Chapter V: Part 5

We all know, whoever gratifies any passion, or accustoms the system to any artificial stimulus, at stated periods, invariably finds the difficulty of resisting this passion, and his inclination for this stimulus greatest, at the usual period of gratification: and so it is with the expenditure of animation; in fact, nothing is more certain, than that both mind and body become the slave of those customs, which the manner of our living, and moral conduct, and the circumstances through which we have passed, have fastened around us. Now, as the circumstances and treatment of the insane, have hitherto been different from common life, (the object ought to be, in the treatment of the insane, to resemble common life as much as possible;) and as they are without control over themselves, their mode of displaying their more animated state, must be as different from the civilized man, as the civilized man is from the savage. If, then, habits of civilization may be called a second nature, here it may be said, that a third has been superinduced.

From these circumstances and states of mind, it appears, that, instead of their stock of animal spirits being expended, under the guidance of a moral agency, and regularly diffused over their existence, they are subject to mere physical influence, and become the sport of every eddying wind that blows; and therefore we find every possible variety and irregularity exhibited.—A perfect contrast to that of the good and wise man, if such a one can be found, whose balance of mind is preserved, whose spirits are tranquil and even, who enjoys perpetual sunshine within, and diffuses peace and serenity around him.

Thus, because when their spirits are buoyant, they strangely exhibit their inherent defects of mind, it has in many instances been mistaken for an exacerbation or a returning accession of the disease, and called the chronic type of old incurable cases.

It further appears, that this view is correct, from the fact, that if their manner of talking and acting, in expending their increased flow of spirits, is improperly encouraged or exasperated, then we find their individual and latent defects become more obvious; but with proper treatment, they gradually die away: in fact, these appearances are more or less perceptible, in a great measure, according to the spirit and conduct of the superintendant; and even, under him, to that of their respective attendants. Of this, I could give some striking illustrations. It is astonishing how much the increased flow of the spirits will be dark, gloomy, and vindictive; or light, cheerful, and full of kindliness; just as we by our treatment excite and keep alive one part of the mind or another. The same principle might be illustrated also, on a larger scale, by surveying the conduct of different parties and governments in the world; and on a smaller scale we see every one in authority, a magistrate, a gentleman, a minister, a pastor, the captain of a ship, and a parent, stamp their character on the sphere in which they move.

Were it the place, nothing could be more instructive than examples to demonstrate the correctness of these observations.

The preceding case, I consider, is one of these examples. I have said, that for the most part, these states of excitement and depression, are merely an irregular exhibition in the accumulation and expenditure of the animal spirits, and not always to be considered, according to Dr. Halloran’s view, as the remains of the disease in the state of a returning paroxysm, and that which characterises the permanently insane; but that this originated in, and depended on, causes which equally affect the animal spirits of the sane and insane, with this difference, that in the insane, as in this case, they are modified by the peculiar state of mind, and the sort of treatment they have received.

Grant that, from the state of his mind, any little increase of animation would resemble, in a slight degree, that which he now exhibits, then I am, by the help of facts, in this and some other cases of a similar nature, justified in saying, that I have been able to trace the process and progress of these changes, from small beginnings to their present state. I know, from the best information, that his manner and appearance were, when excited, so laughable and striking, that the attendants and their friends, from want of proper feeling, or perhaps mere thoughtlessness, actually made him a source of private sport and amusement, and thus increased his excited state, which, in the course of time, assumed its present peculiar and amusing form. {141}

A minute detail of all these things, together with unnecessary and injudicious confinement, I am certain, would prove all this.

In many cases, and especially in the last, I have been able to trace, as I have already said, the process and progress of these changes, from small beginnings to their present state. In some cases, any little increase of animation gave rise to manners and conversation, which were extremely amusing, and such as tempted silly and unthinking people, as well as the other patients, to encourage by listening or assenting too much to them, or to exasperate by wantonly making them a source of sport and amusement; conduct which cannot be too strongly deprecated, especially during the critical period of their convalescence.

In most instances, however, it must be allowed, that among these old incurable cases, {142} the most powerful exciting causes are within them. When their minds are at all irradiated, striking ideas, and scenes of the past, cross their imaginations; they are further excited by them; and in proportion as the system is excited, these ideas are themselves more powerfully awakened; they have no clear consciousness nor control over themselves; and this dreaming state of their minds, to them all reality, is sometimes as cheering as the dreams of hope can make it, and at other times as horrible as the night-mare! and thus they are wrought up into the most excited or exasperated state. In some cases, especially the foregoing, this goes on until they are worn out, when they require a corresponding portion of time to renew their vital energies; and thus cause and effect mutually produce each other. These alternate states of excitement and depression, being often repeated, they gradually increase in strength and duration; and thus it is in some few cases, and especially those similar to the last, we find, that their spirits are not expended and renewed, as ours are, once in twenty-four hours, because these changes have become the habitudes of their nature, so that their system becomes governed by new laws of action. It is very singular that those most liable to extremes, are most predisposed to insanity, and in its more confirmed stage to this periodicity of excitement and depression.

