the work with their troubled reason, tore from them by day and night cries and howlings that rendered yet more frightful the clanking of their irons. Some among them, more patient or more crafty than the rest, showed themselves insensible to so many out. rages; but they concealed their resentment, only to gratify it the more fully. They watched narrowly the movements of their tormentors, and surprising them in an embarrassing attitude, they dealt them blows with their chains upon the head or the stomach and felled them dead at their feet. Thus was there ferocity on the one hand, murder on the other.""

Are you your

These were the conditions PINEL had to face. self become mad," asked Couthon, " that you would unchain these animals?" "I am convinced," replied PINEL," that these patients would be less intractable were they not deprived of air and liberty."

When we remember that PINEL entered upon his duties during the most dreadful days of the Reign of Terror, when every innovation incurred suspicion; that moreover he had no power to institute reforms except by authority of the awful Commune, before which he had the courage to appear repeatedly to plead the cause of his unfortunate patients; further, that his very desire to grant a degree of liberty to the insane, thrown promiscuously as they were with prisoners and convicts, made him at once a suspect; that, in consequence, he was at least once arrested and narrowly escaped with his life; that his every act was watched; that he exposed himself to the displeasure of the Commune in refusing to turn over certain patients under his care who were charged with being enemies of the State-remembering all these circumstances, we are enabled to form some conception of the character of the man, and of the significance of the mission he fulfilled.

In two years Bicêtre was transformed, and PINEL was called to perform a like office at the Salpêtrière. In 1801, the year 9 of the Republic, appeared his Treatise on Mental Alienation, which must be set down as an epoch-making book. From a clinical viewpoint it reflects the teachings of CULLEN, whose works PINEL had translated into French; but its chief importance and value lie in the fact that it embodies eight years' experience in the new régime, both in the treatment of patients and hospital administration, and standing as it does at the threshold of the nineteenth century, it

* American Journal of Insanity, January, 1846.

stands also at the portal from which modern psychiatry as a practical science issued forth.

In England, up to this time, the state of affairs had been no better than PINEL had found in France. The asylum at York and Bethlem Hospital in London, unenviably immortalised by Hogarth, were the homes of injustice, cruelty and flagrant abuses, no less revolting than those described at Bicêtre. It is a sufficient comment upon the internal arrangements at these places to recollect that the opprobrious term "bedlam" is merely a contraction of the name of the notorious London hospital.

The reform was initiated by WILLIAM TUKE in 1792, the very year in which PINEL'S appointment at Bicêtre took effect. But how different the circumstances under which the two men worked! While PINEL was visiting his patients within the walls of Bicêtre, the massacres of the Commune were drenching the stones of Paris with blood; meanwhile, far to the North TUKE was peacefully coming and going, in an atmosphere of quiet and calm, for the Retreat at York, in which he ministered for twenty years, was founded and controlled by the Society of Friends, and its work of humanity expanded under their fostering spirit of benevolence.

Thus for the first time in history, by the efforts of TUKE in England, PINEL in France and CHIARUGI in Italy, was the treatment of the insane as a class directed in wholesome channels. The effects for good of this movement cannot be overestimated. By its two main accomplishments-the separation of the strictly criminal class from the insane, in the commonly accepted sense, and the bringing together of the latter under proper hospital conditions-many purposes were furthered which are too patent to require discussion. But besides the direct and immediate effects of promoting the present welfare of a considerable proportion of the population, and of assuring a hopeful future to many otherwise doomed to a life of wretchedness, it is to the hospital idea set forward a hundred years ago, more than to any other factor, that we owe whatever of scientific progress the century has brought forth. Only under the conditions then created have the satisfactory study of the disease and the accumulation of the many new facts now at our disposal been possible. Thus in a double sense must we associate the turning from the eighteenth to the nineteenth century with the real establishing of the course of modern psychiatry.

XI.

There remains to consider the third event in this recent epoch, that marked by the death of HEINROTH in 1843 and the appearance in 1845 of the text-book of WILLIAM GRIESINGER. This event was the final definition of the place of psychiatry among the sciences, its recognition as co-ordinate with the other branches of medicine and the definitive banishment of metaphysical and theologic speculations in investigating the nature of insanity.

The spirit of supernaturalism which dominated the primitive period has never died completely. The church in her thirst for domain has ever had an envious eye on the alluring field of medicine. Long after internal medicine and surgery had been wrested from her grasp, she clung tenaciously to the practice of treating infirmities of the mind. Were not her ministers indeed divinely commissioned as physicians of the soul? But in this field, too, since the Renaissance she has been conducting a losing warfare. During the latter part of the eighteenth century she was partially superseded by the great philosophers of the period, KANT, SCHELLING, LEIBNITZ and their contemporaries, under whose influence the science of mental medicine was seriously retarded. KANT pronounced the plain doctrine that the philosopher is a better judge than the physician of abnormal mental states. Thus was the thought of two generations directed backward, counter to the lines of advance laid down by the Hippocratic school, the only difference being that the retrograde influence had exchanged the garb of theology for that of metaphysics.

