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Rep1·intecl j1·om the ' Jotwn al of M ental S cience,' July, 1898.
Physici an to th e \Vest End Hospital for Nervous Diseases ; form erly Medical
Superint endent of the Darenth Schools for Imbecile Children.
A LTHOUGH a nci ent writers h ave given short descriptions of
mental diseases a.ffectin g children, it was not until the
commen cement of thi s century that the subject b eg1m to
attract attention. Since th en E squirol, Guislain, Delasiauve,
and oth ers h ave wri tt en on the matter, and in 1856 L e
P aulmier, in a thesis, g av e the most complete description of
the affection whi ch h ad previously been published. Num erous
author·s in E ng land, Germany, and France have since 1856
written on the subj ect, but still there seem s to be a good
deal of want of knowledge regarding the mental affections of
The young child is a creature of emotion and of lively
imagination, and he usually h as a good memory, but it is
often difficult to fi x hi s at tention for a long time on a subject,
and h e lacks r eason and reflection. As a matter of fact, the
child is guided in his conduct by instinct or by sentiment,
but his sentiments are usually fickle and changeable. Up to
seven y ears of age mania is comparatively rare, and when it
exists shows itself chiefly under the form of a maniacal
excitement or delirium, frequently coming on with febrile
attacks. The moral sense b ecomes early depraved, and if
r.h e affections are not well developed, it later becomes true
insanity . A s the child grows up the bad inclinations become
stronger, and when puberty comes on there is a furious out•< Read at th e South-Eastern Division at Northampton, October 13th, Ie97.
I nsanity in Chi ld1·en,
burst and a sli ght cause will b e suffi cient to exc ite th e
patie~t to comm it h omicide.
W hat are the causes which produce t h ese troubl es in
infan cy and childhoo d ? ·w ant of tim e will only allow me to
t ouch upon a few of th em.
Th e first and most impor tan t JS t hat of he1·ecldy . E sq mrol
is of opinion t h at of all di seas~s insan ity is th e mo~t
h er editar y, and other psych ologists have co:1fin~.1e d h:s
observations, and some h ave eveu exceeded lum m t h eir
estimates of t h e number of cases in which insanity is due to
h ereditar y taint.
W e must also tak e into account the metamo rphoses or
t ransformations of h er edity. Dr. Moreau, of Tours, has
made an ext ensive study of t h e subject, an d in his " P sychologie m01·bide " h e g ives sever al cases of th e transfo rmation
of h eredity taken from path ology and hi story . " W e must
not," h e says, " look fo r a r etur n of identical p~en?m en a in
each generation . . . . A family ~vhose h e~d h as che dm~ane or
epileptic does not of. necessity co n~ 1 s~ of lu~atJ.cs or
epileptics ; but t he children may ? e 1ch ot s, p~ra,yti ~s, or
scrofulous. What th e father t ransmi ts t o t h e chi ldren JS n ot
insanity, b ut a vicious constitution which wi.ll manifest it self
under various forms, in epilepsy, hysten a, scr ofula, and
rick et s." He goes on t o say, " Just as r eal insanity ma~ b e
h ereditarily r epro duced, only und ~r ~he fo rm of eccent r.ICJty ;
.. . so a state of simple eccen t n CJty m th e p arents may m t h e
children b e t he orig in of insanity ." A s an instance ofthis h e
gives the family history of a boy .aged t en years .
P ate?·nal Zine.-Grandfather mtemperate and Immoral,
n otwithstandin g his advanced age . Grandmoth er very
nervous, lively, peevish, jealous.
Mate1·nal Zine. -Grandfather intelligent, with out ener gy,
easily influenced by t he first comer, and by his eccentricities
excites the laughter and jest s of h is neighbours. Grandmother very obst ina te, imperiou s, extremely violent. Towards
the end of h er life she deli ghted in ill-using p er sons and
t hings. Father.- F eeble in ch aracter, proud, subj ect .to fits
of violence ideas vague and slow of development, mtemperate. M~ther.-V ;;ry intellig~nt, m~ek, h ard-workin g :
B1·othe1·s and sisters of the pattent. -rhe eldest wlumswal,
uncommunicative, of slight intelligence, simple-minded .
2nd.- The patient .
. .
3rd.-Very simple in character, h er SlmphCJty contras.t:ng
strongly with the wickedness of most member s of t he family.
4th. -Of the same character as th e p atien t, but h e h as not
yet h ad fi ts of vi olence .
5th . -An in tell igent g irl, but eccentric in h er t astes.
