word denoting a state of happiness. . river any body of water. any part of a river. any plant or animal living in rivers. any term of physical geography. any vessel or contrivance for navigation. . white any object or substance that is always or often white or very light in color. any color. any word clearly related to the word white used as a proper name. . beautiful any word denoting aesthetic pleasure. name or any female person. any product of the fine arts or of decorative handicraft. any decorative plant or flower. any article of attire. natural scenery. any division of the diurnal cycle. . window any word pertaining to illumination. word pertaining to movements of air. any attachment to a window for the control of transmission of light or air. any building or apartment . rough any object or substance which is characteristically rough to the touch. word denoting or implying irregularity of surface. any skin lesion which may impart to the skin the quality of roughness. any word implying carelessness, lack of consideration, or crudeness; any word used to designate action or conduct which may be characterized as careless, inconsiderate, or crude. . citizen any word pertaining to political organization, or to factors either favorable or unfavorable to it. any term or proper name of political geography. common or proper name of any male person. . foot any means or manner of locomotion involving the use of the feet. any part or any tissue of the animal body. any article of foot-wear. any way constructed or used for walking. any unit of linear measure. . spider word employed to designate subjective characterization of or reaction to an object of dislike. any insect. word pertaining to the characteristic habits of spiders, with reference either to location and construction of nest, or to manner of catching prey. . needle any material used in making clothes. any special sewing operation; any occupation in which sewing constitutes part of the work. any special kind of needles. any instrument which is used in connection with a needle in any operation, or of which a needle forms a part. . red word which may be used to express subjective characterization of the red color. any object or substance which is always or often red in color. anything which is by convention or common usage connected with the red color. any organ, tissue, or lesion, exposed to view, which may have a red color imparted to it by the blood or by physiological pigment any color or coloring material. any word implying light through incandescence. . sleep word denoting somnolence or a state of lowered consciousness; anything which is a cause of somnolence or of lowered consciousness; anything which induces a desire to sleep. word denoting a state of active consciousness or a transition from lowered to more active consciousness. any division of the diurnal cycle. any word more or less commonly used to characterize sleep in any way. any article of bedding, bed-linen, or night-clothes. any article of furniture used for sitting or lying. . anger any affective state; any common demonstration of emotion. any common cause or provocation of anger. action or conduct caused by anger; word used to characterize such action or conduct. . carpet any material of which carpets are made. any article of house furniture, hangings, or decorations. word denoting home, house, or any part of a house. word pertaining to the manufacture or care of carpets, or denoting a person engaged in the manufacture, sale, or care of carpets. any country especially noted for the manufacture of carpets or rugs. any color. . girl word denoting or implying age of a person. any of the well-known female sexual characteristics. occupation or profession more or less peculiarly feminine. word pertaining to familial relationships or domestic organization. word pertaining to sexual relationships; any word denoting the opposite sex. name of any female person. any part of a person's body. any article of female apparel. . high any word denoting or implying skill, training, achievement, or position. any word denoting or implying valuation. any architectural structure. any object of which the vertical dimension characteristically exceeds any other. any act of progress from a lower to a higher level. name of any mountain or mountain range. anything characteristically situated at a high level. anything characteristically variable in height. . working any occupation, profession, art, or labor. direct results or consequences of work. any place of employment. rest, recreation, inaction, or disinclination to work. word denoting energy, material, capital, equipment. . sour any substance or object which is always or often sour in taste. any word denoting a taste or flavor quality. . earth any substance which enters into the composition of soil. word pertaining to the utilization or cultivation of natural resources; any product of agriculture. any term of physical geography, geology, mineralogy, meteorology, or astronomy. . trouble any affective state. any general cause of active emotional states. any common manifestation of emotion. word denoting or implying defeat. word denoting or implying caution or lack of it. any task. . soldier word pertaining to military organization. word pertaining to any military operation. word pertaining to military discipline or to military decoration. any article of military or naval equipment or attire. common or proper name of any male person. name of any country. word pertaining to political organization. . cabbage any article of food; any meal. any article of table linen, china, silver; any cooking utensil. any process of cooking. word used to designate any person engaged in the cultivation of cabbages or in their preparation for consumption. . hard any solid article of food. word denoting or implying impact. any task or labor. any substance which is hard or unyielding. any agency or process by which a substance is solidified or hardened. any article of furniture used for sitting or lying. any trait of disposition characterized by lack of readiness to yield or lack of consideration for others. . eagle any bird. any piece of currency. anything in connection with which the word eagle is used in a symbolic sense. . stomach any anatomical organ or region. any article of food; any meal. word pertaining to ingestion and assimilation of food. term denoting health or disease; any medicament. . stem any object which has a stem. any part of a plant. any object which is long, slender, and more or less rigid. . lamp any means or source of illumination. word denoting or implying illumination. . dream any product of imagination. any psychical phenomenon; any part of the psychical organ. word denoting or implying unreality or uselessness. word denoting or implying mystery or occultism. any division of the diurnal cycle. any article of bedding, bed-linen or night-clothes. any article of furniture used for sitting or lying. any narcotic substance. . yellow word which may be used to denote subjective characterization of the yellow color. any object or substance which is always or often yellow in color. any color or coloring material. . bread any article of food; any meal any article of table linen, china, or silver; any cooking utensil. any private or public eating place. word pertaining to ingestion and assimilation of food. any ceremony in connection with which bread is used. . justice any word implying crime or tendency to crime, legal trial, retribution or lack of it, or repentance. any officer of the law. word pertaining to judiciary organization. word denoting any kind of ethical relationship. any deity. the name of any justice or judge. any function of a judicial authority. any word denoting or implying equality. . boy word denoting or implying age of a person. word pertaining to familial relationships or domestic organization. word pertaining to sexual relationships; any word denoting the opposite sex. common or proper name of any male person. any part of a person's body. any article of male apparel. any common boys toy or game. word pertaining to educational organization. . light any source, apparatus, or means of illumination. any color or coloring material. word implying light through incandescence. any term of optics; any optical phenomenon. any object or substance which is characteristically light in weight. . health any emotion; any common manifestation of emotion. any disease or symptom. word pertaining to prevention or treatment of disease. word pertaining to any normal bodily function. word pertaining to the preservation of health. word denoting or implying a state of health. any athletic sport or form of exercise. any anatomical organ or region. . bible name of any personage mentioned in the bible. any religion or religious denomination. any name or attribute employed in reference to the deity. any article or act of religious ritual. word denoting or implying belief, disbelief, or doubt. any term of theology. . memory word pertaining to operations, faculties, endowment, training, or condition of the mind. word denoting any degree of accuracy. word denoting the cranium; any part of the psychical organ. word pertaining to the past. any word implying transiency. any subject of study involving the exercise of memory. any method or means for the reinforcement of memory. any of the senses. word denoting retention. . sheep any animal raised or hunted for clothing material, for food, or for its services as a beast of burden. any product manufactured from the skin or wool of sheep. any of the more or less distinctive characteristics of sheep. any food product derived from sheep. . bath word denoting or implying an effect of bathing on the body. any body of water. any kind of bath; any part of bath, lavatory, or toilet equipment. any material of which a bathing equipment is largely made. word denoting a state of partial or complete undress. any beach or bathing resort. any aquatic feat of gymnastics. . cottage word pertaining to landscape gardening. any place of cottage location. any part of a house; any color. any material used in the construction of a cottage. any laborer or mechanic having to do with the construction of a cottage. any part of the process of construction of a cottage. any commercial term pertaining to ownership, taxes, mortgages, sale, renting, or occupancy of a cottage. any article of furniture. . swift any means or manner of locomotion. word denoting or implying motion or rate of motion. any animal or familiar object characterized by rapid locomotion. any word clearly related to the word swift used as a proper name. . blue word which may be used to express subjective characterization of the blue color. any object or substance which is always or often blue in color. anything which is by convention or common usage connected with the blue color. any organ, tissue, or lesion, exposed to view, which may have a blue color imparted to it by the blood or by physiological pigment. any color or coloring material. . hungry any animal. any article of food; any meal. word denoting taste or flavor. word denoting or implying privation or torture. any article of table linen, china, or silver. any private or public eating place. any organ of digestion; any function of nutrition. word designating any person engaged in the preparation or sale of foods. . priest any religion or denomination. any article or act of religious ritual. any term of theology. word denoting or implying sanctity. word denoting or implying belief, disbelief, or doubt. word pertaining to church organization. proper name of any priest. any article of clerical attire. any profession more or less peculiarly masculine. . ocean any body of water. any plant or animal living in the ocean. any term of physical geography. any vessel or contrivance for navigation. word pertaining to navigation; any nautical term. common or proper name of any place bordering on the ocean. any aquatic feat of gymnastics. . head any organization which has a person occupying the highest office. word denoting or implying the highest office of any organization. any intellectual faculty, quality, or operation. any part of the head. any pathological condition affecting the head. . stove any part of a stove. any kitchen utensil. any artificial heating apparatus; any fuel. any manner of cooking; any person engaged in cooking food. any article of household furniture. . long any word involving the concept of duration. word denoting shape, relative or absolute dimension, or distance. any object in which characteristically one dimension exceeds any other. . religion any religion or denomination; the name of any race or nation. any term of theology. any branch of metaphysical philosophy. . whiskey any beverage; the name of any brand of whiskey. any material of which whiskey is made. word denoting taste or flavor. any occasion or ceremony commonly associated with the use of alcoholic beverages. word denoting a state of lowered consciousness. any physiological or pathological effect of alcohol; also any well known, indirect effect. . child word denoting or implying age of a person. word pertaining to familial relationships or domestic organization. name of any person. any part of a person's body. any article of a child's apparel. any common child's toy or game. word pertaining to educational organization. any word descriptive of the natural physical or mental make-up of a child, or of the rate or degree of physical or mental development. word pertaining to any custom or ceremony connected with the birth or rearing of children. any term of obstetrics. any word clearly related to the word child used as a proper name. . bitter any substance having a bitter, sour, sweet, or salt taste, or a complex taste quality which may be characterized as strong. word denoting a taste or flavor quality. any organ of taste. any word in connection with which the word bitter may be used in the sense of poignant. . hammer any tool or weapon. any trade involving the use of a hammer. . thirsty any beverage. any animal. word denoting taste or taste quality. any part of the upper end of the digestive tract. any drinking place; any container of a beverage. any fruit; any dessert. any food ingredient commonly known to excite thirst. . city name of any division of political geography. any architectural structure. any part of a city. word pertaining to the political organization of a city. . square the name of any city. the name of any square in a city or town. any geometrical figure or part of one. any object that is always or often square in shape. any device used in the arts for measuring angles, arcs, or distances between points. any part of a carpenter's or draughtsman's square. any trade involving the use of the square. . butter any article of food; any meal. any article of table linen, china, or silver; any cooking utensil. any process of cooking. . doctor the name of any physician. any medical speciality or practice. any medical or surgical procedure. any therapeutic remedy or method. any organization for the treatment of disease. name of any injury or disease. . loud any sound or sound quality. any part of the human vocal apparatus. any act of vocalization. any musical instrument. any apparatus for making sound signals. word denoting renown or commendation. . thief word denoting crime or wrongdoing. word denoting any circumstance propitious for theft. any common measure for the prevention or punishment of crime. any judicial, police, or penal authority. any readily portable article of value. word denoting renown. . lion word denoting or implying fear. any animal. . joy word denoting a state, quality, faculty, or function of the mind. any common manifestation of emotion. any occasion, act, or means of recreation or of pleasurable excitement. . bed any article of bedding, bed linen, or night-clothes. any article of furniture. any living room, apartment, or building. any part of a room. any division of the diurnal cycle. any material of which beds are made. word pertaining to sleep or rest. . heavy word denoting or implying weight or lightness. any object or substance which characteristically possesses the quality of either great weight or marked lightness. any means of support or suspension. any fabric; any article of clothing or bedding. word denoting something to be carried or transferred. any painful emotion. word denoting a state of lowered consciousness. . tobacco the name of any brand or variety of tobacco. term denoting any common quality of tobacco. any physiological or pathological effect of tobacco. any word which expresses subjective characterization of tobacco. . baby word denoting or implying age or size of a person. word pertaining to familial relationships or domestic organization. name of any person. any part of a person's body. any article of a child's apparel. any common child's toy or game. word pertaining to any custom or ceremony connected with the birth or rearing of children. any term of obstetrics. . moon any term of astronomy. word denoting or implying illumination or obscuration of light. any division of the diurnal cycle. . scissors any operation or handicraft involving the use of scissors. any fabric; any article of clothing. any metal of which scissors are made. any tool for cutting, piercing, or sharpening. any operation of cutting, piercing, or sharpening. . quiet any place where silence usually prevails or is enforced. word denoting or implying a state of lowered psychical activity or of psychical inhibition. word denoting heightened psychical activity. any word pertaining to the emotions. . green word which may be used to express subjective characterization of the green color. any object or substance which is always or often green in color. anything which is by convention or common usage connected with the green color. any color or coloring material. any plant, collection of plants, or part of a plant. any word clearly related to the word green used as a proper name. . salt any article of food that is usually seasoned with salt; any seasoning; any relish. any article of table linen, china, or silver. any process of cooking. any term of chemistry. . street name of any street or city. any part of a street. any building. any manner or means of locomotion commonly employed in traveling through streets. . king any name of the deity. the proper or common name of any ruler of a nation or of a smaller municipality. any nation or country. any title of nobility. any word clearly related to the word king used as a proper name. . cheese any article of food; any meal. word denoting any variety of cheese. word pertaining to taste, flavor, or odor. word pertaining to appetite. any article of table linen, china, or silver. . blossom any plant, collection of plants, or part of a plant. any term of botany. any division of the annual cycle. . afraid any affective state; any common demonstration of emotion. any common object of fear. word denoting or implying danger, courage; any means of defense or protection against danger. generously made available by the internet archive.) on the state of lunacy and the legal provision for the insane, with observations on the construction and organization of asylums. by john t. arlidge, m.b., a.b. (lond.), licentiate of the royal college of physicians; associate of king's college, london; physician to the west of london hospital; formerly medical superintendent of st. luke's hospital, and physician to the surrey dispensary, etc. london: john churchill, new burlington street. . printed by taylor and francis, red lion court, fleet street. to the right honourable the earl of shaftesbury, chairman of the commission of lunacy, whose long-continued and untiring efforts in behalf of the insane have earned for him the highest esteem and admiration of all who feel interested in the welfare of that class of the afflicted, this treatise is, by permission, respectfully dedicated by his lordship's most obedient humble servant, the author. preface. the writer of a book is usually expected to show cause for its production,--a custom which, however commendable as a sort of homage to his readers for challenging their attention to his lucubrations, must often put the ingenuity of an author to the test. indeed the writer of this present treatise would feel some embarrassment in accounting for its production, did he not entertain the conviction that he has, in however imperfect a manner, supplied a work on several important subjects which have never before been so placed before the public, and which, moreover, occupy just now a most prominent position among the topics of the day. in the last parliament, up to the period of its dissolution, a special committee of the house of commons was engaged in examining into the condition of lunatics and the laws of lunacy; and the present government has re-appointed the committee, in order to resume the inquiry preparatory to the introduction of new enactments into the legislature. the subjects treated of in the following pages relate to the same matters which have engaged the attention of parliament, and elicited the special inquiry mentioned, viz. the present state of lunacy and of the legal provision for the insane with reference to their future wants. in order to a better appreciation of the existing provision for the insane, and of its defects, the author has introduced certain preliminary chapters on the number of the insane, on the increase of insanity, on the inadequacy of the existing public provision for the insane, and on the curability of insanity. in reviewing the character and extent of the provisions for the insane, the course adopted has been to regard them in reference to their effects on recovery, and to discover the conditions inimical to it, whether without or within asylums. hence the evils of private treatment and of workhouse detention of lunatics, particularly of the latter, have largely claimed attention. the condition of pauper lunatics boarded with their friends or with strangers demanded special notice, as did the long-complained-of evils of sending unfit cases to the county asylums, often to the exclusion of recent and curable ones, which might by proper treatment be restored to health and society. turning to the consideration of our public asylums, considered as curative institutions, the disposition to extend them to an unmanageable size, and to substitute routine for treatment, has called for animadversion, as an error pregnant with numerous evils to their afflicted inmates. another error pointed out is that of appointing too small a medical staff to asylums; and in proving this, as well as in estimating the proper size of asylums, the experience and opinions of both english and foreign physicians are copiously referred to. the future provision for the insane forms an important chapter, which, in order to consider the several schemes proposed, is divided into several sections, viz. concerning the propriety of building separate asylums for recent and for chronic cases--of constructing distinct sections--of distributing certain patients in cottage homes--of erecting separate institutions for epileptics and for idiots. the registration of lunatics has appeared to the author's mind of so great necessity and value that he has devoted several pages to unfold his views and to meet probable objections; and, in order to render the plan effectual, he has propounded as a complementary scheme the appointment of district medical officers, and entered into detail respecting the duties to be imposed upon them. viewing the commission of lunacy as the pivot upon which any system of supervising and protecting all classes of lunatics must turn, it became necessary to examine into the capability of the present board for its duties; and the result of that examination is, that this board is inadequate to the effectual performance of the duties at present allotted to it, and that it would be rendered still more so by the adoption of any scheme for a thoroughly complete inspection and guardianship of all lunatics. this conclusion suggests the proposition to enlarge the commission, chiefly or wholly, by the appointment of assistant commissioners, charged particularly with the duties of inspectors. the concluding chapter, on asylum construction, may be considered supplementary. its chief intent is to develope a principle generally ignored, although (unless the arguments in support of it fail) one of great importance if asylums are to serve, not as simple refuges for lunatics, but as instruments for treating them. this _résumé_ of the heads of subjects discussed in the ensuing pages will, on the one hand, show that the present is not to be reckoned as a medical treatise, but as one addressed to all who are interested either in the legislation for lunatics or in their well-being and treatment; and, on the other, make good, it is trusted, the assertion that it occupies an untrodden field in the literature of insanity, and that its matter is good, even should its manner be thought not so. assuming the publication of the book to be justifiable, it only remains for the author to add that he has not undertaken its composition without bringing to the task thirteen years' study and practical experience among the insane, treated in private houses, in licensed houses, and in public asylums, together with the fruits of observation gathered from the visitation of most of the principal asylums of france, germany, and italy. in conclusion, he hopes that this small volume may in some measure contribute towards the amelioration of the condition of the insane, who have such especial claims on public sympathy and aid. j. t. a. kensington, july . contents. preliminary observations. importance of an inquiry relative to the number of the insane, and the legal provision for them, . chap. i.--of the number of the insane. official returns imperfect, .--divergence of returns of lunacy commissioners and of poor-law board, .--unreported 'private' lunatics, .--criminal lunatics in prisons, .--inadequate estimate of the number of the insane, .--illustration of the difficulty of discovering the true statistics of lunacy, .--number of pauper lunatics in workhouses, .--paupers not enumerated in official returns, .--estimate of the total number of the insane on st of january , .--causes of apparent increase, . chap. ii.--on the increase of insanity. materials for calculation unsatisfactory, .--rate of accumulation of the insane in asylums, .--estimate of increase made by the commissioners, .--table of number of lunatic paupers in workhouses, .--calculation of their rate of increase, .--increase of pauper lunatics not in workhouses or asylums, .--total increase and accumulation of lunatics, .--positive increase of insanity by new cases, .--table of admissions in four years, .--total number of new cases added yearly, .--expenditure on account of the pauper insane, .--proportion of the insane to the population, .--cause of accumulation of the insane, .--suggestions for obtaining improved statistics of pauper lunatics, . chap. iii.--state of the present provision for the insane in asylums.--its inadequacy. commissioners' calculation of asylum accommodation wanted, .--their conclusion that the present provision is inadequate, .--on the accuracy of the commissioners' conclusions, .--pauper lunatics accommodated in workhouses, and boarded out, .--their unsatisfactory condition, .--colony of insane at gheel, in belgium, .--character of lunatics in workhouses, .--unfit cases of insanity in workhouses, .--commissioners' estimate that one-half of lunatic inmates of workhouses are improperly detained, .--estimate of asylum accommodation required, . chap. iv.--on the curability of insanity. insanity a very curable disorder, .--experience of american physicians, .--exceptional circumstances in american asylums, .--experience of st. luke's hospital, london, .--experience of the derby county asylum, .--advantages of early treatment, . chap. v.--on the causes diminishing the curability of insanity, and involving the multiplication of chronic a. _causes external to asylums._ § _detention of patients in their own homes._ absence of all curative influences at home, .--causes of delay in submitting patients to treatment, .--impediments to transmission to county asylums, .--evils of pauper test in public asylums, .--characters of continental asylums, .--practice followed in america, .--scheme of assessment of means of those applying for admission to public asylums, .--failure of the pauper test to protect the rate-payers, .--its demoralizing and degrading effects, .--suggestion as to conditions and mode of admission into county asylums, .--act in force to recover the costs of maintenance objectionable and inefficient, . § _detention of patients in workhouses._ detention practised on economical considerations, .--examination of the value of such considerations, .--estimated cost in asylums and in workhouses includes different items in the two, .--illustration from the devon asylum report, .--children constitute above two-thirds of workhouse inmates, .--material effect of this on the cost of maintenance, .--inmates of asylums almost all adult, .--fluctuations among inmates of workhouses greater than in asylums, .--mode of estimating the rate per head of cost in workhouses, .--population of workhouses, sane and insane mixed, ;--that of asylums of insane especially, .--those insane who involve increased cost rejected from workhouses, .--remarks on this point by dr. bucknill, .--economy of workhouses for the insane doubtful, .--cost of asylums contrasted with that of workhouses, .--system of asylum structure hitherto adopted unnecessarily expensive, .--workhouses and asylums not fairly comparable as to cost, .--plan to diminish cost of asylums one-half, .--chronic lunatics can be provided with asylum accommodation at a rate not exceeding that for workhouses, .--internal cost of asylums and workhouses compared, .--mistaken policy of constructing lunatic wards, .--unfitness of workhouses for insane patients, , .--evils attending presence of lunatics in workhouses, .--american experience in the matter, .--workhouses unfit by structure and organization, , .--workhouse detention especially prejudicial to recent cases, , .--deficiency of medical care and of nursing in workhouses, , .--the dietary of workhouses insufficient for lunatics, , .--injurious effects of workhouse wards upon lunatics, , .--lunacy commissioners' remarks thereon, .--dr. bucknill's remarks on the same subject, .--characters of the lunatic inmates of workhouses, .--the majority of them imbecile and idiotic, .--proportion especially claiming asylum care, .--epileptics and paralytics unfit inmates of workhouses, .--old demented cases badly provided for in workhouses, .--imbecile patients are, as a rule, unfit inmates, .--idiots improperly detained in workhouses, .--none but a few imbeciles permissible in workhouses, .--on the class of supposed 'harmless' lunatics, .--remarks by dr. bucknill on this class, .--experience of the surrey magistrates on transferring 'harmless' patients to workhouses, .--degradation of the patients' condition in workhouses, .--legality of workhouse detention examined, .--remarks on this subject by the lunacy commissioners, .--clauses of the lunacy asylums act bearing on the subject, .--defects of the law in protecting the pauper insane, .--remarks of the lunacy commissioners on the anomalies of the law, .--objections to the powers conferred upon parochial officers, .--the law obscure, and open to evasion, .--duties of the parish medical officers ill-defined, .--proposal of a district medical officer, .--contravention of the law by boards of guardians, , .--the further construction of lunatic wards should be stopped, .--necessity for the supervision of the lunacy commissioners over workhouses, .--several amendments of the lunacy laws suggested, .--proposed regulations for supervision of workhouses containing lunatics, , .--lunatics in workhouses should be under certificates, .--proposal to increase powers of lunacy commissioners over workhouses, .--on the supplement to the 'twelfth report' ( ) 'of the commissioners in lunacy,' on workhouses, .--abstract of its contents:--unfitness of workhouses for lunatics, .--workhouses in large towns most objectionable, .--lunatic wards more objectionable than the intermixture of the insane with the other inmates, .--miserable state of the insane in lunatic wards, , .--no efficient visitation of workhouse lunatics, .--insufficiency of the dietary for insane inmates, .--medical treatment and nursing most defective, .--fearful abuse of mechanical restraint in workhouses, .--wretched neglect and want in the internal arrangements for lunatics in workhouses, .--abuse of seclusion in workhouses, .--varieties of mechanical restraint employed, .--absence of all means for exercise and occupation, .--lunatics in workhouses committed to gaol, .--neglect and contravention of the law by parish officers, .--amendments in the law suggested by the lunacy commissioners, .--proposal to erect asylums for chronic cases, , .--visiting justices of asylums to supervise workhouse lunatic inmates, , . § _pauper lunatics living with relatives or strangers._ number of such lunatics, .--neglect of their condition, .--question of insanity should be left to the district medical officer, , .--this officer should visit and report on their condition, , .--indications of the unsatisfactory state of this class of pauper lunatics, .--evidence from dr. hitchman's reports, .--wretched state of 'single' pauper patients in scotland, .--neglect of poor-law medical officers towards such patients, .--objections to boarding pauper lunatics with strangers, .--district medical officer to select their residence, , .--advantage of keeping them in lodgings near asylums, , .--distribution of lunatics in cottage homes, , .--notice of the colony of insane at gheel, , . § _unfit cases sent to asylums.--improper treatment prior to admission._ recklessness and cruelty in transmitting patients, .--non-lunatic cases sent to asylums, .--cases of very aged persons sent, .--previous horrible neglect of patients, and their moribund state on admission, .--extracts from reports of asylum superintendents illustrative of the facts, - .--transfer of lunatics to asylums must be committed to some competent and independent officer, .--want of instruction for medical men in insanity, ;--errors committed owing to the want of it, .--neglect of psychological medicine in medical education, .--law regulating transfer of weak cases to asylums, .--an amendment of the law requisite, . chap. vi.--causes operating within asylums to diminish the curability of insanity, and involving a multiplication of chronic lunatics. § _magisterial interference_ and § _excessive size of asylums_. defective medical staff in large asylums, .--efficient treatment impossible, , .--degeneration of management into routine, .--exclusive estimation of so-called 'moral treatment,' .--a very large asylum especially prejudicial to recent cases, .--delegation of medical duties to attendants, .--evils of absence of medical supervision over individual patients, .--evils of large asylums upon character of attendants, .--routine character of medical visits, , .--necessity of medical supervision being complete, , , .--distinction of asylum attendants into two classes--attendants proper, or nurses, and cleaners, .--objections advanced by the lunacy commissioners to large lunatic asylums, .--the erection of large asylums supposed to be economical, .--the supposition fallacious, .--commissioners' remarks on these topics, .--rate of maintenance higher in the largest asylums, .--inadequate remuneration of medical superintendents, .--lord shaftesbury's advocacy of improved salaries, . § _limit to be fixed to the size of asylums._ proper number to be accommodated in an asylum, , , _et seq._--estimate of american physicians, .--estimate of french and german physicians, .--peculiar organization of german asylums, , . § _increase of the medical staff of asylums._ opinions of foreign physicians on the subject, .--estimate of the medical staff requisite, .--erroneous views prevalent in some asylums, .--illustration furnished by the middlesex asylums, .--jacobi's views of asylum organization, .--advantages of unity in the organization of asylums, .--appointment of a chief physician, paramount in authority, .--circumstances affecting the selection of asylum superintendents, . chap. vii.--on the future provision for the insane. rapid extension in the demand for accommodation, .--illustrated by reference to the middlesex asylums, . § _separate asylums for the more recent and for chronic cases._ objections to such separate establishments, .--examination of the value of these objections, .--cases to be transferred from one institution to the other, how determined, .--mixture of recent with chronic cases undesirable, , .--examination of the present relative position of acute and chronic cases, .--separate treatment of recent cases desirable, .--influence of distance on the utility of an asylum as a place of treatment, .--borough asylums, .--many chronic cases removable from asylums, .--less expensive buildings needed for chronic cases, .--views of the lunacy commissioners on these points, .--evidence of lord shaftesbury, .--french system of dividing asylums into 'quarters,' .--permissive power of lunacy act to build distinct asylums for chronic cases, .--on the powers of the home secretary to control asylum construction, .--amendment of present act proposed, .--on mixed asylums, for recent and chronic cases together, .--conditions under which distinct institutions are desirable, .--advantages of an hospital for recent cases, .--number of inmates proper in such an hospital, .--regulations required in it, .--organization of asylums for chronic cases, .--union of counties for the purpose of constructing joint asylums, . § _construction of distinct sections to asylums._ german system of 'relative connexion' of asylums for recent and chronic cases, .--proposition of lunacy commissioners to place industrial classes of patients in distinct wards, .--advantages of separate sections, .--objections to a purely 'industrial classification' of patients, . § _distribution of the chronic insane in cottage homes._ subdivision of asylums for chronic cases, .--illustration of cottage provision for the insane at gheel, .--the system at gheel impracticable as a whole, .--the 'cottage system' deserving of trial under proper restrictions, .--suggestions as to the arrangements required, .--'cottage system' supplementary to asylums, .--economy of 'cottage system,' . § _separate provision for epileptics and idiots._ epileptics need separate provision, .--idiots not fit inmates of lunatic asylums, .--idiots require special asylum provision, .--removal of idiots from workhouses, . chap. viii.--registration of lunatics. necessity of registering the insane, .--large number of insane at present unprotected, .--legal advantages of registration, .--desirability of correct statistics of insanity, .--lord shaftesbury's evidence on this point, .--registration as a means of discovering the existence and condition of lunatics, .--registration would promote early treatment, .--should be accompanied by visitation, .--enactment necessary to regulate the sending of lunatics abroad, .--practice pursued in sardinia, .--suggestions offered, .--all patients removed uncured from asylums ought to have the place of their removal reported, .--objections raised to registration, .--their validity examined, .--principle of a compulsory registration and visitation of all lunatics recognized in belgium, .--english enactments respecting 'single' patients, .--their failure, .--lunatics secluded under the name of 'nervous' patients, .--lord shaftesbury's observations on defects in the lunacy laws respecting 'single' cases, .--clauses to act, proposed by his lordship, to deal with 'nervous' patients, .--clauses open to some objections, .--lord shaftesbury's proposal to report every 'nervous' patient, .--compulsory powers of lunacy act defective, .--suggestions made, .--proposition to report all lunatics to a district medical officer, who should visit, .--additional certificate granted by this officer, .--lunatics well protected, .--modification of present form of certificates of insanity, .--objections to two forms of certificates, .--determination of the nature of certificate to be given, .--clause in scotch asylums act respecting 'single' cases, .--need of mitigated certificates and of intermediate asylums for certain cases of mental disturbance, . chap. ix.--appointment of district medical officers. district physicians appointed in italy and germany, .--recognition of principle of appointing district officers in england, in the instance of sanitary medical officers, .--district medical officers need to be independent, .--extent of districts, .--such officers to register and visit reported cases of lunacy, .--their reports of cases valuable, .--idiots also should be registered, .--district officer might sign order for admission to an asylum, .--better qualified for the duty than magistrates, , .--illustrations from evidence of lord shaftesbury and mr. gaskell, .--suggestions respecting signature of orders, .--objections to clergymen signing orders, .--magistrate's order not required for private patients, .--remarks on proposition of commissioners to leave selection of cases in workhouses for asylum treatment to the union medical officer, .--district officer best qualified for this duty, .--additional protection afforded to lunatics by the appointment of district medical officers, .--district officer to inspect lunatics in workhouses, .--regulations for his guidance, .--lunatics in workhouses should be under certificate, .--medical officer best judge of the wants of cases, .--no removal of lunatics from workhouses without supervision, .--committee of visiting magistrates for workhouses, .--principles of action of the lunacy commission, .--commissioners' recommendation of visiting committees, .--workhouses licensed to receive lunatics, .--lunatics in workhouses reported by district officer, .--visitation of pauper lunatics by parish authorities, .--no such visitation of county lunatics, .--desirability that county lunatics should have a visitor, .--determination of question of lunatics chargeable best left to district officer, .--duties of district officer with outdoor pauper lunatics, .--need of inspection of singly-placed lunatics, .--cost of such inspection, .--district officer to visit single cases in lodgings, &c., .--to visit private asylums as the physician, joined in inspection with the magistrates, .--position and remuneration of district officers, .--such officers to be met with, .--district officers engaged in medico-legal inquiries, .--such a class of officers much needed, .--neglect of organization in state medical matters, .--a proper organization not necessarily costly, . chap. x.--on the lunacy commission. centralization dreaded as an evil, .--importance of a central and independent body to the interests of the insane, , .--want of power in the hands of commissioners, .--reasons for a central board, .--more frequent visitation of asylums desired, .--value of commissioners' opinion on lunatic cases, .--inquiries of commissioners respecting the payment for patients, .--divided authority of commissioners and magistrates in the case of private asylums, .--anomaly of this state of things, .--lunacy commissioners too few, .--magistrates not effectual as asylum visitors, .--jurisdiction of the commission should be the same throughout the country, .--licensing powers of magistrates, .--duties of office of masters in lunacy, .--commissioners should visit all lunatics, whether chancery or not, .--proposed division of lunacy commission, , .--advantages of the division proposed, .--reasons for increasing commission, .--want of commissioners' supervision of lunatics in gaols, .--inadequacy of the present number of commissioners, .--appointment of assistant commissioners, . chap. xi.--of some principles in the construction of public lunatic asylums. principles of construction in general use, .--authorities on asylum construction, .--examination of the 'ward system,' .--sketch of the conditions of life in a 'ward,' .--disadvantages of the arrangements, .--the arrangements of a ward vary widely from those of ordinary life, .--day and night accommodation should be quite separate, .--advantages of this plan, .--salubrity, warming, and ventilation promoted, .--economy resulting therefrom, .--means of communication facilitated, .--supervision facilitated, .--classification improved, .--domestic arrangements facilitated, .--management facilitated, .--a smaller staff of attendants required, .--the cost of construction diminished, .--objections to a third story removed, . the state oe lunacy, and the legal provision for the insane. preliminary observations. the number of the insane, and the legal provision requisite for their protection, care, and treatment, are subjects which will always recommend themselves to public attention and demand the interest alike of the political economist, the legislator, and the physician. to the first, the great questions of the prevalence of insanity in the community, its increase or decrease, its hereditary character, and others of the same kind, possess importance in relation to the general prosperity and advance of the nation; to the second devolves the duty of devising measures to secure the protection both of the public and the lunatic, with due regard to the personal liberty, and the proper care and treatment, of the latter; to the last belongs the practical application of many of the provisions of the law, besides the exercise of professional skill in the management and treatment of the insane. moreover it will not be denied that, owing to the intimate manner in which he is concerned with all that relates to the lunatic, with all the details of the laws regulating his custody and general treatment, as well as with the institutions in which he is detained, with the features of his malady, and with all his wants, the physician devoted to the care of the insane is well qualified to offer suggestions and recommendations to the legislator. hence the present pages, in which the aim is to examine the present state of lunacy; the advantages to be gained by early treatment; and the adequacy of the existing legal provision for the insane; and to offer some suggestions for improving the condition, and for amending the laws relating to the care and treatment, of this afflicted class of our fellow-creatures. the whole subject of the efficiency of the lunacy laws and of their administration, occupies just now a prominent place in public attention, owing to the rapid multiplication of county asylums and the constantly augmenting charges entailed by them; to the prevalent impression that insanity is rapidly increasing; to recent agitation in our law courts respecting the legal responsibility of the insane and the conditions under which they should be subjected to confinement, and still more to the proposed legislation on the matter during the present session of parliament. it would be a great desideratum could the lunacy laws be consolidated, and an arrest take place in the almost annual additions and amendments made to them by parliament; but, perhaps, this is next to impracticable, owing to the attempts at any systematic, effectual, and satisfactory legislation for the insane, being really of very recent date, and on that account subject to revisions enforced by experience of its defects and errors. however, the present time appears singularly suited to make the attempt at consolidation, so far as practicable, inasmuch as the appointment of a special committee of the house of commons on the lunacy laws, furnishes the means for a complete investigation into existing defects, and for receiving information and suggestions from those practically acquainted with the requirements of the insane, and with the operations of existing enactments. to fulfil the objects taken in hand, and, in the first place, to sketch the present state of lunacy in this country, it will be necessary to investigate the number of the insane, and the annual rate of their increase; then to examine the extent of the present provision for them in asylums and of probable future wants. this done, after a brief essay on the curability of insanity, as a means of judging what may be done to mitigate the evil, we shall review the present provision for lunatics, point out its defects, and suggest various remedial measures, calculated in our opinion to improve the condition of the insane, diminish the evil of the accumulation of chronic cases, and render asylums more serviceable and efficient. in carrying out our design, we shall be found in some measure occupying ground already taken up by the commissioners in lunacy, and by some able essayists in the medical journals. we do not regret this, although it may deprive us somewhat of the merit of originality of conception and elucidation, as it will strengthen our positions and enhance the value of our remarks. fortunately, too, we coincide generally with the opinions from time to time put forth by the lunacy commissioners, to whom so great merit is due for their labours in the interests of the insane, and for the character and position our county asylums enjoy in the estimation of our own people and of foreign nations. to attempt the character of a reformer when the affairs of lunacy and lunatic asylums are in such good hands may be deemed somewhat ambitious; yet as sometimes an ordinary looker-on may catch sight of a matter which has eluded the diligent observer, and, as the views and suggestions advanced are the result of mature and independent thought, aided by experience of considerable length, and very varied, the undertaking may, we trust, be received with favour. at all events, we flatter ourselves that the representation of the state of lunacy in england and wales; the estimate of its increase and of the provision made for it; the evils of workhouses as primary or permanent receptacles for the insane; the ill consequences of large asylums, and some of the legal amendments proposed, are in themselves subjects calculated to enlist the attention of all interested in the general welfare of our lunatic population, and in the administration of the laws and institutions designed whether for its protection or for its care and treatment. chap. i.--of the number of the insane. this inquiry must be preliminary to any consideration of the provision made or to be made for the insane. in carrying it out, we have chiefly to rely upon the annual reports of the commissioners in lunacy along with, so far as pauper lunatics are concerned, those of the poor-law board. however, these reports do not furnish us with complete statistics, and the total number of our insane population can be only approximately ascertained. the lunacy commission is principally occupied with those confined in public asylums and hospitals, and in licensed houses, and publishes only occasional imperfect returns of patients detained in workhouses or singly in private dwellings. on the other hand, the poor-law board charges itself simply with the enumeration of pauper lunatics supported out of poor-rates, whether in asylums or workhouses, or living with friends or elsewhere. hence the returns of neither of these public boards represent the whole case; and hence, too, the chief apparent discrepancies which occur when those returns are compared. to show this, we may copy the tables presented in appendix h of the report of the commissioners in lunacy for , p. . "increase of lunatics of all classes during the last five years, according to commissioners' reports paupers , , private patients , , ------ ------ , , "according to returns published by poor law board during same period county and borough asylums , , licensed houses , , workhouses , , with friends or elsewhere , , ------ ------ , , ." this very considerable difference of patients between the two estimates is mainly due--as reference to the summary (at p. ) proves--to the omission, on the part of the lunacy commissioners, of those resident in workhouses and "with friends, or elsewhere," reckoned in the table of the poor-law board. this explanation, however, is only partial, for, after allowing for it, the two estimates are found to diverge very considerably. thus, on adding the numbers in the categories last named, viz. + = , in ,--and + = , , in to the total given by the commissioners in each of those years, viz. to , and , , respectively, we obtain a total of , in , and one of , in ; a variation of in the former, and of in the latter year, from the results given in the table presented by the poor-law board. much of this wide difference is explicable by the board last mentioned not having reckoned the private patients, who amounted in to , and in to . still, after all attempts to balance the two accounts, there is a difference unaccounted for, of in , and of in . no clue is given in the official documents to the cause of this discrepancy, and we are left in doubt which estimate of our lunatic population is the more correct. the excess occurs in the commissioners' returns; for on adding together, in each year in question, the numbers reported by the poor-law board, as detained in county and borough asylums and in licensed houses, we find that the totals respectively are less than the whole number of paupers as calculated by the lunacy commissioners, by the precise difference we have made out, viz. in and in . of the two returns before us, we accept that of the lunacy commission, viz. that there were, including those in workhouses, and with friends or elsewhere, , reported lunatics in , and , in ; and account for this larger total by the fact that the poor-law board returns apply only to unions and omit the lunacy statistics of many single parishes, under local acts, and some rural parishes under 'gilbert's act,'--containing in them together above a million and a half people more than are found in unions. moreover, the poor-law board returns do not include county and borough patients. looking to these facts, the excess of in , and of in , over and above the totals quoted from the summary of the poor-law board, is not surprising; indeed, taking the average usually allowed of one lunatic in every , the number in one million and a half would be above ; that is, more than half as many again as ; a result, which would indicate the commissioners' total to be within the truth. we have just used the term 'reported lunatics,' for, besides those under certificates and those returned as chargeable to parishes, comprised in the foregoing numbers, there are very many of whom no public board has cognizance. most such are private patients supported by their own means, disposed singly in the residences of private persons, throughout the length and breadth of the country, and, with few exceptions, without the supervision, in reference to their accommodation and treatment, of any public officer. the lunacy commissioners justly deplore this state of things; lament their inability, under existing acts, to remedy it, and confess that not a tithe of such patients is reported to them, according to the intention of the law ( & vict. cap. . sect. xvi.). it would appear that less than such cases are known to them; and it would not be an extravagant or unwarrantable estimate to calculate their whole number at about half that of the inmates of licensed houses, viz. at . this number would comprise those found lunatic by inquisition, not enumerated in the commissioners' summary, although under the inspection of the "medical visitors of lunatics." according to the returns moved for by mr. tite "of the total number of lunatics in respect of whom commissions in lunacy are now in force," there were, on the th july, , such lunatics, and of them were, according to the commissioners' tables, detained in asylums or licensed houses, leaving not reckoned upon. in addition to this class of the insane there is an unascertained small number of persons of unsound mind in the horde of vagrant paupers, alluded to occasionally in the lunacy commissioners' reports. the number of criminal lunatics in asylums is noted in the returns, but that of those in jails is not reckoned. although this is comparatively small, owing to the usual custom of transferring prisoners, when insane, to asylums, yet, at any one period, a proportion sufficient to figure in a calculation of the whole insane population of the country will always be found. nay more, besides such scattered instances in county prisons, there is a very appreciable number in the government jails and reformatories, as appears from the returns presented to parliament (reports of the directors of convict prisons, .) the prisons included in these reports are:--pentonville, millbank, portland, portsmouth, dartmoor, parkhurst, chatham, brixton, fulham refuge, and lewes. in the course of , persons of unsound mind were confined, some for a longer or shorter period, others for the whole of the year, in one or other of those prisons. making allowance for those of the who by removal from one prison to another (a transfer apparently of common occurrence, the rationale of which we should find it difficult to explain), might be reckoned twice, it may be safely stated that at least were in the prison-infirmaries in question the whole year. in fact, the infirmary of dartmoor prison has wards specially appropriated to insane patients, and actually constitutes a criminal asylum of no insignificant magnitude. for instance, the report tells us that on the st of january, , there remained in that prison cases; that were received during the year; discharged (where, or how, we are not told, except of , who were sent to bethlem hospital); and remained on the st of january . it is also worth noting that in this dartmoor prison infirmary, epileptics remained on january st, ; were admitted, discharged, and remained on january st, . the total of epileptics coming under notice in the infirmaries of the several prisons in question, in the course of , amounted to . the remarks on some of these cases of epilepsy by the medical officers, are sufficient to show that the convulsive malady has seriously affected the mental health, and that they might rightly be placed in the category of the insane. however, having no wish to enhance the proportion of the subjects for lunatic asylums, we will deal only with those enumerated as mentally disordered. these amounted, according to the preceding calculations, in the government prisons, to , and it would seem no exaggerated estimate to assert that an equal number may be found in the various other prisons and reformatories throughout the country. to put the matter in another form, lunatics are to be found in english prisons at any date that a census may be taken. consequently this sum of must be added in calculating the total of insane persons in this kingdom. to establish still further the proposition with which we set out, that our public statistics of insanity are incomplete, the history of every county asylum might be adduced: for, notwithstanding very considerable pains have been taken, on the proposition to build a new asylum, to ascertain the probable number of claimants, and a wide margin over and above that estimate has been allowed in fixing on the extent of accommodation provided, yet no sooner has the institution got into operation, than its doors have been besieged by unheard-of applicants for admission, and within one-half or one-third of the estimated time, its wards have been filled and an extension rendered imperative. such is a _résumé_ of the general history of english county asylums, attested in the strongest manner by that of the middlesex, the lancashire, and the montgomery asylums; and confirmatory of the fact of the augmentation of insanity in the country at a rate exceeding, more or less, that collected from county returns and public statistics. it is, moreover, to be observed, that the official statistics represent the total of lunatics existing on one particular day, usually the first of january, in each year, and take no account of those many who are admitted and discharged within the year, and who rightly should be reckoned in an estimate of the total number of the insane belonging to that period. the average daily number resident in asylums would be a more correct representation of their insane population than the total taken on any one day, although it would fail to show the lunacy of the year. lastly, to illustrate the point discussed, to indicate how imperfect our present estimate of the prevalence of insanity most probably is, and to show the difficulties and defects of any ordinary census, we may appeal to the experience of the special commission charged by the legislature of massachusetts to examine the statistics of lunacy and the condition of asylums in that state, as recorded in their report, published in . "in " (they write, p. ), "a committee of the legislature, appointed to 'consider the whole subject connected with insanity within the commonwealth,' ascertained and reported the number of insane in this state to be , of whom were able to furnish the means of their own support, and were unable to do so, and the pecuniary condition of was not ascertained. "in making that survey in , the commissioners addressed their letters of inquiry 'to the municipal authorities of every city and town in the commonwealth.' "these public officers had direct means of knowing the number and condition of the pauper insane, and probably this part of the report was complete; but they had no other facilities of knowing the condition of those lunatics who were in private families, and supported by their own property or by their friends, than other men not in office, and could only speak of those who were within their circle of personal acquaintance. consequently the report included only a part of the independent insane who were then actually in, or belonged to, the state." "in (p. ), the marshals, the agents of the national government who were appointed to take the census, visited every family; and, among other items of information, they asked for the insane and idiots in the household. "by this personal and official inquiry, made of some responsible member of every family, the marshals obtained the account of only insane persons and idiots, which is but little more than two-thirds of the number ascertained by this commission. "making all due allowance for the increase of population, and consequently of the insane and idiots, these figures undoubtedly show far less than the real amount of lunacy and idiotcy at that time, and render it extremely probable that many concealed the facts that the law required them to state to the marshals." thus the marshals discovered the number of insane to be in nearly double that returned in , and from their apparently searching inquiry, it might have been presumed that they had made a near approximation to the truth in the figures they published. however, the most pains-taking and varied investigations of the special commissioners in , prove the marshals to have much underrated the number, for the result arrived at was, that in the autumn of the year just named, there were lunatics, of whom were idiots, in the state of massachusetts. the partial explanation of the divergence in numbers, viz.:--"that it is probable that many of the families refused or neglected to report to the marshals the insane and idiots who were in their households,"--is of itself an indication of one of the impediments to a correct enumeration of the insane members of a community, even when such is attempted under favourable circumstances. it is one likewise which, however operative in the united states, where the public asylums are open to, and resorted to by, all classes of the community, must be still more so in this country, where family pride endeavours in every way to ignore and keep secret the mental affliction of a member, as though it were a plague spot. besides this, in no english census yet taken, has the enumeration of the insane constituted a special subject of inquiry. this illustration from american experience, coupled with the considerations previously advanced, suffice to demonstrate that the published statistics of insanity in england and wales are incomplete and erroneous, and that the machinery hitherto employed for collecting them has been imperfect. the corollary to this conclusion is, that the number of lunatics mentioned in the public official papers is much below the real one. however, the facts and figures in hand justify the attempt to fix a number which may be taken to represent _approximatively_ the total insane population of this kingdom. in their last report ( ), the english commissioners in lunacy state that, on january st, , there were confined in asylums, hospitals, and licensed houses, , pauper, and private patients, exhibiting an increase of pauper and of private cases upon the returns of the year preceding. pauper lunatics in workhouses are stated ( th annual report of the poor law board, ) to have numbered , and those receiving out-door relief , ; making a total of , . by the kindness of mr. purdy, the head of the statistical department of the poor-law office, we are enabled to explain that it is the custom of the office to reckon pauper lunatics in asylums and licensed houses among those receiving out-door relief; consequently the sum of , comprises both those patients provided for as just specified, and others boarded with their friends or elsewhere. we, however, learn further, from the same excellent authority, that, owing to the imperfection of the periodical returns, only a comparatively small portion of the pauper insane confined in asylums and licensed houses is included in that total. indeed, the fact of its being very much smaller than that of the lunatics in asylums and licensed houses, clearly enough shows that the latter are not reckoned in it except partially. considering that the poor law board obtain no record of the pauper insanity in one million and a half of the population of england and wales, nor of the number of insane belonging to counties and boroughs,--for this reason, that their cost of maintenance is not directly defrayed out of the poor-rates, there must necessarily be a much greater number in workhouses at large than the mentioned, and no inconsiderable proportion of poor lunatics dispersed abroad in the country not enumerated in the counted as existing in january st, . on these grounds, we assume as an approximative figure to represent the total of insane poor not under confinement in asylums and workhouses, believing fully that it will be found, on the publication of the returns for this year ( ), within the mark. private patients not in asylums, or licensed houses, often confined without certificates, and the majority unknown to the lunacy commissioners, we have put down, at a moderate estimate, at . the present state of the law does not enable the commissioners or others to discover these, often, we fear, neglected patients: and, on the other hand, the operation of the laws regulating asylums, and the feeling evoked by certain public trials of individuals confined in licensed houses, have, together, combined to render them more numerous, by inducing friends to keep them at home, to send them abroad to continental institutions, or to place them under the care of private persons or attendants in lodgings. this completes our enumeration; and the figures stand thus, on the st of january, :-- _pauper._ _private._ _total._ in asylums and licensed houses , , , in workhouses , ... , with friends, or elsewhere , , , in prisons, vagrants, &c. ... ------- ------- ------- , , , to extend the estimate to the commencement of the present year ( ), we require to add the gross increase of lunatics during to the total just arrived at: , . what this increase may be cannot be decisively stated; but to anticipate the estimate of it, which we shall presently arrive at, viz. per annum, the result is, that _on the st of january_ there were in england and wales, in round numbers, , persons of unsound mind, or, to employ the legal phraseology, lunatics and idiots. it perhaps should be explained, and more particularly with reference to those detained in workhouses or supported by their parishes at their own houses, that besides idiots, or those congenitally deficient, a very large proportion of them is composed of weak and imbecile folk, who would, in olden times, have been considered and called "fools," and not lunatics, and been let mix with their fellow-men, serve as their sport or their dupes, and exhibit their hatred and revenge by malicious mischief and fiendish cruelty. but, thanks to modern civilization and benevolence, these poor creatures are rightly looked upon as proper objects for the supervision, tending and kindness of those whom providence has favoured with a higher degree of intelligence. this act of philanthropy, effected at a great cost, elevates at the same time, very materially, the ratio of insane persons to the population, and thereby gives cause of alarm at the prevalence of mental disorder, and makes our sanitary statistics contrast unfavourably with those of foreign lands, where the same class of the sick poor has not been so diligently sought out and brought together with a view to their moral and material well-being. chap. ii.--on the increase of insanity. the only data at hand to calculate the gross increase of the insane in this country, year by year, or over a series of years, are those contained in the official reports of the commissioners in lunacy and of the poor-law board. these, as we have just shown in the preceding chapter, are incomplete as records of the state of lunacy, since they take no notice of numerous patients not in recognized asylums. moreover, the annual summary of the returns made by the commissioners of insane patients confined in asylums and licensed houses, represents a compound quantity, made up of the increment by accumulation in past years, and of the fresh cases admitted in any particular year, and remaining at its close. the same is true of the figures supplied by the poor-law board. now, though these summaries are useful to show the rate of accumulation of the insane in the various receptacles for them, annually or over any fixed period, they do not tell us how many persons are attacked by madness in any year, or other space of time; or, in other words, they do not inform us whether there is an actual increase, or a decrease in the annual number of persons becoming insane. this question of the simple increase or decrease of insanity cannot be correctly answered. it is elucidated in some measure, so far as licensed institutions for the insane are concerned, by the tables of admission for different years furnished by the reports of the lunacy commissioners; and it may be assumed to be partially answered by the returns of the number of lunatics in workhouses published by the poor-law board, after an allowance made for the diminution caused by deaths which have taken place in the twelvemonth; but no means whatever exist of discovering the number of persons annually attacked with mental disorder, who do not fall under the cognizance of the public boards. with the materials in hand, let us in the first place examine the results which follow from a comparison of the lunacy statistics of the commissioners, instituted at intervals of more or fewer years. by this course we shall attain, not indeed an estimate of the progressive increase of our insane population, but a valuable comparative return of the number of those enjoying the advantages of asylum care and management in different years. the summary presented in each annual report shows that there were in _males._ _females._ _total._ --private patients , , = , } pauper patients , , = , } = , --private patients , , = , } pauper patients , , = , } = , --private patients , , = , } pauper patients , , = , } = , from these tables it therefore appears that the accumulation of insane persons in asylums in the ten years between and , equalled ; and in the five years between and , ; or progressed at the rate of per annum in the ten years, and of · (or in round numbers ) per annum in the five years under review, or upwards of per cent. faster in the latter space of time. in their twelfth report ( ) the commissioners in lunacy attempt to calculate the probable demands for asylum accommodation on the st of january , from the increased number of lunatics in the space of one year, from january st, , to january st, , amounting to . but as we have pointed out in a paper in the "journal of mental science" (vol. v. , p. ), the conclusion drawn from such data must be fallacious. for instance, a calculation on the result of one year's statistics is evidently worth little. there are many causes at work in asylums which materially affect the relative number of admissions and discharges, and consequently produce an inequality in the rate of increase viewed year by year. moreover, where the same plan of calculation has been adopted in determining what asylum accommodation was necessary, experience has soon exhibited the fallacy, and both the admissions and the demands for admission have far exceeded the total reckoned upon. to arrive at a nearer approximation to the truth, the augmentation in the number of lunatics ought to be noted for a space of several years; and to make the deduction more satisfactory, the increase of the general population, the conditions of the period affecting the material prosperity of the people, and its political aspects; and, lastly, the mere circumstance of the opening of new asylums,--a circumstance always followed by an unexpected influx of patients, need be taken into account. in the preceding considerations only the returns of lunatics in asylums, hospitals, and licensed houses are discussed; but, as we have seen, there is an almost equally large number detained in workhouses, or boarded with their relatives, or other persons, at the expense of their parishes, whose increase or decrease is a matter of kindred importance. on reviewing the returns of their numbers at periods when they have been taken cognizance of by the lunacy commission, we find that there were in workhouses and elsewhere, together, in , _in workhouses._ _with friends and elsewhere._ , , = , , , = , exhibiting an increase of in the ten years between and , and a decrease in the four between and of , owing, doubtless, to the opening of new asylums during that space of time. the returns of the two classes of pauper lunatics together being both so infrequently made, and, as before shown (p. ), open to criticism on account of their incompleteness, we shall attempt to arrive at a more correct estimate of increase than that just made. in the first place, with respect to union workhouses, the summary of indoor paupers, published by the poor law commission ( th report, p. ), affords the necessary data. according to this tabular statement, we find, that, there were on the st of january in each of the ensuing years the following numbers of pauper lunatics:-- , , , , , , , , , , , these columns show, that since the minimum number of insane, at a corresponding date in each year, occurred in . once indeed since, but at a different period of the year, viz. on july st, , the number fell to , or less than at the date before named. two or three years excepted, the increment has been progressive; at one time, indeed, much more rapidly so than at another. the fluctuations observable are, in the first place, due to the opening of new, or the repletion of existing, asylum accommodation; and in a lesser degree, to the rise or fall of pauperism in the community at large, or to an increased mortality at times, as, for example, in , when cholera prevailed--an event which in part, at least, explains the smaller figure of insane inmates in . but whatever the fluctuations observable year by year may be, there is a most distinct increase in the space of any five or ten years selected from the list, suggestive of the unwelcome fact that, notwithstanding the very large augmentation of asylum accommodation and the reduction of numbers by death, the rate of accumulation has proceeded in a ratio exceeding both those causes of decrease of workhouse inmates combined. thus, to take the decennial period between and , we discover an increase of just , or an average annual one of ; and, what is remarkable, as large a total increase, within a few units, is met with in the quinquennial period between and , and consequently the yearly average on the decennial period is doubled; viz. instead of . this doubling of the average in the last five years would be a more serious fact, were it not that in the number of workhouse inmates had been reduced upon , and had only slightly advanced above that of . rejecting the maximum rate of accumulation, we will calculate the average of the last three years cited, from to , a period during which there has been no notable cause of fluctuation, and no such increase of population as materially to affect the result, and for these reasons better suited to the purpose. in this space of time the increment equalled , or an average of per annum; which may fairly be considered to represent the rate of accumulation of lunatics in union workhouses at the present time. the absence of returns of lunatics in the workhouses of parishes under local acts, is an obstacle to a precise computation of them; however, on the assumption that the proportion of lunatics in those workhouses to the population ( , , ) of the parishes they belong to, is equal to that of those in union workhouses to the estimated population ( , , ) of the unions, and that the average increase is proportionate in the two cases, this increase should equal / th of , or somewhat more than , per annum; making the total average rate of accumulation in workhouses at large annually. unfortunately, no separate record is regularly kept of those poor insane persons who are boarded with friends or others, and their number has been only twice published, viz. in and , when, as seen in a preceding page, it was, respectively, and . these two sums exhibit an increase of to have accrued in the ten years included between those dates, or an average one of per annum. we have, above, calculated the average annual increase on those in union workhouses and those with friends, at annually; and consequently that of the latter being , the yearly increase of the former stands, according to the returns employed, at . however, we have proved that the average increase, in union workhouses, has reached in the last three years the amount of , and in workhouses at large , which, added to , produces , or in round numbers, , as the sum-total of accumulation of pauper lunatics not in asylums, hospitals, or licensed houses. adding the annual rate of increase of the insane in asylums, viz. , to that among paupers, unprovided with asylum accommodation, , we obtain the total accumulation per annum of lunatics reported to the public boards. to this sum there should rightly be added the accumulative increase among insane persons not known to those boards, and which, in the absence of any means to ascertain its amount, may be not extravagantly conceived to raise the total to . we come now to the second part of our present task, viz. to discover the comparative number of new cases in several past years, so as to obtain an answer to the question,--has there been an increase of the annual number of persons attacked with lunacy during that period? for previous figures leave no doubt there is an augmented ratio of insane persons in the population of the country. at the outset of this inquiry an insuperable difficulty to a correct registration of the number arises from the circumstance that, during any term of years we may select, the accommodation for the insane has never, even for one year, been fixed, but has been progressively increased by the erection of new, and the enlargement of old asylums. this occurrence, necessarily, very materially affects the returns made by the commissioners of the number of admissions into asylums and licensed houses. even if the comparison of the annual admissions into any one county asylum only, were of value to our purpose, the same difficulty would ensue by reason of the enlargement of the institution from time to time, and of the circumstance that, as it progressively filled with chronic cases, the number of admissions will have grown smaller. likewise, the farther that the inquiry is extended back, the more considerable will this difficulty in the desired computation be. in short, it may be stated generally, that the proportion of admissions will vary almost directly according to the accommodation afforded by asylums, and the inducements offered to obtain it. on the other hand, the consequences of the variations in asylum accommodation upon the total of admissions are to a certain extent compensated for by the fluctuations they produce upon the number of lunatics not provided for in asylums; for this reason, that where a county asylum opens for the reception of patients, the majority of these are withdrawn from licensed houses and workhouses, and thereby a reduction is effected in the number of inmates of those establishments. after the above considerations, it is clear that an estimate of the number of insane persons in any year, as gathered from the statistics of those brought under treatment in asylums or elsewhere, can be only an approach to the truth. still it is worth while to see what results follow from an examination of the returns of admissions, as collected by the commissioners in lunacy. it would be of no service to extend the inquiry far backward in time, on account of the rapidity with which asylum accommodation has been enlarged; we will therefore compare the admissions over the space of four years, viz. , , , and , during which the changes in asylums have been less considerable. _table of admissions._ --county and borough asylums , hospitals licensed houses , ----- total , ----- --county and borough asylums , hospitals licensed houses , ----- total , ----- --county and borough asylums , hospitals licensed houses , ----- total , ----- --county and borough asylums , hospitals licensed houses , ----- total , ----- there is a remarkable degree of uniformity in the sum of admissions in each of these four years; and if each several sum could be taken to represent the accession of new cases of insanity in the course of the year, there would appear no actual progressive increase of the disease in the community during the four years considered. the average of the admissions for that period is ; those therefore of and are in excess, and those of and are within it. the widest difference is observed in , when a sudden rise takes place, which, by the way, is not explicable by the greater provision of asylum accommodation in that year than in the three preceding. yet this increase is not so striking when viewed in relation to the totals of other years; for it exceeds the average only by , a sum little greater than that expressing the decrease of upon the total of . it is difficult to decide what value should be assigned to these results, deducible from a comparison of the yearly admissions, in determining the question of the increase of insanity, viewed simply as that of the comparative number attacked year by year,--it would, however, seem a not unreasonable deduction from them, that the proportion of persons attacked by mental disorder advances annually at a rate little above what the progressive increase of population is sufficient to explain. if this be so, the increase by accumulation of chronic and incurable cases becomes so much the more remarkable, and an investigation of the circumstances promoting, and of those tending to lessen, that accumulation, so much the more important. there are, as heretofore remarked, very many insane persons who are not sent to asylums or private houses, at least to those in this country, and whose relative number yearly it is impossible, in the absence of all specific information, to compute. although the agitation of the public mind respecting private asylums, and the facility and economy of removing insane persons abroad, may have latterly multiplied the number of such unregistered patients, yet there is no reason to assume that their yearly positive increase is other than very small. the pauper lunatics living in workhouses have as yet been omitted from the present inquiry. their yearly number is affected not only by the introduction of fresh cases, but also by removals to asylums and by deaths; or, in other words, it is a compound quantity of new inmates received and of the accumulation of old. however, the returns above quoted (p. ) show that between and there was an increase of almost exactly , or, as before calculated, an average of annually. the poor law board report unfortunately gives no returns of the annual admissions; hence we do not possess the means of discovering what proportion of the growing increase observed is due year by year to the accession of fresh inmates. the advancing growth in numbers of those pauper insane receiving out-door relief is not clearly discoverable: from the few data in possession, as before quoted (p. ), about are annually added. it appears pretty clearly, then, that there are at least reported lunatics added to the insane population of the country yearly, and of this increase only , or in · , are supported out of their own resources in asylums; the remainder, with some few exceptions, falling upon the rates for their entire maintenance. it would therefore be difficult to exaggerate the importance of the question of the provision for the insane poor in this country, both to the political economist and to the legislator. there are certainly more than persons yearly so affected in mind as to be unfit or unable to take care of themselves, and to obtain their own livelihood, and who, under this distressing infliction of providence, demand the care and charity of their neighbours, and the succour of the state, properly to protect and provide for them. to perform this duty at the least cost, compatible with justice to these afflicted individuals, involves a tax upon the community of which few persons have any adequate conception. supposing, by way of illustration, that the number mentioned required the accommodation of an asylum, the cost of providing it, according to the system hitherto in vogue, would nearly equal that incurred in the establishment and maintenance of the middlesex county asylum at colney hatch, or a sum of £ , for land, buildings, and fittings (equal, at per cent. to a yearly rental of £ , ), and an annual charge of £ , for maintenance. the example of colney hatch, chosen for illustration, is a very fair one, and the figures used in round numbers are actually within the average expenditure in and for the establishment of county asylums in this country, as may be seen on reference to appendix d. (commissioners' report, ), and to the table of asylums in course of erection, printed at p. of their twelfth report ( ). on applying these results to the total number of pauper lunatics in asylums, which, according to the return on the st of january , amounted to , , the sum of £ , , (not including interest) will have been expended in providing them accommodation, and an annual charge incurred of £ , for their care and maintenance. all this, too, is independent of the cost on account of those maintained in licensed houses, in workhouses, and in lodgings with friends or others, the amount of which we do not possess sufficient information to determine. the commissioners in lunacy, in their elaborate report in , took the population of england and wales at , , , and reckoned on the existence of , lunatics on the st january of that year, of whom , were paupers. the latter, they calculated, stood in the proportion of to in the population, or, more correctly, in ; and the total lunatics as to . on the st of january , they found the pauper lunatics to be in the proportion of in ; whilst pauper and private together equalled in , to the estimated population, , , . adopting the figures arrived at in the preceding discussion, viz. that there are , insane persons in this country, and assuming the population on the st of january, , to have been , , , the proportion of the insane would be as high as in persons. this much-enlarged ratio of insanity to the population admits of several explanations, without a resort to the belief that the disease is actually and fearfully on the increase. as before said, we regard the accumulation of chronic and incurable lunatics to be the chief element in raising the total number, and this accumulation is favoured by all causes operating against the cure of insanity; by the increased attention to the disease, and by all those conditions improving the value of life of the insane, supplied, at the present day, in accordance with the improved views respecting their wants, and the necessity of placing them under conditions favourable for their health, care and protection. on the operation of these causes, favouring the multiplication of insane persons in the community, we shall, however, not at present further enter, but proceed to inquire how far the existing provision for the insane is adequate to their requirements. before entering on this inquiry, a few words are wanting to convey a suggestion or two respecting the collection of the statistics of pauper lunatics. it is most desirable we should be able to discover, from the official returns of the public boards, with precision, what number of insane persons is wholly or partially chargeable to the poor rates, what to borough, and what to county rates. the returns of the poor-law office ought not to be marred by the omission of the statistics of parishes, which by local or special acts escape the direct jurisdiction of the board. if the central board be denied a direct interference in their parochial administration, it ought to be informed of the number of their chargeable poor, including lunatics. it is equally unsatisfactory, that the pauper registry kept by the poor-law board is not rendered complete by the record of all those chargeable to counties and boroughs, as this could be so readily done by the clerks of county and borough magistrates. an amendment, too, is desirable in the practice of the poor-law office of reckoning together in their tables pauper lunatics in asylums among the recipients of out-door relief with those boarded with their friends or elsewhere, whence it is impossible to gather the proportion of such class. this technicality of considering workhouse inmates as the only recipients of _in-door_ relief, to the exclusion of asylum patients who are in reality receiving it in an equal degree, although in another building than the workhouse, is an official peculiarity we can neither explain nor approve; and it appears to us most desirable that lunatic paupers in asylums should be arranged in a distinct column, and that the same should be done with those living with their friends or others. by the adoption of this plan the questions of the number of the pauper insane, of their increase and decrease, whether in asylums or elsewhere, and of the adequacy of accommodation for them, could be ascertained by a glance at the tables. we would likewise desire to see those paupers belonging to parishes not in union and under local acts, and those chargeable to counties and boroughs, tabulated in a similar manner. a practical suggestion, connected with the statistics of insanity, we owe to mr. purdy, viz. that section of the "lunatic asylums' act, " ( & vict. cap. ) should be amended by the insertion of a few words requiring the clerks of unions to make the returns of the number of chargeable lunatics on a specified day, as on the first of january in each year. this practice was formerly enjoined, and probably its omission from the act now in force was accidental. the present enactment requires that the clerks of unions "shall, on the first day of january in every year, or as soon after as may be, make out and sign a true and faithful list of all lunatics chargeable to the union or parish;" and the only alteration required is the addition of two or three words at the end of this paragraph, such as:--'on the first day of january of that year.' the want of a fixed date of this kind, mr. purdy says, imposes great trouble in getting the clerks to make their returns with reference to the same day in the several unions and parishes. chap. iii.--state of the present provision for the insane in asylums.--its inadequacy. in their report for , the commissioners in lunacy have presented us with a memorandum of the present accommodation afforded in county asylums, and of that in course of being supplied, and have attempted further a calculation of the probable requirements on the st of january . the former may be accepted as nearly correct, but the latter affords, as before noticed, a rough, and not sufficiently accurate, estimate. their statement is, that on the st of january, , , beds were provided in public asylums; that, by the projected enlargement of existing institutions, others would be obtained, and, by the completion of eight asylums in course of erection, there would be added more--a total of , on or before january . of the increase in additional buildings, beds, or thereabouts, would not be ready at so early a date as that named; and in calculating existing provision, need be deducted from the total of , ; consequently the accommodation in county asylums would, according to the commissioners, in this year, , reach , , and in , , . the county asylum accommodation on january st, , expressed by the sum of , , exceeded the total of pauper lunatics returned as actually partaking its advantages at that date, viz. , , by the large number of ; showing a surplus to that amount, including beds, in infirmary wards. what may be the precise number of the last, or, in other words, of those generally inapplicable to ordinary cases, labouring under no particular bodily infirmity, we cannot tell, but we feel sure that of them would be available; in fact, the whole number by classification might be rendered so. be this so or not, the commissioners have omitted any reference to this present available accommodation, in calculating what may be necessary in . on the other hand, they have rather over-estimated the future provision in asylums, by adding together that in the beds., herts., and hunts. asylum now in use, viz. , with that to be secured in the new one, viz. , instead of counting on the difference only, , as representing the actual increase obtained,--for the intention is to disuse the old establishment as a county institution. to proceed. the commissioners calculate on an addition of beds to the number provided in january (according to our correction, in round numbers, ), and proceed to say, that "if to this estimate ... we apply the ratio of increase in the numbers requiring accommodation observable during the last year, some conclusion may be formed as to the period for which these additional beds are likely to be found sufficient to meet the constantly increasing wants of the country, and how far they will tend towards the object we have sought most anxiously to promote ever since the establishment of this commission, namely, the ultimate closing of licensed houses for pauper lunatics. on the st of january, , the number of pauper lunatics in county and borough asylums, hospitals, and licensed houses, amounted to , . on the st of january, , this number had increased to , , showing an increase during the year of patients; and of the total number were confined in the various metropolitan and provincial licensed houses. "assuming, then, that during the next two years the progressive increase in the number of pauper lunatics will be at least equal to that of the year , it follows, that on the st of january, , accommodation for additional patients will be required; and if to this number be added the patients who are now confined in licensed houses, there will remain, to meet the wants of the ensuing year, only vacant beds. it is obvious, therefore, that if licensed houses are to be closed for the reception of pauper lunatics, some scheme of a far more comprehensive nature must be adopted in order to provide public accommodation for the pauper lunatics of this country." this conclusion must indeed be most unwelcome and discouraging to the rate-payers, and to the magistracy, in whose hands the government reposes the duty of providing for the due care of pauper lunatics in county asylums. to the latter it must be most dispiriting, when we reflect on the zeal and liberality which have generally marked their attempts to secure, not merely the necessary accommodation, but that of the best sort, for the insane poor of their several counties. it is, indeed, an astounding statement for the tax-payer to hear, that, after the expenditure of one or two millions sterling to secure the pauper lunatics of this country the necessary protection, care, and treatment, and the annual burden for maintenance, that a far more comprehensive scheme is demanded. no wonder that the increase of insanity is viewed as so rapid and alarming; no wonder that every presumed plan of saving expense by keeping patients out of asylums should be readily resorted to. the value of the conclusion, and of the facts whereon it rests, certainly merit careful examination; and after the investigation made as to the number of the insane, and their rate of increase and accumulation, such an examination can be more readily accomplished. to revert to the figures put forward by the commissioners, of the number of beds existing in asylums on the st of january, , and of that to be furnished by . they reckoned on , beds at the former date, and on the addition of by the year , or a total of , . we have, however, shown, that in january there were vacant beds, and that there was an over-estimate of the future increase by about , leaving, without reckoning the number in progress, to meet coming claims. this sum being therefore added, gives a total of , to supply the wants of the pauper insane between the st of january, , and the completion of the new asylums in . using the average increase adopted by the commissioners, viz. per annum, there would be at the commencement of the year , applicants for admission, to be added to the confined in licensed houses, whom the lunacy commissioners are so anxious to transfer to county institutions, making in all . but according to our corrected valuation, there would be in the course of , room for patients, that is, a surplus accommodation for . it must be admitted as incorrect on the part of the commissioners, in the report just quoted, to calculate on the whole number of beds obtained by new buildings, as available in january , when, in all probability, of them will not be ready much before the close of the year; still, after making allowance for the increased number of claimants accruing between that date and the opening of the new asylums, there would, according to the data used, remain vacancies for some thousand or more, instead of the reckoned upon by the commissioners. our review, therefore, is thus far favourable, and suggestive of the possibility of a breathing time before the necessity of a scheme of a "far more comprehensive nature" need be adopted. but, alas! the inquiries previously gone into concerning the number and increase of the insane render any such hope fallacious, and prove that the commissioners have very much underestimated the number to be duly lodged and cared for in asylums; unless indeed, after having secured the transfer of those now in licensed houses to county asylums, they should consider their exertions on behalf of the unfortunate victims of mental disorder among the poor brought to a close. such an idea, however, is, we are persuaded, not entertained by those gentlemen, who have, on the contrary, in their reports frequently advocated the provision of asylums for all the pauper insane with few exceptions, and distinctly set forth the objections to their detention in workhouses. in fact, every well-wisher for the lunatic poor, is desirous to see workhouses disused as receptacles for them, and it naturally appears more important to transfer some of their inmates to proper asylums than to dislodge those detained in licensed houses, where, most certainly, the means of treatment and management available are superior to those existing in workhouse wards. but our efforts on behalf of the insane poor must not cease even when those in workhouses are better cared for, since there then remains that multitude of poor mentally disordered patients scattered among the cottagers of the country, indifferently lodged, and not improbably, indifferently treated, sustained on a mere pittance unwillingly doled out by poor-law guardians, and under no effectual supervision, either by the parish medical officers or by the members of the lunacy board. some provision surely is necessary for this class of the insane; some effectual watching over their welfare desirable; for the quarterly visits required by law ( & vict. cap. , sect. ) to be made to them by the overworked and underpaid union medical officers cannot be deemed a sufficient supervision of their wants and treatment. these visits, for which the noble honorarium of _s._ _d._ is to be paid, whatever the distance the medical officer may have to travel,--are intended by the clause of the act to qualify the visitor to certify "whether such lunatics are or are not properly taken care of, and may or may not properly remain out of an asylum;" but practically nothing further is attained by them than a certificate that the pauper lunatic still exists as a burden upon the parish funds; and even this much, as the commissioners in lunacy testify, is not regularly and satisfactorily obtained. a proper inquiry into the condition of the patient, the circumstances surrounding him, the mode of management adopted, and into the means in use to employ or to amuse him, cannot be expected from a parish medical officer at the remuneration offered, engaged as he is in arduous duties; and, more frequently than not, little acquainted with the features of mental disease, or with the plans for its treatment, alleviation, or management. even in the village of gheel in belgium, which has for centuries served as a receptacle for the insane, where there is a well-established system of supervision by a physician and assistants, and where the villagers are trained in their management, those visitors who have more closely looked into its organization and working, have remarked numerous shortcomings and irregularities. but compared with the plan of distributing poor demented patients and idiots, as pursued in this country, in the homes of our poorer classes and peasantry, unused to deal with them, too often regarding them as the subjects of force rather than of persuasion and kindness, and under merely nominal medical oversight four times a year, gheel is literally "a paradise of fools." indeed a similar plan might with great advantage be adopted, particularly in the immediate vicinity of our large county asylums. but to return to the particular subject in question, viz. the proportion of insane poor in workhouses and elsewhere who should rightly find accommodation in asylums, a class of lunatics, as said before, not taken into account by the commissioners in their estimate of future requirements. we let pass the inquiry, what should be done for the poor imbecile and idiotic paupers boarded in the homes of relatives or others, and confine our observations to the inmates of workhouses. now, although we entertain a strong conviction of the evils of workhouses as receptacles for the insane, with very few exceptions,--a conviction we shall presently show good grounds for, yet, instead of employing our own estimate, we shall endeavour to arrive at that formed by the lunacy commissioners, of the proportion of lunatics living in them, for whom asylum accommodation should be provided. the principal and special report on workhouses, in relation to their insane inmates, was published in , and in it the commissioners observe (p. ), that they believe they "are warranted in stating, as the result of their experience, that of the entire number of lunatics in workhouses,--two-thirds at the least--are persons in whom, as the mental unsoundness or deficiency is a congenital defect, the malady is not susceptible of cure, in the proper sense of the expression, and whose removal to a curative lunatic asylum, except as a means of relieving the workhouse from dangerous or offensive inmates, can be attended with little or no benefit. a considerable portion of this numerous class, not less perhaps than a fourth of the whole, are subject to gusts of passion and violence, or are addicted to disgusting propensities, which render them unfit to remain in the workhouse.... but although persons of this description are seldom fit objects for a curative asylum, they are in general capable of being greatly improved, both intellectually and morally, by a judicious system of training and instruction; their dormant or imperfect faculties may be stimulated and developed; they may be gradually weaned from their disgusting propensities; habits of decency, subordination, and self-command may be inculcated, and their whole character as social beings may be essentially ameliorated." in their ninth report ( ), speaking of those classed in the workhouse in-door relief lists, under the head of lunatics or idiots, they observe:--"these terms, which are themselves vague and comprehensive, are often applied with little discrimination, and in practice are made to include every intermediate degree of mental unsoundness, from imbecility on the one hand, to absolute lunacy or idiotcy on the other; and, in point of fact, a very large proportion of the paupers so classed in workhouses, especially in the rural districts, and perhaps four-fifths of the whole, are persons who may be correctly described as harmless imbeciles, whose mental deficiency is chronic or congenital, and who, if kept under a slight degree of supervision, are capable of useful and regular occupation. in the remainder, the infirmity of mind is for the most part combined with and consequent upon epilepsy or paralysis, or is merely the fatuity of superannuation and old age; and comparatively few come within the description of lunatics or idiots, as the terms are popularly understood." lastly, in the eleventh report ( ), the class of pauper insane, whose detention in workhouses is allowable, is indicated in the following paragraph:--"they (workhouses) are no longer restricted to such pauper lunatics as requiring little more than the ordinary accommodation, and being capable of associating with the other inmates, no very grave objection rests against their receiving.... but these are now unhappily the exceptional cases." these extracts are certainly not precise enough to enable us to state, except very approximatively, what may be the estimate of the lunacy commissioners of the numbers who should be rightly placed in asylums. that first quoted appears to set aside one-third as proper inmates of a curative asylum, and amenable to treatment; and then to describe a fourth of the remaining two-thirds, that is, one-sixth, as proper objects of asylum care. on adding these quantities, viz. one-third to one-sixth, we get as the result, one-half as the proportion of workhouse insane considered to be fit subjects for asylums. the second quotation by itself is of little use to our purpose, except in conjunction with the third one and with the context, as printed in the report from which it is taken, relative to the general question of the evils of workhouses as receptacles for the insane. so examined in connection, the published statements and opinions of the commission, lead to the conclusion that the great majority of the insane in workhouses should rightly enjoy the advantages of the supervision, general management, nursing, and dietary of asylums. however, to escape the possible charge of attempting to magnify the deficiency of asylum accommodation, we will, for the time, assume that only one-half of the lunatic inmates of workhouses require asylum treatment; even then we had some to be provided with it at the beginning of , and should have at the least by january . having now reduced the estimate of the demands for asylum care to figures, it is practicable to calculate how far those demands can be met by the existing provision in asylums and what may be its deficiency. on the one side, there will be, at the most moderate computation, made as far as possible from data furnished by the reports of the lunacy commissioners, inmates of workhouses, who should, on or before january st, , obtain asylum care and treatment. on the other, there will be, as above shown, about beds unoccupied at the date mentioned, after accommodation is afforded to the pauper residents in licensed houses, and to the number of insane resulting from accumulation and increase in the course of two years from january . the consequence is, that in january , there will remain some pauper lunatics unprovided for in proper asylums. in the course of the preceding arguments, we have kept as closely as possible to data furnished by the lunacy commissioners' reports, and withal have made out, satisfactorily we trust, that the provision supplied by existing asylums and by those now in progress of erection, is inadequate to the requirements of the insane population of this country. the idea of its inadequacy would be very greatly enhanced by the employment of the statistical conclusions we have arrived at respecting the number of the insane and their rate of accumulation, and by the reception of the views we entertain against their detention, with comparatively few exceptions, in other receptacles than those specially constructed and organized for their care and treatment. the truth of our opinions we shall endeavour to establish in subsequent pages; and respecting the rate of accumulation of pauper cases, we feel confident that per annum is within the truth. to meet this increase, both the asylums in existence and those in course of erection are undoubtedly inadequate, and, as the necessary result, workhouse pauper inmates must continue to multiply. if the opinion were accepted that public asylum accommodation should be provided for all the pauper poor, not many more than one-half are at present found to be in possession of it, that is, , of the , in the country. hence it would be required, to more than double the present provision in asylums for pauper lunatics, to give room for all and to meet the rapid annual rate of accumulation. chap. iv.--on the curability of insanity. an inquiry into the curability of insanity forms a natural pendent to that concerning the provision required for the insane, and is at the same time a fitting prelude to an investigation of the insufficiency and defects of the present organization of asylums: for it is important to satisfy ourselves as to what extent we may hope to serve the insane, by placing them under the most advantageous circumstances for treatment, before incurring the large expenditure for securing them. now it may be most confidently stated that insanity is a very curable disorder, if only it be brought early under treatment. american physicians go so far as to assert, that it is curable in the proportion of per cent., and appeal to their asylum statistics to establish the assertion. the lunacy commission of the state of massachusetts (_op. cit._ p. ) thus write:--"in recent cases the recoveries amount to the proportion of to per cent. of all that are submitted to the restorative process. yet it is an equally well-established fact, that these disorders of the brain tend to fix themselves permanently in the organization, and that they become more and more difficult to be removed with the lapse of time. although three-fourths to nine-tenths may be healed if taken within a year after the first manifestation of the disorder, yet if this measure be delayed another year, and the diseases are from one to two years' standing, the cures would probably be less than one-half of that proportion, even with the same restorative means; another and a third year added to the disease diminishes the prospect of cure, and in a still greater ratio than the second; and a fourth still more. the fifth reduces it so low, as to seem to be nothing." dr. kirkbride, physician to the pennsylvania hospital for the insane, in his book "on the construction and organization of hospitals for the insane," says (p. ):--"of recent cases of insanity, properly treated, between and per cent. recover. of those neglected or improperly managed, very few get well." this is certainly a very flattering estimate, and, inasmuch as it is founded on experience, cannot fairly be questioned. however, before comparing it with the results arrived at in this country, there are some circumstances which call for remark. in the first place, american public asylums are not branded with the appellation 'pauper,' they are called 'state asylums,' and every facility is offered for the admission of cases, and particularly of recent ones, whatever their previous civil condition. again, there is not in the united states the feeling of false pride, of imaginary family dishonour or discredit, to the same extent which is observed in this country, when it pleases providence to visit a relative with mental derangement,--to oppose the transmission to a place of treatment. from these two causes it happens that in america the insane ordinarily receive earlier attention than in this country. lastly, the united states' institutions, by being more accessible, admit a certain proportion of cases of temporary delirium, the consequence of the abuse of alcoholic drinks, of overwrought brain and general excitement,--causes more active in that comparatively new, changing, and rapidly-developing country than in ours. but such cases, which for the most part get well, do not find their way into the asylums of this kingdom. such are some of the circumstances influencing favourably the ratio of cures in america, which need be remembered when comparing it with that which is attained in our own land. the proportion of recoveries above stated, is calculated upon cases of less than a year's duration. let us see what can be effected in england under conditions as similar as practicable, though not equally advantageous. the most satisfactory results we can point to are those obtained at st. luke's hospital, london, where the cures have averaged per cent. upon the admissions during the last ten years. at this and likewise at bethlehem hospital, the rules require that the disorder be not of more than one year's duration at the time of application for admission, and that it be not complicated with epilepsy or paralysis, maladies which so seriously affect its curability. such are the conditions favourable to a high rate of recoveries enforced by rule. on the other hand, there are at st. luke's not a few circumstances in operation prejudicial to the largest amount of success possible. its locality is objectionable, its general construction unfavourable, its grounds for exercise and amusement very deficient, and the means of employment few. but apart from these disadvantages, so prejudicial to its utility and efficiency, there are other causes to explain its ratio of success being less than that estimated by our american brethren to be practicable. though the rule excludes patients the benefit of the hospital if their disease be of more than a year's duration, yet from the great difficulties attending in many cases the inquiry respecting the first appearance of the insanity; its sometimes insidious approach; the defect of observation, or the ignorance, and sometimes the misrepresentations of friends, resorted to in order to ensure success in their application to the charity, older cases gain admission. again, of those admitted in any year, there are always several whose disorder is known to be of nine, ten, or eleven months' duration, and at least a fourth in whom it is of six months' date and upwards. further, although the rules exclude epileptics and paralytics, yet at times the history of fits is withheld by the patients' friends, or the fits are conceived to be of a different character, or the paralysis is so little developed as not to be very recognizable; and as in all ambiguous cases,--whether it be the duration or the complication of the mental disorder which is in doubt, the committee of the hospital give the benefit of the doubt to the patient,--the consequence is, that several such unfavourable cases are received annually. on referring to the statistical tables of the institution, these "unfit" admissions are found to amount to per cent. we have thought these details desirable, on the one hand, to account for the difference in the ratio of cures attained in st. luke's compared with that fixed by american writers; and on the other, to show that though the rate of recoveries at that london hospital is highly gratifying, it might be rendered yet more so if certain impediments to success were removed, and that similar benefits could be realized elsewhere if due provision were made for the early and efficient treatment of the malady. were we at all singular in the assertion of the curability of insanity, we should endeavour to establish it by an appeal to the statistics of recoveries among recent cases in the different english asylums; but instead of advancing a novel opinion, we are only bearing witness to a well-recognized fact substantiated by general experience. this being so, it would be fruitless to occupy time in quoting many illustrations from asylum reports: one will answer our purpose. at the derby county asylum, under the charge of dr. hitchman, a high rate of cures has been reached. in the third report that able physician writes (p. ),--"it cannot be too often repeated, that the date of the patient's illness at the time of admission is the chief circumstance which determines whether four patients in a hundred, or seventy patients in a hundred, shall be discharged cured. of the cases which have been admitted into the asylum during the past year, eleven only have been received within a week of the onset of their malady; of these eleven, ten have been discharged cured,--the other has been but a short time under treatment." in his sixth report ( , p. ), the same gentleman observes,--"the cures during the past year have reached per cent. upon the admissions; but the most gratifying fact has been, that of twenty patients, unafflicted with general paralysis, who were admitted within one month of the primary attack of their maladies, sixteen have left the asylum cured,--three are convalescent, and will probably be discharged at the next meeting of the committee, and the other one was in the last stage of pulmonary consumption when she came to the asylum, and died in three weeks after her admission." after this review of what may be effected in restoring the subjects of mental disorder to reason and society, to their homes and occupations, by means of early treatment, it is discouraging to turn to the average result of recoveries on admissions obtained in our county asylums at large. this average may be taken at per cent., and therefore there will remain of every patients admitted, sixty-five, or, after deducting per cent. of deaths, fifty-five at the end of the year. this number, fifty-five, might fairly be taken to represent the annual per centage of accumulation of the insane in asylums, were the data employed sufficient and satisfactory. but so far as we have yet examined the point, this proportion is larger than a calculation made over a series of years, and may be approximatively stated at per cent. on the admissions. how great would be the gain, alike to the poor lunatic and to those chargeable with his maintenance, could this rapid rate of accumulation be diminished, by raising that of recoveries, or, what is tantamount to it, by securing to the insane prompt and efficient care and treatment! how does it happen that this desideratum is not accomplished by the asylums in existence? what are the impediments to success discoverable in their organization and management, or in the history of their inmates prior to admission? and what can be done to remedy discovered defects, and to secure the insane the best chances of recovery? such are some of the questions to be next discussed. chap. v.--on the causes diminishing the curability of insanity, and involving the multiplication of chronic lunatics. in the preliminary chapters on the number and increase of the insane in this country, we limited ourselves to determine what that number and that increase were, and entered into no disquisition respecting the causes which have operated in filling our asylums with so many thousands of chronic and almost necessarily incurable patients. nor shall we now attempt an investigation of them generally, for this has been well done by others, and particularly by the lunacy commissioners in their ninth report, ; but shall restrict ourselves to intimate that the increase of our lunatic population, mainly by accumulation, is due to neglect in past years; to the alteration of the laws requiring the erection of county asylums for pauper lunatics generally; to the collection and discovery of cases aforetime unthought of and unknown; to the extension of the knowledge of the characters and requirements of the insane both among professional men and the public; and, lastly, to the advantages themselves of asylum accommodation which tend to prolong the lives of the inmates. such are among the principal causes of the astounding increase in the number of the insane of late years, relatively to the population of the country, some of which fortunately will in course of time be less productive. those, however, which we now desire to investigate, are such as directly affect the curability of insanity, either by depriving its victims of early and efficient treatment, or by lessening the efficiency and usefulness of the public asylums. the history of an insane patient is clearly divisible into three portions: st, that before admission into an asylum; nd, that of his residence in an asylum; and rd, of that after his discharge from it. the last division we have at present nothing to do with; and with reference to the causes influencing his curability, these group themselves under two heads parallel to the first two divisions of the patient's history; viz. , those in operation external to, and , those prevailing in, asylums. a. _causes external to asylums._ the chief cause belonging to this first class is that of delay in submitting recent cases to asylum care and treatment. this delay, as we have sufficiently proved, operates most seriously by diminishing the curability of insanity, and thereby favours the accumulation of chronic lunatics. it takes place in consequence either of the desire of friends to keep their invalid relatives at their homes; or of the economical notions of poor-law officers, who, to avoid the greater cost of asylums, detain pauper lunatics in workhouses. other causes of incurability and of the accumulation of incurables are found in injudicious management and treatment before admission, and in the transmission of unfit cases to asylums. to discuss the several points suggested in these considerations will require this chapter to be subdivided; and first we may treat of the detention of patients in their own homes. § _detention of patients in their own homes._ although the immense importance of early treatment to recent cases of insanity is a truth so well established and so often advocated, yet the public generally fail to appreciate it, and from unfortunate notions of family discredit, from false pride and wounded vanity, delay submitting their afflicted relatives to efficient treatment. unless the disorder manifest itself by such maniacal symptoms that no one can be blind to its real character, the wealthier classes especially will shut their eyes to the fact they are so unwilling to recognize, and call the mental aberration nervousness or eccentricity; and as they are unwilling to acknowledge the disorder, so are they equally indisposed to subject it to the most effectual treatment, by removing the patient from home, and the exciting influence of friends and surrounding circumstances in general, to a properly organized and managed asylum. usually a patient with sufficient resources at command, is kept at home as long as possible, at great cost and trouble; and if he be too much for the control of his relatives and servants, attendants are hired from some licensed house to manage him; the only notion prevailing in the minds of his friends being that means are needed to subdue his excitement and to overcome his violence. there are, in fact, no curative agencies at work around him, but on the contrary, more or fewer conditions calculated to exalt his furor, to agitate and disquiet his mind, and to aggravate his malady. the master of the house finds himself checked in his will; disobeyed by his servants; an object of curiosity, it may be, of wonder and alarm; and sadly curtailed in his liberty of action. the strange attendants forced upon him are to be yielded to only under passionate protests, and probably after a struggle. in all ways the mental disorder is kept up if not aggravated, and every day the chances of recovery are diminished. perhaps matters may grow too bad for continued residence at home, or the malady have lasted so long, that the broken-up state of family and household can no longer be tolerated, and a transfer from home is necessitated. yet even then removal to an asylum,--the only step which can hold out a fair prospect of recovery, is either rejected as quite out of the question, or submitted to usually after still longer delay,--a "trial" being made of a lodging with a medical man or other person, probably with an asylum attendant. by this plan certainly the patient is saved from the presence and excitement of his family, and placed under altered conditions, calculated to exercise in some respects a salutary influence on his mind; still many others are wanting, and no guarantee is attainable of the manner in which he is treated; for as a single patient, and as is usually the case, restrained without certificates, he is almost invariably unknown to the commissioners, and virtually unprotected, even though a medical man be paid to attend him occasionally. at last, however, except for a few, the transfer to the asylum generally becomes inevitable, and too often too late to restore the disordered reason; and years of unavailing regret fail to atone for time and opportunity lost. the same unwillingness to subject their insane friends to asylum care and treatment pervades, moreover, the less wealthy classes, and even the poorer grades of the middle class of society. madness, to their conceptions likewise, brings with it a stigma on the family, and its occurrence must, it is felt, be kept a secret. hence an asylum is viewed as an evil to be staved off as long as possible, and only resorted to when all other plans, or else the pecuniary means, are exhausted. if it be the father of the family who is attacked, the hope is, that in a few days or weeks he may resume his business or return to his office, as he might after ordinary bodily illness, without such loss of time as shall endanger his situation and prospects, and without the blemish of a report that he has been the inmate of a madhouse. if it be the wife, the hope is similar, that she will shortly be restored to her place and duties in her family. should progress be less evident than desired, a change away from home will probably be suggested by the medical attendant, and at much expense and trouble carried out. but too frequently, alas! the hopes are blighted and the poor sufferer is at length removed with diminished chance of cure to an asylum. for the poorer members of the middle class, and for many moving in a somewhat higher circle of society, whom the accession of mental disorder impoverishes and cuts off from independence, there are, it is most deeply to be regretted, few opportunities of obtaining proper asylum care and treatment. in very many instances, the charges of even the cheapest private asylum can be borne for only a limited period, and thus far, at the cost of great personal sacrifices and self-denial. sooner or later no refuge remains except the county asylum, where, it may be, from the duration of his disorder, the patient may linger out the remainder of his days. how happy for such a one is it--a person unacquainted with the system of english county asylums, might remark--that such an excellent retreat is afforded! to this it may be replied, that the public asylum ought not to be the _dernier ressort_ of those too poor to secure the best treatment and care in a well-found private establishment, and yet too respectable to be classed and dealt with as paupers entirely and necessarily dependent on the poor's rate. yet so it is under the operation of the existing law and parochial usages, there is no intermediate position, and to reap the benefits of the public asylum, the patient must be classed with paupers and treated as one. his admission into it is rendered as difficult, annoying, and degrading as it can be. his friends, worn out and impoverished in their charitable endeavours to sustain him in his independent position as a private patient, are obliged to plead their poverty, and to sue as paupers the parish officials for the requisite order to admit their afflicted relative to the benefits of the public asylum as a pauper lunatic. in short, they have to pauperize him; to announce to the world their own poverty, and to succumb to a proceeding which robs them of their feelings of self-respect and independence, and by which they lose caste in the eyes of their neighbours. as for the patient himself, unless the nature and duration of his malady have sufficiently dulled his perception and sensibilities, the consciousness of his position as a registered pauper cannot fail to be prejudicial to his recovery; opposed to the beneficial influences a well-regulated asylum is calculated to exert, and to that mental calm and repose which the physician is anxious to procure. in the class of cases just sketched, we have presumed on the ability of the friends to incur the cost of private treatment for a longer or shorter period; but many are the persons among the middle classes, who if overtaken by such a dire malady as insanity, are almost at once reduced to the condition of paupers and compelled to be placed in the same category with them. as with the class last spoken of, so with this one, the law inflicts a like injury and social degradation, and at the same time operates in impeding their access to proper treatment. no one surely, who considers the question, and reflects on the necessary consequences of the present legal requirement that, for a lunatic to enjoy the advantages of a public asylum, towards which he may have for years contributed, he must be formally declared chargeable to the rates as a pauper,--can deny the conclusion that it is a provision which must entail a social degradation upon the lunatic and his family, and act as a great impediment to the transmission of numerous recent cases to the county asylum for early treatment. it will be urged as an apology for it, that the test of pauperism rests on a right basis; that it is contrived to save the rate-payer from the charge of those occupying a sphere above the labouring classes, who fall, as a matter of course, upon the parochial funds whenever work fails or illness overtakes them. it is, in two words, a presumed economical scheme. however, like many other such, it is productive of extravagance and loss, and is practically inoperative as a barrier to the practice of imposition. if it contributes to check the admission of cases at their outbreak into asylums, as no one will doubt it does, it is productive of chronic insanity and of permanent pauperism; and, therefore, besides the individual injury inflicted, entails a charge upon the rates for the remaining term of life of so many incurable lunatics. if, on the contrary, our public asylums were not branded by the appellation "pauper;" if access to them were facilitated and the pauperizing clause repealed, many unfortunate insane of the middle class in question, would be transmitted to them for treatment; the public asylum would not be regarded with the same misgivings and as an evil to be avoided, but it would progressively acquire the character of an hospital, and ought ultimately to be regarded as a place of cure, equivalent in character to a general hospital, and as entailing no disgrace or discredit on its occupant. the commissioners in lunacy, in their ninth report ( , p. ), refer to the admissions into county asylums, of patients from the less rich classes of society reduced to poverty by the occurrence of the mental malady, and hint at their influence in swelling the number of the chronic insane, owing to their transfer not taking place until after the failure of their means and the persistence of their disorder for a more or less considerable period. this very statement is an illustration in point; for the circumstance deplored is the result of the indisposition on the part of individuals to reduce their afflicted relatives to the level of paupers by the preliminaries to, and by the act of, placing them in an asylum blazoned to the world as the receptacle for paupers only; an act, whereby, moreover, they advertise to all their own poverty, and their need to ask parish aid for the support of their poor lunatic kindred. on the continent of europe and in the united states of america we obtain ample evidence that the plan of pauperizing patients in order to render them admissible to public asylums, is by no means necessary. most continental asylums are of a mixed character, receiving both paying and non-paying inmates, and care is taken to investigate the means of every applicant for admission, and those of his friends chargeable by law with his maintenance. those who are paid for are called "pensioners" or boarders, and are divided into classes according to the sum paid, a particular section of the asylum being assigned to each class. besides those pensioners who pay for their entire maintenance, there are others whose means are inadequate to meet the entire cost, and who are assessed to pay a larger or smaller share of it. lowest in the scale of inmates are those who are entirely chargeable to the departmental or provincial revenue, being devoid of any direct or indirect means of support. probably the machinery of assessment in the continental states might not accord with english notions and be too inquisitorial for adoption _in toto_; but at all events, on throwing open public asylums for the reception of all lunatics who may apply for it, without the brand of pauperism being inflicted upon them, some scheme of fairly estimating the amount they ought to contribute to their maintenance should be devised. for the richer classes a plan of inquisition into their resources is provided, and there seems no insuperable difficulty in contriving some machinery whereby those less endowed with worldly goods might, at an almost nominal expense, have their means duly examined and apportioned to their own support and that of their families. overseers and relieving officers are certainly not the persons to be entrusted with any such scheme, nor would we advocate a jury, for in such inquiries few should share; but would suggest it as probably practicable that the amount of payment might be adjudged by two or three of the committee of visitors of the asylum with the clerk of the guardians of the union or parish to which the lunatic belonged. in the united states of america, every tax-payer and holder of property is entitled as a tax-payer, when insane, to admission into the asylum of the state of which he is a citizen. he is considered as a contributor to the erection and support of the institution, and as having therefore a claim upon its aid if disease overtake him. the cost of his maintenance is borne by the township or county to which he belongs, and the question of his means to contribute towards it is determined by the county judge and a jury. most of the asylums of the republic also receive boarders at fixed terms, varying according to the accommodation desired; hence there are very few private asylums in the states. in the state of new york there is a special legal provision intended to encourage the early removal of recent cases to the asylum; whereby persons not paupers, whose malady is of less than one year's duration, are admitted without payment, upon the order of a county judge, granted to an application made to him, setting forth the recent origin of the attack and the limited resources of the patient. such patients are retained two years, at the end of which time they are discharged, their friends being held responsible for the removal. their cost in the asylum is defrayed by the county or parish to which they belong. we have said above, that the requirement of the declaration of pauperism is ineffectual in guarding the interests of the rate-payer against the cost of improper applicants. indeed, the proceeding adopted to carry it out is both absurd and useless, besides being, as just pointed out, mischievous in its effects. in the interpretation clause of "the lunatic asylums' act, ," it is ordered that a "pauper shall mean every person maintained wholly or in part by, or chargeable to, any parish, union, or county." hence when insanity overtakes an unfortunate person who is not maintained by a parish or union, it is required that he be made chargeable to one, or, as we have briefly expressed the fact, that he be pauperized. to effect this object, the rule is, that the patient shall reside at least a day and a night in a workhouse. this proceeding, we repeat, carries absurdity on the face of it. either it may be a mere farce privately enacted between the parish officers and the friends of the patient, to the complete frustration of the law so far as the protection of the rate-payers is contemplated; or, it may be made to inflict much pain and annoyance on the applicants by the official obstructiveness, impertinent curiosity, obtuseness, and possible ill-feeling of the parish functionaries in whose hands the law has practically entrusted the principal administration of the details regulating the access to our public asylums. it is no secret among the superintendents of county asylums, that by private arrangements with the overseers or guardians of parishes, cases gain admission contrary to the letter and spirit of the law, and to the exclusion of those who have legally a prior and superior claim. we have, indeed, the evidence of the lunacy commissioners, to substantiate this assertion. in their ninth report ( , p. ) they observe,--"in some districts a practice has sprung up, by which persons, who have never been themselves in receipt of parochial relief, and who are not unfrequently tradesmen, or thriving artisans, have been permitted to place lunatic relations in the county asylums, as pauper patients, under an arrangement with the guardians for afterwards reimbursing to the parish the whole, or part, of the charge for their maintenance. this course of proceeding is stated to prevail to a considerable extent in the asylums of the metropolitan counties, and its effect in occupying with patients, not strictly or originally of the pauper class, the space and accommodations which were designed for others who more properly belong to it, has more than once been made the subject of complaint." desiring, as we do, to see our county asylums thrown open to the insane generally, by the abolition of the pauper qualification, it is rather a subject of congratulation that cases of the class referred to do obtain admission into them, even when contrary to the letter of the law. but we advance the quotation and assertion above to show, that the pauperizing provision of the act is ineffective in the attainment of its object; and to remark, that the opportunities at connivance it offers to parochial officials, must exercise a demoralizing influence and be subversive of good government. if private arrangements can be made between the applicants for an assumed favour, and parish officers, who will undertake to say that there shall not be bribery and corruption? sufficient, we trust, has been said to demonstrate the evils of the present system of pauperizing patients to qualify them for admission into county asylums, and the desirability of opening those institutions to all lunatics of the middle classes whose means are limited, and whose social position as independent citizens is jeopardized by the existence of their malady. this class of persons, as before said, calls especially for commiseration and aid; being so placed, on the one hand, that their limited means must soon fail to afford them the succour of a private asylum; and on the other, with the door of the public institution closed against them, except at the penalty of pauperism and social degradation. what we would desire is, that every recent case of insanity should at once obtain admission into the public asylum of the county or borough, if furnished with the necessary medical certificates and with an order from a justice who has either seen the patient or received satisfactory evidence as to his condition (see remarks on duties of district medical officers), and obtained from the relatives an undertaking to submit to the assessment made by a commission as above proposed, or constituted in any other manner thought better; or the speedy admission of recent cases might otherwise be secured by prescribing their attendance and that of their friends before the weekly committee of the visitors of the asylum, by whom the order for reception might be signed on the requisite medical certificates being produced, and the examination for the assessment of the patient's resources formally made, with the assistance possibly of some representative of the parish interests,--such for instance as the clerk to the board of guardians. in the county courts the judges are daily in the habit of ordering periodical payments to be made in discharge of debts upon evidence offered to them of the earnings or trade returns of the debtor; and there seems no _a priori_ reason against the investigation of the resources of a person whose friends apply for his admission into a county asylum. it is for them to show cause why the parish or county should assume the whole or the partial cost of the patient's maintenance, and this can be done before the committee of the asylum or any private board of inquiry with little annoyance or publicity. rather than raise an obstacle to the admission of the unfortunate sufferer, it would be better to receive him at once and to settle pecuniary matters afterwards. we must here content ourselves with this general indication of the machinery available for apportioning the amount of payment to be made on account of their maintenance by persons not paupers, or for determining their claim upon the asylum funds. yet we cannot omit the opportunity to remark that the proceedings as ordered by the existing statute with a similar object are incomplete and unsatisfactory. these proceedings are set forth in _sects._ xciv. and civ. ( & vict. cap. ). the one section of the act is a twin brother to the other, and it might be imagined by one not "learned in the law," that one of the two sections might with little alteration suffice. be this as it may, it is enacted that if it appear to two justices (_sect._ xciv.) by whose order a patient has been sent to an asylum, or (_sect._ civ.) "to any justice or justices by this act authorized to make any order for the payment of money for the maintenance of any lunatic, that such lunatic" has property or income available to reimburse the cost of his maintenance in the asylum, such justices (_sect._ xciv.) shall apply to the nearest known relative or friend for payment, and if their notice be unattended to for one month, they may authorize a relieving officer or overseer to seize the goods, &c. of