Part 24

Sweden 1 in 92,375 The Milanais 1 ... 72,570 Russia, 1819-1820 1 ... 36,860 ---- 1824-1827 1 ... 34,246 Prussia 1 ... 14,224 Saxony 1 ... 8,446 St. Petersburg 1 ... 416 London, 18th century 1 ... 10,572 ---- 19th century 1 ... 21,491 Paris 1 ... 2,215 Geneva 1 ... 3,714 Berlin, 1788-1797 1 ... 23,066 ---- 1798-1807 1 ... 12,917 ---- 1813-1822 1 ... 3,312 Hamburg 1 ... 4,800 Leipzig 1 ... 3,143 Milan 1 ... 1,821 Naples 1 ... 27,230 New York 1 ... 9,474 Baltimore 1 ... 15,696 Philadelphia 1 ... 20,000

According to our ingenious author, drunkenness is the chief cause of suicide in England, Prussia, and Germany; love and gambling in France; whilst bigotry, or the fear of dying without having received the sacrament, he supposes, prevents it in Spain, where, comparatively speaking, suicide is seldom heard of.

The same remark may apply to Italy, where a Roman lady, having heard of such an action, exclaimed, "_Dev' essere un forestiere; gli Italiani non sono tanto matti_." She was right, the suicide was a melancholy German tailor.

In India, where the doctrine of predestination is generally prevalent, it is calculated that in one year there were forty suicides in a population of 250,000, twenty-three of which were females.

Arntzenius quotes Gall's opinion, that suicide arises from too great a predominance of the organ of cautiousness. Combe and other phrenologists are of opinion, that with this predominance a deficient development of hope and a large destructiveness must be conjoined.

It has been remarked that in Spain and Portugal, where insanity is comparatively rare, malconformation of the brain and consequent idiotism are very frequent.

Since the peace it may be more difficult to arrive at any conclusion on the subject of increase of lunacy, founded on the admission of lunatics into public and private establishments, since emigration has carried so many families and operatives of every description abroad, many of whom, from various disappointments and vexations, might have been predisposed to insanity.

It appears that in 1836 there existed in England and Wales 6402 lunatics, 7265 idiots--13,667 lunatics and idiots. Of paupers alone, or lunatics and idiots, there were 1.00098 of the total population, or 1 in 1024.

However, according to the most probable calculation, the number of lunatics in England amounts to about 14,000, out of which about 11,000 are paupers. Idiots are nearly as numerous as lunatics. Sir A. Halliday states the former to amount to 5741, and the latter to 6806. To this it must be observed that many harmless idiots are allowed to remain in their usual residence. In Wales it appears that idiots are to lunatics in the proportion of seven to one. The difficulty of obtaining any certain information on this subject, however, is such, that it is scarcely possible to decide the question with any chance of a probable certainty.

In regard to the prevalence of lunacy in other countries, the following are curious statistical statements:

In Spain, in 1817, according to the report of Dr. Luzuriaga, there only existed in the asylums of Toledo, Granada, Cordova, Valencia, Cadiz, Saragossa, and Barcelona, 509 lunatics--only fifty were in the hospitals of Cadiz, sixty in that of Madrid, and thirty-six in the kingdom of Granada.

In Italy, in twenty-five asylums in Turin, Genoa, Milan, Brescia, Verona, Venice, Parma, Modena, Bologna, Ferrara, Florence, Sienna, Lucca, and Rome, Mr. Brierre only found 3441 patients. The population of these parts of Italy amounting to about 16,789,000 inhabitants, which gives one lunatic to 4879 persons.

Scott, who accompanied Lord Macartney's embassy to China, observed that very few insane persons were to be found there. Humboldt states that madness is rare amongst the natives of South America. Carr made the same remark in Russia. In Spain and Italy, religious melancholy, and that most vexatious species of insanity called _erotomania_, are the more common.

