Observations on Madness and Melancholy Part 6

In about three months he had added considerably to his stock of language, but, unluckily, he had selected his expressions from those patients who were addicted to swearing and obscene conversation. To teach him the letters of the alphabet had many times been endeavoured, but always without success; the attempt uniformly disgusted him: he was not to be stimulated by coaxing or coercion; his mind was too excursive, to submit to the painful toil of recording elementary sounds; but it may rather be inferred that he did not possess a sufficient power of attention to become acquainted with arbitrary characters.

He was in good health, his pulse and bowels were regular, and his appet.i.te was keen, but not voracious. One circ.u.mstance struck me, as very peculiar, in this boy,--he appeared to have very incorrect ideas of distance: he would frequently stretch out his hand, to grasp objects considerably beyond his reach, but this referred princ.i.p.ally to height: he would endeavour to pluck out a nail from the ceiling, or s.n.a.t.c.h at the moon. In October he became unwell, and, at the mother's request, was discharged from the hospital.

In September 1805, I again saw the boy: he was then thirteen years of age, had grown very tall, and appeared to be in good health. He recollected me immediately, and mentioned the words, school Moorfields, nasty physic. On meeting with some of the female patients, he perfectly remembered them, and seemed for the moment, much pleased at the renewal of the acquaintance. By this time, he had made comparatively, a great progress in language; he knew the names of ordinary things, and was able to tell correctly the street in which he resided, and the number of his house. His mother informed me that he was particularly fond of going to church, although he was unable to comprehend the purpose for which he went: when there, he conducted himself with great order and decorum, but was disposed to remain after the congregation had dispersed. To shew how little he understood, why he frequented a place of worship: his mother once took him to church on Sacrament-sunday, and fearful of disturbing the persons a.s.sembled, by compelling him to return home, allowed him to be a spectator of those solemn administrations. The only reflexion he made on the subject, but in disjointed expressions, was, that he thought it extremely hard, that the ladies and gentlemen should eat rolls and drink gin, and never ask him to partake. In his person he was clean, and dressed himself with neatness. Having been taught when in the hospital to use a bowl for his necessary occasions, he obstinately continued the same practice when he returned home, and could never be persuaded to retire to the closet of convenience; but the business did not terminate here, when he had evacuated his intestines into the bowl he never failed to paint the room with its contents. To watch other boys when they were playing, or to observe the progress of mischief, gave him great satisfaction: but he never joined them, nor did he ever become attached to any one of them. Of his mother he appeared excessively fond, and he was constantly caressing her: but in his paroxysms of fury he felt neither awe nor tenderness, and on two occasions he threw a knife at her. Although equally ignorant of letters, as when discharged from the hospital, he took great delight in having gilt books; indeed every thing splendid attracted his attention, but more especially soldiers and martial music. He retained several tunes, and was able to whistle them very correctly. The day on which I last saw him his mind was completely occupied with soldiers; when questions were put to him, if he answered them it was little to the purpose, generally he did not notice them, but turned round to his mother and enquired about the soldiers.

The defect of this lad's mind, appeared to be a want of continued attention to things, in order to become acquainted with their nature; and he possessed less curiosity than other children, which serves to excite such attention: and this will in some degree explain, why he had never acquired any knowledge of things in a connected manner. His sentences were short, and he employed no particles to join them together. Although he was acquainted with the names of many things, and also with expressions which characterize pa.s.sion, he applied them in an insulated way. For instance, if a shower fell, he would look up and say, "rains;" or when fine, "sun shines." When in the street he would pull his mother, to arrest her attention, and point to objects, as a fine horse, or a big dog; when he returned home he would repeat what had attracted his notice, but always speaking of himself in the third person. "Billy see fine horse, big dog, &c."[12] Of circ.u.mstances boldly impressed, or reiterated by habit, his memory was retentive, but as his attention was only roused by striking appearances, or loud intonations, ordinary occurrences pa.s.sed by un.o.bserved.

In the month of July 1803, my opinion was requested respecting a young gentleman, ten years of age, who was sent here, accompanied by a kind and decent young man, to take care of him. Previously to his arrival I had corresponded respecting his case with a very learned and respectable physician in the country, under whose care the boy had been placed. From the information furnished by this gentleman, and that which was collected from the keeper, I believe the former history of his case is correctly given.

