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+Project Gutenberg's Observations on Madness and Melancholy, by John Haslam
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: Observations on Madness and Melancholy
+       Including Practical Remarks on those Diseases together
+       with Cases and an Account of the Morbid Appearances on
+       Dissection
+
+Author: John Haslam
+
+Release Date: August 21, 2011 [EBook #37144]
+
+Language: English
+
+Character set encoding: ISO-8859-1
+
+*** START OF THIS PROJECT GUTENBERG EBOOK OBSERVATIONS ON MADNESS AND ***
+
+
+
+
+Produced by The Online Distributed Proofreading Team at
+http://www.pgdp.net (This file was produced from images
+generously made available by The Internet Archive.)
+
+
+
+
+
+
+
+
+
+  OBSERVATIONS ON MADNESS AND MELANCHOLY:
+
+  INCLUDING PRACTICAL REMARKS ON THOSE DISEASES;
+
+  TOGETHER WITH CASES:
+
+  AND AN ACCOUNT OF THE MORBID APPEARANCES
+  ON _DISSECTION_.
+
+
+  BY JOHN HASLAM,
+
+  LATE OF PEMBROKE HALL, CAMBRIDGE;
+  MEMBER OF THE ROYAL COLLEGE OF SURGEONS,
+  AND APOTHECARY TO BETHLEM HOSPITAL.
+
+  _The Second Edition, considerably enlarged._
+
+  "Of the uncertainties of our present state, the
+  most dreadful and alarming is the uncertain
+  continuance of reason."
+                          Dr. JOHNSON'S RASSELAS.
+
+
+  London:
+
+  PRINTED FOR J. CALLOW, MEDICAL BOOKSELLER,
+  CROWN COURT, PRINCES STREET, SOHO;
+  BY G. HAYDEN, BRYDGES STREET, COVENT GARDEN.
+  1809.
+
+
+
+
+  AS A GRATEFUL ACKNOWLEDGMENT
+  FOR MANY FAVOURS,
+  AN OBLATION TO SUBSISTING FRIENDSHIP,
+  AND A TRIBUTE TO SUPERIOR JUDGMENT,
+  EXERCISING THE PROFESSION OF MEDICINE WITH
+  SKILL AND LIBERALITY:
+  THE PRESENT VOLUME IS RESPECTFULLY
+  DEDICATED TO
+  DR. THOMAS MONRO,
+  A FELLOW OF THE COLLEGE, AND PHYSICIAN
+  TO BETHLEM HOSPITAL.
+
+
+
+
+Preface.
+
+
+_The alarming increase of Insanity, as might naturally be expected, has
+incited many persons to an investigation of this disease;--some for the
+advancement of Science, and others with the hope of emolument._
+
+_More than ten years having elapsed since the publication of the
+"Observations on Insanity," a trifle, which the Profession has held in
+greater estimation than its intrinsic merits could justify: the present
+work is modestly introduced to the public notice, as a corrected copy of
+the former, with considerable additions, which the extensive scope of
+Bethlem Hospital would have furnished more liberally to a more intelligent
+observer._
+
+_To have taken a comprehensive survey of the human faculties in their
+sound state; to have exhibited them impaired by natural decay, and
+transformed by disease, would have implied an ability to which I cannot
+pretend; would have required many volumes to unfold, and perhaps more
+patience than any rational experience could have attributed to the reader.
+The contents of the following pages are therefore to be considered as an
+abbreviated relation, and condensed display of many years observation and
+practice, in a situation affording constant opportunities and abundant
+supplies for such investigations._
+
+_It is natural to presume, that amongst my professional acquaintance the
+subject of Insanity must have been frequently introduced as a topic of
+discourse; and I am ready to acknowledge, that I have often profited by
+their remarks and suggestions: but I should be ungrateful were I not to
+confess my particular obligations to my esteemed friend, Anthony Carlisle,
+Esq. Surgeon to the Westminster Hospital, for many corrections, and some
+communications, which I shall ever value as judicious and important._
+
+  BETHLEM HOSPITAL,
+  NOV. 21, 1808.
+
+
+
+
+ERRATA.
+
+
+  _Page_ 3, _line_ 7, _for_ controverted, _read_ converted.
+         5,        2, _for_ phrenitic, _read_ phrenetic.
+        90,        3, _for_ hyatids, _read_ hydatids.
+       254, _in the Table_, _for_ manical, _read_ maniacal.
+
+
+
+
+OBSERVATIONS ON MADNESS, &c. &c.
+
+
+
+
+CHAPTER I.
+
+DEFINITION.
+
+
+There is no word in the English language more deserving of a precise
+definition than madness: and if those who have treated on this subject
+have been so unfortunate as to disagree with each other, and consequently
+have left their readers to reconcile their discordant opinions; yet it
+must be confessed that considerable pains have been bestowed, to convey a
+clear and accurate explanation of this term. Although this contrariety of
+sentiment has prevailed concerning the precise meaning of the word
+madness, medical practitioners have been sufficiently reconciled as to the
+thing itself: so that when they have seen an insane person, however
+opposite their definitions, they have readily coincided that the patient
+was mad.
+
+From this it would appear that the thing itself, is, generally speaking,
+sufficiently plain and intelligible; but that the term which represents
+the thing is obscure. Perhaps, we might be somewhat assisted, by tracing
+back this word, in order to discover its original meaning, and shewing
+from its import the cause of its imposition.
+
+If the reader, as is now the custom, should turn to Johnson's Dictionary
+for the meaning and etymology of this word, he will find that the Doctor
+has derived it both from the Anglo-Saxon gemaad and the Italian
+_matto_; but without giving any meaning as the cause of its employment.
+The word is originally Gothic, and meant anger, rage, [Gothic: Mod].
+[Mod]. It is true that we have now controverted the o, into a, and write
+the word mad: but mod was anciently employed.
+
+  "Yet sawe I MODNESSE laghyng in his _rage_."
+          _Chaucer. Knight's Tale, fol. 1561, p. 6._
+
+There is so great a resemblance between anger and violent madness, that
+there is nothing which could more probably have led to the adoption of the
+term. Dr. Beddoes, who appears to have examined the subject of insanity
+with the eye of an enlightened philosopher, is decidedly of this opinion,
+he says, HYGEIA, _No. 12, p. 40_, "Mad, is one of those words which mean
+almost every thing and nothing. At first, it was, I imagine, applied to
+the transports of rage; and when men were civilized enough to be capable
+of insanity, their insanity, I presume, must have been of the frantic
+sort, because in the untutored, intense feelings seem regularly to carry a
+boisterous expression."
+
+MAD is therefore not a complex idea, as has been supposed, but a complex
+term for all the forms and varieties of this disease. Our language has
+been enriched with other terms expressive of this affection, all of which
+have a precise meaning. Delirium, which we have borrowed from the latin,
+merely means, _out of the track_, de lira, so that a delirious person, one
+who starts out of the track regularly pursued, becomes compared to the
+same deviation in the process of ploughing. _Crazy_, we have borrowed from
+the French _ecrasé_, crushed, broken: we still use the same meaning, and
+say that such a person is crack'd. Insane, deranged, or disarranged,[1]
+melancholic, out of one's wits, lunatic, phrenitic, or as we have
+corrupted it, frantick, require no explanation. _Beside one's self_ most
+probably originated from the belief of possession by a devil, or evil
+spirit.
+
+The importance of investigating the original meaning of words must be
+evident when it is considered that the law of this country impowers
+persons of the medical profession to confine and discipline those to whom
+the term mad or lunatic can fairly be applied. Instead of endeavouring to
+discover an infallible definition of madness, which I believe will be
+found impossible, as it is an attempt to comprise, in a few words, the
+wide range and mutable character of this Proteus disorder: much more
+advantage would be obtained if the circumstances could be precisely
+defined under which it is justifiable to deprive a human being of his
+liberty.
+
+Another impediment to an accurate definition of madness, arises from the
+various hypotheses, which have been entertained concerning the powers and
+operations of the human mind: and likewise from the looseness and
+unsettled state of the terms by which it is to be defined.
+
+Before treating of the intellect in a deranged state, it will perhaps be
+expected that some system of the human mind, in its perfect and healthy
+condition, should be laid down. It will be supposed necessary to establish
+in what sanity of intellect consists, and to mark distinctly some fixed
+point, the aberrations from which are to constitute disease.
+
+To have a thorough knowledge of the nature, extent, and rectitude of the
+human faculties, is particularly incumbent on him who undertakes to write
+of them in their distempered state; and, in a legal point of view, it is
+most important that the medical practitioner should be enabled to
+establish the state of the patient's case, as a departure from that which
+_is_ reason.
+
+The difficulty of proposing a satisfactory theory of the human mind, must
+have been felt by every person, who has touched this delicate string since
+the days of Aristotle, and failure must be expected in him who attempts
+it: yet the endeavour is laudable, and miscarriage is not linked with
+disgrace. Every contribution, to illustrate what are the powers of mind we
+possess; how we are acted upon by external circumstances in the
+acquisition of knowledge; and concerning the manner in which we use this
+knowledge for the purposes of life; ought to be candidly received.
+
+Enquiries of this nature have been usually conducted by commenting on the
+numerous and discordant authorities which have treated on metaphysical
+subjects; these persons, however they may differ on many points, appear to
+be pretty generally agreed, that the human mind possesses certain
+faculties and powers; as imagination, judgment, reason, and memory. They
+seem to consider these, as so many departments, or offices of the mind,
+and therefore class men according to the excellence or predominance of
+these powers. One man, is said to be distinguished by the brilliancy of
+his imagination; another, by the solidity of his judgment; a third, by the
+acuteness of his reason; and a fourth, by the promptitude and accuracy of
+his recollection.
+
+As far as I have observed respecting the human mind, (and I speak with
+great hesitation and diffidence,) it does not possess, all those powers
+and faculties with which the pride of man has thought proper to invest it.
+By our senses, we are enabled to become acquainted with objects, and we
+are capable of recollecting them in a greater or less degree; the rest,
+appears to be merely a contrivance of language.
+
+If mind, were actually capable of the operations attributed to it, and
+possessed of these powers, it would necessarily have been able to create a
+language expressive of these powers and operations. But the fact is
+otherwise. The language, which characterizes mind and its operations, has
+been borrowed from external objects; for mind has no language peculiar to
+itself. A few instances will sufficiently illustrate this position. After
+having committed an offence it is natural to say that the mind feels
+contrition and sorrow.
+
+Contrition is from _cum_ and _tero_, to rub together, which cannot
+possibly have any thing to do with the operations of the mind, which is
+incapable of rubbing its ideas or notions together. Contrition is a
+figurative expression, and may possibly mean the act of rubbing out the
+stain of vice, or wearing down by friction the prominences of sin.
+
+If we were to analyze the word Sorrow, which is held to be a mental
+feeling, we should find it to be transferred from bodily sufferance: for
+the mind, is incapable of creating a term correctly expressive of its
+state, and therefore, it became necessary to borrow it from _soreness_ of
+body.--_See Mr. Tooke's Diversions of Purley, vol. ii. p. 207_, where
+_sore_, _sorry_, and _sorrow_ are clearly made out to be the same word.
+
+It is customary to speak of a man, of accurate perceptions, and of
+another, who has grand and luminous conceptions of human nature.
+Perception, from _per_, and _capio_ to take, seize, grasp, through the
+medium of the organs of sense, being implied. But to take, seize, and
+grasp are the operations of the hand, and can only, by extreme courtesy,
+be attributed to mind.
+
+Mr. Dugald Stewart, the most thoughtful and intelligent of modern
+metaphysicians, has said, "By conception I mean that power of the mind
+which enables it to form a notion of an absent object of perception, or of
+a sensation which it has formerly felt."--_Elements of the Philosophy of
+the Human Mind, 8vo. p. 133._
+
+This definition means merely memory; and by perusing attentively the whole
+chapter the reader will be convinced of it. Conception, from _cum_ and
+_capio_, has been applied to mind from the physical sense of embracing,
+comprehending, or probably from the notion of being impregnated with the
+subject. It may be remarked, that these three terms, by which conception
+has been explained, have been all applied to mental operation.
+
+The words reason and reasoning, I believe, in most languages, strictly
+imply numeration, reckoning, proportion; the Latin _ratio_, _ratiocinor_,
+_ratiocinator_ are sufficient examples. A curious coincidence between the
+Latin _ratio_ and the Gothic _rathjo_, together with some pertinent and
+interesting observations, may be seen in Ihre's Glossarium Svio-gothicum,
+_p._ 393, _art._ Rækna. As we now acknowledge the science of number to be
+the purest system of reasoning, a system, on which all persons agree, and
+so unlike medicine, politics, and divinity, concerning which there is a
+constant, and hostile variety of sentiment, it adds some force to the
+argument. Indeed, Mr. Locke, who almost personifies reason, after having
+painfully sifted this matter, appears to be much of the same way of
+thinking: he says, "Reason, though it penetrates into the depth of the sea
+and earth, elevates our thoughts as high as the stars, and leads us
+through the vast spaces and large rooms of this mighty fabrick, _yet it
+comes far short of the real extent of even corporeal being_; and there are
+many instances wherein it fails us: as,
+
+"First: it perfectly fails us where our ideas fail: it neither does, nor
+can extend itself farther than they do, and therefore, wherever we have no
+ideas our reasoning stops, and we are at an end of our reckoning: and if
+at any time _we reason about words, which do not stand for any ideas_, it
+is only about those sounds, and nothing else.
+
+"Secondly: our reason is often puzzled, and at a loss, because of the
+obscurity, confusion or imperfection of the ideas it is employed about;
+and there we are involved in difficulties and contradictions. Thus, not
+having any perfect idea of the least extension of matter, nor of infinity,
+we are at a loss about the divisibility of matter; _but having perfect,
+clear, and distinct ideas of number, our reason meets with none of those
+inextricable difficulties in numbers, nor finds itself involved in any
+contradictions about them_."--_Works. 4to, vol. i, p. 431._
+
+It can scarcely be necessary, longer to fatigue the patience of the
+reader, by reverting to the etymology of those terms, which have been
+considered as significant of mind and its operations. Every one will be
+able sufficiently to develope imagination, reflection, combination, [as
+applied to ideas, importing the amalgamation of _two_ into one]
+abstraction, [_vide Mr. Tooke, from p. 15 to 426, vol. ii._] and a
+variety of others; and to shew, that they have arisen from physical
+objects, and the circumstances which surround us, and are independant of
+any operation which mind has elaborated.
+
+But as madness, by some, has been exclusively held to be a disease of the
+imagination, and by others, to be a defect of the judgment; considering
+these as separate and independant powers or faculties of the intellect; it
+is certainly worth the trouble to enquire, whether such states of mind did
+ever exist as original and unconnected disorders. With respect to
+imagination, there can be but little difficulty; yet this will so far
+involve the judgment and memory, that it will not be easy to institute a
+distinction. If a cobbler should suppose himself an emperor, this
+supposition, may be termed an elevated flight, or an extensive stretch of
+imagination, but it is likewise a great defect in his judgment, to deem
+himself that which he is not, and it is certainly an equal lapse of his
+recollection, to forget what he really is.
+
+Having endeavoured to give some reasons for not according with the
+generally received opinions, concerning the different powers of the mind,
+it may be proper shortly to state, that, from the manner in which we
+acquire knowledge, the human mind appears to be composed of a sum of
+individual perceptions: that, in proportion as we dwell by the eye, the
+ear, or the touch on any object (which is called attention,) we are more
+likely to become acquainted with it, and to be able to remember it. For
+the most part, we remember these perceptions in the succession in which
+they were presented, although, they may afterwards, from circumstances, be
+differently sorted.
+
+The minds of ordinary men are well contented to deal out their ideas, in
+the order in which they were received; and, not having found the necessity
+of bringing them to bear on general subjects, they are commonly minutely
+accurate in the detail of that which they have observed. By such persons,
+a story is told with all the relations of time and place; connected with
+the persons who were present, their situation, state of health, and a vast
+variety of associated particulars; and these persons, however tedious,
+generally afford the most correct account. On the other hand, those who
+are men of business, and have much to communicate in a given space, are
+obliged to subtract the more material circumstances from the gross
+narrative, and exhibit these as the sum total. It is in this way, that
+words, originally of considerable length, have been abbreviated for the
+conveniency of dispatch, and from this necessity short hand writing has
+been employed.
+
+As the science of arithmetic consists in addition to, or subtraction from,
+a given number; so does the human mind appear to be capable solely of
+adding to, or separating from, its stock of ideas, as pleasure may prompt,
+or necessity enforce.
+
+Language, the representative of thought, bears the same construction; and
+it is curious to remark in the investigation of its abbreviations, that
+those words, which serve to connect ideas together, (_conjunctions_) and
+which have been supposed to mark certain operations of intellect, postures
+of mind, and turns of thought, have merely the force and meaning of to
+add, or to subtract.
+
+Insanity is now generally divided into Mania and Melancholia, but formerly
+its distributions were more numerous. Paracelsus, speaking of this
+disease, says, "Vesaniæ hujus genera quatuor existunt: primi _Lunatici_
+vocantur: secundi _Insani_: tertii _Vesani_: quarti _Melancholici_,
+Lunatici sunt qui omnem suum morbum ex Luna accipiunt, et juxta eam sese
+gerunt ac moventur. Insani sunt, qui malum id ab utero materno hauserunt,
+veluti hæreditarium, uno subindè insaniam in alterum transferente. Vesani
+sunt, qui a cibis ac potibus ita inficiuntur ac taminantur, ut ratione
+sensuque priventur. Melancholici sunt, qui ex intimæ naturæ vitio a
+ratione deturbantur, et ad vesaniam precipitantur." Paracelsus, however,
+thinks that a fifth genus may be added. "Ad quatuor hac genera genus
+insuper aliud quodammodo annumerari potest, videlicet _obsessi_, qui a
+diabolo variis modis occupari solent."--_Paracelsi Opera, folio, tom. i.
+fol. 572._
+
+The idea of being besieged, beset, or possessed by the devil was formerly
+a very favourite notion, and is derived to us by an authority we are
+taught to reverence: indeed it is still the opinion of many harmless and
+believing persons, some of whom have bestowed considerable pains to
+convince me that the violent and mischievous maniacs in Bedlam were under
+the dominion of this insinuating spirit. They have employed one argument
+which would seem to have considerable weight, namely, that the most
+atrocious crimes are stated in our indictments (much to the credit of
+human nature) to have been committed by the instigation of the devil: and
+they have also endeavoured to explain, how a late and eminently successful
+practitioner, by an union of the holy office with consummate medical
+skill, was enabled to cure nine lunatics out of ten, which certainly has
+not hitherto been accounted for.
+
+Paracelsus, who contemplated this subject with uncommon gravity and
+solicitude, is of opinion that the devil enters us much in the same manner
+as a maggot gets into a filbert.--_Vide Fragmentum Libri Philosophiæ de
+Dæmoniacis et Obsessis, tom. ii. p. 460._
+
+To conclude this part of the subject, and to exhibit the state of belief
+at that period, I shall take the liberty of extracting a portion from the
+11th chapter of Dr. Andrewe Boord's Extravagantes, which "doth shewe of a
+Demoniacke person, the which is possessed of or with the devyll or
+devylls.
+
+"Demoniacus or Demoniaci be the Latin wordes. In Greke it is named
+Demonici. In Englyshe it is named he or they, the whiche be mad and
+possessed of the devyll or devils, and their propertie is to hurt and kyll
+them selfe, or els to hurt and kyll any other thynge, therfore let every
+man beware of them, and kepe them in a sure custody.
+
+_The cause of this Matter._
+
+"This matter doth passe all maner sickenesses and diseases, and it is a
+fearefull and terryble thyng to se a devyll or devylles shoulde have so
+muche and so greate a power over man, as it is specified of such persons
+dyvers tymes in the gospell, specyally in the IX. Chapitre of St. Marke.
+Chryste sendynge his disciples to preache the worde of God, gevynge them
+power to make sicke men whole, lame men to go, blynde to se, &c. Some of
+them dyd go by a mans that was possessed of devils and they coud not make
+him whole. Shortly to conclude, Chryst dyd make hym whole. The dysciples
+of Chryste asked of him why that they coud not make the possessed man of
+the devylls whole. And Jesus Chryste said to them: this kynde of devylls
+can not be cast out without prayer and fastynge. Here it is to be noted,
+that nowe a dayes fewe or els none doth set by prayer or fastynge,
+regardyng not gods wordes; in this matter, I do feare that suche persons
+be possessed of the devil, although they be not starke madde, and to shew
+further of demoniacke persons the whiche be starke madde. The fyrste tyme
+that I dyd dwell in Rome, there was a gentilwoman of Germani, the whych
+was possessed of devyls, and she was brought to Rome to be made whole.
+For within the precynct of St. Peters church, without St. Peters chapel,
+standeth a pyller of whyte marble grated round about with iron, to the
+which our Lorde Jesus Chryste dyd lye in hymselfe unto the Pylates hal, as
+the Romaynes doth say, to the which pyller al those that be possessed of
+the devyl, out of dyvers countreys and nacions be brought thyther, and as
+they say of Rome, such persons be made there whole. Amonge al other this
+woman of Germany, which is CCCC myles and odde from Rome, was brought to
+the pyller, (I then there beyng presente,) with great strength and
+violently with a XX or mo men, this woman was put into that pyller within
+the yron grate, and after her dyd go in a preeste, and dyd examine the
+woman under this maner in the Italian tonge. Thou devyl or devyls, I do
+abjure thee by the potencial power of the father, and of the sonne our
+Lorde Jesus Christe, and by the vertue of the Holy Ghoste, that thou do
+shewe to me, for what cause that thou doeste possess this woman: what
+wordes was aunswered I will not write, for men will not beleve it, but
+wolde say it were a foule and great lye, but I dyd heare that I was afrayd
+to tarry any longer, lest that the devyls shulde have come out of her, and
+to have entred into me; remembrynge what is specified in the viii Chapitre
+of St. Matthewe, when that Jesus Christ had made two men whole, the
+whiche, was possessed with a legion of devils. A legion is IX M. IX C.
+nynety and nyne: the sayd devyls dyd desyre Jesus, that when they were
+expelled out of the aforesayde twoo men, that they might enter into a
+herde of hogges, and so they did, and the hogges did runne into the sea
+and were drowned. I consyderynge this, and weke of faith and afeard,
+crossed myselfe and durste not heare and se such matters, for it was to
+stupendious and above all reason yf I shulde wryte it; and in this matter
+I dyd marvell of an other thynge; if the efficacitie of such makynge one
+whole, dyd rest in the vertue that was in the pyller, or els in the wordes
+that the preest dyd speake. I do judge it shulde be in the holy wordes
+that the prest dyd speak, and not in the pyller; for and yf it were in the
+pyller, the Byshops, and the Cardinalles that hathe ben many yeres past,
+and those that were in my tyme, and they that hath bin sence, wolde have
+had it in more reverence, and not to suffre rayne, hayle, snowe, and such
+wether to fal on it, for it hath no coverynge, but at laste when that I
+did consyder that the vernacle, the phisnomy of Christ, and scarse the
+sacrament of the aulter was in maner uncovered and al St. Peters Churche
+downe in ruyne, and utterly decayed, and nothing set by, consideringe in
+olde chapels, beggers and baudes, hoores and theves dyd lye within them,
+asses and moyles dyd defyle within the precincte of the Churche, and
+byenge and sellynge there was used within the precinct of the sayde church
+that it dyd pytie my harte and mynde to come and se any tyme more the
+sayde place and churche."--_Andrewe Boorde,[2] the seconde Boke of the
+Brevyary of health, 1557, fol. 4th._
+
+To return from this digression. Dr. Ferriar, whom to mention otherwise
+than as a man of genius, of learning, and of taste, would be unjust, has
+adopted the generally accepted division of insanity into mania and
+melancholia. In mania he conceives "false perception, and consequently
+confusion of ideas, to be a leading circumstance." The latter, he supposes
+to consist "in intensity of idea, which is a contrary state to false
+perception." From the observations I have been able to make respecting
+Mania, I have by no means been led to conclude, that false perception, is
+a leading circumstance in this disorder, and still less, that confusion of
+ideas must be the necessary consequence of false perception.
+
+By perception I understand, with Mr. Locke, the apprehension[3] of
+sensations; and after a very diligent enquiry of patients who have
+recovered from the disease, and from an attentive observation of those
+labouring under it, I have not frequently found, that insane people
+perceive falsely the objects which have been presented to them.
+
+We find madmen equally deranged upon those ideas, which they have been
+long in the possession of, and on which the perception has not been
+recently exercised, as respecting those, which they have lately received:
+and we frequently find those who become suddenly mad, talk incoherently
+upon every subject, and consequently, upon many, on which the perception
+has not been exercised for a considerable time.
+
+It is well known, that maniacs often suppose they have seen and heard
+those things, which really did not exist at the time; but even this I
+should not explain by any disability, or error of the perception; since it
+is by no means the province of the perception to represent unreal
+existences to the mind. It must therefore be sought elsewhere; most
+probably in the senses.
+
+We sometimes (more especially in the early stages of furious madness) find
+patients from very slight resemblances, and sometimes, where none whatever
+can be perceived by others of sound mind, confounding one person with
+another. Even in this case it does not seem necessary to recur to false
+perception for the explanation. It is equally probable that the organs of
+vision are affected in consequence of the disease of the brain, and
+therefore receive incorrect sensations: and still more likely, from the
+_rapid succession_ in which objects are noticed, that a very slight trait
+of countenance would recal the idea [or name] of some particular person.
+
+I have known many cases of patients who insisted that they had seen the
+devil. It might be urged, that in these instances, the perception was
+vitiated; but it must be observed there could be no perception of that,
+which was not present and existing at the time. Upon desiring these
+patients to describe what they had seen, they all represented him as a
+big, black man, with a long tail, and sharp talons, such as is seen
+pictured in books; a proof that the idea was revived in the mind from some
+former impressions. One of these patients however carried the matter a
+little further, as she solemnly declared, she heard him break the iron
+chain with which God had confined him, and saw him pass fleetly by her
+window, with a truss of straw upon his shoulder.
+
+That "confusion of ideas" should be the necessary consequence of false
+perception, is very difficult to admit. It has often been observed that
+madmen will reason correctly from false premises, and the observation is
+certainly true: we have indeed occasion to notice the same thing in those
+of the soundest minds. It is very possible for the perception to be
+deceived in the occurrence of a thing, which, although it did not actually
+happen, yet was likely to take place; and which had frequently occurred
+before.--The reception of this as a truth, if the person were capable of
+deducing from it the proper inferences, could neither create confusion nor
+irregularity of ideas.
+
+Melancholia, the other form in which this disease is supposed to exist, is
+made by Dr. Ferriar to consist in "intensity of idea." By intensity of
+idea, I presume is meant, that the mind is more strongly fixed on, or
+more frequently recurs to, a certain set of ideas, than when it is in a
+healthy state. But this definition applies equally to mania; for we every
+day see the most furious maniacs suddenly sink into a profound
+melancholia, and the most depressed and miserable objects become violent
+and raving. There are patients in Bethlem Hospital, whose lives are
+divided between furious and melancholic paroxysms, and who, under both
+forms, retain the same set of ideas. It must also have been observed, by
+those who are conversant with this disorder, that there is an intermediate
+state, which cannot be termed maniacal nor melancholic: a state of
+complete insanity, yet unaccompanied by furious or depressing
+passions.[4]
+
+In speaking of the two forms of this disease, mania and melancholia, there
+is a circumstance sufficiently obvious, which hitherto does not appear to
+have been noticed: I mean the rapid or slow succession of the patient's
+ideas. Probably sound and vigorous mind consists as much in the moderate
+succession of our ideas, as in any other circumstance. It may be enquired,
+how we are to ascertain this increased, proportionate, and deficient
+activity of mind? From language, the medium by which thought is conveyed.
+The connexion between thought and utterance is so strongly cemented by
+habit, that the latter becomes the representative of the former.
+
+The physiology of mind, I humbly conceive to be at present in its infancy,
+but there seems good reason to imagine, that furious madness implies a
+rapid succession of ideas; and the circumstance of rage, from whence its
+origin has been deduced, points out the hurried consecution. In this state
+of mind the utterance succeeds
+
+  --------------------"sudden as the spark
+  From smitten steel; from nitrous grain the blaze."
+
+and it frequently happens, after the tumult has subsided, the person
+remembers but little of that which had escaped him.
+
+  "I then, all-smarting with my wounds, being cold,
+  (To be so pestered with a popingay)
+  Out of my greefe, and my Impatience,
+  Answered (neglectingly) _I know not what_--
+  _He should, or should not_: for he made me _mad_."
+
+From this connexion between thought and utterance, we find many persons
+(particularly those who are insane) talking to themselves; especially when
+their minds are intently occupied; and taking the converse, we frequently
+observe those who are desirous to acquire any subject by heart, repeating
+it aloud.
+
+From the same cause we have often occasion to remark, that strong, and
+perhaps involuntary, propensity to repeat the emphatical words in a
+sentence, and which are commonly the last, before we endeavour to reply
+to, or confute them.
+
+  "_King._ No: on the barren Mountaine let him sterve:
+           For I shall never hold that man my friend
+           Whose tongue shall aske me for one peny cost
+           To ransome home revolted Mortimer.
+
+  "_Hotsp._ Revolted Mortimer?
+            He never did fall off, my Soveraigne Liege,
+            But by the chance of warre:"
+
+As the terms Mania and Melancholia, are in general use, and serve to
+distinguish the forms under which insanity is exhibited, there can be no
+objection to retain them; but I would strongly oppose their being
+considered as opposite diseases. In both there is an equal derangement. On
+dissection, the state of the brain does not shew any appearances peculiar
+to melancholia; nor is the treatment, which I have observed most
+successful, different from that which is employed in mania.
+
+As the practitioner's own mind must be the criterion, by which he infers
+the insanity of any other person; and when we consider the various, and
+frequently opposite, opinions of these intellectual arbitrators; the
+reader will be aware that I have not abstained from giving a definition of
+madness without some reason. There is indeed a double difficulty: the
+definition ought to comprize the aberrations of the lunatic, and fix the
+standard for the practitioner.
+
+But it may be assumed that sound mind and insanity stand in the same
+predicament, and are opposed to each other in the same manner, as right to
+wrong, and as truth to the lie. In a general view no mistake can arise,
+and where particular instances create embarrassment, those most conversant
+with such persons will be best able to determine.
+
+The terms sound mind and insanity are sufficiently plain. If to an
+ordinary observer, a person were to talk in an incoherent manner, he would
+think him mad; if his conduct were regular, and his observations
+pertinent, he would pronounce him in his senses: the two opposite states,
+well marked, are well understood; but there are many different shades,
+which are not so likely to strike the common examiner.
+
+
+
+
+CHAP. II.
+
+SYMPTOMS OF THE DISEASE.
+
+
+On this part of the subject, authors have commonly descended to minute
+particularities, and studied discriminations. Distinctions have been
+created, rather from the peculiar turn of the patient's propensities and
+discourse, than from any marked difference in the varieties and species of
+the disorder. Every person of sound mind, possesses something peculiar to
+himself, which distinguishes him from others, and constitutes his
+idiosyncrasy of body and individuality of character: in the same manner,
+every lunatic discovers something singular in his aberrations from sanity
+of intellect. It is not my intention to record these splintered
+subdivisions, but to exhibit the prominent features, by which insanity may
+be detected, as far as such appearances seem worthy of remark, and have
+been the subject of my own observation.
+
+In most public hospitals, the first attack of diseases is seldom to be
+observed; and it might naturally be supposed, that there existed in
+Bethlem, similar impediments to an accurate knowledge of incipient
+madness. It is true, that all who are admitted into it, have been a
+greater, or less time afflicted with the disorder; yet from the occasional
+relapses to which insane persons are subject, we have frequent and
+sufficient opportunities of observing the beginning, and tracing the
+progress of this disease.
+
+Among the incurables, there are some, who have intervals of perfect
+soundness of mind; but who are subject to relapses, which would render it
+improper, and even dangerous, to trust them at large in society: and with
+those, who are upon the curable establishment, a recurrence of the malady
+very frequently takes place. Upon these occasions, there is an ample scope
+for observing the first attack of the disease.
+
+On the approach of mania, they first become uneasy,[5] are incapable of
+confining their attention, and neglect any employment to which they have
+been accustomed; they get but little sleep, they are loquacious, and
+disposed to harangue, and decide promptly, and positively upon every
+subject that may be started. Soon after, they are divested of all
+restraint in the declaration of their opinions of those, with whom they
+are acquainted. Their friendships are expressed with fervency and
+extravagance; their enmities with intolerance and disgust. They now become
+impatient of contradiction, and scorn reproof. For supposed injuries, they
+are inclined to quarrel and fight with those about them. They have all the
+appearance of persons inebriated, and those who are unacquainted with the
+symptoms of approaching mania, generally suppose them to be in a state of
+intoxication. At length suspicion creeps in upon the mind, they are aware
+of plots, which had never been contrived, and detect motives that were
+never entertained. At last the succession of ideas is too rapid to be
+examined;[6] the mind becomes crouded with thoughts, and confusion
+ensues.
+
+Those under the influence of the depressing passions, will exhibit a
+different train of symptoms. The countenance wears an anxious and gloomy
+aspect, and they are little disposed to speak. They retire from the
+company of those with whom they had formerly associated, seclude
+themselves in obscure places, or lie in bed the greatest part of their
+time. Frequently they will keep their eyes fixed to some object for hours
+together, or continue them an equal time "bent on vacuity." They next
+become fearful, and conceive a thousand fancies: often recur to some
+immoral act which they have committed, or imagine themselves guilty of
+crimes which they never perpetrated: believe that God has abandoned them,
+and, with trembling, await his punishment. Frequently they become
+desperate, and endeavour by their own hands to terminate an existence,
+which appears to be an afflicting and hateful incumbrance.
+
+Madmen, do not always continue in the same furious or depressed states:
+the maniacal paroxysm abates of its violence, and some beams of hope,
+occasionally cheer the despondency of the melancholic patients. We have
+in the hospital some unfortunate persons, who are obliged to be secured
+the greater part of their time, but who now and then become calm, and to a
+certain degree rational: upon such occasions, they are allowed a greater
+range, and are admitted to associate with the others. In some instances
+the degree of rationality is more considerable; they conduct themselves
+with propriety, and in a short conversation will appear sensible and
+coherent. Such remission has been generally termed a _lucid interval_.
+
+When medical persons are called upon to attend a commission of lunacy,
+they are always asked, whether the patient has had a _lucid interval_? A
+term of such latitude as interval, requires to be explained in the most
+perspicuous and accurate manner. [The circumstances which probably
+occasioned the employment of this term are pointed out in the chapter
+which enumerates the causes of insanity.] In common language, it is made
+to signify both a moment and a number of years, consequently it does not
+comprize any stated time. The term _lucid interval_ is therefore relative.
+As the law requires a precise developement of opinion, I should define a
+_lucid interval_ to be a complete recovery of the patient's intellects,
+ascertained by repeated examinations of his conversation, and by constant
+observation of his conduct, for a time sufficient to enable the
+superintendant to form a correct judgment. Unthinking people, are
+frequently led to conclude, that if, during a short conversation, a person
+under confinement shall bewray nothing absurd or incorrect, he is well,
+and often remonstrate on the injustice of secluding him from the world.
+Even in common society, there are many persons whom we never suspect,
+from a few trifling topics of discourse, to be shallow minded; but, if we
+start a subject, and wish to discuss it through all its ramifications and
+dependancies, we find them incapable of pursuing a connected chain of
+reasoning. In the same manner insane people will often, for a short time,
+conduct themselves, both in conversation and behaviour, with such
+propriety, that they appear to have the just exercise and direction of
+their faculties: but let the examiner protract the discourse until the
+favourite subject shall have got afloat in the mad man's brain, and he
+will be convinced of the hastiness of his decision. To those unaccustomed
+to insane people, a few coherent sentences, or rational answers, would
+indicate a lucid interval, because they discovered no madness; but he, who
+is in possession of the peculiar turn of the patient's thoughts, might
+lead him to disclose them, or by a continuance of the conversation, they
+would spontaneously break forth. A beautiful illustration of this is
+contained in the Rasselas of Dr. Johnson, where the astronomer is admired
+as a person of sound intellect and great acquirements by Imlac, who is
+himself a philosopher, and a man of the world. His intercourse with the
+astronomer is frequent; and he always finds in his society information and
+delight. At length he receives Imlac into the most unbounded confidence,
+and imparts to him the momentous secret. "Hear, Imlac, what thou wilt not,
+without difficulty, credit. I have possessed, for five years, the
+regulation of weather, and the distribution of the seasons. The Sun has
+listened to my dictates, and passed from tropic to tropic by my direction.
+The clouds, at my call, have poured their waters, and the Nile has
+overflowed at my command. I have restrained the rage of the Dog-star, and
+mitigated the fervours of the Crab. The winds alone, of all the elemental
+powers, have hitherto refused my authority; and multitudes have perished
+by equinoctial tempests, which I found myself unable to prohibit or
+restrain. I have administered this great office with exact justice, and
+made to the different nations of the earth an impartial dividend of rain
+and sunshine. What must have been the misery of half the globe, if I had
+limited the clouds to particular regions, or confined the Sun to either
+side of the Equator?"
+
+A real case came under my observation some years ago, and which is equally
+apposite to the subject. A young man had become insane from habitual
+intoxication; and, during the violence of his disorder, had attempted to
+destroy himself. Under a supposed imputation of having unnatural
+propensities, he had amputated his penis, with a view of precluding any
+future insinuations of that nature. For many months, after he was
+admitted into the hospital, he continued in a state which obliged him to
+be strictly confined, as he constantly meditated his own destruction. On a
+sudden, he became apparently well, was highly sensible of the delusion
+under which he had laboured, and conversed, as any other person, upon the
+ordinary topics of discourse. There was, however, something in the reserve
+of his manner, and peculiarity of his look, which persuaded me he was not
+well, although no incoherence could be detected in his conversation. I had
+observed him for some days to walk rather lame, and once or twice had
+noticed him sitting with his shoes off, rubbing his feet. On enquiring
+into the motives of his doing so, he replied, that his feet were
+blistered, and wished that some remedy might be applied to remove the
+vesications. When I requested to look at his feet, he declined it, and
+prevaricated, saying, that they were only tender and uncomfortable. In a
+few days afterwards, he assured me they were perfectly well. The next
+evening I observed him, unperceived, still rubbing his feet, and then
+peremptorily insisted on examining them. They were quite free from any
+disorder. He now told me, with some embarrassment, that he wished much for
+a confidential friend, to whom he might impart a secret of importance;
+upon assuring him that he might trust me, he said, that the boards on
+which he walked, (the second story) were heated by subterraneous fires,
+under the direction of invisible and malicious agents, whose intentions,
+he was well convinced, were to consume him by degrees.
+
+From these considerations, I am inclined to think, that a _lucid interval_
+includes all the circumstances, which I have enumerated in my definition
+of it. If the person, who is to examine the state of the patient's mind,
+be unacquainted with his peculiar opinions, he may be easily deceived,
+because, wanting this information, he will have no clue to direct his
+enquiries, and madmen do not always, nor immediately intrude their
+incoherent notions: they have sometimes such a high degree of control over
+their minds, that when they have any particular purpose to carry, they
+will affect to renounce those opinions, which shall have been judged
+inconsistent: and it is well known, that they have often dissembled their
+resentment, until a favourable opportunity has occurred of gratifying
+their revenge.
+
+Of this restraint, which madmen have sometimes the power of imposing on
+their opinions, the remark has been so frequent, that those who are more
+immediately about their persons, have termed it, in their rude phrase,
+_stifling the disorder_.
+
+Among the numerous instances of this cunning and dissimulation, which I
+have witnessed in insane persons, the relation of one case will be
+sufficient to exemplify the subject.
+
+An Essex farmer, about the middle age, had on one occasion so completely
+masked his disorder, that I was induced to suppose him well, when he was
+quite otherwise. He had not been at home many hours, before his
+derangement was discernable by all those, who came to congratulate him on
+the recovery of his reason. His impetuosity, and mischievous disposition
+daily increasing, he was sent to a private mad-house; there being, at that
+time, no vacancy in the hospital. Almost from the moment of his
+confinement he became tranquil, and orderly, but remonstrated on the
+injustice of his seclusion.
+
+Having once deceived me, he wished much, that my opinion should be taken
+respecting the state of his intellects, and assured his friends that he
+would submit to my determination. I had taken care to be well prepared for
+this interview, by obtaining an accurate account of the manner in which he
+had conducted himself. At this examination, he managed himself with
+admirable address. He spoke of the treatment he had received, from the
+persons under whose care he was then placed, as most kind and fatherly: he
+also expressed himself as particularly fortunate in being under my care,
+and bestowed many handsome compliments on my skill in treating this
+disorder, and expatiated on my sagacity in perceiving the slightest tinges
+of insanity. When I wished him to explain certain parts of his conduct,
+and particularly some extravagant opinions, respecting certain persons and
+circumstances, he disclaimed all knowledge of such circumstances, and felt
+himself hurt, that my mind should have been poisoned so much to his
+prejudice. He displayed equal subtilty on three other occasions when I
+visited him; although by protracting the conversation, he let fall
+sufficient to satisfy my mind that he was a mad-man. In a short time he
+was removed to the hospital, where he expressed great satisfaction in
+being under my inspection. The private mad-house, which he had formerly so
+much commended, now became the subject of severe animadversion; he said
+that he had there been treated with extreme cruelty; that he had been
+nearly starved, and eaten up by vermin of various descriptions. On
+enquiring of some convalescent patients, I found (as I had suspected) that
+I was as much the subject of abuse, when absent, as any of his supposed
+enemies; although to my face his behaviour was courteous and respectful.
+More than a month had elapsed, since his admission into the hospital,
+before he pressed me for my opinion; probably confiding in his address,
+and hoping to deceive me. At length he appealed to my decision, and urged
+the correctness of his conduct during confinement as an argument for his
+liberation. But when I informed him of circumstances he supposed me
+unacquainted with, and assured him, that he was a proper subject for the
+asylum where he then inhabited; he suddenly poured forth a torrent of
+abuse; talked in the most incoherent manner; insisted on the truth of what
+he had formerly denied; breathed vengeance against his family and friends,
+and became so outrageous that it was necessary to order him to be strictly
+confined. He continued in a state of unceasing fury for more than fifteen
+months.
+
+As the memory, appears to be particularly defective in cases of insanity,
+it is much to be wished, that we possessed a correct history, and
+physiological account of this wonderful faculty. Unfortunately, this
+knowledge is not to be sought for with much prospect of attainment, from
+books which treat of the human mind and its philosophy; nor is the present
+work, to be considered as the depository of such information. A deliberate
+attention, to the precise order in which we acquire information on any
+subject; a consideration of the effects of its repetition; an
+investigation of the result (comparing it to a chain) whenever the links
+are separated, together with a knowledge of the contrivance of abbreviated
+signs, would perhaps render the matter sufficiently intelligible. But it
+would be necessary, thoroughly to understand the nature of the thing, of
+which the sign has been abbreviated: particularly, as the usual mode of
+education is satisfied with possessing the convenience of the
+abbreviation, without any inquiry into the nature of the thing, and the
+cause of the abbreviation of its sign. This faulty mode of instruction,
+has furnished us with a profusion of names, and left us ignorant of the
+things they represent.
+
+Ben Johnson has afforded us the shortest, and probably, the best account
+of memory.
+
+"_Memory_ of all the _powers_ of the mind, is the most _delicate_, and
+frail: It is the first of our _faculties_ that age invades. Seneca, the
+Father, the _Rhetorician_, confesseth of himself, he had a miraculous one,
+not only to receive, but to hold. I myself could in my youth, have
+repeated all that ever I had made, and so continued till I was past
+forty: since it is much decayed in me. Yet I can repeat whole books that I
+have read, and _Poems_ of some selected friends, which I have lik'd to
+charge my memory with. It was wont to be faithful to me, but shaken with
+_Age_ now, and _Sloth_ (which weakens the strongest abilities) it may
+perform somewhat, but cannot promise much. By exercise it is to be made
+better and serviceable. Whatsoever I pawn'd with it while I was young and
+a boy, it offers me readily, and without stops: but what I trust to it
+now, or have done of later years, it lays up more negligently, and
+sometimes loses; so that I receive mine own (though frequently called for)
+as if it were new and borrow'd. Nor do I always find presently from it
+what I do seek; but while I am doing another thing, that I laboured for
+will come: and what I sought with trouble, will offer itself when I am
+quiet. Now in some men I have found it as happy as nature, who, whatsoever
+they read or pen, they can say without book presently; as if they did then
+write in their mind. And it is more a wonder in such as have a swift
+stile, for their Memories are commonly slowest; such as torture their
+writings, and go into council for every word, must needs fix somewhat, and
+make it their own at last, though but through their own
+vexation."--_Discoveries, vol. vi. p. 240, 1716._
+
+If in a chain of ideas, a number of the links are broken, or leaving out
+the metaphor, if there be an inability to recollect circumstances in the
+order, in which they occurred, the mind cannot possess any accurate
+information. When patients of this description are asked a question, they
+appear as if awakened from a sound sleep: they are searching, they know
+not where, for the proper materials of an answer, and, in the painful,
+and fruitless efforts of recollection, generally lose sight of the
+question itself. Shakespeare, the highest authority in every thing
+relating to the human mind and its affections, seems to be persuaded, that
+some defect of memory is necessary to constitute madness.
+
+                          "It is not madnesse
+  That I have uttered: bring me to the test
+  And I the matter will _re-word_, which madnesse
+  Would gambol from."--_Hamlet, Act III. Scene 4._
+
+In persons of sound mind, as well as in maniacs, the memory is the first
+power which decays; and there is something remarkable in the manner of its
+decline. The transactions of the latter part of life are feebly
+recollected, whilst the scenes of youth and of manhood, remain more
+strongly impressed. When I have listened to the conversations of the old
+incurable patients, the topic has generally turned upon the transactions
+of early days; and, on the circumstances of that period of life, they have
+frequently spoken with tolerable correctness. In many cases, where the
+mind has been injured by intemperance, the same withering of the
+recollection may be observed. It may, perhaps, arise from the mind at an
+early period of life, being most susceptible and retentive of impressions,
+and from a greater disposition to be pleased, with the objects which are
+presented: whereas, the cold caution, and fastidiousness with which age
+surveys the prospects of life, joined to the dulness of the senses, and
+the slight curiosity which prevails, will, in some degree, explain the
+difficulty of recalling the history of later transactions.
+
+Insane people, who have been good scholars, after a long confinement,
+lose, in a wonderful degree, the correctness of orthography: when they
+write, above half the words are frequently mis-spelt, they are written
+according to the pronunciation. It shews how treacherous the memory is
+without reinforcement. The same necessity of a constant recruit, and
+frequent review of our ideas, satisfactorily explains, why a number of
+patients lapse nearly into a state of ideotism. These have, for some
+years, been the silent and gloomy inhabitants of the hospital, who have
+avoided conversation, and courted solitude; consequently have acquired no
+new ideas, and time has effaced the impression of those, formerly stamped
+on the mind. Mr. Locke, well observes, although he speaks figuratively,
+"that there seems to be a constant decay of all our ideas, even of those
+which are struck deepest, and in minds the most retentive; so that, if
+they be not sometimes renewed by repeated exercise of the senses, or
+reflection on those kind of objects, which at first occasioned them, the
+print wears out, and at last there remains nothing to be seen."
+
+Connected with loss of memory, there is a form of insanity which occurs in
+young persons; and, as far as these cases have been the subject of my
+observation, they have been more frequently noticed in females. Those whom
+I have seen, have been distinguished by prompt capacity and lively
+disposition: and in general have become the favourites of parents and
+tutors, by their facility in acquiring knowledge, and by a prematurity of
+attainment. This disorder commences, about, or shortly after, the period
+of menstruation, and in many instances has been unconnected with
+hereditary taint; as far as could be ascertained by minute enquiry. The
+attack is almost imperceptible; some months usually elapse, before it
+becomes the subject of particular notice; and fond relatives are
+frequently deceived by the hope that it is only an abatement of excessive
+vivacity, conducing to a prudent reserve, and steadiness of character. A
+degree of apparent thoughtfulness and inactivity precede, together with a
+diminution of the ordinary curiosity, concerning that which is passing
+before them; and they therefore neglect those objects and pursuits which
+formerly proved sources of delight and instruction. The sensibility
+appears to be considerably blunted; they do not bear the same affection
+towards their parents and relations; they become unfeeling to kindness,
+and careless of reproof. To their companions they shew a cold civility,
+but take no interest whatever in their concerns. If they read a book, they
+are unable to give any account of its contents: sometimes, with steadfast
+eyes, they will dwell for an hour on one page, and then turn over a number
+in a few minutes. It is very difficult to persuade them to write, which
+most readily develops their state of mind: much time is consumed and
+little produced. The subject is repeatedly begun, but they seldom advance
+beyond a sentence or two: the orthography becomes puzzling, and by
+endeavouring to adjust the spelling, the subject vanishes. As their apathy
+increases they are negligent of their dress, and inattentive to personal
+cleanliness. Frequently they seem to experience transient impulses of
+passion, but these have no source in sentiment; the tears, which trickle
+down at one time, are as unmeaning as the loud laugh which succeeds them;
+and it often happens that a momentary gust of anger, with its attendant
+invectives, ceases before the threat can be concluded. As the disorder
+increases, the urine and fæces are passed without restraint, and from the
+indolence which accompanies it, they generally become corpulent. Thus in
+the interval between puberty and manhood, I have painfully witnessed this
+hopeless and degrading change, which in a short time has transformed the
+most promising and vigorous intellect into a slavering and bloated ideot.
+
+Of the organs of sense, which become affected in those labouring under
+insanity, the ear, more particularly suffers. I scarcely recollect an
+instance of a lunatic becoming blind, but numbers are deaf. It is also
+certain that in these persons, more delusion is conveyed through the ear
+than the eye, or any of the other senses. Those who are not actually deaf,
+are troubled with difficulty of hearing, and tinnitus aurium. Thus an
+insane person shall suppose that he has received a commission from the
+Deity; that he has ordered him to make known his word, or to perform some
+act, as a manifestation of his will and power. It is however much to be
+regretted, that these divine commissions generally terminate in human
+mischief and calamity, and instances are not unfrequent, where these holy
+inspirations, have urged the unfortunate believer to strangle his wife,
+and attempt the butchery of his children. From this source may be
+explained, the numerous delusions of modern prophecies, which
+circumstantially relate the gossipings of angels, and record the
+hallucinations of feverish repose.
+
+In consequence of some affection of the ear, the insane sometimes insist
+that malicious agents contrive to blow streams of infected air into this
+organ: others have conceived, by means of what they term hearkening wires
+and whiz-pipes, that various obscenities and blasphemies are forced into
+their minds; and it is not unusual for those who are in a desponding
+condition, to assert, that they distinctly hear the devil tempting them
+to self-destruction.
+
+A considerable portion of the time of many lunatics, is passed in replies
+to something supposed to be uttered. As this is an increasing habit, so it
+may be considered as an unfavourable symptom, and at last the patient
+becomes so abstracted from surrounding objects, that the greater part of
+the day is consumed in giving answers to these supposed communications. It
+sometimes happens that the intelligence conveyed, is of a nature to
+provoke the mad-man, and on these occasions, he generally exercises his
+wrath on the nearest bystander; whom he supposes, in the hurry of his
+anger, to be the offending party.
+
+In the soundest state of our faculties, we are more liable to be deceived
+by the ear, than through the medium of the other senses: a partial
+obstruction by wax, shall cause the person so affected, to hear the
+bubbling of water, the ringing of bells, or the sounds of musical
+instruments; and on some occasions, although the relation seems tinged
+with superstition, men of undeviating veracity, and of the highest
+attainments, have asserted, that they have heard themselves _called_. "He
+[Dr. Johnson] mentioned a thing as not unfrequent, of which I [Mr.
+Boswell] had never heard before--being _called_, that is, hearing one's
+name pronounced by the voice of a known person at a great distance, far
+beyond the possibility of being reached by any sound, uttered by human
+organs. An acquaintance on whose veracity I can depend, told me, that
+walking home one evening to Kilmarnock, he heard himself called from a
+wood, by the voice of a brother who had gone to America; and the next
+packet brought account of that brother's death. Macbean asserted that
+this inexplicable _calling_ was a thing very well known. Dr. Johnson said,
+that one day at Oxford, as he was turning the key of his chamber, he heard
+his mother distinctly call _Sam_. She was then at Litchfield; but nothing
+ensued. This phænomenon is, I think, as wonderful as any other mysterious
+fact, which many people are very slow to believe, or rather, indeed,
+reject with an obstinate contempt."--_Boswell's Life of Dr. Johnson,
+4to. vol. ii. p. 384._
+
+One of the most curious cases of this nature which has fallen under my
+observation, I shall here venture to relate, for the amusement of the
+reader. The patient was a well educated man, about the middle age; he
+always stopped his ears closely with wool, and, in addition to a flannel
+night-cap, usually slept with his head in a tin saucepan. Being asked the
+reason why he so fortified his head, he replied, "To prevent the
+intrusion of the _sprites_." After having made particular enquiry
+concerning the nature of these beings, he gravely communicated the
+following information:--"Sir, you must know that in the human seminal
+fluid there are a number of vital particles, which being injected into the
+female, impregnate her, and form a foetus of muscles and bones. But this
+fluid has other properties, it is capable, by itself, of producing
+vitality under certain circumstances, and experienced chemists and
+hermetical philosophers have devised a method of employing it for other
+purposes, and some, the most detrimental to the condition and happiness of
+man. These philosophers, who are in league with princes, and their
+convenient and prostituted agents, contrive to extract a portion of their
+own semen, which they conserve in rum or brandy: these liquors having the
+power of holding for a considerable time the seminal fluid, and keeping
+its vitality uninjured. When these secret agents intend to perform any of
+their devilish experiments on a person, who is an object of suspicion to
+any of these potentates, they cunningly introduce themselves to his
+acquaintance, lull him to sleep by artificial means, and during his
+slumbers, infuse a portion of their seminal fluid (conserved in rum or
+brandy) into his ears.
+
+"As the semen in the natural commerce with the woman, produces a child,
+so, having its vitality conserved by the spirit, it becomes capable of
+forming a _sprite_; a term, obviously derived from the spirit in which it
+had been infused. The ear is the most convenient nidus for hatching these
+vital particles of the semen. The effects produced on the individual,
+during the incubation of these seminal germs, are very disagreeable; they
+cause the blood to mount into the head, and produce considerable giddiness
+and confusion of thought. In a short time, they acquire the size of a
+pin's head; and then they perforate the drum of the ear, which enables
+them to traverse the interior of the brain, and become acquainted with the
+hidden secrets of the person's mind. During the time they are thus
+educated, they enlarge according to the natural laws of growth; they then
+take wing, and become invisible beings, and, from the strong ties of
+natural affection, assisted by the principle of attraction, they revert to
+the parent who afforded the semen, and communicate to him their
+surreptitious observations and intellectual gleanings. In this manner, I
+have been defrauded of discoveries which would have entitled me to
+opulence and distinction, and have lived to see others reap honours and
+emoluments, for speculations which were the genuine offsprings of my own
+brain."
+
+By some persons, madness has been considered as a state of mind analogous
+to dreaming: but an inference of this kind supposes us fully acquainted
+with the actual state, or condition of the mind in dreaming, and in
+madness. The whole question hinges on a knowledge of this _state of mind_,
+which I fear is still involved in obscurity. As it is not the object of
+the present work to discuss this curious question, the reader is referred
+to the fifth section of the first part of Mr. Dugald Stewart's Elements of
+the Philosophy of the Human Mind, and to the note, o, at the end; he will
+also find the subject treated with considerable ingenuity in the eleventh
+section of Mr. Brown's Observations on Zoonomia.
+
+There is, however, a circumstance, which to my knowledge, has not been
+noticed by those who have treated on this subject, and which appears to
+establish a marked distinction between madness and dreaming. In madness,
+the delusion we experience is most frequently conveyed through the ear; in
+dreaming, the deception is commonly optical; we see much, and hear little;
+indeed dreaming, at least with myself, seems to be a species of
+intelligible pantomime, that does not require the aid of language to
+explain it. It is true, that some who have perfectly recovered from this
+disease, and who are persons of good understanding and liberal education,
+describe the state they were in, as resembling a dream: and when they have
+been told how long they were disordered, have been astonished that the
+time passed so rapidly away. But this only refers to that consciousness of
+delusion, which is admitted by the patient on his return to reason; in the
+same manner as the man awake, smiles at the incongruous images, and
+abrupt transitions of the preceding night. In neither condition, does the
+consciousness of delusion, establish any thing explanatory of the _state_
+of the mind.
+
+In a description of madness, it would be blameable to omit a form of this
+disease which is commonly very intractable, and of the most alarming
+consequences; I mean, the insanity which arises from the habit of
+intoxication. All persons who have had any experience of this disease,
+readily allow that fermented liquors, taken to excess, are capable of
+producing mental derangement: but the medical practitioner has in such
+cases, to contend, and generally without effect, with popular prejudice,
+and sometimes, with the subordinate advisers of the law.
+
+To constitute madness, the minds of ignorant people expect a display of
+continued violence, and they are not satisfied that the person can be
+pronounced in that state, without they see him exhibit the pranks of a
+baboon, or hear him roar and bellow like a beast. By these people the
+patient is stated only to be intemperate; they confess that he does very
+foolish things when intoxicated; but that he is not mad, and only requires
+to be restrained from drinking. Thus, a man is permitted slowly to poison
+and destroy himself; to produce a state of irritation, which disqualifies
+him for any of the useful purposes of life; to squander his property
+amongst the most worthless and abandoned; to communicate a loathsome and
+disgraceful disease to a virtuous wife, and leave an innocent and helpless
+family to the meager protection of the parish. If it be possible, the law
+ought to define the circumstances, under which it becomes justifiable, to
+restrain a human being from effecting his own destruction, and involving
+his family in misery and ruin. When a man suddenly bursts through the
+barriers of established opinions; if he attempt to strangle himself with a
+cord, to divide his larger blood-vessels with a knife, or swallow a vial
+full of laudanum, no one entertains any doubt of his being a proper
+subject for the superintendance of keepers, but he is allowed, without
+control, by a gradual process, to undermine the fabric of his own health,
+and destroy the prosperity of his family.
+
+All patients have not the same degree of memory of what has passed during
+the time they were disordered: and I have frequently remarked, when they
+were unable to give any account of the peculiar opinions which they had
+indulged, during a raving paroxysm of long continuance, that they well
+remembered any coercion which had been used, or any kindness which had
+been shewn them.
+
+Insane people, are said to be generally worse in the morning; in some
+cases they certainly are so, but perhaps not so frequently as has been
+supposed. In many instances (and, as far as I have observed) in the
+beginning of the disease, they are more violent in the evening, and
+continue so the greatest part of the night. It is, however, a certain
+fact, that the majority of patients of this description, have their
+symptoms aggravated by being placed in a recumbent posture. They seem,
+themselves, to avoid the horizontal position as much as possible, when
+they are in a raving state: and when so confined that they cannot be
+erect, will keep themselves seated upon the breech.
+
+Many of those who are violently disordered will continue particular
+actions for a considerable time: some are heard to gingle the chain, with
+which they are confined, for hours without intermission; others, who are
+secured in an erect posture, will beat the ground with their feet the
+greatest part of the day. Upon enquiry of such patients, after they have
+recovered, they have assured me that these actions afforded them
+considerable relief. We often surprize persons who are supposed free from
+any mental derangement, in many strange and ridiculous movements,
+particularly if their minds be intently occupied:[7]--this does not
+appear to be so much the effect of habit, as of a particular state of
+mind.
+
+Among the bodily particularities which mark this disease, may be observed
+the protruded, and oftentimes glistening eye, and a peculiar cast of
+countenance, which, however, cannot be described. In some, an appearance
+takes place which has not hitherto been noticed by authors. This is a
+relaxation of the integuments of the cranium, by which they may be
+wrinkled, or rather gathered up by the hand to a considerable degree. It
+is generally most remarkable on the posterior part of the scalp; as far as
+my enquiries have reached, it does not take place in the beginning of the
+disease, but after a raving paroxysm of some continuance. It has been
+frequently accompanied with contraction of the iris.
+
+On the suggestion of a medical gentleman, I was induced to ascertain the
+prevailing complexion and colour of the hair in insane patients. Out of
+two hundred and sixty-five who were examined, two hundred and five were of
+a swarthy complexion, with dark, or black hair; the remaining sixty were
+of a fair skin, and light, brown, or redhaired. What connexion this
+proportion may have, with the complexion and colour of the hair of the
+people of this country in general, and what alterations may have been
+produced by age, or a residence in other climates, I am totally
+uninformed.
+
+Of the power which maniacs possess of resisting cold, the belief is
+general, and the histories which are on record are truly wonderful: it is
+not my wish to disbelieve, nor my intention to dispute them; it is proper,
+however, to state that the patients in Bethlem Hospital possess no such
+exemption from the effects of severe cold. They are particularly subject
+to mortifications of the feet; and this fact is so well established from
+former accidents, that there is an express order of the house, that every
+patient, under strict confinement, shall have his feet examined morning
+and evening in the cold weather by the keeper, and also have them
+constantly wrapped in flannel; and those who are permitted to go about,
+are always to be found as near to the fire as they can get, during the
+winter season.
+
+From the great degree of insensibility which prevails in some states of
+madness, a degree of cold would scarcely be felt by such persons, which
+would create uneasiness in those of sound mind; but experience has shewn
+that they suffer equally from severity of weather. When the mind is
+particularly engaged on any subject, external circumstances affect us less
+than when unoccupied. Every one must recollect that, in following up a
+favourite pursuit, his fire has burned out, without his being sensible of
+the alteration of temperature; but when the performance has been finished,
+or he has become indifferent to it from fatigue, he then becomes sensible
+to cold, which he had not experienced before.
+
+Some maniacs refuse all covering, but these are not common occurrences;
+and it may be presumed, that by a continued exposure to the atmosphere,
+such persons might sustain, with impunity, a low temperature, which would
+be productive of serious injury to those who are clad according to the
+exigences of the season. Such endurance of cold is more probably the
+effect of habit, than of any condition peculiar to insanity.
+
+Having thus given a general account of the symptoms, I shall now lay
+before my readers a history of the appearances which I have noticed on
+opening the heads of several maniacs who have died in Bethlem Hospital.
+
+
+
+
+CHAP. III.
+
+CASES, WITH THE APPEARANCES ON DISSECTION.
+
+
+CASE I.
+
+J. H. a man twenty-eight years of age, was admitted a patient in May,
+1795. He had been disordered for about two months before he came into the
+hospital. No particular cause was stated to have brought on the complaint.
+It was most probably an hereditary affection, as his father had been
+several times insane and confined in our hospital. During the time he was
+in the house, he was in a very low and melancholic state; shewed an
+aversion to food, and said he was resolved to die. His obstinacy in
+refusing all nourishment was very great, and it was with much difficulty
+forced upon him. He continued in this state, but became daily weaker and
+more emaciated until August 1st, when he died. Upon opening the head, the
+pericranium was found loosely adherent to the scull. The bones of the
+cranium were thick. The pia mater was loaded with blood, and the medullary
+substance, when cut into, was full of bloody points. The pineal gland
+contained a large quantity of gritty matter.[8] The consistence of the
+brain was natural; he was opened twenty-four hours after death.
+
+
+CASE II.
+
+J. W. was a man of sixty-two years of age, who had been many years in the
+house as an incurable patient, but with the other parts of whose history I
+am totally unacquainted. He appeared to be a quiet and inoffensive person,
+who found amusement in his own thoughts, and seldom joined in any
+conversation with the other patients: for some months he had been troubled
+with a cough, attended with copious expectoration, which very much reduced
+him; dropsical symptoms followed these complaints. He became every day
+weaker, and on July 10th, 1795, died. He was opened eighteen hours after
+death. The pericranium adhered loosely to the scull; the bones of the
+cranium were unusually thin. There were slight opacities in many parts of
+the tunica arachnoidea; in the ventricles about four ounces of water were
+contained--some large hyatids were discovered on the plexus choroides of
+the right side. The consistence of the brain was natural.
+
+
+CASE III.
+
+G. H. a man twenty-six years of age, was received into the hospital, July
+18th, 1795. It was stated that he had been disordered six weeks previously
+to his admission, and that he never had any former attack. He had been a
+drummer with a recruiting party, and had been for some time in the habit
+of constant intoxication, which was assigned as the cause of his insanity.
+He continued in a violent and raving state about a month, during the whole
+of which time he got little or no sleep. He had no knowledge of his
+situation, but supposed himself with the regiment, and was frequently
+under great anxiety and alarm for the loss of his drum, which he imagined
+had been stolen and sold. The medicines which were given to him he
+conceived were spirituous liquors, and swallowed them with avidity. At the
+expiration of a month he was very weak and reduced; his legs became
+oedematous--his pupils were much diminished. He now believed himself a
+child, called upon the people about him as his playfellows, and appeared
+to recal the scenes of early life with facility and correctness. Within a
+few days of his decease he only muttered to himself. August 26th, he died.
+He was opened six hours after death. The pericranium was loosely adherent.
+The tunica arachnoidea had generally lost its transparency, and was
+considerably thickened. The veins of the pia mater were loaded with blood,
+and in many places seemed to contain air. There was a considerable
+quantity of water between the membranes, and, as nearly as could be
+ascertained, about four ounces in the ventricles, in the cavity of which,
+the veins appeared remarkably turgid. The consistence of the brain was
+more than usually firm.
+
+
+CASE IV.
+
+E. M. a woman, aged sixty, was admitted into the house, August 8th, 1795;
+she had been disordered five months: the cause assigned was extreme grief,
+in consequence of the loss of her only daughter. She was very miserable
+and restless; conceived she had been accused of some horrid crime, for
+which she apprehended she should be burned alive. When any persons entered
+her room she supposed them officers of justice, who were about to drag her
+to some cruel punishment. She was frequently violent, and would strike
+and bite those who came near her. Upon the idea that she should shortly be
+put to death, she refused all sustenance; and it became necessary to force
+her to take it. In this state she continued, growing daily weaker and more
+emaciated, until October 3d, when she died.
+
+Upon opening the head, there was a copious determination of blood to the
+whole contents of the cranium. The pia mater was considerably inflamed;
+there was not any water either in the ventricles or between the membranes.
+The brain was particularly soft. She was opened thirty hours after death.
+
+
+CASE V.
+
+W. P. a young man, aged twenty-five, was admitted into the hospital,
+September 26th, 1795. He had been disordered five months, and had
+experienced a similar attack six years before. The disease was brought on
+by excessive drinking. He was in a very furious state, in consequence of
+which he was constantly confined. He very seldom slept--during the greater
+part of the night he was singing, or swearing, or holding conversations
+with persons he imagined to be about him: sometimes he would rattle the
+chain with which he was confined, for several hours together, and tore
+every thing to pieces within his reach. In the beginning of November, the
+violence of his disorder subsided for two or three days, but afterwards
+returned; and on the 10th he died compleatly exhausted by his
+exertions.--Upon opening the head the pericranium was found firmly
+attached; the pia mater was inflamed, though not to any very considerable
+degree; the tunica arachnoidea in some places was slightly shot with
+blood; the membranes of the brain, and its convolutions, when these were
+removed, were of a brown, or brownish straw colour. There was no water in
+any of the cavities of the brain, nor any particular congestion of blood
+in its substance--the consistence of which was natural. He was opened
+twenty hours after death.
+
+
+CASE VI.
+
+B. H. was an incurable patient, who had been confined in the house from
+the year 1788, and for some years before that time in a private madhouse.
+He was about sixty years of age--had formerly been in the habit of
+intoxicating himself. His character was strongly marked by pride,
+irascibility, and malevolence. During the four last years of his life, he
+was confined for attempting to commit some violence on one of the
+officers of the house. After this, he was seldom heard to speak; yet he
+manifested his evil disposition by every species of dumb insult. Latterly
+he grew suspicious, and would sometimes tell the keeper that his victuals
+were poisoned. About the beginning of December he was taken ill with a
+cough, attended with copious expectoration. Being then asked respecting
+his complaints, he said, he had a violent pain across the stomach, which
+arose from his navel string at his birth having been tied too short. He
+never spoke afterwards, though frequently importuned to describe his
+complaints. He died December 24, 1795.
+
+Upon dividing the integuments of the head, the pericranium was found
+scarcely to adhere to the scull. On the right parietal bone there was a
+large blotch, as if the bone had been inflamed: there were others on
+different parts of the bone, but considerably smaller. The glandulæ
+Pacchioni were uncommonly large: the tunica arachnoidea in many places
+wanted the natural transparency of that membrane: there was a large
+determination of blood to the substance of the brain: the ventricles
+contained about three ounces of water: the consistence of the brain was
+natural. He was opened two days after death.
+
+
+CASE VII.
+
+A. M. a woman, aged twenty-seven, was admitted into the hospital, August
+15, 1795; she had then been eleven weeks disordered. Religious enthusiasm,
+and a too frequent attendance on conventicles, were stated to have
+occasioned her complaint. She was in a very miserable and unhappy
+condition, and terrified by the most alarming apprehensions for the
+salvation of her soul. Towards the latter end of September, she appeared
+in a convalescent state, and continued tolerably well until the middle of
+November, when she began to relapse.
+
+The return of her disorder commenced with loss of sleep. She alternately
+sang, and cried the greatest part of the night. She conceived her inside
+full of the most loathsome vermin, and often felt the sensation as if they
+were crawling into her throat. She was suddenly seized with a strong and
+unconquerable determination to destroy herself; became very sensible of
+her malady, and said, that God had inflicted this punishment on her, from
+having (at some former part of her life) said the Lord's Prayer backwards.
+She continued some time in a restless and forlorn state; at one moment
+expecting the devil to seize upon her and tear her to pieces; in the next,
+wondering that she was not instigated to commit violence on the persons
+about her. On January 12, 1796, she died suddenly. She was opened twelve
+hours after death. The thoracic and abdominal viscera were perfectly
+healthy.
+
+Upon examining the contents of the cranium, the pia mater was considerably
+inflamed, and an extravasated blotch, about the size of a shilling, was
+seen upon that membrane, near the middle of the right lobe of the
+cerebrum. There was no water between the membranes, nor in the ventricles,
+but a general determination of blood to the contents of the cranium. The
+medullary substance, when cut into, was full of bloody points. The
+consistence of the brain was natural.
+
+
+CASE VIII.
+
+M. W. a very tall and thin woman, forty-four years of age, was admitted
+into the hospital, September 19, 1795. Her disorder was of six months
+standing, and eight years before she had also had an attack of this
+disease. The cause assigned to have brought it on, the last time, was the
+loss of some property, the disease having shortly followed that
+circumstance.--The constant tenor of her discourse was, that she should
+live but a short time. She seemed anxiously to wish for her dissolution,
+but had no thoughts of accomplishing her own destruction. In the course of
+a few weeks she began to imagine, that some malevolent person had given
+her mercury with an intention to destroy her. She was constantly shewing
+her teeth, which had decayed naturally, as if this effect had been
+produced by that medicine: at last she insisted, that mercurial
+preparations were mingled in the food and medicines which were
+administered to her. Her appetite was voracious, notwithstanding this
+belief. She had a continual thirst, and drank very large quantities of
+cold water.
+
+On January 14, 1796, she had an apoplectic fit, well marked by stertor,
+loss of voluntary motion, and insensibility to stimuli. On the following
+day she died. She was opened two days after death. There was a remarkable
+accumulation of blood in the veins of the dura and pia mater; the
+substance of the brain was loaded with blood. When the medullary substance
+was cut into, blood oozed from it; and, upon squeezing it, a greater
+quantity could be forced out. On the pia mater covering the right lobe of
+the cerebrum, were some slight extravasations of blood. The ventricles
+contained no water; on the plexus choroides were some vesicles of the size
+of coriander-seeds, filled with a yellow fluid. The pericranium adhered
+firmly to the scull. The consistence of the brain was firmer than usual.
+
+
+CASE IX.
+
+E. D. a woman, aged thirty-six, was admitted into the hospital, February
+20, 1795; she had then been disordered four months. Her insanity came on a
+few days after having been delivered. She had also laboured under a
+similar attack seven years before, which, like the present, supervened
+upon the birth of a child. Under the impression that she ought to be
+hanged, she destroyed her infant, with the view of meeting with that
+punishment. When she came into the house, she was very sensible of the
+crime she had committed, and felt the most poignant affliction for the
+act. For about a month she continued to amend: after which time she became
+more thoughtful, and frequently spoke about the child: great anxiety and
+restlessness succeeded. In this state she remained until April 23, when
+her tongue became thickly furred, the skin parched, her eyes inflamed and
+glassy, and her pulse quick. She now talked incoherently; and, towards the
+evening, merely muttered to herself. She died on the following day
+comatose.
+
+She was opened about twenty-four hours after death. The scull was thick,
+the pericranium scarcely adhered to the bone, the dura mater was also but
+slightly attached to its internal surface. There was a large quantity of
+water between the dura mater and tunica arachnoidea; this latter membrane
+was much thickened, and was of a milky white appearance. Between the
+tunica arachnoidea and pia mater, there was a considerable accumulation of
+water. The veins of the pia mater were particularly turgid. About three
+ounces of water were contained in the lateral ventricles: the veins of the
+membrane lining these cavities were remarkably large and turgid with
+blood. When the medullary substance of the cerebrum and cerebellum was cut
+into, there appeared a great number of bloody points. The brain was of its
+natural consistence.
+
+
+CASE X.
+
+C. M. a man, forty years of age, was admitted into the hospital, December
+26, 1795. It was stated, that he had been disordered two months previously
+to his having been received as a patient. His friends were unacquainted
+with any cause, which was likely to have induced the disease. During the
+time he was in the house he seemed sulky, or rather stupid. He never asked
+any questions, and if spoken to, either replied shortly, or turned away
+without giving any answer. He scarcely appeared to take notice of any
+thing which was going forward, and if told to do any little office
+generally forgot what he was going about, before he had advanced half a
+dozen steps. He remained in this state until the beginning of May, 1796,
+when his legs became oedematous, and his abdomen swollen. He grew very
+feeble and helpless, and died rather suddenly, May 19th. He was opened
+about forty-eight hours after death. The pericranium and dura mater
+adhered firmly to the scull; in many places there was an opake whiteness
+of the tunica arachnoidea. About four ounces of water were found in the
+ventricles. The plexus choroides were uncommonly pale. The medullary
+substance afforded hardly any bloody points when cut into. The consistence
+of the brain I cannot describe better than by saying, it was doughy.
+
+
+CASE XI.
+
+S. M. a man, thirty-six years of age, was admitted as an incurable patient
+in the year 1790. Of the former history of his complaint I have no
+information. As his habits, which frequently came under my observation,
+were of a singular nature, it may not here be improper to relate
+them.--Having at some period of his confinement been mischievously
+disposed, and, in consequence, put under coercion, he never afterwards
+found himself comfortable when at liberty. When he rose in the morning he
+went immediately to the room where he was usually confined, and placed
+himself in a particular corner, until the keeper came to secure him. If
+he found any other patient had pre-occupied his situation, he became very
+outrageous, and generally forced them to leave it. When he had been
+confined, for which he appeared anxious, as he bore any delay with little
+temper, he employed himself throughout the remainder of the day, by
+tramping or shuffling his feet. He was constantly muttering to himself, of
+which scarcely one word in a sentence was intelligible. When an audible
+expression escaped him it was commonly an imprecation. If a stranger
+visited him, he always asked for tobacco, but seldom repeated his
+solicitation. He devoured his food with avidity, and always muttered as he
+ate.
+
+In the month of July, 1796, he was seized with a diarrhoea, which
+afterwards terminated in dysentery. This continued, notwithstanding the
+employment of every medicine usually given in such a case, until his
+death, which took place on September 23, of the same year. He was opened
+twelve hours after death. The scull was unusually thin; the glandulæ
+Pacchioni were large and numerous: there was a very general determination
+of blood to the brain: the medullary substance, when cut, shewed an
+abundance of bloody points: the lateral ventricles contained about four
+ounces of water: the consistence of the brain was natural.
+
+
+CASE XII.
+
+E. R. was a woman, to all appearance about eighty years of age, but of
+whose history, before she came into the hospital, it has not been in my
+power to acquire any satisfactory intelligence. She was an incurable
+patient, and had been admitted on that establishment in February, 1782.
+
+During the time I had an opportunity of observing her, she continued in
+the same state: she appeared feeble and childish. During the course of the
+day, she sat in a particular part of the common-room, from which she never
+stirred. Her appetite was tolerably good, but it was requisite to feed
+her. Except she was particularly urged to speak she never talked. As the
+summer declined she grew weaker, and died October 19, 1796, apparently
+worn out. She was opened two days after death. The scull was particularly
+thin; the pericranium adhered firmly to the bone, and the scull-cap was
+with difficulty separated from the dura mater. There was a very large
+quantity of water between the membranes of the brain: the glandulæ
+Pacchioni were uncommonly large: the tunica arachnoidea was in many
+places blotched and streaked with opacities: when the medullary substance
+of the brain was cut into, it was every where bloody; and blood could be
+pressed from it, as from a sponge. There were some large hydatids on the
+plexus choroides: in the ventricles about a tea spoonful of water was
+observed: the consistence of the brain was particularly firm, but it could
+not be called elastic. There were no symptoms of general dropsy.
+
+
+CASE XIII.
+
+J. D. a man, thirty-five years of age, was admitted into the hospital in
+October, 1796. He was a person of good education, and had been regularly
+brought up to medicine, which he had practised in this town for several
+years. It was stated by his friends, that, about two years before, he had
+suffered a similar attack, which continued six months: but it appears
+from the observations of some medical persons, that he never perfectly
+recovered from it, although he returned to the exercise of his profession.
+A laborious attention to business, and great apprehensions of the want of
+success, were assigned as causes of his malady. In the beginning of the
+year 1796 the disease recurred, and became so violent that it was
+necessary to confine him.
+
+At the time he was received into Bethlem hospital, he was in an unquiet
+state, got little or no sleep, and was constantly speaking loudly: in
+general he was worse towards evening. He appeared little sensible of
+external objects: his exclamations were of the most incoherent nature.
+
+During the time he was a patient he was thrice cupped on the scalp. After
+each operation, he became rational to a certain degree; but these
+intervals were of a short continuance, as he relapsed in the course of a
+few hours. The scalp, particularly at the posterior part of the head, was
+so loose that a considerable quantity of it could be gathered up by the
+hand.[9] The violence of his exertions at last exhausted him, and on
+December 11, he died. He was opened about twenty-four hours after death.
+There was a large quantity of water between the dura mater and tunica
+arachnoidea, and also between this latter membrane and the pia mater. The
+tunica arachnoidea was thickened and opake; the vessels of the pia mater
+were loaded with blood: when the medullary substance was cut into, it was
+very abundant in bloody points: about three ounces of water were contained
+in the lateral ventricles: the plexus choroides were remarkably turgid
+with blood: a quantity of water was found in the theca vertebralis: the
+consistence of the brain was natural.
+
+
+CASE XIV.
+
+J. C. a man, aged sixty-one, was admitted into the hospital September 17,
+1796. It was stated, that he had been disordered ten months. He had for
+thirty years kept a public house, and had for some time been in the habit
+of getting intoxicated. His memory was considerably impaired:
+circumstances were so feebly impressed on his mind, that he was unable to
+give any account of the preceding day. He appeared perfectly reconciled to
+his situation, and conducted himself with order and propriety. As he
+seldom spoke but when interrogated, it was not possible to collect his
+opinions. In this quiet state he continued about two months, when he
+became more thoughtful and abstracted, walked about with a quick step, and
+frequently started, as if suddenly interrupted. He was next seized with
+trembling, appeared anxious to be released from his confinement: conceived
+at one time that his house was filled with company; at another that
+different people had gone off without paying him, and that he should be
+arrested for sums of money which he owed. Under this constant alarm and
+disquietude he continued about a week, when he became sullen, and refused
+his food. When importuned to take nourishment, he said it was ridiculous
+to offer it to him, as he had no mouth to eat it: though forced to take
+it, he continued in the same opinion; and when food was put into his
+mouth, insisted that a wound had been made in his throat, in order to
+force it into his stomach. The next day he complained of violent pain in
+his head, and in a few minutes afterwards died. He was opened twelve hours
+after death. There was a large quantity of water between the tunica
+arachnoidea and pia mater; the latter membrane was much suffused with
+blood, and many of its vessels were considerably enlarged: the lateral
+ventricles contained at least six ounces of water: the brain was very
+firm.
+
+
+CASE XV.
+
+J. A. a man, forty-two years of age, was first admitted into the house on
+June 27, 1795. His disease came on suddenly whilst he was working in a
+garden, on a very hot day, without any covering to his head. He had some
+years before travelled with a gentleman over a great part of Europe: his
+ideas ran particularly on what he had seen abroad; sometimes he conceived
+himself the king of Denmark, at other times the king of France. Although
+naturally dull and wanting common education, he professed himself a master
+of all the dead and living languages; but his most intimate acquaintance
+was with the old French: and he was persuaded he had some faint
+recollection of coming over to this country with William the Conqueror.
+His temper was very irritable, and he was disposed to quarrel with every
+body about him. After he had continued ten months in the hospital, he
+became tranquil, relinquished his absurdities, and was discharged well in
+June 1796. He went into the country with his wife to settle some domestic
+affairs, and in about six weeks afterwards relapsed. He was re-admitted
+into the hospital August 13th.
+
+He now evidently had a paralytic affection; his speech was inarticulate,
+and his mouth drawn aside. He shortly became stupid, his legs swelled, and
+afterwards ulcerated: at length his appetite failed him; he became
+emaciated, and died December 27th, of the same year. The head was opened
+twenty hours after death. There was a greater quantity of water between
+the different membranes of the brain than has ever occurred to me. The
+tunica arachnoidea was generally opake and very much thickened: the pia
+mater was loaded with blood, and the veins of that membrane were
+particularly enlarged. On the forepart of the right hemisphere of the
+brain, when stripped of its membranes, there was a blotch, of a brown
+colour, several shades darker than the rest of the cortical substance: the
+ventricles were much enlarged, and contained, by estimation, at least six
+ounces of water. The veins in these cavities were particularly turgid.
+The consistence of the brain was firmer than usual.
+
+
+CASE XVI.
+
+J. H. a man, aged forty-two, was admitted into the house on April 12,
+1794. He had then been disordered two months: it was a family disease on
+his father's side. Having manifested a mischievous disposition to some of
+his relations, he was continued in the hospital upon the incurable
+establishment. His temper was naturally violent, and he was easily
+provoked. As long as he was kept to any employment he conducted himself
+tolerably well; but when unoccupied, would walk about in a hurried and
+distracted manner, throwing out the most horrid threats and imprecations.
+He would often appear to be holding conversations: but these conferences
+always terminated in a violent quarrel between the imaginary being and
+himself. He constantly supposed unfriendly people were placed in different
+parts of the house to torment and annoy him. However violently he might be
+contesting any subject with these supposed enemies, if directed by the
+keepers to render them any assistance, he immediately gave up the dispute
+and went with alacrity. As he slept but little, the greatest part of the
+night was spent in a very noisy and riotous manner. In this state he
+continued until April 1796, when he was attacked with a paralytic
+affection, which deprived him of the use of the left side. His
+articulation was now hardly intelligible; he became childish, got
+gradually weaker, and died December 28, 1796. He was opened twenty-four
+hours after death. There was a general opacity of the tunica arachnoidea,
+and a small quantity of water between that membrane and the pia mater:
+the ventricles were much enlarged and contained a considerable quantity of
+water, by estimation, four ounces; the consistence of the brain was
+natural.
+
+
+CASE XVII.
+
+M. G. a woman, about fifty years of age, had been admitted on the
+incurable establishment in July 1785. She had for some years before been
+in a disordered state, and was considered as a dangerous patient. Her
+temper was violent; and if interrupted in her usual habits, she became
+very furious. Like many others among the incurables, she was an insulated
+being: she never spoke except when disturbed. Her greatest delight
+appeared to be in getting into some corner to sleep; and the interval
+between breakfast and dinner, was usually past in this manner. At other
+times she was generally committing some petty mischief, such as slyly
+breaking a window, dirtying the rooms of the other patients, or purloining
+their provisions. She had been for some months in a weak and declining
+state, but would never give any account of her disorder. On January 5,
+1797, she died, apparently worn out. The head was opened three days after
+death. The pericranium adhered but slightly to the scull, nor was the dura
+mater firmly attached. There was water between the membranes of the brain;
+and the want of transparency of the tunica arachnoidea, indicated marks of
+former inflammation. The posterior part of the hemispheres of the brain
+was of a brownish colour. In this case there was a considerable appearance
+of air in the veins; the medullary substance, when cut, was full of bloody
+points: the lateral ventricles were small, but filled with water: the
+plexus choroides were loaded with vesicles of a much larger size than
+usual: the consistence of the brain was natural.
+
+
+CASE XVIII.
+
+S. T. a woman, aged fifty-seven, was admitted into the house, January 14,
+1797. It was stated by her friends, that she had been disordered eight
+months: they were unacquainted with any cause, which might have induced
+the disease. She had evidently suffered a paralytic attack, which
+considerably affected her speech, and occasioned her to walk lame with the
+right leg. As she avoided all conversation, it was not possible to collect
+any further account of her case. Three days after her admission, she had
+another paralytic stroke, which deprived her entirely of the use of the
+right side. Two days afterwards she died. She was opened forty-eight hours
+after death. There was a small quantity of water between the tunica
+arachnoidea and pia mater, and a number of opake spots on the former
+membrane. On the pia mater, covering the posterior part of the left
+hemisphere of the brain, there was an extravasated blotch, about the size
+of a shilling: the medullary substance was unusually loaded with blood:
+the lateral ventricles were large, but did not contain much water: the
+consistence of the brain was very soft.
+
+
+CASE XIX.
+
+W. C. a man, aged sixty-three, was admitted into the hospital, January 21,
+1797. The persons, who attended at his admission, deposed, that he had
+been disordered five months; that he never had been insane before, and
+that the disease came on shortly after the death of his son. He was in a
+very anxious and miserable state. No persuasion could induce him to take
+nourishment; and it was with extreme difficulty that any food could be
+forced upon him. He paced about with an hurried step; was often suddenly
+struck with the idea of having important business to adjust in some
+distant place, and which would not admit of a moment's delay. Presently
+after, he would conceive his house to be on fire, and would hastily
+endeavour to rescue his property from the flames. Then he would fancy that
+his son was drowning, that he had twice sunk: he was prepared to plunge
+into the river to save him, as he floated for the last time: every moment
+appeared an hour until he rose. In this miserable state he continued till
+the 27th, when, with great perturbation, he suddenly ran into his room,
+threw himself on the bed, and in a few minutes expired. The head was
+opened twenty-four hours after death. The pericranium was but slightly
+adherent to the scull: the tunica arachnoidea, particularly where the
+hemispheres meet, was of a milky whiteness. Between this membrane, which
+was somewhat thickened, and the pia mater, there was a very large
+collection of water: the pia mater was inflamed: the veins of this
+membrane were enlarged beyond what I had ever before observed: there was a
+striking appearance of air in the veins: the medullary substance of the
+brain, when cut into, bled freely, and seemed spongy from the number and
+enlargement of its vessels: in the ventricles, which were of a natural
+capacity, there was about half an ounce of water: the brain was of a
+healthy consistence.
+
+
+CASE XX.
+
+M. L. a woman, aged thirty-eight, was admitted into the house, June 11,
+1796. From the information of the people who had attended her, it
+appeared, that she had been disordered six weeks, and that the disease
+took place shortly after the death of her husband. At the first attack she
+was violent, but she soon became more calm. She conceived that the
+overseers of the parish, to which she belonged, meditated her destruction:
+afterwards she supposed them deeply enamoured of her, and that they were
+to decide their claims by a battle. During the time she continued in the
+hospital she was perfectly quiet, although very much deranged. She fancied
+that a young man, for whom she had formerly entertained a partiality, but
+who had been dead some years, appeared frequently at her bed-side, in a
+state of putrefaction, which left an abominable stench in her room. Soon
+after she grew suspicious, and became apprehensive of evil intentions in
+the people about her. She would frequently watch at her door, and, when
+asked the reason, replied that she was fully aware of a design, which had
+been formed, to put her secretly to death.--Under the influence of these
+opinions she continued to her death, which took place on February 8, 1797,
+in consequence of a violent rheumatic fever. She was opened twelve hours
+after death. There were two opake spots on the tunica arachnoidea: the pia
+mater was slightly inflamed: there was a general congestion of blood to
+the whole contents of the cranium: the consistence of the brain did not
+differ from what is found in a healthy state.
+
+
+CASE XXI.
+
+H. C. a woman, of about sixty-five years of age, had been admitted on the
+incurable establishment in the year 1788. I have not been able to collect
+any particulars of her former history. During the time I had an
+opportunity of seeing her, she continued in a very violent and irritable
+state: it was her custom to abuse every one who came near her. The
+greatest part of the day was passed in cursing the persons she saw about
+her; and when no one was near, she usually muttered some blasphemy to
+herself. She died of a fever on February 19, 1797, on the fourth day after
+the attack. She was opened two days after death. The tunica arachnoidea
+was, in many parts, without its natural transparency: the pia mater was
+generally suffused with blood, and its vessels were enlarged: the
+consistence of the brain was firm.
+
+
+CASE XXII.
+
+J. C. a man, aged fifty, was admitted into the hospital, August 6, 1796.
+It was stated that he had been disordered about three weeks, and that the
+disease had been induced by too great attention to business, and the want
+of sufficient rest. About four years before, he had been a patient, and
+was discharged uncured. He was an artful and designing man, and with great
+ingenuity once effected his escape from the hospital. His time was mostly
+passed in childish amusements, such as tearing pieces of paper and
+sticking them on the walls of his room, collecting rubbish and assorting
+it. However, when he conceived himself unobserved, he was intriguing with
+other patients, and instructing them in the means, by which they might
+escape. Of his disorder he seemed highly sensible, and appeared to approve
+so much of his confinement, that when his friends wished to have him
+released, he opposed it, except it should meet with my approbation;
+telling them, in my presence, that, although he might appear well to them,
+the medical people of the house were alone capable of judging of the
+actual state of his mind; yet I afterwards discovered, that he had
+instigated them to procure his enlargement, by a relation of the grossest
+falshoods and most unjust complaints. In April 1797, he was permitted to
+have a month's leave of absence, as he appeared tolerably well, and wished
+to maintain his family by his industry. For above three weeks of this
+time, he conducted himself in a very rational and orderly manner. The day
+preceding that, on which he was to have returned thanks, he appeared
+gloomy and suspicious, and felt a disinclination for work. The night was
+passed in a restless manner, but in the morning he seemed better, and
+proposed coming to the hospital to obtain his discharge. His wife having
+been absent for a few minutes from the room, found him, on her return,
+with his throat cut. He was re-admitted as a patient, and expressed great
+sorrow and penitence for what he had done; and said that it was committed
+in a moment of rashness and despair. After a long and minute examination,
+he bewrayed nothing incoherent in his discourse. His wound, from which it
+was stated that he had lost a large quantity of blood, was attended to by
+Mr. Crowther, the surgeon to the hospital. Every day he became more
+dispirited, and at last refused to speak. He died May 29th, about ten days
+after his re-admission. His head was opened two days after death. There
+were some slight opacities of the tunica arachnoidea, and the pia mater
+was a little inflamed: the other parts of the brain were in an healthy
+state, and its consistence natural.
+
+
+CASE XXIII.
+
+E. L. was a man, about seventy-eight years of age; had been admitted on
+the incurable establishment, January 3, 1767. By report, I have understood
+that he was formerly in the navy, and that his insanity was caused by a
+disappointment of some promotion which he expected. It was also said, that
+he was troublesome to some persons high in office, which rendered it
+necessary that he should be confined. At one time he imagined himself to
+be the king, and insisted on his crown. During the time I had an
+opportunity of knowing him, he conducted himself in a very gentlemanly
+manner. His disposition was remarkably placid, and I never remember him to
+have uttered an unkind or hasty expression. With the other patients he
+seldom held any conversation. His chief amusement was reading, and writing
+letters to the people of the house. Of his books he was by no means
+choice; he appeared to derive as much amusement from an old catalogue as
+from the most entertaining performance. His writings always contained
+directions for his release from confinement; and he never omitted his high
+titles of God's King, Holy Ghost, Admiral, and Physician. He died June 13,
+1797, worn out with age. He was opened two days after death. The scull was
+thick and porous. There was a large quantity of water between the
+different membranes. The tunica arachnoidea was particularly opake: the
+veins seemed to contain air: in the medullary substance the vessels were
+very copious and much enlarged: the lateral ventricles contained two
+ounces of pellucid water: the consistence of the brain was natural.
+
+It has been stated, by a gentleman of great accuracy, and whose situation
+affords him abundant opportunity of acquiring a knowledge of diseased
+appearances, that the fluid of hydrocephalus appears to be of the same
+nature with the water which is found in dropsy of the thorax and
+abdomen.[10] That this is generally the case, there can be no doubt, from
+the respectable testimony of the author of the Morbid Anatomy: but in
+three instances, where I submitted this fluid to experiment, it was
+incoagulable by acids and by heat; in all of them its consistence was not
+altered even by boiling. There was, however, a cloudiness produced; and,
+after the liquor had stood some time, a slight deposition of animal
+matter took place, which, prior to the application of heat or mineral
+acids, had been dissolved in the fluid. This liquor tinged green the
+vegetable blues; produced a copious deposition with nitrat of silver; and,
+on evaporation, afforded cubic crystals (nitrat of soda). From this
+examination it was inferred, that the water of the brain, collected in
+maniacal cases, contained a quantity of uncombined alkali and some common
+salt. What other substances may enter into its composition, from want of
+sufficient opportunity, I have not been enabled to determine.
+
+
+CASE XXIV.
+
+S. W. a woman, thirty-five years of age, was admitted into the hospital,
+June 3, 1797. It was stated that she had been one month disordered, and
+had never experienced any prior affection of the same kind. The disease
+was said to have been produced by misfortunes which had attended her
+family, and from frequent quarrels with those who composed it. She was in
+a truly melancholic state; she was lost to all the comforts of this life,
+and conceived herself abandoned for ever by God. She refused all food and
+medicines. In this wretched condition she continued until July 29th, when
+she lost the use of her right side. On the 30th she became lethargic, and
+continued so until her death, which happened on August the 3d. She was
+opened two days after death. There was a large collection of water between
+the different membranes of the brain, amounting at least to four ounces:
+the pia mater was very much inflamed, and was separable from the
+convolutions of the brain with unusual facility: the medullary substance
+was abundantly loaded with bloody points: the consistence of the brain
+was remarkably firm.
+
+
+CASE XXV.
+
+D. W. a man, about fifty-eight years of age, had been admitted upon the
+incurable establishment in 1789. He was of a violent and mischievous
+disposition, and had nearly killed one of the keepers at a private mad
+house previously to his admission into the hospital. At all times he was
+equally deranged respecting his opinions, although he was occasionally
+more quiet and tractable: these intervals were extremely irregular as to
+their duration and period of return. He was of a very constipated habit,
+and required large doses of cathartic medicines to procure stools. On
+August 3, 1797, he was in a very furious state; complained of costiveness,
+for which he took his ordinary quantity of opening physic, which operated
+as usual. On the same day he ate his dinner with a good appetite; but
+about six o'clock in the evening he was struck with hemiplegia, which
+deprived him completely of the use of his left side. He lay insensible of
+what passed about him, muttered constantly to himself, and appeared to be
+keeping up a kind of conversation. The pulse was feeble, but not oppressed
+or intermitting. He never had any stertor. He continued in this state
+until the 12th, when he died. He was opened twelve hours after death.
+There was some water between the tunica arachnoidea and pia mater: the
+former membrane was opake in many places; bearing the marks of former
+inflammation: in the veins of the membranes of the brain there was a
+considerable appearance of air, and they were likewise particularly
+charged with blood: the vessels of the medullary substance were numerous
+and enlarged. On opening the right lateral ventricle, which was much
+distended, it was found filled with dark and grumous blood; some had also
+escaped into the left, but in quantity inconsiderable when compared with
+what was contained in the other: the consistence of the brain was very
+soft.
+
+
+CASE XXVI.
+
+J. S. a man, forty-four years of age, was received into the hospital, June
+24, 1797. He had been disordered nine months previous to his admission.
+His insanity was attributed to a violent quarrel, which had taken place
+with a young woman, to whom he was attached, as he shortly afterwards
+became sullen and melancholy.
+
+During the time he remained in the house he seldom spoke, and wandered
+about like a forlorn person. Sometimes he would suddenly stop, and keep
+his eyes fixed on an object, and continue to stare at it for more than an
+hour together. Afterwards he became stupid, hung down his head, and
+drivelled like an ideot. At length he grew feeble and emaciated, his legs
+were swollen and oedematous, and on September 13th, after eating his
+dinner, he crawled to his room, where he was found dead about an hour
+afterwards. He was opened two days after death. The tunica arachnoidea had
+a milky whiteness, and was thickened. There was a considerable quantity of
+water between that membrane and the pia mater, which latter was loaded
+with blood: the lateral ventricles were very much enlarged, and contained,
+by estimation, about six ounces of transparent fluid: the brain was of its
+natural consistence.
+
+
+CASE XXVII.
+
+T. W. a man, thirty-eight years of age, was admitted into the house, May
+16, 1795. He had then been disordered a year. His disease was stated to
+have arisen, from his having been defrauded, by two of his near relations,
+of some property, which he had accumulated by servitude. Having remained
+in the hospital the usual time of trial for cure, he was afterwards
+continued on the incurable establishment, in consequence of a strong
+determination he had always shewn, to be revenged on those people who had
+disposed of his property, and a declared intention of destroying himself.
+He was in a very miserable state, conceived that he had offended God, and
+that his soul was burning in Hell. Notwithstanding he was haunted with
+these dreadful imaginations, he acted with propriety upon most occasions.
+He took delight in rendering any assistance in his power to the people
+about the house, and waited on those who were sick, with a kindness that
+made him generally esteemed. At some period of his life he had acquired an
+unfortunate propensity to gaming, and whenever he had collected a few
+pence, he ventured them at cards. His losses were borne with very little
+philosophy, and the devil was always accused of some unfair interposition.
+
+On September 14, 1797, he appeared jaundiced, the yellowness daily
+increased, and his depression of mind was more tormenting than ever. From
+the time he was first attacked by the jaundice he had a strong
+presentiment that he should die. Although he took the medicines which were
+ordered, as a mark of attention to those who prescribed them, he was
+firmly persuaded they could be of no service. The horror and anxiety he
+felt, was, he said, sufficient to kill him, independantly of the jaundice.
+
+On the 20th he was drowsy, and on the following day died comatose. He was
+opened twenty-four hours after death. In some places the tunica
+arachnoidea was slightly opake: the pia mater was inflamed; and in the
+ventricles were found about two tea-spoons full of water tinged deeply
+yellow, and the vesicles of the plexus choroides were of the same colour:
+to the whole contents of the cranium there was a considerable congestion
+of blood: the consistence of the brain was natural: the liver was sound:
+the gall-bladder very much thickened, and contained a stone of the
+mulberry appearance, of a white colour. Another stone was also found in
+the duodenum.
+
+
+CASE XXVIII.
+
+R. B. a man, sixty-four years of age, was admitted into the hospital,
+September 2, 1797. He had then been disordered three months. It was also
+stated, that he had suffered an attack of this disease seven years before,
+which then continued about two months. His disorder had, both times, been
+occasioned by drinking spirituous liquors to excess. He was a person of
+liberal education, and had been occasionally employed as usher in a
+school, and at other times as a librarian and amanuensis. When admitted he
+was very noisy, and importunately talkative. During the greatest part of
+the day he was reciting passages from the Greek and Roman poets, or
+talking of his own literary importance. He became so troublesome to the
+other madmen, who were sufficiently occupied with their own speculations,
+that they avoided, and excluded him from the common room; so that he was,
+at last, reduced to the mortifying situation of being the sole auditor of
+his own compositions.
+
+He conceived himself very nearly related to Anacreon, and possessed of the
+peculiar vein of that poet. He also fancied that he had discovered the
+longitude; and was very urgent for his liberation from the hospital, that
+he might claim the reward, to which his discovery was intitled. At length
+he formed schemes to pay off the national debt: these, however, so much
+bewildered him that his disorder became more violent than ever, and he was
+in consequence obliged to be confined to his room. He now, after he had
+remained two months in the house, was more noisy than before, and had
+little sleep. These exertions very much reduced him.
+
+In the beginning of January, 1798, his conceptions were less distinct, and
+although his talkativeness continued, he was unable to conclude a single
+sentence. When he began to speak, his attention was diverted by the first
+object which caught his eye, or by any sound that struck him. On the 5th
+he merely muttered; on the 7th he lost the use of his right side, and
+became stupid and taciturn. In this state he continued until the 14th,
+when he had another fit; after which he remained comatose and insensible.
+On the following day he died. He was opened thirty-six hours after death.
+The pericranium adhered very loosely to the scull: the tunica arachnoidea
+was generally opake, and suffused with a brownish hue: a large quantity of
+water was contained between it and the pia mater: the contents of the
+cranium were unusually destitute of blood: there was a considerable
+quantity of water (perhaps four ounces) in the lateral ventricles, which
+were much enlarged: the consistence of the brain was very soft.
+
+
+CASE XXIX.
+
+E. T. a man, aged thirty years, was admitted a patient, July 23, 1796. The
+persons who attended, related, that he had been disordered eleven months,
+and that his insanity shortly supervened to a violent fever. It also
+appeared, from subsequent enquiries, that his mother had been affected
+with madness.
+
+He was a very violent and mischievous patient, and possessed of great
+bodily strength and activity. Although confined, he contrived several
+times during the night to tear up the flooring of his cell; and had also
+detached the wainscot to a considerable extent, and loosened a number of
+bricks in the wall. When a new patient was admitted, he generally enticed
+him into his room, on pretence of being an old acquaintance, and, as soon
+as he came within his reach, immediately tore his clothes to pieces. He
+was extremely dexterous with his feet, and frequently took off the hats of
+those who were near him with his toes, and destroyed them with his teeth.
+After he had dined he generally bit to pieces a thick wooden bowl, in
+which his food was served, on the principle of sharpening his teeth
+against the next meal. He once bit out the testicles of a living cat,
+because the animal was attached to some person who had offended him. Of
+his disorder he appeared to be very sensible; and after he had done any
+mischief, always blamed the keepers for not securing him so, as to have
+prevented it. After he had continued a year in the hospital he was
+retained as an incurable patient. He died February 17, 1798, in
+consequence of a tumor of the neck. He was opened two days after death.
+The tunica arachnoidea was generally opake, and of a milky whiteness: the
+vessels of the pia mater were turgid, and its veins contained a quantity
+of air; about an ounce of water was contained in the lateral ventricles:
+the consistence of the brain was unusually firm, and possessed of
+considerable elasticity: it is the only instance of this nature which has
+fallen under my observation.
+
+
+CASE XXX.
+
+T. G. a man, about fifty-five years of age, was admitted into the
+hospital, January 20, 1798. It was stated, that he had been disordered a
+year and half, and that his madness arose from repeated intoxication.
+Having set fire to several hay-stacks, and committed frequent depredations
+on the neighbouring farmers, it had been found necessary to confine him in
+the county goal. His behaviour in this situation marked the cunning and
+malignity of his mind, so that he was always attempting some mischief
+either by violence or stratagem.
