, *# TT, 
 
 p, 
 
DR. THOMAS MORE MADDEN, M.A.O. 
 
 HONORIS CAUSA. OF THE ROYAL UNIVERSITY. 
 
 We said on the happy occasion last week when the honorary degree of the Royal 
 Unirersity was conferred on Dr More Madden that as a specialist, Dr More Madden 
 occupies a foremost place in the Medical World. He ba been as successful 
 as an author as be has been as a practitioner. Some of the treatises 
 be has written are standard works. In a word, be has won distinctions 
 as a writer, as a teacher, and as a practitioner. He has 
 
 THE LIBRARY 
 
 OF 
 
 THE UNIVERSITY 
 OF CALIFORNIA 
 
 PRESENTED BY 
 
 PROF. CHARLES A. KOFOID AND 
 MRS. PRUDENCE W. KOFOID 
 
DR. THOMAS MOKE MADDEN, 3I.A.O. 
 
 HONORIS CAUSA. OF THE ROYAL UNIVERSITY. 
 
 We said on the happy occasion last week when the honorary degree of the Royal 
 Unirersity was conferred on Dr More Madden that as a specialist, Dr More Madden 
 occupies a foremost place in the Medical World. He has been a3 successful 
 as an author as be has been as a practitioner. Some of the treatises 
 be has written are standard works. In a word, he has won distinctions 
 as a writer, as a teacher, and as a practitioner. He has 
 
 filled the oS':cs of president cf the Obnietric Section of the Royl Academy 
 of Medicine ia Iralatv_ 3 ,;.d uf ttu-. British Medical Assoeiation. He has been Hoa 
 President of the International Congress of Obsterica at Brussels, s.ud Vice-President 
 of the British Gytaeolo.sical Society. Ha has won honours at nonce and abroad, 
 and in Dablin ha holds ssreral important professional appointments. 
 writings are so well-known that any enumeration ot them is unnecessary. It i 
 needless te epeak of the literary aud oiner qualities of his disting 
 whose works are so well known aud aopreciased. 
 
 DAILY INDEPENDENT. 
 WEDNESDAY, OCTOBER 28, fS9& 
 
n A . 
 
 ON 
 
 INSANITY, 
 
 AND THE 
 
 CRIMINAL RESPONSIBILITY 
 
 ffa THE 
 
 INSANE. 
 
 BY 
 
 THOMAS MORE MADDEN, M.R.I.A.; 
 
 LICENTIATE OF THE KING AND QUEEN'S COLLEGE OF PHTSICIAN3 IN IRELAND; 
 MEMBER OF THE EOTAL COLLEGE OF SURGEONS OF ENGLAND; 
 
 AUTHOB OF A TREATISE " OX CHANGE OF CLIMATE," ETC.; 
 
 CLMATB OF MALAGA, AND ITS REMEDIAL INTLUENCE OX CHRONIC PULMONARY DISEASES; 
 "ON RINDERPEST, AND ITS RELATION TO CHOLEKA, PLAGUE, AND OTHER EPIDEMIC DISEASES." 
 
 Read before the Medical Society of the College of Physicians in Ireland. 
 
 DUBLIN: 
 JOHN FALCONER, 53, UPPER SACKVILLE -STREET, 
 
 JJrhtter anb JJablisjier, Statiotter anb gmber. 
 
 1866. 
 
 
[Reprinted from the Dublin Quarterly Journal of Medical Science, November, 1866.] 
 
AJ/f 
 
 r, 1MB 1DDEI, 
 MERRION SQUARE, 
 
 30TTBLIK. 
 
 ON 
 
 INSANITY, 
 
 AND THE 
 
 CRIMINAL RESPONSIBILITY OF THE INSANE. 
 
 A REMARKABLE case of insanity, leading to a double attempt at murder 
 and suicide, which came under my notice in May, 1865, led me to devote 
 consideration to the medico-legal relations of insanity in reference to 
 criminal responsibility. The result of this inquiry has been to show me 
 in how unsatisfactory a state our criminal jurisprudence is on these 
 points ; and I now call attention to this case for the purpose of pointing 
 out the defects of the present system, and of offering some suggestions for 
 its improvement. 
 
 On the 22nd of May, 1865, J. E., aged eighteen, an inferior employs' 
 in a public office, who had only, within a period of six or eight weeks, 
 recovered from fever, was observed by a medical gentleman in the office 
 to present a wild and restless appearance, and was recommended to go 
 home and remain there for some days ; accordingly, he returned to his 
 mother's house, at Drumcondra, where nothing peculiar in the lad's 
 conduct was observed by his family. At the expiration of some days he 
 returned to his employment, stating he was quite well. The gentleman 
 above referred to again observed the same expression he had before 
 noticed, and called the attention of the senior clerk of the office to it 
 desiring that the boy should be allowed to leave the office earlier than 
 usual, or for some days more, if he wished, to remain at home. He left 
 that day at the usual hour ; conducted himself quietly during the evening ; 
 but at night, when all the members of the family were asleep, he arose 
 and made his way to his mother's room, on entering which, he flew at 
 her then in bed and attempted to kill her with a hatchet, which it was 
 afterwards ascertained had been concealed by him several days previously ; 
 but her cries, fortunately, brought timely assistance, and she escaped 
 
4 On Insanity, and the Criminal Responsibility of the Insane. 
 
 with some slight injuries. Before the lad was seized, however, he inflicted 
 a slight wound upon himself, in the right breast, with a clasp knife ; threw 
 himself on the ground, roaring vehemently, and endeavoured to dash his 
 head against the wall. Having been secured, he was carried to his 
 bed, when, after some hours feigning sleep, he took advantage of the 
 inattention of those who watched him, and, early next morning, made 
 his escape from the house and flung himself into the River Tolka, near 
 his place of abode, in Clontarf ; he was pulled out, with some difficulty, 
 by a policeman. 
 
 Next day he was brought before a police magistrate, charged with the 
 attempt at murder and suicide, and was committed to prison. By the 
 exertions of Dr. R. R. Madden, however, he was, ultimately, sent to the 
 Richmond Lunatic Asylum, and placed under the able care of Dr. Lalor ; 
 he was discharged, as cured, in November last, and is now earning his 
 bread comfortably and creditably in another public office in this city. 
 
 This young man was a pale, cachectic lad, of emaciated habit and leuco- 
 phlegmatic temperament, badly brought up, ill-educated ; his only reading 
 being the cheap sensational tales and novels published in the London 
 penny serials, to the perusal of which, notwithstanding various remon- 
 strances and admonitions of his superiors, he devoted every spare moment. 
 
 After the outbreak of insanity, which I have described, a quantity of 
 papers and fragments of papers, in this individual's hand- writing, were 
 found in his desk, written in the sensational-novel style he delighted in. 
 Amongst these manuscripts was one document, entitled, "Autobiography 
 of J. E.," written immediately previous to his attempted matricide ; and 
 I am now induced to publish a few extracts from this paper as a 
 curiosity of psychological literature. These fragments furnish the best 
 comment I have ever seen on the effects to be apprehended from the 
 prevalent sensational cheap literature of the present day. 
 
 " Autobiography of Joseph E. Joseph E. was born on the 20th of 
 March, 1846. He displayed in his infancy a quick, volatile, proud dis- 
 position, and, although this was seen by his mother, she never took any 
 pains to eradicate it, and let him go on without doing anything towards 
 removing this grievous evil ; but she was a poor struggling woman, and 
 had her husband lying ill for months and months on his back, and she 
 had no means of support only merely what she would earn by her own 
 industry. There was never in this world a more industrious woman in 
 the world, though she never took any pains to inculcate this virtue into 
 Joe, for she thought as she acquired this industry naturally, as she 
 thought herself, she imagined Joe could not be otherwise ; so, thus, the 
 best boy in the world was ruined by being let go and take his own head 
 and habits in all things, for his mother thought all was over when she 
 sent him to school. 
 
 "You never, I suppose, thought it necessary to know whether he 
 
By DR. T. M. MADDEN. 5 
 
 minded his prayers or not, or religious duties or not; oh, 'twas ter- 
 rible ! oh, horrible ! horrible ! Oh, how could God stand it and let the 
 child live and go with such wings to the devil ? Oh ! never, never, 
 will she forgive herself for this. But to return, as well as my poor 
 head can let me, unfortunately as it proved he was sent to a small 
 National School when six years of age, and his disposition may be 
 proved by an instance which I may lay before the reader, if ever this 
 finds one. . . . Oh, reader ! never take pleasure in reading those things ; 
 never soil your hands with them, but of dire necessity as a warning, and 
 take care you take it in that light. Oh, my God! my God! never, 
 never let such things as low novels, romances, &c., stay a moment before 
 your eyes. Oh ! consign them to the flames at once, and never let them 
 stay in children's hands for a moment, for if you do, they are drinking in 
 destruction. Oh, hear me, ye mothers! mind the principal affair of 
 your children's welfare, viz. : the affair of their salvation, and never let 
 those things or any such like enter your child's hands ; if thou hast nature 
 in thee stand it not. Oh horrible things ! oh, Reynolds and Company, 
 what a horrible mess your are making of young minds and young hearts 
 by bringing them to ruin by your heathenish publications. Oh, you are 
 a set of sheep in wolfs clothing. But to return to the subject : Joe's 
 mind was capable of any impression that might be affixed on it. He 
 might have been good at anything if his mind got any good impressions 
 at that time, for a better disposed child never lived ; yet, worst of mothers, 
 look at what your darling boy came to by your heathenish way, and 
 you now may curse the day you married your last husband, for since then 
 you never attended to religious duties, and you may thank that accursed 
 marriage for all the evils that it has brought on all and your darling 
 son. Oh, mother of mothers, have not I reason to curse you, if I would 
 do it ; but may God in His mercy and pity have mercy and pity on your 
 poor unfortunate soul ; oh, I pray that he may ; oh, the Lord hear my 
 prayer ; oh God of glory have mercy on you ; oh may the angels bear 
 you away, my mother ; oh let me suffer in another state till judgment 
 day, and stay there for ever until the judgment day ; oh mother, picture 
 the delight of us two poor mortals to be in that transitory state for years 
 until all, all our sins are purged away ; oh mother, picture then our 
 delight on being admitted into heaven among God and his saints and 
 faithful, when we will get the lowest, lowest, lowest place among them, 
 please the great God of all glory, of all glory, of all mercy, of all infinite 
 goodness ; oh mother, mother, darling mother, can we get into such a 
 place, think you, can we, oh mother ; you have received such injuries, 
 such crosses, oh mother forgive all I have said to you; oh forgive 
 mother and forget also, mother, God will forgive, oh God will forgive 
 us ; oh we were mad cracked oh, we were mad ; oh mother, the 
 light of hope shines on my path, and I am here writing this in great hope, 
 
6 On Insanity, and the Criminal Responsibility of the Insane. 
 
 mother darling, of being with you in heaven. Oh, may the Lord my 
 God look over them ; oh 'twill be little matter of me when my body is 
 rotting in the earth, of my body which I was sent mad by you, and 
 everyone, being so proud of it ; oh let me never look on the face of 
 myself, my diabolical, unfortunate self again ; oh, may the God of all 
 glory, look on the virtues, oh but where will he find them ; oh none 
 none none none none none none none none none none 
 none none. Till judgment day I might cry none ; oh, may heaven 
 deign to look on you and me with pity and mercy and clemency. Oh, 
 the devil tempted the whole of us to sin ; oh mother, still you did not 
 fall into great crimes, for witness your horror of hearing Mary the fish- 
 woman swear false ; oh mother, I am greatly afraid I will not find the 
 same favour of you ; oh heaven grant it ; oh, if you be sent to heaven and 
 I get my choice of either you or I to go to heaven, one of us and not the 
 two, oh, I will willingly, mother, let you go, and I will e'en take 
 
 place with the d d. Oh mother hear me and heed me, I pray 
 
 you ; oh, mother, prepare for death, neither of us can live long ; oh mother, 
 'twill be an imposition to stay for two weeks here, and then get the 
 month's money after getting one month's pay in advance already. Oh 
 mother, why, oh why did you not take great care that I would be 
 properly minded and taken care of ? Oh horrible, oh horrible, most 
 horrible ; if thou hast nature in thee stand it not ; oh mother, mother, 
 mother ! goodbye goodbye goodbye goodbye goodbye. Oh mother, 
 what might have been oh, unfortunate fool of a mother, oh why 
 did you not come to me long ago, and never forsake the true path ; 
 oh mother, mother, goodbye goodbye goodbye goodbye goodbye 
 goodbye goodbye goodbye goodbye goodbye goodbye goodbye 
 goodbye goodbye goodbye goodbye goodbye goodbye. Oh, 
 mother, my dear fond alas, too fond affectionate alas, fatally so ; oh 
 mother, mother, mother unfortunate mother ; oh mother, mother, I pity 
 you I pity you I pity you I pity you I pity oh mother, you did 
 not pity me ; oh mother no no no no no ! Oh mother, you were 
 greatly at fault. Oh, reader, if this finds one, take warning ; oh, for 
 Jesus sake, take warning ; oh, for heaven's sake take heed ; my God, 
 my God, why hast thou suffered this ? oh why not put me on my guard ? 
 oh, why not question me ? " 
 
 In the same desk as the foregoing insane autobiography there were 
 also found several other documents which were equally characteristic of 
 the writer's insanity. Amongst these were the following fragments of 
 unconnected observations not of the same date, probably, as the preceding 
 rhapsodies : 
 
 " You saw in me the germs of the worst passions that could ever be sown 
 in any mortal. Oh, poor unfortunate mother ! oh ! you are reaping the 
 harvest you have sown ; you are mourning for your cupidity ; oh, you 
 
By DR. T. M. MADDEN. 7 
 
 are looking towards the grave of the son you have ruined with horror, for 
 he chiefly employs his time in cursing the day he was born ; oh, poor 
 deluded wretch ! from the teaching and from the praise he got from the 
 companions of his boyhood and youth, they puffed up the already too 
 proud and headstrong spirit of the boy, and made him forget almost that 
 there was any God in the heavens. Oh, poor boy! oh, unfortunate 
 child ! oh, wretched youth ! oh, poor boy ! who never tasted any of the 
 true delights of this life, let alone any of the foretastes of the next. Oh, 
 heavens ! what a good disposition he possessed, and what a lively, hearty, 
 enthusiastic child ; of a strong and healthy frame, although his father 
 was a poor, sickly, weak man. 
 
 " Oh ! with what a quick hurried bound he leaped into school ; no 
 hesitation, no drawing back then; no, no, all straight; head up, and 
 ready to look the world in the face. Oh ! with a little care what fine 
 stuff was there to be moulded to a good shape, but it was let run to rust, 
 and now it is gone completely to ruin. Oh, poor unfortunate child ! oh, 
 infernal mother ! oh, mother ! who being blessed with a son never once 
 in his infancy held up his childish hands in prayer to the great God of 
 all glory. Oh, villain ! worse than the most diabolical" .... 
 
 The handwriting of the preceding rhapsodies, though very legible, is 
 peculiar. The words run closely into each other. There are no stops, 
 no space left unwritten, no margin left unscribbled on the sides of the 
 paper. The absence of margins and stops has been noticed in other 
 cases of documents written by the insane, and has been commented upon ; 
 among others by Olivier d'Anges, and Bayard, in the Annales ffHygiene, 
 Vol. XIX., p. 490. 
 
 In this case we find a boy originally of a low order of intellect, of 
 limited capacity, vain, frivolous, and of weak resolution, whose education 
 and moral discipline evidently appear to have been neglected, and whose 
 only reading was the lowest class of sensational literature, full of thrilling 
 tales of crime and mystery. This kind of reading engaged his entire 
 leisure, and evidently filled his imagination ; so that like Don Quixote 
 he surrounded himself with a world of fiction, which shaped his sub- 
 sequent mania. Thus the autobiography, the attempted murder, and 
 abortive suicide, all bear the impress of this mental dram-drinking 
 furnished to the poor in the London penny sensational periodicals, and to 
 the rich in more pretentious sensation novels and magazines. 
 
 The ill effects of the long continued and exclusive perusal of such 
 literature, especially on young minds, are similar to those described by 
 Fabius : 
 
 " Educatio altera natura ; alterat animos et voluntatem ; atque utinam 
 (inquit) liberorum nostrorum mores non ipsi perderemus, quum infantiam 
 statim deliciis solvimus; mollior ista educatio, quam indulgentian voca- 
 mus, nervos omnes et mentis et corporis frangit : fit ex his consuetude, 
 inde natura." Lib. L, cap. 3. 
 
8 On Insanity i and the Criminal Responsibility of the Insane. 
 
 I have heard it said that the influence on the particular forms of crime 
 which have been ascribed to novels is as imaginary as are the scenes 
 depicted in those works themselves. But that such is not the case we 
 have abundant proof. Madame de Stael assures us that the Sorrows of 
 Werter occasioned a vast increase in the number of suicides in Germany 
 at the time of its publication. Any one who has had occasion to turn over 
 the police reports of the London newspapers of some forty years ago, will 
 find this influence of literature shown in the number of foolish youths 
 charged each morning with emulating the exploits of the heroes of 
 Mr. Pierce Egan's then celebrated Life in London, Some years later Mr. 
 Ainsworth's Jack Sheppard seems to have excited a highwayman epidemic 
 among the lads in many a country town. And we have reason to sup- 
 pose that a similar influence is still exercised by the penny serials, such 
 as The Boy Pirate, The Young Highwayman, and the cheap and coarse 
 stimulating literature of the penny weekly journals, to which the indi- 
 vidual on whose case I am commenting, abandoned his feeble mind. 
 
 This case is a good example of the manie raisonnante of Pinel supervening 
 on fever. There seems to have been no hallucination, but, simply, a 
 perverted affection which led the boy to suppose that, as his mother had, 
 by neglect of her duties, religious and maternal, imperilled her salvation, 
 it was his duty to save her from eternal retribution by depriving her of 
 time and opportunity for incurring further guilt by killing her, and then 
 committing suicide with the view of joining her in the next world. 
 This manie raisonnante has its analogies with Bardolph's reasoning in his 
 lamentation for his dead master : " Would I were with him wheresome'er 
 he is either in heaven or in hell ! " 
 
 Had this boy succeeded in his attempt on his mother's life he would 
 have been tried, as a matter of course, for murder ; and if the plea of 
 insanity were set up we should, in all probability, have had abundant 
 sarcasms about " the pseudo-sentimentality of the mad doctors," and what 
 one journal, commenting on a trial, not long since, elegantly designated 
 " the moral insanity dodge for cheating the gallows." We would have 
 found medical men, who had seen the patient, testifying their belief in 
 the perfect sanity and consequent criminal responsibility of the writer of 
 the preceding diary. Very possibly, too, he might have been tried by a 
 judge who disbelieves in partial, or so-called " moral," insanity, and a 
 jury who believe, of course, whatever they are told by the judge ; and 
 the wholesome and salutary spectacle might have been exhibited of a 
 human being publicly put to death because suffering from the most dire 
 disease that can afflict human nature. 
 
