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prevention of crime, and does justice to the labours of Dr. Bruce Thompson, whom he quotes largely.

Second Question.-1. What are the psychic and moral causes of insanity? 2. What part does the brain play concurrently with these causes? 3. Has it been observed that insanity shows itself more at one time than another, under certain events, or certain ideas, either political or religious, or by the effect of certain works of the imagination? 4. Are there epidemic outbreaks of insanity, and how are they explained.

Psychic and Moral Causes of Pathologic Insanity.--Insanity from purely psychic or moral causes is rare, and the pathologic affections of the brain which produce insanity are nearly always due to several causes, to a union of physical and moral causes. The chief physical cause is cerebral feebleness, a particular disposition of the brain to be invaded by pathologic states which produce mental alienation. Every psychical act which fatigues the brain, which disturbs its activity and consequently affects its tissue, which causes congestion, etc., may, if the brain is not sufficiently streng to support the attacks, disturb its normal physiologic activity, and give rise to pathologic activity. Too prolonged application of the mind, which produces arterial congestion, as shown by redness of the face and eyes, by insomnia and cephalalgia, injures the brain.

The forced intellectual work to which some children are submitted, in whom the brain is debilitated, and when this organ has acquired neither consistence nor development, disposes to intellectual impotence-imbecility.

Abuse of alcoholic liquors is a most powerful cause of cerebral disorganisation, by virtue of this organic law :— The deleterious action of alcohol makes itself more particularly felt on that organ of the body which by reason of the kind of life of the subject is more often fatigued. Another cause is the state of febrile activity in which we live, as M. Thiers observed in the Chamber (30th July, 1868), " In our days, man is impatient of living; he will not allow to the acts of life, the time necessary for their accomplishment: that which should take a year he wishes to do in a month, that which demands a month, he wants to get done in a day, in an hour."

Insanity is much more frequent among the lower classes (in France at least); this is due to the abuse of alcohol, to their extreme misery, with its accompanying debilitating physical and its depressing moral causes, rather than to in

tellectual inactivity, as Dr. Richardson affirms. On the other hand, if we meet with in England many serious diseases, such as gout, rheumatism, gravel, affections of the liver, stomach and kidneys, among mind workers, these diseases are not due to their intellectual activity, as Dr. Richardson supposes, but to the fact that in England the class of mind workers are nearly always in easy circumstances or even rich; nearly all are used to too much animal diet, and too frequent alcoholic drinks, which are causes of the abovenamed diseases; absence of exercise also favours these diseases.

Dr. Despine believes that there is an antagonism between pulmonary phthisis and cerebral affections, which produce insanity. He agrees with Dr. Maudsley that the fatigue of the brain from excess of intellectual work is a cause of insanity much less powerful than the disturbance which emotions from moral causes produce in this organ.

Dr. Despine argues that the cause of there not having been any notable increase of insanity by the effects of the Prussian siege, and the domination of the Commune, is due to the fact that those who would have become mad were killed in the insurrection; being excited by alcohol and possessed by an audacious stupidity, they confronted danger without comprehending it.

Physical causes produce in the cerebral functions disturbances having nearly constantly the same characters, whilst moral causes do not, or the relation is only fortuitous.

The state of the circulation influences the cerebral function in an important way. Moral impressions act with energy on the great sympathetic system, which produce the various organic effects in emotion. In paralysis of the vaso-motor nerves the capillary vessels of the brain do not contract, the vessels become congested, and microscopic apoplectic spots are produced. In excitation (stimulation) of these nerves the capillaries contract, receive very little blood, and the brain is insufficiently supplied with the agent for exciting its activity. Moral causes play an important part in the production of insanity, but always among persons whose brain is predisposed to pathologic affections.

Dr. Despire, relying on Dr. Robertson's opinion that insanity is not on the increase, in England at least, believes that the productive causes of insanity have reached their highest point of intensity.

On the question of insanity and civilization, he observes:

If there is a coincidence between the frequency of insanity and the progress of civilization, this is caused not by civilization itself, but by the numerous abuses which it introduces, which act especially on the brain and nervous system. We have to pass over his interesting observations on epidemics of insanity, some of which are very curious.

Third Question.-In what cases of insanity may it be useful to combat and even cure it by a treatment which only acts on the feelings, ideas, habits; in a word, on the moral and intellectual faculties ? Give various experiences in this kind of treatment, etc., and the value of results.

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1. Preservative psychic treatment of pathologic insanity. This consists entirely of a translation (not, however, perfectly correct) of a large part of Dr. Maudsley's work, Responsibility in Mental Disease (or as Dr. Despine entitles it Crime and Madness") with a few running comments. He does not believe in the efficacy of mere intellectual work, but says that only good instinctive feelings can counteract bad instincts or the passions; the practice of a calm, regular, and moral life may, however, ward off an attack, in persons feebly predisposed to insanity, but if the predisposition is great all moral precautions will be useless.