+
+When brought to the hospital he conducted himself with propriety and
+order, and appeared to be in a state of recovery. On the second of May he
+was attacked with a diarrhoea which daily encreased, notwithstanding the
+medicines employed for its removal. His mind became violently agitated
+from the commencement of the diarrhoea, and it was found proper to
+secure him. On the 8th, dysenteric symptoms appeared, which continued to
+the 13th, when he died.
+
+_Appearances on Dissection._
+
+The head was opened twenty-four hours after death. The pericranium was
+loosely attached to the scull, and the dura mater adhered but slightly to
+the internal surface of the cranium; there was a considerable quantity of
+water between the dura mater and tunica arachnoidea, this latter membrane
+(especially where the hemispheres meet) was of a milky whiteness, and
+generally so in the course of the veins of the pia mater. The glandulæ
+Pacchioni were very large and numerous. Between the tunica arachnoidea and
+pia mater there was much water; and from the lateral ventricles, which
+were uncommonly enlarged and distended, eight ounces of fluid were
+collected: the infundibulum was remarkably large: the membrane lining the
+cavity of the lateral ventricles had its veins very turgid: the
+consistence of the brain was softer than natural.
+
+The fluid obtained from the brain in this case being very pellucid and
+abundant, it was submitted to some chemical tests in order to ascertain
+its composition.
+
+An attempt of this kind had been made before; (vide Case 23) the present
+may be considered a small addition to our knowledge of this fluid, though
+by no means a satisfactory developement of its materials, according to the
+severity and precision of modern analysis.[11]
+
+ANALYSIS OF THE FLUID.
+
+  _Tincture of Galls_,  produced a white precipitate in
+                        moderate quantity.
+
+  _Lime Water_,         afforded a considerable quantity
+                        of a white precipitate, which was
+                        redissolved without effervescence
+                        by muriatic acid.
+
+  _Solution of Sulphat  A drop of this solution added to
+    of Copper._         two drams of the brain fluid
+                        tinged it with a pretty deep blue.
+
+The presence of animal matter is inferred from the deposition produced by
+infusion of galls.
+
+The precipitation by lime-water indicates the phosphoric acid.
+
+And it appears from the blue tinge given to the fluid by the sulphat of
+copper, that ammonia or some of its combinations was contained.
+
+As it occurred on many former trials, there was no coagulation by heat; a
+slight sediment fell, after boiling some minutes.
+
+As this patient remained in the hospital from the middle of January to the
+beginning of May, in a state perfectly tranquil, and without the
+appearance of disarrangement of mind, it is improbable that a so great
+enlargement of the ventricles, and accumulation of water, could have taken
+place within the short space of two weeks, it is therefore most likely
+that the greatest part of this fluid had been previously collected.
+
+It may be conjectured that a very gradual accumulation of water (although
+the quantity be at last considerable) would not affect the sensorium so as
+a sudden secretion of fluid; or, that a quantity, which at one time had
+occasioned great disturbance, would by habit become less inconvenient.
+
+We are not well informed, but there is reason to believe, that gradual
+pressure on the brain, will not occasion those serious symptoms which a
+sudden pressure would excite.
+
+
+CASE XXXI.
+
+H. K. a woman, aged thirty, was admitted into the hospital, October 15,
+1796. She had then been mad about four months, and her disorder was stated
+to have supervened on the birth of a child. From subsequent enquiry it was
+ascertained that her mother had been insane, and that her elder sister
+had been similarly affected; but from the best information it did not
+appear that her brothers (she had two) had ever been visited with this
+calamity.
+
+Previously to her admission she had frequently attempted to destroy
+herself, and had also endeavoured to take away the life of her husband. In
+the hospital she was extremely violent; supposed her neighbours had
+conspired to take away her liberty, and became jealous of her husband: she
+was often naming some female of her acquaintance who had artfully ensnared
+his affections, and whom he had decked out in her best apparel: she
+breathed revenge when she should return home, and seemed much delighted
+with the idea of destroying these favourites, when they were dressed for
+some excursion with her husband.
+
+She had understood that a year was the extent of time that persons were
+detained in the hospital, and conceived she should be liberated when it
+had elapsed, to put her menaces into execution. Her disorder being of a
+dangerous tendency she was retained in the hospital after the period of
+probation. When she found the hope of gratifying her revenge frustrated,
+by being kept beyond the time of her expectation, she began to pine away,
+her appetite diminished, and a cough, with copious expectoration and
+hectic fever supervened. During the whole period of her bodily disease,
+she would never acknowledge herself to be ill, and the violence of her
+mental disorder was unabated. She died of Phthisis Pulmonalis, April 1st,
+1798.
+
+The head was opened twenty four hours after her decease. The tunica
+arachnoidea was in many places opake; the pia mater was highly inflamed,
+and loaded with blood, and a considerable quantity of water was contained
+between it and the former membrane. The ventricles were enlarged, but
+contained scarcely any fluid. The other parts of the brain were healthy,
+and its consistence was natural.
+
+It is a common opinion, that Phthisis Pulmonalis is frequently suspended
+by the supervention of mania; medical books abound with such accounts, and
+some persons have supposed it difficult, if not impossible, for these
+diseases to co-exist. It is not my intention to dispute the accuracy of
+such relations, nor to question the power which Mania may possess in
+arresting the progress of Phthisis Pulmonalis, but, to state that the
+converse does not obtain; and, that whatever obligations may be due from
+Phthisis to Mania, the compliment has not been returned. From my own
+experience I can affirm, that insane persons are as liable to Phthisis
+Pulmonalis as others, that numbers of them die of that disease; and that I
+never saw any abatement of the maniacal symptoms through the progress of
+consumption.
+
+
+CASE XXXII.
+
+J. P. aged 57, was admitted into the hospital, January 19, 1799; he was
+stated to have been insane about three weeks, and that his disorder came
+on shortly after the death of his master, in whose service he had
+continued many years, and to whom he was much attached. He had been in the
+hospital three times before, and had each time been discharged well. His
+disorder usually recurred every seven or eight years. His father also had
+been maniacal about the middle period of life, but never recovered. When
+admitted he was very talkative, although his natural character was
+reserved. He endeavoured to explain his meaning with superior correctness,
+and sought to define every subject, however trifling, with a tedious
+minuteness; but, upon religion and politics, the Scylla and Charybdis of
+human discussion, he was pertinacious and intollerant. This dictatorial
+manner and stubbornness of opinion, not being capable of producing the
+relations of peace and amity with other philosophers, equally obstinate,
+and whose principles had been matured by long confinement, it became
+necessary to shut him up in his cell. During the period of his seclusion,
+nothing very incoherent escaped from him; every thing he said was within
+the sphere of possibility. His fastidiousness rendered him unhappy: he
+acknowledged the food which was brought him to be good, but he conceived
+it might have been better. The cathartic medicine, which was administered
+to him, he confessed had answered the purpose, but its taste was most
+nauseous, and he had never before been so severely griped. He ornamented
+his person and apartment in a very whimsical manner: latterly he tore his
+clothes because he suspected the taylor had deceived him in the materials.
+After this he continued naked until the beginning of March, when he
+appeared more composed, and sensible of the state he had been in. On the
+morning of the 12th, when the keeper opened his cell, he was speechless;
+his mouth drawn to the right side, and so feeble that he could not support
+himself. A cathartic medicine was given, and sinapisms were applied to the
+feet and legs. In the evening he was much recovered, his speech had
+returned, and he was able to move himself. He was visited again at
+midnight, when he appeared still better. In the morning it was evident
+that he had experienced another attack, his mouth was drawn aside; he was
+stupid, and died within half an hour. The head was opened on the
+following day. The tunica arachnoidea was in some places slightly opake.
+The pia mater was inflamed, but not to any considerable degree. There was
+no water between any of the membranes. The ventricles were of a natural
+capacity, and did not contain any fluid. There was no extravasation in any
+part of the substance of the cerebrum or cerebellum. Excepting the slight
+inflammation of the pia mater, the brain had a very healthy appearance;
+its consistence was firm; the scull was unusually thick. I regret, from a
+promise which had been made to the friends, of inspecting the head only,
+that the thoracic and abdominal viscera were not examined.
+
+This history has been related to shew, that although the patient died with
+those symptoms, which indicate pressure on the brain, as loss of speech,
+the mouth being drawn aside, stupor and insensibility; yet the brain did
+not afford the same appearances, on dissection, as have been usually
+detected in such cases. The following relation is an additional example of
+the same fact:
+
+
+CASE XXXIII.
+
+N. B. He had been many years in the hospital as an incurable patient; his
+mother was known to have been maniacal; his two brothers and his sister
+have been insane. His eldest son, on taking a very small quantity of
+fermented liquor, becomes frantic, and its effects continue much longer
+than on persons in general. During this patient's confinement, he was, as
+far as could be ascertained, completely in his senses; this induced the
+medical persons of the hospital, on two or three occasions, to give him
+leave of absence, that he might return on trial to his wife and family;
+but, in a few hours after he came home, he felt uneasy, and found himself
+bewitched at all points: the devil and his imps had pre-occupied the best
+places in the house; he became very turbulent, and also jealous of his
+wife, and was obliged to be returned to the hospital. As he found his home
+so beset with difficulties he resolved that he would never enter it again.
+During eight years that I was acquainted with him I never discovered the
+least insanity in his actions or conversation. He was perfectly sensible
+that his intellects were disordered whenever he returned to his family.
+His wife and children frequently visited him in Bethlem, and he always
+conducted himself affectionately towards them. About 14 months before his
+death he laboured under a severe dysentery, which continued six weeks, and
+left him in a very reduced state, with oedematous legs, and incipient
+dropsy of the abdomen. On his recovery from these symptoms he became
+troubled with fits; they appeared to be such as a medical person would
+have termed apoplectic. After the attack, no symptoms of paralysis
+remained, nor did he experience the fatigue and exhaustion, or fall into a
+profound sleep, which usually accompanies Epilepsy. On October 10th, 1802,
+being then in a pretty good state of health, he fell down, and expired in
+a few minutes. He was about sixty-five years of age. On examination of the
+head after death, there was a considerable determination of blood to the
+brain; but there was no extravasation of that fluid, nor any collection of
+water: the brain and its membranes had a healthy appearance, and its
+consistence was natural. The heart was sound, and the abdominal viscera
+were not conspicuously diseased.
+
+
+CASE XXXIV.
+
+J. P. a man, aged thirty, was admitted into the hospital, October 18th,
+1800. It was then deposed, by the persons who brought him, that he had
+been for eight months in a melancholic state; but they were unable to
+assign any circumstances, which preceded his disorder, as a cause of his
+disease. He had a large tumor on the throat which extended backward to the
+neck, principally on the left side; the increase of this swelling, they
+alledged, had much alarmed him, at the commencement of his melancholic
+attack. During the time he was the subject of my observation, he was in a
+very mopish and stupid state; if spoken to, he would sometimes give a
+short answer, but ordinarily he took no notice of those who addressed him.
+Some days he would walk slowly in the less frequented part of the
+building; frequently he sat down for some hours in a corner. His appetite
+was good, he ate the food which was brought him, but never took the
+trouble to go for it, when serving out. In this state he continued until
+April 2d, when he became more stupid, and could not be made to rise from
+his bed. He did not appear to be in any pain, nor was he at all convulsed.
+His bowels were regular. On the 5th he became comatose, and on the 9th he
+died.
+
+_Appearances on Dissection._
+
+There was an excessive determination of blood to the brain, and the pia
+mater was highly inflamed. On the inferior part of the middle lobe of the
+brain, there was a gangrene of considerable extent, together with a
+quantity of very foetid purulent matter.
+
+This is the only instance of a gangrenous state of the brain which has
+fallen under my observation.
+
+
+CASE XXXV.
+
+T. C. This person had remained many years in the hospital on the incurable
+establishment. He had been a schoolmaster at Warrington in Lancashire, and
+was a man of acuteness and extensive mathematical learning. As he became
+very furious on the attack of his maniacal disorder, he was placed in the
+Lunatic Asylum at Manchester, where he killed the person who had the care
+of him, by stabbing him in the back with a knife.
+
+The following is the account he gave me of that transaction, and which I
+immediately committed to paper; as it conveys a serious and important
+lesson to those who are about the persons of the insane.
+
+  "He that would govern others, first should be
+  The master of himself, richly indu'd
+  With depth of understanding, height of courage."
+                _Massinger's Bondman, Act I. Scene 3._
+
+It ought to be more generally understood that a madman seldom forgets the
+coercion he has undergone, and that he never forgives an indignity.
+
+"The man whom I stabbed richly deserved it. He behaved to me with great
+violence and cruelty, he degraded my nature as a human being; he tied me
+down, handcuffed me, and confined my hands much higher than my head, with
+a leathern thong: he stretched me on a bed of torture. After some days he
+released me. I gave him warning, for I told his wife I would have justice
+of him. On her communicating this to him, he came to me in a furious
+passion, threw me down, dragg'd me through the court-yard, thumped on my
+breast, and confined me in a dark and damp cell. Not liking this
+situation, I was induced to play the hypocrite. I pretended extreme sorrow
+for having threatened him, and by an affectation of repentance, prevailed
+on him to release me. For several days I paid him great attention, and
+lent him every assistance. He seemed much pleased with the flattery, and
+became very friendly in his behaviour towards me.--Going one day into the
+kitchen, where his wife was busied, I saw a knife; (this was too great a
+temptation to be resisted;) I concealed it, and carried it about me. For
+some time afterwards the same friendly intercourse was maintained between
+us; but, as he was one day unlocking his garden door, I seized the
+opportunity, and plunged the knife up to the hilt in his back."--He
+always mentioned this circumstance with peculiar triumph, and his
+countenance (the most cunning and malignant I ever beheld) became highly
+animated at the conclusion of the story.
+
+During the time he was in Bethlem Hospital he most ingeniously formed a
+stiletto out of a mop-nail; it was an elaborate contrivance, and had
+probably been the work of several months. It was rendered extremely sharp
+and polished, by whetting on a small pebble; it was fixed into a handle,
+and had a wooden sheath made from the mop-stick. This instrument he
+carried in his left breeches pocket, his right hand grasping the hilt. As
+I always found him in that posture when I visited him, I suspected he had
+some concealed implement of mischief, and therefore employed a
+convalescent patient to watch him through the key-hole of his door. This
+person saw him with the weapon, and also ascertaining the distance at
+which he could use it.
+
+The instrument was taken from him by surprise. When he found he was
+prevented from executing his purpose, he roared out the most horrid
+imprecations; he cursed the Almighty for creating him, and more especially
+for having given him the form of a human being, and he wished to go to
+Hell that he might not be disgraced by an association with the Deity.
+
+He had an uniform and implacable aversion to the officers and servants of
+the hospital; he said he courted their hatred for their curse was a
+blessing. He seldom answered a question but some impiety was contained in
+the reply. An indifferent person remarking that it was a bad day, he
+immediately retorted, "Sir, did you ever know God make a good one?"
+Although the whole of the day, and the greatest part of the night, were
+consumed in pouring forth abuse and coining new blasphemies; yet there
+were some few patients for whom he professed a friendship, and with whom
+he conversed in a mild and civil way: this confidence had been obtained by
+the compliments they had addressed to him on the score of his
+understanding, of which he entertained a very high opinion. At one time he
+conceived himself to be the Messiah, at another, that he was Mr. Adam, the
+architect; and that he was shortly to go to America in order to build the
+new Jerusalem in Philadelphia.
+
+About six months before his death he complained of pain in his stomach,
+and said he felt as if he had no intestines. His appetite diminished, and
+he became melancholic.
+
+The scene now began to alter; he had a presentiment that his time in this
+world would be short, and he dreaded the change: no hope arose, no
+consolation could cheer him; he became daily more emaciated and despairing
+until he died, which took place August 27, 1801; he appeared to be about
+seventy years of age.
+
+On opening the head, the pericranium was scarcely adherent. This membrane
+being removed, blood oozed freely from the parietal bones. There was a
+large accumulation of water between the dura mater and tunica arachnoidea;
+when this was let out the dura mater became flaccid, and seemed to hang
+loose on the brain. On the left posterior lobe of the cerebrum there was a
+large quantity of a milky fluid, between the tunica arachnoidea and pia
+mater, giving the appearance of a vesication; and in that place there was
+a depression or cavity formed in the convolutions of the brain. The
+convolutions were so strongly and distinctly marked, that they resembled
+the intestines of a child. The lateral ventricles were but little
+distended, and did not contain much water. The head was not particularly
+loaded with blood, nor were the bloody points, in the medullary substance,
+very abundant. The brain was of a natural consistence. There was no
+disease in the stomach, intestines, or liver. The body was opened about
+six hours after his death.
+
+
+CASE XXXVI.
+
+B. S. a man, generally noticed by those who have visited Bethlem hospital
+a few years ago. It was said, that an attachment to a young woman, who
+slighted his addresses, was the cause of his becoming insane. He was
+considered a very dangerous lunatic, and for many years was confined to
+his cell. In this situation he employed himself in the manufacture of
+straw baskets and table mats. The desire of money was the leading feature
+of his mind, and the whole of his energies were devoted to its
+acquisition; nor was he at all scrupulous as to the means, by which he
+attained his object. Although repeatedly assured that he would never be
+liberated, he disbelieved such information, and was persuaded, when he had
+acquired a sum sufficient to purchase a horse and cart, filled with
+higler's ware, that he should be released. The idea of becoming a trader,
+on so large a scale, stimulated him to constant occupation. He employed
+several lunatic journeymen to plat the straw for him, but they were poorly
+rewarded. He generally chose for his workmen such as were chained, and
+could not come personally to insist on the reward of their labour. He
+commonly pretended that the platting was badly performed, and
+consequently unsaleable; sometimes he would protest that he had settled
+with them, but that they were too mad to recollect it; and if at any time
+he did pay them, it was in bad coin. For many years he was unrivalled in
+this trade, and, by every species of fraud, had amassed nearly sufficient
+to set his plans afloat: when an unfortunate event took place, which
+considerably reduced his capital. He had always a propensity to game,
+which, from his skill and dexterity in cheating, was generally attended
+with success; but in this science he was once over-matched. An insane
+soldier, an ingenious man, became his intimate friend, and finding him
+possessed of some money proposed a game at cards. The result was deeply
+disastrous to the artificer in straw, who endeavoured to evade the
+payment; but his friend stated it to be a debt of honor; and besides he
+was a very powerful man, of a stern aspect, and not to be trifled with;
+he was therefore compelled to tell down at once the slow accumulation of
+several years. It was intended to make the soldier restore the property,
+but he, conceiving that he had already derived sufficient benefit from the
+hospital, went away in the night, without the formalities of a regular
+discharge.
+
+To fill up the measure of his misfortunes, when Hatfield, the maniac who
+shot at his Majesty in the theatre, was brought to Bethlem, he, in
+conjunction with a contriving cobbler, established a rival manufactory,
+which shortly eclipsed the fabric of the old school, and by superior taste
+rendered his further exertions unnecessary.
+
+It is natural to suppose, that no great cordiality could exist between
+persons, where the prosperity of one had been established on the ruin of
+the other. Frequent altercations arose, and much offensive language was
+exchanged. At length the patience of the original dealer was exhausted,
+and, in collecting his force to give his opponent a blow, he fell down and
+instantly expired.--He was about fifty-eight years of age.
+
+Some of his habits and opinions were extremely singular; he believed that
+all occurrences were regulated by witches: prosperity was to be attributed
+to the good witches having obtained the mastery; and when bad witches
+gained the ascendancy, misfortunes arose. When the latter were at work he
+supposed himself in possession of a power to frighten and disperse them,
+and this was effected by a peculiar noise he made. It is probable he might
+have laboured under indigestion, for immediately after he had eaten his
+dinner, he sent forth a dreadful howl, which he continued for about ten
+minutes: but his great terror was a thunder storm; when this occurred, he
+took a very active part, and brought the whole force of his lungs to bear
+upon the enemy. A cat was supposed to have a natural antipathy to bad
+witches, she could smell them at a distance; for which reason he always
+domesticated an animal of that kind to sleep in his cell.
+
+When his head was opened, the dura mater was very easily separable from
+the scull; upon puncturing this membrane a considerable quantity of blood
+flowed from the opening; and there was a copious extravasation of this
+fluid between the membranes of the brain: but the most remarkable
+circumstance was, that the tunica arachnoidea was so thickened, that it
+exceeded the dura mater on an accurate comparison. The pia mater was
+loaded with blood, and its vessels were enlarged. The brain and its
+cavities were sound and natural.
+
+
+CASE XXXVII.
+
+R. B. This man had been many years an incurable patient, and it was
+supposed that jealousy of his wife had been the cause of his madness,
+although it appeared from very respectable testimony that he had no real
+grounds for such suspicion. During eight years, (the period he was subject
+to my observation,) he was mostly in a very furious state, and obliged to
+be strictly confined. His mischeivous disposition was manifested on every
+occasion; he would hurl the bowl, in which his food was served, against
+those who passed his cell; and when his hands were secured he would kick,
+bite, or throw his head into the stomachs of those who came near him. He
+entertained a constant aversion to his keeper, whom he suspected to be
+connected with his wife. His life was miserably divided between furious
+paroxysms and melancholic languor, and there was great uncertainty in the
+duration of these states. He has been known to continue ten months in the
+highest degree of violence, and relapse into the same state after a few
+days passed in tranquil depression. There was one circumstance which never
+failed to produce a relapse, however quietly he might have conducted
+himself, this was a visit from any of his family, and a very striking
+instance occurred. From May, 1799, to September, 1800, he had every
+appearance of being perfectly recovered: he was, in consequence, allowed
+additional comforts, and treated as a convalescent. At this time he was
+visited by his son, who, after many hours conversation with him, was
+persuaded that he had perfectly recovered his intellects; and he expressed
+himself astonished at his father's accurate recollection of particulars
+which might be supposed to have been obliterated from his mind. This
+dutiful visit and affectionate intercourse produced unpleasant
+consequences. The numerous enquiries which the patient had made, furnished
+him with materials for reflexion. On the departure of his son he began to
+detect mismanagement in his affairs, and improprieties in the conduct of
+his family: he was very talkative, and became impatient to return home.
+The following day he had a wildness in his eyes, spoke fast, and appeared
+busy: before the evening he was so irritable and disobedient that it
+became necessary to confine him. From this time he continued in the most
+furious condition, singing and vociferating the greatest part of the
+night, until January 2d, 1801, when he became suddenly calm, complained of
+extreme debility, and said he should die in a few hours. He gave very
+proper answers to the questions which were asked him, but complained of
+the fatigue which talking induced. On the next morning he expired. He was
+sixty-eight years of age. The head was opened two days after his death.
+The tunica arachnoidea was in many places opake, and considerably
+thickened. There was a small quantity of limpid water between this
+membrane and the pia mater. When the medullary substance was cut into,
+there oozed from many points a quantity of dark blood, indeed the whole
+head was loaded with venous blood. The lateral ventricles were
+considerably enlarged and filled with water--four ounces were collected.
+The internal carotid arteries were much enlarged, and when divided, did
+not collapse, but remained open, as arteries in the other parts of the
+body. The consistence of the brain was doughy.
+
+
+
+
+CHAP. IV.
+
+CASES OF INSANE CHILDREN.
+
+
+In the month of March, 1799, a female child, three years and a quarter
+old, was brought to the hospital for medical advice. She was in good
+bodily health, and born of sane and undiseased parents. The mother, who
+attended, stated that her husband's parents and her own had never been in
+the slightest degree afflicted with mania, but that she had a brother who
+was born an ideot. She related that her child, until the age of two years
+and a half, was perfectly well, of ordinary vivacity, and of promising
+talents; when she was inoculated for the small pox. Severe convulsions
+ushered in the disease, and a delirium continued during its course. The
+eruption was of the mild kind, and the child was not marked with the
+pustules. From the termination of the small-pox to the above date, (nine
+months) the child continued in an insane state. Previously to the
+small-pox, she could articulate many words, and use them correctly for the
+things they signified: but since that time she completely forgot her
+former acquisitions, nor ever attempted to imitate a significant sound.
+Whatever she wished to perform, she effected with promptitude and
+facility. She appeared anxious to possess every thing she saw, and cried
+if she experienced any disappointment; and on these occasions she would
+bite, or express her anger by kicking or striking. Her appetite was
+voracious, and she would devour any thing that was given to her, without
+discrimination; as fat, raw animal food, or tainted meat. To rake out the
+fire with her fingers was a favourite amusement, nor was she deterred from
+having frequently burned them. She passed her urine and fæces in any place
+without restraint; but she could retain a considerable quantity of the
+former before she discharged it. Some cathartic remedies were ordered for
+her, with an emetic occasionally, and she was brought to the hospital
+every fortnight, but she did not appear in any degree amended. On June 22
+she was admitted a patient, and continued in the hospital until the middle
+of October, when she was attacked with an eruptive fever, and consequently
+discharged. During this time little progress was made, although
+considerable pains were bestowed. She became more cunning, and her taste
+appeared improved. The cathartic medicine, which she drank at first
+without reluctance, became afterwards highly disgusting, and when she saw
+the basket which contained it, she endeavoured to escape and hide
+herself. To particular persons she was friendly, and felt an aversion to
+others. She was sensible of the authority of the nurse who attended her,
+and understood by the tone of her voice whether she were pleased or
+offended. The names of some things she appeared to comprehend, although
+they were extremely few; when the words, dinner, cakes, orange, and some
+more were mentioned, she smiled, and appeared in expectation of receiving
+them. By great attention and perseverance on the part of the nurse, she
+was brought to evacuate her fæces and urine in a night stool.
+
+After the elapse of three years I was informed that the child had made no
+intellectual progress.
+
+W. H. a boy, nearly seven years of age, was admitted into the Hospital,
+June 8th, 1799. His mother, who frequently visited him, related the
+following particulars respecting his case.--She said that, within a month
+of being delivered of this child, she was frightened by a man in the
+street, who rudely put his hand on her abdomen. When the child was born it
+was subject to startings, and became convulsed on any slight
+indisposition. When a year old, he suffered much with the measles: and
+afterwards had a mild kind of inoculated small-pox. At this age she
+thought the child more lively than usual, and that he slept less than her
+other children had done. At two years, the mother perceived he could not
+be controled, and therefore frequently corrected him.
+
+There was a tardiness in the developement of his physical powers. He was
+fifteen months old before he had a tooth, and unable to go alone at two
+years and a half: his mind was equally slow; he had arrived at his fourth
+year before he began to speak; and, when in his fifth, he had not made a
+greater proficiency in language than generally may be observed in children
+between two and three years. When admitted into the hospital, he wept at
+being separated from his mother, but his grief was of very short
+continuance. He was placed on the female side, and seemed highly delighted
+with the novelty of the scene: every object excited his curiosity, but he
+did not pause or dwell on any. He was constantly in action, and rapidly
+examined the different apartments of the building. To the patients in
+general he behaved with great insolence--he kicked and spat at them, and
+distorted his face in derision; but, on the appearance of the nurse, he
+immediately desisted, and assured her he was a very good boy. Great, but
+ineffectual, pains were taken, to make him understand the nature of
+truth,--he could never be brought to confess any mischief he had
+committed, and always took refuge in the convenient shelter of a lie. In a
+short time he acquired a striking talent for mimickry, and imitated many
+of the patients in their insane manners; he generally selected, for his
+models, those who were confined, as he could practise from such with
+impunity.
+
+In about three months he had added considerably to his stock of language,
+but, unluckily, he had selected his expressions from those patients who
+were addicted to swearing and obscene conversation. To teach him the
+letters of the alphabet had many times been endeavoured, but always
+without success; the attempt uniformly disgusted him: he was not to be
+stimulated by coaxing or coercion; his mind was too excursive, to submit
+to the painful toil of recording elementary sounds; but it may rather be
+inferred that he did not possess a sufficient power of attention to become
+acquainted with arbitrary characters.
+
+He was in good health, his pulse and bowels were regular, and his appetite
+was keen, but not voracious. One circumstance struck me, as very peculiar,
+in this boy,--he appeared to have very incorrect ideas of distance: he
+would frequently stretch out his hand, to grasp objects considerably
+beyond his reach, but this referred principally to height: he would
+endeavour to pluck out a nail from the ceiling, or snatch at the moon. In
+October he became unwell, and, at the mother's request, was discharged
+from the hospital.
+
+In September 1805, I again saw the boy: he was then thirteen years of age,
+had grown very tall, and appeared to be in good health. He recollected me
+immediately, and mentioned the words, school Moorfields, nasty physic. On
+meeting with some of the female patients, he perfectly remembered them,
+and seemed for the moment, much pleased at the renewal of the
+acquaintance. By this time, he had made comparatively, a great progress in
+language; he knew the names of ordinary things, and was able to tell
+correctly the street in which he resided, and the number of his house. His
+mother informed me that he was particularly fond of going to church,
+although he was unable to comprehend the purpose for which he went: when
+there, he conducted himself with great order and decorum, but was disposed
+to remain after the congregation had dispersed. To shew how little he
+understood, why he frequented a place of worship: his mother once took him
+to church on Sacrament-sunday, and fearful of disturbing the persons
+assembled, by compelling him to return home, allowed him to be a
+spectator of those solemn administrations. The only reflexion he made on
+the subject, but in disjointed expressions, was, that he thought it
+extremely hard, that the ladies and gentlemen should eat rolls and drink
+gin, and never ask him to partake. In his person he was clean, and dressed
+himself with neatness. Having been taught when in the hospital to use a
+bowl for his necessary occasions, he obstinately continued the same
+practice when he returned home, and could never be persuaded to retire to
+the closet of convenience; but the business did not terminate here, when
+he had evacuated his intestines into the bowl he never failed to paint the
+room with its contents. To watch other boys when they were playing, or to
+observe the progress of mischief, gave him great satisfaction: but he
+never joined them, nor did he ever become attached to any one of them. Of
+his mother he appeared excessively fond, and he was constantly caressing
+her: but in his paroxysms of fury he felt neither awe nor tenderness, and
+on two occasions he threw a knife at her. Although equally ignorant of
+letters, as when discharged from the hospital, he took great delight in
+having gilt books; indeed every thing splendid attracted his attention,
+but more especially soldiers and martial music. He retained several tunes,
+and was able to whistle them very correctly. The day on which I last saw
+him his mind was completely occupied with soldiers; when questions were
+put to him, if he answered them it was little to the purpose, generally he
+did not notice them, but turned round to his mother and enquired about the
+soldiers.
+
+The defect of this lad's mind, appeared to be a want of continued
+attention to things, in order to become acquainted with their nature; and
+he possessed less curiosity than other children, which serves to excite
+such attention: and this will in some degree explain, why he had never
+acquired any knowledge of things in a connected manner. His sentences were
+short, and he employed no particles to join them together. Although he was
+acquainted with the names of many things, and also with expressions which
+characterize passion, he applied them in an insulated way. For instance,
+if a shower fell, he would look up and say, "rains;" or when fine, "sun
+shines." When in the street he would pull his mother, to arrest her
+attention, and point to objects, as a fine horse, or a big dog; when he
+returned home he would repeat what had attracted his notice, but always
+speaking of himself in the third person. "Billy see fine horse, big dog,
+&c."[12] Of circumstances boldly impressed, or reiterated by habit, his
+memory was retentive, but as his attention was only roused by striking
+appearances, or loud intonations, ordinary occurrences passed by
+unobserved.
+
+In the month of July 1803, my opinion was requested respecting a young
+gentleman, ten years of age, who was sent here, accompanied by a kind and
+decent young man, to take care of him. Previously to his arrival I had
+corresponded respecting his case with a very learned and respectable
+physician in the country, under whose care the boy had been placed. From
+the information furnished by this gentleman, and that which was collected
+from the keeper, I believe the former history of his case is correctly
+given.
+
+The parents are persons of sound mind, and they do not remember any
+branches of their respective families to have been (in any manner)
+disordered in their intellects. The subject of the present relation was
+their eldest son; the second child was of a disposition remarkably mild;
+and the youngest, a boy, about two years and a half, was distinguished by
+the irritability and impatience of his temper. At the age of two years,
+the subject of the present relation, became so mischievous and
+uncontroulable, that he was sent from home to be nursed by his aunt. In
+this situation, at the request of his parents, and with the concurrence of
+his relation, he was indulged in every wish, and never corrected for any
+perverseness or impropriety of conduct. Thus he continued until he was
+nearly nine years old, the creature of volition and the terror of the
+family. At the suggestion of the physician, whom I have before mentioned,
+and who was the friend of his parents: a person was appointed to watch
+over him. It being the opinion of the doctor that the case originated in
+over indulgence and perverseness; a different system of management was
+adopted. The superintendant was ordered to correct him for each individual
+impropriety. At this time the boy would neither dress nor undress himself,
+though capable of doing both; when his hands were at liberty, he tore his
+clothes: he broke every thing that was presented to him, or which came
+within his reach, and frequently refused to take food. He gave answers
+only to such questions as pleased him, and acted in opposition to every
+direction. The superintendant exercised this plan for several months, but
+perhaps not to the extent laid down; for it may be presumed, that after a
+a few flagellations his humanity prevailed over the medical hypothesis.
+When he became the subject of my own observation, he was of a very healthy
+appearance, and his head was well formed; this was also the opinion of
+several gentlemen, distinguished for their anatomical knowledge, to whom
+the boy was presented. His tongue was unusually thick, though his
+articulation was perfectly distinct. His countenance was decidedly
+maniacal.[13] His stature, for his age, was short, but he was well
+compacted, and possessed great bodily strength. Although his skin was
+smooth and clear, it was deficient in its usual sensibility; he bore the
+whip and the cane with less evidence of pain than other boys. Another
+circumstance convinced me of this fact. During the time he resided in
+London he was troubled with a boil on his leg; various irritating
+applications were made to the tumor, and the dressings were purposely
+taken off with less nicety than usual, yet he never complained. His pulse
+was natural, and his bowels were regular. His appetite was good, but not
+inordinate, and he bore the privation of food for a considerable time
+without uneasiness. Although he slept soundly, he often awoke as if
+suddenly alarmed, and he seemed to require a considerable duration of
+sleep.
+
+He had a very retentive memory, and had made as great proficiency in
+speech as the generality of boys of his own age. Few circumstances
+appeared to give him pleasure, but he would describe very correctly any
+thing which had delighted him. As he wanted the power of continued
+attention, and was only attracted by fits and starts, it may be naturally
+supposed he was not taught letters, and still less that he would copy
+them. He had been several times to school, and was the hopeless pupil of
+many masters, distinguished for their patience and rigid discipline; it
+may therefore be concluded, that from these gentlemen, he had derived all
+the benefits which could result from privations to his stomach, and from
+the application of the rod to the more delicate parts of his skin.
+
+On the first interview I had with him, he contrived, after two or three
+minutes acquaintance, to break a window and tear the frill of my shirt. He
+was an unrelenting foe to all china, glass, and crockery ware, whenever
+they came within his reach he shivered them instantly. In walking the
+street, the keeper was compelled to take the wall, as he uniformly broke
+the windows if he could get near them, and this operation he performed so
+dextrously, and with such safety to himself, that he never cut his
+fingers. To tear lace and destroy the finer textures of female ornament,
+seemed to gratify him exceedingly, and he seldom walked out without
+finding an occasion of indulging this propensity. He never became attached
+to any inferior animal, a benevolence so common to the generality of
+children: to these creatures his conduct was that of the brute: he
+oppressed the feeble, and avoided the society of those more powerful than
+himself. Considerable practice had taught him that he was the cat's
+master, and whenever this luckless animal approached him he plucked out
+its whiskers with wonderful rapidity; to use his own language, "_I must
+have her beard off_." After this operation, he commonly threw the creature
+on the fire, or through the window. If a little dog came near him he
+kicked it, if a large one he would not notice it. When he was spoken to,
+he usually said, "I do not choose to answer." When he perceived any one
+who appeared to observe him attentively, he always said, "Now I will look
+unpleasant." The usual games of children afforded him no amusement;
+whenever boys were at play he never joined them: indeed, the most singular
+part of his character was, that he appeared incapable of forming a
+friendship with any one: he felt no considerations for sex, and would as
+readily kick or bite a girl as a boy. Of any kindness shewn him, he was
+equally insensible; he would receive an orange as a present, and
+afterwards throw it in the face of the donor.
+
+To the man who looked after him, he appeared to entertain something like
+an attachment: when this person went out of the room, and pretended that
+he would go away, he raised a loud outcry, and said, "what will become of
+me, if he goes away; I like him, for he carries the cane which makes me a
+good boy:" but it is much to be doubted, whether he really bore an
+affection for his keeper; the man seemed to be of a different opinion, and
+said, when he grew older he should be afraid to continue with him, as he
+was persuaded the boy would destroy him, whenever he found the means and
+opportunity.
+
+Of his own disorder he was sometimes sensible: he would often express a
+wish to die, for he said, "God had not made him like other children;" and
+when provoked, he would threaten to destroy himself.
+
+During the time he remained here, I conducted him through the hospital,
+and pointed out to him several patients who were chained in their cells;
+he discovered no fear or alarm; and when I shewed him a mischievous maniac
+who was more strictly confined than the rest, he said, with great
+exultation, "this would be the right place for me." Considering the
+duration of his insanity, and being ignorant of any means by which he was
+likely to recover, he returned to his friends, after continuing a few
+weeks in London.
+
+
+
+
+CHAP. V.
+
+CAUSES OF INSANITY.
+
+
+When patients are admitted into Bethlem Hospital, an enquiry is always
+made of the friends who accompany them, respecting the cause supposed to
+have occasioned their insanity.
+
+It will be readily conceived, that there must be great uncertainty
+attending the information we are able to procure upon this head: and even
+from the most accurate accounts, it would be difficult to pronounce, that
+the circumstances which are related to us, have actually produced the
+effect. The friends and relatives of patients are, upon many occasions,
+very delicate concerning this point, and cautious of exposing their
+frailties or immoral habits: and when the disease is connected with the
+family, they are oftentimes still more reserved in disclosing the truth.
+
+Fully aware of the incorrect statement, frequently made concerning these
+causes, I have been at no inconsiderable pains to correct or confirm the
+first information, by subsequent enquiries.
+
+The causes which I have been enabled most certainly to ascertain, may be
+divided into PHYSICAL and MORAL.[14]
+
+Under the first, are comprehended repeated intoxication: blows received
+upon the head; fever, particularly when attended with delirium; mercury,
+largely and injudiciously administered; cutaneous eruptions repelled, and
+the suppression of periodical or occasional discharges and secretions;
+hereditary disposition, and paralytic affections.
+
+By the second class of causes, which have been termed _moral_, are meant
+those which are supposed to originate in the mind, or which are more
+immediately applied to it. Such are, the long endurance of grief; ardent
+and ungratified desires; religious terror; the disappointment of pride;
+sudden fright; fits of anger; prosperity humbled by misfortunes:[15] in
+short, the frequent and uncurbed indulgence of any passion or emotion, and
+any sudden or violent affection of the mind.
+
+There are, doubtless, many other causes of both classes, which may tend to
+produce this disease. Those which have been stated, are such as I am most
+familiar with; or, to speak more accurately, such are the circumstances
+most generally found to have preceded this affection.
+
+It is an old opinion, and continues still to prevail, that maniacs are
+influenced by the changes of the moon. In the fourth chapter of St.
+Matthew's Gospel, verse 24, we find the word "[Greek: Selêniaxomenous]"
+which is rendered in the English version, "those which were lunatic."
+Notwithstanding the notion of being moon-struck might prevail among the
+ignorant people of Galilee, yet Hippocrates, a philosopher, and correct
+observer of natural phænomena, does not appear to have placed any faith in
+this planetary influence. Although the Romans were infected with this
+popular tradition, as may be seen in the following passage of the Art of
+Poetry,
+
+  "Ut mala quem scabies aut morbus regius urget,
+  Aut fanaticus error, et IRACUNDA DIANA
+  Vesanum tetigisse timent fugiuntque poetam,
+  Qui sapiunt:"--
+
+yet Celsus did not consider the operation of the moon on the human
+intellect sufficiently well founded to admit it into his medical work.
+Not a word on this subject is mentioned in the eighteenth chapter of his
+third book, which particularly treats of Insanity, "_De tribus insaniæ
+generibus_;" it is true that, in the fourth chapter of the first book,
+which speaks "_De his quibus caput infirmum est_," he says "Cui caput
+infirmum est, is si bene concoxit, leniter perfricare id mane manibus suis
+debet; nunquam id, si fieri potest, veste velare; aut ad cutem tondere:
+utileque lunam vitare, maximeque ante ipsum lunæ solisque concursum." By
+the _infirmum caput_, Celsus does not mean madness, as may be clearly seen
+by perusing the chapter: the weakness of intellect, which frequently
+continues after fever, or other violent diseases, is evidently his
+meaning; but Dr. Cox has quoted the above passage, to prove that Celsus
+was impressed with the truth of this vulgar opinion. He says, "This idea
+of lunar influence, in _maniacal complaints_, was handed down to us by
+our medical forefathers, and is still very generally adopted."
+
+It is most probable that this idea of planetary regency, however it might
+have arisen, or to whatever extent it may have been credited, received in
+the Arabian school, the stamp by which its currency has been subsequently
+maintained. For the revival and dispersion of ancient medical knowledge,
+we are confessedly under considerable obligations to the Arabians;[16] and
+more especially for the incorporation of astrology, magic and alchymy,
+with medicine.
+
+Popular superstitions and national proverbs, are seldom without some
+foundation; and with respect to the present, it may be observed, that if
+it were not in some degree rooted in fact, and trained up by observation,
+it would become difficult to ascertain how such an opinion came to be
+adopted; and this investigation is rendered still more important from the
+consideration, that the existing law in this country, respecting insane
+persons, has been established on the supposed prevalence of this lunar
+regulation. A commission is issued, de _lunatico_ inquirendo, and the
+commissioners sitting for that purpose, are particular in their enquiries,
+whether the patient enjoys lucid intervals. The term _lucid interval_ has
+been properly connected with the word _lunacy_; for, if the patient, as
+they supposed, became insane at particular changes of the moon, the
+inference was natural, that in the intervening spaces of time he would
+become rational.
+
+It is more than probable, that the origin of this supposition of the lunar
+influence may be traced to the following circumstances. The period of the
+return of the moon, and of regular menstruation in women, is four weeks;
+and the terms which designate them, have been imposed from the period of
+time in which both are compleated. Insanity and epilepsy are often
+connected with menstruation, and suffer an exacerbation of their paroxysms
+at the period when this discharge happens, or ought to take place. If,
+therefore, the period of menstruation in an insane woman should occur at
+the full of the moon, and her mind should then be more violently
+disturbed, the recurrence of the same state may be naturally expected at
+the next full moon. This is a necessary coincidence, and should be
+discriminated from effect. But such has been the prevalence of this
+opinion, that when patients have been brought to Bethlem hospital,
+especially those from the country, their friends have generally stated
+them to be worse at some particular change of the moon, and of the
+necessity they were under, at those times, to have recourse to a severer
+coercion. Indeed, I have understood from some of these _lunatics_, who
+have recovered, that the overseer or master of the work-house himself has
+frequently been so much under the dominion of this planet, and keeping
+steadily in mind the old maxim, _venienti occurrite morbo_, that, without
+waiting for any display of increased turbulence on the part of the
+patient, he has bound, chained, flogged, and deprived these miserable
+people of food, according as he discovered the moon's age by the almanack.
+
+To ascertain how far this opinion was founded in fact, I kept, during more
+than two years, an exact register, but without finding, in any instance,
+that the aberrations of the human intellect corresponded with, or were
+influenced by, the vicissitudes of this luminary.
+
+As insane persons, especially those in a furious state, are but little
+disposed to sleep, even under the most favourable circumstances, they will
+be still less so, when the moon shines brightly into their apartments.
+
+It has also been considered, that intellectual labour frequently becomes a
+cause of insanity; that those, who are in the habit of exercising the
+faculty of thought, for the perfection and preservation of the reason of
+others, are thereby in danger of losing their own. We hear much of this,
+from those who have copiously treated of this disease, without the toil of
+practical remark; whose heads become bewildered by the gentlest exercise,
+and to whom the recreation of thinking becomes the exciting cause of
+stupidity or delirium. These persons enumerate, among the exciting causes
+of delirium, "Too great, or too long continued exertion of the mental
+faculties, as in the delirium which often succeeds long continued and
+abstract calculation; and the deliria to which men of genius are
+peculiarly subject."
+
+The mind of every man is capable of a definite quantity of exertion to
+good effect; all endeavours, beyond that point, are impotent and
+perplexing. The attention is capable of being fixed to a certain extent,
+and, when that begins to deviate, all continuance is time lost. It is
+certain that, by habit, this power may be much increased; and, by frequent
+exercise, that, which at first excited fatigue, may be continued with
+facility and pleasure. What species of delirium is that, which succeeds
+long continued and abstract calculation? Newton lived to the age of 85
+years, Leibnitz to 70, and Euler to a more advanced period, yet their
+several biographers have neglected to inform us, that their studies were
+checquered with delirious fermentations. The mathematicians of the present
+day (and there are many of distinguished eminence) would conceive it no
+compliment to suppose that they retired from their labours with addled
+brains, and that writers of books on insanity should impute to them
+miseries which they never experienced.
+
+It is curious to remark, in looking over a biographical chart, that
+mathematicians and natural philosophers have in general attained a
+considerable age; so that long continued and abstract calculation, or
+correct thinking upon any subject does not appear, with all these
+delirious visitations, to shorten the duration of human life. What is
+meant by the deliria, to which men of genius are peculiarly subject, I am
+unable, from a want of sufficient genius and delirium, to comprehend.
+
+It is well understood, that a want of rational employment is a very
+successful mode of courting delirium; that an indulgence in those reveries
+which keep the imagination on the wing, and imprison the understanding, is
+likely to promote it: and it must be owned, that the same effect has often
+been produced, where vanity or ambition has urged minds, puny by nature,
+and undrilled in intellectual exercises, to attempt to grasp that which
+they were unable to embrace. This may be illustrated by the following
+case.
+
+A young gentleman of slender capacity, and very moderate education, at the
+age of nineteen, was placed in a merchant's counting house, where he
+continued for two years diligently, though slowly, to perform the duties
+of the office. Coming at this time into the possession of considerable
+property, and perhaps, aware of the uncultivated state of his own mind, he
+very laudably determined to improve it. He frequented the society of
+persons esteemed learned and eminent in their different professions, and
+became much delighted with their conversation; but at the same time
+sensible that he was unable to contribute to the discourse. He resolved to
+become a severe student, and for this purpose purchased an immense
+quantity of books on most subjects of literature and science. History
+commenced the career of his enquiries: Rollin, Gibbon, Hume and Robertson
+were anxiously and rapidly perused; but he never paused to consider, or to
+connect dates and circumstances, so that these excellent authors, after he
+had waded through them, left scarcely an impression on his mind. Chemistry
+next engaged his attention, and on this subject, he pored over many
+volumes with little advantage: the terms proved a source of embarrassment,
+and he made no experiments. In a hasty succession, the ancient languages,
+antiquities, etymology, agriculture, and moral philosophy, occupied his
+mind. About eight hours were daily devoted to reading. Somewhat more than
+two years were consumed in this employment, which had distracted his mind,
+without conferring any positive knowledge.
+
+His friends and acquaintances now began to perceive a considerable
+alteration in his temper; though naturally diffident, he had assumed a
+high degree of literary importance, and plumed himself on the extent of
+his learning. Before this excessive, but ill-directed application, he was
+a strict relator of the truth, but he now found a convenience in supplying
+by fancy, that, which the indigence of his memory was unable to afford.
+Shortly he began to complain that he could not sleep, and that the long
+night was passed in shifting from side to side.
+
+  "Lasso, ch'n van te chiamo, et queste oscure,
+  Et gelide ombre in van lusingo: o piume
+  D'asprezza colme: o notti acerbe, et dure."
+                                      _Gio: Della Casa._
+
+Fever succeeded, accompanied with delirium in the evening. By quietness,
+and the ordinary remedies, these symptoms were removed; but he was left in
+a state of extreme weakness. As he recovered from this, his habits became
+materially altered: he would continue to lie in bed for several days,
+after which, he would suddenly rise and walk a number of miles. Personal
+cleanliness, and dress were entirely neglected: sometimes he would fast
+for two or three days, and then eat voraciously. Afterwards he became
+suspicious that poison had been mixed with his food. It was found
+necessary to confine him, from having attempted to castrate himself: this
+he afterwards effected in a very complete manner, and continues a maniac
+to the present time.
+
+Few persons, I believe, will be disposed to consider the above case, as an
+instance of insanity succeeding to a laborious exercise of the
+intellectual faculties. It is true, he was busied with books: but this
+occupation could not have strained his mind, for he appears neither to
+have comprehended, nor retained any of the objects of his pursuit.
+
+
+_Hereditary Disposition._
+
+    "Ut male posuimus initia sic cetera sequuntur."--_Cicero._
+
+    "Whatever was in the womb imperfect, as to her proper work, comes very
+    rarely, or never at all, to perfection afterwards."--_Harrington's
+    Works, p. 177._
+
+Considerable diversity of opinion has prevailed, whether insanity be
+hereditary or not; and much has been said on both sides of this question.
+Great ingenuity has been exerted to prove that this disease is accidental,
+or that there are sufficient causes to account for its occurrence, without
+supposing it one of those calamities that "_flesh is heir to_." It has
+been argued, that, if the disease were hereditary, it ought uniformly to
+be so, and that the offspring of a mad parent should necessarily become
+insane.
+
+All theories and reasonings appear to be good for as much as they prove;
+and if the term _hereditary_ be employed with a degree of strictness, so
+as to denote certain and infallible transmission, such inevitable descent
+cannot be defended. Several instances have come under my observation where
+the children of an insane parent have not hitherto been affected with
+madness, and some have died early in life, without having experienced any
+derangement of mind. More time is therefore required.
+
+All observations concur in acknowledging that there are many circumstances
+in which children resemble their parents. It is very common to see them
+resemble one of their parents in countenance, and when there are several
+children, some shall bear the likeness of the father and others of the
+mother. Children often possess the make and fashion of the body, peculiar
+to one or other of their parents, together with their gait and voice; but
+that which has surprized me most is the resemblance of the hand-writing.
+If a parent had taught his son to write, it might be expected that a
+considerable similarity would be detected; but in general the fact appears
+to be otherwise, for it seldom happens that the scholars, though
+constantly imitating the copy of the master, write at all like him, or
+like each other. In a few instances I have noticed a correct resemblance
+between the hand-writing of the father and son, where the former died
+before the latter had been taught the use of the pen, and who probably
+never saw the hand-writing of his father. The transmission of personal
+deformities is equally curious. I am acquainted with a person in this
+town, whose middle and ring finger are united, and act as one; all the
+children of this man carry the same defect. A toenail, particularly
+twisted, has been traced through three generations, on the same foot and
+toe. Abundant instances might be adduced on this subject; there is
+scarcely a family which cannot produce something in confirmation; and if
+to these circumstances in the human species, were to be added the
+experiments which have been made on the breeding of cattle, perhaps
+little doubt would remain.
+
+The reasoners against the transmission of madness urge, that, if the
+contrary were true, we should by this time have detected the rule or law
+by which nature acts, and that we should have been able to
+determine,--First, whether the disorder descended to the male or female
+children accordingly as the father or mother was affected.--Secondly,
+which of the parents is most capable of transmitting the
+disease?--Thirdly, what alternations in the succession take place, does it
+shift from the male to the female line, and, does it miss a generation,
+and afterwards return?
+
+These, and a multitude of other queries, might be proposed; I believe much
+faster than they could be answered. Nature appears to delight in producing
+new varieties, perhaps less in man than in other animals, and still less
+in the animal than in the vegetable kingdom. Before these subtile
+reasoners expect, from those who maintain that madness generally descends
+from the parent to the offspring, a developement of the laws by which
+Nature acts, it would be convenient first to settle whether in this matter
+she be under the dominion of any law whatever.
+
+The investigation of the hereditary tendency of madness is an object of
+the utmost importance, both in a legal and moral point of view. Parents
+and guardians, in the disposal, or direction of the choice of their
+children in marriage, should be informed, that an alliance with a family,
+where insanity has prevailed, ought to be prohibited.
+
+Having directed some attention to enquiries of this nature, I am enabled
+truly to state, that, where one of the parents have been insane, it is
+more than probable that the offsprings will be similarly affected.
+
+Madness has many colours, and colours have many hues; actual madness is a
+severe calamity, yet experience has pointed out the treatment, and the law
+has permitted the imposition of the necessary restraint: but it very
+frequently occurs that the descendants from an insane stock, although they
+do not exhibit the broad features of madness, shall yet discover
+propensities, equally disqualifying for the purposes of life, and
+destructive of social happiness.
+
+The slighter shades of this disease include eccentricity, low spirits, and
+oftentimes a fatal tendency to immoral habits, notwithstanding the
+inculcation of the most correct precepts, and the force of virtuous
+example.
+
+In illustration of the fact, that the offsprings of insane persons are,
+_ceteris paribus_, more liable to be affected with madness than those
+whose parents have been of sound minds; it was my intention to have
+constructed a table, whereon might be seen the probably direct course of
+this disease, and also its collateral bearings: but difficulties have
+arisen. It appeared, on consideration, improper to attempt precision with
+that which was variable, and as yet unsettled; I have therefore been
+content to select a few histories from my book of notes, and to exhibit
+them in the rude state in which they were set down.
+
+_1st._--R. G. His grandfather was mad, but there was no insanity in his
+grandmother's family. His father was occasionally melancholic, and once
+had a raving paroxysm. His mother's family was sane. His father's brother
+died insane. R. G. has a brother and five sisters; his brother has been
+confined in St. Luke's, and is occasionally in a low spirited state. All
+his sisters have been insane; with the three youngest the disease came on
+after delivery.
+
+_2d._--M. M. Her grandmother was insane and destroyed herself. Her father
+was mad for many years, but after the birth of all his children. M. M. has
+two brothers and a sister; both her brothers have been insane; the sister
+has never been so affected, but was a person of loose character. The
+insanity of M. M. was connected with her menstruation; after its cessation
+she recovered, although she had been confined more than sixteen years.
+
+_3d._--M. H. Her father had been several times insane; her mother was
+likewise so affected a few months before her death. Afterwards her father
+married a woman perfectly sane, by whom he had three children, two female
+and a male; both the females are melancholic, the male was a vicious
+character, and has been transported. M. H. has had ten children, three
+have died with convulsions, the eldest, a girl, is epileptic.
+
+_4th._--T. B. His mother became insane soon after being delivered of him,
+and at intervals has continued so ever since. He has a brother who became
+furiously mad at the age of twenty, and afterwards recovered. T. B.'s
+disorder came on at the age of twenty-six.
+
+_5th._--S. F. Her father's mother was insane, and confined in the
+hospital. Her father never discovered any symptoms of insanity, and her
+mother was perfectly sane. Her only sister (she had no brothers) was mad
+about five years ago, and recovered. S. F. has been twice in the hospital.
+
+_6th._--P. W. After the best enquiries it does not appear that her father
+or mother ever experienced any attack of madness or melancholy. P. W.'s
+disorder commenced shortly after the delivery of a child. She has three
+sisters, the eldest has never been married, and has hitherto continued of
+sound mind. The two younger have been mothers, and in both insanity has
+supervened on childbearing.
+
+_7th._--J. A. H. His father's father was insane, and his father was also
+disordered, and destroyed himself. His mother was of sound mind. J. A. H.
+became insane at the age of twenty-three. He has two sisters, the elder
+has once been confined for insanity, the younger is of weak intellects,
+nearly approaching to ideotism.
+
+_8th._--M. D. Her mother was insane and died so. M. D. continued of sane
+mind until she had attained the age of fifty-seven, when she became
+furiously maniacal; her only daughter, eighteen years of age, was attacked
+with mania during the time her mother was confined.
+
+_9th._--G. F. His mother was melancholic during the time she was pregnant
+with him, and never afterwards completely recovered. She had five children
+previously to this melancholic attack, who have hitherto continued of
+sound mind. She bore another son after G. F. who is extremely flighty and
+unmanageable. G. F. was attacked with madness at the age of nineteen, and
+died apoplectic, from the violence and continued fury of his disorder.
+
+_10th._--M. T. Her mother was of sound mind. Her father was in a
+melancholic state for two years, before she was born, but this was
+afterwards dissipated by active employment. M. T. has two brothers,
+younger than herself, who have been attacked with insanity, neither of
+whom have recovered. She has two sisters, some years older than herself,
+these have never been deranged. M. T. has had nine children. The three
+first have been melancholic. The youngest, at the age of five years, used
+to imagine she saw persons in the room covered with blood, and other
+horrible objects, she afterwards became epileptic and died. The youngest
+of her three first children has been married and had three children, one
+of whom is afflicted with chorea Sancti Viti, and another is nearly an
+ideot.
+
+Of the causes termed moral, the greatest number may, perhaps, be traced to
+the errors of education, which often plant in the youthful mind those
+seeds of madness which the slightest circumstances readily awaken into
+growth.
+
+It should be as much the object of the teachers of youth, to subjugate the
+passions, as to discipline the intellect. The tender mind should be
+prepared to expect the natural and certain effects of causes: its
+propensity to indulge an avaricious thirst for that which is unattainable,
+should be quenched: nor should it be suffered to acquire a fixed and
+invincible attachment to that which is fleeting and perishable.
+
+Of the more immediate, or, as it is generally termed, the proximate cause
+of this disease, I profess to know nothing. Whenever the functions of the
+brain shall be fully understood, and the use of its different parts
+ascertained, we may then be enabled to judge, how far disease, attacking
+any of these parts, may increase, diminish, or otherwise alter its
+functions. But this is a degree of knowledge, which we are not likely soon
+to attain. It seems, however, not improbable, that the only source, from
+whence the most copious and certain information can be drawn, is a strict
+attention to the particular appearances which morbid states of this organ
+may present.
+
+From the preceding dissections of insane persons, it may be inferred, that
+madness has always been connected with disease of the brain and of its
+membranes. Having no particular theory to build up, they have been related
+purely for the advancement of science and of truth.
+
+It may be a matter, affording much diversity of opinion, whether these
+morbid appearances of the brain be the cause or the effect of madness: it
+may be observed that they have been found in all states of the disease.
+When the brain has been injured from external violence, its functions have
+been generally impaired, if inflammation of its substance, or more
+delicate membranes has ensued. The same appearances have for the most part
+been detected, when patients have died of phrenitis, or in the delirium of
+fever: in these instances, the derangement of the intellectual functions
+appears evidently to have been caused by the inflammation. If in mania the
+same appearances be found, there will be no necessity of calling in the
+aid of other causes, to account for the effect: indeed, it would be
+difficult to discover them.
+
+Those who entertain an opposite opinion are obliged to suppose, _a disease
+of the mind_. Such a morbid affection, from the limited nature of my
+powers, perhaps I have never been able to conceive. Possessing, however,
+little knowledge of metaphysical controversy, I shall only offer a few
+remarks upon this part of the subject, and beg pardon for having at all
+touched it.
+
+Perhaps it is not more difficult to suppose, that matter, peculiarly
+arranged, may _think_,[17] than to conceive the union of an immaterial
+being with a corporeal substance. It is questioning the infinite wisdom
+and power of the Deity to say, that he does not, or cannot, arrange matter
+so that it shall think. When we find insanity, as far as has been hitherto
+observed, uniformly accompanied with disease of the brain, is it not more
+just to conclude, that such organic affection has produced this incorrect
+association of ideas, than that a being, which is immaterial,
+incorruptible, and immortal, should be subject to the gross and
+subordinate changes which matter necessarily undergoes?
+
+But let us imagine _a disease of ideas_. In what manner are we to effect a
+cure? To this subtle spirit the doctor can apply no medicines. Though so
+refined as to elude the force of material remedies, some may however think
+that it may be reasoned with. The good effects which have resulted from
+exhibiting logic as a remedy for madness, must be sufficiently known to
+every one who has conversed with insane persons, and must be considered as
+time very judiciously employed: speaking more gravely, it will readily be
+acknowledged, by persons acquainted with this disease, that, if insanity
+be a disease of ideas, we can possess no corporeal remedies for it: and
+that an endeavour to convince madmen of their errors, by reasoning, is
+folly in those who attempt it, since there is always in madness the
+firmest conviction of the truth of what is false, and which the clearest
+and most circumstantial evidence cannot remove.
+
+
+
+
+CHAP. VI.
+
+ON THE PROBABLE EVENT OF THE DISEASE.
+
+
+The prediction of the event, in cases of insanity, must be the result of
+accurate and extensive experience; and even then it will probably be a
+matter of very great uncertainty. The practitioner can only be led to
+suppose, that patients, of a particular description, will recover, from
+knowing that, under the same circumstances, a certain number have been
+actually restored to sanity of intellect.
+
+The practice of an individual, however active and industrious he may be,
+is insufficient to accumulate a stock of facts, necessary to form the
+ground of a regular and correct prognosis: it is therefore to be wished,
+that those, who exclusively confine themselves to this department of the
+profession, would occasionally communicate to the world the result of
+their observations.
+
+Physicians, attending generally to diseases, have not been reserved, in
+imparting to the public the amount of their labours and success: but, with
+regard to this disorder, those, who have devoted their whole attention to
+its treatment, have either been negligent, or cautious of giving
+information respecting it. Whenever the powers of the mind are
+concentrated to one object, we may naturally expect a more rapid progress
+in the attainment of knowledge: we have therefore only to lament the want
+of observations upon this subject, and endeavour to repair it.
+
+The records of Bethlem Hospital have afforded me some satisfactory
+information, though far from the whole of what I wished to obtain. From
+them, and my own observations, the prognosis of this disease is, with
+great diffidence, submitted to the reader.
+
+In our own climate, women are more frequently afflicted with insanity than
+men. Several persons, who superintend private mad-houses, have assured me,
+that the number of females brought in annually, considerably exceeds that
+of the males. From the year 1748 to 1794, comprizing a period of forty-six
+years, there have been admitted into Bethlem Hospital, 4832 women, and
+4042 men.
+
+The natural processes, which women undergo, of menstruation, parturition,
+and of preparing nutriment for the infant, together with the diseases, to
+which they are subject at these periods, and which are frequently remote
+causes of insanity, may, perhaps, serve to explain their greater
+disposition to this malady. As to the proportion in which they recover,
+compared with males, it may be stated, that of 4832 women affected, 1402
+were discharged cured; and that, of the 4042 men, 1155 recovered. It is
+proper here to mention, that, in general, we know but little of what
+becomes of those who are discharged; a certain number of those cured,
+occasionally relapse, and some of those, who are discharged uncured,
+afterwards recover: perhaps in the majority of instances where they
+relapse, they are sent back to Bethlem. To give some idea of the number,
+so re-admitted, it may be mentioned, that, during the last two years,[18]
+there have been admitted 389 patients, 53 of whom had at some former time
+been in the house. There are so many circumstances, which, supposing they
+did relapse, might prevent them from returning, that it can only be stated
+with certainty, that within twelve months, the time allowed as a trial of
+cure, so many have been discharged perfectly well.
+
+To shew how frequently insanity supervenes on parturition, it may be
+remarked, that from the year 1784 to 1794 inclusive, 80 patients have been
+admitted, whose disorder shortly followed the puerperal state. Women
+affected from this cause, recover in a larger proportion than patients of
+any other description of the same age. Of these 80, 50 have perfectly
+recovered. The first symptoms of the approach of this disease after
+delivery, are want of sleep; the countenance becomes flushed; a
+constrictive pain is often felt in the head; the eyes assume a morbid
+lustre, and wildly glance at objects in rapid succession; the milk is
+afterwards secreted in less quantity; and when the mind becomes more
+violently disordered, it is totally suppressed. Where the disease is
+hereditary, parturition very frequently becomes an exciting cause.
+
+From whatever cause this disease may be produced in women, it is
+considered as very unfavourable to recovery, if they should be worse at
+the period of menstruation, or have their catamenia in very small or
+immoderate quantities.
+
+A few cases have occurred where the disease, being connected with
+menstruation, and having continued many years, has completely disappeared
+on the cessation of the uterine discharge.
+
+At the first attack of this disease, and for some months afterwards,
+during its continuance, females most commonly labour under amenorrhoea.
+The natural and healthy return of this discharge generally precedes
+convalescence.
+
+From the following statement it will be seen, that insane persons recover
+in proportion to their youth, and that as they advance in years, the
+disease is less frequently cured. It comprizes a period of about ten
+years, viz. from 1784 to 1794. In the first column the age is noticed; in
+the second, the number of patients admitted; the third contains the number
+cured; the fourth, those who were discharged not cured.
+
+                   _Number         _Number         _Number
+  _Age between_    admitted._     discharged      discharged
+                                    cured._        uncured._
+
+  10 and 20           113             78              35
+  20 and 30           488            200             288
+  30 and 40           527            180             347
+  40 and 50           362             87             275
+  50 and 60           143             25             118
+  60 and 70            31              4              27
+                  -------        -------         -------
+               Total 1664      Total 574      Total 1090
+                  -------        -------         -------
+
+From this table it will be seen, that when the disease attacks persons
+advanced in life, the prospect of recovery is but small.
+
+I am led to conclude, from the very rare instances of complete cure, or
+durable amendment, among the class of patients deemed incurable, as well
+as from the infrequent recovery of those who have been admitted, after the
+disorder has been of more than twelve months standing, that the chance of
+cure is less, in proportion to the length of time which the disorder shall
+have continued.
+
+Although patients, who have been affected with insanity more than a year,
+are not admissible into the hospital, to continue there for the usual time
+of trial for cure, namely, a twelvemonth, yet, at the discretion of the
+committee, they may be received into it, from Lady-day to Michaelmas, at
+which latter period they are removed. In the course of the last twenty
+years seventy-eight patients of this description have been received, of
+whom only one has been discharged cured: this patient, who was a woman,
+has since relapsed twice, and was ultimately sent from the hospital
+uncured.
+
+When the reader contrasts the preceding statement with the account
+recorded in the report of the Committee, appointed to examine the
+Physicians who have attended His Majesty, &c. he will either be inclined
+to deplore the unskilfulness or mismanagement which has prevailed among
+those medical persons who have directed the treatment of mania in the
+largest public institution in this kingdom, of its kind, compared with the
+success which has attended the private practice of an individual; _or to
+require some other evidence, than the bare assertion of the man
+pretending to have performed such cures_.[19]
+
+It was deposed by that reverend and celebrated physician, that of patients
+placed under his care, within three months after the attack of the
+disease, nine out of ten had recovered;[20] and also that the age was of
+no signification, unless the patient had been afflicted before with the
+same malady.[21]
+
+How little soever I might be disposed to doubt such a bold, unprecedented,
+and marvellous account, yet, I must acknowledge, that my mind would have
+been much more satisfied, as to the truth of that assertion, had it been
+plausibly made out, or had the circumstances been otherwise than feebly
+recollected by that very successful practitioner. Medicine has generally
+been esteemed a progressive science, in which its professors have
+confessed themselves indebted to great preparatory study and long
+subsequent experience for the knowledge they have acquired; but, in the
+case to which we are now alluding, the outset of the Doctor's practice was
+marked with such splendid success, that time and observation have been
+unable to increase it.
+
+This astonishing number of cures has been effected by the vigorous agency
+of remedies, which others have not hitherto been so fortunate as to
+discover; by remedies, which, when remote causes have been operating for
+twenty-seven years, such as weighty business, severe exercise, too great
+abstemiousness and little rest, are possessed of adequate power directly
+to _meet and counteract_ such causes.[22]
+
+It will be seen by the preceding table, that a greater number of patients
+have been admitted, between the age of 30 and 40, than during any other
+equal period of life. The same fact also obtains in France, as may be seen
+from the statement of Dr. Pinel, (_Traité Medico-Philosophique sur la
+Manie, p. 109_,) and which, from its agreement with that of Bethlem
+Hospital, is here introduced to the notice of the reader.
+
+  +--------------------------------------------------------------+
+  |Manical       |                                         |     |
+  |Patients      |              AGE BETWEEN                |     |
+  |admitted into |-----------------------------------------|Total|
+  |the Bicêtre,  | 15 & | 20 & | 30 & | 40 & | 50 & | 60 & |     |
+  |in the Years  |  20  |  30  |  40  |  50  |  60  |  70  |     |
+  +--------------|------|------|------|------|------|------|-----|
+  |  1784        |   5  |  33  |  31  |  24  |  11  |   6  | 110 |
+  |  1785        |   4  |  39  |  49  |  25  |  14  |   3  | 134 |
+  |  1786        |   4  |  31  |  40  |  32  |  15  |   5  | 127 |
+  |  1787        |  12  |  39  |  41  |  26  |  17  |   7  | 142 |
+  |  1788        |   9  |  43  |  53  |  21  |  18  |   7  | 151 |
+  |  1789        |   6  |  38  |  39  |  33  |  14  |   2  | 132 |
+  |  1790        |   6  |  28  |  34  |  19  |   9  |   7  | 103 |
+  |  1791        |   9  |  26  |  32  |  16  |   7  |   3  |  93 |
+  |  1792        |   6  |  26  |  33  |  18  |  12  |   3  |  98 |
+  |  1793        |   1  |  13  |  13  |   7  |   4  |   2  |  40 |
+  |  1794        |   3  |  23  |  15  |  15  |   9  |   6  |  71 |
+  +--------------------------------------------------------------+
+
+There may be some reasons assigned for the increased proportion of insane
+persons at this age. Although I have made no exact calculation, yet from a
+great number of cases, it appears to be the time when the hereditary
+disposition is most frequently called into action; or, to speak more
+plainly, it is that stage of life, when persons, whose families have been
+insane, are most liable to become mad. If it can be made to appear, that
+at this period persons are more subject to be acted upon by the remote
+causes of the disease, or that a greater number of such causes are then
+applied, we may be able satisfactorily to explain it.
+
+At this age people are generally established in their different
+occupations, are married, and have families; their habits are more
+strongly formed, and the interruptions of them are consequently attended
+with greater anxiety and regret. Under these circumstances, they feel the
+misfortunes of life more exquisitely. Adversity does not depress the
+individual for himself alone, but as involving his partner and his
+offspring in wretchedness and ruin. In youth we feel desirous only of
+present good; at the middle age, we become more provident and anxious for
+the future; the mind assumes a serious character; and religion, as it is
+justly or improperly impressed, imparts comfort, or excites apprehension
+and terror.
+
+By misfortunes the habit of intoxication is readily formed. Those who in
+their youth have shaken off calamity as a slight incumbrance, at the
+middle age feel it corrode and penetrate; and when fermented liquors have
+once dispelled the gloom of despondency, and taught the mind to provoke a
+temporary assemblage of cheerful scenes, or to despise the terror of
+impending misery, it is natural to recur to the same, though destructive
+cause, to re-produce the effect.
+
+Patients, who are in a furious state, recover in a larger proportion than
+those who are depressed and melancholic. An hundred violent, and the same
+number of melancholic cases were selected: of the former, sixty-two were
+discharged well; of the latter, only twenty-seven: subsequent experience
+has confirmed this fact. The same investigation, on the same number of
+persons has been twice instituted, and with results little varying from
+the originally stated proportions. When the furious state is succeeded by
+melancholy, and after this shall have continued a short time, the violent
+paroxysm returns, the chance of recovery is very slight. Indeed, whenever
+these states of the disease frequently change, such alteration may be
+considered as very unfavourable.
+
+After a raving paroxysm of considerable duration, it is a hopeful symptom,
+if the patient become dull, and in a stupid state; inclined to sleep much,
+and feeling a desire of quietude. This appears to be the natural effect of
+that exhaustion, and, if the language be allowable, of that expenditure of
+the sensorial energy, which the continued blaze of furious madness would
+necessarily consume. When they gradually recover from this state there is
+a prospect that the cure will be permanent.
+
+In forming a prognosis of this disease, it is highly important to
+establish a distinction between derangement and decline of intellect: the
+former may frequently be remedied; the latter admits of no assistance from
+our art. Where insanity commences with a loss of mental faculty, and
+gradually proceeds with increasing imbecility, the case may be considered
+hopeless.
+
+When the disorder has been induced from remote physical causes, the
+proportion of those who recover is considerably greater, than where it has
+arisen from causes of a moral nature. In those instances where insanity
+has been produced by a train of unavoidable misfortunes, as where the
+father of a large family, with the most laborious exertions, ineffectually
+struggles to maintain it, the number who recover is very small indeed.
+
+Paralytic affections are a much more frequent cause of insanity than has
+been commonly supposed, and they are also a very common effect of madness;
+more maniacs die of hemiplegia and apoplexy than from any other disease.
+In those affected from this cause, we are, on enquiry, enabled to trace a
+sudden affection, or fit, to have preceded the disease. These patients
+usually bear marks of such affection, independently of their insanity: the
+speech is impeded, and the mouth drawn aside; an arm, or leg, is more or
+less deprived of its capability of being moved by the will: and in most of
+them the memory is particularly impaired. Persons thus disordered are in
+general not at all sensible of being so affected. When so feeble, as
+scarcely to be able to stand, they commonly say that they feel perfectly
+strong, and capable of great exertions. However pitiable these objects may
+be to the feeling spectator, yet it is fortunate for the condition of the
+sufferer, that his pride and pretensions are usually exalted in proportion
+to the degradation of the calamity which afflicts him. None of these
+patients have received any benefit in the hospital; and from the
+enquiries I have been able to make at the private mad-houses, where they
+have been afterwards confined, it has appeared, that they have either died
+suddenly, from apoplexy, or have had repeated fits, from the effects of
+which they have sunk into a stupid state, and gradually dwindled away.
+
+The paralytic require to be kept warm, and to be allowed a more nutritious
+diet and cheering beverage than insane patients of any other description.
+In the winter months they suffer extremely, and ought to be treated as
+hot-house plants. The fare of the workhouse is ungenial to this wretched
+state of existence, and therefore they seldom long continue a burden to
+the parish.
+
+When insanity supervenes on epilepsy, or where the latter disease is
+induced by insanity, a cure is very seldom effected. In two instances I
+have known madness alternate with epilepsy: one, a man about forty-eight
+years of age, was a pauper in the Cripplegate workhouse, where he had been
+kept about three years on account of his epileptic fits, but, becoming
+insane, was admitted into Bethlem Hospital, therein he continued a year,
+without being at all benefited; during that time he had no epileptic fit.
+Being returned to the workhouse, he there recovered his senses in a few
+months, when his epileptic attacks returned, and continued with their
+usual frequency. About two years afterwards he was re-admitted into the
+hospital, his insanity having recurred, and continued there another year
+without experiencing any attack of epilepsy. The other was a young woman,
+who had been epileptic for many years until she became insane, when she
+lost her epileptic fits; these, however, were said to have returned in a
+short time after she had recovered from her insanity.
+
+All authors who have treated this subject appear to agree respecting the
+difficulty of curing religious madness. The infrequent recoveries in this
+species of insanity, have caused thinking persons to suppose, that this
+disorder is little under the dominion of the medical practitioner; and,
+that restoration to reason in all cases is more the effect of accident, or
+of circumstances not "dreamt of in our philosophy," than the result of
+observation, skill, and experience. The idea that RELIGION; that which
+fastens us to the duties of this life; that which expounds the laws of God
+and of his creation to the ignorant; that which administers consolation to
+the afflicted; that which regulates man's conduct towards his fellow
+creatures, to exercise charity among them, and, from such benevolence, to
+purchase happiness to himself: to believe, that the cultivation of such
+exalted sentiments would decoy a human being into madness, is a foolish
+and impious supposition.
+
+      "Thou, fair Religion, wast design'd,
+        Duteous daughter of the skies,
+      To warm and chear the human mind,
+        To make men happy, good, and wise;
+      To point, where sits in love array'd,
+        Attentive to each suppliant call,
+      The God of universal aid,
+        The God, the Father of us all.
+
+  "First shewn by Thee, thus glow'd the gracious scene,
+      'Til Superstition, fiend of woe,
+      Bad doubts to rise and tears to flow,
+  And spread deep shades our view and heaven between."
+                                                  _Penrose._
+
+It is therefore sinful to accuse RELIGION, which preserves the dignity and
+integrity of our intellectual faculty, with being the cause of its
+derangement. The mind becomes refreshed and corroborated by a fair and
+active exercise of its powers directed to proper objects; but when an
+anxious curiosity leads us to unveil that which must ever be shrouded from
+our view, the despair, which always attends those impotent researches,
+will necessarily reduce us to the most calamitous state.
+
+Instituting a generous and tolerant survey of religious opinions, we see
+nothing in the solemn pomp of catholic worship which could disorganize the
+mind; as human beings, they have employed human art to render the
+impression more vivid and durable. The decorous piety, and exemplary life
+of the quaker has signally exempted him from this most severe of human
+infirmities. The established church of this country, of which I am an
+unworthy member, will delude no one, by its terrors, to the brink of
+fatuity: the solid wisdom, rational exposition, and pure charity, which
+flow through the works of Taylor, Barrow, Secker, and Tillotson, will
+inspire their readers with a manly confidence: the most enlightened of our
+species will advance in wisdom and in happiness from their perusal; and
+the simplicity and truth of their comments will be evident to those of
+less cultivated understanding. The pastors of this church are all men of
+liberal education, and many have attained the highest literary character;
+they are therefore eminently qualified to afford instruction. But what can
+be expected, when the most ignorant of our race attempt to inform the
+multitude; when the dregs of society shall assume the garb of sanctity and
+the holy office; and pretend to point out a privy path to heaven, or cozen
+their feeble followers into the belief that they possess a picklock for
+its gates? The difficulty of curing this species of madness will be
+readily explained from the consideration, that the whole of their doctrine
+is a base system of delusion, rivetted on the mind by terror and despair;
+and there is also good reason to suppose, that they frequently contrive,
+by the grace of cordials, to fix the waverings of belief, and thus
+endeavour to dispel the gloom and dejection which these hallucinations
+infallibly excite.
+
+Although the faction of faith will owe me no kindness for the disclosure
+of these opinions, yet it would be ungrateful were I to shrink from the
+avowal of my obligations to methodism[23] for the supply of those numerous
+cases which has constituted my experience of this wretched calamity.
+
+When the natural small-pox attacks insane persons it most commonly proves
+fatal. I was induced to draw this conclusion from consulting the records
+of Bethlem, where I found that few of those who had been sent to the
+Small-pox Hospital recovered; but subsequent experience has enabled me to
+point out this distinction: that those who have been in a furious state
+have generally experienced a fatal termination, and that those who
+recovered had the small-pox when they were in a state of convalescence
+from their insanity.
+
+When patients, during their convalescence, become more corpulent than they
+were before, it is a favourable symptom; and, as far as I have remarked,
+such persons have very seldom relapsed. But it should also be observed,
+that many, who become stupid, and in a state, verging on ideotism, are
+very much disposed to obesity: these cases are not to be remedied.
+
+In proportion as insanity has assumed a systematic character, it become
+more difficult of cure. It ought to be noticed, that this state of
+methodical madness implies, that the disease has been of some continuance;
+and, to use a figurative expression, has been more extensively rooted in
+the mind. Every occurrence is blended with the ruling persuasion, and the
+delusion becomes daily corroborated. As
+
+  --------------"Trifles, light as air,
+  Are to the jealous, confirmations strong
+  As proofs of holy writ;"
+
+so in madness, circumstances wholly unconnected readily support the
+favourite system, and persons the most disinterested are supposed to form
+a part of the conspiracy.
+
+
+
+
+CHAP. VII.
+
+MANAGEMENT.
+
+
+Our own countrymen have acquired the credit of managing insane people with
+superior address; but it does not appear that we have arrogated to
+ourselves any such invidious pre-eminence. Foreigners, who have visited
+the public or private institutions of this country, may, perhaps, in their
+relations, have magnified our skill in the treatment of this disease:
+compared with a great part of the north of Europe, which I have visited,
+we certainly excel.
+
+Whether it be that we have more mad persons in England than in other
+countries, and thereby have derived a greater experience of this
+calamity; or, whether the greater number of receptacles we possess for the
+insane, and the emoluments which have resulted from this species of
+farming, have led persons to speculate more particularly on the nature and
+treatment of this affection, may be difficult to determine. Dr. Pinel[24]
+allows the reputation we have acquired; but, with a laudable curiosity, is
+desirous to understand how we became possessed of it.
+
+"Is it," he says, "from a peculiar national pride, and to display their
+superiority over other nations, that the English boast of their ability in
+curing madness by moral remedies; and at the same time conceal the cunning
+of this art with an impenetrable veil? or, on the contrary, may not that
+which we attribute to a subtile policy, be merely the effect of
+circumstances? and, is it not necessary to distinguish the steps of the
+English empirics from the methods of treatment adopted in their public
+hospitals?
+
+"Whatever solution may be given to these questions, yet, after fifteen
+years diligent enquiry, in order to ascertain some of the leading features
+of this method, from the reports of travellers; the accounts published of
+such establishments; the notices concerning their public and private
+receptacles, which are to be found in the different journals, or in the
+works of their medical writers, I can affirm, that I have never been able
+to discover any development of this English secret for the treatment of
+insanity, though all concur in the ability of their management. Speaking
+of Dr. Willis,[25] it is said, that sweetness and affability seem to
+dwell upon his countenance; but its character changes the moment he looks
+on a patient: the whole of his features suddenly assume a different
+aspect, which enforces respect and attention from the insane. His
+penetrating eye appears to search into their hearts, and arrest their
+thoughts as they arise. Thus he establishes a dominion, which is
+afterwards employed as a principal agent of cure. But, where is the
+elucidation of these general principles to be sought; and, in what manner
+are they to be applied according to the character, varieties, and
+intensity of madness? Is the work of Dr. Arnold otherwise remarkable than
+as a burdensome compilation, or a multiplication of scholastic divisions,
+more calculated to retard than advance the progress of Science? Does Dr.
+Harpur, who announces in his preface, that he has quitted the beaten
+track, fulfil his promise in the course of his work? and is his section on
+mental indications any thing but a prolix commentary on the doctrines of
+the ancients? The adventurous spirit of Dr. Crichton, may justly excite
+admiration, who has published two volumes on maniacal and melancholic
+affections, merely on the authority of some observations drained from a
+German Journal; together with ingenious dissertations on the doctrines of
+modern physiologists, and a view of the moral and physical effects of the
+human passions. Finally, can a mere advertisement of Dr. Fowler's
+establishment for the insane in Scotland, throw any light on the
+particular management of such persons, although it profess the purest and
+most dignified humanity, successfully operating on the moral treatment of
+madness?"
+
+Dr. Pinel is deserving of considerable credit for directing the attention
+of medical men to this very important point of the moral management of the
+insane. I have also heard much of this fascinating power which the mad
+doctor is said to possess over the wayward lunatic; but, from all I have
+observed amongst the eminent practitioners of the present day, who
+exercise this department of the profession, I am led to suspect, that,
+although this influence may have been formerly possessed, and even to the
+extent attributed to the late reverend doctor, it ought now to be lamented
+among the _artes deperditæ_. Could the attention of lunatics be fixed, and
+could they be reduced to obedience, by
+
+  "Strong impression and strange powers which lie
+  Within the magic circle of the eye,"
+
+all other kinds of restraint would be superfluous and unnecessarily
+severe. But the fact is notoriously otherwise. Whenever the doctor visits
+a violent or mischievous maniac, however controlling his physiognomy,
+such patient is always secured by the straight waistcoat; and it is,
+moreover, thought expedient to afford him the society of one or more
+keepers.
+
+It has, on some occasions, occurred to me to meet with gentlemen who have
+imagined themselves eminently gifted with this awful imposition of the
+eye, but the result has never been satisfactory; for, although I have
+entertained the fullest confidence of any relation, which such gentlemen
+might afterwards communicate concerning the success of the experiment, I
+have never been able to persuade them to practise this rare talent tetè a
+tetè with a furious lunatic.
+
+However Dr. Pinel may be satisfied of our superiority in this respect, it
+is but decorous to return the compliment, and if any influence were to be
+gained over maniacal patients by assumed importance, protracted staring,
+or a mimicry of fierceness, I verily believe that such pantomime would be
+much better performed in Paris than in London.
+
+It is to be lamented, that general directions only can be given concerning
+the management of insane persons; the address, which is acquired by
+experience and constant intercourse with maniacs, cannot be communicated;
+it may be learned, but must perish with its possessor. Though man appears
+to be more distinguished from other animals by the capability he has of
+transmitting his acquirements to posterity, than by any other attribute of
+his nature, yet this faculty is deplorably bounded in the finer and more
+enviable offsprings of human attainment. The happy dexterity of the
+artisan, the impressive and delighting powers of the actor,
+
+  "And every charm of gentler eloquence,
+  All perishable--like the electric fire,
+  But strike the frame, and, as they strike, expire."
+
+As most men perceive the faults of others without being aware of their
+own, so insane people easily detect the nonsense of other madmen, without
+being able to discover, or even to be made sensible of the incorrect
+associations of their own ideas. For this reason it is highly important,
+that he who pretends to regulate the conduct of such patients, should
+first have learned the management of himself. It should be the great
+object of the superintendant to gain the confidence of the patient, and to
+awaken in him respect and obedience; but it will readily be seen, that
+such confidence, obedience, and respect, can only be procured by
+superiority of talents, discipline of temper, and dignity of manners.
+Imbecility, misconduct, and empty consequence, although enforced with the
+most tyrannical severity, may excite fear, but this will always be mingled
+with contempt. In speaking of the management of insane persons, it is to
+be understood that the superintendant must first obtain an ascendency over
+them. When this is once effected, he will be enabled, on future occasions,
+to direct and regulate their conduct, according as his better judgment may
+suggest. He should possess firmness, and, when occasion may require,
+should exercise his authority in a peremptory manner. He should never
+threaten but execute; and when the patient has misbehaved, should confine
+him immediately. As example operates more forcibly than precept, I have
+found it useful, to order the delinquent to be confined in the presence of
+the other patients. It displays authority; and the person who has
+misbehaved becomes awed by the spectators, and more readily submits. It
+also prevents the wanton exercise of force, and those cruel and unmanly
+advantages which might be taken when the patient and keeper are shut up in
+a private room. When the patient is a powerful man, two or more should
+assist in securing him: by these means it will be easily effected; for,
+where the force of the contending persons is nearly equal, the mastery
+cannot be obtained without difficulty and danger.
+
+When the patient is in a furious state, and uncontrolable by kindness and
+persuasion, he will generally endeavour, by any means, to do as much
+mischief as possible to the person who opposes him; and instances are not
+rare where he has overcome the keeper. When the maniac finds his strength,
+or skill in the contest prevail, he is sure to make the most of such
+advantage, and the consequence of his victory has sometimes proved fatal
+to the keeper. On the other hand, it ought to be the object of the keeper
+to subdue the maniac without doing him any personal injury; and after he
+has overpowered, to confine him, and thus prevent him from attempting any
+further mischief. When the patient is a strong man, and highly irritated,
+it will be impossible for any keeper singly to overcome him without his
+most forcible exertions, and these cannot be put forth without great
+violence to the patient. But subduing the maniac, is not the only object,
+he must afterwards be secured by the straight-waistcoat, or by manacles.
+It will be seen, that the keeper, who, by the great exertion of his bodily
+powers, has become faint and exhausted, will be very little in a condition
+to secure the patient, as his hands must be employed with the implements
+necessary to confine him; moreover, the patient will have additional
+strength from the temperate manner, in which he is made to live; whereas,
+it is but too common, for the keeper to indulge in a diet and beverage,
+which induce corpulence and difficulty of breathing.[26]
+
+As management is employed to produce a salutary change upon the patient,
+and to restrain him from committing violence on others and himself; it may
+here be proper to enquire, upon what occasions, and to what extent,
+coercion may be used. The term coercion has been understood in a very
+formidable sense, and not without reason. It has been recommended by very
+high medical authority to inflict corporal punishment upon maniacs, with a
+view of rendering them rational, by impressing terror.[27] From Dr. Mead's
+section on madness it would appear, that in his time flagellation was a
+common remedy for this disorder. "There is no disease more to be dreaded
+than madness. For what greater unhappiness can befal a man, than to be
+deprived of his reason and understanding, to attack his fellow creatures
+with fury, like a wild beast; to be tied down, _and even beat_, to
+prevent his doing mischief to himself or others."--_Medical Precepts and
+Cautions, page 74._
+
+Dramatic writers abound with allusions to the whip, in the treatment of
+madness. "Love is meerely a madnesse, and I tel you, deserves as well a
+darke house, and a whip, as madmen do: and the reason why they are not so
+punish'd and cured, is, that the Lunacie is so ordinary, that the whippers
+are in love too."--_As You Like It, act III. scene 2._
+
+Another instance to the same effect may be found in Mr. Dennis's comedy of
+Jacobite Credulity. "_Bull Junior._ Look you, old gentleman, I will touch
+this matter as gently as I can to you. Your friends taking notice, that
+you were grown something foolish, whimsical, absurd, and so forth, thought
+fit to have you sent to the College here, [Bedlam] that you might go
+through a course of philosophy, and be cudgel'd and firk'd into a little
+wisdom, by the surly Professors of this place."--_Select Works, vol. ii.
+p. 363._ And again, in the next page; "If thou canst give but so much as a
+reasonable answer to any thing; if thou either knowest what thou art, or
+where thou art, or with whom thou art, then will I be contented to be
+thought mad, and dieted and flogged in thy stead."
+
+It also appears from Mr. Douce's valuable dissertation, that the
+domesticated fool frequently underwent a similar castigation, to curb the
+licentiousness of his discourse, or, as a punishment for the obscenity of
+his actions. Indeed this system of corporal chastisement seems to have
+been general, and may afford some apology for introducing, from a very
+rare little book, an account of the manner of treating this malady in
+Constantinople, about the middle of the 16th century.[28]
+
+"_Of a place called Timarahane for the Correction of the Insane._
+
+"The sultan Bajazet caused a building to be erected for the reception of
+insane persons, in order, that they might not wander about the city, and
+there exhibit their mad pranks. This building is constructed in the manner
+of an hospital: there are about an hundred and fifty keepers appointed to
+look after them; they are likewise furnished with medicines and other
+necessary articles. These keepers, armed with cudgels, patrole the city in
+search of the insane; and when they discover such, they secure them by the
+neck and hands with an iron chain, and, by dint of the cudgel, convey them
+to Timarahane. On entering this place, they are confined by the neck, with
+a much larger chain, which is fixed into the wall, and comes over their
+bed place, so that they are kept chained in their beds. In general, about
+forty are confined there, at some distance from each other.
+
+"They are frequently visited by the people of the city, as a species of
+amusement. The keepers constantly stand over them with cudgels; for, if
+left to themselves, they would spoil and destroy their beds and hurl the
+tables at each other. At the times of giving them food, the keepers
+examine them, and, if they notice any, who are disorderly, they beat them
+severely; but, if they should by accident, find any, who no longer exhibit
+symptoms of insanity, they treat them with greater regard."
+
+What success may have followed such disgraceful and inhuman treatment, I
+have not yet learned; nor should I be desirous of meeting with any one,
+who could give me the information.
+
+If the patient be so far deprived of understanding, as to be insensible
+why he is punished, such correction, setting aside its cruelty, is
+manifestly absurd: and, if his state be such, as to be conscious of the
+impropriety of his conduct, there are other methods more mild and
+effectual. Would any rational practitioner, in a case of phrenitis, or in
+the delirium of fever, order his patient to be scourged? he would rather
+suppose, that the brain, or its membranes, were inflamed, and that the
+incoherence of discourse and violence of action were produced by such
+local disease. It has been shewn by the preceding dissections, that the
+contents of the cranium, in all the instances that have occurred to me,
+have been in a morbid state. It should, therefore, be the object of the
+practitioner, to remove such disease, rather than irritate and torment the
+sufferer.--Coercion should only be considered as a protecting and salutary
+restraint.
+
+In the most violent state of the disease, the patient should be kept
+alone in a dark and quiet room, so that he may not be affected by the
+stimuli of light or sound, such abstraction more readily disposing to
+sleep. As in this violent state there is a strong propensity to associate
+ideas, it is particularly important to prevent the accession of such as
+might be transmitted through the medium of the senses. The hands should be
+properly secured, and the patient should also be confined by one leg; this
+will prevent him from committing any violence. The more effectual and
+convenient mode of confining the hands is by metallic manacles; for,
+should the patient, as frequently occurs, be constantly endeavouring to
+liberate himself, the friction of the skin against a polished metallic
+body may be long sustained without injury; whereas excoriation shortly
+takes place when the surface is rubbed with linen or cotton. Ligatures
+should on all occasions be avoided. The straight waistcoat is admirably
+calculated to prevent patients from doing mischief to themselves; but in
+the furious state, and particularly in warm weather, it irritates, and
+increases that restlessness which patients of this description usually
+labour under. They then disdain the incumbrance of clothing, and seem to
+delight in exposing their bodies to the atmosphere. Where the patient is
+in a condition to be sensible of restraint, he may be punished for
+improper behaviour, by confining him to his room, by degrading him, and
+not allowing him to associate with the convalescents, and by withholding
+certain indulgences, he had been accustomed to enjoy.
+
+In speaking of coercion, I cannot avoid reprobating a practice, which has
+prevailed in some private receptacles for the insane, but which, it is
+presumed, will henceforward be discontinued. I mean, the practice of
+half-stifling a noisy patient, by placing a pillow before the mouth, and
+forcibly pressing upon it, so as to stop respiration. It is unnecessary to
+enquire, how such wanton cruelty came to be introduced; it must have been
+the suggestion of ignorance, and the perpetration of savageness and
+brutality. Sighs, tears, sobs, and exclamations, are the unaffected
+language of passion, and come kindly to our relief, in states of sorrow
+and alarm. Indeed, they appear to be the natural remedies, to
+
+  "Cleanse the stufft bosom of that perillous stuffe,
+  Which weighs upon the heart."
+
+The mild and rational practice of Bethlem Hospital, tolerates these
+involuntary ejaculations. It is there considered, that a noisy and
+loquacious maniac, has not the power to control his utterance of sounds,
+which, from the habitual connexion between ideas and speech, must
+necessarily follow. It is there only viewed as a symptom, or part of the
+disorder; and that, if the cause cannot be suppressed, the effect should
+not be punished.
+
+As madmen frequently entertain very high, and even romantic notions of
+honour, they are often rendered much more tractable by wounding their
+pride, than by severity of discipline.
+
+Speaking of the effects of management, on a very extensive scale, I can
+truly declare, that by gentleness of manner, and kindness of treatment, I
+have seldom failed to obtain the confidence, and conciliate the esteem of
+insane persons, and have succeeded by these means in procuring from them
+respect and obedience. There are certainly some patients who are not to
+be trusted, and in whom malevolence forms the prominent feature of their
+character: such persons should always be kept under a certain restraint,
+but this is not incompatible with kindness and humanity.
+
+It would, in this part of the work, be particularly gratifying to my
+feelings if I could develope this _English secret_ for the moral
+management of the insane, which has been so ardently, yet unsuccessfully
+sought after by Dr. Pinel. For fourteen years I have been daily in the
+habit of visiting a very considerable number of madmen, and of mixing
+indiscriminately among them, without ever having received a blow or
+personal insult. During this time I have always gone alone, and have never
+found the necessity for the assistance or protection of a keeper. The
+superintendant of the Bicêtre, according to Dr. Pinel's account, is
+usually attended by his keepers, [gens de service] though he is said to
+possess[29] "une fermeté inébranlable, un courage raisonné et soutenu par
+des qualités physiques les plus propres á imposer, une stature de corps
+bien proportionnée, des membres pleins de force et de vigeur, et dans des
+momens orageux le ton de voix le plus foudroyant, la contenance la plus
+fiére et la plus intrepide." Not being myself endowed with any of these
+rare qualities; carrying no thunder in my voice, nor lightning in my eye,
+it has been requisite for me to have recourse to other expedients. In the
+first place, it has been thought proper to devote some time and attention
+to discover the character of the patient, and to ascertain wherein, and on
+what points, his insanity consists: it is also important to learn the
+history of his disorder, from his relatives and friends, and to enquire
+particularly respecting any violence he may have attempted towards himself
+or others.
+
+In holding conferences with patients in order to discover their insanity,
+no advantage has ever been derived from assuming a magisterial importance,
+or by endeavouring to stare them out of countenance: a mildness of manner
+and expression, an attention to their narrative, and seeming acquiescence
+in its truth, succeed much better. By such conduct they acquire confidence
+in the practitioner; and if he will have patience, and not too frequently
+interrupt them, they will soon satisfy his mind as to the derangement of
+their intellects.
+
+When a patient is admitted into Bethlem Hospital, if he be sufficiently
+rational to profit by such tuition, it is explained to him, by the keepers
+and convalescents, that he is to be obedient to the officers of the
+house, and especially to myself, with whom he will have daily intercourse;
+they point out to him, that all proper indulgences will be allowed to good
+behaviour, and that seclusion and coercion instantly succeed to
+disobedience and revolt. As _nemo repente turpissimus_, so no one in an
+instant, from a state of tranquillity, becomes furiously mad: the
+precursory symptoms are manifold and successive, and allow of sufficient
+time to secure the patient before mischief ensues; it is principally by
+taking these precautions that our patients are observed to be so orderly
+and obedient. The examples of those who are under strict coercion, being
+constantly in view, operate more forcibly on their minds than any precepts
+which the most consummate wisdom could suggest. In this moral management,
+the co-operation of the convalescents is particularly serviceable; they
+consider themselves in a state of probation, and, in order to be
+liberated, are anxious, by every attention and assistance, to convince the
+superintendants of their restoration to sanity of mind. From mildness of
+treatment, and confidence reposed in them, they become attached, and are
+always disposed to give information concerning any projected mischief.
+
+Considering how much we are the creatures of habit, it might naturally be
+hoped, and experience justifies the expectation, that madmen might be
+benefited by bringing their actions into a system of regularity. It might
+be supposed, that as thought precedes action, that whenever the ideas are
+incoherent, the actions will also be irregular. Most probably they would
+be so, if uncontroled; but custom, confirmed into habit, destroys this
+natural propensity, and renders them correct in their behaviour, though
+they still remain equally depraved in their intellects.
+
+We have a number of patients in Bethlem Hospital, whose ideas are in the
+most disordered state, who yet act, upon ordinary occasions, with great
+steadiness and propriety, and are capable of being trusted to a
+considerable extent. A fact of such importance in the history of the human
+mind, might lead us to hope, that by superinducing different habits of
+thinking, the irregular associations would be corrected.
+
+It is impossible to effect this suddenly, or by reasoning, for madmen can
+never be convinced of the folly of their opinions. Their belief in them is
+firmly fixed, and cannot be shaken. The more frequently these opinions are
+recurred to, under a conviction of their truth, the deeper they subside in
+the mind, and become more obstinately entangled:[30] the object should
+therefore be to prevent such recurrence by occupying the mind on different
+subjects, and thus diverting it from the favorite and accustomed train of
+ideas.
+
+As I have been induced to suppose, from the appearances on dissection,
+that the immediate cause of this disease probably consists in a morbid
+affection of the brain, it may be inferred, that all modes of cure by
+reasoning, or conducting the current of thought into different channels,
+must be ineffectual, so long as such local disease shall continue. It is,
+however, likely that insanity is often continued by habit; that incoherent
+associations, frequently recurred to, become received as truths, in the
+same manner as a tale, which, although untrue, by being repeatedly told,
+shall be credited at last by the narrator, as if it had certainly
+happened. It should likewise be observed, that these incorrect
+associations of ideas are acquired in the same way as just ones are
+formed, and that such are as likely to remain as the most accurate
+opinions. The generality of minds are very little capable of tracing the
+origin of their ideas; there are many opinions we are in possession of,
+with the history and acquisition of which, we are totally unacquainted. We
+see this in a remarkable manner in patients who are recovering from their
+insanity: they will often say such appearances have been presented to my
+mind, with all the force and reality of truth: I saw them as plainly as I
+now behold any other object, and can hardly be persuaded that they did not
+occur. It also does not unfrequently happen, that patients will declare,
+that certain notions are forced into their minds, of which they see the
+folly and incongruity, and yet complain that they cannot prevent their
+intrusion.
+
+As the patient should be taught to view the medical superintendant as a
+superior person, the latter should be particularly cautious never to
+deceive him. Madmen are generally more hurt at deception than punishment;
+and, whenever they detect the imposition, never fail to lose that
+confidence and respect which they ought to entertain for the person who
+governs them.
+
+In the moral management of the insane, this circumstance cannot be too
+strongly impressed on the mind of the practitioner: and those persons, who
+have had the greatest experience in this department of medical science,
+concur in this opinion. The late Dr. John Monro expressly says, "The
+physician should never deceive them in _any_ thing, but more especially
+with regard to their distemper; for as they are generally conscious of it
+themselves, they acquire a kind of reverence for those who know it; and by
+letting them see, that he is thoroughly acquainted with their complaint,
+he may very often gain such an ascendant over them, that they will readily
+follow his directions."[31]
+
+Very different directions are, however, issued by a late writer,[32] and
+which, on account of their novelty, contrivance, and singular morality,
+deserve the consideration of the reader.
+
+"The _conscientious physician_, in the execution of his duty, attempting
+the removal of these deplorable maladies, is under the necessity of
+occasionally deviating from the accustomed routine of practice, of
+stepping out of the beaten track, and, in some cases, that have resisted
+the usual methods, is warranted in adopting any others, that have _only_
+the slightest _plausibility_, or that promise the smallest hope of
+success. Thus, the employment of what may be termed _pious frauds_: as
+when _one_ simple erroneous idea stamps the character of the disease,
+depriving the affected party of the common enjoyments of society, though
+capable of reasoning with propriety, perhaps, with ingenuity, on every
+subject, not connected with that of his hallucination, the correction of
+which has resisted our very best exertions, and, where there is no obvious
+corporeal indisposition, it certainly is allowable to try the effect of
+certain deceptions, contrived to make strong impressions on the senses,
+by means of _unexpected_, _unusual_, _striking_, or apparently
+_supernatural_ agents; such as after waking the party from sleep, either
+suddenly or by a gradual process, by _imitated thunder_, or soft music,
+according to the peculiarity of the case; _combating_ the erroneous
+deranged notion, either by some _pointed sentence_, or signs _executed in
+phosphorus_ upon the wall of the bed chamber; or by some _tale_,
+_assertion_, or _reasoning_; by one in the character of an _angel_,
+_prophet_, or _devil_: but the actor in this drama must possess much
+_skill, and be very perfect in his part_."
+
+It is of great service to establish a system of regularity in the actions
+of insane people. They should be made to rise, take exercise, and food, at
+stated times. Independently of such regularity contributing to health, it
+also renders them much more easily manageable.
+
+Concerning their diet, it is merely necessary to observe, that it should
+be light, and easy of digestion. The proper quantity must be directed by
+the good sense of the superintendant, according to the age and vigour of
+the patient, and proportioned to the degree of bodily exercise he may be
+in the habit of using; "but they should never be suffered to live too low,
+especially while they are under a course of physic."[33] To my knowledge,
+no experiments have yet been instituted respecting the diet of insane
+persons: they have never been compelled to live entirely on farinaceous
+substances. The diet of Bethlem Hospital allows animal food three times a
+week, and on the other days bread with cheese, or occasionally butter,
+together with milk pottage, rice milk, &c. Those who are regarded as
+incurable patients ought certainly to be indulged in a greater latitude
+of diet, but this should never be permitted to border on intemperance. To
+those who are in circumstances to afford such comforts, wine may be
+allowed in moderation, and the criterion of the proper quantity, will be
+that which does not affect the temper of the lunatic, that which does not
+exasperate his aversions, or render his philosophy obtrusive. Although it
+seems rational in all states of madness, that temperance should be
+strictly enjoined, yet an author of the present day[34] steps out of the
+trodden path, and seriously advises us, in difficult cases, to drown
+lunacy in intoxication; and, strange as it may appear, has taught us to
+await the feast of Reason from the orgies of Bacchus. "The conversion of
+religious melancholy into furious madness is a frequent occurrence, and is
+generally followed by recovery. This has suggested the _propriety_, in
+some cases that have resisted more common means, of producing a degree of
+excitement by means of stimuli, in fact, _keeping the patient for days in
+succession in a state of intoxication_, which has often occasioned an
+alleviation of symptoms, and sometimes _restored the sufferers to
+reason_."
