Morbid Appetites of the Insane
235 Art. VII.? :Author: W. A. P. BROWNE, ESQ, Psychological Consnltant, Crichton Institution, Dumfries; recently Medical Commissiotier in Lunacy, Scotland.
” She can cranch A sack of small coal, eat your lime and hair, Soap, ashes, loam, and has a dainty spice Of the green sickness.”?Ben Jonson.
On visiting the wards of an asylum there may be encountered individuals of both sexes and of every station, of pleasing aspect, respectful or refined address, and of coherent, even intelligent conversation. If the pursuits and amusements of such a com- munity be witnessed, they may present the same animation and decorum, the same enjoyment and self-control, which cha- racterise similar meetings in rational and respectable society. These scenes are mere simulacra, semblances of sanity. They are presented to the critical eye as an advertisement of success, as the triumphs of common sense and common humanity in rehabilitating the native ugliness of disgusting desires or savage passions, in rebuilding the ruined temple of the soul, or as appropriate appeals to the sympathies and convictions of the observer. But they form merely the outer wall of a whited sepulchre. There is, within and below, the loathsomeness of decay, rottenness, and degeneracy. There will be found in other strata of ” the relics of another and an outer world ” of past health and happiness, degradations, perversions, and brutish tendencies so gross and grovelling as to extort the enquiry, can all this be consistent with the past dignity and nobility, the future glory and immortality of that being who is a little lower than the angels ? The attractive colours of the picture are not, however, a fable or a falsity; they constitute the genuine and legitimate fruits of improved treatment, founded upon science and a partial knowledge of the requirements and regulation of the human mind; while the feebleness, the fatuity, and the foulness which lurk behind are as genuine fruits of this partial knowledge, and of the ignorance and incompetency which are confessed, but not yet overcome, and which the splendid enlightenment already spreading around us serves to reveal, but not to remove. Dark and gloomy although such destinies of our fellow-men may be, they are not in- scrutable. Many solutions have at least been offered of this fallen estate. It has been attributed to the direct vengeance of Deity, as a punishment for sins personal or ancestral; it has been identified with Satanic possession; it lias been traced back to our brute nature, and paraded as a proof of our descent and evolution from some less-gifted animal. We conceive that another explanation less remote and recondite, and more in harmony with the history of each individual, is accessible, and that a brief narrative of some even of the most hideous forms in which alienation may present itself may develop this, and may at the same time serve to warn the sanguine that com- paratively little has been accomplished in the amelioration of mental disease; that they should not be misled by the frac- tional good which has been done, nor withdrawn from the contemplation of the enormous amount that remains undone, as a stimulus and reward to coming Psychologists.
PHTTOPHAGES.
Structural arrangements and the astute vigilance of trained attendants have suppressed much of the violence, the vagaries, and absurdities of the chronic insane, but they have failed, and must, perhaps, always fail, in frustrating the grotesque devices by which perverted appetites and aptitudes are manifested or gratified since the abandonment of a mask or a chain. Many patients display a taste and a talent for deception and evasion, and derive pleasure from eluding or defeating the provisions instituted for the purpose of making them human and happy. Many years ago we had as a patient an officer in the navy who was partially demented and incoherent, but who retained the language and many of the habits of his former condition. The contraction of his fingers indicated that he had suffered from hemiplegia, but his firm and rounded form, his blooming and smiling features, showed that he was robust and well-nourished. He often wrote with chalk or some substitute on the pavement, and while tracing his gigantic letters he assumed the quadrupedal position which might have betrayed to certain theorists a relic of his origin from animals of a lower grade. He had another peculiarity which seemed to corroborate this fanciful idea. His lips were repeatedly noticed to be green, and particles of grass suggested the suspicion that he chewed and perhaps swallowed the herbage in the airing ground. He was watched and detected in devouring considerable quantities of the grass and in making what might have served as a meal for one of the herbivora. This man had abundance of plain food, lacked not tobacco, and indulged in this practice in order to administer, it was at the time conjectured, to a depraved taste, or to allay the cravings of morbid hunger. We have since met with many instances of similar depravation, where the leaves of trees, lierbs and vegetables of all kinds, seeds, roots, unripe fruits were taken at random and in large quantities.
