Observations on Madness and Melancholy Part 2

"It is not madnesse That I have uttered: bring me to the test And I the matter will _re-word_, which madnesse Would gambol from."--_Hamlet, Act III. Scene 4._

In persons of sound mind, as well as in maniacs, the memory is the first power which decays; and there is something remarkable in the manner of its decline. The transactions of the latter part of life are feebly recollected, whilst the scenes of youth and of manhood, remain more strongly impressed. When I have listened to the conversations of the old incurable patients, the topic has generally turned upon the transactions of early days; and, on the circ.u.mstances of that period of life, they have frequently spoken with tolerable correctness. In many cases, where the mind has been injured by intemperance, the same withering of the recollection may be observed. It may, perhaps, arise from the mind at an early period of life, being most susceptible and retentive of impressions, and from a greater disposition to be pleased, with the objects which are presented: whereas, the cold caution, and fastidiousness with which age surveys the prospects of life, joined to the dulness of the senses, and the slight curiosity which prevails, will, in some degree, explain the difficulty of recalling the history of later transactions.

Insane people, who have been good scholars, after a long confinement, lose, in a wonderful degree, the correctness of orthography: when they write, above half the words are frequently mis-spelt, they are written according to the p.r.o.nunciation. It shews how treacherous the memory is without reinforcement. The same necessity of a constant recruit, and frequent review of our ideas, satisfactorily explains, why a number of patients lapse nearly into a state of ideotism. These have, for some years, been the silent and gloomy inhabitants of the hospital, who have avoided conversation, and courted solitude; consequently have acquired no new ideas, and time has effaced the impression of those, formerly stamped on the mind. Mr. Locke, well observes, although he speaks figuratively, "that there seems to be a constant decay of all our ideas, even of those which are struck deepest, and in minds the most retentive; so that, if they be not sometimes renewed by repeated exercise of the senses, or reflection on those kind of objects, which at first occasioned them, the print wears out, and at last there remains nothing to be seen."

Connected with loss of memory, there is a form of insanity which occurs in young persons; and, as far as these cases have been the subject of my observation, they have been more frequently noticed in females. Those whom I have seen, have been distinguished by prompt capacity and lively disposition: and in general have become the favourites of parents and tutors, by their facility in acquiring knowledge, and by a prematurity of attainment. This disorder commences, about, or shortly after, the period of menstruation, and in many instances has been unconnected with hereditary taint; as far as could be ascertained by minute enquiry. The attack is almost imperceptible; some months usually elapse, before it becomes the subject of particular notice; and fond relatives are frequently deceived by the hope that it is only an abatement of excessive vivacity, conducing to a prudent reserve, and steadiness of character. A degree of apparent thoughtfulness and inactivity precede, together with a diminution of the ordinary curiosity, concerning that which is pa.s.sing before them; and they therefore neglect those objects and pursuits which formerly proved sources of delight and instruction. The sensibility appears to be considerably blunted; they do not bear the same affection towards their parents and relations; they become unfeeling to kindness, and careless of reproof. To their companions they shew a cold civility, but take no interest whatever in their concerns. If they read a book, they are unable to give any account of its contents: sometimes, with steadfast eyes, they will dwell for an hour on one page, and then turn over a number in a few minutes. It is very difficult to persuade them to write, which most readily develops their state of mind: much time is consumed and little produced. The subject is repeatedly begun, but they seldom advance beyond a sentence or two: the orthography becomes puzzling, and by endeavouring to adjust the spelling, the subject vanishes. As their apathy increases they are negligent of their dress, and inattentive to personal cleanliness. Frequently they seem to experience transient impulses of pa.s.sion, but these have no source in sentiment; the tears, which trickle down at one time, are as unmeaning as the loud laugh which succeeds them; and it often happens that a momentary gust of anger, with its attendant invectives, ceases before the threat can be concluded. As the disorder increases, the urine and faeces are pa.s.sed without restraint, and from the indolence which accompanies it, they generally become corpulent. Thus in the interval between p.u.b.erty and manhood, I have painfully witnessed this hopeless and degrading change, which in a short time has transformed the most promising and vigorous intellect into a slavering and bloated ideot.

