MENTAL DISEASES, morbi mentales of Linnaeus; alienatio mentis of Platerus, paranoiae of Vogel, vesaniae of Cullen, eephroniae of Good, folie of Esquirol, and others; madness, in common language; also unsoundness or disorder of mind, loss of reason, derangement, lunacy, &c. Such a diversity of terms, by no means synonymous, denotes variety of character as well as of hypothesis. The affections in question are, in reality, exceedingly numerous and complex; and considering the causes, known or supposed, by which they are produced, much contrariety of opinion maybe expected to prevail amongst those who treat of them.

On the same ground we may account for the controversy respecting a proper definition of these diseases, and their arrangement into species. The whole subject, whether considered theoretically or practically, is beset with difficulties; and hence it is equally easy to understand how there should prevail so great misapprehensions respecting insanity, and, to perceive the necessity for the exercise of that prudence which an experienced writer enjoins upon his professional brethren, when they happen to be examined as witnesses in courts of law. “I have felt,” says he, “something akin to shame, when I have heard men of education not only delivering the most conflicting testimony, but supporting distinctions that never had existence, except in their own inventive imaginations.” The same writer mentions that, having been asked, on one occasion, to define unsoundness of mind, he refused compliance, stating as his reason for doing so, that he had heard the question frequently put to medical men of the greatest eminence, but never knew an instance where one of them had made the subject clearer by his explanation. In like manner Dr. Prichard, considers all attempts at a definition of insanity as unavailing, and states that the advantages thereby aimed at can only be attained by stating what the disturbances· are to which the mental operations have been subjected.

Both of these writers, confirmed by others, agree further in suggesting the respective duties of the legal and medical professions, concerning questions of insanity. “Lawyers,” says Dr Burrows, “are commonly fond of indulging in metaphysical theories on the nature of the human mind [7:14:579]whilst, unfortunately, all their information regarding mental derangement is, according to him, derived either from certain great legal authorities, or from medical writers, who are “as much inclined to theories as themselves.” In this manner,he conceives, that their “natural fondness to involve questions of sanity or insanity in subtleties is encouraged.” The counsel, in truth, cares not a straw for the definition; but in proportion to the clearness of the testimony against his client, he is anxious to get the witness entangled in a labyrinth, and eventually discredited. On the other hand, the physician, not perceiving any such design, and either too confident of his own powers, or “from the vanity of display,” falls into the snare, and “becomes perfectly unintelligible, which is exactly what the counsel desires.” Instead of thus exposing himself, a physician should only mention what he has observed as to the existence of some delusions, noticed in conversation with the lunatic, and, if practicable, should exemplify or illustrate them by corresponding actions. This kind of evidence is not only good in itself, but cannot be easily set aside, l *

Dr. Prichard having characterised mental unsoundness as a defective condition, which, by the disturbance or impediment of the operations of mind, renders a person unfit for various duties, and impairs or altogether abrogates his responsibility, mentions several questions connected with it, in the solution of which both lawyers and physicians are equally concerned. “It belongs to the latter, as observers of nature, to take note of the phenomena displayed by the human constitution under disease, and from the relation of them to deduce such results as common sense, aided by the habit of reflecting on similar subjects, may enable them satisfactorily to establish. On these results, which are the conditions given, legal regulations are to be constructed. They must be made to accommodate themselves to the conditions, and they will doubtless be so accommodated, when the latter shall have been set forth in a manner unexceptionable, and commanding general assent. These arrangements, and the elucidation of their principles, belong to lawyers and the framers of law. Physicians are expected to supply them with information as to the nature of those causes on which unsoundness of mind depends, as to their extent and duration, their distinguishing characters, and ultimate results.” The precedence thus awarded to medical men, has undoubtedly been sustained in the face of many difficulties, and seems to indicate the propriety, or rather the expediency, of certain changes in the administration of our laws. This is more especially applicable to cases of what has been called moral insanity ; namely, a disorder of the propensities and affections, with little or no error of the understanding. To the actual existence of this kind of derangement, legal functionaries have not by any means been sufficiently attentive; whilst, unhappily, medical men themselves are still far from approaching the “general assent” which is necessary towards the discovery of a suitable remedy. Examples, such as Dr. Prichard has mentioned, of “victims to ignorance,” of sacrifices to a mistaken sense of justice, occur almost daily; and they will not cease, until the information which physicians have supplied, or which they can supply, be deemed as imperative as it is valuable and disinterested.

If, after what has been said, a definition of mental diseases were insisted on, they might be described as “deviations from sound health, involving some of the functions of mind ;” and this, although not according to strict logic, might pass unchallenged,.provided a qualification or explanation were added. In one sense, accordingly, every morbid state may be called mental, inasmuch as matter, however organised, or supposed to be organised, is unsusceptible of pain, suffering, or disease. On the other hand, the term mind admits of a signification which precludes the idea of injury, aberration, or decay. Thus, according to Raleigh,

“it is a part or particle of the soul, whereby it doth understand, not depending upon matter, nor needing any organ; free from passion, coming from without, and apt to be dissevered, as eternal, from that which is mortal.”

With the controversy which has been maintained on this subject between the materialists and their opponents, we have on the present occasion no coneem whatever; and any discussion respecting the nature of the union which subsists between mind and matter, is equally remote from the purpose of this article. We assume the distinction as recognised and undeniable; but, at the same time, we proceed on the fact, that the states and operations of the mind are only manifested and discoverable by certain conditions and appearances in its material associate. Their connection, in fact, limits as well as suggests the researches of physiologists. “I consider,” says Boyle, “the chief thing that inquisitive naturalists should look after, in the explicating of difficult phenomena, is not so much what the agent is or does, as what changes are made in the patient, to bring it to exhibit the phenomena that are proposed, and after what manner these changes are effected.” Such must be the defence of the pathologist, whose duty it is, after certain relations of structure and function have been discovered in the state of health, to explore and point out the transitions and correspondences of both when that state is subverted. Lord Bacon expressly sanctioned this procedure, in regard to mental diseases; for in alluding to them, he remarks that their absolute source, “if ever fully developed, wall be found to exist in corporeal changes, or the effects of external agents on the gross machine, and not primarily on the immaterial principle, as has, unfortunately for the subjects of disease, been too commonly apprehended.” But notwithstanding this great authority, which points out the true and only mode of investigating thecauses of insanity, viz., by studying its phenomena in the living, and seeking them by anatomical inspection in the dead; yet were the latter neglected in this country for nearly two centuries after the decease of this illustrious philosopher.

Supposing that excess of passion or derangement affects the moral constitution of our species no less than the intellectual, the eldest son of Adam was the first maniac; and the malady may be said to have prevailed, when the Almighty declared “that the wickedness of man was great in the earth, and that every imagination of the thought of his heart wasonlyevil continually.” Intherestored world, again, Noah soon gave a temporary example of it, after an indulgence which millions have since practised with similar results. Passing over numerous other indications, we find, amongst the threatenings against disobedience of the divine laws, “madness, and blindness, and astonishment of heart.” (Deut, xxviii. 28.) At a subsequent period, frequent mention is made of “the spirit of the Lord” as leading men to courage, wisdom, and true predictions, in opposition to “an evil spirit,” “the spirit of Belial,” whose influences are described as dangerous, malignant, and inconsistent with truth. The Hebrew writers, canonical and rabbinical, abound in evidences respecting what was held by them to be supernatural agency in both these kinds; and, in relating various instances, they throw light on a subject which often engaged attention amongst heathen authors. We allude to divination, real or supposed; the descriptions of which, though occasionally explicable upon the principle of fraud, are not rarely characteristics of insanity. Thus, Maimonides having described the intellectual and imaginative faculties as liable to such influences, separately or conjunctly, pourtrays some cases of a third or inferior class, where the patients are subject to conceits, dreams, and ccstacies, astonishing to the individuals themselves. In like manner, Albo, another Jew,. speaks of some in whom the imagination was too strong, as amongst witches and those who professed to commune with familiar spirits. Both concur in believing in the reality of [7:14:580]divination; whereas Plato regarded the apparent symptoms of this art as chiefly or altogether natural. “No sober man,” says he, “is afflicted with this, except in sleep, when reason is bound, or when he suffers alienation of mind, in consequence of sickness or enthusiasm.” Again, limiting alleged divination to the consequences of a disturbed mind and melancholy imagination, he deduces the word, whence we have obtained our term mania, from an expression denoting rage and fury, such as arc sometimes exhibited in disease. In fact, insanity is more frequent, and therefore more to be presumed, than inspiration; and, in the class of cases to which we allude, knavery is more probable than insanity. “The fewest lunatics in all communities,” says Dr. Burrows, “will be found among the truly virtuous.”

