CHAPTER XV.

LUCID INTERVALS.

§ 400. It is well known that many diseases—especially of the class called nervous - observe a law of periodicity which is not uncommon in the actions of the animal economy. One effect of this curious law consists in an intermission of the outward. manifestations of the disease, so complete as to bear the appearance of a perfect cure, and this, in the present state of our knowledge, is all that we can, with certainty, say of it. As to the change that takes place in the organic condition of the part affected, during the intermission, we can at best hazard nothing more than a rude conjecture. We have no warrant for believing that the pathological affection itself entirely disappears with the symptoms that arise from it, and perhaps never shall have, until we are able to explain why, after such disappearance, the tendency of the disease to return at certain intervals should still remain; or, in other words, wherein the final, perfect cure differs from the temporary intermission. But in view of the established fact that organic disease often exists without producing its ordinary symptoms, or revealing itself by any appreciable signs, it seems the more probable supposition, that the pathological condition of the affected organs does not disappear entirely during the intermission, but continues with, perhaps, a modified intensity.

§ 401. The slightest examination will convince us that, in the most complete intermission of any disease that affects the whole system to some extent, the patient is far from enjoying sound health, or free from every indication of morbid action. A greater contrast in the matter of health can scarcely be pre

sented in the same individual, than that between the paroxysm and the intermission of a quotidian fever; yet none will say, after the former has passed off, and the patient, no longer shaking with cold nor parched with heat, is able to arise and give some attention to his duties, that he is entirely well. Better, no doubt, he is; but his mind is weak, his stomach declines its once favorite food, a little exertion overcomes him, a certain malaise not easily described pervades his whole system, and which, though not excessively painful, is something very different from the buoyant sensation of health. We are therefore bound to believe that the disease still exists, though its external aspect has changed. And here it may be as well to remark, that we must not be led by an abuse of language to attribute that to the disease to the pathological condition which belongs only to one of its symptoms. When the epileptic, a few days after one of his frightful convulsions, appears to have regained his customary health, no intelligent physician imagines that the proximate cause of this disturb ance has vanished with the fit, leaving the organ it affected as sound as ever. The fit itself, which is a mere symptom, is indeed of periodical occurrence, but the pathological condition on which it depends, continues, slowly and surely, though imperceptibly, to undermine the powers of the constitution. The general expression of all our knowledge on the subject of the intermission of diseases is, then, that certain pathological conditions give rise, among other phenomena, to some that disappear for a time, only to recur after an interval of more or less duration.

§ 402. That insanity, or rather mania, is one of the diseases that are subject in some respects to this law of periodicity, is universally admitted; but to what extent the law operates, is a point on which there is much diversity of opinion. There are few cases in which we may not observe various periods in their course, when the severity of the symptoms is greatly alleviated; when calmness takes the place of fury, and a quiet

and sober demeanor succeeds to noisy and restless agitation; when reason, driven from her throne, seems to be retracing her steps and struggling for her lost dominion. In all this, however, there is nothing different from what occurs in many, if not the greater proportion, of chronic diseases. In mania but in no other form of insanity, this abatement of the severity of the symptoms may amount to a complete intermission, when the patient is conscious of his true condition, converses rationally, and admits his having been insane. But, that the intermissions of mania are ever so complete that the mind. is restored to its original integrity, or so sudden as to justify the statement of Baron Rolfe, that "such is the nature of the mind that it might be one minute sane, and another minute insane," would seem scarcely probable, from the fact, that the very seat of the pathological changes is the material organ on which the manifestations of the mental phenomena depend. For if the mind be rendered as sound as before the attack, it necessarily follows that the brain is equally restored, since in point of health they stand to each other in the relation of cause and effect. But as there is no proof that such is the case, and as the supposition is not supported by what we know of pathological actions, we have no right, at present, to conclude that the physical condition on which mania depends is entirely removed during the intermission. We are thus led to scrutinize a little more closely these periodical restorations of the insane mind, or lucid intervals, as they are called, in order to ascertain if possible what is the actual state of the mind at these times. But before doing this, it will be proper to show what is understood in law by lucid intervals, as explained by eminent legal authorities.

