fever. For this, I prescribed suitable remedies; but I took no notice, nor made any inquiry of him respecting his late rash attempt to destroy himself. During the fever he was quite docile and collected. When it had subsided, I reasoned with him on the subject. He confessed himself horror-struck on the reflection of the act he had committed, and entreated I never would again mention it. In fact, his mind was entirely free from all delusion; and in a fortnight he returned home cured, and has remained well ten years.

Persons of weak intellects, and even in a state of dementia, when that condition was not connate, or from mechanical injury, have, from an attack of fever, been known not only to be restored to reason, but to have acquired a degree of shrewdness exceeding their original capacity. Willis has an axiom, " Interdùm febris quosdam stultos et stupidos sanavit, et acutiores reddidit;"* and he cites several cases in proof of it.

It is highly probable, that in fatuous persons the brain is, according to Cullen's definition, in a state of collapse; and as fever itself may be a re-action, a febrile attack produces the salutary effect of restoring, permanently or temporarily, the wonted energies of the brain, and conse→ quently the intellectual faculties.

The action of mercury inducing salivation, which is a temporary state of febrile excitation, has cured insanity.

Memory, consciousness, and even a certain degree of ratiocination, often return just previous to death in those who have been deprived of almost every sentient or mental faculty.

True hectic fever always improves the mental powers. Percival, in illustration, mentions a case of fatuity subsisting from infancy, and nearly approaching idiocy, which, after thirty-four years' continuance, ended in

• De Stupiditate, p. 190.

K

consumption, of which hectic fever was of course a concomitant. Towards the fatal close of this case the patient actually displayed a great degree of intellectual vigour.*

The most remarkable case of this kind is one related by Dr. Albert. A young man, after he had been in a furious delirium for seven years, in the course of two days sunk into a complete state of idiocy. He maintained a squatted position, with his legs continually bent over his thighs, the articulation of the knees and hips having become anchylosed. The heels, by constant compression, appeared to be buried in the buttocks; and his cheeks, which reposed on each knee, between which his head was placed, seemed to have ceded to the permanent pressure they sustained. After fifteen years passed in this miserable state, he suddenly returned to consciousness and a knowledge of his existence, and of objects and persons surrounding him. But this was the signal of approaching death, which followed in five days. He recovered also his voice in this interval, and complained of an obstruction in the gullet, which hindered him from swallowing.

This unhappy being had not only experienced as great disorder of intellect as was possible, but had also undergone as great a physical change as the human body, while endowed with the vital principle, is susceptible of; for, besides being degraded from all those attributes of man which reason and form bestow, his very substance was changed. His whole body was remarkably blanched, and had the appearance of wax or adipocire, and looked in every part almost diaphanous, while each member was shrunk and atrophised.+

This temporary recovery of reason and reminiscence has often been adverted to as a proof that mind is inde

* Works, vol. ii. p. 339, ed. 1.

† Annales Cliniques de Montpellier, tom. xlii.

pendent of matter. But this phenomenon, is perhaps capable of explanation without recourse to occult causes or metaphysics.

Preceding the dissolution of such maniacs, symptoms indicative of some increased action of the nervous or vascular system are apparent. Many, no doubt, die suddenly, in whom no change in the functions, mental or physical, is perceptible. But when the decline is gradual, this sudden recovery of reason is not uncommon. As the powers both of the nervous and vascular systems are mutually exhausted by long-continued action and re-action, and as some degree of vascular excitement generally comes on just at the last crisis, a fresh, though feeble and fleeting impulse is thereby imparted to the nervous system; and thus, the balance being temporarily restored, a condition of the brain essential for the right exercise of the intellectual faculties is recovered. This restoration, however, of the mental powers is at the expense of the vital powers; for death soon closes this transient effort.

Accelerated circulation, therefore, operates according to the state of health of the organ in the healthy brain it may produce functional derangement; in the morbid brain, restoration of its functions.

If fever occasionally remove insanity, it sometimes fails to produce any effect at all on a disordered mind. This perhaps may also be accounted for. In some, the cause of insanity is only a simple morbid action of the brain, sympathetically induced, of which dissection affords no trace; in others, a temporary lesion may attend; and in others, cerebral disorganisation. Hence fever in the first case may effect a perfect cure; in the second, the new or febrile action, while it lasts, overcomes the existing morbid action, but which again prevails upon the exciting power ceasing; while, in the third, no adventitious cause, however excitant, can remedy the organic lesion.

2. When the Blood is in Quantity or Momentum defective.

It being manifest, that a certain quantity of blood is requisite to give energy to the functions of the brain, it is equally so, that if, from defect in the process of sanguification, or of momentum in the arterial system, a due supply be not given, the cerebral functions cannot be properly performed. That such deficiencies, both in the supply and motion of the blood, do frequently occur in certain forms of intellectual derangement, is evident.

Such is the case of those in a state of demency or fatuity. All extenuating diseases, excessive or longcontinued evacuations, whether from hæmorrhages, alvine dejections, urine, perspiration or ptyalism, venery, and especially the odious and exhausting practice of masturbation, or deficiency of nutriment, are adequate to this effect. The structure and incapacity of the cranium itself, either to admit or contain a sufficient supply of blood for the full development of the intellectual organ, has been supposed to be a cause of positive idiocy.

Sydenham mentions a peculiar species of mania, which was the sequel of inveterate intermitting fevers; and which, he says, contrary to all other kinds of madness, would not yield to plentiful venesection and purging, but the reverse-slight evacuations produced the relapse of a convalescent, and violent ones inevitably rendered the patients idiotic and incurable.*

Although we cannot admit this celebrated physician's theory, that all other kinds of madness proceed from "too great spirituousness and richness of the blood," and this particular one from its " state of depression and vapidness from long fermentation,"-yet it is clear, that this accurate observer of disease was correct in principle- that is, that in common insanity the condition of

• Observ. Med. sect. i. cap. 5.

the blood and circulation are very different from what they were in the peculiar species he describes. Both the quality and quantity of blood were in this case doubtless much deteriorated; and the vis vitæ also so much diminished, that the action of the heart was incompetent. Hence, the brain being deprived of the necessary stimulus, a state of atony ensued.

A deficiency in the supply of blood first deteriorates the corporeal, and then the mental faculties, and finally extinguishes both.

Haller,* Boerhaave, Vogel, &c., among the causes which affect the reasoning powers, refer to a deficiency of blood to the encephalon.

Persons exhibit, in particular forms of mania, a peculiar pallor of the skin, accompanied with such extreme emaciation, that a deficiency in the supply of blood is strongly indicated. The capillary vessels on the surface seem completely exanguined; and the frequent insusceptibility of such patients to all external sensations, seems to imply that the circulation in the cutaneous vessels is so languid as to have impaired the nervous power and influence.

This pallor of the complexion, and tabid state of the body, may originate in a morbid condition of the mesenteric glands; for, in the bodies of insane persons much extenuated, these glands will generally be seen greatly enlarged. But this condition is observed in maniacs in whose bodies neither the mesenteric glands, nor any of the abdominal or thoracic viscera, are perceptibly diseased. Probably, in such cases some gastric disease might exist, and the powers of assimilation being impaired, the supply of blood necessary to sustain the proportions and muscular force of the body, and the energies of the mind, is inadequately furnished.

* Physiol. Oper. p. 563.