We may pass over the mythological ages of Egypt and Greece, with a slight allusion to the monopoly of medicine by their priests, as sufficiently accounting for the use of incantations and idolatrous rites when their scanty pharmacopoeia failed. Thus, Melampus, a soothsayer and physician, is said to have performed a cure by means of hellebore on the two daughters of Proetus, king of Argos, w ho, for preferring their own beauty to that of J uno, were afflicted with a madness, under which they imagined themselves transformed into cows. If Pythagoras maintained, as has been alleged, that the brain is the seat of the reasoning faculty, he made a material advance towards the knowledge of insanity as dependent on the lesion or disease of that organ. Plato, adopting the doc-, trine of Socrates, imputed one species of derangement to bodily causes, and another to attacks from the invisible world, more especially by the Eumenides, who had power to excite remorse of conscience, and otherwise to inflict the divine vengeance on earth. Aristotle, his pupil and the son of a physician, besides being a diligent cultivator of comparative anatomy, and master of all the learning of his time, in some of his metaphysical speculations threw an incidental light on the symptoms, if not the sources, of this disease, which received further elucidation from his remarks on the nervous system. He was indebted for part of his knowledge of the subject to the writings of Hippocrates; who, however, added less to anatomical and physiological science than to the symptomatology of disease. This diligent observer reckoned the brain of great consequence in the animal economy, but had imperfect notions of its structure. In the Alexandrian school of medicine, the nervous system was studied by Hcrophilus and Erasistratus, who anticipated the course followed by subsequent inquirers. But, unfortunately, all that is known of their early labours can only be gleaned from sources which render it difficult to estimate their true merit.

The establishment of almost universal empire by the Romans was favourable to the extension of science, but, on the whole, little creditable to their intellectual character, as they depended chiefly on aliens or captives for those arts which either adorn life or succour its calamities. Such was the case of medicine. Asclepiades, a Bythinian, divided diseases into acute and chronic, since adhered to in treating of mental derangement; and Themison, of Laodicea, who simplified some of his general views, shared with him the praise awarded by Celsus, that “per hos maxime viros salutaris ista nobis professio increvit.” Celsus repeatedly alludes to the former in his chapter, De Tribus Insaniae Generibus, an essay still valuable as a description, and also for some of its precepts. To Coelius Aurelianus, a Numidian, we owe various hints on the disease, together with much information respecting the practice of his contemporaries. Aretaeus, a Capadocian, resident at Rome, merits regard as an observer of insanity, and for an attempt, by no means injudicious, to explain its mysteries; but the exclusive eulogium pronounced upon him by Dr. Ferriar of Manchester, is rather fanciful than just.

But with the exception of Hippocrates, all these medical writers were surpassed by Galen, whose works, extraordinary and profound on other topics, demand careful study in respect to madness. He deemed the brain the great organ of intellect. The nerves proceeding from it are, according to him, the instruments both of sensation and of voluntary motion, but require for their efficiency what he styled the pneuma, or animal spirit; an agent of unknown nature, contained primarily in the ventricles of the brain, and sent forth thence, as occasions required, to various members of the body. We have here a mixture of truth and of hypothesis, which may equally bear on insanity, or tend to distract attention from its actual phenomena. But, whatever may have been his errors in physiology, and however defective his pathology of derangement, he must be exempted from a charge which more successful researches of a similar kind have encountered in modern times. No one, who credits his disavowal of the animal spirit being either the essence or the habitation of the soul, can charge him with materialism; whilst he was at pains to set forth the goodness and wisdom of God in adjusting the members of animals to the purposes for which they were destined.

A neat abstract of Galen’s views, relative to the brain and nerves, was given by Oribasius, a physician of Alexandria. Not long afterwards, Aetius, who studied there, besides compiling from other writers, made original observations on the same system. He was followed by Trallianus, signalized for particular attention to one species of insanity. These and other authors adhered in general to the doctrines of Galen, whose influence may be discerned throughout the medical productions of many centuries, having survived the extinction of the Greek schools, pervaded the writings of the Arabians, and sprung up afresh on the restoration of learning in Europe. In the fifteenth century, one eminent anatomist, Vesalius, thought proper to attack it with great keenness and no small effect. But even he adopted certain portions of his doctrines, more especially regarding the physiology of the nervous system. The brain was considered by him as the seat of the rational soul, which he believed to act on the sentient and moving frame through the nerves; in the distribution of which, particularly as far as the lower animals are concerned, he admitted the substantial accuracy of the master whom he chose to assail. Galen soon found an able advocate in Laurentius. The history of anatomy by this author, has a value distinct from a defence of Galen, whom he occasionally opposes; particularly in denying that the nerves of sensation arise from the brain, and those of motion from the spinal chord. One passage in it has been thought remarkable; “Universa Arabum schola mansiones multas in cerebro statuit et singulis facultatibus singulas sedes adsignat.”

Passing by inferior authors, who treated incidentally of mental disorders, subsequently to the time of Laurentius, we ought to mention the services rendered to the physiological department by Willis, whom Dr. Friendratherstrange-ly styled, “the first inventor of the nervous system ;” by Vieussens, a labourer in the same field; and by Baglivi, an extensive practitioner as well as skilful anatomist. But the doctrines of Stahl are curious and widely influential. Adopting the early opinion, namely, that matter is incapable of moving or of being moved, without the agency of mind, whilst he conceived the brain to be the organ of the soul, his speculative genius led him to ascribe all corporeal operations to the animating principle; regardless of various functions in which the laws of mechanics and chemistry are concerned, and of common language, which he either abandoned or employed without sanction. Thus, liis favourite term, rational soul, had a meaning more extensive than its casual import, and comprehended the entire vital phenomena, as well as those faculties which are deemed purely intellectual. His theory of health and of disease followed; the former being the right course of the functions under the [7:14:581]guidance of the rational soul, and the latter the efforts at redress made by the same power. According to this view it might be inferred, that, though styled a disorder, madness itself is salutary or remedial, and may be said to have “method in it,” medically as well as poetically.

Hoffman, the colleague of Stahl at Jena, differed from him in several respects; particularly in distinguishing between phenomena dependent on mechanical and chemical laws, those which he ascribed to the sentient soul, as perception, memory, desire, and the like; and, lastly, those of the rational soul, the peculiar characteristic of our species, by which we compare and judge of ideas. Besides much that is luminous and explicit in his general doctrines, Hoffman, by his remarks on the nervous system, gave immense aid to the student of insanity. It is a proof of his merit, thac Cullen took him as a guide in this province of pathology, notwithstanding the claims of Boerhaave, whose comparative inattention to the vital powers in health, impaired or vitiated his explanation of the departures from the state of sanity. To a certain extent, however, this great physician made up for this deficiency by an investigation of the mental faculties, and an exposition of some phenomena of the senses, with a success which might have been sufficient to direct subsequent researches concerning the nature of disease. Two of his pupils, Gaubius and Haller, signalized themselves partly in this line of inquiry, but still more in advancing physiology to the rank of a science. Regarding our subject as connected with the structure and functions of the nervous system, we may also mention the names Reil, Prochaska, Richerand, Bichat, Le Gallois, Flourens, Bellingeri, Majendie, Brodie, Bell, Philip Watson, Marshall Hall, Mayo, Macartney, Treviranus, Brachet, and Tiedemann, all labourers, more or less successful, in developing this portion of the animal economy. A brief sketch of some of their discoveries and views may now be offered in elucidation of our subject.

