Paralysis of the will or aboulomania may be produced by certain diseases and drugs. In hysteria, for instance, it is often the case that the patient takes to her bed, and remains there for months, or even years, without any other reason for so doing than that her power of volition is destroyed or greatly impaired, and that, therefore, she cannot get up and go about her work or duties. It is well known, too, that alcohol and opium have the effect of weakening the will to such an extent as to render the subject absolutely incapable of taking the initiative in any important undertaking, or of resisting influences brought to bear upon him, and which he knows he ought to resist. Wills are thus made, and property given away, which the individual knows he ought not to execute or part with, but with his diminished volitional power he yields, because he is not strong enough to successfully

oppose.

De Quincey' sets out the volitional degradation of the opium-eater very forcibly when he says of him that he "loses none of his moral sensibilities or aspirations; he wishes and longs as earnestly as ever to realize what he believes possible and feels to be exacted by duty, but his intellectual apprehension of what is possible infinitely outruns his power, not of execution only, but of power to attempt. He lies under the weight of incubus and nightmare; he lies in sight of all he would fain perform, just as a man forcibly confined to his bed by the mortal languor of a relaxing disease, who is compelled to witness injury or outrage offered to some object of his tenderest love. He curses the spells which chain him down from motion; he would lay down his life if he might but get up and walk; but he is powerless as an infant, and cannot even attempt to rise."

It would appear, however, that in some cases of aboulomania there exists what has been called by Mr. Skey' the "latent force" of the will, which can be brought out, as in hysterical subjects, by some strong impression made upon the mind, or some exceedingly important object to be accomplished. This "latent force" exists to some extent with all persons, even in the healthy state. To use a simile suggested by Mr. Skey, let us suppose that a strong man has found by experience that he can barely lift two hundred and fifty "Confessions of an English Opium-Eater."

"Six Lectures on Hysteria," etc., London, 1866.

pounds of sand with the utmost exertion of his will and muscles. Put two hundred and sixty pounds of gold before him, and tell him that, if he lifts it, it is his, and he will raise it without difficulty.

The ancients were fully aware of the existence of this "latent force." It is told of Alexander the Great that one day, while sitting in front of his tent, a soldier passed him staggering under the weight of a bag of gold he was carrying to the treasury. "My friend," said the King to him, "do not suffer so painfully. Carry the bag to your own tent, for it is all your own," and the soldier tripped off with the load as easily as though the sack had been changed for one of feathers.

The woman, also, who has been in bed for years, unable, as she thinks, to stand alone, and in whom the will power for certain acts is almost entirely abolished, jumps from her bed and runs nimbly down stairs if the house catches fire. Her latent will power, which only a strong impression can bring out, is at once developed, and she does what no ordinary excitation could possibly accomplish.

And the same is true of aboulomania occurring in persons unaffected with other diseases-a primary affection in fact; and the fact is well exemplified in the first case of the kind to which my attention has been directed, and to which I have alluded in another place. In this instance a gentleman never could make up his mind how to invest his money, and every day he would go down town to Wall Street, thinking that at last he had found the investment to make, but always returning in the morning without having accomplished his purpose. Day after day this conduct was repeated, and several months elapsed without his money being invested.

I then lost sight of this patient, and did not see him again. till the latter part of the year 1882, when he again came under my charge. In answer to my inquiries, he informed me that the trouble about the money had been settled, soon after I last saw him, by his wife taking it from his desk and purchasing some securities with it, but that soon afterward an extension of his hesitation had ensued, and that now there were many things he could not do. He had given up trying to invest his money, but he now had a like difficulty in buying anything, no matter how trifling, and this was a source of great disturbance to him. If, for instance, he went into 1 "Cerebral Hyperæmia," etc., New York, 1879, p. 29.