The parents are persons of sound mind, and they do not remember any branches of their respective families to have been (in any manner) disordered in their intellects. The subject of the present relation was their eldest son; the second child was of a disposition remarkably mild; and the youngest, a boy, about two years and a half, was distinguished by the irritability and impatience of his temper. At the age of two years, the subject of the present relation, became so mischievous and uncontroulable, that he was sent from home to be nursed by his aunt. In this situation, at the request of his parents, and with the concurrence of his relation, he was indulged in every wish, and never corrected for any perverseness or impropriety of conduct. Thus he continued until he was nearly nine years old, the creature of volition and the terror of the family. At the suggestion of the physician, whom I have before mentioned, and who was the friend of his parents: a person was appointed to watch over him. It being the opinion of the doctor that the case originated in over indulgence and perverseness; a different system of management was adopted. The superintendant was ordered to correct him for each individual impropriety. At this time the boy would neither dress nor undress himself, though capable of doing both; when his hands were at liberty, he tore his clothes: he broke every thing that was presented to him, or which came within his reach, and frequently refused to take food. He gave answers only to such questions as pleased him, and acted in opposition to every direction. The superintendant exercised this plan for several months, but perhaps not to the extent laid down; for it may be presumed, that after a a few flagellations his humanity prevailed over the medical hypothesis.

When he became the subject of my own observation, he was of a very healthy appearance, and his head was well formed; this was also the opinion of several gentlemen, distinguished for their anatomical knowledge, to whom the boy was presented. His tongue was unusually thick, though his articulation was perfectly distinct. His countenance was decidedly maniacal.[13] His stature, for his age, was short, but he was well compacted, and possessed great bodily strength. Although his skin was smooth and clear, it was deficient in its usual sensibility; he bore the whip and the cane with less evidence of pain than other boys. Another circ.u.mstance convinced me of this fact. During the time he resided in London he was troubled with a boil on his leg; various irritating applications were made to the tumor, and the dressings were purposely taken off with less nicety than usual, yet he never complained. His pulse was natural, and his bowels were regular. His appet.i.te was good, but not inordinate, and he bore the privation of food for a considerable time without uneasiness. Although he slept soundly, he often awoke as if suddenly alarmed, and he seemed to require a considerable duration of sleep.

He had a very retentive memory, and had made as great proficiency in speech as the generality of boys of his own age. Few circ.u.mstances appeared to give him pleasure, but he would describe very correctly any thing which had delighted him. As he wanted the power of continued attention, and was only attracted by fits and starts, it may be naturally supposed he was not taught letters, and still less that he would copy them. He had been several times to school, and was the hopeless pupil of many masters, distinguished for their patience and rigid discipline; it may therefore be concluded, that from these gentlemen, he had derived all the benefits which could result from privations to his stomach, and from the application of the rod to the more delicate parts of his skin.

On the first interview I had with him, he contrived, after two or three minutes acquaintance, to break a window and tear the frill of my shirt. He was an unrelenting foe to all china, gla.s.s, and crockery ware, whenever they came within his reach he shivered them instantly. In walking the street, the keeper was compelled to take the wall, as he uniformly broke the windows if he could get near them, and this operation he performed so dextrously, and with such safety to himself, that he never cut his fingers. To tear lace and destroy the finer textures of female ornament, seemed to gratify him exceedingly, and he seldom walked out without finding an occasion of indulging this propensity. He never became attached to any inferior animal, a benevolence so common to the generality of children: to these creatures his conduct was that of the brute: he oppressed the feeble, and avoided the society of those more powerful than himself. Considerable practice had taught him that he was the cat's master, and whenever this luckless animal approached him he plucked out its whiskers with wonderful rapidity; to use his own language, "_I must have her beard off_." After this operation, he commonly threw the creature on the fire, or through the window. If a little dog came near him he kicked it, if a large one he would not notice it. When he was spoken to, he usually said, "I do not choose to answer." When he perceived any one who appeared to observe him attentively, he always said, "Now I will look unpleasant." The usual games of children afforded him no amus.e.m.e.nt; whenever boys were at play he never joined them: indeed, the most singular part of his character was, that he appeared incapable of forming a friendship with any one: he felt no considerations for s.e.x, and would as readily kick or bite a girl as a boy. Of any kindness shewn him, he was equally insensible; he would receive an orange as a present, and afterwards throw it in the face of the donor.

To the man who looked after him, he appeared to entertain something like an attachment: when this person went out of the room, and pretended that he would go away, he raised a loud outcry, and said, "what will become of me, if he goes away; I like him, for he carries the cane which makes me a good boy:" but it is much to be doubted, whether he really bore an affection for his keeper; the man seemed to be of a different opinion, and said, when he grew older he should be afraid to continue with him, as he was persuaded the boy would destroy him, whenever he found the means and opportunity.