Of the organs of sense, which become affected in those labouring under insanity, the ear, more particularly suffers. I scarcely recollect an instance of a lunatic becoming blind, but numbers are deaf. It is also certain that in these persons, more delusion is conveyed through the ear than the eye, or any of the other senses. Those who are not actually deaf, are troubled with difficulty of hearing, and tinnitus aurium. Thus an insane person shall suppose that he has received a commission from the Deity; that he has ordered him to make known his word, or to perform some act, as a manifestation of his will and power. It is however much to be regretted, that these divine commissions generally terminate in human mischief and calamity, and instances are not unfrequent, where these holy inspirations, have urged the unfortunate believer to strangle his wife, and attempt the butchery of his children. From this source may be explained, the numerous delusions of modern prophecies, which circ.u.mstantially relate the gossipings of angels, and record the hallucinations of feverish repose.

In consequence of some affection of the ear, the insane sometimes insist that malicious agents contrive to blow streams of infected air into this organ: others have conceived, by means of what they term hearkening wires and whiz-pipes, that various obscenities and blasphemies are forced into their minds; and it is not unusual for those who are in a desponding condition, to a.s.sert, that they distinctly hear the devil tempting them to self-destruction.

A considerable portion of the time of many lunatics, is pa.s.sed in replies to something supposed to be uttered. As this is an increasing habit, so it may be considered as an unfavourable symptom, and at last the patient becomes so abstracted from surrounding objects, that the greater part of the day is consumed in giving answers to these supposed communications. It sometimes happens that the intelligence conveyed, is of a nature to provoke the mad-man, and on these occasions, he generally exercises his wrath on the nearest bystander; whom he supposes, in the hurry of his anger, to be the offending party.

In the soundest state of our faculties, we are more liable to be deceived by the ear, than through the medium of the other senses: a partial obstruction by wax, shall cause the person so affected, to hear the bubbling of water, the ringing of bells, or the sounds of musical instruments; and on some occasions, although the relation seems tinged with superst.i.tion, men of undeviating veracity, and of the highest attainments, have a.s.serted, that they have heard themselves _called_. "He [Dr. Johnson] mentioned a thing as not unfrequent, of which I [Mr.

Boswell] had never heard before--being _called_, that is, hearing one's name p.r.o.nounced by the voice of a known person at a great distance, far beyond the possibility of being reached by any sound, uttered by human organs. An acquaintance on whose veracity I can depend, told me, that walking home one evening to Kilmarnock, he heard himself called from a wood, by the voice of a brother who had gone to America; and the next packet brought account of that brother's death. Macbean a.s.serted that this inexplicable _calling_ was a thing very well known. Dr. Johnson said, that one day at Oxford, as he was turning the key of his chamber, he heard his mother distinctly call _Sam_. She was then at Litchfield; but nothing ensued. This phaenomenon is, I think, as wonderful as any other mysterious fact, which many people are very slow to believe, or rather, indeed, reject with an obstinate contempt."--_Boswell's Life of Dr. Johnson, 4to. vol. ii. p. 384._

One of the most curious cases of this nature which has fallen under my observation, I shall here venture to relate, for the amus.e.m.e.nt of the reader. The patient was a well educated man, about the middle age; he always stopped his ears closely with wool, and, in addition to a flannel night-cap, usually slept with his head in a tin saucepan. Being asked the reason why he so fortified his head, he replied, "To prevent the intrusion of the _sprites_." After having made particular enquiry concerning the nature of these beings, he gravely communicated the following information:--"Sir, you must know that in the human seminal fluid there are a number of vital particles, which being injected into the female, impregnate her, and form a foetus of muscles and bones. But this fluid has other properties, it is capable, by itself, of producing vitality under certain circ.u.mstances, and experienced chemists and hermetical philosophers have devised a method of employing it for other purposes, and some, the most detrimental to the condition and happiness of man. These philosophers, who are in league with princes, and their convenient and prost.i.tuted agents, contrive to extract a portion of their own s.e.m.e.n, which they conserve in rum or brandy: these liquors having the power of holding for a considerable time the seminal fluid, and keeping its vitality uninjured. When these secret agents intend to perform any of their devilish experiments on a person, who is an object of suspicion to any of these potentates, they cunningly introduce themselves to his acquaintance, lull him to sleep by artificial means, and during his slumbers, infuse a portion of their seminal fluid (conserved in rum or brandy) into his ears.

