Finch, Salisbury; William Lascelles Norris, Stourbridge; James White, Chester; Henry Nicholson Settle, Leeds; Thomas Armstrong Cammack, Spalding. Admitted Thursday, April 1st:-George Burton Payne, Birmingham; Henry Vevers; Thomas Balle Forster, Plymouth; John Lane Cutcliffe, South Molton; George Augustus Hartelbury Hepworth, Tewkesbury; James Tarzewell, Dorchester, Dorset; George Herring, Yarmouth; John Ingman, Trenddyn, Flintshire; William Nowell, Dewsbury; John Jessup Sewell, Fendrayton, Cambridge. OBITUARY. Died, March 30th, at St. Albans, aged 53, John Coales, Esq., Surgeon, one of the Magistrates of that borough. April 11th, at Bishop's Stortford, J. J. Cribb, Esq., Surgeon, late of Cambridge. BOOKS RECEIVED. A Treatise on the Human Ear, with New Views on the Physiology of the Tympanum. By J. W. Moses, M.D., M.R.C.S., &c. St. Asaph. 1847. 8vo., pp. 18. An Essay, Literary and Practical, on Inversio Uteri. By John Green Crosse, M.D., FR.S.. F.R.C.S., Senior Surgeon to the Norfolk and Norwich Hospital, &c. &c. Part II. London: Churchill. 1847. 8vo., plates. Practical Remarks on the Inhalation of the Vapour M.D. London: Churchill. 1847. 8vo., pp. 68. of Sulphuric Æther, &c. By W. Philpot Brookes, Our present Gaol System deeply depraving to the Prisoner, and a Positive Evil to the Community. Some Remedies proposed. By Joseph Adshead, Author of "Prisons and Prisoners," &c. 1847. 8vo., pp. 107. METEOROLOGICAL JOURNALS FOR FEBRUARY, 1847. Kept at Sidmouth, by W. H. CULLEN, M.D.; at Honiton, by JAMES CAMPBELD, M.D.; at Romsey, Hants, by FRANCIS BUCKELL, Esq., Surgeon. Communications have been received from Dr. Cullen; a Member of the Association; the Sheffield Medical Society; Mr. C. Hawkins; Mr. J. F. Clark; Dr. Radford; Dr. Holbrook; Dr. Chambers; Mr. G. King; Mr. H. Sharp; Dr. J. Campbell; Mr. Worthington; Mr. Storrs; Mr. H. Stead. Vaccine Matter. Mr. P. Fernie, of Kimbolton, Hunts, will feel greatly obliged by any of the readers of the Provincial Medical and Surgical Journal supplying him with a small quantity of active vaccine virus. PROVINCIAL MEDICAL & SURGICAL JOURNAL. I commence this paper by acknowledging my obligations to M. José, Membre de l'Institut Historique de Paris, for his able memoir on the "History of Insanity," and for the opportunity thus given me of freely translating a great part of it for the benefit of the English reader. I have, in addition, endeavoured to carry out some views upon the nature and treatment of this singular disease, which, though they may advance no novelty, may merit some attention, as being the result of much experience,-may conduce to calm observation and calmer conclusions,—and may divest the subject of much metaphysical subtlety, in which it has pleased many writers to involve it. History is an inexhaustible mine, from which science, art, literature, language, politics, can be enriched; and at no period has it been more searched into than at present. The old historians are examined, translated, commented upon in various ways, and perhaps no science has drawn more from this source than that of medicine. Be that as it may, there seems in this wide field a place not equally cultivated; or, to drop all metaphor, it appears to me, that from tracing the periodic history of insanity, some more complete intelligence as to its forms, its mode of treatment, and its cure, is yet to be obtained. The following paper is merely an attempt at an object which is surely desirable, though I must readily grant that much more time, and much more information, than my leisure or my abilities can supply, are requisite for its fulfilment : If insanity is more prevalent now than at any former time, (a position which may be doubted,) it is not so with its causes, which, with the exception of a few, always arising from some dominant action of the period, and connected with the events proceeding from it, are the same to day as formerly. In all times, and under all climates, hereditary constitution, habitual drunkenness, disappointed ambition, wounded feelings, unbridled passions, political even moral antagonism, have been the most ordinary causes of mental diseases. No. 9, May 5, 1847, History affords us, from the Pythoness of Delphi, down to the hallucinated of the Thebaid, and the possessed of the middle ages, the means of classing those cases which have been the subject of many a drama, many an episode, many a romantic tale ;* and philosophy can now teach us, that in contemplating such pictures, at once so sad yet so animated, that we there find a perfect reflexion of human nature. It is the picture of humanity, with its passions, its revolutions, its errors, its prejudices, its systems, crimes, and virtues,-a picture so exact, that it is shewn to us without disguise; in it are seen emperors and kings, ministers and