I have already noticed, {143} that the excitement of the depressing and exhilarating passions alternately, is the most striking characteristic of the old insane,—so striking that the general division of insanity is intomania and melancholia; a division, however, which is altogether unphilosophical, as the mania and melancholia are not any abstract difference in the cause of the disease itself, but merely the results of the over-active nervous energy operating in different directions—at one time on the depressing, another on the exhilarating passions; this indeed is the case, more or less, with all those who preserve not this mental equilibrium, but who act more from the impulse of their feelings and passions than the cold calculations of reason, and the rigid restraints of principle. To what extremes are the passions of the human mind liable, when neither the true light of the understanding nor any right sense of justice guide them! We see this in ignorant and unprincipled individuals, who suddenly rush out of their thraldom and pupilage into liberty and licensciousness; we see the same thing exhibited by agitated and wicked masses, as in the French Revolution, when the moral, like the physical ocean, is let loose from its order and control, and heaves its tumultuous waves of passion, as if by an earthquake, from one overwhelming extreme to another.

When then, as in the insane, all the restraining powers of the mind are lost, can we wonder that the mental energies should be subject to accidental and baneful influences? that they should impetuously rush with fearful, because with unguided force, into the most opposite and direful extremes? These extremes, however, always correspond to the individual peculiarity of mind, and the nature of the exciting causes, which exciting causes often exist internally long before they become externally evident; thus gradually forming ruts in those weak or soft parts of the mind, as it were, in which their feelings are naturally more apt to run; and thus they acquire the increasing facility and strength of habit, in operating in one direction rather than another, until they become irresistible: or in other words, until the understanding has no longer the power to extricate the mind from their influence.—Body and mind have been allowed conjointly and reciprocally to produce and increase these effects. The effects are first, disordered action; next, inflamed and diseased organization of the brain, as well as this disordered action being continually strengthened by a daily increase in the power of mental association, “calling forth an increased susceptibility to the action of certain exciting causes;” and so far I agree with Dr. Halloran, that a something like the original “accession of the disease,” more readily takes place. {145a}

I have said, {145b} that in cases of permanent insanity, the alternations into these opposite mental states occur most frequently among persons whose previous character was marked by extremes,—who were easily excited, and as easily depressed, either by their hopes, their fears, their anger, or their affections. And I have often had occasion to hear these remarks on their admission; and further, that they could not bear stimulants, especially ardent spirits; and that there was insanity decidedly developed during their worst paroxysms of intoxication.

In fact, the history of their lives, at least of some of them, was that of comedy and tragedy, perpetually prophesying and exhibiting a threatening prelude of their present more awful state; more awful in appearance, because it has now become bereft of its former lucid interludes; which lucid interludes had, possibly for some time, been externally maintained only by the mere power of external moral influences, long after the internal control had ceased to preside over the mental operations.

We call it insanity when external restraints are broken down and disregarded; we cannot decide how long absurd and delusive feelings and notions have monopolized all the operations of the little world within. I shall have occasion hereafter to adduce the history of many cases which will serve to illustrate the truth of these views. I may briefly mention, that they occur most frequently in those families where such a constant April atmosphere exists: and, as a further argument it may be stated, that a greater proportion of victims to these causes occur among the women than among the men; and in the male sex we find they are those of a more feminine character, or those whose feelings naturally predominate over their understandings.

Thus children who resemble their parents, through the spirit in which they were conceived and brought forth, become still more like them by example and education; and hence the very important fact, that the greater number of those who lose the power over their own minds, are from among those who have been unaccustomed at an early stage of their existence to exercise a salutary control over their feelings and habits; and of those especially such as naturally possess strong animal and sentimental feelings. Hence it is said, “that of all the causes of mental derangement termed moral causes, perhaps the greatest number may be traced to the error of early education.” {147} Thus, as I have already remarked, an only child, or the youngest, (who has often as much exclusive attachment as an only child, because he is the son of old age, or is young when the rest cease to be children; or may be the only one left at home,) are numerous amongst the insane.

Again, in confirmation of the same argument, we may here remark, that the greatest number of those who become insane, become so between the ages of thirty and forty,—a period when establishments are formed, and habits have been strengthened by time, while the feelings yet retain all their energy and susceptibility of action. Thus we can conceive why reverses and disappointments should then have the most fatal and overwhelming influence.—Still less need we wonder that this should happen to those whose animal propensities and sentimental feelings have been exclusively cultivated, as they then find that if understanding and principle are insufficient to restrain them, the claims of society forbid their gratification. Hence the conflict becomes dreadful and dangerous, confounding and overturning the balance of the mind. Even without this, bad passions, disjointed and exclusive habits of feeling and thinking can hardly go on progressively increasing to this age, without becoming so irresistible as to threaten to destroy and swallow up in their vortex all that remains of the man within them. Such is a true and beautiful description that Johnson has given of Imlac’s insanity in his Rasselas. Any passion or propensity of our souls, when improperly indulged and carried to excess, is an abnegation of reason; and in saying this, we give a true definition of insanity, however startling this wide application may appear.

What is the most obvious history of most cases?—Thoughts and feelings are indulged on any given point, to the detriment or suppression of others which might draw us from this dangerous and exclusive habit of the mind; till at last we become incapable of resisting any other train of thought, and feeling, and action; “they are at first imperious, and at last despotic.”

