fect and excellent uniformity in the principles upon which the Courts deal with the various classes of cases which come before them, and in which the real issue is the question of sanity or insanity. We have seen that the rules which have been laid down in relation to the capacity and responsibility of persons who labor under mental disease are, notwithstanding the numerous attacks which have been made upon them by medical gentleman, philanthropists, and others, satisfactory when viewed either in relation to law, or to the facts of this painful disease. We have arrived at this conclusion only after a long and careful examination of all that could be, and all that had been, said on the other side. We arrived at it after as careful a study of the phenomena of insanity as our opportunities enabled us to make. We enunciated this opinion in the first edition of this work, and we cannot now see any reason to express another. We believe that its accuracy will appear from what has already been said, but that it will be more conclusively proved from an examination of other parts of this work.

CHAPTER II.

% 32.

ON THE CAUSES OF INSANITY.

Reasons why the Subject is treated in this Work. It may seem to some of the readers of this work that in speaking of the causes of insanity we are dealing with questions which do not fall within the scope of medical jurisprudence. We are, however, so thoroughly impressed with the belief that the real appreciation of the subject depends, to a very large extent, upon a knowledge of the etiology of disease, that an intelligent understanding of insanity depends so much upon a study of the conditions which conduce to it, that it seems necessary to say something as to this vexed question in this place. Few subjects have been more largely discussed, and few discussions have been productive of so little profit. Many medical men have shown a peculiar ineptitude in this connection, and the public in general have felt the whole matter so doubtful, that they have now ascribed it to possession by the Devil, and now to affliction by the hand of God. Indeed, superstition has a way of appropriating everything that is dark and inexplicable. These circumstances seem to us to justify some consideration of the questions connected with the causes of insanity. One other circumstance would make this doubly expedient. In modern times, the fact of hereditary transmission of mental qualities has become prominent, and is now almost universally recognized. The past is admitted to throw much and useful light upon the present, and in considering the causes of insanity,

A friendly reviewer of the first edition of this work said: "Mr. Browne has no more need to give us a chapter on the causes of insanity than a lawyer writing a gest of statute law to give a chapter on the causes of crimes."-Edinburgh Medical Journal, Sept., 1871.

we will have to discuss the important question of hereditary tendency and transmitted disease. Without a knowledge of the main facts which are recognized as the ground of this theory, a study of medical psychology would be of little use. Many things, to be well understood, must be looked at in relation to the race as well as the individual; and insanity, or the subject of health in its wide sense, as including mental life as well as physical existence, is preeminently one of these.

233. The Difficulty of Discovering the Cause of Insanity. The cause of anything in the present is the whole past! But we have to limit our inquiry to the little things which are next in point of succession to the effectevents of our time; and we call them causes, without raising the metaphysical question. Two things known together, mean knowledge-that is all we know. It is in this light, then, that we must look at the question of the etiology of insanity. Who can say what are the causes of insanity? One must enter into a synthesis of causes, and confess that the man is half the cause of his own hurt, if he is pierced by an arrow, and that he is half the cause of his own disease, if through any combination of circumstances he becomes insane. Life is like a long string of algebraic figures, with the signs plus (+) and minus (-) before each quantity. They are always varying and being carried over from one side to the other of the equation which is to determine the value of x, which stands for health. It follows, therefore, that he who would say why a man goes insane, would require a complete and thorough biography of this man-nay, would require to know of the lives of those who went before him; of the influences to which he fell heir; of the chains which were forged for him by the material fate of a hereditary transmission. "Every man carries his destiny on his forehead," say the Mohammedans; but not on his forehead only, say we. Every nerve has an iron destiny forged in the past. Man is like a watch wound up by fate, to go for a season: he is made for [good or evil, by the past; and it is not the present that predetermines the future, but the past that predetermines all time. And what past went before that past? One thing alone

seems certain, that any answer to the question, as to what causes insanity-save that "through all time, if we read aright, sin was, is, and will be the parent of misery," and misery is the parent-and often the child resembles the sire-of insanity-is almost impossible. But the question narrows itself on account of our inability to answer it. All that we can hope to do is to arrive at a knowledge of some of the elements which went to constitute the cause, and by keeping in view the fact, that these are only elements of a cause and not causes, avoid one of the errors which so many have fallen into, of ascribing certain composite effects to certain single antecedent events.

34. Classification of Causes.-Causes, then, which are thought at the present time to conduce to insanity have been divided into predisposing and exciting, and into physical and moral. One thing is clear, whether there is nothing but mind, or nothing but matter; and that is, that the one set of these causes, in so far as we are here concerned, may be regarded as operating through, or by means of, the other. If mind is a manifestation of body, it is quite evident that moral causes are causes only on account of the physical changes which they produce. If mind manifests itself through body (which may be the objective idea), it is with those manifestations that we have to do in this place; for if, as bad glass distorts the images we see through it, by twisting the rays of light, so defective organism, or the lack of power to adapt subjective ideas to the objective idea, may distort the manifestations of mind-it is with the cause of this distortion that we have here to do.

235. Of Remote or Predisposing Causes.-Civilization, it is said, has led to an increase of insanity. Statistics, in so far as they bear upon this question, are rubbish. We are told that insanity is rare amongst uncivilized peoples, and that in this country one in every five hundred is mad. Does that statement afford any figures for comparison? What is "common" expressed in numerical relation? And if it were settled, what would it prove? Not what it is meant to establish, it seems to us. We are glad to see that Dr. Ray, in an

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able article upon the causes of insanity,' has expressed his dissent from the popular adage that figures wont lie, and shows that it is upon far other grounds that we must expect to arrive at correct conclusions as to the causes of mental disease. We hear, however, that theoretical considerations lead one to suppose that insanity has increased, and that civilization is the predisposing cause. Those theoretical considerations, as explained by Dr. Maudsley, are, that as in a complex organization like the human body, there is a greater liability to disease, and the possibility of many more diseases, so in the increased complexity of the mental organization, it is reasonable to expect an increased liability to mental disorder. But why? In the first place, he assumes a fact; and in the second, we know that notwithstanding the increased complexity of structure of the human body, notwithstanding the number of kinds of tissues, and the orderly subcrdination of parts, that "man seems in his transitions from one climate to another to resemble domestic animals, with this difference, that he bears those changes better in proportion as he is civilized." Why should not the same principle hold good here? Why should not the more complex mental organization lead to a more careful mode of life? Why should not the higher mental development lead, through science, to the diminution of the disease, through cure, by care in breeding, and by the avoidance of those actions which lead directly or indirectly to abnormal mental conditions?

There is more earnest living in these days, it is true; but why the human mind, which has made for itself the power to be earnest, which has so far overcome barbarism as to have gained the capacity for being "bored," should not have at the same time gained the vigor to withstand its unhealthy influences, it is difficult to say. To assert that the tendencies to disease only can be transmitted, is to say what is absurd; but it is to express plainly what seems to have been tacitly assumed in this case, for the sake of argument. Health is

See Contributions to Mental Pathology, Boston, 1873.

Waitz, Anthropology, § 4, p, 205.

3 It was Comte who regarded the capacity for being bored as one of the most unmistakable signs of civilization.