Essay on the Classification of the Insane
Date: 2018-10-22T00:00:00+00:00
Keywords: Mental illness

The Project Gutenberg eBook of Essay on the Classification of the Insane

This ebook is for the use of anyone anywhere in the United States and most other parts of the world at no cost and with almost no restrictions whatsoever. You may copy it, give it away or re-use it under the terms of the Project Gutenberg License included with this ebook or online at www.gutenberg.org. If you are not located in the United States, you will have to check the laws of the country where you are located before using this eBook.

Title: Essay on the Classification of the Insane

Author: M. Allen

Release date: October 22, 2018 [eBook #58152]

Language: English

Credits: Transcribed from the [1837] John Taylor edition by David Price

*** START OF THE PROJECT GUTENBERG EBOOK ESSAY ON THE CLASSIFICATION OF THE INSANE ***

Transcribed from the [1837] John Taylor edition by David Price, email ccx074@pglaf.org

ESSAY
ON
THE CLASSIFICATION OF
THE
INSANE.

BY

M. ALLEN, M.D.

MEMBER OF THE ROYAL MEDICAL SOCIETY OF EDINBURGH, AND OF THE
MEDICO-CHIRURGICAL SOCIETY OF LONDON; CORRESPONDING MEMBER OF THE
METEOROLOGICAL SOCIETY OF LONDON, AND OF THE PHRENOLOGICAL SOCIETIES
OF LONDON AND EDINBURGH; HONORARY MEMBER OF THE LITERARY
AND PHILOSOPHICAL SOCIETIES OF LEEDS, HULL, AND WAKEFIELD, &C.

“Thou shalt not break the bruised reed.”—Is.

“The care of the human mind is the most noble branch of medicine.”—Grotius.

LONDON:
JOHN TAYLOR, UPPER GOWER-STREET.

PREFACE.

It appears necessary to explain the somewhat abrupt commencement of this Essay on Classification.  It was written, and even a great part of it printed, as a continuation of my defence in the case of Allen v. Dutton; but during the progress of printing, I soon became weary of this defensive attitude; and I also soon discovered, that so far from the ex-parte and perfectly false statements which were reported of the trial having any injurious influence, they rapidly expedited my success.  Thanks to the zeal and exertion of all those friends who were anxious to counteract the effect which these falsehoods were calculated to make against me; they spoke from personal experience, and with all the ardour which gratitude and justice could inspire.

The design, therefore, of publishing it as a part and continuation of my defence, was gladly abandoned.  Many of the first sheets, however, containing no improper allusion to this case, remain: I mention this, because it accounts for that which might otherwise appear an abrupt commencement, especially to those who have not previously read that defence.  On this account, I shall bind up that defence, (without additional expense) at the end of this Essay, for those who may wish to have this connexion before them.  It is necessary, also, to inform the reader of the origin of this Essay, for another reason, in order that he may understand (and I trust, also, under such circumstances, he will excuse) why there is so much personal minuteness in describing our system of procedure and exertions, which could not, and would not, otherwise, have been obtruded on the public.

But if, after being thus justified and compelled to come forth in my defence, the matter should be found useful, either to myself or mankind, it would be foolish affectation to seem to feel shame and regret by too anxiously apologising and explaining the origin and consequent peculiar complexion of this publication, or of those which may follow in regular succession.  And it is a truth, that it has increased my zeal and strengthened my resolve to prosecute that most useful of all studies, the study of mind,—its errors and diseases, with, I trust, so ardent a love of the truth, that I earnestly pray I may be enabled to trace every error to its source; for so much does the ground appear to me to be untrodden, that I pray also, that opportunity, life, health, and encouragement may be given me to complete the work I have to do, that, however slender my talents may be, I may yet feel that they have not been given me altogether in vain.

In explaining in this Essay all the plans necessary to the moral and physical purposes of an efficient system of Classification, I have had slightly to introduce many cases and subjects to illustrate my present purpose; and feeling that I had not done them or myself justice, I have said, on these occasions, I shall hereafter treat this case or subject more amply in that part of the work in which they will be more directly and specifically introduced.

Having thus incidently introduced many subjects without their being under any specific head or title, I shall, to enable the reader to form some conception of the matter, give in the contents something like a minute dissection of the whole.

From all this, and also from what I say in my former work on Insanity, as well as in Allen v.  Dutton, it will be seen that I have been induced to give pledge after pledge so repeatedly, that it becomes a serious matter, “partaking of the nature of a solemn obligation;” if, therefore, I fail to exert myself to redeem these pledges, I cannot have the excuse of those who promise without even intending to perform.

In the preliminary remarks of Allen v. Dutton, I say at the conclusion, “I find I must do even more than this, (meaning the defence); for my defence would still be imperfect without a short statement of my views on the insane.  For this purpose, I propose to write the following Essays:

1st.—On Classification, and Tables in Illustration. [vi]

2nd.—The different Divisions, into which I divide the Insane.

3rd.—Their General and Specific Character.

4th.—The Correspondence between Causes and Effects.

5th.—That the Study of Mind will evolve the Principle of Universal Generalization.

6th.—Their Moral and Medical Treatment.

7th.—A Selection of Cases in Illustration.

By this I shall be able to give a more full and perfect understanding of the peculiar character and proper treatment of this particular case; and by which will be seen, though imperfectly, something of those principles, and of that spirit which has pervaded the whole of our conduct to all those entrusted to our care.

“To do all this, in connexion with the above case, would not be right, were I influenced by any improper spirit; but as my conviction is confirmed by experience, that these unjust persecutions, provided we use them rightly, are for our good, I feel in no danger of indulging in any spirit, but a spirit of gratitude and forgiveness.”

From all this, (whatever variation I may make in the plan as I proceed) as well as from what I say in my first work on Insanity, where the same principle and mode of procedure is adopted, it will be seen that my task is not a slight one.  In the preface to that work, I say,

“Many subjects, not usually included in works of this kind, will be introduced; but as my reasons for doing so will best explain themselves in due course, and as one subject will be introductory to another, it is unnecessary to mention them now, particularly as it might excite critical objections, which I would rather wish to disarm than pretend to brave.

“Without presuming on the experience, knowledge, or the materials I may possess, of this I am confident, that so long as I am conscious that the love of truth is my pole-star, so long will my faith continue firm in this, that with patience and perseverance, and the love of truth for our guide, scarcely any man’s powers are so limited but he may hope to acquire some clearer views, or perhaps make some discoveries in the matters he has undertaken to investigate.

“The objects of my enquiries are very numerous, and involve so many either undiscovered or unadmitted truths, which are so closely connected with subjects of inquiry the most interesting, that I have adopted this slow and humble plan of proceeding for the present, and have suspended, for a while, my first purpose of publishing a systematic treatise on insanity.”

It is intended that each publication shall contain one subject, at least, in some measure complete, so that each part may have its distinctive title, and be had separately.

The study of mental philosophy, of which insanity is a very important part, is, of all studies, provided we are on the road where truth is the guide, the most useful to our moral state.  This belief was the first motive which induced me, now more than thirty years ago, to direct my medical attention to this most radically-important, though hitherto-neglected branch of the profession, as well as to whatever seemed best calculated to make me understand the sources of all erroneous and extreme views, and which a series of painful circumstances through life have excited and continually strengthened; but it is not necessary to state them: I may, however, mention that, as early as 1807, I visited lunatic asylums con amoré, and that in 1816, 1817, 1818, and 1819, I was engaged in lecturing on Mind and its Diseases.  Before this time, I had no conception that I should ever be exclusively devoted to this department of the profession, which circumstances at that period forced upon me.  I trust, however, that I have endeavoured to profit by the opportunities which this new situation afforded me of more fully comprehending the nature of mind, its connection with life and organization, its diseased manifestations, and of ascertaining the best modes of co-operating with nature in the removal of them; and, at any rate, it is certain that, for the purpose of lessening the miseries and increasing the comforts of those under my care, I, for the most part, have sacrificed every personal consideration.

From 1819 to 1824, I continued medical resident and superintendant of York Asylum; and on leaving it, it was voted unanimously, “That I deserved the thanks of the Governors, for my constant and successful efforts in establishing and perfecting the mild system of treatment there.”  I was again engaged in lecturing, at the request of several institutions, on Mind and its Diseases; soon afterwards, in 1825, I fixed on this situation, as the best adapted of any part of the country about London which I saw, (and I spent several weeks in the examination; nor have I since that time seen any I like better) to carry into effect my views of the treatment of the insane, either as respects the recovery or the comfort of recent or confirmed cases; for here, together with domestic comfort, diversity of occupations and amusements suited to their various states, the retirement, pure air, and sweet scenery around, afford ample scope for walks, without annoyance, and apparently without restraint; which, with judicious moral and medical management, combine many acknowledged requisites to assist the disturbed and diseased mind to regain its tranquillity, and in many cases to resume its healthy tone of action.

I shall only add, that all these views have been amply justified by the beneficial results on those entrusted to my care; so much so, that these results and my success have greatly exceeded my most sanguine anticipations.

I here gladly close these personal remarks, which have been forced from me, for self is a subject which it is seldom wise and always dangerous to introduce.

It only remains to notice another peculiarity in this essay, which is, that of having introduced some animadversions on legislators whose minds are not sufficiently pure or comprehensive to enable them to avoid the common error of overlooking general principles, and not to presume to judge and draw conclusions from the hasty, partial, and erroneous views they have acquired on the subject on which they legislate.  This has often led to, or been combined with, that great selfish view of making themselves and their property the chief good, not considering the real objects of legislative care, nor “that life is more than meat, and the body more than raiment.”  This it is which has corrupted all our laws, especially our criminal code, which was a system of legal murder, not justice, and a perfect scandal to the nation.

The same faults are visible in all they have done for the poor insane.  They have given an undue and exclusive consideration to property and to the few extreme and violent cases; treating them and all who have the care of them as criminals.  To live amongst them, appears to be deemed a crime, for which neither goodness nor talent can atone.  All which must, in various ways, have an injurious influence.  To banish these errors is to better the treatment of the insane.  This conviction is my excuse for introducing the subject, and which makes me anxious to prove, from experience, that such extreme cases hardly have any existence at all under a proper system of treatment; and, that at all events, this liberal treatment materially lessens the horror and danger usually conceived to attend these places.

Insanity is, no doubt, a terrible visitation; but why should we allow a false and unreasonable horror to increase it? and why should we thus sever our sympathy from a disease which more than any other requires it?  The medicinal virtues of the fruits of charity are best proved amongst them.  Grant that the disease arises from some remote or proximate ill-directed mental states.  Why should we have more horror of insanity, than many other consequences of ill-regulated minds?  To me, the foul ward of some large public Hospital, is incomparably more horrible and loathsome.  Such direct consequences of wickedness present the object before us in an aspect that makes it difficult for us to exercise any feelings of commiseration towards them.  Not so the insane.  But these are views, however, into the consideration of which I shall not enter in this place; but I mention or rather hint at the diseases of other organs, for the purpose of asserting that the reality and appearance of the miserable state of the insane is not so shocking as people imagine; but that still I allow it is an awful visitation.

When the gloom and horror at present thrown around establishments for the insane shall be cleared away, Dante’s inscription over the gates of Hell, will be no longer applicable to them,

“Lasciate ogni speranza, voi, ch’entrate;” [xiii]

this, or perhaps another passage from Euripides, has been imitated by our Milton,

“Here hope never comes, which comes to all.”

They will be considered houses of cure, or hospitals for the insane.

The erroneous and false impressions concerning the character and state of the insane, will be corrected.  The popular impression, that they are all violent and vociferous, destructive and dangerous, will be removed.  Hitherto medical writers, by selecting the most striking cases, have contributed their share to this popular error.  They have been led to do this, partly because they are cases, which more naturally arrest their own observation; but chiefly, because they are more easily described, make a more interesting picture, and are the most curable.  A statement of the recovery of such patients, though it may serve to exalt the writer in public estimation, is wrong in itself, and very injurious in its influence; for it increases the unreasonable horrors and false impressions entertained about the insane, and propagates and perpetuates the evils of which the public and legislature complain.  They receive impressions from extreme cases, which average about five per cent. then speak and act just as if all the insane were in a similar condition.

It would seem that these prejudices and horrors of the insane exist in a much greater degree in this part of the kingdom than they do in Yorkshire.  There I was in the constant habit of taking convalescent patients with me into family parties of the first respectability; and members of these families were also in the constant habit of visiting them as friends and acquaintances, and of inviting them to tea and to spend the evening at their own homes; and this practice, in most instances, had a very pleasing and beneficial influence.  This was the case with other institutions; but I have not found, neither have some others found, any such faith in, and sympathy for, the insane in this part of the kingdom, but quite otherwise; and yet I am certain, it is an example they cannot too soon imitate—its beneficial influence will bring satisfaction to themselves, will remove their prejudices, destroy their painful fears, and lessen the chances of the calamity invading themselves.  There is a protection around those who are striving to alleviate the distresses of others.

This difference, which I and others have experienced, makes me more anxious “to impress these views on others, and especially on those around me, in order that I may not be obliged, from too great a deference to the fears and prejudices of those I most anxiously wish to conciliate, to abridge the exercise and lessen the happy effects of a system which theory and feeling have suggested and compelled me to pursue; and which nearly twenty years’ experience and increased knowledge have confirmed and justified.” [xv]

So important have I considered just views of the insane, that I have added an Appendix for the express purpose of exhibiting a fair average of the general appearance of the insane.  With the same view, I have given a few portraits of such of these cases as are now, either themselves, or their friends, dead, or little known.  I had the same principle in view in my first publication, which induced me to give cases in regular rotation, “rather,” as I there say, “than the common mode of making a selection of extreme ones, that I might not give a distorted picture of the insane, nor add to the unreasonable horrors and false impressions on their state, as this has, I am convinced, been one cause of an improper spirit and conduct towards them.”

It is scarcely necessary, after what I have already said in the Appendix, again to guard the reader against the mistake of supposing that the cases and treatment described in that Appendix form any data or criterion for judging of the kind of cases and treatment in my own private establishment.  The medical swing, for instance, is stated as having been useful, in some violent cases of mania; but this was even then soon laid aside as objectionable; but it would be worse than useless now, because, under a system which does not cultivate the habitual exercise of the vindictive passions, cases in which it was of use, no longer exist.  In fact, to have recourse to any means which operates so much on the fears, whatever medical virtues it may appear to possess, is adopting a principal which philosophy and Christianity equally condemn.  It ought ever to be the aim of all persons IN POWER to call in no principle but that of the OMNIPOTENCE of SYMPATHY and BENEVOLENCE; and this PRINCIPLE is not to be excluded even from those whose spirits are imprisoned in bodily evils and diseases.

CONTENTS.

Page

On the buildings, grounds, situation, and system, necessary for all purposes of an efficient classification

1

Illustrated by an interesting case of recovery, No. 106.

5

Do. do. do.  No. 195.

12

On the common division of Insanity into Mania and Melancholia, not necessarily being separate classes of cases, but generally, merely variable states of the same case, requiring corresponding changes and modes of moral treatment

15

This view of these cases is confirmed, and their danger forewarned, by an examination of the natural constitution of mind and previous habits of those subject to these states

18

The delicate treatment which such cases often require, renders a separate house, where the medical proprietor and superintendant and family reside, of great importance, as well for them as for milder and convalescent cases

25

That cases under this system, are induced, when they know it from experience, or have it faithfully explained to them, to come and return without fear or reluctance

28

The great importance of this first step; and of making truth the basis.  The manner of doing this explained, and its beneficial influence stated

29

Illustrated by an interesting case of recovery, No. 335.

36

Ditto do. do.  No. 373.

45

Further observations on such cases and the above principles

47

That suitable classification and association is better than entire seclusion

49

Illustrated by cases, No. 425 and No. 429

51

On the beneficial influence of their being accustomed to the usual habits, manners, and privileges of civilized life

53

On the propriety of diminishing the prejudices which exist against the mere residence at an Asylum, if for the purpose of restoration

59

The evils of considering diseases of the brain as a greater disgrace, and as an indication of greater criminality than other diseases

61

That our aim in all our moral treatment should be, to call forth self-control, and all the better principles and feelings of the human mind; and that this important subject will be resumed

65

Illustrated by a case, No. 372.

69

Do. do.  No. 395.

71

That often we have only a choice of evils, and must choose the least

73

Illustrated by a case, No. 421.

75

Do. do.  No. 396.

77

On the use of exercise, and a retired situation for the purpose

78

An account of a system of cure, by being made to work, related by Dr. Gregory

81

Regular work always useful, when willingly undertaken, but not otherwise; easily managed with the labouring, but as difficult with a higher, class of patients

82

The danger of irritation, illustrated by a case

83

The contrary system of soothing, illustrated by a case

84

Further remarks and quotations on this subject

86

The talents and sacrifices all this requires, and their influence,

89

Notwithstanding all this apparent extra trouble, it is, when done from right motives, the safest and easiest in the end

100

That these views are based on the firm ground of Christian philosophy

108

CONTENTS OF APPENDIX.

Explanation of the object of this Appendix; which is, by giving a correct description of the state and character of a fair average number of old insane cases, to counteract the usual misconceptions and prejudices existing against them

111

Case No. 1.—His eccentricity, and exaggeration of his natural character and that of his family.  Has seasons of excitement

113

Observation 1st.—That the fluctuations of the animal spirits of the old insane often depend on causes which equally act on the sane; but, that from differences of state and circumstances, the effects are very different

115

Case No. 2.—Though in a very torpid state, yet he has (as every case has) his distinguishing peculiarities

116

Illustrated by a Portrait

116

Observation 2nd.—That mind is a garden which we must cultivate—a fire which requires stirring and feeding

116

Case No. 3.—An example, which indeed every one is, more or less, of the correspondence, as far as the remnants of mind exist, between his present and original character and organization.  His habits of employment, and its happy influence

118

Illustrated by a Portrait

118

Observation 3rd.—On the use of employment, and its easy application

119

Case No. 4.—That of an idiot.  Odd displays of an increase of animation

120

Illustrated by a Portrait

120

Case No. 5.—Torpid lethargy.  His natural character amiable

121

Case No. 6.—Though in a very singularly deranged state, evinced by the most extravagant fancies and exploits, which he delights to detail to every one, yet he is constantly employed, useful, and happy

122

Illustrated by a Portrait

122

Observation 4th.—The explanation of the peculiarity of his character, proves that, in all cases, truth should never be violated in our conduct towards them

124

Case No. 7.—A very singular case of periodical violence and sleep.  His habit of gyration described

125

Observation 5th.—His habit of gyration explained.  How far the generally alternate states of excitement and depression of the insane is the return of their primary disease, or for the most part, merely the habits acquired of irregularly expending their nervous energy, which fluctuations are further increased by the usual atmospheric causes of excitement and depression

127

The influence of temperature, moisture, climate, seasons, diurnal periods, atmospheric changes, and different years, on our health and spirits, and the type of our diseases, (and that this subject will be resumed), and how all this is modified by the states, habits, and circumstances of the insane

129

Why they are less subject to the prevailing diseases

133

The mental condition must, in all diseases, be considered

134

Illustrated by cases

135

How the state of mind and circumstances of the insane must modify these physical influences

136

Why this is differently exhibited by the insane, than it is by those who retain the power over their own spirits

137

That this view is proved to be correct, by the fact that these causes produce different effects by their being under different modes of treatment

139

That the various character of insanity is but the same excitement of the vital energies operating on different parts of the mind, according to previous or present habits and states

143

Hence, the insane are often caracatures of their own, as well as of family habits and character

146

The truth of this reasoning proved by the fact, that the greatest number of insane cases occur when mental conflicts and worldly struggles are greatest, and among those whose minds are ill regulated or miserably circumstanced; but still it does not necessarily and always follow that those whose minds are most wicked are soonest overthrown, but sometimes the reverse

147

The practical object of these observations

150

Case No. 8.—One of the extreme cases of furious mania, with a leprous eruption of the skin

151

Observation 6th.—Whether cutaneous disorders are common to the insane?  The treatment of this case

153

Case No. 9.—One proof, out of many, which proves, that the last strongest impression of their sane state continues prominent, even when their minds seem for ever lost to themselves and all passing objects around them

154

Case No. 10.—In which an injury on the head produced symptoms in correspondence with the phrenological office of the part injured

155

Case No. 11.—Apparently perfect dementia, and yet he is always employed

156

Observation 7th.—An excellent illustration that there is scarcely any insane person’s mind so much lost, but that still, provided labour has been their early common habit, they may with ease be brought into habits of useful employment, and which with such a class, should, both for their cure and comfort, be adopted, and arrangements made for the purpose

157

Case No. 12.—A female instance of scolding and kindness by turns

158

Case No. 13.—Constantly talking to imaginary objects, but still perseveres in his habits of usefulness

159

Case No. 14.—A beautiful exhibition of female kindness and love of children, as well as of many other symptoms which indicate that her former habits and general natural character and disposition have been amiable

159

Illustrated by a Portrait

159

Case No. 15.—Like a passionate and proud man in a constant state of inebriation

161

Observation 8th.—A striking instance of the correspondence between cause and effect

162

Case No. 16.—Vanity turned into stone

163

Illustrated by a Portrait

116

Case No. 17.—An unmarried female, useful as a laundress, and distinguished by her affection for cats and kittens

163

Case No. 18.—An extreme instance of the most furious excitement of the vindictive and destructive passions, and the habits and states to which his treatment had reduced him

164

Observation 9th.—The mistake of calling those facts, which are the effects of improper treatment, symptoms of insanity

166

Case No. 19.—Constantly like one muttering in his dreams.  Very good-natured

167

Observation 10th.—Perhaps his reason might have been re-awakened by constant judicious treatment and attention

168

Case No. 20.—An ideot, but employed

168

Illustrated by a Portrait

168

Case No. 21.—Was formerly in states of furious revenge, now gradually diminished in frequency and degree, by kindness

169

Observation 9th.—A happy illustration of the effects of kindness

170

Case No. 22.—Mind a perfect wreck—the effect of disappointed love

170

Case No. 23.—A very interesting caricature of political mania of a person of family and title.  He fancies himself constantly employed in making calculations and in doing many strange acts, all necessary parts of his mighty task of paying the national debt, which abstracts him from all external objects, and from all consciousness to his own bodily sensations

171

Observation 12th.—That the correspondence between the present and previous habits of mind, are, in most cases, and certainly in this, most striking

175

On the effects of heat and cold, and the changes of temperature in the insane

175

That we are not to mistake, which is often done, the mind, in a state of abstraction, being insensible to the external changes of temperature, for the physical system being unaffected by their action

175

That the changes and unequal diffusion of heat correspond with the general and particular state of the mind, and that in cases of pure intellectual abstraction, and in those excited by the bad passions, it is very different, and in cases of gradual decay of mind, it is altogether defective

176

To discriminate those differences is necessary to regulate our treatment according to the exigencies of the case

179

Observation 13th.—On the effects of intense study and general intemperance of the mind

180

That when study is blamed, I have often found that the intemperate feelings, wicked and irregular habits, were the real causes

180

That proper mental exercise is as essential to the health as bodily exercise

181

That it is a great error to suppose such exercise injurious or discountenanced by religion, provided always the mind is under the influence of right motives

182

Case No. 25.—A dignified exhibition of all the mental energies arranging and concentrating themselves under his self esteem

190

Illustrated by a Portrait

190

Case No. 26.—A caricature of a masculine female

193

Case No. 27.—One of extreme torpor and debility

193

Observation 14th.—That the character of all hereditary cases retains something of a family resemblance

194

Case No. 28.—A caricature of Johanna Southcott’s followers

195

Illustrated by a Portrait

195

Case No. 29.—A most horrible object of demoniacal violence suspended twice by a physical accident and disease

197

Observation 18th. [26]—On the doctrine of demons, and that the subject will be resumed in an after part of this work

198

Case No. 30.—A very interesting demonstration of the misery of ill-assorted marriages, and that the painful and powerful association of the original cause of the disease produced its frequent recurrence

199

Observation 19th.—On the evils of such marriages, and that the consideration of this important subject will be resumed in an after part of this work

202

Case No. 31.—A singular and most interesting case of an active, excitable, and overworked mind being overthrown by family afflictions, his power of personating various celebrated characters of different periods of the world, which he believes himself for the while to be.  His splendid eloquence and conversations with imaginary beings, &c.  Still, there were encouraging symptoms, that by proper and laborious methods of mental occupation, he might possibly have had the balance of his mind restored

203

Illustrated by a Portrait

203

General explanation of the peculiar complexion of this work, and of the Appendix in particular

207

Concluding observations, that the object of this Essay, and especially of the Appendix, has been to lessen the prejudices against and better the treatment of, the insane

209

LIST OF DR. ALLEN’S PUBLICATIONS.

CASES OF INSANITY, with Medical, Moral, and Philosophical Observations and Essays upon them.  1 vol. 8vo. price 8s.

“Thou shalt not break the bruised reed.”—Isaiah.

“The care of the human mind is the most noble branch of Medicine,”—Grutius.

Extracts from the Reviews.

“We consider Dr. Allen’s Work one of great interest.”—London Medical Journal.

“Dr. Allen’s work is well worthy the attention, not only of the Faculty, but of all persons who have relatives or friends afflicted with that fearful malady.”—Periodical Review.

“Strong, perspicuous, and concise; this work is deserving the highest estimation.”—Periodical Review.

“Our limits prevent our doing such justice as we could wish to this very able book.”—Union Monthly Magazine.

LECTURES on the Temper and Spirit of the Christian Religion; on the Preliminary Principles of Early Education; on Christian Forbearance.  Written for the use of Families, Schools, and other Institutions.—Price 10s.

Extract from the Reviews.

“We hope this excellent book will find its way, not only into the hands of all heads of families, but also into the hands of all persons engaged in the education of youth.  The tendency of the discourses is elevating and good; they are evidently written from a heart warm in the cause of humanity, Christian toleration, and for the improvement of the human mind.”—Monthly Magazine.

OUTLINES OF A COURSE OF LECTURES ON CHEMICAL PHILOSOPHY.  Price 5s.

Extracts from the Reviews.

“A Series of Essays, rich in ingenuity of argument, and abounding in masterly views on the great subject of Chemical Agency, as effecting changes in the modes of existence of physical matter: the whole enquiry is conducted with much philosophical acumen.”—London Medical Repository.

MEDICAL, MORAL, AND PHILOSOPHICAL ESSAYS AND OBSERVATIONS UPON INSANITY.

ESSAY ON CLASSIFICATION, Illustrated by Cases.

ALLEN versus DUTTON, consisting of Preliminary Remarks: Affidavits in Reply, and Affidavits in General; and General History of Mrs. Dutton’s Case, as they appeared on this trial.—Price 3s.

“A series of Facts very material to all having care of the Insane.”

The above Works may be had of John Taylor, Upper Gower-street; or through the medium of any country bookseller.

Also, by the same Author.

OUTLINES OF A
COURSE OF LECTURES ON CHEMICAL PHILOSOPHY.

ESSAYS OX CHEMICAL PHILOSOPHY.

In the Annual Review of Medicine and Collateral Science for 1818, of the London Medical Repository, the following notice is taken of these Essays.—

“In the Philosophical Magazine the reader will find a series of Essays by Mr. Allen; rich in ingenuity of argument, and abounding in masterly views on the great subject of chemical agency, as affecting changes in the modes of existing of physical matter.  These essays all go upon the principle, that in every change of existence that matter is capable of undergoing, caloric is given out or absorbed in the form of either electricity, of galvanism, of caloric, or of light.  Respecting the important question which has recently agitated the philosophical world, and which has been proposed as a prize in one of the Societies abroad; viz. In what does the difference consist between galvanism and electricity?  Mr. Allen observes, ‘In electricity we contrive, by mechanical means, to collect the loose and uncombined quantity from the earth and surrounding medium; and this we do in circumstances in which it has nothing to act upon, as free from moisture of any kind as possible; in fact, from every thing readily soluble in heat or in this power.  I would therefore, he says, define electricity to be the object of science which treats of the mechanical and natural means of separating this grand agent from some of its combinations, and of ascertaining its actions in this state.’  ‘In galvanism, on the other hand, this solvent power, this electric fire, is produced in circumstances in which it has substances to act upon; substances which are most readily dissolved in it; substances, in fact, which seem to form the grand medium between this power and passive substances, and which are partially dissolved in it.  And hence I define galvanism as the electric fire, or grand agent, only partially separated from its combinations; by which I refer principally to oxygen and hydrogen.’  After illustrating this principle, by referring to the circumstances in which the chemical agency of galvanism appears more conspicuous than that of electricity, he adds, ‘thus we perceive, that when the grand agent of nature is more perfectly separated from its combinations it is ELECTRICITY; when partially separated, GALVANISM.’  Of these views and principles we have a more ample illustration and defence as the author proceeds in his investigation; and the whole inquiry is conducted with much philosophical acumen.  Hypothetical, of course, part of it must be: but how different are the hypotheses of the present from those of former times, when science was a sort of poetry, and dealt in abstractions and inventions!”

ESSAY
ON CLASSIFICATION.

The better to explain and illustrate my ideas and views on the important subject of Classification, I shall, in the first instance, give a brief description of the present plans, arrangement, and manner of proceeding, in my own establishment.

Fair Mead House, Leopard’s Hill Lodge, and Springfield, with appendages to each, constitute my present establishment at High Beach; and I wish to have it most distinctly and most fully understood, that they are simply for classification, of a more general or more specific nature; and consequently, besides the advantages derived from having three houses, I have (as far as I could) made arrangements in each for this purpose.  Leopard’s Hill Lodge, where I have more especially made arrangements for the purpose of classification, consists of a front, or what may be called the family portion of the house, and galleries behind, with appropriate rooms for patients requiring more restraint.

