Bartholomew himself was only a compiler of information—a very learned man, it is true, but a clergyman-teacher, not a physician. Translations of his book were probably more widely read in England, in proportion to the number of the reading public, than any modern encyclopaedia has ever been. He said :
" Madness cometh sometime of passions of the soul, as of business and of great thoughts, of sorrow and of too great study, and of dread : sometime of the biting of a wood-hound [mad dog], or some other venomous beast ; sometime of melancholy meats, and sometime of drink of strong wine. And as the causes be diverse, the tokens and signs be diverse. For some cry and leap and hurt and wound themselves and other men, and darken and hide themselves in privy and secret places. The medicine of them is, that they be bound, that they hurt not themselves and other men. And namely such shall be refreshed, and comforted, and withdrawn from cause and matter of dread and busy thoughts. And they must be gladded with instruments of music and some deal be occupied." (Italics ours).
Bartholomew recognizes the two classes of causes of mental disturbance, the mental and the physical, and, it will be noted, has nothing to say about the spiritual—that is, diabolic possession. Writing in the thirteenth century, diabolism was not a favourite thought of the men of his time, and Bartholomew omits reference to it as a cause of madness entirely. Food and drink, and especially strong spirituous liquor, are set down as prominent causes. It may seem curious in our time that the bite of a mad dog, or a " wood hound," as Bartholomew put it, should be given so important a place; but in the absence of legal regulation rabies must have been rather common, and the disease was so striking from the fact that its onset was often delayed for a prolonged interval after the bite, that it is no wonder that a popular encyclopaedist should make special note of it.
The effect of alcohol in producing insanity was well recognized during the Middle Ages, and many writers have alluded to it. Pagel, in the chapters on Medieval Medicine in Puschmann's " Handbook," says that Arculanus, of whom there is mention in the chapter on Oral Surgery and the Minor Surgical Specialities, has an excellent description of alcoholic insanity. The ordinary assumption that medieval physicians did not recognize the physical factors which lead up to insanity, and practically always attributed mental derangement to spiritual conditions, especially to diabolic possession, is quite unfounded so far as authoritative physicians were concerned. Their suggestions as to treatment, above all in their care for the general health of the patient and the supplying of diversion of mind, was in principle quite as good as anything that we have been able to accomplish in mental diseases down to the present time. Their insanity rate, and above all their suicide rate, was much lower than ours, for life was less strenuous and conscious, and though men and women often had to suffer from severe physical strains and stresses, their free outdoor life made them more capable of standing them.
The history of human care for the insane, it is often said by those who are reviewing the whole subject briefly, may be represented by the steps in progress from the presumption of diabolical possession, and exorcism for its relief, to intelligent understanding, sympathetic treatment, and gentle surveillance, with the implication that this has all been a gradual evolution. There is no doubt that during the Middle Ages even physicians often thought of possession by the devil as the cause of irrational states of mind. Not only some of the genuinely insane—though not all, be it noted—but also sufferers from dreads and inhibitions of various kinds, the victims of tics and uncontrollable habits, especially the childish repetition of blasphemous words, and sufferers from other psychoses and neuroses, were considered to be the victims of diabolic action. Exorcism then became a favourite form of treatment of all these conditions, but its general acceptance came about because it was so often successful. The mental influence of the ceremonies of exorcism was often quite as efficient in the cure of these mental states as mesmerism, hypnotism, psycho-analysis, and other mental influences in the modern time.
It may particularly be compared in this regard to psycho-analysis in our own day, for this cures patients by making them feel that they have been the victims of some very early evil impression, usually sexual in character, which has continued unconsciously to them to colour all their subsequent mental life. Some of the curious theories of secondary personality, the subliminal self and what has recently been called " our hidden guest," represent in other terms what the medieval observers and thinkers expressed in their way by an appeal to diabolic influence. They felt that there was a spirit influencing these patients quite independent of themselves in some way, and their thoroughgoing belief in a personal devil led them to think that there must be some such explanation of the phenomena. Even great scientists in the modern time who have studied psychic research have not been able to get away entirely from the feeling that there is something in such possession, and have admitted that there may be even alien influence by an evil spirit. The more one studies the question from all sides, and not merely from a narrow materialistic standpoint, the less one is ready to condemn the medievalists for their various theories of diabolic possession. The Christian Church still teaches not only its possibility but its actual occurrence.
Such conservative thinkers as Sir Thomas More, one of England's greatest Lord Chancellors, the only one who ever cleared the docket of the Court of Chancery, continued to believe in it nearly a century after the Middle Ages had closed, but above all is quite frank in the expression of his opinion that some of the mutism, the tics, and bad habits, and repeated blasphemies, attributed to it, may be cured by soundly thrashing the young folks who are subject to them. Neurological experts will recall similar experiences in the modern time. Charcot's well-known story of the little boy whose tic was the use of the word uttered by the corporal at Waterloo, and was cured by being soundly licked by some playmates at the Salpetriere gate, is a classic. Some of the medieval cruelty represented unfortunate developments from the observations that had been made that a number of the impulsive neuroses and psychoneuroses could be favourably modified, or even entirely corrected, by attaching to the continuance of the habit a frequently repeated memory of distinctly unpleasant consequences that had come upon the patient because of it. Our experience in the recent war called to attention a great many cases of mutism, functional blindness, tremors, and incapacities of all kinds, some of which were cured by painful applications of electricity. The medieval use of the lash for such cases can be better understood now as the result of this very modern set of clinical observations.