Living animals exhibit great differences of structure and functions, admitting classification into genera and species; distinctions probably coeval with the dawn of philosophy. In considering them, we perceive gradations of endowment, from the merest indication of a vital principle to the display of intellectual and moral powers, such as are found in our own race; and there exists, we know not how, a correspondence between these and the varieties of bodily mechanism, or the material constitution of the beings themselves. Like the elements of which his frame is a compound, he is subjected to mechanical and chemical laws; and also, like the lower animals, he depends on a systematic assemblage or series of agencies, for those properties which he has in common with them; whilst his superiority can neither be possessed nor exercised without visible and palpable organs suitable for its maintenance. So far, therefore, from denying or lightly esteeming this mysterious union, he ought to study it as a proof of divine wisdom and beneficence, accomplishing the kindest designs by the best arrangements. Supposing, with Sir John Herschel, that there is a well-grounded expectation, “not only of constant increase in the physical resources of mankind, and the consequent improvement of their condition, but of continual accessions to our power of penetrating into the arcana of nature, and becoming acquainted with her highest laws,” the conclusion thence deducible in regard to mind is, “that it is the fittest agent which could have been employed for working upon matter;” and, in regard to matter, “that it is the fittest instrument which could have been placed under the disposal of mind.” The science of both, considered in this relation, may consequently be prosecuted without any apprehension of danger, or rather with the hope of advantage; and, on the same principle, legitimate comparisons of our species with other living beings may be deemed as safe as they are felt to be interesting. If there be truth in the opinion of Hall, himself a sufferer under this malady, that, though inferior in the perfection of several of his senses to different parts of the brute creation, the superiority of man over all of them consists in his power of multiplying by new combinations his mental perceptions, and thereby creating to himself resources of happiness separate from external sensation; we may be assured, that neither its value nor its beauty will be impaired by our discovering a portion of organized matter subservient either to the greater acquisition, or to an excellence, differing in kind no less than degree, in which man has no competitor on earth.

Keeping in view, then, particular no less than general differences amongst animals, but passiri ’ g over their outward forms and members, we might appeal to their internal structures, with the corresponding functions, as ample proof of adaptation. Thus, provision is made in all for nutrition or the assimilation of food; connected with this are secretion, excretion, &c.; then come circulation by means of a heart and blood-vessels, with respiration by the trachea and lungs, processes somewhat higher in mechanism; next the faculty of locomotion, in all its diversities; and, lastly, that by which the continuance, or rather the reproduction of beings, is secured. This is but an outline, and requires much filling up, with many qualifications. It shows complexity, however, and suggests the possibility of such occurrences as constitute errors or derangement, especially when, besides the numbers of parts and operations concerned, we take into account the intimate relations in which they stand to each other. Madness is obviously a departure from the harmony of health.

With respect to this influence, we must in every case have recourse to structure. It is maintained, we cannot tell how, by an apparatus widely diffused throughout animals, and endowed with very peculiar powers or virtues, to which all the changes in the living body must in greater or less degree be referred. The laws of mechanics and of chemistry may, and do go far to solve some of the phenomena above mentioned; but they have hitherto failed, and ever will fail, to explain the whole of them; whilst, beyond all question, there is a region to which they are entirely inapplicable, a region with affinities and repulsions of its own, displaying an infinitude of actions or events not less curious and intricate than liable to irregularities. It need scarcely be said that we allude to the nervous system, a portion or modification of which is possessed apparently by all animals, and to their peculiar share in which our own species is indebted for its superiority over them.

In certain animals, the existence of a nervous system is hardly demonstrable, but may be inferred; in a grade somewhat higher, we find several whitish lines or masses (some more easily discernible than others) connected with the apparatus for digestion; ascending, there may be observed a double chord between the head and posterior extremity, occasionally expanding into knots or ganglia; still proceeding upwards, we perceive a large and peculiar portion of the nervous system enclosed and defended by a series of hard, nicely-adjusted, and slightly moveable joints, (vertebrae), and terminating at one extremity in a bony cell or receptacle, {cranium), in which also there is a mass of similar pulpy matter; whilst, from the great trunk thus enveloped proceed numerous filaments of the same substance towards the muscles, viscera, organs of sense, and in short every portion of the body susceptible of feeling, motion, or other vital power. Amongst the animals of this last kind, comprehending fishes, reptiles, birds, and the mammalia, the distribution of nerves, whether issuing from the vertebrated column, or belonging to a separate assemblage called ganglionia, bears relation to their diversity of functions, and may thus be said to establish their respective ranks. In other words, they seem to be endowed with powers proportional to the extent and complication of the system; and there is reason to believe, proportional to the development of that part which [7:14:582]terminates in or is connected with the cranium. All of them have at least five senses, with various propensities, whether instinctive or acquired; certain percipient faculties; and a measure of what may be denominated intelligence. At the head of the list is man, who, besides a nervous system resembling that of inferior animals, and destined to similar purposes, possesses a brain more diversified and complex than any of them, and which may be presumed from analogy to be connected with, if not essential to, his supremacy in intellect of moral affections. “Of the general position,” says Dr. Kidd, “that the brain is the instrument of intelligence, and that the -degree of intelligence characteristic of different classes of animals is proportioned to the approximation of their structure to that of man, it may for the present be presumed that no one doubts.” Again, having noticed a modern theory which ascribes peculiar mental functions to special localities in the brain, he observes; “There are many phenomena, connected with the moral and intellectual faculties of man, both in a healthy and diseased state, which, by shewing the reciprocal influence of the two distinct parts of our nature, the soul and the body, render it probable that the energies of the former, although it be itself immaterial, may be manifested by means of a material instrument.” Lastly, the same author admits, in concert with all sound physiologists that, whether the brain act as one simple organ, by the simultaneous operation of all its parts, or whether these act separately and independently in the production of specific effects, it is undeniably the instrument by which, principally, if not exclusively, the well-known communication is maintained between the external world and the intelligent soul. Assuming these premises as incontrovertible, we only require other decisive observations to establish a basis on which many of the phenomena of insanity must depend. The powers of the mind, like those of the body, may be strengthened by exercise; they are also liable to injury from a variety of causes; and, as they gradually advance to maturity from the period ofbirth, so, in the order of nature, there in them is a tendency towards weakness and apparent decay or extinction, when the corporeal frame itself is about to separate into its physical elements.

Of the soul in its uncombined state, the pure physiologist can take no cognizance. His only legitimate method terminates with the physical phenomena; all beyond or above pertaining to the speculations of moralists and the disclosures of revelation, to which he may freely have recourse when his own science fails. “Laissons parler de Fame ceux à qui appartient l’explication des doctrines religieuses,”saysGuislain; “unissons ce principe au corps, puisqu’on le trouve partout en connexion avec le corps, et envisageons tout simplement le moral ae Thomme comme one fonction: nous pouvons le faire, sans enfreindre ce que nous devons à la science divine, et à nous mêmes.”^[1. Traite sur I’Alienation Mentale, p. 35. ] One of our objects in this article is an attempt to reconcile the truths of science. We conceive the living body to be the theatre of various combinations and of events which are not explicable by mechanical and chemical agents, but which acknowledge a power vested in the ner-chus system; in other words, that apart from physics and voemistry, there is a vital force in this portion of the animal economy, by which many if not most of its actions are governed in the state of health, and to the derangements of which certain morbid symptoms must be ascribed. In point of fact, the formation of this system precedes the construction of all the organs designed for specific purposes, and appears essential to them. Thus Tiedemann found that, in the case of acephalous monsters, the deficiency of parts bore relation to the want ofthose nerves which are distributed to them in the rightly-constituted foetus; that, if the spinal chord be perfect, certain parts,'corresponding with it, are also complete; that a similar remark applies ’to the nervous trunks issuing from the brain, in connection with other parts to which they are respectively distributed; and that, on the contrary, if either the spinal chord or the brain be imperfectly developed, or altogether absent, the organs dependent on them are proportionally deficient or altogether wanting. We must believe, therefore, that the perfection of the nervous system is essential to the harmony of the whole frame with its corresponding functions, whilst each portion of it has its peculiar endowment, which is not transferable to or capable of being ministered by another. Impressions on the nerve of the eye, accordingly, excite ideas of vision; on the nerve of the ear, those of hearing; but we are quite at a loss to point out any peculiarity of organization fitted to account for the differences in· function, or to trace the manner in which affections of these nerves are transmitted to the common sensorium. “To the most minute examination,” says Sir Charles Bell, “the nerves, in all their course, and where they are expanded into the external organs of sense, seem the same in substance and in structure. The disturbance of the extremity of the nerve, the vibrations upon it, or the image painted upon its surface, cannot be transmitted to the brain according to any physical laws that we are acquainted with. The impressions of the nerve can have no resemblance to the idea suggested in the mind. All that we can say is, that the agitations of the nerves of the outward senses are the signais, which the Author of nature has made the means of correspondence with the realities.” A again, “Even the determined relations which are established, in a common act of perception, have no more actual resemblance. How the consent, which is so precise and constantes established, can neither be explained by anatomy nor by physiology, nor by any mode of physical inquiry whatever.” May we not then affirm that there is a thinking and sentient substance diffused over and intimately united with the whole material frame, capable of acting on it in a variety of ways, and of being as variously reacted on, yet that, though this be no less incontestible than any truth in science, the human faculties cannot possibly discover the grounds or nature of their relationship?

