he was at that time placed as most kind and fatherly; he also expressed himself as particularly fortunate in being under my care, and bestowed many handsome compliments upon my skill in treating this disorder, and expatiated on my sagacity in perceiving the slightest tinges of insanity. When I wished him to explain certain parts of his conduct, and particularly some extravagant opinions respecting certain persons and circumstances, he disclaimed any knowledge of such circumstances, and felt himself hurt that my mind should have been poisoned so much to his prejudice. He displayed equal subtlety on three other occasions when I visited him; although by protracting the conversation he let fall sufficient to satisfy my mind that he was a madman. In a short time he was removed to the hospital, where he expressed great satisfaction in being under my inspection. The private madhouse, which he had formerly so much commended, now became the subject of severe animadversion; he said that he had there been treated with extreme cruelty, that he had been nearly starved and eaten up by vermin of various descriptions. On inquiring of some convalescent patients I found (as I had suspected) that I was as much the subject of abuse when absent, as any of his supposed enemies, although to my face he was courteous and respectful. More than a month had elapsed since his admission into the hospital before he pressed me for my opinion, probably confiding in his address, and hoping to deceive me. At length he appealed to my decision, and urged the correctness of his conduct during confinement as an argument for his liberation. But when I informed him of circumstances he supposed me unacquainted with, and assured him that he was a proper subject for the asylum which he then inhabited, he suddenly poured forth a torrent of abuse, talked in the most incoherent manner, insisted on the truth of what he formerly denied, breathed vengeance against his family and friends, and became so outrageous that it became necessary to order him to be strictly confined. He continued in a state of unceasing fury for more than fifteen months."*

With the view of arriving at a correct conclusion with regard to the existence of insanity or not the French have recourse to what they call the interrogatory, the continued observation and the inquest. Method in such matters is, of course, of the greatest use, and it has

Haslam, 'On Madness,' 53.

been said by some writers that the efficacy of the French system is proved by the admirable way in which it works.

The interrogatory embraces all that will be considered in the chapter which will be devoted to the examination of lunatics. And it is instituted with a view to obtaining all the information which can be had from the individual himself, or from any one who has had opportunities of becoming acquainted with his past history, and of observing his conduct. When the examination of the lunatic or interrogatory fails to establish the existence of insanity, and not unfrequently this will be the case where moral mania or imbecility alone are present, the French have recourse to the second method

Continued observation. The importance of a careful observation of a person supposed to be insane extending over a long course of time can scarcely be exaggerated. At any visit of a medical man the patient may be on his guard and may manage to conceal his insanity, but very few insane persons can continue to act the part of sanity for a long time. They will inevitably be off their guard now and then, and the true mental symptoms will manifest themselves. Observation when the patient is unconscious that he is watched will often throw light upon actual mental disease which is most carefully hidden when they are in the presence of others. It seems as in the case of criminals who cannot, even when assisted by the discipline of a prison, remain "good" for long, but must have their "outbreaks," so it is with the lunatic who would conceal his delusion. The probability is that he raves when he imagines himself unobserved. Opportunities of observation should therefore be secured and care taken to note all his habitual acts which may be within the range of the influence of delusion, as it is in those acts which are automatic that the morbidity is most likely to be observed. We have in another place pointed out the importance of examining the writings of those who are suspected of lunacy.

The inquest, according to the French method, implies a consideration of the past history of the case, and bringing the facts derived from others as to the possible causes of the disease to bear upon the case. In this place we need only say that all these means which are formulated by Georget and other French writers in the way we have indicated have been all along appreciated by English and American writers, and

* See post p. 320.

that, perhaps, a more philosophical classification of the facts to be observed will suggest itself to many readers. Little difficulty can arise if an examination such as we have recommended in another place is conducted with the care and intelligence which is necessary to the success of all scientific research. But after the cases which have been alluded to in this chapter, it is evident that in many instances one or two interviews with a lunatic will not be sufficient, and that in some a long course of observation will be requisite to establish the fact of the existence of mental disease.

CHAPTER XX.

ON LUCID INTERVALS.

THERE is no law more marked, as we have already said, in relation to vital phenomena than that of periodicity. Everything in nature is periodic. The sun, which is, as it were, the bulb root of life, makes the seasons, makes night and day, makes noon and midnight, and so it is that the whole of the vital processes in man had to become periodic. Thus habit, which tends to constant reproduction of automatic acts, is influenced by this law and produces acts in relation to certain periods. Thus recreations become periodic; sleep becomes periodic; the appetites become periodic; and it would be anomalous if, when all the processes of health are modified by this principle, the morbid conditions of body should not also be under its control. Nervous force becomes exhausted, and a period of rest must follow a period of activity. Nervous force must be accumulated. Now habit, which is like the fly-wheel of a steam engine and governs and regulates the movements, makes this periodical necessity of rest a matter in relation to time rather than in relation to labour already done. In this way periodical accumulation of nervous force, periodical feelings of kindness become a part of man's constitution. So it is with diseases, especially, as could be argued from the above explanation, with nervous diseases. Thus it is we find neuralgia coming on at a certain hour, and from these facts it is not difficult to infer that most, if not all, diseases are periodic. Now, the question as to periodicity when it comes to be asked with regard to insanity must have the answer which has been indicated by the above deductions. The fact that the name by which it is still known-lunacy—ascribed the origin of the disease to the influence of that body evidently points to remissions and exacerbations of the disease corresponding to the monthly changes. That this periodicity is not so marked now is true, but that it was observed in old times seems certain. That the tides

should be in the leading strings of lunar influences, that all the waters of the world should be moved by the gravitation of the moon, and that man should be unaffected by this influence, it is somewhat difficult to conceive. How far the menstrual discharge is governed by this law it is impossible to conjecture, and all our efforts to ascertain the exact effects of this cause fall very short of the mark.

The philosophy of medicine is not sufficient to dream of all things in heaven and earth. Now, that there are marked remissions in insanity is a well-known fact. We know that at certain hours of the day the wards of an asylum are more noisy, just as at certain hours of a day the pulse is higher. But besides these simple remissions in the violence of the manifestations of disease, there are some remissions which have a striking resemblance to mental health. And these have been called lucid intervals. That there may be long periods of health between attacks of mania has scarcely been doubted, but many medical men have hesitated to believe that, in those remissions of a shorter duration which do take place in the course of this disease, there is any return to a normal mental condition. Thus, Dr. Combe observes," However calm and rational the patient may appear to be during the lucid intervals, as they are called, and while enjoying the quietude of domestic society, or the limited range of a well-regulated asylum, it must never be supposed that he is in as perfect possession of his senses as if he had never been ill. In ordinary circumstances, and under ordinary excitement, his perceptions may be accurate, and his judgment perfectly sound, but a degree of irritability of brain remains behind, which renders him unable to withstand any unusual emotion, any sudden provocation, or any unexpected emergency. Were not this the case, it is manifest that he would not be more liable to a fresh paroxysm than if he had never been attacked. And the opposite is notoriously the fact; for relapses are always to be dreaded, not only after a lucid interval, but even after perfect recovery; and it is but just, as well as proper, to keep this in mind, as it has too often happened that the lunatic has been visited with the heaviest responsibility for acts committed during such an interval, which previous to the first attack of the disease he would have shrunk from with horror."* Considerable misunderstanding has existed upon this point up to the present time.

* Observations on Mental Derangement,' p. 241.