To show that these houses are merely for the purposes of classification, I may mention, that there is no sort of difference in the three houses, excepting that in the one generally and latterly inhabited by ourselves, we prefer having those to whom our individual and more immediate attention may be useful.  The same patients are even sometimes at one house, and sometimes at another, according to their state; and sometimes for the mere purpose of change.  In fact, the greater part of our first class of patients have been occasionally at Leopard’s Hill, and this with the knowledge and approval of their friends.

As I have published some hints on this point, and addressed them to the Commissioners in Lunacy, I may be permitted, in order to show I have long entertained the same views, to quote two or three passages.

I there state, “that two establishments on the same grounds should be allowed and encouraged for the purpose of Classification.  My reason for this alteration, in the Act relative to such places, is, that large and crowded houses are decidedly objectionable, from the greater chance of noise and disturbance, from their being less healthy, and from their assuming more of a prison-like appearance, than of a family mansion.  With two, we can adopt a better and more complete method of classification; and it is a consideration of very great importance, that in one of them the proprietor and his family should reside, and devote themselves to recent, partial, slight, or convalescent cases.”

As I conceive this plan of two establishments for the purposes of classification, to be of the highest importance, and essential to the moral regulation, as well as to the cure of the insane, so far from avoiding any investigation of either the principle of their adoption, or their mode of management, I wish the most exact knowledge to be obtained of the one, and invite the fullest scrutiny of the other.

I would have not only two establishments in the same grounds, but these sufficiently separated so as to prevent annoyance; and, not only this separation, but I would have one to consist of a male and female part, sufficiently separated from each other.  This arrangement I have at my own establishments, which consist of Fair Mead House, and of Leopard’s Hill Lodge, for males, and Springfield for females, with appendages, and separate cottages; and more especially, I would have each house divided into a front and back part, and this front part so contrived, that in appearance it should be sufficiently distinct from the other, so that patients might feel, on recovery, that removal to this part withdrew them from the more painful associations of their past state, and afforded them solace and encouragement; thus might their recovery be expedited, and the chances of relapse lessened.  In the domestic part of the establishment, the proprietor and his family should reside.

In many cases, an entirely separate house is required.  I have known cases, the cure of which would have been apparently blighted and blasted for ever, if they could not have been wholly removed from, not merely the real, but the apparent, association of former scenes and circumstances, and this without any change in their servants and medical treatment and attendance, which is also essential.  Yet it is perfectly true, that in other cases this association is not so injurious as most people would imagine; the dawnings of the light of the understanding are, for the most part, so gradual, and the mists of delusion so gently steal away, that there would be a greater shock given by a sudden transfer to rational scenes and real life, than by their continuance in the place where they might be at the time.

I have often, with feelings of wonder and admiration, had occasion to observe these occurrences.  I have seen a convalescent patient very much attracted by, and perfectly delighted with, the strange remarks, speeches, and conduct of another inmate, sometimes fancying it was meant purposely for his amusement and diversion; and on whom, refined wit would have been lost, while the incongruous combinations of unguided thought, which no wit or ingenuity can equal, appears, and is the very essence of wit to him.  Notwithstanding the truth of all this, there are other cases,—cases of more sudden convalescence, where all this would shock and horrify, and produce a revulsion of feeling, most dangerous to them in their delicate and fragile state, and perhaps permanently fatal to their recovery.  This is more particularly the danger in the incipient stage of convalescence in some violent cases of mania, [5] and where I am quite certain delicate and judicious attention have been essential; and where first, perhaps, removal to the family part of the house, then removal altogether to our own house, was apparently their salvation.

No. 106, admitted April 11th, 1820, aged 65.

This was one of the cases apparently saved by such timely attention, and which I intend hereafter to describe more particularly, for the purpose of illustrating both the medical and moral treatment of many similar cases of insanity.  I shall, however, state so much of the case now, as will be sufficient to show, that there is not only a critical period of the disease, when judicious medical and intellectual attention arrests and prevents its transition into another and equally dangerous form of over-excitation, so dangerous, that if allowed to take its course, it not unfrequently ends in dementia, but also, and more especially to show, that in all cases our moral treatment must have in view the nature of the existing causes, in order that we may be able to adopt the most suitable methods of counteracting their effects,—a part of treatment which has hitherto been either wholly overlooked, or else exercised without much knowledge and discretion; although I am certain it is of great importance in the treatment of all curable cases of insanity, and in many cases so important, that by such methods we may ultimately succeed in removing these causes altogether; and removing them, remove also the fear of their again (at any future time) being allowed to have any baneful operation.

This person, who was a dissenting minister, had always been reckoned by all parties, one who entertained gloomy views in religion, and pushed these into extremes; his zeal was equally violent and vindictive, and he besides possessed a mind with every opposite quality in excess, and which had always, as far as I could ascertain, been in a state of irregular and discordant excitation; it is quite certain that during many years past, it had been habitually kept in a very painful and irritable state, by several causes, and one more especially deserving notice.  He lived unhappily with his wife and her friends,—instead of union and harmony, all was dislike and contradiction, perpetual storms and altercations, which had just before terminated in a separation between himself and them.

Thus, from the condition of his own unsettled and ill-constituted mind, his gloomy and vindictive views in religion, his variable and irritable temper, and from the nature of the domestic excitement under which he had suffered most severely, it was easy to trace the distressing and awful form of his derangement to the causes which had produced it.

He was in a state of the most furious mania;—his was one of the most violent and distressing cases I had ever seen.  It is impossible to convey any adequate conception of its appalling nature.  His language was obscene and vulgar, and his horrible oaths and blasphemous speeches were poured forth for some weeks without ceasing, and without sleep, with a volubility, rapidity, and a voice so loud, and so foaming with passion, and with such a frightful expression of countenance, that even those most accustomed to such scenes, and of the strongest nerves, trembled before him.  He had a demoniac energy and eloquence, which was, indeed, of the most harrowing and awful kind.  It was truly terrific! for even at a distance, his voice sounded like a river escaping from some narrowed part, and rushing with impetuosity over every thing that would impede its course.

Had a short-hand writer taken down his ravings, it would have proved that this picture is far from being an overcharged one.  One principle subject of his furious raving, was his favourite doctrine of Election; or rather, perhaps, I ought to say, his blasphemous doctrine of Reprobation.  He was constantly denouncing every one (and against myself he was peculiarly severe) as lost, whose belief on this point was not, even in phraseology, the same as his own;—calling on God to execute vengeance upon them;—then blaspheming God, that his prayers and commands were neither heard nor obeyed;—taunting and cursing Him with a contempt which no language can describe;—calling his clemency weakness, and his not executing his decrees a proof he did not possess the power he pretended to have.  In fact no one could hear and see him without feeling shocked, and without having a conviction forced upon him that there must be something wrong—some perversion of truth in those doctrines, as well as in his own mental system, out of which all this dreadful spirit, and all these terrific extremes originated, and of which this case appeared a Satanic caricature.  It is a truth, that there is no error or perversion of truth that we may not perceive in reviewing the history of mind caricatured, and perhaps in a still more striking manner among those who are in confinement from being directly denounced insane.

On the subsidence of his excitement, he was overwhelmed with the perfect recollection of all he had uttered during the utmost fury of his dreadful ravings, and his state was truly miserable and deplorable.  In this state I took great pains with him, treated him with every possible kindness, and endeavoured to show him every possible mark of my confidence: one instance of which may be mentioned.—I gave him, at a very early period of his convalescence, a set of manuscript sermons, all in loose slips, and which he read with great pleasure, and preserved with great care.  They were affectionate moral discourses, strictly, I believe, in agreement with the spirit of Christianity, though not on any peculiar doctrines; for in these I had purposely avoided all doctrinal points, although doctrinal views may, when properly presented, be the best preventives, and in some cases the best medicines, in the cure of insanity; but the circumstances in which I was at that time placed, appeared to forbid even their most cautious introduction, and were scarcely admissible to an audience consisting of some of almost all denominations.  However, he said, the spirit of these discourses just suited his altered state of mind, for he himself felt horror-struck at the views which had led to such awful consequences.

Though no one can feel more than I do, the necessity of not busily trying to proselyte or unhinge unnecessarily any one’s settled opinions, yet this was an extreme case, and in such cases, where cure seems to depend on the proper administration of counteractive views, every other feeling should give way to this conviction; but at the same time, every thing depends on the judicious mode of stating these sounder views.  This case was a remarkable instance of the necessity of such management; and where such views were apparently of the utmost importance to his comfort and peace.  But it would require a separate Essay to defend what I conceive those sounder views; and even were I to give this striking case as a specimen of their happy influence, I still might lay myself open to cavils and objections.  I shall, therefore, in a separate Essay, bring forth all the arguments, and exert all the power I possess in their defence.

Though his furious state was so unusually violent, yet it was of long duration, and after it had left him, it was some time before he was able to overcome the painful reflections which came over him; he however recovered, and returned home in the September following, since which period I have received many, and almost constant proofs of his great gratitude and attachment to me, one of which is worthy of being stated.

In the autumn of 1824, he walked about a hundred miles to see me, and not finding my place of residence, he called on a medical acquaintance, to whom his description of my kindness and attention, and their happy influence upon himself, were so powerful and eloquent, that this new and accidental medical acquaintance, became from that time to the present, my first and warmest medical friend in encouraging me to establish myself in my present residence, and to whom I have to attribute the origin of all my success; so that this recovered patient’s gratitude, who followed me unexpectedly, was the first step in my progress, and was the sole foundation of every thing which I have done or exists in this place.  It was my only introduction.  I may be permitted, therefore, to acknowledge my great obligations to the warm-heart friendship of the person, of whose melancholy state I have just given a general description, as well as, the medical friend to whom I have alluded.

No. 195, admitted October 27th, 1821.

This case, I shall hereafter show, was apparently saved by this separation from former associates, at this critical period of convalescence, and he was one who required very superior and intellectual attention.

He was a young man of some talents, and of various pursuits and acquirements, by far too many to be perfect in any one.  Born with a large proportion of the family failing, his vanity had been fed by flattery and example, so much so, that it might be said he was bred in vanity’s hot-house; and ultimately, from over excitation, and too little collision with the world, he fancied himself a second Crichton.  Of course with such an estimate of himself, it could not be otherwise but that he was constantly meeting with disappointments and mortifications, on his entrance into his profession, and the real business of life.  From these causes, as well as from an increase at this time, of parental embarrassments and mortifications, (and home had always been an atmosphere of perpetual storms), from an hereditary scrofulous habit, and from his self-made morbid state, his mind was at last overwhelmed.  But it is not my intention to enter into all the details of his history, further than to prove that the causes which produced his disease, and the form his insanity assumed, perfectly corresponded with each other.

On his arrival he was in a very exalted state of over-excitation; he was the greatest of men in every mental capacity and acquirement; all Philosophers, Poets, Painters, and Linguists, that had been, or were in existence, were nothing in comparison with himself, nor were their works to be compared with those he intended to execute, and the basis of which he had already formed in his own conception.  Nothing could exceed the vain and pompous displays of his talents and acquirements; and it is impossible to conceive, from the difficulty he had to support his pretensions, with the defects under which he then laboured, what a very painful and ridiculous exhibition it produced.  Still his vanity and exaggerated estimate of himself, combined with his ineffable contempt for others, remained unchecked.  One feature was very striking; he possessed considerable powers of imitation, in the exercise of which he took great delight, and in pouring forth his contempt against others, he did it with the attitude and voice of Kemble; it was almost impossible not to feel the force of his manner, and against myself he was particularly severe, and his poignant expressions of contempt and indignity were most provoking and overwhelming.  When, however, a change of state occurred, I felt so interested for his trembling and doubtful situation, that I had even a bed put up for him in my own room.  I had always some case of this kind about me, and no one can conceive the sacrifice of health and comfort it cost me.

This case, as well as the last described, may perhaps be detailed more particularly in their proper place, to illustrate a general principle, of far more importance than even moral treatment.  And even in moral treatment it will appear how important this general principle is, to enable us to perceive how we may best counteract the effects which may have arisen from the operation of baneful causes: for by it we shall be able to trace errors to their source, and without this, we can never counteract and cure them.  And this we can only do with certainty, by possessing correct views of the origin, nature, and constitution of the human mind, and of the correspondence which exists between physical effects, and mental or spiritual causes: out of which views this general principle will be educed, and it will be found to be of universal application.

In this case it is evident, a system of moral and intellectual treatment was required, in order to counteract and cure the effects which had arisen out of the soil in which he had existed, very different from that which was necessary for the previous case; and it is equally evident, without such knowledge, it is more than probable that neither of these minds would ever have been restored to their balance, or right state.

He recovered, and his character appeared much improved by his severe visitation.  He became very much attached to me, and wrote a great deal for me, as my amanuensis.  It is worthy of remark, that he remained of choice for a considerable time after his health was re-established, on account of the dread he felt at returning to the place and circumstances where his disease had arisen.

It is remarkable also, that after he had been some weeks in private lodgings, assisting his father, in his profession at the Assizes, he, the very night previous to their intended return home, made his escape to America.

It is singular, that the first case I had, as an insane patient, after I left York, was his sister.

I might select a great number of cases, where I conceive such attention was apparently one principal cause of their recovery, and which I took under my more immediate care on this account, and to whom I devoted much of my time, and made many sacrifices of my comfort and convenience.

In order to show the importance of such attention, it will be necessary briefly to explain the description and character of the cases to which I more particularly allude, and that it may appear that these opinions are not new, I shall quote from the first part of this volume already published.  I there say, “What is called mania and melancholia, are for the most part effects of the same power being overactive, but overactive in different directions.”  If the distressing passions are overactive, we have melancholia,—if the animal propensities, we have furious mania,—and if the exhilirating passions, we have an exuberance of joyous activity.

“This is a view not before taken, and will account for much of the difference in the effect from the same cause.  This melancholy, or state of depression, caused by the activity of the depressing passions, is to be distinguished from the state of exhaustion and debility, which succeeds some violent paroxysms, or which follows an exhausted state of body and mind from overexertion, and assumes either an apparent melancholy character, from torpor or partial suspension of mind, or is in reality a case of melancholia of the most miserable description, from the exclusive activity of these depressing passions, which are then more likely to become the sole masters of the field of action.” [16]

In the former mentioned cases, it appears, that the exciting and depressing passions alternately take on habitudes of action, so that it is still over excitement, but the effects, from its direction being different, are diametrically opposed to each other: in the one case, as I have already said, this nervous energy is employed in exciting into activity the passions which exhilirate: in the other, those which depress us.

This excitement of the depressing and exhilarating passions alternately, is the most striking characteristic of the insane.  It is true, that both these states or stages of the disease, if long continued and not well managed, are necessarily followed by a third state of exhaustion.  The systems of body and mind are wholly worn out by exertion, and require rest to recruit and manifest their renewed power, but changes from one state to another is only a partial exhaustion; another class of feelings become active, while the former are suspended, so that the melancholy and “high state” are for the most part, states of mind or changes in the direction of its energies, and not that the melancholy have less than the furiously malignant or joyous maniac, of that power which is equally necessary to mental activity of every description.

For instance, I have known the same person sent at one time as patient under the influence of religious melancholy, originating in erroneous extreme Calvinistic views; and at another period in the most joyous state of religious excitement, from having come under the influence of extreme Arminian views.  On the same principle, I have by the most laborious process of argumentation and the statement of what I conceive right views, produced a counter-impression, given another character and form to the disease, and in some cases, on this principle, effected a cure. [18]

As these cases are much more common, and these views of much more importance than mankind, or even medical men imagine; and as many who possess a susceptible constitution of mind, similar to those whose cases I have described, are living in the world in this fearful and continual state of mental excitation, and of course, may be on the verge of the same precipice, it is right they should be warned of the danger to which they expose themselves.

It need scarcely be mentioned, that the present constitution of society is not in a healthy state.  It is not bound together by that order and sympathy which should exist, but on the contrary, discord and disseverment prevail to an extent which seem to threaten its decomposition and destruction.  But too many individuals are intoxicated with the fury of their various passions and inordinate desires, and mad with the endless anxieties and reverses they produce.  One part of society, as well as one part of the mind, is at war with another.  I wish it, however, to be particularly observed, because I shall have to revert to the fact hereafter, that it is not so much these exciting causes, or even the sad effects of these feverish and wasting passions, that are in themselves so dreadful and fatal, as they are when accompanied or followed by the conflicts and condemnations of conscience.  Wherever there is the endeavour to overturn and sacrifice some confirmed and good principle, that which is lowest is encouraged to struggle for pre-eminence, and the mind suffers extreme misery and distraction.

It is in this way that we often find minds that have much that is amiable about them, are soonest overthrown; but in all cases when (as in this and what is in fatality next to this, perpetual domestic discord) the fire of our spirits, which should give life, health, and support to our exertions, is not united and clothed with that wisdom which ought to diffuse itself in every useful direction; it is in an altered and dangerous state, producing, according to this alteration of state, disordered function, acrid secretions, and if long continued, disease; and when disease is established, its state is further altered, so as literally to “eat up the flesh,” and in one form or another burns, scathes, withers, and consumes us, [20] but I need not now enter into all the various evils, miseries, and conflicts in which the mind is involved, and the dangers to which it is exposed, nor the corresponding physical effects, nor show that even were these extremes exclusive and improper, activity does not exist, but where the understanding seems most completely called forth; still we have reason to fear that we pursue the important duties of civil life, whether it be the weighty matters of legislation, or the scarcely less responsible exercise of the learned professions, or what ought to be the binding and sweet influence of faithful dealings in trade, and our common intercourse with each other, in an improper spirit, and from improper motives, and not with that singleness and simplicity of heart for each other’s good, which alone is useful and safe; which we could not fail to do, were we sufficiently aware, that in as far as we depart from this purity of spirit, our views of truth must be perverted, and our healthy vital energies changed, causing fever, paralysis, or some morbid state, and all our sympathies poisoned and deranged.  But I might find enough of matter for illustration without detailing the effects of over-excitation, arising from our mad desires after wealth, fame, and distinction, or even the consequent distracting and overwhelming miseries of misfortune, poverty, and starvation, in the modes and amusements of fashionable life, to which sensitive persons, and especially those who have made themselves morbidly sensitive, become, as in the case last stated, the victims.

Excitable and cheerful persons often fall into states of depression, purely because they have drawn too largely and exclusively on their exhilirating passions; whereas, had they drawn equally on the depressing passions, they would have tempered and balanced each other, and kept the mind in its right state; and such is the constitution of the world we live in, that our duties require that both should have their relative and appropriate share of exercise.

Persons, often, in company, think it necessary exclusively to exercise the exhilirating passions, and they return home not only with these feelings exhausted, but with the depression passions assuming in their turn an over-active state, and in this state they perhaps encourage a spirit of discontent, and peevishness, making sad havoc of domestic peace, and producing an unhealthy state of mind, an alteration in the state of the nervous energy, generating an acrid and morbific matter in the system, and ultimately disease, both in themselves and others. [22]

It is too well known that many who are all life and energy in company, sink on returning home, into this state of apathetic melancholy.  This is especially the case with those persons who are betrayed by their buoyant spirits and powers of pleasing into extremes, exciting themselves by stimulus and other excesses; and as they are often minds originally of the most amiable constitution, they afterwards, when left to sober reflection, are overwhelmed with self-condemnation; and should they, to raise their sinking spirits, have again recourse to stimulus, the evil is increased, and the effects are terrific.  It is to these painful and conscientious conflicts, as much, and perhaps more, than the mere physical effect of their excess, that the disorder and destruction of their minds are to be attributed.

I mention these simple and common forms of irregular and discordant excitation, to shew that from such causes the susceptible mind gets into the habit which may terminate in the more fixed and serious form of alternate states of irresistible excitement of the exhilirating and depressing passions, constituting insane cases, just as we find those of the alternate over-excitement of the kindly and benevolent affections; or, of the angry and malevolent passions terminate in corresponding states.

How many persons live in this baneful domestic atmosphere of perpetual storm and sunshine?  And hence, when the mind of one of these becomes morbid, and the malevolent passions assume the exclusive sway, they are said to hate those they formerly loved, which is simply the more permanent state of their former fits of anger; in fact, every form of incipient insanity may be traced with more or less ease, to these corresponding causes.  This may not be popular doctrine, but it is the truth.

Many married persons get into this destructive habit of indulging in these extremes of anger and affection; and where they are known to have existed in no common measure, they propagate this their state of mind in their children, and which is afterwards most effectually and successfully educated by their conduct and example; and hence such domestic circles are fruitful soils in producing insane cases.  I could state some fearful examples of the truth of these observations, but I would gladly throw a veil over these melancholy pictures of human nature.  The sword may slay its thousands, but the demon of domestic strife is much more destructive to man’s life, health, and peace.

I mention all these matters, to show that such are exactly, in their incipient form, the cases which require the most delicate, intellectual, and laborious attention.  The delusions which occur in an after stage, arise out of these habits, and until they appear without disguise, it is difficult for strangers to pronounce them insane; and yet these are causes which produce the worst and most incurable consequences; and if cure is to be effected, it can only be by a system of management, which by calming and tranquillising the mind, will best allow the physical effects to subside.  But when this painful and irritable state of mind has been of long duration, and some chronic and inflammatory state of insiduous, slow, and gradual growth, is the consequence; then a longer time will be required before cure can be brought about.  I may here remark, that it is absurd to suppose we can expect this, by moral or medical means singly,—they must always co-operate, and never be separated in the mind of him whose object is cure: and it is a most important and fearful consideration, that on their treatment depends the increase or diminution of their disease.

To show there is the greatest difficulty, delicacy, and anxiety required to be exercised in the management of these cases, it is only necessary to mention, that they are precisely those, who, as I have already said, though they are either in reality, or ultimately prove the worst and most dangerous cases, can nevertheless, in the incipient stage of the disease, and more especially immediately after being placed under moral restraint and medical care, exert their remaining power of self-control over their delusions and extravagances, so as to appear, for some considerable time, perfectly sane.  Indeed, it may be considered as a general fact, that where the insane person preserves his individuality of character, and his alarming state is chiefly indicated by his having his prominent peculiarities in the natural constitution of his mind in a highly exaggerated and caricatured state, (which is always a most unfavourable prognostic, and more particularly if this exaggeration be grounded in self-love,) the incipient stage assumes this delusive appearance.

It is to such cases, in their incipient stage, that I have hitherto devoted myself, and which I have had for the last fourteen years constantly about me.

In devoting ourselves to such cases, we are doing no more than we conceive to be our duty, nor do I conceive this explanation makes, in all cases, our own house superior to others.  In some cases, the reverse is the fact.  This explanation is intended to show the necessity of classification, and division of labour.  In many cases, so far from giving a preference to ourselves, I would give a preference to the surgeon, matron, and attendants at the other houses.  In many cases, they become attached to them, and prefer remaining with them.  Besides, a mere change is sometimes useful, and often operates as a powerful check;—they are in their favourite house,—they behave ill, and a threat of removal restrains them.  All this requires attention, and is assisted by the arrangements described.

To show this is no new and fallacious view, manufactured and brought forward for the mere purpose of my own defence, I beg leave to quote from an explanation of the drawings and plans of the houses and grounds, which were, according to the Act of Parliament, sent to the Quarter Sessions at Chelmsford, now many years ago.—Speaking of Leopard’s Hill establishment, I said—

“At present there are no very violent cases, and some that were so are convalescent, and when patients become convalescent, they are often removed to my own house at Fair Mead, in order to relieve them from painful associations; by contributing in every way to their comfort and their happiness, and by devoting ourselves more particularly to them, we secure and expedite their cure; this removal is often most expedient and useful, but it sometimes happens, [27] that they prefer remaining amongst those to whom they have become attached; and they are then removed out of the galleries, and have apartments in the front and family part of the house.”

“Fair Mead House, I wish it to be distinctly understood, is an additional house in the same grounds, but at a sufficient distance to serve the purpose I have just stated,—the purpose of humane classification, according to their state.  In fact, agreeable to these views, it may be considered as a necessary appendage to the others.  It enables us the better to discharge a most important and delicate duty, that of more closely watching, and more directly and personally attending to patients during the incipient and critical stage of convalescence; a period when, wanting such attention, they are driven by a revulsion of feeling into their old state, or sink from exhaustion, and die.”

“Again, by having three houses separated in this way, and for these purposes, it not only enables us to divide the males from the females, but also to devote ourselves to those to whom a more delicate and intellectual attention may be useful, in this critical period of convalescence, and it also enables us to select such, whether old or recent cases, as are capable of participating in, and not deranging very much the enjoyments of the domestic and social circle.  All which will include convalescents; some incipient cases; some that are melancholy; others that are imbecile; some that may be permanently deranged, but very full of good nature, and not troublesome; and some that are hopeless upon some specific point, but pretty correct on all others.”

Another consideration of greater moment is, that persons necessarily attach an importance to the house in which we more generally reside, and even some recent slight cases feel none of that painful repugnance in coming to us, that is usually felt on the bare mention of a place of confinement, [28] and many come not only without reluctance, but with voluntary pleasure.  In my tables, sent to Lord Lyndhurst three years ago, I there show that more than one-third of the patients then received, had been so brought, and “that I had always held forth to them the promise that they were coming as visitors,” saying, “as long as you behave as such, you shall be treated as such.”  When they forfeit this, they are deprived of their privileges, and, in some cases, they may be sent to Leopard’s Hill establishment; and in others, a threat of their being removed from this to Fair Mead, answers the same purpose.

I consider it a point of the very first importance, that truth should never be violated; we must, therefore, on no account, at any time, deceive them, and more especially in the first instance.  If we begin by destroying confidence, we destroy the basis on which alone all moral good can be effected.  Without truth there can be no confidence.  It is quite a mistake to suppose a system of deceit is necessary for the purpose of more quietly accomplishing their removal from home.  I can conscientiously assert that my own experience proves the contrary, and that I have not found in a tithe of the cases which I have had to manage, any very great difficulty in persuading them willingly to accompany me, more especially if I had sufficient time given me to ingratiate myself into their good opinion and confidence, which I do, by fully explaining the object of their removal, the treatment I intend to adopt, and the means to be used to make them as happy as possible in the new circumstances in which they are about to be placed.  Whenever this was done, and I found them in a state to understand it, which is the case in a greater number of instances than most persons imagine, they have then almost invariably been persuaded to come willingly, without using any arts of deception.

I delicately, but candidly tell them, that they are considered to be insane, that the disease has produced some change in their usual mode of feeling and thinking, that the object of the proposed visit is their good, and that if they will only go willingly along with me, I pledge myself they shall be treated as visitors, unless their own conduct should oblige me to act otherwise towards them.  If after all the pains I take, (and no pains can be too great to accomplish my object in this faithful way,) they still refuse, I then tell them, that their going is a matter quite settled, and cannot possibly be altered; that they may as well make a merit of necessity, and like rational beings, go at once with cheerfulness, and good-will, in order that they may still receive the good which I have promised them.

If after such explanations they do consent to go willingly, or even without much force, a grand point is accomplished; for in this case, suppose after their arrival they grossly commit themselves, and justly forfeit their claim to the treatment I have promised them, and I am obliged to abridge them of the liberty they had really given them, they then feel and often acknowledge the justice of any change in their treatment, which is the result of their gross misconduct, and they exert themselves with the hope of regaining the liberal privileges they have forfeited, and thus from their desire to be considered and treated as visitors, they put forth into operation what is of the greatest importance, the valuable principle of self-control.

In most cases, while nothing is more consoling to their afflicted spirits than friendship, and the society of those they love, nothing is more grievous to them than its loss.  To form such a feeling, is very difficult; but by beginning and proceeding on these principles, showing them that truth and justice and kindness are the basis of our actions, we establish a wonderful moral influence over them.

It will often happen, however, in stating to them that their minds are not considered in a right state, they will stoutly deny it.  I then assure them, I shall be very glad to find they are right, and hope they will not force upon me by their conduct, a different conviction.  Stating to them very gravely, what I understand has led to this conclusion, saying, if we judge by the acknowledged rules of the world, they must confess there is something very unusual and strange in their words and actions; but at the same time, I trust they will not in future commit or lose themselves, as it appears they must have done.  In which case I promise them I will myself befriend them, and endeavour to replace them as soon as possible, in the confidence of their friends, but which I can only do when their conduct will enable me to transfer to their friends the confidence it has given me.  Many, of course, assert, that what others call insanity, they know to be correct and proper; then I say, we must have time to examine it at leisure, that it is too weighty a matter to determine in haste.  Where the person cannot be made to comprehend all this reasoning, of course other methods must be adopted, according to the nature, exigencies, and the state of each patient.  In fact, it is impossible to state all that is, or ought to be done on these occasions; we can only hint at the spirit of the procedure, for every separate case requires its own appropriate plan of procedure.

To show the propriety and advantages in this method of proceeding, I shall state the important fact, that some few have at once been cured, without removal from home, by the powerful influence of its candour and honesty.—And in all cases, when, after all this labour and delicacy, they are removed, and are, subsequently, on the same principles, and in the same spirit, treated with every possible indulgence, and the greatest degree of forbearance, even overlooking many lesser faults, and waiting, until, as we say, “they break out and commit themselves,” in some very decided manner, so as to furnish us (even in their own estimation) with a very palpable plea to abridge them of their indulgencies, they have then forced upon them the conviction of their error, and are obliged to acknowledge the justice of any change that is made.

