The head was opened twenty four hours after her decease. The tunica arachnoidea was in many places opake; the pia mater was highly inflamed, and loaded withblood, and a considerable quantity of water was contained between it and the former membrane. The ventricles were enlarged, but contained scarcely any fluid. The other parts of the brain were healthy, and its consistence was natural.
It is a common opinion, that Phthisis Pulmonalis is frequently suspended by the supervention of mania; medical books abound with such accounts, and some persons have supposed it difficult, if not impossible, for these diseases to co-exist. It is not my intention to dispute the accuracy of such relations, nor to question the power which Mania may possess in arresting the progress of Phthisis Pulmonalis, but, to state that the converse does not obtain; and, that whatever obligations may be due from Phthisis to Mania, the compliment has not been returned. From my own experience I can affirm, that insane persons are as liable toPhthisis Pulmonalis as others, that numbers of them die of that disease; and that I never saw any abatement of the maniacal symptoms through the progress of consumption.
CASE XXXII.
J. P. aged 57, was admitted into the hospital, January 19, 1799; he was stated to have been insane about three weeks, and that his disorder came on shortly after the death of his master, in whose service he had continued many years, and to whom he was much attached. He had been in the hospital three times before, and had each time been discharged well. His disorder usually recurred every seven or eight years. His father also had been maniacal about the middle period of life, but never recovered. When admitted he was very talkative, although his natural characterwas reserved. He endeavoured to explain his meaning with superior correctness, and sought to define every subject, however trifling, with a tedious minuteness; but, upon religion and politics, the Scylla and Charybdis of human discussion, he was pertinacious and intollerant. This dictatorial manner and stubbornness of opinion, not being capable of producing the relations of peace and amity with other philosophers, equally obstinate, and whose principles had been matured by long confinement, it became necessary to shut him up in his cell. During the period of his seclusion, nothing very incoherent escaped from him; every thing he said was within the sphere of possibility. His fastidiousness rendered him unhappy: he acknowledged the food which was brought him to be good, but he conceived it might have been better. The cathartic medicine, which was administered to him, he confessed had answered thepurpose, but its taste was most nauseous, and he had never before been so severely griped. He ornamented his person and apartment in a very whimsical manner: latterly he tore his clothes because he suspected the taylor had deceived him in the materials. After this he continued naked until the beginning of March, when he appeared more composed, and sensible of the state he had been in. On the morning of the 12th, when the keeper opened his cell, he was speechless; his mouth drawn to the right side, and so feeble that he could not support himself. A cathartic medicine was given, and sinapisms were applied to the feet and legs. In the evening he was much recovered, his speech had returned, and he was able to move himself. He was visited again at midnight, when he appeared still better. In the morning it was evident that he had experienced another attack, his mouth was drawn aside; he was stupid,and died within half an hour. The head was opened on the following day. The tunica arachnoidea was in some places slightly opake. The pia mater was inflamed, but not to any considerable degree. There was no water between any of the membranes. The ventricles were of a natural capacity, and did not contain any fluid. There was no extravasation in any part of the substance of the cerebrum or cerebellum. Excepting the slight inflammation of the pia mater, the brain had a very healthy appearance; its consistence was firm; the scull was unusually thick. I regret, from a promise which had been made to the friends, of inspecting the head only, that the thoracic and abdominal viscera were not examined.
This history has been related to shew, that although the patient died with those symptoms, which indicate pressure on thebrain, as loss of speech, the mouth being drawn aside, stupor and insensibility; yet the brain did not afford the same appearances, on dissection, as have been usually detected in such cases. The following relation is an additional example of the same fact:
CASE XXXIII.
N. B. He had been many years in the hospital as an incurable patient; his mother was known to have been maniacal; his two brothers and his sister have been insane. His eldest son, on taking a very small quantity of fermented liquor, becomes frantic, and its effects continue much longer than on persons in general. During this patient’s confinement, he was, as far as could be ascertained, completely in his senses; this induced the medical persons of the hospital, on two or three occasions,to give him leave of absence, that he might return on trial to his wife and family; but, in a few hours after he came home, he felt uneasy, and found himself bewitched at all points: the devil and his imps had pre-occupied the best places in the house; he became very turbulent, and also jealous of his wife, and was obliged to be returned to the hospital. As he found his home so beset with difficulties he resolved that he would never enter it again. During eight years that I was acquainted with him I never discovered the least insanity in his actions or conversation. He was perfectly sensible that his intellects were disordered whenever he returned to his family. His wife and children frequently visited him in Bethlem, and he always conducted himself affectionately towards them. About 14 months before his death he laboured under a severe dysentery, which continued six weeks, and left him in a very reduced state, withœdematous legs, and incipient dropsy of the abdomen. On his recovery from these symptoms he became troubled with fits; they appeared to be such as a medical person would have termed apoplectic. After the attack, no symptoms of paralysis remained, nor did he experience the fatigue and exhaustion, or fall into a profound sleep, which usually accompanies Epilepsy. On October 10th, 1802, being then in a pretty good state of health, he fell down, and expired in a few minutes. He was about sixty-five years of age. On examination of the head after death, there was a considerable determination of blood to the brain; but there was no extravasation of that fluid, nor any collection of water: the brain and its membranes had a healthy appearance, and its consistence was natural. The heart was sound, and the abdominal viscera were not conspicuously diseased.
CASE XXXIV.
J. P. a man, aged thirty, was admitted into the hospital, October 18th, 1800. It was then deposed, by the persons who brought him, that he had been for eight months in a melancholic state; but they were unable to assign any circumstances, which preceded his disorder, as a cause of his disease. He had a large tumor on the throat which extended backward to the neck, principally on the left side; the increase of this swelling, they alledged, had much alarmed him, at the commencement of his melancholic attack. During the time he was the subject of my observation, he was in a very mopish and stupid state; if spoken to, he would sometimes give a short answer, but ordinarily he took no notice of those who addressed him. Somedays he would walk slowly in the less frequented part of the building; frequently he sat down for some hours in a corner. His appetite was good, he ate the food which was brought him, but never took the trouble to go for it, when serving out. In this state he continued until April 2d, when he became more stupid, and could not be made to rise from his bed. He did not appear to be in any pain, nor was he at all convulsed. His bowels were regular. On the 5th he became comatose, and on the 9th he died.
Appearances on Dissection.
