This disease is characterized by sudden attacks of acute pain in the lower part of the chest, which shoots up the shoulder and extends down the arm of the left side : they are attended with laborious respiration and an apprehension of immediate suffocation, while there is frequently an irregular action of the sanguiferous sys tem, or even a temporary suspension of the motion of the heart. The paroxysms are of short duration, and come on at uncertain intervals, while, at other times, the patient is nearly in his ordinary state of health, un til the disease, by frequent repetition, gradually under mines the constitution, and the attacks become more and more violent, until at length one of them proves fatal. Their accession may generally be traced to sonie obvious exciting cause, of which the most frequent is walking briskly up a steep ascent, and this is especially the case, when the stomach is in a state of repletion ; mental emotions are also among the exciting causes of the paroxysms; and when the disease exists in its violent form, it may be induced by almost any muscular exertion, however slight, or even without any obvious cause. It is not a little remarkable, that until about the middle of the last century, this affection, although so severe and well marked in its symptoms, and not of very rare oc currence, should have passed unnoticed as a distinct dis ease. Latterly, however, its phenomena have been ac curately described, and its nature carefully examined ; and we learn, as the result of this examination, that it is generally connected with an ossification of some of the valves or orifices of the heart. Although this change of structure has not been detected in every instance, yet we may conceive of other circumstances producing a similar effect upon the transmission of the blood through the heart, and may therefore conclude that its proximate cause is always to be referred to some circumstance connected with the mechanism of the circulation. With respect to the cure of the disease, our hopes of relief must depend very much upon the period when it comes under our care ; in the latter stages, where ossification has actually taken place, we can do little more than use all our endeavours to obviate the exciting causes; but in the earlier stages, when th::re is no morbid change of structure, very decided benefit has been obtained by large caustic issues. Our attention is forcibly directed to the situation of the patient during the paroxysm, which is not only attended with exquisite suffering, but is sometimes immediately fatal. Yet it is doubtful whe ther any thing, except rest in the horizontal posture, will be of service in shortening the fit, or mitigating its violence. It is of great importance to preserve the sto mach and bowels in a healthy condition, by a strict at tention to diet and purgatives, and we muy. avoid all undue action of either the bodily or the mental powers. It does not appear that opium, or any of the antispasmo dics, afford retief in this complaint, and we conceive that the employment of stimulants or excitants might be po sitively injurious.* We have arranged the idiopathic affections of the mental faculties in a separate class, under the denomi nation of Vesanix ; for although we may conceive, that they always depend upon some derangement of the brain, the instrument by which they are exercised, yet their phenomena are so peculiar, and the relation which exists between the corporeal and the intellectual part of our frame is so obscure, as to be altogether beyond our comprehension, at the same time that the two kinds of diseases require a totally different method of treatment. This part of medicine has unfortunately been much em barrassed, by the application of what has been termed metaphysical reasoning, but which has, in fact, consisted of the use of certain ill-defined and unmeaning phrases; the effect of which has often been, to produce the same confusion in the mind of the reader, which must have existed in that of the writer. Another, and perhaps a still greater source of difficulty, in every thing that re spects the pathology of insanity, has arisen from an un reasonable prejudice that has attached to certain opi nions respecting the nature of the intellectual faculties, in consequence ot their being supposed to be adverse to religion and morals. Respecting the real merits of the doctrine of materialism, the one here alluded to, we do not pretend to decide; but we consider it a fair and tegi timate object of philosophical inquiry, and it is one which is intimately connected with any hypothesis that we may form respecting the nature of the human powers, and their relation to the external world. It has not, how ever, any immediate or necessary connexion with patho logy; for, whatever may be our opinion respecting the cause on which the faculties ultimately depend, we know that they are always exercised through the intervention of the brain ; and with respect to the subject of insanity, it becomes an important practical question, whether the structural derangement ot this organ corresponds, or is proportional to the mental disease, On this point, we arc disposed to decide in the negative ; for although we are informed, from high authority, that whenever the brain has been accurately examined in cases of insanity, some disease in its structure may be detected, we are of opinion, that it frequently bears no proportion to the vio lence of the complaint, while, on the contrary, we have equally numerous cases of great destruction, or disor ganization of the brain, without a corresponding injury of the faculties.
Insanity has been divided into different genera and spe cies ; but we think it sufficient to consider it under two forms only—that where the faculties are prevented, and that where they are, in a greater or less degree, destroy ed ; the first constituting Mania, the latter Amentia. Al though the phenomena of Mania are familiar to every one, both professional and unprofessional, yet there is perhaps no disease which it is so difficult to define, and the existence of which it is often so difficult to ascertain. The question of Insanity frequently comes to be discus sed in courts of law, and we perpetually observe men of the most acute discernment and extensive information, differ in their opinion upon particular cases that are sub jected to their judgment. This, in fact, depends upon a circumstance, which may appear sufficiently mortifying, that there are really no exact limits by which insanity can be separated from that state of mind which is deem ed sufficiently sound to enable a person to transact the usual affairs of life. The most lamentable weakness of judgment, and the most singular perversion of the rea soning powers, unless exercised in a certain way, which is dangerous to the existence of the patient, or those about him, pass by as not differing from the condition of the rest of mankind, except in degree ; and it is frequent ly from some accidental circumstance connected with it, that it acquires the name of disease, and subjects -the patient to restraint and confinement. It is indeed usually more from the degree of the affection than any thing specific in its nature, that our judgment is ultim itely formed, and rather by a detailed history of the of the case, and by comparing the present 1th the former state of the patient, than by any single diag nostic circumstance, that we finally decide.
There are several "varieties of mental derangement which it is important to attend to ; the first and most equivocal kind is that which consists in extreme caprice, or irritability of temper, and is the most difficult to dis criminate from a sound state of the mind, as passing into it by shades that are absolutely insensible. Another va riety is, where the disposition and habits undergo a com plete change, which is independent of external circum stances, or of moral causes; a state that is often charac telized by the mind becoming exclusively devoted to some one object, which is at one time of the most im portant, and at another of the most trifling nature, but still not decidedly beyond the limits of what may be con sidered as the result of rational deduction. From these we proceed to that variety of the disease where there is a complete perversion on one or two points; while on every other subject the mind retains its full powers ; and from this we glide insensibly into that deplorable condition of the human nature, where the understanding is entirely deranged—where the individual is uncon scious of the effect of his actions, and almost insensible to the impressions of surrounding objects upon the or gans of sense.
Besides the difficulty which so frequently exists re specting the actual presence of the disease, other equally embarrassing points come under the cognizance of the physician. The first of these respects the question, whether the state of the patient requires his being re moved from his friends, and whether the symptoms are such as to render him a proper inmate of a public asy lum. As a general rule, we conceive it to be clearly established, that the patient is always best managed by those whose business it is to take care of the insane; and in a great majority of instances it seems that recovery is more promoted by the patient being removed from his accustomed abode, than by any plan which can he pursued, while he is surrounded by the scenes with which he had been previously familiar. The unpleasant association which must attach to a residence in a luna tic asylum is, no doubt, an objection to the removal, and formerly, while these institutions were regarded rather as places for coercion than for medical treatment, every one must have felt anxious to avoid the painful neces sity of subjoeting a friend or a relation to their cruel discipline. The enlightened spirit of the present age has, however, happily reformed the greatest part, if not the whole, of this system, and has thus not only rescued a large portion of our fellow-creatures from unmerited suffering, but lads afforded them the prospect of a re storation to the blessings of health and the comforts of society.