Even in their Report, 1875, the Board of Lunacy, Scotland, has issued a circular warning of the evil and fatal effects arising from a6cess to yew leaves and berries. It does not seem necessary to seek an explanation for such indulgence in the origin of species or in the reappearance of an instinct, extinct in the individual, but existing in his progenitors and in their unevolved unhumanised ascendants. We are acquainted with the history of J. Gordon, the mother of a microcephalic idiot boy, who throughout life displayed an in- surmountable repugnance to animal food. A modification of this perversion is met with in hypochondriacs, who, it is ?well known, cherish their maladies, have a predilection for infirmity and invalidism, recoil from robust health, are en- grossed with medication, and who, though rejecting natural and attractive aliments, acquire a positive pleasure in subsisting upon drugs. Abstinence is certainly a frequent symptom; but bulimia, or inordinate appetite, is likewise met with in melan- cholies, extending to inedible, disgusting, and noxious matters, and may depend upon an advanced stage of that irritation which leads primarily to the rejection of food in other individuals. This uneasiness or craving, which sometimes amounts to torture in the region of the stomach, may be traced to exalted or morbid sensibility of the nerve, and which may suggest the desire for food without any consideration of its esculent or digestible qualities. Gratification appeases the inordinate appetite tem- porarily, and extinguishes the local pain; but the recurrence of the inclination to eat takes place much earlier than can arise from the wants of the system, or from a healthy state of the stomach. In such cases, where patients do not sleep, food is sometimes supplied during the night, which appears to remove the cause of their restlessness, and is followed by sound refresh- ing sleep.
The earliest and most celebrated illustration of morbid vegetable-eating is that to be found in the Book of Daniel. As this narrative has been discussed by the present writer in a theological work under the shadow and sanction of the venerable name of Dr Pusey, it may be here introduced as connected with this enquiry. It is stated that Nebuchadnezzar ” was driven from men, and did eat grass as oxen, and his body was wet with the dew of heaven, till his hairs were grown like eagles’ feathers and his nails like birds’ claws.” It is now conceded that the madness thus delineated was allied to a rare sort of disease called Lycanthropy, or one form of it of which our earliest notice is in a Greek medi- cal writer of the 4th century after our Lord, in which the sufferer retains his consciousness in other respects, but imagines himself to be changed into some animal, and acts, up to a certain point, in conformity with that persuasion. Those who imagined themselves changed into wolves howled like wolves, and, there is reason to believe, accused themselves falsely of bloodshed. Others imitated the cries of dogs; it is said that others thought themselves nightingales, lions, cats, or cocks, and these crowed like a cock. “We attended a lady who conceived herself trans- muted into a cow, but did not frequent the ” pastures sweet.” In many classes of the insane the eating garbage, excrement, even grass, is a symptom both of general debasement and of a perverted craving for unsuitable and innutritious diet. If Nebuchadnezzar’s punishment, then, be regarded as alienation, involving the greatest conceivable amount of degradation, the ” eating grass as oxen,” the expulsion from the society of his fellow-men, and the exposure to the elements may be viewed as most graphic features of his disease, and of the cruel treat- ment to which, in those and in much more recent days, such an affection subjected the sufferer.
