Part 31

On this most important subject I feel much gratification in quoting the following opinion of the experienced Pinel: "It appears in general that the primitive seat of insanity is in the region of the stomach and intestinal canal, and it is from this central part that mental aberration is propagated as by irradiation." Esquirol is of opinion that insanity arises from a lesion of the vital functions of the brain, and not unfrequently from a disturbance in the various points of sensibility in different parts of the system.

That mental emotions, whether producing any alteration in the physical condition of the individual, or not, occasion various degrees of insanity, is proved by experience. The French revolution, during its execrable phases, offered a wide and fertile field of observation on this subject; and the various events that marked those fearful times were certainly well calculated to affect any brain capable of becoming deranged. The following results of these observations are curious: "Among the lunatics confined at Bicetre," says Pinel, "during the third year of the Republic, I observed that the exciting causes of their maladies, in a great majority of cases, were extremely vivid affections of the mind; such as ungovernable or disappointed ambition, religious fanaticism, profound chagrin, and unfortunate love. Out of one hundred and thirteen madmen with whose history I took pains to make myself acquainted, thirty-four were reduced to this state by domestic misfortunes, twenty-four by obstacles to matrimonial union, thirty by political events, and twenty-five by religious fanaticism. Those were chiefly affected who belonged to professions in which the imagination is unceasingly or ardently engaged, and not controlled in its excitement by the exercise of the tamer functions of the understanding, which are more susceptible of satiety and fatigue. Hence the Bicetre registers were chiefly filled from the professions of priests, artists, painters, sculptors, poets, and musicians, while they contained no instances of persons whose line of life demands a predominant exercise of the judging faculty,--not one naturalist, physician, chemist, or geometrician."

The following is a return of the supposed moral causes of insanity observed in the Salpetriere. In the years 1811 and 1812

Domestic affliction 105 Disappointed love 46 Political events 14 Fanaticism 8 Fright 38 Jealousy 18 Anger 16 Misfortunes in circumstances 77 Offended vanity 1 --- Total 323

In Mr. Esquirol's private establishment during the same period:

Domestic affliction 31 Disappointed love 25 Political events 32 Fanaticism 1 Fright 8 Jealousy 14 Misfortunes 14 Offended vanity 16 Baffled ambition 12 Intense study 13 Misanthropy 2 --- Total 168

It must be observed that the latter return, in which we find twenty-eight persons maddened by disappointed ambition and offended pride, is of a private establishment, whose inmates of course belonged to the better classes of the community.

By the return from Pennsylvania, out of fifty lunatics, thirty-four cases arose from moral causes. Of physical causes hereditary madness is the most prevalent, as appears clearly from the following table extracted from the registers of the Salpetriere.

Hereditary insanity 105 Convulsion during gestation 11 Epilepsy 11 Female derangements 55 Diseases of child-birth 52 Critical periods 27 Old age 60 Insolation 12 Injuries of the head 14 Fever 13 Syphilis 8 Effects of mercury 14 Worms 24 Apoplexy 60

When speaking of hereditary madness, Dr. Abercrombie is of opinion that where a tendency to insanity exists, there may be in many cases, circumstances in mental habits or mental discipline calculated to favour or to counteract the tendency, when the mind wanders away from the proper duties of life or luxuriates amid scenes of imagination, thus permitting mental emotions, of whatever kind, to be excited in a manner disproportional to the true relation of the object which gave rise to them; allowing the mind to ramble among imaginary events, or to be led away by slight and casual relations, instead of steadily exercising the judgment in the investigation of truth.

These observations are no doubt most luminous, yet as I have elsewhere remarked, hereditary predisposition to insanity may be brought into action, by the constant scenes that pass in the presence of those individuals who may daily have to witness the aberrations of an unhappy relative. The mind dwells on the sad subject, and it becomes a source of constant apprehension, when the mere dread of an hereditary evil is perhaps sufficient to drive to madness. So powerful is the sway even of imaginary terror, that we need not wonder that natural fear should be productive of results still more injurious to our intellects. There seems to exist a certain fascination in what we should dread and avoid; instead of resisting evil, by a strange fatality we seem to be self-impelled to court it. We indulge in thoughts, in hopes and fears, too often chimerical, instead of endeavouring to dismiss them from our mind, by other pursuits and busy occupation; and we brood upon future and ideal miseries until we actually, from supineness and timidity, sink under their overwhelming influence.