 The term " moral insanity," which many might apply to the foregoing 
 case, is often and, I think, justly objected to ; but the idea intended to be 
 conveyed by it, of insanity marked by hallucination of the moral faculties 
 or affections, without any obvious derangement of the intellectual powers, 
 
By DR. T. M. MADDEN. 9 
 
 unquestionably applies to many cases. Every one conversant with the 
 forms of insanity must have met cases in which a sudden perversion of 
 feeling sets in and hastily changes the natural disposition and character 
 of individuals whose minds still preserve the semblance of reason, while 
 their moral conduct or natural affections become so unaccountably 
 changed. The phrase itself, "moral insanity," seems to me a most 
 unhappy one, however. For, although cases do sometimes occur, as 
 within the last few weeks we have had a notable instance, in a recent 
 trial in Dublin, in which disorder of the moral faculties alone is apparent, 
 it does not follow that disease of other mental faculties does not co-exist 
 with this moral disorder, though not so evident. Moreover, the very 
 serious objection has been urged that the idea of " moral insanity," if 
 widely extended, would lead to the fearful doctrine, that crime is 
 generally the result of an involuntary and irresistible mental malady by 
 which all freedom of volition and of action are destroyed, and, that crime 
 and madness being synonymous, men are, consequently, not responsible 
 for their evil actions. 
 
 Instead of the numerous terms used to describe the various types and 
 forms of insanity and which seem to me, although, doubtless, of value 
 to the psychological physician, calculated rather to embarrass and perplex, 
 than to aid the medical witness in courts of law I would venture to 
 suggest that, for medico-legal purposes, unsoundness of mind, not includ- 
 ing mental deficiency or idiotcy, should be divided into the two classes 
 only, of general and partial insanity ; the latter being the only one in 
 which medical evidence is needed in cases of crime ascribed to insanity. 
 
 A madman is, it may be presumed, one in whom the faculties, or any 
 one of them, which should regulate and point out his relations and 
 behaviour towards God, his neighbour, or himself, are either lost or 
 impaired by disease. 
 
 Obviously, such a person cannot be considered as either morally or 
 legally responsible for his actions. For to be responsible for an act it is 
 essential that the person committing it should possess liberty of will as 
 well as of action, which a lunatic does not enjoy, or he would be none. 
 
 But besides the state of mind in which a man is responsible for his 
 acts, or sanity, and that condition in which he is not accountable for 
 them, or insanity there is a third condition of mind in no way provided 
 for by our law, and which seems not sufficiently recognized even by the 
 medical profession. I allude to what Baron Von Feuchtersleben terms, 
 " a state of half freedom." That is a state of transition between the 
 healthy and unsound mind, either preceding or following insanity. In 
 this state the patient is only partially able to exercise self-control, and 
 therefore is but partially responsible for his actions. This peculiar 
 condition of mind should be recognized by law in this country, as it is 
 in France, where on a jury bringing in a verdict of " plus innocent 
 que conpable," the Avocat-Gene'ral may order an investigation into the 
 
10 On Insanity, and the Criminal Responsibility of the Insane. 
 
 state of mind of the prisoner, and award a punishment in proportion to 
 the real guilt of the accused. 
 
 However, although insanity is too often punished as crime, on the other 
 hand, crime sometimes shelters itself under the disguise of insanity. For 
 my part I am not one of those who share Lord Hale's opinion, that " all 
 crime is the result of partial insanity : " a dogma which appears to me 
 not only subversive of the principles of all religion, and dangerous to 
 society, but at variance with common sense. 
 
 Mere passion is not madness. Nor should any, so called, irresistible 
 impulse, not connected with a diseased brain ; nor any emotion or custom 
 which is not of itself a proof of insanity, be considered as conferring 
 immunity from the just punishment of crime. None are free from 
 passions or impulses, which if they be not checked may become almost 
 irresistible from habit, and may lead to crime. But in such cases the 
 perpetrators of crimes being accountable for the acts by which the control 
 over the passions was originally weakened, they are equally accountable 
 for all the consequences that may arise therefrom. A madman is not 
 thus responsible, not being answerable for the diseased action in his 
 brain whence the insane act proceeds. 
 
 The law of England, as laid down by the judges in their reply to the 
 queries of the House of Lords on this subject, is that if the perpetrator 
 of an action is capable of distinguishing right from wrong at the time he 
 committed it, he is legally responsible for it, even though he may be 
 partially insane. The following are the words of this decision : 
 1st. "Notwithstanding that the party committing a wrong act, when 
 labouring under the idea of redressing a supposed grievance, or injury, or 
 under the impression of obtaining some public or private benefit, he was 
 liable to punishment. 
 
 2nd. " That before a plea of insanity should be allowed, undoubted 
 evidence ought to be adduced that the accused was of diseased mind, and 
 that at the time he committed the act he was not conscious of right 
 or wrong." . . . . " Every person was supposed to know what the 
 law was, and therefore nothing could justify a wrong act, except it was 
 clearly proved the party did not know right from wrong. If that was 
 not satisfactorily proved the accused was liable to punishment." 
 
 The 3rd question was not answered, and as it was purely legal need 
 not be quoted. 
 
 4th. " The judges were unanimous in opinion, that if the delusion was 
 only partial, that the party accused was equally liable with a person of 
 sane mind. If the accused killed another in self defence he would be 
 entitled to an acquittal ; but if committed for any supposed injury he 
 would then be liable to the punishment awarded by the laws for his 
 crime." a 
 
 a Hansard's Parliamentary Debates, 1843. 
 
By DR. T. M. MADDEN. 11 
 
 The 5th and last question refers to the examination of experts as to the 
 patient's state of mind at the time when he committed the crime, and, with 
 the exception of Justice Maule, it was decided that the question was one 
 for the jury, and should not be put to the witness except under certain 
 special conditions. 
 
 Similar views have been at all times promulgated from the judicial 
 bench in England. On the trial of Arnold, in 1723, for shooting at Lord 
 Onslow, Mr. Justice Tracy stated, that a lunatic to be exempted from 
 punishment for his acts " must be a man that is totally deprived of his 
 understanding and memory, and doth not know what he is doing no more 
 than an infant, than a brute, or a wild beast." a In 1812 Mr. Justice 
 Le Blanc, in a case of murder tried before him at the Old Baily, in- 
 structed the jury thus : " Provided you should be of opinion that when 
 he (the prisoner) committed the offence he was capable of distinguishing 
 right from wrong, and was not under the influence of such a delusion as 
 disabled him from distinguishing a wrong act, in that case he was 
 answerable to the justice of his country, and guilty in the eye of the law." 
 Chief Justice Mansfield, in his charge in the case of Bellingham, who was 
 tried for the murder of Mr. Percival, told the jury that if the prisoner 
 fancied the existence of an imaginary injury, and sought redress for this 
 by some illegal act, but " was capable in other respects of distinguishing 
 right from wrong, there was no excuse for any act of atrocity he might 
 commit under this description of insanity ; " and Lord Lyndhurst, on the 
 trial of Offord in 1831, expressed his coincidence with Chief Justice 
 Mansfield's charge ; and, further, informed the jury that they would not 
 be justified in acquitting the prisoner on the ground of insanity unless 
 they could answer this question in the negative, viz. : " Did the prisoner 
 know that in committing the act he offended against the laws of God and 
 man ? " b Sir William Follet, then Solicitor-General, who prosecuted 
 M'Naughten for the murder of Mr. Drummond in 1843, stated the law 
 to be that " to excuse him (the prisoner) it will not be sufficient that he 
 laboured at the time under partial insanity, that he had a morbid dis- 
 position of mind which would not exist in a sane person ; that is not 
 enough ; if he had that degree of intellect to enable him to know and to 
 distinguish right from wrong, if he knew what would be the effect of his 
 crime, and if with that consciousness he wilfully committed it." c 
 
 On the memorable trial of Townley, convicted of the murder of Miss 
 Goodwin in 1863, Baron Martin addressing the jury said: "In his 
 opinion the law was best laid down by Justice Le Blanc, as able a judge 
 as ever sat on the bench. Justice Le Blanc, in the case alluded to, 
 observed to the jury that it was for them to determine whether the 
 
 a Hargrare's State Trials, 322 ; and Collinson on Lunacy, Vol i., p. 672. 
 b Corrinton and Payne's Reports, VoL v., p. 168. 
 c Annual Register, 1843 Law Cases, p. 347. 
 
12 On Insanity, and the Criminal Responsibility of the Insane. 
 
 prisoner, when he committed the offence with which he stood charged, 
 was incapable of distinguishing right from wrong, or under the influence 
 of any illusion which rendered his mind insensible of the nature of the 
 act he was about to commit. Since in that case he would not be legally 
 responsible for his conduct. On the other hand, provided they should be 
 of opinion that when he committed the offence he was capable of dis- 
 tinguishing right from wrong, and not under the influence of such an 
 illusion as disabled him from discerning that he was doing a wrong act, 
 he would be amenable to the justice of his country, and guilty in the eye 
 of the law." a 
 
 This " knowledge of right and wrong " which is made the legal proof 
 of criminal responsibility is, perhaps, as fallacious a test of mental 
 sanity as could well be devised. The majority of the inmates of our lunatic 
 asylums have, to a certain extent, the power of distinguishing between 
 right and wrong. For they often adopt precautions and practice con- 
 cealment when doing acts they know to be wrong, thus clearly showing that 
 they are aware of the impropriety of their conduct, and are anxious to 
 escape its punishment. And yet, such patients may, in other respects, be 
 obviously insane. 
 
 The expounders of our law appear to me in this point to confound 
 conscience with consciousness. How is this abstract " knowledge 
 of right and wrong" to be decided? Is it by the conscience of 
 the accused ? or by public opinion which differs so widely in different 
 times and places? or by the civil law, which in one state makes 
 that a crime which in an adjoining country may be none ? Is the 
 question to be tried by the divine law, acting in self-supposed conformity 
 to which, men, otherwise of sane mind, have conscientiously perpetrated 
 actions which the great bulk of mankind regard as reprehensible? 
 Surely, therefore, the so-called knowledge of right and wrong cannot, 
 of itself, be regarded as a sufficient test of sanity and consequent 
 responsibility. 
 
 It would be easy to quote numerous cases in illustration of the con- 
 sequences of the inhumane law that has reigned and still is enforced in 
 England, with reference to criminal lunacy. I shall, however, content 
 myself with alluding to some of the most notorious cases in which either 
 the sentence of death has been pronounced, or has actually been carried 
 into execution, on persons in the state of madness. 
 
 It will hardly be necessary before giving these cases to prove that it 
 can be neither lawful nor expedient to inflict punishment on a lunatic. 
 Although I might quote curious passages from Hansard's Parliamentary 
 Debates (Volume 67) to show that this practice has been vindicated by a 
 Right Rev. Prelate who undertook the Christian office of proving that 
 dangerous lunatics should be dealt with after the fashion of mad dogs, 
 * Annual Register, 1863 Law Cases, p. 308. 
 
By DR. T. M. MADDEN. 13 
 
 and should be destroyed for the good of society. But as this humane 
 sentiment is not often so explicitly avowed, I shall merely quote the 
 words of two eminent lawyers : 
 
 "The only way to look at the punishment of death," says Lord 
 Wharncliffe in his evidence, " is to say is it an example or not ? If an 
 example, it is defensible ; if it is not, it is not defensible."* There can 
 be no question that a madman, not being under the dominion of reason, 
 cannot be acted upon by the force of example, and thus deterred from an 
 insane act. And, therefore, any punishment is unjust ; for, as Mr. 
 Stephens says "The end or final cause of human justice is not, by 
 way of atonement or expiation for the crime committed for that must be 
 left to the just determination of the Supreme Being but as a precaution 
 against future offences of the same kind." b 
 
 It seems to have been generally admitted that Bellingham, who was 
 tried for the murder of Mr. Percival, was improperly executed, the 
 application of his counsel for a short postponement having been refused, 
 although witnesses could have been then produced to prove clearly his 
 insanity. The case of Bowler affords another example of the execution 
 of a madman subject to epileptic fits, and exhibiting all the symptoms of 
 mania. Baron Alderson afterwards, at the trial of Oxford, justly 
 remarked, with reference to the last case: "Bowler was executed, 
 I believe, and very barbarous it was." In the case to which I have 
 already referred, which was tried before Mr. Justice Le Blanc, at the 
 Old Baily, 1812, a prisoner was charged with shooting at a man named 
 Burrowes, and although a commission of lunacy had found him insane 
 only one month before he committed the offence, still the jury brought in 
 a verdict of guilty, and he was accordingly condemned and executed. 
 
 John Barclay who was executed at Glasgow in 1833, was also of 
 unsound mind. He was familiarly known as " Daft Jack." The clergy- 
 man of the parish had always regarded him as imbecile. He thought 
 that a watch was a living animal ; and that there was no distinction 
 between killing an ox and killing a man. Yet, although Barclay's weak- 
 ness of mind was recognised both by the judge and by the jury, who, on 
 that ground recommended him to mercy, still he was condemned and 
 executed on the plea, forsooth, that " he knew right from wrong." 
 
 John Howison, who was tried before the High Court of Justiciary in 
 Scotland, in December, 1831, and convicted of the murder of the widow 
 Geddes, and subsequently executed was undoubtedly insane. He was a 
 peddler, and up to a certain period was a man of orderly habits and ordi- 
 nary manners ; immediately after a fever his habits changed completely. 
 He became morose, silent, fond of solitude, and superstitious, wearing a 
 Bible tied to his head, or dangling from his wrist. He sprinkled salt on 
 
 Evidence of Lord Wharncliffe Commissioners' Report, 1836, p. 96. 
 b Stephens New Commentaries on the Laws of England, Vol. ir., p. 64. 
 
14 On Insanity ) and the Criminal Responsibility of the Insane. 
 
 his bed, and used to sit for hours brushing away imaginary flies. His 
 appetite became enormous, and he contracted a craving for blood, and 
 would eat an incredible quantity of bullock's liver nearly raw, and slept 
 always with weapons under his head. At one time he became a Quaker, 
 but during the worship would sit muttering to himself, and running pins 
 and needles into his wrists and arms, would suck the blood with great 
 gusto. Moreover, he complained of pain and uneasiness in the head. 
 The crime for which he suffered was apparently quite motiveless ; and he 
 accused himself of eight other murders, none of which had ever 
 occurred.* 
 
 In 1862 Charles Foulkes was tried for the murder of Daniel Stone at 
 Walditch on the 29th of August. Immediately after the murder he had 
 atttempted to shoot himself. There appeared to be no motive for the act, 
 except that he had some vague notion that people, and his victim among 
 the number, laughed and jeered at him. Dr. Tuke, who examined the 
 prisoner, said : " My examination left no doubt on my mind but that he 
 
 is at this moment of unsound mind I do not believe him 
 
 responsible for his actions." The judge's charge in this case was the 
 strongest proof of the incompetency of an unprofessional tribunal to deal 
 with cases of lunacy. He told the jury: "Although you may be 
 satisfied that this man had some insane delusions ; yet if at the time he 
 did this act he knew the nature of that act, and what the consequence 
 would be, and also that it was wrong, then it is your duty to find him 
 guilty." This criminal lunatic was accordingly found guilty, and 
 sentenced to be hanged. 
 
 At the Maidstone Assizes, at the same time (1862) a lad aged eighteen, 
 named Burton, was tried for the murder of a boy, between nine and ten 
 years old, on the Chatham Railroad. The prisoner had given himself up 
 voluntarily. There was no cognizable sane motive whatever for the 
 crime. The prisoner having expressed an insane desire of being hanged, 
 had apparently committed the murder solely to accomplish that object. 
 Burton's mother had been twice in a lunatic asylum ; his brother was 
 foolish ; and he himself was generally considered of weak mind. Medical 
 evidence was given which sustained this opinion. But Mr. Justice 
 Wightman, in summing up, is reported to have said, that the prisoner 
 " was supposed to desire to be hanged, and in order to attain that object 
 committed murder. That might show a morbid state of mind but not 
 delusion. Homicidal mania, again, showed no delusion." So, accord- 
 ingly, Burton was found guilty, and sentenced to be hanged. 
 
 George Victor Townley, who was sentenced to death at the Derbyshire 
 
 Winter Assizes in 1863, for the murder of Miss Goodwin, a young 
 
 lady to whom he had been engaged to be married, was described as being 
 
 "a man of very quiet and refined manners, a good linguist, and an 
 
 a Edinburgh Medical and Surgical Journal, Vol. xxxviii., p. 51. 
 
By DR. T. M. MADDEN. 15 
 
 accomplished musician." The defence set up was insanity. Some 
 members of the prisoner's family were proved to have been mad. Dr. 
 Winslow in his evidence said : " His (the prisoner's) moral sense was 
 
 more vitiated than I ever saw that of any other human being 
 
 I think that at this present moment he is a man of deranged intellect." 
 Similar evidence was given by others ; and his conduct after the murder, 
 when he gave himself up to justice, assisted to carry home the body of 
 Miss Goodwin, and then took tea with her grandfather, was also ably set 
 forward by his counsel as proof of insanity. The jury, however, took only 
 five minutes to consider the case, and returned a verdict of guilty, and he 
 was sentenced to death. The presiding judge, Baron Martin, next day 
 made a communication to the Home Secretary, the result of which was that 
 forty-eight hours before the time fixed for his execution he was examined 
 by the Commissioners in Lunacy, who reported, " that (for certain reasons 
 given) the prisoner could not be considered as being then of sound mind ; 
 but that according to the law, as laid down by Baron Martin, which was 
 in accordance with the highest legal authorities on the subject, he was 
 responsible for his actions ! ! ! " Most fortunately the same post brought 
 a certificate, signed by three magistrates and two medical men, in accor- 
 dance with the 3rd & 4th Victoria, cap. 54, testifying to the insanity of 
 Townley, who was respited on this report. 
 
 The subsequent proceedings in this case are not a little curious. 
 Thirty-nine visiting justices of Derbyshire, with an enthusiasm worthy 
 of Dennis, the hangman in Barndby Rudge, signed a strong protest 
 against the respite. Public meetings were held, at which, and in a large 
 section of the press, a torrent of invective was showered upon Sir George 
 Grey, on those who had signed the certificate of lunacy, and on those who 
 had given evidence of Townley's insanity. The effect of all this was, 
 that a second commission were appointed to again report on the prisoner's 
 mental condition. These gentlemen came to the conclusion that Townley 
 was of sound mind, and he was again in danger of being executed. 
 Ultimately the sentence was commuted to penal servitude for life, and, 
 finally, this wretched lunatic, by committing suicide in prison, justified 
 the opinion of those who pronounced him mad. 
 
 In the Ofiicial Report on Irish Prisons for 1864, p. 8, I find the 
 following case, ably reported by Mr. Lentaigne, the Inspector-General 
 of prisons, which, although less certainly a case of insanity than those 
 I have already alluded to, is one, at any rate, very closely resembling 
 some of those very remarkable cases mentioned by Dr. Winslow, and 
 other psychologists, in which murder has been connected with the influence 
 of some impression made on the mind in sleep by a dream. Dreaming, 
 I may here remark, being a state that presents many analogies with 
 insanity. 
 