+
+Confinement is always necessary in cases of insanity, and should be
+enforced as early in the disease as possible. By confinement, it is to be
+understood that the patient should be removed from home. During his
+continuance at his own house he can never be kept in a tranquil state. The
+interruptions of his family, the loss of the accustomed obedience of his
+servants, and the idea of being under restraint, in a place where he
+considers himself the master, will be constant sources of irritation to
+his mind. It is also known, from considerable experience, that of those
+patients who have remained under the immediate care of their relatives and
+friends, very few have recovered. Even the visits of their friends, when
+they are violently disordered, are productive of great inconvenience, as
+they are always more unquiet and ungovernable for some time afterwards. It
+is a well-known fact, that they are less disposed to acquire a dislike to
+those who are strangers, than to those with whom they have been intimately
+acquainted; they become therefore less dangerous, and are more easily
+restrained. It ought to be understood that no interruption to this
+discipline should defeat its salutary operation. On this account more
+patients recover in a public hospital, than in a private house,
+appropriated for the reception of lunatics. In the former, the
+superintendants persist in a plan laid down, and seldom deviate from
+their established rules: such asylum being a place of charitable relief,
+they are indifferent about pleasing the friends and relatives of the
+patient, who cannot there intrude to visit them at their option. In a
+private receptacle emolument is the first object, and however wisely they
+may have formed their regulations, they soon feel themselves subordinate
+to the caprice and authority of those by whom they are paid.
+
+It frequently happens, that patients who have been brought immediately
+from their families, and who were said to be in a violent and ferocious
+state at home, become suddenly calm and tractable when placed in the
+hospital. On the other hand it is equally certain, that there are many
+patients whose disorder speedily recurs after having been suffered to
+return to their families, although they have for a length of time
+conducted themselves, under confinement, in a very orderly manner. When
+they are in a convalescent state the occasional visits of their friends
+are attended with manifest advantage. Such an intercourse imparts
+consolation, and presents views of future happiness and comfort. But
+certain restrictions should be imposed on the visits of these friends;
+ignorant people often, after a few minutes conversation with the patient,
+will suppose him perfectly recovered, and acquaint him with their opinion:
+this induces him to suppose that he is well, and he frequently becomes
+impatient of confinement and restraint. From such improper intercourse I
+have known many patients relapse, and in two instances I have a
+well-founded suspicion that it excited attempts at suicide.
+
+Many patients have received considerable benefit by change of situation,
+which occupies the mind with new objects, and this sometimes takes place
+very shortly after the removal.
+
+  "Haply the Seas and Countries different
+  With variable objects, shall expell
+  This something setled matter in his heart:
+  Whereon his Braines still beating, puts him thus
+  From fashion of himselfe."
+
+In what particular cases, or stages of the disease, this may be
+recommended, I am not enabled, by sufficient experience, to determine.
+
+
+
+
+CHAP. VIII.
+
+REMEDIES FOR INSANITY.
+
+
+_Bleeding._
+
+Where the patient is strong, and of a plethoric habit, and where the
+disorder has not been of any long continuance, bleeding has been found of
+considerable advantage, and as far as I have yet observed, is the most
+beneficial remedy that has been employed. The melancholic cases have been
+equally relieved with the maniacal by this mode of treatment. Venesection
+by the arm is, however, inferior in its good effects to blood taken from
+the head by cupping. This operation, performed in the manner to which I
+have been accustomed, consists in having the head previously shaven, and
+six or eight cupping glasses applied on the scalp. By these means any
+quantity of blood may be taken, and in as short a time, as by an orifice
+made in a vein by the lancet. When the raving paroxysm has continued for a
+considerable time, and the scalp has become unusually flaccid; or where a
+stupid state has succeeded to violence of considerable duration, no
+benefit has been derived from bleeding: indeed these states are generally
+attended by a degree of bodily weakness, sufficient to prohibit such
+practice independently of other considerations.
+
+The quantity of blood to be taken, must be left to the discretion of the
+practitioner: from eight to sixteen ounces may be drawn, and the
+operation occasionally repeated, as circumstances may require.
+
+In some cases where blood was drawn at the commencement of the disease
+from the arm, and from patients who were extremely furious and
+ungovernable, it was covered with a buffy coat; but in other cases it has
+seldom or never such an appearance. In more than two hundred patients,
+male and female, who were let blood by venesection, there were only six
+whose blood could be termed sizy.
+
+In some few instances hemoptysis has preceded convalescence, as has also a
+bleeding from the hemorrhoidal veins. Epistaxis has not, to my knowledge,
+ever occurred.
+
+Before particular remedies, to be employed for the cure of mania and
+melancholia, are recommended, it may be necessary to give some directions
+concerning the means to be used for their certain administration.
+
+Maniacs in general feel a great aversion to become benefited from those
+medicinal preparations which practitioners employ for their relief; and on
+many occasions they refuse them altogether. Presuming that some good is to
+be procured by the operation of medicines on persons so affected, and
+aware of their propensity to reject them, it becomes a proper object of
+enquiry how such salutary agents may most securely, and with the least
+disadvantage, be conveyed into the stomachs of these refractory subjects.
+For the attainment of this end various instruments have been contrived,
+but that which has been more frequently employed, and is the most
+destructive and devilish engine of this set of apparatus, is termed a
+_spouting_ boat. It will not be necessary to fatigue the reader with a
+particular description of this coarse tool, except to remark, that it is
+constructed somewhat like a child's pap boat; and is intended to force an
+entrance into the mouth through the barriers of the teeth.[35]
+
+In those cases, where patients have been obstinately bent on starving
+themselves, or where they have become determined to resist the
+introduction of remedies calculated for their relief, I have always been
+enabled to convey both into their stomachs, at any time, and in any
+quantity that might be necessary, by the employment of an instrument, of
+which the figure and dimensions are here given.
+
+[Illustration]
+
+Since the use of this very simple and efficient instrument, which I
+constructed about twelve years ago, I can truly affirm, that no patient
+has ever been deprived of a tooth, and that the food or remedy has always
+been conveyed into the stomach of the patient.
+
+The manner in which this compulsory operation is performed, consists in
+placing the head of the patient between the knees of the person who is to
+use the instrument: a second assistant secures the hands, (if the
+straight-waistcoat be not employed) and a third keeps down the legs. As
+soon as the mouth is opened, the instrument may be introduced; it presses
+down the tongue, and keeps the jaws sufficiently asunder to admit of the
+introduction of the medicine, which should be contained in a vial, or tin
+pot with a spout, to allow it to run in a small stream. The nose of the
+patient being held by the left hand of the person who uses the
+instrument, a small quantity of the medicine is to be poured into the
+mouth, and when deglutition has commenced, is to be repeated, so as to
+continue the act of swallowing until the whole be taken.
+
+A little address will obviate the determination of the patient to keep his
+teeth closed: he may be blindfolded at the commencement, which never fails
+to alarm him, and urges him to enquire what the persons around him are
+about: causing him to sneeze, by a pinch of snuff, always opens the mouth
+previously to that convulsion, or tickling the nose with a feather
+commonly produces the same effect.
+
+With delicate females, where one or more of the grinder-teeth are wanting,
+the finger may be introduced on the inside of the cheek, which being
+strongly pressed outwards will prevent the patient from biting, and form
+a sufficient cavity to pour in the liquid. With a wish of speaking
+confidently on this subject, I have usually performed the business of
+forcing, more especially amongst the females, and it has, in some degree,
+rewarded my trouble; it has ascertained the practicability of
+administering remedies; and it has also afforded the consolation, that,
+where the means employed have produced no good, the patient has sustained
+no injury.
+
+
+_Purging._
+
+An opinion has long prevailed, that mad people are particularly
+constipated, and likewise extremely difficult to be purged. From all the
+observations I have been able to make, insane patients, on the contrary,
+are of very delicate and irritable bowels, and are well, and copiously
+purged, by a common cathartic draught. That, which has been commonly
+employed at the hospital, was prepared agreeably to the following formula:
+
+  [Precsription] Infusi sennæ [ounce] iss ad [ounce] ij
+                 Tincturæ sennæ [dram] i ad [dram] ij
+                 Syrupi spinæ cervinæ, [dram] i ad [dram] ij.
+
+but, within the last seven years, the tinctura jalapij has been
+substituted for the tinctura sennæ. It is so far an improvement, that it
+operates more speedily, and produces less griping.
+
+This medicine seldom fails of procuring four or five stools, and
+frequently a greater number.
+
+In confirmation of what I have advanced, respecting the irritable state of
+the intestines in mad people, it may be mentioned, that the ordinary
+complaints, with which they are affected, are diarrhoea and dysentery:
+these have heretofore been very violent and obstinate.
+
+Perhaps it may be attributed to superior care that the occurrence of these
+complaints has, of late years, been comparatively rare, contrasted with
+the numbers who were formerly attacked with such diseases; and, when they
+do happen, an improved method of treatment has rendered these intestinal
+affections no longer formidable or fatal.
+
+In those very violent diarrhoeas, which ordinarily terminate in
+dysentery, from five to ten grains of the pilula hydrargyri have been
+given according to the sex, constitution, and nature of the complaint,
+once or twice a day, and with general success.
+
+It may be necessary to add, that it is proper, during the course of this
+mercurial remedy, which shortly arrests the disease, to keep the bowels
+in an open state, by some of the milder purgatives employed every third or
+fourth day.
+
+Diarrhoea very often proves a natural cure of insanity; at least, there
+is sufficient reason to suppose, that such evacuation has very much
+contributed to it. The number of cases, which might be adduced in
+confirmation of this remark, is considerable; and the speedy
+convalescence, after such evacuation, is still more remarkable.
+
+In many cases of insanity there prevails a great degree of insensibility,
+so that patients have scarcely appeared to feel the passing of setons, the
+drawing of blisters, or the punctures of cupping. On many occasions, I
+have known the urine retained for a considerable time, without complaint
+from the patient, although it is well ascertained, that there is no
+affection more painful and distressing than distension of the bladder.
+
+Of this general insensibility the intestinal canal may be supposed to
+partake; but this is not commonly the case; and, if it should frequently
+prevail, would be widely different from a particular and exclusive torpor
+of the primæ viæ.
+
+But, sometimes, there arises a state of disease in maniacs, where the
+stomach and intestines are particularly inert. The patient refuses to take
+food, and is obstinately constipated: the tongue is foul, and the skin is
+tinged with a yellowish hue: the eyes assume a glossy lustre, and exhibit
+a peculiar wildness. In this state, I have given two drachms of the pulvis
+jalapij for a dose, and which, on some occasions, has procured but one
+stool, so that it has been necessary several times to repeat the same
+quantity. After the bowels have been sufficiently evacuated, the appetite
+commonly returns, and the patient takes food as usual.
+
+Much mischief may be produced, if it be attempted to force food into the
+stomach in such a case, which the ignorance of keepers may attempt,
+supposing it to originate in the obstinacy of the patient. In order to
+continue the bowels in a relaxed state, after they have been sufficiently
+emptied of their contents, the following formula has been employed with
+advantage:
+
+  [Precsription] Infusi sennæ, [ounce] vijss
+                 Kali Tartarizati, [ounce] ss
+                 Antimonij Tartarizati, gr 1ss
+                 Tincturæ jalapij, [dram] ij
+
+From two to three table spoonsful may be given once or twice a day, as
+occasion may require.
+
+There are some circumstances unconnected with disease of mind, which might
+dispose insane persons to costiveness. I now speak of such as are
+confined, and who come more directly under our observation. When they are
+mischievously disposed they require a greater degree of restraint, and are
+consequently deprived of that air and exercise which so much contribute to
+regularity of bowels. It is well known that those who have been in the
+habits of free living, and who come suddenly to a more temperate diet, are
+very much disposed to costiveness. But to adduce the fairest proof of what
+has been advanced, I can truly state, that incurable patients, who have
+for many years been confined in the Hospital, are subject to no
+inconveniences from constipation. Many patients are averse to food, and
+where little is taken in, the egesta must be inconsiderable.
+
+To return from this digression: it is concluded, from very ample
+experience, that cathartic medicines are of the greatest service, and
+ought to be considered as an indispensable remedy in cases of insanity.
+The good sense and experience of every practitioner must direct him as to
+the dose, and frequency with which these means are to be employed, and of
+the occasions where they would be prejudicial.
+
+
+_Vomiting._
+
+However strongly this practice may have been recommended, and how much
+soever it may at present prevail, I am sorry that it is not in my power to
+speak of it favourably. In many instances, and in some where blood-letting
+had been previously employed, paralytic affections have within a few hours
+supervened on the exhibition of an emetic, more especially where the
+patient has been of a full habit, and has had the appearance of an
+increased determination to the head.
+
+It has been for many years the practice of Bethlem Hospital to administer
+to the curable patients four or five emetics in the spring of the year;
+but, on consulting my book of cases, I have not found that such patients
+have been particularly benefited by the use of this remedy. From one grain
+and half to two grains of tartarized antimony has been the usual dose,
+which has hardly ever failed of procuring full vomiting. In the few
+instances where the plan of exhibiting this medicine in nauseating doses
+was pursued for a considerable time, it by no means answered the
+expectations which had been raised in its favour by very high authority.
+Where the tartarized antimony, given with this intention, operated as a
+purgative, it generally produced beneficial effects.
+
+Ten years have elapsed since the former edition of this work appeared; but
+this length of time, and subsequent observation, have not enabled me to
+place any greater confidence in the operation of emetics, as a cure for
+insanity.
+
+An author[36] who has lately published a work, entitled "_Practical
+Observations on Insanity_," is however a determined fautor of emetics in
+maniacal cases. In his skilful hands they have worked marvellous cures;
+nor have any prejudicial effects ever resulted from their employment.
+Perhaps no one has enjoyed a fairer opportunity of witnessing the effects
+of remedies for insane persons than myself; and when emetics are employed
+in Bethlem Hospital they have the best chance of effecting all the relief
+they are competent to afford, as they are given by themselves, without the
+intervention of other medicines; and this course of emetics usually
+continues six weeks. Had Dr. Cox confined himself to the relation of his
+own victories in combating madness with vomits, it would have been
+sufficient; but he endeavours to raise the leveé en masse of medical
+opinion to co-operate with his sentiments. He says, page 78, "Yet _every_
+physician, who has devoted his attention to this branch of the profession,
+_must_ differ from him when he treats of vomiting." It was never my
+intention to deny, in a disordered state of the stomach, that the madman
+would be equally benefited with one in his senses by the operation of a
+vomit: but I have asserted, that after the administration of many thousand
+emetics to persons who were insane, but otherwise in good health, that I
+never saw any benefit derived from their use. It will also be granted,
+that some ascendancy may be gained over a furious maniac by forcing him to
+take a vomit, or any other medicine, but this is widely different from any
+positive advantage resulting from the act of vomiting. Sir John Colebatch,
+in his "_Dissertation concerning Misletoe_," says, _p._ 35, "But I have
+been for some years afraid of giving vomits, even of the gentlest sort, in
+convulsive distempers, from some terrible accidents, that have been likely
+to ensue, from moderate doses of Ipecacuanha itself."
+
+In St. Luke's hospital, the largest public receptacle for insane persons,
+where the medical treatment is directed by a physician of the highest
+character and eminence, and whose experience is, at least, equal to that
+of any professional man in this country, vomits are by no means considered
+as the order of the day; they may be employed to remove symptoms
+concomitant with madness, but are not held as specifics for this disease.
+
+In reading over the cases related by Dr. Cox, there is no one, where
+emetics have been solely employed as agents of cure; they have been always
+linked with other remedies; and it requires more sagacity than even the
+doctor can exact, to pronounce, when different means of cure are combined,
+to which the palm should be adjudged. In the relation of my own experience
+concerning vomiting, as a remedy for insanity, I have had only in view the
+communication of facts, for I entertain neither partiality nor aversion to
+any remedies, beyond the fair claim which their operations possess. Had I
+modestly ventured to state, after the example of the Doctor, "that I had
+_devoted_ myself _exclusively_ and _assiduously_ for a _series of years_,
+to the care of insane patients in an _establishment_, where persons of
+_both sexes_ are received,"[37] it might be suspected, that the
+superstructure of my philosophy had been reared on the basis of private
+emolument.
+
+
+_Camphor._
+
+This remedy has been highly extolled, and doubtless with reason, by those
+who have recommended it: my own experience merely extends to ten cases; a
+number, from which no decisive inference of its utility ought to be drawn.
+The dose was gradually increased, from five grains to two drachms, twice a
+day; and, in nine cases, the use of this remedy was continued for the
+space of two months. Of the patients, to whom the camphor was given, only
+two recovered: one of these had no symptoms of convalescence for several
+months after the use of this remedy had been abandoned: the other, a
+melancholic patient, certainly mended during the time he was taking it;
+but he was never able to bear more than ten grains thrice a day. He
+complained that it made him feel as if he were intoxicated. Considering
+the insoluble nature of camphor, and the impracticability of compelling a
+lunatic to swallow a pill or bolus, it has been found convenient (when a
+large quantity was required) to give this medicine in the form of an
+emulsion, by dissolving the camphor in hot olive oil, and afterwards
+adding a sufficient quantity of warm water and aqua ammoniæ puræ.
+
+
+_Cold Bathing._
+
+This remedy having for the most part been employed, in conjunction with
+others, it becomes difficult to ascertain how far it may be exclusively
+beneficial in this disease. The instances where it has been separately
+used for the cure of insanity, are too few to enable me to draw any
+satisfactory conclusions. I may, however, safely relate, that in many
+instances, paralytic affections have in a few hours supervened on cold
+bathing, especially where the patient has been in a furious state, and of
+a plethoric habit. That this is not unlikely to happen may be supposed
+from the difficulty of compelling the patient to go head-foremost into the
+bath. In some cases vertigo, and in others a considerable degree of fever
+ensued after immersion. The shower-bath was employed some years ago in the
+hospital, and many cases were selected in order to give a fair trial to
+this remedy, but I am unable to say, that any considerable advantage was
+derived to the patients from its use. If I might be permitted to give an
+opinion on this subject, the principal benefit resulting from this remedy,
+has been in the latter stages of the disease, and when the system had been
+previously lowered by evacuations. As a remedy for insanity cold bathing
+has been disregarded by a celebrated practitioner. To a question from a
+select committee of the House of Commons to Doctor Willis, 9th March,
+1807, the following answer was given.
+
+_Question._ Are you of opinion that warm and cold baths are necessary for
+lunatic patients?
+
+_Answer._ I think warm baths may be very useful, but it _can seldom
+happen_ that a cold bath will be required.[38]
+
+
+_Blisters._
+
+These have been in several cases applied to the head, and a very copious
+discharge maintained for many days, but without any manifest advantage.
+The late Dr. John Monro, who had, perhaps, seen more cases of this disease
+than any other practitioner, and who, joined to his extensive experience,
+possessed the talent of accurate observation, mentions, that he "never saw
+the least good effect of blisters in madness, unless it was at the
+beginning, while there was some degree of fever, or when they have been
+applied to particular symptoms accompanying this complaint."[39] Dr. Mead
+also concurs in this opinion. "Blistering plasters applied to the head
+will possibly be thought to deserve a place among the remedies of this
+disease, but I have often found them do more harm than good by their over
+great irritation."--_Medical Precepts, page 94._ Although blisters
+appear to be of little service, when put on the head, yet I have, in many
+cases, seen much good result from applying them to the legs. In patients
+who have continued for some time in a very furious state, and where
+evacuations have been sufficiently employed, large blisters applied to the
+inside of the legs, have often, and within a short time, mitigated the
+violence of the disorder.
+
+In a few cases setons have been employed, but no benefit has been derived
+from their use, although the discharge was continued above two months.
+
+Respecting opium, it may be observed, that whenever it has been exhibited,
+during a violent paroxysm, it has hardly ever procured sleep: but, on the
+contrary, has rendered those who have taken it much more furious: and,
+where it has for a short time produced rest, the patient has, after its
+operation, awaked in a state of increased violence.
+
+Many of the tribe of narcotic poisons have been recommended for the cure
+of madness; but, my own experience of those remedies is very limited, nor
+is it my intention to make further trials. Other, and perhaps whimsical
+modes of treating this disorder, have been mentioned: whirling,[40] or
+spinning a madman round, on a pivot, has been gravely proposed; and, music
+has been extolled, with a considerable glow of imagination, by the same
+gentleman.--That the medical student may be fully aware of the manifold
+agents which _practical physicians_ have suggested for the restoration of
+reason, I shall conclude my volume with the following extract.[41]
+
+"The medical philosopher, in his study of human nature, must have
+observed, that _sympathetic correspondence of action_ between the mind and
+body, which is _uniformly_ present in health and disease, though _varying_
+with circumstances. The different passions, according to their nature, the
+degree or intensity of application, and the sensibility of the party,
+exhibit certain characteristic expressions of countenance, and produce
+obvious _changes_, actions, or motions, in the animal economy. MUSIC has
+been found to occasion _all_ these actions, changes, and movements, in
+some sensible systems; and where one passion morbidly predominates, as
+frequently happens in mania, those species of simple or combined sounds,
+_capable of exciting an opposite passion_, may be _very usefully_
+employed. _If_ then such effects _can_ be produced by such a power, acting
+on a mind only endued with its healthy proportion of susceptibility, what
+may we _not_ expect where the sensibility is morbidly increased, and where
+the patient is alive to the most minute impressions? Cases frequently
+occur where such acuteness of sensibility, and _extreme_ delicacy of
+system exist, that most of the more common, _moral_, and medical means are
+contra-indicated; _here_ relief may be often administered through the
+medium of the _senses_; the _varied modulations, the lulling, soothing_
+cords of even an Eölian harp have _appeased_ contending passions,
+_allayed_ miserable feeling, and afforded ease and tranquillity to the
+bosom _tortured_ with real or fancied woe: and I can easily _imagine_,
+that _jarring discord_, _grating harsh rending_ sounds, applied to an ear
+_naturally_ musical, would uniformly excite great commotion. Under
+circumstances calculated to assist this action, by producing unpleasant
+impressions through the medium of the other senses, as when SCREECHES and
+YELLS are made in an apartment painted _black_ and _red_, or _glaring
+white_, every man must be painfully affected: the maniacal patient,
+_however torpid_, _must_ be roused: or, on the contrary, where an opposite
+state obtains, extreme sensibility and impatience of powerful impression,
+there _much may be expected_ from placing the patient in an _airy room_,
+surrounded with _flowers breathing odours_, the walls and furniture
+_coloured green_, and the air agitated by undulations of the softest
+harmony. _Much_ of this may appear FANCIFUL and RIDICULOUS, but the
+_enquiring_ practitioner _will_ find, on making the experiment, it
+deserves his _serious_ attention; and no mean is to be despised that is
+capable of arresting the attention, changing the trains of thought,
+interesting the affections, removing or diminishing painful sensations,
+and ultimately rendering both mind and body sensible to impressions, and
+_all this has been effected by music_. Every individual is not capable of
+accurately estimating the _extensive powers_ of this agent; but I would
+ask the _musical amateur_, or the _experienced professor_, if he have not
+frequently felt sensations the most _exquisite_ and _indescribable_; if he
+have not experienced the whole frame _trilling_ with _inexpressible
+delight_, when the _tide_ of full harmony has FLOWN on his ear, and the
+most _wretched miserable_ feeling, UNIVERSAL HORRIPILATIO and CUTIS
+ANSERINA from the _grating crash_ of discord? All the varied sensations
+from transport to disgust, have been occasioned by the different movements
+in one piece of music. I might _amuse_ my readers with a great variety of
+instances where persons have been very singularly affected by means of
+music, and where its powers have extended to the _brute creation_, but
+this I purposely avoid."
+
+
+FINIS.
+
+
+  Printed by G. HAYDEN,}
+  Brydges Street, Covent Garden.}
+
+
+
+
+FOOTNOTES:
+
+[1] The choice of these words must be left to the taste of the reader, Dr.
+Johnson not having thought proper to admit them into his dictionary.
+
+[2] Some doubts are entertained whether Dr. Boord was physician to King
+Henry the eighth, but he was certainly a fellow of the College.
+
+[3] Apprehension of sensations. This is perhaps only an endeavour to
+explain the thing, _by_ the thing, or producing words of similar import
+with different sounds. Junius, speaking of the word hand (as derived from
+the gothic Handus) says, "Quidam olim deduxerunt vocabulum ab antiquo
+verbo HENDO, _Capio_: unde PREHENDO, APPREHENDO, &c."--_Gothicum
+Glossarium_, p. 188. Professor Ihre conceives it equally probable that the
+old latin word _hendo_ may have had a northern origin. "Id vero non
+possum, quin addam, oppidó mihi probabile fieri, ipsammet hanc vocem latio
+olim peregrinam non fuisse, quod quippe augurar ex derivato HENDO, capio,
+unde prehendo cum derivatis pullularunt."--_Glossarium Sviogothicum. tom.
+i. p. 778._
+
+[4] Quere. Why should the most _active_ characteristics of our nature be
+termed _Passions_? The word seems properly employed in _Passion week_, the
+period commemorative of Christ's suffering or _Passion_. But we are said
+to _fly_, or _fall_ into a passion, and then passion _gets the better of
+us_. For the softer sex we conceive the most delicate, refined, and
+honorable _passion_, yet every one allows the dreadful consequences which
+ensue from an indulgence of our _passions_, and most persons agree that
+_passion_, carried to excess, constitutes madness--we live in a world of
+metaphor.
+
+[5] In many instances, although it is far from being general, pain of the
+head, and throbbing of its arteries precede an attack of insanity;
+sometimes giddiness is complained of as a precursory symptom. Those who
+have been several times disordered, are now and then sensible of the
+approaching return of their malady. Some have stated, a sense of working
+in the head, and also in the intestines, as if they were in a state of
+fermentation. Others observe that they do not seem to possess their
+natural feelings, but they all agree that they feel confused from the
+sudden and rapid intrusion of unconnected thoughts.
+
+[6] To illustrate how necessarily our sensations, or ideas must become
+confused, when their succession is too rapid, the relation of some
+experiments on that subject will sufficiently conduce.
+
+"But by the able assistance of Mr. Herschel, I am in a condition to give
+some approximation, at least, towards ascertaining the velocity of our
+audible sensations. For having, by means of a clock, produced sounds,
+which succeeded each other with such rapidity, that the intervals between
+each of them were (as far as could be judged) the smallest posible; he
+found he could evidently distinguish one hundred and sixty of them to flow
+in a second of time. Now as each interval must in this case be reckoned as
+a sensation likewise, as it might be filled up with a sound thereby making
+it a continued one; it follows, that we are capable of entertaining at
+least three hundred and twenty audible sensations in that period of
+time."--_Vide a Treatise on Time, by W. Watson, Jun. M. D. F. R. S. 8vo,
+1785, page 32._
+
+[7] The late Dr. Johnson was remarkably distinguished by certain
+peculiarities of action when his mind was deeply engaged. Sir Joshua
+Reynolds was of opinion "that it proceeded from a habit he had indulged
+himself in, of accompanying his thoughts with certain untoward actions."
+"One instance of his absence, and particularity as it is characteristic of
+the man, may be worth relating. When he and I took a journey into the
+West, we visited the late Mr. Banks, of Dorsetshire; the conversation
+turning upon pictures, which Johnson could not well see, he retired to a
+corner of the room, stretching out his right leg as far as he could reach
+before him, then bringing up his left leg, and stretching his right still
+further on. The old gentleman observing him, went up to him, and in a very
+courteous manner assured him, that though it was not a new house, the
+flooring was perfectly safe. The Doctor started from his reverie like a
+person waked out of his sleep, but spoke not a word."--_Boswell's Life of
+Dr. Johnson, vol. i. p. 76._ In the same work other of his tricks are
+recorded, as talking to himself, measuring his steps in a mysterious
+manner, half whistling, clucking like a hen, rubbing his left knee, &c.
+Many sensible persons, with whom I am now acquainted, when particularly
+thoughtful, discover strange bodily motions, of which they are by no means
+conscious at the time.
+
+[8] This gritty matter, subjected to chemical examination, was found to be
+_phosphat of lime_.
+
+[9] This appearance I have found frequently to occur in maniacs who have
+suffered a violent paroxysm of considerable duration: and in such cases,
+when there has been an opportunity of inspecting the contents of the
+cranium after death, water has been found between the dura mater and
+tunica arachnoidea.
+
+[10] Morbid Anatomy, page 304.
+
+[11] Mr. Fourcroy does not appear to have given any particular attention
+to this fluid. He says, "Cette humeur ne paraît pas différer de celle qui
+mouille toutes les parois membraneuses du corps humain en general, et dont
+j'ai déja parlé. C'est un liquide mucoso gelatineux, plus ou moins
+albumineux, et contenant _quelques matiéres salines_."--_Systéme des
+Connoisances Chimiques, 8vo. tom. ix. p. 303._
+
+[12] It may be remarked, that all children in the early attempts at
+language, speak of themselves and others in the third person, and never
+employ the pronoun; they likewise never use connectives, or the
+inflections of verbs, until they begin to acquire some knowledge of
+numbers. Beyond this rude state our patient never advanced.
+
+[13] For this term the indulgent reader must give the author credit,
+because he finds himself unable adequately to explain it.--It is a complex
+_term_ for many ideas, on which language has not as yet, and perhaps will
+never be imposed. Very unfortunately there are many terms of this nature,
+equally incapable of description--a smile, for instance, is not very easy
+to be defined. Dr. Johnson calls it "a slight contraction of the face"
+which applies as properly to a paralytic affection. He also states it to
+be "opposed to frown." If curiosity should prompt the inquisitive reader
+to seek in the same author for the verb, to frown, he will find it "to
+express displeasure _by contracting the face_ to wrinkles." He who would
+
+  "Finde the minde's construction in the face"
+
+must not expect to be able to communicate to others, in a few words, that
+knowledge which has been the slow and progressive accumulation of years.
+
+[14] These are the usual terms employed by writers on this subject, but
+the propriety of their use must be left to the judgment of the reader.
+Every person will occasionally hesitate whether certain occurrences, said
+to be causes, ought to be referred to one class, in preference to the
+other. They are loose and vague names: for instance, a course of
+debauchery long persisted in, would probably terminate in paralysis;
+excessive grief we know to be capable of the same effect. Paralysis
+frequently induces derangement of mind, and in such case it would be said,
+that the madness was induced by the paralysis as a physical cause. But it
+often happens that debauchery and excessive grief are followed by madness,
+without the intervention paralysis. Moral, in this sense, means merely
+habitudes or customs, reiteration of circumstances confirmed into usage;
+and these may be indifferently accounted physical or moral.
+
+[15]
+
+  "----nessun maggior dolore,
+  Che ricordarsi del tempo felice
+  Nella miseria."--_Dante._
+
+[16] The Jews also were particularly instrumental in the practice and
+propagation of medical knowledge at that period.
+
+[17] Cogitatio, (hîc minimè prætereunda) est motus peculiaris Cerebri,
+quod hujus facultatis est proprium organum: vel potiùs Cerebri pars
+quædam, in medulla spinali et nervis cum suis meningibus continuata, tenet
+animi principatum, motumque perficit tam cogitationis quam sensationis;
+quæ secundùm Cerebri diversam in omnium animalium structuram, mirè
+variantur.--_Tolandi Pantheisticon, p. 12._
+
+[18] 1796, 1797.
+
+[19] Vide Report, Part II. p. 25.
+
+[20] Report, p. 59.
+
+[21] Ibid, 57.
+
+[22] Report 54.
+
+[23] "We shall use the general term of methodism, to designate these three
+classes of fanatics, [Arminian and Calvinistic methodists, and the
+_evangelical_ clergymen of the church of England] not troubling ourselves
+to point out the finer shades, and nicer discriminations of lunacy, but
+treating them all as in one general conspiracy against common sense, and
+rational orthodox christianity."--_Edinburgh Review, Jan. 1808, p. 342._
+
+[24] Traité Medico-Philosophique sur l'Alienation Mentale, 8vo. Paris, an.
+9, p. 47.
+
+[25] The late Reverend Dr. Willis.
+
+[26] With respect to the persons, called Keepers, who are placed over the
+insane, public hospitals have generally very much the advantage. They are
+there better paid, which makes them more anxious to preserve their
+situations by attention and good behaviour: and thus they acquire some
+experience of the disease. But it is very different in the private
+receptacles for maniacs. They there procure them at a cheaper rate; they
+are taken from the plough, the loom, or the stable; and sometimes this
+tribe consists of decayed smugglers, broken excisemen, or discharged
+sheriffs' officers:
+
+  "All that at home no more can beg or steal."
+
+How well such a description of persons is calculated to regulate and
+direct the conduct of an insane gentleman may be easily conjectured. If
+any thing could add to the calamity of mental derangement, it would be the
+mode which is generally adopted for its cure. Although an office of some
+importance and great responsibility, it is held as a degrading and odious
+employment, and seldom accepted but by idle and disorderly persons.
+
+[27] Vide Cullen, First Lines, vol. iv. p. 154.
+
+[28] "_D'uno luogo chiamato Timarahane, dove si castigano i matti._
+
+"In Costantinopoli fece fare un luogo Sultan Paiaxit dove si dovessero
+menare i pazzi, accioche non andassero per la citta, facendo pazzie, et è
+fatto à modo d'uno Spedale, dove sono circa cento cinquanta guardiani in
+loro custodia, et sonvi medicine, et altre cose per loro bisogni, e i
+detti guardiani vanno per la citta con bastoni cercando i matti, et quando
+ne truovano alcuno, lo'ncatenano per il collo con cathene di ferro, et per
+le mani, et à suon di bastoni lo menano al detto luogo, et quivi gli
+mettono una catena al collo assai maggiore, che è posta nel muro, et viene
+sopra del letto, tal mente che nel letto per il collo tutti gli tengono
+incatenati, et vene saranno per ordine, lontano l'uno dall'altro numero di
+quaranta, i quali per piacere di quelli della citta molte volte sono
+visitati, et di continovo col bastone i guardiani gli stanno appresso:
+Percio che non essendovi guastano i letti, et tiransi le tavole l'uno à
+l'altro: et venuta l'hora del mangiare, i guardiani gli vanno esaminando
+tutti per ordine, et trovando alcuno, che non istia in buon proposito,
+crudelmente lo battono, et se à caso truovano alcuno, che non faccia piu
+pazzie, gli banno miglior cura, che à gli altri." _J. Costumi et la vita
+de Turchi di Gio. Antonio Menavino Genovese da Vultri, 12mo, in Fiorenza,
+1551._
+
+[29] Traité sur la Mania, page 103.
+
+[30] The frequent recurrence of any propensity leads, by sure steps, to
+the final adjustment of the character; and even when the propensity is
+ideal, the repetition of the fits will, in the end, invest fancy with the
+habitudes of nature.--_Criticism on the Elegy written in a Country Church
+Yard, p. 3._
+
+[31] Remarks on Dr. Batties' Treatise on Madness, p. 38.
+
+[32] Dr. Cox, Practical Observations on Insanity, p. 28.
+
+[33] Dr. John Monro's Remarks on Dr. Battie, p. 39.
+
+[34] Vide Dr. Cox's _Practical_ Obs. on Insanity, p. 42.
+
+[35] It is a painful recollection to recur to the number of interesting
+females I have seen, who, after having suffered a temporary disarrangement
+of mind, and undergone the brutal operation of _spouting_, in private
+receptacles for the insane, have been restored to their friends without a
+front tooth in either jaw. Unfortunately the task of forcing patients to
+take food or medicines is consigned to the rude hand of an ignorant and
+unfeeling servant: it should always be performed by the master or mistress
+of the mad-house, whose reputations ought to be responsible for the
+personal integrity of the unhappy beings committed to their care.
+
+[36] Dr. Cox.
+
+[37] See Dr. Cox's Advertisement prefixed to his book.
+
+[38] Vide Report from the select committee appointed to enquire into the
+state of lunatics, page 25.
+
+[39] Remarks on Dr. Batties' Treatise on Madness.
+
+[40] See Dr. Cox, page 102.
+
+[41] Dr. Cox, p. 61.
+
+
+
+
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+12--BADHAM's OBSERVATIONS on the INFLAMMATORY AFFECTIONS of the MUCOUS
+MEMBRANE of the BRONCHIÆ. Comprehending an account of the acute
+inflammation of the parts, of peripneumonia notha, of chronic coughs, &c.
+by CHARLES BADHAM, M. D. Physician to his Royal Highness the Duke of
+Sussex, and to his Household; Physician to the Westminster General
+Dispensatory, and Lecturer on the Practice of Physic, &c. 12mo. price 4s
+in _boards_.
+
+13--CUTHBERTSON's PRACTICAL TREATISE on ELECTRICITY and GALVANISM, by John
+Cuthbertson, Philosophical Instrument Maker, and Member of the
+Philosophical Societies of Holland and Utrecht, in one vol. 8vo.
+illustrated with nine copper plates,--price in _boards_ 10s 6d, 1807.
+
+14--CRICHTON's SYNOPTICAL TABLE of DISEASES, exhibiting their Arrangement
+in Classes, Orders, Genera, and Species, designed for the Use of Students,
+on two sheets imperial folio,--price 2s 6d.
+
+15--CROWTHER's PRACTICAL OBSERVATIONS on the DISEASE of the JOINTS,
+commonly called WHITE SWELLING; with some Remarks on Caries, Necrosis, and
+Scrofulous Abscess, in which a new and successful Method of treating these
+Diseases is pointed out. A Second Edition, with considerable Additions and
+Improvements. By BRYAN CROWTHER, Member of the Royal College of Surgeons
+in London, and Surgeon to Bridewell and Bethlem Hospitals,--in one volume
+8vo. illustrated with seven coloured plates, price 10s 6d. _boards_,
+1808.--Ditto large paper, with proof Impressions of the Plates, 16s.
+
+16--COUPER's SPECULATIONS on the MODE and APPEARANCES of IMPREGNATION in
+the HUMAN FEMALE; with an Account of the Principal Ancient, and an
+Examination of the Modern Theories of Generation, _the Third Edition, with
+considerable Additions_, 4s, 1808.
+
+17--DUFOUR's TREATISE on the URINARY CANAL, particularly describing the
+various Symptoms attending Strictures, Obstructions, Gleets, &c. and an
+the prevention of the Stone and Gravel, with a Variety of Cases, tending
+to shew the Efficacy of Daran's medicated Bougies, and a new Method of
+treating a Gonorrhoea, &c. 6th edition, price 2s 6d, 1808.
+
+18--DAUBENTON's OBSERVATIONS on INDIGESTION, in which is satisfactorily
+shewn the Efficacy of Ipecacuanha, in relieving this, as well as its
+connected Train of Complaints peculiar to the Decline of Life, _translated
+from the French_. Second Edition with Additions, by Dr. Buchan, 1s 6d,
+1807.
+
+19--EARLE's (Sir JAMES) Letter, containing some Observations on the
+Fractures of the Lower Limbs; to which is added, an Account of a
+Contrivance to administer Cleanliness and Comfort to the Bed-ridden, or
+Persons confined to Bed by Age, Accident, Sickness, or any other
+Infirmity, with Explanatory Plates--price, _sewed_, 3s, 1807.
+
+20--EARLE's (Sir JAMES) OBSERVATIONS on HÆMORRHOIDAL EXCRESCENCES, the
+Second Edition, price, _sewed_, 1s 6d, 1807.
+
+21--GRIFFITH's PRACTICAL OBSERVATIONS on the CURE of HECTIC and SLOW
+FEVERS and the PULMONARY CONSUMPTION; to which is added, a Method of
+treating several Kinds of internal Hæmorrhages, _a new edition, sewed_, 1s
+6d.
+
+22--GIBBON's MEDICAL CASES and REMARKS, Part I. on the Good Effects of
+Salivation in Jaundice, arising from Calculi. Part II. on the free Use of
+Nitre in Hæmorrhages, _boards_, 2s 6d, 8vo.
+
+23--GIRDLESTONE on DIABETES, with an Historical Sketch of that Disease,
+_sewed_, 2s 6d, 8vo.
+
+24--GORDON's (Dr. Alexander) TREATISE on the EPIDEMIC PUERPERAL FEVER of
+ABERDEEN, _sewed_, 2s 6d.
+
+25--HARTY's (Dr.) OBSERVATIONS on the SIMPLE DYSENTERY, and its
+COMBINATIONS; containing a Review of the most celebrated Authors, who have
+written on this Subject, and also an Investigation into the Source of
+Contagion, in that and some other Diseases, _boards_, 7s 6d, 8vo.
+
+    "This Work we find no difficulty in recommending to our Readers; it
+    contains, unquestionably, a larger mass of evidence than is any where
+    else to be found, of the various species of this formidable disease;
+    and again we think it right once more to recommend the Work before us,
+    as the most valuable digest of all that has been written upon
+    it."--Vide MEDICAL and PHYSICAL JOURNAL, for December, 1805.
+
+26--HAMILTON's OBSERVATIONS on SCROPHULOUS AFFECTIONS, with Remarks on
+Schirrus Cancer, and Rachitis, _boards_, 3s, 12mo.
+
+27--INDENTITIES ASCERTAINED; or, an Illustration of Mr. Ware's Opinion
+respecting the sameness of Infection in Venereal Gonorrhoea, and the
+Ophthalmia of Egypt; with an Examination of Affinity between ancient
+Leprosy and Lues--price 2s 6d, 8vo. 1808.
+
+28--LAWRENCE's (WILLIAM) TREATISE on HERNIA, being the Essay which gained
+the Prize offered by the Royal College of Surgeons, in the year 1806,
+_illustrated with three plates, boards_, 9s.
+
+    "Mr. Lawrence has done his part: he has united in this Essay elegance
+    of language, correctness of description, a discriminating judgment,
+    and a fund of learning, which does equal credit to his talents and his
+    industry."--CRITICAL REVIEW for Feb. 1808.
+
+29--LIND on DISEASES incidental to EUROPEANS in HOT CLIMATES, with the
+Method of preventing their fatal Consequences, the Sixth Edition, in one
+vol. octavo, price 8s, _boards_, 1808.
+
+30--LONDON PRACTICE of MIDWIFERY; or, a MANUAL for STUDENTS; being a
+complete Course of Practical Midwifery; in which are included the
+Treatment of Lying-in Women and the Diseases of Children, the second
+edition corrected, 12mo. _boards_, 6s. 1807.
+
+31--LUXMORE's FAMILIAR OBSERVATIONS on RUPTURES, for the Use of Patients
+of both Sexes afflicted with those Complaints. Second edition, price 2s.
+
+32--LIPSCOMB's MANUAL of INOCULATION, for the Use of the Faculty and
+private families; pointing out the most approved method of Inoculating,
+and conducting Patients through the Small Pox, _sewed_, 1s.
+
+33--LONDON DISSECTOR; or, a Compendium of Practical Anatomy; containing a
+Description of the Muscles, Vessels, Nerves, and Viscera of the Human
+Body, as they appear on Dissection. A new Edition improved, _boards_, 5s.
+1808.
+
+34--MEDICAL FACTS and OBSERVATIONS; consisting principally of original
+Communications from Gentlemen of the Faculty, on important Subjects, in
+Medicine and Surgery, &c. by Dr. Simmons, vol. 8, _boards_, 4s 6d, 8vo.
+
+35--POLE's ANATOMICAL INSTRUCTOR; or, an Illustration of the modern and
+most approved Method of preparing and preserving the different Parts of
+the Human Body, and of Quadrupeds, with _plates, boards_, 7s, 8vo.
+
+36--PEARSON's (JOHN) PRACTICAL OBSERVATIONS on CANCEROUS COMPLAINTS, with
+an Account of some Diseases, which have been confounded with the Cancer;
+also, Critical Remarks on some of the Operations performed in Cancerous
+Cases, _sewed_, 2s 6d, 8vo.
+
+37--PEARSON's OBSERVATIONS on the EFFECTS of VARIOUS ARTICLES of the
+MATERIA MEDICA, in the CURE of LUES VENEREA, illustrated with Cases. By
+JOHN PEARSON, F. R. S. Senior Surgeon of the Lock Hospital and Asylum, and
+Surgeon to the Public Dispensatory; Reader on the Principles and Practice
+of Surgery, the Second Edition, with Additions, _price_ 7s, 8vo. 1807.
+
+38--PEARSON's PRINCIPLES of SURGERY, for the Use of Chirurgical Students.
+A new Edition with Additions. By JOHN PEARSON, F. R. S. &c. 8vo. _boards_,
+8s 6d. 1808.
+
+39--POTT's (P) CHIRURGICAL WORKS: a new Edition, with his last
+Corrections. To which are added, a short Account of the Life of the
+Author, a Method of curing the Hydrocele by Injection, and occasional
+Notes and Observations. By Sir James Earle, 3 vol. _boards_, 1l 7s. 1808.
+
+40--RICHERAND's ELEMENTS of PHYSIOLOGY; containing a Comprehensive View
+and Clear Explanation of the Functions of the Human Body, in which the
+modern Improvements in Chemistry, Galvanism, and other Sciences, are
+applied to explain the Actions of the Animal Economy with a new
+Classification, and a copious Index; translated from the French of A.
+Richerand, Professor of Anatomy and Physiology, and principal Surgeon of
+the Hospital of the North, in Paris. By ROBERT KERRISON, Member of the
+Royal College of Surgeons, in London, &c. _In one closely printed vol._
+8vo. price 6s. _boards_, 1806.
+
+41--REES's (Dr. GEORGE) OBSERVATIONS on DISEASES of the UTERUS; in which
+are included, Remarks on Moles, Polypi, and Prolapsus, as also on
+Schirrous and Cancerous Affections of that Organ, _boards_, 4s 6d, 8vo.
+
+42--REES's (Dr. GEORGE) TREATISE on the PRIMARY SYMPTOMS of LUES VENEREA,
+with a concise, critical, and chronological Account of all the English
+Writers on this Subject, from 1735 to 1783, to which is added, an Analysis
+of a Course of Lectures delivered by the Author, _boards_, 5s, 8vo.
+
+43--ROLLO's CASES of the DIABETES MELLITUS, with the Results of the Trials
+of certain Acids and other Substances, in the Cure of the Lues Venerea,
+Second Edition, with large Additions, _boards_, 6s, 8vo. 1806.
+
+44--ROYSTON's OBSERVATIONS on the RISE and PROGRESS of the MEDICAL ART in
+the BRITISH EMPIRE; containing Remarks on Medical Literature, and a View
+of a Bibliographia Medicinæ Britannicæ, by W. ROYSTON, Esq. _price_ 2s,
+1808.
+
+45--RYDING's VETERINARY PATHOLOGY; or, a Treatise on the Cure and Progress
+of the Disease of the Horse, &c. &c. and an Appendix, or Veterinary
+Dispensatory, &c. _boards_, 3s 6d, 8vo.
+
+46--SMITH's ESSAY on the CAUSES of the VARIETY of COMPLEXION and FIGURE in
+the HUMAN SPECIES; to which are added, STRICTURES on LORD KAIMES's
+DISCOURSE of the ORIGINAL DIVERSITY of MANKIND, _boards_, 3s.
+
+47--UNDERWOOD's TREATISE on the DISEASES of CHILDREN, with Directions for
+the Management of Infants, from the Birth, and now precisely adapted to
+professional Readers, Fifth Edition, 3 vol. _boards_, 13s 6d, 8vo.
+
+48--UNDERWOOD's SURGICAL TRACTS, containing a Treatise on ULCERS of the
+LEGS, in which, former Modes of Treatment are examined and compared with
+one more rational and safe, effected without Rest and
+Confinement:--together with Hints on a successful Method of treating some
+Scrophulous Tumours, the Mammary Abscess, and sore Nipples of Lying-in
+Women; Observations on the more common Disorders of the Eye, and on
+Gangrene, _boards_, 6s, 8vo.
+
+49--WEBSTER's FACTS, tending to shew the CONNEXION of the STOMACH with
+LIFE, DISEASE, and RECOVERY, _sewed_, 1s 6d.
+
+50--WADD's PRACTICAL OBSERVATIONS, on the Nature and Cure of STRICTURES in
+the URETHRA. By WILLIAM WADD, Member of the Royal College of Surgeons in
+London, 8vo, 3s 6d, 1808.
+
+51--WATT (ROBERT) CASES of DIABETES, CONSUMPTION, &c. with Observations on
+the History and Treatment of Disease in general, _boards_, 8s, 1808.
+
+
+
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+    Where may be had, just published, J. CALLOW's NEW CATALOGUE, for 1808
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+    Surgery, Chemistry, Botany, &c. To which is added, an Appendix,
+    containing a choice Collection of Second-hand Books in various
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+Transcriber's Notes:
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+Passages in italics are indicated by _italics_.
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+      The Project Gutenberg eBook of Observations on Madness and Melancholy, by John Haslam.
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+Project Gutenberg's Observations on Madness and Melancholy, by John Haslam
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: Observations on Madness and Melancholy
+       Including Practical Remarks on those Diseases together
+              with Cases and an Account of the Morbid Appearances on
+              Dissection
+
+Author: John Haslam
+
+Release Date: August 21, 2011 [EBook #37144]
+
+Language: English
+
+Character set encoding: ISO-8859-1
+
+*** START OF THIS PROJECT GUTENBERG EBOOK OBSERVATIONS ON MADNESS AND ***
+
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+Produced by The Online Distributed Proofreading Team at
+http://www.pgdp.net (This file was produced from images
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+</pre>
+
+
+
+
+<p class="center"><span class="large">OBSERVATIONS</span></p>
+<p class="center"><small>ON</small></p>
+<p class="center"><span class="giant">MADNESS</span></p>
+<p class="center"><small>AND</small></p>
+<p class="center"><span class="giant">MELANCHOLY:</span></p>
+
+<p class="center"><small>INCLUDING</small></p>
+<p class="center">PRACTICAL REMARKS ON THOSE DISEASES;</p>
+
+<p class="center"><small>TOGETHER WITH</small></p>
+<p class="center"><span class="huge">CASES:</span></p>
+
+<p class="center"><small>AND AN</small></p>
+<p class="center">ACCOUNT OF THE MORBID APPEARANCES</p>
+<p class="center"><small>ON</small></p>
+<p class="center"><span class="huge"><i>DISSECTION</i>.</span></p>
+<p>&nbsp;</p>
+<p class="center"><span class="smcap">By</span> JOHN HASLAM,<br />
+<small>LATE OF PEMBROKE HALL, CAMBRIDGE;<br />
+MEMBER OF THE ROYAL COLLEGE OF SURGEONS,<br />
+AND APOTHECARY TO BETHLEM HOSPITAL.</small></p>
+<p>&nbsp;</p>
+<p class="center"><i>The Second Edition, considerably enlarged.</i></p>
+<p>&nbsp;</p>
+<table border="0" cellpadding="0" cellspacing="5" summary="table">
+<tr><td>&#8220;Of the uncertainties of our present state, the most dreadful<br />
+and alarming is the uncertain continuance of reason.&#8221;<br />
+<span style="margin-left: 12em;">Dr. <span class="smcap">Johnson&#8217;s Rasselas</span>.</span></td></tr></table>
+<p>&nbsp;</p>
+<p class="center">London:<br />
+PRINTED FOR J. CALLOW, MEDICAL BOOKSELLER,<br />
+CROWN COURT, PRINCES STREET, SOHO;<br />
+<small>BY G. HAYDEN, BRYDGES STREET, COVENT GARDEN.</small><br />
+1809.</p>
+
+
+<p>&nbsp;</p><p>&nbsp;</p>
+<p class="center"><small>AS<br />
+A GRATEFUL ACKNOWLEDGMENT<br />
+FOR MANY FAVOURS,<br />
+AN OBLATION TO SUBSISTING FRIENDSHIP,<br />
+AND A<br />
+TRIBUTE TO SUPERIOR JUDGMENT,<br />
+EXERCISING THE PROFESSION OF MEDICINE WITH<br />
+SKILL AND LIBERALITY:<br />
+THE PRESENT VOLUME IS RESPECTFULLY<br />
+DEDICATED TO</small><br />
+DR. THOMAS MONRO,<br />
+<small>A FELLOW OF THE COLLEGE, AND PHYSICIAN<br />
+TO BETHLEM HOSPITAL.</small></p>
+
+
+<p>&nbsp;</p><p>&nbsp;</p>
+<hr style="width: 50%;" />
+<p><span class="pagenum"><a name="Page_v" id="Page_v">[Pg v]</a></span></p>
+<h2>Preface.</h2>
+
+
+<p>&nbsp;</p>
+<p class="dropcap"><span class="caps"><i>The</i></span> <i>alarming increase of Insanity, as might naturally be expected, has
+incited many persons to an investigation of this disease;&mdash;some for the
+advancement of Science, and others with the hope of emolument.</i></p>
+
+<p><i>More than ten years having elapsed since the publication of the</i>
+&#8220;Observations on Insanity,&#8221; <i>a trifle, which the Profession has held in
+greater estimation than its intrinsic merits could justify: the present<span class="pagenum"><a name="Page_vi" id="Page_vi">[Pg vi]</a></span>
+work is modestly introduced to the public notice, as a corrected copy of
+the former, with considerable additions, which the extensive scope of
+Bethlem Hospital would have furnished more liberally to a more intelligent
+observer.</i></p>
+
+<p><i>To have taken a comprehensive survey of the human faculties in their
+sound state; to have exhibited them impaired by natural decay, and
+transformed by disease, would have implied an ability to which I cannot
+pretend; would have required many volumes to unfold, and perhaps more
+patience than any rational experience could have attributed to the reader.
+The contents of the following pages are therefore to be considered as an
+abbreviated relation, and condensed display of many years observation and
+practice, in a situation affording constant opportunities and abundant
+supplies for such investigations.</i></p>
+
+<p><span class="pagenum"><a name="Page_vii" id="Page_vii">[Pg vii]</a></span><i>It is natural to presume, that amongst my professional acquaintance the
+subject of Insanity must have been frequently introduced as a topic of
+discourse; and I am ready to acknowledge, that I have often profited by
+their remarks and suggestions: but I should be ungrateful were I not to
+confess my particular obligations to my esteemed friend, Anthony Carlisle,
+Esq. Surgeon to the Westminster Hospital, for many corrections, and some
+communications, which I shall ever value as judicious and important.</i></p>
+
+<p><br /><span class="smcap">Bethlem Hospital</span>,<br />
+<span style="margin-left: 1em;"><span class="smcap">Nov. 21, 1808.</span></span></p>
+
+
+<p>&nbsp;</p><p>&nbsp;</p>
+<hr style="width: 50%;" />
+<p><span class="pagenum"><a name="Page_viii" id="Page_viii">[Pg viii]</a></span></p>
+<h2>ERRATA.</h2>
+
+<table border="0" cellpadding="0" cellspacing="5" summary="table">
+<tr><td><i>Page</i></td>
+    <td align="right">3,</td>
+    <td><i>line</i></td>
+    <td align="right">7,</td>
+    <td><i>for</i> controverted, <i>read</i> converted.</td></tr>
+<tr><td>&nbsp;</td>
+    <td align="right">5,</td>
+    <td>&nbsp;</td>
+    <td align="right">2,</td>
+    <td><i>for</i> phrenitic, <i>read</i> phrenetic.</td></tr>
+<tr><td>&nbsp;</td>
+    <td align="right">90,</td>
+    <td>&nbsp;</td>
+    <td align="right">3,</td>
+    <td><i>for</i> hyatids, <i>read</i> hydatids.</td></tr>
+<tr><td>&nbsp;</td>
+    <td align="right">254,</td>
+    <td colspan="3"><i>in the Table</i>, <i>for</i> manical, <i>read</i> maniacal.</td></tr></table>
+
+
+<p>&nbsp;</p><p>&nbsp;</p>
+<hr style="width: 50%;" />
+<p><span class="pagenum"><a name="Page_1" id="Page_1">[Pg 1]</a></span></p>
+<p class="center"><span class="large">OBSERVATIONS</span></p>
+<p class="center"><small>ON</small></p>
+<p class="center"><span class="giant">MADNESS, &amp;c. &amp;c.</span></p>
+<p>&nbsp;</p>
+<h2>CHAPTER I.</h2>
+<p class="center"><span class="large">DEFINITION.</span></p>
+
+<p>&nbsp;</p>
+<p class="dropcap"><span class="caps">There</span> is no word in the English language more deserving of a precise
+definition than madness: and if those who have treated on this subject
+have been so unfortunate as to disagree with each other, and consequently
+have left their readers to reconcile their discordant opinions; yet it
+must be confessed that considerable pains have been bestowed, to convey a
+clear and accurate explanation of this term. Although this<span class="pagenum"><a name="Page_2" id="Page_2">[Pg 2]</a></span> contrariety of
+sentiment has prevailed concerning the precise meaning of the word
+madness, medical practitioners have been sufficiently reconciled as to the
+thing itself: so that when they have seen an insane person, however
+opposite their definitions, they have readily coincided that the patient
+was mad.</p>
+
+<p>From this it would appear that the thing itself, is, generally speaking,
+sufficiently plain and intelligible; but that the term which represents
+the thing is obscure. Perhaps, we might be somewhat assisted, by tracing
+back this word, in order to discover its original meaning, and shewing
+from its import the cause of its imposition.</p>
+
+<p>If the reader, as is now the custom, should turn to Johnson&#8217;s Dictionary
+for the meaning and etymology of this word, he<span class="pagenum"><a name="Page_3" id="Page_3">[Pg 3]</a></span> will find that the Doctor
+has derived it both from the Anglo-Saxon &#659;emaa&#4331; and the Italian
+<i>matto</i>; but without giving any meaning as the cause of its employment.
+The word is originally Gothic, and meant anger, rage, <img src="images/mod.jpg" alt="mod" />.
+[Mod]. It is true that we have now <ins class="errata" title="Errata: Page 3, line 7, for 'controverted' read 'converted'.">converted</ins> the o, into a, and write
+the word mad: but mod was anciently employed.</p>
+
+<p class="poem">&#8220;Yet sawe I <span class="smcaplc">MODNESSE</span> laghyng in his <i>rage</i>.&#8221;<br />
+<span style="margin-left: 4em;"><i>Chaucer.</i> <i>Knight&#8217;s Tale</i>, <i>fol.</i> 1561, <i>p.</i> 6.</span></p>
+
+<p>There is so great a resemblance between anger and violent madness, that
+there is nothing which could more probably have led to the adoption of the
+term. Dr. Beddoes, who appears to have examined the subject of insanity
+with the eye of an enlightened philosopher, is decidedly of this opinion,
+he says, <span class="smcap">Hygeia</span>, <i>No.</i> 12, <i>p.</i> 40, &#8220;Mad, is one of those words which mean
+almost every thing and nothing. At first, it was, I imagine, applied to
+the transports<span class="pagenum"><a name="Page_4" id="Page_4">[Pg 4]</a></span> of rage; and when men were civilized enough to be capable
+of insanity, their insanity, I presume, must have been of the frantic
+sort, because in the untutored, intense feelings seem regularly to carry a
+boisterous expression.&#8221;</p>
+
+<p><span class="smcap">Mad</span> is therefore not a complex idea, as has been supposed, but a complex
+term for all the forms and varieties of this disease. Our language has
+been enriched with other terms expressive of this affection, all of which
+have a precise meaning. Delirium, which we have borrowed from the latin,
+merely means, <i>out of the track</i>, de lira, so that a delirious person, one
+who starts out of the track regularly pursued, becomes compared to the
+same deviation in the process of ploughing. <i>Crazy</i>, we have borrowed from
+the French <i>ecras&eacute;</i>, crushed, broken: we still use the same meaning, and
+say that such a person is crack&#8217;d. <span class="pagenum"><a name="Page_5" id="Page_5">[Pg 5]</a></span>Insane,
+deranged, or disarranged,<a name='fna_1' id='fna_1' href='#f_1'><small>[1]</small></a>
+melancholic, out of one&#8217;s wits, lunatic, <ins class="errata" title="Errata: Page 5, line 2, for 'phrenitic' read 'phrenetic'.">phrenetic</ins>, or as we have
+corrupted it, frantick, require no explanation. <i>Beside one&#8217;s self</i> most
+probably originated from the belief of possession by a devil, or evil
+spirit.</p>
+
+<p>The importance of investigating the original meaning of words must be
+evident when it is considered that the law of this country impowers
+persons of the medical profession to confine and discipline those to whom
+the term mad or lunatic can fairly be applied. Instead of endeavouring to
+discover an infallible definition of madness, which I believe will be
+found impossible, as it is an attempt to comprise, in a few words, the
+wide range and mutable character of this Proteus disorder: much more<span class="pagenum"><a name="Page_6" id="Page_6">[Pg 6]</a></span>
+advantage would be obtained if the circumstances could be precisely
+defined under which it is justifiable to deprive a human being of his
+liberty.</p>
+
+<p>Another impediment to an accurate definition of madness, arises from the
+various hypotheses, which have been entertained concerning the powers and
+operations of the human mind: and likewise from the looseness and
+unsettled state of the terms by which it is to be defined.</p>
+
+<p>Before treating of the intellect in a deranged state, it will perhaps be
+expected that some system of the human mind, in its perfect and healthy
+condition, should be laid down. It will be supposed necessary to establish
+in what sanity of intellect consists, and to mark distinctly some fixed
+point, the aberrations from which are to constitute disease.</p>
+
+<p><span class="pagenum"><a name="Page_7" id="Page_7">[Pg 7]</a></span>To have a thorough knowledge of the nature, extent, and rectitude of the
+human faculties, is particularly incumbent on him who undertakes to write
+of them in their distempered state; and, in a legal point of view, it is
+most important that the medical practitioner should be enabled to
+establish the state of the patient&#8217;s case, as a departure from that which
+<i>is</i> reason.</p>
+
+<p>The difficulty of proposing a satisfactory theory of the human mind, must
+have been felt by every person, who has touched this delicate string since
+the days of Aristotle, and failure must be expected in him who attempts
+it: yet the endeavour is laudable, and miscarriage is not linked with
+disgrace. Every contribution, to illustrate what are the powers of mind we
+possess; how we are acted upon by external circumstances in the
+acquisition of knowledge; and concerning the manner in which we use this<span class="pagenum"><a name="Page_8" id="Page_8">[Pg 8]</a></span>
+knowledge for the purposes of life; ought to be candidly received.</p>
+
+<p>Enquiries of this nature have been usually conducted by commenting on the
+numerous and discordant authorities which have treated on metaphysical
+subjects; these persons, however they may differ on many points, appear to
+be pretty generally agreed, that the human mind possesses certain
+faculties and powers; as imagination, judgment, reason, and memory. They
+seem to consider these, as so many departments, or offices of the mind,
+and therefore class men according to the excellence or predominance of
+these powers. One man, is said to be distinguished by the brilliancy of
+his imagination; another, by the solidity of his judgment; a third, by the
+acuteness of his reason; and a fourth, by the promptitude and accuracy of
+his recollection.</p>
+
+<p><span class="pagenum"><a name="Page_9" id="Page_9">[Pg 9]</a></span>As far as I have observed respecting the human mind, (and I speak with
+great hesitation and diffidence,) it does not possess, all those powers
+and faculties with which the pride of man has thought proper to invest it.
+By our senses, we are enabled to become acquainted with objects, and we
+are capable of recollecting them in a greater or less degree; the rest,
+appears to be merely a contrivance of language.</p>
+
+<p>If mind, were actually capable of the operations attributed to it, and
+possessed of these powers, it would necessarily have been able to create a
+language expressive of these powers and operations. But the fact is
+otherwise. The language, which characterizes mind and its operations, has
+been borrowed from external objects; for mind has no language peculiar to
+itself. A few instances will sufficiently illustrate this position. After
+having committed an <span class="pagenum"><a name="Page_10" id="Page_10">[Pg 10]</a></span>offence it is natural to say that the mind feels
+contrition and sorrow.</p>
+
+<p>Contrition is from <i>cum</i> and <i>tero</i>, to rub together, which cannot
+possibly have any thing to do with the operations of the mind, which is
+incapable of rubbing its ideas or notions together. Contrition is a
+figurative expression, and may possibly mean the act of rubbing out the
+stain of vice, or wearing down by friction the prominences of sin.</p>
+
+<p>If we were to analyze the word Sorrow, which is held to be a mental
+feeling, we should find it to be transferred from bodily sufferance: for
+the mind, is incapable of creating a term correctly expressive of its
+state, and therefore, it became necessary to borrow it from <i>soreness</i> of
+body.&mdash;<i>See Mr. Tooke&#8217;s Diversions of Purley</i>, <i>vol.</i> ii.<span class="pagenum"><a name="Page_11" id="Page_11">[Pg 11]</a></span> <i>p.</i> 207, where
+<i>sore</i>, <i>sorry</i>, and <i>sorrow</i> are clearly made out to be the same word.</p>
+
+<p>It is customary to speak of a man, of accurate perceptions, and of
+another, who has grand and luminous conceptions of human nature.
+Perception, from <i>per</i>, and <i>capio</i> to take, seize, grasp, through the
+medium of the organs of sense, being implied. But to take, seize, and
+grasp are the operations of the hand, and can only, by extreme courtesy,
+be attributed to mind.</p>
+
+<p>Mr. Dugald Stewart, the most thoughtful and intelligent of modern
+metaphysicians, has said, &#8220;By conception I mean that power of the mind
+which enables it to form a notion of an absent object of perception, or of
+a sensation which it has formerly felt.&#8221;&mdash;<i>Elements of the Philosophy of
+the Human Mind</i>, 8<i>vo.</i> <i>p.</i> 133.</p>
+
+<p><span class="pagenum"><a name="Page_12" id="Page_12">[Pg 12]</a></span>This definition means merely memory; and by perusing attentively the whole
+chapter the reader will be convinced of it. Conception, from <i>cum</i> and
+<i>capio</i>, has been applied to mind from the physical sense of embracing,
+comprehending, or probably from the notion of being impregnated with the
+subject. It may be remarked, that these three terms, by which conception
+has been explained, have been all applied to mental operation.</p>
+
+<p>The words reason and reasoning, I believe, in most languages, strictly
+imply numeration, reckoning, proportion; the Latin <i>ratio</i>, <i>ratiocinor</i>,
+<i>ratiocinator</i> are sufficient examples. A curious coincidence between the
+Latin <i>ratio</i> and the Gothic <i>rathjo</i>, together with some pertinent and
+interesting observations, may be seen in Ihre&#8217;s Glossarium Svio-gothicum,
+<i>p.</i> 393, <i>art.</i> R&aelig;kna. As we now acknowledge the science of number<span class="pagenum"><a name="Page_13" id="Page_13">[Pg 13]</a></span> to be
+the purest system of reasoning, a system, on which all persons agree, and
+so unlike medicine, politics, and divinity, concerning which there is a
+constant, and hostile variety of sentiment, it adds some force to the
+argument. Indeed, Mr. Locke, who almost personifies reason, after having
+painfully sifted this matter, appears to be much of the same way of
+thinking: he says, &#8220;Reason, though it penetrates into the depth of the sea
+and earth, elevates our thoughts as high as the stars, and leads us
+through the vast spaces and large rooms of this mighty fabrick, <i>yet it
+comes far short of the real extent of even corporeal being</i>; and there are
+many instances wherein it fails us: as,</p>
+
+<p>&#8220;First: it perfectly fails us where our ideas fail: it neither does, nor
+can extend itself farther than they do, and therefore, wherever we have no
+ideas our<span class="pagenum"><a name="Page_14" id="Page_14">[Pg 14]</a></span> reasoning stops, and we are at an end of our reckoning: and if
+at any time <i>we reason about words, which do not stand for any ideas</i>, it
+is only about those sounds, and nothing else.</p>
+
+<p>&#8220;Secondly: our reason is often puzzled, and at a loss, because of the
+obscurity, confusion or imperfection of the ideas it is employed about;
+and there we are involved in difficulties and contradictions. Thus, not
+having any perfect idea of the least extension of matter, nor of infinity,
+we are at a loss about the divisibility of matter; <i>but having perfect,
+clear, and distinct ideas of number, our reason meets with none of those
+inextricable difficulties in numbers, nor finds itself involved in any
+contradictions about them</i>.&#8221;&mdash;<i>Works.</i> 4<i>to</i>, <i>vol.</i> i, <i>p.</i> 431.</p>
+
+<p>It can scarcely be necessary, longer to fatigue the patience of the
+reader, by reverting<span class="pagenum"><a name="Page_15" id="Page_15">[Pg 15]</a></span> to the etymology of those terms, which have been
+considered as significant of mind and its operations. Every one will be
+able sufficiently to develope imagination, reflection, combination, [as
+applied to ideas, importing the amalgamation of <i>two</i> into one]
+abstraction, [<i>vide Mr. Tooke</i>, <i>from p.</i> 15 to 426, <i>vol.</i> ii.] and a
+variety of others; and to shew, that they have arisen from physical
+objects, and the circumstances which surround us, and are independant of
+any operation which mind has elaborated.</p>
+
+<p>But as madness, by some, has been exclusively held to be a disease of the
+imagination, and by others, to be a defect of the judgment; considering
+these as separate and independant powers or faculties of the intellect; it
+is certainly worth the trouble to enquire, whether such states of mind did
+ever exist as original and unconnected disorders. With respect to
+imagination, there<span class="pagenum"><a name="Page_16" id="Page_16">[Pg 16]</a></span> can be but little difficulty; yet this will so far
+involve the judgment and memory, that it will not be easy to institute a
+distinction. If a cobbler should suppose himself an emperor, this
+supposition, may be termed an elevated flight, or an extensive stretch of
+imagination, but it is likewise a great defect in his judgment, to deem
+himself that which he is not, and it is certainly an equal lapse of his
+recollection, to forget what he really is.</p>
+
+<p>Having endeavoured to give some reasons for not according with the
+generally received opinions, concerning the different powers of the mind,
+it may be proper shortly to state, that, from the manner in which we
+acquire knowledge, the human mind appears to be composed of a sum of
+individual perceptions: that, in proportion as we dwell by the eye, the
+ear, or the touch on any object (which is called attention,)<span class="pagenum"><a name="Page_17" id="Page_17">[Pg 17]</a></span> we are more
+likely to become acquainted with it, and to be able to remember it. For
+the most part, we remember these perceptions in the succession in which
+they were presented, although, they may afterwards, from circumstances, be
+differently sorted.</p>
+
+<p>The minds of ordinary men are well contented to deal out their ideas, in
+the order in which they were received; and, not having found the necessity
+of bringing them to bear on general subjects, they are commonly minutely
+accurate in the detail of that which they have observed. By such persons,
+a story is told with all the relations of time and place; connected with
+the persons who were present, their situation, state of health, and a vast
+variety of associated particulars; and these persons, however tedious,
+generally afford the most correct account. On the other hand, those<span class="pagenum"><a name="Page_18" id="Page_18">[Pg 18]</a></span> who
+are men of business, and have much to communicate in a given space, are
+obliged to subtract the more material circumstances from the gross
+narrative, and exhibit these as the sum total. It is in this way, that
+words, originally of considerable length, have been abbreviated for the
+conveniency of dispatch, and from this necessity short hand writing has
+been employed.</p>
+
+<p>As the science of arithmetic consists in addition to, or subtraction from,
+a given number; so does the human mind appear to be capable solely of
+adding to, or separating from, its stock of ideas, as pleasure may prompt,
+or necessity enforce.</p>
+
+<p>Language, the representative of thought, bears the same construction; and
+it is curious to remark in the investigation of its abbreviations, that
+those words, which serve to connect ideas together, (<i>conjunctions</i>) and<span class="pagenum"><a name="Page_19" id="Page_19">[Pg 19]</a></span>
+which have been supposed to mark certain operations of intellect, postures
+of mind, and turns of thought, have merely the force and meaning of to
+add, or to subtract.</p>
+
+<p>Insanity is now generally divided into Mania and Melancholia, but formerly
+its distributions were more numerous. Paracelsus, speaking of this
+disease, says, &#8220;Vesani&aelig; hujus genera quatuor existunt: primi <i>Lunatici</i>
+vocantur: secundi <i>Insani</i>: tertii <i>Vesani</i>: quarti <i>Melancholici</i>,
+Lunatici sunt qui omnem suum morbum ex Luna accipiunt, et juxta eam sese
+gerunt ac moventur. Insani sunt, qui malum id ab utero materno hauserunt,
+veluti h&aelig;reditarium, uno subind&egrave; insaniam in alterum transferente. Vesani
+sunt, qui a cibis ac potibus ita inficiuntur ac taminantur, ut ratione
+sensuque priventur. Melancholici sunt, qui ex intim&aelig; natur&aelig; vitio a
+ratione deturbantur, et ad vesaniam precipitantur.&#8221;<span class="pagenum"><a name="Page_20" id="Page_20">[Pg 20]</a></span> Paracelsus, however,
+thinks that a fifth genus may be added. &#8220;Ad quatuor hac genera genus
+insuper aliud quodammodo annumerari potest, videlicet <i>obsessi</i>, qui a
+diabolo variis modis occupari solent.&#8221;&mdash;<i>Paracelsi Opera</i>, <i>folio</i>, <i>tom.</i>
+i. <i>fol.</i> 572.</p>
+
+<p>The idea of being besieged, beset, or possessed by the devil was formerly
+a very favourite notion, and is derived to us by an authority we are
+taught to reverence: indeed it is still the opinion of many harmless and
+believing persons, some of whom have bestowed considerable pains to
+convince me that the violent and mischievous maniacs in Bedlam were under
+the dominion of this insinuating spirit. They have employed one argument
+which would seem to have considerable weight, namely, that the most
+atrocious crimes are stated in our indictments (much to the credit of
+human nature) to have been committed by the <span class="pagenum"><a name="Page_21" id="Page_21">[Pg 21]</a></span>instigation of the devil: and
+they have also endeavoured to explain, how a late and eminently successful
+practitioner, by an union of the holy office with consummate medical
+skill, was enabled to cure nine lunatics out of ten, which certainly has
+not hitherto been accounted for.</p>
+
+<p>Paracelsus, who contemplated this subject with uncommon gravity and
+solicitude, is of opinion that the devil enters us much in the same manner
+as a maggot gets into a filbert.&mdash;<i>Vide Fragmentum Libri Philosophi&aelig; de
+D&aelig;moniacis et Obsessis</i>, <i>tom.</i> ii. <i>p.</i> 460.</p>
+
+<p>To conclude this part of the subject, and to exhibit the state of belief
+at that period, I shall take the liberty of extracting a portion from the
+11th chapter of Dr. Andrewe Boord&#8217;s Extravagantes, which &#8220;doth shewe<span class="pagenum"><a name="Page_22" id="Page_22">[Pg 22]</a></span> of a
+Demoniacke person, the which is possessed of or with the devyll or
+devylls.</p>
+
+<p>&#8220;Demoniacus or Demoniaci be the Latin wordes. In Greke it is named
+Demonici. In Englyshe it is named he or they, the whiche be mad and
+possessed of the devyll or devils, and their propertie is to hurt and kyll
+them selfe, or els to hurt and kyll any other thynge, therfore let every
+man beware of them, and kepe them in a sure custody.</p>
+
+<p class="center"><i>The cause of this Matter.</i></p>
+
+<p>&#8220;This matter doth passe all maner sickenesses and diseases, and it is a
+fearefull and terryble thyng to se a devyll or devylles shoulde have so
+muche and so greate a power over man, as it is specified of such persons
+dyvers tymes in the gospell, specyally in the IX. Chapitre of St. Marke.
+Chryste sendynge his disciples to preache<span class="pagenum"><a name="Page_23" id="Page_23">[Pg 23]</a></span> the worde of God, gevynge them
+power to make sicke men whole, lame men to go, blynde to se, &amp;c. Some of
+them dyd go by a mans that was possessed of devils and they coud not make
+him whole. Shortly to conclude, Chryst dyd make hym whole. The dysciples
+of Chryste asked of him why that they coud not make the possessed man of
+the devylls whole. And Jesus Chryste said to them: this kynde of devylls
+can not be cast out without prayer and fastynge. Here it is to be noted,
+that nowe a dayes fewe or els none doth set by prayer or fastynge,
+regardyng not gods wordes; in this matter, I do feare that suche persons
+be possessed of the devil, although they be not starke madde, and to shew
+further of demoniacke persons the whiche be starke madde. The fyrste tyme
+that I dyd dwell in Rome, there was a gentilwoman of Germani, the whych
+was possessed of devyls, and she was brought to Rome to be made<span class="pagenum"><a name="Page_24" id="Page_24">[Pg 24]</a></span> whole.
+For within the precynct of St. Peters church, without St. Peters chapel,
+standeth a pyller of whyte marble grated round about with iron, to the
+which our Lorde Jesus Chryste dyd lye in hymselfe unto the Pylates hal, as
+the Romaynes doth say, to the which pyller al those that be possessed of
+the devyl, out of dyvers countreys and nacions be brought thyther, and as
+they say of Rome, such persons be made there whole. Amonge al other this
+woman of Germany, which is CCCC myles and odde from Rome, was brought to
+the pyller, (I then there beyng presente,) with great strength and
+violently with a XX or mo men, this woman was put into that pyller within
+the yron grate, and after her dyd go in a preeste, and dyd examine the
+woman under this maner in the Italian tonge. Thou devyl or devyls, I do
+abjure thee by the potencial power of the father, and of the sonne our
+Lorde Jesus Christe, and by<span class="pagenum"><a name="Page_25" id="Page_25">[Pg 25]</a></span> the vertue of the Holy Ghoste, that thou do
+shewe to me, for what cause that thou doeste possess this woman: what
+wordes was aunswered I will not write, for men will not beleve it, but
+wolde say it were a foule and great lye, but I dyd heare that I was afrayd
+to tarry any longer, lest that the devyls shulde have come out of her, and
+to have entred into me; remembrynge what is specified in the viii Chapitre
+of St. Matthewe, when that Jesus Christ had made two men whole, the
+whiche, was possessed with a legion of devils. A legion is IX M. IX C.
+nynety and nyne: the sayd devyls dyd desyre Jesus, that when they were
+expelled out of the aforesayde twoo men, that they might enter into a
+herde of hogges, and so they did, and the hogges did runne into the sea
+and were drowned. I consyderynge this, and weke of faith and afeard,
+crossed myselfe and durste not heare and se such matters, for it was to<span class="pagenum"><a name="Page_26" id="Page_26">[Pg 26]</a></span>
+stupendious and above all reason yf I shulde wryte it; and in this matter
+I dyd marvell of an other thynge; if the efficacitie of such makynge one
+whole, dyd rest in the vertue that was in the pyller, or els in the wordes
+that the preest dyd speake. I do judge it shulde be in the holy wordes
+that the prest dyd speak, and not in the pyller; for and yf it were in the
+pyller, the Byshops, and the Cardinalles that hathe ben many yeres past,
+and those that were in my tyme, and they that hath bin sence, wolde have
+had it in more reverence, and not to suffre rayne, hayle, snowe, and such
+wether to fal on it, for it hath no coverynge, but at laste when that I
+did consyder that the vernacle, the phisnomy of Christ, and scarse the
+sacrament of the aulter was in maner uncovered and al St. Peters Churche
+downe in ruyne, and utterly decayed, and nothing set by, consideringe in
+olde chapels, beggers and baudes, hoores and theves dyd lye<span class="pagenum"><a name="Page_27" id="Page_27">[Pg 27]</a></span> within them,
+asses and moyles dyd defyle within the precincte of the Churche, and
+byenge and sellynge there was used within the precinct of the sayde church
+that it dyd pytie my harte and mynde to come and se any tyme more the
+sayde place and churche.&#8221;&mdash;<i>Andrewe Boorde,</i><a name='fna_2' id='fna_2' href='#f_2'><small>[2]</small></a> <i>the seconde Boke of the
+Brevyary of health</i>, 1557, <i>fol.</i> 4<i>th</i>.</p>
+
+<p>To return from this digression. Dr. Ferriar, whom to mention otherwise
+than as a man of genius, of learning, and of taste, would be unjust, has
+adopted the generally accepted division of insanity into mania and
+melancholia. In mania he conceives &#8220;false perception, and consequently
+confusion of ideas, to be a leading circumstance.&#8221; The latter, he supposes
+to consist &#8220;in intensity of idea, which is a contrary<span class="pagenum"><a name="Page_28" id="Page_28">[Pg 28]</a></span> state to false
+perception.&#8221; From the observations I have been able to make respecting
+Mania, I have by no means been led to conclude, that false perception, is
+a leading circumstance in this disorder, and still less, that confusion of
+ideas must be the necessary consequence of false perception.</p>
+
+<p>By perception I understand, with Mr. Locke, the apprehension<a name='fna_3' id='fna_3' href='#f_3'><small>[3]</small></a> of
+sensations;<span class="pagenum"><a name="Page_29" id="Page_29">[Pg 29]</a></span> and after a very diligent enquiry of patients who have
+recovered from the disease, and from an attentive observation of those
+labouring under it, I have not frequently found, that insane people
+perceive falsely the objects which have been presented to them.</p>
+
+<p>We find madmen equally deranged upon those ideas, which they have been
+long in the possession of, and on which the perception has not been
+recently exercised, as respecting those, which they have lately received:
+and we frequently find those who become suddenly mad, talk incoherently
+upon every subject, and consequently, upon many, on which the perception
+has not been exercised for a considerable time.</p>
+
+<p>It is well known, that maniacs often suppose they have seen and heard
+those things, which really did not exist at the<span class="pagenum"><a name="Page_30" id="Page_30">[Pg 30]</a></span> time; but even this I
+should not explain by any disability, or error of the perception; since it
+is by no means the province of the perception to represent unreal
+existences to the mind. It must therefore be sought elsewhere; most
+probably in the senses.</p>
+
+<p>We sometimes (more especially in the early stages of furious madness) find
+patients from very slight resemblances, and sometimes, where none whatever
+can be perceived by others of sound mind, confounding one person with
+another. Even in this case it does not seem necessary to recur to false
+perception for the explanation. It is equally probable that the organs of
+vision are affected in consequence of the disease of the brain, and
+therefore receive incorrect sensations: and still more likely, from the
+<i>rapid succession</i> in which objects are noticed, that a very slight trait
+of <span class="pagenum"><a name="Page_31" id="Page_31">[Pg 31]</a></span>countenance would recal the idea [or name] of some particular person.</p>
+
+<p>I have known many cases of patients who insisted that they had seen the
+devil. It might be urged, that in these instances, the perception was
+vitiated; but it must be observed there could be no perception of that,
+which was not present and existing at the time. Upon desiring these
+patients to describe what they had seen, they all represented him as a
+big, black man, with a long tail, and sharp talons, such as is seen
+pictured in books; a proof that the idea was revived in the mind from some
+former impressions. One of these patients however carried the matter a
+little further, as she solemnly declared, she heard him break the iron
+chain with which God had confined him, and saw him pass fleetly by her
+window, with a truss of straw upon his shoulder.</p>
+
+<p><span class="pagenum"><a name="Page_32" id="Page_32">[Pg 32]</a></span>That &#8220;confusion of ideas&#8221; should be the necessary consequence of false
+perception, is very difficult to admit. It has often been observed that
+madmen will reason correctly from false premises, and the observation is
+certainly true: we have indeed occasion to notice the same thing in those
+of the soundest minds. It is very possible for the perception to be
+deceived in the occurrence of a thing, which, although it did not actually
+happen, yet was likely to take place; and which had frequently occurred
+before.&mdash;The reception of this as a truth, if the person were capable of
+deducing from it the proper inferences, could neither create confusion nor
+irregularity of ideas.</p>
+
+<p>Melancholia, the other form in which this disease is supposed to exist, is
+made by Dr. Ferriar to consist in &#8220;intensity of idea.&#8221; By intensity of
+idea, I presume is meant, that the mind is more strongly fixed<span class="pagenum"><a name="Page_33" id="Page_33">[Pg 33]</a></span> on, or
+more frequently recurs to, a certain set of ideas, than when it is in a
+healthy state. But this definition applies equally to mania; for we every
+day see the most furious maniacs suddenly sink into a profound
+melancholia, and the most depressed and miserable objects become violent
+and raving. There are patients in Bethlem Hospital, whose lives are
+divided between furious and melancholic paroxysms, and who, under both
+forms, retain the same set of ideas. It must also have been observed, by
+those who are conversant with this disorder, that there is an intermediate
+state, which cannot be termed maniacal nor melancholic: a state of
+complete insanity, yet unaccompanied by furious or depressing
+passions.<a name='fna_4' id='fna_4' href='#f_4'><small>[4]</small></a></p>
+
+<p><span class="pagenum"><a name="Page_34" id="Page_34">[Pg 34]</a></span>In speaking of the two forms of this disease, mania and melancholia, there
+is a circumstance sufficiently obvious, which hitherto does not appear to
+have been noticed: I mean the rapid or slow succession of the patient&#8217;s
+ideas. Probably sound and vigorous mind consists as much in the moderate
+succession of our ideas, as in any other circumstance. It may be enquired,
+how we are to ascertain this increased, proportionate, and deficient
+activity of mind? From language, the medium by which thought is conveyed.
+The connexion between thought and utterance is so strongly cemented by
+habit, that the latter becomes the representative of the former.</p>
+
+<p><span class="pagenum"><a name="Page_35" id="Page_35">[Pg 35]</a></span>The physiology of mind, I humbly conceive to be at present in its infancy,
+but there seems good reason to imagine, that furious madness implies a
+rapid succession of ideas; and the circumstance of rage, from whence its
+origin has been deduced, points out the hurried consecution. In this state
+of mind the utterance succeeds</p>
+
+<p class="poem">&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&#8220;sudden as the spark<br />
+From smitten steel; from nitrous grain the blaze.&#8221;</p>
+
+<p>and it frequently happens, after the tumult has subsided, the person
+remembers but little of that which had escaped him.</p>
+
+<p class="poem">&#8220;I then, all-smarting with my wounds, being cold,<br />
+(To be so pestered with a popingay)<br />
+Out of my greefe, and my Impatience,<br />
+Answered (neglectingly) <i>I know not what</i>&mdash;<br />
+<i>He should, or should not</i>: for he made me <i>mad</i>.&#8221;</p>
+
+<p>From this connexion between thought and utterance, we find many persons
+(particularly those who are insane) talking to themselves; especially when
+their minds<span class="pagenum"><a name="Page_36" id="Page_36">[Pg 36]</a></span> are intently occupied; and taking the converse, we frequently
+observe those who are desirous to acquire any subject by heart, repeating
+it aloud.</p>
+
+<p>From the same cause we have often occasion to remark, that strong, and
+perhaps involuntary, propensity to repeat the emphatical words in a
+sentence, and which are commonly the last, before we endeavour to reply
+to, or confute them.</p>
+
+<p class="poem">&#8220;<i>King.</i> No: on the barren Mountaine let him sterve:<br />
+<span style="margin-left: 2.8em;">For I shall never hold that man my friend</span><br />
+<span style="margin-left: 2.8em;">Whose tongue shall aske me for one peny cost</span><br />
+<span style="margin-left: 2.8em;">To ransome home revolted Mortimer.</span><br />
+<br />
+&#8220;<i>Hotsp.</i> Revolted Mortimer?<br />
+<span style="margin-left: 3.25em;">He never did fall off, my Soveraigne Liege,</span><br />
+<span style="margin-left: 3.25em;">But by the chance of warre:&#8221;</span></p>
+
+<p>As the terms Mania and Melancholia, are in general use, and serve to
+distinguish the forms under which insanity is exhibited, there can be no
+objection to retain<span class="pagenum"><a name="Page_37" id="Page_37">[Pg 37]</a></span> them; but I would strongly oppose their being
+considered as opposite diseases. In both there is an equal derangement. On
+dissection, the state of the brain does not shew any appearances peculiar
+to melancholia; nor is the treatment, which I have observed most
+successful, different from that which is employed in mania.</p>
+
+<p>As the practitioner&#8217;s own mind must be the criterion, by which he infers
+the insanity of any other person; and when we consider the various, and
+frequently opposite, opinions of these intellectual arbitrators; the
+reader will be aware that I have not abstained from giving a definition of
+madness without some reason. There is indeed a double difficulty: the
+definition ought to comprize the aberrations of the lunatic, and fix the
+standard for the practitioner.</p>
+
+<p>But it may be assumed that sound mind<span class="pagenum"><a name="Page_38" id="Page_38">[Pg 38]</a></span> and insanity stand in the same
+predicament, and are opposed to each other in the same manner, as right to
+wrong, and as truth to the lie. In a general view no mistake can arise,
+and where particular instances create embarrassment, those most conversant
+with such persons will be best able to determine.</p>
+
+<p>The terms sound mind and insanity are sufficiently plain. If to an
+ordinary observer, a person were to talk in an incoherent manner, he would
+think him mad; if his conduct were regular, and his observations
+pertinent, he would pronounce him in his senses: the two opposite states,
+well marked, are well understood; but there are many different shades,
+which are not so likely to strike the common examiner.</p>
+
+
+<p>&nbsp;</p><p>&nbsp;</p>
+<hr style="width: 50%;" />
+<p><span class="pagenum"><a name="Page_39" id="Page_39">[Pg 39]</a></span></p>
+<h2>CHAP. II.</h2>
+<p class="center"><span class="large">SYMPTOMS OF THE DISEASE.</span></p>
+
+<p>&nbsp;</p>
+<p class="dropcap"><span class="caps">On</span> this part of the subject, authors have commonly descended to minute
+particularities, and studied discriminations. Distinctions have been
+created, rather from the peculiar turn of the patient&#8217;s propensities and
+discourse, than from any marked difference in the varieties and species of
+the disorder. Every person of sound mind, possesses something peculiar to
+himself, which distinguishes him from others, and constitutes his
+idiosyncrasy of body and individuality of character: in the same manner,
+every lunatic discovers something singular in his aberrations from sanity
+of<span class="pagenum"><a name="Page_40" id="Page_40">[Pg 40]</a></span> intellect. It is not my intention to record these splintered
+subdivisions, but to exhibit the prominent features, by which insanity may
+be detected, as far as such appearances seem worthy of remark, and have
+been the subject of my own observation.</p>
+
+<p>In most public hospitals, the first attack of diseases is seldom to be
+observed; and it might naturally be supposed, that there existed in
+Bethlem, similar impediments to an accurate knowledge of incipient
+madness. It is true, that all who are admitted into it, have been a
+greater, or less time afflicted with the disorder; yet from the occasional
+relapses to which insane persons are subject, we have frequent and
+sufficient opportunities of observing the beginning, and tracing the
+progress of this disease.</p>
+
+<p>Among the incurables, there are some, who have intervals of perfect
+soundness of<span class="pagenum"><a name="Page_41" id="Page_41">[Pg 41]</a></span> mind; but who are subject to relapses, which would render it
+improper, and even dangerous, to trust them at large in society: and with
+those, who are upon the curable establishment, a recurrence of the malady
+very frequently takes place. Upon these occasions, there is an ample scope
+for observing the first attack of the disease.</p>
+
+<p>On the approach of mania, they first become uneasy,<a name='fna_5' id='fna_5' href='#f_5'><small>[5]</small></a> are incapable of
+confining their attention, and neglect any employment to which they have
+been accustomed;<span class="pagenum"><a name="Page_42" id="Page_42">[Pg 42]</a></span> they get but little sleep, they are loquacious, and
+disposed to harangue, and decide promptly, and positively upon every
+subject that may be started. Soon after, they are divested of all
+restraint in the declaration of their opinions of those, with whom they
+are acquainted. Their friendships are expressed with fervency and
+extravagance; their enmities with intolerance and disgust. They now become
+impatient of contradiction, and scorn reproof. For supposed injuries, they
+are inclined to quarrel and fight with those about them. They have all the
+appearance of persons inebriated, and those who are unacquainted with the
+symptoms of approaching mania, generally suppose them to be in a state of
+intoxication. At length suspicion creeps in upon the mind, they are aware
+of plots, which had never been contrived, and detect motives that were
+never entertained. At last the succession of ideas is too rapid to be
+<span class="pagenum"><a name="Page_43" id="Page_43">[Pg 43]</a></span>examined;<a name='fna_6' id='fna_6' href='#f_6'><small>[6]</small></a> the mind becomes crouded with thoughts, and confusion
+ensues.</p>
+
+<p>Those under the influence of the depressing passions, will exhibit a
+different train of symptoms. The countenance wears an anxious and gloomy
+aspect, and they are little disposed to speak. They retire from<span class="pagenum"><a name="Page_44" id="Page_44">[Pg 44]</a></span> the
+company of those with whom they had formerly associated, seclude
+themselves in obscure places, or lie in bed the greatest part of their
+time. Frequently they will keep their eyes fixed to some object for hours
+together, or continue them an equal time &#8220;bent on vacuity.&#8221; They next
+become fearful, and conceive a thousand fancies: often recur to some
+immoral act which they have committed, or imagine themselves guilty of
+crimes which they never perpetrated: believe that God has abandoned them,
+and, with trembling, await his punishment. Frequently they become
+desperate, and endeavour by their own hands to terminate an existence,
+which appears to be an afflicting and hateful incumbrance.</p>
+
+<p>Madmen, do not always continue in the same furious or depressed states:
+the maniacal paroxysm abates of its violence, and some beams of hope,
+occasionally cheer the<span class="pagenum"><a name="Page_45" id="Page_45">[Pg 45]</a></span> despondency of the melancholic patients. We have
+in the hospital some unfortunate persons, who are obliged to be secured
+the greater part of their time, but who now and then become calm, and to a
+certain degree rational: upon such occasions, they are allowed a greater
+range, and are admitted to associate with the others. In some instances
+the degree of rationality is more considerable; they conduct themselves
+with propriety, and in a short conversation will appear sensible and
+coherent. Such remission has been generally termed a <i>lucid interval</i>.</p>
+
+<p>When medical persons are called upon to attend a commission of lunacy,
+they are always asked, whether the patient has had a <i>lucid interval</i>? A
+term of such latitude as interval, requires to be explained in the most
+perspicuous and accurate manner. [The circumstances which probably
+occasioned<span class="pagenum"><a name="Page_46" id="Page_46">[Pg 46]</a></span> the employment of this term are pointed out in the chapter
+which enumerates the causes of insanity.] In common language, it is made
+to signify both a moment and a number of years, consequently it does not
+comprize any stated time. The term <i>lucid interval</i> is therefore relative.
+As the law requires a precise developement of opinion, I should define a
+<i>lucid interval</i> to be a complete recovery of the patient&#8217;s intellects,
+ascertained by repeated examinations of his conversation, and by constant
+observation of his conduct, for a time sufficient to enable the
+superintendant to form a correct judgment. Unthinking people, are
+frequently led to conclude, that if, during a short conversation, a person
+under confinement shall bewray nothing absurd or incorrect, he is well,
+and often remonstrate on the injustice of secluding him from the world.
+Even in common society, there are many persons whom we never suspect,
+from<span class="pagenum"><a name="Page_47" id="Page_47">[Pg 47]</a></span> a few trifling topics of discourse, to be shallow minded; but, if we
+start a subject, and wish to discuss it through all its ramifications and
+dependancies, we find them incapable of pursuing a connected chain of
+reasoning. In the same manner insane people will often, for a short time,
+conduct themselves, both in conversation and behaviour, with such
+propriety, that they appear to have the just exercise and direction of
+their faculties: but let the examiner protract the discourse until the
+favourite subject shall have got afloat in the mad man&#8217;s brain, and he
+will be convinced of the hastiness of his decision. To those unaccustomed
+to insane people, a few coherent sentences, or rational answers, would
+indicate a lucid interval, because they discovered no madness; but he, who
+is in possession of the peculiar turn of the patient&#8217;s thoughts, might
+lead him to disclose them, or by a continuance of the conversation, they<span class="pagenum"><a name="Page_48" id="Page_48">[Pg 48]</a></span>
+would spontaneously break forth. A beautiful illustration of this is
+contained in the Rasselas of Dr. Johnson, where the astronomer is admired
+as a person of sound intellect and great acquirements by Imlac, who is
+himself a philosopher, and a man of the world. His intercourse with the
+astronomer is frequent; and he always finds in his society information and
+delight. At length he receives Imlac into the most unbounded confidence,
+and imparts to him the momentous secret. &#8220;Hear, Imlac, what thou wilt not,
+without difficulty, credit. I have possessed, for five years, the
+regulation of weather, and the distribution of the seasons. The Sun has
+listened to my dictates, and passed from tropic to tropic by my direction.
+The clouds, at my call, have poured their waters, and the Nile has
+overflowed at my command. I have restrained the rage of the Dog-star, and
+mitigated the fervours of the Crab. The<span class="pagenum"><a name="Page_49" id="Page_49">[Pg 49]</a></span> winds alone, of all the elemental
+powers, have hitherto refused my authority; and multitudes have perished
+by equinoctial tempests, which I found myself unable to prohibit or
+restrain. I have administered this great office with exact justice, and
+made to the different nations of the earth an impartial dividend of rain
+and sunshine. What must have been the misery of half the globe, if I had
+limited the clouds to particular regions, or confined the Sun to either
+side of the Equator?&#8221;</p>
+
+<p>A real case came under my observation some years ago, and which is equally
+apposite to the subject. A young man had become insane from habitual
+intoxication; and, during the violence of his disorder, had attempted to
+destroy himself. Under a supposed imputation of having unnatural
+propensities, he had amputated his penis, with a view of precluding any
+future insinuations<span class="pagenum"><a name="Page_50" id="Page_50">[Pg 50]</a></span> of that nature. For many months, after he was
+admitted into the hospital, he continued in a state which obliged him to
+be strictly confined, as he constantly meditated his own destruction. On a
+sudden, he became apparently well, was highly sensible of the delusion
+under which he had laboured, and conversed, as any other person, upon the
+ordinary topics of discourse. There was, however, something in the reserve
+of his manner, and peculiarity of his look, which persuaded me he was not
+well, although no incoherence could be detected in his conversation. I had
+observed him for some days to walk rather lame, and once or twice had
+noticed him sitting with his shoes off, rubbing his feet. On enquiring
+into the motives of his doing so, he replied, that his feet were
+blistered, and wished that some remedy might be applied to remove the
+vesications. When I requested to look at his feet, he declined it, and
+prevaricated, saying,<span class="pagenum"><a name="Page_51" id="Page_51">[Pg 51]</a></span> that they were only tender and uncomfortable. In a
+few days afterwards, he assured me they were perfectly well. The next
+evening I observed him, unperceived, still rubbing his feet, and then
+peremptorily insisted on examining them. They were quite free from any
+disorder. He now told me, with some embarrassment, that he wished much for
+a confidential friend, to whom he might impart a secret of importance;
+upon assuring him that he might trust me, he said, that the boards on
+which he walked, (the second story) were heated by subterraneous fires,
+under the direction of invisible and malicious agents, whose intentions,
+he was well convinced, were to consume him by degrees.</p>
+
+<p>From these considerations, I am inclined to think, that a <i>lucid interval</i>
+includes all the circumstances, which I have enumerated in my definition
+of it. If the person,<span class="pagenum"><a name="Page_52" id="Page_52">[Pg 52]</a></span> who is to examine the state of the patient&#8217;s mind,
+be unacquainted with his peculiar opinions, he may be easily deceived,
+because, wanting this information, he will have no clue to direct his
+enquiries, and madmen do not always, nor immediately intrude their
+incoherent notions: they have sometimes such a high degree of control over
+their minds, that when they have any particular purpose to carry, they
+will affect to renounce those opinions, which shall have been judged
+inconsistent: and it is well known, that they have often dissembled their
+resentment, until a favourable opportunity has occurred of gratifying
+their revenge.</p>
+
+<p>Of this restraint, which madmen have sometimes the power of imposing on
+their opinions, the remark has been so frequent, that those who are more
+immediately about<span class="pagenum"><a name="Page_53" id="Page_53">[Pg 53]</a></span> their persons, have termed it, in their rude phrase,
+<i>stifling the disorder</i>.</p>
+
+<p>Among the numerous instances of this cunning and dissimulation, which I
+have witnessed in insane persons, the relation of one case will be
+sufficient to exemplify the subject.</p>
+
+<p>An Essex farmer, about the middle age, had on one occasion so completely
+masked his disorder, that I was induced to suppose him well, when he was
+quite otherwise. He had not been at home many hours, before his
+derangement was discernable by all those, who came to congratulate him on
+the recovery of his reason. His impetuosity, and mischievous disposition
+daily increasing, he was sent to a private mad-house; there being, at that
+time, no vacancy in the hospital. Almost from the moment of his
+confinement he became tranquil, and <span class="pagenum"><a name="Page_54" id="Page_54">[Pg 54]</a></span>orderly, but remonstrated on the
+injustice of his seclusion.</p>
+
+<p>Having once deceived me, he wished much, that my opinion should be taken
+respecting the state of his intellects, and assured his friends that he
+would submit to my determination. I had taken care to be well prepared for
+this interview, by obtaining an accurate account of the manner in which he
+had conducted himself. At this examination, he managed himself with
+admirable address. He spoke of the treatment he had received, from the
+persons under whose care he was then placed, as most kind and fatherly: he
+also expressed himself as particularly fortunate in being under my care,
+and bestowed many handsome compliments on my skill in treating this
+disorder, and expatiated on my sagacity in perceiving the slightest tinges
+of insanity. When I wished him to explain certain parts<span class="pagenum"><a name="Page_55" id="Page_55">[Pg 55]</a></span> of his conduct,
+and particularly some extravagant opinions, respecting certain persons and
+circumstances, he disclaimed all knowledge of such circumstances, and felt
+himself hurt, that my mind should have been poisoned so much to his
+prejudice. He displayed equal subtilty on three other occasions when I
+visited him; although by protracting the conversation, he let fall
+sufficient to satisfy my mind that he was a mad-man. In a short time he
+was removed to the hospital, where he expressed great satisfaction in
+being under my inspection. The private mad-house, which he had formerly so
+much commended, now became the subject of severe animadversion; he said
+that he had there been treated with extreme cruelty; that he had been
+nearly starved, and eaten up by vermin of various descriptions. On
+enquiring of some convalescent patients, I found (as I had suspected) that
+I was as much the subject of<span class="pagenum"><a name="Page_56" id="Page_56">[Pg 56]</a></span> abuse, when absent, as any of his supposed
+enemies; although to my face his behaviour was courteous and respectful.
