COMMENTARY IV.

MORTALITY.

INSANITY, it has been said, is not mortal of itself. Nay, many consider it conducive to longevity. The first, as an axiom, I am disposed to question; the latter is an egregious mistake.

If insanity imply only a disorder of the ideas, then it may be true that no one ever died of it; but taken with reference, as it should be, to a disorder of the functions of a most important organ- the brain, then I contend that, per se, it is a frequent cause of death.

To suppose that madmen are generally long-lived, Monro contended was a vulgar error. On the contrary, he thought that madness destroyed two-thirds of those who were afflicted with it. Besides apoplexies, palsies, convulsions, &c., lunatics are subject to many chronic affections, which are the result of their own obstinacy, and the difficulty of overcoming it.

Whenever an instance of longevity in a lunatic occurs, the paroxysms have had long intervals; or the patient must have his mental faculties so much obtunded, that he is indifferent to every thing; or his derangement be of a happy, joyous character, and himself have been well provided with every comfort essential to his animal wants. Then, if he live in a regular manner, a strong constitution may carry him to extreme old age.

*

* A lunatic is reported to have died in 1821, in Dr. Langworthy's establishment, after being an inmate of it sixty-nine years, at the astonish

I repeat, that whenever the intellectual functions of the brain are deteriorated, the vital functions are also deteriorated. The healthy brain exercises an influence on the human system similar to that which the sun exercises on the vegetable system. Deprive the body of any portion of the cerebral influence, and the system becomes comparatively obnoxious to the effects of very trivial diseases. So, whatever impedes and diminishes the influence of the solar rays, proportionably injures the vigour of vegetation, and disease and death follow.

Thus we see insane persons, when attacked by some ordinary and trifling complaint, sometimes sink and expire without the intervention of any one symptom to create apprehension. One or two such instances occurred to me before it excited more than surprise; but others followed, where neither depletion, nor violent remedies, nor any coercion, had been employed. Neither could any cause of death be discovered upon the most careful postmortem examination.

I have, therefore, been forced to the conclusion, that vitality itself is diminished whenever the intellectual functions are disordered, and that a sane mind is essential to constitute perfect health.

This conclusion is supported by the well-known connexion that subsists between the brain and those organs by which the essential functions of life are conducted. The former cannot sustain any lesion without some one of the latter participating, and commencing a morbid action. The influence of such lesion on the nervous system is further shewn by the singular capability often imparted to the insane, of bearing extremes of temperature, pain, hunger, &c. But these also are morbid conditions which

ing age of 104! He always enjoyed good health, and worked in the garden till within a few weeks of his death.

can only be borne for a time, and are never experienced but at the expense of the vital principle.

Insane persons may be said to die of sheer lunacy when they exhibit no marks of bodily disease; but in such cases death may be the simple effect of exhaustion, the patient being worn out by mere mental excitement, raving, and violence. This sometimes actually happens ;* and I see no reason why it should not so happen, since great mental excitation, or excessive bodily fatigue, will bring on instant death.

Though mania sometimes ends suddenly in death, yet it is not near so fatal as melancholia. Few melancholics, indeed, attain old age; and where life is unexpectedly extinguished, preceded only by a sudden debility, such event occurs chiefly in this form of insanity.

In melancholia, the patient experiences all the ill effects of the depressing passions by which the mind is worn down and enfeebled, and the constitution then gives way. In mania the patient is often void of all care; he is impressed only by gay and pleasurable ideas; hence the mind is invigorated and supported, and the corporeal powers are strengthened and prolonged.

The knowledge of these facts is very important; for they must convince us that we should be as guarded in our prognosis concerning life as recovery, in many cases of insanity.

Much pains has been taken to ascertain the exact proportion of deaths of insane persons to the number of cases. The mortality in every lunatic institution, public or private, must be much influenced by locality, the number of patients congregated, the accommodations, the regulations for admission and detention, and whether they are of the poorer or better class. For instance, the

* See Tenth Report of the Glasgow Asylum, p. 6.

mortality in Bethlem and St. Luke's Hospitals, where rigid selections are made, and patients generally discharged when seized by any dangerous chronic disorder, will be infinitely less than in those where no selection or exclusion of the patients occurs. Consequently, except where the site, numbers, regulations, mode of treatment, medical and moral, and capabilities, precisely correspond, which they do not in any two establishments, though most so in the above two hospitals, the degree of mortality must widely differ.

I shall, therefore, select for comparison among English asylums only the county pauper lunatic asylums of Lancaster and Wakefield. They are the largest in Great Britain, admit exactly the same classes of patients, viz. the maniacal, melancholic, fatuous, paralytic, epileptic, and idiotic; all of whom may remain till they recover, are withdrawn, or die. This description equally applies to the lunatics admitted and maintained in the French hospitals, and in the Senavra at Milan; and I shall, therefore, quote the rates of mortality in these lunatic asylums also, in order that they may be contrasted.

The proportion of deaths to the admissions in males is 28 in 100.

females, 19 in 100.

Proportion of deaths of both sexes is 24 in 100.

The proportion of deaths to the admissions in males is 25 in 100.

females is 23 in 100.

The proportion of deaths of both sexes is 24 in 100.

The aggregate of mortality in the above public hospitals remarkably agrees; but the proportions in the sexes widely differ.

The proportion of deaths to the admissions in males is 25 in 100.

females is 19 in 100.

The proportion of both sexes is 22 in 100.