The p a.t ient's i~tell i gen ce was well developed . On e day
he went mto a vmeyard to steal som e g rapes . S urpt·ised
by t he fi eld k eeper, he was tak en b efore the propri etor,
whose r emonstrances made such a n effect on his min d t hat
fr~m t his t ime he sh owe d sympto ms of insa,nity . He ran
qmte nak ed through th e str eets, a t·med with a stick with
wh ich h e stru ck children with out any reason . H e was sent
to school, bnt was so lit zy th a t he was sent h ome again.
Nex~ h e was s,ent to a ~ orne, whence h e escaped, hi s arri val
at h1 s p a rents h ouse bemg an noun ced by th e burnin 0o· of a
straw r ick to whi ch h e had set fi re.
Th e fac~1l ty of i1~~itcaion pl ays an imp or tant part, especially
wh en ~ h e 1m1tat or Is a n eurotic per son . In t hi s case t here is,
on e m1 ~·ht s~y, a g round prepared t o r eceive t he impression.
There Is an 111 stance on record , many years ago, at t he t im e
wh en a nu mb er of. children were taking t heie first comm union,
of one of t h em bemg att ack ed with convulsions, and in less
than h alf an h our all, or almost all , were attacked with
~imil ar c.on~ul s.i o~l s . This faculty of imitat ion is so imperiou s
m certam m~1 v1du als .that .th ey cannot see any action, or
hear of on e, with out b em g di sposed to imi tate it . The most
fo rmi dabl e imitati ons are th ose of suicid e and homicide .
A boy aged fo urteen year s was of a lively a nd happy d isposition . On th e day on whi ch h e died he was happy and contented. Some days b efore h e had att ended the fun eral of a
pl ayfellow wh o had committed suicide, an d h e was h eard to say
pl ayfully, " I mu st kill myself too." H e came some time
afterwards t o th e place where hi s fri end had committe d
sui cide . . The sig ht of .a cord, .th e s ui ~abili ty of th e place,
struck h1m, and he r eali sed t he Idea wlu ch h e h ad previously
expresse d .
Prosper Lucas relat es th e case of a ehild of from six t o
eight years of age, who had choked his yo ungest b rother.
Th e fat h er and mother surprised t he b oy in th e act. T he
child thr ew him self into t h eir arm s cryin g , and said t h at h e
had only don e it in imitati on of the devi l whom h e l1 ad seen
stran gle P unch.
'l' here is no doubt that th ~ g reat publicity now g iven in
th~ newspap er s t o ~urd er JS the cause of many similar
cr1mes. A p er son WJth a weak or ill-b alan ced mind sees in
the n ewsp apers reports as t o th e h ealth of t he murder er, his
I nsanity in Child1·en,
conduct a nd behaviour, and endeavours to acquire n oto t·iety
by com mitting· a simila r crime. A seve1·e shock or j1·ight is
well known to b e t h e cause of convulsions, and i t may also
orig inate a mental affection. Chorea is often produced by a
severe fright. Esq uirol mentions the case of a young girl, aged
e ig ht years, who saw h er fat her murdered. Since then she
had often suffer ed from violent terror; at the age of fou r teen
the m e nses appeared, but only irregularly; sh e b ecame
mania cal, and wi sh ed to fight eve rybody . 'l1 h e sight of a
weapon, a knife, or of many men asse mbled together was
s uffi cient to excite in her the most violent fury .
E xcess in stucly is a very active cause. Th e late De. Hack
'l'uke r ead a pap er entitled "Intemperance in Study" at the
annual meeting of the British Medical Association, h eld at
Cork in 1879, in which h e pointed out t hat brain-fag, mental
excitemen t, depression of spirits (sometim es s ui cide), epi lepsy,
and chorea were produced by over-study. I n these days,
when so much attention is paid to exer cise and athletics in
sch ools, at first sight one would think t hat this statement
could not b e true, but he mentioned a case of mania from
t his cause which came under his n otice, a nd which had to be
confined to an asyl um, and he had see u several cases of
suicidal melancholia b rought on by overw ork. As he truly
said,." no . doubt worry h as a great clea1 to do with th e prolluctwn of the dtsease, but t h e r eal cause is that the schoolboy has to master too many s ubjects in too sh ort a t ime."
