A Treatise on Insanity, and Other Disorders Affecting the Mind

1839-01-01 00:00:00

THE BRITISH AND FOREIGN MEDICAL REVIEW, FOR JANUARY, PART FIRST. anti (ftrittcal Kebietog. ^nalgttcal Art. I. I. A Treatise on and other Disorders the Mind. Insanity, affecting By James Cowles m.d. &c. 1835. Prichard, f.r.s., &c.?London, 8vo. 483. pp. 2. Des Men tales considerees sous les Maladies Medical, Rapports et Par E. Medecin en chef de Hygienique, Medico-legal. Esquirol, la Maison des Alienes de &c. &c. Charenton, Royale Accompagne.es de 27 1838. Tomes ii.?8vo. Planchesgravees.?Paris, pp. 676,864. Mental Maladies considered in relation to and Medicine, Hygiene, Medical E. &c. &c. Jurisprudence. Esquirol, By 3. on the the Insane. M. m.d. &c. Allen, Essay Classification of By no date. 8vo. with Plates. ?London, pp.212; 4. A Treatise on the and Treatment Nature, Symptoms, Causes, of with Practical Observations on Lunatic and Insanity; Asylums, the the Lunatic of Description of Pauper Asylum for County at with a detailed Account its Middlesex, Hanwell, of Management. Sir W. C. Resident Medical and Ellis, m.d., By Superintendent, 1838. 8vo. of the at Wakefield.?London, formerly Asylum pp.344. 5. Delle Malattie della ovvero delle diverse di Follie. Mente, Specie di Luigi Dottor di 1830 Ferrarese, Medicina, Opera &c.?Napoli, and 1832. Two Vols. 8vo. 112. 220, pp Maladies the or the Madness. Mind, Of of different Species of By Luigi m.d. &c. Ferrarese, Tenth the Directors the Connecticut Retreat the of Report of for Insane.?1834. 7. the Lunatic in St. Report of Asylum Petersburgh.?1834. sulla Statistica Medica della Real Casa dei Matti di Saggio Palermo. Scritto da Antonio Medico ordinario della sudetta Greco, Real Casa dei 1835. 8vo. Matti, &c.?Palermo, pp.24. Medical Statistics the Institution the Insane at Palermo. of Royal for A. in &c. By Greco, Physician Ordinary, VII. NO. XIII. 1 VOL. 2 Prichard, Esquirol, Allen, Ellis, Ferrarese, [Jan 9. State the New-York and of Hospital, Bloomingdale Asylum.?1835 and 1836. the Directors the Dundee 10. Sixteenth and Report of of Eighteenth and 1838. Lunatic Asylum.?1836 called The Persons 11. State an Institution near York, Retreat, for of the Mind.?1836. with Disorders of afflicted Documents to the State Lunatic 12. and other relating Hospital Reports Mass. Printed order the Senate.?1837. at Worcester, by of and the The the Seventh 13. Justices, Forty-fourth Report of Visiting Resident and Treasurer the Middlesex the Report of Physician of Lunatic Pauper Asylum.?1837. to the the Lunatic 14. Physician's Report Managers of Asylum of Aberdeen.?1838. Lunatic and the 15. On the Statistics Asylums, of English Reform William no their Public date. Farr.?London, of Management. By 8vo. 46. pp. Observations on the illustrated 16. Madhouses; Management of by Occurrences in the a,nd Middlesex Caleb West-Riding Asylums. By Senior to the m.d., Crowther, formerly Physician West-Riding 1838. 8vo. 145. Lunatic Pauper Asylum.?London, pp. which have reached us relative to The number of the publications subject of since the commencement of the attest that the present insanity, year, class of maladies of which treat is increased important they attracting whilst the contents of some of them show that attention; sufficiently there are circumstances better yet many requiring consideration, by which the welfare of lunatics is affected. It would an materially require article all reasonable limits to do to extending beyond complete justice the various treatises and of which we have the but titles; reports quoted we to condense and comment may, serviceably attempt perhaps, upon some of the most facts and which these numerous important opinions works contain. the of involved in this Independently many interesting questions the nature of and the of its actual subject respecting insanity, signs pre- the consideration of its actual in a sence, mere practical management medicinal sense has we the attention think, scarcely, sufficiently engaged of the one with the details of profession. Every acquainted private no must know that there are cases which occasion more practice per- and and lead to alarm, plexity eventually greater practical improprieties, than the various forms of disordered mind. The artificial definitions of mental have done little more than confusion; the philosophers produce demonstrations of morbid anatomists have sometimes shown irremediable and sometimes no which the changes, changes explained satisfactorily which and the set forth in books phenomena death; preceded practice has been often and often Accustomed to subdue capricious empirical. acute diseases and definite and to if not to by measures, control, prompt chronic affections the shuns cure, by intelligible indications, practitioner as much as the of a class of cases in which excite~ possible responsibility ment resists all methods of or is obstinate reduction, ordinary depression r &c.on 3 Greco, Fare, Crowther, 1839.] Insanity. whilst all the offensive of under stimulus; and every peculiarities lunacy, fears of and the accusations of the and the various friends, unfriendly, distresses incidental to cases of combine to render him insanity, impatient to of his and to surrender in one who will it, charge, glad any way, any what he deems a or even a office. undertake thankless, disgusting a former Number of this Journal we inserted an account of the first In on record to liberate maniacs from chains and attempt dungeons; public an act of heroism at the as well as of for which Pinel time, philanthropy, barbarous are now un- deserved a statue. of treatment so Openly plans that a observation lead to the conclusion that common, might superficial was that could desire or skill could accomplished everything humanity Numerous establishments exist for the of the suggest. reception insane, of and of them are conducted many by persons incapable unnecessary known for their honorable and humane care of and those harshness, only intrusted to them. Some of our institutions are in certain public respects models of excellent and successive acts of the management; legislature have at least had for their that of efficient object throwing protection class of around the insane of every society. we are constrained to that the theories of To these admissions add, and medical men are entertained, occasionally uttered, by vague insanity of medicine in mental disorders and ill that the is considered; practice the will exists on the of much and where unsettled; that, relatives, part be and with committed, complete impunity. Everyone injustice may yet how little value is attached to the evidence of medical men in knows wild and fanciful notions which cases of on account of the lunacy, they with them. In common if declares often into court bring practice, insanity and resists and all the of the itself, bleeding, blistering, purging, anxiety and send is to the out of his to him no hands, get patient practitioner more him: and we can ourselves matter so that he sees no of tes- where, that a nervous be taken from from observation, tify, personal patient may who has been in under the most the attendance, dragged practitioner unfavorable circumstances before sentenced to confinement another, the means of immediate and lunatics, among placed beyond possible of a common lunatic-house at liberation. The selfish laughs keeper him of a Provided that the letter of the law to patient. attempts deprive he cares not how is with as the certificates, regards irregularly complied and those who have made a those certificates have been obtained; only formal remonstrance know with what reluctance the move, magistrates for will not and that lord and that the the stir, visiting physicians county not or cannot listen to The chancellors will appeal. metropolitan any at all will be found we to commissioners believe, times, ready, sincerely in to do all in their but that amounts, cases, nothing: power; many they the to institute an which at the will, utmost, magistrates enquiry; request will most in of the of the those do, probably, presence keeper magistrates Such facts have taken and thus baffle all interference. lunatic-house, and we fear are far from un- under our own observation, they place common. of When it is also recollected that lunatic were the scenes asylums the when the incredible until them; indignation purged barbarity, public of the commissioners of are with which the lunacy secrecy proceedings in is reflected some but conducted (necessary, perhaps, degree, upon, 4 Ferrarese, Prichard, Esquirol, Allen, Ellis, [Jan. and when is remembered that the relatives of lunatics to it abuse;) open seldom hail their to health with as Mr. Farr restoration gratitude, but, as welcome "the lunatic's return to his senses as it, ruefully expresses of his find would a heir the resurrection prodigal grandfatherwe the before the attention of the abundant reasons for bringing subject and and the again again. profession public who feel this sometimes be Those subject may suspected strongly upon but let one look into the of statements; any making exaggerated past and he will find how it is for records of York and of Bethlem, possible be sheltered under the sanction of all that the world to every enormity The These evils were of travellers calls* general. reports respectable. of of of the state of the Scotland, France, past asylums Italy, respecting the documents forwarded to us are and appalling; (obligingly by relative to the and condition of the State Dr. Woodward) past present of the same Lunatic Worcester, Massachusetts, give testimony Hospital of former incredible now all that skill and neglect, happily superseded by can humanity suggest. work is of several treatises M. at differ- Esquirol's composed published ent and now collected into two in not the best volumes, order, periods, as it seems to treatise and us; although every every page published by so able a after contains to physician, forty years' experience, something interest or instruct the medical reader. The section with which the first entitled volume de la numerous facts and commences, Folie, comprises statements to which we shall find further occasion to Of those on refer. Hallucinations and Illusions we observe the To these suc- same. may in the same treatises or on ceed, volume, essays Puerperal Insanity, and Melancholia and Suicide. Epilepsy, (Lypemanie), Demonomania, In the M. second treats of De- volume, Monomania, Mania, Esquirol and five Statistical and Memoirs and mentia, follow; Idiocy; Hygienic three on considered in its Some of relations. Insanity medico-legal these we must and the over, others, subjects necessarily pass particularly one last we must defer of until another occasion. mentioned, speaking Our efforts must at be confined to a few present selecting practical points for such as illustration derive from the works before us. they important The of M. work is save more calculated to trouble to plan Esquirol's the author than to the and and an some reader, produces repetitions of want of if not the of appearance arrangement. Much, whole, the section de la Folie we been has, think, previously published; that on is Hallucinations dated in that on Illusions in 1817; 1832; the one entitled de la Fureur in that on 1816; Puerperal Insanity in that on in a on the critical ter- 1819; 1815; Epilepsy chapter minations of Folie is then dated in and the section 1818; inserted, on Melancholia is dated in 1820. Demonomania and Suicide are dated 1814 and 1821. in These discussed this incon- subjects being venient order in the first second with the treatises on volume, begins and the first or at Monomania, Mania, Dementia; recently composed least the second dated in and the third in 1814. revised, 1818, Among other inconveniences hence the reader is to conclude resulting, disposed that M. considers melan- Esquirol hallucinations, illusions, folie, fury, and monomania as so This is cholia, disorders. mania, many separate on &c 5 Greco, Farr, Crowther, 1839.] Insanity. the case as la we understand which insa- regards Folie, particularly by and la which we should understand the if the Manie, same, nity, by observations made under this head did not show that the latter term by M. means a distinct affection. We conclude that la Folie is Esquirol to and intended la Manie its maniacal general express insanity, only but the definitions of terms little form; these afford given help, being word for word the same: the difference that being nearly only important la Manie is described as state marked excitement. by La l'alienation est une affection ordinairement folie, mentale, cerebrale, chronique, caracterisee des desordres de la de sans de la fievre, par sensibilite, l'intelligence, volonte. la folie est d'une Je dis courte ordinairement, que quelquefois durtfe, parce debut et dans le cours de cette il se manifeste des maladie, qu'au symptomes parce i. febriles." 5.) (Vol. p. La manie est une affection ordinairement sans carac- cerebrale, chronique, fifevre, de de terisee la et l'exaltation la et de la sensibilite, l'intelligence, par perturbation volont6. Je dis ordinairement sans dans le debut, fifevre, parce qu'au quelquefois cours de la on observe des febriles en manie, symptomes qui peuvent imposer, etqui difficile le ii. rendent diagnostic. (Vol. p. 132.) to their the treatises are all Whatever be may objected arrangement, full facts the most in the course of of of interesting description, gathered and with unusual detailed with clear- opportunities, long experience reflections indicative of ness and and the acute force, accompanied by of the author's mind. and character judicious Dr. Prichard's treatise was the first of those of which the among origin has been the to the of Practical attributed, writers, by Cyclopaedia if and no more direct benefit should have been communicated Medicine; to the that we of profession by comprehensive publication, (which are, far from the indirect and to course, very asserting,) advantages arising, from the volumes which it has are and will be such as arise, suggested, editors must the with satisfaction. Dr. always contemplate profound Prichard's rank the most medical authors is among distinguished living too well known to laboured introduction of him to the notice require any of our readers. The character of his treatise be said to general may be, that it contains the best information which is at on the present possessed various matters of which it treats. It is a and fair, clear, admirably condensed of documents and statements from various au- compendium collected in various the in establishments for various thorities, insane, so and with so much discrimination countries; com- placed together, as mented to convince the reader that the first of the author upon, object has been to elicit truths on which the the the practitioner, moralist, and the legislator might jurist, rely. In his after the unsuccessful introductory chapter, noticing attempts at definition made several Dr. Prichard with writers, by previous quotes the observation of that in certain approbation Pinel, consists, insanity in a morbid of the affections and moral exclu- cases, perversion feelings and without lesion of the intellectual faculties; sively, any perceptible an observation which he considers of the highest importance, pathologi- and and which he takes much to confirm. cally practically, pains Dr. Prichard's division of into moral insa- therefore, is, first, insanity, and intellectual the latter subdivided secondly, nity, insanity; being 6 Prichard, Esquirol, Allen, Ellis, Ferrarese, [Jan. into or or and monomania, madness; partial insanity; mania, raving or dementia. incoherence, This division is and seems to admit of useful simple, practical applica- tion : it also as Dr. the recommen- Prichard, possesses, expressed great by dation of in words. We concur in conveying intelligible ideas, English the and the that there are cases author, Pinel, opinion expressed by by of in which the disorder is shown in a disturbance or a insanity chiefly of the and in their affections; depravement feelings cases, indeed, which, little but eccentricities of or of slighter forms, present feeling temper, in in different benevolent or in modes of exercised, examples, spiteful but in without action; of of many cases, any general suspicion insanity effects which the of mind; the producing families; destroy happiness of what are of as extreme or habitual consequences commonly spoken or bad as the attachments of temper, capriciousness regards friendship or This kind of moral in the de- relationship. insanity begins slightest from and be traced of partures healthy feeling, may through every variety shade to forms of in which it is so associated with an severity evidently as to leave some infirm, mind, ill-judging, ill-reasoning, perverted doubts, in whether our the forms of moral are not estimation, slightest insanity in connected with some defect in the mental reality proportional powers. "We must as is our deference to Dr. Prichard's confess, indeed, that, great we have some in the observation, existence superior difficulty admitting of of moral form from some of mental in- any insanity disjoined degree less in the but in manifest the cases, severer; firmity, perceptible slighter in some instances out an in others characte- marking individual, merely all the ramifications of a and in the latter case rizing family, illustrating almost of moral disorder and mental every possible variety peculiarity. One is one is one is one is ever immoral, morose, extravagant, pursuing fancied and none is of sound mind. The connexion of these discoveries; cases with a certain mental character seems to us to be shown in that this, whatever affects the wine or for in- palpably mind,?as drinking spirits, out the more the of the one stance,?brings peculiarity affection, making more another more another immoral, openly thoughtlessly extravagant, more another more morose, dangerously wildly speculative: showing that the disordered affection shoots out the more in as the proportion mental is and it removed; that its controlling power rendering probable first in the character was at least in to springing up attributable, part, some want of mental balance:?we in because we that say part, presume a to be more or less affected moral disposition by particular impressions, as well as or rather arise from the constitu- must, physical, may, original tion of the nervous of the of that of the individual; frame, system part whatever it on which such are or in which the be, made, impressions moral be said to reside. Even in the case adduced feelings may by Dr. in which Prichard, the consists of violent of insanity merely gusts we should lean to the old embodied in an ancient anger, belief, pro- and attribute these sudden storms of to the want of verb, feeling partly mental to control and of to an inherent course, power them, partly, morbid We cannot what be a in excitability. conquer, may prejudice belief that in all such the intellectual are us,?a cases faculties somewhat unsound. It is also of that whenever the mental facul- remark, worthy ties are is to in case of the moral disordered,?that say, every insanity, &c. on 7 Crowther, 1839.] Greco, Farr, Insanity. are to some their and affections extent feelings impaired: perversion, the first of mental and ushers in is often indeed, derangement, symptom successive attack. In all the intervals in which a man is in sound every his he live with his and be to children: wife, mind, may happily indulgent of he treats his wife with when the attack is on, insanity coming cruelty, the life of those children. M. that and threatens Esquirol truly remarks, a return to the usual is the surest of a restored mind. The feelings sign or is the of whether not the return of the the is, feelings effect question whether the is a to excess in the restored mind; fault original proneness and or or a defect in the mental affections, good bad, power. feelings There at all an evident in such cases between is, events, disproportion and the the and the of faculties, feelings controlling practical importance cases is not less than that which Dr. Prichard attaches to this class of if alone can decide the we must acknow- them; and, question, authority the attached to that of Dr. Prichard and of Pinel. Dr. ledge weight think has after some Prichard seems to that M. also, hesitation, Esquirol the of the that there is a manie sans a latter, delire, adopted opinion an which exists not without intellectual raisonnante, folie insanity only old and mischievous not but delusion, (that notion, yet quite exploded,) error. without intellectual are so scattered the several memoirs of M. through Esquirol's opinions his two different which form the of dates, principal part recently published know where to look for his latest views on that we volumes, scarcely any in the commencement of his second when volume, but, single point: of in written since the of Dr. treating monomania, pages publication to which he he combats the notion of the intelli- Prichard's work, refers, in a state of in what Dr. Prichard calls moral in- gence being integrity he maintains that there is a mania and a although reasoning sanity, is disturbed in all the monomania. Our belief that the is, understanding in some and in on in in more less others; cases, many subjects one, only others on one for the most for the reasons which and, very subject; part, If it adduces the belief in a mere moral Esquirol against insanity. lunatics would let themselves be were not the so, guided by reasoning, and would see that their are false and their actions unusual principles in it has lost its and eccentric. Their is more or less fault; intelligence is in with the other facul- influence over their it no will, longer harmony ties." vol. ii. 5.) {Esquirol, p. to Dr. The cases which seem to of all that are alluded Prichard, us, by as this are those in which the most view, only departure countenancing from rational modes of action is shown in a fondness for kind of every love of or for an mischief; unmeaning unmeaning equally destroying within or for articles which to reach; belong everything appropriating without motive save that of a disordered state of the others, probable any of or moral as when theft is feeling, practised by persons property, when a will take no food unless what he considers to be stolen. patient be with Cases of inordinate classed these. penuriousness may perhaps which the indi- Certain of natural depraved perversions feeling, subject be vidual to the of a we consi- treatment should, think, criminal, always them as dered to to Dr. Prichard alludes to belong insanity. constituting to disordered sensa- cases of moral belong insanity: they may perhaps tion. with some of are associated eccentricity character, They generally 8 Esquirol, Ellis, Ferrarese, Prichard, Allen, [Jan. arise in minds as has been shown too instances, but, by many may and of a of intellectual yet which, capable high degree acquirement; to the actions of the individual the in certain circumstances, resign or of his disordered alone. The delirium senile, guidance propensities a weak- of old is people, surely very generally accompanied by insanity ened intellect. in these cases of moral the It is to remember that, insanity, important is unless from external and unfavorable, arising any prognosis generally of of which admits or from the influence accidental removal, cause, be abstracted In which the can or defended. other cases the patient either to be or to terminate in another form of disease is likely permanent insanity." Several cases are related Dr. Prichard to illustrate the by description and of moral the relation between and the monomania, them, insanity to the other. A transition from one careful of these cases has perusal to set aside our doubts the existence of moral failed respecting alleged from some disorder of the intellect. In most of the separate insanity cases there as it to indications of an were, us, appears many ill-judging and in of them and weakened most intellectual disorder of a more mind, character The of marked supervened. highly respectable testimony Dr. Wake of of Dr. Dr. and Dr. of York, Bompas, Fox, Symonds, and of Mr. of the Gloucester Lunatic is adduced Bristol, Hitch, Asylum, in of the view taken Dr. Prichard. Mr. Hitch that such by says support in the cases have been and the individuals so long recognized asylum, affected have been termed there "insane in and not in ideas." conduct, The seems to turn the in which the habitual con- question upon degree duct of all individuals mental determinations. We our- depends upon selves incline to the belief that our and affections are the feelings joint result of certain emotions which have been made the of intellec- subject tual or of when these reflection; or affections actions, and, feelings become or we can in case that perverted depraved, hardly any suppose the mental actions continue to be it correctly performed. Such, appears to in was the case the first of Mr. Hitch's illus- us, evidently interesting trations: it is said of the that "on business he would converse patient, most if the had would have but, itself, rationally; opportunity presented his in the most useless He was of expended money purchases. capable the nicest calculations connected with his own and was making affairs, in all correct his data when to a second when left speaking person; but, to his conduct and were ridiculous in the extreme." himself, language Such also to us to have been the case in the little whose con- appears girl dition is so described in the same communication: a child of admirably seven of from and who, years age, being mild, affectionate, clever, became and rude, abrupt, vulgar, perfectly unmanageable," despised her was cruel to eat her would her own parents, sisters, younger faeces, drink her own and swear like a fishwoman." This urine, child, too, was of a in some of the branches of which had family insanity existed; and her health was much disordered. I could never detect in bodily Mr. of her," fixed either fear or which in- says Finch, idea, "any belief, fluenced her conduct. She acted from the of her and impulse feelings, these were unnatural and we should uncontrolled, add, unhealthy:" by the faculties of her the recollections of what she had been mind, by &c. on Greco, Farr, Crowther, Insanity. 