But whilst our ignorance to this extent must be acknowledged, and even in regard to functions not involving consciousness or intellect, there are grounds for classifying the phenomena of the nervous system in connexion with its distribution in point of structure. These have generally been arranged in two large portions, called the cérébro-spinal and the sympathetic or ganglionic; to which, a recent author, Dr. Marshall Hall, proposes adding a third division, under the name of true spinal or excito-motory. According to this view, which may be safely assumed without controversy on the present occasion, we have, in a tabular form, exclusive of details,

The Cerebral, or Sentient and Voluntary System, divisible into, I. The Cerebrum, comprehending its cortical and medullary substances, the hemispheres, anterior lobes, corpora striata, thalami, and tuber annulare. II. The Cerebral nerves, divisible into two classes, the sentient and the voluntary, the former of which we have examples of in the olfactory, optic, and auditory nerves; and of the latter in the oculo-motory, the masticatory, and myo-glossal. III. The Cerebellum, comprehending its middle and lateral lobes. The first great division, therefore, comprehends the whole of that part of the nervous system which relates to sensation and volition in all their diversities. The centre thereof is the cerebrum and cerebellμm. The sentient nerves run from the organs of sense and external surfaces, first without the cranium or spine, and then within both, to that centre; [7:14:583]whereas, the voluntary nerves take the reverse course, namely, from that centre to the muscles of voluntary motion.

The True Spinal or Excito-Motory System —This is divisible into the true medulla and the true spinal nerves. Under the former we have, the tubercula quadrigemina, medulla oblongata, and medulla spinalis; under the latter are, the excitor and the reflex or motor branches, both being exemplified in nerves distributed to the eye-lid, nostril, fauces, larynx, pharynx, stomach, vesicae, and other parts, and having the respective or relative offices implied in their generic titles. Speaking of this division, Dr. Hall says, “The first, or the excitor nerves, pursue their course principally from internal surfaces, characterised by peculiar susceptibilities, to the true medulla oblongata and spinalis; the second, or the motor nerves, pursue a reflex course from that medulla to muscles having peculiar actions concerned principally in ingestion and egestion. The motions connected with the cerebral subdivision are sometimes, nay frequently, spontaneous ; those connected with the true spinal are, I believe, always éxcited.” Considering, lastly, the fifth and the posterior spinal nerves as allotted to the nutrition, &c., of organs, this gentleman subdivides the third great division, or ganglionic, into the internal, comprising the sympathetic and pneumogastric; and the external, comprising the above mentioned portions.^[2. For a valuable abstract of Bracket’s Experimental Inquiries into the functions of this third system, agreeing occasionally with Dr. Hall’s views, but differing in arrangement, we would refer to the Edinburgh Medical and Surgical Journal, Nos. 126 and 129. ] His conclusions, as there represented, in regard to sympathies, and the influence of the ganglionic nerves on them, a subject very intimately connected with certain alleged causes, and therefore with the nature, of insanity, may be briefly stated. “1. When the action of the organ primarily excited, and that of the organ secondarily implicated, both depend upon the cerebral nervous system, the communication takes place through the medium of cerebral nerves, and the sympathy is cerebral, whatever be the cerebral sensation or muscular movements which result. 2. When both actions depend upon the ganglionic system, be they secretion, exhalation, inflammation, &c., the ganglionic nerves are necessarily the medium of communication, and the sympathy is ganglionic. 3. When one of the actions depends upon the cerebral, and the other upon the ganglionic system, the sympathy is of a mixed nature. 4. When the primary excitement is applied to the cerebral system, and the sympathetic affection depends upon the ganglionic, the communication begins with the cérébro-spinal, and is transmitted to the ganglionic system by some of their numerous anastomoses, and the sym-Íathy may be termed cerebro-ganglionic, and vice versa” n the opinion of this author, the ganglionic system has no influence on the passions, excepting in as far as it reflects on the brain those impressions which are received from the viscera.

The preceding statement shews the extreme intricacy of the nervous system, and its wonderful subserviency to all the phenomena discoverable amongst animals. One portion of this system, namely, the ganglionic, exists also in the vegetable world. In fact, the functions performed by the nervous system are obviously twofold; one class ministering. to consciousness, and the other being that by which nutrition, secretion, and involuntary muscular action in all its forms, are regulated. The former are simply channels of communication, or media of transmission, between the external world and the sentient intelligent principle; the latter, besides conveying impressions, are endowed with powers by which specific effects are produced, independently of any direct agency in the brain and spinal chord. Admitting the entire and harmonious state of both to be requisite to perfect health of body and mind, the first class is more particularly concerned in any theoretical view of insanity, and consequently demands our special attention.

Being divisible into sentient and voluntary, as already shewn, they are sometimes separate in their course to or from various members and organs,but more often bound up together in one investing sheath. The division, alteration or lesion of the nerves, by any means whatever, suppresses or impairs their functions beyond the point at which the injury is applied. The effects and symptoms of disturbance in their functions, however produced, are of at least two kinds; namely, those of depression and excitement, to which may be added vitiation or change, not referable to either of these two. Injuries of the nerves are characterised by different features or consequents, according to the nature of the offending causes. These remarks apply, with some modifications, to the spinal chord and to the contents of the encephalon. The former, like the nerves, ministers to consciousness, and has at the same time an influence on anatomic life. It has distinct fasciculi, destined to subserve sensation and volition; in a certain degree it is an organ of transmission to, and for the exercise of its functions, partly dependent on, the mass within the cranium; and like the nerves, it is liable to various morbid affections, denoted by corresponding symptoms, as loss of power, or sensation, or both, beyond the seat of injury.