Many of these cases are k ept at h ome and see n in consul t:=tt i?n practi ce, and therefor e do not appea r in lunacy
'l1 he e~tabli shme}~t of ptdJe?·ty plays a very in:portant part;
as Esqmrol says, t h e trou bles of menstruatiOn are one of
the most fr equent causes of insanity ." In anc ient t imes
Hipp ocrates noticed that pube rty was often the cause of
mental"di.s~ rd e1· . . He m e nt~on s th e case of a Y?ung girl
whose VISIOns order her to Jump, to t hrow h erself mto wells,
to strangle h erself; . . . when ther e ar e n o visions th ere is a
certain pl easure which makes h er long fo r death as something
!S'ood." No doubt th ere is an h ereditary tendency to insanity
m these cases, for, as we all know, menstruation is estaLlished
wi thout much trouble in the great majority of the human
race . R ousseau has pointed ou t the normal a nd morbid
phenomena which take place at the moment of transition
from infancy to adolescence. The establishrn ent of puberty
can, he sa.ys, "provoke accidents capable of being translated
into all forms and all degrees of neuroses, ft·om spasm a nd
convul sion up to delirium, and even stupor." According to
him mania is more freq uent t han melan cholia at this epoch .
"The young boys,'' h e says, "are generally loquacious,
end owed with r emarkabl e activi ty ; t hey ar e fond of boastin g
an d bravado; th ey wi sh to und erta k e everything, they com mence many t hings, hut accomplish nothing. 'J'h e delirium
of young g irl s is less brilli ant; th ey a re gay, ft-olicsome, and
eager to fix attenti on on themselves; their mobil ity is
excess ive, an d t hey pn,ss wit.h surprisin g facility from extr avagant laughter to most abundant tear s." H e is of
opinion t hat when melancholia does supervene the r el igiou s
and erotic forms a t·e t he most co mmon at pub erty .
liic~stw · bation is an important factor.
Very often thi s
pernicious h abit is d ue to instru ction by a, nurse of vicious
principles. An insta nce is on r ecord of a youn g g irl, twelve
years of age, wh o was initiat ed by fL servant in to thi s odiou s
prnctice, and she then taugh t h el' broth er. They were
separated, and the g irl sent to a convent, the b oy to school,
bu t they later led a most dissolute li fe . W hil e still young
t h e boy b le w out hi s brain s.
In so me cases the lmbit is clue to a vicious boy introducin g
it among hi s scho olfell ows. Very often mastnrbation is
den oted by a blu e circle roand tbe eyel id s, a weak ening of
the senses, espec iall y of sig ht, and of the di gestive or gaus, a
feelin g of lassitude, emaciation, and feeble circulation .
These symptoms are foll owed by nervous affections, ep ilepsy,
an d finally· , menta l disease. ~1a.ny of m,y out-p atients at th e
\ ¥est End H ospital come to me suffel'in g from utter prostration and 11 ervou s weakness as the r esult of this practice, and
more than one has t hreatened to com mit s ui cide. In all
t h ese children t h er e i a change of character; there is a,
disapp earance of th e joyfulness whi ch is one of the principal
attributes of youth, and th e propens ity is often t he cause of
atrocious perversion of th e affective faculties. Sens ibility is
profoundly injured, and hence melancholia is t h e fo rm wh ich
most com mon ly occurs as a r esult of this pl'actice.
I ntoxication by alcohol is occasionally a cause, and Mag nan
describes children, aged nine and th irteen, who wer e afflicted
with the vice of drunkenness . Gemme quotes a seri es of
cases of delirium tremens in chil dr en. 'l'h e parents were
drnnkarcl s, and s up plied li quor to their offsprin g. Fom
children suffered from ep il epsy in con sequenc e of excess of
drink, but tru e del iriu m tremens occmrecl in many cases. In
Inscmi ty in Child1·en,
one instance, hallucinations, excitement, confusion, and
insomni a existed in a child aged five years, who had been
given bran.dy d~ily f?r two years by her father, a g lass
of Hungar1an wme darly .by the ~?oth er, and in the evening
the cluld drank beer wrth the father, who kept a publichouse.
Intoxication by drugs, such as b elladonna and stramonium
from children eating the berries, and producino· in som~
cases hallucinations of sight, in others furious dclirium, are
on record, but it is not uecessary furth er to allude to the
subj ect.
.Ac~de afj'ections, such as meningitis, acute hydrocephalus,
sca rlet feve~·, pneumonia, typhoid fev er, are frequent cau ses
of mental drsease. As fa r as meningitis is concerned th ere is
nothing surpri sing in this, for th ere is often direct irritation
of the cere bral substance. "If," as Broussais says "the
meni!1gitis is s li ght, ~he delirium will be acute and 'noisy;
but 1f the leswn rs profound, and injures the substance of
the brain, n ot only perversion but suppression of the
cerebr~al functions follo"':' s, viz. stupor, coma, and paralysis.