When and how are all these evils to be best prevented? We answer, in the preliminary stage of our existence. We shall revert to this important subject in an essay on the primary principles of education; and shall only now remark, that where we perceive a soil full of the seeds of all these evils, we can expect only corresponding fruits? We shall conclude these remarks by directing the reader to look to the soil where these evils exist: we do this, because it exhibits the truth of the principle for which we are contending.

We see, in the history of families, that the extremes of heartless tyranny on the one hand, and the foolish fondness of blind affection on the other, engender soils equally favourable to the production of these terrible fruits to which we allude: still more so is this the case where these extremes exist in the same family.

Many are the married persons who waste their lives in inordinately and alternately hating and loving each other. From small beginnings, breezes arise and gather into storms; at last, exhausted by their violence, they subside, and for a while love returns, and all its ardent affection. Such is the brief but sad history of many a matrimonial union,—but who can describe its baneful influence?—how much evil and misery are propagated! how much reason and principle, health and happiness, reputation and prosperity, are sacrificed in those families, whose parents thus suffer reason and understanding to be the victims of these opposite and alternate mental states!

Of which states, such as become insane, are but the caricature samples of the hereditary family infirmities, and the actual habits of their lives; and perhaps this may happen to one less a hypocrite than the rest, because in such a one, the external and internal become more easily and readily in fixed and permanent correspondence. It is natural, therefore, to expect that this same character will be exhibited still more conspicuously after the understanding has altogether ceased to perform its godlike attribute of rightly using the light of pure reason so as to enthrone and support that one grand ruling principle to which the whole mind should be obedient and subordinate.

I have been the more particular in making these observations, because I conceive they may be useful in a medical point of view. They may prevent us from mistaking the simple, though modified, changes of the natural ebb and flow of our animal spirits, for an exacerbation or new accession of insanity,—and thus warn us from treating the patient with unnecessary restraint, as though he were suffering from a new attack, and from blindly endeavouring to cure a hopeless case by the wanton administration of strong and deleterious drugs, which in most instances would destroy health, as well as the remnant of the faculties: “In the diseases of the mind, as well as in all other ailments, it is an art of no little importance, to administer medicines properly; but it is an art of much greater and more difficult acquisition, to know when to suspend, or altogether omit them.” {151}

_No._ 8.—_Admitted_ 1783.

No statement on record. He was a respectable country Clergyman: his friends say he was a hard student, neglecting exercise, and all attention to himself or his health, and which had, for some time previous to the attack of derangement, been in a very precarious state—the attack was very sudden and violent.

He has a leprous eruption, which has continued since the time of his admission until now, without any very perceptibly abatement. He was formerly the most furious maniac amongst the old incurable cases, though less strikingly peculiar in his appearance and manners than the one last described. During the paroxysms of his greatest fury, he appeared like one whose mind, from excruciating pain and dreadful mental provocation, was wrought up to the highest pitch of passion and revenge; so that he would, as though he had the object of his malignity before him, be incessantly repeating, through whole nights and days, some single phrase, such as, “damn’d dog,” with a sort of suppressed barking, roaring furiousness, even until he foamed at the mouth, and his face was black with passion.

He was most violent when the eruption appeared least on the external surface. When his mind was more at ease, he would play like a little child for whole days together, with the merest trifle, such as a piece of string or paper. At these times, when given any thing he likes, he has something singularly fascinating in his smile.

For this eruption, many things had been administered, without any permanent advantage. Solution of nitric acid, about three years ago, {152} appeared to have, for a time, a good effect; the eruption became somewhat less, and the mind less violent: but this might arise from the debilitating effects, rather than the radical removal of the cause of his disease. After this, the solution of nitrate of potash, had a good effect both on his mind and the disease of his skin, without reducing or debilitating his system. He has lived, for this last twelve months, on vegetable diet, and he is apparently better; but this may be a fallacious appearance, since his vital energies appear to be sinking.

OBSERVATION VI.

It has been said, by the late Dr. Jenner, and some others, that cutaneous disorders are common to the insane. I should think they are not very common. {153} This is the only case that I have seen, where the two have continued to exist together. Whether it was the original cause of his mental malady, I have not been able to ascertain, but it is certain, it aggravated it. That mania, in some instances, follows the disappearance of eruptions, ulcers, and other local diseases, particularly with females, is satisfactorily established; but in many instances, other causes co-operate.

In cases of dementia, arising apparently from continued pressure on the brain, the surface, from the general bad habit of the system, is liable to sores, boils, and ulcerations. This cannot be called a cutaneous disease; it is rather a symptom of the diseased state of the brain, than itself the cause of insanity. Glandular swellings, however, seem to have a more direct connection; but still they appear rather before, than after the alienation has taken place. In a few cases, I have noticed slight eruptions during recent paroxysms, and in two or three, immediately previous to their convalescent state. Had such appearances occurred more frequently, I should gladly have regarded them as favourable prognostics; but they might arise from strong medicines, their state of confinement, or they might be mere accidental coincidences. There are many instances of cures by accidental injuries, {154a} as well as by the accession of consumption and other physical diseases.

