corporeal, affecting the mind through the medium of the stomach.

"A young lady, after eating some heavy paste, had been attacked with a sensation of burning heat at the pit of the stomach, which increased till the whole of the upper part of the body, both externally and internally, appeared to her to be all in flames. She rose up suddenly, left the dinner table, and ran out into the street, where she was immediately brought back. She soon came to herself, and thus described her horrible ideas, that she had been very wicked, and was dragged into the flames of hell. She continued in a precarious situation for some time. Whenever she experienced the burning sensation, of which she first complained, the same dreadful thoughts recurred to her mind. She seized hold of whatever was nearest, to prevent her from being forced away, and such was her alarm, that she dreaded to be alone. This lady had been long distressed by family concerns, and harassed by restless and disturbed nights, which had greatly injured her health."-Willis, p. 129.

Dr. Burrows appears to us to be quite correct in referring to disordered liver and gastric irritation as frequent causes of mental derangement, in consequence of their influence on the nervous system. He has known three instances in which violent nausea from seasickness produced mania, and long continued nausea, he says, is a frequent precursor of a paroxysm of insanity. It seems to depend upon this, that derangement of the mind is so frequently induced, or at least developed, by drunkenness, which is certain to injure the stomach and liver. Accordingly we find that Dr. J. Cheyne reports the extraordinary prevalence of disordered livers anong the lunatics who died and were dissected in the Dublin hospitals, where drunkenness is presumed to be a frequent cause of insanity; and out of 2,507 lunatics admitted into the French hospitals, 185 were insane from drunkenness; of whom 126 were men, and 59 women.* Dr. Halloran also, the physician to the Asylum at Cork, tells that out of 1,370 lunatics, he found 160 cases originating in inebriation.

We have been greatly pleased with the manner in which Dr. Burrows has treated the causes of insanity. Not being a theorist, as we have already hinted, he is not influenced by system to suppress, exaggerate, or pervert facts, in order to support his opinions. He is not influenced by the authorities of Cullen, Crichton, Good, Francis, Willis, &c., to believe that insanity depends on a specific diseased action of those fine vessels that secrete the nervous fluid of the brain; nor of Bordeu, Barthez, Portal, Dumas, Cabanis, Pinel, Foderé, Leroy, Noest, Avenbrugger, &c., who refer to the abdomen as the seat of mania; of Bayle, Calmiel, Voisin, Falret, &c., who ascribe the symptoms to organic morbidity in the brain or its membranes; or of Winslow, Bichât, Sömmering, Cuvier, Magendie, &c., who explain the phenomena by the sympathetic affinities of the ganglionic nerves. Dr. Burrows is a disciple of none of those systems in particular, but judiciously selects from each

"From these dissections it follows:-1. That lesions of the brain, the organ of the intellectual functions, are in the proportion of one to two of those of the other viscera; 2. That more than one in five corpses of maniacs present no evidence of any disease whatever! 3. That in a great majority of cases, the insanity was a sympathetic affection; and, 4. That as, in more than a fifth of 259 dissections, no lesion or alteration could be detected, it strongly corroborates the pinion, that, when such lesions or alterations are observed, they are posterior, and not anterior, to the development of mental derangement.

"These are very important pathological corollaries, and being deduced from a collection of dissections by anatomists of high character, their accuracy ought not to be suspected.”— Burrows, p. 75.

With respect to morbid appearances on dissection, however, we venture to remark, that when we can tell what constitutes the difference between the brain of a peasant, whose ideas extend little further than his wagon, his flock, or his hut, and that of a Bacon, a Mil ton, or a Newton, where so many fine ideas were arranged,-we may then, perhaps, discover the proximate cause of mania. It cannot be exactly known from inspecting the brains of maniacal patients after death, but there are strong presumptions that some disorder of the brain, structural or functional, has existed. For organic lesions are much more frequent in their brains than in the brains of other patients, and in the many cases where nothing can be detected to account for the maniacal symptoms, we have a right to suppose the cause to be in that organ whose texture and mode of action are least known. We are strongly borne out in this opinion by analogy, in the instance, for example, of gutta serena, or amaurosis, in which no appearance can be detected in the eyes, upon dissection, to account for the complete blindness which

characterized the disease.

daughters banished; and if any female affected by such disease became pregnant, she was buried alive!