1339.] was decent and and her She knew and proper, judgment. taught by but avowed that her actions were foolish and could not refrain disgusting, the was and the from them. weakened; then, Surely, controlling power whether or not that resides in the is, controlling only question power intellect? in which or The sections Dr. Prichard describes mad- mania, raving of that excited form the ness; including phenomena protracted insanity, to which so of an excellent succeeds,?the subject paralysis generally treatise M. Calmeil in la consideree by 1826, (De Paralysie published chez les and or are of con- Alienes;) incoherence, dementia, examples and in which is well densed delineation, graphic everything arranged. There is no on no useless re- unnecessary dwelling insignificant points, and the left on the mind is clearer than what is impression petition, derived from on such the diversities of commonly writings subjects; which seem to the common of defy powers arrangement possessed by authors. In the section on the often distinction, Incoherence, neglected medical of the incoherence on or writers, consequent age disease, by or is out. In from natural of well one idiotism, mind, imbecility pointed the are in never existed: in one case case faculties the other lost; they broken recollections of the in the other there are no recol- remain; past causes of and the mind is as that of an infant. The lections, incoherence, a table in or when not are illustrated dementia, congenital, by exhibiting first column the number of such cases admitted into the the Salpetri&re, in 1811 and and the second those admitted into M. 1812; Esquirol's establishment. private TABLE OF CAUSES. Causes. Number Individuals. Physical of Disorders connected with the catamenia .11 29 6 Critical period 5 3 of childbirth .... Consequences 3 0 Blows the head upon 46 3 of Progress age Ataxic fever . 1 0 2 of hemorrhoids ... Suppression 14 4 Mania 13 2 Melancholia ....... 3 Paralysis 3 2 Apoplexy 6 8 and abuse of ... Syphilis mercury Faults of ..... 0 6 regimen ....... 9 Intemperance 4 7 Masturbation Causes. Moral love 1 Disappointed Fright Political excitement 0 0 3 ambition .... Disappointed Poverty 8 4 Domestic griefs into four the first is divides incoherence that of Dr. Prichard degrees: so in old or loss of commonly exemplified persons memory, forgetfulness, in and sometimes individuals at with to recent events; occurring regard which from various sudden to have been an earlier impressions they age, he the of or loss of The second terms stage irrationality, subjected. 10 Ferrarese, Prichard, Esquirol, Allen, Ellis, [Jan. health a state which is the reason; continued, long physical generally rare cases of but from which there are some recovery, remaining good, the attention of the attended with circumstances practitioner. deserving in who had remained the Pinel informs us that persons, many, especially young attacked a or months in a state of absolute have been Bicfitre several by years fatuity, and or continuance. of acute of or five twenty, thirty days' paroxysm mania, twenty, * ' in from a reaction of the are Such he adds, system, many paroxysms,' apparently has been observed on the cases succeeded The same result by perfect rationality.' after or of maniacs in the advanced of restoration of demented stage insanity, persons, fatal to luna- severe attacks of fever attended with delirium. Such attacks are often who recover not a few are restored to the of those tics; but, them, subsequently pos- session of their faculties." (p. 96.) The third of incoherence is that in which the individual is inca- degree of that is said to him. Dr. Prichard comprehending anything says pable it be the of may styled stage incomprehension: is often reduced to this remarkably state, Physical activity displayed by persons and it assumes the of trick or habit. Some or run to and or appearance jump fro, in Some or walk round a circle. dance or vociferate sing, perpetually frequently. talk in the most no ideas whatever to incessantly unmeaning jargon, attaching Many in half and their others their time sentences broken words; muttering pass unceasingly in which it is to discover link of if connexion; scarcely possible any or, expressions, association can be traced in their it is of the most trivial and de- kind, any thoughts, a word some which for a moment attracts a on or on sensible of object degree pending attention. on the other sit in with a sedate and hand, Many, silence, tranquil look, an sometimes with a vacant smile or with and a unmeaning stare, scarcely pronounce for or or even for A few remain crouched in a weeks, syllable months, years. parti- cular which to it seems the most un- though posture, they always prefer, bystanders and even if in a different manner those who have the care of easy, painful: placed by soon resume their habitual demented crowd them, they position. Many persons round a who to visit a lunatic and at stranger happens asylum, gaze him, having just of to new and to which are not accus- enough intelligence perceive something they tomed in his Some individuals in this state have a to adorn aspect. propensity themselves in a manner: take that to be in their strange they anything happens way, and it to their and which is ridiculous. dress, singular append M. has described in a and accurate manner the of coun- Esquirol striking aspect to tenance and to this of the disease. dementia, peculiar especially belonging stage 'To the disordered state of the intellectual he 'the faculties,' says, following symp- toms are added: the face is the moistened with the tears, generally pale, eyes pupils the look the countenance motionless and of devoid dilated, wandering, expression; the muscles of one side are and the face a distorted relaxed, frequently give appear- the is sometimes lean and at others it is loaded with fat: in ance; body emaciated, such instances the face is the neck short. In a few no full, outward ruddy, persons can be of the indicative of sign perceived decay intelligence." (p. 97.) The fourth of incoherence is that of or loss of degree inappetency, instinct and a state in which even the animal instincts are volition; lost, and the individual has or existence; merely organic physical appearing conscious of neither desires or and scarcely life, aversions, having being unable to the calls of nature. Whoever has had of obey opportunities lunatics must the of the sketch of a observing recognize fidelity following of reduced to this miserable condition. group persons exhibition of human can be more than the Scarcely any suffering deeply affecting of a of lunatics reduced to the last of and those who have aspect group stages fatuity, never witnessed such a can so a state of mental spectacle hardly imagine abject degra- dation. In a this of an individual be seeu group description, may always standing &c. on II 1839.] Greco, Farr, Crowthkr, Insanity. erect and with his head and neck bent almost at to his immoveable, right angles trunk, fixed the never or his them move- ground, turning round, by any eyes upon appearing ment or to be conscious of external or even of his own existence. gesture impressions on a Another sits which she to and and throws her limbs into rocking chair, fro, agitates the most uncouth at the same time or a dissonant positions, chanting yelling song, of ideas and sit with their inanity still, only expressing feelings. Many constantly on their their and mouth half unconscious of chins breasts, resting eyes open, hunger and almost or destitute of the which to thirst, belong life; feelings merely physical would never lie down or rise were not in bed and raised they they again by placed their attendants. of the who are reduced to this great proportion patients degree of are found to have lost the use of their in a less limbs or fatuity degree greater by or general partial paralysis. From such a state it is that ever took but scarcely imaginable recovery place, in the last of often for Their stage patients fatuity linger many years. state, however, is not uniform: some of them have lucid in which always intervals, comparatively nature seems to make an effort to the mind and recall lost and light up impressions ideas. I have often observed a who sits all in a wooden elbowed patient day chair, with his chin over his conscious of and breast, hanging appearing hardly existence, unable to assist himself in the calls of who would not if eat food were not nature, into his mouth. He has been for several in the same actually put years state, except that he to rouse and for a short time to recover an unusual occasionally appears himself, of animation. At such he will sometimes read a in the Bible degree periods chapter with a clear voice and a distinct and articulation. Such occasional varia- intelligible tions in the state of demented are not are of persons infrequent. They capable being raised favorable influences from a lower of their disease into one which is by degree above it in the scale." (p. 98.) M. is at some to combat the advanced Esquirol pains opinion by M. and maintained that there is no such as a Foville, by others, thing case of real monomania. Cases to which such a denomination could be we the are, rare; unsound state think, for, correctly applied very although of the mind and is in manifested in relation may, many instances, chiefly to some illusion or careful would seldom belief, particular investigation fail to discover of an coexisting proofs impaired understanding. Dr. Prichard is of that the monomania opinion commonly supervenes upon some of moral and cases in illustration of this degree insanity; gives We cannot see reason for the case of opinion. any good distinguishing a who thinks she can like the in person Rasselas, regulate, philosopher the course of the sun vol. ii. nor those of individuals who (Esquirol, p. 8), think themselves or from cases of mania. A emperors princes, general who considers himself in audible communication with God and patient with can be considered as mad on one his angels scarcely only subject: sense of is to and his mind to illusions, hallucinations, hearing subject (to M. terms as of sensorial and adopt Esquirol's expressive deceptions mental the difference here is more refined than reveries, although again if he he hears voices to he all the real:) writes, dictating him; neglects customs of and when he he believes himself the ordinary religion; speaks, mere echo of a voice from an Such an individual proceeding angel. may be of and verse but there must be so capable writing prose correctly, much disorder in his and faculties as to perceptive reasoning scarcely make it that he should be found rational in all of his con- possible parts duct unconnected delusions. In cases with these other related striking under this head M. we can see of by Esquirol, only examples general mania and which some delusion melancholia; upon particular supervened. A his remarkable for and merchant, long wayward suspicious temper, 12 Prichard, Esquirol, Allen, Ellis, Ferrarese, [Jan. rash and unfortunate in his in his and disordered health, speculations, of in his food, hypochondriacal, lurking quar- always apprehensive poison relsome with an of an affectionate reads an wife, indulgent father, jealous account of himself to a and pretended dauphin, immediately imagines be the real and his into the to claim his forces Tuileries, dauphin, way he in this makes to rights. Although persists assertion, proclamations the and writes a of his we birth, people, plausible history pretended as a new of insa- can all this feature in a case only regard supervening an instance of delusions other and not to be delusions, nity; displacing called a without a confusion of terms. monomania, Persons of conscientious and timid character often an experience of unfairness excessive considered of acts of apprehension being capable or and in or in which are warehouses dishonesty, particularly shops they in the midst of much moveable wealth. The instance of placed strongest these carried to and at the same time one of the excess, feelings being least cases of is related in this section of monomania, questionable M. work. An unmarried of of Esquirol's lady, thirty-four years age, and mild with blue auburn disposition, sanguine temperament, lively eyes, and florid had been as is often the case on hair, complexion, brought up, in the and had been afraid of continent, commerce, always scrupulously of in and in matters of others, business, taking any advantage making out accounts. It was her custom to a visit to an frequent aunt, pay without her and dressed in an which she wore. bonnet, apron usually When about of she evinced an uneasi- eighteen years age, extraordinary when from her aunt's house one the ness, coming away day, respecting of aunt in the to her possibility bringing away anything belonging pocket of her and after that she her aunt visits without time, paid apron; always her She became more and more afraid of out unfair apron. making and when of of it between accounts; touching money, retaining any part her She that this fear was ridiculous, fingers. acknowledged scrupulous but said that she could not At she was it. feeling length help obliged to her commercial Her and her fears give up disquietude occupations. became more After she washed her hands general. touching anything, in a of water. Her constant care was to touch great quantity nothing her hands or her of with and she contracted the custom clothes; rubbing the of each hand the as if to free them from some- other, against fingers under the nails. She refrained from win- thing doors, carefully opening and because of value be attached to the dows, closets, something might and handles or the adhere to her hands. She examined keys, carefully chair or before wore the shoes that she seat, down; every sitting tightest could force her feet in order that contain con- into, they might nothing cealed. After amendments and this has now been many relapses, lady for some time under the care of M. months Esquirol. During eighteen she free from the above and appeared tolerably peculiarities mentioned, the action of the seldom but since was observed; June, rubbing fingers M. this account of her six months the 1837, says Esquirol, later, writing have with and this increases. phenomena appeared greater intensity, daily to a he In order more idea of her describes her habits state, give lively one She at and an hour and a rises six; and half, during day. always sometimes three hours are at the toilette. Before out of getting passed she rubs her feet for ten to remove that have bed, minutes, anything may &c. on 13 Greco, Farr, Crowther, 1839.] Insanity. between the toes or under the she then examines her nails; carefully got maid that and desires her to do the to ascertain con- same, slippers, they Her is times her tain no valuables. comb for through hair, passed many same article of and is the dress, fold, purpose. Every every cautiously with numerous of hands at intervals such rubbings during inspected, all and this done with and extreme and if inspection; fatigue anxiety; the omission leaves her ill at ease all the At ten she is omitted, day. for when the and knives breakfast, napkins, glasses, jugs, ready plates, kind the same of At the same are dinner, scrutiny. precautions undergo of taken. Her for to bed are as minute as those the preparations going toilette. the she or works with her reads, needle; morning During day but these and all other in which her hands are in occupations brought contact with other lead to renewed of the any object, rubbings fingers. If the is and and the she the writes, shaken, paper pens, writing-desk, and she never seals a letter without assured her attendant that being by there is folded in it. If alone in a she will not sit down room, nothing up until some one comes and assures her that there is on the chair nothing to her so She and receives but con- visits, prevent doing. pays always trives to her and when she to see her relatives in cautions; goes practise her native she so her as to arrive in the morn- town, arranges journey early to her dress before to enable her her ing, change completely seeing With all she never talks but is aware of friends. this, unreasonably, her she even sees the of her and absurdity scruples fears, peculiarities; she and and at them or sometimes over herself; groans laughs weeps them. tries to overcome and even out the She often them, means, points such as are to of the better of them. She very disagreeable her, getting to with her never herself: she servant, goes shops touching money goes and the makes to to the theatre into the go public promenades; parties and a social circle Her conversation is evening. country, joins every and sometimes sarcastic but if she lively, clever, (malicieuse); changes her her or if one comes into her or touches or or chair, head, dress, any out of the room she rubs her Her health is good. goes fingers diligently. It is at to detect the least dis- time, impossible, M.Esquirol says, any in in of this order of the the or the affections inte- sensations, reasoning, resting patient. We have mentioned the of this as illustrative of case, pure particulars furnish its moral monomania: extreme conscientiousness to appears pecu- but we should hesitate to with un- it, M.Esquirol, liarity; pronounce marked a morbid state of the senses and of the or by understanding reason: and we cannot of the term manie the raison- recognize justness nante to of this kind or the cases Pinel, (reasoning mania) by applied term moral to them Dr. Prichard. In this instance insanity, given by the moral was the of the but peculiarity probable origin malady; surely sensorial functions and reason became with the impaired complicated morbid conscientiousness. It is no less we incorrect, unquestionably to call kind of mania a mania: the reason in this conceive, reasoning any for is correct on it even retains matters; case, instance, ordinary power but is to out the of the it not conduct; enough point absurdity patient's to that conduct: to that it is powerful enough extent, therefore, prevent It is overmastered an undue in one impaired. by activity, apparently, in of the brain. The reason of the lunatic mono- portion "reasoning 14 Prichard, Esquirol, Allen, Ellis, Ferrarese, [Jan. M. is not for it comes in mania," aid says Esquirol, essentially injured, of the lunatic's and the is to his actions, patient ready always justify deeds and sentiments." These it to warrant circumstances, appears us, conclusions. exactly opposite M. and Dr. Prichard are zealous but we Esquirol anti-phrenologists; incline to think that the could a better account of give phrenologists some of these cases than But that debateable we they. upon ground have that it is too much no wish to with enter; seeing occupied preju- and and to allow the combatants dices, religious, pitiless fierce, political room and It touches too too besides, fair-play. dangerously upon many of those which mankind in conventional delusions; subjects upon rejoice it bare too the much which shrouds artificial social lays sophistry many relations men fear whereupon Lest their own should become too judgments bright, And their free be and earth have too much crimes, thoughts light.'' The if it can so be of drunken called, monomania, persons, properly of and of is M. of incendiaries, homicides, forcibly depicted by Esquirol: these and touch on the deli- the are varieties, numerous; examples they cate the moral is difficult to be where extent of boundary responsibility and the of human controvertible. The exact defined, right punishments limits of these lamentable cases to be out bold and pointed by require them and the inconveniences from to be moralists; enlightened resulting dealt with humane and by courageous legislators. Publicly putting done little to half-lunatic criminals to death we has, promote apprehend, the of and still less to the of the mankind, humanity security improve of such dreadful inflictions. In some future the spectators age, preven- their tion of crimes will more attention than perhaps punishment. occupy the consideration of A section of Dr. Prichard's treatise is devoted to General with first out to Paralysis complicated insanity, pointed physicians M. in the des Sciences a form of Dictionnaire Medicales; by Esquirol more in men than in and more women, frequent among paralysis frequent At of the cultivated classes than the Charenton, patients among poor. number of admis- the of is one sixth of the whole proportion paralytics sions. a with the assistance of We had few an years ago opportunity, M. Calmeil in that admirable the various of himself, asylum, observing forms or of this disorder in of which his work contains degrees lunatics, its nature such a faithful In the first of the description. degree malady, is of the a indicated an in the movements tongue, chiefly by impediment but the can be slowness and in tongue difficulty articulating syllables; and of the face are not distorted. In the the muscles steadily protruded, are second all the and the muscles, sensations, degree, voluntary and affected: the rise and walk with patients difficulty; slight up slowly, In this the skin and nostrils are disregarded. stage, impressions upon the in but the functions of life are a state, patient's physical nearly healthy this condition is In the last of and miserable. deplorable degree dirty are reduced to motionless and these insensible, complication, patients, a a of slow death." It state of mere their existence is kind vegetation; is of these is as that the death seldom, remarkable, however, patients but M. Calmeil the of the cerebral disease; observes, simple consequence is occasioned the formation and of tubercles, pulmonary by suppuration and The inflammation and ulceration of the intestinal canal. by para- &c. on 15 Greco, Farr, Crowther, 1839.] Insanity. itself is in these the result of effusion of blood in not, cases, the lysis or of of acute but almost ramollissement, brain, sanguineous congestion, chronic inflammation of the substance of