There was an excessive determination of blood to the brain, and the pia mater was highly inflamed. On the inferior part of the middle lobe of the brain, there was a gangrene of considerable extent, together with a quantity of very fœtid purulent matter.
This is the only instance of a gangrenous state of the brain which has fallen under my observation.
CASE XXXV.
T. C. This person had remained many years in the hospital on the incurable establishment. He had been a schoolmaster at Warrington in Lancashire, and was a man of acuteness and extensive mathematical learning. As he became very furious on the attack of his maniacal disorder, he was placed in the Lunatic Asylum at Manchester, where he killed the person who had the care of him, by stabbing him in the back with a knife.
The following is the account he gave me of that transaction, and which I immediately committed to paper; as it conveys aserious and important lesson to those who are about the persons of the insane.
“He that would govern others, first should beThe master of himself, richly indu’dWith depth of understanding, height of courage.”Massinger’s Bondman,ActI.Scene3.
It ought to be more generally understood that a madman seldom forgets the coercion he has undergone, and that he never forgives an indignity.
“The man whom I stabbed richly deserved it. He behaved to me with great violence and cruelty, he degraded my nature as a human being; he tied me down, handcuffed me, and confined my hands much higher than my head, with a leathern thong: he stretched me on a bed of torture. After some days he released me. I gave him warning, for I told his wife I would have justice of him. On hercommunicating this to him, he came to me in a furious passion, threw me down, dragg’d me through the court-yard, thumped on my breast, and confined me in a dark and damp cell. Not liking this situation, I was induced to play the hypocrite. I pretended extreme sorrow for having threatened him, and by an affectation of repentance, prevailed on him to release me. For several days I paid him great attention, and lent him every assistance. He seemed much pleased with the flattery, and became very friendly in his behaviour towards me.—Going one day into the kitchen, where his wife was busied, I saw a knife; (this was too great a temptation to be resisted;) I concealed it, and carried it about me. For some time afterwards the same friendly intercourse was maintained between us; but, as he was one day unlocking his garden door, I seized the opportunity, and plunged the knife up to the hilt in his back.”—Healways mentioned this circumstance with peculiar triumph, and his countenance (the most cunning and malignant I ever beheld) became highly animated at the conclusion of the story.
During the time he was in Bethlem Hospital he most ingeniously formed a stiletto out of a mop-nail; it was an elaborate contrivance, and had probably been the work of several months. It was rendered extremely sharp and polished, by whetting on a small pebble; it was fixed into a handle, and had a wooden sheath made from the mop-stick. This instrument he carried in his left breeches pocket, his right hand grasping the hilt. As I always found him in that posture when I visited him, I suspected he had some concealed implement of mischief, and therefore employed a convalescent patient to watch him through the key-hole of his door. This person saw himwith the weapon, and also ascertaining the distance at which he could use it.
The instrument was taken from him by surprise. When he found he was prevented from executing his purpose, he roared out the most horrid imprecations; he cursed the Almighty for creating him, and more especially for having given him the form of a human being, and he wished to go to Hell that he might not be disgraced by an association with the Deity.
He had an uniform and implacable aversion to the officers and servants of the hospital; he said he courted their hatred for their curse was a blessing. He seldom answered a question but some impiety was contained in the reply. An indifferent person remarking that it was a bad day, he immediately retorted, “Sir, did you ever know God make a good one?” Although thewhole of the day, and the greatest part of the night, were consumed in pouring forth abuse and coining new blasphemies; yet there were some few patients for whom he professed a friendship, and with whom he conversed in a mild and civil way: this confidence had been obtained by the compliments they had addressed to him on the score of his understanding, of which he entertained a very high opinion. At one time he conceived himself to be the Messiah, at another, that he was Mr. Adam, the architect; and that he was shortly to go to America in order to build the new Jerusalem in Philadelphia.
About six months before his death he complained of pain in his stomach, and said he felt as if he had no intestines. His appetite diminished, and he became melancholic.
The scene now began to alter; he had a presentiment that his time in this world would be short, and he dreaded the change: no hope arose, no consolation could cheer him; he became daily more emaciated and despairing until he died, which took place August 27, 1801; he appeared to be about seventy years of age.
On opening the head, the pericranium was scarcely adherent. This membrane being removed, blood oozed freely from the parietal bones. There was a large accumulation of water between the dura mater and tunica arachnoidea; when this was let out the dura mater became flaccid, and seemed to hang loose on the brain. On the left posterior lobe of the cerebrum there was a large quantity of a milky fluid, between the tunica arachnoidea and pia mater, giving the appearance of a vesication; and in that place there was a depression orcavity formed in the convolutions of the brain. The convolutions were so strongly and distinctly marked, that they resembled the intestines of a child. The lateral ventricles were but little distended, and did not contain much water. The head was not particularly loaded with blood, nor were the bloody points, in the medullary substance, very abundant. The brain was of a natural consistence. There was no disease in the stomach, intestines, or liver. The body was opened about six hours after his death.
CASE XXXVI.
B. S. a man, generally noticed by those who have visited Bethlem hospital a few years ago. It was said, that an attachment to a young woman, who slighted his addresses, was the cause of his becoming insane. He was considered a very dangerouslunatic, and for many years was confined to his cell. In this situation he employed himself in the manufacture of straw baskets and table mats. The desire of money was the leading feature of his mind, and the whole of his energies were devoted to its acquisition; nor was he at all scrupulous as to the means, by which he attained his object. Although repeatedly assured that he would never be liberated, he disbelieved such information, and was persuaded, when he had acquired a sum sufficient to purchase a horse and cart, filled with higler’s ware, that he should be released. The idea of becoming a trader, on so large a scale, stimulated him to constant occupation. He employed several lunatic journeymen to plat the straw for him, but they were poorly rewarded. He generally chose for his workmen such as were chained, and could not come personally to insist on the reward of their labour. He commonly pretended thatthe platting was badly performed, and consequently unsaleable; sometimes he would protest that he had settled with them, but that they were too mad to recollect it; and if at any time he did pay them, it was in bad coin. For many years he was unrivalled in this trade, and, by every species of fraud, had amassed nearly sufficient to set his plans afloat: when an unfortunate event took place, which considerably reduced his capital. He had always a propensity to game, which, from his skill and dexterity in cheating, was generally attended with success; but in this science he was once over-matched. An insane soldier, an ingenious man, became his intimate friend, and finding him possessed of some money proposed a game at cards. The result was deeply disastrous to the artificer in straw, who endeavoured to evade the payment; but his friend stated it to be a debt of honor; and besides he was a very powerful man, of astern aspect, and not to be trifled with; he was therefore compelled to tell down at once the slow accumulation of several years. It was intended to make the soldier restore the property, but he, conceiving that he had already derived sufficient benefit from the hospital, went away in the night, without the formalities of a regular discharge.
