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 T 
 
 AN 
 
 INAUGURAL DISSERTATION 
 
 ON 
 
 INSANITY: 
 
 SUBMITTED TO THE PUBLIC EXAMINATION OF THE TRUSTEES 
 
 OF THE COLLEGE OF PHYSICIANS AND SURGEONS, 
 
 IN THE STATE OF NEW-YORK, 
 
 SAMUEL BARD, M. D. President, 
 
 FOR THE DEGREE OF 
 
 DOCTOR OF MEDICINE, 
 
 ON' THE 14TH DAY OF MAY, 1811. 
 
 BY THEODRIC ROMEYN BECK, A. M. 
 
 LICENTIATE IX MEDICINE OF THE MEDICAL SOCIETY OF THE 
 COUNTY OF NEW-YORK. 
 
 Canst (lion not minister to a mind dise&s'd ; 
 
 I'luck from the memorj a rooted Borrow ; 
 
 Baze oat the written trouble* of the brain ; 
 
 Ami frith wiinc tweet oblivious antidote, 
 
 derate the foul bosom of thai perilous stuff, 
 
 V\ in* Ij u'i^lis upon the heart I Macbeth 
 
 A'EW-YORK : 
 
 ' I I) !l\ 1. IB1 MOI II. M I. 10, IOIP, MHKKI 
 
 1 1. 
 

 J33fs 
 
 /n/ 
 
TO THE 
 
 REV. JOHN B. ROMEYN, D, D, 
 
 THIS DISSERTATION 
 IS MOST SINCERELY INSCRIBED, 
 
 WITH ALL THE FEELINGS 
 
 THAT GRATITUDE, ESTEEM, AND THE HIGHEST RESPECT 
 
 CAN INSPIRE, 
 
 BY HIS AFFECTIONATE NEPHEW, 
 
 THE AUTHOR 
 
TO 
 
 DAVID HOSACK, M.D. F.L.S. 
 
 PROFESSOR OF THE THEORY AND PRACTICE OF PHYSIC, AND 
 
 CLINICAL MEDICINE, 
 
 IN THE COLLEGE OF PHYSICIANS AND SURGEONS; 
 
 FELLOW OF THE AMERICAN PHILOSOPHICAL SOCIETY, 
 
 AND OF THE 
 
 COLLEGE OF PHYSICIANS AT PHILADELPHIA; 
 
 COIBBSFONBING MEMBER OF THE MEDICAL SOCIETY OF 
 
 LONDON, SCC. &C. 
 
 AS AN ACKNOWLEDGMENT 
 
 FOR HIS 
 
 MEDICAL INSTRUCTIONS, AND PERSONAL ATTENTION, 
 
 OBLIGED PUPIL AND FRIEND. 
 
DRS. WILLIAM M'CLELLAND, 
 
 AND 
 
 JAMES LOW, 
 
 OF ALBANY, 
 
 THIS DISSERTATION, 
 
 THE FIRST FRUITS OF AN EDUCATION COMMENCED 
 UNDER THEIR CARE, 
 
 IS RESPECTFULLY PSESEJVTED. 
 
ERRATA. 
 
 Page 18, line 2, for " vessels of the brains,"' read t: vessels, of the brain is." 
 21, line 8, for " are,'' read " is." 
 line 11, for " are," read " is.' 1 
 
 IH 
 
 4 
 
 
 ■ifyl{/7v$n// 
 
AN 
 
 INAUGURAL DISSERTATION 
 
 ON 
 
 INSANITY. 
 
 o 
 
 F the uncertainties of our present state," says 
 Dr. Johnson, " the most dreadful and alarming is, 
 the uncertain continuance of reason." The sage was 
 himself a mournful example of what melancholy, and 
 the fear of the loss of reason, could effect in a mind 
 at once original, capacious, and powerful. Indeed, 
 men of genius and talents seem, in many instances, 
 to fall victims to the disease of insanity. It embit- 
 tered the life of Cowper ; shrouded in mental dark- 
 ness the declining days of Swift ; and prostrated the 
 acute understanding of Vicq. D'Azyn This spec- 
 tacle of " human nature in ruins," which, while it 
 attacks the learned and wise, does not spare those en- 
 gaged in other pursuits, has attracted the attention of 
 medical men and philosophers in all ages and coun- 
 tries. Their examinations have thrown light on a 
 mysterious subject, but much remains to be still un- 
 folded. A compilation of the more important facts 
 contained in their writings, relative to this disease, is 
 all that can be expected from one whose opportuni- 
 ties of viewing the disease have been scanty, and 
 whose information is derived chiefly from books. 
 
 I 
 
10 
 
 The most common, and probably the most accu- 
 rate division of the faculties and powers of the mind, 
 is that into understanding and will. Under the for- 
 mer are included perception, or the impression made 
 by external objects on the organs of sense, the nerves, 
 and the brain, and conveyed, by means of conscious- 
 ness, to the mind ; memory, comprehending both a 
 power of retaining knowledge, and of recalling it to 
 our thoughts when occasion requires ; judgment and 
 reason, or the faculty of discerning the relation of one, 
 thought or proposition with another, and drawing in- 
 ferences from them j and imagination, whose pro- 
 vince it is to make a selection of qualities and circum- 
 stances from various sources, and by combining and 
 disposing them, to form a new creation of its own. 
 To these may be added, attention, abstraction, and 
 conception. The will comprehends the active pow- 
 ers, as the passions and affections. In most, if not 
 in all the operations of the mind, both these facul- 
 ties concur. Perception is one that arrives to matu- 
 rity, even in infancy. The impressions of external 
 objects are the first which occur to the view, and 
 consequently claim the greatest share of regard. The 
 rest are developed and improved with advancing 
 years. Memory, assisted by attention*, treasures 
 up the knowledge which we have acquired ; whilst 
 reason, in a well governed mind, always exercises a 
 commanding sway over the imagination and passions, 
 regulating the excursions of the one, and restrain- 
 ing the excesses of the otherf. 
 
 * " Attention to things external is properly called observa- 
 tion ; and attention to the subjects of our consciousness, re- 
 flection." — Reid. 
 
 t Vide Reid and Stewart, 
 
il 
 
 These faculties are, however, far from being uni- 
 form in all men. They are influenced, amongst a 
 variety of other causes, by early education^ habit, 
 improper association of ideas, and differences in the 
 physical constitution. Through the varied operation 
 of these agents, our actions in life are guided, and ac- 
 cording as they differ from the standard which the 
 general sense of mankind has adopted, are regarded 
 as deviations from sanity or virtue. The diseases of 
 the mind included under the former are numerous, 
 and have been called by various names. It will pro- 
 bably simplify our remarks on them, by sketching 
 those of the more important faculties separately. Per- 
 ception is liable to injury, both in itself and in its 
 immediate organs. The senses may be affected in 
 numberless ways, by bodily disease. The power 
 itself becomes erroneous, from ignorance, and other 
 subordinate causes, as rashness and credulity. Ob- 
 jects are also at different times presented in too great 
 rapidity, or too slowly, producing the different states 
 of vertigo and ennui. To this class may also be 
 referred the belief in the appearance of apparitions*. 
 It appears to be altogether destroyed, or at least very 
 seldom brought into operation, in fatuity or idiotism, 
 in which " no accurate representation of any exter- 
 nal object, and no abstract thought or reflection ever 
 occursf." The memory may be injured by various 
 
 * Vide an interesting paper " on Apparitions, by John 
 Alderson, M.D." in Edin. Med. and Surg. Journal, vol. vi. 
 p. 287. The author discusses this diseased state of percep- 
 tion) and establishes the difference between it, and lesions of 
 ethet faculties, in a rational and conclusive manner • 
 
 t Crichton OH Mental Derangement, vol. I. p. 314. 
 