"As the s.e.m.e.n in the natural commerce with the woman, produces a child, so, having its vitality conserved by the spirit, it becomes capable of forming a _sprite_; a term, obviously derived from the spirit in which it had been infused. The ear is the most convenient nidus for hatching these vital particles of the s.e.m.e.n. The effects produced on the individual, during the incubation of these seminal germs, are very disagreeable; they cause the blood to mount into the head, and produce considerable giddiness and confusion of thought. In a short time, they acquire the size of a pin's head; and then they perforate the drum of the ear, which enables them to traverse the interior of the brain, and become acquainted with the hidden secrets of the person's mind. During the time they are thus educated, they enlarge according to the natural laws of growth; they then take wing, and become invisible beings, and, from the strong ties of natural affection, a.s.sisted by the principle of attraction, they revert to the parent who afforded the s.e.m.e.n, and communicate to him their surrept.i.tious observations and intellectual gleanings. In this manner, I have been defrauded of discoveries which would have ent.i.tled me to opulence and distinction, and have lived to see others reap honours and emoluments, for speculations which were the genuine offsprings of my own brain."

By some persons, madness has been considered as a state of mind a.n.a.logous to dreaming: but an inference of this kind supposes us fully acquainted with the actual state, or condition of the mind in dreaming, and in madness. The whole question hinges on a knowledge of this _state of mind_, which I fear is still involved in obscurity. As it is not the object of the present work to discuss this curious question, the reader is referred to the fifth section of the first part of Mr. Dugald Stewart's Elements of the Philosophy of the Human Mind, and to the note, o, at the end; he will also find the subject treated with considerable ingenuity in the eleventh section of Mr. Brown's Observations on Zoonomia.

There is, however, a circ.u.mstance, which to my knowledge, has not been noticed by those who have treated on this subject, and which appears to establish a marked distinction between madness and dreaming. In madness, the delusion we experience is most frequently conveyed through the ear; in dreaming, the deception is commonly optical; we see much, and hear little; indeed dreaming, at least with myself, seems to be a species of intelligible pantomime, that does not require the aid of language to explain it. It is true, that some who have perfectly recovered from this disease, and who are persons of good understanding and liberal education, describe the state they were in, as resembling a dream: and when they have been told how long they were disordered, have been astonished that the time pa.s.sed so rapidly away. But this only refers to that consciousness of delusion, which is admitted by the patient on his return to reason; in the same manner as the man awake, smiles at the incongruous images, and abrupt transitions of the preceding night. In neither condition, does the consciousness of delusion, establish any thing explanatory of the _state_ of the mind.

In a description of madness, it would be blameable to omit a form of this disease which is commonly very intractable, and of the most alarming consequences; I mean, the insanity which arises from the habit of intoxication. All persons who have had any experience of this disease, readily allow that fermented liquors, taken to excess, are capable of producing mental derangement: but the medical pract.i.tioner has in such cases, to contend, and generally without effect, with popular prejudice, and sometimes, with the subordinate advisers of the law.

