With most authors, this part of the subject has occupied the greatest
share of their labour and attention: they have generally descended to
minute particularities and studied discriminations. Distinctions have been
created, rather from the peculiar turn of the patients propensities and
discourse, than from any marked difference, in the varieties, and species
of the disorder: and it has been customary to ornament this part of the
work with copious citations from poetical writers. As my plan extends only
to a description of that which I have observed, I shall neither amplify,
nor embellish my volume by quotations.
In most public hospitals, the first attack of diseases is seldom to be
observed; and it might naturally be supposed, that there existed in
Bethlem, similar impediments to an accurate knowledge of madness. It is
true, that all who are admitted into it have been a greater, or less time
afflicted with the complaint; yet from the occasional relapses to which
insane persons are subject, we have frequent and sufficient opportunities
of observing the beginning, and tracing the progress of this disease.
Among the incurables, there are some who have intervals of perfect
soundness of mind; but who are subject to relapses, which would render it
improper, and even dangerous, to trust them at large in society: and with
those who are upon the curable list, a recurrence of the malady very
frequently takes place. Upon these occasions, there is ample scope for
observing the first attack of the disease.
To enumerate every symptom would be descending to useless minutiae, I shall
therefore content myself with describing the more general appearances.
They first become uneasy, are incapable of confining their attention, and
neglect any employment to which they have been accustomed; they get but
little sleep, they are loquacious, and disposed to harangue, and decide
promptly, and positively upon every subject that may be started. Soon
after, they are divested of all restraint in the declaration of their
opinions of those, with whom they are acquainted. Their friendships are
expressed with fervency and extravagance; their enmities with intolerance
and disgust. They now become impatient of contradiction, and scorn
reproof. For supposed injuries, they are inclined to quarrel, and fight
with those about them. They have all the appearance of persons inebriated,
and people unacquainted with the symptoms of approaching mania, generally
suppose them to be in a state of intoxication. At length suspicion creeps
in upon the mind, they are aware of plots which had never been contrived,
and detect motives that were never entertained. At last, the succession of
ideas is too rapid to be examined; the mind becomes crouded with thoughts,
and indiscriminately jumbles them together.
Those under the influence of the depressing passions, will exhibit a
different train of symptoms. The countenance, wears an anxious and gloomy
aspect. They retire from the company of those with whom they had formerly
associated, seclude themselves in obscure places, or lie in bed the
greatest part of their time. They next become fearful, and, when irregular
combinations of ideas have taken place, conceive a thousand fancies:
often recur to some former immoral act which they have committed, or
imagine themselves guilty of crimes which they never perpetrated; believe
that God has abandoned them, and with trembling, await his punishment.
Frequently they become desperate, and endeavour by their own hands to
terminate an existence, which appears to be an afflicting and hateful
incumbrance.
The sound mind seems to consist in a harmonized association of its
different powers, and is so constituted, that a defect, in any one,
produces irregularity, and, most commonly, derangement of the whole. The
different forms therefore under which we see this disease, might not,
perhaps, be improperly arranged according to the powers which are chiefly
affected.
I have before remarked, that the increased vigor of any mental faculty
cannot constitute intellectual disease. If the memory of a person were so
retentive, that he could re-assemble the whole of what he had heard, read,
and thought, such a man, even with a moderate understanding, would pass
through life with reputation and utility. Suppose another to possess a
judgment, so discriminating and correct, that he could ascertain
precisely, the just weight of every argument; this man would be a splendid
ornament to human society. Let the imagination of a third, create images
and scenes, which mankind should ever view with rapture and astonishment,
such a phaenomenon would bring Shakespear to our recollection.
If in a chain of ideas, a number of the links are broken, the mind cannot
possess any accurate information. When patients of this description are
asked a question, they appear as if awakened from a sound sleep; they are
searching, they know not where, for the proper materials of an answer,
and, in the painful, and fruitless efforts of recollection, generally
lose sight of the question itself.
