divine. It is a species of sacrilege to make a profane use of power. I see, to a demonstration, that it is to render the just avenger of crimes a slave to iniquity! Of ourselves we can do nothing, therefore we ought of ourselves to will nothing. We can only act by the efficacy of the Divine power, therefore we ought to will nothing but what is in accordance with the Divine law. Nothing is more evident than these truths. The law of duty is the foundation of all morals. Holy law! which Christians call the love of God, because their God being goodness itself, to obey duty, to love duty, is to obey God, and to love Him above all creatures. We should never love any good absolutely, if it is possible for us not to love it without remorse.

It is remarkable (and it ought to be a motive for candid judgment) how often we find men shrinking, with a degree of horror, from what appear to others to be the legitimate consequences of their principles when logically and in detail carried out. The whole tendency of the more abstract and theoretic part of the philosophy of Malebranche was unquestionably to merge all second causes in the agency of the one, first, infinite cause; and in like manner to absorb all created being in the infinite and the absolute especially to sink the very perception and consciousness of man in a mysterious union with the Deity, in whom all was seen, and known, and done. Malebranche, in fact, conducted the Cartesians to the threshold of Spinozism. Yet nothing was more painful to his mind than those criticisms of his contemporaries which endeavoured to establish analogies between his system and that of Spinoza-" that miserable and impious man," as he always termed him. Mairan, who had been reading the "Ethica" of Spinoza, pointed out to Malebranche the similarity of many of its statements to those of his own "Recherche;" but he positively refused to discuss the subject. In one of his dialogues, in evident allusion to the dogmas of Spinoza respecting the Divine Being, and with little disposition to exercise any gratuitous candour towards that writer, he makes Theodorus say to Aristus: "What a monster, Aristus !-a God necessarily hated, blasphemed, despised! Assuredly, if there are people capable of inventing such a God, upon ideas so monstrous, it is either that they wish to have no God, or else such spirits are born to seek, in the idea of the circle, all the properties of triangles."+

While the reputation of our author, as a thinker and writer, has survived him without interruption to the present time, especially in his own country; one reason why he did not very long retain his influence as a leader in philosophy was, that he was eclipsed by Leibnitz in Germany, and by Locke in England and France. * "Entretiens sur la Métaphysique,” vii. ↑ Ibid. ix.

His works, however, can never cease to attract readers, so long as the French language lasts. He addresses himself, with Descartes, to the philosopher, and with Pascal and Fénélon to the devout; he is the metaphysician, the moralist, and the theologian; and those parts of his writings, especially, which are penned in the dialogue-form, have never been surpassed in brilliancy, point, and life, by any similar production on subjects mainly addressed to the understanding, and cannot fail to prove both instructive and interesting to all readers whose object is improve

ment.

Part Second.

THE STATISTICS OF INSANITY, AND IDIOCY AND CRETINISM. REPORTS OF THE INTERNATIONAL STATISTICAL CONGRESS.

To the Editor of the Journal of Psychological Medicine.

DEAR SIR,-The subject of statistics as an instrument for the solution of the great problems in mental alienation must often have engaged your attention. To arrive at definite and trustworthy results as to these problems by means of statistics, it is above all things necessary that the field of observation should be as nearly as possible co-extensive with the area of mental alienation. It is, in the next place, important that a similar scheme of observation and record should be adopted at the various stations of that area, so that the different subcollections of facts may be compared between themselves, and cast up together to constitute homogeneous groups.

That many questions of vast social, political, pathological, and therapeutical importance admit of being settled, or at least elucidated, by an extended and harmonious system of statistical observation carried out in different countries, there can be no doubt. Impressed with this conviction, the International Statistical Congress, held at Paris in September of last year, delegated to subcommittees of the first section the task of framing schemes of statistical record for general adoption. The Reports of M. Parchappe and M. Boudin on Mental Alienation, and on Idiocy and Cretinism-the results of the deliberations of those sub commitees-were unanimously adopted by the Congress. The Congress was attended by representatives and many distinguished physicians and scientific men from every part of the civilized world. There is hardly any State of importance in which the recommendations of the Congress will not be followed by more or less of practical adoption. It is therefore eminently desirable that England should contribute her share to the common store of knowledge that will be amassed, and in such a form as to admit of comparison and addition with the facts collected in other countries.

I believe that the statistical researches that have hitherto been conducted by the superintendents of our public and some private asylums, constitute a mass of information upon mental alienation not inferior in value to anything of the kind that has been produced in other countries. But it is obvious that methods of observation and tabular forms that differ from each other have been followed, so as often to baffle all attempts at generalization. numerical records of some public institutions are so meagre as to possess

The

scarcely any value in this point of view. The completeness of our statistical collections is thus marred by two serious defects: one of negligence in observation and record of facts; the other, a want of consistency in the method of record.