12 
 
 corporeal agents, for which I need only refer to the. 
 writings of practical physicians. It decays in old 
 age, and among the mental causes which affect it, are 
 to be included inattention and over-exertion. It is 
 a remarkable fact, that persons advanced in life re- 
 member the scenes of youth much better than the 
 transactions of later years. The same thing has oc- 
 curred in cases of old, incurable lunatics*. The 
 judgment and reason, the peculiar birthright of man, 
 become erroneous, defective, or are totally destroyed. 
 Prejudice, passion, ignorance, and all the agents which 
 afivct the other faculties, assist in weakening it. 
 Among the disorders of the imagination, may be men- 
 tioned reverie, or the illusion of waking dreams, and 
 too great sensibility. The latter is the fruitful source 
 of ills, producing enthusiasm, fastidious refinement, 
 and inattention to the necessary business of life. The 
 consequences of ill-regulated passions need not to be 
 mentioned. The other powers are subject to similar 
 imperfections. All of them are more or less disor- 
 dered in mental derangement, but which of them pri-? 
 marily, is difficult to be determined. 
 
 An analogy has been supposed by some to exist be- 
 tween the states of dreaming and insanity, and the opin- 
 ion has some foundation ; particularly if Prof. Stew- 
 art's theory be correct, viz. that the power of the 
 will is suspended during sleepf . Dreams, accord* 
 ing to him, vary with our bodily sensations, the pre- 
 vailing temper of mind, and our habits of association, 
 when awake. The distinction of Haslam, which is 
 
 * Haslam on Madness, &c. 2d edit. p. 61. 
 t It will, however, be difficult to account for somnambu- 
 Visin, arid talking in sleep, on this supposition. 
 
is 
 
 borrowed from Hartley, that in madness the delusion 
 is conveyed principally through the ear, while in 
 dreaming it is optical, will hardly stand the test of 
 fact. A remarkable instance to the contrary is relat- 
 ed by Dr. Beattie, in his Dissertation on Dreaming. 
 From the foregoing imperfect sketch of the " Ana- 
 tomy of the mind," it will be seen that it is subject to 
 disease as well as the body. To arrange the various 
 kinds according to their proper gradations, is almost 
 impossible in the present imperfect state of this 
 science. The following comprehends most of those 
 concerning which we have information. Pleasant 
 dreams*, unpleasant dreams, somnambulism, vigilia, 
 erroneousness of judgment in children, dotage of old 
 
 * Although it will not be denied, that unpleasant dreams 
 are a state of disease, yet many may not be disposed to allow 
 the same concerning pleasant ones. Several circumstan- 
 ces, however, tend to substantiate this assertion, such as the 
 necessity of rest to the mind, as well as the body, the dis- 
 ordered state of the imagination during sleep, unswayed by 
 judgment, and the fact of persons, who are in habits of think- 
 ing, and thus causing over-activity of the mind, dreaming 
 much, while the contrary description of persons, as the labour- 
 er, do not. Locke, (Essay, book 2. chap. 1.) mentions the case 
 of a gentleman who never dreamt, till he had a fever in the 
 25th year of his age. Dr. Beattie, (Dissert, on Dreaming,) 
 mentions a person who never dreamt but when his health 
 was disordered. Medical men have made similar observa- 
 tions. " Observamus somnum, qui ante mediam noctcm 
 capitur, plus incrementi viribus addere, quant qui earn sub- 
 sequitur. Ratio haec esse vidctur, quia, homines tunc 
 temporis profundiori somno merguntur." Hoffman. Opera 
 Fol. Tom. 1. p. 126. An. 1748. Gregory, (Conspectus, vol. 
 1. p. 209.) remarks, " Qui sanissimi altum dormiunt, iis 
 ncquc motus voluntatius est, ncque aensus cxtcrnus, ncque 
 intcmi, ei fjuitfucnl, ulla memoria." 
 
14 
 
 age, reverie, too great liveliness of imagination, dis- 
 ordered association of ideas, frequent recurrence of 
 the same train of thought, loss of memory, nervous 
 affections, violent passions, hypochondriasis, hysteria, 
 epilepsy, madness, melancholy, fatuity, together with 
 delirium, and other affections attendant on acute dis- 
 tempers. Many of these, if not all, are connected 
 with diseases of the body. 
 
 HISTORY OF THE DISEASE. 
 
 IN the earliest medical writings of the ancients, 
 insanity is divided into melancholia and mania. Al- 
 though Hippocrates has left us no particular treatise 
 on this subject, yet it is clearly deducible from va- 
 rious parts of his works, that he considered them as 
 different forms of disease*. Aretoeus, the first writer 
 extant who treats professedly on diseases of the mind, 
 adopts this distinction, but observes, that melancholy 
 appears to him to be the commencement, and con- 
 stitutes part of maniaf ; and succeeding writers, with 
 hardly an exception, have followed this arrangement, 
 until within the last twenty years. Several systems 
 have been offered to the world J, in which insanity is 
 
 * Compare Aphorisms, Sect. 3. Aphor. 20. and 22. and 
 Sect. 6. Aphor. 23. with Lib. De Morbo Sacro, Sect. 3. p. 92. 
 (Ed. Foesii.) 
 
 f " Mihi profecto melancholia /uav/a?, initium atqne pars 
 esse vjdetur." Aretaeus De Caus Diut. affect, lib. 1. p. 29. Ed. 
 Boerhaave, 1735. Caelius Aurelianus observes, that Themi- 
 soji and his disciples were of the same opinion. De Morb. 
 Chron. lib. 1. 340. Ed. Amman. 
 
 $ By Drs. Arnold, Crichton, and Pine!. 
 
15 
 
 divided into a number of species ; but they have gene- 
 rally been found as useless in practice, as they are 
 difficult to be distinguished in theory. The idea of 
 their being one and the same disease, in different 
 forms, according to the temperament and constitution 
 of the patient, seems not unreasonable. The facts 
 of the very frequent conversion of one into the other ; 
 of numbers whose lives are passed between furious 
 and melancholic paroxysms, and under both, retaining 
 the same set of ideas* ; and of the same remedies, 
 with little variation, being found useful for both, ma- 
 terially strengthen this supposition. Mr. Haslam, 
 whose opportunities of viewing the disease in all its 
 varied forms, have been very great, observes, " In 
 both there is equal derangement, and on dissection, 
 the state of the brain does not show any appearances 
 peculiar to melancholiaf." As, however, the symp- 
 toms which are immediately presented to our view 
 appear so diametrically opposite, it will be proper to 
 retain the distinction. Insanity may be divided into 
 melancholy, mania, and idiotism. The first is cha- 
 racterised by an anxious look, love of solitude, and 
 excess of fear. The second by hurried action, lo- 
 quacity, and furious raving. The last, although fre- 
 quently the termination of the previous ones, is in 
 many instances an idiopathic disease:]:. Its peculiar 
 character has been already noticed. 
 
