fixed idea may be removed and a delusion dispelled. Under ordinary circumstances the number of susceptibles is so small that its general use is impossible. In hysteria, as elsewhere, it is a two-edged weapon, and the patient may emerge from hypnosis instituted for a minor difficulty and go into severe hysterical convulsions. One delusion may be removed, but another and more serious one of mind-reading or undue influence may be implanted. For obvious reasons, women should never be hypnotized without reliable witnesses, and the public use of hypnotism can only appeal to the morbid. In this connection its power for harm is proven. There is no longer any doubt that its frequent repetition is harmful to the individual. It tends to destroy self-reliance and to make patients imaginative, weak-minded, and neurasthenic. It also has a tendency to bring discredit upon its employer, and in most instances would better be substituted by measures of equal efficiency and less disadvantage. Suggestion, however, is a mighty aid to the physician, and, without producing hypnosis, positive and intelligent assertion can accomplish all that is likely to be done by hypnotism short of the somnambulistic stage. A fair realization of the part suggestion plays in therapeutics is one of the recent achievements of the most progressive medical minds.

MENTAL DISEASES.

BY

FREDERICK PETERSON, M. D.,

CLINICAL LECTURER ON PSYCHIATRY, COLUMBIA UNIVERSITY; CHIEF of clinic,
DEPARTMENT FOR NERVOUS AND MENTAL DISEASES, COLUMBIA UNIVER-

SITY; EX-PRESIDENT OF THE NEW YORK NEUROLOGICAL SOCIETY;
PRESIDENT OF THE BOARD OF MANAGERS OF THE

CRAIG COLONY FOR EPILEPTICS.

MENTAL DISEASES.

CHAPTER I.

INSANITY.

Synonyms.-Psychosis, Psychopathy. German: Irrsinn, Irresein, Verrücktheit, Wahnsinn. French: Aliénation mentale, Folie.

IT is the object of the author to bring together in the following chapters such matter in relation to the definition, classification, etiology, pathology, symptomatology, and treatment of insanity as will be of actual practical value to the medical student and general practitioner.

The seeker after special information and deeper knowledge of the complex subject of morbid psychology must be referred to the many profound works which deal with this exclusively. These chapters are based upon my clinical lectures given at the Manhattan State Hospital for the Insane and at the Randall's Island Asylum for Idiots during the past four or five years, to the students of the College of Physicians and Surgeons of Columbia University, and to the students of the Woman's Medical College of the New York Infirmary. They, therefore, embody only the facts which I believe to be the most serviceable and useful to those who are often practically concerned with the early diagnosis and prognosis of insanity, and who must be the first arbiters as to the course of care and treatment to be pursued.

Definition. The difficulty of making a rigid definition of insanity is recognized by all who have attempted it. So various are the manifestations of mental aberration, so many the faculties involved, so different the degrees of deviation from the normal, it is no wonder that the expert hesitates and often fails in the effort. The definition, too, must include idiocy, and must exclude certain states of transitory mental disorder, such as the delirium of fevers and of intoxications.

The noted English jurist, Lord Justice Blackburn, once said, while giving evidence before a committee of the House of Commons: “I have read every definition which I could meet with, and never was satisfied with one of them, and have endeavored in vain to make one satisfactory to myself. I verily believe that it is not in human power to do it."

Fortunately, we are not often called upon to give a definition of insanity, and usually we may reply that insanity is a symptom of so

many obscure pathological states, and appears in such divers forms that a narrow definition is not possible. However, the practitioner may find himself in the witness-box some day, and it is not uncommon for one of the legal examiners to ask of the witness in a mental case a definition of insanity. If the witness be wise, he will answer as indicated, or he may qualify such answer by offering to quote some one of the definitions given by alienists, such as follow:

A disease of the brain (idiopathic or sympathetic) affecting the integrity of the mind, whether marked by intellectual or emotional disorder.-(Hack Tuke.)

A special disease, a form of alienation characterized by the accidental, unconscious, and more or less permanent disturbance of the reason. (Régis.)

Morbid derangement, generally chronic, of the supreme cerebral centers, the gray matter of the cerebral convolutions or the intellectorium commune,-giving rise to perverted feeling, defective or erroneous ideation, and discordant conduct, conjointly or separately, and more or less incapacitating the individual for his due social relations.— (Maudsley.)

Insanity is either the inability of the individual to correctly register and reproduce impressions (and conceptions based on these) in sufficient number and intensity to serve as guides to actions in harmony with the individual's age, circumstances, and surroundings, and to limit himself to the registration as subjective realities of impression transmitted by the peripheral organs of sensation, or the failure to properly coördinate such impressions and to thereon frame logical conclusions and actions, these abilities and failures being in every instance considered as excluding the ordinary influences of sleep, trance, somnambulism ; the common manifestations of the general neuroses, such as epilepsy, hysteria, and chorea; of febrile delirium, coma, acute intoxications, intense mental preoccupation; and the ordinary immediate effects of nervous shock and injury.-(Spitzka.)

With these few examples before us of the diversity of definition attained by careful students of psychiatry, we may well content ourselves and acknowledge that a satisfactory definition in brief form is scarcely to be devised. The writer has often qualified this by offering the following, which has at least the merit of brevity, if not of perfect adequacy:

Insanity is a manifestation in language or conduct of disease or defect of the brain.

The law assumes to offer certain definitions of insanity, from which, however, those of medicine would tend to differ, in connection with the three chief points where law and psychiatric medicine meet :

1. A criminal is insane if he does an act whose nature and quality he does not know, or if, knowing the nature and quality of his act, he does not know whether it is right or wrong.

2. A testator is insane if his mind, memory, or understanding is unsound.

3. In a lunacy inquisition the subject of the inquiry is insane if he