839 



INSANITY. 



INSANITY. 



890 



13 to 12. In Italy also the number of male lunatics is greater than 

 that of the females. But in France there are more females than males 

 insane, in the proportion of 14 to 11. Calculating from statistical 

 accounts derived from different parts of the globe, M. Esquirol found 

 that the proportion of men to women insane is nearly as 37 to 38. 

 The concurrent testimony of French and English physicians tends to 

 show that the number of the male sex affected with lunacy, as com- 

 pared with the female sex, is greater in the higher than in the lower 

 ranks of society. 



Insanity is rare, though it sometimes occurs, before the period of 

 puberty. It is from the age of 14 to 17, when a great change is taking 

 place in the system, and when the passions begin to be more active and 

 more liable to excitement, that insanity becomes frequent. The 

 liability to the disease increases up to the age of 40 ; and although the 

 absolute number of persons in lunatic asylums of different ages from 

 40 upwards becomes less and less, yet if we take into consideration 

 that the number of persons living at the more advanced ages is also 

 much less, we shall be led to infer, not that the liability to insanity 

 diminishes in old age, but, on the contrary, that it rapidly increases. 

 An excellent paper by M. Esquirol on the statistics of insanity, in 

 which the number of insane persons at the different ages is compared 

 with the population of the same ages, shows this in a very striking 

 manner. 



Of the causes which excite the development of insanity in individuals 

 predisposed to it, those which act on the mind are the most efficient. 

 It will most frequently be found that immediately before the attack 

 the patient has suffered some severe vexation or disappointment from 

 family troubles, pecuniary embarrassment, 4c. We have seen that 

 insanity rarely shows itself before the age in which the mind is sus- 

 ceptible of strong feelings, and in which the passions are excited by 

 strong interests. A calculation made by M. Pinel represented the pro- 

 portion of cases produced by moral causes, as compared with those due 

 to physical causes, to be, in a space of fire years, as 464 to 219. In 

 one of the largest of our English asylums the proportion of cases ascer- 

 tained to have been excited by moral causes was, during the years 

 1831 to 1836 inclusive, 431 ; those ascribed to physical causes, 291. 

 The proportional influence of moral causes is, however, probably much 

 greater than is here indicated; for in 454 cases admitted into the 

 asylum to which we refer during the six years, no cause was assigned, 

 and of these it must be presumed that a large number were due to 

 moral influence. It is the slow and constant action of the depressing 

 passions that is most instrumental in disordering the mental faculties ; 

 the violent and sudden passions much less frequently have this effect. 

 Of the 431 cases produced by moral causes in the asylum from which 

 we derive these facts, 289 were ascribed to trouble of mind fiom 

 pecuniary distress or family disasters, grief, jealousy, disappointment, 

 &c. Religious impressions are frequently instrumental in exciting 

 complete derangement of the intellect in minds already sensitive and 

 weak ; 43 cases out of the 431 were traced to religious excitement. 

 The other causes acting directly on the mind, which are more or less 

 active in exciting insanity, are disappointed love (a not unfrequeut 

 cause in young females), fright (also acting chiefly on females), exces- 

 sive study, and political excitement, which during the Revolution and 

 succeeding years was a productive source of mental alienation in 

 France ; but cases from that cause are now comparatively rare even in 

 that country, and of upwards of 1200 cases admitted during six year* 

 into an English asylum, two only were traced to political causes. 



Of the physical causes of insanity those connected with circum- 

 stances which affect females only afford the greatest number of cases ; 

 62 out of the 291 cases of insanity from physical cause* were con- 

 nected with parturition or nursing. Insanity occurring under such 

 circumstances is termed puerperal mania, the frequency of which is not 

 easily explained. Retardation of the appearance of the menses and 

 their suppression are likewise occasional causes of insanity in females. 

 The frequent dependence of mental disorder on intemperance, par- 

 ticularly in men, is a fact demanding much attention. Drunkenness is 

 unfortunately a prevailing vice in England, and accordingly we liml a 

 much larger number of insane from that cause in the pauper lunatic 

 asylums of this country than in those of France, where the abuse of 

 intoxicating liquors is less general. Next to intemperance, the causes 

 which act more directly on the brain itself, and give rise to inflammation 

 or disturbance of the circulation in it, are the most influential in pro- 

 ducing the predisposition to insanity, or in exciting it ; such causes 

 are blows on the head, fever, coup de soleil, &c. Epilepsy and, less 

 frequently, apoplexy also lead to insanity. Lastly, any influences acting 

 prejudicially on other parts of the body may indirectly affect the mental 

 organ and disorder its operation. 



Closely connected with the subject of the causes of insanity, and of 

 equal importance, are the statistics of the disease. If we could ascer- 

 tain all the important circumstances which accompany its greater or 

 less prevalence in different countries, we might hope to be able to 

 combat in some measure the evil, by adopting preventive measures. A 

 general result, which appears to rest on correct information, is, that 

 insanity is extremely rare in uncivilised nations, as among the natives 

 of Africa and America. This cannot arise solely from passion less 

 frequently disturbing their moral feeling and affections, though this is 

 mi'l'iiibtodly an influential circumstance. There seems to be an 

 <: of the predisposition to many diseases among the uncivilised 



races. A less highly developed and less active condition of the brain 

 may render it less prone to disease. 