 Mr. Lentaigne says : " In April, 1864, an execution took place in 
 
16 On Insanity, and the Criminal Responsibility of the Insane. 
 
 front of this (the Cavan) gaol, for a murder committed on the 23rd 
 January, under circumstances well deserving attention, as connected with 
 penal legislation. Bernard Cangley lived, fourteen years ago, as farm- 
 servant with Peter Reilly, a farmer, in comfortable circumstances. 
 During that period an ass, belonging to Reilly, bit the left hand of 
 Cangley so severely that it had to be amputated. On his recovery he 
 demanded compensation, which Reilly refused to give. Soon after, as I 
 understand, Cangley went to America, but returning, was convicted of 
 cow-stealing at Trim, and sentenced, on the 9th July, 1861, to three 
 years* penal servitude. During the entire period of his detention in the 
 convict depot he never commited a single breach of prison rules ; and 
 on one occasion, when a fellow prisoner was guilty of an offence, he gave 
 information to his warder. On the 9th January, 1864, he was liberated 
 on license, and, after remaining a few days in Dublin, went to Reilly's 
 house in Cavan, where, on telling his name, he was treated with the 
 greatest hospitality and kindness, and asked to sleep on the loft with the 
 servant boy. Between two and three o'clock in the morning he came 
 down from the loft, only half dressed, saying, " he could not sleep as 
 there were lights or flashes of fire outside the house." Reilly got up to 
 see what was the matter, and was immediately stabbed to death by 
 Cangley, who also stabbed Reilly's wife when she came to her husband's 
 assistance. He then fled, having only his shirt and trousers on, and at 
 once gave himself up at a police barrack some miles distant, saying, " he 
 had stabbed Reilly." The greatest pains were taken by the convict 
 authorities to ascertain if, during the period of his imprisonment, he had 
 ever shown the slightest indication of insanity, but all the medical 
 officers of the convict dopots agreed he was perfectly sane, and the 
 prison officials in Cavan are of the same opinion. It is, therefore, evident 
 that either he had nursed his revenge for the injury during nearly four- 
 teen years, or else on the night in question some sudden impulse had 
 roused him to commit the crime, even at the sacrifice of his own life ; 
 but this is negatived by the fact of his having the knife in his possession. 
 The case is one of those psychological phenomena, the facts of which 
 should be truly recorded, especially at a time when acquittals, on the 
 grounds of insanity, are so easily obtained." 
 
 The Inspectors- General, however, evidently feel themselves in some 
 degree restrained by public opinion, but they observe, in the above 
 quoted report, that acquittals in similar cases are not sufficiently easy 
 (query possible) to be obtained. 
 
 On the 20th of December, 1865, Stephen Forward, alias Southey, who 
 was charged, in August last, with the murder of three boys in London, 
 and also of the murder of his wife and child a day or two after at 
 Ramsgate, was arraigned, tried, and found guilty, before Mr. Justice 
 Mellor, at Maidstone, on the latter charge. The particulars of this case 
 
By DR. T. M. MADDEN. 17 
 
 are too familiar to all of us to need any precis of the facts. And the 
 execution of this wretched man appears to me, in itself, a terrible com- 
 mentary on the injustice of our laws relating to the investigation and 
 punishment of criminal lunacy. 
 
 The last of these cases which I shall refer to is that of Andrew Brown, 
 who was tried before the High Court of Justiciary at Edinburgh, last 
 assizes, and executed at Montrose in January, 1866. The prisoner was 
 the mate of the schooner Nymph, and was tried for the murder of the 
 captain of that vessel, at sea, off the Forfarshire coast. 
 
 On his trial the prisoner pleaded generally " not guilty," and pleaded 
 specially that at the time the act was committed he was labouring under 
 temporary insanity. 
 
 The following is the substance of the evidence : 
 
 "John Pert, sailor, deponed, I was engaged, on the 4th of September, 
 to go a voyage on board the steamer Nymph, of Montrose. There were 
 on board, besides myself, Alexander Reaburnes, Andrew Brown (the 
 prisoner), and John Greig (the master). The prisoner was mate. I first 
 saw the prisoner two or three days before we sailed. We were all sober 
 when we sailed. The prisoner was so, so far as I saw. I had seen him 
 every day for two or three days before that, and had not observed him to 
 be the worse of drink. The master was asleep and snoring when he was 
 killed. Brown slipped forward and went to the forecastle. I did not see 
 him come aft, but I found afterwards that he had slipped behind me. 
 My attention was first directed to that by hearing two heavy blows. I 
 looked over my right shoulder on hearing them, and saw the master's 
 head lying in two halves. I was stunned for a little bit ; and Brown, who 
 had the axe up, let it down again before I could get hold of him. The 
 two blows I first heard were given quickly one after the other, and the 
 prisoner had the third blow struck before I had time to interfere. I 
 then rushed into the bulwarks and took the axe out of his hand and threw 
 it overboard. The master was apparently dead by this time. After I 
 had thrown away the axe Brown said : < I have done the deed, and I will 
 have to suffer for it.' A few minutes afterwards he asked me if I would 
 come and see Mm hanged. About five minutes after I had seized the axe from 
 him he said, c Jack, it is a good job you got the axe, or else you would have got 
 the same. 1 I had a good twist with him before I could get the axe out of 
 his hands. When I was struggling with him he did not speak. I am 
 sure he was sober at that time. I do not think he had much drink that 
 day. Before we went to dinner on shore we had had a drink of ale 
 together, but that was all. The prisoner then took the helm, and steered 
 the vessel for Stonehaven. He spoke about his mother, and in course 
 of conversation, said, but that he wished to see her he would go over the 
 side. I understood by that he would drown himself, but that he wanted 
 to see his mother. He asked the loan of a shilling from me after we 
 
18 On Insanity, and the Criminal Responsibility of the Insane. 
 
 passed Bervie, and said he had a sixpence, and he would give one shilling 
 and sixpence to his mother. He said it would be the last money he 
 would ever give her. He asked Reaburnes and me to wash up the blood, 
 which we did. After the disturbance that had taken place on board we 
 were afraid of Brown. He asked me if I would come to see him hanged. 
 I made no answer. He was not weeping at any time. He said, * Jack, 
 I am going stark mad out of my mind.' This was said about two hours 
 after the deed, and while he was steering." 
 
 Alexander Reaburnes corroborated the evidence. He said : " Prisoner 
 told us, ' Pm master of the ship, and want to go to Stonehaven to see my 
 mother. 9 We tried to get from him, the best way we could, the reason for the 
 murder, and he said, with great violence, and slapping his breast, t 1 have 
 another to kill* We asked what he had done this for. He simply replied, in a 
 lamenting way, ' / have done the deed, and will have to suffer for it.' We 
 asked him who the other person was he had to kill, but he would not tell 
 us. I do not think he meant himself. / did not observe any difference in 
 his spirits after the murder. He was not like a drunken man. He was not 
 swearing or using any harsh language during the afternoon. In sailing 
 into Stonehaven he always gave the orders, and gave them correctly. 
 If this deed itself had not been done, there would have been nothing 
 about him to attract attention at all." 
 
 Cross-examined. " / saw no exhibition of ill-feeling between the master and 
 the prisoner." 
 
 " Evidence was then called for the defence, to show that the prisoner 
 had sustained a fall in boyhood, and that he had had a fall four years ago 
 which led to a surgical operation ; that a block had fallen on his head 
 about a year ago, and that he had suffered other bodily injuries, which 
 had, his sisters deponed, changed his disposition from cheerful to sullen, 
 and that he had gradually fallen into habits of drinking. The witnesses 
 stated that very little drink produced great excitement in the accused, 
 and some thought he was not right in his mind. As one witness 
 expressed it, ' The dram went to his brain.' " 
 
 A verdict of guilty, however, was brought in, in face of this testimony, 
 and the prisoner was sentenced to be executed on the 31st of January. 
 
 The foregoing cases in which sentence of death was pronounced or 
 carried into execution on madmen might be very easily multiplied, but I 
 think I have brought forward quite enough to prove that, by the laws 
 still enforced in England, human life has often been judicially sacrificed, 
 and death has been made the punishment of the most dire calamity that 
 can befal man ; an affliction, too, which may visit the best and wisest of 
 mankind, and against which no precaution can be taken, and no means 
 of prevention adopted the loss of reason. 
 
 We are often told that the inhumane and barbarous customs of our 
 ancestors would not now be tolerated by the advanced civilization and 
 
By DR. T. M. MADDEN. 19 
 
 enlarged philanthropy of the nineteenth century. But I greatly fear that 
 any one who considers the subject which this paper treats of will find 
 too much evidence to prove that we overrate the moral effect of the 
 superior civilization of the present day, and its influence in restraining 
 the evil passions of human nature its cruelty and desire for vengeance, 
 and not for justice. It is true that the insane are no longer lashed and 
 chained in madhouses as they were formerly; but it is not less true 
 that they still may be, and often are, hung by the neck until they are 
 dead, in punishment for acts committed under the impulse of madness. 
 
 I trust that, by the foregoing observations, I have succeeded in showing 
 how uncertain and unjust is our present law in reference to the criminal 
 responsibility of the insane ; but a recent official document, the Report of 
 the Capital Punishment Commission, 1865, proves far more cogently than I 
 could do so, the necessity of an amendment of the laws relating to, and 
 the mode of determining, the mental capacity of criminals charged with 
 capital offences. In the 18th section of that report the Commissioners 
 say: 
 
 " 18. There are other questions of great importance upon which we 
 have taken evidence, viz. : (1.) The propriety of allowing an appeal on 
 matters of fact to a court of law in criminal cases. (2.) The mode in 
 which the crown is advised to exercise the prerogative of mercy by the 
 Home Secretary. (3.) The present state of the law as to the nature and 
 degree of insanity, which is held to relieve the accused from penal 
 responsibility in criminal cases. It is obvious that these difficult questions 
 are not confined to capital crimes only, but pervade the whole adminstra- 
 tion of criminal law. They therefore require a more general and 
 comprehensive treatment than the terms of the commission under which 
 we act will admit. We think, therefore, that while we should not be 
 justified in making any recommendation to your Majesty on any of these 
 points, we should fail in our duty did we not humbly solicit your Majesty's 
 attention to them as requiring further investigation." 
 
 It, however, can surely need little evidence to prove that laws which 
 are connected and deal with a scientific question, and which were enacted 
 when that branch of science was in its infancy, and are in a great 
 measure founded upon the false theories and imperfect knowledge of the 
 time when they were made, are now far behind the present state of 
 psychological information, and therefore require revision. To amend 
 the present state of the law of criminal insanity I would propose two 
 very short and simple, yet, I believe, most effectual, measures, viz. : 
 
 1st. The 64th article of the French code should be adopted by our law 
 in its entirety. 
 
 2nd. The question of madness should be decided by a tribunal of 
 experts. 
 
20 On Insanity, and the Criminal Responsibility of the Insane. 
 
 The article of the Code Napoleon to which I refer is as follows : 
 
 " II n'y a ni crime ni delit, lorsque le preVenu etait en etat de de'mence 
 ail temps de 1'action." a 
 
 In the State of New York a similar law has been long enacted : 
 
 " No act," says this statute, " done by a person in a state of insanity 
 can be punished as an offence, and no insane person can be tried or 
 sentenced to any punishment for any crime committed in that state." b 
 
 In cases in which the defence of insanity is set up, the English law, 
 as laid down by Mr. Justice Mellor, on the trial of Southey at Maidstone, 
 December, 1865, is, that " the question of the fitness of the prisoner to be 
 tried should be determined before he was called on to plead. But in a 
 case which occurred before his brother Blackburn, where it arose in the 
 course of the trial, he put both questions at the end of the trial whether 
 the prisoner was in a fit state to be tried, and whether he was guilty or 
 not guilty. There would be a great loss of time and great inconvenience 
 in having the question tried twice over." c 
 
 By the 39th of George III., cap. 44, it is provided that " If on the 
 trial of any person for murder or felony, he appear to the jury charged 
 on the indictment to be insane, the Court may order the finding to be 
 recorded, and that he be kept in custody till Her Majesty's pleasure 
 be known." It was moreover enacted by the 39th and 40th George III., cap. 
 94, and also by the 3rd and 4th of Victoria, cap. 54, that, even after 
 sentence has been pronounced, " it shall be lawful for any two justices of 
 the peace of the county or place where any person under sentence of 
 death is confined, to inquire, with the aid of two physicians or surgeons, 
 as to the insanity of such person ; and, if it shall be certified by such 
 physicians and surgeons that such person is insane, it shall be lawful for 
 one of Her Majesty's principal Secretaries of State to direct, by warrant, 
 that such person be removed to a proper receptacle for insane persons." 
 This, however, was merely a permissive law, and was so seldom acted upon 
 that when it was put in practice in the case of Townley, the press and 
 public opinion were vehement, and almost unanimous in their condem- 
 nation of those who had ventured to save thus, a madman from the 
 gallows. By the 27th and 28th of Victoria, cap. 29, an important 
 modification was made in the law, by which the power of medical inquiry 
 into the state of mind of persons under sentence of death was confined 
 to physicians and surgeons specially appointed for this purpose by one 
 of her Majesty's Principal Secretaries of State. 
 
 The second point on which I would insist, namely, that the question of 
 insanity should be decided by experts, is unhappily opposed by the 
 weight of public and legal, as distinguished from humane and scientific, 
 opinion. 
 
 French Penal Code, Article 64. 
 b Revised Statutes, vol. ii., p. 697. 
 The Times, December 21st, 1865. 
 
By DR. T. M. MADDEN. 21 
 
 There is, unfortunately, a great aversion to the reception of medical 
 evidence in cases of insanity, and such testimony carries little weight with 
 either the judges or juries in most cases. 
 
 The opinion tersely expressed by Lord Chancellor Westbury, in the 
 House of Lords, not very long since, when he spoke of "the vicious 
 principle of considering insanity as a disease," seems to prevail widely in 
 this country. The Earl of Shaftesbury, in his evidence before the select 
 Committee of the House of Commons on lunatics, went so far as to say : 
 " For my own part I do not hesitate to say, from very long experience, 
 putting aside all its complications from bodily disorder, the mere judgment 
 of the fact whether a man is in a state of unsound mind, and incapable of 
 managing his own affairs, requires no professional knowledge. My firm 
 belief is that a sensible layman conversant with the world and with man- 
 kind can give not only as good an opinion, but a better opinion than all 
 the medical men put together. I am fully convinced of it." At the trial 
 of Foulkes for murder, in August, 1862, the learned judge thus in- 
 structed the jury: "If common sense is not to decide, you ought not to 
 be in that box ; as juries do not pretend, and are not expected to have 
 
 any scientific knowledge You are not to be deprived (added 
 
 the judge to the jury, proudly swelling with the sense of their own 
 sagacity and importance) of the exercise of your common sense, because 
 a gentleman comes from London and tells you scientific sense." Accord- 
 ingly the jury exercised this common sense, and showed their proper 
 contempt for science by finding a man, stark mad, guilty of murder. 
 
 It would, of course, be misplaced and unnecessary here to stop for the 
 purpose of discussing the necessity of scientific evidence, and the 
 fallaciousness of those views which lead to its rejection. That insanity 
 is a disease is patent enough to medical men who are well acquainted 
 with the intimate connexion of mind and body ; the relation which the 
 health of the latter bears to that of the former, and the influence exercised 
 by medicine over the diseased conditions of both ; but it would take more 
 time than I have now at my disposal to prove this proposition to lawyers 
 and jurymen equally ignorant of physiology and psychology. 
 
 The difficulty of recognizing insanity, and of distinguishing between 
 real and feigned insanity, and the consequent danger that under the plea 
 of unsoundness of mind, madness may be feigned, and thus lead to the 
 immunity of criminals, is probably the explanation of the reluctance with 
 which judges and juries generally entertain that plea. This very difficulty 
 is, however, the most powerful argument against the present system of 
 dealing with such cases. 
 
 Nothing can probably require more discrimination, care, and tact than 
 the recognition of some of the less evident forms of mental disease, or 
 than to distinguish between real and simulated insanity. Such knowledge 
 of the human mind cannot be acquired without special training and 
 
22 On Insanity, and the Criminal Responsibility of the Insane. 
 
 experience. And even with such training it is often a matter of extreme 
 difficulty to discover evidence of insanity when delusions the most strange 
 and strongly impressed on the mind actually exist. I was recently 
 requested to visit a gentleman in a lunatic asylum near Dublin, for the 
 purpose of signing a certificate. Yet such was the insane cunning with 
 which he managed to conceal his madness, that although I was previously 
 aware of the nature of his delusion, and conversed with him on the point 
 for an hour, and though he presented the peculiar aspect of insanity which 
 is more familiar to the attendants on the insane, than easy to describe, 
 still I felt obliged to leave without signing the certificate. I, however, 
 subsequently sought an opportunity of again seeing this man, and then, 
 at a single interview, ascertaining his madness, signed the paper. This 
 I mention only as one of the instances which almost every practitioner 
 meets with, showing the difficulty of pronouncing a person sane or mad. 
 
 No rational man would be likely to take the opinion of a jury of 
 grocers, publicans, or tallow chandlers, as to whether his lungs were 
 sound, or his watch in order, in preference to those of a physician or a 
 watchmaker. And yet a question far nicer than either of those, the 
 question of a man's healthy or diseased psychological condition of all 
 scientific investigations the most delicate and difficult is, by the laws of 
 England, left to the decision of such persons, assisted by a judge whose 
 knowledge, however extensive it may be in legal matters, is hardly, if at 
 all greater than theirs on any department of medical science. 
 
 But besides the foregoing, there is, I think, another cause assignable 
 for the unfavourable opinions expressed by lawyers and judges as to the 
 value of medical evidence in cases of insanity. They, perhaps, may 
 consider that medical men, when employed either by the government as 
 witnesses in cases of alleged criminal lunacy, or by either party to a 
 private case of imputed insanity, may, and very likely unconsciously, be 
 influenced by the fact of being produced or preferred by one side or the 
 other and thus sometimes, it may be, have the opinions they express 
 more or less affected by the views of their employers. 
 
 On such occasions, and when placed in such a position, medical men 
 should, however, bear in mind what they are, and consider themselves as 
 members of a pre-eminently exalted, ennobling, and humanizing profes- 
 sion, having the sacred offices of a high and holy calling to perform, and 
 bound at all hazards, and at every sacrifice of self-interest, to sustain the 
 ends of truth and justice alone. 
 
 As lawyers predominate in the legislature, we can hardly hope to wrest 
 the question of lunacy although it is as medical a question as fever or 
 consumption from their control, but still something might be affected 
 towards reforming and obviating the recurrence of the abuses I have 
 indicated. If the voice of the profession were unanimous in urging the 
 great importance of the subject on public attention, it might be possible 
 
By DR. T. M. MADDEN. 23 
 
 to obtain the appointment of medical assessors in lunacy, who, as the 
 nautical assessors do in marine cases, should advise the court on all 
 professional points. This would to a great extent do away with the 
 necessity for the examination of numerous witnesses in lunacy cases, 
 save the public time, and would avoid the perplexing contradictions of 
 conflicting professional opinions. 
 