To const.i.tute madness, the minds of ignorant people expect a display of continued violence, and they are not satisfied that the person can be p.r.o.nounced in that state, without they see him exhibit the pranks of a baboon, or hear him roar and bellow like a beast. By these people the patient is stated only to be intemperate; they confess that he does very foolish things when intoxicated; but that he is not mad, and only requires to be restrained from drinking. Thus, a man is permitted slowly to poison and destroy himself; to produce a state of irritation, which disqualifies him for any of the useful purposes of life; to squander his property amongst the most worthless and abandoned; to communicate a loathsome and disgraceful disease to a virtuous wife, and leave an innocent and helpless family to the meager protection of the parish. If it be possible, the law ought to define the circ.u.mstances, under which it becomes justifiable, to restrain a human being from effecting his own destruction, and involving his family in misery and ruin. When a man suddenly bursts through the barriers of established opinions; if he attempt to strangle himself with a cord, to divide his larger blood-vessels with a knife, or swallow a vial full of laudanum, no one entertains any doubt of his being a proper subject for the superintendance of keepers, but he is allowed, without control, by a gradual process, to undermine the fabric of his own health, and destroy the prosperity of his family.

All patients have not the same degree of memory of what has pa.s.sed during the time they were disordered: and I have frequently remarked, when they were unable to give any account of the peculiar opinions which they had indulged, during a raving paroxysm of long continuance, that they well remembered any coercion which had been used, or any kindness which had been shewn them.

Insane people, are said to be generally worse in the morning; in some cases they certainly are so, but perhaps not so frequently as has been supposed. In many instances (and, as far as I have observed) in the beginning of the disease, they are more violent in the evening, and continue so the greatest part of the night. It is, however, a certain fact, that the majority of patients of this description, have their symptoms aggravated by being placed in a rec.u.mbent posture. They seem, themselves, to avoid the horizontal position as much as possible, when they are in a raving state: and when so confined that they cannot be erect, will keep themselves seated upon the breech.

Many of those who are violently disordered will continue particular actions for a considerable time: some are heard to gingle the chain, with which they are confined, for hours without intermission; others, who are secured in an erect posture, will beat the ground with their feet the greatest part of the day. Upon enquiry of such patients, after they have recovered, they have a.s.sured me that these actions afforded them considerable relief. We often surprize persons who are supposed free from any mental derangement, in many strange and ridiculous movements, particularly if their minds be intently occupied:[7]--this does not appear to be so much the effect of habit, as of a particular state of mind.

Among the bodily particularities which mark this disease, may be observed the protruded, and oftentimes glistening eye, and a peculiar cast of countenance, which, however, cannot be described. In some, an appearance takes place which has not hitherto been noticed by authors. This is a relaxation of the integuments of the cranium, by which they may be wrinkled, or rather gathered up by the hand to a considerable degree. It is generally most remarkable on the posterior part of the scalp; as far as my enquiries have reached, it does not take place in the beginning of the disease, but after a raving paroxysm of some continuance. It has been frequently accompanied with contraction of the iris.

On the suggestion of a medical gentleman, I was induced to ascertain the prevailing complexion and colour of the hair in insane patients. Out of two hundred and sixty-five who were examined, two hundred and five were of a swarthy complexion, with dark, or black hair; the remaining sixty were of a fair skin, and light, brown, or redhaired. What connexion this proportion may have, with the complexion and colour of the hair of the people of this country in general, and what alterations may have been produced by age, or a residence in other climates, I am totally uninformed.

Of the power which maniacs possess of resisting cold, the belief is general, and the histories which are on record are truly wonderful: it is not my wish to disbelieve, nor my intention to dispute them; it is proper, however, to state that the patients in Bethlem Hospital possess no such exemption from the effects of severe cold. They are particularly subject to mortifications of the feet; and this fact is so well established from former accidents, that there is an express order of the house, that every patient, under strict confinement, shall have his feet examined morning and evening in the cold weather by the keeper, and also have them constantly wrapped in flannel; and those who are permitted to go about, are always to be found as near to the fire as they can get, during the winter season.