of the brain, uniformly espe- its sometimes with in the at surface; complicated brain, cially congestion in the cerebral or between the two laminae of the substance, hemorrhage in of ramollissement some the or erosions of the arachnoid, part brain, surface. The mean duration of such cases is a cerebral little more than months. The which is of common twelve occur- complication, certainly rence in to be more rare in the south of and seldom Paris, appears France, in Aversa to be seen the at in It has not been much great asylum Italy. observed in this but Dr. Prichard the that result of several country; says made him on the is an that it is no means opinion enquiries by subject by uncommon in our rare in institutions, public although comparatively pri- M. relates the of vate case a who was asylums. Esquirol patient brought with the that he a to of his but him, might hope give promise recovery; in which he a most unfavorable at the first gave decidedly prognosis founded on the observation of a of diffi- interview; chiefly slight degree with of articulation which the mental excitement was culty complicated. The of these cases he is, observes, rapid progress very striking. The and character of Mania are described with force symptoms great and in M. second volume. fidelity Esquirol's flushed it is and The face of maniacs is and or the hair swelled, contracted; pale is set on end the are brilliant and the shun the (herisse), eyes haggard: patients light of certain have noises and in and have a horror their their colours; they ringing ears; ears are sometimes red: the noise excites them. Monomaniacs have very slightest in the interior of the or a Con- heat voracious headach, cranium, anorexia, appetite. sumed internal are tormented a thirst for cold heat, drinks; by they by devouring they in the have a sensation if burning bowels, or, constipation, insomnia, they sleep, dreams and sudden frightful awakings. are for false illusions and Maniacs remarkable a sensations, hallucinations, faulty association of which are without order or ideas, rapidly reproduced connexion; they for the errors of their are remarkable the of their judgment, affections, perturbation and the violence of their will. have nervous their delirium is excitement; They great all the faculties of the are excited and et general, understanding overturned, (exaltees and that excites an either or moral, boukversees); every thing impression, physical the vain of their them and excites becomes them, including imagination, upon products the of delirium/' ii. subject (Vol. p. 133.) The diverse modes in which the their ideas in maniacal patients express and their various and well are described affections, expressive gestures by M. ii. and no can Esquirol, (vol. p. 151); yet description comprehend all the varieties observed them. Some one word singular among repeat and for some of in the themselves hours; again again many speak always third and we have known some hold and collo- person long objurgatory in two voices. Some invent a some of quies, feigned peculiar language; course vociferate and All these of modes are but sing. peculiar speech so of shades of mental excitement or rea- many expressions oppression; of albeit not mad. The dily comprehended by persons strong feeling, remarkable alterations of the which have attracted less countenance, are described and some of them are observation, graphically by Esquirol; in the terrifically represented plates. The erroneous notion that all lunatics can bear cold and with hunger was since refuted M. Some of the impunity long by Esquirol. patients, 16 Allen, Ellis, Ferrarese, Prichard, Esquirol, [Jan. with feverish in themselves tormented heat, delight exposing apparently them suffer much in to cold air or cold but of the water; many freely A disordered and would die if not from severe exposure. winter, guarded them averse to state of the often renders food; taking digestive organs and M. makes an observation of some on this ; importance point Esquirol arise from the that he has never seen bad any consequences namely, in and in melan- refusal to take food in monomaniacs mania, although, with a hurtful and even fatal stubbornness. is resisted cholic, hunger and and with worse diar- Want of effects, sometimes, sleep, constipation, are common in the maniacal. rhoea, symptoms all the has M. that amidst violence Long experience taught Esquirol, for the most a and of it mania, observes, apparent irregularity part, and this he has endeavoured to describe. We think course; regular in are little with this of the general acquainted part subject. practitioners Maniacal are removed to as soon as patients commonly asylums they to the care of become to those accustomed troublesome, and, them, except is more than to be called to what the upon nothing perplexing say of are in or how the disorder will con- chances case, long recovery any or what will be its character in its These are on tinue, progress. points of M. which it is well worth while to attend to the opinions Esquirol. he "has its we three "Mania," says, precursory symptoms: distinguish periods. of and In the the undefinable uneasiness, first, complain general headach, patients heat of the in the of the cranium, entrails, burning feeling pain epigastrium, disgust have internal for food, thirst, vague constipation: they agitations, inquietudes, alternations of and and sometimes insomnia, reveries, presentiments, gaiety sadness, transient but retain affection for their and friends. The delirium; they yet parents the delirium becomes and the moral affections increase; general symptoms permanent, become The to this second is marked some acts of perverted. passage period by of or after a most violence or after a provoked: time, fury, spontaneous frequently considerable the maniac becomes less less to he turbulent, time, calm, disposed fury; and when is more attentive to outward more docile advised. At impressions, length the moral affections the traits of the countenance become less reawake, agitated and the emaciation the is conscious of diminishes, longer, (convulsifs), patient sleeps his state. in to the reestablishment of the functions of nutritive Ordinarily, proportion and relative a more or less crisis takes but if the functions of life, complete place; nutritive life reestablish and the delirium does not dimi- themselves, proportionably we have reason to fear that the mania will into the chronic and nish, pass state, dege- nerate into ii. dementia." (Vol. p. 158.) The of mania not so progress is, however, always quite regular. "We have continues "that this disease varies in its seen," mode of Esquirol, It varies in the of invasion. succession the in their in their ter- duration, symptoms, mination. Sometimes the mania attains its from the highest very period beginning, and continues to the end of the which takes all at once. The attack, place patient seems then like a who has come out of a it to him as if some person dream; appears obstacle which isolated him from the external world has been or has fallen from torn, before his a diminution of the number and of eyes. Sometimes, progressive intensity the foretelsthe solution of the sometimes the symptoms approaching malady; patient arrives at of convalescence a succession of or less only remissions, greater by complete- ness and duration. One to which I cannot too call is the point strongly attention, remission which is in first from observed the course of the month the invasion of the mania: this remission is constant. Does it mark the cessation of the of irrita- period tion?" (Vol.ii. 167.) p. Mania shows itself most in and of robust constitution, persons plethoric &c. on 17 Greco, Fark, Crowtiier, 1839.] Insanity. or nervous The individuals of the affected are sanguine temperament. often of a and irritable great susceptibility, character, possessed lively ardent to with an anger, imagination embracing disposed extravagant and with themselves to hazardous enthusiasm, projects giving up specu- Some of the are found to have been to hemor- lations. patients subject nervous somnambulism, cephalalgia, dreams, affections, rhages, hysteria, and cutaneous diseases. convulsions, epilepsy, mania of has a The character: it comes on after the epileptics peculiar and lasts either a few hours or a few four Of hundred paroxysms, days. at the are maniacal after the patients Salpetriere, fifty epileptic paroxysm. Their is more and more to be feared than that of other fury dangerous any lunatics. Mania is sometimes or melancholia preceded by hypochondriasis. of the limbs or and an uneasiness, Sadness, distrust, general pains head, of some serious or even of are sometimes illness, apprehension madness, the of mania. precursors Mania does not often break is the most fre- out; but it suddenly yet form of a sudden attack. In some in the general, quent irregularity affections is first and we doubt are these, perceived; not, preceded by mental which manifest in these some disordered become movements, only slow and kind of results. conduct, through irregular By degrees, every the disorder arrives at its Sometimes a violent attack of mania height. a of and is state The are preceded by stupor helplessness. patients remain where are to be dressed and motionless, placed, require fed; they their are brilliant and the face contracted. Then the mania suddenly eyes In other and declares itself. after the of cases, violently disappearance the individual feels a sense of well- some habitual indisposition, perfect thinks himself to have attained the most state of health; being, perfect feels of an of and of possessed extraordinary degree strength happiness: more beautiful in his all nature and seems appears eyes; everything the ensue; Insomnia, agitation, possible. constipation, progressively ideas become and "the enters into the most confused, patient gaily of maladies." vol. ii. frightful (Esquirol, p. 146.) the actual state of the mental in As faculties mania, respects M. considers that it consists in a defective of Esquirol chiefly power in atten- as he a defect of between attention; or, it, expresses harmony tion and the actual and recollections. ii. sensations, ideas, (Vol. p. 148.) we would to is a defect subversive of accurate com- This, observe, beg but a defective state of other or as of the faculties, parison; memory, the the same result. imagination, may produce There is to us in the short section nothing particularly satisfactory Dr. Prichard on the state of the and intellectual introduced sensorial by functions in such cases. Dr. Prichard reverts to Pinel's of the opinion in of the moral and disorder, instances, constitution, primary many the in which Broussais has cha- illustrated the quotes passages devouring racter of this moral to an irritation of the theory by ascribing perversion and in that of the on stomach, trisplanchnic apparatus, especially acting brain. Guislain's endeavours to determine the intellectual the particular which the modification characteristic of madness are undergoes process with is mentioned it to have failed, approbation, although pronounced VOL. VII. NO. XIII. 2 18 Prichard, Esquiroi,, Allen, Ellis, Ferrarese, [Jan. to the inscrutable nature of the research." Hoffbauer owing perhaps from is cited as that disorders of the intellect maintaining many originate which is in certain defects in the of too concentrated attention; power distracted in mania. This observation is and monomania, altogether true of but we that the cause of the cases; presume undoubtedly many attention is sometimes an over-excited sometimes a imagination, impaired some morbid train the of the mind of ideas which prepossession by by a delusion of the attention is sometimes and sometimes enchained, sense, an the the constant effect still this defec- of memory; being impairment tive attention noticed and a state Hoffbauer, others; by by incompatible with and with the exercise of just comparison, consequently judgment. of state of the with The connexion functions any particular physical has not been more established than con- the insanity satisfactorily precise dition of the sensorial and intellectual functions. A disordered state of the canal is the most common; but the nature of the relation alimentary disorder is not of this to the mental established. Acute cases are com- febrile and excitement attended with of the heart and monly symptoms, and with Other cases with arteries, supervene sleeplessness. gradually, a state of the natural and vital functions. Customary discharges, torpid and external and internal sometimes when affections, disappear insanity or their comes and resume when the mental dis- on, reappear progress order subsides: if not to the of "The manifestation maniacal catamenia, suppressed previously soon become or cease after its actual Lochiae symptoms, scanty, entirely appearance. which had and other effluxes are become habitual and ; ulcers, analogous suppressed had are dried chronic or are mate- long discharged, up eruptions generally disappear, in of various cease or become lessened; rially symptoms pulmonary phthisis stages in a remarkable On the decline of mental it is often mitigated degree. disorders, found that the return of such or the revival of trains of morbid discharges, suspended of restoration to a sound state of is the not to phenomena, harbinger mind, though health." complete bodily (Prichard, p. 125.) All who have been in the habit of lunatic must have visiting asylums become familiar with the faces of of the who have been in inmates, many and if confinement or we that ten, twenty, perhaps thirty years; suppose to their means have been the view of proper adopted promote recovery, the of such disorders must become limited. curability extremely Many of the no have been from their nature cases, doubt, incurable, very on a constitution of the brain or on irremediable dependent peculiar lesions. In it is not uncharitable to that medical means some, suppose have been too soon abandoned. If take Death recoveries take not place, they generally place early. follows not after the invasion of madness. If neither long unfrequently of these events takes the sinks into a state place, affording patient very The little and set down as of hope, generally hopeless. complication other affects the and with diseases prognosis; insanity materially nothing makes it more unfavorable than the smallest indication of the general of. When the mental disorder has been paralysis already spoken pre- ceded attacks of the chance of is not by epilepsy, recovery great. is monomania or Mania a more curable form than dementia. The number of cured at out of 487 was of two Charenton, cases, upwards fifths. All the and tables of lunatic seem to establish the reports asylums on &c. 19 Greco, Farr, Crowther, 1839.] Insanity. fact is much more in the than that in the recovery probable early advanced of the The of treatment at malady. importance proper periods such an and the of the early period, impropriety sending patient hurriedly house of with no assurance of a off to a of confinement, proper system is but has been far too treatment evident; much being in, persevered very overlooked. Nor are there cases to that even after wanting prove many in a state of the mind and that such recover; years passed insanity may recoveries have sometimes been overlooked or even concealed we have too much reason to Cases are M. Baumes and related suspect. by by M. in which took after more than Esquirol recovery suddenly place duration of madness. Mr. of to whom Hitch, twenty years' Gloucester, Dr. Prichard himself indebted for so has fur- expresses many particulars, nished him with the each of tables time that case, cases, showing many for its treatment to effect and the of time that required recovery, length the disorder hac^existed in each case to admission. The results are prior show not that the number of reco- highly interesting. They only greater veries take but in in the recent that took cases, some, place recovery in a short time after admission into the the disease place although asylum, had been of anterior duration. Of three male who had been long patients and the other insane ten one was cured in ten two in six months, years, and who had been insane was cured in months; one four years forty months. Of two female who had been insane ten one was patients years, and cured in nine months and the other in a three other cases are year; recorded of cure after and eleven, seventeen, twenty years. the the the is the chance Generally patient is, greater speaking, younger of and from the to the end of life the number of recovery: forty-fifth year Yet in the tables of recoveries diminishes. cited Charenton, progressively Dr. men are marked as recovered after the by Prichard, twenty having fiftieth year. Mr. Farr introduces into his able and two very searching pamphlet Tables of one the total admissions and cures Recoveries, showing reported in lunatic both and the other show- English French, twenty-six asylums, the same circumstances in Irish District and at Haslar and ing asylums, Bethlem The cures in the of these of (the Hospitals. proportion highest Retreat at is 50 and in the 18. cent.; lowest, York,) (Hanwell,) per Exclusive of the the of recoveries is 46.2 Retreat, highest proportion per and the exclusive of is 33. Sir William Ellis cent.; lowest, Hanwell, ascribes the small number of recoveries at Hanwell to the chronic nature must refer who is of the of the cases. We the reader interested majority in the statistics of to Mr. Farr's which is full of work, insanity important facts. Dr. to ascertain the Prichard has taken great pains proportional number of recoveries in and has inserted several tables illustrative general, of this from each other. Dr. point, although varying considerably his own a of Burrows has from reported experience proportion eighty-one cases of in one and in recent cases of in one hundred, recovery ninety-one hundred. Dr. of in cures in Jacobi, Siegburg Westphalia, reports forty hundred six as alleviated. In the French one and the cases, asylums of recoveries is about one third of all the and the same cases, proportion seems to take in the but M. proportion place English asylums; Esquirol numerous in France than in that the cures are more i. (vol. says England, 20 Ferrarese, Prichard, Esquirol, Allen, Ellis, [Jan. and is he his for best 93,) p. reproves countrymen supposing everything out of their own a fault of which are we not, think, gene- country; they to be Of late the of however, proportion rally supposed guilty. years, recoveries at Bethlem has been more than one half; considerably Hospital are admitted in disease but it is to be remembered that no cases which the and that the has lasted than twelve the months, already longer paralytic, the and the infirm are as well as those idiotic, excluded, aged, discharged uncured from other With such the of hospitals. restrictions, generality the cases must be favorable to and Dr. Prichard recovery; very justly the of cures would still observes that be but proportion probably greater, for the which those uncured at the end of a are dis- by regulation year The number of cured at the in the second charged. Salp^triere patients is as five in six to those who recover in the first "We year nearly year. are his usual Dr. with absence of not," Prichard, says exaggeration, to draw on authorized conclusion this but we can any positive subject, fail to entertain a doubt as to the of the strong hardly propriety regula- tion still at and a that it is a relic of the subsisting Bethlem, suspicion of our which calls for such a revision and ignorance predecessors loudly to the state of as would ere now have adaptation improved knowledge, been obtained under our continental neighbours." But the most table is that furnished Mr. of the Tuke, encouraging by Retreat near a table the numbers of admissions into York; exhibiting that from 1812 to 1833 with the results of all the cases. inclusive, asylum Of this table Dr. Prichard the first gives following summary; observing the are divided into three that admissions of each one for classes, year cases of than in a second for of less three months cases more duration, than three but less than twelve and a third for cases of more than months, twelve months: the fourth class contains cases of re-admitted. relapse Removed Removed. Cases classed as above. Died. Improved. First class 63 51 8 1 2 Second class 65 10 6 3 Third class 101 31 15 17 4 Fourth class 105 58 17 13 1 Total 334 168 50 10 is warranted in the reco- this table it is seen that Mr. Tuke estimating By veries in as 7 in but as it that some of those recent cases 8; appears nearly enumerated in the died soon after of other first class admission, disorders, been and as others in the same class had in and eccentric, reality long that the were old Mr. Tuke considers of cases, probability consequently is even than as nine to from in recent cases one. greater recovery insanity Our readers will to the statements contained in this sec- do well to refer tion of Dr. for we believe the enter- Prichard's work; general opinion even of a recent tained with to cases of is more date, respect insanity, us to and the unfavorable than ascertained facts retain; permit despond- view taken of has an evident to weaken the such cases ing tendency efforts of to the better of this class of maladies. practitioners get M. ii. considers the maniacal form of as Esquirol (vol. 177,) insanity p. &c. on 21 Greco, 1839.] Farr, Crowther, Insanity. chances of cure. attack is the The first offering greatest generally curable, if with or The second attack is also epilepsy uncomplicated paralysis. often but the disease becomes more doubtful after cured; the infinitely fourth. Of 269 maniacal cases 132 were first 77 second cured, attacks, 32 third and ten were cases in which the attacks had attacks, attacks, exceeded three in number. The duration of this form of is also insanity shorter than that of others: the number are cured in the first greater year, the as is seen Table of cures. by following in Cured the first 27 month,.... second third 18 fourth fifth 24 sixth seventh 20 eighth ninth 12 tenth twelfth 23 in the second year subsequent years Total 269 We would also recommend to careful the sections in perusal strongly the in Dr. Prichard's Treatise to modes of death and to lunatics, relating and As in most other of the recurrent the work, relapses insanity. parts author has in these sections condensed much of the matter, practical into a small value, highest very space. The is thus stated The for mortality by Esquirol: highest mortality, the two is between the of and that of the women sexes, ages thirty forty; is between and that of the men between and greatest forty fifty; thirty of is women than from and after it forty; sixty years age higher among men. It results that the of lunatics is more mortality precocious among and in advanced women." i. men, age infinitely greater among (Vol. From a of different he concludes the p. 102.) comparison hospitals, in the to be different forms mortality In 1 in Mania, In 1 in 16. Monomania, In 1 in 12. Melancholia, In 1 in Dementia, Some idiots live a time but seldom attain to more than long they thirty The of maniacs is in the first two or greatest forty years. mortality years of the the female the it is among patients (at Salpetriere) malady; in the first greatest year. credible that the other'" It would extraordi- scarcely appear among evidence medical men have on nary given by respecting insanity, they that it has no to some occasions averred shorten solemnly tendency one would would show life. The smallest consideration, think, that so serious a disorder of the nervous must in system general of life. Mr. Farr's function statements signally impair every as and tables on this are, usual, valuable, although subject perhaps 22 Esquirol, Allen, Ellis, Ferrarese, Priciiard, {Jan. somewhat intricate to those unaccustomed to statistical details. The are following particulars intelligible. very TABLE V. OF LUNATICS. MORTALITY Ann. Deaths Total one Deaths. out of Deaths out Asylums. Patients Living 100 of 100 treated. treated. year. living, St. Bethlem, Luke's, Lincoln, Stafford, York, 19782 22295 2057 9.02 10.40 and Hanwell t Gloucester, ?Lunatics General population, 1.50 > ... ... ... 