There is a traditionary belief that a melancholic, suspecting his meals to be poisoned or adulterated, was sustained for a long period upon the contents of cocoa-nuts. We have had several patients who took no support but that of bread; one of whom exercised this self-denial in order that his fellow-sufferers might benefit by his abstinence, and greatly impaired his strength by such abstinence, as well as by secluding himself in a closet traversed by hot-water pipes, so that a larger amount of warmth, according to his estimate, might reach and cheer his companions. This was a delusion, or an erroneous judgment; but if we recollect that millions of our fellow-creatures in India are, at this moment, granivorous, guided partly by superstition and partly by the products of the country and climate; that large, but perhaps not so large, numbers in other parts of the world are frugivorous; that we ourselves, in a certain stage of our life-progress, have depended almost entirely upon cerials; that Creed, for ages, limited ascetics to farinaceous food; that a misinterpretation of physiology has converted thousands into enthusiastic but rigid vegetarians; we cannot justifiably re- gard phytophagism as more than a deviation from modern customs, as a morbid tendency, as the exaltation of a desire for a particular kind of food, which has been over-laid or obscured by usage, luxury, or special circumstances, but which reappears when these superinduced or superincumbent veils or disguises have been torn off by disease, and the rudimentary strata of our instincts and propensities laid bare. The G-ymnosophists were both nudifiers and vegetarians.
LITHOPHAGES.
While paying a professional visit in years when bleeding was still employed as a remedy, an hysterical woman rifled my pocket, extracted from it a small morocco case for two lancets, and, notwithstanding the exertions of those around, swallowed it. About the same time, when manacles had come under the care of science, and the iron which was supposed to enter into the soul, had given place to the reign of leather, stuffed gloves, and but- toned dresses, a lady, whose gown was secured at the back by small padlocks, succeeded in tearing off one of these and pass- ing it down her throat. In what manner these objects entered the stomach or what became of them was never ascertained ; but certain it is that no injury or disturbance followed their entrance into the system. The tolerance of the organs of diges- tion has been demonstrated in various other ways and in a more striking manner. The handles of spoons have been cut out from the walls of the abdomen, which had been furtively thrust down the oesophagus by lunatics, and cases have occurred where, after death, spoons, knives, buckles, buttons, coins, and a miscellaneous collection of small articles have been disclosed by dissection.
In the Register of Deaths, March 1852, a startling instance of this kind is recorded. In a private asylum in London there were found in the stomach of a lunatic thirty-one handles of table- spoons, about a dozen of nails, two or three stones, and a button. It is at first difficult to conceive under what feelings or for what purpose such acts had been resorted to. As none of the metal-eaters appear to have meditated suicide, we are compelled to embrace the supposition that such dangerous experiments were dictated either by delusions of invulnerability or immor- tality, by boastful pretentions of occult or supernatural powers, or should be numbered among the rash, motiveless, frenzied acts characteristic of sudden impulses during maniacal par- oxysms. I have had more than once to contend against the wounds inflicted by portions of window glass thrust into the mouth or oesophagus with the view to destroy life, and upon one occasion was called upon to deal with an excited mastur- bator, who, either under the pangs of remorse, or instigated by those obscure suggestions which emanate from excited csenes- thesis, seized, crunched, and effectually triturated the glass which had fallen from a pair of spectacles, and contrived to swallow a considerable portion of the sharp particles. He sur- vived this accident and ultimately died of phthisis.
