COMMENTARY IX.

DISEASES COMPLICATED WITH INSANITY.

THERE are various diseases with which insanity is commonly complicated, and which also appear to originate in derangement of the balance between the nervous and vascular systems, and thus prove their relationship. The most conspicuous of these affections are, 1, vertigo — 2, epilepsy-3, convulsions-4, apoplexy-5, paralysis- 6, catalepsy—7, hysteria-8, hydropic effusions. In fact, there is a strict analogy in all comatose and mental affections.

In all these maladies, as a general principle, the marks of increased circulation in the vessels of the encephalon are unequivocal. But the reciprocal, and sometimes the preponderating influence of the nervous power in some of them is also strongly marked.

Similar causes, constitutional or accidental, will produce, either directly or remotely, all of these affections; and each is liable to alternate, or terminate in the other, or with insanity.

1. Vertigo.

Vertigo is a disorder of the circulation, and is a very common symptom precursory to, or accompanying insanity. But there are two kinds of vertigo, which, although both originating in disordered circulation, yet proceed from opposite conditions of it, and which it is very essential in a practical point of view to distinguishthe one arising from a too great impulse of blood in the

cerebral vessels, and distinguished by rapid gyration in the head, succeeded sometimes by nausea or vomiting, and frequently by falling senseless; and the other, which, more correctly speaking, is a swimming, when objects seem as if approximating or receding from us and becoming dark; and which state proceeds from a defect in the supply or flow of blood, and assimilates more to that state which induces syncope. The latter is a symptom also of that condition of the system called asthenia.

A careful observer will soon detect the one species of vertigo from the other, and avoid the fatal consequences of an error: for vertigo, whether arising from increased or decreased impetus of the blood, if its cause be mistaken, may produce mental derangement, as well as many other diseases.

Though generally a symptom only, yet in some cases vertigo assumes the character of an idiopathic disease.

Chrichton makes vertigo the third species of the genus Hallucinatio, and defines it "an apparent rotatory motion of external objects, and sense of undulation of the ground, with abolished attention and thought."

But this affection may be induced by any thing impeding the course of the blood to or from the head; such as the wearing of too tight a neckcloth, from which practice first giddiness in stooping has been felt, then a sense of fainting upon the head being suddenly thrown back. These symptoms often terminate in some clonic affection, or paralytic debility of the whole frame, diminution of mental energy, and, finally, either in apoplexy

or mania.

2. Epilepsy.

Epilepsy is frequently complicated with, or ends in, mental derangement. It may be complicated with every form of aberration, alienation, or deficiency of intellect. Thus we find it combined with mania, melan

others, and not unfrequently to the immolating of all whom they most love when sane.

It

When paroxysms of mania suddenly attack persons subject to epilepsy, there is a reckless fury exhibited that seems to differ from the characters of true mania. appears as if the epileptic impulse when not ending in convulsion, acts on the brain in a peculiar mode, and imparts to it that particular action denominated epileptic mania.

The most horrible actions recorded of maniacal fury, have proceeded from this species of insanity.

Those of the epileptic maniacal constitution, are very apt to be prompted to one of these destructive paroxysms by a fanatical impulse, imbibed from perversion of some scriptural passage, imaginary vision, or waking dream.

A very sober, quiet, and industrious tradesman, aged thirty, subject to occasional fits of epilepsy, and who had lately much inclined to religious devotion, was sitting calmly reading his Bible, when a female neighbour came in to ask for a little milk. He looked wildly at her, instantly seized a knife, and attacked her, and then his wife and daughter. His aim appeared to be, to decapitate them, as he commenced with each by cutting on the nape of the neck. Their cries brought assistance, and he was secured before he had inflicted any fatal wound.

I saw him on the following day. His countenance then presented a most hideous and ferocious aspect: the complexion was a dusky red, his eyes starting from their sockets, and he was continually sighing deeply, or extending his jaws as if going to yawn. The pulsation of the temporal and radial arteries was full and laborious. He could make no reply to questions, although he attempted so to do; but he occasionally exclaimed, “Oh dear!" He appeared to be on the very verge of apoplexy. He was depleted freely both by blood-letting and purging; his head was shaved, refrigerating lotions

were applied to it, and a very low diet prescribed. On the third day his intellects were much improved, and he was quiet. He soon quite recovered, but never had the least recollection of the acts he had committed.

About a year before, he had experienced a similar attack; but then shewed only a slight disposition to mischief. Nine years have since elapsed without a recurrence of epilepsy, or disturbance of his mental faculties.

Persons liable to similar attacks, and the public journals attest that they are not unfrequent, often enjoy, as in this instance, long lucid intervals.

Doubtless, these afflicting visitations are generally attended by some premonitory symptom; but sometimes they are so momentary, that mischief is done before it can be prevented. Hence the greater danger of epileptic maniacs associating with the insane, whose aberrations prove perpetual causes of excitation to them. Besides, it has been correctly remarked, that the frequent sight of epileptic paroxysms will produce the like in an ordinary spectator,* and more especially in a maniac.

At first, as in the above case, the mind is affected only in connexion with the approach, access, and decline, of the epileptic convulsion; but in proportion with the frequency of its repetition, the mental faculties are impaired, till at length continuous insanity follows, which ends commonly in permanent fatuity.

The epileptic has been considered an almost hopeless form of insanity. This, however, is an erroneous opinion; for maniacal epilepsy is found to be, under proper treatment, susceptible not only of a great degree of amelioration, but of cure. It is certainly a most formidable and very often obstinate disorder, but is not always absolutely incurable.

* Cullen, Aph. 1292.

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An epileptic patient is an object of constant solicitude, and when pecuniary means are circumscribed, is an intolerable burden to his family; for, from the nature of the disease, epileptics are generally deprived of the power of maintaining themselves; therefore, if straitened in circumstances, although their case may admit of relief, yet the power also of obtaining it is denied. Epilepsy, too, has one feature almost unknown in mania that is, helpless infants and children, as well as adults, are its victims. And when such a distressing case occurs in a family placed above parochial aid, yet only possessing a competency, well may the parent appeal, as a certain man did to our Saviour, "LORD! have mercy on my son, for he is a lunatic, [epileptic,] and sore vexed; for oftentimes he falleth into the fire, and oft into the water." But to whom or where is the appeal to be preferred? There is no help for such a case. For neither in this vast and opulent metropolis, nor in any place of the British empire, though so renowned for charitable institutions, and acts of God-like beneficence, does any asylum exist appropriated solely for epileptics, or even having, I believe, a part allotted for their separate accommodation and curative treatment. Surely this is a great defect in the code of British philanthropy.

All the county pauper asylums, some provincial, and most private lunatic establishments, admit epileptic maniacs; but, I repeat, we have none that offer an arrangement peculiar to epilepsy; or that, receiving such cases when the seat of reason is affected, class them according to their several conditions, so as to offer the best means of relief.* In all the English asylums which I have visited, the epileptics were commingled with the

*This defect, I confidently trust, will be removed by a specific classification of maniacal epilepsy in the intended Middlesex County Asylum for Pauper Lunatics.