40-45, age Sweden 1811-30. of The annual lunatics was 9 the annual the mortality among cent.; mortality per Swedish at the of 40-45 was 1.50 cent. Annals Medicine, population age per (See of It be Swedes need that at this the of the 359.) added, p. scarcely age mortality differs from that of other inconsiderably European nations; madness, therefore, increases the But it is to show that the mean of luna- mortality sixfold. necessary age tics does not exceed 40-45 as there are not observations sufficient to determine years; their at different The mean of 977 admitted in five mortality ages. ages patients years at were in in in Bethlem 1830, thirty-seven 1831, thirty-five; 1832, Hospital years; in in so that 40-45 be thirty-seven; 1833, thirty-six; 1834, thirty-six; may safely as those below taken as the of the entire class?those as well ages above, representing that central (p. 12.) point." Other introduced Mr. enriched the tables one Farr, by particularly by accurate observations of Dr. of the deaths Charlesworth, Lincoln, marking as well as the admissions at decennial of tend to that life, prove periods the as the chances of with increases, mortality diminish, age. recovery not Too little attention has been to the causes of paid insanity; by the so terrible medical but and the of observers, by public; yet prevention an affliction is even of more than the of its cure. consequence possibility An individual who has once been insane seldom his social regains wholly he is with at least occasional and a union position; regarded suspicion; of with him is shunned families. the indications by prudent Still, early a and to are too little heeded, temperament prone insanity proper preven- tive cautions too much A valuable of Dr. Prichard's disregarded. portion book is devoted to this he connected observes, subject. Many questions, with the of mental are and will theory disorders, perhaps always yet of insa- remain involved in but an into the antecedents obscurity, enquiry and is accessible to us. into the disclosed dissection, nity, appearances by We this as one because the mention enquiry, necroscopical phenomena are valuable as the of the dis- throwing light origin chiefly upon physical ordered state of the and form a of that more mind, general enquiry part causes are which the moral causes. The still, comprehends predisposing we of the most Among these, apprehend, important objects study. Dr. Prichard of here- considers the influence constitutional predisposition, or attacks of sex; original; previous insanity ditary age; temperament; and other diseases of the education: brain; and, lastly, being guided, the these by throughout enquiry comprehending interesting particulars, facts collected from and considered. various countries, carefully insa- That certain and are more to certain individuals, families, prone than is a fact admitted on the most extensive nity others, universally &c. on Greco, Farr, Crowther, 1839.] Insanity. and that when once it has arisen it is testimony; frequently transmitted, seems well established. M. is of that the children equally Esquirol opinion in whom declared itself at some before of their parents insanity period birth are more to become insane than those born before the likely appear- ance of the an of which we somewhat the malady; opinion question He is also that the is more soundness. of disease opinion frequently the female than the male. transmitted i. (Vol. 65.) by parent by p. When has in the of both it is reason- insanity appeared parents, family able to that the to it in the children is presume predisposition stronger. the the cases constitute one but the sixth; Among poor, hereditary pro- is still the rich. loc. He has now portion greater among (Esquirol, cit.) under his care the children of several whom he attended in the patients first of his years practice. Out of 1380 admitted into the Middlesex Lunatic it patients Asylum, was ascertained that the or relatives of 214 had been and insane; parents in 125 of the cases no other cause could be for the Sir disease, assigned William Ellis than that it was says, hereditary. ( Treatise, p. 42.) Certain of of the constitutions the laws, physical obeyed by persons same seem to induce at of in the life; periods family, malady particular some families and in others about the of The effect very age fifty. early, in a of between near of kin to marriages persons producing tendency has Accidental the been fright experienced by insanity long suspected. mother is mentioned as a cause and we during by Esquirol; pregnancy unborn have little doubt that the character and of an individual happiness is often the state of the mother's mind her influenced by general during When in several members of one pregnancy. insanity appears family, it is in the same form: the to suicide has often been commonly propensity a nervous thus and it is well known that observed; peculiar temperament exists in some of some of the members are and some which families, mad, to or some are melan- disposed chorea, epilepsy, hysteria; paralysis, nervous. whilst some remain life odd and cholic, through merely to than men is a of Whether women are less question subject insanity which different sides have been on uncertain since the taken, grounds, Dr. time of Coelius who maintained the affirmative. Prichard Aurelianus, evidence of this not has into two such compressed pages satisfactory the that we cannot do better than those before our being case, lay pages in relation readers. The is no means an one, question by unimportant to the causes. The evidence is taken from M. Esquirol's principally on the House of Charenton. report Royal In the of the to which M. has Charenton, hospital during years Esquirol's report the of male admitted to that of female was three to two. reference, proportion patients is different from that This is the result of and circumstances, very proportion peculiar which obtains as well in France as in other countries. From a of elsewhere, variety in the of the and documents it that, great hospitals Bicetre, public appears Salpetrifere in an inverse to that above stated holds the numbers of the two sexes; proportion male at to females in the as two to three. the Bicfetre being Salpetriere only patients does not hold France. It from a number This, however, throughout appears, great of documents which M. has that in the and collected, published Esquirol private male is than cities in the south of France the number of somewhat more considerable that of female in the northern the number of females lunatics; while, departments, bat that in all France the number of insane women in a predominates greater degree; is to that of insane men in the of 14 to 11. From the very nearly proportion Spain 24 Prichard, Esquirol, Allen, Ellls, Ferrarese, [Jan. returns M. the which has been able to obtain are defective: Esquirol result, very which can be looked as a since it rests on few and data, only upon one, presumptive of one fifth hereafter be modified more an excess may information, by copious gives in the number of female lunatics with that of males. In it Italy appears, compared more from the documents that the is there obtained, different; proportion being insane men than of In all 5718 in the women, kingdom Italy, particularly Naples. In accord- male lunatics were and 5067 females. Holland and reckoned, Belgium, to the information to world M. it that the number the ing given by Guislain, appears of females-in the lunatic is much more considerable than that of males, asylums being as this excess on the side of females is rather in the or 34 to 29 and ; greater southern, than in those of the or in the Dutch In north, Belgian provinces, present kingdom. Great Britain and the female lunatics is as 13 to 12. of male to Ireland, proportion In the number of men to that of is more consi- England, insane, compared women, derable than in Scotland and of Ireland. This excess in the number proportional male above that of female lunatics in is to Dr. Burrows, England greater, according in the than in the who this lower classes of M. has cited higher society. Esquirol, adds a remark in to the of different orders of observation, parallel respect comparison in more France; men, society insanity being apparently prevalent among compared with in the than in the lower classes. women, higher In the same M. in the north of the memoir, that, Esquirol computed Europe, female is as above stated: that of male to lunatics than he it proportion greater says is as three to two. In this are included the results obtained from of lunatic reports in and Russia. various of in Subse- asylums Denmark, Norway, parts Germany, to the of this M. Dr. Max. Jacobi has us quently publication report by Esquirol, given extensive information on the state of lunatic in the Prussian on the asylums provinces Rhine. In the different of that the total number of male establishments country, in the was and that of females 835. The result lunatics, 1824, 1180, year nearly coincides with that deduced from other documents for the M. general by Esquirol of proportion Germany. "In has some new a later which in M. memoir, 1830, given appeared Esquirol results from the statistical on lunatics in Dr. Hoist. reports Norway, published by to an of He reduces the of male to female lunatics in that excess proportion country one sixth instead of one third part. In the United States of it from information Dr. America, by Rush, appears given Portman and a of the in Connecticut in of by Massachusetts, asylum printed report that the number of insane men is than that of female lunatics. Later 1827, greater this In the State of New researches have rendered observation more York, precise. and the of males to females is as Pennsylvania, Connecticut, proportion very nearly two to one. On the results of his M. has shown in a that, summing enquiries, Esquirol up in sum total of not all at the same 76,526 lunatics, confined, period, asylums though or of civilized there were males and in various the 37,825 38,701 parts world, hospitals a fraction females. Thus the of males to that of females is, being proportion neg- is much the less in the 37 to 38. This difference so considerable, lected, as, general the number of males somewhat exceeds that of small as it females; population, yet, of Coelius it is as M. to refute the assertion is, sufficient, observes, Aurelianus, Esquirol who women are less to than men." that subject insanity (p. 162.) supposed ii. that mania is We find however, 138,) Esquirol, stating (vol. p. women. In he the more men than men, adds, frequent among among the mania is more violent and consciousness of character of impetuous: more audacious and the habit of command render them and strength difficult to restrain. Women more more and more furious, dangerous, are more and less are more and talk more; dissembling, noisy; cry easily in confide those about them. Before the of is a rare affection: it then becomes age fifteen, insanity not and when middle is with its attained, unfrequent, age occupations &c. on 25 Greco, Farr, Crowther, 1839.] Insanity. of the mind are more and affections common; less cares, being again from the actual number of as admissions) age frequent (judging ap- in are characterized The attacks life ex- early generally by proaches. of middle more assume the those character of citement, age frequently and those of more advanced of but these dementia.; years melancholy, are we to numerous observations liable, presume, exceptions. Indeed, the of individuals till old then become who, proportion surviving age, in the form of is considerable. insane, dementia, especially the causes of Dr. Prichard does not insanity, Among predisposing omit to make a few remarks on the education; out, pointing especially, and a evils of too want of moral and an great indulgence discipline, and exercise of the intellectual overstrained premature powers. Examples of the bad effects of the last-mentioned error are not and it seems rare; reasonable to that a of education calculated to inculcate suppose system and of habitual the restraint violent emotions and sedateness, passions, the of attacks of violent must tend to lessen chances mania. We are aware of facts to which we could in not, however, any confidently point of this not unreasonable proof supposition, although they might possibly in be found in the statistics of the of Friends. insanity Society This of Dr. in a section is treated devoted to a Prichard, subject by consideration of the moral causes of and to the effects insanity, especially of It would that the number of insane in religious appear impressions. to three in a the amounts 1000; : Society nearly very high proportion but Mr. who furnishes the details from which this is Tuke, proportion is to doubt the data which the of computed, disposed upon proportion madness is in lunatics in rests. rare the England Religious very Retreat, or madness from from or domestic disappointed affections, intemperance, afflictions. Mr. Tuke also that moral observes, justly improprieties connected with mental are more as in- peculiarities frequently stamped than in the world at the large. sanity among quakers Upon whole, the that there are fewer cases of therefore, is, presumption insanity among them than occur in other sects. in a section on The circumstance alluded to the Moral and subsequent Causes of that accustomed to among savage nations, Physical Insanity, the most vehement mental disorders are considered to indulge emotions, that women be and the fact are not less rare; of, already spoken prone to than are not of a nature to us to so much men, encourage insanity lay first stress this class of causes as at reasonable: upon might sight appear the our made some minds, observation and, indeed, impression upon by of the forms of in individuals known to or whose insanity previously us, we have been able to habits and character is not that ascertain, previous of them were remarkable for to the great majority susceptibility impres- refinement of warmth of or of sions, nor feeling, passions, activity mind, reverses or afflictions. It for sustained is, having great heavy however, that the number of inmates of the lunatic to be stated, greatest asylums of France consist of and traders, merchants, men; who military persons been to the extremes be to have of and supposed subjected hope may The various tables introduced into this of section disappointment. and well merit the reader's and attention; (Moral Physical Causes) they more than at that moral causes are those of a show, least, frequent phy- kind. sical 26 Priceiard, Esquirol, Allen, Ellis, Ferrarese, [Jan. it will be found that however events, Perhaps generally private appal- and less however are ling, afflictions, severe, private frequently produc- tive of mental disease than those occurrences to which is great publicity The murder of the of in London, given. Marr, twenty ago, family years was of in whom we have ourselves individuals, seen, productive insanity in remote of the The successes and the reverses, parts kingdom. equally and of the late of the took striking dramatic, French, emperor possession and minds in countries of of, disturbed, morbidly many Europe. many in it even these be but the of remarkable Yet, cases, might predominance events in minds and for one diseased, previously prepared usurpation by idea. The of France for has abounded in events history forty years past so or we call them so that we can feel no astonishing, might romantic, on that almost of the scene has surprise finding change every political left its traces in the madhouses of as M. have, Paris, Esquirol says they from the of the Bastile to the last of and taking appearance Bonaparte, from that to the in period present. Kings deposed, queens obscurity, unrecognized dauphins, disregarded patriots, neglected commanders, and chevaliers abound in those institutions; emperors deposed, restored, in our own are to be found zealous re- as, just establishments, actually formers in church and and alarmed madness the to state, clergymen by dread of Roman catholic These circumstances fix them- ascendancy. selves on weak and and disorder morbidly intellects, wandering utterly them. Real and discoveries in science have often the same pretended effects: electrical animal experiments, phantasmagoria, magnetism. The causes of are i. melancholia forcibly depicted by Esquirol, (vol. He enumerates them the air of p. 422.) among marshes, and, during the of hot and countries. Melancholia winds, prevalence particular dry is said to be in and which frequently produced dry burning atmospheres, exalt the and render the vehement. Such was found sensibility passions to be the case in and in to Greece, Aretseus, Bontius, Egypt according and and modern travellers have made simi- Prosper Alpinus, Avicenna; lar observations in Asia and the coasts of Minor, Upper Egypt, Bengal, In Africa. the autumn of the summer of that been 1818, year having hot in more cases of melancholia were numerous than France, unusually but the influence of no means usual; the seasons seems esta- by firmly blished. Cases of to be most however, melancholy appear, frequently cured in the spring. Children have been observed to become and delirious in melancholy of excited the attentions of those to whom consequence jealousy, by they were attached to others: have become and have given being they pale, sunk into fatal marasmus. sometimes of a Melancholia, religious kind, sometimes out of disordered is observed at the of arising passions, period in In adult causes excite both men and women. it, puberty. age, many In old is well it is rare. The melancholic known to age temperament be often associated with and of talents, great great powers application, for or evil. Professions which excite the and the good imagination are found to to it. but, passions strongly predispose Musicians, poets, above are in liable to it. Errors and all, actors, diet, very especially excess in to and Voltaire tend drinking, it; directly produce expressed an truth when he observed that exercised a important constipation disastrous influence on the determinations of the great. Impairment Greco, Farr, &c. on 27 1839.] Crowther, Insanity. of the functions of the skin has been to act as a and cause; thought the retrocession of But sometimes disorders of the eruptions. pas- affections the most sions and to M. are, according Esquirol, frequent all the causes of melancholia. The causes of as of other of this, forms of mental do not exercise their influence disorder, always primary on the brain: their first effects are often on the abdominal produced and on to from that to and melancholia. viscera, pass hypochondriasis, are mentioned in M. and have been the Instances Esquirol's work, of observations made in which the separate him, particular subject by of and the in these cases arose from actual local fancy supposition patient a of some we disease; point practical importance, although apprehend its existence has been in the number of recognized greater scarcely yet lunatic Ulcers in the chronic cancer of throat; asylums. peritonitis; the of the transverse arch of the have occa- stomach; colon, gangrene of the existed as causes from which sionally phenomena hypochondriacs drew false conclusions as to the of creatures in the abdo- presence living men or the throat. The Dr. the tables, Prichard, following quoted by illustrating propor- in the are and tion of cases of married and unmarried, curious, insanity for useful reflection. matter may supply number of male and in "Total Bic&tre, lunatics, imbeciles, epileptics 1822 764 January 1, in the at the same date . . 1726 Total number of females Salpetrifere, are distributed as follows: They r emaies. ivxaxes. Unmarried .... 980 397 201 Married ..... Widowers and widows . . 291 5 3 Divorced .... Not noted 53 Total . . . 1726 In the of unmarried to married is much as Germany proportion persons greater, be from the I which take from Dr. Jacobi's may judged numeration, following Statistik. The total numbers of 1180 male lunatics and 835 females are thus distri- buted: Females. Males. Unmarried .... 599 974 Married ..... 156 176 Widowed ..... 80 30." (p. 185.) Dr. in these tables Prichard that if the observes, disproportion displayed were found to it would constitute a feature in the exist, leading generally of mental but that the of most history derangement; reports hospitals are not with to determine the fact. The reader sufficient kept accuracy can fail to that Dr. Prichard's references are almost scarcely perceive and made to authorities and documents; to invariably foreign foreign a tacit condemnation of our own esta- this circumstance into interpret if not of our own too we deserved. It much, fear, blishments, writers, have how little our lunatic establishments indeed, is, surprising large the of The chief care seems contributed to general knowledge insanity. to be devoted to the mere of the and statistical in- insane; safe-keeping and even the cure of the to be formation, disorder, appear comparatively 28 Prichard, Esquirol, Allen, Ellis, Ferrarese, [Jan. overlooked. Lunatic instead of become show- asylums, being hospitals, places. the moral causes of Dr. Prichard has discussed with Among insanity, fairness and the of in dif- great ability comparative prevalence insanity ferent in Catholics and The and Protestants. sects; religious especially result seems to that wild and vivid and be, enthusiasm, strong preaching, fearful madness in the followers of all sects. impressions produce The of and want of domestic selfishness, disregard religion, prevalent are noticed M. as so affections, causes of disordered by Esquirol many mind in his own and to these he adds a of education in country; system which the mental faculties are more cultivated than the affections of the heart. i. These causes to be but too in all (Vol. p. 50.) appear general countries. An lesson be the fact stated from important may gathered of the moral causes of the most are that, by Esquirol, frequent insanity, reverses of and domestic pride, fear, alarm, ambition, fortune, disqui- etudes Moral he also are more causes, (chagrins domestiques). remarks, than causes of frequent physical insanity. After the causes of of the mentioning, among physical insanity, injuries Dr. Prichard alludes to some of those in head, extraordinary examples which the faculties were such accidents. One of the innu- improved by merable on which the wit of the of has points opponents phrenology been exercised is the of this occurrence; Dr. occasionally Gall, possibility we related the case of an idiot who became reason- believe, having very able after out of a window. It was even re- falling two-pair-of-stairs' commended that a hint should be taken from an such for the example of our curative and that from the enlargement resources, projection windows of stories should be added to other for upper therapeutic agents the deficiencies in like of the human frame. These supplying portions witticisms are shown cases cited who Dr. Prichard, abjures by by phre- to be he he has been informed on nology, quite superfluous: says good that there was some time since a not far from in authority Bristol, family, which there were all three considered as but that one of idiots; boys, them received a severe his of the faculties to having head, injury began and he became a man of and as a bar- brighten, good talents, practised his less still idiotic or imbecile. Like rister; brothers, fortunate, being cases are also from Van Swieten and Haller. quoted to the ardent heat of the sun has a been cause of Exposure frequent and to the heat of a fire has similar effects madness; exposure produced on cooks. The of and has been suppression eruptions discharges long noticed as an occasional and Dr. Prichard that he has seen cause; adds, some cases of mania rheumatism which on had supervening inflammatory "cases of acute the subsided; inflammation affecting large very joints, which had been reduced too a measure which in this by profuse bleedings, disease also rise to metastasis." gives We find several details the of interest connected with of cli- subject mate and