 There are many other topics connected with the subject of insanity and 
 criminal responsibility which my space prevents my even alluding to. I 
 shall therefore conclude with expressing an earnest hope that a wiser and 
 more humane spirit may before long pervade the laws of this country 
 relating to so-called criminal insanity ; and that the most terrible punish- 
 ment that man can inflict shall no longer be awarded to the most 
 unfortunate of all victims of disease. 
 
 *ftr 
 
ON DREAMING, CONSIDERED ESPECIALLY IN 
 RELATION TO INSANITY. 
 
 By THOMAS MOBE MADDEN ME.IA 
 
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 ON DREAMING, CONSIDERED ESPECIALLY IN 
 RELATION TO INSANITY. 
 
 Riad be fore the Medical Society of the College of Physicians, Dublin, 
 March 20th, 1867. 
 
 By THOMAS MORE MADDEN, M.E.I.A., 
 
 LICENTIATE OF THE KINO AND QUEEN 1 S COLLEGE OF PHYSICIAXS IK 
 IRELAND, MEMBER OF THE EOYAL COLLEGE OF SURGEONS OF ENGLAND, 
 AUTHOR OF AX ESSAY " ON INSANITY AND THE CRIMINAL RESPONSI- 
 BILITY OF THE INSANE," " ON CHANGE OF CLIMATE, A GUIDE FOB 
 TRAVELLERS IN PURSUIT OF HEALTH," &C., &C., &C. 
 
 THE subject of the following communication is a branch of 
 medical psychology, which many years ago was discussed 
 before the former Medical Association of this college in a 
 paper by Mr. Andrew Carmichael, read before the Associa- 
 tion on the 6th of April, 1818, by Dr. Brooke, and printed 
 in the transactions for that year. As, however, I purpose 
 to treat the subject from a different point of view to that 
 adapted by Mr. Carmichael in his " Essay on Dreaming, 
 including conjectures on the proximate cause of Sleep," 
 above referred to, I mention this fact merely to show that 
 the question of dreaming, considered especially in relation 
 to thfr study of insanity, seems to be & matter not un- 
 worthy of the attention of this Society, also, which now 
 represents the former Association of "the members of the 
 College of Physicians. 
 
 In considering the nature and causes of insanity I was 
 often strucK by the close resemblance which appears to 
 exist between the state of the mind in insanity, and in the 
 dreaming condition. And I have now attempted to digest 
 the notes I made on this subject during some years into 
 regular form, in the hope of being able to contribute some- 
 thing to what is known concerning a very obscure branch 
 of mental science, and one which may possibly throw some 
 light on tJ|^^iture of the morbid action in the mind which 
 constitun^Hviity. 
 
 By the^^rity of scientific writers, dreaming has been 
 considered from a purely metaphysical point of view, and 
 perhaps on that account has received less attention than it 
 deserves from physiological and pathological inquirers, who 
 too often seem to ignore the truth, well expressed by Reid, 
 that " Medical cannot be separated from moral science 
 without essential mutilation." I know hardly any work 
 in the English language that treats of this question in a 
 full and satisfactory manner. 
 
 The best account of the physiology of dreaming which 
 I am acquainted with is that contained in Sir Henry 
 Holland's " Chapters on Mental Physiology," which, in r 
 teresting and suggestive as it is, yet leaves some parts of 
 the inquiry altogether untouched, and hardly even alludes 
 to the diagnostic and prognostic value of the signs 
 furnished by this condition of the mind. 
 
 I therefore hope that I may claim the indulgent con- 
 sideration of the Medical Society for the following attempt 
 to elucidate the question of dreaming as one of the most 
 interesting problems connected with mental physiology. 
 And I believe that I shall be able to show that this condi- 
 tion of the mind affords indications which, if rightly inter- 
 preted, are calculated to throw light on the diagnosis and 
 prognosis of some of the most obscure diseases which 
 affect mind and bodv. 
 
I. VARIOUS THEORIES OF DREAMING, ANCIENT AND 
 MODERN. 
 
 What a dream really is ? and how and why we dream ? 
 are questions which have been investigated by some of the 
 greatest philosophers of every age, but which, nevertheless, 
 still remain unsolved. Before aying my own views on 
 these questions before the MeoLcal Society, I shall first 
 briefly allude to some of the most remarkable theories on 
 the subject ; as even in the widest speculations on philo- 
 sophical questions we may occ?.s"onally discover some 
 vestige of truth, or <-.t lecst, may learn to avo:d the error 
 of our predecessors. 
 
 In Homer we find the idea that " Dreams descend from 
 Jove."(l) Herodotus makes Artabanus tell Xerxes that 
 " Dreams in general originate from those incidents which 
 have most occupied the thoughts during the day."(2) Epicu- 
 rus, we are told, taught that dreams were occasioned by 
 " images" which were supposed to emanate from all material 
 bodies, and- that being of extreme tenuity these images 
 penetrated into the mind, although the senses were closed, 
 during sleep, and excited in the sensorium a perception, or 
 dream, of the object from which they proceeded. This 
 absurd idea was subsequently adopted, and amplified by 
 Lucretius. 
 
 In the treatise^" On Dreams," commonly attributed to Hip- 
 pocrates, which, although its authenticity is disputed by the 
 late Dr. Adams, is of unquestionable antiquity, being quoted 
 by Galen, we find an exposition of the opinion of the early 
 Greek physicians! on the subject " When the body is at 
 rest the soul being then in a state of movement steals over 
 the organs of the body, manages its own abode, and itself 
 performs all the actions of the body ; for the body being 
 asleep does not perceive, but the soul being awake beholds 
 what is visible, hears what is audible, walks, touches, is 
 grieved, reflects, and in a word, whatever the offices of the 
 soul anti body are, all these the soul performs in sleep. 
 Whoever then knows how to judge of all these correctly 
 will find it a great part of wisdom."(3) 
 
 Most of the early medical writers allude to the species 
 of dreams to which Hippocrates refers in the passage I 
 have just cited, and which they imagined often revealed 
 the remedy for whatever disease the dreamer suffered from. 
 
 Galen tells us that ^Esculapius was supposed to assist the 
 sick in dreams, and in them that he pointed out the proper 
 remedy for whatever disease the patient might suffer from. (4) 
 When Galen himself was suffering from inflamation of the 
 diaphragm, we read that he was instructed in a dream to 
 open a certain vein, which he did, and recovered. Also the 
 physician Abin Zoar acquired in the same way a knowledge 
 of the medicine, by the use of which he was cured of a 
 severe ophthalmia. But it was among the Greeks that this 
 idea was fullv developed and formed into a regular system. 
 
 (1) Homer, "Iliad" Book, i. line 86. 
 ) Herodotus, "Polymnia" chap. xvi. 
 
 (3) See Dr. Adams, Disquisition on the authenticity of the different 
 rreatases attributed to Hippocrates," prefixed to Sydenham Society 
 Edition of Hippocrates, vol. Tp. 8*. 
 
 (4) Galen, ''be Sanit, Tuend.'J^ Lib. i., cap. 8. 
 
In the first volume of SSprengeYs great work on the 
 " History of Medicine," is a most interesting account of the 
 manner in which the Greek's prepared themselves before 
 sleeping in the temples of ^Esculapius, and of the dreams 
 with which they were visited in these places. (5) 
 
 Speaking of the uses of dreams, Jamblicus says : "And 
 bodies, indeed, that are diseased it heals; but properly 
 disposes such things as subsist amongst men erroneously 
 and disorderly. It likewise frequently delivers the dis- 
 coveries of arts, the distribution of justice, and the estab- 
 lishment of legal institutions. Thus, in the temple of 
 ^Esculapius, diseases are healed through divine dreams ; 
 and through the order of nocturnal appearances, the me- 
 dical art is obtained from secret dreams."(6) Herodian tells 
 us that Antonius being ill, " hastened to Pergamus, in Asia, 
 with intent to apply to ^sculapius for the recovery of his 
 health, and there amused himself with dreams."(7) Aristo- 
 iphanes gives a detailed account of the rites used to invoke 
 :a dream in the temple of ./Esculapms in his comedy of 
 .Plutus, or Wealth (Act iii., Scene 2nd). But if, notwith- 
 standing these rites and preparations, the patient did not 
 dream of any remedy, we are told by Artemidorus,(8) that 
 whatever the patient happened to dream about was con- 
 sidered as allegorical of the remedy. Though, as Sir Thomas 
 Brown well observed,' " A man might have been hard put 
 to it, to interpret the language of ^Esculapius, when, to a 
 
 consumptive person, he held forth his ringers; implying, 
 thereby, that his cure lay in dates, from the homonomy of 
 the Greek, which signifies dates and fingers."(l) Being thus 
 vague, these dreams were interpreted by the guardians of 
 the temples, who appear to have generally been shrewd and 
 observant physicians. Plato's theory on this subject was, 
 that dreams are caused by demons, or spirits, which he 
 imagined filled the earth and air ; and that some of these 
 spirits being of good, and others of evil, natures, gave rise 
 to corresponding dreams. (2) Wild and fanciful idea as this 
 is, it is not a little strange to see it advocated by a very sober 
 Scotch philosopher of the 17th century, with some slight 
 modification. " Our dreams," says Mr. Baxter, " are pro- 
 moted by separate immaterial beings." And again, he 
 argues that " these beings lie in wait for, and catch the 
 opportunity of the body, to represent, at the same time, 
 something frightful to the mind."(3) 
 
 (5) Sprengel, "Histoirede la Medicine, Traduite de 1'Allemend par. 
 M. Jourdan, tome premier." Pp. 160, 161. Paris, 1815. 
 
 C6) Jamblicus, "On the Mysteries." Section iii., chap. 3, page 120 
 Translated by Taylor. Cheswick, 1821. 
 
 (7) Herodian's " History of hisQwn Times." Translated by Hart, p. 
 181. London, 1749. 
 
 (8) Artemidorus, " Oneirocritica." Lib. IT., cap. 24, p. 215. 
 
 Sir Thomas Brown, " On Dreams." Works vol. iv., p. 357. 
 215 257 ^Public." Book vii. 
 
 (3) Baxter's " Inquiry into the Nature of the Human Soul." Pp. 
 
\ 
 
More rational than the last quoted speculation was 
 Aristotle's opinion, which, in reality, differs very little from 
 that supported by some modern metaphysicians. He says 
 that every visible object makes an impression on the mind, 
 but that this impression may remain in a latent condition, 
 until it be called into active existence, during sleep, by 
 motions in the brain, commenced before slumber has occur- 
 red, but continuing to operate in sleep, and giving rise to a 
 dream, which is a " Phantasma" or appearance of a thing, 
 after the object itself is removed. 
 
 In the " Diemonalogia" of Don Francesco Torreblanco, 
 published in the early part of the 17th century, the opinions 
 then prevalent on this subject are thus stated: "The 
 visions or dreams which occur in sleep are either to be 
 ascribed to God, nature, or the devil. Those which are 
 from God are distinguishable from those which are to be 
 attributed to the devil, as we are told by Gregory the 
 Great 'Holy men discern between illusions and revela- 
 tions, and distinguish the sounds emitted, and images per- 
 ceived in those visions when cast into deep sleep, so as to 
 know those which emanate from a good spirit, and those 
 which they suffer from (contrary) illusions.' "(4) 
 
 There have been many theories as to the moral signifi- 
 cance of dreams, which at very remote periods of time have 
 expressed a very similar idea, as may be seen by the follow- 
 ing instances : Zeno was of opinion that we might judge 
 of our advancement in virtue from our conduct in dreams ; 
 and that if, in sleep, we discover that our minds are prone 
 to yield to our passions, it is u clear indication that we 
 have great need to watch over ourselves. (5) Sir Thomas 
 Brown says the same thing in other words " However 
 dreams may be fallacious concerning outward events, yet 
 they may be truly significant at home ; and whereby we 
 may more sensibly understand ourselves. Men act in 
 sleep with some conformity unto their awakened senses; 
 and consolations or discouragements may be drawn from 
 
 dreams which intimately tell us ourselves 
 
 Persons of radical integrity will not easily be perverted in 
 their dreams, nor noble minds do pitiful things in sleep."(6) 
 The last opinion I shall quote on this point is that of pro- 
 bably the most philosophical medical writer of the 19th 
 century, the late Sir Benjamin Brodie, who says: 
 " Dreams are, at any rate, an exercise of the imagination, 
 and one effect of them may be to increase the activity of 
 that important faculty during our waking hours. As they 
 are influenced by our prevailing inclinations, so they may 
 help us to form a right estimate of our own characters ; 
 and assuredly it would be presumptuous to say that they 
 may not answer some still further purpose in the economy 
 of percipient and thinking beings."(7) 
 
 T shall conclude this brief notice of the various theories 
 
 of dreaming by citing an English philosopher of the 17th 
 century, a German metaphysical writer of the present day, 
 and a French author, whose work on this subject has been 
 approved of by the Institute of France. Ail these convey 
 the same theory in different forms. The first Thomas 
 Hobbs, of Malmsbury, says" Dreams are the imagination 
 of them that sleep. . . . There is a reciprocation of 
 
 (4) Torreblanco, cited in Dr. R. E. Madden's " Phantasmata ; or, Il- 
 lusions and Fanaticisms." Vol. i.. p. 104. London, 1857. 
 
 (5) Plutarch in "Life of Zeno." 
 
 (6) Sir,Thomas Brown, " On Dreams." Works vol. iv., p. 357. Edi- 
 tion of 1835. 
 
 (7) Sir Benjamin Brodie, " Psychological Inquiries," &c. Part first, 
 p. 158. Fourth Edition. London, 1862. 
 
motion from the brain to the vital parts, and back from 
 the vital parts to the brain ; whereby not only imagination 
 begetteth motion in these parts, but also motion in those 
 parts begetteth imagination like to that by which it was 
 begotten."(l) Baron von Feuchtersleben, an eminent Ger- 
 man phychologist, asserts that " dreaming is nothing more 
 than the occupation of the mind in sleep with the pictoral 
 world of fancy."(2) Monsieur Lemoine, in his interesting work, 
 " Du Sommeil," thus defines a dream: "Un reve," he says, 
 " propennent dit, reduit a sa siinplicite e"le"mentaire, a sa 
 purete" parfaite, c'est une sensation, c'est une vision, c'est 
 une image excit^e tout a coup dans 1'ame par un mouve- 
 ment intestine de 1'organe et qui s'evanouit avec sa cause 
 organique."(3) 
 
 THE NORMAL STATE OF THE MIND DURING SLEEP. 
 
 The question we have first to consider is, whether the 
 mind during sleep is always occupied by dreams or not? 
 And if not, when, and under what circumstances do dreams 
 occur ? Most metaphysical writers on this subject incline 
 to Lock's opinion, that we do not dream always when 
 asleep, for we do not think always, and he argues that we 
 " cannot think at any time, waking or sleeping, without 
 being sensible of it." Therefore. Lock concludes, that 
 " most men pass a great part of their sleep without dream- 
 ing."^) Reid and McNish are of a similar opinion. A 
 much higher authority on all physiological questions than 
 any of those I have just named, Dr. Carpenter holds the 
 same views on this subject, (5) and Lord Brougham in 
 his " Discourse on Natural Theology," expresses his belief 
 that we dream only in the intermediate condition between 
 sleeping and waking. The experience, however, of the 
 great majority of observers confirms the opposite opinion 
 namely, that we seldom, if ever, sleep without dreaming, 
 although in many cases we have no recollection whatever 
 of having dreamt. Baron Von Feuchtersleben holds that, 
 '* we, in fact, never sleep without dreaming."(6) German 
 metaphysicians, as for example, Kant and Von P?hlegel,(7) 
 generally incline to the same opinion; and th^ highest 
 authorities in this country on mental sciencr- believe 
 dreaming to be the normal state of the mind during sleep. 
 The late Sir Benjamin Brodie, says, " I should myself be 
 inclined to doubt whether, we ever sleep without some 
 degree of dreaming. At any rate, not to dream seems to 
 be not the rule, but the exception to the rule."(8) Sir 
 Henry Holland, too, argues that sleep without dreams does 
 not exist ; " for," he says, " otherwise there would be two 
 states of sleep more remote from each other than we can 
 
 } ^' ^ 6 iS D ? Wrks of Thomas Hnbbs (of Malmsbury). Edited 
 
 < ?S ? h ' , >r T J ipOS '" vo1 ' iv ' P- 10 - London. 1840. 
 n T k%^ l ? cl P l ^ ofM ^cal Psychology." By Baron von Feuchter- 
 V Sydenham, 8vo, translation, p. 163. London, 1843. 
 l)r. A. I^mome, "DuSommeil Au Point de vue Phvsioloirique et 
 0uvra S e ooronne par L'Institut de France. P. 155. 
 
 t^c 7 COncernia S the Hu man Understanding. Book ii., Cap. 
 
 I68 
 
 of Li ' 
 
 68 1SirBI ' .'loifi.-al rnquiriw. Vol. i., p. :5|. London, 
 
conceive any two conditions of the same Hying being 
 one in which sensations, thoughts, and emotions are pre- 
 sent inactivity and unceasing change, another in which there 
 is the absence or nullity of every function of mind annihi- 
 lation, in fact, for the time, of everything that is not 
 organic life."( 9 ) ! shall only quote one other authority 
 which, however, appears to me to decide the question. 
 Sir William Hamilton made a series of experiments on 
 himself with regard 'to this point by causing himself to be 
 aroused from sleep at certain fixed intervals, and when 
 thus suddenly awakened from sleep always found that he 
 was either interrupted in the course of some dream, which 
 he remembered, more or less perfectly, or else felt aware, 
 at least, that he was not aroused from an unconscious 
 state. (10) 
 
 INDEED, it must, I think, appear most probable that as 
 long as vitality remains there can never be a complete 
 cessation of thought; and the mind, during sleep, as well 
 as during the waking state, continues to operate, even 
 though in the former condition the consciousness of its 
 operations be suspended, and though the mind may then 
 act faintly or imperfectly; or, perhaps, in a totally dif- 
 ferent way from that in which it acts during the waking 
 state. Every one who has had occasion to sit up with 
 invalids, and to watch them during sleep, knows that 
 dreamers are seen to toss about in bed, to express various 
 emotions in their countenance, are heard to moan and 
 talk in their sleep, and are known to enact their dreams, 
 as in the case of somnambulists, all without any recollec- 
 tion whatever of having dreamt, and such persons, when 
 they are aroused from a dream in which they have given 
 manifest signs of their statue, will often insist that their 
 sleep has been perfectly calm and undisturbed. 
 
 It is evident that the condition of the mind of a 
 dreamer, must be very different from the mental state of 
 the same person when awake. In the latter case the 
 current of thought (except when the individual is absorbed 
 in deep reverie, which is a state very analogous to 
 dreaming) is influenced and modified by the constant suc- 
 cession and change of external impressions transmitted 
 by the senses. But in sound sleep all impressions from 
 the external world are either entirely shut out, and the 
 mind is no longer in any degree under the dominion of 
 their suggestions ; or else, as is perhaps more frequently 
 the case, these impressions are so faintly or imperfectly 
 conveyed as to produce sensations and results altogether 
 different from those they would have occasioned in the 
 waking mind. 
 