2. Curative psychic treatment-

First indication.-To calm the mind by removal from all exciting causes-to place the patient among strangers, who prove to him by contradictions and reasoning that his delusions are useless and injurious.

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Second. To rouse the spirits, when the cerebral activity is in a state of feebleness or torpor.

The patient should be under the care of one who understands his psychic and somatic state. He is to be closely watched night and day, and should know that he is watched. Erroneous ideas ought never to be encouraged; at the outset of cerebral disease where there is not a complete blindness of mind in regard to the inspiration of his passions, a direct contradiction may be useful; but when the disease is confirmed it is useless, and even dangerous, to contradict him.

It is necessary to give rest to those parts of the nervous system which, by the patient's manner of living, are in too great an activity, and to stimulate on the contrary the activity of those which remain in prolonged inaction. Thus, where sedentary life has stopped the abdominal circulation, which has so much influence on the brain through the great

sympathetic; or when intense mental tension, either by impassioned prepossession, or by forced intellectual work, has produced congestion and irritation of the brain, open air exercise, agricultural work, gymnastics, mountain exercise, etc., are very useful. Treatment by distraction has been much vaunted; that is by various amusements, balls, concerts, theatrical performances, change to health resorts, etc. This treatment is very bad; if there is agitation of either a lively or depressing character, it augments it. Under this treatment we have seen melancholics become maniacs; it may, however, do good during convalescence.

In general there should not be more than fifteen patients under treatment in each quarter of the asylum.

Dr. Despine discusses the theory of emotion, and the emotional treatment of insanity. He believes that the disturbing action, either for good or evil, may be attributed to an isometric change in the histologic elements of the brain determined by a disturbance of the nerve elements which preside over the nutrition of this organ, or to a change in the capillary circulation, by an action of the vaso-motor nerves, influenced by causes which have impressed the nervous system. This theory is sufficient to explain all the attacks or cures of insanity from such curious effects, as typhoid fever, scarlatina, pneumonia, injuries, loud noises,

etc.

Opium and Morphia excite the nervous centres of the vasomotor nerves, they give tenacity to the muscles of the small vessels, favouring their contraction and consequently increasing the capillary circulation.

The state of somnambulism artificially produced is one of the most powerful sedatives; it suspends cerebral activity, and is of remarkable efficacy in the treatment of obstinate hysteria.

Camphor is valuable in disturbance of the genital organs, especially onanism.

Quinine is recommended when the insanity has a periodic character, or when it shows itself in marshy districts, or when it is a sequel of dangerous and obstinate remittent fever.

Digitalis in twenty minim doses calms the maniacal excitement of epilepsy.

Various theories of Insanity.-The views of the following authorities are briefly explained and commented upon: 1. Stahl. 2. Heinroth. 3. Idelier. 4. Seuret. 5. Maine de

9. A.

Biran. 6. M. Luys. 7. Maudsley. 8. Dr. Morel. Lemoine. 10. Moran. 11. Auguste Comte. 12. Littré. 13. Dr. Despine. 14. Griesinger.

Dr. Despine's theory.-Madness is not a disease but a psychic state. This state in disease has its origin in a pathologic activity of the brain. But this psychic state may exist in a healthy person (he looks upon crime as a form of insanity). To have a passion roused by a pathologic state of the brain, or by a passion natural to the character, is not to be mad. That which constitutes madness, is psychic phenomena; it is the moral blindness of mind in regard to the passionate inspirations, a blindness caused in consequence of the moral feeling not enlightening the individual upon his passion, those principles of moral reason being stifled by the power of this passion, or not existing in his conscience by reason of a moral abnormality with which the individual is affected.

The word madness serves to designate two kinds of alienation. 1. When the intellectual faculties are intact, but there are moral instinctive perversions, that is to say passions. 2. When the psychic faculties are more or less powerless and incoherent, the ideas limited, when there is no attention, no reasoning and no imagination, and what remains of the moral faculties is more or less perverted.

In our review we have purposely avoided any critical remarks, though frequently tempted to do so. The book is full of suggestive thought, and has evidently been prepared with great care. There is, however, a lack of practical information, and the theories are somewhat too vague and unfeasible. We think that if Dr. Despine had limited himself to the questions of the Academy, and condensed a little more, he would have produced a more useful, though probably less imposing work.

A. H. N.

The Borderland of Insanity and other Allied Papers. By ANDREW WYNTER, M.D. R. Hardwicke, 1875.

This volume consists of essays, most of which have already appeared in the "Quarterly" and "Edinburgh Reviews." Dr. Wynter has endeavoured to show that it is a mistake, excepting in the more violent cases, to send insane persons to asylums; or, at any rate, a mistake "to crowd patients together in an atmosphere sodden with insanity, where they

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