SYMPTOMS OF THE DISEASE.

On this part of the subject, authors have commonly descended to minute particularities, and studied discriminations. Distinctions have been created, rather from the peculiar turn of the patient’s propensities and discourse, than from any marked difference in the varieties and species of the disorder. Every person of sound mind, possesses something peculiar to himself, which distinguishes him from others, and constitutes his idiosyncrasy of body and individuality of character: in the same manner, every lunatic discovers something singular in his aberrations from sanity of intellect. It is not my intention to record these splintered subdivisions, but to exhibit the prominent features, by which insanity may be detected, as far as such appearances seem worthy of remark, and have been the subject of my own observation.

In most public hospitals, the first attack of diseases is seldom to be observed; and it might naturally be supposed, that there existed in Bethlem, similar impediments to an accurate knowledge of incipient madness. It is true, that all who are admitted into it, have been a greater, or less time afflicted with the disorder; yet from the occasional relapses to which insane persons are subject, we have frequent and sufficient opportunities of observing the beginning, and tracing the progress of this disease.

Among the incurables, there are some, who have intervals of perfect soundness of mind; but who are subject to relapses, which would render it improper, and even dangerous, to trust them at large in society: and with those, who are upon the curable establishment, a recurrence of the malady very frequently takes place. Upon these occasions, there is an ample scope for observing the first attack of the disease.

On the approach of mania, they first become uneasy,[5] are incapable of confining their attention, and neglect any employment to which they have been accustomed; they get but little sleep, they are loquacious, and disposed to harangue, and decide promptly, and positively upon every subject that may be started. Soon after, they are divested of all restraint in the declaration of their opinions of those, with whom they are acquainted. Their friendships are expressed with fervency and extravagance; their enmities with intolerance and disgust. They now become impatient of contradiction, and scorn reproof. For supposed injuries, they are inclined to quarrel and fight with those about them. They have all the appearance of persons inebriated, and those who are unacquainted with the symptoms of approaching mania, generally suppose them to be in a state of intoxication. At length suspicion creeps in upon the mind, they are aware of plots, which had never been contrived, and detect motives that were never entertained. At last the succession of ideas is too rapid to be examined;[6] the mind becomes crouded with thoughts, and confusion ensues.

Those under the influence of the depressing passions, will exhibit a different train of symptoms. The countenance wears an anxious and gloomy aspect, and they are little disposed to speak. They retire from the company of those with whom they had formerly associated, seclude themselves in obscure places, or lie in bed the greatest part of their time. Frequently they will keep their eyes fixed to some object for hours together, or continue them an equal time “bent on vacuity.” They next become fearful, and conceive a thousand fancies: often recur to some immoral act which they have committed, or imagine themselves guilty of crimes which they never perpetrated: believe that God has abandoned them, and, with trembling, await his punishment. Frequently they become desperate, and endeavour by their own hands to terminate an existence, which appears to be an afflicting and hateful incumbrance.

Madmen, do not always continue in the same furious or depressed states: the maniacal paroxysm abates of its violence, and some beams of hope, occasionally cheer the despondency of the melancholic patients. We have in the hospital some unfortunate persons, who are obliged to be secured the greater part of their time, but who now and then become calm, and to a certain degree rational: upon such occasions, they are allowed a greater range, and are admitted to associate with the others. In some instances the degree of rationality is more considerable; they conduct themselves with propriety, and in a short conversation will appear sensible and coherent. Such remission has been generally termed a lucid interval.