 18S2. Sir H H ' 1Iiind ' 8 Chapters on "Mental Physiology." London, 
 .'10) Sir Wil\ in -t Lectures on Mrtaphysir*, Vol i., p. 323.. 
 
Impressions, however, may also originate from within the 
 brain itself, as well as be transmitted to it from without. 
 That such may be the origin of some dreams is more than 
 probable for such, as far as we know, is the nature of those 
 sensations, for example, which patients who have under- 
 gone a capital operation, occasionally refer to limbs which 
 no longer exist. Of a character, too, are those hallucina- 
 tions of the organs of special sense that occur in the course 
 of many febrile and nervous complaints, and also in some 
 chronic maladies. These false perceptions of taste, sight, 
 and hearing, occasionally commence in dreams, although 
 they may be continued into, and influence the waking 
 senses. Thus, for instance, a gentleman under my care 
 suffering from dyspepsia, dreamt one night that he was 
 compelled to eat mal gre lui, a quantity of molasses, and 
 on awaking perceived an intensely sweet taste on his palate. 
 This lasted for eight or ten days, and for that time altered 
 and perverted the flavour of everything the patient ate or 
 drank. A somewhat similar case is recorded by Dr. 
 Millingen in his " Curiosities of Medical Experience" 
 (p. 311), in which the sense of vision was effected by an 
 hallucination commencing in a dream. Closely related to 
 this part of the inquiry into the nature of dreams, a sub- 
 ject of considerable interest in connection with the medical 
 jurisprudence of insanity presents itself. In his well- 
 known work on" Obscure Diseases of the Brain," Dr. Forbes 
 Winslow narrates several instances in which dreaming ap- 
 pears either directly or indirectly to have led to the com- 
 mission of serious crimes of various kinds. " A person," 
 says this eminent psychological physician, " apparently 
 well, has gone to bed without manifesting the slightest 
 tendency to self destruction, and on being suddenly 
 aroused from a frightful dream has destroyed himself. "(1) 
 The same author also refers to some cases in which mur- 
 der was apparently committed under the influence of 
 dreams. And, in a communication I had the honour to 
 read before this Society on the 21st of March, 1866, I 
 made some observations on a very remarkable case of a 
 somewhat similar character to those described by Dr. 
 Winslow. (2) 
 
 III. VOLITION NOT NECESSARILY SUSPENDED DURING 
 SLEEP. 
 
 We find it asserted by some physiologists that the 
 essential character of sleep is the suspension of volition, 
 But this proposition is far from being generally true, 
 unless, indeed, we admit that dreaming and sleeping are 
 two separate states of existence. For although the power 
 of controlling and changing the subject of our thoughts is 
 generally suspended in dreams, yet there are many anp 
 striking exceptions to this law recorded, especially by 
 Abercrombie and Eeid, in which the dreamer had the 
 power of stopping a dream at a particular point. And, 
 even without referring at all to the question of somnambu- 
 lism, another objection to the theory that volition is of 
 necessity lost during sleep is presented by the well-known 
 phenomena of incubus, or night-mare, in which volition, 
 although without the power of executing the act willed. 
 
 (1) Dr. Forbes Winslow "On Obscure Diseases of the Brain, and 
 
 ders of the Mind," p. "592. London, 1861. . 
 
 2) Dr. Thomas More Madden "On Insanity, and the Criminal 
 Responsibility of the Insane," pp. 15, 16. Dublin, 1866. 
 
appears to be exerted. Dryden has so admirably rendered 
 Virgil's description of this state that I cannot refrain from 
 quoting it : 
 
 " And as when heavy sleep has closed the sight 
 The sickly fancy labours in the night, 
 We seem to run ; and destitute of force, 
 Our sinking limbs forsake us in the course : 
 In vain we heave for breath, in vain we cry : 
 The nerves, unbraced, their usual strength deny ; 
 And on the tongue the faltering accents die." 
 
 (^XEID B. xii., L. 908.) 
 
 In such dreams it is evident that it is not volition, 
 but the power of co-ordinating the movements which are 
 willed that is suspended by sleep. The cerebellum in 
 dreams being probably quiescent while the cerebrum is 
 active, and therefore no voluntary action can respond to 
 the exercise of the will. 
 
 IV. CHARACTER OF THE VISUAL IMPRESSIONS OF 
 DREAMS. 
 
 It is a generally received opinion that the impressions of 
 visible objects seen in dreams are effected in the retina, 
 from which they were originally, at some previous time, 
 transmitted to the brain, and thence are returned during 
 the dream by the optic nerve, and produce their impression 
 on its occular expansion. If this theory were correct, 
 however, it would be impossible to explain the phenomena 
 of dreams in persons born blind, or in whom the retina has 
 been destroyed by disease, and who, nevertheless, continue 
 to dream of visual objects. It therefore seems, I think, 
 more probable that the visible objects of dreams are inde- 
 pendent of the ordinary channels of vision, and are pro- 
 duced directly within the sensorium. 
 
 V. SLEEP-TALKING 
 
 Into the question of somnambulism I shall not attempt to 
 enter on the present occasion, as the subject is too extensive. 
 But I should gladly, if I should ever have the time and 
 opportunity, for so doing, treat of it as a distinct and most 
 interesting subject of investigation. I may remark, how- 
 ever, that in the state of sleep-talking, which is a form of 
 somnambulism, it appears as though the mind had regained 
 its command over the voluntary muscles which are connec- 
 ted with the vocal organs, and that these respond to the 
 will, and perform their accustomed functions in proportion 
 to the vividness of the dream as well as the strength of vo- 
 lition and state of health of the dreamer, being most ener- 
 getic when the sleeper's health is most delicate. In those 
 rare cases in which the dreamer responds to questions, and 
 to a certain extent is capable of entering into conversation 
 while still asleep, the person's condition is evidently that 
 of partial or imperfect sleep. For not only is the external 
 mpression transmitted through the portio mollis of the 
 seventh cerebral nerve in the ordinary manner, but, moreover, 
 it produces its ordinary action on the portion of the brain 
 connected with the sense of hearing and volition is excited 
 and transmitted to the voluntary muscles of the parts by 
 which the response is made, thus clearly showing that 
 these organs are not under the dominion of sleep. 
 
 VI. TRANSITORY CHARACTER OF THE MENTAL IMPRES- 
 SIONS MADE BY DREAMS. 
 
 The evanescent nature of the impressions made on the 
 mind by dreams is a matter of familiar observation. It 
 is nearly always exceedingly difficult and generally, indeed, 
 impossible to recall to memory an hour or two after we 
 
awake the very subject of even the most vivid dream ; and 
 when we do succeed in recalling the subject our recollec- 
 tions are generally vague, indefinite and obscure. This 
 very curious fact, has, I believe, never been in any way ac- 
 counted for. The only condition that appears to present 
 an analogy in this respect to dreaming, is the state pro- 
 duced by the action of certain stimulating narcotics, such as 
 alcohol, opium, and chloroform, under the influence of 
 which acts are performed and things are suffered of which 
 no trace at all Cor at any rate one as indistinct as the recol- 
 lection of a dream) is left on the memory when the effect 
 of the drug has passed off. 
 
 VII. "SLEEP-INDUCING HALLUCINATIONS." 
 
 Under the above name, Mons. Maury and other 
 recent French writers on this subject describe a form 
 of spurious dreaming which presents a very close ana- 
 logy to insanity, and that which M. Maury states is 
 very common even in persons whose mental as well as 
 bodily health are equally good. These "sleep inducing 
 hallucinations," as they are called, consist of spectra, 
 which appear before the mind just at the moment of sleep, 
 and which, according to M. Maury, are reproduced in the 
 ensuing dream. (1) My own observations, however, lead me 
 to think that this phenomena is not so commonly met with 
 as the writer I have just referred to supposes. In fact, of 
 the very large number of persons I have questioned on this 
 subject very few indeed were conscious of these "pre- 
 somniferous hallucinations." I know one person to whom 
 they sometimes occur, but as far as he is conscious of are 
 never reproduced in the succeeding dream. Occasionally 
 these hallucinations are so vivid that the delusion continues 
 even after the eyes are open. Some months ago after hav- 
 ing passed a restless night, this individual was dozing off 
 towards morning, when in the transition state between 
 sleeping and waking, two spectra, whose faces he felt quite 
 familiar with though they were of collossal size and were 
 clad in the costume of last century, appeared standing one 
 at each side of the foot of the bed, over which they leaned 
 upon their halberds. To assure himself that he was not 
 dreaming, he opened his eyes and sat up in the bed, but 
 the hallucination still continued for some time as distinctly 
 as before, and then suddenly disappeared. This case pre- 
 sents a good example of the close resemblance between th e 
 phenomena of the state just described and insanity. Here 
 was an impression produced by a hallucination on one of 
 the senses, which was as vivid, for the time, as if it had been 
 produced by an objective cause, and had this hallucination 
 extended to the other senses, and if the person had not been 
 able to reason rightly that this impression was unreal, the 
 illusion would have become a delusion, and the individual 
 would have been insane. So nearly do the confines of 
 sanity and insanity approach in dreams. The individual to 
 whom the foregoing hallucination occurred explained it 
 by " the Laws of Association, 3 ' as laid down by the Rev. 
 Dr. Wills. For, the day after the dream I have spoken 
 of, this gentleman visited the exhibition of the Royal 
 Dublin Society, and there, to his surprise, recognised 
 the figures he had seen in his dream in the mutes in 
 Mr. - - excellent painting of "Goldsmith Mourners," 
 which, he says, must impressed itself on his mind at a 
 preceding visit, although he could not recollect having 
 .~een it before. 
 
 (1) Le Sommeil et les Reves, &c., &c., par M. L. F. Alfred Maury, 
 Membre de 1'Institut, Paris, 1862. 
 
The most noticeable points of resemblance between dream- 
 ing and insanity are the loss of all power of discriminating 
 between the possible and the impossible, the absence of 
 surprise at the most astonishing scenes and events, and the 
 ready credulity with which absurd contradictions and im- 
 possibilities are quietly accepted by the mind as facts. 
 Another peculiarity of the mind in dreaming, is want of 
 consecutiveness, and connexion between the various dreams 
 which succeed each other, the mind passing with ease from 
 one subject to another in no way connected to it in the 
 same manner as it also does in insanity. 
 
 VIII. OCCASIONAL MANIFESTATION OF MENTAL POWER 
 DURING DREAMS. 
 
 One of the most remarkable phenomena in connection 
 with dreaming is the occasional manifestation of intellec- 
 tual activity by persons in this condition. Though this fact 
 is doubted by some psychologists, and amongst others by 
 Rosenkrantz and Baron von Feuchtersleben, who asserts 
 that " intellectual problems are not solved in sleep, because 
 intense thought is without images, whereas dreaming is 
 a creation of irnages."(l) This assertion, however, is di 
 rectly opposed to many well-known cases, in which the full 
 powers of the mind have been exercised by persons appa- 
 rently in a sleeping condition. 
 
 Sir Thomas Brown goes so far as to believe that " Sleep 
 is the waking of the soul; the ligation of sense, but the 
 liberty of reason." Condillac states that while engaged in 
 his "Cours de Etude," he frequently developed and finished 
 in his dreams a subject which had engaged his attention 
 when he retired to rest. Condorcet had presented to him 
 in sleep the solution of a difficult calculation that had 
 puzzled him all the preceding day. 
 
 " Nous avons quelquefois," says Cabanis, " en songes 
 des idees que nous n'avons jamais eues. Nous croyons 
 converser, par exemple, avec un hoinme qui nous dit des 
 choses que nous ne savons pas. J'ai connu un homme tres- 
 sage et tres-eclaire (Franklin) qui croyait avoir e"te plu- 
 sieurs fois instruit en song de Tissue des affairs qui 1'occu- 
 paient dans le moment." Cabanis accounts for this by 
 supposing that the mind continues to occupy itself in such 
 cases with its waking thoughts, and continues these with 
 the fictitious creations of the dreaming imagination. (2) The 
 same thing is said to have occurred to Brindley, the engineer, 
 when constructing the Bridgewater canal. Dr. Gregory, 
 too, stated that he found his dreams often occupied by 
 thoughts and arguments " so just in point of reasoning and 
 so good in point of language" that he made use of them in 
 his lectures. 
 
 Goethe says in his Memoirs: "The objects whi -h had 
 occupied my attention during the day often reappeared at 
 night in 'connected dreams. On awakening, a new compo- 
 sition, or a portion of one I had already commenced, pre- 
 sented itself to my mind. In the morning I was accustomed 
 
 (l)Von Feuehtersleben, " Medical Psychology," p. 167. 
 
 (2)Cabanis, "Rapports du Physique etdu Moral del'Homme," 8th 
 edition. Paris. 1844. P. 574. 
 
to record my ideas on paper."(3) In Lord Jeffrey's life it 
 is stated that this judge of unenviable notoriety entertained 
 a somewhat similar opinion. " He (Lord Jeffrey) had a 
 fanhy that though he went to bed with his head stuffed 
 wity the names, dates, and other details of various causes, 
 the were all in order in the morning, which he accounted 
 forcby saying that during sleep they all crystallized round 
 their proper centres."(4) 
 
 The well-known history of the composition of Coleridge's 
 poem of " Kuola Khan" during sleep may also be here 
 cited as a further illustration of my statement. We read 
 that in the summer of 1797 Mr. Coleridge, being then in 
 ill health, was rusticating in a quiet farm-house in the 
 country. On one occasion, having previously taken an 
 anodyne, he fell asleep in his chair, while reading in 
 " Purchas Pilgrimages" a passage referring to the Khan 
 Kubla. He slept on for three hours, and during this time, 
 as he subsequently asserted, he had the most perfect confi- 
 dence that he composed from two to three hundred lines of 
 poetry whilst still asleep, and did not experience the least 
 consciousness of effort in so doing. When he awoke he 
 had a perfect recollection of the whole poem, and instantly 
 wrote down the fragment which exists of " Kubla Khan." 
 But whilst thus engaged he was called out of tlie room for 
 about an hour, and on his return he found that he had lost 
 all distinct recollection of the poem, although he still re- 
 tained a dim consciousness of its general purport, and even 
 remembered a few scattered lines. (5) The late Sir B. 
 Brodie (in his "Psychological Inquiries") relates a somewhat 
 analogous case, in which a friend of his, whose mind had 
 been deeply occupied with some abstruse scientific point, 
 about which he failed to satisfy himself, imagined that the 
 matter had been cleared up suddenly in a dream. It would 
 be easy to add to these cases, but enough has been said to 
 prove that the exercise of mental power is not incompatible 
 with the sleeping state. 
 
 It must be admitted, however, that such cases as the 
 foregoing are comparatively rare exceptions, and that the 
 faculties most commonly exercised in dreams are the me- 
 mory and the imagination, unbridled by the judgment. 
 
 The sense of the ludicrous is occasionally highly developed 
 in dreams. I know a gentleman who seldom indulges in a 
 pun when awake (although when he does attempt them 
 they are generally good), but when asleep he frequently 
 fancies that he has made a capital pun, which amuses him 
 exceedingly at the time, though on recalling which he 
 can always do in the morning he finds that it is very far 
 from being as witty as he had supposed. 
 
 Sir Thomas Brown thus recorded his own experience on 
 this subject " I am in no way facetious, nor disposed for 
 the mirth and galliardise of company ; yet in one dream I 
 can compose a whole comedy, behold the action, apprehend 
 the jests, and laugh myself awake at the conceits thereof. 
 Were my memory as faithful as my reason is then fruitful, 
 I would never study but in my dreams, and this time also 
 would I choose for my devotions; but our grosser memories 
 have then so little hold of our abstracted understandings, 
 that they forget the story, and can only relate to our 
 awakened souls a confused and broken tale of that that 
 hath passed." 
 
 3 Lroethe s' Memoirs," p. 126. .London. 1824. 
 S^nl ^ > Ur ^' S " Life of ^^ Jeffrey," vol. i., p. 243 (note). 
 Lolendge's Poems," Adeline edition. London. 1848. P. 214 
 
THE rapidity with which events that appear to have 
 occupied long periods of time pass before the mind in 
 dreams is another very interesting question. " In dreams," 
 says Dr. R. R. Madden, " the time occupied by the play- 
 ing out of entire scenes of an ideal drama, the wonderfiil 
 incidents of which could not be described (were they to be 
 written down) in half an hour, is often hardly appreciable ; 
 sometimes it is estimated by seconds, at other times by 
 minutes."(l) This fact is so generally admitted that I 
 have referred to it only in consequence of some remarks in 
 the Rev. Dr. Wills' learned paper " On Dreams," in which 
 he says " It seems probable that most dreams occupy the 
 same time which the same succession of ideas would in 
 waking ; there seems at least no ground for the contrary 
 opinion."(2) 
 
 It would be easy, however, to quote numerous instances 
 in refutation of this theory of Dr. Wills'. Very interesting 
 illustrations of the inaccurate perception of the time occu- 
 pied by dreams are given in Lord Brougham's " Discourse 
 on Natural Theology," and also in Dr. Winslow's work, 
 " On Obscure Diseases of the Brain." Dr. Abercrombie 
 narrates the following instance of this : " A gentleman 
 dreamt that he had enlisted as a soldier, joined his regiment, 
 deserted, was apprehended, carried back, tried, condemned 
 to be shot, and at last led out for execution. After all the 
 usual preparations a gun was fired ; he awoke with the re- 
 port, and found that a noise in an adjoining room had both 
 produced the dream and awakened him."(3) The late Sir 
 B. Brodie's remarks on this topic are very suggestive. He 
 says " If we were to pursue this subject it would lead us 
 to some curious speculations as to our estimate of time, and 
 the difference between the real and the apparent duration 
 of life. . . . The apparent duration of time is longer or 
 shorter in proportion as a greater or smaller number of dif- 
 ferent states of mind follow each other in succession."(4) 
 
 From the foregoing observations we may, I think, arrive 
 at the conclusion that neither of the two theories one or 
 other of which ?re most generally adopted with regard to 
 
 dreams i.e., that which teaches that dreams depend on 
 the association of ideas, on the one hand, and that which 
 supposes their origin in bodily sensations on the other 
 afford any satisfactory explanation of the phenomena of 
 dreaming, though, as has been already shown, both these 
 causes, either alone or combined together, frequently do 
 influence the state of the mind in sleep. But to assert that 
 a dream is occasioned by some physical sensation, or by 
 the association of ideas, affords, I think, little insight into 
 the real nature of a mental condition in which the images 
 aet before us, and the impressions produced upon the mind 
 
 (1) Dr. R. R. Madden, " Phantasmata, or Illusions and Fanaticisms of 
 Protean Forms Productive of Great Evils," vol. i.,p.92. London. 1857. 
 
 (2) Rev. Dr. Wills, " On Dreams," Transactions Royal Irish Andemy 
 1659. Part 2nd. 
 