+More than a month had elapsed, since his admission into the hospital,
+before he pressed me for my opinion; probably confiding in his address,
+and hoping to deceive me. At length he appealed to my decision, and urged
+the correctness of his conduct during confinement as an argument for his
+liberation. But when I informed him of circumstances he supposed me
+unacquainted with, and assured him, that he was a proper subject for the
+asylum where he then inhabited; he suddenly poured forth a torrent of
+abuse; talked in the most incoherent manner; insisted on the truth of what
+he had formerly denied; breathed vengeance against his family and friends,
+and became so outrageous that it was necessary to order him to be strictly
+confined. He continued in a state<span class="pagenum"><a name="Page_57" id="Page_57">[Pg 57]</a></span> of unceasing fury for more than fifteen
+months.</p>
+
+<p>As the memory, appears to be particularly defective in cases of insanity,
+it is much to be wished, that we possessed a correct history, and
+physiological account of this wonderful faculty. Unfortunately, this
+knowledge is not to be sought for with much prospect of attainment, from
+books which treat of the human mind and its philosophy; nor is the present
+work, to be considered as the depository of such information. A deliberate
+attention, to the precise order in which we acquire information on any
+subject; a consideration of the effects of its repetition; an
+investigation of the result (comparing it to a chain) whenever the links
+are separated, together with a knowledge of the contrivance of abbreviated
+signs, would perhaps render the matter sufficiently intelligible. But it
+would be<span class="pagenum"><a name="Page_58" id="Page_58">[Pg 58]</a></span> necessary, thoroughly to understand the nature of the thing, of
+which the sign has been abbreviated: particularly, as the usual mode of
+education is satisfied with possessing the convenience of the
+abbreviation, without any inquiry into the nature of the thing, and the
+cause of the abbreviation of its sign. This faulty mode of instruction,
+has furnished us with a profusion of names, and left us ignorant of the
+things they represent.</p>
+
+<p>Ben Johnson has afforded us the shortest, and probably, the best account
+of memory.</p>
+
+<p>&#8220;<i>Memory</i> of all the <i>powers</i> of the mind, is the most <i>delicate</i>, and
+frail: It is the first of our <i>faculties</i> that age invades. Seneca, the
+Father, the <i>Rhetorician</i>, confesseth of himself, he had a miraculous one,
+not only to receive, but to hold. I myself could in my youth, have
+repeated all that<span class="pagenum"><a name="Page_59" id="Page_59">[Pg 59]</a></span> ever I had made, and so continued till I was past
+forty: since it is much decayed in me. Yet I can repeat whole books that I
+have read, and <i>Poems</i> of some selected friends, which I have lik&#8217;d to
+charge my memory with. It was wont to be faithful to me, but shaken with
+<i>Age</i> now, and <i>Sloth</i> (which weakens the strongest abilities) it may
+perform somewhat, but cannot promise much. By exercise it is to be made
+better and serviceable. Whatsoever I pawn&#8217;d with it while I was young and
+a boy, it offers me readily, and without stops: but what I trust to it
+now, or have done of later years, it lays up more negligently, and
+sometimes loses; so that I receive mine own (though frequently called for)
+as if it were new and borrow&#8217;d. Nor do I always find presently from it
+what I do seek; but while I am doing another thing, that I laboured for
+will come: and what I sought with trouble, will offer itself when I am<span class="pagenum"><a name="Page_60" id="Page_60">[Pg 60]</a></span>
+quiet. Now in some men I have found it as happy as nature, who, whatsoever
+they read or pen, they can say without book presently; as if they did then
+write in their mind. And it is more a wonder in such as have a swift
+stile, for their Memories are commonly slowest; such as torture their
+writings, and go into council for every word, must needs fix somewhat, and
+make it their own at last, though but through their own
+vexation.&#8221;&mdash;<i>Discoveries</i>, <i>vol.</i> vi. <i>p.</i> 240, 1716.</p>
+
+<p>If in a chain of ideas, a number of the links are broken, or leaving out
+the metaphor, if there be an inability to recollect circumstances in the
+order, in which they occurred, the mind cannot possess any accurate
+information. When patients of this description are asked a question, they
+appear as if awakened from a sound sleep: they are searching, they know
+not where,<span class="pagenum"><a name="Page_61" id="Page_61">[Pg 61]</a></span> for the proper materials of an answer, and, in the painful,
+and fruitless efforts of recollection, generally lose sight of the
+question itself. Shakespeare, the highest authority in every thing
+relating to the human mind and its affections, seems to be persuaded, that
+some defect of memory is necessary to constitute madness.</p>
+
+<p class="poem"><span style="margin-left: 8em;">&#8220;It is not madnesse</span><br />
+That I have uttered: bring me to the test<br />
+And I the matter will <i>re-word</i>, which madnesse<br />
+Would gambol from.&#8221;&mdash;<i>Hamlet</i>, <i>Act</i> III. <i>Scene</i> 4.</p>
+
+<p>In persons of sound mind, as well as in maniacs, the memory is the first
+power which decays; and there is something remarkable in the manner of its
+decline. The transactions of the latter part of life are feebly
+recollected, whilst the scenes of youth and of manhood, remain more
+strongly impressed. When I have listened to the conversations of the old
+incurable patients, the topic has generally turned upon the transactions<span class="pagenum"><a name="Page_62" id="Page_62">[Pg 62]</a></span>
+of early days; and, on the circumstances of that period of life, they have
+frequently spoken with tolerable correctness. In many cases, where the
+mind has been injured by intemperance, the same withering of the
+recollection may be observed. It may, perhaps, arise from the mind at an
+early period of life, being most susceptible and retentive of impressions,
+and from a greater disposition to be pleased, with the objects which are
+presented: whereas, the cold caution, and fastidiousness with which age
+surveys the prospects of life, joined to the dulness of the senses, and
+the slight curiosity which prevails, will, in some degree, explain the
+difficulty of recalling the history of later transactions.</p>
+
+<p>Insane people, who have been good scholars, after a long confinement,
+lose, in a wonderful degree, the correctness of orthography: when they
+write, above half the<span class="pagenum"><a name="Page_63" id="Page_63">[Pg 63]</a></span> words are frequently mis-spelt, they are written
+according to the pronunciation. It shews how treacherous the memory is
+without reinforcement. The same necessity of a constant recruit, and
+frequent review of our ideas, satisfactorily explains, why a number of
+patients lapse nearly into a state of ideotism. These have, for some
+years, been the silent and gloomy inhabitants of the hospital, who have
+avoided conversation, and courted solitude; consequently have acquired no
+new ideas, and time has effaced the impression of those, formerly stamped
+on the mind. Mr. Locke, well observes, although he speaks figuratively,
+&#8220;that there seems to be a constant decay of all our ideas, even of those
+which are struck deepest, and in minds the most retentive; so that, if
+they be not sometimes renewed by repeated exercise of the senses, or
+reflection on those kind of objects, which at first occasioned them, the
+print wears<span class="pagenum"><a name="Page_64" id="Page_64">[Pg 64]</a></span> out, and at last there remains nothing to be seen.&#8221;</p>
+
+<p>Connected with loss of memory, there is a form of insanity which occurs in
+young persons; and, as far as these cases have been the subject of my
+observation, they have been more frequently noticed in females. Those whom
+I have seen, have been distinguished by prompt capacity and lively
+disposition: and in general have become the favourites of parents and
+tutors, by their facility in acquiring knowledge, and by a prematurity of
+attainment. This disorder commences, about, or shortly after, the period
+of menstruation, and in many instances has been unconnected with
+hereditary taint; as far as could be ascertained by minute enquiry. The
+attack is almost imperceptible; some months usually elapse, before it
+becomes the subject of particular notice; and fond relatives are
+frequently<span class="pagenum"><a name="Page_65" id="Page_65">[Pg 65]</a></span> deceived by the hope that it is only an abatement of excessive
+vivacity, conducing to a prudent reserve, and steadiness of character. A
+degree of apparent thoughtfulness and inactivity precede, together with a
+diminution of the ordinary curiosity, concerning that which is passing
+before them; and they therefore neglect those objects and pursuits which
+formerly proved sources of delight and instruction. The sensibility
+appears to be considerably blunted; they do not bear the same affection
+towards their parents and relations; they become unfeeling to kindness,
+and careless of reproof. To their companions they shew a cold civility,
+but take no interest whatever in their concerns. If they read a book, they
+are unable to give any account of its contents: sometimes, with steadfast
+eyes, they will dwell for an hour on one page, and then turn over a number
+in a few minutes. It is very difficult to persuade<span class="pagenum"><a name="Page_66" id="Page_66">[Pg 66]</a></span> them to write, which
+most readily develops their state of mind: much time is consumed and
+little produced. The subject is repeatedly begun, but they seldom advance
+beyond a sentence or two: the orthography becomes puzzling, and by
+endeavouring to adjust the spelling, the subject vanishes. As their apathy
+increases they are negligent of their dress, and inattentive to personal
+cleanliness. Frequently they seem to experience transient impulses of
+passion, but these have no source in sentiment; the tears, which trickle
+down at one time, are as unmeaning as the loud laugh which succeeds them;
+and it often happens that a momentary gust of anger, with its attendant
+invectives, ceases before the threat can be concluded. As the disorder
+increases, the urine and f&aelig;ces are passed without restraint, and from the
+indolence which accompanies it, they generally become corpulent. Thus in
+the interval<span class="pagenum"><a name="Page_67" id="Page_67">[Pg 67]</a></span> between puberty and manhood, I have painfully witnessed this
+hopeless and degrading change, which in a short time has transformed the
+most promising and vigorous intellect into a slavering and bloated ideot.</p>
+
+<p>Of the organs of sense, which become affected in those labouring under
+insanity, the ear, more particularly suffers. I scarcely recollect an
+instance of a lunatic becoming blind, but numbers are deaf. It is also
+certain that in these persons, more delusion is conveyed through the ear
+than the eye, or any of the other senses. Those who are not actually deaf,
+are troubled with difficulty of hearing, and tinnitus aurium. Thus an
+insane person shall suppose that he has received a commission from the
+Deity; that he has ordered him to make known his word, or to perform some
+act, as a manifestation of his will and power. It<span class="pagenum"><a name="Page_68" id="Page_68">[Pg 68]</a></span> is however much to be
+regretted, that these divine commissions generally terminate in human
+mischief and calamity, and instances are not unfrequent, where these holy
+inspirations, have urged the unfortunate believer to strangle his wife,
+and attempt the butchery of his children. From this source may be
+explained, the numerous delusions of modern prophecies, which
+circumstantially relate the gossipings of angels, and record the
+hallucinations of feverish repose.</p>
+
+<p>In consequence of some affection of the ear, the insane sometimes insist
+that malicious agents contrive to blow streams of infected air into this
+organ: others have conceived, by means of what they term hearkening wires
+and whiz-pipes, that various obscenities and blasphemies are forced into
+their minds; and it is not unusual for those who are in a desponding
+condition, to<span class="pagenum"><a name="Page_69" id="Page_69">[Pg 69]</a></span> assert, that they distinctly hear the devil tempting them
+to self-destruction.</p>
+
+<p>A considerable portion of the time of many lunatics, is passed in replies
+to something supposed to be uttered. As this is an increasing habit, so it
+may be considered as an unfavourable symptom, and at last the patient
+becomes so abstracted from surrounding objects, that the greater part of
+the day is consumed in giving answers to these supposed communications. It
+sometimes happens that the intelligence conveyed, is of a nature to
+provoke the mad-man, and on these occasions, he generally exercises his
+wrath on the nearest bystander; whom he supposes, in the hurry of his
+anger, to be the offending party.</p>
+
+<p>In the soundest state of our faculties, we are more liable to be deceived
+by the ear, than through the medium of the other<span class="pagenum"><a name="Page_70" id="Page_70">[Pg 70]</a></span> senses: a partial
+obstruction by wax, shall cause the person so affected, to hear the
+bubbling of water, the ringing of bells, or the sounds of musical
+instruments; and on some occasions, although the relation seems tinged
+with superstition, men of undeviating veracity, and of the highest
+attainments, have asserted, that they have heard themselves <i>called</i>. &#8220;He
+[Dr. Johnson] mentioned a thing as not unfrequent, of which I [Mr.
+Boswell] had never heard before&mdash;being <i>called</i>, that is, hearing one&#8217;s
+name pronounced by the voice of a known person at a great distance, far
+beyond the possibility of being reached by any sound, uttered by human
+organs. An acquaintance on whose veracity I can depend, told me, that
+walking home one evening to Kilmarnock, he heard himself called from a
+wood, by the voice of a brother who had gone to America; and the next
+packet brought account of that brother&#8217;s death.<span class="pagenum"><a name="Page_71" id="Page_71">[Pg 71]</a></span> Macbean asserted that
+this inexplicable <i>calling</i> was a thing very well known. Dr. Johnson said,
+that one day at Oxford, as he was turning the key of his chamber, he heard
+his mother distinctly call <i>Sam</i>. She was then at Litchfield; but nothing
+ensued. This ph&aelig;nomenon is, I think, as wonderful as any other mysterious
+fact, which many people are very slow to believe, or rather, indeed,
+reject with an obstinate contempt.&#8221;&mdash;<i>Boswell&#8217;s Life of Dr. Johnson</i>,
+4<i>to.</i> <i>vol.</i> ii. <i>p.</i> 384.</p>
+
+<p>One of the most curious cases of this nature which has fallen under my
+observation, I shall here venture to relate, for the amusement of the
+reader. The patient was a well educated man, about the middle age; he
+always stopped his ears closely with wool, and, in addition to a flannel
+night-cap, usually slept with his head in a tin saucepan. Being asked the
+reason why<span class="pagenum"><a name="Page_72" id="Page_72">[Pg 72]</a></span> he so fortified his head, he replied, &#8220;To prevent the
+intrusion of the <i>sprites</i>.&#8221; After having made particular enquiry
+concerning the nature of these beings, he gravely communicated the
+following information:&mdash;&#8220;Sir, you must know that in the human seminal
+fluid there are a number of vital particles, which being injected into the
+female, impregnate her, and form a f&oelig;tus of muscles and bones. But this
+fluid has other properties, it is capable, by itself, of producing
+vitality under certain circumstances, and experienced chemists and
+hermetical philosophers have devised a method of employing it for other
+purposes, and some, the most detrimental to the condition and happiness of
+man. These philosophers, who are in league with princes, and their
+convenient and prostituted agents, contrive to extract a portion of their
+own semen, which they conserve in rum or brandy: these liquors having the
+power<span class="pagenum"><a name="Page_73" id="Page_73">[Pg 73]</a></span> of holding for a considerable time the seminal fluid, and keeping
+its vitality uninjured. When these secret agents intend to perform any of
+their devilish experiments on a person, who is an object of suspicion to
+any of these potentates, they cunningly introduce themselves to his
+acquaintance, lull him to sleep by artificial means, and during his
+slumbers, infuse a portion of their seminal fluid (conserved in rum or
+brandy) into his ears.</p>
+
+<p>&#8220;As the semen in the natural commerce with the woman, produces a child,
+so, having its vitality conserved by the spirit, it becomes capable of
+forming a <i>sprite</i>; a term, obviously derived from the spirit in which it
+had been infused. The ear is the most convenient nidus for hatching these
+vital particles of the semen. The effects produced on the individual,
+during the incubation of these seminal germs, are very<span class="pagenum"><a name="Page_74" id="Page_74">[Pg 74]</a></span> disagreeable; they
+cause the blood to mount into the head, and produce considerable giddiness
+and confusion of thought. In a short time, they acquire the size of a
+pin&#8217;s head; and then they perforate the drum of the ear, which enables
+them to traverse the interior of the brain, and become acquainted with the
+hidden secrets of the person&#8217;s mind. During the time they are thus
+educated, they enlarge according to the natural laws of growth; they then
+take wing, and become invisible beings, and, from the strong ties of
+natural affection, assisted by the principle of attraction, they revert to
+the parent who afforded the semen, and communicate to him their
+surreptitious observations and intellectual gleanings. In this manner, I
+have been defrauded of discoveries which would have entitled me to
+opulence and distinction, and have lived to see others reap honours and
+emoluments,<span class="pagenum"><a name="Page_75" id="Page_75">[Pg 75]</a></span> for speculations which were the genuine offsprings of my own
+brain.&#8221;</p>
+
+<p>By some persons, madness has been considered as a state of mind analogous
+to dreaming: but an inference of this kind supposes us fully acquainted
+with the actual state, or condition of the mind in dreaming, and in
+madness. The whole question hinges on a knowledge of this <i>state of mind</i>,
+which I fear is still involved in obscurity. As it is not the object of
+the present work to discuss this curious question, the reader is referred
+to the fifth section of the first part of Mr. Dugald Stewart&#8217;s Elements of
+the Philosophy of the Human Mind, and to the note, o, at the end; he will
+also find the subject treated with considerable ingenuity in the eleventh
+section of Mr. Brown&#8217;s Observations on Zoonomia.</p>
+
+<p>There is, however, a circumstance, which<span class="pagenum"><a name="Page_76" id="Page_76">[Pg 76]</a></span> to my knowledge, has not been
+noticed by those who have treated on this subject, and which appears to
+establish a marked distinction between madness and dreaming. In madness,
+the delusion we experience is most frequently conveyed through the ear; in
+dreaming, the deception is commonly optical; we see much, and hear little;
+indeed dreaming, at least with myself, seems to be a species of
+intelligible pantomime, that does not require the aid of language to
+explain it. It is true, that some who have perfectly recovered from this
+disease, and who are persons of good understanding and liberal education,
+describe the state they were in, as resembling a dream: and when they have
+been told how long they were disordered, have been astonished that the
+time passed so rapidly away. But this only refers to that consciousness of
+delusion, which is admitted by the patient on his return to reason; in the
+same manner as<span class="pagenum"><a name="Page_77" id="Page_77">[Pg 77]</a></span> the man awake, smiles at the incongruous images, and
+abrupt transitions of the preceding night. In neither condition, does the
+consciousness of delusion, establish any thing explanatory of the <i>state</i>
+of the mind.</p>
+
+<p>In a description of madness, it would be blameable to omit a form of this
+disease which is commonly very intractable, and of the most alarming
+consequences; I mean, the insanity which arises from the habit of
+intoxication. All persons who have had any experience of this disease,
+readily allow that fermented liquors, taken to excess, are capable of
+producing mental derangement: but the medical practitioner has in such
+cases, to contend, and generally without effect, with popular prejudice,
+and sometimes, with the subordinate advisers of the law.</p>
+
+<p>To constitute madness, the minds of <span class="pagenum"><a name="Page_78" id="Page_78">[Pg 78]</a></span>ignorant people expect a display of
+continued violence, and they are not satisfied that the person can be
+pronounced in that state, without they see him exhibit the pranks of a
+baboon, or hear him roar and bellow like a beast. By these people the
+patient is stated only to be intemperate; they confess that he does very
+foolish things when intoxicated; but that he is not mad, and only requires
+to be restrained from drinking. Thus, a man is permitted slowly to poison
+and destroy himself; to produce a state of irritation, which disqualifies
+him for any of the useful purposes of life; to squander his property
+amongst the most worthless and abandoned; to communicate a loathsome and
+disgraceful disease to a virtuous wife, and leave an innocent and helpless
+family to the meager protection of the parish. If it be possible, the law
+ought to define the circumstances, under which it becomes justifiable, to
+restrain a human being from <span class="pagenum"><a name="Page_79" id="Page_79">[Pg 79]</a></span>effecting his own destruction, and involving
+his family in misery and ruin. When a man suddenly bursts through the
+barriers of established opinions; if he attempt to strangle himself with a
+cord, to divide his larger blood-vessels with a knife, or swallow a vial
+full of laudanum, no one entertains any doubt of his being a proper
+subject for the superintendance of keepers, but he is allowed, without
+control, by a gradual process, to undermine the fabric of his own health,
+and destroy the prosperity of his family.</p>
+
+<p>All patients have not the same degree of memory of what has passed during
+the time they were disordered: and I have frequently remarked, when they
+were unable to give any account of the peculiar opinions which they had
+indulged, during a raving paroxysm of long continuance, that they well
+remembered<span class="pagenum"><a name="Page_80" id="Page_80">[Pg 80]</a></span> any coercion which had been used, or any kindness which had
+been shewn them.</p>
+
+<p>Insane people, are said to be generally worse in the morning; in some
+cases they certainly are so, but perhaps not so frequently as has been
+supposed. In many instances (and, as far as I have observed) in the
+beginning of the disease, they are more violent in the evening, and
+continue so the greatest part of the night. It is, however, a certain
+fact, that the majority of patients of this description, have their
+symptoms aggravated by being placed in a recumbent posture. They seem,
+themselves, to avoid the horizontal position as much as possible, when
+they are in a raving state: and when so confined that they cannot be
+erect, will keep themselves seated upon the breech.</p>
+
+<p>Many of those who are violently <span class="pagenum"><a name="Page_81" id="Page_81">[Pg 81]</a></span>disordered will continue particular
+actions for a considerable time: some are heard to gingle the chain, with
+which they are confined, for hours without intermission; others, who are
+secured in an erect posture, will beat the ground with their feet the
+greatest part of the day. Upon enquiry of such patients, after they have
+recovered, they have assured me that these actions afforded them
+considerable relief. We often surprize persons who are supposed free from
+any mental derangement, in many strange and ridiculous movements,
+particularly if their minds be intently occupied:<a name='fna_7' id='fna_7' href='#f_7'><small>[7]</small></a>&mdash;this does not
+appear<span class="pagenum"><a name="Page_82" id="Page_82">[Pg 82]</a></span> to be so much the effect of habit, as of a particular state of
+mind.</p>
+
+<p>Among the bodily particularities which mark this disease, may be observed
+the protruded, and oftentimes glistening eye, and a peculiar cast of
+countenance, which, however, cannot be described. In some, an appearance
+takes place which has not hitherto been noticed by authors. This is a
+relaxation of the integuments of the <span class="pagenum"><a name="Page_83" id="Page_83">[Pg 83]</a></span>cranium, by which they may be
+wrinkled, or rather gathered up by the hand to a considerable degree. It
+is generally most remarkable on the posterior part of the scalp; as far as
+my enquiries have reached, it does not take place in the beginning of the
+disease, but after a raving paroxysm of some continuance. It has been
+frequently accompanied with contraction of the iris.</p>
+
+<p>On the suggestion of a medical gentleman, I was induced to ascertain the
+prevailing complexion and colour of the hair in insane patients. Out of
+two hundred and sixty-five who were examined, two hundred and five were of
+a swarthy complexion, with dark, or black hair; the remaining sixty were
+of a fair skin, and light, brown, or redhaired. What connexion this
+proportion may have, with the complexion and colour of the hair of the
+people of this country in general, and what alterations may<span class="pagenum"><a name="Page_84" id="Page_84">[Pg 84]</a></span> have been
+produced by age, or a residence in other climates, I am totally
+uninformed.</p>
+
+<p>Of the power which maniacs possess of resisting cold, the belief is
+general, and the histories which are on record are truly wonderful: it is
+not my wish to disbelieve, nor my intention to dispute them; it is proper,
+however, to state that the patients in Bethlem Hospital possess no such
+exemption from the effects of severe cold. They are particularly subject
+to mortifications of the feet; and this fact is so well established from
+former accidents, that there is an express order of the house, that every
+patient, under strict confinement, shall have his feet examined morning
+and evening in the cold weather by the keeper, and also have them
+constantly wrapped in flannel; and those who are permitted to go about,
+are always to be found as near to the fire as they can get, during the
+winter season.</p>
+
+<p><span class="pagenum"><a name="Page_85" id="Page_85">[Pg 85]</a></span>From the great degree of insensibility which prevails in some states of
+madness, a degree of cold would scarcely be felt by such persons, which
+would create uneasiness in those of sound mind; but experience has shewn
+that they suffer equally from severity of weather. When the mind is
+particularly engaged on any subject, external circumstances affect us less
+than when unoccupied. Every one must recollect that, in following up a
+favourite pursuit, his fire has burned out, without his being sensible of
+the alteration of temperature; but when the performance has been finished,
+or he has become indifferent to it from fatigue, he then becomes sensible
+to cold, which he had not experienced before.</p>
+
+<p>Some maniacs refuse all covering, but these are not common occurrences;
+and it may be presumed, that by a continued exposure to the atmosphere,
+such persons<span class="pagenum"><a name="Page_86" id="Page_86">[Pg 86]</a></span> might sustain, with impunity, a low temperature, which would
+be productive of serious injury to those who are clad according to the
+exigences of the season. Such endurance of cold is more probably the
+effect of habit, than of any condition peculiar to insanity.</p>
+
+<p>Having thus given a general account of the symptoms, I shall now lay
+before my readers a history of the appearances which I have noticed on
+opening the heads of several maniacs who have died in Bethlem Hospital.</p>
+
+
+<p>&nbsp;</p><p>&nbsp;</p>
+<hr style="width: 50%;" />
+<p><span class="pagenum"><a name="Page_87" id="Page_87">[Pg 87]</a></span></p>
+<h2>CHAP. III.</h2>
+<p class="center"><span class="large">CASES, WITH THE APPEARANCES ON DISSECTION.</span></p>
+
+<p class="center"><br />CASE I.</p>
+
+<p class="dropcap"><span class="caps">J. H.</span> a man twenty-eight years of age, was admitted a patient in May,
+1795. He had been disordered for about two months before he came into the
+hospital. No particular cause was stated to have brought on the complaint.
+It was most probably an hereditary affection, as his father had been
+several times insane and confined in our hospital. During the time he was
+in the house, he was in a very low and <span class="pagenum"><a name="Page_88" id="Page_88">[Pg 88]</a></span>melancholic state; shewed an
+aversion to food, and said he was resolved to die. His obstinacy in
+refusing all nourishment was very great, and it was with much difficulty
+forced upon him. He continued in this state, but became daily weaker and
+more emaciated until August 1st, when he died. Upon opening the head, the
+pericranium was found loosely adherent to the scull. The bones of the
+cranium were thick. The pia mater was loaded with blood, and the medullary
+substance, when cut into, was full of bloody points. The pineal gland
+contained a large quantity of gritty matter.<a name='fna_8' id='fna_8' href='#f_8'><small>[8]</small></a> The consistence of the
+brain was natural; he was opened twenty-four hours after death.</p>
+
+
+<p class="center"><br /><span class="pagenum"><a name="Page_89" id="Page_89">[Pg 89]</a></span>CASE II.</p>
+
+<p>J. W. was a man of sixty-two years of age, who had been many years in the
+house as an incurable patient, but with the other parts of whose history I
+am totally unacquainted. He appeared to be a quiet and inoffensive person,
+who found amusement in his own thoughts, and seldom joined in any
+conversation with the other patients: for some months he had been troubled
+with a cough, attended with copious expectoration, which very much reduced
+him; dropsical symptoms followed these complaints. He became every day
+weaker, and on July 10th, 1795, died. He was opened eighteen hours after
+death. The pericranium adhered loosely to the scull; the bones of the
+cranium were unusually thin. There were slight opacities in many parts of
+the<span class="pagenum"><a name="Page_90" id="Page_90">[Pg 90]</a></span> tunica arachnoidea; in the ventricles about four ounces of water were
+contained&mdash;some large <ins class="errata" title="Errata: Page 90, line 3, for 'hyatids' read 'hydatids'.">hydatids</ins> were discovered on the plexus choroides of
+the right side. The consistence of the brain was natural.</p>
+
+
+<p class="center"><br />CASE III.</p>
+
+<p>G. H. a man twenty-six years of age, was received into the hospital, July
+18th, 1795. It was stated that he had been disordered six weeks previously
+to his admission, and that he never had any former attack. He had been a
+drummer with a recruiting party, and had been for some time in the habit
+of constant intoxication, which was assigned as the cause of his insanity.
+He continued in a violent and raving state about a month, during the whole
+of which time he got little or no sleep. He had no knowledge of his
+situation, but supposed himself with the <span class="pagenum"><a name="Page_91" id="Page_91">[Pg 91]</a></span>regiment, and was frequently
+under great anxiety and alarm for the loss of his drum, which he imagined
+had been stolen and sold. The medicines which were given to him he
+conceived were spirituous liquors, and swallowed them with avidity. At the
+expiration of a month he was very weak and reduced; his legs became
+&oelig;dematous&mdash;his pupils were much diminished. He now believed himself a
+child, called upon the people about him as his playfellows, and appeared
+to recal the scenes of early life with facility and correctness. Within a
+few days of his decease he only muttered to himself. August 26th, he died.
+He was opened six hours after death. The pericranium was loosely adherent.
+The tunica arachnoidea had generally lost its transparency, and was
+considerably thickened. The veins of the pia mater were loaded with blood,
+and in many places seemed to contain air. There was a <span class="pagenum"><a name="Page_92" id="Page_92">[Pg 92]</a></span>considerable
+quantity of water between the membranes, and, as nearly as could be
+ascertained, about four ounces in the ventricles, in the cavity of which,
+the veins appeared remarkably turgid. The consistence of the brain was
+more than usually firm.</p>
+
+
+<p class="center"><br />CASE IV.</p>
+
+<p>E. M. a woman, aged sixty, was admitted into the house, August 8th, 1795;
+she had been disordered five months: the cause assigned was extreme grief,
+in consequence of the loss of her only daughter. She was very miserable
+and restless; conceived she had been accused of some horrid crime, for
+which she apprehended she should be burned alive. When any persons entered
+her room she supposed them officers of justice, who were about to drag her
+to some cruel punishment. She was <span class="pagenum"><a name="Page_93" id="Page_93">[Pg 93]</a></span>frequently violent, and would strike
+and bite those who came near her. Upon the idea that she should shortly be
+put to death, she refused all sustenance; and it became necessary to force
+her to take it. In this state she continued, growing daily weaker and more
+emaciated, until October 3d, when she died.</p>
+
+<p>Upon opening the head, there was a copious determination of blood to the
+whole contents of the cranium. The pia mater was considerably inflamed;
+there was not any water either in the ventricles or between the membranes.
+The brain was particularly soft. She was opened thirty hours after death.</p>
+
+
+<p class="center"><br />CASE V.</p>
+
+<p>W. P. a young man, aged twenty-five, was admitted into the hospital,
+September<span class="pagenum"><a name="Page_94" id="Page_94">[Pg 94]</a></span> 26th, 1795. He had been disordered five months, and had
+experienced a similar attack six years before. The disease was brought on
+by excessive drinking. He was in a very furious state, in consequence of
+which he was constantly confined. He very seldom slept&mdash;during the greater
+part of the night he was singing, or swearing, or holding conversations
+with persons he imagined to be about him: sometimes he would rattle the
+chain with which he was confined, for several hours together, and tore
+every thing to pieces within his reach. In the beginning of November, the
+violence of his disorder subsided for two or three days, but afterwards
+returned; and on the 10th he died compleatly exhausted by his
+exertions.&mdash;Upon opening the head the pericranium was found firmly
+attached; the pia mater was inflamed, though not to any very considerable
+degree; the tunica arachnoidea in some places was slightly<span class="pagenum"><a name="Page_95" id="Page_95">[Pg 95]</a></span> shot with
+blood; the membranes of the brain, and its convolutions, when these were
+removed, were of a brown, or brownish straw colour. There was no water in
+any of the cavities of the brain, nor any particular congestion of blood
+in its substance&mdash;the consistence of which was natural. He was opened
+twenty hours after death.</p>
+
+
+<p class="center"><br />CASE VI.</p>
+
+<p>B. H. was an incurable patient, who had been confined in the house from
+the year 1788, and for some years before that time in a private madhouse.
+He was about sixty years of age&mdash;had formerly been in the habit of
+intoxicating himself. His character was strongly marked by pride,
+irascibility, and malevolence. During the four last years of his life, he
+was confined for attempting to commit some violence on one<span class="pagenum"><a name="Page_96" id="Page_96">[Pg 96]</a></span> of the
+officers of the house. After this, he was seldom heard to speak; yet he
+manifested his evil disposition by every species of dumb insult. Latterly
+he grew suspicious, and would sometimes tell the keeper that his victuals
+were poisoned. About the beginning of December he was taken ill with a
+cough, attended with copious expectoration. Being then asked respecting
+his complaints, he said, he had a violent pain across the stomach, which
+arose from his navel string at his birth having been tied too short. He
+never spoke afterwards, though frequently importuned to describe his
+complaints. He died December 24, 1795.</p>
+
+<p>Upon dividing the integuments of the head, the pericranium was found
+scarcely to adhere to the scull. On the right parietal bone there was a
+large blotch, as if the bone had been inflamed: there were others<span class="pagenum"><a name="Page_97" id="Page_97">[Pg 97]</a></span> on
+different parts of the bone, but considerably smaller. The glandul&aelig;
+Pacchioni were uncommonly large: the tunica arachnoidea in many places
+wanted the natural transparency of that membrane: there was a large
+determination of blood to the substance of the brain: the ventricles
+contained about three ounces of water: the consistence of the brain was
+natural. He was opened two days after death.</p>
+
+
+<p class="center"><br />CASE VII.</p>
+
+<p>A. M. a woman, aged twenty-seven, was admitted into the hospital, August
+15, 1795; she had then been eleven weeks disordered. Religious enthusiasm,
+and a too frequent attendance on conventicles, were stated to have
+occasioned her complaint. She was in a very miserable and unhappy
+condition, and terrified by the most alarming <span class="pagenum"><a name="Page_98" id="Page_98">[Pg 98]</a></span>apprehensions for the
+salvation of her soul. Towards the latter end of September, she appeared
+in a convalescent state, and continued tolerably well until the middle of
+November, when she began to relapse.</p>
+
+<p>The return of her disorder commenced with loss of sleep. She alternately
+sang, and cried the greatest part of the night. She conceived her inside
+full of the most loathsome vermin, and often felt the sensation as if they
+were crawling into her throat. She was suddenly seized with a strong and
+unconquerable determination to destroy herself; became very sensible of
+her malady, and said, that God had inflicted this punishment on her, from
+having (at some former part of her life) said the Lord&#8217;s Prayer backwards.
+She continued some time in a restless and forlorn state; at one moment
+expecting the devil to seize upon her and tear her to pieces; in the next,
+wondering that<span class="pagenum"><a name="Page_99" id="Page_99">[Pg 99]</a></span> she was not instigated to commit violence on the persons
+about her. On January 12, 1796, she died suddenly. She was opened twelve
+hours after death. The thoracic and abdominal viscera were perfectly
+healthy.</p>
+
+<p>Upon examining the contents of the cranium, the pia mater was considerably
+inflamed, and an extravasated blotch, about the size of a shilling, was
+seen upon that membrane, near the middle of the right lobe of the
+cerebrum. There was no water between the membranes, nor in the ventricles,
+but a general determination of blood to the contents of the cranium. The
+medullary substance, when cut into, was full of bloody points. The
+consistence of the brain was natural.</p>
+
+
+<p class="center"><br /><span class="pagenum"><a name="Page_100" id="Page_100">[Pg 100]</a></span>CASE VIII.</p>
+
+<p>M. W. a very tall and thin woman, forty-four years of age, was admitted
+into the hospital, September 19, 1795. Her disorder was of six months
+standing, and eight years before she had also had an attack of this
+disease. The cause assigned to have brought it on, the last time, was the
+loss of some property, the disease having shortly followed that
+circumstance.&mdash;The constant tenor of her discourse was, that she should
+live but a short time. She seemed anxiously to wish for her dissolution,
+but had no thoughts of accomplishing her own destruction. In the course of
+a few weeks she began to imagine, that some malevolent person had given
+her mercury with an intention to destroy her. She was constantly shewing
+her teeth, which had<span class="pagenum"><a name="Page_101" id="Page_101">[Pg 101]</a></span> decayed naturally, as if this effect had been
+produced by that medicine: at last she insisted, that mercurial
+preparations were mingled in the food and medicines which were
+administered to her. Her appetite was voracious, notwithstanding this
+belief. She had a continual thirst, and drank very large quantities of
+cold water.</p>
+
+<p>On January 14, 1796, she had an apoplectic fit, well marked by stertor,
+loss of voluntary motion, and insensibility to stimuli. On the following
+day she died. She was opened two days after death. There was a remarkable
+accumulation of blood in the veins of the dura and pia mater; the
+substance of the brain was loaded with blood. When the medullary substance
+was cut into, blood oozed from it; and, upon squeezing it, a greater
+quantity could be forced out. On the pia mater covering the right lobe of
+the cerebrum, were some slight <span class="pagenum"><a name="Page_102" id="Page_102">[Pg 102]</a></span>extravasations of blood. The ventricles
+contained no water; on the plexus choroides were some vesicles of the size
+of coriander-seeds, filled with a yellow fluid. The pericranium adhered
+firmly to the scull. The consistence of the brain was firmer than usual.</p>
+
+
+<p class="center"><br />CASE IX.</p>
+
+<p>E. D. a woman, aged thirty-six, was admitted into the hospital, February
+20, 1795; she had then been disordered four months. Her insanity came on a
+few days after having been delivered. She had also laboured under a
+similar attack seven years before, which, like the present, supervened
+upon the birth of a child. Under the impression that she ought to be
+hanged, she destroyed her infant, with the view of meeting with that
+punishment. When she came into the house, she was very sensible<span class="pagenum"><a name="Page_103" id="Page_103">[Pg 103]</a></span> of the
+crime she had committed, and felt the most poignant affliction for the
+act. For about a month she continued to amend: after which time she became
+more thoughtful, and frequently spoke about the child: great anxiety and
+restlessness succeeded. In this state she remained until April 23, when
+her tongue became thickly furred, the skin parched, her eyes inflamed and
+glassy, and her pulse quick. She now talked incoherently; and, towards the
+evening, merely muttered to herself. She died on the following day
+comatose.</p>
+
+<p>She was opened about twenty-four hours after death. The scull was thick,
+the pericranium scarcely adhered to the bone, the dura mater was also but
+slightly attached to its internal surface. There was a large quantity of
+water between the dura mater and tunica arachnoidea; this latter membrane
+was much thickened, and was of a<span class="pagenum"><a name="Page_104" id="Page_104">[Pg 104]</a></span> milky white appearance. Between the
+tunica arachnoidea and pia mater, there was a considerable accumulation of
+water. The veins of the pia mater were particularly turgid. About three
+ounces of water were contained in the lateral ventricles: the veins of the
+membrane lining these cavities were remarkably large and turgid with
+blood. When the medullary substance of the cerebrum and cerebellum was cut
+into, there appeared a great number of bloody points. The brain was of its
+natural consistence.</p>
+
+
+<p class="center"><br />CASE X.</p>
+
+<p>C. M. a man, forty years of age, was admitted into the hospital, December
+26, 1795. It was stated, that he had been disordered two months previously
+to his having been received as a patient. His friends were unacquainted
+with any cause,<span class="pagenum"><a name="Page_105" id="Page_105">[Pg 105]</a></span> which was likely to have induced the disease. During the
+time he was in the house he seemed sulky, or rather stupid. He never asked
+any questions, and if spoken to, either replied shortly, or turned away
+without giving any answer. He scarcely appeared to take notice of any
+thing which was going forward, and if told to do any little office
+generally forgot what he was going about, before he had advanced half a
+dozen steps. He remained in this state until the beginning of May, 1796,
+when his legs became &oelig;dematous, and his abdomen swollen. He grew very
+feeble and helpless, and died rather suddenly, May 19th. He was opened
+about forty-eight hours after death. The pericranium and dura mater
+adhered firmly to the scull; in many places there was an opake whiteness
+of the tunica arachnoidea. About four ounces of water were found in the
+ventricles. The plexus choroides were <span class="pagenum"><a name="Page_106" id="Page_106">[Pg 106]</a></span>uncommonly pale. The medullary
+substance afforded hardly any bloody points when cut into. The consistence
+of the brain I cannot describe better than by saying, it was doughy.</p>
+
+
+<p class="center"><br />CASE XI.</p>
+
+<p>S. M. a man, thirty-six years of age, was admitted as an incurable patient
+in the year 1790. Of the former history of his complaint I have no
+information. As his habits, which frequently came under my observation,
+were of a singular nature, it may not here be improper to relate
+them.&mdash;Having at some period of his confinement been mischievously
+disposed, and, in consequence, put under coercion, he never afterwards
+found himself comfortable when at liberty. When he rose in the morning he
+went immediately to the room where he was usually confined, and placed
+himself<span class="pagenum"><a name="Page_107" id="Page_107">[Pg 107]</a></span> in a particular corner, until the keeper came to secure him. If
+he found any other patient had pre-occupied his situation, he became very
+outrageous, and generally forced them to leave it. When he had been
+confined, for which he appeared anxious, as he bore any delay with little
+temper, he employed himself throughout the remainder of the day, by
+tramping or shuffling his feet. He was constantly muttering to himself, of
+which scarcely one word in a sentence was intelligible. When an audible
+expression escaped him it was commonly an imprecation. If a stranger
+visited him, he always asked for tobacco, but seldom repeated his
+solicitation. He devoured his food with avidity, and always muttered as he
+ate.</p>
+
+<p>In the month of July, 1796, he was seized with a diarrh&oelig;a, which
+afterwards terminated in dysentery. This continued, notwithstanding the
+employment of every<span class="pagenum"><a name="Page_108" id="Page_108">[Pg 108]</a></span> medicine usually given in such a case, until his
+death, which took place on September 23, of the same year. He was opened
+twelve hours after death. The scull was unusually thin; the glandul&aelig;
+Pacchioni were large and numerous: there was a very general determination
+of blood to the brain: the medullary substance, when cut, shewed an
+abundance of bloody points: the lateral ventricles contained about four
+ounces of water: the consistence of the brain was natural.</p>
+
+
+<p class="center"><br />CASE XII.</p>
+
+<p>E. R. was a woman, to all appearance about eighty years of age, but of
+whose history, before she came into the hospital, it has not been in my
+power to acquire any satisfactory intelligence. She was an<span class="pagenum"><a name="Page_109" id="Page_109">[Pg 109]</a></span> incurable
+patient, and had been admitted on that establishment in February, 1782.</p>
+
+<p>During the time I had an opportunity of observing her, she continued in
+the same state: she appeared feeble and childish. During the course of the
+day, she sat in a particular part of the common-room, from which she never
+stirred. Her appetite was tolerably good, but it was requisite to feed
+her. Except she was particularly urged to speak she never talked. As the
+summer declined she grew weaker, and died October 19, 1796, apparently
+worn out. She was opened two days after death. The scull was particularly
+thin; the pericranium adhered firmly to the bone, and the scull-cap was
+with difficulty separated from the dura mater. There was a very large
+quantity of water between the membranes of the brain: the glandul&aelig;
+Pacchioni were uncommonly large: the tunica arachnoidea<span class="pagenum"><a name="Page_110" id="Page_110">[Pg 110]</a></span> was in many
+places blotched and streaked with opacities: when the medullary substance
+of the brain was cut into, it was every where bloody; and blood could be
+pressed from it, as from a sponge. There were some large hydatids on the
+plexus choroides: in the ventricles about a tea spoonful of water was
+observed: the consistence of the brain was particularly firm, but it could
+not be called elastic. There were no symptoms of general dropsy.</p>
+
+
+<p class="center"><br />CASE XIII.</p>
+
+<p>J. D. a man, thirty-five years of age, was admitted into the hospital in
+October, 1796. He was a person of good education, and had been regularly
+brought up to medicine, which he had practised in this town for several
+years. It was stated by his friends, that, about two years before, he had
+<span class="pagenum"><a name="Page_111" id="Page_111">[Pg 111]</a></span>suffered a similar attack, which continued six months: but it appears
+from the observations of some medical persons, that he never perfectly
+recovered from it, although he returned to the exercise of his profession.
+A laborious attention to business, and great apprehensions of the want of
+success, were assigned as causes of his malady. In the beginning of the
+year 1796 the disease recurred, and became so violent that it was
+necessary to confine him.</p>
+
+<p>At the time he was received into Bethlem hospital, he was in an unquiet
+state, got little or no sleep, and was constantly speaking loudly: in
+general he was worse towards evening. He appeared little sensible of
+external objects: his exclamations were of the most incoherent nature.</p>
+
+<p>During the time he was a patient he was thrice cupped on the scalp. After
+each<span class="pagenum"><a name="Page_112" id="Page_112">[Pg 112]</a></span> operation, he became rational to a certain degree; but these
+intervals were of a short continuance, as he relapsed in the course of a
+few hours. The scalp, particularly at the posterior part of the head, was
+so loose that a considerable quantity of it could be gathered up by the
+hand.<a name='fna_9' id='fna_9' href='#f_9'><small>[9]</small></a> The violence of his exertions at last exhausted him, and on
+December 11, he died. He was opened about twenty-four hours after death.
+There was a large quantity of water between the dura mater and tunica
+arachnoidea, and also between this latter membrane and the pia mater. The
+tunica arachnoidea was thickened and opake; the vessels of the pia mater
+were loaded with blood: when the medullary substance was cut into, it was<span class="pagenum"><a name="Page_113" id="Page_113">[Pg 113]</a></span>
+very abundant in bloody points: about three ounces of water were contained
+in the lateral ventricles: the plexus choroides were remarkably turgid
+with blood: a quantity of water was found in the theca vertebralis: the
+consistence of the brain was natural.</p>
+
+
+<p class="center"><br />CASE XIV.</p>
+
+<p>J. C. a man, aged sixty-one, was admitted into the hospital September 17,
+1796. It was stated, that he had been disordered ten months. He had for
+thirty years kept a public house, and had for some time been in the habit
+of getting intoxicated. His memory was considerably impaired:
+circumstances were so feebly impressed on his mind, that he was unable to
+give any account of the preceding day. He appeared perfectly reconciled to
+his situation, and conducted himself with order and propriety.<span class="pagenum"><a name="Page_114" id="Page_114">[Pg 114]</a></span> As he
+seldom spoke but when interrogated, it was not possible to collect his
+opinions. In this quiet state he continued about two months, when he
+became more thoughtful and abstracted, walked about with a quick step, and
+frequently started, as if suddenly interrupted. He was next seized with
+trembling, appeared anxious to be released from his confinement: conceived
+at one time that his house was filled with company; at another that
+different people had gone off without paying him, and that he should be
+arrested for sums of money which he owed. Under this constant alarm and
+disquietude he continued about a week, when he became sullen, and refused
+his food. When importuned to take nourishment, he said it was ridiculous
+to offer it to him, as he had no mouth to eat it: though forced to take
+it, he continued in the same opinion; and when food was put into his
+mouth, insisted that a wound had<span class="pagenum"><a name="Page_115" id="Page_115">[Pg 115]</a></span> been made in his throat, in order to
+force it into his stomach. The next day he complained of violent pain in
+his head, and in a few minutes afterwards died. He was opened twelve hours
+after death. There was a large quantity of water between the tunica
+arachnoidea and pia mater; the latter membrane was much suffused with
+blood, and many of its vessels were considerably enlarged: the lateral
+ventricles contained at least six ounces of water: the brain was very
+firm.</p>
+
+
+<p class="center"><br />CASE XV.</p>
+
+<p>J. A. a man, forty-two years of age, was first admitted into the house on
+June 27, 1795. His disease came on suddenly whilst he was working in a
+garden, on a very hot day, without any covering to his head. He had some
+years before travelled with a <span class="pagenum"><a name="Page_116" id="Page_116">[Pg 116]</a></span>gentleman over a great part of Europe: his
+ideas ran particularly on what he had seen abroad; sometimes he conceived
+himself the king of Denmark, at other times the king of France. Although
+naturally dull and wanting common education, he professed himself a master
+of all the dead and living languages; but his most intimate acquaintance
+was with the old French: and he was persuaded he had some faint
+recollection of coming over to this country with William the Conqueror.
+His temper was very irritable, and he was disposed to quarrel with every
+body about him. After he had continued ten months in the hospital, he
+became tranquil, relinquished his absurdities, and was discharged well in
+June 1796. He went into the country with his wife to settle some domestic
+affairs, and in about six weeks afterwards relapsed. He was re-admitted
+into the hospital August 13th.</p>
+
+<p><span class="pagenum"><a name="Page_117" id="Page_117">[Pg 117]</a></span>He now evidently had a paralytic affection; his speech was inarticulate,
+and his mouth drawn aside. He shortly became stupid, his legs swelled, and
+afterwards ulcerated: at length his appetite failed him; he became
+emaciated, and died December 27th, of the same year. The head was opened
+twenty hours after death. There was a greater quantity of water between
+the different membranes of the brain than has ever occurred to me. The
+tunica arachnoidea was generally opake and very much thickened: the pia
+mater was loaded with blood, and the veins of that membrane were
+particularly enlarged. On the forepart of the right hemisphere of the
+brain, when stripped of its membranes, there was a blotch, of a brown
+colour, several shades darker than the rest of the cortical substance: the
+ventricles were much enlarged, and contained, by estimation, at least six
+ounces of water. The veins in these cavities<span class="pagenum"><a name="Page_118" id="Page_118">[Pg 118]</a></span> were particularly turgid.
+The consistence of the brain was firmer than usual.</p>
+
+
+<p class="center"><br />CASE XVI.</p>
+
+<p>J. H. a man, aged forty-two, was admitted into the house on April 12,
+1794. He had then been disordered two months: it was a family disease on
+his father&#8217;s side. Having manifested a mischievous disposition to some of
+his relations, he was continued in the hospital upon the incurable
+establishment. His temper was naturally violent, and he was easily
+provoked. As long as he was kept to any employment he conducted himself
+tolerably well; but when unoccupied, would walk about in a hurried and
+distracted manner, throwing out the most horrid threats and imprecations.
+He would often appear to be holding conversations: but these conferences
+always <span class="pagenum"><a name="Page_119" id="Page_119">[Pg 119]</a></span>terminated in a violent quarrel between the imaginary being and
+himself. He constantly supposed unfriendly people were placed in different
+parts of the house to torment and annoy him. However violently he might be
+contesting any subject with these supposed enemies, if directed by the
+keepers to render them any assistance, he immediately gave up the dispute
+and went with alacrity. As he slept but little, the greatest part of the
+night was spent in a very noisy and riotous manner. In this state he
+continued until April 1796, when he was attacked with a paralytic
+affection, which deprived him of the use of the left side. His
+articulation was now hardly intelligible; he became childish, got
+gradually weaker, and died December 28, 1796. He was opened twenty-four
+hours after death. There was a general opacity of the tunica arachnoidea,
+and a small quantity of water between<span class="pagenum"><a name="Page_120" id="Page_120">[Pg 120]</a></span> that membrane and the pia mater:
+the ventricles were much enlarged and contained a considerable quantity of
+water, by estimation, four ounces; the consistence of the brain was
+natural.</p>
+
+
+<p class="center"><br />CASE XVII.</p>
+
+<p>M. G. a woman, about fifty years of age, had been admitted on the
+incurable establishment in July 1785. She had for some years before been
+in a disordered state, and was considered as a dangerous patient. Her
+temper was violent; and if interrupted in her usual habits, she became
+very furious. Like many others among the incurables, she was an insulated
+being: she never spoke except when disturbed. Her greatest delight
+appeared to be in getting into some corner to sleep; and the interval
+between breakfast and dinner, was usually<span class="pagenum"><a name="Page_121" id="Page_121">[Pg 121]</a></span> past in this manner. At other
+times she was generally committing some petty mischief, such as slyly
+breaking a window, dirtying the rooms of the other patients, or purloining
+their provisions. She had been for some months in a weak and declining
+state, but would never give any account of her disorder. On January 5,
+1797, she died, apparently worn out. The head was opened three days after
+death. The pericranium adhered but slightly to the scull, nor was the dura
+mater firmly attached. There was water between the membranes of the brain;
+and the want of transparency of the tunica arachnoidea, indicated marks of
+former inflammation. The posterior part of the hemispheres of the brain
+was of a brownish colour. In this case there was a considerable appearance
+of air in the veins; the medullary substance, when cut, was full of bloody
+points: the lateral ventricles were small,<span class="pagenum"><a name="Page_122" id="Page_122">[Pg 122]</a></span> but filled with water: the
+plexus choroides were loaded with vesicles of a much larger size than
+usual: the consistence of the brain was natural.</p>
+
+
+<p class="center"><br />CASE XVIII.</p>
+
+<p>S. T. a woman, aged fifty-seven, was admitted into the house, January 14,
+1797. It was stated by her friends, that she had been disordered eight
+months: they were unacquainted with any cause, which might have induced
+the disease. She had evidently suffered a paralytic attack, which
+considerably affected her speech, and occasioned her to walk lame with the
+right leg. As she avoided all conversation, it was not possible to collect
+any further account of her case. Three days after her admission, she had
+another paralytic stroke, which deprived her entirely of the use of<span class="pagenum"><a name="Page_123" id="Page_123">[Pg 123]</a></span> the
+right side. Two days afterwards she died. She was opened forty-eight hours
+after death. There was a small quantity of water between the tunica
+arachnoidea and pia mater, and a number of opake spots on the former
+membrane. On the pia mater, covering the posterior part of the left
+hemisphere of the brain, there was an extravasated blotch, about the size
+of a shilling: the medullary substance was unusually loaded with blood:
+the lateral ventricles were large, but did not contain much water: the
+consistence of the brain was very soft.</p>
+
+
+<p class="center"><br />CASE XIX.</p>
+
+<p>W. C. a man, aged sixty-three, was admitted into the hospital, January 21,
+1797. The persons, who attended at his admission, deposed, that he had
+been disordered five<span class="pagenum"><a name="Page_124" id="Page_124">[Pg 124]</a></span> months; that he never had been insane before, and
+that the disease came on shortly after the death of his son. He was in a
+very anxious and miserable state. No persuasion could induce him to take
+nourishment; and it was with extreme difficulty that any food could be
+forced upon him. He paced about with an hurried step; was often suddenly
+struck with the idea of having important business to adjust in some
+distant place, and which would not admit of a moment&#8217;s delay. Presently
+after, he would conceive his house to be on fire, and would hastily
+endeavour to rescue his property from the flames. Then he would fancy that
+his son was drowning, that he had twice sunk: he was prepared to plunge
+into the river to save him, as he floated for the last time: every moment
+appeared an hour until he rose. In this miserable state he continued till
+the 27th, when, with great perturbation, he suddenly<span class="pagenum"><a name="Page_125" id="Page_125">[Pg 125]</a></span> ran into his room,
+threw himself on the bed, and in a few minutes expired. The head was
+opened twenty-four hours after death. The pericranium was but slightly
+adherent to the scull: the tunica arachnoidea, particularly where the
+hemispheres meet, was of a milky whiteness. Between this membrane, which
+was somewhat thickened, and the pia mater, there was a very large
+collection of water: the pia mater was inflamed: the veins of this
+membrane were enlarged beyond what I had ever before observed: there was a
+striking appearance of air in the veins: the medullary substance of the
+brain, when cut into, bled freely, and seemed spongy from the number and
+enlargement of its vessels: in the ventricles, which were of a natural
+capacity, there was about half an ounce of water: the brain was of a
+healthy consistence.</p>
+
+
+<p class="center"><br /><span class="pagenum"><a name="Page_126" id="Page_126">[Pg 126]</a></span>CASE XX.</p>
+
+<p>M. L. a woman, aged thirty-eight, was admitted into the house, June 11,
+1796. From the information of the people who had attended her, it
+appeared, that she had been disordered six weeks, and that the disease
+took place shortly after the death of her husband. At the first attack she
+was violent, but she soon became more calm. She conceived that the
+overseers of the parish, to which she belonged, meditated her destruction:
+afterwards she supposed them deeply enamoured of her, and that they were
+to decide their claims by a battle. During the time she continued in the
+hospital she was perfectly quiet, although very much deranged. She fancied
+that a young man, for whom she had formerly entertained a partiality, but
+who had<span class="pagenum"><a name="Page_127" id="Page_127">[Pg 127]</a></span> been dead some years, appeared frequently at her bed-side, in a
+state of putrefaction, which left an abominable stench in her room. Soon
+after she grew suspicious, and became apprehensive of evil intentions in
+the people about her. She would frequently watch at her door, and, when
+asked the reason, replied that she was fully aware of a design, which had
+been formed, to put her secretly to death.&mdash;Under the influence of these
+opinions she continued to her death, which took place on February 8, 1797,
+in consequence of a violent rheumatic fever. She was opened twelve hours
+after death. There were two opake spots on the tunica arachnoidea: the pia
+mater was slightly inflamed: there was a general congestion of blood to
+the whole contents of the cranium: the consistence of the brain did not
+differ from what is found in a healthy state.</p>
+
+
+<p class="center"><br /><span class="pagenum"><a name="Page_128" id="Page_128">[Pg 128]</a></span>CASE XXI.</p>
+
+<p>H. C. a woman, of about sixty-five years of age, had been admitted on the
+incurable establishment in the year 1788. I have not been able to collect
+any particulars of her former history. During the time I had an
+opportunity of seeing her, she continued in a very violent and irritable
+state: it was her custom to abuse every one who came near her. The
+greatest part of the day was passed in cursing the persons she saw about
+her; and when no one was near, she usually muttered some blasphemy to
+herself. She died of a fever on February 19, 1797, on the fourth day after
+the attack. She was opened two days after death. The tunica arachnoidea
+was, in many parts, without its natural transparency: the pia mater was
+generally suffused with blood,<span class="pagenum"><a name="Page_129" id="Page_129">[Pg 129]</a></span> and its vessels were enlarged: the
+consistence of the brain was firm.</p>
+
+
+<p class="center"><br />CASE XXII.</p>
+
+<p>J. C. a man, aged fifty, was admitted into the hospital, August 6, 1796.
+It was stated that he had been disordered about three weeks, and that the
+disease had been induced by too great attention to business, and the want
+of sufficient rest. About four years before, he had been a patient, and
+was discharged uncured. He was an artful and designing man, and with great
+ingenuity once effected his escape from the hospital. His time was mostly
+passed in childish amusements, such as tearing pieces of paper and
+sticking them on the walls of his room, collecting rubbish and assorting
+it. However, when he conceived himself unobserved, he was intriguing with
+other <span class="pagenum"><a name="Page_130" id="Page_130">[Pg 130]</a></span>patients, and instructing them in the means, by which they might
+escape. Of his disorder he seemed highly sensible, and appeared to approve
+so much of his confinement, that when his friends wished to have him
+released, he opposed it, except it should meet with my approbation;
+telling them, in my presence, that, although he might appear well to them,
+the medical people of the house were alone capable of judging of the
+actual state of his mind; yet I afterwards discovered, that he had
+instigated them to procure his enlargement, by a relation of the grossest
+falshoods and most unjust complaints. In April 1797, he was permitted to
+have a month&#8217;s leave of absence, as he appeared tolerably well, and wished
+to maintain his family by his industry. For above three weeks of this
+time, he conducted himself in a very rational and orderly manner. The day
+preceding that, on which he was to have returned thanks, he appeared<span class="pagenum"><a name="Page_131" id="Page_131">[Pg 131]</a></span>
+gloomy and suspicious, and felt a disinclination for work. The night was
+passed in a restless manner, but in the morning he seemed better, and
+proposed coming to the hospital to obtain his discharge. His wife having
+been absent for a few minutes from the room, found him, on her return,
+with his throat cut. He was re-admitted as a patient, and expressed great
+sorrow and penitence for what he had done; and said that it was committed
+in a moment of rashness and despair. After a long and minute examination,
+he bewrayed nothing incoherent in his discourse. His wound, from which it
+was stated that he had lost a large quantity of blood, was attended to by
+Mr. Crowther, the surgeon to the hospital. Every day he became more
+dispirited, and at last refused to speak. He died May 29th, about ten days
+after his re-admission. His head was opened two days after death. There
+were some slight<span class="pagenum"><a name="Page_132" id="Page_132">[Pg 132]</a></span> opacities of the tunica arachnoidea, and the pia mater
+was a little inflamed: the other parts of the brain were in an healthy
+state, and its consistence natural.</p>
+
+
+<p class="center"><br />CASE XXIII.</p>
+
+<p>E. L. was a man, about seventy-eight years of age; had been admitted on
+the incurable establishment, January 3, 1767. By report, I have understood
+that he was formerly in the navy, and that his insanity was caused by a
+disappointment of some promotion which he expected. It was also said, that
+he was troublesome to some persons high in office, which rendered it
+necessary that he should be confined. At one time he imagined himself to
+be the king, and insisted on his crown. During the time I had an
+opportunity of knowing him, he conducted himself in a very gentlemanly<span class="pagenum"><a name="Page_133" id="Page_133">[Pg 133]</a></span>
+manner. His disposition was remarkably placid, and I never remember him to
+have uttered an unkind or hasty expression. With the other patients he
+seldom held any conversation. His chief amusement was reading, and writing
+letters to the people of the house. Of his books he was by no means
+choice; he appeared to derive as much amusement from an old catalogue as
+from the most entertaining performance. His writings always contained
+directions for his release from confinement; and he never omitted his high
+titles of God&#8217;s King, Holy Ghost, Admiral, and Physician. He died June 13,
+1797, worn out with age. He was opened two days after death. The scull was
+thick and porous. There was a large quantity of water between the
+different membranes. The tunica arachnoidea was particularly opake: the
+veins seemed to contain air: in the medullary substance the vessels were
+very copious and much<span class="pagenum"><a name="Page_134" id="Page_134">[Pg 134]</a></span> enlarged: the lateral ventricles contained two
+ounces of pellucid water: the consistence of the brain was natural.</p>
+
+<p>It has been stated, by a gentleman of great accuracy, and whose situation
+affords him abundant opportunity of acquiring a knowledge of diseased
+appearances, that the fluid of hydrocephalus appears to be of the same
+nature with the water which is found in dropsy of the thorax and
+abdomen.<a name='fna_10' id='fna_10' href='#f_10'><small>[10]</small></a> That this is generally the case, there can be no doubt, from
+the respectable testimony of the author of the Morbid Anatomy: but in
+three instances, where I submitted this fluid to experiment, it was
+incoagulable by acids and by heat; in all of them its consistence was not
+altered even by boiling. There was, however, a cloudiness produced; and,
+after the liquor had stood some time, a slight <span class="pagenum"><a name="Page_135" id="Page_135">[Pg 135]</a></span>deposition of animal
+matter took place, which, prior to the application of heat or mineral
+acids, had been dissolved in the fluid. This liquor tinged green the
+vegetable blues; produced a copious deposition with nitrat of silver; and,
+on evaporation, afforded cubic crystals (nitrat of soda). From this
+examination it was inferred, that the water of the brain, collected in
+maniacal cases, contained a quantity of uncombined alkali and some common
+salt. What other substances may enter into its composition, from want of
+sufficient opportunity, I have not been enabled to determine.</p>
+
+
+<p class="center"><br />CASE XXIV.</p>
+
+<p>S. W. a woman, thirty-five years of age, was admitted into the hospital,
+June 3, 1797. It was stated that she had been one month disordered, and
+had never <span class="pagenum"><a name="Page_136" id="Page_136">[Pg 136]</a></span>experienced any prior affection of the same kind. The disease
+was said to have been produced by misfortunes which had attended her
+family, and from frequent quarrels with those who composed it. She was in
+a truly melancholic state; she was lost to all the comforts of this life,
+and conceived herself abandoned for ever by God. She refused all food and
+medicines. In this wretched condition she continued until July 29th, when
+she lost the use of her right side. On the 30th she became lethargic, and
+continued so until her death, which happened on August the 3d. She was
+opened two days after death. There was a large collection of water between
+the different membranes of the brain, amounting at least to four ounces:
+the pia mater was very much inflamed, and was separable from the
+convolutions of the brain with unusual facility: the medullary substance
+was abundantly loaded with bloody<span class="pagenum"><a name="Page_137" id="Page_137">[Pg 137]</a></span> points: the consistence of the brain
+was remarkably firm.</p>
+
+
+<p class="center"><br />CASE XXV.</p>
+
+<p>D. W. a man, about fifty-eight years of age, had been admitted upon the
+incurable establishment in 1789. He was of a violent and mischievous
+disposition, and had nearly killed one of the keepers at a private mad
+house previously to his admission into the hospital. At all times he was
+equally deranged respecting his opinions, although he was occasionally
+more quiet and tractable: these intervals were extremely irregular as to
+their duration and period of return. He was of a very constipated habit,
+and required large doses of cathartic medicines to procure stools. On
+August 3, 1797, he was in a very furious state; complained of costiveness,
+for which he took his ordinary<span class="pagenum"><a name="Page_138" id="Page_138">[Pg 138]</a></span> quantity of opening physic, which operated
+as usual. On the same day he ate his dinner with a good appetite; but
+about six o&#8217;clock in the evening he was struck with hemiplegia, which
+deprived him completely of the use of his left side. He lay insensible of
+what passed about him, muttered constantly to himself, and appeared to be
+keeping up a kind of conversation. The pulse was feeble, but not oppressed
+or intermitting. He never had any stertor. He continued in this state
+until the 12th, when he died. He was opened twelve hours after death.
+There was some water between the tunica arachnoidea and pia mater: the
+former membrane was opake in many places; bearing the marks of former
+inflammation: in the veins of the membranes of the brain there was a
+considerable appearance of air, and they were likewise particularly
+charged with blood: the vessels of the medullary substance were<span class="pagenum"><a name="Page_139" id="Page_139">[Pg 139]</a></span> numerous
+and enlarged. On opening the right lateral ventricle, which was much
+distended, it was found filled with dark and grumous blood; some had also
+escaped into the left, but in quantity inconsiderable when compared with
+what was contained in the other: the consistence of the brain was very
+soft.</p>
+
+
+<p class="center"><br />CASE XXVI.</p>
+
+<p>J. S. a man, forty-four years of age, was received into the hospital, June
+24, 1797. He had been disordered nine months previous to his admission.
+His insanity was attributed to a violent quarrel, which had taken place
+with a young woman, to whom he was attached, as he shortly afterwards
+became sullen and melancholy.</p>
+
+<p>During the time he remained in the house he seldom spoke, and wandered<span class="pagenum"><a name="Page_140" id="Page_140">[Pg 140]</a></span>
+about like a forlorn person. Sometimes he would suddenly stop, and keep
+his eyes fixed on an object, and continue to stare at it for more than an
+hour together. Afterwards he became stupid, hung down his head, and
+drivelled like an ideot. At length he grew feeble and emaciated, his legs
+were swollen and &oelig;dematous, and on September 13th, after eating his
+dinner, he crawled to his room, where he was found dead about an hour
+afterwards. He was opened two days after death. The tunica arachnoidea had
+a milky whiteness, and was thickened. There was a considerable quantity of
+water between that membrane and the pia mater, which latter was loaded
+with blood: the lateral ventricles were very much enlarged, and contained,
+by estimation, about six ounces of transparent fluid: the brain was of its
+natural consistence.</p>
+
+
+<p class="center"><br /><span class="pagenum"><a name="Page_141" id="Page_141">[Pg 141]</a></span>CASE XXVII.</p>
+
+<p>T. W. a man, thirty-eight years of age, was admitted into the house, May
+16, 1795. He had then been disordered a year. His disease was stated to
+have arisen, from his having been defrauded, by two of his near relations,
+of some property, which he had accumulated by servitude. Having remained
+in the hospital the usual time of trial for cure, he was afterwards
+continued on the incurable establishment, in consequence of a strong
+determination he had always shewn, to be revenged on those people who had
+disposed of his property, and a declared intention of destroying himself.
+He was in a very miserable state, conceived that he had offended God, and
+that his soul was burning in Hell. Notwithstanding he was haunted with
+these<span class="pagenum"><a name="Page_142" id="Page_142">[Pg 142]</a></span> dreadful imaginations, he acted with propriety upon most occasions.
+He took delight in rendering any assistance in his power to the people
+about the house, and waited on those who were sick, with a kindness that
+made him generally esteemed. At some period of his life he had acquired an
+unfortunate propensity to gaming, and whenever he had collected a few
+pence, he ventured them at cards. His losses were borne with very little
+philosophy, and the devil was always accused of some unfair interposition.</p>
+
+<p>On September 14, 1797, he appeared jaundiced, the yellowness daily
+increased, and his depression of mind was more tormenting than ever. From
+the time he was first attacked by the jaundice he had a strong
+presentiment that he should die. Although he took the medicines which were
+ordered, as a mark of attention to<span class="pagenum"><a name="Page_143" id="Page_143">[Pg 143]</a></span> those who prescribed them, he was
+firmly persuaded they could be of no service. The horror and anxiety he
+felt, was, he said, sufficient to kill him, independantly of the jaundice.</p>
+
+<p>On the 20th he was drowsy, and on the following day died comatose. He was
+opened twenty-four hours after death. In some places the tunica
+arachnoidea was slightly opake: the pia mater was inflamed; and in the
+ventricles were found about two tea-spoons full of water tinged deeply
+yellow, and the vesicles of the plexus choroides were of the same colour:
+to the whole contents of the cranium there was a considerable congestion
+of blood: the consistence of the brain was natural: the liver was sound:
+the gall-bladder very much thickened, and contained a stone of the
+mulberry appearance, of a white<span class="pagenum"><a name="Page_144" id="Page_144">[Pg 144]</a></span> colour. Another stone was also found in
+the duodenum.</p>
+
+
+<p class="center"><br />CASE XXVIII.</p>
+
+<p>R. B. a man, sixty-four years of age, was admitted into the hospital,
+September 2, 1797. He had then been disordered three months. It was also
+stated, that he had suffered an attack of this disease seven years before,
+which then continued about two months. His disorder had, both times, been
+occasioned by drinking spirituous liquors to excess. He was a person of
+liberal education, and had been occasionally employed as usher in a
+school, and at other times as a librarian and amanuensis. When admitted he
+was very noisy, and importunately talkative. During the greatest part of
+the day he was reciting passages from the Greek and Roman poets, or
+talking of<span class="pagenum"><a name="Page_145" id="Page_145">[Pg 145]</a></span> his own literary importance. He became so troublesome to the
+other madmen, who were sufficiently occupied with their own speculations,
+that they avoided, and excluded him from the common room; so that he was,
+at last, reduced to the mortifying situation of being the sole auditor of
+his own compositions.</p>
+
+<p>He conceived himself very nearly related to Anacreon, and possessed of the
+peculiar vein of that poet. He also fancied that he had discovered the
+longitude; and was very urgent for his liberation from the hospital, that
+he might claim the reward, to which his discovery was intitled. At length
+he formed schemes to pay off the national debt: these, however, so much
+bewildered him that his disorder became more violent than ever, and he was
+in consequence obliged to be confined to his room. He now, after he had
+remained two months in the house,<span class="pagenum"><a name="Page_146" id="Page_146">[Pg 146]</a></span> was more noisy than before, and had
+little sleep. These exertions very much reduced him.</p>
+
+<p>In the beginning of January, 1798, his conceptions were less distinct, and
+although his talkativeness continued, he was unable to conclude a single
+sentence. When he began to speak, his attention was diverted by the first
+object which caught his eye, or by any sound that struck him. On the 5th
+he merely muttered; on the 7th he lost the use of his right side, and
+became stupid and taciturn. In this state he continued until the 14th,
+when he had another fit; after which he remained comatose and insensible.
+On the following day he died. He was opened thirty-six hours after death.
+The pericranium adhered very loosely to the scull: the tunica arachnoidea
+was generally opake, and suffused with a brownish hue: a large quantity of
+water was <span class="pagenum"><a name="Page_147" id="Page_147">[Pg 147]</a></span>contained between it and the pia mater: the contents of the
+cranium were unusually destitute of blood: there was a considerable
+quantity of water (perhaps four ounces) in the lateral ventricles, which
+were much enlarged: the consistence of the brain was very soft.</p>
+
+
+<p class="center"><br />CASE XXIX.</p>
+
+<p>E. T. a man, aged thirty years, was admitted a patient, July 23, 1796. The
+persons who attended, related, that he had been disordered eleven months,
+and that his insanity shortly supervened to a violent fever. It also
+appeared, from subsequent enquiries, that his mother had been affected
+with madness.</p>
+
+<p>He was a very violent and mischievous patient, and possessed of great
+bodily strength and activity. Although confined, he <span class="pagenum"><a name="Page_148" id="Page_148">[Pg 148]</a></span>contrived several
+times during the night to tear up the flooring of his cell; and had also
+detached the wainscot to a considerable extent, and loosened a number of
+bricks in the wall. When a new patient was admitted, he generally enticed
+him into his room, on pretence of being an old acquaintance, and, as soon
+as he came within his reach, immediately tore his clothes to pieces. He
+was extremely dexterous with his feet, and frequently took off the hats of
+those who were near him with his toes, and destroyed them with his teeth.
+After he had dined he generally bit to pieces a thick wooden bowl, in
+which his food was served, on the principle of sharpening his teeth
+against the next meal. He once bit out the testicles of a living cat,
+because the animal was attached to some person who had offended him. Of
+his disorder he appeared to be very sensible; and after he had done any
+mischief, always blamed the<span class="pagenum"><a name="Page_149" id="Page_149">[Pg 149]</a></span> keepers for not securing him so, as to have
+prevented it. After he had continued a year in the hospital he was
+retained as an incurable patient. He died February 17, 1798, in
+consequence of a tumor of the neck. He was opened two days after death.
+The tunica arachnoidea was generally opake, and of a milky whiteness: the
+vessels of the pia mater were turgid, and its veins contained a quantity
+of air; about an ounce of water was contained in the lateral ventricles:
+the consistence of the brain was unusually firm, and possessed of
+considerable elasticity: it is the only instance of this nature which has
+fallen under my observation.</p>
+
+
+<p class="center"><br />CASE XXX.</p>
+
+<p>T. G. a man, about fifty-five years of age, was admitted into the
+hospital, January 20, 1798. It was stated, that he had been<span class="pagenum"><a name="Page_150" id="Page_150">[Pg 150]</a></span> disordered a
+year and half, and that his madness arose from repeated intoxication.
+Having set fire to several hay-stacks, and committed frequent depredations
+on the neighbouring farmers, it had been found necessary to confine him in
+the county goal. His behaviour in this situation marked the cunning and
+malignity of his mind, so that he was always attempting some mischief
+either by violence or stratagem.</p>
+
+<p>When brought to the hospital he conducted himself with propriety and
+order, and appeared to be in a state of recovery. On the second of May he
+was attacked with a diarrh&oelig;a which daily encreased, notwithstanding the
+medicines employed for its removal. His mind became violently agitated
+from the commencement of the diarrh&oelig;a, and it was found proper to
+secure him. On the 8th, dysenteric symptoms appeared, which continued to
+the 13th, when he died.</p>
+
+<p class="center"><span class="pagenum"><a name="Page_151" id="Page_151">[Pg 151]</a></span><i>Appearances on Dissection.</i></p>
+
+<p>The head was opened twenty-four hours after death. The pericranium was
+loosely attached to the scull, and the dura mater adhered but slightly to
+the internal surface of the cranium; there was a considerable quantity of
+water between the dura mater and tunica arachnoidea, this latter membrane
+(especially where the hemispheres meet) was of a milky whiteness, and
+generally so in the course of the veins of the pia mater. The glandul&aelig;
+Pacchioni were very large and numerous. Between the tunica arachnoidea and
+pia mater there was much water; and from the lateral ventricles, which
+were uncommonly enlarged and distended, eight ounces of fluid were
+collected: the infundibulum was remarkably large: the membrane lining the
+cavity of the lateral ventricles had its veins very turgid: the
+consistence of the brain was softer than natural.</p>
+
+<p><span class="pagenum"><a name="Page_152" id="Page_152">[Pg 152]</a></span>The fluid obtained from the brain in this case being very pellucid and
+abundant, it was submitted to some chemical tests in order to ascertain
+its composition.</p>
+
+<p>An attempt of this kind had been made before; (vide Case 23) the present
+may be considered a small addition to our knowledge of this fluid, though
+by no means a satisfactory developement of its materials, according to the
+severity and precision of modern analysis.<a name='fna_11' id='fna_11' href='#f_11'><small>[11]</small></a></p>
+
+<p class="center">ANALYSIS OF THE FLUID.</p>
+
+<table border="0" cellpadding="0" cellspacing="5" summary="table">
+<tr><td valign="top"><i>Tincture of Galls</i>,</td>
+    <td><span class="spacer">&nbsp;</span></td>
+    <td>produced a white precipitate in<br />moderate quantity.</td></tr>
+<tr><td>&nbsp;</td></tr>
+<tr><td valign="top"><span class="pagenum"><a name="Page_153" id="Page_153">[Pg 153]</a></span><i>Lime Water</i>,</td>
+    <td>&nbsp;</td>
+    <td>afforded a considerable quantity<br />of a white precipitate, which was<br />redissolved without effervescence<br />by muriatic acid.</td></tr>
+<tr><td>&nbsp;</td></tr>
+<tr><td valign="top"><i>Solution of Sulphat</i><br /><span style="margin-left: 1em;"><i>of Copper.</i></span></td>
+    <td>&nbsp;</td>
+    <td>A drop of this solution added to<br />two drams of the brain fluid<br />tinged it with a pretty deep blue.</td></tr></table>
+
+<p>The presence of animal matter is inferred from the deposition produced by
+infusion of galls.</p>
+
+<p>The precipitation by lime-water indicates the phosphoric acid.</p>
+
+<p><span class="pagenum"><a name="Page_154" id="Page_154">[Pg 154]</a></span>And it appears from the blue tinge given to the fluid by the sulphat of
+copper, that ammonia or some of its combinations was contained.</p>
+
+<p>As it occurred on many former trials, there was no coagulation by heat; a
+slight sediment fell, after boiling some minutes.</p>
+
+<p>As this patient remained in the hospital from the middle of January to the
+beginning of May, in a state perfectly tranquil, and without the
+appearance of disarrangement of mind, it is improbable that a so great
+enlargement of the ventricles, and accumulation of water, could have taken
+place within the short space of two weeks, it is therefore most likely
+that the greatest part of this fluid had been previously collected.</p>
+
+<p>It may be conjectured that a very gradual<span class="pagenum"><a name="Page_155" id="Page_155">[Pg 155]</a></span> accumulation of water (although
+the quantity be at last considerable) would not affect the sensorium so as
+a sudden secretion of fluid; or, that a quantity, which at one time had
+occasioned great disturbance, would by habit become less inconvenient.</p>
+
+<p>We are not well informed, but there is reason to believe, that gradual
+pressure on the brain, will not occasion those serious symptoms which a
+sudden pressure would excite.</p>
+
+
+<p class="center"><br />CASE XXXI.</p>
+
+<p>H. K. a woman, aged thirty, was admitted into the hospital, October 15,
+1796. She had then been mad about four months, and her disorder was stated
+to have supervened on the birth of a child. From subsequent enquiry it was
+ascertained that her mother had been insane, and that her elder<span class="pagenum"><a name="Page_156" id="Page_156">[Pg 156]</a></span> sister
+had been similarly affected; but from the best information it did not
+appear that her brothers (she had two) had ever been visited with this
+calamity.</p>
+
+<p>Previously to her admission she had frequently attempted to destroy
+herself, and had also endeavoured to take away the life of her husband. In
+the hospital she was extremely violent; supposed her neighbours had
+conspired to take away her liberty, and became jealous of her husband: she
+was often naming some female of her acquaintance who had artfully ensnared
+his affections, and whom he had decked out in her best apparel: she
+breathed revenge when she should return home, and seemed much delighted
+with the idea of destroying these favourites, when they were dressed for
+some excursion with her husband.</p>
+
+<p>She had understood that a year was the<span class="pagenum"><a name="Page_157" id="Page_157">[Pg 157]</a></span> extent of time that persons were
+detained in the hospital, and conceived she should be liberated when it
+had elapsed, to put her menaces into execution. Her disorder being of a
+dangerous tendency she was retained in the hospital after the period of
+probation. When she found the hope of gratifying her revenge frustrated,
+by being kept beyond the time of her expectation, she began to pine away,
+her appetite diminished, and a cough, with copious expectoration and
+hectic fever supervened. During the whole period of her bodily disease,
+she would never acknowledge herself to be ill, and the violence of her
+mental disorder was unabated. She died of Phthisis Pulmonalis, April 1st,
+1798.</p>
+
+<p>The head was opened twenty four hours after her decease. The tunica
+arachnoidea was in many places opake; the pia mater was highly inflamed,
+and loaded with<span class="pagenum"><a name="Page_158" id="Page_158">[Pg 158]</a></span> blood, and a considerable quantity of water was contained
+between it and the former membrane. The ventricles were enlarged, but
+contained scarcely any fluid. The other parts of the brain were healthy,
+and its consistence was natural.</p>
+
+<p>It is a common opinion, that Phthisis Pulmonalis is frequently suspended
+by the supervention of mania; medical books abound with such accounts, and
+some persons have supposed it difficult, if not impossible, for these
+diseases to co-exist. It is not my intention to dispute the accuracy of
+such relations, nor to question the power which Mania may possess in
+arresting the progress of Phthisis Pulmonalis, but, to state that the
+converse does not obtain; and, that whatever obligations may be due from
+Phthisis to Mania, the compliment has not been returned. From my own
+experience I can affirm, that insane persons are as liable to<span class="pagenum"><a name="Page_159" id="Page_159">[Pg 159]</a></span> Phthisis
+Pulmonalis as others, that numbers of them die of that disease; and that I
+never saw any abatement of the maniacal symptoms through the progress of
+consumption.</p>
+
+
+<p class="center"><br />CASE XXXII.</p>
+
+<p>J. P. aged 57, was admitted into the hospital, January 19, 1799; he was
+stated to have been insane about three weeks, and that his disorder came
+on shortly after the death of his master, in whose service he had
+continued many years, and to whom he was much attached. He had been in the
+hospital three times before, and had each time been discharged well. His
+disorder usually recurred every seven or eight years. His father also had
+been maniacal about the middle period of life, but never recovered. When
+admitted he was very talkative, although his natural character<span class="pagenum"><a name="Page_160" id="Page_160">[Pg 160]</a></span> was
+reserved. He endeavoured to explain his meaning with superior correctness,
+and sought to define every subject, however trifling, with a tedious
+minuteness; but, upon religion and politics, the Scylla and Charybdis of
+human discussion, he was pertinacious and intollerant. This dictatorial
+manner and stubbornness of opinion, not being capable of producing the
+relations of peace and amity with other philosophers, equally obstinate,
+and whose principles had been matured by long confinement, it became
+necessary to shut him up in his cell. During the period of his seclusion,
+nothing very incoherent escaped from him; every thing he said was within
+the sphere of possibility. His fastidiousness rendered him unhappy: he
+acknowledged the food which was brought him to be good, but he conceived
+it might have been better. The cathartic medicine, which was administered
+to him, he confessed had answered the <span class="pagenum"><a name="Page_161" id="Page_161">[Pg 161]</a></span>purpose, but its taste was most
+nauseous, and he had never before been so severely griped. He ornamented
+his person and apartment in a very whimsical manner: latterly he tore his
+clothes because he suspected the taylor had deceived him in the materials.
+After this he continued naked until the beginning of March, when he
+appeared more composed, and sensible of the state he had been in. On the
+morning of the 12th, when the keeper opened his cell, he was speechless;
+his mouth drawn to the right side, and so feeble that he could not support
+himself. A cathartic medicine was given, and sinapisms were applied to the
+feet and legs. In the evening he was much recovered, his speech had
+returned, and he was able to move himself. He was visited again at
+midnight, when he appeared still better. In the morning it was evident
+that he had experienced another attack, his mouth was drawn aside; he was
+stupid,<span class="pagenum"><a name="Page_162" id="Page_162">[Pg 162]</a></span> and died within half an hour. The head was opened on the
+following day. The tunica arachnoidea was in some places slightly opake.
+The pia mater was inflamed, but not to any considerable degree. There was
+no water between any of the membranes. The ventricles were of a natural
+capacity, and did not contain any fluid. There was no extravasation in any
+part of the substance of the cerebrum or cerebellum. Excepting the slight
+inflammation of the pia mater, the brain had a very healthy appearance;
+its consistence was firm; the scull was unusually thick. I regret, from a
+promise which had been made to the friends, of inspecting the head only,
+that the thoracic and abdominal viscera were not examined.</p>
+
+<p>This history has been related to shew, that although the patient died with
+those symptoms, which indicate pressure on the<span class="pagenum"><a name="Page_163" id="Page_163">[Pg 163]</a></span> brain, as loss of speech,
+the mouth being drawn aside, stupor and insensibility; yet the brain did
+not afford the same appearances, on dissection, as have been usually
+detected in such cases. The following relation is an additional example of
+the same fact:</p>
+
+
+<p class="center"><br />CASE XXXIII.</p>
+
+<p>N. B. He had been many years in the hospital as an incurable patient; his
+mother was known to have been maniacal; his two brothers and his sister
+have been insane. His eldest son, on taking a very small quantity of
+fermented liquor, becomes frantic, and its effects continue much longer
+than on persons in general. During this patient&#8217;s confinement, he was, as
+far as could be ascertained, completely in his senses; this induced the
+medical persons of the hospital, on two or three occasions,<span class="pagenum"><a name="Page_164" id="Page_164">[Pg 164]</a></span> to give him
+leave of absence, that he might return on trial to his wife and family;
+but, in a few hours after he came home, he felt uneasy, and found himself
+bewitched at all points: the devil and his imps had pre-occupied the best
+places in the house; he became very turbulent, and also jealous of his
+wife, and was obliged to be returned to the hospital. As he found his home
+so beset with difficulties he resolved that he would never enter it again.
+During eight years that I was acquainted with him I never discovered the
+least insanity in his actions or conversation. He was perfectly sensible
+that his intellects were disordered whenever he returned to his family.
+His wife and children frequently visited him in Bethlem, and he always
+conducted himself affectionately towards them. About 14 months before his
+death he laboured under a severe dysentery, which continued six weeks, and
+left him in a very reduced state, with <span class="pagenum"><a name="Page_165" id="Page_165">[Pg 165]</a></span>&oelig;dematous legs, and incipient
+dropsy of the abdomen. On his recovery from these symptoms he became
+troubled with fits; they appeared to be such as a medical person would
+have termed apoplectic. After the attack, no symptoms of paralysis
+remained, nor did he experience the fatigue and exhaustion, or fall into a
+profound sleep, which usually accompanies Epilepsy. On October 10th, 1802,
+being then in a pretty good state of health, he fell down, and expired in
+a few minutes. He was about sixty-five years of age. On examination of the
+head after death, there was a considerable determination of blood to the
+brain; but there was no extravasation of that fluid, nor any collection of
+water: the brain and its membranes had a healthy appearance, and its
+consistence was natural. The heart was sound, and the abdominal viscera
+were not conspicuously diseased.</p>
+
+
+<p class="center"><br /><span class="pagenum"><a name="Page_166" id="Page_166">[Pg 166]</a></span>CASE XXXIV.</p>
+
+<p>J. P. a man, aged thirty, was admitted into the hospital, October 18th,
+1800. It was then deposed, by the persons who brought him, that he had
+been for eight months in a melancholic state; but they were unable to
+assign any circumstances, which preceded his disorder, as a cause of his
+disease. He had a large tumor on the throat which extended backward to the
+neck, principally on the left side; the increase of this swelling, they
+alledged, had much alarmed him, at the commencement of his melancholic
+attack. During the time he was the subject of my observation, he was in a
+very mopish and stupid state; if spoken to, he would sometimes give a
+short answer, but ordinarily he took no notice of those who addressed him.
+Some<span class="pagenum"><a name="Page_167" id="Page_167">[Pg 167]</a></span> days he would walk slowly in the less frequented part of the
+building; frequently he sat down for some hours in a corner. His appetite
+was good, he ate the food which was brought him, but never took the
+trouble to go for it, when serving out. In this state he continued until
+April 2d, when he became more stupid, and could not be made to rise from
+his bed. He did not appear to be in any pain, nor was he at all convulsed.
+His bowels were regular. On the 5th he became comatose, and on the 9th he
+died.</p>
+
+<p class="center"><i>Appearances on Dissection.</i></p>
+
+<p>There was an excessive determination of blood to the brain, and the pia
+mater was highly inflamed. On the inferior part of the middle lobe of the
+brain, there was a gangrene of considerable extent, together with a
+quantity of very f&oelig;tid purulent matter.</p>
+
+<p><span class="pagenum"><a name="Page_168" id="Page_168">[Pg 168]</a></span>This is the only instance of a gangrenous state of the brain which has
+fallen under my observation.</p>
+
+
+<p class="center"><br />CASE XXXV.</p>
+
+<p>T. C. This person had remained many years in the hospital on the incurable
+establishment. He had been a schoolmaster at Warrington in Lancashire, and
+was a man of acuteness and extensive mathematical learning. As he became
+very furious on the attack of his maniacal disorder, he was placed in the
+Lunatic Asylum at Manchester, where he killed the person who had the care
+of him, by stabbing him in the back with a knife.</p>
+
+<p>The following is the account he gave me of that transaction, and which I
+immediately committed to paper; as it conveys a<span class="pagenum"><a name="Page_169" id="Page_169">[Pg 169]</a></span> serious and important
+lesson to those who are about the persons of the insane.</p>
+
+<p class="poem">&#8220;He that would govern others, first should be<br />
+The master of himself, richly indu&#8217;d<br />
+With depth of understanding, height of courage.&#8221;<br />
+<span style="margin-left: 7em;"><i>Massinger&#8217;s Bondman</i>, <i>Act</i> I. <i>Scene</i> 3.</span></p>
+
+<p>It ought to be more generally understood that a madman seldom forgets the
+coercion he has undergone, and that he never forgives an indignity.</p>
+
+<p>&#8220;The man whom I stabbed richly deserved it. He behaved to me with great
+violence and cruelty, he degraded my nature as a human being; he tied me
+down, handcuffed me, and confined my hands much higher than my head, with
+a leathern thong: he stretched me on a bed of torture. After some days he
+released me. I gave him warning, for I told his wife I would have justice
+of him. On her <span class="pagenum"><a name="Page_170" id="Page_170">[Pg 170]</a></span>communicating this to him, he came to me in a furious
+passion, threw me down, dragg&#8217;d me through the court-yard, thumped on my
+breast, and confined me in a dark and damp cell. Not liking this
+situation, I was induced to play the hypocrite. I pretended extreme sorrow
+for having threatened him, and by an affectation of repentance, prevailed
+on him to release me. For several days I paid him great attention, and
+lent him every assistance. He seemed much pleased with the flattery, and
+became very friendly in his behaviour towards me.&mdash;Going one day into the
+kitchen, where his wife was busied, I saw a knife; (this was too great a
+temptation to be resisted;) I concealed it, and carried it about me. For
+some time afterwards the same friendly intercourse was maintained between
+us; but, as he was one day unlocking his garden door, I seized the
+opportunity, and plunged the knife up to the hilt in his back.&#8221;&mdash;He<span class="pagenum"><a name="Page_171" id="Page_171">[Pg 171]</a></span>
+always mentioned this circumstance with peculiar triumph, and his
+countenance (the most cunning and malignant I ever beheld) became highly
+animated at the conclusion of the story.</p>
+
+<p>During the time he was in Bethlem Hospital he most ingeniously formed a
+stiletto out of a mop-nail; it was an elaborate contrivance, and had
+probably been the work of several months. It was rendered extremely sharp
+and polished, by whetting on a small pebble; it was fixed into a handle,
+and had a wooden sheath made from the mop-stick. This instrument he
+carried in his left breeches pocket, his right hand grasping the hilt. As
+I always found him in that posture when I visited him, I suspected he had
+some concealed implement of mischief, and therefore employed a
+convalescent patient to watch him through the key-hole of his door. This
+person saw him<span class="pagenum"><a name="Page_172" id="Page_172">[Pg 172]</a></span> with the weapon, and also ascertaining the distance at
+which he could use it.</p>
+
+<p>The instrument was taken from him by surprise. When he found he was
+prevented from executing his purpose, he roared out the most horrid
+imprecations; he cursed the Almighty for creating him, and more especially
+for having given him the form of a human being, and he wished to go to
+Hell that he might not be disgraced by an association with the Deity.</p>
+
+<p>He had an uniform and implacable aversion to the officers and servants of
+the hospital; he said he courted their hatred for their curse was a
+blessing. He seldom answered a question but some impiety was contained in
+the reply. An indifferent person remarking that it was a bad day, he
+immediately retorted, &#8220;Sir, did you ever know God make a good one?&#8221;
+Although the<span class="pagenum"><a name="Page_173" id="Page_173">[Pg 173]</a></span> whole of the day, and the greatest part of the night, were
+consumed in pouring forth abuse and coining new blasphemies; yet there
+were some few patients for whom he professed a friendship, and with whom
+he conversed in a mild and civil way: this confidence had been obtained by
+the compliments they had addressed to him on the score of his
+understanding, of which he entertained a very high opinion. At one time he
+conceived himself to be the Messiah, at another, that he was Mr. Adam, the
+architect; and that he was shortly to go to America in order to build the
+new Jerusalem in Philadelphia.</p>
+
+<p>About six months before his death he complained of pain in his stomach,
+and said he felt as if he had no intestines. His appetite diminished, and
+he became melancholic.</p>
+
+<p><span class="pagenum"><a name="Page_174" id="Page_174">[Pg 174]</a></span>The scene now began to alter; he had a presentiment that his time in this
+world would be short, and he dreaded the change: no hope arose, no
+consolation could cheer him; he became daily more emaciated and despairing
+until he died, which took place August 27, 1801; he appeared to be about
+seventy years of age.</p>
+
+<p>On opening the head, the pericranium was scarcely adherent. This membrane
+being removed, blood oozed freely from the parietal bones. There was a
+large accumulation of water between the dura mater and tunica arachnoidea;
+when this was let out the dura mater became flaccid, and seemed to hang
+loose on the brain. On the left posterior lobe of the cerebrum there was a
+large quantity of a milky fluid, between the tunica arachnoidea and pia
+mater, giving the appearance of a vesication; and in that place there was
+a depression or <span class="pagenum"><a name="Page_175" id="Page_175">[Pg 175]</a></span>cavity formed in the convolutions of the brain. The
+convolutions were so strongly and distinctly marked, that they resembled
+the intestines of a child. The lateral ventricles were but little
+distended, and did not contain much water. The head was not particularly
+loaded with blood, nor were the bloody points, in the medullary substance,
+very abundant. The brain was of a natural consistence. There was no
+disease in the stomach, intestines, or liver. The body was opened about
+six hours after his death.</p>
+
+
+<p class="center"><br />CASE XXXVI.</p>
+
+<p>B. S. a man, generally noticed by those who have visited Bethlem hospital
+a few years ago. It was said, that an attachment to a young woman, who
+slighted his addresses, was the cause of his becoming insane. He was
+considered a very dangerous<span class="pagenum"><a name="Page_176" id="Page_176">[Pg 176]</a></span> lunatic, and for many years was confined to
+his cell. In this situation he employed himself in the manufacture of
+straw baskets and table mats. The desire of money was the leading feature
+of his mind, and the whole of his energies were devoted to its
+acquisition; nor was he at all scrupulous as to the means, by which he
+attained his object. Although repeatedly assured that he would never be
+liberated, he disbelieved such information, and was persuaded, when he had
+acquired a sum sufficient to purchase a horse and cart, filled with
+higler&#8217;s ware, that he should be released. The idea of becoming a trader,
+on so large a scale, stimulated him to constant occupation. He employed
+several lunatic journeymen to plat the straw for him, but they were poorly
+rewarded. He generally chose for his workmen such as were chained, and
+could not come personally to insist on the reward of their labour. He
+commonly pretended that<span class="pagenum"><a name="Page_177" id="Page_177">[Pg 177]</a></span> the platting was badly performed, and
+consequently unsaleable; sometimes he would protest that he had settled
+with them, but that they were too mad to recollect it; and if at any time
+he did pay them, it was in bad coin. For many years he was unrivalled in
+this trade, and, by every species of fraud, had amassed nearly sufficient
+to set his plans afloat: when an unfortunate event took place, which
+considerably reduced his capital. He had always a propensity to game,
+which, from his skill and dexterity in cheating, was generally attended
+with success; but in this science he was once over-matched. An insane
+soldier, an ingenious man, became his intimate friend, and finding him
+possessed of some money proposed a game at cards. The result was deeply
+disastrous to the artificer in straw, who endeavoured to evade the
+payment; but his friend stated it to be a debt of honor; and besides he
+was a very powerful man, of a<span class="pagenum"><a name="Page_178" id="Page_178">[Pg 178]</a></span> stern aspect, and not to be trifled with;
+he was therefore compelled to tell down at once the slow accumulation of
+several years. It was intended to make the soldier restore the property,
+but he, conceiving that he had already derived sufficient benefit from the
+hospital, went away in the night, without the formalities of a regular
+discharge.</p>
+
+<p>To fill up the measure of his misfortunes, when Hatfield, the maniac who
+shot at his Majesty in the theatre, was brought to Bethlem, he, in
+conjunction with a contriving cobbler, established a rival manufactory,
+which shortly eclipsed the fabric of the old school, and by superior taste
+rendered his further exertions unnecessary.</p>
+
+<p>It is natural to suppose, that no great cordiality could exist between
+persons, where the prosperity of one had been established on the ruin of
+the other. Frequent <span class="pagenum"><a name="Page_179" id="Page_179">[Pg 179]</a></span>altercations arose, and much offensive language was
+exchanged. At length the patience of the original dealer was exhausted,
+and, in collecting his force to give his opponent a blow, he fell down and
+instantly expired.&mdash;He was about fifty-eight years of age.</p>
+
+<p>Some of his habits and opinions were extremely singular; he believed that
+all occurrences were regulated by witches: prosperity was to be attributed
+to the good witches having obtained the mastery; and when bad witches
+gained the ascendancy, misfortunes arose. When the latter were at work he
+supposed himself in possession of a power to frighten and disperse them,
+and this was effected by a peculiar noise he made. It is probable he might
+have laboured under indigestion, for immediately after he had eaten his
+dinner, he sent forth a dreadful howl, which he continued for about ten
+minutes: but his great terror was<span class="pagenum"><a name="Page_180" id="Page_180">[Pg 180]</a></span> a thunder storm; when this occurred, he
+took a very active part, and brought the whole force of his lungs to bear
+upon the enemy. A cat was supposed to have a natural antipathy to bad
+witches, she could smell them at a distance; for which reason he always
+domesticated an animal of that kind to sleep in his cell.</p>
+
+<p>When his head was opened, the dura mater was very easily separable from
+the scull; upon puncturing this membrane a considerable quantity of blood
+flowed from the opening; and there was a copious extravasation of this
+fluid between the membranes of the brain: but the most remarkable
+circumstance was, that the tunica arachnoidea was so thickened, that it
+exceeded the dura mater on an accurate comparison. The pia mater was
+loaded with blood, and its vessels were enlarged. The brain and its
+cavities were sound and natural.</p>
+
+
+<p class="center"><br /><span class="pagenum"><a name="Page_181" id="Page_181">[Pg 181]</a></span>CASE XXXVII.</p>
+
+<p>R. B. This man had been many years an incurable patient, and it was
+supposed that jealousy of his wife had been the cause of his madness,
+although it appeared from very respectable testimony that he had no real
+grounds for such suspicion. During eight years, (the period he was subject
+to my observation,) he was mostly in a very furious state, and obliged to
+be strictly confined. His mischeivous disposition was manifested on every
+occasion; he would hurl the bowl, in which his food was served, against
+those who passed his cell; and when his hands were secured he would kick,
+bite, or throw his head into the stomachs of those who came near him. He
+entertained a constant aversion to his keeper, whom he suspected to be
+connected with his wife. His life<span class="pagenum"><a name="Page_182" id="Page_182">[Pg 182]</a></span> was miserably divided between furious
+paroxysms and melancholic languor, and there was great uncertainty in the
+duration of these states. He has been known to continue ten months in the
+highest degree of violence, and relapse into the same state after a few
+days passed in tranquil depression. There was one circumstance which never
+failed to produce a relapse, however quietly he might have conducted
+himself, this was a visit from any of his family, and a very striking
+instance occurred. From May, 1799, to September, 1800, he had every
+appearance of being perfectly recovered: he was, in consequence, allowed
+additional comforts, and treated as a convalescent. At this time he was
+visited by his son, who, after many hours conversation with him, was
+persuaded that he had perfectly recovered his intellects; and he expressed
+himself astonished at his father&#8217;s accurate recollection of particulars
+which<span class="pagenum"><a name="Page_183" id="Page_183">[Pg 183]</a></span> might be supposed to have been obliterated from his mind. This
+dutiful visit and affectionate intercourse produced unpleasant
+consequences. The numerous enquiries which the patient had made, furnished
+him with materials for reflexion. On the departure of his son he began to
+detect mismanagement in his affairs, and improprieties in the conduct of
+his family: he was very talkative, and became impatient to return home.
+The following day he had a wildness in his eyes, spoke fast, and appeared
+busy: before the evening he was so irritable and disobedient that it
+became necessary to confine him. From this time he continued in the most
+furious condition, singing and vociferating the greatest part of the
+night, until January 2d, 1801, when he became suddenly calm, complained of
+extreme debility, and said he should die in a few hours. He gave very
+proper answers to the questions which were asked him, but<span class="pagenum"><a name="Page_184" id="Page_184">[Pg 184]</a></span> complained of
+the fatigue which talking induced. On the next morning he expired. He was
+sixty-eight years of age. The head was opened two days after his death.
+The tunica arachnoidea was in many places opake, and considerably
+thickened. There was a small quantity of limpid water between this
+membrane and the pia mater. When the medullary substance was cut into,
+there oozed from many points a quantity of dark blood, indeed the whole
+head was loaded with venous blood. The lateral ventricles were
+considerably enlarged and filled with water&mdash;four ounces were collected.
+The internal carotid arteries were much enlarged, and when divided, did
+not collapse, but remained open, as arteries in the other parts of the
+body. The consistence of the brain was doughy.</p>
+
+
+<p>&nbsp;</p><p>&nbsp;</p>
+<hr style="width: 50%;" />
+<p><span class="pagenum"><a name="Page_185" id="Page_185">[Pg 185]</a></span></p>
+<h2>CHAP. IV.</h2>
+<p class="center"><span class="large">CASES OF INSANE CHILDREN.</span></p>
+
+<p>&nbsp;</p>
+<p class="dropcap"><span class="caps">In</span> the month of March, 1799, a female child, three years and a quarter
+old, was brought to the hospital for medical advice. She was in good
+bodily health, and born of sane and undiseased parents. The mother, who
+attended, stated that her husband&#8217;s parents and her own had never been in
+the slightest degree afflicted with mania, but that she had a brother who
+was born an ideot. She related that her child, until the age of two years
+and a half, was perfectly well, of ordinary vivacity, and of promising
+talents; when she was inoculated for the small pox. Severe convulsions
+<span class="pagenum"><a name="Page_186" id="Page_186">[Pg 186]</a></span>ushered in the disease, and a delirium continued during its course. The
+eruption was of the mild kind, and the child was not marked with the
+pustules. From the termination of the small-pox to the above date, (nine
+months) the child continued in an insane state. Previously to the
+small-pox, she could articulate many words, and use them correctly for the
+things they signified: but since that time she completely forgot her
+former acquisitions, nor ever attempted to imitate a significant sound.