It is singular, that many have on this plan been speedily cured by the self-restraint this system conspired with other things to give them; and many others have recovered without ever feeling or considering themselves as having been treated as insane patients; and most of them do not consider themselves as under any confinement whatever.  Not more than about 3 p. cent. suffer any personal restraint, and not one for years under any constant personal coercion, and we have, at times, been for months together with not more than one patient whom we were afraid of trusting in the grounds alone.

I must more particularly advert to this most powerful argument in favour of this plan, which is, that it conduces to form the habit of self-control, which is the habit above all others which ought ever be our aim to form.  It ought to be the primary object in every moral plan of cure.  But I shall have some further observations to make on this principle, and the various means which tend to form and increase it, in another place.  I only hint at these things at this time, for the purpose of showing that all these delicate, modified, conditional, and encouraging plans of superintendance are assisted by the arrangements I have described.

In fact, so important have I considered this plan of Classification, that when I first came to Leopard’s Hill Lodge, I contrived the best way I could, with my means, to have a family and front part of the house, independent of the galleries; and should I be called upon to extend my plan to meet my increasing success, and should my life be spared, and time and health permit me to follow out my views and to build an Asylum upon a larger scale, I should keep these principles of Classification, as well as many others, in view, in the plan I should adopt, for I am more and more confirmed that they are extremely important; and I may mention as proofs, that at all the houses we have had parties in the front part, who would, in their conduct and pursuits, and social enjoyments, put to shame many families who are reckoned perfectly sane.  We have visiting parties from house to house, with the usual amusements of cards, chess, billiards, cricket, &c.  For some months we published a weekly newspaper of considerable interest.  Nor is it unworthy of notice, that some articles of a very superior kind in our critical Journals have been written in this place; all which gives it more an air of social enjoyment and comfort, than the coldness and repulsiveness usually attendant on the loss of liberty, and forms within ourselves a little world of interest, better suited, I believe, to the state of the inhabitants than the real world could be to them.  It is, in fact, a System of Classification, originating, if not in the most enlightened, at any rate in the most humane considerations of the various states and maladies of mental aberration, and which enables us to exercise a powerful influence over those under our care.  It is in agreement with our conviction of the importance of that which may be laid down as a maxim, that, if the mind be maintained in a state of tranquillity, the affections are more likely to be brought into a right state, the effects of functional disorder, or even disease, to subside; the mists of delusion to clear away; and the light of the understanding to resume its province.

The last and most important consideration is, that this plan has induced several (especially before the letter and spirit of the law were opposed thereto) to return voluntarily on their perceiving symptoms of their returning malady.

I could give, were it not that motives of delicacy forbid me, some very striking and interesting cases, illustrative of these facts and these principles, and the beneficial results which arise out of them.

One of these cases, illustrative of this necessity of more delicate and intellectual treatment in certain states of mental aberration, I am advocating, I may mention.  It is that of a lady who had been, upwards of seventeen years, in alternate states of excitement and depression, and in confinement all this time, whose recovery I attribute, combined with medical means, principally to such attention.

No. 335 was first admitted of her own accord, March 5th, 1826, aged 56; discharged May the 4th, 1826; again returned of her own accord, June 30th, 1826 [36]

This case was a most striking sample of a great number of a similar description, who are the subjects and victims of this perverse and irregular mental excitation, which become, without proper management, more confirmed cases of mania and melancholia, which continuance in this state for a sufficient time, produces disease, and disorganization of the brain, and ultimately terminates in incurable dementia, either of a partial or more general character.

She was a person of a highly sanguine temperament, possessing by nature great capabilities, but her intellectual powers had not, by education or circumstances in life, been so much developed and increased as her energetic feelings, which were most excitable, strong, and active.  If her education had equalled her natural endowments, her understanding would have assumed no common pre-eminence, and in which case her feelings would probably have been brought under due subordination.  It was not, however, so much even the defects of her education, as the circumstances of her life, and especially those connected with her religious associations, which were incomparably more calculated to increase the strength and activity of her feelings, than to call forth and cultivate her intellectual powers; indeed, instead of any such cultivation in any proportionate degree, there is every reason to believe, these associations had a paralysing influence; nor perhaps were any habits of self-control, or any mental restraint whatever, formed or acquired in this connection, except that which operated too exclusively on her religious and conscientious fears; and hence, without entering into the details of her history, the result was the formation of a character, such as is most common under the present artificial systems and circumstances in modern times, ill formed to withstand the effects of adverse or prosperous fortune.

It was her lot to pass through these extremes, and after suffering many reverses, mortifications, disappointments, bereavements, and some matters of a private and most afflictive nature, she had a rheumatic fever, when the explosion took place; then the weak and over-exercised parts of her mind displayed themselves in an irregular and increased degree.  Her state was an exaggeration of her former energetic and acute nervous sensibility, operating alternately on the depressing, and exhilirating passions.

When she came to me, for she had been in various places previous to this period, she was in a state of religious melancholia.  Her conscientious fears were dreadful, and her misery extreme.  She conceived herself condemned to eternal punishment—she was already in torture.  When in this terrible state, she had more power to engage one’s commiseration, than any patient I ever had.  Her descriptions of her own state were extremely eloquent and affecting, and her appeals for sympathy were overpowering and irresistible, and I was absolutely worn out and overcome by the fatigue and misery I endured in my efforts to console and restore her.  I shall always continue to feel the painful effects of my anxious exertions in this and several similar cases of melancholia; but no case and perhaps no number of cases, shook and overwhelmed my nervous system as this did, (unless it be one through whom I had a nervous fever); not merely because of her extreme agony, but my own health and spirits were then in a very depressed state, having been for years a martyr to chronic enteritis and gastritis.  I mention this to account for the obligation I felt myself under, to dissever my sympathies from this overwhelming influence, and to transfer her to the kind care of Mrs. Allen, to whose lively and cheerful disposition, uniform and judicious kindness, combined with great firmness and gentleness, soothed and softened her melancholy state, and, in time, tempered the extremes to which she had been subject, and kept her spirits in a better direction.

One great art in this management was that of Mrs. Allen’s making her useful as her deputy in every thing in the house, either in matters of a household nature, or in attending upon others.  And notwithstanding her own miserable state, no one was ever more qualified for a nurse, or better understood every thing connected with the arrangements of the table; and her very perfection in all these matters, had, before Mrs. Allen came, been the cause of an increase rather than a relief to her misery, for she became the object of great jealousy and dislike to my housekeepers and matrons, on this score: but now it became a source of employment, amusement, and diversion.  Though she long continued to possess, for the most part, this disposition to fall into the same miserable state, yet it never afterwards degenerated into that dreadful agony and distraction I have described.  At times it ceased altogether, and her more happy state supervened, when she was full of hope and self-esteem, of life and activity, the very antipodes of her former state.  But it is altogether astonishing how both these states were lessened and kept in check by Mrs. Allen’s manners, combining the most inflexible firmness with admirable tact and good nature.  When all her almost exhaustless fund of sympathy failed, it was always found a sufficient check, and at once to call forth our patient’s powers of self-control, for Mrs. Allen to say that she really could not bear the association of her miserable state any longer, and that they must separate; and it was very seldom necessary to hold out the threat, that she must be removed into the gallery and back part of the house.

Perseverance in this system of unwearied and perhaps unequalled kindness, gradually mitigated and diminished these alternate states of excitement and depression; thus shewing to demonstration, that in this way, with the aid of medical treatment, the excitement of the depressing and the exhilirating passions may be checked and restrained, so that in time they may regain their due equilibrium;—that instead of these cases degenerating, as they have almost always done, into hopeless cases of mania or melancholia, and often terminating in complete dementia, they, by this system, might in process of time regain the due equipoise, or the relative and appropriate share of the exercise of the different functions of mind, and be brought, as in the case just described, to repossess the greatest of blessings, the healthy action of the feelings and faculties in the discharge of those duties which constitute alike the object, the usefulness, and the happiness of her present existence.

I mention such cases, because I shall hereafter do all I can to draw attention to similar mental states, as the common causes of insanity.  That almost all cases begin in this way, but that they are disguised or kept from our view, with those who possess self control, until (unless the tendency be cured by such efforts to disguise it) they at last burst forth into some form of insanity; and indeed insanity itself may be defined generally, the uncontrolled over-excitement, imbecility, suspended or paralysed state of one or more of the mental functions, arising from some previous faulty state of action.  I shall have to show hereafter how all these cases might in their incipient and curable stage have their specific modes of moral and medical treatment applied in order to counteract and cure them; and by this method incurable cases would be almost unknown.

At the same time let it be observed, that such treatment requires much more delicate and intellectual attention than is in the power of those who for the most part live amongst the insane, and, have the direct and important management of them; and that, in justice to ourselves, I have a right to assert, that where such treatment has existed, and does exist, it is not a matter which money can remunerate, and that in this case there was no pecuniary reward.  It was no such inducement that had any influence in regulating the conduct which we pursued with such unwearied diligence; and not merely was there no pecuniary reward, but even gratitude was wanting for a time; for this attention was so delicate, that she was always made to feel she was the person conferring rather than receiving favours; so that when she was relieved from her depressed state, and it was superseded by the excitement of the exhilirating passions, her self esteem dwelt only on the favours she imagined she had been conferring.  She was useful, but her usefulness was more for her own good than for ours.  Indeed, we paid the price of patient endurance to a degree and extent which can never be conceived or known, still less was she in a state to perceive or appreciate our motives, therefore she conceived, and was confirmed in the impression that she was actually the person to whom obligation and gratitude were due.  This impression was the last remains of her disease, or of that over-excitement of the exhilirating passions, which with the longer-continued paroxysms of the over-excitement of the depressing passions, constituted the character of her case; and she left us, not merely before the “high state” had solely subsided, but at the very time when we felt it to be our duty to restrain and subdue it, and of course when she felt most mortified, and was least able to perceive and appreciate our motives, but which she has since done to our entire satisfaction.

She has now been upwards of three years in the world, engaged in useful and active duties, and though she may be liable to extremes, and be too susceptible of the action of exciting causes, yet I have every reason to believe, that experience has taught her the necessity of counteracting and restraining their baneful influence.  I am told by her friends, that now collision with the world having smoothed down the peculiarities which her long seclusion had contracted, her character appears much improved.

I might detail many such cases, and prove that cures have apparently been effected by this intellectual and delicate attention, and more especially in some slight and incipient cases.  But I may also state, that many cases of the most serious kind have been so treated, and have recovered.  I particularly have in view, two cases of the most determined suicidal melancholy, that were so delicately treated and watched, that they were not themselves aware for months, they were even in a place of confinement, or they had an eye of anxiety constantly watching over them.  To this watchfulness and constant exertion to amuse and divert them, I principally attribute the gradual diminution of their melancholy, and ultimately their recovery.  These cases, No. 412, and 373, have each returned three or four times of their own accord, and have each time, under this system, gradually recovered.

Is it not then of importance that we should do every thing possible to lessen the present feelings of horror associated with such places? then might we expect to find them come of their own accord, have confidence in their medical friend, concur and co-operate in the plan marked out for their cure, and the consequence would be, that we should find them generally recover.

No. 373 came of his own choice,

And was a most distressing case of hypochondria, which had from various causes been increasing upon him for about twenty years; and when he so came, he was in the most depressed and melancholy state possible.  His whole mucous membrane had long suffered from chronic inflammation, and was in a state of the greatest irritability.  He was, in less than nine months, altogether another being; his habits were altered, and his health greatly re-established; and this person was one whose cure was partly to be attributed to my mode of amusing him.  I do not mean to enter into his particular history, or his medical treatment, for it would itself make a volume; but I introduce a brief notice of his cure, for the sake of illustrating the foregoing principles of Classification, and to show that a variety of methods are necessary to accomplish the object we ought ever to have in view, and that it would never answer to apply indiscriminately the same medical or moral treatment to any two cases.

A plan was proposed to spend an hour at least with him every evening, and this hour I devoted to that of detailing to him a history of my own life, always contriving, in the style of the Arabian Nights Entertainments, to break off suddenly at some point of interest; and these conversations, had they been committed to writing, would have formed some very amusing volumes.  The great art and merit of the plan consisted not merely in making them amusing, but in contriving to introduce, without appearing intentionally to do so, (that I might not in his over sensitive state offend him), facts and views calculated to counteract the errors and bad habits into which he had fallen.

In all cases it is necessary to know every extreme view and error to which the human mind is liable, and where these exist, as inmost cases of insanity, to endeavour to counteract them by clear and beautiful views of the truth.

What is of the greatest consequence, is that it is still more necessary to know the best mode of making truth admissible and effectual; for it ought never to be forgotten, that in all cases where error and delusion exist, even if we know those views which are best calculated to counteract and remove them, still more depends on the manner, circumstances, and spirit in which we present and apply them.  I am anxious to draw attention to this truth, because it appears to me the world at present has no adequate conception of this great and necessary art in its propagation: still less does it appear that mankind, nor even many medical men, have formed any proper estimate of the vast importance of such a system in the treatment of the insane: a system, however, which requires that we should be fully acquainted with the history of man, and be able to perceive the causes and effects of false and perverted views of philosophy, morals, and religion, and above all that we should possess a knowledge of the constitution of the human mind, with all the specific differences of every individual case.

I mention this case with others, to show that there are many instances where something more than common attention is required, and that to such patients we devote ourselves, and have them at our own house for this purpose.  These are precisely those who are over excitable.  They form a large proportion of the insane, and in their incipient stage, their minds are rather in a state of perversion, than absolutely lost or deranged; whose cure depends on correcting this perversion, and restoring the relative and appropriate share of activity and energy to each function, in the exact measure, proper place, and according to the order of their right distribution.

If then, these houses serve these various purposes, who is best able to judge when such purposes can be best served?  The exact moment lost can never be regained! a wrong word, or even look, may unhinge, and bring on a relapse!  It is a species of discipline like that of a nursery;—children commit some fault, and are removed from the objects of their affection as their punishment; and no punishment is greater or more effectual.  Some of our circle break out into passion, or give way to some strong propensity; they are told it won’t do, and are removed: they soon promise to behave better, and return.  The causes are sudden and unexpected, and sometimes trivial; and this mild medicine, instantly administered, has a wonderful influence.  Sometimes the attendants will be better suited for some specific cases at one house than at the other; and it may be injustice to other patients to change them, but great justice to change the patient on their account.

When I state to patients’ friends these matters, and the difference of these houses, I say decidedly, that in those cases to whom our attention, and the comforts of the domestic circle may be useful,—those friends should, if they possess the means, prove, by a corresponding remuneration, that they duly estimate such delicate attention; particularly as they do generally acknowledge that it is not in the power of money to compensate for the expenditure of so much feeling, and being subjected to so much annoyance.  In all cases where it appears this attention and placing them in our domestic circle, will contribute to their comfort or their cure, we, as a matter of feeling and of duty, treat them with equal kindness and attention, always giving considerations of comfort and of cure, the first place.

Besides, most cases are improved by association with those of a different character.  I have seen many old torpid cases, and a still greater number of recent cases of suspension of mind, cured by being placed occasionally among those who were in a more lively state, and this after every other means had failed.—And it is reasonable, for nothing can exceed the comic effect of the strange and laughable speeches and manners of some among this class of patients; and, in the case, the treatment of which was altogether mistaken or mis-represented, there was surely nothing incredible or unreasonable in saying I preferred, that this lady should have the chance of being roused out of her torpid state, by remaining at Leopard’s Hill Lodge, where of course, she might have these means occasionally put in force; for all the females were then at that house, and at the same time, she did possess the advantage of every possible delicacy of attention from Mrs. Allen, who was, with her children and an additional number of servants, then living altogether at that house.

The case No. 335, was, as I have already mentioned, always soonest roused out of her melancholy condition, by being placed for a short time in the midst of such association.  It would be contrary to the economy of providence, as exemplified by the constitution of society, to place all the melancholy in one class, and all the lively in another.  The truth of this argument receives additional confirmation, when we consider, which I am prepared to prove, that insanity in many cases, is produced by, and consists of, an aggravation of the original peculiarity of character, and therefore it is evident, that such collision, like collision in the world, is making one extreme tend to correct another, though of course, the worst and most dangerous cases of every description, are not in their treatment included in this principle.

Many instances are recorded, of two opposite cases, by being thrown together, neutralizing, like an acid and alkali, each other; that is, the melancholy have been roused by the lively, and the lively depressed by the melancholy, and thus both have been brought into a better state.

Sometimes the insane have been cured by witnessing their own case caricatured in that of another.  For instance, two proud men, the victims of their gradual and progressive false estimate of themselves, assume in their insane state, the same crown and kingdom, and by witnessing each other’s delusion, have been forced to feel that one must be in the wrong; and thus, one or both were brought to reflection, and ultimately to a more sound and sober state of mind.

Even the imbecile and idiot, are roused and improved by such associations, more than they had been, even with every endeavour to improve them, while they were in a state of seclusion.  I have lately had two very remarkable instances of this kind.

No. 425 and 429.

Imbeciles, though they were from birth, they improved after their arrival; the scene was very different to the solitude in which they had been placed; the common scenes and circumstances of life, had not had sufficient power to rouse the dormant and torpid state of their mental functions, while scenes and circumstances, that are in themselves very painful, were better calculated to arouse in their moping minds, something like feeble efforts of reflection.  I have seen them behold the strange antics of others, with intense wonder and interest.—Often they will catch the contagion of laughter; and thus if the understanding has no part in the matter, their spirits, at all events, partake of the merriment of the scene around them; and though insanity, considered in the abstract, is a melancholy thing, yet it is a truth, that there is much more of merriment than melancholy among the insane.  I believe their average of happiness is greater than would be found among the same number in the world.  Those who look with prejudice from impressions received from a few extreme cases, of course make out a different conclusion.  Again, there is another consideration, which further proves that the happiness of these imbeciles and ideots may be increased by such association.  They have still the blind affections craving for food, and they here find food for their gratification, better suited to their state than they could find it in the world.  These affections without understanding, are to the world repulsive.  It is strength of affection, guided by strength of understanding, that so powerfully attracts and binds society together.  In this sphere they cannot revolve; here, eccentric as it is, they have one better suited to their state.

I daily see ideots and imbeciles taught to walk arm in arm; evidently pleased and gratified that they have objects for their blind affections to rest upon.  Besides this, it is a very singular and remarkable fact, that this exercise of their affections, has contributed to the improvement of their physical state.  Whatever increases innocent enjoyment, and contributes to happiness, are excellent medicines.  Peace and purity of mind are better than physic.  This exercise of their blind affections conduces alike to their felicity, and to the preservation of their health, by innocently keeping alive the regular and happy exercise of their animal spirits, by the only outlet they possess, that of their blind and instinctive affections; and hence, it is very remarkable, that in consequence of their animal spirits being no longer pent up, as was formerly the case, they are not now so liable to those sudden bursts and irregular displays of passion, to which they had been the victims; and what is still more remarkable, they are in better health, and not so liable to cramps and colics, which had been the corresponding physical effects of their irregular nervous distribution; so that even with them the truth is evident, that it is not good to be alone; the little world they live in is better suited to amuse and contribute to their happiness, than the quietude of civilized life, from which they could receive no enjoyment, and to which they could only give pain.

It is also worthy of remark, that some patients sink more rapidly into moping idiotcy when kept in a state of perfect seclusion, than they even do in the society of those who are insane like themselves.

I have seen patients who had not been accustomed to any association, who were, on their first arrival, in appearance, manners, behaviour, especially in their mode of eating, and their dirty habits, scarcely human; it was evident from all this, that they had long been unaccustomed to the common conveniences and decencies of life, as well as from the astonishment and delight they first exhibit, on these things being restored to them;—to see companions, and to find a table with the usual appendages of knives and forks, &c. evidently excited pleasing reminiscences and gave them additional life,—their improvement (externally, at any rate) was rapid, and, by continued attention, their restoration to habits of cleanliness complete.

To insure all these as well as many other advantages, and to make cure the primary object, requires not only that the proprietor should live amongst them, but also that he should be a medical man, and one who has experience, guided by upright principles and Christian feelings; for if medical men of talent and character could be induced to undertake this painful and anxious life, submitting cheerfully to all these sacrifices and inconveniences, much might be done to improve this neglected department of medicine, and augment the number of cures; at all events, most certainly increase the comforts of the incurable, and lessen the distressing apprehensions of those who fear the accession, or recurrence of mental aberration; yet notwithstanding the paramount importance of these things, so ignorant or so blinded by prejudice is the world on the subject, and so little aware of the talents and capabilities required for such a situation, that they consider the very name of a proprietor, and superintendant of an asylum, as absolutely sinking the character in public estimation; whereas no class of medical men, were they efficient, should be considered more honourable, because none can be more useful than those who devote themselves to the cure and comfort of persons in this most lamentable state.

When the gloom and horror at present thrown around establishments for the insane shall be cleared away, Dante’s inscription over the gates of Hell, will be no longer applicable to them,

“Lasciate ogni speranza, voi, ché ntrate;” [55]

this, or perhaps another passage from Euripides, has been imitated by our Milton,

“Here hope never comes, which comes to all.”

They will be considered houses of cure, or hospitals for the insane.

The erroneous and false impressions, concerning the character and state of the insane, will be corrected.  The popular impression, that they are all violent and vociferous, destructive and dangerous, will be removed.  Hitherto medical writers, by selecting the most striking cases, have contributed their share to this popular error.  They have been led to do this, partly because they are cases, which more naturally arrest their own observation; but chiefly, because they are more easily described; make a more interesting picture, and are the most curable.  A statement of the recovery of such patients, though it may serve to exalt the writer in public estimation, is wrong in itself, and very injurious in its influence; for it increases the unreasonable horrors and false impressions entertained about the insane, and propagates and perpetuates the evils of which the public and legislature complain.  They receive impressions from extreme cases, which average about five per cent. then speak just as if all the insane were in a similar condition.

Mr. Samuel Tuke says, “Many errors in the construction, as well as in the management, of asylums for the insane, appear to arise from excessive attention to safety; people in general have the most erroneous notions of the constantly outrageous behaviour, or malicious dispositions of deranged persons; and it has in many instances, been found convenient to encourage these sentiments, to apologize for the treatment of the unhappy sufferers, or admit the vicious neglect of their attendants.”

In the construction of such places, cure and comfort ought to be as much considered as security; and I have no hesitation in declaring, that a system which, by limiting the power of the attendant, obliges him not to neglect his duty, and makes it his interest to obtain the good opinion of those under his care, provides more effectually for the safety of the keeper, as well as of the patient, than all “the apparatus of chains, darkness, and anodynes.”

“The safety of those who attend upon the insane, is certainly an object of great importance; but it is worthy of enquiry whether it may not be attained, without materially interfering with another object, the recovery of the patient.  It may also deserve enquiry, whether the extensive practice of coercion, which obtains in some institutions, does not arise from erroneous views of the character of insane persons; from indifference to their comfort, or from having rendered coercion necessary by previous unkind treatment.”

But there is another fact to be considered, not hitherto contemplated by any writer, and which is well expressed in a letter I received from a friend, in answer to one requesting his opinion in a case [57] wherein its importance has been shown to demonstration.  He says, (and he is a man of great humanity,) “I am most solicitous that the distinction should be understood between those who cannot act and think or decide for themselves, and those who can, and who, sensible of their defective state, or of the approach even of absolute derangement, can of their own free will, place themselves in a situation, where they know that every medical and moral means will be used for their restoration.  It is of the utmost importance, that the legislature should have it completely demonstrated to them, that there is a condition of the insane never contemplated by any legislator; the judicious management of which, is of the greatest consequence to them.  Instead of the mental malady being allowed to proceed, until the sufferer is introduced into these retreats by force, its first approaches will be yielded to as soon as recognised, and the unhappy individual, whilst still in the possession of reason, will voluntarily or by gentle and affectionate solicitations, enter some refuge for mental distress, where, separated and secluded from the scenes and circumstances which were hurrying on intellectual destruction, he may, in a short period, in a condition of comparative happiness, escape the most tremendous calamity with which human nature can be assailed.”

I believe all the former evils connected with the management of the insane, have arisen from ignorance of their state; and therefore I am anxious to be perfectly understood, and labour most earnestly to correct this erroneous impression; and not only so, but I wish to prove the popular prejudice, that they are all ill treated, to be no where, as far as my knowledge extends, true or deserved; neither am I aware that this branch of medicine has been more abused than others; nor do I know in all my experience, of any unjust confinement for interest’s sake; there may be ignorance of the treatment required, but surely in these enlightened times, a medical man of any character can never lend himself to any thing so suicidal to his own fair character and prospects.  I know, on the contrary, of evils arising from over caution in the other extreme.  I am perfectly convinced that no insane person, should be without medical superintendance, and that to be placed singly in private houses, not medical, I know from experience to be sometimes most fatal and destructive; some few, it is true, are above all praise.

Sir Andrew Halliday after stating the number of insane, who are known and registered according to act of Parliament, says, “there is a number, if not equally great, at least nearly so, of whom the law takes no cognizance, and whose existence is known only to their relations and friends.  These consist of individuals placed in solitary confinement, with persons who take only one patient.  This is a state of things which ought not to be allowed to remain as it is, for a single hour, in this boasted land of liberty; I do not say, that it ever has taken place, though I have known one or two instances that might almost bear such a construction;—but I maintain that it may take place, for there is no law to prevent it; that individuals may have been sent into such seclusion, who never suffered from the pangs of madness; and it must be evident to every one who gives this subject the least consideration, that it only requires a faithful keeper, and that watchfulness, to retain such a person in prison for life.  This number is said to have been prodigiously increased by the new Act.”

At the same time it must be allowed, that many incipient cases, requiring seclusion and separation from friends, would be aggravated by too sudden an introduction amongst masses of insane patients; and even by the very circumstance of arriving when there is the chance of exciting the usual horror and prejudice entertained against such places; but this ought not, and would not be the case, were the plans and systems of classification I have advocated, carried into practice.  Every way and in every thing, we have imperfections and abuses; and it is much easier to condemn than to cure them; and they who at once believe abuses exist in proportion to the popular description that is given during some temporary excitement and prejudice, are not safe persons to have the important charge of removing them.  I make these remarks, to show, that while a paternal government is justly, most anxious to protect the persons and property of those who can no longer protect and defend themselves, they should at the same time remember, that sanity of mind is still of much higher value; and that therefore concern about the property should not out weigh our concern for the cure.

I say nothing in the mean time, of the degrading suspicion and paralyzing interference, which the best and most conscientious man may under such system feel, in proceeding with the plans which, he from experience, knows to be essential to their restoration; but I contend, that the common error in legislation, of making property of more value than life, must here as well as wherever it is committed, have a baneful influence.  In this instance, the acts or laws made under the influence of this very great and very selfish delusion, produce this very serious mischief, that they tend to increase the prejudice and aversion common to places of this description, some of which would otherwise be considered not merely unobjectionable places of residence, but places of seclusion, very agreeable in themselves, and most desirable as places of cure.

In many complaints, change of scene and association, are justly considered necessary to the restoration of health.  It is not only the same in many cases of insanity but absolutely the first and most important step in every system which gives them a chance of restoration.  Should then a bare residence in any place for the mere purpose of cure, be accompanied (in very many cases, it is unnecessary,) by an act which is considered as fixing the mark of degradation upon them, any more than it should in any other disease?  This, instead of healing, is calculated to crush a heart already breaking; it is often fatal to their recovery! it is a principal cause of frequent relapses!  They feel a stigma, thus fixed on their character, so confirming the prejudices of the world, and so encouraging that distressing and fatal look of suspicion towards them, that they are forced to feel that no one reposes any faith in them; and if this feeling does not ultimately destroy all comfort and confidence, all order and stability within them, it must very much weaken that concentration of energy so necessary to the successful exercise of all mental operations; and if their minds are weakened by previous attacks, and not well sustained by right principles, but on the contrary, like many others, merely regulated by worldly principles and considerations, then, they are not only deprived of the rock on which mind is based, but also of all the motives and objects which stimulate to mental action.  In this state, what is mind but a sad wreck floating on the fathomless ocean of life, at the mercy of every wind and wave?  To what else shall we compare its situation?—It is like a city broken down and without walls, any enemy may enter in, and overthrow it.  Can we wonder then that persons whose minds are in this position, and whose prospects in life are thus blasted, should have a recurrence of the same awful visitation? or what is worse, that they should constantly feel their spirits paralyzed, and a melancholy gloom thus thrown over the remainder of their existence!

To make it necessary in all cases to have certificates, so far from being a security against abuse, is more likely to be a cloak for those who may wish to take advantage of the patient’s defenceless state; whereas in cases of voluntary seclusion, there can be no risk; for with such honourable confidence, we have at once, the proof and the security that it cannot and will not be abused.  These, however, are not the most desirable inmates, as it regards the ease and comfort of the superintendant, and therefore no one can have any other motive in recommending this practice of voluntary seclusion, but that which arises from the conscientious consideration of its being more conducive to cure.

That all should have the sanction and concurrence of medical recommendation, is every way indispensable; but what I argue for is, that this should be done, in the manner best calculated to make it appear to the patient, that cure, and not mere confinement, is the object of the measure they are recommended to accede to without reluctance.  That a great number will require certificates, and all the aid of authority, to make them submit to the measure, is certain; and in these cases, the law, so far from being a hardship, is a great convenience and advantage.