Familiar with pronators, grovellers, burrowers, and hiders, who dallied with dirt and gravel or excavated the ground near to tliem, I long suspected that many inedible substances were subjected to mastication; but not until I had an opportunity of being present at the examination of the bodies of individuals who had died in a workhouse during an epidemic of cholera did I form any conception of the extent to which earth-eating was carried by the insane. Of many opened, five bodies con- tained earth in the intestines. It had not, apparently, undergone any change, but was at some points caked into masses; at others it remained disintegrated or pulpacious. In all these persons the colon was the chief receptacle of this foreign matter, which was present in such enormous quantities, although the precise amount was, unfortunately, neither measured nor weighed, that the enlarged and distended gut had been forced by its contents across and almost down into the pelvis, occupying the position, in fact, formerly supposed to be characteristic of melancholia. Of the history of these cases nothing was known, except that they had long lived in seclusion and died during cholera ; but it was surmised that the low diet and depressing surroundings of their situation might have had some influence over the foul and perhaps fatal practice thus disclosed; in fact, that recourse had been had to mother earth because food was insufficient. Either to allay an irresistible impulse, or as a mode of malingering or of suicide, dirt and plaster eating was constantly resorted to by enslaved negroes, and induced the disease or the death which they coveted. There are peoples who supplement their ordinary nourishment by taking insecti- ferous earth. There are savage tribes who gorge themselves with mould, or balls of mould, in order to distend the stomach, and thus to mitigate the cravings of hunger. There are, again, those who devour an unctuous clay, and expect to derive support from the animal or vegetable oil with which it is saturated, thus proving the omnivorousness of our species, so that what was done by lunatics from necessity is repeated by their brethren in freedom, from choice. It is known that rocks have yielded oils which have been utilised for food and medicine. Eomance tells us that pearls have been dissolved in order that royal lips might quaff a draught unparalleled in value, how- ever unpalatable it might be; and I have seen chlorotic and dyspeptic girls, both sane and insane, devour chalk, cinders,* and other disgusting solids, but have met with few examples of stone-swallowing so extraordinary as the following:?J. C., a thin, pale melancholic, was long under my care. She was stealthy in her gait, secretive and cunning in some of her habits, moderate in appetite, and was placed under special observation, as it was feared that she added to the ordinary bill of fare some less digestible matters. Such apprehensions were, however, long disarmed by the absence of all other symptoms of in- disposition than anaemia and attenuation of frame. At length a dose of castor-oil was required, and its operation confirmed the accuracy of the original suspicion. The stools contained, besides healthy coacted faeces, a large number of pebbles, evi- dently obtained while taking exercise in the grounds; but whether all had been swallowed at once, or at several times, there were no grounds for conjecture. During the next twenty- four hours there were collected 158 stones, now upon my writing-desk. The total number weighed nine and three- quarter ounces, the largest reaching to six drachms. They were of all forms, and sometimes presented rough surfaces and sharp edges. Increased care and watchfulness interfered with any further indulgence in this extraordinary modification of crapu- lence ; but the unfortunate patient was removed to another establishment, where, after some years, she became bedridden, and ultimately died of what was supposed to be chronic gastritis. On inspection the stomach was found filled by a rolled dark mass, which is now before me, and which consisted of hair, some portion of which might have been stolen from her mattress, but the largest portion was evidently plucked from her own head. This propensity is sometimes associated with fsecophagism.
SARCOPIIAGES.
I would not treat as flesh-eaters such as enjoy cooked joints every day. A large portion of the inhabitants of the world delight in and depend upon animal food; but it is remarkable that, as we approach the primitive or unreclaimed condition, the enjoyment of such a viand seems to be enhanced by the fresh- ness of the muscle, by its half-cooked or raw condition. The North American Indian and his children sit around the fire, immediately after the chase, and luxuriate in a repast upon the yet palpitating carcass and suck thfe marrow from bones which have been heated as much by vital warmth as on the blazing hearth. It has been asserted that the correct mode of securing an unrivalled beefsteak is to cut a slice from the haunch of a living bullock and to heat it slightly in the sun. It would be absurd to suppose that any such refinements of the gastronomic art actuated the wife who, longing to taste her husband’s shoulder, killed him in order to possess herself of the coveted morsel; but it has been well established that under circumstances of hunger, cold, exhaustion and expo- sure, as well as in pregnancy, the most