 Various theories have been proposed, as it respects 
 the affection of the mind in these stages. In melan- 
 choly it is invariably fixed on a single train of 
 
 • Iluslam on Madness, p. 33. 
 
 t Ilaslain, |>. 
 
 t v in ilic Cretiiw of Switzerland. 
 
thought* : while in mania, it is roving with rapidity 
 from one subject to another. By an application of 
 the principles already laid down, the difficulty of ar- 
 riving at any certainty on this point will be immedi- 
 ately perceived. Maniacs, in many instances, have 
 false perceptions ; that is, they assert they have seen 
 objects which it is impossible could have appeared to 
 them. But this defect is not universal. In some 
 the idea is evidently derived from former impressions, 
 and no trace can be perceived of diseased perception. 
 The reasoning faculty also, though impaired, is not 
 destroyed. The patient argues correctly from false 
 premises. We are ignorant of the train of thought 
 passing in his mind, and judge only by the incoher- 
 ence of his conversation, which may be owing to the 
 rapidity of his ideas, and his expressing only part of 
 them. The ideas may be represented either with un-< 
 natural rapidity ', unnatural association^ or unnatural 
 vividness^. The passions appear occasionally to be 
 the seat of insanity, unaccompanied with defect of 
 judgment and imagination. The whole disease in 
 this case appears to consist in a preternatural suscep- 
 tibility to emotions. It may be said, that these dif- 
 ferent lesions of the faculties of the mind certainly 
 prove the existence of different diseases ; but the ob- 
 jection is at once repelled by the fact of a single pa- 
 tient at various times passing through all the grada- 
 tions, from furious phrenzy to complete fatuity. 
 
 * " Est autem (in melancholia) animi anger in una cogita- 
 tione defixus." Aretseus ut antea. Dr. Ferriar's definition of 
 melancholy is, u intensity of idea," grcniting an object ex- 
 elusive attention. 
 
 t London Med. Review, vol. 1. p. 46. 
 
17 
 
 The following is the most correct explanation, 
 (though liable to objection,) which the author has 
 met with, and is one that will elucidate a great num- 
 ber of the phenomena that occur. " The true rela- 
 tion between the two general forms of insanity may 
 be stated to consist in abstraction, and in vivid imagin- 
 ation. The one will comprehend that state, where the 
 mind separates the combinations which are presented 
 to it, and fixes its attention exclusively upon one 
 single object. The other combines the different ob- 
 jects and various sensations, creates new ones, and 
 mistakes conceptions, the recollection of past per- 
 ceptions for real existences.*'' 
 
 A similar diversity of opinion has taken place, 
 (though not in so great a degree,) as to its seat in the 
 body. Hippocrates supposed the brain to be affect- 
 ed in two ways, by the bile and pituita ; the heating 
 and cooling principle. The one causing mania, and 
 the other melancholy f. Aurelianus supposed the 
 head to be disordered in the former, and the stomach 
 in the latter J. The moderns in general refer it to the 
 brain, allowing, however, in some instances, that the 
 stomach is the primary organ diseased. A kind of 
 
 * Edinburgh Review, vol. 2. p. 169. 
 
 t " At cerebri corruptio ex pituita et bile oritur, utrum- 
 que autem hoc modo dignosces. Qui ex pituita quidem in- 
 saniunt, quieti sunt, neque vociferantur, neque tumultuan- 
 tur ; qui vero ex bile, clamosi, maligni et minime quieti, 
 semper aliquid intempestivum faciunt. Ex his igitur causis 
 continue insaniunt." De Morbo Sacro Sect. 3. p. 92. line 36. 
 (Ed. Focsii ) 
 
 \ " Differt autem, siqr.idem in ista (melancholia) principa- 
 liter stomachus patitur, in furiosis vcro caput." Lael. Aure» 
 lian. ut antea. 
 
 C 
 
18 
 
 chronic inflammation or plethora of the vessels of the 
 brains, supposed by many to occur. In what the other 
 changes from health consist, it is difficult to explain. 
 
 The diagnosis, or distinguishing symptom of insa- 
 nity, has been universally stated to be " delirium sine 
 febre." The correctness of this is destroyed, by the 
 fact, of a patient during the hysteric paroxysms be- 
 ing in the same situation* 
 
 The difficulty of giving a correct definition, has 
 been of late unwillingly acknowledged. " There 
 is, indeed, a double difficulty ; the definition ought 
 to comprehend the aberrations of the lunatic, and fix 
 the standard of the practitioner. But it may be as- 
 sumed, that sound mind and insanity stand in the 
 same predicament, and are opposed to each other in 
 the same manner as right and wrong, and as truth to 
 the lie*." 
 
 SYMPTOMS. 
 
 IN many instances, an attack of insanity is pre- 
 ceded by pain in the head, throbbing of the arteries, 
 and even giddiness; tightness about the region of 
 the abdomen, want of appetite, peculiar sensation in 
 the intestines, costiveness, loss of sleep. All the 
 patients agree that they feel confused from the sudden 
 and rapid intrusion of unconnected thoughts. 
 
 They who are attacked with mania become unea- 
 sy ; are unable to confine their attention ; are loqua- 
 cious ; walk with a quick and hurried step, and stop 
 suddenly. They express their opinions with great 
 fervency and extravagance, and are highly impatient 
 * Haslam, p. 37. 
 
19 
 
 of reproof. Some laugh, cry, and sing, by turns. 
 The eyes protrude, and are often glistening. The 
 cheeks are flushed. A relaxation of the integuments 
 of the occiput, together with contraction of the iris, 
 occur in some cases. A very vigorous action of 
 both body and mind takes place, particularly great 
 muscular strength. Some fancy themselves kings, 
 prophets, &c. Some feel an ungovernable incli- 
 nation to acts of fury and violence, and maim and 
 murder those whom they can approach. They be- 
 come suspicious of plots. This fury increases, until 
 at last confinement is necessary ; while in that situa- 
 tion they are observed to continue a particular action 
 for a length of time, such as shaking their chains, or 
 beating with their feet. They readily yield to supe- 
 rior force, and a stern countenance. 
 
 The melancholic attack, on the other hand, com- 
 mences with a gloomy, anxious countenance ; little 
 disposition to speak ; avoidance of company, frequent- 
 ly keeping the eye " bent on vacuity," for hours. 
 The patient often bursts into tears ; imagines he has 
 committed some heinous crime, and not unfrequently 
 finishes his hated existence. 
 
 The maniac and melancholic, however, do not al- 
 ways remain in these situations; the paroxysms abate, 
 and are succeeded by calmness, and a certain degree 
 of rationality. This has been called the lucid interval. 
 " I have no where," says Pinel, " met, excepting in 
 romances, with fonder husbands, more affectionate pa- 
 rents, more impassioned lovers, more pure and exalted 
 patriots, than in the lunatic asylum, during the inter- 
 vals of calmness and reason-. Its duration is, how- 
 
 • Pine i on Inanity, translated by Dr. Davis, p, 16 
 
2® 
 
 ever, very uncertain, and ought to have no weight 
 with the physician, as to preventing watchfulness, 
 and pursuing the proper method of cure. The ex- 
 haustion that follows the paroxysm is highly danger- 
 ous, and must be carefully guarded against*. 
 
 Madmen are said to possess the power of resisting 
 cold; but this is denied by late writers. Mr. Has- 
 lam observes, that they are very subject to mortifica- 
 tion of the toes from exposure to inclement weatherf . 
 Those that are permitted to walk about are always 
 found near the fire in winter. Probably the great 
 engagement of the mind causes insensibility during 
 the paroxysm. They are also said to possess the 
 power of resisting hunger. Many refuse food, from 
 an apprehension ol being poisoned. In some instan- 
 ces the fasting has been prolonged to fourteen days J. 
 Mr. Pinel gives a melancholy account of the mortality 
 in the Asylums of France, during the storms of the re- 
 volution, when the daily allowance of bread was re- 
 duced §. 
 
 Of the organs of sense the ear is most affected ; ma- 
 ny become deaf, but very few blind||. The majority 
 of patients grow worse from lying in the recumbent 
 posture. Of 265 lunatics, in Bethlem hospital, who 
 were examined, 205 were swarthy, with dark or black 
 
 * Haslam, Pinel, and Ferriar. " Whoever," says the latter, 
 " would gain a knowledge of the symptoms of madness from 
 books, more particularly than that afforded by Aretaeus, must 
 consult Shaksfteare." In proof of this I need only refer to 
 the tragedies of Lear, Macbeth, and Hamlet. 
 
 t P. 84. 
 
