The Press. — London, England, 1854-09-09 00:00:00

Letteentian Lectures on Insanity. By Forbes Winslow, M.D. London : Churchill. THE subject of insanity is one of great import ance to all civilised communities, and in the three lectures contained in this volume (delivered before the Medical Society by Dr. Winslow in his year of election as Lettsomian Professor) the author has given us, though in a mere outline, new and original observations upon its development and treatment As the lectures are distinguished by clear exposition of principles, thorough practical knowledge of details, extensive experience, a wide range of illustration, and vigorous argumentation, it may be received not only as an excellent con tribution to medical science, but to our general literature. In the first lecture, upon the " Psychological Education of the Physician," Dr. Winslow insists upon the necessity of a profound know ledge of mental philosophy to the physician generally, and especially to those occupied in the treatment of mental alienation: — The physician is daily called upon, in the exercise of his profession,to witness the powerful effect of mental emotion upon the material fabric. He recognises the fact, although he may be unable to explain its rationale. He perceives that moral causes induce disease, destroy life, retard re covery, and often interfere with the most potent remedial means exhibited for the alleviation and cure of bodily disease and suffering. Although such influences are ad mitted to play an important part either for good or for evil, I do not conceive that, as physicians, we have sufficient appreciation of their great importance. How is it possible for us to influence the minds of ~ thers if we have no accurate knowledge of the constitution and operation of our own understandings? As well might the physician administer for the relief of an acute malady a material agent of whose properties and modes operandi he is avowedly ignorant. To the physician occupied in the ini vestigation of deranged conditions of mind j some knowledge of mental philosophy is indispensable. And yet, hitherto, with few exceptions, the case of the insane has been given over to men not only grossly ignorant of the constitution of the mind, but unacquainted with the first principles of medical science : It is only in recent times (remarks Dr. Winslow) that it has been considered necessary to ascertain whether Parties desiring to undertake the case and treatment of the insane have any other qualification to recommend them to the office than the possession of a house of certain dimen sions and a sufficient amount of capital to enable them to carry into effect the mere commercial speculation. This reasoning carries conviction with it, for it is obvious that men who are to under take the care and cure of mental diseases should be well acquainted with the nature of the organ they have to treat. In the second lecture, upon the " Medical Treatment of Insanity," Dr. Winslow supports the theory that " all insanity whatever is the " consequence of organic disease of the brain, " either palpable or concealed," and rejects the spiritual theory, which attributes such an affliction to Divine wrath or malignant influence or some such analogous views : Considering the subject practically (remarks Dr. Wins low), let us for a moment ask ourselves the question, what have been the consequences of the general belief in the spiritual and functional character of this disease? The lamentable effect has undoubtedly been to discourage and discountenance the use of remedial measures ; and the effect upon the public mind has, alas! been to create the false impn.ssion that mental affections were not curable maladies, and that it was not in the power of the phy sician by means of medicine to administer to their relief. The error of treatment hitherto has been a vain effort to discover one uniform method of management or specific mode of procedure, adapted to all eases. But of the general curability of insanity, except in cases of severe injury to the head, or hereditary diathesis, Dr. Winslow asserts " that, if brought within " the sphere of medical treatment in the earlier " stages, insanity is as easily curable, as any " other form of bodily disease for the treat " ment of which we apply the resources of our " art." While insisting on the importance of medical treatment, Dr. Winslow hints that the atrocities of the greatest monsters in the world's history may be probably referred to cerebral derangement : We do not possess data to enable us to judge satisfac torily of the mental or physical state of a Nero, a Caligula, or a Tiberius, who, as Tacitus informs us, was designated by his tutor, at the age of twenty, as " a compound of mud and blood ;" but it. is not charitable to suppose they were physically and morally diseased, and of unsound mind, the insanity manifesting itself in conduct, and not in ideas. Again, can we advance anything, as psychologists, in pal- 858 I\ THE PRESS. liation of the crimes of Catherine de Medici ?