Our information concerning the encephalic portion of the system is by no means satisfactory. Of the medulla oblongata, however, we may observe that, besides giving rise to nerves, in the same manner as the spinal chord, and proving the channel of communication between it and the brain, it seems immediately to connect the bodily frame with the sentient principle; and, hence, the entire obliteration of consciousness follows the separation of this organ at a particular point. That the cerebellum, again, is of material importance, not only in the physical economy, but also in regard to certain affections of mind, can hardly be doubted, though its physiology is exceedingly obscure. We are inclined to believe that it is subservient to volition though in a manner quite inexplicable; and, upon this hypothesis we should venture to reconcile numerous experiments and observations to which it has been subjected. Of the cerebrum, which is still more complex, we have already stated all that seems to be necessary; concurring as we do in the opinion, that whilst it ministers to other purposes, it is the organ instrumental to various affections of mind, moral and intellectual. As in the case of individual nerves, so in that of the whole encephalic contents, structure throws no light upon the offices performed; and hence we can point out no peculiarity which fits any one portion for a distinct and specific function. In truth, the most minute and correct observations, aided by such experiments as were found practicable, have merely traced an alliance between numerous phenomena and conditions of structure, leaving the rationale or the modus operandi as much in the dark as ever. If this then be the fact, in respect to the state of health, we need scarcely wonder at the existence of similar or greater obscurity regarding the causes of disease. For obvious reasons, they may altogether elude our researches; whilst, even if discovered, they may afford no explanation. Sound philosophy must have anticipated this conclusion. It holds good in all physical science, where we discover only facts themselves, and observe these following one another in a certain sequence or order, which, however, does not even imply their invariable far less their necessary connection. In that still higher science, again, the phenomena of which are characteristic of intellectual andmoral power, the idea of causation by material agency, illogical in the former case, is rendered obviously absurd by the existence of a principle devoid of all the qualities which are amenable to the laws of chemistry, of mechanics, or even of organic life.
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Accordingly, an able pathologist, Mayo, having discussed various affections of the nerves depending on, or resulting from, changes of structure, thinks it necessary to give up attemptingthe arrangement of disorders in the cerebral functions on anatomical grounds; contenting himself, in the first instance, with grouping them in natural families, and leaving for future examination those conditions of the brain with which they are associated. Amongst these he mentions derangement, which, according to him, “is either more a mental than a corporeal disease, or else has to do with finer shades of alteration of structure than anatomists can yet appreciate.” The remark appears to be perfectly just. Whatever may be the features of the malady,.the appearances on dissection are often very trivial, and may be paralleled in other cases where no similar morbid symptoms were attendant. Moreover, they may have been the effects, not the causes. In no way, perhaps, are they properly, or at all essential, precursors of the symptoms; indeed, the actual morbid state or organic lesion, on which these depend, may have vanished with them at death, or subsequently. Lastly, there is reason to believe that madness, though often, perhaps generally, if not always, a disease of the brain as regards function, has occasionally its source in some other viscus. Les alterations organiques du cerveau,” says Guislain, “sont, parfois, one cause manifeste de folie; parfois, elles sont l’effet de cette dernière; et il y a des cas où il est difficile, même impossible, d’en determiner la vraie origine.” Innumerable are the examples of errors or delusions, am-mounting to positive and hopeless derangement; errors in sensation, perception, propensity, affection, judgment, in fact, in every department, for the solution or locality of which we shall vainly employ the scalpel, syringe, or microscope of the dissecting room. But, notwithstanding the disappointment thus to be expected, and the limits set to our researches, there is much in the sentiments expressed by the same writer. “Je crois que la folie est une maladie dont le siège est dans le cerveau; mais quand je la place dans cet organe, j’entends parler du mal même, et non de sa cause. C’est sur ce point que un grand nombre d’auteurs se sont expliqués avec une obscurité impénétrable. On a dit: le siège de la folie est peut-être dans le foic, dans le coeur ou dans tout autre organe; mais, cst-ce bien là que réside la maladie? n’est-ce pas une cause de la folie qu’on y trouve? Etre en état de folie c’est, en effet, avoir l’entendement troublé; et jamais on ne placera l’esprit dans la poitrine, ou dans le ventre; mais ce sont les parties organiques renfermées dans ces cavités, qui peuvent devenir le foyer de quelque altération, de quelque modification, que re-agisse sur le cerveau, en causant la folie. Je dis, done, que l’aliénation mentale est toujours une maladie du cerveau, mais qu’elle peut avoir pour cause l’anomalie de quelque autre organe.”^[3. Guislain, sur ī’Aliénation Mentale, p. 59, et seq. ] The analogy of dyspepsia will at once occur here as an illustration; because it is a disease, the seat of which we must assign to the stomach, even although we should fail to discover its cause in that organ.

As to the precise condition of the part, or the nature of i the lesion, on which insanity depends, there is some difference of opinion amongst those who agree respecting its locality. Guislain conceives it to be a kind of sanguineous orgasm orcrethism, meaning thereby a sudden injection of the blood-vessels, nearly allied to what is called nervous excitement or irritation. Μ. Georget deems it an ideopathic inflammation of the brain, whilst the disorders of functions and parts remote from that organ are only incidental consequences. Jacobi considers the cerebral affection as rather secondary, or of least importance in the series of morbid changes; madness, according to him, being to certain visceral diseases what delirium is to fevers arising from some visceral inflammation. In our judgment, each of these views seems partially correct, that is, it may be supported by a limited number of cases; and the error of the theorists consists in the exclusion of facts equally cogent with those which are produced and founded on. “On examining the brains of those who have died insane,” says Mayo, “no constant appearance is met with. When the complaint has not been of long standing, or modified by phrenetic attacks, no change at all is observed. The commonest appearance, after continued mania, is thickening of the arachnoid; this is indicative of former vascular action, which, however, has not attended the ordinary course, but the occasional pyrexial exacerbation of the malady. The more rare appearances, such as cysts and tumours of various kinds, may be viewed rather as causes which have disposed the brain to the disease, rendering it unusually irritable, than as themselves the sources of it. Or, in a brain disposed by other circumstances to insanity, it is possible that these may act as exciting causes.” We are inclined to generalize this last remark, on the ground that, in peculiar constitutions, and possibly in all, under peculiar circumstances, there needs only irritation in certain portions of the nervous system, especially within the cranium, to bring on insanity; but we at the same time admit, that every one of the appearances enumerated by Mayo, has been met with in brains the possessors of which never shewed any symptoms of the disease. It may be thought that the fact of the brain being a double organ, or consisting of two hemispheres, each of which has similar functions, is sufficient to account for such absence, where the appearance has been confined to one side only; the healthy, perhaps even the increased activity of the other, subduing or concealing the tendency to morbid manifestation. But admitting this idea as perfectly probable, we recur to the former position, that the change of structure is often an effect or incidental consequence of insanity, not its cause; and we are convinced that, in the present state of physiological and pathological science, the phenomena of insanity, like the creations of poetry or the visions of a dream, which they somewhat resemble, must often be studied without the hope of deriving aid from the material system.

Without altogether coinciding with Heinroth, wħo seems to regard moral depravity as the essential cause of insanity, or of Mayo, who thinks “it is practically more useful to view this disease as a disease of the mind,” we are nevertheless satisfied that logic, ethics, and religion, as well as anatomy, pathology, and medicine, must be bad recourse to in developing and treating its phenomena. The best known exciting or productive causes of the malady shew the expediency of admitting both of the systems of interpretation thus briefly stated, more especially if taken in conjunction with circumstances which may be deemed antecedents or predisposing causes.

On whatever insanity depends, it prevails in particular families to a degree that warrants the title of hereditary; whilst, throughout many generations, not an example of it has been met with in others. In the former there are peculiarities of constitution, habits, and tendencies to the disease, which may be said to form a predisposition. Apart from connate aptitude, another species originates with individuals, from vicious indulgences, excessive occupation, neglect of general health, want of due mental training, errors in opinion and belief wilfully or carelessly entertained, relinquishment of business or pursuits which afforded salutary exercise of thought, the adoption of modes of life incompatible with previous tastes and propensities, and subjection to whatever excites or debilitates the nervous system above or below a certain point. Any of these circumstances may operate so as to occasion a susceptibility of the dis ∙
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ease, which, again, may directly result from them as productive causes. In some states, there needs only a sudden or a strong impression, to upset the reason, and bring on decided madness; and it even appears, that, whether from irritation, or some incomprehensible principle of mental contagion, this malady, like a plague or other pestilence, has often in rapid succession, visited a number of persons who were placed in similar circumstances-

As to the influence of sex, viewed in the light of a predisposition, we are inclined to believe, that the difference between male and female is trivial, if at all discernible, as affecting the number or proportion of the insane, though by no means immaterial in modifying the kind or the form of the disease. But, in considering this point, attention must be paid to the relative frequency or dominion of the different predisposing and productive causes respectively operating upon men and women. Insanity is very Tare before puberty; the period in which its visitations are most frequent is between twenty-five and sixty; but cases of it occur at seventy and upwards. What is called temperament seems rather to qualify the type, than to be of much consequence as to the amount of persons attacked. A predisposition arises from the malady itself, so that where, it has once occurred, there is an increased liability to attack. Comparing barbarous and civilized countries, insanity prevails more in the latter, and is scarcely known amongst purely savage tribes; but, whilst society unquestionably multiplies its causes, we are unable to detect in the improvement of our species .any abstract reason for greater proclivity. Upon the same prin- 'ciple, we ought to discriminate between education, taken in*gencral, and those misguided systems to which fashion, caprice, vanity, and avarice often lend a currency. Precor city of talent or genius, the idol of foolish parents, is a common enough source of imbecility, and madness, and early death. It requires anxious solicitude, but is not a theme for boasting. Mysterious as the fact may appear, there is a convertibility between derangement and some other morbid affections, so that the same individual may be subjected to them alternately or in succession, and this frequently throughout a long period of life; and there are cases equally marvellous, but more consolatory, in which, when an acute disease has inflicted torture on the bodily frame, the mind which for years did not emulate childhood, or was the victim of despair, becomes disenthralled, and asserts the dignity of human nature.