season in M. treatise. The in temperate climates, Esquirol's which of the are are the most changes atmosphere frequent, productive of Excess of cold in and of heat in Russia, insanity. Egypt, produced cases in the French The commotions about many army. atmospherical the are found to excite become more and equinoxes lunatics; they noisy, demand more care. The admissions to the are most numerous Salpetriere &c. on 1839.] Greco, Farr, Crowther, Insanity. in and and least numerous in and March. May, June, July, February in in winter. When Some lunatics are so and some an summer, only itself in or if it does not end attack shows it summer, promptly, spring is to the winter. The monomania and mania of commonly prolonged end in favours the cure autumn the Summer most of de- only spring. mentia. Cures which take in the hot season are but of a rare, place character. M. has not been able to himself Esquirol satisfy permanent As with relation to the of the moon's influence. the question regards character of he that there are observes madness, epidemic certainly years in of moral madness seems all at once to which, causes, independently in a number of individuals. i. appear great (Vol. p. 25.) The abuse of cause of is a stimulating liquors frequent insanity among the the and the but rare the Americans; English, Germans, among French. has sometimes had the same effect. There as re- Opium is, both in and a some indivi- gards opium mercury, peculiar idiosyncrasy which are roused to extreme on duals, by they irritability, bordering these if the medicine is mania, medicines; by which, persevered in, may, and which we doubt not in some cases on to mania. has, gone Insanity in of sensual vices is more common in France than consequence probably in the countries above mentioned as so unfortunately distinguished by allusion in excess in We find and spirituous liquors. frequent Esquirol, indeed in most of the works before to the serious of us, consequences It is we that too much stress is laid think, upon manustupration. possible, this habit as a the actual circumstances of lunatics in confinement cause, considered. We must that Sir William Ellis's to remark, being attempt his readers from details of this kind them alto- guard general by putting in into an is to be as unfortunate its result as the gether appendix, likely similar one of the editors of certain Classics for the Use of Schools, very who omitted in the but collected text, objectionable passages carefully them all at of each the end volume. Intestinal irritation has already been alluded and the various states of the uterine which lead to; system to have attracted attention. An has been made insanity general attempt to the of the which often connected with state intestinal canal is specify mental and Dr. Prichard's it is contained in disease; opinion concerning the following passage. much more "The state of the intestinal canal to which I allude is itself frequently of an nature than it has been or at least than it was inflammatory generally imagined, to In that which rise to Costive- be. condition of the canal formerly supposed gives and ness with and with alternating diarrhoea, flatulence, accompanied indigestion, anorexia and transient but often acute in the eructations, nausea, pains hypochondria, livid and suff of in or redness of the usions the viscid secretions the mouth, yellow skin, fauces and with a and the whole train of often surface, palate, glazed dry symptoms a low of chronic inflammation in the mucous membrane of the depends upon degree in intestinal and this is a if not an those cases canal; state, perhaps frequent, ordinary in which disorders of the nervous on of the stomach system supervene complaints and bowels. This form Ferriar and several of disease has been described Dr. by other but it is to M.Broussais that we are indebted for a more writers; practical of its ample development pathology. "The enteric which the foundation for maniacal as well disorder, lays symptoms, as for other affections of the nervous is the result in different instances of va- system, rious and diverse noxious most is in of sti- causes. The excess the use very frequent mulant and food. Too of the the more indigestible great indulgence appetite among and the lower classes unwholesome diet, opulent, among long-continued constipation, 30 Prichard, Esquirol, Allen, Ellis, Ferrarese, [Jan. the use of salt to cold and or of warm want, provisions, exposure neglect clothing, rise to diseases of the same give description." 206.) (p. Such is the of of of the cases probably explanation many insanity which occur in of the as in quiet agricultural districts, parts country, where is no means an uncommon affection: but we have insanity by little doubt that there are shades of intestinal most se- many irritation, the short of the condition. In brain, riously affecting inflammatory towns and in those in which the diet is sti- cities, especially customary is in as it the irritation more Paris, mulating, certainly may frequently the or assume character. inflammatory sub-inflammatory It be an error to ascribe all of however, cases to intes- would, insanity in tinal which marks of intestinal disorder existed life disorder, or during are after death. found Inflammation and ulceration of the mucous membrane of the intestines no more as M. that observes, prove, Esquirol that membrane was the seat of the of the than disorder, origin they prove, in that the disorder there. Lunatics are obnoxious to phthisis, begins kinds of chronic become become inflammation; scorbutic; many they they we must to find the intestinal mucous phthisical: expect, therefore, membrane diseased. i. In three of the how- (Vol. p. 87.) cases, eighths the same admits that the die of diseases of the ever, authority patients in two of abdomen diseases of the and in two of ; chest; eighths, eighths, affections, These calculations are the result of the 104.) encephalic (p. examination of about 600 cases after death. We must our belief, express founded in on the of lunatic that the part Reports establishments, corpo- real ailments under which the and die are unhappy patients languish very often and are not met treatment. overlooked, consequently by proper The we have a are made kind of show-houses: establishments, observed, should be for the diseases which involve the they hospitals complicated functions of the mind. We that the mental often be grant malady may but the first of that total of the frame which or sign impairment phthisis, or or or marasmus afterwards more scorbutus, hydrothorax, paralysis, but we there are cases in if the life of declare; the plainly suspect which, were some of the maladies on the patient preserved through supervening mental the mind would be found to be and the disorder, restored, malady to be critical. With the of lunatic these present management hospitals, can neither be verified nor refuted. In of them medi- conjectures many cal aid is considered to be and in some we are in- nearly superfluous; formed the that of in has if not appointment physicians ordinary been, the at least to as if the debate, rejected by governors, subjected grave were no more than a county asylum supplementary county-jail. Pinel observed that lunatics are liable to sudden and fatal attacks of in winter. It is most common in the old. All at apoplexy, particularly once the most violent or and in a few delirium moments the ceases, fury as if all the forces of life were exhausted. vol. i. dies; patient (Esquirol, In one that of an emaciated man of there had case, p. 107.) seventy-two, been continual delirium with for three months: the on agitation patient, asked his servant for his took a of awaking, very snuff-box, calmly pinch and Putrefaction of the and no snuff', expired. body proceeded rapidly, alteration was found within the cranium. M. maintains that remit- be either continued, Esquirol insanity may or intermittent. In the form is acute tent, continued there an stage, &c. on 31 Greco, Farr, Crowther, 1839.] Insanity. concomitant then a chronic of with delirium; symptoms; stage simple and a third in which the attack declines. Remittent cases stage, present the of the com- remarkable both as to character and duration anomalies, a be three months and three months melancholic, may plaint: patient and then four months or more in a state of and so dementia; maniacal, with more maniacs are on or less Some successively, regularity. only at certain times of the on or seasons. In- violent or certain day, days termittent cases be annual. may quotidian, tertian, monthly, quartan, He i. that the doctrine of crises is 79.) thinks, also, (Vol. p. applicable to cases of and that a a crisis is not to be cure unmarked insanity; by as he the disease terminates Sometimes, depended upon. expresses it, in and sometimes a of the absorbent resolution, by predominance system; and the become the delirium If the delirium fat, patients disappears. the is a of dementia. In other emaciation continues, sign cases, obesity advances almost to a fatal and then takes These point, recovery place. M. terminations considers to be critical. cases are re- Esquirol Many solved fever. The and the of the catamenia by appearance disappearance often critical. the cutaneous diseases which prove equally Among by their an mentions end to M. the madness, itch, appearance put Esquirol to the of Persons of acute according opinion Hippocrates. sensibility well we what it is to the actions of know, presume, go through crying, and shed a are to when not to tear. Maniacs this; and, yet subject do shed a cure sometimes follows. A state of the tears, they transpirable restored warm baths or the return of is often skin, by by spring, very serviceable. Several mentioned effected are of cures interesting examples moral in one of the a on his to drown cases, man, by impressions: way was attacked he defended himself and himself, robbers; by got stoutly, rid of his madness. In the fifth of Dr. Prichard's treatise the various morbid chapter very detected in the head in cases of appearances insanity, by Morgagni, and Greding, Haslam, Pinel, Calmeil, Foville, Esquirol, Georget, Bayle, are and do conduct the reader reviewed; clearly although they not, perhaps, to deserve his attentive consideration. conclusions, very positive certainly The results of M. Foville's to examinations are not familiar yet very students. In acute he has observed intense redness of the English cases, surface and of the of substance of the without adhesions matter, grey any the membranes to such adhesions he a characteristic it; thinks, being, of the chronic connected with their In the chronic cases, incurability. the cortical to a certain found firm was and cases, substance, depth, a distinct when torn left the dense, lamina; which, constituting off, remainder of cortical substance the and somewhat red, soft, mammillated, in these cases the surface of the cortical sub- resembling granulations: is stance The volume of the convolutions is either natural or very pale. diminished. There is sometimes a real of the convolutions, atrophy which is in the frontal of the and a chasm frequent regions hemispheres; filled with of the the absorbed substance. The serosity occupies place in these the external lamina of the cranium diploe disappears cases, the a on the head. approaches internal, causing superficial depression of the cortical substance is also a observed in Softening phenomenon chronic an of the whole cortical and cases; substance; equal softening this is sometimes with coexistent increased hardness of the medullary 32 Prichard, Esquirol, Allen, Ellis, Ferrarese, [Jan. It would seem that these to cases of the portion. belong appearances last of with and marasmus. The dementia, degree general paralysis and substance also are not unfre- texture of the white colour, density, altered in the brains of lunatics: it is sometimes more or less quently in sometimes of a white and increased hard- injected: splendid colour, tries an effect which M. Foville to account for that ness; by supposing fibre has contracted adhesions with the fibres. each cerebral surrounding Sometimes the brain is full of serous and sometimes fluid fluids; limpid is collected in numerous small from the size of a millet-seed to cavities, and to be the extravasations. that of a of nut, supposed sequelae The which have been observed M. Foville in the mem- changes by branes in acute of the the arachnoid cases, mater, are, injection pia pre- natural in is its chronic the arachnoid and serving aspect: cases, opaque and are formed on its thickened; granulations surface, pseudo-membranes and is effused into the cellular tissue of the mater and the serosity pia ventricles. M. Foville These are all indicative of inflam- remarks, appearances, the brain the in the itself; membranes disease, changes matory affecting with an it; opinion quite being only accidentally complicated opposite to that maintained M. who considers to be the effect by insanity Bayle, of inflammation of the membranes. The few consecutive necroscopical made in own lunatic if do not en- observations our establishments, they countenance the of the invariable existence of the appear- tirely opinion ances described M. are at least insufficient to contradict Foville, it; by it is that the desire to maintain views although possible particular may an unconscious influence on M. Foville's of obser- have exercised powers vation. The whole of medicine tells us to distrust the most those history which the most their and systems appear imposing by uniformity simpli- When will our institutions for the insane assist in the city. large public elucidation of these questions? The most constant observed in connexion with mental affec- changes tions are to M. in the cortical substance of the found, according Foville, and he considers the view of M. who ascribes the brain; Calmeil, paralysis to as these the attended some incorrect; changes, paralysis being always by alteration of the white to the cortical substance, change. superadded A remarkable which occurred in the clinical course of M. in case, very Esquirol, in affords evidence favour of M. Foville's The cerebrum of 1823, strong argument. an idiot the substance of both in the last of displayed grey hemispheres stage atrophy and while the white of the brain remained on one side. disorganization, portion perfect In this the intellect had been but the muscular on defective, person entirely power one side had failed. From this and similar M. Foville concludes observations, only that the function of the cineritious of the brain is connected with essentially portion the intellectual and that of the fibrous or white structure with muscular operations, action." 225.) (p. The case here adduced in of the is inte- support opinion extremely but means a new one. the itself is no M. Foville's resting; opinion by that morbid in the cortical principal inferences, however, are, changes substance are connected with intellectual and derangement, directly in in the white substance with disorders the motive changes powers. In cases of the of the and the madness, brain, puerperal paleness absence of the have led M. Foville to consider above mentioned, changes &c. on Farr, 33 1839.] Greco, Crowther, Insanity. of this form of mental disorder to be the result some disease deeply-seated of the uterus or abdomen. There can be little doubt that the contradic- evidence different observers of the of the brain tory given by appearance in in the existence of to be accounted for cases in is, insanity part, by which the affection of the is functional and brain merely sympathetic; the disease in some other in some of the primary being organ, especially viscera. abdominal We consider the observations of M. in relation to the mor- Esquirol, bid and to the conclusions to be drawn from as them, appearances, of remembered. The various states of the cranium highly worthy being and the brain with of the cerebral functions should compatible integrity be and the from or be- ascertained; scrupulously appearances resulting to concomitant maladies be from those longing carefully distinguished which to the mental affection. The existence of lesions belong organic of the brain is declared distinct from the madness: chronic by symptoms inflammation and and results produces compression paralysis, paralysis from cerebral and of the hemorrhage: tubercles, tumours, softening brain have their which cannot be confounded with peculiar symptoms, mental alienation. the and instantaneous sudden relief ex- Moreover, in some cases of madness is not to be Two circum- perienced forgotten. mentioned when the morbid stances, also, by Esquirol, enumerating in different ever to be borne found in cases, ought appearances actually in dissections of no alteration of mind; lunatics, namely, that, many any kind has been had existed for and found, although insanity many years; of the brain has been found every part altered, suppurated, destroyed, without chronic lesion of the i. understanding. (Vol. p. 113.) The maniacal form of M. fatal. The is, insanity Esquirol says, rarely do not die of the cerebral but of patients affection, fever, typhus phthisis and convulsions. die as if the pulmonalis, epileptiform They suddenly, to life was exhausted. In a case men- sensibility necessary previously in which death took in this no cerebral lesion was tioned, manner, place found and after the same was observed in the case of a death; young woman who was killed in a state of recent and furious mania. accidentally Sometimes the brain and its membranes are found when the uninjured disease has lasted a is watched some When case he life, years. during thinks the in which the cerebral lesion commences be known epoch may the When he is of mania has existed that by symptoms. long, opinion the weakness of the last of life to local inflammations. days disposes the he concludes the labours of MM. whole, that, Upon notwithstanding and has not Foville, Calmeil, Guislain, pathological Bayle, anatomy yet declared the reason of mania. this organic Thirty years ago," says veteran I should have written on the observer, willingly pathological cause of I will not now so difficult a such are labour, insanity: attempt the in the results of the and contradiction examinations of uncertainty the bodies of lunatics after death to this But I that modern add, up day. researches and us to for more clear, permit hope positive, satisfactory notions." ii. (Vol. 181.) p. Severe diseases of the obscure or life, lungs, unsuspected during appear to be common in cases even cavernous of excavations, very insanity: no when has been observed. Diseases of the heart are expectoration the relation of attendants on but the nature of these, frequent insanity; VOL. VII. NO. XIII. 3 34 Prichard, Esquirol, Allen, Ellis, Ferrarese, [Jan. as well as of the to the is not es- affections, insanity, pulmonary clearly tablished. are not to be looked as causes. Of They probably upon affections in cases of inflammation of abdominal the insanity, existing mucous membrane of the canal seems to be the most common. alimentary M. some time described of the Esquirol, ago, displacement colon, which observed in of he had several melancholia. The examples colon, in these had assumed a its left instances, perpendicular position, extremity to the behind the os If the state of the liver has descending pelvis pubis. with as has often a close connexion been so and insanity, long generally this at seldom found to have considered, organ is, least, undergone structural in such cases. A number of melancholic change great patients of are found to die die of abdominal diseases; phthisis pulmonalis; many in the are but alterations intestines rare in them. vol. i. organic {Esquirol., p. 464.) As in some instances to arise from direct disorder in insanity appears the without structural and sometimes from evident disease brain, change, as in other cases it to be of that occasioned the dis- organ; appears by ease first other as the and affecting organs, liver, intestines, uterus, &c., the and in addition to these there brain; as, secondarily affecting cases, are others in the first made on the which, probably impression being is on the a effect or brain, liver, intestines, uterus, secondary produced from which a reflex action and more intense other disorder is organs, occasioned in the it cannot occasion to find what brain; surprise ingeni- ous have hence arisen as to the first cause of among pathologists disputes be a disease some it to of the some that it mind, insanity: maintaining and others that it is an is disor- always idiopathic, entirely sympathetic the source of which has furnished further of der; yet subject controversy. Dr. Prichard maintains in a of the whole that, cases, great proportion inflammation of brain train of the and its phenomena depends upon and that in the rest there is reason to believe that a membranes; every of the brain is or induced which has condition a primarily secondarily to on an and he in character; observes, put inflammatory that, tendency the of brain cases of the which renders duration, long disorganization or is it, inflam- recovery impossible, generally precludes produced by These of an the mation. opinions have, course, important bearing upon treatment. We in M. Treatment of Insanity. observe volumes oc- Esquirol's that so little effort is made to make casional lunatic regrets expressed of instruction for Mr. Farr also alludes pupils. asylums places very to this Of the of under certain ob- this, strongly subject. practicability and a vious no doubt seems to be entertained him; similar by regulations, is Sir W. and Mr. whose work on Browne, Ellis, by opinion given by Lunatic we noticed in a former Number. This was ear- Asylums subject the but without ten of advocated, effect, ago, nestly years by professor on the medical school of the the establishment of London medicine, to this little has been done to facilitate the very University. Up period details of of a of the the serious acquisition knowledge practical very class of the interests of mental disorders; the and, although public impe- demand that medical should be furnished with more riously practitioners exact notions and indications of treatment in the various cases received &c. on 1839.] Greco, Farr, Crowther, Insanity. been into for the there has not found sufficient moral insane, asylums yet of of the or in the sufficient managers great public institutions, courage any in medical to establish clinical instruction on a scale any school, enterprise or to a diffuse a extensive, sufficiently plan sufficiently systematic, ge- with the and the of neral acquaintance phenomena therapeutics insanity. In this state of the of those who have had the things, practical experience and the of care of who communicate results their lunatics, many practice to be considered. to the public, ought attentively We should well observes M. endeavour to ascertain if first, Esquirol, there are indications to be fulfilled. When there is any urgent lively and in excitement and baths which the plethora, bleedings, tepid patient is a and sometimes time, cooling drinks, laxatives, light diet, kept long counter-irritants to the almost a skin, applied always produce remission, and sometimes a marked in intermission, fifteen, very eight, twenty-one, or Time is then afforded to consider and combat the causes thirty days. of the disorder. If which were have been hemorrhages customary sup- if an ulcer has or a cutaneous affection dried, pressed, disappeared, pre- vious or the of to the outbreak of mania these monomania, reappearance will almost cure the mental affection. i. If this (Vol. p. 145.) certainly to effect should not we then have recourse treat- follow, may empirical ment. Dr. Prichard his observations under the two natural arranges practical the latter heads of the and the a term com- Moral; Therapeutical being on disorders of the to a combination used writers mind, monly by express of mental witn moral means of the cure. For the sake of forwarding to this we shall our observations order, according arrange unexception- able which is that Dr. Ferrarese. also division; by adopted Treatment. The indications to this as Therapeutical belonging