GEN. I. that the patient is uninfluenced by the effects of cold, and hunger, and very generally unsusceptible of febrile Insanity. miasm. Ecphronia. Craziness. Thus a madman will often mistake one person who is Illustrated. introduced to him for another, and under the influence of this mistake will reason correctly concerning him, and although he may have been for years his next neighbour, will ask him when he came from China or the East Indies, by what ship he returned home, and whether his Voyage has been successful. In all which the error may be that of the perception alone. But if, as is frequently the case, the patient address his visitor by his proper name, he gives a ground for believing that he perceives him aright, and that the error is that of the judgement, which thus unites incongruous ideas, applying a visionary history to a real and identified person. At another time, Further he may, from the first, perfectly recognize the individual so presented to him; and to prove his recollection and the correctness of his perception, may rapidly run over a long list of his relations, and a long string of anecdotes respecting his former life: after which he may suddenly start, and looking at the visitor's walking-stick, tell him that that drawn sword will never save him from destruction, nor all the men that slept with him in the same bed the night before-that his rival is now pushing forward with all speed on a black horse with a large army behind him, and that to-morrow he will fight and lose his crown. paroxysm In such a case, and it is by no means an extreme one, the perception and the judgement travel soundly and in harmony at the outset of the interview; but they soon separate and abandon each other as far as east and west. It is not always easy to say whether the fresh of insanity that thus suddenly displays itself is limited to the one faculty or to the other, or is common to both. For if the perception suddenly wander, the judgement has a new train of ideas presented to it, and must necessarily take a new direction. Yet it is difficult to conceive how the judgement can be thus abruptly led astray if it continue sound; and hence it is more probable that illustration. Not always easy to de termine which faculty is most at fault. GEN. I. Ecphronia. Insanity. Craziness. Correct ideas of perception how rendered incorrect by a diseased judgement: the judgement itself is at fault, and admits a train of ideas It How far a morbid state of the mental faculties may in any case depend upon the mind itself, as distinct from the sensorium or instrument by which it is connected with the body, it is impossible for us to know till we become acquainted with the nature of this connexion, and perhaps also with the essence of the mind, which, in our present state of information, seems to be a hopeless subject of inquiry. But we may possibly obtain some insight into the manner in which correct ideas of perception are changed in their nature and rendered incorrect or incongruous by a diseased judgement, by attending to a process of variation that is frequently occurring in perfect sanity and acuteness of mind. "The ideas we receive by sensation," says Mr. Locke, in adverting to this process," are often in grown people altered by the judgement without our taking notice of it." And he explains this position by observing that when a ball of any uniform colour, as of gold, alabaster, or jet, is placed before the eye, the idea thereby imprinted in the mind is that only of a flat circle variously shadowed, with different degrees of light and brightness coming to the organ of sight. "But having by use been accustomed to perceive what kind of appearance convex bodies are wont to make in us; what alterations are made in the reflexions of light by the difference of the sensible figures of bodies, the judgement presently, by an habitual custom, alters the appearances into their causes; so that from that which truly is variety of shadow or colour, collecting the figure, it makes it pass for a mark of figure, and frames to itself the perception of a convex figure and an uniform colour"*. And the same * Hum. Underst. Book 1. Ch. ix. § 8. Ecphronia. plained. missions or intermis sions of the in insanity. And how the disease change occurs still more conspicuously in looking at an GEN. I. engraving or a picture, in which the only idea presented Insanity. by the eye to the perception is that of a plane variously Craziness. shaded or coloured; but which the judgement immediate- further exly changes and multiplies into other ideas of life and motion, and running streams, and fathomless woods, and cloud-capt mountains. And if in a sane state we find the judgement capable of thus varying the ideas of perception presented to it, we can have no great difficulty, I think, in conceiving by what means such a variation may be produced and may ramify into incongruities of great extravagance in a judgement deranged by disease. Nor is there much difficulty in conceiving how the Whence reparoxysm should be subject to remissions or even intermissions more or less regular; or the derangement be limited, as we frequently find it, and especially in melancholy, to particular subjects or trains of ideas. For first all diseases have a tendency to remissions or intermissions; but those connected with the brain or nerves more than any others, as is evident in hemicrania, epilepsy, hysteria, and