Curiosities of Medical Experience Part 19

That mental emotions, whether producing any alteration in the physical condition of the individual, or not, occasion various degrees of insanity, is proved by experience. The French revolution, during its execrable phases, offered a wide and fertile field of observation on this subject; and the various events that marked those fearful times were certainly well calculated to affect any brain capable of becoming deranged. The following results of these observations are curious: "Among the lunatics confined at Bicetre," says Pinel, "during the third year of the Republic, I observed that the exciting causes of their maladies, in a great majority of cases, were extremely vivid affections of the mind; such as ungovernable or disappointed ambition, religious fanaticism, profound chagrin, and unfortunate love. Out of one hundred and thirteen madmen with whose history I took pains to make myself acquainted, thirty-four were reduced to this state by domestic misfortunes, twenty-four by obstacles to matrimonial union, thirty by political events, and twenty-five by religious fanaticism. Those were chiefly affected who belonged to professions in which the imagination is unceasingly or ardently engaged, and not controlled in its excitement by the exercise of the tamer functions of the understanding, which are more susceptible of satiety and fatigue. Hence the Bicetre registers were chiefly filled from the professions of priests, artists, painters, sculptors, poets, and musicians, while they contained no instances of persons whose line of life demands a predominant exercise of the judging faculty,--not one naturalist, physician, chemist, or geometrician."

The following is a return of the supposed moral causes of insanity observed in the Salpetriere. In the years 1811 and 1812

Domestic affliction 105 Disappointed love 46 Political events 14 Fanaticism 8 Fright 38 Jealousy 18 Anger 16 Misfortunes in circ.u.mstances 77 Offended vanity 1 --- Total 323

In Mr. Esquirol's private establishment during the same period:

Domestic affliction 31 Disappointed love 25 Political events 32 Fanaticism 1 Fright 8 Jealousy 14 Misfortunes 14 Offended vanity 16 Baffled ambition 12 Intense study 13 Misanthropy 2 --- Total 168

It must be observed that the latter return, in which we find twenty-eight persons maddened by disappointed ambition and offended pride, is of a private establishment, whose inmates of course belonged to the better cla.s.ses of the community.

By the return from Pennsylvania, out of fifty lunatics, thirty-four cases arose from moral causes. Of physical causes hereditary madness is the most prevalent, as appears clearly from the following table extracted from the registers of the Salpetriere.

Hereditary insanity 105 Convulsion during gestation 11 Epilepsy 11 Female derangements 55 Diseases of child-birth 52 Critical periods 27 Old age 60 Insolation 12 Injuries of the head 14 Fever 13 Syphilis 8 Effects of mercury 14 Worms 24 Apoplexy 60

When speaking of hereditary madness, Dr. Abercrombie is of opinion that where a tendency to insanity exists, there may be in many cases, circ.u.mstances in mental habits or mental discipline calculated to favour or to counteract the tendency, when the mind wanders away from the proper duties of life or luxuriates amid scenes of imagination, thus permitting mental emotions, of whatever kind, to be excited in a manner disproportional to the true relation of the object which gave rise to them; allowing the mind to ramble among imaginary events, or to be led away by slight and casual relations, instead of steadily exercising the judgment in the investigation of truth.

These observations are no doubt most luminous, yet as I have elsewhere remarked, hereditary predisposition to insanity may be brought into action, by the constant scenes that pa.s.s in the presence of those individuals who may daily have to witness the aberrations of an unhappy relative. The mind dwells on the sad subject, and it becomes a source of constant apprehension, when the mere dread of an hereditary evil is perhaps sufficient to drive to madness. So powerful is the sway even of imaginary terror, that we need not wonder that natural fear should be productive of results still more injurious to our intellects. There seems to exist a certain fascination in what we should dread and avoid; instead of resisting evil, by a strange fatality we seem to be self-impelled to court it. We indulge in thoughts, in hopes and fears, too often chimerical, instead of endeavouring to dismiss them from our mind, by other pursuits and busy occupation; and we brood upon future and ideal miseries until we actually, from supineness and timidity, sink under their overwhelming influence.