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. To many conversations of the old incurable patients to
which I have listened, the topic has always turned upon the scenes of
early days. In many cases, where the faculties of the mind have 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, or rather
impossibility, 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 generally mis-spelt--they are written according
to the pronunciation. 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 sought solitude; consequently have acquired no new
ideas, and time has effaced the impression of those formerly stamped upon
the mind. Mr. Locke well observes, "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."
As it has been attempted to explain, how an imbecility or loss of memory
will obstruct the operation of the other powers of the mind: the next
object is to shew, how necessarily our ideas must be disarranged where the
determination on their comparison is wrong, or where the mind determines,
or judges, with little previous examination or comparison. An example or
two will illustrate this more satisfactorily than any length of
reasoning. I remember a patient who conceived, that, although dead men
told no tales, yet their feeling was very acute. This assumed principle he
extended to inferior animals, and refused to eat meat, because he could
not endure to be nourished at the expence of the cruel sufferings, which
beef steaks necessarily underwent in their cookery. Another madman, who
pretended to extraordinary skill in surgery, contrived to steal the wooden
leg of an insane patient, and laid upon it for a considerable time, with a
firm belief of hatching it into a limb of flesh and blood.
If a man shall form such ideas, and conceive them to be true, either from
a defect in the power of his judgment, or without any comparison or
examination shall infer them to be so, such defect will afford a
sufficient source of derangement.
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 passed so rapidly away.
Others speak of their disorder as accompanied with great hurry and
confusion of mind, where the succession of ideas is so rapid and
evanescent, that when they have endeavoured to arrest or contemplate any
particular thoughts, they have been carried away by the tide, which was
rolling after them.
All patients have not the same degree of memory of what has passed during
the time they were disordered: but for the most part they recollect those
ideas which were transmitted through the medium of the senses, better than
the combinations of their own minds. I have frequently remarked that,
when they were unable to give any account of the peculiar opinions which
they had indulged during a raving paroxysm of long continuance, 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 recumbent 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, they 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 assured me, that these actions afforded them
considerable relief. We often surprize persons who are free from
intellectual disease in many strange and ridiculous movements,
particularly if their minds be intently occupied:--this does not appear to
be the effect of habit, but of a particular state of mind.
Madmen do not always continue in the same furious or depressed states: the
maniacal paroxysm abates of its violence, and some beams of hope
occasionally cheer the despondency of the melancholick patients. We have
some unfortunate persons who are obliged to be secured the greatest part
of their time, but who now and then become calm, and to a certain degree
rational: upon such occasions, they are allowed a greater range, and are
permitted to associate with the others. In some instances, the degree of
rationality is more considerable; they conduct themselves with propriety,
and in a short conversation will appear sensible and coherent. Such
remission, has been generally termed a _lucid interval_.
When medical men are called upon to attend a commission of lunacy, they
are always asked, whether the patient has had a _lucid interval_? A term
of such latitude as _interval_ requires to be explained in the most
perspicuous and accurate manner. In common language it is made to signify,
both a moment and a number of years, consequently it does not comprize
any stated time. The term _lucid interval_ is therefore relative. I should
define a _lucid interval_ to be _a complete recovery of the patient's
intellects, ascertained by repeated examinations of his conversation, and
by constant observation of his conduct, for a time sufficient to enable
the superintendant to form a correct judgment_. Unthinking people are
frequently led to conclude that, if during a conversation of a few
minutes, a person under confinement shall betray nothing absurd or
incorrect, he is well, and often remonstrate on the injustice of secluding
him from the world. Even in common society, there are many persons whom we
never suspect from a few trifling topics of discourse to be shallow
minded; but, if we start a subject, and wish to discuss it through all
it's ramifications and dependances we find them incapable of pursuing a
connected chain of reasoning. In the same manner, insane people will
often, for a short time, conduct themselves, both in conversation and
behaviour, with such propriety, that they appear to have the just exercise
and direction of their faculties; but let the examiner protract the
discourse, until the favourite subject shall have got afloat in the
madman's brain, and he will be convinced of the hastiness of his decision.
