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 A DISCOURSE 
 
 INFLUENCE OF DISEASES 
 
 INTELLECTUAL AND MORAL 
 
 POWERS. 
 
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A DISCOURSE 
 
 INFLUENCE OF DISEASES 
 
 THE INTELLECTUAL AND MORAL POWERS, 
 
 DELIVERED AS AN 
 
 INTRODUCTORY LECTURE 
 
 COLLEGE OF PHYSICIANS AND SURGEONS, 
 
 IN THE CITY OF NEW-YORK, 
 October 30th, 1848. 
 
 BY JOSEPH MATHER SMITH, M. D., 
 
 Professor of the Theory and Practice of Physic, and Clinical Medicine 
 
 N E W-Y R K : 
 
 DANIEL ADEE, PRINTER, 107 FULTON-STREET, 
 
 18 48. 
 
New- York, Nov. 2d, 1848. 
 Dear Sir :— 
 
 At a meeting of the Students of the College of Physicians and Surgeons, 
 held on Wednesday morning, Nov. 1st., the undersigned were appointed a com- 
 mittee to ten* er you the thanks of the class for the able introductory discourse 
 pronounced by you on Monday evening, and to request a copy of the same for 
 publication. 
 
 We are, sir, yours with great respect, 
 
 J. M. Cleaveland, 
 
 B. L. Budd, 
 H. Gomez, 
 
 A. H. Jackson, 
 
 C. M. Allin. 
 Professor J. M. Smith, 
 
 New- York, Nov. 20th, 1848. 
 Gentlemen : — 
 
 Your note, informing me that at a meeting of the Students of the Col- 
 lege of Physicians and Surgeons, you were appointed a committee to request a 
 copy of my Lecture delivered at the opening of the College, for publication, I 
 duly received. Not anticipating that the Lecture would have been deemed wor- 
 thy of such an expression of approbation, I have hesitated in complying with 
 the request. Being desirous, however, of contributing every thing in my power 
 to advance the knowledge, and gratify the wishes of the class, I have concluded 
 to revise the discourse at my earliest convenience, and place it at the disposal 
 of the committee. » 
 
 With great respect, 
 
 I am, gentlemen, your ob't. serv't., 
 
 JOSEPH M, SMITH. 
 
 Messrs. J. M. Cleaveland, 
 
 B. L. Budd, 
 H. Gomez, 
 
 A. H. Jackson, 
 
 C. M. Allin. 
 
DISCOURSE 
 
 Gentlemen : 
 
 The occasion of opening the present, or forty-second 
 session of this College, forms a new epoch in its history. 
 A new feature is to be imparted to its character, by extend- 
 ing the courses of instruction and adding to the Faculty 
 a Professor of Physiology and Pathology. In thus enlarg- 
 ing the means and reforming the plan of collegiate instruc- 
 tion in medicine, the Trustees and Faculty have manifested 
 the determination to elevate the standard of medical edu- 
 cation. In this effort they are supported by their own con- 
 victions of right, and by the recommendations of the Amer- 
 ican Medical Association. In conformity with these changes 
 additional zeal and exertion will be expected from the 
 teachers: and here, there is no hesitation in giving the 
 assurance that love of ease will not be permitted to inter- 
 fere with their devotion to the instruction of their pupils. 
 
 In introducing the courses of instruction at this time 
 before a mixed auditory. I feel myself called upon to dis- 
 course on some topic, connected with medicine, which may 
 be treated, for the most part, without an array of the tech- 
 nicalities and principles of the science. As one of this 
 kind, and hence as appropriate to the occasion, I have se- 
 lected for remark the conditions of the mind in various 
 
diseases. I am aware that in announcing a theme so ex- 
 tensive in its details, it may occur to you that the limits of 
 an introductory lecture will not allow of anything more 
 than a partial or synoptical view of it. Further than this 
 no attempt will be made to enlarge on the subject. 
 
 In order to exhibit the phenomena of the mind in dis- 
 ease, in their distinctive and diversified forms, it may be 
 well, in the first place, to advert to our mental constitution ; 
 and, in doing so, let it be premised, that we regard the 
 mind as essentially immaterial in its nature, and endowed 
 with the property of existence, independent of the body : 
 and yet, as connected with the organism, so long as it holds 
 an immediate relation with temporal things, being mani- 
 fested and influenced by the instrumentality of the brain. 
 Avoiding the question whether the cerebral apparatus is a 
 single organ, having an individuality of function, or a con- 
 geries or plurality of organs, each having a special func- 
 tion, we shall consider the mental faculties under the 
 forms recognised by the generality of writers on psycholog- 
 ical science. 
 
 As a preliminary, then, to our main design, it is to be 
 observed that the powers of the human mind are divided 
 into two classes, to wit, first, the Intellectual, and sec- 
 ondly, the Moral. 
 
 The intellectual powers comprise the faculties of per- 
 ception, attention, memory, reflection, imagination, and 
 judgment or reason ; and have for their objects the cogni- 
 zance of intuitive truth, and the acquisition of a knowl- 
 edge of the qualities, analogies, and relations of things. 
 Their higher exercises are displayed in the examination 
 and comparison of particular facts, and in deducing from 
 them general truths or ultimate principles. They enable 
 us to reflect on the events of the past, contemplate the oc- 
 
currences of the present, and meditate on the probabilities 
 and certainties of the future. 
 
 The moral powers are equally well characterised. They 
 are certain conditions of the mind, usually denominated the 
 moral affections, feelings, or faculties. They manifest 
 themselves in various degrees of intensity, under the forms 
 of desire and aversion, hope and fear, joy and sorrow, and 
 in the active movements of the will and the conscience. 
 They are the source of our mental sensibilities and sympa- 
 thies, and on them depend our mental happiness and mis- 
 ery. They are the chief determining motives of our ac- 
 tions ; and hence they constitute the most important part 
 of our mental being. 
 
 But though the intellectual and moral powers are differ- 
 ent in their nature and character, they are, nevertheless, 
 closely associated ; and, indeed, like the animal and organic 
 functions of the body, are inseparably united. In a sound 
 and well regulated mind, both classes of powers act in 
 beautiful harmony and coincidence. In each department 
 there is a supreme power, reason in the intellectual and 
 conscience in the moral* These presiding principles ac- 
 complish their offices in modes totally dissimilar. While 
 reason, in order to arrive at truth, labors through a series 
 of logical deductions, conscience intuitively distinguishes 
 right from wrong, and instantly announces it. In its pro- 
 cesses of investigation, reason is liable to wander from the 
 truth, being led astray by false premises and erroneous in- 
 terpretations of phenomena, and hence is not a guide in 
 which we can always repose with confidence. It is not so 
 with the operations of conscience. When enlightened and 
 rightly exercised, its decisions are infallible, and from them 
 
 * See Philosophy of the Moial Feelings, by John Abererombie. M. D. 
 
the mind seeks no appeal. From the correct action of 
 these two leading principles of the mind, spring results 
 which elevate our species far above the lower animals. 
 From the exercise of reason man discovers evidences of de- 
 sign and utility in the works of nature; and hence he 
 infers the existence of a wise, almighty, and beneficent 
 Creator. From the stirrings of his conscience are evolved 
 the sentiments of religion and moral responsibility. And 
 all this, on due examination and reflection, he finds accord- 
 ant with divine revelation. In performing their appropri- 
 ate functions, conscience indicates the pathway of duty, and 
 reason urges the propriety, and displays the advantages of 
 pursuing it. 
 