Again, violent and extreme cases may be said to certificate themselves, in these there can be no risk of making any mistake, and doing any injustice in the first instance; the injustice may be afterwards in improper treatment, and in over detention.  But to prevent all such abuses, we must first make men perfect, and then we should have no diseases to cure.  It is certain, that under a proper system, ameliorated by all these plans of procedure I have stated, it is astonishing how these violent and extreme cases would become less prominent.  I believe they would not average five per cent. at any one time; and take the average of a number of years, and I suppose it would not be more than half that number.  I am certain the proportion, during sixteen years of my experience, has been much less than even this; it is seven years since we had occasion to treat any one single case as a constantly furious and dangerous maniac; and even suppose, such cases, under the best management, were more frequent in occurrence, and continue in this state for some time, how easy it would be so to contrive an Establishment, that these violent cases should not annoy or disturb the rest; and when thus managed, so far from their influence being hurtful, they would become interesting and salutary objects of reflection and commiseration to those who are in a better state; and often, by example, would teach the greatest of all moral lessons, that which holds the primary place as a preventive, and is always a necessary adjunct in the business of restoration—self control.

In fact, every system of management that does not make this principle, of mildly calling forth and gently exercising this internal principle of self-control on matters that are least connected with the diseased parts of the brain, a constant and primary object of attention, is not merely defective, but exhibits very great ignorance of the attributes of mind, as well as of the causes and nature of its maladies; and it follows that, as a system, it must be without any clear principle to guide its physical and moral treatment.  In all things, we ought to remember, and especially in a matter of such importance, that we can do good only so far as our knowledge extends; and even this knowledge is useless, unless we are zealously desirous and able to reduce it to practice.  Whatever may be our proportion of knowledge, zeal, and ability, it cannot be arrogance, when called upon, to say, that I believe this principle is more brought into practice by the plans and arrangements I have described, than is the case with any system of treatment in any place that I have hitherto heard of or seen.

It is not known, as it ought to be, how powerful with the higher class of patients is the principle of honour; with many, a sense of religion; and with all, the fear of losing the approbation and friendship of those who are kind to them; as well as, from selfish motives, to secure the liberty and indulgences they have enjoyed.  These means, and every principle which operates on human nature as checks on one part of the mind, and as encouragements to another, should be constantly and steadily kept in view, for the purpose of never losing an opportunity of instantly bringing them into useful, and of course successful, operation.

It is on this philosophical system of kindness, that every thing should be so contrived that the principle of internal self-control should be excited, and kept in exercise; and thus, being brought to depend somewhat on themselves, the depressing effects of the absolute restraint of fear, induced by harsh measures, and the tyranny into which a mere place of confinement with walls, and bolts and bars, must almost necessarily degenerate, is avoided.

The propriety of these measures will receive additional confirmation, when we come to consider the causes as well as the nature of the evils which we are called upon to combat; but it may in the mean time be sufficient to state the appalling fact, that insanity is very often the consequence of early over indulgence.—I have frequently had to remark that an only child,—the youngest, or one brought up by a grandmother,—were the victims of a system of gratifying the feelings, without due attention to the cultivation and exercise of the understanding, as the delegated power destined to guide the future man.

There are few minds, even amongst the insane, who are not accessible to the salutary influence of this kind and liberal mode of proceeding.  It is true, that many paupers, who have long been subjected to a very different system, are scarcely receptive of any of the impressions which belong to human nature; but with a higher class of patients, this can seldom or never be the case, unless it be in cases of absolute dementia.  Even in the height of the most furious paroxysms, it is astonishing how much may be done by liberality and kindness.  Nothing but absolute necessity should justify absolute restraint.  It must always be considered as an evil to which we are reduced, in order to avoid a greater.  Whenever it is unnecessary, and continued too long, it will do more harm than good: the furious will be made more furious, and the suicide more determined to effect his purpose.  Whenever the patient is indulged with more liberty and behaves better, we must have forbearance to the utmost extent, and submit to all possible risks, losses, and expenses, rather than again have recourse to it; and when it is repeated, the patient must be made, if possible, to feel that it is deserved.

Their faults, like those of children, must be viewed with pity.  They are the wild displays of feeling, without understanding.  We must make excuses for them; often overlook, as often visit them slightly, only seldom with seriousness, and always with moderation, justice, and prudence.  No evil is greater than the evil of constantly chiding and suspiciously watching for faults.  It is an evil spirit that poisons and inflames every thing within its sphere.  A contrary spirit has a healing influence; and though it requires numerous attendants, and makes the whole business of superintending the insane a source of constant and intense anxiety and solicitude, yet it is pleasing to have it in my power to state many “striking” examples of its efficacy, but I shall, notwithstanding, content myself with only slightly glancing at two or three.

No. 372.

I shall not at present give the particulars of this interesting case, except so far as is necessary for the purposes of illustration.

When he came from a private Asylum, he was in a state of the most furious, destructive, and malignant excitement, and had been in this state for so many months, that he was considered by his friends as an incurable case.

I attribute his cure, chiefly to his being treated with apparent confidence, and induced to work with a spade, when even in his worst state—a state so dreadful, that the least word or wrong look would have roused him to commit some dreadful act of vengeance, and it therefore required two men to be constantly in attendance to watch him, and this without appearing to do so.

He was induced to work with willingness, by being brought to believe he had the contrivance, management, and superintendance, of some improvements in the place; such as some alterations in the garden, and especially that of making a new road from one house to another, which now bears his name.  It was observed, that after a hard day’s work, especially if he had profusely perspired, he had a more sound night’s sleep, and awoke somewhat improved in the morning; it is, however, to be remarked, that all this time he continued to have a regular system of medical treatment, which consisted in small repeated bleedings with leeches, averaging about three times in the fortnight, with purgatives, alteratives, and salines.  It is impossible to conceive the delicacy that was observed towards him.  Not a word or a look was done to offend him, let him speak or act ever so provokingly; and he was as perverse and as provoking, as it is possible to conceive a perfect dæmon to be.  His was the exclusive excitement of anger and malignity, combined with the most acute cunning to effect his destructive purposes.  The serpent, the wolf, the tiger, and vulture, seemed all that remained of the man.  In this state, to bring the better parts of his mind into life, was a great difficulty.  However, perseverance in this system restored him; and never was gratitude greater, or more substantially evinced, than has been by his conduct, and by that of his friends.

I can truly say, with Dr. Haslam, that “by gentleness of manner and kindness of treatment, I have seldom failed to obtain the confidence, and conciliate the esteem, of insane persons; and have succeeded, by these means, in procuring from them respect and obedience;” and I am of the same opinion with Mr. Samuel Tuke, wherein he states “that a large majority of the instances, in which the malevolent dispositions are peculiarly apparent, and are considered as characterising the disorder, may readily be traced to secondary causes; arising from the peculiar circumstances of the patient, or from the mode of management.”

It is worthy of remark, that where the patients have known the superintendants when in a convalescent state, or in a state still capable of estimating the kindness shown to them, they will much more readily submit, and show much less of anger and vindictiveness, even in their insane state.  This effect will be still more striking, if they have been in a place where a severer system is practiced, and where they have become depraved and brutalised, by being subject to too much coercion.  Of this I shall state as much of a very interesting case as may illustrate this great and important principle.

No. 395, admitted Dec. 3, 1829.

This patient, on her first admission, was suspicious, vindictive, and implacable,—refusing food, and medicines, &c.—after recovery, and returning voluntarily, she was confiding, affectionate, and submissive, comparatively, even in her worst state.

On my seeing her at her own home, at the time of her second admission, she instantly said.  “Good God! had you been here three days before, you had saved me!”  On asking if she would like to return with me, she instantly said, “above all things in the world.”  She came, and was apparently well in about ten days, and so continued for about seven weeks, when she returned home: but in less than a week she came back in the most raving and furious state, and yet nothing apparently dangerous or vindictive; on the contrary, she showed affection and attachment to us all; and if she displayed any vindictiveness, it was connected with some past recollections: but this has been slight and evanescent, compared to that which she exhibited in her former state;—a testimony, even from among the insane, which shows how much depends on the directions we give to each other’s mental energies.  In this case, long walks in the most secluded parts of the forest, often removed or lessened an approaching paroxysm, and always superseded the necessity of having recourse to any restrictive measures.  She is now perfectly recovered, and returned home.

Now, it is evident that ferocious and furious maniacs are those, wherein a direct system of coercion is said to be essential; and yet it is evident, that these are cases where it must do the greatest injury.  They are those in which the animal part is excited and inflamed, and of course all causes of irritation must increase it.  It is adding fuel to the fire, which already burns too fiercely—it is lacerating a wound which requires to be mollified with ointment.  The best-tempered house-dog becomes savage by being constantly chained.

Restraint and coercion are only justified when used either from absolute necessity, or as the mildest species of discipline; and then in all instances it must be proportioned to the causes and exigencies of the case; or when they are so violent, or so unconscious of their own state, or so bent on their own destruction, that there is less evil to be feared by restraint, than by indulgence.—But even here, popular feelings, prejudices, and fears, must not be the judges.

The word coercion has been used, but it conveys an erroneous impression, as if some degree of punishment were necessarily included in the restraint which the safety of others and of the patients require; but so far from this being the case, it ought never to be forgotten, that if the murderous and destructive maniac are made to feel, that with this necessary restraint is conjoined the indulgence of a vindictive spirit of retaliation, it will have an injurious influence, aggravate the disease, and of course will progressively increase the necessity and rigour of the restraint.

In cases of determination to suicide, it should be made to appear to the patient, what in truth it always should be—the kindest guardianship and protection.  In cases of some lesser faults, or such as breaking or tearing, instead of restraint, a small dark closet I have found more useful than the strait waistcoat; yet neither the one nor the other, have, now for a long time, (seven years at least) scarcely ever been resorted to, for more than an hour or so; but to be able to do all this requires a superabundance of servants and attendants, and these must be serious, active, laborious, and vigilant as possible.

I have known cases where the patient himself, on feeling his destructive propensity coming upon him, requested that he might be placed under restraint, and he felt afterwards more comfortable, from the conviction that he was safer in that state.  In such a case, the request should be readily attended to, as being not merely unobjectionable, but likely to have a beneficial influence.

It has been, that restraint was resorted to, from the idleness and carelessness of keepers; and in these cases, when restrained, being neglected, they acquired dirty habits, very often, simply from the effect of custom inducing a disregard and insensibility to the discomfort of their filthy state; sometimes they acquired these habits, from, in the first instance, a determined vindictive motive of teasing those whom they thought had acted unjustly towards them, as the only means they had in their power of gratifying their revenge.  In cases of debility and approaching marasmus, the effects of retention, when they are thus deprived of the power of relieving themselves, soon destroys the natural and healthy functions of the sphincters.  I have often known a contrary system cure all these habits especially in the two first class of cases mentioned; though, in other respects, the mind remained the same.  In the case last described, good and judicious management may retard the progress of the disease; but the system gradually decays, like a tree stripped of its bark by lightning.

As a proof, we have only a choice of evils, and we must always choose the least, I shall state a case.

No. 421.

This patient who had been several times under my care, was one who was soon made worse both in his bodily and mental state, by any restraint, however mild; and therefore we submitted to the losses which his very destructive habits occasioned, rather than have recourse to them.  These losses were enormous.  By this treatment, he so far recovered, that a medical friend, who had known him all his life, declared, on an accidental interview in the grounds, that his mind seemed in a state of integrity, as perfect as he had ever known it to be previous to the accession of any symptoms of Insanity.

In this state, he was removed by his friends from, I believe, parsimonious motives, to Bedlam, and this was done in spite of my positive opinion, declared in writing, that it would be fatal to his bodily and mental health, and that he would sink under the depressing effects of his situation.  In less than six months, he was covered with ulcers, and a mass of disease.  In this state he was removed to his own house in the country, where he recovered his bodily health, but his mind is gone for ever.

I could adduce, to illustrate the same principle, many cases similar to the last, and indeed so powerfully have I felt impressed with its importance, that I have frequently written letters to, and had conversations with, the friends of patients, stating, that from the nature and state of their case, we had only a choice of evils, and therefore it was better to run the risk of rather overmuch liberty, than the positive evils of goading and exasperating them by what is generally deemed, particularly in these cases, necessary restraints and confinement.  In most instances, they have not only fully entered into my views, and given me their necessary co-operation, but also readily agreed, that, if in consequence of this liberty any accident should happen, they would acquit me of all blame, and we have hitherto been most providentially favoured in having none of any moment.  It is true, one very peculiar patient takes advantage of this indulgence, and visits his friends without leave of absence; but so far from any blame or anger on the part of his friends against us on this account, they are pleased to see him, and he is always on these occasions very happy with the idea of having given us so much trouble, and at the same time, he shows he esteems our kindness by willingly, readily, and cheerfully returning to us.  Indeed as we have no case which better illustrates the principle for which I am contending, I shall here introduce so much of its description, as may be necessary for the purpose of enforcing its importance.

No. 396.

It is a case, where little insanity is observable in his conversation, but appears almost altogether in this constant propensity to indulge in destructiveness—breaking windows, tearing his clothes, &c.  The more costly the articles he destroys, the more pleasure he seems to have in the indulgence of this propensity for mischief and evil.  By over-much confinement and coercion, this patient would soon have become a settled case of furious and destructive mania; but by great liberality, and using restraint occasionally, the habit is much lessened: still, however, the propensity exists, and might be easily aggravated.  A week of the usual coercive measures, would make this case degenerate into one equally malignant and murderous as that of Walsh, whose character is given in the Sketches of Bedlam.

A great number of cases might be adduced in support of these views; but I trust these may suffice to enforce the argument in favour of the system, which some have blamed, as being too liberal and indulgent.  I have therefore quoted a few such cases, both as an illustration of my views and motives, and also as the best apology and vindication I can give in my own defence.

In all violent cases, there is one remark that must not be forgotten—that when it is possible, good may often be expected from violent exercise, always taking care that the patient is in a state to bear the fatigue, and still more so if he undertakes any sort of exercise with voluntary pleasure.  In cases, however, sinking into marasmus,—cases which I class under those of gradual decay of mind—exercise must be undertaken at suitable seasons, and when in a proper state, and must always be gentle and moderate.  Besides, though the greatest good may be expected in almost all cases from labour and exercise, properly regulated, and willingly undertaken, it is to be remarked, that while, with a great proportion of a pauper class of patients, various kinds of labour and exercise are, from their previous habits, easily adopted, and soon, by vigilant management, reduced to a regular system, and such system is of paramount importance to their health and mental restoration; yet with a higher class of patients, who had not acquired at an early period of life regular habits of industry, even the attempt to do the same thing might be altogether as difficult and injurious; and therefore though exercise is of very great importance, this should not make us overlook the necessity of not urging and compelling them to it in a way to cause irritation, unless indeed, in some extreme perverse cases, who must be forced to walk or ride rather than their health suffer from deficiency of air and exercise.  What I mean is, that we must avoid doing a positive evil where the good is only probable.  For though exercise is one of the most powerful means of withdrawing the determination of the nervous energy and blood from the head, and distributing them properly through the whole system, and thus combining a mental and physical power of diversion to the train of thoughts which injuriously occupy and produce a destructive fire in the mind, fatal to its existence; yet in these cases, we may produce a greater irritation by unnecessary compulsion.  It is well known, that in many cases, besides the animal and angry passions being very active, pride and vanity are with many, if not the whole cause and very seat, often parts of the disease; and that when once excited, all moral means to restrain and subdue them are as futile as it would be to attempt by artificial aid to quench the fury of a burning volcano.

I have often, however, known the violent maniacal excitement very much lessened in force, and bettered in direction, by being allowed, with an attendant, to ramble, and dance, and scream about, in the secluded parts of the forest, for a whole day together, and which superseded the necessity of the straight waistcoat. [80]

When this class of patients cannot be induced to walk, they may be pleased with carriage exercise, and in cases of approaching marasmus, where much fatigue would be injurious, airings will amuse and help to invigorate their feeble system, and perhaps, retard in some degree, the progress of destruction.

Though I have incidentally been led to notice the importance of employment and amusement, as a remedial measure of great efficacy among the insane; and though I could adduce many further striking proofs of its being apparently the sole cause of cure; I feel, to do so in this place, would be to forestall and usurp a subject to which I intend (as it deserves) to devote a separate essay; yet I cannot help saying, that I have some recent cases in proof of its efficacy, that were it not that their peculiar character and employment is so striking, that to describe them, would be almost to name them, I should feel tempted to bring them forward, for the purpose of proving that, among a better class of patients, this employment must never, on any account, be made a disagreeable task, but a matter of pleasurable choice, if we mean it to have a beneficial influence.  This is often very difficult; a task requiring great tact and no selfishness.  I believe, considering the class of patients we have under our charge, I am justified in asserting, that there is no place where a greater number, or more pains have been taken, and greater sacrifices made, so to employ and amuse them.

Dr. Gregory used to mention the fact of a farmer, who, by giving his patients, on their first admission, convincing proofs of his undoubted strength and pugilistic pre-eminence, brought them to a state of passive obedience and non-resistance, and then made them work; and, it is said, cured them.

No doubt many would be cured by this system, and these would propagate his fame; but whether the quality and proportion of those who would be injured by such a system, were greater evils than the good which was thus effected, we have now no means of ascertaining; nor is it necessary to know this, before we venture to condemn a system so perfectly savage and quackishly indiscriminate in its practice.

Where pride and vanity, angry passions, and love of power, are active, we cannot, with impunity, force them to work against their inclination; at the same time, it is our duty to lay the axe to the root of the evil, and restrain, and if possible subdue, these inordinate passions; but what I assert, is, that these are very difficult and dangerous passions to encounter, and they are not, with this class, to be restrained and subdued by the mere authority of a tax-master.  When we encounter them, it must be with great mental power and moral force; and this, even, to be exercised with effect, requires, that we first make ourselves beloved and respected by them.  Oh! it is a difficult and delicate thing to preserve that spirit, in combating these provoking cases, which alone has the power to overcome and cure them.

A state of furious mania is frequently the effect of injudicious management.  Of this opinion, Mr. S. Tuke says, “a striking illustration occurred in this Institution, some years ago.  A patient, of rather a vindictive and self-important character, who had previously conducted himself with tolerable propriety, one day climbed up against a window, which overlooked the court where he was confined, and amused himself by contemplating the interior of the room.  An attendant, who had not been long in office, perceiving his situation, ran hastily towards him, and, without preamble, drew him to the ground.  The patient was highly incensed: a scuffle immediately ensued, in which he succeeded in throwing his antagonist; and had not the loud vociferations of this attendant alarmed the family, it is probable that he would have paid for his rash conduct, by the loss of his life.  The furious state of the patient’s mind did not continue long; but, after this circumstance, he was more vindictive and violent.”

“In some instances, the superintendant has known furious mania temporarily induced, by the privations necessary on a relapse, after a considerable lucid interval, during which the patient had enjoyed many privileges that were incompatible with his disordered state.  Here we may suggest the expediency, where it is possible, of employing such of the attendants to control the patient during his paroxysms, as had little intercourse with him in his lucid interval.  Instances of furious mania have been, however, very rare; but a considerable number of patients have been admitted, who were reported to be so furiously insane as to require constant coercion.

“The evidence of attendants, who have been employed, previously to the admission of patients into the retreat, is not considered a sufficient reason for any extraordinary restraint; and cases have occurred, in which persuasion and kind treatment have superseded the necessity of any coercive means.

“Some years ago, a man, about thirty-four years of age, of almost Herculean size and figure, was brought to the house.  He had been afflicted several times before; and so constantly, during the present attack, had he been kept chained, that his clothes were contrived to be taken off and put on by means of strings, without removing his manacles.  They were, however, taken off, when he entered the Retreat, and he was ushered into the apartment where the superintendants were supping.  He was calm: his attention appeared to be arrested by his new situation.  He was desired to join in the repast, during which he behaved with tolerable propriety.  After it was concluded, the superintendant conducted him to his apartment, and told him the circumstances on which his treatment would depend; that it was his anxious wish to make every inhabitant of the house as comfortable as possible; and that he sincerely hoped the patient’s conduct would render it unnecessary for him to have recourse to coercion.  The maniac was sensible of the kindness of his treatment.  He promised to restrain himself, and he so completely succeeded, that, during his stay, no coercive means were ever employed towards him.  This case affords a striking example of the efficacy of mild treatment.  The patient was frequently very vociferous, and threatened his attendants, who in their defence were very desirous of restraining him by the jacket.  The superintendant, on these occasions, went to his apartment; and though the first sight of him seemed rather to increase the patient’s irritation; yet after sitting some time quietly beside him, the violent excitement subsided, and he would listen with attention to the persuasions and arguments of his friendly visitor.  After such conversations, the patient was generally better for some days or a week; and in about four months he was discharged, perfectly recovered.”

“Can it be doubted, that, in this case, the disease had been greatly exasperated by the mode of management? or that the subsequent kind treatment had a great tendency to promote his recovery?”

“It may probably be urged, and I am very well aware of it, that there is a considerable class of patients, whose eccentricities may, in great measure, be controlled; and who may be kept in subjection and apparent orderly habits, by the strong excitement of the principle of fear.—They may be made to obey their keepers, with the greatest promptitude; to rise, to sit, to stand, to walk, or run at their pleasure; though only expressed by a look.  Such an obedience, and even the appearance of affection, we not unfrequently see in the poor animals who are exhibited to gratify our curiosity in natural history: but who can avoid reflecting, in observing such spectacles, that the readiness with which the savage tiger obeys his master, is the result of treatment, at which humanity would shudder; and shall we propose by such means

“To calm the tumult of the breast,
Which madness has too long possest;
To chase away the fiend Despair,
To clear the brow of gloomy care;
Bid pensive Melancholy cease to mourn,
Calm Reason reassume her seat;
Each intellectual power return?”

“If those who are friendly to what may be termed the terrific system of management, could prove, that notwithstanding it may fix for life the misery of a large majority of the melancholies; and drive many of the more irritable maniacs to fury or desperation; yet that it is still, in its operation upon a large scale, adapted to promote the cure of insanity; they would have some apology for its discriminate adoption.  If, on the contrary, a statement of the proportion of cures in the Retreat, shall sufficiently prove the superior efficacy of mild means, would not those, who are adopting an opposite line of treatment, do well to reflect on the awful responsibility which attaches to their conduct.  Let us all constantly remember, that there is a Being, to whose eye darkness is light; who sees the inmost recesses of the dungeon, and who has declared, ‘For the sighing of the poor, and the crying of the needy, I will arise.’”

“From the view we have now taken of the propriety of exciting fear, as a means of promoting the cure of insanity, by enabling the patient to control himself, it will, perhaps, be almost superfluous to state as our opinion, that the idea, which has too generally obtained, of it being necessary to commence an acquaintance with lunatics, by an exhibition of strength, or an appearance of austerity, is utterly erroneous.  The sentiment appears allied to that cruel system, probably dictated by indolence and timidity, which has so long prevailed, and unhappily still prevails, in many receptacles for the insane.”

“There is much analogy between the judicious treatment of children, and that of insane persons.  Locke has observed that ‘the great secret of education, lies in finding the way to keep the child’s spirit easy, active, and free; and yet, at the same time, to restrain him from many things he has a mind to, and to draw him to many things which are uneasy to him.’”

It is highly desirable that the attendants on lunatics should possess this influence over their minds, but it will never be obtained by austerity and rigour; nor will assumed consequence and airs of self-importance be generally more successful; at the same time, it must be acknowledged that as insanity is often the consequence of over-indulgence, as well as of a system of tyranny, while under parental care, that therefore both extremes are to be, not only avoided, but their effects counteracted by a judicious and curative system of treatment, and that this will require to be varied according to the peculiarities of each individual case.

A private establishment, where cure and reformation are thus conjoined, becomes an interesting little world of its own.  Though to live in this world is a life of ceaseless anxiety, there is such a perpetual succession of such an endless and inconceivable variety of strange incidents and speeches, odd displays of feelings and manners, inside views of the human heart, and, as it were, of the invisible world, that the charms of novelty, the excitements of wonder, the enquiries of reason, and the demands of sympathy, keep the mind so alive, that I have often observed that the revolutions of the sun seem to run their course more rapidly now, than before I lived among them.  And though the feeling of being excluded from rational society, often presents itself to the mind as a terrible sacrifice to those whose earliest and fondest wish was to live in the sphere of intellect and genius, yet we are often reminded that they are not always irrational, that some, are so only on a single point, while on every other they possess more than common powers of pleasing; others, are in a state of convalescence, and many of them are, for a while at least, grateful and amiable in the extreme; and it is delightful to see those who awake from a lost or raving state, as from a sound sleep or a disturbed dream, with all the freshness of joyous gratitude and celestial ecstacy, on suddenly beholding a new world of mind and matter bursting upon them.  So that if we cannot always exist in an intellectual sphere, we are seldom without that of affection and gratitude; and though it is difficult to prevent, in such scenes as must often assail us, occasional paroxysms of discontent and wearisomeness coming over us, they seldom last long, and they are sometimes cured, as well as brought on, by an occasional peep into the motley world.

Shut out from the world, one is as apt at one time, on again entering into it, to be as much oversurprised and delighted with the blessed fire-side scenes where the wise and good man resides, as one is at another time to be equally over-disappointed and revolted with the follies and miseries of the moral insanities which exist unrestrained among men in real life.  Nor do I conceive we have more appalling consequences of disobedience to the natural and divine laws of our being, in this place, than can be seen in the world, walking in wantonness in the broad light of the noon-day sun.

Insanity is, no doubt, a terrible visitation, but why should we allow a false and unreasonable horror to increase it, and why should we thus sever our sympathy from a disease which more than any other requires it?  The medicinal virtues of the fruits of charity are best proved amongst them.  Grant that the disease arises from some remote or proximate ill-directed mental states.  Why should we have more horror of insanity, than many other consequences of ill-regulated minds.—To me, the foul ward of some large public Hospital, is incomparably more horrible and loathsome.—Such direct consequences of wickedness present the object before us in an aspect that makes it difficult for us to exercise any feelings of commiseration towards them.  Not so the insane! but these are views, however, into the consideration of which, I shall not enter in this place; but I mention or rather hint at the diseases of other organs, for the purpose of asserting that the reality and appearance of the miserable state of the insane is not so shocking as people imagine, but that still I allow it is an awful visitation.

But while I allow this, it is at the same time the strongest reason why we should be anxious to remove all those false and unreasonable horrors, which can only aggravate the calamity, by giving countenance to the imaginary necessity of having recourse to harsh measures,—one ceases with the other,—it will not only do this, but it will also, I repeat, remove those depressing feelings of degradation which, whenever reason gleams, is death to their hopes, and which often prevents their recovery, brings on relapses, and is the most painful and heartrending feeling they have to contend against in the critical and incipient stage of their convalescence.

By this system of greater liberality, it would soon be found, that patients would no longer consist of violent and extreme cases alone, but that every thing repulsive in their present state and aspect would quickly disappear, their whole character assume a milder form in reality as well as in appearance.—Indeed, this is already the case.  All things are improved.  Thus popular prejudice ought to cease, and a more favourable prepossession should occupy its place; and the world being fully persuaded, that there is much more to hope than to fear from a residence at such a place, persons at the commencement of the malady are easily induced to enter them of their own accord, or are sent by their friends without delay or reluctance, before the disease has passed the curable stage.  “Cases,” as a friend of mine justly observes, “were this feeling fully established, would be relieved without proceeding to the utmost degree of severity; and we might confidently anticipate that when the decided excellence of such a system, as regards moral, intellectual, and physical management, is adequately understood, the premonitory symptoms, often slight and various, but generally significant, will no longer be disregarded: and incipient mental disease, arrested by the judicious means there pursued, will not be allowed to assume a form and magnitude constituting the most awful calamity to which man is subject:” and why should it be allowed to do so, when it may be asserted, without contradiction, that functional disorders of the brain, are less liable to end in disorganization, and possess a greater power of readjustment, than any other part of the human system—woe unto us if it were not so.

The advantages which may arise from this system will appear in a still more striking point of view, when we reflect that those cases which without proper care in the early stages of the disease ultimately become the worst and the most dangerous, are precisely those which are fatally neglected, in the first instance, and which are scarcely ever placed under any medical treatment or moral discipline until the evil is past all remedy.  Cases of suspension and cases of gradual decay of mind, as well as cases of Hypochondria, are of this description.  I had lately applications to receive three patients of the latter description, all of whom committed suicide during the delay between the application and the intended removal.

It is true, there are cases, which require a very delicate, and conditional sort of superintendance, and that harsh measures and indiscriminate treatment would, in many instances, be more injurious than even absolute neglect; but at the same time, it must be observed, that such persons generally require to be placed under some judicious and delicate restraint, from the fact that their vicious inclination (for in these cases the disease begins in chronic inflammation and ultimately softening of the cerebellum) leading them into vicious habits, would rapidly accelerate the disease and make it a confirmed and incurable case.  I have had some cases of gradual decay of mind, which, if not curable, might, with care, have continued for years in a tolerable state, but when allowed their liberty only for one week, they so accelerated the progress of the disease by dissipation and excess, that they suddenly sank into hopeless idiotcy.

I have known several such cases, who were never under any care, but left wholly to themselves, sink as suddenly into the same hopeless state.—Cases of Melancholia and Suicide, are often unsafe; the first is not a less decided case, though less avowed and acknowledged inclination to suicide; the other, though avowed will often pretend to be much better; sometimes even strongly confess their guilt in having allowed themselves to indulge in so dreadful a propensity; and all this, merely for the purpose of throwing their friends off their guard; when, the moment they suspend their vigilance, the suicide seizes with avidity whatever means or opportunity may be presented to him, to terminate his present miserable state of existence.

It is evident that to pursue this system, it will require great anxiety and vigilance, and that we must not care for labour or sacrifices but seek to do good for the sake of the good to be done; and when this is the case, we shall be most desirous thoroughly to understand every form and species of the disease, for we shall then know that it requires that we should, with the utmost nicety be able to discriminate between the different forms and species of insanity, in order that we may discover, prescribe, superintend, or enforce the peculiar treatment which each case requires.

