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In La Salpetrière, a twentieth part of the female lunatics are reckoned to be insane from prostitution. This is a cause always more actively operating in large than in small towns or in the country.

Drunkenness, which prevails most among males, is one reason why, generally, so many more men than women are insane; otherwise, the exciting physical causes to which females are naturally exposed, and from which males are exempt, would possibly have occasioned a different result.

4. Age.

At what age the constitution is most prone to insanity, it is of some importance to know. The difficulty of recovery is always progressive with the advance of age. This rule perhaps equally applies in most human diseases. In a prophylactic point of view also, it is desirable to ascertain the age when mental derangement may be expected to be developed, as well as when it most prevails.

Authors mention infants becoming insane; but the only case of this kind distinctly described is one seen by Greding.* He asserts, the child was born mad, and relates acts which he committed, certainly very extra'ordinary. When this infant commenced teething, he wasted and died. If the description be correct, this was a real case of congenital fury; but unless there was proof of mind, it cannot rank as mental derangement.

Esquirol, in the whole of his extensive experience, does not appear to have met with any case of infantile madness; for he refers only to an insane child two years old, quoted by Jos. Frank, which he had met with in St. Luke's Hospital in 1802, and likewise to the three cases related by Dr. Haslam.+ In two of these latter cases, however, I conceive there was decided original

Crichton, vol. ii. p. 356.

+ Observ. &c. chap. iv.

deficiency of intellect; and in the third, where most intelligence was displayed, there was more of moral than mental perversion, so that the boy's perceptions were correct, and no delusion existed.

As a general maxim, insanity cannot occur before the approach of puberty; because previously, the intellectual faculties are not developed, or have not acquired strength to exercise perfect functions.

Nevertheless, I cannot prove that no child was ever insane; but if it occur, such instances are like those remarkable examples of precocity of physical and of mental powers which we sometimes see as exceptions to the general law of nature. Children are often highly nervous, irritable, and eccentric, and evince very acute perceptions and feelings. Here are the elements of a strong propensity to mental derangements. In such constitutions, an erroneous education, or strong exciting cause, such as ill-usage, or sudden fear, might induce an attack of insanity, even at the age of childhood.

At the epoch of puberty, the mind in some is very early and rapidly developed, and with a fecundity of ideas, brilliancy of imagination, and aptitude for the arts or sciences, truly wonderful. Too intense, or ill-directed application, sometimes very soon deranges such minds. This rapid development is more peculiar to girls; and it often happens, that this brilliancy gradually declines, or at once becomes stationary, and the understanding is left in absolute mediocrity. This sudden progress and check of mental power I have witnessed, though more rarely, in boys.

Cabanis and other natural philosophers assume, that the brain and nervous system require the influence of the seminal secretion before it is susceptible of maniacal excitation; and this same influence is supposed by them, when highly or morbidly excited in adults, to be the frequent cause of insanity. Since the development of the

sexual system is contemporaneous with that of the mental faculties, cause and effect may at this age be frequently confounded. Hence I am not disposed to coincide with the French physiologists, who attribute so large a share of insanity to the influence of the sexual passion.

The ages, with reference to the sex of the insane admitted into the French hospitals, are thus stated :—

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Thus we find, as might be anticipated, that insanity exceeds in both sexes in the most active period of life, between 30 and 39. In the next decade, the period of life especially critical to females, viz. from 40 to 49, the proportion of insane women to men is as 290 to 231; which, in relation to the totals of each sex admitted, viz. women 1412, and men 1095, shews, either that the critical period does not influence insanity in women so much as is supposed, or that there is some moral exciting cause in the condition of men at this epoch, which is equivalent in effect to this physical exciting cause in the other sex.

PART II.

COMMENTARY I.

DIVISION OF INSANITY.

A DEFINITION suitable to every form of insanity is an ignis fatuus in medical philosophy, which all follow, and which eludes and bewilders pursuit.

A profundity of learning and psychological knowledge has been displayed on the subject; but hitherto no two nosologists have coincided even in a general definition of insanity. Hence, as might be expected, nothing but confusion and discrepancies prevail.

Guided by metaphysical and speculative theories, philosophers and physicians attempt definitions of insanity; but none survive the test of rational inquiry. Medicine is not exempt from vanity; and when the physician, for the purpose of display, adopts pure hypothesis for induction, he must expect to fail, and be exposed.

Having traced the sources and connexions of the physical phenomena of mental derangement, and compared them with the manifestations of a morbid mind, the physician should be content with applying the knowledge he has thus acquired to the forming of a sound judgment of the disease, and how most successfully to treat it. Definitions of the morbid phenomena of mind he should leave to schoolmen, who love to indulge in subtilties.

The utility of such definitions in all juridical inquiries, is as problematical, perhaps, as in medicine. The failure of the attempt of the late very erudite Dr. Thomas Arnold, to define the mental characters of insanity, and reduce them to nosological arrangement, sufficiently testifies that it is not to be accomplished.*

Warned by such examples, I shall decline all definitions of the infinite varieties of insanity, and confine myself to a simple division of the most conspicuous and ordinary forms in which it appears.

Except the abortive attempts at definition, nothing more strikingly exemplifies the incertitude respecting the nature and proximate cause of insanity, than the multitude of terms used to designate this malady.

Words are the symbols of our thoughts; and it doubtless would be as advantageous in medicine as in general science, if those only were employed which convey a specific meaning, and were so understood universally. Such, however homely, are preferable which are most intelligible to those for whom we write. Philologists perhaps will cavil at this apparent barbarism; nevertheless, it is just.

If a short retrospect be taken of the nomenclature of mental disorders, we shall be struck with its variety. Thus, we find, the Deliria of Sauvages and Sagar; the Paranoia of Vogel and Swediaur; the Ideales of Linnæus; the Mental Diseases of Macbride; the Vesania of Cullen; the Paraneurismi of Young; the Delirium of Crichton and Foderé; the Alienation Mentale of Pinel; the Folie of Esquirol; the Ecphronia of Good, &c.

If the learned thus differ, we must not be surprised if popular opinion vacillate on a subject so difficult even to designate.

* Observ. on the Nature, Kinds, Causes, and Prevention of Insanity, vol. ii. p. 93.

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