We have taken some pains to show that M. de Boismont has very much underrated the influence of disease. It is an error as great, a danger as fearful, to exaggerate it.

In taking leave for the present of this strangely fascinating and deeply important subject, we feel ourselves called upon to offer some apologies to the able author of the work before us for the omission of more detailed reference to many topics which he has handled with remarkable vigour and effect. We have been tempted, on several occasions, to offer our own commentaries upon the questions suggested in the text, rather than to attempt a task in which we could scarcely hope to succeed-namely, that of presenting a full and clear analysis of the abundant matter collected by M. de Boismont. For the most ample collection of facts--for the most methodical digest of facts and opinions illustrating the history, nature, social and medico-legal relations of suicide, we refer our readers to the book itself. There is one part of the work to which we would especially invite the attention of our medical friends who are engaged in the treatment of the insane--we mean that in which the author details his method and experience in the treatment of patients afflicted with suicidal tendencies. It is at once the most practical, and that in which M. de Boismont's great experience, sagacity, philanthropy, and sound judgment are most conspicuously displayed.

Part Third.

Foreign Psychological Literature.

Relations of Anatomy to Psychiatry.
By DR. F. W. HAGEN.

DR. HAGEN commences a very elaborate examination into the claims of anatomy to throw light upon mental affections, by some general remarks upon the progress of medical science, of which psychiatry is a branch, and one which, he remarks, has hitherto been viewed with some doubt and suspicion. The cause of this is "want of time" to pursue this definite branch of study whilst there are such multifarious claims upon the attention of the medical man. He must be physician, surgeon, and obstetrician; whilst in keeping pace with the scientific pursuits of the day, he must be engaged now in physiology, now in chemistry, now in microscopic research, and again in vivisection and natural history-all indicating clearly the necessity for some division of labour, if rapid progress be desired. Another cause of the comparatively unsatisfactory state, as yet, of mental pathology and therapeutics is the general change in the character of medical research, and the evils attached to a transition state of science. Whilst in times past medicine was almost entirely founded upon theories which were chiefly mere formulæ of words, it is now based upon observation

of facts, and deductions from them. But, although the old building has been thrown to the ground, the materials for the new and projected one are not yet collected; the science is unconstructed-meantime" the sick will be healed-healing is the end and aim of medicine, and its fulfilment cannot be delayed until we have brought our researches in anatomy, physiology, and chemistry to an end." Hence the small assistance as yet derived by therapeutics from science-it remains chiefly empirical.

As a contribution to the advancement, or, at least, the definition of our knowledge in one department, Dr. Hagen proposes for investigation the four following questions:

1. What morbid changes in the brain or its membranes have been found in the examination of the bodies of the insane?

2. In what relation do these stand to the psychical symptoms? 3. Is there between these symptoms and these changes any certain and constant relation?

4. In what relation especially do the anatomical lesions stand to the entire psychical derangement?

Dr. Hagen commences the answer of the first question by excluding from consideration many morbid products sometimes found- -as lymph, cysts, cancroid developments, fibrous tumours, tubercle, and exostosisas these occur very rarely amongst the insane, and, on the other hand, produce (or are conjoined with) very unimportant and variable symptoms often when occurring amongst the sane. Well-defined inflammation of the substance of the brain, suppuration, and red or white softening, are also (he states) very rare, or at least not more frequent amongst the insane than the sane-on the same grounds adhesion of the membranes is excluded from special notice.

A much more difficult point is that connected with congestion, which has always played an important part in all theories devised for the explanation of disordered mental phenomena. "Indeed, nothing is more captivating than this congestion-theory. Thus, the brain-substance is disordered, because its functions are disturbed-inflammation is not indicated; yet there must be something organically wrong-what can it be but the blood ?" All this is shown to be very unsafe. Congestion may exist during life, and may be vanished before the body is opened-it may only come on during or after death; and even when clearly indicated as present both in life and after death, the question appears legitimate as to whether the congestion caused, or was caused by, the mental derangement.

