fatuous in English asylums, and the proportion of mortality, even in relation to that number, is infinitely smaller. Scurvy, which commits such ravages in the former, is unknown in the latter, where diarrhoea is the most frequent termination of chronic demency. COMMENTARY XI. IDIOCY. IDIOCY is a congenital or an acquired defect of the intellectual faculties. Pinel says, idiocy consists in an obliteration, more or less absolute, of the functions of the understanding and the affections of the heart.* But to this definition I object, as to aliénation mentale, that it implies a previous possession of intelligence. Obliteration, therefore, can only apply to idiocy acquired subsequent to the development of an understanding. Congenital idiocy may originate in mal-conformation of the cranium, or of the brain itself. Acquired idiocy proceeds from mechanical injury of the cranium, by which the functions of the brain are lesed or impeded, or from an injury or disease which that organ has sustained it follows also from excess in sensual pleasures, habitual drunkenness, excessive depletions of blood, masturbation, extenuating diseases, study too intense or wrong directed, and from profound moral causes, as terror, fright, extreme joy, &c. : In the congenital state, the external senses are often wanting or defective, as well as the intellectual, and life is commonly of short duration; in the acquired, the external senses may be quite alienated, or be only partially affected, but they have been once perfect, and life may be protracted to old age. Absolute idiocy admits of no cure. The mental facul Nosographie Philosophique, tome iii. p. 138. ties and external senses have been so impaired by injuries done to the head, as to give all the characters of idiocy to a person; and yet a surgical operation, or nature herself, has restored those faculties. When depraved only by the vices and moral impressions referred to, the mental faculties have been restored by the access of fever, a paroxysm of violent mania, or by such means as have, directly or indirectly, imparted fresh energy to the brain. But in this latter case the event of recovery shews that the mental faculties were in a state of demency, rather than of idiocy. For idiocy signifies an irremediable condition of the mental faculties; demency, of whatever duration, except when there is organic lesion of the brain, or it be the effect of old age, implies a capability of their restoration. : Whenever the term idiocy is applied to a fatuous condition of the understanding, unfortunately it is construed into incurability. From this confounding of terms I fear that some are consigned to oblivion, who, being only in a state of acute demency, might have become useful members of society. However degraded the mind appears, the origin of that state should be carefully inquired into if it proceed from a defect of nature, there is nothing to be done but what compassion for a hapless fellow-being dictates; if it be from injury to the head, the skill of surgery may sometimes afford relief; if from disease, excessive depletions, extenuation, or moral cause, provided no organic change in the organ of intelligence has followed, means which invigorate the constitution and restore the suspended energies of the brain may still effect a cure. To describe the characters which denote idiocy were quite superfluous. There are doubtless different grades of incapacity as well as of capacity; but they cannot be disguised, and need not delineation. PART III. TERMINATIONS OF INSANITY. THE terminations of mental derangements are,-1. Recovery; 2. Relapses and Recurrences; 3. Incurability; 4. Mortality. We will consider them in this order. COMMENTARY I. RECOVERY. Few popular errors have been more prejudicial, either to the interests of science or humanity, than that insanity is commonly incurable, and, consequently, that all remedies are useless. This was not the conviction of the ancients : Et quoniam mentem sanari, corpus ut ægrum, And happily, the experience of the present age, as we shall shew, clearly demonstrates, that a very large proportion of the insane recover the perfect use of their understanding.* * The presumption that few insane persons recover has tended to strengthen, as a natural consequence, the popular error, that insanity is a malady much more prevalent than formerly. This is one of the errors relative to insanity which I have endeavoured to combat (see Inquiry, &c. p. 54). I have there advanced, that " it may be considered as an axiom, which the annals of insanity fully support, that there never Recovery may assuredly take place spontaneously, unaided by art; but this occurs rarely indeed, in comparison with the number who recover when submitted to remedial means. If the proportion which recovered thirty years ago be compared with the present, this conclusion is proved. All organs, once morbidly affected, make slow approaches to health; hence the return to sanity of mind is commonly very gradually accomplished. When the recovery is sudden, we must infer that the functions. only of the brain have been deranged, but lesion of the organ itself has not been sustained. In the proportions in which lunatics recover, continue insane, or die, a material difference will be found; and so likewise will there be in the collateral diseases to which the patients are subject. The regulations of every establishment differ in many respects: was, in any country, a sudden increment of insane persons, without some powerful and evident excitation, physical, moral, theological, or political. While the condition of a people is prosperous, and uninterrupted by violent and sudden changes, insanity never exceeds. But when the dispensations of Providence fail of their accustomed bounteousness, or man by trouble is afflicted beyond his nature, or, by his own wilfulness, overleaps the bounds which nature and reason define, then insanity is engendered, and an increased number of lunatics indefinitely swells the catalogue of human calamities." And, from a careful examination of every register and document that could throw light on this interesting subject, I came to the conclusion that, comparatively with "the progress of the population, the demonstration is clear, that insanity is not an increasing malady." The extended observations of eight years since that opinion was formed still further confirm it. Esquirol refers to my conclusions on this point as regards England; and, having instituted a similar inquiry in France, has published a Memoir on the question: Existe-t-il dans nos jours un plus grand nombre des fous qu'il n'en existait il y a quarante ans?—(Mém. de l'Académie Roy. de Médecine, tome i. 1828.) His inferences are, 1. That the writings of authors, particularly of Pinel, have powerfully |