Practical Observations on the Causes and Cure of Insanity. By WILLIAM SAUNDERS HALLARAN, M.D. Physician to the Lunatic Asylum of Cork, and a Corresponding Member of the Association of the King's and Queen's College of Physicians, Dublin. Second edition. Edwards and Savage, Cork; and Longman and Co. London. 8vo. pp. 213. 1818.

"Nisi sanatus animus sit, quod sine philosophia fieri non potest, finem miseriarum nullam fore."--CICERO.

"THE cloud of darkness and uncertainty which still, unfortunately," says the author, pervades this department of medical science, is deeply to be lamented. An extraordinary neglect on the part of physicians of due attention to the subject of insanity, bespeaks a supineness for which there cannot any admissible excuse."

be

We acknowledge the truth of the sentiment expressed in the first of the foregoing sentences, and shall have occasion, before we have concluded our review of this work, to notice some of the most powerful of the obstacles which have prevented the elucidation of the nature of this malady. But, that insanity has been neglected by physicians of modern ages, is not so evident. They have in general devoted as much attention to this subject as could be thus beneficially applied. The nature of the affection, from which the patients of it are ordinarily collected into particular receptacles under the superintendance of a few individuals, must however deprive the generality of physicians of the means for making original observations; but, that those who have possessed this advantage have not failed to employ it in a proper manner, is so clearly shown by the medical literature of Europe, as to render a formal demonstration of it

unnecessary.

We pass over the rest of the introduction, since it contains. nothing worthy of remark, except some erroneous doctrine respecting "mental insanity," that we shall not meet, with more fully displayed, in the author's "pathological division of insanity." Dr. Hallaran commences this subject with stating that

"A principal object of this treatise is, to point out the practical distinction between that species of insanity which can evidently, ab initio, be referred to mental causes, and may therefore be denomi nated mental insanity, and that particular excitement, which, though partaking of like effects, so far as the sensorium is engaged, might yet appear to owe its origin merely to organic disease. Authors on this subject seem, heretofore, to have passed over this necessary conside

ration."

The principal object of this treatise is, then, to advance a point of doctrine, which has not been excelled in absurdity by any of the chimerical dogmas that error has in any age intro

duced into medical reasoning. The invention of such a doctrine a few centuries since, when almost every branch of science was cultivated on erroneous principles, cannot excite our surprise; but it does this, to find it brought forward at a period when the influence of the works of BACON, of LOCKE, and of CONDILLAC, is generally diffused amongst men engaged in the pursuit of science. Bacon teaches us, that the only knowledge we can acquire of nature, is the history of phenomena evident to our senses; and the metaphysical principles of Locke and Condillac, principles acquired in the mode inculcated by Bacon, declare: the notions advanced by Dr. Hallaran respecting the human: mind to be utterly erroneous. This is the conclusion our best principles of metaphysics lead us to form respecting the proposition, that intellectual insanity can exist independant on corporeal disorder. But let us examine the subject in a physiological point of view; or rather, the arguments of this nature produced by Dr. Hallaran to support what he pleases to consider as his own original doctrine. We shall not enter into a general discussion of it, because it is of a very ancient date, and is now, we believe, almost universally abandoned. As far as we can learn from literary records, it was first adduced by, PLATO, (see his Timæus and Theatetus ;) but the Grecian physicians, cultivating physiology on the principles of HIPPOCRATES, would not admit it: it was again brought forward when the philosophy of DES CARTES, or rather of PEREYRA, came into vogue; and was finally extensively displayed by Dr. ARNOLD, in his treatise on Insanity. These observations will serve as our apology for not entering into a regular discussion of this subject.

j

The author, as his first argument, says,

"I would advert to the many well-authenticated instances of in. sanity, as they have occurred within the last twenty-five years espe cially, and are noted on the records of our lunatic asylum. Amongst those are several which have owed their origin to mental causes, strictly speaking, such as dread of punishment, loss of friends, shame, sudden terror, remorse, &c."

Every physiologist knows (it is proved by dissection) that dread, terror, remorse, and all the passions, are accompanied with inordinate cerebral actions; and LOCKE teaches us, that these inordinate actions only arise, either immediately from the impressions of external objects on the organs of sense, (to which modern physiologists are disposed to add those from the viscera, &c. but this does not alter the question in dispute;) or, subsequently, from the same actions being reproduced by the agency of memory. Dread, grief, shame, terror, remorse, &c; and their consequences, are then essentially dependant on corporeal disorder. Permanent or remittent insanity is sometimes

the result, because those causes may induce either functional or organic lesion.

The author again says,

"The influence of terror on the human mind suddenly induces uncontrollable madness, without seeming to disturb any of the principal organs of vitality."

We have never seen a case of this kind, and we do not think there is another physician in existence who believes that it can possibly happen. If Dr. Hallaran will say that he has seen instances of it, we will say that he has seen inaccurately. . But let us proceed: Dr. Hallaran says,

"I cannot question the immateriality of the mind or soul; but I will not deny that the mind or soul sickens. So long as the soul remains incorporated with man, so long will it partake of his nature, according to his attributes."

And again,

The diseased manifestations of the mind, arising from terror, grief, excess of joy, remorse, shame, loss of property, and despair, prove the sensibility of the mind, though they betray its weakness. To deny the influence of those contending passions, would be, in some respects, to stifle principle, and to sink man below the level upon which Omnipotence had thought fit to place him. If the mind never sickens, conscience, the great inquisitor and monitor of man, would' prove of no avail. Yet, this conscience, this mind, this soul, of man, is but too often most sorely afflicted. It encounters disease with a mighty struggle, and is sometimes triumphant. If the wound be deep, however, it will fall sick;' and with this sickness will come death. The spirit of a man will sustain his infirmity; but a wounded spirit who can bear? (Proverbs, ch. xviii. v. 14.)"