 % Annals of Medicine, vol. 5. p. 383. 
 
 § Pinel, p. 33. and 209. 
 
 I| Haslam, p. 67. 
 
21 
 
 hair, and 60 with fair skin, and light, brown, and red 
 haired*. It is a remark made by Hoffman, and confirm- 
 ed by experience, that maniacs are not subject to epi- 
 demics. Dr. Hosack informs me, that none were at- 
 tacked with yellow fever during its prevalence in this 
 city. Other diseases are also removed by its at- 
 tack f. 
 
 The appearance of idiots are marked by looks de- 
 void of animation, and motion slow and mechan- 
 ical. The senses are imperfectly developed, and the 
 train of ideas, (if any exist,) are very slow and fee- 
 ble. Many of them, after remaining in this state for 
 years, are attacked with paroxysms of active mania, 
 and the symptom is favourable, since in some cases 
 it is succeeded by a return of reasonj. Congenite 
 idiotism is found in the Vallais in Switzerland, in Sa- 
 voy, in the island of Sumatra, in Chinese Tartary, 
 near the great wall, as observed by Sir George Staun- 
 ton§. In most cases they are affected with goitre. A 
 diminution of the size, of the cranium, as well as of the 
 brain, is also said to occur|| . This interesting subject 
 
 * Haslam, p. 83. « Novimus enim hirsutos, nigroque colo- 
 re et habitu tcnues, multo facilius quam candidos et cras- 
 siores, melancholia corripi." Alex. Trallian, voi. 1. p. 84. (Ed. 
 Haller, 1772.) 
 
 t Vide Mead's Med. Precepts, and Ferriar on the Con- 
 Version of Diseases. 
 
 \ Pinel, p. 168. 
 
 § Coxe's Travels in Switzerland, 4th edit. vol. 1. p. 420. 
 et Seq. 
 
 || in a Lecture on Physiology, delivered at Paris, by Dr. 
 Gall, Jan. 15, 1808, he stated as his opinion, that the power 
 of intelligence was in proportion to the dcvclop.-mcnt of the 
 hniin. Thus stupid animals have very little brain, sagacious 
 
m 
 
 is further elucidated in Foder6 " Essai sur le Goitre 
 ,et Cretenisme," and in Dr. Reeve's " Account of 
 Cretenism, ,, in Edin. Med. &, Surg. Journal, vol. 5. 
 p. 31. 
 
 CAUSES. 
 
 THE remote causes of insanity are either bodily 
 or mental. 
 
 Bodily causes. Repeated intoxication ; blows, and 
 other injuries on the head ; fever, particularly when 
 attended with delirium ; cutaneous eruptions repell- 
 ed ; suppression of periodical or occasional dis- 
 charges and secretions ; excessive evacuations ; mer- 
 cury largely and injudiciously administered* ; para- 
 lytic affections ; great heat of climate ; coup de so- 
 leil; changes of the moonf ; influence of the sea- 
 sons, particularly suramerf ; in England, the month 
 of November ; hereditary predisposition ; melancho- 
 lic, and probably the sanguineous temperament; 
 manufactures §. 
 
 ones more, none so much as man ; and among men idiots ar« 
 remarkable for smallness of the head, and paucity of brain. 
 He exhibited the heads of several idiots in proof of this po- 
 sition. Literary Panorama, vol. 4. p. 1 64. 
 
 * Haslam. 
 
 t Hence called lunatics. This cause, although denied by 
 Haslam and others to be one, has the testimony of many phy- 
 sicians in favour of it, and among the rest may be named Dr. 
 Balfour in his Theory of Sol Lunar Influence. Vide Asiatic 
 Researches, vol. 8th. 
 
 \ Pinel. 
 
 § According to the Report of the Committee of the 
 House of Commons, in 18u7, Lancashire has 272 lunatics^ 
 
23 
 
 Mental causes. The principal source of these is, 
 errors in early education ; pursuing a system which 
 injures the body, gives free scope to the pas- 
 sions, and does not discipline the intellect. It would 
 be a highly interesting speculation, to consider, in 
 connexion with this subject, the differences in the 
 moral and physical constitution of man, produced by 
 successive changes from barbarism to civilization; to- 
 gether with the influence of increase of wealth and 
 luxury. National character deserves also to be no- 
 ticed. England, Switzerland, and Spain, have the 
 greatest number of lunatics, in proportion to their 
 population, of any countries in Europe. In France 
 there were but few, until the Revolution*. The fre- 
 quent and uncurbed indulgence of any violent pas- 
 sions or emotions a*e the most common mental 
 caused. Gray has delineated their effects with gra- 
 phic accuracy. — 
 
 These shall the fury passions tear, 
 The vultures of the mind, 
 Disdainful anger, pallid fear., 
 And shame that skulks hehind ; 
 Or pining love shall waste their youth,, 
 Or jealousy with rankling tooth, 
 That inly gnaws the secret heart, 
 And envy wan, and faded care, 
 Grim visag'd comfortless desflair, 
 And sorrow's piercing dart. 
 
 outofapopulation of 670,000, while the countiesof Cambridge, 
 Huntingdon] Hertford, and Essex, have 7, out of 444,000. The 
 East Riding of Yorkshire three ; North Riding, twenty-three ; 
 while the West Riding lias 424. Literary Panorama, vol. 2. 
 p. \25'J. 
 
 ' Anmld on Insanity, vol. 1. Met 3 
 
24 
 
 Ambition this shall tempt to rise, 
 Then whirl the wretch from high. 
 To bitter scorn a sacrifice, 
 And grinning infamy. 
 
 Avarice, domestic misfortunes, commercial specu- 
 lations*, political contests!, enthusiastic patriotism^, 
 mistaken ideas of religion causing either enthusiasm 
 or superstition, and sudden joy, may also be men- 
 tioned. Minds destitute of order in their intellectual 
 operations, are much predisposed to insanity. 
 
 Of 113 madmen confined atBicetre, in 1795, Mr. 
 Pinel found, that 34 were reduced to that state by- 
 domestic misfortunes, 24 by disappointments in love, 
 30 by events connected with the Revolution, and 25 
 by religious fanaticism. The subjects were princi- 
 pally monks, many artists, painters, and musicians, 
 versifiers, *' who have all the melancholy madness of 
 poetry, without its inspiration;" and a great number 
 of advocates and attornies. No instances of a single 
 physician, chemist, or mathematician §. 
 
 Of the Proximate Cause we know nothing. 
 
 DISSECTIONS. 
 
 IT is well observed by Dr. Arnold, that in no 
 disease are the appearances on dissection more falla- 
 cious, as to guiding us in our opinion of the seat and 
 cause of it, than in insanity. According to him 
 
 * Willan. 
 
 t Rush. 
 
 } Pinel, p. 15. 
 
 § Pinel, p. 113, 114 
 
this must be attributed to the danger of mistaking ef- 
 fects for causes. The following are among the more 
 remarkable appearances of the brain, which occurred 
 in the dissections of Morgagni, Greding*, and Has- 
 lam. The dura and pia mater diseased, and water 
 between them. The consistence of the brain in most 
 instances soft, in some cases quite elasticf. Pineal 
 gland diseased. Water in the -ventricles. Hydatids 
 on the plexus choroides. Vessels of the brain dis- 
 tended, and the brain itself showing marks of inflam- 
 mation or congestion. In slight cases, nothing parti- 
 cular was observed, except a determination of blood. 
 Nothing important was observed in the viscera. M. 
 Prost, a physician in Paris, places insanity in the sto- 
 mach and bowels, as he has found the intestines and 
 gall bladder diseased in several dissections of ma- 
 niacjs. Mr. Pinel supposes, that in the majority of 
 cases there is no organic lsesion of the brain, on ac- 
 count of the success which attended the exclusive use 
 of moral management^. 
 
