GEN. I. Ecphronia. Insanity. Craziness. Haslam. Greding, What pe most subject to insanity. Esquirol and M. Georget concur in the same remarks. The observations of Haslam are nearly to the same effect for they concur in showing that, except in so considerable a misformation of the scull or its contents, as to induce idiotism from an early period of life, as in the case of cretinism, nothing decisive can be obtained in reference to insanity from any variations of appearance that have hitherto been detected. The dissections of Greding extended to not fewer than two hundred and sixteen maniacal patients, the whole of whom, however, died of disorders unconnected with their mental ailments: three of the heads were exceedingly large, two exceedingly small; some of the scull-bones extremely thick, others peculiarly thin; in some, the frontal bones were small and contracted, in others, the temporal bones compressed and narrow *. In a table containing an aggregate of the patients reriods of life ceived into the lunatic asylum at Bicêtre during a considerable part of the French revolution, from 1784 to 1792, by far the greatest number admitted were between the ages of thirty and forty: next, those between forty and fifty; next to these, patients between twenty and thirty; then those from sixty to seventy; and lastly, those from fifteen to twenty; below which we have no account of any admission whatever. Hence different stadia of life seem to exercise some control, and the period most exposed to the disease is that in which the influence of the passions may be conceived to be naturally strongest and most operative. "Among the lunatics confined at Bicêtre," says M. Pinel, " during the third year of the republic, and whose cases I particularly examined, I ob • Vermischte Schriften, ut suprà. peraments dispose or pursuits excite the dis served that the exciting causes of their maladies, in a GEN. I. Ecphronia. great majority of instances, were extremely vivid affec- Insanity. tions of the mind; as ungovernable or disappointed ambi- Craziness. tion, religious fanaticism, profound chagrin, and unfor- What temtunate love. Out of one hundred and thirteen madmen, chiefly prewith whose histories I took pains to make myself acquainted, thirty-four were reduced to this state by domestic misfortunes: twenty-four by obstacles to matrimonial ease. unions which they had ardently desired to form; thirty by political events connected with the revolution; 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 Bicêtre 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. a from a dis eased condi tion of the epigastric or other abdominal organs. proximate But there are other organs that also betray very pro- Whether minent signs of diseased action in insanity as well as the originating brain, as those of the epigastrium and the adjoining regions and hence other physiologists have sought for remote or even a proximate cause of the malady in these, rather than in the encephalon. This was the case among several, though not the majority, of the Greek physicians as we have seen already and it is to this quarter that Common M. Pinel refers the proximate cause in almost every in- cause of stance in our own day. It is here he supposes the disease Pinel. to commence, and contends that the affection of the brain and of the mental faculties is subsequent to the abdominal symptons, and altogether dependent upon them and in proof of this he adverts to various dissections which have shown a considerable derangement, not only in the function but even in the structure of one or more of the abdominal organs, and particularly a displacement of the transverse colon. GEN. I. Ecphronia. Insanity. Encephalon and abdominal organs often affected jointly: and the disease But this is to give a weight to the morbid appearances occasionally manifested in these organs, above what is alCraziness. lowed to like misformations in the cranium. Yet there can be no doubt that, in most cases of insanity, the brain and epigastrium suffer jointly; and that the discase may, and often does, commence in some structural or functionary affection of the abdominal organs is perfectly clear from the frequency of this complaint during pregnancy and in child-bed: its being connected with a peculiar state of the genital organs, as we shall presently have occasion to show, and its following upon a sudden suppression of the menstrual or hemorrhoidal discharge. seems occasionally to originate in either. This association of influence explained. Inference from the general inquiry. Nor is it difficult to account for this association of influence from the extensive distribution of the par vagum, and more particularly of the intercostal nerve over the abdominal viscera: on which account a like sympathy is by no means uncommon in various other disorders. Thus while a concussion or compression of the brain produces nausea, sickness, and constipation, worms are frequently found to excite convulsions or epilepsy. The fair result of the whole inquiry appears to be, that insanity, in every instance, to adopt the language of Sir A. Crichton," arises from a diseased state of the brain or nerves, or