From the great degree of insensibility which prevails in some states of madness, a degree of cold would scarcely be felt by such persons, which would create uneasiness in those of sound mind; but experience has shewn that they suffer equally from severity of weather. When the mind is particularly engaged on any subject, external circ.u.mstances affect us less than when unoccupied. Every one must recollect that, in following up a favourite pursuit, his fire has burned out, without his being sensible of the alteration of temperature; but when the performance has been finished, or he has become indifferent to it from fatigue, he then becomes sensible to cold, which he had not experienced before.

Some maniacs refuse all covering, but these are not common occurrences; and it may be presumed, that by a continued exposure to the atmosphere, such persons might sustain, with impunity, a low temperature, which would be productive of serious injury to those who are clad according to the exigences of the season. Such endurance of cold is more probably the effect of habit, than of any condition peculiar to insanity.

Having thus given a general account of the symptoms, I shall now lay before my readers a history of the appearances which I have noticed on opening the heads of several maniacs who have died in Bethlem Hospital.

CHAP. III.

CASES, WITH THE APPEARANCES ON DISSECTION.

CASE I.

J. H. a man twenty-eight years of age, was admitted a patient in May, 1795. He had been disordered for about two months before he came into the hospital. No particular cause was stated to have brought on the complaint.

It was most probably an hereditary affection, as his father had been several times insane and confined in our hospital. During the time he was in the house, he was in a very low and melancholic state; shewed an aversion to food, and said he was resolved to die. His obstinacy in refusing all nourishment was very great, and it was with much difficulty forced upon him. He continued in this state, but became daily weaker and more emaciated until August 1st, when he died. Upon opening the head, the pericranium was found loosely adherent to the scull. The bones of the cranium were thick. The pia mater was loaded with blood, and the medullary substance, when cut into, was full of b.l.o.o.d.y points. The pineal gland contained a large quant.i.ty of gritty matter.[8] The consistence of the brain was natural; he was opened twenty-four hours after death.

CASE II.

J. W. was a man of sixty-two years of age, who had been many years in the house as an incurable patient, but with the other parts of whose history I am totally unacquainted. He appeared to be a quiet and inoffensive person, who found amus.e.m.e.nt in his own thoughts, and seldom joined in any conversation with the other patients: for some months he had been troubled with a cough, attended with copious expectoration, which very much reduced him; dropsical symptoms followed these complaints. He became every day weaker, and on July 10th, 1795, died. He was opened eighteen hours after death. The pericranium adhered loosely to the scull; the bones of the cranium were unusually thin. There were slight opacities in many parts of the tunica arachnoidea; in the ventricles about four ounces of water were contained--some large hyatids were discovered on the plexus choroides of the right side. The consistence of the brain was natural.

CASE III.

G. H. a man twenty-six years of age, was received into the hospital, July 18th, 1795. It was stated that he had been disordered six weeks previously to his admission, and that he never had any former attack. He had been a drummer with a recruiting party, and had been for some time in the habit of constant intoxication, which was a.s.signed as the cause of his insanity.

He continued in a violent and raving state about a month, during the whole of which time he got little or no sleep. He had no knowledge of his situation, but supposed himself with the regiment, and was frequently under great anxiety and alarm for the loss of his drum, which he imagined had been stolen and sold. The medicines which were given to him he conceived were spirituous liquors, and swallowed them with avidity. At the expiration of a month he was very weak and reduced; his legs became oedematous--his pupils were much diminished. He now believed himself a child, called upon the people about him as his playfellows, and appeared to recal the scenes of early life with facility and correctness. Within a few days of his decease he only muttered to himself. August 26th, he died.

He was opened six hours after death. The pericranium was loosely adherent.

The tunica arachnoidea had generally lost its transparency, and was considerably thickened. The veins of the pia mater were loaded with blood, and in many places seemed to contain air. There was a considerable quant.i.ty of water between the membranes, and, as nearly as could be ascertained, about four ounces in the ventricles, in the cavity of which, the veins appeared remarkably turgid. The consistence of the brain was more than usually firm.

CASE IV.

