2 -3 I DEDICATE THIS BOOK ΤΟ J. S. JEWELL, M. D., PROFESSOR OF NERVOUS AND MENTAL DISEASES IN THE CHICAGO MEDICAL COLLEGE, WHOSE LEARNING HAS ALWAYS COMMANDED MY HEARTIEST ADMIRATION, AND WHOSE FRIENDSHIP IS ONE OF THE GREATEST PLEASURES OF MY LIFE. IN presenting to the medical profession a new work on the subject of Insanity, it seems proper that I should state the reasons which have induced me to add another volume to the store of medico-psychological literature, and to point out briefly what are, I think, distinctive features of the present production. I have long been convinced that the term "insanity" has hitherto been applied in altogether too limited and illogical a manner. It has been understood, both in and out of the profession, that a person, in order to be considered the subject of mental aberration, must, at some time or other, present certain marked symptoms, which he cannot avoid exhibiting, and which are sufficient to indicate to the world that he is not in his right mind. Starting from the points that all normal mental phenomena are the result of the action of a healthy brain, and that all abnormal manifestations of mind are the result of the functionation of a diseased or deranged brain, I do not see why these latter should not be included under the designation of "insanity," as much as the former are embraced under the term "sanity." There can be no middle ground, for the brain is either in a healthy or in an unhealthy condition. If healthy, the product of its action is "sanity;" if unhealthy, "insanity.” Of course, very little of such insanity comes under the signification given to the word by lawyers and the public gen erally. But legal insanity and medical insanity are very different things, and the two standards can never and ought never to be the same. The law establishes an arbitrary and unscientific line, and declares that every act performed on one side of this line is the act of a sane mind, while all acts done on the other side result from insane minds. This line may be in one place to-day, and in an entirely different place to-morrow, at the whim or caprice of a Legislature; it may be established on a certain parallel in one country, and on an entirely different parallel in another country. In the State of New York, for instance, it is drawn at the knowledge of right and wrong; and perhaps, all things considered, this is about as correct a legal line as a due regard for the safety of society will permit to be made. But every physician knows that it is absolutely untenable from his point of view; that it is not a medical line, and that there are thousands of lunatics insane enough to believe themselves to be veritable Julius Cæsars, and yet sufficiently sane to know that a particular act is contrary to law, and to be fully aware of the nature and consequences of such act. Hence it follows that, from a medical stand-point, there is no middle ground between sanity and insanity. The line of demarkation is sharply drawn, and it is but a step from one territory to the other. There is a large proportion of the population of every civilized community composed of individuals whose insanity is known only to themselves, and perhaps to some of those who are in intimate social relations with them, who have lost none of their rights, privileges, or responsibilities as citizens, who transact their business with fidelity and accuracy, and yet who are as truly insane, though in a less degree, as the most furious maniac. who dashes his head against the stone-walls of his cell. To many of these persons life is a burden they would willingly throw off, if death concerned them alone, for they are painfully conscious of their actual suffering, and morbidly apprehensive in regard to the future. There are very few people who have not at some time or other, perhaps for a moment only, been medically insane. It is time, therefore, that the |