both*": but that in many instances this diseased state is a primary affection, and in others a secondary, dependent upon a morbid condition of the epigastric or some other abdominal organ: for, in whatever this morbid condition may consist, and whatever symptoms it may evince, it is not till the sensorium has by degrees associated in the chain of unhealthy action that the signs of insanity are unequivocal. And, in like manner, dyspeptic and other abdominal symptoms are not unfrequently brought on by a previous diseased state of the mind and it is hence peculiarly difficult, and perhaps in some cases altogether impossible, to determine, where we are not acquainted with the incipient symptoms, whether melancholy or hypochondrias, has originated in *Of-Mental Derangement, Vol. 1. p. 138. GEN. I. Ecphronia. the state of the abdominal viscera or of the cranium; or in other words, whether the one or the other be a primary Insanity. or a secondary affection. When, however, we are made acquainted with the history of the incipient symptoms, we have a tolerable clue to guide us; and, for the most part may safely decide that the region primarily affected, is that which first evinces morbid symptoms: and hence, while we shall have little scruple in assigning the origin of most cases of hypochondrism to a morbid condition of one or more of the digestive organs, we need have as little in assigning the greater number of cases of mania to a primary misaffection of the brain or the nerves. In what that misaffection consists is a question that has never been settled to the present hour, and from our total inacquaintance with the nature of the connexion between the brain and the mind, it never will be in any very satisfactory manner. The morbid changes, indeed, which we have already seen are frequently to be traced in the structure of the brain, show very sufficiently that a considerable degree of diseased action has been taking place there; but as these changes are also found in other disorders of the head as well as in mania, and more especially as we cannot tell whether they have preceded or been produced by such action, they give us little information as to the nature of the diseased action itself. Craziness. Where the history of the incipient symclear, the disease may be assigned to its primary seat. ptoms are Proximate cause of insanity. Dr. Cullen has offered a series of ingenious arguments Cullen's hypothesis. to prove that mania consists in some inequality in the excitement of the brain*, or of the nervous power †, and in most cases in an increased excitement. Dr. Cullen's idea of the nervous power, as we have already had occasion to observe, is very far from being explicit: for he defines it "a subtile very moveable fluid included or inherent in a manner we do not clearly understand in every part of the medullary substance of the brain and nerves." While in other parts of his writings he represents it as never * Pract. Phys. Vol. rv. Aph. мDLXII. + Id. MDXLIV. GEN. I. Ecphronia. Insanity. Craziness. either recruited or exhausted, and thus conceives it to possess qualities beyond the ordinary endowments of living matter. Yet his general principle appears to be well founded, and Sir Alexander Crichton has availed himself of it in giving a fuller explanation of this highly probable hypothesis: and, after appealing to the doctrine which has already been advanced and supported in the preceding pages of the present work, that the nervous power is a peculiar fluid secreted in the medullary substance of the brain or the nerves, he endeavours to show pathological that the cause of insanities is a specific morbid action doctrines of of the vessels which secrete the nervous fluid in the the present brain *; and which may hereby be altered not only in quantity but in quality +. Crichton's hypothesis highly probable; and concurrent with the work. Proofs that the senso rial power is some From the quickness of the external senses, the irascibility, heat of the skin, flushed countenance, and uncommon energy which maniacs evince, we have reason to believe this morbid action to be, for the most part, a preternaturally increased action; and we are hence able to account for the various exacerbations and remissions which it evinces, sometimes periodically, and sometimes irregularly. Yet as the health of the faculties of the mind must depend upon a healthy energy of the vessels, too scanty a secretion of nervous fluid must be as effectual a cause of mental derangement as too copious a flow: and hence torpor of the vessels of the brain may prove as certain a cause of a wandering mind as entony, and, consequently, typhous fever may become a source of delirium as well as inflammatory. And as the various secretions can only be elaborated from the blood, and are often affected by its condition, we may see also how madness may be a result of acrid narcotics and other poisons introduced into the blood by absorption, or a transfusion of blood from animals of a different nature, of which Dionis has given some very striking examples. That there is a tendency not only to an increased * Of Mental Derangement, Vol. 1. p. 174. + Id. Vol. 1. p. 169, |