+Whatever she wished to perform, she effected with promptitude and
+facility. She appeared anxious to possess every thing she saw, and cried
+if she experienced any disappointment; and on these occasions she would
+bite, or express her anger by kicking or striking. Her appetite was
+voracious, and she would devour any thing that was given to her, without
+discrimination; as fat, raw animal food, or tainted<span class="pagenum"><a name="Page_187" id="Page_187">[Pg 187]</a></span> meat. To rake out the
+fire with her fingers was a favourite amusement, nor was she deterred from
+having frequently burned them. She passed her urine and f&aelig;ces in any place
+without restraint; but she could retain a considerable quantity of the
+former before she discharged it. Some cathartic remedies were ordered for
+her, with an emetic occasionally, and she was brought to the hospital
+every fortnight, but she did not appear in any degree amended. On June 22
+she was admitted a patient, and continued in the hospital until the middle
+of October, when she was attacked with an eruptive fever, and consequently
+discharged. During this time little progress was made, although
+considerable pains were bestowed. She became more cunning, and her taste
+appeared improved. The cathartic medicine, which she drank at first
+without reluctance, became afterwards highly disgusting, and when she saw
+the basket which <span class="pagenum"><a name="Page_188" id="Page_188">[Pg 188]</a></span>contained it, she endeavoured to escape and hide
+herself. To particular persons she was friendly, and felt an aversion to
+others. She was sensible of the authority of the nurse who attended her,
+and understood by the tone of her voice whether she were pleased or
+offended. The names of some things she appeared to comprehend, although
+they were extremely few; when the words, dinner, cakes, orange, and some
+more were mentioned, she smiled, and appeared in expectation of receiving
+them. By great attention and perseverance on the part of the nurse, she
+was brought to evacuate her f&aelig;ces and urine in a night stool.</p>
+
+<p>After the elapse of three years I was informed that the child had made no
+intellectual progress.</p>
+
+<p>W. H. a boy, nearly seven years of age, was admitted into the Hospital,
+June 8th,<span class="pagenum"><a name="Page_189" id="Page_189">[Pg 189]</a></span> 1799. His mother, who frequently visited him, related the
+following particulars respecting his case.&mdash;She said that, within a month
+of being delivered of this child, she was frightened by a man in the
+street, who rudely put his hand on her abdomen. When the child was born it
+was subject to startings, and became convulsed on any slight
+indisposition. When a year old, he suffered much with the measles: and
+afterwards had a mild kind of inoculated small-pox. At this age she
+thought the child more lively than usual, and that he slept less than her
+other children had done. At two years, the mother perceived he could not
+be controled, and therefore frequently corrected him.</p>
+
+<p>There was a tardiness in the developement of his physical powers. He was
+fifteen months old before he had a tooth, and unable to go alone at two
+years and a<span class="pagenum"><a name="Page_190" id="Page_190">[Pg 190]</a></span> half: his mind was equally slow; he had arrived at his fourth
+year before he began to speak; and, when in his fifth, he had not made a
+greater proficiency in language than generally may be observed in children
+between two and three years. When admitted into the hospital, he wept at
+being separated from his mother, but his grief was of very short
+continuance. He was placed on the female side, and seemed highly delighted
+with the novelty of the scene: every object excited his curiosity, but he
+did not pause or dwell on any. He was constantly in action, and rapidly
+examined the different apartments of the building. To the patients in
+general he behaved with great insolence&mdash;he kicked and spat at them, and
+distorted his face in derision; but, on the appearance of the nurse, he
+immediately desisted, and assured her he was a very good boy. Great, but
+ineffectual, pains were taken, to make him understand the<span class="pagenum"><a name="Page_191" id="Page_191">[Pg 191]</a></span> nature of
+truth,&mdash;he could never be brought to confess any mischief he had
+committed, and always took refuge in the convenient shelter of a lie. In a
+short time he acquired a striking talent for mimickry, and imitated many
+of the patients in their insane manners; he generally selected, for his
+models, those who were confined, as he could practise from such with
+impunity.</p>
+
+<p>In about three months he had added considerably to his stock of language,
+but, unluckily, he had selected his expressions from those patients who
+were addicted to swearing and obscene conversation. To teach him the
+letters of the alphabet had many times been endeavoured, but always
+without success; the attempt uniformly disgusted him: he was not to be
+stimulated by coaxing or coercion; his mind was too excursive, to submit
+to the painful toil of recording elementary sounds; but it may<span class="pagenum"><a name="Page_192" id="Page_192">[Pg 192]</a></span> rather be
+inferred that he did not possess a sufficient power of attention to become
+acquainted with arbitrary characters.</p>
+
+<p>He was in good health, his pulse and bowels were regular, and his appetite
+was keen, but not voracious. One circumstance struck me, as very peculiar,
+in this boy,&mdash;he appeared to have very incorrect ideas of distance: he
+would frequently stretch out his hand, to grasp objects considerably
+beyond his reach, but this referred principally to height: he would
+endeavour to pluck out a nail from the ceiling, or snatch at the moon. In
+October he became unwell, and, at the mother&#8217;s request, was discharged
+from the hospital.</p>
+
+<p>In September 1805, I again saw the boy: he was then thirteen years of age,
+had grown very tall, and appeared to be in good health. He recollected me
+<span class="pagenum"><a name="Page_193" id="Page_193">[Pg 193]</a></span>immediately, and mentioned the words, school Moorfields, nasty physic. On
+meeting with some of the female patients, he perfectly remembered them,
+and seemed for the moment, much pleased at the renewal of the
+acquaintance. By this time, he had made comparatively, a great progress in
+language; he knew the names of ordinary things, and was able to tell
+correctly the street in which he resided, and the number of his house. His
+mother informed me that he was particularly fond of going to church,
+although he was unable to comprehend the purpose for which he went: when
+there, he conducted himself with great order and decorum, but was disposed
+to remain after the congregation had dispersed. To shew how little he
+understood, why he frequented a place of worship: his mother once took him
+to church on Sacrament-sunday, and fearful of disturbing the persons
+assembled, by compelling him to <span class="pagenum"><a name="Page_194" id="Page_194">[Pg 194]</a></span>return home, allowed him to be a
+spectator of those solemn administrations. The only reflexion he made on
+the subject, but in disjointed expressions, was, that he thought it
+extremely hard, that the ladies and gentlemen should eat rolls and drink
+gin, and never ask him to partake. In his person he was clean, and dressed
+himself with neatness. Having been taught when in the hospital to use a
+bowl for his necessary occasions, he obstinately continued the same
+practice when he returned home, and could never be persuaded to retire to
+the closet of convenience; but the business did not terminate here, when
+he had evacuated his intestines into the bowl he never failed to paint the
+room with its contents. To watch other boys when they were playing, or to
+observe the progress of mischief, gave him great satisfaction: but he
+never joined them, nor did he ever become attached to any one of<span class="pagenum"><a name="Page_195" id="Page_195">[Pg 195]</a></span> them. Of
+his mother he appeared excessively fond, and he was constantly caressing
+her: but in his paroxysms of fury he felt neither awe nor tenderness, and
+on two occasions he threw a knife at her. Although equally ignorant of
+letters, as when discharged from the hospital, he took great delight in
+having gilt books; indeed every thing splendid attracted his attention,
+but more especially soldiers and martial music. He retained several tunes,
+and was able to whistle them very correctly. The day on which I last saw
+him his mind was completely occupied with soldiers; when questions were
+put to him, if he answered them it was little to the purpose, generally he
+did not notice them, but turned round to his mother and enquired about the
+soldiers.</p>
+
+<p>The defect of this lad&#8217;s mind, appeared to be a want of continued
+attention to things,<span class="pagenum"><a name="Page_196" id="Page_196">[Pg 196]</a></span> in order to become acquainted with their nature; and
+he possessed less curiosity than other children, which serves to excite
+such attention: and this will in some degree explain, why he had never
+acquired any knowledge of things in a connected manner. His sentences were
+short, and he employed no particles to join them together. Although he was
+acquainted with the names of many things, and also with expressions which
+characterize passion, he applied them in an insulated way. For instance,
+if a shower fell, he would look up and say, &#8220;rains;&#8221; or when fine, &#8220;sun
+shines.&#8221; When in the street he would pull his mother, to arrest her
+attention, and point to objects, as a fine horse, or a big dog; when he
+returned home he would repeat what had attracted his notice, but always
+speaking of himself in the third person. &#8220;Billy see fine horse, big dog,<span class="pagenum"><a name="Page_197" id="Page_197">[Pg 197]</a></span>
+&amp;c.&#8221;<a name='fna_12' id='fna_12' href='#f_12'><small>[12]</small></a> Of circumstances boldly impressed, or reiterated by habit, his
+memory was retentive, but as his attention was only roused by striking
+appearances, or loud intonations, ordinary occurrences passed by
+unobserved.</p>
+
+<p>In the month of July 1803, my opinion was requested respecting a young
+gentleman, ten years of age, who was sent here, accompanied by a kind and
+decent young man, to take care of him. Previously to his arrival I had
+corresponded respecting his case with a very learned and respectable
+physician in the country, under whose care the boy had been placed. From
+the information furnished by this gentleman, and<span class="pagenum"><a name="Page_198" id="Page_198">[Pg 198]</a></span> that which was collected
+from the keeper, I believe the former history of his case is correctly
+given.</p>
+
+<p>The parents are persons of sound mind, and they do not remember any
+branches of their respective families to have been (in any manner)
+disordered in their intellects. The subject of the present relation was
+their eldest son; the second child was of a disposition remarkably mild;
+and the youngest, a boy, about two years and a half, was distinguished by
+the irritability and impatience of his temper. At the age of two years,
+the subject of the present relation, became so mischievous and
+uncontroulable, that he was sent from home to be nursed by his aunt. In
+this situation, at the request of his parents, and with the concurrence of
+his relation, he was indulged in every wish, and never corrected for any
+perverseness or impropriety of conduct.<span class="pagenum"><a name="Page_199" id="Page_199">[Pg 199]</a></span> Thus he continued until he was
+nearly nine years old, the creature of volition and the terror of the
+family. At the suggestion of the physician, whom I have before mentioned,
+and who was the friend of his parents: a person was appointed to watch
+over him. It being the opinion of the doctor that the case originated in
+over indulgence and perverseness; a different system of management was
+adopted. The superintendant was ordered to correct him for each individual
+impropriety. At this time the boy would neither dress nor undress himself,
+though capable of doing both; when his hands were at liberty, he tore his
+clothes: he broke every thing that was presented to him, or which came
+within his reach, and frequently refused to take food. He gave answers
+only to such questions as pleased him, and acted in opposition to every
+direction. The superintendant exercised this plan for several<span class="pagenum"><a name="Page_200" id="Page_200">[Pg 200]</a></span> months, but
+perhaps not to the extent laid down; for it may be presumed, that after a
+a few flagellations his humanity prevailed over the medical hypothesis.
+When he became the subject of my own observation, he was of a very healthy
+appearance, and his head was well formed; this was also the opinion of
+several gentlemen, distinguished for their anatomical knowledge, to whom
+the boy was presented. His tongue was unusually thick, though his
+articulation was perfectly distinct. His countenance was decidedly
+maniacal.<a name='fna_13' id='fna_13' href='#f_13'><small>[13]</small></a> His stature, for his age, was short, but he was well
+compacted, and possessed great bodily strength.<span class="pagenum"><a name="Page_201" id="Page_201">[Pg 201]</a></span> Although his skin was
+smooth and clear, it was deficient in its usual sensibility; he bore the
+whip and the cane with less evidence of pain than other boys. Another
+circumstance convinced me of this fact. During the time he resided in
+London he was troubled with a boil on his leg; various irritating
+applications were made to the tumor, and the dressings were purposely
+taken off with less nicety than usual, yet he never complained. His pulse
+was natural, and his bowels were regular. His appetite was good, but not
+inordinate, and he bore the privation of food for a considerable time
+without uneasiness. Although<span class="pagenum"><a name="Page_202" id="Page_202">[Pg 202]</a></span> he slept soundly, he often awoke as if
+suddenly alarmed, and he seemed to require a considerable duration of
+sleep.</p>
+
+<p>He had a very retentive memory, and had made as great proficiency in
+speech as the generality of boys of his own age. Few circumstances
+appeared to give him pleasure, but he would describe very correctly any
+thing which had delighted him. As he wanted the power of continued
+attention, and was only attracted by fits and starts, it may be naturally
+supposed he was not taught letters, and still less that he would copy
+them. He had been several times to school, and was the hopeless pupil of
+many masters, distinguished for their patience and rigid discipline; it
+may therefore be concluded, that from these gentlemen, he had derived all
+the benefits which could result from privations to his stomach,<span class="pagenum"><a name="Page_203" id="Page_203">[Pg 203]</a></span> and from
+the application of the rod to the more delicate parts of his skin.</p>
+
+<p>On the first interview I had with him, he contrived, after two or three
+minutes acquaintance, to break a window and tear the frill of my shirt. He
+was an unrelenting foe to all china, glass, and crockery ware, whenever
+they came within his reach he shivered them instantly. In walking the
+street, the keeper was compelled to take the wall, as he uniformly broke
+the windows if he could get near them, and this operation he performed so
+dextrously, and with such safety to himself, that he never cut his
+fingers. To tear lace and destroy the finer textures of female ornament,
+seemed to gratify him exceedingly, and he seldom walked out without
+finding an occasion of indulging this propensity. He never became attached
+to any inferior animal, a benevolence so common to the generality<span class="pagenum"><a name="Page_204" id="Page_204">[Pg 204]</a></span> of
+children: to these creatures his conduct was that of the brute: he
+oppressed the feeble, and avoided the society of those more powerful than
+himself. Considerable practice had taught him that he was the cat&#8217;s
+master, and whenever this luckless animal approached him he plucked out
+its whiskers with wonderful rapidity; to use his own language, &#8220;<i>I must
+have her beard off</i>.&#8221; After this operation, he commonly threw the creature
+on the fire, or through the window. If a little dog came near him he
+kicked it, if a large one he would not notice it. When he was spoken to,
+he usually said, &#8220;I do not choose to answer.&#8221; When he perceived any one
+who appeared to observe him attentively, he always said, &#8220;Now I will look
+unpleasant.&#8221; The usual games of children afforded him no amusement;
+whenever boys were at play he never joined them: indeed, the most singular
+part of his character was, that he <span class="pagenum"><a name="Page_205" id="Page_205">[Pg 205]</a></span>appeared incapable of forming a
+friendship with any one: he felt no considerations for sex, and would as
+readily kick or bite a girl as a boy. Of any kindness shewn him, he was
+equally insensible; he would receive an orange as a present, and
+afterwards throw it in the face of the donor.</p>
+
+<p>To the man who looked after him, he appeared to entertain something like
+an attachment: when this person went out of the room, and pretended that
+he would go away, he raised a loud outcry, and said, &#8220;what will become of
+me, if he goes away; I like him, for he carries the cane which makes me a
+good boy:&#8221; but it is much to be doubted, whether he really bore an
+affection for his keeper; the man seemed to be of a different opinion, and
+said, when he grew older he should be afraid to continue with him, as he
+was persuaded the boy<span class="pagenum"><a name="Page_206" id="Page_206">[Pg 206]</a></span> would destroy him, whenever he found the means and
+opportunity.</p>
+
+<p>Of his own disorder he was sometimes sensible: he would often express a
+wish to die, for he said, &#8220;God had not made him like other children;&#8221; and
+when provoked, he would threaten to destroy himself.</p>
+
+<p>During the time he remained here, I conducted him through the hospital,
+and pointed out to him several patients who were chained in their cells;
+he discovered no fear or alarm; and when I shewed him a mischievous maniac
+who was more strictly confined than the rest, he said, with great
+exultation, &#8220;this would be the right place for me.&#8221; Considering the
+duration of his insanity, and being ignorant of any means by which he was
+likely to recover, he returned to his friends, after continuing a few
+weeks in London.</p>
+
+
+<p>&nbsp;</p><p>&nbsp;</p>
+<hr style="width: 50%;" />
+<p><span class="pagenum"><a name="Page_207" id="Page_207">[Pg 207]</a></span></p>
+<h2>CHAP. V.</h2>
+<p class="center"><span class="large">CAUSES OF INSANITY.</span></p>
+
+<p>&nbsp;</p>
+<p class="dropcap"><span class="caps">When</span> patients are admitted into Bethlem Hospital, an enquiry is always
+made of the friends who accompany them, respecting the cause supposed to
+have occasioned their insanity.</p>
+
+<p>It will be readily conceived, that there must be great uncertainty
+attending the information we are able to procure upon this head: and even
+from the most accurate accounts, it would be difficult to pronounce, that
+the circumstances which are related to us, have actually produced the
+effect. The friends and relatives of patients are, upon<span class="pagenum"><a name="Page_208" id="Page_208">[Pg 208]</a></span> many occasions,
+very delicate concerning this point, and cautious of exposing their
+frailties or immoral habits: and when the disease is connected with the
+family, they are oftentimes still more reserved in disclosing the truth.</p>
+
+<p>Fully aware of the incorrect statement, frequently made concerning these
+causes, I have been at no inconsiderable pains to correct or confirm the
+first information, by subsequent enquiries.</p>
+
+<p>The causes which I have been enabled most certainly to ascertain, may be
+divided into <span class="smcap">Physical</span> and <span class="smcap">Moral</span>.<a name='fna_14' id='fna_14' href='#f_14'><small>[14]</small></a></p>
+
+<p><span class="pagenum"><a name="Page_209" id="Page_209">[Pg 209]</a></span>Under the first, are comprehended repeated intoxication: blows received
+upon the head; fever, particularly when attended with delirium; mercury,
+largely and injudiciously administered; cutaneous eruptions repelled, and
+the suppression of periodical or occasional discharges and secretions;
+hereditary disposition, and paralytic affections.</p>
+
+<p>By the second class of causes, which have been termed <i>moral</i>, are meant
+those which are supposed to originate in the mind, or which are more
+immediately applied to it.<span class="pagenum"><a name="Page_210" id="Page_210">[Pg 210]</a></span> Such are, the long endurance of grief; ardent
+and ungratified desires; religious terror; the disappointment of pride;
+sudden fright; fits of anger; prosperity humbled by misfortunes:<a name='fna_15' id='fna_15' href='#f_15'><small>[15]</small></a> in
+short, the frequent and uncurbed indulgence of any passion or emotion, and
+any sudden or violent affection of the mind.</p>
+
+<p>There are, doubtless, many other causes of both classes, which may tend to
+produce this disease. Those which have been stated, are such as I am most
+familiar with; or, to speak more accurately, such are the circumstances
+most generally found to have preceded this affection.</p>
+
+<p>It is an old opinion, and continues still to prevail, that maniacs are
+influenced by<span class="pagenum"><a name="Page_211" id="Page_211">[Pg 211]</a></span> the changes of the moon. In the fourth chapter of St.
+Matthew&#8217;s Gospel, verse 24, we find the word
+&#8220;<ins class="correction" title="Sel&ecirc;niaxomenous">&#931;&#949;&#955;&#951;&#957;&#953;&#945;&#958;&#959;&#956;&#941;&#957;&#959;&#965;&#962;</ins>&#8221;
+which is rendered in the English version, &#8220;those which were lunatic.&#8221;
+Notwithstanding the notion of being moon-struck might prevail among the
+ignorant people of Galilee, yet Hippocrates, a philosopher, and correct
+observer of natural ph&aelig;nomena, does not appear to have placed any faith in
+this planetary influence. Although the Romans were infected with this
+popular tradition, as may be seen in the following passage of the Art of
+Poetry,</p>
+
+<p class="poem">&#8220;Ut mala quem scabies aut morbus regius urget,<br />
+Aut fanaticus error, et <span class="smcap">iracunda Diana</span><br />
+Vesanum tetigisse timent fugiuntque poetam,<br />
+Qui sapiunt:&#8221;&mdash;</p>
+
+<p>yet Celsus did not consider the operation of the moon on the human
+intellect sufficiently well founded to admit it into his<span class="pagenum"><a name="Page_212" id="Page_212">[Pg 212]</a></span> medical work.
+Not a word on this subject is mentioned in the eighteenth chapter of his
+third book, which particularly treats of Insanity, &#8220;<i>De tribus insani&aelig;
+generibus</i>;&#8221; it is true that, in the fourth chapter of the first book,
+which speaks &#8220;<i>De his quibus caput infirmum est</i>,&#8221; he says &#8220;Cui caput
+infirmum est, is si bene concoxit, leniter perfricare id mane manibus suis
+debet; nunquam id, si fieri potest, veste velare; aut ad cutem tondere:
+utileque lunam vitare, maximeque ante ipsum lun&aelig; solisque concursum.&#8221; By
+the <i>infirmum caput</i>, Celsus does not mean madness, as may be clearly seen
+by perusing the chapter: the weakness of intellect, which frequently
+continues after fever, or other violent diseases, is evidently his
+meaning; but Dr. Cox has quoted the above passage, to prove that Celsus
+was impressed with the truth of this vulgar opinion. He says, &#8220;This idea
+of lunar influence, in <i>maniacal complaints</i>, was<span class="pagenum"><a name="Page_213" id="Page_213">[Pg 213]</a></span> handed down to us by
+our medical forefathers, and is still very generally adopted.&#8221;</p>
+
+<p>It is most probable that this idea of planetary regency, however it might
+have arisen, or to whatever extent it may have been credited, received in
+the Arabian school, the stamp by which its currency has been subsequently
+maintained. For the revival and dispersion of ancient medical knowledge,
+we are confessedly under considerable obligations to the Arabians;<a name='fna_16' id='fna_16' href='#f_16'><small>[16]</small></a> and
+more especially for the incorporation of astrology, magic and alchymy,
+with medicine.</p>
+
+<p>Popular superstitions and national proverbs, are seldom without some
+foundation; and with respect to the present, it may be observed, that if
+it were not in some degree<span class="pagenum"><a name="Page_214" id="Page_214">[Pg 214]</a></span> rooted in fact, and trained up by observation,
+it would become difficult to ascertain how such an opinion came to be
+adopted; and this investigation is rendered still more important from the
+consideration, that the existing law in this country, respecting insane
+persons, has been established on the supposed prevalence of this lunar
+regulation. A commission is issued, de <i>lunatico</i> inquirendo, and the
+commissioners sitting for that purpose, are particular in their enquiries,
+whether the patient enjoys lucid intervals. The term <i>lucid interval</i> has
+been properly connected with the word <i>lunacy</i>; for, if the patient, as
+they supposed, became insane at particular changes of the moon, the
+inference was natural, that in the intervening spaces of time he would
+become rational.</p>
+
+<p>It is more than probable, that the origin of this supposition of the lunar
+influence<span class="pagenum"><a name="Page_215" id="Page_215">[Pg 215]</a></span> may be traced to the following circumstances. The period of the
+return of the moon, and of regular menstruation in women, is four weeks;
+and the terms which designate them, have been imposed from the period of
+time in which both are compleated. Insanity and epilepsy are often
+connected with menstruation, and suffer an exacerbation of their paroxysms
+at the period when this discharge happens, or ought to take place. If,
+therefore, the period of menstruation in an insane woman should occur at
+the full of the moon, and her mind should then be more violently
+disturbed, the recurrence of the same state may be naturally expected at
+the next full moon. This is a necessary coincidence, and should be
+discriminated from effect. But such has been the prevalence of this
+opinion, that when patients have been brought to Bethlem hospital,
+especially those from the country, their friends have generally stated<span class="pagenum"><a name="Page_216" id="Page_216">[Pg 216]</a></span>
+them to be worse at some particular change of the moon, and of the
+necessity they were under, at those times, to have recourse to a severer
+coercion. Indeed, I have understood from some of these <i>lunatics</i>, who
+have recovered, that the overseer or master of the work-house himself has
+
+frequently been so much under the dominion of this planet, and keeping
+steadily in mind the old maxim, <i>venienti occurrite morbo</i>, that, without
+waiting for any display of increased turbulence on the part of the
+patient, he has bound, chained, flogged, and deprived these miserable
+people of food, according as he discovered the moon&#8217;s age by the almanack.</p>
+
+<p>To ascertain how far this opinion was founded in fact, I kept, during more
+than two years, an exact register, but without finding, in any instance,
+that the aberrations of the human intellect corresponded<span class="pagenum"><a name="Page_217" id="Page_217">[Pg 217]</a></span> with, or were
+influenced by, the vicissitudes of this luminary.</p>
+
+<p>As insane persons, especially those in a furious state, are but little
+disposed to sleep, even under the most favourable circumstances, they will
+be still less so, when the moon shines brightly into their apartments.</p>
+
+<p>It has also been considered, that intellectual labour frequently becomes a
+cause of insanity; that those, who are in the habit of exercising the
+faculty of thought, for the perfection and preservation of the reason of
+others, are thereby in danger of losing their own. We hear much of this,
+from those who have copiously treated of this disease, without the toil of
+practical remark; whose heads become bewildered by the gentlest exercise,
+and to whom the recreation of thinking becomes the exciting cause of
+stupidity or delirium. These persons <span class="pagenum"><a name="Page_218" id="Page_218">[Pg 218]</a></span>enumerate, among the exciting causes
+of delirium, &#8220;Too great, or too long continued exertion of the mental
+faculties, as in the delirium which often succeeds long continued and
+abstract calculation; and the deliria to which men of genius are
+peculiarly subject.&#8221;</p>
+
+<p>The mind of every man is capable of a definite quantity of exertion to
+good effect; all endeavours, beyond that point, are impotent and
+perplexing. The attention is capable of being fixed to a certain extent,
+and, when that begins to deviate, all continuance is time lost. It is
+certain that, by habit, this power may be much increased; and, by frequent
+exercise, that, which at first excited fatigue, may be continued with
+facility and pleasure. What species of delirium is that, which succeeds
+long continued and abstract calculation? Newton lived to the age of 85
+years, Leibnitz to 70,<span class="pagenum"><a name="Page_219" id="Page_219">[Pg 219]</a></span> and Euler to a more advanced period, yet their
+several biographers have neglected to inform us, that their studies were
+checquered with delirious fermentations. The mathematicians of the present
+day (and there are many of distinguished eminence) would conceive it no
+compliment to suppose that they retired from their labours with addled
+brains, and that writers of books on insanity should impute to them
+miseries which they never experienced.</p>
+
+<p>It is curious to remark, in looking over a biographical chart, that
+mathematicians and natural philosophers have in general attained a
+considerable age; so that long continued and abstract calculation, or
+correct thinking upon any subject does not appear, with all these
+delirious visitations, to shorten the duration of human life. What is
+meant by the deliria, to which men of genius are peculiarly subject, I am
+unable,<span class="pagenum"><a name="Page_220" id="Page_220">[Pg 220]</a></span> from a want of sufficient genius and delirium, to comprehend.</p>
+
+<p>It is well understood, that a want of rational employment is a very
+successful mode of courting delirium; that an indulgence in those reveries
+which keep the imagination on the wing, and imprison the understanding, is
+likely to promote it: and it must be owned, that the same effect has often
+been produced, where vanity or ambition has urged minds, puny by nature,
+and undrilled in intellectual exercises, to attempt to grasp that which
+they were unable to embrace. This may be illustrated by the following
+case.</p>
+
+<p>A young gentleman of slender capacity, and very moderate education, at the
+age of nineteen, was placed in a merchant&#8217;s counting house, where he
+continued for two years diligently, though slowly, to perform the<span class="pagenum"><a name="Page_221" id="Page_221">[Pg 221]</a></span> duties
+of the office. Coming at this time into the possession of considerable
+property, and perhaps, aware of the uncultivated state of his own mind, he
+very laudably determined to improve it. He frequented the society of
+persons esteemed learned and eminent in their different professions, and
+became much delighted with their conversation; but at the same time
+sensible that he was unable to contribute to the discourse. He resolved to
+become a severe student, and for this purpose purchased an immense
+quantity of books on most subjects of literature and science. History
+commenced the career of his enquiries: Rollin, Gibbon, Hume and Robertson
+were anxiously and rapidly perused; but he never paused to consider, or to
+connect dates and circumstances, so that these excellent authors, after he
+had waded through them, left scarcely an impression on his mind. Chemistry
+next engaged his attention, and<span class="pagenum"><a name="Page_222" id="Page_222">[Pg 222]</a></span> on this subject, he pored over many
+volumes with little advantage: the terms proved a source of embarrassment,
+and he made no experiments. In a hasty succession, the ancient languages,
+antiquities, etymology, agriculture, and moral philosophy, occupied his
+mind. About eight hours were daily devoted to reading. Somewhat more than
+two years were consumed in this employment, which had distracted his mind,
+without conferring any positive knowledge.</p>
+
+<p>His friends and acquaintances now began to perceive a considerable
+alteration in his temper; though naturally diffident, he had assumed a
+high degree of literary importance, and plumed himself on the extent of
+his learning. Before this excessive, but ill-directed application, he was
+a strict relator of the truth, but he now found a convenience in supplying
+by fancy, that, which the indigence of his memory was unable to<span class="pagenum"><a name="Page_223" id="Page_223">[Pg 223]</a></span> afford.
+Shortly he began to complain that he could not sleep, and that the long
+night was passed in shifting from side to side.</p>
+
+<p class="poem">&#8220;Lasso, ch&#8217;n van te chiamo, et queste oscure,<br />
+Et gelide ombre in van lusingo: o piume<br />
+D&#8217;asprezza colme: o notti acerbe, et dure.&#8221;<br />
+<span style="margin-left: 12em;"><i>Gio: Della Casa.</i></span></p>
+
+<p>Fever succeeded, accompanied with delirium in the evening. By quietness,
+and the ordinary remedies, these symptoms were removed; but he was left in
+a state of extreme weakness. As he recovered from this, his habits became
+materially altered: he would continue to lie in bed for several days,
+after which, he would suddenly rise and walk a number of miles. Personal
+cleanliness, and dress were entirely neglected: sometimes he would fast
+for two or three days, and then eat voraciously. Afterwards he became
+suspicious that poison had been mixed with his food. It was found
+necessary to confine him, from having <span class="pagenum"><a name="Page_224" id="Page_224">[Pg 224]</a></span>attempted to castrate himself: this
+he afterwards effected in a very complete manner, and continues a maniac
+to the present time.</p>
+
+<p>Few persons, I believe, will be disposed to consider the above case, as an
+instance of insanity succeeding to a laborious exercise of the
+intellectual faculties. It is true, he was busied with books: but this
+occupation could not have strained his mind, for he appears neither to
+have comprehended, nor retained any of the objects of his pursuit.</p>
+
+
+<p class="center"><br /><i>Hereditary Disposition.</i></p>
+
+<p>&#8220;Ut male posuimus initia sic cetera sequuntur.&#8221;&mdash;<i>Cicero.</i></p>
+
+<p>&#8220;Whatever was in the womb imperfect, as to her proper work, comes very
+rarely, or never at all, to perfection afterwards.&#8221;&mdash;<i>Harrington&#8217;s
+Works</i>, <i>p.</i> 177.</p>
+
+<p><span class="pagenum"><a name="Page_225" id="Page_225">[Pg 225]</a></span>Considerable diversity of opinion has prevailed, whether insanity be
+hereditary or not; and much has been said on both sides of this question.
+Great ingenuity has been exerted to prove that this disease is accidental,
+or that there are sufficient causes to account for its occurrence, without
+supposing it one of those calamities that &#8220;<i>flesh is heir to</i>.&#8221; It has
+been argued, that, if the disease were hereditary, it ought uniformly to
+be so, and that the offspring of a mad parent should necessarily become
+insane.</p>
+
+<p>All theories and reasonings appear to be good for as much as they prove;
+and if the term <i>hereditary</i> be employed with a degree of strictness, so
+as to denote certain and infallible transmission, such inevitable descent
+cannot be defended. Several instances have come under my observation where
+the children of an insane parent have not <span class="pagenum"><a name="Page_226" id="Page_226">[Pg 226]</a></span>hitherto been affected with
+madness, and some have died early in life, without having experienced any
+derangement of mind. More time is therefore required.</p>
+
+<p>All observations concur in acknowledging that there are many circumstances
+in which children resemble their parents. It is very common to see them
+resemble one of their parents in countenance, and when there are several
+children, some shall bear the likeness of the father and others of the
+mother. Children often possess the make and fashion of the body, peculiar
+to one or other of their parents, together with their gait and voice; but
+that which has surprized me most is the resemblance of the hand-writing.
+If a parent had taught his son to write, it might be expected that a
+considerable similarity would be detected; but in general the fact appears
+to be otherwise, for it seldom happens that the scholars, though
+<span class="pagenum"><a name="Page_227" id="Page_227">[Pg 227]</a></span>constantly imitating the copy of the master, write at all like him, or
+like each other. In a few instances I have noticed a correct resemblance
+between the hand-writing of the father and son, where the former died
+before the latter had been taught the use of the pen, and who probably
+never saw the hand-writing of his father. The transmission of personal
+deformities is equally curious. I am acquainted with a person in this
+town, whose middle and ring finger are united, and act as one; all the
+children of this man carry the same defect. A toenail, particularly
+twisted, has been traced through three generations, on the same foot and
+toe. Abundant instances might be adduced on this subject; there is
+scarcely a family which cannot produce something in confirmation; and if
+to these circumstances in the human species, were to be added the
+experiments which have been made on the<span class="pagenum"><a name="Page_228" id="Page_228">[Pg 228]</a></span> breeding of cattle, perhaps
+little doubt would remain.</p>
+
+<p>The reasoners against the transmission of madness urge, that, if the
+contrary were true, we should by this time have detected the rule or law
+by which nature acts, and that we should have been able to
+determine,&mdash;First, whether the disorder descended to the male or female
+children accordingly as the father or mother was affected.&mdash;Secondly,
+which of the parents is most capable of transmitting the
+disease?&mdash;Thirdly, what alternations in the succession take place, does it
+shift from the male to the female line, and, does it miss a generation,
+and afterwards return?</p>
+
+<p>These, and a multitude of other queries, might be proposed; I believe much
+faster than they could be answered. Nature appears to delight in producing
+new varieties,<span class="pagenum"><a name="Page_229" id="Page_229">[Pg 229]</a></span> perhaps less in man than in other animals, and still less
+in the animal than in the vegetable kingdom. Before these subtile
+reasoners expect, from those who maintain that madness generally descends
+from the parent to the offspring, a developement of the laws by which
+Nature acts, it would be convenient first to settle whether in this matter
+she be under the dominion of any law whatever.</p>
+
+<p>The investigation of the hereditary tendency of madness is an object of
+the utmost importance, both in a legal and moral point of view. Parents
+and guardians, in the disposal, or direction of the choice of their
+children in marriage, should be informed, that an alliance with a family,
+where insanity has prevailed, ought to be prohibited.</p>
+
+<p>Having directed some attention to enquiries of this nature, I am enabled
+truly to<span class="pagenum"><a name="Page_230" id="Page_230">[Pg 230]</a></span> state, that, where one of the parents have been insane, it is
+more than probable that the offsprings will be similarly affected.</p>
+
+<p>Madness has many colours, and colours have many hues; actual madness is a
+severe calamity, yet experience has pointed out the treatment, and the law
+has permitted the imposition of the necessary restraint: but it very
+frequently occurs that the descendants from an insane stock, although they
+do not exhibit the broad features of madness, shall yet discover
+propensities, equally disqualifying for the purposes of life, and
+destructive of social happiness.</p>
+
+<p>The slighter shades of this disease include eccentricity, low spirits, and
+oftentimes a fatal tendency to immoral habits, notwithstanding the
+inculcation of the most correct precepts, and the force of virtuous
+example.</p>
+
+<p><span class="pagenum"><a name="Page_231" id="Page_231">[Pg 231]</a></span>In illustration of the fact, that the offsprings of insane persons are,
+<i>ceteris paribus</i>, more liable to be affected with madness than those
+whose parents have been of sound minds; it was my intention to have
+constructed a table, whereon might be seen the probably direct course of
+this disease, and also its collateral bearings: but difficulties have
+arisen. It appeared, on consideration, improper to attempt precision with
+that which was variable, and as yet unsettled; I have therefore been
+content to select a few histories from my book of notes, and to exhibit
+them in the rude state in which they were set down.</p>
+
+<p><i>1st.</i>&mdash;R. G. His grandfather was mad, but there was no insanity in his
+grandmother&#8217;s family. His father was occasionally melancholic, and once
+had a raving paroxysm. His mother&#8217;s family was sane. His father&#8217;s brother
+died insane. R. G.<span class="pagenum"><a name="Page_232" id="Page_232">[Pg 232]</a></span> has a brother and five sisters; his brother has been
+confined in St. Luke&#8217;s, and is occasionally in a low spirited state. All
+his sisters have been insane; with the three youngest the disease came on
+after delivery.</p>
+
+<p><i>2d.</i>&mdash;M. M. Her grandmother was insane and destroyed herself. Her father
+was mad for many years, but after the birth of all his children. M. M. has
+two brothers and a sister; both her brothers have been insane; the sister
+has never been so affected, but was a person of loose character. The
+insanity of M. M. was connected with her menstruation; after its cessation
+she recovered, although she had been confined more than sixteen years.</p>
+
+<p><i>3d.</i>&mdash;M. H. Her father had been several times insane; her mother was
+likewise so affected a few months before her death.<span class="pagenum"><a name="Page_233" id="Page_233">[Pg 233]</a></span> Afterwards her father
+married a woman perfectly sane, by whom he had three children, two female
+and a male; both the females are melancholic, the male was a vicious
+character, and has been transported. M. H. has had ten children, three
+have died with convulsions, the eldest, a girl, is epileptic.</p>
+
+<p><i>4th.</i>&mdash;T. B. His mother became insane soon after being delivered of him,
+and at intervals has continued so ever since. He has a brother who became
+furiously mad at the age of twenty, and afterwards recovered. T. B.&#8217;s
+disorder came on at the age of twenty-six.</p>
+
+<p><i>5th.</i>&mdash;S. F. Her father&#8217;s mother was insane, and confined in the
+hospital. Her father never discovered any symptoms of insanity, and her
+mother was perfectly sane. Her only sister (she had no <span class="pagenum"><a name="Page_234" id="Page_234">[Pg 234]</a></span>brothers) was mad
+about five years ago, and recovered. S. F. has been twice in the hospital.</p>
+
+<p><i>6th.</i>&mdash;P. W. After the best enquiries it does not appear that her father
+or mother ever experienced any attack of madness or melancholy. P. W.&#8217;s
+disorder commenced shortly after the delivery of a child. She has three
+sisters, the eldest has never been married, and has hitherto continued of
+sound mind. The two younger have been mothers, and in both insanity has
+supervened on childbearing.</p>
+
+<p><i>7th.</i>&mdash;J. A. H. His father&#8217;s father was insane, and his father was also
+disordered, and destroyed himself. His mother was of sound mind. J. A. H.
+became insane at the age of twenty-three. He has two sisters, the elder
+has once been confined<span class="pagenum"><a name="Page_235" id="Page_235">[Pg 235]</a></span> for insanity, the younger is of weak intellects,
+nearly approaching to ideotism.</p>
+
+<p><i>8th.</i>&mdash;M. D. Her mother was insane and died so. M. D. continued of sane
+mind until she had attained the age of fifty-seven, when she became
+furiously maniacal; her only daughter, eighteen years of age, was attacked
+with mania during the time her mother was confined.</p>
+
+<p><i>9th.</i>&mdash;G. F. His mother was melancholic during the time she was pregnant
+with him, and never afterwards completely recovered. She had five children
+previously to this melancholic attack, who have hitherto continued of
+sound mind. She bore another son after G. F. who is extremely flighty and
+unmanageable. G. F. was attacked with madness at the age of nineteen, and
+died apoplectic, from the violence and continued fury of his disorder.</p>
+
+<p><span class="pagenum"><a name="Page_236" id="Page_236">[Pg 236]</a></span><i>10th.</i>&mdash;M. T. Her mother was of sound mind. Her father was in a
+melancholic state for two years, before she was born, but this was
+afterwards dissipated by active employment. M. T. has two brothers,
+younger than herself, who have been attacked with insanity, neither of
+whom have recovered. She has two sisters, some years older than herself,
+these have never been deranged. M. T. has had nine children. The three
+first have been melancholic. The youngest, at the age of five years, used
+to imagine she saw persons in the room covered with blood, and other
+horrible objects, she afterwards became epileptic and died. The youngest
+of her three first children has been married and had three children, one
+of whom is afflicted with chorea Sancti Viti, and another is nearly an
+ideot.</p>
+
+<p>Of the causes termed moral, the greatest number may, perhaps, be traced to
+the<span class="pagenum"><a name="Page_237" id="Page_237">[Pg 237]</a></span> errors of education, which often plant in the youthful mind those
+seeds of madness which the slightest circumstances readily awaken into
+growth.</p>
+
+<p>It should be as much the object of the teachers of youth, to subjugate the
+passions, as to discipline the intellect. The tender mind should be
+prepared to expect the natural and certain effects of causes: its
+propensity to indulge an avaricious thirst for that which is unattainable,
+should be quenched: nor should it be suffered to acquire a fixed and
+invincible attachment to that which is fleeting and perishable.</p>
+
+<p>Of the more immediate, or, as it is generally termed, the proximate cause
+of this disease, I profess to know nothing. Whenever the functions of the
+brain shall be fully understood, and the use of its different parts
+ascertained, we may then be enabled to<span class="pagenum"><a name="Page_238" id="Page_238">[Pg 238]</a></span> judge, how far disease, attacking
+any of these parts, may increase, diminish, or otherwise alter its
+functions. But this is a degree of knowledge, which we are not likely soon
+to attain. It seems, however, not improbable, that the only source, from
+whence the most copious and certain information can be drawn, is a strict
+attention to the particular appearances which morbid states of this organ
+may present.</p>
+
+<p>From the preceding dissections of insane persons, it may be inferred, that
+madness has always been connected with disease of the brain and of its
+membranes. Having no particular theory to build up, they have been related
+purely for the advancement of science and of truth.</p>
+
+<p>It may be a matter, affording much diversity of opinion, whether these
+morbid appearances of the brain be the cause or<span class="pagenum"><a name="Page_239" id="Page_239">[Pg 239]</a></span> the effect of madness: it
+may be observed that they have been found in all states of the disease.
+When the brain has been injured from external violence, its functions have
+been generally impaired, if inflammation of its substance, or more
+delicate membranes has ensued. The same appearances have for the most part
+been detected, when patients have died of phrenitis, or in the delirium of
+fever: in these instances, the derangement of the intellectual functions
+appears evidently to have been caused by the inflammation. If in mania the
+same appearances be found, there will be no necessity of calling in the
+aid of other causes, to account for the effect: indeed, it would be
+difficult to discover them.</p>
+
+<p>Those who entertain an opposite opinion are obliged to suppose, <i>a disease
+of the mind</i>. Such a morbid affection, from the limited nature of my
+powers, perhaps I<span class="pagenum"><a name="Page_240" id="Page_240">[Pg 240]</a></span> have never been able to conceive. Possessing, however,
+little knowledge of metaphysical controversy, I shall only offer a few
+remarks upon this part of the subject, and beg pardon for having at all
+touched it.</p>
+
+<p>Perhaps it is not more difficult to suppose, that matter, peculiarly
+arranged, may <i>think</i>,<a name='fna_17' id='fna_17' href='#f_17'><small>[17]</small></a> than to conceive the union of an immaterial
+being with a corporeal substance. It is questioning the infinite wisdom
+and power of the Deity to say, that he does not, or cannot, arrange matter
+so that it shall think. When we find insanity, as far as has been hitherto
+observed, uniformly accompanied with disease of the brain,<span class="pagenum"><a name="Page_241" id="Page_241">[Pg 241]</a></span> is it not more
+just to conclude, that such organic affection has produced this incorrect
+association of ideas, than that a being, which is immaterial,
+incorruptible, and immortal, should be subject to the gross and
+subordinate changes which matter necessarily undergoes?</p>
+
+<p>But let us imagine <i>a disease of ideas</i>. In what manner are we to effect a
+cure? To this subtle spirit the doctor can apply no medicines. Though so
+refined as to elude the force of material remedies, some may however think
+that it may be reasoned with. The good effects which have resulted from
+exhibiting logic as a remedy for madness, must be sufficiently known to
+every one who has conversed with insane persons, and must be considered as
+time very judiciously employed: speaking more gravely, it will readily be
+acknowledged, by persons acquainted with this disease,<span class="pagenum"><a name="Page_242" id="Page_242">[Pg 242]</a></span> that, if insanity
+be a disease of ideas, we can possess no corporeal remedies for it: and
+that an endeavour to convince madmen of their errors, by reasoning, is
+folly in those who attempt it, since there is always in madness the
+firmest conviction of the truth of what is false, and which the clearest
+and most circumstantial evidence cannot remove.</p>
+
+
+<p>&nbsp;</p><p>&nbsp;</p>
+<hr style="width: 50%;" />
+<p><span class="pagenum"><a name="Page_243" id="Page_243">[Pg 243]</a></span></p>
+<h2>CHAP. VI.</h2>
+<p class="center"><span class="large">ON THE PROBABLE EVENT OF THE DISEASE.</span></p>
+
+<p>&nbsp;</p>
+<p class="dropcap"><span class="caps">The</span> prediction of the event, in cases of insanity, must be the result of
+accurate and extensive experience; and even then it will probably be a
+matter of very great uncertainty. The practitioner can only be led to
+suppose, that patients, of a particular description, will recover, from
+knowing that, under the same circumstances, a certain number have been
+actually restored to sanity of intellect.</p>
+
+<p>The practice of an individual, however active and industrious he may be,
+is insufficient to accumulate a stock of facts, <span class="pagenum"><a name="Page_244" id="Page_244">[Pg 244]</a></span>necessary to form the
+ground of a regular and correct prognosis: it is therefore to be wished,
+that those, who exclusively confine themselves to this department of the
+profession, would occasionally communicate to the world the result of
+their observations.</p>
+
+<p>Physicians, attending generally to diseases, have not been reserved, in
+imparting to the public the amount of their labours and success: but, with
+regard to this disorder, those, who have devoted their whole attention to
+its treatment, have either been negligent, or cautious of giving
+information respecting it. Whenever the powers of the mind are
+concentrated to one object, we may naturally expect a more rapid progress
+in the attainment of knowledge: we have therefore only to lament the want
+of observations upon this subject, and endeavour to repair it.</p>
+
+<p><span class="pagenum"><a name="Page_245" id="Page_245">[Pg 245]</a></span>The records of Bethlem Hospital have afforded me some satisfactory
+information, though far from the whole of what I wished to obtain. From
+them, and my own observations, the prognosis of this disease is, with
+great diffidence, submitted to the reader.</p>
+
+<p>In our own climate, women are more frequently afflicted with insanity than
+men. Several persons, who superintend private mad-houses, have assured me,
+that the number of females brought in annually, considerably exceeds that
+of the males. From the year 1748 to 1794, comprizing a period of forty-six
+years, there have been admitted into Bethlem Hospital, 4832 women, and
+4042 men.</p>
+
+<p>The natural processes, which women undergo, of menstruation, parturition,
+and of preparing nutriment for the infant, together<span class="pagenum"><a name="Page_246" id="Page_246">[Pg 246]</a></span> with the diseases, to
+which they are subject at these periods, and which are frequently remote
+causes of insanity, may, perhaps, serve to explain their greater
+disposition to this malady. As to the proportion in which they recover,
+compared with males, it may be stated, that of 4832 women affected, 1402
+were discharged cured; and that, of the 4042 men, 1155 recovered. It is
+proper here to mention, that, in general, we know but little of what
+becomes of those who are discharged; a certain number of those cured,
+occasionally relapse, and some of those, who are discharged uncured,
+afterwards recover: perhaps in the majority of instances where they
+relapse, they are sent back to Bethlem. To give some idea of the number,
+so re-admitted, it may be mentioned, that, during the last two years,<a name='fna_18' id='fna_18' href='#f_18'><small>[18]</small></a>
+there have been admitted 389 patients, 53 of whom had at some<span class="pagenum"><a name="Page_247" id="Page_247">[Pg 247]</a></span> former time
+been in the house. There are so many circumstances, which, supposing they
+did relapse, might prevent them from returning, that it can only be stated
+with certainty, that within twelve months, the time allowed as a trial of
+cure, so many have been discharged perfectly well.</p>
+
+<p>To shew how frequently insanity supervenes on parturition, it may be
+remarked, that from the year 1784 to 1794 inclusive, 80 patients have been
+admitted, whose disorder shortly followed the puerperal state. Women
+affected from this cause, recover in a larger proportion than patients of
+any other description of the same age. Of these 80, 50 have perfectly
+recovered. The first symptoms of the approach of this disease after
+delivery, are want of sleep; the countenance becomes flushed; a
+constrictive pain is often felt in the head; the eyes assume a morbid
+lustre, and wildly glance<span class="pagenum"><a name="Page_248" id="Page_248">[Pg 248]</a></span> at objects in rapid succession; the milk is
+afterwards secreted in less quantity; and when the mind becomes more
+violently disordered, it is totally suppressed. Where the disease is
+hereditary, parturition very frequently becomes an exciting cause.</p>
+
+<p>From whatever cause this disease may be produced in women, it is
+considered as very unfavourable to recovery, if they should be worse at
+the period of menstruation, or have their catamenia in very small or
+immoderate quantities.</p>
+
+<p>A few cases have occurred where the disease, being connected with
+menstruation, and having continued many years, has completely disappeared
+on the cessation of the uterine discharge.</p>
+
+<p>At the first attack of this disease, and for some months afterwards,
+during its <span class="pagenum"><a name="Page_249" id="Page_249">[Pg 249]</a></span>continuance, females most commonly labour under amenorrh&oelig;a.
+The natural and healthy return of this discharge generally precedes
+convalescence.</p>
+
+<p>From the following statement it will be seen, that insane persons recover
+in proportion to their youth, and that as they advance in years, the
+disease is less frequently cured. It comprizes a period of about ten
+years, viz. from 1784 to 1794. In the first column the age is noticed; in
+the second, the number of patients admitted; the third contains the number
+cured; the fourth, those who were discharged not cured.</p>
+
+<table border="0" cellpadding="0" cellspacing="5" summary="table">
+<tr><td align="center"><i>Age between</i></td><td><span class="spacer">&nbsp;</span></td>
+    <td align="center"><i>Number<br />admitted.</i></td><td><span class="spacer">&nbsp;</span></td>
+    <td align="center"><i>Number<br />discharged<br />cured.</i></td><td><span class="spacer">&nbsp;</span></td>
+    <td align="center"><i>Number<br />discharged<br />uncured.</i></td><td><span class="spacer">&nbsp;</span></td></tr>
+<tr><td>10 and 20</td><td>&nbsp;</td>
+    <td align="center">113</td><td>&nbsp;</td>
+    <td align="center"><span style="margin-left: .5em;">78</span></td><td>&nbsp;</td>
+    <td align="center"><span style="margin-left: .5em;">35</span></td></tr>
+<tr><td>20 and 30</td><td>&nbsp;</td>
+    <td align="center">488</td><td>&nbsp;</td>
+    <td align="center">200</td><td>&nbsp;</td>
+    <td align="center">288</td></tr>
+<tr><td>30 and 40</td><td>&nbsp;</td>
+    <td align="center">527</td><td>&nbsp;</td>
+    <td align="center">180</td><td>&nbsp;</td>
+    <td align="center">347</td></tr>
+<tr><td>40 and 50</td><td>&nbsp;</td>
+    <td align="center">362</td><td>&nbsp;</td>
+    <td align="center"><span style="margin-left: .5em;">87</span></td><td>&nbsp;</td>
+    <td align="center">275</td></tr>
+<tr><td>50 and 60</td><td>&nbsp;</td>
+    <td align="center">143</td><td>&nbsp;</td>
+    <td align="center"><span style="margin-left: .5em;">25</span></td><td>&nbsp;</td>
+    <td align="center">118</td></tr>
+<tr><td>60 and 70</td><td>&nbsp;</td>
+    <td align="center" class="botbor"><span style="margin-left: .5em;">31</span></td><td>&nbsp;</td>
+    <td align="center" class="botbor"><span style="margin-left: 1em;">4</span></td><td>&nbsp;</td>
+    <td align="center" class="botbor"><span style="margin-left: .5em;">27</span></td></tr>
+<tr><td>&nbsp;</td>
+    <td align="right">Total</td><td align="center"><span style="margin-left: -.5em;">1664</span></td>
+    <td align="right">Total</td><td align="center">574</td>
+    <td align="right">Total</td><td align="center"><span style="margin-left: -.5em;">1090</span></td></tr></table>
+
+<p><span class="pagenum"><a name="Page_250" id="Page_250">[Pg 250]</a></span>From this table it will be seen, that when the disease attacks persons
+advanced in life, the prospect of recovery is but small.</p>
+
+<p>I am led to conclude, from the very rare instances of complete cure, or
+durable amendment, among the class of patients deemed incurable, as well
+as from the infrequent recovery of those who have been admitted, after the
+disorder has been of more than twelve months standing, that the chance of
+cure is less, in proportion to the length of time which the disorder shall
+have continued.</p>
+
+<p>Although patients, who have been affected with insanity more than a year,
+are not admissible into the hospital, to continue there for the usual time
+of trial for cure, namely, a twelvemonth, yet, at the discretion of the
+committee, they may be received into it, from Lady-day to Michaelmas, at<span class="pagenum"><a name="Page_251" id="Page_251">[Pg 251]</a></span>
+which latter period they are removed. In the course of the last twenty
+years seventy-eight patients of this description have been received, of
+whom only one has been discharged cured: this patient, who was a woman,
+has since relapsed twice, and was ultimately sent from the hospital
+uncured.</p>
+
+<p>When the reader contrasts the preceding statement with the account
+recorded in the report of the Committee, appointed to examine the
+Physicians who have attended His Majesty, &amp;c. he will either be inclined
+to deplore the unskilfulness or mismanagement which has prevailed among
+those medical persons who have directed the treatment of mania in the
+largest public institution in this kingdom, of its kind, compared with the
+success which has attended the private practice of an individual; <i>or to
+require some other evidence, than the bare<span class="pagenum"><a name="Page_252" id="Page_252">[Pg 252]</a></span> assertion of the man
+pretending to have performed such cures</i>.<a name='fna_19' id='fna_19' href='#f_19'><small>[19]</small></a></p>
+
+<p>It was deposed by that reverend and celebrated physician, that of patients
+placed under his care, within three months after the attack of the
+disease, nine out of ten had recovered;<a name='fna_20' id='fna_20' href='#f_20'><small>[20]</small></a> and also that the age was of
+no signification, unless the patient had been afflicted before with the
+same malady.<a name='fna_21' id='fna_21' href='#f_21'><small>[21]</small></a></p>
+
+<p>How little soever I might be disposed to doubt such a bold, unprecedented,
+and marvellous account, yet, I must acknowledge, that my mind would have
+been much more satisfied, as to the truth of that assertion, had it been
+plausibly made out, or had the circumstances been otherwise than feebly
+recollected by that very successful <span class="pagenum"><a name="Page_253" id="Page_253">[Pg 253]</a></span>practitioner. Medicine has generally
+been esteemed a progressive science, in which its professors have
+confessed themselves indebted to great preparatory study and long
+subsequent experience for the knowledge they have acquired; but, in the
+case to which we are now alluding, the outset of the Doctor&#8217;s practice was
+marked with such splendid success, that time and observation have been
+unable to increase it.</p>
+
+<p>This astonishing number of cures has been effected by the vigorous agency
+of remedies, which others have not hitherto been so fortunate as to
+discover; by remedies, which, when remote causes have been operating for
+twenty-seven years, such as weighty business, severe exercise, too great
+abstemiousness and little rest, are possessed of adequate power directly
+to <i>meet and counteract</i> such causes.<a name='fna_22' id='fna_22' href='#f_22'><small>[22]</small></a></p>
+
+<p><span class="pagenum"><a name="Page_254" id="Page_254">[Pg 254]</a></span>It will be seen by the preceding table, that a greater number of patients
+have been admitted, between the age of 30 and 40, than during any other
+equal period of life. The same fact also obtains in France, as may be seen
+from the statement of Dr. Pinel, (<i>Trait&eacute; Medico-Philosophique sur la
+Manie</i>, <i>p.</i> 109,) and which, from its agreement with that of Bethlem
+Hospital, is here introduced to the notice of the reader.</p>
+
+<table border="0" cellpadding="0" cellspacing="0" summary="table">
+<tr><td class="btlr" rowspan="2" align="center"><ins class="errata" title="Errata: Page 254, in the Table, for 'manical' read 'maniacal'.">Maniacal</ins><br />Patients<br />admitted into<br />the Bic&ecirc;tre,<br />in the Years</td>
+    <td class="btr" colspan="6" align="center">AGE BETWEEN</td>
+    <td class="btr" rowspan="2" align="center">Total</td></tr>
+<tr><td align="center" class="btr">15 &amp; 20</td>
+    <td align="center" class="btr">20 &amp; 30</td>
+    <td align="center" class="btr">30 &amp; 40</td>
+    <td align="center" class="btr">40 &amp; 50</td>
+    <td align="center" class="btr">50 &amp; 60</td>
+    <td align="center" class="btr">60 &amp; 70</td></tr>
+<tr><td class="btlr" align="center">1784</td>
+    <td class="btr" align="center"><span style="margin-left: .5em;">5</span></td>
+    <td class="btr" align="center">33</td>
+    <td class="btr" align="center">31</td>
+    <td class="btr" align="center">24</td>
+    <td class="btr" align="center">11</td>
+    <td class="btr" align="center">6</td>
+    <td class="btr" align="center">110</td></tr>
+<tr><td class="blr" align="center">1785</td>
+    <td class="br" align="center"><span style="margin-left: .5em;">4</span></td>
+    <td class="br" align="center">39</td>
+    <td class="br" align="center">49</td>
+    <td class="br" align="center">25</td>
+    <td class="br" align="center">14</td>
+    <td class="br" align="center">3</td>
+    <td class="br" align="center">134</td></tr>
+<tr><td class="blr" align="center">1786</td>
+    <td class="br" align="center"><span style="margin-left: .5em;">4</span></td>
+    <td class="br" align="center">31</td>
+    <td class="br" align="center">40</td>
+    <td class="br" align="center">32</td>
+    <td class="br" align="center">15</td>
+    <td class="br" align="center">5</td>
+    <td class="br" align="center">127</td></tr>
+<tr><td class="blr" align="center">1787</td>
+    <td class="br" align="center">12</td>
+    <td class="br" align="center">39</td>
+    <td class="br" align="center">41</td>
+    <td class="br" align="center">26</td>
+    <td class="br" align="center">17</td>
+    <td class="br" align="center">7</td>
+    <td class="br" align="center">142</td></tr>
+<tr><td class="blr" align="center">1788</td>
+    <td class="br" align="center"><span style="margin-left: .5em;">9</span></td>
+    <td class="br" align="center">43</td>
+    <td class="br" align="center">53</td>
+    <td class="br" align="center">21</td>
+    <td class="br" align="center">18</td>
+    <td class="br" align="center">7</td>
+    <td class="br" align="center">151</td></tr>
+<tr><td class="blr" align="center">1789</td>
+    <td class="br" align="center"><span style="margin-left: .5em;">6</span></td>
+    <td class="br" align="center">38</td>
+    <td class="br" align="center">39</td>
+    <td class="br" align="center">33</td>
+    <td class="br" align="center">14</td>
+    <td class="br" align="center">2</td>
+    <td class="br" align="center">132</td></tr>
+<tr><td class="blr" align="center">1790</td>
+    <td class="br" align="center"><span style="margin-left: .5em;">6</span></td>
+    <td class="br" align="center">28</td>
+    <td class="br" align="center">34</td>
+    <td class="br" align="center">19</td>
+    <td class="br" align="center"><span style="margin-left: .5em;">9</span></td>
+    <td class="br" align="center">7</td>
+    <td class="br" align="center">103</td></tr>
+<tr><td class="blr" align="center">1791</td>
+    <td class="br" align="center"><span style="margin-left: .5em;">9</span></td>
+    <td class="br" align="center">26</td>
+    <td class="br" align="center">32</td>
+    <td class="br" align="center">16</td>
+    <td class="br" align="center"><span style="margin-left: .5em;">7</span></td>
+    <td class="br" align="center">3</td>
+    <td class="br" align="center"><span style="margin-left: .5em;">93</span></td></tr>
+<tr><td class="blr" align="center">1792</td>
+    <td class="br" align="center"><span style="margin-left: .5em;">6</span></td>
+    <td class="br" align="center">26</td>
+    <td class="br" align="center">33</td>
+    <td class="br" align="center">18</td>
+    <td class="br" align="center">12</td>
+    <td class="br" align="center">3</td>
+    <td class="br" align="center"><span style="margin-left: .5em;">98</span></td></tr>
+<tr><td class="blr" align="center">1793</td>
+    <td class="br" align="center"><span style="margin-left: .5em;">1</span></td>
+    <td class="br" align="center">13</td>
+    <td class="br" align="center">13</td>
+    <td class="br" align="center"><span style="margin-left: .5em;">7</span></td>
+    <td class="br" align="center"><span style="margin-left: .5em;">4</span></td>
+    <td class="br" align="center">2</td>
+    <td class="br" align="center"><span style="margin-left: .5em;">40</span></td></tr>
+<tr><td class="bblr" align="center">1794</td>
+    <td class="bbr" align="center"><span style="margin-left: .5em;">3</span></td>
+    <td class="bbr" align="center">23</td>
+    <td class="bbr" align="center">15</td>
+    <td class="bbr" align="center">15</td>
+    <td class="bbr" align="center"><span style="margin-left: .5em;">9</span></td>
+    <td class="bbr" align="center">6</td>
+    <td class="bbr" align="center"><span style="margin-left: .5em;">71</span></td></tr></table>
+
+<p><span class="pagenum"><a name="Page_255" id="Page_255">[Pg 255]</a></span>There may be some reasons assigned for the increased proportion of insane
+persons at this age. Although I have made no exact calculation, yet from a
+great number of cases, it appears to be the time when the hereditary
+disposition is most frequently called into action; or, to speak more
+plainly, it is that stage of life, when persons, whose families have been
+insane, are most liable to become mad. If it can be made to appear, that
+at this period persons are more subject to be acted upon by the remote
+causes of the disease, or that a greater number of such causes are then
+applied, we may be able satisfactorily to explain it.</p>
+
+<p>At this age people are generally established in their different
+occupations, are married, and have families; their habits are more
+strongly formed, and the interruptions of them are consequently attended<span class="pagenum"><a name="Page_256" id="Page_256">[Pg 256]</a></span>
+with greater anxiety and regret. Under these circumstances, they feel the
+misfortunes of life more exquisitely. Adversity does not depress the
+individual for himself alone, but as involving his partner and his
+offspring in wretchedness and ruin. In youth we feel desirous only of
+present good; at the middle age, we become more provident and anxious for
+the future; the mind assumes a serious character; and religion, as it is
+justly or improperly impressed, imparts comfort, or excites apprehension
+and terror.</p>
+
+<p>By misfortunes the habit of intoxication is readily formed. Those who in
+their youth have shaken off calamity as a slight incumbrance, at the
+middle age feel it corrode and penetrate; and when fermented liquors have
+once dispelled the gloom of despondency, and taught the mind to provoke a
+temporary assemblage of cheerful<span class="pagenum"><a name="Page_257" id="Page_257">[Pg 257]</a></span> scenes, or to despise the terror of
+impending misery, it is natural to recur to the same, though destructive
+cause, to re-produce the effect.</p>
+
+<p>Patients, who are in a furious state, recover in a larger proportion than
+those who are depressed and melancholic. An hundred violent, and the same
+number of melancholic cases were selected: of the former, sixty-two were
+discharged well; of the latter, only twenty-seven: subsequent experience
+has confirmed this fact. The same investigation, on the same number of
+persons has been twice instituted, and with results little varying from
+the originally stated proportions. When the furious state is succeeded by
+melancholy, and after this shall have continued a short time, the violent
+paroxysm returns, the chance of recovery is very slight. Indeed, whenever
+these states of the disease frequently change, such<span class="pagenum"><a name="Page_258" id="Page_258">[Pg 258]</a></span> alteration may be
+considered as very unfavourable.</p>
+
+<p>After a raving paroxysm of considerable duration, it is a hopeful symptom,
+if the patient become dull, and in a stupid state; inclined to sleep much,
+and feeling a desire of quietude. This appears to be the natural effect of
+that exhaustion, and, if the language be allowable, of that expenditure of
+the sensorial energy, which the continued blaze of furious madness would
+necessarily consume. When they gradually recover from this state there is
+a prospect that the cure will be permanent.</p>
+
+<p>In forming a prognosis of this disease, it is highly important to
+establish a distinction between derangement and decline of intellect: the
+former may frequently be remedied; the latter admits of no assistance from
+our art. Where insanity commences<span class="pagenum"><a name="Page_259" id="Page_259">[Pg 259]</a></span> with a loss of mental faculty, and
+gradually proceeds with increasing imbecility, the case may be considered
+hopeless.</p>
+
+<p>When the disorder has been induced from remote physical causes, the
+proportion of those who recover is considerably greater, than where it has
+arisen from causes of a moral nature. In those instances where insanity
+has been produced by a train of unavoidable misfortunes, as where the
+father of a large family, with the most laborious exertions, ineffectually
+struggles to maintain it, the number who recover is very small indeed.</p>
+
+<p>Paralytic affections are a much more frequent cause of insanity than has
+been commonly supposed, and they are also a very common effect of madness;
+more maniacs die of hemiplegia and apoplexy than from any other disease.
+In those <span class="pagenum"><a name="Page_260" id="Page_260">[Pg 260]</a></span>affected from this cause, we are, on enquiry, enabled to trace a
+sudden affection, or fit, to have preceded the disease. These patients
+usually bear marks of such affection, independently of their insanity: the
+speech is impeded, and the mouth drawn aside; an arm, or leg, is more or
+less deprived of its capability of being moved by the will: and in most of
+them the memory is particularly impaired. Persons thus disordered are in
+general not at all sensible of being so affected. When so feeble, as
+scarcely to be able to stand, they commonly say that they feel perfectly
+strong, and capable of great exertions. However pitiable these objects may
+be to the feeling spectator, yet it is fortunate for the condition of the
+sufferer, that his pride and pretensions are usually exalted in proportion
+to the degradation of the calamity which afflicts him. None of these
+patients have received any benefit in the hospital; and from the
+enquiries<span class="pagenum"><a name="Page_261" id="Page_261">[Pg 261]</a></span> I have been able to make at the private mad-houses, where they
+have been afterwards confined, it has appeared, that they have either died
+suddenly, from apoplexy, or have had repeated fits, from the effects of
+which they have sunk into a stupid state, and gradually dwindled away.</p>
+
+<p>The paralytic require to be kept warm, and to be allowed a more nutritious
+diet and cheering beverage than insane patients of any other description.
+In the winter months they suffer extremely, and ought to be treated as
+hot-house plants. The fare of the workhouse is ungenial to this wretched
+state of existence, and therefore they seldom long continue a burden to
+the parish.</p>
+
+<p>When insanity supervenes on epilepsy, or where the latter disease is
+induced by insanity, a cure is very seldom effected. In<span class="pagenum"><a name="Page_262" id="Page_262">[Pg 262]</a></span> two instances I
+have known madness alternate with epilepsy: one, a man about forty-eight
+years of age, was a pauper in the Cripplegate workhouse, where he had been
+kept about three years on account of his epileptic fits, but, becoming
+insane, was admitted into Bethlem Hospital, therein he continued a year,
+without being at all benefited; during that time he had no epileptic fit.
+Being returned to the workhouse, he there recovered his senses in a few
+months, when his epileptic attacks returned, and continued with their
+usual frequency. About two years afterwards he was re-admitted into the
+hospital, his insanity having recurred, and continued there another year
+without experiencing any attack of epilepsy. The other was a young woman,
+who had been epileptic for many years until she became insane, when she
+lost her epileptic fits; these, however, were<span class="pagenum"><a name="Page_263" id="Page_263">[Pg 263]</a></span> said to have returned in a
+short time after she had recovered from her insanity.</p>
+
+<p>All authors who have treated this subject appear to agree respecting the
+difficulty of curing religious madness. The infrequent recoveries in this
+species of insanity, have caused thinking persons to suppose, that this
+disorder is little under the dominion of the medical practitioner; and,
+that restoration to reason in all cases is more the effect of accident, or
+of circumstances not &#8220;dreamt of in our philosophy,&#8221; than the result of
+observation, skill, and experience. The idea that <span class="smcap">Religion</span>; that which
+fastens us to the duties of this life; that which expounds the laws of God
+and of his creation to the ignorant; that which administers consolation to
+the afflicted; that which regulates man&#8217;s conduct towards his fellow
+creatures, to exercise charity among them, and, from such benevolence, to
+purchase<span class="pagenum"><a name="Page_264" id="Page_264">[Pg 264]</a></span> happiness to himself: to believe, that the cultivation of such
+exalted sentiments would decoy a human being into madness, is a foolish
+and impious supposition.</p>
+
+<p class="poem"><span style="margin-left: 2em;">&#8220;Thou, fair Religion, wast design&#8217;d,</span><br />
+<span style="margin-left: 3em;">Duteous daughter of the skies,</span><br />
+<span style="margin-left: 2em;">To warm and chear the human mind,</span><br />
+<span style="margin-left: 3em;">To make men happy, good, and wise;</span><br />
+<span style="margin-left: 2em;">To point, where sits in love array&#8217;d,</span><br />
+<span style="margin-left: 3em;">Attentive to each suppliant call,</span><br />
+<span style="margin-left: 2em;">The God of universal aid,</span><br />
+<span style="margin-left: 3em;">The God, the Father of us all.</span><br />
+<br />
+&#8220;First shewn by Thee, thus glow&#8217;d the gracious scene,<br />
+<span style="margin-left: 2em;">&#8217;Til Superstition, fiend of woe,</span><br />
+<span style="margin-left: 2em;">Bad doubts to rise and tears to flow,</span><br />
+And spread deep shades our view and heaven between.&#8221;<br />
+<span style="margin-left: 16em;"><i>Penrose.</i></span></p>
+
+<p>It is therefore sinful to accuse <span class="smcap">Religion</span>, which preserves the dignity and
+integrity of our intellectual faculty, with being the cause of its
+derangement. The mind becomes refreshed and corroborated by a fair and
+active exercise of its powers directed to<span class="pagenum"><a name="Page_265" id="Page_265">[Pg 265]</a></span> proper objects; but when an
+anxious curiosity leads us to unveil that which must ever be shrouded from
+our view, the despair, which always attends those impotent researches,
+will necessarily reduce us to the most calamitous state.</p>
+
+<p>Instituting a generous and tolerant survey of religious opinions, we see
+nothing in the solemn pomp of catholic worship which could disorganize the
+mind; as human beings, they have employed human art to render the
+impression more vivid and durable. The decorous piety, and exemplary life
+of the quaker has signally exempted him from this most severe of human
+infirmities. The established church of this country, of which I am an
+unworthy member, will delude no one, by its terrors, to the brink of
+fatuity: the solid wisdom, rational exposition, and pure charity, which
+flow through the works of Taylor, Barrow,<span class="pagenum"><a name="Page_266" id="Page_266">[Pg 266]</a></span> Secker, and Tillotson, will
+inspire their readers with a manly confidence: the most enlightened of our
+species will advance in wisdom and in happiness from their perusal; and
+the simplicity and truth of their comments will be evident to those of
+less cultivated understanding. The pastors of this church are all men of
+liberal education, and many have attained the highest literary character;
+they are therefore eminently qualified to afford instruction. But what can
+be expected, when the most ignorant of our race attempt to inform the
+multitude; when the dregs of society shall assume the garb of sanctity and
+the holy office; and pretend to point out a privy path to heaven, or cozen
+their feeble followers into the belief that they possess a picklock for
+its gates? The difficulty of curing this species of madness will be
+readily explained from the consideration, that the whole of their doctrine
+is a base system of delusion, rivetted<span class="pagenum"><a name="Page_267" id="Page_267">[Pg 267]</a></span> on the mind by terror and despair;
+and there is also good reason to suppose, that they frequently contrive,
+by the grace of cordials, to fix the waverings of belief, and thus
+endeavour to dispel the gloom and dejection which these hallucinations
+infallibly excite.</p>
+
+<p>Although the faction of faith will owe me no kindness for the disclosure
+of these opinions, yet it would be ungrateful were I to shrink from the
+avowal of my obligations to methodism<a name='fna_23' id='fna_23' href='#f_23'><small>[23]</small></a> for the supply of those numerous
+cases which has constituted my experience of this wretched calamity.</p>
+
+<p><span class="pagenum"><a name="Page_268" id="Page_268">[Pg 268]</a></span>When the natural small-pox attacks insane persons it most commonly proves
+fatal. I was induced to draw this conclusion from consulting the records
+of Bethlem, where I found that few of those who had been sent to the
+Small-pox Hospital recovered; but subsequent experience has enabled me to
+point out this distinction: that those who have been in a furious state
+have generally experienced a fatal termination, and that those who
+recovered had the small-pox when they were in a state of convalescence
+from their insanity.</p>
+
+<p>When patients, during their convalescence, become more corpulent than they
+were before, it is a favourable symptom; and, as far as I have remarked,
+such persons have very seldom relapsed. But it should also be observed,
+that many, who become stupid, and in a state, verging on<span class="pagenum"><a name="Page_269" id="Page_269">[Pg 269]</a></span> ideotism, are
+very much disposed to obesity: these cases are not to be remedied.</p>
+
+<p>In proportion as insanity has assumed a systematic character, it become
+more difficult of cure. It ought to be noticed, that this state of
+methodical madness implies, that the disease has been of some continuance;
+and, to use a figurative expression, has been more extensively rooted in
+the mind. Every occurrence is blended with the ruling persuasion, and the
+delusion becomes daily corroborated. As</p>
+
+<p class="poem">&mdash;&mdash;&mdash;&mdash;&#8220;Trifles, light as air,<br />
+Are to the jealous, confirmations strong<br />
+As proofs of holy writ;&#8221;</p>
+
+<p>so in madness, circumstances wholly unconnected readily support the
+favourite system, and persons the most disinterested are supposed to form
+a part of the conspiracy.</p>
+
+
+<p>&nbsp;</p><p>&nbsp;</p>
+<hr style="width: 50%;" />
+<p><span class="pagenum"><a name="Page_270" id="Page_270">[Pg 270]</a></span></p>
+<h2>CHAP. VII.</h2>
+<p class="center"><span class="large">MANAGEMENT.</span></p>
+
+<p>&nbsp;</p>
+<p class="dropcap"><span class="caps">Our</span> own countrymen have acquired the credit of managing insane people with
+superior address; but it does not appear that we have arrogated to
+ourselves any such invidious pre-eminence. Foreigners, who have visited
+the public or private institutions of this country, may, perhaps, in their
+relations, have magnified our skill in the treatment of this disease:
+compared with a great part of the north of Europe, which I have visited,
+we certainly excel.</p>
+
+<p>Whether it be that we have more mad persons in England than in other
+countries,<span class="pagenum"><a name="Page_271" id="Page_271">[Pg 271]</a></span> and thereby have derived a greater experience of this
+calamity; or, whether the greater number of receptacles we possess for the
+insane, and the emoluments which have resulted from this species of
+farming, have led persons to speculate more particularly on the nature and
+treatment of this affection, may be difficult to determine. Dr. Pinel<a name='fna_24' id='fna_24' href='#f_24'><small>[24]</small></a>
+allows the reputation we have acquired; but, with a laudable curiosity, is
+desirous to understand how we became possessed of it.</p>
+
+<p>&#8220;Is it,&#8221; he says, &#8220;from a peculiar national pride, and to display their
+superiority over other nations, that the English boast of their ability in
+curing madness by moral remedies; and at the same time conceal the cunning
+of this art with an impenetrable veil? or, on the contrary, may not that<span class="pagenum"><a name="Page_272" id="Page_272">[Pg 272]</a></span>
+which we attribute to a subtile policy, be merely the effect of
+circumstances? and, is it not necessary to distinguish the steps of the
+English empirics from the methods of treatment adopted in their public
+hospitals?</p>
+
+<p>&#8220;Whatever solution may be given to these questions, yet, after fifteen
+years diligent enquiry, in order to ascertain some of the leading features
+of this method, from the reports of travellers; the accounts published of
+such establishments; the notices concerning their public and private
+receptacles, which are to be found in the different journals, or in the
+works of their medical writers, I can affirm, that I have never been able
+to discover any development of this English secret for the treatment of
+insanity, though all concur in the ability of their management. Speaking
+of Dr. Willis,<a name='fna_25' id='fna_25' href='#f_25'><small>[25]</small></a><span class="pagenum"><a name="Page_273" id="Page_273">[Pg 273]</a></span> it is said, that sweetness and affability seem to
+dwell upon his countenance; but its character changes the moment he looks
+on a patient: the whole of his features suddenly assume a different
+aspect, which enforces respect and attention from the insane. His
+penetrating eye appears to search into their hearts, and arrest their
+thoughts as they arise. Thus he establishes a dominion, which is
+afterwards employed as a principal agent of cure. But, where is the
+elucidation of these general principles to be sought; and, in what manner
+are they to be applied according to the character, varieties, and
+intensity of madness? Is the work of Dr. Arnold otherwise remarkable than
+as a burdensome compilation, or a multiplication of scholastic divisions,
+more calculated to retard than advance the progress of Science? Does Dr.
+Harpur, who announces in his preface, that he has quitted<span class="pagenum"><a name="Page_274" id="Page_274">[Pg 274]</a></span> the beaten
+track, fulfil his promise in the course of his work? and is his section on
+mental indications any thing but a prolix commentary on the doctrines of
+the ancients? The adventurous spirit of Dr. Crichton, may justly excite
+admiration, who has published two volumes on maniacal and melancholic
+affections, merely on the authority of some observations drained from a
+German Journal; together with ingenious dissertations on the doctrines of
+modern physiologists, and a view of the moral and physical effects of the
+human passions. Finally, can a mere advertisement of Dr. Fowler&#8217;s
+establishment for the insane in Scotland, throw any light on the
+particular management of such persons, although it profess the purest and
+most dignified humanity, successfully operating on the moral treatment of
+madness?&#8221;</p>
+
+<p>Dr. Pinel is deserving of considerable<span class="pagenum"><a name="Page_275" id="Page_275">[Pg 275]</a></span> credit for directing the attention
+of medical men to this very important point of the moral management of the
+insane. I have also heard much of this fascinating power which the mad
+doctor is said to possess over the wayward lunatic; but, from all I have
+observed amongst the eminent practitioners of the present day, who
+exercise this department of the profession, I am led to suspect, that,
+although this influence may have been formerly possessed, and even to the
+extent attributed to the late reverend doctor, it ought now to be lamented
+among the <i>artes deperdit&aelig;</i>. Could the attention of lunatics be fixed, and
+could they be reduced to obedience, by</p>
+
+<p class="poem">&#8220;Strong impression and strange powers which lie<br />
+Within the magic circle of the eye,&#8221;</p>
+
+<p>all other kinds of restraint would be superfluous and unnecessarily
+severe. But the fact is notoriously otherwise. Whenever the doctor visits
+a violent or mischievous<span class="pagenum"><a name="Page_276" id="Page_276">[Pg 276]</a></span> maniac, however controlling his physiognomy,
+such patient is always secured by the straight waistcoat; and it is,
+moreover, thought expedient to afford him the society of one or more
+keepers.</p>
+
+<p>It has, on some occasions, occurred to me to meet with gentlemen who have
+imagined themselves eminently gifted with this awful imposition of the
+eye, but the result has never been satisfactory; for, although I have
+entertained the fullest confidence of any relation, which such gentlemen
+might afterwards communicate concerning the success of the experiment, I
+have never been able to persuade them to practise this rare talent tet&egrave; a
+tet&egrave; with a furious lunatic.</p>
+
+<p>However Dr. Pinel may be satisfied of our superiority in this respect, it
+is but decorous to return the compliment, and if any<span class="pagenum"><a name="Page_277" id="Page_277">[Pg 277]</a></span> influence were to be
+gained over maniacal patients by assumed importance, protracted staring,
+or a mimicry of fierceness, I verily believe that such pantomime would be
+much better performed in Paris than in London.</p>
+
+<p>It is to be lamented, that general directions only can be given concerning
+the management of insane persons; the address, which is acquired by
+experience and constant intercourse with maniacs, cannot be communicated;
+it may be learned, but must perish with its possessor. Though man appears
+to be more distinguished from other animals by the capability he has of
+transmitting his acquirements to posterity, than by any other attribute of
+his nature, yet this faculty is deplorably bounded in the finer and more
+enviable offsprings of human attainment. The happy dexterity of<span class="pagenum"><a name="Page_278" id="Page_278">[Pg 278]</a></span> the
+artisan, the impressive and delighting powers of the actor,</p>
+
+<p class="poem">&#8220;And every charm of gentler eloquence,<br />
+All perishable&mdash;like the electric fire,<br />
+But strike the frame, and, as they strike, expire.&#8221;</p>
+
+<p>As most men perceive the faults of others without being aware of their
+own, so insane people easily detect the nonsense of other madmen, without
+being able to discover, or even to be made sensible of the incorrect
+associations of their own ideas. For this reason it is highly important,
+that he who pretends to regulate the conduct of such patients, should
+first have learned the management of himself. It should be the great
+object of the superintendant to gain the confidence of the patient, and to
+awaken in him respect and obedience; but it will readily be seen, that
+such confidence, obedience, and respect, can only be procured by
+superiority of talents, discipline of temper, and dignity of manners.
+Imbecility,<span class="pagenum"><a name="Page_279" id="Page_279">[Pg 279]</a></span> misconduct, and empty consequence, although enforced with the
+most tyrannical severity, may excite fear, but this will always be mingled
+with contempt. In speaking of the management of insane persons, it is to
+be understood that the superintendant must first obtain an ascendency over
+them. When this is once effected, he will be enabled, on future occasions,
+to direct and regulate their conduct, according as his better judgment may
+suggest. He should possess firmness, and, when occasion may require,
+should exercise his authority in a peremptory manner. He should never
+threaten but execute; and when the patient has misbehaved, should confine
+him immediately. As example operates more forcibly than precept, I have
+found it useful, to order the delinquent to be confined in the presence of
+the other patients. It displays authority; and the person who has
+misbehaved becomes awed by the spectators, and<span class="pagenum"><a name="Page_280" id="Page_280">[Pg 280]</a></span> more readily submits. It
+also prevents the wanton exercise of force, and those cruel and unmanly
+advantages which might be taken when the patient and keeper are shut up in
+a private room. When the patient is a powerful man, two or more should
+assist in securing him: by these means it will be easily effected; for,
+where the force of the contending persons is nearly equal, the mastery
+cannot be obtained without difficulty and danger.</p>
+
+<p>When the patient is in a furious state, and uncontrolable by kindness and
+persuasion, he will generally endeavour, by any means, to do as much
+mischief as possible to the person who opposes him; and instances are not
+rare where he has overcome the keeper. When the maniac finds his strength,
+or skill in the contest prevail, he is sure to make the most of such
+advantage, and the consequence of his victory has<span class="pagenum"><a name="Page_281" id="Page_281">[Pg 281]</a></span> sometimes proved fatal
+to the keeper. On the other hand, it ought to be the object of the keeper
+to subdue the maniac without doing him any personal injury; and after he
+has overpowered, to confine him, and thus prevent him from attempting any
+further mischief. When the patient is a strong man, and highly irritated,
+it will be impossible for any keeper singly to overcome him without his
+most forcible exertions, and these cannot be put forth without great
+violence to the patient. But subduing the maniac, is not the only object,
+he must afterwards be secured by the straight-waistcoat, or by manacles.
+It will be seen, that the keeper, who, by the great exertion of his bodily
+powers, has become faint and exhausted, will be very little in a condition
+to secure the patient, as his hands must be employed with the implements
+necessary to confine him; moreover, the patient will have additional
+strength from the temperate<span class="pagenum"><a name="Page_282" id="Page_282">[Pg 282]</a></span> manner, in which he is made to live; whereas,
+it is but too common, for the keeper to indulge in a diet and beverage,
+which induce corpulence and difficulty of breathing.<a name='fna_26' id='fna_26' href='#f_26'><small>[26]</small></a></p>
+
+<p>As management is employed to produce<span class="pagenum"><a name="Page_283" id="Page_283">[Pg 283]</a></span> a salutary change upon the patient,
+and to restrain him from committing violence on others and himself; it may
+here be proper to enquire, upon what occasions, and to what extent,
+coercion may be used. The term coercion has been understood in a very
+formidable sense, and not without reason. It has been recommended by very
+high medical authority to inflict corporal punishment upon maniacs, with a
+view of rendering them rational, by impressing terror.<a name='fna_27' id='fna_27' href='#f_27'><small>[27]</small></a> From Dr. Mead&#8217;s
+section on madness it would appear, that in his time flagellation was a
+common remedy for this disorder. &#8220;There is no disease more to be dreaded
+than madness. For what greater unhappiness can befal a man, than to be
+deprived of his reason and understanding, to attack his fellow creatures
+with fury, like a wild beast; to be tied down, <i>and even beat</i>, to<span class="pagenum"><a name="Page_284" id="Page_284">[Pg 284]</a></span>
+prevent his doing mischief to himself or others.&#8221;&mdash;<i>Medical Precepts and
+Cautions</i>, <i>page</i> 74.</p>
+
+<p>Dramatic writers abound with allusions to the whip, in the treatment of
+madness. &#8220;Love is meerely a madnesse, and I tel you, deserves as well a
+darke house, and a whip, as madmen do: and the reason why they are not so
+punish&#8217;d and cured, is, that the Lunacie is so ordinary, that the whippers
+are in love too.&#8221;&mdash;<i>As You Like It</i>, <i>act</i> III. <i>scene</i> 2.</p>
+
+<p>Another instance to the same effect may be found in Mr. Dennis&#8217;s comedy of
+Jacobite Credulity. &#8220;<i>Bull Junior.</i> Look you, old gentleman, I will touch
+this matter as gently as I can to you. Your friends taking notice, that
+you were grown something foolish, whimsical, absurd, and so forth, thought
+fit to have you sent to the College<span class="pagenum"><a name="Page_285" id="Page_285">[Pg 285]</a></span> here, [Bedlam] that you might go
+through a course of philosophy, and be cudgel&#8217;d and firk&#8217;d into a little
+wisdom, by the surly Professors of this place.&#8221;&mdash;<i>Select Works</i>, <i>vol.</i>
+ii. <i>p.</i> 363. And again, in the next page; &#8220;If thou canst give but so much
+as a reasonable answer to any thing; if thou either knowest what thou art,
+or where thou art, or with whom thou art, then will I be contented to be
+thought mad, and dieted and flogged in thy stead.&#8221;</p>
+
+<p>It also appears from Mr. Douce&#8217;s valuable dissertation, that the
+domesticated fool frequently underwent a similar castigation, to curb the
+licentiousness of his discourse, or, as a punishment for the obscenity of
+his actions. Indeed this system of corporal chastisement seems to have
+been general, and may afford some apology for introducing, from a very
+rare little book, an<span class="pagenum"><a name="Page_286" id="Page_286">[Pg 286]</a></span> account of the manner of treating this malady in
+Constantinople, about the middle of the 16th century.<a name='fna_28' id='fna_28' href='#f_28'><small>[28]</small></a></p>
+
+<p><span class="pagenum"><a name="Page_287" id="Page_287">[Pg 287]</a></span>&#8220;<i>Of a place called Timarahane for the Correction of the Insane.</i></p>
+
+<p>&#8220;The sultan Bajazet caused a building to be erected for the reception of
+insane persons, in order, that they might not wander about the city, and
+there exhibit their mad pranks. This building is constructed in the manner
+of an hospital: there are about an hundred and fifty keepers appointed to
+look after them; they are likewise furnished with medicines and other
+necessary articles. These keepers, armed with cudgels, patrole the city in
+search of the insane; and when they discover such, they secure them by the
+neck and hands with an iron chain, and, by dint of the cudgel, convey them
+to Timarahane. On entering this place, they are confined by the neck, with
+a much larger chain, which is fixed into the wall, and comes over their
+bed place, so that they are kept chained in their beds. In general, about
+forty are confined there, at some distance from each other.</p>
+
+<p><span class="pagenum"><a name="Page_288" id="Page_288">[Pg 288]</a></span>&#8220;They are frequently visited by the people of the city, as a species of
+amusement. The keepers constantly stand over them with cudgels; for, if
+left to themselves, they would spoil and destroy their beds and hurl the
+tables at each other. At the times of giving them food, the keepers
+examine them, and, if they notice any, who are disorderly, they beat them
+severely; but, if they should by accident, find any, who no longer exhibit
+symptoms of insanity, they treat them with greater regard.&#8221;</p>
+
+<p>What success may have followed such disgraceful and inhuman treatment, I
+have not yet learned; nor should I be desirous of meeting with any one,
+who could give me the information.</p>
+
+<p>If the patient be so far deprived of understanding, as to be insensible
+why he is punished, such correction, setting aside its<span class="pagenum"><a name="Page_289" id="Page_289">[Pg 289]</a></span> cruelty, is
+manifestly absurd: and, if his state be such, as to be conscious of the
+impropriety of his conduct, there are other methods more mild and
+effectual. Would any rational practitioner, in a case of phrenitis, or in
+the delirium of fever, order his patient to be scourged? he would rather
+suppose, that the brain, or its membranes, were inflamed, and that the
+incoherence of discourse and violence of action were produced by such
+local disease. It has been shewn by the preceding dissections, that the
+contents of the cranium, in all the instances that have occurred to me,
+have been in a morbid state. It should, therefore, be the object of the
+practitioner, to remove such disease, rather than irritate and torment the
+sufferer.&mdash;Coercion should only be considered as a protecting and salutary
+restraint.</p>
+
+<p>In the most violent state of the disease,<span class="pagenum"><a name="Page_290" id="Page_290">[Pg 290]</a></span> the patient should be kept
+alone in a dark and quiet room, so that he may not be affected by the
+stimuli of light or sound, such abstraction more readily disposing to
+sleep. As in this violent state there is a strong propensity to associate
+ideas, it is particularly important to prevent the accession of such as
+might be transmitted through the medium of the senses. The hands should be
+properly secured, and the patient should also be confined by one leg; this
+will prevent him from committing any violence. The more effectual and
+convenient mode of confining the hands is by metallic manacles; for,
+should the patient, as frequently occurs, be constantly endeavouring to
+liberate himself, the friction of the skin against a polished metallic
+body may be long sustained without injury; whereas excoriation shortly
+takes place when the surface is rubbed with linen or cotton. Ligatures
+should on all occasions be avoided. The straight<span class="pagenum"><a name="Page_291" id="Page_291">[Pg 291]</a></span> waistcoat is admirably
+calculated to prevent patients from doing mischief to themselves; but in
+the furious state, and particularly in warm weather, it irritates, and
+increases that restlessness which patients of this description usually
+labour under. They then disdain the incumbrance of clothing, and seem to
+delight in exposing their bodies to the atmosphere. Where the patient is
+in a condition to be sensible of restraint, he may be punished for
+improper behaviour, by confining him to his room, by degrading him, and
+not allowing him to associate with the convalescents, and by withholding
+certain indulgences, he had been accustomed to enjoy.</p>
+
+<p>In speaking of coercion, I cannot avoid reprobating a practice, which has
+prevailed in some private receptacles for the insane, but which, it is
+presumed, will henceforward<span class="pagenum"><a name="Page_292" id="Page_292">[Pg 292]</a></span> be discontinued. I mean, the practice of
+half-stifling a noisy patient, by placing a pillow before the mouth, and
+forcibly pressing upon it, so as to stop respiration. It is unnecessary to
+enquire, how such wanton cruelty came to be introduced; it must have been
+the suggestion of ignorance, and the perpetration of savageness and
+brutality. Sighs, tears, sobs, and exclamations, are the unaffected
+language of passion, and come kindly to our relief, in states of sorrow
+and alarm. Indeed, they appear to be the natural remedies, to</p>
+
+<p class="poem">&#8220;Cleanse the stufft bosom of that perillous stuffe,<br />
+Which weighs upon the heart.&#8221;</p>
+
+<p>The mild and rational practice of Bethlem Hospital, tolerates these
+involuntary ejaculations. It is there considered, that a noisy and
+loquacious maniac, has not the power to control his utterance of sounds,
+which, from the habitual <span class="pagenum"><a name="Page_293" id="Page_293">[Pg 293]</a></span>connexion between ideas and speech, must
+necessarily follow. It is there only viewed as a symptom, or part of the
+disorder; and that, if the cause cannot be suppressed, the effect should
+not be punished.</p>
+
+<p>As madmen frequently entertain very high, and even romantic notions of
+honour, they are often rendered much more tractable by wounding their
+pride, than by severity of discipline.</p>
+
+<p>Speaking of the effects of management, on a very extensive scale, I can
+truly declare, that by gentleness of manner, and kindness of treatment, I
+have seldom failed to obtain the confidence, and conciliate the esteem of
+insane persons, and have succeeded by these means in procuring from them
+respect and obedience. There are certainly some patients who are not to
+be<span class="pagenum"><a name="Page_294" id="Page_294">[Pg 294]</a></span> trusted, and in whom malevolence forms the prominent feature of their
+character: such persons should always be kept under a certain restraint,
+but this is not incompatible with kindness and humanity.</p>
+
+<p>It would, in this part of the work, be particularly gratifying to my
+feelings if I could develope this <i>English secret</i> for the moral
+management of the insane, which has been so ardently, yet unsuccessfully
+sought after by Dr. Pinel. For fourteen years I have been daily in the
+habit of visiting a very considerable number of madmen, and of mixing
+indiscriminately among them, without ever having received a blow or
+personal insult. During this time I have always gone alone, and have never
+found the necessity for the assistance or protection of a keeper. The
+superintendant of the Bic&ecirc;tre, according to Dr. Pinel&#8217;s account, is
+usually attended by his keepers,<span class="pagenum"><a name="Page_295" id="Page_295">[Pg 295]</a></span> [gens de service] though he is said to
+possess<a name='fna_29' id='fna_29' href='#f_29'><small>[29]</small></a> &#8220;une fermet&eacute; in&eacute;branlable, un courage raisonn&eacute; et soutenu par
+des qualit&eacute;s physiques les plus propres &aacute; imposer, une stature de corps
+bien proportionn&eacute;e, des membres pleins de force et de vigeur, et dans des
+momens orageux le ton de voix le plus foudroyant, la contenance la plus
+fi&eacute;re et la plus intrepide.&#8221; Not being myself endowed with any of these
+rare qualities; carrying no thunder in my voice, nor lightning in my eye,
+it has been requisite for me to have recourse to other expedients. In the
+first place, it has been thought proper to devote some time and attention
+to discover the character of the patient, and to ascertain wherein, and on
+what points, his insanity consists: it is also important to learn the
+history of his disorder, from his relatives and friends, and<span class="pagenum"><a name="Page_296" id="Page_296">[Pg 296]</a></span> to enquire
+particularly respecting any violence he may have attempted towards himself
+or others.</p>
+
+<p>In holding conferences with patients in order to discover their insanity,
+no advantage has ever been derived from assuming a magisterial importance,
+or by endeavouring to stare them out of countenance: a mildness of manner
+and expression, an attention to their narrative, and seeming acquiescence
+in its truth, succeed much better. By such conduct they acquire confidence
+in the practitioner; and if he will have patience, and not too frequently
+interrupt them, they will soon satisfy his mind as to the derangement of
+their intellects.</p>
+
+<p>When a patient is admitted into Bethlem Hospital, if he be sufficiently
+rational to profit by such tuition, it is explained to him, by the keepers
+and convalescents, that<span class="pagenum"><a name="Page_297" id="Page_297">[Pg 297]</a></span> he is to be obedient to the officers of the
+house, and especially to myself, with whom he will have daily intercourse;
+they point out to him, that all proper indulgences will be allowed to good
+behaviour, and that seclusion and coercion instantly succeed to
+disobedience and revolt. As <i>nemo repente turpissimus</i>, so no one in an
+instant, from a state of tranquillity, becomes furiously mad: the
+precursory symptoms are manifold and successive, and allow of sufficient
+time to secure the patient before mischief ensues; it is principally by
+taking these precautions that our patients are observed to be so orderly
+and obedient. The examples of those who are under strict coercion, being
+constantly in view, operate more forcibly on their minds than any precepts
+which the most consummate wisdom could suggest. In this moral management,
+the co-operation of the convalescents is particularly serviceable; they
+consider themselves in a state<span class="pagenum"><a name="Page_298" id="Page_298">[Pg 298]</a></span> of probation, and, in order to be
+liberated, are anxious, by every attention and assistance, to convince the
+superintendants of their restoration to sanity of mind. From mildness of
+treatment, and confidence reposed in them, they become attached, and are
+always disposed to give information concerning any projected mischief.</p>
+
+<p>Considering how much we are the creatures of habit, it might naturally be
+hoped, and experience justifies the expectation, that madmen might be
+benefited by bringing their actions into a system of regularity. It might
+be supposed, that as thought precedes action, that whenever the ideas are
+incoherent, the actions will also be irregular. Most probably they would
+be so, if uncontroled; but custom, confirmed into habit, destroys this
+natural propensity, and renders them correct in their behaviour,<span class="pagenum"><a name="Page_299" id="Page_299">[Pg 299]</a></span> though
+they still remain equally depraved in their intellects.</p>
+
+<p>We have a number of patients in Bethlem Hospital, whose ideas are in the
+most disordered state, who yet act, upon ordinary occasions, with great
+steadiness and propriety, and are capable of being trusted to a
+considerable extent. A fact of such importance in the history of the human
+mind, might lead us to hope, that by superinducing different habits of
+thinking, the irregular associations would be corrected.</p>
+
+<p>It is impossible to effect this suddenly, or by reasoning, for madmen can
+never be convinced of the folly of their opinions. Their belief in them is
+firmly fixed, and cannot be shaken. The more frequently these opinions are
+recurred to, under a conviction of their truth, the deeper they subside in
+the mind, and become more <span class="pagenum"><a name="Page_300" id="Page_300">[Pg 300]</a></span>obstinately entangled:<a name='fna_30' id='fna_30' href='#f_30'><small>[30]</small></a> the object should
+therefore be to prevent such recurrence by occupying the mind on different
+subjects, and thus diverting it from the favorite and accustomed train of
+ideas.</p>
+
+<p>As I have been induced to suppose, from the appearances on dissection,
+that the immediate cause of this disease probably consists in a morbid
+affection of the brain, it may be inferred, that all modes of cure by
+reasoning, or conducting the current of thought into different channels,
+must be ineffectual, so long as such local disease shall continue. It is,
+however, likely that insanity is often continued by habit; that incoherent
+associations, frequently recurred to,<span class="pagenum"><a name="Page_301" id="Page_301">[Pg 301]</a></span> become received as truths, in the
+same manner as a tale, which, although untrue, by being repeatedly told,
+shall be credited at last by the narrator, as if it had certainly
+happened. It should likewise be observed, that these incorrect
+associations of ideas are acquired in the same way as just ones are
+formed, and that such are as likely to remain as the most accurate
+opinions. The generality of minds are very little capable of tracing the
+origin of their ideas; there are many opinions we are in possession of,
+with the history and acquisition of which, we are totally unacquainted. We
+see this in a remarkable manner in patients who are recovering from their
+insanity: they will often say such appearances have been presented to my
+mind, with all the force and reality of truth: I saw them as plainly as I
+now behold any other object, and can hardly be persuaded that they did not
+occur. It also does not unfrequently happen, that<span class="pagenum"><a name="Page_302" id="Page_302">[Pg 302]</a></span> patients will declare,
+that certain notions are forced into their minds, of which they see the
+folly and incongruity, and yet complain that they cannot prevent their
+intrusion.</p>
+
+<p>As the patient should be taught to view the medical superintendant as a
+superior person, the latter should be particularly cautious never to
+deceive him. Madmen are generally more hurt at deception than punishment;
+and, whenever they detect the imposition, never fail to lose that
+confidence and respect which they ought to entertain for the person who
+governs them.</p>
+
+<p>In the moral management of the insane, this circumstance cannot be too
+strongly impressed on the mind of the practitioner: and those persons, who
+have had the greatest experience in this department of medical science,
+concur in this opinion. The late<span class="pagenum"><a name="Page_303" id="Page_303">[Pg 303]</a></span> Dr. John Monro expressly says, &#8220;The
+physician should never deceive them in <i>any</i> thing, but more especially
+with regard to their distemper; for as they are generally conscious of it
+themselves, they acquire a kind of reverence for those who know it; and by
+letting them see, that he is thoroughly acquainted with their complaint,
+he may very often gain such an ascendant over them, that they will readily
+follow his directions.&#8221;<a name='fna_31' id='fna_31' href='#f_31'><small>[31]</small></a></p>
+
+<p>Very different directions are, however, issued by a late writer,<a name='fna_32' id='fna_32' href='#f_32'><small>[32]</small></a> and
+which, on account of their novelty, contrivance, and singular morality,
+deserve the consideration of the reader.</p>
+
+<p>&#8220;The <i>conscientious physician</i>, in the <span class="pagenum"><a name="Page_304" id="Page_304">[Pg 304]</a></span>execution of his duty, attempting
+the removal of these deplorable maladies, is under the necessity of
+occasionally deviating from the accustomed routine of practice, of
+stepping out of the beaten track, and, in some cases, that have resisted
+the usual methods, is warranted in adopting any others, that have <i>only</i>
+the slightest <i>plausibility</i>, or that promise the smallest hope of
+success. Thus, the employment of what may be termed <i>pious frauds</i>: as
+when <i>one</i> simple erroneous idea stamps the character of the disease,
+depriving the affected party of the common enjoyments of society, though
+capable of reasoning with propriety, perhaps, with ingenuity, on every
+subject, not connected with that of his hallucination, the correction of
+which has resisted our very best exertions, and, where there is no obvious
+corporeal indisposition, it certainly is allowable to try the effect of
+certain deceptions, contrived to make strong impressions on the<span class="pagenum"><a name="Page_305" id="Page_305">[Pg 305]</a></span> senses,
+by means of <i>unexpected</i>, <i>unusual</i>, <i>striking</i>, or apparently
+<i>supernatural</i> agents; such as after waking the party from sleep, either
+suddenly or by a gradual process, by <i>imitated thunder</i>, or soft music,
+according to the peculiarity of the case; <i>combating</i> the erroneous
+deranged notion, either by some <i>pointed sentence</i>, or signs <i>executed in
+phosphorus</i> upon the wall of the bed chamber; or by some <i>tale</i>,
+<i>assertion</i>, or <i>reasoning</i>; by one in the character of an <i>angel</i>,
+<i>prophet</i>, or <i>devil</i>: but the actor in this drama must possess much
+<i>skill, and be very perfect in his part</i>.&#8221;</p>
+
+<p>It is of great service to establish a system of regularity in the actions
+of insane people. They should be made to rise, take exercise, and food, at
+stated times. Independently of such regularity contributing to health, it
+also renders them much more easily manageable.</p>
+
+<p><span class="pagenum"><a name="Page_306" id="Page_306">[Pg 306]</a></span>Concerning their diet, it is merely necessary to observe, that it should
+be light, and easy of digestion. The proper quantity must be directed by
+the good sense of the superintendant, according to the age and vigour of
+the patient, and proportioned to the degree of bodily exercise he may be
+in the habit of using; &#8220;but they should never be suffered to live too low,
+especially while they are under a course of physic.&#8221;<a name='fna_33' id='fna_33' href='#f_33'><small>[33]</small></a> To my knowledge,
+no experiments have yet been instituted respecting the diet of insane
+persons: they have never been compelled to live entirely on farinaceous
+substances. The diet of Bethlem Hospital allows animal food three times a
+week, and on the other days bread with cheese, or occasionally butter,
+together with milk pottage, rice milk, &amp;c. Those who are regarded as
+incurable patients ought certainly to be indulged in a<span class="pagenum"><a name="Page_307" id="Page_307">[Pg 307]</a></span> greater latitude
+of diet, but this should never be permitted to border on intemperance. To
+those who are in circumstances to afford such comforts, wine may be
+allowed in moderation, and the criterion of the proper quantity, will be
+that which does not affect the temper of the lunatic, that which does not
+exasperate his aversions, or render his philosophy obtrusive. Although it
+seems rational in all states of madness, that temperance should be
+strictly enjoined, yet an author of the present day<a name='fna_34' id='fna_34' href='#f_34'><small>[34]</small></a> steps out of the
+trodden path, and seriously advises us, in difficult cases, to drown
+lunacy in intoxication; and, strange as it may appear, has taught us to
+await the feast of Reason from the orgies of Bacchus. &#8220;The conversion of
+religious melancholy into furious madness is a frequent occurrence, and is
+<span class="pagenum"><a name="Page_308" id="Page_308">[Pg 308]</a></span>generally followed by recovery. This has suggested the <i>propriety</i>, in
+some cases that have resisted more common means, of producing a degree of
+excitement by means of stimuli, in fact, <i>keeping the patient for days in
+succession in a state of intoxication</i>, which has often occasioned an
+alleviation of symptoms, and sometimes <i>restored the sufferers to
+reason</i>.&#8221;</p>
+
+<p>Confinement is always necessary in cases of insanity, and should be
+enforced as early in the disease as possible. By confinement, it is to be
+understood that the patient should be removed from home. During his
+continuance at his own house he can never be kept in a tranquil state. The
+interruptions of his family, the loss of the accustomed obedience of his
+servants, and the idea of being under restraint, in a place where he
+considers himself the master, will be constant sources of irritation to
+his mind. It<span class="pagenum"><a name="Page_309" id="Page_309">[Pg 309]</a></span> is also known, from considerable experience, that of those
+patients who have remained under the immediate care of their relatives and
+friends, very few have recovered. Even the visits of their friends, when
+they are violently disordered, are productive of great inconvenience, as
+they are always more unquiet and ungovernable for some time afterwards. It
+is a well-known fact, that they are less disposed to acquire a dislike to
+those who are strangers, than to those with whom they have been intimately
+acquainted; they become therefore less dangerous, and are more easily
+restrained. It ought to be understood that no interruption to this
+discipline should defeat its salutary operation. On this account more
+patients recover in a public hospital, than in a private house,
+appropriated for the reception of lunatics. In the former, the
+superintendants persist in a plan laid down, and seldom deviate from<span class="pagenum"><a name="Page_310" id="Page_310">[Pg 310]</a></span>
+their established rules: such asylum being a place of charitable relief,
+they are indifferent about pleasing the friends and relatives of the
+patient, who cannot there intrude to visit them at their option. In a
+private receptacle emolument is the first object, and however wisely they
+may have formed their regulations, they soon feel themselves subordinate
+to the caprice and authority of those by whom they are paid.</p>
+
+<p>It frequently happens, that patients who have been brought immediately
+from their families, and who were said to be in a violent and ferocious
+state at home, become suddenly calm and tractable when placed in the
+hospital. On the other hand it is equally certain, that there are many
+patients whose disorder speedily recurs after having been suffered to
+return to their families, although they have for a length of time
+conducted themselves, under confinement,<span class="pagenum"><a name="Page_311" id="Page_311">[Pg 311]</a></span> in a very orderly manner. When
+they are in a convalescent state the occasional visits of their friends
+are attended with manifest advantage. Such an intercourse imparts
+consolation, and presents views of future happiness and comfort. But
+certain restrictions should be imposed on the visits of these friends;
+ignorant people often, after a few minutes conversation with the patient,
+will suppose him perfectly recovered, and acquaint him with their opinion:
+this induces him to suppose that he is well, and he frequently becomes
+impatient of confinement and restraint. From such improper intercourse I
+have known many patients relapse, and in two instances I have a
+well-founded suspicion that it excited attempts at suicide.</p>
+
+<p>Many patients have received considerable benefit by change of situation,
+which occupies the mind with new objects, and this<span class="pagenum"><a name="Page_312" id="Page_312">[Pg 312]</a></span> sometimes takes place
+very shortly after the removal.</p>
+
+<p class="poem">&#8220;Haply the Seas and Countries different<br />
+With variable objects, shall expell<br />
+This something setled matter in his heart:<br />
+Whereon his Braines still beating, puts him thus<br />
+From fashion of himselfe.&#8221;</p>
+
+<p>In what particular cases, or stages of the disease, this may be
+recommended, I am not enabled, by sufficient experience, to determine.</p>
+
+
+<p>&nbsp;</p><p>&nbsp;</p>
+<hr style="width: 50%;" />
+<p><span class="pagenum"><a name="Page_313" id="Page_313">[Pg 313]</a></span></p>
+<h2>CHAP. VIII.</h2>
+<p class="center"><span class="large">REMEDIES FOR INSANITY.</span></p>
+
+
+<p class="center"><br /><i>Bleeding.</i></p>
+
+<p class="dropcap"><span class="caps">Where</span> the patient is strong, and of a plethoric habit, and where the
+disorder has not been of any long continuance, bleeding has been found of
+considerable advantage, and as far as I have yet observed, is the most
+beneficial remedy that has been employed. The melancholic cases have been
+equally relieved with the maniacal by this mode of treatment. Venesection
+by the arm is, however, inferior in its good effects<span class="pagenum"><a name="Page_314" id="Page_314">[Pg 314]</a></span> to blood taken from
+the head by cupping. This operation, performed in the manner to which I
+have been accustomed, consists in having the head previously shaven, and
+six or eight cupping glasses applied on the scalp. By these means any
+quantity of blood may be taken, and in as short a time, as by an orifice
+made in a vein by the lancet. When the raving paroxysm has continued for a
+considerable time, and the scalp has become unusually flaccid; or where a
+stupid state has succeeded to violence of considerable duration, no
+benefit has been derived from bleeding: indeed these states are generally
+attended by a degree of bodily weakness, sufficient to prohibit such
+practice independently of other considerations.</p>
+
+<p>The quantity of blood to be taken, must be left to the discretion of the
+practitioner: from eight to sixteen ounces may be drawn,<span class="pagenum"><a name="Page_315" id="Page_315">[Pg 315]</a></span> and the
+operation occasionally repeated, as circumstances may require.</p>
+
+<p>In some cases where blood was drawn at the commencement of the disease
+from the arm, and from patients who were extremely furious and
+ungovernable, it was covered with a buffy coat; but in other cases it has
+seldom or never such an appearance. In more than two hundred patients,
+male and female, who were let blood by venesection, there were only six
+whose blood could be termed sizy.</p>
+
+<p>In some few instances hemoptysis has preceded convalescence, as has also a
+bleeding from the hemorrhoidal veins. Epistaxis has not, to my knowledge,
+ever occurred.</p>
+
+<p>Before particular remedies, to be employed for the cure of mania and
+melancholia, are recommended, it may be necessary to give<span class="pagenum"><a name="Page_316" id="Page_316">[Pg 316]</a></span> some directions
+concerning the means to be used for their certain administration.</p>
+
+<p>Maniacs in general feel a great aversion to become benefited from those
+medicinal preparations which practitioners employ for their relief; and on
+many occasions they refuse them altogether. Presuming that some good is to
+be procured by the operation of medicines on persons so affected, and
+aware of their propensity to reject them, it becomes a proper object of
+enquiry how such salutary agents may most securely, and with the least
+disadvantage, be conveyed into the stomachs of these refractory subjects.