To fill up the measure of his misfortunes, when Hatfield, the maniac who shot at his Majesty in the theatre, was brought to Bethlem, he, in conjunction with a contriving cobbler, established a rival manufactory, which shortly eclipsed the fabric of the old school, and by superior taste rendered his further exertions unnecessary.
It is natural to suppose, that no great cordiality could exist between persons, where the prosperity of one had been established on the ruin of the other. Frequentaltercations arose, and much offensive language was exchanged. At length the patience of the original dealer was exhausted, and, in collecting his force to give his opponent a blow, he fell down and instantly expired.—He was about fifty-eight years of age.
Some of his habits and opinions were extremely singular; he believed that all occurrences were regulated by witches: prosperity was to be attributed to the good witches having obtained the mastery; and when bad witches gained the ascendancy, misfortunes arose. When the latter were at work he supposed himself in possession of a power to frighten and disperse them, and this was effected by a peculiar noise he made. It is probable he might have laboured under indigestion, for immediately after he had eaten his dinner, he sent forth a dreadful howl, which he continued for about ten minutes: but his great terror wasa thunder storm; when this occurred, he took a very active part, and brought the whole force of his lungs to bear upon the enemy. A cat was supposed to have a natural antipathy to bad witches, she could smell them at a distance; for which reason he always domesticated an animal of that kind to sleep in his cell.
When his head was opened, the dura mater was very easily separable from the scull; upon puncturing this membrane a considerable quantity of blood flowed from the opening; and there was a copious extravasation of this fluid between the membranes of the brain: but the most remarkable circumstance was, that the tunica arachnoidea was so thickened, that it exceeded the dura mater on an accurate comparison. The pia mater was loaded with blood, and its vessels were enlarged. The brain and its cavities were sound and natural.
CASE XXXVII.
R. B. This man had been many years an incurable patient, and it was supposed that jealousy of his wife had been the cause of his madness, although it appeared from very respectable testimony that he had no real grounds for such suspicion. During eight years, (the period he was subject to my observation,) he was mostly in a very furious state, and obliged to be strictly confined. His mischeivous disposition was manifested on every occasion; he would hurl the bowl, in which his food was served, against those who passed his cell; and when his hands were secured he would kick, bite, or throw his head into the stomachs of those who came near him. He entertained a constant aversion to his keeper, whom he suspected to be connected with his wife. His lifewas miserably divided between furious paroxysms and melancholic languor, and there was great uncertainty in the duration of these states. He has been known to continue ten months in the highest degree of violence, and relapse into the same state after a few days passed in tranquil depression. There was one circumstance which never failed to produce a relapse, however quietly he might have conducted himself, this was a visit from any of his family, and a very striking instance occurred. From May, 1799, to September, 1800, he had every appearance of being perfectly recovered: he was, in consequence, allowed additional comforts, and treated as a convalescent. At this time he was visited by his son, who, after many hours conversation with him, was persuaded that he had perfectly recovered his intellects; and he expressed himself astonished at his father’s accurate recollection of particulars whichmight be supposed to have been obliterated from his mind. This dutiful visit and affectionate intercourse produced unpleasant consequences. The numerous enquiries which the patient had made, furnished him with materials for reflexion. On the departure of his son he began to detect mismanagement in his affairs, and improprieties in the conduct of his family: he was very talkative, and became impatient to return home. The following day he had a wildness in his eyes, spoke fast, and appeared busy: before the evening he was so irritable and disobedient that it became necessary to confine him. From this time he continued in the most furious condition, singing and vociferating the greatest part of the night, until January 2d, 1801, when he became suddenly calm, complained of extreme debility, and said he should die in a few hours. He gave very proper answers to the questions which were asked him, butcomplained of the fatigue which talking induced. On the next morning he expired. He was sixty-eight years of age. The head was opened two days after his death. The tunica arachnoidea was in many places opake, and considerably thickened. There was a small quantity of limpid water between this membrane and the pia mater. When the medullary substance was cut into, there oozed from many points a quantity of dark blood, indeed the whole head was loaded with venous blood. The lateral ventricles were considerably enlarged and filled with water—four ounces were collected. The internal carotid arteries were much enlarged, and when divided, did not collapse, but remained open, as arteries in the other parts of the body. The consistence of the brain was doughy.
CASES OF INSANE CHILDREN.
Inthe month of March, 1799, a female child, three years and a quarter old, was brought to the hospital for medical advice. She was in good bodily health, and born of sane and undiseased parents. The mother, who attended, stated that her husband’s parents and her own had never been in the slightest degree afflicted with mania, but that she had a brother who was born an ideot. She related that her child, until the age of two years and a half, was perfectly well, of ordinary vivacity, and of promising talents; when she was inoculated for the small pox. Severe convulsionsushered in the disease, and a delirium continued during its course. The eruption was of the mild kind, and the child was not marked with the pustules. From the termination of the small-pox to the above date, (nine months) the child continued in an insane state. Previously to the small-pox, she could articulate many words, and use them correctly for the things they signified: but since that time she completely forgot her former acquisitions, nor ever attempted to imitate a significant sound. Whatever she wished to perform, she effected with promptitude and facility. She appeared anxious to possess every thing she saw, and cried if she experienced any disappointment; and on these occasions she would bite, or express her anger by kicking or striking. Her appetite was voracious, and she would devour any thing that was given to her, without discrimination; as fat, raw animal food, or taintedmeat. To rake out the fire with her fingers was a favourite amusement, nor was she deterred from having frequently burned them. She passed her urine and fæces in any place without restraint; but she could retain a considerable quantity of the former before she discharged it. Some cathartic remedies were ordered for her, with an emetic occasionally, and she was brought to the hospital every fortnight, but she did not appear in any degree amended. On June 22 she was admitted a patient, and continued in the hospital until the middle of October, when she was attacked with an eruptive fever, and consequently discharged. During this time little progress was made, although considerable pains were bestowed. She became more cunning, and her taste appeared improved. The cathartic medicine, which she drank at first without reluctance, became afterwards highly disgusting, and when she saw the basket whichcontained it, she endeavoured to escape and hide herself. To particular persons she was friendly, and felt an aversion to others. She was sensible of the authority of the nurse who attended her, and understood by the tone of her voice whether she were pleased or offended. The names of some things she appeared to comprehend, although they were extremely few; when the words, dinner, cakes, orange, and some more were mentioned, she smiled, and appeared in expectation of receiving them. By great attention and perseverance on the part of the nurse, she was brought to evacuate her fæces and urine in a night stool.