Finally, it must in this, as in all changes, be remembered that the insane have to die by means of certain pathological alterations, or that such accompany their death; and that these may or may not be the same as those which caused the abnormal mental phenomena during life.

Dr. Hagen found in sixty-eight examinations of the bodies of the insane, made during five years, only twenty-two cases of congestion of the brain. From the particulars given of the mode of death in these twenty-two cases, he shows clearly that in three-fourths of them the congestion only occurred during the act of death.

After further showing the difficulty of defining in many cases the normal and the congested condition of the brain, he concludes that hyperæmia is not the proximate cause of insanity, but either a synchronous phenomenon, a distant accessory, or a sequel to it.

Hæmorrhage into the substance of the brain is very rare in the insane, and the previous remarks are applicable to it. It is found more frequently in the cavity of the arachnoid, and is then most commonly attended with certain physical results, as paralysis, &c., as well as the fundamental psychical disorder. Inflammation of the membranes of the brain is more common than these hæmorrhages; yet we seldom find the actual inflammations, but only their products-thickenings, adhesions of the membranes to each other, to the brain, and to the cranium, &c. "These are considered weighty matters-the neighbourhood of an inflamed membrane, it is thought, must disturb the functions of an organ; but I cannot even recognise this as a causative. In the sixty-eight cases above mentioned, I have found (including the slightest cases) twenty-nine instances of such inflammatory products or results." Nineteen of these occurred in paralytic patients; five others were extremely slight, such as are found often in the bodies of those who have never suffered from mental disorder, or anything more serious than habitual or periodical headaches; one was adhesion of the dura mater to the skull in an old man; one was of very old standing, history imperfect; one was a long-continued drunkard, with evidences of disease in the kidney and many other organs; one had suffered repeated falls on the head; and the last had severe habitual headaches, in a paroxysm of which he died. From this analysis Dr. Hagen concludes that inflammation of the membranes is not an "essential, but (so to speak) an accident of insanity." "I do not deny, however, that a brain whose membranes have been inflamed, may be deteriorated thereby. Cæteris paribus, it will have less power of resistance to certain morbid influences than a sound brain, and especially to that process (whatever it may be) which sets up any form of insanity. But this process is something quite distinct from such inflammation, thickening, or adhesion; and either may exist without the other, just as disease of lung, heart, or kidney may exist without insanity; although when this has once begun to develop itself, each will have a tendency to aggravate the other."

To serous effusions our author is as little inclined to attribute definite causation, as to the former morbid changes. These he found twenty-nine times in the sixty-eight cases, but doubts whether in most of the instances the effusion did not come on during or after death. Edema of the brain he also considers in the same light.

The remarks upon atrophy of the brain are important, but scarcely admit of compression, and are too extended for extract entire. This change, as well as thickening of the skull so often co-existent with it, is shown clearly, by a similar course of reasoning to the above, not to be an essential element of insanity in any of its forms, but an addition, a casualty. One observation concerning the mutual connexion between thickening and atrophy is interesting:

"The atrophy is often supposed to be consequent and dependent upon the thickening of the skull; but if this were the case, the cause being purely me. chanical, the corresponding ventricle should be compressed and diminished in size; whereas, in true atrophy, the contrary is the case-the ventricle is larger than the uncompressed one.'