+For the attainment of this end various instruments have been contrived,
+but that which has been more frequently employed, and is the most
+destructive and devilish engine of this set of apparatus, is termed a
+<i>spouting</i> boat. It will not be necessary to fatigue the reader with<span class="pagenum"><a name="Page_317" id="Page_317">[Pg 317]</a></span> a
+particular description of this coarse tool, except to remark, that it is
+constructed somewhat like a child&#8217;s pap boat; and is intended to force an
+entrance into the mouth through the barriers of the teeth.<a name='fna_35' id='fna_35' href='#f_35'><small>[35]</small></a></p>
+
+<p>In those cases, where patients have been obstinately bent on starving
+themselves, or where they have become determined to resist the
+introduction of remedies calculated for their relief, I have always been
+enabled to convey both into their stomachs, at any time, and in any
+quantity that might be<span class="pagenum"><a name="Page_318" id="Page_318">[Pg 318]</a></span> necessary, by the employment of an instrument, of
+which the figure and dimensions are here given.</p>
+
+<p>&nbsp;</p>
+<div class="figcenter"><img src="images/page_318.jpg" alt="" /></div>
+<p>&nbsp;</p>
+
+<p><span class="pagenum"><a name="Page_319" id="Page_319">[Pg 319]</a></span>Since the use of this very simple and efficient instrument, which I
+constructed about twelve years ago, I can truly affirm, that no patient
+has ever been deprived of a tooth, and that the food or remedy has always
+been conveyed into the stomach of the patient.</p>
+
+<p>The manner in which this compulsory operation is performed, consists in
+placing the head of the patient between the knees of the person who is to
+use the instrument: a second assistant secures the hands, (if the
+straight-waistcoat be not employed) and a third keeps down the legs. As
+soon as the mouth is opened, the instrument may be introduced; it presses
+down the tongue, and keeps the jaws sufficiently asunder to admit of the
+introduction of the medicine, which should be contained in a vial, or tin
+pot with a spout, to allow it to run in a small stream. The nose of the
+patient being held<span class="pagenum"><a name="Page_320" id="Page_320">[Pg 320]</a></span> by the left hand of the person who uses the
+instrument, a small quantity of the medicine is to be poured into the
+mouth, and when deglutition has commenced, is to be repeated, so as to
+continue the act of swallowing until the whole be taken.</p>
+
+<p>A little address will obviate the determination of the patient to keep his
+teeth closed: he may be blindfolded at the commencement, which never fails
+to alarm him, and urges him to enquire what the persons around him are
+about: causing him to sneeze, by a pinch of snuff, always opens the mouth
+previously to that convulsion, or tickling the nose with a feather
+commonly produces the same effect.</p>
+
+<p>With delicate females, where one or more of the grinder-teeth are wanting,
+the finger may be introduced on the inside of the cheek, which being
+strongly pressed<span class="pagenum"><a name="Page_321" id="Page_321">[Pg 321]</a></span> outwards will prevent the patient from biting, and form
+a sufficient cavity to pour in the liquid. With a wish of speaking
+confidently on this subject, I have usually performed the business of
+forcing, more especially amongst the females, and it has, in some degree,
+rewarded my trouble; it has ascertained the practicability of
+administering remedies; and it has also afforded the consolation, that,
+where the means employed have produced no good, the patient has sustained
+no injury.</p>
+
+
+<p class="center"><br /><i>Purging.</i></p>
+
+<p>An opinion has long prevailed, that mad people are particularly
+constipated, and likewise extremely difficult to be purged. From all the
+observations I have been able to make, insane patients, on the contrary,
+are of very delicate and irritable bowels, and<span class="pagenum"><a name="Page_322" id="Page_322">[Pg 322]</a></span> are well, and copiously
+purged, by a common cathartic draught. That, which has been commonly
+employed at the hospital, was prepared agreeably to the following formula:</p>
+
+<table border="0" cellpadding="0" cellspacing="5" summary="table">
+<tr><td>&#8478;.</td><td>Infusi senn&aelig; &#8485;iss ad &#8485;ij.</td></tr>
+<tr><td>&nbsp;</td><td>Tinctur&aelig; senn&aelig; &#8488;i ad &#8488;ij.</td></tr>
+<tr><td>&nbsp;</td><td>Syrupi spin&aelig; cervin&aelig; &#8488;i ad &#8488;ij.</td></tr></table>
+
+<p>but, within the last seven years, the tinctura jalapij has been
+substituted for the tinctura senn&aelig;. It is so far an improvement, that it
+operates more speedily, and produces less griping.</p>
+
+<p>This medicine seldom fails of procuring four or five stools, and
+frequently a greater number.</p>
+
+<p>In confirmation of what I have advanced, respecting the irritable state of
+the intestines in mad people, it may be mentioned, that the ordinary
+complaints, with which<span class="pagenum"><a name="Page_323" id="Page_323">[Pg 323]</a></span> they are affected, are diarrh&oelig;a and dysentery:
+these have heretofore been very violent and obstinate.</p>
+
+<p>Perhaps it may be attributed to superior care that the occurrence of these
+complaints has, of late years, been comparatively rare, contrasted with
+the numbers who were formerly attacked with such diseases; and, when they
+do happen, an improved method of treatment has rendered these intestinal
+affections no longer formidable or fatal.</p>
+
+<p>In those very violent diarrh&oelig;as, which ordinarily terminate in
+dysentery, from five to ten grains of the pilula hydrargyri have been
+given according to the sex, constitution, and nature of the complaint,
+once or twice a day, and with general success.</p>
+
+<p>It may be necessary to add, that it is proper, during the course of this
+mercurial<span class="pagenum"><a name="Page_324" id="Page_324">[Pg 324]</a></span> remedy, which shortly arrests the disease, to keep the bowels
+in an open state, by some of the milder purgatives employed every third or
+fourth day.</p>
+
+<p>Diarrh&oelig;a very often proves a natural cure of insanity; at least, there
+is sufficient reason to suppose, that such evacuation has very much
+contributed to it. The number of cases, which might be adduced in
+confirmation of this remark, is considerable; and the speedy
+convalescence, after such evacuation, is still more remarkable.</p>
+
+<p>In many cases of insanity there prevails a great degree of insensibility,
+so that patients have scarcely appeared to feel the passing of setons, the
+drawing of blisters, or the punctures of cupping. On many occasions, I
+have known the urine retained for a considerable time, without complaint
+from the patient, although it is well <span class="pagenum"><a name="Page_325" id="Page_325">[Pg 325]</a></span>ascertained, that there is no
+affection more painful and distressing than distension of the bladder.</p>
+
+<p>Of this general insensibility the intestinal canal may be supposed to
+partake; but this is not commonly the case; and, if it should frequently
+prevail, would be widely different from a particular and exclusive torpor
+of the prim&aelig; vi&aelig;.</p>
+
+<p>But, sometimes, there arises a state of disease in maniacs, where the
+stomach and intestines are particularly inert. The patient refuses to take
+food, and is obstinately constipated: the tongue is foul, and the skin is
+tinged with a yellowish hue: the eyes assume a glossy lustre, and exhibit
+a peculiar wildness. In this state, I have given two drachms of the pulvis
+jalapij for a dose, and which, on some occasions, has procured but one
+stool, so that it has been<span class="pagenum"><a name="Page_326" id="Page_326">[Pg 326]</a></span> necessary several times to repeat the same
+quantity. After the bowels have been sufficiently evacuated, the appetite
+commonly returns, and the patient takes food as usual.</p>
+
+<p>Much mischief may be produced, if it be attempted to force food into the
+stomach in such a case, which the ignorance of keepers may attempt,
+supposing it to originate in the obstinacy of the patient. In order to
+continue the bowels in a relaxed state, after they have been sufficiently
+emptied of their contents, the following formula has been employed with
+advantage:</p>
+
+<table border="0" cellpadding="0" cellspacing="5" summary="table">
+<tr><td>&#8478;.</td><td>Infusi senn&aelig;, &#8485;vijss</td></tr>
+<tr><td>&nbsp;</td><td>Kali Tartarizati, &#8485;ss</td></tr>
+<tr><td>&nbsp;</td><td>Antimonij Tartarizati, gr 1ss</td></tr>
+<tr><td>&nbsp;</td><td>Tinctur&aelig; jalapij, &#8488;ij</td></tr></table>
+
+<p>From two to three table spoonsful may be given once or twice a day, as
+occasion may require.</p>
+
+<p><span class="pagenum"><a name="Page_327" id="Page_327">[Pg 327]</a></span>There are some circumstances unconnected with disease of mind, which might
+dispose insane persons to costiveness. I now speak of such as are
+confined, and who come more directly under our observation. When they are
+mischievously disposed they require a greater degree of restraint, and are
+consequently deprived of that air and exercise which so much contribute to
+regularity of bowels. It is well known that those who have been in the
+habits of free living, and who come suddenly to a more temperate diet, are
+very much disposed to costiveness. But to adduce the fairest proof of what
+has been advanced, I can truly state, that incurable patients, who have
+for many years been confined in the Hospital, are subject to no
+inconveniences from constipation. Many patients are averse to food, and
+where little is taken in, the egesta must be inconsiderable.</p>
+
+<p><span class="pagenum"><a name="Page_328" id="Page_328">[Pg 328]</a></span>To return from this digression: it is concluded, from very ample
+experience, that cathartic medicines are of the greatest service, and
+ought to be considered as an indispensable remedy in cases of insanity.
+The good sense and experience of every practitioner must direct him as to
+the dose, and frequency with which these means are to be employed, and of
+the occasions where they would be prejudicial.</p>
+
+
+<p class="center"><br /><i>Vomiting.</i></p>
+
+<p>However strongly this practice may have been recommended, and how much
+soever it may at present prevail, I am sorry that it is not in my power to
+speak of it favourably. In many instances, and in some where blood-letting
+had been previously employed, paralytic affections have within a few hours
+supervened on the exhibition of an emetic,<span class="pagenum"><a name="Page_329" id="Page_329">[Pg 329]</a></span> more especially where the
+patient has been of a full habit, and has had the appearance of an
+increased determination to the head.</p>
+
+<p>It has been for many years the practice of Bethlem Hospital to administer
+to the curable patients four or five emetics in the spring of the year;
+but, on consulting my book of cases, I have not found that such patients
+have been particularly benefited by the use of this remedy. From one grain
+and half to two grains of tartarized antimony has been the usual dose,
+which has hardly ever failed of procuring full vomiting. In the few
+instances where the plan of exhibiting this medicine in nauseating doses
+was pursued for a considerable time, it by no means answered the
+expectations which had been raised in its favour by very high authority.
+Where the tartarized antimony, given with this intention, operated as<span class="pagenum"><a name="Page_330" id="Page_330">[Pg 330]</a></span> a
+purgative, it generally produced beneficial effects.</p>
+
+<p>Ten years have elapsed since the former edition of this work appeared; but
+this length of time, and subsequent observation, have not enabled me to
+place any greater confidence in the operation of emetics, as a cure for
+insanity.</p>
+
+<p>An author<a name='fna_36' id='fna_36' href='#f_36'><small>[36]</small></a> who has lately published a work, entitled &#8220;<i>Practical
+Observations on Insanity</i>,&#8221; is however a determined fautor of emetics in
+maniacal cases. In his skilful hands they have worked marvellous cures;
+nor have any prejudicial effects ever resulted from their employment.
+Perhaps no one has enjoyed a fairer opportunity of witnessing the effects
+of remedies for insane persons than myself; and when emetics are employed
+in Bethlem Hospital they have<span class="pagenum"><a name="Page_331" id="Page_331">[Pg 331]</a></span> the best chance of effecting all the relief
+they are competent to afford, as they are given by themselves, without the
+intervention of other medicines; and this course of emetics usually
+continues six weeks. Had Dr. Cox confined himself to the relation of his
+own victories in combating madness with vomits, it would have been
+sufficient; but he endeavours to raise the leve&eacute; en masse of medical
+opinion to co-operate with his sentiments. He says, page 78, &#8220;Yet <i>every</i>
+physician, who has devoted his attention to this branch of the profession,
+<i>must</i> differ from him when he treats of vomiting.&#8221; It was never my
+intention to deny, in a disordered state of the stomach, that the madman
+would be equally benefited with one in his senses by the operation of a
+vomit: but I have asserted, that after the administration of many thousand
+emetics to persons who were insane, but otherwise in good health, that I
+never saw any benefit<span class="pagenum"><a name="Page_332" id="Page_332">[Pg 332]</a></span> derived from their use. It will also be granted,
+that some ascendancy may be gained over a furious maniac by forcing him to
+take a vomit, or any other medicine, but this is widely different from any
+positive advantage resulting from the act of vomiting. Sir John Colebatch,
+in his &#8220;<i>Dissertation concerning Misletoe</i>,&#8221; says, <i>p.</i> 35, &#8220;But I have
+been for some years afraid of giving vomits, even of the gentlest sort, in
+convulsive distempers, from some terrible accidents, that have been likely
+to ensue, from moderate doses of Ipecacuanha itself.&#8221;</p>
+
+<p>In St. Luke&#8217;s hospital, the largest public receptacle for insane persons,
+where the medical treatment is directed by a physician of the highest
+character and eminence, and whose experience is, at least, equal to that
+of any professional man in this country, vomits are by no means considered
+as the<span class="pagenum"><a name="Page_333" id="Page_333">[Pg 333]</a></span> order of the day; they may be employed to remove symptoms
+concomitant with madness, but are not held as specifics for this disease.</p>
+
+<p>In reading over the cases related by Dr. Cox, there is no one, where
+emetics have been solely employed as agents of cure; they have been always
+linked with other remedies; and it requires more sagacity than even the
+doctor can exact, to pronounce, when different means of cure are combined,
+to which the palm should be adjudged. In the relation of my own experience
+concerning vomiting, as a remedy for insanity, I have had only in view the
+communication of facts, for I entertain neither partiality nor aversion to
+any remedies, beyond the fair claim which their operations possess. Had I
+modestly ventured to state, after the example of the Doctor, &#8220;that I had
+<i>devoted</i> myself <span class="pagenum"><a name="Page_334" id="Page_334">[Pg 334]</a></span><i>exclusively</i> and <i>assiduously</i> for a <i>series of years</i>,
+to the care of insane patients in an <i>establishment</i>, where persons of
+<i>both sexes</i> are received,&#8221;<a name='fna_37' id='fna_37' href='#f_37'><small>[37]</small></a> it might be suspected, that the
+superstructure of my philosophy had been reared on the basis of private
+emolument.</p>
+
+
+<p class="center"><br /><i>Camphor.</i></p>
+
+<p>This remedy has been highly extolled, and doubtless with reason, by those
+who have recommended it: my own experience merely extends to ten cases; a
+number, from which no decisive inference of its utility ought to be drawn.
+The dose was gradually increased, from five grains to two drachms, twice a
+day; and, in nine cases, the use of this remedy was continued for the
+space of two months. Of the patients, to whom the camphor was given, only
+two recovered:<span class="pagenum"><a name="Page_335" id="Page_335">[Pg 335]</a></span> one of these had no symptoms of convalescence for several
+months after the use of this remedy had been abandoned: the other, a
+melancholic patient, certainly mended during the time he was taking it;
+but he was never able to bear more than ten grains thrice a day. He
+complained that it made him feel as if he were intoxicated. Considering
+the insoluble nature of camphor, and the impracticability of compelling a
+lunatic to swallow a pill or bolus, it has been found convenient (when a
+large quantity was required) to give this medicine in the form of an
+emulsion, by dissolving the camphor in hot olive oil, and afterwards
+adding a sufficient quantity of warm water and aqua ammoni&aelig; pur&aelig;.</p>
+
+
+<p class="center"><br /><i>Cold Bathing.</i></p>
+
+<p>This remedy having for the most part<span class="pagenum"><a name="Page_336" id="Page_336">[Pg 336]</a></span> been employed, in conjunction with
+others, it becomes difficult to ascertain how far it may be exclusively
+beneficial in this disease. The instances where it has been separately
+used for the cure of insanity, are too few to enable me to draw any
+satisfactory conclusions. I may, however, safely relate, that in many
+instances, paralytic affections have in a few hours supervened on cold
+bathing, especially where the patient has been in a furious state, and of
+a plethoric habit. That this is not unlikely to happen may be supposed
+from the difficulty of compelling the patient to go head-foremost into the
+bath. In some cases vertigo, and in others a considerable degree of fever
+ensued after immersion. The shower-bath was employed some years ago in the
+hospital, and many cases were selected in order to give a fair trial to
+this remedy, but I am unable to say, that any considerable advantage was
+derived to the patients from its<span class="pagenum"><a name="Page_337" id="Page_337">[Pg 337]</a></span> use. If I might be permitted to give an
+opinion on this subject, the principal benefit resulting from this remedy,
+has been in the latter stages of the disease, and when the system had been
+previously lowered by evacuations. As a remedy for insanity cold bathing
+has been disregarded by a celebrated practitioner. To a question from a
+select committee of the House of Commons to Doctor Willis, 9th March,
+1807, the following answer was given.</p>
+
+<p><i>Question.</i> Are you of opinion that warm and cold baths are necessary for
+lunatic patients?</p>
+
+<p><i>Answer.</i> I think warm baths may be very useful, but it <i>can seldom
+happen</i> that a cold bath will be required.<a name='fna_38' id='fna_38' href='#f_38'><small>[38]</small></a></p>
+
+
+<p class="center"><br /><span class="pagenum"><a name="Page_338" id="Page_338">[Pg 338]</a></span><i>Blisters.</i></p>
+
+<p>These have been in several cases applied to the head, and a very copious
+discharge maintained for many days, but without any manifest advantage.
+The late Dr. John Monro, who had, perhaps, seen more cases of this disease
+than any other practitioner, and who, joined to his extensive experience,
+possessed the talent of accurate observation, mentions, that he &#8220;never saw
+the least good effect of blisters in madness, unless it was at the
+beginning, while there was some degree of fever, or when they have been
+applied to particular symptoms accompanying this complaint.&#8221;<a name='fna_39' id='fna_39' href='#f_39'><small>[39]</small></a> Dr. Mead
+also concurs in this opinion. &#8220;Blistering plasters applied to the head
+will possibly<span class="pagenum"><a name="Page_339" id="Page_339">[Pg 339]</a></span> be thought to deserve a place among the remedies of this
+disease, but I have often found them do more harm than good by their over
+great irritation.&#8221;&mdash;<i>Medical Precepts</i>, <i>page</i> 94. Although blisters
+appear to be of little service, when put on the head, yet I have, in many
+cases, seen much good result from applying them to the legs. In patients
+who have continued for some time in a very furious state, and where
+evacuations have been sufficiently employed, large blisters applied to the
+inside of the legs, have often, and within a short time, mitigated the
+violence of the disorder.</p>
+
+<p>In a few cases setons have been employed, but no benefit has been derived
+from their use, although the discharge was continued above two months.</p>
+
+<p>Respecting opium, it may be observed, that whenever it has been exhibited,
+during<span class="pagenum"><a name="Page_340" id="Page_340">[Pg 340]</a></span> a violent paroxysm, it has hardly ever procured sleep: but, on the
+contrary, has rendered those who have taken it much more furious: and,
+where it has for a short time produced rest, the patient has, after its
+operation, awaked in a state of increased violence.</p>
+
+<p>Many of the tribe of narcotic poisons have been recommended for the cure
+of madness; but, my own experience of those remedies is very limited, nor
+is it my intention to make further trials. Other, and perhaps whimsical
+modes of treating this disorder, have been mentioned: whirling,<a name='fna_40' id='fna_40' href='#f_40'><small>[40]</small></a> or
+spinning a madman round, on a pivot, has been gravely proposed; and, music
+has been extolled, with a considerable glow of imagination, by the same
+gentleman.&mdash;That the medical student may be fully aware of<span class="pagenum"><a name="Page_341" id="Page_341">[Pg 341]</a></span> the manifold
+agents which <i>practical physicians</i> have suggested for the restoration of
+reason, I shall conclude my volume with the following extract.<a name='fna_41' id='fna_41' href='#f_41'><small>[41]</small></a></p>
+
+<p>&#8220;The medical philosopher, in his study of human nature, must have
+observed, that <i>sympathetic correspondence of action</i> between the mind and
+body, which is <i>uniformly</i> present in health and disease, though <i>varying</i>
+with circumstances. The different passions, according to their nature, the
+degree or intensity of application, and the sensibility of the party,
+exhibit certain characteristic expressions of countenance, and produce
+obvious <i>changes</i>, actions, or motions, in the animal economy. <span class="smcap">Music</span> has
+been found to occasion <i>all</i> these actions, changes, and movements, in
+some sensible systems; and where one passion morbidly <span class="pagenum"><a name="Page_342" id="Page_342">[Pg 342]</a></span>predominates, as
+frequently happens in mania, those species of simple or combined sounds,
+<i>capable of exciting an opposite passion</i>, may be <i>very usefully</i>
+employed. <i>If</i> then such effects <i>can</i> be produced by such a power, acting
+on a mind only endued with its healthy proportion of susceptibility, what
+may we <i>not</i> expect where the sensibility is morbidly increased, and where
+the patient is alive to the most minute impressions? Cases frequently
+occur where such acuteness of sensibility, and <i>extreme</i> delicacy of
+system exist, that most of the more common, <i>moral</i>, and medical means are
+contra-indicated; <i>here</i> relief may be often administered through the
+medium of the <i>senses</i>; the <i>varied modulations, the lulling, soothing</i>
+cords of even an E&ouml;lian harp have <i>appeased</i> contending passions,
+<i>allayed</i> miserable feeling, and afforded ease and tranquillity to the
+bosom <i>tortured</i> with real or fancied woe: and I can easily <i>imagine</i>,
+<span class="pagenum"><a name="Page_343" id="Page_343">[Pg 343]</a></span>that <i>jarring discord</i>, <i>grating harsh rending</i> sounds, applied to an ear
+<i>naturally</i> musical, would uniformly excite great commotion. Under
+circumstances calculated to assist this action, by producing unpleasant
+impressions through the medium of the other senses, as when <span class="smcaplc">SCREECHES</span> and
+<span class="smcaplc">YELLS</span> are made in an apartment painted <i>black</i> and <i>red</i>, or <i>glaring
+white</i>, every man must be painfully affected: the maniacal patient,
+<i>however torpid</i>, <i>must</i> be roused: or, on the contrary, where an opposite
+state obtains, extreme sensibility and impatience of powerful impression,
+there <i>much may be expected</i> from placing the patient in an <i>airy room</i>,
+surrounded with <i>flowers breathing odours</i>, the walls and furniture
+<i>coloured green</i>, and the air agitated by undulations of the softest
+harmony. <i>Much</i> of this may appear <span class="smcaplc">FANCIFUL</span> and <span class="smcaplc">RIDICULOUS</span>, but the
+<i>enquiring</i> practitioner <i>will</i> find, on making the experiment, it
+deserves his <i>serious</i> <span class="pagenum"><a name="Page_344" id="Page_344">[Pg 344]</a></span>attention; and no mean is to be despised that is
+capable of arresting the attention, changing the trains of thought,
+interesting the affections, removing or diminishing painful sensations,
+and ultimately rendering both mind and body sensible to impressions, and
+<i>all this has been effected by music</i>. Every individual is not capable of
+accurately estimating the <i>extensive powers</i> of this agent; but I would
+ask the <i>musical amateur</i>, or the <i>experienced professor</i>, if he have not
+frequently felt sensations the most <i>exquisite</i> and <i>indescribable</i>; if he
+have not experienced the whole frame <i>trilling</i> with <i>inexpressible
+delight</i>, when the <i>tide</i> of full harmony has <span class="smcaplc">FLOWN</span> on his ear, and the
+most <i>wretched miserable</i> feeling, <span class="smcaplc">UNIVERSAL HORRIPILATIO</span> and <span class="smcaplc">CUTIS
+ANSERINA</span> from the <i>grating crash</i> of discord? All the varied sensations
+from transport to disgust, have been occasioned by the different movements
+in one piece of music. I might <span class="pagenum"><a name="Page_345" id="Page_345">[Pg 345]</a></span><i>amuse</i> my readers with a great variety of
+instances where persons have been very singularly affected by means of
+music, and where its powers have extended to the <i>brute creation</i>, but
+this I purposely avoid.&#8221;</p>
+
+
+<p class="center"><br />FINIS.</p>
+
+<p><br />Printed by <span class="smcap">G. Hayden</span>,<br />
+Brydges Street, Covent Garden.</p>
+
+
+<p>&nbsp;</p><p>&nbsp;</p>
+<hr style="width: 50%;" />
+<div class="verts">
+<p class="center"><span class="huge">MEDICAL BOOKS</span></p>
+<p class="center">Lately Published by</p>
+<p class="center">J. CALLOW,</p>
+<p class="center"><i>No. 10, Crown Court, Princes Street</i>,</p>
+<p class="center">SOHO,</p>
+<p class="center">Who either gives the full Value for <span class="smcap">Medical Books</span>, or exchanges them.</p>
+
+
+<p class="hang"><br />1&mdash;<span class="smcap">Adams</span>&#8217;s OBSERVATIONS on MORBID POISONS, in Two Parts:&mdash;Part I.
+Containing Syphilis, Yaws, Sivvens, Elephantiasis, and the Anomala
+confounded with them. Part II. On Acute Contagions, particularly the
+Variolous and Vaccine. Second Edition, illustrated with four coloured
+Engravings, copious practical Remarks, and further Commentaries on Mr.
+Hunter&#8217;s Opinions; by JOSEPH ADAMS, M. D. F. L. S. Physician to the Small
+Pox and Inoculation Hospitals, in one large quarto, boards, &pound;1 5s.</p>
+
+<p class="blockquot">&#8220;Some judicious remarks on Variolus and Vaccine Inoculation terminate
+this work; which must be considered as far superior to the ephemeral
+productions of authors, who want to write themselves into a high road
+to riches and renown. This volume is valuable in another point of
+view, because it inculcates the habit of analyzing diseases, and shows
+the importance of minute attention in tracing the history and progress
+of every series of morbid action.&#8221;&mdash;Vide Edinburgh Journal, Vol. III.</p>
+
+<p class="hang">2&mdash;ADAMS&#8217;s (Dr. <span class="smcap">Joseph</span>) GUIDE to MADEIRA, containing a Short Account of
+Funchall, with Instructions to such as repair to that Island for Health,
+<i>2nd edit. price</i> 1s 6d, 1808.</p>
+
+<p class="hang">3&mdash;ADAMS&#8217;s (Dr. <span class="smcap">Joseph</span>) OBSERVATIONS on the CANCEROUS BREAST, <i>sewed</i>, 3s
+6d.</p>
+
+<p class="hang">4&mdash;ANDREWS&#8217;s OBSERVATIONS on the APPLICATION of LUNAR CAUSTIC to
+STRICTURES in the URETHRA and the &OElig;SOPHAGUS; illustrated by Cases, and
+with Plates, by M. W. <span class="smcap">Andrews</span>, M. D. Member of the Royal College of
+Surgeons, London, late Army Surgeon, and now Physician, at Madeira,
+<i>octavo, boards</i>, <i>price</i> 5s 6d.</p>
+
+<p class="hang">5&mdash;BLAIR&#8217;s HINTS for the CONSIDERATION of PARLIAMENT, in a LETTER to Dr.
+JENNER, on the supposed Failures of Vaccination at <span class="smcap">Ringwood</span>; including a
+report of the Royal Jennerian Society on that subject after a careful
+public investigation on the spot: also containing remarks on the prevalent
+Abuse of Variolous Inoculation, and on the dreadful Exposure of
+Out-Patients attending at the Small Pox Hospital, 8s 6d, <i>boards</i>, 1808.</p>
+
+<p class="hang">6&mdash;BOYER&#8217;s LECTURES upon DISEASES of the BONES, arranged into a systematic
+Treatise, by A. Richerand, Professor of Anatomy and Philosophy, and
+principal Surgeon to the Northern Hospital at Paris: translated from the
+French, by M. Farrell, M. D. 2 vol. <i>plates, boards</i>, 10s, 1800.</p>
+
+<p class="hang">7&mdash;BLANE&#8217;s OBSERVATIONS on the DISEASES of SEAMEN, 3rd edition, <i>boards</i>,
+7s, 8vo.</p>
+
+<p class="hang">8&mdash;BUTTER&#8217;s (Dr. <span class="smcap">William</span>) ACCOUNT of PUERPERAL FEVERS as they appeared in
+Derbyshire and some of the counties adjacent, illustrated by Cases and
+successful Methods both of Prevention and Cure, 2s 6d.</p>
+
+<p class="hang">9&mdash;BUTTER&#8217;s TREATISE on the ANGINA PECTORIS, 2s.</p>
+
+<p class="hang">10&mdash;BUTTER&#8217;s TREATISE on the VENEREAL ROSE, commonly termed the
+Gonorrh&oelig;a Virulenta, containing a simple, safe, and certain Method of
+Cure, without the use of Mercury, 2s 6d.</p>
+
+<p class="hang">11&mdash;BUTTER on the INFANTILE REMITTENT FEVER, commonly called the Worm
+Fever; accurately describing that fatal Disease, explaining its Causes and
+Nature, and discovering an easy, safe, and successful Method of Cure, 2nd
+edit.&mdash;price 1s 6d, 1806.</p>
+
+<p class="hang">12&mdash;BADHAM&#8217;s OBSERVATIONS on the INFLAMMATORY AFFECTIONS of the MUCOUS
+MEMBRANE of the BRONCHI&AElig;. Comprehending an account of the acute
+inflammation of the parts, of peripneumonia notha, of chronic coughs, &amp;c.
+by <span class="smcap">Charles Badham</span>, M. D. Physician to his Royal Highness the Duke of
+Sussex, and to his Household; Physician to the Westminster General
+Dispensatory, and Lecturer on the Practice of Physic, &amp;c. 12mo. price 4s
+in <i>boards</i>.</p>
+
+<p class="hang">13&mdash;CUTHBERTSON&#8217;s PRACTICAL TREATISE on ELECTRICITY and GALVANISM, by John
+Cuthbertson, Philosophical Instrument Maker, and Member of the
+Philosophical Societies of Holland and Utrecht, in one vol. 8vo.
+illustrated with nine copper plates,&mdash;price in <i>boards</i> 10s 6d, 1807.</p>
+
+<p class="hang">14&mdash;CRICHTON&#8217;s SYNOPTICAL TABLE of DISEASES, exhibiting their Arrangement
+in Classes, Orders, Genera, and Species, designed for the Use of Students,
+on two sheets imperial folio,&mdash;price 2s 6d.</p>
+
+<p class="hang">15&mdash;CROWTHER&#8217;s PRACTICAL OBSERVATIONS on the DISEASE of the JOINTS,
+commonly called WHITE SWELLING; with some Remarks on Caries, Necrosis, and
+Scrofulous Abscess, in which a new and successful Method of treating these
+Diseases is pointed out. A Second Edition, with considerable Additions and
+Improvements. By BRYAN CROWTHER, Member of the Royal College of Surgeons
+in London, and Surgeon to Bridewell and Bethlem Hospitals,&mdash;in one volume
+8vo. illustrated with seven coloured plates, price 10s 6d. <i>boards</i>,
+1808.&mdash;Ditto large paper, with proof Impressions of the Plates, 16s.</p>
+
+<p class="hang">16&mdash;COUPER&#8217;s SPECULATIONS on the MODE and APPEARANCES of IMPREGNATION in
+the HUMAN FEMALE; with an Account of the Principal Ancient, and an
+Examination of the Modern Theories of Generation, <i>the Third Edition, with
+considerable Additions</i>, 4s, 1808.</p>
+
+<p class="hang">17&mdash;DUFOUR&#8217;s TREATISE on the URINARY CANAL, particularly describing the
+various Symptoms attending Strictures, Obstructions, Gleets, &amp;c. and an
+the prevention of the Stone and Gravel, with a Variety of Cases, tending
+to shew the Efficacy of Daran&#8217;s medicated Bougies, and a new Method of
+treating a Gonorrh&oelig;a, &amp;c. 6th edition, price 2s 6d, 1808.</p>
+
+<p class="hang">18&mdash;DAUBENTON&#8217;s OBSERVATIONS on INDIGESTION, in which is satisfactorily
+shewn the Efficacy of Ipecacuanha, in relieving this, as well as its
+connected Train of Complaints peculiar to the Decline of Life, <i>translated
+from the French</i>. Second Edition with Additions, by Dr. Buchan, 1s 6d,
+1807.</p>
+
+<p class="hang">19&mdash;EARLE&#8217;s (Sir JAMES) Letter, containing some Observations on the
+Fractures of the Lower Limbs; to which is added, an Account of a
+Contrivance to administer Cleanliness and Comfort to the Bed-ridden, or
+Persons confined to Bed by Age, Accident, Sickness, or any other
+Infirmity, with Explanatory Plates&mdash;price, <i>sewed</i>, 3s, 1807.</p>
+
+<p class="hang">20&mdash;EARLE&#8217;s (Sir JAMES) OBSERVATIONS on H&AElig;MORRHOIDAL EXCRESCENCES, the
+Second Edition, price, <i>sewed</i>, 1s 6d, 1807.</p>
+
+<p class="hang">21&mdash;GRIFFITH&#8217;s PRACTICAL OBSERVATIONS on the CURE of HECTIC and SLOW
+FEVERS and the PULMONARY CONSUMPTION; to which is added, a Method of
+treating several Kinds of internal H&aelig;morrhages, <i>a new edition, sewed</i>, 1s
+6d.</p>
+
+<p class="hang">22&mdash;GIBBON&#8217;s MEDICAL CASES and REMARKS, Part I. on the Good Effects of
+Salivation in Jaundice, arising from Calculi. Part II. on the free Use of
+Nitre in H&aelig;morrhages, <i>boards</i>, 2s 6d, 8vo.</p>
+
+<p class="hang">23&mdash;GIRDLESTONE on DIABETES, with an Historical Sketch of that Disease,
+<i>sewed</i>, 2s 6d, 8vo.</p>
+
+<p class="hang">24&mdash;GORDON&#8217;s (Dr. Alexander) TREATISE on the EPIDEMIC PUERPERAL FEVER of
+ABERDEEN, <i>sewed</i>, 2s 6d.</p>
+
+<p class="hang">25&mdash;HARTY&#8217;s (Dr.) OBSERVATIONS on the SIMPLE DYSENTERY, and its
+COMBINATIONS; containing a Review of the most celebrated Authors, who have
+written on this Subject, and also an Investigation into the Source of
+Contagion, in that and some other Diseases, <i>boards</i>, 7s 6d, 8vo.</p>
+
+<p class="blockquot">&#8220;This Work we find no difficulty in recommending to our Readers; it
+contains, unquestionably, a larger mass of evidence than is any where
+else to be found, of the various species of this formidable disease;
+and again we think it right once more to recommend the Work before us,
+as the most valuable digest of all that has been written upon
+it.&#8221;&mdash;Vide <span class="smcap">Medical</span> and <span class="smcap">Physical Journal</span>, for December, 1805.</p>
+
+<p class="hang">26&mdash;HAMILTON&#8217;s OBSERVATIONS on SCROPHULOUS AFFECTIONS, with Remarks on
+Schirrus Cancer, and Rachitis, <i>boards</i>, 3s, 12mo.</p>
+
+<p class="hang">27&mdash;INDENTITIES ASCERTAINED; or, an Illustration of Mr. Ware&#8217;s Opinion
+respecting the sameness of Infection in Venereal Gonorrh&oelig;a, and the
+Ophthalmia of Egypt; with an Examination of Affinity between ancient
+Leprosy and Lues&mdash;price 2s 6d, 8vo. 1808.</p>
+
+<p class="hang">28&mdash;LAWRENCE&#8217;s (WILLIAM) TREATISE on HERNIA, being the Essay which gained
+the Prize offered by the Royal College of Surgeons, in the year 1806,
+<i>illustrated with three plates, boards</i>, 9s.</p>
+
+<p class="blockquot">&#8220;Mr. Lawrence has done his part: he has united in this Essay elegance
+of language, correctness of description, a discriminating judgment,
+and a fund of learning, which does equal credit to his talents and his
+industry.&#8221;&mdash;<span class="smcap">Critical Review</span> for Feb. 1808.</p>
+
+<p class="hang">29&mdash;LIND on DISEASES incidental to EUROPEANS in HOT CLIMATES, with the
+Method of preventing their fatal Consequences, the Sixth Edition, in one
+vol. octavo, price 8s, <i>boards</i>, 1808.</p>
+
+<p class="hang">30&mdash;LONDON PRACTICE of MIDWIFERY; or, a MANUAL for STUDENTS; being a
+complete Course of Practical Midwifery; in which are included the
+Treatment of Lying-in Women and the Diseases of Children, the second
+edition corrected, 12mo. <i>boards</i>, 6s. 1807.</p>
+
+<p class="hang">31&mdash;LUXMORE&#8217;s FAMILIAR OBSERVATIONS on RUPTURES, for the Use of Patients
+of both Sexes afflicted with those Complaints. Second edition, price 2s.</p>
+
+<p class="hang">32&mdash;LIPSCOMB&#8217;s MANUAL of INOCULATION, for the Use of the Faculty and
+private families; pointing out the most approved method of Inoculating,
+and conducting Patients through the Small Pox, <i>sewed</i>, 1s.</p>
+
+<p class="hang">33&mdash;LONDON DISSECTOR; or, a Compendium of Practical Anatomy; containing a
+Description of the Muscles, Vessels, Nerves, and Viscera of the Human
+Body, as they appear on Dissection. A new Edition improved, <i>boards</i>, 5s.
+1808.</p>
+
+<p class="hang">34&mdash;MEDICAL FACTS and OBSERVATIONS; consisting principally of original
+Communications from Gentlemen of the Faculty, on important Subjects, in
+Medicine and Surgery, &amp;c. by Dr. Simmons, vol. 8, <i>boards</i>, 4s 6d, 8vo.</p>
+
+<p class="hang">35&mdash;POLE&#8217;s ANATOMICAL INSTRUCTOR; or, an Illustration of the modern and
+most approved Method of preparing and preserving the different Parts of
+the Human Body, and of Quadrupeds, with <i>plates, boards</i>, 7s, 8vo.</p>
+
+<p class="hang">36&mdash;PEARSON&#8217;s (JOHN) PRACTICAL OBSERVATIONS on CANCEROUS COMPLAINTS, with
+an Account of some Diseases, which have been confounded with the Cancer;
+also, Critical Remarks on some of the Operations performed in Cancerous
+Cases, <i>sewed</i>, 2s 6d, 8vo.</p>
+
+<p class="hang">37&mdash;PEARSON&#8217;s OBSERVATIONS on the EFFECTS of VARIOUS ARTICLES of the
+MATERIA MEDICA, in the CURE of LUES VENEREA, illustrated with Cases. By
+JOHN PEARSON, F. R. S. Senior Surgeon of the Lock Hospital and Asylum, and
+Surgeon to the Public Dispensatory; Reader on the Principles and Practice
+of Surgery, the Second Edition, with Additions, <i>price</i> 7s, 8vo. 1807.</p>
+
+<p class="hang">38&mdash;PEARSON&#8217;s PRINCIPLES of SURGERY, for the Use of Chirurgical Students.
+A new Edition with Additions. By JOHN PEARSON, F. R. S. &amp;c. 8vo. <i>boards</i>,
+8s 6d. 1808.</p>
+
+<p class="hang">39&mdash;POTT&#8217;s (P) CHIRURGICAL WORKS: a new Edition, with his last
+Corrections. To which are added, a short Account of the Life of the
+Author, a Method of curing the Hydrocele by Injection, and occasional
+Notes and Observations. By Sir James Earle, 3 vol. <i>boards</i>, 1l 7s. 1808.</p>
+
+<p class="hang">40&mdash;RICHERAND&#8217;s ELEMENTS of PHYSIOLOGY; containing a Comprehensive View
+and Clear Explanation of the Functions of the Human Body, in which the
+modern Improvements in Chemistry, Galvanism, and other Sciences, are
+applied to explain the Actions of the Animal Economy with a new
+Classification, and a copious Index; translated from the French of A.
+Richerand, Professor of Anatomy and Physiology, and principal Surgeon of
+the Hospital of the North, in Paris. By <span class="smcap">Robert Kerrison</span>, Member of the
+Royal College of Surgeons, in London, &amp;c. <i>In one closely printed vol.</i>
+8vo. price 6s. <i>boards</i>, 1806.</p>
+
+<p class="hang">41&mdash;REES&#8217;s (Dr. GEORGE) OBSERVATIONS on DISEASES of the UTERUS; in which
+are included, Remarks on Moles, Polypi, and Prolapsus, as also on
+Schirrous and Cancerous Affections of that Organ, <i>boards</i>, 4s 6d, 8vo.</p>
+
+<p class="hang">42&mdash;REES&#8217;s (Dr. GEORGE) TREATISE on the PRIMARY SYMPTOMS of LUES VENEREA,
+with a concise, critical, and chronological Account of all the English
+Writers on this Subject, from 1735 to 1783, to which is added, an Analysis
+of a Course of Lectures delivered by the Author, <i>boards</i>, 5s, 8vo.</p>
+
+<p class="hang">43&mdash;ROLLO&#8217;s CASES of the DIABETES MELLITUS, with the Results of the Trials
+of certain Acids and other Substances, in the Cure of the Lues Venerea,
+Second Edition, with large Additions, <i>boards</i>, 6s, 8vo. 1806.</p>
+
+<p class="hang">44&mdash;ROYSTON&#8217;s OBSERVATIONS on the RISE and PROGRESS of the MEDICAL ART in
+the BRITISH EMPIRE; containing Remarks on Medical Literature, and a View
+of a Bibliographia Medicin&aelig; Britannic&aelig;, by W. ROYSTON, Esq. <i>price</i> 2s,
+1808.</p>
+
+<p class="hang">45&mdash;RYDING&#8217;s VETERINARY PATHOLOGY; or, a Treatise on the Cure and Progress
+of the Disease of the Horse, &amp;c. &amp;c. and an Appendix, or Veterinary
+Dispensatory, &amp;c. <i>boards</i>, 3s 6d, 8vo.</p>
+
+<p class="hang">46&mdash;SMITH&#8217;s ESSAY on the CAUSES of the VARIETY of COMPLEXION and FIGURE in
+the HUMAN SPECIES; to which are added, STRICTURES on LORD KAIMES&#8217;s
+DISCOURSE of the ORIGINAL DIVERSITY of MANKIND, <i>boards</i>, 3s.</p>
+
+<p class="hang">47&mdash;UNDERWOOD&#8217;s TREATISE on the DISEASES of CHILDREN, with Directions for
+the Management of Infants, from the Birth, and now precisely adapted to
+professional Readers, Fifth Edition, 3 vol. <i>boards</i>, 13s 6d, 8vo.</p>
+
+<p class="hang">48&mdash;UNDERWOOD&#8217;s SURGICAL TRACTS, containing a Treatise on ULCERS of the
+LEGS, in which, former Modes of Treatment are examined and compared with
+one more rational and safe, effected without Rest and
+Confinement:&mdash;together with Hints on a successful Method of treating some
+Scrophulous Tumours, the Mammary Abscess, and sore Nipples of Lying-in
+Women; Observations on the more common Disorders of the Eye, and on
+Gangrene, <i>boards</i>, 6s, 8vo.</p>
+
+<p class="hang">49&mdash;WEBSTER&#8217;s FACTS, tending to shew the CONNEXION of the STOMACH with
+LIFE, DISEASE, and RECOVERY, <i>sewed</i>, 1s 6d.</p>
+
+<p class="hang">50&mdash;WADD&#8217;s PRACTICAL OBSERVATIONS, on the Nature and Cure of STRICTURES in
+the URETHRA. By WILLIAM WADD, Member of the Royal College of Surgeons in
+London, 8vo, 3s 6d, 1808.</p>
+
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+the History and Treatment of Disease in general, <i>boards</i>, 8s, 1808.</p>
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+
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+
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+and 1809, of a modern Collection of Books, in Anatomy, Medicine,
+Surgery, Chemistry, Botany, &amp;c. To which is added, an Appendix,
+containing a choice Collection of Second-hand Books in various
+Languages, among which, are many rare Articles, recently purchased.</p>
+
+<p>Also J. CALLOW&#8217;s General Catalogue of Medical Books, New and
+Second-hand, in various Languages, containing upwards of 10,000
+Volumes.</p></div></div>
+
+
+<p>&nbsp;</p><p>&nbsp;</p>
+<hr style="width: 50%;" />
+<p><strong>Footnotes:</strong></p>
+
+<p><a name='f_1' id='f_1' href='#fna_1'>[1]</a> The choice of these words must be left to the taste of the reader, Dr.
+Johnson not having thought proper to admit them into his dictionary.</p>
+
+<p><a name='f_2' id='f_2' href='#fna_2'>[2]</a> Some doubts are entertained whether Dr. Boord was physician to King
+Henry the eighth, but he was certainly a fellow of the College.</p>
+
+<p><a name='f_3' id='f_3' href='#fna_3'>[3]</a> Apprehension of sensations. This is perhaps only an endeavour to
+explain the thing, <i>by</i> the thing, or producing words of similar import
+with different sounds. Junius, speaking of the word hand (as derived from
+the gothic Handus) says, &#8220;Quidam olim deduxerunt vocabulum ab antiquo
+verbo <span class="smcaplc">HENDO</span>, <i>Capio</i>: unde <span class="smcap">Prehendo</span>, <span class="smcaplc">APPREHENDO</span>, &amp;c.&#8221;&mdash;<i>Gothicum
+Glossarium</i>, p. 188. Professor Ihre conceives it equally probable that the
+old latin word <i>hendo</i> may have had a northern origin. &#8220;Id vero non
+possum, quin addam, oppid&oacute; mihi probabile fieri, ipsammet hanc vocem latio
+olim peregrinam non fuisse, quod quippe augurar ex derivato <span class="smcaplc">HENDO</span>, capio,
+unde prehendo cum derivatis pullularunt.&#8221;&mdash;<i>Glossarium Sviogothicum.</i>
+<i>tom.</i> i. <i>p.</i> 778.</p>
+
+<p><a name='f_4' id='f_4' href='#fna_4'>[4]</a> Quere. Why should the most <i>active</i> characteristics of our nature be
+termed <i>Passions</i>? The word seems properly employed in <i>Passion week</i>, the
+period commemorative of Christ&#8217;s suffering or <i>Passion</i>. But we are said
+to <i>fly</i>, or <i>fall</i> into a passion, and then passion <i>gets the better of
+us</i>. For the softer sex we conceive the most delicate, refined, and
+honorable <i>passion</i>, yet every one allows the dreadful consequences which
+ensue from an indulgence of our <i>passions</i>, and most persons agree that
+<i>passion</i>, carried to excess, constitutes madness&mdash;we live in a world of
+metaphor.</p>
+
+<p><a name='f_5' id='f_5' href='#fna_5'>[5]</a> In many instances, although it is far from being general, pain of the
+head, and throbbing of its arteries precede an attack of insanity;
+sometimes giddiness is complained of as a precursory symptom. Those who
+have been several times disordered, are now and then sensible of the
+approaching return of their malady. Some have stated, a sense of working
+in the head, and also in the intestines, as if they were in a state of
+fermentation. Others observe that they do not seem to possess their
+natural feelings, but they all agree that they feel confused from the
+sudden and rapid intrusion of unconnected thoughts.</p>
+
+<p><a name='f_6' id='f_6' href='#fna_6'>[6]</a> To illustrate how necessarily our sensations, or ideas must become
+confused, when their succession is too rapid, the relation of some
+experiments on that subject will sufficiently conduce.</p>
+
+<p>&#8220;But by the able assistance of Mr. Herschel, I am in a condition to give
+some approximation, at least, towards ascertaining the velocity of our
+audible sensations. For having, by means of a clock, produced sounds,
+which succeeded each other with such rapidity, that the intervals between
+each of them were (as far as could be judged) the smallest posible; he
+found he could evidently distinguish one hundred and sixty of them to flow
+in a second of time. Now as each interval must in this case be reckoned as
+a sensation likewise, as it might be filled up with a sound thereby making
+it a continued one; it follows, that we are capable of entertaining at
+least three hundred and twenty audible sensations in that period of
+time.&#8221;&mdash;<i>Vide a Treatise on Time, by W. Watson, Jun. M. D. F. R. S.</i> 8<i>vo</i>,
+1785, <i>page</i> 32.</p>
+
+<p><a name='f_7' id='f_7' href='#fna_7'>[7]</a> The late Dr. Johnson was remarkably distinguished by certain
+peculiarities of action when his mind was deeply engaged. Sir Joshua
+Reynolds was of opinion &#8220;that it proceeded from a habit he had indulged
+himself in, of accompanying his thoughts with certain untoward actions.&#8221;
+&#8220;One instance of his absence, and particularity as it is characteristic of
+the man, may be worth relating. When he and I took a journey into the
+West, we visited the late Mr. Banks, of Dorsetshire; the conversation
+turning upon pictures, which Johnson could not well see, he retired to a
+corner of the room, stretching out his right leg as far as he could reach
+before him, then bringing up his left leg, and stretching his right still
+further on. The old gentleman observing him, went up to him, and in a very
+courteous manner assured him, that though it was not a new house, the
+flooring was perfectly safe. The Doctor started from his reverie like a
+person waked out of his sleep, but spoke not a word.&#8221;&mdash;<i>Boswell&#8217;s Life of
+Dr. Johnson</i>, <i>vol.</i> i. <i>p.</i> 76. In the same work other of his tricks are
+recorded, as talking to himself, measuring his steps in a mysterious
+manner, half whistling, clucking like a hen, rubbing his left knee, &amp;c.
+Many sensible persons, with whom I am now acquainted, when particularly
+thoughtful, discover strange bodily motions, of which they are by no means
+conscious at the time.</p>
+
+<p><a name='f_8' id='f_8' href='#fna_8'>[8]</a> This gritty matter, subjected to chemical examination, was found to be
+<i>phosphat of lime</i>.</p>
+
+<p><a name='f_9' id='f_9' href='#fna_9'>[9]</a> This appearance I have found frequently to occur in maniacs who have
+suffered a violent paroxysm of considerable duration: and in such cases,
+when there has been an opportunity of inspecting the contents of the
+cranium after death, water has been found between the dura mater and
+tunica arachnoidea.</p>
+
+<p><a name='f_10' id='f_10' href='#fna_10'>[10]</a> Morbid Anatomy, page 304.</p>
+
+<p><a name='f_11' id='f_11' href='#fna_11'>[11]</a> Mr. Fourcroy does not appear to have given any particular attention
+to this fluid. He says, &#8220;Cette humeur ne para&icirc;t pas diff&eacute;rer de celle qui
+mouille toutes les parois membraneuses du corps humain en general, et dont
+j&#8217;ai d&eacute;ja parl&eacute;. C&#8217;est un liquide mucoso gelatineux, plus ou moins
+albumineux, et contenant <i>quelques mati&eacute;res salines</i>.&#8221;&mdash;<i>Syst&eacute;me des
+Connoisances Chimiques</i>, 8<i>vo.</i> <i>tom.</i> ix. <i>p.</i> 303.</p>
+
+<p><a name='f_12' id='f_12' href='#fna_12'>[12]</a> It may be remarked, that all children in the early attempts at
+language, speak of themselves and others in the third person, and never
+employ the pronoun; they likewise never use connectives, or the
+inflections of verbs, until they begin to acquire some knowledge of
+numbers. Beyond this rude state our patient never advanced.</p>
+
+<p><a name='f_13' id='f_13' href='#fna_13'>[13]</a> For this term the indulgent reader must give the author credit,
+because he finds himself unable adequately to explain it.&mdash;It is a complex
+<i>term</i> for many ideas, on which language has not as yet, and perhaps will
+never be imposed. Very unfortunately there are many terms of this nature,
+equally incapable of description&mdash;a smile, for instance, is not very easy
+to be defined. Dr. Johnson calls it &#8220;a slight contraction of the face&#8221;
+which applies as properly to a paralytic affection. He also states it to
+be &#8220;opposed to frown.&#8221; If curiosity should prompt the inquisitive reader
+to seek in the same author for the verb, to frown, he will find it &#8220;to
+express displeasure <i>by contracting the face</i> to wrinkles.&#8221; He who would</p>
+
+<p class="poem">&#8220;Finde the minde&#8217;s construction in the face&#8221;</p>
+
+<p>must not expect to be able to communicate to others, in a few words, that
+knowledge which has been the slow and progressive accumulation of years.</p>
+
+<p><a name='f_14' id='f_14' href='#fna_14'>[14]</a> These are the usual terms employed by writers on this subject, but
+the propriety of their use must be left to the judgment of the reader.
+Every person will occasionally hesitate whether certain occurrences, said
+to be causes, ought to be referred to one class, in preference to the
+other. They are loose and vague names: for instance, a course of
+debauchery long persisted in, would probably terminate in paralysis;
+excessive grief we know to be capable of the same effect. Paralysis
+frequently induces derangement of mind, and in such case it would be said,
+that the madness was induced by the paralysis as a physical cause. But it
+often happens that debauchery and excessive grief are followed by madness,
+without the intervention paralysis. Moral, in this sense, means merely
+habitudes or customs, reiteration of circumstances confirmed into usage;
+and these may be indifferently accounted physical or moral.</p>
+
+<p><a name='f_15' id='f_15' href='#fna_15'>[15]</a></p>
+
+<p class="poem">&#8220;&mdash;&mdash;nessun maggior dolore,<br />
+Che ricordarsi del tempo felice<br />
+Nella miseria.&#8221;&mdash;<i>Dante.</i></p>
+
+<p><a name='f_16' id='f_16' href='#fna_16'>[16]</a> The Jews also were particularly instrumental in the practice and
+propagation of medical knowledge at that period.</p>
+
+<p><a name='f_17' id='f_17' href='#fna_17'>[17]</a> Cogitatio, (h&icirc;c minim&egrave; pr&aelig;tereunda) est motus peculiaris Cerebri,
+quod hujus facultatis est proprium organum: vel poti&ugrave;s Cerebri pars
+qu&aelig;dam, in medulla spinali et nervis cum suis meningibus continuata, tenet
+animi principatum, motumque perficit tam cogitationis quam sensationis;
+qu&aelig; secund&ugrave;m Cerebri diversam in omnium animalium structuram, mir&egrave;
+variantur.&mdash;<i>Tolandi Pantheisticon</i>, <i>p.</i> 12.</p>
+
+<p><a name='f_18' id='f_18' href='#fna_18'>[18]</a> 1796, 1797.</p>
+
+<p><a name='f_19' id='f_19' href='#fna_19'>[19]</a> Vide Report, Part II. p. 25.</p>
+
+<p><a name='f_20' id='f_20' href='#fna_20'>[20]</a> Report, p. 59.</p>
+
+<p><a name='f_21' id='f_21' href='#fna_21'>[21]</a> Ibid, 57.</p>
+
+<p><a name='f_22' id='f_22' href='#fna_22'>[22]</a> Report 54.</p>
+
+<p><a name='f_23' id='f_23' href='#fna_23'>[23]</a> &#8220;We shall use the general term of methodism, to designate these three
+classes of fanatics, [Arminian and Calvinistic methodists, and the
+<i>evangelical</i> clergymen of the church of England] not troubling ourselves
+to point out the finer shades, and nicer discriminations of lunacy, but
+treating them all as in one general conspiracy against common sense, and
+rational orthodox christianity.&#8221;&mdash;<i>Edinburgh Review</i>, <i>Jan.</i> 1808, <i>p.</i>
+342.</p>
+
+<p><a name='f_24' id='f_24' href='#fna_24'>[24]</a> Trait&eacute; Medico-Philosophique sur l&#8217;Alienation Mentale, 8vo. Paris, an.
+9, p. 47.</p>
+
+<p><a name='f_25' id='f_25' href='#fna_25'>[25]</a> The late Reverend Dr. Willis.</p>
+
+<p><a name='f_26' id='f_26' href='#fna_26'>[26]</a> With respect to the persons, called Keepers, who are placed over the
+insane, public hospitals have generally very much the advantage. They are
+there better paid, which makes them more anxious to preserve their
+situations by attention and good behaviour: and thus they acquire some
+experience of the disease. But it is very different in the private
+receptacles for maniacs. They there procure them at a cheaper rate; they
+are taken from the plough, the loom, or the stable; and sometimes this
+tribe consists of decayed smugglers, broken excisemen, or discharged
+sheriffs&#8217; officers:</p>
+
+<p class="poem">&#8220;All that at home no more can beg or steal.&#8221;</p>
+
+<p>How well such a description of persons is calculated to regulate and
+direct the conduct of an insane gentleman may be easily conjectured. If
+any thing could add to the calamity of mental derangement, it would be the
+mode which is generally adopted for its cure. Although an office of some
+importance and great responsibility, it is held as a degrading and odious
+employment, and seldom accepted but by idle and disorderly persons.</p>
+
+<p><a name='f_27' id='f_27' href='#fna_27'>[27]</a> Vide Cullen, First Lines, vol. iv. p. 154.</p>
+
+<p><a name='f_28' id='f_28' href='#fna_28'>[28]</a> &#8220;<i>D&#8217;uno luogo chiamato Timarahane, dove si castigano i matti.</i></p>
+
+<p>&#8220;In Costantinopoli fece fare un luogo Sultan Paiaxit dove si dovessero
+menare i pazzi, accioche non andassero per la citta, facendo pazzie, et &egrave;
+fatto &agrave; modo d&#8217;uno Spedale, dove sono circa cento cinquanta guardiani in
+loro custodia, et sonvi medicine, et altre cose per loro bisogni, e i
+detti guardiani vanno per la citta con bastoni cercando i matti, et quando
+ne truovano alcuno, lo&#8217;ncatenano per il collo con cathene di ferro, et per
+le mani, et &agrave; suon di bastoni lo menano al detto luogo, et quivi gli
+mettono una catena al collo assai maggiore, che &egrave; posta nel muro, et viene
+sopra del letto, tal mente che nel letto per il collo tutti gli tengono
+incatenati, et vene saranno per ordine, lontano l&#8217;uno dall&#8217;altro numero di
+quaranta, i quali per piacere di quelli della citta molte volte sono
+visitati, et di continovo col bastone i guardiani gli stanno appresso:
+Percio che non essendovi guastano i letti, et tiransi le tavole l&#8217;uno &agrave;
+l&#8217;altro: et venuta l&#8217;hora del mangiare, i guardiani gli vanno esaminando
+tutti per ordine, et trovando alcuno, che non istia in buon proposito,
+crudelmente lo battono, et se &agrave; caso truovano alcuno, che non faccia piu
+pazzie, gli banno miglior cura, che &agrave; gli altri.&#8221; <i>J. Costumi et la vita
+de Turchi di Gio. Antonio Menavino Genovese da Vultri</i>, 12<i>mo, in Fiorenza</i>,
+1551.</p>
+
+<p><a name='f_29' id='f_29' href='#fna_29'>[29]</a> Trait&eacute; sur la Mania, page 103.</p>
+
+<p><a name='f_30' id='f_30' href='#fna_30'>[30]</a> The frequent recurrence of any propensity leads, by sure steps, to
+the final adjustment of the character; and even when the propensity is
+ideal, the repetition of the fits will, in the end, invest fancy with the
+habitudes of nature.&mdash;<i>Criticism on the Elegy written in a Country Church
+Yard</i>, <i>p.</i> 3.</p>
+
+<p><a name='f_31' id='f_31' href='#fna_31'>[31]</a> Remarks on Dr. Batties&#8217; Treatise on Madness, p. 38.</p>
+
+<p><a name='f_32' id='f_32' href='#fna_32'>[32]</a> Dr. Cox, Practical Observations on Insanity, p. 28.</p>
+
+<p><a name='f_33' id='f_33' href='#fna_33'>[33]</a> Dr. John Monro&#8217;s Remarks on Dr. Battie, p. 39.</p>
+
+<p><a name='f_34' id='f_34' href='#fna_34'>[34]</a> Vide Dr. Cox&#8217;s <i>Practical</i> Obs. on Insanity, p. 42.</p>
+
+<p><a name='f_35' id='f_35' href='#fna_35'>[35]</a> It is a painful recollection to recur to the number of interesting
+females I have seen, who, after having suffered a temporary disarrangement
+of mind, and undergone the brutal operation of <i>spouting</i>, in private
+receptacles for the insane, have been restored to their friends without a
+front tooth in either jaw. Unfortunately the task of forcing patients to
+take food or medicines is consigned to the rude hand of an ignorant and
+unfeeling servant: it should always be performed by the master or mistress
+of the mad-house, whose reputations ought to be responsible for the
+personal integrity of the unhappy beings committed to their care.</p>
+
+<p><a name='f_36' id='f_36' href='#fna_36'>[36]</a> Dr. Cox.</p>
+
+<p><a name='f_37' id='f_37' href='#fna_37'>[37]</a> See Dr. Cox&#8217;s Advertisement prefixed to his book.</p>
+
+<p><a name='f_38' id='f_38' href='#fna_38'>[38]</a> Vide Report from the select committee appointed to enquire into the
+state of lunatics, page 25.</p>
+
+<p><a name='f_39' id='f_39' href='#fna_39'>[39]</a> Remarks on Dr. Batties&#8217; Treatise on Madness.</p>
+
+<p><a name='f_40' id='f_40' href='#fna_40'>[40]</a> See Dr. Cox, page 102.</p>
+
+<p><a name='f_41' id='f_41' href='#fna_41'>[41]</a> Dr. Cox, p. 61.</p>
+
+
+
+
+
+
+
+
+
+<pre>
+
+
+
+
+
+End of the Project Gutenberg EBook of Observations on Madness and Melancholy, by 
+John Haslam
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+</body>
+</html>
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+Project Gutenberg's Observations on Madness and Melancholy, by John Haslam
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: Observations on Madness and Melancholy
+       Including Practical Remarks on those Diseases together
+       with Cases and an Account of the Morbid Appearances on
+       Dissection
+
+Author: John Haslam
+
+Release Date: August 21, 2011 [EBook #37144]
+
+Language: English
+
+Character set encoding: ASCII
+
+*** START OF THIS PROJECT GUTENBERG EBOOK OBSERVATIONS ON MADNESS AND ***
+
+
+
+
+Produced by The Online Distributed Proofreading Team at
+http://www.pgdp.net (This file was produced from images
+generously made available by The Internet Archive.)
+
+
+
+
+
+
+
+
+
+  OBSERVATIONS ON MADNESS AND MELANCHOLY:
+
+  INCLUDING PRACTICAL REMARKS ON THOSE DISEASES;
+
+  TOGETHER WITH CASES:
+
+  AND AN ACCOUNT OF THE MORBID APPEARANCES
+  ON _DISSECTION_.
+
+
+  BY JOHN HASLAM,
+
+  LATE OF PEMBROKE HALL, CAMBRIDGE;
+  MEMBER OF THE ROYAL COLLEGE OF SURGEONS,
+  AND APOTHECARY TO BETHLEM HOSPITAL.
+
+  _The Second Edition, considerably enlarged._
+
+  "Of the uncertainties of our present state, the
+  most dreadful and alarming is the uncertain
+  continuance of reason."
+                          Dr. JOHNSON'S RASSELAS.
+
+
+  London:
+
+  PRINTED FOR J. CALLOW, MEDICAL BOOKSELLER,
+  CROWN COURT, PRINCES STREET, SOHO;
+  BY G. HAYDEN, BRYDGES STREET, COVENT GARDEN.
+  1809.
+
+
+
+
+  AS A GRATEFUL ACKNOWLEDGMENT
+  FOR MANY FAVOURS,
+  AN OBLATION TO SUBSISTING FRIENDSHIP,
+  AND A TRIBUTE TO SUPERIOR JUDGMENT,
+  EXERCISING THE PROFESSION OF MEDICINE WITH
+  SKILL AND LIBERALITY:
+  THE PRESENT VOLUME IS RESPECTFULLY
+  DEDICATED TO
+  DR. THOMAS MONRO,
+  A FELLOW OF THE COLLEGE, AND PHYSICIAN
+  TO BETHLEM HOSPITAL.
+
+
+
+
+Preface.
+
+
+_The alarming increase of Insanity, as might naturally be expected, has
+incited many persons to an investigation of this disease;--some for the
+advancement of Science, and others with the hope of emolument._
+
+_More than ten years having elapsed since the publication of the
+"Observations on Insanity," a trifle, which the Profession has held in
+greater estimation than its intrinsic merits could justify: the present
+work is modestly introduced to the public notice, as a corrected copy of
+the former, with considerable additions, which the extensive scope of
+Bethlem Hospital would have furnished more liberally to a more intelligent
+observer._
+
+_To have taken a comprehensive survey of the human faculties in their
+sound state; to have exhibited them impaired by natural decay, and
+transformed by disease, would have implied an ability to which I cannot
+pretend; would have required many volumes to unfold, and perhaps more
+patience than any rational experience could have attributed to the reader.
+The contents of the following pages are therefore to be considered as an
+abbreviated relation, and condensed display of many years observation and
+practice, in a situation affording constant opportunities and abundant
+supplies for such investigations._
+
+_It is natural to presume, that amongst my professional acquaintance the
+subject of Insanity must have been frequently introduced as a topic of
+discourse; and I am ready to acknowledge, that I have often profited by
+their remarks and suggestions: but I should be ungrateful were I not to
+confess my particular obligations to my esteemed friend, Anthony Carlisle,
+Esq. Surgeon to the Westminster Hospital, for many corrections, and some
+communications, which I shall ever value as judicious and important._
+
+  BETHLEM HOSPITAL,
+  NOV. 21, 1808.
+
+
+
+
+ERRATA.
+
+
+  _Page_ 3, _line_ 7, _for_ controverted, _read_ converted.
+         5,        2, _for_ phrenitic, _read_ phrenetic.
+        90,        3, _for_ hyatids, _read_ hydatids.
+       254, _in the Table_, _for_ manical, _read_ maniacal.
+
+
+
+
+OBSERVATIONS ON MADNESS, &c. &c.
+
+
+
+
+CHAPTER I.
+
+DEFINITION.
+
+
+There is no word in the English language more deserving of a precise
+definition than madness: and if those who have treated on this subject
+have been so unfortunate as to disagree with each other, and consequently
+have left their readers to reconcile their discordant opinions; yet it
+must be confessed that considerable pains have been bestowed, to convey a
+clear and accurate explanation of this term. Although this contrariety of
+sentiment has prevailed concerning the precise meaning of the word
+madness, medical practitioners have been sufficiently reconciled as to the
+thing itself: so that when they have seen an insane person, however
+opposite their definitions, they have readily coincided that the patient
+was mad.
+
+From this it would appear that the thing itself, is, generally speaking,
+sufficiently plain and intelligible; but that the term which represents
+the thing is obscure. Perhaps, we might be somewhat assisted, by tracing
+back this word, in order to discover its original meaning, and shewing
+from its import the cause of its imposition.
+
+If the reader, as is now the custom, should turn to Johnson's Dictionary
+for the meaning and etymology of this word, he will find that the Doctor
+has derived it both from the Anglo-Saxon gemaad and the Italian
+_matto_; but without giving any meaning as the cause of its employment.
+The word is originally Gothic, and meant anger, rage, [Gothic: Mod].
+[Mod]. It is true that we have now controverted the o, into a, and write
+the word mad: but mod was anciently employed.
+
+  "Yet sawe I MODNESSE laghyng in his _rage_."
+          _Chaucer. Knight's Tale, fol. 1561, p. 6._
+
+There is so great a resemblance between anger and violent madness, that
+there is nothing which could more probably have led to the adoption of the
+term. Dr. Beddoes, who appears to have examined the subject of insanity
+with the eye of an enlightened philosopher, is decidedly of this opinion,
+he says, HYGEIA, _No. 12, p. 40_, "Mad, is one of those words which mean
+almost every thing and nothing. At first, it was, I imagine, applied to
+the transports of rage; and when men were civilized enough to be capable
+of insanity, their insanity, I presume, must have been of the frantic
+sort, because in the untutored, intense feelings seem regularly to carry a
+boisterous expression."
+
+MAD is therefore not a complex idea, as has been supposed, but a complex
+term for all the forms and varieties of this disease. Our language has
+been enriched with other terms expressive of this affection, all of which
+have a precise meaning. Delirium, which we have borrowed from the latin,
+merely means, _out of the track_, de lira, so that a delirious person, one
+who starts out of the track regularly pursued, becomes compared to the
+same deviation in the process of ploughing. _Crazy_, we have borrowed from
+the French _ecrase_, crushed, broken: we still use the same meaning, and
+say that such a person is crack'd. Insane, deranged, or disarranged,[1]
+melancholic, out of one's wits, lunatic, phrenitic, or as we have
+corrupted it, frantick, require no explanation. _Beside one's self_ most
+probably originated from the belief of possession by a devil, or evil
+spirit.
+
+The importance of investigating the original meaning of words must be
+evident when it is considered that the law of this country impowers
+persons of the medical profession to confine and discipline those to whom
+the term mad or lunatic can fairly be applied. Instead of endeavouring to
+discover an infallible definition of madness, which I believe will be
+found impossible, as it is an attempt to comprise, in a few words, the
+wide range and mutable character of this Proteus disorder: much more
+advantage would be obtained if the circumstances could be precisely
+defined under which it is justifiable to deprive a human being of his
+liberty.
+
+Another impediment to an accurate definition of madness, arises from the
+various hypotheses, which have been entertained concerning the powers and
+operations of the human mind: and likewise from the looseness and
+unsettled state of the terms by which it is to be defined.
+
+Before treating of the intellect in a deranged state, it will perhaps be
+expected that some system of the human mind, in its perfect and healthy
+condition, should be laid down. It will be supposed necessary to establish
+in what sanity of intellect consists, and to mark distinctly some fixed
+point, the aberrations from which are to constitute disease.
+
+To have a thorough knowledge of the nature, extent, and rectitude of the
+human faculties, is particularly incumbent on him who undertakes to write
+of them in their distempered state; and, in a legal point of view, it is
+most important that the medical practitioner should be enabled to
+establish the state of the patient's case, as a departure from that which
+_is_ reason.
+
+The difficulty of proposing a satisfactory theory of the human mind, must
+have been felt by every person, who has touched this delicate string since
+the days of Aristotle, and failure must be expected in him who attempts
+it: yet the endeavour is laudable, and miscarriage is not linked with
+disgrace. Every contribution, to illustrate what are the powers of mind we
+possess; how we are acted upon by external circumstances in the
+acquisition of knowledge; and concerning the manner in which we use this
+knowledge for the purposes of life; ought to be candidly received.
+
+Enquiries of this nature have been usually conducted by commenting on the
+numerous and discordant authorities which have treated on metaphysical
+subjects; these persons, however they may differ on many points, appear to
+be pretty generally agreed, that the human mind possesses certain
+faculties and powers; as imagination, judgment, reason, and memory. They
+seem to consider these, as so many departments, or offices of the mind,
+and therefore class men according to the excellence or predominance of
+these powers. One man, is said to be distinguished by the brilliancy of
+his imagination; another, by the solidity of his judgment; a third, by the
+acuteness of his reason; and a fourth, by the promptitude and accuracy of
+his recollection.
+
+As far as I have observed respecting the human mind, (and I speak with
+great hesitation and diffidence,) it does not possess, all those powers
+and faculties with which the pride of man has thought proper to invest it.
+By our senses, we are enabled to become acquainted with objects, and we
+are capable of recollecting them in a greater or less degree; the rest,
+appears to be merely a contrivance of language.
+
+If mind, were actually capable of the operations attributed to it, and
+possessed of these powers, it would necessarily have been able to create a
+language expressive of these powers and operations. But the fact is
+otherwise. The language, which characterizes mind and its operations, has
+been borrowed from external objects; for mind has no language peculiar to
+itself. A few instances will sufficiently illustrate this position. After
+having committed an offence it is natural to say that the mind feels
+contrition and sorrow.
+
+Contrition is from _cum_ and _tero_, to rub together, which cannot
+possibly have any thing to do with the operations of the mind, which is
+incapable of rubbing its ideas or notions together. Contrition is a
+figurative expression, and may possibly mean the act of rubbing out the
+stain of vice, or wearing down by friction the prominences of sin.
+
+If we were to analyze the word Sorrow, which is held to be a mental
+feeling, we should find it to be transferred from bodily sufferance: for
+the mind, is incapable of creating a term correctly expressive of its
+state, and therefore, it became necessary to borrow it from _soreness_ of
+body.--_See Mr. Tooke's Diversions of Purley, vol. ii. p. 207_, where
+_sore_, _sorry_, and _sorrow_ are clearly made out to be the same word.
+
+It is customary to speak of a man, of accurate perceptions, and of
+another, who has grand and luminous conceptions of human nature.
+Perception, from _per_, and _capio_ to take, seize, grasp, through the
+medium of the organs of sense, being implied. But to take, seize, and
+grasp are the operations of the hand, and can only, by extreme courtesy,
+be attributed to mind.
+
+Mr. Dugald Stewart, the most thoughtful and intelligent of modern
+metaphysicians, has said, "By conception I mean that power of the mind
+which enables it to form a notion of an absent object of perception, or of
+a sensation which it has formerly felt."--_Elements of the Philosophy of
+the Human Mind, 8vo. p. 133._
+
+This definition means merely memory; and by perusing attentively the whole
+chapter the reader will be convinced of it. Conception, from _cum_ and
+_capio_, has been applied to mind from the physical sense of embracing,
+comprehending, or probably from the notion of being impregnated with the
+subject. It may be remarked, that these three terms, by which conception
+has been explained, have been all applied to mental operation.
+
+The words reason and reasoning, I believe, in most languages, strictly
+imply numeration, reckoning, proportion; the Latin _ratio_, _ratiocinor_,
+_ratiocinator_ are sufficient examples. A curious coincidence between the
+Latin _ratio_ and the Gothic _rathjo_, together with some pertinent and
+interesting observations, may be seen in Ihre's Glossarium Svio-gothicum,
+_p._ 393, _art._ Raekna. As we now acknowledge the science of number to be
+the purest system of reasoning, a system, on which all persons agree, and
+so unlike medicine, politics, and divinity, concerning which there is a
+constant, and hostile variety of sentiment, it adds some force to the
+argument. Indeed, Mr. Locke, who almost personifies reason, after having
+painfully sifted this matter, appears to be much of the same way of
+thinking: he says, "Reason, though it penetrates into the depth of the sea
+and earth, elevates our thoughts as high as the stars, and leads us
+through the vast spaces and large rooms of this mighty fabrick, _yet it
+comes far short of the real extent of even corporeal being_; and there are
+many instances wherein it fails us: as,
+
+"First: it perfectly fails us where our ideas fail: it neither does, nor
+can extend itself farther than they do, and therefore, wherever we have no
+ideas our reasoning stops, and we are at an end of our reckoning: and if
+at any time _we reason about words, which do not stand for any ideas_, it
+is only about those sounds, and nothing else.
+
+"Secondly: our reason is often puzzled, and at a loss, because of the
+obscurity, confusion or imperfection of the ideas it is employed about;
+and there we are involved in difficulties and contradictions. Thus, not
+having any perfect idea of the least extension of matter, nor of infinity,
+we are at a loss about the divisibility of matter; _but having perfect,
+clear, and distinct ideas of number, our reason meets with none of those
+inextricable difficulties in numbers, nor finds itself involved in any
+contradictions about them_."--_Works. 4to, vol. i, p. 431._
+
+It can scarcely be necessary, longer to fatigue the patience of the
+reader, by reverting to the etymology of those terms, which have been
+considered as significant of mind and its operations. Every one will be
+able sufficiently to develope imagination, reflection, combination, [as
+applied to ideas, importing the amalgamation of _two_ into one]
+abstraction, [_vide Mr. Tooke, from p. 15 to 426, vol. ii._] and a
+variety of others; and to shew, that they have arisen from physical
+objects, and the circumstances which surround us, and are independant of
+any operation which mind has elaborated.
+
+But as madness, by some, has been exclusively held to be a disease of the
+imagination, and by others, to be a defect of the judgment; considering
+these as separate and independant powers or faculties of the intellect; it
+is certainly worth the trouble to enquire, whether such states of mind did
+ever exist as original and unconnected disorders. With respect to
+imagination, there can be but little difficulty; yet this will so far
+involve the judgment and memory, that it will not be easy to institute a
+distinction. If a cobbler should suppose himself an emperor, this
+supposition, may be termed an elevated flight, or an extensive stretch of
+imagination, but it is likewise a great defect in his judgment, to deem
+himself that which he is not, and it is certainly an equal lapse of his
+recollection, to forget what he really is.
+
+Having endeavoured to give some reasons for not according with the
+generally received opinions, concerning the different powers of the mind,
+it may be proper shortly to state, that, from the manner in which we
+acquire knowledge, the human mind appears to be composed of a sum of
+individual perceptions: that, in proportion as we dwell by the eye, the
+ear, or the touch on any object (which is called attention,) we are more
+likely to become acquainted with it, and to be able to remember it. For
+the most part, we remember these perceptions in the succession in which
+they were presented, although, they may afterwards, from circumstances, be
+differently sorted.
+
+The minds of ordinary men are well contented to deal out their ideas, in
+the order in which they were received; and, not having found the necessity
+of bringing them to bear on general subjects, they are commonly minutely
+accurate in the detail of that which they have observed. By such persons,
+a story is told with all the relations of time and place; connected with
+the persons who were present, their situation, state of health, and a vast
+variety of associated particulars; and these persons, however tedious,
+generally afford the most correct account. On the other hand, those who
+are men of business, and have much to communicate in a given space, are
+obliged to subtract the more material circumstances from the gross
+narrative, and exhibit these as the sum total. It is in this way, that
+words, originally of considerable length, have been abbreviated for the
+conveniency of dispatch, and from this necessity short hand writing has
+been employed.
+
+As the science of arithmetic consists in addition to, or subtraction from,
+a given number; so does the human mind appear to be capable solely of
+adding to, or separating from, its stock of ideas, as pleasure may prompt,
+or necessity enforce.
+
+Language, the representative of thought, bears the same construction; and
+it is curious to remark in the investigation of its abbreviations, that
+those words, which serve to connect ideas together, (_conjunctions_) and
+which have been supposed to mark certain operations of intellect, postures
+of mind, and turns of thought, have merely the force and meaning of to
+add, or to subtract.
+
+Insanity is now generally divided into Mania and Melancholia, but formerly
+its distributions were more numerous. Paracelsus, speaking of this
+disease, says, "Vesaniae hujus genera quatuor existunt: primi _Lunatici_
+vocantur: secundi _Insani_: tertii _Vesani_: quarti _Melancholici_,
+Lunatici sunt qui omnem suum morbum ex Luna accipiunt, et juxta eam sese
+gerunt ac moventur. Insani sunt, qui malum id ab utero materno hauserunt,
+veluti haereditarium, uno subinde insaniam in alterum transferente. Vesani
+sunt, qui a cibis ac potibus ita inficiuntur ac taminantur, ut ratione
+sensuque priventur. Melancholici sunt, qui ex intimae naturae vitio a
+ratione deturbantur, et ad vesaniam precipitantur." Paracelsus, however,
+thinks that a fifth genus may be added. "Ad quatuor hac genera genus
+insuper aliud quodammodo annumerari potest, videlicet _obsessi_, qui a
+diabolo variis modis occupari solent."--_Paracelsi Opera, folio, tom. i.
+fol. 572._
+
+The idea of being besieged, beset, or possessed by the devil was formerly
+a very favourite notion, and is derived to us by an authority we are
+taught to reverence: indeed it is still the opinion of many harmless and
+believing persons, some of whom have bestowed considerable pains to
+convince me that the violent and mischievous maniacs in Bedlam were under
+the dominion of this insinuating spirit. They have employed one argument
+which would seem to have considerable weight, namely, that the most
+atrocious crimes are stated in our indictments (much to the credit of
+human nature) to have been committed by the instigation of the devil: and
+they have also endeavoured to explain, how a late and eminently successful
+practitioner, by an union of the holy office with consummate medical
+skill, was enabled to cure nine lunatics out of ten, which certainly has
+not hitherto been accounted for.
+
+Paracelsus, who contemplated this subject with uncommon gravity and
+solicitude, is of opinion that the devil enters us much in the same manner
+as a maggot gets into a filbert.--_Vide Fragmentum Libri Philosophiae de
+Daemoniacis et Obsessis, tom. ii. p. 460._
+
+To conclude this part of the subject, and to exhibit the state of belief
+at that period, I shall take the liberty of extracting a portion from the
+11th chapter of Dr. Andrewe Boord's Extravagantes, which "doth shewe of a
+Demoniacke person, the which is possessed of or with the devyll or
+devylls.
+
+"Demoniacus or Demoniaci be the Latin wordes. In Greke it is named
+Demonici. In Englyshe it is named he or they, the whiche be mad and
+possessed of the devyll or devils, and their propertie is to hurt and kyll
+them selfe, or els to hurt and kyll any other thynge, therfore let every
+man beware of them, and kepe them in a sure custody.
+
+_The cause of this Matter._
+
+"This matter doth passe all maner sickenesses and diseases, and it is a
+fearefull and terryble thyng to se a devyll or devylles shoulde have so
+muche and so greate a power over man, as it is specified of such persons
+dyvers tymes in the gospell, specyally in the IX. Chapitre of St. Marke.
+Chryste sendynge his disciples to preache the worde of God, gevynge them
+power to make sicke men whole, lame men to go, blynde to se, &c. Some of
+them dyd go by a mans that was possessed of devils and they coud not make
+him whole. Shortly to conclude, Chryst dyd make hym whole. The dysciples
+of Chryste asked of him why that they coud not make the possessed man of
+the devylls whole. And Jesus Chryste said to them: this kynde of devylls
+can not be cast out without prayer and fastynge. Here it is to be noted,
+that nowe a dayes fewe or els none doth set by prayer or fastynge,
+regardyng not gods wordes; in this matter, I do feare that suche persons
+be possessed of the devil, although they be not starke madde, and to shew
+further of demoniacke persons the whiche be starke madde. The fyrste tyme
+that I dyd dwell in Rome, there was a gentilwoman of Germani, the whych
+was possessed of devyls, and she was brought to Rome to be made whole.
+For within the precynct of St. Peters church, without St. Peters chapel,
+standeth a pyller of whyte marble grated round about with iron, to the
+which our Lorde Jesus Chryste dyd lye in hymselfe unto the Pylates hal, as
+the Romaynes doth say, to the which pyller al those that be possessed of
+the devyl, out of dyvers countreys and nacions be brought thyther, and as
+they say of Rome, such persons be made there whole. Amonge al other this
+woman of Germany, which is CCCC myles and odde from Rome, was brought to
+the pyller, (I then there beyng presente,) with great strength and
+violently with a XX or mo men, this woman was put into that pyller within
+the yron grate, and after her dyd go in a preeste, and dyd examine the
+woman under this maner in the Italian tonge. Thou devyl or devyls, I do
+abjure thee by the potencial power of the father, and of the sonne our
+Lorde Jesus Christe, and by the vertue of the Holy Ghoste, that thou do
+shewe to me, for what cause that thou doeste possess this woman: what
+wordes was aunswered I will not write, for men will not beleve it, but
+wolde say it were a foule and great lye, but I dyd heare that I was afrayd
+to tarry any longer, lest that the devyls shulde have come out of her, and
+to have entred into me; remembrynge what is specified in the viii Chapitre
+of St. Matthewe, when that Jesus Christ had made two men whole, the
+whiche, was possessed with a legion of devils. A legion is IX M. IX C.
+nynety and nyne: the sayd devyls dyd desyre Jesus, that when they were
+expelled out of the aforesayde twoo men, that they might enter into a
+herde of hogges, and so they did, and the hogges did runne into the sea
+and were drowned. I consyderynge this, and weke of faith and afeard,
+crossed myselfe and durste not heare and se such matters, for it was to
+stupendious and above all reason yf I shulde wryte it; and in this matter
+I dyd marvell of an other thynge; if the efficacitie of such makynge one
+whole, dyd rest in the vertue that was in the pyller, or els in the wordes
+that the preest dyd speake. I do judge it shulde be in the holy wordes
+that the prest dyd speak, and not in the pyller; for and yf it were in the
+pyller, the Byshops, and the Cardinalles that hathe ben many yeres past,
+and those that were in my tyme, and they that hath bin sence, wolde have
+had it in more reverence, and not to suffre rayne, hayle, snowe, and such
+wether to fal on it, for it hath no coverynge, but at laste when that I
+did consyder that the vernacle, the phisnomy of Christ, and scarse the
+sacrament of the aulter was in maner uncovered and al St. Peters Churche
+downe in ruyne, and utterly decayed, and nothing set by, consideringe in
+olde chapels, beggers and baudes, hoores and theves dyd lye within them,
+asses and moyles dyd defyle within the precincte of the Churche, and
+byenge and sellynge there was used within the precinct of the sayde church
+that it dyd pytie my harte and mynde to come and se any tyme more the
+sayde place and churche."--_Andrewe Boorde,[2] the seconde Boke of the
+Brevyary of health, 1557, fol. 4th._
+
+To return from this digression. Dr. Ferriar, whom to mention otherwise
+than as a man of genius, of learning, and of taste, would be unjust, has
+adopted the generally accepted division of insanity into mania and
+melancholia. In mania he conceives "false perception, and consequently
+confusion of ideas, to be a leading circumstance." The latter, he supposes
+to consist "in intensity of idea, which is a contrary state to false
+perception." From the observations I have been able to make respecting
+Mania, I have by no means been led to conclude, that false perception, is
+a leading circumstance in this disorder, and still less, that confusion of
+ideas must be the necessary consequence of false perception.
+
+By perception I understand, with Mr. Locke, the apprehension[3] of
+sensations; and after a very diligent enquiry of patients who have
+recovered from the disease, and from an attentive observation of those
+labouring under it, I have not frequently found, that insane people
+perceive falsely the objects which have been presented to them.
+
+We find madmen equally deranged upon those ideas, which they have been
+long in the possession of, and on which the perception has not been
+recently exercised, as respecting those, which they have lately received:
+and we frequently find those who become suddenly mad, talk incoherently
+upon every subject, and consequently, upon many, on which the perception
+has not been exercised for a considerable time.
+
+It is well known, that maniacs often suppose they have seen and heard
+those things, which really did not exist at the time; but even this I
+should not explain by any disability, or error of the perception; since it
+is by no means the province of the perception to represent unreal
+existences to the mind. It must therefore be sought elsewhere; most
+probably in the senses.
+
+We sometimes (more especially in the early stages of furious madness) find
+patients from very slight resemblances, and sometimes, where none whatever
+can be perceived by others of sound mind, confounding one person with
+another. Even in this case it does not seem necessary to recur to false
+perception for the explanation. It is equally probable that the organs of
+vision are affected in consequence of the disease of the brain, and
+therefore receive incorrect sensations: and still more likely, from the
+_rapid succession_ in which objects are noticed, that a very slight trait
+of countenance would recal the idea [or name] of some particular person.
+
+I have known many cases of patients who insisted that they had seen the
+devil. It might be urged, that in these instances, the perception was
+vitiated; but it must be observed there could be no perception of that,
+which was not present and existing at the time. Upon desiring these
+patients to describe what they had seen, they all represented him as a
+big, black man, with a long tail, and sharp talons, such as is seen
+pictured in books; a proof that the idea was revived in the mind from some
+former impressions. One of these patients however carried the matter a
+little further, as she solemnly declared, she heard him break the iron
+chain with which God had confined him, and saw him pass fleetly by her
+window, with a truss of straw upon his shoulder.
+
+That "confusion of ideas" should be the necessary consequence of false
+perception, is very difficult to admit. It has often been observed that
+madmen will reason correctly from false premises, and the observation is
+certainly true: we have indeed occasion to notice the same thing in those
+of the soundest minds. It is very possible for the perception to be
+deceived in the occurrence of a thing, which, although it did not actually
+happen, yet was likely to take place; and which had frequently occurred
+before.--The reception of this as a truth, if the person were capable of
+deducing from it the proper inferences, could neither create confusion nor
+irregularity of ideas.
+
+Melancholia, the other form in which this disease is supposed to exist, is
+made by Dr. Ferriar to consist in "intensity of idea." By intensity of
+idea, I presume is meant, that the mind is more strongly fixed on, or
+more frequently recurs to, a certain set of ideas, than when it is in a
+healthy state. But this definition applies equally to mania; for we every
+day see the most furious maniacs suddenly sink into a profound
+melancholia, and the most depressed and miserable objects become violent
+and raving. There are patients in Bethlem Hospital, whose lives are
+divided between furious and melancholic paroxysms, and who, under both
+forms, retain the same set of ideas. It must also have been observed, by
+those who are conversant with this disorder, that there is an intermediate
+state, which cannot be termed maniacal nor melancholic: a state of
+complete insanity, yet unaccompanied by furious or depressing
+passions.[4]
+
+In speaking of the two forms of this disease, mania and melancholia, there
+is a circumstance sufficiently obvious, which hitherto does not appear to
+have been noticed: I mean the rapid or slow succession of the patient's
+ideas. Probably sound and vigorous mind consists as much in the moderate
+succession of our ideas, as in any other circumstance. It may be enquired,
+how we are to ascertain this increased, proportionate, and deficient
+activity of mind? From language, the medium by which thought is conveyed.
+The connexion between thought and utterance is so strongly cemented by
+habit, that the latter becomes the representative of the former.
+
+The physiology of mind, I humbly conceive to be at present in its infancy,
+but there seems good reason to imagine, that furious madness implies a
+rapid succession of ideas; and the circumstance of rage, from whence its
+origin has been deduced, points out the hurried consecution. In this state
+of mind the utterance succeeds
+
+  --------------------"sudden as the spark
+  From smitten steel; from nitrous grain the blaze."
+
+and it frequently happens, after the tumult has subsided, the person
+remembers but little of that which had escaped him.
+
+  "I then, all-smarting with my wounds, being cold,
+  (To be so pestered with a popingay)
+  Out of my greefe, and my Impatience,
+  Answered (neglectingly) _I know not what_--
+  _He should, or should not_: for he made me _mad_."
+
+From this connexion between thought and utterance, we find many persons
+(particularly those who are insane) talking to themselves; especially when
+their minds are intently occupied; and taking the converse, we frequently
+observe those who are desirous to acquire any subject by heart, repeating
+it aloud.
+
+From the same cause we have often occasion to remark, that strong, and
+perhaps involuntary, propensity to repeat the emphatical words in a
+sentence, and which are commonly the last, before we endeavour to reply
+to, or confute them.
+
+  "_King._ No: on the barren Mountaine let him sterve:
+           For I shall never hold that man my friend
+           Whose tongue shall aske me for one peny cost
+           To ransome home revolted Mortimer.
+
+  "_Hotsp._ Revolted Mortimer?
+            He never did fall off, my Soveraigne Liege,
+            But by the chance of warre:"
+
+As the terms Mania and Melancholia, are in general use, and serve to
+distinguish the forms under which insanity is exhibited, there can be no
+objection to retain them; but I would strongly oppose their being
+considered as opposite diseases. In both there is an equal derangement. On
+dissection, the state of the brain does not shew any appearances peculiar
+to melancholia; nor is the treatment, which I have observed most
+successful, different from that which is employed in mania.
+
+As the practitioner's own mind must be the criterion, by which he infers
+the insanity of any other person; and when we consider the various, and
+frequently opposite, opinions of these intellectual arbitrators; the
+reader will be aware that I have not abstained from giving a definition of
+madness without some reason. There is indeed a double difficulty: the
+definition ought to comprize the aberrations of the lunatic, and fix the
+standard for the practitioner.
+
+But it may be assumed that sound mind and insanity stand in the same
+predicament, and are opposed to each other in the same manner, as right to
+wrong, and as truth to the lie. In a general view no mistake can arise,
+and where particular instances create embarrassment, those most conversant
+with such persons will be best able to determine.
+
+The terms sound mind and insanity are sufficiently plain. If to an
+ordinary observer, a person were to talk in an incoherent manner, he would
+think him mad; if his conduct were regular, and his observations
+pertinent, he would pronounce him in his senses: the two opposite states,
+well marked, are well understood; but there are many different shades,
+which are not so likely to strike the common examiner.
+
+
+
+
+CHAP. II.
+
+SYMPTOMS OF THE DISEASE.
+
+
+On this part of the subject, authors have commonly descended to minute
+particularities, and studied discriminations. Distinctions have been
+created, rather from the peculiar turn of the patient's propensities and
+discourse, than from any marked difference in the varieties and species of
+the disorder. Every person of sound mind, possesses something peculiar to
+himself, which distinguishes him from others, and constitutes his
+idiosyncrasy of body and individuality of character: in the same manner,
+every lunatic discovers something singular in his aberrations from sanity
+of intellect. It is not my intention to record these splintered
+subdivisions, but to exhibit the prominent features, by which insanity may
+be detected, as far as such appearances seem worthy of remark, and have
+been the subject of my own observation.
+
+In most public hospitals, the first attack of diseases is seldom to be
+observed; and it might naturally be supposed, that there existed in
+Bethlem, similar impediments to an accurate knowledge of incipient
+madness. It is true, that all who are admitted into it, have been a
+greater, or less time afflicted with the disorder; yet from the occasional
+relapses to which insane persons are subject, we have frequent and
+sufficient opportunities of observing the beginning, and tracing the
+progress of this disease.
+
+Among the incurables, there are some, who have intervals of perfect
+soundness of mind; but who are subject to relapses, which would render it
+improper, and even dangerous, to trust them at large in society: and with
+those, who are upon the curable establishment, a recurrence of the malady
+very frequently takes place. Upon these occasions, there is an ample scope
+for observing the first attack of the disease.
+
+On the approach of mania, they first become uneasy,[5] are incapable of
+confining their attention, and neglect any employment to which they have
+been accustomed; they get but little sleep, they are loquacious, and
+disposed to harangue, and decide promptly, and positively upon every
+subject that may be started. Soon after, they are divested of all
+restraint in the declaration of their opinions of those, with whom they
+are acquainted. Their friendships are expressed with fervency and
+extravagance; their enmities with intolerance and disgust. They now become
+impatient of contradiction, and scorn reproof. For supposed injuries, they
+are inclined to quarrel and fight with those about them. They have all the
+appearance of persons inebriated, and those who are unacquainted with the
+symptoms of approaching mania, generally suppose them to be in a state of
+intoxication. At length suspicion creeps in upon the mind, they are aware
+of plots, which had never been contrived, and detect motives that were
+never entertained. At last the succession of ideas is too rapid to be
+examined;[6] the mind becomes crouded with thoughts, and confusion
+ensues.
+
+Those under the influence of the depressing passions, will exhibit a
+different train of symptoms. The countenance wears an anxious and gloomy
+aspect, and they are little disposed to speak. They retire from the
+company of those with whom they had formerly associated, seclude
+themselves in obscure places, or lie in bed the greatest part of their
+time. Frequently they will keep their eyes fixed to some object for hours
+together, or continue them an equal time "bent on vacuity." They next
+become fearful, and conceive a thousand fancies: often recur to some
+immoral act which they have committed, or imagine themselves guilty of
+crimes which they never perpetrated: believe that God has abandoned them,
+and, with trembling, await his punishment. Frequently they become
+desperate, and endeavour by their own hands to terminate an existence,
+which appears to be an afflicting and hateful incumbrance.
+
+Madmen, do not always continue in the same furious or depressed states:
+the maniacal paroxysm abates of its violence, and some beams of hope,
+occasionally cheer the despondency of the melancholic patients. We have
+in the hospital some unfortunate persons, who are obliged to be secured
+the greater part of their time, but who now and then become calm, and to a
+certain degree rational: upon such occasions, they are allowed a greater
+range, and are admitted to associate with the others. In some instances
+the degree of rationality is more considerable; they conduct themselves
+with propriety, and in a short conversation will appear sensible and
+coherent. Such remission has been generally termed a _lucid interval_.
+
+When medical persons are called upon to attend a commission of lunacy,
+they are always asked, whether the patient has had a _lucid interval_? A
+term of such latitude as interval, requires to be explained in the most
+perspicuous and accurate manner. [The circumstances which probably
+occasioned the employment of this term are pointed out in the chapter
+which enumerates the causes of insanity.] In common language, it is made
+to signify both a moment and a number of years, consequently it does not
+comprize any stated time. The term _lucid interval_ is therefore relative.
+As the law requires a precise developement of opinion, I should define a
+_lucid interval_ to be a complete recovery of the patient's intellects,
+ascertained by repeated examinations of his conversation, and by constant
+observation of his conduct, for a time sufficient to enable the
+superintendant to form a correct judgment. Unthinking people, are
+frequently led to conclude, that if, during a short conversation, a person
+under confinement shall bewray nothing absurd or incorrect, he is well,
+and often remonstrate on the injustice of secluding him from the world.
+Even in common society, there are many persons whom we never suspect,
+from a few trifling topics of discourse, to be shallow minded; but, if we
+start a subject, and wish to discuss it through all its ramifications and
+dependancies, we find them incapable of pursuing a connected chain of
+reasoning. In the same manner insane people will often, for a short time,
+conduct themselves, both in conversation and behaviour, with such
+propriety, that they appear to have the just exercise and direction of
+their faculties: but let the examiner protract the discourse until the
+favourite subject shall have got afloat in the mad man's brain, and he
+will be convinced of the hastiness of his decision. To those unaccustomed
+to insane people, a few coherent sentences, or rational answers, would
+indicate a lucid interval, because they discovered no madness; but he, who
+is in possession of the peculiar turn of the patient's thoughts, might
+lead him to disclose them, or by a continuance of the conversation, they
+would spontaneously break forth. A beautiful illustration of this is
+contained in the Rasselas of Dr. Johnson, where the astronomer is admired
+as a person of sound intellect and great acquirements by Imlac, who is
+himself a philosopher, and a man of the world. His intercourse with the
+astronomer is frequent; and he always finds in his society information and
+delight. At length he receives Imlac into the most unbounded confidence,
+and imparts to him the momentous secret. "Hear, Imlac, what thou wilt not,
+without difficulty, credit. I have possessed, for five years, the
+regulation of weather, and the distribution of the seasons. The Sun has
+listened to my dictates, and passed from tropic to tropic by my direction.