When medical persons are called upon to attend a commission of lunacy, they are always asked, whether the patient has had a lucid interval? A term of such latitude as interval, requires to be explained in the most perspicuous and accurate manner. [The circumstances which probably occasioned the employment of this term are pointed out in the chapter which enumerates the causes of insanity.] In common language, it is made to signify both a moment and a number of years, consequently it does not comprize any stated time. The term lucid interval is therefore relative. As the law requires a precise developement of opinion, I should define a lucid interval to be a complete recovery of the patient’s intellects, ascertained by repeated examinations of his conversation, and by constant observation of his conduct, for a time sufficient to enable the superintendant to form a correct judgment. Unthinking people, are frequently led to conclude, that if, during a short conversation, a person under confinement shall bewray nothing absurd or incorrect, he is well, and often remonstrate on the injustice of secluding him from the world. Even in common society, there are many persons whom we never suspect, from a few trifling topics of discourse, to be shallow minded; but, if we start a subject, and wish to discuss it through all its ramifications and dependancies, we find them incapable of pursuing a connected chain of reasoning. In the same manner insane people will often, for a short time, conduct themselves, both in conversation and behaviour, with such propriety, that they appear to have the just exercise and direction of their faculties: but let the examiner protract the discourse until the favourite subject shall have got afloat in the mad man’s brain, and he will be convinced of the hastiness of his decision. To those unaccustomed to insane people, a few coherent sentences, or rational answers, would indicate a lucid interval, because they discovered no madness; but he, who is in possession of the peculiar turn of the patient’s thoughts, might lead him to disclose them, or by a continuance of the conversation, they would spontaneously break forth. A beautiful illustration of this is contained in the Rasselas of Dr. Johnson, where the astronomer is admired as a person of sound intellect and great acquirements by Imlac, who is himself a philosopher, and a man of the world. His intercourse with the astronomer is frequent; and he always finds in his society information and delight. At length he receives Imlac into the most unbounded confidence, and imparts to him the momentous secret. “Hear, Imlac, what thou wilt not, without difficulty, credit. I have possessed, for five years, the regulation of weather, and the distribution of the seasons. The Sun has listened to my dictates, and passed from tropic to tropic by my direction. The clouds, at my call, have poured their waters, and the Nile has overflowed at my command. I have restrained the rage of the Dog-star, and mitigated the fervours of the Crab. The winds alone, of all the elemental powers, have hitherto refused my authority; and multitudes have perished by equinoctial tempests, which I found myself unable to prohibit or restrain. I have administered this great office with exact justice, and made to the different nations of the earth an impartial dividend of rain and sunshine. What must have been the misery of half the globe, if I had limited the clouds to particular regions, or confined the Sun to either side of the Equator?”

A real case came under my observation some years ago, and which is equally apposite to the subject. A young man had become insane from habitual intoxication; and, during the violence of his disorder, had attempted to destroy himself. Under a supposed imputation of having unnatural propensities, he had amputated his penis, with a view of precluding any future insinuations of that nature. For many months, after he was admitted into the hospital, he continued in a state which obliged him to be strictly confined, as he constantly meditated his own destruction. On a sudden, he became apparently well, was highly sensible of the delusion under which he had laboured, and conversed, as any other person, upon the ordinary topics of discourse. There was, however, something in the reserve of his manner, and peculiarity of his look, which persuaded me he was not well, although no incoherence could be detected in his conversation. I had observed him for some days to walk rather lame, and once or twice had noticed him sitting with his shoes off, rubbing his feet. On enquiring into the motives of his doing so, he replied, that his feet were blistered, and wished that some remedy might be applied to remove the vesications. When I requested to look at his feet, he declined it, and prevaricated, saying, that they were only tender and uncomfortable. In a few days afterwards, he assured me they were perfectly well. The next evening I observed him, unperceived, still rubbing his feet, and then peremptorily insisted on examining them. They were quite free from any disorder. He now told me, with some embarrassment, that he wished much for a confidential friend, to whom he might impart a secret of importance; upon assuring him that he might trust me, he said, that the boards on which he walked, (the second story) were heated by subterraneous fires, under the direction of invisible and malicious agents, whose intentions, he was well convinced, were to consume him by degrees.

From these considerations, I am inclined to think, that a lucid interval includes all the circumstances, which I have enumerated in my definition of it. If the person, who is to examine the state of the patient’s mind, be unacquainted with his peculiar opinions, he may be easily deceived, because, wanting this information, he will have no clue to direct his enquiries, and madmen do not always, nor immediately intrude their incoherent notions: they have sometimes such a high degree of control over their minds, that when they have any particular purpose to carry, they will affect to renounce those opinions, which shall have been judged inconsistent: and it is well known, that they have often dissembled their resentment, until a favourable opportunity has occurred of gratifying their revenge.

Of this restraint, which madmen have sometimes the power of imposing on their opinions, the remark has been so frequent, that those who are more immediately about their persons, have termed it, in their rude phrase, stifling the disorder.

Among the numerous instances of this cunning and dissimulation, which I have witnessed in insane persons, the relation of one case will be sufficient to exemplify the subject.

