ist Dr. Maudsley, and Dr. Tourtellot admits that, however great may be the want of evidence to establish the theory, it is at least a consistent position. Dr. Maudsley says, "To write as if sanity is a thing of the immaterial, and insanity a thing of the material world, is to infer that men are furnished with brains only that they may become insane." Yet it seems that some physicians find it convenient to entertain both theories; and we are informed in this discourse that Dr. John P. Gray, Superintendent of the State Lunatic Asylum at Utica, in a paper read before the New York State Medical Society, on "The Dependence of Insanity on Physical Disease," takes the ground that mental aberration is due to bodily disorder; but, being "no materialist, he does not regard sound mental action as the result of a sound and healthy brain, and denounces such a notion" as "an attempt to revive the exploded vagaries of the French materialism of the encyclopedists and the Revolution." Obviously the superintendent is a politician as well as a doctor.
But, even assuming that insanity is a bodily disease, Dr. Tourtellot maintains that it is impossible to find the indications of it in the bodily structures. He quotes Leidersdorf as declaring any such demonstration "outside the realm of possibility;" while Griesinger, the celebrated German authority, ridicules the "belief that every mental disorder must correspond to a palpable cerebral lesion." The practical evil of the extreme theory, that insanity is in all cases essentially a bodily disease, Dr. Tourtellot thinks to be an undue reliance upon medication for a cure. This leads to the appeal for legislative aid upon an enormous scale, to provide medical establishments for the treatment of the insane. Upon this point Dr. Tourtellot remarks:
"I must point you to one other evil, of perhaps greater magnitude, which is directly due to Dr. Gray's false theory and vicious reasoning. You are doubtless aware that the demand for new hospital-asylums, to provide for all the insane of the State, has been based mainly upon the doctrine that insanity is a bodily disease, easily curable in its early stages. At length, the Legislature of this State was prevailed upon to authorize the building of two such asylums. And, as they were in the end to save vast sums of money through the speedy cure of those who must otherwise, as incurable, become a public charge for life, it was not necessary to spare expense upon them. These asylums, in fact, were planned to reqiure an outlay of from $8,000,000 to $10,000,000 for a total capacity of 800 patients. Now, I need not stop to prove to you how even more absurd is the plan of 'stamping out' insanity by medical treatment than that of exterminating cancer and scrofula would be. The serious proposal of such a scheme by a medical man in any part of Europe would be enough to brand him as a visionary or a quack. That it should not only have been proposed, but apparently accepted as the basis of a policy of provision for the insane in this country, seems hardly credible. But, as you know, the policy is still urged upon our State Legislatures, and the argument for it is repeated in nearly all our asylum-reports, year after year."
Dr. Gray makes the statement in his last report to the Legislature, that "a recovery of four-fifths" (of insane persons) "might reasonably be expected, if treated within three months of the first attack; while, if twelve months are allowed to elapse, the same proportion may be considered as incurable." Dr. Tourtellot replies that this is a fallacy, and states that, in a large number of the cases, the outbreak is sudden and transient, and that "it is quite certain that four-fifths of such patients will recover even without special treatment.... But, on the other hand, patients brought to the asylum a year or more after their attack, are of a wholly different class. Their insanity was chronic, not only in its fully-developed stage, but in the stage of invasion. It was never possible to bring them to an asylum within three months of the date of their attack. Their insanity came on imperceptibly, and opinions might differ months or even years as to the time of its beginning."
In regard to the vexed question of the definition of insanity, the author remarks:
"After what has been said, you will not expect me, in closing, to present you with a definition of insanity as a physical fact. The term is a purely metaphysical one, and cannot be translated into the language of natural science. To say that insanity is morbid energy of the nervous element, is to state what we all admit to be a legitimate scientific hypothesis, but at the same time know to be worthless as a definition. On the other
