effectually, but in a large proportion of instances they will, by great prudence, keep clear of this great calamity. Many medical men disbelieve wholly in hereditary predisposition, while others refer to it half the evils that "flesh is heir to;" the truth in this, as in most other cases, probably lies between. The following cases, from one family, have come under my care in the course of the last twelve months. Towards the close of November, 1839, a young woman aged eighteen was brought into the Hospital in a state of complete dementia; she was not conscious where she was, nor who were around her; she would remain statue-like wherever she was placed, and neither ate nor drank, nor attended to the calls of nature, without being fed, or moved, by others; she gradually improved under efficient medical treatment, and in four months, some time in March, she returned to her friends, completely recovered. In April following, a little more than a month after this young woman left the Hospital, her mother was brought to our care, in a situation nearly like that of her daughter. Nothing could be worse than the situation of this woman. She improved slowly at first, but rapidly afterwards, and at the end of three months was restored to health and soundness of mind. She also returned to her home, and gave joy to afflicted friends in a restoration perfect and entire. She left the Hospital towards the close of July. In October, a son of the last named patient, and own brother of the first, aged twenty-two, was brought to the Hospital a furious maniac. The case was a bad one, the excitement continued long and severe : he is now improving favorably, with a fair prospect of recovery. Before there was any essential amendment in this last formidable case, another victim, from the same devoted household, came to our charge; the sister of the last named, and daughter of the one preceding, an interesting young woman of twenty-four years of age; and this was the worst case of all, for, in addition to common symptoms, was the debility and susceptibility of the puerperal state; her infant was one week old only, when the symptoms of this formidable species of mania were rapidly developed; the excitement was extreme, the mind perfectly chaotic, and jactitation so great as to require, in addition to restraint usual in such cases, the active vigilance of two experienced nurses. This patient is now convalescing, and we have reasonable ground to hope that both the brother and sister will return in less than a year from the time of the first sister's complete recovery: so that the four may be in a hospital, in the very worst circumstances, and all be well, in one year. Such cases as this are rare, although it is by no means uncommon that as many individuals of one family are successively insane. Some time in the year 1838, a young lady was taken suddenly insane, on a journey to the west; she was detained a few days in one of the institutions in the middle states. In a few weeks she was brought to our care; before there was any change in the case, a brother was also brought to the Hospital, who had been long insane, but who had then frozen his feet so badly that his friends determined to afford him better winter quarters; before the necessary arrangements were made, however, mortification commenced in the frozen feet, and by the time he reached the Hospital he was in a dying state, and did not survive his journey twenty-four hours. The sister convalesced favorably, but by this and other trials, relapsed, and was again as bad as ever. Before she became calm and tranquil again, another sister, older than herself, was brought to the Hospital; the case was violent, but the amendment rapid, and in a few weeks she was recovered, and went to her friends before the sister first committed was entirely well; the latter continued to convalesce, and was finally completely restored to sanity of mind. Before she finally left the Hospital, a messenger camé to us, post haste, to say that another brother of this afflicted woman was a furious maniac; papers were immediately prepared for his admission to the Hospital; before the messenger arrived with them this brother died in the greatest possible excitement. The sister who endured all this affliction, steadily convalesced and has since returned to her friends, quite well. The evidence of a constitutional predisposition to insanity, in such cases, is too strong to be resisted; but the strength and activity of the hereditary taint is very different in different cases, and in different individuals in the same family. All cases that have had a recurrence of insanity, once or more than once, are placed in the table as periodical: the interval between these occurrences is extremely various; from a few months to many years. Strictly, the term periodical should be applied to such cases only, as recur at regular periods. There are many such cases; but they hardly amount, as far as we have known, to ten per cent. of the number in the table. In the British Report, much is said about relapse; one third, and in some instances, one half their cases relapse. I am not able to say, what is the precise meaning which they attach to this word. From the very great number of relapses reported by some of their institutions, I have supposed that any recurrence of insanity, after one attack, was considered a relapse. In my opinion, this is a wrong view of the case. If, on a patient's return from an institution as recovered, some traces of disease are found to remain, or if, after a certain period of appearing quite well, the symptoms of insanity recur before perfect health has been established, it is, strictly speaking, a relapse. But if the period of a year, or many years, elapses before this recurrence takes place, and the individual has enjoyed a ratio al mind the whole time, and pursued his occupation, and appeared to all around him a rational being, the recurrence should not be called a relapse. The rule applicable to other diseases is applicable to insanity. No physician considers a second attack of pleurisy, rheumatism, or colic, a relapse, if months, and particularly if one or more years have elapsed between the two attacks; although the predisposition or susceptibility is much increased by this first attack, and a second will occur