The Physical Signs of Reasoning Madness
317 Art. VIII.?1 (” FOLIE RAISONNANTE “). (Translated, condensed, and slightly altered from the Report of Debates in the Society Medico- Psychologiques, Paris, on a Paper by M. Jules Falret, in the numbers of the ” Annales Medico- Psychologiques,” May and July 1876.) :Author: M. Legkand du Saulle.
A new question has been submitted to our society. Do there exist physical signs of la Folie Raisonnante, and how can we determine them ? Besides the intellectual peculiarities of this psychose, can we, practically, rest upon a group of physical signs as characteristic of the disease ? I reply in the affirmative. I would in the first place inquire as to the order in which the bodily signs present themselves; and I esteem this as indispen- sable, in order to place psychology upon a legitimate scientific basis, and to redeem it from the doubtful position in which it has been placed by the Press, the Bar, and the Magistracy. The necessity for adopting the precision which characterises modern medicine is illustrated by observing what now occurs in the dealings of an alienist in a court of law, where there is no longer any discussion as to where reason ends and insanity begins, where philosophical subtleties are dispensed with; where psychology is ignored, and where counsel, judge, jury, and physician confine themselves strictly within the bounds of practical observation. Such is the advantage of experience over speculation. Formerly we guillotined insane criminals under the influence of a doubtful theory; to-day they are sent to an asylum for observation and restoration. The dwelling and due sphere of psychology ought not to be in our libraries and anti- quarian museums, but in the wards of our hospitals and at the bedside.
It is, then, essential in all inquiries as to mental conditions, and especially into that of Folie Raisonnante, mania without delirium, moral insanity, or derangement manifested in act, to retrace the whole of the medical history and all previous pathological conditions of the lunatic. In such a survey the principal crises or constitutional changes are as follows : Puberty, and the mental states associated with it; anomalies in the development of the organs, and of the feelings connected with virility; cerebral symptoms indicative of congestion and hseraor- rhage?conditions which continue throughout and close the life of the patient. Such are the grand categories or epochs con- nected with the manifestations of the mental conditions of which we treat; but to enter upon a more detailed exposition of the characteristics of them.
1st. The cranium is very frequently malformed. Micro- cephalism exists only in a few cases, but in many there is great irregularity of the surface, prominences, depressions, ridges, on various parts of the skull. Calmeil states that of thirteen Beason- ing Lunatics twelve presented a marked flattening of the pos- terior part of the head. The coincidence between the mental infirmity and the physical deformity in this series is worthy of serious consideration. My own experience would show that this relation is met with in one-half the cases examined. All malformations acquired subsequent to birth are excluded from this calculation. The custom of bandaging the heads of infants before the closure of the sutures and the ossification of the bones leads to great cranial distortion and deformity. The results from such interference are likewise omitted from our estimate. Sometimes the face presents anomalies as great and grotesque as the skull; such as absence of harmony, symmetry, and proportion between the different features, so that the individual is odd and ugly. Among the more important devia- tions from natural conformation are squinting, nystagmus, choreic contraction of particular muscles, enormous size of mouth, thickening of the lower lip, defects or diseases of the teeth, vaulted palate, malposition or imperfect development of ears, imperfections of external senses, hyperesthesia, and neu- ralgia, gastralgia, and many other indications of unhealthy, nervous, or imperfect action. It may be noted in passing that these defects or perversions are all of hereditary origin. One or other of these indications may be detected in every patient of this class, and it seems expedient that they should be associated with the clinical and mental symptoms as highly significative in framing a diagnosis.
2nd. Mental disturbance at puberty. This period is, in accordance with the confessions of the sufferers, pregnant with perils and disorder, and, in despite of all resources, may even- tuate in delirium. The susceptibility is so great- that the least emotion, contrariety, constitutional change, or common cold, almost inevitably developes a paroxysm of delirium. Thus a single glass of wine or a convivial party will, notwithstanding habitual temperance, dethrone reason and simulate the first stages of drunkenness. Chlorosis, amennorhoea, hysteria, ten- dency to syncope, feeling of suffocation, lachrymoseness, catalepsy, chorea, somnambulism, and all the signs of the minor neuroses widening into abstinence, mysticism, and even into mild mania or melancholy, are one or all encountered among females. Boys of from 12 to 16, if removed from their native mountains, become nostalgic, mischievous, kleptomaniac, and vagabond, tempted to incendiarism or suicide; and may be found ultimately under the charge of the police, labouring under diseases con- tracted from the most degraded or abominable practices. The close of such a morbid career is either the galleys or the guillo- tine.