In the savage tribes of Africa and America insanity is very rare. Dr. Winterbotham affirms, that among the Africans near Sierra Leone, mania is a disease which seldom if ever occurs. Idiotism was likewise a rare phenomenon among them. Among the negro slaves in the West Indies it is scarcely known, and during three years' residence in the Bahamas, only one case of monomania fell under my observation. Amongst the native races of America it scarcely exists. From these observations we may conclude, with Esquirol, that insanity belongs almost exclusively to civilized races of men, that it scarcely exists among savages, and is rare in barbarous countries. To what circumstance are we to attribute this exemption? Possibly it may be attributed to simplicity in living, which predisposes to less disease and morbid varieties of organization, and to the absence of that refined education which exposes man to the artificial wants and miseries of high civilization. It is moreover probable that the constant occupation which the existence of the savage requires to satisfy his absolute necessities, does not leave him leisure time to ponder over gloomy ideas and fictitious sufferings. In addition to these circumstances, Dr. Pritchard has justly remarked, that we might also conjecture that congenital predisposition is wanting in the offspring of uncivilized races. The same author admits the probability of the brain receiving a different development in the progeny of cultivated races, or of those whose mental faculties have been awakened.

Various professions have been supposed to exercise much influence on the intellectual faculties. The following observations at the Salpétrière during one year may tend to illustrate this subject:

Field labourers 43 Servants 51 Needlework women 85 Cooks 16 Shopkeepers 21 Pedlars 16 Shoemakers 8 House-painters and varnishers 5 Housekeepers 192 Women of the town 33

In Mr. Esquirol's establishment:

Farmers 3 Military men 33 Seamen 3 Merchants 50 Students 25 Clerks in public offices 21 Engineers 2 Lawyers 11 Chemists 4 Physicians 4 Artists 8

According to the prevalence of the ideas connected with their former pursuits do we observe the hallucination of these unfortunate persons to be of a different character. Dr. Abercrombie relates the case of a Scotch clergyman, who was brought before a jury to be what is called in Scotland _cognosced_, or declared incapable of managing his affairs. Amongst the acts of extravagance alleged against him was, that he had burnt his library. When he was asked by the jury what account he would give of this part of his conduct, he replied in the following terms: "In the early part of my life I had imbibed a liking for a most unprofitable study, namely, controversial divinity. On reviewing my library, I found a great part of it to consist of books of this description, and I was so anxious that my family should not be led to follow the same pursuits, that I determined to burn the whole." He gave answers equally plausible to questions which were put to him respecting other parts of his conduct; and the result was, that the jury found no sufficient ground for cognoscing him; but in the course of a fortnight from that time, he was in a state of decided mania.

What a school of humility is a lunatic asylum! What a field of observation does it not present to the philosopher who ranges among its inmates! We find the same aberrations that obtain in society; similar errors, similar passions, similar miserable self-tormenting chimeras, empty pride, worthless vanity, and overweening ambition. There we

See that noble and most sovereign reason, Like sweet bells jangled, out of tune and harsh.

Each madhouse has its gods and priests, its sovereigns and its subjects, terrific mimicry of worldly superstitions, pomp, pride, and degradation! There, tyranny rules with iron sway, until the keeper's appearance makes tyrants know there does exist a power still greater than their own. In madhouses egotism prevails as generally as in the world, and nothing around the lunatic sheds any influence unless relating to his wretched self. In this struggle between the mind and body, this constant action and reaction of the moral and the corporeal energies, when reason has yielded to the brute force of animal passions, and the body with all its baseness has triumphed over the soul, one cannot but think of Plutarch's fanciful idea, that, should the body sue the mind for damages before a court of justice, it would be found that the defendant had been a ruinous tenant to the plaintiff.

