Part 12

There is no statement of this case on record; but I have been informed, it was the consequence of injury on the head. He is a hopeless, and the most striking, case of idiotcy, at present in the house: a poor, simple, innocent, dangling, pouting, starved-looking creature, with a bluish red nose, and his head hanging forwards, saliva running over his falling lip—generally moving about to gratify his childish curiosity. Yet, as little mind as there is about him, still even he has fluctuations of the animal spirits: sometimes he is depressed and miserable; at other times he is animated and happy. When depressed, he for the most part repeats, in a feeble, plaintive tone,—“poor creature.” When animated and happy, he will throw his arms about in a most laughable manner, to the great amusement of other patients; so much so, that it is impossible to convey any conception of it, unless it be by making an old person try to imitate the frisky movements of an infant’s arms. These exhibitions are of rare occurrence. He will mumble over a tune very correctly, {121a} but has seldom any words. He is pleased with striking objects, particularly such as have glaring colours about them; and women, or their dress, arrest his attention. {121b}

No. 5.—Admitted 1791.

There is likewise no statement of this case on record, from which any satisfactory information can be drawn.

His personal appearance, and moping manners, were so very like the case described, No. 2, that it was common for those in the house to mistake the one for the other. He, like many other old and incurable cases, sat in a solitary, half-dozing state, his head reclining against the fire-guard, and seemed, when roused, like one who wakened out of his sleep unrefreshed. He was most remarkable for his extreme good nature, and excellent disposition. {122a} When on his death-bed, his gratitude and affection to his attendant (who was certainly an excellent nurse) were very pleasing. He had been long sinking from disease of the lungs, constantly coughing and spitting; and, latterly, purulent matter, in a very great quantity. He died on the 13th April, 1822.

No. 6.—Admitted 1791.

There is no statement of his case, and I have not been able to collect much information about him. It is said, he received a severe wound, and the mark remains on the upper back part of his head. {122b} Report says, that he fancied himself in love with a farmer’s daughter, and walked whole nights before her father’s door, without the slightest previous acquaintance with the object of his choice. This would seem rather the effect than the cause—a common mistake; they are constantly confounded together, or mistaken for each other. It is certain, that his neighbours were obliged to send him to a place of confinement, for this reason—whenever he saw any cattle in a poor pasture, he, from the impulse of his nature, invariably removed them into a better.

He is well known through the house, and even through the town; and on this account, I feel some hesitation and difficulty in attempting to describe his case.

He is a general favourite, and every one meets him, and he meets every one, with a welcome, good-natured smile, and he appears so much pleased to entertain them with some extraordinary ridiculous tale, that a stranger would suppose he talked absurdly, on purpose to amuse him. {123} Notwithstanding all his talk, he is most industrious, and the most useful man in the house; does his work most correctly and systematically; delights in going upon errands amongst his acquaintances in town, always delivering the messages properly; and the moment he has done so, begins with his own strange nonsense, to the great delight of his hearers. His spirits are always even, he has regular exercise, and his good nature is proverbial; nothing vexes him, unless it be, threatening that another shall be employed instead of him, to do the work he has been in the habit of doing for his favourites in the house.—His delight is, night or day, to be of service to others, so that his energies are wholly and regularly expended in being useful, making himself happy, and pleasing all who come near him.

OBSERVATION IV.

Probably his astonishing correctness in delivering messages, &c., in the midst of so much apparent confusion of mind, may be thus explained:—From the pre-eminence of his good nature, the desire to please still retains some hold over the rest of his faculties, and, perhaps, also over the extreme extravagance of his conversation, which may arise from the same cause. We have only to imagine, that his erroneous tales were, in the first instance, listened to (a fact, this, of injudicious treatment, which is too common,) with seeming assent and delight, until he found, from daily experience, that to please others, he had only to encourage his foolish thoughts, and utter them, and then the habit would insensibly grow upon him, until it became inveterate; and hence is explained another singularity about him,—that in his present manner of talking, it appears as if he were talking absurdly for the very purpose of amusing others. It is now, however, certain, that it would be not only useless, but cruel, to try, by direct means, to prevent it. Yet, though we are not to tease and vex him, by contradiction, or by refusing to listen to his tales; it ought to be remembered, that in this and all other cases, we ought never, on any account, to violate the truth.

