Insanity. insanity. it is sometimes di secretion of sensorial power in the head in most cases of GEN. I. insanity, but to an accumulation of it from all parts of Ephronia. the body, and especially from the surface, is clear from Craziness. the patient's diminished sensibility to external impres- times insions, and his being able to endure the severest winter's creased in cold, and a fasting of many days without inconvenience or indeed consciousness. But that there is, in some Proofs that cases, a diminished secretion of this fluid producing general debility of the living fibre, is also clear from the minished. great tendency manifested by some maniacs, whose brain gives no proof of increased excitement, to a gangrene in their extremities, and, where they are uncleanly, about the buttocks. The insensibility from this cause is sometimes so considerable as to affect, not only the diffuse organ of feeling, but some of the local senses as well. And hence some patients lose their hearing, and others are capable of staring at the meridian sun without pain, or any change in the diameter of the iris *. Sometimes, however, the increased secretion of sensorial power is so considerable as not only to affect the head, but to augment the corporeal sensibility generally. And hence Hoffman makes accumulated sensation an ordinary symptom of this disease †, mistaking the exception for the general rule: and Riedlin gives us an instance of a maniac, who, instead of calling for and being able to endure large quantities of snuff, sneezed and was convulsed on smelling the mildest aromatics ‡. Insanity often a re It is a melancholy reflection that insanity is often the result of an hereditary predisposition. This, indeed, sult of hehas been denied by a few writers; but their opinion reditary pre has unhappily been confuted by the concurrent voice of disposition. those who have thought differently, and the irresistible evidence of daily facts. Mysterious as the subject is Illustrated. we have perpetual proofs that a peculiarity of mental character is just as propagable as a peculiarity of corporeal; and hence wit, madness, and idiotism are as GEN. I. Ecphronia. Insanity. Craziness. Whether manifested by external signs. Modifica tion of the disease more af fected by the tempe rament distinctly an heir-loom of some families as scrophula, consumption and cancer of others. In most of the latter we have already observed that something of a constitutional make or physiognomy is often discernible; and the same is contended for by many authorities in the disease before us. Yet, if we examine the marks accurately we shall find that they merge, for the most part, into the common symptoms of a sanguineous, or a melancholic temperament: either of which constitutions exercises such a control over the disease as to give it a peculiar modification whatever be the nature of the exciting cause; which is in truth of little importance to the constitutional turn the malady may take, though well worth attending to in the moral treatment. "The violence of the maniacal paroxysm", observes M. Pinel, " appears to be independent of the nature of the exciting cause; or at least, to be far more influenced by the constitution of the individual, and the peculiar degree than by the of his physical and moral sensibility. Men of a robust constitution, of mature years, with black hair, and susIllustrated. ceptible of strong and violent passions, appear to retain the same character when visited by this most distressing of human misfortunes. Their ordinary energy is augmented to outrageous fury. Violence, on the other hand, is seldom characteristic of the paroxysms of individuals of more moderate passions, with brown or auburn hair. Nothing is more common than to see men with lightcoloured hair sink into soothing and pleasureable reveries; while it seldom or never happens that they become furious or unmanageable. Their pleasing dreams, however, are at length overtaken by, and lost amidst the gloom of an incurable fatuity. Those of the greatest mental excitement, of the warmest passions, the most active imagination, the most acute sensibility, are chiefly predisposed to insanity. A melancholy reflection !-but such as is calculated to call forth our best and tenderest sympathies." exciting cause. Insanity whether more common to It has long been a current opinion that insanity is a disease more common to our own country than to any GEN. I. Ecphronia. than other and whe ther of late an increas ing malady? other and this opinion has of late been rendered more seriously alarming by the following assertion of Dr. Powell, secretary to the commissioners for licensing luna- Craziness. tic establishments, and which is given as the result of his England official tables of returns from 1775 to 1809 inclusive, countries? divided into lustra or periods of five years each. "Insanity appears to have been considerably upon the increase for if we compare the sums of two distant lustra, the one beginning with 1775, and the other ending with 1809, the proportion of patients returned as having been received into lunatic houses during the latter period, is to that of the former nearly as 129 to 100." "The facts also", says he," which present themselves to the observation of the