An Essex farmer, about the middle age, had on one occasion so completely masked his disorder, that I was induced to suppose him well, when he was quite otherwise. He had not been at home many hours, before his derangement was discernable by all those, who came to congratulate him on the recovery of his reason. His impetuosity, and mischievous disposition daily increasing, he was sent to a private mad-house; there being, at that time, no vacancy in the hospital. Almost from the moment of his confinement he became tranquil, and orderly, but remonstrated on the injustice of his seclusion.

Having once deceived me, he wished much, that my opinion should be taken respecting the state of his intellects, and assured his friends that he would submit to my determination. I had taken care to be well prepared for this interview, by obtaining an accurate account of the manner in which he had conducted himself. At this examination, he managed himself with admirable address. He spoke of the treatment he had received, from the persons under whose care he was then placed, as most kind and fatherly: he also expressed himself as particularly fortunate in being under my care, and bestowed many handsome compliments on my skill in treating this disorder, and expatiated on my sagacity in perceiving the slightest tinges of insanity. When I wished him to explain certain parts of his conduct, and particularly some extravagant opinions, respecting certain persons and circumstances, he disclaimed all knowledge of such circumstances, and felt himself hurt, that my mind should have been poisoned so much to his prejudice. He displayed equal subtilty on three other occasions when I visited him; although by protracting the conversation, he let fall sufficient to satisfy my mind that he was a mad-man. In a short time he was removed to the hospital, where he expressed great satisfaction in being under my inspection. The private mad-house, which he had formerly so much commended, now became the subject of severe animadversion; he said that he had there been treated with extreme cruelty; that he had been nearly starved, and eaten up by vermin of various descriptions. On enquiring of some convalescent patients, I found (as I had suspected) that I was as much the subject of abuse, when absent, as any of his supposed enemies; although to my face his behaviour was courteous and respectful. More than a month had elapsed, since his admission into the hospital, before he pressed me for my opinion; probably confiding in his address, and hoping to deceive me. At length he appealed to my decision, and urged the correctness of his conduct during confinement as an argument for his liberation. But when I informed him of circumstances he supposed me unacquainted with, and assured him, that he was a proper subject for the asylum where he then inhabited; he suddenly poured forth a torrent of abuse; talked in the most incoherent manner; insisted on the truth of what he had formerly denied; breathed vengeance against his family and friends, and became so outrageous that it was necessary to order him to be strictly confined. He continued in a state of unceasing fury for more than fifteen months.

As the memory, appears to be particularly defective in cases of insanity, it is much to be wished, that we possessed a correct history, and physiological account of this wonderful faculty. Unfortunately, this knowledge is not to be sought for with much prospect of attainment, from books which treat of the human mind and its philosophy; nor is the present work, to be considered as the depository of such information. A deliberate attention, to the precise order in which we acquire information on any subject; a consideration of the effects of its repetition; an investigation of the result (comparing it to a chain) whenever the links are separated, together with a knowledge of the contrivance of abbreviated signs, would perhaps render the matter sufficiently intelligible. But it would be necessary, thoroughly to understand the nature of the thing, of which the sign has been abbreviated: particularly, as the usual mode of education is satisfied with possessing the convenience of the abbreviation, without any inquiry into the nature of the thing, and the cause of the abbreviation of its sign. This faulty mode of instruction, has furnished us with a profusion of names, and left us ignorant of the things they represent.

Ben Johnson has afforded us the shortest, and probably, the best account of memory.

“Memory of all the powers of the mind, is the most delicate, and frail: It is the first of our faculties that age invades. Seneca, the Father, the Rhetorician, confesseth of himself, he had a miraculous one, not only to receive, but to hold. I myself could in my youth, have repeated all that ever I had made, and so continued till I was past forty: since it is much decayed in me. Yet I can repeat whole books that I have read, and Poems of some selected friends, which I have lik’d to charge my memory with. It was wont to be faithful to me, but shaken with Age now, and Sloth (which weakens the strongest abilities) it may perform somewhat, but cannot promise much. By exercise it is to be made better and serviceable. Whatsoever I pawn’d with it while I was young and a boy, it offers me readily, and without stops: but what I trust to it now, or have done of later years, it lays up more negligently, and sometimes loses; so that I receive mine own (though frequently called for) as if it were new and borrow’d. Nor do I always find presently from it what I do seek; but while I am doing another thing, that I laboured for will come: and what I sought with trouble, will offer itself when I am quiet. Now in some men I have found it as happy as nature, who, whatsoever they read or pen, they can say without book presently; as if they did then write in their mind. And it is more a wonder in such as have a swift stile, for their Memories are commonly slowest; such as torture their writings, and go into council for every word, must needs fix somewhat, and make it their own at last, though but through their own vexation.”—Discoveries, vol. vi. p. 240, 1716.

