credited this man's statement, and to have only superficially examined him, would have been to conclude that there was something wrong about his heart, especially as he had a quick and somewhat irregular pulse. This is a very common pulse in some forms of flatulent dyspepsia, when the accumulation of gas in the stomach and bowels really produces some feeling of suffocation in the patient, and often interferes mechanically with the free action of the heart. All his unpleasantness and pain subsided, as I told you they would, after a mild course of vege

mental truths of pathology, it is the business, as
it will ever be the pleasure, of myself and my
more able colleagues to point out and par-
ticularize to you, day by day, in our hospital at-
tendance. Like all demonstrative facts, they are
only to be properly brought before you in
their individual evidences they are only to
be correctly comprehended by seeing them
in their living detail. To give you some general
notion of them, as we are yet dealing only
in generalities, suppose a patient comes to
you complaining of headache. This is a very

pend upon pregnancy; or the uterus may be undergoing some morbid change. This organ, how. ever, may not be at fault: habitual constipation, which females are often in the habit of neglecting, may be the cause of the suffering; or it may be occasioned by hemorrhoids.

Such, and so many, nay many more, are the varieties of pains in the head, having different causes, and requiring different forms of treatment. Take coughs, again, how diverse are the pathological conditions inducing them. You remember an out-patient I have,

from

table tonics, with ammonia and resinous purga- generic sort of term, and may involve a great an attack of jaundice. She had ing

tives, with assafoetida. I believe the very next variety of specialities-some serious, and others
patient we saw after this man was a woman, com- simple. One patient, we will say, is in his teens,
plaining of distressing pain in her chest. I asked or not far out of them, yet he looks older by many
her if she had any cough or difficulty of breathing, years than he ought to do. His face is blanched
especially in hazy weather; if the pain were in and parchment-like; cheeks sunken; eyes hollow,
creased in walking up hill, or up stairs; to all of lusterless, and watery, and they never look fairly
which she said, no. I then asked her to point to at you; the man is timid, nervous, shuns society,
the particular situation of her pain, and you re- and has no inclination for active pursuits; he is
member she put her hand upon the epigastrium. subject to giddiness and forgetfulness, and has
The lower orders of people almost invariably call almost constantly a dull, heavy pain at the back
the stomach the chest, and the entire abdomen of his head, perhaps extending down the spine,
the stomach. To have passed hurriedly over this with a sense of weight and dragging of his legs.
woman's case, and credited her statement, would Here yon have a nervous system enfeebled and
have been to suggest a line of practice very dif- shaken from causes you will easily learn, if you
ferent to what we pursued, and which would no pointedly inquire after the personal habits of the
doubt have been attended with very different sufferer. Another complains of oppressive pain,
results. As in the former case, we neither leeched, chiefly over his eyes, scarcely ever leaving him,
nor blistered, nor plastered the region of the but distressingly aggravated at different periods of
heart, so in this one we prescribed no expecto- the day. It is probable that these periods are
rants, and advised no counter-irritation. The subsequent to meal times, and that then the head.
woman was treated on a simple tonic plan, under ache is attended also with drowsiness. The man
which she recovered. About two months back is dyspeptie. He will tell you that his bowels are
we had a lad, Mitchell, in the top ward, the sub- confined, and that he is troubled with wind.
ject of simple fever. One morning he told us Look at his tongue, and you will see that it is
he had "something very bad amiss" with his furred with, most likely, a brownish patch in the
kidneys. He had a severe pain in the small of centre. Percuss the right hypochondrium, and
his back, but it did not shoot down either thigh; you may find a greater extent of dulness, or more
there was no retraction of either testis, or pain in tenderness, than natural. The condition of the
it; he had no sickness; his pulse was not in- great viscus here is wrong. Liver, stomach, and
creased; and his urine was not unnatural in quan- bowels are the sources of that frontal headache.
tity or composition. I found that the pain was Another patient has pain in the forehead, but it is
first felt, and in a moment, when he was getting acute and lancinating, and not persistent. Its
up, and that it was excessively sharp; on request- periods of accession and departure are pretty re-
ing him to keep his legs straight, and to try to gular. Ask the precise spot of the pain, and you
"bend forwards, I perceived that he could not will have indicated the exit of the supra-orbital
do so. From all these things I concluded nerve of either side, probably the left. Here you
that the pain was simply muscular. He was have a case of tic douloureux, which may have no
ordered a mustered poultice to his loins, obvious exciting cause, or may result from expo-
twelve inches by eight, which was kept sure to cold, from dyspepsia, from pregnancy, from
on for twenty minutes. The following day he uterine disease, or disorder, &c. Another com-
complained very little, and was shortly well. plains of aching all over his head, considerably
This lad told us he had something the matter with increased by heat or cold, as the case may be. On
his kidneys, no doubt because he had no idea of further inquiry you learn that the pain is chiefly
pain in the small of the back unconnected with superficial, and that to rub the patient's hair, in
those organs. I remember being consulted about different directions, sharply, is to agonize him.
three years ago, by a man named Merrick, a Here you have rheumatism of the cranial integu-
patient of Dr. Mackay's, in this town. He said ments. Look cautiously after this case. You
he was the subject of "kidney disease that was may suddenly have a pain of a different kind, and
killing him"; and, strangely enough, was offended deeper seated, ushered in by screaming, and shout-
because his medical adviser had tried to unde-ing, followed by restlessness and delirium, with a
ceive him. I saw no reason whatever to en-
courage his belief, and repeated, what he had
been told before, that his ailments were dyspepsia
and lumbago. He was half inclined to be saucy
with me because I would not consider him a
victim. He submitted to a course of mild tonic
treatment, and wore an opium plaster across his
loins; but I verily believe he rather grudged,
than was grateful for, his recovery.