selfish and sanguinary propensities are called into activity, overcoming every motive save those of self-preservation and the satisfaction of the dominant appetite. Thus we are told that during the latter stages of the journey of Sir John Eichardson and his party the mind became impaired, egoism predominated, and when game could not be procured, men murdered their masters and comrades in order to appease their sufferings, and were then killed in turn to arrest a series of similar tragedies. He says: ” I observed that, in proportion as our strength decayed our minds exhibited symptoms of weakness, evinced by a kind of unreasonable pettishness with each other.” It is possible that famine or imperfect nourishment may have called forth the longing for flesh in certain cannibal lunatics, the selection of their own muscles or those of companions being determined by the restraints under which they lived, but this cannot be received as the explanation of other cases on record. A chronic maniac, under my own charge, bit off the nose of a sleeping friend, but was prevented from swallowing it; another attempted to devour a part of her own arm; a third picked and plucked off the greater part of the lobes of both ears, appa- rently enjoying his repast of the shreds and blood, invariably uttering during the process, ” the royal blood of peacocks.” These patients were well fed and cared for and under constant superintendence. A desire for living flesh is mentioned by Dr Laycock, on the authority of Dr Elliotson, ” so that some have eaten live kittens and rats and instances have recently come under my own notice where live mice, frogs, beetles, and worms were devoured; but the pressure of want may have tempted an idiot lad, whose case has been stated to me, to eat part of the shoulder of’ the corpse of his mother, with which he had been locked into a room. In individuals, the disorder of whose mind receives a colouring from criminal impulses, where homicide precedes or proceeds from anthropophagism, the promptings of hunger seem to be connected with the blood-thirst; but ample details upon this revolting division of the subject may be found in an ” Essai sur l’anthropophagie, par M. le Dr Legrande du Saulle,” ” Annales Medico-Psychologiques,” Third Series, t. viii. p. 472, and in an article on ” Necrophilism,” ” Journal of Mental Science,” January 1875.
Our concern is with innocent, because insane, carnivorous human beings. We have had patients who subsisted, and for long periods, exclusively upon animal-meat, some of whom delighted in raw or semi-prepared meals; others loathed, or affected to loathe, all farinaceous or vegetable matter, while others delighted in the quantity rather than the quality of what was offered. The latter, like Mary Queen of England, whose voracity required an addition of ?26 per annum to the Court expenses for meat breakfasts and suppers, were gluttons, but under such restraint as interfered with any estimate of their powers of consumption; yet, when opportiuiity offered, they were detected in appropriating the portions of three or four of their fellows, so that the range and extent of their limitless and insatiable hunger was but imperfectly ascertained. It was at one time benevolently believed that rice-eaters were in disposition mild, timid, treacherous, and the events of the Indian mutiny in part substantiated this opinion. It was like- wise believed that flesh-eaters were daring, barbarous, san- guinary, and savage, and, so far as very narrow experience of the habits of this class among lunatics may justify any con- clusion, such propensities were developed in connection with the strictly animal diet. Such persons were generally, although not always, maniacs, and may have acted under the influence of their real or imaginary powers, and of morbid passions rather than of morbid appetites. In Dahomy it is recounted that the wives of the Thunder-Grod cut slices from the bodies of those killed by lightning and chew them. The cave- men, of whom our naturalists speak, must have been hearth- less as well as houseless, and must have used their game of Elk, Bear, &c., raw or merely heated, and I have re- peatedly seen inmates of asylums who were utterly regardless of the culinary art, and others who wo aid have dispensed with all cooking. I have just heard of a man who, during his absence from an asylum from which he had escaped, lived upon the raw flesh of fowls and rabbits. In my own practice I examined an imbecile who chewed and swallowed dead or half-dead leeches, although he was understood to have been tempted to partake of this shocking repast by a bribe. Now, when compared with our own modes of sustenance, and with the habits of decent society, such tastes and indulgences will appear monstrous and unnatural;. yet it is highly pro- bable that the choice of animal food is merely the cropping out of a primary instinct, and that the preference of raw flesh may date from the ages when in our woods the noble savage ran, but no earlier; and, if we consider the slow growth of artificial tastes and tendencies, the accumulated impressions which have for these ages trained and transformed human inclinations, no wonder need be felt that the origin of such mental manifestations should be prehistoric, or that they should reappear during cataclysms, whether general or individual, or when man is stripped of all that constitutes him the man of civilisation.