the patient, whether in the hands of a trustee or not, to the amount set forth in their order. _sect._ civ. makes no provision for applying to relatives or friends in the first instance, but empowers the justice or justices to proceed in a similar way to that prescribed by _sect._ xciv., to repay the patient's cost; with the additional proviso that, besides the relieving officer or overseer, "the treasurer or some other officer of the county to which such lunatic is chargeable, or in which any property of the lunatic may be, or an officer of the asylum in which such lunatic may be," may proceed to recover the amount charged against him. concerning these legal provisions, we may observe, that the state of the lunatic's pecuniary condition is left to accidental discovery. the justices signing the order of admission (_sect._ xciv.) have no authority given them to institute inquiries, although they may learn by report that the patient for whom admission is solicited is not destitute of the means of maintenance. nor are the justices who make the order for payment (_sect._ civ.) in any better position for ascertaining facts. there is, in short, no authorized and regular process for investigating the chargeability of those who are not actually in the receipt of parochial relief on or before application for their admission into the county asylum, or who must necessarily be chargeable by their social position when illness befalls them. again, according to the literal reading of the sections in question, no partial charge for maintenance can be proposed; no proportion of the cost can be assessed, where the patient's resources are unequal to meet the whole. lastly, the summary process of seizing the goods or property of any sort, entrusted to those who are most probably the informers of the justices, namely overseers and relieving officers; and, by _sect._ civ., carried out without any preliminary notice or application, and without any investigation of the truth of the reports which may reach the justices, is certainly a proceeding contrary to the ordinary notions of equity and justice. § _detention of patients in workhouses._ in the case of the insane poor, whose condition, circumstances, and social position have been such that whenever any misfortune, want of work, or sickness has overtaken them, the workhouse affords a ready refuge, the requirement of pauperization to qualify for admission to the county asylum is in itself no hardship and no obstacle to their transmission to it. probably the prevailing tactics of parish officers may at times contribute to delay the application for relief, but the great obstacle to bringing insane paupers under early and satisfactory treatment in the authorized receptacle for them--the county asylum, is the prevalence of an economical theory respecting the much greater cheapness of workhouse compared with asylum detention. the practical result of this theory is, that generally where a pauper lunatic can by any means be managed in a workhouse, he is detained there. if troublesome, annoying, and expensive, he is referred to the county asylum; this is the leading test for the removal; the consideration of the recent or chronic character of his malady is taken little or no account of. in fresh cases the flattering hope is that the patients will soon recover, and that the presumed greater cost of asylum care can be saved; in old ones the feeling is that they are sufficiently cared for, if treated like the other pauper inmates, just that amount of precaution being attempted which may probably save a public scandal or calamity. to the prevalence of these economical notions and practice may be attributed the large number of lunatics detained in workhouses (nearly ), and the equally large one living with their friends or others. now it is very desirable to inquire whether these theories of the superior economy of workhouses compared with asylums as receptacles for the insane, are true and founded on facts. this question is in itself twofold, and leaves for investigation, first, that of the mere saving in money on account of maintenance and curative appliances; and secondly, that of the comparative fitness or unfitness, the advantages or disadvantages, the profit or loss, of the two kinds of institutions in relation to the welfare, the cure, and the relief of the poor patients placed in them. these questions press for solution in connexion with the subject of the accumulation of lunatics and the means to be adopted for its arrest, or, what is equivalent to this, for promoting the curability of the insane. on making a comparative estimate of charges, it is essential to know whether the same elements of expenditure are included in the two cases; if the calculated cost per head for maintenance in workhouses and asylums respectively comprises the same items, and generally, if the conditions and circumstances so far as they affect their charges are rightly comparable. an examination we are confident, will prove that in no one of these respects are they so. in the first place, the rate of maintenance in an asylum is calculated on the whole cost of board, clothing, bedding, linen, furniture, salaries, and incidental expenditure; that is, on the total disbursements of the establishment, exclusive only of the expenditure for building and repairs, which is charged to the county. on the contrary, the "in-maintenance" in workhouses comprises only the cost of food, clothing, and necessaries supplied to the inmates (see poor-law board tenth report, p. ). the other important items reckoned on in fixing the rate of cost per head in asylums are charged to the "establishment" account of the workhouse, and are omitted in the calculation of the rate of maintenance. reference to the tables given in the poor-law board returns (tenth report, p. , sub-column _e_ and a portion of _f_) will prove that the expenditure on account of those other items must be nearly or quite equal to that comprehended under the head of "in-maintenance" cost. we have no means at hand to calculate with sufficient precision what sum should be added to the "in-maintenance" cost of paupers per head in workhouses, but it is quite clear that the figures usually employed to represent it, cannot be rightly compared with those exhibiting the weekly charge of lunatics in asylums. at the very least half as much again must be added to a workhouse estimate before placing it in contrast with asylum cost. since the preceding remarks were written, dr. bucknill has favoured us with the thirteenth report of the devon asylum, in which he has discussed this same question and illustrated it by a special instance. to arrive at the actual cost of an adult sane pauper in a union-house, he gathered "the following particulars relative to the house of the st. thomas union in which this asylum is placed; a union, the population of which is , , and which has the reputation of being one of the best managed in the kingdom. the cost of the maintenance of paupers in this union-house is _s._ _d._ per head, per week, namely, _s._ _d._ for food and _d._ for clothing. the establishment charges are _s._ - / _d._ per head, per week, making a total of _s._ - / _d._ for each inmate. the total number of pauper inmates during the twelfth week of the present quarter was ; and of these were infants and children, and youths above sixteen and adults. a gentleman intimately acquainted with these accounts, some time since calculated for me that each adult pauper in the st. thomas's union-house cost _s._ a week. now the average cost of all patients in the devon asylum at the present time is _s._ _d._, but of this at least _s._ must be set down to the extra wages, diet, and other expenses needful in the treatment of the sick, and of violent and acute cases, leaving the cost of the great body of chronic patients at not more than _s._ _d._ a week. now if a sane adult pauper in a union-house costs even _s._ _d._ a week, is it probable that an insane one would cost less than _s._ _d._? for either extra cost must be incurred in his care, or he must disturb the discipline of the establishment, and every such disturbance is a source of expense." this quotation is really a reiteration of dr. bucknill's conclusions as advanced in , in an excellent paper in the 'asylum journal' (vol. iv. p. ), and as a pendent to it the following extract from this paper is appropriate; viz. "that the cost of a chronic lunatic properly cared for, and supplied with a good dietary, in a county asylum, is not greater than that of a chronic lunatic supplied with a coarse and scanty dietary, and detained in neglect and wretchedness as the inmate of a union workhouse." another most important circumstance to be borne in mind when the cost of workhouses and asylums is contrasted, is that in the former establishments more than two-thirds of the inmates are children. thus the recipients of in-door relief on the st of january, , consisted, according to the poor-law returns, of , adults, and , children under sixteen years of age. now as the rate of maintenance is calculated on the whole population of a workhouse, adults and children together, it necessarily follows that it falls much within that of asylums, in which almost the whole population is adult. this very material difference in the character of the inmates of the two institutions may fairly be valued as equivalent to a diminution of one-fourth of the expense of maintenance in favour of workhouses; and without some such allowance, the comparison of the cost per head in asylums and union-houses respectively is neither fair nor correct. again, there is another difference between asylums and workhouses, which tells in favour of the latter in an economical point of view, whilst it proves that the expenditure of the two is not rightly comparable without making due allowance for it along with the foregoing considerations. this difference subsists in the character of the two institutions respectively; namely, that in the asylum the movements of the population are slight, whereas in the workhouse they are very considerable by the constant ingress and egress of paupers; driven to it by some passing misfortune or sickness, it may be for a week or two only or even less, and discharging themselves so soon as the temporary evil ceases to operate or the disorder is overcome: for the poor generally, except the old and decrepit who cannot help themselves, both dread a lodging in the workhouse, and escape from it as soon as possible; in fact, even when they have no roof of their own to shelter them, they will often use the union accommodation only partially, leaving it often by day and returning to it by night. all this implies a large fluctuation of inmates frequently only partially relieved, whether in the way of board or clothing; and consequently when the average cost per head of in-door paupers is struck, it appears in a greater or less degree lower than it would have done had the same constancy in numbers and in the duration and extent of the relief afforded prevailed as it does in asylums. the effect of the fluctuations in population in union-houses ought, we understand, to be slight, if the "orders in council" laid down to guide parochial authorities in the calculation of the cost of their paupers, were adhered to; viz. that for all those belonging to any one parish in union, who may have received in-door relief during the year or for any less period of time, an equivalent should be found representing the number who have been inmates throughout the year; or the total extent of relief be expressed by estimating it to be equal to the support of one hypothetical individual for any number of years equivalent to the sum of the portions of time the entire number of the paupers of the particular parish received the benefits of the establishment. we do not feel sure that these plans of calculating the cost per head are faithfully and fully executed; the rough method of doing so, viz. by taking the whole cost of "in-maintenance" at the end of the year and dividing it by the number of its recipients, and assuming the quotient to represent the expenditure for each. whether this be the case or not, these daily changes among its inmates, the frequent absence of many for a great part of the day and the like, are to be enumerated among the circumstances which tend to keep down expenditure of workhouses; and which are not found in asylums. there is yet another feature about workhouses which distinguishes them from asylums, and is of considerable moment in the question of the comparative cost of maintenance in the two: this is, the circumstance of the population of workhouses being of a mixed character, of which the insane constitute merely a small section; while, on the contrary, that of asylums is entirely special, and each of its members to be considered a patient or invalid demanding particular care and special appliances. therefore, _a priori_, no comparison as to their expenditure can justly be drawn between two institutions so dissimilar. yet even this extent of dissimilarity between them is not all that exists; for the union-house is so constituted by law as to serve as a test of poverty; to offer no inducements to pauperism, and to curtail the cost of maintenance as far as possible. it has properly no organization for the detention, supervision, moral treatment and control, nor for the nursing or medical care of the insane; and when its establishment is attempted it is a step at variance with its primary intention, and involves an extra expenditure. consequently, before overseers or guardians can with any propriety contrast the workhouse charges of maintenance with those of asylums, it is their business to estimate what an adult pauper lunatic costs them per week, instead of, as usual, quoting the cost per head calculated on the whole of the inmates, old and young, sane and insane. once more, even after a fair estimate of the cost of an adult insane inmate of a workhouse is obtained, there is still another differential circumstance favourable to a less rate than can be anticipated in asylums; for this reason:--that in the former institutions the practice is to reject all violent cases, the major portion of recent ones, and, generally, all those who give particular annoyance and trouble; whilst the latter is, as it rightly should be, regarded as the fitting receptacle for all such patients;--that is, in other words, those classes of patients which entail the greatest expense are got rid of by the workhouses and undertaken by the asylums. dr. bucknill has well expressed the same circumstances we have reviewed, in the following paragraph (report, devon asylum, , p. ):--"in estimating the cost of lunatic paupers in asylums, the important consideration must not be omitted, that the charge made for the care and maintenance of lunatics in county asylums is averaged upon those whose actual cost is much greater, and those whose actual cost is less than the mean; so that it would be unfair for the overseers of a parish to say of any single patient that he could be maintained for a smaller sum than that charged, when the probability is that there are or have been patients in the asylum from the same parish, whose actual cost to the asylum has been much greater than that charged to the parish. i have shown, that the actual cost of chronic patients in an asylum exceeds that of adult paupers in union-houses to a much smaller extent than has been stated: but if all patients of this description were removed from the asylum, the inevitable result must be that the average cost of those who remained would be augmented, so that the pecuniary result to the parishes in the county would be much the same. the actual cost of an individual patient, if all things are taken into calculation, is often three or four times greater than the average. leaving out of consideration the welfare of the patients, it would be obviously unfair to the community, that a parish having four patients in the asylum, the actual cost of two of whom was _s._ a week, and of the other two only _s._ a week, should be allowed to remove the two who cost the smaller sum, and be still permitted to leave the other two at the average charge of _s._" the conclusion of the whole matter is, that _cæteris paribus_, _i. e._ supposing workhouses to be equally fitting receptacles for the insane as asylums, the differential cost of the two can only be estimated when it is ascertained that the items of maintenance are alike in the two, and after that an allowance is made for the different characters of their population and of their original purpose; that is, in the instance of workhouses, for the very large number of juvenile paupers; for the great fluctuations in the residents; for the mixed character of their inmates, of sane and insane together, and the small proportion of insane, and for the exclusion of the most expensive classes of such patients. let these matters be fairly estimated, and we doubt much if, even _primâ facie_, it can be shown that the workhouse detention of pauper lunatics is more economical than that of properly constructed and organized asylums. should we even be so far successful as to make poor-law guardians and overseers perceive that the common rough-and-ready mode of settling the question of relative cost in asylums and workhouses, by contrasting the calculated rate per head for in-door relief with that for asylum care, is not satisfactory; we cannot cherish the flattering hope that they will be brought to perceive that, simply in an economical point of view, no saving at all is gained by the detention of the insane in workhouses. those poor-law officials generally are so accustomed to haggle about fractional parts of a penny in voting relief, to look at an outlay of money only with reference to the moment, forgetful of future retribution for false economy, and to handle the figures representing in their estimate the economical superiority of the workhouse for the insane, when they desire to silence an opponent;--that the task of proving to them that their theory and practice are wrong, is equivalent to the infelicitous endeavour to convince men against their will. still, however unpromising our attempt may appear, it is not right to yield whilst any legitimate arguments are at hand; and our repertory of them, even of those suited to a contest concerning the pounds, shillings, and pence of the matter, is not quite exhausted; for we are prepared to prove, that asylum accommodation can be furnished to the lunatic poor at an outlay little or not at all exceeding that for workhouses. now this point to be argued, the cost of asylum construction, is not, like the foregoing considerations, chiefly the affair of poor-law guardians and overseers, but concerns more particularly the county magistrates, inasmuch as it is defrayed out of the county instead of the poor rate. but although this is the case, there is no doubt that the very great expense of existing asylums has acted as an impediment to the construction of others, and has seemed to justify, to a certain extent, the improper detention of many insane persons in workhouses: for, on one side, asylums are found to have cost for their construction and fittings, £ , £ , and upwards per head, whilst on the other, workhouses are built at the small outlay, on an average, of eighty-six such establishments, of £ per head. the "return" made to the house of commons, june , , "of the cost of building workhouses in england and wales, erected since ," shows indeed a very wide variation of cost in different places, from £ per head for the congleton union house; £ for the erpingham; £ for the stockton and tenterden, to £ for the kensington; £ for the dulverton; £ for the city of london; £ for st. margaret westminster; and £ for the paddington. this enormous difference of expenditure on workhouse lodging,--for, unlike asylum costs, it does not include fittings, extending from £ to £ per inmate,--is really inexplicable, after allowing for the varying ideas of parish authorities as to what a workhouse should be, and for the slight differences in the cost of building materials and labour in some parts of the country than in others. either some workhouses must be most miserable and defective habitations even for paupers, or others must be very extravagant and needlessly expensive in their structure. there is this much to be said in explanation of the contrast of cost in different workhouses, that in those belonging to large town populations, infirmary accommodation becomes an item of importance and involves increased expenditure, whilst in those situated in agricultural districts, this element of expense is almost wanting. moreover it is in town workhouses generally that lunatic inmates are found, who, if not in the infirmary, are lodged in special wards, often so constructed as to meet their peculiar wants, and therefore more costly than the rest of the institution occupied by the ordinary pauper inmates. this is the same with saying that where workhouses are used as receptacles for the insane, it greatly enhances the cost of their construction. it will be evident to every thinking person that the costs of asylum and of workhouse construction are not fairly comparable. the asylum is a special building; an instrument of treatment; peculiarly arranged for an invalid population, affording facilities for classification, recreation, and amusements; and fitted with costly expedients for warming and ventilation; whereas the workhouse is essentially a refuge for the destitute, necessarily made not too inviting in its accommodation and internal arrangements; suited to preserve the life of sound inmates who need little more than the shelter of a roof and the rude conveniences the majority of them have been accustomed to. now these very characteristics of workhouses are among the best arguments against the detention of lunatics within these buildings; but of these hereafter. there is doubtless a permissible pride in the ability to point to a well-built asylum, commanding attention by its dimensions and architectural merits, and we would be the last to decry the beauties and benefits of architecture, and know too, that an ugly exterior may cost as much or more than a meritorious one; yet we must confess to misgivings that there has been an unnecessary and wasteful expenditure in this direction. nevertheless it is with asylums as with railways, the present race of directors are reaping instruction from the extravagances and errors its predecessors fell into. the change of opinion among all classes respecting the character and wants of the insane and their mode of treatment, is of itself so great, that many of the structural adaptations and general dispositions formerly made at great cost, are felt to be no longer necessary, and the very correct and happy persuasion daily gains ground, that the less the insane are dealt with as prisoners, and treated with apprehension and mistrust, the more may their accommodation be assimilated to that of people in general, and secured at a diminished outlay. all this suggests the possibility of constructing asylums at a much less cost than formerly, and of thereby lessening the force of one of the best pleas for using workhouses as receptacles for the insane. the possibility of so doing has been proved both theoretically and practically. in an essay 'on the construction of public asylums,' published in the "asylum journal" for january (vol. iv. p. ), we advocated the separation of the day- from the night-accommodation of patients, and the abolition of the system of corridors with day- and sleeping-rooms, or, as we briefly termed it, "the ward-system," and showed that by so doing a third of the cost of construction might be saved, whilst the management of the institution would be facilitated, and the position of the patients improved. by a careful estimate, made by a professional architect, with the aid of the necessary drawings, for a building of considerable architectural pretension, it was calculated that most satisfactory, cheerful, and eligible accommodation could be secured, including farm-buildings, and fittings for warming, ventilation, drainage, gas, &c., at the rate of £ per head for patients of all classes, or at one-half of the ordinary cost. experience has shown that chronic lunatics, at least, can be accommodated in an asylum at a lower rate, in fact, at little more than half the expense that we calculated upon. like other county asylums, the devon became filled with patients; still they came, and after attempts to cram more into the original edifice, by slight alterations, and by adding rooms here and there, it was at length found necessary to make a considerable enlargement. instead of adding floors or wings to the old building, which would have called for a repetition of the same original expensive construction of walls, and of rooms and corridors, the committee, with the advice of their excellent physician, wisely determined to construct a detached building on a new plan, which promised every necessary convenience and security with wonderful cheapness; and, for once in a way, an architect's cheap estimate was not exceeded. instead of £ or £ per head, as of old, accommodation was supplied at the rate of £ : _s._ per patient, including fittings for all the rooms and a kitchen:--a marvel, certainly, in asylum construction, and one which should have the effect of reviving the hopes and wishes of justices, once at least so laudably entertained, to provide in county asylums for _all_ pauper lunatics of the county. it is only fair to remark, that, as dr. bucknill informs us (asylum journal, , p. ), this new section of the devon asylum is dependent on the old institution for the residences of officers, for chapel, dispensary, store-rooms, &c. "it is difficult," writes dr. bucknill, "to estimate the proportion which these needful adjuncts to the wards of a complete asylum bear to the expense of the old building; they can scarcely, however, be estimated at so high a figure as one-eighth of the whole." but, as a set-off against the increased cost per patient involved in supplying the necessary offices described by dr. bucknill, we may mention that there are twenty single sleeping-rooms provided in the building, and that a greater cost was thereby entailed, than many would think called for, where only chronic, and generally calm patients, were to be lodged. these illustrations of what may be done in the way of obtaining good asylum accommodation for pauper lunatics at no greater rate, we are persuaded, than that incurred in attempting to provide properly for them in workhouses, furnish a most valid reason for discontinuing their detention in the latter, and the more so, if, as can be demonstrated, they are unfit receptacles for them. the possibility of constructing cheap asylums being thus far proved, the question might be put, whether the internal cost of such institutions could not be lessened? we fear that there is not much room for reform in this matter, if the patients in asylums are rightly and justly treated, and the officers and attendants fairly remunerated. in producing power, an asylum exceeds a workhouse, and therein derives an advantage in diminishing expenditure and the cost of maintenance. on the other hand, the expenditure of a workhouse is much less in salaries, particularly in those given to its medical officer and servants, a form of economy which will never repay, and, we trust, will never be tried in asylums. warming, ventilation, and lighting are less thought of, little attempted, and therefore less expensive items in workhouse than in asylum accounts. with respect to diet and clothing, workhouses ought to exhibit a considerable saving; but this saving is rather apparent than real, and certainly in the wrong direction; for lunatics of all sorts require a liberal dietary, warm clothing, and, from their habits frequently, more changes than the ordinary pauper inmates; yet these are provisions, which, except there is actual sickness or marked infirmity, the insane living in a workhouse do not enjoy; for they fare like the other inmates, are clothed the same, and are tended or watched over by other paupers; the saving, therefore, is at the cost of their material comfort and well-being. excepting, therefore, the gain to be got by the labours of the patients, there is no set-off in favour of asylum charges; in short, in other respects none can be obtained without inflicting injury and injustice. on the other hand, workhouse expenditure need be raised if the requisite medical and general treatment, nursing, dietary, employment, and recreation are to be afforded; which is the same as saying, that workhouses, if receptacles for the insane at all, should be assimilated to asylums,--a principle, which, if admitted and acted upon, overturns at once the only argument for their use as such, viz. its economy. the perception on the part of parochial authorities, that something more than the common lodging and attendance of the workhouse is called for by the insane inmates, has led to the construction of "lunatic wards" for their special accommodation, a scheme which may be characterized as an extravagant mistake, whether viewed in reference to economical principles or the welfare of the patients. if structurally adapted to their object, they must cost as much as a suitable asylum need; and if properly supervised and managed, if a sufficient dietary be allowed, and a proper staff of attendants hired, no conceivable economical advantage over an asylum can accrue. on the contrary, as dr. bucknill has remarked (asylum journal, vol. iv. p. ), any such attempts at an efficient management of the insane in small and scattered asylums attached to union workhouses, will necessarily increase their rate of maintenance above that charged in a large central establishment, endowed with a more complete organization and with peculiar resources for their management. dr. bucknill returns to the discussion of this point in his just published report (rep. devon asylum, , p. ). he puts the question, "would a number of small asylums, under the denomination of lunatic wards, be more economical than one central asylum?" and, thus proceeds to reply to it:--"the great probability is that they would not be; st, on account of the larger proportion of officials they would require; nd, on account of the derangement they would occasion to the severe economy which is required by the aim and purpose of union-houses as tests of destitution. where lunatics do exist in union-houses in consequence of the want of accommodation in the county asylum, the commissioners in lunacy insist upon the provision of what they consider things essential to the proper care of insane persons wherever they be placed. the following are the requirements which they insisted upon as _essential_ in the liverpool workhouse:--a sufficient staff of responsible paid nurses and attendants; a fixed liberal dietary sanctioned by the medical superintendent of the asylum; good and warm clothing and bedding; the rooms rendered much more cheerful and better furnished; the flagged court-yards enlarged and planted as gardens; the patients frequently sent to walk in the country under proper care; regular daily medical visitation; and the use of the official books kept according to law in asylums. if the direct cost of such essentials be computed with the indirect cost of their influence upon the proper union-house arrangements, it will require no argument to prove that workhouse lunatic wards so conducted would effect no saving to the ratepayers. the measures needed to provide in the union-house kitchen a liberal dietary for the lunatic wards and a restricted one for the sane remainder, to control the staff of paid attendants, to arrange frequent walks into the country for part of the community, while the other part was kept strictly within the walls;--these would be inevitable sources of disturbance to the proper union-house discipline, which would entail an amount of eventual expenditure not easily calculated." if, on economical grounds, the system of lunatic wards has no evident merit, none certainly can be claimed for it on the score of its adaptation to their wants and welfare. indeed, the argument for workhouse accommodation, on the plea of economy, loses all its weight when the well-being of the insane is balanced against it. for, if there be any value in the universally accepted opinions of enlightened men, of all countries in europe, of the requirements of the insane, of the desirability for them of a cheerful site, of ample space for out-door exercise, occupation and amusement, of in-door arrangements to while away the monotony of their confinement and cheer the mind, of good air, food and regimen, of careful watching and kind nursing, of active and constant medical supervision and control, or to sum up all in two words, of efficient medical and moral treatment,--then assuredly the wards of a workhouse do not furnish a fitting abode for them. the unfitness of workhouses for the detention of the insane, and the evils attendant upon it, have been repeatedly pointed out by the commissioners in lunacy in their annual reports, and by several able writers. we were also glad to see from the report of his speech, on introducing the lunatic poor (ireland) bill into the house of commons, that lord naas is strongly opposed to the detention of the insane in workhouses, and therein agrees with the irish special lunacy commissioners ( , p. ), who have placed their opinion on record in these words:--"it appears to us that there can be no more unsuitable place for the detention of insane persons than the ordinary lunatic wards of the union workhouses." this is pretty nearly the same language as that used by the english commissioners in , viz. "we think that the detention in workhouses of not only dangerous lunatics, but of all lunatics and idiots whatever, is highly objectionable." to make good these general statements, we will, at the risk of some repetition, enter into a few particulars. on the one hand, the presence of lunatics in a workhouse is a source of annoyance, difficulty, and anxiety to the official staff and to the inmates, and withal of increased expense to the establishment. if some of them may be allowed to mix with the ordinary inmates, there are others who cannot, and whose individual liberty and comfort must be curtailed for the sake of the general order and management, and of the security and comfort of the rest. some very pertinent observations occur in the report of the massachusetts lunacy commission (_op. cit._ p. ), on the mixing of the sane and insane together in the state almshouses, which correspond to our union workhouses. they report that the superintendents "were unanimous in their convictions that the mingling of the insane with the sane in these houses operated badly, not only for both parties, but for the administration of the whole institution." further on, the commissioners observe (p. ), "by this mingling the sane and insane together, both parties are more disturbed and uncontrollable, and need more watchfulness and interference on the part of the superintendent and other officers.... it has a reciprocal evil effect in the management of both classes of inmates. the evil is not limited to breaches of order; for there is no security against violence from the attrition of the indiscreet and uneasy paupers with the excitable and irresponsible lunatics and idiots. most of the demented insane, and many idiots, have eccentricities; they are easily excited and disturbed; and nothing is more common than for inmates to tease, provoke, and annoy them, in view of gratifying their sportive feelings and propensities, by which they often become excited and enraged to a degree to require confinement to ensure the safety of life.... the mingling of the state paupers, sane and insane, makes the whole more difficult and expensive to manage. it costs more labour, watchfulness, and anxiety to take care of them together than it would to take care of them separately." these sketches from america may be matched in our own country; and they truthfully represent the reciprocal disadvantages of mixing the sane and insane together in the same establishment. even supposing the presence of insane in workhouses involved, on the one hand, no disadvantages to the institutions, or to the sane inmates; yet on the other, the evils to the lunatic inhabitants would be condemnatory of it; for the insane necessarily suffer in proportion as the workhouse accommodation differs from that of asylums; or, inversely, as the economical arrangements and management of a workhouse approach those of an asylum. they suffer from many deficiencies and defects in locality and organization, in medical supervision and proper nursing and watching, in moral discipline, and in the means of classification, recreation, and employment. workhouses are commonly town institutions; their locality often objectionable; their structure indifferent and dull; their site and their courts for exercise confined and small, and their means of recreation and of occupation, especially out of doors, very limited. petty officers of unions so often figure before the world, and have been so admirably portrayed by dickens and other delineators of character, on account of their peculiarities of manner and practice, that no sketch from us is needed to exhibit their unfitness as guardians and attendants upon the insane. as to workhouse nurses, little certainly can be expected from them, seeing that they are only pauper inmates pressed into the service; if aged, feeble and inefficient; if young, not unlikely depraved or weak-minded; always ignorant, and it may be often cruel; without remuneration or training, and chosen with little or no regard to their qualifications and fitness. however satisfactory the structure of the ward and its supervision might be rendered, its connexion with a union workhouse will be disadvantageous to the good government and order of the establishment, as above noticed, and detrimental to the welfare of the insane confined in it. thus it must be remembered that very many of the lunatic inmates have been reduced to seek parochial aid solely on account of the distressing affliction which has overtaken them; before its occurrence, they may have occupied an honourable and respectable position in society, and, consequently, where consciousness is not too much blunted, their position among paupers--too often the subjects of moral degradation--must chafe and pain the disordered mind and frustrate more or less all attempts at its restoration. to many patients, therefore, the detention in a workhouse is a punishment superadded to the many miseries their mental disorder inflicts upon them; and consequently, when viewed only in this light, ought not to be tolerated. of all cases of lunacy, the wards of a workhouse are least adapted to recent ones, for they are deficient of satisfactory means of treatment, whether medical or moral, and the only result of detention in them to be anticipated, must be to render the malady chronic and incurable. yet although every asylum superintendent has reported against the folly and injury of the proceeding, and notwithstanding the distinct and strong condemnation of it by the commissioners in lunacy, the latter, in their report for , have to lament an increasing disposition, on the part of union officers, to receive and keep recent cases in workhouses. moral treatment we hold to be impossible in an establishment where there are no opportunities of classification, no proper supervision and attendance, and no means for the amusement and employment of the mind; but where, on the contrary, the place and organization are directly opposed to it, and the prospects of medical treatment are scarcely less unfavourable. an underpaid and overworked medical officer, in his hasty visits through the wards of the workhouse daily, or perhaps only three or four times a week, very frequently without any actual experience among the insane, cannot be expected to give any special attention to the pauper lunatics, who are mostly regarded as a nuisance in the establishment, to be meddled with as little as possible, and of whose condition only unskilled, possibly old and unfeeling pauper nurses, can give any account. indeed, unless reported to be sick, it scarcely falls into the routine of the union medical officer regularly to examine into the state and condition of the pauper lunatics. these remarks are confirmed by the statement of the lunacy commissioners, in their 'further report,' (p. ), that pauper inmates, "in their character of lunatics merely, are rarely the objects of any special medical attention and care," and that it "was never found (except perhaps in a few cases) that the medical officer had taken upon himself to apply remedies specially directed to the alleviation or cure of the mental disorder. nor was this indeed to be expected, as the workhouse never can be a proper place for the systematic treatment of insanity." it would unnecessarily extend the subject to examine each point of management and organization affecting the well-being of the insane in detail, in order to show how unsuitable in all respects a workhouse must be for their detention; yet it may be worth while to direct attention to one or two other matters. except when some bodily ailment is apparent, the lunatic fare like the ordinary inmates; that is, they are as cheaply fed as possible, without regard to their condition as sufferers from disease, which, because mental, obtains no special consideration. it is in the power of the medical officer, on his visits, to order extra diet if he observes any reason in the general health to call for it; but the dependent position of this gentleman upon the parish authorities, and his knowledge that extra diet and its extra cost will bring down upon him the charge of extravagance and render his tenure of office precarious, are conditions antagonistic to his better sentiments concerning the advantages of superior nutriment to his insane patients. moreover, the cost of food is a principal item in that of the general maintenance of paupers, and one wherein the guardians of the poor believe they reap so great an economical advantage over asylums. but this very gain, so esteemed by poor-law guardians, is scouted as a mistake and proved an extravagance, _i. e._ if the life and well-being of the poor lunatics are considered, by the able superintendents of county asylums. dr. bucknill has well argued this matter in a paper "on the custody of the insane poor" (asylum journal, vol. iv. p. ), and in the course of his remarks says,--"the insane cannot live on a low diet; and while they continue to exist, their lives are rendered wretched by it, owing to the irritability which accompanies mental disease. the assimilating functions in chronic insanity are sluggish and imperfect, and a dietary upon which sane people would retain good health, becomes in them the fruitful source of dysentery and other forms of fatal disease." in his just published report, already quoted, the same excellent physician remarks (p. ),--"a good diet is essential to the tranquil condition of many idiots and chronic lunatics, and is, without doubt, a principal reason why idiots are easily manageable in this asylum, who have been found to be unmanageable in union houses. the royal commission which has recently reported on the lunatic asylums in ireland states this fact broadly, that 'the ordinary workhouse dietary is unsuited and insufficient for any class of the insane.' it is therefore my opinion, founded upon the above considerations, that neither the lunatics nor the idiots in the list presented are likely to retain their present state of tranquillity, and to be harmless to themselves and others, if they are placed in union houses, unless they are provided with those means which are found by experience to ensure the tranquillity of the chronic insane, and especially with a sufficient number of trustworthy attendants, and with a dietary adapted to their state of health. i have thought it desirable to ascertain the practice of charitable institutions especially devoted to the training of idiots, and i find that a fuller dietary is used in them than in this asylum." until a recent date, it was the custom in workhouses, with few exceptions, to allow most of their insane inmates to mingle with the ordinary pauper inmates of the same age and sex, and in general to be very much on the same footing with them "in everything that regards diet, occupation, clothing, bedding, and other personal accommodation" (report, , p. ). this mingling of the sane and insane, having been found subversive of good order and management, gave rise first to the plan of placing most of the latter class in particular wards, many of them in the infirmary, and, subsequently, owing to the advance of public opinion respecting the wants of the insane, to the construction, in many unions, of special lunatic wards, emulating more or less the character and purposes of asylums. the false economy of this plan has been already exposed; and although the lunacy commissioners have always set their faces against lunatic wards, yet their construction has of late been so rapid as to call forth a more energetic denunciation of it:--"impressed strongly (the commissioners write, report, , p. ) with a sense of their many evils, it became our duty, during the past year, to address the poor-law board against the expediency of affording any encouragement or sanction to the further construction, in connexion with union workhouses, of lunatic wards." the evils of lunatic wards, alluded to in the last-quoted paragraph, are thus enlarged upon in another page of the same report (p. ):--"it is obvious that the state of the workhouses, as receptacles for the insane, is becoming daily a subject of greater importance. they are no longer restricted to such pauper lunatics as,--requiring little more than the ordinary accommodation, and being capable of associating with the other inmates,--no very grave objection rests against their receiving. indeed it will often happen that residence in a workhouse, under such conditions, is beneficial to patients of this last-mentioned class; by the inducements offered, from the example of those around them, to engage in ordinary domestic duties and occupations, and so to acquire gradually the habit of restraining and correcting themselves. but these are now unhappily the exceptional cases. many of the larger workhouses, having lunatic wards containing from to inmates, are becoming practically lunatic asylums in everything but the attendance and appliances which ensure the proper treatment, and above all, in the supervision which forms the principal safeguard of patients detained in asylums regularly constituted. "the result is, that detention in workhouses not only deteriorates the more harmless and imbecile cases to which originally they are not unsuited, but has the tendency to render chronic and permanent such as might have yielded to early care. the one class, no longer associating with the other inmates, but congregated in separate wards, rapidly degenerate into a condition requiring all the attendance and treatment to be obtained only in a well-regulated asylum; and the others, presenting originally every chance of recovery, but finding none of its appliances or means, rapidly sink into that almost hopeless state which leaves them generally for life a burthen on their parishes. nor can a remedy be suggested so long as this workhouse system continues. the attendants for the most part are pauper inmates, totally unfitted for the charge imposed upon them. the wards are gloomy, and unprovided with any means for occupation, exercise, or amusement; and the diet, essential above all else to the unhappy objects of mental disease, rarely in any cases exceeds that allowed for the healthy and able-bodied inmates." the subject had previously received their attention, and is thus referred to in their ninth report (p. ):--"they are very rarely provided with any suitable occupation or amusement for the inmates. the means of healthful exercise and labour out of doors are generally entirely wanting, and the attendants (who are commonly themselves paupers) are either gratuitous, or so badly organized and so poorly requited, that no reliance can be placed on the efficiency of their services. in short, the wards become in fact places for the reception and detention of lunatics, without possessing any of the safeguards and appliances which a well-constructed and well-managed lunatic asylum affords. your lordship, therefore, will not be surprised to learn that while we have used our best endeavours to remedy their obvious defects and to ameliorate as far as possible the condition of their inmates, we have from the first uniformly abstained from giving any official sanction or encouragement to their construction." they further make this general observation:--"so far as the lunatic and idiotic inmates are concerned, the condition of the workhouses which have separate wards expressly appropriated to the use of that class, is generally inferior to that of the smaller workhouses, and in some instances extremely unsatisfactory." dr. bucknill, whose excellent remarks on lunatic wards in their economical aspect we have already quoted, has very ably canvassed the question of their fitness as receptacles for the insane, and, in a paper in the 'asylum journal' (vol. iii. p. ), thus treats on it:--"it is deserving of consideration, whether the introduction of liberally-conducted lunatic wards into a union workhouse would not interfere with the working of the latter in its legitimate scope and object. a workhouse is the test of destitution. to preserve its social utility, its economy must always be conducted on a parsimonious scale. no luxuries must be permitted within its sombre walls; even the comforts and conveniences of life must be maintained in it below the average of those attainable by the industry of the labouring poor. how can a liberally-conducted lunatic ward be engrafted upon such a system? it would leaven the whole lump with the taint of liberality, and the so-called pauper bastile would, in the eyes of the unthrifty and indolent poor, be deprived of the reputation which drives them from its portals." there is a general concurrence among all persons competent to form any opinion on the matter, that workhouses are most unfit places for the reception of recent cases of insanity. on the other hand, there is a prevalent belief that there is a certain class of the insane, considered "harmless," for whom such abodes are not unsuitable. the lunacy commissioners, in the extract from the eleventh report above quoted, partake in this opinion: let us therefore endeavour to ascertain, as precisely as we can, the class of patients intended, and the proportion they bear to the usual lunatic inmates of union workhouses. in their 'further report' for , the commissioners enter into a particular examination of the characters of the lunatics found in workhouses, and class them under three heads (p. ):-- st, those who, from birth, or from an early period of life, have exhibited a marked deficiency of intellect as compared with the ordinary measure of understanding among persons of the same age and station; ndly, those who are demented or fatuous; that is to say, those whose faculties, not originally defective, have been subsequently lost, or become greatly impaired through the effects of age, accident, or disease; and rdly, those who are deranged or disordered in mind, in other words, labouring under positive mental derangement, or, as it is popularly termed, "insanity." those in whom epilepsy or paralysis is complicated with unsoundness of mind, although their case requires a separate consideration, do not in strictness constitute a fourth class, but may properly be referred, according to the character of their malady and its effects upon their mental condition, to one or other of these three classes. further on in the report, after remarking on the difficulties besetting their inquiry, they write (p. ):-- "we believe, however, we are warranted in stating, as the result of our experience thus far, that of the entire number of lunatics in workhouses, whom we have computed at or thereabouts, two-thirds at the least, or upwards of , would be properly placed in the first of the three classes in the foregoing arrangement; or, in other words, are persons in whom, as the mental unsoundness or deficiency is a congenital defect, the malady is not susceptible of cure, in the proper sense of the expression; and whose removal to a curative lunatic asylum, except as a means of relieving the workhouse from dangerous or offensive inmates, can be attended with little or no benefit. "a considerable portion of this numerous class, not less, perhaps, than a fourth of the whole, are subject to gusts of passion and violence, or are addicted to disgusting propensities, which render them unfit to remain in the workhouse; and it is the common practice, when accommodation can be procured, to effect the removal of such persons to a lunatic asylum, where their vicious propensities are kept under control, and where, if they cannot be corrected, they at least cease to be offensive or dangerous. but although persons of this description are seldom fit objects for a curative asylum, they are in general capable of being greatly improved, both intellectually and morally, by a judicious system of training and instruction; their dormant or imperfect faculties may be stimulated and developed; they may be gradually weaned from their disgusting propensities; habits of decency, subordination, and self-command may be inculcated, and their whole character as social beings may be essentially ameliorated." the conclusion to be deduced from these extracts is, that one-fourth or two-thirds, that is, one-sixth of the whole number of occupants in workhouses of unsound mind, found in , were unfit for those receptacles, and demanded the provision of institutions in which a moral discipline could be carried out, and their whole condition, as social beings, ameliorated and elevated. a further examination of the data supplied in the same report will establish the conviction that, besides the proportion just arrived at, requiring removal to fitting asylums, there is another one equally large demanding the same provision. in this number are certainly to be placed all those of the third class "labouring under positive mental derangement," and who, although reported as "comparatively few" in , have subsequently been largely multiplied, according to the evidence of the 'eleventh report' (_ante_, p. ). those, again, "in whom epilepsy or paralysis is complicated with unsoundness of mind," are not suitable inmates for workhouse wards. no form of madness is more terrible than the furor attendant on epileptic fits; none more dangerous; and, even should the convulsive affection have so seriously damaged the nervous centres that no violence need be dreaded, yet the peril of the fits to the patient himself, and their painful features, render him an unfit inmate of any other than an establishment provided with proper appliances and proper attendants. as to the paralytic insane, none call for more commiseration, or more careful tending and nursing--conditions not commonly to be found in workhouses. the commissioners in lunacy have not omitted the consideration of workhouses as receptacles for epileptics and paralytics, and have arrived at the following conclusions:--after treating, in the first place, of epileptics whose fits are slight and infrequent, and the mental disturbance mild and of short duration, they observe that, as such persons "always require a certain amount of supervision, and as they are quite incompetent, when the fits are upon them, to take care of themselves, and generally become violent and dangerous, it would seem that the workhouse can seldom be a suitable place for their reception, and that their treatment and care would be more properly provided for in a chronic hospital especially appropriated to the purpose." concerning paralytics, they state that they are far less numerous than epileptics, and being for the most part helpless and bedridden, are treated as sick patients in the infirmary of the workhouse. their opinion is, however, that a chronic hospital would be a more appropriate receptacle for them,--a conclusion in which all must coincide, who know how much can be done to prolong and render more tolerable their frail and painful existence, by good diet and by assiduous and gentle nursing,--by such means, in short, as are not to be looked for in establishments where rigid economy must be enforced, and pauper life weighed against its cost. to turn now to the second class of workhouse lunatic inmates, the demented from age, accident, or disease: these, we do not hesitate to say, are not suitably accommodated in workhouses, for, like the paralytic, they require careful supervision, good diet and kind nursing; they are full-grown children, unable to help or protect themselves, to control their habits and tendencies; often feeble and tottering, irritable and foolish, and, without the protection and kindness of others, the helpless subjects of many ills. for such, the whole organization of the workhouse is unsuited; even the infirmary is not a fitting refuge; for, on the one hand, they are an annoyance to the other inmates, and, on the other, pauper nurses--whose office is often thrust upon them without regard to their fitness for it,--are not fitting guardians for them. in fine, where age, accident or disease has so deteriorated the mental faculties, we have a complication of physical and mental injury to disqualify the patient from partaking with his fellow-paupers in the common accommodation, diet, and nursing. in the reverse order which we have pursued, the first class of congenital, imbecile, and idiotic inmates comes to be considered last. this happens by the method of exclusion adopted in the argument; for the second and third classes have been set aside as proper inmates of some other institution than a workhouse, and it now remains to inquire, who among the representatives of the first class are not improperly detained in workhouses. this class includes, as already seen, some two-thirds of the whole number of inmates mentally disordered; and among whom, we presume, are to be found those individuals who may, in the commissioners' opinion, mix advantageously with the general residents of the establishment. the number of the last cannot, we believe, be otherwise than very small; for the very supposition that there is imbecility of mind, is a reason of greater or less force, according to circumstances, for not exposing them to the contact of an indiscriminate group of individuals, more especially of that sort to be generally found in workhouses. the evils of mingling the sane and insane in such establishments have already been insisted upon; and besides these, such imbecile patients as are under review, lack in workhouses those means of employment and diversion which modern philanthropy has suggested to ameliorate and elevate their physical and moral condition. lastly, if the remaining members of this class be considered, in whom the imbecility amounts to idiocy, the propriety of removing them from the workhouse will be questioned by few. indeed, will any one now-a-days advocate the "_laissez faire_" system in the case of idiots? experience has demonstrated that they are improveable, mentally, morally, and physically; and if so, it is the duty of a christian community to provide the means and opportunities for effecting such improvement. it cannot be contended that the workhouse furnishes them; on the contrary, it is thoroughly defective and objectionable by its character and arrangements, and, as the commissioners report, (_op. cit._ p. ) a very unfit abode for idiots. on looking over the foregoing review of the several classes of lunatic inmates of workhouses distinguished by the commissioners in lunacy, the opinion to be collected clearly is, that only a very few partially imbecile individuals among them are admissible into workhouses, if their bodily health, their mental condition, their due supervision and their needful comforts and conveniences are to be duly attended to and provided for. in accordance with the views we entertain, as presently developed, of the advantages of instituting asylums for confirmed chronic, quiet, and imbecile patients, we should permit, if any at all, only such imbecile individuals as residents in workhouses, who could pass muster among the rest, without annoyance, prejudice or discomfort to themselves or others, and be employed in the routine occupations of the establishment. so much is heard among poor-law guardians and magistrates about a class of "harmless patients" suitably disposed of in workhouses and rightly removeable from asylums, that a few remarks are called for concerning them. to the eye of a casual visitor of an asylum, there does certainly appear a large number of patients, so quiet, so orderly, so useful and industrious, that, although there is something evidently wrong about their heads, yet the question crosses the mind, whether asylum detention is called for in their case. the doubt is not entertained by the experienced observer, for he knows well that the quiet, order, and industry observable are the results of a well-organized system of management and control; and that if this fails, the goodly results quickly vanish to be replaced by the bitter fruits generated by disordered minds. the "harmless" patient of the asylum ward becomes out of it a mischievous, disorderly, and probably dangerous lunatic. in fact, the tranquillity of many asylum inmates is subject to rude shocks and disturbances, even under the care and discipline of the institution; and the inoffensive-looking patient of to-day may, by his changed condition, be a source of anxiety, and a subject for all the special appliances it possesses, to-morrow. any asylum superintendent would be embarrassed to select a score of patients from several hundred under his care whom he could deliberately pronounce to be literally "harmless" if transferred to the workhouse. he might be well able to certify that for months or years they have gone on quietly and well under the surrounding influences and arrangements of the asylum, but he could not guarantee that this tranquillity should be undisturbed by the change to the wards of the workhouse; that untrained attendants and undesirable associates should not rekindle the latent tendency to injure and destroy; that defective organization and the absence of regular and regulated means of employment and recreation should not revive habits of idleness and disorder; or that a less ample dietary, less watchfulness and less attention to the physical health, should not aggravate the mental condition and engender those disgusting habits, which a good diet and assiduous watching are known to be the best expedients to remedy. dr. bucknill has some very cogent remarks on this subject in his last report of the devon asylum (p. ). "the term 'harmless patients,' or in the words of the statute, those 'not dangerous to themselves or others' (he writes), i believe to be inapplicable to any insane person who is not helpless from bodily infirmity or total loss of mind: it can only with propriety be used as a relative term, meaning that the patient is not so dangerous as others are, or that he is not known to be refractory or suicidal. it should not be forgotten, that the great majority of homicides and suicides, committed by insane persons, have been committed by those who had previously been considered harmless; and this is readily explained by the fact, that those known to be dangerous or suicidal are usually guarded in such a manner as to prevent the indulgence of their propensities; whilst the so-called harmless lunatic or idiot has often been left without the care which all lunatics require, until some mental change has taken place, or some unusual source of irritation has been experienced, causing a sudden and lamentable event. in an asylum such patients may truly be described as not dangerous to themselves or others, because they are constantly seen by medical men experienced in observing the first symptoms of mental change or excitement, and in allaying them by appropriate remedies; they are also placed under the constant watchfulness and care of skilful attendants, and they are removed from many causes of irritation and annoyance to which they would be exposed if at large, in villages or union houses. "it not unfrequently happens that idiots who have lived for many years in union houses, and have always been considered harmless and docile, under the influence of some sudden excitement, commit a serious overt act, and are then sent to an asylum. one of the most placid and harmless patients in this asylum, who is habitually entrusted with working tools, is a criminal lunatic, of weak intellect, who committed a homicide on a boy, who teased him while he was breaking stones on the road. if this is the case with those suffering only from mental deficiency, it is evidently more likely to occur in those suffering from any form of mental disease, which is often liable to change its character, and to pass from the form of depression to one of excitement. for these reasons i am convinced that all lunatics, and many strong idiots, can only be considered as 'not dangerous to themselves or others,' when they are placed under that amount of superintendence and care which it has been found most desirable and economical to provide for them in centralized establishments for the purpose. "for the above reasons, i am unable to express the opinion that any insane patients who are not helpless from bodily infirmity or total loss of mind are _unconditionally_ harmless to themselves and others. i have, however, made out a list of sixty patients who are incurable, and who are likely, _under proper care_, to be harmless to themselves and others. "of the patients in this list who are lunatic, only nine have sufficient bodily strength to be engaged in industrial pursuits. the remaining twenty-three are so far incapacitated by the infirmities of old age, or by bodily disease, or by loss of mental power, that they are unable to be employed, and require careful nursing and frequent medical attendance. the patients who have sufficient bodily strength to be employed, are also with the least degree of certainty to be pronounced harmless to themselves and others. as the result of long training, they willingly and quietly discharge certain routine employments under proper watch; but it is probable, that if removed from their present position, any attempts made to employ them by persons unaccustomed to the peculiarities of the insane, will be the occasion of mental excitement and danger. "the twenty-eight idiots have, with few exceptions, been sent to the asylum from union houses, where it has been found undesirable to detain them, on account either of their violent conduct, or of their dirty habits, or some other peculiarity connected with their state of mental deficiency; habits of noise or indecency for instance." probably the following extract from the report of the committee of the surrey asylum ( ) may have more weight with some minds than any of the arguments and illustrations previously adduced, to prove that the detention of presumed "harmless patients" in workhouses will not answer. the declaration against the plan on the part of the surrey magistrates is the more important, because they put it into practice with the persuasion that it would work well. but to let them speak for themselves, they write,--"the committee adverted at considerable length in their last annual report to the circumstance of the asylum being frequently unequal to the requirements of the county, and of their intention to attempt to remedy the defect by discharging all those patients, who, being harmless and inoffensive, it was considered might be properly taken care of in their respective union houses. "the plan has been tried, and has not been successful. patients who, under the liberal and gentle treatment they experience in the asylum, are quiet and tractable, are not necessarily so under the stricter regulations of a workhouse; indeed, so far as the experiment has been tried, the reverse has been found to be the case; most of the patients so discharged having been shortly afterwards returned to the asylum, or placed in some other institution for the insane, in consequence of their having become, with the inmates of the workhouse, 'a mutual annoyance to each other.' any arrangement, short of an entire separation from the other inmates of the workhouse, will be found to be inefficient." this is the same as saying that if lunatics are to reside in workhouses, a special asylum must be instituted in the establishment for their care, and the comfort and safety of the other inmates. if the well-being of the insane were the only question to be settled, no difficulty would attend the solution, for experience has most clearly evidenced the vast advantages of asylums over workhouses as receptacles for insane patients, whatever the form or degree of their malady. dr. bucknill has some very forcible remarks in his paper on "the custody of the insane poor" (asylum journal, vol. iv. p. ), with illustrative cases; and in his report last quoted, reverts to this subject of the relative advantages of asylums and workhouses; but we forbear to quote, if only from fear of being thought to enlarge unduly upon a question which has been decided long ago by the observation and experience of all those concerned in the management of the pauper insane; viz. that whatever the type and degree of mental disorder and of fatuity, its sufferers become improved in properly managed asylums, as intellectual, moral, and social beings upon removal from workhouses; and by a reverse transfer, are deteriorated in mind, and rendered more troublesome and more costly. to the workhouse the lunatic ward is an excrescence, and its inmates an annoyance: in its organization, there is an absence or deficiency of almost all those means conducive to remedy or remove the mental infirmity, and the very want of which contributes as much as positive neglect and maltreatment to render the patient's condition worse, by lowering his mental and moral character. but such deterioration or degradation is not an isolated evil, or the mere negation of a better state; for it acts as a positive energy in developing moral evil, and brings in its train perverseness, destructiveness, loss of natural decency in habits, conversation and conduct, and many other ills which render their subjects painfully humiliating as human beings, and a source of trouble, annoyance, and expense to all those concerned with them. in a previous page we have sought to determine what was the proportion of lunatic inmates found by the lunacy commissioners in workhouses considered to be not improperly detained in them, and have estimated it at one-half of the whole number. the foregoing examination, however, of the adaptation of workhouses for the several classes of lunatics distinguishable, leads to the conviction that a very much less proportion than one-half ought to be found in those establishments. for our own part, we would wish to see the proportion reduced by the exclusion of most of its component members, reckoned as "harmless" patients; a reduction which would well nigh make the proportion vanish altogether. what is to be done with the lunatics removed from workhouses, is a question to be presently investigated. but before proceeding further, some consideration of the legal bearings of workhouse detention of lunatics is wanting, for it has been advanced by some writers that such detention is illegal. now, in the first place, it must be admitted that a workhouse is not by law, nor in its intent and purpose, a place of imprisonment or detention. its inmates are free to discharge themselves, and to leave it at will when they no longer stand in need of its shelter and maintenance. whilst in it, they are subject to the general rules of workhouse-government, and to a superior authority, empowered, if not by statute, yet by orders of the poor-law board, or by bye-laws of the guardians, to exercise discipline by the enforcement of penalties involving a certain measure of punishment. temporary seclusion in a room may be countenanced, although not positively permitted by law; but prolonged confinement, the deprivation of liberty, and a persistent denial of free egress from the house, are proceedings opposed to the true principles of english law. yet it may be that a plea for their detention might be sustained in the case of sick or invalid patients (with whom the insane would be numbered) under certificate of the parochial medical officer, provided no friend came forward to guarantee their proper care, or that they could not show satisfactorily the means of obtaining it; for, of such cases, the workhouse authorities may be considered the rightful and responsible guardians, required in the absence of friends to undertake their charge and maintenance. upon such grounds, probably, cause might be shown for the detention of the greater part of workhouse lunatic inmates, although there is no act of parliament explicitly to sanction it. should such a plea be admitted, the notion, entertained by dr. bucknill, that an action would lie for false imprisonment against the master and guardians of the workhouse, would be found erroneous. the lunacy commissioners presented some remarks on this question, indicating a similar view to that just advanced in their 'further report,' . for instance (p. , _op. cit._), they observed:-- "how far a system of this kind, which virtually places in the hands of the masters, many of whom are ignorant, and some of whom maybe capricious and tyrannical, an almost absolute control over the personal liberty of so many of their fellow men, is either warranted by law, or can be wholesome in itself, are questions which seem open to considerable doubt. probably if the legality of the detention came to be contested before a judicial tribunal in any individual case, the same considerations of necessity or expediency which originally led to the practice, might be held to justify the particular act, provided it were shown that the party complaining of illegal detention could not be safely trusted at large, and that his detention, therefore, though compulsory, instead of being a grievance, was really for his benefit as well as that of the community." again, in the second place, the law, without direct legislation to that effect, yet admits,--by the provisions it makes for pauper lunatics not in asylums or licensed houses, and by the distinction it establishes between persons proper to be sent to an asylum, and lunatics generally so-called,--that insane patients may be detained elsewhere than in asylums. for instance, by _sect._ lxvi. & vict. cap. , , provision is made for a quarterly visit by the union or parish medical officer to any pauper lunatic _not being_ in a workhouse, asylum, registered hospital, or licensed house, in order that he may ascertain how the lunatic is treated, and whether he "may or may not properly remain out of an asylum." so likewise by _sect._ lxiv. of the same act, the clerk or overseers are required to "make out and sign a true and faithful list of all lunatics chargeable to the union or parish in the form in schedule (d)." this form is tabular, and presents five columns, under the heading of "where maintained," of which three are intended for the registry of the numbers not confined in asylums, hospitals, and licensed houses, but who are ( ) in workhouses, ( ) in lodgings, or boarding out, or ( ) residing with relatives. further, the law distinguishes, by implication, a class of lunatics as specially standing in need of asylum care, and as distinct from others. by the poor-law amendment act ( & will. iv. cap. . sect. ), it is ordered that nothing in that act "shall authorize the detention in any workhouse of any dangerous lunatic, insane person, or idiot for any longer period than fourteen days; and every person wilfully detaining in any workhouse any such lunatic, insane person, or idiot for more than fourteen days, shall be deemed guilty of a misdemeanour." this section is still in force, is constantly acted upon by the poor-law board, and is legally so read as if the word 'dangerous' were repeated before the three divisions of mentally-disordered persons referred to, viz. lunatics, insane persons, and idiots. so, likewise, by _sect._ lxvii. ( & vict. cap. )--the "lunatic asylums' act, ," now in operation,--the transmission of an insane individual to an asylum is contingent on the declaration that he is "a lunatic and a _proper person to be sent to an asylum_." moreover, by _sect._ lxxix. of the same act, it is competent to any three visitors of an asylum, or to any two in conjunction with the medical officer of the asylum, to discharge on trial for a specified time "any person detained in such asylum, whether such person be recovered or not;" and by the following section (lxxx.) it is ordered, that, upon receipt of the notice of such discharge, "the overseers or relieving officers respectively shall cause such lunatic to be forthwith _removed to_ their parish, or to the _workhouse of the union_." by the th section it is further provided, that "in case any person so allowed to be absent on trial for any period do not return at the expiration of such period, and a medical certificate as to his state of mind, certifying that his detention in an asylum is no longer necessary, be not sent to the visitors, he may, at any time, within fourteen days after the expiration of such period, be retaken, as herein provided in the case of an escape." on the other hand, simple removal from an asylum is by the th section, curiously enough interdicted except to another asylum, a registered hospital, or a licensed house. this intent, too, of the section is not changed by the amendment, _sect._ viii. & vict. cap. . lastly, no other place than an asylum, registered hospital, or licensed house, is constituted lawful by _sect._ lxxii. for the reception of any person found lunatic and under "order by a justice or justices, or by a clergyman and overseer or relieving officer, to be dealt with as such." but this section has to be read in connexion with preceding ones, for instance, with _sect._ lvii., by which it is laid down that the justices or other legal authority must satisfy themselves not only that the individual is a lunatic, but also that he is "a proper person to be sent to an asylum." these quotations indicate the state of the law respecting the detention of lunatics elsewhere than in asylums. this state cannot be held to be satisfactory: it evidently allows the detention of lunatics in workhouses, while at the same time it affords them little protection against false imprisonment, and makes no arrangement for their due supervision and care, except by means of the visits of the lunacy commissioners, which are only made from time to time, not oftener than once a year, and rarely so often. the alleged lunatics are for the most part placed and kept in confinement without any legal document to sanction the proceeding; without a certificate of their mental alienation, and without an order from a magistrate. within the workhouse, they are, unless infirm or sick, treated like ordinary paupers, save in the deprivation of their liberty of exit; they may be mechanically restrained, or placed in close seclusion by the order of the master, who is likely enough to appreciate the sterner means of discipline and repression, but not the moral treatment as pursued in asylums; and, lastly, they live deprived of all those medical and general measures of amelioration and recovery as here before sketched. an extract from the 'further report' of the commissioners in lunacy will form a fitting appendix to the observations just made. it occurs at p. (_op. cit._), and stands thus:-- "it certainly appears to be a great anomaly, that while the law, in its anxiety to guard the liberty of the subject, insists that no persons who are insane--not even dangerous pauper lunatics--shall be placed or kept in confinement in a lunatic asylum without orders and medical certificates in a certain form, it should at the same time be permitted to the master of a workhouse forcibly to detain in the house, and thus to deprive of personal liberty, any inmate whom, upon his own sole judgment and responsibility, he may pronounce to be a person of unsound mind, and therefore unfit to be at large." it is unsatisfactory that the law recognizes the distinction between dangerous and other lunatics, designated as "harmless;" for we have pointed out that no such rigid separation can be made; that it is with very few exceptions impracticable to say with certainty what patients are harmless and what not, inasmuch as their state is chiefly determined by surrounding conditions, by the presence or absence of moral control and treatment. it is likewise to be regretted that so much is left to the discretion of relieving officers and overseers, in the determination of the lunatics "proper to be sent to an asylum;" for those parish functionaries nearly always display a proclivity, where relief is to be afforded, to any plan which at first sight promises to be the most cheap; and hence it is, as remarked in previous pages, they think to serve the rate-payers best by keeping, if practicable, the insane in workhouses. the expediency of asylum treatment for those who claim it, is surely not a question to be determined by such officers. yet the wording of the act (_sect._ lxvii.), that, if they have notice from the parish medical officer of any pauper who "is, or is deemed to be a lunatic, and a proper person to be sent to an asylum," or if they in any other manner gain knowledge of a pauper "who is, or is deemed to be a lunatic, and a proper person to be sent to an asylum, they shall within three days" give notice thereof to a magistrate,--seems to put the solution of the question pretty much in their hands. although when they receive a notice of a pauper lunatic from the union medical officer, they would appear by _sect._ lxx. to be bound to apprise a justice of the matter, yet, in the absence of such a notice, an equal power in determining on the case is lodged in their hands as in those of the medical officer, by the phrase "is, or is deemed to be a lunatic, and a proper person to be sent to an asylum;" for this clause respecting the fitness of the case, reads with the parts of the sentence as though it stood thus in full--'is a lunatic and a proper person to be sent to an asylum, or is deemed a lunatic and a proper person to be sent to an asylum;' and there is nothing in _sect._ lxx. to enforce, under these circumstances, a notice being sent to a justice. it is, indeed, evidently left to the discretion of the overseer or relieving officer to report a case of lunacy falling within his own knowledge to a justice, for he is empowered to assume the function of deciding whether it is or is not a proper one for an asylum. moreover, we cannot refrain from thinking that a parochial medical officer is not always sufficiently independent, as a paid _employé_, to certify to the propriety of asylum care so often as he might do, where the guardians or other directors of parish affairs are imbued with rigid notions of economy, and hold the asylum cost for paupers in righteous abhorrence. in fine, were this enactment for reporting pauper lunatics to county and borough justices, in order to obtain a legal sanction for their detention, sufficiently clear and rigidly enforced, there would not be so many lunatics in workhouses, and none of those very unfit ones animadverted upon by the commissioners in lunacy (see p. , and th rep. c. l. ). the first clause of _sect._ lxvii. is ambiguous; for though it is evidently intended primarily to make the union medical officer the vehicle of communicating the knowledge of the existence of pauper lunatics in his parish, yet it is neither made his business to inquire after such persons, nor when he knows of their existence, to visit and ascertain their condition. it is left open for him to act upon a report that such a pauper "is deemed to be a lunatic, and a proper person to be sent to an asylum," without seeing the individual; but generally he will officially hear first of such patients through the channel of the relieving officer, by receiving an order to visit them. indeed, the relieving officer is legally the first person to be informed of a pauper requiring medical or other relief; and, as we have seen, it is competent for him to decide on the question of asylum transmission or not for any case coming directly to his knowledge. hence, in the exercise of his wisdom, he may order the lunatic forthwith into the union-house, and call upon the medical officer there to visit him. the consignment of the lunatic to the workhouse being now an accomplished fact, it becomes a hazardous enterprise, and a gratuitous task on the part of the medical officer (for no remuneration is offered for his report), to give the relieving officer or overseer a written notice that the poor patient should rightly be sent to the asylum, when he knows that those parish authorities have made up their minds that it is not a proper case to be sent there. in fact, the law makes no demand of a notice from the medical officer of the union necessary where the knowledge of a lunatic pauper first reaches the relieving officer or overseer, or where the patient is already in the workhouse; and no report will be sought from him under such circumstances, unless the parochial authorities decide that they will not take charge of the case in the workhouse. the object of the th and five following sections is evidently to promote the discovery of pauper lunatics, and to ensure the early transmission of all those amenable to treatment to county asylums; but these advantages are not attained, the legal machinery being defective. to fulfil the intention, it should be made imperative on the part of the relatives or friends to make known the occurrence of a case of lunacy at its first appearance to a duly-appointed medical man, who should visit and register it, and, with the concurrence of a magistrate, order detention in a properly-constituted asylum. such a medical officer would have a district assigned to him; of his duties at large we shall have occasion hereafter to speak; to allude further to them in this place will cause us to diverge too widely from the subject under consideration. the th section of the "lunatic asylums' act," which has above been submitted to criticism, we find referred to in the lunacy commissioners' eleventh report, wherein it is spoken of as disregarded by parochial authorities; its ambiguity and the loophole to a contravention of its meaning being, however, unnoticed. the reference occurs in the following passage (_op. cit._ p. ), which censures a practice we have already animadverted upon:-- "and here we take occasion to remark, that if the law were more strictly carried out in one particular, the same temptation to a mistaken and ill-judged economy would not so frequently present itself to boards of guardians; nor could it so often occur to them as an advantage, that they should themselves manage their insane poor by the resources at their own disposal. a custom prevails, very generally, of sending all pauper lunatics to the workhouses in the first instance, instead of at once procuring an order for their transmission to an asylum; and nothing has more contributed to the many recent and acute cases improperly so detained. the practice, it is hardly necessary to say, is in direct contravention of the law applicable to insane paupers. assuming that they come ordinarily at first under the care of the district parish surgeon, he is bound to give notice (under the th section of the lunatic asylums' act) to the relieving officer, by whom communication is to be made to the magistrate, upon whose order they are to be conveyed to an asylum; but in effect these provisions are disregarded altogether. and thus it follows, that the patient, if found to be manageable in the workhouse, is permanently detained there; or even should he ultimately find his way to an asylum, it is not until so much valuable time has been lost that his chances of cure are infinitely lessened. for, although it is our invariable habit, on the occasion of visiting workhouses, to recommend the removal to asylums of all whom we consider as curable, or exposed to treatment unsuited to their state, we find nothing so difficult as the enforcement of such recommendations; and for the most part the report of the medical officer of the union, to the effect that the patient is 'harmless,' is suffered to outweigh any opinion we can offer." in this quotation, therefore, we have an official proof that the defective and ambiguous legislation above commented upon is practically not without its mischievous fruits to the well-being of the insane poor. to amend it, some such scheme as we have sketched is called for to secure the reporting of lunatics, their examination and registration, and the legal sanction to their detention for the purposes of their own safety and that of others, and of their treatment; and were it not that at the present moment asylum accommodation cannot be afforded to all the pauper lunatics of the kingdom, their confinement in workhouses ought to be at once rendered illegal. convinced as we are, that asylums for the insane could be erected, fitted, organized, and maintained at a cost which would leave no pecuniary advantage economically on the side of workhouses; and that, even were the primary expenditure of the latter considerably less, they would in the long run be more expensive on account of their unfitness for lunatic patients, whatever the type of their malady, the injuries they entail on the well-being of all, and the chronic insanity they produce and foster,--it is with much reluctance we are forced to endorse the statement made by the commissioners in lunacy, in their th report (p. ), that workhouse "lunatic wards will have to be continued for some time longer," until, we may add, a more comprehensive, and withal a modified scheme be brought into operation, to cherish, to succour, and to cure those suffering under the double evil of poverty and insanity. though a remedy to meet the whole case must unfortunately be delayed, yet the lunacy commissioners nevertheless need continue energetically to discourage the plan of building special lunatic wards to workhouses, as one, according to their own showing, indeed, fraught with very many evils to their inmates. such erections ought, in fact, to be rendered illegal; the money spent on them would secure proper accommodation in connexion with a duly organized and managed asylum, as demonstrated in previous pages (p. ), for all those classes of pauper lunatics, which, under any sort of plea or pretence, can be detained in workhouses. lastly, we must look to the commissioners to maintain an active supervision over workhouse inmates,--to hold, at least, an annual "jail delivery" of every union-house, to order the immediate transfer of evidently improper inmates, and to remove others, so to speak, for trial. the "leading principles," as laid down by the commissioners in (report, p. ), and to which, in subsequent reports, they state their continued adhesion, are as good as the present state of lunacy and lunatic asylums permit to be enforced; but they can be enforced only by the commissioners themselves, or others possessing equal authority; for workhouse officials will interpret them through the medium of their own coloured vision; and if magistrates were entrusted with the task, we have no confidence that it would be efficiently performed by them as inexperienced, non-medical men, with whom economical considerations will hold the first place. the principles referred to are expressed in the following paragraph:-- "we have invariably maintained that the permanent detention in a workhouse of any person of unsound mind, whether apparently dangerous or not, whose case is of recent origin, or otherwise presents any hope of cure through the timely application of judicious treatment, or who is noisy, violent, and unmanageable, or filthy and disgusting in his habits, and must therefore be a nuisance to the other inmates, is an act of cruelty and injustice, as well as of great impolicy; and we have on all occasions endeavoured, so far as our authority extends, to procure the speedy removal of persons of that description to a lunatic asylum." the following practical suggestions, calculated to improve the condition of the insane poor, are deducible from the foregoing remarks on workhouses considered as receptacles for lunatics. . the county asylums should afford aid to all insane persons unable to procure proper care and treatment in private asylums; and , such patients should be directly transmitted to them; the circumstance of their entire or partial liability to the poor-rates being, if necessary, subsequently investigated. . as a corollary to the last suggestion, the primary removal of patients to a workhouse should, save in very exceptional cases, such as of distance from the asylum and unmanageable violence at home, be rendered illegal; or, what is nearly tantamount to it, for the future no alleged lunatic should be suffered to become an inmate of a workhouse, except with the written authority of the district medical officer or inspector proposed to be appointed. . without the sanction of this officer, likewise, no lunatic should be permitted to be discharged or removed from a workhouse. this is necessary for the patient's protection, for securing him against confinement in any house or lodging under disadvantages to his moral and physical well-being, to check improper discharges, and to protect the asylum against the transfer to it of unfit cases, a circumstance which will presently be shown to be of frequent occurrence. . no person should be detained as a lunatic or idiot, or as a person of unsound mind in a workhouse, except under a similar order as that required in the case of asylum detention, and a medical certificate to the fact of his insanity. . if workhouses need be used, whether as temporary or as permanent receptacles for the insane, they should be directly sanctioned by law, placed under proper regulations, and under effective supervision, not only of the lunacy commissioners, but also of a committee of visitors, and of the district medical officer, whose duty it would be to watch over the welfare of the insane inmates, their treatment, diet, occupation, and amusement. the visitors should be other than guardians or overseers of the poor of the union or parish in which the workhouse is situated, although every union should be represented on the committee; and they might be selected from the magistrates, and from the respectable classes among the rate-payers. if the county were large, it might be advantageously divided into districts, a committee of visitors of workhouses being appointed in each district. . every workhouse containing lunatics should be licensed as a place of detention for them by the committee of visitors, who should have authority to revoke the license. this power of revoking the license should be also vested in the commissioners in lunacy. . every such workhouse, and the number of its insane inmates, should be reported to the lunacy commissioners. according to our scheme, the district medical officer would do this, as well as report generally to the lunacy board, the condition and circumstances both of the workhouse and of its insane inmates. . for the future, the erection or the appropriation of distinct lunatic wards to workhouses should be interdicted by law. by the preceding suggestions reforms are, indeed, proposed to render confinement in workhouses legal; to make it more satisfactory; to provide for effectual supervision, and in general to assimilate the wards of union-houses more closely to those of asylums. yet all this is done only on the ground of the necessity for some legislation on these matters, and more particularly under the pressing circumstances of the time. the present state of lunacy compels acquiescence in the lunacy commissioners' statement, that workhouse-wards must for some time longer be used for the detention of insane paupers; and this fact alone supplies an apology for making suggestions to improve them. moreover, apart from it, the workhouse will at times necessarily be the temporary refuge for some few cases, and may be occupied as a permanent dwelling by those rare instances of imbecility of mind which can be allowed to intermingle with the other inmates, and be usefully occupied; and for these reasons it need be rendered both a legal and not unsuitable abode. at the same time, it is most desirable that the lunacy commissioners should be able not only to discourage, but also to veto the construction of lunatic-wards for the future, on the grounds already so largely pointed out; and for this reason, moreover, that where such wards exist, they are thought good enough for their poor inmates, and are looked upon as asylums over which the county institution has little preference. the existence, therefore, of any specially erected or adapted ward, may always be urged against the proposition for further expenditure in providing for pauper lunatics elsewhere in suitable asylums;--a plea, which should consequently be set aside by overturning the foundation whereon it rests. since the preceding observations on the detention of pauper lunatics in workhouses were in print, a most important supplementary report on the subject has been put forth by the commissioners in lunacy (supplement to the twelfth report; ordered to be printed th of april, ). we have read this report with pleasure, so far as it confirms the views we have taken, but with surprise and pain at the details it unfolds of practices the most revolting to our better feelings, and, in general, of a state of things discreditable to a civilized and christian country. by being confirmatory of the opinions and statements advanced by us, it may be said to give an official sanction to them; and as it is one of the most important documents ever issued by the board, we shall attempt an analysis of its contents. in the first place, the commissioners resort to some recent corrected returns of the poor-law board, and discover that the number of pauper lunatics in workhouses was, on the st of january, , , _i. e._ upwards of above that returned in the tenth report of the same board, and referred to in the foregoing pages; and on the st of july in that same year it amounted to . they then proceed to describe the "character and forms of insanity most prevalent in workhouses," and show that their insane inmates all require protection and control; that "some, reduced to poverty by their disease, are of superior habits to those of ordinary paupers, and require better accommodation than a workhouse affords. many are weak in body, and require better diet. many require better nursing, better clothing, and better bedding; almost all (and particularly those who are excitable) require more healthful exercise, and, with rare exceptions, all require more tender care and more vigilant superintendence than is given to them in any workhouse whatsoever." on turning to the "design and construction of union buildings," they rightly point out that the stringent conditions to ensure economy, and to check imposition and abuse, the "reduced diet, task labour, confinement within the narrow limits of the workhouse premises," the plan of separating the inmates into classes, the scanty means of out-door exercise, &c., are inimical to the well-being of the insane residents. in the "modes of workhouse direction and administration" there is great unfitness. the rules under which the officers act "are mainly devised to check disorderly conduct in ordinary paupers; and it is needless to say with how much impropriety they are extended to the insane. any increase of excitement, or outbreak of violence, occurring in the cases of such patients, instead of being regarded as a manifestation of diseased action requiring medical or soothing treatment, has subjected the individual to punishment, and in several instances led to his imprisonment in a jail. in addition to these hardships, the lunatic patient is for the most part precluded from leaving the workhouse at his own will. in effect he becomes a prisoner there for life, incapable of asserting his rights, often of signifying his wants, yet amenable to as much punishment as if he were perfectly sane, and a willing offender against the laws or regulations of the place. nor, as will hereafter be seen, is his lot much bettered in the particular cases where it is found convenient to the authorities to relax those restrictions, and give him the power at will to discharge himself." rural workhouses of small size are generally preferable abodes for the insane than those of larger dimensions, since their "arrangements have a more homely and domestic character, and there are more means of occupation and of free exercise in the open air;" and where their imbecile inmates can be associated with the ordinary paupers, and regularly employed, their condition is not unfavourable; "but these form only the exceptions." workhouses in the metropolis and in large towns generally, are for the most part "of great size, old, badly constructed, and placed in the midst of dense populations. the weak-minded and insane inmates are here generally crowded into rooms of insufficient size, sometimes in an attic or basement, which are nevertheless made to serve both for day and sleeping accommodation. they have no opportunity of taking exercise; and, from the want of space and means of separation, are sometimes associated with the worst characters, are subjected unnecessarily to seclusion and mechanical restraint, and are deprived of many of the requisites essential to their well-being." "of the workhouses in england and wales, somewhat more than a tenth part are provided with separate lunatic and idiot wards." the "objections to intermixture of inmates" are briefly stated. "there is no mode of complying with suggestions for" the peculiar benefit of insane inmates, "without disturbing the general economy of the house,--a fact which shows how important it is that no lunatic or idiot should be retained for whom any special arrangements are necessary." separate lunatic wards are declared to be more objectionable than the intermixture of the pauper inmates. only occasionally are such wards found at all tolerable; and even then, the constant medical supervision, proper attendants and nursing, sufficient diet, exercise, occupation, and other needful provisions, are deficient. the majority are thus sketched:--"in some of the wards attached to the old workhouses the rooms are crowded, the ventilation imperfect, the yards small and surrounded by high walls; and in the majority of instances the bed-rooms are used also as day-rooms. in these rooms the patients are indiscriminately mixed together; and there is no opportunity for classification. there is no separation where the association is injurious; and no association where such would be beneficial. in fact, patients of all varieties of character,--the weak, the infirm, the quiet, the agitated, the violent and vociferous, the dirty and epileptic,--are all mingled together, and the excitement or noise of one or more injures and disturbs the others. the restless are often confined to bed to prevent annoyance to the other patients, and the infirm are thus disposed of for the want of suitable seats. their condition when visited in the daytime is obviously bad, and at night must be infinitely worse. even in workhouses where the wards are so constructed as to provide day-rooms, these are often gloomy, much too small in size, and destitute of ordinary comforts; while the furniture is so poor and insufficient, that in some instances, there being no tables whatever, the patients are compelled to take their meals upon their knees. other cases to be hereafter mentioned will indeed show that it is reserved for lunatic wards of this description, and now happily for them only, to continue to exhibit some portion of that disregard of humanity and decency, which at one time was a prevailing characteristic in the treatment of insanity." not only, again, are there no sufficiently responsible authorities in the house, and no qualified responsible attendants, but also no records of restraint, of seclusion, of accident, or injury, or of medical or other treatment. "above all, there is no efficient and authoritative official visitation. the visiting justices never inspect the lunatic wards in workhouses, and our own visits are almost useless, except as enabling us to detect the evil that exists at the time of our visit, and which, after all, we have no power to remove." the "results of neglect in deteriorating the condition of patients" of all classes are ably portrayed. in the absence of attentive and experienced persons to watch and to supply their wants, many of the insane suffer unheeded and without complaint, to the prejudice of their mental and bodily state; or become inattentive to natural wants, and prone to violence and mischief. "in a very recent case of semi-starvation at the bath union, when the frauds and thefts of some of the attendants had, for a considerable time, systematically deprived the patients of a full half of their ordinary allowance of food, the only complaint made was by the wan and wasted looks of the inmates." in the two next sections the commissioners insist that the duty of distinguishing the cases in workhouses to be classified as "lunatics, insane persons and idiots," should be performed by the medical man independently of the master; and that, without examination and sanction from that officer, no person of weak mind should be discharged, or allowed to discharge himself. very ample cause for this latter proposition is shown in the illustrations appended, particularly in the case of imbecile females, who not unfrequently become, when at large, the prey to the vicious, further burden the parish by their illegitimate offspring, and often by an idiotic race. "the diet necessary for the insane" is required to be more liberal than for other inmates; yet the commissioners have "in very numerous instances" animadverted upon its inadequacy, both in quantity and quality, but without result, except "in very few instances:" for, notwithstanding that "the medical officer of a union has full power" (by the consolidated order , art. no. ) "to give directions, and make suggestions as to the diet, classification and treatment of the sick paupers, and paupers of unsound mind," yet, we are sorry to learn, that "the power thus given, although backed by our constant recommendations, is rarely exercised by the medical officer." this circumstance is so far confirmatory of a view we have above taken, that the medical officer of a parish or union is neither sufficiently independent, as the paid _employé_ of the guardians, to carry out measures that may be necessary for the alleviation of the condition of lunatics in workhouses, where such means involve increased cost (we regret to entertain the notion); nor always sufficiently acquainted with the wants of the insane. considering the disadvantages of workhouses as receptacles for them, the general statement follows naturally, that as a class of workhouse inmates, the lunatics "are manifestly lower in health and condition than the same class in asylums. hence," add the commissioners, "the patients' bodily health and mental state decline upon removal from asylums to workhouses--an effect chiefly due to the inferior diet." there are great "variations in workhouse dietaries,"--from one spare meat dinner in the week to a meat dinner daily. this latter provision is furnished "in a very small number of houses." these dietaries are indeed much inferior to those considered necessary for criminals in jails; a fact that affords a sad comment on english consistency, which is thus found dealing with more favour and consideration towards those who have transgressed the laws of their country, than to those whose only crime is poverty, or poverty complicated with disease or infirmity. medical treatment would, in truth, seem to be not legally provided at all for lunatics in workhouses: no clause makes a visit of the union medical officer to the lunatic-ward of a workhouse imperative. as examples of the slight esteem in which medical supervision is held, the leicester and the winchcombe houses are quoted. in the former, the visits of the medical officer were only made quarterly; in the latter, by stipulation three times a week, but in practice very irregularly. attendance and nursing are, as might be expected, on a par with medical treatment. even imbeciles have been found exercising the functions of nurses, and, generally speaking, the selection of attendants is made from old and feeble people, having no experience, no aptness for the duties, no particular qualities of intellect or temper to recommend them, and receiving such a mere pretence, if any at all, in the way of remuneration for their trouble, that no painstaking efforts can be looked for from them. "yet to such individuals, strait waistcoats, straps, shackles, and other means of restraining the person are not unfrequently entrusted; and they are, moreover, possessed of the power of thwarting and punishing at all times, for any acts of annoyance or irregular conduct, which, although arising from disease, are nevertheless often sufficient to provoke punishment from an impatient and irresponsible nurse." the interior accommodation, fittings, and furniture are, if not abominably bad, excessively defective: and on reaching this part of the report, where the details of internal fittings and management come under review, the impression derivable from its perusal is akin to that gathered from the revelations of madhouses made by the parliamentary committees of and . the sketch of the evils suffered by lunatics in workhouses, which we have ourselves attempted in past pages, tells a flattering tale compared with the realities unfolded to us by the commissioners, and adds a tenfold force to the arguments against the detention of lunatics in such places. to continue the practice would be to perpetuate a blot upon the internal polity, the philanthropy and the christianity of the country. let those who would know the whole case refer to the report in question; it is sufficient for our purpose to attempt a mere outline of its revelations. patients are frequently kept in bed because there are no suitable seats for them; a tub at times answers the double purpose of a urinal and a wash-basin; a privy is partitioned off in a small dormitory; baths are almost unknown; a trough or sink common to all supplies the want of basins for washing, and an outhouse or the open air furnishes the appropriate place for personal ablutions. clothing, again, is often ragged and insufficient; in an unwarmed dormitory, a single blanket, or only a coverlet, is all the covering afforded by night; loose straw in a trough bedstead usually constitutes the bed for wet and dirty patients to nestle in; and whether the bed be straw or not, the practice of using it night after night, when "filthy with dirt, and often rotting from frequent wetting, has been many times animadverted upon." in some workhouses two male patients are constantly placed in the same bed; nor is the character of the bedfellows much heeded; for a sane and insane, two idiots, one clean and one dirty, and even two dirty inmates, have been found associated together in the same bed, occasionally in a state of complete nudity. further, the want of exercise and employment, the absence of supervision and control, and the entrusting of means of coercion to irresponsible and unfit attendants, lead to the most shocking abuse of restraint, and to cruel seclusion. "the requirement occasionally made by the visiting commissioner, that the master shall make a written record of such proceedings, is utterly neglected. the dark, strong cells, constructed for the solitary confinement of refractory paupers, are used for the punishment of the insane, merely to prevent trouble; quiet helpless creatures, from whom no violence could be apprehended, are kept in bed during the daytime, or coerced; and even the dead-house has been made to serve the purpose of a seclusion-room." "the examples of restraint practised," as adduced in the report, recall to mind all those barbarities which civilized men of the present day are in the habit of congratulating themselves as matters of the past, and the subject of history. the catalogue of appliances for restraint reappears once more on the scene; and we read of straps, leather muffs, leg-locks, hobbles, chains and staples, strait-jackets, and other necessary paraphernalia, as of yore, worn for days, or weeks, or months. excellent matter, indeed, in all this, to garnish a discourse on the advancement of civilization, on the prevalence of improved notions respecting the treatment of the insane, or on some similar topic addressed to the vanity of the present generation! but the chapter does not end here. "it would be difficult to select places so entirely unfit for the purpose of exercise, or so prejudicial to the mental or bodily state of the person confined," as the yards or spaces set apart for it; and yet "of all the miseries undergone by this afflicted class, under the manifold disadvantages before described, and of all the various sources of irritation and discomfort to which we have shown that they are exposed, there is probably none which has a worse effect than the exclusion from all possibility of healthy movement. nothing more powerfully operates to promote tranquillity than the habit of extensive exercise; and in its absence, the patients often become excited, and commit acts of violence more or less grave, exposing them at once to restraint or seclusion, and not unfrequently to punishment. in not a few instances the outbreak has been looked upon as an offence or breach of discipline, and as the act of a responsible person; and the patient has been taken before a magistrate and committed to prison. "a very grave injustice, it is hardly necessary to add, is thus committed, in punishing by imprisonment individuals who are recognized and officially returned as being of unsound mind. these persons in no respect differ from the class of the insane usually met with in asylums, and are equally entitled to the same protection, and the same exemption from punishment. instead of such protection, however, the patient is exposed to double injury:--first, he is subjected to various sources of irritation while confined in the workhouse, directly occasioning excitement; and, secondly, the mental disturbance resulting therefrom is regarded as a crime, and is punished by imprisonment." the commissioners in lunacy next direct attention to the principal cause of the evils described, which they discover in the neglect and evasion of the duties imposed by the law on the officers of parishes and unions, in the interests of the pauper insane. thus, as remarked in previous pages,--"instead of causing the patient to be dealt with as directed by the th and th sections of the lunatic asylums' act, , and immediate steps to be taken for his direct removal to the asylum, workhouses have been to a great extent made use of primarily as places for the reception, and (in many instances) for the detention of recent cases of insanity. "the workhouse is thus illegally made to supply the place of a lunatic establishment, and the asylum, with its attendant comforts and means of cure, which the law has provided for the insane poor, is altogether disregarded; or it comes into operation only when the patient, by long neglect, has become almost hopelessly incurable. we should remark that this occurs most frequently in the larger workhouses, and in those having insane wards." ... "how totally unfit even workhouses having insane wards are for the proper treatment of recent curable cases, we have endeavoured to exhibit in some detail. nevertheless, the practice of making use of them for all classes of insane patients is rapidly increasing, and our efforts to check it have proved hitherto quite ineffectual." after further adverting to the influence of the neglect of the laws in increasing pauper lunacy, they very briefly discuss the comparative cost of lunatics in workhouses and in asylums, but their examination adds nothing to what we have much more fully put forward on this subject. their "conclusion" contains some valuable suggestions, more or less identical with those we have ourselves independently advanced, and which may be briefly summed up as follows:-- "to remedy many of the evils adverted to would, in our opinion, be impracticable, so long as insane patients are detained in workhouses, whether mixed with other inmates or placed in distinct wards. "the construction and management of workhouses present insurmountable obstacles to the proper treatment of the disease of insanity; and therefore the removal of the majority of the patients, and the adoption of stringent measures to prevent the admission of others, have become absolutely necessary." the notions of parish authorities of the very great comparative economy of workhouses over asylums rest, say the commissioners, on a false basis; and to place the question fairly before them, "it is essential that the mode of keeping the accounts should be assimilated in each, and that in the asylum only food and clothing should be charged to the parishes, and all other expenses to the county. in such case, we believe it would be found that the charges in each would be brought so nearly to a level, that there would exist little or no inducement on the plea of economy to tempt the guardians to keep their insane patients in workhouses, instead of sending them at once to a county asylum." to provide proper accommodation for the insane poor in workhouses, inasmuch as many asylums are on "so large a scale as not to admit of the necessary extension, whilst some are of a size much beyond that which is compatible with their efficient working," the commissioners propose "the erection of inexpensive buildings, adapted for the residence of idiotic, chronic, and harmless patients, in direct connexion with, or at a convenient distance from, the existing institutions. these auxiliary asylums, which should be under the management of the present visiting justices, would be intermediate between union workhouses and the principal curative asylums. the cost of building need not, in general, much exceed one-half of that incurred in the erection of ordinary asylums; and the establishment of officers and attendants would be upon a smaller and more economical scale than those required in the principal asylums." "whether or not such additional institutions as we recommend be provided, we think it essential that visiting justices of asylums should be invested with full power, by themselves or their medical officers, to visit workhouses, and to order the removal of insane inmates therefrom to asylums at their discretion. they should also be empowered, upon the report of the commissioners, to order the removal into the asylum of pauper patients boarded with strangers." "and in the event of our obtaining your lordship's approval of such suggestions for legislative enactment, we would further recommend that it should include the following provisions:-- "no lunatic, or alleged lunatic, to be received into or detained in a workhouse, unless he shall have been duly taken before a justice or officiating clergyman, and adjudged by him as not proper to be sent to an asylum. "in any case, however, wherein an order for a lunatic's reception into an asylum shall be made by a justice or officiating clergyman, it shall be competent to him, if, for special reasons to be set forth in his order, he shall deem it expedient, to direct that such lunatic be taken, _pro tempore_, to the workhouse, and there detained for such limited period, not exceeding two clear days, as may be necessary, pending arrangements for his removal to the asylum. "a list of all inmates of unsound mind to be kept by the medical officer of a workhouse, and left accessible to the visiting commissioners. "the medical officer to specify, in such list, the forms of mental disorder, and to indicate the patients whom he may deem curable, or otherwise likely to benefit by, or in other respects proper for, removal to an asylum. "the visiting commissioner, and the poor-law inspector, to be empowered to order and direct the relieving officer to take any insane inmate before a justice, under the provisions of the th section of the lunatic asylums' act, . "in all cases of inmates of unsound mind temporarily detained in workhouses, the medical officer to be invested with full powers as respects classification, diet, employment, and medical and moral treatment, and otherwise." of some of these suggestions we shall take a future opportunity to speak, and at present pass from the consideration of the state and wants of lunatics in workhouses to notice, briefly, the condition of those living with their friends or elsewhere. § _pauper lunatics living with their relatives or with strangers._ in the previous chapter "on the state of the present provision for the insane," some remarks have been made on the class of lunatic poor living with their relatives or strangers, calculated to arrest attention to their numbers and their neglected position. the commissioners in lunacy have as a rule, and in the absence of particular information, calculated that they are about equal in number to those resident in workhouses. considering the imperfect nature of the statistical records of them, and the fact that they escape official observation and inquiry to a much greater extent than even the lunatic inmates of workhouses, we have assumed them to be more numerous, and that there are so distributed in the homes of our industrial classes. of these , more or less, poor persons, dependent, on account of distinct imbecility or idiocy, upon others for protection and support, no one outside their abodes, it may be generally said, thoroughly knows their condition, although a partial knowledge may be possessed by the parochial authorities of the union or parish to which they are chargeable. to these authorities, however, they possess no interest; they are regarded as burdens upon the public purse, to be arranged for on the cheapest terms. the only person at all responsible for their condition is the parish medical officer, who is required by sect. ( & vic. cap. ) to visit them quarterly, and to certify "whether such lunatics are or are not properly taken care of, and may or may not remain out of an asylum." in the first place, the matter of deciding what pauper reported as insane, imbecile, or idiotic is actually so, is not by law given to any parochial officer; hence it frequently happens that differences of opinion and divisions arise between the medical officer on the one hand, and the poor-law guardians on the other, as to the chargeability of this and that pauper to the parish as insane; and the decision acquires intensified importance from the fact that one half-crown per quarter is at stake on each pauper chattle in dispute; for if the medical man gain the day, just that sum has to be squeezed out of the rate-payers to compensate him for his quarterly call upon the admitted lunatic. we leave the reader to imagine the battlings of the vestrymen on the knotty point; sane or not insane, that is the question, the solution of which must cause the consumption of much time and breath yearly to many an honourable board of guardians, to animated discussions, bold definitions and fine-drawn distinctions, lost to the _profanum vulgus_ enjoying no seat in the conclave. here, then, appears a duty which, in our opinion, should be performed by a duly appointed officer, such as a district medical inspector or examiner; for we would deprive the guardians of the poor of all voice in deciding on the sanity or insanity of any individual. the law might with equal or with greater propriety leave the decision of the success or non-success of the operation of vaccination to a vestry, as that of the question under remark. further, since many might argue, that to leave the determination of the question to an officer like the parish medical man, directly interested in settling it in one way, and who might saddle the parish with an annual charge for every poor person in it who did not come up to his standard of mental strength, would be unfair to the rate-payers; an independent opinion, given by an officer in no way interested in the decision of the point at issue, would seem to afford the very best means of settling the point, and a sufficient guarantee against any supposable irregularities. we would suggest, therefore, that the district inspector should visit every poor person wholly or partially chargeable, or proposed to be made chargeable to any parish, as being of unsound mind, and make a return to the parochial authorities and to the poor-law board, and that the certificate of this officer should be held to be a sufficient proof of the insanity of the individual. but the duties of this officer, in relation to the lunatic poor under consideration, would not stop here. in his visit we would require him to investigate more narrowly than a union medical officer can be expected to do at the remuneration offered, and amid his many other arduous engagements,--into the condition and the circumstances by which the poor patient is surrounded, to report thereon to the lunacy board and to the proper union officials, and in general to state, in the words of the act, whether he is or is not properly taken care of, and is or is not a fit subject for asylum care. the officer we propose, would approach the inquiry independently of the parish authorities, and indifferent to their censure, having no position and no pay to lose by his decision; whilst as an experienced physician, understanding the varying features of mental disorder, and the conditions necessary to its amelioration or cure, his opinions would claim greater respect. inasmuch as it is impossible, owing to their small number, for the lunacy commissioners, without totally neglecting their other duties, to make themselves acquainted with the condition of these pauper lunatics, scattered here and there over the country, in cottages and lodgings, we really possess, as before said, under the existing system, no information worth having, what that condition really is. judging from the state in which workhouse lunatic inmates are found, the impression is unavoidable, that the pauper lunatics under notice must be in a worse one, since there is not only no sort of supervision over them equivalent to that provided in workhouses, but also the sums allowed towards their maintenance are most scanty, and, where they are lodged with strangers, no care and no sustenance beyond what is felt to be actually paid for, can be presumed to be given. now and then a glimpse of the actual state of things is casually afforded by the report of a county asylum; and such are the glimpses we have got through this medium, that, except to arouse public attention by their recital, in order to bring about a reform, it were well, for the sake of the reputation of the country, that the revelations were unrecorded. asylum superintendents could, indeed, more frequently raise the veil upon scenes of wretchedness and cruelty undergone by our lunatic poor in the habitations where parish officials place or keep them; but they generally forbear to do so in their reports, although enough is shown by the description of the state in which patients are admitted into the asylums, and of the length of time that has been suffered to elapse since the commencement of their sad malady. dr. hitchman, in the reports of the derby county asylum, has more than once referred to the state of patients on admission from their homes or lodgings. thus, in , he narrates the case of a poor woman who had been demented for five years, and "kept at home until she fell into the fire and became extensively and severely burnt;" and not till after this accident was she taken to the asylum. a little way further on, in the same report, he observes,--"those only who have lived in public asylums know the misery, the wretchedness, and the wrong which are constantly inflicted upon lunatics in obscure places, even by their relatives and 'friends,' and which cease only with the life of the patient, unless he be conveyed to a well-conducted institution. it is, moreover, a remarkable phenomenon, that many individuals who perpetrate these enormities upon their kith and kin, who have habitually fastened them with cords, who have deprived them of a proper supply of clothing or of food, who have, in short, rendered them permanent cripples in body, as well as hopeless idiots in mind, have done so without malice, as a general rule, without passion, by slow degrees, and with no conception whatever of the present suffering or ultimate mischief effected by their proceedings. they affect no secrecy among their neighbours while these things are going on. familiarity to the spectacle blinds their perceptions and blunts their feelings.... others there are, who, from penurious and selfish motives, inflict much wrong upon the lunatic. of such a kind appears the following:--'t. g., removed from the custody of his relatives by the order of the magistrates. has been insane thirty-eight years, under the management of his relatives, who have generally had him confined in an out-building.' 