 PROGNOSIS. 
 
 Sex. By a reference to the Appendix, it will be 
 Been, that in England females are more liable to this 
 complaint than men ; whilst on the continent the con- 
 trary takes place || . 
 
 • Medical Aphorisms, translated by Crichton. 
 t Haslam, chap. 3. 
 
 J Edin Med. & Surg. Journal, vol. 1. p. 455. 
 S Pinel, p. 5. 
 
 |, M V'iri sane et furore ct melancholia corripiuntur ; ra- 
 rius autem quam viri, led dctcrius mulicres funis agitajltUI*. 
 
 I) 
 
26 
 
 Age. By a similar examination it appears, that the 
 number of patients admitted at Bethlem and Bicetre, 
 between the age of 30 and 40, were greater, than be- 
 tween any other ten years. This is probably owing 
 to the circumstances of misfortunes affecting the mind 
 more sensibly at that time of life, when a family is 
 generally to be provided for. Intoxication is also rea- 
 dily induced at that age, from similar causes ; and the 
 hereditary predisposition, (if any exists,) will make 
 its appearance. Instances of insane children are rare. 
 Mr. Haslam relates three cases, of the respective 
 ages of three, seven, and ten years*. 
 
 State of Disease. Of 100 patients in a furious 
 state, 62 were cured : of 100 melancholic, only 27f . 
 If the disease arise from physical causes, the prog- 
 nosis is more favourable than when from moral ones ; 
 thus, of 80 cases of puerperal mania, 50 recoveredf . 
 The chance of cure is diminished in proportion to 
 the length of time that the disease has remained. 
 The frequent alternations of raving and melancholy 
 madness are unfavourable, as are also those in which the 
 temper is more affected than the understanding^. Hea- 
 viness after the paroxysm, hsemoptisis and cutaneous 
 eruptions, are favourable symptoms. Relapses are fre- 
 quent from affections of the mind, or error in diet and 
 regimen. Madness, of the hereditary or religious 
 
 .Etas, qure prope statum est, et ipse status huic malo subji- 
 ciuntur." Aretseus, Lib. 1. De Caus. Morb. Diutur. p. 30. 
 
 * Haslam, chap. 4. 
 
 t Haslam, p. 257. 
 
 | Haslam, p. 247. 
 
 § Ferriar's Essay on Insanity, in Med. Hist. 8c Reflect, 
 vol. 2. 
 
27 
 
 kinds ; or complicated with epilepsy and paralysis, or 
 gradually declining into idiotism, is generally incur- 
 able. In addition to the statements in the appendix, it 
 may be added, that Dr. Willis deposed, that of patients 
 committed to him within three months after the attack, 
 nine out often recovered ; and Dr. Arnold states, that 
 in his own private establishment, and the Leicester lu- 
 natic asylum, two thirds of those admitted are cured*. 
 Dr. Rush is said to have cured twelve out of thirteen ; 
 and of recent cases cures four out of fivef. 
 
 Termination. It is an observation of Celsusf , and 
 confirmed by succeeding writers, that insanity does 
 not prevent patients from arriving at old age. Dr. 
 Heberden attributes this to the parts of the brain, which 
 are subservient to animal life, being distinct from those 
 which are essential to the use of reason $. Lunatics 
 are very subject to diarrhea. The diseases which 
 generally close their unhappy existence are, apoplexy, 
 palsy, phthisis, atrophy, and hydrothorax||. 
 
 CURE. 
 
 AS the causes are of different kinds, so it is pro- 
 per that the cure should be appropriate to each. For 
 the removal of insanity arising from mental causes, 
 a method is at present pursued, styled in general, 
 
 MoralManagement. This consists in removing 
 
 • Quarterly Review, vol. 2. p. 160. 
 
 t This fact is communicated to the author' by Prof. J. 
 A. Smith. 
 
 \ l)c Medicina, lib. 1. sect. 18. " Ut vitam non impediat." 
 $ flcbcrdcn's Med. Commentaries, p. 277. 
 
 (I Greding. 
 
28 
 
 patients from their residence to some proper asylum ; 
 and for this purpose, a calm retreat in the country is to 
 be preferred : for it is found that continuance at home 
 aggravates the disease, as the improper association of 
 ideas cannot be destroyed. A system of humane 
 vigilance is adopted. Coercion, by blows, stripes, 
 and chains, although sanctioned by the authority of 
 CeJsus and Cullen, is now justly laid aside. The rules 
 most proper to be observed are the following : Con- 
 vince the lunatics that the power of the physician and 
 keeper is absolute ; have humane attendants, who shall 
 act as servants to them ; never threaten but execute ; 
 offer no indignities to them, as they have a high 
 sense of honour ; punish disobedience perempto- 
 rily, in the presence of the other maniacs : if unruly, 
 forbid them the company of others, use the strait 
 waistcoat, confine them in a dark and quiet room, order 
 spare diet, and if danger is apprehended, apply me- 
 tallic manacles to their hands and feet, as they are 
 found not to injure by friction so much as linen or 
 cotton ; tolerate noisy ejaculations ; strictly exclude 
 visitors ; let their fears and resentments be soothed 
 without unnecessary opposition ; adopt a system of 
 regularity ; make them rise, take exercise and food 
 at stated times. The diet ought to be light, and easy 
 of digestion, but never too low. When convales- 
 cent, allow limited liberty ; introduce entertaining 
 books and conversation, exhilirating music, employ- 
 ment of body in agricultural pursuits, as is the case in 
 the hospitals of York and Saragossa; and admit friends 
 under proper restrictions. It will also be proper to for- 
 bid their returning home too soon. By thus acting, the 
 patient will " minister to himself." 
 
29 
 
 Remedies. A comparison of the ancients with the 
 moderns in this particular, will fully prove, that but 
 few important improvements have been made by the 
 latter. A general abstract of the practice of the 
 most distinguished of each, is all that the length of 
 this Dissertation will allow. Aretasus recommends 
 moderate venisection ; to be repeated, if the patient 
 is plethoric, purging with black hellebore, and in 
 some cases emetics ; nourishing diet. If arising from 
 suppressed discharges, more active remedies are ad- 
 vised. He also mentions bathing in warm mineral 
 waters, friction with oil, and purges exhibited occa- 
 sionally for a length of time*. Trallian has similar di- 
 rections ; he prefers topical bleeding, as it does not 
 debilitate so much as venisection. He also recom- 
 mends the warm bath highly, and condemns the use 
 of white hellebore, as a vomit, being too violentf . It 
 is remarkable, that in the writings of the ancients, no 
 traces are to be found of their considering hellebore 
 as a specific, although this is the received opinion. It 
 has probably arisen from the poet's enlarging on its 
 virtues in a metaphorical manner. Aurelianus re- 
 commends shaving of the head, and the application 
 of sinapisms J. Celsus speaks in high terms of the 
 use of cold water to the head§. Poppies applied 
 to the head were advised by some, but it does not ap- 
 pear that they were generally used. 
 
 • Arctceus Dc Curat. Diut. Affect, lib. 1. chap. 5. 
 
 t Trallian, lib. i. chap. 17. 
 
 \ Aurelianus, Dc Morb. Chron. lib. l.chap. 5 and 6. He 
 rcj< . is a remedy that had been advised by some, and gives 
 tin following reason : " Quippe cum sit possibile ex consuetis 
 " P. 341. 
 
 § Celsus, lib. 3. sect. 18. 
 