To those unaccustomed to insane people, a few coherent sentences, or
rational answers would indicate a lucid interval, because they discover no
madness; but he who is in possession of the peculiar turn of the patient's
thoughts, might lead him to disclose them, or by a continuance of the
conversation they would spontaneously break forth. A beautiful
illustration of this is contained in the Rasselas of Dr. Johnson: where
the astronomer is admired as a person of sound intellect and great
acquirements by Imlac, who is himself a philosopher, and a man of the
world. His intercourse with the astronomer is frequent; and he always
finds in his society information and delight. At length he receives Imlac
into the most unbounded confidence, and imparts to him the momentous
secret. "Hear Imlac what thou wilt not without difficulty credit. I have
possessed for five years the regulation of weather, and the distribution
of the seasons. The sun has listened to my dictates, and passed from
tropic to tropic by my direction. The clouds at my call have poured their
waters, and the Nile has overflowed at my command. I have restrained the
rage of the Dog-star, and mitigated the fervours of the Crab. The winds
alone of all the elemental powers have hitherto refused my authority, and
multitudes have perished by equinoctial tempests, which I found myself
unable to prohibit or restrain. I have administered this great office with
exact justice, and made to the different nations of the Earth an impartial
dividend of rain and sunshine. What must have been the misery of half the
globe, if I had limited the clouds to particular regions, or confined the
sun to either side of the equator?"
A real case came under my observation a few months ago, and which is
equally apposite to the subject. A young man had become insane from
habitual intoxication, and during the violence of his complaint had
attempted to destroy himself. Under a supposed imputation of having
unnatural dispositions he had amputated his penis, with a view of
precluding any future insinuations of that nature. For many months after
he was admitted into the hospital, he continued in a state which obliged
him to be strictly confined, as he constantly meditated his own
destruction. On a sudden he became apparently well, was highly sensible of
the delusion under which he had laboured, and conversed as any other
person upon the ordinary topics of discourse. There was, however,
something in the reserve of his manner, and peculiarity of his look, which
persuaded me that he was not well, although no incoherence of ideas could
be detected in his conversation. I had observed him for some days to walk
rather lame, and once or twice had noticed him sitting with his shoes off,
rubbing his feet. On enquiring into the motives of his doing so, he
replied, that his feet were blistered, and wished that some remedy might
be applied to remove the vesications. When I requested to look at his
feet, he declined it and prevaricated, saying, that they were only tender
and uncomfortable. In a few days afterwards, he assured me they were
perfectly well. The next evening I observed him, unperceived, still
rubbing his feet, and then peremptorily insisted on examining them. They
were quite free from any disorder. He now told me with some embarrassment,
that he wished much for a confidential friend, to whom he might impart a
secret of importance. Upon assuring him that he might trust me, he said,
that the boards on which he walked, (the second story) were heated by
subterraneous fires, under the direction of invisible and malicious
agents, whose intentions, he was well convinced, were to consume him by
degrees.
From these considerations I am inclined to think, that a _lucid interval_
includes all the circumstances which I have enumerated in my definition of
it. If the person who is to examine the state of the patient's mind be
unacquainted with his peculiar opinions, he may be easily deceived,
because, wanting this information, he will have no clue to direct his
enquiries, and madmen do not always, nor immediately intrude their
incoherent notions into notice. They have sometimes such a high degree of
controul over their minds, that when they have any particular purpose to
carry, they will affect to renounce those opinions which shall have been
judged inconsistent: and it is well known that they have often dissembled
their resentment, until a favourable opportunity has occurred of
gratifying their revenge.
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 means of 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
265 who were examined, 205 were of a swarthy complection, with dark, or
black hair; the remaining 60 were of a fair skin, and light, brown, or red
haired. What connection this proportion may have with the complection and
colour of the hair of the people of this country in general, and what
alterations may have been produced by age or 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 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.
Having thus given a general account of the symptoms which I have observed
to occur most commonly in persons affected with madness, I shall now lay
before my readers a history of all the appearances which I have noticed on
opening the heads of several maniacs, who have died in Bethlem Hospital.