ness of salvation at last so wrought her into rash frenzy that she deprived herself of life. But there is an equally wellmarked phase of this disease which has been designated hypochondriacal melancholia. In this disease, the patient feels that he is excessively ill. No assurances will convince him that he is not suffering from painful, serious, and fatal disease. He will weep for hours because he cannot enlist the sympathy which his calamity merits, and because no one will believe that he has one .foot in the grave. He is convinced in his own mind that he never sleeps at night. He will talk lorg and lugubriously about himself, and will detail innumerable and incompatible symptoms. Often he will complain of terrible weakness, and insist upon being allowed to remain in bed, on the ground that if he got up he could not stand, and withal he may be strong enough to support his own and another's weight. Although this terrible hypochondriasis is indicative of the disease, the patient is not unfrequently careless of life, and attempts at suicide are to be expected in almost every case of acute melancholia.

2272. Physical Symptoms of Acute Melancholia.The physical symptoms of this form of disease are very like those which we have described in relation to simple melancholia. Emaciation and anæmia are almost invariably to be met with. The mucous membranes are generally pale, and the muscles soft and flaccid. The expression of the face is generally typical. There is a drawn, pinched look associated with the lines of grief which would differentiate it from ordinary sorrow. The face is as fixed in one expression as the mind behind it is in one idea. It is not unfrequent to find those persons who are affected by melancholia indulging in continuous rhythmic movements of the body or limbs. Emotion generally frees more energy than can be used in the thoughts associated with the feeling, and that energy flows over into the muscles and produces action. That action will take the road which has been made by voluntary energy, but soon becomes habitual, and the movements become, as it were, a necessary part of the disease. Just as wringing of the hands is associated with ordinary sorrow, so are many

motions, such as rocking backwards and forwards or beating with the hands, associated with the diseased form of grief which we call melancholia.

273. Melancholia in relation to Criminal Acts.From what has been said above, it is not difficult to understand that many acts which are cognizable by the criminal law have their origin in melancholia. Ideas of persecution, which are not unfrequent in any of the cases, are very often associated with diseases which are characterized by depression. The administration of necessary medicines naturally suggests ideas of poisoning. The necessary counsel which a family must take when one of its members becomes diseased, of necessity compels a belief in conspiracy, and our books are full of cases in which crimes have resulted from these diseased impressions. Thus, just before the trial of Rogers in the United States, whose case has been repeatedly mentioned, and whose crime was due to acute melancholia, which subsequently caused his death by suicide, a young man of the name of Gardiner was tried in Baltimore for stabbing a Mr. Wickliffe, the Postmaster-General. The two were going down the Potomac in a steamboat together, and young Gardiner, without any warning or provocation, drew a dagger and stabbed Mr. Wickliffe in the breast. There being a suspicion that Gardiner's mind was affected at the time of the act, a commission of inquiry was held at Baltimore on his conduet, and they pronounced him insane. It seemed that he had been a person of studious habits, and for some time previous to the outbreak, had exhibited symptoms of alienation of mind. His mother had even taken advice on her son's case, but the physician had not treated it as one of positive insanity. The prisoner himself said that at the time of committing the act he believed that Governor Wickliffe was in a conspiracy with others on board to throw him overboard, and that he acted in self-defence. He could give no reason for his imagination, but only supposed that b was to be the victim of a foul conspiracy. From all the circumstances, we are convinced that this was, like many others

See Beport of Rogers' Trial, p. 74.

of a similar nature, a crime committed under the influence of delusional melancholia.