§ 403. D'Aguesseau, in his pleading in the case of the Abbé d'Orleans, says: "It must not be a superficial tranquillity, a shadow of repose, but on the contrary a profound tranquillity, a real repose; it must be, not a mere ray of reason, which only Reg. v. Layton, 6 Cox, C. C. 149.

makes its absence more apparent when it is gone,

flash of lightning, which pierces through the darkness only to

render it more gloomy and dismal, not a glimmering which joins the night to the day; but a perfect light, a lively and continued lustre, a full and entire day interposed between the two separate nights of the fury that precedes and follows it; and, to use another image, it is not a deceitful and faithless stillness which follows or forebodes a storm, but a sure and steadfast tranquillity for a time, a real calm, a perfect serenity; in fine, without looking for so many metaphors to represent our idea, it must be not a mere diminution, a remission of the complaint, but a kind of temporary cure, an intermission so clearly marked, as in every respect to resemble the restoration of health."1

§ 404. Many years after, Lord Thurlow, in the court of chancery, thus stated his views of the condition of mind necessary to constitute a lucid interval: "By a perfect interval, I do not mean a cooler moment, an abatement of pain or violence, or of a higher state of torture, a mind relieved from excessive pressure; but an interval in which the mind, having thrown off the disease, had recovered its general habit." 2

§ 405. Here, then, is the lucid interval as clearly and minutely described, as a profusion of words and metaphors could do it, and as such it was believed by these authorities, no doubt, to have a real existence. In the early periods of the English law, the doctrine of lucid intervals was universally admitted, and they seem to have been considered not a rare, but a very common phenomenon of mental derangement. Indeed, judg ing from the frequent mention made of them in all discussions on the subject, and from the fact that idiocy and lunacy which latter was considered, as its name would lead us to suspect, to be of an intermittent nature constituted, for a long time, the only division of mental diseases, it will not, perhaps,

Pothier on Obligations, by Evans, Appendix, 579.

Attorney-General v. Parnther, 3 Brown's Ch. Cases, 234.

be too strong an expression to say, that they were viewed as an essential feature of mania. This, however, was in the infancy of medical science, before the phenomena of mania which, until recently, has always been less understood than other diseases were thoroughly and accurately observed, and the men whose ideas we have just quoted had no practical acquaintance with the disorder whose phases they so vividly described. Before adopting their views, then, it will be proper to inquire how far they are supported by the investigations of modern medical science.

§ 406. While the doctrine of lucid intervals, as explained by the language above quoted, is upheld by scarcely a single eminent name in the medical profession, we find that their existence is either denied altogether or they are regarded as being only a remission, instead of an intermission, of the disease; an abatement of the severity of the symptoms, not a temporary cure. Mr. Haslam, who is no mean authority on any question connected with insanity, emphatically declares that, "as a constant observer of this disease for more than twenty-five years, I cannot affirm that the lunatics with whom I have had daily intercourse have manifested alternations of insanity and reason. They may at intervals become more tranquil and less disposed to obtrude their distempered fancies into notice. For a time their minds may be less active, and the succession of their thoughts consequently more deliberate; they may endeavor to effect some desirable purpose, and artfully conceal their real opinions, but they have not abandoned nor renounced their distempered notions. It is as unnecessary to repeat that a few coherent sentences do not constitute the sanity of the intellect, as that the sounding of one or two notes of a keyed instrument could ascertain it to be in tune.” 1

§ 407. Strong as this testimony is, and true, no doubt, as the result of an individual's experience, it cannot be denied that others, whose opportunities have not been less than Mr. Medical Jurisprudence, as it relates to Insanity, 224.