After the elapse of three years I was informed that the child had made no intellectual progress.
W. H. a boy, nearly seven years of age, was admitted into the Hospital, June 8th,1799. His mother, who frequently visited him, related the following particulars respecting his case.—She said that, within a month of being delivered of this child, she was frightened by a man in the street, who rudely put his hand on her abdomen. When the child was born it was subject to startings, and became convulsed on any slight indisposition. When a year old, he suffered much with the measles: and afterwards had a mild kind of inoculated small-pox. At this age she thought the child more lively than usual, and that he slept less than her other children had done. At two years, the mother perceived he could not be controled, and therefore frequently corrected him.
There was a tardiness in the developement of his physical powers. He was fifteen months old before he had a tooth, and unable to go alone at two years and ahalf: his mind was equally slow; he had arrived at his fourth year before he began to speak; and, when in his fifth, he had not made a greater proficiency in language than generally may be observed in children between two and three years. When admitted into the hospital, he wept at being separated from his mother, but his grief was of very short continuance. He was placed on the female side, and seemed highly delighted with the novelty of the scene: every object excited his curiosity, but he did not pause or dwell on any. He was constantly in action, and rapidly examined the different apartments of the building. To the patients in general he behaved with great insolence—he kicked and spat at them, and distorted his face in derision; but, on the appearance of the nurse, he immediately desisted, and assured her he was a very good boy. Great, but ineffectual, pains were taken, to make him understand thenature of truth,—he could never be brought to confess any mischief he had committed, and always took refuge in the convenient shelter of a lie. In a short time he acquired a striking talent for mimickry, and imitated many of the patients in their insane manners; he generally selected, for his models, those who were confined, as he could practise from such with impunity.
In about three months he had added considerably to his stock of language, but, unluckily, he had selected his expressions from those patients who were addicted to swearing and obscene conversation. To teach him the letters of the alphabet had many times been endeavoured, but always without success; the attempt uniformly disgusted him: he was not to be stimulated by coaxing or coercion; his mind was too excursive, to submit to the painful toil of recording elementary sounds; but it mayrather be inferred that he did not possess a sufficient power of attention to become acquainted with arbitrary characters.
He was in good health, his pulse and bowels were regular, and his appetite was keen, but not voracious. One circumstance struck me, as very peculiar, in this boy,—he appeared to have very incorrect ideas of distance: he would frequently stretch out his hand, to grasp objects considerably beyond his reach, but this referred principally to height: he would endeavour to pluck out a nail from the ceiling, or snatch at the moon. In October he became unwell, and, at the mother’s request, was discharged from the hospital.
In September 1805, I again saw the boy: he was then thirteen years of age, had grown very tall, and appeared to be in good health. He recollected meimmediately, and mentioned the words, school Moorfields, nasty physic. On meeting with some of the female patients, he perfectly remembered them, and seemed for the moment, much pleased at the renewal of the acquaintance. By this time, he had made comparatively, a great progress in language; he knew the names of ordinary things, and was able to tell correctly the street in which he resided, and the number of his house. His mother informed me that he was particularly fond of going to church, although he was unable to comprehend the purpose for which he went: when there, he conducted himself with great order and decorum, but was disposed to remain after the congregation had dispersed. To shew how little he understood, why he frequented a place of worship: his mother once took him to church on Sacrament-sunday, and fearful of disturbing the persons assembled, by compelling him toreturn home, allowed him to be a spectator of those solemn administrations. The only reflexion he made on the subject, but in disjointed expressions, was, that he thought it extremely hard, that the ladies and gentlemen should eat rolls and drink gin, and never ask him to partake. In his person he was clean, and dressed himself with neatness. Having been taught when in the hospital to use a bowl for his necessary occasions, he obstinately continued the same practice when he returned home, and could never be persuaded to retire to the closet of convenience; but the business did not terminate here, when he had evacuated his intestines into the bowl he never failed to paint the room with its contents. To watch other boys when they were playing, or to observe the progress of mischief, gave him great satisfaction: but he never joined them, nor did he ever become attached to any one ofthem. Of his mother he appeared excessively fond, and he was constantly caressing her: but in his paroxysms of fury he felt neither awe nor tenderness, and on two occasions he threw a knife at her. Although equally ignorant of letters, as when discharged from the hospital, he took great delight in having gilt books; indeed every thing splendid attracted his attention, but more especially soldiers and martial music. He retained several tunes, and was able to whistle them very correctly. The day on which I last saw him his mind was completely occupied with soldiers; when questions were put to him, if he answered them it was little to the purpose, generally he did not notice them, but turned round to his mother and enquired about the soldiers.
The defect of this lad’s mind, appeared to be a want of continued attention to things,in order to become acquainted with their nature; and he possessed less curiosity than other children, which serves to excite such attention: and this will in some degree explain, why he had never acquired any knowledge of things in a connected manner. His sentences were short, and he employed no particles to join them together. Although he was acquainted with the names of many things, and also with expressions which characterize passion, he applied them in an insulated way. For instance, if a shower fell, he would look up and say, “rains;” or when fine, “sun shines.” When in the street he would pull his mother, to arrest her attention, and point to objects, as a fine horse, or a big dog; when he returned home he would repeat what had attracted his notice, but always speaking of himself in the third person. “Billy see fine horse, big dog,&c.”[12]Of circumstances boldly impressed, or reiterated by habit, his memory was retentive, but as his attention was only roused by striking appearances, or loud intonations, ordinary occurrences passed by unobserved.
In the month of July 1803, my opinion was requested respecting a young gentleman, ten years of age, who was sent here, accompanied by a kind and decent young man, to take care of him. Previously to his arrival I had corresponded respecting his case with a very learned and respectable physician in the country, under whose care the boy had been placed. From the information furnished by this gentleman, andthat which was collected from the keeper, I believe the former history of his case is correctly given.