N.B.?In towns children of this type are choreic, somnam- bulic, erotic, pietistic, or victims of persecution. If affluent they are slaves to hypochondriasis and crime. I might quote a case of a young lady so hypochondriacal as to be almost insane, who was completely restored by the water cure, riding, travelling, fishing, etc., and cod-liver oil; and of a youth labouring under genuine hysteriform symptoms, hemiplegia, and anaesthesia of the same side, whose restoration may be expected. These odd beings will ultimately be urged by their intellectual activity beyond or outside normal lines of conduct, and even before the invasions of such morbid mental phenomena as are patent to all. Their errors may be merely fantastic, eccentric, irrepressible, querulous, conceited, violent, lazy, instinctively wicked, and are likewise marked by cruelty, by habitual deceit, by indisposition to regular employment, and by dishonest habits. Undisciplined, they torment their family, defy their teachers. Their pathological perversity-is incurable. Acute and clever, they acquire and retain knowledge with a marvellous facility. They may be prodigies in the arts of music, drawing, calculation, poetry; or may become orators, improvisators, or actors. But at the critical epoch of puberty their brilliant facul- ties fade and die out; refuge is taken in the Navy or the Army, where insubordination exposes to court-martial and punishment. Marriage precipitates the catastrophe in girls. Sucn crises, ac- cording to M. Fairet’s just prognosis, may evolve into either in- creased mental feebleness or la Kolie Raisonnante. We may meet the distinguished companions of our college life, after passing through a stage of sudden imbecility or the depths of scandalous debauchery, wild adventure, and equivocal speculation, as reasoning madmen in the prison or police office. Selfishness is the aim and end of their being. They prove disobedient chil- dren, inconstant lovers, unfaithful husbands, negligent fathers; their heart is cold and hard. Cowardly, corrupt, jealous, vain, ambitious of distinction without the power of obtaining any eminence except that of extravagance and infamy, they combine a group of pernicious qualities which constitute them the dis- turbers and contaminators of all with whom they come into contact. They are in fact the dangerous classes of society, the material out of which waifs and strays, conspirators, criminals, visionaries, and speculators are formed.
3rd. The absence of the organs and of the passions and functions which constitute and characterise the respective sexes. In this category there may either be absolute hermaphro- ditism or partial, but marked, departures from the normal structure and relations of parts. There may be beardless men, who play the part of women, and bearded women, who become soldiers, sailors, enter into plots or professions which permit of the exercise of the sterner and masculine qualities of humanity. With these characteristics are often associated symptoms of actual insanity, or vices which claim such an origin. The non- development or malformation of the organs under consideration are often met with in the weak-minded and wickedly disposed; but while such individuals are identified by certain observers with the class under consideration, M. Pinel and his school elevated Eeasoning Madmen to the highest rank of lunatics in intelligence and in strength, though not in stability or sub- ordination of mental powers. The prevalence of solitary vices, erotic practices, and of sterility in conjunction with anatomical defects, cannot be separated from the description of Folie Eai- sonnante; but although science purifies all that it touches, a narrator recoils from enlarging upon the darker and more re- volting colours of the picture. The nature of such atrocitiek may, however, be conjectured from the fact that in some cases the only betrayal of morbidity in Eeasoning Madmen has been cohabitation with the dead.
4th. Congestive attacks. An example of an approximation to Folie Eaisonnante may be found in the temporary arrest- ment of the mental symptoms in General Paralysis and by such exceptional irregularity in their succession as to set diagnoses at defiance. Eeasoning Madmen, and such as I have previously represented as hereditarily so, are throughout their whole life subject to attacks of congestion either with or without epilepsy or hemiplegia. When it is recollected that such an attack, however formidable, may pass away, that the embarrassment in articulation may give place to the ordinary mode of utterance, when the tremor and hyperesthesia of the limbs are followed by the re-establishment of the natural amount of voluntary power and sensibility, leaving no other trace than Eeasoning Alienation, it will be understood that great difficulty and perplexity attends diagnosis, and that extreme caution should be exercised in speaking of the future or ultimate issue of the disease. The divergence and absolute contrariety of opinion between medical men may be understood and illustrated by supposing that they have examined a patient during and subsequently to the presence of congestion, a favourable opinion being countenanced by the intermission of all affections of reason, speech, voluntary motions ; the unfavourable prognosis being fulfilled in sudden death from apoplexy or some other cerebral disease. A typical example of such a result may suffice. A member of the Academy drowns himself without motive. The biography of his son is as follows: At twelve he is odd, ungovernable, unsettled, and a source of deep disquietude to his mother. At school he is clever, idle ; as a pupil at the Naval Depot, though brave, am- bitious, and regarded as of good promise, he is dismissed for insubordination. Once more in Paris, he yields to the attractions of the theatre, prepares to go upon the stage; sells the furniture of his home in order to obtain funds to carry out his design, which merges in his association with itinerant exhibitions and actors. As a clerk to the Minister of Public Instruction, he is indocile, irregular, unconscientious, unsociable and useless. Even while in this position he rushed into the provinces to join some of his former doubtful and disreputable companions. Pro- fuse, nomadic, disgraceful in his conduct, he, abandoning his relatives and occupation, appears in California as a priest, where it was rumoured that he might possibly be elevated to the epis- copate. He returns to Paris accompanied by a young prosti- tute, heir to property; now dividing his time and attention between the theatre and the church, and wearing a hybrid garb between that of a priest and a layman. Up to this point this unfortunate has been regarded as a mauvais sujet, a foe to himself and to his family; but a physician discovered that during twenty years he had been subject to cerebral congestion, un- attended with convulsion or loss of consciousness, but that, not- withstanding the temporary suspension of consciousness, he could not be treated or confined as insane.