'he is stated to have been unclothed for many years. when brought into the asylum he was naked, except that around his pelvis were the remains of an article of dress; his hands were tightly bound to each other by ligatures passing around the wrists. when in the cart he was covered with a blanket, but this fell from him during his struggles on being removed. he roared hideously as he was being conveyed to the wards. he is a person of lofty stature and great size. his head and neck are very large; one side of his forehead is greatly disfigured by scars, and he has lost an eye. his ears have been deprived of their normal shape, and their lobes much thickened by the deposition of fibrine or other matter. his lips are large and pouting. his beard has been long unshaven, but has been recently cut with a pair of scissors. the bones and muscles of his arms are of great size; his lower extremities are red, swollen, and 'pit,' under pressure; one of his toes is deprived of its nail, and the whole foot appears to have suffered from the effects of cold. he walks with a stooping gait, and appears unable to retain the erect posture without support. he resists powerfully all attempts to clothe him, and appears to be entirely ignorant of the use of a bedstead. he whines after the manner of a dog that has lost its home. he dreads all who approach him; on being taken from his room in the evening, he hurried back to it with all the haste he could, and on all occasions he shrinks from observation. he is lost to every sense of decency; nakedness is congenial to him, but he will sometimes coil himself in a blanket for the sake of its warmth. he is guided by the lowest instincts only, and his whole appearance and manner, his fears, his whines, his peculiar skulking from observation, his bent gait, his straight hair, large lips, and gigantic fore-arm painfully remind one of the more sluggish of the anthropoid apes, and tell but too plainly to what sad depths the human being can sink under the combined influence of neglect and disease.'" the same excellent physician reverts to these cases in his fourth report ( ), and laments the sad condition of health, and the horrible state of neglect of many patients on their admission. he says, "one or two patients had been confined by manacles in their own cottages until rescued by charitable interference, and were brought to the asylum with their wrists and ankles excoriated by the ligatures deemed necessary for their proper control." one such case had been confined twenty-five years in his cottage-home. these illustrations will suffice for our purpose. they indicate the existence of abuses and wrongs here in england, too similar, alas! to those the special lunacy commission of scotland brought to light by their well-known inquiry in (report, edinburgh, ), and such as the general description in their report, and the particulars in appendix k, too amply demonstrate. it is referred to as "the wretched state" of single patients living with their friends or others, and well merits the designation. they found these poor afflicted beings generally in a state of moral and physical degradation, ill-fed, ill-treated, ill-clothed, miserably lodged, shockingly dirty, abused, restrained by all sorts of mechanical contrivances of the coarser kind, or left to wander unheeded and uncared for; whilst among the imbecile or fatuous women, many were the instances where they had become the mothers of an illegitimate and often idiotic offspring. judging from the specimens before us, we repeat, we have great misgivings lest a similar searching inquiry into the condition of pauper lunatics in england distributed in the homes of our cottagers and labouring classes, should reveal a state of things no less disgraceful to a civilized country. to recall a conviction before expressed, additional legislative provision is demanded for this class of pauper insane. the quarterly visit of the hard-worked and underpaid union medical officer or of his assistant, affords no sufficient guarantee, even when regularly made, that they are duly taken care of, and not improperly deprived of the advantages of asylum treatment. but if we accept official statements, these visits are irregularly made and much neglected, and the reports of them far from properly attended to. in the report of the hants asylum for , the committee took occasion to remark on the extended neglect and the inefficiency of these legal visits and reports; and though the commissioners in lunacy admit that of late matters have improved, yet they say that they are far from satisfactory. from these and other considerations adverted to, we have suggested that the inspection of the lunatic poor in question should be specially undertaken by the district medical officer, and that a report on them should after each visit be made to the lunacy commission, and, with advantage, also to the poor-law board. this officer should be informed of every pauper or other lunatic living with friends or others, and should investigate, as said above, all the circumstances surrounding him, and decide whether or not a transference to an asylum would be for the better. it would consequently be for him to select and recommend the removal to an asylum of all such patients as afforded a prospect of recovery; and since good food and proper nursing improve not only the body, but also the mind and the moral feelings, and promote the lasting relief of the mental disorder,--it should also devolve upon him to signify the extent and mode of out-door relief to be afforded. defective and faulty nutrition concurs powerfully to produce insanity, and, when it is induced, to make it permanent; the best policy must therefore be to nourish pauper lunatics sufficiently;--a policy, which we see, however, under existing circumstances, no prospect of being acted upon by the guardians of the poor. the allowance made to out-door lunatic paupers differs much; for it may be intended to supply almost all the moderate wants of the recipient, or only a small part of them. it is always, however, very limited, and less than the calculated cost of in-door paupers per head, and can never suffice to procure the poor patient adequate nourishment and suitable attendance and clothing. its amount, moreover, is regulated by no definite principles, but is left very much to the caprice of the relieving officers, and to the liberal or the opposite sentiments in the ascendant among the parochial guardians. it is contributed as a grant in aid to the relatives of the patient, and to those not related as a compensation for the outlay and trouble incurred on his account. the former are naturally liable to the maintenance of their lunatic kinsman, and no sufficient objection obtains to his being detained among them, provided his condition is not prejudiced by his exclusion from an asylum, and is duly watched over by competent medical officers, and that those relatives are able to afford him proper control, food and clothing, with or without parochial assistance. but the case is different in respect of those not related to the patient, who as strangers can have little interest in him; but who, on the contrary, have to make his detention serve their own purposes so far as possible, and cannot be expected to do or supply more than they are paid for. now, as the weekly allowance from the parish is to be by rule kept as low as it can be, the lowest offers possess the highest recommendation for acceptance, and the comforts and well-being of the poor imbecile or idiotic people are almost necessarily sacrificed at the shrine of economy. the whole system, therefore, of boarding pauper lunatics in the homes of the poor unconnected with them by blood, as now pursued without restrictions or method, appears fraught with injury to those helpless beings. what sort of attention, food, and lodging can be expected for some or shillings a week? what sort of supervision and control can be looked for from a poor, illiterate labourer or artisan? even a patient's own relatives may and do grudge the cost and the trouble he puts them to, or they may be very imperfectly able to furnish in their cottage-home the means needed to ensure his protection and the conveniences and comforts of others, and be ill-adapted by character and education to act as his directors and guardians. but these difficulties and defects are augmented manifold when the patient becomes a dweller among strangers. only under very peculiar circumstances indeed would we tolerate the boarding of pauper lunatics with strangers; when, for instance, their comforts and safety are hedged round by legal provisions sufficiently ample, and by systematized arrangements to secure them. these ends are to be attained by taking the selection of the abode and the pecuniary details from the hands of parochial officers, and by entrusting them to some competent medical man, who should be responsible that the patients are properly cared for and treated. it should be for him to select the residence, and in so doing to seek out those who by character and condition are best fitted for the charge. if the law were so amended that asylum relief should be afforded to all on the appearance of their malady, the majority of those to be provided for in lodgings would come from the class of chronic, imbecile patients, accounted harmless, whose discharge from the asylum under proper surveillance might be recommended. hence it would render the scheme more perfect and satisfactory, to retain these chronic lunatics in homes within a moderate distance of the county asylum they were previously placed in, so that they might be under the supervision of the medical staff of that institution, and that the propriety of their prolonged absence from it, or of their return to it, might be therefore determinable by those best qualified to judge from past experience of their case. yet, in all probability, this restriction as to the district for receiving patients as boarders, would not always be practicable; and frequently, where the insane poor had near relatives capable and willing to receive them under their care, though at a distance from the asylum, it would not be desirable to sacrifice the advantages of the guardianship of friends to those obtainable by vicinity to the asylum; and, from these or other causes, many poor insane people would be found distributed here and there throughout a county under the charge of cottagers and others. in their cases we would make the district medical inspector the special protector and guardian of their interests and well-being provided by law, and require him to visit them at least twice a quarter, report on their condition, and on the fitness or unfitness of the persons boarding them. in all cases, he should as a preliminary proceeding inquire into the accommodation and general circumstances of the persons proposing to receive an individual of unsound mind into their family, and should reject the application of those who are unable to afford suitable conveniences and adequate management. could a properly-organized system of supervision and control be established, the disposal of poor insane persons in the homes of the industrious classes would not be open to the objections it is at present, when no adequate legal provision to ensure their inspection and welfare is in existence. indeed, it would be an improvement and blessing to many of the chronic lunatics in our great asylums, could they so far be set at liberty, and have their original independence restored to them by a distribution in the cottage-homes of our country, where, under sufficient control, they could exercise useful employments, and relieve the rates of part of their cost. we have used the term 'cottage-homes' advisedly, because it is evident, that, except in very small towns, a town-residence would be most unsuitable. the example of the great colony of insane persons at gheel, in belgium, has suggested this plan of boarding lunatics in the homes of the working classes, chiefly of agriculturists, to the minds of many english philanthropists desirous to ameliorate the condition of our pauper insane, and to lessen the large costs of asylum provision. the only attempt, however, as far as we are aware, partaking at all of the conditions calculated to render such a scheme satisfactory and successful, hitherto made, is that on a small scale at the devon asylum under the direction of dr. bucknill, and we are happy to find from this gentleman's report that the arrangement has hitherto worked well. we shall return to this subject in a subsequent section,--"on the distribution of the chronic insane in cottage-homes." § _transmission of unfit cases to asylums--improper treatment prior to admission._ in preceding pages it has been remarked that the transfer of lunatics to asylums is regulated not by the nature of their case, and its amenability to treatment or amelioration, but by the circumstance of their being refractory and troublesome, annoying by their habits, or so infirm and sick as to require attentive nursing; or, in general, in such a state that their residence involves an increased and unworkhouse-like cost. the question of the recency of the attack is treated as of far less moment; for if the poor sufferer have what are called harmless delusions, or if he is only so melancholic that suicide is not constantly apprehended, then under these and such similar conditions, the economical theory of the establishment commonly preponderates over every consideration of the desirability of treatment in the presumedly expensive asylum, and the patient is retained. in course of time his malady becomes chronic, and in all probability incurable, and his condition so deteriorated in all respects by the absence of proper measures for his mental and moral treatment, that sooner or later his physical health gives way, or his habits grow inconveniently annoying and troublesome, and then it is that workhouse officials discover that the county asylum is his suitable abode. by this system of 'clearance' the workhouses are relieved of their most burdensome and costly inmates, who fall to the charge of asylums, in which their presence necessarily keeps down the rate of recoveries, multiplies the proportion of chronic lunatics, and increases the expenses and the rate of mortality. the medical superintendents of our asylums bear witness to the recklessness, and to the cruelty, at times, which often mark the doings of workhouse authorities when they wish to rid themselves of the cost and trouble of any of the lunatic poor in their keeping. the illustrations at hand, obtained from county asylum reports, are so numerous, that we must content ourselves with a selection of a few of the more striking. dr. boyd, the distinguished physician of the somerset county asylum, makes the following statement in his sixth report ( ):--"several aged persons, and many others in a feeble state, have been admitted during the year, so that the mortality, although less than in the preceding year, has still been considerable. for example, two cases have been recently admitted: one that of a man with dropsy, and broken down in constitution, who is reported to have been given to excess in drinking ardent spirits, and to have been subject to epileptic fits; he was disappointed at not being admitted into a general hospital, became violent, and was sent as a patient here; he has been free from fits since his admission, is rational, but apparently in the last stage of bodily disease. the other case is that of a woman about seventy, paralysed, and unable to sit up in the arm-chair without support. she was troublesome in the union workhouse, and was reported _as dangerous_, and so was sent to the asylum. there have been four males with paralysis recently sent in from being dirty in their habits.... one female was improperly sent with _delirium_ attending on _fever_: she died a fortnight after admission." in his ninth report, this same superintendent says,--"some are sent to the asylum in a state of paralysis, some are aged and in a state of fatuity, and others when they become troublesome, or are in a diseased and feeble state of bodily health, and require more nurse-tending than they receive in the workhouses.... under the existing arrangements, lunatic asylums are gradually losing their proper character of hospitals for the recovery of the insane, and sinking down to be mere auxiliaries to workhouses." out of eighty admissions at the worcester county asylum, fourteen were between sixty and eighty years of age, and for the most part "the subjects of organic disease of the brain, lungs, and heart, or suffered from long-continued mental disease, or from the superannuation of old age, and deficient nutrition of the brain and nervous centres. four of them died during the year.... during the early part of the year some correspondence was entered into with several unions, from which patients had been sent in a dying or exhausted state; and the impropriety of such proceeding was pointed out by your committee.... it is not supposed that those unfortunate cases are wilfully detained with improper intentions at their homes or elsewhere, but from ignorance; and from want of the necessary appliances, and the assistance of those accustomed to the insane, proper measures cannot be adopted for their care and recovery," and various injuries are inflicted. the experienced superintendent of the beds., herts., and hunts. asylum reports, in , that of , as many as twelve died within three months of their being admitted; five did not survive a fortnight. "one male, an epileptic seventy-nine years of age, and having been bedridden for years from contracted limbs, and nearly exhausted from the journey, died on the twelfth day. a female, aged sixty-eight, with disease of the heart, died on the fourth day from exhaustion, having been some time without rest, and having refused her food previous to admission. a female in the last stage of pulmonary consumption, lived but seventeen days; and one very distressing case of a female ... was brought to the asylum, who, worn out from constant excitement, and having a large wound on the leg, with ulcerations from ligatures on the wrists and ankles, sank on the fourteenth day. the two last-mentioned patients were reported to have refused food for nearly a week, but took every kind of nourishment offered to them from the moment they were in the asylum." the report of the suffolk county asylum records the admission of ten poor persons in "nearly seventy years of age, nine over seventy, three over eighty; sixteen in a state of bodily exhaustion; nine either idiots from birth, or imbeciles for a very long period; one child with well-known disease of the heart, and a woman, a cripple, scrofulous, blind and deaf." "what," asks dr. kirkman, the venerable superintendent, "can be done more than good nursing to support a peevish mind in a patient eighty-four, admitted only a few days ago?" he adds, "to give other instances, one man was received some time back on a very qualified certificate, and upon whose case a qualified certificate only could be given; and another (somewhat experimentally) with the notice that his mania, if such it were, existed only in the want of a slight resistance to a wayward will; and another, a girl of sixteen, subsequently found not to be insane, but suffering from aggravated cataleptic hysteria, supposed to have been caused by fright, having spinal disease, and deformed throughout the body." dr. hitchman, whose reports we have found so valuable in former sections of this work, has repeatedly called attention to the subject now under notice. in he writes:--"it is with feelings of deepest sorrow that your physician is compelled to state, that patients continue to be sent to the asylum in very advanced stages of bodily and mental disease.... so long as no violent or overt act has been perpetrated; so long as the sufferer can be 'managed' in the privacy of his miserable home, or by the 'cheap' resources of a workhouse, he is often detained from the lunatic hospital. disease, aggravated by neglect, continues its direful course, the 'harmless' lunatic becomes very dirty in his habits, or very violent in his conduct, windows are broken, clothes are torn, persons are injured, and the strap, the strait-waistcoat, and the chain are brought into service to control for a time the ravings and the mischief of the patient. steps are now taken for his removal--bound, bruised, dirty, and paralysed, the poor creature is taken to an asylum. one glance is sufficient to reveal to the experienced eye that _cure_ is hopeless; that while every resource of the institution will be needed to sustain the exhausted energies of the patient--to preserve him from the sufferings consequent upon the loss of his self-control over the excretions of his body, yet for two or three years he may survive to swell the list of incurables--to diminish the per-centage of cures--to crowd the hospital, and, worse than all, to perpetuate this popular belief, and to encourage the pernicious practice, which are now leading to the moral death and social extinction of hundreds of our fellow-creatures." speaking of the admissions in , he says:--"several were in advanced stages of bodily disease; thus, i. c. expired in eight hours after his arrival at this hospital. he was removed from the vehicle in which he was brought to his bed, where he remained tranquil until the moment of his decease. the state of great prostration in which he was brought, forbade the employment of the usual washing-bath; nor was he subjected to the fatigue of being shaved (of which he stood in much need) in consequence of his exhaustion. f. g., aged years, admitted with the marks of restraint round her wrists, survived eighteen days--only by the administration of wine and warmth. s. c., brought bound by straps and a strait-waistcoat in the afternoon of the th, was so convulsed and epileptic, that she died on the morning of the th, having scarcely spoken during the time she was in the asylum. others were in advanced stages of dropsy, phthisis, and general paralysis, and, although in a hopeless condition, lived on for several weeks under the fostering care of the institution. one poor girl, admitted from lincolnshire, in a perfectly helpless condition (the delirium of fever having been mistaken for the ravings of insanity), was conveyed from the vehicle to a water-bed, where she has remained in a state of great suffering for upwards of twelve weeks, and is never likely again to recover the use of her limbs." the experience of the kent asylum is similar. the age of eleven persons admitted in averaged , and twelve were from to . "in many of these the malady was simply decay of mind, or was due to apoplectic seizures, and attended by palsy." in the report for - , dr. huxley goes more at large into the question of unfitness for asylum admission, and the vigour and clearness of his remarks induces us to quote them at length. he observes:--"it seems difficult to understand on what principle patients are sometimes sent. one man, for an intemperate threat uttered under considerable provocation, is hastened off to the asylum. he can then only be deemed insane in a constructive sense, and in reliance on the undoubted good faith of the whole proceedings for his removal. he is seen to be sane; he remains so, and merely awaits the next discharging-day. in the interval he has had time to reflect on the danger of uncontrolled speech; but perhaps he and his family ought not to have incurred the reproach (as it is held) of insanity in the blood. perhaps, also, he ought not to have swelled the list of persons insane, adding his mite to the evidence which supports the general belief in an actual increase of disorders of the mind. "again, the facility with which a drunken prostitute finds admission and re-admission is astonishing. the delirium, rather than insanity proper, produced by excessive drinking, has, indeed, some alarming modes of expression; but it is a different thing from true mental derangement, and is transient, the patient being generally nearly all right again on arrival. i confess to a feeling which grudges to such patients the benefits of an asylum and association with the inmates who are truly unfortunate. their detention is wholly unsatisfactory; it leads to nothing. long or short, it proves no warning against a return to former bad courses; whilst the presence of people (i do not call them patients) of this sort seriously injures the interior comfort of the wards. ought such cases to swell the returns of lunacy? then, in estimating the supposed growth of insanity among the people, let the fact be remembered, that here is one contributing element, which was not represented until of late years. once again, the extent to which strongly-marked senility is now made the reason for admission to the asylum is, i think, unprecedented. to grow childish, wilful, and intractable; to lose memory, and forget the good habits of a life; to take no note of times and seasons; to wake by night and be restless, and to become generally incapable, are the rule rather than the exception at the close of an extended life. i do not think these natural ills ought to be the cause so frequently as they are found to be, for sending the subjects of them to an asylum. workhouses may not contain the little special accommodation needful for such cases; but it would not be a good argument to hold, that because they _do_ not, the asylum must be the proper receptacle. "poverty is, truly, the great evil; it has no friends able to help. persons in middle society do not put away their aged relatives because of their infirmities, and i think it was not always the custom for worn-out paupers to be sent to the asylum. may not this practice be justly regarded as an abuse of the asylum? it is one more of the ways in which, at this day, the apparent increase of insanity is sustained. it is not a real increase, since the aged have ever been subject to this sort of unsoundness. "decayed persons, once placed in an asylum, are ever after held to have been rightfully deemed insane. if any of their descendants, therefore, become mentally afflicted, the hereditary taint is straightway accounted to them. this is, indeed, to show cause why all the world should be mad! i hold it to be wrong to send persons to an asylum merely on account of second childhood, and a wrong operating to general disparagement. in the first place, the practice is only an indirect consequence of poverty; next, it helps improperly to force asylums to a size inconsistent with their best management; and thirdly, it is one amongst other apparent, but not real grounds, for that increase of mental disorder, which is apprehended with such general alarm. "we received at least twelve persons, who, in my judgment, needed not, and therefore ought not to have been sent, viz. seven aged, being of , , , , , , and years; three children, of , , and years; and two adults. one of the children was not insane, but suffering from chorea (st. vitus's dance) affecting the whole body. this disorder had, apparently, been mistaken for mania." we will close these quotations by one from dr. bucknill's report for :-- "there can be little doubt that those asylums, the admission into which is restricted by legal formalities alone, are not unfrequently made use of as hospitals for the treatment of bodily disease and for the care of the bodily infirm. to such asylums patients are sent suffering from serious and troublesome bodily diseases, whose mental condition would never have been considered a sufficient cause for removal had it existed alone. the number of patients has not been small, who, from time to time, have been admitted into the devon asylum with serious disease of the several organs of the body, and with no greater amount of mental disturbance than is the frequent result of such disease. "patients have been admitted suffering from heart disease, aneurism, and cancer, with scarcely a greater amount of melancholy than might be expected to take place in many sane persons at the near and certain prospect of death. some have been received in the last stages of consumption, with that amount only of cerebral excitement so common in this disorder; others have been received in the delirium or the stupor of typhus; while in several cases the mental condition was totally unknown after admission, and must have been unknown before, since the advanced condition of bodily disease prevented speech, and the expression of intelligence or emotion, either normal or morbid. "these observations are made in no spirit of complaint. the capabilities of these institutions to treat all ailments of mind or body are indeed felt to be a source of satisfaction and pride. it ought, however, to be known, that this county asylum is, to some extent, made use of as a public infirmary, and that the result of such employment must be expected in an obituary somewhat lengthened, if not also in a list of cures somewhat abbreviated." sufficient proofs are surely furnished in the above extracts, selected from many similar ones, to establish the general statements advanced at the beginning of the present subject, viz. that both recklessness and cruelty not unfrequently mark the proceedings of workhouse officials in their transmission of patients to the county asylums. they, moreover, supply facts to prove that the neglect in transferring proper cases for asylum treatment, and the inexcusable folly of sending to asylums the victims of second childishness, the imbecile paralytics, the peevish and perverse sufferers from chronic organic disease, such as poor consumptives, whose days are measured by the shortest span, tend to promote the accumulation of incurable inmates, to raise the mortality, and to increase the expenditure of these institutions. in fact, the annual returns of county asylum experience demonstrate that the transmission to asylums is regulated by no rule, and is attended by great abuses. the practical lesson deducible from this is, that the matter must be placed in other hands, and guided according to some rational principles. the insane poor must no longer be left to pine in neglect and misery in their own homes, until their friends tire of the trouble of them, or some casual circumstance class them, in a relieving officer's opinion, as proper candidates for an asylum; nor must their presence in the workhouse be, for the future, regulated by the mere circumstance of the care, attention and expense they involve, in the estimation of workhouse governors. there need be some specially appointed officer, whose business it should be to know both the existence of every insane person in his district and his condition and treatment, and to report those who require the care of a curative asylum, those who only need the nursing and supervision of a chronic one, and those who can be duly and efficiently tended and cherished in the homes of their families. by the exertions of such an officer, we should no longer read of the removal of dying patients, only to die in the asylums; or of the victims of neglect and wretchedness detained in workhouses or their homes, until the advance of their mental malady, the complication of organic disease, or some casualty, has rendered them hopelessly incurable, and burdensome in cost,--a cause of a decreased rate of cures and of an augmentation of deaths in the asylum. but there is yet another lesson to be learned from the foregoing extracts, confirmatory of our own experience, which we might well wish to ignore, viz. the want of knowledge, both of the characters of insanity and of the treatment it demands, among our professional brethren. undoubtedly a vast stride has been made of late years in diffusing correct views of insanity and its treatment, yet much remains to be done; and it is humiliating to read of cases of delirium from fever, or from organic disease, affecting other organs than the brain; of patients afflicted with chorea; of others delirious from exhaustion or from alcoholic drinks, sent to asylums as cases of insanity. for it is to be remembered, that a medical certificate is a necessary preliminary to the entrance of every person into an asylum; and where the nature of the cases indicates no flagrant error of diagnosis, it at all events exhibits a carelessness or recklessness of the medical man, or his want of moral courage and of official independence, where, for example, he acts as the agent in sending to asylums the aged imbecile of fourscore years, or the poor restless, irritable victim of consumption or other fatal organic bodily disease. moreover, it speaks ill of union medical officers, who are entrusted with the supervision, medical care and treatment, and with the dietary of the lunatic poor, to read of the neglected and wretched state in which they are too often found, both in workhouses and in their own homes, and of the condition in which they sometimes are when received into asylums. the bonds and bands, the physical exhaustion from want of food, are matters rightly placed, in a greater or less measure, in their hands. the treatment by cupping, leeches, general bleeding, blistering and purging, and by other depressing means, lies wholly at their door; and such treatment, we regret to say, is still, by some medical practitioners, deemed proper, although experience has for years shown that madness is a disease of debility, and that to use debilitating means is the most direct way to render it incurable. there is yet another indication of the deficiency of information among medical men in general, often noticed by asylum physicians, viz. their inability to recognize the peculiar form of paralysis attended with disordered mind, known as "general paralysis." where, as at st. luke's hospital, at bethlem, and at hanwell, under the recent regulation for promoting the early treatment of recent cases, the existence of general paralysis disqualifies an applicant from admission, the rejection of patients, on the ground of its presence, often gives rise to disappointment and to irritation on the part of the medical men signing the certificates, who will stoutly deny the justice of the exclusion, because they see no such loss of motion or sensation as they do in hemiplegia or paraplegia, or those forms of palsy to which they are accustomed to restrict the appellation. this defective knowledge of insanity and its treatment ought not to be found, were medical instruction complete. but whilst the medical curricula make no requirement of instruction in mental disease necessary to medical qualifications, they are expanded so as to comprehend almost every branch of human knowledge, under the heads of 'preliminary education' and of 'collateral sciences,' and yet ignore psychological medicine, as though human beings were without minds, or, at least, without minds subject to disorder. the consequence is, as facts above illustrate, medical men enter into practice with no conception of the varied phenomena of mental disorder; unable to diagnose it; unfit to treat it, and glad to keep out of the way of its sufferers. some, as before intimated, associate it, in their views, with inflammatory or congestive disease, and treat it accordingly, by blood-letting and the other parts of the so-called antiphlogistic regimen, to the speedy destruction of the patient, by increased maniacal excitement and concurrent exhaustion, or to his extreme detriment in relation to his prospects of recovery. let us hope that this state of things may ere long be entirely amended, and that medical practitioners may be required to understand disorders of the mind as perfectly as those of the lungs. before quitting the subject of this section, a brief comment on the state of the law regulating the transference of weak cases to asylums will not be misplaced. according to _sect._ lxvii. & vict. cap. , providing for the examination of alleged lunatics prior to removal to an asylum, it is enacted, "that in case any pauper deemed to be lunatic, cannot, on account of his health or other cause, be conveniently taken before a justice, such pauper may be examined at his own abode;" and that, if found lunatic, he shall be conveyed to an "asylum, hospital, or house...; provided also, that if the physician, surgeon, or apothecary by whom any such pauper shall be examined shall certify in writing that he is not in a fit state to be removed, his removal shall be suspended until the same or some other physician, surgeon, or apothecary shall certify in writing that he is fit to be removed; and every such physician, surgeon, and apothecary is required to give such last-mentioned certificate as soon as in his judgment it ought to be given." a similar provision is made in the case of "lunatics wandering at large, not being properly taken care of, or being cruelly treated" or neglected by their relatives, by the section next following (_sect._ lxviii). further, by _sect._ lxxvii., empowering the visitors of asylums to remove patients, it is provided "that no person shall be removed under any such order without a medical certificate signed by the medical officer of the asylum, or the medical practitioner, or one of the medical practitioners, keeping, residing in, or visiting the hospital, or licensed house, from which such person is ordered to be removed, certifying that he is in a fit condition of bodily health to be removed in pursuance of such order." from the clauses above quoted, it is evidently the intent of the law to shield the unfortunate sufferers from mental disease, where prostrated by exhaustion or by organic lesions, against hasty and injudicious removal detrimental to their condition, or dangerous to life; yet, as already seen, these provisions are inoperative in preventing the evil. those, indeed, regulating the transfer or removal of patients to or from an asylum are to a certain extent obligatory, and are probably attended to; but it is not so with those designed to protect lunatics from injurious removals under the direction of parochial authorities, as enacted by _sect._ lxvii. for by this section it is left to the discretion of the medical practitioner called in, to examine the patient, and to certify, in writing, to his unfitness for removal; but much too commonly, according to the testimony of every asylum superintendent, the humane intentions of the law are neglected. this th section need, therefore, to be assimilated to the th, so far as to make it imperative on the part of the medical man who examines the patient, to certify "that he is in a fit state of bodily health to be removed." this is but a slight amendment, but it might save many a poor creature in a totally broken-down, exhausted, or moribund state, from being carried to an asylum far away, only to pine away and die. it is hard to write against the members of one's own profession, but the details put forth by asylum physicians of the manner in which patients are conveyed to the public institutions, and of the state in which they are received, demand, on the score of humanity, a condemnation of the indifference and negligence which sometimes mark the performance of duties rightly chargeable to parochial medical officers. partial excuses for these officers may be found in abundance, on account of their usual wretched remuneration, and the too dependent position they occupy in reference to the parish boards appointing them; but no sufficient explanation appears for their withholding a certificate allowed by law, which might prevent the removal of a patient delirious with fever, of one perishing from heart disease or consumption, or of one dying from the exhaustion of cerebral excitement and defective nutrition. chap. vi.--causes diminishing the curability of insanity, and involving the multiplication of chronic lunatics. other causes than those already examined are in existence, sending to diminish the curability and to multiply the permanent sufferers of insanity, to be found unfortunately in the character and constitution of the very establishments constructed to afford requisite care and treatment for our pauper lunatics. according to the division of our subject (p. ), these causes belong to the second head; or are-- b. _causes in operation within asylums._ § _magisterial interference. excessive size of asylums. insufficient medical supervision._ there are in too many asylums grave errors of construction, government, and management, which detract from their utility, and damage the interests of both superintendents and patients. in several there is too much magisterial meddling, subversive of that unity of action and management which should prevail in an asylum, as it must do in a ship, and prejudicial to the position and authority of the superintendents, by diminishing their responsibility, their self-respect and independence, and their importance in the estimation of those under their direction. the visiting justices of an asylum mistake their office when they descend from matters of general administration and supervision to those of superintendence and internal management. when they exchange their legal position as occasional visitors of the wards for that of weekly or more frequent inspectors; when they directly occupy themselves with the details of the establishment, with the circumstances affecting the patients, with their occupations and amusements, irrespective of the medical officer; when they suffer themselves to be appealed to, and to act as referees in matters of internal discipline; when they assume to themselves the hiring and discharging of attendants; and when, without taking counsel with the medical superintendent, they determine on alterations and additions to their asylum,--they are most certainly pursuing a policy calculated to disturb and destroy the government and the successful operation of the establishment. a meddling policy is in all ways mischievous and bad; it irritates honourable minds, and deters them in their praiseworthy and noble endeavours to merit approval and reward; whilst it at the same time acts as an incentive to apathy, indolence, and neglect: for freedom and independence of action, a feeling of trust reposed, and of merit appreciated, are necessary to the cheerful, energetic and efficient performance of duties. so soon as the zeal of any man of ordinary moral sensibility is doubted, so soon as his competency for his office is so far questioned by the activity and interference of others in his particular field of labour, so soon is a check given to his best endeavours in the discharge of his duties, his interest in them abates, and a blow is inflicted upon his feelings and self-respect. in short, it cannot be disputed, that if an asylum have a duly qualified and trustworthy superintendent, the less a committee of visitors interferes with its internal organization and the direction of its details, the more advantageous is it for the well-being of the institution. again, many asylums have grown to such a magnitude, that their general management is unwieldy, and their due medical and moral care and supervision an impossibility. they have grown into lunatic colonies of eight or nine hundred, or even of a thousand or more inhabitants, comfortably lodged and clothed, fed by a not illiberal commissariat, watched and waited on by well-paid attendants, disciplined and drilled to a well-ordered routine, gratified by entertainments, and employed where practicable, and, on the whole, considered as paupers, very well off; but in the character of patients, labouring under a malady very amenable to treatment, if not too long neglected, far from receiving due consideration and care. although the aggregation of large numbers of diseased persons, and of lunatics among others, is to be deprecated on various grounds, hygienic and others, yet the objections might be felt as of less weight, contrasted with the presumed economical and administrative advantages accruing from the proceeding, were the medical staff proportionately augmented, and the mental malady of the inmates of a chronic and generally incurable character. but, in the instance of the monster asylums referred to, neither is the medical staff at all proportionate to the number of patients, nor are their inmates exclusively chronic lunatics. the medical officer is charged with the care and supervision of some three, four, or five hundred insane people, among whom are cases of recent attack, and of bodily disease of every degree of severity, and to whom a considerable accession of fresh cases is annually made; and to his duties as physician are added more or fewer details of administration, and all those of the internal management of the institution, which bear upon the moral treatment of its inmates, and are necessary even to an attempt at its harmonious and successful working. now, little reflection is needed to beget the conviction, that a medical man thus surcharged with duties cannot efficiently perform them; and the greater will his insufficiency be, the larger the number of admissions, and of recent or other cases demanding medical treatment. he may contrive, indeed, to keep his asylum in good order, to secure cleanliness and general quiet, to provide an ample general dietary, and such like, but he will be unable to do all that he ought to do for the cure and relief of the patients entrusted to him as a physician. to treat insane people aright, they must be treated as individuals, and not _en masse_; they must be individually known, studied, and attended to both morally and medically. if recent insanity is to be treated, each case must be closely watched in all its psychical and physical manifestations, and its treatment be varied according to its changing conditions. can a medical man, surrounded by several hundred insane patients, single-handed, fulfil his medical duties to them effectively, even had he no other duties to perform, and were relieved from the general direction of the asylum? can he exercise a vigilant and efficient superintendence over the inmates? can he watch and personally inform himself of their mental, moral and bodily condition, prescribe their appropriate treatment, diagnose disease and detect its many variations; secure the due administration of medicines and of external appliances; order the necessary food and regimen; feed those who would starve themselves; attend to casualties and to sanitary arrangements; judiciously arrange the classification, the employments and recreations; keep the history of cases, make and record autopsies, and watch the carrying out of his wishes by the attendants? can, we repeat, an asylum superintendent properly perform these, and those many other minor duties of his office, conceivable to all those who experimentally understand the matter, though not readily conveyed by description? can any person perform these duties, if they were separable, without injury to the working of the institution, from the many details of general management which the position of superintendent has attached to it? can he be justly held accountable, if the huge and complex machine goes wrong in any part? can he feel sure that his patients are well looked after, attended to according to his wishes, and kindly treated? can he do justice, lastly, as a physician, to any one afflicted patient, whose restoration to health and to society depends on the efficient exercise of his medical skill, and do this without neglecting other patients and other duties? to these questions, surely, every thinking, reasoning man will reply in the negative. the consequence is, that asylum superintendents, who thus find themselves overburdened with multifarious and onerous duties, and feel the hopelessness of a personal and efficient discharge of all of them, are driven to a system of routine and general discipline, as the only one whereby the huge machine in their charge can work, and look upon recoveries as casual successes or undesigned coincidences (_see further_, p. ). the inadequacy of the medical staff of most asylums is a consequence, in part, of the conduct of superintendents themselves, and in part of the notions of economy, and of the little value in which medical aid is held by visiting justices in general. the contrast of a well-ordered asylum at the present day, with the prison houses, the ill-usage and neglect of the unhappy insane at a period so little removed from it, has produced so striking an effect on mankind at large, that public attention is attracted and riveted to those measures whereby the change has been brought about; in other words, to the moral means of treatment,--to the liberty granted, the comforts of life secured, the amusements contrived, and the useful employment promoted,--all which can, to a greater or less extent, be carried out equally by an unprofessional as by a professional man. it is therefore not so surprising that the importance of a medical attendant is little appreciated, and that the value of medical treatment is little heeded. there has, in fact, been a revulsion of popular feeling in favour of the moral treatment and employment of the insane; and, as a popular sentiment never wants advocates, so it has been with the one in question; and by the laudation by physicians of the so-called moral means of treatment, and the oblivion into which medical aid has been allowed to fall, magistrates, like other mortals, have had their convictions strengthened, that medical superintendents, considered in their professional capacity, are rather ornamental than essential members of an asylum staff; very well in their way in cases of casual sickness or injury, useful to legalize the exit of the inmates from the world, and not bad scape-goats in misadventures and unpleasant investigations into the management, and in general not worse administrators, under the safeguard of their own magisterial oversight, than would be members of most other occupations and professions. as before remarked, the magnitude of an asylum, and the paucity of its medical officers, are matters of much more serious import where recent cases of insanity are under treatment. in a colossal refuge for the insane, a patient may be said to lose his individuality, and to become a member of a machine so put together as to move with precise regularity and invariable routine;--a triumph of skill adapted to show how such unpromising materials as crazy men and women may be drilled into order and guided by rule, but not an apparatus calculated to restore their pristine condition and their independent self-governing existence. in all cases admitting of recovery, or of material amelioration, a gigantic asylum is a gigantic evil, and, figuratively speaking, a manufactory of chronic insanity. the medical attendant, as said before, is so distracted by multitudinous duties, that the sufferer from the acute attack can claim little more attention than his chronic neighbour, except at the sacrifice of other duties. no frequent watching several times a day, and no special interest in the individual case, can be looked for. there is such a thing as a facility in observing and dealing with the phenomena of acute mental disorder, acquired by experience; but it would be well nigh unjust to expect it in a medical officer, in whose field of observation a case of recent attack is the exception, and chronic insanity the rule, among the hundreds around. the practical result of this state of things is, that the recently attacked patient almost inevitably obtains less attention than he needs from the physician, who, from lack of sufficient personal observation, must trust to the reports of others, to the diligence, skill and fidelity of his attendants, and who, in fine, is compelled to repose work in others' hands which should rightly fall into his own. this being the case, the character of the attendants for experience, knowledge, tact and honesty acquires importance directly proportionate to the size of asylums, and the degree of inability of the medical superintendents to perform his duties personally. now, though we need testify to the excellent qualities of some asylum attendants, yet, notwithstanding any admissions of this sort, it is a serious question how far such agents should be employed to supply the defects and omissions of proper medical supervision and treatment. the class of society from which they are usually derived; their common antecedents, as persons unsuccessful or dissatisfied with their previous calling, or otherwise tempted by the higher wages obtainable in asylums, are circumstances not calculated to prepossess the feelings in favour of their employment in that sort of attendance on the insane alluded to. they have no preliminary instruction or training, but have to learn their duties in the exercise of them. many are their failures, many their faults, and often are they very inefficient, as the records of every asylum testify; yet, on the whole, considering their antecedents, and the nature of the duties imposed upon them, their success is remarkable. however, whatever their character as a body, as individuals they require the direct and ever-active oversight and control of the superintendent. the institution of head-attendants is a great relief to the labour of the latter, but rightly affords him no opportunity to relax his own inspection and watchfulness. in a large asylum there must be general routine: it can be conducted only by routine; and the attendants are the immediate agents in carrying it out. their duties necessarily partake largely of a household character; they are engaged in cleaning and polishing, in bed-making and dressing, in fetching and carrying, and in serving meals. but along with these they are entrusted with certain parts of the 'moral treatment' of the patients,--in enforcing the regulations as to exercise, employment, amusement, the distribution of meals, and the general cleanliness and order both of the wards and their inmates; and in the exercise of these functions acquire much knowledge respecting the character and habits of those under their care. yet withal, they are not fit and efficient persons to have medical duties delegated to them. they are not qualified to observe and record the symptoms of disease, to note its changes, nor, except under close surveillance, to apply remedies externally or internally. such is the onset or the serious march of bodily sickness not unfrequently, that even the experienced medical observer is prone to overlook it. this is true where disease attacks those sound in mind, and able to express their sufferings, and to lend the aid of their intelligence towards the discovery of the nature and seat of their malady; but the danger of oversight is increased tenfold when the insane are the subjects of bodily lesion. where the mind is enfeebled and sensibility blunted, and where melancholy broods heavily over its victim, disease is to be discovered only by a watchful and experienced practitioner of medicine; for the unfortunate patient will make no complaint, and the fatal malady may evince itself to the ordinary uninstructed observer by no sufficient symptom to awaken attention; and even where the mind is not imbecile, nor weighed down by its fears and profound apathy, yet the features of its disorder will interfere, in most instances, with the appreciation and interpretation of the symptoms which may reach the knowledge of those about the sufferer, and thereby mask the disease from the non-professional looker-on, and render its diagnosis even difficult to the medical examiner. with respect to the female attendants of asylums, it may also be observed, that they are frequently young women without experience in disease, and rarely qualified as nurses conversant with certain medical matters; and, from our own observation, they are found to be often backward and shy in reporting particulars respecting the female patients, and badly qualified in administering to their wants when sick. moreover, equally with the male attendants, there is, by their education and training, no security for a well-governed temper, for long suffering, patience and sympathy. indeed, the wages given in most asylums are not sufficient to induce a higher class of young women to accept the onerous and often painful and disagreeable duties of attendants on the insane, than that which furnishes housemaids and kitchenmaids to respectable families. if, therefore, their origin be only looked to, it would be contrary to experience to expect from the nurses of asylums, as a body, the possession of high moral principle and sensibility, of correct notions of duty, and of a hearty interest in their duties. we make these remarks, with no intention to censure the whole race of asylum nurses, among whom are many meritorious women; but merely to enforce the opinion that something may be done to improve their character and condition, and that, as a class, they are not rightly chargeable with duties of the kind and to the extent we are engaged in pointing out. on the contrary, their history, position, and education conspire to make them servants in tone and character, unfit often to exercise the discipline and authority entrusted to them; whilst the general duties connected with the cleanliness and order of their wards and rooms, and the observation of the universal routine of the asylum, contribute to the same effect, and the more so in large establishments, where the almost constant supervision of the superintendent is wanting, where individual interest in patients is all but dead, and where their number renders the inmates mere automatons, acted on in this or that fashion according to the rules governing the great machine. from the necessity of the case, the medical superintendent of a colossal asylum is compelled mainly to trust to the observation of his attendants to discover disease, and to report mishaps. he has his mile or upwards of wards and offices to perambulate daily, and, to keep up some connexion with their four or five hundred inmates, must adopt some general plan. for instance, he refers to the attendant of each ward he enters, demands from him if he has anything to report, wends his way through the apartment, looks right and left, remarks if the floor and rooms are duly swept and garnished; now and then inspects the bed and bedding, bids good morning to more or fewer of the patients who may be present, and unless brown or jones has something to report of any one of them, bids good day to all, to recommence the same operation in the next ward. now brown or jones might have had something to report had they medical eyes, and information to detect the first symptoms of disease in one of their patients; but as they have not, the disorder has a fair opportunity to steal a march upon the doctor, and possibly to take such firm possession of its victim before this or that attendant is persuaded something is going wrong, that the doctor only commences his professional operations against it in time to render his certificate of death satisfactory, and the result explicable without a coroner's inquest. we do not blame the medical men for not doing more, but we deprecate the system which places it out of their power to do so. no one can gainsay the possibility, nay, the actual occurrence, of avoidable deaths in the large asylums we condemn; and those who know the working of such institutions, know also that the duties are performed much after the sketch delineated, and could be got through in no greatly improved fashion. but it must not be supposed, that it is only when disease exists or has to be discovered, that the delegation of the principal part of the supervision of patients to ordinary asylum attendants operates injuriously to their well-being; far from it, for many are the cases which require the presence of a more instructed and more sympathizing mind; of a person to appreciate their moral and mental condition; to overrule by his official position disorderly manifestations, to pacify the excitable, to encourage and cheer the melancholy; to espy and anticipate the wants of all; to hear the complaints of some, and to be the confidant of others; to mark the mental changes of individuals, and to adapt surrounding circumstances, their occupations and amusements accordingly. to give such superintendence, or, in other words, to apply such moral and mental treatment, the medical officer is the only fitting person; from him the patients will and do naturally look for it. let any one follow a medical superintendent in his ordinary visits through the wards; and he will observe how ardently the visit is anticipated by many; how numerous are the little troubles and ailments they wish to disclose to the physician, and only to him; how often he can arrest excitement and calm irritation, only aggravated by the interposition of attendants; how often he can recognize mental and bodily symptoms demanding attention, and, in general, how largely he can supply those minutiæ of treatment, insignificant as they appear, and unthought of as they are by others, whose moral feelings, whose intellectual acumen, whose education and manners, and whose position are deficient to conceive them, and insufficient to put them in force. there is no question, it must be granted, but that whatever medical supervision may be supplied, yet that the carrying out of most of the details of management must always devolve upon the attendants; it becomes, therefore, a matter of paramount importance to render that class of asylum functionaries as efficient as possible. they need be encouraged by good wages and good treatment; and, what is of great moment, these should be sufficiently good, to induce persons of a better class than that which usually furnishes attendants, to accept such posts. this idea will probably be scouted by the stickler to "a due regard for economy," at first sight; but we think his economical penchant might be gratified by the plan of carrying out more fully in the wards the distinction of attendants upon the insane and of household servants. for is it not practicable to import the system adopted in the large london hospitals, where the office of 'sisters,' to nurse the patients, is separated from that of under-nurse, to whom the cleanliness of the wards is committed? if so, the immediate attendants on the insane might receive higher wages without increasing the general expenditure of the asylum; for those concerned in the cleaning of the wards would only earn the wages of common household servants. we throw out this suggestion, in passing, for the nature of our treatise forbids our enlarging upon such matters of asylum organization; otherwise, much might be written respecting the duties and the remuneration of attendants, and the advantages of pensions for them after a certain term of faithful service. to conclude this topic, we may remark that it would be easy, did the subject stand in need of proof, to multiply illustrations, showing that, to transfer the work of medical and moral supervision to attendants, in any similar extent and measure to that which must of necessity prevail in the excessively large asylums which county magistrates rear in opposition to the decided opinion of those best able to judge, is to frustrate the object of those institutions as curative asylums, and to detract from their advantages as refuges for the incurable. the evils of overgrown asylums have not, as might be expected, escaped the observation and reprobation of the commissioners in lunacy, who have referred to them in several of their annual reports, but more at large in that of , wherein they detail their contest with the middlesex magistrates respecting the further enlargement of the enormous asylums of hanwell and colney hatch, and their strange defeat, the magistrates having contrived to influence the home secretary in opposition to the decided opinion of the commissioners, though seconded by experience, by the general assent of all asylum physicians, and by their position as the referees appointed by the state in all matters touching the erection and management of asylums. with this acquiescence in the erroneous scheme of a county magistracy in opposition to a government commission, we have at present no immediate concern, and may content ourselves with reporting it as an anomalous proceeding which ought never to have occurred: but to revert to the sentiments of the commissioners, they are expressed in the following quotation from the report mentioned. "it has always been the opinion of this board that asylums beyond a certain size are objectionable: they forfeit the advantage which nothing can replace, whether in general management or the treatment of disease, of individual and responsible supervision. to the cure or alleviation of insanity, few aids are so important as those which may be derived from vigilant observation of individual peculiarities; but where the patients assembled are so numerous that no medical officer can bring them within the range of his personal examination and judgment, such opportunities are altogether lost, and amid the workings of a great machine, the physician as well as the patient loses his individuality. when to this also is added, what experience has of late years shown, that the absence of a single and undivided responsibility is equally injurious to the general management, and that the rate of maintenance for patients in the larger buildings has a tendency to run higher than in buildings of a smaller size, it would seem as if the only tenable plea for erecting them ought to be abandoned. to the patients, undoubtedly, they bring no corresponding benefit. the more extended they are, the more abridged become their means of cure; and this, which should be the first object of an asylum, and by which alone any check can be given to the present gradual and steady increase in the number of pauper lunatics requiring accommodation, is unhappily no longer the leading characteristic of colney hatch or of hanwell." as may be supposed, the disposition to build huge asylums is due to the same cause as that of the detention of insane persons in workhouses, viz. to the plea of economy; a plea, which we believe to be about as fallacious in the one case as in the other. the economy is supposed to arise from the saving in commissariat matters and in the governing staff; and it is no doubt proportionately cheaper to provision persons than , other things being the same. but, on the one hand, very competent persons assert that the cost of officers and servants for a population of insane is more than double that for one of half that amount, when proportionately compared. the multiplication of inferior officers beyond a certain point entails that of superior ones in a higher ratio to overlook them; there is not the same amount of productive labour considering the number employed. the capability of the superintendent to supervise his attendants and the patients stops at a certain point, and he need call to his aid a head attendant at superior wages, and so add an extra person to the staff; if the extent of his charge is farther increased by additional patients and their necessary attendants, then an officer of a higher grade is called for, and other overlookers of attendants and of the _régime_ of the house. but figures showing the relative costs presently appealed to will do more to convince the reader of the fact under notice than any 'aids to reflection' we can supply. there can be no question, that to build asylums for the insane above a certain size is a fallacy when viewed even in an economical aspect; but when regarded in relation to its ulterior consequences, the plan is not only erroneous, but reprehensible. were it really the case that a pecuniary saving resulted from the aggregation of large masses of mentally disordered folk, according to the figures in the ledger of the institution, yet no positive gain could be boasted of until it was proved that every case was placed in the most favourable conditions for recovery. can it be pretended that the very extensive asylums of this country, with their present corps of medical officers, furnish such conditions? certainly not, if there be any truth in the account we have published of their evils and defects. and if those conditions are not supplied, the primary object of these institutions, _i. e._ the cure of the insane, is frustrated, and chronic lunacy increased. where, then, is the economy, if patients, failing to receive the means of recovery, by reason of the constitution of the asylum on so large a scale, fall into chronic disease, and become permanent burdens on its funds? where is the economy of a system, which, by standing in the way of efficient treatment, reduces the proportion per cent. of recoveries to twenty or thirty, when under different arrangements that proportion may equal per cent. or upwards? it will be a happy day for the insane, and for the contributors to their maintenance, when visiting justices arrive at the conviction, that they have not done all they can on behalf of the poor disordered people under their guardianship, when they have provided good lodging, board and clothing for them, and such a system of routine and discipline as to check the manifestation of their mental vagaries; and that it is not enough for a recent case, to introduce it into an asylum and the companionship of lunatics, with practically no positive provision for its medical treatment. it will be well, too, for the insane, when the truth becomes more generally assented to, that their malady is no mythical, spiritual alteration, but the consequence of a material lesion of the brain, the marvellous instrument, the subject and servant of the immortal soul, which can by its divine essence know no disorder. this is perhaps, strictly speaking, a digression from the subject; yet erroneous ideas are the parents of erroneous practices, and those we have hinted at form no exception to the rule. but, to return, we have some excellent illustrative remarks on the fallacy of the belief in the economy of very large asylums, contained both in the report of the american and of the english lunacy commissioners. the former thus write in their report (_op. cit._ p. ):-- "the policy which has built large establishments for the insane is a questionable one as applied to economy. after having built a house sufficiently large, and gathered a sufficient number of patients for their proper classification and for the employment of a competent corps of officers and attendants, and allowing each to receive just as much attention as his case requires, and providing no more, any increase of numbers will either crowd the house, or create the necessity of building more rooms; and their management must be either at the cost of that attention which is due to others, or must create the necessity of employing more persons to superintend and to watch them. "if the house be crowded beyond the appropriate numbers, or if the needful attention and the healing influences due to each individual are diminished, the restorative process is retarded, and the recovery is rendered more doubtful; and if additional provision, both of accommodations and professional and subsidiary attendance, is made to meet the increase of patients beyond the best standard, it would cost at least as much per head as for the original number. dr. kirkbride thinks it would cost more, and that the actual recoveries of the curable, and the comfortable guardianship of the incurable, are not so easily attained in large hospitals as in such as come within the description herein proposed. 'it might be supposed that institutions for a much larger number of patients than has been recommended could be supported at a less relative cost; but this is not found to be the case. there is always more difficulty in superintending details in a very large hospital; there are more sources of waste and loss; improvements are apt to be relatively more costly; and, without great care on the part of the officers, the patients will be less comfortable.' "besides the increased cost of maintaining and the diminished efficiency of a large establishment, there is the strong objection of distance and difficulty of access, which must limit the usefulness of a large hospital in the country, and prevent its diffusing its benefits equally over any considerable extent of territory to whose people it may open its doors." having pointed out the evils of large asylums to their inmates, the english commissioners, in their eleventh report (p. ), remark, "that the rate of maintenance for patients in the larger buildings has a tendency to run higher than in buildings of a smaller size," ... and that it therefore "would seem as if the only tenable plea for erecting them ought to be abandoned." to substantiate this assertion, they appeal to the table of weekly charges of the several county asylums, set forth in the appendix c.c. of the same report, which certainly shows that the cost per head is at its maximum in those which receive the largest number of patients. this being so, surely no one can withhold assent to the just conclusion of the commissioners, that the system of erecting asylums above certain dimensions ought to be abandoned, inasmuch as the only plea that can be urged in its behalf, that, namely, of its economy,--a bad plea, by the way, if the real interests of patients and ratepayers are concerned,--is founded in error. one more topic needs a few words, viz. the very inadequate remuneration of the medical superintendents in some asylums,--a circumstance, confirmatory of the small value assigned by their committees of visitors to professional qualifications. the worst instances of underpayment are, in fact, met with in those very asylums where the number of inmates attains its maximum, and the medical provision for their care is at its minimum; where the administrative power of the medical men is the most limited and most interfered with, and their ability to discharge their duties conscientiously and efficiently, utterly crippled by the multitude of claimants upon their attention surrounding them; and where, in fine, they are merely accessory officials, useful in cases of sickness and accident. it must, indeed, be gratifying to the advocates of the rights of women to know, that in one asylum, at least, female labour is rated as equal to male professional labour; that the matron is as well paid as the medical officers, and more valued in the estimation of the committee of visitors. but, however this circumstance may be viewed by the partisans of the interests of the fair sex, we venture to believe that to most people it will appear a gross anomaly. for our own part, we consider also that it would be to the interests both of patients and rate-payers to elevate the position of the medical superintendents of asylums, and to pay them liberally. as this section of our work is passing through the press, we have got the report, just printed, "from the select committee on lunatics," and are most happy in being able to extract from its pages a very decided opinion expressed by the earl of shaftesbury respecting the scanty salaries of medical superintendents. his lordship, in reply to the question ( ), "have you any other remedies to apply to county asylums?" said,--"i do not know whether it is a matter that could be introduced into the bill, but i think the attention of the public should be very much drawn to the state of the medical superintendents in these asylums. it is perfectly clear, that to the greater proportion of the medical superintendents in these asylums, very much larger salaries should be given; and unless you do that, you cannot possibly secure the very best service.... the great object must be to raise the status and character of the superintendents to the highest possible point." in the course of further examination on this subject, his lordship repeats and adds to the opinion just recorded. for instance, he remarks,--"one of the great defects of the present system is, that the salaries of the medical officers are much too low for the service they perform. i think that the county ought to secure the very best talent and responsibility that can be found, and they ought to raise their salaries higher. i believe in some of the asylums the salaries are higher, but i hardly know one where the salary is adequate to the work done.... i cannot think that any superintendent ought to receive much less than from £ to £ a year, besides a house and allowances." in this matter, we hope the liberal views of the noble chairman of the lunacy commission will sooner or later be reciprocated by the visitors of asylums; in the mean time, the thanks of the medical profession are heartily due to his lordship for his able advocacy of its just claims. § _limit to be fixed to the size of asylums._ one remedy against extending the evil consequences of large asylums, is to restrict the size of future buildings within certain limits. we do not hope to persuade the advocates of gigantic asylums, by any representation we can offer of their ill-effects to the patients and their false economy, to abandon their notions; but we do hope that there will be a parliamentary interdiction to their perpetuation, or that the commissioners in lunacy will have sufficient authority lodged in their hands to limit the size of future asylums. although all persons conversant with the treatment and requirements of the insane concur in condemning such huge asylums as hanwell and colney hatch, yet there is some difference in opinion, of no very great extent indeed, among them with regard to the number of patients who should be assigned to the care of a single superintendent. moreover, the number who may be treated in the same building and by one physician, will differ according to the nature of the cases--whether all acute, or all chronic, or mixed, acute and chronic together. in this country all the asylums are of a mixed character, but, excepting two or three hospitals for the insane, contain a large preponderance of chronic cases. they are, moreover, all spoken of by the lunacy commissioners as curative asylums. let us now examine the opinions of some of the best authorities upon the subject, so that a tolerably accurate judgment may be formed of the limits within which the size of asylums should be restricted. in , the metropolitan commissioners in lunacy laid it down as a rule that "no asylum for curable lunatics should contain more than patients, and is, perhaps, as large a number as can be managed with the most benefit to themselves and the public in one establishment."--report, , p. . the present commissioners have expressed similar views, which also were clearly stated before the special committee of the house of commons this year, by the noble chairman, the earl of shaftesbury. if we look to american opinion, we find (rep. commiss. massachus. , p. ) that "it is the unanimous opinion of the american association of medical superintendents of insane asylums that not more than patients should be gathered into one establishment, and that is a better number. when this matter was discussed, there was no dissent as to the maximum; yet those who had the charge of the largest hospitals, and knew the disadvantages of large numbers, thought that a lower number should be adopted. "taking the average of the patients that now present themselves in massachusetts, of whom per cent. are supposed to be curable, and need active treatment, and per cent. incurable, and require principally general management and soothing custodial guardianship, and having 'due regard to the comfort and improvement of the patients,' this limit of should not be exceeded. "the principal physician is the responsible manager of every case, and should therefore be personally acquainted with the character and condition of his patients, the peculiarities of the diseased mind, as manifested in each one, and the sources of trouble and depression, or exaltation and perversity. this knowledge is necessary, in order that he should be able to adapt his means of medical or of moral influence with the best hope of success." dr. kirkbride, in his special treatise on the construction and organization of asylums, thus expresses his views (p. ):--"whatever differences of opinion may have formerly existed on this point (the size of the institution), i believe there are none at present. all the best authorities agree that the number of insane confined in one hospital, should not exceed , and it is very important that at no time should a larger number be admitted than the building is calculated to accommodate comfortably, as a crowded institution cannot fail to exercise an unfavourable influence on the welfare of its patients. the precise number that may be properly taken care of in a single institution, will vary somewhat, according to the ratio of acute cases received, and of course to the amount of personal attention required from the chief medical officer. in state institutions, when full, at least one half of all the cases will commonly be of a chronic character, and require little medical treatment. even when thus proportioned, will be found to be as many as the medical superintendent can visit properly every day, in addition to the performance of his other duties. when the proportion of acute or recent cases is likely to be much greater than that just referred to, the number of patients should be proportionately reduced, and will then be found to be a preferable maximum. while no more patients should be received into any hospital than can be visited daily by the chief medical officer, it is desirable that the number should be sufficiently large to give an agreeable company to each class, and to permit a variety of occupations and amusements that would prove too costly for a small institution, unless filled with patients paying a very high rate of board, or possessed of some permanent endowment. it might be supposed that institutions for a much larger number of patients than has been recommended, could be supported at a less relative cost; but this is not found to be the case. there is always more difficulty in superintending details in a very large hospital--there are more sources of waste and loss; improvements are apt to be relatively more costly; and without great care on the part of the officers, the patients will be less comfortable. "whenever an existing state institution built for patients, contains that number, and does not meet the wants of the community, instead of crowding it, and thereby rendering all its inmates uncomfortable, or materially enlarging its capacity by putting up additional buildings, it will be found much better at once to erect an entirely new institution in another section of the state; for under any circumstances, the transfer of acute cases from a great distance, is an evil of serious magnitude, and constantly deplored by those who have the care of the insane." french authorities take the same views. m. ferrus, who wrote so long back as , and is now one of the inspectors of asylums in france, says, in his book, 'des aliénés,' that an asylum for the treatment of mental disorder ought not to contain above , or at most patients; but that one having a mixed population of cases requiring treatment of incurables and idiots, may receive or even such inmates, provided the physician is afforded sufficient medical assistance. however, his brother inspector, m. parchappe, whose able work, 'des principes à suivre dans la fondation et la construction des asiles d'aliénés' (published so recently as ), forms the most valuable treatise on those subjects, does not approve so large a number of inmates to be collected in an asylum as m. ferrus would sanction. he writes:--"after taking every consideration into account, i think the minimum of patients ought to be fixed at , and the maximum at . below , the economical advantages decline rapidly without a compensatory benefit; above , although the economical advantages augment, it is at the detriment of the utility of the institution in its medical character." m. guislain, the eminent belgian physician, in his grand work on insanity, remarks (vol. iii. p. ), "it would be absurd to attempt to bring together in the same place a very large population; it would tend to foster an injurious degree of excitement; would render the management difficult or impossible; would destroy the unity of plan, and neutralize all scientific effort. the maximum ought not to exceed or insane persons. this limit cannot be exceeded without injury to the well-being of the inmates; but unfortunately this has been but too often disregarded, under the plea of certain views of organization or of economy." jacobi placed the maximum of asylum population at (ueber die anlegung und errichtung von irren-heil-anstalten, p. ); roller expressed his opinion (grundsätze für errichtung neuer irren-anstalten, p. ) that one instituted for the treatment of cases (heil-anstalt) should not at the most receive above ; but that an asylum for chronic cases (pflege-anstalt), connected with the other, may admit from to , making a total population, under the same general direction, of or ; and damerow (ueber die relative verbindung der irren-heil-und pflege-anstalten) unites in the same opinion. it would be useless to multiply quotations; for, in short, there is complete unanimity among all those concerned in the direction of asylums, that such institutions, when of large size, are prejudicial to their inmates and withal not economical. there is likewise a very near coincidence of opinion perceptible with reference to the question of the number of patients which ought to be placed in the same building. supposing the asylum to be specially devoted to the reception of recent cases, it is agreed that it ought to accommodate not more than , and that the smaller number of inmates would be preferable. if a receptacle for both acute and chronic mental disease, some would limit the population to , whilst others would extend it to , provided the medical officers were increased in proportion. the example of the german asylums under the direction of damerow and roller is peculiar; for the curable and chronic cases are not mixed, but placed separately in two sections or two institutions under a general medical direction within the same area. this is the system of 'relative connexion' of the "heil-anstalt,"--institution for treatment, or the hospital, and the "pflege-anstalt," the 'nursing' institution, or the asylum; to the former they would allot , and to the latter as a maximum, making a total of inmates under the same physician in chief and the same general administration, but each division separately served by its own staff and specially organized. § _increase of the medical staff of asylums._ in the next place, the medical staff of an asylum should be large enough to secure daily medical observation and attendance for each individual patient, along with a complete supervision of his moral condition, his amusements and employment. we have said that this provision is deficient in many english asylums, a statement amply confirmed by the opinions of others. dr. kirkbride (_op. cit._ p. ) lays it down as a rule, that "where there are patients, especially if there is a large proportion of recent cases, besides the chief physician, two assistant physicians will be required, one of whom should perform the duties of apothecary. in some institutions, one assistant physician and an apothecary will be sufficient. if the full time of two assistant physicians, however, is taken up by their other duties among the patients, an apothecary may still be usefully employed in addition; and to him, other duties among the male patients may with propriety be assigned." french writers coincide in these views. m. parchappe assigns to an asylum containing to patients, a physician with an assistant, besides a dispenser; to one having to inmates, a physician, two assistants and a dispenser, besides a director to superintend the general administration, who in some institutions is also a medical man. in germany, and generally in italy, the medical staff is still larger in proportion to the number of patients. jacobi apportions to an asylum for or lunatics, a chief physician, a second, and an assistant, besides the dispenser. roller coincides with this, and the asylum at illenau under his superintendence, consisting of two divisions, one for recent, the other for chronic cases, and containing in all patients, has three physicians besides two assistants or 'internes.' so at leubus, in silesia, there are three physicians, although the inmates are only in number; and the rule is, in other german asylums, containing inmates, to have two physicians, besides one or two internes and a dispenser (pharmacien). allowing the opinions and practice of the eminent men quoted, and which in truth are shared in by every asylum superintendent, their due weight, it would seem no extravagant arrangement to allot to an asylum accommodating from to patients (recent and chronic cases together), a physician superintendent and an assistant; and a similar medical staff to an institution for or inmates, all in a state of confirmed chronic insanity, imbecility, and dementia. if the population in an asylum for chronic cases is further augmented to or ,--the latter number we hold to represent the maximum which can economically and with a just regard to efficient government and supervision and to the interests of the patients, be brought together in one establishment,--the medical superintendent will require the aid of two assistants and a dispenser. such aggregations as of to insane people are unwieldy and unmanageable with the best appointed medical staff, unless this be so numerous as utterly to invalidate the plea of economy, the only one, fallacious as it is, that can be produced by the advocates for their existence. and not only are they unmanageable, but also hygienically wrong; for it is a well-recognized fact, that the accumulation of large numbers of human beings in one place, tends to engender endemic disease, uniformly deteriorates the health, and favours the onset, progress, and fatality of all disorders. the history of large asylums bears testimony to the truth of this; for cholera has scourged more than one most severely, and dysentery and chronic or obstinate diarrhoea are pretty constant visitants in their wards. the contrast between the opinions and practice of the distinguished men referred to and those of some committees of visitors respecting the value of medical attendance on the insane, the nature of the duties to be performed, and the amount of labour the superintendent of an asylum may accomplish, is most remarkable. what those of the former are, is stated already; what those held by the latter are, we have an illustration in the administration of the colney hatch and of the hanwell asylums. in the latter establishment we find two medical men appointed to superintend insane inmates, besides nearly persons employed about it. true, we are informed by the committee, that the superintendent of the female department, who has the larger number, some , under his charge, is _assisted_ by the _matron_; and we are sure he must be thankful for any assistance rendered him; yet it is the first time that we have been called upon to recognize a matron as an assistant medical officer. however, we must accept it as a fact,--gratefully we cannot,--but with a protest against placing a subordinate officer on such an independent footing, against entrusting her with duties incompatible with her education and position, and with the relations which should subsist between her and the superintendent, and against making her his equal in the remuneration for her services. did occasion offer, we might ponder over this new development of the matronly office; inquire respecting the medical qualifications demanded, and the manner in which the hanwell committee have ascertained them; and meditate at length on the notions which govern the visiting justices in organizing and directing an asylum; but for the present, we will, for further example's sake, note some of their opinions and doings in the management of the sister 'refuge for lunatics' at colney hatch. we shall, for this purpose, appeal to the report for , and to make the quotations used intelligible, will premise, that the steward, at that date, had turned architect, and produced a plan for the extensive enlargement of the asylum as proposed by the magistrates; and that, very naturally, when writing about it, he was intent to prove that his plan was the best, the cheapest and the most convenient even to the medical superintendents who would be called upon to officiate in it when completed. this much being premised, we will quote the steward's own words. "i must also remind the committee," he observes, "that some three years since it was with them a matter of serious deliberation, whether it was advisable that the male and female departments should be placed under the care of one medical superintendent, and, in fact, whether _one medical officer_ should have the _supervision and direction of inmates_, and an extended range of building; or whether the two departments should continue, as they are at present, separate and distinct." what an excellent insight does this revelation of the cogitations of the committee-room of the middlesex magistrates afford us of the sentiments these gentlemen entertain of the requirement and value of medical skill in an asylum; of the capacity, bodily and mental, of a superintendent for work! but, without waiting to fill up a sketch of the wondrous virtues and faculties which the superintendent of the insane patients need to possess in order to know all, supervise them, direct them, and attend to the multitudinous duties of his office as a physician and director, we will by a further extract gather clearer notions of the extent of the work thought to be not too much for him. the gist of the ensuing paragraph is, that the steward strives to prove that by adding a new story here and there, besides spurs from the previous building, he will increase greatly the accommodation without much augmenting the ambulatory labours of the medical officer. and alluding to one, the male division of the establishment, he proceeds to argue, that "if it is considered feasible for one person to superintend patients of both sexes in a _building extending_ from one extreme to the other, _nearly two-thirds of a mile_, would it not be equally feasible to superintend patients in a building one half the extent [here mr. steward forgets to count the number of furlongs added by his proposed new wards], provided they are conveniently and safely located, although these patients are all males?" to this we may be allowed to subjoin some remarks we penned in a critique published in the 'asylum journal' (vol. ii. p. ) for , and in which many of the observations contained in the present work were briefly sketched. "who, we ask, can dispute the feasibility of a medical or of any other man superintending , , or two or three thousand patients, collected in an asylum or in a town, in the capacity of a director or governor, if subordinate agents in sufficient number are allowed him? but we think the question in relation to asylums is not, how we can govern our insane population most easily and at the least possible cost, but by what means can we succeed in curing the largest number of cases of insanity as they arise, and thus permanently keep down expenditure and save the rates. these results are certainly not to be attained by persevering in the old scheme of congregating lunatics by tens of hundreds, but by making suitable provision for the immediate treatment of the pauper insane in asylums properly organized for it, and under the direction of a sufficient medical staff." how totally different, too, are the views of jacobi to those of the middlesex magistrates concerning the office of superintendent, and the extent of work of which he is capable! in his treatise on asylum construction (tuke's translation, p. ), he presents the following sensible remarks:--"it is not that i should consider a more numerous family (than ) incompatible with the right management of the farming and household economy, nor with the domestic care of the patients; both these might perhaps be organized in an establishment containing a number equal to the largest just named (four or six hundred), in such a manner as to leave nothing to be desired; but it is in regard to the higher government of the establishment, and the treatment of the patients as such, in its widest signification, which must rest upon the shoulders of a single individual,--the director of the establishment,--that i am convinced the number of patients should not exceed two hundred. for when it is considered that the duties of the governor embrace the control of all the economical and domestic arrangements, as well as of the whole body of officers and servants; that he must devote a great share of his time to the writing, correspondence, and consultations connected with his office; that as first physician, he is entrusted with the personal charge and medical treatment of every individual committed to his care; that he must daily and hourly determine, not only the general outlines, but the particular details of the best means for promoting the interests of the collective community, as well as of every separate person composing it; and that, besides all this, he is responsible to science for the results of his medical observations in the establishment over which he presides; nor less so for the promotion of his own advancement as a man and a philosopher;--it will be readily granted, that the given maximum of two hundred patients for a single establishment ought never to be exceeded. indeed, a man of even extraordinary abilities would find himself unequal to the task of discharging these duties, in an establishment containing two hundred patients, were he not supported by such assistance as will hereafter be described; and were there not a great number amongst even this multitude of patients requiring not constant, or at least, a less degree of medical attention." many writers on asylum organization, particularly those of the continent, insist very strongly on so far limiting the size of asylums for the insane, that they may be superintended by one chief medical officer, aided indeed by assistants, but without colleagues of coordinate powers. the venerable jacobi took this view, and desired that the director of an asylum should be the prime authority in all its details of management, and insisted that the institution should not by its size overmatch his powers to superintend it and its inmates as individuals. thus, after reviewing the nature of the duties devolving on the chief physician, he observes (p. , tuke's translation), "it follows as a necessary consequence that one man must be placed at the head of the establishment," ... and that "his mind must pervade the whole establishment." likewise m. parchappe joins in the same opinion; and after speaking (des principes, p. ) of the impossibility of proper medical supervision in a very large asylum, observes, "that to divide the medical direction among two or more physicians is extremely detrimental to the superiority which the medical superintendent ought to hold in the general administration of asylums, and to that unity of purpose and opinions required in the interests of the patients." without citing other foreign writers to substantiate the view under consideration, we may call attention to the fact, that the lunacy commissioners, who have always so stoutly advocated the position of the medical officer as the superintendent of an asylum, likewise appear to accept the same principle; for in their eleventh report (p. ), they remark, that besides the direct injury inflicted upon patients when congregated in excessive numbers in the same institution, "experience has of late years shown, that the absence of a single and undivided responsibility is equally injurious to the general management." lastly, the committee of visitors of the surrey county asylum appear,--judging from their recent appointment of a chief physician to their institution, paramount to the medical officers of the divisions, and invested with full powers as director,--to have arrived at the just conviction that there must be unity and uniformity in the management of an institution. however, we regret to say that this conviction is unaccompanied by that other which jacobi and parchappe would associate with it, viz. that the size of the asylum should be no larger than will admit of the chief physician acquainting himself with every case individually, and treating it accordingly. whilst, indeed, by their proceeding, they constitute the chief physician a governor of a large establishment, and the director of the household and of its economy, they at the same time deprive him of his professional character by removing the opportunities of exhibiting it beyond his reach, both by the relations they place him in to the other medical officers, and by the enormous aggregation of patients they surround him with. few objections, we presume, are to be found to the principle of having a chief medical officer paramount to all others engaged in the work of an asylum; and although, considered as a _medical superintendent_, his professional qualities are not in much requisition in so large an institution as the surrey county asylum, yet we regard such an appointment as most desirable, and as preferable to the system of dividing the management between two medical officers, as pursued in the middlesex county asylums. indeed, the value of the principle of concentrating power in the hands of a chief officer, under the name of governor, or of some equivalent term, is recognized by its adoption in large institutions of every sort in the country. such enormous asylums as those referred to, partake rather of the nature of industrial than of medical establishments. their primary object is to utilize the population as far as practicable, and this end can be attained in a large majority of the inmates; consequently an able director is of more consequence than a skilful physician; for the latter is needed by a very small minority, by such a section, in fact, as is represented by the inmates of a workhouse infirmary only compared with its entire population. therefore, since the enormous asylums in existence are not to be got rid of, it is desirable to give them an organization as perfect as practicable; and it is under this aspect that we approve the plan of the surrey magistrates in appointing a director paramount to every other officer. the approval of this proceeding, however, does not minish aught from our objections to such enormous institutions, considered as curative asylums for the insane. as a refuge for chronic lunatics, an asylum so organized and superintended as is the surrey, may subserve a useful purpose; but we hold it to be an unsuitable place for recent cases demanding treatment as individuals suffering from a curable disease, and requiring the exercise of the skill and experience of a _medical_ man _specially_ directed to it. while the system of congregating so many hundreds of lunatics in one establishment, and the magisterial principle of providing for the care and maintenance and of non-intervention in the individual treatment of the insane prevail, no objection can be taken to the practice of committees of visitors in according the first merit when candidates come forward for the office of medical superintendent of an asylum, to qualifications for the routine government of large masses, for the allotment of labour, for the regulation of the domestic economy of a house, for the profitable management of the farm; in short, for qualities desirable in a governor of a reformatory-school or prison. indeed, they are right in so doing, when they wish to have a well-disciplined and profitably worked asylum; and when their institution attains the dignity of a lunatic colony, it is the best course they can adopt, for medical qualifications in such an establishment sink into insignificance amidst the varied details of general administration, which fall to the lot of the superintendent. but the case would be materially changed were the primary object of an asylum the successful treatment of its inmates, and were its dimensions within the limit to afford its superintendent the opportunity to know all, and to treat all its patients as individuals to be benefited by his professional skill. in selecting the physician of such an asylum, the administrative and agricultural qualifications he might possess, though far from being unnecessary or unimportant, should occupy a secondary place in the estimation of committees of visitors; and the primary requirement should be the possession of properly certified medical skill, of experience in the nature and treatment of insanity, in the wants and management of the insane, and of asylums for them; of evident interest and zeal in his work, and of those intellectual and moral endowments adapted to minister to the mind diseased, to rule by kindness and forbearance, and at the same time with the firmness of authority. chap. vii.--on the future provision for the insane. the only apology permissible for detaining lunatics in workhouses, is that there is no asylum accommodation for them to be had; and the only one attempted on behalf of the construction of colossal asylums is, that the demands for admission and the existing numbers are so many, and the majority of cases chronic and incurable, that the most economical means of providing for them must be adopted, which means are (so it is supposed) found in aggregating masses under one direction and one commissariat. now, whilst we have, on the one hand, contended that workhouses should be as soon as possible disused as receptacles for the insane, we have, on the other hand, endeavoured to prove that very large asylums are neither economical nor desirable, especially if the cure of lunatics, and not their custody only, is contemplated by their erection. indeed the attempt to keep pace in providing accommodation for the insane poor with their multiplication by accumulation and positive increase or fresh additions, has failed, according to the mode in which the attempt has hitherto been made. new asylums have been built and old ones enlarged throughout the country, and between and the end of , the accommodation in them had been increased threefold; whilst, at the same time, pauper lunatics had so multiplied, that their number in licensed houses remained almost the same, and the inmates of workhouses and chargeable imbeciles and idiots residing with their friends or with strangers, had very largely increased. the history of pauper lunacy in middlesex furnishes one of the most striking commentaries upon the system pursued to provide for its accumulation, and on its failure. "when (we quote the th report of the commissioners in lunacy, , p. ), in , hanwell was built for patients, it was supposed to be large enough to meet all the wants of the county. but, two years later, it was full; after another two years, it was reported to contain patients more than it had been built for; after another two years, it had to be enlarged for more; and at this time (colney hatch having been meanwhile constructed for the reception of lunatic paupers belonging to the same county) hanwell contains upwards of patients. colney hatch was opened in ; within a period of less than five years, it became necessary to appeal to the rate-payers for further accommodation; and the latest returns show that, at the close of , there were more than pauper lunatics belonging to the county unprovided for in either of its asylums." at this conjuncture the commissioners proposed a third asylum, so that they might, "by a fresh classification and redistribution of the patients, not only deal with existing evils universally admitted, but guard against a recurrence of evils exactly similar, by restoring to both asylums their proper functions of treatment and care." however, instead of adopting this wise policy, the committee of visitors insisted on following out their old scheme of adding to the existing asylums, in the vain hope of meeting the requirements of the county; and have proceeded to increase the accommodation of hanwell to upwards of , and that of colney hatch asylum to nearly beds. yet let them be assured they have taken a very false step, and that though they heap story on story and add wing to wing, they will be unable to keep pace with the demands of the pauper lunatics of the county; nor will they succeed in the attempt, until they make the curative treatment of the insane the first principle in their official attempts to put into execution those lunacy laws confided to their administration by the legislature. perceiving that this scheme of adding to asylums until they grow into small towns defeats the object of such institutions as places of treatment and cure, and that it will continue to fail, as it has hitherto failed, to supply the demands for accommodation, the commissioners remarked in their last ( th) report, that "a scheme of a far more comprehensive nature" is called for to meet increasing events. they have not hinted in that report at any scheme, but we may gather from other similar documents, especially from that of , that one important plan they have in view is to remove a large number of chronic, imbecile and idiotic patients from the existing, expensively built and organized asylums, and to place them in others erected, adapted and organized for their reception at a much less cost. by this means they count both on rendering the asylums generally, now in existence, available as curative institutions for the reception of new cases as they arise, and on arresting the tendency and the need to erect such enormous edifices as do discredit to the good sense of the magistrates of the counties possessing them. we agree with the commissioners in the general features of the plan advanced, and indeed, in our notice of the reports of the middlesex county asylums, in (asylum journal, vol. ii. p. _et seq._), advocated the establishment in that county of a third asylum especially for the treatment of the recent cases as they occurred. now the adoption of any such plan implies the recognition of a principle which has been very much discussed, viz. that of separating one portion of a number of insane people from another, as less curable or incurable. however, the commissioners in lunacy avoid discussion, and treat the matter in its practical bearings; still a brief critical examination of it will not be here misplaced. § _separate asylums for the more recent and for chronic cases._ the proposition of placing recent and chronic cases of lunacy in distinct establishments is often so put as to beg the question. it is asked if any one can undertake to say categorically that any case of insanity is incurable, and thereupon to transfer it to an asylum for incurables? to the question thus put every humane person will reply in the negative; he will start at the idea of consigning an afflicted creature, conscious of his fate, to an abode, which, like dante's inferno, bears over its portal the sentence, "abandon hope all ye who enter here." but a solution thus extorted is in no way a reply to the question of the expediency or inexpediency of making a distinction in place and arrangement for the treatment of recent and of chronic cases of lunacy severally; for this is a matter of classification, and one particularly and necessarily called for, where the insane are aggregated in large numbers, and the conditions of treatment required for the great mass of chronic cases are insufficient for the well-being of the acute. the real practical questions are,-- , cannot the subjects of recent insanity be separated advantageously, and with a view to their more effectual and successful treatment, from a majority of the sufferers from chronic insanity, imbecility and fatuity, and particularly so where the total number of the asylum inmates exceeds the powers of the medical officer to study and treat them as individuals? and, , does not the separation of the very chronic, and according to all probability, the incurable, afford the opportunity to provide suitably for the care of that vast multitude of poor lunatics, at present denied asylum accommodation; and to effect this at such an expenditure, as renders it practicable to do so, and thereby to meet the present and future requirements of the insane? several eminent psychologists have taken up the question of separating recent and probably curable cases from others found in asylums, in an abstract point of view, as if it were equivalent to forming an absolute decision on the grand question of the curability or incurability of the patients dealt with; and, as a matter of course, their adverse view of the subject has found numerous abettors. the subject is, however, well deserving of examination _de novo_, in the present juncture, when some decided scheme must be agreed to for the future provision of the insane, and for repairing the consequences of past errors. in the first place, let us ask, are the harrowing descriptions of the deep depression and despair felt by patients on their removal after one or two or more years' residence in a curative asylum to another occupied by chronic cases, true and sketched from nature? we think not. writers have rather portrayed the sensations they would themselves, in the possession of full consciousness and of high sensibility, experience by a transfer to an institution as hopelessly mad, and have overlooked both the state of mental abasement and blunted sensibility which chronic insanity induces in so many of its victims, and still more the fact that no such absolute and universal separation of acute and chronic, as they picture to their minds, is intended. indeed, we believe that, even among patients who retain the consciousness and the powers of reflection to appreciate the transfer, no such lively despair as authors depict is felt. in the course of our experience at st. luke's hospital, we have seen many patients discharged 'uncured' after the year's treatment in that institution, and transferred to an asylum, without noting the painful and prejudicial effects on their mental condition supposed. disappointment too is felt by patients rather at discovering that on their discharge from one asylum they are to be transferred to another, instead of being set at liberty and returned to their homes; for few of the insane recognize their malady, and they will think much less about the character of the asylum they are in, than their confinement and restricted liberty. again, it is not at all necessary to contrast the two institutions, by calling the one an asylum for curables, and the other an asylum for incurables; indeed, such a class as incurables should never be heard of, for we are not called upon to define it. the two asylums might be spoken of as respectively intended for acute and for chronic cases; or the one as an hospital, the other as an asylum for the insane; or better still, perhaps, the one as the primary (for primary treatment), and the other as the secondary institution. the removal, and the date at which it should take place, should be left to the discrimination of the medical officer. no period need be fixed at which treatment in the primary institution should be given up; the nature, the prospects, and the requirements of a case must determine when treatment therein should be replaced by treatment in the secondary asylum. moreover, no barrier should be opposed to a reversed transfer; a trial in another institution is often beneficial, and it would be an advantage to have the opportunity of making it. in the removal from the hospital to the asylum there would be no declaration that the patient was incurable, but only that his case was such as not longer to require the special appliances of the former, although it still needed the supervision of an asylum, and a perseverance in a course of treatment and nursing fully and particularly supplied by the resources of the latter. the determination of the cases proper for the secondary asylum lodged in the physician's hands would always enable him to retain those in the primary one, whose state, though chronic, would in his opinion be injuriously affected by a transfer, and any such others besides whose presence in the wards he might deem an advantage in the management. we mention the latter, because the opponents to separation insist on the benefits to an asylum accruing from the admixture of recent and chronic cases. and although we are not prepared to deny an opinion held by so many eminent men, yet we are on the other side not at all persuaded that the presence of old inmates is of any such real advantage, as supposed, to newly-introduced ones. we can assert, from experience, that recent cases can be very satisfactorily treated without the company of old ones; and we must, moreover, confess to certain misgivings that the actual presence of a long-standing case, often eloquent on the injustice of his detention, a job's comforter to the new-comer, by his remarks on the severity of his disorder, with the assertion added, that there was nothing the matter with the speaker's self when he came into the house; full of gossip about all the mishaps of the place, and often exercising an annoying superiority and authority assumed on account of his position as one of the oldest inhabitants. to the statement of the value of their service in aiding the attendants and in watching their neighbours, we rejoin, there should be attendants enough to perform the duties of supervision; that many recent are equally serviceable as chronic cases, and stand in need of being encouraged by the attendants in taking part in those many minor details which characterize life in the wards of an asylum. however this question of the utility of mixing chronic and recent patients together may be solved, we do not contemplate the existence of a primary asylum without the presence of more or fewer chronic cases, retained in it for the best medical and moral reasons. likewise, on the other hand, the secondary asylum will not so exclusively be the abode of incurables. the lapse of time in a case of insanity most potently affects its chances of recovery, but it is not an invariable obstacle to it; for experience decidedly demonstrates that recovery may take place years after every hope of it has passed away, and that patients rally from their affliction, not after four or five years only, but even after ten and twenty; consequently, among the large number of chronic patients under treatment, there would doubtless be every year some restored to reason and to liberty; and the dreaded foreboding of perpetual confinement and hopeless incurability could not take possession of the minds even of those whose perceptions rendered them conscious of their condition and position. to arrive at a correct judgment on this matter, let us look into it from another point of view, and compare the condition of a lunatic in the proposed chronic asylum with that of one in a large county asylum, conducted according to the prevailing system. look to the fact, that in some of the existing large curative (?) asylums, not more than from to per cent. of their six or eight hundred, or one thousand inmates, are deemed curable, and say in what respect a patient introduced into an establishment of the sort, surrounded on every side by crowds of chronic lunatics, enjoys any superiority over one transmitted to a secondary asylum of the description we contemplate. call such an institution what we may, announce it as a curative asylum, or as an hospital for curables, it matters not; to a fresh-comer it has all the drawbacks of a chronic asylum; for if he be alive to his condition, and can reflect on the position and circumstances in which he is placed, he may well find grounds for discouragement and despair on looking round the gigantic building, overflowing with the victims of chronic insanity, many of appearance, habits, and manners, repugnant to the higher and better feelings of any thinking, reflecting mortal; who count their residence there by years and even tens of years, with no prospect of release, and who, it may be in his imagination, are not, or have never been, so afflicted as himself. can such a spectacle be otherwise than injurious to a recent case, sufficiently well to perceive it on admission, or coming to appreciate it during convalescence? and must not the recognition of his position by the patient be most painful and discouraging as one of a multitude, eliciting personally, except perhaps for the few first days, no more attention than the most crazy old inmate near him; submitted to the same daily routine, and having no superior with sufficient time on hand to hear at large his tale of woe, to soothe his irritated spirit, or to encourage him in his contest with his delusions and fears? if the case of the new-comer be chronic, the conditions he finds himself placed in are sufficiently distressing and annoying; but if it be recent and curable, they are damaging to his chance of recovery. the comparison just drawn tells in favour of the system of separation. recent cases would not, in the primary institution or hospital, find themselves an insignificant few surrounded by a host of chronic patients, and they would accordingly escape the evils of such a position; on the contrary, they would be placed under the most favourable conditions for recovery, be individually and efficiently attended to, and encouraged by the many convalescents around them to hope and strive after their own restoration to health and liberty. the sketch presented of the evils of the companionship of long-disordered inmates with new-comers, especially when those are melancholic, is not an imaginary one, but drawn from experience. often will a desponding patient observe, 'i shall become like such or such moping, demented lunatic'; and superintendents, if they would, might often record the ill-effects of example of older inmates upon those newly admitted. attempts by means of classification somewhat mitigate, where made, the evils of large asylums for recent cases, by keeping these to a certain measure apart from most of the other lunatics; but nothing can do away with the injurious impression on a mind sufficiently awake to receive it (on such a one, in short, as the question of the place of treatment can alone concern),--of being one member of many hundreds who have for years and years known no other residence than the huge house of detention they are in: and there is no compensation to be had for the loss of those special appliances, and that individual treatment, which only a properly-organized hospital can supply. the last clause suggests another important argument for the treatment of recent cases in a distinct establishment or in separate sections. it is, that they require a peculiar provision made for them, involving greater expense, a more complete medical staff, a physician accustomed to their supervision and management, unfettered by that host of general duties which the presence of a multitude of chronic patients entails, and a staff of attendants disciplined to their care, and possessing many of the qualifications of nurses. moreover, the building itself for this class of patients need be more expensively constructed and fitted than one for chronic inmates. there is yet another reason against largely extending the size of a county asylum, and in favour of building, in the place of so doing, a distinct structure. this reason is to be found in the influence of distance as an obstacle to the transmission of the insane to an asylum for treatment, and to the visits of their friends to them during their confinement. the lunacy commissioners of the state of massachusetts particularly remarked the operation of distance in debarring insane patients from treatment, and illustrated it by a table showing the numbers received from different places within the district it served, and in relation to their population, into the asylum. likewise in this country, where the distance of the asylum is considerable, it is a reason for delay on the part of the parochial officers, who wish to avoid incurring the expense of removing the case, if they can in any way manage it in the workhouse. but the evil of remoteness operates more frequently, and with much cruelty, against the visits of poor persons to see their afflicted relatives in asylums. many can neither undertake the cost, nor spare the time required for the journey, notwithstanding the modern facilities of travelling. the same evil is likewise an impediment to the visits of parochial officers, who rightly possess a sort of legal guardianship over their lunatic poor in asylums. lord shaftesbury, in his evidence before the select committee, , very properly dwelt upon the advantages of visits from their friends to lunatics in asylums, and even proposed to make their visits compulsory by act of parliament. the commissioners in lunacy also, in their twelfth report ( ), gave examples of the distress not unfrequently attending on the separation of the patient in an asylum at a long distance from his friends. such distress operates to the disadvantage of the patient, and increases the sorrow of his relatives. admitting there are advantages attending the multiplication of asylums instead of aggregating lunatics in very large ones, it would appear the correct policy for boroughs to build asylums for the refuge of their own insane; or, where small, to unite with other boroughs in the county for the same purpose, in place of contributing to the county-establishment, and inducing the magistrates to extend its size injuriously. in a case such as that of middlesex, where the county asylums have attained such an unwieldy size as to be past acting as curative institutions, it would seem no improper extension of the law to make it imperative upon the large metropolitan boroughs to build apart for their own pauper lunatics. of this we are persuaded, that it would soon be found to the profit of the boroughs to undertake to provide for their own pauper insane. we regret that, in advocating the separation of chronic from recent cases, we place ourselves in antagonism to many distinguished men who have devoted themselves to the care of the insane, and among others to our former teacher and respected friend dr. conolly, from whose clinical visits and lectures at the hanwell asylum, many years ago, we derived our first lessons, in the management and treatment of the insane. but although regretting some divergence of opinion on this point, we are confident of his readiness to subscribe to that maxim of a liberal philosophy, expressed by the latin poet, "_nullius addictus jurare in verba magistri_." to return from this digression: there are two propositions to be established, viz.-- . that there are many cases of chronic mental disorder to be found in every county asylum, which encumber it, to the prejudice and exclusion of recent cases, and which could, without mental pain or damage, or any tangible disadvantage, be removed from the institution considered as a curative one. . that less elaborate structural adaptations, and a less expensive organization, would suffice for the proper care and treatment of a large number of chronic cases. let it be understood, however, that neither in past nor future remarks is it our intention to argue against the existence of mixed asylums altogether,--for by careful classification in a moderately-sized establishment, a zealous physician, properly assisted, may contrive to do his duty, both towards the comparatively few acute, and the many chronic cases under his charge; but against the pretence of admitting recent patients for curative treatment in monster institutions filled with chronic cases, where individual daily recognition is all but impracticable, efficient medical supervision unattainable, and proper medical and moral treatment impossible. deferring for the present the inquiry, under what conditions of the insane population of a county should distinct asylums be constructed, let us see what are the views of the lunacy board bearing upon the two propositions put forth, and examine further into the means of providing for the future wants of the insane. so long since as , the then metropolitan commissioners in lunacy advised the institution of distinct asylums for the more chronic cases of insanity (report, p. ), and thus expressed themselves:--"it seems absolutely necessary that distinct places of refuge should be provided for lunatic patients who have become incurable. the great expenses of a lunatic hospital are unnecessary for incurable patients: the medical staff, the number of attendants, the minute classification, and the other requisites of a hospital for the cure of disease, are not required to the same extent. an establishment, therefore, upon a much less expensive scale would be sufficient." an exception might be taken to the wording of this paragraph, as assumptive of incurability being an absolute condition, and as countenancing the scheme of a refuge distinctly provided for incurables; both of them ideas repugnant to the humane mind, instructed by experience, that insanity, at almost any lapse of time, and under most forms, is not to be pronounced absolutely incurable, or beyond the hope of cure. the scope of the argument adduced can, however, not be objected to, for it will be generally admitted that less expensive institutions are needed for very chronic cases in general, and that it is an important object to clear the present curative asylums of such cases, so as to facilitate the admission and the early treatment of recent patients. the present lunacy board, in their tenth report, , repeated these views, and pointed out the importance of erecting detached buildings in connexion with the offices used for the different occupations pursued in the establishment, instead of adding new stories, or new wings, to the main building. in the report for the following year ( ), the commissioners returned to the subject, in connexion with the proposed enlargement of the middlesex county asylums; and, having remarked on the rapid accumulation and crowding of those refuges with chronic cases, so soon after that at colney hatch was opened, thus write (p. ):--"manifestly the remedy now was, not to exaggerate the mistake already committed, by additions on the same costly scale for purposes to which they would be as inappropriate; but, by a fresh classification and redistribution of the patients, not only to deal with existing evils, universally admitted, but to guard against a recurrence of evils exactly similar, by restoring to both asylums their proper functions of treatment and care. it had become not more matter of justice to the lunatics themselves, than of consideration for the rate-payers, to urge, that the additional accommodation required being for classes of patients, as to whom, for the most part, small hope of cure remained, might be supplied in an asylum much better suited to them, and of a far less costly character." at a subsequent page (p. ), they recur to the theme. after pointing out that the plan of placing chronic, and presumed harmless patients taken out of asylums, in workhouses and "in their private homes," had signally failed, they observe:--"we are, therefore, brought back to the conclusion already stated ..., to which we find all reasoning upon the subject necessarily converge, and which we desire to impress as strongly as possible upon every one to whom the care of the insane is committed, that a new, and less costly kind of provision is now very generally required for large classes of pauper lunatics, to whom the existing expensive structures are unsuited. "our last report directed attention to the fact, that in providing, not merely for the harmless and demented, but for the more orderly and convalescing, the most suitable was also the least expensive mode; that they might satisfactorily be placed in buildings more simple in character, and far more economically constructed; and that therefore it was advisable, wherever the necessity for enlarging one of the existing asylums presented itself, that the question should be considered in reference to these two kinds of patients. and whether the mode adopted may be, for the convalescing, by simple and cheerful apartments detached from the main building, and with opportunity for association with the officials engaged in industrial pursuits; or, for harmless and chronic cases, by auxiliary rooms near the out-buildings, of plain or ordinary structure, without wide corridors or extensive airing-court walls, and simply warmed and ventilated; it is, we think, become manifest that some such changes of structure must be substituted for the system now pursued, if it be desired to retain the present buildings in their efficiency, and to justify the outlay upon them by their continued employment as really curative establishments. in this way only, as it seems to us, can justice be done to the rate-payer as well as to the pauper." lastly, in their supplementary report on lunatics in workhouses ( ), they repeat their recommendations to erect distinct inexpensive buildings for chronic cases. the paragraph containing their suggestion has already been quoted (p. ), and need not be repeated here. the noble chairman of the lunacy board, according to his valuable evidence given before the special committee of lunatics, just printed, appears to have been an early and constant advocate for constructing distinct receptacles for chronic and acute cases. in reply to query, no. , his lordship has more particularly enlarged upon the utility of the plan, and referred to the distinct proposition of the board in , that it should be carried out by the committees of asylums. the scheme of separately providing for many chronic lunatics has also received the valued support of dr. boyd (seventh report, somerset asylum, p. ), who appears to contemplate the erection of the proposed building contiguous to the existing asylum, so as to make use of the patients' labour "in preparing stone and lime, and in doing all the heavy part of the work," and to unite the two establishments under a common administration and commissariat, as a plan attended with considerable economical advantages. we do not deem it necessary to quote other authorities at large, in support of the system advocated; otherwise we might adduce many continental writers, especially among the germans. it is fair to add, however, that in france generally "mixed asylums" are the rule, and that a few of these contain five or six hundred inmates, but none, we are happy to say, have acquired the prodigious dimensions of several of our english asylums. moreover, the french system is to erect a number of detached buildings, or sections within the general area of the establishment, adapted to the different classes of the insane, according to the character of their disease, or to their condition as pensioners or paupers. we cannot here discuss the advantages or disadvantages of this plan, but it certainly obviates some of the evils of aggregation evidenced in english asylums, consisting of one continuous structure. it has just been said, that in no french asylum are so many lunatics congregated as in some english institutions; yet it is true, that the great parisian hospices contain similar numbers; for instance, la salpêtrière holds as many as ; but in this case the arrangement is such, that each of the five sections it is divided into, constitutes practically a distinct hospital for the insane, structurally separated, or quite detached; with subordinate quarters or sections, to provide for a proper classification of the inmates, and having its own grounds for exercise, &c., and its own medical staff. thus, to the patients there are five physicians, having equal power and privileges, each one the head of his own section. we would not in any way adduce this extensive parisian hospice as an example to follow, either in structure or organization; and have alluded to it in so many words only to show, that though equally large in its population, it is comparable in no other respect to the huge receptacles for the insane to be found in this country. of the prevailing system in germany we shall presently find occasion to speak. lastly, the th & th vict. cap. , gave express powers to provide for the chronic insane in distinct establishments; in order, according to the marginal abstract to sect. xxvii., "to prevent exclusion from asylums of curable lunatics; separate provision to be made for chronic lunatics." the chronic asylums were again referred to in sect. xlii. and in sect. lvi., which conferred the necessary powers on the visitors to remove the patients from one asylum to another. it is not worth while to repeat the clauses referred to, since the act was repealed by the th & th vict. cap. , and no re-enactment of them took place. nevertheless, it is to be observed, that the last quoted act contemplated the provision of asylum accommodation for the whole of the lunatics of each county, and with this object, by sect. xxx., empowered the justices, at any general or quarter sessions, to cause, or to direct the committee of visitors of the county asylum to erect an additional asylum, or to enlarge the existing building, to supply the requisite accommodation; and further, put it into the power of a secretary of state, "upon the report of the commissioners in lunacy," to call upon the magistrates of any county or borough to do the same. this enactment may be enforced by the lunacy board so far as the secretary of state can prevail with a body of magistrates to accede to it, "in such manner as the said secretary of state may see fit, and direct." but this high official has no direct power to compel a committee of visitors under any sort of penalty. "it shall be lawful for such secretary of state," says the clause, "to require" such additional asylum alteration or enlargement; but the history of the contest between that public officer and the middlesex 'committee of visitors' appears to prove that his requisition may be neglected and set aside. "he found" (as lord shaftesbury tells us in his evidence, rep. select comm., query, no. ), "that the passive resistance offered was beyond his power." we coincide with his lordship, that this ought never to have happened, and think, that the secretary of state, acting under the representations and advice of the lunacy commissioners, ought to be armed with full powers to enforce the provision for pauper lunatics in asylums being rendered equal to the demand for it, according to some plan agreed to by them, in every county, in harmony with the true intent and purpose of the act now in force. in order to facilitate the carrying out of this design, and to limit the scope for the passive resistance and attempted delay of some county magistrates, the re-enactment of the sections of the th & th vict. sect. , as quoted, appears desirable, viz. to sanction and promote the erection of distinct retreats for chronic cases. we are, indeed, glad to find, that in this recommendation we are also in accord with the noble lord at the head of the lunacy commission. looking at the matter in a general point of view, therefore, we appear to find, in the plan of separating the more chronic and most unpromising cases of lunacy from the recent and hopeful, so as to leave these in smaller numbers for the purpose of more direct and effectual treatment, one mode of improving and extending the future provision of the insane. however, to elucidate the scheme, we need go into further detail, so as to define more particularly the classes to be separately accommodated, and the extent to which the separation should be carried. the grand distinction, above employed, in discussing the question of separation, has been that of recent and chronic cases, and it has been sought to ignore that of curable and incurable, as not only undesirable, but actually mischievous. by recent cases, we understand all those where the malady is of less than one year's duration, which form a class that demands the more active and constant attention and treatment of the physician, more purely medical care, more consideration and watching from the attendants, ampler measures for moral treatment, and for exercising salutary impressions on the mind; and withal, special arrangements and fittings in the asylum building itself. all these particular conditions for treatment and management are not to be obtained by recent cases of insanity, as we have insisted on throughout this chapter, in asylums which have grown beyond the size which a chief medical officer can personally supervise in all its details, and, so to speak, animate the whole machine. if this be admitted, and if the cure of the insane be treated as the primary and essential object of asylum detention, then surely the necessity of special provision for recent cases will be recognized. in moderately sized asylums acute and chronic cases may be, as said before, received and treated together; for instance, in such as accommodate from to patients, provided that the physician-superintendent is properly assisted, for the proportion returned "as deemed curable" in the english county asylums,--a proportion which represents pretty nearly that of the recent cases, rarely exceeding or per cent.; consequently, the or demanding special supervision and medical care may be undertaken by the superintendent, if he be sufficiently assisted in the management of the chronic cases and in the carrying out of the general details of the establishment. on the other hand, a small, and perfectly distinct asylum for or patients could not be established or conducted so advantageously, and still less so economically; a circumstance, which will always avail to perpetuate the system of mixed asylums for acute and chronic cases together. nevertheless, it must be borne in mind, that the or patients in the population of or , do not constitute the whole number of recently attacked cases which may be admitted for treatment, but, so to say, the residue at a particular date; for instance, the first day of the year. moreover, if the improvements in the law, and in its administration, suggested, are carried out, and the admission of patients immediately on the occurrence of their malady be facilitated, then, as a matter of course, the proportion of those "deemed curable" would be immensely increased; so much so, that it would be a very moderate estimate to reckon on recent, to every chronic cases; or, what is equivalent to this statement, the plan of placing patients under immediate treatment would cause the progressive decrease of chronic cases, and raise the standard of the asylum as a curative institution; a happy result, which, whilst it would necessitate a more complete medical staff, would at the same time well repay its cost. passing now to asylums which exceed the limits assigned as falling within the compass of the abilities of any physician to superintend effectually for the greatest benefit to its inmates, we hold the opinion, that where these amount to or , the most just and humane, and in the end the most economical policy, is, to divide the establishment. yet even here, according to the present system regulating admissions, and the natural consequence of this, the small per-centage of acute cases under care at any one time, viz. from about to per cent. in the whole population, would perhaps be held to furnish too small a number to justify the cost of erection and maintenance of a wholly distinct hospital for their treatment. still we are confident that, if in any county where the pauper lunatics in asylums attained the number mentioned, a distinct institution for the reception of recently afflicted persons were erected, and the admission of such patients were promoted, if that institution were free as a public one for the insane other than paupers, such as those from among the middle classes, unable to meet the costs of a proper private asylum--it would secure to itself the number of patients needed to warrant its establishment as a distinct institution, succeed even as an economical arrangement, and confer an immense boon both on pauper lunatics and their more unfortunate fellows in affliction, who are too rich for the "pauper," and too poor for the "private" asylum. lastly, we come to the consideration of those overgrown establishments where from to lunatics are congregated under one roof. such monstrosities ought never to have been constructed; they are nevertheless looked upon by their promoters with admiration, and spoken of with pride, though there is nothing in them to admire besides their magnitude and pseudo-military discipline, and no more in them to be proud of as county institutions than in enormous prisons; for as the latter indicate the neglected morality of the county, so do the vauntedly large asylums prove the neglected treatment of insanity. however, as the erection of these unmanageable structures is an accomplished fact, nothing is left than to deplore the fatal mistake; to take care that it is not repeated in other instances, and to insist on the construction of distinct hospitals for recent cases. the very existence of such an hospital would invite resort to it, and bring within its agency many cases which do not find their way into the existing institutions until, most probably, all hope of cure is well nigh gone. moreover, just as mentioned above in reference to a proposed county hospital for lunatics, the law should intervene to secure the early transmission of all cases for treatment, and admission be granted to others besides paupers, under certain stipulations, by the payment of more or less of their cost. in counties with a population of lunatics of the extent named, the difficulty of placing the chronic and recent cases of insanity in separate asylums vanishes; for the latter will always be forthcoming in sufficient number to justify a distinct institution for their treatment both on medical and economical grounds; and the former, we apprehend, will always be found numerous enough to occupy the accommodation provided. as refuges for old cases, the evils of the existing gigantic establishments would happily be mitigated, although not removed, by appropriating them solely to the use of long-standing cases of lunacy. where the construction of a distinct hospital for recent cases of lunacy is decided on as necessary, it should certainly accommodate not more than . all patients should be admitted whose disease is of less than one year's duration; but this limitation should not be so absolute as to prevent the physician to admit, after the lapse of a longer period, any cases which might appear to him amenable to successful treatment;--a point in prognosis, taught, and only taught, by experience in dealing with recent insanity. although the great majority of the insane who recover, do so within the first year of their attack, yet statistics show that about per cent. are restored in the course of the second year of treatment; it would therefore seem that two years would constitute a fair and sufficient period for the duration of residence in the primary asylum. here again the knowledge and experience of the physicians must be allowed scope, both to discharge certain cases within the period named, and to retain others beyond it. we should not consider it expedient to reject all cases of epilepsy and general paralysis forthwith upon their application, although insanity so complicated is generally very hopeless; for an asylum with special appliances for treatment would at least be desirable to the victims of those sad maladies in their early stages. it is unnecessary to define the classes of lunatics who would occupy the secondary asylums. as said before, we do not contemplate these institutions as mere places of refuge; we do not consider the attempt and the hope of cure relinquished in their wards, but that the means of treatment are diligently persevered with. we would have them to be neither hopeless retreats for patients, nor institutions calculated to encourage supineness or apathy on the part of their medical officers. indeed a slender objection we have met with against the separation of the recent from chronic patients, involves a slur upon the medical profession in supposing a lack of interest and energy as incumbent upon the superintendent of an asylum for chronic lunatics;--a supposition, which reflects unfairly upon, and is untrue with respect to many superintendents of asylums actually in existence. are not interest and zeal, we may ask, exercised for the benefit of those deemed incurable; are they not exercised on account of idiots even, for whom their absence might be esteemed not surprising? if cure is not attainable, the physician to the insane, unless unfit for his calling, seeks and finds his reward in ameliorating their condition; in elevating their mental and moral, and in improving their physical being. in those counties in which the number of the insane and the prevalence of insanity are not sufficiently extended as to justify the institution of a distinct curative asylum, the plan of the union of counties, as followed for the provision of the ordinary asylums, suggests itself to the mind. practically, however, we believe, it is a plan which would not answer, since it would render arrangements between counties in possession of asylums difficult, and their accounts complicated. the only way in which it could be made feasible would be by the levying of a general rate throughout the country for the maintenance of lunatics, and by dividing the country into districts, as is the practice in scotland and ireland, apportioned in size to the population, to each of which an asylum for chronic, and one for recent cases of insanity, might be assigned. such a scheme of a general rate, however, we do not expect to see realized, although many arguments are adducible in support of it. sir charles wood, when chancellor of the exchequer, made the proposition to contribute on behalf of the maintenance of asylums a portion of the proceeds of the general taxation of the country; but the scheme met with little favour, and was dropped. the principal objections advanced against it were, that it was wrong in principle, a novel and uncalled for attempt to interfere with local government, and no more to be justified than would be a contribution from the revenue of the country towards providing for the relief of any other form of disease. respecting the last objection, it is worth noting, that district dispensaries throughout ireland are partially supported by parliamentary grants; surely, therefore, if the principle of subsidizing hospitals or dispensaries is admitted in one part of the united kingdom, there can be nothing unreasonable in a proposition to extend it to another. where to provide for the lunatic population of a county considerably exceeds the legitimate dimensions of a single asylum, and yet the proportion of recent cases is too small to warrant the construction of a distinct institution for them, we have proposed the establishment of two asylums, each of a mixed character. under such circumstances, and likewise where a single asylum threatens to outgrow a manageable size, there are certain very advantageous arrangements to be made, adapted to secure much more efficient treatment, particularly of recent cases, than is usually provided under the present system of aggregating all under one roof to be subjected to one course of routine and discipline. these arrangements are effected by the § _construction of distinct sections to asylums._ the french system of asylum construction, as before noticed, is to divide the building into several, more or less, sometimes quite distinct sections, having a general administration and offices in common. the number of sections and the character of their residents is a matter of medical classification, and in each one there is a mixture of acute and chronic cases, just as in our asylum wards; the combination being regulated by the similarity in the phases of their malady, as, for instance, if refractory; if epileptic; if clean and orderly; or demented, paralytic and dirty. in germany, on the contrary, although this same medical classification is carried out, there is a primary separation of the insane of the province or state into acute and chronic. but in the mode of providing for the treatment of the two classes apart, two plans are pursued, one termed that of "absolute separation," and the other of "relative connexion" (relativ verbindung); the former consists in placing recent and chronic cases in buildings completely detached; each one having its own staff, organization and management; the latter, whilst keeping the chronic and recent cases apart, possesses a common medical and general administration in a building composed of two principal sections, either forming parts of the same structure (as at illenau, in baden), or detached, but within the same area (as at halle, in saxon prussia). damerow is the most able advocate of the system of relative connexion, on which he has largely written, and it is one which appears to be gaining ground in germany. now, except in the case of the overgrown middlesex asylums, where the lunacy commissioners distinctly recommended a third asylum to be erected, the plans propounded by that board for affording additional accommodation in institutions already large enough, are in principle much that of the "relative connexion" system as proposed by the germans. the reports above quoted, in connexion with the question of separating recent from chronic cases, show generally what the plans of the commissioners are. they would erect "detached day-rooms and associated dormitories near the wash-houses on the women's side, and the workshops and farm-buildings on the men's side." ( th report, , p. .) to prove the advantages of the plan, they go on to say, "in making our visitations to the larger county asylums, we have repeatedly observed that a considerable portion of time is occupied by the servants, who have charge of the wash-house and workshop department, in merely collecting the patients in the wards, and in conducting them to and from their respective places of employment. in one asylum, we ascertained by minute inquiries that not less than one hour and a half was thus every day wasted by the servants, and was passed unprofitably and unpleasantly by the patients themselves. "in addition to the saving of cost and time obtained by adopting the plan we now recommend, we have the best reason for believing that the patients derived a direct benefit, in many ways, from residing in cheerful airy apartments detached from the main building, and associated with officials engaged in conducting industrial pursuits. a consciousness that he is useful, and thought worthy of confidence, is necessarily induced in the mind of every patient, by removal from the ordinary wards, where certain restrictions are enforced, into a department where he enjoys a comparative degree of freedom; and this necessarily promotes self-respect and self-control, and proves highly salutary in forwarding the patient's restoration. as a means of treatment, we consider this species of separate residence of the utmost importance, constituting in fact a probationary system for patients who are convalescing; giving them greater liberty of action, extended exercise, with facilities for occupation; and thus generating self-confidence, and becoming not only excellent tests of the sanity of the patient, but operating powerfully to promote a satisfactory cure. "the want of such an intermediate place of residence is always much felt; and it often happens, that a patient just recovered from an attack of insanity, and sent into the world direct from a large asylum, is found so unprepared to meet the trials he has to undergo, by any previous use of his mental faculties, that he soon relapses, and is under the necessity of being again returned within its walls." (p. , rep. .) the proposition of the commissioners has been carried out to a certain extent in several large asylums; for instance, at the leicester, the wakefield, and the devon. at the last it has been most fully developed in the construction of a detached building for patients; respecting the excellence and cheapness of which, we have spoken in a previous page (p. ). the views of the commissioners will meet with general approval. the prevalent system in france of breaking up an asylum into sections, more or less detached, we hold as preferable to the close aggregation of wards under one roof, with continuous corridors, seen in the majority of english asylums. the correct principle to be pursued in an asylum is, to assimilate its character and arrangements as far as possible to those of the homes of the classes of persons detained in them. can this be effected in a large building constructed as much unlike ordinary houses as it well can be; recalling in its general character that of an extensive factory, workhouse, or barrack, of somewhat more ornate architecture indeed, and with better "belongings" within and without, where the patients live by day in long corridors, and sleep by night in boxes opening out of the same, and where perhaps they are mustered and marched in great force into a great hall to eat their meals? certainly all this is not home-like, however excellent to the lovers of routine or the admirers of military discipline. but the separation into sections greatly lessens this objectionable state of things; the population becomes thereby divided, so to speak, into families, overlooked and controllable as such. the advantage of transferring an improving patient from one ward to another is considerable; but it would be much more so, if the transfer were from one section to another; for the construction of separate sections admits of the architectural arrangements, the fittings, &c., being varied to a much greater extent than they can be in the case of wards, forming mere apartments of one large building, constructed, as it must be, on a nearly uniform plan. from the same grounds likewise follow the economical advantages of distinct sections; for the more expensive building arrangements required for acute cases need not be repeated in the section for quiet, orderly, chronic, or for convalescent patients, where accommodation may be beneficially made to accord as nearly as possible with that of their cottage homes. if detached sections were adopted, the elaborate, complicated and costly systems of warming and ventilation would not be needed; there would be less to cherish the feeling of imprisonment; and, lastly, to recal the valuable observation of the commissioners before quoted (p. ), this species of separate residence would be a means of treatment "of the utmost importance, constituting in fact a probationary system," and a most excellent addition to the means of 'moral treatment' now in operation. there is one subsidiary recommendation made by the lunacy commissioners, which we cannot so freely subscribe to, that, viz. of classifying the patients in sections according to their occupations. those of the same trade or employment must, as a matter of course, be associated together, during the hours of labour; but at the expiration of those hours we would wish to see that association broken up. the congregation of the same mentally disordered persons always together is not desirable; the insane are selfish enough--absorbed in self, from the effects of their malady; and it should always be a point in treatment, to disturb this condition, to arouse the attention to others, and to other things; an effort which would be the more difficult in a small knot of people always accustomed to meet together, knowing each other's ways and whims, and each thinking the other mad, though not himself. again, if the workers are entirely separated from the drones in the hive, the latter are likely to remain drones still: they lose the benefit of example, which operates, as among children, so strongly with the insane. to apply these observations to one class of workers, for example, to the laundresses: it seems to us scarcely merciful to keep these poor patients to the wash-tub all day; at the close of their labour to turn them into an adjoining room, and at night consign them to sleep over it. instead of being thus scarcely allowed to escape the sphere and atmosphere of their toil, they should have their condition varied as far as possible, be brought into new scenes, mixed with others who have been otherwise engaged, and made to feel themselves patients in an asylum, and not washer-women. is it, in short, not a radical error in the direction of an asylum, to place the inmates in such a position and under such circumstances, as to make them feel themselves workmen under compulsion, regularly employed, dealt with only as labourers and artisans, by being kept all day in their workshops, and in the evening and night brought together, because they are workers, and unlike the other residents of the asylum, who will in their opinion come to be regarded, as unlike themselves,--as the fitting occupants, and the only patients? treated apart in the manner under notice, there would be nothing in the position or circumstances around the industrious inmate to suggest to him that he was a patient, except in name, as called so by the officials. we are, therefore, opposed to this _industrial system_ of classification, and regard medical classification as the only proper one. the division into quarters or sections is a plan more applicable to an asylum for chronic than to one for acute cases. in the latter, patients are to be treated specially and individually; and as sufferers from acute disease must be classified medically rather than with reference to any matters of management, occupation, and discipline, and are on the whole less conformable to general orders and plans: yet certain principal sections are wanted in them; as, for example, for the refractory and violent, for the quiet and orderly, and the convalescent. to some of the last named, a separate section, of a home-like character, regulated less as an asylum than as a family residence, and where the highest amount of liberty compatible with safety and order is the rule, would afford a most valuable means of treatment. § _distribution of the chronic insane in cottage homes._ the subdivision of an asylum for chronic cases could be carried very far. not only might sections be appropriated specially to idiots, to epileptics, to imbeciles, and to the very aged and infirm in an infirmary, but also to several classes of the chronic insane not falling under either of those categories, distinguishable by the greater or less amount of trust to be reposed in them, by their dispositions and tendencies, and by their industrious and moral habits. however, there must be at some point a limit to the utility of subdividing an establishment necessitated by the requirements of its administration and of an effective and easy supervision; and as yet, in this country, the system of aggregation prevails most largely over that of segregation. english asylums have, some of them, detached wards and a few farm-buildings, affording lodging to patients engaged in industrial pursuits; but the plan of segregating their residents has not been pushed farther, except to a small extent by dr. bucknill, who has placed some selected pauper lunatics in the homes of cottagers living in the vicinity of the county asylum; for we cannot call the boarding out of the imbecile poor--scattered, as it were, broad-cast over the country, disposed of in cottages, according to the notions of the inferior parochial officers, and watched over only nominally,--a system of providing for them. if system at all, it is merely one for putting them out of the way, of escaping responsibility, and of hiding them from observation. the colony of insane at gheel, in belgium, is the only one where the segregation of the insane has been systematically carried out. it presents most of the elements of success in its constitution and government. it has an organized medical staff; it is a naturally secluded locality; its sane inhabitants have been for ages accustomed to act as the guardians and nurses of the insane, and to receive them as boarders into their families. yet, notwithstanding the eulogiums of many visitors to this village, others who have more minutely examined into it have detected many irregularities, and pointed out weighty objections against its management. the questions may be fairly put,--are the irregularities inevitable? are the objections inseparable from the system? to discuss these points in detail would carry us far beyond the limits we must observe; but we may express our belief in the value of the system, considered as such, although we do not see how or where it can be applied to a similar extent as found at gheel. the irregularities which have been remarked are remediable, and the objections generally removeable. it is a defect at gheel, that there is no central establishment of the character of an asylum and infirmary, and it is a mistake to undertake the charge of recent and violent cases, and of epileptics for the most part, and likewise of paralytics, in cottages under cottagers' supervision only. other classes of patients might be pointed out as unfit residents in peasants' families. the system, in short, is pushed to an extreme in this place; but this error does not invalidate it as a system. objectionable cases for the cottage home could be collected in a central establishment, and there would be plenty left to partake of the "air libre et la vie de famille," which a recent physician of the colony of gheel, m. parigot, commended in his _brochure_ addressed to the consideration of the friends of the insane. many who have become acquainted with the system pursued at gheel have been enraptured by its many apparent advantages, the liberty it affords, and the great cheapness of its management, and have wished to import it as a whole into this country. such a scheme we regard as both impracticable and undesirable; yet we at the same time believe something may be attempted in the same direction most beneficially (see p. ). the attempt should first be made in connexion with some of our county asylums of a moderate size. a similar secluded district as that of the commune of gheel is, thanks to providence, not to be found perhaps in england; but this is of no such primary importance: a moderate distance from considerable towns, or from large villages, is all that is strictly requisite, and several asylums are so situated. the difficulty of place being encountered, a more serious one appears, viz. that of finding suitable cottagers to undertake the charge of patients. at first, a suitable class could not be reckoned on; but, according to the laws of supply and demand, it would only require time to form such a class. sufficient inducements only are wanting, and probably those supplied would be found so. it is an advantage to a cottager to have a constant lodger, to receive a certain weekly payment; and it would constitute a greater one to have as an inmate one who could assist in certain labours of the house and garden. we might hope to see old attendants of the asylum settled around, after retirement from their employment, with a pension; and to the care of such two or three, or even more, selected patients might be entrusted. if the land belonging to the asylum were of sufficient extent, the patients boarding around might still be employed upon it; or, if they were artisans, they might daily resort to its workshops, its bakehouse or brewhouse, just as the ordinary peasant labourer goes to and fro to his place of employment. the asylum would thus still reap the benefit of the patients' labour, and this arrangement, we believe, would work better than one providing for their employment with strangers at a distance from the institution. by limiting the area inhabited by patients in lodgings to that immediately surrounding the asylum, a satisfactory supervision could be exercised by the authorities; and on the occurrence of illness, or a change in the mental condition, a transfer to the asylum could be speedily accomplished. again, by keeping the insane within a moderate range of the asylum, and by retaining them as labourers on its grounds, the advantages of a central general administration would be found in the provision and distribution of food and clothing. in previous pages we have advocated, under certain conditions, the erection of distinct asylums for chronic cases of insanity; to this plan the system just developed, of boarding out a certain number in cottages, must be held as supplementary. a chronic, or a moderate, manageable-sized, mixed asylum must form the nucleus of the 'cottage system' of providing for the insane. the cases must be selected from the asylum-residents, and the selection be left with the medical superintendent. the persons receiving patients must be held responsible to the superintendent, and to the members of the lunacy board, for their proper care and management, and they must enter into some sort of covenant with the visitors of the asylum. to carry out the scheme under notice, many matters of detail are required, but these it would be out of place here to enter upon. there is this evident general and economical advantage about this 'cottage system,' that it would obviate the necessity of constructing large asylums for chronic lunatics at an inevitably heavy outlay, and also of instituting so large a staff of officers and servants as is called for to govern and conduct an expensive special establishment. in country districts, agricultural labourers and other small householders might be found willing to board, lodge, and look after patients for or shillings per week each; or, according to the plan we prefer, the asylum would provide board, and receive the benefit of the patients' labour, and only some small sum would be payable for his lodging and care. having only in view at the time the amelioration of the present condition of the insane boarded out with friends or strangers, we have proposed in a preceding page (p. ), their frequent supervision, and the arrangements necessary to their welfare, being entrusted to a distinct medical officer under the central control of the lunacy board. this plan would still hold good with reference to all those lunatics not living within the fixed radius around the asylum; within which the superintendent would be the directing authority, the supervisor and protector. moreover, as we have remarked (p. ), residence with their immediate relatives would be frequently preferable to their severance from them in order to be brought within the sphere of the asylum; and such patients would derive benefit from the inspection proposed. § _separate provision for epileptics and idiots._ the extent to which the separation of epileptics and idiots, but more particularly of the former, from other classes of mentally disordered persons should be carried, is a matter much discussed. the rule is to have epileptic wards in large asylums, although there are some epileptics in whom violence and dementia are such prominent features, as to justify their position severally with the refractory or with the demented. however, the painful features of their malady, the special provisions needed in the apartments occupied by epileptics, and the precautionary measures to be observed in their clothing and food, the ill effects of the sight of their paroxysms upon others, and other reasons well known to medical men, constitute sufficient grounds for the ordinary practice pursued of keeping epileptic lunatics generally in particular wards. this plan answers well in moderately-sized asylums; where their number is considerable, as in large establishments, we should prefer their location in a distinct section; and if the county possessed one asylum for recent, and another for chronic cases, the majority of the epileptics should be residents in a section of the latter. of the great value of separate provision for idiots we think there can be no doubt. indeed, the association of idiots with lunatics is an accident of legal origin rather than a proceeding dictated by science and medicine. the law places together idiots and lunatics under similar protection, and treats them as nearly in the same position socially. hence it has come to pass that their legal claim to care and protection has brought them within the walls of the county asylums. their presence there, however, we regard as a mistake prejudicial to their own welfare and an onus upon the asylum authorities. of old, all that was considered necessary for idiots, was to provide food and lodging for them, and to keep them out of harm's way. but, thanks to modern philanthropy, the prospects of the idiot are much improved; the amelioration of his condition is attempted; his moral, mental and physical powers are found to be improveable, and it is sought to elevate his status as a social being, and to foster his capacity for amusement and for useful employment. contrasted with previous neglect, the care and management afforded in an asylum render the poor idiots an infinite service; yet withal a lunatic asylum is not the proper abode for them. within its walls they are unfit associates for the rest of the inmates, and it is therefore felt to be necessary to place them in a special ward. too frequently this ward is in the worst placed and most forgotten section of the building, sometimes with little open space about it, and devoid of those conditions calculated to evolve the little cerebral power possessed. whatever their claims upon the attention of the medical superintendent, and however zealous he may be to discharge all his duties, yet amidst the multifarious occupations pressing upon him, and specially occupied as he is in treating insanity, that officer finds himself unable to do more than watch over the health of the idiotic inmates, and attend to the improvement of their habits: he is not in a position, and has not the opportunities to superintend the education of idiots; and we are certain that every asylum-physician would rejoice, both for his own sake and for the interests of the idiots themselves, to see them removed to a special institution, or to a section of the asylum specially organized for their care. not only are idiots in the way in a lunatic asylum, and their ward an excrescence upon it, but the organization and arrangements are not adapted for them. idiots require a schoolmaster as much as a doctor; the latter can see that all those means are provided for them to improve their habits and their physical condition; but it must devolve on a patient instructor to operate more immediately upon the relic of mental power which is accorded to them. the sooner they are brought under the teacher's care the better: experience shows that much more may be effected with idiots during their childhood than when they have arrived at a more mature age, and the developmental changes in the brain have so far ceased, that an increased production of nervous power can be scarcely looked for. this is a theme we cannot further enter upon; and to conclude this section, we may remark, that the number of idiots is so large as to justify the erection of several distinct institutions for their care and improvement. several counties might unite in the establishment of an idiot asylum, the parishes being charged for the number belonging to them in it; an arrangement, which would no more complicate parochial accounts, than where one charge has to be met (as often is the case at present) for the maintenance of a certain number of lunatics in the county asylum; a second for that of another portion in a licensed house; and a third for some others in the workhouse wards. there is another matter worth noting. the county asylums for the most part being filled to the exclusion of recent cases of insanity, and the condition of idiots being held in still less importance than that of the insane by workhouse authorities, it is not to be wondered at that, on the one hand, the admission of idiots into asylums is not promoted, and that, on the other, so many idiotic paupers are found in workhouses. to provide, therefore, cheaply for idiots in distinct institutions, and to facilitate and enforce their transfer to them, will be a means of ridding union-houses of a portion of their inmates, for which they are so entirely unfitted. to the genuine philanthropist and the truly humane, no hesitation would arise as to securing every necessary provision, and the best means for ameliorating the fate of any sufferers, and particularly that of the poor helpless idiots. but to the majority of mankind the question of cost is preliminary to the exercise of philanthropy; and some perhaps think it enough to feed and clothe, to watch and keep clean the miserable drivelling idiot, since all the money that could be spent upon one would only produce after all a poor, weak-minded creature, of little or no service in the world. this argument cannot be gain-said, though it must be condemned by every christian animated by the leading principle of his religion, that of "love." to the sticklers for economy, the proposition may be propounded for consideration, whether, on the adoption of the plan of erecting distinct asylums for the chronic insane, the idiots could be less expensively provided for in a section or "quarter" of such an asylum, properly furnished with the means of improving their condition, than in an establishment reared specially for the purpose? we content ourselves with putting the question. chap. viii.