After some interesting observations on the deformities of the skull in cretins, idiots, and others, Dr. Hagen asserts his conviction that usually the morbid changes indicate "only the effects, sequelae, and results of the morbid processes which have destroyed the life of the patient. If an insane person dies by violence, or by any intervening illness not affecting the brain, the rule is, that we shall find nothing! Thus we had (in the sixty-eight) six or seven cases where actually nothing abnormal was found. The opinion of the older writers, that usually no morbid change was to be perceived in the brains of the purely insane, is so far strengthened by our researches, that we consider the appearances such as do not afford the proximate cause for the explanation of the morbid phenomena." This agrees with the opinions of Esquirol, Pinel (the elder), Georget, Lelut, and others, that the morbid changes are not the cause of the insanity, but are connected with the paralyses, convulsions, and epilepsies so often united with it. Dr. Hagen looks hopefully to the future, not for additional revelations from the well-trodden field which we have passed in review, but to researches in microscopic anatomy. But chiefly he inculcates the necessity of considering man as an entire entity, and life as a condition of which the laws, powers, and developments are essentially and indivisibly connected: in the study of their actions and reactions, he considers that the true method of investigation of mental disease is to be sought.

Dr. Dämerow's Résumé of the Question concerning Monomania, and Remarks upon Doubtful Alienation of Mind. (Allg. Zeitsch. für Psychiatrie, 1855.)

(IN presenting an abstract of opinions emanating from authority so high, we must not be understood as pledging ourselves to a belief in their validity, nor as passing any judgment whatever upon them. -REC.)

I remark that the discussions upon monomania in the Annales Medico-Psychologiques are brought to a close. I confine myself to the following brief notices:

In the sessions of December, 1853, and January and February, 1854, the discussion turned upon the distinction between the intellectual faculties and the disposition or moral nature-on this latter as the basis of monomania, and on the uncertainty of the limits of passion and madness. Morel, with justice, remarked, that in the judicial question concerning monomania, he confines himself entirely to one inquiry-viz., "Was the man insane at the time of the act committed ?"-because the insane, as well as the sane, are subject to changes from time to time.

Continuing the subject in February, March, and April, the principal matters discussed were the duality of the brain (Wigan), and the seat of madness; also remarks from Dr. Delasianoe on the apparent unprofitableness of searching into the connexion of the brain with the soul. The discussion passes more and more into this unprofitable ground.

The concluding discussion of June 26th runs off again into the unconditioned. Garnier asserts that, in his opinion, error and crime are "short madnesses," for which, however, men are responsible. Upon which, Baillarger expressed his astonishment, and repudiated the idea of confounding insanity and passion. Lady Macbeth and a gourmand were used as illustrations.

I enter more closely into the argument of Fabret, "On the Nonexistence of Monomania."

The memoir is divided into a critical, a clinical, and a practical part. 1. The origin and support of the doctrine of monomania is (according to him) the too physiological (psychological ?) direction of the science, and the exclusive observation of the predominant idea, a plan both im perfect and superficial.

2. In the second, the clinical part-and this is the essence of the question-Fabret repeats his conviction, that neither in public nor in private practice has he met with a true monomania. In all cases, he says, a universal morbid condition exists, the foundation of the disorder, which at certain times arises into a complete paroxysm, but ordinarily is only partially manifested.

Concerning the apparently misleading view, derived from the "physiological" mode of investigation, that anatural connexion exists between a cause and the symptoms of the ascertained mental disorder, Fabret says, that this "genealogy" is generally opposed to observation. One cause scarcely ever produces insanity-the nature of the cause, and the character of the malady, stand only exceptionally in any true and definite relation; and then they indicate the predominant character of the delirium, and not the ultimate nature of the disease-more frequently than we suppose is the form of the affection exactly opposed to the predicated cause.

3. In the third part are pointed out the consequences of the doctrine of the non-existence of monomania. In the first place, it leads to more careful and extended observation of the fundamental affection, instead of contentedly observing only one symptom. To the reproach of cruelty in denying monomania, it is answered, that the evil is even greater under the opposed view. The recognition of monomania. makes impossible the broad line of demarcation which ought to exist between passion and madness, and leaves the determination of this most delicate question to the chances of a judgment not founded upon scientific principles, but upon an individual valuation of opinions only derived from the case itself: Such being a very brief résumé of Fabret's opinions, Dr. Dämerow adds, that "in essence" he subscribes to them. He also states that he knows of no case of monomania (so called) in which there was not a fundamental general psychical disorder.