If in a chain of ideas, a number of the links are broken, or leaving out the metaphor, if there be an inability to recollect circumstances in the order, in which they occurred, the mind cannot possess any accurate information. When patients of this description are asked a question, they appear as if awakened from a sound sleep: they are searching, they know not where, for the proper materials of an answer, and, in the painful, and fruitless efforts of recollection, generally lose sight of the question itself. Shakespeare, the highest authority in every thing relating to the human mind and its affections, seems to be persuaded, that some defect of memory is necessary to constitute madness.

“It is not madnesse
That I have uttered: bring me to the test
And I the matter will re-word, which madnesse
Would gambol from.”—Hamlet, Act III. Scene 4.

In persons of sound mind, as well as in maniacs, the memory is the first power which decays; and there is something remarkable in the manner of its decline. The transactions of the latter part of life are feebly recollected, whilst the scenes of youth and of manhood, remain more strongly impressed. When I have listened to the conversations of the old incurable patients, the topic has generally turned upon the transactions of early days; and, on the circumstances of that period of life, they have frequently spoken with tolerable correctness. In many cases, where the mind has been injured by intemperance, the same withering of the recollection may be observed. It may, perhaps, arise from the mind at an early period of life, being most susceptible and retentive of impressions, and from a greater disposition to be pleased, with the objects which are presented: whereas, the cold caution, and fastidiousness with which age surveys the prospects of life, joined to the dulness of the senses, and the slight curiosity which prevails, will, in some degree, explain the difficulty of recalling the history of later transactions.

Insane people, who have been good scholars, after a long confinement, lose, in a wonderful degree, the correctness of orthography: when they write, above half the words are frequently mis-spelt, they are written according to the pronunciation. It shews how treacherous the memory is without reinforcement. The same necessity of a constant recruit, and frequent review of our ideas, satisfactorily explains, why a number of patients lapse nearly into a state of ideotism. These have, for some years, been the silent and gloomy inhabitants of the hospital, who have avoided conversation, and courted solitude; consequently have acquired no new ideas, and time has effaced the impression of those, formerly stamped on the mind. Mr. Locke, well observes, although he speaks figuratively, “that there seems to be a constant decay of all our ideas, even of those which are struck deepest, and in minds the most retentive; so that, if they be not sometimes renewed by repeated exercise of the senses, or reflection on those kind of objects, which at first occasioned them, the print wears out, and at last there remains nothing to be seen.”

Connected with loss of memory, there is a form of insanity which occurs in young persons; and, as far as these cases have been the subject of my observation, they have been more frequently noticed in females. Those whom I have seen, have been distinguished by prompt capacity and lively disposition: and in general have become the favourites of parents and tutors, by their facility in acquiring knowledge, and by a prematurity of attainment. This disorder commences, about, or shortly after, the period of menstruation, and in many instances has been unconnected with hereditary taint; as far as could be ascertained by minute enquiry. The attack is almost imperceptible; some months usually elapse, before it becomes the subject of particular notice; and fond relatives are frequently deceived by the hope that it is only an abatement of excessive vivacity, conducing to a prudent reserve, and steadiness of character. A degree of apparent thoughtfulness and inactivity precede, together with a diminution of the ordinary curiosity, concerning that which is passing before them; and they therefore neglect those objects and pursuits which formerly proved sources of delight and instruction. The sensibility appears to be considerably blunted; they do not bear the same affection towards their parents and relations; they become unfeeling to kindness, and careless of reproof. To their companions they shew a cold civility, but take no interest whatever in their concerns. If they read a book, they are unable to give any account of its contents: sometimes, with steadfast eyes, they will dwell for an hour on one page, and then turn over a number in a few minutes. It is very difficult to persuade them to write, which most readily develops their state of mind: much time is consumed and little produced. The subject is repeatedly begun, but they seldom advance beyond a sentence or two: the orthography becomes puzzling, and by endeavouring to adjust the spelling, the subject vanishes. As their apathy increases they are negligent of their dress, and inattentive to personal cleanliness. Frequently they seem to experience transient impulses of passion, but these have no source in sentiment; the tears, which trickle down at one time, are as unmeaning as the loud laugh which succeeds them; and it often happens that a momentary gust of anger, with its attendant invectives, ceases before the threat can be concluded. As the disorder increases, the urine and fÆces are passed without restraint, and from the indolence which accompanies it, they generally become corpulent. Thus in the interval between puberty and manhood, I have painfully witnessed this hopeless and degrading change, which in a short time has transformed the most promising and vigorous intellect into a slavering and bloated ideot.