 The distinctive peculiarities of the intellectual and 
 moral faculties are conspicuously exhibited in the diversity 
 of character which arises from their union in unequal de- 
 grees of strength and correctness of action. This diversity 
 is attributable in part to the varieties of physical temper- 
 ament, but chiefly to a partial and defective education. 
 Reason and conscience, each in its department, are the last 
 of the mental powers fully developed. In the lowest de- 
 gree of untutored nature, as in infancy, neither power ap- 
 pears to be unfolded. Whether there are instances in 
 which one of them may be totally inactive, and the other 
 in healthful operation, is a question of curious interest.* 
 However this may be. no fact is more obvious, than that 
 the intellectual faculties may possess vigor of the highest 
 order, evinced by splendid achievements in literature, sci- 
 ence, and the arts, and yet the moral powers be not merely 
 undisciplined, but deeply depraved and vicious. And so 
 on the other hand, the moral faculties may be highly ac- 
 
 * See Dr. Rush's Inquiry into the Influence of Physical Causes upon the Me- 
 al Faculty. 
 
tive, and steadily regulated by the dictates of an enlight- 
 ened conscience, while the intellect remains, for the most 
 part, uncultivated, and the faculty of reason is but feebly 
 exercised. But such discordance of the two classes of men- 
 tal powers, are by no means common. In most persons, 
 both classes are so far unfolded and regulated as to yield 
 sufficient intelligence to conduct the ordinary pursuits of 
 life, and sufficient virtue to answer the requisitions of honor 
 and justice, between man and man. 
 
 With this sketch of the intellectual and moral constitu- 
 tion of the human mind, let us inquire in what manner its 
 economy is affected by disease. 
 
 It is evident that a distinct notion of the termination of 
 life cannot be formed without a certain amount of intelli- 
 gence. The inferior animals appear to be destitute of the 
 requisite powers of observation, and reason, to acquire such 
 intelligence ; but man, an observing, reflecting and reason- 
 ing being, soon learns the truth, that his body must sooner 
 or later, yield to decay and dissolution. The knowledge of 
 this important truth is attained exclusively by the intellec- 
 tual powers ; but the mere knowledge of the fact, apart 
 from the moral feelings, occasions no pain or uneasiness. 
 In this view, death is no more alarming or interesting than 
 any other event. It is in the other department of our 
 mental constitution, namely, the moral, that the idea of 
 death excites disturbance. So intimately and indissolubly 
 are the functions of the two classes of faculties connected, 
 that a movement in one of them produces a movement in 
 the other ; and accordingly, in most instances, no sooner ia 
 the idea of death and its certainty deeply impressed on the 
 intellect, than it sympathetically strikes deep among the 
 moral affections, and there excites, with other feelings, the 
 
8 
 
 fearful emotion so forcibly implied to in the phrase, " Death 
 is the king of terrors." 
 
 But though such is the mode in which the knowledge and 
 apprehension of death arise in the mind, it is not in every 
 individual of our species that the knowledge exists, or the 
 apprehension occurs. Such ignorance and absence of fear 
 prevail in the earliest or infantile period of life, and 
 in certain conditions of the mind at a later age. To 
 know nothing of dissolution, would be desirable, were there 
 no momentous consequences after it. The abstract idea of 
 death is, doubtless, for wise and beneficent reasons, concealed 
 from the lower animals. The fact, however, that life must 
 end, is familiar to every human mind that is fully and 
 soundly developed ; and hence the apprehension of death is 
 felt and acknowledged, varying in degree from slight alarm 
 on the one hand, up to terrific emotion on the other. The 
 circumstances in which the mind is thus variously affected, 
 in view of the event we are contemplating, are worthy of 
 attentive remark. 
 
 In persons of mature age, and in perfect health, who are 
 in circumstances free from apparent danger, the feelings are 
 seldom disturbed by the thought that they must pay the 
 debt of nature. It is in sickness and incidents of peril that 
 death demands attention, and claims the tribute of our fears. 
 But in such situations, there are not unfrequently circum- 
 stances which repress apprehension, or entirely dispel it. In 
 diseases, the mind is often as much altered from its ordina- 
 ry condition, as the body is from its normal state. Com- 
 monly, both the intellectual and moral powers are affected, 
 though sometimes very unequally. In acute diseases, the 
 former are generally blunted, deranged, or prostrated. 
 They are incapable of any protracted and profound processes 
 of thought. Self confidence is destroyed ; and judgments 
 
requiring but slight efforts of reason, are formed with inde- 
 cision and doubt. The imagination is sometimes restless, 
 ungovernable, and occasionally extraordinarily vivid and 
 excursive. The memory is more or less impaired, though 
 it sometimes recalls ideas, scenes and events which had long 
 been forgotten. 
 
 While such are some of the intellectual phenomena, the 
 moral affections have often an ascendency which tkey seldom 
 display in health. Among those of the most frequent occur- 
 rence are anxiety, despondency, impatience, irascibility, 
 kindliness of disposition, and affectionate tenderness. The 
 conscience is quickened, active, and searching ; regrets and 
 contritions spring up ; and these, with the fear of death and 
 future retribution, elicit resolves of reform and devotion to 
 the interests of religion. Sometimes the conscience causes 
 little or no alarm, being pure and tranquil in view of the 
 past, and this, conjoined with elevated devotional feelings, 
 occasions, amidst the anguish of disease, a high degree of 
 serenity. In some instances the moral principle is obtuse, 
 and its movements, in reference to the former course of ac- 
 tions, sluggish or powerless. It is also observable that in 
 some forms of disease the religious affections, which are 
 strong and unwavering in health, are occasionally so enfee- 
 bled, or suspended, as to leave the individual in a state of 
 indifference to the future, or to sink into doubt and despair. 
 Sometimes, too. the moral feelings are so perverted as to 
 cause the patient to utter profanities and obscenities which 
 are totally at variance with the general purity of his 
 thoughts and words. 
 
 But there is another moral feeling which is especially 
 active in disease — one that more constantly attends upon 
 every variety and stage of sickness, than any other. It is 
 hope, "the most vital movement mortals feel." In health 
 
10 
 
 this passion bears up the mind under the corroding cares 
 and trials of life, and sustains it in achieving exterprises 
 that reach to 
 
 " Earth's loneliest bounds, and ocean's wildest shore." 
 
 With effective power it resists the fatal assaults of disease. 
 In sickness it exerts an antagonistic force to the depressing 
 passions, and weakens the moral forces that tend to the 
 destruction of life. It is, as the poet Cowley says, the sick 
 man's health. 
 
 Usually, hope continues to support the mind until the 
 accession of the moribund state. But sometimes, when the 
 suffering is great, or has been of long duration, or when life 
 is embittered by misfortunes, or rendered irksome and mis- 
 erable by sensual satieties, and sometimes, also, when there 
 is a firm and unvarying belief that the soul is secure in its 
 prospect of happiness, hope ceases to favor the solution of 
 disease, and is often succeeded by a fervent desire for death. 
 In this state of mind, patients sometimes safely pass the 
 critical states of disease, and not unfrecjuently, when the 
 fact is announced to them, they manifest disappointment 
 and regret. 
 