head, from the laid down Dr. differ in indications Prichard, by nothing general of cure in all other the first to if diseases; being restore, possible, object the diseased to a state of an indication but not health; organ chiefly, and of to the acute exclusively, applicable stage early period insanity. The second indication is to restore and as far as it can be maintain, a condition of the or natural and to functions, done, physical healthy of the which be obviate or remove disorders in other parts system, may connected or coincident with the diseased condition of the brain." in This indication is in some involved the (p. 275.) evidently degree first. in In the different the discussing particulars comprehended therapeutic manifests his usual excellent review- Dr. Prichard treatment, judgment, each and and his with ing deliberately, expressing opinions candidly as we have before calmness and discrimination. He assumes, observed, that the condition of the brain connected with disordered mani- usually on festations of mind is one of excitement to but he inflammation; passing cautions the that the disease is cer- reader therefore concluding against to be cured measures 251); (p. inflammatory tainly by antiphlogistic of the and not he but a excitement, observes, disease, being part wholly it. In an active of constituting adoption antiphlogistic many patients, whilst it would not subdue the would exhaust the measures, disorder, of in the of the insane life. This is one of the treatment powers points on which we have medical men at fault: nor can we observed repeatedly 36 Prichard, Esquirol, Allen, Ellis, Ferrarese, [Jan. wonder that should be so: but a with they nothing larger acquaintance cases of than falls to the lot of insanity usually private practitioners sufficient to that cases as it show, doubt, seeming beyond presenting, would manifest of arterial affect- seem, very signs excitement, especially the will not be benefited not even bear without brain, ing by,?will or result of some unfavorable treatment which kind,?the exasperation vascular excitement seems to The of a clinical require. plainly practice could alone throw full on this and on well-managed asylum light many for there are other of the treatment; cases of of parts particularly insanity, date and in in recent which measures vigorous persons, antiphlogistic are found to be of immediate and service. The of important opinion that increases the of the disorder to into Pinel, bleeding tendency pass dementia Dr. Prichard is, of but he remarks, attention; deserving quotes the of in favour of moderate in testimony Esquirol bleedings plethoric and a few leeches at a with cold cases, particularly by time, applied ap- to the head. Dr. Dr. and Haslam, plications Rush, Frank, Joseph were much warmer advocates for and M. bleeding; Foville, observing that adhesions are common in chronic and in rare acute cases, very very when have once taken are with ones, and, the they place, incompatible return of concludes that or are of reason, bleedings, general local, great in the number of recent in which cases; importance greater opinion Dr. Prichard coincides, His observations 011 the 258.) (p. particular cases that call for are of bleeding deserving especially every practitioner's reflection. After these Dr. Prichard does not cases, conceal specifying remarkable fact in the the Gloucester Lunatic under the that, Asylum, of Dr. Shute and Mr. the of use the superintendence Hitch, lancet, drastic the leeches, blisters, of cupping-glasses, purgatives, practice the are and that recoveries head, take shaving totally proscribed;" yet in a and no cases of sudden or hemi- place large proportion, apoplexy have occurred, plegia (p. 261.) Sir William Ellis makes some observations on this head: he important that of the received into the as recent cases says many patients hospitals have been bled to so that the constitution cannot excess, previously and a much takes in the recent cases than greater rally, mortality place the old. There is a of he in cure, among greater probability thinks, cases in which the cause is if the attack is allowed its own permanent, than when the of the constitution are wasted excessive bourse, powers by in actual and in cases depletions. (Treatise, p. 150.) Except phrenitis, from he thinks free allowable. arising physical injury, bleedings scarcely In cases a moral he is convinced that the cause, acknowledging patient to be local be generally requires supported, although bleedings may very serviceable, He in cases of 168.) also, that, (p. says many insanity manifested in he has found a of propensities, greater degree particular heat in the the of the brain scalp covering region assigned by phrenolo- to such and the have so gists propensity; patients generally complained of in that when are he is the silent, pain that, they governed locality, by character of the in the local This existing derangement application. kind of evidence is to and obvious be open objections, yet may perfectly true. A more observation made Sir William Ellis that important by is, small local had recourse to on the of by bleedings, promptly appearance the of in a renewed chronic a who attack, symptoms cases, patient, 1839 &c. on 37 Greco, Farr, ] Crowther, Insanity. would suffer for often be relieved in a few otherwise months, may days, 249.) (p. In the acute of mania it is to i. best, stage according Esquirol, (vol. that the should be in a cool and dark as recom- p. 140,) patient place, mended the in the chronic he with Pinel ancients; by but, stage, agrees that should be allowed free for their in the air. they scope activity open When the disorder has come on in a a return to a cooler hot climate, increases the chances of and vice versd. The clothing, especi- recovery, the of should be of even next the and melancholic, woollen, skin; ally frictions of the skin are found a useful. recommends mattress, Esquirol a and a of horse-hair: the should be and bolster, pillow coverings light, the head uncovered. the once or is with head twice a week of Shaving spoken approbation Dr. Prichard. The cold shower-bath is to by chiefly applicable young : in cases of much the reaction is an to its persons excitability, objection and is in with a there old cases to con- employment; danger, disposition of small of cold water gestion, producing paralysis. quantities Pouring on the head until it covers the and has some- body produces shivering, times been in warm with con- useful. a the ice Placing bath, patient to the has also been of much but the head, service; stantly applied a and to be into the bath more than once for patient requires put day, two or three hours each time. Warm or is often of much tepid bathing use to those in whom the skin is cold and the circulation lan- patients all of is and these methods often the guid. obtained, By bathing, sleep diminished. Dr. Ferrarese the of agitation urges strikingly necessity the a sufficient time in the warm or and bath; keeping patient tepid M. seems to of the use the bath in of Esquirol approve tepid meager, and irritable for several hours: cold nervous, prolonged very subjects, should means be to the head at the same either of cloths time, applied by in cold cold water contained in a bladder. or Sir water, dipped by William Ellis recommends ice in a of cotton. pounded cap waterproof The cold bath robust well with and who agrees very young subjects, suffer much from heat. For enfeebled vicious or practices subjects by solicitude the bath and cold affusions are suitable. long (chagrins) plunge Several cases of mania in are related M. which (vol. ii.) by Esquirol, affusion was serviceable. Pinel and M. singularly proscribed, Esquirol has never the of not "bath employed, surprise;" only conceiving, pro- that little was to be from an bably, good throwing expected unhappy lunatic be into water and him to unexpectedly, allowing nearly drowned, but for the more serious it would that he knows it to have reason, seem, been he fatal. i. He in that does not think avows, (Vol. p. 147.) fact, it to the out third on of the the preferable throwing patient story, prin- which we have alluded to. ciple already We never fail find M. calm and in to his estimation Esquirol judicious of remedial means. he of the douche as and Although speaks refreshing sometimes useful to lunatics who are and and young, strong, active, where there is of the their and re- particularly head, pain calming fury, them to he also out when received on the obedience; that, ducing points it exercises a head, action on the sympathetic epigastrium, causing pain and an inclination to and after its the are vomit; that, action, patients and sometimes It should never be exhibited after a pale, meal; yellow. 38 Prichard, Allen, Ellis, Ferrarese, Esquirol, [Jan. and the first be it is taken. It should not should cleared before passages which be continued more than a few nor should its minutes; application, sometimes serious ever be intrusted to servants. produces accidents, In some of the cases of small water thrown upon stupor, quantities face have been serviceable. occasionally The use of blisters and counter-irritation the tartar-emetic ointment, by limited than and of setons and is more be being issues, might expected; chronic forms of the monomania ac- confined to the to chiefly disease, and to cases characterized and insensi- companied by stupor, by torpor In cases of with a to coma and lethargy, bility. paralysis, tendency Dr. Prichard has found remedies He these decidedly advantageous. considers setons best to disorders of a chronic "but when form; adapted there is of and a state of the brain great intensity disease, threatening fatal issues the increase, made a incision in the over sagit- by long scalp tal suture are Dr. P. has means more useful." found this particularly beneficial than other in and dementia attacks of following any stupor in the or or severe and he would it fevers; apoplexy, paralysis, adopt in a of insane as be general paralysis persons, although, might expected disease of which we have that M. considers the course ra- seen Esquirol not with of benefit. We do not pidly progressive, very sanguine hope find M. of or even of the actual Esquirol speaking setons, hopefully to i. the back of the neck in these cases, 154;) cautery applied (vol. p. this with success in furious method has sometimes been used although mania. The cases in the second volume would incline us to 216,) (p. ascribe much of the effect of this when it to the succeeds, good means, which it the moral effect even occasions. In all cases of fright insanity, of remedies to be into the account. taken physical requires The of has been established. how- are, utility long They purgatives of in- sometimes of little in states the ever, service; and, very particular testinal hurtful. One of the critical terminations of canal, insanity, is diarrhoea. occasionally occurring, In the of an insane a must now and management person, practitioner then to find to in of the expect opposition medicine, consequence patient himself to In these be in much better health than usual. cases, believing observes that if the some medicine is without Esquirol patient's given and which excites and it causes him to knowledge, evacuations, pain become more anxious about and makes him also more docile. himself, He has not found substances external frictions with effectual; purgative and this would either seem the or this other- to have been case, commonly wise convenient method of such medicines in cases of lunacy employing has not attracted much attention. Somewhat effects of exists the conflicting testimony respecting good emetics. It has it for the in the been, seems, many years, practice Bethlem to the curable four or five emetics in the Hospital give patients of the in Dr. Haslam's without benefit. Dr. Cox spring year; opinion, recommends found them effica- and Dr. Wake has them; strongly very cious in the York is obvious that the use of such remedies It Asylum. should not be but be found advanta- indiscriminate; may probably they in cases of melancholia with and even sometimes geous stupor, during furious in which exhibition is said to have been found to their excitement, be followed and In cases of violent by excitement, tranquillity by sleep. &c. on Greco, Fark, Crowther, 39 1839.] Insanity. of tartarized are six or ten to grains antimony required produce vomiting; but Dr. Prichard recommends that moderate doses be com- begun with, bined with doses of are ipecacuanha. Nauseating antimony certainly in often serviceable maniacal excitement. In violent controlling cases, Sir William Ellis of the effects of half a of tartar speaks highly grain emetic three combined with of hours, given every sulphate magnesia, until and evacuations are This is rather copious vomiting produced. severe however. We are still less inclined to with Sir think, practice, W. that the effect of is in melan- E., nauseating advantageous antimony the miseries of which it can lessen. cholia; scarcely Where there is considerable excitement of the heart and arteries, digi- so much extolled Dr. and on the continent Muller and talis, by Cox, by will be of relief. In the Hanwell Guislain, probably productive Asylum it has been found useful as a means at once of the circulation reducing and the to fifteen of anti- secretion, increasing urinary give drops of monial and half the the* tinctures of and of wine, quantity digitalis with fifteen of the eetheris and ten of nitrici, squill, spiritus grains nitre, three or four times a day. We believe that and other narcotics late have, opium during years, been used in of in this with a of some the bold- degree asylums country, ness of which the in is not at all if we aware; profession general and, success. Dr. are with whilst informed, Prichard, rightly proportionate that is in some cases advises caution he admits useful, decidedly opium in its and he considers it when the vas- employment; generally injurious brain is overloaded with blood, He cular of the has 269.) system (p. seen in such a on its administration in a mo- state, supervene apoplexy, of derate dose: he "there is a condition the but, adds, living body, pro- excitement or when the duced of stimulation, by long-continued powers reaction are to be and what the Brunonians term exhausted, beginning in sudden abstraction of indirect which the stimuli ensues, debility gives and in this as in delirium rise to extreme state, tremens, prostration;" he thinks that be the vital actions opium may beneficial, "by sustaining the restorative of the in a certain of until consti- degree energy powers into and exert their usual influence." tution can come (p. 269.) play, Incases of restlessness it would indicated. long-continued appear clearly are we in their Moderate doses not, think, very satisfactory usually results. Van and Klieber of are Cullen, Darwin, Berlin, Swieten, in but Dr. Prichard is as it of quoted having given large quantities; opi- nion that the maximum of a first dose should be two perhaps grains, in its Sir William Ellis little that "it favour; asserting 271.) says (p. heat and febrile action than more creates general procures frequently If at he is of that it should be in all, given opinion conjunction sleep." with 171.) ipecacuanha, (p. is sometimes in full to useful, doses; but, very according Hyoscyamus We have also Dr. not a of much Prichard, remedy importance. certainly in the and uneasiness attributed to its observed, instances, languor many in which its influence is but there are cases marked and administration; been but we do not has recommended, salutary. Camphor strongly of its have much effects in think that experience English practitioners of maniacal disorders. To the and allay irritability incipient insanity, the exacerbations in old is a deside- that which attends cases, certainly 40 Ferrarese, Prichard, Esquirol, Allen, Ellis, [Jan. belief ratum in and we wish we could entertain the medicine; consolatory in nature some un- Sir William that there is professed by Ellis, (p. 187,) discovered a in these cases. medicine which would act as specific which has been recommended for has been largely Mercury, everything, in cases of insa- some in this and other countries, employed by physicians, on causes removable this Such cases by nity. may occasionally depend to valuable Dr. Prichard it be as and, observes, may expected remedy; be serviceable in cases of with defective secretions. torpor, especially and But its we are well hurtful; is, convinced, very general employment in some cases we of of the brain. productive, suspect, great irritability That there are cases of mental disorder in which tonic medicines and diet are of extreme is all who have much importance agreed by acquaint- ance with these these and other disorders. The of general opinion given medicines M. an idea of the result to be by Esquirol perhaps conveys " " he have expected. Camphor," says, musk, iron, quinia, antimony, often been These medicines are as in useful, employed specifics insanity. but of an individual when we are succeed utility; they marvellously to seize the indication for but are dan- them; happy enough they proper and hurtful if to all i. gerous applied patients." (Vol. p. 153.) M. in his to has he unsuccessful Esquirol been, says, quite attempts cure madness the he the plan trials, by magnetising patients: gave many with different without magnetisers, advantage. We have entertained some doubts as to the of always propriety reducing a him in a chair to to obedience refractory patient by putting subjected inclined to class this as well as the motion; rapid device, rotatory being bath of with other of torture too common in formerly surprise," species cases of but now abolished. As a remedial means, insanity, happily it is men consider it occasion- to that however, impossible deny practical useful and advisable. It induces nausea and which have ally sickness, been found to an end to of violent excitement. It is put requi- paroxysms site for the should be success of this that the motion con- means, rotatory tinued until is and violent and as induced; sickness, vomiting purging, and and of and sometimes fainting, great strength, epistaxis, prostration and a of are its we are threatening apoplexy, among consequences, glad to learn in from M. that its use is abandoned the French Esquirol i. asylums." (Vol. 156, p. note.) The most difficult task for the must often be to ascertain practitioner on what condition of certain remote from the the cerebral brain, organs, irritation in such cases and this must of course depends; yet knowledge the due of means of In cases of con- relief. precede long employment the has in which treatment directed tinuance, period generally passed to the condition of the brain is to be serviceable, immediately likely very and some in chest or removable chronic disorder exist the abdomen, may and on its removal the considerable or com- mental affection undergo may alleviation. The of Dr. Prichard as established, plete fact, spoken by that lunatics have been cured a course of remedies (p. 275), many by to the is of restoration of their health adapted great general very practical M. that the chances of cure in but importance. Esquirol insanity, says in offer more when we are able to especially melancholia, always hope some disorder in i. the functions of assimilative life. perceive 476.) (Vol. p. In the Gloucester Lunatic to the health seems attention Asylum general &c. on 41 Greco, Farr, Crowther, 1839.] Insanity. indication of cure that is not to be the in old regarded; principal only in instances in which the disease is in a of but cases, stage incubation, and with the Mr. Hitch assures Dr. of such effect, Prichard, preventing on to mania. The medical called cases actual treatment for in passing in which the mental disorder or on each case depends chiefly entirely some disordered condition of the the the the intes- heart, liver, stomach, the &c. must of course in each tinal canal, uterus, case, vary particular be conducted on It has been found that in and general principles. exhausted the of a liberal diet is often followed the subjects adoption by even kinds of best irritation. Various effects; calming existing employ- in the air are also now with excellent in all ment results, open adopted, well-regulated asylums. of in Some observations relation to practical M.Esquirol paralytic are of much to those who have the of lunatics them. consequence charge eat and enormous of food to collect voraciously, permit quantities They in the which sometimes are unable to con- swallow; pharynx, they they with from which become threatened but suffocation, sequently nothing aid can save them. One case is related in which the had patient prompt several times choked himself with calf's and at head, nearly length, a morsel than could not be relieved to swallow usual, attempting larger from and died. The was found distended a it, oesophagus greatly by in brain was the of calf's head the mem- it; red, piece impacted very thickened and and the were with branes were blood. lungs gorged injected, Another circumstance which attention ii. (Vol. 279.) requires vigilant p. the rectum is the obstinate of their bowels; inactivity being paralysed, becomes almost the bowels remain in this defecation impossible: may state or without made the thirty any complaint being twenty days by be the and inflammation and mortification results. patient; may Purga- and of the abdomen have no effect. Sometimes it is tives frictions neces- to unload the rectum mechanical means. but more by Retention, sary their incontinence of are also afflictions: urine, frequently among patients in latter attention to their and the state great bedding require clothing, and with aromatic infusions or and water. washings spirit Paralytic allow themselves to be burnt the and even fire, patients frequently by without are also in liable, complaining: they dangerously, endeavouring and in a few to their to fall on the die after- head, change position, days ward. When these have followed a fall out of consequences bed, of M. has several times found the dura Esquirol ecchymosis mater, or a circumscribed to the arachnoid; extending subjacent sanguineous and extended over the outer of effusion, the membraniform, layer arachnoid. and even for insane are So now persons many large splendid asylums established in several of the countries of that one would Europe, suppose for the value of there is little now a well existing enforcing necessity chosen site and a well ordered and and cheerful building, dry airing in this in this The evils which remain, are grounds. respect, country, be met with in the nor we in not to institutions, even, hope, public many of the of the some latter establishments; there private although still are in a want of and of which space proper undoubtedly ventilation, and of a sufficient number of and attendants, for general arrangements That comfort and are but too obvious. the results are lamentable cure, 42 Ferrarese, Prichard, Esquirol, Allen, Ellis, [Jan. on the health of the as indeed inmates we feel assured; unlucky perfectly obser- no one can doubt without the of M. doubting Esquirol's justness to become that the constitution of lunatics has a vation, tendency rapidly weaker. of the he diseases contract, skin, engorge- They says, lymphatic in and and he are reasons for care the scorbutus; ments, these, says, How selection of the site and of for their habitation. design buildings must have observed; become, every rapidly old-looking they practitioner and in some of the old-fashioned institutions we fear that some of those for- terrible are even now sometimes to be which were seen, examples mental far more of the extremest and common, merly bodily helplessness induced of want of cleanliness, air, by good positive neglect; neglect mind. and of sufficient and of food either for or for clothing, proper body We have of some of the it desirable to allude to the thought opinions authors works on the medicinal whose we are now considering experienced treatment of because it includes lunatics; many particulars concerning to which of and candour are found differ; practitioners great judgment deserve reflection and