+The clouds, at my call, have poured their waters, and the Nile has
+overflowed at my command. I have restrained the rage of the Dog-star, and
+mitigated the fervours of the Crab. The winds alone, of all the elemental
+powers, have hitherto refused my authority; and multitudes have perished
+by equinoctial tempests, which I found myself unable to prohibit or
+restrain. I have administered this great office with exact justice, and
+made to the different nations of the earth an impartial dividend of rain
+and sunshine. What must have been the misery of half the globe, if I had
+limited the clouds to particular regions, or confined the Sun to either
+side of the Equator?"
+
+A real case came under my observation some years ago, and which is equally
+apposite to the subject. A young man had become insane from habitual
+intoxication; and, during the violence of his disorder, had attempted to
+destroy himself. Under a supposed imputation of having unnatural
+propensities, he had amputated his penis, with a view of precluding any
+future insinuations of that nature. For many months, after he was
+admitted into the hospital, he continued in a state which obliged him to
+be strictly confined, as he constantly meditated his own destruction. On a
+sudden, he became apparently well, was highly sensible of the delusion
+under which he had laboured, and conversed, as any other person, upon the
+ordinary topics of discourse. There was, however, something in the reserve
+of his manner, and peculiarity of his look, which persuaded me he was not
+well, although no incoherence could be detected in his conversation. I had
+observed him for some days to walk rather lame, and once or twice had
+noticed him sitting with his shoes off, rubbing his feet. On enquiring
+into the motives of his doing so, he replied, that his feet were
+blistered, and wished that some remedy might be applied to remove the
+vesications. When I requested to look at his feet, he declined it, and
+prevaricated, saying, that they were only tender and uncomfortable. In a
+few days afterwards, he assured me they were perfectly well. The next
+evening I observed him, unperceived, still rubbing his feet, and then
+peremptorily insisted on examining them. They were quite free from any
+disorder. He now told me, with some embarrassment, that he wished much for
+a confidential friend, to whom he might impart a secret of importance;
+upon assuring him that he might trust me, he said, that the boards on
+which he walked, (the second story) were heated by subterraneous fires,
+under the direction of invisible and malicious agents, whose intentions,
+he was well convinced, were to consume him by degrees.
+
+From these considerations, I am inclined to think, that a _lucid interval_
+includes all the circumstances, which I have enumerated in my definition
+of it. If the person, who is to examine the state of the patient's mind,
+be unacquainted with his peculiar opinions, he may be easily deceived,
+because, wanting this information, he will have no clue to direct his
+enquiries, and madmen do not always, nor immediately intrude their
+incoherent notions: they have sometimes such a high degree of control over
+their minds, that when they have any particular purpose to carry, they
+will affect to renounce those opinions, which shall have been judged
+inconsistent: and it is well known, that they have often dissembled their
+resentment, until a favourable opportunity has occurred of gratifying
+their revenge.
+
+Of this restraint, which madmen have sometimes the power of imposing on
+their opinions, the remark has been so frequent, that those who are more
+immediately about their persons, have termed it, in their rude phrase,
+_stifling the disorder_.
+
+Among the numerous instances of this cunning and dissimulation, which I
+have witnessed in insane persons, the relation of one case will be
+sufficient to exemplify the subject.
+
+An Essex farmer, about the middle age, had on one occasion so completely
+masked his disorder, that I was induced to suppose him well, when he was
+quite otherwise. He had not been at home many hours, before his
+derangement was discernable by all those, who came to congratulate him on
+the recovery of his reason. His impetuosity, and mischievous disposition
+daily increasing, he was sent to a private mad-house; there being, at that
+time, no vacancy in the hospital. Almost from the moment of his
+confinement he became tranquil, and orderly, but remonstrated on the
+injustice of his seclusion.
+
+Having once deceived me, he wished much, that my opinion should be taken
+respecting the state of his intellects, and assured his friends that he
+would submit to my determination. I had taken care to be well prepared for
+this interview, by obtaining an accurate account of the manner in which he
+had conducted himself. At this examination, he managed himself with
+admirable address. He spoke of the treatment he had received, from the
+persons under whose care he was then placed, as most kind and fatherly: he
+also expressed himself as particularly fortunate in being under my care,
+and bestowed many handsome compliments on my skill in treating this
+disorder, and expatiated on my sagacity in perceiving the slightest tinges
+of insanity. When I wished him to explain certain parts of his conduct,
+and particularly some extravagant opinions, respecting certain persons and
+circumstances, he disclaimed all knowledge of such circumstances, and felt
+himself hurt, that my mind should have been poisoned so much to his
+prejudice. He displayed equal subtilty on three other occasions when I
+visited him; although by protracting the conversation, he let fall
+sufficient to satisfy my mind that he was a mad-man. In a short time he
+was removed to the hospital, where he expressed great satisfaction in
+being under my inspection. The private mad-house, which he had formerly so
+much commended, now became the subject of severe animadversion; he said
+that he had there been treated with extreme cruelty; that he had been
+nearly starved, and eaten up by vermin of various descriptions. On
+enquiring of some convalescent patients, I found (as I had suspected) that
+I was as much the subject of abuse, when absent, as any of his supposed
+enemies; although to my face his behaviour was courteous and respectful.
+More than a month had elapsed, since his admission into the hospital,
+before he pressed me for my opinion; probably confiding in his address,
+and hoping to deceive me. At length he appealed to my decision, and urged
+the correctness of his conduct during confinement as an argument for his
+liberation. But when I informed him of circumstances he supposed me
+unacquainted with, and assured him, that he was a proper subject for the
+asylum where he then inhabited; he suddenly poured forth a torrent of
+abuse; talked in the most incoherent manner; insisted on the truth of what
+he had formerly denied; breathed vengeance against his family and friends,
+and became so outrageous that it was necessary to order him to be strictly
+confined. He continued in a state of unceasing fury for more than fifteen
+months.
+
+As the memory, appears to be particularly defective in cases of insanity,
+it is much to be wished, that we possessed a correct history, and
+physiological account of this wonderful faculty. Unfortunately, this
+knowledge is not to be sought for with much prospect of attainment, from
+books which treat of the human mind and its philosophy; nor is the present
+work, to be considered as the depository of such information. A deliberate
+attention, to the precise order in which we acquire information on any
+subject; a consideration of the effects of its repetition; an
+investigation of the result (comparing it to a chain) whenever the links
+are separated, together with a knowledge of the contrivance of abbreviated
+signs, would perhaps render the matter sufficiently intelligible. But it
+would be necessary, thoroughly to understand the nature of the thing, of
+which the sign has been abbreviated: particularly, as the usual mode of
+education is satisfied with possessing the convenience of the
+abbreviation, without any inquiry into the nature of the thing, and the
+cause of the abbreviation of its sign. This faulty mode of instruction,
+has furnished us with a profusion of names, and left us ignorant of the
+things they represent.
+
+Ben Johnson has afforded us the shortest, and probably, the best account
+of memory.
+
+"_Memory_ of all the _powers_ of the mind, is the most _delicate_, and
+frail: It is the first of our _faculties_ that age invades. Seneca, the
+Father, the _Rhetorician_, confesseth of himself, he had a miraculous one,
+not only to receive, but to hold. I myself could in my youth, have
+repeated all that ever I had made, and so continued till I was past
+forty: since it is much decayed in me. Yet I can repeat whole books that I
+have read, and _Poems_ of some selected friends, which I have lik'd to
+charge my memory with. It was wont to be faithful to me, but shaken with
+_Age_ now, and _Sloth_ (which weakens the strongest abilities) it may
+perform somewhat, but cannot promise much. By exercise it is to be made
+better and serviceable. Whatsoever I pawn'd with it while I was young and
+a boy, it offers me readily, and without stops: but what I trust to it
+now, or have done of later years, it lays up more negligently, and
+sometimes loses; so that I receive mine own (though frequently called for)
+as if it were new and borrow'd. Nor do I always find presently from it
+what I do seek; but while I am doing another thing, that I laboured for
+will come: and what I sought with trouble, will offer itself when I am
+quiet. Now in some men I have found it as happy as nature, who, whatsoever
+they read or pen, they can say without book presently; as if they did then
+write in their mind. And it is more a wonder in such as have a swift
+stile, for their Memories are commonly slowest; such as torture their
+writings, and go into council for every word, must needs fix somewhat, and
+make it their own at last, though but through their own
+vexation."--_Discoveries, vol. vi. p. 240, 1716._
+
+If in a chain of ideas, a number of the links are broken, or leaving out
+the metaphor, if there be an inability to recollect circumstances in the
+order, in which they occurred, the mind cannot possess any accurate
+information. When patients of this description are asked a question, they
+appear as if awakened from a sound sleep: they are searching, they know
+not where, for the proper materials of an answer, and, in the painful,
+and fruitless efforts of recollection, generally lose sight of the
+question itself. Shakespeare, the highest authority in every thing
+relating to the human mind and its affections, seems to be persuaded, that
+some defect of memory is necessary to constitute madness.
+
+                          "It is not madnesse
+  That I have uttered: bring me to the test
+  And I the matter will _re-word_, which madnesse
+  Would gambol from."--_Hamlet, Act III. Scene 4._
+
+In persons of sound mind, as well as in maniacs, the memory is the first
+power which decays; and there is something remarkable in the manner of its
+decline. The transactions of the latter part of life are feebly
+recollected, whilst the scenes of youth and of manhood, remain more
+strongly impressed. When I have listened to the conversations of the old
+incurable patients, the topic has generally turned upon the transactions
+of early days; and, on the circumstances of that period of life, they have
+frequently spoken with tolerable correctness. In many cases, where the
+mind has been injured by intemperance, the same withering of the
+recollection may be observed. It may, perhaps, arise from the mind at an
+early period of life, being most susceptible and retentive of impressions,
+and from a greater disposition to be pleased, with the objects which are
+presented: whereas, the cold caution, and fastidiousness with which age
+surveys the prospects of life, joined to the dulness of the senses, and
+the slight curiosity which prevails, will, in some degree, explain the
+difficulty of recalling the history of later transactions.
+
+Insane people, who have been good scholars, after a long confinement,
+lose, in a wonderful degree, the correctness of orthography: when they
+write, above half the words are frequently mis-spelt, they are written
+according to the pronunciation. It shews how treacherous the memory is
+without reinforcement. The same necessity of a constant recruit, and
+frequent review of our ideas, satisfactorily explains, why a number of
+patients lapse nearly into a state of ideotism. These have, for some
+years, been the silent and gloomy inhabitants of the hospital, who have
+avoided conversation, and courted solitude; consequently have acquired no
+new ideas, and time has effaced the impression of those, formerly stamped
+on the mind. Mr. Locke, well observes, although he speaks figuratively,
+"that there seems to be a constant decay of all our ideas, even of those
+which are struck deepest, and in minds the most retentive; so that, if
+they be not sometimes renewed by repeated exercise of the senses, or
+reflection on those kind of objects, which at first occasioned them, the
+print wears out, and at last there remains nothing to be seen."
+
+Connected with loss of memory, there is a form of insanity which occurs in
+young persons; and, as far as these cases have been the subject of my
+observation, they have been more frequently noticed in females. Those whom
+I have seen, have been distinguished by prompt capacity and lively
+disposition: and in general have become the favourites of parents and
+tutors, by their facility in acquiring knowledge, and by a prematurity of
+attainment. This disorder commences, about, or shortly after, the period
+of menstruation, and in many instances has been unconnected with
+hereditary taint; as far as could be ascertained by minute enquiry. The
+attack is almost imperceptible; some months usually elapse, before it
+becomes the subject of particular notice; and fond relatives are
+frequently deceived by the hope that it is only an abatement of excessive
+vivacity, conducing to a prudent reserve, and steadiness of character. A
+degree of apparent thoughtfulness and inactivity precede, together with a
+diminution of the ordinary curiosity, concerning that which is passing
+before them; and they therefore neglect those objects and pursuits which
+formerly proved sources of delight and instruction. The sensibility
+appears to be considerably blunted; they do not bear the same affection
+towards their parents and relations; they become unfeeling to kindness,
+and careless of reproof. To their companions they shew a cold civility,
+but take no interest whatever in their concerns. If they read a book, they
+are unable to give any account of its contents: sometimes, with steadfast
+eyes, they will dwell for an hour on one page, and then turn over a number
+in a few minutes. It is very difficult to persuade them to write, which
+most readily develops their state of mind: much time is consumed and
+little produced. The subject is repeatedly begun, but they seldom advance
+beyond a sentence or two: the orthography becomes puzzling, and by
+endeavouring to adjust the spelling, the subject vanishes. As their apathy
+increases they are negligent of their dress, and inattentive to personal
+cleanliness. Frequently they seem to experience transient impulses of
+passion, but these have no source in sentiment; the tears, which trickle
+down at one time, are as unmeaning as the loud laugh which succeeds them;
+and it often happens that a momentary gust of anger, with its attendant
+invectives, ceases before the threat can be concluded. As the disorder
+increases, the urine and faeces are passed without restraint, and from the
+indolence which accompanies it, they generally become corpulent. Thus in
+the interval between puberty and manhood, I have painfully witnessed this
+hopeless and degrading change, which in a short time has transformed the
+most promising and vigorous intellect into a slavering and bloated ideot.
+
+Of the organs of sense, which become affected in those labouring under
+insanity, the ear, more particularly suffers. I scarcely recollect an
+instance of a lunatic becoming blind, but numbers are deaf. It is also
+certain that in these persons, more delusion is conveyed through the ear
+than the eye, or any of the other senses. Those who are not actually deaf,
+are troubled with difficulty of hearing, and tinnitus aurium. Thus an
+insane person shall suppose that he has received a commission from the
+Deity; that he has ordered him to make known his word, or to perform some
+act, as a manifestation of his will and power. It is however much to be
+regretted, that these divine commissions generally terminate in human
+mischief and calamity, and instances are not unfrequent, where these holy
+inspirations, have urged the unfortunate believer to strangle his wife,
+and attempt the butchery of his children. From this source may be
+explained, the numerous delusions of modern prophecies, which
+circumstantially relate the gossipings of angels, and record the
+hallucinations of feverish repose.
+
+In consequence of some affection of the ear, the insane sometimes insist
+that malicious agents contrive to blow streams of infected air into this
+organ: others have conceived, by means of what they term hearkening wires
+and whiz-pipes, that various obscenities and blasphemies are forced into
+their minds; and it is not unusual for those who are in a desponding
+condition, to assert, that they distinctly hear the devil tempting them
+to self-destruction.
+
+A considerable portion of the time of many lunatics, is passed in replies
+to something supposed to be uttered. As this is an increasing habit, so it
+may be considered as an unfavourable symptom, and at last the patient
+becomes so abstracted from surrounding objects, that the greater part of
+the day is consumed in giving answers to these supposed communications. It
+sometimes happens that the intelligence conveyed, is of a nature to
+provoke the mad-man, and on these occasions, he generally exercises his
+wrath on the nearest bystander; whom he supposes, in the hurry of his
+anger, to be the offending party.
+
+In the soundest state of our faculties, we are more liable to be deceived
+by the ear, than through the medium of the other senses: a partial
+obstruction by wax, shall cause the person so affected, to hear the
+bubbling of water, the ringing of bells, or the sounds of musical
+instruments; and on some occasions, although the relation seems tinged
+with superstition, men of undeviating veracity, and of the highest
+attainments, have asserted, that they have heard themselves _called_. "He
+[Dr. Johnson] mentioned a thing as not unfrequent, of which I [Mr.
+Boswell] had never heard before--being _called_, that is, hearing one's
+name pronounced by the voice of a known person at a great distance, far
+beyond the possibility of being reached by any sound, uttered by human
+organs. An acquaintance on whose veracity I can depend, told me, that
+walking home one evening to Kilmarnock, he heard himself called from a
+wood, by the voice of a brother who had gone to America; and the next
+packet brought account of that brother's death. Macbean asserted that
+this inexplicable _calling_ was a thing very well known. Dr. Johnson said,
+that one day at Oxford, as he was turning the key of his chamber, he heard
+his mother distinctly call _Sam_. She was then at Litchfield; but nothing
+ensued. This phaenomenon is, I think, as wonderful as any other mysterious
+fact, which many people are very slow to believe, or rather, indeed,
+reject with an obstinate contempt."--_Boswell's Life of Dr. Johnson,
+4to. vol. ii. p. 384._
+
+One of the most curious cases of this nature which has fallen under my
+observation, I shall here venture to relate, for the amusement of the
+reader. The patient was a well educated man, about the middle age; he
+always stopped his ears closely with wool, and, in addition to a flannel
+night-cap, usually slept with his head in a tin saucepan. Being asked the
+reason why he so fortified his head, he replied, "To prevent the
+intrusion of the _sprites_." After having made particular enquiry
+concerning the nature of these beings, he gravely communicated the
+following information:--"Sir, you must know that in the human seminal
+fluid there are a number of vital particles, which being injected into the
+female, impregnate her, and form a foetus of muscles and bones. But this
+fluid has other properties, it is capable, by itself, of producing
+vitality under certain circumstances, and experienced chemists and
+hermetical philosophers have devised a method of employing it for other
+purposes, and some, the most detrimental to the condition and happiness of
+man. These philosophers, who are in league with princes, and their
+convenient and prostituted agents, contrive to extract a portion of their
+own semen, which they conserve in rum or brandy: these liquors having the
+power of holding for a considerable time the seminal fluid, and keeping
+its vitality uninjured. When these secret agents intend to perform any of
+their devilish experiments on a person, who is an object of suspicion to
+any of these potentates, they cunningly introduce themselves to his
+acquaintance, lull him to sleep by artificial means, and during his
+slumbers, infuse a portion of their seminal fluid (conserved in rum or
+brandy) into his ears.
+
+"As the semen in the natural commerce with the woman, produces a child,
+so, having its vitality conserved by the spirit, it becomes capable of
+forming a _sprite_; a term, obviously derived from the spirit in which it
+had been infused. The ear is the most convenient nidus for hatching these
+vital particles of the semen. The effects produced on the individual,
+during the incubation of these seminal germs, are very disagreeable; they
+cause the blood to mount into the head, and produce considerable giddiness
+and confusion of thought. In a short time, they acquire the size of a
+pin's head; and then they perforate the drum of the ear, which enables
+them to traverse the interior of the brain, and become acquainted with the
+hidden secrets of the person's mind. During the time they are thus
+educated, they enlarge according to the natural laws of growth; they then
+take wing, and become invisible beings, and, from the strong ties of
+natural affection, assisted by the principle of attraction, they revert to
+the parent who afforded the semen, and communicate to him their
+surreptitious observations and intellectual gleanings. In this manner, I
+have been defrauded of discoveries which would have entitled me to
+opulence and distinction, and have lived to see others reap honours and
+emoluments, for speculations which were the genuine offsprings of my own
+brain."
+
+By some persons, madness has been considered as a state of mind analogous
+to dreaming: but an inference of this kind supposes us fully acquainted
+with the actual state, or condition of the mind in dreaming, and in
+madness. The whole question hinges on a knowledge of this _state of mind_,
+which I fear is still involved in obscurity. As it is not the object of
+the present work to discuss this curious question, the reader is referred
+to the fifth section of the first part of Mr. Dugald Stewart's Elements of
+the Philosophy of the Human Mind, and to the note, o, at the end; he will
+also find the subject treated with considerable ingenuity in the eleventh
+section of Mr. Brown's Observations on Zoonomia.
+
+There is, however, a circumstance, which to my knowledge, has not been
+noticed by those who have treated on this subject, and which appears to
+establish a marked distinction between madness and dreaming. In madness,
+the delusion we experience is most frequently conveyed through the ear; in
+dreaming, the deception is commonly optical; we see much, and hear little;
+indeed dreaming, at least with myself, seems to be a species of
+intelligible pantomime, that does not require the aid of language to
+explain it. It is true, that some who have perfectly recovered from this
+disease, and who are persons of good understanding and liberal education,
+describe the state they were in, as resembling a dream: and when they have
+been told how long they were disordered, have been astonished that the
+time passed so rapidly away. But this only refers to that consciousness of
+delusion, which is admitted by the patient on his return to reason; in the
+same manner as the man awake, smiles at the incongruous images, and
+abrupt transitions of the preceding night. In neither condition, does the
+consciousness of delusion, establish any thing explanatory of the _state_
+of the mind.
+
+In a description of madness, it would be blameable to omit a form of this
+disease which is commonly very intractable, and of the most alarming
+consequences; I mean, the insanity which arises from the habit of
+intoxication. All persons who have had any experience of this disease,
+readily allow that fermented liquors, taken to excess, are capable of
+producing mental derangement: but the medical practitioner has in such
+cases, to contend, and generally without effect, with popular prejudice,
+and sometimes, with the subordinate advisers of the law.
+
+To constitute madness, the minds of ignorant people expect a display of
+continued violence, and they are not satisfied that the person can be
+pronounced in that state, without they see him exhibit the pranks of a
+baboon, or hear him roar and bellow like a beast. By these people the
+patient is stated only to be intemperate; they confess that he does very
+foolish things when intoxicated; but that he is not mad, and only requires
+to be restrained from drinking. Thus, a man is permitted slowly to poison
+and destroy himself; to produce a state of irritation, which disqualifies
+him for any of the useful purposes of life; to squander his property
+amongst the most worthless and abandoned; to communicate a loathsome and
+disgraceful disease to a virtuous wife, and leave an innocent and helpless
+family to the meager protection of the parish. If it be possible, the law
+ought to define the circumstances, under which it becomes justifiable, to
+restrain a human being from effecting his own destruction, and involving
+his family in misery and ruin. When a man suddenly bursts through the
+barriers of established opinions; if he attempt to strangle himself with a
+cord, to divide his larger blood-vessels with a knife, or swallow a vial
+full of laudanum, no one entertains any doubt of his being a proper
+subject for the superintendance of keepers, but he is allowed, without
+control, by a gradual process, to undermine the fabric of his own health,
+and destroy the prosperity of his family.
+
+All patients have not the same degree of memory of what has passed during
+the time they were disordered: and I have frequently remarked, when they
+were unable to give any account of the peculiar opinions which they had
+indulged, during a raving paroxysm of long continuance, that they well
+remembered any coercion which had been used, or any kindness which had
+been shewn them.
+
+Insane people, are said to be generally worse in the morning; in some
+cases they certainly are so, but perhaps not so frequently as has been
+supposed. In many instances (and, as far as I have observed) in the
+beginning of the disease, they are more violent in the evening, and
+continue so the greatest part of the night. It is, however, a certain
+fact, that the majority of patients of this description, have their
+symptoms aggravated by being placed in a recumbent posture. They seem,
+themselves, to avoid the horizontal position as much as possible, when
+they are in a raving state: and when so confined that they cannot be
+erect, will keep themselves seated upon the breech.
+
+Many of those who are violently disordered will continue particular
+actions for a considerable time: some are heard to gingle the chain, with
+which they are confined, for hours without intermission; others, who are
+secured in an erect posture, will beat the ground with their feet the
+greatest part of the day. Upon enquiry of such patients, after they have
+recovered, they have assured me that these actions afforded them
+considerable relief. We often surprize persons who are supposed free from
+any mental derangement, in many strange and ridiculous movements,
+particularly if their minds be intently occupied:[7]--this does not
+appear to be so much the effect of habit, as of a particular state of
+mind.
+
+Among the bodily particularities which mark this disease, may be observed
+the protruded, and oftentimes glistening eye, and a peculiar cast of
+countenance, which, however, cannot be described. In some, an appearance
+takes place which has not hitherto been noticed by authors. This is a
+relaxation of the integuments of the cranium, by which they may be
+wrinkled, or rather gathered up by the hand to a considerable degree. It
+is generally most remarkable on the posterior part of the scalp; as far as
+my enquiries have reached, it does not take place in the beginning of the
+disease, but after a raving paroxysm of some continuance. It has been
+frequently accompanied with contraction of the iris.
+
+On the suggestion of a medical gentleman, I was induced to ascertain the
+prevailing complexion and colour of the hair in insane patients. Out of
+two hundred and sixty-five who were examined, two hundred and five were of
+a swarthy complexion, with dark, or black hair; the remaining sixty were
+of a fair skin, and light, brown, or redhaired. What connexion this
+proportion may have, with the complexion and colour of the hair of the
+people of this country in general, and what alterations may have been
+produced by age, or a residence in other climates, I am totally
+uninformed.
+
+Of the power which maniacs possess of resisting cold, the belief is
+general, and the histories which are on record are truly wonderful: it is
+not my wish to disbelieve, nor my intention to dispute them; it is proper,
+however, to state that the patients in Bethlem Hospital possess no such
+exemption from the effects of severe cold. They are particularly subject
+to mortifications of the feet; and this fact is so well established from
+former accidents, that there is an express order of the house, that every
+patient, under strict confinement, shall have his feet examined morning
+and evening in the cold weather by the keeper, and also have them
+constantly wrapped in flannel; and those who are permitted to go about,
+are always to be found as near to the fire as they can get, during the
+winter season.
+
+From the great degree of insensibility which prevails in some states of
+madness, a degree of cold would scarcely be felt by such persons, which
+would create uneasiness in those of sound mind; but experience has shewn
+that they suffer equally from severity of weather. When the mind is
+particularly engaged on any subject, external circumstances affect us less
+than when unoccupied. Every one must recollect that, in following up a
+favourite pursuit, his fire has burned out, without his being sensible of
+the alteration of temperature; but when the performance has been finished,
+or he has become indifferent to it from fatigue, he then becomes sensible
+to cold, which he had not experienced before.
+
+Some maniacs refuse all covering, but these are not common occurrences;
+and it may be presumed, that by a continued exposure to the atmosphere,
+such persons might sustain, with impunity, a low temperature, which would
+be productive of serious injury to those who are clad according to the
+exigences of the season. Such endurance of cold is more probably the
+effect of habit, than of any condition peculiar to insanity.
+
+Having thus given a general account of the symptoms, I shall now lay
+before my readers a history of the appearances which I have noticed on
+opening the heads of several maniacs who have died in Bethlem Hospital.
+
+
+
+
+CHAP. III.
+
+CASES, WITH THE APPEARANCES ON DISSECTION.
+
+
+CASE I.
+
+J. H. a man twenty-eight years of age, was admitted a patient in May,
+1795. He had been disordered for about two months before he came into the
+hospital. No particular cause was stated to have brought on the complaint.
+It was most probably an hereditary affection, as his father had been
+several times insane and confined in our hospital. During the time he was
+in the house, he was in a very low and melancholic state; shewed an
+aversion to food, and said he was resolved to die. His obstinacy in
+refusing all nourishment was very great, and it was with much difficulty
+forced upon him. He continued in this state, but became daily weaker and
+more emaciated until August 1st, when he died. Upon opening the head, the
+pericranium was found loosely adherent to the scull. The bones of the
+cranium were thick. The pia mater was loaded with blood, and the medullary
+substance, when cut into, was full of bloody points. The pineal gland
+contained a large quantity of gritty matter.[8] The consistence of the
+brain was natural; he was opened twenty-four hours after death.
+
+
+CASE II.
+
+J. W. was a man of sixty-two years of age, who had been many years in the
+house as an incurable patient, but with the other parts of whose history I
+am totally unacquainted. He appeared to be a quiet and inoffensive person,
+who found amusement in his own thoughts, and seldom joined in any
+conversation with the other patients: for some months he had been troubled
+with a cough, attended with copious expectoration, which very much reduced
+him; dropsical symptoms followed these complaints. He became every day
+weaker, and on July 10th, 1795, died. He was opened eighteen hours after
+death. The pericranium adhered loosely to the scull; the bones of the
+cranium were unusually thin. There were slight opacities in many parts of
+the tunica arachnoidea; in the ventricles about four ounces of water were
+contained--some large hyatids were discovered on the plexus choroides of
+the right side. The consistence of the brain was natural.
+
+
+CASE III.
+
+G. H. a man twenty-six years of age, was received into the hospital, July
+18th, 1795. It was stated that he had been disordered six weeks previously
+to his admission, and that he never had any former attack. He had been a
+drummer with a recruiting party, and had been for some time in the habit
+of constant intoxication, which was assigned as the cause of his insanity.
+He continued in a violent and raving state about a month, during the whole
+of which time he got little or no sleep. He had no knowledge of his
+situation, but supposed himself with the regiment, and was frequently
+under great anxiety and alarm for the loss of his drum, which he imagined
+had been stolen and sold. The medicines which were given to him he
+conceived were spirituous liquors, and swallowed them with avidity. At the
+expiration of a month he was very weak and reduced; his legs became
+oedematous--his pupils were much diminished. He now believed himself a
+child, called upon the people about him as his playfellows, and appeared
+to recal the scenes of early life with facility and correctness. Within a
+few days of his decease he only muttered to himself. August 26th, he died.
+He was opened six hours after death. The pericranium was loosely adherent.
+The tunica arachnoidea had generally lost its transparency, and was
+considerably thickened. The veins of the pia mater were loaded with blood,
+and in many places seemed to contain air. There was a considerable
+quantity of water between the membranes, and, as nearly as could be
+ascertained, about four ounces in the ventricles, in the cavity of which,
+the veins appeared remarkably turgid. The consistence of the brain was
+more than usually firm.
+
+
+CASE IV.
+
+E. M. a woman, aged sixty, was admitted into the house, August 8th, 1795;
+she had been disordered five months: the cause assigned was extreme grief,
+in consequence of the loss of her only daughter. She was very miserable
+and restless; conceived she had been accused of some horrid crime, for
+which she apprehended she should be burned alive. When any persons entered
+her room she supposed them officers of justice, who were about to drag her
+to some cruel punishment. She was frequently violent, and would strike
+and bite those who came near her. Upon the idea that she should shortly be
+put to death, she refused all sustenance; and it became necessary to force
+her to take it. In this state she continued, growing daily weaker and more
+emaciated, until October 3d, when she died.
+
+Upon opening the head, there was a copious determination of blood to the
+whole contents of the cranium. The pia mater was considerably inflamed;
+there was not any water either in the ventricles or between the membranes.
+The brain was particularly soft. She was opened thirty hours after death.
+
+
+CASE V.
+
+W. P. a young man, aged twenty-five, was admitted into the hospital,
+September 26th, 1795. He had been disordered five months, and had
+experienced a similar attack six years before. The disease was brought on
+by excessive drinking. He was in a very furious state, in consequence of
+which he was constantly confined. He very seldom slept--during the greater
+part of the night he was singing, or swearing, or holding conversations
+with persons he imagined to be about him: sometimes he would rattle the
+chain with which he was confined, for several hours together, and tore
+every thing to pieces within his reach. In the beginning of November, the
+violence of his disorder subsided for two or three days, but afterwards
+returned; and on the 10th he died compleatly exhausted by his
+exertions.--Upon opening the head the pericranium was found firmly
+attached; the pia mater was inflamed, though not to any very considerable
+degree; the tunica arachnoidea in some places was slightly shot with
+blood; the membranes of the brain, and its convolutions, when these were
+removed, were of a brown, or brownish straw colour. There was no water in
+any of the cavities of the brain, nor any particular congestion of blood
+in its substance--the consistence of which was natural. He was opened
+twenty hours after death.
+
+
+CASE VI.
+
+B. H. was an incurable patient, who had been confined in the house from
+the year 1788, and for some years before that time in a private madhouse.
+He was about sixty years of age--had formerly been in the habit of
+intoxicating himself. His character was strongly marked by pride,
+irascibility, and malevolence. During the four last years of his life, he
+was confined for attempting to commit some violence on one of the
+officers of the house. After this, he was seldom heard to speak; yet he
+manifested his evil disposition by every species of dumb insult. Latterly
+he grew suspicious, and would sometimes tell the keeper that his victuals
+were poisoned. About the beginning of December he was taken ill with a
+cough, attended with copious expectoration. Being then asked respecting
+his complaints, he said, he had a violent pain across the stomach, which
+arose from his navel string at his birth having been tied too short. He
+never spoke afterwards, though frequently importuned to describe his
+complaints. He died December 24, 1795.
+
+Upon dividing the integuments of the head, the pericranium was found
+scarcely to adhere to the scull. On the right parietal bone there was a
+large blotch, as if the bone had been inflamed: there were others on
+different parts of the bone, but considerably smaller. The glandulae
+Pacchioni were uncommonly large: the tunica arachnoidea in many places
+wanted the natural transparency of that membrane: there was a large
+determination of blood to the substance of the brain: the ventricles
+contained about three ounces of water: the consistence of the brain was
+natural. He was opened two days after death.
+
+
+CASE VII.
+
+A. M. a woman, aged twenty-seven, was admitted into the hospital, August
+15, 1795; she had then been eleven weeks disordered. Religious enthusiasm,
+and a too frequent attendance on conventicles, were stated to have
+occasioned her complaint. She was in a very miserable and unhappy
+condition, and terrified by the most alarming apprehensions for the
+salvation of her soul. Towards the latter end of September, she appeared
+in a convalescent state, and continued tolerably well until the middle of
+November, when she began to relapse.
+
+The return of her disorder commenced with loss of sleep. She alternately
+sang, and cried the greatest part of the night. She conceived her inside
+full of the most loathsome vermin, and often felt the sensation as if they
+were crawling into her throat. She was suddenly seized with a strong and
+unconquerable determination to destroy herself; became very sensible of
+her malady, and said, that God had inflicted this punishment on her, from
+having (at some former part of her life) said the Lord's Prayer backwards.
+She continued some time in a restless and forlorn state; at one moment
+expecting the devil to seize upon her and tear her to pieces; in the next,
+wondering that she was not instigated to commit violence on the persons
+about her. On January 12, 1796, she died suddenly. She was opened twelve
+hours after death. The thoracic and abdominal viscera were perfectly
+healthy.
+
+Upon examining the contents of the cranium, the pia mater was considerably
+inflamed, and an extravasated blotch, about the size of a shilling, was
+seen upon that membrane, near the middle of the right lobe of the
+cerebrum. There was no water between the membranes, nor in the ventricles,
+but a general determination of blood to the contents of the cranium. The
+medullary substance, when cut into, was full of bloody points. The
+consistence of the brain was natural.
+
+
+CASE VIII.
+
+M. W. a very tall and thin woman, forty-four years of age, was admitted
+into the hospital, September 19, 1795. Her disorder was of six months
+standing, and eight years before she had also had an attack of this
+disease. The cause assigned to have brought it on, the last time, was the
+loss of some property, the disease having shortly followed that
+circumstance.--The constant tenor of her discourse was, that she should
+live but a short time. She seemed anxiously to wish for her dissolution,
+but had no thoughts of accomplishing her own destruction. In the course of
+a few weeks she began to imagine, that some malevolent person had given
+her mercury with an intention to destroy her. She was constantly shewing
+her teeth, which had decayed naturally, as if this effect had been
+produced by that medicine: at last she insisted, that mercurial
+preparations were mingled in the food and medicines which were
+administered to her. Her appetite was voracious, notwithstanding this
+belief. She had a continual thirst, and drank very large quantities of
+cold water.
+
+On January 14, 1796, she had an apoplectic fit, well marked by stertor,
+loss of voluntary motion, and insensibility to stimuli. On the following
+day she died. She was opened two days after death. There was a remarkable
+accumulation of blood in the veins of the dura and pia mater; the
+substance of the brain was loaded with blood. When the medullary substance
+was cut into, blood oozed from it; and, upon squeezing it, a greater
+quantity could be forced out. On the pia mater covering the right lobe of
+the cerebrum, were some slight extravasations of blood. The ventricles
+contained no water; on the plexus choroides were some vesicles of the size
+of coriander-seeds, filled with a yellow fluid. The pericranium adhered
+firmly to the scull. The consistence of the brain was firmer than usual.
+
+
+CASE IX.
+
+E. D. a woman, aged thirty-six, was admitted into the hospital, February
+20, 1795; she had then been disordered four months. Her insanity came on a
+few days after having been delivered. She had also laboured under a
+similar attack seven years before, which, like the present, supervened
+upon the birth of a child. Under the impression that she ought to be
+hanged, she destroyed her infant, with the view of meeting with that
+punishment. When she came into the house, she was very sensible of the
+crime she had committed, and felt the most poignant affliction for the
+act. For about a month she continued to amend: after which time she became
+more thoughtful, and frequently spoke about the child: great anxiety and
+restlessness succeeded. In this state she remained until April 23, when
+her tongue became thickly furred, the skin parched, her eyes inflamed and
+glassy, and her pulse quick. She now talked incoherently; and, towards the
+evening, merely muttered to herself. She died on the following day
+comatose.
+
+She was opened about twenty-four hours after death. The scull was thick,
+the pericranium scarcely adhered to the bone, the dura mater was also but
+slightly attached to its internal surface. There was a large quantity of
+water between the dura mater and tunica arachnoidea; this latter membrane
+was much thickened, and was of a milky white appearance. Between the
+tunica arachnoidea and pia mater, there was a considerable accumulation of
+water. The veins of the pia mater were particularly turgid. About three
+ounces of water were contained in the lateral ventricles: the veins of the
+membrane lining these cavities were remarkably large and turgid with
+blood. When the medullary substance of the cerebrum and cerebellum was cut
+into, there appeared a great number of bloody points. The brain was of its
+natural consistence.
+
+
+CASE X.
+
+C. M. a man, forty years of age, was admitted into the hospital, December
+26, 1795. It was stated, that he had been disordered two months previously
+to his having been received as a patient. His friends were unacquainted
+with any cause, which was likely to have induced the disease. During the
+time he was in the house he seemed sulky, or rather stupid. He never asked
+any questions, and if spoken to, either replied shortly, or turned away
+without giving any answer. He scarcely appeared to take notice of any
+thing which was going forward, and if told to do any little office
+generally forgot what he was going about, before he had advanced half a
+dozen steps. He remained in this state until the beginning of May, 1796,
+when his legs became oedematous, and his abdomen swollen. He grew very
+feeble and helpless, and died rather suddenly, May 19th. He was opened
+about forty-eight hours after death. The pericranium and dura mater
+adhered firmly to the scull; in many places there was an opake whiteness
+of the tunica arachnoidea. About four ounces of water were found in the
+ventricles. The plexus choroides were uncommonly pale. The medullary
+substance afforded hardly any bloody points when cut into. The consistence
+of the brain I cannot describe better than by saying, it was doughy.
+
+
+CASE XI.
+
+S. M. a man, thirty-six years of age, was admitted as an incurable patient
+in the year 1790. Of the former history of his complaint I have no
+information. As his habits, which frequently came under my observation,
+were of a singular nature, it may not here be improper to relate
+them.--Having at some period of his confinement been mischievously
+disposed, and, in consequence, put under coercion, he never afterwards
+found himself comfortable when at liberty. When he rose in the morning he
+went immediately to the room where he was usually confined, and placed
+himself in a particular corner, until the keeper came to secure him. If
+he found any other patient had pre-occupied his situation, he became very
+outrageous, and generally forced them to leave it. When he had been
+confined, for which he appeared anxious, as he bore any delay with little
+temper, he employed himself throughout the remainder of the day, by
+tramping or shuffling his feet. He was constantly muttering to himself, of
+which scarcely one word in a sentence was intelligible. When an audible
+expression escaped him it was commonly an imprecation. If a stranger
+visited him, he always asked for tobacco, but seldom repeated his
+solicitation. He devoured his food with avidity, and always muttered as he
+ate.
+
+In the month of July, 1796, he was seized with a diarrhoea, which
+afterwards terminated in dysentery. This continued, notwithstanding the
+employment of every medicine usually given in such a case, until his
+death, which took place on September 23, of the same year. He was opened
+twelve hours after death. The scull was unusually thin; the glandulae
+Pacchioni were large and numerous: there was a very general determination
+of blood to the brain: the medullary substance, when cut, shewed an
+abundance of bloody points: the lateral ventricles contained about four
+ounces of water: the consistence of the brain was natural.
+
+
+CASE XII.
+
+E. R. was a woman, to all appearance about eighty years of age, but of
+whose history, before she came into the hospital, it has not been in my
+power to acquire any satisfactory intelligence. She was an incurable
+patient, and had been admitted on that establishment in February, 1782.
+
+During the time I had an opportunity of observing her, she continued in
+the same state: she appeared feeble and childish. During the course of the
+day, she sat in a particular part of the common-room, from which she never
+stirred. Her appetite was tolerably good, but it was requisite to feed
+her. Except she was particularly urged to speak she never talked. As the
+summer declined she grew weaker, and died October 19, 1796, apparently
+worn out. She was opened two days after death. The scull was particularly
+thin; the pericranium adhered firmly to the bone, and the scull-cap was
+with difficulty separated from the dura mater. There was a very large
+quantity of water between the membranes of the brain: the glandulae
+Pacchioni were uncommonly large: the tunica arachnoidea was in many
+places blotched and streaked with opacities: when the medullary substance
+of the brain was cut into, it was every where bloody; and blood could be
+pressed from it, as from a sponge. There were some large hydatids on the
+plexus choroides: in the ventricles about a tea spoonful of water was
+observed: the consistence of the brain was particularly firm, but it could
+not be called elastic. There were no symptoms of general dropsy.
+
+
+CASE XIII.
+
+J. D. a man, thirty-five years of age, was admitted into the hospital in
+October, 1796. He was a person of good education, and had been regularly
+brought up to medicine, which he had practised in this town for several
+years. It was stated by his friends, that, about two years before, he had
+suffered a similar attack, which continued six months: but it appears
+from the observations of some medical persons, that he never perfectly
+recovered from it, although he returned to the exercise of his profession.
+A laborious attention to business, and great apprehensions of the want of
+success, were assigned as causes of his malady. In the beginning of the
+year 1796 the disease recurred, and became so violent that it was
+necessary to confine him.
+
+At the time he was received into Bethlem hospital, he was in an unquiet
+state, got little or no sleep, and was constantly speaking loudly: in
+general he was worse towards evening. He appeared little sensible of
+external objects: his exclamations were of the most incoherent nature.
+
+During the time he was a patient he was thrice cupped on the scalp. After
+each operation, he became rational to a certain degree; but these
+intervals were of a short continuance, as he relapsed in the course of a
+few hours. The scalp, particularly at the posterior part of the head, was
+so loose that a considerable quantity of it could be gathered up by the
+hand.[9] The violence of his exertions at last exhausted him, and on
+December 11, he died. He was opened about twenty-four hours after death.
+There was a large quantity of water between the dura mater and tunica
+arachnoidea, and also between this latter membrane and the pia mater. The
+tunica arachnoidea was thickened and opake; the vessels of the pia mater
+were loaded with blood: when the medullary substance was cut into, it was
+very abundant in bloody points: about three ounces of water were contained
+in the lateral ventricles: the plexus choroides were remarkably turgid
+with blood: a quantity of water was found in the theca vertebralis: the
+consistence of the brain was natural.
+
+
+CASE XIV.
+
+J. C. a man, aged sixty-one, was admitted into the hospital September 17,
+1796. It was stated, that he had been disordered ten months. He had for
+thirty years kept a public house, and had for some time been in the habit
+of getting intoxicated. His memory was considerably impaired:
+circumstances were so feebly impressed on his mind, that he was unable to
+give any account of the preceding day. He appeared perfectly reconciled to
+his situation, and conducted himself with order and propriety. As he
+seldom spoke but when interrogated, it was not possible to collect his
+opinions. In this quiet state he continued about two months, when he
+became more thoughtful and abstracted, walked about with a quick step, and
+frequently started, as if suddenly interrupted. He was next seized with
+trembling, appeared anxious to be released from his confinement: conceived
+at one time that his house was filled with company; at another that
+different people had gone off without paying him, and that he should be
+arrested for sums of money which he owed. Under this constant alarm and
+disquietude he continued about a week, when he became sullen, and refused
+his food. When importuned to take nourishment, he said it was ridiculous
+to offer it to him, as he had no mouth to eat it: though forced to take
+it, he continued in the same opinion; and when food was put into his
+mouth, insisted that a wound had been made in his throat, in order to
+force it into his stomach. The next day he complained of violent pain in
+his head, and in a few minutes afterwards died. He was opened twelve hours
+after death. There was a large quantity of water between the tunica
+arachnoidea and pia mater; the latter membrane was much suffused with
+blood, and many of its vessels were considerably enlarged: the lateral
+ventricles contained at least six ounces of water: the brain was very
+firm.
+
+
+CASE XV.
+
+J. A. a man, forty-two years of age, was first admitted into the house on
+June 27, 1795. His disease came on suddenly whilst he was working in a
+garden, on a very hot day, without any covering to his head. He had some
+years before travelled with a gentleman over a great part of Europe: his
+ideas ran particularly on what he had seen abroad; sometimes he conceived
+himself the king of Denmark, at other times the king of France. Although
+naturally dull and wanting common education, he professed himself a master
+of all the dead and living languages; but his most intimate acquaintance
+was with the old French: and he was persuaded he had some faint
+recollection of coming over to this country with William the Conqueror.
+His temper was very irritable, and he was disposed to quarrel with every
+body about him. After he had continued ten months in the hospital, he
+became tranquil, relinquished his absurdities, and was discharged well in
+June 1796. He went into the country with his wife to settle some domestic
+affairs, and in about six weeks afterwards relapsed. He was re-admitted
+into the hospital August 13th.
+
+He now evidently had a paralytic affection; his speech was inarticulate,
+and his mouth drawn aside. He shortly became stupid, his legs swelled, and
+afterwards ulcerated: at length his appetite failed him; he became
+emaciated, and died December 27th, of the same year. The head was opened
+twenty hours after death. There was a greater quantity of water between
+the different membranes of the brain than has ever occurred to me. The
+tunica arachnoidea was generally opake and very much thickened: the pia
+mater was loaded with blood, and the veins of that membrane were
+particularly enlarged. On the forepart of the right hemisphere of the
+brain, when stripped of its membranes, there was a blotch, of a brown
+colour, several shades darker than the rest of the cortical substance: the
+ventricles were much enlarged, and contained, by estimation, at least six
+ounces of water. The veins in these cavities were particularly turgid.
+The consistence of the brain was firmer than usual.
+
+
+CASE XVI.
+
+J. H. a man, aged forty-two, was admitted into the house on April 12,
+1794. He had then been disordered two months: it was a family disease on
+his father's side. Having manifested a mischievous disposition to some of
+his relations, he was continued in the hospital upon the incurable
+establishment. His temper was naturally violent, and he was easily
+provoked. As long as he was kept to any employment he conducted himself
+tolerably well; but when unoccupied, would walk about in a hurried and
+distracted manner, throwing out the most horrid threats and imprecations.
+He would often appear to be holding conversations: but these conferences
+always terminated in a violent quarrel between the imaginary being and
+himself. He constantly supposed unfriendly people were placed in different
+parts of the house to torment and annoy him. However violently he might be
+contesting any subject with these supposed enemies, if directed by the
+keepers to render them any assistance, he immediately gave up the dispute
+and went with alacrity. As he slept but little, the greatest part of the
+night was spent in a very noisy and riotous manner. In this state he
+continued until April 1796, when he was attacked with a paralytic
+affection, which deprived him of the use of the left side. His
+articulation was now hardly intelligible; he became childish, got
+gradually weaker, and died December 28, 1796. He was opened twenty-four
+hours after death. There was a general opacity of the tunica arachnoidea,
+and a small quantity of water between that membrane and the pia mater:
+the ventricles were much enlarged and contained a considerable quantity of
+water, by estimation, four ounces; the consistence of the brain was
+natural.
+
+
+CASE XVII.
+
+M. G. a woman, about fifty years of age, had been admitted on the
+incurable establishment in July 1785. She had for some years before been
+in a disordered state, and was considered as a dangerous patient. Her
+temper was violent; and if interrupted in her usual habits, she became
+very furious. Like many others among the incurables, she was an insulated
+being: she never spoke except when disturbed. Her greatest delight
+appeared to be in getting into some corner to sleep; and the interval
+between breakfast and dinner, was usually past in this manner. At other
+times she was generally committing some petty mischief, such as slyly
+breaking a window, dirtying the rooms of the other patients, or purloining
+their provisions. She had been for some months in a weak and declining
+state, but would never give any account of her disorder. On January 5,
+1797, she died, apparently worn out. The head was opened three days after
+death. The pericranium adhered but slightly to the scull, nor was the dura
+mater firmly attached. There was water between the membranes of the brain;
+and the want of transparency of the tunica arachnoidea, indicated marks of
+former inflammation. The posterior part of the hemispheres of the brain
+was of a brownish colour. In this case there was a considerable appearance
+of air in the veins; the medullary substance, when cut, was full of bloody
+points: the lateral ventricles were small, but filled with water: the
+plexus choroides were loaded with vesicles of a much larger size than
+usual: the consistence of the brain was natural.
+
+
+CASE XVIII.
+
+S. T. a woman, aged fifty-seven, was admitted into the house, January 14,
+1797. It was stated by her friends, that she had been disordered eight
+months: they were unacquainted with any cause, which might have induced
+the disease. She had evidently suffered a paralytic attack, which
+considerably affected her speech, and occasioned her to walk lame with the
+right leg. As she avoided all conversation, it was not possible to collect
+any further account of her case. Three days after her admission, she had
+another paralytic stroke, which deprived her entirely of the use of the
+right side. Two days afterwards she died. She was opened forty-eight hours
+after death. There was a small quantity of water between the tunica
+arachnoidea and pia mater, and a number of opake spots on the former
+membrane. On the pia mater, covering the posterior part of the left
+hemisphere of the brain, there was an extravasated blotch, about the size
+of a shilling: the medullary substance was unusually loaded with blood:
+the lateral ventricles were large, but did not contain much water: the
+consistence of the brain was very soft.
+
+
+CASE XIX.
+
+W. C. a man, aged sixty-three, was admitted into the hospital, January 21,
+1797. The persons, who attended at his admission, deposed, that he had
+been disordered five months; that he never had been insane before, and
+that the disease came on shortly after the death of his son. He was in a
+very anxious and miserable state. No persuasion could induce him to take
+nourishment; and it was with extreme difficulty that any food could be
+forced upon him. He paced about with an hurried step; was often suddenly
+struck with the idea of having important business to adjust in some
+distant place, and which would not admit of a moment's delay. Presently
+after, he would conceive his house to be on fire, and would hastily
+endeavour to rescue his property from the flames. Then he would fancy that
+his son was drowning, that he had twice sunk: he was prepared to plunge
+into the river to save him, as he floated for the last time: every moment
+appeared an hour until he rose. In this miserable state he continued till
+the 27th, when, with great perturbation, he suddenly ran into his room,
+threw himself on the bed, and in a few minutes expired. The head was
+opened twenty-four hours after death. The pericranium was but slightly
+adherent to the scull: the tunica arachnoidea, particularly where the
+hemispheres meet, was of a milky whiteness. Between this membrane, which
+was somewhat thickened, and the pia mater, there was a very large
+collection of water: the pia mater was inflamed: the veins of this
+membrane were enlarged beyond what I had ever before observed: there was a
+striking appearance of air in the veins: the medullary substance of the
+brain, when cut into, bled freely, and seemed spongy from the number and
+enlargement of its vessels: in the ventricles, which were of a natural
+capacity, there was about half an ounce of water: the brain was of a
+healthy consistence.
+
+
+CASE XX.
+
+M. L. a woman, aged thirty-eight, was admitted into the house, June 11,
+1796. From the information of the people who had attended her, it
+appeared, that she had been disordered six weeks, and that the disease
+took place shortly after the death of her husband. At the first attack she
+was violent, but she soon became more calm. She conceived that the
+overseers of the parish, to which she belonged, meditated her destruction:
+afterwards she supposed them deeply enamoured of her, and that they were
+to decide their claims by a battle. During the time she continued in the
+hospital she was perfectly quiet, although very much deranged. She fancied
+that a young man, for whom she had formerly entertained a partiality, but
+who had been dead some years, appeared frequently at her bed-side, in a
+state of putrefaction, which left an abominable stench in her room. Soon
+after she grew suspicious, and became apprehensive of evil intentions in
+the people about her. She would frequently watch at her door, and, when
+asked the reason, replied that she was fully aware of a design, which had
+been formed, to put her secretly to death.--Under the influence of these
+opinions she continued to her death, which took place on February 8, 1797,
+in consequence of a violent rheumatic fever. She was opened twelve hours
+after death. There were two opake spots on the tunica arachnoidea: the pia
+mater was slightly inflamed: there was a general congestion of blood to
+the whole contents of the cranium: the consistence of the brain did not
+differ from what is found in a healthy state.
+
+
+CASE XXI.
+
+H. C. a woman, of about sixty-five years of age, had been admitted on the
+incurable establishment in the year 1788. I have not been able to collect
+any particulars of her former history. During the time I had an
+opportunity of seeing her, she continued in a very violent and irritable
+state: it was her custom to abuse every one who came near her. The
+greatest part of the day was passed in cursing the persons she saw about
+her; and when no one was near, she usually muttered some blasphemy to
+herself. She died of a fever on February 19, 1797, on the fourth day after
+the attack. She was opened two days after death. The tunica arachnoidea
+was, in many parts, without its natural transparency: the pia mater was
+generally suffused with blood, and its vessels were enlarged: the
+consistence of the brain was firm.
+
+
+CASE XXII.
+
+J. C. a man, aged fifty, was admitted into the hospital, August 6, 1796.
+It was stated that he had been disordered about three weeks, and that the
+disease had been induced by too great attention to business, and the want
+of sufficient rest. About four years before, he had been a patient, and
+was discharged uncured. He was an artful and designing man, and with great
+ingenuity once effected his escape from the hospital. His time was mostly
+passed in childish amusements, such as tearing pieces of paper and
+sticking them on the walls of his room, collecting rubbish and assorting
+it. However, when he conceived himself unobserved, he was intriguing with
+other patients, and instructing them in the means, by which they might
+escape. Of his disorder he seemed highly sensible, and appeared to approve
+so much of his confinement, that when his friends wished to have him
+released, he opposed it, except it should meet with my approbation;
+telling them, in my presence, that, although he might appear well to them,
+the medical people of the house were alone capable of judging of the
+actual state of his mind; yet I afterwards discovered, that he had
+instigated them to procure his enlargement, by a relation of the grossest
+falshoods and most unjust complaints. In April 1797, he was permitted to
+have a month's leave of absence, as he appeared tolerably well, and wished
+to maintain his family by his industry. For above three weeks of this
+time, he conducted himself in a very rational and orderly manner. The day
+preceding that, on which he was to have returned thanks, he appeared
+gloomy and suspicious, and felt a disinclination for work. The night was
+passed in a restless manner, but in the morning he seemed better, and
+proposed coming to the hospital to obtain his discharge. His wife having
+been absent for a few minutes from the room, found him, on her return,
+with his throat cut. He was re-admitted as a patient, and expressed great
+sorrow and penitence for what he had done; and said that it was committed
+in a moment of rashness and despair. After a long and minute examination,
+he bewrayed nothing incoherent in his discourse. His wound, from which it
+was stated that he had lost a large quantity of blood, was attended to by
+Mr. Crowther, the surgeon to the hospital. Every day he became more
+dispirited, and at last refused to speak. He died May 29th, about ten days
+after his re-admission. His head was opened two days after death. There
+were some slight opacities of the tunica arachnoidea, and the pia mater
+was a little inflamed: the other parts of the brain were in an healthy
+state, and its consistence natural.
+
+
+CASE XXIII.
+
+E. L. was a man, about seventy-eight years of age; had been admitted on
+the incurable establishment, January 3, 1767. By report, I have understood
+that he was formerly in the navy, and that his insanity was caused by a
+disappointment of some promotion which he expected. It was also said, that
+he was troublesome to some persons high in office, which rendered it
+necessary that he should be confined. At one time he imagined himself to
+be the king, and insisted on his crown. During the time I had an
+opportunity of knowing him, he conducted himself in a very gentlemanly
+manner. His disposition was remarkably placid, and I never remember him to
+have uttered an unkind or hasty expression. With the other patients he
+seldom held any conversation. His chief amusement was reading, and writing
+letters to the people of the house. Of his books he was by no means
+choice; he appeared to derive as much amusement from an old catalogue as
+from the most entertaining performance. His writings always contained
+directions for his release from confinement; and he never omitted his high
+titles of God's King, Holy Ghost, Admiral, and Physician. He died June 13,
+1797, worn out with age. He was opened two days after death. The scull was
+thick and porous. There was a large quantity of water between the
+different membranes. The tunica arachnoidea was particularly opake: the
+veins seemed to contain air: in the medullary substance the vessels were
+very copious and much enlarged: the lateral ventricles contained two
+ounces of pellucid water: the consistence of the brain was natural.
+
+It has been stated, by a gentleman of great accuracy, and whose situation
+affords him abundant opportunity of acquiring a knowledge of diseased
+appearances, that the fluid of hydrocephalus appears to be of the same
+nature with the water which is found in dropsy of the thorax and
+abdomen.[10] That this is generally the case, there can be no doubt, from
+the respectable testimony of the author of the Morbid Anatomy: but in
+three instances, where I submitted this fluid to experiment, it was
+incoagulable by acids and by heat; in all of them its consistence was not
+altered even by boiling. There was, however, a cloudiness produced; and,
+after the liquor had stood some time, a slight deposition of animal
+matter took place, which, prior to the application of heat or mineral
+acids, had been dissolved in the fluid. This liquor tinged green the
+vegetable blues; produced a copious deposition with nitrat of silver; and,
+on evaporation, afforded cubic crystals (nitrat of soda). From this
+examination it was inferred, that the water of the brain, collected in
+maniacal cases, contained a quantity of uncombined alkali and some common
+salt. What other substances may enter into its composition, from want of
+sufficient opportunity, I have not been enabled to determine.
+
+
+CASE XXIV.
+
+S. W. a woman, thirty-five years of age, was admitted into the hospital,
+June 3, 1797. It was stated that she had been one month disordered, and
+had never experienced any prior affection of the same kind. The disease
+was said to have been produced by misfortunes which had attended her
+family, and from frequent quarrels with those who composed it. She was in
+a truly melancholic state; she was lost to all the comforts of this life,
+and conceived herself abandoned for ever by God. She refused all food and
+medicines. In this wretched condition she continued until July 29th, when
+she lost the use of her right side. On the 30th she became lethargic, and
+continued so until her death, which happened on August the 3d. She was
+opened two days after death. There was a large collection of water between
+the different membranes of the brain, amounting at least to four ounces:
+the pia mater was very much inflamed, and was separable from the
+convolutions of the brain with unusual facility: the medullary substance
+was abundantly loaded with bloody points: the consistence of the brain
+was remarkably firm.
+
+
+CASE XXV.
+
+D. W. a man, about fifty-eight years of age, had been admitted upon the
+incurable establishment in 1789. He was of a violent and mischievous
+disposition, and had nearly killed one of the keepers at a private mad
+house previously to his admission into the hospital. At all times he was
+equally deranged respecting his opinions, although he was occasionally
+more quiet and tractable: these intervals were extremely irregular as to
+their duration and period of return. He was of a very constipated habit,
+and required large doses of cathartic medicines to procure stools. On
+August 3, 1797, he was in a very furious state; complained of costiveness,
+for which he took his ordinary quantity of opening physic, which operated
+as usual. On the same day he ate his dinner with a good appetite; but
+about six o'clock in the evening he was struck with hemiplegia, which
+deprived him completely of the use of his left side. He lay insensible of
+what passed about him, muttered constantly to himself, and appeared to be
+keeping up a kind of conversation. The pulse was feeble, but not oppressed
+or intermitting. He never had any stertor. He continued in this state
+until the 12th, when he died. He was opened twelve hours after death.
+There was some water between the tunica arachnoidea and pia mater: the
+former membrane was opake in many places; bearing the marks of former
+inflammation: in the veins of the membranes of the brain there was a
+considerable appearance of air, and they were likewise particularly
+charged with blood: the vessels of the medullary substance were numerous
+and enlarged. On opening the right lateral ventricle, which was much
+distended, it was found filled with dark and grumous blood; some had also
+escaped into the left, but in quantity inconsiderable when compared with
+what was contained in the other: the consistence of the brain was very
+soft.
+
+
+CASE XXVI.
+
+J. S. a man, forty-four years of age, was received into the hospital, June
+24, 1797. He had been disordered nine months previous to his admission.
+His insanity was attributed to a violent quarrel, which had taken place
+with a young woman, to whom he was attached, as he shortly afterwards
+became sullen and melancholy.
+
+During the time he remained in the house he seldom spoke, and wandered
+about like a forlorn person. Sometimes he would suddenly stop, and keep
+his eyes fixed on an object, and continue to stare at it for more than an
+hour together. Afterwards he became stupid, hung down his head, and
+drivelled like an ideot. At length he grew feeble and emaciated, his legs
+were swollen and oedematous, and on September 13th, after eating his
+dinner, he crawled to his room, where he was found dead about an hour
+afterwards. He was opened two days after death. The tunica arachnoidea had
+a milky whiteness, and was thickened. There was a considerable quantity of
+water between that membrane and the pia mater, which latter was loaded
+with blood: the lateral ventricles were very much enlarged, and contained,
+by estimation, about six ounces of transparent fluid: the brain was of its
+natural consistence.
+
+
+CASE XXVII.
+
+T. W. a man, thirty-eight years of age, was admitted into the house, May
+16, 1795. He had then been disordered a year. His disease was stated to
+have arisen, from his having been defrauded, by two of his near relations,
+of some property, which he had accumulated by servitude. Having remained
+in the hospital the usual time of trial for cure, he was afterwards
+continued on the incurable establishment, in consequence of a strong
+determination he had always shewn, to be revenged on those people who had
+disposed of his property, and a declared intention of destroying himself.
+He was in a very miserable state, conceived that he had offended God, and
+that his soul was burning in Hell. Notwithstanding he was haunted with
+these dreadful imaginations, he acted with propriety upon most occasions.
+He took delight in rendering any assistance in his power to the people
+about the house, and waited on those who were sick, with a kindness that
+made him generally esteemed. At some period of his life he had acquired an
+unfortunate propensity to gaming, and whenever he had collected a few
+pence, he ventured them at cards. His losses were borne with very little
+philosophy, and the devil was always accused of some unfair interposition.
+
+On September 14, 1797, he appeared jaundiced, the yellowness daily
+increased, and his depression of mind was more tormenting than ever. From
+the time he was first attacked by the jaundice he had a strong
+presentiment that he should die. Although he took the medicines which were
+ordered, as a mark of attention to those who prescribed them, he was
+firmly persuaded they could be of no service. The horror and anxiety he
+felt, was, he said, sufficient to kill him, independantly of the jaundice.
+
+On the 20th he was drowsy, and on the following day died comatose. He was
+opened twenty-four hours after death. In some places the tunica
+arachnoidea was slightly opake: the pia mater was inflamed; and in the
+ventricles were found about two tea-spoons full of water tinged deeply
+yellow, and the vesicles of the plexus choroides were of the same colour:
+to the whole contents of the cranium there was a considerable congestion
+of blood: the consistence of the brain was natural: the liver was sound:
+the gall-bladder very much thickened, and contained a stone of the
+mulberry appearance, of a white colour. Another stone was also found in
+the duodenum.
+
+
+CASE XXVIII.
+
+R. B. a man, sixty-four years of age, was admitted into the hospital,
+September 2, 1797. He had then been disordered three months. It was also
+stated, that he had suffered an attack of this disease seven years before,
+which then continued about two months. His disorder had, both times, been
+occasioned by drinking spirituous liquors to excess. He was a person of
+liberal education, and had been occasionally employed as usher in a
+school, and at other times as a librarian and amanuensis. When admitted he
+was very noisy, and importunately talkative. During the greatest part of
+the day he was reciting passages from the Greek and Roman poets, or
+talking of his own literary importance. He became so troublesome to the
+other madmen, who were sufficiently occupied with their own speculations,
+that they avoided, and excluded him from the common room; so that he was,
+at last, reduced to the mortifying situation of being the sole auditor of
+his own compositions.
+
+He conceived himself very nearly related to Anacreon, and possessed of the
+peculiar vein of that poet. He also fancied that he had discovered the
+longitude; and was very urgent for his liberation from the hospital, that
+he might claim the reward, to which his discovery was intitled. At length
+he formed schemes to pay off the national debt: these, however, so much
+bewildered him that his disorder became more violent than ever, and he was
+in consequence obliged to be confined to his room. He now, after he had
+remained two months in the house, was more noisy than before, and had
+little sleep. These exertions very much reduced him.
+
+In the beginning of January, 1798, his conceptions were less distinct, and
+although his talkativeness continued, he was unable to conclude a single
+sentence. When he began to speak, his attention was diverted by the first
+object which caught his eye, or by any sound that struck him. On the 5th
+he merely muttered; on the 7th he lost the use of his right side, and
+became stupid and taciturn. In this state he continued until the 14th,
+when he had another fit; after which he remained comatose and insensible.
+On the following day he died. He was opened thirty-six hours after death.
+The pericranium adhered very loosely to the scull: the tunica arachnoidea
+was generally opake, and suffused with a brownish hue: a large quantity of
+water was contained between it and the pia mater: the contents of the
+cranium were unusually destitute of blood: there was a considerable
+quantity of water (perhaps four ounces) in the lateral ventricles, which
+were much enlarged: the consistence of the brain was very soft.
+
+
+CASE XXIX.
+
+E. T. a man, aged thirty years, was admitted a patient, July 23, 1796. The
+persons who attended, related, that he had been disordered eleven months,
+and that his insanity shortly supervened to a violent fever. It also
+appeared, from subsequent enquiries, that his mother had been affected
+with madness.
+
+He was a very violent and mischievous patient, and possessed of great
+bodily strength and activity. Although confined, he contrived several
+times during the night to tear up the flooring of his cell; and had also
+detached the wainscot to a considerable extent, and loosened a number of
+bricks in the wall. When a new patient was admitted, he generally enticed
+him into his room, on pretence of being an old acquaintance, and, as soon
+as he came within his reach, immediately tore his clothes to pieces. He
+was extremely dexterous with his feet, and frequently took off the hats of
+those who were near him with his toes, and destroyed them with his teeth.
+After he had dined he generally bit to pieces a thick wooden bowl, in
+which his food was served, on the principle of sharpening his teeth
+against the next meal. He once bit out the testicles of a living cat,
+because the animal was attached to some person who had offended him. Of
+his disorder he appeared to be very sensible; and after he had done any
+mischief, always blamed the keepers for not securing him so, as to have
+prevented it. After he had continued a year in the hospital he was
+retained as an incurable patient. He died February 17, 1798, in
+consequence of a tumor of the neck. He was opened two days after death.
+The tunica arachnoidea was generally opake, and of a milky whiteness: the
+vessels of the pia mater were turgid, and its veins contained a quantity
+of air; about an ounce of water was contained in the lateral ventricles:
+the consistence of the brain was unusually firm, and possessed of
+considerable elasticity: it is the only instance of this nature which has
+fallen under my observation.
+
+
+CASE XXX.
+
+T. G. a man, about fifty-five years of age, was admitted into the
+hospital, January 20, 1798. It was stated, that he had been disordered a
+year and half, and that his madness arose from repeated intoxication.
+Having set fire to several hay-stacks, and committed frequent depredations
+on the neighbouring farmers, it had been found necessary to confine him in
+the county goal. His behaviour in this situation marked the cunning and
+malignity of his mind, so that he was always attempting some mischief
+either by violence or stratagem.
+
+When brought to the hospital he conducted himself with propriety and
+order, and appeared to be in a state of recovery. On the second of May he
+was attacked with a diarrhoea which daily encreased, notwithstanding the
+medicines employed for its removal. His mind became violently agitated
+from the commencement of the diarrhoea, and it was found proper to
+secure him. On the 8th, dysenteric symptoms appeared, which continued to
+the 13th, when he died.
+
+_Appearances on Dissection._
+
+The head was opened twenty-four hours after death. The pericranium was
+loosely attached to the scull, and the dura mater adhered but slightly to
+the internal surface of the cranium; there was a considerable quantity of
+water between the dura mater and tunica arachnoidea, this latter membrane
+(especially where the hemispheres meet) was of a milky whiteness, and
+generally so in the course of the veins of the pia mater. The glandulae
+Pacchioni were very large and numerous. Between the tunica arachnoidea and
+pia mater there was much water; and from the lateral ventricles, which
+were uncommonly enlarged and distended, eight ounces of fluid were
+collected: the infundibulum was remarkably large: the membrane lining the
+cavity of the lateral ventricles had its veins very turgid: the
+consistence of the brain was softer than natural.
+
+The fluid obtained from the brain in this case being very pellucid and
+abundant, it was submitted to some chemical tests in order to ascertain
+its composition.
+
+An attempt of this kind had been made before; (vide Case 23) the present
+may be considered a small addition to our knowledge of this fluid, though
+by no means a satisfactory developement of its materials, according to the
+severity and precision of modern analysis.[11]
+
+ANALYSIS OF THE FLUID.
+
+  _Tincture of Galls_,  produced a white precipitate in
+                        moderate quantity.
+
+  _Lime Water_,         afforded a considerable quantity
+                        of a white precipitate, which was
+                        redissolved without effervescence
+                        by muriatic acid.
+
+  _Solution of Sulphat  A drop of this solution added to
+    of Copper._         two drams of the brain fluid
+                        tinged it with a pretty deep blue.
+
+The presence of animal matter is inferred from the deposition produced by
+infusion of galls.
+
+The precipitation by lime-water indicates the phosphoric acid.
+
+And it appears from the blue tinge given to the fluid by the sulphat of
+copper, that ammonia or some of its combinations was contained.
+
+As it occurred on many former trials, there was no coagulation by heat; a
+slight sediment fell, after boiling some minutes.
+
+As this patient remained in the hospital from the middle of January to the
+beginning of May, in a state perfectly tranquil, and without the
+appearance of disarrangement of mind, it is improbable that a so great
+enlargement of the ventricles, and accumulation of water, could have taken
+place within the short space of two weeks, it is therefore most likely
+that the greatest part of this fluid had been previously collected.
+
+It may be conjectured that a very gradual accumulation of water (although
+the quantity be at last considerable) would not affect the sensorium so as
+a sudden secretion of fluid; or, that a quantity, which at one time had
+occasioned great disturbance, would by habit become less inconvenient.
+
+We are not well informed, but there is reason to believe, that gradual
+pressure on the brain, will not occasion those serious symptoms which a
+sudden pressure would excite.
+
+
+CASE XXXI.
+
+H. K. a woman, aged thirty, was admitted into the hospital, October 15,
+1796. She had then been mad about four months, and her disorder was stated
+to have supervened on the birth of a child. From subsequent enquiry it was
+ascertained that her mother had been insane, and that her elder sister
+had been similarly affected; but from the best information it did not
+appear that her brothers (she had two) had ever been visited with this
+calamity.
+
+Previously to her admission she had frequently attempted to destroy
+herself, and had also endeavoured to take away the life of her husband. In
+the hospital she was extremely violent; supposed her neighbours had
+conspired to take away her liberty, and became jealous of her husband: she
+was often naming some female of her acquaintance who had artfully ensnared
+his affections, and whom he had decked out in her best apparel: she
+breathed revenge when she should return home, and seemed much delighted
+with the idea of destroying these favourites, when they were dressed for
+some excursion with her husband.
+
+She had understood that a year was the extent of time that persons were
+detained in the hospital, and conceived she should be liberated when it
+had elapsed, to put her menaces into execution. Her disorder being of a
+dangerous tendency she was retained in the hospital after the period of
+probation. When she found the hope of gratifying her revenge frustrated,
+by being kept beyond the time of her expectation, she began to pine away,
+her appetite diminished, and a cough, with copious expectoration and
+hectic fever supervened. During the whole period of her bodily disease,
+she would never acknowledge herself to be ill, and the violence of her
+mental disorder was unabated. She died of Phthisis Pulmonalis, April 1st,
+1798.
+
+The head was opened twenty four hours after her decease. The tunica
+arachnoidea was in many places opake; the pia mater was highly inflamed,
+and loaded with blood, and a considerable quantity of water was contained
+between it and the former membrane. The ventricles were enlarged, but
+contained scarcely any fluid. The other parts of the brain were healthy,
+and its consistence was natural.
+
+It is a common opinion, that Phthisis Pulmonalis is frequently suspended
+by the supervention of mania; medical books abound with such accounts, and
+some persons have supposed it difficult, if not impossible, for these
+diseases to co-exist. It is not my intention to dispute the accuracy of
+such relations, nor to question the power which Mania may possess in
+arresting the progress of Phthisis Pulmonalis, but, to state that the
+converse does not obtain; and, that whatever obligations may be due from
+Phthisis to Mania, the compliment has not been returned. From my own
+experience I can affirm, that insane persons are as liable to Phthisis
+Pulmonalis as others, that numbers of them die of that disease; and that I
+never saw any abatement of the maniacal symptoms through the progress of
+consumption.
+
+
+CASE XXXII.
+
+J. P. aged 57, was admitted into the hospital, January 19, 1799; he was
+stated to have been insane about three weeks, and that his disorder came
+on shortly after the death of his master, in whose service he had
+continued many years, and to whom he was much attached. He had been in the
+hospital three times before, and had each time been discharged well. His
+disorder usually recurred every seven or eight years. His father also had
+been maniacal about the middle period of life, but never recovered. When
+admitted he was very talkative, although his natural character was
+reserved. He endeavoured to explain his meaning with superior correctness,
+and sought to define every subject, however trifling, with a tedious
+minuteness; but, upon religion and politics, the Scylla and Charybdis of
+human discussion, he was pertinacious and intollerant. This dictatorial
+manner and stubbornness of opinion, not being capable of producing the
+relations of peace and amity with other philosophers, equally obstinate,
+and whose principles had been matured by long confinement, it became
+necessary to shut him up in his cell. During the period of his seclusion,
+nothing very incoherent escaped from him; every thing he said was within
+the sphere of possibility. His fastidiousness rendered him unhappy: he
+acknowledged the food which was brought him to be good, but he conceived
+it might have been better. The cathartic medicine, which was administered
+to him, he confessed had answered the purpose, but its taste was most
+nauseous, and he had never before been so severely griped. He ornamented
+his person and apartment in a very whimsical manner: latterly he tore his
+clothes because he suspected the taylor had deceived him in the materials.
+After this he continued naked until the beginning of March, when he
+appeared more composed, and sensible of the state he had been in. On the
+morning of the 12th, when the keeper opened his cell, he was speechless;
+his mouth drawn to the right side, and so feeble that he could not support
+himself. A cathartic medicine was given, and sinapisms were applied to the
+feet and legs. In the evening he was much recovered, his speech had
+returned, and he was able to move himself. He was visited again at
+midnight, when he appeared still better. In the morning it was evident
+that he had experienced another attack, his mouth was drawn aside; he was
+stupid, and died within half an hour. The head was opened on the
+following day. The tunica arachnoidea was in some places slightly opake.
+The pia mater was inflamed, but not to any considerable degree. There was
+no water between any of the membranes. The ventricles were of a natural
+capacity, and did not contain any fluid. There was no extravasation in any
+part of the substance of the cerebrum or cerebellum. Excepting the slight
+inflammation of the pia mater, the brain had a very healthy appearance;
+its consistence was firm; the scull was unusually thick. I regret, from a
+promise which had been made to the friends, of inspecting the head only,
+that the thoracic and abdominal viscera were not examined.
+
+This history has been related to shew, that although the patient died with
+those symptoms, which indicate pressure on the brain, as loss of speech,
+the mouth being drawn aside, stupor and insensibility; yet the brain did
+not afford the same appearances, on dissection, as have been usually
+detected in such cases. The following relation is an additional example of
+the same fact:
+
+
+CASE XXXIII.
+
+N. B. He had been many years in the hospital as an incurable patient; his
+mother was known to have been maniacal; his two brothers and his sister
+have been insane. His eldest son, on taking a very small quantity of
+fermented liquor, becomes frantic, and its effects continue much longer
+than on persons in general. During this patient's confinement, he was, as
+far as could be ascertained, completely in his senses; this induced the
+medical persons of the hospital, on two or three occasions, to give him
+leave of absence, that he might return on trial to his wife and family;
+but, in a few hours after he came home, he felt uneasy, and found himself
+bewitched at all points: the devil and his imps had pre-occupied the best
+places in the house; he became very turbulent, and also jealous of his
+wife, and was obliged to be returned to the hospital. As he found his home
+so beset with difficulties he resolved that he would never enter it again.
+During eight years that I was acquainted with him I never discovered the
+least insanity in his actions or conversation. He was perfectly sensible
+that his intellects were disordered whenever he returned to his family.
+His wife and children frequently visited him in Bethlem, and he always
+conducted himself affectionately towards them. About 14 months before his
+death he laboured under a severe dysentery, which continued six weeks, and
+left him in a very reduced state, with oedematous legs, and incipient
+dropsy of the abdomen. On his recovery from these symptoms he became
+troubled with fits; they appeared to be such as a medical person would
+have termed apoplectic. After the attack, no symptoms of paralysis
+remained, nor did he experience the fatigue and exhaustion, or fall into a
+profound sleep, which usually accompanies Epilepsy. On October 10th, 1802,
+being then in a pretty good state of health, he fell down, and expired in
+a few minutes. He was about sixty-five years of age. On examination of the
+head after death, there was a considerable determination of blood to the
+brain; but there was no extravasation of that fluid, nor any collection of
+water: the brain and its membranes had a healthy appearance, and its
+consistence was natural. The heart was sound, and the abdominal viscera
+were not conspicuously diseased.
+
+
+CASE XXXIV.
+
+J. P. a man, aged thirty, was admitted into the hospital, October 18th,
+1800. It was then deposed, by the persons who brought him, that he had
+been for eight months in a melancholic state; but they were unable to
+assign any circumstances, which preceded his disorder, as a cause of his
+disease. He had a large tumor on the throat which extended backward to the
+neck, principally on the left side; the increase of this swelling, they
+alledged, had much alarmed him, at the commencement of his melancholic
+attack. During the time he was the subject of my observation, he was in a
+very mopish and stupid state; if spoken to, he would sometimes give a
+short answer, but ordinarily he took no notice of those who addressed him.
+Some days he would walk slowly in the less frequented part of the
+building; frequently he sat down for some hours in a corner. His appetite
+was good, he ate the food which was brought him, but never took the
+trouble to go for it, when serving out. In this state he continued until
+April 2d, when he became more stupid, and could not be made to rise from
+his bed. He did not appear to be in any pain, nor was he at all convulsed.
+His bowels were regular. On the 5th he became comatose, and on the 9th he
+died.
+
+_Appearances on Dissection._
+
+There was an excessive determination of blood to the brain, and the pia
+mater was highly inflamed. On the inferior part of the middle lobe of the
+brain, there was a gangrene of considerable extent, together with a
+quantity of very foetid purulent matter.
+
+This is the only instance of a gangrenous state of the brain which has
+fallen under my observation.
+
+
+CASE XXXV.
+
+T. C. This person had remained many years in the hospital on the incurable
+establishment. He had been a schoolmaster at Warrington in Lancashire, and
+was a man of acuteness and extensive mathematical learning. As he became
+very furious on the attack of his maniacal disorder, he was placed in the
+Lunatic Asylum at Manchester, where he killed the person who had the care
+of him, by stabbing him in the back with a knife.
+
+The following is the account he gave me of that transaction, and which I
+immediately committed to paper; as it conveys a serious and important
+lesson to those who are about the persons of the insane.
+
+  "He that would govern others, first should be
+  The master of himself, richly indu'd
+  With depth of understanding, height of courage."
+                _Massinger's Bondman, Act I. Scene 3._
+
+It ought to be more generally understood that a madman seldom forgets the
+coercion he has undergone, and that he never forgives an indignity.
+
+"The man whom I stabbed richly deserved it. He behaved to me with great
+violence and cruelty, he degraded my nature as a human being; he tied me
+down, handcuffed me, and confined my hands much higher than my head, with
+a leathern thong: he stretched me on a bed of torture. After some days he
+released me. I gave him warning, for I told his wife I would have justice
+of him. On her communicating this to him, he came to me in a furious
+passion, threw me down, dragg'd me through the court-yard, thumped on my
+breast, and confined me in a dark and damp cell. Not liking this
+situation, I was induced to play the hypocrite. I pretended extreme sorrow
+for having threatened him, and by an affectation of repentance, prevailed
+on him to release me. For several days I paid him great attention, and
+lent him every assistance. He seemed much pleased with the flattery, and
+became very friendly in his behaviour towards me.--Going one day into the
+kitchen, where his wife was busied, I saw a knife; (this was too great a
+temptation to be resisted;) I concealed it, and carried it about me. For
+some time afterwards the same friendly intercourse was maintained between
+us; but, as he was one day unlocking his garden door, I seized the
+opportunity, and plunged the knife up to the hilt in his back."--He
+always mentioned this circumstance with peculiar triumph, and his
+countenance (the most cunning and malignant I ever beheld) became highly
+animated at the conclusion of the story.
+
+During the time he was in Bethlem Hospital he most ingeniously formed a
+stiletto out of a mop-nail; it was an elaborate contrivance, and had
+probably been the work of several months. It was rendered extremely sharp
+and polished, by whetting on a small pebble; it was fixed into a handle,
+and had a wooden sheath made from the mop-stick. This instrument he
+carried in his left breeches pocket, his right hand grasping the hilt. As
+I always found him in that posture when I visited him, I suspected he had
+some concealed implement of mischief, and therefore employed a
+convalescent patient to watch him through the key-hole of his door. This
+person saw him with the weapon, and also ascertaining the distance at
+which he could use it.
+
+The instrument was taken from him by surprise. When he found he was
+prevented from executing his purpose, he roared out the most horrid
+imprecations; he cursed the Almighty for creating him, and more especially
+for having given him the form of a human being, and he wished to go to
+Hell that he might not be disgraced by an association with the Deity.
+
+He had an uniform and implacable aversion to the officers and servants of
+the hospital; he said he courted their hatred for their curse was a
+blessing. He seldom answered a question but some impiety was contained in
+the reply. An indifferent person remarking that it was a bad day, he
+immediately retorted, "Sir, did you ever know God make a good one?"
+Although the whole of the day, and the greatest part of the night, were
+consumed in pouring forth abuse and coining new blasphemies; yet there
+were some few patients for whom he professed a friendship, and with whom
+he conversed in a mild and civil way: this confidence had been obtained by
+the compliments they had addressed to him on the score of his
+understanding, of which he entertained a very high opinion. At one time he
+conceived himself to be the Messiah, at another, that he was Mr. Adam, the
+architect; and that he was shortly to go to America in order to build the
+new Jerusalem in Philadelphia.
+
+About six months before his death he complained of pain in his stomach,
+and said he felt as if he had no intestines. His appetite diminished, and
+he became melancholic.
+
+The scene now began to alter; he had a presentiment that his time in this
+world would be short, and he dreaded the change: no hope arose, no
+consolation could cheer him; he became daily more emaciated and despairing
+until he died, which took place August 27, 1801; he appeared to be about
+seventy years of age.
+
+On opening the head, the pericranium was scarcely adherent. This membrane
+being removed, blood oozed freely from the parietal bones. There was a
+large accumulation of water between the dura mater and tunica arachnoidea;
+when this was let out the dura mater became flaccid, and seemed to hang
+loose on the brain. On the left posterior lobe of the cerebrum there was a
+large quantity of a milky fluid, between the tunica arachnoidea and pia
+mater, giving the appearance of a vesication; and in that place there was
+a depression or cavity formed in the convolutions of the brain. The
+convolutions were so strongly and distinctly marked, that they resembled
+the intestines of a child. The lateral ventricles were but little
+distended, and did not contain much water. The head was not particularly
+loaded with blood, nor were the bloody points, in the medullary substance,
+very abundant. The brain was of a natural consistence. There was no
+disease in the stomach, intestines, or liver. The body was opened about
+six hours after his death.
+
+
+CASE XXXVI.
+
+B. S. a man, generally noticed by those who have visited Bethlem hospital
+a few years ago. It was said, that an attachment to a young woman, who
+slighted his addresses, was the cause of his becoming insane. He was
+considered a very dangerous lunatic, and for many years was confined to
+his cell. In this situation he employed himself in the manufacture of
+straw baskets and table mats. The desire of money was the leading feature
+of his mind, and the whole of his energies were devoted to its
+acquisition; nor was he at all scrupulous as to the means, by which he
+attained his object. Although repeatedly assured that he would never be
+liberated, he disbelieved such information, and was persuaded, when he had
+acquired a sum sufficient to purchase a horse and cart, filled with
+higler's ware, that he should be released. The idea of becoming a trader,
+on so large a scale, stimulated him to constant occupation. He employed
+several lunatic journeymen to plat the straw for him, but they were poorly
+rewarded. He generally chose for his workmen such as were chained, and
+could not come personally to insist on the reward of their labour. He
+commonly pretended that the platting was badly performed, and
+consequently unsaleable; sometimes he would protest that he had settled
+with them, but that they were too mad to recollect it; and if at any time
+he did pay them, it was in bad coin. For many years he was unrivalled in
+this trade, and, by every species of fraud, had amassed nearly sufficient
+to set his plans afloat: when an unfortunate event took place, which
+considerably reduced his capital. He had always a propensity to game,
+which, from his skill and dexterity in cheating, was generally attended
+with success; but in this science he was once over-matched. An insane
+soldier, an ingenious man, became his intimate friend, and finding him
+possessed of some money proposed a game at cards. The result was deeply
+disastrous to the artificer in straw, who endeavoured to evade the
+payment; but his friend stated it to be a debt of honor; and besides he
+was a very powerful man, of a stern aspect, and not to be trifled with;
+he was therefore compelled to tell down at once the slow accumulation of
+several years. It was intended to make the soldier restore the property,
+but he, conceiving that he had already derived sufficient benefit from the
+hospital, went away in the night, without the formalities of a regular
+discharge.
+
+To fill up the measure of his misfortunes, when Hatfield, the maniac who
+shot at his Majesty in the theatre, was brought to Bethlem, he, in
+conjunction with a contriving cobbler, established a rival manufactory,
+which shortly eclipsed the fabric of the old school, and by superior taste
+rendered his further exertions unnecessary.
+
+It is natural to suppose, that no great cordiality could exist between
+persons, where the prosperity of one had been established on the ruin of
+the other. Frequent altercations arose, and much offensive language was
+exchanged. At length the patience of the original dealer was exhausted,
+and, in collecting his force to give his opponent a blow, he fell down and
+instantly expired.--He was about fifty-eight years of age.
+
+Some of his habits and opinions were extremely singular; he believed that
+all occurrences were regulated by witches: prosperity was to be attributed
+to the good witches having obtained the mastery; and when bad witches
+gained the ascendancy, misfortunes arose. When the latter were at work he
+supposed himself in possession of a power to frighten and disperse them,
+and this was effected by a peculiar noise he made. It is probable he might
+have laboured under indigestion, for immediately after he had eaten his
+dinner, he sent forth a dreadful howl, which he continued for about ten
+minutes: but his great terror was a thunder storm; when this occurred, he
+took a very active part, and brought the whole force of his lungs to bear
+upon the enemy. A cat was supposed to have a natural antipathy to bad
+witches, she could smell them at a distance; for which reason he always
+domesticated an animal of that kind to sleep in his cell.
+
+When his head was opened, the dura mater was very easily separable from
+the scull; upon puncturing this membrane a considerable quantity of blood
+flowed from the opening; and there was a copious extravasation of this
+fluid between the membranes of the brain: but the most remarkable
+circumstance was, that the tunica arachnoidea was so thickened, that it
+exceeded the dura mater on an accurate comparison. The pia mater was
+loaded with blood, and its vessels were enlarged. The brain and its
+cavities were sound and natural.
+
+
+CASE XXXVII.
+
+R. B. This man had been many years an incurable patient, and it was
+supposed that jealousy of his wife had been the cause of his madness,
+although it appeared from very respectable testimony that he had no real
+grounds for such suspicion. During eight years, (the period he was subject
+to my observation,) he was mostly in a very furious state, and obliged to
+be strictly confined. His mischeivous disposition was manifested on every
+occasion; he would hurl the bowl, in which his food was served, against
+those who passed his cell; and when his hands were secured he would kick,
+bite, or throw his head into the stomachs of those who came near him. He
+entertained a constant aversion to his keeper, whom he suspected to be
+connected with his wife. His life was miserably divided between furious
+paroxysms and melancholic languor, and there was great uncertainty in the
+duration of these states. He has been known to continue ten months in the
+highest degree of violence, and relapse into the same state after a few
+days passed in tranquil depression. There was one circumstance which never
+failed to produce a relapse, however quietly he might have conducted
+himself, this was a visit from any of his family, and a very striking
+instance occurred. From May, 1799, to September, 1800, he had every
+appearance of being perfectly recovered: he was, in consequence, allowed
+additional comforts, and treated as a convalescent. At this time he was
+visited by his son, who, after many hours conversation with him, was
+persuaded that he had perfectly recovered his intellects; and he expressed
+himself astonished at his father's accurate recollection of particulars
+which might be supposed to have been obliterated from his mind. This
+dutiful visit and affectionate intercourse produced unpleasant
+consequences. The numerous enquiries which the patient had made, furnished
+him with materials for reflexion. On the departure of his son he began to
+detect mismanagement in his affairs, and improprieties in the conduct of
+his family: he was very talkative, and became impatient to return home.
+The following day he had a wildness in his eyes, spoke fast, and appeared
+busy: before the evening he was so irritable and disobedient that it
+became necessary to confine him. From this time he continued in the most
+furious condition, singing and vociferating the greatest part of the
+night, until January 2d, 1801, when he became suddenly calm, complained of
+extreme debility, and said he should die in a few hours. He gave very
+proper answers to the questions which were asked him, but complained of
+the fatigue which talking induced. On the next morning he expired. He was
+sixty-eight years of age. The head was opened two days after his death.
+The tunica arachnoidea was in many places opake, and considerably
+thickened. There was a small quantity of limpid water between this
+membrane and the pia mater. When the medullary substance was cut into,
+there oozed from many points a quantity of dark blood, indeed the whole
+head was loaded with venous blood. The lateral ventricles were
+considerably enlarged and filled with water--four ounces were collected.
+The internal carotid arteries were much enlarged, and when divided, did
+not collapse, but remained open, as arteries in the other parts of the
+body. The consistence of the brain was doughy.
+
+
+
+
+CHAP. IV.
+
+CASES OF INSANE CHILDREN.
+
+
+In the month of March, 1799, a female child, three years and a quarter
+old, was brought to the hospital for medical advice. She was in good
+bodily health, and born of sane and undiseased parents. The mother, who
+attended, stated that her husband's parents and her own had never been in
+the slightest degree afflicted with mania, but that she had a brother who
+was born an ideot. She related that her child, until the age of two years
+and a half, was perfectly well, of ordinary vivacity, and of promising
+talents; when she was inoculated for the small pox. Severe convulsions
+ushered in the disease, and a delirium continued during its course. The
+eruption was of the mild kind, and the child was not marked with the
+pustules. From the termination of the small-pox to the above date, (nine
+months) the child continued in an insane state. Previously to the
+small-pox, she could articulate many words, and use them correctly for the
+things they signified: but since that time she completely forgot her
+former acquisitions, nor ever attempted to imitate a significant sound.
+Whatever she wished to perform, she effected with promptitude and
+facility. She appeared anxious to possess every thing she saw, and cried
+if she experienced any disappointment; and on these occasions she would
+bite, or express her anger by kicking or striking. Her appetite was
+voracious, and she would devour any thing that was given to her, without
+discrimination; as fat, raw animal food, or tainted meat. To rake out the
+fire with her fingers was a favourite amusement, nor was she deterred from
+having frequently burned them. She passed her urine and faeces in any place
+without restraint; but she could retain a considerable quantity of the
+former before she discharged it. Some cathartic remedies were ordered for
+her, with an emetic occasionally, and she was brought to the hospital
+every fortnight, but she did not appear in any degree amended. On June 22
+she was admitted a patient, and continued in the hospital until the middle
+of October, when she was attacked with an eruptive fever, and consequently
+discharged. During this time little progress was made, although
+considerable pains were bestowed. She became more cunning, and her taste
+appeared improved. The cathartic medicine, which she drank at first
+without reluctance, became afterwards highly disgusting, and when she saw
+the basket which contained it, she endeavoured to escape and hide
+herself. To particular persons she was friendly, and felt an aversion to
+others. She was sensible of the authority of the nurse who attended her,
+and understood by the tone of her voice whether she were pleased or
+offended. The names of some things she appeared to comprehend, although
+they were extremely few; when the words, dinner, cakes, orange, and some
+more were mentioned, she smiled, and appeared in expectation of receiving
+them. By great attention and perseverance on the part of the nurse, she
+was brought to evacuate her faeces and urine in a night stool.
+
+After the elapse of three years I was informed that the child had made no
+intellectual progress.
+
+W. H. a boy, nearly seven years of age, was admitted into the Hospital,
+June 8th, 1799. His mother, who frequently visited him, related the
+following particulars respecting his case.--She said that, within a month
+of being delivered of this child, she was frightened by a man in the
+street, who rudely put his hand on her abdomen. When the child was born it
+was subject to startings, and became convulsed on any slight
+indisposition. When a year old, he suffered much with the measles: and
+afterwards had a mild kind of inoculated small-pox. At this age she
+thought the child more lively than usual, and that he slept less than her
+other children had done. At two years, the mother perceived he could not
+be controled, and therefore frequently corrected him.
+
+There was a tardiness in the developement of his physical powers. He was
+fifteen months old before he had a tooth, and unable to go alone at two
+years and a half: his mind was equally slow; he had arrived at his fourth
+year before he began to speak; and, when in his fifth, he had not made a
+greater proficiency in language than generally may be observed in children
+between two and three years. When admitted into the hospital, he wept at
+being separated from his mother, but his grief was of very short
+continuance. He was placed on the female side, and seemed highly delighted
+with the novelty of the scene: every object excited his curiosity, but he
+did not pause or dwell on any. He was constantly in action, and rapidly
+examined the different apartments of the building. To the patients in
+general he behaved with great insolence--he kicked and spat at them, and
+distorted his face in derision; but, on the appearance of the nurse, he
+immediately desisted, and assured her he was a very good boy. Great, but
+ineffectual, pains were taken, to make him understand the nature of
+truth,--he could never be brought to confess any mischief he had
+committed, and always took refuge in the convenient shelter of a lie. In a
+short time he acquired a striking talent for mimickry, and imitated many
+of the patients in their insane manners; he generally selected, for his
+models, those who were confined, as he could practise from such with
+impunity.
+
+In about three months he had added considerably to his stock of language,
+but, unluckily, he had selected his expressions from those patients who
+were addicted to swearing and obscene conversation. To teach him the
+letters of the alphabet had many times been endeavoured, but always
+without success; the attempt uniformly disgusted him: he was not to be
+stimulated by coaxing or coercion; his mind was too excursive, to submit
+to the painful toil of recording elementary sounds; but it may rather be
+inferred that he did not possess a sufficient power of attention to become
+acquainted with arbitrary characters.
+
+He was in good health, his pulse and bowels were regular, and his appetite
+was keen, but not voracious. One circumstance struck me, as very peculiar,
+in this boy,--he appeared to have very incorrect ideas of distance: he
+would frequently stretch out his hand, to grasp objects considerably
+beyond his reach, but this referred principally to height: he would
+endeavour to pluck out a nail from the ceiling, or snatch at the moon. In
+October he became unwell, and, at the mother's request, was discharged
+from the hospital.
+
+In September 1805, I again saw the boy: he was then thirteen years of age,
+had grown very tall, and appeared to be in good health. He recollected me
+immediately, and mentioned the words, school Moorfields, nasty physic. On
+meeting with some of the female patients, he perfectly remembered them,
+and seemed for the moment, much pleased at the renewal of the
+acquaintance. By this time, he had made comparatively, a great progress in
+language; he knew the names of ordinary things, and was able to tell
+correctly the street in which he resided, and the number of his house. His
+mother informed me that he was particularly fond of going to church,
+although he was unable to comprehend the purpose for which he went: when
+there, he conducted himself with great order and decorum, but was disposed
+to remain after the congregation had dispersed. To shew how little he
+understood, why he frequented a place of worship: his mother once took him
+to church on Sacrament-sunday, and fearful of disturbing the persons
+assembled, by compelling him to return home, allowed him to be a
+spectator of those solemn administrations. The only reflexion he made on
+the subject, but in disjointed expressions, was, that he thought it
+extremely hard, that the ladies and gentlemen should eat rolls and drink
+gin, and never ask him to partake. In his person he was clean, and dressed
+himself with neatness. Having been taught when in the hospital to use a
+bowl for his necessary occasions, he obstinately continued the same
+practice when he returned home, and could never be persuaded to retire to
+the closet of convenience; but the business did not terminate here, when
+he had evacuated his intestines into the bowl he never failed to paint the
+room with its contents. To watch other boys when they were playing, or to
+observe the progress of mischief, gave him great satisfaction: but he
+never joined them, nor did he ever become attached to any one of them. Of
+his mother he appeared excessively fond, and he was constantly caressing
+her: but in his paroxysms of fury he felt neither awe nor tenderness, and
+on two occasions he threw a knife at her. Although equally ignorant of
+letters, as when discharged from the hospital, he took great delight in
+having gilt books; indeed every thing splendid attracted his attention,
+but more especially soldiers and martial music. He retained several tunes,
+and was able to whistle them very correctly. The day on which I last saw
+him his mind was completely occupied with soldiers; when questions were
+put to him, if he answered them it was little to the purpose, generally he
+did not notice them, but turned round to his mother and enquired about the
+soldiers.
+
+The defect of this lad's mind, appeared to be a want of continued
+attention to things, in order to become acquainted with their nature; and
+he possessed less curiosity than other children, which serves to excite
+such attention: and this will in some degree explain, why he had never
+acquired any knowledge of things in a connected manner. His sentences were
+short, and he employed no particles to join them together. Although he was
+acquainted with the names of many things, and also with expressions which
+characterize passion, he applied them in an insulated way. For instance,
+if a shower fell, he would look up and say, "rains;" or when fine, "sun
+shines." When in the street he would pull his mother, to arrest her
+attention, and point to objects, as a fine horse, or a big dog; when he
+returned home he would repeat what had attracted his notice, but always
+speaking of himself in the third person. "Billy see fine horse, big dog,
+&c."[12] Of circumstances boldly impressed, or reiterated by habit, his
+memory was retentive, but as his attention was only roused by striking
+appearances, or loud intonations, ordinary occurrences passed by
+unobserved.
+
+In the month of July 1803, my opinion was requested respecting a young
+gentleman, ten years of age, who was sent here, accompanied by a kind and
+decent young man, to take care of him. Previously to his arrival I had
+corresponded respecting his case with a very learned and respectable
+physician in the country, under whose care the boy had been placed. From
+the information furnished by this gentleman, and that which was collected
+from the keeper, I believe the former history of his case is correctly
+given.
+
+The parents are persons of sound mind, and they do not remember any
+branches of their respective families to have been (in any manner)
+disordered in their intellects. The subject of the present relation was
+their eldest son; the second child was of a disposition remarkably mild;
+and the youngest, a boy, about two years and a half, was distinguished by
+the irritability and impatience of his temper. At the age of two years,
+the subject of the present relation, became so mischievous and
+uncontroulable, that he was sent from home to be nursed by his aunt. In
+this situation, at the request of his parents, and with the concurrence of
+his relation, he was indulged in every wish, and never corrected for any
+perverseness or impropriety of conduct. Thus he continued until he was
+nearly nine years old, the creature of volition and the terror of the
+family. At the suggestion of the physician, whom I have before mentioned,
+and who was the friend of his parents: a person was appointed to watch
+over him. It being the opinion of the doctor that the case originated in
+over indulgence and perverseness; a different system of management was
+adopted. The superintendant was ordered to correct him for each individual
+impropriety. At this time the boy would neither dress nor undress himself,
+though capable of doing both; when his hands were at liberty, he tore his
+clothes: he broke every thing that was presented to him, or which came
+within his reach, and frequently refused to take food. He gave answers
+only to such questions as pleased him, and acted in opposition to every
+direction. The superintendant exercised this plan for several months, but
+perhaps not to the extent laid down; for it may be presumed, that after a
+a few flagellations his humanity prevailed over the medical hypothesis.
+When he became the subject of my own observation, he was of a very healthy
+appearance, and his head was well formed; this was also the opinion of
+several gentlemen, distinguished for their anatomical knowledge, to whom
+the boy was presented. His tongue was unusually thick, though his
+articulation was perfectly distinct. His countenance was decidedly
+maniacal.[13] His stature, for his age, was short, but he was well
+compacted, and possessed great bodily strength. Although his skin was
+smooth and clear, it was deficient in its usual sensibility; he bore the
+whip and the cane with less evidence of pain than other boys. Another
+circumstance convinced me of this fact. During the time he resided in
+London he was troubled with a boil on his leg; various irritating
+applications were made to the tumor, and the dressings were purposely
+taken off with less nicety than usual, yet he never complained. His pulse
+was natural, and his bowels were regular. His appetite was good, but not
+inordinate, and he bore the privation of food for a considerable time
+without uneasiness. Although he slept soundly, he often awoke as if
+suddenly alarmed, and he seemed to require a considerable duration of
+sleep.
+
+He had a very retentive memory, and had made as great proficiency in
+speech as the generality of boys of his own age. Few circumstances
+appeared to give him pleasure, but he would describe very correctly any
+thing which had delighted him. As he wanted the power of continued
+attention, and was only attracted by fits and starts, it may be naturally
+supposed he was not taught letters, and still less that he would copy
+them. He had been several times to school, and was the hopeless pupil of
+many masters, distinguished for their patience and rigid discipline; it
+may therefore be concluded, that from these gentlemen, he had derived all
+the benefits which could result from privations to his stomach, and from
+the application of the rod to the more delicate parts of his skin.
+
+On the first interview I had with him, he contrived, after two or three
+minutes acquaintance, to break a window and tear the frill of my shirt. He
+was an unrelenting foe to all china, glass, and crockery ware, whenever
+they came within his reach he shivered them instantly. In walking the
+street, the keeper was compelled to take the wall, as he uniformly broke
+the windows if he could get near them, and this operation he performed so
+dextrously, and with such safety to himself, that he never cut his
+fingers. To tear lace and destroy the finer textures of female ornament,
+seemed to gratify him exceedingly, and he seldom walked out without
+finding an occasion of indulging this propensity. He never became attached
+to any inferior animal, a benevolence so common to the generality of
+children: to these creatures his conduct was that of the brute: he
+oppressed the feeble, and avoided the society of those more powerful than
+himself. Considerable practice had taught him that he was the cat's
+master, and whenever this luckless animal approached him he plucked out
+its whiskers with wonderful rapidity; to use his own language, "_I must
+have her beard off_." After this operation, he commonly threw the creature
+on the fire, or through the window. If a little dog came near him he
+kicked it, if a large one he would not notice it. When he was spoken to,
+he usually said, "I do not choose to answer." When he perceived any one
+who appeared to observe him attentively, he always said, "Now I will look
+unpleasant." The usual games of children afforded him no amusement;
+whenever boys were at play he never joined them: indeed, the most singular
+part of his character was, that he appeared incapable of forming a
+friendship with any one: he felt no considerations for sex, and would as
+readily kick or bite a girl as a boy. Of any kindness shewn him, he was
+equally insensible; he would receive an orange as a present, and
+afterwards throw it in the face of the donor.
+
+To the man who looked after him, he appeared to entertain something like
+an attachment: when this person went out of the room, and pretended that
+he would go away, he raised a loud outcry, and said, "what will become of
+me, if he goes away; I like him, for he carries the cane which makes me a
+good boy:" but it is much to be doubted, whether he really bore an
+affection for his keeper; the man seemed to be of a different opinion, and
+said, when he grew older he should be afraid to continue with him, as he
+was persuaded the boy would destroy him, whenever he found the means and
+opportunity.