Delas1auv e attended a grrl aged six years for this affection;
before th e attack sh e was intellectual and vivaciou s but
afterwards she became gloomy, and was subject to whi1~1 sical
desires and hysterical caprices.
As regards sca1·let j eve1·, ind ependently of th e delirium
which sometimes comes on in the course of the fever-a delirium characterised by hallucinations and a kind of a nxious
melancholy,-many authors have observed that psychical
troubles so metim es occur after th e fever is over. One instance will suffice. Dr. vVick attended a very young man
who had a severe attack of scarlet fever. :Searcely had the
fev~r ceased, and at a time when everythiu g pointed to a
rap1d convalescence, the patient presented mental troublesdelirium with hallucinations, agitation, insomnia, a nd delirium
of speech. H e remained in this condition for a week but
after strong doses of chloral h e recovered after b eing' two
months ill.
During the course of typhoid j e'I:B?' the cerebral faculti es are
often weakened, so that the children when convalescent have
forgotten much of what they had learnt, and learn new subjects with difficulty. In some children this intell ectual weakn ess is :very marked, and present::; all the characte ri stics of
dementr a . Marce relates the case of a girl au·ed thirteen
years, wh o was very intelligent, but at th e encl of a se vere
attack of typhoid fever she became quite idiotic. !Ier spe~ch
was drawling and silly; she addressed every body wrth chrld1sh
questions, weeping at the time, forgot the names of those
a round her, and became uncl ean in her habits. Instead of
dementia maniacal delirium, with or without hallucinations,
is someti~es produced, or· the delirium may b e partial, and
present all the symptoms of monomani~. In other ca:ses the
monomania is more co mpl ete, and often characterised by
ambitious ideas; h allucinations and attacks of epilepsy also
As r egard s the age at which insanity is n oticed, Dr.
B erkh am has coll ected particulars of forty -seven cases. They
are as follow : 1 child at
ll childr en at
9 months old.
2t years
7 to 7t ,,"
4 childrcu at 8 years old .
10 to 10 ~ Je:Lrs old.
11 y ears old.
Paroxysms of fury and pass ion stron gly resembling mania
are often seen in mere infants, but according to the table
above given, proclivity to insanity st-ems to in crease with the
ao·e of t he children. Of thirteen cases that have been under
u~y care, one case occurred at nine y ears, and two at ten years;
the others show ed mental di sease at the age of twelve years
and upwards.
As r egards sex , twenty of the forty -seven cases were boys
anfl fourteen girl s ; the sex of th e others was not stated. Of
the thirteen cases which I have seen, eight were boys and five
girls. :So fa r· as my information at present . go~s, it ?eems,
t h en that more boys than g irl s ar e affected wrth m samty.
A~ f~tr as age is concerned, there is no doubt that up to
se ven years of age convul sions and arrest of intel.ligenc ~ are
most commonly observed, although, as I mentiOned m a
former p art o[ this p aper, delirium is often seen as th e result
of febrile affections . From seven to fom·tee u year s of age
true mania and melancholia are most frequent, while hysteria
shows itself very often as s_oon as the me~ses appear: . .
Amon o· the psychical chseases met w1th dementw rs fre quently ;bserved. Acute dementia, which is the most c?mmon
fol'm, frequently occ~n·s betw ee~1 ~~1~ ages ~£ ten and s1xteen,
and differs from se ml e dem entia m t hat 1t seems to depend
on the imperfect nutrition of the nervous system, and is generally curable by generous diet and oth er means that supply
materials for construction."
Burrows relates th e case of a boy who, up to twelve years
of age, "had evinced all the capacity and ac tivity usual to
his years. At thi,; period some change was observed in his
disposition and habits. H e b ecam e negligent and irascible,
fond of amusements below his age, and if opposed fell into
silly passions. What he desired he cared not h ow h e obtainecl.
At length slight sy mptoms like chorea cam e on.
aged fourteen years," l~ e says, "he (the pati ent) was broug ht
to London for my aclvJCe. He appeared then to b e a stout
lad with a healthy complexion. 'l'he conformation of hi s
head was g ood. 'l'he express ion of his countenance de not ed
a degree of vacui ty. H e hesita ted in his speech a little, and
then uttered hi s word s suddenly . H e desired alm ost evet·ything he saw, and att empted to gain it with force :mel violence,
and if restrain ed brok e into furi ous passions. H e had lost
all knowledge of th e classics, and only amused him self with
childish books and pictures. A y ear afterward s his t utot·
wrote to me that he was g raduall y becomin g worse ; his
senses were more imp aired, hi s movemen ts were more restrided; in short, he was quite in a sta te of vacuity ."