 In some forms of disease, and particularly such as are 
 local and malignant, and which do not early disturb the 
 general functions, but slowly undermine the powers of the 
 constitution, the influence of hope is variable. Some indi- 
 viduals, in these circumstances, when convinced of the fatal 
 nature of their maladies, become, for the most part, resigned 
 to their destiny. In cases of this kind, the mind may be 
 serene in the waking state, though death is the prevailing 
 theme of meditation ; but often, in dreaming, the thought 
 of dissolution is absent, and the imagination pictures scenes 
 of health and enjoyment. Such mental visions may prove 
 
11 
 
 the occasions of extremely distressing emotions ; for in pas- 
 sing from the slumbering to the waking state, there is a re- 
 membrance of them, with a feeling of refreshment, derived 
 from sleep. In these transient moments, there is a forget- 
 fulness of the deadly nature of the malady, and a revival of 
 hope : but no sooner are the reflective faculties fully aroused 
 than the illusion vanishes, and the truth that death is near, 
 flashes through the mind, and for a season, overwhelms it 
 with despondency. 
 
 In some diseases, the effect of hope is illusory, removing 
 fear and giving promise of certain recovery. In all cases, 
 its recuperative influence happily coincides with the vis 
 medicatrix naturae. Of the sanative power of hope, physi- 
 cians avail themselves in their management of the sick, and 
 there is reason to believe that life is often preserved by 
 cherishing and supporting it. 
 
 Allied to hope, in its remedial operation, but more ener- 
 getic in its action on the body, is the influence of the imag- 
 ination, excited by faith in the curative efficacy of the means 
 employed for the removal of disease. It is a curious and 
 remarkable fact, that the mind may act so powerfully on a 
 part, or the whole body, as to produce in it the most aston- 
 ing effects. The phenomena arising from this mental in- 
 fluence, are observable in producing diseases, and also in 
 correcting morbid conditions. But in order to readily ef- 
 fect the salutary changes, two things are necessary, namely, 
 first, a peculiar mental temperament, a credulous, imagina- 
 tive, or superstitious cast of mind ; and secondly, the use 
 of some agent or appliance, which the patient is made to 
 regard as possessing the power of producing the effect it is 
 desired to accomplish. When the temperament now referred 
 to does not naturally exist, it is difficult, if not impossible, 
 to excite the remedial power of the imagination, or excite 
 
12 
 
 faith in the efficacy of a therapeutic prescription. To a 
 certain extent, however, the mental disposition in question 
 obtains in most persons ; and in sickness, it is frequently 
 exalted to a high degree, insomuch that faith in the vaunt- 
 ed nostrums of charlatans, and certain popular remedies, is 
 easily established. In this way, it is believed, that inert 
 topical applications are sometimes the indirect means of 
 obviating or removing local diseases ; and that certain 
 drops, pills, and powders, of no salutary properties, or, at 
 least, of no adaptation to the diseases in which they are 
 prescribed, contribute to the cure of general disorders. 
 When the garrison at Breda, in 1625, was on the point of 
 surrendering, on account of its force being weakened by the 
 prevalence of scurvy, the Prince of Orange ordered a few 
 phials of sham medicine to be conveyed into the fortress, 
 and distributed in doses of a few drops among the patients, 
 as an infallible specific. The effects were wonderful. 
 "Such as had not moved their limbs for a month, were 
 seen walking in the streets, sound, straight and whole. 
 Many, who declared that they had been rendered worse by 
 all former remedies, recovered in a few days, to their inex- 
 pressible joy." Perkins cured certain diseases by metallic 
 tractors; and Dr. Haygarth of Bath, and Mr. Smith of 
 Bristol, in order to ascertain whether the cures were effect- 
 ed by the tractors or by the power of the mind, applied in 
 similar cases, with ceremonious gravity, instruments made 
 of wood, and painted to resemble the metallic tractors, and 
 found the results to be equally favorable. It is through 
 the power of the mind that charms, incantations, and amu- 
 lets produce their sanative effects. That the benefits which 
 sometimes follow the use of homoeopathic remedies are the 
 consequences of the dietetic and regimenal treatment to 
 
13 
 
 which patients are subjected, and of the influence of the 
 imagination, has been proved by numerous and satisfactory 
 experiments. 
 
 The peculiar disposition of the mind, of which we are 
 speaking-, is not confined to the low and illiterate ; it is 
 met with in the higher and cultivated classes of society ; 
 though at present it is less prevalent than in former and 
 more superstitious ages. " Pericles," says Plutarch, " show- 
 ed to a friend who came to visit him in his sickness, an 
 amulet which the women had hung about his neck." 
 
 But though we are prone to ridicule and condemn the 
 use of means which have no direct physiological action on 
 the body, it is a question of interest, no less than of cu- 
 rious inquiry, whether the active remedies, appropriately 
 and skilfully applied, do not in many cases, exert their cu- 
 rative power as forcibly through the medium of the mind, 
 as they do immediately on the corporeal frame. That such 
 is sometimes the fact, and further, that the imagination co- 
 operating with faith, is sometimes the sole efficient cause of 
 recovery, when active remedies are employed, it is as rea- 
 sonable to suppose, as to admit that a remedy of no power, 
 can, in the mode above mentioned, effect a cure ; for, there 
 is obviously nothing in the modus operandi of an efficient- 
 medicinal agent which can interfere with the remedial ac- 
 tion of the mind. 
 
 Such are some of the mental phenomena observable in 
 diseases. The causes to which they are principally refera- 
 ble, are the diversified forms of disease connected with dif- 
 ferences of age, sex, temperament, profession, habits of life, 
 and religious faith or creed. In analyzing particular cases, 
 most of these causes are found to have an influence on the 
 mind ; and hence an idea may be formed of the extent of 
 
14 
 
 inquiry which would be necessary to determine the number 
 and variety of mental conditions in sickness; and especially 
 of exhibiting the slighter shades of difference between them. 
 The most we shall attempt, on the present occasion, is to 
 notice some of the more common intellectual and moral 
 phenomena which have their origin in, and which in some 
 degree, aid in distinguishing diseases. 
 
 That the state of the mind in many diseases depends 
 more upon the nature and seat of the malady than upon 
 any other cause, is evident to the most superficial observer.. 
 This fact is clearly exhibited in the more common disor- 
 ders of the body ; and particularly in those of the head, 
 thorax, and abdomen, and such as constitute the class of 
 essential fevers. These divisions of diseases are severally 
 attended by mental phenomena somewhat characteristic; 
 and each division has its varieties, as we shall now proceed 
 to show. 
 