 (3) Dr. Aber^romb'e, "Inquiries Concerning the Intellectual Powers," 
 p. 234. London. 1853. 
 
 (4 SirBenjaminBrodie, " Psychological Inquiries," part 1st. p 149 
 London. 1862. 
 
are as vivid, and apparently as actual, as those transmitted 
 through the waking senses, and far more distinct than 
 those which can be called up by any voluntary exercise of 
 the memory. Nor do these theories in any wise explain or 
 even throw the least light upon the singular exaltation of 
 the mental powers, or at any rate of certain faculties of the 
 mind, such as the imagination or the memory, which occa- 
 sionally occur in the dreaming state. 
 
 Too many well-authenticated facts are recorded concern- 
 ing this mysterious condition of the mind to permit us to 
 doubt that manifestations of a nature which cannot be ex- 
 plained by any reference to physical laws have taken place 
 during sleep. To all these cases I would apply the words 
 of Bossuet, when speaking on the same subject " II y a," 
 he says, " des choses tres admirables qui e"chappent a notre 
 rue et qui n' sont ni moms vrais, ni moins desirables, 
 quoiqu'on ne les puisse ni comprener ni imaginer."(l) I 
 have collected a very large amount of facts bearing on this 
 branch of the present inquiry. This, however, would not 
 be a proper place for entering into the consideration of so 
 extensive, though so important and interesting, a topic. But 
 I would gladly recur to it should I be again afforded an 
 opportunity of doing so. The subject, however, which we 
 have now to consider is one of a very different character 
 from the foregoing namely, the physiology of dreaming. 
 
 X. THE PROXIMATE CAUSE OF DREAMING. 
 
 It is probable that dreaming is intimately connected with 
 the peculiar state of the cerebral circulation during sleep. 
 In proportion to its size no part of the body receives so 
 large a supply of blood as the brain, and none of the other 
 organs of the human frame are provided with such ex- 
 quisite adaption of structure for the maintenance of a 
 healthy and constant equilibrium between the contents of 
 the veins and arteries as it is. I should apologize to this 
 learned Society for alluding to what must be familiar to 
 every member present, were it not that this reference to 
 the physiology of the cranial circulation is indispensable to 
 the consideration of the physiology of dreaming. 
 
 We should therefore bear in mind that, in consequence, 
 probably, of its high vitality and complex organization, the 
 brain requires and receives a constant and very largo sup- 
 ply of blood, amounting, as physiologists assert, to no less 
 than one-fifth of the entire quantity of blood in circulation 
 in the body. And certainly in no part of the frame do we 
 find such ample provision for the supply of a due amount 
 of arterial blood, and, more especially, such a provision made 
 for the constant equilibrium between the relative proportions 
 of venous and arterial blood, as within the cranial cavity, 
 provided as it is with four great arterial trunks, numerous 
 veins, sixteen large sinuses and a most remarkable system 
 of anastomosis, not confined as in other parts to the ca- 
 pillary branches, but occurring, as in the circle of Willis, 
 directly between the large arteries. Moreover, the cerebral 
 vessels are peculiarly fitted for the maintenance of the ba- 
 lance of the circulation between their veins and arteries by 
 the middle or contractile muscular coat of the cerebral 
 veins being developed in a way which does not exist in 
 other parts of the venous system. 
 
 Chefs d'CEuvre de Boaauet," p. 449. Paris edition. 1829. 
 
The majority of recent physiologists appear to agree with 
 Mr. Durham, in the conclusions he arrived at from his 
 elahorate experiments on this subject, namely, that 
 " During sleep the brain is in a comparatively bloodless 
 condition ; and the blood in the encephalic vessels is not 
 in only diminished quantity, but moves with diminished 
 
 rapidity". (1) The following case, observed at Montpellier, 
 very strongly confirms this opinion: A woman having lost 
 part of the skull, from disease, the corresponding portion of 
 the brain and its membranes remained exposed. " When 
 she was in a deep or sound sleep, the brain lay in the skull 
 almost motionless ; when she was dreaming, it became 
 elevated; and when her dreams (which she related on 
 waking) were vivid or interesting, the brain was protruded 
 through the cranial aperture."(2) It must be borne in mind 
 that in this case, and in those in which a portion of the 
 cranium has been removed purposely, as was done in Mr. 
 Durham's most interesting experiments, the brain and its 
 membranes were in an abnormal state, and therefore such 
 observations must be regarded as more or less unsatis- 
 factory and liable to error. Indeed, so far are we yet from 
 an accurate knowledge of the true vascular condition of the 
 brain during sleep, that in a work published within the last 
 few years by a very distinguished member of the Institute 
 of France, we find it asserted that "during sleep the brain 
 is in a state of passive congestion."(3) 
 
 Opposite as these opinions may appear, it will, I think, be 
 found that dreaming is best explained by adopting both 
 these conjectures in part. If we combine these theories 
 thus, we may suppose that dreams are caused by a partial 
 relaxation of the tonic contractility of the cerebral vein?, 
 which limits the amount of blood that passes through these 
 vessels, and that thus the different parts of the encephalon may 
 be in very different conditions at the same time. For in- 
 stance, the blood may be moving with much greater force 
 and rapidity through the capillaries of the base of the 
 brain, than in those of the superior portions of the hemis- 
 pheres. Or, in other words, that something like active con- 
 gestion, confined to a small portion of the brain , occurs. And 
 if, as it has been conjectured, the localitiesor parts of the cere- 
 brum are subservient to the several functions of the mind, (a 
 point on which I offer no opinion, however), by this theory 
 we might more easily comprehend the phenomena of a 
 state marked by the activity of certain of the mental 
 powers, whilst the rest are for the time suspended. But, 
 without any reference to phrenological views, I think that 
 the state of the cerebral circulation during sleep seems to 
 be immediately connected with dreaming, and probably 
 there is then some alteration in the vascular condition of 
 the superficial gray structure of the brain during sleep 
 modifying the character of the nervous force evolved by it. 
 What the nature of this supposed change in the action of the 
 brain during sleep consists in, is a matter which we must ne- 
 cessarily remain utterly ignorant of. For, in truth, nothing is 
 
 Oiiuon, law. f. 24. 
 
 (2) Caldwell in " Psychological Journal" vol. T. p 
 
 (3) Mom. L. F. Maury, *LeSomtiUEiLetRwt$. 
 
 .74. 
 Paris. 1863. 
 
known of the nature of the cerebral action by which nervous 
 force is evolved at any time or under any circumstances ; and 
 modern physiologists have done little more than re-echo the 
 often repeated and as often contradicted assertion, that all 
 the operations of the mind are accompanied by a molecular 
 change in the cortical or vesicular substance of the brain. 
 
 If "this theory be correct, it does not lessen the interest 
 attaching to this most remarkable condition of the mind. 
 The physical change in the vesicular structure of the 
 brain, which I have described as probably connected with 
 dreaming, if it does really occur at all, as I have sup- 
 posed (for where proof is impossible a reasonable conjecture 
 is all that can be offered in its place) is merely an accompa- 
 niment, and cannot be regarded as the cause of dreaming. 
 For this vesicular change could only take place in conse- 
 quence of some primary existing cause, which we may 
 suppose to be the action of the mental principle. 
 
 XI. THE PATHOLOGICAL INDICATIONS FURNISHED BT 
 DREAMS. 
 
 Having now discussed the physiology of dreaming, we 
 may next proceed to consider its pathological and medical 
 aspects. In the earliest annals of every country we find 
 that the interpretation of dreams was a part of the office of 
 the physician. In the treatise "On Dreams," commonly 
 ascribed to Hippocrates ; in the last volume of " Saxon 
 Leechdoms," published in 1866 by direction of the Master 
 of the Rolls ; and in an ancient Irish Medical MS., a trans- 
 lation of which, by Mr. 0. Longan, may be found in the MS. 
 collection of the Royal Irish Academy, we find sufficient 
 proof, without referring to other authorities, of the same 
 importance being attached to those signs of disease which 
 were supposed to be furnished by dreams, in countries and 
 ages very remote from each" other. 
 
 Opinions that are very wide-spread and generally adopted 
 are seldom devoid of some foundation in truth ; and although 
 the subject I am treating of has now passed completely 
 out of the hands of medical writers, who regard it as some- 
 thing puerile and unworthy of scientific investigation, I 
 shall endeavour to show that this view of the matter is not 
 altogether just, and that something may occasionally be 
 learned by attending to the peculiar character of our 
 patient's dreams in certain cases. 
 
 The phenomena accompanying any deviation from the 
 normal quantity of blood in the encephalon, and the func- 
 tional disturbance of the brain resulting therefrom, as 
 evinced under all circumstances that occasion either an 
 augmented or diminished supply of arterial blood, naturally 
 lead us to anticipate that similar circumstances will act 
 still more potently in sleep, when the intellectual opera- 
 tions are more directly under the influence of physical and 
 internal causes. 
 
 The early physicians were evidently aware of this ; thus, the 
 " Father of Physic," or at least some cotemporaneous Greek 
 physician, laid down the theory that " Such dreams as 
 represent at night a man's actions during the day, and 
 exhibit them in the manner in which they occurred, 
 namely, as performed well and justly deliberated, these are 
 good to a man, and prognosticate health, inasmuch as the 
 soul perseveres in its diurnal cogitations, and is not weighed 
 down by any repletion, evacuation, or any other external 
 
accident. But when the dreams are very opposite to the 
 actions of the day, and when there is a conflict between 
 them when this happens, I say, it indicates a disorder in 
 the body ; when the contrast is great, the evil is great, and 
 when the one is small, the other is small also. ; '(l) An Eng- 
 lish philosopher of the seventeenth century, Thomas Hobbs, 
 propounds the following theory on this subject : "And seeing 
 dreams are occasioned by the distemper of some of the 
 inward parts of the body, divers distempers must needs 
 cause different dreams."(2) 
 
 A renowned physician and philosopher of the same 
 century, Guy Patin, says : 
 
 " II est constant que Fon peut connaitre par les songes 
 quelque dispositions corporelle. Je suis la'dessus du 
 sentiment de Sainte Thomas, quand il dit. " Medici dicunt 
 esse intendendum somnis ad interiores dispositiones." En 
 effect, les malades songent d'ordinaire autrement que ceux 
 que se portant bien ; les melancholiques autrement que leg 
 sanguins, les bilieux autrement que les pituiteux, mais je 
 ra'en tiens la, sans tirer d'auters conjectures sur les choses 
 libres et de pur hazard, jusqua ce que je croye qu'il yait 
 du surnaturel dans ce qu'on a songe ; alors je rappelk- dans 
 ma memoire V histoire de Joseph, de Daniel, &c., pour 
 in'y soumettre comme a' des moyens dont 1' Eternel se sert, 
 pour faire connaitre aux hommes ses volontez."(3) I regret 
 exceedingly that my space obliges me to omit Sir Thomas 
 Brown's observations on this topic in his most eloquent 
 work, the " Letter to a Friend on the death of an intimate 
 Friend." 
 
 Albers, as cited by Baron von Feuchtersleben, enumerates 
 the following as among the most approved signs to be ob- 
 tained from the mecScal interpretation of dreams. He 
 says : " Lively dreams are, in general, a sign of the excite- 
 ment of nervous action. Soft dreams a sign of slight irri- 
 tation of the brain ; often, in nervous fevers, announcing 
 the approach of a favourable crisis. Frightful dreams are 
 a sign of determination of blood to the head. Dreams 
 
 about tire are, in women, signs of an impending haemorrhage. 
 Dreams about blood and red objects are signs of inflamma- 
 tory conditions. Dreams about rain and water are often 
 signs of diseased mucous membranes and dropsy. Dreams 
 of distorted forms are frequently a sign of abdominal ob- 
 structions and disorders of the liver. Dreams in which the 
 patient sees any part of the body especially suffering, in- 
 dicate disease in that part. Dreams about death often 
 proceed apoplexy, which is connected with determination 
 of blood to the head. The nightmare (incubus, ephialtes), 
 with great sensitiveness, is a sign of determination of blood 
 to the chest." "To these/' says Baron Feuchtersleben, 
 " we may add that dreams of dogs, after the bite of a mad 
 dog, often precede the appearance of hydrophobia, but may 
 be only the consequences of excited iniagination."(l) 
 
Dr. l-Y.i l>e.-> Winslow quotes several case.s in which dreams 
 fire .-aid to have been prognostic : " Arnauld de Villeneuve 
 dreamt one night that a black cat bit him on the side. 
 The next day an anthrax appeared on the part bitten. A 
 patient of Galen's dreamt than one of his limbs was changed 
 into stone. Some days after this leg was paralysed. 
 Koger D'Oxteyn, Knight of the Company of Douglas, 
 went to sleep in good health ; towards the middle of the 
 night he saw in his dream a man infected with the plague, 
 quite naked, who attacked him with fury, threw him on 
 the ground after a desperate struggle, and, holding him 
 between his open thighs, vomited the plague into his mouth. 
 Three days after he was seized with the plague, and died. 
 Hippocrates remarks that dreams in which one sees black 
 spectres are a bad omen."(2) 
 
 So far we have traced the literature of this subject, from 
 the earliest time down to the latest work of authority on 
 psychological medicine, and it only remains now to add a 
 few practical observations on the signs of disease especially 
 of mental disease furnished by dreams occasionally. 
 
 Fearful dreams, if frequently repeated, may eventually in- 
 fluence the permanent state of the mind, and considering 
 the close resemblance between the phenomena of dreaming 
 and insanity, which Sir H. Holland defines as "awaking 
 and active dream, (3) we may expect that the former con- 
 dition, if prolonged, might pass into the latter state. In- 
 sanity occasionally does commence in a dream that con- 
 tinues after the cessation of sleep, and cases are recorded 
 in which persons recovering from mental alienation were 
 nightly disturbed in their dreams by the same hallucinations 
 which had previously haunted them in the waking state(4) 
 
 Esquirol regarded dreams as capable of furnishing valu- 
 able indications in some obscure cases of insanity in which 
 the subject of the mental disorder was carefully concealed 
 during the day, but was revealed in sleep by watching the 
 patient's dreams. M. Brierre de Boismont also records 
 several cases in which the patient's dreams lead to a dis- 
 covery of the nature of the mental disease from which they 
 suffered."(5) 
 
 The derangement of the cerebro-spinal functions accom- 
 panying fever is, in all cases, greatest towards night, at 
 which time, even in mild cases, some degree of delirium or 
 wandering is commonly observed. Now, if this take place 
 while the patient is still awake, and subject to the influence 
 of external impressions, how much more readily will such 
 derangement be produced when the mind is no longer under 
 the correction of the senses. The disturbed dreams of fever- 
 patients are probably caused by the general vascular ex- 
 citement, by some local irregularity of the cerebral circula- 
 tion, and, perhaps, more directly, by the action of the fever- 
 poison in the blood on the vesicular structure of the brain. 
 And to the imperfect elimination of this poison from the 
 blood, we may also attribute the painful and disagreeable 
 dreams which often continue for some time to disturb the 
 repose of persons Convalescing after severe attacks of fever. 
 
 {*) Uuoted by Dr. Forbes Winslow in "Obscure Diseases of the Brain, 
 
 (3) Sir. ITenry Holland. Chapters on Mental Physiology, p. no. 
 
 (4) gee Dr. Bnerre De Boismon. Dei Hallucination*, p. 233 Paris 1845 
 
 (5) " D;s Hallucinations." Paris, 1846. P. 332, 233 *( 
 
XT. TfTE PATHOLOGICAL ;NDIC.vTluNs 1LRNISHED BY 
 DREAMS (contli' 
 
 K fevers are also very frequently preceded for days 
 by "Paroniri'i" <>r morbid dreaming, which is probably 
 produced by the direct actioai of the fever-poison on the 
 highly sentient brain-structure before it occasions its con- 
 stitutional symptoms. The exanthemata are very commonly 
 presaged by fearful dreams. Rhazes, the Arabian phy- 
 sician of the ninth century, notes, among the signs of ap- 
 proaching small-pox, " terrors in sleep." He regarded this 
 prognostic as of considerable importance, and says, " When, 
 therefore, you see these symptoms, or some of the worst of 
 them (such as the pain of the back, and the terrors in sleep, 
 with the continued fever), then you may be assured that 
 the eruption of one or other of these diseases is nigh at 
 hand. "(I) Intermittent fever is often announced several 
 days before any of the recognised symptoms set in, by per- 
 sistent dreams of terrifying character. I have experienced 
 this in my own person, and heard it confirmed by other 
 sufferers on the African coast. The following case of morbid 
 dreaming, ushering in yellow fever, I subjoin in the words 
 of the gentleman to whom it occurred, himself a medical 
 man. holding a high official position on the Gold Coast 
 when it occurred : 
 
 " In the early part of 1840, I was an inmate of Cape 
 Coast Castle, and as some repairs were then being made in 
 the Castle, the room assigned to me was that in which the 
 ill-fated L. E. L. (Mrs. Maclean), the wife of the Governor 
 <.f Cape Coast had been found dead, poisoned by prus- 
 sic acid, not very long previously. I had kiiown her in 
 London, and had been intimately acquainted with her 
 history, and much interested in it. Her body had been 
 found on the floor, near the door, and in front of a window. 
 After a fatiguing excursion to some of the adjoining British 
 settlements on the coast, having retired to rest, I awoke 
 disturbed by a dream of a very vivid character, in which I 
 imagined that I saw the dead body of the lady who had 
 died in that chamber lying on the floor before me. On 
 awaking, the image of the corpse kept possession of my 
 imagination. The moon was shining brightly into the 
 part of the room where the body had been found, and there 
 it seemed to me, on awaking, it lay pale and lifeless as it 
 appeared to me in my dream. 
 
 " After some minutes, I started up, determined to ap- 
 proach the spot where the body seemed to be. I did so. ! 
 not without terror, and walking over the very spot on i 
 which the moon was shining, the fact all at once became j 
 evident and obvious that no body was there that I 
 must have been dreaming of one. I returned to bed, and 
 had not long fallen asleep, when the same vivid dream 
 recurred the same waking disturbance occurring while 
 awake. As long as I lay gazing on the floor I could not 
 lispi,s> t 's> my mind of that appalling vision, but when I 
 -tarred up and stood erect, it vanished at the first glance. 
 
 " Again I returned to bed, dozed, dreamt again of 
 poor L. L. E.'s lamentable end, and of her remains on the 
 same spot ; again awaked, and arose with the same strange 
 results. 
 
