It is not proposed here to give any detailed account of the nature, causes, symptoms, &c., of insanity or madness. The subject is one of great difficulty, engrossing all the powers and abilities of medical men of eminence who have devoted themselves specially to its study and treatment. It cannot, therefore, be expected that anything but a very general sketch of it can be given in such a work as this, intended for the reading of the general public. What will be attempted here will be to put down, as simply as possible, practical points connected with the causes and signs of insanity, and the general treatment of the insane, which the pub lic ought to make themselves acquainted with. The knowledge of these points may help some to regulate their own or the lives of others in a way to ward off an infliction that may be sus pected and dreaded, and may also lead to more proper views of a distressing malady about which, even yet, there are utterly erroneous views and prejudices.
For a long time the insane were regarded as people deserving of being cast outside of the pale of civilization. They were viewed as people who had been singled out by God for the purpose of being branded with marks of his special abhorrence, or as people given over to the power and kingdom of the devil. Society, therefore, could only cast them out from its midst, and humanity could have no feeling for their distresses. No wonder then that they became the victims of horrid cruelty or bar barous neglect. A hundred years have not yet elapsed since Pinel released in Paris fifty insane who had been for years chained in dungeons. Now, however, general enlightenment, and spe cially the progress of medicine, have brought about a better state of feeling. It is now recog nized that an insane or perverted state of mind is accompanied by and due to an unsound and perverted state of body. A man who suffers from breathlessness, pain, and weakness, owing to an unsound state of lungs, is pitied and cared for. It is admitted that the symptoms from which he suffers are due to a disease in his lungs, the presence of which commends him to our consideration and kindness. The brain is as much a bodily organ as the lungs ; feeling, will, intelligence, are as much the functions or duties of the brain, however much more they may be, as are all the functions involved in respiration the duties of the lungs. Interference with these functions of respiration, diseases pre venting their performance or altering and per verting their characters, are regarded as dis eases of the lung, and so interference with the intellectual faculties, altered or perverted will or feelings, are to be regarded as diseases of the brain. The man who suffers from lung disease is not regarded as a criminal or de graded, neither should the man who suffers from diseased brain. Both are unfortunate
sufferers to be dealt with patiently, and sym pathetically, and skilfully, the insane not less but rather more than the consumptive. In all cases of insanity alterations of one kind or another may be found in the tissues of the brain, and these medical science regards as the causes of the disease.
Insanity, then, is a disease of the brain, having for its symptoms enfeeblement, excite ment, or derangement of the mental faculties. This departure from the normal state of mind is shown in the speech and conduct, and often in accompanying disturbances of other bodily organs.
It is to be noted that temporary derange ment may be present, as excitement or de lirium, in fever, or due to the action of poisons like opium, belladonna, henbane, Indian hemp, or alcohol, which are not included under the term insanity.
Also it must be observed that insanity is to be regarded as a departure from the normal in the individual himself One man may have unusual ideas and actions, or his conduct may be unusual from that of his fellowmen, but that need not be insanity. We call him peculiar or eccentric. It is when a man, whose conduct and mode of life up to a particular period have been of the ordinary kind, suddenly or slowly becomes changed in character and disposition (not, it is to be noticed, suiting himself to new circumstances or new views) that his sanity may be questioned. When the cheerful man becomes morose, sullen, desponding, when the kind and gentle becomes harsh and brutal, when the virtuous becomes obscene, and the peaceful becomes violent and turbulent, it is then that there is the departure from the normal of the insane kind.
Now while insanity is a disease of the brain, nay just because it is a disease of the brain, it has causes that may be to some extent under stood, and to a large extent guarded against. Even as, to return to our former illustration, a man may have brought on the disease in his lungs we call consumption by his own neglect or folly, so may another by his own acts lay himself open to insanity. The roan who, with no great disease-resisting power, catches cold by going about in damp clothes, and then adopts no measures to drive off the attack, but permits it to take firmer and firmer grip of him, is actually responsible should consumption in course of time develop itself. Similarly an individual with a weak or excitable nervous system who indulges in excesses of passion or vice, even in passions that are not in them selves immoral, may become actually respon sible for an attack of insanity.
We shall now proceed to discuss briefly in detail the various causes of insanity.