30 
 
 Dr. Harvey's method of cure was by repeated 
 bleedings, mild purges, and chalybeatesf . Dr. Tho- 
 mas Willis speaks in high terms of iron in melancho- 
 ly!. The practice of Hoffman is similar to the above. 
 Dr. Mead, besides these remedies, advises attention 
 to the evacuation by urine in cases of madness, and 
 directs nitre to be used. He found blisters hurtful 
 in most cases, and preferred setons in the neck. He 
 also gave medicines to promote perspiration ; ordered 
 frequent use of the cold bath ; and in some instan- 
 ces prescribed anodynes §. 
 
 Among the practitioners of the last century and 
 the present day, the method of cure of the following 
 deserves notice. Dr. Ferriar found single emetics at 
 the commencement of the disease useful, but objects 
 to nauseating doses of tartrite of antimony frequently 
 repeated, and gives cautions similar to the above nam- 
 ed with respect to venEesection. He speaks in very 
 high terms of the strict antiphlogistic treatment in 
 cases arising from intemperance, but has found 
 camphor, digitalis, and opium, even in large quan- 
 tities, of no benefit. He uses the warm bath in 
 mania, and the cold, together with bark and wine, 
 in melancholy, with great advantage. Setons and 
 blisters, were found beneficial. Under the head of 
 purges, he prefers calomel, but in several cases 
 where he gave it so as to cause salivation, it pro- 
 
 t " De se testatur, quod aliquot maniacos per vensesec- 
 tionem, bis vel ter repetitas, lenes purgationes et medica- 
 menta antihypochondriaca mineralia, intra sex septimanas feli- 
 citer curaverit." De Vanitatibus, &c. Medicorum ; In Acta 
 Eruditorum, i701. p. 438. 
 
 \ " De Anima Brutorum" in Opera, 1695. vol. 2. p. 278, 
 
 § Mead's Medical Precepts and Cautions* 
 
31 
 
 duced no sensible effect on die disease*. Mr: 
 Haslam prefers blood drawn from die head by cup- 
 ping, to any other method. He has found cathartics 
 of great service. Jalap and senna are principally used. 
 He found emetics and cold baths hurtful, in many cases 
 inducing paralytic affections ; and opium and setons 
 useless. Blisters applied to the legs were advantageous, 
 in some instances! . Prof. Pinel speaks slightingly of 
 all kind of remedies, as he considers the disease 
 to be curable by moral management alone. He re- 
 commends however a few drams of sulphate of mag- 
 nesia, as an excellent preventive of approaching 
 paroxysms J. Dr. Chiarugi, of Florence, speaks in 
 very high terms, of friction with opium ointment ; it 
 produced calmness in every case, and in some it af- 
 fected a cure§. Dr. Cox uses the rotatory swing with 
 similar success. Dr. Rush recommends venae section 
 to a large extent ; mercury given so as to cause saliva- 
 tion ; warm and cold bath ; blisters to the ancles ; 
 together with fresh air and gentle exercise||. The 
 famous Dr. Francis Willis, who attended the pre- 
 sent king of England, and the queen of Portu- 
 gal, during their insanity, is said to have prefer- 
 
 • Medical Histories and Reflections, 1810. vol. 1.214; and 
 vol. 2. p. 107. In the Nova Acta Curios, vol. 1. p. 346. is 
 related a case, cured by mercurial friction in a month, after 
 all previous remedies had failed. 
 
 t Haslam, chap. 8. Dr. Hosack informs me, that he hus 
 found blisters applied to the head, and continued fora length 
 ol time, of great use. 
 
 { I'age 44. 
 
 % Annals of Medicine* vol. 3. p. 105. 
 
 || Med. Inquiries and Observations, 3d edit. vol. 4. p. 416. 
 V Coxe'l Med. .Museum, vol. 4. p. 136. 
 
32 
 
 red emetics. Opium he thought did harm ; and 
 when narcotics were required, he employed hyos- 
 cyamus. Blisters on the neck he found hurtful. 
 Digitalis was considered proper in some cases, as 
 was also the warm bath*. In the case of George 
 III. which he attributed to weighty business, severe 
 exercise, and too great abstemiousness; the bark, 
 after a little calomel and a cathartic, appeared to be 
 productive of very decided advantage!. 
 
 NOTE. — The Harvey, noticed above, was Dr. 
 Gideon Harvey, physician to Charles II. in his exile. 
 He flourished at the end of the seventeenth century. 
 
 MEDICAL JURISPRUDENCE AND POLICE. 
 
 THE Medical Jurisprudence of Lunatics may be 
 considered in two points of view. 1. The security of 
 the public, and 2. The proper treatment of the pa- 
 tients. 
 
 To effect the first, it becomes absolutely necessary 
 that they should be confined in some convenient 
 place, in order to prevent the commission of crimes, 
 to which they are all more or less liable. The law 
 has humanely forbidden the exercise of punishment 
 on them, since its ends cannot be answered. " So- 
 ciety," (says Dr. Johnstone, and the sentiment is ap- 
 plauded by all good men,) " may obtain an adequate 
 protection by the confinement of maniacs, without 
 blood.'' Cases frequently occur, where medical men 
 
 * Edin. Med. 8c Surg. Journal, vol. 4. p. 195. 
 t Quarterly Review, vol. 2. p. 168. 
 
3S 
 
 are called on to decide before a jury respecting the state 
 of a person's mind, who has committed a crime, or 
 made an unjust will. In both, it is of importance, that 
 they should have formed proper opinions on the se- 
 veral symptoms of this disease, for in none are men 
 more apt to err, than on the apparent sanity of a ma- 
 niac. The term lucid interval has been applied to 
 this state. In matters of law, the following observa- 
 tion of Mr. Haslam is certainly the most proper to 
 guide us : "I should define a lucid interval to be a 
 complete recovery of the patient's intellects, ascer- 
 tained by repeated examinations of his conversation, 
 and by constant observation of his conduct, for a time 
 sufficient to form a correct judgment*." Dr. John- 
 stone notices a discordance in the laws of England, 
 which is highly disgraceful to a civilized nation. In 
 matters of property, the law forbids the restoration 
 of it, until the return of perfect reason and intellect, 
 while merely appearances of sanity during the mo- 
 ment of committing a crime, are sufficient to condemn 
 the maniac, although insane both before and afterf. 
 "Whether this inhuman statute has force in our own 
 country, the writer is unable to learn.t/ 
 
 2. The Treatment of Patients. Different methods 
 have been pursued for this purpose, according to the 
 
 • Haslam, p. 46. 
 
 t Medical Jurisprudence of Madness, by J. Johnstone, M. 
 D. 1800. 
 
 J Dr. Mahon,in his Legal Medicine, observes, that in cases 
 of maniacs committing crimes, we should follow the maxim 
 of enlightened jurisconsults. " Scmcl furiosus, semper 
 presumitur furiosus, et contrarium tencnti incumbit onus pro 
 bandi ■anam mentcm." Lond. Med. &. I'hvs. Journ. voi. 9. 
 
 p. ra. 
 
 » 
 
S4 
 
 inclination of relatives, or the laws of the country. 
 Thus criminal lunatics have been [confined in jails, 
 but this is evidently incompatible with proper attend- 
 ance, and the safety of the other prisoners. Nor is 
 the plan of confinement in private mad-houses, free 
 from objection. Even if their superintendants be 
 humane, the accommodations are generally insuffi- 
 cient and inadequate for public security, since the 
 instances of escape from them are numerous. But 
 more important charges may be brought against 
 them. They may be made, (and in Great-Britain are 
 made,) the lw«% tombs of the victims of avarice and 
 revenge. In them the most dreadful cruelty may be 
 exercised with impunity. To feel the justice of these 
 censures, it is only necessary for any person to ask 
 himself the question, What would be his feelings, 
 were a relative or friend secluded in these abodes, 
 through the malice of others ? If private mad-houses 
 are tolerated, they ought certainly to be watched with 
 a jealous eye. The establishment of asylums, in va- 
 rious central parts of a country, exclusively appro- 
 priated to this purpose, under the particular superin- 
 tendance of government, and open to the watchful 
 inspection of proper commissioners, together with 
 the advice and care of able physicians and humane 
 keepers, is the plan which is open to the least objec- 
 tion, and is one which promises the happiest results 
 as to the recovery and restoration of the insane to 
 society*. 
 