Of the organs of sense, which become affected in those labouring under insanity, the ear, more particularly suffers. I scarcely recollect an instance of a lunatic becoming blind, but numbers are deaf. It is also certain that in these persons, more delusion is conveyed through the ear than the eye, or any of the other senses. Those who are not actually deaf, are troubled with difficulty of hearing, and tinnitus aurium. Thus an insane person shall suppose that he has received a commission from the Deity; that he has ordered him to make known his word, or to perform some act, as a manifestation of his will and power. It is however much to be regretted, that these divine commissions generally terminate in human mischief and calamity, and instances are not unfrequent, where these holy inspirations, have urged the unfortunate believer to strangle his wife, and attempt the butchery of his children. From this source may be explained, the numerous delusions of modern prophecies, which circumstantially relate the gossipings of angels, and record the hallucinations of feverish repose.

In consequence of some affection of the ear, the insane sometimes insist that malicious agents contrive to blow streams of infected air into this organ: others have conceived, by means of what they term hearkening wires and whiz-pipes, that various obscenities and blasphemies are forced into their minds; and it is not unusual for those who are in a desponding condition, to assert, that they distinctly hear the devil tempting them to self-destruction.

A considerable portion of the time of many lunatics, is passed in replies to something supposed to be uttered. As this is an increasing habit, so it may be considered as an unfavourable symptom, and at last the patient becomes so abstracted from surrounding objects, that the greater part of the day is consumed in giving answers to these supposed communications. It sometimes happens that the intelligence conveyed, is of a nature to provoke the mad-man, and on these occasions, he generally exercises his wrath on the nearest bystander; whom he supposes, in the hurry of his anger, to be the offending party.

In the soundest state of our faculties, we are more liable to be deceived by the ear, than through the medium of the other senses: a partial obstruction by wax, shall cause the person so affected, to hear the bubbling of water, the ringing of bells, or the sounds of musical instruments; and on some occasions, although the relation seems tinged with superstition, men of undeviating veracity, and of the highest attainments, have asserted, that they have heard themselves called. “He [Dr. Johnson] mentioned a thing as not unfrequent, of which I [Mr. Boswell] had never heard before—being called, that is, hearing one’s name pronounced by the voice of a known person at a great distance, far beyond the possibility of being reached by any sound, uttered by human organs. An acquaintance on whose veracity I can depend, told me, that walking home one evening to Kilmarnock, he heard himself called from a wood, by the voice of a brother who had gone to America; and the next packet brought account of that brother’s death. Macbean asserted that this inexplicable calling was a thing very well known. Dr. Johnson said, that one day at Oxford, as he was turning the key of his chamber, he heard his mother distinctly call Sam. She was then at Litchfield; but nothing ensued. This phÆnomenon is, I think, as wonderful as any other mysterious fact, which many people are very slow to believe, or rather, indeed, reject with an obstinate contempt.”—Boswell’s Life of Dr. Johnson, 4to. vol. ii. p. 384.