from a much slighter cause. In case the individual is exposed a second time to the cause of insanity, which produced the disease in the first instance, such as intemperance, disappointment in business, domestic affliction, or ill health, there would be the strongest reason to believe, that the disease was wholly of new origin, independent entirely of the previous attack. The true physiological view of the case is this: certain derangements of the brain and nervous system produce insanity of one kind or another; while these derangements continue, insanity continues with as much certainty as lameness continues from gout or rheumatism; when this derangement is removed, so that the functions of the brain and nerves are restored, then insanity disappears, as lameness disappears when the inflammation of gout or rheumatism subsides. I present these views to explain the table, and to show the rule adopted by us relative to relapses and periodicity. Since the opening of the Hospital, we have had thirteen patients who have actually attempted homicide; except in two instances, the dangerous wounds inflicted proved fatal; eleven were immediately fatal. Of these, two have died, and two have been discharged recovered-in both instances, by the high courts of the Commonwealth. It is a question of very serious import, whether an insane man, who has taken life in the excitement and from the impulse of his disease, should ever be enlarged. If he has not recovered from his insanity, the case to me is a clear one; the tendency to a recurrence of the act would be very strong, the circumstances of the case being the same. Every case of insanity has its peculiarities, the appetites, propensities, and passions are affected in different ways, in different cases. We will not stop to inquire, whether this arises from different conformation of the brain in different individuals, the fact is undeniable. One will tear his clothes and bedding, one will ornament his person, another will besmear himself with all kinds of filth; in one, benevolence will be active, in another a propensity to mischief will predominate; in a few the propensity is to kill, although such individuals may be generally harmless, yet at periods they are not so; and in many cases these impulses are so sudden that no precautions can prevent danger. Other cases, no less unsafe, are those who suppose that they are commissioned to execute the commands of Heaven by destroying a fellowbeing; their plans are devised and executed with so much art and secrecy, that no vigilance will detect the danger, the fatal stroke is struck without warning, and the hapless victim knows not the agent that has inflicted the deadly blow. All such cases should be perpetually confined; no argument should weigh for a moment with a court of justice in favor of liberating such an individual. The fact that life has been taken, should overbalance all motives to send such a person into society again while the delusions and estrangements of insanity continue. There is another case which, if not as clear, is one in which the propriety of liberation is very questionable, it is a case of insanity arising from a specific cause, liable to recur at any time when that cause is brought to operate, in which the first impulse is a desire or disposition to kill. It is extremely questionable, whether such an individual should be permitted to have liberty again; in my view all right to liberty is forfeited by such an act, unless there is the clearest evidence of entire restoration, and the strongest probability that the cause of the disease will hereafter be avoided. If the cause is a voluntary one, the case is rendered still stronger as, in general, there is a greater probability of its future influence than such as are strictly involuntary. By voluntary causes I mean intemperance, the secret vice, speculation, and all others that it is in the power of the individual to avoid. In the course of the last year, two cases of homicidal insanity were discharged from the Hospital. One was an unfortunate female, who, under the delusions of disease, supposed it her duty to destroy her children, to rid them from the suffering and degradation of living with a drunken, worthless, and abusive parent. She inflicted dreadful wounds on two lovely children, and also on a female friend who went to their rescue; fortunately, but very unexpectedly, all recovered, and she was saved the agonizing suffering which must have unavoidably been her portion, if, on recovering, she had found that her own offspring had been destroyed by her own hand. She was not conscious for a long time what she had done, but had a dreamy impression that she had assailed and wounded her children; she hoped, and half bebelieved, it was a dream. When far advanced toward recovery, a violent patient got angry with her, and called her a "murderer;" the dreadful reality flashed upon her mind and she was in an agony of suffering. I was sent for; after awhile she was quieted, and heard with composure the truth of the case; the circumstance that the children were living and well, was impressed forcibly upon her mind-had it been otherwise, had they died, I now fear that her mind would have been entirely overset by the intelligence. She recovered very favorably, and went to her friends in the care of her judicious spiritual guide, and has since lived happily in the enjoyment of her children, a most exemplary and worthy woman. The other case was a temporary violent insanity, the result of intemperance. The man was under a delusion that a voice came to him from one whom he felt bound to obey, commanding him to take an axe and destroy a neighbor, to whom he was not at all hostile, with all possible despatch. He executed the bloody deed, and was immediately arrested and placed in confinement, from whence, by order of court, he was soon transferred to the Hospital; by this time the delusion and the insanity had departed. One year after his confinement, application was made to the Supreme Court for his discharge, but the discharge was not granted; six months after, the Court of Common Pleas granted his release. He will probably be a safe man till he returns to his cups; if he should again become intemperate, neither his friends nor the community will be for a moment secure from danger. |