Here I leave the question for the present, till I come to some cases, where, according to the theory of such a connection subsisting, (which I believe is the case in a few instances,) the tartarized antimonial ointment has been applied; {154b} but I confess, that there is no part of my experience in which my sanguine expectations of cure, after a certain duration of the disease, on this principle of counteraction, have been more disappointed. In the early stages of insanity, it is decidedly the most valuable principle in our practice.

_No._ 9.—_Admitted_ 1793.

No statement on record, that gives any satisfactory information. She was a respectable farmer’s wife, and her insanity was occasioned by her husband’s heavy losses of cattle. Her first symptom was throwing her little infant at the feet of the parish officers, saying, “there, take it.” {155} She often repeats, with a very moaning sound, and tears, “God rest thy soul, poor old mare.” She will be easily known, when I say, she is a poor, moaning, miserable looking imbecile, constantly sitting cowering in a corner, always crying for tobacco. She was one of those who were kept naked in loose straw, and hence her inclination to undress herself, her dirty habits, and her peculiar mode of sitting: indeed, formerly, throughout the house, the lowest and worst patients had no seats allowed them.

_No._ 10.—_Admitted_ 1793.

Nothing recorded of this case. It is said, that when young, he was severely kicked by a horse. There is now a considerable indentation just above his left ear.

His mind, though extremely childish, is altogether in a torpid state, for the most part quiet and good-natured; but sometimes, when more excited, he exhibits a love of mischief, generally very childishly, but sometimes more seriously so. {156a} His temperament is phlegmatic, and he has a heavy, dull look. He has been for years employed in the garden.

_No._ 11.—_Admitted_ 1793.

Nothing on record. I have been informed, that he was a well-sinker, and that his insanity was the consequence of a rheumatic fever. No one, except a complete idiot, can be in a more stupidly stagnant state of mind; he scarcely notices any thing, and never speaks unless spoken to, and then his answers are merely monosyllables. About once in twelve months, a slight exhibition of excitement shows itself in a sort of ill-tempered obstinate fit, {156b} but which soon subsides, especially with the aid of sulphate of magnesia. He is, together with No. 10, constantly employed in the garden.

OBSERVATION VII.

The observation which suggests itself on No. 10 and 11, is, that from such facts as these, it is very evident, there can scarcely be an old pauper patient in such a state as wholly incapacitates him from being brought, with a little trouble, into habits of useful employment.

As stupid men are generally less diverted from an object which once engages their attention, than men of greater capacity; so it is with these poor automata; if the first difficulty be but once overcome, that of acquiring the habit of working, there is no fear; but they will proceed in it more steadily than those who feel that they have a right to consult their own choice. They cannot be tempted, nor do they possess the power of giving their energies a new direction; and hence, as habit gathers strength, we may depend on them as on our time-pieces. If amusements and employment are good for these, how much better for those who are not past the hope of recovery; it may change the object of their thoughts, and gradually turn them to one of a less dangerous nature. I shall have some very interesting cures, partly attributable to this principle, to state in due course; in the mean time we perceive, that if even they are past the hope of recovery, they are kept in a better and more healthful state; and what is more, it diffuses a satisfactory feeling through the whole system, and they are made happier than they would be by a life of idleness.

_No._ 12.—_Admitted_ 1797.

Nothing on record; and I have failed in my efforts to obtain any information of her previous history. It is said, that her relations are respectable; yet her residence here is paid for by a parish in London. She has long been, together with No. 7, the most useful and hardworking person in the house. In the midst of her work, she will often scold and swear with vehemence, but no one knows about what, or against whom; and though her voice is loud and shrill, no one regards it, saying, “Oh! it is only poor M. W.” Yet she is very kind-hearted and friendly, giving away her own meat, especially to those who are ill; and when prevented from doing so, will throw it away with indignation. She would gladly starve herself to feed others; and always asserts, when a patient dies, “that they died for want of something to eat.” She used to practice this singular fancy, that of frightening the devil away, by taking a sweeping brush with her to bed; but now, a tin pint serves the same purpose. She is a tall, meagre-looking woman.

_No._ 13.—_Admitted_ 1798.

No statement of this case; but it is said that, in the first instance, he was very violent. His mind is now in a fixed imbecile state, and exhibits no alteration, except the slight changes which mere alterations of our spirits produce; when he is more easily provoked—talks, laughs, and sings more, or holds conversations with persons dead or absent; sometimes scolds them, fancying they tease him in some strange manner, which he calls “triangling;” but it is impossible to ascertain what ideas he affixes to the word; he is a very quiet, good-natured man, a general favourite, and is usefully employed by the attendants in the house. {159}

_No._ 14.—_Admitted_ 1799.

No statement of her case; and I have failed in obtaining any very satisfactory information about her.