Of his own disorder he was sometimes sensible: he would often express a wish to die, for he said, "G.o.d had not made him like other children;" and when provoked, he would threaten to destroy himself.

During the time he remained here, I conducted him through the hospital, and pointed out to him several patients who were chained in their cells; he discovered no fear or alarm; and when I shewed him a mischievous maniac who was more strictly confined than the rest, he said, with great exultation, "this would be the right place for me." Considering the duration of his insanity, and being ignorant of any means by which he was likely to recover, he returned to his friends, after continuing a few weeks in London.

CHAP. V.

CAUSES OF INSANITY.

When patients are admitted into Bethlem Hospital, an enquiry is always made of the friends who accompany them, respecting the cause supposed to have occasioned their insanity.

It will be readily conceived, that there must be great uncertainty attending the information we are able to procure upon this head: and even from the most accurate accounts, it would be difficult to p.r.o.nounce, that the circ.u.mstances which are related to us, have actually produced the effect. The friends and relatives of patients are, upon many occasions, very delicate concerning this point, and cautious of exposing their frailties or immoral habits: and when the disease is connected with the family, they are oftentimes still more reserved in disclosing the truth.

Fully aware of the incorrect statement, frequently made concerning these causes, I have been at no inconsiderable pains to correct or confirm the first information, by subsequent enquiries.

The causes which I have been enabled most certainly to ascertain, may be divided into PHYSICAL and MORAL.[14]

Under the first, are comprehended repeated intoxication: blows received upon the head; fever, particularly when attended with delirium; mercury, largely and injudiciously administered; cutaneous eruptions repelled, and the suppression of periodical or occasional discharges and secretions; hereditary disposition, and paralytic affections.

By the second cla.s.s of causes, which have been termed _moral_, are meant those which are supposed to originate in the mind, or which are more immediately applied to it. Such are, the long endurance of grief; ardent and ungratified desires; religious terror; the disappointment of pride; sudden fright; fits of anger; prosperity humbled by misfortunes:[15] in short, the frequent and uncurbed indulgence of any pa.s.sion or emotion, and any sudden or violent affection of the mind.

There are, doubtless, many other causes of both cla.s.ses, which may tend to produce this disease. Those which have been stated, are such as I am most familiar with; or, to speak more accurately, such are the circ.u.mstances most generally found to have preceded this affection.

It is an old opinion, and continues still to prevail, that maniacs are influenced by the changes of the moon. In the fourth chapter of St.

Matthew's Gospel, verse 24, we find the word "[Greek: Seleniaxomenous]"

which is rendered in the English version, "those which were lunatic."

Notwithstanding the notion of being moon-struck might prevail among the ignorant people of Galilee, yet Hippocrates, a philosopher, and correct observer of natural phaenomena, does not appear to have placed any faith in this planetary influence. Although the Romans were infected with this popular tradition, as may be seen in the following pa.s.sage of the Art of Poetry,

"Ut mala quem scabies aut morbus regius urget, Aut fanaticus error, et IRACUNDA DIANA Vesanum tetigisse timent fugiuntque poetam, Qui sapiunt:"--

yet Celsus did not consider the operation of the moon on the human intellect sufficiently well founded to admit it into his medical work.

Not a word on this subject is mentioned in the eighteenth chapter of his third book, which particularly treats of Insanity, "_De tribus insaniae generibus_;" it is true that, in the fourth chapter of the first book, which speaks "_De his quibus caput infirmum est_," he says "Cui caput infirmum est, is si bene conc.o.xit, leniter perfricare id mane manibus suis debet; nunquam id, si fieri potest, veste velare; aut ad cutem tondere: utileque lunam vitare, maximeque ante ipsum lunae solisque concursum." By the _infirmum caput_, Celsus does not mean madness, as may be clearly seen by perusing the chapter: the weakness of intellect, which frequently continues after fever, or other violent diseases, is evidently his meaning; but Dr. c.o.x has quoted the above pa.s.sage, to prove that Celsus was impressed with the truth of this vulgar opinion. He says, "This idea of lunar influence, in _maniacal complaints_, was handed down to us by our medical forefathers, and is still very generally adopted."

It is most probable that this idea of planetary regency, however it might have arisen, or to whatever extent it may have been credited, received in the Arabian school, the stamp by which its currency has been subsequently maintained. For the revival and dispersion of ancient medical knowledge, we are confessedly under considerable obligations to the Arabians;[16] and more especially for the incorporation of astrology, magic and alchymy, with medicine.