Never credit what patients say of this organ or the other; let your opinion be the issue of your own deliberate examination-not of their

crotchets.

glaring injected eye-the meninges of the brain
will be suffering from metastatic rheumatism in its
most active form. It was gout, thus transferred,
that destroyed the valuable life of Dr. Ingleby,
your late Professor of Midwifery. Another has
acute pain darting through his temples and ears,
especially when he gets warm in bed; at the same
time he has what he well describes, as "gnawing
pains" in his shinbones; his nose is tender, and
the roof of it painful; he has, or has had, sore
throat, and there are copper-coloured patches
about his body. This headache has its founda-
tion in syphilis: mind your treatment, or the
more delicate bones of the head and face may be
sacrificed. I show you a characteristic specimen
in illustration. See how the nasal and temporal
bones have suffered here!

A delicate female complains of heavy throbbing
pain over the middle, or at the back, of the head.
She has had it several months, more or less, and
it is liable to periodical exacerbations. The uterus
has likely something to do with this pain. It may
be a case of simple amenorrhoea; it may denote
the climacteric period of female life; it may de

cough, which the physical condition of her lungs, as evidenced on examination, told us was due to the congested, sluggish state of her liver. She took no expectorants, yet her cough entirely subsided under the influence of aperients with alterative doses of calomel, and an ammoniaco-mercurial plaster to her side. On the other hand, the boy Yardley, with scarcely any cough, and no character about it, gave us ample evidence of extensive mischief in his lungs, which the post-mortem proved. I pointed out to you the other day an irritable cough in a man of nervous temperament, which is fast getting better under the influence of strychnine. The man Bates, in the front top ward, had a distressing cough on admission, with difficult breathing. I told you, after having auscultated and percussed his chest, that my opinion was his lungs were suffering from engorgement, consequent upon hypertrophy of the right side of his heart. We gave him digitalis, in infusion of gentian, and the subsidence of his cough and difficult breathing has exactly corresponded with the diminished force and frequency of his heart's action.

A cough supervening upon a gouty attack, you know, rarely gets well until the gout begins to disappear. The cough of amenorrhoea will last for months and years, obstinate and painful, and yet subside, as if by enchantment, on the recurrence of the proper uterine function. The presence of worms in the intestinal canal will give rise to cough and expectoration of most serious aspect; ignorant of pathology and physical diagnosis, you might easily mistake a case of this kind for phthisis; yet, on the expulsion of the parasites, the cough and bronchial discharge will often cease immediately. A stomach cough, you know, is a very common trouble; you have lately had several good examples of its subsidence under the exclusive use of tonics and aperients, with restricted diet.

The stomach, gentlemen, is an organ with which you will have frequent dealings in your practical career. It relates itself so intimately, in sympathy, with the functions of all other organs, that there is no limit to the mischief that may follow its own derangement. I have several times illustrated to you, in the cases we have had lately, how intractable, often, is simple fever supervening upon dyspepsia. Accidents in this state are difficult of reparation: the ends of broken bones are apt to form imperfect callus, and incised wounds seldom heal kindly, and by the first intention; inflammatory action, superficial or deep-seated, is prone to be suppurative; moreover, in certain diatheses, dyspepsia provides a ready opportunity for tuberculescence. Joints have a strange sympathy with the digestive apparatus. This deranged, often gives rise to aches and pains resembling articular rheumatism; whilst the latter, in reality, never fails to be aggravated by a fit of dyspepsia. If a patient come to you with a sprained knee, look carefully to his stomach. It will be a chance if his injury get well whilst there is fur upon his tongue. Amenorrhoea, again, is often protracted by the exhibition of heavy iron tonics, when lighter ones, of the vegetable class, would relieve the condition of the digestive organs, upon which the uterine irregularity depended. The latter, again, may be the leading pathological feature, and give rise to excessive epigastric pain, or to constant nausea or vomiting, in which the stomach has only a secondary share. You meet with a chlorotic pa tient sometimes, with legs of uniform thickness

from the ankle to the hip-joint. The heart, or liver, or kidneys, have nothing to do with this: leeches to the groin, or to the vulva, will do far more towards relieving it, than any amount of diuretics and hydragogue purges.