+
+Of his own disorder he was sometimes sensible: he would often express a
+wish to die, for he said, "God had not made him like other children;" and
+when provoked, he would threaten to destroy himself.
+
+During the time he remained here, I conducted him through the hospital,
+and pointed out to him several patients who were chained in their cells;
+he discovered no fear or alarm; and when I shewed him a mischievous maniac
+who was more strictly confined than the rest, he said, with great
+exultation, "this would be the right place for me." Considering the
+duration of his insanity, and being ignorant of any means by which he was
+likely to recover, he returned to his friends, after continuing a few
+weeks in London.
+
+
+
+
+CHAP. V.
+
+CAUSES OF INSANITY.
+
+
+When patients are admitted into Bethlem Hospital, an enquiry is always
+made of the friends who accompany them, respecting the cause supposed to
+have occasioned their insanity.
+
+It will be readily conceived, that there must be great uncertainty
+attending the information we are able to procure upon this head: and even
+from the most accurate accounts, it would be difficult to pronounce, that
+the circumstances which are related to us, have actually produced the
+effect. The friends and relatives of patients are, upon many occasions,
+very delicate concerning this point, and cautious of exposing their
+frailties or immoral habits: and when the disease is connected with the
+family, they are oftentimes still more reserved in disclosing the truth.
+
+Fully aware of the incorrect statement, frequently made concerning these
+causes, I have been at no inconsiderable pains to correct or confirm the
+first information, by subsequent enquiries.
+
+The causes which I have been enabled most certainly to ascertain, may be
+divided into PHYSICAL and MORAL.[14]
+
+Under the first, are comprehended repeated intoxication: blows received
+upon the head; fever, particularly when attended with delirium; mercury,
+largely and injudiciously administered; cutaneous eruptions repelled, and
+the suppression of periodical or occasional discharges and secretions;
+hereditary disposition, and paralytic affections.
+
+By the second class of causes, which have been termed _moral_, are meant
+those which are supposed to originate in the mind, or which are more
+immediately applied to it. Such are, the long endurance of grief; ardent
+and ungratified desires; religious terror; the disappointment of pride;
+sudden fright; fits of anger; prosperity humbled by misfortunes:[15] in
+short, the frequent and uncurbed indulgence of any passion or emotion, and
+any sudden or violent affection of the mind.
+
+There are, doubtless, many other causes of both classes, which may tend to
+produce this disease. Those which have been stated, are such as I am most
+familiar with; or, to speak more accurately, such are the circumstances
+most generally found to have preceded this affection.
+
+It is an old opinion, and continues still to prevail, that maniacs are
+influenced by the changes of the moon. In the fourth chapter of St.
+Matthew's Gospel, verse 24, we find the word "[Greek: Seleniaxomenous]"
+which is rendered in the English version, "those which were lunatic."
+Notwithstanding the notion of being moon-struck might prevail among the
+ignorant people of Galilee, yet Hippocrates, a philosopher, and correct
+observer of natural phaenomena, does not appear to have placed any faith in
+this planetary influence. Although the Romans were infected with this
+popular tradition, as may be seen in the following passage of the Art of
+Poetry,
+
+  "Ut mala quem scabies aut morbus regius urget,
+  Aut fanaticus error, et IRACUNDA DIANA
+  Vesanum tetigisse timent fugiuntque poetam,
+  Qui sapiunt:"--
+
+yet Celsus did not consider the operation of the moon on the human
+intellect sufficiently well founded to admit it into his medical work.
+Not a word on this subject is mentioned in the eighteenth chapter of his
+third book, which particularly treats of Insanity, "_De tribus insaniae
+generibus_;" it is true that, in the fourth chapter of the first book,
+which speaks "_De his quibus caput infirmum est_," he says "Cui caput
+infirmum est, is si bene concoxit, leniter perfricare id mane manibus suis
+debet; nunquam id, si fieri potest, veste velare; aut ad cutem tondere:
+utileque lunam vitare, maximeque ante ipsum lunae solisque concursum." By
+the _infirmum caput_, Celsus does not mean madness, as may be clearly seen
+by perusing the chapter: the weakness of intellect, which frequently
+continues after fever, or other violent diseases, is evidently his
+meaning; but Dr. Cox has quoted the above passage, to prove that Celsus
+was impressed with the truth of this vulgar opinion. He says, "This idea
+of lunar influence, in _maniacal complaints_, was handed down to us by
+our medical forefathers, and is still very generally adopted."
+
+It is most probable that this idea of planetary regency, however it might
+have arisen, or to whatever extent it may have been credited, received in
+the Arabian school, the stamp by which its currency has been subsequently
+maintained. For the revival and dispersion of ancient medical knowledge,
+we are confessedly under considerable obligations to the Arabians;[16] and
+more especially for the incorporation of astrology, magic and alchymy,
+with medicine.
+
+Popular superstitions and national proverbs, are seldom without some
+foundation; and with respect to the present, it may be observed, that if
+it were not in some degree rooted in fact, and trained up by observation,
+it would become difficult to ascertain how such an opinion came to be
+adopted; and this investigation is rendered still more important from the
+consideration, that the existing law in this country, respecting insane
+persons, has been established on the supposed prevalence of this lunar
+regulation. A commission is issued, de _lunatico_ inquirendo, and the
+commissioners sitting for that purpose, are particular in their enquiries,
+whether the patient enjoys lucid intervals. The term _lucid interval_ has
+been properly connected with the word _lunacy_; for, if the patient, as
+they supposed, became insane at particular changes of the moon, the
+inference was natural, that in the intervening spaces of time he would
+become rational.
+
+It is more than probable, that the origin of this supposition of the lunar
+influence may be traced to the following circumstances. The period of the
+return of the moon, and of regular menstruation in women, is four weeks;
+and the terms which designate them, have been imposed from the period of
+time in which both are compleated. Insanity and epilepsy are often
+connected with menstruation, and suffer an exacerbation of their paroxysms
+at the period when this discharge happens, or ought to take place. If,
+therefore, the period of menstruation in an insane woman should occur at
+the full of the moon, and her mind should then be more violently
+disturbed, the recurrence of the same state may be naturally expected at
+the next full moon. This is a necessary coincidence, and should be
+discriminated from effect. But such has been the prevalence of this
+opinion, that when patients have been brought to Bethlem hospital,
+especially those from the country, their friends have generally stated
+them to be worse at some particular change of the moon, and of the
+necessity they were under, at those times, to have recourse to a severer
+coercion. Indeed, I have understood from some of these _lunatics_, who
+have recovered, that the overseer or master of the work-house himself has
+frequently been so much under the dominion of this planet, and keeping
+steadily in mind the old maxim, _venienti occurrite morbo_, that, without
+waiting for any display of increased turbulence on the part of the
+patient, he has bound, chained, flogged, and deprived these miserable
+people of food, according as he discovered the moon's age by the almanack.
+
+To ascertain how far this opinion was founded in fact, I kept, during more
+than two years, an exact register, but without finding, in any instance,
+that the aberrations of the human intellect corresponded with, or were
+influenced by, the vicissitudes of this luminary.
+
+As insane persons, especially those in a furious state, are but little
+disposed to sleep, even under the most favourable circumstances, they will
+be still less so, when the moon shines brightly into their apartments.
+
+It has also been considered, that intellectual labour frequently becomes a
+cause of insanity; that those, who are in the habit of exercising the
+faculty of thought, for the perfection and preservation of the reason of
+others, are thereby in danger of losing their own. We hear much of this,
+from those who have copiously treated of this disease, without the toil of
+practical remark; whose heads become bewildered by the gentlest exercise,
+and to whom the recreation of thinking becomes the exciting cause of
+stupidity or delirium. These persons enumerate, among the exciting causes
+of delirium, "Too great, or too long continued exertion of the mental
+faculties, as in the delirium which often succeeds long continued and
+abstract calculation; and the deliria to which men of genius are
+peculiarly subject."
+
+The mind of every man is capable of a definite quantity of exertion to
+good effect; all endeavours, beyond that point, are impotent and
+perplexing. The attention is capable of being fixed to a certain extent,
+and, when that begins to deviate, all continuance is time lost. It is
+certain that, by habit, this power may be much increased; and, by frequent
+exercise, that, which at first excited fatigue, may be continued with
+facility and pleasure. What species of delirium is that, which succeeds
+long continued and abstract calculation? Newton lived to the age of 85
+years, Leibnitz to 70, and Euler to a more advanced period, yet their
+several biographers have neglected to inform us, that their studies were
+checquered with delirious fermentations. The mathematicians of the present
+day (and there are many of distinguished eminence) would conceive it no
+compliment to suppose that they retired from their labours with addled
+brains, and that writers of books on insanity should impute to them
+miseries which they never experienced.
+
+It is curious to remark, in looking over a biographical chart, that
+mathematicians and natural philosophers have in general attained a
+considerable age; so that long continued and abstract calculation, or
+correct thinking upon any subject does not appear, with all these
+delirious visitations, to shorten the duration of human life. What is
+meant by the deliria, to which men of genius are peculiarly subject, I am
+unable, from a want of sufficient genius and delirium, to comprehend.
+
+It is well understood, that a want of rational employment is a very
+successful mode of courting delirium; that an indulgence in those reveries
+which keep the imagination on the wing, and imprison the understanding, is
+likely to promote it: and it must be owned, that the same effect has often
+been produced, where vanity or ambition has urged minds, puny by nature,
+and undrilled in intellectual exercises, to attempt to grasp that which
+they were unable to embrace. This may be illustrated by the following
+case.
+
+A young gentleman of slender capacity, and very moderate education, at the
+age of nineteen, was placed in a merchant's counting house, where he
+continued for two years diligently, though slowly, to perform the duties
+of the office. Coming at this time into the possession of considerable
+property, and perhaps, aware of the uncultivated state of his own mind, he
+very laudably determined to improve it. He frequented the society of
+persons esteemed learned and eminent in their different professions, and
+became much delighted with their conversation; but at the same time
+sensible that he was unable to contribute to the discourse. He resolved to
+become a severe student, and for this purpose purchased an immense
+quantity of books on most subjects of literature and science. History
+commenced the career of his enquiries: Rollin, Gibbon, Hume and Robertson
+were anxiously and rapidly perused; but he never paused to consider, or to
+connect dates and circumstances, so that these excellent authors, after he
+had waded through them, left scarcely an impression on his mind. Chemistry
+next engaged his attention, and on this subject, he pored over many
+volumes with little advantage: the terms proved a source of embarrassment,
+and he made no experiments. In a hasty succession, the ancient languages,
+antiquities, etymology, agriculture, and moral philosophy, occupied his
+mind. About eight hours were daily devoted to reading. Somewhat more than
+two years were consumed in this employment, which had distracted his mind,
+without conferring any positive knowledge.
+
+His friends and acquaintances now began to perceive a considerable
+alteration in his temper; though naturally diffident, he had assumed a
+high degree of literary importance, and plumed himself on the extent of
+his learning. Before this excessive, but ill-directed application, he was
+a strict relator of the truth, but he now found a convenience in supplying
+by fancy, that, which the indigence of his memory was unable to afford.
+Shortly he began to complain that he could not sleep, and that the long
+night was passed in shifting from side to side.
+
+  "Lasso, ch'n van te chiamo, et queste oscure,
+  Et gelide ombre in van lusingo: o piume
+  D'asprezza colme: o notti acerbe, et dure."
+                                      _Gio: Della Casa._
+
+Fever succeeded, accompanied with delirium in the evening. By quietness,
+and the ordinary remedies, these symptoms were removed; but he was left in
+a state of extreme weakness. As he recovered from this, his habits became
+materially altered: he would continue to lie in bed for several days,
+after which, he would suddenly rise and walk a number of miles. Personal
+cleanliness, and dress were entirely neglected: sometimes he would fast
+for two or three days, and then eat voraciously. Afterwards he became
+suspicious that poison had been mixed with his food. It was found
+necessary to confine him, from having attempted to castrate himself: this
+he afterwards effected in a very complete manner, and continues a maniac
+to the present time.
+
+Few persons, I believe, will be disposed to consider the above case, as an
+instance of insanity succeeding to a laborious exercise of the
+intellectual faculties. It is true, he was busied with books: but this
+occupation could not have strained his mind, for he appears neither to
+have comprehended, nor retained any of the objects of his pursuit.
+
+
+_Hereditary Disposition._
+
+    "Ut male posuimus initia sic cetera sequuntur."--_Cicero._
+
+    "Whatever was in the womb imperfect, as to her proper work, comes very
+    rarely, or never at all, to perfection afterwards."--_Harrington's
+    Works, p. 177._
+
+Considerable diversity of opinion has prevailed, whether insanity be
+hereditary or not; and much has been said on both sides of this question.
+Great ingenuity has been exerted to prove that this disease is accidental,
+or that there are sufficient causes to account for its occurrence, without
+supposing it one of those calamities that "_flesh is heir to_." It has
+been argued, that, if the disease were hereditary, it ought uniformly to
+be so, and that the offspring of a mad parent should necessarily become
+insane.
+
+All theories and reasonings appear to be good for as much as they prove;
+and if the term _hereditary_ be employed with a degree of strictness, so
+as to denote certain and infallible transmission, such inevitable descent
+cannot be defended. Several instances have come under my observation where
+the children of an insane parent have not hitherto been affected with
+madness, and some have died early in life, without having experienced any
+derangement of mind. More time is therefore required.
+
+All observations concur in acknowledging that there are many circumstances
+in which children resemble their parents. It is very common to see them
+resemble one of their parents in countenance, and when there are several
+children, some shall bear the likeness of the father and others of the
+mother. Children often possess the make and fashion of the body, peculiar
+to one or other of their parents, together with their gait and voice; but
+that which has surprized me most is the resemblance of the hand-writing.
+If a parent had taught his son to write, it might be expected that a
+considerable similarity would be detected; but in general the fact appears
+to be otherwise, for it seldom happens that the scholars, though
+constantly imitating the copy of the master, write at all like him, or
+like each other. In a few instances I have noticed a correct resemblance
+between the hand-writing of the father and son, where the former died
+before the latter had been taught the use of the pen, and who probably
+never saw the hand-writing of his father. The transmission of personal
+deformities is equally curious. I am acquainted with a person in this
+town, whose middle and ring finger are united, and act as one; all the
+children of this man carry the same defect. A toenail, particularly
+twisted, has been traced through three generations, on the same foot and
+toe. Abundant instances might be adduced on this subject; there is
+scarcely a family which cannot produce something in confirmation; and if
+to these circumstances in the human species, were to be added the
+experiments which have been made on the breeding of cattle, perhaps
+little doubt would remain.
+
+The reasoners against the transmission of madness urge, that, if the
+contrary were true, we should by this time have detected the rule or law
+by which nature acts, and that we should have been able to
+determine,--First, whether the disorder descended to the male or female
+children accordingly as the father or mother was affected.--Secondly,
+which of the parents is most capable of transmitting the
+disease?--Thirdly, what alternations in the succession take place, does it
+shift from the male to the female line, and, does it miss a generation,
+and afterwards return?
+
+These, and a multitude of other queries, might be proposed; I believe much
+faster than they could be answered. Nature appears to delight in producing
+new varieties, perhaps less in man than in other animals, and still less
+in the animal than in the vegetable kingdom. Before these subtile
+reasoners expect, from those who maintain that madness generally descends
+from the parent to the offspring, a developement of the laws by which
+Nature acts, it would be convenient first to settle whether in this matter
+she be under the dominion of any law whatever.
+
+The investigation of the hereditary tendency of madness is an object of
+the utmost importance, both in a legal and moral point of view. Parents
+and guardians, in the disposal, or direction of the choice of their
+children in marriage, should be informed, that an alliance with a family,
+where insanity has prevailed, ought to be prohibited.
+
+Having directed some attention to enquiries of this nature, I am enabled
+truly to state, that, where one of the parents have been insane, it is
+more than probable that the offsprings will be similarly affected.
+
+Madness has many colours, and colours have many hues; actual madness is a
+severe calamity, yet experience has pointed out the treatment, and the law
+has permitted the imposition of the necessary restraint: but it very
+frequently occurs that the descendants from an insane stock, although they
+do not exhibit the broad features of madness, shall yet discover
+propensities, equally disqualifying for the purposes of life, and
+destructive of social happiness.
+
+The slighter shades of this disease include eccentricity, low spirits, and
+oftentimes a fatal tendency to immoral habits, notwithstanding the
+inculcation of the most correct precepts, and the force of virtuous
+example.
+
+In illustration of the fact, that the offsprings of insane persons are,
+_ceteris paribus_, more liable to be affected with madness than those
+whose parents have been of sound minds; it was my intention to have
+constructed a table, whereon might be seen the probably direct course of
+this disease, and also its collateral bearings: but difficulties have
+arisen. It appeared, on consideration, improper to attempt precision with
+that which was variable, and as yet unsettled; I have therefore been
+content to select a few histories from my book of notes, and to exhibit
+them in the rude state in which they were set down.
+
+_1st._--R. G. His grandfather was mad, but there was no insanity in his
+grandmother's family. His father was occasionally melancholic, and once
+had a raving paroxysm. His mother's family was sane. His father's brother
+died insane. R. G. has a brother and five sisters; his brother has been
+confined in St. Luke's, and is occasionally in a low spirited state. All
+his sisters have been insane; with the three youngest the disease came on
+after delivery.
+
+_2d._--M. M. Her grandmother was insane and destroyed herself. Her father
+was mad for many years, but after the birth of all his children. M. M. has
+two brothers and a sister; both her brothers have been insane; the sister
+has never been so affected, but was a person of loose character. The
+insanity of M. M. was connected with her menstruation; after its cessation
+she recovered, although she had been confined more than sixteen years.
+
+_3d._--M. H. Her father had been several times insane; her mother was
+likewise so affected a few months before her death. Afterwards her father
+married a woman perfectly sane, by whom he had three children, two female
+and a male; both the females are melancholic, the male was a vicious
+character, and has been transported. M. H. has had ten children, three
+have died with convulsions, the eldest, a girl, is epileptic.
+
+_4th._--T. B. His mother became insane soon after being delivered of him,
+and at intervals has continued so ever since. He has a brother who became
+furiously mad at the age of twenty, and afterwards recovered. T. B.'s
+disorder came on at the age of twenty-six.
+
+_5th._--S. F. Her father's mother was insane, and confined in the
+hospital. Her father never discovered any symptoms of insanity, and her
+mother was perfectly sane. Her only sister (she had no brothers) was mad
+about five years ago, and recovered. S. F. has been twice in the hospital.
+
+_6th._--P. W. After the best enquiries it does not appear that her father
+or mother ever experienced any attack of madness or melancholy. P. W.'s
+disorder commenced shortly after the delivery of a child. She has three
+sisters, the eldest has never been married, and has hitherto continued of
+sound mind. The two younger have been mothers, and in both insanity has
+supervened on childbearing.
+
+_7th._--J. A. H. His father's father was insane, and his father was also
+disordered, and destroyed himself. His mother was of sound mind. J. A. H.
+became insane at the age of twenty-three. He has two sisters, the elder
+has once been confined for insanity, the younger is of weak intellects,
+nearly approaching to ideotism.
+
+_8th._--M. D. Her mother was insane and died so. M. D. continued of sane
+mind until she had attained the age of fifty-seven, when she became
+furiously maniacal; her only daughter, eighteen years of age, was attacked
+with mania during the time her mother was confined.
+
+_9th._--G. F. His mother was melancholic during the time she was pregnant
+with him, and never afterwards completely recovered. She had five children
+previously to this melancholic attack, who have hitherto continued of
+sound mind. She bore another son after G. F. who is extremely flighty and
+unmanageable. G. F. was attacked with madness at the age of nineteen, and
+died apoplectic, from the violence and continued fury of his disorder.
+
+_10th._--M. T. Her mother was of sound mind. Her father was in a
+melancholic state for two years, before she was born, but this was
+afterwards dissipated by active employment. M. T. has two brothers,
+younger than herself, who have been attacked with insanity, neither of
+whom have recovered. She has two sisters, some years older than herself,
+these have never been deranged. M. T. has had nine children. The three
+first have been melancholic. The youngest, at the age of five years, used
+to imagine she saw persons in the room covered with blood, and other
+horrible objects, she afterwards became epileptic and died. The youngest
+of her three first children has been married and had three children, one
+of whom is afflicted with chorea Sancti Viti, and another is nearly an
+ideot.
+
+Of the causes termed moral, the greatest number may, perhaps, be traced to
+the errors of education, which often plant in the youthful mind those
+seeds of madness which the slightest circumstances readily awaken into
+growth.
+
+It should be as much the object of the teachers of youth, to subjugate the
+passions, as to discipline the intellect. The tender mind should be
+prepared to expect the natural and certain effects of causes: its
+propensity to indulge an avaricious thirst for that which is unattainable,
+should be quenched: nor should it be suffered to acquire a fixed and
+invincible attachment to that which is fleeting and perishable.
+
+Of the more immediate, or, as it is generally termed, the proximate cause
+of this disease, I profess to know nothing. Whenever the functions of the
+brain shall be fully understood, and the use of its different parts
+ascertained, we may then be enabled to judge, how far disease, attacking
+any of these parts, may increase, diminish, or otherwise alter its
+functions. But this is a degree of knowledge, which we are not likely soon
+to attain. It seems, however, not improbable, that the only source, from
+whence the most copious and certain information can be drawn, is a strict
+attention to the particular appearances which morbid states of this organ
+may present.
+
+From the preceding dissections of insane persons, it may be inferred, that
+madness has always been connected with disease of the brain and of its
+membranes. Having no particular theory to build up, they have been related
+purely for the advancement of science and of truth.
+
+It may be a matter, affording much diversity of opinion, whether these
+morbid appearances of the brain be the cause or the effect of madness: it
+may be observed that they have been found in all states of the disease.
+When the brain has been injured from external violence, its functions have
+been generally impaired, if inflammation of its substance, or more
+delicate membranes has ensued. The same appearances have for the most part
+been detected, when patients have died of phrenitis, or in the delirium of
+fever: in these instances, the derangement of the intellectual functions
+appears evidently to have been caused by the inflammation. If in mania the
+same appearances be found, there will be no necessity of calling in the
+aid of other causes, to account for the effect: indeed, it would be
+difficult to discover them.
+
+Those who entertain an opposite opinion are obliged to suppose, _a disease
+of the mind_. Such a morbid affection, from the limited nature of my
+powers, perhaps I have never been able to conceive. Possessing, however,
+little knowledge of metaphysical controversy, I shall only offer a few
+remarks upon this part of the subject, and beg pardon for having at all
+touched it.
+
+Perhaps it is not more difficult to suppose, that matter, peculiarly
+arranged, may _think_,[17] than to conceive the union of an immaterial
+being with a corporeal substance. It is questioning the infinite wisdom
+and power of the Deity to say, that he does not, or cannot, arrange matter
+so that it shall think. When we find insanity, as far as has been hitherto
+observed, uniformly accompanied with disease of the brain, is it not more
+just to conclude, that such organic affection has produced this incorrect
+association of ideas, than that a being, which is immaterial,
+incorruptible, and immortal, should be subject to the gross and
+subordinate changes which matter necessarily undergoes?
+
+But let us imagine _a disease of ideas_. In what manner are we to effect a
+cure? To this subtle spirit the doctor can apply no medicines. Though so
+refined as to elude the force of material remedies, some may however think
+that it may be reasoned with. The good effects which have resulted from
+exhibiting logic as a remedy for madness, must be sufficiently known to
+every one who has conversed with insane persons, and must be considered as
+time very judiciously employed: speaking more gravely, it will readily be
+acknowledged, by persons acquainted with this disease, that, if insanity
+be a disease of ideas, we can possess no corporeal remedies for it: and
+that an endeavour to convince madmen of their errors, by reasoning, is
+folly in those who attempt it, since there is always in madness the
+firmest conviction of the truth of what is false, and which the clearest
+and most circumstantial evidence cannot remove.
+
+
+
+
+CHAP. VI.
+
+ON THE PROBABLE EVENT OF THE DISEASE.
+
+
+The prediction of the event, in cases of insanity, must be the result of
+accurate and extensive experience; and even then it will probably be a
+matter of very great uncertainty. The practitioner can only be led to
+suppose, that patients, of a particular description, will recover, from
+knowing that, under the same circumstances, a certain number have been
+actually restored to sanity of intellect.
+
+The practice of an individual, however active and industrious he may be,
+is insufficient to accumulate a stock of facts, necessary to form the
+ground of a regular and correct prognosis: it is therefore to be wished,
+that those, who exclusively confine themselves to this department of the
+profession, would occasionally communicate to the world the result of
+their observations.
+
+Physicians, attending generally to diseases, have not been reserved, in
+imparting to the public the amount of their labours and success: but, with
+regard to this disorder, those, who have devoted their whole attention to
+its treatment, have either been negligent, or cautious of giving
+information respecting it. Whenever the powers of the mind are
+concentrated to one object, we may naturally expect a more rapid progress
+in the attainment of knowledge: we have therefore only to lament the want
+of observations upon this subject, and endeavour to repair it.
+
+The records of Bethlem Hospital have afforded me some satisfactory
+information, though far from the whole of what I wished to obtain. From
+them, and my own observations, the prognosis of this disease is, with
+great diffidence, submitted to the reader.
+
+In our own climate, women are more frequently afflicted with insanity than
+men. Several persons, who superintend private mad-houses, have assured me,
+that the number of females brought in annually, considerably exceeds that
+of the males. From the year 1748 to 1794, comprizing a period of forty-six
+years, there have been admitted into Bethlem Hospital, 4832 women, and
+4042 men.
+
+The natural processes, which women undergo, of menstruation, parturition,
+and of preparing nutriment for the infant, together with the diseases, to
+which they are subject at these periods, and which are frequently remote
+causes of insanity, may, perhaps, serve to explain their greater
+disposition to this malady. As to the proportion in which they recover,
+compared with males, it may be stated, that of 4832 women affected, 1402
+were discharged cured; and that, of the 4042 men, 1155 recovered. It is
+proper here to mention, that, in general, we know but little of what
+becomes of those who are discharged; a certain number of those cured,
+occasionally relapse, and some of those, who are discharged uncured,
+afterwards recover: perhaps in the majority of instances where they
+relapse, they are sent back to Bethlem. To give some idea of the number,
+so re-admitted, it may be mentioned, that, during the last two years,[18]
+there have been admitted 389 patients, 53 of whom had at some former time
+been in the house. There are so many circumstances, which, supposing they
+did relapse, might prevent them from returning, that it can only be stated
+with certainty, that within twelve months, the time allowed as a trial of
+cure, so many have been discharged perfectly well.
+
+To shew how frequently insanity supervenes on parturition, it may be
+remarked, that from the year 1784 to 1794 inclusive, 80 patients have been
+admitted, whose disorder shortly followed the puerperal state. Women
+affected from this cause, recover in a larger proportion than patients of
+any other description of the same age. Of these 80, 50 have perfectly
+recovered. The first symptoms of the approach of this disease after
+delivery, are want of sleep; the countenance becomes flushed; a
+constrictive pain is often felt in the head; the eyes assume a morbid
+lustre, and wildly glance at objects in rapid succession; the milk is
+afterwards secreted in less quantity; and when the mind becomes more
+violently disordered, it is totally suppressed. Where the disease is
+hereditary, parturition very frequently becomes an exciting cause.
+
+From whatever cause this disease may be produced in women, it is
+considered as very unfavourable to recovery, if they should be worse at
+the period of menstruation, or have their catamenia in very small or
+immoderate quantities.
+
+A few cases have occurred where the disease, being connected with
+menstruation, and having continued many years, has completely disappeared
+on the cessation of the uterine discharge.
+
+At the first attack of this disease, and for some months afterwards,
+during its continuance, females most commonly labour under amenorrhoea.
+The natural and healthy return of this discharge generally precedes
+convalescence.
+
+From the following statement it will be seen, that insane persons recover
+in proportion to their youth, and that as they advance in years, the
+disease is less frequently cured. It comprizes a period of about ten
+years, viz. from 1784 to 1794. In the first column the age is noticed; in
+the second, the number of patients admitted; the third contains the number
+cured; the fourth, those who were discharged not cured.
+
+                   _Number         _Number         _Number
+  _Age between_    admitted._     discharged      discharged
+                                    cured._        uncured._
+
+  10 and 20           113             78              35
+  20 and 30           488            200             288
+  30 and 40           527            180             347
+  40 and 50           362             87             275
+  50 and 60           143             25             118
+  60 and 70            31              4              27
+                  -------        -------         -------
+               Total 1664      Total 574      Total 1090
+                  -------        -------         -------
+
+From this table it will be seen, that when the disease attacks persons
+advanced in life, the prospect of recovery is but small.
+
+I am led to conclude, from the very rare instances of complete cure, or
+durable amendment, among the class of patients deemed incurable, as well
+as from the infrequent recovery of those who have been admitted, after the
+disorder has been of more than twelve months standing, that the chance of
+cure is less, in proportion to the length of time which the disorder shall
+have continued.
+
+Although patients, who have been affected with insanity more than a year,
+are not admissible into the hospital, to continue there for the usual time
+of trial for cure, namely, a twelvemonth, yet, at the discretion of the
+committee, they may be received into it, from Lady-day to Michaelmas, at
+which latter period they are removed. In the course of the last twenty
+years seventy-eight patients of this description have been received, of
+whom only one has been discharged cured: this patient, who was a woman,
+has since relapsed twice, and was ultimately sent from the hospital
+uncured.
+
+When the reader contrasts the preceding statement with the account
+recorded in the report of the Committee, appointed to examine the
+Physicians who have attended His Majesty, &c. he will either be inclined
+to deplore the unskilfulness or mismanagement which has prevailed among
+those medical persons who have directed the treatment of mania in the
+largest public institution in this kingdom, of its kind, compared with the
+success which has attended the private practice of an individual; _or to
+require some other evidence, than the bare assertion of the man
+pretending to have performed such cures_.[19]
+
+It was deposed by that reverend and celebrated physician, that of patients
+placed under his care, within three months after the attack of the
+disease, nine out of ten had recovered;[20] and also that the age was of
+no signification, unless the patient had been afflicted before with the
+same malady.[21]
+
+How little soever I might be disposed to doubt such a bold, unprecedented,
+and marvellous account, yet, I must acknowledge, that my mind would have
+been much more satisfied, as to the truth of that assertion, had it been
+plausibly made out, or had the circumstances been otherwise than feebly
+recollected by that very successful practitioner. Medicine has generally
+been esteemed a progressive science, in which its professors have
+confessed themselves indebted to great preparatory study and long
+subsequent experience for the knowledge they have acquired; but, in the
+case to which we are now alluding, the outset of the Doctor's practice was
+marked with such splendid success, that time and observation have been
+unable to increase it.
+
+This astonishing number of cures has been effected by the vigorous agency
+of remedies, which others have not hitherto been so fortunate as to
+discover; by remedies, which, when remote causes have been operating for
+twenty-seven years, such as weighty business, severe exercise, too great
+abstemiousness and little rest, are possessed of adequate power directly
+to _meet and counteract_ such causes.[22]
+
+It will be seen by the preceding table, that a greater number of patients
+have been admitted, between the age of 30 and 40, than during any other
+equal period of life. The same fact also obtains in France, as may be seen
+from the statement of Dr. Pinel, (_Traite Medico-Philosophique sur la
+Manie, p. 109_,) and which, from its agreement with that of Bethlem
+Hospital, is here introduced to the notice of the reader.
+
+  +--------------------------------------------------------------+
+  |Manical       |                                         |     |
+  |Patients      |              AGE BETWEEN                |     |
+  |admitted into |-----------------------------------------|Total|
+  |the Bicetre,  | 15 & | 20 & | 30 & | 40 & | 50 & | 60 & |     |
+  |in the Years  |  20  |  30  |  40  |  50  |  60  |  70  |     |
+  +--------------|------|------|------|------|------|------|-----|
+  |  1784        |   5  |  33  |  31  |  24  |  11  |   6  | 110 |
+  |  1785        |   4  |  39  |  49  |  25  |  14  |   3  | 134 |
+  |  1786        |   4  |  31  |  40  |  32  |  15  |   5  | 127 |
+  |  1787        |  12  |  39  |  41  |  26  |  17  |   7  | 142 |
+  |  1788        |   9  |  43  |  53  |  21  |  18  |   7  | 151 |
+  |  1789        |   6  |  38  |  39  |  33  |  14  |   2  | 132 |
+  |  1790        |   6  |  28  |  34  |  19  |   9  |   7  | 103 |
+  |  1791        |   9  |  26  |  32  |  16  |   7  |   3  |  93 |
+  |  1792        |   6  |  26  |  33  |  18  |  12  |   3  |  98 |
+  |  1793        |   1  |  13  |  13  |   7  |   4  |   2  |  40 |
+  |  1794        |   3  |  23  |  15  |  15  |   9  |   6  |  71 |
+  +--------------------------------------------------------------+
+
+There may be some reasons assigned for the increased proportion of insane
+persons at this age. Although I have made no exact calculation, yet from a
+great number of cases, it appears to be the time when the hereditary
+disposition is most frequently called into action; or, to speak more
+plainly, it is that stage of life, when persons, whose families have been
+insane, are most liable to become mad. If it can be made to appear, that
+at this period persons are more subject to be acted upon by the remote
+causes of the disease, or that a greater number of such causes are then
+applied, we may be able satisfactorily to explain it.
+
+At this age people are generally established in their different
+occupations, are married, and have families; their habits are more
+strongly formed, and the interruptions of them are consequently attended
+with greater anxiety and regret. Under these circumstances, they feel the
+misfortunes of life more exquisitely. Adversity does not depress the
+individual for himself alone, but as involving his partner and his
+offspring in wretchedness and ruin. In youth we feel desirous only of
+present good; at the middle age, we become more provident and anxious for
+the future; the mind assumes a serious character; and religion, as it is
+justly or improperly impressed, imparts comfort, or excites apprehension
+and terror.
+
+By misfortunes the habit of intoxication is readily formed. Those who in
+their youth have shaken off calamity as a slight incumbrance, at the
+middle age feel it corrode and penetrate; and when fermented liquors have
+once dispelled the gloom of despondency, and taught the mind to provoke a
+temporary assemblage of cheerful scenes, or to despise the terror of
+impending misery, it is natural to recur to the same, though destructive
+cause, to re-produce the effect.
+
+Patients, who are in a furious state, recover in a larger proportion than
+those who are depressed and melancholic. An hundred violent, and the same
+number of melancholic cases were selected: of the former, sixty-two were
+discharged well; of the latter, only twenty-seven: subsequent experience
+has confirmed this fact. The same investigation, on the same number of
+persons has been twice instituted, and with results little varying from
+the originally stated proportions. When the furious state is succeeded by
+melancholy, and after this shall have continued a short time, the violent
+paroxysm returns, the chance of recovery is very slight. Indeed, whenever
+these states of the disease frequently change, such alteration may be
+considered as very unfavourable.
+
+After a raving paroxysm of considerable duration, it is a hopeful symptom,
+if the patient become dull, and in a stupid state; inclined to sleep much,
+and feeling a desire of quietude. This appears to be the natural effect of
+that exhaustion, and, if the language be allowable, of that expenditure of
+the sensorial energy, which the continued blaze of furious madness would
+necessarily consume. When they gradually recover from this state there is
+a prospect that the cure will be permanent.
+
+In forming a prognosis of this disease, it is highly important to
+establish a distinction between derangement and decline of intellect: the
+former may frequently be remedied; the latter admits of no assistance from
+our art. Where insanity commences with a loss of mental faculty, and
+gradually proceeds with increasing imbecility, the case may be considered
+hopeless.
+
+When the disorder has been induced from remote physical causes, the
+proportion of those who recover is considerably greater, than where it has
+arisen from causes of a moral nature. In those instances where insanity
+has been produced by a train of unavoidable misfortunes, as where the
+father of a large family, with the most laborious exertions, ineffectually
+struggles to maintain it, the number who recover is very small indeed.
+
+Paralytic affections are a much more frequent cause of insanity than has
+been commonly supposed, and they are also a very common effect of madness;
+more maniacs die of hemiplegia and apoplexy than from any other disease.
+In those affected from this cause, we are, on enquiry, enabled to trace a
+sudden affection, or fit, to have preceded the disease. These patients
+usually bear marks of such affection, independently of their insanity: the
+speech is impeded, and the mouth drawn aside; an arm, or leg, is more or
+less deprived of its capability of being moved by the will: and in most of
+them the memory is particularly impaired. Persons thus disordered are in
+general not at all sensible of being so affected. When so feeble, as
+scarcely to be able to stand, they commonly say that they feel perfectly
+strong, and capable of great exertions. However pitiable these objects may
+be to the feeling spectator, yet it is fortunate for the condition of the
+sufferer, that his pride and pretensions are usually exalted in proportion
+to the degradation of the calamity which afflicts him. None of these
+patients have received any benefit in the hospital; and from the
+enquiries I have been able to make at the private mad-houses, where they
+have been afterwards confined, it has appeared, that they have either died
+suddenly, from apoplexy, or have had repeated fits, from the effects of
+which they have sunk into a stupid state, and gradually dwindled away.
+
+The paralytic require to be kept warm, and to be allowed a more nutritious
+diet and cheering beverage than insane patients of any other description.
+In the winter months they suffer extremely, and ought to be treated as
+hot-house plants. The fare of the workhouse is ungenial to this wretched
+state of existence, and therefore they seldom long continue a burden to
+the parish.
+
+When insanity supervenes on epilepsy, or where the latter disease is
+induced by insanity, a cure is very seldom effected. In two instances I
+have known madness alternate with epilepsy: one, a man about forty-eight
+years of age, was a pauper in the Cripplegate workhouse, where he had been
+kept about three years on account of his epileptic fits, but, becoming
+insane, was admitted into Bethlem Hospital, therein he continued a year,
+without being at all benefited; during that time he had no epileptic fit.
+Being returned to the workhouse, he there recovered his senses in a few
+months, when his epileptic attacks returned, and continued with their
+usual frequency. About two years afterwards he was re-admitted into the
+hospital, his insanity having recurred, and continued there another year
+without experiencing any attack of epilepsy. The other was a young woman,
+who had been epileptic for many years until she became insane, when she
+lost her epileptic fits; these, however, were said to have returned in a
+short time after she had recovered from her insanity.
+
+All authors who have treated this subject appear to agree respecting the
+difficulty of curing religious madness. The infrequent recoveries in this
+species of insanity, have caused thinking persons to suppose, that this
+disorder is little under the dominion of the medical practitioner; and,
+that restoration to reason in all cases is more the effect of accident, or
+of circumstances not "dreamt of in our philosophy," than the result of
+observation, skill, and experience. The idea that RELIGION; that which
+fastens us to the duties of this life; that which expounds the laws of God
+and of his creation to the ignorant; that which administers consolation to
+the afflicted; that which regulates man's conduct towards his fellow
+creatures, to exercise charity among them, and, from such benevolence, to
+purchase happiness to himself: to believe, that the cultivation of such
+exalted sentiments would decoy a human being into madness, is a foolish
+and impious supposition.
+
+      "Thou, fair Religion, wast design'd,
+        Duteous daughter of the skies,
+      To warm and chear the human mind,
+        To make men happy, good, and wise;
+      To point, where sits in love array'd,
+        Attentive to each suppliant call,
+      The God of universal aid,
+        The God, the Father of us all.
+
+  "First shewn by Thee, thus glow'd the gracious scene,
+      'Til Superstition, fiend of woe,
+      Bad doubts to rise and tears to flow,
+  And spread deep shades our view and heaven between."
+                                                  _Penrose._
+
+It is therefore sinful to accuse RELIGION, which preserves the dignity and
+integrity of our intellectual faculty, with being the cause of its
+derangement. The mind becomes refreshed and corroborated by a fair and
+active exercise of its powers directed to proper objects; but when an
+anxious curiosity leads us to unveil that which must ever be shrouded from
+our view, the despair, which always attends those impotent researches,
+will necessarily reduce us to the most calamitous state.
+
+Instituting a generous and tolerant survey of religious opinions, we see
+nothing in the solemn pomp of catholic worship which could disorganize the
+mind; as human beings, they have employed human art to render the
+impression more vivid and durable. The decorous piety, and exemplary life
+of the quaker has signally exempted him from this most severe of human
+infirmities. The established church of this country, of which I am an
+unworthy member, will delude no one, by its terrors, to the brink of
+fatuity: the solid wisdom, rational exposition, and pure charity, which
+flow through the works of Taylor, Barrow, Secker, and Tillotson, will
+inspire their readers with a manly confidence: the most enlightened of our
+species will advance in wisdom and in happiness from their perusal; and
+the simplicity and truth of their comments will be evident to those of
+less cultivated understanding. The pastors of this church are all men of
+liberal education, and many have attained the highest literary character;
+they are therefore eminently qualified to afford instruction. But what can
+be expected, when the most ignorant of our race attempt to inform the
+multitude; when the dregs of society shall assume the garb of sanctity and
+the holy office; and pretend to point out a privy path to heaven, or cozen
+their feeble followers into the belief that they possess a picklock for
+its gates? The difficulty of curing this species of madness will be
+readily explained from the consideration, that the whole of their doctrine
+is a base system of delusion, rivetted on the mind by terror and despair;
+and there is also good reason to suppose, that they frequently contrive,
+by the grace of cordials, to fix the waverings of belief, and thus
+endeavour to dispel the gloom and dejection which these hallucinations
+infallibly excite.
+
+Although the faction of faith will owe me no kindness for the disclosure
+of these opinions, yet it would be ungrateful were I to shrink from the
+avowal of my obligations to methodism[23] for the supply of those numerous
+cases which has constituted my experience of this wretched calamity.
+
+When the natural small-pox attacks insane persons it most commonly proves
+fatal. I was induced to draw this conclusion from consulting the records
+of Bethlem, where I found that few of those who had been sent to the
+Small-pox Hospital recovered; but subsequent experience has enabled me to
+point out this distinction: that those who have been in a furious state
+have generally experienced a fatal termination, and that those who
+recovered had the small-pox when they were in a state of convalescence
+from their insanity.
+
+When patients, during their convalescence, become more corpulent than they
+were before, it is a favourable symptom; and, as far as I have remarked,
+such persons have very seldom relapsed. But it should also be observed,
+that many, who become stupid, and in a state, verging on ideotism, are
+very much disposed to obesity: these cases are not to be remedied.
+
+In proportion as insanity has assumed a systematic character, it become
+more difficult of cure. It ought to be noticed, that this state of
+methodical madness implies, that the disease has been of some continuance;
+and, to use a figurative expression, has been more extensively rooted in
+the mind. Every occurrence is blended with the ruling persuasion, and the
+delusion becomes daily corroborated. As
+
+  --------------"Trifles, light as air,
+  Are to the jealous, confirmations strong
+  As proofs of holy writ;"
+
+so in madness, circumstances wholly unconnected readily support the
+favourite system, and persons the most disinterested are supposed to form
+a part of the conspiracy.
+
+
+
+
+CHAP. VII.
+
+MANAGEMENT.
+
+
+Our own countrymen have acquired the credit of managing insane people with
+superior address; but it does not appear that we have arrogated to
+ourselves any such invidious pre-eminence. Foreigners, who have visited
+the public or private institutions of this country, may, perhaps, in their
+relations, have magnified our skill in the treatment of this disease:
+compared with a great part of the north of Europe, which I have visited,
+we certainly excel.
+
+Whether it be that we have more mad persons in England than in other
+countries, and thereby have derived a greater experience of this
+calamity; or, whether the greater number of receptacles we possess for the
+insane, and the emoluments which have resulted from this species of
+farming, have led persons to speculate more particularly on the nature and
+treatment of this affection, may be difficult to determine. Dr. Pinel[24]
+allows the reputation we have acquired; but, with a laudable curiosity, is
+desirous to understand how we became possessed of it.
+
+"Is it," he says, "from a peculiar national pride, and to display their
+superiority over other nations, that the English boast of their ability in
+curing madness by moral remedies; and at the same time conceal the cunning
+of this art with an impenetrable veil? or, on the contrary, may not that
+which we attribute to a subtile policy, be merely the effect of
+circumstances? and, is it not necessary to distinguish the steps of the
+English empirics from the methods of treatment adopted in their public
+hospitals?
+
+"Whatever solution may be given to these questions, yet, after fifteen
+years diligent enquiry, in order to ascertain some of the leading features
+of this method, from the reports of travellers; the accounts published of
+such establishments; the notices concerning their public and private
+receptacles, which are to be found in the different journals, or in the
+works of their medical writers, I can affirm, that I have never been able
+to discover any development of this English secret for the treatment of
+insanity, though all concur in the ability of their management. Speaking
+of Dr. Willis,[25] it is said, that sweetness and affability seem to
+dwell upon his countenance; but its character changes the moment he looks
+on a patient: the whole of his features suddenly assume a different
+aspect, which enforces respect and attention from the insane. His
+penetrating eye appears to search into their hearts, and arrest their
+thoughts as they arise. Thus he establishes a dominion, which is
+afterwards employed as a principal agent of cure. But, where is the
+elucidation of these general principles to be sought; and, in what manner
+are they to be applied according to the character, varieties, and
+intensity of madness? Is the work of Dr. Arnold otherwise remarkable than
+as a burdensome compilation, or a multiplication of scholastic divisions,
+more calculated to retard than advance the progress of Science? Does Dr.
+Harpur, who announces in his preface, that he has quitted the beaten
+track, fulfil his promise in the course of his work? and is his section on
+mental indications any thing but a prolix commentary on the doctrines of
+the ancients? The adventurous spirit of Dr. Crichton, may justly excite
+admiration, who has published two volumes on maniacal and melancholic
+affections, merely on the authority of some observations drained from a
+German Journal; together with ingenious dissertations on the doctrines of
+modern physiologists, and a view of the moral and physical effects of the
+human passions. Finally, can a mere advertisement of Dr. Fowler's
+establishment for the insane in Scotland, throw any light on the
+particular management of such persons, although it profess the purest and
+most dignified humanity, successfully operating on the moral treatment of
+madness?"
+
+Dr. Pinel is deserving of considerable credit for directing the attention
+of medical men to this very important point of the moral management of the
+insane. I have also heard much of this fascinating power which the mad
+doctor is said to possess over the wayward lunatic; but, from all I have
+observed amongst the eminent practitioners of the present day, who
+exercise this department of the profession, I am led to suspect, that,
+although this influence may have been formerly possessed, and even to the
+extent attributed to the late reverend doctor, it ought now to be lamented
+among the _artes deperditae_. Could the attention of lunatics be fixed, and
+could they be reduced to obedience, by
+
+  "Strong impression and strange powers which lie
+  Within the magic circle of the eye,"
+
+all other kinds of restraint would be superfluous and unnecessarily
+severe. But the fact is notoriously otherwise. Whenever the doctor visits
+a violent or mischievous maniac, however controlling his physiognomy,
+such patient is always secured by the straight waistcoat; and it is,
+moreover, thought expedient to afford him the society of one or more
+keepers.
+
+It has, on some occasions, occurred to me to meet with gentlemen who have
+imagined themselves eminently gifted with this awful imposition of the
+eye, but the result has never been satisfactory; for, although I have
+entertained the fullest confidence of any relation, which such gentlemen
+might afterwards communicate concerning the success of the experiment, I
+have never been able to persuade them to practise this rare talent tete a
+tete with a furious lunatic.
+
+However Dr. Pinel may be satisfied of our superiority in this respect, it
+is but decorous to return the compliment, and if any influence were to be
+gained over maniacal patients by assumed importance, protracted staring,
+or a mimicry of fierceness, I verily believe that such pantomime would be
+much better performed in Paris than in London.
+
+It is to be lamented, that general directions only can be given concerning
+the management of insane persons; the address, which is acquired by
+experience and constant intercourse with maniacs, cannot be communicated;
+it may be learned, but must perish with its possessor. Though man appears
+to be more distinguished from other animals by the capability he has of
+transmitting his acquirements to posterity, than by any other attribute of
+his nature, yet this faculty is deplorably bounded in the finer and more
+enviable offsprings of human attainment. The happy dexterity of the
+artisan, the impressive and delighting powers of the actor,
+
+  "And every charm of gentler eloquence,
+  All perishable--like the electric fire,
+  But strike the frame, and, as they strike, expire."
+
+As most men perceive the faults of others without being aware of their
+own, so insane people easily detect the nonsense of other madmen, without
+being able to discover, or even to be made sensible of the incorrect
+associations of their own ideas. For this reason it is highly important,
+that he who pretends to regulate the conduct of such patients, should
+first have learned the management of himself. It should be the great
+object of the superintendant to gain the confidence of the patient, and to
+awaken in him respect and obedience; but it will readily be seen, that
+such confidence, obedience, and respect, can only be procured by
+superiority of talents, discipline of temper, and dignity of manners.
+Imbecility, misconduct, and empty consequence, although enforced with the
+most tyrannical severity, may excite fear, but this will always be mingled
+with contempt. In speaking of the management of insane persons, it is to
+be understood that the superintendant must first obtain an ascendency over
+them. When this is once effected, he will be enabled, on future occasions,
+to direct and regulate their conduct, according as his better judgment may
+suggest. He should possess firmness, and, when occasion may require,
+should exercise his authority in a peremptory manner. He should never
+threaten but execute; and when the patient has misbehaved, should confine
+him immediately. As example operates more forcibly than precept, I have
+found it useful, to order the delinquent to be confined in the presence of
+the other patients. It displays authority; and the person who has
+misbehaved becomes awed by the spectators, and more readily submits. It
+also prevents the wanton exercise of force, and those cruel and unmanly
+advantages which might be taken when the patient and keeper are shut up in
+a private room. When the patient is a powerful man, two or more should
+assist in securing him: by these means it will be easily effected; for,
+where the force of the contending persons is nearly equal, the mastery
+cannot be obtained without difficulty and danger.
+
+When the patient is in a furious state, and uncontrolable by kindness and
+persuasion, he will generally endeavour, by any means, to do as much
+mischief as possible to the person who opposes him; and instances are not
+rare where he has overcome the keeper. When the maniac finds his strength,
+or skill in the contest prevail, he is sure to make the most of such
+advantage, and the consequence of his victory has sometimes proved fatal
+to the keeper. On the other hand, it ought to be the object of the keeper
+to subdue the maniac without doing him any personal injury; and after he
+has overpowered, to confine him, and thus prevent him from attempting any
+further mischief. When the patient is a strong man, and highly irritated,
+it will be impossible for any keeper singly to overcome him without his
+most forcible exertions, and these cannot be put forth without great
+violence to the patient. But subduing the maniac, is not the only object,
+he must afterwards be secured by the straight-waistcoat, or by manacles.
+It will be seen, that the keeper, who, by the great exertion of his bodily
+powers, has become faint and exhausted, will be very little in a condition
+to secure the patient, as his hands must be employed with the implements
+necessary to confine him; moreover, the patient will have additional
+strength from the temperate manner, in which he is made to live; whereas,
+it is but too common, for the keeper to indulge in a diet and beverage,
+which induce corpulence and difficulty of breathing.[26]
+
+As management is employed to produce a salutary change upon the patient,
+and to restrain him from committing violence on others and himself; it may
+here be proper to enquire, upon what occasions, and to what extent,
+coercion may be used. The term coercion has been understood in a very
+formidable sense, and not without reason. It has been recommended by very
+high medical authority to inflict corporal punishment upon maniacs, with a
+view of rendering them rational, by impressing terror.[27] From Dr. Mead's
+section on madness it would appear, that in his time flagellation was a
+common remedy for this disorder. "There is no disease more to be dreaded
+than madness. For what greater unhappiness can befal a man, than to be
+deprived of his reason and understanding, to attack his fellow creatures
+with fury, like a wild beast; to be tied down, _and even beat_, to
+prevent his doing mischief to himself or others."--_Medical Precepts and
+Cautions, page 74._
+
+Dramatic writers abound with allusions to the whip, in the treatment of
+madness. "Love is meerely a madnesse, and I tel you, deserves as well a
+darke house, and a whip, as madmen do: and the reason why they are not so
+punish'd and cured, is, that the Lunacie is so ordinary, that the whippers
+are in love too."--_As You Like It, act III. scene 2._
+
+Another instance to the same effect may be found in Mr. Dennis's comedy of
+Jacobite Credulity. "_Bull Junior._ Look you, old gentleman, I will touch
+this matter as gently as I can to you. Your friends taking notice, that
+you were grown something foolish, whimsical, absurd, and so forth, thought
+fit to have you sent to the College here, [Bedlam] that you might go
+through a course of philosophy, and be cudgel'd and firk'd into a little
+wisdom, by the surly Professors of this place."--_Select Works, vol. ii.
+p. 363._ And again, in the next page; "If thou canst give but so much as a
+reasonable answer to any thing; if thou either knowest what thou art, or
+where thou art, or with whom thou art, then will I be contented to be
+thought mad, and dieted and flogged in thy stead."
+
+It also appears from Mr. Douce's valuable dissertation, that the
+domesticated fool frequently underwent a similar castigation, to curb the
+licentiousness of his discourse, or, as a punishment for the obscenity of
+his actions. Indeed this system of corporal chastisement seems to have
+been general, and may afford some apology for introducing, from a very
+rare little book, an account of the manner of treating this malady in
+Constantinople, about the middle of the 16th century.[28]
+
+"_Of a place called Timarahane for the Correction of the Insane._
+
+"The sultan Bajazet caused a building to be erected for the reception of
+insane persons, in order, that they might not wander about the city, and
+there exhibit their mad pranks. This building is constructed in the manner
+of an hospital: there are about an hundred and fifty keepers appointed to
+look after them; they are likewise furnished with medicines and other
+necessary articles. These keepers, armed with cudgels, patrole the city in
+search of the insane; and when they discover such, they secure them by the
+neck and hands with an iron chain, and, by dint of the cudgel, convey them
+to Timarahane. On entering this place, they are confined by the neck, with
+a much larger chain, which is fixed into the wall, and comes over their
+bed place, so that they are kept chained in their beds. In general, about
+forty are confined there, at some distance from each other.
+
+"They are frequently visited by the people of the city, as a species of
+amusement. The keepers constantly stand over them with cudgels; for, if
+left to themselves, they would spoil and destroy their beds and hurl the
+tables at each other. At the times of giving them food, the keepers
+examine them, and, if they notice any, who are disorderly, they beat them
+severely; but, if they should by accident, find any, who no longer exhibit
+symptoms of insanity, they treat them with greater regard."
+
+What success may have followed such disgraceful and inhuman treatment, I
+have not yet learned; nor should I be desirous of meeting with any one,
+who could give me the information.
+
+If the patient be so far deprived of understanding, as to be insensible
+why he is punished, such correction, setting aside its cruelty, is
+manifestly absurd: and, if his state be such, as to be conscious of the
+impropriety of his conduct, there are other methods more mild and
+effectual. Would any rational practitioner, in a case of phrenitis, or in
+the delirium of fever, order his patient to be scourged? he would rather
+suppose, that the brain, or its membranes, were inflamed, and that the
+incoherence of discourse and violence of action were produced by such
+local disease. It has been shewn by the preceding dissections, that the
+contents of the cranium, in all the instances that have occurred to me,
+have been in a morbid state. It should, therefore, be the object of the
+practitioner, to remove such disease, rather than irritate and torment the
+sufferer.--Coercion should only be considered as a protecting and salutary
+restraint.
+
+In the most violent state of the disease, the patient should be kept
+alone in a dark and quiet room, so that he may not be affected by the
+stimuli of light or sound, such abstraction more readily disposing to
+sleep. As in this violent state there is a strong propensity to associate
+ideas, it is particularly important to prevent the accession of such as
+might be transmitted through the medium of the senses. The hands should be
+properly secured, and the patient should also be confined by one leg; this
+will prevent him from committing any violence. The more effectual and
+convenient mode of confining the hands is by metallic manacles; for,
+should the patient, as frequently occurs, be constantly endeavouring to
+liberate himself, the friction of the skin against a polished metallic
+body may be long sustained without injury; whereas excoriation shortly
+takes place when the surface is rubbed with linen or cotton. Ligatures
+should on all occasions be avoided. The straight waistcoat is admirably
+calculated to prevent patients from doing mischief to themselves; but in
+the furious state, and particularly in warm weather, it irritates, and
+increases that restlessness which patients of this description usually
+labour under. They then disdain the incumbrance of clothing, and seem to
+delight in exposing their bodies to the atmosphere. Where the patient is
+in a condition to be sensible of restraint, he may be punished for
+improper behaviour, by confining him to his room, by degrading him, and
+not allowing him to associate with the convalescents, and by withholding
+certain indulgences, he had been accustomed to enjoy.
+
+In speaking of coercion, I cannot avoid reprobating a practice, which has
+prevailed in some private receptacles for the insane, but which, it is
+presumed, will henceforward be discontinued. I mean, the practice of
+half-stifling a noisy patient, by placing a pillow before the mouth, and
+forcibly pressing upon it, so as to stop respiration. It is unnecessary to
+enquire, how such wanton cruelty came to be introduced; it must have been
+the suggestion of ignorance, and the perpetration of savageness and
+brutality. Sighs, tears, sobs, and exclamations, are the unaffected
+language of passion, and come kindly to our relief, in states of sorrow
+and alarm. Indeed, they appear to be the natural remedies, to
+
+  "Cleanse the stufft bosom of that perillous stuffe,
+  Which weighs upon the heart."
+
+The mild and rational practice of Bethlem Hospital, tolerates these
+involuntary ejaculations. It is there considered, that a noisy and
+loquacious maniac, has not the power to control his utterance of sounds,
+which, from the habitual connexion between ideas and speech, must
+necessarily follow. It is there only viewed as a symptom, or part of the
+disorder; and that, if the cause cannot be suppressed, the effect should
+not be punished.
+
+As madmen frequently entertain very high, and even romantic notions of
+honour, they are often rendered much more tractable by wounding their
+pride, than by severity of discipline.
+
+Speaking of the effects of management, on a very extensive scale, I can
+truly declare, that by gentleness of manner, and kindness of treatment, I
+have seldom failed to obtain the confidence, and conciliate the esteem of
+insane persons, and have succeeded by these means in procuring from them
+respect and obedience. There are certainly some patients who are not to
+be trusted, and in whom malevolence forms the prominent feature of their
+character: such persons should always be kept under a certain restraint,
+but this is not incompatible with kindness and humanity.
+
+It would, in this part of the work, be particularly gratifying to my
+feelings if I could develope this _English secret_ for the moral
+management of the insane, which has been so ardently, yet unsuccessfully
+sought after by Dr. Pinel. For fourteen years I have been daily in the
+habit of visiting a very considerable number of madmen, and of mixing
+indiscriminately among them, without ever having received a blow or
+personal insult. During this time I have always gone alone, and have never
+found the necessity for the assistance or protection of a keeper. The
+superintendant of the Bicetre, according to Dr. Pinel's account, is
+usually attended by his keepers, [gens de service] though he is said to
+possess[29] "une fermete inebranlable, un courage raisonne et soutenu par
+des qualites physiques les plus propres a imposer, une stature de corps
+bien proportionnee, des membres pleins de force et de vigeur, et dans des
+momens orageux le ton de voix le plus foudroyant, la contenance la plus
+fiere et la plus intrepide." Not being myself endowed with any of these
+rare qualities; carrying no thunder in my voice, nor lightning in my eye,
+it has been requisite for me to have recourse to other expedients. In the
+first place, it has been thought proper to devote some time and attention
+to discover the character of the patient, and to ascertain wherein, and on
+what points, his insanity consists: it is also important to learn the
+history of his disorder, from his relatives and friends, and to enquire
+particularly respecting any violence he may have attempted towards himself
+or others.
+
+In holding conferences with patients in order to discover their insanity,
+no advantage has ever been derived from assuming a magisterial importance,
+or by endeavouring to stare them out of countenance: a mildness of manner
+and expression, an attention to their narrative, and seeming acquiescence
+in its truth, succeed much better. By such conduct they acquire confidence
+in the practitioner; and if he will have patience, and not too frequently
+interrupt them, they will soon satisfy his mind as to the derangement of
+their intellects.
+
+When a patient is admitted into Bethlem Hospital, if he be sufficiently
+rational to profit by such tuition, it is explained to him, by the keepers
+and convalescents, that he is to be obedient to the officers of the
+house, and especially to myself, with whom he will have daily intercourse;
+they point out to him, that all proper indulgences will be allowed to good
+behaviour, and that seclusion and coercion instantly succeed to
+disobedience and revolt. As _nemo repente turpissimus_, so no one in an
+instant, from a state of tranquillity, becomes furiously mad: the
+precursory symptoms are manifold and successive, and allow of sufficient
+time to secure the patient before mischief ensues; it is principally by
+taking these precautions that our patients are observed to be so orderly
+and obedient. The examples of those who are under strict coercion, being
+constantly in view, operate more forcibly on their minds than any precepts
+which the most consummate wisdom could suggest. In this moral management,
+the co-operation of the convalescents is particularly serviceable; they
+consider themselves in a state of probation, and, in order to be
+liberated, are anxious, by every attention and assistance, to convince the
+superintendants of their restoration to sanity of mind. From mildness of
+treatment, and confidence reposed in them, they become attached, and are
+always disposed to give information concerning any projected mischief.
+
+Considering how much we are the creatures of habit, it might naturally be
+hoped, and experience justifies the expectation, that madmen might be
+benefited by bringing their actions into a system of regularity. It might
+be supposed, that as thought precedes action, that whenever the ideas are
+incoherent, the actions will also be irregular. Most probably they would
+be so, if uncontroled; but custom, confirmed into habit, destroys this
+natural propensity, and renders them correct in their behaviour, though
+they still remain equally depraved in their intellects.
+
+We have a number of patients in Bethlem Hospital, whose ideas are in the
+most disordered state, who yet act, upon ordinary occasions, with great
+steadiness and propriety, and are capable of being trusted to a
+considerable extent. A fact of such importance in the history of the human
+mind, might lead us to hope, that by superinducing different habits of
+thinking, the irregular associations would be corrected.
+
+It is impossible to effect this suddenly, or by reasoning, for madmen can
+never be convinced of the folly of their opinions. Their belief in them is
+firmly fixed, and cannot be shaken. The more frequently these opinions are
+recurred to, under a conviction of their truth, the deeper they subside in
+the mind, and become more obstinately entangled:[30] the object should
+therefore be to prevent such recurrence by occupying the mind on different
+subjects, and thus diverting it from the favorite and accustomed train of
+ideas.
+
+As I have been induced to suppose, from the appearances on dissection,
+that the immediate cause of this disease probably consists in a morbid
+affection of the brain, it may be inferred, that all modes of cure by
+reasoning, or conducting the current of thought into different channels,
+must be ineffectual, so long as such local disease shall continue. It is,
+however, likely that insanity is often continued by habit; that incoherent
+associations, frequently recurred to, become received as truths, in the
+same manner as a tale, which, although untrue, by being repeatedly told,
+shall be credited at last by the narrator, as if it had certainly
+happened. It should likewise be observed, that these incorrect
+associations of ideas are acquired in the same way as just ones are
+formed, and that such are as likely to remain as the most accurate
+opinions. The generality of minds are very little capable of tracing the
+origin of their ideas; there are many opinions we are in possession of,
+with the history and acquisition of which, we are totally unacquainted. We
+see this in a remarkable manner in patients who are recovering from their
+insanity: they will often say such appearances have been presented to my
+mind, with all the force and reality of truth: I saw them as plainly as I
+now behold any other object, and can hardly be persuaded that they did not
+occur. It also does not unfrequently happen, that patients will declare,
+that certain notions are forced into their minds, of which they see the
+folly and incongruity, and yet complain that they cannot prevent their
+intrusion.
+
+As the patient should be taught to view the medical superintendant as a
+superior person, the latter should be particularly cautious never to
+deceive him. Madmen are generally more hurt at deception than punishment;
+and, whenever they detect the imposition, never fail to lose that
+confidence and respect which they ought to entertain for the person who
+governs them.
+
+In the moral management of the insane, this circumstance cannot be too
+strongly impressed on the mind of the practitioner: and those persons, who
+have had the greatest experience in this department of medical science,
+concur in this opinion. The late Dr. John Monro expressly says, "The
+physician should never deceive them in _any_ thing, but more especially
+with regard to their distemper; for as they are generally conscious of it
+themselves, they acquire a kind of reverence for those who know it; and by
+letting them see, that he is thoroughly acquainted with their complaint,
+he may very often gain such an ascendant over them, that they will readily
+follow his directions."[31]
+
+Very different directions are, however, issued by a late writer,[32] and
+which, on account of their novelty, contrivance, and singular morality,
+deserve the consideration of the reader.
+
+"The _conscientious physician_, in the execution of his duty, attempting
+the removal of these deplorable maladies, is under the necessity of
+occasionally deviating from the accustomed routine of practice, of
+stepping out of the beaten track, and, in some cases, that have resisted
+the usual methods, is warranted in adopting any others, that have _only_
+the slightest _plausibility_, or that promise the smallest hope of
+success. Thus, the employment of what may be termed _pious frauds_: as
+when _one_ simple erroneous idea stamps the character of the disease,
+depriving the affected party of the common enjoyments of society, though
+capable of reasoning with propriety, perhaps, with ingenuity, on every
+subject, not connected with that of his hallucination, the correction of
+which has resisted our very best exertions, and, where there is no obvious
+corporeal indisposition, it certainly is allowable to try the effect of
+certain deceptions, contrived to make strong impressions on the senses,
+by means of _unexpected_, _unusual_, _striking_, or apparently
+_supernatural_ agents; such as after waking the party from sleep, either
+suddenly or by a gradual process, by _imitated thunder_, or soft music,
+according to the peculiarity of the case; _combating_ the erroneous
+deranged notion, either by some _pointed sentence_, or signs _executed in
+phosphorus_ upon the wall of the bed chamber; or by some _tale_,
+_assertion_, or _reasoning_; by one in the character of an _angel_,
+_prophet_, or _devil_: but the actor in this drama must possess much
+_skill, and be very perfect in his part_."
+
+It is of great service to establish a system of regularity in the actions
+of insane people. They should be made to rise, take exercise, and food, at
+stated times. Independently of such regularity contributing to health, it
+also renders them much more easily manageable.
+
+Concerning their diet, it is merely necessary to observe, that it should
+be light, and easy of digestion. The proper quantity must be directed by
+the good sense of the superintendant, according to the age and vigour of
+the patient, and proportioned to the degree of bodily exercise he may be
+in the habit of using; "but they should never be suffered to live too low,
+especially while they are under a course of physic."[33] To my knowledge,
+no experiments have yet been instituted respecting the diet of insane
+persons: they have never been compelled to live entirely on farinaceous
+substances. The diet of Bethlem Hospital allows animal food three times a
+week, and on the other days bread with cheese, or occasionally butter,
+together with milk pottage, rice milk, &c. Those who are regarded as
+incurable patients ought certainly to be indulged in a greater latitude
+of diet, but this should never be permitted to border on intemperance. To
+those who are in circumstances to afford such comforts, wine may be
+allowed in moderation, and the criterion of the proper quantity, will be
+that which does not affect the temper of the lunatic, that which does not
+exasperate his aversions, or render his philosophy obtrusive. Although it
+seems rational in all states of madness, that temperance should be
+strictly enjoined, yet an author of the present day[34] steps out of the
+trodden path, and seriously advises us, in difficult cases, to drown
+lunacy in intoxication; and, strange as it may appear, has taught us to
+await the feast of Reason from the orgies of Bacchus. "The conversion of
+religious melancholy into furious madness is a frequent occurrence, and is
+generally followed by recovery. This has suggested the _propriety_, in
+some cases that have resisted more common means, of producing a degree of
+excitement by means of stimuli, in fact, _keeping the patient for days in
+succession in a state of intoxication_, which has often occasioned an
+alleviation of symptoms, and sometimes _restored the sufferers to
+reason_."
+
+Confinement is always necessary in cases of insanity, and should be
+enforced as early in the disease as possible. By confinement, it is to be
+understood that the patient should be removed from home. During his
+continuance at his own house he can never be kept in a tranquil state. The
+interruptions of his family, the loss of the accustomed obedience of his
+servants, and the idea of being under restraint, in a place where he
+considers himself the master, will be constant sources of irritation to
+his mind. It is also known, from considerable experience, that of those
+patients who have remained under the immediate care of their relatives and
+friends, very few have recovered. Even the visits of their friends, when
+they are violently disordered, are productive of great inconvenience, as
+they are always more unquiet and ungovernable for some time afterwards. It
+is a well-known fact, that they are less disposed to acquire a dislike to
+those who are strangers, than to those with whom they have been intimately
+acquainted; they become therefore less dangerous, and are more easily
+restrained. It ought to be understood that no interruption to this
+discipline should defeat its salutary operation. On this account more
+patients recover in a public hospital, than in a private house,
+appropriated for the reception of lunatics. In the former, the
+superintendants persist in a plan laid down, and seldom deviate from
+their established rules: such asylum being a place of charitable relief,
+they are indifferent about pleasing the friends and relatives of the
+patient, who cannot there intrude to visit them at their option. In a
+private receptacle emolument is the first object, and however wisely they
+may have formed their regulations, they soon feel themselves subordinate
+to the caprice and authority of those by whom they are paid.
+
+It frequently happens, that patients who have been brought immediately
+from their families, and who were said to be in a violent and ferocious
+state at home, become suddenly calm and tractable when placed in the
+hospital. On the other hand it is equally certain, that there are many
+patients whose disorder speedily recurs after having been suffered to
+return to their families, although they have for a length of time
+conducted themselves, under confinement, in a very orderly manner. When
+they are in a convalescent state the occasional visits of their friends
+are attended with manifest advantage. Such an intercourse imparts
+consolation, and presents views of future happiness and comfort. But
+certain restrictions should be imposed on the visits of these friends;
+ignorant people often, after a few minutes conversation with the patient,
+will suppose him perfectly recovered, and acquaint him with their opinion:
+this induces him to suppose that he is well, and he frequently becomes
+impatient of confinement and restraint. From such improper intercourse I
+have known many patients relapse, and in two instances I have a
+well-founded suspicion that it excited attempts at suicide.
+
+Many patients have received considerable benefit by change of situation,
+which occupies the mind with new objects, and this sometimes takes place
+very shortly after the removal.
+
+  "Haply the Seas and Countries different
+  With variable objects, shall expell
+  This something setled matter in his heart:
+  Whereon his Braines still beating, puts him thus
+  From fashion of himselfe."
+
+In what particular cases, or stages of the disease, this may be
+recommended, I am not enabled, by sufficient experience, to determine.
+
+
+
+
+CHAP. VIII.
+
+REMEDIES FOR INSANITY.
+
+
+_Bleeding._
+
+Where the patient is strong, and of a plethoric habit, and where the
+disorder has not been of any long continuance, bleeding has been found of
+considerable advantage, and as far as I have yet observed, is the most
+beneficial remedy that has been employed. The melancholic cases have been
+equally relieved with the maniacal by this mode of treatment. Venesection
+by the arm is, however, inferior in its good effects to blood taken from
+the head by cupping. This operation, performed in the manner to which I
+have been accustomed, consists in having the head previously shaven, and
+six or eight cupping glasses applied on the scalp. By these means any
+quantity of blood may be taken, and in as short a time, as by an orifice
+made in a vein by the lancet. When the raving paroxysm has continued for a
+considerable time, and the scalp has become unusually flaccid; or where a
+stupid state has succeeded to violence of considerable duration, no
+benefit has been derived from bleeding: indeed these states are generally
+attended by a degree of bodily weakness, sufficient to prohibit such
+practice independently of other considerations.
+
+The quantity of blood to be taken, must be left to the discretion of the
+practitioner: from eight to sixteen ounces may be drawn, and the
+operation occasionally repeated, as circumstances may require.
+
+In some cases where blood was drawn at the commencement of the disease
+from the arm, and from patients who were extremely furious and
+ungovernable, it was covered with a buffy coat; but in other cases it has
+seldom or never such an appearance. In more than two hundred patients,
+male and female, who were let blood by venesection, there were only six
+whose blood could be termed sizy.
+
+In some few instances hemoptysis has preceded convalescence, as has also a
+bleeding from the hemorrhoidal veins. Epistaxis has not, to my knowledge,
+ever occurred.
+
+Before particular remedies, to be employed for the cure of mania and
+melancholia, are recommended, it may be necessary to give some directions
+concerning the means to be used for their certain administration.
+
+Maniacs in general feel a great aversion to become benefited from those
+medicinal preparations which practitioners employ for their relief; and on
+many occasions they refuse them altogether. Presuming that some good is to
+be procured by the operation of medicines on persons so affected, and
+aware of their propensity to reject them, it becomes a proper object of
+enquiry how such salutary agents may most securely, and with the least
+disadvantage, be conveyed into the stomachs of these refractory subjects.
+For the attainment of this end various instruments have been contrived,
+but that which has been more frequently employed, and is the most
+destructive and devilish engine of this set of apparatus, is termed a
+_spouting_ boat. It will not be necessary to fatigue the reader with a
+particular description of this coarse tool, except to remark, that it is
+constructed somewhat like a child's pap boat; and is intended to force an
+entrance into the mouth through the barriers of the teeth.[35]
+
+In those cases, where patients have been obstinately bent on starving
+themselves, or where they have become determined to resist the
+introduction of remedies calculated for their relief, I have always been
+enabled to convey both into their stomachs, at any time, and in any
+quantity that might be necessary, by the employment of an instrument, of
+which the figure and dimensions are here given.
+
+[Illustration]
+
+Since the use of this very simple and efficient instrument, which I
+constructed about twelve years ago, I can truly affirm, that no patient
+has ever been deprived of a tooth, and that the food or remedy has always
+been conveyed into the stomach of the patient.
+
+The manner in which this compulsory operation is performed, consists in
+placing the head of the patient between the knees of the person who is to
+use the instrument: a second assistant secures the hands, (if the
+straight-waistcoat be not employed) and a third keeps down the legs. As
+soon as the mouth is opened, the instrument may be introduced; it presses
+down the tongue, and keeps the jaws sufficiently asunder to admit of the
+introduction of the medicine, which should be contained in a vial, or tin
+pot with a spout, to allow it to run in a small stream. The nose of the
+patient being held by the left hand of the person who uses the
+instrument, a small quantity of the medicine is to be poured into the
+mouth, and when deglutition has commenced, is to be repeated, so as to
+continue the act of swallowing until the whole be taken.
+
+A little address will obviate the determination of the patient to keep his
+teeth closed: he may be blindfolded at the commencement, which never fails
+to alarm him, and urges him to enquire what the persons around him are
+about: causing him to sneeze, by a pinch of snuff, always opens the mouth
+previously to that convulsion, or tickling the nose with a feather
+commonly produces the same effect.
+
+With delicate females, where one or more of the grinder-teeth are wanting,
+the finger may be introduced on the inside of the cheek, which being
+strongly pressed outwards will prevent the patient from biting, and form
+a sufficient cavity to pour in the liquid. With a wish of speaking
+confidently on this subject, I have usually performed the business of
+forcing, more especially amongst the females, and it has, in some degree,
+rewarded my trouble; it has ascertained the practicability of
+administering remedies; and it has also afforded the consolation, that,
+where the means employed have produced no good, the patient has sustained
+no injury.
+
+
+_Purging._
+
+An opinion has long prevailed, that mad people are particularly
+constipated, and likewise extremely difficult to be purged. From all the
+observations I have been able to make, insane patients, on the contrary,
+are of very delicate and irritable bowels, and are well, and copiously
+purged, by a common cathartic draught. That, which has been commonly
+employed at the hospital, was prepared agreeably to the following formula:
+
+  [Precsription] Infusi sennae [ounce] iss ad [ounce] ij
+                 Tincturae sennae [dram] i ad [dram] ij
+                 Syrupi spinae cervinae, [dram] i ad [dram] ij.
+
+but, within the last seven years, the tinctura jalapij has been
+substituted for the tinctura sennae. It is so far an improvement, that it
+operates more speedily, and produces less griping.
+
+This medicine seldom fails of procuring four or five stools, and
+frequently a greater number.
+
+In confirmation of what I have advanced, respecting the irritable state of
+the intestines in mad people, it may be mentioned, that the ordinary
+complaints, with which they are affected, are diarrhoea and dysentery:
+these have heretofore been very violent and obstinate.
+
+Perhaps it may be attributed to superior care that the occurrence of these
+complaints has, of late years, been comparatively rare, contrasted with
+the numbers who were formerly attacked with such diseases; and, when they
+do happen, an improved method of treatment has rendered these intestinal
+affections no longer formidable or fatal.
+
+In those very violent diarrhoeas, which ordinarily terminate in
+dysentery, from five to ten grains of the pilula hydrargyri have been
+given according to the sex, constitution, and nature of the complaint,
+once or twice a day, and with general success.
+
+It may be necessary to add, that it is proper, during the course of this
+mercurial remedy, which shortly arrests the disease, to keep the bowels
+in an open state, by some of the milder purgatives employed every third or
+fourth day.
+
+Diarrhoea very often proves a natural cure of insanity; at least, there
+is sufficient reason to suppose, that such evacuation has very much
+contributed to it. The number of cases, which might be adduced in
+confirmation of this remark, is considerable; and the speedy
+convalescence, after such evacuation, is still more remarkable.
+
+In many cases of insanity there prevails a great degree of insensibility,
+so that patients have scarcely appeared to feel the passing of setons, the
+drawing of blisters, or the punctures of cupping. On many occasions, I
+have known the urine retained for a considerable time, without complaint
+from the patient, although it is well ascertained, that there is no
+affection more painful and distressing than distension of the bladder.
+
+Of this general insensibility the intestinal canal may be supposed to
+partake; but this is not commonly the case; and, if it should frequently
+prevail, would be widely different from a particular and exclusive torpor
+of the primae viae.
+
+But, sometimes, there arises a state of disease in maniacs, where the
+stomach and intestines are particularly inert. The patient refuses to take
+food, and is obstinately constipated: the tongue is foul, and the skin is
+tinged with a yellowish hue: the eyes assume a glossy lustre, and exhibit
+a peculiar wildness. In this state, I have given two drachms of the pulvis
+jalapij for a dose, and which, on some occasions, has procured but one
+stool, so that it has been necessary several times to repeat the same
+quantity. After the bowels have been sufficiently evacuated, the appetite
+commonly returns, and the patient takes food as usual.
+
+Much mischief may be produced, if it be attempted to force food into the
+stomach in such a case, which the ignorance of keepers may attempt,
+supposing it to originate in the obstinacy of the patient. In order to
+continue the bowels in a relaxed state, after they have been sufficiently
+emptied of their contents, the following formula has been employed with
+advantage:
+
+  [Precsription] Infusi sennae, [ounce] vijss
+                 Kali Tartarizati, [ounce] ss
+                 Antimonij Tartarizati, gr 1ss
+                 Tincturae jalapij, [dram] ij
+
+From two to three table spoonsful may be given once or twice a day, as
+occasion may require.
+
+There are some circumstances unconnected with disease of mind, which might
+dispose insane persons to costiveness. I now speak of such as are
+confined, and who come more directly under our observation. When they are
+mischievously disposed they require a greater degree of restraint, and are
+consequently deprived of that air and exercise which so much contribute to
+regularity of bowels. It is well known that those who have been in the
+habits of free living, and who come suddenly to a more temperate diet, are
+very much disposed to costiveness. But to adduce the fairest proof of what
+has been advanced, I can truly state, that incurable patients, who have
+for many years been confined in the Hospital, are subject to no
+inconveniences from constipation. Many patients are averse to food, and
+where little is taken in, the egesta must be inconsiderable.
+
+To return from this digression: it is concluded, from very ample
+experience, that cathartic medicines are of the greatest service, and
+ought to be considered as an indispensable remedy in cases of insanity.
+The good sense and experience of every practitioner must direct him as to
+the dose, and frequency with which these means are to be employed, and of
+the occasions where they would be prejudicial.
+
+
+_Vomiting._
+
+However strongly this practice may have been recommended, and how much
+soever it may at present prevail, I am sorry that it is not in my power to
+speak of it favourably. In many instances, and in some where blood-letting
+had been previously employed, paralytic affections have within a few hours
+supervened on the exhibition of an emetic, more especially where the
+patient has been of a full habit, and has had the appearance of an
+increased determination to the head.
+
+It has been for many years the practice of Bethlem Hospital to administer
+to the curable patients four or five emetics in the spring of the year;
+but, on consulting my book of cases, I have not found that such patients
+have been particularly benefited by the use of this remedy. From one grain
+and half to two grains of tartarized antimony has been the usual dose,
+which has hardly ever failed of procuring full vomiting. In the few
+instances where the plan of exhibiting this medicine in nauseating doses
+was pursued for a considerable time, it by no means answered the
+expectations which had been raised in its favour by very high authority.
+Where the tartarized antimony, given with this intention, operated as a
+purgative, it generally produced beneficial effects.
+
+Ten years have elapsed since the former edition of this work appeared; but
+this length of time, and subsequent observation, have not enabled me to
+place any greater confidence in the operation of emetics, as a cure for
+insanity.
+
+An author[36] who has lately published a work, entitled "_Practical
+Observations on Insanity_," is however a determined fautor of emetics in
+maniacal cases. In his skilful hands they have worked marvellous cures;
+nor have any prejudicial effects ever resulted from their employment.
+Perhaps no one has enjoyed a fairer opportunity of witnessing the effects
+of remedies for insane persons than myself; and when emetics are employed
+in Bethlem Hospital they have the best chance of effecting all the relief
+they are competent to afford, as they are given by themselves, without the
+intervention of other medicines; and this course of emetics usually
+continues six weeks. Had Dr. Cox confined himself to the relation of his
+own victories in combating madness with vomits, it would have been
+sufficient; but he endeavours to raise the levee en masse of medical
+opinion to co-operate with his sentiments. He says, page 78, "Yet _every_
+physician, who has devoted his attention to this branch of the profession,
+_must_ differ from him when he treats of vomiting." It was never my
+intention to deny, in a disordered state of the stomach, that the madman
+would be equally benefited with one in his senses by the operation of a
+vomit: but I have asserted, that after the administration of many thousand
+emetics to persons who were insane, but otherwise in good health, that I
+never saw any benefit derived from their use. It will also be granted,
+that some ascendancy may be gained over a furious maniac by forcing him to
+take a vomit, or any other medicine, but this is widely different from any
+positive advantage resulting from the act of vomiting. Sir John Colebatch,
+in his "_Dissertation concerning Misletoe_," says, _p._ 35, "But I have
+been for some years afraid of giving vomits, even of the gentlest sort, in
+convulsive distempers, from some terrible accidents, that have been likely
+to ensue, from moderate doses of Ipecacuanha itself."
+
+In St. Luke's hospital, the largest public receptacle for insane persons,
+where the medical treatment is directed by a physician of the highest
+character and eminence, and whose experience is, at least, equal to that
+of any professional man in this country, vomits are by no means considered
+as the order of the day; they may be employed to remove symptoms
+concomitant with madness, but are not held as specifics for this disease.
+
+In reading over the cases related by Dr. Cox, there is no one, where
+emetics have been solely employed as agents of cure; they have been always
+linked with other remedies; and it requires more sagacity than even the
+doctor can exact, to pronounce, when different means of cure are combined,
+to which the palm should be adjudged. In the relation of my own experience
+concerning vomiting, as a remedy for insanity, I have had only in view the
+communication of facts, for I entertain neither partiality nor aversion to
+any remedies, beyond the fair claim which their operations possess. Had I
+modestly ventured to state, after the example of the Doctor, "that I had
+_devoted_ myself _exclusively_ and _assiduously_ for a _series of years_,
+to the care of insane patients in an _establishment_, where persons of
+_both sexes_ are received,"[37] it might be suspected, that the
+superstructure of my philosophy had been reared on the basis of private
+emolument.
+
+
+_Camphor._
+
+This remedy has been highly extolled, and doubtless with reason, by those
+who have recommended it: my own experience merely extends to ten cases; a
+number, from which no decisive inference of its utility ought to be drawn.
+The dose was gradually increased, from five grains to two drachms, twice a
+day; and, in nine cases, the use of this remedy was continued for the
+space of two months. Of the patients, to whom the camphor was given, only
+two recovered: one of these had no symptoms of convalescence for several
+months after the use of this remedy had been abandoned: the other, a
+melancholic patient, certainly mended during the time he was taking it;
+but he was never able to bear more than ten grains thrice a day. He
+complained that it made him feel as if he were intoxicated. Considering
+the insoluble nature of camphor, and the impracticability of compelling a
+lunatic to swallow a pill or bolus, it has been found convenient (when a
+large quantity was required) to give this medicine in the form of an
+emulsion, by dissolving the camphor in hot olive oil, and afterwards
+adding a sufficient quantity of warm water and aqua ammoniae purae.
+
+
+_Cold Bathing._
+
+This remedy having for the most part been employed, in conjunction with
+others, it becomes difficult to ascertain how far it may be exclusively
+beneficial in this disease. The instances where it has been separately
+used for the cure of insanity, are too few to enable me to draw any
+satisfactory conclusions. I may, however, safely relate, that in many
+instances, paralytic affections have in a few hours supervened on cold
+bathing, especially where the patient has been in a furious state, and of
+a plethoric habit. That this is not unlikely to happen may be supposed
+from the difficulty of compelling the patient to go head-foremost into the
+bath. In some cases vertigo, and in others a considerable degree of fever
+ensued after immersion. The shower-bath was employed some years ago in the
+hospital, and many cases were selected in order to give a fair trial to
+this remedy, but I am unable to say, that any considerable advantage was
+derived to the patients from its use. If I might be permitted to give an
+opinion on this subject, the principal benefit resulting from this remedy,
+has been in the latter stages of the disease, and when the system had been
+previously lowered by evacuations. As a remedy for insanity cold bathing
+has been disregarded by a celebrated practitioner. To a question from a
+select committee of the House of Commons to Doctor Willis, 9th March,
+1807, the following answer was given.
+
+_Question._ Are you of opinion that warm and cold baths are necessary for
+lunatic patients?
+
+_Answer._ I think warm baths may be very useful, but it _can seldom
+happen_ that a cold bath will be required.[38]
+
+
+_Blisters._
+
+These have been in several cases applied to the head, and a very copious
+discharge maintained for many days, but without any manifest advantage.
+The late Dr. John Monro, who had, perhaps, seen more cases of this disease
+than any other practitioner, and who, joined to his extensive experience,
+possessed the talent of accurate observation, mentions, that he "never saw
+the least good effect of blisters in madness, unless it was at the
+beginning, while there was some degree of fever, or when they have been
+applied to particular symptoms accompanying this complaint."[39] Dr. Mead
+also concurs in this opinion. "Blistering plasters applied to the head
+will possibly be thought to deserve a place among the remedies of this
+disease, but I have often found them do more harm than good by their over
+great irritation."--_Medical Precepts, page 94._ Although blisters
+appear to be of little service, when put on the head, yet I have, in many
+cases, seen much good result from applying them to the legs. In patients
+who have continued for some time in a very furious state, and where
+evacuations have been sufficiently employed, large blisters applied to the
+inside of the legs, have often, and within a short time, mitigated the
+violence of the disorder.
+
+In a few cases setons have been employed, but no benefit has been derived
+from their use, although the discharge was continued above two months.
+
+Respecting opium, it may be observed, that whenever it has been exhibited,
+during a violent paroxysm, it has hardly ever procured sleep: but, on the
+contrary, has rendered those who have taken it much more furious: and,
+where it has for a short time produced rest, the patient has, after its
+operation, awaked in a state of increased violence.
+
+Many of the tribe of narcotic poisons have been recommended for the cure
+of madness; but, my own experience of those remedies is very limited, nor
+is it my intention to make further trials. Other, and perhaps whimsical
+modes of treating this disorder, have been mentioned: whirling,[40] or
+spinning a madman round, on a pivot, has been gravely proposed; and, music
+has been extolled, with a considerable glow of imagination, by the same
+gentleman.--That the medical student may be fully aware of the manifold
+agents which _practical physicians_ have suggested for the restoration of
+reason, I shall conclude my volume with the following extract.[41]
+
+"The medical philosopher, in his study of human nature, must have
+observed, that _sympathetic correspondence of action_ between the mind and
+body, which is _uniformly_ present in health and disease, though _varying_
+with circumstances. The different passions, according to their nature, the
+degree or intensity of application, and the sensibility of the party,
+exhibit certain characteristic expressions of countenance, and produce
+obvious _changes_, actions, or motions, in the animal economy. MUSIC has
+been found to occasion _all_ these actions, changes, and movements, in
+some sensible systems; and where one passion morbidly predominates, as
+frequently happens in mania, those species of simple or combined sounds,
+_capable of exciting an opposite passion_, may be _very usefully_
+employed. _If_ then such effects _can_ be produced by such a power, acting
+on a mind only endued with its healthy proportion of susceptibility, what
+may we _not_ expect where the sensibility is morbidly increased, and where
+the patient is alive to the most minute impressions? Cases frequently
+occur where such acuteness of sensibility, and _extreme_ delicacy of
+system exist, that most of the more common, _moral_, and medical means are
+contra-indicated; _here_ relief may be often administered through the
+medium of the _senses_; the _varied modulations, the lulling, soothing_
+cords of even an Eoelian harp have _appeased_ contending passions,
+_allayed_ miserable feeling, and afforded ease and tranquillity to the
+bosom _tortured_ with real or fancied woe: and I can easily _imagine_,
+that _jarring discord_, _grating harsh rending_ sounds, applied to an ear
+_naturally_ musical, would uniformly excite great commotion. Under
+circumstances calculated to assist this action, by producing unpleasant
+impressions through the medium of the other senses, as when SCREECHES and
+YELLS are made in an apartment painted _black_ and _red_, or _glaring
+white_, every man must be painfully affected: the maniacal patient,
+_however torpid_, _must_ be roused: or, on the contrary, where an opposite
+state obtains, extreme sensibility and impatience of powerful impression,
+there _much may be expected_ from placing the patient in an _airy room_,
+surrounded with _flowers breathing odours_, the walls and furniture
+_coloured green_, and the air agitated by undulations of the softest
+harmony. _Much_ of this may appear FANCIFUL and RIDICULOUS, but the
+_enquiring_ practitioner _will_ find, on making the experiment, it
+deserves his _serious_ attention; and no mean is to be despised that is
+capable of arresting the attention, changing the trains of thought,
+interesting the affections, removing or diminishing painful sensations,
+and ultimately rendering both mind and body sensible to impressions, and
+_all this has been effected by music_. Every individual is not capable of
+accurately estimating the _extensive powers_ of this agent; but I would
+ask the _musical amateur_, or the _experienced professor_, if he have not
+frequently felt sensations the most _exquisite_ and _indescribable_; if he
+have not experienced the whole frame _trilling_ with _inexpressible
+delight_, when the _tide_ of full harmony has FLOWN on his ear, and the
+most _wretched miserable_ feeling, UNIVERSAL HORRIPILATIO and CUTIS
+ANSERINA from the _grating crash_ of discord? All the varied sensations
+from transport to disgust, have been occasioned by the different movements
+in one piece of music. I might _amuse_ my readers with a great variety of
+instances where persons have been very singularly affected by means of
+music, and where its powers have extended to the _brute creation_, but
+this I purposely avoid."
+
+
+FINIS.
+
+
+  Printed by G. HAYDEN,}
+  Brydges Street, Covent Garden.}
+
+
+
+
+FOOTNOTES:
+
+[1] The choice of these words must be left to the taste of the reader, Dr.
+Johnson not having thought proper to admit them into his dictionary.
+
+[2] Some doubts are entertained whether Dr. Boord was physician to King
+Henry the eighth, but he was certainly a fellow of the College.
+
+[3] Apprehension of sensations. This is perhaps only an endeavour to
+explain the thing, _by_ the thing, or producing words of similar import
+with different sounds. Junius, speaking of the word hand (as derived from
+the gothic Handus) says, "Quidam olim deduxerunt vocabulum ab antiquo
+verbo HENDO, _Capio_: unde PREHENDO, APPREHENDO, &c."--_Gothicum
+Glossarium_, p. 188. Professor Ihre conceives it equally probable that the
+old latin word _hendo_ may have had a northern origin. "Id vero non
+possum, quin addam, oppido mihi probabile fieri, ipsammet hanc vocem latio
+olim peregrinam non fuisse, quod quippe augurar ex derivato HENDO, capio,
+unde prehendo cum derivatis pullularunt."--_Glossarium Sviogothicum. tom.
+i. p. 778._
+
+[4] Quere. Why should the most _active_ characteristics of our nature be
+termed _Passions_? The word seems properly employed in _Passion week_, the
+period commemorative of Christ's suffering or _Passion_. But we are said
+to _fly_, or _fall_ into a passion, and then passion _gets the better of
+us_. For the softer sex we conceive the most delicate, refined, and
+honorable _passion_, yet every one allows the dreadful consequences which
+ensue from an indulgence of our _passions_, and most persons agree that
+_passion_, carried to excess, constitutes madness--we live in a world of
+metaphor.
+
+[5] In many instances, although it is far from being general, pain of the
+head, and throbbing of its arteries precede an attack of insanity;
+sometimes giddiness is complained of as a precursory symptom. Those who
+have been several times disordered, are now and then sensible of the
+approaching return of their malady. Some have stated, a sense of working
+in the head, and also in the intestines, as if they were in a state of
+fermentation. Others observe that they do not seem to possess their
+natural feelings, but they all agree that they feel confused from the
+sudden and rapid intrusion of unconnected thoughts.
+
+[6] To illustrate how necessarily our sensations, or ideas must become
+confused, when their succession is too rapid, the relation of some
+experiments on that subject will sufficiently conduce.
+
+"But by the able assistance of Mr. Herschel, I am in a condition to give
+some approximation, at least, towards ascertaining the velocity of our
+audible sensations. For having, by means of a clock, produced sounds,
+which succeeded each other with such rapidity, that the intervals between
+each of them were (as far as could be judged) the smallest posible; he
+found he could evidently distinguish one hundred and sixty of them to flow
+in a second of time. Now as each interval must in this case be reckoned as
+a sensation likewise, as it might be filled up with a sound thereby making
+it a continued one; it follows, that we are capable of entertaining at
+least three hundred and twenty audible sensations in that period of
+time."--_Vide a Treatise on Time, by W. Watson, Jun. M. D. F. R. S. 8vo,
+1785, page 32._
+
+[7] The late Dr. Johnson was remarkably distinguished by certain
+peculiarities of action when his mind was deeply engaged. Sir Joshua
+Reynolds was of opinion "that it proceeded from a habit he had indulged
+himself in, of accompanying his thoughts with certain untoward actions."
+"One instance of his absence, and particularity as it is characteristic of
+the man, may be worth relating. When he and I took a journey into the
+West, we visited the late Mr. Banks, of Dorsetshire; the conversation
+turning upon pictures, which Johnson could not well see, he retired to a
+corner of the room, stretching out his right leg as far as he could reach
+before him, then bringing up his left leg, and stretching his right still
+further on. The old gentleman observing him, went up to him, and in a very
+courteous manner assured him, that though it was not a new house, the
+flooring was perfectly safe. The Doctor started from his reverie like a
+person waked out of his sleep, but spoke not a word."--_Boswell's Life of
+Dr. Johnson, vol. i. p. 76._ In the same work other of his tricks are
+recorded, as talking to himself, measuring his steps in a mysterious
+manner, half whistling, clucking like a hen, rubbing his left knee, &c.
+Many sensible persons, with whom I am now acquainted, when particularly
+thoughtful, discover strange bodily motions, of which they are by no means
+conscious at the time.
+
+[8] This gritty matter, subjected to chemical examination, was found to be
+_phosphat of lime_.
+
+[9] This appearance I have found frequently to occur in maniacs who have
+suffered a violent paroxysm of considerable duration: and in such cases,
+when there has been an opportunity of inspecting the contents of the
+cranium after death, water has been found between the dura mater and
+tunica arachnoidea.
+
+[10] Morbid Anatomy, page 304.
+
+[11] Mr. Fourcroy does not appear to have given any particular attention
+to this fluid. He says, "Cette humeur ne parait pas differer de celle qui
+mouille toutes les parois membraneuses du corps humain en general, et dont
+j'ai deja parle. C'est un liquide mucoso gelatineux, plus ou moins
+albumineux, et contenant _quelques matieres salines_."--_Systeme des
+Connoisances Chimiques, 8vo. tom. ix. p. 303._
+
+[12] It may be remarked, that all children in the early attempts at
+language, speak of themselves and others in the third person, and never
+employ the pronoun; they likewise never use connectives, or the
+inflections of verbs, until they begin to acquire some knowledge of
+numbers. Beyond this rude state our patient never advanced.
+
+[13] For this term the indulgent reader must give the author credit,
+because he finds himself unable adequately to explain it.--It is a complex
+_term_ for many ideas, on which language has not as yet, and perhaps will
+never be imposed. Very unfortunately there are many terms of this nature,
+equally incapable of description--a smile, for instance, is not very easy
+to be defined. Dr. Johnson calls it "a slight contraction of the face"
+which applies as properly to a paralytic affection. He also states it to
+be "opposed to frown." If curiosity should prompt the inquisitive reader
+to seek in the same author for the verb, to frown, he will find it "to
+express displeasure _by contracting the face_ to wrinkles." He who would
+
+  "Finde the minde's construction in the face"
+
+must not expect to be able to communicate to others, in a few words, that
+knowledge which has been the slow and progressive accumulation of years.
+
+[14] These are the usual terms employed by writers on this subject, but
+the propriety of their use must be left to the judgment of the reader.
+Every person will occasionally hesitate whether certain occurrences, said
+to be causes, ought to be referred to one class, in preference to the
+other. They are loose and vague names: for instance, a course of
+debauchery long persisted in, would probably terminate in paralysis;
+excessive grief we know to be capable of the same effect. Paralysis
+frequently induces derangement of mind, and in such case it would be said,
+that the madness was induced by the paralysis as a physical cause. But it
+often happens that debauchery and excessive grief are followed by madness,
+without the intervention paralysis. Moral, in this sense, means merely
+habitudes or customs, reiteration of circumstances confirmed into usage;
+and these may be indifferently accounted physical or moral.
+
+[15]
+
+  "----nessun maggior dolore,
+  Che ricordarsi del tempo felice
+  Nella miseria."--_Dante._
+
+[16] The Jews also were particularly instrumental in the practice and
+propagation of medical knowledge at that period.
+
+[17] Cogitatio, (hic minime praetereunda) est motus peculiaris Cerebri,
+quod hujus facultatis est proprium organum: vel potius Cerebri pars
+quaedam, in medulla spinali et nervis cum suis meningibus continuata, tenet
+animi principatum, motumque perficit tam cogitationis quam sensationis;
+quae secundum Cerebri diversam in omnium animalium structuram, mire
+variantur.--_Tolandi Pantheisticon, p. 12._
+
+[18] 1796, 1797.
+
+[19] Vide Report, Part II. p. 25.
+
+[20] Report, p. 59.
+
+[21] Ibid, 57.
+
+[22] Report 54.
+
+[23] "We shall use the general term of methodism, to designate these three
+classes of fanatics, [Arminian and Calvinistic methodists, and the
+_evangelical_ clergymen of the church of England] not troubling ourselves
+to point out the finer shades, and nicer discriminations of lunacy, but
+treating them all as in one general conspiracy against common sense, and
+rational orthodox christianity."--_Edinburgh Review, Jan. 1808, p. 342._
+
+[24] Traite Medico-Philosophique sur l'Alienation Mentale, 8vo. Paris, an.
+9, p. 47.
+
+[25] The late Reverend Dr. Willis.
+
+[26] With respect to the persons, called Keepers, who are placed over the
+insane, public hospitals have generally very much the advantage. They are
+there better paid, which makes them more anxious to preserve their
+situations by attention and good behaviour: and thus they acquire some
+experience of the disease. But it is very different in the private
+receptacles for maniacs. They there procure them at a cheaper rate; they
+are taken from the plough, the loom, or the stable; and sometimes this
+tribe consists of decayed smugglers, broken excisemen, or discharged
+sheriffs' officers:
+
+  "All that at home no more can beg or steal."
+
+How well such a description of persons is calculated to regulate and
+direct the conduct of an insane gentleman may be easily conjectured. If
+any thing could add to the calamity of mental derangement, it would be the
+mode which is generally adopted for its cure. Although an office of some
+importance and great responsibility, it is held as a degrading and odious
+employment, and seldom accepted but by idle and disorderly persons.
+
+[27] Vide Cullen, First Lines, vol. iv. p. 154.
+
+[28] "_D'uno luogo chiamato Timarahane, dove si castigano i matti._
+
+"In Costantinopoli fece fare un luogo Sultan Paiaxit dove si dovessero
+menare i pazzi, accioche non andassero per la citta, facendo pazzie, et e
+fatto a modo d'uno Spedale, dove sono circa cento cinquanta guardiani in
+loro custodia, et sonvi medicine, et altre cose per loro bisogni, e i
+detti guardiani vanno per la citta con bastoni cercando i matti, et quando
+ne truovano alcuno, lo'ncatenano per il collo con cathene di ferro, et per
+le mani, et a suon di bastoni lo menano al detto luogo, et quivi gli
+mettono una catena al collo assai maggiore, che e posta nel muro, et viene
+sopra del letto, tal mente che nel letto per il collo tutti gli tengono
+incatenati, et vene saranno per ordine, lontano l'uno dall'altro numero di
+quaranta, i quali per piacere di quelli della citta molte volte sono
+visitati, et di continovo col bastone i guardiani gli stanno appresso:
+Percio che non essendovi guastano i letti, et tiransi le tavole l'uno a
+l'altro: et venuta l'hora del mangiare, i guardiani gli vanno esaminando
+tutti per ordine, et trovando alcuno, che non istia in buon proposito,
+crudelmente lo battono, et se a caso truovano alcuno, che non faccia piu
+pazzie, gli banno miglior cura, che a gli altri." _J. Costumi et la vita
+de Turchi di Gio. Antonio Menavino Genovese da Vultri, 12mo, in Fiorenza,
+1551._
+
+[29] Traite sur la Mania, page 103.
+
+[30] The frequent recurrence of any propensity leads, by sure steps, to
+the final adjustment of the character; and even when the propensity is
+ideal, the repetition of the fits will, in the end, invest fancy with the
+habitudes of nature.--_Criticism on the Elegy written in a Country Church
+Yard, p. 3._
+
+[31] Remarks on Dr. Batties' Treatise on Madness, p. 38.
+
+[32] Dr. Cox, Practical Observations on Insanity, p. 28.
+
+[33] Dr. John Monro's Remarks on Dr. Battie, p. 39.
+
+[34] Vide Dr. Cox's _Practical_ Obs. on Insanity, p. 42.
+
+[35] It is a painful recollection to recur to the number of interesting
+females I have seen, who, after having suffered a temporary disarrangement
+of mind, and undergone the brutal operation of _spouting_, in private
+receptacles for the insane, have been restored to their friends without a
+front tooth in either jaw. Unfortunately the task of forcing patients to
+take food or medicines is consigned to the rude hand of an ignorant and
+unfeeling servant: it should always be performed by the master or mistress
+of the mad-house, whose reputations ought to be responsible for the
+personal integrity of the unhappy beings committed to their care.
+
+[36] Dr. Cox.
+
+[37] See Dr. Cox's Advertisement prefixed to his book.
+
+[38] Vide Report from the select committee appointed to enquire into the
+state of lunatics, page 25.
+
+[39] Remarks on Dr. Batties' Treatise on Madness.
+
+[40] See Dr. Cox, page 102.
+
+[41] Dr. Cox, p. 61.
+
+
+
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+Transcriber's Notes:
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+Passages in italics are indicated by _italics_.
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+The original text includes symbols that are represented in this text
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+End of the Project Gutenberg EBook of Observations on Madness and Melancholy, by
+John Haslam
+
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