The result of this struggle was the rivalry, during the first half of the nineteenth century, of two schools of psychiatry-on the one hand the Somatics, on the other the Spiritualists-who attempted from opposite view-points to determine the nature of the psyche and its pathologic variations. For the Spiritualistic school mental disease was a primary affection of the soul itself, and physical disorders, if they appeared, were but secondary manifestations. The Somatics, on the contrary, asserted that a primary disease of the soul was unthinkable and that every disturbance of the mind must have some definite bodily cause. Maintaining rigidly the doctrine of psycho-physical parallelism, they held that every possible physical ailment might lead to a corresponding morbid mental expression, the mental symptoms being, however, in each case secondary.

But the noise of strife between Somatics and Spiritualists has long since died out in medical circles. The Spiritualists were driven from their position, the Somatics won the day, and established what we believe to be the abiding criteria for the pursuit of the science of mind. As the years have passed, however, the teaching of the Somatic school has undergone gradual modification, and we behold monistic tendencies encroaching more and more upon the earlier dualism.'

But let us return for a moment to the teaching of HEINROTH, the chief representative and the last of the Spiritualistic school, at whose death died also the moralising tendency in psychiatry, let us hope for good and all.

HEINROTH (1773-1843) set out with the artificial distinction of a good and an evil principle, which he assumed as specific, independent and constant entities. Life becomes teleologic, and represents continually the result of the conflict between these two principles. The pestilential doctrine that man is by nature inclined to evil was the cornerstone of HEINROTH'S system. However, "Purity and integrity in human nature, while by no means unattainable, are attainable only by the religious point of view, and we know no other true religious standpoint than that of the redeeming faith which Christ brought into the world and the apostles spread abroad."

Here we have a clear statement of scholastic dogma which constitutes the foundation of HEINROTH'S psychiatry. Page after page of his text-book, published in 1818 while he was associate professor at Leipsic, we pore over, fancying that we are in the depths of some mediæval treatise on theology. His psychology

'An interesting attempt at reconciliation between the hostile views of the early nineteenth century was made by GROOS, who declared that mutual infirmity of both soma and psyche was the underlying essential of alienation. GROOS taught that the normal mind expresses itself in a constant striving to realise that which we call good. The weakening or absence of this striving constitutes the first condition of insanity, and this factor he designates the "psychic negative." To this psychic negative must now be added a "somatic positive," that is, some form of organic abnormality, in order that the mental balance may be shaken and a psychosis result. Mental disease is, therefore, a “psycho-somatic" affection.

[Entwurf einer philosophischen Grundlage für die Lehre von den Geisteskrankheiten, 1828.]

'Lehrbuch der Störungen des Seelenlebens, 1818.

he draws from the gospels, much as others have attempted to reconstruct geology from Genesis. The life of mental health is the life of piety. The etiology of madness is sin. Repentance and a return to faith are the means of cure.

66

10

Whatever one may say," exclaims HEINROTH, “there is no mental disease, except where there is complete defection from God. Where God is, there is strength, light, love and life; where Satan is, weakness, darkness, hatred and destruction everywhere. An evil spirit abides, therefore, in the mentally deranged; they are the truly possessed." " Anticipating the charge that this is an absurd opinion, he neatly justifies it by saying that it is no more absurd to hold that the insane are children of the Devil than that the righteous are the children of God. "In short," he concludes, "we find the essence of mental disease in the partnership of the human soul with the evil principle-and not merely in partnership, but rather in its entire subjection to the latter." This is the complete explanation of the lack of freedom or unreason in which all the mentally disturbed are involved." "

As we should expect, HEINROTH combated the innovation of PINEL in allowing a degree of liberty to his patients, and suggested instead confinement and moral lessons.

Views such as those we have just been reviewing are happily seldom heard to-day, and then usually from but two sources, namely, from certain quarters of the church, and from patients who are suffering from depressive psychoses.

The appearance in 1845 of the work of GRIESINGER" (18171868) was the death stroke of moralistic psychiatry. This is the first of the older books which smacks of modernity. In various editions it was a cherished authority for more than thirty years, and is of practical value to-day. No more startling contrast could be found than between the works of HEINROTH and GRIESINGER. The latter, basing his science upon the psychology of HERBART, brought together as had never been done before, careful clinical observation, psychologic analysis and the study of physiologic and pathologic changes.

10 The italics are introduced by way of comment.

"Heinroth consistently entitles his text-book "Diseases of the Soul" rather than of the mind.

12 Loc. cit.

13

Die Pathologie und Therapie der psychischen Krankheiten.