20 



MEDI 



fmrtic*. they always depend upon some derangement of the 

 ,~^ brain, the instrument by which they are exercised, yet 

 their phenomena are so peculiar, and the relation which 

 exists between the corporeal and the intellectual part 

 of our frain.', is so ob-cure as to be altogether beyond 

 our comprehension, at the same time that the two 

 kinds of diseases require a totally different method of 

 treatment. This part of medicine has unfortunately 

 been much embarrassed, by the application of what has 

 been termed metaphysical reasoning, but which has in 

 fact consisted of the use of certain ill-defined and un- 

 meaning phrases; the effect of which has often been, 

 to produce the same confusion in the mind of the reader 

 which must have existed in that of the writer. Another, 

 and perhaps a still greater source of difficulty, in every 

 thing that respects the pathology of insanity, has arisen 

 from an unreasonable prejudice that has attached to 

 certain opinions respecting the nature of the intellectual 

 faculties, in consequence of their being supposed to be 

 adverse to religion and morals. Respecting the real 

 merits oT the doctrine of materialism, the one here al- 

 luded to, we do not pretend to decide ; but we consider 

 it a fair and legitimate object of philosophical inquiry, 

 and it is one which is intimately connected with any 

 hypothesis that we may form respecting the nature of 

 the human powers, and their relation to the external 

 world. It has not, however, any immediate or neces- 

 sary connexion with pathology ; for whatever may be 

 our opinion respecting the cause on which the faculties 

 ultimately depend, we know that they are always ex- 

 ercised through the intervention of the brain ; and with 

 respect to the subject of insanity, it becomes an impor- 

 tant practical question, whether the structural derange- 

 ment of this organ corresponds, or is proportional to the 

 mental disease. On this point, we are disposed to de- 

 cide in the negative; for although we are informed, 

 fivm high authority, that whenever the brain has been 

 accurately examined in cases of insanity, some disease 

 in its structure may be detected, we are of opinion, that 

 it frequently bears no proportion to the violence of the 

 complaint, while, on the contrary, we have equally nu- 

 merous cases of great destruction, or disorganization of 

 the brain, without a corresponding injury of the facul- 

 ties. 



Arrange- Insanity has been divided into different genera and 

 ment of species ; but we think it sufficient to consider it under 

 genera aiij two forms only that where the faculties are prevented, 

 k|*fcte.<. and that where they are, in a greater or less degree de- 

 stroyed ; the first constituting Mania, the latter Amen- 

 tia. Although the phenomena of Mania are familiar to 

 every one, both professional and unprofessional, yet 

 there is perhaps no disease which it is so difficult to de- 

 fine, and the existence of which it is often so difficult to 

 ascertain. The question of Insanity frequently comes 

 to be discussed in courts of law, and we perpetually ob- 

 serve men of the most acute discernment and extensive 

 information differ in their opinion upon particular cases 

 that are subjected to their judgment. This in fact de- 

 pends upon a circumstance, which may appear suffi- 

 ciently mortifying, that there are really no exact limits 

 by which insanity can be separated from that state of 

 mind which is deemed sufficiently sound to enable a 

 person to transact the usual affairs of life. The most 

 lamentable weakness of judgment, and the most singu- 

 lar perversion of the reasoning powers, unless exercised 

 . in a certain way, which is dangerous to the existence of 

 the patient, or those about him, pass by as not differing 

 from the condition of the rest of mankind except in de- 

 gree ; and it is frequently from some accidental circum- 

 *tance connected with it, that it acquires the name of 



CINE. 



disease, and subjects the patient to restraint and con- Practice, 

 finement. It is indeed usually more from the degree of v " 

 the affection than any thing specific in its nature, that 

 our judgment is ultimately formed, and rather by a de- 

 tailed history of the circumstances of the case, and by 

 comparing the present with the former state of the pa- 

 tient, than by any single diagnostic circumstance, that 

 we finally decide. 



There are several varieties of mental derangement Varieties. 

 which it is important to attend to ; the first and most 

 equivocal kind is that which consists in extreme caprice, 

 or irritability of temper, and is the most difficult to dis- 

 criminate from a sound state of the mind, as passing in- 

 to it by shades that are absolutely insensible. Another 

 variety is, where the disposition and habits undergo a 

 complete change, which is independent of external cir- 

 cumstances, or of moral causes ; a state that is often 

 characterized by the mind becoming exclusively devot- 

 ed to some one object, which is at one time of the most 

 important, and at another of the most trifling nature, 

 but still not decidedly beyond the limits of what may 

 be considered as the result of rational deduction. From 

 these we proceed to that variety of the disease where 

 there is a complete perversion on one or two points, 

 while on every other subject the mind retains its full 

 powers ; and from this we glide insensibly into that de- 

 plorable condition of the human nature, where the un- 

 derstanding is entirely deranged where the individual 

 is unconscious of the effect of his actions, and almost 

 insensible to the impressions of surrounding objects 

 upon the organs of sense. 



Besides the difficulty which so frequently exists re- Manage- 

 specting the actual presence of the disease, other equal- ment - 

 ly embarrassing points come under the cognizance of 

 the physician. The first of these respects the question, 

 whether the state of the patient requires his being re- 

 moved from his friends, and whether the symptoms 

 are such as to render him a proper inmate of a public 

 asylum. As a general rule, we conceive it to be clear- 

 ly established, that the patient is always best managed 

 by those whose business it is to take care of the in- 

 sane ; and in a great majority of instances it seems 

 that recovery is more promoted by the patient being 

 removed from his accustomed abode, than by any plan 

 which can be pursued, while he is surrounded by the 

 scenes with which he had been previously familiar. 

 The unpleasant association which must attach to a re- 

 sidence in a lunatic asylum is no doubt an objection to 

 the removal, and formerly, while these institutions 

 were regarded rather as places for coercion than for 

 medical treatment, every one must have felt anxious to 

 avoid the painful necessity of subjecting a friend or a 

 relation to their cruel discipline. The enlightened 

 spirit of the present age has, however, happily reform- 

 ed the greatest part, if not the whole, of this system, 

 and has thus not only rescued a large portion of our 

 fellow-creatures from unmerited suffering, but has 

 afforded them the prospect of a restoration to the bless- 

 ings of health and the comforts of society. 



In this brief sketch, we shall not enter into any de- t'ure, 

 tail respecting the means of curing insanity. One of 

 our first objects must be to inquire into the exciting 

 cause, and if possible to remove it; we are next to 

 examine the condition of the system generally, and of 

 the circulation in particular, whether there be any de- 

 viation from the healthy state, which we may have it 

 in our power to relieve. Beyond this we have perhaps 

 no general principles on which to proceed. The diges- 

 tive organs are always to be carefully attended to, and 

 in females we are minutely to watch the state of the 



