536 



INSANITY. 



from which miners are for a great portion of their 

 life withdrawn ? In six maritime counties the 

 lunatics are to the population as one to 1000, and 

 idiots are to luimtics as two to one ; while in six 

 counties of North Wales there are seven idiots to 

 one lunatic, and one lunatic to 850. In South 

 Wales the proportion of lunatics to the population 

 is one to 750, and idiots are to the insane as one 

 to eight and a half. Throughout Wales, as in 

 many parts of England, there is a preponderance 

 on the side of female lunatics over males ; female 

 idiots are also more numerous than males ; in Wales 

 the excess is very great. The explanation afforded 

 for this is, that nearly half the population is em- 

 ployed in agriculture. There is a general impres- 

 sion that, in agricultural districts, where people 

 work heard and where Females are employed in 

 labour, the violent exertions required in such occu- 

 pations produce distortion of the body, and may 

 very materially affect the growth and development 

 of the brain, and even the form of the cranium in 

 utero. It is well known that females are obliged 

 to work during the whole of their pregnancy, and 

 there can be no doubt of the injury which such 

 occupations must entail on the offspring. Accord- 

 ing to a return made for Scotland in 1821, the pro- 

 portion of lunatics to the population is one to 474, 

 but little reliance can be placed on this as a cor- 

 rect estimate of the state of insanity there. By 

 the returns which were made for the French hos- 

 pitals, from 1801 up to 1823, there is a steady and 

 progressive increase. The first return gave, in 

 1801, 1070 lunatics, and the last, in 1823, gave 

 2493. Rating the population at thirty-two mil- 

 lions, Esquirol estimates the insane as one in 1000. 

 In France, as in England, the operating causes 

 vary very much. Of 336 lunatics in his establish- 

 ment, Esquirol says, there were only three from 

 drunkenness. It, however, prevails as an exciting 

 cause to a great degree in Salpetriere, where 

 women only are admitted, and of whom one- 

 twelfth part are girls of the town. We find also, 

 by the reports which Dr Whally has made on the 

 effect of drunkenness, that it prevails to a great 

 extent in Lancaster infirmary. 



All the attempts which have hitherto been 

 made to account for insanity by pathological ap- 

 pearances have proved hopeless. In examining 

 the morbid results, we are led to consider how the 

 mental disease could have resulted from them; but 

 here the nature of the subject completely baffles 

 us. In cases of other diseases, as of the lungs, 

 whose functions are now well understood, the mor- 

 bid change accounts for the derangement, but the 

 case is quite different when the mind is affected. 

 We are ignorant of the manner in which it per- 

 forms its functions, and of the connection between 

 the organic agents and the operations commonly 

 referred to it. Hence, some are inclined to doubt 

 whether the phenomena of insanity are the result 

 of changes discovered in the brain, and view them 

 as the result of the diseased operations of the 

 mind, believing that hardness of brain and thick- 

 ening of membranes are only formed after mental 

 disease of long standing, and are altogether want- 

 ing in recent cases of insanity ; upon these grounds 

 mental disease is considered as a deviation from 

 the healthy state, different from that which ana- 

 tomy exhibits. 



The different states of the intestinal canal have 

 been considered a fruitful source of insanity, both 

 to the rich and the poor to the former, from 



over-indulgence; to the latter, from very opposita 

 causes low diet, bad food, cold, constipation. 

 Worms have been viewed as producing it, because, 

 in some cases, mad people were cured, on the ex- 

 pulsion of worms by the intestines. Esquirol 

 records two cases of this kind. It was also a 

 popular belief that it is more intimately connected 

 with disease of the abdominal viscera than the 

 thoracic, but this has been proved not to be the 

 fact. In 168 cases Esquirol found only two cases 

 of liver-complaint, whilst in the same number he 

 found sixty-five cases of disease of the lungs, and 

 he is disposed to believe that insanity is attended 

 by disease of the thoracic viscera in two cases out 

 of eight. To this opinion Georget is inclined, who 

 adds, that one-half of the lunatics who die at S;il- 

 petritire are cut off by phthisis. In some of those 

 patients it is rather curious that, where large ex- 

 cavations are found to exist after death, no expec- 

 toration took place during life. Greding found in 

 a hundred maniacs, forty affected with phthisis; 

 of the whole number, seventy-six had effusion into 

 one or other cavity of the thorax. 



In the Dutch States, the number of insane, from 

 1820 to 1825, was 4520. Guislain is disposed to 

 ascribe the increase of insanity to the positive aug- 

 mentation which has taken place in the population 

 since the war, by which the number may be aug- 

 mented in the ratio of the population. He agrees 

 with Sir A. Halliday, that though a temporary 

 augmentation may take place, from the pressure of 

 circumstances, there is no danger of its perma- 

 nently progressive increase. 



The returns afforded by the Prussian States, if 

 correct, should necessarily alarm us, but Jacobi, 

 who has had opportunities of judging of their 

 fidelity, attaches but little faith to them. The 

 proportion of lunatics there to the population, is 

 one in 666. 



Perhaps the best statistics are supplied by the 

 government of Norway. In 1825 returns were 

 ordered of the sex, age, situation, and "number of 

 insane. The report was drawn up by Dr Hoist, 

 and published in 1828. The lunatics are to the 

 population as one to 551. Here is a marked dif- 

 ference as compared with England and France. 

 The population of Norway is employed much in 

 agriculture and rearing cattle, embosomed in 

 mountains, and without any manufacturing towns. 

 These are to be taken into account in considering 

 the comparative state of insanity there, in com- 

 parison with other countries. 



From Spain we are without any satisfactory re- 

 turns, while we find the Italian States giving only 

 one in 4879. Here we find that, where insanity 

 is scarce, idiotism is always found to predominate, 

 more especially in Spain and Portugal. 



The statistics of insanity in the United States 

 of America are less complete than those of Eu- 

 rope. In many of the States nothing is known 

 upon the subject, no measures having as yet been 

 adopted to ascertain the number of the insane. A 

 few of the States have made some partial investi- ' 

 gations ; but the object of these has generally been 

 to ascertain if the insane were sufficiently nume- 

 rous, and their situation sufficiently necessitous, 

 to require the assistance of the state for their 

 support. That there was such a number, and 

 such want, has soon been ascertained, and then 

 further investigations ceased. A committee of 

 the legislature of the State of New York, ap- 

 pointed to examine this subject, reported in 1831, 