Esquirol relates some curious coincidences of hereditary insanity. A Swiss merchant lost both his sons in a state of mania at the age of 19. A lady lost her senses after childbirth at the age of 25. Her daughter became insane in her 25th year. In one family, the grandfather, the father, and the son, destroyed themselves at the age of 50. Near Newton, seven insane sisters had been observed in one family. An unfortunate female in the Salpetriere, under the influence of liquor, threw herself three times in the river and her sister in a state of intoxication drowned herself. A gentleman whose intellects became deranged in consequence of the misfortunes of the revolution remained for ten years secluded in his chamber. His daughter became insane about the same period, and with equal obstinacy could not be prevailed upon to leave her room.

There is no doubt, but that were these early predispositions attended to and watched, an active course of education adopted, and change of locality resorted to, much future misery might be avoided, and possibly the invasion of the malady arrested.

If the observations of the phrenologist are entitled to consideration, the mind may become mainly instrumental in attaining this desideratum, as the detection of certain propensities may place us upon our guard in the education of youth. This would be a point of still greater importance, were these organs innate, dooming us to the blind law of fatality; but the phrenologists maintain, that the development of these organic inequalities on the surface of the cranium are produced and developed by a corresponding enlargement of the brain, which is greater or lesser in the ratio of the preponderance of the organ as the indulgence in the propensities which they indicate.

Pinel relates a curious case of hereditary mania in a man who, up to the age of fifty, fulfilled with intelligence and activity the duties of an important office which he held. At this period he indulged in various excesses, and sunk in the debasement of the lowest society. These excesses he represented to his wondering friends and acquaintances as the source of divine pleasure and celestial enjoyment. He declared that he would erect a temple to the god of love, and officiate himself as high priest at his altars; he compared the very lowest of women to angelic creatures; and finally was confined, a furious and desperate maniac.

Education carried on upon mistaken principles has also been known to prepare the way to insanity, and La Bruyere has justly observed, that there are parents, the study of whose life appears to have been, their giving their children just reason not to regret their loss. Pinel has given us the interesting history of two orphan brothers, who had been brought up in a most anomalous manner--with extreme kindness and effeminacy by a nurse, and with much harshness and injustice by a tutor. The result of this erroneous management was a deficient development in their intellectual faculties, and a debilitated frame, which gradually led to a state of imbecility. When examined by Pinel at the age of twenty and twenty-two, their conversation was puerile in the extreme, and they both displayed a taste for infantile sports and pastimes, befitting children of three or four years old. They sought to express themselves with great volubility, but their language, consisting chiefly of broken syllables, was scarcely intelligible. Notwithstanding their apathic appearance, by a sort of automatic habit, every evening brought on an absurd scene of sentimentality. They would join each other in earnest conversation in a corner of the room; and, with bitter tears and deep sighs, bewail the loss of their parents, who had thus left them in a helpless orphan condition, in their tender years, expressing the sincerest affection for their nurse, but speaking of their tutor with bitter imprecations. A great partiality shown to one sister has driven another one to a state of dementia, that arose from her continually dwelling on the wrongs she experienced, which, of course, were exaggerated by jealousy.

External agents producing sudden terror have been frequently known to bring on insanity. It is related of a child of three years of age, who was so terrified on being brought into a madhouse, that he was subject to horrible dreams and visions until his seventeenth year, when he became a perfect lunatic. Women frightened during pregnancy have often become alienated; and there are two cases reported of young ladies who were found insane the day after their nuptials.

While disappointments and misfortunes are often the origin of insanity, a sudden melioration in circumstances, and unexpected pleasing intelligence have been also known to derange the intellects. A man who came into the possession of a large fortune, after having lived for many years in penury, was so alarmed at the thought of losing this property, that the apprehension of the evil deprived him of his senses. An instance is recorded of a young girl, long separated from her lover by parents averse to their union, who became insane immediately after her marriage.