courtiers, poets, painters, warriors, legislators, martyrs to chastity, and the victims of incontinence. From Nebuchadnezzar to Saul, from the Greek dramatists, through the history of many of the Roman emperors, let alone that of the early period and of the commonwealth of Rome, down to the times of Rousseau and our own incendiary, Martin, there are not wanting opportunities of writing it fully and entirely. MENTAL ALIENATION. It can be established, that the therapeutics of mental disease have been in all times conformable to its etiology, or in other words, that the treatment has always been in relation to the assigned cause of the malady. Thus history shews us mental alienation considered as a disease, sacred-sent especially by the Almighty, and so more particularly held in superstitious favour, as among the Pythonesses; or otherwise, as a chastisement from the Divinity, and then its treatment submitted entirely to religious ordinances. The alienated, considered as victims of the anger of the Gods, would necessarily be delivered over to the ministers of their altars, to obtain any relief from their misery. This relief was rarely implored in vain, and not unfrequently the cure was the reward of the ardent faith of the sufferer, let alone the pomp with which the preparatory ceremonies were performed, and the numberless forms to which the patients were subjected before their admission into the sanctuary. If to these be added the rigorous fast during many Particularly the madness of Ajax, who, among other vagaries, flogged unmercifully a great ram, whom he took for his rival Ulysses. Vide also the madness of Orestes. I days, the saner faculties worked upon by all the modes that superstition knows how to employ,—the imagination excited by miraculons details,—by the distractions of the voyage, by the hope of relief from the unknown agent, can it be doubted or wondered at, that frequently some great cure or sensible re-action would take place? Nevertheless, mental alienation, better studied in its symptoms, in its causes, and in its effects, was deprived by the Pythogoreans of its divine prestige, and reduced to a simple cause, depending upon some affections of the liver-of the spleen-of the stomach of the brain; then emetics and purgatives became the most usual therapeutical agents, perhaps entirely the whole means. Hellebore, with its mythological reputation, derived from those ages, has descended even into our own; but alas! in our hands it has not produced the miraculous effects that it performed under the adininistration of Melampus. This physician was an inhabitant of Argos, and in his time did many remarkable things, also performing wonderful cures. Herodotus relates his history; he is also mentioned by Homer, in his " Odyssey." Hippocrates gave the last blow to this divine therapeutic, which the blind zeal of paganism had received; while adopting the ideas of Anaxagoras and Clayomenus, he extended the means of treating insanity according to the etiology he had established. He asserted and proved the beneficial influence upon this disease of other derivatives; also how effectual in the cure were gymnastics, variety of occupation, change of climate, &c.; and hellebore, long considered as a miraculous remedy, was now only proposed to be administered as the most efficient purgative. The impulse being thus given, other observations were presently obtained. Erasistratus was the first to refer maniacal affections to lesions of the nervous centre, and from thence deduced his celebrated cure of Antiochus Soter, who was maddened by his love for his mother-in-law, Phila. part, on the ground floor, and away from noise, furnished with a bed firmly fixed, and so placed that the patient cannot perceive who enters or goes out. If the excitement prevents the use of the bed, the straw, which must be the next resource, should be well chosen, and conveniently arranged. All wounds and contusions should be carefully washed and dressed. The attendants should be enjoined not to permit visitors, not to exasperate by rudeness or blows, at the same time not using too much condescendence, but letting the maniac see that his faults are known, and that it will be to his advantage to amend them. If an ascendancy be obtained, care should be taken not to compromise it by too frequent visits; the state of the pulse will indicate if bleeding be useful; occasionally it may be necessary to employ restraint, and this should be done with great caution, with as little force as possible; the ligatures should also be made of some soft and pliable substance, otherwise the paroxysm of fury is increased instead of being abated." Then follows the advice concerning aliment, the evacuations, the indications, where it may be considered necessary to shave the head, to apply