% 274. Impulse in connection with Melancholia.-Many cases are on record in which these mental organisms which have been termed impulses have been noted in connection with that abnormal depression which is a symptom of this disease. But although these impulses undoubtedly exist-and it may be noted that such impulses are incident te health, and are consequently more likely to assert themselves in relation to any diseased condition-there is often much reason to question their irresistibility. The fact that they have not been resisted proves nothing as to their uncontrollableness, but the fact that in many cases will has asserted itself and restrained these sudden, morbid tendencies, goes far to indicate that they are for the most part amenable to control. Here is a case given by a recent writer: "It is only a few weeks since that I was asked to see a gentleman of about seventy years of age, whom I found extremely and acutely melancholy. He at once told me that he felt so depressed that he wished to destroy himself, and afterwards told me that upon waking that morning he felt an irresistible impulse urging him to kill his wife. He fortunately told his wife of his intention, and she immediately took steps for the protection of both the patient and herself." Here is a case in which it seems to us the word "irresistible" is used in that loose way which is so apt to introduce confusion into a clear subject. It is evident that in that case the impulse or suggestion had no overwhelming force, and it seems to us most illogical to quote cases in which an impulse has been withstood as illustrations of their irresistibility. It is to be remembered that patients in speaking of these promptings are almost certain to exaggerate their violence. We by no means deny, however, that impulses practically irresistible do occur in relation to melancholia, and cases in which they have led to criminal outrages have more than once come. under our notice. It may be said that it is suspicious that the impulse always manifests itself criminally, but the answer

1 Medicine in relation to Mind, by J. Thompson Dickson. London: 1874.

to this suspicion is that it is not the fact. Many impulses to virtue occur in relation to disease; many tendencies to foolishness and violence short of criminal outrage are found to result from melancholia. Thus, Dr. Dickson mentions the case of a gentleman who was under his care for about two years. "He was suffering from acute melancholia, and very soon after the commencement of the attack, though depressed to the utmost, constantly exhibited outbreaks of violence, the impulse to which he assured me was irresistible. One morning at breakfast he threw his bread at his wife; on another occasion he took up from the table some knives and threw them with violence against the door; on another occasion he broke a looking-glass with his fist; and he committed many similar acts, all of which he detailed to me with sorrow and contrition."

275. The Legal Relations of Melancholia.-We have already said that the tests of responsibility which have been laid down by law do not differ in their relation to different diseases, but that they are applicable to all. We do not say that all persons laboring under this form of disease are to be exempted from punishment: we do not argue that the legal test is of such a nature that it will give a means of distinguishing all persons laboring under melancholia from all persons who are of sound mind. That is not the object of the legal tests. Their purpose is to distinguish those who are amenable to the laws of the land from those who are not: to give a means of differentiating those to whom punishment is properly and logically applicable from those to whom it is not. And we do assert that the legal tests explained as we have already interpreted them, and understood in their wide and real sense, will do this in relation to melancholics. In many cases of melancholia, we are convinced that the will is operative, and that consequently the individual is punishable. In others, however, the law as to delusions is applicable; and as that law has been explained elsewhere, nothing further need be said in this place in relation to the responsibility of melancholics in connection with crime.

Op. cit.. p. 199.

CHAPTER XII.

DEMENTIA.

276. Nature of Dementia.-Dementia is an exaggeration of the enfeeblement of old age-a more ruinous dotage. It [202] is due to exhaustion and torpor of mind. It is attended with general enfeeblement of all the faculties. The mental house is in ruins. It is the return of chaos which education had conquered. Cultivation makes a wilderness a garden, but a time may come when it becomes a wilderness again

"Last scene of all,

That ends this strange, eventful history,

Is second childishness and mere oblivion:

Sans teeth, sans eyes, sans taste, sans everything."

That is dementia. When these symptoms come on in the fulness of time, when they are incident to the natural decay of a man whose energies abate, whose senses are blunted, whose emotions are dulled, when it is due to the wearing out of the tissues at the end of life, it is designated senile dementia. But this enfeeblement is not unfrequently an earlier scene in the history of a life. The dénouement is hastened by disease. This general enfeeblement of a man's intellectual and moral nature may be brought on by disease, although it sometimes seems to be little more than the exaggerated decrepitude of extreme old age. Thus, we often find dementia coming on in people who have not nearly reached the limit of man's years, after mania, or after epilepsy. When, however, the disease has established itself, there is no striking difference in the symptoms. A case, described by an accurate observer and an eloquent writer, will enable the reader more graphically to understand the symptoms of this dis

ease.