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  OBSERVATIONS ON MADNESS AND MELANCHOLY:

  INCLUDING PRACTICAL REMARKS ON THOSE DISEASES;

  TOGETHER WITH CASES:

  AND AN ACCOUNT OF THE MORBID APPEARANCES
  ON _DISSECTION_.


  BY JOHN HASLAM,

  LATE OF PEMBROKE HALL, CAMBRIDGE;
  MEMBER OF THE ROYAL COLLEGE OF SURGEONS,
  AND APOTHECARY TO BETHLEM HOSPITAL.

  _The Second Edition, considerably enlarged._

  "Of the uncertainties of our present state, the
  most dreadful and alarming is the uncertain
  continuance of reason."
                          Dr. JOHNSON'S RASSELAS.


  London:

  PRINTED FOR J. CALLOW, MEDICAL BOOKSELLER,
  CROWN COURT, PRINCES STREET, SOHO;
  BY G. HAYDEN, BRYDGES STREET, COVENT GARDEN.
  1809.




  AS A GRATEFUL ACKNOWLEDGMENT
  FOR MANY FAVOURS,
  AN OBLATION TO SUBSISTING FRIENDSHIP,
  AND A TRIBUTE TO SUPERIOR JUDGMENT,
  EXERCISING THE PROFESSION OF MEDICINE WITH
  SKILL AND LIBERALITY:
  THE PRESENT VOLUME IS RESPECTFULLY
  DEDICATED TO
  DR. THOMAS MONRO,
  A FELLOW OF THE COLLEGE, AND PHYSICIAN
  TO BETHLEM HOSPITAL.




Preface.


_The alarming increase of Insanity, as might naturally be expected, has
incited many persons to an investigation of this disease;--some for the
advancement of Science, and others with the hope of emolument._

_More than ten years having elapsed since the publication of the
"Observations on Insanity," a trifle, which the Profession has held in
greater estimation than its intrinsic merits could justify: the present
work is modestly introduced to the public notice, as a corrected copy of
the former, with considerable additions, which the extensive scope of
Bethlem Hospital would have furnished more liberally to a more intelligent
observer._

_To have taken a comprehensive survey of the human faculties in their
sound state; to have exhibited them impaired by natural decay, and
transformed by disease, would have implied an ability to which I cannot
pretend; would have required many volumes to unfold, and perhaps more
patience than any rational experience could have attributed to the reader.
The contents of the following pages are therefore to be considered as an
abbreviated relation, and condensed display of many years observation and
practice, in a situation affording constant opportunities and abundant
supplies for such investigations._

_It is natural to presume, that amongst my professional acquaintance the
subject of Insanity must have been frequently introduced as a topic of
discourse; and I am ready to acknowledge, that I have often profited by
their remarks and suggestions: but I should be ungrateful were I not to
confess my particular obligations to my esteemed friend, Anthony Carlisle,
Esq. Surgeon to the Westminster Hospital, for many corrections, and some
communications, which I shall ever value as judicious and important._

  BETHLEM HOSPITAL,
  NOV. 21, 1808.




ERRATA.


  _Page_ 3, _line_ 7, _for_ controverted, _read_ converted.
         5,        2, _for_ phrenitic, _read_ phrenetic.
        90,        3, _for_ hyatids, _read_ hydatids.
       254, _in the Table_, _for_ manical, _read_ maniacal.




OBSERVATIONS ON MADNESS, &c. &c.




CHAPTER I.

DEFINITION.


There is no word in the English language more deserving of a precise
definition than madness: and if those who have treated on this subject
have been so unfortunate as to disagree with each other, and consequently
have left their readers to reconcile their discordant opinions; yet it
must be confessed that considerable pains have been bestowed, to convey a
clear and accurate explanation of this term. Although this contrariety of
sentiment has prevailed concerning the precise meaning of the word
madness, medical practitioners have been sufficiently reconciled as to the
thing itself: so that when they have seen an insane person, however
opposite their definitions, they have readily coincided that the patient
was mad.

From this it would appear that the thing itself, is, generally speaking,
sufficiently plain and intelligible; but that the term which represents
the thing is obscure. Perhaps, we might be somewhat assisted, by tracing
back this word, in order to discover its original meaning, and shewing
from its import the cause of its imposition.

If the reader, as is now the custom, should turn to Johnson's Dictionary
for the meaning and etymology of this word, he will find that the Doctor
has derived it both from the Anglo-Saxon gemaad and the Italian
_matto_; but without giving any meaning as the cause of its employment.
The word is originally Gothic, and meant anger, rage, [Gothic: Mod].
[Mod]. It is true that we have now controverted the o, into a, and write
the word mad: but mod was anciently employed.