Ju~enil e dementi a, as a result of inh erited sy philis, is
occaswnally met with. Mental defi ciency is noti ced at t h e
age of the second dentition, and from thi s tim e gradual
degen eration ensues, with sometim es paraly tic and ep il epti c
seizures, and death occurs in three or four years. I h ad a
well-marked case under my care, in which after death th e
brain was found to be small in size, and ther e was thi ckenin g
of the membran es a nd diminished calibre oE tlHl cerebral
JJionorncm ia, or de lusional insanity, which "con sist s in an
exaltation ot· undu e predomin an ce of some one fac ultv and
characterised by some particul ar illusion or erron eou~ 'convi.ction impressed upon th e und erstanding," is comm only met
wtth. 'l'be pati ent suffers from delusions and h allucin ati ons.
I h ad a case under my care at Dar enth, a girl aged twelve
yea_rs, who was full of reli g ious delu sions. As fa r as hallu cinatwns are concern ed, Mor eau is of opini on t hat while t hose
of tl? e adult may be gay or sad in charactet·, in children tl1 ey
ar e m ninety-nin e tim es out of a hu ndred sad. Th e hallu cin ati ons of sig·ht consist of a rm ed men wh o menace the child, of
r eel ~r bl ack devil s, of cot·pses dresse d up, and so on. T hose of
hearm g are usually tetTifying in th eir character. Th e child
n ot onl y sees but hears people ay, " I am o·oinO' to c ut· ,-our
.k~ or I shall knock you odown,"
nee l(, ""B e qmc
" If J y ou
move you will di e," and similar sentences, which frighten
him. Many cases are on record, but the following is a good
example. A child aged seven y ears, after hearing some
stories told by her nurse, had hallucinations of sight. She
saw one evening on the wall opposite to h er b ed a great red
man. At h er cries th ey ran to her, and pointing' to the
figure with h er fin g er, she said, "Do you see him on th e wall ?
he is looking at me ." This condit ion p ersist ed for a long
Th eomania., demonomania, kleptomani a, pyromania, and
dipsomania occur in childeen, but it is not necessary to discuss
these affections now.
E1·o tomanic~ has been observed in early life. Th e expression of the face and the g-estures have an amorou s lang uor,
but as a rul e the children so affect ed are ch ast e. Por the most
part the di sease lasts for a short time, but individuals predispose d to in sanity often fall into so much physical and
moral languor as to constitute wh at th e l!., ren ch call "amor ous
cachexi a.." Esquirol describ es su ch a case :-"The eyes ar e
lively an d anim ated, the look passionate, th e t alk t ende r, but
er otomaniacs do not become ind ecent. Th ey forge t th emselves; they devote to the obj ect of their· love a pure and
secret worship; they b ecome slaves, and execute hi s ord ers
with a childi sh fidelity .. . . 'l'he facial asp ect is deject ed,
th e complexion pale, the character altered, sleep and app etite
disappeal', and they b eco me r estless, dreamer s, desper?'te,
irri table, an gry, and so on. 'l'he return of t h e b eloved obJ ect
mak es t hem drunk with joy, and the happiness which they
enj oy break s fo r th in th emselves, and is communicat ed to
every one aro und them . . . . Nig ht and day th ey are pursued
by th e same id eas, the same affections. . .. Th ey d ese rt t heir
paren ts and friend s, scorn fo r tun e, despi se social propriety ,
and are cap able of t he most ext raordinary, difficult, painful,
and eccentri c ac tions."
Fat· mor e import ant is ~~ymp homania and sntyriasis; due n o
doubt to th e in flu ence of heredity a nd exaltation of th e
gener al sensibility . Instances are on r ecord in whi ch. tl~e
affections have been seen at a vet·y early age; s~ttyr1ast s
has occurred in b oys only three years old, and. in g irl s cases
of pregn ancy h av e b een obser ve d at nin e years of age.
Buchan stat es th a t th e first sympt oms of nymphomani a have
b een obser ved in a g irl three years old, wh o was in t he habit
of throwin g herself in to t he most indec ent attitudes, and
indulg ing in t h e most li cent ious movements.
Insanity in Child1·en,
I have already spoken of homicidal 1nania as the result of
imitation; but there is no doubt that the influence of heredity
and an overpowering impulse must also be taken into account.