and these are so as to careful particulars important clinical With to the mental and moral treatment of experiment. regard the it is to believe that if medical men are few, insane, any, consolatory delicate at now with the on which such unacquainted attempts principles conducted. In the section control and should ever be management devoted to this in Dr. Prichard's and in various of the work, part subject of M. the reader will find an parts writings, ample exposition Esquirol's to of all that it is most to in mind in the requisite keep attempt perform a nature. The duties of most arduous and separate questions, responsible all of which at time or other in some occasion every practitioner's anxiety from of the seclusion of insane of them mind, patients, removing parti- and nature of the control cular and of the extent associations, impressions the of the infirm to which should be and of management they subjected, are discussed both these writers. distinguished understanding, fully by we must even These so that questions interesting topics comprehend many to at refrain from their enumeration, recommending present strongly of the works which we have men- student the of those every perusal parts is tioned in matters are with the fulness which due which these spoken direct the reader's to their In an manner we would especial importance. mania in M. second attention to the section on the treatment of Esquirol's wherein he will find most 187 et volume; important principles page seq., illustrated by very striking examples. to the mind on One itself observation, however, suggests very forcibly on to the M. admirable remarks the advantage arising perusing Esquirol's from a and almost constant medical attendant on the insane friendly communication with as well as from several remarkable them; examples made on the related him of the effect of moral impressions patients. by to each he is often The first idea of the treatment case, applicable says, derived in the the the from observed actions, looks, aspect, something these which are the or the and in shades of conversation, gestures, imper- of the treat- to others. i. And again, speaking ceptible (Vol. 116.) p. ment of he observes that the moral medi- cases of melancholia 465), (p. the medi- cine which seeks in the heart the causes of the primary malady, the and cine?which consoles, sufferings pities, weeps, partakes to all other. reawakens the of the is often Every hope patient, preferable on &c. 43 1839.] Greco, Farr, Crowther, Insanity. he melancholic must be controlled a adds, patient, (p. 472,") by perfect of his his his and habits. We being mind, character, knowledge acquired need not accumulate of the same but need passages expressive opinions: that to we that medical men remark, should, expect generally speaking, the delicate here of as possess knowledge spoken by Esquirol, possessing, at so few of these indications do, of present they opportunities studying and the shades of disordered would be in the degrees mind, visionary Until are students of highest degree. opportunities enjoyed by seeing lunatic with as much as it will be vain other to patients facility patients, much in their the care of which will con- treatment; expect improvement tinue to devolve for the most men of some necessarily part upon practical with but who not had the have educa- acquaintance asylums, preparatory tion for or for the cure of the requisite effecting improvement, conducting various and delicate cases intrusted to them on enlightened principles. When the actual of a affected with mania devolves responsibility patient a the immediate which besets him is that of upon practitioner, difficulty the from himself or those around him. preventing patient injuring Timid attendants and alarmed aid and relatives look for prompt security to the medical and he must be For attendant, prepared accordingly. want moral of or other and better mere force and resources, courage, are often resorted and the unfortunate is and to, severity patient injured, obstacles arise out of the with which he is treated which injudicious cruelty eventual Firmness and firm- may impede recovery. kindness,?perfect and kindness not to be averted from its the ness, objects by perverseness of the will be found more than threats and patient, powerful severity. Dr. Prichard the excellent directions of M. as quotes Georget, condensing the discursive of Pinel and on some of these opinions Esquirol points, It is not to be that who manifest a (p. 299.) forgotten patients tendency to or other must never be lost or trusted suicide, murder, violence, of, sight with the means of mischief. For and often for addicted these, patients to indecent a strait-waistcoat is Sometimes it is practices, necessary. better to shut them in their rooms; or to confine them round up by straps their fastened down in an arm-chair. When the use of chains was legs, the and of it was found that discontinued, Pinel, by philanthropy courage the number of furious lunatics was and the accidents which diminished, occurred became less The strait-waistcoat, formerly frequent. seclusion, removal from one of the to the and another, shower-bath, part asylum occasional are the means found most efficacious in privations, public institutions. It is remarked that a violent particularly by Esquirol lunatic is the more if one or two only enraged opposed by keepers; whereas if a force is to bear him at or six or great brought upon once, are before he will desist from all violence and eight him, keepers brought submit. If he be and seized on all sides; or necessary, may approached he be bewildered his head in a may by being suddenly enveloped napkin. in the first of maniacal is to M.Esquirol's plan period insanity place the in a room but little cool if patient freely ventilated, admitting light, the season is and warmed in cold If the weather. is hot, patient he is fastened on his or his movements are violent, con- extremely bed, fined the strait-waistcoat. A severe diet is cold by prescribed; drinks, or or almond or emulsion, or whey, barley-water, cherry-water, pure and other diluents are The is left the water, simple given. patient alone, 44 Prichard, Esquirol, Ferrarese, Allen, Ellis, [Jan. friends attendants at the and relatives and door, being excluded, being so as to the number of reduce to the smallest possible impres- patient to the first sions and excitements." But this treatment is only adapted and even ii. After that it is desirable, necessary, period. (Vol. p. 183.) that should be allowed exercise in the and sufficient free open air, they for their harmless to the fullest extent, indeed, extravagances, scope con- with their and that of others. Restraint too long compatible safety first the of the and the chances tinued increases fury patient, secondly, of The of convalescence different stage supervening paralysis. requires of and measures; change place, diet, occupations. various methods of in the the violent, Among restraining particularly first of the that mentioned Sir William Ellis seems the stage malady, by to several possess advantages. The most and least mode of is that of a of confinement, simple objectionable pair wide canvass connected a broad canvass so as to rest sleeves, shoulder-strap, easily by on the shoulders. to come well on the and to extend about shoulders, They ought up an inch the ends of the the the hand should be made beyond fingers: covering part of stiff to the hand the arms leather, tolerably prevent grasping anything. They keep and in a natural the sides of the are fastened hanging easily, by body. They position, at the back two one from one sleeve a little above the across elbow, by straps, going to a similar in a second lower and the loins the other three sleeve; down, by position in similar in the the latter secured esta- front, buckles, which, straps being by large where there are to be attended to one to blishments, by keeper, ought many patients be locked. This mode of has over the strait-waistcoat. fastening many advantages In the first is it no the and it less the pressure upon chest, place, heating, produces secured from have so much freedom that the blood can circu- arms, mischief, though late as with of are these sleeves It ligatures every description unnecessary. freely; is sometimes also to secure the feet. For this we that a find, requisite purpose couple of with round the and secured to leathern well lined the wool, ankles, straps placed bed is all that is In cases will sometimes by 'staples, necessary. hospital practice where it to secure the in its This can be be occur, bedding place. may necessary done a thick fastened over the three leathern to blankets, by having quilt by straps, It unless this the sides of the bed. is that, taken, occasionally happens, precaution the will toss all the clothes off the bed." 164.) patient (p. In some cases we have seen that M. mentions the fatal results Esquirol of a refusal to take food. It is in the course of the found, probably extensive afforded a that this case more practice by large asylum, presents than would at first to attend it. difficulties Doubtless in sight appear cases it is to introduce food into the mouth of the many possible patient the in the manner so when the by closing nostrils, successfully adopted is to force children to swallow and the medicines; object unpalatable that its has so an aversion to this is not patient great process, repetition This method seems at least as to as it easy practise always necessary. can be to introduce the tube of the in the manner recom- stomach-pump, M. work mended Mr. the translator of on the Liddell, by Esquirol's Illusions As to take food often of the Insane. the repugnance depends on the of the that it is intended to this them; supposition poison patients the delusion if be or of force should, combated, employment possible, is hurtful As it not associated with may produce agitation. unfrequently the belief that instead of food see or nauseous and needles, they pins, substances to it is that some of the them, disgusting presented possible when be to take food blindfolded. These cases patients might persuaded often forcible and to the of the require feelings yet judicious appeals &c. on Greco, Farii, Crowther, 1839.] Insanity. If all means M. advises the introduction of a fail, tube Esquirol patients. the nostrils: this means he has saved lives: in a case by many through it to be five recited i. used months. 663,) (Vol. p. required nearly measures are useful in the and These those chiefly melancholicpatients who intend to themselves starvation. Maniacal destroy by patients a treatment. In these M. different cases the maintains, require, Esquirol to take food does not often continue Sometimes many repugnance days. on disorder of the and sometimes on a it temporary stomach, depends delirium which takes all of want: in of sense the latter degree away a blister to each sometimes overcomes the instances, leg applied refusal to eat. we the and number as extent of the com- are, Compelled, by subjects in the consideration of to at least for abstain, prehended general insanity, the from the of moral entering upon important subject treatment; present, we cannot refrain from to the consideration recommending philanthropic the of houses of of all medical men retreat and importance separation from lunatics of the convalescent. Without such a the cure must retreat, often be must suffer and imperfect; many unhappy patients relapses, uncertain to the in a state of detriment many linger long recovery, great of their to the of their and to the affairs, great misery families, worldly utter ruin of their own For of the comfortable happiness. patients which their it is to condition classes, easy provide- every advantage but for the classes of whose affairs are often poorer society, requires; is thrown into disorder their unfortunate it far more difficult by malady, a convalescent abode. Sir William Ellis to suitable comments provide on this with sense and equal good humanity. subject when a who has been for a time an inmate of man, a Unfortunately, poor long where his wants have been without care or lunatic daily supplied any asylum, anxiety is in him on his becomes there into the sane, introducing part, great difficulty again and him his own without at exertions, the world, making entirely dependent upon of than his brain same time a enfeebled and nervous feeling producing greater anxiety are of of the on their are system capable bearing. Many paupers, recovery, entirely without and are driven of into the until resources; they necessity workhouses, they can obtain this is more than are able to bear. The benevolence of employment: they a of the name of has done much to relieve cases of this gentleman Harrison, kind, in the West of Yorkshire. Her Queen Adelaide is the Riding Majesty occurring of a which has for its the to the immediate and most patroness charity, object supply necessities of the when from the at discharged cured, asylum pressing paupers, Hanwell. Her contributed to it one hundred and other sums have Majesty pounds, been which have raised the amount of Adelaide's Fund Queen to already subscribed, of one thousand hundred : this has been invested in the sum the eight pounds nearly and the dividends in several been the means of such have, instances, funds; affording as in all a and enabled has, the con- timely assistance, probability, prevented relapse, in comfort and valescent to maintain himself respectability. But further is still wanted. A comfortable where such of the something place, as deemed for a find food and be might objects, might, time, patients proper shelter, would be an and a until could invaluable home, they procure employment, blessing to and if such an institution were even at the cost of established, it them; parishes, be tried in such an would in the end a establish- saving. Many might prove patients and restored to who are now to remain in the ment, eventually society, compelled as in of their some erroneous on some lunatics, consequence retaining view, asylum not interfere with their matter. this does of unimportant Although capability judg- between and or them from their it is an ing right wrong, prevent performing duty, a certificate of insurmountable bar to a medical their signing superintendent sanity; 46 Prichard, Esquirol, Allen, Ellis, Ferrarese, [Jan. and without the cannot order their I have no this, visiting justices discharge. doubt, that in this erroneous would be effaced a little instances, many impression by mixing in the and in the business of : I cases life have known of this world, ordinary indeed, where the friends have made the and have the of the kind, trial, procured discharges on their that shall be no a burden to the The patients, undertaking they longer parish. success has been the result: the of and the greatest complete change scene, occupa- tion of mind diverted the from the have on which the erro- entirely thoughts subject ceased neous and as this to be dwelt the remained; impression upon, derangement wore and the soon became sane." off, patient perfectly 250.) gradually (p. The of Dr. Prichard's work devoted to the Statistics of portions to Unsoundness of Mind in relation to to Insanity; Jurisprudence; Ecstatic the of Somnambulism and Affections, including phenomena we Animal can mention the titles of. Much informa- Magnetism; only tion is in A each. note of conveyed supplementary twenty-two pages contains the of this eminent on which to objections physician phrenology; we shall make no further comment than to the observe, that, admitting of Dr. P.'s we do not think them subversive of the remarks, justness doctrines. The taken is one of the most work, phrenological altogether, valuable books on in our and one which insanity language, every practi- tioner should make himself well with. acquainted In like there are and valuable of M. manner, large parts Esquirol's volumes which we do not to make the of observa- design subject present tion. Such are the section on in the and the Suicide, first volume; Statistical and and the section on Mental Alienation Memoirs, Hygienic in to which more than half of the second. Medicine, regard Legal occupy In these will be those who consult valu- found, them, by carefully many able results of M. notices observation; Esquirol's long including many of much interest to those who have the care bearing upon practical points of lunatics. The Atlas of Plates contains most twenty-five expressive of delineations of the several forms of melancholia, insanity; particularly dementia. The of the and of cases or into mania, passing passed history individuals of whom the the likenesses are interest- plates represent very That of de a but cele- ing. Theroigne Mericour, highly-gifted woman, brated for her and her the revolution, irregularities political activity during of attractions and and is a most narrative impressive powers misapplied; we can more than the fixed and touching scarcely imagine anything of the who is the of the third lady subject plate; hopeless expression of unfortunate Duke been in childhood the the who, having playmate on his when she was but seven- at became, death, d'Enghien Chantilly, teen of sunk into and melancholy, years age, suddenly grey; profound remained almost motionless and her for ever fixed on silent, eyes wholly who her the window where she seemed to hear or see some one engaged her incurable sorrow. until death an end to attention; These, put are but a few the dreadful afforded the of doubtless, commentaries, by on the crimes of those sane. madhouse, reputed the Insane its Dr. Allen's on the Classification of promises, Essay by of but the classification of the to treat a title, very important subject; in the work itself defective. Both in this work and is subjects extremely the is in Sir William but most in Dr. Allen's, such, Ellis's, rambling style the works and the so that have, speaking, plan unintelligible, properly neither nor end. Dr. Allen accounts in for the middle, part beginning, oddities of his it was and even great written, production by saying &c. on Greco, Farr, Crowtiier, 1839.] Insanity. of it as a continuation of defence in the case of his Allen part printed," v. of which we to we have no recollection. Dutton, defence, regret say, that the said shall be bound The defence at the preface promises up end of the but we have looked for it in vain. less con- essay, Anything distinct than secutive and the we have not for a time preface long perused. succeeds what is called an To this on to Classification, Essay extending and to this is an of 102 with ten joined pages, pages; appendix por- The traits of lunatics. with an account of Fair Mead Essay begins Hill which and constitute House, Leopard's Lodge, Springfield, Allen's establishment at we Dr. all these High Beach; localities, fear, not much known to readers in we have little doubt being general, although that furnish comfortable and well-conducted retreats for the insane. they The of them is made with of the laudable classi- arrangement very design the and of the patients, particularly recent, partial, fying subjecting or convalescent cases" to attention. A remarkable case slight, particular as is but the table of con- introduced, abruptly enough, professedly, tents to illustrate this which case does indeed illustrate subject; says, Dr. Allen's of a most violent and miserable judicious management fanatic, but has not the least on the of classification. bearing subject Every successive convinces us the more of our to fathom the page incapacity and of Dr. Allen's and the detached obser- tendency meaning; yet scope detailed in kind of reminiscent are often vations, manner, colloquial, sensible The here and is not however, there, enough. theory, dispersed so much of we demur to an alteration in the us; quite approved by and state of the nervous an acrid matter in energy, generating morbific the and disease." At we have a 22.) page 55, system, ultimately (p. whole of the most thrust into the middle of page preface, unaccountably but the not of the essay, transposed by any sleepiness printer, repeated, as it would an and this tends to the oversight; appear, by explain both of and Preface. The remainder of the con- strangeness Essay essay and neither which kind sists of cases of of observations, present any some of the cases are and the obser- although curious, practical novelty, are The contains vations, generally, unexceptionable. appendix thirty- of which are some one some and We cases; instructive, amusing. highly are bound to confess that the heads in the furnish represented plates very respectable phrenological testimony. Of the benevolent views of Sir William and of his Ellis, great practical his Treatise sufficient The which it experience, gives proof. description the institution at Hanwell would alone contains of render it valuable large to medical readers. Its as we have is style, already observed, discursive, in the on the and we do not see much and nature, chapters symptoms, of with which works had left us causes previous insanity, unacquainted. We cannot but that Sir William Ellis too much claim think, also, lays the both because this to the merit of lunatics; is not employing system now to be considered a new and because when so inmates of one, many are so few in and an in which the cures the incurable so number, asylum are exhibited to the as a of numerous, public affording spectacle tranquil and useful a intrudes itself that at of some, occupation, suspicion least, who classed the be these individuals are restored among incurable, might to their modes of which and not the mere life; house- ordinary result, less of an much its should asylum, vain-glorious display, surely keeping 48 Prichard, Esquirol, Allen, Ellis, Ferrarese, [Jan. be the first of the At our lunatic ambition. object physician's present, or some of them at exhibit in their a sin- asylums, least, management for whilst the to whom a with their gular student, familiarity anomaly; which their and with the and economy, changeful striking phenomena inmates would be is denied all useful, sturdily present, extremely as if his intrusion was a not to be the at endured, entrance, thing public and as a to these on to fair. The large throng places Sundays holidays zealous student sometimes be of and in careful, anxious, might service, modes and on occasions an of the in chief; many many auxiliary physician but the miscellaneous visitors must often be mischievous. Sir William when of to feels that Ellis, Hanwell, speaking admitting pupils evidently he is on unsure and Hanwell is one of the of treading sights ground; yet the of London. This if in one sense inasmuch useful, vicinity publicity, as it is a to the all is is to that well conducted us a there, security public far less noble recommendation than would be circumstance of that the institution at once the best conducted for large being hospital madness, and the on which a number of students were ever spot diligent imbibing the of rational be over to them diffused the whole treatment, principles by or over the whole world. This would be an of kingdom, object worthy the of the and of their it aspirations governors, worthy philanthropy; would act as a stimulus of the most kind on the medical officers; salutary and the we of benefits to be believe, incalculable source, really society. Then we to from time to from that establish- receive, time, might expect with the of which a wide field of ment, weight authority experience always statistical details of the new and varied value, gives, highest pscycholo- and and clinical results which this observations, gical pathological by of medicine would be raised from its unsatisfac- department present very condition. We in have to tory might then, short, something point to, of with the of and of worthy comparison writings Esquirol Foville, and Guislain of Bayle. the works of which the titles are to the Among prefixed present article, is one Dr. of a whose Crowther, Wakefield, by physician practical lunatics with establishments for and acquaintance great respectability entitle his remarks to much attention. He takes his at a time up pen, of life in which the favour or disfavour of men is of little as consequence, the