cupping glasses, leeches, and revulsives of various kinds. Cælies being much averse to the use of opium, yet anxious to relieve the "insomnium," which he considers of high importance in the case, recommends a hammock, the monotonous and gentle noise of water falling from a height, the application of warm sponges to the eylids. As occasion serves, recourse should be had to walking, singing, reading, conversation, even the theatre; each patient should be treated in this way according to his accustomed condition of life, and should be induced to feel an interest in his former employments and occupations; every opportunity should be seized of preventing weariness, or the patient relapsing into the thoughts and modes of feeling which may well be called the atmosphere of his malady. In conclusion, Cælius animadverts strongly upon those theoretical practitioners, some who prescribe a complete imprisonment, others total abstinence, others bodily inflictions of punishments, others active refrigerants, others even drunkenness, others music, without discriminating the cases they had to deal with. He was well aware that madness is often the consequence of the abuse of fermented liquors; that music, where it might calm Aretæus, after him, occupied himself less with one in ten, would excite the others. So also be the treatment than the causes of insanity, preparing attacked those practitioners who recommended love as the way for Cælius Aurelianus,† whose superiority of a means of cure. Is it not absurd to suppose, he says, knowledge can only be appreciated by presenting a that love, itself a passion, can ever be the means for rapid exposition of the precepts he has left. Thus: promoting a cure of an excitment still more violent. "The apartment of the patient should be of moderate In truth we are obliged to confess, what all welltemperature, lighted by a window from the upper instructed men must feel, that the ancients have stated what we repeat as new, and that very frequently, we are only very poor plagiarists, Celsus, who flourished under Tiberius, excelled in his moral treatment (as it is generally called,) of insanity, and has left rules admirably adapted, even for the present time. It is curious, however, that he strongly recommended the modes of severity which for so long a period have cast such a blot upon humanity in the treatment of this affliction. - Aretæus, the Cappadocian, supposed to have flourished in the time of Vespasian. + Supposed to have flourished in the second century, and said to be a Numidian, Be this as it may, this doctrine of Cælius Aurelianus, HISTORY AND TREATMENT OF INSANITY. stamped as it is with the marks that distinguish the true observer, concludes all that we possess from ancient history, on the treatment of mental alienation. The way opened by the genius of the physician of Sicca was never followed by his successors, and for fourteen centuries, the therapeutics of insanity retrograded, so as to equal, if not to surpass, in absurd and barbarous practices, in superstitious prejudices, those of the earliest days of ignorance. Human reason then appeared to soar, only to fall with more violence, like Montaigne's drunken man, who, being set straight on one side, tumbled down on the other. 227 judged to be cured; and then, a miracle! a miracle! was shouted out; so great indeed was the uproar, that it was impossible to hear the voice of the preacher. As for those whose violent paroxysms rendered them dangerous, they were placed in the public establishments, and Reil thus draws a picture of their mode of treatment:-"These miserable beings, as if they were prisoners of state, are thrown into the lowest dungeons, where the eye of humanity never penetrates; they are left there under the weight of chains which injure their limbs, and amid the stench of their own ordure. Their appearance is pale and fleshless. They are shown as a sight for public curiosity, and greedy attendants expose them as they would wild beasts. They are crowded together peli mell; fear is the only discipline employed,-whips, chains, the only means of persuasion, until the time comes when nature ends their miseries." This picture of the treatment of the insane in Germany, applies with a fearful reality to that pursued at the same period in Great Britain, France, Italy, and indeed the whole of Europe. As to the physicians, we find them during this long period of many ages, forgetful of the admirable lessons of Celsus, Aretæus, and Cælius Aurelianus, involving themselves in the ridicu In the mean while Christianity, in working an entire change in religious belief, altered also very much the frame of human opinions. Eastern imagination vehemently exaggerated the severity of the Christian doctrines. It was soon assumed that man was in a constant strife with the