These are cases that test your pathology, and tell you of its value. You will be better able to appreciate its indispensableness when we come to consider such cases more directly in detail.

A simple glance over the foregoing numbers will show, as Dulong previously asserted, that the quantity of hydrogen burned by a carnivorous animal is much greater than that consumed by an herbivorous one; this excess is counterbalanced by the quantity of fatty matter taken up in the food of the latter.

We will now proceed to explain the mode of conducting these experiments; and, as man stands foremost in the scale, we will first consider the conditions by which he should he surrounded, so as to arrive at correct results. If, after inspiring some air into the lungs, we expire it over mercury, an analysis of the air thus collected would certainly give us its composition; but this would not permit us to decide as to the composition of the air during normal respiration. Every effort necessarily modifies the composition of the air escaping from the lungs; we must, if we would have correct data, take the air resulting from a free and independent respiration; we must examine the air expired at different periods of the day, but invariably at those moments when the respiration is neither retarded nor accelerated by exterior causes: by following such precautions we shall be enabled to arrive at correct results. The apparatus which I have used for this purpose consists of a glass globe or flask, with a long neck, having a capacity of about 500 cubic centimètres, and correctly graduated upon one of the sides of the neck into centimètres or half-centimètres; also of a glass tube which is to be fixed into the flask, and of which the diameter is so calculated that the annular space which it leaves in the neck of the vessel shall be equal, or nearly so, to its internal section. When we wish to use this apparatus, we must inspire the air by the nose, and expire it by the mouth. This habit is easily acquired; and, while doing it myself, I can with facility read or write at the same time. After having respired in this manner for half or a quarter of an hour, we may be sure that the flask will be completely filled with the expired air; then, continuing all the while to breathe into the vessel, we are cautiously to remove the tube; the opening of the flask is to be immediately closed, and the vessel to be inverted over mercury; the volume of the gas must now be correctly measured, and the carbonic acid absorbed by caustic potass. The flask being divided into cubic centimètres a division easily deciphered upon its neck—and its capacity being about 500 centimètres, every degree of absorption corresponds to 1-500 part of the total volume, or thereabout. By operating in this manner, we find that, in a healthy man, the expired air contains from three to five per cent. of carbonic acid; never less than three, nor more than five. But, in a state of disease, the proportion may be reduced to one or one and a half per cent., or even carried as high as seven or eight.

Now, we may calculate that an adult man introduces about a third of a litre of air into

his lungs at each inspiration; he makes sixteen of these inspirations in the minute; the

expired air, as we have said, contains from three to five per cent. of carbonic acid, and it has lost from four to six per cent. of oxygen; so that, under the ordinary conditions of temperature, and of atmospheric pressure, there passes daily into the lungs from seven to eight cubic mètres of air. He will have burned, at a mean calculation, and by reducing the hydrogen into carbon, equivalent to 250

or 300 grammes of carbon in the twenty-four hours.
Supposing the maximum consumption, this com-
bustion requires a full supply of 300 grammes of
oxygen; the total weight of carbonic acid is then
1,100 grammes, or 550 litres: to produce this, a
quantity of air amounting to 2,750 litres must
have been completely deprived of oxygen.
We will now explain, in a few words, what takes
place, if, instead of respiring under the ordinary
atmospheric pressure, this condition be more or less
modified. If a man be carried to the top of a high
mountain, in proportion as the density of the air
diminishes, so is the respiration accelerated, and
the number of pulsations of the heart increased.
In the diving-bell, on the contrary, in which, be-
sides the ordinary pressure, we have to support that
of the whole superincumbent column of water, the
respiration is retarded. Again, in the apparatus
invented by M. Taburié, where we can apply a very
strong pressure, the respiration is rendered much
slower. It was also remarked, during one of the
irruptions into the Thames Tunnel, that a diver,
after having filled his lungs in the diving-bell,
under a pressure almost double that of the ordinary
atmosphere, could remain under the water a much
longer time than usual. This result is naturally
owing to the density of the inspired air. The
quantity of oxygen inspired is, then, nearly constant
in the normal state, the number of inspirations
being diminished or augmented, to compensate for
the excess or defect of density in the air. If a man
inspire a very dense air too quickly, his tempera-
ture is soon raised; but if he respire a rarefied at-
mosphere too slowly, the animal heat sinks. When
a hot-blooded animal passes into the state of hyber-
nation, its respiration becomes slow and superficial,
and much less carbon is burned than in its period of
activity. So, on the contrary, when cold-blooded
animals become capable of producing heat, as at
the period of incubation, we find their respiration
accelerated, and their consumption of aliments in-
creased.

To sum up: all that physiology and chemistry have
taught us in relation to respiration may then be
comprised in one sentence, namely a slow com-
bustion of the materials of the blood by the oxygen
of the surrounding air.

ORIGINAL CONTRIBUTIONS.

