COMMENTARY VII.

SENILE INSANITY.

THIS is a species of mental aberration peculiar to old age, and hence designated by some, Delirium Senile; by others, Senile Insanity, and so I distinguish it.

It developes itself in those who may never before have been insane, nor possess hereditary predisposition. It comes on, perhaps, when the reflections attending a well-spent life, and every earthly comfort, might otherwise ensure calm repose for the short remnant of existence. Hence this affection is the more distressing to the patient's family, since it is the disappointment of a promise well deserved.

In this singular affection the system is influenced by an extraordinary excitation, prompting the revival of youthful passions and follies, when the powers of fruition. have long ceased.

The whole moral and intellectual character of the patient is changed: the pious become impious, the content and happy discontent and miserable, the prudent and economical imprudent and ridiculously profuse, the Persons in liberal penurious, the sober drunken, &c. whom the sexual passion has been long dormant suddenly become lascivious and obscene, and abandon themselves to all sorts of vices. In fact, the reverence which and the conduct suited to it always commands, is converted into shame and pity at the perversion of those moral and social qualities which, perhaps, have hitherto adorned the decline of the patient's days, and endeared him to his family and friends.

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The character of this delirium may be gay or sad. I was lately consulted in two cases of this kind, but where the characters of the attack were quite opposite.

A gentleman of a noble family had, during the course of a long life, experienced many singular reverses of fortune. He was a man of fashion of the old school, and of high honour and character, but had long resided in dignified retirement upon a very ample fortune.

His constitution was hale, though he had many years suffered from dysuria. He possessed naturally strong feelings and passions; but, even to the ninetieth year of his age, enjoyed in a remarkable degree every faculty, and especially a clear understanding.

Suddenly he became more violent and imperious in his conduct and conversation, purchased many ridiculous things, especially those which would gratify a taste for good eating; he grew fond of wine and spirits, and now took much more than his usual quantum. He gave orders for the increase of his establishment and the purchase of estates, &c., and in every thing evinced. an altered and profuse disposition. At length, the least contradiction or gentlest remonstrance threw him into ungovernable fits of passion, and he threatened violence to all who opposed him. He also entertained many

absurd delusions.

At this juncture I first saw him. I immediately placed him under the guidance of a careful and judicious attendant.

It was remarkable, that the natural standard of this. gentleman's pulse had never, in the vigour of his life, exceeded fifty. It now beat the same, and was full and strong. He had for some time felt a dull pain and weight in his head; it was now hot, his face was flushed, the conjunctiva much injected, and the eyes sparkling, the tongue whitish and rather parched, and he was

very restless at night; the bowels were obstinately constipated.

Such gentle means were used to remove cerebral excitation and regulate his bowels as his great age pointed out to be suitable. In a short time he improved in his bodily health from this plan, but none of his propensities and delusions varied; yet he could command himself very well during my visits; and as he possessed a senile memory, that is, a perfect recollection of far-gone events, though not of recent, he would then relate, in a very delightful way, anecdotes of the most distinguished characters of the past century, with whom he had associated.

In about three months the powers of his constitution gradually declined, and when the hot weather set in he sunk, the delirium continuing to the last.

The other case was that of a gentleman of fortune, aged eighty-four, of great accomplishments and high estimation, and possessing every worldly happiness.

He suddenly displayed an extraordinary and erroneous view of his own affairs, and all the relations of life. He fancied that his pecuniary circumstances were dreadfully deranged; that he had not the means of subsistence; that he was an object of his children's and grandchildren's abhorrence, though he lived affectionately regarded in the bosom of his family.

I saw him at this period. No hereditary predisposition existed. There was little corporeal derangement, except some slight gastric affection, his digestion being lately somewhat impaired, and the action of his bowels rather irregular. I prescribed such remedies as might improve the power of the digestive organs, and such means as were calculated to soothe and amuse him. But especially recommended that the patient's conduct should be carefully watched, lest, entertaining such desponding and wretched ideas, he should attempt his own life. As he was not violent, the family would not be

persuaded to place him under the supervision of a proper attendant.

Three days afterwards, in going to his chamber, the staircase-window being open, he precipitated himself into the area, and was killed on the spot!

Another case of this affection, proceeding from metastasis of intestine irritation, is detailed at page 209.

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It has been remarked by Aretæus, that this peculiar condition of the mind in old people is always fatal result naturally to be expected, considering the advanced age when it appears. All the vital powers are at this period deteriorated, and then very slight cerebral irritation will generally suffice to destroy the enfeebled system. Therefore, it is not the violence of the disorder, but the weakness of the patient, which precludes recovery. Nevertheless, if the delirium be of a happy character, and the constitution good, it may persevere, unchanged, for months and years.

The treatment of Senile Insanity must generally be purely palliative; but I see no absolute reason, when the cause is not organic, and due care is used to prevent the consequences of a delirious paroxysm, why proper treatment should not much ameliorate the condition of the patient; or even, when the powers of life are not too exhausted, effect a restoration of the mental faculties.

It is obvious, that the only remedies which can be prescribed in these cases, are those which will remove any inordinate action in the system without reducing the strength, regulate the natural functions, and renovate.

COMMENTARY VIII.

SUICIDE.

A PROPENSITY to self-destruction, like any other peculiar delusion, is but a symptom of deranged intellect, and can only be viewed as a feature of melancholia. But from the frequency of suicide, and its important effects on society, it claims a distinct consideration.

Suicide is committed under very opposite impulses; and, under certain circumstances, a doubt may naturally arise, whether it be not sometimes perpetrated by a sane mind. The art with which the means are often prepared, and the time occupied in planning them, seem to mark it as an act of deliberate volition; but the acts of an insane mind are involuntary, and not voluntary; therefore the question must always revert to, what was the real condition of the mind when suicide was committed?

The propensity to suicide is sometimes innate or hereditary, and the act is done without any other apparent or assignable cause. Sometimes it is premeditated, resulting from a moral cause too great for the mind to sustain; sometimes it is the effect of a sudden and violent impression, where no time is left for reflection; sometimes it is incited when the spirits are depressed or agitated by some unlucky association of thoughts, and a favourable opportunity presents; sometimes to elude disgrace or merited criminal punishment; and sometimes, although physical pain is always supported with more resignation than moral agony, yet suicide has been deliberately committed to escape extreme bodily suffering.