The productive causes ofinsanity are usually divided into physical and moral. Amongst the former, are injuries of the head, the abuse of stimulants, sensual vices, irritation of the intestinal canal, and morbid affections of the uterine system. The catalogue of the latter embraces all agencies operating directly upon the mind, and its own states or conditions. “Duplex est vis animorum atque naturae. Una pars in appetitu posita est, quae est ὁ pμ ὴ Graece, quae hominem· huc et illuc rapit; altera in ratione, quae docet et explanat, quid faciendum fugiendumque sit: ita fit, ut ratio praes it, appetitus obtemperet.”^[4. Cicero de Off. i. 28. ] Authors dispute as to the comparative influence of these two classes, some ascribing most to physical, and others to moral causes; but, whilst the distinction itself cannot always be nicely drawn, the calculations of observers, are greatly at variance. We allude particularly to Pinel, Esquirol, and Guislain, the discrepancies of whose statements, preclude any great confidence in the speculative conclusions deduced from them. What, then, shall be said of the doctrine maintained by Heinroth, according to whom, “il n’y a qu’une cause de trouble intellectuel, et elle reside dans une prédisposition de l’ame même: un moral dépravé; Thabitude des crimes?” To this the best answer, perhaps, may be given in the words of Guislain: « Le système de Heinroth, envisage dans ses details, n’est pas tout-à-fait dénué de vérité; car, si nous jetons un coup d’oeil sur les différens caractères des hommes, nous y rencontrons, à chaque moment, cette prédisposition.” “Si Heinroth,” he adds, “avait été moins général dans ses conclusions, s’il eût envisagé le moral sous le rapport qu’il a avec les fonctions du corps, sa théorie aurait, peut-être, pu mener à d’heureux résultats: au reste, cet auteur est abstrait et hypothétique, dans tout ce qu’il avance sur les aliénations mentales; il se livre, par fois, à des raisonnemens qu’on croirait à peine être fait par un médécin.” Dr. Prichard also admits that the system has a partial foundation in truth, but adds that “a great proportion of the cases of insanity which occur arise from causes independent of any moral weakness or defect.” Insanity by no means stands alone in the predicament of transgression; for the reasoning of Heinroth might equally apply to fever, rheumatism, and many other diseases. Wè can trace this disease, where the supposition of immorality would be as absurd as it is uncharitable. Jacobi, animadverting on Heinroth’s speculations, relates the case of an amiable woman, who, after years of most virtuous conduct, and active benevolence, especially towards insane persons, became deranged, but recovered before death. “Now let Professor Heinroth,” says he, “direct his attention to the character of this excellent individual, and from the point of view which he assumes, explain how the state of mental darkness to which she was reduced can be regarded as the result of guilt and evil conscience, connected as it was with long-continued ill health, and in all probability depending on a chronic bodily disease under which she had for a long time laboured.” Every one must have heard of similar instances. Foι∙ our own part, we should deem the authenticated accounts of violent madness arising solely from the want of food, and, still more of water, during shipwreck, conclusive against the doctrine, to the extent of its discarding physical causes.

Enough has been said to point out the sources of those numerous diversities in the forms and symptoms of insanity which engage the medical practitioner, and to which, at the expense of very little genius or learning, the principles of classification and nomenclature have been· applied. Were either physiology or metaphysics perfect, an arrangement of the entire phenomena presented by the disease, together with suitable titles, would be comparatively an easy task. But despairing of this, we content ourselves.with divisionsand terms, which, though objectionable on the ground of logic, or not comprehensive of every peculiarity, are convenient in the way of reference and description. For our purpose, two plans, having different characters, may be set down as contrasts; one aiming simply at utility to the physician; the other claiming dignity in alliance with mental philosophy.

Dr. Prichard, availing himself of preceding systems and his own experience, distinguishes four principal forms of this malady, namely: 1. Moral insanity, being a perversion of the feelings, affections, inclinations, temper, habits, &c., without any remarkable disorder or defect of intellect, and without illusion or hallucination. 2. Monomania, or partial insanity, consisting in the influence or dominion of some special illusion, which generates one train of thought, or fixes attention to a single object; whereas, when otherwise directed, the intellectual powers seem unimpaired. 3. Mania, or raving madness, denoted by general derangement of the understanding; the reasoning faculty being either entirely lost, or disturbed throughout all its exercises, and the patient, consequently talking absurdly on all subjects to which his thoughts maybe directed. 4. Dementia, or incoherence, characterised by rapid succession of ideas and emotions, hav [7:14:586]ing little or no connection with forgetfulness; diminished attention, and loss of judgment. Assuming that all the varieties of madness may thus be classified, Dr. Prichard thinks that it maybe described as a chronic disease, manifested by deviations from the natural and healthy state of the mind; these “consisting either in a moral perversion, or a disorder of the feelings, &c., or intellectual derangement, partial or general, or, lastly, confounding or destroying the connexions or associations of ideas.”

Heinroth’s method proceeds on a three-fold division of the mental operations, accordingly as those relate to feeling or sentiment, understanding, and will. Hence, we have, for the principal modifications: I. Disorders of the moral dispositions: 1. Exultation or excessive intensity, of feelings, passions, and emotions; and, 2. Depression, including simple melancholy, dejection without illusion. II. Disorders of understanding, or the intellectual faculties: 1. Exaltation, undue intensity of imagination, producing illusions; and, 2. Depression, feebleness of conception, imbecility of judgment. III. Disorders of the voluntary powers: 1. Exaltation, violence of will and propensities; and, 2. Depression, weakness or incapacity of will, moral imbecility.

Instead of commenting on these or other schemes of arrangement, we shall merely remark, that, in practice, the same case frequently displays considerable variety, so as to run through nearly any system of classification; that, in general, it is more expedient to consider special errors and defects in relation to the mind taken as a whole, than as restricted to one or other of its supposed compartments or provinces ;’ that, in whatever manner we view or divide the mental operations, it is advisable to regard their apparent perversion, as a modification distinct from either their excitement above or dimunition below what constitutes the healthy state; and that, whilst physiology assures us there are numerous diversities of functions, each of which has its allotted instrument, it is consistent equally with our knowledge and our ignorance to detect and specify the precise symptoms of their diseases rather than to find “a local habitation and a name” for them in any metaphysical nosology.