 " There was no more disturbance that night of which, at 
 
 conscious, but, when morning came, fever was 
 
 oi' me in unmistakeable force, in its worst form, and par- 
 
 ,1, Khazes " On the Small-pox and Measles." Translated from the i 
 Arabian by Dr. Greenhill. P. 34. London, 1848. 
 
tial delirium'set in the same night. I was reduced to the 
 
 last extremity about the third or fourth night of my illness, 
 when a conviction seized on my mind that it was absolutely 
 essential to my life that I should not pass another night iu 
 < 'ape Coast Castle. I caused the negro servant I had for- 
 tunately brought out with me from England, to have a litter 
 prepared for me at dawn, and, stretched on this litter, 
 hardly able to lift hand or foot, I was carried out of my 
 bfd by four native soldiers, and was conveyed to the house 
 of a merchant and countryman of mine, to whose care and 
 kindness I owe my life. So much for a visionary precursor 
 of fever on the West Coast of .A f 
 
 In neuralgia, disturbed dreaming is occasionally a promi- 
 nent symptom. In one obscure case I was led to make 
 what I believe to be a true diagnosis from the indications 
 furnished by the patient's dreams. The individual in 
 question is a man aged about 45, of an anaemic habit, con- 
 fined by a sedentary occupation, who, for many years, had 
 suffered from hemicrania, which latterly has become more 
 intense and the intervals shorter. A couple of days before 
 the attack, his sleep becomes broken by unpleasant dreams. 
 and when the paroxysm has attained its height, he in- 
 variably dreams that he is the helpless victim of a persecu- 
 
 j tor, who finishes a series of torments by driving a stake 
 through his skull, after which he becomes insensible. 
 
 j During his recovery from each attack, he states that his 
 dreams are of a most agreeable character, though so vague 
 that he cannot give any account of them. The frequent 
 repetition of this dream leads me to conclude that there is 
 some osseous growth within the cranium, and that the vas- 
 cular distention accompanying the neuralgic attack, occa- 
 sions pressure upon this, giving rise to the sensation I have 
 referred to, while the subsequent feeling of comfort results 
 from that pressure being removed. 
 
 Cardiac disease and hydro-thorax, which occasionally in- 
 terferes with the functions of the circulatory apparatus, are 
 often attended with disturbed dreaming. " Persons/'' says 
 Dr. Copeland, " labouring under disease of the substance 
 or valves of the heart, are subject not only to imperfect or 
 disturbed sleep, but also to fearful dreams ; and it' they fall 
 asleep in an uneasy position, or on the left side, in some 
 cases they generally waken up soon from a fearful dream, 
 as falling down from a precipice, drowning, &c. ; their 
 dreams being more pleasant when the position is more 
 comfortable. "(1) "Paroniria" is also very frequently occa- 
 sioned by disease or irritation of some remote part or organ 
 of the body ; and, in many instances, morbid dreaming may 
 be directly traced to the influence of some article of diet. 
 Thus, for example, I am acquainted with a lady who, if 
 she takes tea ID the evening, is not kept awake by it a* 
 some persons are> but when she falls asleep, is thrown by 
 it into a state of horrible dreaming, from which F.he always 
 awakes up suddenly, under the illusion that a number of 
 shadowy figures are sitting crouched up on every chair iu 
 
 . her room. She is quite sensible at the time of its being an 
 
 i hallucination, but still cannot banish this idea from her 
 
 , mind. I need not make any remarks on the analogy which 
 this kind of dreaming presents to the symptoms of inci- 
 
 ; pient insanity, although, in reality, very different from that 
 state, as I already have spoken on this point in my com- 
 
 i ments on another case of this kind which I described. 
 
 /,-Tw~~r!nTwland' "Dictionary of Practical Medicine." Art. 81ep. 
 (l ; Dr. t/op 'r'Q,,- London 1858. 
 ToLiii.,partu.,p.805. ixmaon, lew*. 
 
j 
 
 XII. THE TREATMENT OF " PARONIRIA," OR MORBID 
 DREAMING. 
 
 Cases occasionally occur in medical practice in which the 
 patient complains of nothing whatever but morbid dream- 
 ing, and its effects, and in which this one complaint, trivial 
 us it might at first appear, is sufficient to destroy either his 
 mental or bodily health, or both. 
 
 Some years ago, I had a patient under my care, whose 
 principle complaint was " paroniria," as morbid dreaming 
 has been termed by some writers, and a most formidable 
 disease it was. This individual, who was a person of a 
 highly nervous temperament, had been suffering for some 
 
 time from severe dysentery, the result of long residence in 
 a tropical climate, and when he came to me was greatly 
 weakened by this malady. The dysentery gradually sub- 
 sided under treatment, and then I lost sight of him for 
 several months, at the expiration of which he returned, 
 looking worse than ever. He was miserably thin, and 
 so nervous that the sudden closing of the door alarmed him. 
 His memory was effected to a great degree, and he was 
 afraid to speak to his familiar acquaintance, having lost 
 all recollection of their names. There had been no return 
 of the dysentery; he suffered from no pain, but had lost his 
 appetite, and was extremely weak. Having told me all 
 this in reply to my questions, he added "I am half 
 ashamed to tell you how much I dread night and bed hour, 
 as I have such horrible dreams that for several successive 
 nights I have not gone to bed at all, but slept a little in a 
 chair." In short, this was a well-marked case of " paroniria," 
 which, I may add, was finally cured by a combination of 
 moral and physical remedies, with the necessary medi- 
 cines. But I have very little doubt that, had this symp- 
 tom been neglected much longer, the case would suddenly 
 and speedily have passed from the state of premonitory into 
 that of confirmed insanity. In these cases the hallucina- 
 tions, as pointed out by Dr. Forbes Winslow, appear to be 
 most vivid at night. " When the patient is placed in a 
 recumbent position, on account, it is conceived, of the me- 
 chanical facilities thus afforded for the blood gravitating 
 freely to the head."(l) 
 
 The first indication in the treatment of morbid drp.fl.ming 
 Ls to remove the primary morbid action or condition, of 
 which disturbed dreaming may be merely a symptom. 
 Thus, for instance, if an unduly acid state of the gastric 
 juice be, as it often is, the cause of uneasy dreaming, we 
 may cure this by alkaline remedies. If, again, we can trace 
 as, indeed, in most cases of " paroniria" we may the 
 morbid dreaming to the reflex irritation occasioned by the 
 accumulation of excrementitious matter in the intestinal 
 canal, purgatives should be administered, and in nine out 
 often cases of this kind they will remove the cause of com- 
 plaint. But if the blood be loaded with lithic or lactic acid 
 (for we will generally find that our gouty and rheumatic 
 patients complain of uneasy sleep and distressing dreams, 
 the transmission of these "blood-poisons" through the 
 brain, oftentimes giving rise to nervous irritation and ex- 
 citement, which is most marked during sleep in the 
 patLnt's dreams) it will then be necessary, in the first place, 
 to correct this vitiated state of the blood by mineral 
 
 (1) Dr. Forbea "Winslow " On Obscure Diseases of the Brain andDis- 
 orders of he Mind," p. 583. London. 1861. 
 
waters and other appropriate remedies. In a word, to cure 
 morbid dreaming, we must endeavour to put our patient 
 in the most favourable circumstances for sour.d and healthy 
 sleep, by removing, as far as possible, every source of ner- 
 vous irritation. 
 
 In conclusion, it only remains for me to apologise for the 
 length of this communication, the only excuse I can offer 
 for which is its importance in relation to the study of in- 
 sanity. I shall be well satisfied, without aspiring to the 
 merit of any very original theory on the subject of dream- 
 ing, if the concise view I have afforded of the pathological 
 indications which are furnished by certain forms of dream- 
 ing may attract more attention to this ^question than has 
 hitherto been given to it by medical writers on insanity. 
 The only way to study the diseased actions of the insane 
 mind with advantage is to investigate the healthy actions 
 of the sane mind ; and no condition of the mind in health 
 presents so strong an analogy to the condition of the mind 
 in disease as dreaming, and therefore I think that an 
 inquiry into this state is well calculated to throw light on 
 the causes, Lhe nature, and even the treatment of insanity. 
 
 1U 
 
 it*Jis 
 
ON MORBID SOMNOLENCE AND DEATH-TRANCE. 857 
 
 ON MORBID SOMNOLENCE AND DEATH-TRANCE. 
 
 BY THOS. MORE MADDEN, M.D., F.R.C.S. Ed., M.A. O., Honoris 
 Causa Royal University, Ireland, Obstetric Physician and Gynaecologist, 
 Mater Misericordiae Hospital, Consulting Physician to the Children's 
 Hospital, and Consultant to the National Lying-in Hospital, Dublin, etc. 
 
 IT was well observed by Reid that " medical cannot be 
 separated from moral science without essential mutilation ". 
 The partial recognition of this truth at different epochs has 
 been demonstrated by the periodic recurrence of evanescent 
 manifestations of wide-spread professional interest in questions 
 such as the present, lying on the borderland between the two 
 sciences above referred to. These topics, however, seldom 
 retain any lasting hold on public attention, and being generally 
 soon displaced by matters of more apparent practical import- 
 ance, become relegated to the limbo of oblivion, from which 
 in the course of time they may be disinterred, and in new 
 guise brought into prominence before a succeeding generation. 
 Such a recrudescence has been recently evinced with regard 
 to the phenomena of lethargy and trance, and also to the 
 possibility of premature interment in cases of this kind, sub- 
 jects which appear to me deservedly of still wider and more 
 permanent medical consideration than has yet been accorded 
 to them. 
 
 With this view therefore I now venture to review briefly 
 the older literature and points of chief practical interest con- 
 nected with this topic, which many years ago I discussed in 
 various long-forgotten contributions, of some of which I shall 
 avail myself in the following observations on morbid somno- 
 lence, or lethargy, and on hypnotic, or death-trance. 
 
858 THE MEDICAL MAGAZINE. 
 
 I. MORBID SOMNOLENCE, OR LETHARGY. 
 
 The etiology of cases of this character, varying as they do 
 in degree from a trivial exaggeration of ordinary profound sleep 
 to that profound and prolonged state of lethargy in the depres- 
 sion of the cerebro-nervous functions, is so intense as to be ap- 
 parently almost undistinguishable from their complete cessation, 
 is obviously most complex. Probably, as Dr. Dana has pointed 
 out, the majority of such cases are distinctly neurotic in their 
 origin. This I may observe is clearly exemplified in instances 
 of so-called hypnotic sleep. In other instances morbid som- 
 nolence may be found traceable to cerebral lesions, or mal- 
 nutrition, constitutional toxaemia, or general debility. In 
 some "cases, however, the phenomena of lethargy are ap- 
 parently inexplicable on any of these hypotheses. The 
 familiar definition of lethargy as "an exaggerated sleep" 
 can convey no distinct conception of this condition until we 
 are agreed as to the normal duration of sleep. As a matter 
 of fact the amount of rest required by each individual must be 
 determined by age, temperament, and preceding expenditure 
 of cerebro-nervous and physical energy, as well as by many 
 other circumstances. For instance, the infant whose rest is 
 interrupted only by brief intervals of wakefulness for food, 
 sleeps as naturally as the healthy adult who takes his seven 
 hours' rest, or as the old man who is well satisfied if he has 
 obtained three or four hours of light and perhaps broken 
 slumber. 
 
 These typical conditions of somnolency at different periods 
 of life may in exceptional cases be reversed without apparent 
 ill results. For instance, I once attended a family in which 
 infantile insomnia for eighteen out of the twenty-four hours 
 was the rule in four or five successive cases, without apparent 
 cause or injury. On the other hand, the ordinary light sleep 
 of the old is sometimes replaced by an increasing torpidity 
 of mind and body until at last " life passes into sleep and 
 sleep into death ". 
 
ON MORBID SOMNOLENCE AND DEATH-TRANCE. 859 
 
 Nor is age the only factor to be taken into account in 
 considering the natural period of rest, for, as I have just said, 
 individual temperament and habit have their share in the 
 problem. Thus I have known an instance where a young 
 officer, otherwise in perfect health, was of so sleepy a dis- 
 position that he could not do with less than fourteen hours 
 daily sleep, an indulgence which cost him his commission. 
 
 The influence of climate and weather on sleep is un- 
 questionable, the " Sleepy Hollow" of fiction being but a 
 popular explication of the well-grounded belief in the sedative 
 of a condensed atmosphere. In common parlance, sudden in- 
 creasement of atmospheric pressure is described as heavy or 
 drowsy weather, and most people sleep better in low r lying 
 situations, and when at sea, or in its vicinity, than in the 
 rarefied atmosphere of higher districts. 
 
 No sleep is healthy from which we cannot be easily aroused ; 
 and its duration, as a rule, should correspond in adults with 
 the preceding expenditure of sensorial and volitional nerve 
 force. In several of the cases of lethargy which will be here 
 described, however, there was no history of any previous un- 
 due waste of nervous energy. Hence, in such cases we must 
 seek the cause of the prolonged somnolency in arrested de- 
 velopment of sensorial power from either cerebral lesion, 
 malnutrition, or toxaemia, rather than in that exhaustion 
 of cerebro-nervous energy which is the proximate cause of 
 natural sleep. 
 
 During morbid somnolency the patient's mental condition 
 must be essentially similar to that present during ordinary 
 sleep as between natural rest and lethargy, the chief tangible 
 difference is that of degree or duration. Now, as mental 
 action of some character, whether it be thought and conscious- 
 ness when awake, or dreaming whilst in sleep, seems inseparable 
 from existence, even in the most profound trance the mind 
 probably continues to operate incessantly, however abnormally 
 or imperfectly, or however unconscious we may subsequently 
 
86o THE MEDICAL MAGAZINE. 
 
 be of its operations. us, for instance, every one who has 
 
 had occasion to watch uiten by the bedside of the sleeping 
 has seen and heard the changing phases of dreams expressed 
 in motions and words, of the cause of which the sleeper on 
 awakening has no recollection. I have myself been long 
 subject, from the exigencies of my profession, to frequent 
 interruptions of rest, and can call to mind few occasions in 
 which I was thus suddenly aroused from dreamless sleep. 
 
 During sleep, and still more so in lethargy, all impressions 
 from the external world may possibly be shut out entirely from 
 the mind. More frequently, however, these impressions are 
 conveyed to the sensorium in so faint or imperfect a manner 
 as to produce effects different from those they would have 
 occasioned in the waking mind. Moreover, impressions may 
 originate within the cerebrum as well as be conveyed to it 
 from without. The possibility of active intellectual operations 
 during sleep is unquestionable. In one of my earliest essays 
 published in The Medical Press many years ago, I cited 
 numerous illustrations to show that although the faculties most 
 commonly exercised in our dreams are memory and imagina- 
 tion unbridled by judgment, nevertheless in some exceptional 
 instances the activity of all the mental powers may continue 
 unsuspended by sleep. Amongst cases of this kind some of 
 the best known are Coleridge's composition of ' Kubla 
 Kahn " during sleep, Lord Jeffreys' Sleeping Judgments, 
 and Condorcet's Dreaming Solution of a Mathematical Cal- 
 culation. Similar instances are recorded in the works of Sir 
 Thomas Brown, Brindley, the engineer, Dr. Gregory and 
 Cabanis. A much earlier case of the same kind is related in 
 the life of St. Caedmon of Whitby, who on first entering 
 monastic life was mortified at being unable to play the harp 
 and sing with the other monks. One night a stranger 
 appeared to him, says the old legend, in his sleep and com- 
 manded him to sing a hymn on the Creation. This he at 
 once did, the verse flowing spontaneously and, being remem- 
 
Ox MORBID SOMNOLENCE j VD DEATH-TRANCE. 86 1 
 
 berecl on waking, was by him, a ough untaught, set to 
 music. 
 
 The phenomena of nightmare in which the patient is 
 deprived of the co-ordinating power of accomplishing the 
 movements that are willed are sufficient to show that in sleep 
 volition is not necessarily suspended. And on the other 
 hand we need only refer to somnambulism to show that 
 during sleep as profound as lethargy the volitional impulse 
 may be responded t6 by motional activity. If, therefore, 
 during lethargy the mind be in the same state, which seems 
 probable, as in sleep, then in that protracted torpor "what 
 dreams may come," and between this state and the restoration 
 of consciousness, what agony may be endured in the effort to 
 regain muscular power " must give us pause ". 
 
 I may here make a short reference to some cases of 
 lethargy that have come under my own notice, and of which 
 a fuller account may be read in my former papers on this 
 subject.'" Of these cases the first is one of so-called neurotic 
 or hysterical lethargy. A young lady, Miss R., apparently in 
 health, went to her room after luncheon. A few minutes 
 afterwards she was found in a deep sleep, from which she 
 could not be awakened. When I saw her twenty-four hours 
 later, she was still sleeping, the decubitus being dorsal, respira- 
 tion scarcely perceptible, pulse extremely small, face pallid, 
 lips motionless, and extremities cold. At this moment so 
 death-like was her aspect that a casual observer might almost 
 have doubted the possibility of the vital spark still lingering in 
 that apparently inanimate frame, on which no external stimulus 
 seemed to produce any sensorial impression, with the excep- 
 tion that the pupils responded to light. Sinapisms were 
 applied over the heart and to the legs, where they were left 
 <>n until vesication was occasioned, without causing any 
 evidence of pain. Faradisation was also resorted to without 
 
 * Vide. Dublin Journal of Medical Science, 1881, and Medical Press and 
 Circular, 2jth April, 1887. 
 
862 THE MEDICAL MAGAZINE. 
 
 effect. In this state she remained from the evening of the 
 3ist of December until the afternoon of the 3rd of January, 
 when the pulse became completely imperceptible, the surface 
 of the body icy cold, the respiratory movements apparently 
 ceased, and her appearance hardly distinguishable from death. 
 Under the influence of hypodermic injections of sulphuric ether 
 and other remedies, however, her pulse and temperature im- 
 proved. But she still slept on until the morning of the Qth, 
 when she suddenly awoke, and to the astonishment of those 
 about her, called for her clothes, which had been removed 
 from their ordinary place, and wanted to come down stairs, 
 being without the least consciousness of what had occurred. 
 Her recovery was complete. 
 
 The second was a case of lethargy from cerebral malnu- 
 trition and toxaemia in the instance of a boy who after an 
 attack of fever fell into a state of complete lethargic coma, 
 in which he lay insensible between life and death for forty- 
 seven days. In this case also the patient ultimately re- 
 covered. 
 
 In a third instance, a lady under my care after a lethargic 
 sleep of twenty-seven days, recovered consciousness for a few 
 hours, and then relapsed into her former comatose condition 
 in which she died. 
 
 The fourth was, like the first case, one of neurotic lethargy 
 which lasted for seventy hours, and in this instance the patient 
 recovered. 
 
 The fifth and last instance of profound lethargy that has 
 come within my observation occurred some years ago in the 
 Mater Misericordiae Hospital, in the case of a young woman 
 under the care of my colleague Dr. Boyd. In that instance, 
 despite all that medical skill and unremitting attention could 
 do, it was found impossible to arouse the patient from the 
 apparently lethargic sleep in which she ultimately sank and 
 died. 
 
 ( To be continued. ) 
 
[Xow Ready, med* 8vo, with 259 Illustration*.] 
 
 CLINICAL GYNAECOLOGY: 
 
 BEING 
 
 HANDBOOK OF DISE/SES OF WOMEN. 
 
 BY 
 
 THOMAS MORE MADDEN, M.D., F.R.C.S.Ed.; 
 
 Obstetric Physician and Gynaecologist, Mater Misei icordiae Hospital, Dublin: 
 Consulting Physician, Hospital for Children ; 
 
 FORMERLY 
 
 Examiner in the Queen's University, and on the Conjoint Board of Royal College of 
 
 Surgeons, and Apothecaries' Hall, Ireland; Master, National Lying-in-. 
 