These conditional plans of superintendance must be allowed the widest range, a range which no inexperienced person, still less those who have false notions and impressions of the general character of the insane, can possibly imagine, and for which no acts or rules can give directions—How then can those without knowledge and experience pretend to undertake such a charge?  Often we have only a choice of evils; and we must be less anxious about the risk of accidents, our own credit, or interest, than the cure or chances of good to be done.  In some cases absolute confinement would rapidly make the patient’s state worse, and we must give either real or apparent liberty; a liberty which some would think imprudent. [95]—Yet I believe it is a fact, that there are the fewest accidents where to appearance the greatest liberty is given, [96] harsh measures always increase the evils which they would pretend to cure; but should one accident occur under this mild system, the person adopting it would be more blamed than he who had twenty accidents on the old plan.—With the first system, it is often difficult to persuade the friends of the patients to concur and co-operate.—The family dispositions often render this probable; nor can we always blame them: but he who undertakes this charge, while he endeavours to persuade and conciliate as far as possible, must in many cases feel himself called upon to act with decision.—If he adopts the fears and prejudices of others, then his system will become one of duplicity and tyranny, exciting suspicion and vindictiveness, destructive alike of all confidence and chance of cure; for unless we acquire the confidence of the patient, no good can be done; mutual distrust will end in absolute slavery and restraint to the patient, and in the baneful habit of exercising the love of power on the part of those who have the superintendance.—Hence the evils apprehended by their friends as likely to arise out of the patient’s vindictive state, will be most effectually established and increased.  Instead of the calming effects of a system of confidence and liberty, tranquillity, and peace, this contrary system will continue to goad, irritate, and inflame that part of the brain through which the mind, in this state, is operating; and in pursuing such a course we are clearly guilty of making that become fixed and permanent which otherwise might only have been of very temporary duration.

While nothing is more certain than that, in most cases, too sudden a return to old scenes and associations is extremely dangerous, there are some others where I have known their returning home at an early period, or even at some critical point of convalescence, decidedly expedite and confirm their cure:—when there appear evident reasons to augur favourably of such a change, the trial should be made—we have only a choice of evils, and we must endeavour to choose the least.

It is remarkable, that many have, in an incipient state of convalescence, been placed on parole of honor; first, they are simply restricted to the garden, and afterwards the fields; and if no breach of confidence occurs, they are allowed a pass key to go out and in when they please; and scarcely an instance has occurred in which they have taken advantage of this privilege to make their escape;—nor have they opened the doors to others.—Those who escape are always those who are not so trusted.

In some cases, I have known the convalescence of patients confirmed, not merely by placing them on their parole of honor, but by discharging them as patients, and inviting them to remain and consider themselves as voluntary visitors.

It is astonishing what a stimulus all this is to others to exert their SELF-CONTROL, and to behave more correctly; and still more so, on promising that on their continuing correct for a given length of time, they shall have these indulgences.  But all this shall be more minutely detailed under the Essay, Moral Treatment; when I shall state the effects produced by always treating them as rational beings, and allowing them, in proportion as they conduct themselves more rationally, to have the privileges of, and as far as possible to associate with, those who are so.—The efforts which (in consequence of this principle being observed in all our conduct towards them,) they constantly and anxiously make to be considered rational, is an acquisition of prodigious moment and when we see they possess it, we may pronounce it an excellent symptom of the returning control of the will and understanding.

This is in perfect accordance with the principle which stimulates men, in society, to the useful or baneful exercise of their understandings; and where it exists not, the mind will rapidly sink into a state of apathy and indifference, [99a] and I have no doubt, that many an insane patient who feels that he no longer possesses this stimulus to mental exertion and control, gives way to his foolish thoughts, and still more so, when he finds it more easy to give pleasure to others by their utterance than by endeavouring to talk rationally: thus he acquires the habit of talking nonsense, and hence this constitutes the character of many of the old insane, who might, I believe, have otherwise been brought into a more rational state. [99b]

We should never for our own ease encourage their delusions, but tell them (when we do notice them at all, for silence is often the most effectual reproof we can give; but when we are obliged to notice them, we must honestly, but with charity, tell them) what is false and dangerous, and which often has a good effect; and if it does not cure, it restrains them from talking on the subject of their delusions.

Many instances of cures on this principle are recorded, and many more of my own I shall have to state when I come to Moral Treatment.

Nothing can be worse than the common practice in public institutions of allowing idle visitors to amuse themselves by listening to, and of course encouraging, their conversation on the subject of their individual insanity.—When we do notice these delusions, and it must be seldom, it must be a very important and grave matter; and we must exert all our eloquence, and call forth the most overpowering arguments against the folly, wickedness and direful consequences of encouraging these delusions.

Dr. Crowther says, “Mad persons are frequently capable of being reasoned with; and it is sometimes in the power of the physician to remove false impressions from the patient’s mind, by a well-directed reply and judicious reasoning.”

Another patient imagined himself to be Jesus Christ; and in proof of it showed me a scar he had in his side, which, he said, had been occasioned by his having been pierced with a spear.—I remonstrated with him on his assertion, and remarked that our Saviour was wounded on the side opposite to that be had indicated as the part wounded in himself.—Convinced, and apparently ashamed at the consciousness of the fallacy of his own reasoning, the patient recoiled, hid himself under the bed clothes, and never reverted to the impression under which he had previously laboured.

In many points the insane are accessible to reason; and at all times and in all cases, as a rule, they should be treated as if they were still reasonable beings.—Many are able to detect ignorance, and can appreciate and respect knowledge: convicted ignorance in a superintendent is fatal to his influence and authority.  To have the character of being intelligent, is of great service.—Nothing impresses them with this conviction so much, as proofs that you possess a key to unlock their minds—that you have a perfect insight into the peculiarities of each—can trace to its origin their insane state,—the evil of extremes,—and more especially can meet these with clear views of the truth of that which they have perverted.—But all this still more requires that you are not merely esteemed for talents, but also for goodness; then will your arguments and example be like oil on the stormy waves, calming turbulence and breathing peace even upon the victims of passion, misery, and distraction.

All this will be acknowledged to be of great importance, when it is considered that to call forth the exercise of self-control is the most powerful moral means of recovering the lost equipoise of mind.  And that this may be done, is certain, for many have some power of self-control remaining, but self-control in a state of misdirection.  Numbers also have many avenues of the mind still open, through which the understanding may be stimulated into active exercise, and the will turned into a right direction; and thus the same principle may in many cases ultimately become the means of promoting their restoration.

They generally know the points which others consider as proofs of their insanity, and they should be made ashamed to display them, but never directly irritated by a domineering opposition, which would only rouse the bad passions and the spirit of self-will to resist all means of counteraction. [102]—Hence where these rules are observed, it is often perceived that they will, on their first entrance, keep their delusions out of sight; so much so, that it is often for awhile difficult to discover their insanity.—The early prospect also of their liberation often induces this concealment: we must encourage this, but at the same time, they should see that we have the power to perceive when it is real, and when it is feigned for this purpose.  When they know we judge from the state of the inner, and not the outward, man, the effect is wonderful.

It is not by any system of fear, as was once imagined, that all this is to be done.  This is a restraining power, which must be seldom resorted to, and then only for specific and temporary purposes, and never of long duration, otherwise the mind will be thrown on itself, and feed on its notions.  It should never be used except conjoined with the suspension and loss of sympathy which they have felt valuable, or for the sake of others whose comforts are not to be sacrificed merely that they may selfishly indulge in their absurd whims, and annoying conduct, or in their erroneous views and vicious propensities: for these reasons and purposes they must be separated, and if not corrected by occasional separation, then they must be classed with those whose comfort they cannot derange.  They must feel all this as the effect of their conduct, and that their treatment depends on their behaviour; but any discipline or change must never be made without a self-evident cause, and never in the doing carry the air of tyranny, passion, or injustice.

All the principles applicable to the management of children, are equally applicable to them.  Though we must watch every probable and threatening storm, we must not too eagerly anticipate its approach—we must wait until it breaks out and gives us an opportunity to justify the moral measures we conceive are best calculated to produce a beneficial influence.

As I have shown, we always endeavour most sedulously (especially in the first instance begin with) to act on this principle.  We treat nearly all on their arrival as if they came merely as visitors, and never alter our conduct until they cease to behave as other people; and then they cannot but blame themselves for their confinement or any change of treatment that their conduct renders necessary, and which must therefore be always sufficiently gross, even in their own estimation, to justify the change.  As classification must be based on these moral views, there is necessarily included in this Essay much that will fail to be more minutely considered under the Essay, Moral Treatment, and much more that, it may at present appear, I have, altogether omitted—such as the obvious necessity of separating the vociferous, the dirty, the epileptic, &c. from the more rational, delicate, and nervous.

One principle is very important, hereafter to be enforced, which is, that some must be classed so that bad habits may be prevented by the constant presence of others to call forth the sense of shame to restrain them.

In fact, this plan of treatment should embrace every means conducive to the cure of its objects, such as domestic quiet, and the removal of every possible annoyance; and we are, above all things, carefully to avoid every appearance of restraint, and to adopt as little of the reality as is compatible with the security of the violent, dangerous, and discontented, who must be restrained, and if possible, without exciting or increasing their diseased state.  We must do every thing we can to soothe and comfort the disappointed and melancholy, and diligently labour to heal the broken-hearted; we must ascertain causes and effects, and remove or counteract them; we must strive to correct or cure wrong notions and impressions; we must cultivate and strengthen better feelings and principles, and discourage all that is bad, or allow it to die away for want of nourishment and exercise: for such purposes the superintendant must be armed with medical and moral means at all points, and be above selfish considerations.  To describe all this in detail, would be to write volumes.  It is evident then, that every variety of suitable treatment should be adopted, according to the nature and circumstances of the case.

All this is not to be done by mechanism, nor by the strictest attention to any plan which some cold rules prescribe.  Acts of Parliament can never make these places what they ought to be, and which it is of the first importance they should be; I mean places for the voluntary seclusion of an exhausted mind, or nervous invalid, and in every case as institutions not so much for the confinement, as for the cure, of the insane.

Acts of Legislation may interfere with, cramp, or destroy the heaven-born and heaven-directed energies of the mind.—It is dreadful to paralyze or destroy the spirit of kindness, guided by experience and wisdom, by confining it to rules which have merely for their object the prevention of evil, and not the production of good!  Those who legislate, should be careful not to meddle in the province out of the reach of human interference.  By so doing, they may destroy, but they can never give, the spirit by which alone good can be done.

The present system adds to the horrid association of these houses, (and for which some of these houses may be accused of all the blame,) and prevents them from becoming what I conceive would be of the first importance,—I mean places for the voluntary seclusion of an exhausted mind, or of a nervous invalid, which would be of the first advantage to them, and would besides take away the feeling of horror associated with such houses.  It is so in France.  On the same principle, those who are sent without their own concurrence, should never be treated as if they were insane; the names “Asylum,” “Patient,” “Keeper,” “Insanity,” should never be heard among them; many have been made worse by a contrary system of treatment; and I may also mention that I am more and more convinced of the necessity and efficacy of proper medical aid, and of course of a medical man, or of one having acquired medical experience, being amongst them,—I repeat “that no man ought to keep a house for the care of the Insane, who does not make cure his ruling motive for receiving, detaining, or discharging patients from his house.”

Again, the arguments are endless to prove every thing should be done not to increase, but diminish, the horror associated with these places.  No act of Parliament can give knowledge and principle, and good feelings; and no Act should be made as a substitute for knowledge and principle and good feelings, which every one in his specific sphere should possess.  No Act can give knowledge and principle, but an Act can carry with it so much opprobrium, that men of feeling and knowledge and principle, are deterred from undertaking a department of the profession, which the law supposes is only in the hands of base, unprincipled men.  The aim of the Legislature should be, to add to its respectability, and to offer encouragement to those persons who possess that knowledge and principle and have it in effectual operation.

Mankind in general, are not made better by treatment that shows our want of confidence in them.  Though the mild system is universally allowed to be, not only the most judicious, but that which ought exclusively to be adopted, it will be seen that it may be carried further than it has hitherto been done, and much greater latitude given than we have yet conceived possible, and all this with the best possible results.

The principles of human nature, its moral and physical laws, are illustrated among the insane, as well as sane; and if revolutions and abuses of liberty in the world are the unrestrained re-actions of the spirit of justice in men, against those who have neglected or improperly restrained them; so, in lunatic asylums, improper conduct towards the insane, or too much restraint, has given rise to much of the misdirection and irregularity in the display of their animal spirits; and be it observed, that here, as well as in the world, those men are the first to blame effects which they either themselves caused, or which it was their province to foresee, prevent, or cure.

When the understanding is enlightened, or the higher feelings cultivated, the impulses of our inferior feelings will assume a better character, and be less liable to abuse.  In asylums, whatever mischief and malignity, are, by improper treatment produced, the attendants place the whole to the account of their insanity; very readily, and without any self-accusation, blaming, and perhaps, severely punishing effects which they themselves have either been the sole cause of, or which they might have prevented.  Nor can we wonder that such evils have existed, if we consider how very difficult it is, to find combined kindness, understanding, and practical usefulness in those who can be procured to attend upon them.  Yet all this should exist in the character and conduct of those who undertake their management.

The grand principle of treatment is, to avoid even the appearance of unnecessary restraint, and to treat them with apparent confidence: such a plan of procedure will almost invariably excite their secret but proudest endeavours to preserve and retain this confidence.  There is a secret power which holds the helm of the mind, and by its controlling and moral influence guides it more effectually than any rude restraints applied to the bones and muscles of the human frame.

There is no influence so powerful as the sphere of a moral influence.

It is painful to reflect on their former treatment; caged in iron-gratings and exhibited for money!  Treated as wild beasts, they necessarily became like them, or worse!  Devils in revenge and evil, Satans in deceit and delusion!  Or if any portion of the man remained, think of the spirit writhing in agony, or sinking with despair within them!  All this, and worse, in some despotic countries, even now exists; and in how many places are they not still made to drink the bitter cup of neglect and coldness, contempt and cruelty.  Where do they receive, as they ought, judiciously and constantly, the cordial of sympathy and friendship?  Where is every appearance of confinement and injurious association carefully avoided, and every thing studied to make them feel at home, and all this combined with medical attendance?  Say not all this is unnecessary; for if life, under any circumstances, cannot be said to exist without some association of sympathy, it is certain there are among the insane, cases of misery and wretchedness which absolutely require for their cure, as well as their comfort, all the moral kindness and medical attention we can possibly give them.

It has been an universal complaint, that there is nothing certain or fixed in the treatment of Insanity, and that it is presumed it is not yet fully understood.  I am of opinion that no medical treatment in any case can be fixed as certain or judicious unless we understood the origin and nature of disease; and I have therefore devoted a considerable portion of this Essay to the consideration of the correspondence which exists between the causes and effects produced; and this I only consider as preliminary to a more full and adequate investigation of causes than I am aware has hitherto been made; but still, as preliminary to this important subject, I shall, in my next Essay, first give a general explanation of the origin and cause of disease, and this in agreement with a principle which I conceive to be of universal application.

APPENDIX
TO THE
ESSAY ON CLASSIFICATION.

INTRODUCTORY OBSERVATIONS.

As in the foregoing Essay on Classification, I have several times stated my objections against writers on Insanity selecting only extreme cases, by which, I conceive, impressions of horror against the Insane are increased to their prejudice; I shall, therefore, for the express purpose of exhibiting a fair specimen of the general character of the insane collectively, in their worst and most revolting state, add, in an Appendix to this Essay, about twenty of the oldest in age as well as in the duration of the disease, and of course of the most incurable cases, taken in regular rotation from the Register Book of the oldest Asylum in the kingdom, excepting Bedlam; containing, at the time the living characters were described, about one hundred of the same class.  Now though these are taken from among those who had suffered all the brutalizing influence of the old and neglected system of treatment, yet they do not, as a whole, exhibit so shocking a picture as previous popular prejudice would imagine.  Notwithstanding this truth, it is proper to state, that they are incomparably a worse picture, than the same number would make, taken with equal fidelity and correctness, from among my own patients, admitted within the period of my own exclusive superintendance,—this would, therefore, be much better calculated to correct this injurious prejudice than that which I now give for this purpose: but they are too recent to be so introduced; yet as this would be a very striking contrast illustrating the effects of different treatment, I shall be prepared, should I live long enough for time to throw his dark veil over their memory, with the same number of cases, taken and described on the same principle.

I am the more anxious to do this at present, and fulfil this my future intention, because it may perhaps be laid to my charge, that in adducing cases illustrative of the principles contained in this Essay on Classification, as well as those which, from similar reasons, I may have hereafter to introduce, that I have been guilty, and may be guilty of the same error of selecting peculiar and extreme cases for my purpose; but I have been led into this, from the feeling that circumstances had forced upon me, however contrary to my previous intentions, something of a defensive attitude.

These are the reasons which have been my inducements in adding this Appendix; at the same time, to make the cases, in this naked form, as interesting and as useful as possible, I have not only drawn them with the most minute attention to truth, but to each I have appended some appropriate and useful observation.

Previous, then, to my entering upon the important subject mentioned at the end of this Essay, I shall now introduce these cases as a faithful portraiture of the Insane.

No. 1.—Admitted 1782; aged 76.

There is nothing recorded of this case, from which any correct information of the causes of the malady, or of its nature, when admitted, or of its progress since that period, can be drawn.  Some of his relations are insane, and many of them exceedingly eccentric.  His friends accuse some nurse of an improper application for the itch; yet, notwithstanding this accusation, the disease was gradual in its approach.  He was gay when at Cambridge, and lost considerable sums at the gaming table.  There is reason to believe that he had always been eccentric; and I have been told, that in his youth, he was proverbially called the proud and polite man. [114a]  Whether this be correct or not, it is certain, that even now, though so little mind remains, he is soonest roused and offended, though otherwise very good-natured, by whatever questions his own importance.

Though, like many old men, he is fond of dozing away his time in bed, he has, notwithstanding, seasons of greater animation, when he seems more busily occupied with his own thoughts, often talking to himself; repeating very correctly passages committed to memory, probably forty years ago. [114b]

At these periods, unless teased or vexed in the way already stated, he is very good-natured and polite; and from his general manners, and particularly in the modulation of his voice, he still appears, in spite of the coarseness of his dress, [114c] the remains of a perfect gentleman.  At these times, he is, for the most part, very happy, laughing and playing like a little child; and his very mischievous tricks—throwing stones, writing on the walls, tearing his clothes in order to make some little fanciful change and decoration of his dress, seem to be done rather as resources for regular employment or amusement, than from any malicious design or delight to be mischievous.

OBSERVATION I.

The slight changes or states of excitement described in this case, are in my opinion, the mere fluctuation of his animal spirits.  I shall hereafter make further remarks (see ob. 5) on this subject; and therefore, in the mean time, (to obviate the objections which may be brought against this view,) I shall only observe that when we consider the defective and uncontrolled state of mind, [115] in these old and incurable cases of insanity, any change or increase of their animal spirits must, though perhaps depending on causes which equally affect the sane, display itself in them, in a very different manner.

No. 2.—Admitted 1785; aged 67.

There is no statement of this case on record, from which any satisfactory information can be derived; nor have I been able to obtain any account of his former life, or the nature or treatment of his case.  There has been nothing of late years to distinguish his case from many old ones, whose minds have sunk into the torpid state, except it be, which is scarcely worthy of notice, that he has sometimes stood on his head to say his prayers; sometimes spit in his pocket; and, when provoked, used indecent language; otherwise his state of mind has not, for many years, exhibited any observable alteration. [116]  He will be best known when I say, that he is singled out from the rest, as a little, timid, old-looking man, uniformly sitting in a moping, creeping posture.

OBSERVATION II.

This man is not more of an idiot than the one just described, yet there is much less appearance of mind about him; but his mental powers had not formerly been so much evolved and improved by education; and the mind, like the soil we tread on, once properly broken up and cultivated, will, in defiance of neglect, long retain traces of its former improved state.  Besides his want of early culture, being one of the middle class of patients, he was wholly left without mental food or exercise.  There was, under the old system, a complete sacrifice of the lowest, utter neglect of the middle, for the sake of the higher class of patients; so that there was, with the middle class, for the most part, no intellectual interest excited by social converse and attention; nor, on the other hand, were the malignant passions kept alive by brutal treatment: and hence we now find amongst this class, the greatest proportion [117] of those whose minds have sunk into torpid inactivity; and not so much because they are lost, but because, from their want of excitement, they have too long continued in this motionless state.  It is true, that their minds may, by the first attack, have undergone some great shock, to derange or paralyse the more perfect performance of its functions; but it is certain, that afterwards, no means were used to resuscitate or feed the powers of the mind into renewed vigour and activity.  Few, even in the perfect possession of their faculties, could bear to be excluded from the air and sunshine of social life, and mingle only with beings in this melancholy state, without feeling its effects upon them.  We are not to wonder, then, that those whose spirits have thus been prematurely entombed within them, should have become almost as dead to themselves and the world, as if the soul had already left them.  To prevent these consequences, I shall state all that I think ought to be done, in another number of this work; which I conceive is the most interesting part in the treatment of insanity.

No. 3.—Admitted 1787.

There is nothing on record about this case, nor have I been able to obtain any information of his previous history.

His mind is not in so defective or deranged a state, as strangers and superficial observers are, from appearances, apt to imagine.  It is true, he seems stupid and churlish, always silent unless spoken to, and then he answers with abruptness and impatience, in a murmuring, grumbling, and almost unintelligible manner, putting his words oddly together, like a child, or one unused, or too lazy, to articulate, and not that his answers are absolutely irrational.

He plays well at draughts and whist, but his doing so appears to depend more on old habits, [119a] than on the present exercise of his faculties; which, though, as already observed, they are not wholly lost, yet, from his torpor, age, and the natural obstinacy of his disposition, he is disinclined to exert himself out of his usual course: and though his constant habits of employment and amusement in the house, make up for him a considerable stock of felicity, and aid in procuring the degree of health and spirits he enjoys, and the degree of mind he still possesses; yet he is so extremely obstinate and tenacious of his own mode of procedure, that any attempts to oppose him, will arouse his temper into fits of angry passion. [119b]

OBSERVATION III.

There is nothing particular to observe here, unless it be the obvious remark, that from his age and confinement for such a number of years, among beings who, for the most part, have no commerce with right feelings and thoughts, it is wonderful that any thing like powers of mind should still remain; or that he should, excluded from the excitement and collision of the world, possess any inclination to exercise them; but this is most probably owing to the amusements and employments already stated; and for the sake of drawing attention to this fact, have I been induced to make any observation on this case.

No. 4.—Admitted 1787.

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

No. 5.—Admitted 1791.

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

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

No. 6.—Admitted 1791.

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

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

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

OBSERVATION IV.

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

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

No. 7.—Admitted 1792.

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

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

OBSERVATION V.

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

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

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

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

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

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

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

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

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

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

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

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

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

At the same time I assert that our moral state has more to do with disease, either directly or indirectly, than is generally credited, yet these moral causes are necessarily every where physical in their operation, so that the assertion that our physical corresponds with our moral state, and what we call physical causes are the effects of this state, need not alarm us, in fact, the interesting truth is now demonstrated, [135] that health and longevity correspond with our moral state, (though this is true as a general principle, there are many real and apparent exceptions,) in fact, natural and moral effects co-operate, just as the circulation depends on the nervous energy, so the nervous energy depends greatly on our mental condition.

Whether, however, the causes of diseases are more of a mental or corporeal character, is not now the question to decide.

For though in the Essay I propose to give on atmospheric influence, I shall endeavour to point out the various causes which may give rise to an irregular display of the spirits of the insane, I am far, however, from denying, that there are alternate states of excitement and depression, of better and worse days, which we may not be able to trace to these causes, but which may depend on principles similar to other physical intermittents, just as we have periodical head-aches, having their accession and intermission most frequently every alternate day, and yet, even in these cases, I have been able to discover the origin of these head-aches, as was my own case, to alternate sleepless and distressing nights.  Looking at these periodical exacerbations of insanity, without tracing them up to their first causes, they seem like the operation of some disturbing cause, requiring a given time to arrive at their crisis, or to produce the effect, and when produced, to subside again, and this cause, thus viewed in its less remote operation, seems altogether of a physical nature.  But this periodicity, which I also advocate, will be more fully examined in the third section of the Essay on Atmospheric Influence, in which some observations will be ventured on lunar influence.

Let the reader in the mean time take it for granted that such an influence exists; we shall then be able to examine the modifying influence which the peculiar state of the mind, in each, among the insane, must have over their manner of exhibiting these alterations in their animal spirits, especially among the old incurable cases, labouring, as it has been said, under the chronic form of insanity.

Often, after the first attack, their minds are left in an imperfect state; yet, notwithstanding this inability to discharge the functions of mind properly, they generally retain their physical energies, enjoy vigorous health, and, of course, the flow of their animal spirits dependent thereon, is more likely to be improved than otherwise; with respect to mind, however, they not merely want volition, and the common motives and principles of control over themselves, but there have been circumstances connected with their confinement, which, co-operating with the excitement, (the cause of which I shall hereafter attempt to explain,) have formed in the system regular periodical returns of these states; so that, at these periods, they not only, more obviously, exhibit these changes in their spirits, and, of course, display without disguise, their peculiarities of mind, as children do, and sometimes as even men do, when warmed with friendship, or with wine; but they also do so in a higher degree, and, of course, with all their latent imperfections of mind, in a much more striking manner; they then “show themselves,” their peculiar character and defects; nor should this explanation of the periodical return of these states of excitement, from the above-mentioned co-operating causes, surprise us; we may every day witness the operation of the same principle, among men possessed of reason.

We all know, whoever gratifies any passion, or accustoms the system to any artificial stimulus, at stated periods, invariably finds the difficulty of resisting this passion, and his inclination for this stimulus greatest, at the usual period of gratification: and so it is with the expenditure of animation; in fact, nothing is more certain, than that both mind and body become the slave of those customs, which the manner of our living, and moral conduct, and the circumstances through which we have passed, have fastened around us.  Now, as the circumstances and treatment of the insane, have hitherto been different from common life, (the object ought to be, in the treatment of the insane, to resemble common life as much as possible;) and as they are without control over themselves, their mode of displaying their more animated state, must be as different from the civilized man, as the civilized man is from the savage.  If, then, habits of civilization may be called a second nature, here it may be said, that a third has been superinduced.

From these circumstances and states of mind, it appears, that, instead of their stock of animal spirits being expended, under the guidance of a moral agency, and regularly diffused over their existence, they are subject to mere physical influence, and become the sport of every eddying wind that blows; and therefore we find every possible variety and irregularity exhibited.—A perfect contrast to that of the good and wise man, if such a one can be found, whose balance of mind is preserved, whose spirits are tranquil and even, who enjoys perpetual sunshine within, and diffuses peace and serenity around him.

Thus, because when their spirits are buoyant, they strangely exhibit their inherent defects of mind, it has in many instances been mistaken for an exacerbation or a returning accession of the disease, and called the chronic type of old incurable cases.

It further appears, that this view is correct, from the fact, that if their manner of talking and acting, in expending their increased flow of spirits, is improperly encouraged or exasperated, then we find their individual and latent defects become more obvious; but with proper treatment, they gradually die away: in fact, these appearances are more or less perceptible, in a great measure, according to the spirit and conduct of the superintendant; and even, under him, to that of their respective attendants.  Of this, I could give some striking illustrations.  It is astonishing how much the increased flow of the spirits will be dark, gloomy, and vindictive; or light, cheerful, and full of kindliness; just as we by our treatment excite and keep alive one part of the mind or another.  The same principle might be illustrated also, on a larger scale, by surveying the conduct of different parties and governments in the world; and on a smaller scale we see every one in authority, a magistrate, a gentleman, a minister, a pastor, the captain of a ship, and a parent, stamp their character on the sphere in which they move.

Were it the place, nothing could be more instructive than examples to demonstrate the correctness of these observations.

The preceding case, I consider, is one of these examples.  I have said, that for the most part, these states of excitement and depression, are merely an irregular exhibition in the accumulation and expenditure of the animal spirits, and not always to be considered, according to Dr. Halloran’s view, as the remains of the disease in the state of a returning paroxysm, and that which characterises the permanently insane; but that this originated in, and depended on, causes which equally affect the animal spirits of the sane and insane, with this difference, that in the insane, as in this case, they are modified by the peculiar state of mind, and the sort of treatment they have received.

Grant that, from the state of his mind, any little increase of animation would resemble, in a slight degree, that which he now exhibits, then I am, by the help of facts, in this and some other cases of a similar nature, justified in saying, that I have been able to trace the process and progress of these changes, from small beginnings to their present state.  I know, from the best information, that his manner and appearance were, when excited, so laughable and striking, that the attendants and their friends, from want of proper feeling, or perhaps mere thoughtlessness, actually made him a source of private sport and amusement, and thus increased his excited state, which, in the course of time, assumed its present peculiar and amusing form. [141]

A minute detail of all these things, together with unnecessary and injudicious confinement, I am certain, would prove all this.

In many cases, and especially in the last, I have been able to trace, as I have already said, the process and progress of these changes, from small beginnings to their present state.  In some cases, any little increase of animation gave rise to manners and conversation, which were extremely amusing, and such as tempted silly and unthinking people, as well as the other patients, to encourage by listening or assenting too much to them, or to exasperate by wantonly making them a source of sport and amusement; conduct which cannot be too strongly deprecated, especially during the critical period of their convalescence.