  "Yet sawe I MODNESSE laghyng in his _rage_."
          _Chaucer. Knight's Tale, fol. 1561, p. 6._

There is so great a resemblance between anger and violent madness, that
there is nothing which could more probably have led to the adoption of the
term. Dr. Beddoes, who appears to have examined the subject of insanity
with the eye of an enlightened philosopher, is decidedly of this opinion,
he says, HYGEIA, _No. 12, p. 40_, "Mad, is one of those words which mean
almost every thing and nothing. At first, it was, I imagine, applied to
the transports of rage; and when men were civilized enough to be capable
of insanity, their insanity, I presume, must have been of the frantic
sort, because in the untutored, intense feelings seem regularly to carry a
boisterous expression."

MAD is therefore not a complex idea, as has been supposed, but a complex
term for all the forms and varieties of this disease. Our language has
been enriched with other terms expressive of this affection, all of which
have a precise meaning. Delirium, which we have borrowed from the latin,
merely means, _out of the track_, de lira, so that a delirious person, one
who starts out of the track regularly pursued, becomes compared to the
same deviation in the process of ploughing. _Crazy_, we have borrowed from
the French _ecrase_, crushed, broken: we still use the same meaning, and
say that such a person is crack'd. Insane, deranged, or disarranged,[1]
melancholic, out of one's wits, lunatic, phrenitic, or as we have
corrupted it, frantick, require no explanation. _Beside one's self_ most
probably originated from the belief of possession by a devil, or evil
spirit.

The importance of investigating the original meaning of words must be
evident when it is considered that the law of this country impowers
persons of the medical profession to confine and discipline those to whom
the term mad or lunatic can fairly be applied. Instead of endeavouring to
discover an infallible definition of madness, which I believe will be
found impossible, as it is an attempt to comprise, in a few words, the
wide range and mutable character of this Proteus disorder: much more
advantage would be obtained if the circumstances could be precisely
defined under which it is justifiable to deprive a human being of his
liberty.

Another impediment to an accurate definition of madness, arises from the
various hypotheses, which have been entertained concerning the powers and
operations of the human mind: and likewise from the looseness and
unsettled state of the terms by which it is to be defined.

Before treating of the intellect in a deranged state, it will perhaps be
expected that some system of the human mind, in its perfect and healthy
condition, should be laid down. It will be supposed necessary to establish
in what sanity of intellect consists, and to mark distinctly some fixed
point, the aberrations from which are to constitute disease.

To have a thorough knowledge of the nature, extent, and rectitude of the
human faculties, is particularly incumbent on him who undertakes to write
of them in their distempered state; and, in a legal point of view, it is
most important that the medical practitioner should be enabled to
establish the state of the patient's case, as a departure from that which
_is_ reason.

The difficulty of proposing a satisfactory theory of the human mind, must
have been felt by every person, who has touched this delicate string since
the days of Aristotle, and failure must be expected in him who attempts
it: yet the endeavour is laudable, and miscarriage is not linked with
disgrace. Every contribution, to illustrate what are the powers of mind we
possess; how we are acted upon by external circumstances in the
acquisition of knowledge; and concerning the manner in which we use this
knowledge for the purposes of life; ought to be candidly received.

Enquiries of this nature have been usually conducted by commenting on the
numerous and discordant authorities which have treated on metaphysical
subjects; these persons, however they may differ on many points, appear to
be pretty generally agreed, that the human mind possesses certain
faculties and powers; as imagination, judgment, reason, and memory. They
seem to consider these, as so many departments, or offices of the mind,
and therefore class men according to the excellence or predominance of
these powers. One man, is said to be distinguished by the brilliancy of
his imagination; another, by the solidity of his judgment; a third, by the
acuteness of his reason; and a fourth, by the promptitude and accuracy of
his recollection.

As far as I have observed respecting the human mind, (and I speak with
great hesitation and diffidence,) it does not possess, all those powers
and faculties with which the pride of man has thought proper to invest it.
By our senses, we are enabled to become acquainted with objects, and we
are capable of recollecting them in a greater or less degree; the rest,
appears to be merely a contrivance of language.

If mind, were actually capable of the operations attributed to it, and
possessed of these powers, it would necessarily have been able to create a
language expressive of these powers and operations. But the fact is
otherwise. The language, which characterizes mind and its operations, has
been borrowed from external objects; for mind has no language peculiar to
itself. A few instances will sufficiently illustrate this position. After
having committed an offence it is natural to say that the mind feels
contrition and sorrow.

Contrition is from _cum_ and _tero_, to rub together, which cannot
possibly have any thing to do with the operations of the mind, which is
incapable of rubbing its ideas or notions together. Contrition is a
figurative expression, and may possibly mean the act of rubbing out the
stain of vice, or wearing down by friction the prominences of sin.

If we were to analyze the word Sorrow, which is held to be a mental
feeling, we should find it to be transferred from bodily sufferance: for
the mind, is incapable of creating a term correctly expressive of its
state, and therefore, it became necessary to borrow it from _soreness_ of
body.--_See Mr. Tooke's Diversions of Purley, vol. ii. p. 207_, where
_sore_, _sorry_, and _sorrow_ are clearly made out to be the same word.