Children are generally exempted from this calamitous visitation; yet Frank relates the case of a child at St. Luke's who had been deranged since he was two years old. Age, to a certain extent, seems to influence insanity, and most individuals are alienated between their twentieth and fiftieth years. Haslam states, that out of one thousand six hundred and sixty-four patients admitted into Bedlam, nine hundred and ten came within this period of life. In France it appears that most cases of insanity are noticed between the ages of twenty-five and thirty-five. One-fifteenth of these cases among men, and one-sixth among women, are observed before their twentieth year; and in the wealthy classes of society one-fourth occur before the same period. The following table from Bicetre regarding age is not without interest.

Years. Aged 15 20 30 40 50 60 Total. ------------------------------------------- 1784 ... 5 33 31 24 11 6 110 1785 ... 4 29 49 25 14 3 124 1786 ... 4 31 40 32 15 5 127 1787 ... 12 39 41 26 17 7 142 1788 ... 9 43 53 21 18 7 151 1789 ... 6 38 39 33 14 2 132 1790 ... 6 28 34 19 9 7 103 1791 ... 9 26 32 16 7 3 93 1792 ... 6 26 33 18 12 3 98 1793 ... 4 36 28 22 13 10 113 ---------------------------- Total 65 329 380 236 130 53 1193

Thus it would appear that the astounding events which took place in France, but more especially in Paris, from the year 1789, the breaking out of the revolution, to 1793, the reign of terror, had no effect upon the intellects of the population; unless it is supposed that the entire nation being in a state of insanity, either madmen were not noticed as any peculiarity, or rushed into mischief and were murdered. This observation as to the influence of public events is confirmed by the following statement of admissions in the Salpetriere during the comparatively tranquil years of 1811, 1812, 1813, and 1814, although many cases of insanity were said to have arisen from the harsh laws of the conscription.

Years. Aged 20 25 30 35 40 50 60 70 80 Total. ------------------------------------------------------ 1811 ... 34 37 38 27 48 38 24 12 4 262 1812 ... 52 34 33 18 38 57 26 19 3 280 1813 ... 43 29 33 41 32 57 31 13 6 285 1814 ... 42 35 38 31 26 53 34 22 10 291 ---------------------------------------- Total 171 135 142 117 144 205 115 66 23 1118

Therefore one might fairly conclude that the taking of the Bastille, the execution of Louis XVI., the bloody sway of the Jacobins, the ambitious wars of Napoleon, and the restoration of Louis XVIII., did not in the slightest degree affect the brains of our happy and philosophical neighbours.

It has been generally imagined that women are more subject to mental alienation than men; this, however, is by no means proved by observation in other countries, as will appear by the following calculation:

Men. Women. 1756 Marseilles 50 49 1786 Paris 500 509 1786-1794 Bedlam 4992 882 1807 St. Luke's 110 153 1802 Paris 1 to 2 ---- Berlin 1 to 2 ---- Vienna 117 94 ---- Pennsylvania 2 to 1 1807-1812 Various Madhouses in France 488 700 1802-1814 Mr. Esquirol's establishment 191 144 ---- ---- Total 6452 6536

In the Lunatic Asylum of Hanwell I have now under my care 265 males, and 351 females.

It has long been a current opinion that madness is a more common disease in our country than any where else. This may possibly arise from the greater number of our eccentric countrymen that are widely scattered over the globe; and whenever an individual is observed whose manners and conduct are totally at variance with the habits of any other member of the community, he is generally considered an Englishman. Voltaire came to the sweeping conclusion that one half of the nation was scrofulous, and the other moiety insane.

However, it would appear that insanity is on the increase; for in the report of the commissioners for licensing lunatic establishments we find the following statement: "Insanity appears to have been considerably on the increase; for if we compare the sums of two distant lustra, the one beginning with 1775, and the other ending with 1809, the proportion of patients returned as having been received into lunatic asylums during the latter period, is to that of the former nearly as one hundred and twenty-nine to one hundred." Dr. Burrows has endeavoured to impugn the correctness of this statement by proving that suicide is more frequent in other countries; now, unless Dr. Burrows can prove that suicide is always an act of insanity, which will by no means be admitted, his observation can bear no weight.