--registration of lunatics. we are fain to look upon a complete registration as a remedy to many admitted evils affecting the welfare of lunatics, and we may add, of idiots also. lunacy may be regarded as a form of "civil death;" it deprives its sufferer of his rights as a citizen; subjects him to the loss or restriction of liberty; disqualifies him from many civil privileges, and invalidates his powers of dealing with property and of executing legal documents. yet not unfrequently are lunatics, particularly among the more wealthy classes, placed under the penalties of their condition without the knowledge and authority of the officers of the state, by whom alone can such penalties be legally enforced. an individual, we say, is often deprived of his liberty and of the control over his affairs, at the hands of relatives or friends, and often indeed transferred to the house of a stranger, and there subjected to surveillance and repression; and all this done against his will, and, what is more, against the principles of english law and english freedom. elaborate provision is made and still further attempted to prevent the unnecessary detention of persons in asylums, whose cases have been regularly reported to the public authorities; but no steps have as yet been taken to discover unreported cases of alleged lunacy or private cases treated singly; no enactment contrived to bring within the knowledge of any government-board the number of persons, year by year attacked with insanity, and thereby, for a longer or shorter period, disqualified from the exercise of their civil rights. to our mind, this state of things proves a grievous defect in the law of lunacy. every person has an inherent right to the protection of the law; yet practically, if insane, he does not at all, as a matter of course, obtain it: his malady and position may very probably be unknown, and he may be helpless, or otherwise debarred from making it known. were a machinery contrived to report it to legally constituted authorities, the sufferer would have the satisfaction of feeling that he was dealt with according to law in the process of the treatment he was subjected to. were each case of lunacy systematically registered, it would, we believe, frequently save legal contests. documents dealing with property are often matters of litigation, on the plea of the insanity of the person executing them, and enormous costs are incurred on the one side to substantiate, and on the other to overthrow the plea. evidence collateral and direct is hunted up, probably years after the date of the alleged state of insanity; and often enough it comes out, or is decided by the jury, that the individual was once insane, or was so at the date of executing the document in dispute. now, in such a case, had the insanity which has been so laboriously, tediously and expensively established as having occurred, been registered in a public office at the time of its occurrence, how great would have been the gain to the feelings, the interests, and the convenience of every person concerned in the suit! if the document had been executed during the period the individual was registered as of unsound mind, the production of the register alone would have availed in proof of its invalidity. the whole litigation, indeed, might have been prevented by a search of the register before the action was begun. in the introductory chapters on the statistics of insanity, we have remarked on the very incomplete records of the prevalence of the disease, and on the consequent impossibility of discovering the actual number of the insane, and of determining the question of their increase in the community. yet it will be granted that such statistics are of great importance in a civilized country, and have bearings upon several questions in social economy. the earl of shaftesbury, in his valuable evidence before the 'select committee on lunatics' ( ), observes, in answer to query , "i think it would be very desirable if we could have proper statistics upon insanity drawn up and put upon a good footing. it would require great trouble and expense; but i think it would be worth the trouble and expense, if it could be put in the hands of some competent persons; and i have no doubt that some remarkable results would be brought out." every one, who knows how defective are the existing statistics of the disease, will cheerfully second his lordship's wish. this, however, does not go so far as our own; for lord shaftesbury appears, as far as we can judge from his words, solicitous only to take a sort of census of the insane and to deduce from it certain facts; whereas we desire not only an accurate census at present, but also a well-arranged scheme for keeping up the correctness of the statistics of the insane for the future, by making every instance of insanity returnable to the lunacy board. our desire, in short, is to bring every lunatic in the kingdom within the cognizance of the commissioners in lunacy, either directly or by some recognized agent acting in their place, so that protection and proper care may be assured to every such afflicted individual. a necessary supplementary provision to placing a name on the register would be required for removing it on certified recovery; the return of which should be made through the same channels as the report of the attack. should the registration proposed be enforced by law,--as it must be to render it at all perfect, under a penalty,--it would afford a remedy against the wide-spread plan of placing lunatics where they are unheard of, and unknown to all except those concerned in their detention. it would make the commissioners acquainted with all those very numerous patients who often drag on a painful and neglected existence in lodgings, under the control of persons of all sorts, with many of whom, it is to be apprehended, the gain to be got by their detention is the ruling motive in their actions. another advantage obtainable by a system of registration, so conducted as to ensure the reporting of cases immediately, or almost so, on their occurrence, is, that it would prepare the way for early treatment, more particularly so perhaps in the case of pauper lunatics. in the instance of the last-named class of insane, the law might render their removal to an asylum imperative, on the report of the onset of their disorder, by refusing their friends the attendance of the parochial medical officer on the patient at home as well as parochial relief, and by holding them responsible on the ground of culpable neglect for anything untoward that may happen to the patient or others. we anticipate that such an arbitrary interference of the law would be but very seldom required, for the poor mostly would be only too happy to rid themselves of a troublesome and useless member of the family. moreover, in the case of those raised above poverty and competent to provide for their insane relatives, it would be no undue stretch of legal authority to require them to satisfy some duly appointed and experienced officer, that the provisions contemplated or furnished by them for the patient were of a satisfactory character and calculated to favour recovery. the existing law, indeed, goes so far as to interfere with the friends of a lunatic and to deprive them of his care, if there be evidence to show that he is cruelly treated or neglected. it moreover imposes upon the friends all costs incurred on behalf of the patient. the section cited is _sect._ lxviii. and vict. cap. , and the suggestion we offer is but an amendment of this, so far as to require the friends of every insane person not placed in a licensed house or asylum, to show that such lunatic is properly treated and taken care of. the registration must be accompanied by visitation. the appointed medical registrar must be a witness to the fact he is called upon to register; and a case once registered should be visited at least once in three months, until recovery or death takes place, when in either case the return of the patient as a lunatic would be cancelled under a certificate to the fact supplied by the registrar. these remarks apply specially where patients are placed out singly. this plan of registration, coupled with that of visitation, would not only give security that the patient was properly treated, but would also prevent secret removals to lodgings or other uncertified receptacles for lunatics, or to a foreign country. with reference to the last-named proceeding, there ought assuredly to be some stringent legal provisions, if not to prevent it entirely, at least to place it under great restrictions. the lunacy law in its intent and administration is both stringent and minute where it deals with asylum provision for the insane in this country; but it is impotent if the friends of a lunatic choose to send him out of the country. the act cuts him off from all protection of the laws he was born under and has never forfeited. certainly it must be granted, that in every civilized country of the world lunacy laws are enacted for the protection of the insane; yet even where those laws are good, we know of no realm, and we believe there is none, where the interests of the insane are so well watched over and so adequately provided for, as in our own. this opinion we assert as the result of personal observation in most of the countries of europe, and the perusal of the reports on the state of the insane in those countries. where english lunatics are transferred to foreign public asylums--and there are many sent to such, particularly to those in france--there is often very excellent treatment and moderate state supervision; but it must be borne in mind, that the poor patients are thrust among strangers by nation, by habits, and by laws; there is no security against their being placed among the lowest classes of pensioners, who are less tenderly dealt with than our asylum paupers; and they are besides entirely at the mercy of their relatives or friends, who may as far as possible ignore their existence, prey upon their substance at home, and allow only some pittance for their maintenance in the foreign land. we are persuaded that the allusion to this defect in the laws of lunacy is sufficient to extort attention to it, and obtain its redress. the project of the law of lunacy for sardinia, which we translated for the pages of the 'journal of psychological medicine' (vol. x. p. ), contained the two following clauses:--"art. . it shall be incumbent on all individuals who shall place an insane person in a foreign asylum, to present, every thirty days, to the minister of the interior a precise report of the physical and mental condition of the patient, prepared by the physician of the asylum. art. . it shall be in the power of the minister of the interior, by previous concert with his colleague for foreign affairs, to cause any patient confined in a foreign asylum to be brought back to his own country, provided that this can be done without injury to the patient, and that he can be readily provided for in his own family, and is in possession of sufficient pecuniary means for his maintenance." some such clauses need be added to any new act of parliament for the care and treatment of lunatics in this kingdom. the commissioners in lunacy would be the right persons to move first in the matter by calling upon friends for information respecting their lunatic relatives abroad; and the foreign minister, acting upon their recommendation, would, we presume, be the proper official to arrange with the authorities abroad for the transfer of the patient to his own country. it may not be possible so to limit individual liberty as to interdict the removal of lunatics from their native country; but it is undoubtedly consonant with english law, and a matter of justice to the poor lunatic, when so dealt with by his friends as a commodity to barter about, that the legal protection due to him in his own land should be so far extended to him in a foreign state, that some public authority should be satisfied that he is duly cared for, and treated in the asylum he occupies, and has that allowance set aside for his maintenance, which his pecuniary means will justify. likewise, it would be no illegal stretch of power to call upon the friends of a lunatic, whose condition abroad was unsatisfactory, to bring him back to his native country; or, in case of their refusing to do so, to have the order carried out by others, and its costs levied upon the recusant friends. after all, however, before any such law could be effectual, the opportunities of ascertaining the existence of lunatics must be gained by the adoption of the system of registration; for, otherwise, the commissioners could derive no knowledge of the cases sent abroad, even of such as might have at one time been under their jurisdiction in licensed asylums. this remark leads us to notice another default in the lunacy code, viz. that of not enforcing a return in the case of all patients removed from asylums uncured, of the place to which they are removed. at present it is possible for the friends of a lunatic in an asylum or licensed house, to order his discharge, and to remove him where they please, to some spot unknown, if they so choose, to any but themselves. the superintendents of the asylums make a return to the lunacy commissioners that such a patient has been discharged by order of the relative or friend who authorized his admission, and that he has gone out uncured or relieved, but no information is required of the place and manner in which the lunatic is to be disposed of for the future. this circumstance is true of all cases of lunacy not found so by inquisition; that is, all except those put under the jurisdiction of the lord chancellor, or of his representatives in lunacy affairs, the masters in lunacy. for these so-called 'chancery lunatics' the sanction of the masters is required, both to the removal, to the locality, and to the persons proposed for the patient's reception. similar protection should be extended to all insane persons. the power of removal cannot be taken out of the hands of a lunatic's immediate relatives, but it may be hedged about by the restriction, that the removal of an uncured patient shall be reported to the commissioners in lunacy, who shall, after acquainting themselves with the place, the persons, and the provisions intended for the welfare of the patient, have the power to permit or to refuse it. the registration of all lunatics, particularly on the accession of their malady, is exposed to certain objections, none of which, however, are, in our opinion, of sufficient weight to militate against the plan. one great impediment to its adoption, among most persons above the condition of paupers, and in some degree among the poor also, is the desire of secrecy on the part of friends, who endeavour in every way to restrict the knowledge of their relative's mental disorder to the circle of his own family, and, if possible, to ignore its being actual insanity. on the one hand, the insanity is treated as if it brought discredit on all related to the afflicted person; and on the other, relations dread its recognition by any public authority, and set themselves in array against any inquiry which seems to trench on their private affairs. the self-same feelings and prejudices, as before shown (p. ), operate against the early and successful treatment of private patients; and as obstacles to registration they are equally to be regretted. the attempt to keep secret an attack of insanity is virtually impracticable; and though it is, in truth, a dire misfortune to both patient and family, yet is an attack of mental disorder a less discredit than one of gout, which our forefathers, in their folly, courted as a pledge of good manners and good breeding. the mischief of these notions, however, is, that they operate inimically to the interests of the patient: they stand in the way of early and appropriate treatment, and thereby tend to prolong the malady, or to render it inveterate. could the friends bring themselves boldly to face the whole truth, and admit the fact that their relative was insane, and were they encouraged by their medical man to take this true view of the matter, and to act upon it, by submitting the patient to the necessary treatment, they would very often escape the evil of exposure they dread, and soon have their relative restored to them again, instead of having, by various subterfuges, to hide his condition, and to account for his long disappearance from society and from home. besides, the hollowness of the pretences or excuses for absence must some day be found out, when the impression upon acquaintances will be the more profound, and the self-respect of the relatives suffer the wound inflicted by the exposure of the vain deception they have essayed to practise. again, the recording of the occurrence of insanity in a member of a family, which we hold to be as important to the patient and his friends as to the state, need not be regarded as an inquisitorial proceeding. it can be effected with every attention to secrecy;--the registrar would be sworn to secrecy, and the register in the central office would be a sealed book, except under certain conditions authorized by the courts of law. there is no public declaration of the fact of the insanity involved by its being recorded in the books of an office under the security of its functionaries. allowing that family prejudices and pride were of more moment than we are willing to admit, yet they should not suspend the enforcement of registration; for it must be remembered that the insane stand in a different class to patients suffering from any bodily infirmity. they forfeit by their malady the power to act in their own affairs; or their actions, if their mental disorder has been as far as possible concealed, are at any time during their life or after their death, liable to be called in question on the plea of insanity. it is undoubtedly, then, the province of the law to interpose on their behalf for the interests both of themselves and of others. the law is remiss if it permit a mentally unsound person to act on his own behalf, or others to act for him, without its sanction; and is it, we ask, consonant with english jurisprudence to detain a man against his will, in other words, to imprison him, even in his own house, and under the authority of his own immediate relatives? as soon as insanity has declared itself, so soon, we maintain, should both the person and the property of the sufferer come under the protection of the law; and this protection ought to be promptly and cheaply afforded. interference with a mentally disordered individual had better be premature than be delayed until by some actions his interests, his property, or his condition suffer. it is better for him to be found a lunatic, or, to avoid a painful and objectionable term, be adjudged to be unable properly to take care of himself and his affairs, and to be deprived for a time of liberty of action,--than that he should be treated as a sound man, and be suffered to damage his own prospects and property, and to expose himself or family to future litigation on account of his actions. when a violent or sudden death, or a suicide occurs, be it in whatever class of society it may, there is no escaping the requirement of the law, however painful be the circumstances the inquiry evokes; the coroner must hold an inquest, and the whole matter be publicly investigated before a jury. family pride and prejudice, however much they may be offended, are not allowed to stay the inquiry. why should they then be suffered to stand in the way of a simple recognition, made not through the intervention of a public court, but as secretly as possible, of a disorder, which places the sufferer in a state of social and civil death, and perhaps more seriously deranges his pecuniary affairs than even natural death itself? to repeat, the law is bound to watch over the interests of the insane, by seeing that they are properly provided for, whether in their own houses or elsewhere. no difference of opinion will occur to the proposition where the insane are placed with those who are directly or indirectly advantaged by their detention. to meet the case of such, indeed, an attempt to secure a legal recognition and protection has been made by and vict. cap. . but the same unanimity will be wanting when it is proposed to demand a return, and to sanction the supervision by public functionaries, of patients residing in their own homes: and although we have endeavoured to show good reasons why such a requirement should be made,--and the arguments could be enforced by illustrations proving that, both among rich and poor, insane persons are not satisfactorily, nay more, not even kindly treated by their own relatives,--yet lord shaftesbury stated it to be his persuasion (evid. of com. p. ) that public opinion is not ripe to introduce a new power to enter domestic establishments. nevertheless, if public opinion be not ripe for such an innovation, "it would seem (to employ sir erskine perry's query, no. , as an affirmation) that whenever a person is put under surveillance, it is not too much for the legislature to require information of that fact;" that is to say, if "domestic rights" must yet for a time be allowed to hide domestic wrongs to the helpless victims of mental disease, by denying them the protection of the law they live under, they should not avail against their being reported or registered. however, in the case of those who are obliged to seek for parochial aid, the domestic impediments to the institution of a public officer to inspect the condition of their lunatic relatives, could not be suffered to operate. now the principle of requiring a compulsory return and visitation of all insane persons confined in their own homes or in lodgings, is not new. the belgian lunacy commissioners recommended in their report on the amelioration of the lunacy laws, in , that no person should be confined in his own home, excepting after an examination by two physicians, and a certificate from them of the necessity of the restraint upon his liberty. the certificate was to be handed to the "juge de paix," who might order other visits; and if dissatisfied with the arrangements for the care and treatment of the patient, might require others to be entered into. the family medical man was likewise charged, under a penalty for non-performance, to send in a quarterly report of the state and condition of the patient. with the same object in view of obviating abuses in the domiciliary treatment of the insane, m. bonacossa, the chief physician of the turin asylum, proposed the following clause to the sardinian lunacy code:--"that, as patients are often kept in confinement in their own homes or in the houses of private persons to their detriment, it shall be made imperative on all individuals retaining an insane person in their house, to report the fact to the syndic of the commune, or to the intendant of the province." the british legislature has taken some steps in the same direction, but the fear of encroachment upon individual liberty has conspired to render its comparatively feeble attempts to provide for the due protection of single patients nugatory. by the act of , every medical man who had been in charge of a private patient for eleven months was required to send the name of the patient, under a sealed cover, to the lunacy commission; but this document could only be opened upon application to the lord chancellor. moreover, the fixing of the period of eleven months led to the transfer of the poor lunatics from one person to another within that period, so as to render the requirement of notice of his existence and detention null and void. by the and vict. cap. , this enactment was repealed, and by _sect._ xc. it was ordered that no person, except one who derived "no profit from the charge, or a committee appointed by the lord chancellor," should receive a lunatic into his house, to board or lodge, without the legal order and medical certificates, as required for admission into a registered house or asylum; and that within seven days after the reception of a lunatic, the person receiving him should transmit to the commissioners copies of the order and medical certificates, together with a notice of the situation of the house, and the name both of the occupier and of the person taking charge of the patient. it further ordered that every such patient should be visited at least once in every two weeks, by a duly qualified medical man, who should also enter a statement after each visit of the state of the patient's health, both bodily and mental, and of the condition of the house. with a view to secrecy, the same act ordained (_sect._ lxxxix.) the institution of a private committee of three of the lunacy commissioners,--to whom alone the register (_sect._ xci.) of such patients was to be submitted for inspection,--who should visit those registered single lunatics, report upon them in a private book (_sect._ xcii.), and, if desirable, send this report to the lord chancellor, who could order the removal of the patient elsewhere (_sect._ xciii.), if his state was proved to be unsatisfactory. this legal apparatus completely failed to attain the desired object: it was left open for the person receiving the patient to consider him a lunatic or not, and to report him or not at discretion; for no penalty hung over his head for disobedience to the act. so, again, the three members of the "private committee" could neither derive official knowledge of the single patients they ought to visit, nor find time or opportunity to carry out the visitation of those reported to them, living as they did scattered throughout the country. the last-named act, having thus failed in its objects, was much varied by that of ( and vict. cap. ), the last enacted, which was less ambitious in its endeavours to deal with the single private lunatics. by this act the private committee was abolished, and any member of the lunacy commission was empowered to visit those single cases reported to the board; at least one visit a year being required. but the provisions under this act are very ineffectual, both for the discovery and for the protection of the patients. the commissioners are directed to visit those only who are placed under certificate and known to them; and although every person taking charge of a lunatic or an alleged lunatic is required (by _sect._ viii.), before receiving the patient, to be furnished with the usual order and medical certificates, and (by _sect._ xvi.) to make an annual report of his mental and bodily condition to the commissioners during his residence in his house, yet there are, in the first place, no means provided for discovering the existence of the lunatic unless the person receiving him choose to report it; and again, the requirement as to the certificates and order may be complied with, but no copy be sent to the commissioners; and lastly, it is left to the will and pleasure, or to the honesty of the individual receiving the case, whether it is to be considered as one of lunacy or not. it is needless to attempt to prove that a law so loosely framed must be inoperative. no person who has given a thought to the subject but knows that there are many hundred, nay, in all probability some two thousand--as we have surmised in our estimate (p. ), single private (not pauper) patients in england: yet, as lord shaftesbury acquaints us in his evidence (committee on lunatics, p. ), only such patients are known to the lunacy board. some few of the many others may be under certificates, though unreported; still the great majority are, there is no doubt, detained without attention to any legal formalities or legal sanction, and for the most part treated as "nervous patients," and as therefore not amenable to the commissioners in lunacy. the existence of the lunacy is thus disguised under the term of 'nervousness,' and the patients robbed of the protection which the law has rightly intended, and yet signally failed to afford. the noble chairman of the lunacy commission, in the course of his able evidence before the "committee on lunatics" ( ), has given some admirable suggestions for the amendment of the law in order to bring the so-called "nervous patients" under the cognizance of the commission, and to obtain a more complete knowledge of the number and position of the many lunatics detained in private houses. according to the existing law (evid. comm. p. ), it is only, says lord shaftesbury, "where a patient is put out to board with some person who is benefited by the circumstance that the commissioners can, upon application to the chancellor, obtain access to a house where they have reasonable ground to believe there is a patient restrained, and who ought to be under certificate. but not only, in the first place, is it difficult to ascertain where such patients are, but it is also difficult afterwards, as we must have good testimony to induce the chancellor to give us a right to enter a private house, and make an examination accordingly." in reply to queries , , , , and , his lordship insists on the necessity of the law interposing to compel persons who receive any patients whatever for profit, whether styled nervous or epileptic patients, to give notice of their reception to the commissioners in lunacy, who should have the power to visit and ascertain their state of mind, and determine whether they should or should not be put under certificate as lunatic. if they were found to be only 'nervous' persons, the commissioners would have nothing to do with them. to give these suggestions a legal force, his lordship produced the following clauses as additions to the lunacy act (evid. comm. query , p. ):-- "whereas many persons suffer from nervous disorders and other mental affections of a nature and to an extent to incapacitate them from the due management of themselves and their affairs, but not to render them proper persons to be taken charge of, and detained under care and treatment as insane; and whereas such persons are frequently conscious of their mental infirmity, and desirous of submitting themselves to medical care and supervision, and it is expedient to legalize and facilitate voluntary arrangements for that object, so far as may be compatible with the free agency of the persons so affected, be it enacted, as follows:-- "subject to the provisions hereinafter contained, it shall be lawful for any duly-qualified medical practitioner or other person, by his direction, to receive and entertain as a boarder or patient any person suffering from a nervous disorder, or other mental affection requiring medical care and supervision, but not such as to justify his being taken charge of and detained as a person of unsound mind. no person shall be received without the written request in the form, schedule --., to this act, of a relative or friend who derives no profit from the arrangement, and his own consent, in writing, in the form in the same schedule, the signatures to which request and consent respectively shall be witnessed by some inhabitant householder. "the person receiving such patient shall, within two days after his reception, give notice thereof to the commissioners in lunacy, and shall at the same time transmit to the commissioners a copy of the request and consent aforesaid. it shall be lawful for one or more commissioners, at any time after the receipt of such notice aforesaid, and from time to time, to visit and examine such patient, with a view to ascertain his mental state and freedom of action; and the visiting commissioner or commissioners shall report to the board the result of their examination and inquiries. no such patient shall be received into a licensed house." lord shaftesbury proceeds to say that by this plan "every person, professional or not, who receives a patient into his house, or attends a patient in such circumstances, should notify it to the commissioners; but we should not require them to notify it until after three months should have elapsed, because a patient might be suffering from brain fever, or a temporary disorder; but i would say that any person accepting or attending a patient in these circumstances should notify it to the commissioners, after three months shall have elapsed from the beginning of the treatment." in the after part of his evidence (query , p. ), his lordship desired to supply an omission in the preceding clause, viz. to make it compulsory on a medical man attending a nervous patient, and not only the person receiving one, to communicate the fact to the commissioners, so that they might go and see him, and form their own judgment whether he should or should not be placed under certificate. there is much that is excellent in the clauses suggested, yet some improvement is needed in their wording. thus it is provided that a medical practitioner, or a person under his direction, may receive a 'nervous' patient, and the subsequent provisions are made in accordance with this principle, as though only medical men could receive such patients, or that they alone were amenable to the laws regulating their detention. sir erskine perry detected this oversight (query ), and lord shaftesbury admitted the want of sufficient technicality in the drawing up of the clause. again, we do not conceive there is adequate reason for postponing the report of a case until three months after the commencement of the treatment; a delay, not imposed, indeed, under the clause as propounded, but implied in his lordship's subsequent remarks. to refer to the class of patients mentioned as properly exempt from a return to the lunacy commission until after three months have elapsed:--a case of so-called 'brain fever' is not likely to be sent from home to board with a medical man or other person during the existence of the acute malady commonly known under that term. on the other hand, genuine cases of acute mania get called by the same name, and such certainly ought to be reported to the commissioners before the expiration of three months. besides, the delay to notify 'temporary disorder' for so long a time is likely to be injurious and to defeat the object of the clause. delirium or mental aberration lasting for three months is something more than a symptom of any one commonly recognized bodily disease, and rightly deserves the designation of madness; and, if this be the case, it also claims the supervision of the commissioners or other duly appointed officers over its management, particularly when this is undertaken, with the object of profit to the person treating it. moreover, the delay proposed involves an idea not flattering to the discernment and the powers of diagnosis of the members of the medical profession; for its intent, we take it, is solely to prevent giving unnecessary trouble and distress to all concerned, in having to send a notification of the disorder, while yet unconfirmed, to the commissioners: an annoyance which ought never to happen; for every medical man should be able to distinguish the delirium of fever, of drinking, or of other corporeal conditions it is sometimes linked with, from insanity; and it would be very discreditable to the medical skill of any one not to find out the true nature of the case long before the expiration of three months. further, for the sake of promoting early and efficient treatment, the notification of disorder, whether called 'nervous' or mental, should be given before the end of three months. the change from home to board with a medical man may be all that is desired for a 'nervous' patient; but if it be a case of recent insanity, something more than solitary treatment at home or in a private lodging is essential. the evils of the last-named plan are largely illustrated in the evidence of lord shaftesbury himself, and of other witnesses before the select committee. it is consequently desirable to have cases, under what designation soever they are received, reported before the close of three months, so that the commissioners may see them and determine whether or not the conditions under which they are placed are conducive to their well-being and recovery, and may give their recommendations accordingly. the proposition appended by the noble earl, to the effect that every medical man attending a 'nervous' patient should communicate the fact to the lunacy commissioners, is most important, and in its scope approaches that of enforcing a registration, as advocated by ourselves: for we presume that his lordship would desire the paragraph to be so worded, that the notice should be demanded from the medical attendant, as well in the case of a lunatic or alleged lunatic as in that of a so-called 'nervous' patient. a similar defect attaches to the clauses proposed as to those actually in force under existing acts; that is to say, the want of means of enforcing them. by the act th and th vict. cap. , _sect._ xlv., it is made a misdemeanour to receive or detain a person in a house without a legal order and medical certificates; and by _sect._ xliv. it is declared a misdemeanour to receive two or more lunatics into any unlicensed house. these clauses are, however, valueless in preventing the abuses they aim at checking; for, as so often said before, alleged and undoubted lunatics are perpetually received by persons into their private houses as 'nervous' patients, mostly without certificates, or, if under certificates, unreported to the commissioners. no solid argument is conceivable, why a person having two lunatics under charge should be liable to punishment for a misdemeanour, whilst another may detain one with impunity. the penalty should be similar in each case. the same legal infliction, too, should, we think, be visited alike upon the friends putting away a relative under private care and upon the individual receiving him. it might also be rendered competent for any relative or friend to call upon those concerned in secluding, or in removing the patient from home under restraint, to show cause for so doing; and the production of the medical certificates and of a copy of the notification sent to the commissioners, with or without a certificate from such an officer as we propose as a district medical inspector, should serve to stay proceedings. the detention or the seclusion of a person, whether at home or elsewhere, contrary to his will, and at the sacrifice of his individual liberties and civil rights, appears to us tantamount to false imprisonment, and an act opposed to the principles of english liberty, whether it be perpetrated by relatives or strangers, if done without the knowledge and sanction of the law and of its administrators. but whatever amendments be introduced, we hold them to be secondary to a complete system of registration of lunatics and 'nervous' patients rendered compulsory upon the medical men attending them, or taking them under their charge, and likewise upon the relatives, or, in the case of paupers, upon the relieving officers or overseers of their parish. the family medical attendant appears the most fitting person to make a return of the sort: his professional knowledge must be called in to testify to, or to decide on, the nature of the disease, and the fact can be best communicated by him in his medical capacity. the lunacy commissioners of massachusetts had recourse to the physicians living in every town and village of the state; and it was only by so doing that they were enabled to arrive at an accurate knowledge of the number of the insane, and to correct the statistics gathered through other channels, which might, at first sight, have appeared ample to their discovery. further, as already noted, we advocate another step in conjunction with registration; for we would convey the notification of the existence of the alleged insane or nervous patient primarily to the district medical officer, and then call upon this gentleman to visit the patient, with every deference to family sensitiveness and necessary privacy, in order that he may make a report on the nature and character of the malady, and the conditions surrounding the patient, to the commissioners in lunacy. the immediate visitation of a reported case by such a skilled officer would be of advantage to the patient, to his friends, and to the commissioners. without overruling or controlling the medical attendant or others, his advice on the wants of the case would be useful, and he could fulfil one purpose proposed to be effected by a visit from the commissioners, viz. that of signifying whether the patient should be placed under certificates or not; his opinion being subject to revision by the visiting commissioners, should the nature of his report appear to them to call for their personal examination of the case. if, again, medical certificates were required, these might be countersigned by the district officer in question, after a separate examination, and an additional protection be thus applied against illegality in the legal documents required to sanction the patient's restriction or detention. this plan would likewise afford a check to the transmission to the lunacy board of those insufficient certificates which at the present time involve such frequent trouble. but, although the district officer's signature or certificate might by its presence be held to increase the validity of the evidence for a patient's insanity, yet its absence, where his opinion differed from that of the medical men called in to sign the legal certificates, should not operate as a bar to dealing with the alleged lunatic as such, until an examination by one of the board of commissioners could be had; and therefore the registrar should be bound to transmit the order and certificates, when properly filled up, accompanied by his own report of the case. supposing these provisions just sketched to be carried out, and that an individual is found lunatic by his immediate medical attendants, by the official registrar, a perfectly disinterested person, and, sooner or later by the commissioners, there certainly appears no reason why the lunatic himself, or any officious friend or sharp lawyer in search of business, should be able to challenge by legal proceedings a decision so cautiously arrived at by so many competent persons. the determination of a trial by jury we hold to be less satisfactory, and less likely to be in accordance with fact; so easy is it in some instances for a clever counsel to frighten witnesses, to get fallacious evidence, and to represent his client's cause, and appeal to the passions of the jurors of very miscellaneous mental calibre, often with more feeling than judgment, and generally to use all those arts which are thought legitimate by the practitioners of the law to win a verdict. there is one subject well deserving notice; one which acts as a stumbling-block to the treatment of mentally disordered persons, and will also do so, more or less, to registration; viz. the present legal necessity of placing all in the category of lunatics. the practical questions are, whether this proceeding is necessary, and if not, whether the present form of the order and medical certificates cannot be so modified, as to lessen the objections of friends to place their suffering relatives under the protection of the law and its officers; we should add, to remove the objections of patients themselves; for it is irritating to the minds of certain classes of the insane to know that they are accounted lunatics by law equally with the most degraded victims of mental disorder with whom they may find themselves associated; and it offers an impediment at times, as those conversant with the management of asylums know, to patients voluntarily submitting themselves to treatment. the adoption of two forms of certificate, one for persons found to be of unsound mind, and the other for the class of 'nervous' patients, would undoubtedly involve some disadvantages. it would be the aim of all those in a position to influence opinion, to obtain the registration of their insane friends under the ambiguous appellation of 'nervous' patients; and this could be met only by placing it in the power of an officer attached to the lunacy commission to make the decision, after an examination of the patient, respecting the nature of the certificate required. perhaps the examination to be made by a commissioner, according to the scheme propounded by lord shaftesbury (p. ), is intended, though not said to be so, to serve the purpose referred to; otherwise it would be a defect in his lordship's plan, that no person is empowered to discriminate the individuals he would legislate for as 'nervous' patients not properly the subjects for asylum treatment, from those mentally disordered persons who are so. although the introduction of a modified or mitigated form of certificate of mental unsoundness, besides the one now in use, may be open to the objection mentioned, and to others conceivable, yet it would, on the other hand, possess certain advantages, and would, among others, be certainly an improvement upon the present state of things, by promoting the registration of numerous cases now unknown to the administrators of the lunacy laws. it would be impossible to draw the line rigidly between really insane persons and those suffering from temporary delirium, or 'nervousness.' no ready cut and dried definitions of insanity would serve the purpose, and the discrimination of cases in order to their return as 'lunatic,' or as 'nervous,' must within certain limits rest upon definitions imposed by law, and beyond these to common sense and professional experience. with such criteria to guide, no sufferers from the delirium of fever, of alcoholism, or other kindred morbid state, and no eccentric personages whose peculiarities are not necessarily injurious to themselves, to others, or to their property, should be brought within the operation of the laws contrived to protect positive mental disorder. they would not occupy the same legal position as those classes proposed to be under one or other form of certificate; for, in our humble opinion, all those under certificate, whether as insane or as 'nervous' patients, should be under like legal disabilities in the management of themselves and their affairs, and partake of equal legal protection. in the preamble to the clauses suggested by lord shaftesbury, the nervous disorder or other mental affection is very properly supposed to be of a nature and extent to incapacitate the sufferers from the due management of themselves and their affairs; that is, that they are to be rightly placed under similar civil disabilities with the insane;--a position, which could, moreover, not be relaxed even in favour of those voluntarily placing themselves under treatment, without giving rise to much legal perplexity and quibbling. but this last-named result we have some apprehension might ensue, if the next sentence of the clause to those quoted were retained: forasmuch as, farther to define the class of persons to be legislated for, this sentence requires that their disorder shall not render them proper persons to be taken charge of and detained under care and treatment as insane; a condition, which seems to exclude them from the catalogue of insane persons in the eye of the law, and therefore to relieve them from the legal disabilities attaching to lunatics; but, perhaps, it is from ignorance of law that we cannot conceive how it is proposed to provide for the care and official supervision of persons alleged to be incapacitated from the management of themselves and their affairs, and at the same time to pronounce them unfit to be dealt with as insane. the scotch asylums act ( ) contains a clause ( st) to authorize the detention of persons labouring under mental aberration, in its earlier stages, in private houses, under a form of certificate set forth in schedule g, wherein the medical man certifies that the individual in question is suffering from some form of mental disorder, not as yet confirmed, and that it is expedient to remove him from his home for temporary residence in a private house (not an asylum), with a view to his recovery. this plan of disposing of a patient is permitted to continue for six months only. by some such scheme as this, it seems possible to bring the sufferers from disordered mental power within the cognizance of the public authorities appointed to watch over their interests, and at the same time to rescue them from being classed with the inmates of lunatic asylums, and from the frequently painful impression, in their own minds, that they are publicly considered to be lunatics. to avoid disputes and litigation, however, such patients should, even when under that amount of surveillance intimated, be debarred from executing any acts in reference to property, which might be subsequently called into question on the plea of their insanity. according to the present state of the law, there is no intermediate position for a person suffering from any form of cerebral agitation or of mental disturbance; he must be declared by certificate a lunatic, or his insanity must be called 'nervousness.' under the latter designation of his malady, he cannot receive treatment in an asylum or licensed house; and yet, all his acts in behalf of his own affairs, that is, where his friends do not arbitrarily assume the power to act for him, may at any future time be disputed as those of a lunatic. yet, as noticed more than once before, all the probable disadvantages of this anomalous position are risked in very many cases, and the best chances of recovery thrown away, because the friends (and the patient too very often) are unwilling to have him certified as a lunatic. an alteration, therefore, of the law seems much required in this matter. the earl of shaftesbury has met this want partially by the clause he has proposed in favour of 'nervous' patients, and his lordship, in a preceding portion of his evidence (queries - ), expressed himself in favour of mitigating the wording of the medical certificates required. we have also heard dr. forbes winslow express sentiments to a similar effect, that the law ought to recognise the legality of placing certain patients suffering from some varieties of mental disturbance under treatment in licensed houses, and especially those who will voluntarily submit themselves to it, without insisting on their being certified as lunatics. this is not an improper place in our remarks to direct attention to the proposition to legalize the establishment of intermediate institutions, of a character standing midway, so to speak, between the self-control and liberty of home and the discipline of the licensed asylum or house, to afford accommodation and treatment for those who would be claimants for them under the mitigated certificates above considered. such institutions would be very valuable to the so-called 'nervous patients,' and to the wretched victims of 'dipsomania'--the furor for intoxicating drinks; for there are many advantages attending the treatment of these, as of insane patients, in well-ordered and specially arranged establishments, over those which can be afforded in private houses. it may likewise be added, that the facilities of supervision by the appointed public functionaries are augmented, and greater security given to the patients when so associated in suitable establishments. we add this because, although the certificates are mitigated in their case, and they are not accounted lunatics, yet we regard that degree of visitation by the commissioners, indicated by lord shaftesbury, to be in every way desirable. it is not within the compass of this work to enter into the details for establishing and organizing these retreats: they have been discussed by several physicians, and more particularly in scotland, where, it would seem, examples of drunken mania are more common than in england. chap. ix.--appointment of district medical officers. throughout the preceding portion of this book we have pointed out numerous instances wherein the legal provision for the insane fails in its object from the want of duly-appointed agents, possessing both special experience and an independence of local and parochial authorities; and we have many times referred to a district medical officer, inspector or examiner, as a public functionary much needed in any systematic scheme to secure the necessary supervision and protection of the insane, particularly of such as are paupers. we will now endeavour to specify somewhat more precisely the position and duties of that proposed officer; but, before doing so, we may state that the appointment of district medical officers is not without a parallel in most of the continental states. in italy there are provincial physicians, and in germany kreis-artzte, or district-physicians, who exercise supervision over the insane within their circle, besides acting in all public medico-legal and sanitary questions. in our humble opinion, the institution of a similar class of officers would be an immense improvement in our public medical and social system. the want of public medical officers to watch over the health and the general sanitary conditions of our large towns has been recognised and provided for; although the machinery for supplying it is much less perfect than could be wished: for to entrust the sanitary oversight and regulation of populous districts to medical men engaged in large general practice, often holding union medical appointments, and rarely independent of parish authorities, is not a plan the best calculated to secure the effectual performance of the duties imposed; for, as a natural result, those duties must rank next after the private practice of the medical officer, and constitute an extraneous employment. in the establishment of a class of district medical officers,--chiefly for the examination, supervision and registration of all lunatics or alleged lunatics and 'nervous' patients not in asylums, but placed, or proposed to be placed, under surveillance, accompanied with deprivation of their ordinary civil and social rights,--we would protest against the commission of such an error in selecting them, as has, in our opinion, occurred in the appointment of sanitary medical officers generally: for the performance of the duties which would devolve on the district medical officer, it would indeed be essential that he should be perfectly independent of local authorities, that he should not hold his appointment subject to them, and that his position among his professional brethren should be such as to disarm all sentiments of rivalry or jealousy among those with whom his official duties would bring him in contact. what should be his position and character will, however, be better estimated after the objects of his appointment are known. the extent of the district assigned to this official would necessarily vary according to the density of population; so that some counties would constitute a single district, and others be divided into several. in the instance of a county so small as rutland, the services of a separate district medical officer would hardly be required, and the county might be advantageously connected with an adjoining one. one principal purpose of his office would be to receive notice of every case of insanity, of idiocy, or of 'nervousness' (as provided for by lord shaftesbury's proposal), and to register it; the notice to be sent to him by the medical attendant upon the patient. upon receiving such notice, he should forthwith, except under certain contingences hereafter indicated, visit the case, and determine whether it should be rightly placed under certificates as one of lunacy, or as one of 'nervous' disorder, amenable to treatment without the seclusion of an asylum; and should transmit the result of his examination and the report of the case to the lunacy board. it might supply an additional protection to the lunatic, and be satisfactory otherwise, if the signature of this officer were required to the original certificates (see p. ) before their transmission to the central office in london. the return made by the district medical officer to the commissioners in lunacy would be of much service to them in determining their future course with reference to the visitation of the patient (in carrying out lord shaftesbury's proposal, p. ), supposing him to be detained at home, or in lodgings with strangers, instead of being transferred to an asylum or licensed house. so again, if the patient were removed to an asylum, he would furnish a report of his history and condition to the physician or proprietor, and thereby render a valuable service, particularly in the case of paupers, of whom next to nothing can frequently be learnt from the relieving officers who superintend their removal to the county asylum. the want of a medical report of cases on admission is, in fact, much felt and deplored by medical superintendents; and, since it is proposed that the district officer should visit the patient at his own home, or, in exceptional cases, elsewhere, and inquire into his mental and bodily state, and into the history of his disorder, before his removal to the asylum, and as soon as possible after the onset of the attack, he would be well-qualified to render a full account of his case. we have spoken of a notice of idiots within his district being sent to the district inspector, and of his duty to register them. this matter we regard as certainly calling for attention, for, as remarked in a previous page (p. ), idiots need be submitted to appropriate educational and medical means at an early age to derive the full benefits of those measures; and among the poor, they certainly should not be left uncared for and unnurtured in the indifferent and needy homes of their friends, until, probably, their condition is almost past amelioration. again, with reference to the transmission of pauper lunatics to county asylums, we are disposed to recommend that the order for it be signed by the district medical officer, without recourse to a justice, in those cases where he can visit them, and in comparison of which indeed others ought to be exceptional. where, for instance, by reason of the remoteness of the patient's home, or of the workhouse or other building wherein he is temporarily detained, the district medical officer's visit could not be specially made except at great cost, the removal of the patient to the asylum might be carried out under the order of a magistrate, and the examination made by the district officer, as soon after his reception as possible; or better, at his own residence, which ought to be in a town not far from the county asylum. we advocate the delegation of the authority to the district officer to make an order in lieu of a justice, on the production of the legal medical certificate required, because we consider him much better qualified to administer that portion of the lunacy law, particularly as that law at present stands, which puts it in the power of a justice to impede the transmission of a lunatic for treatment, if, in his opinion, the patient's malady do not require asylum care: and it is a fact, that the clause permitting a justice this influence over a patient's future condition is often exercised; at times, contrary to the decided advice of medical men, and to the detriment of the poor patient. lord shaftesbury refers to such an occurrence in his evidence (_op. cit._, query ). having in view private patients especially, his lordship remarks that nothing could be worse than to take them before a magistrate: "there would be a degree of publicity about it that would be most painful ..., and to have the matter determined by him whether the patient should or should not be put under medical treatment. in ninety-nine cases out of one hundred, the magistrate knows little or nothing about the matter. a case occurred the other day of a poor man who was taken before a magistrate, and he refused to certify, because the man was not in an infuriated state. 'a quiet person like him,' he said, 'ought not to be put into an asylum; take him back.' he was in a low, desponding state, and if he had been sent to a curative asylum, he might have been cured and restored to society." mr. gaskell also adds his evidence to that of the noble chairman of the board, in reply to query (_op. cit._ p. ) put by sir george grey:--"is the magistrate to be quite satisfied on the evidence that the pauper is a proper person to be taken charge of in the county asylum?" mr. gaskell replies, "yes, as i said, on the medical gentleman giving a certificate. then it is his duty to make an order, and if he is not satisfied by his own examination, or the medical evidence is not sufficient to justify the order, he declines. i am sorry to say that they frequently do." it is also to be remembered that the existing law allows the justice's order to be dispensed with, if it cannot be readily obtained, or if the patient cannot be conveniently taken before him, and admits as a substitute an order signed by an officiating clergyman and an overseer or a relieving officer, upon the production of a medical certificate. moreover, by the interpretation clause, the chaplain of a workhouse is to be deemed an officiating clergyman within the meaning of the act. now, these conditions seem to us to frustrate the undoubted intent of the law in requiring a magistrate's order, viz. to guard against the unnecessary detention of an alleged lunatic; for they place the liberty of the pauper entirely in the hands of parish officers and paid servants, who will naturally act in concert; and it is conceivable that workhouse authorities might be anxious to get rid of a refractory pauper, and could together with the relieving officer influence in a certain degree the opinions and sentiments of the salaried chaplain and medical officer, in order to sanction his removal to the county asylum. we have, indeed, in previous pages (p. , _et seq._), shown that unfit and occasionally non-lunatic patients are sent to asylums; but, even did such an event never happen, we should still hold that the protection to the alleged lunatic intended by the requirement of an order signed by the officials designated, is very little worth, and would be advantageously replaced by the order of a district medical officer appointed and authorized by the scheme we propose. it is also worthy of note, that patients sent to asylums under the order of the chaplain and relieving officer feel themselves sometimes much aggrieved that no magistrate or other independent authority has had a voice in the matter. they regard the relieving officer or the overseer, as the case may be, to be directly interested in their committal to the asylum, and only look upon the chaplain of the union as a paid officer, almost bound to append his signature to any document matured at the board of guardians, when called upon to do so. moreover, they can recognise in him, in his professional capacity as a clergyman, no especial qualifications for deciding on the question whether they are proper persons to be confined on the ground of their insanity. this remark, too, extends to every other clergyman called upon to act in the matter. nay, more, there is another more potent objection at times to a clergyman signing the order; viz. when the patient is of a different faith, or when perhaps animated by strong prejudices against the clergy of the english church, and when, consequently, it is possible for him to imagine himself the victim of religious persecution or of intolerance. even lord shaftesbury, who is so identified with the interests of religion and of its ministers, manifests no disposition to entrust to the clergy the interests of the insane. in reply to the query (no. , evid. com.), whether he would desire ministers of religion to pronounce on the fitness or unfitness of persons for confinement as of unsound mind, he replies, "i should have more distrust of the religious gentleman than i should have of the medical man; and i say that with the deepest respect for the ministers of religion. the difficulty of it would be incalculable, if you were to throw the duty on the parochial clergy in the neighbourhood, who are already overburdened." in truth, there is no more reason for assigning to the clergy the determination of the question of sanity or insanity of an alleged lunatic, than for entrusting it to any other respectable and educated class of society. we have seen that magistrates sometimes exercise their privilege of deciding the question in an arbitrary and injudicious manner, and it is permissible to suppose the clergy not to be always in the right in exercising the same function. indeed, we have at least one instance on record that they are not, in the supplement to the twelfth report of the commissioners in lunacy; viz. in the case of an epileptic woman, subject to paroxysms of dangerous violence and destructiveness,--such as are common to the epileptic insane in asylums, and reported by the master of the workhouse "as unsafe to be associated with the other inmates. for these offences she had been subjected to low diet, restraint, and seclusion, and on three occasions had been sent to prison. the medical officer of the workhouse considered her of unsound mind, not fit to be retained in the workhouse, and improperly treated by being sent to prison. in march , and february , he had given certificates to this effect, and steps were taken to remove her to the asylum. when taken on those occasions, however, before the vicar of the parish, he refused to sign the order, and she was consequently treated as refractory, and sent to prison." taking the foregoing remarks into consideration, the only circumstances under which we would call upon an officiating clergyman, not being the chaplain of the union, to make the order, would be where no magistrate resided in the neighbourhood, and where, from the remoteness of the locality, the district medical examiner could scarcely be expected to visit the individual case,--an event that would be of rare occurrence in this country. there are indeed cases, such as of acute mania, where the justification of the confinement of a lunatic, by the order of a magistrate or clergyman, is a mere formality, and might be altogether dispensed with, and all legal protection guaranteed by the medical certificate, and an order signed by a parish officer to authorize the asylum authorities to receive the patient at the charge of the parish sending him. but if this were objected to, then assuredly the examination of the lunatic immediately upon or just before his admission into the asylum by the district medical officer, would supply every desideratum in the interests of the patient, and such an examination would, according to our scheme, be always made at this stage of the patient's history. lastly, let it be remembered that a magistrate's order is not required for the admission of a private patient into an asylum or licensed house. a relative or friend may sign the order and statement, and the alleged lunatic is thought to be sufficiently protected by the two medical certificates. now, were a magistrate's or a clergyman's order any real security against the commission of a wrong to an individual, it would be much more necessary in the instance of private patients possessing property, and whose confinement might serve the interests of others, than in the case of paupers, for whose confinement in an asylum no inducement, but rather the contrary feeling, exists. in fact, the confirmation given to the propriety of placing a pauper lunatic in an asylum by the district medical officer, as proposed, might be considered supererogatory, considering that a certificate is required from the superintendent of the asylum shortly after admission, had it no other purpose in view. according to the proposition advanced by us, an experienced opinion by an independent authority would be obtained in lieu of one formed by an inexperienced magistrate (who would generally prefer escaping an interview with a madman, mostly act upon the medical opinion set forth, or if not, be very likely to make a blunder in the case), or of one certified by two inexperienced, paid, and therefore not sufficiently independent, workhouse functionaries. the clause proposed by the commissioners (supp. rep. , p. ), "that the medical officer of the workhouse shall specify, in the list of lunatic inmates kept by him, the forms of mental disorder, and indicate the patients whom he may deem curable, or otherwise likely to benefit by, or be in other respects proper for, removal to an asylum," is virtually unobjectionable; but, with due submission, we would advocate that, whether with or without this list and those expressions of opinion, the district medical officer's report should be considered the more important document whereon to act. the evidence given before the late committee of the house of commons ( ) shows that we must not expect much book-keeping or reporting from the parochial medical officers, and that many misconceptions and erroneous views prevail, and will damage results collected from them. the union medical officer will necessarily have his own opinions respecting the nature and prospects of the lunatics under his observation, and no great objection can be taken to his recording them, if thought worth while: yet they would be sure to be given, even without any legal requisition; and might often help, when privately expressed, the district examiner in his inquiries; and it would, besides, be better to avoid the chances of collision between the written opinions of two officers who should work together harmoniously. also, in the instance of private patients to be placed in an asylum, licensed house, or elsewhere with strangers, we look upon the visitation and examination of such a medical officer as we suggest as a valuable additional protection and security to them. he would constitute an authority in no way interested in the detention, and, by the nature of his office, bring to bear upon any doubtful cases an unusual amount of special knowledge and experience. we cannot help thinking that such a functionary would be much more efficient and useful than a magistrate (to whom some have proposed an appeal), as a referee to determine on the expediency of placing a person under certificate as of unsound mind. another class of duties to devolve on a district medical officer comprises those required to watch over the interests and welfare of pauper lunatics sent to, or resident in, workhouses. at p. , we have advanced the proposition, that, in future, no alleged lunatics should be removed to a workhouse, except as a temporary expedient under particular conditions, such as of long distance from the asylum or unmanageable violence at home; and that in all cases a certificate to authorize any length of detention in a workhouse should emanate from the district medical officer. the object of this proposal is to prevent the introduction of new, and particularly of acute cases of insanity, into workhouses; for, as we have shown in the section 'on the detention of patients in workhouses' (p. , _et seq._), the tendency is, when they are once received, to keep them there. according to our scheme, the district officer would receive notice of all fresh cases from the medical practitioner in attendance upon them, and, in general, visit them at their homes before removal to the workhouse or elsewhere. with respect to the actual inmates of the workhouse, it would be equally his duty to ascertain their mental and bodily state, to suggest measures to ameliorate their condition, and to report on those whom he might consider fit for removal either to the county asylum or to lodgings out of the union-house. he would make his report both to the committee of visitors of the workhouse, hereafter spoken of, and to the lunacy commissioners. it should devolve primarily upon the committee to act upon the reports, or, on their omission so to do, the commissioners in lunacy, either with or without a special examination made by one or more of their number, should be empowered to enforce those changes which might in their opinion be absolutely necessary. again, by suggestion (p. ), we provide that no person shall be detained as a lunatic or idiot, or as a person of unsound or weak mind, except under an order and a medical certificate to the existence of mental derangement, just such as is needed to legalize confinement in an asylum. the order would best come from the district medical examiner, whilst the certificate would, as usual, be signed by the union medical officer. now, by one of the propositions contained in the supplementary report of the commissioners in lunacy ( , p. ), it is sought to render a similar protection by another expedient; viz. that the alleged lunatic "shall be taken before a justice or officiating clergyman, and adjudged by him as not proper to be sent to an asylum." by the next paragraph, it is further proposed that, "in any case wherein an order for a lunatic's reception into an asylum shall be made by a justice or officiating clergyman, it shall be competent for him, if, for special reasons, to be set forth in his order, he shall deem it expedient, to direct that such lunatic be taken, _pro tempore_, to the workhouse, and there detained for such limited period, not exceeding two clear days, as may be necessary, pending arrangements for his removal to the asylum." now, with all becoming deference to the position and experience of the commissioners, we must confess to a predilection for our own plan, which, indeed, was drawn out before the appearance of the supplemental report. this preference we entertain for the reasons shown when speaking of the relative qualifications of magistrates and clergymen to make the order for admission into asylums; viz. that on the one hand there are no à priori grounds for supposing their discrimination of insanity, and of its wants and requisite treatment, to be better than that of other people; that some direct objections attach to clergymen, and that experience proves that neither justices nor clergymen have hitherto so performed the duty as to afford any inducement to increase its extent; and, on the other, that in the district medical officer we have an independent and skilled person to accomplish the work. nevertheless the suggestion offered by the commissioners is a great improvement upon the practice in vogue, which leaves the determination of the place and means of treatment, and of the capability of a patient to be discharged or removed, to the parish authorities. on this matter we have commented in previous pages, and illustrated at large in the history of the condition of the insane in workhouses, or boarded with their friends outside. by suggestion (p. ), we propose that no lunatic or other person of unsound mind in a workhouse should be allowed to be discharged or removed without the sanction of the district medical officer. this proposition we regard as of great importance; for we have seen (p. , _et seq._) with what recklessness, contempt of common sense, and cruelty, poor lunatics are removed from workhouses to asylums under the operation of existing arrangements. again, some directing, experienced and independent authority is needed (p. ) to overrule the removal of imbecile and other inmates to the houses of their relatives or of strangers; to indicate the cases to be sent, and to examine the accommodation, and ascertain the character and fitness of the persons offering to receive them. these functions also we would delegate to the district medical officer. once more, imbecile, partially idiotic, and occasionally patients more rightly called lunatic, are sent away, or allowed to discharge themselves from, the workhouse, with the sanction of the authorities of the house and of the guardians. the terrible evils of this proceeding are alluded to at p. , and more fully entered into in the commissioners' supplementary report ( ), and in the evidence before the committee on lunatics ( , queries - ). the district medical officer would here again come into requisition, and, under a distinct enactment of the law, resist the discharge, unless satisfied that the relatives of the disordered or imbecile paupers, particularly when females, could afford proper supervision and accommodation, and exercise due control over them. the sixth suggestion we have made (p. ) contemplates the visitation of lunatics in workhouses, not only by the lunacy commissioners, as heretofore, but also by a committee of magistrates, and the district medical officer. the powers committed to the lunacy commissioners by existing acts to inspect workhouses are very inadequate and unsatisfactory; for, as the commissioners observe, they can make recommendations, but have no authority to enforce attention to them, and the only course open to them is, to get their views represented through the medium of the poor law board; and, although this board co-operates most readily in their recommendations, yet it has no positive power to enforce them. the result is, the commissioners find that the circuitous and troublesome proceeding to which they are restricted renders their endeavours in behalf of workhouse lunatics almost nugatory. to rectify this objectionable state of things, the first principle to be recognised is, that the lunacy board shall be charged with the custody of all lunatics, whose interests it shall watch over and have the necessary power to promote, however and wherever they may be found. it should not have to exercise its authority, to enforce its orders and regulations, through the medium or by the agency of any other board. no competing authority should exist. all lunatics should be reported to the commissioners; all should be subject to their visitation, or to that of any assistants appointed under them; and the power of release should be lodged in their hands in respect of all classes of patients when they see reason to exercise it. in the instance of pauper lunatics in workhouses, they should be able to interpose in their behalf, to require every necessary precaution to be taken for their security, and due accommodation and treatment provided. the district medical officer would be their local representative; would make frequent inspections, and report to them and act under their direction. he would indeed be responsible to them in all duties connected with the interests of the insane. we have (p. ) proposed a committee of visitors of workhouses, for each county or for each division of the county, selected from the magistrates and from the respectable classes of ratepayers, not being guardians or overseers, although chosen with a view to represent parochial interests. this committee should visit, at least once a quarter, every workhouse containing a person of unsound mind or an idiot, in the district under its jurisdiction; and it would be desirable that the district medical inspector should visit in company with the committee, besides making other visits by himself at other times. we are happy to find that this suggestion tallies in general with one made by the commissioners in lunacy in their recent supplementary report, as well as with the views of dr. bucknill. but we conceive it rather a defect in the commissioners' scheme that they propose that "the visiting commissioner and the poor law inspector be empowered to order and direct the relieving officer to take any insane inmate before a justice, under the provision of the th section of the lunatic asylums act, ." for, according to the principle enunciated in the last page, the lunacy commissioners, as the special guardians of the insane, should alone be concerned in the direct administration of the laws of lunacy, and on this ground we object to the power proposed to be conferred on the poor law inspectors; and we take a further objection to their being called upon to form an opinion respecting the lunatics who require asylum treatment, and those who do not. there is truly no impediment, in the abstract, to their forming an opinion; yet, on the other hand, we would not have them to act upon it, but desire them to report the circumstances falling under their notice to the lunacy commissioners, who would thereupon examine into them, and decide on the steps to be taken. by the plan, however, which we have drawn out, and by the functions proposed to be entrusted to the district medical officer, the whole clause last discussed would be rendered superfluous. the seventh suggestion (p. ) submitted to consideration is, that every workhouse containing lunatics should, under certain necessary regulations, be licensed as a place of detention for them, by the committees of visitors of workhouses when situated in the provinces, and by the lunacy commissioners when in the metropolitan district, and that the licence should be revoked by the committees, after reference to the lunacy board, in the case of workhouses licensed by them, and by the commissioners solely in the instance of any workhouse whatever. this plan confers the requisite power on the commissioners to control the accommodation and management of workhouse wards for lunatics, and resembles the one pursued at present with regard to asylums. it would likewise permit them to order the closure of lunatic wards, and the removal of all lunatics from a workhouse, when they were persuaded that proper asylum or other accommodation was available for the insane inmates. whatever course they adopted, or whatever decision they arrived at on such matters, they would be chiefly guided by the results of the inspection and the reports thereon made by the district medical officer, and further established by their own visitation. the present number of commissioners is far too small for them to visit each workhouse even once a year; and, if our views respecting the necessity of a complete examination of every one of such institutions, at least four times a year, be correct, it would still be impossible to get this work done by them, even though their number was trebled; therefore, as just said, the inspection made by the district medical officer would afford the chief materials for their guidance in dealing with workhouse lunatics, and save them an immense amount of labour. our eighth suggestion (p. ) is to the effect that all lunatics in workhouses should be reported to the lunacy commissioners, and that this should be done by the district medical officer (p. ). the number, age, sex, form and duration of malady, previous condition in life and occupation, and all particulars touching the mental and bodily condition of the patients, would be thus duly registered. the advantages of such a system of reporting are obvious, and, as this branch of the district officer's work has partially come under notice before, it need not be enlarged upon here. the law provides for the occasional visitation of pauper lunatics in asylums chargeable to parishes, by a certain number of the officers, and among them the medical officer of the parish to which, as paupers, they are chargeable; and something, by way of remuneration for their trouble, is allowed out of the funds of the union or parish. this arrangement keeps up a connexion between a parish and the lunatics chargeable to it in the county asylum, which in various respects is desirable, and probably satisfactory to the ratepayers. but the lunatic inmates of an asylum chargeable to the county do not receive the benefit of any such wise provision: when once in the asylum, they find none interested in their condition save the staff of the asylum, its visitors, and the commissioners. the last-named, in their annual visit, can have no time to consider them apart,--not even to discover and distinguish them from the rest. very many of them are foreigners, and their condition is consequently more deserving commiseration, as being, most likely, without friends, to interest themselves in their behalf. if the inquiry were made of the superintendents of county asylums, we believe it would be found that the omission of the law in providing for the more immediate watching of these poor lunatics is attended with disadvantages and injuries to them. to supply this want, we are disposed to recommend the district medical inspector as their special visitor; for he would be identified, on the one hand, with the county in which his duties lie, and, on the other, with the lunacy board, in such a manner as to be able to lay before it, in the readiest and best manner, any circumstances respecting these county pauper lunatics which it might seem desirable to report, and, when they were foreigners, to bring about a communication with the foreign office, and secure their removal to their own country. the visitation of these lunatics would rightly entitle the district officer to remuneration, which might be the same as that now paid per head for the visitation of out-door pauper lunatics, viz. half-a-crown per quarter. this amount would be payable by the county to which the patients were chargeable, and would add to the fund applicable for the general purposes of the lunacy board. the supplementary report of the lunacy commissioners ( , p. - ) contains some observations relative to the decision, in the instance of workhouse inmates, of the question who among them are to be reckoned as "lunatics, insane persons, and idiots" on the parish books? it is at present a task left to the guardians, the master, or to the parish medical officer; but the commissioners rightly recommend that it should be entrusted to the last-named officer. however, we should prefer to see the duty delegated to the district medical inspector, as better qualified, in general, by experience, and, what would be of more importance, as being independent of parochial functionaries: for the duty is a delicate and responsible one; and, the disposition of guardians being economical where money is to be expended on the poor, they always desire to escape the heavier charge entailed by lunatics, and, where they can manage it, are pleased to witness the discharge of imbecile paupers, and of others more correctly called insane, whom they may choose for the time to consider as sane enough to be at large. the difficulties besetting this question of determining what paupers are to be considered insane, and what not, is remarked upon by the scotch lunacy commissioners in their recently-published first report ( ), and was referred to in the english commissioners' report for (p. & p. ). the enormous evils attending the present loose mode of deciding the question are sketched in the supplementary report quoted, and in previous pages of this book. we now come to the duties of the district medical officer in reference to the pauper insane not in workhouses or asylums, but boarded with relatives or strangers: as, however, we have, treated of them at some length in the section on the condition of those lunatics (p. , _et seq._), we will refer the reader back to that portion of the book. suffice it here to say, that the district medical officer is very much needed as an independent and competent functionary to supervise and regulate the state and circumstances of this class of poor patients. he should visit every poor person wholly or partially chargeable, or proposed to be made chargeable, to the parish, as being of unsound mind (p. ), and make a quarterly return to the parochial authorities and to the lunacy board (p. ). he should also take in hand the selection of the residence and the examination into the circumstances surrounding the patient (p. ). if the scheme of boarding the pauper insane in the vicinity of the county asylums, in cottage-homes (see p. , and p. ), were carried out, the extent of the duties of the district inspector would be much curtailed, inasmuch as a majority of such lunatics would fall within the sphere of the asylum superintendents in all matters of supervision. the subsequent publication of the "evidence before the select committee on lunatics," , enables us to refer the reader to other illustrations of much weight, to show the pressing demand for an efficient inspection of single cases, and for securing satisfactory returns of their condition, particularly when paupers. the necessity for inspection is proved by lord shaftesbury's exposure of the wretched state of single patients (at p. , _et seq._), and the want of returns by the evidence of mr. gaskell (p. , _et seq._). the passages bearing on these points are too long for quotation at this part of our work, and are very accessible (blue book above-mentioned) to every reader desirous of seeing other evidence than that adduced in preceding pages. the appointment of the district medical officer would have this further benefit with reference to out-door pauper lunatics, that it would set aside discussions respecting the persons who should receive relief as such; a circumstance, upon which turns, as noticed before (p. ), the question of the quarterly payment of two shillings and sixpence for each lunatic visited. the district officer would possess an entire independence of parish officials, and could not be suspected of any interested motive in making his decision. in undertaking the inspection of this class of pauper lunatics, he would certainly displace the parish medical officers, and the small fee payable to these last would fall into the treasury of the lunacy board; yet the loss to an individual union medical officer would be scarcely appreciable; for the number of lunatics boarded out in any one parish or portion of a parish coming under his care, would, in every case, be very small; whilst, on the other hand, the sum in the aggregate paid into the hands of the commissioners, on account of all such patients in the kingdom, would,--supposing, for example, our estimate of to be tolerably correct,--form a not inconsiderable sum; taking the number mentioned, it would amount to £ per annum,--a useful contribution to the fund for meeting the expenses of district medical inspectors, and sufficient to pay the salary of eight such officers. but the fee might be doubled without being burdensome to any parish. although the commissioners in lunacy might occasionally visit private lunatics in their own homes, and more especially those boarded with strangers, yet it would be impossible for them, even if their number were doubled, to exercise that degree of supervision which is called for. this would particularly be the case, were the system of registration, or of reporting all persons under restraint on account of mental disorder or mental weakness, carried out; and the only plan that appears for securing the desired inspection of their condition, and of the circumstances and propriety of their detention, is that of imposing the duty upon the district medical officer. we have already suggested that this officer should see all such cases when first registered; by so doing, he would be brought into contact with the patients and their families, and would, as a county physician, also constitute a less objectionable inspector than even the commissioners themselves in their character as strangers and as members of a public board. the medical inspector's visit should be made at least four times a year, and a moderate fee be paid on account of it to the general fund of the lunacy board. if it were only half-a-guinea per quarter for each patient, it would produce a considerable sum available for the purposes of the commission. there is yet one other duty we would delegate to the district medical officer, viz. that of visiting the private asylums not in the metropolitan district, in company with the committee of visiting justices, who, according to the requirement of the present law, must join with themselves a physician, in making their statutory visits. we conceive that the assistance of such a physician as we would wish appointed in the capacity of district medical officer, would render the magisterial visits more satisfactory, and establish a desirable connexion between the visiting justices and the lunacy board. we do hear, at times, of a species of rivalry or of opposition between the visitors of private asylums and the commissioners, to the detriment of proprietors. if such an evil prevails, one means of checking it would, we believe, be found in the position and authority of the district medical officer when called on, as suggested, to act as the visiting physician with the magistracy as well as the local representative of the commissioners in lunacy. on reviewing the duties to be undertaken by a district medical officer, the propriety of the remarks with which we began this chapter will appear:--viz. that he should occupy as independent a position as possible; that, as a medical man, he should be free from all sentiments of rivalry, and therefore not be engaged in practice,--or at least not in general practice. it would be much better that he should not practise at all on his own account, but should be so remunerated that he might devote all his time and attention to the duties of his office. he should receive a fixed annual stipend, and not be dependent on fees. by this course, he could not be accused of having any interest in the seclusion of the insane under his supervision. so, again, in order to confer on him the necessary independence in the discharge of his duties, his appointment should be made by the lunacy board with the concurrence of the home secretary or of the lord chancellor,--not by the magistrates, nor by any parochial authorities. it should also be a permanent appointment, held during good behaviour, and revocable by the commissioners only, after an investigation of any charges of misconduct, and upon conviction. the acquisition of the services of suitable and competent medical men might be started as a difficulty in carrying out our scheme; yet it is really of so little moment that it scarcely needs discussion. the development of the country perpetually opens up new offices and creates a demand for fitting men to fill them; but, by the law of political economy, that where there is a demand there will be a supply, individuals rapidly come forward who are adapted, or soon become adapted, to the new class of duties. and so it would be on instituting the post of district medical officer in each county or division of a county; for it is to be remembered that the rapid extension of asylums has raised up a class of medical practitioners specially conversant with the insane; so that, when a vacancy occurs in any one such institution, qualified candidates spring up by the dozen, and the difficulty is, not to find a suitable man, but to decide which of many very suitable applicants is the most so. moreover, the anxiety, the mental wear and tear, and the greater or less seclusion of an asylum superintendent's life, are such, that his retirement after some fifteen or twenty years' service is most desirable, although his age itself may not be so far advanced but that many years of active usefulness are before him: to many such a retired superintendent, the post of district medical inspector, even at a very moderate salary, would be acceptable, whilst its duties would be most competently performed by him. our business has been to point out wherein a necessity appears for the appointment of a district medical officer in the interests of the insane, and to indicate, in general, the duties which would devolve upon him in regard to them; but we may be allowed to hint at another set of duties which, we are of opinion, might most advantageously be allotted to him, and afford an additional argument in favour of creating him a public servant, so paid as legitimately to demand his withdrawal from private medical practice. the duties we mean are in connexion with medico-legal investigations in cases of sudden and of violent death, of criminal injuries, and of alleged lunacy; duties, by the way, which are exercised by the district or provincial physicians in continental states. we should, by such an arrangement, obtain the services of a medical man expert in all those inquiries and trials which come before the coroner's court and the higher courts of law; we should obtain a skilled and experienced physician, occupying a position perfectly independent of either side, in any trial or investigation where a medical opinion or the result of medical observation was called for. medical witnesses, in a legal inquiry, are not unfrequently blamed, and still oftener criticized, and perhaps unfairly so, by their professional brethren, respecting the manner in which they may have made an autopsy, or conducted the examination in other ways, touching the cause of death, or an act of criminal violence; and they are always exposed to the rivalry of their neighbours; and wishes that some skilled individual had been sent for in their stead to conduct the investigation, find their way into the public papers. again, it should be remembered that a medico-legal inquiry is an exceptional event in the practice of most medical men: they bring to it no particular experience, and generally they would much prefer to escape such investigations altogether, as they seriously interfere with their ordinary avocations, and obtain for them no adequate remuneration. yet withal, the plan proposed would far from entirely prevent their being engaged in the subjects comprehended in the term 'medical jurisprudence,' or deprive them of fees. as the actual practitioners of the country and always near at hand, they would be the first sent for in any case, the history or termination of which might involve a judicial inquiry; whilst, on the other hand, the district medical officer would have to be summoned and would act in the case only as the representative of the public interests and of the public security. lastly, the district medical officer in the discharge of his duties would not render the services of special medical jurists unnecessary; the chemist, for instance, would be as important in his special calling as he is at the present time, wherever death by poisoning was suspected. it would be beside our purpose in this treatise to enlarge upon the medico-legal duties which would devolve on the district medical officer in the position in which we would place him, or on the benefits that would accrue from his labour to public justice, and to the interests of the state. reflection upon the plan will, we believe, convince any reader, who knows how matters now are, that it would lead to an immense improvement. it appears to be a feature of our countrymen, both in public and private affairs, that they will avoid, as long as possible, recourse to a system or to a plan of organization; they seem to prefer letting matters go on as long as they will in their own way, and only awake to a consciousness that something is wanting when errors and grievances have reached their culminating point, and a continuation in the old course becomes practically impossible. then, when the evil has attained gigantic dimensions, when much injury has been inflicted, and an enormous waste in time and money has occurred, committees of inquiry and special commissioners are hastily appointed, a sort of revelry indulged in the revelations of past misadventures and past folly and neglect; and some scheme is seen to be imperatively necessary, the costliness of which must be endured; and, perhaps, the conviction all at once arises, that the cost of the needed plan of organization, which can be estimated, is in fact much less than what has been submitted to, without attempting an estimate, for a long time before. we lag behind most countries on the continent in our state medical organization; our individual instruments are better, yet they are not co-ordinated in any general system. we trust that this has been in some measure shown in the preceding pages, and that it has been made out, that if the insane, and more particularly those in private houses and those who are paupers, are to be efficiently looked after, and their protection from injuries and their proper care and treatment secured, some such scheme as we have indicated is now called for. surely evils have sufficiently culminated, when at least one-half of the insane inhabitants of this country have either no direct legal protection, are unknown to the publicly-appointed authorities under whose care they ought to be, or are so situated that their protection and their interests are most inadequately provided for. did not a necessity for an improved and extended organization on behalf of the interests of the insane exist, the plea of its cost would probably defeat an attempt to establish it, notwithstanding the plainest proofs of its contingent advantages, and of the fact that sooner or later its adoption would be imperative. but, looking at the question merely with reference to the cost entailed, we believe, that this would not be considerable, and that, as a new burden, it would indeed be very small: for, as we have pointed out, there are certain moneys now paid under acts of parliament, which would, by the organization advocated, become available towards defraying its expenses. for instance, the fee of ten shillings per annum, payable for the quarterly visits to every pauper lunatic not in asylums, would revert to the district officers; as likewise would the fee payable to the physician called upon by the visitors to the licensed houses in every county. we have also proposed a fee to be paid for a quarterly visit to all county patients in lunatic asylums, and to all private patients provided for singly, and are of opinion that a payment should be made for each lunatic or 'nervous' patient, when registered as such, whether pauper or not; the sum, in the case of a pauper, however, of a smaller amount than that for a private lunatic. considering the character and extent of the supervision and attention proposed to be rendered, and the numerous advantages, direct and indirect, which would necessarily accrue from the establishment of the organization suggested, there are certainly good grounds for enforcing payment for services rendered, so as to make the whole scheme nearly, or quite, self-supporting. to repeat one observation before concluding this chapter,--it should be so ordered, that all moneys levied on account of the visits of district medical officers, and of registration, should be paid to the credit of the lunacy board, through the medium of which those officers would receive their salaries. chap. x.--on the lunacy commission. we put forward our remarks upon this subject with all becoming deference; yet it was impossible to take a review of the state of lunacy and of the legal provision for the insane without referring to it. indeed, in previous pages several observations have fallen respecting the duties and position of the commission of lunacy, and the operation and powers of this board have also formed the topic of many remarks and discussions in other books, as well as in journals, and elsewhere. there appears to be in the english character such an aversion to centralization as to constitute a real impediment to systematic government. various questions in social science are allowed, as it were, to work out their own solution, and are not aided and guided towards a correct one by an attempt at system or organization. confusion, errors, and miseries must prevail for a time, until by general consent an endeavour to allay them is agreed upon, and a long-procrastinated scheme of direction and control is submitted to, and slowly recognized as a long-deferred good. such is the history of the care and treatment of the insane. after ages of neglect, evils had so accumulated and so loudly cried for redress, that some plan of conveying relief became imperative; and it is only within our own era, that the first systematic attempt at legislation for the insane was inaugurated. from time to time experience has shown the existence of defects, and almost every parliament has been called upon to amend or to repeal old measures, and to enact new ones, to improve and extend the legal organization for the care and treatment of lunatics and of their property. one most important part of this organization was the establishment of the lunacy commission, which has given cohesion and efficacy to the whole. to the energy and activity of this board are mainly due the immense improvements in the treatment of the insane which characterize the present time, and contrast so forcibly with the state of things that prevailed before this central authority was called into power. the official visitation by its members of all the asylums of the country has imparted a beneficial impulse to every superintendent; the commissioners have gone from place to place, uprooting local prejudices, overturning false impressions, and transplanting the results of their wide experience and observation on the construction and organization of asylums, and on the treatment of the insane, by means of their written and unwritten recommendations, and by their official reports, which form the depositories of each year's experience. an attempt to show the manifold advantages of this central board would be here out of place; but we may, for example's sake, adduce the recent investigation into the condition of lunatics in workhouses, as one of many excellent illustrations of the benefits derived from an independent central authority. but, whilst illustrating how much and how long the supervision of independent visitors has been, and, in fact, still is needed over lunatics in those receptacles, it also proves that the existing staff is inadequate to fulfil the task. we have, indeed, suggested the appointment of a class of district medical officers who would relieve the commissioners from the greatest part of the labour of inspecting workhouse lunatic wards, but we would not thereby entirely absolve them from this duty. an annual visit from one commissioner to each union-house containing more than a given number of lunatics would not be too much; and, to make this visit effectual, the commissioner should be armed with such plenary powers as to make his recommendations all but equivalent to commands, though subject to appeal. at present the lunacy commissioners are practically powerless; the law orders their visits to be made, and sanctions their recommendations, but gives neither to them nor to the officers of the poor law board the power to insist on their advice being attended to if no reasonable grounds to the contrary can be shown. in this matter, therefore, a reform of the law is called for. the court of appeal from the views of the commissioners might be formed of a certain number of the members of the poor law board and of the lunacy commission, combined for the purpose when occasion required. the proposition has been made (p. ) to institute a committee of visitors of workhouses, chiefly selected from the county magistracy; and it is one that will no doubt be generally approved. but to the further proposition, that the supervision of workhouse lunatics should be entirely entrusted to these committees, and that the commissioners in lunacy should not be at all concerned in it, we do not agree; for, in the first place, we wish to see the lunacy commissioners directly interested in every lunatic in the kingdom, and acquainted with each one by their own inspection or by that of special officers acting immediately under their authority; and, in the second place, we desire to retain the visitation of the members of the commission in the capacity of independent and experienced inspectors. the advantages of an independent body of visitors, as stated in the commissioners' 'further report,' (p. ), chiefly with reference to asylums (see p. ), have much the same force when applied to the visitors of workhouses,--that is, if the insane in these latter receptacles are to be placed on an equality, as far as regards public protection and supervision, with their more fortunate brethren in affliction detained in asylums. but, besides the arguments based on the advantages accruing from an independent and experienced body of visitors, there is yet another to be gathered from the past history of workhouses and their official managers: for among the members of boards of guardians, to whom the interests of the poor in workhouses are confided, are to be found, in a large number of parishes, magistrates holding the position of ordinary or of honorary guardians; and, notwithstanding this infusion of the magisterial element, we find that almost incredible catalogue of miseries revealed to us by the lunacy commissioners to be endured by the greater number of lunatics in workhouses. in fact, to assign the entire supervision of workhouse lunatic inmates to a committee of visiting justices is merely to transfer the task to another body of visitors, who have little further recommendations for the office than the boards of guardians as at present constituted. from these and other considerations, we advocate not only the visitation of lunatics in workhouses by the district medical officers proposed, but also, at longer intervals, by one or more of the commissioners or of their assistants; and, if this idea is to be realized, an increase of the commission will be necessary, at least until union-houses are evacuated of their insane inmates. the beneficial results flowing from the visitation of asylums by the lunacy commissioners is a matter of general assent; and the opinion is probably as widely shared, that this visitation should be rendered more frequent. a greater frequency of visits would allay many public suspicions and prejudices regarding private asylums, and would, we believe, be cheerfully acquiesced in by asylum proprietors, who usually desire to meet with the countenance and encouragement of the commissioners in those arrangements which they contrive for the benefit of their patients. the proceeding in question would, likewise, furnish the commissioners with opportunities for that more thorough and repeated examination of cases, particularly of those which are not unlikely to become the subject of judicial inquiries. the ability to do this might, indeed, often save painful and troublesome law processes; for, surely, the careful and repeated examinations of the commissioners, skilled in such inquiries, when terminating in the conclusion that the patient is of unsound mind, and rightly secluded, should be accounted a sufficient justification of the confinement, and save both the sufferer and his friends from a public investigation of the case. the decision of the lunacy commissioners, we are of opinion, should be held equivalent to that of a public court, and should not be set aside except upon appeal to a higher court, and on evidence being shown that there are good reasons for supposing the original decision to be in some measure faulty. is not, it may be asked, the verdict of a competent, unprejudiced body of gentlemen, skilled in investigating lunacy cases, of more value than that of a number of perhaps indifferently-instructed men, of no experience in such matters, under the influence of powerful appeals to their feelings by ingenious counsel, and confounded by the multiplicity and diversity of evidence of numerous witnesses, scared or ensnared by cross-examination in its enunciation? again, the more frequent visitation of the insane by the commissioners would be productive of the further benefit of obviating the imputation that patients are improperly detained after recovery; and it would also, in some cases, be salutary to the minds of patients, fretting under the impression of their unnecessary seclusion; for the inmates of asylums naturally look to the commissioners for release, anticipate their visits with hope, and regret the long interval of two, three, or more months, before they can obtain a chance of making their wants known, particularly since they are conscious how many affairs are to be transacted during the visit, and that only one or two of their number can expect to obtain special consideration. there is, moreover, a new set of duties the commissioners propose to charge themselves with, involved in the clause of the bill introduced in the last session of parliament (clause ), requiring information to be given them of the payment made for patients in asylums, in order to their being able to satisfy themselves that the accommodation provided is equivalent to the charges paid. this task will necessarily entail increased labour on the commission, and lead, not only to inquiries touching the provision made for the care and comfort of the patients within the asylum, but also to others concerning the means in the possession of their friends, and the fair proportion which ought to be alloted for their use. in short, we cannot help thinking that the duties proposed will frequently lead the commissioners to take the initiative in a course of inquiries respecting the property of lunatics available for their maintenance. according to present arrangements, although every asylum in the country is under the jurisdiction of the commissioners in lunacy, yet, beyond the metropolitan district, their jurisdiction is divided, and the county magistrates share in it. indeed, provincial asylums are placed especially under the jurisdiction of the magistrates, by whom the plans of licensed houses are approved, licences granted or revoked, and four visitations made in the course of each year; whilst the commissioners, although they can, by appeal to the chancellor, revoke licences in the provinces, are not concerned in granting them, and make only two visits yearly to each licensed house beyond the metropolitan district. this variety in the extent of the jurisdiction of the lunacy board in town and country, is, to our mind, anomalous, and without any practical advantage. if the magisterial authority is valuable in the regulation of asylums at one portion of the country, it must be equally so at another; the 'non-professional element' (evid. com., query ), if of importance in the country, must be equally so in the neighbourhood of the metropolis. we do not argue against the introduction of magisterial visitation of asylums, but against the anomaly of requiring it in the country and not in town, and against treating provincial asylums as not equally in need of the supervision of the central board with the metropolitan. we perceive a distinction made, but cannot recognize a difference. there is a single jurisdiction in the instance of one set of asylums, and a divided one in that of another; and yet the circumstances are alike in the two. the real explanation of this anomaly in the public supervision and control of asylums, is, we believe, to be found in the fact of the inadequacy of the lunacy commission to undertake the entire work. the superiority of the commissioners, as more efficient, experienced, and independent visitors, will be generally admitted; but they are too few in number to carry out the same inspection of all the private asylums in the country, as they do of those in the metropolitan district. the commissioners are free from local prejudices, unmixed in county politics, and constitute a permanent, unfluctuating board of inspection and reference; whereas county and borough magistrates owe their appointment usually to political considerations and influence: politics are a subject of bitter warfare among them in most counties; local and personal prejudices and dislikes are more prone to affect them as local men; and, withal, the committees of visiting justices are liable to perpetual change, and, out of the entire number elected on a committee, the actual work is undertaken only by a few, who therefore wield all the legal powers entrusted to the whole body. a passage from the 'further report' of the lunacy commissioners ( ) recently referred to (p. ) may be serviceably quoted in this place. speaking of the extracts selected by them for publication in the report, "to show that occasions are continually arising, where the intervention of authority is beneficial," the commissioners proceed to remark that "the defects adverted to in the extracts may sometimes appear to be not very important; but they are considerable in point of number, and, taken altogether, the aggregate amount of benefit derived by the patients from their amendment, and from the amendment of many other defects only verbally noticed by the commissioners, has been very great. it is most desirable that no defect, however small, which can interfere with the comfort of the patient, should at any time escape remark. a careful and frequent scrutiny has been found to contribute more than anything else to ensure cleanliness and comfort in lunatic establishments, and good treatment to the insane. these facts will tend to show how advantageous, and indeed how necessary, is the frequent visitation of all asylums. it is indispensable that powers of supervision should exist in every case; that they should be vested in persons totally unconnected with the establishment; and that the visitations should not be limited in point of number, and should be uncertain in point of time: for it is most important to the patients that every proprietor and superintendent should always be kept in expectation of a visit, and should thus be compelled to maintain his establishment and its inmates in such a state of cleanliness and comfort as to exempt him from the probability of censure. we are satisfied, from our experience, that, if the power of visitation were withdrawn, all or most of the abuses that the parliamentary investigations of , , and brought to light, would speedily revive, and that the condition of the lunatic would be again rendered as miserable as heretofore." we have in past pages referred to magisterial authority in relation with the pauper insane, as frequently exercised prejudicially, and with reference to asylum construction and organization, as sometimes placed in antagonism to acknowledged principles and universal practice, much to the injury of the afflicted inmates. its operation is not more satisfactory when extended to the duties of inspection. we have heard complaints made that magistrates sometimes act very arbitrarily in their capacity of visitors to asylums, and that it is not uncommon for them, instead of acting in concert with the commissioners in lunacy, to place themselves in opposition to their views. in fact, the annual reports of the commissioners testify to the not unfrequent want of harmony between the visiting magistrates and the commissioners in lunacy; and the very facts, that the latter have to make special yearly reports to the lord chancellor on the neglect or unfitness of certain private houses, and that they have sometimes to apply to him to revoke licences, demonstrate that the magisterial authorities are at times backward and negligent in their duties. indeed, the impression to be gathered from the annual reports of the commission is, that almost the only efficient supervision and control of provincial asylums are exercised by the lunacy commissioners. the publication of the evidence before the select committee ( ) adds fresh proofs that magistrates make but indifferent visitors of asylums, and but imperfectly protect the interests of the insane; and that an extension of the jurisdiction and of the inspection by the lunacy commissioners is much needed. we would refer for particulars to queries and answers numbered from to , and from to . we have commented in previous pages on the manner in which the visiting justices of public asylums perform their duties, and need not repeat the statements already made; yet we may here remark that the visitation of the wards of county asylums is often so very carelessly made, that it has little or no value, and that it is frequently difficult to get the quorum of two justices to make it, the majority objecting on personal and other grounds. from the foregoing considerations we would advocate the extension of the commissioners' jurisdiction, and its assimilation to that in force within the metropolitan district. to extend it merely to thirty miles around the metropolis, as some have proposed, would be only to increase the anomaly complained of. the lunatics, and those in whose charge they live, in every district in england, should be under one uniform jurisdiction, with the authority and protection of one set of public officers and one code of rules. if magisterial supervision have a real value, let it be superadded to a complete scheme of inspection and control exercised by the lunacy commissioners; and if it exist anywhere, let no district be exempt from it; for the existence of any such exemption furnishes a standing argument against the value attributed to its presence. for instance, it may be fairly asked,--are the metropolitan licensed houses any the worse for the absence of magisterial authority, or, otherwise, are the provincial any better for its presence? according to lord shaftesbury's evidence,--and his lordship is favourable to the authority of the justices being perpetuated,--the system of licensing provincial houses is sometimes loosely conducted; the house is only known to the licensing magistrates by the plan presented, and its internal arrangements must be virtually unknown, inasmuch as no inspection is made of the premises. this furnishes an argument for handing over the licensing power to the commissioners in lunacy, who exercise this portion of their duties with the greatest care and after the most minute examination. but, besides this, the position of a magistrate does not afford in itself any guarantee of capacity for estimating what the requirements of the insane ought to be, or of judging of the fitness of a house for their reception. the act of licensing should certainly be conducted upon one uniform system and set of regulations; and the revocation of licences should likewise be in the hands of one body. no division of opinion should arise between a public board and a committee of justices respecting the circumstances which should regulate the granting or the refusing, the continuation or the revocation of a licence. a divided, and therefore jarring jurisdiction, cannot be beneficial; and the arguments for the introduction of the magisterial element depend on the popular plea for the liberty of local government,--a liberty, which too often tends to the annihilation of all effectual administration. if our views are correct, and if the jurisdiction of the commissioners in lunacy ought to be increased, then, as a result, the number of commissioners must also be augmented. in the need of this increase, very many, indeed the large majority of persons acquainted with the legal provisions made for the care and treatment of lunatics, concur; and reasons for it will still further appear upon a review of the other functions assigned to the commissioners, and of those with which we would charge them. by existing arrangements there are two state authorities concerned with lunatics, one particularly charged with their persons, whether rich or poor,--the lunacy commission;--the other with their estates, and therefore, with those only who have more or less property,--the office of the masters in lunacy. here, then, is another instance of divided jurisdiction, although it is one wherein there are no cross-purposes, the distinction of powers and duties being accurately defined in most respects. perhaps the separation of the two authorities is too distinct and too wide, and a united jurisdiction might work better; but on this point we forbear to speak, not having the knowledge of the laws of property and of their administration necessary to guide us to a correct conclusion. yet we may thus far express an opinion, that the visitation of lunatics, whether found so by inquisition or not, should devolve on the members of the lunacy commission. we can perceive no reason for having distinct medical visitors to chancery lunatics; as it is, a large number of such lunatics is found in asylums and licensed houses, and comes therefore under the inspection of the commissioners. thus, according to the returns moved for by mr. tite ( ), it appears there are lunatics, in respect of whom a commission of lunacy is in force, and of these, are inmates of asylums; therefore one-half of the entire number of such lunatics is regularly inspected by the lunacy commissioners, and the visits of the "medical visitors of lunatics" are nothing else than formal; we would therefore suggest that two assistant commissioners should be added to the lunacy board, who should receive the salaries now payable to the chancery lunatics' medical visitors, be disallowed practice, and be entirely engaged as medical inspectors under the direction of the board; or that, in other words, the moneys derived from the lunacy masters' office should be paid over to the commission for its general purposes, upon its undertaking to provide for the efficient protection and visitation of all lunatics, so found on inquisition. the plan of bringing all lunatics and all so-called 'nervous' patients, whether placed out singly or detained in asylums of any sort under the cognizance and care of the commission, as enlarged upon in previous pages, would materially augment the labours of the central office; and, in our humble opinion, a greater division of labour than has hitherto marked the proceedings of the commission would greatly facilitate the work to be done. at present, the members of the commission perform a threefold function; viz. of inspectors, reporters, and judges. the task of inspecting asylums and their insane inmates, of ascertaining the treatment pursued and examining the hygienic measures provided, is peculiarly one falling within the province of medical men, and should be chiefly performed by medical commissioners. on the other hand, the business of the board, in its corporate capacity, is only indirectly and partially medical. lord shaftesbury, indeed, goes so far as to say (query , evid. com.) "that the business transacted at the board is entirely civil in ninety-nine cases out of one hundred. a purely medical case does not come before us once in twenty boards." these considerations certainly appear to indicate a natural and necessary division of the board into a deliberative central body, sitting _en permanence_, once, twice, or oftener in the week, if necessary, and a corps of visitors and reporters to examine the state of asylums and the insane throughout the country. this division of the commission would obviate the chief objection to an increase of the number of members; viz. that a larger number of commissioners than at present would render the board unwieldy, and rather impede than facilitate its business as a deliberative assembly. we entertain, moreover, the opinion that it would be more satisfactory to those who sought instructions, or whose affairs or conduct were in any way the subject of investigation, to have to deal with such a permanent deliberative or judicial body as proposed, than with one combining, like the members of the present board, the various functions of inspectors, reporters, and judges; a condition, whereby any question agitated must, to a certain extent, be prejudged by the official reports of the very same persons called upon to examine it. again, if this proposed division of the lunacy board took place, it would furnish a better justification for increasing certain of its powers, as these would be wielded by a permanent deliberative body, instead of, as at present, by a commission exercising mingled functions. the value of the board would be increased as a court of reference in all matters, such as the construction and the size of asylums, where the authority of the state, by duly ordered channels, is called for to overrule the decisions of local administrative bodies. lastly, this arrangement would facilitate the amalgamation, proposed by some persons, of the office of the masters with the commission in lunacy; or it would, at least, render the co-operation and combined action of the two offices more simple and easy. there are other reasons for an increase of the staff of the lunacy commission, following from the amount of work which, by any revision of existing statutes, must fall within the compass of its operations. for instance, we regard the suggestion that we have made, that no uncured lunatic or 'nervous' patient should be removed from an asylum or other establishment, without the sanction of the commissioners and their approval of the place and conditions to which the removal is intended,--as very important for the protection of the insane. to carry out this duty will involve a certain amount of labour, particularly as it would often require some member of the commission to examine the patient and the locality in which it is proposed to place him, and to report on the expediency of his removal. often, perhaps, this business might be entrusted to the district medical officer, particularly in the country. on the other hand, in the metropolitan district, the work of district medical officers might be advantageously performed,--at least in all that concerns the insane,--by a couple of the assistant commissioners hereafter spoken of, in addition to their other duties elsewhere. another piece of evidence, to our apprehension, that the present commission is inadequate to the multifarious duties imposed upon it, is, that the commissioners have never hitherto effectually inspected gaols, nor succeeded in getting imbecile and lunatic criminals reported to them with the least approach to accuracy. the inspection of workhouses proved that it did not suffice to receive the reports of workhouse officials respecting the existence and number of insane inmates, but that, to ascertain these facts, personal examination by the commissioners was necessary; and there is no satisfactory reason for supposing the discrimination of insane prisoners to be much better effected than that of workhouse lunatics, in the many prisons distributed over the country. it comes out, in the course of the evidence before the select committee, , that the commissioners know little about the insane inmates of gaols, and that reports of the presence of such inmates are but rarely supplied them. the law requires the commissioners to visit gaols where any lunatics are reported to them to exist; but the duty of reporting is made the business of no particular individual, and therefore, as a natural consequence, no one attends to it. in the evidence referred to, the case of ten alleged lunatics, committed to york castle and imprisoned there for a series of years, as criminals acquitted on the ground of insanity, elicited much attention, and lord shaftesbury alluded to the interference of the lunacy commission on behalf of several lunatics in different prisons. the fact we have brought to light from one government report, as stated at p. of this treatise, is of much moment in discussing the present subject; viz. that there were as many as persons of unsound mind in the ten convict prisons under the immediate control of the government, in the course of one year, and that of these the dartmoor prison wards contained as many as such inmates. there is no allusion, in the commissioners' reports or in the printed evidence of the select committee, to show that these insane prisoners were visited by, or known to, any members of the lunacy board. but, besides these insane inmates thus distinctly made known to us to exist in so few prisons, there must be many more detained in the numerous houses of detention throughout the kingdom. these facts render it an obvious duty on the part of the commission of lunacy to ascertaining the number and condition of this unhappy class of lunatics, and to order suitable provision to be made for them. there is a disposition on the part of some visitors of gaols to erect, or set apart, special wards for lunatic prisoners; a system to be much more deprecated than even the establishment of lunatic wards in connexion with workhouses, and one which will require the active interposition of the lunacy board to discourage and arrest. it were easy to take up the duties of the commissioners in lunacy in detail, and to show that they cannot be efficiently performed by the existing staff; but the fact will be patent to any attentive reader of this chapter and of the foregoing dissertations on the provisions necessary for the care and supervision of lunatics in general. the scheme which we have, with all due deference to established authorities, sketched in outline, to increase the jurisdiction and usefulness of the lunacy commission, provides for a division of its staff; in the first place, by altering to a greater or less extent the character and position of the present board, so as to constitute it a fixed central commission or council, chiefly charged with adjudging and determining questions put before it; with superintending the public arrangements for the interests of the insane generally, and with providing for the good and regular management, organization, and construction of lunatic asylums; and in the next place, by instituting, in connexion with this head deliberative body (which need not, by the way, consist of so many members as the present commission), a corps of assistant commissioners, specially charged with the duties of visitation, inspection, and reporting, and with the carrying out of the resolutions determined on by the deliberative council. at the same time, the power of visiting and reporting might still be left with some commissioners under certain circumstances, as well as in making special investigations, and in examining matters of dispute raised upon the reports of the assistants. though differing from so high an authority as the noble chairman of the lunacy board, we must say that we cannot conceive of it as at all a necessary consequence, that, if the work of visitation to asylums and lunatics is performed by a class of inspectors or assistant commissioners, and not by the present members of the commission, it must be indifferently done, and prove a source of dissatisfaction:--that is, we have no such apprehensions, provided always that proper men are appointed, and that their official status is made what it ought to be, both in remuneration and in independence of position. nor can we agree to the giving up of the proposed plan on the score of its expense. if the whole of the lunatic and 'nervous' people suffering confinement in this country are to be brought within the knowledge and under the supervision of the lunacy commissioners, if the enlarged provisions of the law necessary for their proper care and treatment,--and even those only among them proposed by the commissioners themselves are to be carried into effect,--the commission must be increased. and, instead of adding new commissioners on the same footing and salary as the existing ones, we believe the public would be better served by the appointment of assistant commissioners with the duties we have proposed,--two of whom could be remunerated at the same outlay as one full commissioner. moreover, we have proposed that the sum payable out of the masters' office to medical visitors be devoted to the purposes of the commission; and, if our notion of a central deliberative body were accepted, one legal and one medical member of the present commission could well be spared to undertake more especially the duties of visiting commissioners. lastly, if the jurisdiction and powers of the commission were extended to all lunatics living singly and to so-called 'nervous patients,' a considerable addition to the treasury would be obtained, even by a small tax, or per-centage on income. probably six assistant commissioners, constantly employed in the work of inspection, with the aid of two visiting chief commissioners from the present board, would suffice for the discharge of the duties to be entrusted to them. if so, the cost of six such additional officers would be very trifling, covered as it would be by increased funds passing into the hands of the central office in the administration of the improved legislation. if precedent be a recommendation to a plan, it can be found in favour of appointing assistant commissioners in the example of the scotch lunacy commission, and in the constitution of the poor law board, which has a distinct class of officers known as inspectors. in fact, every other government board or commission, except that of lunacy, has a staff of assistants or of inspectors. chap. xi.