Though we should never forget to exercise prudence, we must be careful that truth still presides at the helm, otherwise it may degenerate into cunning; then what we call prudence, is vicious and mischievous; and yet, men persuade themselves while doing so, that some evil is avoided, or some good is secured. No power of the mind should ever be so exercised, as to require the suspension or sacrifice of another. To exercise every virtue in its place, and to give to each “its relative and appropriate share,” is the perfection at which we should ever aim. This principle, as it is the best prevention, so also it is the best remedy in the cure, of insanity.

No. 7.—Admitted 1792.

No statement of this case, from which any information can be drawn: it is, however, certain, that insanity is in the family.

Among the old cases, we have none that arrests the attention of strangers so much as this, and he never fails to attract the gaze of idle curiosity. His habits of circumgyration, with sudden stops and starts,—his strange air of abstractedness, a sort of excogitative look, apparently puzzled to find something out,—odd way of talking to himself, as if he himself were some other person, saying, “what a noise the fellow makes,” “I think the fellow’s a fool,” and striking his face in apparent anger,—strange mode of mentioning names once familiar to him,—putting a question,—seeming to listen, and giving an answer quite foreign to it, are most striking, and such as no descriptive powers can enable another to conceive, without seeing him. When noticed or teased, and sometimes without, he strikes and scratches, in a way that would seem either like a bad habit that had been taught him; or half frolic and half mischief, and which, by provocation, becomes more serious; otherwise, he is sensible of kind treatment; and now, from increasing age, and perhaps from being, on the whole, less teased, he exhibits less of this disposition. This state of continued exertion and restlessness, is followed by a proportional degree of depression, and, after being recruited by sleep, returns. These regular alternate states of excitement and restlessness, of depression and sleep, last each for several days, and this for many years’ duration. When most excited, he makes a strange loud singing noise, stamps with his feet, strikes his head and face, and exhibits various incommunicable indications of surprise, pleasure, or anger, just as his mind happens to be agitated, like one in a dream, with the floating and shattered images of times gone by, passing confusedly through his mind.

OBSERVATION V.

I am unable to ascertain, from any traditionary treatment of this case, whether the habit of gyration originated in some diseased imagination; or was merely, as I believe is more frequently the case, a habit which he had acquired from long confinement in a small space. This habit was common in former times, when they were confined in cells, and had no airing grounds; and yet some writers, without attending to this circumstance, have called it a symptom common to insanity! in this way, many things have been called symptoms, which have been, in fact, indications of improper treatment. The peculiar states of excitement and depression, so striking in this case, and which is so common with the old insane, as to have been called the chronic type of the incurable, I shall endeavour to show, how, in many instances, it may be explained on a different principle.

Dr. Halloran, in his practical observations on Insanity, says,—“Chronic insanity is that form of the disease, which, having passed through the acute and convalescent stages, has assumed the more permanent character, and is known by the frequent exacerbation of the original accession; also, finally, under circumstances of less violence, and with symptoms subacute in relation to the primary affection.” He adds,—“There are few Practioners of the most ordinary discernment, who will not feel themselves disposed to acknowledge that cases of insanity, precisely of this form, compose the greater majority of those committed to their care.” He further says,—“That these paroxysms are for the most part periodical in their approach; for though of shorter duration, they continue pertinaciously unyielding.”

From the observations which I have to suggest, it will be seen, that I conceive in some instances, in opposition to Dr. Halloran, and some others, that the chronic type, or the paroxysms of some of the permanently insane, are merely an exhibition of the irregular increase in the stock of their animal spirits, and not an exacerbation or new accession of the disease: and that even, in many cases, where the alternating changes of excitement and depression are most striking, I believe they first originated in those fluctuations of the animal spirits, common to all of us; in some instances, it is true, (and the case last described is one,) singularly modified, not merely by the state of mental alienation, but by circumstances connected with their confinement. Before, however, I endeavour to explain these singular modifications, it appears necessary to premise some observations on one of the causes which conspires to produce them, which cause is connected with the atmosphere.

But as I intend to devote an Essay on Atmospheric influence, I shall content myself with asserting, in the mean time, that there is some common cause, or causes, assigned either to atmospherical changes, or co-ordinate with these changes, affecting the animal spirits of the sane and the insane—of the healthy and diseased, (in all, the manifestation is according to individual state,) is generally, and indeed, I might perhaps say, universally admitted, that the fact will require no further proof, either to introduce or confirm its truth. There is then a certain periodicity in the excitement and depression of our spirits, as well as in all our diseases, mental or corporeal, so absolutely certain, that it must be the conjoined effect of some order in the operations of nature, and cannot be explained on the principle of accidental or apparent coincidence, by which credulous and superstitious minds are often deceived.