[Picture: No. 14 page 159]

It is said, that she gradually became insane, after the death of her only boy, named “Charles,” (who was the natural son of Sir —:) this is probably true, as she now imagines that Charles is constantly with her—sleeps with her—that she feeds him at her meals—carries him about in a corner of her apron—nurses him—and talks to him with delight and maternal fondness. She often fancies, too, that she has been confined, and has got more children. {160}

Her appearance and manners are exceedingly polite, pleasing, and affectionate; she is attentive to others, in all those little nameless etiquettes of life, which, when regulated by truth, constitute the innocent fascination of a kind-hearted and well-bred character; and it is so with her: every one doats upon her as upon a favourite child. She never fails to tell me, if I have been out during dinner-time, when she next meets me, “you have not got your dinner, go and get it immediately;” and yet left to herself, she is wholly taken up with scolding some imaginary beings who annoy her, get into her throat, head, back, &c., run her through with swords, and do a thousand other strange and cruel things to her. Every evening she has a long scolding, with a tone three-fourths of anger and one-fourth affection, with some men who plague her in her bed and in her bed-room, and continue to do so till her attendant comes, sometimes at her call, to drive them away. Is this the lingering last impression made on her mind by her seducer? In the midst of her scolding she will often swear in a strange under tone of voice; and when accused, she says it is some other person, frequently Jack Swales. Her conversation is so exceedingly extravagant and varied, that it is impossible, except by the most lengthened description, to convey to others any adequate conception of it. Names of dukes, kings, queens, pipes of wine, sums of money, estates, &c., are as common to her as household words; yet strange as all this is, it seems to have some connexion with her past life, having formerly held a situation in a family of consequence. Her former situation and disposition are hinted at by these reminiscences, which are delightful traits of what she has been.

_No._ 15.—_Admitted_ 1799.—_Aged_ 50.

No statement on record; it is certain, however, from his own account, that he was formerly steward and butler in a gentleman’s family, and had been what some call a “hearty good fellow” all his life. His manner continued that of a blustering, passionate, half-inebriated man; {162} his skin was covered with a scorbutic eruption, and his face a bloated livid red. He died of dropsy in the chest, March 6th, 1821.

OBSERVATION VIII.

The observation, or rather the moral, in this case is so obvious, that it is almost superfluous to add, that from the nature of his case, and his own account of himself, his system both of body and mind had been brought into the extreme state of morbid irritability by the conjoined excitement of the dissipated companions, particularly of his early life,—unchecked in their effects by the exercise of any moral restraint over himself; and hence his mental powers and passions were not so much shattered and decayed, as they were like a vessel without its pilot, the sport of every wind and wave that assails it: bad habits had become too inveterate to allow the will to be taught obedience to reason; all measures of coercion, instead of inducing self-control, could only irritate and exasperate, as he was perhaps still less accessible by religion than by reason. I believe, however, that by gentle, and indirect means, he gradually became less boisterous in his manners; but it is proper also to add, that from age and disease, the sinking of his physical powers and animal spirits might imperceptibly, but more effectually, tame him.

_No._ 16.—_Admitted_ 1799.

Nothing on record.—It is said she was a belle: she is thin and tall, and is remarkable for a demure, prim, affected, stiff manner of sitting, like vanity turned to stone. She will spend hours in dressing, undressing, washing, &c. I have never heard her say more than “pretty well, thank you.” Her mind seems rather empty and motionless than diseased or deranged.

[Picture: No. 16 page 163]

_No._ 17.—_Admitted_ 1799.

Nothing on record.—She is a neat, clean, but rather crabbed-looking, middle-aged woman; and who, unless she is provoked, is scarcely to be distinguished from the sane; but when provoked, she is exceedingly abusive, and exhibits the deranged state of her mind. She is very useful as a laundress, and is known only by that name. The great objects of her affections are cats and kittens. {164}

_No._ 18.—_Admitted_ 1800.

Nothing on record.—He was an Italian, of a swarthy complexion, dark eyes, black hair; and to look on his countenance reminded one of an assassin, “the mark was upon him.” He was subject to violent fits of excitement when he was suspicious and thought himself insulted by a look or a word; and from his ignorance of the English language, he might perhaps have greater scope for suspicion. When offended, he gnashed his teeth; striking one hand violently against the other; appearing from these, and various other indications, to be preparing for action, and lashing himself into a state of the most determined revenge, he watched his opportunity, and seizing his victim with his teeth, was quite delighted if he drew blood. He bit several, some seriously; and in one instance, he bit a piece completely out of the lip of another. They all agree in the house that they never saw a patient so ferocious, or one where harsh measures _seemed_ more justifiable; yet nothing could conquer him—his attendant believes “he would have died first.” It was no accidental result of passion, but the settled object of his mind. {165a} He would chuckle and triumph over the injury he had done; and this was the more remarkable, as his mind in other respects was so much gone, that he continued to the time of his leaving the asylum, occasionally a dirty patient. Still it ought to be stated, that this ferocious disposition and these dirty habits, if they had not been absolutely grafted on his natural disposition, must have at any rate been made much worse by his brutalizing treatment; for he was one of those who were formerly kept naked in loose straw,—besides having during this time lost his toes, supposed to be from his exposure to the cold, he could not so well defend himself, and so might have been taught by necessity to have recourse to his teeth. That he was made worse by his treatment, is evident, as latterly he became sensible of kindness, and improved in personal cleanliness; and his general manners indicated much less malignity of feeling; indeed something like affection {165b} and gratitude to his attendants, began to excite in them, without effort, kindly feelings towards him. At first, (after the new state of things) it was with the utmost difficulty that he was made to keep his clothes on, or to be kept clean; but latterly, for many weeks together, he went on without any restraint whatever. He was removed in May, 1822.