--on some principles in the construction of public lunatic asylums. in the preceding pages of this book we have had occasion to discuss many important points respecting the organization of public asylums; and, as we entertain some views at variance with the prevalent system of asylum construction, a supplementary chapter to elucidate them cannot be misplaced. the substance of the following remarks formed the subject of a chapter on asylum construction published by us in the 'asylum journal' (vol. iv. , p. ) above a year since, and, as we then remarked, the principles put forward had been adopted by us some five or six years previously, and were strengthened and confirmed by the extended observations we had personally made more recently on the plans and organization of most of the principal asylums of france, germany, and italy. all the public asylums of this country are, with slight variations, constructed after one model, in which a corridor, having sleeping-rooms along one side, and one or more day-rooms at one end,--or a recess (a sort of dilatation or offset of the corridor at one spot), in lieu of a room, constituting a section or apartment fitted for constant occupation, day and night, forms--to use the term in vogue--a 'ward.' an asylum consists of a larger or smaller number of these wards, united together on the same level, and also superposed in one, two, three, and occasionally four stories. there are, indeed, variations observed in different asylums, consisting chiefly in the manner in which the wards are juxtaposed and disposed in reference to the block and ground plans, or in the introduction of accessory rooms, sometimes on the opposite side of the corridor to the general row of small chambers, to be used as dormitories or otherwise; but these variations do not involve a departure from the principle of construction adopted. those who have perambulated the corridors of monastic establishments will recognize in the 'ward-system' a repetition of the same general arrangements,--a similarity doubtless due in part to the fact of ancient monasteries having been often appropriated to the residence of the insane, and in part to the old notions of treatment required by the insane, as ferocious individuals, to be shut apart from their fellow-men. whilst the ideas of treatment just alluded to prevailed, there was good reason for building corridors and rows of single rooms or cells; but, since they have been exploded, and a humane system of treating the insane established in their place, the perpetuation of the 'ward-system' has been an anomaly and a disastrous mistake. the explanation of the error is to be found in the facts,--that medical men in england, engaged in the care of the insane, have contented themselves with suggesting modifications of the prevailing system,--than which indeed they found no other models in their own country; and that the usual course has been, to seek plans from architects, who, having no personal acquaintance with the requirements of the insane, and the necessary arrangements of asylums, have been compelled to become copyists of the generally-approved principle of construction, which they have only ventured to depart from in non-essential details, and in matters of style and ornamentation. the literature of asylum architecture in this country evidences the little attention which has been paid to the subject. the only indigenous work on asylum-building--for the few pages on construction in tuke's introduction to his translation of jacobi's book, and the still fewer pages in dr. brown's book on asylums, published above twenty years ago, do not assume the character of treatises--is the small one by dr. conolly, and even this is actually more occupied by a description of internal arrangements in connexion with the management of lunatics, than by an examination of the principles and plans of construction. this bald state of english literature on the subject of construction contrasts strongly with the numerous publications produced on the continent, and chiefly by asylum physicians, the best-qualified judges of what an asylum ought to be in structure and arrangements. however, to resume the consideration of the 'ward-system' as it exists, let us briefly examine it in its relations to the wants and the treatment of the insane. every day adds conviction to the impression, that the less the insane are treated as exceptional beings, the better is it both for their interests and for those who superintend them. in other words, the grand object to be kept in view when providing for the accommodation of the insane, is to assimilate their condition and the circumstances surrounding them as closely as possible to those of ordinary life. now, though it is clearly impracticable to repeat all the conditions of existence prevailing in the homes of the poorer middle and pauper classes of society who constitute the inmates of our public asylums, when these persons are brought together to form a large community for their better treatment and management, yet we may say of the 'ward-system,' that it is about as wide a departure from those conditions as can well be conceived. it is an inversion of those social and domestic arrangements under which english people habitually live. the new-comer into the asylum is ushered into a long passage or corridor, with a series of small doors on one side, and a row of peculiarly-constructed windows on the other; he finds himself mingled with a number of eccentric beings, pacing singly up and down the corridor, or perhaps collected in unsocial groups in a room opening out of it, or in a nondescript sort of space formed by a bulging-out of its wall at one spot, duly lighted, and furnished with tables, benches, and chairs, but withal not a room within the meaning of the term, and in the patient's apprehension. presently, he will be introduced through one of the many little doors around him into his single sleeping-room, or will find himself lodged in a dormitory with several others, and by degrees will learn that another little door admits him to a lavatory, another to a bath, another to a scullery or store-closet, another to a water-closet (with which probably he has never been before in such close relation), another to a _sanctum sanctorum_--the attendant's room, within which he must not enter. within this curiously constructed and arranged place he will discover his lot to be cast for all the purposes of life, excepting when out-door exercise or employment in a workroom calls him away: within it he will have to take his meals, to find his private occupation or amusement, or join in intercourse with his fellow-inmates, to take indoor exercise, and seek repose in sleep; he will breathe the same air, occupy the same space, and be surrounded by the same objects, night and day. this sketch may suffice to illustrate the relations of a ward as a place of abode for patients, and to exhibit how widely different are all the arrangements from those they have been accustomed to. let us now notice briefly the relations of the ward-system to the treatment required for insane inmates. the monotonous existence is unfavourable: the same apartment and objects night and day, and the same arrangements and routine, necessitated by living in a ward, are not conducive to the relief of the disordered mind. where access to the sleeping-rooms is permitted by day, the torpid and indolent, the melancholic, the morose and the mischievous, will find occasion and inducement to indulge in their several humours; opportunity is afforded them to elude the eye of the attendants, to indulge in reverie, and to cherish their morbid sentiments. when the rules of the institution forbid resort to their rooms by day, the idea of being hardly dealt with by the refusal will probably arise in their minds, since the inducement to use them is suggested by their contiguity; the doors, close at hand, will ever create the desire to indulge in the withheld gratification of entering them. how many insane are animated with a desire to lounge, to mope unseen, and to lie in bed, needs not to be told to those conversant with their peculiarities; and, surely, the removal of the temptation to indulge would be a boon both to physician and patients. again, the corridor and its suite of rooms present obstacles to ventilation and warming, and, as the former in general serves, besides the purpose of a covered promenade, that of a passage of communication between adjoining wards, it is less fitted for the general purposes of daily life, and the passage to and fro of persons through it is a source of disturbance to its occupants, and often objectionable to the passer-by. as a place of indoor exercise, the corridor has little real value, especially when considered in relation to the other objects it has to serve. those who desire to sit still, to read, to amuse or to employ themselves, feel it an annoyance to have one or more individuals walking up and down, and often disposed to vagaries of various sorts; few of the whole number care for perambulating it if they can get out of doors for exercise (and there are not many days when they cannot), and, as far as concerns the health of those few who use the corridor for exercise, it would be better to encourage them to walk in the grounds, than, by having such a space within doors, to induce their remaining there. when casual sickness or temporary indisposition overtakes a patient, and a removal to the infirmary ward is not needed, though repose is required, it is a great disadvantage to have an exercising corridor in such immediate contiguity with the bedroom, and to have the room open into the corridor; for it is an arrangement more or less destructive of quiet, and exposes the poor sufferer to the intrusion of the other inmates of the ward, unless the room-door be locked,--a proceeding rarely advisable under the circumstances supposed. the introduction of the plan of building an open recess in a corridor as a sitting apartment instead of an ordinary room was a consequence of the difficulties experienced in exercising an efficient supervision of the inmates when dispersed, some in the corridor, and others in the day or dining rooms. yet, although the plan in question partially removes these difficulties, no one could wish to exchange the advantages in comfort and appearance of a sitting-room with the greater approximation it affords to the ordinary structure of a house, for a recess in a corridor, if effectual supervision could in any other way be attained. but the plan of a corridor with an offset in lieu of a room does not secure a completely effective oversight, control, and regulation of the occupants, since it presents many opportunities, in its large space, and by the disposition of its parts, for those to mope who may be so disposed, and for the disorderly to annoy their neighbours, without arresting the attention of the one or two attendants. in the construction and arrangements of a ward, it is necessary to provide for all the wants of the inmates both by day and night, to supply the fittings and furniture needed by the little community inhabiting it; and all such arrangements and conveniences have consequently to be repeated in every one of the many wards found in the asylum, at a very large cost. again, by the ward-system, the patients are lodged on each floor of the building, and therefore the service of the asylum becomes more difficult, just in proportion to the number of stories above the ground-floor, or the basement, where the kitchen and other general offices are situated. it is chiefly to obviate this difficulty that the elevation of our public asylums has been limited to two stories, and a greater expenditure thereby incurred for their extension over a larger area. (see p. .) from whatever point of view the ward-system may be regarded, there is in it, to our view, an absence of all those domestic and social arrangements and provisions which give a charm to the homes of english people. the peculiar combination of day and night accommodation is without analogy in any house; whilst the sitting, working, or reading, and, occasionally, the taking of meals, in a corridor, a place used also for exercise, and for the passage of persons from one part of the asylum to another, represent conditions of life without parallel among the domestic arrangements of any classes of the community. the principle of construction we contend for is, the separation, as far as practicable, of the day from the night accommodation. instead of building wards fitted for the constant habitation of their inmates, we propose to construct a series of sitting or day rooms on the ground-floor, and to devote the stories above entirely to bedroom accommodation. not that we would have none to sleep on the ground-floor, for we recognise the utility of supplying accommodation there, both by night and day, for certain classes of patients, such, for instance, as the aged and infirm, who can with difficulty mount or descend stairs; the paralytics; some epileptics, and others of dirty habits, and the most refractory and noisy patients. the last-named are, in our opinion, best lodged in a detached wing, particularly during their paroxysms of noise and fury, according to the plan adopted in several french asylums. and we may, by the way, remark, that if such patients were so disposed of, one reason assigned for internal corridors as places requisite for indoor exercise, would be set aside, inasmuch as these are supposed practically to be most useful to that class of asylum inmates. in our paper on construction in the 'asylum journal,' before referred to, we illustrated (_op. cit._ p. ) our views by reference to a rough outline of a part of a plan for a public asylum we had some years before designed; but it seems unnecessary to reproduce that special plan here, since, if the principle advocated be accepted, it becomes a mere matter of detail to arrange the disposition, the relative dimensions, and such like particulars, whether of the day-rooms below or of the chambers above. there is this much, however, worth noting, that, by the construction of adjoining capacious sitting-rooms, it is easy so to order it, that any two, or even three, may, by means of folding-doors, be thrown into one, and a suite of rooms obtained suited for public occasions, for dancing, for lectures, or theatricals. so again, even in the case of those who may be placed together in the same section of the establishment, and who join at meals, the construction of two or more contiguous sitting-rooms affords an opportunity for a more careful classification, in consideration of their different tastes, and of their capability for association, for employment, or for amusement. however, without delaying to point out the advantages accruing in minor details of internal arrangements when the principle is carried out, let us briefly examine its merits abstractedly, and in relation to the system in vogue. . it assimilates the condition of the patients to that of ordinary life, as far as can be done in a public institution. they are brought together by day into a series of sitting-rooms adapted to the particular class inhabiting them, and varied in fittings and furniture according to the particular use to which they are applied,--as, for instance, for taking meals, or for the lighter sorts of work, indoor amusements, and reading. for the sections, indeed, inhabited by the more refractory and the epileptic, a single day-room would suffice. when thus brought together in rooms, instead of being distributed along a corridor and its divergent apartments, association between the several patients can be more readily promoted; and this is a matter worth promoting, for the insane are morbidly selfish and exclusive. likewise, it becomes more easy for the attendants to direct and watch them in their amusements or occupations, and to give special attention or encouragement to some one or more of their number without overlooking the rest. besides this, rooms admit of being arranged and furnished as such apartments should be; whilst, whatever money may be laid out in furnishing and ornamenting corridors, they can never be rendered like any sort of apartment to be met with in the homes of english people. the separation of the sleeping-rooms from the day accommodation also has the similar advantage of meeting the wishes and habits of our countrymen, who always strive to secure themselves a sitting and a bed room apart: and, altogether, it may be said, that in a suite of day-rooms disposed after the plan advocated, and in the perfectly separated bedroom accommodation, there is, to use a peculiarly english word, a _comfort_ completely unattainable by the ward-system, however thoroughly developed. . greater salubrity and greater facilities for warming and ventilation are secured. it will be universally conceded that sleeping-rooms are more healthy when placed above the ground-floor, so as to escape the constant humidity and exhalations from the earth, particularly at night. the system suggested secures this greater salubrity for the majority of the population, who occupy the upper floors during the night; those only being excepted, whom, for some sufficient reason, it is desirable not to move up and down stairs, or not to lodge at night in the immediate vicinity of the rest of the patients. again, the separation of the apartments for use by day from those occupied at night favours the health of the establishment by rendering ventilation more easy and complete. in a ward occupied all day and all night, the air is subject to perpetual vitiation, and, whilst patients are present, it is, especially in bad weather, difficult or quite unadvisable to attempt thorough ventilation by the natural means of opening windows and doors,--a means which we believe to be preferable to all the schemes of artificial ventilation of all the ingenious engineers who have attempted to make the currents of air and the law of diffusion of gases obedient to their behests. but "the wind bloweth where it listeth," and all the traps set to catch the foul exhalations, and all the jets of prepared fresh air sent in from other quarters, will not serve their bidding: the airy currents will disport themselves pretty much as they please, and intermingle in spite of the solicitations of opposing flues to draw them different ways. but if, on our plan, the apartments for day use are kept completely distinct from those used by night, each set being emptied alternately, a most thorough renewal of air may be obtained by every aperture communicating with the external atmosphere. the actual construction of a ward creates an impediment to the perfect ventilation of all its apartments. there is a wide corridor, and along one side a series of small chambers, the windows of which are necessarily small, and sometimes high up; the windows, too, both in rooms and corridor, must be peculiarly constructed, and the openings in them for ventilation small. although it is easy in this arrangement to get a free circulation of air along the corridor, it is not so to obtain it for each room opening out of it. by the scheme of construction we propose, these difficulties are mostly removed. the day-rooms on the ground-floor need no corridor alongside, and, as a single series or line of apartments, are permeated by a current of air traversing them from side to side. but if, for the convenience of the service of the house, some passage were thought necessary, it would be external to the rooms, and in designing the asylum it should be an object to prevent such corridors of communication interfering with the introduction of windows on the opposite sides of each sitting-room. on the bedroom-floor above, a corridor, where necessary, would not be a wide space for exercise, such as is required for a ward, but merely a passage, giving access from one part of the building to another. so, with respect to the windows, except those in the single bedrooms, it would be perfectly compatible with security to construct them much after the usual style adopted in ordinary houses, and thereby allow large openings for the free circulation of air. further, when the patients inhabit ordinarily-constructed sitting-rooms, the warming of these may be effected by the common open fires, which are dear to the sight and feelings of every englishman, and impart a cheerful and home-like character. likewise, there would be no need of keeping the whole building constantly heated at an enormous expense; for only one half of it would be occupied at a time, nor would those most costly and complicated systems of heating be at all required. the saving in large public asylums would be something very large in this one item,--that of fuel to burn, without counting the expenditure which is generally incurred for the heating apparatus, flues, furnaces, and shafts. as with the warming, so with the lighting of an institution constructed on our model,--only one-half would require illumination at the same time, and much gas-fitting would be saved by the diminution of the number of small apartments, repeated, after the prevailing model, in every ward, and requiring to be lighted. . access to the airing courts, offices, workshops, &c., becomes easier to all the inmates. according to the established system of construction, the half, or upwards, of the patients have to descend from the wards on the upper floors for exercise or for work, and to ascend again to them for their meals, or to retire to rest. this ascent and descent of stairs may have to be repeated several times daily; and it must be remembered that it cannot take place without the risk of various inconveniences and dangers necessarily dependent on stairs, and that it must frequently entail trouble and anxiety upon the attendants, particularly in mischievous and in feeble cases. the plan advocated obviates all these evils, so far as practicable. the patients would have to go up and down stairs only once a-day, and the attendants, therefore, escape much of the constantly occurring trouble of helping the feeble, or of inducing the unwilling to undertake the repeated ascent and descent,--a task ever likely to be neglected, and to lead to patients being deprived, to a greater or less extent, of out-door exercise and amusement. . it facilitates supervision. supervision, both by the medical officers and by the attendants, becomes much more easy and effectual when the patients are collected in rooms, affording them no corners or hiding-places for moping and indulging in their mental vagaries, their selfishness and moroseness. when the medical officer enters the day-room, all the inmates come at once under his observation, and this affords him the best opportunity of noting their cases, and of discovering their condition and progress. by the attendants similar advantages are to be gained; the patients will be more immediately and constantly under their eye than when distributed in a corridor and connected rooms; their requirements will be sooner perceived, and more readily supplied; their peculiarities better detected and provided against; their insane tendencies more easily controlled and directed; whilst, at the same time, the degree and mode of association will call forth feelings of interest and attachment between the two. just as supervision becomes more easy by day, so does watching by night; for almost the whole staff of attendants would sleep on the same floor with the patients, and thereby a more immediate communication between them be established, and a salutary check on the conduct of the latter, from the knowledge of the attendants being close at hand, more fully attained. perhaps these advantages will appear more clear when it is understood that the subdivision of the bed-room floor into several distinct wards, cut off from each other by doors, stair-landings, &c., would not be at all necessary on the principle of construction recommended. the comparatively few noisy patients in a well-regulated asylum would occupy the sleeping-rooms of the ground-floor wings, if not placed in a distinct section; and therefore, the inhabitants of the floor above being all quiet patients, no partitions need separate their section of the building into distinct portions or wards, and act as impediments to the freedom of communication and ventilation. this matter of the partitions needed is, however, a point of detail, which would have to be determined pretty much by the general design adopted. . classification is more perfect. owing to the sleeping apartments being quite distinct from those occupied by day, the rule usually observed in a ward, as a matter of necessary convenience, of keeping the same group of occupants in it both night and day, need not at all be followed. on retiring from their sitting-rooms, where they have been placed according to the principles of classification pursued, the day association would be broken up, and their distribution in the sleeping-rooms might be regulated according to their peculiar requirements at night. this valuable idea, of arranging patients differently by day and by night, was put forward by dr. sankey, of hanwell ('asylum journal,' vol. ii. , p. ), in the following paragraph:--"whatever the basis of the classification, it will not hold good throughout the twenty-four hours: why, therefore, should it be attempted to make it do so? at night the classification should be based on the requirement of the patient during the night; and during the day, the patient should be placed where he can be best attended during the day." let us add, that the more perfectly dr. sankey's principle could be carried out, the more easy would supervision be rendered. since mechanical restraint has been set aside, seclusion in a specially-constructed chamber, or in the patient's own room, has in some measure taken its place, and been frequently abused; for it is more difficult to control the employment of seclusion than of instrumental restraint, and in a ward there is almost a temptation to employ it where a patient is inconveniently troublesome to the attendant; the single room is close at hand, and it is a simple matter to thrust the patient into it, and an easy one to release him if the footstep of the superintendent is heard approaching. the plan of construction we would substitute for the ward-system would almost of itself cure the evil alluded to. furthermore, since sitting-rooms and other apartments to meet the exigencies of daily use are excluded from the upper floors, it would become easier for the architect to dispose the single rooms and dormitories, and more especially the attendants' rooms, with a view to the most effectual supervision. we may, in fine, state under the two last heads, generally, that access to the patients, their quiet and comfort, their watching and tending and their classification will be more readily and also more efficiently secured by the arrangement pointed out, than by the system of construction hitherto pursued in this country. . domestic arrangements will be facilitated in various ways.--the patients, in the first place, will be less disturbed by the necessary operations of cleaning, which every superintendent knows are apt to be a source of irritation and annoyance, both to patients and attendants. the ground-floor may be prepared for the day's use before the patients leave their bedrooms; and in the same way the latter may be cleaned during the occupation of the ground-floor. by the present constitution of a ward for use both night and day, considerable inconvenience, and many irregularities in management constantly result. the cleaning has to be hurried over, or to be done at awkward hours, to avoid alike the interruption of patients, or the being interrupted by them; and, at the best, it will from time to time happen that patients are excluded from their day or their bedrooms, or from the corridors, during the operation. another advantage will accrue from the system proposed. the amount of cleaning will be much diminished, for the two floors will be used only alternately, and not only the wear and tear of the entire building, but also the exposure to dirt will be greatly lessened; above all, the small extent of corridor will make an immense difference in the labour of the attendants in cleaning, compared with that which now falls to their lot. again, the drying of floors after they have been washed is always a difficulty, particularly in winter, and is the more felt in the case of the bedrooms, which have, when single-bedded or small, but a slight current of air through them, and consequently dry slowly. this difficulty is augmented, when, as it often happens, it is necessary for them to be kept locked, to prevent the intrusion of their occupants or of others. the ill effects of frequently wetted floors in apartments constantly occupied, and therefore dried during occupation, have been fully recognized and admitted by hospital surgeons, and have impressed some so strongly, that, to escape them, they have substituted dry rubbing and polished floors to avoid the pail and scrubbing-brush. by the arrangements submitted, however, this difficulty in washing the floors is removed, since there is no constant occupancy of the rooms, and therefore ample time for drying permitted. further, by the plan in question, the distribution of food, of medicine, and of stores, becomes more easy and rapid; the collection, and the serving of the patients at meals, are greatly simplified and expedited. a regularity of management in many minor details will likewise be promoted. as the majority of the patients are quite removed from proximity to their sleeping-rooms, the temptation and inducement to indulge in bed by day, or before the appointed hour at night, will be removed, as will also the irregularity frequently seen in wards some time before the hour of bed, of patients prematurely stowed away in their beds, and of others disrobing, whilst the remainder of the population is indulging in its amusements, its gossips, or in the 'quiet pipe,' before turning in. . management facilitated.--our own experience convinces us that there is no plan so effectual for keeping otherwise restless and refractory patients in order as that of bringing them together into a room, under the immediate influence and control of an attendant, who will do his best to divert or employ them. we are, let it be understood, only now speaking of their management when necessarily in-doors; for, where there is no impediment to it, there is nothing so salutary to such patients as out-door exercise, amusement, and employment. on the contrary, to turn refractory patients loose into a large corridor, we hold to be generally objectionable. its dimensions suggest movement; the patient will walk fast, run, jump, or dance about, and will, under the spur of his activity, meddle with others, or with furniture, and the like; and if an attendant follow or interfere, irritation will often ensue. but in a room with an attendant at hand, there are neither the same inducements nor similar opportunities for such irregularities. some would say, such a patient is well placed in a corridor, for he there works off his superabundant activity. but we cannot subscribe to this doctrine; for we believe the undue activity may be first called forth by his being placed in a corridor; and that it is besides rare that a patient, particularly if his attack be recent, has any actual strength to waste in such constant abnormal activity as the existence of a space to exercise it in encourages. and, lastly, it is better to restrict the exhibition of such perverted movement to the exercising grounds, or better still to divert it to some useful purpose by occupation; for in a ward such exhibitions are contagious. these remarks bear upon the question of the purpose and utility of corridors as places for exercise, concerning which we have previously expressed ourselves as having a poor opinion, and have throughout treated corridors mainly as passages or means of communication. . a less staff of attendants required.--if the foregoing propositions, relative to the advantages of the system propounded, be admitted, the corollary, that a less staff of attendants will suffice, must likewise be granted, and needs not a separate demonstration. there is this much, however, to be said, that the proposition made in a former page to distinguish attendants upon the insane from the cleaners or those more immediately concerned in the domestic work of the house, would be an easier matter when the construction followed the principles recommended. the attendants upon the occupants of the sitting-rooms need be but few, for their attention would not be distracted from their patients by domestic details; for the cleaners would prepare the apartments ready for occupation, would be engaged in fetching and carrying meals, fuel, and other things necessary for use, and the attendants would thereby be deprived of numerous excuses for absence from their rooms, and for irregularities occurring during their occupation with household duties. . the actual cost of construction of an asylum on the plan set forth would be greatly diminished.--it has just been shown that the proposed plan will ensure a more ready and economical management; and if structural details could be here entered upon, in connexion with an estimate of costs for work and materials, it could without difficulty be proved, that the cost of accommodation per head, for the patients, would fall much under that entailed by the plan of building generally followed. the professional architect who assisted us made a most careful estimate of the cost of carrying out the particular plan we prepared (designed to accommodate patients), and calculated that every expense of construction, including drainage of the site, gas apparatus, farm-buildings, &c., would be covered by £ , , _i. e._ at the rate of less than £ (£ ) per head. that a considerable saving must attend the system propounded will be evident from the fact, that, instead of a corridor, on the first floor, at least twelve feet wide, as constructed on the prevailing plan, one of six feet, or less, simply as a passage for communication, is all that is required, and thus a saving of about that number of feet in the thickness or depth of the building, in each story above the ground-floor, is at once gained. a similar, though smaller, economical advantage is likewise obtained on the ground-floor, for the corridor there need be nothing more than an external appendage, and of little cost to construct. a further saving would attend the construction of an asylum on the plan set forth, both from the concentration of the several parts for night and day use respectively, and generally from the rejection of the ward-system. the construction of almost all the sleeping accommodation on one floor would render many provisions for safety and convenience unnecessary,--for instance, in the construction of the windows. so the substitution of what may be termed divisions, or quarters in lieu of wards, would do away with the necessity of many arrangements requisite for apartments, when intended for use, both by night and day. as constructed commonly, each ward is a complete residence in itself, replete with all the requisites for every-day life, except indeed in the cooking department; and the consequence is, there is a great repetition throughout the institution of similar conveniences and appurtenances. indeed, in the plan we designed, the influence of example or general usage led us to introduce many repetitions of several accessory apartments, which were, in fact, uncalled for, and added much to the estimate. for instance, we assigned a bath-room to each division, although we consider that a room, well-placed, to contain several baths (_i. e._ in french phrase, a 'salle des bains'), would more conveniently serve the purpose of the whole ground-floor inmates, and be much cheaper to construct and to supply. yet, if this notion of a 'bath-house' be unacceptable to english asylum superintendents, a smaller number of bath-rooms than was either provided in the particular plan alluded to, or is usually apportioned to asylums, would assuredly suffice. the same may be said of the lavatories, sculleries, and store-rooms. . the plan removes most of the objections to the erection of a second-floor or third-story. these objections generally owe their force to the difficulty of assuring the inmates of a third-story their due amount of attention, and their fair share of out-door exercise, and of much indoor amusement, without entailing such trouble upon all parties concerned, that a frequent dereliction or negligence of duty is almost a necessary consequence. dr. bucknill ('asylum journal,' vol. iii., , p. , _et seq._) has well argued against the erection of a third-story, on economical grounds; and remarks that "practically, in asylums built with a multiplicity of stories, the patients who live aloft, are, to a considerable extent, removed from the enjoyment of air and exercise, and the care and sympathy of their fellow-men. they are less visited by the asylum officers, and they less frequently and fully enjoy the blessings of out-door recreation and exercise. those below will have many a half-hour's run from which they are debarred; the half-hours of sunshine on rainy days, the half-hours following meals, and many of the scraps of time, which are idly, but not uselessly spent, in breathing the fresh air." the foregoing considerations are certainly sufficient to condemn the appropriation of a third story for the day and night uses of patients, according to the 'ward-system' in operation; but they have no weight when the floor is occupied only for sleeping. we must confess we cannot appreciate the chief objection of dr. bucknill (_op. cit._ pp. , ,) to the use of a third floor for sleeping-rooms only, for we do not see the reason why "the use of a whole story for sleeping-rooms renders the single-room arrangement exceedingly inconvenient;" for surely, on the common plan of construction, a row of single rooms might extend the whole length of a third floor on one side of a corridor, equally well as on the floors beneath. without desiring to enter on the question of the relative merits of single-room and of dormitory accommodation, to examine which is the special object of the paper quoted, we may remark, that the addition of a third story, when the plan we have advocated is carried out, obviates the generally admitted objections to such a proceeding. the same arrangement of apartments may obtain in it as on the bedroom-floor below, and the proportion of single rooms to dormitories, viz. one-third of the whole sleeping accommodation to the former, insisted upon by dr. bucknill, can be readily supplied. attention would only be required to allow in the plan sufficient day-room space on the ground-floor,--a requirement to be met without difficulty. the existence of a third story is no necessary feature to an asylum constructed on the principle discussed, and we have adverted to it for the sole purpose of showing that the ordinary objections to it are invalid, when the arrangement and purposes of its accommodation are rendered conformable to the general principles of construction advocated in this chapter. a hint from dr. bucknill's excellent remarks on the advantage of being able to utilize spare half-hours must not be lost. two flights of stairs, he well states, constitute a great obstacle to a frequent and ready access to the open air, and we are sure he would allow even one to be a considerable impediment to it; and, consequently, that an asylum with no stairs interposing between the patients and their pleasure-grounds would possess the advantage of facilitating their enjoyment of them. these remarks on the advantages of the principle of construction we advise for adoption would admit of extension, but sufficient has been advanced, we trust, to make good our views. we have taken in hand to write a chapter on some principles in the construction of public asylums, but we must stop at the point we have now reached; for it would grow into a treatise, did we attempt to examine the many principles propounded, and entirely surpass the end and aim of this present work. the end. printed by taylor and francis, red lion court, fleet street. spiritualism and the new psychology an explanation of spiritualist phenomena and beliefs in terms of modern knowledge by millais culpin with an introduction by professor leonard hill london edward arnold [_all rights reserved_] preface my object in writing this book is to present an explanation of so-called occult phenomena concerning which credulity is still as busy as in the days of witchcraft. the producers of these phenomena have been exposed efficiently and often, but their supporters are as active as ever, and show a simple faith which is more convincing than any argument. moreover, the producers themselves--mediums, clairvoyants, water-diviners, seers, or whatever they may be--are sometimes of such apparent honesty and simplicity that disbelief seems almost a sacrilege; therefore part of my aim is to show how a man believing firmly in his own honesty may yet practise elaborate trickery and deceit. as the book is intended for readers presumably unacquainted with the trend of modern psychology, it is necessary to point out how much of the opinions set forth are accepted by workers at the subject. the theory of dissociation has, as far as i know, no opponents. it was applied by pierre janet to hysteria and water-divining, thought-reading, etc., all of which he regarded as psychologically identical.[ ] [footnote : see _l'automatisme psychologique_. alcan; paris.] the theory of the unconscious, which we owe to freud, of vienna, is still strongly opposed, and the influence, or even the existence, of repressions is disputed by those who have not looked for them, undoubted cases of loss of memory being regarded as something of quite different nature. a growing number of workers, however, both here and in america, appreciate the importance of these contributions to psychology. the possible development of the hysteric from the malingerer by the repression of the knowledge of deceit is an idea of my own, which is not accepted by any one of importance. these explanations are necessary in fairness to the reader, but i regard appeals to authority on matters of opinion as pernicious, and try to present my opinions in such a way as to allow them to be judged on their merits. nevertheless, since i take for granted that supernatural phenomena are not what their producers would have us believe, and at the same time make no general attempt to prove their human origin, i must refer the reader to books on the subject, viz., _studies in psychical research_, by the late frank podmore, which treats the spiritualists sympathetically and weakens occasionally in its unbelief; _spiritualism and sir oliver lodge_, by dr. charles mercier, which is a direct and vigorous attack upon them; and _the question_, by edward clodd, a book dealing with the subject historically from primitive man to 'feda'. stuart cumberland, in _spiritualism--the inside truth_, records some of the results of his vain search for spiritist phenomena that will bear investigation; and in _the road to endor_ the authors relate the story of a deliberate fraud that was accepted by their friends as a genuine manifestation. m. c. contents preface introduction i. the unconscious ii. complexes iii. forgetting and repression iv. dissociation v. water-divining vi. suggestion vii. hypnotism viii. dreams ix. hysteria x. experiments, domestic and other xi. about mediums xii. the accounts of believers xiii. the evolution of the medium conclusion introduction by professor leonard hill, f.r.s. the body of man is made up of an infinite number of cells--minute masses of living substance--grouped into organs subserving particular functions, and held together by skeletal structures, bones and containing membranes such as the horny layer of the skin which are formed by the living cells. the whole is comparable to citizens grouped in farms and factories subserving one or other function necessary for the commonweal; and just as the city has its transport connecting the whole, distributing food and the various products of the factories, a drainage and scavenger system taking away the waste material, and a telephone system through which operations can be ordered and co-ordinated according to the needs of the commonweal, so has the body its blood circulation, digestive and excretive systems, and a co-ordinating nervous system. how small are the cells, how infinite their number is shown by the fact that each drop of blood the size of a pin's head contains five million red corpuscles; there are five or six pints of blood in the body! the living substance, e.g. of a nerve cell, appears as a watery substance crowded with a countless number of granules, which are so small that only the light dispersed around each is visible under the highest power of the microscope when illuminated by a beam of light against a dark ground, just as the halo of each dust particle in the air is made visible by a beam of light crossing a dark room, and just as these dust particles are in dancing motion due to the currents of air, so are the particles in the living substance ceaselessly kept dancing by the play of inter-molecular forces. from the dead substance of the cells the chemist extracts various complex colloidal substances, e.g. proteins, fats, carbohydrates, and various salts, and these in their turn he can resolve into chemical elements. the interplay of energy between the multitude of electrically charged granules inside the cell, and the environment outside keeps up the dance of life, the radiant energy of the sun, and the atomic energy of the elements being the ultimate source of the energy transmutations exhibited by both living and non-living matter. in the living cell there is an interplay of the energy of masses of molecules forming the granules, of single molecules in watery solution, of atoms which compose the molecules, and of electrons, the various groupings of which compose the atoms of the elements. the elements themselves are now recognised to be transmutable through simplification and rearrangement of their electronic structure, and to be evolved out of one primordial electronic unit, a unit of energy, unknowable in nature, out of the groupings and transmutations of which arise all manner of living and non-living forms, the apparently indestructible stable materials being no less in a state of flux and evolution than the most unstable. the complexity of the transmutations of energy and ultimate unknowableness and mystery of their cause are no less in the case of a drop of water or a particle of dirt than in that of a living cell. the scientific conception of the universe, the very opposite of materialism, approaches pantheism. the living substance of a uni-cellular organism, similarly the congery of cells forming the body of man, has evolved the power of sensing and of moving towards, or away from life-giving or destroying sources of energy. special sense-organs, receptive of one or other form of energy have been evolved through the æons of the struggle for existence, together with nervous and muscular systems, to enable him to preserve his life in the midst of the shocks and thrills of his environment. there are also evolved inner senses, and a sympathetic nervous system which knits all parts of the body in harmonious action; the community of action also being brought about by the circulating fluids of the body, the blood and the lymph, to which each living cell gives and from which each cell takes. for communion with the environment, eyes for visual, and sense organs in the skin for thermal radiant energy have been perfected, ears for sound waves travelling through air, taste organs for substances in solution, smell organs for particles of substances floating in the atmosphere, touch organs for sensing movements of masses. the receptive cells of the special sense organs are composed of watery, granular, living substance and elaborate mechanisms have been evolved for converting one or other form of energy into such a form that it can be received by the living substance, e.g. the intricate structure of the eye with its focussing lenses, retinal cells laden with pigment sensitive to light, the ear with its drum membrane vibrating in unison with sound waves in the air, its chain of transmitting osicles, and complicated receiving organ placed in the spiral turns of the cochlea. be it noted, the receptive cells of the sense organs are immersed in fluid, and each sense organ is specifically sensitive, i.e. only to that form of energy which it has been evolved to receive through countless ages of evolution. the nervous system is composed of myriads of nerve cells, and of nervous fibres, which are long and exceedingly slender processes of these cells formed of similar substance, each shielded and insulated by a double coat. the nerve cells and the nerves are arranged in an ordered plan which has been unravelled by ingenious methods. they connect all parts of the body one with another. think of the whole telephone system of britain linked up together with millions of receivers, thousands of local exchanges, hundreds of central exchanges, etc., the nervous system with its sense organs, sensory nerves, lower and higher nerve centres and motor nerves, is infinitely more intricate than that. the whole forms an interlacing feltwork formed of watery nerve cells and processes, and not only receives sensory stimuli and transmits them as motor impulses, but is more or less permanently _modified_ by each sensory thrill which enters it, memorising each, more or less, for longer or shorter time according to its character or intensity. thus the response of the nervous system to sensory excitation changes with education, habits form and character develops from birth to manhood, to decay again from manhood to old age, ceaselessly changing, but becoming graved on a certain plan. the making thereof depends on inborn qualities of the living substance--the conjugate product of the male and female parents, this moulded by environmental conditions, both in utero and after birth, by food, and the ceaseless instreaming of sensations. depending on the nutrition of the cortex of the great brain, abrogated by narcotics, absent in sleep, consciousness of our being flickers from moment to moment, the product of the instreaming of sensations from the outer world and from our own body, and of memories of past sensations, aroused, by some present sensation. conscious judgement arises from the balancing of present sensations with memorised sensations and leads to purposeful actions. beneath the conscious world an infinite host of functions are carried out unconsciously, functions depending on the nervous connection of one part with another, just as the common people carry out a host of actions through the telephone system without the cognisance of the government which is seated at the highest central exchange. to find food, satisfy the sexual instinct, escape enemies, gain shelter from excessive physical changes of environment, the special senses and nervous system have then been evolved and perfected in the intricacy of their mechanism through vast æons of evolution. there is evidence that man has for some million years trod the earth; but the senses of sight, hearing, smell, taste, touch were evolved in the vast procession of lower animals which preceded him for those millions of years which reach back and ever back to the first generation of life. the realisation of these facts saves the physiologist from being deceived, either by fraudulent tricks or those natural chances of human occurrence which occasion the belief of the credulous in telepathy. he recognises that the human nervous system is built on a common plan, and that it is to be expected that the sensory stimuli received from a given environmental condition will often arouse the same train of thought in two or more people, standing together, especially in those who habitually associate. such coincidences of thought, which astonish the ignorant, are due to natural law. human experience shows that judgements of fundamental importance which would, if transmittable to another at a distance by telepathy, win a fortune, save a defeat, etc., are never so transmitted. the stock exchange and the army in the field must have their telephone and telegraph systems and messengers. no more concentrated will to send information, which might bring succour, say from the artillery, could be given than by men in peril of their lives in the trenches, when the enemy came swarming over the top, but we know that with the wires cut and the human messengers killed no succour came. neither does it come to the liner which, in full proud course with its freight of thousands of souls strikes an iceberg, unless the wireless mechanism be installed and operated so that the s.o.s. signal is despatched. otherwise it sinks without trace, as the germans advised their 'u' boats to let their victim merchant ships sink. the phenomena of wireless telegraphy and of radio-active elements have led people to think that some direct means of communication of energy from one brain to another may be possible, that is without intervention of the special senses. there is not the least evidence in favour of this view; the evolution of the senses is wholly against it. it is true that all vital activity is accompanied by electrical change--by a flow of electrons--in the living matter, the nervous impulse itself may be so transmitted. such electrical change by a special evolution of structure is magnified in the electric organ of certain fishes and used by them as a weapon of offence. it is then sensed just as an electric shock from a battery is sensed, and the intensity of the shock lessens inversely as the square of the distance. there is no evidence that the minute electrical changes accompanying nervous action in man are transmittable to a distance through space; the nerves are evolved to confine and convey these as nerve impulses to suitable receivers within their body whereby function is co-ordinated. a radio-active element enters into the composition of the living matter, e.g. potassium. a nutritive fluid can be prepared from a watery solution of sodium calcium and potassium salts capable of keeping the excised heart of the frog in action. the place of potassium in this fluid can be taken by the energy radiated from radio-active material placed suitably near the weak solution of the other two salts which contains the heart. too strong a radiation kills the heart. wonderful as this new discovery is it is comparable with the well-known fact that the radiant energy of the sun--either heat rays or the cold ultraviolet rays of intense chemical action--while beneficent, when properly graded, kill the living substance which is over-exposed to them. hence the evolution of the green colour of plants and the pigment in the skin of animals, which acts as screens. it has recently been shown that trees pick up the long waves used in wireless telegraphy, and can be used as receivers, but there is no evidence that animals are sensitive to these waves. no one knew either of their existence or of that of magnetic storms until instruments were invented suitably tuned to pick up the waves of energy and demonstrate them to one or other of man's special senses--sight, hearing or touch. every invention of science goes to prove that knowledge enters only through the avenue of the senses, which are tuned to the receipt of certain forms of energy. other forms of energy to which the senses are not tuned must be converted by instrumental means into a form of energy which can be sensed. contrary then to scientific evidence is the supposition that waves of energy proceed directly through space from the watery granular living substance of one brain, confined within skull and skin, and passes into the similar substance of another. if any such direct transmission and reception of energy were possible why were æons spent in the evolution of sense organs, and why is the labour of men spent in perfecting the means of communication of his thoughts by observation of the movements of expression, by speech, writing, semaphore, heliograph, telegraph and telephone and by waves of energy sent through wires or wireless space? in _the road to endor_, we read how two clever officers, e. h. jones and c. w. hill, giving the whole time of a tedious captivity to evolving tricks of the business, successfully fooled a hundred of their fellow-officer prisoners, men of intelligence and education, into belief in telepathy. in the appendix of their book there is given a portion of their telepathy code to show the sort of system which may be worked, a code which allowed the communication of the names of hundreds of common articles, numbers, the names of all the officers in the camp, etc. they could use the code with, or without speaking; perfection in its use, the authors say, involved a good deal of memory work and constant practice. 'nothing but the blankness of our days, and the necessity of keeping our minds from rusting could have excused the waste of time entailed by preparation for a thought-reading exhibition. it is hardly a fitting occupation for free men.' what these officers could do obviously the professional conjurer can do, no less the humbug and quack who swindles money out of the credulous and superstitious. let no one give credence to telepathy till he or she has read this most amusing and educative book. the authors no less humbugged the camp by planchette writing whereby they transmitted messages supposed to come from disembodied spirits. they fooled not only their fellow-prisoners with these spirit messages, but the turkish interpreter and commandant of the camp, gaining thereby important concessions. they planned a daring method of escape which depended on exciting the cupidity of the commandant and on a hunt for buried treasure, occupying many months of preparation, and only failing at the last through the unwitting interference of a brother officer. some of their 'spirit' messages were actually transmitted through the commandant to the war office in constantinople, so implicit became his obedience. what these two officers affected is unequalled by anything in sir oliver lodge's evidence as set forth in _raymond_. they give details of how they used chance remarks and trivial facts heard and memorised months beforehand, and of how they observed and were guided by the slightest variation in tone of answer or movement of their victims, which expressed interest and excitement or the reverse, and so built up a story of some past action which clinched belief. the hits were striking and memorised, and the misses unnoticed, forgotten--for such is the tendency of the human mind. such are the methods of the professional medium, and in _the road to endor_ they lie unravelled and fully exposed. the physiologist recognises the tendency of those with unstable, nervous temperaments--e.g. hysterical girls--to gain interest and cause excitement at any cost of trouble in developing methods of deceit. hence the ghostly visitations of houses, the mysterious bell-ringings, rappings, spillings of water, etc. i, myself, have personally come across and investigated two of these cases--one of a young, educated woman who played pranks on the house of her hosts, pouring water into their beds, etc.; the other of a servant-maid who caused the disappearance of meat from the larder, and dirtying the cat's feet made it make foot-marks on a perpendicular wall leading to the larder window, who spirited away the gardener's firewood and wrote mysterious letters in a feigned hand, the imprint of which were found in her blotting-book, and who reported she saw a mysterious woman prowling round the house. the few eminent scientists who have expressed their belief in spiritualism are mostly physicists, e.g. crookes, oliver lodge and w. barrett--men who have not made a life-study of physiology and nervous disorders, who are not familiar with the attainments and methods of conjurers and professional impostors, and are shielded in their laboratories and home life from close acquaintance with human deceit and cunning. their familiarity with the transmission of waves of energy in dead material, and through space leads them to concepts which cannot justly be applied to living beings. to the physiologist, who recognises the majestic unity of natural phenomena, belief in telepathy and spiritualism appear a form of materialism as gross as the ju-ju superstition of the benin native. nothing can excite greater contempt than the mean trivialities which are served as communications from that infinite, silent universe wherein the energy of individual life sinks on death. the belief in spiritualism works grave harm on ignorant, credulous people of nervous temperament, and fills the pockets of rascally impostors. its practice should then be as sternly suppressed by the law as any other fraud and imposture. dr. culpin, in his valuable and thoughtful treatment of this subject, shows, _inter alia_, how the medium requires no less to be protected from deception and ruin of his own soul than does his dupe. spiritualism and the new psychology chapter i the unconscious from the moment of waking till we fall asleep again our thoughts are busy, one thought following another all day long without a break and each being in some way related to the preceding one. memories come up into the stream, the outer world is constantly affecting it through our senses, and we tend to think that all our mind-work is done in this 'stream of consciousness'. but beneath our stream of consciousness lies a deep sea of memories, feelings, and directive influences. all our previous experience is buried there, and no man knows how much he knows. every one has experienced the sudden recollections which come up unsought when a sight, a sound, or a scent makes association with something long past and apparently forgotten; and not only our memories of things, places, and people, but our past mental processes themselves lie in this deep sea of the _unconscious_, to help or hinder us in the present or future. i speak of the unconscious, though there are objections to the use of the word, which may lead to such a contradiction of terms as 'unconscious knowledge'. it is much more than a storehouse of memories: it is the seat of mental processes which take place unknown to us and are revealed at times in strange and unexpected ways. it comes into contact with the stream of consciousness, and, as we so often find in attempting to classify natural phenomena, there are no well-marked lines of demarcation between one and the other, though the extremes are definite enough. the unconscious is not always a willing servant and often refuses to obey the wishes of its owner. every one has at some time vainly tried to recall a name which is 'on the tip of the tongue', and one name after another is tried till perhaps the right one comes up and leaves us wondering where the difficulty was. there is, according to the teaching of some psychologists, always a reason for this failure to remember, though even an apparently ordinary example may need a skilful analysis to show how the failure arose and why the other names presented themselves. slips of the tongue are likewise dependent upon unconscious influences, and, although i was once sceptical, a few examinations of my own slips have convinced me of the truth of this little theory. here is an example of one of them, such as occurs often enough and would ordinarily be passed over without further examination:-- sitting one evening with friends who were interested in this subject, i read aloud a paragraph from the book i was reading, and was asked the name of the author. my answer, after a slight pause, was 'robert brown'; it was immediately corrected by one of my friends, who pointed out that the author was robert smith (the names are fictitious), and called upon me for an explanation of the mistake. the first question was, 'who is brown?' and the only brown i knew was a man concerning whom i had a few days before received a letter with information about him which led me to regard him with strong dislike. the next point was that we had been recently discussing the private life of robert smith, and i had manifested dislike towards his actions. then i remembered that when i was asked the name of the author there had flashed into my consciousness the feeling that he was not precisely the sort of man i liked. although the rest of the chain of thought was unknown to me at the time, yet it became plain, under my friends' cross-examination, that this feeling of dislike had called up the name of the other victim of my displeasure, though questions from my friends were necessary before i could remember to whom the other name referred. the last point is quite characteristic, for there seems to be a definite resistance in the mind of the perpetrator of the slip against piecing together his thought processes, and the aid of some one else is necessary to enable, or force him, to do it; then he feels compelled to acknowledge the hidden thoughts. the difficulty in recognising and admitting the cause of such slips is due to their being so often the expression of feelings which the owner does not like to publish to the world or perhaps even acknowledge to himself. but the unconscious is not always, or even often, such a useless intruder upon our everyday life. it economises our energies, and often takes us by short cuts to ends which would otherwise need continued reasoning. 'intuition' is the product of previous experience, and rises into the consciousness as a finished judgement without the owner of the gift being aware of the factors concerned in its formation. one kind of intuition is improperly called in my profession 'clinical instinct', but, unlike instinct, it is a result of training and experience, and is never seen without them. here is an example which came under my notice: an ophthalmic house-surgeon, busy with new patients, sees a man aged about thirty-five, who complains of failing sight, and without further investigation he writes on the man's book, 'tobacco amblyopia?' and sends him in to his chief. later on his chief asks him, 'how did you spot this case?' and the house-surgeon answers, 'i don't know, but he looked like it'. the chief agrees that there is something which can be seen but not described in the looks of a sufferer from this complaint. now this house-surgeon, though keen on his work, had seen only a few cases of that disease, and i do not now accept his explanation of how he 'spotted' it. a man of thirty-five may find his sight failing from various causes, but the common ones are not many. if the cause had been 'long-sight', he would have complained that he could not see to read; certain general diseases causing loss of sight at that age would perhaps have visible symptoms; the man was too young for cataract, and his eyes looked healthy. in short, tobacco amblyopia was a reasonable guess, and, when we remember that the disease is caused by smoking strong pipe tobacco, and that the man who smokes that tobacco generally smells of it, it is fair to suppose that it was not the evidence of his eyes alone that guided the house-surgeon in his guess, though he was not conscious of any train of reasoning nor was he aware of the smell of stale tobacco. this suggests that a stimulus may act upon our thoughts without our being conscious of the origin of the feeling produced, and this is what happens in connection with that well-known sensation, felt on visiting a new place, that one has been there before. if a close examination is made it will be found that there is really something--a picture, a scent, or even so slight a stimulus as a puff of warm air--which has stirred a memory in the unconscious; this memory fails to reach the consciousness in its entirety, or it would immediately be recognised as caused by the particular stimulus, but in its incomplete form it appears as a memory of nothing in particular. such a memory being inconceivable it is at once joined on to the whole scene, and one feels 'i've surely been here before'. this feeling may be regarded as an intuition in its most useless and incomplete form, but its theoretical importance will be seen later. women exercise intuition more than do men, and up to a point this gives them an advantage, though it may annoy the male who prefers to find his reasons on the surface and call them logical. 'the reason why i cannot tell, but this i know and know full well, i do not like thee, dr. fell', is a perfect example of intuition, and a full analysis of the unconscious of the poet would undoubtedly recall a wealth of reasons why. still, intuition is likely to be a fallible guide, and the man who wishes to avoid trouble with his personal dislikes must always be prepared to check it by whatever conscious knowledge and reasoning power he may possess. the lines quoted above would be a poor defence against a charge of assault. the person who is guided by intuition in some accustomed situation may be incapable of understanding why another person has not that power. i saw an example of this when i was making a short journey in the north queensland bush with a white boy who had been reared in that district, but was a stranger to the particular locality in which we then were. it was a rainy day, and we were bound for a place which could be reached by following a stream down to the main river and then travelling up the latter, and this route i proposed to take. my companion showed astonishment at this, and said, pointing as it were along the other side of the triangle, 'but that's the way.' i agreed, but told him that i couldn't find the way and should get 'bushed' if i tried. he could not understand, but we set off for a ride of some nine to ten miles through fairly dense timber with the boy as guide. in vain i asked him how he kept his course; in similar circumstances i should have marked a tree as far ahead as possible and ridden towards it, marking another before i reached the first, and so on. all he could say was, 'that's the way', and i puzzled him by my questions more than he puzzled me by his ability to go straight to our destination. the sense of direction is of course well known amongst animals, and i have often in my bush-days confidently trusted my horse to take me to his and my home on the darkest of nights. although one talks of the 'sense of direction', there is no need to assume anything more than ordinary sense perceptions interpreted by the unconscious workings of the mind. the man who is over-anxious about his capabilities cannot allow his unconscious to take charge of his thoughts in this way. i was always afraid of being lost in the bush and always preoccupied with the need for carefully watching my course; therefore, although i could find my way, i never developed a 'sense of direction'. to sum up, the unconscious is a collection of mental processes, memories, desires, and influences of infinite variety which are not always or even often perceived as such by our conscious mind, but the presence of which may and does influence our thoughts and actions. by its aid we obtain results the factors of which are unknown to us, and of which we fail to recognise the origin, and in it is stored not only what we remember but also what we forget. it is in relation to our stream of consciousness and normally blends with it, but the more independently we can allow it to operate the more surely does it reach its end in certain cases. i must add that freud introduces a _foreconscious_ to indicate the mind-contents which are accessible to the consciousness, but are not of it, but for the sake of simplicity i have avoided the use of that word. the reader must bear in mind that such terms are used to describe not phenomena, but conceptions. newspapers, the voices of men in the train or the street, marks on ballot-papers, are all phenomena, but 'public opinion' is only a conception useful to facilitate the expression of ideas. if one asks, 'where is this unconscious and what does it look like?', i can only answer by asking, 'where is this "public opinion" and what does it look like?' the same caution is necessary in regard to other phrases. the stream of consciousness and dissociation are conceptions only, and are not intended to indicate the existence of things having relation to each other in space; the words are used as convenient means to sum up processes which i hope to show really take place. chapter ii complexes every man likes to think that his creed, religious, political, or social, is founded upon reason; but let the reader consider the beliefs of his acquaintances and he will soon realise that they depend far more upon early training, social position, and the general influence of surroundings than upon any reasoning process. after this exercise let him turn his critical powers upon his own beliefs and examine closely how far they are dependent upon reason or upon influences which he has not recognised before. who can say that, in the days when home-rulers and anti-home-rulers abounded, the average voter was swayed by a reasoned knowledge of the subject? yet he was quite sure that his side was right and the other wrong, and found it hard to understand how any sane man could own the opinions the other fellows held. let us picture two neighbours of opposite political beliefs:--if they are both keen gardeners they may exchange views about methods and manures, and in case of difference of opinion one will possibly convince the other by argument. on other matters, too, they will mutually be open to conviction. if one favours ilfracombe for a holiday and the other swears by torquay, the latter may decide to try ilfracombe for a change. but let them discuss home rule till the crack of doom and neither will convince the other by any process of reasoning; yet each will believe firmly that his opinions are the results of reason, finding an infinity of argument to support them. or let anyone start a discussion on a so-called moral question, such as polygamy. he will arouse the warmest expressions of opinion that polygamy is sinful, absurd, and unworkable, and may point in vain to such countries as china, where it apparently works with no more trouble than occurs with our system. reasons will be showered on him, but scarcely anyone will admit that he objects to polygamy because he has been taught to regard monogamy as the only proper state of marriage. a man, honestly believing that he is always actuated by certain moral principles, may do things which others regard as opposed to those principles, and if approached on the subject will be greatly annoyed and produce a chain of argument to justify his actions. scarcely any of us are free from these failings; certain beliefs we keep stored away, allowing nothing to interfere with them. they are placed in logic-tight compartments and carefully guarded by a pseudo-reasoning which satisfies our desire for logical explanation. to this pseudo-reasoning is given the name of 'rationalisation', and, lest anyone may be offended by finding the same term applied to the process by which lunatics defend their delusions, i will add that there is no dividing line between health and disease, and the modes of thought of the insane are not so very different from those of the ordinary man. to return now to the subject of 'logic-tight compartments'. each contains a collection of ideas which are treated by the owner in a special way, cherished and guarded carefully from those forces which may cause modification. at the same time he will probably refuse to admit that they influence his consideration of certain questions related to them. the more logic-tight the compartment is, the more warmly does its owner defend it; but where plain reasoning is concerned few men can be roused to enthusiasm. even though there may be people who regard the reasonings of euclid as purely appeals to the emotions, what mathematician could grow excited about a man who denied the truth of the fifth proposition? but to run counter to a man's political or social beliefs is a sure way to raise the controversial temperature. as will be easily seen, rationalisation is of everyday occurrence with all of us, and the man who rationalises always believes he is reasoning. consider now the business rogue who makes a success of his roguery and then launches out as a philanthropist, still continuing his roguery as a permanent side-line. such cases are not unknown, and the man seems able to carry on without any sense of conflict between his two activities. or consider those not uncommon instances where a man prominent in religious work is detected in some financial crime; it is usual to regard him as a hypocrite who has used religion as a cloak, but it is equally probable that he was honestly religious, that his earliest steps into crime were reconciled to his principles by rationalisations, and, as he advanced, a logic-tight compartment was built up to prevent conflict between his wrong-doing and his self-respect. in these examples we have a part of the stream which comes into contact with the main stream of consciousness only by means of a process of rationalisation which allows the two to exist without great mental conflict, but this will never be admitted by the owner, though other people may be acutely conscious of it. here, to simplify explanation, i must introduce the word _complex_ as used to indicate a system of ideas having a common centre,[ ] whether the system is present in the consciousness or exists only in the unconscious. [footnote : the word 'complex' was originally used by freud only in regard to ideas existing in the unconscious, but the way in which i use it is convenient and follows the custom of some english writers.] our ideas of morality, religion, or politics form complexes, as do our desires and disappointments. an ardent photographer or naturalist is possessed of a complex concerning his hobby, and this complex tends to turn his thoughts in the corresponding direction. if a keen botanist and an equally keen amateur photographer are travelling by train each views the scenery according to his complex: the one might note the trees and plants, their flowering or bursting into leaf, and how they vary with the soil, and might speculate as to what finds a closer view might produce; the other sees the same objects, but is busy composing pictures, thinking out distances and exposures, or differences of light and shade. the man with 'a bee in his bonnet' gives an example of a single powerful complex; but all our thinking is a matter of complexes except on those rare occasions when logic alone is concerned, such as the consideration of a problem of mathematics. scientific men are prone to believe that their mind-work is purely logical; so it is, up to a certain point, and the more exact the science the less room there is for thinking in complexes; but the reception of a new theory is always opposed by those whose firmly established complexes are offended by it. the aim of scientific training is to eliminate complex thinking and substitute logic, and in the exact sciences this is practically attained; but as soon as the trained man forsakes his laboratory or workshop methods he is at the mercy of his complexes and becomes the ordinary rationalising human being. there is a great difference between a complex, such as photography, of which the influence is recognised and admitted by its owner, and another, such as a political one, where the influence is strongly denied. the latter is kept in a logic-tight compartment and reconciled to the reason by rationalisations. instincts have their abode in the unconscious and differ from acquired influences in being inborn and common to the race. it is difficult to determine what emotions and desires are truly inborn, as benjamin kidd shows in a valuable personal observation.[ ] [footnote : _the science of power_, p. . methuen & co., .] he found a wild duck's nest as the young birds had just emerged from the egg, the mother-bird flying off at his approach. he took the young birds out of the nest and they showed no fear, nestling from time to time on his feet. then he moved away and saw the mother-bird return with 'the great terror of man' upon her; next he approached the group again, but the mother-bird flew away with warning quacks and the little ones scattered to cover. he found one of them, but it was now 'a wild transformed creature trembling in panic which could not be subdued'. mcdougall, whose work on instinct holds high rank, places 'flight' with its emotion of 'fear' among the primary instincts. the apperception of danger is necessary in order to call up this instinct, and kidd shows that when once the fear of danger from man is planted in the young birds it becomes integrated with the instinct and inseparable from it. acquired tendencies associated with emotion can therefore share the strength of instincts (the application of this fact is the theme of mr. kidd's book), and we accordingly find the results of early training accepted by the consciousness as perfect and unquestionable. this same characteristic applies, in a modified degree, to all complex thinking. carry on an argument with an intelligent man on any complex-governed subject, and he will nearly always come down to the bed-rock foundation that he believes his view to be right because he _feels it_. then you may cease the discussion. it is by this reasoning that we can understand the attributes of the german mind. the german had certain complexes concerning the right of might so built into his unconscious that he gave them the obedience that is demanded by an instinct, and nothing short of national disaster could induce him to relinquish them. chapter iii forgetting and repression how we remember is an old and unsolved question, but few people think of asking how we forget: and yet one problem is as important as the other. i cannot answer either except by putting a new one, which is, 'do we ever forget?' if we specify the factors concerned in memory and say that it depends upon impression, retention, and recall, then what do we mean by 'forgetting'? if an event makes no impression upon the mind there is neither remembering nor forgetting; if there is retention of a memory, but one cannot recall it, it is nevertheless stored in the mind and may yet be revived by some association. so that the only certain factor in forgetting is the loss of power of recall, for what is apparently quite forgotten may still be retained in the unconscious. can we voluntarily forget? if by that is meant, 'can we voluntarily lose the power of voluntary recall?' i must, strange as it seems at first sight, assert that we can, though i make the proviso that 'voluntarily' is a word with a very elastic meaning, and one whose definition would open up the never-ended argument about free-will. i will take refuge in a quotation[ ]:-- 'we ought not to assume that a clear and full anticipation or idea of the end is an essential condition of purposive action, and we have no warrant for setting up the instances in which anticipation is least incomplete as alone conforming to the purposive type, and for setting apart all instances in which anticipation is less full and definite as of a radically different nature.' [footnote : mcdougall, _social psychology_, p. .] expressing this idea in the terms employed in the previous chapters, we can picture an action as being produced by motives in consciousness, and these motives as being influenced to a greater or less extent by the instincts, emotions, and desires of the unconscious. every action is influenced by the unconscious, however voluntary it may appear. the young man who seeks the society of a maiden may think he is acting voluntarily and with full consciousness of the end in view, but the end is often visualised by the friends of the pair before the young man realises where his instincts and emotions have led him. the man who resolutely refuses to think of an unpleasant experience and shuts off the thought of it whenever it rises into his consciousness may not have the intention of placing it beyond reach of voluntary recall, but he may succeed in so doing, and the process by which the end was reached was voluntary. that we have this power is shown by the investigation of war-strained soldiers of the type said to be suffering from 'shell-shock'. these men are often stout fellows who have fought long and bravely, and whose condition is a result of the emotions they have suffered rather than of any particular shell explosion. their typical symptoms are depression, dreams of battle horrors, tremors and stammerings, and strange fears without apparent cause. in an ordinary case there is great difficulty in persuading the man to talk about his war experiences: he says plainly that he doesn't want to talk about them, or may persistently avoid the subject, or he gives a poor account and shows difficulty in recall, or he claims to have forgotten and requires stimulating in order to remember, or he may have an absolute blank in his memory for certain periods. here we see all grades of the result of trying to forget, and the more successful the result the more difficult is the cure; for though the memories are repressed their associated emotions cannot be so dealt with, but remain in consciousness exaggerated and distorted. the dependence of an emotion upon a repressed memory prevents the sufferer from knowing its cause, and the sufferer from an apparently causeless emotion is to be pitied, for he can see no end to his trouble. a man who was afraid of walking in the dark for fear of falling into holes which he knew only existed as a product of his fancy, affords a simple example of this condition. he said that his fear was absurd, therefore it was useless to point out to him its absurdity; the proper course was to show that it was not absurd, that it had a cause, and that the cause was something in the past which, when recognised, could be reasoned away. fortunately the cause was easily found by any one with a knowledge of modern war: there was soon brought to light a 'forgotten' memory of his mates being drowned in shell-holes at night, and the fear disappeared as the patient learnt to look his memories in the face and not sink them into his unconscious. more striking, however, are those cases in which a man forgets all his war experiences, and, though he is ready to believe that he has spent, say, two years in france, has no recollection of them. such cases are not rare, the loss of memory often including part or all of the patient's previous life. one man could only remember the last three months of his life and failed to recognise his own father, though his memory was subsequently restored; this loss, occurring suddenly, could hardly be in any degree voluntary, though it served the purpose of excluding many horrible memories from his consciousness. another nervous lad was so constituted that he forgot all incidents that frightened him, only to be haunted by the emotions attached to them. seeing a steeple-jack fall was forgotten, and produced nightmares for years; a practical joke gave him a terror of the dark; his sister calling to him when burglars were in the house gave him hallucinations of voices; and minor incidents were equally forgotten, each producing its own symptoms. as the individual memories were brought up from his unconscious he went through the fright again, but the associated symptoms soon disappeared. in these pathological losses of memory, whether for one incident or for a whole period, it is important to note that the patient does not necessarily recognise the incident when he is told of it, just as the lad mentioned above failed to recognise his father when he met him. a patient may in a sleep-walking state act as if performing a definite action, such as bayoneting one of the enemy, and when awake deny all knowledge of such an incident; yet the memory of it may return later with overwhelming emotion. this failure to recognise a personal experience is of great importance in the consideration of some spiritualist phenomena. it requires little thought to realise that the only memories we try to repress are those that conflict with our other feelings or desires, and their repression is to some extent tolerated by a healthy man and may be regarded to that extent as a normal process. but in addition to the repression of unpleasant memories there are other ways of forgetting. it has been assumed that each individual has a limit to his capacity for remembering, and that when that limit is reached fresh memories can be stored up only by casting out old ones. whether that be so or not, it is certain that we can recall to consciousness only a tiny fraction of our past experiences, and no one can say what proportion that fraction bears to the whole contents of the storehouse of the unconscious. let two men meet and recall old school-days spent together: one memory brings up another, schoolboy phrases and terms of speech appear as it were spontaneously, and by their united efforts the two recall far more than the sum of their recollections before the meeting, and still neither knows how much is left untouched. the ordinary man reads many books, and each one leaves some impression and has some influence upon his later thoughts, though in time the recollection, not only of the contents of the book, but even of having read it, may fade away. this is the explanation of some cases of literary plagiarism: a previously read phrase comes up from the unconscious, and all recognisable connections with memory having been lost it is greeted as a fresh creation and given rank accordingly. there is still another type of forgetting: most of us know the man who 'draws the long bow', who embellishes his story and embroiders it with imagined incidents, whilst we listen and wonder how much the narrator himself believes. fishermen's stories and snake yarns are examples, and one explains the mental process of the story-teller by saying, 'he's told the story so often that at last he believes it himself.' the process is really one of forgetting and is closely allied to the repression of an unpleasant memory, for the man is the victim of a mental conflict: on the one side is his desire to tell a good story, and on the other is his moral complex which forbids a lie, so he solves the conflict by forgetting that the embroideries are inventions. this type is an important one, and what i shall call the 'repression of the knowledge of deceit' plays an important part in the explanation of the abnormal phenomena with which this book deals. in tracing the development of the abnormal we must start with what is nearest the normal, and the man who embroiders his story gives an illustration of the simplest form of this particular repression. now, just as memories are repressed because they were repugnant to the other contents of the consciousness, so other complexes may be repugnant and meet the same fate. to be torn by conflicting emotions is the fate of most people at some time or other, and the conflict between two complexes may be solved in various ways. the healthy way is to face the difficulty, to reason it out, and reach a conclusion by which action may be guided; another way, a common one, is to seclude one complex in a logic-tight compartment and so avoid the conflict. the man who uses sharp or shady methods in the city and is a gentle-minded philanthropist in other walks of life is using the latter method, and will produce such rationalisations as 'business is business' when the contents of his different compartments need protection from each other. but for some people such methods are impossible: either they cannot directly solve the conflict or they are too self-critical to build a logic-tight compartment, and in such cases a repression of one of the opposing complexes may result. in this way complexes concerning ambitions and desires may be repressed, and so may those concerning fears and dislikes. the youth put to an uncongenial trade, the man or woman married to an unsuitable partner, may find no escape from the position and decide to bear it and forget its anxiety. how far this succeeds depends upon the previously existing tendencies of the individual: he may suffer no evil from the repression or, like the soldier's repressed war memories, it may manifest itself by indirect means and the unfortunate sufferer becomes a victim of one of the varied forms of neurosis. the day-dreams of youth are rarely openly expressed: no one can tell what fantasies a child may have, and many of us are familiar with the thoughtful child who sits lost in meditation and presents an impenetrable barrier to the grown-up who would enter into the secrets of the day-dream. these fancies may be, and probably are, completely forgotten, but they can still lie in the unconscious, and freud and his followers claim that they influence us throughout life. chapter iv dissociation as you sit reading this book you perhaps cross your legs or move to an easier position. did you think, 'my leg is beginning to feel tired, i'll shift it?' did you even know you were shifting it? watch a friend next time he drives you in his car. if he is an expert driver he will talk to you whilst his car slips through the traffic, and handle the various gears and controls as occasion arises without apparently giving any thought to the action; moreover, if you direct his attention to what he is doing he may do it with less accuracy than before--like the billiard player who carefully studies a shot and then makes a miss-cue. it is not sufficient to call the driving automatic, though that word is often used to describe actions of this type, for it is dependent upon innumerable stimuli that reach the driver's mind through all his senses and there produce sensations and impulses which have to be translated into actions. there is much real mind-work involved, and we must regard the driving as carried on by a part of his consciousness which is temporarily apart from his main stream, the latter being devoted to your intellectual entertainment. so far as it concerns this example the splitting-off is normal. most of us develop such capability in some way or other: the skilful pianist will talk while playing from sight a difficult passage, and the smoker carries out puffing actions by his little split-off stream whilst the main stream is solving the problem of the moment. all sorts of trivial actions are done unknown to the doer. for instance, a man whilst reading may have the habit of turning a pencil over and over and if any one gently removes the pencil he will reach out for it and continue to turn it, whilst his main stream knows nothing of the little by-play. we see that consciousness is not fully and evenly aware of all our actions; some actions with their accompanying mental process can be carried on by an independent stream and, as in the case of the pianist, the streams are of such balanced complexity that we can regard them as co-equal. others, like turning over the pencil, are associated with such a lack of awareness that they hardly seem conscious, and if they are regarded as due to a split-off stream the stream is a very minor one. this loss of awareness can be carried further, and actions involving complicated processes can be performed without the main personality knowing of them. the easiest example by way of illustration is automatic writing, often carried out by planchette, which is a small platform mounted on wheels and bearing a pencil whose point touches a sheet of paper. if two people, sitting opposite each other, place their finger-tips upon the platform it immediately begins to move, for unless the muscular push of one operator is absolutely balanced by that of the other the apparatus moves away from one of them; the other person straightway resists the movement and pushes in an opposite direction, and thus a see-saw motion is kept up which the operators cannot stop. the resulting scrawls on the paper may be deciphered according to fancy, but with practice a legible product is obtained; further, some people are able to concentrate the mind upon, or in other words fill the stream of consciousness with, another set of ideas by means of talking or reading, so that the automatic writing is carried on by a split-off stream of which the main stream is unaware. one person can use planchette alone, though the experiment is oftener carried out as described above because unintended movements are more readily produced by two operators. by this trick of splitting-off, or dissociation, the operator is able to allow ideas and memories from the unconscious to come to the surface unrestrained by the cramping control of the consciousness; hence the product of the automatism is usually fantastic and imaginative, though memories are available which may be beyond the reach of the consciousness. an excellent example of this dissociation is given in _the gate of remembrance_, a book which i shall consider later. the view might be held that the dissociated stream is really a part of the unconscious whose results make themselves manifest in the consciousness, as i described in the first chapter when writing about intuition; but in automatic writing the main personality is not aware of the results: the dissociated writer does not know what he has written until he reads it, and it may be as much news to him as to a bystander. the two streams of thought flowing side by side exemplify one kind of dissociation of consciousness, and others of this kind will be described later; this type i shall call _continuous dissociation_, but there is another which at first sight seems quite different and of which i will give an example:-- an ex-soldier suffered from fears and depressions which made his life a misery, and an endeavour was made to find the cause in a repressed memory. his account of events was complete up to a certain time, but there his recollections ceased; then one day something touched up the hidden memory and in the presence of his doctor he went through a most dramatic scene, showing horror at falling down a dark dug-out upon the bodies of dead germans and at subsequent experiences which had strongly affected him and whose revival produced again the same emotions as the original events. at the next interview the following dialogue took place:-- 'i want you to tell me about falling down the dug-out.' 'what dug-out, sir?' 'the one you told me about last time.' 'i don't remember telling you about it.' 'yes you do, the dug-out at....' 'no, i don't remember any dug-out at....' there was no reason why the man should lie, and his expression of surprise and absence of other emotion seemed indicative of truth. when the doctor made the man close his eyes and thus shut out his present surroundings the memory returned with strong emotional reaction, less intense, however, than on the former occasion. this case can be explained by regarding his repressed complex as lying in the unconscious, held there by the repugnance he felt towards it; then during the interview with the doctor it rose into consciousness and swept every other thought away. the stream of consciousness was suddenly cut off, its place being taken by this new stream with its recollections and emotions, and when the ordinary consciousness resumed its flow there was no connection between it and the dramatic episode which had interrupted, so that all memory of the episode was lost. we can picture the repressed complex not as lying in the unconscious but as forming a dissociated stream flowing parallel with the main one, and showing its presence by producing those apparently causeless fears and depressions from which the patient suffered, till it suddenly swept aside the main stream and took its place. this alternative view shows the absence of any sharp division between the concept of the unconscious and of a dissociated consciousness, and at the same time brings this _abrupt dissociation_ into harmony with continuous dissociation. such a dissociation, but with less emotional contents, can persist for a long time, the subject living, as it were, the life of the dissociated stream. then we have a man with no memory of his previous life, but whose repressed memories, desires, or troubles, forming a complex in the unconscious, have finally broken across the stream of consciousness and taken its place as a second personality. such instances have been described[ ] as 'double personalities', and to this group belong those cases in which a man is found wandering with all memory of his name or associations gone. in soldiers with repressed war memories the repression may include the whole of their war experiences, and they can tell nothing of, say, a year spent in france; here, as long as the repression continues, there is the potentiality of the outbreak of a second personality. [footnote : see the _psychology of insanity_.] the story of _dr. jekyll and mr. hyde_, stripped of those portions which r. l. stevenson introduced to make it suit his public--the bodily change and the drugs which produced it--can be read with interest as a study of the development of a dissociation, the main personality being aware of the dissociated stream but unable to control it when once the splitting-off had been accomplished. a less fanciful story of a dissociation is given in _a tale of two cities_, where the unfortunate dr. manette, having learnt shoemaking whilst a prisoner in the bastille, insists on retaining his tools and material after he is rescued and brought to england, in times of stress secluding himself for a period and living his old life again, working at the old employment and hardly aware of the real world around him. the source of the story might be made a subject of research by the dickens fellowship, for it is too accurate to be purely a fantasy of charles dickens, who, like all of his craft that live, was no mean psychologist. even dr. manette's insistence upon retaining his tools, unaware as he was of his own reason for doing so, is consistent with what really happens when a dissociated stream influences the personality. the different degrees of dissociation can be represented diagramatically. (see opposite page.) it is to be noted that the dissociation may be the result of purposive action on the part of the subject, though, as will be seen in later chapters, an entirely wrong interpretation may be given to it by the person most concerned and by other people as well; or it may be the result of a repression, and in that case any interpretation given by the subject must necessarily be a wrong one, for he is ignorant of its cause on account of the mechanism of repression, or, to put it differently, if he knows the cause it is no longer repressed. [illustration: two streams of equal value and under the same control. examples: the pianist and the motor-car driver. _a normal phenomenon_, but linked to the next class by cases of absent-mindedness.] [illustration: two streams, one being the ordinary stream of consciousness and the other a stream not under the control of the main personality, which is concerned only with the ordinary stream. examples: automatic writing, water-divining and hysteria (see chapter viii). _continuous dissociation._] [illustration: a continuous dissociation with a sudden irruption of the dissociated into the main stream, completely replacing it for a period. examples: the case of the ex-soldier and those of double personality; also somnambulisms and spiritualist trances. _abrupt dissociation._] once again i will emphasise the difficulty of drawing a line between normal and abnormal. my boy guide referred to in chapter i was as near normal as could be, though the means by which he kept his course might be described as a product of dissociation. if he had been imaginative and i credulous he could have foisted upon me a supernatural explanation of his powers and taken his place with clairvoyants and water-diviners. but there are manifestations of distinctly abnormal character to explain which is the object of this book, and for the people producing these manifestations i propose the name of dissociates, since dissociation is the key to the understanding of the phenomena they present. the logic-tight compartments previously described are to be regarded as partial dissociations to which we are all liable, the partitions being unrecognised by their owner and the contents kept apart from the modifying influences of the main personality. hence when the onlooker becomes aware of the presence of such a dissociation he does not judge the contents of the compartment by the same standard that he applies to the person as a whole. there is nothing fresh in this point of view, which is admitted when virulent political opponents can be good friends by each ignoring the dissociated prejudices of the other, or in everyday life when in some circles the discussion of political or religious subjects is avoided for the sake of good fellowship. extreme dissociation by reason of a logic-tight compartment is shown in that kind of insanity in which the sufferer behaves as an ordinary being with ordinary actions and ideas except for the influence of a systematised delusion (generally persecutory or grandiose) of most irrational type which is impregnable to explanation or argument. on all other points the man is sane, and the purely mental origin of the disease is suggested by his remaining in good health and without mental deterioration apart from the delusional system, in this respect differing greatly from the sufferers from most other forms of insanity. some psychiatrists claim to have traced the delusions back to repressions that took place in early life.[ ] [footnote : for a fuller account of dissociation i would refer the reader to _the psychology of insanity_, by dr. bernard hart, to which i am indebted for the form of some of my ideas. (cambridge university press.)] chapter v water-divining water-divining, or dowsing, is accepted in many parts of the world and used as a practical method of locating underground water. official bodies as well as private individuals employ practitioners of the art, and among people generally there is a strong belief in its genuineness. it is carried out by means of a forked twig, hazel by traditional preference, which is grasped in the dowser's two hands and is said to be twisted upwards by an unknown force when there is water underground. as an addition it is sometimes claimed that the twig will indicate the presence of metals by being twisted downwards. believers in the twisting of the twig are generally ignorant that it was formerly used in the pursuit and detection of criminals and the finding of buried treasure[ ] and that it was being used in the year to locate a seam of coal. going farther afield, we learn that the witch-findings practised by african savages are sometimes carried out by means of a stick which points at the victim. [footnote : see janet, op. cit., p. , where he also says: 'il est probable que, dans quelques campagnes, subsiste encore la croyance aux révélations de la baguette divinatoire.'] such varied uses demand a new and complicated system of physics if the results are due to any forces external to the diviner, but my own observations satisfy me that we need not overturn our ordinary conceptions of cause and effect to explain the different properties of the divining-rod. when a friend told me of the presence of a dowser in the neighbourhood and gave me a would-be convincing account of how he had seen him at work, how the twig was twisted upwards with such force that my informant was unable to depress it, and how the man was employed by engineers to tell them where to sink wells, i became interested and asked to see the marvel. the resulting experiment, though conducted haphazard, was instructive as regards both water-divining and credulity. the man broke a forked twig from a bush, and, holding it in the way described later, was directed down a path leading to a tennis-court. along this path no water was known to exist, but the twig rose twice. beneath the tennis-court ran a water-pipe which had burst during the previous winter, and of which the position was known to six at least of those present. this pipe was located by the man, and he demonstrated it again and again by walking across it, the twig rising each time. it rose again when he was directed past a cook-house. next he was sent along a path leading from the cook-house to the main building, and the twig rose several times. he said, 'there is water all along here', and was told that there was a pipe running along the path. here i intervened and asked him to try across one edge of the path, which was about six feet wide. the twig rose, and, just as on the tennis-court, he walked again and again across the indicated line, the twig rising every time, though as a fact the pipe lay on the other side of the path. he explained to us that god gave 'the gift' to moses, and that now only one man in ten thousand received the gift. when he left i took a twig and showed that i had the gift, or, at least, that the twig performed in my hands exactly as it had done in his. 'but', said my friends, 'he found the pipe on the tennis-court.' it mattered nothing that he had found water twice within a few yards where none was known, or that at least six of the bystanders knew of the existence of the water-pipe and were ready to show their anticipation as he approached it and their delight when he located it, nor that he located the other pipe on the wrong side of the path. the movements of the twig might be a fraud, his other finds might be failures or guesses, but his one success was enough for them. even the padre, when i said that the man had the face typical of a mystic, was moved to ask, 'but may not a mystic have powers of which we know nothing?' in short, the rising of the twig was produced by the man himself, and his findings were guesses, aided by ordinary knowledge as to where water-pipes are to be expected, and more especially aided by the attitude and expression of the bystanders. yet by his manner he showed that he plainly believed in his own powers: otherwise his reference to the gift of god was simple blasphemy, and he seemed an earnest man. [illustration] how can we explain this belief on the one hand and the trickery on the other? first let us examine the mechanism involved in the upward twisting of the twig. suppose you take a tough and springy forked twig, each arm of the fork being about nine or ten inches long, hold it with the apex away from you, and, with your palms facing together and your finger-tips pointing upward, place the thumb and little finger of each hand inside the fork at the places marked t and f. now close each hand, and you have each arm of the fork firmly gripped; next, keeping your elbows well in, bend the arms of the fork outward as in fig. , with your palms now looking upward. you will then find that a sort of trigger action tends to occur, and by a slight pressure of your ring-fingers against the twig you can make it rise. still gripping firmly and pressing your hands a little together you will find it continues to rise, and by bending your hands downwards at the wrists and pressing your elbows to your side you can easily persuade an observer, and perhaps yourself, that you are trying to hold the twig down. you may even find that it leaves a pressure mark on your little finger, which you can show as evidence of how you tried to restrain it. if one arm of the fork is weaker than the other it may break, and that of course will be conclusive proof of the working of a mysterious power. so we see there is nothing very strange in the man believing that his muscular action was not responsible for the moving of the twig; but his two-sided make-up--piety on one side and trickery on the other--can best be explained by a dissociation, with repression of the knowledge of trickery as far as the main personality is concerned. we might split up his consciousness like this:-- piety, and belief in knowledge of the means water-divining employed. hypersensitive as the gift of god. mechanism for carrying it on. perhaps it is unfair to talk of trickery; he may have deceived himself from the start and never known that he was deceiving any one. at first i pictured him as learning the trick from some one else, trying it on with his friends--maybe across a bridge over a stream--and being taken seriously, and then, when he could not escape from his reputation without owning up to the fraud, being compelled for his peace of mind to repress the deceit complex and carry on as a dissociate. the man himself would be the last person to gain information from, for his repression, however it began, is now complete. the discussion that followed the experiment was instructive: most of the bystanders appeared to believe in the existence of some unknown force of nature operating through a specially-gifted person, the mechanism of the twig being unnoticed and the greatest emphasis placed upon the one success. i have no doubt that in a short time the memory of that one success would be the only part of the performance not forgotten. moreover, if any one of the bystanders had told me the story, describing fully and fairly everything he had observed, i should have been unable to criticise the facts thus presented and denial of the miraculous would have been ineffectual; yet these bystanders were all educated and intelligent men. with the information gained from this experiment i was able to understand the next example. the subject was mentioned in a provincial newspaper, and incidentally a story was told of how a dowser who also had the power of locating metals was able by means of the twig to indicate the position of two sovereigns concealed under a carpet, showing the relationship of water-divining to some forms of 'thought reading.' in the next number of the paper appeared 'some corroborative testimony' from a well-known local gentleman, who was also a dowser, and some of his testimony i will quote:-- 'i have had twigs as thick as my little finger twist off and break after scoring my hand until it was red. the muscles of the arm become contracted when the bodily magnetism is affected by the presence of water, and a strong spring will make my arms ache badly. it is quite true that only running water affects me, and on one occasion i had a curious example of this. it was on a saturday evening, and i quite accidentally found the presence of water close to a house where my sister was living. the following day i told her about the spring and tried the spot, when no effect was observable. on enquiry she told me that there was a pipe underneath connected with a ram which was always put out of action on sunday.' further on, referring to another incident, he says:-- 'i had dowsed the ground, and in addition had noted, with the help of an eminent geologist, the geological strata. the dowsing satisfied me that the ground was full of water: the geological survey suggested the best place to collect it. i suppose the power must have something to do with the composition of the blood and nerve cells, but i have never yet come across a scientific explanation of the power, which is certainly possessed by many people.' here we have a country gentleman of indisputable honesty and intelligence attributing to unknown forces such movements and sensations as any one can produce who follows the preceding instructions, water or no water being present. the 'bodily magnetism' is a pure rationalisation and beyond discussion, but the story of the pipe and the ram is different: a ram is a pump worked by a stream of water and the noise of it is carried a long way, especially along any pipe connected with it, and if i told this gentleman that he had heard the noise of the ram he would strenuously deny the possibility, and might challenge me to test whether i could hear the noise; but i have no dissociated water-divining personality unhampered by my conscious efforts and trained to pick up such indications. it would seem incredible to him that he heard the noise of the ram on the saturday, failed to hear it on the sunday, deduced that the water was no longer running, and then showed this deduction by refraining from tilting up the twig; but with our knowledge of dissociation and repression, and of the working of the unconscious, we can understand all this taking place without his main stream of consciousness being aware of it. the reference to geology is also instructive; he evidently has a knowledge of that subject, and he might perhaps admit that the indications of the twig coincided with the geological indications, though he is unaware of and cannot admit any dependence of the former on the knowledge of the latter. thus in both these cases the likelihood of the presence of water is only a matter of observation--skilled and minute no doubt--and the movement of the twig is in no way caused by any physical forces except those exercised by the muscles of the dowser. that the second personality of the dowser is able to deceive him is now explained, and his obvious honesty so influences non-critical observers that their credulity is no cause for wonder. an example of water-divining without dissociation was given me by dr. w. h. bryce, of fifeshire, whose words are as follows:-- 'there was an old scot who was reputed to be very skilful in finding water and who was so employed throughout his neighbourhood. he was not above using the twigs, but told me they were no use, but he judged entirely by the lie of the land. in his own language he always looked for the "rise of the metals" in looking for water. a diviner came to the neighbourhood and located water in two places. in the one place the old countryman said, "how can he get water there? now at the top of the den where the metals rise each way he might get it." bores were sunk at both places that the diviner indicated, but no water was got.' this man would probably have refused such a test as locating a water-pipe, for his conclusions were based upon conscious reasoning and he would be incapable of making guesses or picking up indications from the behaviour of bystanders; therefore in the eyes of the credulous he would be inferior to the wonder-working dowser. one repeatedly hears stories of how the dowser has found water when geologists have failed, but the man who is sufficiently uncritical to accept the working of the twig as due to some strange 'gift' is likely to be as credulous in observation and beliefs concerning the rest of the phenomena. chapter vi suggestion 'the power of suggestion' is a plausible explanation of varied phenomena. by it the feelings of a crowd are swayed, fashions are spread, mistakes are made, and beliefs are imposed upon the multitude, and in the production of hypnotic and hysterical manifestation the words 'power of suggestion' and 'personal magnetism' are sufficient explanation of all things visible and invisible. 'personal magnetism' and its kindred phrases implying the existence of some subtle physical force are, except when used figuratively, mere incoherences, but suggestion is an undoubted cause of certain effects and we must try to understand the meaning of the word. mcdougall defines suggestion as 'a process of communication resulting in the acceptance with conviction of the communicated proposition in the absence of logical grounds for its acceptance'.[ ] [footnote : _social psychology_, p. .] our thinking (apart from the observation of cause and effect in the small affairs of ordinary life) is generally a matter of complexes, logic being concerned only in rare cases; hence if we use the above definition the greater part of our accepted propositions owe their acceptance to suggestion. this is true as regards most of our political, religious, and social beliefs, and, since children believe what they are taught chiefly because the teacher says so, there does not seem much opinion or knowledge of the abstract for which suggestion is not accountable. if a suggestion agrees with the complexes already existing in the mind of the hearer then acceptance is likely to follow; this partly explains the psychology of crowds and the power of oratory, which appeals to emotions and prejudice rather than to reason. the knowledge that one's fellows believe is sufficient to convince the ordinary man, and often the existence of widespread belief is used as an argument to prove the truth of a proposition. one recognises this tendency at once in people of another race and other superstitions. an educated chinese once assured me that blood from those nearly related would mix if dropped into a bowl of water, and drops from the veins of strangers would remain apart, and that this test was used to decide cases of disputed relationship. when i showed incredulity my friend assured me, 'it's true, quite true, every one knows it.' within a day or two an englishman, whilst discussing telegony, or the influence of a first mating upon the progeny of subsequent pairings, maintained that the widespread belief among dog-breeders in the existence of this influence proved its truth, and my recollection of the argument of my chinese friend showed me how alike are the causes of belief among all mankind. man tends to believe what his fellows believe and act as his fellows act, and this tendency has been erected into an instinct by trotter, who shows how important the herd instinct is to all gregarious animals, including man.[ ] [footnote : _instincts of the herd in peace and war._ t. fisher unwin.] but if suggestion is to be made synonymous with the herd instinct it explains too much, and we must seek to narrow its meaning or use another word. it is already used in a somewhat special sense to account for the acceptance of propositions which an ordinary man in his ordinary state of mind would not accept, and especially is it used in relation to abnormal states such as hypnosis and hysteria. an authoritative and confident manner makes easy the acceptance of suggestion, as every confidence-trick man knows; the writer of advertisements or political articles knows it too, but in the last example we see a new factor. the hardened big-ender would be impervious to the most imposing suggestions from a little-endian source, but would accept the saddest nonsense from a journal of his own party. we see here an active desire to accept propositions that accord with a powerful complex, and as complexes become more separated from the influence of reason so this desire increases. this i shall call 'receptivity', and to the term i shall give a further meaning in the sense not only of desiring to accept propositions but of anticipating or guessing them, of picking up hints as to what is in the minds of the other persons concerned and reflecting them as if they originated in the mind of the receiver. in some cases of hysteria the patient presents a weak or paralysed limb, and this limb is often so insensitive that pins may be pushed through the skin without any manifestations of pain. this phenomenon, which resembles the insensitive patches that under the name of 'devil's claws' were found upon witches when witchcraft was fashionable, has been long known as a sign of hysteria. there is now a tendency to ascribe it to suggestibility or, as i should prefer, to receptivity. in the early stage of the disease some one examines the arm, pricks it, and asks, 'do you feel that?' it is my experience that the patient sometimes flinches at the first prick, but answers 'no', and until this newly-implanted belief is removed he never flinches again when the limb is pricked. the question is taken by the patient to mean that the doctor expects that the prick will not be felt--or why should he ask? the hint is accepted and the insensibility established, though its unreal nature is shown by the fact that the patient is not especially disposed to burn or injure the limb, unlike the sufferer from a true loss of sensation, who is always liable to such an accident owing to the lack of the protective sense of pain. i believe that this is the true explanation for many cases, and put it forward as a good example of receptivity. the insensitiveness is similarly explained by babinski,[ ] who uses a different method of examination. he blindfolds the patient, who must not have been subjected to a previous test, and stimulating him variously in different places asks what he feels. this avoids the suggestion of loss of sensation, and the result is that babinski finds few examples of such loss in cases where the 'do you feel that?' method would produce many positive results. [footnote : _hysteria or pithiatism and nervous troubles of reflex order._ london university press.] it may also be explained by a dissociation of consciousness, in which the split-off stream deals with the paralysed limb and therefore the main stream of consciousness knows nothing about the prick. the difference between the two theories is not so great as appears, for the control of the supposed loss of sensation, once it is established, finds its home in a split-off stream, and the process i describe is only a stage in the dissociation. i must admit, however, to seeing cases where a hysterical loss of voice of long duration is accompanied by a loss of sensation in the throat which is not explicable by receptivity, and it is possible for the dissociation to be directly responsible for the loss. jung expresses sound views when he writes:-- 'it should long ago have been realised that a suggestion is only accepted by one it suits.... this pseudo-scientific talk about suggestion is based upon the unconscious superstition that suggestion actually possesses some magic power. no one succumbs to suggestion unless from the very bottom of his heart he be willing to co-operate.'[ ] [footnote : _analytical psychology_, p. . baillière, tindall & cox, .] whilst stripping suggestion of its magic i by no means deny its power. let one person at a dinner suggest that the fish is tainted and he will generally have one or two supporters who would have eaten it without a doubt of its freshness if no one had cast suspicion upon it; or let one of a class of medical students say with sufficient assurance that he hears a murmur over a patient's heart and, even if the heart sounds are quite ordinary, others will hear it too. there are conditions, such as fatigue or sleep, in which the effort necessary to examine the truth of a proposition seems too great, and suggestions are accepted which would be rejected in a state of fuller consciousness. for example, i was awakened one night, when a hospital resident, and told that one of my patients was very restless. i could not remember the man, but asked a few questions about him and ordered a soporific. next morning on waking i became aware that i had no such patient, and on enquiry found that i had been mistaken for another resident whose slumbers had been undisturbed, thanks to my suggestibility, for had i been fully awake i should have repudiated any connection with the case. the confident manner of the messenger assisted the suggestion, and i like to think that had there been a trick intentionally played upon me even my sleepy consciousness might have detected some warning change of tone. psychologists regard hypnotic suggestibility as only a further stage of this sleepy non-resistance, but i see in the former a more active desire to accept. though suggestion might be further classified according to the factors concerned in its acceptance, the class showing 'receptivity' is the important one for our consideration. there remains auto-suggestion to be considered; it is as difficult to define as suggestion, but in the absence of any more precise term it must be accepted as indicating certain mental processes. the sensations felt in the arms and hands by the water-diviner or table-turner are partly the result of auto-suggestion and partly of muscular contractions, themselves produced by the same cause, and some of the varied sensations of the hysteric are of similar origin. creepy feelings at the mention of snakes, and unpleasant sensations at the thought of those 'minor horrors of war' that live in undergarments, are further examples. as far as the persons concerned are able to judge, the sensations are often real enough, though it was long before i could believe that a confirmed hysteric who complained of a severe pain really suffered from that pain; the description of a water-diviner's sensations, given by himself and quoted in another chapter, are such that one must believe in the honesty of the writer. one might say auto-suggestion arises from the unconscious or from a dissociated stream of consciousness, and this would make it account for hallucinations and obsessions, but here we must again take account of borderline cases. the person who feels a cold shiver at the mention of a snake cannot tell us precisely to what extent the shiver is due to conscious thoughts, or whether he feels it just because he must; and the feeling may be due to what he remembers being told about snakes, in which case it would not be due to pure auto-suggestion. the explanation of the success of suggestion in particular cases is to be sought in the emotional state of the subject. when i was the victim, as described above, my readiness to believe arose from my being accustomed to nocturnal interruptions when my patients were in trouble and also from my reliance on the hospital staff, my emotional state being one of expectation and confidence. if to these influences are added stronger emotional forces, such as wonder or terror, acceptance of suggestion is still easier, and when people assembled together are swayed by these feelings the herd instinct reaches its full strength and we have the ingredients for the manufacture of a collective delusion. there are many examples of strange and supernatural occurrences vouched for by masses of observers, and i see no reason to doubt the good faith of the historians. we all know how infectious is emotion and how hard it is for one man to remain unmoved when around him are others all under the influence of some excitement, and man always insists on finding reasons for his feelings or objects for his emotions. when wonder or terror are roused by the operation of the herd instinct, the individual, not knowing their origin, projects them externally and seeks an object for them. he is now ready to see or hear anything that will fit his emotions, and when an object is suggested he will speedily accept its existence as a reality. i will give some further examples of suggestion in varying degrees of strength. during the arrival of recently wounded men at a hospital in france, i was in a ward with two eminent members of my profession and another medical officer. as one man seemed bad the sister asked me to see him at once; his left arm was paralysed, and he had a wound on the head where in the brain beneath lies the 'motor area' of the left arm. looking at the wound, which was obscured by hair and blood, i said, 'that's pulsating'; the two consultants and the other officer agreed with my observation, and appropriate treatment was recommended. the importance of pulsation lies in the fact that it is a sign of the exposure of brain substance, which pulsates strongly, and in this case it signified the presence of a hole in the skull which allowed the pulsation to appear; but in the operating theatre shortly afterwards the skull was found intact, and therefore pulsation had not been present. how did this joint error of observation arise? the combination of a gunshot wound of the head with a paralysed limb may occur in connection with a hole in the skull, and such penetrating wounds were common before the introduction of helmets. my unconscious had worked out the probabilities and led me to expect the signs of penetration; deceiving myself, by my confident manner i imposed my belief upon my colleagues, who had, i may assume, placed unjustified confidence in my reliability as an observer; and we all saw that which was not. another example shows how ghost stories arise: a man related to me how at the age of sixteen he was sleeping with his brother, and woke up to see a ghostly face on the wall. so far we have an ordinary half-awake hallucinatory condition, which is not uncommon; but the lad became terrified and tried to cover his head to hide the sight, when the brother woke up, and, being told of the face, promptly saw it too. the brother's evidence is strongly corroborative, not of the presence of a ghost, but of the power of suggestion when the way is prepared by strong emotion. it may be remarked that the man was one of those nervous people who fear the dark or being alone; seeing a ghost was not the cause of his condition, but resulted from the inculcation of a belief in ghosts in a person predisposed to fall a prey to his own unconscious. the next example is a well-worn tale which has been quoted by frank podmore, w. h. myers, sir william barrett, and probably many others. i take it from pages and of _human personality_, vol. i.[ ] [footnote : longmans & co., london, .] it (the account) was given by mr. charles lett on december , , and reads as follows:-- 'on the th of april, , my wife's father, captain towns, died at his residence, cranbrook, rose bay, near sydney, new south wales. about six weeks after his death my wife had occasion, one evening about nine o'clock, to go to one of the bedrooms in the house. she was accompanied by a young lady, miss britton, and as they entered the room--the gas was burning all the time--they were amazed to see, reflected as it were upon the polished surface of the wardrobe, the image of captain towns. it was barely half-figure, the head, shoulders, and part of the arms only showing--in fact it was like an ordinary medallion portrait, but life-size. the face appeared wan and pale, as it did before his death; he wore a kind of grey flannel jacket, in which he had been accustomed to sleep. surprised and half alarmed at what they saw, their first idea was that a portrait had been hung in the room, and that what they saw was its reflection, but there was no picture of the kind. 