Homicidal mania h as been observed at a very early age.
Esquirol relates the case of a child aged four years, in whom
the instinct to murder revealed itself sudd enly; h e armed
himself with a knife, and stooping over the cradle of a baby
ten months old, cut its no se and made horrible gashes on the
body. Quite lately the newspapers have contained an account
of a b oy seven years old who was r etu rned for trial at the
assiz es for the murd er of his brother, aged six months. I do
not know whether the trial h as yet come on, but in this case
there is no doubt the influence of heredity is very marked.
The mother had been confined in an asylum two years ago,
and all h er children were weak-minded.
Melancholia appears incompatible with early life, but the
buoyancy and g ladness of childhood may give place to
despondency and despair. It may be sudden or in sidious in
its attack; a primary disorder, or the sequel of some other
form of insanity. 'l'here are two forms: the first, a pure
abstract indefinable depression ; the second, a despondent
condition, having relation to religious matters or a future
stat e. In the case of a boy aged sixteen years, who was
under my care at Darenth, the parents were n ervou s, excitable, irritable, and s ubj ect to nightmare. , The boy was
born under the stress of h ard work (the mother was a t each er
of music). When fifteen years old he came h ome for hi s
holidays, not knowin g that his grandfather was dead. 'l'he
news, the mother said, "worked upon him." Here we have
the influence of heredity and a shock. Five day s afterwards
he awoke, after goin g to bed, and shrieked out that h e was
dying. H e saw visions, became melancholy, and swa m long
distances in t he ornamental water, Regent's P ark, at night.
H e was restless and careless of consequences. vVhen admitted h e was bright and. good-temper ed, and very fond of
r eadi ng . At the end of two years he commenced t o hav e fits
of depression, which after a time came on more frequ ently,
and h e remained in the same condition when I left four
years ago.
_ As to s~•icide in ecwly l'i fe, ther e are num erous in stances.
In these cases h eredity exerts a great influence, but v ery
often. there is an overpowering impulse, or terror produ ced by
certam hallucinations will cause th e child to commit suicide.
'l'he fear of reprimand or bad treatm ent is a frequent cause
of suicide, as are also self-l ove and disappointment at not
obtaining a high position in school. Falret mentions a case
in which a child aged twelv e years committed suicide b ecause she was twelfth in her place in class. Soultz r elates
the case of a child aged twelve years who committed the
act in order to escape the t ediousness of having to go to
sc hool. Seizing a knife from the table, he buri ed it deep in
his chest three tim es. Unfortunately, suicide in children
seems to b e increasing; in France there have b een 482
during sixteen years, and in Russia 57 during ten years. I
have no statistics at present with r egard to England .
M cmin is cha racterised by ~t general delirium, wit h loquacity, incoherence, iutellec tual excitement, and deliri ous conceptions. The movements are Yi olent and incessant. 'l'he
children cry, run about, laugh, sing, break and destroy
things, undress themselves, and do evel'ything without any
aim m· design. 'l'he muscular strength seems to be increased,
and one sees young children ove l'come obstacles and lift
heavy thiugs with extraordinary facility. In this form of
mental affection del usiorrs are more frequ ent t han hallucinations . Of the thirteen cases which luwe been und er my C<:~,re
no less that nine s uffered from mania, and in fiv e of these it
came on <tfter attack s of epil epsy. 'l' he following is a, representative case :- vV. A. R-, aged twelv e years on admission,
was a fairly nouri sh ed b oy, of dark complexion and engaging
disposition, but of excitable temperament. 'rhere was a
history of phthisis on the father's side of the fami ly . 'l'he
case was a congenital one, and was supposed t o b e due to
the mo ther b eing insulted by a man wben three months
pregnant. Th e child h ad alw ays been on the move since
bir th, but had become more restless lately. H e had fits of
scr eaming a fortnig ht before admission . H e was th e only
child. On admission h e was noticed to speak in a sh ort,
sharp manner, a nd g ive in coh er ent answers t o qu estio ns. His
attention could only be anested for a vel'y short time. H e
was constantly moving abo ut, and b ecame violent after states
of excitement. H e was very mischievous. H e had no epil eptic
fit s, but violent scr eam in g attacks. In one of these maniacal
states h e threw hi s trousers into the fir e, broke so me basins,
and threw two clmmber-pots a t t he head of some h elpless
im becile children near him . -Wh en ask ed about it, h e said
h e did it, but gave n o r eason.