In most instances, however, it must be allowed, that among these old incurable cases, [142] the most powerful exciting causes are within them.  When their minds are at all irradiated, striking ideas, and scenes of the past, cross their imaginations; they are further excited by them; and in proportion as the system is excited, these ideas are themselves more powerfully awakened; they have no clear consciousness nor control over themselves; and this dreaming state of their minds, to them all reality, is sometimes as cheering as the dreams of hope can make it, and at other times as horrible as the night-mare! and thus they are wrought up into the most excited or exasperated state.  In some cases, especially the foregoing, this goes on until they are worn out, when they require a corresponding portion of time to renew their vital energies; and thus cause and effect mutually produce each other.  These alternate states of excitement and depression, being often repeated, they gradually increase in strength and duration; and thus it is in some few cases, and especially those similar to the last, we find, that their spirits are not expended and renewed, as ours are, once in twenty-four hours, because these changes have become the habitudes of their nature, so that their system becomes governed by new laws of action.  It is very singular that those most liable to extremes, are most predisposed to insanity, and in its more confirmed stage to this periodicity of excitement and depression.

I have already noticed, [143] that the excitement of the depressing and exhilarating passions alternately, is the most striking characteristic of the old insane,—so striking that the general division of insanity is intomania and melancholia; a division, however, which is altogether unphilosophical, as the mania and melancholia are not any abstract difference in the cause of the disease itself, but merely the results of the over-active nervous energy operating in different directions—at one time on the depressing, another on the exhilarating passions; this indeed is the case, more or less, with all those who preserve not this mental equilibrium, but who act more from the impulse of their feelings and passions than the cold calculations of reason, and the rigid restraints of principle.  To what extremes are the passions of the human mind liable, when neither the true light of the understanding nor any right sense of justice guide them!  We see this in ignorant and unprincipled individuals, who suddenly rush out of their thraldom and pupilage into liberty and licensciousness; we see the same thing exhibited by agitated and wicked masses, as in the French Revolution, when the moral, like the physical ocean, is let loose from its order and control, and heaves its tumultuous waves of passion, as if by an earthquake, from one overwhelming extreme to another.

When then, as in the insane, all the restraining powers of the mind are lost, can we wonder that the mental energies should be subject to accidental and baneful influences? that they should impetuously rush with fearful, because with unguided force, into the most opposite and direful extremes?  These extremes, however, always correspond to the individual peculiarity of mind, and the nature of the exciting causes, which exciting causes often exist internally long before they become externally evident; thus gradually forming ruts in those weak or soft parts of the mind, as it were, in which their feelings are naturally more apt to run; and thus they acquire the increasing facility and strength of habit, in operating in one direction rather than another, until they become irresistible: or in other words, until the understanding has no longer the power to extricate the mind from their influence.—Body and mind have been allowed conjointly and reciprocally to produce and increase these effects.  The effects are first, disordered action; next, inflamed and diseased organization of the brain, as well as this disordered action being continually strengthened by a daily increase in the power of mental association, “calling forth an increased susceptibility to the action of certain exciting causes;” and so far I agree with Dr. Halloran, that a something like the original “accession of the disease,” more readily takes place. [145a]

I have said, [145b] that in cases of permanent insanity, the alternations into these opposite mental states occur most frequently among persons whose previous character was marked by extremes,—who were easily excited, and as easily depressed, either by their hopes, their fears, their anger, or their affections.  And I have often had occasion to hear these remarks on their admission; and further, that they could not bear stimulants, especially ardent spirits; and that there was insanity decidedly developed during their worst paroxysms of intoxication.

In fact, the history of their lives, at least of some of them, was that of comedy and tragedy, perpetually prophesying and exhibiting a threatening prelude of their present more awful state; more awful in appearance, because it has now become bereft of its former lucid interludes; which lucid interludes had, possibly for some time, been externally maintained only by the mere power of external moral influences, long after the internal control had ceased to preside over the mental operations.

We call it insanity when external restraints are broken down and disregarded; we cannot decide how long absurd and delusive feelings and notions have monopolized all the operations of the little world within.  I shall have occasion hereafter to adduce the history of many cases which will serve to illustrate the truth of these views.  I may briefly mention, that they occur most frequently in those families where such a constant April atmosphere exists: and, as a further argument it may be stated, that a greater proportion of victims to these causes occur among the women than among the men; and in the male sex we find they are those of a more feminine character, or those whose feelings naturally predominate over their understandings.

Thus children who resemble their parents, through the spirit in which they were conceived and brought forth, become still more like them by example and education; and hence the very important fact, that the greater number of those who lose the power over their own minds, are from among those who have been unaccustomed at an early stage of their existence to exercise a salutary control over their feelings and habits; and of those especially such as naturally possess strong animal and sentimental feelings.  Hence it is said, “that of all the causes of mental derangement termed moral causes, perhaps the greatest number may be traced to the error of early education.” [147]  Thus, as I have already remarked, an only child, or the youngest, (who has often as much exclusive attachment as an only child, because he is the son of old age, or is young when the rest cease to be children; or may be the only one left at home,) are numerous amongst the insane.

Again, in confirmation of the same argument, we may here remark, that the greatest number of those who become insane, become so between the ages of thirty and forty,—a period when establishments are formed, and habits have been strengthened by time, while the feelings yet retain all their energy and susceptibility of action.  Thus we can conceive why reverses and disappointments should then have the most fatal and overwhelming influence.—Still less need we wonder that this should happen to those whose animal propensities and sentimental feelings have been exclusively cultivated, as they then find that if understanding and principle are insufficient to restrain them, the claims of society forbid their gratification.  Hence the conflict becomes dreadful and dangerous, confounding and overturning the balance of the mind.  Even without this, bad passions, disjointed and exclusive habits of feeling and thinking can hardly go on progressively increasing to this age, without becoming so irresistible as to threaten to destroy and swallow up in their vortex all that remains of the man within them.  Such is a true and beautiful description that Johnson has given of Imlac’s insanity in his Rasselas.  Any passion or propensity of our souls, when improperly indulged and carried to excess, is an abnegation of reason; and in saying this, we give a true definition of insanity, however startling this wide application may appear.

What is the most obvious history of most cases?—Thoughts and feelings are indulged on any given point, to the detriment or suppression of others which might draw us from this dangerous and exclusive habit of the mind; till at last we become incapable of resisting any other train of thought, and feeling, and action; “they are at first imperious, and at last despotic.”

When and how are all these evils to be best prevented?  We answer, in the preliminary stage of our existence.  We shall revert to this important subject in an essay on the primary principles of education; and shall only now remark, that where we perceive a soil full of the seeds of all these evils, we can expect only corresponding fruits?  We shall conclude these remarks by directing the reader to look to the soil where these evils exist: we do this, because it exhibits the truth of the principle for which we are contending.

We see, in the history of families, that the extremes of heartless tyranny on the one hand, and the foolish fondness of blind affection on the other, engender soils equally favourable to the production of these terrible fruits to which we allude: still more so is this the case where these extremes exist in the same family.

Many are the married persons who waste their lives in inordinately and alternately hating and loving each other.  From small beginnings, breezes arise and gather into storms; at last, exhausted by their violence, they subside, and for a while love returns, and all its ardent affection.  Such is the brief but sad history of many a matrimonial union,—but who can describe its baneful influence?—how much evil and misery are propagated! how much reason and principle, health and happiness, reputation and prosperity, are sacrificed in those families, whose parents thus suffer reason and understanding to be the victims of these opposite and alternate mental states!

Of which states, such as become insane, are but the caricature samples of the hereditary family infirmities, and the actual habits of their lives; and perhaps this may happen to one less a hypocrite than the rest, because in such a one, the external and internal become more easily and readily in fixed and permanent correspondence.  It is natural, therefore, to expect that this same character will be exhibited still more conspicuously after the understanding has altogether ceased to perform its godlike attribute of rightly using the light of pure reason so as to enthrone and support that one grand ruling principle to which the whole mind should be obedient and subordinate.

I have been the more particular in making these observations, because I conceive they may be useful in a medical point of view.  They may prevent us from mistaking the simple, though modified, changes of the natural ebb and flow of our animal spirits, for an exacerbation or new accession of insanity,—and thus warn us from treating the patient with unnecessary restraint, as though he were suffering from a new attack, and from blindly endeavouring to cure a hopeless case by the wanton administration of strong and deleterious drugs, which in most instances would destroy health, as well as the remnant of the faculties: “In the diseases of the mind, as well as in all other ailments, it is an art of no little importance, to administer medicines properly; but it is an art of much greater and more difficult acquisition, to know when to suspend, or altogether omit them.” [151]

No. 8.—Admitted 1783.

No statement on record.  He was a respectable country Clergyman: his friends say he was a hard student, neglecting exercise, and all attention to himself or his health, and which had, for some time previous to the attack of derangement, been in a very precarious state—the attack was very sudden and violent.

He has a leprous eruption, which has continued since the time of his admission until now, without any very perceptibly abatement.  He was formerly the most furious maniac amongst the old incurable cases, though less strikingly peculiar in his appearance and manners than the one last described.  During the paroxysms of his greatest fury, he appeared like one whose mind, from excruciating pain and dreadful mental provocation, was wrought up to the highest pitch of passion and revenge; so that he would, as though he had the object of his malignity before him, be incessantly repeating, through whole nights and days, some single phrase, such as, “damn’d dog,” with a sort of suppressed barking, roaring furiousness, even until he foamed at the mouth, and his face was black with passion.

He was most violent when the eruption appeared least on the external surface.  When his mind was more at ease, he would play like a little child for whole days together, with the merest trifle, such as a piece of string or paper.  At these times, when given any thing he likes, he has something singularly fascinating in his smile.

For this eruption, many things had been administered, without any permanent advantage.  Solution of nitric acid, about three years ago, [152] appeared to have, for a time, a good effect; the eruption became somewhat less, and the mind less violent: but this might arise from the debilitating effects, rather than the radical removal of the cause of his disease.  After this, the solution of nitrate of potash, had a good effect both on his mind and the disease of his skin, without reducing or debilitating his system.  He has lived, for this last twelve months, on vegetable diet, and he is apparently better; but this may be a fallacious appearance, since his vital energies appear to be sinking.

OBSERVATION VI.

It has been said, by the late Dr. Jenner, and some others, that cutaneous disorders are common to the insane.  I should think they are not very common. [153]  This is the only case that I have seen, where the two have continued to exist together.  Whether it was the original cause of his mental malady, I have not been able to ascertain, but it is certain, it aggravated it.  That mania, in some instances, follows the disappearance of eruptions, ulcers, and other local diseases, particularly with females, is satisfactorily established; but in many instances, other causes co-operate.

In cases of dementia, arising apparently from continued pressure on the brain, the surface, from the general bad habit of the system, is liable to sores, boils, and ulcerations.  This cannot be called a cutaneous disease; it is rather a symptom of the diseased state of the brain, than itself the cause of insanity.  Glandular swellings, however, seem to have a more direct connection; but still they appear rather before, than after the alienation has taken place.  In a few cases, I have noticed slight eruptions during recent paroxysms, and in two or three, immediately previous to their convalescent state.  Had such appearances occurred more frequently, I should gladly have regarded them as favourable prognostics; but they might arise from strong medicines, their state of confinement, or they might be mere accidental coincidences.  There are many instances of cures by accidental injuries, [154a] as well as by the accession of consumption and other physical diseases.

Here I leave the question for the present, till I come to some cases, where, according to the theory of such a connection subsisting, (which I believe is the case in a few instances,) the tartarized antimonial ointment has been applied; [154b] but I confess, that there is no part of my experience in which my sanguine expectations of cure, after a certain duration of the disease, on this principle of counteraction, have been more disappointed.  In the early stages of insanity, it is decidedly the most valuable principle in our practice.

No. 9.—Admitted 1793.

No statement on record, that gives any satisfactory information.  She was a respectable farmer’s wife, and her insanity was occasioned by her husband’s heavy losses of cattle.  Her first symptom was throwing her little infant at the feet of the parish officers, saying, “there, take it.” [155]  She often repeats, with a very moaning sound, and tears, “God rest thy soul, poor old mare.”  She will be easily known, when I say, she is a poor, moaning, miserable looking imbecile, constantly sitting cowering in a corner, always crying for tobacco.  She was one of those who were kept naked in loose straw, and hence her inclination to undress herself, her dirty habits, and her peculiar mode of sitting: indeed, formerly, throughout the house, the lowest and worst patients had no seats allowed them.

No. 10.—Admitted 1793.

Nothing recorded of this case.  It is said, that when young, he was severely kicked by a horse.  There is now a considerable indentation just above his left ear.

His mind, though extremely childish, is altogether in a torpid state, for the most part quiet and good-natured; but sometimes, when more excited, he exhibits a love of mischief, generally very childishly, but sometimes more seriously so. [156a]  His temperament is phlegmatic, and he has a heavy, dull look.  He has been for years employed in the garden.

No. 11.—Admitted 1793.

Nothing on record.  I have been informed, that he was a well-sinker, and that his insanity was the consequence of a rheumatic fever.  No one, except a complete idiot, can be in a more stupidly stagnant state of mind; he scarcely notices any thing, and never speaks unless spoken to, and then his answers are merely monosyllables.  About once in twelve months, a slight exhibition of excitement shows itself in a sort of ill-tempered obstinate fit, [156b] but which soon subsides, especially with the aid of sulphate of magnesia.  He is, together with No. 10, constantly employed in the garden.

OBSERVATION VII.

The observation which suggests itself on No. 10 and 11, is, that from such facts as these, it is very evident, there can scarcely be an old pauper patient in such a state as wholly incapacitates him from being brought, with a little trouble, into habits of useful employment.

As stupid men are generally less diverted from an object which once engages their attention, than men of greater capacity; so it is with these poor automata; if the first difficulty be but once overcome, that of acquiring the habit of working, there is no fear; but they will proceed in it more steadily than those who feel that they have a right to consult their own choice.  They cannot be tempted, nor do they possess the power of giving their energies a new direction; and hence, as habit gathers strength, we may depend on them as on our time-pieces.  If amusements and employment are good for these, how much better for those who are not past the hope of recovery; it may change the object of their thoughts, and gradually turn them to one of a less dangerous nature.  I shall have some very interesting cures, partly attributable to this principle, to state in due course; in the mean time we perceive, that if even they are past the hope of recovery, they are kept in a better and more healthful state; and what is more, it diffuses a satisfactory feeling through the whole system, and they are made happier than they would be by a life of idleness.

No. 12.—Admitted 1797.

Nothing on record; and I have failed in my efforts to obtain any information of her previous history.  It is said, that her relations are respectable; yet her residence here is paid for by a parish in London.  She has long been, together with No. 7, the most useful and hardworking person in the house.  In the midst of her work, she will often scold and swear with vehemence, but no one knows about what, or against whom; and though her voice is loud and shrill, no one regards it, saying, “Oh! it is only poor M. W.”  Yet she is very kind-hearted and friendly, giving away her own meat, especially to those who are ill; and when prevented from doing so, will throw it away with indignation.  She would gladly starve herself to feed others; and always asserts, when a patient dies, “that they died for want of something to eat.”  She used to practice this singular fancy, that of frightening the devil away, by taking a sweeping brush with her to bed; but now, a tin pint serves the same purpose.  She is a tall, meagre-looking woman.

No. 13.—Admitted 1798.

No statement of this case; but it is said that, in the first instance, he was very violent.  His mind is now in a fixed imbecile state, and exhibits no alteration, except the slight changes which mere alterations of our spirits produce; when he is more easily provoked—talks, laughs, and sings more, or holds conversations with persons dead or absent; sometimes scolds them, fancying they tease him in some strange manner, which he calls “triangling;” but it is impossible to ascertain what ideas he affixes to the word; he is a very quiet, good-natured man, a general favourite, and is usefully employed by the attendants in the house. [159]

No. 14.—Admitted 1799.

No statement of her case; and I have failed in obtaining any very satisfactory information about her.

It is said, that she gradually became insane, after the death of her only boy, named “Charles,” (who was the natural son of Sir —:) this is probably true, as she now imagines that Charles is constantly with her—sleeps with her—that she feeds him at her meals—carries him about in a corner of her apron—nurses him—and talks to him with delight and maternal fondness.  She often fancies, too, that she has been confined, and has got more children. [160]

Her appearance and manners are exceedingly polite, pleasing, and affectionate; she is attentive to others, in all those little nameless etiquettes of life, which, when regulated by truth, constitute the innocent fascination of a kind-hearted and well-bred character; and it is so with her: every one doats upon her as upon a favourite child.  She never fails to tell me, if I have been out during dinner-time, when she next meets me, “you have not got your dinner, go and get it immediately;” and yet left to herself, she is wholly taken up with scolding some imaginary beings who annoy her, get into her throat, head, back, &c., run her through with swords, and do a thousand other strange and cruel things to her.  Every evening she has a long scolding, with a tone three-fourths of anger and one-fourth affection, with some men who plague her in her bed and in her bed-room, and continue to do so till her attendant comes, sometimes at her call, to drive them away.  Is this the lingering last impression made on her mind by her seducer?  In the midst of her scolding she will often swear in a strange under tone of voice; and when accused, she says it is some other person, frequently Jack Swales.  Her conversation is so exceedingly extravagant and varied, that it is impossible, except by the most lengthened description, to convey to others any adequate conception of it.  Names of dukes, kings, queens, pipes of wine, sums of money, estates, &c., are as common to her as household words; yet strange as all this is, it seems to have some connexion with her past life, having formerly held a situation in a family of consequence.  Her former situation and disposition are hinted at by these reminiscences, which are delightful traits of what she has been.

No. 15.—Admitted 1799.—Aged 50.

No statement on record; it is certain, however, from his own account, that he was formerly steward and butler in a gentleman’s family, and had been what some call a “hearty good fellow” all his life.  His manner continued that of a blustering, passionate, half-inebriated man; [162] his skin was covered with a scorbutic eruption, and his face a bloated livid red.  He died of dropsy in the chest, March 6th, 1821.

OBSERVATION VIII.

The observation, or rather the moral, in this case is so obvious, that it is almost superfluous to add, that from the nature of his case, and his own account of himself, his system both of body and mind had been brought into the extreme state of morbid irritability by the conjoined excitement of the dissipated companions, particularly of his early life,—unchecked in their effects by the exercise of any moral restraint over himself; and hence his mental powers and passions were not so much shattered and decayed, as they were like a vessel without its pilot, the sport of every wind and wave that assails it: bad habits had become too inveterate to allow the will to be taught obedience to reason; all measures of coercion, instead of inducing self-control, could only irritate and exasperate, as he was perhaps still less accessible by religion than by reason.  I believe, however, that by gentle, and indirect means, he gradually became less boisterous in his manners; but it is proper also to add, that from age and disease, the sinking of his physical powers and animal spirits might imperceptibly, but more effectually, tame him.

No. 16.—Admitted 1799.

Nothing on record.—It is said she was a belle: she is thin and tall, and is remarkable for a demure, prim, affected, stiff manner of sitting, like vanity turned to stone.  She will spend hours in dressing, undressing, washing, &c.  I have never heard her say more than “pretty well, thank you.”  Her mind seems rather empty and motionless than diseased or deranged.

No. 17.—Admitted 1799.

Nothing on record.—She is a neat, clean, but rather crabbed-looking, middle-aged woman; and who, unless she is provoked, is scarcely to be distinguished from the sane; but when provoked, she is exceedingly abusive, and exhibits the deranged state of her mind.  She is very useful as a laundress, and is known only by that name.  The great objects of her affections are cats and kittens. [164]

No. 18.—Admitted 1800.

Nothing on record.—He was an Italian, of a swarthy complexion, dark eyes, black hair; and to look on his countenance reminded one of an assassin, “the mark was upon him.”  He was subject to violent fits of excitement when he was suspicious and thought himself insulted by a look or a word; and from his ignorance of the English language, he might perhaps have greater scope for suspicion.  When offended, he gnashed his teeth; striking one hand violently against the other; appearing from these, and various other indications, to be preparing for action, and lashing himself into a state of the most determined revenge, he watched his opportunity, and seizing his victim with his teeth, was quite delighted if he drew blood.  He bit several, some seriously; and in one instance, he bit a piece completely out of the lip of another.  They all agree in the house that they never saw a patient so ferocious, or one where harsh measures seemed more justifiable; yet nothing could conquer him—his attendant believes “he would have died first.”  It was no accidental result of passion, but the settled object of his mind. [165a]  He would chuckle and triumph over the injury he had done; and this was the more remarkable, as his mind in other respects was so much gone, that he continued to the time of his leaving the asylum, occasionally a dirty patient.  Still it ought to be stated, that this ferocious disposition and these dirty habits, if they had not been absolutely grafted on his natural disposition, must have at any rate been made much worse by his brutalizing treatment; for he was one of those who were formerly kept naked in loose straw,—besides having during this time lost his toes, supposed to be from his exposure to the cold, he could not so well defend himself, and so might have been taught by necessity to have recourse to his teeth.  That he was made worse by his treatment, is evident, as latterly he became sensible of kindness, and improved in personal cleanliness; and his general manners indicated much less malignity of feeling; indeed something like affection [165b] and gratitude to his attendants, began to excite in them, without effort, kindly feelings towards him.  At first, (after the new state of things) it was with the utmost difficulty that he was made to keep his clothes on, or to be kept clean; but latterly, for many weeks together, he went on without any restraint whatever.  He was removed in May, 1822.

OBSERVATION IX.

The observations that naturally suggest themselves on this case on the efficiency of mild treatment, are so obvious, that it would be obtrusive particularly to state them.  I cannot, however, omit adverting to the fact of the probability of his having lost his toes by exposure to cold, because it illustrates the remark made in observation V.  Patients, in former times, were kept naked in loose straw; and from their exposure to cold, mortifications in the extreme parts were common; and then writers on insanity say, that mortification of the extreme parts and insensibility to cold, are symptoms of mental derangement!!—See also observation 12th.

No. 19.—Admitted 1800.

Nothing on record.  He was a respectable tradesman.

He is constantly muttering and talking to himself, apparently busy in making calculations, holding in his hand something he calls an almanack, made by himself, as well as some pieces of money he has polished.  He repeats something, seemingly as a duty imposed upon him, perhaps meant as a prayer.  Though the shrivelled and decayed scraps of mind that remain, look only like the apparitions of his previous habits of life; yet they so wholly engross his attention, that he never notices passing and external objects around him.  Sometimes, however, he can with great difficulty be for a moment diverted from his object, and while roused, will answer questions with considerable point and shrewdness, but returns as quickly into the same uniform abstracted state.

He is evidently of a contented and happy disposition.  There is something in his appearance and countenance which seems to say, “I have been a respectable and good-natured fellow.”

OBSERVATION X.

The only observation here is one which I shall notice more particularly when I come to treat on the efficacy of moral management—viz. that, notwithstanding the deranged state of his mind, and the imaginary objects which occupy his attention, still he can be roused for a moment to something like a proper use of his faculties.

No. 20.—Admitted 1801.

Nothing satisfactory on record.  Said to have been a violent maniac.  He was kept naked on loose straw.  Since that time it is said he was improved by a seton; but still he was to the last a stupid, heavy, idiotical looking man, and in reality was so. [168]  That he was less dirty, and kept himself dressed, was owing to better habits, into which proper management had gradually moulded him.  But his mind was irrecoverably gone; he was motionless and silent, unless spoken to, or urged to some action.  His replies were merely monosyllabic, and these only correct when they referred to something he had formerly best known; he was, however, drilled into some degree of usefulness, in helping about the wash-house.  He was removed by his friends in April, 1821.

No. 21.—Admitted 1801.

Nothing on record.—He was one of those who was formerly kept naked on loose straw.  He has been for years, for the most part, in a moping, poring, and solitary looking state; yet he has had occasional seasons of excitement, when the disposition towards furious revenge seemed to possess him, so much so, that he would, unprovoked, place his back against a corner of the wall in the attitude of self-defence, shaking his doubled fists in a daring and threatening manner.  Though these effervescences of his spirits occur as frequently as ever, yet the malicious disposition seems dying away, and instead of which he will, at these periods, sing a little comic air, and give other indications of his mind being happy and full of good-nature, as much so as the little mind he possesses will enable him to be, if, indeed, beings in such a state can be said to have minds at all; for what an appalling difference between them and minds enriched with laborious habits of reading and reflection!

OBSERVATION XI.

In addition to the observations already made on former and present treatment, it is only justice further to say, that amongst recent patients, I have scarcely seen (if indeed I have seen) one instance of continued revenge.  Their spirits exhibit themselves in good or ill-nature, according to the direction that is given them, and even in the old cases, as in the one above stated, it appears simply the remains of their former usage; so that if their minds are still agitated in some sort with feelings of revenge, it is only like the sea which will fluctuate awhile after the storm has ceased; but the winds are hushed, and every wave becomes less and less, until it subsides into a calm.

No. 22.—Admitted 1801.

Nothing on record.—I have been informed, that his mind was instantly wrecked by the female of his heart unexpectedly marrying another the very day previous to that on which she had promised to be made his own for ever.  He was an idiot, who could barely answer in a low whisper, and to a few very simple questions, “yes” or “no.”  He was old, and pale, and thin—had a long face—his head hanging forwards—his stare was ludicrously vacant and goggling—his lower jaw fallen, and saliva flowing over his large hanging lip—though he generally stood quietly in a corner with his face to the wall, yet sometimes he would for some hours together make a strange and disagreeable noise—what was still more disgusting about him, he had the sickening habit of bringing up his food and regorging it, yet, in other respects he was not a dirty patient—perhaps because having been with a better class, he had received more attention.—He had this singular fancy, that if he had one or fifty pieces of bread and butter, he would eat, or secrete, or pocket them all, except one.  He gradually declined from old age, and died in December, 1821.

No. 23.—Admitted 1801.

No statement of his case.  It is reported that he was a clever man, a hard student, fond of political subjects, and that speculations on the national debt were the cause of his insanity.—This report receives a colouring of probability from two large trunks full of books now in the Asylum belonging to him, almost wholly on subjects of political science, among which is a large collection of pamphlets on the national debt, and it is apparently confirmed by the nature of his hallucination; only I cannot trace the report to any certain source.  It is certain he was Superintendant of the Police at Bombay.

His appearance and manners are very peculiar, and very difficult to describe.  He holds his head forwards and obliquely upwards in a calculating position; moving his hands in different directions, and working with his fingers like unto one gathering something in the air.—At times he extends and stretches his hands higher than his head, moving and working them in the same manner: he will hold his face directly upwards—open and shut his mouth in a gaping and catching style, as if he were feeding on air; repeating these operations, and intermingling them with a strange gurgling noise in his throat—almost always muttering to himself as if he held busy converse with his own thoughts, with visible appearances of pleasure or anger on his countenance, occasioned by his imaginary operations being successful or otherwise.

Though he is sometimes as immoveable as a statue, yet he is for the most part moving about, and has a singular mode of treading with his feet like one who has been accustomed to a tread-mill, lifting them higher than necessary, and setting them down cautiously,—sometimes pulling off his shoes—sometimes, however, quickening all his motions, as if something required extraordinary haste and dispatch; and thus he marches about like some star-gazer treading on precious and frail materials; seldom more than a few moments in one place, and in all his movements in different rooms and parts and corners of his gallery, stairs, and airing court, and in all his operations and mutterings it is evident that he, in his imagination, is performing some essential part of his mighty task of paying the national debt, for when any of his operations or mutterings are interrupted, like one whose studies are suddenly broken in upon at some unlucky moment, he seems vexed and unhinged; sometimes bursting into a violent passion, when he is most eloquent in the use of scurrilous epithets (a proof that to use abusive epithets requires very little mind) calling the person who has impeded him in his great work, low-bred, mean, dirty scoundrel, rascal, villain, thief, vagabond, madman; accusing him of being the cause of the loss of many millions to the nation, threatening him with the direst punishment, particularly that he shall be whipped in the air.  He is otherwise remarkably quiet and inoffensive, and uniformly intent upon this object, except that sometimes, as already stated, he appears unhinged and irritable by the unsuccessful issue of his calculations, and is then more liable to take offence, especially at any disrespectful deportment towards him, for it must be observed that he is still very fond of his title and of that deference due to a man of rank.  Occasionally, like some alchemist of old, he fancies that some äerial being, which he calls the clown of the air, plagues him in various strange ways and interrupts his operations, for which mischievous interference he, in his way, severely scolds him.

The politeness which may be traced in his manners, is evidently the result or remains of his old habits, as he is so absorbed in abstract speculations that all attention to himself or external objects is utterly excluded; he is always solitary, but it is like the solitariness of one whose intense studies allow him no time for fellowship or the exercise of social feelings, so much so, that notwithstanding a consciousness of kind and respectful treatment towards him, he scarcely yet seems to know the name of his attendant.

Although his system is delicately susceptible of changes of temperature, he scarcely ever notices it himself; and when roused to pay attention to his feelings, he says that it is the clown in the air that has teased him with the iron ague.

He has been subject to occasional attacks of asthma, brought on, apparently, by exposure to cold in the night time, during these operations, (for he frequently jumps out of his bed to carry on this great patriotic duty.)

Though he can, if properly roused and managed, still answer questions much more correctly than all these appearances would indicate, yet it is evident that his mind is gradually declining, from age, exertion, and the nature of his case; he is an object of interest and sympathy, and nothing can exceed the way in which it is shewn towards him by his attendant.

OBSERVATION XII.

The correspondence between the insane state and the previous character and habits are in most cases, and certainly in this, very striking.  On this subject I refer to the Essay on the Changes and Correspondence between the previous Natural Character, and that which they exhibit in their Insane State.