Esquirol relates some curious coincidences of hereditary insanity. A Swiss merchant lost both his sons in a state of mania at the age of 19. A lady lost her senses after childbirth at the age of 25. Her daughter became insane in her 25th year. In one family, the grandfather, the father, and the son, destroyed themselves at the age of 50. Near Newton, seven insane sisters had been observed in one family. An unfortunate female in the Salpetriere, under the influence of liquor, threw herself three times in the river and her sister in a state of intoxication drowned herself. A gentleman whose intellects became deranged in consequence of the misfortunes of the revolution remained for ten years secluded in his chamber. His daughter became insane about the same period, and with equal obstinacy could not be prevailed upon to leave her room.

There is no doubt, but that were these early predispositions attended to and watched, an active course of education adopted, and change of locality resorted to, much future misery might be avoided, and possibly the invasion of the malady arrested.

If the observations of the phrenologist are ent.i.tled to consideration, the mind may become mainly instrumental in attaining this _desideratum_, as the detection of certain propensities may place us upon our guard in the education of youth. This would be a point of still greater importance, were these organs innate, dooming us to the blind law of fatality; but the phrenologists maintain, that the development of these organic inequalities on the surface of the cranium are produced and developed by a corresponding enlargement of the brain, which is greater or lesser in the ratio of the preponderance of the organ as the indulgence in the propensities which they indicate.

Pinel relates a curious case of hereditary mania in a man who, up to the age of fifty, fulfilled with intelligence and activity the duties of an important office which he held. At this period he indulged in various excesses, and sunk in the debas.e.m.e.nt of the lowest society. These excesses he represented to his wondering friends and acquaintances as the source of divine pleasure and celestial enjoyment. He declared that he would erect a temple to the G.o.d of love, and officiate himself as high priest at his altars; he compared the very lowest of women to angelic creatures; and finally was confined, a furious and desperate maniac.

Education carried on upon mistaken principles has also been known to prepare the way to insanity, and La Bruyere has justly observed, that there are parents, the study of whose life appears to have been, their giving their children just reason not to regret their loss. Pinel has given us the interesting history of two orphan brothers, who had been brought up in a most anomalous manner--with extreme kindness and effeminacy by a nurse, and with much harshness and injustice by a tutor.

The result of this erroneous management was a deficient development in their intellectual faculties, and a debilitated frame, which gradually led to a state of imbecility. When examined by Pinel at the age of twenty and twenty-two, their conversation was puerile in the extreme, and they both displayed a taste for infantile sports and pastimes, befitting children of three or four years old. They sought to express themselves with great volubility, but their language, consisting chiefly of broken syllables, was scarcely intelligible. Notwithstanding their apathic appearance, by a sort of automatic habit, every evening brought on an absurd scene of sentimentality. They would join each other in earnest conversation in a corner of the room; and, with bitter tears and deep sighs, bewail the loss of their parents, who had thus left them in a helpless orphan condition, in their tender years, expressing the sincerest affection for their nurse, but speaking of their tutor with bitter imprecations. A great partiality shown to one sister has driven another one to a state of dementia, that arose from her continually dwelling on the wrongs she experienced, which, of course, were exaggerated by jealousy.

External agents producing sudden terror have been frequently known to bring on insanity. It is related of a child of three years of age, who was so terrified on being brought into a madhouse, that he was subject to horrible dreams and visions until his seventeenth year, when he became a perfect lunatic. Women frightened during pregnancy have often become alienated; and there are two cases reported of young ladies who were found insane the day after their nuptials.

While disappointments and misfortunes are often the origin of insanity, a sudden melioration in circ.u.mstances, and unexpected pleasing intelligence have been also known to derange the intellects. A man who came into the possession of a large fortune, after having lived for many years in penury, was so alarmed at the thought of losing this property, that the apprehension of the evil deprived him of his senses. An instance is recorded of a young girl, long separated from her lover by parents averse to their union, who became insane immediately after her marriage.