This is such utter and irrelevant nonsense, that we almost criminate ourselves for having thought the author's arguments on this subject worthy of our notice. But, as we have com menced, we will proceed:

"The mind is capable of impressions which evidently disturb its natural functions: it will continue thus disturbed for a series of years, and not impart any ostensible disease to the organs of life; it will be partially or generally affected, and will frequently, without any strong effort, resume its original character."

Those impressions (corporeal, of course; or, if not, what can they possibly be?) which disturb the natural functions of the mind, are disordered, or diseased, impressions. No action that destroys the harmony of the economy can be considered as an healthy action. That insanity exists for a series of years, without producing" any ostensible disease in the organs of life," is very doubtful. But this is not a point of material importance, because it is well ascertained that functional derangement, es

specially deranged circulation, will exist in the brain for years, without dissection furnishing ostensible disease. We can point out sufficient proof of this fact, and at the same time direct the attention of the reader to an excellent practical work, by referring to Dr. PARRY's Elements of Pathology.

We will not argue on the absurdity of supposing that an im. material existence can be partially diseased, and have efforts in itself by which it diseases itself, and then by an effort restores itself to health. We wish to consider the subject physiologically.

Dr. Hallaran proceeds to say,

"If the mind, under those circumstances, be not diseased, how are we to account for the relief which has been so repeatedly obtained, through agencies that cannot be supposed to influence any other than the perverted powers of the intellectual faculties ?"

The influences to which the author here alludes are moral influences, which act on the mind through the medium of the brain, and may casually relieve the disease of the brain causing diseased manifestation of the intellects, just as the same influences will remove the disease of the brain, causing epilepsy, and even lesions in the functions of more remote parts, appearing as chorea, hysteria, ague, &c.; instances of which occur almost daily to the observance of the physician. A remarkable instance of this kind is that which BOERHAAVE relates of his curing, simultaneously, a whole troop of young girls, in an orphan asylum, affected with epilepsy, by threatening to burn them if the fit again occurred, and exposing the red-hot iron to their view. The great excitement thus produced in one portion of the brain, may probably remove that existing in another, as cauteries, &c. do diseases of parts adjacent to those to which they are applied, or those distantly situated, by sympathetic or nervous influence.

Dr. Hallaran, pursuing his course, adduces the following case in support of his hypothesis:

"Mental delusions, inciting to suicide, have often occurred, and, to my knowledge, are now in danger of occurring, where no bodily infirmity has been ever ascertained to account for such a propensity, The present justly-celebrated Dr. Gregory, of Edinburgh, was accus. tomed to relate a case, in his clinical lectures, very much in point, of a man, who, in a fit of insanity, had determined on self-destruction; and who had escaped from his house in London, at night, with the determination of precipitating himself from Westminster-bridge into the Thames. When about to complete his purpose, he was suddenly assaulted by an armed footpad, who threatened him with instant death. This not being the mode by which he bad purposed to part with life, alarm for his safety instantly seized him, to the exclusion of the hallu cination which had been but the moment before predominant. Being

he Causes and Cure of Insanity. freed from his unsought danger, he, with altered sentiments, returned to his family, fully impressed with the criminality of his design, as well as relieved from the pressure of his previous perplexity.

"Are we, from this well-authenticated fact, to infer that the individual alluded to had been, at the time of so sudden a transition from disease to health, a sufferer from the consequences of mere corporeal ailment? What form of bodily complaint could have been urgent,, which, with such unexampled rapidity, was disposed to give way? We do not in general find diseases, arising from organic lesion, disposed to assume the healthy aspect with this convenient speed. The mind, we must here admit, had sickened, and was discased."

The remark we made respecting the cure of epilepsy, will also explain the nature of this case; and though "diseases arising from organic lesion are not disposed to assume the healthy aspect with this convenient speed," diseases arising from func tional derangement are thus commonly relieved; especially in the brain, where a little inordinate vascular action will produce great disturbance of its faculties. As we like to support our opinions by those of others, we refer for proofs of this statement to a work in the possession, we hope, of every medical student, -the Elements of Pathology, of Dr. Parry.*

"The sequel of this case," (of the man who intended to drown himself,) says Dr. Hallaran, "enforces the conclusion, no proof of corporeal or organic injury had been alleged." We allege again, that the existence of insanity was a proof of orga nic injury; and the want of evidence of this injury by other symptoms proves nothing, because it is so common to meet with organic lesion in the brain when it has not been suspected by every physician.

We have noticed all that the author has produced, bearing the semblance of argument, in favour of his hypothesis of the "mental origin" of insanity: we shall now extract a passage from his work, in which he himself refutes his own propositions.

"Doctor Spurzheim admits, that certainly the manifestations of the mind may be deranged.' Those manifestations I am disposed to consider as the essence of the mind at the time being. If the manifesta, tions of the mind be diseased from any given cause, they naturally must betray an unsound mind, in the ordinary acceptation."

Now, if the manifestations of the mind be the essence of the mind, (at the time being" is a vague and unmeaning expression, because the essential quality of a thing is its quality at all times and on all occasions,)-the essence of the mind must be

* We must here remark, that we speak with such approbation of this work, because of the multitude of accurate observations it contains relative to the phe nomena of disease: these are equally valuable, whatever opinion may be held of the physiological basis on which the doctrine contained in that work is raised.