The parents are persons of sound mind, and they do not remember any branches of their respective families to have been (in any manner) disordered in their intellects. The subject of the present relation was their eldest son; the second child was of a disposition remarkably mild; and the youngest, a boy, about two years and a half, was distinguished by the irritability and impatience of his temper. At the age of two years, the subject of the present relation, became so mischievous and uncontroulable, that he was sent from home to be nursed by his aunt. In this situation, at the request of his parents, and with the concurrence of his relation, he was indulged in every wish, and never corrected for any perverseness or impropriety of conduct.Thus he continued until he was nearly nine years old, the creature of volition and the terror of the family. At the suggestion of the physician, whom I have before mentioned, and who was the friend of his parents: a person was appointed to watch over him. It being the opinion of the doctor that the case originated in over indulgence and perverseness; a different system of management was adopted. The superintendant was ordered to correct him for each individual impropriety. At this time the boy would neither dress nor undress himself, though capable of doing both; when his hands were at liberty, he tore his clothes: he broke every thing that was presented to him, or which came within his reach, and frequently refused to take food. He gave answers only to such questions as pleased him, and acted in opposition to every direction. The superintendant exercised this plan for severalmonths, but perhaps not to the extent laid down; for it may be presumed, that after a a few flagellations his humanity prevailed over the medical hypothesis. When he became the subject of my own observation, he was of a very healthy appearance, and his head was well formed; this was also the opinion of several gentlemen, distinguished for their anatomical knowledge, to whom the boy was presented. His tongue was unusually thick, though his articulation was perfectly distinct. His countenance was decidedly maniacal.[13]His stature, for his age, was short, but he was well compacted, and possessed great bodily strength.Although his skin was smooth and clear, it was deficient in its usual sensibility; he bore the whip and the cane with less evidence of pain than other boys. Another circumstance convinced me of this fact. During the time he resided in London he was troubled with a boil on his leg; various irritating applications were made to the tumor, and the dressings were purposely taken off with less nicety than usual, yet he never complained. His pulse was natural, and his bowels were regular. His appetite was good, but not inordinate, and he bore the privation of food for a considerable time without uneasiness. Althoughhe slept soundly, he often awoke as if suddenly alarmed, and he seemed to require a considerable duration of sleep.
He had a very retentive memory, and had made as great proficiency in speech as the generality of boys of his own age. Few circumstances appeared to give him pleasure, but he would describe very correctly any thing which had delighted him. As he wanted the power of continued attention, and was only attracted by fits and starts, it may be naturally supposed he was not taught letters, and still less that he would copy them. He had been several times to school, and was the hopeless pupil of many masters, distinguished for their patience and rigid discipline; it may therefore be concluded, that from these gentlemen, he had derived all the benefits which could result from privations to his stomach,and from the application of the rod to the more delicate parts of his skin.
On the first interview I had with him, he contrived, after two or three minutes acquaintance, to break a window and tear the frill of my shirt. He was an unrelenting foe to all china, glass, and crockery ware, whenever they came within his reach he shivered them instantly. In walking the street, the keeper was compelled to take the wall, as he uniformly broke the windows if he could get near them, and this operation he performed so dextrously, and with such safety to himself, that he never cut his fingers. To tear lace and destroy the finer textures of female ornament, seemed to gratify him exceedingly, and he seldom walked out without finding an occasion of indulging this propensity. He never became attached to any inferior animal, a benevolence so common to the generalityof children: to these creatures his conduct was that of the brute: he oppressed the feeble, and avoided the society of those more powerful than himself. Considerable practice had taught him that he was the cat’s master, and whenever this luckless animal approached him he plucked out its whiskers with wonderful rapidity; to use his own language, “I must have her beard off.” After this operation, he commonly threw the creature on the fire, or through the window. If a little dog came near him he kicked it, if a large one he would not notice it. When he was spoken to, he usually said, “I do not choose to answer.” When he perceived any one who appeared to observe him attentively, he always said, “Now I will look unpleasant.” The usual games of children afforded him no amusement; whenever boys were at play he never joined them: indeed, the most singular part of his character was, that heappeared incapable of forming a friendship with any one: he felt no considerations for sex, and would as readily kick or bite a girl as a boy. Of any kindness shewn him, he was equally insensible; he would receive an orange as a present, and afterwards throw it in the face of the donor.
To the man who looked after him, he appeared to entertain something like an attachment: when this person went out of the room, and pretended that he would go away, he raised a loud outcry, and said, “what will become of me, if he goes away; I like him, for he carries the cane which makes me a good boy:” but it is much to be doubted, whether he really bore an affection for his keeper; the man seemed to be of a different opinion, and said, when he grew older he should be afraid to continue with him, as he was persuaded the boywould destroy him, whenever he found the means and opportunity.
Of his own disorder he was sometimes sensible: he would often express a wish to die, for he said, “God had not made him like other children;” and when provoked, he would threaten to destroy himself.
During the time he remained here, I conducted him through the hospital, and pointed out to him several patients who were chained in their cells; he discovered no fear or alarm; and when I shewed him a mischievous maniac who was more strictly confined than the rest, he said, with great exultation, “this would be the right place for me.” Considering the duration of his insanity, and being ignorant of any means by which he was likely to recover, he returned to his friends, after continuing a few weeks in London.
CAUSES OF INSANITY.
Whenpatients are admitted into Bethlem Hospital, an enquiry is always made of the friends who accompany them, respecting the cause supposed to have occasioned their insanity.
It will be readily conceived, that there must be great uncertainty attending the information we are able to procure upon this head: and even from the most accurate accounts, it would be difficult to pronounce, that the circumstances which are related to us, have actually produced the effect. The friends and relatives of patients are, uponmany occasions, very delicate concerning this point, and cautious of exposing their frailties or immoral habits: and when the disease is connected with the family, they are oftentimes still more reserved in disclosing the truth.
Fully aware of the incorrect statement, frequently made concerning these causes, I have been at no inconsiderable pains to correct or confirm the first information, by subsequent enquiries.
The causes which I have been enabled most certainly to ascertain, may be divided intoPhysicalandMoral.[14]
Under the first, are comprehended repeated intoxication: blows received upon the head; fever, particularly when attended with delirium; mercury, largely and injudiciously administered; cutaneous eruptions repelled, and the suppression of periodical or occasional discharges and secretions; hereditary disposition, and paralytic affections.
