wish to avoid the odious imputation of swelling out a few hasty observations into a bulky volume. The periodical paroxysms of insanity show also its analogy to other diseases of particular parts connected with general disorder, Simple disorder of the bowels, headach, and general irritability, accompanied, perhaps, with some local inflammation, have often been found to be periodical. Dr. Mayo has noticed in insanity the periodical ending in the continuous state, and then being cured. I have observed the same of fits of toothach, and other local affections of particular nerves. Lastly; the success of the lowering treatment in insanity tends to establish the parallel. Do we not find in many local inflammations, particularly about the head, that by our first producing a healthy condition of the digestive organs the symptoms abate, but that the local inflammation, not being subdued, keeps up the irritation, the digestion goes wrong again, and all is as bad as ever: recourse is then had to antiphlogistic measures of a more violent nature; the patient undergoes general depletion, and in time the affected part and general health get well together? Is not this often the process in insanity? 2 Thus the phenomena of insanity, both in the symptoms and treatment, show its physical nature, and its analogy to other diseases of particular parts, accompanied by general ill health, liable to periodical returns, best cured by alterative medicines and depletion, Such a view of the subject, in proportion as it is confirmed by observation, must alter the practice in insanity. Instead of being deluded by the specious appearance of amendment under the tonic regimen, or of omitting medical treatment altogether, from the apparent incurableness of the disease, and the versatility of its symptoms, we must proceed steadily with the lowering plan. As soon as the first doubtful signs of the disease appear in the periodical paroxysms of unusual irritability, we must note the circumstances before alluded to as denoting the determination of blood to the head, and must advert to the state of the abdominal viscera, These must become the first objects of attention, since experience has shown that we cannot expect any amendment in the nervous symptoms while the organs of digestion remain disordered. If by alterative medicines the healthy state of these functions be not effected; or if the nervous symptoms do not subside See the Work above cited. 2 Consult Spurzheim on Insanity: Hallè sur la Manie Atrabilaire, &e. &c. &c. VOL. XV. Pam. NO. XXIX. H with the visceral disorder, more active measures must be adopted, such as stronger cathartic medicines, repeated bleeding, and absti nence. The manner in which such general and continued depletion acts in the cure of local inflammation remains unknown: but the balance of action in the sanguiferous system, and of excitability in the brain and nerves, seem to be restored by such means, both in madness and in a numerous train of other nervous maladies. The obscurity of the cause of these diseases is increased by the periodical fits in which they happen, many of which occur in particular seasons, or in daily and monthly paroxysms, referrible to atmospherical causes. The facts, however inexplicable, are undeniably true, and merit general attention. These periods will, in some measure, direct the conduct of the physician. We may prepare against the attack, or forcibly break the chain of consecutive symptoms. At the monthly periods, too, the crisis of certain forms of disease happen. These are also important, as it is injurious to begin certain remedies just before the critical exacerbation of many complaints. Rational views of the physical nature of insanity, if duly acted on, may invalidate the charge brought against the practice in this disease of making gaols of lunatic hospitals; of treating the insane more like prisoners than patients; of grouping various kinds of madmen together; and of fulfilling the character of mad houses; an epithet which the satirical pen of some continental writer has applied, as designating houses manifestly ill calculated for madmen. These errors have partly arisen from the prevalence of a prejudice that insanity was the disease of a Being essentially distinct from the Body, and, therefore, not regulated by the ordinary laws of animal life. The identification of the mind with the material organs is not intended to be understood by this allusion: but I insist on the disorder of the organs as the cause of madness. I will not pretend either to defend or to dispute the propriety of the nomenclature used for the organs; but it serves to express the distinct faculties of the mind, whose organs have been named according to the new doctrine, the principles of which now begin to be admitted by the ablest physiologists.—I have alluded to the The Case which, being related to me by a foreign physician, first suggested this opinion, was that of a man who, after the alterative plan alone had failed, recovered of a bad paroxysm after copious bleeding from wounds which he repeatedly gave to his own body. I have lately read of two similar Cases. 2 I refer the reader to Dr. Spurzheim's Plate of the Brain. general principles of this theory, in order to afford a more extensive opportunity to those who have the care of the insane, to investigate, and thereby to confirm or to confute the particulars. I have myself constantly noticed, in examples too numerous to detail, that mad persons are often deranged in the manifestation of those passions and faculties whereof the material organs (according to Gall's and Spurzheim's division) are the largest. While I proceed with and solicit research, I do not pretend to enough knowledge of insanity to assert positively the universal application of this theory. But facts are always useful; and the publication of them, by exciting inquiry, may lead to a nearer knowledge of their causes. |