8. Scurvy.

This disease has made great ravages among the lunatics in the French hospitals. It chiefly attacks the melancholic or fatuous, and imbecile paralytics, who, with all the accustomed symptoms of scurvy, fall into a state of heaviness and stupor, and perish.

Scurvy generally has its origin in locality, want of good pure air, or defective nutriment; and is the concomitant of that state of atrophy consequent thereon.

Probably from somewhat similar causes, scurvy and flux very much prevailed in Old Bethlem about fifty years ago.* These disorders, however, subsided upon a more generous diet being introduced. Scurvy is now wholly banished from every British lunatic asylum; dysentery is very rare; and chronic diarrhoea, which is meant by flux, and which in all situations seems the inheritance of inveterate lunacy, is infinitely less

common.

In the French hospitals, the fatal occurrence of scurvy in so great a degree has been ascribed to the damp and comfortless state of the courts and lodges where the imbeciles are kept; but the late improvements in the buildings for the accommodation of this class of patients are reported to have already checked the prevalence of this disease in La Salpetrière.

• Hist. Account of Bethlem Hosp. 1783, p. 10, in notȧ.

COMMENTARY XII.

A SYNOPSIS OF FATAL DISEASES OF INSANE PERSONS.

THIS includes all the diseases which have had a fatal termination among the insane upon whom I have professionally attended in the last thirteen years. It is impossible to contrast them with the number of patients who have come under my care, because many have been reI moved before their cases were finished. I have placed the diseases numerically, and without reference to any classification :

COMMENTARY XIII.

CLIMATE, OCCUPATION, SEX, AGE.

AMONG other causes influencing insanity, Climate, Occupation, Sex, and Age, are ordinarily enumerated. Each therefore demands some notice.

1. Climate.

The inhabitants of particular countries have been supposed to possess more or less talent and wit; and others to be more or less obnoxious to mental derangement.

Whether the first position holds, it is not my province to examine; the second certainly is founded on very questionable authority.

Again, mania has been considered as specially attaching to the inhabitants of this, melancholy to that, and suicide to another, country. But this prepossession is gradually dissipating, as investigation of the subject proceeds; for it is clear, that each form of insanity is to be found in every civilised nation of the world. Of course, one form may preponderate more than another, according with the moral, civil, and religious condition of the people; but observation disproves the notion, that the form is governed by peculiar climes.

A particular and obnoxious state of the atmosphere may obtain, at certain seasons and places, very inimical to the human constitution, and induce that morbid condition of it which is favourable to the development of mental derangement. This happens where obstinate intermittents prevail.

Insanity is clearly endemical: it has its remote cause often in palludal miasma, as in Lombardy, and may occur in one country as well as in another.

Mental derangement is a consequence of insolation, which is more likely to happen in the torrid than in the temperate zone; but a coup de soleil may occur in hot weather any where under too great exposure to the vertical rays of the sun. A high state of inflammation of the encephalon immediately follows; and if the patient survive, permanent intellectual derangement is a frequent consequence.

In some so predisposed, trivial exposure to the solar rays will induce cerebral inflammation and high delirium. The midsummer of 1826 was excessively hot. In one of the days when the temperature was at the highest, a lady who had been sitting reading in her garden, but under the shade of trees, was suddenly seized with an agonising pain in the head; fever followed, and shortly furious delirium. She died in a few days. Upon opening the head, there were marks of recent high inflammation of the membranes, and likewise of long-standing disease; and on the surface of the brain an ulcer as large as a shilling was found.

This case is, besides, an example how much patients are themselves deceived as to the seat of their diseases. This lady had been complaining for several years; but referred all her sufferings to the site of the abdomen, and had often said, that when she was dead, there would be found the seat of her disorder. Upon the most careful examination of the viscera, however, not a trace of disease could be found. Did not these uneasy sensations in the abdomen arise from sympathy with the brain, which had, during the whole period, been the seat of a morbid irritation, and which slight insolation excited to an active state of inflammation?

Whether a native of the north visits the south, or

vice versú, it does not follow that he is subject to insanity more than a native of the soil. A native of one part of the tropics removed into another part of the same region, is perhaps quite as liable to become a victim to this

affection.

Humboldt mentions,* that a young and robust negro, born in Guinea, on his arrival at Cumana, in South America, went mad; and he infers, because this negro had lived some years on the high plain of Castile (Old Spain), that his organisation had acquired that kind of irritability which renders the miasma of the torrid zone so dangerous to the inhabitants of northern regions. That miasma will so deteriorate the constitution as to make it more prone to the maniacal action, we know; and doubtless, the native of Guinea, who had become in constitution European, might experience this change as well as a native of the temperate region.

I have met with two facts which favour the position, that natives of the torrid zone upon becoming acclimaté in England, may be soon affected by mental derangement. One was a youth of Madagascar, not arrived at puberty, who had been brought over by the Missionary Society to be educated and instructed in the principles of Christianity. He could read a little, but could not speak English. He was in a state of melancholia, and after being in my establishment three or four months, recovered and went home. The other was a native of South America, and a well-educated young man. He also sunk into melancholia. There was no apparent cause in either case to occasion insanity.

Madness is less frequent in the East Indies, in South America, or in South Carolina, where the heat, according to Dr. Wells,† is very great, than in this country. From a statistical account published last year,

* Personal Narrative, vol. ii. p. 191.

+ Trans. Soc. for imp. Med. and Chir. Know. vol. iii. p. 527.