There is another fact in this last case, which may conveniently serve the purpose of introducing some observations ON THE EFFECTS OF HEAT AND COLD AND THE STATE AND CHANGES OF TEMPERATURE IN INSANE PERSONS, which may be considered as an Appendage to the remarks made in Observation V. and IX.

The fact to which I allude in this case is this, viz. that his system “is delicately susceptible of changes of temperature, but that he himself scarcely ever notices it.”

When the hallucinations of the insane are purely intellectual, and wholly and intensely occupy the attention, the generation of animal heat appears less than usual; and decidedly less than in those cases where the aberrations of the mind are connected with the stimulus of selfish and exciting passions,—hence the system is cold.  But this arises rather from defective quantity of heat, than from any irregularity in its distribution; and thus, while the mind, from its state of abstraction, either disregards, or is wholly unconscious of exposure to the cold, the body is very sensibly and strongly affected by it.

In the last stages of gradual decay of mind, the changes and disturbances in the quantity, state, and diffusion of heat, resemble that observable in paralytics; there is great insensibility to heat and cold, and the infliction of pain; and, previous to the period of their dissolution, the slightest pressure, even so slight as to give no pain, produces ulcerations, which rapidly degenerate into gangrenous ulcers.—In old torpid cases of neglect—cases of suspension of mind; and in cases of pure mental abstraction, it is deficient in quantity, although equable in its diffusion.

In all these cases, as well as in cases of over activity of mind, especially during violent paroxysms, there is a general loss, or want, of consciousness to the usual impression of the corporeal system.  Sometimes, however, this consciousness is on some points morbidly acute, indicated by strange sounds, and sights, desires, or aversions, &c., according to the parts or organs affected.  In fact, it is this undue concentration of energy, which abstracts or confuses, rather than destroys the proper diffusion of consciousness.

Hence the insane, during violent paroxysms, bear the want of sleep and food, resist the action of severe cold, and the effects of large doses of strong medicines.  In most cases their minds are so absorbed or suspended during their paroxysms that passing and external events are wholly excluded, and though some few, after their recovery, vividly remember their dreadful dreams; to others, all has been a blank, and they feel just as a person feels respecting that section of the country in which he happens to sleep as he travels; but all these things, (which I intend shall be noticed more particularly hereafter,) are not peculiar to the insane, as has been held by some; they are equally the case with patients during the paroxysms and delirium in the inflammatory stage of fevers.  Indeed, the same principle is exemplified in the cases of men of spirit or energy, who, during the excitement produced by the achievement of some difficult enterprise, bear the want of food and sleep, and resist the effects of cold and exhaustion, to an extent which would seem to have exempted them from the common laws of humanity, and these are the incidents in life which are never forgotten; but then, as with the insane, this extraordinary expenditure of the cerebral energy leaves the system exhausted, and it requires all our art and care to recover the enfeebled powers.  It is this critical period of convalescence which is so important, and so difficult in the management of the insane.

I further observe, that the variation of temperature of the system, observed during paroxysms of insanity, is more like that produced by the passions in a state of excitement than that which accompanies inflammatory fever.  It appears to fluctuate in quantity, and to be tumultuous in its distribution, in proportion as the exciting and depressing passions are active and contending with each other.  In proof of the truth of this, I need only mention that every thing which excites the malignant passions, or produces misery and distraction of mind, increases these appearances.  I allude not merely to the expression of the countenance, but to the absolute heat of different parts of the system,—of different parts of the head in particular, of which they complain and to which they point distinctly, being often sensible to the external touch of another.  It is to be remarked, that the changes and unequal diffusion of heat in other parts of the body correspond with the general and particular state of the mind: indeed the condition, (as it regards health or disease) of each part of the bodily system, directly or indirectly, corresponds with, and indicates states of the mind: but this truth requires more than an observation to do it justice; I make the remark, however, in the mean time, because there is no better guide to us in our treatment than this knowledge, and it explains this temperature as one of the corresponding effects.  And though I shall not now enter on the medical nature of the treatment these indications afford us, neither is it necessary to say what kind of moral treatment they point out to us as our wisest course to pursue.  In all such cases, and indeed in every case, we ought always to be anxious not only to keep our sympathies alive, but, in order that we may never fail rightly to direct them, we must also possess ourselves of a thorough knowledge of the mind, and its individual peculiarities.—To give settled calmness and tranquillity to the distracted mind, and bloom to the wild and faded countenance, ought not to be considered matters of trifling importance.

OBSERVATION XIII.
ON THE EFFECTS OF INTENSE STUDY, AND GENERAL INTEMPERANCE OF MIND.

Though the effect of intense study and general intemperance of mind, may be better illustrated by many cases than by the preceding, yet for the sake of the moral deducible from the combined view of this part of the subject, and the preceding observations on the distribution of animal heat, I am tempted briefly to glance at the important reflections included within it; intending to resume a more elaborate consideration of its merits when I come to the Essay on the Causes which produce Insanity.

In those cases where intense study has been considered as the exciting cause of insanity, I have almost always been able, on closer investigation, to trace it rather to the intemperate feelings and sentiments of the mind, combined with the injudicious mode of procedure and irregular habits attending it.  In young students, these studies are blamed; but, alas! how often have I ascertained that much greater and more decided causes (secret and wicked causes) have long been exercising the most baneful influence.  In cases of regular and well-balanced exertion, however severe, the effects were rather a general depression and weakness of the whole nervous system than absolute derangement, producing either debility or suspension of mind, but which for its restoration required only cessation from accustomed exertions.  Calmness and tranquillity, combined with innocent diversions and general attention to hygeian rules, invariably effected a cure.

I am the more particular on this point, as some authors on the subject of insanity seem almost to discourage all mental exertion whatever; whereas, we should never lose an opportunity of repeating the common observation, that the judicious exercise of mind, as well as body, is equally conducive to health and strength, as it is to mental improvement and worth.  Rightly to apportion and conjoin the exercise of the feelings and understanding, as well as of the corporeal frame, constitutes the whole of Physiology as applied to health.  When the civil duties of life are performed from right motives, we then are obedient to the first law of nature, as well as of the Decalogue: then all is healthy co-operation—all portions of the system have their fair proportion of exercise—none are over-worked, neither in the individual nor in the mass—neither in body nor in mind, as we at present see to be the case, singly and collectively: everywhere the effect is similar, destructive alike of all healthy, mental, and corporeal energy, and of all the sweet ties and charities of life which bind families and societies together.

It is remarked by Dr. Arnold and Dr. Penel, that most mathematicians and philosophers have not only lived to an advanced age, but have enjoyed good health, and have been exempt from mental diseases.  Perhaps the number of such men vouchsafed to the world, has been too inconsiderable to enable us to form any correct comparative estimate between them and the rest of mankind, yet reason proclaims it true; and as far as medical statistics furnish us with facts, they all tend to confirm the truth.  Certain it is, that nothing conduces so much to health and long life as conduct, well regulated, and a mind habitually preserved in a state of intellectual calmness.

Such exercise of the reflective faculties not merely subjugates, but virtually diminishes the energy of the passions; for reflection convinces that every improper gratification must produce dangerous consequences.  The very exertion of thought on subjects of exact enquiry, by appropriating the vital energies to its more exalted purposes, abstracts as much from the strength of the passions and propensities as it adds might to the powers of reason and conscience to subdue and control them.  On the contrary, persons with vacant and ill-regulated minds, (instead of possessing the passport to the wise and good, whose habits create in the social circle cheerfulness and felicity, and from thence diffuse these blessings to others around them,) fly, when unoccupied, to those who expend the energies of their existence in senseless follies or sensual gratifications.  The virtuous man has an ever-living zeal about him, which benevolence warmly inspires, and truth calmly regulates.  There is no destructive warfare among the powers of his mind, as is the case with those whose zeal is generated by pride, and nourished by malignity, but his more noble faculties take the lead in activity, and superintend the whole; all are cheered and invigorated by the co-operation and harmony that reigns among them.  It is wonderful how with this proper balance and use of the faculties they stimulate each other, and keep the mind alive;—“Peace is within these walls, prosperity within these palaces.”  Such a one alone possesses his soul with the full use of its instruments of operation.  Where the powers of body mind are well balanced—every thing is in its place—every part subservient to every other—all reduced to practice—then the mental and corporeal powers wear well—age brings few diseases, and no apprehensions—our peace of mind becomes more settled—our wisdom greater—our friendships more valuable, and we come to the grave in a full age, like a shock of corn in its season.  To say, that knowledge is power, is only to assert half the truth: it is knowledge combined with moral worth, or as Solomon more beautifully expresses it, “Wisdom is Strength.”—Without virtue, knowledge is ruinous and destructive; with it, the progress of improvement and happiness is illimitable,—here providence smiles—there she frowns; this is equally applicable to individuals as well as nations.  History is but one large commentary on this truth, and when men (indeed such a period appears now to dawn) have learned wisdom by the severe lessons of providence, then the Rise and Progress, not “the Decline and Fall, of Empires,” will be the title of the volumes of some future historian.

Were it not for the vast importance of the subject, this might seem the place to introduce some observations on that most grievous error so common among religious persons, of supposing that God requires, on sacred matters, the abnegation of reason—of that reason which distinguishes men, and without which there is no distinction between us and brutes;—it is not merely our will, or affections, or instincts, but this will combined with the superadded attribute of our own understanding which makes us men, and makes us even images and likenesses, (so far as the will and understanding are united, and exist in perfection,) of our Maker!  These doctors teach their hearers to dethrone reason, in order, as they say, that the Gospel, the grace, the wisdom, the justice, and goodness of God, may be exalted thereon.  They call all this a reasonable and acceptable service.  Strange paradox!  Wonderful perversion, that a view so contradictory and false can be enforced with a fiery zeal that proves it is believed, embraced, and retained under the influence of the fear, (and not the conviction in the understanding,) that it is essential to their salvation! yet I know this doctrine is the main branch, or the first fruits of that grand fundamental error which is called in the strong prophetic language of Scripture, “the abomination which maketh desolate.”—Some of the effects are, separating faith from charity, truth from goodness, the will from the understanding; and all that God hath, according to the laws of order in the Creation ordained to be joined together, it tears asunder, throwing the mind into a dislocated and distracted state, destructive alike of its peace, and of the bonds which preserve society together:—madness, wickedness, infidelity, and anarchy are the fruits which it produces.

If people are destroyed for lack of knowledge—if to hate the light is a proof of deeds being evil—if the fear of the Lord is the beginning of wisdom—if this knowledge is the continent in the mind for the reception of every other what shall we say of those who teach—that this—the first, the best, the godlike gift of the Creator, must be sacrificed in order to embrace the view of religion which they propose?  I cannot use stronger language than I have used already, but repeat that mental alienation is one of the dreadful consequences of that doctrine which is emphatically called the ‘abomination which maketh desolate;’—of that doctrine, whose fruits are bitter, and which fills the mind with doubt, gloom, and misery.

When the only true basis of religious knowledge is removed, and insane notions occupy its place, what desolation follows!

At present, however, I will not enter into a clear and full explanation of this momentous subject; but I trust hereafter I shall be able show, that I am fully prepared to prove these assertions, and, moreover, to prove that, besides the extremes of pride and presumption, despair and misery, with endless indications that it is not according to the wisdom which cometh from above, it is the most common and frightful cause of the most incurable forms of insanity which I have found in lunatic asylums, I repeat, however, that so important and awfully true are these facts in my estimation, that I cannot remain contented with simply making these slight allusions to them, and I therefore intend hereafter to attack the error with all the force which my conception of its magnitude and baneful influence can inspire.  Oh! that I could attack it with such effect that it would be rooted up for ever—so that it would no longer exist as the cause, (as it has hitherto been,) of gloom, misery, and desolation to minds of the most gentle, amiable, and acute construction.  Such would not be the case did mankind behold the delightful harmony which exists between revealed truth and the constitution of the human mind.  I see no lines and separations in knowledge, but behold in each part a portion of one grand whole.  Science, intelligence, wisdom, and religion, are all One, and woe to the man who separates them!

O that mankind knew these glorious truths, which are everywhere most beautifully held forth to our view—not only knew these things, but knew also the happiness of making all this knowledge increase the well being and happiness of others around them!  Then would the world possess the channels for the right influx of the inspiration of the heart; and then would that true and steady light be received into the understanding which would prevent it from falling into the mazes and darkness of error, or into actual evils and miseries of heart and of life.

Then, indeed, would the fire of Divine Love purify the earth of the human mind;—then would the oil of charity be the fuel on the altar of every heart;—then would the light of Divine Wisdom ascend into understanding, there to remain a sun without clouds for ever.

No. 24.—Admitted 1802.—Aged 25.

Nothing on record.  She was brought up tenderly and respectably: her health was rendered delicate by close confinement at her needle-work, and her fondness for reading and writing.  She was from home when her mind received a severe shock by the unexpected intelligence of her father having put an end to his own existence.  Soon after this a grievous disappointment completed the overthrow of her mind.  Before her father’s death, it was generally supposed he was wealthy: she was then engaged to one who had secured her affections; after her lover knew of her father’s death, and the involved state of his affairs, he still continued to profess his attachment, and held out the prospect of speedily fulfilling his promise of marriage;—she believed him, until she happened accidentally in company to cast her eye on the announcement of his marriage to another, when she shuddered and shrieked, and exclaimed “Wretch!” and from that moment she was insane, and has been so ever since.  Her lucid intervals are considerable; yet she always retains so painful a recollection of this fact, that though fond of talking of all other occurrences of her former life, she studiously evades all conversation, or any question that at all alludes to this; so much so, that from this fact, as well as some others, I think it highly probable that even her present less violent, and less frequent paroxysms, are partly brought on by associations which awaken the same agony of mind and feelings of indignation as she then suffered.  When highly excited, she will, like one who has received some extreme provocation, (her face red and swoln with rage) burst forth into the most violent passion, using the most scurrilous language; sometimes it is maniacal fury; at other times, only like one excessively angry, venting feelings by a hearty scolding; at others, she is only perverse and sulky, and frequently merely odd and flighty.  All these symptoms for the most part occur, more or less, at certain periods, (see Observation V. and Essay on Atmospherical Influence,) but now they are something less violent at all times, and sometimes, for many months in succession, so slight that strangers could not perceive them, when she continues conversable and pleasant.  She is very agreeable and useful in the house, which she considers her home.  Perhaps this improvement may be attributed partly to the application of the medical swing—partly to the greater mildness of her present attendant: she is made happy by a little attention, and often visits her friends in York.  Her natural talents are good, and improved by reading; her disposition is friendly and benevolent, but hasty, credulous, and incautious.

No. 25.—Admitted 1803.—Aged 28.

Nothing satisfactory on record.  I have been informed by his family and friends, that he was a proud, passionate, spoiled child, and that the immediate exciting causes of his derangement were these.  Through the interest of an elder brother, he expected to obtain a most lucrative and respectable situation in the East Indies, but it was discovered on his examination that he did not possess the requisite qualifications, consequently, he was not merely disappointed, but his pride was doubly mortified by being reduced to the necessity of undertaking the management of a common farm; there, with several other causes, these things operating on a spirit ill prepared for any adverse wind or the common storms of life, soured his temper; and at last produced so exasperated and violent a state of mind, that his mother, sisters, and friends, were compelled on account of various outrageous acts of passion to confine him.

It is said that he was so violent after this, that it was deemed necessary to punish him, by chaining him for years, at times, to another patient; and yet, notwithstanding this treatment, it is evident from the remark of an old journal he then wrote, that he possessed a considerable proportion of mind; there are many excellent reflections on general subjects, joined, it is true, with what must appear to others, trivial observations, on the conduct of the attendants in the house.  About two years ago he was subject to maniacal fits of outrageous passion, when his manner was proud and stalking, his voice loud and blustering, and his language contemptuous and imperative; calling the house his own; commanding every one of us as his servants, in grand style.  The mention of a single fact, out of an immense number, will be sufficient to characterise his spirit and manners.  Often have I seen him look at the patients with ineffable arrogance and contempt, and say, in a style which no acting could imitate, “Take this dog out of my sight.”

This violence and noise was so exciting to others, and unhappy for himself, that after various attempts by methods of kindness and argumentation, he was, without any previous threat, taken to the medical swing, where I told him that I was sorry to be obliged to apply so severe a medicine, but that I was certain from his conduct lately he must be very unwell, and that this would cure him, and more to the same purpose.  Since this time, I have never heard any noise, or seen any violence about him.  The name of the swing, after this, was enough to check him; but now even this was not necessary, and his seasons of excitement have from self restraint disappeared; and he is now, though an old incurable case, much more social than he was.  In fact, he appears affable to me, and in some measure, even is so to the patients around him.  He is fond of whist, and has very much improved in the game; and when I add to this, that reading the newspapers, walking, taking large quantities of snuff, and laying leaning on his arm, fill up his time, and that he is a dark, cadaverous, sulky, proud, gaunt looking man, all the house will know him. [192]

No. 26.—Admitted 1806—Aged 45.

There was nothing on record; nor have I been able to obtain any information about her previous history, except that she was a charwoman.  Her appearance was rather respectable, her manners and conversation were distinguished by sort of bravado air of pride, very often extremely wild and extravagant; she was particularly fond of boasting of and displaying herself as being or doing something great and wonderful,—a general, lord mayor, king, &c.—always a male, and had a full beard on the upper lip, and her voice was more like that of a man than a woman.  When addressed as a female, she immediately said she was a man, or a woman turned into one.  She was very fond of decorating herself in a fantastic style.  When provoked, she swore and talked most brutishly and strangely.  She was removed May 15th, 1822—much in the same state, except that latterly she was worse, and not so useful in the laundry as she had heretofore been.

No. 27.—Admitted 1806.—Aged 36.

Nothing on record about her, but report says, that others in the family are insane; and that the exciting cause, in her case, was the loss of some money she had saved in service as a cook.

She is at present in a state of imbecility of mind, and she looks a quiet, timid, silent, motionless, stupid creature, sitting continually in the same posture, like one almost shivering with cold.  Although extremely peaceable and timid, yet her mind is irritable, wanting, however, courage for retaliation, so that when provoked, she looks angry, but walks away: she never speaks unless spoken to, and then her answers are short, but mostly correct, though it is evidently all force work.  This has been for years her state, or rather debility, with scarcely any perceptible changes, except that her mind appears gradually sinking.  She was formerly more conversable, and would have done something at her needle, but at present she is always idle, and has latterly, from inaction, become less cleanly in her person.

OBSERVATION XIV.

Her habits of saving (if the report be true) prove her love of money, the loss of which would of course, be felt in proportion as she valued it; and, with her exceedingly susceptible and delicate mind, it must have been overpowering; hence, as in all hereditary cases, there was something discoverable in the natural disposition which rendered the exciting cause more efficient, and we find benevolence, caution, and consciousness large, and self-esteem and combativeness defective.

No. 28.—Admitted 1806.—Aged 23.

There is nothing on record, but I have been informed that the cause was religious controversy, resulting from association with the followers of Johanna Southcote. [195]  He was the son of a respectable country wright and joiner, and had a decent ordinary education.

His present state of mind presents a strange mass of confusion from which nothing can be drawn or collected, except that from his fondness for drawing houses, and different things connected with building, and from his muttering to himself (for he declines all conversation with others) something about measurement, the square being so much, &c. some traces of his former habits of life, may be remarked and determined: the strange and absurd material views of the coming new order of things, betray the view which did (and I am told, still,) belong to that sectarian delusion.  He is chiefly distinguished by his unsocial habits, and by the singular practice of always cramming a part of his meat, and sometimes other things, into his ears, shoes, breeches, and different parts of his dress.

No. 29.—Admitted 1808.—Aged 47.

Once for all, I must say of these old cases, since there is no book or documents concerning them, that the origin, nature, and progress of the disease cannot now be known except from enquiries directly made, either by writing, or of such friends as may occasionally visit them; and with many of these lower class of patients, it cannot of course surprise us that they should not have any friends to visit them after such a lapse of time.  This is more likely to be the fact when the character of the case is of a more revolting nature—as is very singularly so of the one I am about to describe.  Yet she has had visitors, from whom, however, I was not able to gather any information upon which I could depend; her insanity was said to be hereditary, she having a sister who is insane.

She is one of those old cases which, in former times in this institution, were kept naked in loose straw and not allowed seats; and hence she now, from this deprivation, sits huddled up, resting on her calves, when worn out by her violence, curled up like an urchin in a corner in a sort of dog sleep, the slightest noise instantly rousing her, when she starts into her strangely agitated state,—shaking her head and gnashing her teeth, and uttering horrible curses with a sort of barking, hoarse, and hideous gutteral sound, apparently against some object present to her imagination; in this violence she formerly continued, sometimes for weeks, latterly only for days, with the most part only for hours, with scarcely any intermission.  In fact, she was in appearance and manner the most brutal and blasphemous demon—no imagination can picture any thing at all equal to the awful reality; and yet it is a remarkable fact, that, some years since, her intellect was restored by a very decided physical cause, the breaking of her leg; when, during the process of the bone uniting, her reason returned: her manners were mild, grateful, and affable, and the tone of her voice was soft and sweet; and again, when her leg was healed, she relapsed into the same violent state.  It has continued, excepting a short convalescence during an attack of dysentery: and this is now more than seven years ago; and after which, an artificial drain was kept open, but with no apparent benefit; the dysenteric attack was also imitated, but with no further benefit or effect than its mere physical depressing influence at the time.  It is worthy of notice, that when taken to the swing [198] a second time, she talked more sensibly, refrained from swearing, promised to behave better, and in a sweet tone begged not to be swung: since this time, she has been less violent, has shaken her head and sworn less than before; indeed she has a more good-natured manner, and very often expends her excitement in mirthful dancing and singing, and generally seizes my hand, that I may dance with her.

OBSERVATION XVIII.

Though the doctrine of Demons, or being possessed, has been discarded; yet, in my opinion, it deserves a more serious consideration than medical men imagine:—it involves the true theory of mind and matter, their connection with each other, and the principles on which this connection depends, and by which it is regulated.  I shall leave this question for the present, with the intention of returning to it at some future opportunity.  However, one thing this case serves to prove and illustrate, which is, that whatever mysterious link the mind may constitute in the order of being, it is certain that this is according to or dependant on the physical condition of the material organs through which this connection operates, so that the physical reasoning on disordered and diseased organization remains precisely the same, whether we admit or deny that the visible, and invisible world subsist together and are in indissoluble connection.

No. 30.—Admitted 1808.—Aged 47.

I have not been able to obtain a very accurate or full history of this old and incurable case.  He was a clergyman of the Church of England.  He had been a hard reader and distinguished student at Cambridge, and he now gives proof of his having been an excellent classic.  It is said, that after he had obtained a small vicarage, although not an immoral man, he was gay and expensive in his habits.  After the age of thirty, he hastily married an exceedingly beautiful girl of about sixteen years of age, but who was uneducated and from a low station of life.  Afterwards discovering her deficiencies as a companion, his love cooled into indifference, and his naturally proud, impatient, and uncontrollable temper was made worse; he treated her harshly, their quarrels became habitual, and they lived in hatred, misery, and distraction together.

In this state of his disappointed affections he was seduced into various intrigues.  Shame, conscience, and loss of character, quarrels with his parishioners, aggravated at the same time by a fall from his horse on his head, increased his natural irratibility of temper, and so mortified his pride, that he became desperate and attempted suicide.  After this he had a regular paroxysm of maniacal violence, which subsided, although it has returned with considerable increasing intervals up to this time.

During his lucid intervals, he will talk of the harshness with which he was used, when it was first considered necessary to remove him from home; and there is no doubt there is some truth in his statements: at the same time it seems right to observe that, if in any instance it can be excusable to allow our natural feelings for a moment to overcome us, this was one of such cases.  The proud, malignant, and contemptuous manner displayed in his violence, was irritating in the extreme.

About eight years ago, he continued for some time in a perfect state of convalescence, and when the paroxysm returned, its violence and duration appeared in proportion to the length of intermission.  These paroxysms and intervals of convalescence have since preserved the same ratio to each other.  It is remarkable that the last interval of convalescence, commencing about five years ago, continued for more than three years, which I attribute to the absence of causes of irritation, more delicate and attentive treatment, and constant resources of various amusements.  During the whole of this time, he could not be persuaded to leave the place; he said “It would not do;” that he “should soon be worse than ever.”  The name of home and his wife seemed to make him shudder; and when asked if he should not like to go, he shook his head, turned away, and said nothing; but he evidently painfully felt the association of old exciting causes.

It ought, however, to be mentioned that during the whole of this time he would frequently exhibit signs of great uneasiness and irritability, would pace the gallery or airing court, in quick and hurried steps, and afterwards call his attendants to play a game at whist or backgammon: at these times he was in the habit of chewing orange-peel, which he constantly carried in his pocket for that purpose, and afterwards he would say his troubles were overcome.  He has since had a return of his insanity, from which he never perfectly recovered; I have since understood that he is dead.

OBSERVATION XIX.

The most obvious remark suggested by this case is, that, like many old cases, when once an irritable habit is established in any part of the mind, how easily the mere association of old existing causes will overturn the balance and introduce a relapse into the same state: no exciting causes can have more power to do this, than the constant painful state of mind which ill-assorted and unhappy marriages produce; and therefore, the next most obvious remark suggested by this case, is the evil which arises from the whole mind being ultimately disagreeably affected by the contraction of hasty, mistaken, and ill-assorted matrimonial connexions.  As the sublime principle of rightly-constituted and spiritual or mental marriage is involved in the consideration of such cases; and as, from the want of a proper understanding of this principle being duly impressed upon mankind, the evils and miseries which the parties bring upon themselves and entail upon their offspring in the world, are so numerous and so frightful, and so frequently the cause of the most terrible forms of insanity, I shall, in an after part of this work, endeavour to embody in an essay expressly on this subject, all the arguments which I can bring forth, for the purpose of enforcing this first, this inmost, this greatest, grandest principle involving the happiness and well-being of the world.

No. 31.—Admitted 1808.—Aged 30.

He is a surgeon, and was formerly in great repute as a successful practitioner, as well as a lecturer on anatomy, surgery, and the practice of physic.

He was very studious, and chiefly during the night, though his sleep was already sufficiently broken by his professional labour.  As a young student he was ambitious to excel, as he would often say, “I employed my time well, that it might serve me in after life; and it did so.”

His mind is naturally one of much greater activity than power, hence his harassing day and night practice and preparation for lecturing induced a morbid state of mind, in which condition a fever in his family occurred.  Rapidly and unexpectedly, four male children, a niece, and a maid-servant, were the victims, and this completed the wreck of his overworked, active, and feeling mind.

His present state is most interesting and singular, and very difficult to describe.  His activity of mind, prodigious command of words, and most animated and graceful manner, excite the greatest surprise; and even in his present deranged and deluded condition, with his varied stores of information, these exhibitions are mistaken for the remnants of versatility of genius; yet, as I have already said, it is most true that his mind was not naturally one of so much power as it was of amazing ambition and activity.

He will suddenly rush into some of his anatomical, surgical, and medical lectures, going through different parts of the human body, operations, and practice.  His lectures on the circulation of the blood, seem to have been most strongly impressed upon his memory.  At other times, his eloquence is displayed in imitations of various celebrated characters.  If they are ancients, and he be asked, how can this be? since they lived two thousand years ago, he says: “Yes, but I died and rose again in the world.”  And thus, he imagines himself every character he personifies, and that at that time he was alive, and afterwards died, again reappearing in such another character.  In this way having passed through numberless transmigrations, he was Adam, Abel, or Melchisadeck, Abraham, Isaac, and Jacob, Moses, Joshua, Samson, Goliah, David, and Solomon.  Solomon had great attractions: frequently describing, with great animation, his state of grandeur and enjoyment.  In the same way he was Aristotle, Pythagoras, Confucius, Plato, Zoroaster, Pliny, Ptolemy, Cicero, Demosthenes, and particularly Homer, Mahomet, and even our Saviour, &c.  All these he will still personate, and make speeches differing in manner and matter, and suitable in some measure to each of them.

In medicine, all the list of celebrated men are claimed as the same transmigration of his soul.  He lifted up the serpent.  He was Hypocrates, Celsus, Galen, Paracelsus, Stahl, Van Helmont, Boerhave, Cullen.  In anatomy, surgery, chemistry, and natural philosophy, it was the same.  The whole list of celebrated medical men is monopolized by this mania of transmigration.

He always addressed strangers as contemporaries, saying, “Good God! you were alive at such a time: I knew you well; you were with me when I conquered at the plains of Marathon! or, you met me at such a place when I was singing the Iliad, as old Homer,” and so on.  All this with such a fascination of look, manner, and address, that he arrests and amuses every one, especially strangers.  He frequently talks with imaginary, and especially angelic beings, which he does with a manner and expression that prove he believes he beholds their actual presence.

He had a peculiarly bright and glistening eye, indicative of the secret and destructive habit so dreadfully fatal to the insane.

It appeared to me, since amidst all this strange confusion and delusion, his intellectual powers were still in existence, that if his understanding could be constantly occupied, this confused condition might in time be corrected, and his mind restored to a right state: for this purpose I undertook to make him translate a French work, while I wrote from his dictation, at the same time checking and controlling his wild starts into all these vagaries.  In this manner we nearly finished an important medical work together, and he was evidently much improved by the exercise; the task was however so amazingly arduous, that in the midst of my other duties I was obliged to discontinue it, and he then relapsed into his former state.

The effect, however, was sufficiently decided to prove a fact of very great importance, and many such facts having since occurred, which further tend to confirm that many cases which are generally given over as incurable, may be cured by a well-directed exercise of the understanding, by which it is at once strengthened, and the mind drawn and excluded from the exercise of its insane feelings and hallucinations.  In some cases I have made them translate a work on the nature and effects of their secret vice, and it has silently checked this habit, and at last restored them.