It is customary to speak of a man, of accurate perceptions, and of
another, who has grand and luminous conceptions of human nature.
Perception, from _per_, and _capio_ to take, seize, grasp, through the
medium of the organs of sense, being implied. But to take, seize, and
grasp are the operations of the hand, and can only, by extreme courtesy,
be attributed to mind.

Mr. Dugald Stewart, the most thoughtful and intelligent of modern
metaphysicians, has said, "By conception I mean that power of the mind
which enables it to form a notion of an absent object of perception, or of
a sensation which it has formerly felt."--_Elements of the Philosophy of
the Human Mind, 8vo. p. 133._

This definition means merely memory; and by perusing attentively the whole
chapter the reader will be convinced of it. Conception, from _cum_ and
_capio_, has been applied to mind from the physical sense of embracing,
comprehending, or probably from the notion of being impregnated with the
subject. It may be remarked, that these three terms, by which conception
has been explained, have been all applied to mental operation.

The words reason and reasoning, I believe, in most languages, strictly
imply numeration, reckoning, proportion; the Latin _ratio_, _ratiocinor_,
_ratiocinator_ are sufficient examples. A curious coincidence between the
Latin _ratio_ and the Gothic _rathjo_, together with some pertinent and
interesting observations, may be seen in Ihre's Glossarium Svio-gothicum,
_p._ 393, _art._ Raekna. As we now acknowledge the science of number to be
the purest system of reasoning, a system, on which all persons agree, and
so unlike medicine, politics, and divinity, concerning which there is a
constant, and hostile variety of sentiment, it adds some force to the
argument. Indeed, Mr. Locke, who almost personifies reason, after having
painfully sifted this matter, appears to be much of the same way of
thinking: he says, "Reason, though it penetrates into the depth of the sea
and earth, elevates our thoughts as high as the stars, and leads us
through the vast spaces and large rooms of this mighty fabrick, _yet it
comes far short of the real extent of even corporeal being_; and there are
many instances wherein it fails us: as,

"First: it perfectly fails us where our ideas fail: it neither does, nor
can extend itself farther than they do, and therefore, wherever we have no
ideas our reasoning stops, and we are at an end of our reckoning: and if
at any time _we reason about words, which do not stand for any ideas_, it
is only about those sounds, and nothing else.

"Secondly: our reason is often puzzled, and at a loss, because of the
obscurity, confusion or imperfection of the ideas it is employed about;
and there we are involved in difficulties and contradictions. Thus, not
having any perfect idea of the least extension of matter, nor of infinity,
we are at a loss about the divisibility of matter; _but having perfect,
clear, and distinct ideas of number, our reason meets with none of those
inextricable difficulties in numbers, nor finds itself involved in any
contradictions about them_."--_Works. 4to, vol. i, p. 431._

It can scarcely be necessary, longer to fatigue the patience of the
reader, by reverting to the etymology of those terms, which have been
considered as significant of mind and its operations. Every one will be
able sufficiently to develope imagination, reflection, combination, [as
applied to ideas, importing the amalgamation of _two_ into one]
abstraction, [_vide Mr. Tooke, from p. 15 to 426, vol. ii._] and a
variety of others; and to shew, that they have arisen from physical
objects, and the circumstances which surround us, and are independant of
any operation which mind has elaborated.

But as madness, by some, has been exclusively held to be a disease of the
imagination, and by others, to be a defect of the judgment; considering
these as separate and independant powers or faculties of the intellect; it
is certainly worth the trouble to enquire, whether such states of mind did
ever exist as original and unconnected disorders. With respect to
imagination, there can be but little difficulty; yet this will so far
involve the judgment and memory, that it will not be easy to institute a
distinction. If a cobbler should suppose himself an emperor, this
supposition, may be termed an elevated flight, or an extensive stretch of
imagination, but it is likewise a great defect in his judgment, to deem
himself that which he is not, and it is certainly an equal lapse of his
recollection, to forget what he really is.

Having endeavoured to give some reasons for not according with the
generally received opinions, concerning the different powers of the mind,
it may be proper shortly to state, that, from the manner in which we
acquire knowledge, the human mind appears to be composed of a sum of
individual perceptions: that, in proportion as we dwell by the eye, the
ear, or the touch on any object (which is called attention,) we are more
likely to become acquainted with it, and to be able to remember it. For
the most part, we remember these perceptions in the succession in which
they were presented, although, they may afterwards, from circumstances, be
differently sorted.

The minds of ordinary men are well contented to deal out their ideas, in
the order in which they were received; and, not having found the necessity
of bringing them to bear on general subjects, they are commonly minutely
accurate in the detail of that which they have observed. By such persons,
a story is told with all the relations of time and place; connected with
the persons who were present, their situation, state of health, and a vast
variety of associated particulars; and these persons, however tedious,
generally afford the most correct account. On the other hand, those who
are men of business, and have much to communicate in a given space, are
obliged to subtract the more material circumstances from the gross
narrative, and exhibit these as the sum total. It is in this way, that
words, originally of considerable length, have been abbreviated for the
conveniency of dispatch, and from this necessity short hand writing has
been employed.

As the science