In many cases of insanity we observe a singular fertility of glowing imagination and a vivacity of memory which is often surprising. Dr. Willis mentions a patient who was subject to occasional attacks of insanity, and who assured him that he expected the paroxysms with impatience, as they proved to him a source of considerable delight. "Every thing," he said, "appeared easy to me. No obstacles presented themselves either in theory or in practice. My memory acquired of a sudden a singular degree of perfection. Long passages of Latin authors occurred to my mind. In general I have great difficulty in finding rhythmical terminations, but then I could write verse with as much facility as prose."

Old associations thus recalled into the mind are often mixed up with recent occurrences, in the same manner as in dreaming. Dr. Gooch mentions a lady who became insane in consequence of an alarm of fire in her neighbourhood. She imagined that she was transformed into the Virgin Mary, and that a luminous halo beamed round her head.

It is said that the Egyptians placed a mummy at their festive board, to remind man of mortality. Would not a frequent visit to a lunatic asylum afford a wholesome lesson to the reckless despot, the proud statesman, and the arbitrary chieftain? There they might converse with tyrants, politicians, and self-created heroes, in all the naked turpitude of the evil passions, who in their frantic gestures would show them that which they wish to be--that which the world considers they are! Often would they hear the maniac express the very thoughts that ruffle their own pillows, until the dreaded bell that announces the doctor's visit, and which with one loud peal destroys his fond illusions, herald of that knell which sooner or later must call them from the busy world they think their own. How beautifully has Filmer expressed the madman's fears!

See yon old miser laden with swelling bags Of ill-got gold, with how much awkward haste He limps away to shelter! See how he ducks, And dives, and dodges with the gods; and all Only in hope to avoid, for some few days Perhaps, the just reward of his own sad extortions. The hot adulterer, now all chill and impotent With fear, leaps from the polluted bed, And crams himself into a cranny! There mighty men of blood, who make a trade Of murder, forget their wonted fierceness; Out-nois'd, they shrink aside, and shake for fear O' th' louder threat'nings of the angry gods.

Whatever may be the nature of insanity or our fallacious views regarding it, it is a matter of great consolation to find that our mode of treating it is at last founded on rational and humane principles. The unfortunate lunatic is no longer an object of horror and disgust, chained down like a wild beast, and sunk by ignorance or avarice, even below the level of that degradation in the scale of human beings, to which it had pleased Providence to reduce him,--we no longer behold him rising from his foul and loathsome bed of straw, scantily covered with filthy tatters, his hair and beard wild and grisly--his eyes under the influence of constant excitement, darting menacing looks--the foam bubbling through his gnashing teeth--clanking his fetters with angry words and gestures, threatening heaven and earth--gazed at with dismay, through massive bars--the very female seeming of doubtful sex:

Her unregarded locks Matted like fury-tresses, her poor limbs Chain'd to the ground; and stead of those delights Which happy lovers taste, her keeper's stripes, A bed of straw, and a coarse wooden dish Of wretched sustenance.[18]

Now, the unfortunate persons are restored to social life as much as their sad condition allows; they enjoy every comfort that can solace them in their lucid intervals, when their hallucinations cease; in illness they are treated with kindness and liberality, and in health, their former associations with the busy world, are recalled by labour, voluntarily performed or stimulated by the incentive of some additional comfort. No coercion is resorted to, except to prevent the furious maniac from injuring himself and others, and then, such means are adopted that restrain his violence without a painful process. Even the straight waistcoat, which impedes respiration, is generally banished in all well-regulated establishments, and belts, sleeves, and muffs, which merely secure the hands, without preventing a free motion of the articulations, are usually resorted to. To such an extent is healthy occupation carried on in lunatic asylums, that at this moment at Hanwell, out of upwards of 600 inmates under my care, 421 are at work and distributed as follows:

_Males._

57 Working in the garden and grounds. 53 Handicrafts at various trades. 38 Assistants in the wards. 28 Picking coir, or the external fibre of the cocoa-nut, for stuffing mattresses, &c. 2 Clerks in the office. ---- 178 ----

_Females._

120 At needlework. 2 Making brushes. 21 In the kitchen and dairy. 21 Assisting in the wards. 26 Picking coir. 30 Working in the garden. 23 In the laundry. ---- 243 ----

Hanwell may be said to be an asylum for incurables, since it is doomed to receive old cases that scarcely ever afford a chance of recovery; to which are added a large proportion of the idiots and epileptics of Middlesex, whose families cannot support them.