K elp gives the case of a boy, aged thirteen years, who
suffered hom foli e ci1·c~ilaiTe . He \\·a s a dull child, and had
I nsanity 'in Ch,i ld1·en,
b een so often punish ed at sch ool, on account of hi s slow prog ress, t hat h e became deeply melan ch oly and t ri ed t o kill
him se lf. Th e melanch oli a altern ated with mania, in whi ch
h e whistled and san g day and ni g ht, tore his cloth es, and was
filthy in his habits. A case of thi s kind is r a re, h e says, at
such an age.
Chm ·eamam·c~ consists chi efly of capri ciousness, irritability,
and a g r eat t end ency to sudden emotional di sturbances .
Hallucin a ti ons, illusion s, alJCl a mania cal delirium may also
occur. I have seen on e such case myself. L eid esdorf h as
directed attention to th e r esemblance of ch oreic t o t oxic
in sanity, as supportin g th e vi ew t h a t ch orea ma,y b e of
infec ti ous origin. 'l'h ere is no doub t th at it is clue to a bloo d
stat e, but ·wh at thi s is we are at present nmtbl e t o say. In
the ninth volum e of th e P sychologiwl J 01wnnl a case of
ch oreamania is 1·elated, in whi ch a b oy t en years of age
lifted an adel e,·, suppos ing it t o b e a stick, and was so much
alarm ed, thoug h p erfec tly nninjured, th at mania, accompani ed by involun ta ry and g rotesque attit ud es an d gesticu lation s, was induced.
.Moral insani ty is of h eqn ent occ urrence in childh oo cl, and
I ha ve seen se veral cases, though in Am eri ca it seems to b e
of mor e fr equ ent occ urren ce tha.n in EDgl and. 'L'he intellect ua l fac ulti es ar e unimpaired, ancl th e chil d is usually
sharp anil clever, bu t morall y h e is a thi13f, a liar, full of
cunnin g, horribly cru el, and often of imm oral tend encies .
vVh en r emonstrated with he will express contriti on an d
promi se amendm ent, but t h ese promi ses ar e soon for gotten,
and a f r·esh outbreak occurs. }\'I ay o relat es tl1 e case of a boy
of fa ir· talents a nd consider abl e intelli gen ce, but of t he most
sin g ul arly v icious, unrnl y, wayw:nd, and depraved ch a racter.
U n der all means h ad r ecourse to fo r hi s r efo rm ation h e had
b een alike intractabl e. H e was selfi sh, violen t, deli ghte d in
misehi ef, lmd drawn a knife on one of his tutors, ex posed hi s
per son, and gave way to ever y degr adin g vi ce.
H yste1·icL h as b een frequ ently n ot ice d. Tables have been
pub li sh ed of th e va ri ous ages at w hich it most fr eq nently
occurs, and from a study of these it seems that hysteri a
ra rely appears b efore the age of six or seven years. As in
th e adul t, so in t he child, i t presen ts th e convul sive and non convul sive fo rm s. Ra rely the re jg a convulsive attack ; mor e
commonly it comm ences with intell ectual d iso rd ers, a ncl
vari ous t roubles o-E sensation and movem en t . Usuall y t hose
affected h ave a liv el.Y appearance, keen imag ina,tion and intel-
uy FLE'l' CHEl{ B EAc H, M.B.
ligence, and seek to dra w a ttent ion t o th e mselves by exaggerat ing their sufferings. 'l'h ese cases are extremely impressionable, and la ugh and cry on the slightest provocation.
'l'he will is weak. Hyste ria is mor e common in girl s than
b ovs, but when the latter suffe L' from the affection they
b e~ome timid, a,nd blush and lower their eyes when spoken
to . 'l'hey will n ot play with b oys of their own ag e, but
prefer the games of little girls, such as playing with a
doll, &c.
R ecently Dr. Wiglesworth has described two cases of
degenerative ce rebral disease in children, presenting· sy mptoms r esembling those of geneml p aralysis. Lack of time,
h owever, preve nts me from desm·ibing t hem. 'l'he clictgnosis
of most of th ese forms of mental disease is easy. The chief
difficulty arises in di sting uishing m[Lni a from the delirium
which appea rs in the course of al:ute diseases . A cnte m ening·i tis rn a:r be mi st ak en for mania, and vice 'V ersc6 . But in
1neningitis th e pulse is full a nd strong, and t he tempera ture
raised. 'l'her e is h eadach e, vomit ing, a nd convulsions. 'l'he
pup ils are co ntracted, and stra bismus will ofte n b e observed.
