raved. In this condition she continued about six months, when she began to improve quite rapidly, and in the course of a month or two, went home, entirely restored, with her husband whose conduct, she then admitted, had always been most exemplary. Had this woman been submitted to the examination of a committee of physicians, they would unquestionably have reported her as being of sound mind and an unsuitable subject for confinement. § 375. When delusions or other indications of insanity, of equivalent value, have been detected by competent observers, we cannot understand why their existence should be denied by other observers, merely because they have failed to detect them. To prove a negative under any circumstances, is no easy matter, but to prove it in the face of an affirmative, requires a course of protracted and varied observation, aided by strong professional sagacity, very different from the hasty examinations we usually witness. Especially should we be cautious in cases of moral insanity, where the very incidents which, viewed precisely as they occurred, furnish indubitable proofs of disease, may be so easily represented by a little false coloring, in a totally different light. Had this caution been duly observed, the world would probably have been spared some of those disagreements which are little calculated to advance its confidence in medical opinions. § 376. Continued observation. A systematic course of observations continued for some time, may establish the fact of insanity in doubtful cases, after several personal interviews have completely failed. Opportunities, therefore, should be demanded for visiting the patient freely and frequently; for watching him at times when he supposes himself unobserved; and for exercising a general surveillance over his conduct and conversation. Those about him should be enjoined to watch his movements, and he should often, but cautiously, be led to speak of the motives of those who are anxious to prove his insanity. It often happens, too, that those who are most successful in concealing every indication of disordered mind, in their conversation, will betray themselves the moment they commit their thoughts to paper. They should be induced, therefore, to write letters to their friends, describing their present situation, and to prepare statements of their wrongs and grievances, and thus we may be readily furnished with instances of incoherence and folly, which the patient had self-command enough to withhold, when put on his guard by questions which he knows well enough are designed to entrap him. "The rapid transitions and odd unions of discordant subjects, the relations of things which have not happened, and could not have happened, are in many cases very remarkable; and a forgetfulness of common modes of spelling, or of the arrangement of the letters of words well known, will be evinced by maniacs who have been well educated, and who would commit no such mistakes but for their malady."1 $377. Inquest.· When the above means fail, our inquiries must take a wider range and be directed to the previous history of the patient, as made known to us by the testimony of friends and relatives, and those who have been connected with him in business, or had any other good opportunity of becoming acquainted with his mental condition. "The Inquest," says Georget, "consists in collecting information respecting the patient's condition before and after the presumed disease, and the causes suspected to have impaired his mind. For this purpose we consult his writings, and recur to the testimony of those who have been about him and conversed with him; who have been able to observe him closely and to witness his insane actions and irrational discourse. We should be particularly careful, however, to require of witnesses facts rather than opinions. We should ascertain if madness be a disease of the family; if he have already evinced a degree of singularity in his moral and intellectual character, or exaltation of any kind; if he have been exposed to the influence of powerful causes, such as chagrins, severe and repeated crosses, reverses of fortune, etc.; if, without any real motive, he has manifested any 1 Connolly Inquiry concerning the Indications of Insanity, 469. change of his habits, tastes, or affections; in short, we should inquire into all those circumstances which so frequently precede the development of the disease." 1 We are to look into his business transactions, his management of family affairs, his conduct in the domestic and social relations, and the part he has taken in public scenes and duties. His letters and written communications should be closely scrutinized, especially those that have any reference to the state of his health, or to the legal measures that have been taken against him, for here we may meet with incoherent and foolish ideas, that we have found nowhere else. In short, no source of information likely to enlighten us on the subject of the patient's mental condition, should be suffered to go unexplored. If the means thus indicated are faithfully used—if the whole life of the individual have passed in review before us, and after all, we are unable to prove the patient's insanity beyond a doubt, we are bound to conclude that his mind is sound, or at least, that he is not a proper subject for legal interference. This conclusion will be no less proper, even though we still entertain some doubt of his mental soundness, for if he have sufficient self-control and penetration to enable him to conceal his mental impairments and conduct himself rationally, but little harm will probably arise from leaving him at present to his own discretion. 1 Des Maladies Mentales, 57. CHAPTER XVII. EPILEPSY AND ITS LEGAL CONSEQUENCES. § 378. EPILEPSY is a nervous disease characterized by paroxysms of insensibility, unconsciousness, and convulsions. These vary in severity, from that of a simple vertigo, continuing for a few seconds and scarcely discernible by others, to that of a most distressful convulsive fit enduring from five to fifteen minutes. They may recur twice or thrice a day for several days together, or once a week, month, or year. They sometimes occur without warning, but as often perhaps they are preceded by symptoms indicative of disturbance of the nervous functions; such as, giddiness, pain of the head, drowsiness, frightful dreams, hallucinations of sight or of hearing, vigilance, irritability of temper. So distressing is the condition of many epileptics, says Esquirol, previous to the paroxysm, that they endeavor to hasten its access, and for this purpose resort to spirituous drinks. The cessation of the paroxysm is followed by somnolence, pain in the head, and a sense of weakness. The recurrence of the fits is determined by whatever disturbs the general health, more especially by derangements of those organs in which the series of morbid phenomena takes its origin. Anger, fright, or any strong moral emotion is very liable to produce a paroxysm. A soldier, in mounting a breach, was frightened into a fit of epilepsy by the bursting of a bomb-shell near him. He was soon cured, but at sight of the place, twenty years afterwards, he was thrown into a fit.1 § 379. Epilepsy seldom continues for any length of time without destroying the natural soundness of the mind, rendering the patient listless and forgetful, indisposed and un 1 Esquirol, Des Malad. Ment. i. 297. able to think for himself, yielding without any will of his own to every outward influence, and finally sinking into hopeless fatuity, or becoming incurably maniacal. Esquirol states that of three hundred and thirty-nine epileptics in the Salpetrière, twelve were monomaniacs; sixty-four were maniacal, of whom thirty-four were furious; one hundred and forty-five were imbecile or demented, of whom one hundred and twenty-nine were so only immediately after the fit; eight were idiots; fifty were habitually rational, but with loss of memory, exaltation of the ideas, sometimes a temporary delirium and a tendency to dementia; sixty had no derangement of intellect, but were very irritable, irascible, obstinate, capricious, and eccentric.1 § 380. From this statement it appears, that of the one hundred and forty-five imbecile or demented epileptics, all but sixteen were so only immediately after the fit, and that this was also the case with three of the thirty-four who were furious. This is a fact of no little importance in a medicolegal point of view, and should never be lost sight of in judicial investigations of the mental condition of epileptics. The maniacal fury of these patients is of the wildest and blindest kind which nothing can tame, the individual acting automatically as it were, and in a state of unconsciousness. It may continue for minutes, hours, or days. The dementia which is the form of mental derangement to which epileptics are most liable after the fit, is characterized by intellectual stupor and moral depression, in which, however, they have sufficient energy, under some circumstances, to commit acts of violence, of which they retain only an imperfect recollection when they recover. Another direct, though temporary effect of the epileptic fit, is to leave the mind in a morbidly irritable condition, in which the slightest provocation will derange it entirely. Sometimes this irritability is accompanied by a sense of anxiety, distrust, jealousy, and unfounded fear, and sometimes by great activity of the lower propensities. |