—or that would extenuate in the eyes of the world the brutal treat ment to which Frederick William of Prussia, father of Fre derick the Great, subjected his son?—or would be an apology for tie atrocious tyranny and savage brutality of Judge Jeffreys?—anything to excuse the cold, calculating murders of Henry VIII. ; —or the refined crimes of, and thirst for blood exhibited by, Robespierre ? • • • Catherine de Medici's disposition did not show itself until after the death of her husband. I am not in a position to say how much of her conduct was to be attributed to the shock of his dissolution; but it is said she suffered from d 'nination of blood to the head, so severe in its cha r.ie ••r as to require occasional bleeding for its relief. Fre derick William of Prussia was a debauchee and a drunkard. He conceived, without any reason, an inveterate hostility to his eldest sister, and to the prince his son, afterwards Frederick the Great. He compelled them to eat the most unwholesome, disgusting, and nauseous articles of diet. He was in the habit of spitting in their food, and behaving towards his son with great ferocity. King Frederick suffered from severe attacks of hypochondriabis, and great mental depression, and it was during one of these paroxysms that he attempted suicide. Who can entertain a doubt of his insanity, or of the good that would have resulted had his brutality and cruelty been considered symptoms of some affection of the brain, and he had been treated accordingly? Robespierre, after his death, was found to have extensive visceral disease; and it is notorious he suffered much from this affection during life. It is re corded that he rolled on the ground for hours in acute pain. Judge Jeffreys. it is said, was " tortured by a cruel in ternal malady, which had been aggravated by intemperance." In the celebrated Western or " Bloody" Assizes, this mon ster is said to have hanged 320 and transported 855 per sons for "the most part of blameless life and of high religious profession!" Previously to his starting for the circuit, Jeffreys' health and spirits had given way. • • There are crimes for which men have been hanged which might have been prevented by physical treatment. Damien persietA in declaring to the last that had he been bled in the morning, as he wished and requested, he never would have attempted the assassination of Louis XV. It is recorded of Caligula, that his reign commenced with mildness, but that the end of the first year, after a violent attack of bodily illness, he commenced his career of cruelty, violence, and crime, slaughtering the noblest men of Rome, and hunting the spectators of a public show into the waters of the Tiber! If this theory be just, whole classes and nations would have occasionally to be put under medical care, and a council of physicians would be the best preservative against national mania. The third and most important of the lectures is on medico-legal evidence in cases of insanity. Though careful to surround with prudent limitations those principles which at first sight would appear startling, yet on the whole the author gives us an impression that the conduct which is unnatural or irrational may most often be referred to a diseased condition of the brain. " Positive, dangerous, and " irresponsible insanity," he says, "is often " unassociated with any manifested delusive " impression, or appreciable hallucination." If this be so, how is insanity to be defined? The author relies on what he terms the great psychological fact, thut no mind can properly be considered to be " unsound" or " insane" which is not subject to actual disease, the " insanity" and " unsound ness" being invariably the products—the effects—the con sequences, of some deviation from the healthy condition of the brain, its vessels or investments, disordering the mental manifestations. But then arises the question how the fact of cerebral disease is to be determined : As medico-legal witnesses, we have to deal with phe nomena of the essence or intimate nature of which we know absolutely, positively, nothing It is our duty to elucidate principles of belief, to unravel motives of action, to explain erratic conduct the most anomalous and extra ordinary; we have to trace the line which separates passion ; the subtle and shifting transformations of wild, ungovern able,and impetuous passion from the excitement of mania and the morbid emotions incident to the minor forms of diseased mind; to sketch the varying frontier, the nice and shadowy distinctions which separate lunacy from malig nity—madness from brutality ; to point out where folly merges into mental derangement ; where responsibility terminates and irresponsibility commences ; to distinguish between eccentricity and insanity—crime and alienation of mind—vice and mental derangement—between the delu sions of the lunatic and the false conclusions, the illogical deductions, the uriphilosophical reasoningof men of sound intellect and of rational understanding—to separate the normal rhapsodies of the healthy imagination from those morbid conceptions and thick " coming fancies," the pro ducts, the