By the second class of causes, which have been termedmoral, are meant those which are supposed to originate in the mind, or which are more immediately applied to it.Such are, the long endurance of grief; ardent and ungratified desires; religious terror; the disappointment of pride; sudden fright; fits of anger; prosperity humbled by misfortunes:[15]in short, the frequent and uncurbed indulgence of any passion or emotion, and any sudden or violent affection of the mind.
There are, doubtless, many other causes of both classes, which may tend to produce this disease. Those which have been stated, are such as I am most familiar with; or, to speak more accurately, such are the circumstances most generally found to have preceded this affection.
It is an old opinion, and continues still to prevail, that maniacs are influenced bythe changes of the moon. In the fourth chapter of St. Matthew’s Gospel, verse 24, we find the word “Σεληνιαξομένους” which is rendered in the English version, “those which were lunatic.” Notwithstanding the notion of being moon-struck might prevail among the ignorant people of Galilee, yet Hippocrates, a philosopher, and correct observer of natural phænomena, does not appear to have placed any faith in this planetary influence. Although the Romans were infected with this popular tradition, as may be seen in the following passage of the Art of Poetry,
“Ut mala quem scabies aut morbus regius urget,Aut fanaticus error, etiracunda DianaVesanum tetigisse timent fugiuntque poetam,Qui sapiunt:”—
yet Celsus did not consider the operation of the moon on the human intellect sufficiently well founded to admit it into hismedical work. Not a word on this subject is mentioned in the eighteenth chapter of his third book, which particularly treats of Insanity, “De tribus insaniæ generibus;” it is true that, in the fourth chapter of the first book, which speaks “De his quibus caput infirmum est,” he says “Cui caput infirmum est, is si bene concoxit, leniter perfricare id mane manibus suis debet; nunquam id, si fieri potest, veste velare; aut ad cutem tondere: utileque lunam vitare, maximeque ante ipsum lunæ solisque concursum.” By theinfirmum caput, Celsus does not mean madness, as may be clearly seen by perusing the chapter: the weakness of intellect, which frequently continues after fever, or other violent diseases, is evidently his meaning; but Dr. Cox has quoted the above passage, to prove that Celsus was impressed with the truth of this vulgar opinion. He says, “This idea of lunar influence, inmaniacal complaints, washanded down to us by our medical forefathers, and is still very generally adopted.”
It is most probable that this idea of planetary regency, however it might have arisen, or to whatever extent it may have been credited, received in the Arabian school, the stamp by which its currency has been subsequently maintained. For the revival and dispersion of ancient medical knowledge, we are confessedly under considerable obligations to the Arabians;[16]and more especially for the incorporation of astrology, magic and alchymy, with medicine.
Popular superstitions and national proverbs, are seldom without some foundation; and with respect to the present, it may be observed, that if it were not in some degreerooted in fact, and trained up by observation, it would become difficult to ascertain how such an opinion came to be adopted; and this investigation is rendered still more important from the consideration, that the existing law in this country, respecting insane persons, has been established on the supposed prevalence of this lunar regulation. A commission is issued, delunaticoinquirendo, and the commissioners sitting for that purpose, are particular in their enquiries, whether the patient enjoys lucid intervals. The termlucid intervalhas been properly connected with the wordlunacy; for, if the patient, as they supposed, became insane at particular changes of the moon, the inference was natural, that in the intervening spaces of time he would become rational.
It is more than probable, that the origin of this supposition of the lunar influencemay be traced to the following circumstances. The period of the return of the moon, and of regular menstruation in women, is four weeks; and the terms which designate them, have been imposed from the period of time in which both are compleated. Insanity and epilepsy are often connected with menstruation, and suffer an exacerbation of their paroxysms at the period when this discharge happens, or ought to take place. If, therefore, the period of menstruation in an insane woman should occur at the full of the moon, and her mind should then be more violently disturbed, the recurrence of the same state may be naturally expected at the next full moon. This is a necessary coincidence, and should be discriminated from effect. But such has been the prevalence of this opinion, that when patients have been brought to Bethlem hospital, especially those from the country, their friends have generally statedthem to be worse at some particular change of the moon, and of the necessity they were under, at those times, to have recourse to a severer coercion. Indeed, I have understood from some of theselunatics, who have recovered, that the overseer or master of the work-house himself has frequently been so much under the dominion of this planet, and keeping steadily in mind the old maxim,venienti occurrite morbo, that, without waiting for any display of increased turbulence on the part of the patient, he has bound, chained, flogged, and deprived these miserable people of food, according as he discovered the moon’s age by the almanack.
To ascertain how far this opinion was founded in fact, I kept, during more than two years, an exact register, but without finding, in any instance, that the aberrations of the human intellect correspondedwith, or were influenced by, the vicissitudes of this luminary.
As insane persons, especially those in a furious state, are but little disposed to sleep, even under the most favourable circumstances, they will be still less so, when the moon shines brightly into their apartments.
It has also been considered, that intellectual labour frequently becomes a cause of insanity; that those, who are in the habit of exercising the faculty of thought, for the perfection and preservation of the reason of others, are thereby in danger of losing their own. We hear much of this, from those who have copiously treated of this disease, without the toil of practical remark; whose heads become bewildered by the gentlest exercise, and to whom the recreation of thinking becomes the exciting cause of stupidity or delirium. These personsenumerate, among the exciting causes of delirium, “Too great, or too long continued exertion of the mental faculties, as in the delirium which often succeeds long continued and abstract calculation; and the deliria to which men of genius are peculiarly subject.”
The mind of every man is capable of a definite quantity of exertion to good effect; all endeavours, beyond that point, are impotent and perplexing. The attention is capable of being fixed to a certain extent, and, when that begins to deviate, all continuance is time lost. It is certain that, by habit, this power may be much increased; and, by frequent exercise, that, which at first excited fatigue, may be continued with facility and pleasure. What species of delirium is that, which succeeds long continued and abstract calculation? Newton lived to the age of 85 years, Leibnitz to 70,and Euler to a more advanced period, yet their several biographers have neglected to inform us, that their studies were checquered with delirious fermentations. The mathematicians of the present day (and there are many of distinguished eminence) would conceive it no compliment to suppose that they retired from their labours with addled brains, and that writers of books on insanity should impute to them miseries which they never experienced.