 In no disorder can the mind be changed from its ordinary 
 state, if the functions of the brain be not disturbed: for 
 this organ is the immediate instrument of intellect and 
 moral feeling. As to the kind of change which the mind 
 undergoes, much depends, not only upon the nature of the 
 cerebral disturbance, but upon the manner in which it 
 arises, whether primarily or secondarily. Disease of the 
 brain which is secondary or sympathetic of disease of some 
 other part of the body, is usually comparatively mild, and 
 generally transient and variable. It may, however, by long 
 continuance or extraordinary severity, arising from great 
 susceptibility of the brain to sympathetic irritation, assume 
 the character of a primary or idiopathic affection of that 
 organ ; and when this happens, the mind of course under- 
 goes corresponding changes. The diagnosis of such cases 
 is determined by their early history. Moreover, it is im- 
 
15 
 
 portant to remark that in many diseases in which there are 
 considerable variations of the mind from its normal state, 
 there is no appreciable organic alteration of the brain, but 
 merely what is termed functional derangement. 
 
 With regard to primary or idiopathic diseases of the 
 head, there are no two of them that present precisely the 
 same train of symptoms, or the smae mental conditions. 
 The phenomena by which they are manifested consist of" 
 lesions of sensation, motion, and mind. To the last of 
 these we shall confine our attention. 
 
 In sudden and fatal seizures of apoplexy, there is, to all 
 appearance, an instantaneous prostration of the intellectual 
 and moral powers. In the language of nosology, there is 
 a total loss of sense and voluntary motion. If, in the 
 slighter attacks, there is any consciousness, it is probably 
 attended with an indistinct perception of surrounding 
 things, with perhaps a sense of impending danger, and a 
 strong disposition to sleep. In every pathological variety of 
 this disease, the mind is manifestly incapable of strong 
 emotion, and recovery is rarely accompanied with any re- 
 collection of what had taken place during the attack. 
 
 A similar state of mind occurs during the paroxysms of 
 epilepsy. In this disease, however, there is sometimes a 
 premonitory stage, in which the mental faculties are singu- 
 larly aiFected. The patient, besides being frequently un- 
 easy, irascible, or melancholy, is sometimes instantly thrown 
 into a fit upon the starting up before him of a spectre, the 
 appearance of which is always a sure harbinger of a par- 
 oxysm. " Dr. Gregory/'' says Abercrombie, u used to men- 
 tion in his lectures a gentleman liable to epileptic fits, in 
 whom the paroxysm was generally preceded by the appear- 
 ance of an old woman in a red cloak, who seemed to come 
 
16 
 
 up to him and strike him on the head with her crutch ; at 
 that instant he fell down in the fit." 
 
 The same general impairment of the mind usually oc- 
 curs in the severe forms of palsy, as hemiplegia, though 
 commonly in a less degree than in the diseases just men- 
 tioned. The intellectual faculties are frequently entirely 
 prostrated ; and often, when partially active, and the dis- 
 ease is protracted, are liable to become fatuitous. The 
 memory, especially, suffers ; recent events rapidly pass into 
 oblivion ; but what is worthy of notice, occurrences and 
 objects, long forgotten, are sometimes recalled in all their 
 original freshness. Such of the moral powers as remain 
 excitable, particularly in chronic cases, are those which in- 
 duce fretfulness, weeping, and childishness. Instances of 
 paralysis, however, are sometimes met with, in which there 
 is no apparent diminution of intelligence. 
 
 In other forms of cerebral disease, the phenomena are 
 in many respects different. Instead of there being an ex- 
 tinction or imbecility of the mental faculties, there is a 
 morbid activity of them. Thus, in those acute inflamma- 
 tions of the brain, described under the terms of phrenitis, 
 cerebretis, meningitis, and arachnitis, lesion of the mind is 
 more common than either lesion of sensation or motion, 
 appearing sometimes in a mild form, and at other times in 
 wild aberrations of reason and furious outbreaks of pas- 
 sion. In the earlier period of these dangerous diseases, the 
 deviations of the mind from its sound state, appears to 
 consist in a simple confusion of thought and apprehension 
 of phrenzy. After passing this period, the mental opera- 
 tions run into delirious excitement, and at length, dimin- 
 ishing in energy, are merged in the stupor that attends the 
 close of life. But though such is the usual course of fatal 
 inflammations of the brain, it sometimes happens that 
 
there ts of correct action of the mind — lucid in- 
 
 tervals, which give hopes of recovery. There are cases, also, 
 in which, in the last stage, even to the extreme verge of 
 life, a degree of intelligence remains, no less surprising 
 than curious to the pathologist who examines after death 
 the extent of the organic' ravages which the disease has 
 produced in the head. 
 
 The permanent changes produced in the mind of those 
 wh : recover from inflammation and injuries of the brain. 
 are often exceedingly grave in their character. But some- 
 times it is otherwise. In some instances the mental powers 
 are greatly enlarged and invigorated. We are told that a 
 son of Dr. Priestly, whose intellect was naturally feeble, 
 fell from the window of a two story house and fractured 
 his skull. From this time his intellect became greatly im- 
 proved. A similar result occurred in the case " of a young 
 man of naturally very limited intelligence, who lost to the 
 amount of two tea-spoonsful of brain by a pistol-shot, be- 
 sides considerable quantities which were discharged at sev- 
 eral subsequent dressings. He lived for two years after 
 this occurrence, with his intellect vastly improved."* Though 
 inflammation of the brain in children is extremely liable 
 to permanently impair the mind, yet cases occur in which 
 no such consequence is observable, and in some of which 
 there is reason to believe that the influence of the disease 
 is to invigorate the intellect. It is related of the celebrated 
 botanist; De Candolle, that " in his seventh year he suffered 
 from an attack of acute hydrocephalus, but fortunately con- 
 quered a disease so often fatal to childhood, or which in 
 other cases so frequently leaves behind a feebleness of the 
 mental powers. But the youth and man, with his well or- 
 
 * Sewali'a Esami nation of Phventlogy, p. 76. 
 
18 
 
 ganized head, fitted for the most difficult processes of 
 thought, suffered no further ill effects from this distressing 
 malady.' 1 * 
 
 There is another group of diseases of the brain, distin- 
 guished by the general term of Insanity. Differing essen- 
 tially from the comatose and inflammatory maladies already 
 noticed, in not being usually attended by evident symptoms 
 of vascular disorder, they present peculiarities which ren- 
 der their nature exceedingly obscure. In many cases the 
 only morbid phenomenon observable, is simple derangement 
 of the mind. 
 
 The forms in which insanity appears, are so numerous 
 and diversified, that no investigation, however industriously 
 pursued, can furnish a full and just description of them. 
 In every case there is a unique individuality of character, 
 which must be studied by itself. There are, however, cer- 
 tain general forms of the disease which may be classified ; 
 and to a notice of these we shall limit our attention. 
 
 The varieties of mental lesion which constitute the class 
 of insane disorders, are properly divided into two kinds, 
 namely : first, Moral Insanity, and secondly, Intellec- 
 tual Insanity. 
 
 Under the head of moral insanity are comprehended all 
 conditions of the mind which consist in morbid alterations 
 of the natural disposition, habits, and affections or feelings, 
 without any decided hallucination or marked disorder of 
 the intellectual faculties. 
 
 In some of its lighter forms or phases, this kind of mad- 
 ness is frequently met in our intercourse with the world, 
 It is encountered in the domestic circle, in the saloons of 
 gayety and fashion, in the thoroughfares of trade and in 
 
 * American Journal of Science and Arts, Vol. xliv. 
 