“When we’read of Lalande carrying in his pocket a box filled with common spiders and caterpillars, one of which he from time to time ate, as other men take comfits or tobacco, we are not entitled to recoil from a statement of the disgusting substances, the putrilage, the filthy abominations which may be swallowed during alienation, as this sketch would be imperfect without such disclosures, although we raise the veil with repugnance. This reluctance should likewise be lessened when we recall the fact that the Samoiedes and Kamtchadales elect putrid fish as an article of diet, or when we find that among the Chinese Tibetians the initiation of pleasure in ” still meat “?that is, maggoty meat with a decaying game flavour?is favoured as a means of creating ferocious valour, and that for this purpose they cut meat into thin slices, dry it in the sun, grind it to powder, and then mix it with fresh blood, put it in a cloth, and give it to infants to suck.
There are before me copious notes by a trustworthy phy- sician of the case of a gentleman of large fortune, who lived in a palace, and who, as may be inferred from what follows, was literally lord of all he surveyed. This educated person was deranged, and although he spoke rationally and presided at his own table ; yet he lived in a small apartment which no one had been allowed to enter for months. Our medical reporter, penetrating within its hideous recesses, found the floor covered with the remains of the meals served to its master for the last six months, as he would not allow them to be removed. These consisted of game, fish, lobsters, of every kind, of aliment or luxury which the resources of an ample estate and establishment could supply. These were passing through every stage of putrefaction, and exhaled a smell of the most disgusting and overpowering kind, but which was declared grateful to the senses of the occupant. This was not all; portions of excre- ment appeared among the dishes; a soaked and soiled bed, which never was changed, lay in a corner, and urine was preserved as a beverage; nothing, in short, was ever removed from this den with the knowledge or consent of the lunatic. The latter horrible practice was traced to a delusion that the beer, which was taken in large quantities, passed through the body un- changed. In addition to this, five large rooms in this splendid mansion were found to contain, under lock and key, enormous quantities of animal matter, of hares, pheasants, or their skeletons or mummies, one dried roebuck hanging from the post of a mag- nificent curtained bed; none of these objects having been known to exist, or having, at least, been disturbed by the household. This gentleman is said to have recovered. It is but compas- sionate to suppose that, in addition to many delusions known to have existed, there were present perversions or hallucinations of the senses of taste and smell. I have, however, repeatedly- met with inmates of asylums who drank their own urine where no such explanation or excuse could be advanced, where the other habits were those of refined gentlefolks or respectable peasants, and where food was taken with relish and propriety. Still more frequent are instances of individuals, not otherwise debased, washing or rubbing the body with this secretion, evidently under the absurd notion that it may act as a restora- tive unguent on ablution. Within a few days we have visited a gentleman of good position and manners, far-travelled and well- informed, but long an inmate of an asylum. He is generally bedridden, and his skin, linen, &c., are redolent of urinous exhalations; and while he does not eat ordure, he cannot be persuaded to part with it, touches it, fondles it, &c. His most prominent moral feature is a sort of sentimental re- ligiosity, and during a former stage of his malady he horded with scrupulous care and anxiety every hair which fell from his long locks, every paring of his nails, conceiving them to be sacred and precious, as parts of his living body, under a morbid misapplication of the doctrine or the emotion as to the relics of the great and the good. Unfortunately, such aberrations and degeneracy descend still lower; we have known lunatics who daubed their persons with ordure, who ate it, who resorted to every contrivance and misrepresentation in order to gratify this obscene lust, and who never seemed to comprehend the degra- dation to themselves and the outrage to others involved in such acts. Esquirol had a patient who, in besmearing the walls, con- ceived he was using colour pigments. Superstition presents, under the sanction of the Grand Lama, parallels to these horrors. A partially restored maniac, so plausible in conversation as to have imposed upon his relatives the belief that reason was completely re-established, exemplified the association of revolting peculiarities with intelligence, and of. the ineradicability of habits contracted and confirmed under powerful emotion, by presenting a faithful and trusted attendant, on their separation, with a rouleau, which the grateful servant supposed to consist of sovereigns, but which, on being opened, was found to contain a mass of hardened faeces. The bitterness of the disappoint- ment was deepened by the contumelious words with which the insulting gift was accompanied : ” I am sorry that I cannot re- ward you better.”