OBSERVATION IX.

The observations that naturally suggest themselves on this case on the efficiency of mild treatment, are so obvious, that it would be obtrusive particularly to state them. I cannot, however, omit adverting to the fact of the probability of his having lost his toes by exposure to cold, because it illustrates the remark made in observation V. Patients, in former times, were kept naked in loose straw; and from their exposure to cold, mortifications in the extreme parts were common; and then writers on insanity say, that mortification of the extreme parts and insensibility to cold, are symptoms of mental derangement!!—See also observation 12th.

_No._ 19.—_Admitted_ 1800.

Nothing on record. He was a respectable tradesman.

He is constantly muttering and talking to himself, apparently busy in making calculations, holding in his hand something he calls an almanack, made by himself, as well as some pieces of money he has polished. He repeats something, seemingly as a duty imposed upon him, perhaps meant as a prayer. Though the shrivelled and decayed scraps of mind that remain, look only like the apparitions of his previous habits of life; yet they so wholly engross his attention, that he never notices passing and external objects around him. Sometimes, however, he can with great difficulty be for a moment diverted from his object, and while roused, will answer questions with considerable point and shrewdness, but returns as quickly into the same uniform abstracted state.

He is evidently of a contented and happy disposition. There is something in his appearance and countenance which seems to say, “I have been a respectable and good-natured fellow.”

OBSERVATION X.

The only observation here is one which I shall notice more particularly when I come to treat on the efficacy of moral management—viz. that, notwithstanding the deranged state of his mind, and the imaginary objects which occupy his attention, still he can be roused for a moment to something like a proper use of his faculties.

_No._ 20.—_Admitted_ 1801.

Nothing satisfactory on record. Said to have been a violent maniac. He was kept naked on loose straw. Since that time it is said he was improved by a seton; but still he was to the last a stupid, heavy, idiotical looking man, and in reality was so. {168} That he was less dirty, and kept himself dressed, was owing to better habits, into which proper management had gradually moulded him. But his mind was irrecoverably gone; he was motionless and silent, unless spoken to, or urged to some action. His replies were merely monosyllabic, and these only correct when they referred to something he had formerly best known; he was, however, drilled into some degree of usefulness, in helping about the wash-house. He was removed by his friends in April, 1821.

[Picture: No. 20 page 168]

_No._ 21.—_Admitted_ 1801.

Nothing on record.—He was one of those who was formerly kept naked on loose straw. He has been for years, for the most part, in a moping, poring, and solitary looking state; yet he has had occasional seasons of excitement, when the disposition towards furious revenge seemed to possess him, so much so, that he would, unprovoked, place his back against a corner of the wall in the attitude of self-defence, shaking his doubled fists in a daring and threatening manner. Though these effervescences of his spirits occur as frequently as ever, yet the malicious disposition seems dying away, and instead of which he will, at these periods, sing a little comic air, and give other indications of his mind being happy and full of good-nature, as much so as the little mind he possesses will enable him to be, if, indeed, beings in such a state can be said to have minds at all; for what an appalling difference between them and minds enriched with laborious habits of reading and reflection!

OBSERVATION XI.

In addition to the observations already made on former and present treatment, it is only justice further to say, that amongst recent patients, I have scarcely seen (if indeed I have seen) one instance of continued revenge. Their spirits exhibit themselves in good or ill-nature, according to the direction that is given them, and even in the old cases, as in the one above stated, it appears simply the remains of their former usage; so that if their minds are still agitated in some sort with feelings of revenge, it is only like the sea which will fluctuate awhile after the storm has ceased; but the winds are hushed, and every wave becomes less and less, until it subsides into a calm.

_No._ 22.—_Admitted_ 1801.

Nothing on record.—I have been informed, that his mind was instantly wrecked by the female of his heart unexpectedly marrying another the very day previous to that on which she had promised to be made his own for ever. He was an idiot, who could barely answer in a low whisper, and to a few very simple questions, “yes” or “no.” He was old, and pale, and thin—had a long face—his head hanging forwards—his stare was ludicrously vacant and goggling—his lower jaw fallen, and saliva flowing over his large hanging lip—though he generally stood quietly in a corner with his face to the wall, yet sometimes he would for some hours together make a strange and disagreeable noise—what was still more disgusting about him, he had the sickening habit of bringing up his food and regorging it, yet, in other respects he was not a dirty patient—perhaps because having been with a better class, he had received more attention.—He had this singular fancy, that if he had one or fifty pieces of bread and butter, he would eat, or secrete, or pocket them all, except one. He gradually declined from old age, and died in December, 1821.

_No._ 23.—_Admitted_ 1801.