palpitation of the heart. And next, there is no man in a state of the most perfect sanity whose judgement is equally strong and exact upon all subjects: and few whose judgements are not manifestly influenced and led astray by partialities, or peculiar incidents of a thousand kinds; insomuch that we dare not, on various occasions, entrust to a man of the strictest honesty and the clearest head a particular subject for his decision, whom we should fly to as our counsellor upon every other occurrence. And it is not therefore very extraordinary that, in a morbid state of the mind, and particularly of that faculty which constitutes the judgement, there should be an aberration in some directions or upon some subjects which does not exist upon others. The corporeal indications differ as much as those of the mind, and generally as being governed by the latter. We have hence sometimes, as an opening symptom, an extraordinary flow of high spirits, at others extreme confined at times to par ticular trains of ideas? The corpo real indica tions vary as those of the mind. GEN. I. Ecphronia. Insanity. Craziness. Remote cause of insanity. Whether a diseased condition of any part of the encephalon ? How far this established by dissections. terror. The countenance is pale and ghastly, and strongly expressive of inward emotion; the speech hurried and tremulous, and the extremities bedewed with a cold sweat. In other instances the eye glares malignantly, the face is flushed, and evinces a dreadful ferocity; the objects of • terror become objects of vengeance, and the patient is furious. In some there is an unusual degree of suspicion, and an anticipation of evil, and a belief in imaginary plots or conspiracies. In others great irascibility and malignity, and a desire to commit some act of desperation, vengeance or cruelty. All this is often combined with head-ache, giddiness, throbbing of the temples, or impaired vision. There is little or no sleep, for the mind is in a state of too much excitement, though at times the patient lies listless and refuses to be roused *. Concerning therefore the remote or even the proximate cause of the disease, we have yet much to learn. From the view we have taken in the proem of the close connexion between the mind and the brain, it seems reasonable to conceive that the remote cause is ordinarily dependent upon some misconstruction or misaffection of the cerebral organs: and hence every part of them has been scrutinized for proofs of so plausible an hypothesis, but hitherto to no purpose whatever. The form of the cranium, its thickness, and other qualities; the meninges, the substance of the brain, the ventricles, the pineal gland, the commissures, the cerebellum, have all been analyzed in turn, by the most dextrous and prying anatomists of England, France, Germany, and Italy, but with no satisfactory result. The shape or thickness of the scull has been started, indeed, as a cause, by many anatomists of high and established reputation; but the conjecture has been completely disproved by others, who have found the very structures supposed to be most certain of producing madness, exist in numerous instances with perfect soundness of intellect. A particular shape of the scull seems, * Annual Report of the Glasgow Asylum for Lunatics, 1821. GEN. I. indeed, to be often connected with idiotism from birth or soon after birth, but with no other species of mental Ephronia. derangement whatever. Insanity. Morgagni engaged in an extensive course of dissections Morgagni. upon this subject, and pursued it with peculiar ardour : and his results are given in his eighth epistle from the second to the eighteenth article. In some cases the brain was harder, in some softer, than in a healthy state; occasionally the dura mater was thicker, and was studded with soft, whitish bodies on the sides of the longitudinal sinus. This sinus itself sometimes evinced polypous concretions; and the pineal gland, or several of the glands in the plexus choroides were in a diseased state. Dr. Greding, with a like spirit of investigation, arrived at a like diversity of facts. Meckel tells us that he found Meckel. the brain denser and harder than usual; Dr. Smith descried a bony concretion, and Plenciz and various others represent the brain as bony or calculous in various parts; while Jones, in the Medical Commentaries, found it softer Jones. than usual with a thickening of the membranes and a turgescence of the ventricles. From all which, nothing Nothing precise or pathognomic can be collected, since all such precise or morbid appearances have been traced under other diseases mie has as well as under insanity. pathogno hitherto been col. M. Pinel is firmly decided upon this point; and after lected. a very extensive course of investigations he asserts, with Pinel. respect to the cranium, that there are no facts yet clearly established which prove the faculties of the mind (except in the case of idiotism) to be, in any degree, influenced by its size, figure, or density: while with respect to the contents of the cranium, "I can affirm", says he, "that I have never met with any other appearances within the cavity of the scull, than are observable on opening the bodies of persons who have died of apoplexy, epilepsy, nervous fevers, and convulsions:" and his successors M. • Vermischte medicinische und chirurgische Schriften. Altenb. 1781. |