In Turkey, Spain, and Italy, insanity is comparatively less prevalent, 

 if we may judge from the imperfect reports obtained from those 

 countries, than in the more northern European nations and the United 

 States of America. The proportion of lunatics to the population in 

 England and France is, according to the calculations of Sir A. Halliday 

 and M. Esquirol, about 1 to 1000. In Prussia the proportion, as 

 stated by M. Jacobi, is about the same. But in Wales the proportion 

 of insane to the population was estimated by Sir A. Halliday to be as 

 high as 1 to 800, and in Scotland 1 to 574. In Norway too, a country 

 somewhat similar in its physical character and in the condition of its 

 inhabitants to Scotland, the estimate of the proportion of lunatics 

 given by Dr. Hoist is 1 to 551. A great and surprising difference in 

 found to exist in the proportional number of insane in manufacturing 

 and agricultural districts of England ; the number being greater in the 

 agricultural counties. This is an analogous fact to the prevalence of 

 the disease in Wales and Scotland. There is certainly less call for the 

 exertion of the intellectual faculties in the agricultural than in the 

 manufacturing counties, and in Wales than in England ; an explana- 

 tion of the facts must therefore be sought in other circumstances. In 

 the statistical calculations are included not merely the insane, but the 

 idiotic from birth, and the excess in the number of unsound in mind in 

 Wales, Scotland, and Norway, as compared with France and England, is 

 due to the greater number of idiots, of which we can find some explana- 

 tion in the hardships to which the poor of those mountainous and 

 partly barren countries are exposed ; idiotcy being a disease dependent 

 on imperfect formation of the brain, and generally attended with other 

 marks of an ill-developed organisation. The greater liability of the 

 agricultural population of England to insanity is less easily accounted for. 

 The much greater degree in which insanity presses on the lower than 

 on the higher classes of society, is another important consideration. 

 One cause of this is undoubtedly the much less check which is put 

 upon the spreading of the disease by marriage with individuals whose 

 families have the predisposition in the lower than in the higher classes. 

 Another may be the deprivations to which parents, and particularly 

 pregnant females, are exposed. A third is the prevalence of intemperance 

 among the poor. The opinion has prevailed in France as well as in 

 England, that insanity is on the increase, but the data on which this 

 supposition is founded cannot be implicitly trusted, for the greater 

 number and better management of lunatic asylums at the present day 

 cause many more persons to be conveyed to them, and thus placed 

 within the reach of statistical research ; while formerly many lunatics 

 were allowed to wander about as beggars ; many from shame^or fear 

 of the horrors of the asylum, were concealed in private families ; and 

 some, from ignorance, were punished as criminals. 



The principal means of checking insanity, which the facts above 

 detailed seem to suggest, are, 1, the prevention of the marriage of 

 individuals predisposed by inheritance to the disease ; 2, the improve- 

 ment of the physical condition of the poor ; 3, the encouragement of 

 intellectual cultivation and amusements among the lower classes, as a 

 means of checking intemperance and sensual indulgence generally ; 4, a 

 better education of the moral feelings in all classes of society, so as to 

 discipline the passions and enable the mind to resist their disturbing 

 influence. 



Before entering on the consideration of the mode of -detecting insanity, 

 it will be necessary to inquire into the probable nature of the disease. 

 We will first state the facts on which is founded the opinion that it is 

 dependent on some disease in the brain. It is not requisite to offer 

 any proof that the brain is, in the healthy state, the seat of the mental 

 operations, the organ or instrument by which the mental principle, 

 whatever it be, acts. Admitting this, we may naturally suppose that 

 the cause which disturbs the functions of the mind has its seat in the 

 same organ. Then again, although in many cases no change of structure 

 can be found in the brain after death (which cannot surprise *s if we 

 remember the delicacy of the organ, and the slight change that would 

 be sufficient to disorder its action), yet it is certain that morbid 

 appearances are found much more frequently in the brain than in any 

 other part of the body of the insane after death. The commencement 

 of the disease is generally accompanied by pain and other symptoms of 

 inflammation or vascular fulness of the head. In some cases we per- 

 ceive a diatinct connection between marked disease of the brain and 

 insanity, as where the latter affection supervenes on epilepsy or 

 apoplexy. The physical causes too are hi many instances such as act 

 directly on the brain ; we allude to blows on the head, inflammation of 

 the brain, coup de soleil, &c. Even the moral causes of insanity afford 

 an argument in favour of the cerebral pathology of the disease ; for 

 the inordinate action of the brain which must attend the long con- 

 tinuance and great violence of a particular passion would be likely to 

 excite diseased structure of the organ. The diseased states of other 

 viscera, those of the abdomen for example, can only be regarded as 

 consequences of the insanity, or as accidental complications, or if they 

 stand at all in the relation of causes, as acting only through the medium 

 of the brain. 



It being thus premised that the brain is the seat of the disease, can 

 we recognise any particular character in the disordered reasoning and 

 feelings of the insane which will afford- us a means of denning it, and 

 enable us to distinguish it from other disturbed states of the mind and 