Children are generally exempted from this calamitous visitation; yet Frank relates the case of a child at St. Luke's who had been deranged since he was two years old. Age, to a certain extent, seems to influence insanity, and most individuals are alienated between their twentieth and fiftieth years. Haslam states, that out of one thousand six hundred and sixty-four patients admitted into Bedlam, nine hundred and ten came within this period of life. In France it appears that most cases of insanity are noticed between the ages of twenty-five and thirty-five. One-fifteenth of these cases among men, and one-sixth among women, are observed before their twentieth year; and in the wealthy cla.s.ses of society one-fourth occur before the same period. The following table from Bicetre regarding age is not without interest.

Years. Aged 15 20 30 40 50 60 Total.

------------------------------------------- 1784 ... 5 33 31 24 11 6 110 1785 ... 4 29 49 25 14 3 124 1786 ... 4 31 40 32 15 5 127 1787 ... 12 39 41 26 17 7 142 1788 ... 9 43 53 21 18 7 151 1789 ... 6 38 39 33 14 2 132 1790 ... 6 28 34 19 9 7 103 1791 ... 9 26 32 16 7 3 93 1792 ... 6 26 33 18 12 3 98 1793 ... 4 36 28 22 13 10 113 ---------------------------- Total 65 329 380 236 130 53 1193

Thus it would appear that the astounding events which took place in France, but more especially in Paris, from the year 1789, the breaking out of the revolution, to 1793, the reign of terror, had no effect upon the intellects of the population; unless it is supposed that the entire nation being in a state of insanity, either madmen were not noticed as any peculiarity, or rushed into mischief and were murdered. This observation as to the influence of public events is confirmed by the following statement of admissions in the Salpetriere during the comparatively tranquil years of 1811, 1812, 1813, and 1814, although many cases of insanity were said to have arisen from the harsh laws of the conscription.

Years. Aged 20 25 30 35 40 50 60 70 80 Total.

------------------------------------------------------ 1811 ... 34 37 38 27 48 38 24 12 4 262 1812 ... 52 34 33 18 38 57 26 19 3 280 1813 ... 43 29 33 41 32 57 31 13 6 285 1814 ... 42 35 38 31 26 53 34 22 10 291 ---------------------------------------- Total 171 135 142 117 144 205 115 66 23 1118

Therefore one might fairly conclude that the taking of the Bastille, the execution of Louis XVI., the b.l.o.o.d.y sway of the Jacobins, the ambitious wars of Napoleon, and the restoration of Louis XVIII., did not in the slightest degree affect the brains of our happy and philosophical neighbours.

It has been generally imagined that women are more subject to mental alienation than men; this, however, is by no means proved by observation in other countries, as will appear by the following calculation:

Men. Women.

1756 Ma.r.s.eilles 50 49 1786 Paris 500 509 1786-1794 Bedlam 4992 882 1807 St. Luke's 110 153 1802 Paris 1 to 2 ---- Berlin 1 to 2 ---- Vienna 117 94 ---- Pennsylvania 2 to 1 1807-1812 Various Madhouses in France 488 700 1802-1814 Mr. Esquirol's establishment 191 144 ---- ---- Total 6452 6536

In the Lunatic Asylum of Hanwell I have now under my care 265 males, and 351 females.

It has long been a current opinion that madness is a more common disease in our country than any where else. This may possibly arise from the greater number of our eccentric countrymen that are widely scattered over the globe; and whenever an individual is observed whose manners and conduct are totally at variance with the habits of any other member of the community, he is generally considered an Englishman. Voltaire came to the sweeping conclusion that one half of the nation was scrofulous, and the other moiety insane.

However, it would appear that insanity is on the increase; for in the report of the commissioners for licensing lunatic establishments we find the following statement: "Insanity appears to have been _considerably_ on the increase; for if we compare the sums of two distant l.u.s.tra, the one beginning with 1775, and the other ending with 1809, the proportion of patients returned as having been received into lunatic asylums during the latter period, is to that of the former nearly as one hundred and twenty-nine to one hundred." Dr. Burrows has endeavoured to impugn the correctness of this statement by proving that suicide is more frequent in other countries; now, unless Dr. Burrows can prove that suicide is always an act of insanity, which will by no means be admitted, his observation can bear no weight.