One of the most curious cases of this nature which has fallen under my observation, I shall here venture to relate, for the amusement of the reader. The patient was a well educated man, about the middle age; he always stopped his ears closely with wool, and, in addition to a flannel night-cap, usually slept with his head in a tin saucepan. Being asked the reason why he so fortified his head, he replied, “To prevent the intrusion of the sprites.” After having made particular enquiry concerning the nature of these beings, he gravely communicated the following information:—“Sir, you must know that in the human seminal fluid there are a number of vital particles, which being injected into the female, impregnate her, and form a foetus of muscles and bones. But this fluid has other properties, it is capable, by itself, of producing vitality under certain circumstances, and experienced chemists and hermetical philosophers have devised a method of employing it for other purposes, and some, the most detrimental to the condition and happiness of man. These philosophers, who are in league with princes, and their convenient and prostituted agents, contrive to extract a portion of their own semen, which they conserve in rum or brandy: these liquors having the power of holding for a considerable time the seminal fluid, and keeping its vitality uninjured. When these secret agents intend to perform any of their devilish experiments on a person, who is an object of suspicion to any of these potentates, they cunningly introduce themselves to his acquaintance, lull him to sleep by artificial means, and during his slumbers, infuse a portion of their seminal fluid (conserved in rum or brandy) into his ears.

“As the semen in the natural commerce with the woman, produces a child, so, having its vitality conserved by the spirit, it becomes capable of forming a sprite; a term, obviously derived from the spirit in which it had been infused. The ear is the most convenient nidus for hatching these vital particles of the semen. The effects produced on the individual, during the incubation of these seminal germs, are very disagreeable; they cause the blood to mount into the head, and produce considerable giddiness and confusion of thought. In a short time, they acquire the size of a pin’s head; and then they perforate the drum of the ear, which enables them to traverse the interior of the brain, and become acquainted with the hidden secrets of the person’s mind. During the time they are thus educated, they enlarge according to the natural laws of growth; they then take wing, and become invisible beings, and, from the strong ties of natural affection, assisted by the principle of attraction, they revert to the parent who afforded the semen, and communicate to him their surreptitious observations and intellectual gleanings. In this manner, I have been defrauded of discoveries which would have entitled me to opulence and distinction, and have lived to see others reap honours and emoluments, for speculations which were the genuine offsprings of my own brain.”

By some persons, madness has been considered as a state of mind analogous to dreaming: but an inference of this kind supposes us fully acquainted with the actual state, or condition of the mind in dreaming, and in madness. The whole question hinges on a knowledge of this state of mind, which I fear is still involved in obscurity. As it is not the object of the present work to discuss this curious question, the reader is referred to the fifth section of the first part of Mr. Dugald Stewart’s Elements of the Philosophy of the Human Mind, and to the note, o, at the end; he will also find the subject treated with considerable ingenuity in the eleventh section of Mr. Brown’s Observations on Zoonomia.

There is, however, a circumstance, which to my knowledge, has not been noticed by those who have treated on this subject, and which appears to establish a marked distinction between madness and dreaming. In madness, the delusion we experience is most frequently conveyed through the ear; in dreaming, the deception is commonly optical; we see much, and hear little; indeed dreaming, at least with myself, seems to be a species of intelligible pantomime, that does not require the aid of language to explain it. It is true, that some who have perfectly recovered from this disease, and who are persons of good understanding and liberal education, describe the state they were in, as resembling a dream: and when they have been told how long they were disordered, have been astonished that the time passed so rapidly away. But this only refers to that consciousness of delusion, which is admitted by the patient on his return to reason; in the same manner as the man awake, smiles at the incongruous images, and abrupt transitions of the preceding night. In neither condition, does the consciousness of delusion, establish any thing explanatory of the state of the mind.

In a description of madness, it would be blameable to omit a form of this disease which is commonly very intractable, and of the most alarming consequences; I mean, the insanity which arises from the habit of intoxication. All persons who have had any experience of this disease, readily allow that fermented liquors, taken to excess, are capable of producing mental derangement: but the medical practitioner has in such cases, to contend, and generally without effect, with popular prejudice, and sometimes, with the subordinate advisers of the law.

To constitute madness, the minds of ignorant people expect a display of continued violence, and they are not satisfied that the person can be pronounced in that state, without they see him exhibit the pranks of a baboon, or hear him roar and bellow like a beast. By these people the patient is stated only to be intemperate; they confess that he does very foolish things when intoxicated; but that he is not mad, and only requires to be restrained from drinking. Thus, a man is permitted slowly to poison and destroy himself; to produce a state of irritation, which disqualifies him for any of the useful purposes of life; to squander his property amongst the most worthless and abandoned; to communicate a loathsome and disgraceful disease to a virtuous wife, and leave an innocent and helpless family to the meager protection of the parish. If it be possible, the law ought to define the circumstances, under which it becomes justifiable, to restrain a human being from effecting his own destruction, and involving his family in misery and ruin. When a man suddenly bursts through the barriers of established opinions; if he attempt to strangle himself with a cord, to divide his larger blood-vessels with a knife, or swallow a vial full of laudanum, no one entertains any doubt of his being a proper subject for the superintendance of keepers, but he is allowed, without control, by a gradual process, to undermine the fabric of his own health, and destroy the prosperity of his family.