There are rational men who are either insensible to noxious and noisome smells or who enjoy them; who frequent Abattoirs ?and Knackeries, and who move unconcernedly in an atmosphere impregnated with the effluvia of corrupting animal matter. A similar indifference to such impressions has been observed among- the insane, and even a more pronounced morbidity occa- sionally presents itself. A patient of our own lived in a water- closet in the airing-yard when not forced by the attendants to leave his retreat. Intreaties, compulsion, penalties, all failed to overcome this proclivity, until the anaemic and haggard aspect, and the anasarca of the man necessitated more heroic measures, and the building was removed. The patient was a melancholic, and had attempted suicide, and may have been induced, by a desire for concealment, solitude, or darkness, to adopt the singular course described; but he eventually recovered, and his obstinacy and obnoxious habits were not then, of course, adverted to or explained.
Among the industrial sections of the cloistered insane many ?excesses are committed in purloining uncooked meats, in steal- ing or sharing the unsavoury and inedible messes committed to them for the use of pigs, poultry, &c., reminding us of the parable of the Prodigal Son in Scripture.
We extract the following apposite illustration from the Annual Report of the Inverness County Asylum for 1874, by Dr Aitken: ” An imbecile employed in the garden and at the piggeries died somewhat suddenly, and the true cause of his death was only revealed by the post-mortem examination, when it was found that no less than eight pints were contained in his stomach consisting of porridge, raw cabbage, peelings of potatoes, pieces of carrot, turnips, peas, and barley, &c. The organ, it may be added, was measured before being opened, and its equa- torial circumference was found to be 34 inches, its circumference in the plane of the greater and lesser curvatures 32 inches, and its circumference in the plane perpendicular to the other two planes 21 inches.”
Such consumption of crudities and half-decayed aliments is more general where patients remain in their own families or under guardians, or where they rare less watched and warded. Indisposition often follows such indulgence, and surfeits, and we have often been disposed to attribute the paroxysms of excite- ment, delirium, tremour, noticed in such dements and chronic lunatics, otherwise inexplicable, to poisoning from the putrescent or fermented substances to which they had access. Such mani- festations are sometimes the concomitants of fits of excitement only.
Besides the objects enumerated in the preceding pages, my attention has been recently directed to lunatics who have ate or swallowed tar, thread, silk, swill, soap, cotton handkerchiefs, clothes, buttons, crushed tobacco pipes, paper, the foot of a tea-caddy, ueedles and pins by hundreds, slate pencils, poultices, raw eggs, carbolic acid, and lucifer matches (see 17th Report, Board of Lunacy, Scotland).
To trace such moral obliquities to a common origin would be fruitless, except under the generalisations that, wherever mental disease exists, all faculties, feelings, and propensities participate and are, less or more, impaired or vitiated; that, in proportion to the extent and intensity of the prominent disease, are the special vitiations; and, that the most minute deviation from mental or moral health, even an innocent hallucination or a morbid instinct, may be fairly regarded as a part rather than a sign or prognostic of an affection involving the whole psychical constitution.
In order to show that we have not been dealing with micro- scopic objects, with selected or solitary cases, with what did, but does not, exist, we are enabled through the kind co-operation of medical superintendents, having at present under their charge the gross number of 2,355 patients in the lower walks of life, to subjoin the following as the proportions of the different classes treated of in the foregoing pages: of fsecophages, 73; sarcophages, 12; lithophages, 11; phycophages, 29. Of 155 patients of the affluent classes, 4 were fsecophages, 5 litho- phages, and 8 pliytophages.
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