In 1nania the pulse is onl y sligh t ly quickened, n otwithstanding the violence of the delirium, a nd there is no vomi t ing nor
Asthenic pnetmwni a a nd t yphoid feveJ' are 'sometim es accompanied by violent delirium which mask s the essen tial
sympto ms of t h e disease, but t he delirium of these diseases is
always prece ded by a long or sh ort febrile p eriod; whil~ in
1nania the febrile p eriod only b eco mes developed at the time
when delirium is at its hig hest p oint of intensity.
As reo·at·d s p rognosis, t h e presence or absence of h er editary
predi spo~itio :1 wil l h elp us t o d ecide wheth e.r t~e patie nt will
r ecover, or 1f h e r ecovers whether there IS hkely t o b e a
r elapse. Generally .one may say that if a chi.l d h as an attac~
of mania, melanchoh a, or other mental affectwn, and there I S
n o history of h ereditary predispos ition or masturbation, the
progn osis will b e fa vourable ; on t h e other hand, if heredity is
well marked and masturbation is much practised, the prognosis will b e bad, esp.ecially as rega~·~ s the. future. ~n exception must b e made m. ~he cases. of J~Vemle dementia t~18
r esult of hereditary sypluhs, moralmsamty, general paralysis,
and usually by nymphomania and satyriasis. In these cases
t h e prog nosis is always b ad .
As to t1·eatment, opium is ra rely n ecessary; when sedatives
a re r equired, a warm b ath daily will b e found useful , a nd
Insanity in Children,
when there is intense delirium we can add to this t h e application of cold to the h ead ; in other cases a wet pack will b e
preferable. The admin istration of bromide of sodinm in
doses, accor~ing ~o the age of ~be c!1ild, will act as a calming
agent, especmlly m cases of ep1l ept1C mania. In cases wl1ere
there is much sleeplessness trional in doses of from 3 to 8
grains m::1y be given for a few nights. A tonic treatm ent is
to bP: aimed at in order to r estore the strength of the patient,
and m those who mastmbate the administration of quinine
and camphor will b e found convenient. Cod-liver oil and
extract of malt will h elp to reduce any emaciation whi ch may
b e present. Care muEt of course be taken to ke ep the
bowels well open. Open-air exercise is to be employed in
all cases, b ut gymnastics sholl ld be made use of as a r ecreation in cases of melancholia, and as a reo·ulator
of mov ements
in choreic insanity. In some cases it wil1 be necessary to
stop all intellectual occupation; in others to encourao·e it.,
and also make the child interested in the general affairs of
life ; in the hi gher classes the study of painting, literature,
and t h e mo~ern lan guages, and employment in carpentering
ar:d garde1:nng f~r the boys, and fancy work for the girls,
will m_atenally mel t~e cure. One of the most imp ortant
par_ts, 1f not the_most 1mportant, of the treatment is th e sepa eatwn of the ch1lcl from hJS fr1 ends; among strangers h e will
be obliged to conform to th e ru les of the hou se, and carry out
th e treatment which h as been ord er ed . Visits from friends
should be permitted rarely at first, and regarded as a favou r
or reward for good behaviour. Under these circum stances
amelioration will proceed much more rapidly.
·with regard to moral insanity, Dr. Jules Morel, who has
seen a good many children suffering from it in Belo·ium
advocates special institutions fm· them. I am of his opinion:
and thmk they should be put into institutions in which they
sho~1ld undergo industrial tratning, and be k ept under control
durmg the period of th eir lives. If allowed to be without
control they are sure to comm it some act which will bring
them in contact with the law . Tl1e result of this will be that
they will most probably be sent to prison, which is not the
proper place for them .
_ 'l'h~ p1·evention of_ insanity_ in childhood is most important.
~1fe m the open mr, work m a garden or on a farm, recreatiOn of all sorts, absence of forced prolonged intellectual
labour, and the suppression of excessive emotion ar e ·th e
chief hygienic indications in those predisposed to insanity.
'ro strengthen the body first is the main point, and having
laid a good foundation, we can then proceed to educate the
mind. In many cases the opposite view h as been held, and
children's minds have been pushed on with no regard to
their physical condition, and insanity or severe nervous
disease is the result. I see children of this kind every year.
Fortunately of late various societies have sprun g up, whose
objects are to study the development of the mind of the
child and endeavour to gLJard against over-pressure, and I
hope that in time greater attention will be paid to education
in relation to the child's mental condition.
I must apologise for only b eing able to give you a short
sketch of what I consider is a very important subject, but
want of time has prevented me from go ing more fully into
the matter.