instances of mental disturbance originating in injuries of this organ, or in secretions of morbid bile, or obstruc tions of the biliary ducts by gall-stones, spasm, &c.

Diseases of the hepatic system will even originate delirium, furious mania, melancholy, and suicide.

Insanity is much more common among the lowest classes than the supporters of its mental origin are inclined to admit. Now, drunkenness is certainly the great vice of this class in Great Britain and Ireland, and the propensity is gratified usually by ardent spirits. In a table of 1370 lunatics, admitted into the Asylum at Cork, Dr. Hallaran says 160 were insane from this unhappy indulgence.*

Dr. J. Cheyne,t on the authority of the late Mr. Todd, mentions the great prevalence of hepatic disease upon examining the bodies of lunatics who had died in the hospitals of Dublin. I need scarcely remark, that from the cheapness of spirits, and the habits of the lower orders of Irish, such appearances might naturally be expected. Indeed, I have myself discovered in the bodies of several poor lunatics which I dissected, a condition of the liver that favours the inference that it was produced by excessive drinking.

The French, comparatively, are considered a sober people; but it appears that inebriation is a frequent cause

* Pract. Observ. on Insanity, ed. 2, p. 35.

+ Obs. on Apoplexy, p. 198.

In a paper I published in the Lond. Med. Rep. vol. vi. p. 284, entitled "OBSERVATIONS ON THE PATHOLOGY OF INSANITY," I quoted, on the authority of Mr. Todd, as referred to by Dr. J. Cheyne, that the former had found the liver more or less diseased in upwards of four hundred maniacs and idiots whose bodies he had dissected. The more I reflected upon this statement, the stronger, I.confess, was my conviction that there must be some error in it. I therefore made particular inquiry; and I feel it a duty I owe to the public, as well as to myself, to mention, that I learnt Mr. Todd's statement to be a great exaggeration of facts.

of insanity among the Parisians. One hundred and eighty-five out of 2,507 lunatics admitted into the French hospitals, were insane from drunkenness; and of these one hundred and twenty-six were men, and fifty-nine women!*

Perhaps in no instance would the liver of an habitual drunkard be found diseased, without the stomach also having undergone, by the same process, a structural lesion. Without such stimulus, gastric affections are among the most constant attendants of insanity, especially in melancholia and hypochondriacal patients.

It appears, indeed, a legitimate conclusion, that a morbid condition of the chylopoietic viscera is sympathetically a frequent cause of mental derangement.

Gastric irritation, too, is a much more frequent cause of mental derangement, through this mysterious agency, than is usually imagined. Long-continued nausea is often a precursor of a paroxysm of insanity. Violent nausea also, from sea-sickness continued for a few hours, has produced mania in three instances within my knowledge.

The efficacy of remedies, with a view to restore the functions of the digestive organs, after the violence of a paroxysm of insanity has abated, strongly implies that the disorder of them has powerfully influenced the mental derangement.

Intestinal irritation has, doubtless, its share in sympathetically influencing the brain. Some authors ascribe delirium to intestinal worms; and among the poor, who live on a bad diet, this may be a frequent cause of much sympathetical irritation of the brain.

Anatomists also describe singular states of disease of the spleen in the bodies of persons dying insane, and hence have imputed much influence to this organ. I 1 have met with two such cases on dissection; but no

* Compte Rendu, &c. 1826.

symptom existed which indicated disease of this viscus while the patients were living. Indeed, the physiology of the spleen is too obscure to justify any reliance on an opinion respecting its functions and sympathies.

The reciprocal sympathies between the uterine system and the brain, inducing insanity, are too frequent and notorious to escape observation.

In two instances I have known sudden mania originate from the irritation of cutting the dentes sapientiæ.

Mental derangement has more often its rise from scrofula than is generally supposed. If we inquire into the history of a patient, or well examine his exterior, the traces of this morbid condition will be very frequently discovered.

Scrofula very frequently extends to the brain, and then incurable insanity commonly follows. Now many physiologists insist, that this organ is a gland; and when scrofula attacks the glands, we know that it renders them unfitted for the particular function assigned to them. Cannot the brain be affected by scrofula in the same way? This is certain, that insanity grafted on scrofula is always very obstinate, unless it finds a solution in the suppurative process.

Mania alternating with the enlargement or diminution of the maxillary and sub-maxillary glands, and other cases where the induration of them always occasioned great mental excitement, sometimes occur.

The lamentable vice of masturbation is a frequent and formidable cause of insanity. It is a habit too often acquired before puberty; and if persisted in, at length subverts the constitution and the intellectual faculties. But sometimes, Pinel tells us, it is the consequence of association, in large communities of insane persons, and then it is the effect of the loss of reason.

Much has been ascribed to the influence of temperaments in predisposing to insanity generally, and also to

particular species of it. The sanguine temperament is supposed to be predisposed to mania; the nervous, characterised by extreme susceptibility, to both mania and monomania; the dry or melancholic, characterised by timidity and inquietude, to melancholy; the moist or choleric, to mania and melancholia, and sometimes to demency. Writers on insanity add the apoplectic temperament also, with a large head, as predisposing to demency.

There is, unquestionably, reason for imagining, that both our moral and mental qualities are influenced by the peculiarities of constitution; and that more of the sanguine and nervous temperament are maniacal, and of the bilious and melancholic melancholy. But the degree of minuteness to which some physiologists have descended, in connecting human peculiarities with mental aberration, can only be justified by those who still adhere to the ancient humoral theories.

What was excusable in Pinel, in his researches on a subject so neglected as he found insanity, would, now that our pathological knowledge is more extended, be mere affectation.

It may gratify curiosity, but of what practical utility have been the inquiries respecting the meagerness or obesity of the bodies of the insane, or the stature, colour of complexion, hair, and eyes?

If the character of the derangement always corresponded with such particular features, then a distinct form of insanity would be peculiar to each nation.

In the southern countries of Europe, where the inhabitants, very generally, have black eyes and hair, and dark complexions, nearly all the cases would present one character. In the northern, where these features are as commonly light and fair, the opposite. But the fact is, that insanity does not assume a specific type in any

H

country. We meet with its varieties in every constitution and in every clime.

Nevertheless, I do not infer that the doctrine of temperaments is altogether to be disregarded in medicine; for it is certain that our judgment, guided by attention to constitutional peculiarities, may frequently anticipate the nature of an approaching disease. It is to the generalisation only of the doctrine, and not to the principle, that objection lies.

Any reference to the influence of the planets as a physical cause of insanity, might be judged superfluous, were there not many who still insist on the occult operation of lunation on the human body. This impression is a remnant of astrological medicine, which assumed that all human motives, actions, and diseases, were directed by the movements of the planetary system. Hence, that the changes in our ideas and actions were regulated by the phases of the moon, became a common superstition; and hence, lunacy, derived from the Latin, luna (moon), was adopted as synonymous with the old Gothic word,

mad.

Aretæus attributed epilepsy directly to lunar influence. Galen entertained the same opinion. Celsus acknowledged the influence of the sun and moon on the human body. A century ago, Mead wrote expressly on the same subject; and he adds, that Tyson, Physician to Bedlam, observed, that the ravings of mad people kept lunar periods, accompanied by epileptic fits.

Heberden wisely remarks,* that no one has yet confirmed the opinion of the influence of the moon on the human constitution; and those who have had the best and most extensive opportunities of observation, unanimously reject it.

*Commentarii de Morb. Hist. et Cur.