genius of evil, personified in the devil, who from that moment was considered the cause of all the evil both of the intellectual and the moral world ;-to him alone was attributed all the different forms of insanity, except those of imbecility and idiotcy, which by a strange confusion of ideas were considered a sort of angelic state and an object of worship. The cause of the disease being thus simplified, the treatment became equally so;—the mad-lous doctrines of the humoral pathology, concerning man was possessed, and it became necessary to deliver him from the demon. The physician here had nothing to do, the patient entered a religious house, and exorcisms became the only means employed. The Jews seem to have received some additional notions concerning evil spirits and their operations from the Chaldeans, and after their return from the captivity, to have ascribed many diseases and disorders to these invisible agents, besides those which were to be accounted for by natural causes. In this the early Christians followed them, and it is probable that mad, melancholy, and epileptic people were accounted to be possessed, at least for the most part, in the early centuries. black bile and phlegm. Some, however, less the slaves of received prejudices, employed a treatment based upon observation and experience. Alexander of Tralles, Marcellus of Sida, Forestus, Sylvaticus, Sylvius, Professor of Medicine at Leyden, Plater, Sydenham, Sennert, Highmore, Willis, Baglivi, Valsalva, and his disciple Morgagni, have left some useful precepts, but which have had no particular influence upon the progress of the curative treatment of insanity. At length, in 1792, Pinel appeared. By his persuasion, eighty violent madmen, the terror of their keepers, and reported incurable and dangerous, were freed from their chains, and placed under a mode of treatment, which produced a cure in several of them. Thus was the first blow struck; the mental therapeutics established 1500 years ago by Cælius Aurelianus once more triumphed; bad treatment, corporal violence, was for ever laid aside. From that period psychological medi Every form of alienation was considered as so many methods adopted by the demon to manifest his presence in the body of the patient; hence, also, were multiplied all the evils of a disturbed imagination. Compacts were made with the devil,-sorcery-charms-amulets-cine, varying its resources according to the forms of wolfmen,-all gave a variety to the forms of insanity. All persons labouring under hallucinations were burnt, hung, or suffocated, without pity. All those thought possessed were exorcised. Various places were celebrated for the cure of insanity through the relics of Saints. The pilgrimage to St. Maur, near Paris, was the most celebrated, and continued so, down to 1735. The Abbe Leboeuf tells us that during the four hours which the matins occupied, the patients crowded in the church, cried out with all their might, "St. Maur send me fcure and health," and when any one had repeated three times following this prayer, he was the disease, restores to themselves, to their families, and their country, one half of those placed under care. These suggestions were soon listened to in this country, and great effects were made to modify the abuses then so called, and to improve the condition of patients, as well as to establish better principles of treatment. We all know how the Society of Friends came forward for such purposes, but the only remark I will make here is that it was not a love of cruelty that institgated the mal-practices, but erroneous and ignorant impressions. I think an historical sketch of the almost infiaite varieties of mental alienation is thus worked out, which not only proves its connection with the events of history, but also the impossibility of establishing one particular mode of treatment for all cases; it seems as if four periods could be distinctly marked, the first, where the disease was presumed to be sent from Heaven, either as a gift or a punishment, in the latter case alone a cure was solicited by the ministers of the religion; the second, where the malady is referred to a morbid state of some one organ, or of several organs, and then treated by evacuants; the third, where it is attributed to some malevolent being, and then to be subdued by exorcisms or corporal violence; finally, the fourth, in which the etiology of the disorder, better established, perceives the more sensible opinion of the second period, frees itself from the folly and nonsense of the first and third, and so multiplies its curative resources that the general fact is now established, that at least one half of the cases of insanity admitted into public or private institutions are capable of cure. This is surely a valuable result, but there is a