 * Much interesting information on this subject will be 
 found in the Report of the Committee of the house of Com- 
 mons, and Prof. Duncan's paper on the State of Lunatics in 
 Great-Britain, in Edin. Med. 8c Surg. Journal, vol. 4. p. 129, 
 and 144, 
 
APPENDIX. 
 
 THE following account of Lunatic Asylums in Europe 
 and America, may probably be interesting to the reader. 
 ENGLAND. 
 THE largest establishments in England which are appro- 
 priated to the confinement of Lunatics are, St. Luke's and 
 JBethlem Hospitals in London. 
 
 St. Luke's Hospital. This institution was founded in 1732, 
 and opened in 1737. It then admitted 1 10 patients. On account 
 of the increasing number of applicants, a new building, larger, 
 and more commodious, was erected, in 1787, which accommo- 
 dates 300 patients, divided into two lists or classes ; 200 on the 
 curable, and 100 on the incurable list. The latter are received 
 according to the order in which they have been discharged as 
 uncured from the Hospital. Of these there are at present 
 (1810) more than 600 waiting for admission. Idiots are not ad- 
 mitted. Among its officers are, the Duke of Leeds Presi- 
 dent, and Dr. S. F. Simmons, Physician. The patients ad- 
 mitted from July 30, 175 1, to April 21, 1809, amount to 9042, 
 of which those discharged as incurable, and received again, 
 amount to 323. Of these, 
 
 Patients remaining, April 21st. 1809, ... 199 
 
 discharged cured, ----- 3915 
 
 uncured, - - - - 3101 
 
 as idiots, - - - 783 
 
 dead, - 748 
 
 taken away by friends, and discharged from 
 
 various causes, - - - - - 296 
 
 Patients received the second time, and remaining in 
 
 the house, - - - - - - 100 
 
 taken away by friends, - - - - 56 
 
 dead, 145 
 
 cured, ------- \q 
 
 discharged from various causes, - 4 
 
 J23 
 Mr. Dunstan, Master of St. Luke's Hospital, states, in his 
 examination before the Committee of the House of Com- 
 mons, that the average number of curable patients admitted 
 annually are, and those discharged are, 
 
 Males Femalea Total 
 Males, W> Cured, 37 71 108 
 
 Females* 153 Uncured, 100 
 
 Unfit from various causes, 28 
 
 20*3 Dead, 27 
 
 36 
 
56 
 
 From the above, it appears, that the proportion of males to 
 females admitted, is nearly as 2 to 3 j of females cured to 
 males, nearly as 2 to 1*. 
 
 Bethlem Hospital, (commonly called Bedlam,) was appro- 
 priated by Henry VIII. to the reception of lunatics, in 1547, 
 at the suppression of monasteries. The present building was 
 completed in 1676. It can contain 170 curable patients on 
 an average Of incurables, it receives 100 ; fifty of each sex. 
 A new hospital is about building. The improper practice of 
 allowing admission to visitors, has been strictly forbidden and 
 prevented since the year 1770. Physician, Dr. Thomas 
 Munro. 
 
 Report of Patients in Bethlem Hospital, Dec. 31, 1809. 
 Remaining, Dec. 31, 1808, - - - 147 
 
 Admitted in 1809, - - - - - 103 
 
 250 
 
 Cured and discharged, ■ 
 
 Died, - 
 
 Patients, Dec. 31, 1309, 
 
 Of these, men under cure, - - * - 39 
 
 Incurable, - - - - - 38 
 
 Women under cure, - - - - - 21 
 
 Incurable, ----- 45 
 
 250 
 
 77 
 
 66 
 143| 
 
 Mr. Haslam states, that from 1748, to 1794, forty-six years, 
 there have been admitted into Bethlem Hospital, 4832 wo- 
 men, and 4042 men. Of the women, 1 402 have been dis- 
 charged cured ; and of the men, 1155. The following is a 
 statement of the difference of age in the patients admitted, 
 from 1784 to 1794, ten years. 
 
 * Highmore on the Public Charities of London, p. 172. ; and Ed. M . & S, 
 J. vol. 4. p. 138. 
 f Highmore, p. 13. et Seq. & Literary Panorama, vol, 8. p. 870. 
 
37 
 
 Age between 
 
 !0 
 
 Sc 
 
 20 
 
 20 
 
 Sc 
 
 30 
 
 30 
 
 8c 
 
 40 
 
 40 
 
 Sc 
 
 50 
 
 50 
 
 Sc 
 
 60 
 
 60 
 
 Ec 
 
 70 
 
 No. discharged No. discharged 
 cured. uncured. 
 
 Several other asylums and mad-houses are established in 
 different parts of England. A system of reform on this 
 point, and the erection of hospitals in various central parts of 
 the kingdom, has been proposed by the Committee of the 
 House of Commons, and it is hoped will be adopted. Ac- 
 cording to their Report, it appears that there were, in July 
 1807, thirty-seven lunatics confined in different jails ; 187S 
 in houses of correction, poor-houses, Sec. ; and 483 in private 
 custody ; besides about 600 in the public hospitals of Lon- 
 don ; making nearly 3000 in England alone. The real num- 
 ber, however, is much greaterf. In Scotland and Ireland, no 
 public provision has yet been made for them. 
 
 FRANCE. 
 
 Asylum De Bicetre. This hospital admits 200 patients. 
 Of these the idiots constitute always one-fourth, if not more. 
 At my last survey, says Mr. Pinel, there were 27 melancho- 
 lies, 95 maniacs, 18 affected with dementia, and 60 idiots. 
 
 * Hailam.p. 2*5— 2-i'J. 
 
 j Literary Panorama, vol. 2. p. 1259. ; and Dr. Willan's Reports on (lie 
 Diseases of Loudon. Hfl estimates Qie lunatics in and uear London alone, nl 
 WO thousand. 
 
38 
 
 r Maniacs admitted|from 1784 to 1794, inclusive, with their 
 respective ages. 
 
 In 1784 
 1785 
 1786 
 1787 
 1788 
 1789 
 1790 
 1791 
 1792 
 1793 
 1794 
 
 Total. 
 
 Between 
 10 & 20 
 
 20&30 
 
 5 
 
 33 
 
 4 
 
 39 
 
 4 
 
 35 
 
 12 
 
 39 
 
 9 
 
 43 
 
 6 
 
 38 
 
 6 
 
 28 
 
 9 
 
 2© 
 
 6 
 
 26 
 
 1 
 
 . 13 
 
 3 
 
 23 
 
 65 
 
 339 
 
 
 
 30&40 
 
 31 
 49 
 40 
 41 
 53 
 39 
 34 
 32 
 33 
 13 
 15 
 
 380 
 
 40&50 
 
 24 
 25 
 32 
 26 
 21 
 33. 
 19 
 16 
 18 
 7 
 15 
 
 236 
 
 50&60 
 
 60&70 
 
 6 
 
 li 
 
 14 
 
 3 
 
 15 
 
 5 
 
 17 
 
 7 
 
 18 
 
 7 
 
 14 
 
 2 
 
 9 
 
 7 
 
 7 
 
 3 
 
 12 
 
 3 
 
 4 
 
 2 
 
 9 
 
 6 
 
 130 
 
 51 
 
 
 
 Total. 
 