'whilst they were looking and wondering, my wife's sister, miss towns, came into the room, and before either of the others had time to speak, she exclaimed, "good gracious! do you see papa?" one of the housemaids happened to be passing downstairs at the moment and she was called in, and asked if she saw anything, and her reply was "oh, miss: the master." graham--captain towns' old body-servant--was then sent for, and he also exclaimed, "oh, lord save us! mrs. lett, it's the captain!" the butler was called, and then mrs. crane, my wife's nurse, and they both said what they saw. finally mrs. towns was sent for, and, seeing the apparition, she advanced towards it ... as she passed her hand over the panel of the wardrobe the figure gradually faded away, and never again appeared. 'these are the facts of the case, and they admit of no deceit; no kind of intimation was given to any of the witnesses; the same question was put to each one as they came into the room, and the reply was given without hesitation by each. 'mrs. lett is positive that the recognition of the appearance on the part of each of the later witnesses was _independent_, and not due to any suggestion from the persons already in the room.' then follows a statement by two of the witnesses that this account is correct. in the lapse of twelve years between the incident and its narration a story of this nature would have been re-told many times, and we know what happens under such conditions. as the tale is given, however, it reveals more than the narrator thinks it does. most interesting is the denial of suggestion when we have present all the factors necessary for suggestion of the most powerful kind. picture miss towns coming into the room whilst the first two were 'looking and wondering' (and not in silence, we may be sure, in spite of the words 'before either of the others had time to speak', which are interpolated to strengthen the story); she straightway experiences the same emotion as do the others and sees what they see. now we have three emotional people, and as each new witness is brought along the emotion increases till it would require a very self-possessed and sceptical person to resist its influence. the butler and the nurse simply _had_ to see the ghost, though the account is a little ambiguous at that point. 'the same question was put to each one as they came into the room', but is it likely that under such a condition of excitement enough self-control was left to every individual to ensure that the same question, _and nothing else_, was put to each newcomer? such a thing could only happen by careful pre-arrangement, which was lacking here, and the writer's insistence shows that somewhere in his mind was present the suspicion that suggestion had a hand in the production of the unanimous evidence. mrs. lett is equally insistent that the recognition was not due to any suggestion from the persons already in the room, but she was unaware that suggestion can occur without intent and that the most powerful suggestion is that which is unintentional. can we suppose that there were no signs of wonder and awe on the faces of those present, no excited exclamations, no glances towards the wardrobe, no pointing of hands: only a few calm and self-possessed people asking each newcomer if he or she saw anything? if two or three people tried by suggestion to persuade others to see a ghost they would not be able to reach the emotional state of the actors in this scene, and the intentional effort at suggestion would have a good chance of failure. the minute account of the apparition, given by some one who was not present, and told as if it were the result of the immediate observations of the first two witnesses, has been influenced by discussion after the incident and is itself another product of suggestion. the narrator has over-shot the mark in his protest against the possibility of suggestion, and has produced a story in which the apparition is not the only improbability. i have given this analysis because the story is quoted repeatedly by writers on the spiritualist side, and until one examines it critically it appears convincing. the rumour of the russian troops passing through england in september, , will go down in history as a proof that mass credulity was then as powerful as ever. the rumour, however it began, was aided by the usual forces: herd instinct (for what every one believed was felt to be true), the desire to believe in what we wanted to happen, and the desire to be personally connected with important events. the last factor was shown by the number of people who claimed to have personal experience of the transit of the russian reinforcements; every one had seen the troops or knew some one who had. one of my friends, a man eminent in a profession which demands clear thinking, told me that his own brother-in-law was responsible for arrangements for their railway transport. the reader will see in this rumour a perfect example of the working of suggestion in a case familiar to every one, and if the lesson is borne in mind a list of believers in some unnatural occurrence will not necessarily carry conviction. chapter vii hypnotism the history of hypnotism is closely associated with that of charlatanry, though at some periods the practice has reached an honourable position in therapeutics. the 'temple sleep' of ancient greek medicine was a hypnosis, but in later days hypnotism fell into oblivion till the time of mesmer, when it was so mingled with quackery and theatrical display that some disrepute is even to this day attached to its honest use in curative medicine. the common attitude to it is one of mistrust. thanks to its exploitation by novelists, 'hypnotic power' is regarded as marvellous and uncanny, and the mysterious person who exercises it is able to lead his victims along any path. the fashion for public shows of mesmerism has apparently died away, their place being taken by thought-reading performances which cater for the desire of man to believe that he is seeing a manifestation of the occult. the 'mesmeric eye', whose pupil dilates or contracts at the will of its owner while its gaze remains fixed, has by imaginative writers been ascribed alike to lord kitchener and the monk rasputin, and presents a phenomenon unknown to physiologists. the 'will-power' of the hypnotist is as much a product of imagination, whilst the confident and willing co-operation of the subject is really the factor of most importance. nobody but a very credulous person can be hypnotised against his will, and at the beginning of the process the full co-operation of the subject is necessary, though with repeated sittings his suggestibility becomes increased and to that extent his 'will-power' may be said to have diminished. in the induction of hypnosis the essentials are quiet surroundings and confidence of success on the part of both operator and subject. the subject is then led to think only of the operator and his remarks and directions, whilst generally some mechanical method is used which by tiring the eyes produces a feeling of sleepiness. success varies according to the skill and confidence of the operator and their persuasive effect on the subject. several sittings may be necessary before any depth of hypnosis is obtained. if the result is successful the stream of consciousness is thinned out and its place is taken by other thoughts and suggestions supplied by the operator. in light hypnosis there is produced a condition in which suggestions concerning, say, the cessation of bad habits or modes of thought are more readily accepted than in the normal state of consciousness, the subject having afterwards a complete memory of the sitting. in deeper stages hypnotic sleep is produced, suggestions concerning the bodily functions--producing, for example, temporary rigidity or paralysis or loss of feeling--may take effect, and the memory of the sitting may not be recalled afterwards; the subject may carry out various movements by direction of the operator, and may believe what his senses should contradict. in this deeper stage he is in a condition to receive suggestions as to actions to be performed after the hypnotic state has ceased. the explanation of the increased suggestibility of the hypnotic subject lies in the abolition, total or partial, of his stream of consciousness. such critical powers as he possesses are suspended and he has no standard by which to judge assertions presented to him, like a man in a dream who through a similar absence of standards of comparison sees no absurdity in the suspension of the laws of gravity. the unconscious of the subject is now accessible to suggestions which may be planted there and will bear fruit even if the subject is unaware of them. it is an experimental commonplace for a subject, told in a hypnotic state to perform a simple but unnecessary action after waking, to invent a rationalisation to account for doing it, whilst having no suspicion that he does it as a result of suggestion. but throughout all the stages he still has a volition of his own and will do nothing that seriously conflicts with his well-rooted ideas of conduct. if he is persuaded that an imaginary some one is sitting in a chair, and is directed to stab him with an imaginary knife, he will perhaps do so, for he would not object to doing so in his waking state; but suggest to him that he should steal a real watch, and if he be a man of ordinary honesty he will find reasons for not stealing it, though perhaps the man of criminal tendencies would fall to the suggestion. a story in illustration of this resistance was told me by a doctor who practised hypnotism for the cure of the alcohol habit. having successfully suggested to a patient that whisky would produce nausea, he congratulated himself on a cure, but to his annoyance the patient came home one day cheerfully intoxicated with beer. further hypnosis was tried and, although the hypnotic state was induced as before, suggestion had no further effect on the drinking habit. it turned out that the patient had decided not to be cured of the beer habit, hence the failure. in hypnosis we have another example of dissociation; during the process of induction the stream of consciousness is thinned out or completely abolished according to the depth of hypnosis. the fact that there may or may not be during the waking state a recollection of the events in a previous hypnosis shows that the dissociation may be continuous or abrupt (see chapter iv). the substituted stream is made up of suggestions from the operator and of material from the unconscious, for the hypnosis may be used to revive memories that have been lost to the consciousness through repression. in this last use we see a relation to automatic writing and other methods of bringing to light the contents of the unconscious. in my account of the water-diviner i suggested that his dissociated stream was especially trained to pick up indications that are not observed by his ordinary self. the study of the hypnotic state shows that our senses sometimes work better when freed from the control of the consciousness, so that the subject is able to see or hear or feel what is unobserved by the ordinary man. he possesses a hyperæsthesia such as we see in a sleeping dog who wakes at the approach of a footstep inaudible to the human ear and recognises whether it belongs to friend or stranger. a similar alertness and its opposite can be seen at work in ordinary sleep. the mother is roused by the slightest whimper of her babe, whilst louder noises pass unheard; but the person who, with the best intention of breaking a bad habit, has an alarm clock by his bedside, may neglect its call for a few mornings and end by entirely failing to hear it. the hyperæsthesia belonging to the unconscious is shown in other conditions than hypnosis and ordinary sleep. jung quotes experiments[ ] of binet, who says: 'according to the calculations i have been able to make, the unconscious sensitiveness of a hysteric is on some occasions fifty times more acute than that of a normal person.' [footnote : _analytical psychology_, p. .] dr. hurst, writing on war neuroses,[ ] says: 'in one severe case true hyperacusis was present, and captain e. a. peters estimated that the patient heard sixteen times more acutely than the average normal individual. it was possible to carry on a conversation with him by whispering in one corner of the ward when he was lying in the opposite corner, although men with normal hearing who were standing half-way between in the centre of the room could not hear a word of what was whispered.' [footnote : _british medical journal_, september , .] i myself knew a war-strained patient who, as a result of terrifying experiences, had a dread of aeroplanes and could not only hear a plane long before his comrades but could tell at once by the hum of the engine whether it was british or german. in other respects his hearing was no better than his neighbour's. another case under my observation was that of a nervous lady with a fear of draughts. whilst secluded in her bedroom she claimed to be affected when far-away doors were open, and showed a most uncanny and accurate knowledge as to whether they were open or shut, though this knowledge was probably derived from the sense of hearing and not from any sensitivity to heat or cold. the word 'hyperæsthesia' is used to denote an excessive acuity of our senses. the examples quoted above refer to the sense of hearing; but other senses, such as touch and sight, may be similarly sharpened. binet's experiments were carried out on the sense of touch. there is no question here of the development of any new sense; the hyperæsthesia is only an exaggeration of the senses we already possess. its importance lies in its common alliance with a dissociated receptivity which may lead it to be overlooked and cause its results to be ascribed to something else. chapter viii dreams the mystery of dreams and their interpretation has occupied men's thoughts in all ages. the jews paid great attention to them, as the old testament shows, and there is evidence that the prophet daniel had a shrewd knowledge, based upon psychological facts, concerning dream meanings. there are probably 'dream books' still sold which purport to provide interpretations for the enquiring dreamer, but it is only in recent years that the scientific study of dreams has produced useful results. freud laid the foundations of our modern knowledge, but unfortunately certain parts of his theories have raised so much antagonism that the sound work he has done is still scorned and dream interpretation is regarded as fanciful; nevertheless i propose to show that in dreams we have a key to the unconscious of the dreamer. before attempting an explanation of dreams we must first consider sleep, which is an interruption of consciousness, so that whatever mind work is carried on in sleep is a product of dissociation. the interruption of consciousness is more or less complete, the light sleeper reacting to external stimuli, turning away from a touch or making movements to protect himself from heat or cold, whilst the heavy sleeper fails to react to these minor disturbances. the memory of occurrences in the outside world during sleep may be vaguely present in the waking stage, and some sleepers will answer questions or obey orders without waking and have little or no recollection of them afterwards. such observations point to a resemblance between sleep and that form of dissociation called hypnosis. in hypnosis the memories and emotions in the unconscious may be brought to the surface, and in sleep the unconscious, escaping from the control of the consciousness, sends up thoughts and feelings which manifest themselves in dreams. how far external stimuli cause or influence dreams is uncertain, but the more one investigates the less importance does one attach to physical stimuli. the dreams of adults are concerned largely with what i have described in a previous chapter as repressions. these repressions are buried in the unconscious, and their efforts to come into consciousness cause our apparently senseless and fantastic dreams. if we dreamed distinctly about these forgotten episodes, and remembered the dream on waking, they would come into consciousness and be recognised, but, being buried and refused admission to the wide-awake world, before entering consciousness they are so distorted as to be unrecognisable. to the mechanism that holds them down or distorts them is given the name of the 'censor', and the interpreter of dreams must seek to evade the censor and resolve the distorted story into its proper elements. this method is of value in that treatment of the war-strained soldier which aims at making him face his memories and grow accustomed to them, for if a memory is repressed it tends to appear in the sufferer's dreams, which give an opportunity for its recovery by dream analysis. the opponents of this method picture the analyst, armed with a dictionary of dream meanings, listening to a patient's account of a dream, then giving him an explanation and persuading him to believe it; but, though a shrewd guess may often be made as to the meaning of a dream, the interpretation, to be of any value, must come from the patient. he is made to close his eyes and, visualising the dream, to describe it carefully. if it is a terrifying dream the telling of it will reproduce the feeling of terror, and appropriate questions will recall the occasion on which the same feeling first occurred. if the real incident is recalled there is an emotional outbreak which often startles the observer, who has the satisfaction of knowing that the greater the outbreak the greater will be the benefit. here is an example of the practical use of a dream: the patient had lost all memory of his experience in france, and this loss spread to his life before the war so that he failed to recall even his former employment; he slept badly and had terrifying dreams, one of which was as follows:-- 'i was on a pleasure steamer with a lot of cheerful people; it went to sea and then entered a dark cavern. on the floor of the cavern were broken skeletons, and at the far end of the cavern was a hole with light showing through. two pirates with cocked hats came and led seven of us up the cavern, where we saw some old men with whiskers. the pirates were quite kind and led us through another hole into a small cavern; the wall of the cavern began to fall down, so i picked up a broken sword and began to bore into the wall. then something like a ball of fire came at me, and i woke up frightened.' though the reader could probably guess what the dream was about yet the man had no idea of the meaning, for the censor was still at work. he was made to close his eyes and visualise the ball of fire till he became frightened again, so frightened, indeed, that he was in a state of dissociation, his stream of consciousness being filled by the feeling of terror and only in relation to the outside world by means of the voice of the questioner. (the fact that memories restored by this method are often forgotten again as soon as the patient opens his eyes is proof of a dissociation.) at this stage he was told, 'you felt like that in france, what was it?' the normal stream of consciousness being cut off, the censor was now out of action, and the man, putting his hands to his head, cried, 'it's a minnewerfer', and when he became calmer told of a dug-out being blown in and several of his mates being killed. then he was taken over the dream and made to look at the various parts and tell what they 'turned to'. the pleasure steamer was the boat in which he went to france, the cheery people on board being other soldiers; he now recognised the place from which the boat started and the port where he landed. the cavern was a tunnel up which a captain and a sergeant-major (the pirates) had led seven men; the cocked hats resolved into the sergeant-major having a piece torn from the cloth cover of his helmet which flapped in the wind; the broken skeletons were the bodies of his slain comrades; the second cavern was the dug-out; the broken sword a bayonet which broke when he tried to dig his way out with it; the old men were german prisoners, and the ball of fire was the flash of the explosion. all this was explained by the patient. if he had been told the probable meaning of the dream he might have believed it; but the result would have been valueless--it was necessary that he should bring up the memories himself. the dream is unusually coherent, but serves as a good example of the modern methods of dream interpretation. half-conscious fears or desires are often represented by symbolisms apparent to the analyst but unrecognised by the dreamer. a man told me of a dream in which he met some one whom he had defeated in a business disagreement, and, to his surprise, he shook hands with his old opponent. i told him that he felt the pricking of conscience and was desirous of making amends. this was little more than a guess, but its truth was admitted though the dreamer said that he had hardly realised his feelings before. it is characteristic of dreams, as of the slips of the tongue discussed in chapter i, that there is an obstacle to the dreamer's unaided understanding of them. a simple dream of my own will illustrate this: when going upstairs at a seaside hotel my wife, noticing a stuffed bird, said to me, 'is that a sea-gull?' and i answered 'yes'. the next morning i remembered a dream for which i could trace no cause, and said to my wife, 'i wonder why i dreamed of my old schoolmaster last night?' at this she asked, 'which one?' and when i answered, 'mr. gull', the connection at once became obvious, though something had prevented my seeing the obvious without aid. since a dream is a product of dissociation, we expect to find in it the same qualities that belong to the product of other dissociations. the world of the dream is pictured as something external to the dreamer and not arising from his own mind, just as the revelations of automatic writing or the movements of the divining-rod are accepted as coming from some one or something other than the agent. the dream taps the unconscious, the stories about poets and musicians who rise in the night-watches to pen their elusive inspirations being paralleled by the poetic imagery in the automatic writings of the glastonbury archæologists. lost memories appear in the dream and the dreamer may deny the incidents, as mentioned in chapter iii. in the same way the apparently honest medium may produce a memory, more or less distorted, as a revelation, and deny that it is a memory. the dissociated stream is hypersensitive and makes use of hints and fears that have passed unperceived by the consciousness. this use accounts for prophetic dreams, which are, like intuitions, the result of unconscious processes. in my own experience i have known but two circumstantial accounts of dream prophecies which were claimed to be fulfilled: one concerned a railway accident, and the other the destruction by fire of a distant house. both the dreamers, who were of the male sex, had suffered from gross hysterical manifestations, or, in other words, had been woefully led astray by the unconscious concerning something other than prophecy. accounts of prophetic dreams must always be suspect because of their origin in the unconscious and the inability of the dreamer either to interpret them or trace their origin. it is to be noted that psychologists who work at dream analysis make no mention of dream prophecies, although the fact that 'the wish is father to the thought' explains why a dream sometimes expresses an unconscious desire that later attains fulfilment in reality. the biblical account of nebuchadnezzar's dream of the idol with feet of clay bears the stamp of genuine history. the king, like the neurotic sufferer of to-day, 'dreamed dreams, wherewith his spirit was troubled, and his sleep brake from him.' the magicians, called upon to interpret, asked that the king should first tell his dream; but the king answered, 'the thing is gone from me; if ye will not make known unto me the dream, with the interpretation thereof, ye shall be cut in pieces and your houses shall be made a dunghill.' the magicians and astrologers, the sorcerers and the chaldeans, failed, but the prophet daniel took up the task and told the king his forgotten dream. we can only imagine his method, but it is possible to revive a dream by using the emotion felt on waking, and such a method, or even direct hypnosis, may have been available to daniel; and if we regard the interpretation, not as prophetic, but as revealing to the king his forebodings of future disaster, then the chapter accords with modern conceptions of dream analysis. nebuchadnezzar was already a psycho-neurotic on the borderline of insanity, as his subsequent history shows, and would easily come to rely upon and reward a psychologist like daniel, who convincingly laid bare to him the working of his unconscious. by tradition the old civilisations of the east were the sources of occult knowledge, and this view of a scrap of old testament history gives a hint how the tradition arose. if there existed an esoteric knowledge of psychological technique such as i ascribe to daniel, then its possessors would easily obtain reputations for more than worldly wisdom. chapter ix hysteria the word 'hysteria', like 'lunacy', is evidence of a belief now discarded. when the theory of demoniacal possession ceased to satisfy the desire for reasons, and material explanations were sought for certain conditions, it was supposed that the uterus (greek, _hystera_) came adrift from its position and wandered about the body, producing the condition thenceforward known as hysteria. advancing knowledge killed this theory, but the influence of the word remained and the disease was attributed to some derangement or irritation of the uterus and its associated organs. charcot, of paris, showed the mental origin of hysteria, but, becoming lost in a maze of hypnotism and suggestion, he described as symptoms of the disease various manifestations which were really called up by himself or his assistants. there are medical men who still insist on a bodily cause, but such causes serve merely as pegs on which to hang the symptoms. as usual, i shrink from a definition, but in this case i have good reason. every writer who describes hysteria expresses his own ideas about it, and as the ideas of no two writers are alike some definitions scarcely seem to refer to the same subject. here is a definition by babinski, a french writer of international reputation:-- 'hysteria is a peculiar psychical state capable of giving rise to certain conditions which have features of their own. it manifests itself in primary and secondary symptoms. the former can be exactly reproduced by suggestion in certain subjects and can be made to disappear under the sole influence of suggestion.' and here is one by pierre janet, a man of equal eminence:-- 'hysteria is a form of mental depression characterised by retraction of the field of personal consciousness, and a tendency to complete division of the personality, and subconscious mental conditions grow and form a kind of second personality.' and here are a few words from ernest jones, the chief exponent of freud's views in this country:-- 'it is in the excessive tendency to displace affects by means of superficial associations that the final key to the explanation of abnormal suggestion is to be sought. even if it were true, which it certainly is not, that most hysterical symptoms are the product of verbal suggestion, the observation would be of hardly any practical or theoretical interest.' when the reader has finished this chapter he will perhaps return to these definitions, and see how each represents one aspect, and how the best understanding is reached by a consideration of all of them. the great war has provided plenty of material for the study of hysteria, and french and german writers have dealt extensively with it. the paucity of english writings on the subject may indicate a smaller amount of material, but there has been sufficient considerably to increase our knowledge. the common form of hysteria is a mimicry of bodily disease; pains, paralyses, contractions and joint affections most often occur, though fits and trances are typical and there are few diseases which are not imitated. hysteria therefore has a superficial resemblance to malingering, or the conscious simulation of disease for a definite end, and many people find it hard to conceive any difference between the two. various criteria have been given to distinguish them, but, in my opinion, when the question arises the distinction can rarely be made upon physical grounds and is chiefly a matter of judgement concerning the honesty of the patient; that is to say, the hysteric believes in his disease as a reality, but the malingerer knows that it is fictitious. i believe there is no definite line between the groups, though some authorities assert that they are quite distinct. practical experience proves that in many cases there is an intense desire for cure which cannot be reconciled with any consciousness of simulation, and the apparently heartfelt gratitude often shown by the patient on recovery is further proof of the reality of this desire. it is a matter for regret that we have no word to take the place of 'hysteria', which is a mark of superstition; the only excuse for its use being that every one knows that it does not mean what it says. popular and even professional ideas concerning hysteria are so far from the truth that it is a pity a new word is not employed. if a man has fought bravely for years and at last succumbed in his effort to forget the horrors he has seen, it sounds an insult to say he is suffering from hysteria. yet the newer term of 'shell-shock' was worse, for it conveyed a totally false idea of causation and treatment: to regard as due to the concussion of a shell symptoms which are of purely mental origin led to muddled thinking. a common history in these cases was that the man became 'unconscious' after a shell explosion, and on returning to consciousness found himself mute, shaky, or paralysed. these facts led to the belief that the condition was actually due to the physical effect of an explosion, 'shell-shock' and 'concussion' being regarded as almost synonymous. but the same symptoms occurred when there was no question of concussion, whilst the recoveries, often sensationally reported in the press, after accidental or deliberate stimuli of various kinds were on all fours with the cures wrought by christian science or the pilgrimage to lourdes. hence the hysterical nature of the symptoms became evident and the concussion theory faded away. when one of these patients is encouraged to talk he often tells how he had felt himself overpowered by the horrors of his surroundings and forced to make increased efforts to keep going and avoid showing his condition to his fellows--in other words, to repress his emotions. the strain continuing, the shell-burst proved the last straw, and his repressed feelings broke into consciousness and took possession of it; this is what the man called being 'unconscious', but the condition is really an abrupt dissociation. in course of time--hours, days, or even weeks--he comes to himself again, and once more his feelings are buried; but now he is a hysteric, and his buried feelings--his dissociated stream--produce and maintain his symptoms. in whatever way the hysteria arises the developed symptoms are the result of a mental activity which is powerful enough to overcome for a long time the desire for recovery. there are two streams of thought--the one desirous of cure and the other engaged in keeping up the symptoms--and we recognise an extreme example of continuous dissociation, in which the main stream is not only unaware of the existence of the other and unable to control it, but in which the results produced by the dissociated stream are antagonistic to the desires of the main personality. this conception accords fairly well with janet's definition as given above, but though it gives us a description of the disease and indicates its relation to other phenomena we have yet to understand why the dissociation occurs. this is a difficult problem, and one to which several answers can be given. i have suggested one above, and freud supplies another, which he applies not only to hysteria but to allied nervous conditions. what follows is not an exposition of his ideas, but rather my interpretation of such as are acceptable and useful to me. a complex, which according to freud usually centres around an infantile sexual desire, is repugnant to the consciousness and becomes repressed as a result of conflict in just the same way as a memory is repressed. the complex is kept thrust down in the unconscious, but always tends to produce effects; it may do so in dreams or may obtain symbolic representation in the form of a neurosis, especially in times of stress. besides the primary aim of expressing repression by a symbolic representation, freud admits a 'secondary function' of the neurosis by which the patient may derive some advantage from the disease. here is a case capable of explanation by the freudian hypothesis: a man said he had fallen on to the blade of an aeroplane propeller and bruised his neck; he complained of severe pain in one side of his neck, with twitching of the arm on the same side, which continued for months. it was found that the patient, who was apprenticed to engineering, had such a deep-seated fear of making mistakes that he had sometimes stayed at the workshop for hours after the day's work was over in order to familiarise himself with the use of tools; but in spite of this his fear increased, until the handling of a file or spanner produced feelings of anxiety. then he joined the army. being put to work at aeroplanes he tried to do his duty and succeeded so far as to be made a corporal, saying never a word about his fears and banishing them as far as possible from his thoughts. at last the repression broke forth and took symbolic form in pain, the expression of his fear of the machinery which was blamed as its material cause. no account can picture the emotion produced by the recall of this complex, and it was evident that his feelings were intense and of more importance to him than one unfamiliar with such cases would suppose. his pains ceased when the cause had been revealed, and, what is very important, when he was told that he could not be expected to work at machinery. it must be added that the out-and-out freudian would not be satisfied with this explanation; he would trace the cause of the original fear of making mistakes, and would expect to find it in some repression of infantile desires or fears. certainly i have a feeling that the case had only been half investigated, but it will serve as a simple example of symbolic representation. the 'secondary function' of this neurosis is plain: the patient succeeded in keeping away from machinery all the time the pain lasted, and his anxiety symptoms were powerful enough to lead to his removal to another kind of work. this leads on to adler's theory,[ ] which, like freud's, is based upon conflict and repression, but regards the hysteria as derived from the 'will to power'. the potential neurotic has a feeling of inferiority combined with a desire to be master of his own fate, and, since direct attainment of this desire is impossible, the end is striven for by a fantasy or fiction produced by the unconscious. this view, thus baldly put, shows a relation between hysteria and malingering, and, returning to the case of the prentice engineer, we can see his work in the shop becoming more and more distasteful whilst his anxiety tended to become a means of escape; then in the army the neurosis took a more determined form which might be confounded with malingering by an observer who assumed that all actions were the result of conscious motives. [footnote : _the neurotic constitution._ kegan paul.] my present opinion is that the theory of repression offers the only explanation of many cases of hysteria. this applies particularly to those cases where the symptoms represent a permanent state of embarrassment or fear, such as stammers and tremors, and to the unreasonable fears and impulses, the phobias and obsessions, of the war-strained soldier. as an example i will quote a case of a soldier who had an impulse to attack any single companion, which was cured by bringing into consciousness the repressed memory of a gruesome hand-to-hand fight in which he killed his opponent. the repression was so complete that after its first revival under hypnosis it was 'forgotten' again and again at subsequent interviews in the waking state. this example illustrates freud's 'tendency to displace affects.' the repressed complex contained within itself the impulse to fight; this 'affect' reached consciousness and an object had to be found for it, the object being the single companion of the patient. as regards those hysterias in which the secondary function is conspicuous, i incline to the 'will to power' theory, and add to it the 'repression of the consciousness of deceit.' to illustrate this, let us trace the growth of a case of hysteria. imagine a girl who is 'misunderstood', who has her round of daily tasks and feels that she was meant for higher things, that she ought to be loved and obeyed instead of being subject to the will of others. to no one can she tell her thoughts and troubles, sympathy is denied her, and she sees no hope of satisfying her desires or changing her position in the world. or imagine another type, the pampered girl who has never had to face a trouble or unpleasant task and has come to regard her own wishes as the supreme law, until at last the time comes when some desire, some wish that she cannot or will not face and conquer, remains ungratified. she feels the need to express her feelings, to obtain that sympathy that she thinks she deserves. in either case there comes the hysterical manifestation, and here i will quote from jung[ ]:-- 'but, the astonished reader asks, what is supposed to be the use of the neurosis? what does it effect? whoever has had a pronounced case of neurosis in his immediate environment knows all that can be "effected" by a neurosis. in fact there is altogether no better means of tyrannising over a whole household than by a striking neurosis. heart attacks, choking fits, convulsions of all kinds achieve enormous effects, that can hardly be surpassed. picture the fountains of pity let loose, the sublime anxiety of the dear kind parents, the hurried running to and fro of the servants, the incessant sounding of the call of the telephone, the hasty arrival of the physicians, the delicacy of the diagnosis, the detailed examinations, the lengthy courses of treatment, the considerable expense: and there in the midst of all the uproar, lies the innocent sufferer to whom the household is even overflowingly grateful, when he has recovered from the "spasms".' [footnote : loc. cit., p. .] but the end is not always thus. there are victims of hysteria whose symptoms continue for months or years, till cure seems impossible, although, as i have said before in this chapter, there is present in the consciousness a strong desire for recovery. let us imagine the patient complaining of severe pain in one foot: the sympathising friends tend her with care and affection, the doctor suspects the early stage of some bone disease, and, as is the fate of so many practitioners, he is urged by the friends to say 'what is the matter.' then the supposed disease receives a name, muscular action pulls the foot into an abnormal position, deformity appears, and if the true nature of the disease is now discovered not only the patient but the friends and family need the most careful treatment. what has been happening all this time in the mind of the patient? we will assume that she knew at the beginning that her pains were fictitious; what course is now open to her if she wishes to end the deceit when her friends, by their pardonable credulity, have allowed themselves to be deceived and her troubles have been accepted by the doctor as real? her pride or self-respect prevents open confession, and in her ignorance of the course of the supposed disease she thinks an unexpected recovery will reveal the fraud. here are the materials for another mental conflict, and her alternatives are:-- . to solve the conflict by confession or recovery, and i have shown the difficulties of this course. . to build a logic-tight compartment; to say, for example, 'they have never given me a chance, and now i am quite right in imposing upon them as long as i can.' but her feelings concerning right and wrong are probably too strong to maintain this attitude indefinitely. . to repress the consciousness of deceit and maintain her symptoms as the price of her peace of mind. this last course is followed, and the patient is now a dissociate. in the dissociated stream are:-- . the original desires which led to the manifestation of disease--the desire for sympathy, the desire to have her own way, the 'will to power.' . the knowledge of deceit. . the mechanism for maintaining the symptoms--the pains, the paralysis or contracture. this stream is now independent of the main personality and out of its control; as far as the patient knows her pains are real, her deformity is a disease, and whoever doubts it is not only ignorant but cruel. we can now understand the capriciousness of the hysteric, her moods and contrary ways. on the one side is a mind with ordinary motives, and on the other is the split-off portion containing the complexes catalogued above. if the reader thinks this conception brings us back to the old one of demoniacal possession i will admit that the only difference lies in the definition of the demon. the description of this imagined case will perhaps be acceptable to those who believe in the connection between hysteria and malingering. this connection i at one time emphasised, and i still believe that in some cases the repression of a knowledge of deceit plays an important part in the development of the disease. but motives are derived more or less from the unconscious, and when the unconscious elements predominate we approach the condition in which there has never existed any consciousness of deceit. the case of the soldier with an obsession to attack his companion does not admit of the hypothesis of a stage in which the symptom was due to a conscious desire to any end: but his repression might have shown itself, let us suppose, in a paralysis of his legs as a symbol of exhaustion or terror. then we should have a hysteria in which there had never been any deceit complex, though in the absence of knowledge of the workings of the patient's mind a firm believer in the 'will to power' theory might attribute the origin of the condition to a definite desire to escape the strain of war. i can now state that some of the results of conflict between desire and reality form a graduated series, beginning at cases of conscious simulation, then passing on to those of hysteria with repression of the knowledge of deceit, and ending with cases where deceit has never existed; but no one theory explains satisfactorily the origin of all cases of hysteria. it is difficult to understand those cases in which the hysteric inflicts injuries upon him or herself; the individual who thrusts needles into his body and comes to hospital again and again to have them removed is a curious but not very uncommon object. an ophthalmic surgeon of my acquaintance had a patient who placed irritants under the lid of one eye till the sight was lost and the organ was removed, and the process was begun on the remaining eye before the trick was discovered. such things occur in the history of malingering, and what the consciousness can do the dissociated stream is equally capable of doing: the only difficulty is the very practical one of believing that the patient can carry out the necessary action without being fully aware of what is happening, unless we assume an abrupt dissociation with the main personality temporarily abolished. certain hypnotic experiments throw light upon this difficulty, which also occurs in connection with some spiritualist phenomena. it has for long been disputed whether mental processes can produce bleeding into the skin or blisters upon it. such bleedings were the 'stigmata' representing the marks of the crucifixion, that have been described as appearing upon the bodies of religious devotees, and they have been thought to be real and due in some way to auto-suggestion. hysterical subjects often show the production of raised wheals if the skin is lightly stroked with the finger-nail or the head of a needle; one can write a word upon the skin and watch it become visible. this is purely a circulatory phenomenon, but experiments have been made under hypnosis in which the skin is touched with a pencil and the subject is told that he is being burnt and that a blister will follow. success has been claimed for this experiment, but one source of error is hard to exclude. if a blister appears the next day, and the subject is known to be an honest man with no end to gain by cooking the experiment, an observer might be inclined to accept the result as due to the direct influence of suggestion; but the subject is, by the terms of the experiment, in a state of dissociation, and in the dissociated personality exists the suggestion that a blister should appear. in addition there exists the desire to carry out the wishes of the hypnotist, and since this is out of the control of the main personality whose honesty is accepted as sufficient guarantee against fraud he must nevertheless be regarded as willing and eager to produce a blister. milne bramwell[ ] quotes a case in which suggestion, under stringent conditions, apparently produced blistering: the subject's arm was then enveloped in bandages in which sheets of paper were incorporated, and after further suggestion and a night's rest it was found that, although the subject had been watched continually, she had succeeded in penetrating the bandages with a hair-pin. a further experiment, in which the arm was enveloped in plaster of paris bandage, gave a negative result. this experiment is very valuable; it does not disprove the possibility of producing blisters by suggestion, but it does prove that if we judge the dissociate by ordinary standards we expose ourselves to victimisation. if i were the subject of such an experiment i should certainly require that every precaution should be taken to prevent me from producing a blister by mechanical means. [footnote : _hypnotism_, rd ed., . wm. rider & son.] now let us consider the signs of the disease. in the chapter on suggestion i showed that in a limb paralysed by hysteria the loss of sensitiveness, the so-called hysterical anæsthesia, resulted from a desire on the part of the patient that the doctor should find what he was looking for, and this desire i called receptivity. the receptivity is at first necessary to keep up the deception, for the patient does not know the symptoms of the simulated disease, and must always be on the alert to pick up hints. when dissociation occurs, the receptivity finds its place in the split-off stream, forming part of the mechanism for keeping up the symptoms; but having passed out of the control of the main personality it tends to become exaggerated and misdirected. hence the hysteric becomes very suggestible and all kinds of fantastic symptoms may be produced. if the resistance to recovery is not great then suggestion may even remove symptoms, just as it created them; and if we now turn back to babinski's definition we shall find that it fits into our theories, although it concerns itself with only a restricted view of the subject. since one object of the dissociated stream is to maintain the symptoms, it follows that any method that will remove them may abolish the dissociation, though still leaving the patient with those desires and conflicts, conscious or unconscious, which preceded their appearance and which form the so-called 'hysterical predisposition'. this explains the success which has followed the employment of exorcism, christian science, nasty drugs, cold water, electric shocks, persuasion, or rest cures; and to this list, i hasten to admit, some people would add treatment according to the method of bringing repressions into the light of consciousness. i have tried to make clear the subject of hysteria for the following reasons: there is at the present day no school of believers desirous of attributing supernatural causes to the disease, and therefore i am spared the task of attacking a mass of credulity; and, further, the mental processes are identical with those shown in other phenomena concerning which credulity is still powerful. i can now proceed to show how the theory of dissociation explains the production of the spuriously supernatural by the apparently honest. chapter x experiments, domestic and other there are certain parlour tricks which have an attractive flavour of the occult and sometimes form an introduction to it. most of us have seen children mystified by a thought-reading performance depending upon a more or less obvious code, but sometimes we are treated to one which is more genuine. the procedure is something like this: one person goes out of the room and the others decide that on his return he shall perform an action such as unlacing a shoe or pushing on the hands of a clock to a certain hour. then he returns and, according to arrangement, may be blindfolded or not, and one of the party may or may not place a hand upon his shoulder; the audience next 'concentrate their minds' upon what the performer is to do, whilst he 'makes his mind a blank'. sometimes success follows, and the result is taken as proof of 'thought-reading'. now let us examine the process in the light of what we have assumed in previous chapters. to make the mind a blank, if it means anything, means to cut off the stream of consciousness, and we straightway have our old friend a dissociation. the performer is then in a state resembling hypnosis, and, as we have seen before, in hypnosis the senses may be abnormally sharpened. this sharpness, together with the receptivity of the subject, makes him ready to pick up the faintest signs, and in the case where the hand of a second person, also concentrating his mind on the desired action and therefore to a certain extent dissociated, is placed upon his shoulder, there are easily conveyed enough pressure-signs to indicate when he is going right or wrong. when there is no actual contact other indications than touch are not lacking. the passing expressions of pleasure or disappointment on the faces of the audience, the sigh of relief when a wrong step is retraced, the glances at the object to be handled, are all picked up by the dissociated stream whilst the main personality of the subject is for the time almost obliterated. we must bear in mind that all the audience are concentrating their minds, that concentration of mind upon an action is likely to be followed by movements corresponding to the action, and that no one is watching his neighbour or suspects any such unconscious indications. the thought-reading is not performed without prolonged pauses, the subject making several halting steps before the right one is taken. it reminds one of the manner in which the medium feels his way to the thoughts of his victims. domestic blindfolding is not very efficient, and may be of use to the subject by allowing him to look without the direction of his glances being noticed. so this thought-reading is reduced to the children's game of 'hot and cold', but instead of fully conscious people producing and receiving sounds we have a group of 'concentrated' (that is, partly dissociated) streams sending out indications to be picked up by a hypersensitive dissociated stream. the subject is often exhausted by his efforts, and the performance is not likely to be of benefit to any one who misinterprets it. the human mind contains enough errors without producing a voluntary dissociation further to deceive its owner. there is one well-known experiment the significance of which is generally missed. if the reader is not familiar with it let him follow these directions and he will probably find that he is possessed of some amount of so-called hypnotic power. having procured a weight fastened to a short cord (a heavy watch with its chain will serve), direct a friend to sit in a chair and, resting his elbows upon his knees, to hold the cord by the fingers of both hands so that the weight is suspended between his separated knees. let him keep his eyes upon the weight and assure him that it will begin to swing from knee to knee. the weight, at first indecisively wobbling, will soon take on the swing you describe, which will gradually increase in amplitude. i have heard people ascribe this motion to 'magnetic power'--blessed words that mean nothing, but serve to give an appearance of reason to an explanation that should satisfy no one. the real cause of the motion is shown if you experiment with a fresh subject, who must know nothing of the first trial. ask him to hold the weight in the same manner but, standing in front of him, tell him the weight will swing towards you (that is, at right angles to its swing in the first experiment). if you show sufficient assurance you will probably succeed in both experiments, but your chance of success is less than that of the man who has seen the trick and accepts the 'magnetic' explanation, for his belief in the physical cause of the phenomenon will give him a natural assurance which is lacking in one who realises that the weight swings in a certain direction because the agent is made to believe that it will. it is plain that your friend swings the weight himself, but he is unaware of two factors: he knows nothing of his own muscular action and nothing of his own mental processes which have produced that action; hence this experiment must be placed among the automatisms like table-turning and water-divining. one is prepared to find that the trick has its place among the mechanical adjuncts of spiritualism: it was used in ancient times as a means of divination, and is used by mediums of to-day when they tap out spirit revelations with a gold ring suspended in a glass tumbler. if intelligent people like your friends can be made to believe that the weight is moved by some extraneous force, it can be understood that the trained medium, full of a belief in the supernatural, finds it an easy task to let the unconscious have possession of his or her muscular actions and spell out memories and fantasies which one is asked to accept as evidence of spirit control. planchette (described in chapter iv) finds a place in the family circle, sometimes with the result that a single hit becomes a tradition after all the other stuff has faded from memory. a friend, who told me that he saw planchette predict truly the month in which the boer war ended, admitted that his family had toyed with the instrument night after night, but he failed to remember any other results. i must add that he never believed in the thing, but, nevertheless, the one lucky shot was remembered. table-turning is another half-way house between the parlour trick and the full-blown occult. several people sit round a light table with their hands placed upon it, and, after due 'concentration of mind', aided often by a dim light, the table begins to move and the spirits are at work. then a sort of morse code is invented to communicate with the spirit entities, and the revelations begin. here i will quote from page of _raymond_, that widely-circulated book by sir oliver lodge:-- 'during the half-hour ... i had felt every now and then a curious tingling in my hands and fingers, and then a much stronger drawing sort of feeling through my hands and arms, which caused the table to have a strange intermittent trembling sort of feeling, though it was not a movement of the _whole_ table.... nearly every time i felt these queer movements lady lodge asked, "did you move, woodie?" ... lady lodge said it must be due to nerves or muscles, or something of the sort.' compare this with the feelings of the water-diviner (chapter v):-- 'the muscles of the arm become contracted when the bodily magnetism is affected by the presence of water.... i suppose it must have something to do with the composition of the blood and nerve cells.' or with those of a hysteric who, previously relieved from mutism, was again struck dumb during a thunderstorm: ... 'i felt the electricity passing all over my body; it made all my muscles quiver and then went out at my finger-tips.' no one can deny the reality of these feelings, as feelings, but in the first instance they are due to spirits, and in the next to water, and only in the case of the man known to be sick in mind is the real explanation likely to be accepted by the subject. they are all products of imagination, suggestion, self-deceit, or dissociation--call it what you please if you understand that the feelings have their origin in the mind of the subject and are not due to any external cause. but in the first two examples they are associated with muscular movements which, we must believe, are carried out unknown to the doers and hence have their source in a dissociated stream. as usual, once the dissociation is established, there is no limit to its manifestations. picture three or four dissociates at work at a table, all bent upon producing signs of the marvellous, all blind to the mechanism at work, and with the hypersensitiveness of the dissociated stream ready to draw on the memories of the unconscious. mixed with this is the possibility of more elaborate deceit: when the hands of all are raised from the table their knees may still be under it; and if the knees are clear of it a blackened lath concealed up a sleeve can still work miracles. this is taking us beyond the purely domestic, but there is no difference between the after-dinner tilting of the table for amusement and the same thing done at a séance--the mechanism is the same, but one is treated as a jest whilst the other is something worse. we see again the typical series with simple trickery at one end and reason-destroying dissociation at the other. palmistry seems too absurd to be discussed, but it is another half-way house. that the lines of life, or love, or what-not, are to be found on the palms of dead-born babies and of monkeys should be enough to stop the cult; but handbooks of palmistry seem to profit their publishers, and the palmists and clairvoyants flourish. the girl who buys a handbook and amuses her friends by reading their hands is comparatively harmless, though even she, becoming shrewd to note when she hits the mark, is likely to develop an unconscious receptivity and drift into fraud. crystal-gazing is a form of mediumism admirably fitted to give play both to trickery and dissociation. used by the medium to 'see as in a glass darkly' and gain time for the help of his or her receptivity, it also allows of the induction of a self-hypnosis, the memories or fancies from the unconscious showing themselves as visions in the crystal. table-turning is easily first among the ways of giving rein to the unconscious. it has the advantage of allowing several people to play the same game at once, and further of allowing one dissociate to work the miracle, whilst no one, not even the dissociate himself, knows who is doing it. this is illustrated in _the new revelation_, p. , where sir arthur says: 'some one, then, was moving the table; i thought it was they. they probably thought that i did it.' _the gate of remembrance_[ ] gives an illustration of tapping the unconscious and producing results that seem astonishing. [footnote : by f. b. bond; blackwell, oxford.] two gentlemen, mr. f. b. bond and his friend j. a. i., had devoted years of study to the archæology of glastonbury, exploring every available source of information in history or tradition and thinking hard and often about the edgar chapel, a part of the abbey whose site was undetermined. after this preparatory storing up of memories and thoughts in the unconscious, they proceeded to tap them. i quote from page :-- 'what was clear enough was the need of somehow switching off the mere logical machinery of the brain which is for ever at work combining the more superficial and obvious things written on the pages of memory, and by its dominant activity excluding that which a more contemplative element in the mind would seek to revive from the half-obliterated traces below.' recognising an old friend, we are not surprised to find that automatic writing was the means employed to switch off the main stream of consciousness and produce a dissociation. i find myself more in accord with the writer than reviews had led me to expect, for he disclaims 'the action of discarnate intelligences from the outside upon the physical or nervous organisation of the sitters' (p. ). the automatic writing is apparently controlled by richard bere, johannes, and other influences which would be welcomed by spiritualists as 'objective entities'; but the writer gives his opinion regarding johannes (p. ) as follows: 'whether we are dealing with a singularly vivid imaginative picture or with the personality of a man no one can really decide.' here i must differ and claim to have decided, for myself at least, that no personality other than that of the actual writer was concerned. the record of hysterical phenomena contains so many similar 'personalities' that i find no reason to call in the supernatural to account for this one. if a natural explanation is available we must not appeal to the supernatural; i am sure that f. b. b. is not unacquainted with occam's razor--miracles must not be unnecessarily multiplied. since the writer does not stress the supernatural, and allows me to credit to his unconscious the poetical imaginings produced in the script and the 'veridical passages' concerning the discoveries of the edgar chapel, i have no need to criticise them, especially as he is scrupulous in giving credit to the conscious predictions of others when they hit the mark. the book is a record of an experiment--successful from the psychological point of view--carried out by two dissociates who _knew what they were doing_; the dissociated streams were entirely out of their control, and although i must, from the psychological standpoint, class the experiment with the other dissociations described in this book, yet it is far from my purpose to class the experimenters with 'feda' and others of her kind. the earlier chapters of this book were written before i read _the gate of remembrance_, but whoever reads the conclusion in the latter book will find many opinions in agreement with those in my chapter on the unconscious. table-turning, water-divining, automatic writing, thought-reading, and the use of the pendulum are examples of a psychological automatism in which the agent is conscious neither of the muscular movements concerned nor, what is more important, of the mental processes producing them. they can be cultivated to provide amazing results in tapping the memories of the unconscious, and if the agents remain in ignorance of their true mechanism a systematised delusion is built up and accepted as proof of the supernatural. chapter xi about mediums just as any one believing all actions to be the result of fully conscious motives may regard the hysteric as a simple fraud, so he may dismiss the medium and the clairvoyant in the same easy way and consider the matter settled. but we find men in positions which lend authority not only vouching for the honesty of the medium but sometimes taking an active part in the production of the phenomena for which the explanation of fraud is regarded as sufficient; as a result this explanation fails to convince and we meet many people who believe there must be 'something in it'. so there is: there is the same graduated series, from the simple cheat to the complete dissociate, that we saw in the consideration of hysteria, but in addition there is a fervent desire to believe, and the dissociate, instead of being regarded as a victim of disease, is treated as a person gifted with supernatural powers. let me describe my first experience of a medium. friends had told me of his gifts and had met my incredulity with 'how do you explain this?' followed by some story of supernatural revelation. i could not explain, but accepted an invitation to meet the miracle-worker and, perhaps, be converted. his method of demonstrating communication with the spirit world was to sit in a meditative attitude with one hand before his eyes, whilst watching between his slightly separated fingers the assembled believers so as to note the effect of his revelations, which were apparently presented to him by the spirits in two forms. descriptions of the spirit world came through freely, one might call them fluent but incoherent, whilst revelations such as my friends had promised came in a halting and uncertain trickle. the enthusiastic accounts had not prepared me for such a poor show. i had pictured him saying something like--'your grandmother's name was georgina; she died at the age of seventy-two, after an illness lasting three days; she was a good horsewoman and disliked mr. gladstone'. instead of this the procedure was: 'i hear a name, is it george? (no bite)--georgina? (a look of intelligence)--you have a friend named georgina--a young girl--no, not a young girl, she was older, a relative, yes, a relative'--and so on. finally georgina is discovered to be a grandmother of one of those present, and is described sufficiently well to be recognised as the grandmother on the father's side, though, curiously, georgina was the name of the maternal grandmother. what could be more convincing? of course spirit communication is difficult and such a mistake only proves the genuineness of the article; but the description of the grandmother was built up on certain characteristics of the father, who was present, and the source was obvious to any one not blinded by the desire to believe. one incident shows that the medium had received some education in the superficial signs of disease. an elderly lady with a rather puffy face, which had raised in me a suspicion of kidney disease, was told by him: 'it is strange, but i _must_ tell you for your own sake. you have trouble with your kidneys.' he was wrong and so was i, but if events had proved us right the credit would have been his. then my turn came and the spirits told about my own disposition, which i had unfortunately revealed by a single observation before the real business began, and the exulting glances of the audience told me the first score had gone to the medium. then more intimate stuff came through; names were presented and i nibbled at one: 'yes, i know him', with a stress on the 'i'. more revelations--he was my enemy (here a nod from me), i had suspected it for a long time, but right would conquer, and i must not fear. then a relative came into the play, and a look of sadness drew forth the surprising news that she was dead but her spirit was watching over me. next came the phrase, heard once before in the séance, 'i see a far-off land', and the believers brightened up again. quick came the news, 'you have been abroad,' and i couldn't deny it. thus the game went on; when a hint could be picked up it was used at once or later, to be cast back as a spirit revelation. as the game developed i gave hints in plenty, whilst my friends showed their joy at seeing a sceptic receive convincing proofs of the spirit powers. the séance being ended, my first task was to persuade the believers that the revelations vouchsafed to me bore little relation to the truth; 'but you said they were true.' 'yes, and they were not.' 'then you were really telling lies.' 'yes, and he believed them and so did the spirits.' 'well, of course, if you deceive the spirits like that how can you expect the truth in return?' so the rationalisations went on and the logic-tight compartments were protected from injury. in this show we see a fine example of receptivity, like that of the hysteric who watches the doctor to learn what symptoms he expects to find; and just as the doctor may suggest absurd symptoms and find them present, so i was able to suggest falsehoods and have them reflected as revelations. but the believer would never do that; he is eager to fit every phrase to some fact within his knowledge, those that cannot be so fitted being forgotten as soon as the next lucky shot occurs, and in his eagerness he helps along the medium and provides him with more material. lest it may be thought that this experience is not typical, i will use the light given by it to examine some of the spirit news given in _raymond_. but we must first understand who are the _dramatis personæ_ of a séance. since the time of the witch of en-dor the expert medium has had a familiar spirit which speaks through him to this world and at the same time is in contact with the spirit world. the psychological explanation, if the medium is a true dissociate and not a conscious fraud, is that the results of the dissociated stream are perceived by its owner as something of external origin. in the same way a lunatic whose dissociated stream produces voices will project them externally and believe them to be warnings or commands from an outside source; the table-turners, water-diviners, and watch-swingers follow the same reasoning, though their results are purely motor; and when ideas come up from the cut-off stream the individual cannot recognise them as mental products of his own, but feels impelled to credit them to another personality. i am reminded of a charming little girl whose one desire was to please her parents but who often gave way to the mischievous tendencies of a healthy child; whenever that happened she produced an imaginary 'naughty john' who broke toys and cut off little girls' hair. that is how the dissociated medium proceeds: unable to rate at their proper value the ideas which present themselves, he invents a familiar spirit who serves as their ostensible origin. the familiar thus called into being can draw upon the unconscious of the medium for the material to build up fantasies about another world. the spirits of the dead are part of these fantasies, so that we finally have the medium, the medium's split-off personality, often with a name of its own, and the spirit that meets the demand of the moment. the secondary personalities in sir oliver's mediums are feda and moonstone, and in the dialogue feda tells what raymond is doing or saying, occasionally carrying on asides of her own. all this seems very complicated, but an explanation is necessary in order to understand what follows. the medium (or, in this case, feda) tells sir oliver lodge (see pp. _et seq._), 'it's a browny-coloured earth, not nice green, but sandy-coloured ground. as feda looks at the land, the ground rises sharp at the back. must have been made to rise, it sticks up in the air.... the raised up land is at the back of the tent, well set back. it doesn't give an even sticking up, but it goes right along, with bits sticking up and bits lower down.' of this the scientific sir oliver says: 'the description of the scenery showed plainly that it was woolacombe sands that was meant.' the reader will have no difficulty in fitting this description to any sands he likes, but the believer wants it to be woolacombe, and woolacombe it is. then, the medium having discovered that o. j. l.'s family had a tent by the water, o. j. l. asks: 'is it all one chamber in the tent?' answer: 'he didn't say that. he was going to say no, and then he stopped to think. no, i don't think it was, it was divided off.' next a yacht appears out of the spirit world, and o. j. l. asks: 'what about the yacht with sails, did it run on the water?' the medium needs time to think, and the answer comes: 'no' (feda (_sotto voce_): oh, raymond! don't be silly!) he says, 'no. (feda: it must have done.) he is showing feda like a thing on land--yes, a land thing. it's standing up, like edgeways. a narrow thing. no, it isn't water, but it has got nice white sails.' o. j. l. 'did it go along?' 'he says it _didn't_! he's laughing! when he said "didn't" he shouted it.' feda should have said, 'he laid particular emphasis on it.' the first question is capable of two interpretations and the answer is ambiguous, though the ambiguity is further 'evidence' to sir oliver, because he remembers that a double-chamber tent had been turned into a single-chamber one. the second question may be compared with 'did you feel that?' in the production of hysterical anæsthesia (see chapter viii). the hysteric reasons, consciously or unconsciously:--it is natural to feel a pin prick, but the doctor is looking for signs of disease and he must expect to find a numbness or he wouldn't ask the question, so the answer is 'no'. when sir oliver asks concerning a yacht, 'did it run on the water?' the reasoning is similar, and the word 'run' helps, for no yacht runs on the water; if the yacht sailed on the water the question would not be asked, therefore the answer here was 'no', but the medium maintained a clever ambiguity whilst feeling her way. the third answer was a cleaner guess, but wrong. he says: 'all this about the tent and boat is excellent, though not outside my knowledge'.... then he adds, concerning the boat, 'i believe it went along the sands very fast occasionally, but it still wouldn't sail at right angles to the wind as they wanted it.... on the whole it was regarded as a failure, the wheels were too small; and raymond's "didn't" is quite accepted.' and raymond's 'did' would have been as readily accepted and put in the same chapter headed 'two evidential sittings.' contrast these halting scraps to the following (p. ): 'he wants to tell you that mr. myers says that in ten years from now the world will be a different place. he says that about fifty per cent. of the civilised portion of the globe will be either spiritualists or coming into it.' no hesitation here, but no possible verification either, nor any hint that a hundred per cent. of the uncivilised people of the globe are already spiritualists. sir oliver's imagination does not keep pace with his readiness to fit revelation to fact. after the tent, the water, and the yacht, comes--'rods and things, long rods. some have got little round things shaking on them like that. and he's got strings, some have got strings. "strings" isn't the right word, but it will do. smooth, strong, string-like.' of this sir oliver says: 'the rod and rings and strings mentioned after the "boat", i don't at present understand. so far as i have ascertained the boys don't understand either at present.' surely an out-of-door family like this includes at least one fisherman; why not think out who he is and score another bull's-eye to the medium? a delightful example of sir oliver's anxiety to help the medium occurs on page :-- o. j. l.: 'do you remember a bird in our garden?' (feda (_sotto voce_): 'yes, hopping about'). o. j. l.: 'no, feda, a big bird.' 'of course not sparrows, he says. yes he does.' (feda (_sotto voce_): did he hop, raymond?) 'no, he says you couldn't call it a hop.' this book of sir oliver lodge's shows an honesty which, together with the circumstances under which it was written, makes critical examination difficult; but there are similar circumstances in many a household to-day, and the honesty of the writer leads many people, who reason that what an eminent man honestly believes must be true, to turn to a mind-wrecking belief in mediums instead of finding consolation in a saner philosophy or religion. at my first séance it strained my belief in human intelligence to find respected friends believing the romances and guesses of a trickster to be spiritual manifestations, and i thought that there must at least be a more elaborate type of deceit, since believers were to be found among our scientific aristocracy. my belief is no longer strained, but broken, for i find in sir oliver's medium the same tricks, the receptivity, the halting search for material, and the same easy flow of unverifiable revelations that characterised the medium i first met. thanks to his honesty, one is able from the material supplied by this writer to trace the source of many 'revelations', and in the rare examples where the source is not manifest (as in the 'pedestal' incident, p. ) it is scarcely unfair to presume some unintentional suppression. i say unintentional because sir oliver, blind to the explanations his own book offers, is plainly incapable of wilfully suppressing facts that tell against himself. spiritualism has its fashions, apparitions and materialisations having now given place to communications with the dead, which is the 'new revelation'. its newness is not so apparent when we read the story of the witch of en-dor. even the occasional deportation of undesirable mediums is not new, for saul 'put away those that had familiar spirits, and the wizards, out of the land' ( samuel, chap. xxviii.). when he disguised himself to visit the witch she recognised him just as the mediums recognise sir oliver; but the modern resemblance is best seen when we read that saul, after asking for samuel, 'said unto her, what form is he of? and she said, an old man cometh up, and he is covered with a mantle. and saul perceived that it was samuel.' here we see the medium giving to the credulous believer just what he wants, and the believer reaching out to accept the trivial guess as a spirit revelation. but the remoteness of the event (even at the time the account was written) allowed of prophecies far more to the point than any modern medium's, though, as often happens nowadays, their fulfilment was described by the same writer that reported them. in one respect we have degenerated since the days of saul; the witch of en-dor was not hailed as an instrument of divine power destined to provide a new driving force for religion. chapter xii the accounts of believers one is repeatedly faced with a story of the marvellous and invited to explain it away or believe in the supernatural. my favourite way of dealing with such a proposition is to borrow a pack of cards, invite the story-teller to take a card, and, without letting me see it, to think of it whilst holding my hand. after a silent pause i name the card and may be told, 'of course that's a trick', and on assuring my friends that the spirits have told me the name of the card i am called a scoffer; somehow a pack of cards is not spiritual enough. some stories are hard to explain without full evidence, and here is one of them: a friend assured me that in _raymond_ was an account of how one of sir oliver lodge's family went to london to visit a medium, and how after she had started some others of the family met in birmingham, and, calling up the spirit of raymond, asked him to say 'honolulu' at the london séance. sure enough at the london séance held on the same day 'honolulu' came into the spirit talk. this account is substantially correct (see pp. _et seq._) and the incident is inexplicable so far; sir oliver lodge says of the episode:-- ' . it establishes a reality about the home sittings. . it so entirely eliminates anything of the nature of collusion, conscious or unconscious. . the whole circumstances of the test make it an exceedingly good one.' then, after suggesting telepathy as an explanation, he writes: 'i venture to say there is no normal explanation, since in my judgement chance is out of the question.' if the information had stopped at this no explanation on natural lines would be possible, but so painfully honest is sir oliver that in the same book he supplies full material for such an explanation. at a london séance on december th, , with the same medium there occurs the following:-- (question): 'what used he to sing?' (answer): 'hello-hullolo, sounds like hullulu-hullulo, something about "hottentot," but he is going back a long way he thinks.' on april th, , a song of raymond's is found with the words written in pencil:-- 'any little flower from a tulip to a rose if you'll be mrs. john james brown of hon-o-lu-la-lu-la town.' this song is fitted to the medium's revelations as given above, and the next point of interest is whether the medium is informed of her success. this we are not told, but we find on page that when another medium had hit the mark, with a sentence now interpreted as a warning of the death of raymond before it took place, sir oliver wrote to the daughter of the medium: 'the reference to the poet and faunus in your mother's last script is quite intelligible, and a good classical allusion; you might tell the communicator sometime if there is opportunity.' plainly he is desirous of letting his mediums know when they succeed and it is fair to suggest that the hullulu medium found she had hit the mark, the interpretation of the gibberish being 'honolulu', though hottentot failed to score. a medium will always follow up a lucky shot and it needs not even an appeal to chance to explain the repetition of the word at the next sitting, after the verification, which was on may th (the date of the simultaneous test), the following being the words used:-- (the medium says): 'you could play.' (n. m. l. asks): 'play what?' (the medium): 'not a game, a music.' (n. m. l.): 'i'm afraid i can't, raymond.' (feda (_sotto voce_): 'she can't do that'): 'he wanted to know whether you could play hulu-honolulu.' one of the strongest 'evidential' stories in the book being thus explicable without calling upon the supernatural, any others lose their value even if no explanation can be based on the available facts; but apart from this explanation the choice of the test word throws a light upon the little group tilting the table at birmingham. with the whole dictionary and all geography from which to choose, they selected a sound which had occurred in a former revelation and therefore had a chance of repetition. if in his laboratory days sir oliver examined a substance for the presence of arsenic, he would first test his reagents for the presence of that metal lest they might contain a trace of it and vitiate the experiment. in this test the experimenters did what was equivalent to selecting an arsenic-contaminated test-tube to use in an analysis for that substance. how did the word come to be selected? if the family of this distinguished man had used ordinary caution in formulating the test, they would certainly have chosen a word that had not occurred before, and i think that point must be clear to the reader. but, though they are probably sensible people in ordinary life, when they turn to the spirit world they fall a prey to their dissociated streams, in which was the knowledge that the word or something like it had been used before and was likely to be used again, especially if, as i suggest, the medium knew it had scored. hence these believers were, as far as concerned their dissociated streams, deliberately introducing a source of error or, in laboratory language, cooking the experiment. among my card tricks is included the elementary one (technically known as 'forcing a card') described at the beginning of this chapter, but i may let some one choose a card from the pack on the table whilst my back is turned; then, the card being placed in the pack which i have now taken in my hand, i do some other trick. it is common for these tricks to be confounded, and for one of my audience to assure friends that i let him or her take a card from the pack on the table when my back was turned and then named it by 'thought-reading.' such a performance is beyond me, but a like garbled account is characteristic of what we hear concerning séances: the story-tellers are in a state of mental confusion, they add or subtract in order to make the result emphatic, any power of criticism they possess is suspended, and we are asked to swallow the final product and confess ourselves believers. after considering my own experiences and the evidence produced by sir oliver lodge, i have reached the conclusion that no one desirous of believing only the truth can accept anything 'supernormal' without the strictest investigation on the spot, aided by a knowledge of trickery, verbal or material, as well as of the results produced by dissociation and logic-tight compartments in the minds of the would-be honest. sir arthur conan doyle shows how convincing a twice-told tale becomes. i borrow from _the new revelation_ (p. ):-- 'or once again, if raymond can tell us of a photograph no copy of which had reached england, and which proved to be exactly as he described it, and if he can give us, through the lips of strangers, all sorts of details of his home life, which his own relatives had to verify before they found them to be true, is it unreasonable to suppose that he is fairly accurate in his description of his own experiences and state of life at the moment at which he is communicating?' the words 'can tell us of a photograph no copy of which had reached england' would lead us to believe that information that the photograph existed came from raymond: fortunately the original account is accessible. here is the photograph story, taken from _raymond_ (p. ). the medium speaks, saying: 'you have several portraits of this boy. before he went away you had got a good portrait of him--two--no three. two where he is alone and one where he is in a group of other men. he is particular that i should tell you of this. in one you see his walking-stick'. (moonstone here put an imaginary stick under his arm.) this is ordinary guess-work, and it would be true of the families of most officers, even as to the stick; but it was not true in this case, for we read that though they had 'single photographs of him of course, and in uniform', they had _not_ one of him in a group of other men; yet this is the revelation referred to by sir arthur--the photograph incident that has impressed so many. let us put the two statements side by side:-- before he went away you ... raymond can tell us had ... one where he is in a of a photograph no copy of group of other men. he is which had reached england? particular that i should tell you of this. not being able to explain the extraordinary identity of these photographs, i must leave the problem to the creator of sherlock holmes; we shall gain no help from sir oliver, for his ideas of identity, as we shall see in the next paragraph, are equally curious. now for 'exactly as he described it': sir oliver lodge, having been informed in an ordinary letter that a group photograph containing raymond is being sent to him from france, went to another medium and told her, 'he said something about having a photograph taken with some other men' (this itself is a garbled statement); leading questions followed, and the medium fenced with them. here are the important ones:-- o. j. l.: 'do you recollect the photograph at all?' 'he thinks there were several others taken with him, not one or two, but several.' (this is not even a guess.) o. j. l.: 'does he remember how he looked in the photograph?' 'no, he doesn't remember how he looked.' o. j. l.: 'no, no. i mean was he standing up?' 'no, he doesn't seem to think so. some were raised up round; he was sitting down, and some were raised up at the back of him. some were standing, and some were sitting, he thinks.' (here is a correct description, anyhow; it is an even chance whether he is sitting or standing, and, the sitting chance being taken, the rest is padding. we are told on page that another photograph showed him standing, so that a hit could have been scored if the other chance had been taken.) o. j. l.: 'did he have a stick?' 'he doesn't remember that.' (yet the presence of a stick in the picture is hailed on page as one of the strikingly correct peculiarities mentioned by raymond. be it noted that the stick was spoken of in connection with one of the three photographs that the family was said to have _before he went away_, and is used as 'evidence' concerning _the one sent home from france_.) o. j. l.: 'was it out of doors?' 'yes, practically.' feda (_sotto voce_): 'what you mean, "yes practically," must have been out of doors or not out of doors. you mean yes, don't you?' feda thinks he means 'yes,' because he says 'practically'. o. j. l.: 'it may have been a shelter.' 'it might have been. try to show feda. at the back he shows me lines going down. it looks like a black background, with lines at the back of them. (feda here kept drawing vertical lines in the air.)' (the shelter is suggested by o. j. l.; feda takes the hint and visualises the shelter. most shelters have vertical lines in their structure. such lines occur in the photograph and are strong 'evidence.' the background is not black except for two open windows.) the only revelation worthy of attention is this: 'he remembers that some one wanted to lean on him; but he is not sure if he was taken with some one leaning on him.... the last what he gave you, what were a b, will be rather prominent in that photograph. it wasn't taken in a photographer's place.' (few out-door groups are.) in the photograph he has some one's hand resting on his shoulder, and an ambiguous guess scores a hit. as for b, sir oliver writes: 'i have asked several people which member of the group seemed most prominent; and except as regards central position a well-lighted standing figure on the right has usually been pointed to as the most prominent. this one is "b", as stated, namely, captain s. t. boast.' some initials are guessed--c, b, r, and k. as there are twenty-one people in the group, and the alphabet contains only twenty-four letters (excluding x and z), it is hardly a mathematical surprise that seventy-five per cent. are correct. so much for the photograph that proved to be 'exactly as he described it' (sir arthur) and 'one of the best pieces of evidence that has been given' (sir oliver). 'all sorts of details of his home life' we must suppose refers to the scenery of woolacombe, the tent, the boat that went (or didn't) on land, the song about hululu and the hottentot, the fishing rods that are not understood at present, and so on. as a test of unintentional garbling i asked a professional man, who had read _raymond_ sympathetically, to give me a short account of what the medium said about the photograph. here is his version, and it must be understood that he knew i should criticise it:-- 'sir oliver lodge was told by a medium that raymond wished to tell him about a photograph taken in france. the medium said the photograph was of a group of officers including raymond--a photo sir oliver had not seen. _there were lines running vertically in the background. raymond is seated._ some one's knee was preventing him from sitting comfortably and annoyed him. he was holding a stick. _the photo was out of doors_, but in a sheltered position.' the only points in which this tallies with the book description of what the medium (not sir oliver) said are those shown by the words in italic. the rest is garbled, and for the garbling my friend and sir oliver are about equally responsible. i have since asked other intelligent people to read the chapter and then write out the story; the result is generally similar to that just given. the affair is such a to-do about nothing that the sympathetic and uncritical reader, deceived by the fuss, thinks there must be something in it and makes additions of his own to account for his belief. had he read it critically he would have recognised the emptiness of the story, but once he is impressed by it he must improve it or become aware of its flimsiness. once again i must emphasise the way in which a guess, wide of the truth, is wrenched into an application to something entirely irrelevant. the first medium says that before raymond went away his family had a photograph which showed him in a group of other men; _because this is not true_, it is twisted into a reference to a photograph taken in france and not yet received. the revelations of this medium must be cut out of the story, and the whole incident is reduced to sir oliver lodge being told in an ordinary letter that a group photograph is on its way to him; then he tells another medium about a group photograph, and in answer to leading questions she makes the halting guesses reproduced above. this is the famous photograph story, stripped of exaggeration and garbling. sir arthur conan doyle would lead us to believe that the medium told sir oliver about the existence of the photograph, but the true account shows that, so far from this being the case, _sir oliver told the medium_. it is a commonplace of spiritualism that a medium may be guilty of trickery at one time and genuinely gifted at another. we may freely admit that mediums are peculiar people, but when sir arthur conan doyle writes on a subject that needs careful observation and description and gives this distorted account of the photograph story, he can expect little credence when he writes in the same book equally convincing stories of the supernatural and puts them before the public as a contribution to religious thought. he gives a list of eminent men who vouch for the genuineness of supernatural phenomena, and says that the days are past when their opinions can be dismissed with the empty 'all rot' or 'nauseating drivel' formula. i agree, and regard their opinions as interesting objects of psychological study. a little research could produce a longer list of men, equally eminent in their day, who believed in witchcraft and were willing to execute people in accordance with that belief. the belief may yet return with all its horrors if _the new revelation_ is taken seriously. on page we read concerning the cheriton poltergeist[ ]:-- 'it is very probable that mr. rolfe is, unknown to himself, a physical medium, and that when he was in the confined space of the cellar he turned it into a cabinet in which his magnetic powers could accumulate and be available for use.' (it is hard to believe that he who speaks like this about 'magnetic powers' once had at least an elementary knowledge of physics.) on page we read, concerning another poltergeist, that '... a clergyman, with some knowledge of occult matters, has succeeded by sympathetic reasoning and prayer in obtaining a promise from the entity that it will plague the household no more.' [footnote : a poltergeist is a spirit that throws things about; its appearance is generally associated with the presence of some young person, whose tricks may be detected to the discredit of the ghostly cause. if trickery is not detected the poltergeist is the manifestation of an evil spirit.] poor mr. rolfe has had a narrow escape of being mixed up with an 'entity' who, or which, might have led him to the stake in a thorough-going spiritualist age. this relation between spiritualism and witchcraft is not a fantasy of my unconscious; listen to this from another believer:-- 'the dangers of the spiritual world are greater because, bad as a man living on our plane may be, he cannot compare in that respect with a thoroughly wicked denizen of the fourth-dimensional space, whose power is all the greater because his very existence is almost universally denied. what little good was ever in him has been blotted out in the course, perhaps, of centuries; his cunning passes earthly comprehension; his experience of the ways and foibles of humanity is profound; his malignity is dreadful. to be fully under the influence of such an entity as this is to be at his mercy, and, as no such word exists in his vocabulary, the end is a foregone conclusion, unless another force of a contrary character and at least as powerful is directed against him.'[ ] [footnote : _problems of the borderland_, p. , by j. herbert slater. wm. rider & sons, .] it is indeed fortunate that the existence of these entities is almost universally denied. hangings and burnings would be soon in fashion again if any large proportion of us were influenced by such a horrible complex. sir arthur conan doyle has given an account to the papers (see _daily telegraph_, february th, ) of a séance in wales. hymns were sung to produce a suitable emotional state, and 'the lights were turned down in order to obtain the proper conditions, because ether transmits light, and is also the source of all psychic phenomena.' then, the medium being tied down, a tambourine rattled, and a coat and furniture flew about. the bearing of this upon life in the hereafter, which sir arthur discusses in connection with the performance, is not clear, but the effects are identical with those produced by the davenport brothers, who were exposed in .[ ] [footnote : see _the question_, p. .] the list of witnesses, who numbered about twenty, leads me to remark that though in a multitude of counsellors there may be wisdom yet in a crowd of witnesses there is herd instinct. with a conspicuous member of the herd like sir arthur in the lead, the sway of emotion will dull any criticism, and if a few are unconvinced they will remain silent.[ ] [footnote : in _spiritualism--the inside truth_ (chap. vi) stuart cumberland tells how this medium refused to admit him to a séance. stringent precautions, however, were followed by a failure to produce spirit manifestations.] the statement that ether is the source of all psychic phenomena is startling, but unsupported. another believer, sir william crookes, says, concerning exhibitions of what he calls 'psychic force', that '... everything recorded has taken place _in the light_'.[ ] so there seems to be some fundamental error about the observations of one of them. but sir william's results were obtained from the famous daniel home, whose years of experience in credulity allowed him to take risks which the humble beginners in wales hardly dared. [footnote : _phenomena of modern spiritualism_, p. . 'two worlds' publishing co., .] to examine all the stories of the supernatural is impossible; many are, i frankly admit, inexplicable _on the evidence_; but it is fair to assert that when an observer, on a subject which requires the most careful watching and closest reasoning, shows by his own account that he is ready to be deceived, then we cannot be convinced by his statements when they are unverifiable. sir arthur conan doyle is thus ruled out of court, for his account of the photograph story shows, to put it gently, a lack of clear writing, and his readiness to thrust upon the public a repetition of the davenport tricks, without a warning as to their history, is not what we should expect from a man who has studied the subject for thirty years. sir william crookes gives detailed accounts of marvellous happenings, but two mediums in whom he had implicit trust were detected in deliberate fraud by other people,[ ] so that his critical powers failed him. [footnote : miss fox and mrs. cook; see _the question_, pp. and .] some of his accounts show curious lapses. in one experiment an accordion is placed in a cage under the table and mr. home puts his hand into the top of the cage to do psychic things with the instrument. the temperature of the room is carefully recorded (that doesn't matter, but imparts a scientific flavour to the observations) although we are not told why the experiment was done under the table instead of in a more convenient position on top of it, though 'my assistant went under the table, and reported that the accordion was expanding and contracting,' and 'dr. a. b. now looked under the table and said that mr. home's hand appeared quite still.' sir william would never have made such an omission if he had been using the same reasoning powers that he used in his scientific descriptions. it is noticeable that the chief 'scientific' supporters of spiritualism are eminent in physical science; they have been trained in a world where honesty is assumed to be a quality of all workers. a laboratory assistant who played a trick upon one of them would find his career at an end, and ordinary cunning is foreign to them. when they enter upon the world of dissociates, where deceit masquerades under the disguise of transparent honesty, these eminent men are but as babes--country cousins in the hands of confidence-trick men--and their opinions are of less value than those of a smart schoolboy. spirit photographs are useful to people who desire to show material evidence for their beliefs, and for more than fifty years the desire has been met by periodical outbreaks of this particular manifestation, with occasional exposures of fraud. the spirit effects can be produced by double exposure of one plate or by printing on one paper from two negatives, so that the declaration that a photograph is that of a spirit carries no proof with it and one must examine the circumstances under which the photograph is obtained. a friend of mine, with a decided tendency to belief in the reality of spirit photography, was good enough to show me photographs of himself with spirit forms beside him, and undertook to repeat his visit to the photographer--who is accepted as genuine by leading spiritualists and appears to be the chief exponent in the art of spirit photography in this country--and take with him plates supplied by myself. the photographer allows you to bring your own plates, goes with you into the dark-room, and allows you to initial the plate before it is put in the frame (whether it is your plate which you mark depends upon the will and dexterity of the artist, aided by the darkness and a preliminary hymn and prayer which should remove all doubts from your mind). then the plate is put in the camera and, whilst attendant ladies pass into a trance, an exposure is made with yourself as the sitter. next the plate is developed under your eyes and perhaps a spirit form is revealed. i provided my friend with a packet of four plates, three of which had been exposed so that on being developed they would show a very conspicuous cross. at the séance two plates were first exposed and developed; on one appeared a cross with the portrait of the sitter, on the other appeared only the portrait. the photographer now knew that one plate at least was marked, and when the remaining two plates were exposed and developed the cross appeared on both of them.[ ] there had been no substitution, but no spirit photographs either. then the old excuse appeared--'one negative thought will spoil a whole circle', or, in other words, 'if you are on the watch for trickery we won't perform'. [footnote : this is doubtful. my informant reported that he saw no cross on the last two plates, but when the four prints came to hand the cross appeared on three of them. two prints were identical--though each was supposed to be from its own negative. if the photographer aimed at puzzling me he has succeeded.] it must be remembered that even in a 'good' séance only one or two spirit results may appear in several exposures, so the photographer can always expose, develop, and examine any or all of your plates, and at the least suspicion that yours are marked he may refrain from substituting his own prepared plates and blame the spirits for the lack of manifestations. one may ask why a private mark (say a faint file scratch on the edge) was not put on the plates so that the photographer himself could not detect, even after development, that they were marked in any way? such a course would at once reveal whether substitution had taken place--though even then the real believer could declare that the spirits had removed the scratches. but this test is frustrated by the photographer--simple honest man--who refuses to part with the plates; he says they are now his property, but he will let you have some prints! in this example we find, as in so much 'evidential material', a point where investigation is blocked and credulity is demanded. another piece of evidence is produced in this case, and i am shown a spirit photograph beside a lady's. the lady claims that the spirit is that of a young man, now deceased, to whom she was engaged. she was a stranger to the photographer, so how could he produce the likeness even if he substituted his own plates? but when i showed this spirit photograph to a friend, with a query as to sex, she answered, 'but it _is_ a woman, isn't it? it looks rather like n----.' now n---- is a mature maiden lady, so that the sexless features of the spirit leave plenty of room for the play of fancy. we are invited to accept or disprove stories of spirit photography reported from the continent, but whilst leading spiritualists in this country accept the productions of the man whose methods i have described i must refuse attention to anything they vouch for farther afield. mr. crawford, a mathematician and engineer of belfast, has published reports of investigations of table-lifting séances, and builds up a theory of spiritual cantilevers which he believes to explain his results. the theory is pretty and the diagrams are impressive, but the facts first call for examination. reading his accounts, i find that the experiments are carried out in a dim red light, for a sudden white light causes the immediate cessation of the phenomena. in addition there is a sacred line between the medium and the levitated table which must not be investigated on pain of dreadful results to the medium. this threat of physical evil to the medium if the sceptic should investigate at a crucial point is a common pretext, but though sceptics have often taken the risk, and seized a spirit to discover a disguised medium, there is no record of such disastrous results as mr. crawford would have us fear. i suggest that this investigator should use his technical knowledge to show how a simple but material cantilever, operated by the medium along the sacred line, can produce levitation of the table. the complaint is made that scientific men scoff at spiritualism and yet refuse to investigate it; in the last two examples we see why this is inevitable. investigation is prevented in each at the very point where fraud might be detected; so long as such obstruction is maintained the spiritualists are likely to continue their complaints, and one must be content to speculate on the mental state which allows a few men of scientific training to support their claims. the reader must not think that my aim is to convert spiritualists from their belief. it is, as i have tried to show in earlier chapters, useless to attack rationalisations in an effort to penetrate a logic-tight compartment; as soon as one defence is broken down another is built up, and one can only take comfort from the history of other examples of _pseudodoxia epidemica_, as sir thomas browne (he himself being, strangely enough, an active believer in witchcraft) called them, and look forward to the fading away of this delusion. just as the belief in witchcraft passed away from the educated and intelligent, lingering only amongst the ignorant, so this delusion will pass and leave our descendants to wonder how some of us came to be its victims. chapter xiii the evolution of the medium after meeting my first medium i came away with the feeling that he was a rather artful liar; but now, whilst retaining that opinion, i am ready to admit that perhaps his lying was not a product of his consciousness. i know nothing of his history, but he was accepted by intelligent people as honest and respectable; moreover, records of spiritualism contain so many examples of people whose belief in their own supernatural powers must be accepted as real in spite of manifest deceit, that we must again fall back upon dissociation to explain their state of mind. i shall assume the existence of three groups just as in connection with hysteria, and classify mediums, clairvoyants, water-diviners and other producers of the supernatural into-- . the deceiver pure and simple. . the deceiver who has repressed the consciousness of deceit and become a dissociate. . the subject who has never been conscious of deceit, but, led astray by his unconscious, has deceived himself from the beginning and finished as a dissociate. to place any performer in the proper group is again a matter of judgement. having a small repertory of tricks, including water-divining and a few manifestations with a pack of cards, i have sometimes put myself in the first group with temporary success. the development of a case of the second group is probably not a phenomenon that has ever been continuously observed, but robert browning has formed such an excellent conception of it in _mr. sludge, the medium_, that his description bears comparison with my theory of the development of some hysterics. david sludge is a house-servant and his master is pictured discussing high finance with his guests when the boy breaks in, saying, 'sir, i've a five-dollar note.' the scorn of the guests is immediate:--'he stole it, then; shove him out'. and david is given the swift kick of ignominy. * * * * * 'but,' says the poet, 'let the same lad hear you talk as grand of signs and wonders, the invisible world. if he break in with "sir, i saw a ghost!" ah, the ways change!' browning leaves us to imagine the boy's motive; perhaps his was just a boyish trick inspired by a desire for notoriety of which he himself was scarcely conscious, but, like the unfortunate hysteric who meets credulity, david is led on to produce more manifestations. 'and, david, (is not that your christian name?) of all things, should this happen twice--it may-- be sure while fresh in mind, you let us know!' then later:-- '"... came raps! while a light whisked" ... "shaped somewhat like a star? well, like some sort of stars, ma'am." "so we thought! and any voice? not yet? try hard, next time, if you can't hear a voice; we think you may." * * * * * 'so david holds the circle, rules the roast, narrates the vision, peeps in the glass ball, sets-to the spirit-writing, hears the raps, as the case may be.' then begins his conflict; like the patient who successfully feigns symptoms, he finds withdrawal difficult:-- 'you'd prove firmer in his place? you'd find the courage--that first flurry over, that mild bit of romancing-work at end, ... to interpose with "it gets serious, this; must stop here. sir, i saw no ghost at all. inform your friends i made--well, fools of them, and found you ready-made. i've lived in clover these three weeks: take it out in kicks of me!" i doubt it. ask your conscience!' says poor david:-- 'there's something in real truth (explain who can) one casts a wistful eye at.' now he faces the same dilemma that the developing hysteric has to meet, and as the hysteric reaches a false salvation by the repression of the knowledge of deceit so does david:-- 'why, when i cheat, mean to cheat, do cheat, and am caught in the act, are you, or, rather, am i sure o' the fact? well then i'm not sure! i may be, perhaps, free as a babe from cheating: how it began, my gift ... no matter; what 'tis got to be in the end now, that's the question; answer that! had i seen, perhaps, what hand was holding mine, leading me whither, i had died of fright.' nor does the poet omit the development of receptivity:-- 'i'm eyes, ears, mouth of me, one gaze and gape, nothing eludes me, everything's a hint, handle and help.' at the last the youth, once an innocent jester, pours a stream of half-believed lies upon the man who, having caught him in his fraud, lets him go with a chance to start life afresh. browning does not carry the idea of repression as far as i do, sludge producing clouds of rationalisations to cover his inconsistencies. the idea of dissociation does not present itself, but the whole picture can be taken to represent the evolution of many mediums with their mixture of belief and deception. just as in the hysteric we meet with mechanical ways of deceit, shown by self-inflicted injuries, so in the medium we meet with mechanical tricks for the production of spurious phenomena. in both cases fully-conscious deceit, reconciled to the moral complexes by rationalisations, is the easiest explanation, but sometimes fully-conscious deceit is unlikely. there is a disappointing lack of originality in spiritualist literature, for the same stories of the marvellous are repeated in one book and another. the fox sisters, slade, eglington, eusapia palladino and others appear according to the fancy of the writer, and their fraudulent tricks may or may not be acknowledged. it is a peculiarity of spiritualist reasoning that if a medium is caught cheating it only proves that he was cheating when he was caught; if he is not caught next time, we must accept as genuine the phenomena then produced. but no spiritualist writer can avoid the names of home, stainton moses and mrs. piper, for _they were never caught cheating_; nevertheless, we apparently need testimonials at great length to their honesty. mr. j. arthur hill gives two pages of testimonials to stainton moses, and repeats a story telling how the reverend medium made an automatic drawing of a horse and truck and gave a spirit message concerning a man who had been killed that day under a steamroller in baker street. mr. hill says: 'mr. moses had passed through baker street in the afternoon, but had heard nothing of any such incident.'[ ] [footnote : _spiritualism_, p. . cassell & co., .] if mr. hill knew anything about dissociation he would not give us this oft-quoted but flimsy story. whence does he obtain his evidence that the medium had heard nothing of the incident? of course, from the honest personality of mr. stainton moses himself. but a story of some terrifying episode is often, by psychological technique, extracted from a war-strained soldier only to be repressed and honestly denied by the man a little while later. if the dissociated sufferer can deny the truth of an incident which, when recalled again, fills him with horror, then the denial by another dissociate that he has heard of a street accident does not carry weight, even if we read a bookful of testimony to his honesty. the accounts of this famous medium, who is still held in awe by believers, are full of such happenings. on another occasion the spirit in possession of him gave the names of members of a family who had died in india and were unknown to him or any one present. the names were verified by reference to the obituary column of _the times_ of a few days before. we can assume that the honest stainton moses did not read _the times_, but that the dissociated stainton moses read and remembered. with this dissociation well established and having for its object the production of occult phenomena, we can understand the rest of the manifestations that he produced for his circle of friends. he received numerous communications from the dead, produced spirit lights, transferred objects from one room to another through closed doors, floated about, and, in short, went through all the spiritualist repertory. the ball is kept rolling by all sorts of people. the late archdeacon wilberforce, who believed in 'objective entities that seem able to manipulate or influence nerve currents, or magnetic ether, or whatever it is, of persons in the flesh',[ ] wrote approvingly of him: 'the most remarkable medium i ever knew was the reverend stainton moses, a clergyman in my father's diocese of oxford'.[ ] [footnote : _there is no death_, p. .] [footnote : _ibid._, p. .] of the same medium mr. podmore says: 'apart from the moral difficulties involved, there is little or nothing to forbid the supposition that the whole of these messages were deliberately concocted by mr. moses himself and palmed off upon his unsuspecting friends.'[ ] [footnote : _studies in psychical research_, p. .] the moral difficulties disappear when we consider the case as one of dissociation. his spirit communications were psychologically identical with the automatic writings of the glastonbury archæologists (see chapter ix); he read obituary notices, studied out-of-the-way stories of men and women, and from the stores of his unconscious he produced this information as news from the spirit world. but, knowing nothing of the ways of the unconscious and becoming a prey to his own dissociated stream, he fed this stream and drifted with it into something a little removed from sanity. i know not how the manifestations began, and whether he belonged to my second or third group i do not attempt to discuss; i am satisfied if i have made it clear that the work of this wonderful medium can be explained otherwise than by one of the two alternatives of spiritualism or conscious deceit. we meet with the same rush to testify to the honesty of mrs. piper. sir oliver lodge of course guarantees her, and the late professor william james, the harvard psychologist, wrote of her: 'practically i should be willing now to stake as much money on mrs. piper's honesty as on that of any one i know, and am quite satisfied to leave my reputation for wisdom or folly so far as human nature is concerned to stand or fall by this declaration.'[ ] [footnote : re-quoted from _spiritualism_, p. .] this honesty of the main personality of the dissociate leads astray professors of physics or of the old psychology.[ ] it is the honest but mistaken man who misleads his fellows. we are on our guard against the rogue, and the conscious deceiver must needs be a good actor if he would succeed. the best actor knows he is acting, but the reverend moses needed no effort to preserve for years the appearance of straightforwardness and honesty. as far as he knew, he _was_ straightforward and honest, though beneath his consciousness lay fathomless possibilities of deceit, ever ready to take advantage of the externals of an honest man. [footnote : i may owe an apology here to the memory of professor james, for the original quotation is given without its context.] as i said in chapter vi, an authoritative and confident manner makes easy the acceptance of suggestion. what can be more authoritative and confident than the manner of a man who believes what he says and knows that his hearers are willing to believe? if what he says are lies and delusions, that makes no difference in his manner, and his unsuspicious hearers are still ready to stake their reputations upon his honesty. that readiness only makes them the more suggestible and renders valueless their opinion as to the truth of what he says. spiritualist writers are glib concerning 'subliminal consciousness', and, knowing not what they mean, attribute to it powers of communication with the spirit world. the only one worthy of study is the late f. h. myers, and though his stories of the marvellous are largely repetitions of old material yet his treatment of the psychology of double personality is illuminating. his work on _human personality_, if free from the spiritualist complex, would probably rank well in advance of its period. he has a good grasp of the subject of hysterical double personality, giving some excellent examples, but postulates a transition from the imaginings of the hysteric to the revelations of the spirit world. that the mind should pass through disease on its way to divine revelation, the boundary between the two being only a matter of judgement, is a necessary part of his explanation of mediumism. just as spiritualists will maintain their belief in a medium after fraud has been detected, placing upon unbelievers the onus of proving fraud in every case, so myers, knowing the workings of hysterical double personality, claims the right to exclude hysteria whenever he pleases and to attribute a divine origin to the material then produced. this demand appeals neither to the religious man nor to the sceptic. i take the liberty of borrowing a story from mr. hereward carrington, a spiritualist of some critical power.[ ] [footnote : _personal experiences in spiritualism_, pp. - . t. werner laurie, ltd.] 'one of the most interesting cases that i have ever encountered is the following, which i consider of remarkable psychological interest from various points of view. during the early summer of , a gentleman called upon me, stating that he knew a wonderful physical medium, of the same type as palladino. he himself was a lawyer; his friend, the medium, was also a lawyer, and had "a scientific interest in these things," and in "having the remarkable manifestations which occurred in his presence solved," etc. for three years and a half, i was told, this case had been under private observation, and the manifestations had grown more and more numerous and bewildering as time went on. this, and much more of like nature, i heard by way of preliminary to the investigation of what appeared to be a very promising case. an evening having been arranged, the two gentlemen called at my house, and, after a chat, the demonstrations were undertaken. a broom was placed on the floor, and then, the medium kneeling over the object (or, rather, squatting on the ground), he placed his fingers on either side of the broom-handle, and then gradually took them away. as he did so the broom was seen to rise into the air. it remained suspended in space for a few seconds, then fell to the floor. the effect was most striking, while the phenomenon was of that simple order which one would naturally expect to discover in a simple undeveloped medium. the first two or three experiments interested me immensely, i must confess. but i noted one particular thing about the movements of the medium, which was that every time he placed an object on the floor, he placed it very close to his knees; this caused me to look between his knees intently instead of at the object during the next few trials. the result was that i distinctly saw _a fine black thread_ stretched from leg to leg, forming a loop, into which the various objects were slipped in the act of placing them on the floor. the rest was only a matter of balance. in spite of the fact that i had discovered the _modus operandi_, i did not wish to act hastily, having been accused so often in the past of condemning too hastily upon discovering the fraud. accordingly i asked the medium to meet me a few evenings later at the office of my friend, dr. gustave sayer, and here we witnessed a second demonstration. it would be useless to repeat the details of this performance, which was simply a repetition of the first. suffice it to say that not only was the medium seen using the loop of thread throughout, but this loop broke twice during the evening--once in the middle of the experiment--the thread being heard to break, and the object at once falling to the ground. on the first occasion the medium made an excuse, retired upstairs, and evidently arranged the thread, for he came down again in a few minutes and proceeded to give us a further test. upon the thread (audibly) breaking a second time, however, he said that he "did not think he could do any more for us that evening," and sat down, apparently exhausted. it was the most flagrant and bare-faced swindle i ever came across, and in this dr. sayer agrees with me. and yet here was a young lawyer practising these tricks, apparently for no motive, and constantly lying about them in a most astonishing manner; and this was a case from which much was to be hoped, apparently.' this story hardly needs comment; but the writer's attitude towards another and more famous medium, eusapia palladino, is very different. until i read the book from which these passages are quoted i thought no one regarded this lady as anything but an exposed fraud; even sir oliver lodge has written concerning her, 'my only regret is that i allowed myself to make a report, although only a private report, to the society for psychical research, on the strength of a few exceptionally good sittings, instead of waiting until i had likewise experienced some of the bad or tricky sittings to which all the continental observers had borne frequent witness.'[ ] [footnote : quoted from _the question_, p. .] mr. carrington says of this lady[ ]:-- 'in any event, it appears to me obvious that, even assuming that fraud was intended on this occasion, it proves nothing more than the fact that eusapia will resort to clever trickery whenever the occasion is given her to do so--a fact which all students of her phenomena know full well already; and it does not in the least prove that the whole séance was fraudulent--which is what is implied in professor munsterberg's article. every one knows well enough that scores of phenomena have been observed in the past which could not possibly have been accounted for, even assuming that the medium had both her feet free--a fact i have previously pointed out. the difference between eusapia and the other mediums spoken of in this volume is this, that in their case they invariably fail whenever "test conditions" are imposed, whereas eusapia generally succeeds; further, the whole tenor and setting of the séance, so to speak, is entirely different. lastly, we have the unanimity of opinion amongst scientific men as to eusapia's powers, whereas we have nothing of the sort in the case of any other medium. on the contrary, whenever they are investigated along these lines, they either fail altogether or are detected in fraud.' [footnote : _personal experiences_, p. .] this gentleman has reason for pride in his powers of observation, but his spiritualist complexes are so firmly enclosed in their logic-tight compartment that his own critical powers beat in vain against the door. it was unfortunate for the young lawyer, but at the same time inexplicable, that mr. carrington pitted his observations, made at two sittings only, against those of the people who had had the case under private observation for three and a half years. surely this respectable young man deserved the laurels of mediumism as much as did eusapia. what are two failures against three and a half years' manifestations that 'had grown more and more numerous and bewildering as time went on'? i am sure that, if mr. hereward carrington had given his blessing, this young man might have become a famous medium instead of being blighted after his years of successful effort. but mr. carrington cannot conceive an alternative between a bare-faced swindle and a spirit manifestation, and in this he is harsher than i. it is plain that this young lawyer had the respect of his friends and was believed to be honest, just like mrs. piper and stainton moses, and mr. carrington missed a chance of useful psychological investigation when he dismissed the case so curtly. the chance cannot be recalled, but a talk with this medium might have helped in the understanding of his distinctly disordered mind. i once had the chance of a frank talk with the accomplice of a professional medium, but, though he had some belief in the occult, he was so fully conscious of his roguery that i learned no more psychology than i have picked up from a three-card trickster. anyhow, mr. carrington gives us an example of a medium in the making who we can only guess was a man whose disappointed ambitions and neurotic 'will to power' had led him astray. i wonder how mr. carrington explains the failure of previous observers to detect the trickery? the man's apparent honesty of course helped, but the herd instinct was also at work and converts would be unlikely to criticise when a few reputable people had expressed their belief. certain card-tricks are safer from detection by a large audience than by a small one. if three people are present and one thinks he detects the trick he may speak, for he is only in a minority of one to two; but if five out of fifteen detect it, each one, feeling he is in a minority of one to fourteen, is over-ruled by his sense of insignificance and remains silent accordingly. it is easier to sway a crowd than to persuade an individual. let me make it clear that i do not merely compare the medium with the hysteric, i regard them as identical except in those cases where the medium is a conscious deceiver. the attitude of the believers in the honesty of the medium is the same as that of the sympathising friends of the hysteric patient, and it is often as difficult and thankless a task to explain the patient's condition to his or her friends as it is to save the credulous from falling a prey to the fortune-teller. but such difference as there may be is in favour of the unfortunate hysteric, who is the victim of forces that are too powerful to be resisted without help and who often anxiously desires recovery. i have seen in a man suffering from war-strain the spontaneous development of what would be accepted as clairvoyance; the identity of his performance with that of the medium is of great importance. the patient was in that condition of dissociation or partial hypnosis into which these men easily pass, and was apparently 'seeing' some of the horrors he had experienced. as a rule such revivals of war episodes can be relied upon as a true reproduction of actual events, but in this case there were inconsistencies in the story. for example, describing how uhlans drove their lances into belgian babies, he said: 'if i had my revolver i'd let them have it,' but gave no indication of what he, a british soldier, was doing unarmed and under such circumstances. moreover, though the account was given with due emphasis, there was a lack of the emotion characteristic of the revival of actual horrors. then a break came in the story, and he went on to describe a tragedy which had recently roused public interest. he saw the murderer walking with his victim, described how she handed over certain articles to him, and then how the man shot her and hurried off. all this was graphically related as if he were actually witnessing the tragedy, and as i listened i realised how any one ignorant of the workings of a disordered mind would feel compelled to believe in the reality of clairvoyance and might be impelled to act upon the belief, for the description of the murder, if true, could only have been derived from something like second-sight. the cause at work in producing these fantasies was fairly clear. the man had seen three years of fighting, and had resolutely tried to forget all that he had passed through; he had the usual symptoms of 'shell-shock', and in addition complained bitterly of being haunted by dreams of murder. i know not what particular happening had so impressed him, but in his unconscious were the memories of many horrors which, refused admission to his consciousness, insisted on manifesting themselves by dreams and waking fears. every horrible thing he read or heard was joined on to his dissociated stream of memories and emotions, to be reproduced in dreams and fantasies. in his imaginings there was a mixture of truth and fancy; the figure of the murderer, for example, proved to be associated in his mind with the figure of an officer who was present at a time of great emotional strain, and the articles handed over by the victim were identical with articles familiar to the patient and of emotional importance to him. the other reproductions proved to be of incidents which had been related to him and to which he had given an intimate personal interest whilst elaborating them; his own experiences were more deeply repressed. his condition was identical with that of the honest medium--whether stainton moses or more recently advertised seers--but fortunately his friends recognised the true nature of his disorder and, instead of cultivating it as a 'gift', took steps to have it treated as a disease. in the description of mediums we often find hints of hysterical symptoms. sir oliver lodge tells of the sighings and writhings of one of his performers, but it is not often that a definite diagnosis is made as in the following extract[ ]:-- 'i do not think that any one who has seen the effects of a _good_ séance upon eusapia could doubt its reality. she has been known to suffer from partial paralysis, from hysteria, nausea, amnesia, loss of vision, as well as great weakness, prostration, etc., after the séance. i have seen her actively nauseated--excessively ill--after a good séance of this character, a symptom which is unlikely to be simulated, even if it could be. it is only after a _good_ séance that such things occur, however. after a poor séance at which, perhaps, much fraud has occurred ... i think that eusapia often simulates exhaustion when, as a matter of fact, there is little or none, but this would not deceive one who has carefully watched her for weeks and months together, and has observed the effects of a genuine séance upon her.' [footnote : _personal experiences_, p. .] the behaviour described by mr. carrington is precisely that of the hysteric, but it is not clear what he means when he says that her being actively nauseated is a symptom unlikely to be simulated, even if it could be. hysterical vomiting--resulting from mental processes, and not from any physical cause--is very common, and is a simulation of bodily disease, though i do not imply that the patient is aware of the simulation. perhaps being nauseated was, in this case, a symbol of the disgust which one personality felt towards the frauds and lies of the other. eusapia, having reached a condition of hysterical dissociation, presents the material symptoms of such a condition, for the nausea, paralysis, amnesia, loss of vision, prostration, etc., are classical symptoms of hysteria. the spiritualist actually holds them forth as proofs of the reality of spirit communication! let the reader bear in mind that they show eusapia to have been not merely a cheat, but mentally diseased. there is a sad list of books purporting to instruct beginners how to communicate with the dead, and the instructions are such as to induce dissociation--a mental condition with possibilities of self-deception and hysterical manifestations like those shown by eusapia palladino. bad enough it is to believe the fantasies of a diseased mind to be revelations from beyond the grave, but how can one sufficiently condemn men of learning and position who would lead along the pathway of disease those who mourn their lost ones? a few extracts from _how to speak with the dead_[ ] will illustrate these pernicious attempts. [footnote : by sciens: kegan paul, trench, trübner & co.] (page ) 'by sitting in some place quite alone and free from interruption, and by adopting a mental attitude of passive receptivity and expectancy, the soul becomes ready to perceive and be affected by any spirits that may be in its vicinity and that may attempt to open up communications.... the manifestations ... may vary from thought-suggestion to positive physical phenomena ... such as the hearing of a voice or even the visual appearance of some supernormal object. all depends upon whether the sitter is or is not susceptible to psychical influence, and also upon whether the locality or the sitter personally is or is not haunted.' then (page ) when the dissociation has developed:-- 'in cases where the sitter is markedly "psychic" it frequently happens that normal control over the body is lost. a condition of trance supervenes, and while this continues the spirit--which may be either a "second personality" or a soul from the outside--that has gained the upper hand makes use to a greater or less extent of the brain and other organs subject to its mastery. the hand may write: the mouth may speak: the whole body may be engaged in some impersonation; and all this may take place beyond the scope of the sitter's normal consciousness.' lest the hysterical dissociation is not yet enough developed, the victim receives, on page , another thrust along the road to disease:-- 'if it be found on trial that psychic powers exist to an appreciable extent it may be taken for granted that they are capable of very great increase by persevering effort and systematic employment.' a warning is both given and stultified on page :-- 'self-deception and the imaginations bred of wishes and emotions are to be guarded against;' ... 'in solitary expectancy fraud and trickery are completely absent, and all manifestations are matters of the most simple personal observation, the accuracy of which can be confirmed--as in an ordinary scientific laboratory--by the test of repetition.' these directions are sufficient to start victims along the path taken by eusapia, and, though we do not know how this woman reached the condition described by mr. carrington, yet the men who fostered her deception certainly helped the unfortunate creature in her development of a second personality compounded of delusion and fraud. the description of the other case of mr. carrington's contains a significant phrase: 'the phenomenon was of that simple order which one would naturally expect to discover in a simple undeveloped medium.' just so: the game was only beginning, but, if the medium had developed, the split-off personality would have taken charge and limitless cheating and fraud could have been carried on by a medium who was to all seeming an honest man. but as i showed that the causes of hysteria are to be found in conflict and repression, only taking the 'will to power' and 'repression of the knowledge of deceit' as particular forms applying to a few cases, so i must allow that the medium may not always be influenced by the last two factors. the hysteric is the prey of emotions and experiences which cannot be faced unaided, and the strivings and desires that arise from the unconscious, which in one individual may find expression in social work, may find vent by a neurosis in another, or by mysticism in a third. the desires may be of the noblest kind, and, failing to find legitimate expression, may show themselves in fantasies. i am not the first to draw attention to the psychology of joan of arc, and we can picture her urged by the noblest emotions to seek in a dissociated stream powers beyond the reach of consciousness; her visions were real to her, and tradition may be believed when it relates the story of her detection of king charles disguised as one of his own courtiers. 