Popular superst.i.tions and national proverbs, are seldom without some foundation; and with respect to the present, it may be observed, that if it were not in some degree rooted in fact, and trained up by observation, it would become difficult to ascertain how such an opinion came to be adopted; and this investigation is rendered still more important from the consideration, that the existing law in this country, respecting insane persons, has been established on the supposed prevalence of this lunar regulation. A commission is issued, de _lunatico_ inquirendo, and the commissioners sitting for that purpose, are particular in their enquiries, whether the patient enjoys lucid intervals. The term _lucid interval_ has been properly connected with the word _lunacy_; for, if the patient, as they supposed, became insane at particular changes of the moon, the inference was natural, that in the intervening s.p.a.ces of time he would become rational.

It is more than probable, that the origin of this supposition of the lunar influence may be traced to the following circ.u.mstances. The period of the return of the moon, and of regular menstruation in women, is four weeks; and the terms which designate them, have been imposed from the period of time in which both are compleated. Insanity and epilepsy are often connected with menstruation, and suffer an exacerbation of their paroxysms at the period when this discharge happens, or ought to take place. If, therefore, the period of menstruation in an insane woman should occur at the full of the moon, and her mind should then be more violently disturbed, the recurrence of the same state may be naturally expected at the next full moon. This is a necessary coincidence, and should be discriminated from effect. But such has been the prevalence of this opinion, that when patients have been brought to Bethlem hospital, especially those from the country, their friends have generally stated them to be worse at some particular change of the moon, and of the necessity they were under, at those times, to have recourse to a severer coercion. Indeed, I have understood from some of these _lunatics_, who have recovered, that the overseer or master of the work-house himself has frequently been so much under the dominion of this planet, and keeping steadily in mind the old maxim, _venienti occurrite morbo_, that, without waiting for any display of increased turbulence on the part of the patient, he has bound, chained, flogged, and deprived these miserable people of food, according as he discovered the moon's age by the almanack.

To ascertain how far this opinion was founded in fact, I kept, during more than two years, an exact register, but without finding, in any instance, that the aberrations of the human intellect corresponded with, or were influenced by, the vicissitudes of this luminary.

As insane persons, especially those in a furious state, are but little disposed to sleep, even under the most favourable circ.u.mstances, they will be still less so, when the moon shines brightly into their apartments.

It has also been considered, that intellectual labour frequently becomes a cause of insanity; that those, who are in the habit of exercising the faculty of thought, for the perfection and preservation of the reason of others, are thereby in danger of losing their own. We hear much of this, from those who have copiously treated of this disease, without the toil of practical remark; whose heads become bewildered by the gentlest exercise, and to whom the recreation of thinking becomes the exciting cause of stupidity or delirium. These persons enumerate, among the exciting causes of delirium, "Too great, or too long continued exertion of the mental faculties, as in the delirium which often succeeds long continued and abstract calculation; and the deliria to which men of genius are peculiarly subject."

The mind of every man is capable of a definite quant.i.ty of exertion to good effect; all endeavours, beyond that point, are impotent and perplexing. The attention is capable of being fixed to a certain extent, and, when that begins to deviate, all continuance is time lost. It is certain that, by habit, this power may be much increased; and, by frequent exercise, that, which at first excited fatigue, may be continued with facility and pleasure. What species of delirium is that, which succeeds long continued and abstract calculation? Newton lived to the age of 85 years, Leibnitz to 70, and Euler to a more advanced period, yet their several biographers have neglected to inform us, that their studies were checquered with delirious fermentations. The mathematicians of the present day (and there are many of distinguished eminence) would conceive it no compliment to suppose that they retired from their labours with addled brains, and that writers of books on insanity should impute to them miseries which they never experienced.

It is curious to remark, in looking over a biographical chart, that mathematicians and natural philosophers have in general attained a considerable age; so that long continued and abstract calculation, or correct thinking upon any subject does not appear, with all these delirious visitations, to shorten the duration of human life. What is meant by the deliria, to which men of genius are peculiarly subject, I am unable, from a want of sufficient genius and delirium, to comprehend.

It is well understood, that a want of rational employment is a very successful mode of courting delirium; that an indulgence in those reveries which keep the imagination on the wing, and imprison the understanding, is likely to promote it: and it must be owned, that the same effect has often been produced, where vanity or ambition has urged minds, puny by nature, and undrilled in intellectual exercises, to attempt to grasp that which they were unable to embrace. This may be ill.u.s.trated by the following case.