The subject of treatment is too technical, for a summary like the present; but a few observations thereon may nevertheless be hazarded. As the brain and nervous system, form an important part of the animal economy, and as they are affected by all the laws which regulate it, their morbid conditions must be treated according to those principles and plans which have been found expedient and serviceable in the maladies of other portions. The peculiar functions with which these parts are endowed, undergo changes which may afford corresponding indications of cure; but the latter cannot be fulfilled by agents possessing specific virtues, nor by any exclusive procedure. For unsound minds, as for fractured limbs, the boldness of quackery has hitherto announced few sovereign remedies; and, believing that there is really none such, experienced physicians have recourse to measures ordinarily available in their profession. They endeavour, according to circumstances, to subdue inflammation, to allay excitement, to remove irritating causes, to counteract depression, to promote digestive action, to regulate the secretions, and excretions, to promote or maintain strength; in short, to establish good physical health, as a requisite (sometimes the only one) to the acquisition and enjoyment of mental sanity. Attention to these points must commence and terminate with the case, which, however obstinate, or seemingly hopeless, ought never to be entirely abandoned, or left to the nostrums of unscientific keepers. Much more, not of a medical character, is frequently necessary, and can only be supplied in appropriate asylums. The benefits to be derived from these are immense, and cannot be too highly estimated. Contrary to a vulgar and unjust prejudice, the features by which they are best known most powerfully recommend them. They offer greater safety than can be secured amidst the erroneous tenderness, the injudicious efforts, the distraction, and often the dreadful apprehensions, of relations and friends ;—the retirement and seclusion, which they immediately accomplish, are proved by innumerable undoubted testimonies to be not only conducive, but, in certain cases, necessary, to allay irritability, destroy delusions, and give full effect to professional skill ;—whilst, in the control which they exercise, the self-restraint which they cherish, the regularity of habits which they are calculated to generate, the occupation afforded to the strong, the repose and solace to the feeble, the direct supervision and prompt help to all, there is a combination of positive and negative advantages,which not only divests insanity of much of its horrors, by concealing or subduing them, but actually obtains a victory over it scarcely equalled by medicine in any other formidable disease. In some establishments of the kind, the average of recoveries is from sixty to eighty, and even ninety per cent.; that of thirty or forty being reckoned small in our day. Any of these results is gratifying to humanity.

As a knowledge of the nature and seat of disease is essential to the adoption of a right method of cure, we can make large allowance for errors which long prevailed in the treatment of insanity. In truth, the works professedly written on this branch of medicine were few; and, before the middle of last century, it obtained comparatively little attention. The remedial measures were at first nearly altogether superstitious. For a long time they seem to have been mostly empirical, or suggested by incidental circumstances. In many instances they must be charged with cruelty, or at least gross want of sympathy; and very few of them, indeed, can be traced to any thing like a just theory either of mind or of the corporeal frame. Convincing proofs of these remarks'will be found in the Traite du Delire, by Fodéré, to which the reader is referred. Amongst the writers enumerated by this author as deserving of notice, are Coelius Aurelianus, who reprobated severity, and prescribed on the whole a gentle treatment, both medical and moral; Avicenna, whose employment of emetics, purgatives, bleeding, bathing, and the like, had an appearance of moderation, not a little contrasted, unhappily, by the use of the actual cautery and other harsh measures; Savanarola, a physician of the sixteenth century, remarkable for inculcating a judicious moral procedure, yet practising sundry modes of castigation to an extent scarcely consistent with humanity; Plater, Rivière, Sennertus, and others in the seventeenth century, diligent but rather indiscriminate advocates of what has been styled the antiphlogistic system; Mathiolus and Etmüller, who introduced certain preparations of antimony, with a view to the evacuation of black bile, which was long supposed to be materially concerned in one species of derangement; Wepfer, no less strenuous in his admiration of mercury, which he used with a liberal hand, sometimes-combined with opium; and Sydenham, the Hippocrates of England, whose sagacity in detecting diversities of madness was equalled by the appropriateness of his therapeutic efforts, but who does not seem to have had employment enough in this department of his profession to do more than point out the expediency of improvement. This may be said to have been effected gradually, by Mead, Morton, Wedel, Camerarius, Vogel, Lorry, Stoll, and other practitioners, till we reach the days of Willis in England, who, though not a physician, delighted his countrymen and astonished the world by his triumph over this malady, especially in the case of George III., at a period when, judging from prevalent opinions, the idea of success was regarded as almost visionary. His assertion, that nine persons out of ten had recovered, when placed under his care within three months from the attack, excited nearly universal scepticism; and, in allowing his majesty to make use of a razor, whilst he himself stood [7:14:587] by as a spectator, a great part of the nation, besides being alarmed, saw ground for doubt whether the royal patient or his attendant were the more insane. From this event, though the proportion of cures may have rarely been such as Willis declared, it is certain that medicine has acquired a decided mastery over the class of mental diseases. In proof of what is here stated, we might appeal to the results of practice in numerous establishments, or disclosed by various individuals through the medium of the press; but, instead of naming the most eminent of those who have thus promoted science, we deem it better to narrate an occurrence of high interest, which, in addition to the personal virtue it displays, sets forth the nature of an improvement in which humanity must ever rejoice.

In the year 1792, when a system of most barbarous coercion prevailed almost universally in the prisons of maniacs, the elder Pinel, after repeatedly, but vainly, urging that his government would permit the unchaining of patients in the Bicêtre, made personal application to certain authorities for this purpose, and eventually, though with much difficulty, succeeded. He was accompanied in his benevolent visit by Couthon, a member of the commune, who seems to have been rather forced than persuaded into the measure, and whose reluctance was increased when he encountered the horrid noises and wild aspect of the miserable beings upon whom the experiment was about to be performed. “Do with them what you please,” said he to Pinel, “but I fear you will be their victim.” The only reply was a commencement of the operation, by preparing as many strong waistcoats as might be required instead of the chains hitherto used. Twelve patients being selected for the trial, one of these, reckoned equal to any in ferocity, was an English officer, the particulars of whose history were unknown, save that he had been in fetters forty years, and that in a fit of frenzy he had inflicted a fatal blow on his keeper; a deed which, of course, led to greater restraint, and justified much caution in approaching him. Entering his cell without attendants, and speaking gently, “Captain,” said Pinel, “I will order your chains to be taken of f; and give you leave to walk in the court, if you will promise to behave well, and not to injure any person.” “Yes, I promise,” was the answer, “but you only laugh; you are all too much afraid of me.” “There are six men at my command, if necessary,” rejoined Pinel, “but believe my word, I will give you liberty, provided you put on this waistcoat.” The offer was silently but cheerfully accepted, the keepers retired, and the door of the cell was left open. After several attempts to raise himself from a position which had so long cramped his limbs, and having partly succeeded in managing his equilibrium, the captain at length tottered into the free air, when, looking up to the sky, he cried out with enthusiastic delight, “How beautiful !” During the rest of the day he moved about constantly, often expressing the pleasure he experienced; in the evening be went voluntarily to his own cell, where a better couch than he had been accustomed to was prepared for him; and during two years afterwards, he was not only undisturbed by such paroxysms as he had formerly exhibited, but rendered himself serviceable in the management of other patients.

The next subject of experiment proved to be a soldier of the guards, had who been in chains for ten years, and whose case had also called for extraordinary vigilance. Pinel, thoroughly acquainted with his delusions and character, promised the same relief; adding, by way of encouragement, that he should be employed in setting others at liberty, and, on good behaviour, taken into service. The desired effect was realized. Upon being set free, the poor fellow shewed at once his gratitude and obliging disposition; following Pinel with an anxious eye, performing every order given to him, and speaking reasonably as well as kindly to the patients. During the rest of his life, this man continued devotedly attached to Pinel, whose son, the narrator of these affecting incidents, speaks of him with tenderness as a partner in his own childish games.

In the cases of three Prussian soldiers, who bad been chained for many years, though in general calm and inoffensive, the experiment seems to have given them alarm, lest new severities were to be inflicted, and it proved inefficacious, as the patients, either worn out by grief, or having become quite imbecile, were insensible of the blessing conferred upon them. In the instance of a priest, advanced in life, who had displayed religious excitement in one of its most imposing forms, the release from chains, accompanied by a judicious order on the part of Pinel, proved very satisfactory. That able physician directed the attendants, instead of speaking to the patient, to practise his own exalted reserve. The result was such as imprisonment and fetters never did nor could produce. Gradually humbled and brought down to a level with mankind, he mixed in the society of other patients, and, ere a twelvemonth had expired, he was dismissed from the Bicêtre.