'be not amazed, nothing is hid from me', are the words attributed to her, and the incident well exemplifies the hypersensitivity of a dissociated stream. i cannot picture a modern medium actuated by high motives, but am ready to admit that even in our days there may be mystics whose dissociations arose from commendable origins. theosophy is bound up with the story of two women, madame blavatsky and mrs. besant; the former was a self-confessed deceiver, but the latter is a very different kind of woman. brought up in strict religious surroundings, she found herself compelled to cast aside her religious beliefs and, at great personal sacrifice, take up a public attitude directly opposite to them; but her old beliefs still lay in the unconscious, and when the opportunity arose she found relief from her conflict in a fantastic creed of the supernatural. no one who has studied her life can deny her honesty, but honesty does not make her beliefs easier of acceptance. before leaving the subject of mediums i must allude again to witchcraft. to those who believe in spirits, good or evil, which can take possession of us and make us do their will, and can throw about bricks and sand and furniture in our material world, there is nothing remarkable in epidemics of bewitchery, especially as the witch-finders were more fortunate than our spiritualists in having the unanimous support of the most eminent authorities of their day. to explain the psychology of witchcraft is beyond the scope of this book, but it is not hard to conceive that when the belief in witchcraft was strong certain unfortunate people who set out to play tricks, maybe for notoriety or temporary gain, became ensnared by credulity and finding escape difficult came to believe in their own powers. thus dissociation would be set up and on the side of the witch-finders herd instinct (or suggestion) and logic-tight compartments did the rest. the fact that confessions of witchcraft were apparently common makes this explanation more probable. for a career ending at the stake to have such a trivial origin as a desire for notoriety is in agreement with the history of sludge, whose downfall began with a desire to draw attention to himself. call them ambitions and the desires seem less trivial, nor do i shrink from suggesting that the 'gifts' of the water-diviner and the most financially disinterested medium, even of mr. stainton moses himself, have origin in a desire to shine before one's fellows--a neurotic 'will to power'. conclusion although i have emphasised the part that dissociation plays in the production of beliefs and actions, yet dissociation is only a particular manifestation of the unconscious and it is the latter which is becoming the field of research as to the causes of human action. from the evolutionary standpoint consciousness is a late development. man sacrificed many advantages when he rose above the beast; in every mere bodily endowment he has superiors in the animal world, and as the influence of consciousness has become more and more important so the sphere of his unconscious actions has diminished. the bird needs no foresight for the building of her nest: the impulse to build comes and must be obeyed. when migration time arrives there is no reasoned plan of going to a distant land, no scheming of routes or destinations: she just goes. so it is with the intricate instincts of other creatures, of the wasp that builds her brood-cell, fills it with living victims, and places there an egg of whose future she can know nothing. seeing these things we marvel at the intelligence of the agent, but the child who ties a rag round a stick and gives it a name uses more initiative than any other animal possesses. here, rather late, i will introduce mcdougall's definition of an instinct:-- 'instinct is an innate psycho-physical tendency to pay attention to objects of a certain class, to experience emotional excitement of peculiar quality on such perceptions, and to act or have an impulse to act in a particular way with regard to that object.' we can see that instinct suffices for the bird or insect, living almost entirely in the unconscious, to carry on the important affairs of life. even in regard to what looks like the exercise of reason or memory we can find a parallel in the human unconscious. the unreasonable fears and obsessions of the 'shell-shocked' soldier rest upon causes of which he is unaware, and the burnt child dreads the fire even if he were too young to remember the burning. the chicken that has once tasted a nauseous caterpillar will ever after avoid its like, but we only know that a certain emotion is called up by the sight of the caterpillar which causes the chicken to abstain; it is an unnecessary assumption that memory, as we know it, is concerned. the obsession of the soldier who felt that he must attack his companion (see chapter viii) arose from the unconscious, and those animal actions which we attribute to memory can similarly have their origins apart from consciousness. mcdougall's definition of instinct applies very well to obsessions, except that the latter are not innate but acquired; that one definition should apply to both groups is due to them all having their origin in the unconscious. man, though urged by the instincts and memories of his unconscious, yet lives in his stream of consciousness and tends to believe that there is no other mind-work involved in his thoughts and actions; but as the latest evolved function is the most variable and unstable so man's consciousness is his most uncertain function, its chief variability being in the extent to which it controls or is controlled by the unconscious. the ideal human mind would be perfectly integrated, there would be no logic-tight compartments, all its complexes would be apparent to the consciousness, all memories available when needed, all emotions assigned to their proper cause and all instincts recognised and well-directed; and the owner of it would find life in our world intolerable. remote from this ideal is the mind whose unconscious has taken the place, wholly or in part, of the stream of consciousness. perhaps the consciousness has not developed--then we find idiocy or imbecility; perhaps some distorted emotion from the unconscious has been the source of a dissociated stream of ideas which becomes predominant and brings its owner within the legal definition of a lunatic. between the extremes are the rest of mankind, the matter-of-fact man who reconciles himself to his world by a few serviceable logic-tight compartments, the man of temperament--artist, poet, or tramp--who counts the emotions arising from the unconscious as among the real things of life, and the other people of temperament who, finding their emotions and desires in discord with their surroundings, misdirect them and join the sufferers whom we call neurotic. then there are those who build up from the unconscious a fantastic world of imaginings, and, knowing nothing of the source, attribute them to outside intelligences or beings like themselves. to these belong the seers and mystics and their present-day representatives, the mediums, clairvoyants, and other believers in their own fantasies. the counterpart of the medium is the ready believer, and each is reciprocally the victim of the other. the medium has his dissociated stream with its hyperæsthesia and receptivity--alert to pick up the slightest hint and cast it back as a spirit revelation, and ready, moreover, to use more material trickery if needful. on the side of the believer is a logic-tight compartment containing his readiness to seize upon the feeblest evidence of the supernatural. how far he progresses into a dissociation one cannot tell, but when two dissociates apparently bearing the stamp of honesty--one the medium and one the believer--work into each other's hands results may well be such as to defy explanation. the study of the unconscious is legitimate, and if one chooses knowingly to tap its stores by a method of dissociation some increase of knowledge (not about the supernatural, but about the ways of the human mind) may be expected. but whoever hands himself over to a belief that the products of a dissociation--whether of his own consciousness or of another's--are manifestations of the spirit world, may come to say-- 'had i seen, perhaps, what hand was holding mine, leading me whither, i had died of fright.' _printed in great britain by_ unwin brothers, limited woking and london generously made available by the internet archive.) observations on madness and melancholy: including practical remarks on those diseases; together with cases: and an account of the morbid appearances on _dissection_. by john haslam, late of pembroke hall, cambridge; member of the royal college of surgeons, and apothecary to bethlem hospital. _the second edition, considerably enlarged._ "of the uncertainties of our present state, the most dreadful and alarming is the uncertain continuance of reason." dr. johnson's rasselas. london: printed for j. callow, medical bookseller, crown court, princes street, soho; by g. hayden, brydges street, covent garden. . as a grateful acknowledgment for many favours, an oblation to subsisting friendship, and a tribute to superior judgment, exercising the profession of medicine with skill and liberality: the present volume is respectfully dedicated to dr. thomas monro, a fellow of the college, and physician to bethlem hospital. preface. _the alarming increase of insanity, as might naturally be expected, has incited many persons to an investigation of this disease;--some for the advancement of science, and others with the hope of emolument._ _more than ten years having elapsed since the publication of the "observations on insanity," a trifle, which the profession has held in greater estimation than its intrinsic merits could justify: the present work is modestly introduced to the public notice, as a corrected copy of the former, with considerable additions, which the extensive scope of bethlem hospital would have furnished more liberally to a more intelligent observer._ _to have taken a comprehensive survey of the human faculties in their sound state; to have exhibited them impaired by natural decay, and transformed by disease, would have implied an ability to which i cannot pretend; would have required many volumes to unfold, and perhaps more patience than any rational experience could have attributed to the reader. the contents of the following pages are therefore to be considered as an abbreviated relation, and condensed display of many years observation and practice, in a situation affording constant opportunities and abundant supplies for such investigations._ _it is natural to presume, that amongst my professional acquaintance the subject of insanity must have been frequently introduced as a topic of discourse; and i am ready to acknowledge, that i have often profited by their remarks and suggestions: but i should be ungrateful were i not to confess my particular obligations to my esteemed friend, anthony carlisle, esq. surgeon to the westminster hospital, for many corrections, and some communications, which i shall ever value as judicious and important._ bethlem hospital, nov. , . errata. _page_ , _line_ , _for_ controverted, _read_ converted. , , _for_ phrenitic, _read_ phrenetic. , , _for_ hyatids, _read_ hydatids. , _in the table_, _for_ manical, _read_ maniacal. observations on madness, &c. &c. chapter i. definition. there is no word in the english language more deserving of a precise definition than madness: and if those who have treated on this subject have been so unfortunate as to disagree with each other, and consequently have left their readers to reconcile their discordant opinions; yet it must be confessed that considerable pains have been bestowed, to convey a clear and accurate explanation of this term. although this contrariety of sentiment has prevailed concerning the precise meaning of the word madness, medical practitioners have been sufficiently reconciled as to the thing itself: so that when they have seen an insane person, however opposite their definitions, they have readily coincided that the patient was mad. from this it would appear that the thing itself, is, generally speaking, sufficiently plain and intelligible; but that the term which represents the thing is obscure. perhaps, we might be somewhat assisted, by tracing back this word, in order to discover its original meaning, and shewing from its import the cause of its imposition. if the reader, as is now the custom, should turn to johnson's dictionary for the meaning and etymology of this word, he will find that the doctor has derived it both from the anglo-saxon gemaad and the italian _matto_; but without giving any meaning as the cause of its employment. the word is originally gothic, and meant anger, rage, [gothic: mod]. [mod]. it is true that we have now controverted the o, into a, and write the word mad: but mod was anciently employed. "yet sawe i modnesse laghyng in his _rage_." _chaucer. knight's tale, fol. , p. ._ there is so great a resemblance between anger and violent madness, that there is nothing which could more probably have led to the adoption of the term. dr. beddoes, who appears to have examined the subject of insanity with the eye of an enlightened philosopher, is decidedly of this opinion, he says, hygeia, _no. , p. _, "mad, is one of those words which mean almost every thing and nothing. at first, it was, i imagine, applied to the transports of rage; and when men were civilized enough to be capable of insanity, their insanity, i presume, must have been of the frantic sort, because in the untutored, intense feelings seem regularly to carry a boisterous expression." mad is therefore not a complex idea, as has been supposed, but a complex term for all the forms and varieties of this disease. our language has been enriched with other terms expressive of this affection, all of which have a precise meaning. delirium, which we have borrowed from the latin, merely means, _out of the track_, de lira, so that a delirious person, one who starts out of the track regularly pursued, becomes compared to the same deviation in the process of ploughing. _crazy_, we have borrowed from the french _ecrasé_, crushed, broken: we still use the same meaning, and say that such a person is crack'd. insane, deranged, or disarranged,[ ] melancholic, out of one's wits, lunatic, phrenitic, or as we have corrupted it, frantick, require no explanation. _beside one's self_ most probably originated from the belief of possession by a devil, or evil spirit. the importance of investigating the original meaning of words must be evident when it is considered that the law of this country impowers persons of the medical profession to confine and discipline those to whom the term mad or lunatic can fairly be applied. instead of endeavouring to discover an infallible definition of madness, which i believe will be found impossible, as it is an attempt to comprise, in a few words, the wide range and mutable character of this proteus disorder: much more advantage would be obtained if the circumstances could be precisely defined under which it is justifiable to deprive a human being of his liberty. another impediment to an accurate definition of madness, arises from the various hypotheses, which have been entertained concerning the powers and operations of the human mind: and likewise from the looseness and unsettled state of the terms by which it is to be defined. before treating of the intellect in a deranged state, it will perhaps be expected that some system of the human mind, in its perfect and healthy condition, should be laid down. it will be supposed necessary to establish in what sanity of intellect consists, and to mark distinctly some fixed point, the aberrations from which are to constitute disease. to have a thorough knowledge of the nature, extent, and rectitude of the human faculties, is particularly incumbent on him who undertakes to write of them in their distempered state; and, in a legal point of view, it is most important that the medical practitioner should be enabled to establish the state of the patient's case, as a departure from that which _is_ reason. the difficulty of proposing a satisfactory theory of the human mind, must have been felt by every person, who has touched this delicate string since the days of aristotle, and failure must be expected in him who attempts it: yet the endeavour is laudable, and miscarriage is not linked with disgrace. every contribution, to illustrate what are the powers of mind we possess; how we are acted upon by external circumstances in the acquisition of knowledge; and concerning the manner in which we use this knowledge for the purposes of life; ought to be candidly received. enquiries of this nature have been usually conducted by commenting on the numerous and discordant authorities which have treated on metaphysical subjects; these persons, however they may differ on many points, appear to be pretty generally agreed, that the human mind possesses certain faculties and powers; as imagination, judgment, reason, and memory. they seem to consider these, as so many departments, or offices of the mind, and therefore class men according to the excellence or predominance of these powers. one man, is said to be distinguished by the brilliancy of his imagination; another, by the solidity of his judgment; a third, by the acuteness of his reason; and a fourth, by the promptitude and accuracy of his recollection. as far as i have observed respecting the human mind, (and i speak with great hesitation and diffidence,) it does not possess, all those powers and faculties with which the pride of man has thought proper to invest it. by our senses, we are enabled to become acquainted with objects, and we are capable of recollecting them in a greater or less degree; the rest, appears to be merely a contrivance of language. if mind, were actually capable of the operations attributed to it, and possessed of these powers, it would necessarily have been able to create a language expressive of these powers and operations. but the fact is otherwise. the language, which characterizes mind and its operations, has been borrowed from external objects; for mind has no language peculiar to itself. a few instances will sufficiently illustrate this position. after having committed an offence it is natural to say that the mind feels contrition and sorrow. contrition is from _cum_ and _tero_, to rub together, which cannot possibly have any thing to do with the operations of the mind, which is incapable of rubbing its ideas or notions together. contrition is a figurative expression, and may possibly mean the act of rubbing out the stain of vice, or wearing down by friction the prominences of sin. if we were to analyze the word sorrow, which is held to be a mental feeling, we should find it to be transferred from bodily sufferance: for the mind, is incapable of creating a term correctly expressive of its state, and therefore, it became necessary to borrow it from _soreness_ of body.--_see mr. tooke's diversions of purley, vol. ii. p. _, where _sore_, _sorry_, and _sorrow_ are clearly made out to be the same word. it is customary to speak of a man, of accurate perceptions, and of another, who has grand and luminous conceptions of human nature. perception, from _per_, and _capio_ to take, seize, grasp, through the medium of the organs of sense, being implied. but to take, seize, and grasp are the operations of the hand, and can only, by extreme courtesy, be attributed to mind. mr. dugald stewart, the most thoughtful and intelligent of modern metaphysicians, has said, "by conception i mean that power of the mind which enables it to form a notion of an absent object of perception, or of a sensation which it has formerly felt."--_elements of the philosophy of the human mind, vo. p. ._ this definition means merely memory; and by perusing attentively the whole chapter the reader will be convinced of it. conception, from _cum_ and _capio_, has been applied to mind from the physical sense of embracing, comprehending, or probably from the notion of being impregnated with the subject. it may be remarked, that these three terms, by which conception has been explained, have been all applied to mental operation. the words reason and reasoning, i believe, in most languages, strictly imply numeration, reckoning, proportion; the latin _ratio_, _ratiocinor_, _ratiocinator_ are sufficient examples. a curious coincidence between the latin _ratio_ and the gothic _rathjo_, together with some pertinent and interesting observations, may be seen in ihre's glossarium svio-gothicum, _p._ , _art._ rækna. as we now acknowledge the science of number to be the purest system of reasoning, a system, on which all persons agree, and so unlike medicine, politics, and divinity, concerning which there is a constant, and hostile variety of sentiment, it adds some force to the argument. indeed, mr. locke, who almost personifies reason, after having painfully sifted this matter, appears to be much of the same way of thinking: he says, "reason, though it penetrates into the depth of the sea and earth, elevates our thoughts as high as the stars, and leads us through the vast spaces and large rooms of this mighty fabrick, _yet it comes far short of the real extent of even corporeal being_; and there are many instances wherein it fails us: as, "first: it perfectly fails us where our ideas fail: it neither does, nor can extend itself farther than they do, and therefore, wherever we have no ideas our reasoning stops, and we are at an end of our reckoning: and if at any time _we reason about words, which do not stand for any ideas_, it is only about those sounds, and nothing else. "secondly: our reason is often puzzled, and at a loss, because of the obscurity, confusion or imperfection of the ideas it is employed about; and there we are involved in difficulties and contradictions. thus, not having any perfect idea of the least extension of matter, nor of infinity, we are at a loss about the divisibility of matter; _but having perfect, clear, and distinct ideas of number, our reason meets with none of those inextricable difficulties in numbers, nor finds itself involved in any contradictions about them_."--_works. to, vol. i, p. ._ it can scarcely be necessary, longer to fatigue the patience of the reader, by reverting to the etymology of those terms, which have been considered as significant of mind and its operations. every one will be able sufficiently to develope imagination, reflection, combination, [as applied to ideas, importing the amalgamation of _two_ into one] abstraction, [_vide mr. tooke, from p. to , vol. ii._] and a variety of others; and to shew, that they have arisen from physical objects, and the circumstances which surround us, and are independant of any operation which mind has elaborated. but as madness, by some, has been exclusively held to be a disease of the imagination, and by others, to be a defect of the judgment; considering these as separate and independant powers or faculties of the intellect; it is certainly worth the trouble to enquire, whether such states of mind did ever exist as original and unconnected disorders. with respect to imagination, there can be but little difficulty; yet this will so far involve the judgment and memory, that it will not be easy to institute a distinction. if a cobbler should suppose himself an emperor, this supposition, may be termed an elevated flight, or an extensive stretch of imagination, but it is likewise a great defect in his judgment, to deem himself that which he is not, and it is certainly an equal lapse of his recollection, to forget what he really is. having endeavoured to give some reasons for not according with the generally received opinions, concerning the different powers of the mind, it may be proper shortly to state, that, from the manner in which we acquire knowledge, the human mind appears to be composed of a sum of individual perceptions: that, in proportion as we dwell by the eye, the ear, or the touch on any object (which is called attention,) we are more likely to become acquainted with it, and to be able to remember it. for the most part, we remember these perceptions in the succession in which they were presented, although, they may afterwards, from circumstances, be differently sorted. the minds of ordinary men are well contented to deal out their ideas, in the order in which they were received; and, not having found the necessity of bringing them to bear on general subjects, they are commonly minutely accurate in the detail of that which they have observed. by such persons, a story is told with all the relations of time and place; connected with the persons who were present, their situation, state of health, and a vast variety of associated particulars; and these persons, however tedious, generally afford the most correct account. on the other hand, those who are men of business, and have much to communicate in a given space, are obliged to subtract the more material circumstances from the gross narrative, and exhibit these as the sum total. it is in this way, that words, originally of considerable length, have been abbreviated for the conveniency of dispatch, and from this necessity short hand writing has been employed. as the science of arithmetic consists in addition to, or subtraction from, a given number; so does the human mind appear to be capable solely of adding to, or separating from, its stock of ideas, as pleasure may prompt, or necessity enforce. language, the representative of thought, bears the same construction; and it is curious to remark in the investigation of its abbreviations, that those words, which serve to connect ideas together, (_conjunctions_) and which have been supposed to mark certain operations of intellect, postures of mind, and turns of thought, have merely the force and meaning of to add, or to subtract. insanity is now generally divided into mania and melancholia, but formerly its distributions were more numerous. paracelsus, speaking of this disease, says, "vesaniæ hujus genera quatuor existunt: primi _lunatici_ vocantur: secundi _insani_: tertii _vesani_: quarti _melancholici_, lunatici sunt qui omnem suum morbum ex luna accipiunt, et juxta eam sese gerunt ac moventur. insani sunt, qui malum id ab utero materno hauserunt, veluti hæreditarium, uno subindè insaniam in alterum transferente. vesani sunt, qui a cibis ac potibus ita inficiuntur ac taminantur, ut ratione sensuque priventur. melancholici sunt, qui ex intimæ naturæ vitio a ratione deturbantur, et ad vesaniam precipitantur." paracelsus, however, thinks that a fifth genus may be added. "ad quatuor hac genera genus insuper aliud quodammodo annumerari potest, videlicet _obsessi_, qui a diabolo variis modis occupari solent."--_paracelsi opera, folio, tom. i. fol. ._ the idea of being besieged, beset, or possessed by the devil was formerly a very favourite notion, and is derived to us by an authority we are taught to reverence: indeed it is still the opinion of many harmless and believing persons, some of whom have bestowed considerable pains to convince me that the violent and mischievous maniacs in bedlam were under the dominion of this insinuating spirit. they have employed one argument which would seem to have considerable weight, namely, that the most atrocious crimes are stated in our indictments (much to the credit of human nature) to have been committed by the instigation of the devil: and they have also endeavoured to explain, how a late and eminently successful practitioner, by an union of the holy office with consummate medical skill, was enabled to cure nine lunatics out of ten, which certainly has not hitherto been accounted for. paracelsus, who contemplated this subject with uncommon gravity and solicitude, is of opinion that the devil enters us much in the same manner as a maggot gets into a filbert.--_vide fragmentum libri philosophiæ de dæmoniacis et obsessis, tom. ii. p. ._ to conclude this part of the subject, and to exhibit the state of belief at that period, i shall take the liberty of extracting a portion from the th chapter of dr. andrewe boord's extravagantes, which "doth shewe of a demoniacke person, the which is possessed of or with the devyll or devylls. "demoniacus or demoniaci be the latin wordes. in greke it is named demonici. in englyshe it is named he or they, the whiche be mad and possessed of the devyll or devils, and their propertie is to hurt and kyll them selfe, or els to hurt and kyll any other thynge, therfore let every man beware of them, and kepe them in a sure custody. _the cause of this matter._ "this matter doth passe all maner sickenesses and diseases, and it is a fearefull and terryble thyng to se a devyll or devylles shoulde have so muche and so greate a power over man, as it is specified of such persons dyvers tymes in the gospell, specyally in the ix. chapitre of st. marke. chryste sendynge his disciples to preache the worde of god, gevynge them power to make sicke men whole, lame men to go, blynde to se, &c. some of them dyd go by a mans that was possessed of devils and they coud not make him whole. shortly to conclude, chryst dyd make hym whole. the dysciples of chryste asked of him why that they coud not make the possessed man of the devylls whole. and jesus chryste said to them: this kynde of devylls can not be cast out without prayer and fastynge. here it is to be noted, that nowe a dayes fewe or els none doth set by prayer or fastynge, regardyng not gods wordes; in this matter, i do feare that suche persons be possessed of the devil, although they be not starke madde, and to shew further of demoniacke persons the whiche be starke madde. the fyrste tyme that i dyd dwell in rome, there was a gentilwoman of germani, the whych was possessed of devyls, and she was brought to rome to be made whole. for within the precynct of st. peters church, without st. peters chapel, standeth a pyller of whyte marble grated round about with iron, to the which our lorde jesus chryste dyd lye in hymselfe unto the pylates hal, as the romaynes doth say, to the which pyller al those that be possessed of the devyl, out of dyvers countreys and nacions be brought thyther, and as they say of rome, such persons be made there whole. amonge al other this woman of germany, which is cccc myles and odde from rome, was brought to the pyller, (i then there beyng presente,) with great strength and violently with a xx or mo men, this woman was put into that pyller within the yron grate, and after her dyd go in a preeste, and dyd examine the woman under this maner in the italian tonge. thou devyl or devyls, i do abjure thee by the potencial power of the father, and of the sonne our lorde jesus christe, and by the vertue of the holy ghoste, that thou do shewe to me, for what cause that thou doeste possess this woman: what wordes was aunswered i will not write, for men will not beleve it, but wolde say it were a foule and great lye, but i dyd heare that i was afrayd to tarry any longer, lest that the devyls shulde have come out of her, and to have entred into me; remembrynge what is specified in the viii chapitre of st. matthewe, when that jesus christ had made two men whole, the whiche, was possessed with a legion of devils. a legion is ix m. ix c. nynety and nyne: the sayd devyls dyd desyre jesus, that when they were expelled out of the aforesayde twoo men, that they might enter into a herde of hogges, and so they did, and the hogges did runne into the sea and were drowned. i consyderynge this, and weke of faith and afeard, crossed myselfe and durste not heare and se such matters, for it was to stupendious and above all reason yf i shulde wryte it; and in this matter i dyd marvell of an other thynge; if the efficacitie of such makynge one whole, dyd rest in the vertue that was in the pyller, or els in the wordes that the preest dyd speake. i do judge it shulde be in the holy wordes that the prest dyd speak, and not in the pyller; for and yf it were in the pyller, the byshops, and the cardinalles that hathe ben many yeres past, and those that were in my tyme, and they that hath bin sence, wolde have had it in more reverence, and not to suffre rayne, hayle, snowe, and such wether to fal on it, for it hath no coverynge, but at laste when that i did consyder that the vernacle, the phisnomy of christ, and scarse the sacrament of the aulter was in maner uncovered and al st. peters churche downe in ruyne, and utterly decayed, and nothing set by, consideringe in olde chapels, beggers and baudes, hoores and theves dyd lye within them, asses and moyles dyd defyle within the precincte of the churche, and byenge and sellynge there was used within the precinct of the sayde church that it dyd pytie my harte and mynde to come and se any tyme more the sayde place and churche."--_andrewe boorde,[ ] the seconde boke of the brevyary of health, , fol. th._ to return from this digression. dr. ferriar, whom to mention otherwise than as a man of genius, of learning, and of taste, would be unjust, has adopted the generally accepted division of insanity into mania and melancholia. in mania he conceives "false perception, and consequently confusion of ideas, to be a leading circumstance." the latter, he supposes to consist "in intensity of idea, which is a contrary state to false perception." from the observations i have been able to make respecting mania, i have by no means been led to conclude, that false perception, is a leading circumstance in this disorder, and still less, that confusion of ideas must be the necessary consequence of false perception. by perception i understand, with mr. locke, the apprehension[ ] of sensations; and after a very diligent enquiry of patients who have recovered from the disease, and from an attentive observation of those labouring under it, i have not frequently found, that insane people perceive falsely the objects which have been presented to them. we find madmen equally deranged upon those ideas, which they have been long in the possession of, and on which the perception has not been recently exercised, as respecting those, which they have lately received: and we frequently find those who become suddenly mad, talk incoherently upon every subject, and consequently, upon many, on which the perception has not been exercised for a considerable time. it is well known, that maniacs often suppose they have seen and heard those things, which really did not exist at the time; but even this i should not explain by any disability, or error of the perception; since it is by no means the province of the perception to represent unreal existences to the mind. it must therefore be sought elsewhere; most probably in the senses. we sometimes (more especially in the early stages of furious madness) find patients from very slight resemblances, and sometimes, where none whatever can be perceived by others of sound mind, confounding one person with another. even in this case it does not seem necessary to recur to false perception for the explanation. it is equally probable that the organs of vision are affected in consequence of the disease of the brain, and therefore receive incorrect sensations: and still more likely, from the _rapid succession_ in which objects are noticed, that a very slight trait of countenance would recal the idea [or name] of some particular person. i have known many cases of patients who insisted that they had seen the devil. it might be urged, that in these instances, the perception was vitiated; but it must be observed there could be no perception of that, which was not present and existing at the time. upon desiring these patients to describe what they had seen, they all represented him as a big, black man, with a long tail, and sharp talons, such as is seen pictured in books; a proof that the idea was revived in the mind from some former impressions. one of these patients however carried the matter a little further, as she solemnly declared, she heard him break the iron chain with which god had confined him, and saw him pass fleetly by her window, with a truss of straw upon his shoulder. that "confusion of ideas" should be the necessary consequence of false perception, is very difficult to admit. it has often been observed that madmen will reason correctly from false premises, and the observation is certainly true: we have indeed occasion to notice the same thing in those of the soundest minds. it is very possible for the perception to be deceived in the occurrence of a thing, which, although it did not actually happen, yet was likely to take place; and which had frequently occurred before.--the reception of this as a truth, if the person were capable of deducing from it the proper inferences, could neither create confusion nor irregularity of ideas. melancholia, the other form in which this disease is supposed to exist, is made by dr. ferriar to consist in "intensity of idea." by intensity of idea, i presume is meant, that the mind is more strongly fixed on, or more frequently recurs to, a certain set of ideas, than when it is in a healthy state. but this definition applies equally to mania; for we every day see the most furious maniacs suddenly sink into a profound melancholia, and the most depressed and miserable objects become violent and raving. there are patients in bethlem hospital, whose lives are divided between furious and melancholic paroxysms, and who, under both forms, retain the same set of ideas. it must also have been observed, by those who are conversant with this disorder, that there is an intermediate state, which cannot be termed maniacal nor melancholic: a state of complete insanity, yet unaccompanied by furious or depressing passions.[ ] in speaking of the two forms of this disease, mania and melancholia, there is a circumstance sufficiently obvious, which hitherto does not appear to have been noticed: i mean the rapid or slow succession of the patient's ideas. probably sound and vigorous mind consists as much in the moderate succession of our ideas, as in any other circumstance. it may be enquired, how we are to ascertain this increased, proportionate, and deficient activity of mind? from language, the medium by which thought is conveyed. the connexion between thought and utterance is so strongly cemented by habit, that the latter becomes the representative of the former. the physiology of mind, i humbly conceive to be at present in its infancy, but there seems good reason to imagine, that furious madness implies a rapid succession of ideas; and the circumstance of rage, from whence its origin has been deduced, points out the hurried consecution. in this state of mind the utterance succeeds --------------------"sudden as the spark from smitten steel; from nitrous grain the blaze." and it frequently happens, after the tumult has subsided, the person remembers but little of that which had escaped him. "i then, all-smarting with my wounds, being cold, (to be so pestered with a popingay) out of my greefe, and my impatience, answered (neglectingly) _i know not what_-- _he should, or should not_: for he made me _mad_." from this connexion between thought and utterance, we find many persons (particularly those who are insane) talking to themselves; especially when their minds are intently occupied; and taking the converse, we frequently observe those who are desirous to acquire any subject by heart, repeating it aloud. from the same cause we have often occasion to remark, that strong, and perhaps involuntary, propensity to repeat the emphatical words in a sentence, and which are commonly the last, before we endeavour to reply to, or confute them. "_king._ no: on the barren mountaine let him sterve: for i shall never hold that man my friend whose tongue shall aske me for one peny cost to ransome home revolted mortimer. "_hotsp._ revolted mortimer? he never did fall off, my soveraigne liege, but by the chance of warre:" as the terms mania and melancholia, are in general use, and serve to distinguish the forms under which insanity is exhibited, there can be no objection to retain them; but i would strongly oppose their being considered as opposite diseases. in both there is an equal derangement. on dissection, the state of the brain does not shew any appearances peculiar to melancholia; nor is the treatment, which i have observed most successful, different from that which is employed in mania. as the practitioner's own mind must be the criterion, by which he infers the insanity of any other person; and when we consider the various, and frequently opposite, opinions of these intellectual arbitrators; the reader will be aware that i have not abstained from giving a definition of madness without some reason. there is indeed a double difficulty: the definition ought to comprize the aberrations of the lunatic, and fix the standard for the practitioner. but it may be assumed that sound mind and insanity stand in the same predicament, and are opposed to each other in the same manner, as right to wrong, and as truth to the lie. in a general view no mistake can arise, and where particular instances create embarrassment, those most conversant with such persons will be best able to determine. the terms sound mind and insanity are sufficiently plain. if to an ordinary observer, a person were to talk in an incoherent manner, he would think him mad; if his conduct were regular, and his observations pertinent, he would pronounce him in his senses: the two opposite states, well marked, are well understood; but there are many different shades, which are not so likely to strike the common examiner. chap. ii. symptoms of the disease. on this part of the subject, authors have commonly descended to minute particularities, and studied discriminations. distinctions have been created, rather from the peculiar turn of the patient's propensities and discourse, than from any marked difference in the varieties and species of the disorder. every person of sound mind, possesses something peculiar to himself, which distinguishes him from others, and constitutes his idiosyncrasy of body and individuality of character: in the same manner, every lunatic discovers something singular in his aberrations from sanity of intellect. it is not my intention to record these splintered subdivisions, but to exhibit the prominent features, by which insanity may be detected, as far as such appearances seem worthy of remark, and have been the subject of my own observation. in most public hospitals, the first attack of diseases is seldom to be observed; and it might naturally be supposed, that there existed in bethlem, similar impediments to an accurate knowledge of incipient madness. it is true, that all who are admitted into it, have been a greater, or less time afflicted with the disorder; yet from the occasional relapses to which insane persons are subject, we have frequent and sufficient opportunities of observing the beginning, and tracing the progress of this disease. among the incurables, there are some, who have intervals of perfect soundness of mind; but who are subject to relapses, which would render it improper, and even dangerous, to trust them at large in society: and with those, who are upon the curable establishment, a recurrence of the malady very frequently takes place. upon these occasions, there is an ample scope for observing the first attack of the disease. on the approach of mania, they first become uneasy,[ ] are incapable of confining their attention, and neglect any employment to which they have been accustomed; they get but little sleep, they are loquacious, and disposed to harangue, and decide promptly, and positively upon every subject that may be started. soon after, they are divested of all restraint in the declaration of their opinions of those, with whom they are acquainted. their friendships are expressed with fervency and extravagance; their enmities with intolerance and disgust. they now become impatient of contradiction, and scorn reproof. for supposed injuries, they are inclined to quarrel and fight with those about them. they have all the appearance of persons inebriated, and those who are unacquainted with the symptoms of approaching mania, generally suppose them to be in a state of intoxication. at length suspicion creeps in upon the mind, they are aware of plots, which had never been contrived, and detect motives that were never entertained. at last the succession of ideas is too rapid to be examined;[ ] the mind becomes crouded with thoughts, and confusion ensues. those under the influence of the depressing passions, will exhibit a different train of symptoms. the countenance wears an anxious and gloomy aspect, and they are little disposed to speak. they retire from the company of those with whom they had formerly associated, seclude themselves in obscure places, or lie in bed the greatest part of their time. frequently they will keep their eyes fixed to some object for hours together, or continue them an equal time "bent on vacuity." they next become fearful, and conceive a thousand fancies: often recur to some immoral act which they have committed, or imagine themselves guilty of crimes which they never perpetrated: believe that god has abandoned them, and, with trembling, await his punishment. frequently they become desperate, and endeavour by their own hands to terminate an existence, which appears to be an afflicting and hateful incumbrance. madmen, do not always continue in the same furious or depressed states: the maniacal paroxysm abates of its violence, and some beams of hope, occasionally cheer the despondency of the melancholic patients. we have in the hospital some unfortunate persons, who are obliged to be secured the greater part of their time, but who now and then become calm, and to a certain degree rational: upon such occasions, they are allowed a greater range, and are admitted to associate with the others. in some instances the degree of rationality is more considerable; they conduct themselves with propriety, and in a short conversation will appear sensible and coherent. such remission has been generally termed a _lucid interval_. when medical persons are called upon to attend a commission of lunacy, they are always asked, whether the patient has had a _lucid interval_? a term of such latitude as interval, requires to be explained in the most perspicuous and accurate manner. [the circumstances which probably occasioned the employment of this term are pointed out in the chapter which enumerates the causes of insanity.] in common language, it is made to signify both a moment and a number of years, consequently it does not comprize any stated time. the term _lucid interval_ is therefore relative. as the law requires a precise developement of opinion, i should define a _lucid interval_ to be a complete recovery of the patient's intellects, ascertained by repeated examinations of his conversation, and by constant observation of his conduct, for a time sufficient to enable the superintendant to form a correct judgment. unthinking people, are frequently led to conclude, that if, during a short conversation, a person under confinement shall bewray nothing absurd or incorrect, he is well, and often remonstrate on the injustice of secluding him from the world. even in common society, there are many persons whom we never suspect, from a few trifling topics of discourse, to be shallow minded; but, if we start a subject, and wish to discuss it through all its ramifications and dependancies, we find them incapable of pursuing a connected chain of reasoning. in the same manner insane people will often, for a short time, conduct themselves, both in conversation and behaviour, with such propriety, that they appear to have the just exercise and direction of their faculties: but let the examiner protract the discourse until the favourite subject shall have got afloat in the mad man's brain, and he will be convinced of the hastiness of his decision. to those unaccustomed to insane people, a few coherent sentences, or rational answers, would indicate a lucid interval, because they discovered no madness; but he, who is in possession of the peculiar turn of the patient's thoughts, might lead him to disclose them, or by a continuance of the conversation, they would spontaneously break forth. a beautiful illustration of this is contained in the rasselas of dr. johnson, where the astronomer is admired as a person of sound intellect and great acquirements by imlac, who is himself a philosopher, and a man of the world. his intercourse with the astronomer is frequent; and he always finds in his society information and delight. at length he receives imlac into the most unbounded confidence, and imparts to him the momentous secret. "hear, imlac, what thou wilt not, without difficulty, credit. i have possessed, for five years, the regulation of weather, and the distribution of the seasons. the sun has listened to my dictates, and passed from tropic to tropic by my direction. the clouds, at my call, have poured their waters, and the nile has overflowed at my command. i have restrained the rage of the dog-star, and mitigated the fervours of the crab. the winds alone, of all the elemental powers, have hitherto refused my authority; and multitudes have perished by equinoctial tempests, which i found myself unable to prohibit or restrain. i have administered this great office with exact justice, and made to the different nations of the earth an impartial dividend of rain and sunshine. what must have been the misery of half the globe, if i had limited the clouds to particular regions, or confined the sun to either side of the equator?" a real case came under my observation some years ago, and which is equally apposite to the subject. a young man had become insane from habitual intoxication; and, during the violence of his disorder, had attempted to destroy himself. under a supposed imputation of having unnatural propensities, he had amputated his penis, with a view of precluding any future insinuations of that nature. for many months, after he was admitted into the hospital, he continued in a state which obliged him to be strictly confined, as he constantly meditated his own destruction. on a sudden, he became apparently well, was highly sensible of the delusion under which he had laboured, and conversed, as any other person, upon the ordinary topics of discourse. there was, however, something in the reserve of his manner, and peculiarity of his look, which persuaded me he was not well, although no incoherence could be detected in his conversation. i had observed him for some days to walk rather lame, and once or twice had noticed him sitting with his shoes off, rubbing his feet. on enquiring into the motives of his doing so, he replied, that his feet were blistered, and wished that some remedy might be applied to remove the vesications. when i requested to look at his feet, he declined it, and prevaricated, saying, that they were only tender and uncomfortable. in a few days afterwards, he assured me they were perfectly well. the next evening i observed him, unperceived, still rubbing his feet, and then peremptorily insisted on examining them. they were quite free from any disorder. he now told me, with some embarrassment, that he wished much for a confidential friend, to whom he might impart a secret of importance; upon assuring him that he might trust me, he said, that the boards on which he walked, (the second story) were heated by subterraneous fires, under the direction of invisible and malicious agents, whose intentions, he was well convinced, were to consume him by degrees. from these considerations, i am inclined to think, that a _lucid interval_ includes all the circumstances, which i have enumerated in my definition of it. if the person, who is to examine the state of the patient's mind, be unacquainted with his peculiar opinions, he may be easily deceived, because, wanting this information, he will have no clue to direct his enquiries, and madmen do not always, nor immediately intrude their incoherent notions: they have sometimes such a high degree of control over their minds, that when they have any particular purpose to carry, they will affect to renounce those opinions, which shall have been judged inconsistent: and it is well known, that they have often dissembled their resentment, until a favourable opportunity has occurred of gratifying their revenge. of this restraint, which madmen have sometimes the power of imposing on their opinions, the remark has been so frequent, that those who are more immediately about their persons, have termed it, in their rude phrase, _stifling the disorder_. among the numerous instances of this cunning and dissimulation, which i have witnessed in insane persons, the relation of one case will be sufficient to exemplify the subject. an essex farmer, about the middle age, had on one occasion so completely masked his disorder, that i was induced to suppose him well, when he was quite otherwise. he had not been at home many hours, before his derangement was discernable by all those, who came to congratulate him on the recovery of his reason. his impetuosity, and mischievous disposition daily increasing, he was sent to a private mad-house; there being, at that time, no vacancy in the hospital. almost from the moment of his confinement he became tranquil, and orderly, but remonstrated on the injustice of his seclusion. having once deceived me, he wished much, that my opinion should be taken respecting the state of his intellects, and assured his friends that he would submit to my determination. i had taken care to be well prepared for this interview, by obtaining an accurate account of the manner in which he had conducted himself. at this examination, he managed himself with admirable address. he spoke of the treatment he had received, from the persons under whose care he was then placed, as most kind and fatherly: he also expressed himself as particularly fortunate in being under my care, and bestowed many handsome compliments on my skill in treating this disorder, and expatiated on my sagacity in perceiving the slightest tinges of insanity. when i wished him to explain certain parts of his conduct, and particularly some extravagant opinions, respecting certain persons and circumstances, he disclaimed all knowledge of such circumstances, and felt himself hurt, that my mind should have been poisoned so much to his prejudice. he displayed equal subtilty on three other occasions when i visited him; although by protracting the conversation, he let fall sufficient to satisfy my mind that he was a mad-man. in a short time he was removed to the hospital, where he expressed great satisfaction in being under my inspection. the private mad-house, which he had formerly so much commended, now became the subject of severe animadversion; he said that he had there been treated with extreme cruelty; that he had been nearly starved, and eaten up by vermin of various descriptions. on enquiring of some convalescent patients, i found (as i had suspected) that i was as much the subject of abuse, when absent, as any of his supposed enemies; although to my face his behaviour was courteous and respectful. more than a month had elapsed, since his admission into the hospital, before he pressed me for my opinion; probably confiding in his address, and hoping to deceive me. at length he appealed to my decision, and urged the correctness of his conduct during confinement as an argument for his liberation. but when i informed him of circumstances he supposed me unacquainted with, and assured him, that he was a proper subject for the asylum where he then inhabited; he suddenly poured forth a torrent of abuse; talked in the most incoherent manner; insisted on the truth of what he had formerly denied; breathed vengeance against his family and friends, and became so outrageous that it was necessary to order him to be strictly confined. he continued in a state of unceasing fury for more than fifteen months. as the memory, appears to be particularly defective in cases of insanity, it is much to be wished, that we possessed a correct history, and physiological account of this wonderful faculty. unfortunately, this knowledge is not to be sought for with much prospect of attainment, from books which treat of the human mind and its philosophy; nor is the present work, to be considered as the depository of such information. a deliberate attention, to the precise order in which we acquire information on any subject; a consideration of the effects of its repetition; an investigation of the result (comparing it to a chain) whenever the links are separated, together with a knowledge of the contrivance of abbreviated signs, would perhaps render the matter sufficiently intelligible. but it would be necessary, thoroughly to understand the nature of the thing, of which the sign has been abbreviated: particularly, as the usual mode of education is satisfied with possessing the convenience of the abbreviation, without any inquiry into the nature of the thing, and the cause of the abbreviation of its sign. this faulty mode of instruction, has furnished us with a profusion of names, and left us ignorant of the things they represent. ben johnson has afforded us the shortest, and probably, the best account of memory. "_memory_ of all the _powers_ of the mind, is the most _delicate_, and frail: it is the first of our _faculties_ that age invades. seneca, the father, the _rhetorician_, confesseth of himself, he had a miraculous one, not only to receive, but to hold. i myself could in my youth, have repeated all that ever i had made, and so continued till i was past forty: since it is much decayed in me. yet i can repeat whole books that i have read, and _poems_ of some selected friends, which i have lik'd to charge my memory with. it was wont to be faithful to me, but shaken with _age_ now, and _sloth_ (which weakens the strongest abilities) it may perform somewhat, but cannot promise much. by exercise it is to be made better and serviceable. whatsoever i pawn'd with it while i was young and a boy, it offers me readily, and without stops: but what i trust to it now, or have done of later years, it lays up more negligently, and sometimes loses; so that i receive mine own (though frequently called for) as if it were new and borrow'd. nor do i always find presently from it what i do seek; but while i am doing another thing, that i laboured for will come: and what i sought with trouble, will offer itself when i am quiet. now in some men i have found it as happy as nature, who, whatsoever they read or pen, they can say without book presently; as if they did then write in their mind. and it is more a wonder in such as have a swift stile, for their memories are commonly slowest; such as torture their writings, and go into council for every word, must needs fix somewhat, and make it their own at last, though but through their own vexation."--_discoveries, vol. vi. p. , ._ if in a chain of ideas, a number of the links are broken, or leaving out the metaphor, if there be an inability to recollect circumstances in the order, in which they occurred, the mind cannot possess any accurate information. when patients of this description are asked a question, they appear as if awakened from a sound sleep: they are searching, they know not where, for the proper materials of an answer, and, in the painful, and fruitless efforts of recollection, generally lose sight of the question itself. shakespeare, the highest authority in every thing relating to the human mind and its affections, seems to be persuaded, that some defect of memory is necessary to constitute madness. "it is not madnesse that i have uttered: bring me to the test and i the matter will _re-word_, which madnesse would gambol from."--_hamlet, act iii. scene ._ in persons of sound mind, as well as in maniacs, the memory is the first power which decays; and there is something remarkable in the manner of its decline. the transactions of the latter part of life are feebly recollected, whilst the scenes of youth and of manhood, remain more strongly impressed. when i have listened to the conversations of the old incurable patients, the topic has generally turned upon the transactions of early days; and, on the circumstances of that period of life, they have frequently spoken with tolerable correctness. in many cases, where the mind has been injured by intemperance, the same withering of the recollection may be observed. it may, perhaps, arise from the mind at an early period of life, being most susceptible and retentive of impressions, and from a greater disposition to be pleased, with the objects which are presented: whereas, the cold caution, and fastidiousness with which age surveys the prospects of life, joined to the dulness of the senses, and the slight curiosity which prevails, will, in some degree, explain the difficulty of recalling the history of later transactions. insane people, who have been good scholars, after a long confinement, lose, in a wonderful degree, the correctness of orthography: when they write, above half the words are frequently mis-spelt, they are written according to the pronunciation. it shews how treacherous the memory is without reinforcement. the same necessity of a constant recruit, and frequent review of our ideas, satisfactorily explains, why a number of patients lapse nearly into a state of ideotism. these have, for some years, been the silent and gloomy inhabitants of the hospital, who have avoided conversation, and courted solitude; consequently have acquired no new ideas, and time has effaced the impression of those, formerly stamped on the mind. mr. locke, well observes, although he speaks figuratively, "that there seems to be a constant decay of all our ideas, even of those which are struck deepest, and in minds the most retentive; so that, if they be not sometimes renewed by repeated exercise of the senses, or reflection on those kind of objects, which at first occasioned them, the print wears out, and at last there remains nothing to be seen." connected with loss of memory, there is a form of insanity which occurs in young persons; and, as far as these cases have been the subject of my observation, they have been more frequently noticed in females. those whom i have seen, have been distinguished by prompt capacity and lively disposition: and in general have become the favourites of parents and tutors, by their facility in acquiring knowledge, and by a prematurity of attainment. this disorder commences, about, or shortly after, the period of menstruation, and in many instances has been unconnected with hereditary taint; as far as could be ascertained by minute enquiry. the attack is almost imperceptible; some months usually elapse, before it becomes the subject of particular notice; and fond relatives are frequently deceived by the hope that it is only an abatement of excessive vivacity, conducing to a prudent reserve, and steadiness of character. a degree of apparent thoughtfulness and inactivity precede, together with a diminution of the ordinary curiosity, concerning that which is passing before them; and they therefore neglect those objects and pursuits which formerly proved sources of delight and instruction. the sensibility appears to be considerably blunted; they do not bear the same affection towards their parents and relations; they become unfeeling to kindness, and careless of reproof. to their companions they shew a cold civility, but take no interest whatever in their concerns. if they read a book, they are unable to give any account of its contents: sometimes, with steadfast eyes, they will dwell for an hour on one page, and then turn over a number in a few minutes. it is very difficult to persuade them to write, which most readily develops their state of mind: much time is consumed and little produced. the subject is repeatedly begun, but they seldom advance beyond a sentence or two: the orthography becomes puzzling, and by endeavouring to adjust the spelling, the subject vanishes. as their apathy increases they are negligent of their dress, and inattentive to personal cleanliness. frequently they seem to experience transient impulses of passion, but these have no source in sentiment; the tears, which trickle down at one time, are as unmeaning as the loud laugh which succeeds them; and it often happens that a momentary gust of anger, with its attendant invectives, ceases before the threat can be concluded. as the disorder increases, the urine and fæces are passed without restraint, and from the indolence which accompanies it, they generally become corpulent. thus in the interval between puberty and manhood, i have painfully witnessed this hopeless and degrading change, which in a short time has transformed the most promising and vigorous intellect into a slavering and bloated ideot. of the organs of sense, which become affected in those labouring under insanity, the ear, more particularly suffers. i scarcely recollect an instance of a lunatic becoming blind, but numbers are deaf. it is also certain that in these persons, more delusion is conveyed through the ear than the eye, or any of the other senses. those who are not actually deaf, are troubled with difficulty of hearing, and tinnitus aurium. thus an insane person shall suppose that he has received a commission from the deity; that he has ordered him to make known his word, or to perform some act, as a manifestation of his will and power. it is however much to be regretted, that these divine commissions generally terminate in human mischief and calamity, and instances are not unfrequent, where these holy inspirations, have urged the unfortunate believer to strangle his wife, and attempt the butchery of his children. from this source may be explained, the numerous delusions of modern prophecies, which circumstantially relate the gossipings of angels, and record the hallucinations of feverish repose. in consequence of some affection of the ear, the insane sometimes insist that malicious agents contrive to blow streams of infected air into this organ: others have conceived, by means of what they term hearkening wires and whiz-pipes, that various obscenities and blasphemies are forced into their minds; and it is not unusual for those who are in a desponding condition, to assert, that they distinctly hear the devil tempting them to self-destruction. a considerable portion of the time of many lunatics, is passed in replies to something supposed to be uttered. as this is an increasing habit, so it may be considered as an unfavourable symptom, and at last the patient becomes so abstracted from surrounding objects, that the greater part of the day is consumed in giving answers to these supposed communications. it sometimes happens that the intelligence conveyed, is of a nature to provoke the mad-man, and on these occasions, he generally exercises his wrath on the nearest bystander; whom he supposes, in the hurry of his anger, to be the offending party. in the soundest state of our faculties, we are more liable to be deceived by the ear, than through the medium of the other senses: a partial obstruction by wax, shall cause the person so affected, to hear the bubbling of water, the ringing of bells, or the sounds of musical instruments; and on some occasions, although the relation seems tinged with superstition, men of undeviating veracity, and of the highest attainments, have asserted, that they have heard themselves _called_. "he [dr. johnson] mentioned a thing as not unfrequent, of which i [mr. boswell] had never heard before--being _called_, that is, hearing one's name pronounced by the voice of a known person at a great distance, far beyond the possibility of being reached by any sound, uttered by human organs. an acquaintance on whose veracity i can depend, told me, that walking home one evening to kilmarnock, he heard himself called from a wood, by the voice of a brother who had gone to america; and the next packet brought account of that brother's death. macbean asserted that this inexplicable _calling_ was a thing very well known. dr. johnson said, that one day at oxford, as he was turning the key of his chamber, he heard his mother distinctly call _sam_. she was then at litchfield; but nothing ensued. this phænomenon is, i think, as wonderful as any other mysterious fact, which many people are very slow to believe, or rather, indeed, reject with an obstinate contempt."--_boswell's life of dr. johnson, to. vol. ii. p. ._ one of the most curious cases of this nature which has fallen under my observation, i shall here venture to relate, for the amusement of the reader. the patient was a well educated man, about the middle age; he always stopped his ears closely with wool, and, in addition to a flannel night-cap, usually slept with his head in a tin saucepan. being asked the reason why he so fortified his head, he replied, "to prevent the intrusion of the _sprites_." after having made particular enquiry concerning the nature of these beings, he gravely communicated the following information:--"sir, you must know that in the human seminal fluid there are a number of vital particles, which being injected into the female, impregnate her, and form a foetus of muscles and bones. but this fluid has other properties, it is capable, by itself, of producing vitality under certain circumstances, and experienced chemists and hermetical philosophers have devised a method of employing it for other purposes, and some, the most detrimental to the condition and happiness of man. these philosophers, who are in league with princes, and their convenient and prostituted agents, contrive to extract a portion of their own semen, which they conserve in rum or brandy: these liquors having the power of holding for a considerable time the seminal fluid, and keeping its vitality uninjured. when these secret agents intend to perform any of their devilish experiments on a person, who is an object of suspicion to any of these potentates, they cunningly introduce themselves to his acquaintance, lull him to sleep by artificial means, and during his slumbers, infuse a portion of their seminal fluid (conserved in rum or brandy) into his ears. "as the semen in the natural commerce with the woman, produces a child, so, having its vitality conserved by the spirit, it becomes capable of forming a _sprite_; a term, obviously derived from the spirit in which it had been infused. the ear is the most convenient nidus for hatching these vital particles of the semen. the effects produced on the individual, during the incubation of these seminal germs, are very disagreeable; they cause the blood to mount into the head, and produce considerable giddiness and confusion of thought. in a short time, they acquire the size of a pin's head; and then they perforate the drum of the ear, which enables them to traverse the interior of the brain, and become acquainted with the hidden secrets of the person's mind. during the time they are thus educated, they enlarge according to the natural laws of growth; they then take wing, and become invisible beings, and, from the strong ties of natural affection, assisted by the principle of attraction, they revert to the parent who afforded the semen, and communicate to him their surreptitious observations and intellectual gleanings. in this manner, i have been defrauded of discoveries which would have entitled me to opulence and distinction, and have lived to see others reap honours and emoluments, for speculations which were the genuine offsprings of my own brain." by some persons, madness has been considered as a state of mind analogous to dreaming: but an inference of this kind supposes us fully acquainted with the actual state, or condition of the mind in dreaming, and in madness. the whole question hinges on a knowledge of this _state of mind_, which i fear is still involved in obscurity. as it is not the object of the present work to discuss this curious question, the reader is referred to the fifth section of the first part of mr. dugald stewart's elements of the philosophy of the human mind, and to the note, o, at the end; he will also find the subject treated with considerable ingenuity in the eleventh section of mr. brown's observations on zoonomia. there is, however, a circumstance, which to my knowledge, has not been noticed by those who have treated on this subject, and which appears to establish a marked distinction between madness and dreaming. in madness, the delusion we experience is most frequently conveyed through the ear; in dreaming, the deception is commonly optical; we see much, and hear little; indeed dreaming, at least with myself, seems to be a species of intelligible pantomime, that does not require the aid of language to explain it. it is true, that some who have perfectly recovered from this disease, and who are persons of good understanding and liberal education, describe the state they were in, as resembling a dream: and when they have been told how long they were disordered, have been astonished that the time passed so rapidly away. but this only refers to that consciousness of delusion, which is admitted by the patient on his return to reason; in the same manner as the man awake, smiles at the incongruous images, and abrupt transitions of the preceding night. in neither condition, does the consciousness of delusion, establish any thing explanatory of the _state_ of the mind. in a description of madness, it would be blameable to omit a form of this disease which is commonly very intractable, and of the most alarming consequences; i mean, the insanity which arises from the habit of intoxication. all persons who have had any experience of this disease, readily allow that fermented liquors, taken to excess, are capable of producing mental derangement: but the medical practitioner has in such cases, to contend, and generally without effect, with popular prejudice, and sometimes, with the subordinate advisers of the law. to constitute madness, the minds of ignorant people expect a display of continued violence, and they are not satisfied that the person can be pronounced in that state, without they see him exhibit the pranks of a baboon, or hear him roar and bellow like a beast. by these people the patient is stated only to be intemperate; they confess that he does very foolish things when intoxicated; but that he is not mad, and only requires to be restrained from drinking. thus, a man is permitted slowly to poison and destroy himself; to produce a state of irritation, which disqualifies him for any of the useful purposes of life; to squander his property amongst the most worthless and abandoned; to communicate a loathsome and disgraceful disease to a virtuous wife, and leave an innocent and helpless family to the meager protection of the parish. if it be possible, the law ought to define the circumstances, under which it becomes justifiable, to restrain a human being from effecting his own destruction, and involving his family in misery and ruin. when a man suddenly bursts through the barriers of established opinions; if he attempt to strangle himself with a cord, to divide his larger blood-vessels with a knife, or swallow a vial full of laudanum, no one entertains any doubt of his being a proper subject for the superintendance of keepers, but he is allowed, without control, by a gradual process, to undermine the fabric of his own health, and destroy the prosperity of his family. all patients have not the same degree of memory of what has passed during the time they were disordered: and i have frequently remarked, when they were unable to give any account of the peculiar opinions which they had indulged, during a raving paroxysm of long continuance, that they well remembered any coercion which had been used, or any kindness which had been shewn them. insane people, are said to be generally worse in the morning; in some cases they certainly are so, but perhaps not so frequently as has been supposed. in many instances (and, as far as i have observed) in the beginning of the disease, they are more violent in the evening, and continue so the greatest part of the night. it is, however, a certain fact, that the majority of patients of this description, have their symptoms aggravated by being placed in a recumbent posture. they seem, themselves, to avoid the horizontal position as much as possible, when they are in a raving state: and when so confined that they cannot be erect, will keep themselves seated upon the breech. many of those who are violently disordered will continue particular actions for a considerable time: some are heard to gingle the chain, with which they are confined, for hours without intermission; others, who are secured in an erect posture, will beat the ground with their feet the greatest part of the day. upon enquiry of such patients, after they have recovered, they have assured me that these actions afforded them considerable relief. we often surprize persons who are supposed free from any mental derangement, in many strange and ridiculous movements, particularly if their minds be intently occupied:[ ]--this does not appear to be so much the effect of habit, as of a particular state of mind. among the bodily particularities which mark this disease, may be observed the protruded, and oftentimes glistening eye, and a peculiar cast of countenance, which, however, cannot be described. in some, an appearance takes place which has not hitherto been noticed by authors. this is a relaxation of the integuments of the cranium, by which they may be wrinkled, or rather gathered up by the hand to a considerable degree. it is generally most remarkable on the posterior part of the scalp; as far as my enquiries have reached, it does not take place in the beginning of the disease, but after a raving paroxysm of some continuance. it has been frequently accompanied with contraction of the iris. on the suggestion of a medical gentleman, i was induced to ascertain the prevailing complexion and colour of the hair in insane patients. out of two hundred and sixty-five who were examined, two hundred and five were of a swarthy complexion, with dark, or black hair; the remaining sixty were of a fair skin, and light, brown, or redhaired. what connexion this proportion may have, with the complexion and colour of the hair of the people of this country in general, and what alterations may have been produced by age, or a residence in other climates, i am totally uninformed. of the power which maniacs possess of resisting cold, the belief is general, and the histories which are on record are truly wonderful: it is not my wish to disbelieve, nor my intention to dispute them; it is proper, however, to state that the patients in bethlem hospital possess no such exemption from the effects of severe cold. they are particularly subject to mortifications of the feet; and this fact is so well established from former accidents, that there is an express order of the house, that every patient, under strict confinement, shall have his feet examined morning and evening in the cold weather by the keeper, and also have them constantly wrapped in flannel; and those who are permitted to go about, are always to be found as near to the fire as they can get, during the winter season. from the great degree of insensibility which prevails in some states of madness, a degree of cold would scarcely be felt by such persons, which would create uneasiness in those of sound mind; but experience has shewn that they suffer equally from severity of weather. when the mind is particularly engaged on any subject, external circumstances affect us less than when unoccupied. every one must recollect that, in following up a favourite pursuit, his fire has burned out, without his being sensible of the alteration of temperature; but when the performance has been finished, or he has become indifferent to it from fatigue, he then becomes sensible to cold, which he had not experienced before. some maniacs refuse all covering, but these are not common occurrences; and it may be presumed, that by a continued exposure to the atmosphere, such persons might sustain, with impunity, a low temperature, which would be productive of serious injury to those who are clad according to the exigences of the season. such endurance of cold is more probably the effect of habit, than of any condition peculiar to insanity. having thus given a general account of the symptoms, i shall now lay before my readers a history of the appearances which i have noticed on opening the heads of several maniacs who have died in bethlem hospital. chap. iii. cases, with the appearances on dissection. case i. j. h. a man twenty-eight years of age, was admitted a patient in may, . he had been disordered for about two months before he came into the hospital. no particular cause was stated to have brought on the complaint. it was most probably an hereditary affection, as his father had been several times insane and confined in our hospital. during the time he was in the house, he was in a very low and melancholic state; shewed an aversion to food, and said he was resolved to die. his obstinacy in refusing all nourishment was very great, and it was with much difficulty forced upon him. he continued in this state, but became daily weaker and more emaciated until august st, when he died. upon opening the head, the pericranium was found loosely adherent to the scull. the bones of the cranium were thick. the pia mater was loaded with blood, and the medullary substance, when cut into, was full of bloody points. the pineal gland contained a large quantity of gritty matter.[ ] the consistence of the brain was natural; he was opened twenty-four hours after death. case ii. j. w. was a man of sixty-two years of age, who had been many years in the house as an incurable patient, but with the other parts of whose history i am totally unacquainted. he appeared to be a quiet and inoffensive person, who found amusement in his own thoughts, and seldom joined in any conversation with the other patients: for some months he had been troubled with a cough, attended with copious expectoration, which very much reduced him; dropsical symptoms followed these complaints. he became every day weaker, and on july th, , died. he was opened eighteen hours after death. the pericranium adhered loosely to the scull; the bones of the cranium were unusually thin. there were slight opacities in many parts of the tunica arachnoidea; in the ventricles about four ounces of water were contained--some large hyatids were discovered on the plexus choroides of the right side. the consistence of the brain was natural. case iii. g. h. a man twenty-six years of age, was received into the hospital, july th, . it was stated that he had been disordered six weeks previously to his admission, and that he never had any former attack. he had been a drummer with a recruiting party, and had been for some time in the habit of constant intoxication, which was assigned as the cause of his insanity. he continued in a violent and raving state about a month, during the whole of which time he got little or no sleep. he had no knowledge of his situation, but supposed himself with the regiment, and was frequently under great anxiety and alarm for the loss of his drum, which he imagined had been stolen and sold. the medicines which were given to him he conceived were spirituous liquors, and swallowed them with avidity. at the expiration of a month he was very weak and reduced; his legs became oedematous--his pupils were much diminished. he now believed himself a child, called upon the people about him as his playfellows, and appeared to recal the scenes of early life with facility and correctness. within a few days of his decease he only muttered to himself. august th, he died. he was opened six hours after death. the pericranium was loosely adherent. the tunica arachnoidea had generally lost its transparency, and was considerably thickened. the veins of the pia mater were loaded with blood, and in many places seemed to contain air. there was a considerable quantity of water between the membranes, and, as nearly as could be ascertained, about four ounces in the ventricles, in the cavity of which, the veins appeared remarkably turgid. the consistence of the brain was more than usually firm. case iv. e. m. a woman, aged sixty, was admitted into the house, august th, ; she had been disordered five months: the cause assigned was extreme grief, in consequence of the loss of her only daughter. she was very miserable and restless; conceived she had been accused of some horrid crime, for which she apprehended she should be burned alive. when any persons entered her room she supposed them officers of justice, who were about to drag her to some cruel punishment. she was frequently violent, and would strike and bite those who came near her. upon the idea that she should shortly be put to death, she refused all sustenance; and it became necessary to force her to take it. in this state she continued, growing daily weaker and more emaciated, until october d, when she died. upon opening the head, there was a copious determination of blood to the whole contents of the cranium. the pia mater was considerably inflamed; there was not any water either in the ventricles or between the membranes. the brain was particularly soft. she was opened thirty hours after death. case v. w. p. a young man, aged twenty-five, was admitted into the hospital, september th, . he had been disordered five months, and had experienced a similar attack six years before. the disease was brought on by excessive drinking. he was in a very furious state, in consequence of which he was constantly confined. he very seldom slept--during the greater part of the night he was singing, or swearing, or holding conversations with persons he imagined to be about him: sometimes he would rattle the chain with which he was confined, for several hours together, and tore every thing to pieces within his reach. in the beginning of november, the violence of his disorder subsided for two or three days, but afterwards returned; and on the th he died compleatly exhausted by his exertions.--upon opening the head the pericranium was found firmly attached; the pia mater was inflamed, though not to any very considerable degree; the tunica arachnoidea in some places was slightly shot with blood; the membranes of the brain, and its convolutions, when these were removed, were of a brown, or brownish straw colour. there was no water in any of the cavities of the brain, nor any particular congestion of blood in its substance--the consistence of which was natural. he was opened twenty hours after death. case vi. b. h. was an incurable patient, who had been confined in the house from the year , and for some years before that time in a private madhouse. he was about sixty years of age--had formerly been in the habit of intoxicating himself. his character was strongly marked by pride, irascibility, and malevolence. during the four last years of his life, he was confined for attempting to commit some violence on one of the officers of the house. after this, he was seldom heard to speak; yet he manifested his evil disposition by every species of dumb insult. latterly he grew suspicious, and would sometimes tell the keeper that his victuals were poisoned. about the beginning of december he was taken ill with a cough, attended with copious expectoration. being then asked respecting his complaints, he said, he had a violent pain across the stomach, which arose from his navel string at his birth having been tied too short. he never spoke afterwards, though frequently importuned to describe his complaints. he died december , . upon dividing the integuments of the head, the pericranium was found scarcely to adhere to the scull. on the right parietal bone there was a large blotch, as if the bone had been inflamed: there were others on different parts of the bone, but considerably smaller. the glandulæ pacchioni were uncommonly large: the tunica arachnoidea in many places wanted the natural transparency of that membrane: there was a large determination of blood to the substance of the brain: the ventricles contained about three ounces of water: the consistence of the brain was natural. he was opened two days after death. case vii. a. m. a woman, aged twenty-seven, was admitted into the hospital, august , ; she had then been eleven weeks disordered. religious enthusiasm, and a too frequent attendance on conventicles, were stated to have occasioned her complaint. she was in a very miserable and unhappy condition, and terrified by the most alarming apprehensions for the salvation of her soul. towards the latter end of september, she appeared in a convalescent state, and continued tolerably well until the middle of november, when she began to relapse. the return of her disorder commenced with loss of sleep. she alternately sang, and cried the greatest part of the night. she conceived her inside full of the most loathsome vermin, and often felt the sensation as if they were crawling into her throat. she was suddenly seized with a strong and unconquerable determination to destroy herself; became very sensible of her malady, and said, that god had inflicted this punishment on her, from having (at some former part of her life) said the lord's prayer backwards. she continued some time in a restless and forlorn state; at one moment expecting the devil to seize upon her and tear her to pieces; in the next, wondering that she was not instigated to commit violence on the persons about her. on january , , she died suddenly. she was opened twelve hours after death. the thoracic and abdominal viscera were perfectly healthy. upon examining the contents of the cranium, the pia mater was considerably inflamed, and an extravasated blotch, about the size of a shilling, was seen upon that membrane, near the middle of the right lobe of the cerebrum. there was no water between the membranes, nor in the ventricles, but a general determination of blood to the contents of the cranium. the medullary substance, when cut into, was full of bloody points. the consistence of the brain was natural. case viii. m. w. a very tall and thin woman, forty-four years of age, was admitted into the hospital, september , . her disorder was of six months standing, and eight years before she had also had an attack of this disease. the cause assigned to have brought it on, the last time, was the loss of some property, the disease having shortly followed that circumstance.--the constant tenor of her discourse was, that she should live but a short time. she seemed anxiously to wish for her dissolution, but had no thoughts of accomplishing her own destruction. in the course of a few weeks she began to imagine, that some malevolent person had given her mercury with an intention to destroy her. she was constantly shewing her teeth, which had decayed naturally, as if this effect had been produced by that medicine: at last she insisted, that mercurial preparations were mingled in the food and medicines which were administered to her. her appetite was voracious, notwithstanding this belief. she had a continual thirst, and drank very large quantities of cold water. on january , , she had an apoplectic fit, well marked by stertor, loss of voluntary motion, and insensibility to stimuli. on the following day she died. she was opened two days after death. there was a remarkable accumulation of blood in the veins of the dura and pia mater; the substance of the brain was loaded with blood. when the medullary substance was cut into, blood oozed from it; and, upon squeezing it, a greater quantity could be forced out. on the pia mater covering the right lobe of the cerebrum, were some slight extravasations of blood. the ventricles contained no water; on the plexus choroides were some vesicles of the size of coriander-seeds, filled with a yellow fluid. the pericranium adhered firmly to the scull. the consistence of the brain was firmer than usual. case ix. e. d. a woman, aged thirty-six, was admitted into the hospital, february , ; she had then been disordered four months. her insanity came on a few days after having been delivered. she had also laboured under a similar attack seven years before, which, like the present, supervened upon the birth of a child. under the impression that she ought to be hanged, she destroyed her infant, with the view of meeting with that punishment. when she came into the house, she was very sensible of the crime she had committed, and felt the most poignant affliction for the act. for about a month she continued to amend: after which time she became more thoughtful, and frequently spoke about the child: great anxiety and restlessness succeeded. in this state she remained until april , when her tongue became thickly furred, the skin parched, her eyes inflamed and glassy, and her pulse quick. she now talked incoherently; and, towards the evening, merely muttered to herself. she died on the following day comatose. she was opened about twenty-four hours after death. the scull was thick, the pericranium scarcely adhered to the bone, the dura mater was also but slightly attached to its internal surface. there was a large quantity of water between the dura mater and tunica arachnoidea; this latter membrane was much thickened, and was of a milky white appearance. between the tunica arachnoidea and pia mater, there was a considerable accumulation of water. the veins of the pia mater were particularly turgid. about three ounces of water were contained in the lateral ventricles: the veins of the membrane lining these cavities were remarkably large and turgid with blood. when the medullary substance of the cerebrum and cerebellum was cut into, there appeared a great number of bloody points. the brain was of its natural consistence. case x. c. m. a man, forty years of age, was admitted into the hospital, december , . it was stated, that he had been disordered two months previously to his having been received as a patient. his friends were unacquainted with any cause, which was likely to have induced the disease. during the time he was in the house he seemed sulky, or rather stupid. he never asked any questions, and if spoken to, either replied shortly, or turned away without giving any answer. he scarcely appeared to take notice of any thing which was going forward, and if told to do any little office generally forgot what he was going about, before he had advanced half a dozen steps. he remained in this state until the beginning of may, , when his legs became oedematous, and his abdomen swollen. he grew very feeble and helpless, and died rather suddenly, may th. he was opened about forty-eight hours after death. the pericranium and dura mater adhered firmly to the scull; in many places there was an opake whiteness of the tunica arachnoidea. about four ounces of water were found in the ventricles. the plexus choroides were uncommonly pale. the medullary substance afforded hardly any bloody points when cut into. the consistence of the brain i cannot describe better than by saying, it was doughy. case xi. s. m. a man, thirty-six years of age, was admitted as an incurable patient in the year . of the former history of his complaint i have no information. as his habits, which frequently came under my observation, were of a singular nature, it may not here be improper to relate them.--having at some period of his confinement been mischievously disposed, and, in consequence, put under coercion, he never afterwards found himself comfortable when at liberty. when he rose in the morning he went immediately to the room where he was usually confined, and placed himself in a particular corner, until the keeper came to secure him. if he found any other patient had pre-occupied his situation, he became very outrageous, and generally forced them to leave it. when he had been confined, for which he appeared anxious, as he bore any delay with little temper, he employed himself throughout the remainder of the day, by tramping or shuffling his feet. he was constantly muttering to himself, of which scarcely one word in a sentence was intelligible. when an audible expression escaped him it was commonly an imprecation. if a stranger visited him, he always asked for tobacco, but seldom repeated his solicitation. he devoured his food with avidity, and always muttered as he ate. in the month of july, , he was seized with a diarrhoea, which afterwards terminated in dysentery. this continued, notwithstanding the employment of every medicine usually given in such a case, until his death, which took place on september , of the same year. he was opened twelve hours after death. the scull was unusually thin; the glandulæ pacchioni were large and numerous: there was a very general determination of blood to the brain: the medullary substance, when cut, shewed an abundance of bloody points: the lateral ventricles contained about four ounces of water: the consistence of the brain was natural. case xii. e. r. was a woman, to all appearance about eighty years of age, but of whose history, before she came into the hospital, it has not been in my power to acquire any satisfactory intelligence. she was an incurable patient, and had been admitted on that establishment in february, . during the time i had an opportunity of observing her, she continued in the same state: she appeared feeble and childish. during the course of the day, she sat in a particular part of the common-room, from which she never stirred. her appetite was tolerably good, but it was requisite to feed her. except she was particularly urged to speak she never talked. as the summer declined she grew weaker, and died october , , apparently worn out. she was opened two days after death. the scull was particularly thin; the pericranium adhered firmly to the bone, and the scull-cap was with difficulty separated from the dura mater. there was a very large quantity of water between the membranes of the brain: the glandulæ pacchioni were uncommonly large: the tunica arachnoidea was in many places blotched and streaked with opacities: when the medullary substance of the brain was cut into, it was every where bloody; and blood could be pressed from it, as from a sponge. there were some large hydatids on the plexus choroides: in the ventricles about a tea spoonful of water was observed: the consistence of the brain was particularly firm, but it could not be called elastic. there were no symptoms of general dropsy. case xiii. j. d. a man, thirty-five years of age, was admitted into the hospital in october, . he was a person of good education, and had been regularly brought up to medicine, which he had practised in this town for several years. it was stated by his friends, that, about two years before, he had suffered a similar attack, which continued six months: but it appears from the observations of some medical persons, that he never perfectly recovered from it, although he returned to the exercise of his profession. a laborious attention to business, and great apprehensions of the want of success, were assigned as causes of his malady. in the beginning of the year the disease recurred, and became so violent that it was necessary to confine him. at the time he was received into bethlem hospital, he was in an unquiet state, got little or no sleep, and was constantly speaking loudly: in general he was worse towards evening. he appeared little sensible of external objects: his exclamations were of the most incoherent nature. during the time he was a patient he was thrice cupped on the scalp. after each operation, he became rational to a certain degree; but these intervals were of a short continuance, as he relapsed in the course of a few hours. the scalp, particularly at the posterior part of the head, was so loose that a considerable quantity of it could be gathered up by the hand.[ ] the violence of his exertions at last exhausted him, and on december , he died. he was opened about twenty-four hours after death. there was a large quantity of water between the dura mater and tunica arachnoidea, and also between this latter membrane and the pia mater. the tunica arachnoidea was thickened and opake; the vessels of the pia mater were loaded with blood: when the medullary substance was cut into, it was very abundant in bloody points: about three ounces of water were contained in the lateral ventricles: the plexus choroides were remarkably turgid with blood: a quantity of water was found in the theca vertebralis: the consistence of the brain was natural. case xiv. j. c. a man, aged sixty-one, was admitted into the hospital september , . it was stated, that he had been disordered ten months. he had for thirty years kept a public house, and had for some time been in the habit of getting intoxicated. his memory was considerably impaired: circumstances were so feebly impressed on his mind, that he was unable to give any account of the preceding day. he appeared perfectly reconciled to his situation, and conducted himself with order and propriety. as he seldom spoke but when interrogated, it was not possible to collect his opinions. in this quiet state he continued about two months, when he became more thoughtful and abstracted, walked about with a quick step, and frequently started, as if suddenly interrupted. he was next seized with trembling, appeared anxious to be released from his confinement: conceived at one time that his house was filled with company; at another that different people had gone off without paying him, and that he should be arrested for sums of money which he owed. under this constant alarm and disquietude he continued about a week, when he became sullen, and refused his food. when importuned to take nourishment, he said it was ridiculous to offer it to him, as he had no mouth to eat it: though forced to take it, he continued in the same opinion; and when food was put into his mouth, insisted that a wound had been made in his throat, in order to force it into his stomach. the next day he complained of violent pain in his head, and in a few minutes afterwards died. he was opened twelve hours after death. there was a large quantity of water between the tunica arachnoidea and pia mater; the latter membrane was much suffused with blood, and many of its vessels were considerably enlarged: the lateral ventricles contained at least six ounces of water: the brain was very firm. case xv. j. a. a man, forty-two years of age, was first admitted into the house on june , . his disease came on suddenly whilst he was working in a garden, on a very hot day, without any covering to his head. he had some years before travelled with a gentleman over a great part of europe: his ideas ran particularly on what he had seen abroad; sometimes he conceived himself the king of denmark, at other times the king of france. although naturally dull and wanting common education, he professed himself a master of all the dead and living languages; but his most intimate acquaintance was with the old french: and he was persuaded he had some faint recollection of coming over to this country with william the conqueror. his temper was very irritable, and he was disposed to quarrel with every body about him. after he had continued ten months in the hospital, he became tranquil, relinquished his absurdities, and was discharged well in june . he went into the country with his wife to settle some domestic affairs, and in about six weeks afterwards relapsed. he was re-admitted into the hospital august th. he now evidently had a paralytic affection; his speech was inarticulate, and his mouth drawn aside. he shortly became stupid, his legs swelled, and afterwards ulcerated: at length his appetite failed him; he became emaciated, and died december th, of the same year. the head was opened twenty hours after death. there was a greater quantity of water between the different membranes of the brain than has ever occurred to me. the tunica arachnoidea was generally opake and very much thickened: the pia mater was loaded with blood, and the veins of that membrane were particularly enlarged. on the forepart of the right hemisphere of the brain, when stripped of its membranes, there was a blotch, of a brown colour, several shades darker than the rest of the cortical substance: the ventricles were much enlarged, and contained, by estimation, at least six ounces of water. the veins in these cavities were particularly turgid. the consistence of the brain was firmer than usual. case xvi. j. h. a man, aged forty-two, was admitted into the house on april , . he had then been disordered two months: it was a family disease on his father's side. having manifested a mischievous disposition to some of his relations, he was continued in the hospital upon the incurable establishment. his temper was naturally violent, and he was easily provoked. as long as he was kept to any employment he conducted himself tolerably well; but when unoccupied, would walk about in a hurried and distracted manner, throwing out the most horrid threats and imprecations. he would often appear to be holding conversations: but these conferences always terminated in a violent quarrel between the imaginary being and himself. he constantly supposed unfriendly people were placed in different parts of the house to torment and annoy him. however violently he might be contesting any subject with these supposed enemies, if directed by the keepers to render them any assistance, he immediately gave up the dispute and went with alacrity. as he slept but little, the greatest part of the night was spent in a very noisy and riotous manner. in this state he continued until april , when he was attacked with a paralytic affection, which deprived him of the use of the left side. his articulation was now hardly intelligible; he became childish, got gradually weaker, and died december , . he was opened twenty-four hours after death. there was a general opacity of the tunica arachnoidea, and a small quantity of water between that membrane and the pia mater: the ventricles were much enlarged and contained a considerable quantity of water, by estimation, four ounces; the consistence of the brain was natural. case xvii. m. g. a woman, about fifty years of age, had been admitted on the incurable establishment in july . she had for some years before been in a disordered state, and was considered as a dangerous patient. her temper was violent; and if interrupted in her usual habits, she became very furious. like many others among the incurables, she was an insulated being: she never spoke except when disturbed. her greatest delight appeared to be in getting into some corner to sleep; and the interval between breakfast and dinner, was usually past in this manner. at other times she was generally committing some petty mischief, such as slyly breaking a window, dirtying the rooms of the other patients, or purloining their provisions. she had been for some months in a weak and declining state, but would never give any account of her disorder. on january , , she died, apparently worn out. the head was opened three days after death. the pericranium adhered but slightly to the scull, nor was the dura mater firmly attached. there was water between the membranes of the brain; and the want of transparency of the tunica arachnoidea, indicated marks of former inflammation. the posterior part of the hemispheres of the brain was of a brownish colour. in this case there was a considerable appearance of air in the veins; the medullary substance, when cut, was full of bloody points: the lateral ventricles were small, but filled with water: the plexus choroides were loaded with vesicles of a much larger size than usual: the consistence of the brain was natural. case xviii. s. t. a woman, aged fifty-seven, was admitted into the house, january , . it was stated by her friends, that she had been disordered eight months: they were unacquainted with any cause, which might have induced the disease. she had evidently suffered a paralytic attack, which considerably affected her speech, and occasioned her to walk lame with the right leg. as she avoided all conversation, it was not possible to collect any further account of her case. three days after her admission, she had another paralytic stroke, which deprived her entirely of the use of the right side. two days afterwards she died. she was opened forty-eight hours after death. there was a small quantity of water between the tunica arachnoidea and pia mater, and a number of opake spots on the former membrane. on the pia mater, covering the posterior part of the left hemisphere of the brain, there was an extravasated blotch, about the size of a shilling: the medullary substance was unusually loaded with blood: the lateral ventricles were large, but did not contain much water: the consistence of the brain was very soft. case xix. w. c. a man, aged sixty-three, was admitted into the hospital, january , . the persons, who attended at his admission, deposed, that he had been disordered five months; that he never had been insane before, and that the disease came on shortly after the death of his son. he was in a very anxious and miserable state. no persuasion could induce him to take nourishment; and it was with extreme difficulty that any food could be forced upon him. he paced about with an hurried step; was often suddenly struck with the idea of having important business to adjust in some distant place, and which would not admit of a moment's delay. presently after, he would conceive his house to be on fire, and would hastily endeavour to rescue his property from the flames. then he would fancy that his son was drowning, that he had twice sunk: he was prepared to plunge into the river to save him, as he floated for the last time: every moment appeared an hour until he rose. in this miserable state he continued till the th, when, with great perturbation, he suddenly ran into his room, threw himself on the bed, and in a few minutes expired. the head was opened twenty-four hours after death. the pericranium was but slightly adherent to the scull: the tunica arachnoidea, particularly where the hemispheres meet, was of a milky whiteness. between this membrane, which was somewhat thickened, and the pia mater, there was a very large collection of water: the pia mater was inflamed: the veins of this membrane were enlarged beyond what i had ever before observed: there was a striking appearance of air in the veins: the medullary substance of the brain, when cut into, bled freely, and seemed spongy from the number and enlargement of its vessels: in the ventricles, which were of a natural capacity, there was about half an ounce of water: the brain was of a healthy consistence. case xx. m. l. a woman, aged thirty-eight, was admitted into the house, june , . from the information of the people who had attended her, it appeared, that she had been disordered six weeks, and that the disease took place shortly after the death of her husband. at the first attack she was violent, but she soon became more calm. she conceived that the overseers of the parish, to which she belonged, meditated her destruction: afterwards she supposed them deeply enamoured of her, and that they were to decide their claims by a battle. during the time she continued in the hospital she was perfectly quiet, although very much deranged. she fancied that a young man, for whom she had formerly entertained a partiality, but who had been dead some years, appeared frequently at her bed-side, in a state of putrefaction, which left an abominable stench in her room. soon after she grew suspicious, and became apprehensive of evil intentions in the people about her. she would frequently watch at her door, and, when asked the reason, replied that she was fully aware of a design, which had been formed, to put her secretly to death.--under the influence of these opinions she continued to her death, which took place on february , , in consequence of a violent rheumatic fever. she was opened twelve hours after death. there were two opake spots on the tunica arachnoidea: the pia mater was slightly inflamed: there was a general congestion of blood to the whole contents of the cranium: the consistence of the brain did not differ from what is found in a healthy state. case xxi. h. c. a woman, of about sixty-five years of age, had been admitted on the incurable establishment in the year . i have not been able to collect any particulars of her former history. during the time i had an opportunity of seeing her, she continued in a very violent and irritable state: it was her custom to abuse every one who came near her. the greatest part of the day was passed in cursing the persons she saw about her; and when no one was near, she usually muttered some blasphemy to herself. she died of a fever on february , , on the fourth day after the attack. she was opened two days after death. the tunica arachnoidea was, in many parts, without its natural transparency: the pia mater was generally suffused with blood, and its vessels were enlarged: the consistence of the brain was firm. case xxii. j. c. a man, aged fifty, was admitted into the hospital, august , . it was stated that he had been disordered about three weeks, and that the disease had been induced by too great attention to business, and the want of sufficient rest. about four years before, he had been a patient, and was discharged uncured. he was an artful and designing man, and with great ingenuity once effected his escape from the hospital. his time was mostly passed in childish amusements, such as tearing pieces of paper and sticking them on the walls of his room, collecting rubbish and assorting it. however, when he conceived himself unobserved, he was intriguing with other patients, and instructing them in the means, by which they might escape. of his disorder he seemed highly sensible, and appeared to approve so much of his confinement, that when his friends wished to have him released, he opposed it, except it should meet with my approbation; telling them, in my presence, that, although he might appear well to them, the medical people of the house were alone capable of judging of the actual state of his mind; yet i afterwards discovered, that he had instigated them to procure his enlargement, by a relation of the grossest falshoods and most unjust complaints. in april , he was permitted to have a month's leave of absence, as he appeared tolerably well, and wished to maintain his family by his industry. for above three weeks of this time, he conducted himself in a very rational and orderly manner. the day preceding that, on which he was to have returned thanks, he appeared gloomy and suspicious, and felt a disinclination for work. the night was passed in a restless manner, but in the morning he seemed better, and proposed coming to the hospital to obtain his discharge. his wife having been absent for a few minutes from the room, found him, on her return, with his throat cut. he was re-admitted as a patient, and expressed great sorrow and penitence for what he had done; and said that it was committed in a moment of rashness and despair. after a long and minute examination, he bewrayed nothing incoherent in his discourse. his wound, from which it was stated that he had lost a large quantity of blood, was attended to by mr. crowther, the surgeon to the hospital. every day he became more dispirited, and at last refused to speak. he died may th, about ten days after his re-admission. his head was opened two days after death. there were some slight opacities of the tunica arachnoidea, and the pia mater was a little inflamed: the other parts of the brain were in an healthy state, and its consistence natural. case xxiii. e. l. was a man, about seventy-eight years of age; had been admitted on the incurable establishment, january , . by report, i have understood that he was formerly in the navy, and that his insanity was caused by a disappointment of some promotion which he expected. it was also said, that he was troublesome to some persons high in office, which rendered it necessary that he should be confined. at one time he imagined himself to be the king, and insisted on his crown. during the time i had an opportunity of knowing him, he conducted himself in a very gentlemanly manner. his disposition was remarkably placid, and i never remember him to have uttered an unkind or hasty expression. with the other patients he seldom held any conversation. his chief amusement was reading, and writing letters to the people of the house. of his books he was by no means choice; he appeared to derive as much amusement from an old catalogue as from the most entertaining performance. his writings always contained directions for his release from confinement; and he never omitted his high titles of god's king, holy ghost, admiral, and physician. he died june , , worn out with age. he was opened two days after death. the scull was thick and porous. there was a large quantity of water between the different membranes. the tunica arachnoidea was particularly opake: the veins seemed to contain air: in the medullary substance the vessels were very copious and much enlarged: the lateral ventricles contained two ounces of pellucid water: the consistence of the brain was natural. it has been stated, by a gentleman of great accuracy, and whose situation affords him abundant opportunity of acquiring a knowledge of diseased appearances, that the fluid of hydrocephalus appears to be of the same nature with the water which is found in dropsy of the thorax and abdomen.[ ] that this is generally the case, there can be no doubt, from the respectable testimony of the author of the morbid anatomy: but in three instances, where i submitted this fluid to experiment, it was incoagulable by acids and by heat; in all of them its consistence was not altered even by boiling. there was, however, a cloudiness produced; and, after the liquor had stood some time, a slight deposition of animal matter took place, which, prior to the application of heat or mineral acids, had been dissolved in the fluid. this liquor tinged green the vegetable blues; produced a copious deposition with nitrat of silver; and, on evaporation, afforded cubic crystals (nitrat of soda). from this examination it was inferred, that the water of the brain, collected in maniacal cases, contained a quantity of uncombined alkali and some common salt. what other substances may enter into its composition, from want of sufficient opportunity, i have not been enabled to determine. case xxiv. s. w. a woman, thirty-five years of age, was admitted into the hospital, june , . it was stated that she had been one month disordered, and had never experienced any prior affection of the same kind. the disease was said to have been produced by misfortunes which had attended her family, and from frequent quarrels with those who composed it. she was in a truly melancholic state; she was lost to all the comforts of this life, and conceived herself abandoned for ever by god. she refused all food and medicines. in this wretched condition she continued until july th, when she lost the use of her right side. on the th she became lethargic, and continued so until her death, which happened on august the d. she was opened two days after death. there was a large collection of water between the different membranes of the brain, amounting at least to four ounces: the pia mater was very much inflamed, and was separable from the convolutions of the brain with unusual facility: the medullary substance was abundantly loaded with bloody points: the consistence of the brain was remarkably firm. case xxv. d. w. a man, about fifty-eight years of age, had been admitted upon the incurable establishment in . he was of a violent and mischievous disposition, and had nearly killed one of the keepers at a private mad house previously to his admission into the hospital. at all times he was equally deranged respecting his opinions, although he was occasionally more quiet and tractable: these intervals were extremely irregular as to their duration and period of return. he was of a very constipated habit, and required large doses of cathartic medicines to procure stools. on august , , he was in a very furious state; complained of costiveness, for which he took his ordinary quantity of opening physic, which operated as usual. on the same day he ate his dinner with a good appetite; but about six o'clock in the evening he was struck with hemiplegia, which deprived him completely of the use of his left side. he lay insensible of what passed about him, muttered constantly to himself, and appeared to be keeping up a kind of conversation. the pulse was feeble, but not oppressed or intermitting. he never had any stertor. he continued in this state until the th, when he died. he was opened twelve hours after death. there was some water between the tunica arachnoidea and pia mater: the former membrane was opake in many places; bearing the marks of former inflammation: in the veins of the membranes of the brain there was a considerable appearance of air, and they were likewise particularly charged with blood: the vessels of the medullary substance were numerous and enlarged. on opening the right lateral ventricle, which was much distended, it was found filled with dark and grumous blood; some had also escaped into the left, but in quantity inconsiderable when compared with what was contained in the other: the consistence of the brain was very soft. case xxvi. j. s. a man, forty-four years of age, was received into the hospital, june , . he had been disordered nine months previous to his admission. his insanity was attributed to a violent quarrel, which had taken place with a young woman, to whom he was attached, as he shortly afterwards became sullen and melancholy. during the time he remained in the house he seldom spoke, and wandered about like a forlorn person. sometimes he would suddenly stop, and keep his eyes fixed on an object, and continue to stare at it for more than an hour together. afterwards he became stupid, hung down his head, and drivelled like an ideot. at length he grew feeble and emaciated, his legs were swollen and oedematous, and on september th, after eating his dinner, he crawled to his room, where he was found dead about an hour afterwards. he was opened two days after death. the tunica arachnoidea had a milky whiteness, and was thickened. there was a considerable quantity of water between that membrane and the pia mater, which latter was loaded with blood: the lateral ventricles were very much enlarged, and contained, by estimation, about six ounces of transparent fluid: the brain was of its natural consistence. case xxvii. t. w. a man, thirty-eight years of age, was admitted into the house, may , . he had then been disordered a year. his disease was stated to have arisen, from his having been defrauded, by two of his near relations, of some property, which he had accumulated by servitude. having remained in the hospital the usual time of trial for cure, he was afterwards continued on the incurable establishment, in consequence of a strong determination he had always shewn, to be revenged on those people who had disposed of his property, and a declared intention of destroying himself. he was in a very miserable state, conceived that he had offended god, and that his soul was burning in hell. notwithstanding he was haunted with these dreadful imaginations, he acted with propriety upon most occasions. he took delight in rendering any assistance in his power to the people about the house, and waited on those who were sick, with a kindness that made him generally esteemed. at some period of his life he had acquired an unfortunate propensity to gaming, and whenever he had collected a few pence, he ventured them at cards. his losses were borne with very little philosophy, and the devil was always accused of some unfair interposition. on september , , he appeared jaundiced, the yellowness daily increased, and his depression of mind was more tormenting than ever. from the time he was first attacked by the jaundice he had a strong presentiment that he should die. although he took the medicines which were ordered, as a mark of attention to those who prescribed them, he was firmly persuaded they could be of no service. the horror and anxiety he felt, was, he said, sufficient to kill him, independantly of the jaundice. on the th he was drowsy, and on the following day died comatose. he was opened twenty-four hours after death. in some places the tunica arachnoidea was slightly opake: the pia mater was inflamed; and in the ventricles were found about two tea-spoons full of water tinged deeply yellow, and the vesicles of the plexus choroides were of the same colour: to the whole contents of the cranium there was a considerable congestion of blood: the consistence of the brain was natural: the liver was sound: the gall-bladder very much thickened, and contained a stone of the mulberry appearance, of a white colour. another stone was also found in the duodenum. case xxviii. r. b. a man, sixty-four years of age, was admitted into the hospital, september , . he had then been disordered three months. it was also stated, that he had suffered an attack of this disease seven years before, which then continued about two months. his disorder had, both times, been occasioned by drinking spirituous liquors to excess. he was a person of liberal education, and had been occasionally employed as usher in a school, and at other times as a librarian and amanuensis. when admitted he was very noisy, and importunately talkative. during the greatest part of the day he was reciting passages from the greek and roman poets, or talking of his own literary importance. he became so troublesome to the other madmen, who were sufficiently occupied with their own speculations, that they avoided, and excluded him from the common room; so that he was, at last, reduced to the mortifying situation of being the sole auditor of his own compositions. he conceived himself very nearly related to anacreon, and possessed of the peculiar vein of that poet. he also fancied that he had discovered the longitude; and was very urgent for his liberation from the hospital, that he might claim the reward, to which his discovery was intitled. at length he formed schemes to pay off the national debt: these, however, so much bewildered him that his disorder became more violent than ever, and he was in consequence obliged to be confined to his room. he now, after he had remained two months in the house, was more noisy than before, and had little sleep. these exertions very much reduced him. in the beginning of january, , his conceptions were less distinct, and although his talkativeness continued, he was unable to conclude a single sentence. when he began to speak, his attention was diverted by the first object which caught his eye, or by any sound that struck him. on the th he merely muttered; on the th he lost the use of his right side, and became stupid and taciturn. in this state he continued until the th, when he had another fit; after which he remained comatose and insensible. on the following day he died. he was opened thirty-six hours after death. the pericranium adhered very loosely to the scull: the tunica arachnoidea was generally opake, and suffused with a brownish hue: a large quantity of water was contained between it and the pia mater: the contents of the cranium were unusually destitute of blood: there was a considerable quantity of water (perhaps four ounces) in the lateral ventricles, which were much enlarged: the consistence of the brain was very soft. case xxix. e. t. a man, aged thirty years, was admitted a patient, july , . the persons who attended, related, that he had been disordered eleven months, and that his insanity shortly supervened to a violent fever. it also appeared, from subsequent enquiries, that his mother had been affected with madness. he was a very violent and mischievous patient, and possessed of great bodily strength and activity. although confined, he contrived several times during the night to tear up the flooring of his cell; and had also detached the wainscot to a considerable extent, and loosened a number of bricks in the wall. when a new patient was admitted, he generally enticed him into his room, on pretence of being an old acquaintance, and, as soon as he came within his reach, immediately tore his clothes to pieces. he was extremely dexterous with his feet, and frequently took off the hats of those who were near him with his toes, and destroyed them with his teeth. after he had dined he generally bit to pieces a thick wooden bowl, in which his food was served, on the principle of sharpening his teeth against the next meal. he once bit out the testicles of a living cat, because the animal was attached to some person who had offended him. of his disorder he appeared to be very sensible; and after he had done any mischief, always blamed the keepers for not securing him so, as to have prevented it. after he had continued a year in the hospital he was retained as an incurable patient. he died february , , in consequence of a tumor of the neck. he was opened two days after death. the tunica arachnoidea was generally opake, and of a milky whiteness: the vessels of the pia mater were turgid, and its veins contained a quantity of air; about an ounce of water was contained in the lateral ventricles: the consistence of the brain was unusually firm, and possessed of considerable elasticity: it is the only instance of this nature which has fallen under my observation. case xxx. t. g. a man, about fifty-five years of age, was admitted into the hospital, january , . it was stated, that he had been disordered a year and half, and that his madness arose from repeated intoxication. having set fire to several hay-stacks, and committed frequent depredations on the neighbouring farmers, it had been found necessary to confine him in the county goal. his behaviour in this situation marked the cunning and malignity of his mind, so that he was always attempting some mischief either by violence or stratagem. when brought to the hospital he conducted himself with propriety and order, and appeared to be in a state of recovery. on the second of may he was attacked with a diarrhoea which daily encreased, notwithstanding the medicines employed for its removal. his mind became violently agitated from the commencement of the diarrhoea, and it was found proper to secure him. on the th, dysenteric symptoms appeared, which continued to the th, when he died. _appearances on dissection._ the head was opened twenty-four hours after death. the pericranium was loosely attached to the scull, and the dura mater adhered but slightly to the internal surface of the cranium; there was a considerable quantity of water between the dura mater and tunica arachnoidea, this latter membrane (especially where the hemispheres meet) was of a milky whiteness, and generally so in the course of the veins of the pia mater. the glandulæ pacchioni were very large and numerous. between the tunica arachnoidea and pia mater there was much water; and from the lateral ventricles, which were uncommonly enlarged and distended, eight ounces of fluid were collected: the infundibulum was remarkably large: the membrane lining the cavity of the lateral ventricles had its veins very turgid: the consistence of the brain was softer than natural. the fluid obtained from the brain in this case being very pellucid and abundant, it was submitted to some chemical tests in order to ascertain its composition. an attempt of this kind had been made before; (vide case ) the present may be considered a small addition to our knowledge of this fluid, though by no means a satisfactory developement of its materials, according to the severity and precision of modern analysis.[ ] analysis of the fluid. _tincture of galls_, produced a white precipitate in moderate quantity. _lime water_, afforded a considerable quantity of a white precipitate, which was redissolved without effervescence by muriatic acid. _solution of sulphat a drop of this solution added to of copper._ two drams of the brain fluid tinged it with a pretty deep blue. the presence of animal matter is inferred from the deposition produced by infusion of galls. the precipitation by lime-water indicates the phosphoric acid. and it appears from the blue tinge given to the fluid by the sulphat of copper, that ammonia or some of its combinations was contained. as it occurred on many former trials, there was no coagulation by heat; a slight sediment fell, after boiling some minutes. as this patient remained in the hospital from the middle of january to the beginning of may, in a state perfectly tranquil, and without the appearance of disarrangement of mind, it is improbable that a so great enlargement of the ventricles, and accumulation of water, could have taken place within the short space of two weeks, it is therefore most likely that the greatest part of this fluid had been previously collected. it may be conjectured that a very gradual accumulation of water (although the quantity be at last considerable) would not affect the sensorium so as a sudden secretion of fluid; or, that a quantity, which at one time had occasioned great disturbance, would by habit become less inconvenient. we are not well informed, but there is reason to believe, that gradual pressure on the brain, will not occasion those serious symptoms which a sudden pressure would excite. case xxxi. h. k. a woman, aged thirty, was admitted into the hospital, october , . she had then been mad about four months, and her disorder was stated to have supervened on the birth of a child. from subsequent enquiry it was ascertained that her mother had been insane, and that her elder sister had been similarly affected; but from the best information it did not appear that her brothers (she had two) had ever been visited with this calamity. previously to her admission she had frequently attempted to destroy herself, and had also endeavoured to take away the life of her husband. in the hospital she was extremely violent; supposed her neighbours had conspired to take away her liberty, and became jealous of her husband: she was often naming some female of her acquaintance who had artfully ensnared his affections, and whom he had decked out in her best apparel: she breathed revenge when she should return home, and seemed much delighted with the idea of destroying these favourites, when they were dressed for some excursion with her husband. she had understood that a year was the extent of time that persons were detained in the hospital, and conceived she should be liberated when it had elapsed, to put her menaces into execution. her disorder being of a dangerous tendency she was retained in the hospital after the period of probation. when she found the hope of gratifying her revenge frustrated, by being kept beyond the time of her expectation, she began to pine away, her appetite diminished, and a cough, with copious expectoration and hectic fever supervened. during the whole period of her bodily disease, she would never acknowledge herself to be ill, and the violence of her mental disorder was unabated. she died of phthisis pulmonalis, april st, . the head was opened twenty four hours after her decease. the tunica arachnoidea was in many places opake; the pia mater was highly inflamed, and loaded with blood, and a considerable quantity of water was contained between it and the former membrane. the ventricles were enlarged, but contained scarcely any fluid. the other parts of the brain were healthy, and its consistence was natural. it is a common opinion, that phthisis pulmonalis is frequently suspended by the supervention of mania; medical books abound with such accounts, and some persons have supposed it difficult, if not impossible, for these diseases to co-exist. it is not my intention to dispute the accuracy of such relations, nor to question the power which mania may possess in arresting the progress of phthisis pulmonalis, but, to state that the converse does not obtain; and, that whatever obligations may be due from phthisis to mania, the compliment has not been returned. from my own experience i can affirm, that insane persons are as liable to phthisis pulmonalis as others, that numbers of them die of that disease; and that i never saw any abatement of the maniacal symptoms through the progress of consumption. case xxxii. j. p. aged , was admitted into the hospital, january , ; he was stated to have been insane about three weeks, and that his disorder came on shortly after the death of his master, in whose service he had continued many years, and to whom he was much attached. he had been in the hospital three times before, and had each time been discharged well. his disorder usually recurred every seven or eight years. his father also had been maniacal about the middle period of life, but never recovered. when admitted he was very talkative, although his natural character was reserved. he endeavoured to explain his meaning with superior correctness, and sought to define every subject, however trifling, with a tedious minuteness; but, upon religion and politics, the scylla and charybdis of human discussion, he was pertinacious and intollerant. this dictatorial manner and stubbornness of opinion, not being capable of producing the relations of peace and amity with other philosophers, equally obstinate, and whose principles had been matured by long confinement, it became necessary to shut him up in his cell. during the period of his seclusion, nothing very incoherent escaped from him; every thing he said was within the sphere of possibility. his fastidiousness rendered him unhappy: he acknowledged the food which was brought him to be good, but he conceived it might have been better. the cathartic medicine, which was administered to him, he confessed had answered the purpose, but its taste was most nauseous, and he had never before been so severely griped. he ornamented his person and apartment in a very whimsical manner: latterly he tore his clothes because he suspected the taylor had deceived him in the materials. after this he continued naked until the beginning of march, when he appeared more composed, and sensible of the state he had been in. on the morning of the th, when the keeper opened his cell, he was speechless; his mouth drawn to the right side, and so feeble that he could not support himself. a cathartic medicine was given, and sinapisms were applied to the feet and legs. in the evening he was much recovered, his speech had returned, and he was able to move himself. he was visited again at midnight, when he appeared still better. in the morning it was evident that he had experienced another attack, his mouth was drawn aside; he was stupid, and died within half an hour. the head was opened on the following day. the tunica arachnoidea was in some places slightly opake. the pia mater was inflamed, but not to any considerable degree. there was no water between any of the membranes. the ventricles were of a natural capacity, and did not contain any fluid. there was no extravasation in any part of the substance of the cerebrum or cerebellum. excepting the slight inflammation of the pia mater, the brain had a very healthy appearance; its consistence was firm; the scull was unusually thick. i regret, from a promise which had been made to the friends, of inspecting the head only, that the thoracic and abdominal viscera were not examined. this history has been related to shew, that although the patient died with those symptoms, which indicate pressure on the brain, as loss of speech, the mouth being drawn aside, stupor and insensibility; yet the brain did not afford the same appearances, on dissection, as have been usually detected in such cases. the following relation is an additional example of the same fact: case xxxiii. n. b. he had been many years in the hospital as an incurable patient; his mother was known to have been maniacal; his two brothers and his sister have been insane. his eldest son, on taking a very small quantity of fermented liquor, becomes frantic, and its effects continue much longer than on persons in general. during this patient's confinement, he was, as far as could be ascertained, completely in his senses; this induced the medical persons of the hospital, on two or three occasions, to give him leave of absence, that he might return on trial to his wife and family; but, in a few hours after he came home, he felt uneasy, and found himself bewitched at all points: the devil and his imps had pre-occupied the best places in the house; he became very turbulent, and also jealous of his wife, and was obliged to be returned to the hospital. as he found his home so beset with difficulties he resolved that he would never enter it again. during eight years that i was acquainted with him i never discovered the least insanity in his actions or conversation. he was perfectly sensible that his intellects were disordered whenever he returned to his family. his wife and children frequently visited him in bethlem, and he always conducted himself affectionately towards them. about months before his death he laboured under a severe dysentery, which continued six weeks, and left him in a very reduced state, with oedematous legs, and incipient dropsy of the abdomen. on his recovery from these symptoms he became troubled with fits; they appeared to be such as a medical person would have termed apoplectic. after the attack, no symptoms of paralysis remained, nor did he experience the fatigue and exhaustion, or fall into a profound sleep, which usually accompanies epilepsy. on october th, , being then in a pretty good state of health, he fell down, and expired in a few minutes. he was about sixty-five years of age. on examination of the head after death, there was a considerable determination of blood to the brain; but there was no extravasation of that fluid, nor any collection of water: the brain and its membranes had a healthy appearance, and its consistence was natural. the heart was sound, and the abdominal viscera were not conspicuously diseased. case xxxiv. j. p. a man, aged thirty, was admitted into the hospital, october th, . it was then deposed, by the persons who brought him, that he had been for eight months in a melancholic state; but they were unable to assign any circumstances, which preceded his disorder, as a cause of his disease. he had a large tumor on the throat which extended backward to the neck, principally on the left side; the increase of this swelling, they alledged, had much alarmed him, at the commencement of his melancholic attack. during the time he was the subject of my observation, he was in a very mopish and stupid state; if spoken to, he would sometimes give a short answer, but ordinarily he took no notice of those who addressed him. some days he would walk slowly in the less frequented part of the building; frequently he sat down for some hours in a corner. his appetite was good, he ate the food which was brought him, but never took the trouble to go for it, when serving out. in this state he continued until april d, when he became more stupid, and could not be made to rise from his bed. he did not appear to be in any pain, nor was he at all convulsed. his bowels were regular. on the th he became comatose, and on the th he died. _appearances on dissection._ there was an excessive determination of blood to the brain, and the pia mater was highly inflamed. on the inferior part of the middle lobe of the brain, there was a gangrene of considerable extent, together with a quantity of very foetid purulent matter. this is the only instance of a gangrenous state of the brain which has fallen under my observation. case xxxv. t. c. this person had remained many years in the hospital on the incurable establishment. he had been a schoolmaster at warrington in lancashire, and was a man of acuteness and extensive mathematical learning. as he became very furious on the attack of his maniacal disorder, he was placed in the lunatic asylum at manchester, where he killed the person who had the care of him, by stabbing him in the back with a knife. the following is the account he gave me of that transaction, and which i immediately committed to paper; as it conveys a serious and important lesson to those who are about the persons of the insane. "he that would govern others, first should be the master of himself, richly indu'd with depth of understanding, height of courage." _massinger's bondman, act i. scene ._ it ought to be more generally understood that a madman seldom forgets the coercion he has undergone, and that he never forgives an indignity. "the man whom i stabbed richly deserved it. he behaved to me with great violence and cruelty, he degraded my nature as a human being; he tied me down, handcuffed me, and confined my hands much higher than my head, with a leathern thong: he stretched me on a bed of torture. after some days he released me. i gave him warning, for i told his wife i would have justice of him. on her communicating this to him, he came to me in a furious passion, threw me down, dragg'd me through the court-yard, thumped on my breast, and confined me in a dark and damp cell. not liking this situation, i was induced to play the hypocrite. i pretended extreme sorrow for having threatened him, and by an affectation of repentance, prevailed on him to release me. for several days i paid him great attention, and lent him every assistance. he seemed much pleased with the flattery, and became very friendly in his behaviour towards me.--going one day into the kitchen, where his wife was busied, i saw a knife; (this was too great a temptation to be resisted;) i concealed it, and carried it about me. for some time afterwards the same friendly intercourse was maintained between us; but, as he was one day unlocking his garden door, i seized the opportunity, and plunged the knife up to the hilt in his back."--he always mentioned this circumstance with peculiar triumph, and his countenance (the most cunning and malignant i ever beheld) became highly animated at the conclusion of the story. during the time he was in bethlem hospital he most ingeniously formed a stiletto out of a mop-nail; it was an elaborate contrivance, and had probably been the work of several months. it was rendered extremely sharp and polished, by whetting on a small pebble; it was fixed into a handle, and had a wooden sheath made from the mop-stick. this instrument he carried in his left breeches pocket, his right hand grasping the hilt. as i always found him in that posture when i visited him, i suspected he had some concealed implement of mischief, and therefore employed a convalescent patient to watch him through the key-hole of his door. this person saw him with the weapon, and also ascertaining the distance at which he could use it. the instrument was taken from him by surprise. when he found he was prevented from executing his purpose, he roared out the most horrid imprecations; he cursed the almighty for creating him, and more especially for having given him the form of a human being, and he wished to go to hell that he might not be disgraced by an association with the deity. he had an uniform and implacable aversion to the officers and servants of the hospital; he said he courted their hatred for their curse was a blessing. he seldom answered a question but some impiety was contained in the reply. an indifferent person remarking that it was a bad day, he immediately retorted, "sir, did you ever know god make a good one?" although the whole of the day, and the greatest part of the night, were consumed in pouring forth abuse and coining new blasphemies; yet there were some few patients for whom he professed a friendship, and with whom he conversed in a mild and civil way: this confidence had been obtained by the compliments they had addressed to him on the score of his understanding, of which he entertained a very high opinion. at one time he conceived himself to be the messiah, at another, that he was mr. adam, the architect; and that he was shortly to go to america in order to build the new jerusalem in philadelphia. about six months before his death he complained of pain in his stomach, and said he felt as if he had no intestines. his appetite diminished, and he became melancholic. the scene now began to alter; he had a presentiment that his time in this world would be short, and he dreaded the change: no hope arose, no consolation could cheer him; he became daily more emaciated and despairing until he died, which took place august , ; he appeared to be about seventy years of age. on opening the head, the pericranium was scarcely adherent. this membrane being removed, blood oozed freely from the parietal bones. there was a large accumulation of water between the dura mater and tunica arachnoidea; when this was let out the dura mater became flaccid, and seemed to hang loose on the brain. on the left posterior lobe of the cerebrum there was a large quantity of a milky fluid, between the tunica arachnoidea and pia mater, giving the appearance of a vesication; and in that place there was a depression or cavity formed in the convolutions of the brain. the convolutions were so strongly and distinctly marked, that they resembled the intestines of a child. the lateral ventricles were but little distended, and did not contain much water. the head was not particularly loaded with blood, nor were the bloody points, in the medullary substance, very abundant. the brain was of a natural consistence. there was no disease in the stomach, intestines, or liver. the body was opened about six hours after his death. case xxxvi. b. s. a man, generally noticed by those who have visited bethlem hospital a few years ago. it was said, that an attachment to a young woman, who slighted his addresses, was the cause of his becoming insane. he was considered a very dangerous lunatic, and for many years was confined to his cell. in this situation he employed himself in the manufacture of straw baskets and table mats. the desire of money was the leading feature of his mind, and the whole of his energies were devoted to its acquisition; nor was he at all scrupulous as to the means, by which he attained his object. although repeatedly assured that he would never be liberated, he disbelieved such information, and was persuaded, when he had acquired a sum sufficient to purchase a horse and cart, filled with higler's ware, that he should be released. the idea of becoming a trader, on so large a scale, stimulated him to constant occupation. he employed several lunatic journeymen to plat the straw for him, but they were poorly rewarded. he generally chose for his workmen such as were chained, and could not come personally to insist on the reward of their labour. he commonly pretended that the platting was badly performed, and consequently unsaleable; sometimes he would protest that he had settled with them, but that they were too mad to recollect it; and if at any time he did pay them, it was in bad coin. for many years he was unrivalled in this trade, and, by every species of fraud, had amassed nearly sufficient to set his plans afloat: when an unfortunate event took place, which considerably reduced his capital. he had always a propensity to game, which, from his skill and dexterity in cheating, was generally attended with success; but in this science he was once over-matched. an insane soldier, an ingenious man, became his intimate friend, and finding him possessed of some money proposed a game at cards. the result was deeply disastrous to the artificer in straw, who endeavoured to evade the payment; but his friend stated it to be a debt of honor; and besides he was a very powerful man, of a stern aspect, and not to be trifled with; he was therefore compelled to tell down at once the slow accumulation of several years. it was intended to make the soldier restore the property, but he, conceiving that he had already derived sufficient benefit from the hospital, went away in the night, without the formalities of a regular discharge. to fill up the measure of his misfortunes, when hatfield, the maniac who shot at his majesty in the theatre, was brought to bethlem, he, in conjunction with a contriving cobbler, established a rival manufactory, which shortly eclipsed the fabric of the old school, and by superior taste rendered his further exertions unnecessary. it is natural to suppose, that no great cordiality could exist between persons, where the prosperity of one had been established on the ruin of the other. frequent altercations arose, and much offensive language was exchanged. at length the patience of the original dealer was exhausted, and, in collecting his force to give his opponent a blow, he fell down and instantly expired.