REFLECTIONS AND OBSERVATIONS
ON INSANITY.

By JOSEPH WILLIAMS, M.D., &c. &c. &c.

(Continued from p. 201.)

"Nemo mortalium omnibus horis sapit."
INSANITY VITIATES ALL ACTS.

There must be some limit as to the knowledge of
figures; many most acute persons are very ignorant
on very simple arithmetical calculations. A ques-
tion once put to an alleged lunatic was, if £1,200
produced £20, how much was that per cent.? This
could not be answered. Subsequently, Counsel put
the saine question to one of the jury, who was
equally puzzled! This case strongly shows the
necessity of caution.

The confidential and chief clerk of one of the most eminent banking houses in London, who was a most excellent arithmetician and financier, was once asked the simple question, " If a herring and a half cost three halfpence, what would eleven come to ?" This he worked in various ways, and was unable to solve the question. He had imagined there was great difficulty, and set about some abstruse calculations. But the point to which I wish to direct attention is this: supposing this question to have been put to him by Counsel, before a Commission, to try his sanity, what might have been the consequence? it is perfectly frightful even to contemplate it. Here was a man, placed at the head of a large banking house for his talent, with probity, and yet, although daily living by figures, was unable to respond to a question which boy six years old answered for him. It is very true that, immediately the point was shown him, he not only saw it but understood it, and this of itself proved he was neither imbecile nor insane.

a

It is not sufficient that a man be found" so far debilitated in his mind as to beincapable of the general management of his affairs, and has been of the same state of mind for six months last past"; for in a case, ex parte Cranmer, this verdict was returned, and was quashed by the Lord Chancellor, who said, "The inquiry is, whether his capacity is of that kind that fits him for the government of himself, and the management of his affairs: I must have that returned"; this verdict does not state distinctly that he is incapable, but that he is so far debilitated in his mind that he is not equal to the general management of his affairs. Another inquisition issued, and the jury, under the direction of the Commissioners, found their verdict, that Harry Cranmer is of unsound mind, so that he is not sufficient for the government of himself, his manors, &c., and that he has been in the same state since the 13th of May, 1806.-P. 454., Ves. Rep., vol. 12.

It seems to be essential not only that a jury should find incapacity of a party to manage his affairs, but also other circumstances indicating unsoundness of mind.

66

Inquisitions have been quashed with returns finding persons in the following conditions, namely, "Not sufficient to manage his person and estate"; "Not of sufficient understanding to manage her own affairs"; Not a lunatic, but incapable"; "Not a lunatic, yet not proper to take care of his affairs during his fits"; "Weak for the last twenty years"; "Worn out with age, and incapable of managing her own affairs"; "Had been a lunatic, but that, at that time, he enjoyed a lucid interval, and that he was not at present capable of the management of his own affairs, and that he had been in the same state from the 9th of February last.”— Shelford, p. 109.

But to find, "Not a lunatic, but of unsound mind, so as not to be sufficient for the government of herself, her lands, &c.," was considered good.

It is better for a jury to return a very simple and plain verdict, and not state their premises, or draw any conclusion which does not necessarily follow, or the inquisition may be quashed by mere technicality.

1

An inquisition has been quashed because the verdict had only carried back the lunacy for six years, whereas the party had been idiotic from infancy; and another inquisiti on was quashed because the jury did not carry back the lunacy as far

as the evidence warranted.

In returning a verdict it should always be stated whether the party has or has not had lucid intervals; but, even if such be omitted, the return may be received, and a traverse may then be allowed.-Ex parte Ferne, 5 Ves. 450.

In one case, where a person who had been found a lunatic petitioned to supersede the Commission, on the ground that he enjoyed perfect and constant sanity of mind, the Commission was not superseded, but the party was permitted to have the care and management of his estate for several years; and upon his again becoming disordered in his senses, a Committee was appointed of his person and estate.-Shelford, p. 135. Ex parte Fermor, in re Errington; Jacob. Rep. 404. A lunatic, according to Blackstone," is one who hath no understanding, but by disease, grief, or other accident, hath lost the use of his reason"; it not only includes idiots, but extends to all of unsound mind. And again he says, lunacy is a partial derangement of the intellectual faculties, the senses returning at uncertain intervals. 4 Bl.

Com. 24.

An imbecile can think and speak a little, has some feeling and affection, he has a limited capacity for actions and thoughts; while perfect idiots resemble brutes, but without their instinct.

Imbecility shows itself by an incapability of forming a judgment upon even the ordinary concerns of life, the memory being very limited. Such persons are easily excited, easily calmed, and are often fond of talking to themselves; they mistake places, persons, and things, and have no clear per ception between the present, the past, and the future-what is done, is the effect of habit and form, and from this cause they often appear devotional. From this state they may still more decline, the memory becoming more imperfect, the

temper more irritable, until they are unfit for any of the social relations of life.