well-recognised, indisputable symptoms of a mind thrown off its healthy balance by actual cerebral disease. He admits that there is no mode by which we can penetrate behind the curtain, or tear aside the veil that divides the material from the immaterial—mind from matter ; there is no pos. sibility of our obtaining access to that mysterious chamber where the spiritual portion of our nature is elaborated ; we have no gauge, no square rule, by which we can ascer tain in all cases, with any approach to chemical or math*. SATURDAY, matical accuracy, an accurate idea of the actual condition of the mind, when apparently under a cloud. In the elucidation of these points, we are in a great measure left to our unaided mental sense—to the uncertain guidance of our own deceptive experience, and alas! often, fallible judgment. - - It would appear, therefore, that a positive alle gation of cerebral disease, in cases where " the " varying frontier, the nice and shadowy distinc tions," render it difficult to pronounce an opinion, even on the manifestations of the mind, must be received rather as a convenient definition of insanity than a pathological fact. Towards the close of his third lecture the author suggests a consideration which belongs rather to the moralist than to the physician : I maintain, and facts—an overwhelming mass of facts— clearly, irresistibly, and conclusively demonstrate my posi tion,—that there is a vast amount of crime committed by persons who, if not " legally" or " medically" insane, occupy a kind of neutral ground between positive derange ment and mental sanity. Ido not broach this idea with the view of support►ng the absurd, unphilosophical, and dangerous opinion, that all crime is more or less referable to aberration of m lid; but I do affirm, that, in estimating the amount of punishment to be awarded, it is the solemn duty of the judge, not only to look at the act itself, but to consider the physical condition of the culprit—his educa tion—moral advantages—prior social position—his early training—the temptations to which lie has been exposed— awl above all, whether he has not sprung from intem perate, insane, idiotic, and criminal parents. Dr. Haslam maintained that all persons were more or less insane, and to push the above thought to its legitimate conclusion would exempt all crime from punishment. A careful review of some of the principal judicial criteria of insanity, and some leading rules for medical witnesses, conclude a volume full of important suggestions upon a point of the most material importance to the well-being of society. Indian Leisure. By Captain R. Guthrie Mac gregor, Bengal Retired List. London : Smith, Elder, and Co. CAPTAIN MACGREGOR belongs to a class of writers who have, in our ()pinion, a peculiar claim to be gently treated by critics. We speak of conscientious and competent transla tors who make the great mass of readers familiar with the masterpieces in a foreign tongue, yet who are rarely thanked for their labour. If the translation fails, the translator is blamed; if it succeeds, all the praise is bestowed on the original. The most perfect and the most prosperous translation brings little credit to him who has executed it, and his pecuniary reward is always small. Thus, while there is little pay and no honour for the best translations, the penalty of probable and frequently inevitable failure is very heavy. It requires no great calculation, therefore, to compute the value of translation to any man of letters as a speculative undertaking. If some great author be spoiled in the render ing, and be consequently exposed to an injurious estimate, there is no mercy for the unlucky offender. In mere vindication of the author the translator is pilloried. All this is fact ; and a considerable part of it is justice also. But, when we reflect how very useful translations sometimes are, and how often they are necessary ; that every science, and every art, and every calling, have their own literatures ; that the works of one country are, on a thousand occasions, by means of translation, the enlightenment of another ; that by translation civilisation, amity, and emulation, are promoted ; we ought to be cautious of rendering an office already so unpromising to those who undertake it utterly discouraging and repugnant., and afford to good, and painstaking, and able translators like Captain Macgregor their honest due in un grudging praise. There are several conditions, both extrinsic and intrinsic. necessary to make a translation valuable. The extrinsic are chiefly two : first, that the book translated should be worth it; and, secondly, that it should be in some tongue not so commonly understood in the transla tor's country as that almost all readers would prefer using the original to using the version. The intrinsic conditions are those which Cap tain Macgregor exhibits—capacity and earnest ness. His passages from Petrarch, we confess, have surprised us. They might be taken for original English compositions, so completely has he mastered the difficulty of finding Eng lish idioms to correspond with the Italian.