N.B.?In 1874 his conversation became unconnected, incon- sequent and paradoxical, embracing asseverations of his perfect sanity, elevated genius, his achievements in California, his aban- doned course in Paris; at the same conjuncture his expenditure be- came excessive, and he was habitually intoxicated. In the winter of 1874-75 he had three cerebral seizures, attended with temporary hemiplegia and tremor. After disappearance for several days he became amnesic, unsteady in gait, more and more debauched and shameless, squandering or being robbed of every farthing extorted from his friends. Emancipating himself from the trammels of his family, he resided with an old servant in the suburbs, frequently visiting Paris, but forgetting to return. Found insensible in the streets, he is taken to a public hospital, and again taken home. His disease now assumed the form of epilepsy, when he was placed in a private asylum, where, after a partial restoration, he dies suddenly, apparently from apoplexy, and it is inferred from hogmorrliage of the bulb.
The author concludes that, independently of mental signs, there may be always detected physical symptoms in reasoning madmen. 2ndly. A retrospect of the history of persons thus affected demonstrates that at the period of puberty they are affected with certain transitory disorders of the intellect. 3rd. Anatomical peculiarities in the organs and abnormal manifesta- tions of the animal propensities are observed in them. 4th. That they are liable at various ages to suffer from congestive conditions of the brain which have not been hitherto recognised. M. Berthier declared this form of alienation to be frequent among females belonging to the affluent classes; that it might be regarded as the prelude of morbid activity, as the first germ of other psychical affections; that it was the shadow of graver symptoms, clouds portending a storm, and conditions falling almost within the domain of physiology. Its victims are, from their perverseness and morbid sensibility, plagues to themselves and allaround. Among the physical signs may be signalised head- ache, muscular pain, vertigo, disturbance of digestion, with capa- ciousness of appetite, and a host of vagaries of sensation, such as complaints of the tightness of dress ; of the weight of the atmo- sphere ; of the pain inflicted by combing the hair; of the tight- ness of corsets, and consequent incessant undressing; of the weight of the shoes; of the denudation of the throat in swallow- ing food, which is consequently refused; even of currents of air. Such patients are restless, unsettled, incessantly crave change, dislike home, repose, occupation; but, although displaying innumerable manifestations of mental disorder and unhealth, some of which are of great gravity, the malady never seems to shorten life.
N.B.?Stachiomania, as it may be called, may occur at all ages from youth to manhood, but is not infallibly hereditary, even when accompanied by physical conditions ; yet remains doubtful whether there be a set of bodily symptoms specially charac- teristic of each malady; and whether, were such the case, a new element would not be introduced into legal medicine. My observation tends to show that the signs conceived to identify reasoning madness as a distinct species are common to other minor neuroses; and that these indications are compatible with the aspect of health, longevity, and even with the preservation of the logical faculty.
M. Delasiauve chiefly insisted that this class of diseases may originate without any hereditary taint; that physical deformities may suggest emotions which terminate in and are the causes of insanity, and that many patients were perfectly conscious of the mental confusion or perversion under which they laboured.
M. Billod preferred to designate the physical states enumerated as signs in, but not of, Reasoning Madness ; a course which would exclude the error of electing the disease into a pathological Entity resembling Greneral Paralysis, as having bodily and mental symptoms. He conceived that from the physical signs observed during the life of Reasoning Madmen, nothing could be concluded. Such exist and are observed, and seem to claim a pathological signification in the disease under consideration; but, for example, might not the traces of apo- plectic cells discovered in the brain of D , previously men- tioned in this discussion, and to which certain symptoms observed during life were attributed, be as deceptive or as erroneously interpreted as those found in the brains of Pinel and Dupuytren. These lesions have no more special signification than in the cases of Pinel and Dupuytren,and may in other cases be accepted as indicating any form of mental alienation. There may be a correlation, but not an exclusive connection between such signs and Reasoning Madness ; so that the definition ” lesions ” in the disease should be substituted for ” signs ” or ” characteristics” drawn from the somatic condition therein observed. The latter designation may be preferable, as idiocy and other forms of degeneration are included in the physical symptomatology described.
M. Lunier conceived that the indications of hereditary pre- disposition or degeneracy had been confounded with the signs of Reasoning Madness.
[Note.?We conceive that among British alienists there would be a general concurrence in the views expressed by M. Billod, that the physical signs insisted upon should be ranked as coin- cident and not as causative; and that grave suspicions will arise as to whether many of the groups of symptoms, many of the conditions, both physical and psychical, supposed to be charac- teristic of Folie Raisonnante, might not be referred legitimately to other universally recognised forms of insanity, such as de- mentia, hypochondriasis, hysteria; to defective or injudicious education; to uncontrolled original propensities; or even to corrupt or criminal motives for which the individual is respon- sible.? Tk.]
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