INSANITY, AND. ITS RELATIONS

TO MEDICINE.

GENTLEMEN OF THE SOCIETY, LADIES AND GENTLEMEN:

It will be generally admitted, that in the science of medicine, as in other sciences, no one of its various branches can be successfully cultivated without paying due regard to the connection between that branch and the whole body of knowledge to which it belongs.

The object of this address is to show the application of this truth to the case of psychological medicine, in which such application has hitherto been too imperfectly perceived and acted upon; to show that the treatment and care of the insane should be recognized as constituting a department inseparable from general medical science; its study and development governed by the same rules, and its progress made dependent upon the same causes, that advance or retard the progress of all medical knowledge. If this be true, it will appear, not only that a thorough acquaintance with this subject must be founded upon a comprehensive knowledge of the general science, but that, without such acquaintance, the study of the general science itself becomes defective, and that it should therefore form a part of the general course in all medical training, and be accorded a place in the schools where elementary principles are taught.

It was for a long time supposed that the treatment of the so-called diseases of the mind was quite a dif ferent thing from the treatment of diseases of the body; and this idea has not yet wholly disappeared. It will my first object, in order to establish the connection

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between psychological and general medicine, briefly to touch upon some of the facts which tend to prove this supposition an erroneous one, and insanity to be subject to the same laws, and to present the same general pathological conditions, which are found in other diseases.

And first, a reference to the history of this branch of medical knowledge, will show that progress in it has been either rapid or retarded, in direct proportion as the method of studying it has been similar to that pursued in regard to disorders deemed purely physical, or has been founded upon the notion that it was a department of metaphysics rather than of medicine, and so made a subject of metaphysical speculation, instead of a subject of observation and experiment. There is evidence in the writings of the ancients, both of their philosophers and their medical men, to show that they entertained many clear ideas in relation to the physical causation of insanity; and as a consequence, it is safe to aver that, in recognition of the psychical phenomena of the disease, and in the moral treatment to be applied, we have at this day made no astonishing advance from the age of Pythagoras. The Fathers of Medicine did. not regard insanity as a special department, but it was studied, investigated, and treated by them in the same way as other diseases. When Hippocrates was called to treat the King of Macedonia for disease of the lungs, his diagnosis revealed insanity, of which he cured his patient. His fame indeed rested partly on his skill in this direction; and owing to this, he was called to treat the philosopher Democritus, whom he found engaged in dissecting various animals, in order to discover the cause of his malady. "Hippocrates," says Burton, "relates (the story) at large, in his epistle to Damegitus, wherein he doth express, how coming to visit him one day, he found Democritus in his garden at Abdera, in

the suburbs, under a shady bower, with a book on his knees, busy at his study, sometimes writing, sometimes walking. The subject of his book was Melancholy and Madness. About him lay the carcasses of several beasts newly by him cut up and anatomized; not that he did contemn God's creatures, as he told Hippocrates, but to find out the seat of this atra-bilis, or melancholy; whence it proceeds, and how it is engendered in men's bodies, to the intent that he might better cure it in himself, and by his writings and observations teach others how to prevent and avoid it, which good intent of his, Hippocrates highly commended." Medicine and philosophy were then dissevered. Hippocrates was a physician, and Democritus a philosopher.

Among the Egyptians, we are informed, there were retreats for the insane, where wine, music, cheerful amusements and repose were the gentle and effective agencies brought to bear upon the disordered intellect, and modern skill has discovered no better aids to a successful treatment of the disease.

During the middle ages, however, the knowledge of the causes and treatment of insanity was almost lost. It was a subject peculiarly exposed to perversion, from the general tendency of the intellectual activity of those times to abstruse and barren philosophical speculations upon everything connected with the mind, and its relations to the body. Owing to this, as well as to other causes, psychology was the last branch of medical science to emerge from darkness after the revival of learning, and it has remained more or less clogged with the fetters of metaphysical theories even to the present day. It would indeed be interesting to inquire into the various theories of insanity; but it is not practically important or profitable to do so in an address intended only to direct inquiry, awaken interest, and suggest

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practical hints. Still it may say in support of what I have stated, that strange as it may now appear, the almost universal belief, until a comparatively recent period, has been, that the mind itself was diseased -notwithstanding that such a dogma would imply its death, as what may be sick may also die. It is however due to medical science to say, that this has never been fully accepted by the majority of the leading minds of the profession. To show how this idea of disease of the soul or mind adhered to the science long after it was condemned by the developments and progress of pathological investigations, it is only necessary to refer to recent authorities. Dr. Bucknill, in a prize essay on Criminal Lunacy, in 1854, says that there are three theories, the psychic, somatic, and psycho-somatic. With the impulse given to the study of mental philosophy by the writers of the eighteenth century, both in England and on the continent, no corresponding advance took place in the study of mental disorders.

The first step towards progress and improvement in this field of investigation, was not due therefore to mental philosophers, but to physicians and philanthropists. The labors of Pinel, and the results accomplished by him in ameliorating the condition of the insane, are known to all. It is not so generally known, however, that before the philanthropic efforts of Pinel were commenced, the subject had already received the attention of Benjamin Franklin, and other benevolent persons in this country. As early as 1750-forty-three years before the movement of Pinel-the Pennsylvania Hospital, at Philadelphia, was organized, and a department for the care and treatment of the insane established; in which the system afterwards advocated by Pinel, in France, was anticipated, and the barbarous method of treatment to which the insane were then exposed, was