19 
 
 the halls of the exchange. Indeed, so common are the 
 -cases to which the definition of this species of insanity is 
 applicable, that the number is not small of those of whom 
 it can be said, though they have not been subjected to the 
 action of a writ, de lunatico inquirendo, that they have at 
 all times enjoyed the blessing mens sana in corpore sano. 
 
 But moral insanity frequently appears in graver forms, 
 exhibiting a great variety of character. Sometimes it 
 shows itself in the abandonment of ordinary habits and 
 pursuits ; in carelessness of one's own affairs, with random 
 indulgence in follies and gross sensualities. Sometimes it 
 is seen in the form of ardent devotion to a succession of 
 projects, each suddenly conceived and embraced, with, it is 
 believed, the certain prospect of rapidly amassing wealth, 
 or advancing in honor and happiness — and each as suddenly 
 given up in disgust. In some cases there is an uncontrol- 
 lable disposition to merriment, boisterous hilarity, and 
 sportive and mischievous conduct towards others. Occa- 
 sionally the more striking phenomena are inflated pride, 
 exquisite vanity, and contempt of ordinary things. Fre- 
 quently it assumes the character of melancholy or deep 
 gloom, attended with fondness for solitude, and forebodings 
 of evil when all around and in prospect is inviting and 
 joyous. A form not uncommon displays itself in an unac- 
 countable partiality for particular persons, and a dislike of 
 the nearest and dearest friends, with a disposition to revile 
 and injure them. The more serious varieties are those in 
 which there is a suicidal propensity, or a feeling of neces- 
 sity to commit some dreadful crime — for example, to de- 
 stroy a certain individual, perhaps a relative, as a tender 
 and beloved child — an act, the execution of which, the 
 reasoning power strongly opposes, and the conscience 
 prevents by awakening- the feeling of horror. These re- 
 
20 
 
 straining forces, however, are not always sufficient to curb 
 the strong propensity. Sometimes, as if urged irresistibly 
 by some demoniac influence, the fatal deed is perpetrated ; 
 and instant relief from the burning passion is obtained ; 
 the homicide feels that a part of his destiny is fulfilled, and 
 hence an emotion of satisfaction spreads over his mind. 
 But such relief is not always durable ; regret and remorse 
 may succeed, and rankle long and deep in the soul. 
 
 Within the limits of moral derangement, may, perhaps, 
 not improperly, be included some of the remarkable eccen- 
 tricities and obliquities of human character. Such of 
 these as are not usually regarded as disease, as well as some 
 of them that are so. are among the favorite themes of the 
 dramatist. The ordinary movements of the mind are too 
 tame and monotonous to give interest and animation to his 
 scenes. It is from the excitements and perversions of the 
 moral affections that he derives materials for his spirited 
 creations ; and he is regarded as the abler author, whose 
 graphic delineations of character come nearest to truth, with- 
 out exceeding it : and he the better actor, whose represent- 
 ations most closely counterfeit, while they " o'erstep not the 
 modesty of nature."-" 
 
 Moral insanity has a strong tendency to unsettle and de- 
 range the reasoning powers ; and hence it not unfrequently. 
 if not always, precedes intellectual insanity. Of this form 
 of madness there are three species, namely. Mania. Mono- 
 mania, and Dementia. 
 
 In mania the rational powers are generally deranged. 
 There is sometimes great incoherence and rapidity of 
 thought and utterance. The reasoning faculty is bewil- 
 dered : no single subject long engages the attention. Oc- 
 casionally the intellect is occupied in acute and logical ar- 
 guments in relation to things which, for the most part, have 
 
21 
 
 no existence but in the imagination. Frequently the mind 
 is thrown into furious ravings, and the body into violent 
 and convulsive movements. 
 
 In recoveries from mania the intellectual powers are 
 often left in an enfeebled or prostrate state. But the con- 
 verse of this is sometimes observed. Dr. Pliny Earle says, 
 " It is worthy of remark, that an enlarged mental capacity, 
 with greater activity of intellect, sometimes supervenes up- 
 on or accompanies a recovery from insanity f and he adds, 
 " several cases of the kind have come under our observa- 
 tion, and others are reported by Drs. Brigham and Kirk- 
 bride."* 
 
 In the second species, or monomania, the phenomena are 
 widely different. The mental derangement is partial. 
 The same train of thought habitually engages the mind j 
 and though there is a fixed hallucination on a single sub- 
 ject, on all, or most other matters, the reasoning power acts 
 with correctness. The hallucinations which are classed un- 
 der this head are strikingly various in character. Some- 
 times they appear to be of an agreeable kind, though more 
 commonly they are attended with moroseness, misanthropy, 
 anxiety, or alarm, amounting sometimes to despair. 
 
 The attack, as just remarked, is frequently consecutive 
 to derangement of the moral feelings. Dejection of spirits, 
 and melancholy broodings, manifestly in many instances 
 owing to derangement of the health, generally exists for 
 some time prior to the disorder of the understanding. Em- 
 barrassed in its free exercise by disordered moral and phys- 
 ical feelings, the intellect loses its discriminating power, 
 and fixing itself on something, accidentally but forcibly 
 suggested by the imagination, as a matter of reality, dwells 
 
 * American Journal of the Medical Sciences, No. X., April, 1843. 
 
22 
 
 upon it with unremitting attention. The insane idea may 
 relate to the patient's physical condition, as his personal 
 identity; he may fancy himself a king or person of dig- 
 nity, and as such, exact homage or deference from all around 
 him ; or transformed into some inanimate substance, of a 
 kind, perhaps, which is fragile, or easily injured. He may 
 believe there is something, as an animal, within him, which 
 is torturing and slowly destroying him. " A man, men- 
 tioned by Pinel," says Abercrombie, "who had become in- 
 sane during the French revolution, imagined that he had 
 been guillotined ; that the judges had changed their mind 
 after the sentence was executed, and had ordered his head 
 to be put on again ; and that the person entrusted with 
 this duty had made a mistake, and put a wrong head upon 
 him/' The illusion may relate to the patient's pecuniary 
 affairs, or to his worldly prospects — to some matter of con- 
 science, as some imaginary crime, or some real but trifling 
 immorality in his former life, which he magnifies and views 
 in false and distorted relations. It may relate to duties 
 which he fancies are imposed upon him, such as to reform 
 the age, or remodel the system of society. Whether real 
 or imaginary crime is more productive of monomania, is a 
 question which seems not to admit of debate. A writer- 
 remarks that in his own experience, " for every one instance 
 of remorse or repentance for real guilt, leading to mono- 
 mania, there are fifty imaginary ones."* Monomania may 
 appear in an intermittent form — the illusion occurring 
 sometimes in a quotidian or tertian type. Not unfrequent- 
 ly the mental distress is so protracted and overwhelming- 
 that life becomes a burden, and is ended by suicide. 
 
 The characters of the third variety of intellectual in- 
 
 * Med. Chirurg. Review, No. 21, p. 168. 
 