a shop to get a pair of gloves, he could never determine for himself what kind to buy, or what colors; and, when helped out in these matters by the salesman, he could not go through the movements necessary to getting out his pocket-book to pay for them. As a consequence, he either had to have some one with him to pay for the things he bought, or, as frequently happened, he would throw the articles down on the counter, and tell the people to send them home. At first, before he began to take some one with him to aid him in making purchases, he would often spend an hour or more in getting some commonplace article. But, upon one occasion, as he was walking along Broadway, the idea occurred to him that he would take a box of bonbons home to his daughter. He entered a shop which he thought was one he was in the habit of frequenting, purchased an expensive box, and had it filled with the finest sweetmeats in the shop. All this was only accomplished after a large expenditure of time, and after the display of much hesitation, which not only annoyed him, but caused many expressions of disgust from the shopkeeper. Finally, when he came to pay for the purchases, he found, as usual, all his difficulties increased, and this was a part of the procedure in which he would not be assisted by the dealer. After fumbling at his pocket for some time in the vain endeavor to get at his money, he requested that the things might be sent home. He had already found out that the shop was not the one he had intended to enter, and that he was unknown to the proprietor. He was not, therefore, surprised when that person informed him that the box could not leave his place till it was paid for; but he was not prepared for the torrent of abuse which was rained upon him. The effect, however, was very different from what either of the contracting parties anticipated. In an instant my patient became entire master of the situation. He took out his portemonnaie with as much decision as he had ever done anything in his life, laid the exact sum on the counter, and then, taking the box, threw it at the shopkeeper, and walked as composedly to the door as though nothing had happened. But the influence which had brought out his "latent force" was not yet lost. He stopped at the right shop, a few doors off, selected his bonbons without the slightest irresoluteness, and paid for them with as much ease as in the last purchase. The next day, however, he was as bad as ever.

It would appear from cases such as these that the general condition of cerebral excitement produced by certain factors carries with it an augmentation of the power of the will; and it is not at all improbable that the pathological condition causing aboulomania is a state of passive congestion or anæmia. Carpenter,' referring to this state, says that "the strongest volitional effort may be inoperative through some defect of the apparatus by which the nerve-force is transmitted to the muscles which are to execute the behests of the will, as happens in paralysis. But there are states-and it is these which are now under consideration-of absolute incapacity for such effort, the mental desire existing, while the energy necessary to carry it into effect is deficient. That this incapacity arises from a deficient supply of blood to the ideational (cerebral) nerve-centre appears probable from the familiar fact that a general deficiency of volitional power over the muscles is a marked feature of the physical depression which betokens feebleness of the circulation, being especially noticeable in seasickness, while a defect in the distributive action of the vasomotor system of nerves (such as that of which we have evidence in many local congestions) might very well account for such cases as the two following."

99 2

CHAPTER VII.

V.

COMPOUND INSANITIES.

COMPOUND insanities are those forms of mental aberration in which two or more categories of the faculties of the mind are involved to a marked degree. In all the types to be considered under this heading there is, therefore, a general mental derangement, the perceptions, the intellect, the emotions, and the will participating in the disturbance; and often with alternating predominance, or no special predominance, of one set over the other.

1 Op. cit., p. 385.

2 These are the cases cited on page 529.

a-ACUTE MANIA.

By acute mania is to be understood a condition of mental derangement characterized by illusions, hallucinations, delusions, great mental and physical excitement, and often by a tendency to the perpetration of acts of violence and extravagance.

Pinel' defines acute mania as an affection in which there is a general and permanent hyperexcitability of the intellectual and moral faculties. It is exhibited by the most decided symptoms-alteration of the countenance, disorder of the clothing, acts of violence, and confusion of ideas, which succeed each other without order and without logical sequence. It is, moreover, characterized by intense nervous excitement, by extreme agitation, sometimes reaching the point of fury, by a general and more or less well-marked delirium, and often by a complete reversal of all the operations of the mind.

Broussais' says:

"Maniacs are agitated, vociferous; they are irritated by the slightest cause, and even without provocation, but especially if they are spoken to. It is only sufficient to speak to them to excite them to the highest degree. Their ideas are incoherent, their eyes bright, their muscular strength prodigious. It is often necessary to restrain them, for they are actuated by the wish to break and destroy everything which comes within their reach, and they kill those who approach them unless they are kept in subjection. Some of them, when the accession has been sudden, had already murdered several persons before they could be confined. Many turn with fury against themselves, and stab or throw themselves from heights. The pulse is small and tense, and more or less quick. Sometimes there is scarcely any acceleration in the action of the heart. When they have not been bled, the face is red and swollen, the veins enlarged, the skin hot, the tongue red, the epigastrium tender to the touch, anorexia, and sometimes a yellowish tinge about the eyes. They can remain a long time in this deplorable state without food, without sleep, without feeling cold, yelling and blaspheming day and night, making

"Traité médico-philosophique sur l'aliénation mentale," Paris, 1809, seconde édition, p. 139.

"De l'irritation et de la folie," deuxième édition, Paris, 1839, t. ii, p. 352.