Let us hope from this gradual amelioration in the condition of this illfated class of our fellow-creatures, that every institution, both public and private, will shortly be conducted upon a similar plan, having sufficient grounds attached to it, to give occupation to such of their inmates as may still be able to enjoy some share, however trifling it may be, of the blessings of this life.

LEPROSY.

Bontius informs us that this disease was observed on the banks of the Ganges, where it was known by the name of _Cowrap_. Kaempfer noticed it in Ceylon and Japan. In Sumatra, whole generations are infected with both leprosy and elephantiasis; and those who are labouring under the latter disease, although it is not contagious, are driven into the woods. Christopher Columbus found lepers in the island of Buona Vista in 1498, and frictions of turtle blood were used to relieve them.

In our days it is a disease of rare occurrence, at least in Europe; yet it was observed at Vetrolles and Martignes, in France, in 1808, and at Pigua and Castel Franco, in Italy, in 1807. The elephantiasis still prevails in our West India colonies, more especially that species which is called "elephant leg," and which is not uncommon at Barbadoes, St. Christopher, and Nevis. Parsons, in his Travels in Asia and Africa, informs us that a similar complaint exists on the coast of Malabar, where it is called the "Cochin leg." The Hindoo physicians treat it with pills of arsenic and black pepper.

A curious species of leprosy appeared in Rome under the reign of Tiberius, which was brought thither from Asia. The eruption first broke out upon the chin, whence it was called _Mentagra_, and is thus alluded to by Martial:

Non ulcus acre, pustulæve lucentes; Nec triste mentum, sordidive lichenes.

From the chin it extended over the entire body, and on its disappearance left scars more unsightly, if possible, than the former disease. Its virulence and difficulty of cure induced the Romans to send to Egypt for attendance. The same disease prevailed in the second century, and Soranus, a physician of Aquitania, was sent for to heal it. Crispus, a friend of Galen, is said to have discovered the best method of cure. Pliny has given an accurate account of the mentagra in his Natural History, lib. xxvii. cap. 1. According to the same writer, elephantiasis was brought to Rome by Pompey's troops. Plutarch fixes its apparition to the time when Asclepiades of Bithynia flourished as one of his disciples. Themison wrote a treatise on the disease, which is mentioned by Cælius Aurelianus, but has not been preserved from the ravages of time. Lucilius called the affection _odiosa Vitiligo_. The _Gemursa_ of Pliny appears to have been a similar complaint; and Triller thinks that it was the _Gumretha_ of the Talmud.

Formerly, in England, the causes of lepers were committed to the ecclesiastical courts, as it was prohibited to prosecute a leper before a lay judge, as they were under the protection of the church, which separated them from the rest of the people by a ritual. At this period a law existed, called _Leproso amovendo_, for the removal of lepers who ventured to mix in society. Thus leprosy may be considered one of the most terrific maladies inflicted on mankind. Holy Writ affords us abundant proofs of its fatal character. It is probable that this disease was first observed under the scorching sun of Egypt, whence it spread its ravages to Greece and Asia; and when the East was obliged to submit to the Roman legions, the conquerors carried the scourge of the vanquished to their own country. From Italy the disorder extended to France; and in the reign of Philip I. we find some members of the church militant, called _hospitaliers_, who spent their arduous life in attending upon lepers, and waging war against the infidels.