In families in which insanity has once oc

"A young lady of good family and fortune, was placed under my care, in whom mental derangement had been some time developed, till at length she was too violent to be at home. I made the usual inquiry into the probable causes of the malady, and whether hereditary predisposition might be suspected. This was positively denied, but it was suggested, that being very fond of hunting, she had several times experienced severe falls from her horse, and might have injured her head. Upon exanining the cranium, I actually found a very singular depression of a part of the skull, but whether it was natural or accidental, no one could inform me. I stated to my patient's friends my suspicion that this depression might, operate mechanically as a cause of the insanity; and with their consent, an eminent surgeon was consulted upon the propriety of applying the trephine, with a view of removing such cause. Before any decision upon this question, I learnt from another quarter, that several of this young lady's nearest relations had been insane, and that two died in that state. The operation was, therefore, declined, and she recovered. I believe few cases can occur where the inducements to a candid avowal of hereditary predisposition to insanity, were more powerful, yet they were not of sufficient force to elicit the truth. This perverse concealment has often a very baneful effect."-Burrows, p. 103.

We perceive that Dr. Knight denies the fact of insanity being transmitted, when accidentally produced, in persons whose predecessors have been free from the disorder; but the distinction we think is too refined to be useful, It is a well ascertained and remarkable fact, that hereditary insanity is most common among the highest rank of society, in consequence, it is supposed, of intermarriages being common among family relatives, and it has accordingly been found most prevalent where the system of clanship has been strictly preserved. In ancient Scottish families, for example, where such intermarriages are frequent, hereditary insanity is common. The hereditary transmission of diseases from such intermarriages was discovered in Scotland at an early period, as we are informed by Hector Boetius, in his "Cosmographe of Albion," edit. Edinb. 1541; and in order to prevent families from hereditary taint, when any Scot was affected with disease supposed to be transmissible to his progeny, his sons were emasculated and his

to be carefully watched, and if possible checked by timely measures, that the awful consequences of their becoming aggravated or con firmed may be averted. The grand panacea time, however, is but too frequently and vainly depended upon to remove the disorder; but time steals on, the malady increases, a physician is called in, and after receiving a few fees for doing nothing, he recommends a removal to a lunatic asylum,-precisely the very place where the patient ought not to be sent, for supposing the treatment the best and most humane, which can be devised-still it may be asked will the company of the melancholic cheer the mind which is dispirited, sunk, and ready to break down? Or, will the society of maniacs and the ravings of frenzy sooth and calm the mental excitement, which threatens to terminate in furious madness? The following case by Mr. W. J. bears strongly on this point.

"I have witnessed cases in which the most serious consequences have ensued, from placing patients in an incipient state of insanity in

contact with confirmed lunatics. I remember a gentleman whose disorder was an excessive state of nervous irritability; he was a tradesman in affluent circumstances, and lived in a style suitable to his means. His friends deemed it necessary that he should be removed to a lunatic asylum, and the comforts provided for him there, were far inferior to what he had been used to at home. In a very short time, the change caused an accession of excitement, so that he became troublesome, and disturbed the more peaceable patients in that part of the house in which he was lodged, and he was removed into the common ward, and placed among lunatics of all classes. Never shall I forget the dreadful state of agitation in which he continued during the whole of one day; he refused to sit down, or take any food, and stood shaking like an aspen leaf, his wild eyes wandering from patient to patient, as their ges

tures or exclamations attracted his attention.

"Was such treatment as this calculated to remove nervous irritability? Or would it not more probably have the effect of rendering the patient for ever the inmate of a madhouse?"Pract. Observ. p. 28. p.2