It is curious to remark, in looking over a biographical chart, that mathematicians and natural philosophers have in general attained a considerable age; so that long continued and abstract calculation, or correct thinking upon any subject does not appear, with all these delirious visitations, to shorten the duration of human life. What is meant by the deliria, to which men of genius are peculiarly subject, I am unable,from a want of sufficient genius and delirium, to comprehend.
It is well understood, that a want of rational employment is a very successful mode of courting delirium; that an indulgence in those reveries which keep the imagination on the wing, and imprison the understanding, is likely to promote it: and it must be owned, that the same effect has often been produced, where vanity or ambition has urged minds, puny by nature, and undrilled in intellectual exercises, to attempt to grasp that which they were unable to embrace. This may be illustrated by the following case.
A young gentleman of slender capacity, and very moderate education, at the age of nineteen, was placed in a merchant’s counting house, where he continued for two years diligently, though slowly, to perform theduties of the office. Coming at this time into the possession of considerable property, and perhaps, aware of the uncultivated state of his own mind, he very laudably determined to improve it. He frequented the society of persons esteemed learned and eminent in their different professions, and became much delighted with their conversation; but at the same time sensible that he was unable to contribute to the discourse. He resolved to become a severe student, and for this purpose purchased an immense quantity of books on most subjects of literature and science. History commenced the career of his enquiries: Rollin, Gibbon, Hume and Robertson were anxiously and rapidly perused; but he never paused to consider, or to connect dates and circumstances, so that these excellent authors, after he had waded through them, left scarcely an impression on his mind. Chemistry next engaged his attention, andon this subject, he pored over many volumes with little advantage: the terms proved a source of embarrassment, and he made no experiments. In a hasty succession, the ancient languages, antiquities, etymology, agriculture, and moral philosophy, occupied his mind. About eight hours were daily devoted to reading. Somewhat more than two years were consumed in this employment, which had distracted his mind, without conferring any positive knowledge.
His friends and acquaintances now began to perceive a considerable alteration in his temper; though naturally diffident, he had assumed a high degree of literary importance, and plumed himself on the extent of his learning. Before this excessive, but ill-directed application, he was a strict relator of the truth, but he now found a convenience in supplying by fancy, that, which the indigence of his memory was unable toafford. Shortly he began to complain that he could not sleep, and that the long night was passed in shifting from side to side.
“Lasso, ch’n van te chiamo, et queste oscure,Et gelide ombre in van lusingo: o piumeD’asprezza colme: o notti acerbe, et dure.”Gio: Della Casa.
Fever succeeded, accompanied with delirium in the evening. By quietness, and the ordinary remedies, these symptoms were removed; but he was left in a state of extreme weakness. As he recovered from this, his habits became materially altered: he would continue to lie in bed for several days, after which, he would suddenly rise and walk a number of miles. Personal cleanliness, and dress were entirely neglected: sometimes he would fast for two or three days, and then eat voraciously. Afterwards he became suspicious that poison had been mixed with his food. It was found necessary to confine him, from havingattempted to castrate himself: this he afterwards effected in a very complete manner, and continues a maniac to the present time.
Few persons, I believe, will be disposed to consider the above case, as an instance of insanity succeeding to a laborious exercise of the intellectual faculties. It is true, he was busied with books: but this occupation could not have strained his mind, for he appears neither to have comprehended, nor retained any of the objects of his pursuit.
Hereditary Disposition.
“Ut male posuimus initia sic cetera sequuntur.”—Cicero.
“Whatever was in the womb imperfect, as to her proper work, comes very rarely, or never at all, to perfection afterwards.”—Harrington’s Works,p.177.
Considerable diversity of opinion has prevailed, whether insanity be hereditary or not; and much has been said on both sides of this question. Great ingenuity has been exerted to prove that this disease is accidental, or that there are sufficient causes to account for its occurrence, without supposing it one of those calamities that “flesh is heir to.” It has been argued, that, if the disease were hereditary, it ought uniformly to be so, and that the offspring of a mad parent should necessarily become insane.
All theories and reasonings appear to be good for as much as they prove; and if the termhereditarybe employed with a degree of strictness, so as to denote certain and infallible transmission, such inevitable descent cannot be defended. Several instances have come under my observation where the children of an insane parent have nothitherto been affected with madness, and some have died early in life, without having experienced any derangement of mind. More time is therefore required.
All observations concur in acknowledging that there are many circumstances in which children resemble their parents. It is very common to see them resemble one of their parents in countenance, and when there are several children, some shall bear the likeness of the father and others of the mother. Children often possess the make and fashion of the body, peculiar to one or other of their parents, together with their gait and voice; but that which has surprized me most is the resemblance of the hand-writing. If a parent had taught his son to write, it might be expected that a considerable similarity would be detected; but in general the fact appears to be otherwise, for it seldom happens that the scholars, thoughconstantly imitating the copy of the master, write at all like him, or like each other. In a few instances I have noticed a correct resemblance between the hand-writing of the father and son, where the former died before the latter had been taught the use of the pen, and who probably never saw the hand-writing of his father. The transmission of personal deformities is equally curious. I am acquainted with a person in this town, whose middle and ring finger are united, and act as one; all the children of this man carry the same defect. A toenail, particularly twisted, has been traced through three generations, on the same foot and toe. Abundant instances might be adduced on this subject; there is scarcely a family which cannot produce something in confirmation; and if to these circumstances in the human species, were to be added the experiments which have been made on thebreeding of cattle, perhaps little doubt would remain.
The reasoners against the transmission of madness urge, that, if the contrary were true, we should by this time have detected the rule or law by which nature acts, and that we should have been able to determine,—First, whether the disorder descended to the male or female children accordingly as the father or mother was affected.—Secondly, which of the parents is most capable of transmitting the disease?—Thirdly, what alternations in the succession take place, does it shift from the male to the female line, and, does it miss a generation, and afterwards return?
These, and a multitude of other queries, might be proposed; I believe much faster than they could be answered. Nature appears to delight in producing new varieties,perhaps less in man than in other animals, and still less in the animal than in the vegetable kingdom. Before these subtile reasoners expect, from those who maintain that madness generally descends from the parent to the offspring, a developement of the laws by which Nature acts, it would be convenient first to settle whether in this matter she be under the dominion of any law whatever.