But notwithstanding the prevalence of these defects, what M. Parchappe has said is true-namely, that "no other class of diseases has been the subject of statistical studies so general, so persevering." This predilection is to be explained, not so much, it appears to me, by the impulse of humanity and sympathy for the insane, evoked by the genius of Pinel, as by the peculiar nature of the disease itself. Insanity, more than any other disease, leads to segregation: the insane are at once separated from their fellow-men; they are seen apart; and therefore peculiarly lend themselves to statistical study.

This circumstance is at once the explanation of our greater richness in this department of medical statistics, and the justification for further more methodical and extensive investigations.

The schemes of the organization committee, as modified by the sub-committee, and adopted by the Congress, may appear to some to be unnecessarily minute and cumbrous. But those accustomed to rigid analysis of facts-and this process must precede all record of observations in order to make them trustworthy and fitting materials for statistical synthesis-will have learned that no fact is available, or in short is a fact, unless it be the result of minute and careful inquiry. There is perhaps no problem in mental insanity that is more likely to be elucidated by extensive statistical study than the multiform one of etiology. But does any one suppose that much light is thrown upon this subject by such vague and meagre information as is afforded in the socalled tables of causes contained in the annual reports of many lunatic asylums? No. These tables obscure the truth, by the interposition of mere words suggestive of false conclusions.

If I were disposed to criticise the programme of the Congress, I should perhaps object that some of the heads classed amongst the "presumed causes of insanity" will in many cases prove to be merely symptoms-that is, the early manifestation of an antecedent morbid action or original developmental vice. If, for example, in taking the history of a patient on his admission, and seeking for a circumstance to be recorded as the cause of his disease, we know that obvious mental alienation first appeared after cellular imprisonment, and were to assign that as the "cause," a serious error might be committed. We are too apt to seize upon any salient fact, and accept it as the easy solution of the question. But we might by such a course keep out of sight a long antecedent diseased or defective cerebral condition—a condition which might have been the cause not only of the insanity of the patient, but of the incarceration and the crime of the prisoner. It is this hasty disposition to seize upon the first striking event or prominent feature in the history or character of the patient that vitiates so large a portion of what passes by the name of statistical tables, obscuring, not elucidating, the etiology of insanity, and discrediting the science of statistics.

The reply to this objection would be: 1st, That minute and intelligent inquiry into the history of the patient would in many cases save from this catching at effect for cause-this Atalantan error-and lead to the true primordial pathological condition. 2ndly, That if we guard ourselves against erecting presumed" causes into "actual" causes, and look upon the salient historical fact only as an early symptom, or a circumstance provocative of early symp. toms, we draw no false conclusions, but really add to the stores of useful information.

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The objection then really disappears, if we suppose a minute and intelligent analysis of each case; it is a real one only in the records of those whose interrogation of patients is not minute and intelligent.

An objection of more weight would be the apparent exclusion of canses other than those for which a place is provided in the programme. A scheme so totus teres atque rotundus, seems to be a declaration that there can be no other canses. This is to anticipate, in part, the very solution which it is the professed object of the application of statistics to discover. Great freedom must be left to each observer to record whatsoever circumstances may appear to him to possess the greatest etiological value. For this reason I am unable to assent to the propriety of the modification of the programme proposed by my learned colleague, M. Parchappe, to substitute for the causes designated under the names syphilitic diseases, diseases of the skin, ferers, a group of causes called different diseases. If the object of etiological studies be more than the gratification of the love of abstract inquiry-if it be intended to furnish indications for practice, to lead to prevention, the diminution of insanity-then is it in the highest degree desirable to encourage the particularization of the disease that caused the insanity, and to discourage its obscuration under a general phrase which conveys no precise information. For example, it is of immense importance to determine the proportion of cases of mental alienation produced by fever. Weighty hygienic and sanitary measures may be affected. If it be true that fever is a frequent efficient cause of insanity, how powerful the argument for a vigorous sanitary administration! In three Annual Reports under my hand-that of Bethlehem for 1855, the Worcester Asylum for 1555, and of the Crichton Royal Institution for 1855-I find five cases referred to typhus, and one to variola. Had these been confounded under the general phrase of M. Parchappe, valuable truths would have been lost. My own observation in practice has even led me to believe that zymotic diseases occupy a much higher rank in the etiology of insanity than would appear to be justified by existing statistical tables.