Here I close my description of these old cases, conceiving I have given a sufficient number for the purpose I had in view, that of exhibiting a fair average picture of the state and character of the old insane.  After one general abstract observation on the whole essay, I shall afterwards, and following this last case, make my next essay on the origin and nature of disease in general, and of insanity in particular: and which I shall do as preliminary to the more intimate and direct investigation of the causes and nature of insanity; and especially the direct consideration of the cause to which I have alluded in this case, because it is one of the most general and most fatal causes of insanity, and a cause, which if not removed, inevitably renders them incurable.  Such was the habit of the person whose case obliged me very reluctantly to assume a defensive attitude, and refute falsehood by a statement of the truth, or otherwise I should have continued silently to proceed in the path of duty, without obtruding our own secret exertions on the notice of the public, as it may appear that I have done in this essay, as well as in those which are to follow, written, as they will be, in some measure on the same principle, for the truth should not suffer from diffidence, any more than it ought to be brought into disrepute by vain ostentation; still, I am quite certain, that I am actuated by no feelings incompatible with charity and justice.

CONCLUDING OBSERVATIONS.

The concluding general observations on this Essay and its Appendix, are, that the one principal object I have had constantly in view, has been the removal of the erroneous impressions and prejudices which exist almost universally against the insane, as if they alone were all furious wild beasts or infernal demons, and which have hitherto excited and still continue to excite a spirit and conduct toward them, productive of a baneful and injurious influence.

So long as these prejudices exist in the mind, even the soothing treatment which is now so much the boast of the age, assumes a spirit and manner, perhaps as galling and injurious to the afflicted as was, undoubtedly, the heartless tyranny of former times.

I deprecate that altered tone of voice and manner which implies in every word and action, that they are considered either as children, or as beings wholly bereft of rationality.

In the system (which I have in some degree stated and explained) of receiving and treating them as visitors, even as though they were still rational, and of course observing towards them the same polite and delicate attentions as are practised in well-bred society, the same irresistible effects which precept and example always produce in every sphere, in proportion as they are exercised in sincerity and truth, will be found to be produced also on them; and hence we may easily perceive how it comes to pass that we have so much greater dependence on their attachment, good conduct, fidelity, and honour, than is generally imagined to be possible, and why, consequently, the greater liberty which is given them is seldom or never abused; and, as cause and effect increase each other, it is evident that this system, by exciting and exercising the higher feelings and moral principles of the mind, produces, (as will be seen from the tables I shall hereafter introduce) a much greater proportion of cures than has hitherto been the case.  It is much more conducive to cure than the system of perfect separation and exclusion from any association.  This truth is another important reason for being anxious, from the best of motives, to remove these baneful prejudices which have hitherto made a marked moral line of distinction between diseases of the brain, and other parts of the system, exclusively and absurdly making the former a proof of some shameful criminality.  And though this greater degree of well-judged liberty (not indiscriminate) appears alarming to those who retain the usual worldly prejudices against the insane, it is in reality attended with much less of danger or of any thing to excite the fears of others, than most assuredly is a contrary system.

I am now enabled, from nearly twenty years’ experience, to say this with confidence; and I am the more anxious to impress this on the world, in order that I may not be obliged, from too great a deference to its fears and prejudices, to abridge the exercise of this influence, so far as to lessen the happy effects of a system which theory and feeling have suggested and compelled me to pursue, and which increased knowledge and experience have confirmed and justified.

Our fears and prejudices create and realize that which would otherwise have no existence.  We often blame effects of which we ourselves are the cause.  This is one principal, if not the only, source of all our complaints and all our troubles.  Servants, children, families, sects, parties, nations, and even the insane, are more or less good or bad in their conduct and character, in proportion as our principles and conduct towards them are under the influence of a wrong spirit or a right one.

Such are our views, and I trust it will be seen (the experimental part at least,—the theory will be explained in due course) that we have endeavoured, however imperfectly, to reduce them to practice.

Wherever natural and spiritual good exist, there we shall behold those best fruits of charity, of which the vine and fig-tree are beautifully appropriate emblems.

I trust that what I have advanced will be considered less as a personal boast than as an explanatory statement, suggested by recognised evils, and enhanced by candour and conviction.  Although past conduct is the best guarantee for the future, yet it is by no means an infallible security; and it altogether ceases to be the test of any security, the moment boasting, pride, or self-confidence exclude a higher and better dependence.

THE END.

DEAN AND MUNDAY, PRINTERS,
THREADNEEDLE-STREET.

FOOTNOTES.

[vi]  For the present I shall defer the publication of these Tables.

[xiii]  Inferno, c. iii. 9.

[xv]  See page 211.

[26]  A Case and Observations being mislaid when printing, accounts for the error in the number of this observation.

[5]  See hereafter, Divisions of Insanity.

[16]  See Divisions of Insanity.  See also No. 131.

[18]  See No. 71, 81, 88, 105, 145, 146, 175, 208, 339, 374, 375, 376, 379, 380.

[20]  See Essay on a Knowledge of the Human Mind, unfolding the universal principles of generalisation, where I shall show that these words are not mere figures of speech, but that they each express a truth which every fact in medicine demonstrates.

[22]  It is worthy of remark, that these are those who are always ailing, and their complaints correspond with their faulty state of mind.

[27]  See the cases mentioned in Mr. Harris’s and Mr. Balle’s affidavits,—in Allen v.  Dutton.

[28]  See Dr. Birkbeck’s affidavit, in Allen versus Dutton.

[36]  She knew me at York, when she was at the Retreat.

[55]  Inferno, c. iii. 9.

[57]  See No. 427.

[80]  See 395 and 396.

[95]  See Case No. 85.

[96]  I have hitherto had but one out of 600—and he had secreted a rope, and effected his purpose, the day after his arrival by pretending to retire to a place of convenience.—I confess I would rather not state this, as it may look like boasting; but so far from this, I am sure my feelings are only those of gratitude.  A suicide of a most determined character was so delicately watched, that for six months he did not ascertain that he had any loss of liberty, or was in a place of this description, but merely with kind friends of his parents.

[99a]  This evil is prominently seen to result from all modes of charity that are not secret, or have not their origin or are not done in the spirit of kindness, as well as from all punishments that are too severe and unnecessarily degrading in their nature.

[99b]  See case No. 6, in the Appendix.

[102]  See Essay on Forbearance.

[114a]  The organs [114d] of self esteem and benevolence, are well developed, cautiousness defective; indeed, the whole head agrees admirably with what I should conceive his character has been; and from what I have seen and heard characterizes the family.

[114b]  He repeats, most correctly, almost the whole of Goldsmith’s Description of the taking of Quebec.—These cases were written in 1821.  See Essay on Atmospheric Influence.

[114c]  His friends, though rich, from caprice, only allow him a very coarse dress: in other respects, they are exceedingly attentive and kind to him.

[114d]  I think, in the present state of this science, the word—organ objectionable, and merely to say, they are external forms representative of internal states of mind; at the same time, I believe most firmly, that mind can only act through organic forms created expressly for specific uses, and even though this admits that the manifestation depends on organic structure, yet it is best not to appear hasty, and on this account also, I am not satisfied that the present names and divisions, are those which time will determine, and which in nature are true.

[115]  There is some partial or general defect, which renders the operations or manifestations of mind imperfect: whether this defect, and consequent imperfection in the manifestation of mind, arose in the first place from bad habits, producing disorganization, or disorganization bad habits, or from both, is not now the question.  It is, however, I believe, (the evidence on which this belief is founded, will be stated hereafter,) generally the first.

[116]  His head, upon the whole, is well formed, except that there is a slight degree of irregularity, one side being more developed than the other.—Cautiousness and benevolence are most prominent.—Since this was written, two members of his family have been insane.

[117]  See Table.  I shall have occasion again to refer to this fact, and have, therefore, very briefly noticed it in this place.  That the middling class are more torpid, is certain, whether wholly from their treatment, or partly that their minds had been of a more composed habit, or that their insanity had not arisen from violent excitements, are interesting questions to the Medical Physiologist, and Moral Philosopher,—which will be considered in another place.—See Mr. Jona. Gray’s History of York Asylum.

[119a]  See Observation 12.

[119b]  There is a remarkable correspondence between the kind of mind he exhibits, and the configuration of his head.  It is very large and smooth, with self-esteem, love of approbation, large; firmness, full; combativeness, defective.

[121a]  See Observation 12.

[121b]  His head is small, particularly his forehead, where the reflective organs are defective; but individuality, combativeness, and amativeness are full; self-esteem, defective.

[122a]  In this case, the organ of benevolence was exceedingly prominent, and combativeness equally defective; indeed his whole head corresponded most exactly with his character, and was a good one, except that one side was more developed than the other.

[122b]  His head is well formed,—benevolence, and the organs of social feelings, particularly full, with combativeness, very defective; ideality, very full.

[123]  That he has been thousands of miles in a minute; very busy relieving, saving, burying, or getting out of the way, (as he calls it,) thousands of people that have been burned in some great fire—starved in masses of ice many miles thick—or drowned in some dreadful shipwreck, &c., &c.; some of them uncles or aunts of those he is conversing with at the time, &c., &c.

[133a]  Armies sustain immense fatigues during the excitement of a campaign; but when the excitement is over, a prevailing epidemic will often attack, subdue, and sometimes almost annihilate them.

[133b]  In 1759, a typhus prevailed in Bethlem, and from its state at that time, we cannot wonder at this fact.  Dr. Wright, of Bethlem, says, they have had this year a severe erysipelis attacking a great number.

It was observed of the plague of 1707, that persons excluded in religious retirement, escaped the disease, and so did prisoners and all others kept from the air abroad.

[134]  Sydenham thought “there was some secret inexplicable alteration in the bowels of the earth.”

[135]  See Dr. Hawkin’s most valuable work on Medical Statistics.

[141]  Take no pleasure in the folly of an idiot, nor in the whims and fancies of a lunatic, nor in the phrensy of a drunkard; make them the object of thy love and pity, not of thy pastime: when thou, alas! beholdest them, behold how thou art indebted to Him who suffered thee not to be like them!—Retrosp. Rev. p. 185.

[142]  See Observation on Dæmonology.

[143]  See pages 17 and 18.

[145a]  It is a principle throughout nature, that changes, and the repetition of changes give, in proportion to their repetition, a greater aptitude to their periodical recurrence.—Wine merchants say, that wine always undergoes a slight change on the annual recurrence of the original season of its fermentation.

[145b]  See pages 16, 17, & 18.

[147]  See Haslam on Madness, page 236.

[151]  Pinel, p. 10.

[152]  This was written in 1822.

[153]  In seeing the patients bathe, I have been struck with the beautiful sleekness and clearness of their skins.  Many of them, however, retain marks of scrofula.

[154a]  See No. 30.

[154b]  Since the above was written, the disease of the skin was much relieved by Ung. Hydr. Nitrat.

[155]  Her head is generally good, indicating a peaceable, good-natured being.  Combativeness, defective; benevolence and philoprogenitiveness, full.

[156a]  His organ of destructiveness is very full, and the wound has been directly there.

[156b]  Firmness is very full, and combativeness rather so.

[159]  His head corresponds with his character: no combativeness, destructiveness, or caution; but self-esteem, hope, friendship, and benevolence, full.

[160]  I shall hereafter make some observations on the peculiarities of character in females contra-distinguished from that of males.

[162]  Pride, benevolence, hope, combativeness, and amativeness, full; caution, conscientiousness, and veneration, partly defective.

[164]  Philoprogenitiveness is singularly full, so is combativeness and firmness.

[165a]  He had the most immense organ of destructiveness and firmness I ever saw, and was remarkably defective in the social feelings and sentiments, but he had some benevolence.

[165b]  His attendant says, he would have resisted harsh treatment to the very last effort that life would allow him.

[168]  His head was an immense smooth round mass, such as is common to Epileptics, and powerful but sluggish minds.

[192]  Self-esteem, love of approbation, firmness, and amativeness, are very full; caution, causality, combativeness, are next in order; veneration, rather defective.

[195]  For remarks on religious controversy, see Essay on ‘Truth contrasted with Error.’

[198]  This I have never used since, now sixteen years ago.  It is now, under better management, wholly unnecessary, and worse than useless.

*** END OF THE PROJECT GUTENBERG EBOOK ESSAY ON THE CLASSIFICATION OF THE INSANE ***

Updated editions will replace the previous one—the old editions will be renamed.

Creating the works from print editions not protected by U.S. copyright law means that no one owns a United States copyright in these works, so the Foundation (and you!) can copy and distribute it in the United States without permission and without paying copyright royalties. Special rules, set forth in the General Terms of Use part of this license, apply to copying and distributing Project Gutenberg™ electronic works to protect the PROJECT GUTENBERG™ concept and trademark. Project Gutenberg is a registered trademark, and may not be used if you charge for an eBook, except by following the terms of the trademark license, including paying royalties for use of the Project Gutenberg trademark. If you do not charge anything for copies of this eBook, complying with the trademark license is very easy. You may use this eBook for nearly any purpose such as creation of derivative works, reports, performances and research. Project Gutenberg eBooks may be modified and printed and given away—you may do practically ANYTHING in the United States with eBooks not protected by U.S. copyright law. Redistribution is subject to the trademark license, especially commercial redistribution.

START: FULL LICENSE

THE FULL PROJECT GUTENBERG LICENSE

PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK

To protect the Project Gutenberg™ mission of promoting the free distribution of electronic works, by using or distributing this work (or any other work associated in any way with the phrase “Project Gutenberg”), you agree to comply with all the terms of the Full Project Gutenberg™ License available with this file or online at www.gutenberg.org/license.

Section 1. General Terms of Use and Redistributing Project Gutenberg™ electronic works

1.A. By reading or using any part of this Project Gutenberg™ electronic work, you indicate that you have read, understand, agree to and accept all the terms of this license and intellectual property (trademark/copyright) agreement. If you do not agree to abide by all the terms of this agreement, you must cease using and return or destroy all copies of Project Gutenberg™ electronic works in your possession. If you paid a fee for obtaining a copy of or access to a Project Gutenberg™ electronic work and you do not agree to be bound by the terms of this agreement, you may obtain a refund from the person or entity to whom you paid the fee as set forth in paragraph 1.E.8.

1.B. “Project Gutenberg” is a registered trademark. It may only be used on or associated in any way with an electronic work by people who agree to be bound by the terms of this agreement. There are a few things that you can do with most Project Gutenberg™ electronic works even without complying with the full terms of this agreement. See paragraph 1.C below. There are a lot of things you can do with Project Gutenberg™ electronic works if you follow the terms of this agreement and help preserve free future access to Project Gutenberg™ electronic works. See paragraph 1.E below.

1.C. The Project Gutenberg Literary Archive Foundation (“the Foundation” or PGLAF), owns a compilation copyright in the collection of Project Gutenberg™ electronic works. Nearly all the individual works in the collection are in the public domain in the United States. If an individual work is unprotected by copyright law in the United States and you are located in the United States, we do not claim a right to prevent you from copying, distributing, performing, displaying or creating derivative works based on the work as long as all references to Project Gutenberg are removed. Of course, we hope that you will support the Project Gutenberg™ mission of promoting free access to electronic works by freely sharing Project Gutenberg™ works in compliance with the terms of this agreement for keeping the Project Gutenberg™ name associated with the work. You can easily comply with the terms of this agreement by keeping this work in the same format with its attached full Project Gutenberg™ License when you share it without charge with others.

1.D. The copyright laws of the place where you are located also govern what you can do with this work. Copyright laws in most countries are in a constant state of change. If you are outside the United States, check the laws of your country in addition to the terms of this agreement before downloading, copying, displaying, performing, distributing or creating derivative works based on this work or any other Project Gutenberg™ work. The Foundation makes no representations concerning the copyright status of any work in any country other than the United States.

1.E. Unless you have removed all references to Project Gutenberg:

1.E.1. The following sentence, with active links to, or other immediate access to, the full Project Gutenberg™ License must appear prominently whenever any copy of a Project Gutenberg™ work (any work on which the phrase “Project Gutenberg” appears, or with which the phrase “Project Gutenberg” is associated) is accessed, displayed, performed, viewed, copied or distributed:

This eBook is for the use of anyone anywhere in the United States and most other parts of the world at no cost and with almost no restrictions whatsoever. You may copy it, give it away or re-use it under the terms of the Project Gutenberg License included with this eBook or online at www.gutenberg.org. If you are not located in the United States, you will have to check the laws of the country where you are located before using this eBook.

1.E.2. If an individual Project Gutenberg™ electronic work is derived from texts not protected by U.S. copyright law (does not contain a notice indicating that it is posted with permission of the copyright holder), the work can be copied and distributed to anyone in the United States without paying any fees or charges. If you are redistributing or providing access to a work with the phrase “Project Gutenberg” associated with or appearing on the work, you must comply either with the requirements of paragraphs 1.E.1 through 1.E.7 or obtain permission for the use of the work and the Project Gutenberg™ trademark as set forth in paragraphs 1.E.8 or 1.E.9.

1.E.3. If an individual Project Gutenberg™ electronic work is posted with the permission of the copyright holder, your use and distribution must comply with both paragraphs 1.E.1 through 1.E.7 and any additional terms imposed by the copyright holder. Additional terms will be linked to the Project Gutenberg™ License for all works posted with the permission of the copyright holder found at the beginning of this work.

1.E.4. Do not unlink or detach or remove the full Project Gutenberg™ License terms from this work, or any files containing a part of this work or any other work associated with Project Gutenberg™.

1.E.5. Do not copy, display, perform, distribute or redistribute this electronic work, or any part of this electronic work, without prominently displaying the sentence set forth in paragraph 1.E.1 with active links or immediate access to the full terms of the Project Gutenberg™ License.

1.E.6. You may convert to and distribute this work in any binary, compressed, marked up, nonproprietary or proprietary form, including any word processing or hypertext form. However, if you provide access to or distribute copies of a Project Gutenberg™ work in a format other than “Plain Vanilla ASCII” or other format used in the official version posted on the official Project Gutenberg™ website (www.gutenberg.org), you must, at no additional cost, fee or expense to the user, provide a copy, a means of exporting a copy, or a means of obtaining a copy upon request, of the work in its original “Plain Vanilla ASCII” or other form. Any alternate format must include the full Project Gutenberg™ License as specified in paragraph 1.E.1.

1.E.7. Do not charge a fee for access to, viewing, displaying, performing, copying or distributing any Project Gutenberg™ works unless you comply with paragraph 1.E.8 or 1.E.9.

1.E.8. You may charge a reasonable fee for copies of or providing access to or distributing Project Gutenberg™ electronic works provided that:

- • You pay a royalty fee of 20% of the gross profits you derive from the use of Project Gutenberg™ works calculated using the method you already use to calculate your applicable taxes. The fee is owed to the owner of the Project Gutenberg™ trademark, but he has agreed to donate royalties under this paragraph to the Project Gutenberg Literary Archive Foundation. Royalty payments must be paid within 60 days following each date on which you prepare (or are legally required to prepare) your periodic tax returns. Royalty payments should be clearly marked as such and sent to the Project Gutenberg Literary Archive Foundation at the address specified in Section 4, “Information about donations to the Project Gutenberg Literary Archive Foundation.”

- • You provide a full refund of any money paid by a user who notifies you in writing (or by e-mail) within 30 days of receipt that s/he does not agree to the terms of the full Project Gutenberg™ License. You must require such a user to return or destroy all copies of the works possessed in a physical medium and discontinue all use of and all access to other copies of Project Gutenberg™ works.

- • You provide, in accordance with paragraph 1.F.3, a full refund of any money paid for a work or a replacement copy, if a defect in the electronic work is discovered and reported to you within 90 days of receipt of the work.

- • You comply with all other terms of this agreement for free distribution of Project Gutenberg™ works.

1.E.9. If you wish to charge a fee or distribute a Project Gutenberg™ electronic work or group of works on different terms than are set forth in this agreement, you must obtain permission in writing from the Project Gutenberg Literary Archive Foundation, the manager of the Project Gutenberg™ trademark. Contact the Foundation as set forth in Section 3 below.

1.F.

1.F.1. Project Gutenberg volunteers and employees expend considerable effort to identify, do copyright research on, transcribe and proofread works not protected by U.S. copyright law in creating the Project Gutenberg™ collection. Despite these efforts, Project Gutenberg™ electronic works, and the medium on which they may be stored, may contain “Defects,” such as, but not limited to, incomplete, inaccurate or corrupt data, transcription errors, a copyright or other intellectual property infringement, a defective or damaged disk or other medium, a computer virus, or computer codes that damage or cannot be read by your equipment.

1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES - Except for the “Right of Replacement or Refund” described in paragraph 1.F.3, the Project Gutenberg Literary Archive Foundation, the owner of the Project Gutenberg™ trademark, and any other party distributing a Project Gutenberg™ electronic work under this agreement, disclaim all liability to you for damages, costs and expenses, including legal fees. YOU AGREE THAT YOU HAVE NO REMEDIES FOR NEGLIGENCE, STRICT LIABILITY, BREACH OF WARRANTY OR BREACH OF CONTRACT EXCEPT THOSE PROVIDED IN PARAGRAPH 1.F.3. YOU AGREE THAT THE FOUNDATION, THE TRADEMARK OWNER, AND ANY DISTRIBUTOR UNDER THIS AGREEMENT WILL NOT BE LIABLE TO YOU FOR ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL, PUNITIVE OR INCIDENTAL DAMAGES EVEN IF YOU GIVE NOTICE OF THE POSSIBILITY OF SUCH DAMAGE.

1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you discover a defect in this electronic work within 90 days of receiving it, you can receive a refund of the money (if any) you paid for it by sending a written explanation to the person you received the work from. If you received the work on a physical medium, you must return the medium with your written explanation. The person or entity that provided you with the defective work may elect to provide a replacement copy in lieu of a refund. If you received the work electronically, the person or entity providing it to you may choose to give you a second opportunity to receive the work electronically in lieu of a refund. If the second copy is also defective, you may demand a refund in writing without further opportunities to fix the problem.

1.F.4. Except for the limited right of replacement or refund set forth in paragraph 1.F.3, this work is provided to you ‘AS-IS’, WITH NO OTHER WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO WARRANTIES OF MERCHANTABILITY OR FITNESS FOR ANY PURPOSE.

1.F.5. Some states do not allow disclaimers of certain implied warranties or the exclusion or limitation of certain types of damages. If any disclaimer or limitation set forth in this agreement violates the law of the state applicable to this agreement, the agreement shall be interpreted to make the maximum disclaimer or limitation permitted by the applicable state law. The invalidity or unenforceability of any provision of this agreement shall not void the remaining provisions.

1.F.6. INDEMNITY - You agree to indemnify and hold the Foundation, the trademark owner, any agent or employee of the Foundation, anyone providing copies of Project Gutenberg™ electronic works in accordance with this agreement, and any volunteers associated with the production, promotion and distribution of Project Gutenberg™ electronic works, harmless from all liability, costs and expenses, including legal fees, that arise directly or indirectly from any of the following which you do or cause to occur: (a) distribution of this or any Project Gutenberg™ work, (b) alteration, modification, or additions or deletions to any Project Gutenberg™ work, and (c) any Defect you cause.

Section 2. Information about the Mission of Project Gutenberg™

Project Gutenberg™ is synonymous with the free distribution of electronic works in formats readable by the widest variety of computers including obsolete, old, middle-aged and new computers. It exists because of the efforts of hundreds of volunteers and donations from people in all walks of life.

Volunteers and financial support to provide volunteers with the assistance they need are critical to reaching Project Gutenberg™’s goals and ensuring that the Project Gutenberg™ collection will remain freely available for generations to come. In 2001, the Project Gutenberg Literary Archive Foundation was created to provide a secure and permanent future for Project Gutenberg™ and future generations. To learn more about the Project Gutenberg Literary Archive Foundation and how your efforts and donations can help, see Sections 3 and 4 and the Foundation information page at www.gutenberg.org.

Section 3. Information about the Project Gutenberg Literary Archive Foundation

The Project Gutenberg Literary Archive Foundation is a non-profit 501(c)(3) educational corporation organized under the laws of the state of Mississippi and granted tax exempt status by the Internal Revenue Service. The Foundation’s EIN or federal tax identification number is 64-6221541. Contributions to the Project Gutenberg Literary Archive Foundation are tax deductible to the full extent permitted by U.S. federal laws and your state’s laws.

The Foundation’s business office is located at 809 North 1500 West, Salt Lake City, UT 84116, (801) 596-1887. Email contact links and up to date contact information can be found at the Foundation’s website and official page at www.gutenberg.org/contact

Section 4. Information about Donations to the Project Gutenberg Literary Archive Foundation

Project Gutenberg™ depends upon and cannot survive without widespread public support and donations to carry out its mission of increasing the number of public domain and licensed works that can be freely distributed in machine-readable form accessible by the widest array of equipment including outdated equipment. Many small donations ($1 to $5,000) are particularly important to maintaining tax exempt status with the IRS.

The Foundation is committed to complying with the laws regulating charities and charitable donations in all 50 states of the United States. Compliance requirements are not uniform and it takes a considerable effort, much paperwork and many fees to meet and keep up with these requirements. We do not solicit donations in locations where we have not received written confirmation of compliance. To SEND DONATIONS or determine the status of compliance for any particular state visit www.gutenberg.org/donate.

While we cannot and do not solicit contributions from states where we have not met the solicitation requirements, we know of no prohibition against accepting unsolicited donations from donors in such states who approach us with offers to donate.

International donations are gratefully accepted, but we cannot make any statements concerning tax treatment of donations received from outside the United States. U.S. laws alone swamp our small staff.

Please check the Project Gutenberg web pages for current donation methods and addresses. Donations are accepted in a number of other ways including checks, online payments and credit card donations. To donate, please visit: www.gutenberg.org/donate.

Section 5. General Information About Project Gutenberg™ electronic works

Professor Michael S. Hart was the originator of the Project Gutenberg™ concept of a library of electronic works that could be freely shared with anyone. For forty years, he produced and distributed Project Gutenberg™ eBooks with only a loose network of volunteer support.

Project Gutenberg™ eBooks are often created from several printed editions, all of which are confirmed as not protected by copyright in the U.S. unless a copyright notice is included. Thus, we do not necessarily keep eBooks in compliance with any particular paper edition.

Most people start at our website which has the main PG search facility: www.gutenberg.org.

This website includes information about Project Gutenberg™, including how to make donations to the Project Gutenberg Literary Archive Foundation, how to help produce our new eBooks, and how to subscribe to our email newsletter to hear about new eBooks.

back

back

back

back

back

back

back

back

back

back

back

Table of Contents

- ESSAY ON THE CLASSIFICATION OF THE INSANE.

- PREFACE.

- CONTENTS.

- CONTENTS OF APPENDIX.

- LIST OF DR. ALLEN’S PUBLICATIONS.

- Also, by the same Author.

- ESSAY ON CLASSIFICATION.

- No. 106, admitted April 11th, 1820, aged 65.

- No. 195, admitted October 27th, 1821.

- No. 335 was first admitted of her own accord, March 5th, 1826, aged 56; discharged May the 4th, 1826; again returned of her own accord, June 30th, 1826 [36]

- No. 373 came of his own choice,

- No. 425 and 429.

- No. 372.

- No. 395, admitted Dec. 3, 1829.

- No. 421.

- No. 396.

- APPENDIX TO THE ESSAY ON CLASSIFICATION.

- INTRODUCTORY OBSERVATIONS.

- No. 1.—Admitted 1782; aged 76.

- OBSERVATION I.

- No. 2.—Admitted 1785; aged 67.

- OBSERVATION II.

- No. 3.—Admitted 1787.

- OBSERVATION III.

- No. 4.—Admitted 1787.

- No. 5.—Admitted 1791.

- No. 6.—Admitted 1791.

- OBSERVATION IV.

- No. 7.—Admitted 1792.

- OBSERVATION V.

- No. 8.—Admitted 1783.

- OBSERVATION VI.

- No. 9.—Admitted 1793.

- No. 10.—Admitted 1793.

- No. 11.—Admitted 1793.

- OBSERVATION VII.

- No. 12.—Admitted 1797.

- No. 13.—Admitted 1798.

- No. 14.—Admitted 1799.

- No. 15.—Admitted 1799.—Aged 50.

- OBSERVATION VIII.

- No. 16.—Admitted 1799.

- No. 17.—Admitted 1799.

- No. 18.—Admitted 1800.

- OBSERVATION IX.

- No. 19.—Admitted 1800.

- OBSERVATION X.

- No. 20.—Admitted 1801.

- No. 21.—Admitted 1801.

- OBSERVATION XI.

- No. 22.—Admitted 1801.

- No. 23.—Admitted 1801.

- OBSERVATION XII.

- OBSERVATION XIII. ON THE EFFECTS OF INTENSE STUDY, AND GENERAL INTEMPERANCE OF MIND.

- No. 24.—Admitted 1802.—Aged 25.

- No. 25.—Admitted 1803.—Aged 28.

- No. 26.—Admitted 1806—Aged 45.

- No. 27.—Admitted 1806.—Aged 36.

- OBSERVATION XIV.

- No. 28.—Admitted 1806.—Aged 23.

- No. 29.—Admitted 1808.—Aged 47.

- OBSERVATION XVIII.

- No. 30.—Admitted 1808.—Aged 47.

- OBSERVATION XIX.

- No. 31.—Admitted 1808.—Aged 30.

- CONCLUDING OBSERVATIONS.

- FOOTNOTES.

- THE FULL PROJECT GUTENBERG LICENSE