The investigation of the hereditary tendency of madness is an object of the utmost importance, both in a legal and moral point of view. Parents and guardians, in the disposal, or direction of the choice of their children in marriage, should be informed, that an alliance with a family, where insanity has prevailed, ought to be prohibited.
Having directed some attention to enquiries of this nature, I am enabled truly tostate, that, where one of the parents have been insane, it is more than probable that the offsprings will be similarly affected.
Madness has many colours, and colours have many hues; actual madness is a severe calamity, yet experience has pointed out the treatment, and the law has permitted the imposition of the necessary restraint: but it very frequently occurs that the descendants from an insane stock, although they do not exhibit the broad features of madness, shall yet discover propensities, equally disqualifying for the purposes of life, and destructive of social happiness.
The slighter shades of this disease include eccentricity, low spirits, and oftentimes a fatal tendency to immoral habits, notwithstanding the inculcation of the most correct precepts, and the force of virtuous example.
In illustration of the fact, that the offsprings of insane persons are,ceteris paribus, more liable to be affected with madness than those whose parents have been of sound minds; it was my intention to have constructed a table, whereon might be seen the probably direct course of this disease, and also its collateral bearings: but difficulties have arisen. It appeared, on consideration, improper to attempt precision with that which was variable, and as yet unsettled; I have therefore been content to select a few histories from my book of notes, and to exhibit them in the rude state in which they were set down.
1st.—R. G. His grandfather was mad, but there was no insanity in his grandmother’s family. His father was occasionally melancholic, and once had a raving paroxysm. His mother’s family was sane. His father’s brother died insane. R. G.has a brother and five sisters; his brother has been confined in St. Luke’s, and is occasionally in a low spirited state. All his sisters have been insane; with the three youngest the disease came on after delivery.
2d.—M. M. Her grandmother was insane and destroyed herself. Her father was mad for many years, but after the birth of all his children. M. M. has two brothers and a sister; both her brothers have been insane; the sister has never been so affected, but was a person of loose character. The insanity of M. M. was connected with her menstruation; after its cessation she recovered, although she had been confined more than sixteen years.
3d.—M. H. Her father had been several times insane; her mother was likewise so affected a few months before her death.Afterwards her father married a woman perfectly sane, by whom he had three children, two female and a male; both the females are melancholic, the male was a vicious character, and has been transported. M. H. has had ten children, three have died with convulsions, the eldest, a girl, is epileptic.
4th.—T. B. His mother became insane soon after being delivered of him, and at intervals has continued so ever since. He has a brother who became furiously mad at the age of twenty, and afterwards recovered. T. B.’s disorder came on at the age of twenty-six.
5th.—S. F. Her father’s mother was insane, and confined in the hospital. Her father never discovered any symptoms of insanity, and her mother was perfectly sane. Her only sister (she had nobrothers) was mad about five years ago, and recovered. S. F. has been twice in the hospital.
6th.—P. W. After the best enquiries it does not appear that her father or mother ever experienced any attack of madness or melancholy. P. W.’s disorder commenced shortly after the delivery of a child. She has three sisters, the eldest has never been married, and has hitherto continued of sound mind. The two younger have been mothers, and in both insanity has supervened on childbearing.
7th.—J. A. H. His father’s father was insane, and his father was also disordered, and destroyed himself. His mother was of sound mind. J. A. H. became insane at the age of twenty-three. He has two sisters, the elder has once been confinedfor insanity, the younger is of weak intellects, nearly approaching to ideotism.
8th.—M. D. Her mother was insane and died so. M. D. continued of sane mind until she had attained the age of fifty-seven, when she became furiously maniacal; her only daughter, eighteen years of age, was attacked with mania during the time her mother was confined.
9th.—G. F. His mother was melancholic during the time she was pregnant with him, and never afterwards completely recovered. She had five children previously to this melancholic attack, who have hitherto continued of sound mind. She bore another son after G. F. who is extremely flighty and unmanageable. G. F. was attacked with madness at the age of nineteen, and died apoplectic, from the violence and continued fury of his disorder.
10th.—M. T. Her mother was of sound mind. Her father was in a melancholic state for two years, before she was born, but this was afterwards dissipated by active employment. M. T. has two brothers, younger than herself, who have been attacked with insanity, neither of whom have recovered. She has two sisters, some years older than herself, these have never been deranged. M. T. has had nine children. The three first have been melancholic. The youngest, at the age of five years, used to imagine she saw persons in the room covered with blood, and other horrible objects, she afterwards became epileptic and died. The youngest of her three first children has been married and had three children, one of whom is afflicted with chorea Sancti Viti, and another is nearly an ideot.
Of the causes termed moral, the greatest number may, perhaps, be traced to theerrors of education, which often plant in the youthful mind those seeds of madness which the slightest circumstances readily awaken into growth.
It should be as much the object of the teachers of youth, to subjugate the passions, as to discipline the intellect. The tender mind should be prepared to expect the natural and certain effects of causes: its propensity to indulge an avaricious thirst for that which is unattainable, should be quenched: nor should it be suffered to acquire a fixed and invincible attachment to that which is fleeting and perishable.
Of the more immediate, or, as it is generally termed, the proximate cause of this disease, I profess to know nothing. Whenever the functions of the brain shall be fully understood, and the use of its different parts ascertained, we may then be enabled tojudge, how far disease, attacking any of these parts, may increase, diminish, or otherwise alter its functions. But this is a degree of knowledge, which we are not likely soon to attain. It seems, however, not improbable, that the only source, from whence the most copious and certain information can be drawn, is a strict attention to the particular appearances which morbid states of this organ may present.
From the preceding dissections of insane persons, it may be inferred, that madness has always been connected with disease of the brain and of its membranes. Having no particular theory to build up, they have been related purely for the advancement of science and of truth.
It may be a matter, affording much diversity of opinion, whether these morbid appearances of the brain be the cause orthe effect of madness: it may be observed that they have been found in all states of the disease. When the brain has been injured from external violence, its functions have been generally impaired, if inflammation of its substance, or more delicate membranes has ensued. The same appearances have for the most part been detected, when patients have died of phrenitis, or in the delirium of fever: in these instances, the derangement of the intellectual functions appears evidently to have been caused by the inflammation. If in mania the same appearances be found, there will be no necessity of calling in the aid of other causes, to account for the effect: indeed, it would be difficult to discover them.