Many men have weak minds, are very eccentric, and yet have full capacity for acquiring wealth; and in such cases, it is extremely important to ascertain the natural character, and to see whether there has been any great change or deviation from it. Thus in the case of Mr. Davies, a wholesale grocer, aged 27, who was naturally eccentric, nervous, timid, shy, aud habitually anxious, and somewhat vigilant, especially the night preceding the sales of teas at the East India House, but was very clever at his trade. His mother appears, even up to this time, to have held a complete sway over him; she prevented him from going out without her leave, from carrying any pocket money, and from seeing any young females. He much disliked his mother, became hypochondriacal, and consulted several medical men, amongst others Dr. Latham, whom he threatened with vengeance, if the doctor considered him insane, saying, "If you fail, dread the revenge of a madman, for I carry loaded pistols." Soon after this, he left home and went to the Furnival's-inn Coffee-house; he there appeared somewhat wild; and awoke the servants in the middle of the night, thinking there were thieves in the house; he behaved very incoherently, and on the following morning, when remonstrated with by the proprietor of the hotel, he humbly begged pardon on his knees. He was then confined in a private madhouse, and applied for his release. A Commission was granted. He was calm and correct in his answers and conversation; and it appeared in evidence that the very persons who were confining him as unfit to take care of his business, were themselves consulting him about the conduct of that business immediately prior to his removal, and that they could not stir without his advice. Mr. Davies was immediately restored to his liberty and property.

ause he made sacrifices to free

such an odious and

Now, on more closely investigating Mr. Davies's case, we shall find that his learning to box, his spouting poetry, his reading medical books, although dyspeptic, his refusing when twenty-seven years of age to live with a mother who prevented him from leaving home without permission, who constanty interfered in his mercantile business, refused the privilege of carrying any money in his pochts, although he was worth thousands, which had bin realized by his own talents and strict habits of buness, and who also interdicted him from going the theatres, or from forming any female acquailance, lest he might possibly be married, and b himself from the ammels of what he considered natural parent, these were the reasons adduced roofs of his insanity; the laid upon his refusing to return to his mother, a his denial of having been previously insane. It is very true that several inconsistencies, but Davies manifested terfered with his competer affairs, for we find he was to manage his own and skilful in his business, thexact, exemplary, isted in the large income he doof of which exthe considerable sum of money, as well as in It is true he had paid handsome had amassed. town, but many men constantly a villa near and more than the value for any objtoo largely a horse, or a property, when once ts a house, their fancy upon it.

greatest stress being

a.

se in no manner in

been insurmountable. Now, in such a case as this,
the question would not be, whether such a person
should not be confined, because it is at once
evident that he should not be; but the inquiry is,
why should he have been interfered with at all,
since he had not injured the Queen, while his capa-
city for business, and for the regulation of his affairs,
was such that his Committee could not manage his
estate without his individual assistance.

from the delusion are of considerable duration; when, however, these periods are very short, occurring very frequently, the insanity is called paroxysmal. The longer the interval the less is the danger of recurrence.

To certify that a person has a lucid interval, it is necessary to see him several times, under different circumstances, and to question him on various points.

There is a great difference between civil and criminal cases; a will or deed would be invalidated if there was no lucid interval, even although the insanity did not affect that particular subject or In some cases, where it may be proper or justi- topic; but in criminal cases there is always refiable to protect the property, still personal responsibility, unless the insanity is proved to be the straint or actual confinement may be most un- very cause of the act. justifiable; for instance, in the case mentioned by Lord Erskine, where a person imagined he was the Saviour, and where he conducted himself with so much propriety that the judge and jury and every person in court were, for many hours, satisfied of his sanity, was that a fit case for confinement in a madhouse? Subsequently this very gentleman possessed so much self-control that nothing could induce him to acknowledge or revert to his hallucination; and had he not been examined proviously in another court, where shorthand notes of the trial were taken, it would have been impossible to have proved him insane!

So also in the case where the gentleman stated he corresponded in cherry juice, why should he have been locked up in a madhouse? He had neither injured the Princess, nor had he threatened her, nor was he likely to do either; nor would he, as Dr. Conolly has stated, be more likely to recover by associating with others holding worse delusions.

A man may hold deluded opinions upon many subjects, and yet it would be unjustifiable to interfere with his liberty of action or wish. When a jury is called to decide in cases of doubt, their duty is to see whether the point of delusion interferes with the interest of the alleged lunatic, or of others, in person or property, because if a party have sufficient capacity to manage his own affairs, however absurd his opinions upon other subjects, no one has a right to restrain him. A man may imagine himself a tub, or an oyster, may hold extraordinary antipathies, and yet not be a fit subject for a Commission. As Dr. Conolly says, 66 A man may fancy his legs to be butter, and take all due care of them, without injury to himself, his family, his property, or the property and persons of others, and no one can have a right to interfere with him." And yet there are cases of imbecility where no delusions exist, but where, from general ignorance and incompetence, it may be essentially necessary to control the property, and yet not to interfere with or restrain the person.