No statement of his case. It is reported that he was a clever man, a hard student, fond of political subjects, and that speculations on the national debt were the cause of his insanity.—This report receives a colouring of probability from two large trunks full of books now in the Asylum belonging to him, almost wholly on subjects of political science, among which is a large collection of pamphlets on the national debt, and it is apparently confirmed by the nature of his hallucination; only I cannot trace the report to any certain source. It is certain he was Superintendant of the Police at Bombay.

His appearance and manners are very peculiar, and very difficult to describe. He holds his head forwards and obliquely upwards in a calculating position; moving his hands in different directions, and working with his fingers like unto one gathering something in the air.—At times he extends and stretches his hands higher than his head, moving and working them in the same manner: he will hold his face directly upwards—open and shut his mouth in a gaping and catching style, as if he were feeding on air; repeating these operations, and intermingling them with a strange gurgling noise in his throat—almost always muttering to himself as if he held busy converse with his own thoughts, with visible appearances of pleasure or anger on his countenance, occasioned by his imaginary operations being successful or otherwise.

Though he is sometimes as immoveable as a statue, yet he is for the most part moving about, and has a singular mode of treading with his feet like one who has been accustomed to a tread-mill, lifting them higher than necessary, and setting them down cautiously,—sometimes pulling off his shoes—sometimes, however, quickening all his motions, as if something required extraordinary haste and dispatch; and thus he marches about like some star-gazer treading on precious and frail materials; seldom more than a few moments in one place, and in all his movements in different rooms and parts and corners of his gallery, stairs, and airing court, and in all his operations and mutterings it is evident that he, in his imagination, is performing some essential part of his _mighty task of paying the national debt_, for when any of his operations or mutterings are interrupted, like one whose studies are suddenly broken in upon at some unlucky moment, he seems vexed and unhinged; sometimes bursting into a violent passion, when he is most eloquent in the use of scurrilous epithets (a proof that to use abusive epithets requires very little mind) calling the person who has impeded him in his great work, low-bred, mean, dirty scoundrel, rascal, villain, thief, vagabond, madman; accusing him of being the cause of the loss of many millions to the nation, threatening him with the direst punishment, particularly that he shall be whipped in the air. He is otherwise remarkably quiet and inoffensive, and uniformly intent upon this object, except that sometimes, as already stated, he appears unhinged and irritable by the unsuccessful issue of his calculations, and is then more liable to take offence, especially at any disrespectful deportment towards him, for it must be observed that he is still very fond of his title and of that deference due to a man of rank. Occasionally, like some alchemist of old, he fancies that some äerial being, which he calls the clown of the air, plagues him in various strange ways and interrupts his operations, for which mischievous interference he, in his way, severely scolds him.

The politeness which may be traced in his manners, is evidently the result or remains of his old habits, as he is so absorbed in abstract speculations that all attention to himself or external objects is utterly excluded; he is always solitary, but it is like the solitariness of one whose intense studies allow him no time for fellowship or the exercise of social feelings, so much so, that notwithstanding a consciousness of kind and respectful treatment towards him, he scarcely yet seems to know the name of his attendant.

Although his system is delicately susceptible of changes of temperature, he scarcely ever notices it himself; and when roused to pay attention to his feelings, he says that it is the clown in the air that has teased him with the iron ague.

He has been subject to occasional attacks of asthma, brought on, apparently, by exposure to cold in the night time, during these operations, (for he frequently jumps out of his bed to carry on this great patriotic duty.)

Though he can, if properly roused and managed, still answer questions much more correctly than all these appearances would indicate, yet it is evident that his mind is gradually declining, from age, exertion, and the nature of his case; he is an object of interest and sympathy, and nothing can exceed the way in which it is shewn towards him by his attendant.

OBSERVATION XII.

The correspondence between the insane state and the previous character and habits are in most cases, and certainly in this, very striking. On this subject I refer to the Essay on the Changes and Correspondence between the previous Natural Character, and that which they exhibit in their Insane State.

There is another fact in this last case, which may conveniently serve the purpose of introducing some observations ON THE EFFECTS OF HEAT AND COLD AND THE STATE AND CHANGES OF TEMPERATURE IN INSANE PERSONS, which may be considered as an Appendage to the remarks made in Observation V. and IX.

The fact to which I allude in this case is this, viz. that his system “is delicately susceptible of changes of temperature, but that he himself scarcely ever notices it.”

When the hallucinations of the insane are purely intellectual, and wholly and intensely occupy the attention, the generation of animal heat appears less than usual; and decidedly less than in those cases where the aberrations of the mind are connected with the stimulus of selfish and exciting passions,—hence the system is cold. But this arises rather from defective quantity of heat, than from any irregularity in its distribution; and thus, while the mind, from its state of abstraction, either disregards, or is wholly unconscious of exposure to the cold, the body is very sensibly and strongly affected by it.

In the last stages of gradual decay of mind, the changes and disturbances in the quantity, state, and diffusion of heat, resemble that observable in paralytics; there is great insensibility to heat and cold, and the infliction of pain; and, previous to the period of their dissolution, the slightest pressure, even so slight as to give no pain, produces ulcerations, which rapidly degenerate into gangrenous ulcers.—In old torpid cases of neglect—cases of suspension of mind; and in cases of pure mental abstraction, it is deficient in quantity, although equable in its diffusion.