 110 
 
 134 
 
 127 
 
 142 
 
 151 
 
 132 
 
 103 
 
 93 
 
 98 
 
 40 
 
 71 
 
 1201 
 
 The deaths in 1784, were fifty-seven: and in 1788 were 
 ninety-five. In 1794, when the allowance of bread had been 
 raised, they were only twenty -seven*. 
 
 Asylum De Charenton. During twenty -two months, 97 pa- 
 tients were admitted; and of these 14 died, and 33 were 
 cured. Out of 71 cases, whose causes could be ascertained, 
 5 arose from excessive pleasure, 7 from disappointed love, 
 31 from domestic misfortunes, 1 from terror, 2 from sup- 
 pressed discharges, 1 from excessive evacuations, and 5 from 
 hereditary predisposition. Physician, Dr. Gastaldif. 
 
 Asylum La Sdlfietriere. Dr. Pinel, in less than four years, 
 cured 444, out of 8 i 4 maniacs, confined in this hospital. Of 
 36 struck with accidental madness, 29 recovered!. 
 
 AUSTRIA. 
 
 The general hospital at Vienna, was founded by Joseph 
 II. and consists of 1 1 1 rooms. To it is attached a Lunatic 
 Asylum, of three stories high, each 28 rooms. The shape of 
 the latter is that of a perfectly round tower, but the elevation 
 was probably more to gratify the Emperor's whim, than from 
 any particular advantage resulting from such a structure. 
 
 * Pinel on Insanity, p. 32. 112. 173. & 210. 
 
 | Pinel, p. 249. 
 
 •$ Med. Repository, vol. 12. p. 294. 
 
39 
 
 Remaining at the end of 1804, 
 Admitted in 1805, - 
 
 Males. 
 
 Females, 
 
 170 
 
 144 
 
 117 
 
 94 
 
 287 238 
 
 Discharged, ----- 1G4 70 
 
 Died, 42 32 
 
 Remaining at the end of 1 805, - 141 136 
 
 287 238 
 
 The proportion of males to females would probably be 
 greater, were it not for the circumstance of the Ecclesiastics 
 having an asylum for lunatics of their own order*. 
 
 PRUSSIA. 
 
 The principal hospital for the reception of the sick poor 
 at Berlin, is called, " La Maison de Charite." It is a large 
 building, three stories high, containing about 1200 beds, for 
 three classes of patients, who are separated into three divi- 
 sions. 1. Medical and surgical cases. 2. Lunatics. 3. Ly- 
 ing-in women, and their children. The clebrated Hufeland 
 is superintendant of the Hospital. The following is the 
 number of cases during four years. 
 
 1801 1802 1803 1804 
 
 Mental derangement, 179 200 238 200 
 
 Under this head is placed all patients affected with mania, 
 melancholia, and fatuitas. The proportion of men to wo- 
 men is as 104 to 56. Out of 334 cases, 105 were cured ; and 
 the cure is said to be owing to the external application of cold 
 waterf. 
 
 SPAIN. 
 
 According to the Rev. Mr. Townscnd, the government 
 returns of that country for 1787, gave the following list of lu- 
 natics in confinement, in the different provinces. — 
 Arragon, 244. Valencia, 12 1. Granada, 41. Leon, 2. 
 Catalonia, 114. Andalusia, 99. Toledo, 42. Avila, 1. 
 No mention is made of any in the interior provinces}. 
 
 SWITZERLAND. 
 
 There are five hospitals in and near Bern, one of which is 
 hi asylum for lunatics. Nervous diseases arc very common 
 
 intiy, i.nd ilie proportional number oi 
 
 Bdk M I, roi 2. p. M I | Bdin. If, It B. J. voL£ p. 370 
 
 • ;'» Travail in Spain, rot 2. i>. jsi 
 
40 
 
 epileptic and lunatic patients is much greater. Upwards of 
 60 were confined in this asylum, in Aug. 1805, all in separate 
 cells, and almost all of them had dark hair and eyes ; and were 
 melancholic*. 
 
 NEW-YORK HOSPITAL AND ASYLUM. 
 
 Until the year 1808, the insane have been confined in the 
 New-York Hospital. It is stated, on the authority of Dr. 
 Hosack, that during a practice of ten years, as one of the 
 physicians of that Institution, he found the disease to have 
 arisen, in the greatest number of cases, from intemperance ; 
 and that in such, the antiphlogistic treatment was found high- 
 ly useful. The lunatic asylum was opened on the 1 5th July, 
 1808. It contains sixty-four rooms, and can accommodate 
 about 70 patients. Physician, Archibald Bruce, M. D. As 
 there has been but one separate Report of this establishment, 
 (for i 8 i 0,) it has, for the sake of convenience, been incor- 
 porated with those of the hospital. 
 
 
 
 1 
 
 
 
 
 
 
 1 
 
 
 
 Admitted. 
 
 
 Discharged. 
 
 
 1 
 
 
 
 
 a. 
 
 
 | 
 
 < O 
 
 i 
 
 a W 
 
 
 
 2 fl> 
 I 3 
 " §• 
 ■<• 5. 
 
 %<* 
 S? o 
 
 f| 
 
 V! ft 
 
 o 
 
 e 
 
 i 
 
 3-" 
 
 P & 
 
 si 5 
 
 
 P-3 
 3* 
 
 
 I 
 
 - 
 
 
 
 
 •'3 
 
 1 
 
 *?r 
 
 
 1804 | 
 
 11 
 
 46 
 
 22 
 
 5 
 
 12 
 
 3 
 
 15 
 
 
 1805 
 
 15 
 
 60 
 
 30 
 
 4 
 
 13 
 
 8 
 
 20 
 
 
 1806 
 
 20 
 
 68 
 
 29 
 
 
 31 
 
 7 
 
 21 
 
 
 1S07 
 
 21 
 
 47 
 
 18 
 
 3 
 
 19 
 
 4 
 
 24 
 
 
 1S08 
 
 24 
 
 66 
 
 16 
 
 10 
 
 16 
 
 4 
 
 44 
 
 
 1809 1 
 
 44 
 
 80 
 
 22 
 
 4 
 
 48 
 
 8 
 
 42 
 
 
 1810 1 
 
 43 
 
 90 
 
 44 
 
 7 
 
 16 
 
 10 
 
 56 
 
 
 1 
 
 178 
 
 457 
 
 181 
 
 33 
 
 155 
 
 44 
 
 222 
 
 Of 133 in the asylum, in 1810, there were 
 
 Males. 
 86 
 
 Females. 
 49 
 
 Cured, - 
 
 Died, 
 
 Discharged, - 
 Remaining, Dec. 31, 1810, 
 
 35 
 
 n 
 
 10 
 
 34 
 
 86 
 
 & 
 13 
 
 24 
 
 49 
 
 The ahove Statement is obtained from authentic documents, and partly 
 through the politeness of Mr. Green, clerk of the New- York hospital. 
 
 * Edin. M. & S. Journal, vol. 5. p. 254. 
 
 •}" Of these, two died by suicide, and one a few hours after reception. 
 
 FINIS. 
 
COLUMBIA UNIVERSITY 
 
 This bqok is due on the date indicated below, or at the 
 expiration of a definite period after the date of borrowing, 
 as provided by the rules of the Library or by special ar- 
 rangement with the Librarian in charge. 
 
 DATE BORROWED 
 
 DATE DUE 
 
 DATE BORROWED 
 
 DATE DUE 
 
 MkY 2 
 
 3 IJlif 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 C28(638)MS0 
 
 
 
 
B38