23 
 
 sanity, or dementia, or fatuity as it is sometimes called, 
 are also well marked. In this the mind is crowded with 
 ideas which have no rational connection, and which are 
 every moment changing. There is no command of the 
 power of attention, and consequently there is no reflection \ 
 in most cases the perceptive faculty is deeply impaired. 
 This form of mental lesion may arise primarily from 
 causes which fall rapidly and with overpowering force upon 
 the mind. Thus, two brothers standing side by side in 
 battle, one is struck down dead, and the other is instantly 
 seized with dementia. But more frequently dementia is 
 consequent to chronic mania, epilepsy, paralysis, and fever 
 complicated with inflammation of the brain. 
 
 Dementia has been identified with idiocy ; but some 
 modern pathologists have made a broad and just distinction 
 between them. Dementia occurs when the mind has been 
 developed and in healthful action : idiocy, on the contrary, 
 is a congenital incapacity of the intellectual and moral 
 powers, owing to defective organization of the brain ; and 
 hence a person in this condition can no more be regarded 
 as diseased than one born with a deformed arm or leg. 
 
 Besides the lesions of mind which have been described, 
 there is another of so frequent occurrence that we cannot 
 avoid giving it a passing notice. I allude to delirium tre- 
 mens. Arising usually from a specific cause, namely, alco- 
 holic drinks, which produce peculiar effects on the brain 
 and nervous system, its phenomena are remarkably uniform 
 and well characterised. The intellectual and moral powers 
 are all of them thrown into a state of morbid excitement 
 and confusion. The more remarkable hallucinations occur 
 in the imagination as it exists in relation with the organ of 
 lision ; and hence they are accompanied by spectral illu- 
 sions. Like the phantasms described by the writers on ap- 
 
-24 
 
 paritions and demonology, the images in the mind's eye are 
 distinct, and remain sufficiently long to be contemplated 
 with attention. Sometimes they assume forms and atti- 
 tudes that amuse tjie patient. Thus, they may appear as 
 fairies in a dance, on the floor of his apartment, the shapes 
 and costumes of which he regards with curious attention 
 and pleasurable emotions. More commonly the illusions 
 are of an alarming and fearful character. Sometimes the 
 patient imagines he is sought for by the officers of justice, 
 to answer for some heinous offence, of which he declares he 
 is innocent ; he believes that a plot is formed to rob and 
 murder him, or that he is the object of signal vengeance. 
 Occasionally he is annoyed by rats and insects, or terrified 
 oy hideous serpents and monsters. Sometimes he is sur- 
 rounded by devils, each plying some device to torment him. 
 In a word, in no other disease is the mind so fraug*irt 
 with horrible images — so lacerated, tortured, and agonized. 
 Well does it deserve the expressive popular appellation of 
 a the horrors." The furies in tormenting Orestes could 
 inflict no severer sufferings. 
 
 From these general observations on the conditions of the 
 intellectual and moral powers in disorders of the brain, we 
 proceed to remark that the mind in certain maladies of the 
 chest, present some phenomena which are deserving of no- 
 tice. 
 
 Usually, in these diseases, the mental faculties suffer no 
 other disturbance than such as attends ordinary febrile ex- 
 citement. Delirium sometimes occurs: but it is occasional 
 and transient, depending commonly on peculiarities of tem- 
 perament and exacerbations of the symptomatic fever, a 
 circumstance which in general is sufficient to distinguish it 
 from the mental disorder arising from a primitive disease 
 of the brain. Should the sympathetic irritation of the 
 
25 
 
 brain, however, produce a serious injury of that organ. — a 
 lesion that becomes fixed and independent of the thoracic 
 complaint, the mind will of course undergo the same devia- 
 tions from its sound state which occur in idiopathic cerebral 
 affections. 
 
 In the later periods of acute inflammations of the lungs, 
 heart, and pericardium, the mind often betrays much anx- 
 iety and confused emotion : and as the last hours of life 
 pass away, and the aeration of the blood becomes more and 
 more defective, the sensorial power gradually fails, and the 
 mind sinks into inaction or hebetude. 
 
 It is observed by Dr. James Jackson of Boston, in his 
 beautiful memoir of his son. that " the integrity of the mind 
 is much oftener maintained to the last moments of life, in 
 diseases of the thorax, both in acute and chronic, than in 
 those of the abdomen. It is." he says, "'not rare to find pa- 
 tients under pneumonitis and phthisis, rising in bed and 
 even getting up out of bed in the full possession of their 
 minds, within the last hour of life." And he adds. " It is 
 in such cases that we often hear those calm and interesting 
 discourses, upon their own situation and in regard to the 
 affairs of their friends, from patients, who are fully aware 
 how few are the minutes which remain for them in this 
 world."* 
 
 * According to M. Grisolle. delirium in pneumonia " is of importance, not only 
 "because it may arise from different causes, offering opposite indications, but also 
 because it may, in some cases, give rise to the belief in the existence of a cere- 
 bral disease, when in fast the affection is seated in the lungs. And the necessity 
 of a complete examination of the organs is shown by the fact, that where this 
 has been neglected, it has not uncommonly happened that persons have been 
 earried to lunatic establishments on account of a temporary mania, developed 
 during the acute stage or the resolution of pneumonia. 
 
 A third part of such cases manifest themselves in persons addicted to drink- 
 ing; and it has been said that pneumonia of the apex especially gives rise to this 
 •symptom ; but of 27 patients exhibiting delirium. M. Grisolle has found the apex 
 
26 
 
 In some of the chronic forms of the same diseases, and 
 particularly when dropsical effusions have taken place m 
 the cavities of the chest, producing orthopnea and a feeling 
 of impending suffocation, the physical sufferings absorb the 
 attention of the patient, and not unfrequently, when they 
 are long protracted, occasion a strong desire for death. We 
 know of few examples of human malady which more pain- 
 fully excites the sympathy of a sensitive bystander, than 
 the sufferings here alluded to, especially when they occur in 
 a person of refined and cultivated intellect, and of deep re- 
 ligious feeling. Chronic organic disorders of the heart and 
 large vessels, though they may not, when stationary or tar- 
 dy in their progress, impair the soundness and vigor of the 
 mind, are often attended with great depression of spirits, 
 timidity, frightful dreams, and tremulous apprehensions of 
 sudden death. 
 
 But there is no disease of the thorax so uniformly at- 
 tended by the same intellectual and moral phenomena as 
 consumption. This disorder, which in some countries des- 
 troys one fifth or sixth of the population, differs essentially 
 in its nature from all other diseases of the chest ; and what 
 is remarkable, among its characteristics, is a state of the 
 mind rarely observed in any other malady, namely, a delu- 
 sive hope of recovery. This feature of the complaint is 
 regarded by an eminent pathologist, Dr. Good, as distinctly 
 pathognomonic, and as such, it enters into his definition of 
 the disease. 
 
 In the incipient period of the pulmonary affection there 
 is generally more or less anxiety respecting its tendency to 
 
 affected in 9, the base in 14, and the middle lobe in 4; and MM. Anclral aorf. 
 Briquet have made similar observations. It may, however, be stated, that dou- 
 ble pneumonia is more likely to give rise to delirium than single."— British and, 
 Foreign Med. Chirurg. Review, No. IV., pp. 539, 540, from V Union Med,- 
 icale, No. 9. 
 
