X1TY. 



INSANITY. 



HP. 



profuse ; the liberal, penurioiu ; the sober, drunken." Passions which 

 had long been dormant mume their sway, and cart shame mingled 

 with pity over the yean of declining age. 



i The term monomania hat been proposed by M. Eaquirol, and 

 adopted by most writers on mental disorders, to designate those cases 

 of insanity in which the mind is occupied by some illusion or erroneous 

 conviction, the individual still retaining the power of reasoning cor- 

 rectly on matters unconnected with the subject of his delusion. The 

 word " melancholia " has been used in the same scnsr, which has given 

 rise to the erroneous notion that insanity of this kind is necessarily of 



weakness of the nasrming faculty. The subject of the delusion is very 

 various. It may have reference to the condition of the individual s 

 own person ; thus, some fancy that they have lost their head, others 

 that their legs are. not their own, but belong to some other person, 

 others again that they have the devil or some animal within them, that 

 they are dead, or that they are changed to some other form, ic. 

 Monomaniacs subjects of the last delusion are thus described by 



f ' 



' Unnumbered throngs on every ride are icon, 

 Of bodies changed to various forms by spleen ; 

 Here living tei-poti stand, one arm held out, 

 One beat ; the handle this, and that the (pout ; 

 A pipkin there, like Homer's tripod walks ; 

 line tigfas a jar, and there a goose-pie talks." 



It is probable that in many cases of delusion regarding the condition 

 of the body there is some morbid state of the nerves, causing a sensa- 

 tion which excites in a mind prone to insanity an idea which the reason 

 is unable. to correct. Another kind of delusion is that which cha- 

 racterises the " demonomania " of some writers. It consist* in a belief 

 in the presence of invisible beings whom the lunatic sees, hears, and 

 converses with. Religious delusions are frequently of this character : 

 the maniac see* and communes with the Almighty or with angels. 

 Such ideas, being very often combined with despondency, lead to 

 suicide. Others who are subjects of such delusions fancy themselves 

 constantly followed by some person who has the purpose of injuring 

 them. A third kind of delusion refers to unreal events which the 

 individuals believe to have occurred, or consists in a belief in some 

 absurdity which has no foundation except in the patient's imagination. 

 Such a monomaniac was the gentleman who thought he had been con- 

 fined in a castle, and corresponded with a princess by writing letters in 

 cherry-juice. The delusions which most frequently take possession 

 of the thoughts of the proud or vain madman are referrible to the 

 head of those which arise from abstract ideas conceived in the mind 

 being mistaken for realities. An ambitious dreamer may for a moment 

 imagine himself a king, but it is only a lunatic who fails soon to per- 

 ceive that he is such only in hia own thoughts. 



There is generally some connection to be traced between the nature 

 of the illusion and the former occupation of the monomaniac, or the 

 ideas which have chiefly engaged his mind. Thus a butcher is said to 

 have fancied that he had a leg of mutton hanging from his nose ; a 

 youth, the son of an attorney, fancied himself suspected of a horrible 

 crime, and that the officers of justice were following him ; persons who 

 have had their thoughts much directed to religious subjects imagine 

 when they become insane that they have received a charge from the 

 Almighty ; that they are persecuted by the devil, Ac., Ac. 



3. General derangement of the intellect present* many varieties and 

 degree*; but the distinguishing character is that the faculties of the 

 mind generally are disordered ; the patient will not speak on any sub- 

 ject long without betraying the defect of his reasoning power. This 

 will in one person merely lead to strange irrational conduct and con- 

 versation iU necessary consequences; in another it will be attended 

 with loud and violent raving (mania) ; in a third there will be MiiK'iiig. 

 and a gay cheerful air ; while a fourth case will be characterised by a 

 low muttering incoherence. This general insanity is most frequently 

 attended with disturbance of the bodily health. The symptom* of 

 mental excitement frequently increase in violence for a short time, 

 then gradually subside into a more quiet state, which too often termi- 

 nates in rm-nUl imbecility. 



4. The mixed forms of madness are by far the most frequent. Moral 

 insanity, the disturbance of the moral feeling* and propensities, is 

 generally attended with some degree of weakness of the reasoning 

 powers, or with some delusion. The general derangement of intellect 

 has combined with it an excited state of some of the feelings ; and 

 monomania in the pure form, a mental delusion without further disorder 

 of intellect, is very rare. 