It may not be irrelevant, therefore, on a subject so important to many families, to give a brief summary of some of the more common indications of approaching or begun insanity. The precursory symptoms are various, as might be expected in a malady so varied in form. Headache, giddiness, throbbing of the temples, or impaired vision, have severally, or combined, ushered in a paroxysm; and frequently hypochondriacal apprehensions, arising from a disordered state of the digestive organs, have terminated in maniacal delusions. In many instances the symptoms first remarked are, a defect in the power of attention, fits of absence, frequent talking or muttering of the patient to himself, an unmeaning and fixed

stare in the eyes, a dejected countenance, and sometimes jerking motions of the body, or odd gesticulations. Together with these appearances, the mind is sometimes under the depressing influence of hurt pride, disappointed hope, or religious apprehension; perhaps it is brooding over some feeling of remorse, fear, jealousy, or chagrin, on grounds which are wholly imaginary. Love is, in some instances, the predominant impression; and it is equally singular and characteristic, that the object of this affection and the patient are sometimes unacquainted with each other. The first indication in some patients, is an extraordinary flow of high spirits, about to end, at length, in maniacal delirium; in others, extreme terror is first noticed. The countenance is pale, ghastly, and strongly expressive of the inward emotion; the speech is hurried and tremulous; and the extremities are cold, perhaps bedewed with a cold sweat. Soon, however, the eye glares malignantly, the face flushes, and assumes the expression of ferocity; the objects of terror become the objects of vengeance, and the patient is furious. In some, there is an unusual degree of suspicion or of anticipation of evils, and a belief in imaginary plots or conspiracies. In others, there is great irascibility and malignity, and some act of desperation, vengeance, or cruelty, is perhaps the first obvious symptom of the malady. From the commencement of lunacy, and especially as long as the mind continues in a state of excitement, patients generally sleep little, if at all; yet some are disposed to lie constantly in bed, and are unwilling to answer questions, or to converse with their friends or relations. In some instances the patient carefully conceals his illusions for a long time after they have taken possession of the mind. Perhaps, for the first time, he reveals them confidentially to his clergyman, or to his medical attendant. As soon, however, as maniacal illusions are betrayed, the nature of the case is manifest. Cunning is a symptom which, in many cases, manifests itself early-usually accompanies the disorder in its progress-and even continues after a partial cure may have been effected. We have met with the following two remarkable cases illustrative of maniacal cunning, stated by Lord Erskine in his celebrated speech for James Hadfield :

Dr. Sims came into court, who had been prevented by business from an earlier attendance. From him I soon learned that the very man, whom I had been above an hour examining, and with every possible effort which counsel are so much in the habit of exerting, believed himself to be the Lord and Saviour of mankind, not merely at the time of his confinement, which was alone necessary for my defence, but during the whole time he had been triumphing over every attempt to surprise him, in the concealment of his disease. I then af fected to lament the indecency of my ignorant examination, when he expressed his forgiveness, and said, with the utmost gravity and emphasis, in the face of the whole court, IAM THE CHRIST,' and so the cause ended!" The other statement he derived from Lord Mansfield himself, who had tried the cause. "A man of the name of Wood had indicted Dr. Munro for keeping him as a prisoner when he was sane. He underwent the most severe examination by the defendant's counsel, without exposing his complaint; but Dr. Battie having come upon the bench by me, and hav ing desired me to ask him what was become of the princess with whom he corresponded in cherry-juice, he showed in a moment what he was. He answered there was nothing at all in that, because having been (as every body knew) imprisoned in a high tower, and being debarred the use of ink, he had no other means of correspondence than in writing his letters in cherry-juice, and throwing them into the river which surrounded the tower, when the princess received them in a boat. There existed, of course, no tower, no imprisonment, no writing in cherry-juice, no river, no boat, but the whole was the inevitable phantom of a morbid imagination. I immediately," continued Lord Mansfield, " directed Dr. Munro to be acquitted; but this man, Wood, being a merchant in Philpot Lane, and having been carried through the city on his way to the madhouse, indicted Munro over again for the trespass and imprisonment in London, knowing he had lost his cause by speaking of the princess at Westminster. And such," said Lord Mansfield, "is the extraordinary subtlety and cunning of madmen, that he was cross-examined on the trial in London, as he had successfully been before, in order to expose his madness, but all the ingenuity of the bar, and all the authority of the court, could not make him say a single syllable upon the topic which had put an end to the indictment before, although he had still the same indelible impression upon his mind, as he had signified to those who were near him; but, conscious that the delusion had occasioned his defeat at Westminster, he obsti

Jun.'s Reports, ii. 77, exparte Holyland.

mistake, in contiguous columns, thus:

It remains for us to take some notice of the methods of cure, and in reference to the deplorable state in which this branch of medicine stands, we cannot but admire the ingenicus and rational proposal of Mr. W. J.