All patients have not the same degree of memory of what has passed during the time they were disordered: and I have frequently remarked, when they were unable to give any account of the peculiar opinions which they had indulged, during a raving paroxysm of long continuance, that they well remembered any coercion which had been used, or any kindness which had been shewn them.

Insane people, are said to be generally worse in the morning; in some cases they certainly are so, but perhaps not so frequently as has been supposed. In many instances (and, as far as I have observed) in the beginning of the disease, they are more violent in the evening, and continue so the greatest part of the night. It is, however, a certain fact, that the majority of patients of this description, have their symptoms aggravated by being placed in a recumbent posture. They seem, themselves, to avoid the horizontal position as much as possible, when they are in a raving state: and when so confined that they cannot be erect, will keep themselves seated upon the breech.

Many of those who are violently disordered will continue particular actions for a considerable time: some are heard to gingle the chain, with which they are confined, for hours without intermission; others, who are secured in an erect posture, will beat the ground with their feet the greatest part of the day. Upon enquiry of such patients, after they have recovered, they have assured me that these actions afforded them considerable relief. We often surprize persons who are supposed free from any mental derangement, in many strange and ridiculous movements, particularly if their minds be intently occupied:[7]—this does not appear to be so much the effect of habit, as of a particular state of mind.

Among the bodily particularities which mark this disease, may be observed the protruded, and oftentimes glistening eye, and a peculiar cast of countenance, which, however, cannot be described. In some, an appearance takes place which has not hitherto been noticed by authors. This is a relaxation of the integuments of the cranium, by which they may be wrinkled, or rather gathered up by the hand to a considerable degree. It is generally most remarkable on the posterior part of the scalp; as far as my enquiries have reached, it does not take place in the beginning of the disease, but after a raving paroxysm of some continuance. It has been frequently accompanied with contraction of the iris.

On the suggestion of a medical gentleman, I was induced to ascertain the prevailing complexion and colour of the hair in insane patients. Out of two hundred and sixty-five who were examined, two hundred and five were of a swarthy complexion, with dark, or black hair; the remaining sixty were of a fair skin, and light, brown, or redhaired. What connexion this proportion may have, with the complexion and colour of the hair of the people of this country in general, and what alterations may have been produced by age, or a residence in other climates, I am totally uninformed.

Of the power which maniacs possess of resisting cold, the belief is general, and the histories which are on record are truly wonderful: it is not my wish to disbelieve, nor my intention to dispute them; it is proper, however, to state that the patients in Bethlem Hospital possess no such exemption from the effects of severe cold. They are particularly subject to mortifications of the feet; and this fact is so well established from former accidents, that there is an express order of the house, that every patient, under strict confinement, shall have his feet examined morning and evening in the cold weather by the keeper, and also have them constantly wrapped in flannel; and those who are permitted to go about, are always to be found as near to the fire as they can get, during the winter season.From the great degree of insensibility which prevails in some states of madness, a degree of cold would scarcely be felt by such persons, which would create uneasiness in those of sound mind; but experience has shewn that they suffer equally from severity of weather. When the mind is particularly engaged on any subject, external circumstances affect us less than when unoccupied. Every one must recollect that, in following up a favourite pursuit, his fire has burned out, without his being sensible of the alteration of temperature; but when the performance has been finished, or he has become indifferent to it from fatigue, he then becomes sensible to cold, which he had not experienced before.

Some maniacs refuse all covering, but these are not common occurrences; and it may be presumed, that by a continued exposure to the atmosphere, such persons might sustain, with impunity, a low temperature, which would be productive of serious injury to those who are clad according to the exigences of the season. Such endurance of cold is more probably the effect of habit, than of any condition peculiar to insanity.

Having thus given a general account of the symptoms, I shall now lay before my readers a history of the appearances which I have noticed on opening the heads of several maniacs who have died in Bethlem Hospital.