6. The duration of insanity has no certain limits ; the attack may 

 last but a few weeks, or it may continue many years. It i not uncom- 

 mon to meet in lunatic asylums with persons who have been insane 

 twenty or thirty years. When the disordered state of the mind is thud 

 protracted, it usually terminates in loss of the intellectual faculties. The 

 state of imbecility, dementia, or fatuity, which then succeeds, has many 

 degrees. It commences by the loss of memory, particularly for more 

 recent events ; the mind receives impressions and perceives them, but 

 the faculty of retaining them warns to be lost. It is this state which 

 so frequently attends the advance of years, and gives warning of 



approaching decay, when the mind is otherwise sane. In the latter 

 instance the faculties are exercised in a sound manner when the atten- 

 tion is roused ; but frequently the words which were spoken but a few 

 minutes previously are forgotten, though the memory for the events of 

 youth is quite distinct In a second degree of imbecility the power of 

 directing the thoughts is lost ; ideas come and go without order and 

 independently of the will ; questions are still heard and attempts are 

 made to reply to them, but before the answer is half completed the 

 train of thought is lost, and the mind and tongue wander to other sub- 

 jects. In proportion as the mind becomes more and more weakened 

 the external senses also become deadened ; there is a carelessness of all 

 that is going on around ; life is reduced to the state of that of brutis 

 animals ; the instincts alone guide the actions. The features are void 

 of expression, the countenance vacant, the eyes wandering. At last 

 even the instincts are lost ; the miserable creatures seem almost uncon- 

 scious of life ; careless of the calls and want* of nature, they sit or lie 

 motionless in one position, and frequently lose even the use oi 



' 



Disease in the brain may thus go on to the abolition of all the 

 functions by which mind is manifested, without interfering with those 

 other functions of the body on which mere existence depends. Insanity 

 cannot be regarded as a very fatal disease. Of the lunatics at the asy- 

 lum Bieetre in the year 1822, one patient had been there 56 years; 

 8 had been confined upwards of 40 years; 21 more than 30 years; 

 50 upwards of 20 years; aud 107 more than 10 years. Of those in 

 Salpetriere seven cases had been admitted from 50 to 57 years. It is 

 difficult to ascertain the proportional number of recoveries from 

 insanity, so different are the statements made by different writers. 

 While some authors have reported the cure of nearly 5 in 6 cases, 

 others have estimated the proportion cured as less than 5 in 10; some 

 have stated it to be as low as 5 in 15. The chance of recovery, how- 

 ever, varies very much according as the insanity is complicated or not 

 with other disease; it is also influenced by the form of the disease, the 

 period of its course, the age, sex, and constitution of the patient Of 

 the diseases which occasionally complicate insanity, epilepsy and para- 

 lysis are the most important Whether paralysis affect the motion of 

 the limbs or the speech only, the case is generally considered hopeless. 

 The complication with true epilepsy, not mere convulsion from tempo- 

 rary cerebral excitement, is nearly equally unfavourable. It appears 

 that the general derangement of the intellect is more curable than 

 monomania, more especially in men. The state of imbecility is almost 

 certainly incurable. The period of the disease at which it is brought 

 under treatment has a very important influence on the chance of 

 recovery. Of those who enter asylums soon after the commencement 

 of the malady, 7 out of 8, qj- even out of 10, recover ; while after the 

 third year the probable proportion of cured is not more than 1 in 30. 

 The mean duration of cases terminating favourably seems to be from 

 5 to 10 months. The age most favourable for recovery from insanity 

 is the period from the 20th to the 30th year; few recover after the 

 50th. Insanity is generally more curable in women than men. There 

 is more hope of recovery when some secretion of the body is suspended 

 which may be restored by medicine, or when a critical period, such as 

 that of the appearance or cessation of the catamenia in women, is at 

 hand ; at such periods as those last referred to insanity has ceased 

 after having persisted for many years. 



During the period of convalescence there is great liability to relapse, 

 but this diminishes with the increasing length of time during which 

 the patient manifests no symptoms of uusoundness of mind. The 

 more complete the recovery, the more likely it is to be permanent ; if 

 the judgment be strong, and the feelings neither depressed nor irritable, 

 relapse is much less to be feared. 



C'aiaa. Some individuals appear to be so prone to insanity that very 

 slight causes are sufficient to induce it in them ; or it is probable 

 indeed that there is always some peculiarity in the constitution pre- 

 disposing to it, since the apparent causes do not differ from those 

 which, acting on other persons, produce other diseases and not insanity. 

 Be this as it may, a tendency to mental and other cerebral afflictions 

 is often observed to prevail in families, and to be transmitted from 

 parents to offspring. An attack of insanity not only produces such a 

 change in the system as to render it more prone to the disease than 

 before, but the condition of the body, or rather of the brain, thus 

 induced, may be transmitted to the children. This fact is so well 

 known that it is unnecessary to insist further upon it. The hereditary 

 predisposition is said to be stronger when both parents have been 

 insane. A remarkable circumstance relating to the hereditary trans- 

 mission of insanity is that the form of the disease which affects different 

 Individuals of a family is often the same, and that it attacks them 

 about the same age. It is an opinion generally adopted that inter- 

 marriage in families gives rise to the predisposition to mental disorder, 

 as it certainly does to weakness of body and mind. Intermarriage 

 must tend to strengthen or maintain original peculiarities of consti- 

 tution, and therefore any predisposition to rlisfimm which may exist 

 It is almost impossible to ascertain the proportion of cases connected 

 with hereditary predisposition, so much is it the desire and interest of 

 families to conceal such a circumstance. 



The proportion in which the sexes are affected with insanity varies 

 very much in different parts of the world. In Great Britain, and 

 Ireland the proportions of males to females insane is stated to be as 