It is of immense importance to ascertain whether the lucid interval is perfect, whether there is a complete restoration of mental power or vigour, as during an intermission, a very weak and impaired judgment is not unfrequently noticed; and, in such a state, it would be really criminal to allow a lunatic to make any testamentary dispositions, as it is more than probable that under such circumstances these would be very different to what he may have previously contemplated, or to what he would feel it his duty to do on a more complete recovery.

I am certainly inclined to consider that acts which in themselves are perfectly reasonable afford some proof that the state of mind was rational when the party advised or dictated them; but how far the mere execution of a rational will or deed is the proof of sanity must be left for the opinion and decision of another profession.

A rational will affords reasonable grounds for supposing a lucid interval may have occurred, and vice versa. A will made and executed during a lucid interval is valid; the difficulty alone being the proof of a lucid interval; it must not be a mere remission of violent symptoms, but a sufficient return of mental vigour to enable the alleged lunatic to judge of the act be directs and performs.

Sir William Wynne, in deciding as to the validity of a will, in the case of Cartwright v. Cartwright, where the testatrix was declared to have written her will during a lucid interval, the ligatures and straps having been actually removed from her hands for that purpose, said "The strongest and best proof that can arise as to a lucid interval is that which arises from the act itself, which is the thing to be first examined; and if it can be proved and established, that it is a rational act, rationally done, that is sufficient."

The

And supposing even a lunatic who has lucid inIf madness suddenly cease, without any marked tervals makes a will, and it is not known whether crisis or change, it is most probably a case of in- the will was or was not made during a lucid intermittent insanity. Great caution is required interval, yet, if the will is rational, it is presumed to giving an opinion that a cure has occurred, as it have been made when the patient was placid and often happens that a relapse takes place, although calm, but " unquestionably there must be complete not so frequently as is generally believed. Some and absolute proof that the party who had so have even doubted the very possibility of a lucid framed it, did it without any assistance." interval, but there can be no doubt that a return of great point to determine is not whether a man has been insane, but whether he possessed sufficient the usual or habitual soundness of mind does in some cases take place during the intermission of mad- capacity at the time of the execution of a deed as ness; and it will often be observed that the longer ought to give it effect. If, however, such inthe interval the stronger is the reasoning power, and fluence is obtained over a man as to prevent his vice versa, the symptoms usually becoming more exercising sound discretion in making a will, he is aggravated with each returning paroxysm, unless not considered equal to a proper disposition of his the patient is convalescing, when the paroxysms property.-Mountain v. Bennett, 1 Cox. 353.

often become more and more mild.

Most cases have lucid intervals; still it is a most wise law that a person found to have been non compos mentis, and asserting that he has lucid intervals, should be required to prove it. It is often difficult to prove this even while the patient is living, but becomes much more so when the alleged lunatic is dead.

In Groom and Evans v. Thomas and Thomas,

have set While many physicians state that lucid intervals In cases of doubt it may somewhat as are seldom perfect, there are some who even deny quiry to ascertain whether a party has alhe inpeculiar, eccentric, or childish, whether anbeen the very existence of lucid intervals; and Dr. change has occurred. There are cases while Haslam, after twenty-five years' experience, was of impossible to state whether the party has or his this opinion. Dr. Ray has endeavoured to prove a disposing capacity; but, except in homicio pathologically that such a thing is impossible; but, criminal cases, the greater the difficulty in dete as Dr. Prichard has wisely observed, and as is often ing insanity, so is it usually of the less importarnoticed in practice, a person enfeebled with epilepsy the deceased was admitted to have been insane beif unperceived. Thus we read of an instance whers long intervals, and yet, when inspected after fore the execution of two asserted wills, and there a Lord Chancellor dined with a gentleman who th, tubercles or ossific deposition have irritated was evidence of delusion and other indicia of imagined Queen Charlotte was in love with him, brain; so that here is irritation set up, at one derangement existing shortly before as well as suband his Lordship found him very agreeable and producing a fit, and yet an interval of months sequent to the acts. Judgment was given against 's passes without a relapse. the wills; and it was held that proofs of calmness, sensible, except upon the opinion that the Queen and of his doing formal matters of business under was in love with him. A Commission was granted. of tervals of composure or placidity, in cases the sanction of his family, were not sufficient to This alleged lunatic actually so assisted the Com-long, vary as to length, and where these are rebut the presumption against the papers.-Hag. missioners in the management of his estate, that, some called recurrent or intermittent, and named remitting insanity; but, however gard's Eccles. Rep., vol. 2, p. 433. without such assistance, the difficulties would have meant that the intervals of freedom

A singular case occurred professionally to one o

220

THE MEDICAL TIMES.