In all these cases, as well as in cases of over activity of mind, especially during violent paroxysms, there is a general loss, or want, of consciousness to the usual impression of the corporeal system. Sometimes, however, this consciousness is on some points morbidly acute, indicated by strange sounds, and sights, desires, or aversions, &c., according to the parts or organs affected. In fact, it is this undue concentration of energy, which abstracts or confuses, rather than destroys the proper diffusion of consciousness.

Hence the insane, during violent paroxysms, bear the want of sleep and food, resist the action of severe cold, and the effects of large doses of strong medicines. In most cases their minds are so absorbed or suspended during their paroxysms that passing and external events are wholly excluded, and though some few, after their recovery, vividly remember their dreadful dreams; to others, all has been a blank, and they feel just as a person feels respecting that section of the country in which he happens to sleep as he travels; but all these things, (which I intend shall be noticed more particularly hereafter,) are not peculiar to the insane, as has been held by some; they are equally the case with patients during the paroxysms and delirium in the inflammatory stage of fevers. Indeed, the same principle is exemplified in the cases of men of spirit or energy, who, during the excitement produced by the achievement of some difficult enterprise, bear the want of food and sleep, and resist the effects of cold and exhaustion, to an extent which would seem to have exempted them from the common laws of humanity, and these are the incidents in life which are never forgotten; but then, as with the insane, this extraordinary expenditure of the cerebral energy leaves the system exhausted, and it requires all our art and care to recover the enfeebled powers. It is this critical period of convalescence which is so important, and so difficult in the management of the insane.

I further observe, that the variation of temperature of the system, observed during paroxysms of insanity, is more like that produced by the passions in a state of excitement than that which accompanies inflammatory fever. It appears to fluctuate in quantity, and to be tumultuous in its distribution, in proportion as the exciting and depressing passions are active and contending with each other. In proof of the truth of this, I need only mention that every thing which excites the malignant passions, or produces misery and distraction of mind, increases these appearances. I allude not merely to the expression of the countenance, but to the absolute heat of different parts of the system,—of different parts of the head in particular, of which they complain and to which they point distinctly, being often sensible to the external touch of another. It is to be remarked, that the changes and unequal diffusion of heat in other parts of the body correspond with the general and particular state of the mind: indeed the condition, (as it regards health or disease) of each part of the bodily system, directly or indirectly, corresponds with, and indicates states of the mind: but this truth requires more than an observation to do it justice; I make the remark, however, in the mean time, because there is no better guide to us in our treatment than this knowledge, and it explains this temperature as one of the corresponding effects. And though I shall not now enter on the medical nature of the treatment these indications afford us, neither is it necessary to say what kind of moral treatment they point out to us as our wisest course to pursue. In all such cases, and indeed in every case, we ought always to be anxious not only to keep our sympathies alive, but, in order that we may never fail rightly to direct them, we must also possess ourselves of a thorough knowledge of the mind, and its individual peculiarities.—To give settled calmness and tranquillity to the distracted mind, and bloom to the wild and faded countenance, ought not to be considered matters of trifling importance.

OBSERVATION XIII. ON THE EFFECTS OF INTENSE STUDY, AND GENERAL INTEMPERANCE OF MIND.

Though the effect of intense study and general intemperance of mind, may be better illustrated by many cases than by the preceding, yet for the sake of the moral deducible from the combined view of this part of the subject, and the preceding observations on the distribution of animal heat, I am tempted briefly to glance at the important reflections included within it; intending to resume a more elaborate consideration of its merits when I come to the Essay on the Causes which produce Insanity.

In those cases where intense study has been considered as the exciting cause of insanity, I have almost always been able, on closer investigation, to trace it rather to the intemperate feelings and sentiments of the mind, combined with the injudicious mode of procedure and irregular habits attending it. In young students, these studies are blamed; but, alas! how often have I ascertained that much greater and more decided causes (_secret and wicked causes_) have long been exercising the most baneful influence. In cases of regular and well-balanced exertion, however severe, the effects were rather a general depression and weakness of the whole nervous system than absolute derangement, producing either debility or suspension of mind, but which for its restoration required only cessation from accustomed exertions. Calmness and tranquillity, combined with innocent diversions and general attention to hygeian rules, invariably effected a cure.

I am the more particular on this point, as some authors on the subject of insanity seem almost to discourage all mental exertion whatever; whereas, we should never lose an opportunity of repeating the common observation, that the judicious exercise of mind, as well as body, is equally conducive to health and strength, as it is to mental improvement and worth. Rightly to apportion and conjoin the exercise of the feelings and understanding, as well as of the corporeal frame, constitutes the whole of Physiology as applied to health. When the civil duties of life are performed from right motives, we then are obedient to the first law of nature, as well as of the Decalogue: then all is healthy co-operation—all portions of the system have their fair proportion of exercise—none are over-worked, neither in the individual nor in the mass—neither in body nor in mind, as we at present see to be the case, singly and collectively: everywhere the effect is similar, destructive alike of all healthy, mental, and corporeal energy, and of all the sweet ties and charities of life which bind families and societies together.