advocate of the with the intention of out insane, fearlessly pointing evils to which are even in the his they yet, opinion, exposed. Although we do not as Dr. Crowther to that want of do, apprehend, appears any " " could ever cause the evil which so vigilance genius" long public tenanted Bethlem" to domicile itself in Hanwell or we are Wakefield," much with the force of of his observations on the govern- impressed many ment of institutions of this kind. The difficulties in this of particular are and it is more to out some which numerous; government easy point the to and arise from dominion of the than safer more magistrates suggest efficient hands to which to the which must somewhere intrust exist. power We fear Dr. Crowther's would be neither nor efficacious. pleasant remedy of a The name medical board is with very synonymous discords, intrigues, mutual and strife science of that can render accusations, every variety ridiculous and the of truth. and impede Magistrates do, progress may, for are but where no or err, mortals; reli- frequently they but, political &c. on 49 Greco, Farr, Crowther, 1839.] Insanity. we would rather trust to their interfere, gious prejudices plain integrity and sound than to the refinements of association of good feeling any men of a scientific It sometimes no as description. happens, doubt, that make unfit Dr. Crowther observes, magistrates very appointments, and that are inclined to overlook in the instruments delinquencies they have but a medical board would be selected; they unwisely equally The medical of a lunatic fallible. occasion- superintendent asylum may be and have his tried an officious thwarted, ally patience considerably by but several he cannot fail to find some magistrate; among magistrates sense who will him in all men of that deserves Un- support support. all functionaries would he be who had to listen the to beyond happy opi- and be driven to and fro the fancies of half a dozen men of his nions, by own each of ; sudden and in honour, profession jealous quick quarrel." In the one measures would sometimes be in the other case, good delayed; would much more be frustrated. The who acts they frequently physician with is if he exhibits and safe, magistrates surely pretty ordinary capacity from interference in his medical of the management insane; judgment, it is too often is the most of his which, forgotten, important point duty: but he who acted under a medical board could not or prescribe bleeding a without fear of censure or The magistrates purgative impeachment. be in the in the the the board-room, larder, omnipotent may dairy, and from doctor's the but refrain the The kitchen, laundry; they shop. medical board would be Our on these matters are everywhere. opinions formed after some of institutions both classes of experience governed by and we entertain a that no men are less fitted to men, impression strong others than those whose minds are narrowed exclusive devotion govern by to science. On this we find ourselves at issue with point completely Dr. and his would us Crowther; lead much to the opinion question soundness of our if we did not believe that he rather from own, speaks of one of the kinds of of which we have experience government spoken than of both. the best of all medical charities government Perhaps and institutions is that a board or of which a certain committee, by consists of medical but the not to men; portion portion ought prepon- derate. On another this venerable our entire physician has, however, point We as assent. the unlikelihood of the treatment of mean, respects insane well with a and patients being conducted, vigilant unprejudiced from towards the science, eye improvements gradually arising advancing one whose mind has been directed to the of mental by any management diseases Dr. Crowther's observations on this are most only. subject and show the delusion of the cure of judicious, abundantly looking upon madness as a kind of in which men of medicine craft, wholly ignorant become The third of Dr. can Crowther's little work, proficients. chapter On has our and we concur with him in Quackery, hearty approbation; that the diffusion of will alone opinion knowledge efficiently protect medical men from of whose doctors," regular watering-place proceed- he seems to have a intimate The fourth ings very knowledge. chapter the in relates to of at which, prevalence dysentery asylums, especially and in the West and Kent Dr. Crowther Hanwell, Riding asylums, ascribes to The sixth relates to certain falla- negligence. chapter alleged VII. NO. XIII. 4 VOL. 50 Prichard, Esquirol, Allen, Ferrarese, Ei.lis, [Jan. cies in the returns of cures in the lunatic and at asylums; especially the who are the desire of their friends Hanwell; patients discharged by it is down as cured. We can this loose said, being, put scarcely suppose to exist at Dr. Crowther ridicules practice present. naturally enough Miss Martineau's account of the cures at Hanwell the recent of being, in a the truth that the cures are fewer cases, hundred;" ninety being we had occasion to as have than in most of the there, mention, already in the We do not feel to make asylums kingdom. disposed particular allusion to certain other of delusive from imputations which, reporting, we should think Sir William Ellis would be anxious to clear however, himself. In of reasons which actuate us in from consequence refraining on these we have in our of Sir notice W. remarking points, over, passed Ellis's several the tenor of which we no means book, observations, by and which the work too much the air of an elaborate approve; give of of advertisement; another institution then in Hanwell, partly partly and of Sir William and Ellis in all institutions embryo; partly Lady wherever situated. of this kind we see also in Dr. Allen's Something book: we entertain not the smallest doubt of the intelli- and, although and of Mrs. Allen and of gence, kindness, great Ellis, respectability Lady the encomiastic to the feminine head shows the ascen- leaning assuredly of the of the of which we are dancy housekeeping department, propriety extremely sceptical. The of the medical of a allowing impropriety superintendent large to be the steward of the institution is commented asylum very properly Dr. Crowther. We have not the least doubt that in these upon by cases, the is the of the direction best attended to. The housekeeping part becomes a a safe a kind of show- asylum good boarding-house, prison, but not an not a of cure. That these circumstances house, hospital, place have never been before the attention of those who properly brought the chief officers of such and that do not establishments, appoint they entertain notions of the of the medical treatment of the just importance we have for We trust Dr. Crowther's insane, very good grounds believing. remarks on the constitution of and on the duties of the general asylums, officers and attract attention. servants, may general Dr. of in the work which we have once or Ferrarese, twice Naples, mentioned in our to be a of much observations, previous appears physician and of a sound We have read his work with much learning judgment. not so much on account satisfaction; of in his any particular originality or in his as because we have observed observations, views, that novelty he is well with the writers, down to with the Haslam, acquainted English inclusive of and and with the best German French, Esquirol Georget, authors on the of and other From these subject insanity. respectable authorities he has rather a work than compiled well-digested composed a treatise on disorders of the mind. But in of the work we every part uniform indications of of and of perceive sense, good enlightened views, benevolent and well considered of treatment. The work plans forms, an excellent of and in the various indeed, forms epitome theory practice of insanity. The Tenth of the Retreat Connecticut a of Report comprehends period three About one hundred are in the accommodated insti- years. patients &c. on Greco, 51 1839.] Farr, Crowtiier, Insanity. tution. The recoveries are stated as to about being equivalent thirty per cent, in the old and about in recent cases. cases, ninety About one hundred are in the Lunatic patients lodged generally Asylum of St. Of those admitted in in 1834, number, Petersburgh. eighty-eight six received for the second and three for the third time. were The time, of the male were and of the mar- patients unmarried, women, majority ried. The number were admitted between the thirtieth and greater Of those cured and the fol- convalescent, thirty-fifth year. discharged were their of in the house : lowing periods staying . 5 In the month . . 4 In the first month . eighth second ... 4 eleventh . . 6 .5 In two . third . . . .2 years fourth 3 three ... 1 ... 3 six 1 fifth ... .... sixth ... 5 25 25 Total ... 39 In Dr. to the Institution for the Insane 1833, Greco, physician Royal at a on the medical statistics of that insti- Palermo, published pamphlet tution from its about in reformation, thirty years previously, consequence of the Pisani. In a second humane efforts of the Baron edition, Dr. Greco has his tables to 1835. On these we can completed up only make a few observations. It is remarkable that the number of passing women admitted is the men. In the St. less than half that of Petersburgh the number of men and women is In ten at report years nearly equal. the Connecticut Retreat the number of men and women admitted is the same. We researches on have mentioned exactly already Esquirol's this But a itself here which affects point. materially question presents the value of statements in a statistical of view. The admis- hospital point sions of men and often on the accom- it is women, evident, may depend modations and of the and afford no correct evidence regulations hospital; of in the the of men and women affected with neigh- proportion insanity bourhood. In the the admissions are Dundee (18th Report) asylum, to as twelve women to and there the cause is stated men; be, thirty might be a want of more for female Of accommodation patients. expected, men 508 cases admitted into the Retreat at 245 were and 263 York, women. seems rare in the fine climate of to the Idiocy Sicily; giving support of with the of that whilst increases opinion Esquirol insanity progress what is called more on the influences of soil civilization, idiocy depends and climate. This we should no means consider conclusion, however, by as established: the civilization will be found to be as vices of probably of in the as climatorial influences. We productive idiocy offspring any in commercial derive information from the of salutary prevalence insanity but it is not we how much the some- communities; known, think, equally what life of the to solitary, unexciting, indulgent agriculturist disposes in the chief houses of mental disorder; nor has its singular frequency some mountainous districts of our own island been the of much subject that the well known to tourists. We observation, also, although suspect, 52 Prichard, Esquirol, Allen, Ellis, Ferrarese, [Jan. number of to cases allied of mind is closely imbecility very great among the of our young persons composing aristocracy quietest country-towns, and in the monotonous of these cases country-houses England escaping because such minds are called for little or no observation, general upon but the exertion; medical observer cannot overlook them. Talents little cultivated and little exercised for several and a mode of life generations, almost are circumstances which lead to the animal, entirely production of a often robust with round but with heads, fine-looking progeny, large a brain of the smallest of the Even have degree activity. phrenologists failed to notice these curious which our small com- particulars, provincial in of the unenlivened extensive trade and rail- munities, parts country by we some for roads, afford, think, opportunities observing. Dr. Greco introduces a table of which as we occupations, regard very interesting:. MEN. WOMEN. Merchants .... Servants 25 Peasants .... 20 men Military Naval men . . . .36 Tradespeople Priests and monks . . 9 Nobility Students .... Private . . .39 gentlewomen Medical men Nuns ..... 6 Poor . . . .... .17 Lawyers people Nobles .... Total . their estates , .152 Squires living upon Placemen Industrious civilians Peasants Servants .... Artisans .... Beggars Public salesmen Prisoners .... Total In this table we are anxious to out to the reader the number of point cases of the classes of because we do not insanity among poorer society; think the influence of and wretchedness has been poverty sufficiently considered in relation to the and disturbance of reason. We imperfection see the male the and artisans are the most that, among cases, peasants and if to these we add the the and the numerous; servants, beggars, we have more in the hum- than one third of the male lunatics prisoners, bler ranks of the out the women, leaving tradespeople, society. Among the number of and is one half of peasants, servants, nearly poor people the whole. will Other on which we need not arise in reflections, dwell, reader's mind on and their relation to the at the table; every looking and to the of is not causes, insanity, unimpor- consequently prevention tant. We should that the Sicilian is not observe, peasant only exposed to but to and to of the of the the sun, poverty, burning rays vapours charcoal and metals. of are in Dr. The moral causes many insanity Greco's tables. One half of the cases of this kind are ascribed to do- mestic the loss of reverses of sorrow, fortune, ambition, destitution, and Aberdeen of In the parents, persecution. (1838), forty- Report three the of the in causes patients admitted, were, intemperance malady on &c. Greco, Farr, Crowther, ?3 1839.] Insanity* the use in domestic in of dif- eight, seven, spirits disquietude pecuniary ficulties in in out of the two; and, there twenty-two forty-three cases, In was also the Massachusetts the hereditary predisposition. Hospital, of mechanics is and the reason considerable; is their proportion assigned mode of life. Mercantile are an ac- sedentary speculations everywhere of cause and it is observed Dr. Woodward knowledged great frequency; by few of the and that members of the industrious, very steady, temperate become insane. The more we consider these the community matters, more we see that the is in a measure the substi- clearly physician great tute of human reason and of as and these are political wisdom; that, more and more cultivated and he will be less and less improved, required to interfere. contains evidence of the of recent Every Report gratifying curability cases of reasonable deduction from these insanity; and, making every sufficient is held out them to statements, encouragement by prompt of which the so is often seen to lead to the chronic and treatment, neglect forms of mental disorder. The of the New-York unmanageable Report 98 cent, as the number of recoveries in the recent Hospital gives per in the cases. In and indeed various which we have seen this, Reports from other we with much the countries, observe, satisfaction, general diffusion of rational views of moral and treatment. Nowhere do physical we than in the Scotch in see this more which the distinctly Reports, characteristic of our northern is energy neighbours very advantageously exhibited. Accurate numerical statements are reflec- accompanied by tions full and entitled to be called of sense, good philosophical. Every- we least in the more advanced countries of where, trust, (at Europe,) it now be as in the Dundee for said, 1837-38; may Report and useful labour have now succeeded to harsh- Gentleness, candour, exercise, and rest. The hands that were bound in chains ness, deception, inactivity, formerly now the and the the mind that was once bewildered are handling mattock; by spade the arts of false is now soothed the voice of the solitude by truth; misrepresentation, and benumbed the and rendered all our are rest which once faculties, torpid energies, and the heart sunk in now for the of social once the life; exchanged employment of is now the sound of and the gloom religious melancholy, gladdened by praise of salvation." tidings of contain an allusion to a The words this concluding quotation subject of seriousness and the of con- great importance, administering religious than which that zeal should be solation to lunatics; nothing requires more by carefully tempered judgment. The healthiness of the Dundee has been remarkable; its in- Asylum the which was so fatal in lunatic mates cholera, wholly escaped many establishments. The of deaths for six has not been average years past the we have been in- more than six cent. whole, per Upon extremely terested with the of this conducted for such admirably asylum; reports nature of the in we cannot doubt its from the being very reports, which, or interested or business the without ostentation motive, any apparently and scientific character of the is gentle, considerate, management very conspicuous. the before us is one of the of the Retreat Reports Among pamphlets at an institution which we never see mentioned writer on York, by any of admiration and This these without subjects expressions respect. report 54 Esquirol, Ellis, Prichard, Allen, Ferraiiese, [Jan. is for on the but statistical statements founded 1836, comprehends expe- rience of in that Most of these have establishment. forty years already been alluded to. It has been with much that we have the gratification gone through to the State Lunatic at and other documents Reports relating Hospital from which be selected illus- Worcester, Massachusetts; might striking trations of the former dreadful condition of and of the advan- lunatics, of derived from a treatment. The American tages change physicians with the most of in their enlightened keep pace practitioners Europe treatment of whilst alive to the of moral ma- and, insanity, importance stress on the benefit to be in cases derived nagement, lay proper many the and of from medicinal means. In one timely judicious application of the it is stated that of the cases of from Reports insanity intemperance, about 50 cent, of those from domestic about 53 recover; per afflictions, from ill of those about and of those from health, 72; percent.; religious about 50. Of the cases ascribed to which is fre- causes, manustupratio, mentioned as a cause the American 7 about writers, quently by only cent, are said to recover their reason. Some cases of homi- per frightful intended to moral cidal illustrate are inserted in an insanity, insanity, be to Dr. Woodward not It would to mention that appendix. injustice his and in indefatigable attentions, philanthropy, intelligence, carrying into full effect all means of cure in this are of the hospital, spoken by directors as "above all and all praise, beyond price." In of the Hanwell we the see little on 1838,) Report Asylum (January, which we are to make observations. with most disposed any Compared of the of other it is and contains little infor- institutions, reports meager, mation. Sir William states that the of Ellis, however, per centage from its deaths at the Middlesex first to that is time, Asylum, opening "much smaller than in other institution circum- any large similarly with which he is and he illustrates this a table stanced," acquainted; by and in of the number of deaths th6 and Middlesex, patients Wakefield, the three in Lancaster he in Asylums; only large asylums England, says, which are and "where the must remain only received, patients paupers until die or are or cease to assistance." cured, require parochial they By this whilst the annual of deaths for six has table, per centage years past at Lancaster and at Wakefield it is shown to have been, 24.29, 17.87, been 12.56 at Hanwell. This is ascribed Sir W. Ellis to only chiefly by the situation of the Hanwell but of 600 good Asylum; as, patients nearly in the at the time of the Sir W. Ellis remaining asylum making report, all to be at least in all incurable, thirteen, pronounces probability, except the rest must of course die and swell the annual in future. off, mortality Of men admitted last fourteen were cured thirty-seven year, discharged were of women the cures thirteen. The and, admitted, twenty-seven chronic of date than two the or those of cases, were, men, longer years, and of the Of the six men and two seventeen, women, eighteen. rest, women had been insane. A number of the great patients previously men and 260 are We cannot (194 women) constantly employed. help a or a that some like again belief, expressing something certainly hope, of these so so so be re- industrious, patients, docile, orderly, yet may stored to menial health and various, perfect by well-devised, timely and moral medicinal means. applied &c. on Greco, Farr, 55 1839.] Crowther, Insanity. The brief notices we have of Mr. Farr's Statistics are suf- already given ficient to show the and of the included in variety importance particulars On one his which the pamphlet. subject, greatly requires, revision, we cannot at enter. The management of lunatics, public present present is neither convenient nor effective. In Mr. Farr's certainly system words, At there are for commissioners for licensed lunatics, present inspectors Chancery for where the abuses have houses, visiting justices county asylums: Bethlem, greatest is from the of the best existed, regular expressly exempted inspection; reports asylums, those are in no the facts collected supported by subscription, published regular form; the central and the of have never by commissioners, lunatics, inspectors Chancery been A more of delusive, inefficient, published. unsatisfactory system inspection than now obtains cannot be imagined." (p. 37.) The remedies Mr. Farr that the medical proposed by are, inspection should be vested in one and should extend to all establishments body, and that lunatic in the should be included irrespectively; every country in the annual tabular We believe evils would be reports. existing many an end to this the details of which will be found in Mr. put by plan, Farr's and there can be no doubt that it would the be means of pages; statistical results that be relied obtaining might upon. In the of lunatic as some of its past history asylums, revolting early the of those are, passages progressive improvement melancholy recepta- cles for the worst forms of human wretchedness affords a foundation for the most confident in that whatever evils exist their hope yet government will be remedied. To some we institutions understand large gradually that well-educated medical men have been as recently appointed super- men who will intendents; not consider themselves as mere bailiffs or or or show-men of and will have lunatics; who little stewards, keepers, of a institution to avaricious opportunity making public merely subsidiary but will views; remember what is from and them, private expected acquit themselves of duties to the as well as to the establish- important public, ments to which they belong. The observations we to convince medi- suffice, think, preceding every cal reader that there are unsettled to which men of yet many questions scientific education in our lunatic themselves, might usefully apply large institutions. A fuller and closer of the and investigation predisposing causes of careful and trial of different exciting insanity,?a investigation modes of some in medical treatment,?and questions jurisprudence, may be as the attention of who are mentioned, those en- particularly soliciting abled their to devote all their time to this branch of by position great and not will we venture to before practice; many years elapse, prophesy, valuable contributions will be made in our own towards a more country and in all diseases of the mind. satisfactory pathology practice

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A Treatise on Insanity, and Other Disorders Affecting the Mind

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A Treatise on Insanity, and Other Disorders Affecting the Mind

A Treatise on Insanity, and Other Disorders Affecting the Mind

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