It is but too true that in melancholy madness we often observe a prevailing propensity to self-destruction. Dr. Abercrombie's views on this subject are so luminous that I shall transcribe them.

"When the melancholic hallucination has fully taken possession of the mind, it becomes the sole object of attention, without the power of varying the impression, or of directing the thoughts to any facts or considerations calculated to remove or palliate it. The evil seems overwhelming and irremediable, admitting neither of palliation, consolation, nor hope. For the process of mind calculated to diminish such an impression, or even to produce a hope of the palliation of the evil, is precisely that exercise of mind which in this singular condition, is lost or suspended; namely, a power of changing the subject of thought, of transferring the attention to other facts and considerations, and of comparing the mental impression with these, and with the actual state of external things. Under such a conviction of overwhelming and hopeless misery, the feeling naturally arises of life being a burden, and this is succeeded by a determination to quit it. When such an a.s.sociation has once been formed, it also fixes itself upon the mind, and fails to be corrected by those considerations which ought to remove it. That it is in this manner the impression arises, and not from any process a.n.a.logous to the determination of a sound mind, appears, among other circ.u.mstances, from the singular manner in which it is often dissipated, namely by the accidental productions of some new impression not calculated in any degree to influence the subject of thought, but simply to give a momentary direction of the mind to some other feeling. Thus a man mentioned by Pinel had left his house in the night, with the determined resolution of drowning himself, when he was attacked by robbers. He did his best to escape from them, and having done so, returned home, the resolution of suicide being entirely dissipated. A woman mentioned, I believe by Dr.

Burrows, had her resolution changed in the same manner, by something falling on her head, after she had gone out for a similar purpose.

"A very irregular modification occurs in some of these cases. With the earnest desire of death, there is combined an impression of the criminality of suicide; but this instead of correcting the hallucination, only leads to another and most extraordinary mode of effecting the purpose; namely by committing murder, and so dying by the hand of justice.

Several instances are on record in which this remarkable mental process was distinctly traced and acknowledged; and in which there was no mixture of malice against the individuals who were murdered. On the contrary, these were generally children; and in one of the cases, the maniac distinctly avowed his resolution to commit murder, with the view of dying by a sentence of law; and at the same time his determination that his victim should be a child, as he should thus avoid the additional guilt of sending a person out of the world in a state of unrepented sin. The mental process in such a case presents a most interesting subject of reflection.

It appears to be purely a process of a.s.sociation, without the power of reasoning. I should suppose that there had been at a former period, during a comparatively healthy state of the mental faculties, a repeated contemplation of suicide which had been always checked by an immediate contemplation of its dreadful criminality.

In this manner a strong connexion had been formed, which when the idea of suicide afterwards came into the mind, during the state of insanity, led to the impression of its heinousness, not by a process of reasoning, but by simple a.s.sociation. The subsequent steps are the distorted reasonings of insanity, mixed with some previous impression of the safe condition of children dying in infancy. This explanation I think is strongly countenanced by the consideration that, had the idea of the criminality of suicide been in any degree a process of reasoning, a corresponding conviction of the guilt of murder must have followed it. I find, however, one case which is at variance with this hypothesis. The reasoning of that unfortunate individual was, that if he committed murder, and died by the hand of justice, there would be time for his making his peace with the almighty between the crime and his execution, which would not be the case if he should die by suicide. This was a species of reasoning but it was purely the reasoning of insanity."

Still these remarks do not go to prove that suicide is always the result of insanity, since it can in most instances be attributed to a moment of despair and impatience under a heavy visitation of calamity, or the dread of contempt of society. The frequency of this rash act, cannot therefore be adduced as a proof of the greater prevalence of madness in any country.

With greater reason, self-destruction is to be referred to the want of a proper religious education and feeling, which will enable man to bear up against the world's vicissitudes, and deem life a more or less painful journey to a peaceful abode.

Montesquieu was one of the many writers who attributed this propensity as being nearly exclusive to the English. "Les Anglais," he says, "se tuent sans qu'on puisse imaginer aucune raison qui les y determine; ils se tuent dans le sens meme du bonheur. Cette action, chez les Romains etait l'effet de l'education, elle tenait a leur maniere de penser et a leurs coutumes; dans les Anglais c'est l'effet d'une maladie, elle tient a l'etat physique de la machine."