my family, who was legally concerned; it was that equal importance that the evidence in support of
of a lady who had been found by Commission of the allegation of a lucid interval, after derange-
unsound mind, but with lucid intervals. Physi- ment at any period has been established, should be
cians were every now and then sent down to see her, as strong and as demonstrative of such fact as where
to ascertain her state of mind. On her decease, a
will was found dated on a particular Sunday, When a person has once been found insane, there
about four years back; and a physician whom the
the object of the proof is to establish derangement." |
patient had herself sent for had attested it, who, proving him sane.
together with a nurse and one or two others, sub-rules, but not so easy to apply them. It is very
are sometimes great difficulties to overcome in
sequently to her death, declared that the lady was
on that Sunday quite herself, rational, and per- terval really exists, and a deed is executed during
It is easy to form general
fectly aware of what she was doing. The peculi- a lucid interval, it is valid, for "where there is
difficult to prove a lucid interval, but if a lucid in-
arity of the case, however, remains to be told: a satisfactory evidence of the sanity of a party at the
physician had been sent down to see her on that time of a contract, the antecedent state of his mind,
Saturday preceding the day on which she had and the causes of it, may be laid totally out of
made her will, and another doctor saw her on the view."-Shelford, p. 50.
Monday following, both of whom had attested
It is

s a fact that some men can

9

fellow-men; the very same individuals who might have to decide on his guilt or innocence, or on that of any other person, if charged with crime, and which decision might cause his execution. Now, it free from prejudice, and sound enough to judge as is but to be presumed, if these men are sufficiently all the medical finesse, notwithstanding all the life, they are surely capable to give an opinion as to the question which would involve a person's legal subtleties, it is common sense has to decide, pos; for, after all the metaphysical quibbles, with and it is common sense which can best decide, as to to whether an alleged lunatic is compos or non comwhether a man has, or has not, a sufficient capacity to manage his own affairs. For It is at once evident how much contrariety of bedo sa dol

that on their respective visits she was of unsound soundly upon any other subject exceeason very opinion must necessarily occur as to what is con

mind. Her will, although prejudicial to the in-
terests of some, was rational, and was unopposed;
had it been disputed, there can, I think, be but
little doubt that it would have been set aside, as
the time elapsing between the visits of the two
physicians was so short that the lucid interval
could scarcely have been considered complete.

That lucid intervals do occur cannot be doubted,
and in some instances it is of great consequence to
determine whether a patient, even when confined
as a lunatic, should not have the power of making
a will or of signing deeds. I am aware of the
difficulties of the subject, and know that the
greatest circumspection would be necessary; still,
I believe, if, on an application to the Lord Chan-
cellor, two Commissioners were specially appointed
by his Lordship, to visit the petitioner, and having
found him, on two separate visits, with an interval
of at least two days, of sound mind, that a will
attested by them, and sealed and registered under
the Lord Chancellor's authority, should be con-
sidered valid.

Of course, under such circumstances, the Commissioners would avail themselves of every fact connected with the case, would see there was no illusion, no hallucination, and would, by investigating the rationality of the act itself, and in the reasons given by the testator for his various acts, ascertain whether he was or was not at the time of sound mind.

I am aware how artfully a lunatic may conceal his real opinions, and also that a few coherent sentences do not constitute a sound mind, however deliberate and placid a patient may be; but still when I find a man acting rationally, and wishing to do a rational act, in a rational manner, and with a rational wish, I cannot but feel it to be unjust to oppose any barrier to so reasonable a request. Because a person can answer a question put to him, that is not sufficient proof of sound mind, but the competency of mind must be judged of by the nature of the act to be done, and from a considera

tion of all the circumstances of the case. Combe's case, it was agreed by the Judges, "that the sane memory for the making of a will is not at In all times when the party can answer to anything with sense, but he ought to have judgment to discern and to be of perfect memory, otherwise the will is void." And again, according to Lord Coke, "it is not sufficient that the testator have a memory, when he makes his will, to answer familiar and usual questions, but he ought to have a disposing memory, so that he is able to make a disposition of his lands with understanding and reason, and that is such a memory as the law calls sane and perfect."-Shelford, 274.

The powerful impression of habit will sometimes impose the necessary self-restraint, even where insanity is unquestionable. Thus a judge may be only sane when on the bench, or a clergyman when in the pulpit, the importance of their several stations acting as á check upon their inconsistencies. The same fact, although in a slighter degree, is also observed in artisans, who are often perfectly rational while working at their trade, but soon again lapse when the occupation ceases. These circumstances prove the necessity and advantages of employment, and also the benefit and the moral

check which the restraints of society impose even upon lunatics.