27 
 
 run on to confirmed phthisis; and if hemorrhage from the 
 lungs occur, the alarm is greatly increased ; but after fre- 
 quent repetitions of the hemorrhage, and as soon as the pa- 
 thological changes in the lungs have gone to the point of 
 breaking down the structure of these organs, and the con r 
 stitution is brought fully under the influence of the mal- 
 ady, the mind acquires a character in a high degree pecu- 
 liar. The reasoning faculty remains, for the most part, 
 unimpaired, being, in many cases, capable of vigorous ex- 
 ercise in matters of literature and science : the imagination 
 is active, and sometimes more brilliant than in health. 
 The moral affections shine out with unwonted lustre ; and 
 hope ; though often dampened, allows no ordinary occur- 
 rence, no discouragement, no deterioration of symptoms to 
 obscure the prospect of recovery : it sustains its ascendency 
 in the mind amid the ravages of pulmonary disorganiza- 
 tion, and the exhausting paroxysms of hectic. Nothing- 
 can break the delusion but an extremity of suffering or the 
 agony of death. 
 
 The cases of consumption in which an opposite state of 
 mind obtains, are generally complicated with a morbidly 
 irritable nervous system, and a disordered condition of the 
 digestive organs. In such cases despondency may prevail ; 
 but Grdinarily something like a neutral state is observed — 
 neither great alarm on the one hand nor exalted hope on 
 4he other. In most instances of complicated phthisis, how- 
 ever, the moral feelings, whatever may be their general 
 tenor, are variable. Where despondency is the prevailing 
 feeling, hope occasionally 'breaks forth with cheering bright- 
 ness ; and where despondency and hope appear to be in 
 equilibrium they nevertheless are often observed to alter- 
 nately preponderate. It is in the purely unmixed form of 
 
28 
 
 phthisis, that a writer on the subject remarks, quoting and 
 changing a word in the line of a poet . 
 
 " Hope springs eternal in the hectic breast." 
 
 The inquiry is here naturally suggested, whether hope, 
 as a sanative power, is not evolved and strengthened in 
 proportion to the proclivity of certain hectic diseases, to 
 terminate fatally ? That such is the case seems probable, 
 from the facts observed in various hectic diseases, and par- 
 ticularly in consumption, the most certainly fatal -of all 
 such diseases, and one in which the passion in question is 
 more exalted and more irrepressible than in any other dis- 
 order. So great is its power, that there is reason to be- 
 lieve, that, in phthisis, it often protracts life much beyond 
 the period which the disorganized state of the lungs would 
 otherwise admit. Moreover, may it not sometimes, when 
 conjoined with some other passion of an exciting and sus- 
 taining character, act with curative energy ? 
 
 Passing from the conditions of the mind in thoracic dis- 
 eases, let us notice those which attend upon disorders of the 
 abdomen. The sympathy existing between most of the di- 
 gestive organs and the sensorium is so strong and readily 
 excited, that irritation of a certain kind occurring in the 
 former, is rapidly transmitted to the latter, and vice versa. 
 If the disorder be primary in the digestive apparatus, it 
 sympathetically excites a morbid state of the brain, and 
 this by a reflex action aggravates the original affection. 
 These facts are in general more strikingly manifested in 
 the chronic than in the acute diseases of the abdomen. 
 Those of the acute kind, as peritonitis, gastritis, enteritis, 
 hepatitis. &c, are seldom attended by any remarkable in- 
 tellectual or moral phenomena. Delirium may occur ; but 
 
29 
 
 it is usually of the kind procured by simple febrile excite- 
 ment. When such inflammations terminate fatally, the 
 mind often retains much of its healthful energy to the last 
 moments of life, enabling the patient to realize the near 
 approach of death, and to reflect on the momentous inte- 
 rests connected with the solemnity of entering into another 
 state of bein^. 
 
 It is chiefly in the chronic affections of the abdomen,. 
 and particularly in gastric and hepatic derangements, that 
 the mind especially suffers. The more common mental 
 phenomena arising from these disorders, are anxiety, des- 
 pondency, gloomy superstition, disposition to magnify tri- 
 fling symptoms into dangerous and fatal maladies, appre- 
 hensions of loss of reason and of sudden death, and total dis- 
 like for all those things which in health were sources of 
 enjoyment. These phenomena, when existing in a high 
 degree, especially in persons of the melancholic tempera- 
 ment, constitute that form of disease denominated hypo- 
 chondriasis — a disease closely allied to, if not a variety of, 
 monomania — the only difference between them consisting 
 in the mind of the patient, in the former, being morbidly 
 concerned about his physical condition, and in the latter, 
 being deluded on certain subjects foreign to his health. 
 
 To these observations it is important to add, that some 
 of the more formidable instances, not only of moral but of 
 intellectual insanity, though immediately depending upon 
 organic or functional lesions within the cranium, have 
 their Jons ei origo in derangements of the abdominal vis- 
 cera. From the same sources, also, connected frequently 
 with disorder of the uterine functions, spring some of the 
 • curious and protean forms of hysteria. 
 
 The conditions of . the mind in Jevers, strictly so called, 
 are almost of every variety. Generally these diseases pre- 
 
30 
 
 sent certain symptoms which are common to them all : and 
 among those more uniformly present, are such as indicate 
 disturbance of the functions of the brain. A simple inca- 
 pacity of the mind to act with its accustomed clearness and 
 steadiness is the only phenomenon that occurs in ordinary 
 mild attacks ; but between this and the other extreme of 
 total abolition of intelligence in coma, are many grades of 
 mental activity and varieties of aberration. 
 
 In intermittent fever, usually the least dangerous of fe- 
 brile diseases, the intellect rarely suffers beyond a slight 
 diminution of its healthful stability and vigour, though 
 cases sometimes occur in which, during the hot stage, the 
 patient becomes extremely restless, impatient and delirious ; 
 u the time," as Dr. Fordyce remarks, " passed through seems 
 infinitely long," and no assurance, that the paroxysm will 
 soon end favorably, can calm his perturbation. -''Every 
 one," says Dr. Sewall. " who has observed cases of inter- 
 mittent fever, must have been struck with the increased 
 vigor and activity of the mind during the hot stage of the 
 disease. Men of very ordinary capacity while under its 
 influence, often rise to a decree of strength and boldness of 
 conception, and brilliancy of expression truly astonishing." 
 