Two very curious works on suicide have been lately published in Germany by Dr. Arntzenius and Dr. Schlegel. The former writer divides this fatal propensity into acute and chronic; the first marked by great physical excitement, the latter accompanied or preceded by sadness, moroseness, and love of solitude. Curious cases are related in ill.u.s.tration of this doctrine, amongst others we remark that of an English n.o.bleman who cast himself into the crater of Vesuvius. A German in the same year, not being able perhaps to travel so far, threw himself into a smelting furnace.

Several cases are recorded of individuals who formed the desperate resolution of starving themselves. It appears that in many instances the most trifling circ.u.mstance has driven these reckless beings to the commission of this desperate action. The case of a young Parisian author of the name of Escoupe, who suffocated himself because one of his dramatic productions had been severely criticised, is well known. A German student destroyed himself because he had a club-foot, and another youth put an end to his existence in consequence of his not having been allowed to put on his Sunday clothes. Dr. Schlegel has given a curious table of the means of destruction resorted to according to the several ages of individuals, and we give the following abstract:

By pistol. By hanging.

Between 10 and 20 years of age. 61 68 " 20-30 " 283 51 " 30-40 " 182 94 " 40-50 " 150 188 " 50-60 " 161 256 " 60-70 " 126 235 " 70-80 " 35 108 " 80-90 " 2 ---- ---- 1000 1000

In cla.s.sing 9000 cases of suicide which happened in Paris between the years 1796 and 1830, Dr. Schlegel concludes that what he terms the "philosophic suicide," is that which is perpetrated after deliberation, during the night or shortly before sunrise; whilst when it is not the result of premeditation, it occurs during the day.

The choice between shooting and hanging may be accounted for on the same grounds. A young man, in a fit of frantic pa.s.sion, from disappointed love, or losses at play, will probably, on his return home, seize a pistol and blow out his brains; whereas hanging needs reflection and some preparation and precaution, which would alone suffice to bring a reflective creature to a proper sense of his folly, unless predetermined to destroy himself by "philosophic suicide."

It appears in these accounts that suicide in France has greatly increased since the revolution. The average number during the last forty-two years being 409-5/6, the number in Paris being 1639 annually. Dr. Schlegel informs us that there exists a society in Paris called, "Society of the Friends of Suicide." It consists of twelve members, and a lot is cast annually to decide which of them is to destroy himself in the presence of the others. Certain qualifications and testimonials were required before a candidate could be admitted into this amiable club:

1. He must prove himself a man of honour.

2. He must have experienced the injustice of mankind, been injured by a dear friend, or betrayed by a mistress or a wife.

3. He must have experienced, for some considerable time, a miserable vacuity of soul, and a discontent with every thing in the world.

This a.s.sociation reminds me of a ball that was established in Paris after the reign of terror, called _Le Bal des Victimes_, to which no person could be admitted unless they had had a near relation guillotined.

Dr. Schlegel has also given the following statistical table of the proportion of suicides to various populations--both as regarding counties and princ.i.p.al cities:

_Countries._ _Proportion of suicides to population._

Sweden 1 in 92,375 The Milanais 1 ... 72,570 Russia, 1819-1820 1 ... 36,860 ---- 1824-1827 1 ... 34,246 Prussia 1 ... 14,224 Saxony 1 ... 8,446 St. Petersburg 1 ... 416 London, 18th century 1 ... 10,572 ---- 19th century 1 ... 21,491 Paris 1 ... 2,215 Geneva 1 ... 3,714 Berlin, 1788-1797 1 ... 23,066 ---- 1798-1807 1 ... 12,917 ---- 1813-1822 1 ... 3,312 Hamburg 1 ... 4,800 Leipzig 1 ... 3,143 Milan 1 ... 1,821 Naples 1 ... 27,230 New York 1 ... 9,474 Baltimore 1 ... 15,696 Philadelphia 1 ... 20,000