E. M. a woman, aged sixty, was admitted into the house, August 8th, 1795; she had been disordered five months: the cause a.s.signed was extreme grief, in consequence of the loss of her only daughter. She was very miserable and restless; conceived she had been accused of some horrid crime, for which she apprehended she should be burned alive. When any persons entered her room she supposed them officers of justice, who were about to drag her to some cruel punishment. She was frequently violent, and would strike and bite those who came near her. Upon the idea that she should shortly be put to death, she refused all sustenance; and it became necessary to force her to take it. In this state she continued, growing daily weaker and more emaciated, until October 3d, when she died.

Upon opening the head, there was a copious determination of blood to the whole contents of the cranium. The pia mater was considerably inflamed; there was not any water either in the ventricles or between the membranes.

The brain was particularly soft. She was opened thirty hours after death.

CASE V.

W. P. a young man, aged twenty-five, was admitted into the hospital, September 26th, 1795. He had been disordered five months, and had experienced a similar attack six years before. The disease was brought on by excessive drinking. He was in a very furious state, in consequence of which he was constantly confined. He very seldom slept--during the greater part of the night he was singing, or swearing, or holding conversations with persons he imagined to be about him: sometimes he would rattle the chain with which he was confined, for several hours together, and tore every thing to pieces within his reach. In the beginning of November, the violence of his disorder subsided for two or three days, but afterwards returned; and on the 10th he died compleatly exhausted by his exertions.--Upon opening the head the pericranium was found firmly attached; the pia mater was inflamed, though not to any very considerable degree; the tunica arachnoidea in some places was slightly shot with blood; the membranes of the brain, and its convolutions, when these were removed, were of a brown, or brownish straw colour. There was no water in any of the cavities of the brain, nor any particular congestion of blood in its substance--the consistence of which was natural. He was opened twenty hours after death.

CASE VI.

B. H. was an incurable patient, who had been confined in the house from the year 1788, and for some years before that time in a private madhouse.

He was about sixty years of age--had formerly been in the habit of intoxicating himself. His character was strongly marked by pride, irascibility, and malevolence. During the four last years of his life, he was confined for attempting to commit some violence on one of the officers of the house. After this, he was seldom heard to speak; yet he manifested his evil disposition by every species of dumb insult. Latterly he grew suspicious, and would sometimes tell the keeper that his victuals were poisoned. About the beginning of December he was taken ill with a cough, attended with copious expectoration. Being then asked respecting his complaints, he said, he had a violent pain across the stomach, which arose from his navel string at his birth having been tied too short. He never spoke afterwards, though frequently importuned to describe his complaints. He died December 24, 1795.

Upon dividing the integuments of the head, the pericranium was found scarcely to adhere to the scull. On the right parietal bone there was a large blotch, as if the bone had been inflamed: there were others on different parts of the bone, but considerably smaller. The glandulae Pacchioni were uncommonly large: the tunica arachnoidea in many places wanted the natural transparency of that membrane: there was a large determination of blood to the substance of the brain: the ventricles contained about three ounces of water: the consistence of the brain was natural. He was opened two days after death.

CASE VII.

A. M. a woman, aged twenty-seven, was admitted into the hospital, August 15, 1795; she had then been eleven weeks disordered. Religious enthusiasm, and a too frequent attendance on conventicles, were stated to have occasioned her complaint. She was in a very miserable and unhappy condition, and terrified by the most alarming apprehensions for the salvation of her soul. Towards the latter end of September, she appeared in a convalescent state, and continued tolerably well until the middle of November, when she began to relapse.

The return of her disorder commenced with loss of sleep. She alternately sang, and cried the greatest part of the night. She conceived her inside full of the most loathsome vermin, and often felt the sensation as if they were crawling into her throat. She was suddenly seized with a strong and unconquerable determination to destroy herself; became very sensible of her malady, and said, that G.o.d had inflicted this punishment on her, from having (at some former part of her life) said the Lord's Prayer backwards.