summation to be made. Is there any hope of perfect cure to be obtained? Is there any probability of so grievous, so afflicting a malady being extirpated? I fear not; it is a disorder which spares neither age, nor rank, nor condition, nor fortune; it seems interwoven with the institutions and affections of civilized society; those who are the sufferers are often the victims of the ingratitude, of the perfidy, of the injustice of their social relations and business in the present active community of the world. Neither must we be permitted to forget its hereditary influence, nor the immediate influence of our own passions, desires, and feelings, erroneous education, ambitious projects, mortifying results, and on the other side joyous and successful consequences. All these act with energy upon the human mind, and however mysterious the union of corporate and mental capacity may be, my long experience produces to my mind this deduction,—that there is not a faculty or propensity given for man's condition in this world that may not become deranged, or in other words diseased, like any other function. One reason of the especial horror with which mental alienation has been heretofore contemplated, may be the want of knowledge of its obvious source in the physical organization. Delirium, as a consequence of fever, is a temporary mania, and however painful its manifestations may be, there seems a cause to which the hallucination may be referred, and its departure expected with the cessation of the exciting cause; but hitherto, in mania, properly so called, there has been a readiness to put a kind of metaphysical or móral construction upon the whole series of distressing symptoms by which it is characterized. Now, however, a brighter era appears, the morbid manifestations are better understood, the nosology is reconstructed, it is observed to obey certain laws, and experience teaches the practitioner in many instances to be aware of, even to predict, the form of diseasethat will occur, and in a large proportion of recent cases, a cure is not only expected, but generally performed. Much improvement in the department of the medical treatment has taken place, the routine system of bleeding and purging, which descended from father to son, as stated in a committee of the House of Commons, has been utterly condemned; the secret remedies, the green and white powders, so long the resource of impudent empiricism, have been consigned to oblivion, and a rational practice, founded on rational views, of symptoms as they present themselves, established. If it be asked what there is that we have to treat in insanity, I grant the question is a difficult one, yet something like an answer may be attempted. Languageis not always equal fully to elucidate our ideas, or in other words, our knowledge may not be so exact as to clothe them in appropriate terms. I think this is our great difficulty here, yet I apprehend, that in the various forms of insanity, the cerebral centre is in a state of irritation. We all know how hysteria can simulate every disorder in our nosology, and how long organs may continue to be affected, even to a most suspicious degree of disorganization, yet the part be left intact, untainted, perfect in its work, when the disease has left it; and in this way I think much of the history of insanity may be written, for irritation admits of various actions being conjoined with it. There may be inflammatory action to a certain degree, congestion, local disorder of nerves, yet the irritative form of the disease may be the most important, progress, decline, call various sympathies into action, and finally, leave the patient to a happy recovery. I grant also entirely with Dr. Good, that this diseased state may be a secondary affection, dependent upon a morbid condition of the epigastric or some other abdominal organ,―for in whatever it may consist, and whatever symptoms may arise, it is not till the sensorium is by degrees associated in the chain of unhealthy action that the signs of insanity are nnequivocal; also dyspeptic and other abdominal symptoms are not unfrequently brought on by a previously diseased state of the mind, and it is hence peculiarly difficult, and perhaps, in some cases, altogether impossible, to determine, where we are not acquainted with the incipient symptoms, whether melancholy or hypochondriasis, has originated in the state of the abdominal viscera, or of the cranium. Where, however, we are made acquainted with the history of the incipient symptoms, we have a tolerable clue to guide us, and the experienced practitioner may for the most part safely decide, that the region primarily affected is that which first evinces morbid symptoms, and hence there will be as little difficulty in assigning the origin of hypochondrism to a morbid |