As Lord Thurlow has stated, "It certainly is of

which they are hallucinated, hence a question arises whether a person should not be permitted to t upon lunatics, as Dr. Prichard states, may make good make a will, when his hallucination does not turn wills, being reasonable upon such subjects. In upon his property or his family? Even dangerous during the period of lunacy, even though such act is not, and cannot, be connected with the influence civil suits, however, the law avoids every act done of the insanity.

kinson, in re Parkinson, returned "that the said Thomas Parkinson, at the time of taking this inWhen a jury, under a Commission, ex parte Atquisition, is a lunatic, enjoying lucid intervals, and during such lucid intervals he is competent to the government of himself, and the administration of his own affairs," this inquisition was quashed by Lord Chancellor Eldon, who ordered a search to be made for precedents.

tic, but is not of sufficient understanding to manage Among them was Mary Halsey, "is not a lunacellor Talbot, and another inquisition was returned, herself nor her affairs," quashed by Lord Chantwenty years last past the said M. Halsey has been "that the said Mary Halsey is not sufficient for the affected with the same weakness of judgment and government of herself and her estate, and for near understanding"; and upon this inquisition a grant of the Committeeship was made.-Ex parte Barnsley, 3 Atk. 168.

upon the peculiarities of each individual case. No definitions, no positive rules, no single opinions, sidered "capacity sufficient," and this must depend and where incapacity becomes evident, must deto be, sent before a jury to say whether there is can decide it in every case; but it must be, it ought sponsibility and irresponsibility, or between capapend upon the particular merits of each case, To "sufficient capacity." Where reason "disappears, indicate decided insanity in another. ascertain the exact line of demarcation between rebility and incapability, is impossible, for that which would be a sane act in one individual may

(To be continued.)

SURGICAL REPORTS AND OBSERVATIONS,
ROYAL BERKSHIRE HOSPITAL
By F. A. BULLEY, Esq., F.R.C.S., Surgeon to the
Hospital.

GANGRENE OF THE FOOT AND LEG-DEATH-
POST-MORTEM INSPECTION.

grene of the right foot, which had commenced by had increased until it occupied the greater part of J. P., a sawyer, aged forty-eight, was admitted into the hospital Nov. 28, 1846, on account of gana small spot in the integument of the instep, and who was found "worn out with age, so that she is countenance, difficulty and shortness his breathnot capable of the government of herself, her mes-ing, and a constant audible wheezingu inspiration, Another precedent was that of Frances Waller, bed, at times delirious, with great anxiety of the skin of the outer side of the foot, inviving all suages," &c.; upon this return a grant was made. the toes. He kept constantly tossing abut in his could be done but to issue a new Commission. It The Lord Chancellor said he thought nothing sary, the evidence showing that the alleged lunatic was then objected that a Commissiou was unnecesthe management of himself. On considering this petition, his Lordship held it to be a proper case was in such a state of mind as to be competent to for a Commission. Commission issued.-Jacob's Rep., p. 335. 1828.

mind, who appeared to be in a state of imbecility,
Lord Eldon directed two physicians to visit the
Where an inquisition found a person of sound
party, for the purpose of determining whether the
state of her mind was competent to the manage-
ment of her affairs; and, instead of issuing a
of funds in Court, except in the manner directed
second Commission, an order was made to restrain
by the order.-Ridgway v. Darwin, 8 Ves. 65.
the party from executing any deed or will disposing

asthma, which was more resembling what is observed in paroxysm of when the intermittent ac on auscultation over the upper art of the chest particly perceptible beneath the clavicles. Pulse quent, feeble, and regular, this bruit was perceived. The pulsation intermitting. A slight bruit lowed the first beat of the heart, and was mo easily distinguished J was most apparent, somewhat hard anowing account of the progress at other times, when th Contractions were more natural, and this Yrd-like to the feel. of his disease. he came to the hospital. of both the femoral al on the affected side was ies was more feeble than tended him back had commenced on the 11th I received then the gentleman who had at

sympto ligament, and great pain extending of Octobeposure to wet, cold, and fatigue, with sion, after inflammation of the vessels under The prese weeks and six days before admisbe no doubt respecting the necessity of interference At.rds became cold, and gradually the foot beIn the more decided forms of insanity there can Poupe course of the femoral artery and vein. sity for collateral guidance. where there is property; for there are circum- afinsensible, oedematous, of a livid colour, and dow the limb was hotter than natural, but it knowledge which would allow a labourer to guideneral swelling of the limb and the insensibility stances in individual cases which justify the neces-nately gangrenous. The pain in the course of the plough, would not be sufficient to enable of the foot continued. He had had for a long time wealthy heir to manage large estates; and, altho symptoms of heart affection, the least flurry proThe same degree of vessels subsided after the first week, but the it would not be justifiable to restrain or confinducing shooting pains and palpitation, which there persons of either of these examples, yet it could be no doubt were occasioned by organic dis be expedient and just to prevent the hor being robbed, and also to manage his a'the flammation in the left leg in January, 1846, which him with economy; nay, more: supsch is after about five weeks subsided, when his foot relabourer to become the heir, a supposite the mained cold and livid for some time, but ultimately occasionally actually realized, in then, if recovered its natural temperature and appearance. ease. He had experienced a similar attack of inwhich, be it remembered, consist same rule would apply to him; he mission, of weak intellect, be subjected to ary of his

In addition to these particulars, his wife informed me that he had been subject to occasional attacks

1

913