--he was about fifty-eight years of age. some of his habits and opinions were extremely singular; he believed that all occurrences were regulated by witches: prosperity was to be attributed to the good witches having obtained the mastery; and when bad witches gained the ascendancy, misfortunes arose. when the latter were at work he supposed himself in possession of a power to frighten and disperse them, and this was effected by a peculiar noise he made. it is probable he might have laboured under indigestion, for immediately after he had eaten his dinner, he sent forth a dreadful howl, which he continued for about ten minutes: but his great terror was a thunder storm; when this occurred, he took a very active part, and brought the whole force of his lungs to bear upon the enemy. a cat was supposed to have a natural antipathy to bad witches, she could smell them at a distance; for which reason he always domesticated an animal of that kind to sleep in his cell. when his head was opened, the dura mater was very easily separable from the scull; upon puncturing this membrane a considerable quantity of blood flowed from the opening; and there was a copious extravasation of this fluid between the membranes of the brain: but the most remarkable circumstance was, that the tunica arachnoidea was so thickened, that it exceeded the dura mater on an accurate comparison. the pia mater was loaded with blood, and its vessels were enlarged. the brain and its cavities were sound and natural. case xxxvii. r. b. this man had been many years an incurable patient, and it was supposed that jealousy of his wife had been the cause of his madness, although it appeared from very respectable testimony that he had no real grounds for such suspicion. during eight years, (the period he was subject to my observation,) he was mostly in a very furious state, and obliged to be strictly confined. his mischeivous disposition was manifested on every occasion; he would hurl the bowl, in which his food was served, against those who passed his cell; and when his hands were secured he would kick, bite, or throw his head into the stomachs of those who came near him. he entertained a constant aversion to his keeper, whom he suspected to be connected with his wife. his life was miserably divided between furious paroxysms and melancholic languor, and there was great uncertainty in the duration of these states. he has been known to continue ten months in the highest degree of violence, and relapse into the same state after a few days passed in tranquil depression. there was one circumstance which never failed to produce a relapse, however quietly he might have conducted himself, this was a visit from any of his family, and a very striking instance occurred. from may, , to september, , he had every appearance of being perfectly recovered: he was, in consequence, allowed additional comforts, and treated as a convalescent. at this time he was visited by his son, who, after many hours conversation with him, was persuaded that he had perfectly recovered his intellects; and he expressed himself astonished at his father's accurate recollection of particulars which might be supposed to have been obliterated from his mind. this dutiful visit and affectionate intercourse produced unpleasant consequences. the numerous enquiries which the patient had made, furnished him with materials for reflexion. on the departure of his son he began to detect mismanagement in his affairs, and improprieties in the conduct of his family: he was very talkative, and became impatient to return home. the following day he had a wildness in his eyes, spoke fast, and appeared busy: before the evening he was so irritable and disobedient that it became necessary to confine him. from this time he continued in the most furious condition, singing and vociferating the greatest part of the night, until january d, , when he became suddenly calm, complained of extreme debility, and said he should die in a few hours. he gave very proper answers to the questions which were asked him, but complained of the fatigue which talking induced. on the next morning he expired. he was sixty-eight years of age. the head was opened two days after his death. the tunica arachnoidea was in many places opake, and considerably thickened. there was a small quantity of limpid water between this membrane and the pia mater. when the medullary substance was cut into, there oozed from many points a quantity of dark blood, indeed the whole head was loaded with venous blood. the lateral ventricles were considerably enlarged and filled with water--four ounces were collected. the internal carotid arteries were much enlarged, and when divided, did not collapse, but remained open, as arteries in the other parts of the body. the consistence of the brain was doughy. chap. iv. cases of insane children. in the month of march, , a female child, three years and a quarter old, was brought to the hospital for medical advice. she was in good bodily health, and born of sane and undiseased parents. the mother, who attended, stated that her husband's parents and her own had never been in the slightest degree afflicted with mania, but that she had a brother who was born an ideot. she related that her child, until the age of two years and a half, was perfectly well, of ordinary vivacity, and of promising talents; when she was inoculated for the small pox. severe convulsions ushered in the disease, and a delirium continued during its course. the eruption was of the mild kind, and the child was not marked with the pustules. from the termination of the small-pox to the above date, (nine months) the child continued in an insane state. previously to the small-pox, she could articulate many words, and use them correctly for the things they signified: but since that time she completely forgot her former acquisitions, nor ever attempted to imitate a significant sound. whatever she wished to perform, she effected with promptitude and facility. she appeared anxious to possess every thing she saw, and cried if she experienced any disappointment; and on these occasions she would bite, or express her anger by kicking or striking. her appetite was voracious, and she would devour any thing that was given to her, without discrimination; as fat, raw animal food, or tainted meat. to rake out the fire with her fingers was a favourite amusement, nor was she deterred from having frequently burned them. she passed her urine and fæces in any place without restraint; but she could retain a considerable quantity of the former before she discharged it. some cathartic remedies were ordered for her, with an emetic occasionally, and she was brought to the hospital every fortnight, but she did not appear in any degree amended. on june she was admitted a patient, and continued in the hospital until the middle of october, when she was attacked with an eruptive fever, and consequently discharged. during this time little progress was made, although considerable pains were bestowed. she became more cunning, and her taste appeared improved. the cathartic medicine, which she drank at first without reluctance, became afterwards highly disgusting, and when she saw the basket which contained it, she endeavoured to escape and hide herself. to particular persons she was friendly, and felt an aversion to others. she was sensible of the authority of the nurse who attended her, and understood by the tone of her voice whether she were pleased or offended. the names of some things she appeared to comprehend, although they were extremely few; when the words, dinner, cakes, orange, and some more were mentioned, she smiled, and appeared in expectation of receiving them. by great attention and perseverance on the part of the nurse, she was brought to evacuate her fæces and urine in a night stool. after the elapse of three years i was informed that the child had made no intellectual progress. w. h. a boy, nearly seven years of age, was admitted into the hospital, june th, . his mother, who frequently visited him, related the following particulars respecting his case.--she said that, within a month of being delivered of this child, she was frightened by a man in the street, who rudely put his hand on her abdomen. when the child was born it was subject to startings, and became convulsed on any slight indisposition. when a year old, he suffered much with the measles: and afterwards had a mild kind of inoculated small-pox. at this age she thought the child more lively than usual, and that he slept less than her other children had done. at two years, the mother perceived he could not be controled, and therefore frequently corrected him. there was a tardiness in the developement of his physical powers. he was fifteen months old before he had a tooth, and unable to go alone at two years and a half: his mind was equally slow; he had arrived at his fourth year before he began to speak; and, when in his fifth, he had not made a greater proficiency in language than generally may be observed in children between two and three years. when admitted into the hospital, he wept at being separated from his mother, but his grief was of very short continuance. he was placed on the female side, and seemed highly delighted with the novelty of the scene: every object excited his curiosity, but he did not pause or dwell on any. he was constantly in action, and rapidly examined the different apartments of the building. to the patients in general he behaved with great insolence--he kicked and spat at them, and distorted his face in derision; but, on the appearance of the nurse, he immediately desisted, and assured her he was a very good boy. great, but ineffectual, pains were taken, to make him understand the nature of truth,--he could never be brought to confess any mischief he had committed, and always took refuge in the convenient shelter of a lie. in a short time he acquired a striking talent for mimickry, and imitated many of the patients in their insane manners; he generally selected, for his models, those who were confined, as he could practise from such with impunity. in about three months he had added considerably to his stock of language, but, unluckily, he had selected his expressions from those patients who were addicted to swearing and obscene conversation. to teach him the letters of the alphabet had many times been endeavoured, but always without success; the attempt uniformly disgusted him: he was not to be stimulated by coaxing or coercion; his mind was too excursive, to submit to the painful toil of recording elementary sounds; but it may rather be inferred that he did not possess a sufficient power of attention to become acquainted with arbitrary characters. he was in good health, his pulse and bowels were regular, and his appetite was keen, but not voracious. one circumstance struck me, as very peculiar, in this boy,--he appeared to have very incorrect ideas of distance: he would frequently stretch out his hand, to grasp objects considerably beyond his reach, but this referred principally to height: he would endeavour to pluck out a nail from the ceiling, or snatch at the moon. in october he became unwell, and, at the mother's request, was discharged from the hospital. in september , i again saw the boy: he was then thirteen years of age, had grown very tall, and appeared to be in good health. he recollected me immediately, and mentioned the words, school moorfields, nasty physic. on meeting with some of the female patients, he perfectly remembered them, and seemed for the moment, much pleased at the renewal of the acquaintance. by this time, he had made comparatively, a great progress in language; he knew the names of ordinary things, and was able to tell correctly the street in which he resided, and the number of his house. his mother informed me that he was particularly fond of going to church, although he was unable to comprehend the purpose for which he went: when there, he conducted himself with great order and decorum, but was disposed to remain after the congregation had dispersed. to shew how little he understood, why he frequented a place of worship: his mother once took him to church on sacrament-sunday, and fearful of disturbing the persons assembled, by compelling him to return home, allowed him to be a spectator of those solemn administrations. the only reflexion he made on the subject, but in disjointed expressions, was, that he thought it extremely hard, that the ladies and gentlemen should eat rolls and drink gin, and never ask him to partake. in his person he was clean, and dressed himself with neatness. having been taught when in the hospital to use a bowl for his necessary occasions, he obstinately continued the same practice when he returned home, and could never be persuaded to retire to the closet of convenience; but the business did not terminate here, when he had evacuated his intestines into the bowl he never failed to paint the room with its contents. to watch other boys when they were playing, or to observe the progress of mischief, gave him great satisfaction: but he never joined them, nor did he ever become attached to any one of them. of his mother he appeared excessively fond, and he was constantly caressing her: but in his paroxysms of fury he felt neither awe nor tenderness, and on two occasions he threw a knife at her. although equally ignorant of letters, as when discharged from the hospital, he took great delight in having gilt books; indeed every thing splendid attracted his attention, but more especially soldiers and martial music. he retained several tunes, and was able to whistle them very correctly. the day on which i last saw him his mind was completely occupied with soldiers; when questions were put to him, if he answered them it was little to the purpose, generally he did not notice them, but turned round to his mother and enquired about the soldiers. the defect of this lad's mind, appeared to be a want of continued attention to things, in order to become acquainted with their nature; and he possessed less curiosity than other children, which serves to excite such attention: and this will in some degree explain, why he had never acquired any knowledge of things in a connected manner. his sentences were short, and he employed no particles to join them together. although he was acquainted with the names of many things, and also with expressions which characterize passion, he applied them in an insulated way. for instance, if a shower fell, he would look up and say, "rains;" or when fine, "sun shines." when in the street he would pull his mother, to arrest her attention, and point to objects, as a fine horse, or a big dog; when he returned home he would repeat what had attracted his notice, but always speaking of himself in the third person. "billy see fine horse, big dog, &c."[ ] of circumstances boldly impressed, or reiterated by habit, his memory was retentive, but as his attention was only roused by striking appearances, or loud intonations, ordinary occurrences passed by unobserved. in the month of july , my opinion was requested respecting a young gentleman, ten years of age, who was sent here, accompanied by a kind and decent young man, to take care of him. previously to his arrival i had corresponded respecting his case with a very learned and respectable physician in the country, under whose care the boy had been placed. from the information furnished by this gentleman, and that which was collected from the keeper, i believe the former history of his case is correctly given. the parents are persons of sound mind, and they do not remember any branches of their respective families to have been (in any manner) disordered in their intellects. the subject of the present relation was their eldest son; the second child was of a disposition remarkably mild; and the youngest, a boy, about two years and a half, was distinguished by the irritability and impatience of his temper. at the age of two years, the subject of the present relation, became so mischievous and uncontroulable, that he was sent from home to be nursed by his aunt. in this situation, at the request of his parents, and with the concurrence of his relation, he was indulged in every wish, and never corrected for any perverseness or impropriety of conduct. thus he continued until he was nearly nine years old, the creature of volition and the terror of the family. at the suggestion of the physician, whom i have before mentioned, and who was the friend of his parents: a person was appointed to watch over him. it being the opinion of the doctor that the case originated in over indulgence and perverseness; a different system of management was adopted. the superintendant was ordered to correct him for each individual impropriety. at this time the boy would neither dress nor undress himself, though capable of doing both; when his hands were at liberty, he tore his clothes: he broke every thing that was presented to him, or which came within his reach, and frequently refused to take food. he gave answers only to such questions as pleased him, and acted in opposition to every direction. the superintendant exercised this plan for several months, but perhaps not to the extent laid down; for it may be presumed, that after a a few flagellations his humanity prevailed over the medical hypothesis. when he became the subject of my own observation, he was of a very healthy appearance, and his head was well formed; this was also the opinion of several gentlemen, distinguished for their anatomical knowledge, to whom the boy was presented. his tongue was unusually thick, though his articulation was perfectly distinct. his countenance was decidedly maniacal.[ ] his stature, for his age, was short, but he was well compacted, and possessed great bodily strength. although his skin was smooth and clear, it was deficient in its usual sensibility; he bore the whip and the cane with less evidence of pain than other boys. another circumstance convinced me of this fact. during the time he resided in london he was troubled with a boil on his leg; various irritating applications were made to the tumor, and the dressings were purposely taken off with less nicety than usual, yet he never complained. his pulse was natural, and his bowels were regular. his appetite was good, but not inordinate, and he bore the privation of food for a considerable time without uneasiness. although he slept soundly, he often awoke as if suddenly alarmed, and he seemed to require a considerable duration of sleep. he had a very retentive memory, and had made as great proficiency in speech as the generality of boys of his own age. few circumstances appeared to give him pleasure, but he would describe very correctly any thing which had delighted him. as he wanted the power of continued attention, and was only attracted by fits and starts, it may be naturally supposed he was not taught letters, and still less that he would copy them. he had been several times to school, and was the hopeless pupil of many masters, distinguished for their patience and rigid discipline; it may therefore be concluded, that from these gentlemen, he had derived all the benefits which could result from privations to his stomach, and from the application of the rod to the more delicate parts of his skin. on the first interview i had with him, he contrived, after two or three minutes acquaintance, to break a window and tear the frill of my shirt. he was an unrelenting foe to all china, glass, and crockery ware, whenever they came within his reach he shivered them instantly. in walking the street, the keeper was compelled to take the wall, as he uniformly broke the windows if he could get near them, and this operation he performed so dextrously, and with such safety to himself, that he never cut his fingers. to tear lace and destroy the finer textures of female ornament, seemed to gratify him exceedingly, and he seldom walked out without finding an occasion of indulging this propensity. he never became attached to any inferior animal, a benevolence so common to the generality of children: to these creatures his conduct was that of the brute: he oppressed the feeble, and avoided the society of those more powerful than himself. considerable practice had taught him that he was the cat's master, and whenever this luckless animal approached him he plucked out its whiskers with wonderful rapidity; to use his own language, "_i must have her beard off_." after this operation, he commonly threw the creature on the fire, or through the window. if a little dog came near him he kicked it, if a large one he would not notice it. when he was spoken to, he usually said, "i do not choose to answer." when he perceived any one who appeared to observe him attentively, he always said, "now i will look unpleasant." the usual games of children afforded him no amusement; whenever boys were at play he never joined them: indeed, the most singular part of his character was, that he appeared incapable of forming a friendship with any one: he felt no considerations for sex, and would as readily kick or bite a girl as a boy. of any kindness shewn him, he was equally insensible; he would receive an orange as a present, and afterwards throw it in the face of the donor. to the man who looked after him, he appeared to entertain something like an attachment: when this person went out of the room, and pretended that he would go away, he raised a loud outcry, and said, "what will become of me, if he goes away; i like him, for he carries the cane which makes me a good boy:" but it is much to be doubted, whether he really bore an affection for his keeper; the man seemed to be of a different opinion, and said, when he grew older he should be afraid to continue with him, as he was persuaded the boy would destroy him, whenever he found the means and opportunity. of his own disorder he was sometimes sensible: he would often express a wish to die, for he said, "god had not made him like other children;" and when provoked, he would threaten to destroy himself. during the time he remained here, i conducted him through the hospital, and pointed out to him several patients who were chained in their cells; he discovered no fear or alarm; and when i shewed him a mischievous maniac who was more strictly confined than the rest, he said, with great exultation, "this would be the right place for me." considering the duration of his insanity, and being ignorant of any means by which he was likely to recover, he returned to his friends, after continuing a few weeks in london. chap. v. causes of insanity. when patients are admitted into bethlem hospital, an enquiry is always made of the friends who accompany them, respecting the cause supposed to have occasioned their insanity. it will be readily conceived, that there must be great uncertainty attending the information we are able to procure upon this head: and even from the most accurate accounts, it would be difficult to pronounce, that the circumstances which are related to us, have actually produced the effect. the friends and relatives of patients are, upon many occasions, very delicate concerning this point, and cautious of exposing their frailties or immoral habits: and when the disease is connected with the family, they are oftentimes still more reserved in disclosing the truth. fully aware of the incorrect statement, frequently made concerning these causes, i have been at no inconsiderable pains to correct or confirm the first information, by subsequent enquiries. the causes which i have been enabled most certainly to ascertain, may be divided into physical and moral.[ ] under the first, are comprehended repeated intoxication: blows received upon the head; fever, particularly when attended with delirium; mercury, largely and injudiciously administered; cutaneous eruptions repelled, and the suppression of periodical or occasional discharges and secretions; hereditary disposition, and paralytic affections. by the second class of causes, which have been termed _moral_, are meant those which are supposed to originate in the mind, or which are more immediately applied to it. such are, the long endurance of grief; ardent and ungratified desires; religious terror; the disappointment of pride; sudden fright; fits of anger; prosperity humbled by misfortunes:[ ] in short, the frequent and uncurbed indulgence of any passion or emotion, and any sudden or violent affection of the mind. there are, doubtless, many other causes of both classes, which may tend to produce this disease. those which have been stated, are such as i am most familiar with; or, to speak more accurately, such are the circumstances most generally found to have preceded this affection. it is an old opinion, and continues still to prevail, that maniacs are influenced by the changes of the moon. in the fourth chapter of st. matthew's gospel, verse , we find the word "[greek: selêniaxomenous]" which is rendered in the english version, "those which were lunatic." notwithstanding the notion of being moon-struck might prevail among the ignorant people of galilee, yet hippocrates, a philosopher, and correct observer of natural phænomena, does not appear to have placed any faith in this planetary influence. although the romans were infected with this popular tradition, as may be seen in the following passage of the art of poetry, "ut mala quem scabies aut morbus regius urget, aut fanaticus error, et iracunda diana vesanum tetigisse timent fugiuntque poetam, qui sapiunt:"-- yet celsus did not consider the operation of the moon on the human intellect sufficiently well founded to admit it into his medical work. not a word on this subject is mentioned in the eighteenth chapter of his third book, which particularly treats of insanity, "_de tribus insaniæ generibus_;" it is true that, in the fourth chapter of the first book, which speaks "_de his quibus caput infirmum est_," he says "cui caput infirmum est, is si bene concoxit, leniter perfricare id mane manibus suis debet; nunquam id, si fieri potest, veste velare; aut ad cutem tondere: utileque lunam vitare, maximeque ante ipsum lunæ solisque concursum." by the _infirmum caput_, celsus does not mean madness, as may be clearly seen by perusing the chapter: the weakness of intellect, which frequently continues after fever, or other violent diseases, is evidently his meaning; but dr. cox has quoted the above passage, to prove that celsus was impressed with the truth of this vulgar opinion. he says, "this idea of lunar influence, in _maniacal complaints_, was handed down to us by our medical forefathers, and is still very generally adopted." it is most probable that this idea of planetary regency, however it might have arisen, or to whatever extent it may have been credited, received in the arabian school, the stamp by which its currency has been subsequently maintained. for the revival and dispersion of ancient medical knowledge, we are confessedly under considerable obligations to the arabians;[ ] and more especially for the incorporation of astrology, magic and alchymy, with medicine. popular superstitions and national proverbs, are seldom without some foundation; and with respect to the present, it may be observed, that if it were not in some degree rooted in fact, and trained up by observation, it would become difficult to ascertain how such an opinion came to be adopted; and this investigation is rendered still more important from the consideration, that the existing law in this country, respecting insane persons, has been established on the supposed prevalence of this lunar regulation. a commission is issued, de _lunatico_ inquirendo, and the commissioners sitting for that purpose, are particular in their enquiries, whether the patient enjoys lucid intervals. the term _lucid interval_ has been properly connected with the word _lunacy_; for, if the patient, as they supposed, became insane at particular changes of the moon, the inference was natural, that in the intervening spaces of time he would become rational. it is more than probable, that the origin of this supposition of the lunar influence may be traced to the following circumstances. the period of the return of the moon, and of regular menstruation in women, is four weeks; and the terms which designate them, have been imposed from the period of time in which both are compleated. insanity and epilepsy are often connected with menstruation, and suffer an exacerbation of their paroxysms at the period when this discharge happens, or ought to take place. if, therefore, the period of menstruation in an insane woman should occur at the full of the moon, and her mind should then be more violently disturbed, the recurrence of the same state may be naturally expected at the next full moon. this is a necessary coincidence, and should be discriminated from effect. but such has been the prevalence of this opinion, that when patients have been brought to bethlem hospital, especially those from the country, their friends have generally stated them to be worse at some particular change of the moon, and of the necessity they were under, at those times, to have recourse to a severer coercion. indeed, i have understood from some of these _lunatics_, who have recovered, that the overseer or master of the work-house himself has frequently been so much under the dominion of this planet, and keeping steadily in mind the old maxim, _venienti occurrite morbo_, that, without waiting for any display of increased turbulence on the part of the patient, he has bound, chained, flogged, and deprived these miserable people of food, according as he discovered the moon's age by the almanack. to ascertain how far this opinion was founded in fact, i kept, during more than two years, an exact register, but without finding, in any instance, that the aberrations of the human intellect corresponded with, or were influenced by, the vicissitudes of this luminary. as insane persons, especially those in a furious state, are but little disposed to sleep, even under the most favourable circumstances, they will be still less so, when the moon shines brightly into their apartments. it has also been considered, that intellectual labour frequently becomes a cause of insanity; that those, who are in the habit of exercising the faculty of thought, for the perfection and preservation of the reason of others, are thereby in danger of losing their own. we hear much of this, from those who have copiously treated of this disease, without the toil of practical remark; whose heads become bewildered by the gentlest exercise, and to whom the recreation of thinking becomes the exciting cause of stupidity or delirium. these persons enumerate, among the exciting causes of delirium, "too great, or too long continued exertion of the mental faculties, as in the delirium which often succeeds long continued and abstract calculation; and the deliria to which men of genius are peculiarly subject." the mind of every man is capable of a definite quantity of exertion to good effect; all endeavours, beyond that point, are impotent and perplexing. the attention is capable of being fixed to a certain extent, and, when that begins to deviate, all continuance is time lost. it is certain that, by habit, this power may be much increased; and, by frequent exercise, that, which at first excited fatigue, may be continued with facility and pleasure. what species of delirium is that, which succeeds long continued and abstract calculation? newton lived to the age of years, leibnitz to , and euler to a more advanced period, yet their several biographers have neglected to inform us, that their studies were checquered with delirious fermentations. the mathematicians of the present day (and there are many of distinguished eminence) would conceive it no compliment to suppose that they retired from their labours with addled brains, and that writers of books on insanity should impute to them miseries which they never experienced. it is curious to remark, in looking over a biographical chart, that mathematicians and natural philosophers have in general attained a considerable age; so that long continued and abstract calculation, or correct thinking upon any subject does not appear, with all these delirious visitations, to shorten the duration of human life. what is meant by the deliria, to which men of genius are peculiarly subject, i am unable, from a want of sufficient genius and delirium, to comprehend. it is well understood, that a want of rational employment is a very successful mode of courting delirium; that an indulgence in those reveries which keep the imagination on the wing, and imprison the understanding, is likely to promote it: and it must be owned, that the same effect has often been produced, where vanity or ambition has urged minds, puny by nature, and undrilled in intellectual exercises, to attempt to grasp that which they were unable to embrace. this may be illustrated by the following case. a young gentleman of slender capacity, and very moderate education, at the age of nineteen, was placed in a merchant's counting house, where he continued for two years diligently, though slowly, to perform the duties of the office. coming at this time into the possession of considerable property, and perhaps, aware of the uncultivated state of his own mind, he very laudably determined to improve it. he frequented the society of persons esteemed learned and eminent in their different professions, and became much delighted with their conversation; but at the same time sensible that he was unable to contribute to the discourse. he resolved to become a severe student, and for this purpose purchased an immense quantity of books on most subjects of literature and science. history commenced the career of his enquiries: rollin, gibbon, hume and robertson were anxiously and rapidly perused; but he never paused to consider, or to connect dates and circumstances, so that these excellent authors, after he had waded through them, left scarcely an impression on his mind. chemistry next engaged his attention, and on this subject, he pored over many volumes with little advantage: the terms proved a source of embarrassment, and he made no experiments. in a hasty succession, the ancient languages, antiquities, etymology, agriculture, and moral philosophy, occupied his mind. about eight hours were daily devoted to reading. somewhat more than two years were consumed in this employment, which had distracted his mind, without conferring any positive knowledge. his friends and acquaintances now began to perceive a considerable alteration in his temper; though naturally diffident, he had assumed a high degree of literary importance, and plumed himself on the extent of his learning. before this excessive, but ill-directed application, he was a strict relator of the truth, but he now found a convenience in supplying by fancy, that, which the indigence of his memory was unable to afford. shortly he began to complain that he could not sleep, and that the long night was passed in shifting from side to side. "lasso, ch'n van te chiamo, et queste oscure, et gelide ombre in van lusingo: o piume d'asprezza colme: o notti acerbe, et dure." _gio: della casa._ fever succeeded, accompanied with delirium in the evening. by quietness, and the ordinary remedies, these symptoms were removed; but he was left in a state of extreme weakness. as he recovered from this, his habits became materially altered: he would continue to lie in bed for several days, after which, he would suddenly rise and walk a number of miles. personal cleanliness, and dress were entirely neglected: sometimes he would fast for two or three days, and then eat voraciously. afterwards he became suspicious that poison had been mixed with his food. it was found necessary to confine him, from having attempted to castrate himself: this he afterwards effected in a very complete manner, and continues a maniac to the present time. few persons, i believe, will be disposed to consider the above case, as an instance of insanity succeeding to a laborious exercise of the intellectual faculties. it is true, he was busied with books: but this occupation could not have strained his mind, for he appears neither to have comprehended, nor retained any of the objects of his pursuit. _hereditary disposition._ "ut male posuimus initia sic cetera sequuntur."--_cicero._ "whatever was in the womb imperfect, as to her proper work, comes very rarely, or never at all, to perfection afterwards."--_harrington's works, p. ._ considerable diversity of opinion has prevailed, whether insanity be hereditary or not; and much has been said on both sides of this question. great ingenuity has been exerted to prove that this disease is accidental, or that there are sufficient causes to account for its occurrence, without supposing it one of those calamities that "_flesh is heir to_." it has been argued, that, if the disease were hereditary, it ought uniformly to be so, and that the offspring of a mad parent should necessarily become insane. all theories and reasonings appear to be good for as much as they prove; and if the term _hereditary_ be employed with a degree of strictness, so as to denote certain and infallible transmission, such inevitable descent cannot be defended. several instances have come under my observation where the children of an insane parent have not hitherto been affected with madness, and some have died early in life, without having experienced any derangement of mind. more time is therefore required. all observations concur in acknowledging that there are many circumstances in which children resemble their parents. it is very common to see them resemble one of their parents in countenance, and when there are several children, some shall bear the likeness of the father and others of the mother. children often possess the make and fashion of the body, peculiar to one or other of their parents, together with their gait and voice; but that which has surprized me most is the resemblance of the hand-writing. if a parent had taught his son to write, it might be expected that a considerable similarity would be detected; but in general the fact appears to be otherwise, for it seldom happens that the scholars, though constantly imitating the copy of the master, write at all like him, or like each other. in a few instances i have noticed a correct resemblance between the hand-writing of the father and son, where the former died before the latter had been taught the use of the pen, and who probably never saw the hand-writing of his father. the transmission of personal deformities is equally curious. i am acquainted with a person in this town, whose middle and ring finger are united, and act as one; all the children of this man carry the same defect. a toenail, particularly twisted, has been traced through three generations, on the same foot and toe. abundant instances might be adduced on this subject; there is scarcely a family which cannot produce something in confirmation; and if to these circumstances in the human species, were to be added the experiments which have been made on the breeding of cattle, perhaps little doubt would remain. the reasoners against the transmission of madness urge, that, if the contrary were true, we should by this time have detected the rule or law by which nature acts, and that we should have been able to determine,--first, whether the disorder descended to the male or female children accordingly as the father or mother was affected.--secondly, which of the parents is most capable of transmitting the disease?--thirdly, what alternations in the succession take place, does it shift from the male to the female line, and, does it miss a generation, and afterwards return? these, and a multitude of other queries, might be proposed; i believe much faster than they could be answered. nature appears to delight in producing new varieties, perhaps less in man than in other animals, and still less in the animal than in the vegetable kingdom. before these subtile reasoners expect, from those who maintain that madness generally descends from the parent to the offspring, a developement of the laws by which nature acts, it would be convenient first to settle whether in this matter she be under the dominion of any law whatever. the investigation of the hereditary tendency of madness is an object of the utmost importance, both in a legal and moral point of view. parents and guardians, in the disposal, or direction of the choice of their children in marriage, should be informed, that an alliance with a family, where insanity has prevailed, ought to be prohibited. having directed some attention to enquiries of this nature, i am enabled truly to state, that, where one of the parents have been insane, it is more than probable that the offsprings will be similarly affected. madness has many colours, and colours have many hues; actual madness is a severe calamity, yet experience has pointed out the treatment, and the law has permitted the imposition of the necessary restraint: but it very frequently occurs that the descendants from an insane stock, although they do not exhibit the broad features of madness, shall yet discover propensities, equally disqualifying for the purposes of life, and destructive of social happiness. the slighter shades of this disease include eccentricity, low spirits, and oftentimes a fatal tendency to immoral habits, notwithstanding the inculcation of the most correct precepts, and the force of virtuous example. in illustration of the fact, that the offsprings of insane persons are, _ceteris paribus_, more liable to be affected with madness than those whose parents have been of sound minds; it was my intention to have constructed a table, whereon might be seen the probably direct course of this disease, and also its collateral bearings: but difficulties have arisen. it appeared, on consideration, improper to attempt precision with that which was variable, and as yet unsettled; i have therefore been content to select a few histories from my book of notes, and to exhibit them in the rude state in which they were set down. _ st._--r. g. his grandfather was mad, but there was no insanity in his grandmother's family. his father was occasionally melancholic, and once had a raving paroxysm. his mother's family was sane. his father's brother died insane. r. g. has a brother and five sisters; his brother has been confined in st. luke's, and is occasionally in a low spirited state. all his sisters have been insane; with the three youngest the disease came on after delivery. _ d._--m. m. her grandmother was insane and destroyed herself. her father was mad for many years, but after the birth of all his children. m. m. has two brothers and a sister; both her brothers have been insane; the sister has never been so affected, but was a person of loose character. the insanity of m. m. was connected with her menstruation; after its cessation she recovered, although she had been confined more than sixteen years. _ d._--m. h. her father had been several times insane; her mother was likewise so affected a few months before her death. afterwards her father married a woman perfectly sane, by whom he had three children, two female and a male; both the females are melancholic, the male was a vicious character, and has been transported. m. h. has had ten children, three have died with convulsions, the eldest, a girl, is epileptic. _ th._--t. b. his mother became insane soon after being delivered of him, and at intervals has continued so ever since. he has a brother who became furiously mad at the age of twenty, and afterwards recovered. t. b.'s disorder came on at the age of twenty-six. _ th._--s. f. her father's mother was insane, and confined in the hospital. her father never discovered any symptoms of insanity, and her mother was perfectly sane. her only sister (she had no brothers) was mad about five years ago, and recovered. s. f. has been twice in the hospital. _ th._--p. w. after the best enquiries it does not appear that her father or mother ever experienced any attack of madness or melancholy. p. w.'s disorder commenced shortly after the delivery of a child. she has three sisters, the eldest has never been married, and has hitherto continued of sound mind. the two younger have been mothers, and in both insanity has supervened on childbearing. _ th._--j. a. h. his father's father was insane, and his father was also disordered, and destroyed himself. his mother was of sound mind. j. a. h. became insane at the age of twenty-three. he has two sisters, the elder has once been confined for insanity, the younger is of weak intellects, nearly approaching to ideotism. _ th._--m. d. her mother was insane and died so. m. d. continued of sane mind until she had attained the age of fifty-seven, when she became furiously maniacal; her only daughter, eighteen years of age, was attacked with mania during the time her mother was confined. _ th._--g. f. his mother was melancholic during the time she was pregnant with him, and never afterwards completely recovered. she had five children previously to this melancholic attack, who have hitherto continued of sound mind. she bore another son after g. f. who is extremely flighty and unmanageable. g. f. was attacked with madness at the age of nineteen, and died apoplectic, from the violence and continued fury of his disorder. _ th._--m. t. her mother was of sound mind. her father was in a melancholic state for two years, before she was born, but this was afterwards dissipated by active employment. m. t. has two brothers, younger than herself, who have been attacked with insanity, neither of whom have recovered. she has two sisters, some years older than herself, these have never been deranged. m. t. has had nine children. the three first have been melancholic. the youngest, at the age of five years, used to imagine she saw persons in the room covered with blood, and other horrible objects, she afterwards became epileptic and died. the youngest of her three first children has been married and had three children, one of whom is afflicted with chorea sancti viti, and another is nearly an ideot. of the causes termed moral, the greatest number may, perhaps, be traced to the errors of education, which often plant in the youthful mind those seeds of madness which the slightest circumstances readily awaken into growth. it should be as much the object of the teachers of youth, to subjugate the passions, as to discipline the intellect. the tender mind should be prepared to expect the natural and certain effects of causes: its propensity to indulge an avaricious thirst for that which is unattainable, should be quenched: nor should it be suffered to acquire a fixed and invincible attachment to that which is fleeting and perishable. of the more immediate, or, as it is generally termed, the proximate cause of this disease, i profess to know nothing. whenever the functions of the brain shall be fully understood, and the use of its different parts ascertained, we may then be enabled to judge, how far disease, attacking any of these parts, may increase, diminish, or otherwise alter its functions. but this is a degree of knowledge, which we are not likely soon to attain. it seems, however, not improbable, that the only source, from whence the most copious and certain information can be drawn, is a strict attention to the particular appearances which morbid states of this organ may present. from the preceding dissections of insane persons, it may be inferred, that madness has always been connected with disease of the brain and of its membranes. having no particular theory to build up, they have been related purely for the advancement of science and of truth. it may be a matter, affording much diversity of opinion, whether these morbid appearances of the brain be the cause or the effect of madness: it may be observed that they have been found in all states of the disease. when the brain has been injured from external violence, its functions have been generally impaired, if inflammation of its substance, or more delicate membranes has ensued. the same appearances have for the most part been detected, when patients have died of phrenitis, or in the delirium of fever: in these instances, the derangement of the intellectual functions appears evidently to have been caused by the inflammation. if in mania the same appearances be found, there will be no necessity of calling in the aid of other causes, to account for the effect: indeed, it would be difficult to discover them. those who entertain an opposite opinion are obliged to suppose, _a disease of the mind_. such a morbid affection, from the limited nature of my powers, perhaps i have never been able to conceive. possessing, however, little knowledge of metaphysical controversy, i shall only offer a few remarks upon this part of the subject, and beg pardon for having at all touched it. perhaps it is not more difficult to suppose, that matter, peculiarly arranged, may _think_,[ ] than to conceive the union of an immaterial being with a corporeal substance. it is questioning the infinite wisdom and power of the deity to say, that he does not, or cannot, arrange matter so that it shall think. when we find insanity, as far as has been hitherto observed, uniformly accompanied with disease of the brain, is it not more just to conclude, that such organic affection has produced this incorrect association of ideas, than that a being, which is immaterial, incorruptible, and immortal, should be subject to the gross and subordinate changes which matter necessarily undergoes? but let us imagine _a disease of ideas_. in what manner are we to effect a cure? to this subtle spirit the doctor can apply no medicines. though so refined as to elude the force of material remedies, some may however think that it may be reasoned with. the good effects which have resulted from exhibiting logic as a remedy for madness, must be sufficiently known to every one who has conversed with insane persons, and must be considered as time very judiciously employed: speaking more gravely, it will readily be acknowledged, by persons acquainted with this disease, that, if insanity be a disease of ideas, we can possess no corporeal remedies for it: and that an endeavour to convince madmen of their errors, by reasoning, is folly in those who attempt it, since there is always in madness the firmest conviction of the truth of what is false, and which the clearest and most circumstantial evidence cannot remove. chap. vi. on the probable event of the disease. the prediction of the event, in cases of insanity, must be the result of accurate and extensive experience; and even then it will probably be a matter of very great uncertainty. the practitioner can only be led to suppose, that patients, of a particular description, will recover, from knowing that, under the same circumstances, a certain number have been actually restored to sanity of intellect. the practice of an individual, however active and industrious he may be, is insufficient to accumulate a stock of facts, necessary to form the ground of a regular and correct prognosis: it is therefore to be wished, that those, who exclusively confine themselves to this department of the profession, would occasionally communicate to the world the result of their observations. physicians, attending generally to diseases, have not been reserved, in imparting to the public the amount of their labours and success: but, with regard to this disorder, those, who have devoted their whole attention to its treatment, have either been negligent, or cautious of giving information respecting it. whenever the powers of the mind are concentrated to one object, we may naturally expect a more rapid progress in the attainment of knowledge: we have therefore only to lament the want of observations upon this subject, and endeavour to repair it. the records of bethlem hospital have afforded me some satisfactory information, though far from the whole of what i wished to obtain. from them, and my own observations, the prognosis of this disease is, with great diffidence, submitted to the reader. in our own climate, women are more frequently afflicted with insanity than men. several persons, who superintend private mad-houses, have assured me, that the number of females brought in annually, considerably exceeds that of the males. from the year to , comprizing a period of forty-six years, there have been admitted into bethlem hospital, women, and men. the natural processes, which women undergo, of menstruation, parturition, and of preparing nutriment for the infant, together with the diseases, to which they are subject at these periods, and which are frequently remote causes of insanity, may, perhaps, serve to explain their greater disposition to this malady. as to the proportion in which they recover, compared with males, it may be stated, that of women affected, were discharged cured; and that, of the men, recovered. it is proper here to mention, that, in general, we know but little of what becomes of those who are discharged; a certain number of those cured, occasionally relapse, and some of those, who are discharged uncured, afterwards recover: perhaps in the majority of instances where they relapse, they are sent back to bethlem. to give some idea of the number, so re-admitted, it may be mentioned, that, during the last two years,[ ] there have been admitted patients, of whom had at some former time been in the house. there are so many circumstances, which, supposing they did relapse, might prevent them from returning, that it can only be stated with certainty, that within twelve months, the time allowed as a trial of cure, so many have been discharged perfectly well. to shew how frequently insanity supervenes on parturition, it may be remarked, that from the year to inclusive, patients have been admitted, whose disorder shortly followed the puerperal state. women affected from this cause, recover in a larger proportion than patients of any other description of the same age. of these , have perfectly recovered. the first symptoms of the approach of this disease after delivery, are want of sleep; the countenance becomes flushed; a constrictive pain is often felt in the head; the eyes assume a morbid lustre, and wildly glance at objects in rapid succession; the milk is afterwards secreted in less quantity; and when the mind becomes more violently disordered, it is totally suppressed. where the disease is hereditary, parturition very frequently becomes an exciting cause. from whatever cause this disease may be produced in women, it is considered as very unfavourable to recovery, if they should be worse at the period of menstruation, or have their catamenia in very small or immoderate quantities. a few cases have occurred where the disease, being connected with menstruation, and having continued many years, has completely disappeared on the cessation of the uterine discharge. at the first attack of this disease, and for some months afterwards, during its continuance, females most commonly labour under amenorrhoea. the natural and healthy return of this discharge generally precedes convalescence. from the following statement it will be seen, that insane persons recover in proportion to their youth, and that as they advance in years, the disease is less frequently cured. it comprizes a period of about ten years, viz. from to . in the first column the age is noticed; in the second, the number of patients admitted; the third contains the number cured; the fourth, those who were discharged not cured. _number _number _number _age between_ admitted._ discharged discharged cured._ uncured._ and and and and and and ------- ------- ------- total total total ------- ------- ------- from this table it will be seen, that when the disease attacks persons advanced in life, the prospect of recovery is but small. i am led to conclude, from the very rare instances of complete cure, or durable amendment, among the class of patients deemed incurable, as well as from the infrequent recovery of those who have been admitted, after the disorder has been of more than twelve months standing, that the chance of cure is less, in proportion to the length of time which the disorder shall have continued. although patients, who have been affected with insanity more than a year, are not admissible into the hospital, to continue there for the usual time of trial for cure, namely, a twelvemonth, yet, at the discretion of the committee, they may be received into it, from lady-day to michaelmas, at which latter period they are removed. in the course of the last twenty years seventy-eight patients of this description have been received, of whom only one has been discharged cured: this patient, who was a woman, has since relapsed twice, and was ultimately sent from the hospital uncured. when the reader contrasts the preceding statement with the account recorded in the report of the committee, appointed to examine the physicians who have attended his majesty, &c. he will either be inclined to deplore the unskilfulness or mismanagement which has prevailed among those medical persons who have directed the treatment of mania in the largest public institution in this kingdom, of its kind, compared with the success which has attended the private practice of an individual; _or to require some other evidence, than the bare assertion of the man pretending to have performed such cures_.[ ] it was deposed by that reverend and celebrated physician, that of patients placed under his care, within three months after the attack of the disease, nine out of ten had recovered;[ ] and also that the age was of no signification, unless the patient had been afflicted before with the same malady.[ ] how little soever i might be disposed to doubt such a bold, unprecedented, and marvellous account, yet, i must acknowledge, that my mind would have been much more satisfied, as to the truth of that assertion, had it been plausibly made out, or had the circumstances been otherwise than feebly recollected by that very successful practitioner. medicine has generally been esteemed a progressive science, in which its professors have confessed themselves indebted to great preparatory study and long subsequent experience for the knowledge they have acquired; but, in the case to which we are now alluding, the outset of the doctor's practice was marked with such splendid success, that time and observation have been unable to increase it. this astonishing number of cures has been effected by the vigorous agency of remedies, which others have not hitherto been so fortunate as to discover; by remedies, which, when remote causes have been operating for twenty-seven years, such as weighty business, severe exercise, too great abstemiousness and little rest, are possessed of adequate power directly to _meet and counteract_ such causes.[ ] it will be seen by the preceding table, that a greater number of patients have been admitted, between the age of and , than during any other equal period of life. the same fact also obtains in france, as may be seen from the statement of dr. pinel, (_traité medico-philosophique sur la manie, p. _,) and which, from its agreement with that of bethlem hospital, is here introduced to the notice of the reader. +--------------------------------------------------------------+ |manical | | | |patients | age between | | |admitted into |-----------------------------------------|total| |the bicêtre, | & | & | & | & | & | & | | |in the years | | | | | | | | +--------------|------|------|------|------|------|------|-----| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | +--------------------------------------------------------------+ there may be some reasons assigned for the increased proportion of insane persons at this age. although i have made no exact calculation, yet from a great number of cases, it appears to be the time when the hereditary disposition is most frequently called into action; or, to speak more plainly, it is that stage of life, when persons, whose families have been insane, are most liable to become mad. if it can be made to appear, that at this period persons are more subject to be acted upon by the remote causes of the disease, or that a greater number of such causes are then applied, we may be able satisfactorily to explain it. at this age people are generally established in their different occupations, are married, and have families; their habits are more strongly formed, and the interruptions of them are consequently attended with greater anxiety and regret. under these circumstances, they feel the misfortunes of life more exquisitely. adversity does not depress the individual for himself alone, but as involving his partner and his offspring in wretchedness and ruin. in youth we feel desirous only of present good; at the middle age, we become more provident and anxious for the future; the mind assumes a serious character; and religion, as it is justly or improperly impressed, imparts comfort, or excites apprehension and terror. by misfortunes the habit of intoxication is readily formed. those who in their youth have shaken off calamity as a slight incumbrance, at the middle age feel it corrode and penetrate; and when fermented liquors have once dispelled the gloom of despondency, and taught the mind to provoke a temporary assemblage of cheerful scenes, or to despise the terror of impending misery, it is natural to recur to the same, though destructive cause, to re-produce the effect. patients, who are in a furious state, recover in a larger proportion than those who are depressed and melancholic. an hundred violent, and the same number of melancholic cases were selected: of the former, sixty-two were discharged well; of the latter, only twenty-seven: subsequent experience has confirmed this fact. the same investigation, on the same number of persons has been twice instituted, and with results little varying from the originally stated proportions. when the furious state is succeeded by melancholy, and after this shall have continued a short time, the violent paroxysm returns, the chance of recovery is very slight. indeed, whenever these states of the disease frequently change, such alteration may be considered as very unfavourable. after a raving paroxysm of considerable duration, it is a hopeful symptom, if the patient become dull, and in a stupid state; inclined to sleep much, and feeling a desire of quietude. this appears to be the natural effect of that exhaustion, and, if the language be allowable, of that expenditure of the sensorial energy, which the continued blaze of furious madness would necessarily consume. when they gradually recover from this state there is a prospect that the cure will be permanent. in forming a prognosis of this disease, it is highly important to establish a distinction between derangement and decline of intellect: the former may frequently be remedied; the latter admits of no assistance from our art. where insanity commences with a loss of mental faculty, and gradually proceeds with increasing imbecility, the case may be considered hopeless. when the disorder has been induced from remote physical causes, the proportion of those who recover is considerably greater, than where it has arisen from causes of a moral nature. in those instances where insanity has been produced by a train of unavoidable misfortunes, as where the father of a large family, with the most laborious exertions, ineffectually struggles to maintain it, the number who recover is very small indeed. paralytic affections are a much more frequent cause of insanity than has been commonly supposed, and they are also a very common effect of madness; more maniacs die of hemiplegia and apoplexy than from any other disease. in those affected from this cause, we are, on enquiry, enabled to trace a sudden affection, or fit, to have preceded the disease. these patients usually bear marks of such affection, independently of their insanity: the speech is impeded, and the mouth drawn aside; an arm, or leg, is more or less deprived of its capability of being moved by the will: and in most of them the memory is particularly impaired. persons thus disordered are in general not at all sensible of being so affected. when so feeble, as scarcely to be able to stand, they commonly say that they feel perfectly strong, and capable of great exertions. however pitiable these objects may be to the feeling spectator, yet it is fortunate for the condition of the sufferer, that his pride and pretensions are usually exalted in proportion to the degradation of the calamity which afflicts him. none of these patients have received any benefit in the hospital; and from the enquiries i have been able to make at the private mad-houses, where they have been afterwards confined, it has appeared, that they have either died suddenly, from apoplexy, or have had repeated fits, from the effects of which they have sunk into a stupid state, and gradually dwindled away. the paralytic require to be kept warm, and to be allowed a more nutritious diet and cheering beverage than insane patients of any other description. in the winter months they suffer extremely, and ought to be treated as hot-house plants. the fare of the workhouse is ungenial to this wretched state of existence, and therefore they seldom long continue a burden to the parish. when insanity supervenes on epilepsy, or where the latter disease is induced by insanity, a cure is very seldom effected. in two instances i have known madness alternate with epilepsy: one, a man about forty-eight years of age, was a pauper in the cripplegate workhouse, where he had been kept about three years on account of his epileptic fits, but, becoming insane, was admitted into bethlem hospital, therein he continued a year, without being at all benefited; during that time he had no epileptic fit. being returned to the workhouse, he there recovered his senses in a few months, when his epileptic attacks returned, and continued with their usual frequency. about two years afterwards he was re-admitted into the hospital, his insanity having recurred, and continued there another year without experiencing any attack of epilepsy. the other was a young woman, who had been epileptic for many years until she became insane, when she lost her epileptic fits; these, however, were said to have returned in a short time after she had recovered from her insanity. all authors who have treated this subject appear to agree respecting the difficulty of curing religious madness. the infrequent recoveries in this species of insanity, have caused thinking persons to suppose, that this disorder is little under the dominion of the medical practitioner; and, that restoration to reason in all cases is more the effect of accident, or of circumstances not "dreamt of in our philosophy," than the result of observation, skill, and experience. the idea that religion; that which fastens us to the duties of this life; that which expounds the laws of god and of his creation to the ignorant; that which administers consolation to the afflicted; that which regulates man's conduct towards his fellow creatures, to exercise charity among them, and, from such benevolence, to purchase happiness to himself: to believe, that the cultivation of such exalted sentiments would decoy a human being into madness, is a foolish and impious supposition. "thou, fair religion, wast design'd, duteous daughter of the skies, to warm and chear the human mind, to make men happy, good, and wise; to point, where sits in love array'd, attentive to each suppliant call, the god of universal aid, the god, the father of us all. "first shewn by thee, thus glow'd the gracious scene, 'til superstition, fiend of woe, bad doubts to rise and tears to flow, and spread deep shades our view and heaven between." _penrose._ it is therefore sinful to accuse religion, which preserves the dignity and integrity of our intellectual faculty, with being the cause of its derangement. the mind becomes refreshed and corroborated by a fair and active exercise of its powers directed to proper objects; but when an anxious curiosity leads us to unveil that which must ever be shrouded from our view, the despair, which always attends those impotent researches, will necessarily reduce us to the most calamitous state. instituting a generous and tolerant survey of religious opinions, we see nothing in the solemn pomp of catholic worship which could disorganize the mind; as human beings, they have employed human art to render the impression more vivid and durable. the decorous piety, and exemplary life of the quaker has signally exempted him from this most severe of human infirmities. the established church of this country, of which i am an unworthy member, will delude no one, by its terrors, to the brink of fatuity: the solid wisdom, rational exposition, and pure charity, which flow through the works of taylor, barrow, secker, and tillotson, will inspire their readers with a manly confidence: the most enlightened of our species will advance in wisdom and in happiness from their perusal; and the simplicity and truth of their comments will be evident to those of less cultivated understanding. the pastors of this church are all men of liberal education, and many have attained the highest literary character; they are therefore eminently qualified to afford instruction. but what can be expected, when the most ignorant of our race attempt to inform the multitude; when the dregs of society shall assume the garb of sanctity and the holy office; and pretend to point out a privy path to heaven, or cozen their feeble followers into the belief that they possess a picklock for its gates? the difficulty of curing this species of madness will be readily explained from the consideration, that the whole of their doctrine is a base system of delusion, rivetted on the mind by terror and despair; and there is also good reason to suppose, that they frequently contrive, by the grace of cordials, to fix the waverings of belief, and thus endeavour to dispel the gloom and dejection which these hallucinations infallibly excite. although the faction of faith will owe me no kindness for the disclosure of these opinions, yet it would be ungrateful were i to shrink from the avowal of my obligations to methodism[ ] for the supply of those numerous cases which has constituted my experience of this wretched calamity. when the natural small-pox attacks insane persons it most commonly proves fatal. i was induced to draw this conclusion from consulting the records of bethlem, where i found that few of those who had been sent to the small-pox hospital recovered; but subsequent experience has enabled me to point out this distinction: that those who have been in a furious state have generally experienced a fatal termination, and that those who recovered had the small-pox when they were in a state of convalescence from their insanity. when patients, during their convalescence, become more corpulent than they were before, it is a favourable symptom; and, as far as i have remarked, such persons have very seldom relapsed. but it should also be observed, that many, who become stupid, and in a state, verging on ideotism, are very much disposed to obesity: these cases are not to be remedied. in proportion as insanity has assumed a systematic character, it become more difficult of cure. it ought to be noticed, that this state of methodical madness implies, that the disease has been of some continuance; and, to use a figurative expression, has been more extensively rooted in the mind. every occurrence is blended with the ruling persuasion, and the delusion becomes daily corroborated. as --------------"trifles, light as air, are to the jealous, confirmations strong as proofs of holy writ;" so in madness, circumstances wholly unconnected readily support the favourite system, and persons the most disinterested are supposed to form a part of the conspiracy. chap. vii. management. our own countrymen have acquired the credit of managing insane people with superior address; but it does not appear that we have arrogated to ourselves any such invidious pre-eminence. foreigners, who have visited the public or private institutions of this country, may, perhaps, in their relations, have magnified our skill in the treatment of this disease: compared with a great part of the north of europe, which i have visited, we certainly excel. whether it be that we have more mad persons in england than in other countries, and thereby have derived a greater experience of this calamity; or, whether the greater number of receptacles we possess for the insane, and the emoluments which have resulted from this species of farming, have led persons to speculate more particularly on the nature and treatment of this affection, may be difficult to determine. dr. pinel[ ] allows the reputation we have acquired; but, with a laudable curiosity, is desirous to understand how we became possessed of it. "is it," he says, "from a peculiar national pride, and to display their superiority over other nations, that the english boast of their ability in curing madness by moral remedies; and at the same time conceal the cunning of this art with an impenetrable veil? or, on the contrary, may not that which we attribute to a subtile policy, be merely the effect of circumstances? and, is it not necessary to distinguish the steps of the english empirics from the methods of treatment adopted in their public hospitals? "whatever solution may be given to these questions, yet, after fifteen years diligent enquiry, in order to ascertain some of the leading features of this method, from the reports of travellers; the accounts published of such establishments; the notices concerning their public and private receptacles, which are to be found in the different journals, or in the works of their medical writers, i can affirm, that i have never been able to discover any development of this english secret for the treatment of insanity, though all concur in the ability of their management. speaking of dr. willis,[ ] it is said, that sweetness and affability seem to dwell upon his countenance; but its character changes the moment he looks on a patient: the whole of his features suddenly assume a different aspect, which enforces respect and attention from the insane. his penetrating eye appears to search into their hearts, and arrest their thoughts as they arise. thus he establishes a dominion, which is afterwards employed as a principal agent of cure. but, where is the elucidation of these general principles to be sought; and, in what manner are they to be applied according to the character, varieties, and intensity of madness? is the work of dr. arnold otherwise remarkable than as a burdensome compilation, or a multiplication of scholastic divisions, more calculated to retard than advance the progress of science? does dr. harpur, who announces in his preface, that he has quitted the beaten track, fulfil his promise in the course of his work? and is his section on mental indications any thing but a prolix commentary on the doctrines of the ancients? the adventurous spirit of dr. crichton, may justly excite admiration, who has published two volumes on maniacal and melancholic affections, merely on the authority of some observations drained from a german journal; together with ingenious dissertations on the doctrines of modern physiologists, and a view of the moral and physical effects of the human passions. finally, can a mere advertisement of dr. fowler's establishment for the insane in scotland, throw any light on the particular management of such persons, although it profess the purest and most dignified humanity, successfully operating on the moral treatment of madness?" dr. pinel is deserving of considerable credit for directing the attention of medical men to this very important point of the moral management of the insane. i have also heard much of this fascinating power which the mad doctor is said to possess over the wayward lunatic; but, from all i have observed amongst the eminent practitioners of the present day, who exercise this department of the profession, i am led to suspect, that, although this influence may have been formerly possessed, and even to the extent attributed to the late reverend doctor, it ought now to be lamented among the _artes deperditæ_. could the attention of lunatics be fixed, and could they be reduced to obedience, by "strong impression and strange powers which lie within the magic circle of the eye," all other kinds of restraint would be superfluous and unnecessarily severe. but the fact is notoriously otherwise. whenever the doctor visits a violent or mischievous maniac, however controlling his physiognomy, such patient is always secured by the straight waistcoat; and it is, moreover, thought expedient to afford him the society of one or more keepers. it has, on some occasions, occurred to me to meet with gentlemen who have imagined themselves eminently gifted with this awful imposition of the eye, but the result has never been satisfactory; for, although i have entertained the fullest confidence of any relation, which such gentlemen might afterwards communicate concerning the success of the experiment, i have never been able to persuade them to practise this rare talent tetè a tetè with a furious lunatic. however dr. pinel may be satisfied of our superiority in this respect, it is but decorous to return the compliment, and if any influence were to be gained over maniacal patients by assumed importance, protracted staring, or a mimicry of fierceness, i verily believe that such pantomime would be much better performed in paris than in london. it is to be lamented, that general directions only can be given concerning the management of insane persons; the address, which is acquired by experience and constant intercourse with maniacs, cannot be communicated; it may be learned, but must perish with its possessor. though man appears to be more distinguished from other animals by the capability he has of transmitting his acquirements to posterity, than by any other attribute of his nature, yet this faculty is deplorably bounded in the finer and more enviable offsprings of human attainment. the happy dexterity of the artisan, the impressive and delighting powers of the actor, "and every charm of gentler eloquence, all perishable--like the electric fire, but strike the frame, and, as they strike, expire." as most men perceive the faults of others without being aware of their own, so insane people easily detect the nonsense of other madmen, without being able to discover, or even to be made sensible of the incorrect associations of their own ideas. for this reason it is highly important, that he who pretends to regulate the conduct of such patients, should first have learned the management of himself. it should be the great object of the superintendant to gain the confidence of the patient, and to awaken in him respect and obedience; but it will readily be seen, that such confidence, obedience, and respect, can only be procured by superiority of talents, discipline of temper, and dignity of manners. imbecility, misconduct, and empty consequence, although enforced with the most tyrannical severity, may excite fear, but this will always be mingled with contempt. in speaking of the management of insane persons, it is to be understood that the superintendant must first obtain an ascendency over them. when this is once effected, he will be enabled, on future occasions, to direct and regulate their conduct, according as his better judgment may suggest. he should possess firmness, and, when occasion may require, should exercise his authority in a peremptory manner. he should never threaten but execute; and when the patient has misbehaved, should confine him immediately. as example operates more forcibly than precept, i have found it useful, to order the delinquent to be confined in the presence of the other patients. it displays authority; and the person who has misbehaved becomes awed by the spectators, and more readily submits. it also prevents the wanton exercise of force, and those cruel and unmanly advantages which might be taken when the patient and keeper are shut up in a private room. when the patient is a powerful man, two or more should assist in securing him: by these means it will be easily effected; for, where the force of the contending persons is nearly equal, the mastery cannot be obtained without difficulty and danger. when the patient is in a furious state, and uncontrolable by kindness and persuasion, he will generally endeavour, by any means, to do as much mischief as possible to the person who opposes him; and instances are not rare where he has overcome the keeper. when the maniac finds his strength, or skill in the contest prevail, he is sure to make the most of such advantage, and the consequence of his victory has sometimes proved fatal to the keeper. on the other hand, it ought to be the object of the keeper to subdue the maniac without doing him any personal injury; and after he has overpowered, to confine him, and thus prevent him from attempting any further mischief. when the patient is a strong man, and highly irritated, it will be impossible for any keeper singly to overcome him without his most forcible exertions, and these cannot be put forth without great violence to the patient. but subduing the maniac, is not the only object, he must afterwards be secured by the straight-waistcoat, or by manacles. it will be seen, that the keeper, who, by the great exertion of his bodily powers, has become faint and exhausted, will be very little in a condition to secure the patient, as his hands must be employed with the implements necessary to confine him; moreover, the patient will have additional strength from the temperate manner, in which he is made to live; whereas, it is but too common, for the keeper to indulge in a diet and beverage, which induce corpulence and difficulty of breathing.[ ] as management is employed to produce a salutary change upon the patient, and to restrain him from committing violence on others and himself; it may here be proper to enquire, upon what occasions, and to what extent, coercion may be used. the term coercion has been understood in a very formidable sense, and not without reason. it has been recommended by very high medical authority to inflict corporal punishment upon maniacs, with a view of rendering them rational, by impressing terror.[ ] from dr. mead's section on madness it would appear, that in his time flagellation was a common remedy for this disorder. "there is no disease more to be dreaded than madness. for what greater unhappiness can befal a man, than to be deprived of his reason and understanding, to attack his fellow creatures with fury, like a wild beast; to be tied down, _and even beat_, to prevent his doing mischief to himself or others."--_medical precepts and cautions, page ._ dramatic writers abound with allusions to the whip, in the treatment of madness. "love is meerely a madnesse, and i tel you, deserves as well a darke house, and a whip, as madmen do: and the reason why they are not so punish'd and cured, is, that the lunacie is so ordinary, that the whippers are in love too."--_as you like it, act iii. scene ._ another instance to the same effect may be found in mr. dennis's comedy of jacobite credulity. "_bull junior._ look you, old gentleman, i will touch this matter as gently as i can to you. your friends taking notice, that you were grown something foolish, whimsical, absurd, and so forth, thought fit to have you sent to the college here, [bedlam] that you might go through a course of philosophy, and be cudgel'd and firk'd into a little wisdom, by the surly professors of this place."--_select works, vol. ii. p. ._ and again, in the next page; "if thou canst give but so much as a reasonable answer to any thing; if thou either knowest what thou art, or where thou art, or with whom thou art, then will i be contented to be thought mad, and dieted and flogged in thy stead." it also appears from mr. douce's valuable dissertation, that the domesticated fool frequently underwent a similar castigation, to curb the licentiousness of his discourse, or, as a punishment for the obscenity of his actions. indeed this system of corporal chastisement seems to have been general, and may afford some apology for introducing, from a very rare little book, an account of the manner of treating this malady in constantinople, about the middle of the th century.[ ] "_of a place called timarahane for the correction of the insane._ "the sultan bajazet caused a building to be erected for the reception of insane persons, in order, that they might not wander about the city, and there exhibit their mad pranks. this building is constructed in the manner of an hospital: there are about an hundred and fifty keepers appointed to look after them; they are likewise furnished with medicines and other necessary articles. these keepers, armed with cudgels, patrole the city in search of the insane; and when they discover such, they secure them by the neck and hands with an iron chain, and, by dint of the cudgel, convey them to timarahane. on entering this place, they are confined by the neck, with a much larger chain, which is fixed into the wall, and comes over their bed place, so that they are kept chained in their beds. in general, about forty are confined there, at some distance from each other. "they are frequently visited by the people of the city, as a species of amusement. the keepers constantly stand over them with cudgels; for, if left to themselves, they would spoil and destroy their beds and hurl the tables at each other. at the times of giving them food, the keepers examine them, and, if they notice any, who are disorderly, they beat them severely; but, if they should by accident, find any, who no longer exhibit symptoms of insanity, they treat them with greater regard." what success may have followed such disgraceful and inhuman treatment, i have not yet learned; nor should i be desirous of meeting with any one, who could give me the information. if the patient be so far deprived of understanding, as to be insensible why he is punished, such correction, setting aside its cruelty, is manifestly absurd: and, if his state be such, as to be conscious of the impropriety of his conduct, there are other methods more mild and effectual. would any rational practitioner, in a case of phrenitis, or in the delirium of fever, order his patient to be scourged? he would rather suppose, that the brain, or its membranes, were inflamed, and that the incoherence of discourse and violence of action were produced by such local disease. it has been shewn by the preceding dissections, that the contents of the cranium, in all the instances that have occurred to me, have been in a morbid state. it should, therefore, be the object of the practitioner, to remove such disease, rather than irritate and torment the sufferer.--coercion should only be considered as a protecting and salutary restraint. in the most violent state of the disease, the patient should be kept alone in a dark and quiet room, so that he may not be affected by the stimuli of light or sound, such abstraction more readily disposing to sleep. as in this violent state there is a strong propensity to associate ideas, it is particularly important to prevent the accession of such as might be transmitted through the medium of the senses. the hands should be properly secured, and the patient should also be confined by one leg; this will prevent him from committing any violence. the more effectual and convenient mode of confining the hands is by metallic manacles; for, should the patient, as frequently occurs, be constantly endeavouring to liberate himself, the friction of the skin against a polished metallic body may be long sustained without injury; whereas excoriation shortly takes place when the surface is rubbed with linen or cotton. ligatures should on all occasions be avoided. the straight waistcoat is admirably calculated to prevent patients from doing mischief to themselves; but in the furious state, and particularly in warm weather, it irritates, and increases that restlessness which patients of this description usually labour under. they then disdain the incumbrance of clothing, and seem to delight in exposing their bodies to the atmosphere. where the patient is in a condition to be sensible of restraint, he may be punished for improper behaviour, by confining him to his room, by degrading him, and not allowing him to associate with the convalescents, and by withholding certain indulgences, he had been accustomed to enjoy. in speaking of coercion, i cannot avoid reprobating a practice, which has prevailed in some private receptacles for the insane, but which, it is presumed, will henceforward be discontinued. i mean, the practice of half-stifling a noisy patient, by placing a pillow before the mouth, and forcibly pressing upon it, so as to stop respiration. it is unnecessary to enquire, how such wanton cruelty came to be introduced; it must have been the suggestion of ignorance, and the perpetration of savageness and brutality. sighs, tears, sobs, and exclamations, are the unaffected language of passion, and come kindly to our relief, in states of sorrow and alarm. indeed, they appear to be the natural remedies, to "cleanse the stufft bosom of that perillous stuffe, which weighs upon the heart." the mild and rational practice of bethlem hospital, tolerates these involuntary ejaculations. it is there considered, that a noisy and loquacious maniac, has not the power to control his utterance of sounds, which, from the habitual connexion between ideas and speech, must necessarily follow. it is there only viewed as a symptom, or part of the disorder; and that, if the cause cannot be suppressed, the effect should not be punished. as madmen frequently entertain very high, and even romantic notions of honour, they are often rendered much more tractable by wounding their pride, than by severity of discipline. speaking of the effects of management, on a very extensive scale, i can truly declare, that by gentleness of manner, and kindness of treatment, i have seldom failed to obtain the confidence, and conciliate the esteem of insane persons, and have succeeded by these means in procuring from them respect and obedience. there are certainly some patients who are not to be trusted, and in whom malevolence forms the prominent feature of their character: such persons should always be kept under a certain restraint, but this is not incompatible with kindness and humanity. it would, in this part of the work, be particularly gratifying to my feelings if i could develope this _english secret_ for the moral management of the insane, which has been so ardently, yet unsuccessfully sought after by dr. pinel. for fourteen years i have been daily in the habit of visiting a very considerable number of madmen, and of mixing indiscriminately among them, without ever having received a blow or personal insult. during this time i have always gone alone, and have never found the necessity for the assistance or protection of a keeper. the superintendant of the bicêtre, according to dr. pinel's account, is usually attended by his keepers, [gens de service] though he is said to possess[ ] "une fermeté inébranlable, un courage raisonné et soutenu par des qualités physiques les plus propres á imposer, une stature de corps bien proportionnée, des membres pleins de force et de vigeur, et dans des momens orageux le ton de voix le plus foudroyant, la contenance la plus fiére et la plus intrepide." not being myself endowed with any of these rare qualities; carrying no thunder in my voice, nor lightning in my eye, it has been requisite for me to have recourse to other expedients. in the first place, it has been thought proper to devote some time and attention to discover the character of the patient, and to ascertain wherein, and on what points, his insanity consists: it is also important to learn the history of his disorder, from his relatives and friends, and to enquire particularly respecting any violence he may have attempted towards himself or others. in holding conferences with patients in order to discover their insanity, no advantage has ever been derived from assuming a magisterial importance, or by endeavouring to stare them out of countenance: a mildness of manner and expression, an attention to their narrative, and seeming acquiescence in its truth, succeed much better. by such conduct they acquire confidence in the practitioner; and if he will have patience, and not too frequently interrupt them, they will soon satisfy his mind as to the derangement of their intellects. when a patient is admitted into bethlem hospital, if he be sufficiently rational to profit by such tuition, it is explained to him, by the keepers and convalescents, that he is to be obedient to the officers of the house, and especially to myself, with whom he will have daily intercourse; they point out to him, that all proper indulgences will be allowed to good behaviour, and that seclusion and coercion instantly succeed to disobedience and revolt. as _nemo repente turpissimus_, so no one in an instant, from a state of tranquillity, becomes furiously mad: the precursory symptoms are manifold and successive, and allow of sufficient time to secure the patient before mischief ensues; it is principally by taking these precautions that our patients are observed to be so orderly and obedient. the examples of those who are under strict coercion, being constantly in view, operate more forcibly on their minds than any precepts which the most consummate wisdom could suggest. in this moral management, the co-operation of the convalescents is particularly serviceable; they consider themselves in a state of probation, and, in order to be liberated, are anxious, by every attention and assistance, to convince the superintendants of their restoration to sanity of mind. from mildness of treatment, and confidence reposed in them, they become attached, and are always disposed to give information concerning any projected mischief. considering how much we are the creatures of habit, it might naturally be hoped, and experience justifies the expectation, that madmen might be benefited by bringing their actions into a system of regularity. it might be supposed, that as thought precedes action, that whenever the ideas are incoherent, the actions will also be irregular. most probably they would be so, if uncontroled; but custom, confirmed into habit, destroys this natural propensity, and renders them correct in their behaviour, though they still remain equally depraved in their intellects. we have a number of patients in bethlem hospital, whose ideas are in the most disordered state, who yet act, upon ordinary occasions, with great steadiness and propriety, and are capable of being trusted to a considerable extent. a fact of such importance in the history of the human mind, might lead us to hope, that by superinducing different habits of thinking, the irregular associations would be corrected. it is impossible to effect this suddenly, or by reasoning, for madmen can never be convinced of the folly of their opinions. their belief in them is firmly fixed, and cannot be shaken. the more frequently these opinions are recurred to, under a conviction of their truth, the deeper they subside in the mind, and become more obstinately entangled:[ ] the object should therefore be to prevent such recurrence by occupying the mind on different subjects, and thus diverting it from the favorite and accustomed train of ideas. as i have been induced to suppose, from the appearances on dissection, that the immediate cause of this disease probably consists in a morbid affection of the brain, it may be inferred, that all modes of cure by reasoning, or conducting the current of thought into different channels, must be ineffectual, so long as such local disease shall continue. it is, however, likely that insanity is often continued by habit; that incoherent associations, frequently recurred to, become received as truths, in the same manner as a tale, which, although untrue, by being repeatedly told, shall be credited at last by the narrator, as if it had certainly happened. it should likewise be observed, that these incorrect associations of ideas are acquired in the same way as just ones are formed, and that such are as likely to remain as the most accurate opinions. the generality of minds are very little capable of tracing the origin of their ideas; there are many opinions we are in possession of, with the history and acquisition of which, we are totally unacquainted. we see this in a remarkable manner in patients who are recovering from their insanity: they will often say such appearances have been presented to my mind, with all the force and reality of truth: i saw them as plainly as i now behold any other object, and can hardly be persuaded that they did not occur. it also does not unfrequently happen, that patients will declare, that certain notions are forced into their minds, of which they see the folly and incongruity, and yet complain that they cannot prevent their intrusion. as the patient should be taught to view the medical superintendant as a superior person, the latter should be particularly cautious never to deceive him. madmen are generally more hurt at deception than punishment; and, whenever they detect the imposition, never fail to lose that confidence and respect which they ought to entertain for the person who governs them. in the moral management of the insane, this circumstance cannot be too strongly impressed on the mind of the practitioner: and those persons, who have had the greatest experience in this department of medical science, concur in this opinion. the late dr. john monro expressly says, "the physician should never deceive them in _any_ thing, but more especially with regard to their distemper; for as they are generally conscious of it themselves, they acquire a kind of reverence for those who know it; and by letting them see, that he is thoroughly acquainted with their complaint, he may very often gain such an ascendant over them, that they will readily follow his directions."[ ] very different directions are, however, issued by a late writer,[ ] and which, on account of their novelty, contrivance, and singular morality, deserve the consideration of the reader. "the _conscientious physician_, in the execution of his duty, attempting the removal of these deplorable maladies, is under the necessity of occasionally deviating from the accustomed routine of practice, of stepping out of the beaten track, and, in some cases, that have resisted the usual methods, is warranted in adopting any others, that have _only_ the slightest _plausibility_, or that promise the smallest hope of success. thus, the employment of what may be termed _pious frauds_: as when _one_ simple erroneous idea stamps the character of the disease, depriving the affected party of the common enjoyments of society, though capable of reasoning with propriety, perhaps, with ingenuity, on every subject, not connected with that of his hallucination, the correction of which has resisted our very best exertions, and, where there is no obvious corporeal indisposition, it certainly is allowable to try the effect of certain deceptions, contrived to make strong impressions on the senses, by means of _unexpected_, _unusual_, _striking_, or apparently _supernatural_ agents; such as after waking the party from sleep, either suddenly or by a gradual process, by _imitated thunder_, or soft music, according to the peculiarity of the case; _combating_ the erroneous deranged notion, either by some _pointed sentence_, or signs _executed in phosphorus_ upon the wall of the bed chamber; or by some _tale_, _assertion_, or _reasoning_; by one in the character of an _angel_, _prophet_, or _devil_: but the actor in this drama must possess much _skill, and be very perfect in his part_." it is of great service to establish a system of regularity in the actions of insane people. they should be made to rise, take exercise, and food, at stated times. independently of such regularity contributing to health, it also renders them much more easily manageable. concerning their diet, it is merely necessary to observe, that it should be light, and easy of digestion. the proper quantity must be directed by the good sense of the superintendant, according to the age and vigour of the patient, and proportioned to the degree of bodily exercise he may be in the habit of using; "but they should never be suffered to live too low, especially while they are under a course of physic."[ ] to my knowledge, no experiments have yet been instituted respecting the diet of insane persons: they have never been compelled to live entirely on farinaceous substances. the diet of bethlem hospital allows animal food three times a week, and on the other days bread with cheese, or occasionally butter, together with milk pottage, rice milk, &c. those who are regarded as incurable patients ought certainly to be indulged in a greater latitude of diet, but this should never be permitted to border on intemperance. to those who are in circumstances to afford such comforts, wine may be allowed in moderation, and the criterion of the proper quantity, will be that which does not affect the temper of the lunatic, that which does not exasperate his aversions, or render his philosophy obtrusive. although it seems rational in all states of madness, that temperance should be strictly enjoined, yet an author of the present day[ ] steps out of the trodden path, and seriously advises us, in difficult cases, to drown lunacy in intoxication; and, strange as it may appear, has taught us to await the feast of reason from the orgies of bacchus. "the conversion of religious melancholy into furious madness is a frequent occurrence, and is generally followed by recovery. this has suggested the _propriety_, in some cases that have resisted more common means, of producing a degree of excitement by means of stimuli, in fact, _keeping the patient for days in succession in a state of intoxication_, which has often occasioned an alleviation of symptoms, and sometimes _restored the sufferers to reason_." confinement is always necessary in cases of insanity, and should be enforced as early in the disease as possible. by confinement, it is to be understood that the patient should be removed from home. during his continuance at his own house he can never be kept in a tranquil state. the interruptions of his family, the loss of the accustomed obedience of his servants, and the idea of being under restraint, in a place where he considers himself the master, will be constant sources of irritation to his mind. it is also known, from considerable experience, that of those patients who have remained under the immediate care of their relatives and friends, very few have recovered. even the visits of their friends, when they are violently disordered, are productive of great inconvenience, as they are always more unquiet and ungovernable for some time afterwards. it is a well-known fact, that they are less disposed to acquire a dislike to those who are strangers, than to those with whom they have been intimately acquainted; they become therefore less dangerous, and are more easily restrained. it ought to be understood that no interruption to this discipline should defeat its salutary operation. on this account more patients recover in a public hospital, than in a private house, appropriated for the reception of lunatics. in the former, the superintendants persist in a plan laid down, and seldom deviate from their established rules: such asylum being a place of charitable relief, they are indifferent about pleasing the friends and relatives of the patient, who cannot there intrude to visit them at their option. in a private receptacle emolument is the first object, and however wisely they may have formed their regulations, they soon feel themselves subordinate to the caprice and authority of those by whom they are paid. it frequently happens, that patients who have been brought immediately from their families, and who were said to be in a violent and ferocious state at home, become suddenly calm and tractable when placed in the hospital. on the other hand it is equally certain, that there are many patients whose disorder speedily recurs after having been suffered to return to their families, although they have for a length of time conducted themselves, under confinement, in a very orderly manner. when they are in a convalescent state the occasional visits of their friends are attended with manifest advantage. such an intercourse imparts consolation, and presents views of future happiness and comfort. but certain restrictions should be imposed on the visits of these friends; ignorant people often, after a few minutes conversation with the patient, will suppose him perfectly recovered, and acquaint him with their opinion: this induces him to suppose that he is well, and he frequently becomes impatient of confinement and restraint. from such improper intercourse i have known many patients relapse, and in two instances i have a well-founded suspicion that it excited attempts at suicide. many patients have received considerable benefit by change of situation, which occupies the mind with new objects, and this sometimes takes place very shortly after the removal. "haply the seas and countries different with variable objects, shall expell this something setled matter in his heart: whereon his braines still beating, puts him thus from fashion of himselfe." in what particular cases, or stages of the disease, this may be recommended, i am not enabled, by sufficient experience, to determine. chap. viii. remedies for insanity. _bleeding._ where the patient is strong, and of a plethoric habit, and where the disorder has not been of any long continuance, bleeding has been found of considerable advantage, and as far as i have yet observed, is the most beneficial remedy that has been employed. the melancholic cases have been equally relieved with the maniacal by this mode of treatment. venesection by the arm is, however, inferior in its good effects to blood taken from the head by cupping. this operation, performed in the manner to which i have been accustomed, consists in having the head previously shaven, and six or eight cupping glasses applied on the scalp. by these means any quantity of blood may be taken, and in as short a time, as by an orifice made in a vein by the lancet. when the raving paroxysm has continued for a considerable time, and the scalp has become unusually flaccid; or where a stupid state has succeeded to violence of considerable duration, no benefit has been derived from bleeding: indeed these states are generally attended by a degree of bodily weakness, sufficient to prohibit such practice independently of other considerations. the quantity of blood to be taken, must be left to the discretion of the practitioner: from eight to sixteen ounces may be drawn, and the operation occasionally repeated, as circumstances may require. in some cases where blood was drawn at the commencement of the disease from the arm, and from patients who were extremely furious and ungovernable, it was covered with a buffy coat; but in other cases it has seldom or never such an appearance. in more than two hundred patients, male and female, who were let blood by venesection, there were only six whose blood could be termed sizy. in some few instances hemoptysis has preceded convalescence, as has also a bleeding from the hemorrhoidal veins. epistaxis has not, to my knowledge, ever occurred. before particular remedies, to be employed for the cure of mania and melancholia, are recommended, it may be necessary to give some directions concerning the means to be used for their certain administration. maniacs in general feel a great aversion to become benefited from those medicinal preparations which practitioners employ for their relief; and on many occasions they refuse them altogether. presuming that some good is to be procured by the operation of medicines on persons so affected, and aware of their propensity to reject them, it becomes a proper object of enquiry how such salutary agents may most securely, and with the least disadvantage, be conveyed into the stomachs of these refractory subjects. for the attainment of this end various instruments have been contrived, but that which has been more frequently employed, and is the most destructive and devilish engine of this set of apparatus, is termed a _spouting_ boat. it will not be necessary to fatigue the reader with a particular description of this coarse tool, except to remark, that it is constructed somewhat like a child's pap boat; and is intended to force an entrance into the mouth through the barriers of the teeth.[ ] in those cases, where patients have been obstinately bent on starving themselves, or where they have become determined to resist the introduction of remedies calculated for their relief, i have always been enabled to convey both into their stomachs, at any time, and in any quantity that might be necessary, by the employment of an instrument, of which the figure and dimensions are here given. [illustration] since the use of this very simple and efficient instrument, which i constructed about twelve years ago, i can truly affirm, that no patient has ever been deprived of a tooth, and that the food or remedy has always been conveyed into the stomach of the patient. the manner in which this compulsory operation is performed, consists in placing the head of the patient between the knees of the person who is to use the instrument: a second assistant secures the hands, (if the straight-waistcoat be not employed) and a third keeps down the legs. as soon as the mouth is opened, the instrument may be introduced; it presses down the tongue, and keeps the jaws sufficiently asunder to admit of the introduction of the medicine, which should be contained in a vial, or tin pot with a spout, to allow it to run in a small stream. the nose of the patient being held by the left hand of the person who uses the instrument, a small quantity of the medicine is to be poured into the mouth, and when deglutition has commenced, is to be repeated, so as to continue the act of swallowing until the whole be taken. a little address will obviate the determination of the patient to keep his teeth closed: he may be blindfolded at the commencement, which never fails to alarm him, and urges him to enquire what the persons around him are about: causing him to sneeze, by a pinch of snuff, always opens the mouth previously to that convulsion, or tickling the nose with a feather commonly produces the same effect. with delicate females, where one or more of the grinder-teeth are wanting, the finger may be introduced on the inside of the cheek, which being strongly pressed outwards will prevent the patient from biting, and form a sufficient cavity to pour in the liquid. with a wish of speaking confidently on this subject, i have usually performed the business of forcing, more especially amongst the females, and it has, in some degree, rewarded my trouble; it has ascertained the practicability of administering remedies; and it has also afforded the consolation, that, where the means employed have produced no good, the patient has sustained no injury. _purging._ an opinion has long prevailed, that mad people are particularly constipated, and likewise extremely difficult to be purged. from all the observations i have been able to make, insane patients, on the contrary, are of very delicate and irritable bowels, and are well, and copiously purged, by a common cathartic draught. that, which has been commonly employed at the hospital, was prepared agreeably to the following formula: [precsription] infusi sennæ [ounce] iss ad [ounce] ij tincturæ sennæ [dram] i ad [dram] ij syrupi spinæ cervinæ, [dram] i ad [dram] ij. but, within the last seven years, the tinctura jalapij has been substituted for the tinctura sennæ. it is so far an improvement, that it operates more speedily, and produces less griping. this medicine seldom fails of procuring four or five stools, and frequently a greater number. in confirmation of what i have advanced, respecting the irritable state of the intestines in mad people, it may be mentioned, that the ordinary complaints, with which they are affected, are diarrhoea and dysentery: these have heretofore been very violent and obstinate. perhaps it may be attributed to superior care that the occurrence of these complaints has, of late years, been comparatively rare, contrasted with the numbers who were formerly attacked with such diseases; and, when they do happen, an improved method of treatment has rendered these intestinal affections no longer formidable or fatal. in those very violent diarrhoeas, which ordinarily terminate in dysentery, from five to ten grains of the pilula hydrargyri have been given according to the sex, constitution, and nature of the complaint, once or twice a day, and with general success. it may be necessary to add, that it is proper, during the course of this mercurial remedy, which shortly arrests the disease, to keep the bowels in an open state, by some of the milder purgatives employed every third or fourth day. diarrhoea very often proves a natural cure of insanity; at least, there is sufficient reason to suppose, that such evacuation has very much contributed to it. the number of cases, which might be adduced in confirmation of this remark, is considerable; and the speedy convalescence, after such evacuation, is still more remarkable. in many cases of insanity there prevails a great degree of insensibility, so that patients have scarcely appeared to feel the passing of setons, the drawing of blisters, or the punctures of cupping. on many occasions, i have known the urine retained for a considerable time, without complaint from the patient, although it is well ascertained, that there is no affection more painful and distressing than distension of the bladder. of this general insensibility the intestinal canal may be supposed to partake; but this is not commonly the case; and, if it should frequently prevail, would be widely different from a particular and exclusive torpor of the primæ viæ. but, sometimes, there arises a state of disease in maniacs, where the stomach and intestines are particularly inert. the patient refuses to take food, and is obstinately constipated: the tongue is foul, and the skin is tinged with a yellowish hue: the eyes assume a glossy lustre, and exhibit a peculiar wildness. in this state, i have given two drachms of the pulvis jalapij for a dose, and which, on some occasions, has procured but one stool, so that it has been necessary several times to repeat the same quantity. after the bowels have been sufficiently evacuated, the appetite commonly returns, and the patient takes food as usual. much mischief may be produced, if it be attempted to force food into the stomach in such a case, which the ignorance of keepers may attempt, supposing it to originate in the obstinacy of the patient. in order to continue the bowels in a relaxed state, after they have been sufficiently emptied of their contents, the following formula has been employed with advantage: [precsription] infusi sennæ, [ounce] vijss kali tartarizati, [ounce] ss antimonij tartarizati, gr ss tincturæ jalapij, [dram] ij from two to three table spoonsful may be given once or twice a day, as occasion may require. there are some circumstances unconnected with disease of mind, which might dispose insane persons to costiveness. i now speak of such as are confined, and who come more directly under our observation. when they are mischievously disposed they require a greater degree of restraint, and are consequently deprived of that air and exercise which so much contribute to regularity of bowels. it is well known that those who have been in the habits of free living, and who come suddenly to a more temperate diet, are very much disposed to costiveness. but to adduce the fairest proof of what has been advanced, i can truly state, that incurable patients, who have for many years been confined in the hospital, are subject to no inconveniences from constipation. many patients are averse to food, and where little is taken in, the egesta must be inconsiderable. to return from this digression: it is concluded, from very ample experience, that cathartic medicines are of the greatest service, and ought to be considered as an indispensable remedy in cases of insanity. the good sense and experience of every practitioner must direct him as to the dose, and frequency with which these means are to be employed, and of the occasions where they would be prejudicial. _vomiting._ however strongly this practice may have been recommended, and how much soever it may at present prevail, i am sorry that it is not in my power to speak of it favourably. in many instances, and in some where blood-letting had been previously employed, paralytic affections have within a few hours supervened on the exhibition of an emetic, more especially where the patient has been of a full habit, and has had the appearance of an increased determination to the head. it has been for many years the practice of bethlem hospital to administer to the curable patients four or five emetics in the spring of the year; but, on consulting my book of cases, i have not found that such patients have been particularly benefited by the use of this remedy. from one grain and half to two grains of tartarized antimony has been the usual dose, which has hardly ever failed of procuring full vomiting. in the few instances where the plan of exhibiting this medicine in nauseating doses was pursued for a considerable time, it by no means answered the expectations which had been raised in its favour by very high authority. where the tartarized antimony, given with this intention, operated as a purgative, it generally produced beneficial effects. ten years have elapsed since the former edition of this work appeared; but this length of time, and subsequent observation, have not enabled me to place any greater confidence in the operation of emetics, as a cure for insanity. an author[ ] who has lately published a work, entitled "_practical observations on insanity_," is however a determined fautor of emetics in maniacal cases. in his skilful hands they have worked marvellous cures; nor have any prejudicial effects ever resulted from their employment. perhaps no one has enjoyed a fairer opportunity of witnessing the effects of remedies for insane persons than myself; and when emetics are employed in bethlem hospital they have the best chance of effecting all the relief they are competent to afford, as they are given by themselves, without the intervention of other medicines; and this course of emetics usually continues six weeks. had dr. cox confined himself to the relation of his own victories in combating madness with vomits, it would have been sufficient; but he endeavours to raise the leveé en masse of medical opinion to co-operate with his sentiments. he says, page , "yet _every_ physician, who has devoted his attention to this branch of the profession, _must_ differ from him when he treats of vomiting." it was never my intention to deny, in a disordered state of the stomach, that the madman would be equally benefited with one in his senses by the operation of a vomit: but i have asserted, that after the administration of many thousand emetics to persons who were insane, but otherwise in good health, that i never saw any benefit derived from their use. it will also be granted, that some ascendancy may be gained over a furious maniac by forcing him to take a vomit, or any other medicine, but this is widely different from any positive advantage resulting from the act of vomiting. sir john colebatch, in his "_dissertation concerning misletoe_," says, _p._ , "but i have been for some years afraid of giving vomits, even of the gentlest sort, in convulsive distempers, from some terrible accidents, that have been likely to ensue, from moderate doses of ipecacuanha itself." in st. luke's hospital, the largest public receptacle for insane persons, where the medical treatment is directed by a physician of the highest character and eminence, and whose experience is, at least, equal to that of any professional man in this country, vomits are by no means considered as the order of the day; they may be employed to remove symptoms concomitant with madness, but are not held as specifics for this disease. in reading over the cases related by dr. cox, there is no one, where emetics have been solely employed as agents of cure; they have been always linked with other remedies; and it requires more sagacity than even the doctor can exact, to pronounce, when different means of cure are combined, to which the palm should be adjudged. in the relation of my own experience concerning vomiting, as a remedy for insanity, i have had only in view the communication of facts, for i entertain neither partiality nor aversion to any remedies, beyond the fair claim which their operations possess. had i modestly ventured to state, after the example of the doctor, "that i had _devoted_ myself _exclusively_ and _assiduously_ for a _series of years_, to the care of insane patients in an _establishment_, where persons of _both sexes_ are received,"[ ] it might be suspected, that the superstructure of my philosophy had been reared on the basis of private emolument. _camphor._ this remedy has been highly extolled, and doubtless with reason, by those who have recommended it: my own experience merely extends to ten cases; a number, from which no decisive inference of its utility ought to be drawn. the dose was gradually increased, from five grains to two drachms, twice a day; and, in nine cases, the use of this remedy was continued for the space of two months. of the patients, to whom the camphor was given, only two recovered: one of these had no symptoms of convalescence for several months after the use of this remedy had been abandoned: the other, a melancholic patient, certainly mended during the time he was taking it; but he was never able to bear more than ten grains thrice a day. he complained that it made him feel as if he were intoxicated. considering the insoluble nature of camphor, and the impracticability of compelling a lunatic to swallow a pill or bolus, it has been found convenient (when a large quantity was required) to give this medicine in the form of an emulsion, by dissolving the camphor in hot olive oil, and afterwards adding a sufficient quantity of warm water and aqua ammoniæ puræ. _cold bathing._ this remedy having for the most part been employed, in conjunction with others, it becomes difficult to ascertain how far it may be exclusively beneficial in this disease. the instances where it has been separately used for the cure of insanity, are too few to enable me to draw any satisfactory conclusions. i may, however, safely relate, that in many instances, paralytic affections have in a few hours supervened on cold bathing, especially where the patient has been in a furious state, and of a plethoric habit. that this is not unlikely to happen may be supposed from the difficulty of compelling the patient to go head-foremost into the bath. in some cases vertigo, and in others a considerable degree of fever ensued after immersion. the shower-bath was employed some years ago in the hospital, and many cases were selected in order to give a fair trial to this remedy, but i am unable to say, that any considerable advantage was derived to the patients from its use. if i might be permitted to give an opinion on this subject, the principal benefit resulting from this remedy, has been in the latter stages of the disease, and when the system had been previously lowered by evacuations. as a remedy for insanity cold bathing has been disregarded by a celebrated practitioner. to a question from a select committee of the house of commons to doctor willis, th march, , the following answer was given. _question._ are you of opinion that warm and cold baths are necessary for lunatic patients? _answer._ i think warm baths may be very useful, but it _can seldom happen_ that a cold bath will be required.[ ] _blisters._ these have been in several cases applied to the head, and a very copious discharge maintained for many days, but without any manifest advantage. the late dr. john monro, who had, perhaps, seen more cases of this disease than any other practitioner, and who, joined to his extensive experience, possessed the talent of accurate observation, mentions, that he "never saw the least good effect of blisters in madness, unless it was at the beginning, while there was some degree of fever, or when they have been applied to particular symptoms accompanying this complaint."[ ] dr. mead also concurs in this opinion. "blistering plasters applied to the head will possibly be thought to deserve a place among the remedies of this disease, but i have often found them do more harm than good by their over great irritation."--_medical precepts, page ._ although blisters appear to be of little service, when put on the head, yet i have, in many cases, seen much good result from applying them to the legs. in patients who have continued for some time in a very furious state, and where evacuations have been sufficiently employed, large blisters applied to the inside of the legs, have often, and within a short time, mitigated the violence of the disorder. in a few cases setons have been employed, but no benefit has been derived from their use, although the discharge was continued above two months. respecting opium, it may be observed, that whenever it has been exhibited, during a violent paroxysm, it has hardly ever procured sleep: but, on the contrary, has rendered those who have taken it much more furious: and, where it has for a short time produced rest, the patient has, after its operation, awaked in a state of increased violence. many of the tribe of narcotic poisons have been recommended for the cure of madness; but, my own experience of those remedies is very limited, nor is it my intention to make further trials. other, and perhaps whimsical modes of treating this disorder, have been mentioned: whirling,[ ] or spinning a madman round, on a pivot, has been gravely proposed; and, music has been extolled, with a considerable glow of imagination, by the same gentleman.--that the medical student may be fully aware of the manifold agents which _practical physicians_ have suggested for the restoration of reason, i shall conclude my volume with the following extract.[ ] "the medical philosopher, in his study of human nature, must have observed, that _sympathetic correspondence of action_ between the mind and body, which is _uniformly_ present in health and disease, though _varying_ with circumstances. the different passions, according to their nature, the degree or intensity of application, and the sensibility of the party, exhibit certain characteristic expressions of countenance, and produce obvious _changes_, actions, or motions, in the animal economy. music has been found to occasion _all_ these actions, changes, and movements, in some sensible systems; and where one passion morbidly predominates, as frequently happens in mania, those species of simple or combined sounds, _capable of exciting an opposite passion_, may be _very usefully_ employed. _if_ then such effects _can_ be produced by such a power, acting on a mind only endued with its healthy proportion of susceptibility, what may we _not_ expect where the sensibility is morbidly increased, and where the patient is alive to the most minute impressions? cases frequently occur where such acuteness of sensibility, and _extreme_ delicacy of system exist, that most of the more common, _moral_, and medical means are contra-indicated; _here_ relief may be often administered through the medium of the _senses_; the _varied modulations, the lulling, soothing_ cords of even an eölian harp have _appeased_ contending passions, _allayed_ miserable feeling, and afforded ease and tranquillity to the bosom _tortured_ with real or fancied woe: and i can easily _imagine_, that _jarring discord_, _grating harsh rending_ sounds, applied to an ear _naturally_ musical, would uniformly excite great commotion. under circumstances calculated to assist this action, by producing unpleasant impressions through the medium of the other senses, as when screeches and yells are made in an apartment painted _black_ and _red_, or _glaring white_, every man must be painfully affected: the maniacal patient, _however torpid_, _must_ be roused: or, on the contrary, where an opposite state obtains, extreme sensibility and impatience of powerful impression, there _much may be expected_ from placing the patient in an _airy room_, surrounded with _flowers breathing odours_, the walls and furniture _coloured green_, and the air agitated by undulations of the softest harmony. _much_ of this may appear fanciful and ridiculous, but the _enquiring_ practitioner _will_ find, on making the experiment, it deserves his _serious_ attention; and no mean is to be despised that is capable of arresting the attention, changing the trains of thought, interesting the affections, removing or diminishing painful sensations, and ultimately rendering both mind and body sensible to impressions, and _all this has been effected by music_. every individual is not capable of accurately estimating the _extensive powers_ of this agent; but i would ask the _musical amateur_, or the _experienced professor_, if he have not frequently felt sensations the most _exquisite_ and _indescribable_; if he have not experienced the whole frame _trilling_ with _inexpressible delight_, when the _tide_ of full harmony has flown on his ear, and the most _wretched miserable_ feeling, universal horripilatio and cutis anserina from the _grating crash_ of discord? all the varied sensations from transport to disgust, have been occasioned by the different movements in one piece of music. i might _amuse_ my readers with a great variety of instances where persons have been very singularly affected by means of music, and where its powers have extended to the _brute creation_, but this i purposely avoid." finis. printed by g. hayden,} brydges street, covent garden.} footnotes: [ ] the choice of these words must be left to the taste of the reader, dr. johnson not having thought proper to admit them into his dictionary. [ ] some doubts are entertained whether dr. boord was physician to king henry the eighth, but he was certainly a fellow of the college. [ ] apprehension of sensations. this is perhaps only an endeavour to explain the thing, _by_ the thing, or producing words of similar import with different sounds. junius, speaking of the word hand (as derived from the gothic handus) says, "quidam olim deduxerunt vocabulum ab antiquo verbo hendo, _capio_: unde prehendo, apprehendo, &c."--_gothicum glossarium_, p. . professor ihre conceives it equally probable that the old latin word _hendo_ may have had a northern origin. "id vero non possum, quin addam, oppidó mihi probabile fieri, ipsammet hanc vocem latio olim peregrinam non fuisse, quod quippe augurar ex derivato hendo, capio, unde prehendo cum derivatis pullularunt."--_glossarium sviogothicum. tom. i. p. ._ [ ] quere. why should the most _active_ characteristics of our nature be termed _passions_? the word seems properly employed in _passion week_, the period commemorative of christ's suffering or _passion_. but we are said to _fly_, or _fall_ into a passion, and then passion _gets the better of us_. for the softer sex we conceive the most delicate, refined, and honorable _passion_, yet every one allows the dreadful consequences which ensue from an indulgence of our _passions_, and most persons agree that _passion_, carried to excess, constitutes madness--we live in a world of metaphor. [ ] in many instances, although it is far from being general, pain of the head, and throbbing of its arteries precede an attack of insanity; sometimes giddiness is complained of as a precursory symptom. those who have been several times disordered, are now and then sensible of the approaching return of their malady. some have stated, a sense of working in the head, and also in the intestines, as if they were in a state of fermentation. others observe that they do not seem to possess their natural feelings, but they all agree that they feel confused from the sudden and rapid intrusion of unconnected thoughts. [ ] to illustrate how necessarily our sensations, or ideas must become confused, when their succession is too rapid, the relation of some experiments on that subject will sufficiently conduce. "but by the able assistance of mr. herschel, i am in a condition to give some approximation, at least, towards ascertaining the velocity of our audible sensations. for having, by means of a clock, produced sounds, which succeeded each other with such rapidity, that the intervals between each of them were (as far as could be judged) the smallest posible; he found he could evidently distinguish one hundred and sixty of them to flow in a second of time. now as each interval must in this case be reckoned as a sensation likewise, as it might be filled up with a sound thereby making it a continued one; it follows, that we are capable of entertaining at least three hundred and twenty audible sensations in that period of time."--_vide a treatise on time, by w. watson, jun. m. d. f. r. s. vo, , page ._ [ ] the late dr. johnson was remarkably distinguished by certain peculiarities of action when his mind was deeply engaged. sir joshua reynolds was of opinion "that it proceeded from a habit he had indulged himself in, of accompanying his thoughts with certain untoward actions." "one instance of his absence, and particularity as it is characteristic of the man, may be worth relating. when he and i took a journey into the west, we visited the late mr. banks, of dorsetshire; the conversation turning upon pictures, which johnson could not well see, he retired to a corner of the room, stretching out his right leg as far as he could reach before him, then bringing up his left leg, and stretching his right still further on. the old gentleman observing him, went up to him, and in a very courteous manner assured him, that though it was not a new house, the flooring was perfectly safe. the doctor started from his reverie like a person waked out of his sleep, but spoke not a word."--_boswell's life of dr. johnson, vol. i. p. ._ in the same work other of his tricks are recorded, as talking to himself, measuring his steps in a mysterious manner, half whistling, clucking like a hen, rubbing his left knee, &c. many sensible persons, with whom i am now acquainted, when particularly thoughtful, discover strange bodily motions, of which they are by no means conscious at the time. [ ] this gritty matter, subjected to chemical examination, was found to be _phosphat of lime_. [ ] this appearance i have found frequently to occur in maniacs who have suffered a violent paroxysm of considerable duration: and in such cases, when there has been an opportunity of inspecting the contents of the cranium after death, water has been found between the dura mater and tunica arachnoidea. [ ] morbid anatomy, page . [ ] mr. fourcroy does not appear to have given any particular attention to this fluid. he says, "cette humeur ne paraît pas différer de celle qui mouille toutes les parois membraneuses du corps humain en general, et dont j'ai déja parlé. c'est un liquide mucoso gelatineux, plus ou moins albumineux, et contenant _quelques matiéres salines_."--_systéme des connoisances chimiques, vo. tom. ix. p. ._ [ ] it may be remarked, that all children in the early attempts at language, speak of themselves and others in the third person, and never employ the pronoun; they likewise never use connectives, or the inflections of verbs, until they begin to acquire some knowledge of numbers. beyond this rude state our patient never advanced. [ ] for this term the indulgent reader must give the author credit, because he finds himself unable adequately to explain it.--it is a complex _term_ for many ideas, on which language has not as yet, and perhaps will never be imposed. very unfortunately there are many terms of this nature, equally incapable of description--a smile, for instance, is not very easy to be defined. dr. johnson calls it "a slight contraction of the face" which applies as properly to a paralytic affection. he also states it to be "opposed to frown." if curiosity should prompt the inquisitive reader to seek in the same author for the verb, to frown, he will find it "to express displeasure _by contracting the face_ to wrinkles." he who would "finde the minde's construction in the face" must not expect to be able to communicate to others, in a few words, that knowledge which has been the slow and progressive accumulation of years. [ ] these are the usual terms employed by writers on this subject, but the propriety of their use must be left to the judgment of the reader. every person will occasionally hesitate whether certain occurrences, said to be causes, ought to be referred to one class, in preference to the other. they are loose and vague names: for instance, a course of debauchery long persisted in, would probably terminate in paralysis; excessive grief we know to be capable of the same effect. paralysis frequently induces derangement of mind, and in such case it would be said, that the madness was induced by the paralysis as a physical cause. but it often happens that debauchery and excessive grief are followed by madness, without the intervention paralysis. moral, in this sense, means merely habitudes or customs, reiteration of circumstances confirmed into usage; and these may be indifferently accounted physical or moral. [ ] "----nessun maggior dolore, che ricordarsi del tempo felice nella miseria."--_dante._ [ ] the jews also were particularly instrumental in the practice and propagation of medical knowledge at that period. [ ] cogitatio, (hîc minimè prætereunda) est motus peculiaris cerebri, quod hujus facultatis est proprium organum: vel potiùs cerebri pars quædam, in medulla spinali et nervis cum suis meningibus continuata, tenet animi principatum, motumque perficit tam cogitationis quam sensationis; quæ secundùm cerebri diversam in omnium animalium structuram, mirè variantur.--_tolandi pantheisticon, p. ._ [ ] , . [ ] vide report, part ii. p. . [ ] report, p. . [ ] ibid, . [ ] report . [ ] "we shall use the general term of methodism, to designate these three classes of fanatics, [arminian and calvinistic methodists, and the _evangelical_ clergymen of the church of england] not troubling ourselves to point out the finer shades, and nicer discriminations of lunacy, but treating them all as in one general conspiracy against common sense, and rational orthodox christianity."--_edinburgh review, jan. , p. ._ [ ] traité medico-philosophique sur l'alienation mentale, vo. paris, an. , p. . [ ] the late reverend dr. willis. [ ] with respect to the persons, called keepers, who are placed over the insane, public hospitals have generally very much the advantage. they are there better paid, which makes them more anxious to preserve their situations by attention and good behaviour: and thus they acquire some experience of the disease. but it is very different in the private receptacles for maniacs. they there procure them at a cheaper rate; they are taken from the plough, the loom, or the stable; and sometimes this tribe consists of decayed smugglers, broken excisemen, or discharged sheriffs' officers: "all that at home no more can beg or steal." how well such a description of persons is calculated to regulate and direct the conduct of an insane gentleman may be easily conjectured. if any thing could add to the calamity of mental derangement, it would be the mode which is generally adopted for its cure. although an office of some importance and great responsibility, it is held as a degrading and odious employment, and seldom accepted but by idle and disorderly persons. [ ] vide cullen, first lines, vol. iv. p. . [ ] "_d'uno luogo chiamato timarahane, dove si castigano i matti._ "in costantinopoli fece fare un luogo sultan paiaxit dove si dovessero menare i pazzi, accioche non andassero per la citta, facendo pazzie, et è fatto à modo d'uno spedale, dove sono circa cento cinquanta guardiani in loro custodia, et sonvi medicine, et altre cose per loro bisogni, e i detti guardiani vanno per la citta con bastoni cercando i matti, et quando ne truovano alcuno, lo'ncatenano per il collo con cathene di ferro, et per le mani, et à suon di bastoni lo menano al detto luogo, et quivi gli mettono una catena al collo assai maggiore, che è posta nel muro, et viene sopra del letto, tal mente che nel letto per il collo tutti gli tengono incatenati, et vene saranno per ordine, lontano l'uno dall'altro numero di quaranta, i quali per piacere di quelli della citta molte volte sono visitati, et di continovo col bastone i guardiani gli stanno appresso: percio che non essendovi guastano i letti, et tiransi le tavole l'uno à l'altro: et venuta l'hora del mangiare, i guardiani gli vanno esaminando tutti per ordine, et trovando alcuno, che non istia in buon proposito, crudelmente lo battono, et se à caso truovano alcuno, che non faccia piu pazzie, gli banno miglior cura, che à gli altri." _j. costumi et la vita de turchi di gio. antonio menavino genovese da vultri, mo, in fiorenza, ._ [ ] traité sur la mania, page . [ ] the frequent recurrence of any propensity leads, by sure steps, to the final adjustment of the character; and even when the propensity is ideal, the repetition of the fits will, in the end, invest fancy with the habitudes of nature.--_criticism on the elegy written in a country church yard, p. ._ [ ] remarks on dr. batties' treatise on madness, p. . [ ] dr. cox, practical observations on insanity, p. . [ ] dr. john monro's remarks on dr. battie, p. . [ ] vide dr. cox's _practical_ obs. on insanity, p. . [ ] it is a painful recollection to recur to the number of interesting females i have seen, who, after having suffered a temporary disarrangement of mind, and undergone the brutal operation of _spouting_, in private receptacles for the insane, have been restored to their friends without a front tooth in either jaw. unfortunately the task of forcing patients to take food or medicines is consigned to the rude hand of an ignorant and unfeeling servant: it should always be performed by the master or mistress of the mad-house, whose reputations ought to be responsible for the personal integrity of the unhappy beings committed to their care. [ ] dr. cox. [ ] see dr. cox's advertisement prefixed to his book. [ ] vide report from the select committee appointed to enquire into the state of lunatics, page . [ ] remarks on dr. batties' treatise on madness. [ ] see dr. cox, page . [ ] dr. cox, p. . medical books lately published by j. callow, _no. , crown court, princes street_, soho, who either gives the full value for medical books, or exchanges them. --adams's observations on morbid poisons, in two parts:--part i. containing syphilis, yaws, sivvens, elephantiasis, and the anomala confounded with them. part ii. on acute contagions, particularly the variolous and vaccine. second edition, illustrated with four coloured engravings, copious practical remarks, and further commentaries on mr. hunter's opinions; by joseph adams, m. d. f. l. s. physician to the small pox and inoculation hospitals, in one large quarto, boards, £ s. 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