 Hospital; Assistant-Physician, Rotunda Hospital; President, Obstetric 
 
 Section, Royal Academy of Medicine, and British Medical 
 
 Association; Hon. President, First International Congress 
 
 of Obstetrics and Gynaecology; Vice- President, 
 
 British Gynaecological Society, <fec., &c. 
 
 Philadelphia: J. B. LIPPINCOTT COMPANY. 
 London : BAILLIERE, TINDALL & Cox, 20 King William-street, Strand. 
 
 Opinions of % Jrrss : 
 
 " This work contains the writer's experience of the diseases of 
 women, extending over a quarter of a century. . . Although 
 they are called lectures, the chapters are so carefully systematised 
 that the author will not be disappointed in hoping that the treatise 
 may prove acceptable as a handbook of gynaecology. . . The 
 book is written so clearly, and in 'such a judicial spirit, that its 
 appearance is a real gain to students. . . On every page we may 
 read the temperately-worded mature judgment of the writer. . . 
 The work is excellently printed, and the illustrations are good. . . 
 The author may be congratulated in having produced an interesting 
 and highly- commendable work, and upon having placed it in such 
 an excellent form before his readers. It is a work which we bring 
 with confidence to the notice of all earnest students and practi- 
 tioners." British Medical Journal, Jan. 6th, 1894. 
 * * * 
 
 " DR. THOS. MORE MADDEN, who has already acquired an interna- 
 tional reputation by his teachings, writings, and operations, has 
 embraced in this admirable book the practical experience of over a 
 quarter of a century. . . All the lectures are instructive to the 
 general physician as' well as to the specialist. . . We greatly admire 
 the liberaf way in which the author treats all subjects, carefully 
 reviewing all the advanced opinions of the present day. . . Each 
 and all diseases peculiar to women are thus considered in a most 
 thorough and conservative manner." The Medical jBulletin, Phila- 
 delphia, Nov., 1893. 
 
 [OVEB. 
 
"This is a handsome volume, profusely illustrated, and written 
 in the elegant and forceful style of which T. MORE MADDEN is 
 known to be the master. The clinical experience of the author, 
 gathered from an active professional life in one of the large 
 capitals of Europe, combined with sound judgment and an un- 
 bounded enthusiasm in the observation and utilisation of new 
 and important professional facts, mark DR. MADDEN as no ordinary 
 authority, and give to his utterances a value possessed by few 
 who have written on woman's maladies. Placing this high 
 estimate on DR. MADDEN'S book, we have no hesitation in recom- 
 mending it to students and practitioners as a work equal to any, 
 and superior to most, works of its class." Medical and Surgical 
 
 Reporter, St. Joseph, Mo. 
 
 * * * 
 
 " This volume contains the result of the writer's wide experi- 
 ence, ... as obtained hi the Misericordise Hospital, the 
 Rotunda Lying-in Hospital, and other public institutions in Dublin 
 set apart for the treatment of diseases peculiar to women. . . . 
 One of the most notable features of the work is the important 
 account given of the various plans of treatment advocated by 
 different individuals, on which the author frequently throws 
 material light as the result of personal knowledge. As a whole, the 
 work is practical, concise, and, moreover, interestingly readable ; 
 and we may add that since the issue of Sims's ' Uterine Surgery ' 
 there has been no work published of this class which so fully meets 
 the requirements both of the general practitioner and the student, 
 and at the same time answers all the requirements of the 
 specialist." The Medical Age, Detroit, Nov. 10th, 1893. 
 
 " DR. MADDEN, who is well known in America, has produced a 
 work which is at once pleasing and instructive. The style is 
 attractive, and the author has taken occasion to incorporate in the 
 treatise much that he has gleaned in his long service in the Mater 
 Misericordise Hospital. The volume ... is a valuable and 
 welcome addition to the surgeon's library." The Medical Journal, 
 
 Chicago, Nov. 4th, 1893. 
 
 * * * 
 
 " This is a work which must of necessity find its way among 
 other works on gynaecology, because of the vast fund of informa- 
 tion and many features not contained in other works." Medical 
 
 Brief, St. Louis, Nov., 1893. 
 
 * * 
 
 " The lectures cover the whole range of gynaecological practice, 
 including the diseases of pregnancy. . . . There is one important 
 feature of these lectures that is their originality. They are not a 
 mere hash-up of the views and opinions of others, but a record of the 
 author's clinical experience. ... A thoroughly practical and 
 well-written work, its language clear and concise, and the methods 
 of treatment recommended fully ' up to date.' . . . We con- 
 gratulate DR. MORE MADDEN on the completion of this work, which 
 will, we believe, add to his already high reputation." Medical 
 Times and Hospital Gazette, London, 25th Nov., 1893. 
 
 * * * 
 
 " It is no mere compilation, but is the outcome of the experience 
 of a celebrated gynaecologist, whose views demand the closest atten- 
 tion from those differing from him. . . The book is pleasant 
 reading and will not fail to interest." The Dublin Journal of Medi- 
 cal Science, March, 1894. 
 
 * * * 
 
 "It is well written, the subjects are all clearly discussed, and 
 many original ideas are introduced. . : Will prove of valuable 
 assistance to all who require a good work on diseases of women." 
 The St. Louis Clinique, October, 1893. 
 
"In the publication of this work DR. MADDEN has rendered a 
 service to gynaecology, which will certainly be appreciated by his 
 
 fellow workers." Occidental Medical Times, Sacramento, Feb., 1894. 
 
 * * * 
 
 " It covers the whole range of gynaecological subjects. . . The 
 general tone is conservative and safe. . . The book, taken as a 
 whole, is interesting and instructive reading." Boston Medical and 
 
 Surgical Journal, Jan. 18th, 1894. 
 
 * * * 
 
 " A high-class book, which, in this special department of medi- 
 cine, may surely be styled a modern classic.' We venture to say 
 that since the days of the gentle and accomplished F. Churchill, 
 nothing has appeared in Irish medical literature which is destined 
 to take the same place as DR. MORE MADDEN'S book on diseases of 
 women." . . . The Health Record, February, 1894. 
 
 * * * 
 
 " Like all Dr. MORE MADDEN'S works, it is well written and is 
 pleasant reading." Medical Press and Circular, Dec. 13th, 1893. 
 
 ^otkes of otljer Storks, frg % same mthor. 
 E PRINCIPAL HEALTH-RESORTS of 
 
 EUEOPE and AFRICA. Third Edition. Fannin & Co., 
 Graf ton-street, Dublin. 
 
 " A succinct, just, and practically useful guide to the health-resorts and spaa of 
 Europe " Dublin Journal of Medical Science. 
 
 " We beg to thank the author for several hours of pleasant and profitable reading, 
 and most cordially recommend our subscribers to consult the personal experience 
 and studies of Dr. More Madden.' '-Philadelphia Medical Times. 
 
 " As a popular and practical guide on its subject, we have met with no work that 
 more entirely recommends itself to our judgment. It is comprehensive, to the point, 
 and apparently thoroughly trustworthy." The Saturday Review. 
 
 " Such a volume may be pronounced thoroughly seasonable. . . Dr. Madden has 
 a pleasant easy pen. . . What he writes about he has seen, and his work bears the 
 impress of experience on every page." The World. 
 
 AN CHANGE of CLIMATE in the TREATMENT 
 
 " of CHRONIC DISEASE. London : Newby. 
 
 "To all who are in search of a 'health-resort,' and to all who have to advise in the 
 selection of one, we recommend Dr. More Madden's book." Medical Times and 
 Gazette. 
 
 "A well written and agreeable book evidently the work of a well-informed 
 physician." The Lancet. 
 
 " We warmly recommend this book." Dub'in Journal of Medical Science. 
 
 " Puch a book is very opportune.'' - Athenaeum. 
 
 " There are in every chapter evidences of the hereditary transmission of talent 
 which distinguishes our author's father, one of the most prolific of our writers. We 
 trust our quotations will show our readers the value of this excellent book." 
 Medical Press. 
 
 " This is one of the pleasantest and most reasonable medical books we have ever 
 read. The Doctor is a physician and surgeon; bat he is something more he is an 
 accomplished scholar." The Daily News. 
 
 pHlLD CULTURE: MENTAL, PHYSICAL, 
 
 \J and MORAL. Dublin : Fannin & Co. 
 
 " The experience of Dr. More Madden in the treatment of the diseases of children 
 stamp bis words with authority." The Irith Times 
 
 INSANITY and the CRIMINAL RESPON- 
 
 SIBILITY of the INSANE. Dublin : John Falconer. 
 
 " Dr. More Madden, whose writings on other subjects we have frequently had 
 occasion to notice, now proves himself also an accomplished psychological physician, as 
 well as an able writer on one of the most difficult questions of medical juris- 
 prudence." Freeman t Journal. 
 
 " A subject which he appears fully qualified to investigate." The Mail. 
 
 THE DUBLIN PRACTICE of MIDWIFERY. 
 By H. MAUNSELL, M.D. Edited by T. MOKE MADDEN. London: 
 Longmans & Co. 
 
 " It is specially interesting, ... as the directions for contending with certain 
 difficulties show the practice of the present day in the Irish Metropolis in very 
 favourable contrast with former years." British and Foreign Medvio-Chirurgieal 
 Review 
 
THE MEMOIRS of RICHARD EGBERT 
 MADDEN, M.D., F.E.C.S.Eng.. formerly Colonial Secretary 
 of Western Australia ; author of " The Lives and Times of the 
 United Irishmen," &c. Ward & Downey, Publishers, London. 
 
 " We can hardly hope to do justice within moderate limits to the intrinsic interest 
 and to the literary merit of the late Dr. Madden's biography. He was a patriot to 
 whose opinions successive Governments listened with respect ; and, during his long 
 life (1798 to 1886), the author of the 'History of the United Irishmen' played i.o 
 inconsiderable part on a wider stage of politics. His various experiences as itinerant 
 physician and special correspondent in the East; as a co-worker with Clarkson and 
 Wilberforce in their efforts for the abolition of the slave trade, and as a Colonial 
 administrator: his visits to many climes and cities of men, his literary tastes, and his 
 friendship with Lady Blessington, Count D'Orsay. and a host of other celebrities, 
 furnish abundant material for a fascinating biography. " The Times (London). 
 
 "The author of 'The Lives and Times of the United Irishmen' has reared for 
 himself a monument which will perpetuate his name and associate it with honour 
 and gratitude as long as the Irish race remembers and values its history." United 
 Ireland, Dublin. 
 
 "Dr. Madden's Memoirs are most interesting." The Review of Reviews, London. 
 
 " He was a successful physician, an untiring philanthropist, a voluminous writer, 
 (upwards of 40 volumes), an extensive traveller, and a loyal Irishman . . His son 
 has used the material in a vuluints filled with delightful stories of adventure and travel, 
 and narrating the personal reminiscences of an observant man. who visited all parts 
 of the world, and met most of the distinguished people of his time." The American 
 Catholic Quarterly Preview. 
 
 " A happy combination of biography and memoir; in both characters most read 
 able, especially in the memoirs, which are entertaining in the highest degree." The 
 New York Independent. 
 
 " The record of an honourable career and details of noble work done in the service oi 
 his country and of mankind at large. The medical profession and the public owe Dr 
 More Madden a debt of gratitude for publishing the memoirs of his distinguished 
 father, of whom his profession and his conntry may feel proud." The Hospital 
 Gazette. 
 
 " We thank Dr. More Madden for these memoirs of his distinguished father. We 
 have read them with great, though mainly unprofessional, interest." The Dublin 
 Journal of M*dical Science. 
 
 " Here must end our extracts from this charminsr volume." The Sunday Sun. 
 
 "It is of interest to readers of all shades of opinion." The Globe (Boston). 
 
 " For views of nearly every phase of human life Madden's Memoirs are unique." 
 The Monitor (San Francisco). 
 
 THE SPAS of GERMANY, SWITZERLAND, 
 FKANCE, and ITALY. London : Newby. Third Edition. 
 "It is a most readable book, and will maintain the high reputation which Dr. More 
 Madden has already acquired." Medical I'ress and Circular. 
 ' Is a safe and useful authority on the subject " The London Review. 
 '"Jhis volume will, we think, become a favourite both with our profession and with 
 the public." Medical Times and Gazette. 
 
 Now ready, post 8vo, with numerous illustrations. 
 
 A HANDBOOK of OBSTETRIC and GYNE- 
 COLOGICAL NUKSING. Being the Fifth Edition of 
 Churchill's "Manual for Midwives." Eewritten and greatly 
 Enlarged. By THOMAS MORE MADDEN, M.D., F.E.S.Ed., Obstetric 
 Physician and Gynaecologist, Mater Misericordiee Hospital, Dublin, 
 &c. 
 
 " A. most excellent and complete work." Medical Times and Hospital Gazette. 
 
 " It is, therefore, a move in the right direction when such an admitted authoiity as 
 T>r. More Madden throws his energies into the projecting of such a work. . . . 
 Clearly and concisely writteu interesting ail through." -Dublin Journal of Medical 
 Science. 
 
 "There is a great deal of useful information in the book." The Lancet. 
 
 " Containing a clear and comprehensive summary. . . . Deserving the atten- 
 tion of students and junior practitioners." Provincial Medical Journal. 
 
 " This is an excellent manual, written by a man of high professional status. . 
 The work is eminently practical." Australasian Medical Gazette. 
 
 FANNIN & Co , 41 Grafton-street, Dublin. 
 London: BALLIEKE, TINDALL & Cox. 
 
,1 as it is reasonable. Dr. Gould says that a 
 nouncea characteristic of all dreams is their lack of lo^or- 
 respondence with the laws of the real world-a statemen 
 wh L we feel inclined to dispute, not only from our own ex- 
 perience, but that of many other competent observer 
 Ce many times dreamed we were taking part > a debate 
 ^versation, and have carried on the double argument w, 
 entire reasonableness. Like most other observers of d 
 phenomena, Dr. Gould considers that the visual se 
 largely preponderate ; he has never dreamed an odouthe 
 anvthing sweet or sour in his sleep. H,s tacble s D f i 
 
 4ixaf/Mi anvtmng svvcou *-**. ~~ - 
 
 God for my happy dreams, as Mo for my ^gteue s t? r fT" 
 somewhat more than ourselves in our sleeps, and the slumber 
 of the body seems to be but the waking of the soul ; it is the 
 ligation of sense, but the liberty of reason." We know 
 great deal more about psychology now than could have 
 
 In-mum .in tlm rlo ^f CS- TIT T>._ -, 
 
 a 
 been 
 
 puv suoifftiu, ueas 
 papp'B 
 u 'eso 
 
 p-eq 
 
 siq 
 
 UT 
 
 PUB 'uaas J9Aa pisq eq 
 ) "e jo 9SBOJBO ai{^ uo uomtdo 
 v ui ssau^iAi B SB pajTBO SBAV 
 ^Bp aaq^o aq^ ^UQ 
 
 ssaadaa o^ ^uasaad ^-e op ^aq^ u^q^ aaora ^uiop 
 eq o^ sa^add-B ^paraaj aq^ pu 'a^un^jojun ^soin 'asanoo 
 jo 'si siqj, 's^oairp aou^qo SB ^SOUIJB eq XBUI 
 si 9sno aq^ XBA\ aq^ puB 'miq o^ djaq qonui jo aAoad 
 ^ou si aq.Bj^siBui aq^ <\ uoi^oadsui {Buosaad '^Jinbu 
 jo ^oaCqns aq;j si ssauqsajj jo ^UBAV s!}i aaojaq s^Bp ^UBUI pazias 
 U99q SBq ^Baui aq^ uaqAV jo '{BUIIUB pasBasip B UIGJJ si 
 ^nq 'Suo\ oo 1 } ^daj[ uaaq SBq qsap aq^ ^Bip q.ou si 
 
 sasuas ^Bioads UAio siq jo aouapiAa 
 aq^ ajqBua o^ '^jnoo aq^ jo s^ouioaad 
 
 aHl_.9A'BU Ol _30UOBad UOUltUOp 
 
 mir 
 inl 
 
 he; 
 sati 
 acti 
 and 
 ness 
 
 phy; 
 
 the 
 
 tise 
 
 recoi 
 
 alrea 
 
 of si 
 
 the 
 
 ener 
 
 the] 
 
 dime 
 
 that 
 
 stim 
 
 sopor 
 
 ihek 
 n si 
 Pul a( 
 

 ITon[0tnI 
 
 OF THE 
 
 ROYAL COLLEGE OF SURGEONS/*! 
 
 AND 
 
 APOTHECARIES' HALL. 
 
 The Candidate is to attempt all the questions given. 
 The answers to groups A. and B. are to be put into separate books. 
 
 The Candidate is to fill up the blank spaces on the cover of his answer books, and mark 
 each with his Indication Number, NOT HIS NAME. 
 
 FINAL EXAMINATION. 
 
 July, 1895. 
 
 A.S 
 
 B. \ 
 
 MIDWIFERY AND GYNAECOLOGY. 
 
 A. W. BATE, F.R.C.S. 
 THOMAS MORE MADDEN, M.D. 
 
 1. Describe the causes, symptoms, and treatment of acute 
 inversion of the uterus. 
 
 2. Enumerate the causes, and describe the treatment of delay 
 in the third stage of labour. 
 
 3. Mention the circumstances calling for the use of the mid- 
 wifery forceps, and describe the method of its employment. 
 
 4. State the causes, symptoms, and treatment of sub-involution 
 of the uterus. 
 
 5. Describe the symptoms and treatment of retroversion of the 
 uterus. 
 
 6. What are the symptoms of fibroid tumours of the uterus? 
 With what conditions might it be confounded ? How would 
 you diagnose and treat a case of this kind '. 
 
 28 
 
S 
 
 
 m TA 'nTnrvun_naonr>OTfr oBflm am aAtm oa ar>nn"pjd uommool 
 

 
 fitorrcsponUcnce. 
 
 DEATH'S COUNTERFEIT." 
 
 *8 f / 
 
 TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR. 
 
 SIR, -From Dr. Curran's letter in this day's Medical Press 
 it might possibly be inferred that the cases of lethargy or 
 trance referred "to in my recent paper on this subject were 
 taken without acknowledgment from some communications of 
 his published in Health last year, and in Knowledge in Sep- 
 tember, 1885. I would therefore beg to point out that most of 
 the cases alluded to may be found very fully detailed in a 
 paper of mine published in the Dublin Journal of Medical 
 Science for April, 1881, and, moreover, that until to-day 1 
 had neither seen or heard of Dr. Curran's more recent, and 
 I have no doubt, very interesting papers. So much for the 
 question of priority. With regard, however, to the far 
 more important point under consideration, namely, the 
 actual occurrence in well authenticated cases of lethargy or 
 trance so profound as to be confounded with death, I am 
 glad to learn that Dr. Curran's views are apparently in 
 accordance with those I have so long maintained in my 
 papers on the subject. 
 
 I am, &c., 
 
 Merrion Square, Dublin, THOS. MORE-MADDEN. 
 
 May 4th, 1887.