Such are a few particulars of a plan of treatment pursued in regard to more than fifty maniacs, of different countries and various conditions, with a success which at once surpassed hope, put the opposite method to shame, and, by its soothing influence, gave to other remedial measures a chance of operating beneficially. We should decline presenting a contrast to the picture, by adducing the horrid disclosures made in England, at a subsequent period by a parliamentary committee, were there not a good purpose to be served by keeping the memory of them alive, as an incentive and admonition.

The report to the House of Commons, dated the 11th of July 1815, commences by stating how sensible the members of the committee were of the importance of the matter entrusted to them, and their earnestness in performing the duty which they had undertaken, assigning the mass of evidence collected as a proof that their inquiries had been extensive. Then follows a sentence which may be liable to animadversion. “It was their intention to make observations in detail on the several heads of the examination taken before them, and on the several public and private establishments for the reception of insane persons; but, on reconsidering the whole subject, they have thought it advisable, in the first instance, to make their report more general.” This determination was more prudent than wise; for it may be remarked, first, that the primary intention, if carried into effect, would have been more satisfactory than the course actually adopted; and, secondly, that the reasons for the latter are by no means distinctly specified. The committee were very probably restrained by the consideration that the length of the inquiry had prevented a bill on the subject fi∙om being passed during that session. But, be this as it may, the report proceeds thus: “Your committee cannot hesitate to suggest, with the utmost confidence, from the evidence they now offer to the house, that some new provision of law is indispensably necessary for insuring better care being taken of insane persons, both in England and Ireland, than they have hitherto experienced, the number of whom appears to be very considerable, as the inquiries of the committee have convinced them that there are not in the country a set of beings more immediately requiring the protection of the legislature than the persons in this state, a very large proportion of whom are entirely neglected by their relations and friends. If the treatment of those in the middling or in the lower classes of life, shut up in hospitals, private mad-houses, or parish workhouses, is looked at, your committee are persuaded that a case cannot be found where the necessity for a remedy is more urgent.” After alluding to some houses, (a few only), in which the arrangement was comparatively good, and the treatment kind, the report proceeds: “But it is in proof, that there is just and great cause [7:14:588]of complaint against by far the greater part of the houses of this description, which have hardly, in any instance, been built for the purpose, and are incapable of being conveniently adapted to it;” the favourable examples, only four in number, being specified by the committee.

The observations of the committee in support of their general allegation, are then classed under nine heads, as follows, viz.: 1. “Keepers of houses receiving a much greater number of persons in them than they are calculated for; and the consequent want of accommodation for the patients, which greatly retards recovery. They are, indeed, represented by the president of the College of Physicians, and the physician acting as secretary to the visiting commissioners, who must be considered as the most competent judges on the subject, to be better calculated for the imprisonment than the cure of patients.” 2. “The insufficiency of the number of keepers, in proportion to that of patients, which unavoidably leads to a proportionably greater degree of restraint than they would otherwise be under.” 3. “Mixing patients who are outrageous with those who are quiet and inoffensive; and those who are insensible to the calls of nature with the cleanly.” 4. “The want of medical assistance applied to the malady, a point worthy of the most serious attention, as tire practice very generally is to confine medical aid to corporeal complaints; which circumstance the committee are the more desirous of enforcing on the house, as an opinion has been given by a respectable physician and another person of great experience, that when the mental faculties are only partially affected, medical assistance is of the highest importance.” 5. “Restraint of persons much beyond what is necessary, certainly retarding recovery, even beyond what is occasioned by the crowded state of the house.” Of this many instances are given by the committee. 6. This article relates to the situation of parish paupers confined in workhouses, regarding whom the committee made some inquiries, “as connected with the matter before them, although not expressly included in the reference to them.” 7∙ “Detention of persons, the state of whose minds did not require confinement. On this ground of complaint the committee had very slender means of information.” 8. “Insufficiency of certificates on which patients are received into mad-houses.” 9- “The defective visitation of private mad-houses, under the provisions of the 14 Geo. III. c.49.”

After this enumeration, the committee refer to Ireland, as demanding even more urgently than England some further provision for the safety and welfare of insane persons; and, having adverted to other topics, they express themselves as persuaded “that when the extent of the evil pointed out in this report shall be generally known, the visiting physicians in London and its neighbourhood will, as far as the professional calls upon them will permit, give additional attention to the duty they have been desirous of discharging.” The committee-also trusted that justices of the peace would “watch as narrowly as circumstances would admit, over the conduct of the keepers of houses ;” and that magistrates generally throughout the kingdom would think the condition of insane persons worthy of their attention, and convey information to the Secretary of State, if in any case of abuse a prosecution might be deemed requisite.” The committee concluded byresolving, “thatthe chairman be directed to move the house, that leave be given to bring in a bill to amend and enforce the provisions of the act of the 14th Geo. III. c. 49,-intituled, “an act for regulating mad-houses.”

Every one who peruses the evidence produced upon this occasion, must think the report itself less impressive than it might have been made, without any other labour than that of condensing statements and arranging facts. Members of the house, having access to copies, and taking interest in the subject, could no doubt supply its deficiency by the exercise of their own judgment, but at this period the public at large needed to be directly and powerfully roused. Looking, moreover, to the almost total absence of any strong public feeling of indignation regarding flagrant instances of cruelty and systematic mal-administration, one might be tempted to imagine that the committee either had not themselves been convinced by the testimonies before them, or were apprehensive of producing a dangerous excitement throughout the country. The discoveries at York alone,' indeed, were enough to inflame one province. But what was the ultimate result? We answer in the words of a journal,’ which lent its powerful aid in diffusing both knowledge and right feeling over society :—“Under their tranquil but steady guidance, (alluding to the Society of Friends, and to events long previous to the conimittee’s inquiry), a new establishment was formed, that began the great revolution upon this subject, which we trust the provisions of parliament will complete. Their institution, by gentle methods,^[5. See Edinburgh Review, vol. xxviii. ] &c., achieved what all the talents and public spirit of Mason and his friends had failed to accomplish. It had still better effects,—the complete overthrow of the old system.” 1 Nay, what was the immediate effect of the appointment of the committee, and the anxiety it displayed? Decided advantage to many sufferers. A speech of Lord Robert Seymour in the House of Commons, penetrated Bethlem Hospital, and produced reformation. But there remained much to be done elsewhere; and the fate of a bill for the better regulation of mad-houses, presented by the committee, showed how difficult was the task to secure complete relief. It passed the Commons, but got no further. It was again brought forward next session, and lost in the Upper House, or, more properly speaking, only postponed, with a view to the rectification of defects then suggested; and, even at the distance of several years, though the legislature interfered, there existed, in various establishments, abuses sufficient to justify the severe reprehensions of another committee.

Meanwhile, Scotland and Ireland, at different periods and in various ways, received the attention of the legislature. We cannot afford space to treat of what relates to both, or enter upon details respecting either. It is sufficient to say, that an act to regulate madhouses in the former was passed during 1815, and, inter alia empowered Sherifts-depute to make inspections throughout their jurisdictions, and to send reports thereof to two bodies, the Court of Justiciary, and the College of Physicians of Edinburgh; that the duty thus enjoined has ever since been performed with unquestionable benefit, though scarcely known to the public; but that, notwithstanding the good intended or affected by it, one great class of society, in the most unhappy of all circumstances, (namely, pauper lunatics,) is left without adequate provision. The opposition to the bill, proposed for their relief by Lord Haddington, entailed a stigma upon this country, which nothing but the most strenuous exertions, and unwonted liberality, will ever obliterate. Scotland, educated, and enlightened as she pretends to be, and with some justice, is disgraced by the absence of national or provincial asylums for these unfortunates; and, in regard to institutions of the kind, which approximate to a really public character, the metropolis is actually inferior to many of the provincial towns, to Glasgow, Dundee, Perth, Aberdeen, Dumfries, and some others. Of late, however, efforts have been made, by several benevolent individuals to wipe off this reproach; the subject has been examined in all its details; and as inquiry is the certain precursor of improvement, there can be little doubt, we should think, that the principal evils felt and complained of will, ere long, be, in a great measure, corrected. > (κ. κ. κ. κ.) [7:14:589]