"It is said of an oriental monarch, that he pays his physicians only when he is in health; and, were this principle generally adopted, it would be attended with advantage. A modification of it, however, I would adopt, had I a relative.or friend insane. I would pay just so much as would cover the expense of board, &c. and agree to pay a handsome premium when the patient should be discharged cured."Pract. Observ. p. 18.

This, however, would not apply to such cases as that stated by Dr. Bright, the secretary to the commissioners for licensing madhouses, in his evidence before the Middlesex Committee: "A person, a retail chemist and druggist, calling himself an apothecary, induced a brother of his to sign some instrument, by which property to the amount of about 3,000l. was disposed of, and two days after the execution of the instrument, he took this brother to a mad-house, he himself signing the certificate as a medical person."

We are happy to perceive, by the returns of various public and private establishments, both at home and on the Continent, which are given at large by Dr. Burrows, that under favourable circumstances more than one-half of all the cases of deranged mind may be considered curable. In the Quakers' Retreat at York, the proportion is considerably higher, owing to local and other circumstances. In Dr. Burrows' own establishment, at Clapham, (to the superior and even elegant accommodations in which, we can bear personal testimony,) the proportion of cures is fully a half, leaving out of consideration about a sixth considerably relieved. The methods of cure naturally resolve into moral and medical treatment.

Much must depend upon kind and soothing measures in cases of high excitement, and upon cheering the dark despondency of those afflicted with melancholia; but though this looks easy in theory, like a plausible book system of politics or morals, it is extremely difficult and often impossible to put it in practice. The following case will explain this better than any general argument which we could adduce:

"A nobleman of a fine and cultivated mind, was rather suddenly seized with mania. His

"Cephalitis.

[Inflammation of the brain.]

1.

"The paroxysm preceded by sudden and violent pains in the head, back, or limbs, and regions.

When delirium attends, it is complete.

2.

"Vehement fever; and constant burning heat of the skin, and all the other symptoms of pynexia. Tongue parched, at first red, then whitish, yellow, or bluish.

3.

"&c. &c. &c."-Burrows, p. 350.

delusions induced him to think still higher of his consequence and endowments, added to which, he fancied that he was entrusted with a spiritual commission from God. No persuasion or art could induce him to submit to medical discipline or control. Force was at last resorted to, but with all possible caution and respect. It exasperated him violently. The plan was relaxed, but his conduct was wild and dangerous to the highest degree; constraint was resumed. A continued opposition ensued for three months, when, from full abstinence and constant resistance and vituperation, he became quite exhausted, and died. Every thing was done that skill could devise, to enlarge the patient's liberty, but it was dangerous even for a minute. I superintended many attempts to relax his confinement, but all was in vain-the consequences were always terrible.

"In the midst of his delusions and ravings, offended pride was uppermost. He would never enter into any compromise, but invariably insisted on his liberty as his natural right. The following characteristic colloquy took place with him one day in a consultation.

"One of the physicians urged him to walk in the garden for exercise. No, sir,' he replied, I will not, while in this degraded condition! (glancing at the strait waistcoat.) But, my Lord, no one will see you there.' Ah, Sir! what a base man you must be, to think it is being seen! No, sir, it is not my body's degradation, it is my mind that is degraded and suffers!'

"After I heard these sentiments, in which there was so much truth and feeling, I redoubled my efforts to obtain his confidence, and a promise that he would conduct himself quietly if I gave him his liberty. I would unhesitatingly have placed confidence in him, had he made that promise, under a full conviction that he might be trusted; but he refused all pledges. Nevertheless, I again gave him more latitude; but he was, as before, dangerously violent, and again restraint was resumed."Burrows, p. 692.

A case such as this, and it is by no means an uncommon one, will at once show the absurdity of the "fame, vinculis, plagis coërcendus est" of Celsus, and the manacles, fetters, stripes, slender and not over delicate food, clothing rough, bed hard, and treatment severe and rigid, of Dr. Thomas Willis-recommended too, if we mistake not, almost indiscriminately