Though the artificial habits and constitutions of men must modify these influences, we still, notwithstanding, often perceive the effects are simultaneous in time, and sometimes that they preserve the same type, and as such artificial modifications do not exist in the same degree in the animal creation, especially in those undomesticated, on the contrary, these influences are so uniform on them, that the signs and symptoms of their presence are the barometers of rural life, it follows that these very modifications in men, when rightly perceived, are additional proofs of their being the effects of one cause.

Even in man the influence of seasons, climate, and all violent atmospherical changes, are so striking as to be admitted by all, because they are so powerful as to overwhelm all artificial counteracting modifications; but, as it regards all common and minor influences, even when the effect on the mass are coincident in time, they are in individuals so modified by the specific habits, the state of the health, and the peculiar state of mind, that they become so much disguised, and of course so much less obvious to common observation, that even some medical men will deny atmospherical influences altogether when held forth as objects of scientific investigation, and ridicule as fanciful the man who maintains a firm and well-grounded philosophical faith in them; this is most inconsistent, and is like admitting a clock may mark hours, but cannot mark minutes as they pass.—It is the child who has just discovered the use of the hour, but not of the minute hand, of a time-piece.

The philosopher knows that the unobserved and silent influence is the most important, and that the striking results are the mere indexes of its secret movements.

Let ignorance pretend to admire these striking results, and laugh at him who is anxious to discover the cause which produces them; he has incomparably more interest and pleasure, his eyes more open, and his understanding more exercised in these common facts, than other men, while yet he deems them as nothing compared to the end they serve; they are indeed interesting in themselves, but to him they are most interesting, because he considers them the means, but still only as the means, by which he obtains the noblest object which the light of his reason can discover—the discovery of those principles, or of that order of operation of the cause which produces them.

Medical libraries are full of books on the influence of seasons and climate, miasmata, malaria, and other local causes of disease: and they admit also that the influences of all these are such, that almost all diseases common to man will exhibit altered and corresponding symptoms under these varying circumstances, proving they participate in, and are conjoined (or “tinged as it were,” as it is said by some,) with them.

All this, however, I leave for the Essay on the Atmosphere, but I mention these facts and observations in the mean time for the sake of this argument, that if all these modifications are admitted to exist among the sane, how much more strikingly must the peculiar circumstances, the singular habits, and the altered state of mind of the insane, modify the effects of this influence:—so strikingly, that I have no doubt, from these causes, may be explained the very singular exhibitions in this last-mentioned case. Where the particular state of mind, and the peculiar circumstances connected with his confinement, have superinduced in the system the irregular accumulation and expenditure of the nervous energy, so that, though the increase of the animal spirits was, in the first instance, the common effect of a cause operating in and through all, every where,—yet, operating through, and modified by, the peculiarities connected with his case, has in time produced in him, as well as in a less striking degree in others, and in fact, in many, though certainly not in all cases of insanity, effects so very singular and striking.

Again, these changes of the atmosphere, which produce these effects on the sane, seem, on the insane, in many cases, to be wholly expended in producing fluctuations on the animal spirits (not in bodily effects,) so expended, as if this increase of the vital energies were neither subject to the usual laws of corporeal nor intellectual distribution. These insane, consequently, are less subject to disease from these causes, as if they, no longer responsible, paid not, therefore, the price of the use and abuse of the energies continually imparted to all. It is true, that the life they lead, not only removes them from many causes of disease, but the very nature of their diseased state, also, renders the mind more susceptible of impressions, for, beside their excited state, by being shut out from the world, they necessarily give to trifles all the importance of weightier matters, and thus it is, that by their being the victims of mental excitement, {133a} which is every where a protection against prevailing diseases, they are not so liable to be attacked by the prevailing epidemics. {133b}

Whatever influences prevail externally, they must in all cases, sane and insane, be counteracted and modified by internal influences.

But to enter upon this investigation is not at present my intention, therefore I shall not now examine the question, whether the epidemics of different times, and the character of all diseases, which always partake, more or less, of the prevailing epidemic, can be wholly {134} explained as being caused by some difference in the prevailing state of the weather. I shall only remark that it is certain such seasons and states of the weather are equally fruitful in the production of insanity and in the excitement of those already insane. Yet, from these internal mental or moral influences, it is evident that neither insanity nor epidemic diseases can prevail exactly in proportion to the state of the weather, unless it could be proved there always existed a correspondence between the state of the weather and the moral and physical susceptibilities or predisposition of the persons exposed to its influence.