A young gentleman of slender capacity, and very moderate education, at the age of nineteen, was placed in a merchant's counting house, where he continued for two years diligently, though slowly, to perform the duties of the office. Coming at this time into the possession of considerable property, and perhaps, aware of the uncultivated state of his own mind, he very laudably determined to improve it. He frequented the society of persons esteemed learned and eminent in their different professions, and became much delighted with their conversation; but at the same time sensible that he was unable to contribute to the discourse. He resolved to become a severe student, and for this purpose purchased an immense quant.i.ty of books on most subjects of literature and science. History commenced the career of his enquiries: Rollin, Gibbon, Hume and Robertson were anxiously and rapidly perused; but he never paused to consider, or to connect dates and circ.u.mstances, so that these excellent authors, after he had waded through them, left scarcely an impression on his mind. Chemistry next engaged his attention, and on this subject, he pored over many volumes with little advantage: the terms proved a source of embarra.s.sment, and he made no experiments. In a hasty succession, the ancient languages, antiquities, etymology, agriculture, and moral philosophy, occupied his mind. About eight hours were daily devoted to reading. Somewhat more than two years were consumed in this employment, which had distracted his mind, without conferring any positive knowledge.

His friends and acquaintances now began to perceive a considerable alteration in his temper; though naturally diffident, he had a.s.sumed a high degree of literary importance, and plumed himself on the extent of his learning. Before this excessive, but ill-directed application, he was a strict relator of the truth, but he now found a convenience in supplying by fancy, that, which the indigence of his memory was unable to afford.

Shortly he began to complain that he could not sleep, and that the long night was pa.s.sed in shifting from side to side.

"La.s.so, ch'n van te chiamo, et queste oscure, Et gelide ombre in van lusingo: o piume D'asprezza colme: o notti acerbe, et dure."

_Gio: Della Casa._

Fever succeeded, accompanied with delirium in the evening. By quietness, and the ordinary remedies, these symptoms were removed; but he was left in a state of extreme weakness. As he recovered from this, his habits became materially altered: he would continue to lie in bed for several days, after which, he would suddenly rise and walk a number of miles. Personal cleanliness, and dress were entirely neglected: sometimes he would fast for two or three days, and then eat voraciously. Afterwards he became suspicious that poison had been mixed with his food. It was found necessary to confine him, from having attempted to castrate himself: this he afterwards effected in a very complete manner, and continues a maniac to the present time.

Few persons, I believe, will be disposed to consider the above case, as an instance of insanity succeeding to a laborious exercise of the intellectual faculties. It is true, he was busied with books: but this occupation could not have strained his mind, for he appears neither to have comprehended, nor retained any of the objects of his pursuit.

_Hereditary Disposition._

"Ut male posuimus initia sic cetera sequuntur."--_Cicero._

"Whatever was in the womb imperfect, as to her proper work, comes very rarely, or never at all, to perfection afterwards."--_Harrington's Works, p. 177._

Considerable diversity of opinion has prevailed, whether insanity be hereditary or not; and much has been said on both sides of this question.

Great ingenuity has been exerted to prove that this disease is accidental, or that there are sufficient causes to account for its occurrence, without supposing it one of those calamities that "_flesh is heir to_." It has been argued, that, if the disease were hereditary, it ought uniformly to be so, and that the offspring of a mad parent should necessarily become insane.

All theories and reasonings appear to be good for as much as they prove; and if the term _hereditary_ be employed with a degree of strictness, so as to denote certain and infallible transmission, such inevitable descent cannot be defended. Several instances have come under my observation where the children of an insane parent have not hitherto been affected with madness, and some have died early in life, without having experienced any derangement of mind. More time is therefore required.

All observations concur in acknowledging that there are many circ.u.mstances in which children resemble their parents. It is very common to see them resemble one of their parents in countenance, and when there are several children, some shall bear the likeness of the father and others of the mother. Children often possess the make and fashion of the body, peculiar to one or other of their parents, together with their gait and voice; but that which has surprized me most is the resemblance of the hand-writing.

If a parent had taught his son to write, it might be expected that a considerable similarity would be detected; but in general the fact appears to be otherwise, for it seldom happens that the scholars, though constantly imitating the copy of the master, write at all like him, or like each other. In a few instances I have noticed a correct resemblance between the hand-writing of the father and son, where the former died before the latter had been taught the use of the pen, and who probably never saw the hand-writing of his father. The transmission of personal deformities is equally curious. I am acquainted with a person in this town, whose middle and ring finger are united, and act as one; all the children of this man carry the same defect. A toenail, particularly twisted, has been traced through three generations, on the same foot and toe. Abundant instances might be adduced on this subject; there is scarcely a family which cannot produce something in confirmation; and if to these circ.u.mstances in the human species, were to be added the experiments which have been made on the breeding of cattle, perhaps little doubt would remain.