traveller, whatever direction he may take through this country, and all the local information which we receive upon the subject supply us, as I am led to think, with sufficient proof that the increase must actually have been very considerable, though we cannot ascertain what has been its exact proportion" *. The first part of this opinion, or that which regards insanity as a disease PECULIARLY PREVALENT in England, does not seem to rest on any established basis: for, calculating with Dr. Powell, that the number of lunatic paupers, and those received into public hospitals, other counwhich, under the act of parliament are not cognizable by the commissioners, together with those neglected to be returned, compared with the returns entered into the commissioners' books, bear the proportion of three to two, which is probably far above the mark, still the aggregate number of insane persons for the year 1800, contrasted with the general census for the same year, will only hold a ratio of about 1 to 7300: while if we take with Dr. Burrows, the proportion of suicides committed in foreign capitals as a test of the extent to which insanity is prevalent in the same towns, which is nevertheless a loose mode of reckoning, though it is not • Med. Trans, Vol. iv. p. 131, Art. Observations on the Comparative Prevalence of Insanity at different periods. Is not a disease nor apparently so prevalent as in many prevalent tries. GEN. I. easy to obtain a better, we have reason to conclude that Eephronia. Insanity. insanity is comparatively far less frequent among ourCraziness. selves than in most parts of the continent: the suicides of Nor an increasing disease. Examination of Powell's have led to a contrary conclusion. Paris, Berlin, and Copenhagen, as drawn from tables collected by Dr. Burrows for this purpose, being in proportion to the relative population of London as 5 to 2 for the first, 5 to 3 for the second, and 3 to 1 for the third *. Nor does the idea that insanity is an INCREASING DISEASE in our own country appear to rest on a stabler foundation. Taking Dr. Powell's result as drawn from full and incontrovertible data, and comparing the supdata which posed march of the disease with the acknowledged march of the population, although the former may possibly be said to have overstepped the latter by a few paces, the difference will hardly justify the assertion, that "insanity is considerably upon the increase." And if we take into view the intensity of interest with which this subject has for the last twenty years been contemplated by the public, the operation of those feelings of humanity which have dragged the wretched victims of disease from the miserable abodes of prisons and neglected workhouses, and placed them under the professional care of the superintendants of licensed establishments, and above all, the augmented number of such establishments in consequence hereof, and the great respectability of many who have the management of them, thus giving the commissioners returns which by the power of their Act of 26 Geo. III. they could not otherwise have been in possession of, we may, I think, fairly conclude that this apparent overstep, be it what it may, in the march of insanity beyond that of the population of the country, is a real retrogres Admitted by the writer himself to be sion. At this conclusion, we might, I think, fairly arrive, even if the data selected by Dr. Powell were full and ininaccurate; controvertible; but he himself has candidly admitted, that instead of being full and incontrovertible they "are sub Inquiry into certain errors relative to Insanity, &c. p. 93. 8vo. 1820. Ecphronia. and opposed by other tables of Burrows which seem to prove a ject to numerous inaccuracies, and that any deductions GEN. I. which may be made from them must be imperfect." It Insanity. is still more consolatory to learn that the direct deduc- Craziness. tions from the parochial and district establishments are not only not in accordance with Dr. Powell's, but such as seem to show that a retrogression, instead of an advance, has actually taken place. Dr. Burrows has industriously collected many of these, and, as far as they go, they lead to such an inference almost without exception *. Yet it is probable that even this inference does not give us the precise fact, and that it is as chargeable with an error on the favourable side, as the opposite account is on the unfavour- than adable; since the increase of licensed houses, whose returns seem to have swelled the list of the commissioners beyond its proper aggregate, has been considerably supported by a transfer from the establishments which have thus fallen off. And hence, allowing the error on the General one side to compensate that on the other, we are brought to the conclusion which, after all, appears more natural, that the career of insanity is only varied in its uniformity by temporary contingencies, but that it is by no means a prevalent disease in our own country. retrogres sion rather vance. result. SPECIES I. ECPHRONIA. MELANCHOLIA. Melancholy. THE DISCREPANCY BETWEEN THE PERCEPTION AND THE We have already stated that whatever be the exciting cause of mental alienation, the symptoms are, GEN. I. SPEC. I. in every Disease mo dified by the idiosyncrasy. |