The Hebrew tribes, on quitting Egypt, were subject to three kinds of leprosy; all of them were distinguished by the name of _Berat_ ([Hebrew]), or "bright spot." One called _Boak_ ([Hebrew]), of a dull white; and two named _Tsorat_ ([Hebrew]), or "venom or malignity:" the first variety of the latter being the _Berat Lebena_, or bright white berat; and the next the _Berat Cecha_, or the dark and dusky berat; both of which were highly contagious, and rendered those who laboured under their attack unclean, and dangerous to society.

Manetho, Justin, and several historians, pretend that the Hebrews were expelled from Egypt in consequence of their being infected with this formidable disease; a reproach from which Josephus attempted to exculpate his countrymen. It appears, however, that, during their captivity of one hundred and thirty-four years, the Israelites laboured under this awful visitation; and, three thousand years after their migration we find Prosper Alpinus describing the banks of the Nile as the principal seat of the disease. Lucretius gives the same account of it:

Est Elephas morbus, qui, propter flumina Nili Gignitur, Ægypto in mediâ, neque præterea usquam.

Pliny and Marcellus Empiricus refer the calamity to the same source. They state, however, that it was more general in the lower classes, although it sometimes attacked their sovereigns; an event which added to the horrors of the infliction, since it appears that royalty had the privilege of bathing in human blood as one of the most effectual curative means. Gaul and Avicenna attribute its fatal prevalence in Alexandria to the influence of the climate, and the quality of their food. The Persian writer thus expresses himself: "Et quando aggregatur caliditas aëris cum malitiâ cibi, et ejus essentia ex genere piscium, et carne salitâ, et carne grossâ, et carnibus asinorum, et lentibus, procul dubio est ut eveniat lepra, sicut multiplicatur in Alexandriâ."

The _Boak_, or slighter berat, which is not considered to be contagious, still bears the same denomination amongst the Arabs, and is the [Greek: lepra alphos] or dull white leprosy of the Greeks. The bright white and dusky berats of the Hebrews were distinguished on account of their malignity, and with the _Tsorat_ ([Hebrew]) are still called among the Arabians by the Hebrew generic term with a very slight alteration, for the _Berat Lebena_ is their _Beras Bejas_, and the _Berat Cecha_, the _Beras Asved_.

While the Arabians borrowed the Hebrew terms, the Greeks took their denominations from the same source; and from _Tsorat_ they adopted the word _Psora_. The _Tsorat_ is restrained by the Hebrews to the contagious form of leprosy. Amongst the Greeks Lepra was a generic synonyme of _Berat_ or _Beras_.

This confusion in the adaptation of the names given to the varieties of leprosy has occasioned much perplexity in the study of the disease. Actuarius, in endeavouring to rectify these errors, has produced a greater confusion. According to him, they are different forms of a common genus. However, the most important distinction was that which defined the contagious and the non-contagious forms. The leprosy described by Moses under the name of _Boak_ or _Bohak_ was the [Greek: alphos] of Hippocrates; _Seeth_ the [Greek: phakos]; _Saphachath_ and _Misphachath_ the [Greek: leichên]; and _Bahereth_ the [Greek: leukê]; and according to Carthenser and other writers, this leprosy was the _Leucé_ of the Greeks.

The elephantiasis was long confounded with leprosy; but the former is a tubercular affection of the skin, widely different from the scaly leprosy, and certainly not contagious. Its singular name was derived from the condition of the surface of the huge misshapen limbs of those who were affected with the malady, and which bore some resemblance to the leg of an elephant. This morbid state is not uncommon in the island of Barbadoes, and in England it has been called "the Barbadoes leg." The original Arabic name for this affection was _Dal Fil_, or "the elephant's disease," which is now the common denomination; although it is frequently abridged into _Fil_ alone, literally _Elephas_. The elephantiasis is not even alluded to by Moses in his descriptions of leprosy. However, the elephant leg of the Arabians is a disease totally different from the specific elephantiasis, which is a disorder of the skin, the roughness of which led to the name, and which the Arabians called _Juzam_ or _Judam_.