For the same reason I would object to a similar confounding under the common name diseases peculiar to women, of slow and difficult development in young girls, suppression of menstruation, puerperal. It is of the highest importance that the particular disorder of the female sexual system, connected by antecedence with each case of insanity, should be specified. The influence of affections of this class is, in my opinion, so great as to demand the most rigid and penetrating analysis. This branch of the etiology of insanity can only be effectively studied by those whom daily practice brings into close communication with females in all the varied phases of their physiological and pathological vicissitudes. The alienist physician here often sees only the result. The obstetric physician is present at the development of the disease. In time and circumstance he is naturally brought into close approximation with the origin, the etiology. The menstrual function has often a powerful influence over the cerebral action. In many women this influence is so great at every catamenial period, that illusions, hallucinations, and hyperesthesia, bordering upon masia, arise, and not seldom overpower for a time the reasoning faculties and the will. Where certain diseased conditions of the ovaries and uterus impart a pathological character to the catamenial function, the advent of this period is doubly trying to the mind. The extraordinary self-control which many women are accustomed to exercise under these physical and mental trials, is such that in most instances no external evidence betrays, to ordinary observers, the inward struggle. Now, the characters of the mental disorder associated with paramenial affections are often essentially distinct from those which arise in connexion with pregnancy, puerpery, and lactation. It is therefore important to preserve in asylum-records and lunacy-statistics the precise etiological phenomenon. To confound this in a general expression is to commit the folly of abandoning the very object of statistics-that, namely, of illustrating the causes of disease.

In my observation of suckling women, I have seen that the greatest degree

of physical and mental disorder usually comes on towards or after a twelvemonth's lactation-a period which an extended analysis has led me to conclude is the natural term of suckling. I would suggest that when recording the fact of lactation being the apparent cause of insanity, the period of lactation and the number of children to which suck was given be also recorded.

I trust you will forgive me for concluding these remarks by a caution not to expect from the exercise of statistics more than it is capable of telling. It is not so much absolute and isolated facts, as relative and general laws, that statistics can establish. This fundamental truth is often overlooked. One single wellobserved case may prove a pathological fact more conclusively than a voluine of statistical tables. But, on the other hand, there are numerous laws of the highest practical importance which statistics alone can establish on a firm foundation. Just as Louis, the great medical statist, proved by statistical synthesis and analysis that the relation between fatty liver and phthisis was not an accidental conjunction-which was all that a single dissection would have shown-but a condition intimately dependent upon the nature of phthisis, so statistics alone can prove the relation between epilepsy and insanity, and many other relations of the like kind.

So, again, in regard to the etiology of cretinism and idiocy, no isolated observation can convey a demonstrative proof of the influence of any particular circumstance. Thus, no one could deduce from one or two observations any relation between the absence of iodine in the aliment and cretinism; but MM. Chatin, Grange, Boussaingault, and Fourcault have raised a strong presumption that such relation exists, by showing that iodine exists in the air, water, soil, and alimentary products of most districts; that it exists in considerable proportion in the cereals of the Calvados, where the soil is manured with marine plants; and that the geographical, geological, and chemical media in which iodine was wanting were the countries in which goître and cretinism are endemic. M. Boussaingault has observed that in the Andes, where the inhabitants use a marine iodised salt, they are preserved from cretinism and goître, whilst others who are denied this resource are affected by these diseases. These are facts which the collation of numerous positive and negative observations alone can establish. They will serve for an example of the utility of the inquiries indicated in the programme of the Congress.

I entertain no doubt that the superintendents of our national asylums will gladly lend their aid in augmenting the stores of precise knowledge by adopting more or less of the scheme explained in the following Reports. The schemes actually followed in many of these establishments-and especially that in Bethlehem already embrace most of the points required. A little extension, some new tables, is all that is necessary.

But who shall collect, compare, and add together the particular statistics of each asylum, workhouse, and department? Is this task-the culminating point whence all great deductions and useful applications must flow-to be left to private enterprise and devotion, or cannot some organisation of a public character be devised to effect it? It is an object worthy of a special committee of the Association of Medical Officers of Asylums; one, indeed, which has already occupied the attention of the Association. The Commissioners in Lunacy might usefully undertake it. The Board of Health might, with the utmost propriety, address itself to this task The Registrar-General's Department, which shrinks before no useful work, whose labours have mainly contributed to the now rapid spread of statistical investigation throughout the world, will, I feel satisfied, undertake it, if not taken up by others.

Believe me, dear sir, yours faithfully,

13, Devonshire Square,

1st Aug. 1856.

ROBERT BARNES, M.D., F.S.S., Member of the First Section of the Statistical Congress of Paris.