 In remittent and most other kinds of fevers which are 
 protracted for many days, the mind is variously, and often 
 profoundly affected. LTneasy sensations, producing restless- 
 ness, jactitation, and watchfulness, are the principal dis- 
 tressing phenomena. In the milder forms, the disease runs 
 itg course without occasioning any decided lesion of the 
 reasoning power, or change in the moral feelings. Some- 
 times, however, during the exacerbations, the mind is 
 thrown into great disorder ; delirium occurs, and sometimes 
 perverseness of disposition, impatience, obstinacy, dissatis- 
 faction with every thing offered as means of relief, and re- 
 
31 
 
 jeetion of the kind assiduities of friends and physieians. 
 The sleep, instead of being sound, is a dreaming state, the 
 same ideas, or confusion of images and incidents continue, 
 sometimes for hours, to harrass the mind. Occasionally 
 the patient is perplexed by an equivocal consciousness of 
 his personal identity, or possessed with the notion of the 
 certain fatality of his case. In some instances, besides occa- 
 sional delirium, there are great timidity, tenderness of con- 
 science, contrition for past actions, and alarm for the fu- 
 ture; and, at the same time, expressions of affection and 
 thankfulness to those engaged in ministering to their ne- 
 cessities and comfort. In other cases, the tenor of the 
 mind is more uniform, being, for the most part, tranquil, 
 and though liable to variations of feeling, is upon the 
 whole happy and resigned. Frequently in the last stage 
 of typhus and of some other fevers, the lesion of the brain 
 is so considerable, that patients lie on their backs in a half- 
 waking, somnolent or comatose state. In these conditions, 
 the mental powers are deeply deranged and prostrated. 
 The delirious muttering, catching at imaginary objects in 
 the air, and picking and drawing the bed-clothes, betray 
 the confusion and illusory conceptions of the mind. The 
 Moribund state is marked by still greater exhaustion, and 
 the patient dies unconscious of his last moments. It but 
 rarely happens in the fevers we have mentioned, that the 
 closing scene is attended with sufficient intelligence and 
 physical power to give tokens of recognition of surround- 
 ing friends. 
 
 But there is one species of fever in which the mental 
 phenomena are so different from those that occur in the 
 more common kinds of febrile disease, that an adequate 
 wiea of them can scarcely be formed without a practical ac- 
 quaintance with the disorder. I refer to yellow fever. 
 
32 
 
 Though it is not within the design of the present discourse 
 to give the pathological history of any one disease, I may 
 here remark that the opinion, once so generally entertained, 
 that yellow fever is but a higher grade of bilious remittent 
 fever, is now for just reasons regarded as erroneous. Seve- 
 ral of the phenomena that combine to give a distinctive 
 character to yellow fever, are in a high degree peculiar ; 
 and of these there is no one that more strongly attracts the 
 attention of the physician, than the singular preservation of 
 the functions of relation. Attended from the beginning by 
 peculiar, as well as by many of the symptoms common to 
 other fevers, the disease runs through the stage of excite- 
 ment in three or four days, and then sinks into a profound', 
 collapse of the organic or vital functions, leaving the mind 
 and voluntary powers comparatively unimpaired. Not un~ 
 frequently patients, pulseless at the wrist with deadly cold- 
 ness of the extremities, and making no complaint but of 
 morbid sensibility of the stomach, rise from their beds, and 
 though somewhat embarrassed in their movements, and ob- 
 tuse in thought, converse with their friends, write letters, 
 speak of their business, and not only imagine themselves 
 convalescent, but by their intelligence and actions lead 
 those around them to believe that they are so. Examples 
 of this kind are called walking cases ; and the sudden and 
 unexpected occurrence of death in such deceptive appear- 
 ances of recovery, astonish every one not apprised of the 
 fact that the disease in this form is most malignant and 
 most fatal. Sometimes the collapse is attended by differ- 
 ent symptoms, at one time ending mortally in a paroxysm 
 of delirium, and at another in coma. 
 
 An examination similar to the foreo'oins^ might be ex- 
 tended to the conditions of the mind in various other dis- 
 eases ; but as the time allotted to this discourse is exhaust- 
 
33 
 
 ed, I can only add that a full exposition of the subject 
 would comprehend much that is interesting in relation to 
 the mental phenomena of diseases which are modified by 
 the differences of age, sex, temperament, profession, and 
 certain other general causes to which we have before al- 
 luded. 
 
 Gentlemen Students of Medicine : 
 
 I doubt not you will agree with me, that sufficient has 
 been said to render it obvious that a medical education 
 should embrace a knowledge of the philosophy of the hu- 
 man mind. We have seen that the intellectual and moral 
 powers are subject to disturbance and derangement from 
 bodily diseases ; and that, though the mind is essentially 
 immaterial and immortal, when certain of its faculties are 
 excited, they powerfully affect the corporeal frame, produ- 
 cing effects which are salutary or morbid. Engaged as the 
 student is, for the most part, in acquiring a knowledge of 
 the physical signs, anatomical characters and treatment of 
 diseases, he is prone to neglect, in ordinary cases, the con- 
 comitant mental phenomena. Now this should not be so. 
 He should know that to allay anxieties, repress alarms, 
 quell the angry passions, subdue obstinacy, divert the imag- 
 ination, reinstate the reasoning power, and elevate the 
 drooping and desponding spirit, is frequently as necessary 
 to the cure of a patient, as to correct the disordered organic 
 functions ; and that often as much knowledge and skill are 
 wanted to accomplish the former as the latter. 
 
 In looking around on the moral world, nothing is more ob- 
 servable than the fact that some individuals exercise a 
 vastly greater influence over their fellow men than others. 
 Such a moral power, varying in degree, is seen in action on 
 every side ; and every where its agency is productive of 
 
34 
 
 good or evil. When it exists as a vigorous principle in the 
 character of a physician, it gives him an influence, as a 
 practitioner, which no amount of simple medical learning 
 can bestow. In the general practice of medicine minds are 
 encountered which act independently, and which are accus- 
 tomed to rule. To manage such minds in disease, and es- 
 pecially in circumstances of danger and alarm, requires a 
 knowledge of the various and best modes of approaching 
 them — of acquiring their confidence, and of bringing them 
 under moral subjection. There are few in the class of ju- 
 nior physicians that do not feel embarrassment when treat- 
 ing those whom they are conscious are their equals or supe- 
 riors in the quality we have in view. Where is the young 
 physician or surgeon, and the question might be asked in 
 respect to many that are older, who could make an impor- 
 tant prescription or perform a surgical operation for one of 
 the intellectual and moral qualities of Napoleon or Sir 
 Walter Scott, with the same coolness that he would for a 
 hospital patient? It sometimes happens that patients, dis- 
 tinguished for their elevation and decision of character, are 
 aware of the embarrassed feelings of their medical attend- 
 ants ; and not unfrequently endeavor to relieve them by en- 
 couraging expressions. Dr. Johnson, addressing the sur- 
 geon who was engaged in scarifying his dropsical legs, said, 
 " Deeper, deeper, I want length of life, and you are afraid 
 of giving me pain, which I do not value." In this expres- 
 sion, however, it has been thought he was more influenced 
 by the fear of death than a desire to remove the fear of the 
 operator. Washington in his last illness, observing the 
 person who was called as a bleeder, to be agitated, said 
 with difficulty, " Don't be afraid ;" and Philip II. of Spain 
 exclaimed to his physicians, iC Are you afraid to take a few 
 drops of blood from a man who has made it flow in rivers f 
 
35 
 
 I have indulged in these concluding reflections, in the 
 hope that they may induce those who resort to this Uni- 
 versity for medical instruction, to study the operations of 
 the mind in health and disease ; and so to discipline their 
 own intellectual and moral powers, that they may be pre- 
 pared, not only to exert a salutary control over the sick of 
 every rank and character, but with self-possession, founded 
 on competent knowledge and conscious moral integrity, to 
 take a commanding position in society, and thereby sustain 
 the dignity of their profession, and enlarge the circle of 
 their usefulness. 
 
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