A real case came under my observation a few months ago, and which is equally apposite to the subject. A young man had become insane from habitual intoxication, and during the violence of his complaint had attempted to destroy himself. Under a supposed imputation of having unnatural dispositions he had amputated his penis, with a view of precluding any future insinuations of that nature. For many months after he was admitted into the hospital, he continued in a state which obliged him to be strictly confined, as he constantly meditated his own destruction. On a sudden he became apparently well, was highly sensible of the delusion under which he had laboured, and conversed as any other person upon the ordinary topics of discourse. There was, however, something in the reserve of his manner, and peculiarity of his look, which persuaded me that he was not well, although no incoherence of ideas could be detected in his conversation. I had observed him for some days to walk rather lame, and once or twice had noticed him sitting with his shoes off, rubbing his feet. On enquiring into the motives of his doing so, he replied, that his feet were blistered, and wished that some remedy might be applied to remove the vesications. When I requested to look at his feet, he declined it and prevaricated, saying, that they were only tender and uncomfortable. In a few days afterwards, he assured me they were perfectly well. The next evening I observed him, unperceived, still rubbing his feet, and then peremptorily insisted on examining them. They were quite free from any disorder. He now told me with some embarrassment, that he wished much for a confidential friend, to whom he might impart a secret of importance. Upon assuring him that he might trust me, he said, that the boards on which he walked, (the second story) were heated by subterraneous fires, under the direction of invisible and malicious agents, whose intentions, he was well convinced, were to consume him by degrees.
From these considerations I am inclined to think, that a lucid interval includes all the circumstances which I have enumerated in my definition of it. If the person who is to examine the state of the patient’s mind be unacquainted with his peculiar opinions, he may be easily deceived, because, wanting this information, he will have no clue to direct his enquiries, and madmen do not always, nor immediately intrude their incoherent notions into notice. They have sometimes such a high degree of controul over their minds, that when they have any particular purpose to carry, they will affect to renounce those opinions which shall have been judged inconsistent: and it is well known that they have often dissembled their resentment, until a favourable opportunity has occurred of gratifying their revenge.
Among the bodily particularities which mark this disease, may be observed the protruded, and oftentimes glistening eye, and a peculiar cast of countenance which, however, cannot be described. In some, an appearance takes place which has not hitherto been noticed by Authors. This is a relaxation of the integuments of the cranium, by means of which they may be wrinkled, or rather gathered up by the hand to a considerable degree. It is generally most remarkable on the posterior part of the scalp; as far as my enquiries have reached, it does not take place in the beginning of the disease, but after a raving paroxysm of some continuance. It has been frequently accompanied with contraction of the iris.
On the suggestion of a medical gentleman, I was induced to ascertain the prevailing complexion and colour of the hair in insane patients. Out of 265 who were examined, 205 were of a swarthy complection, with dark, or black hair; the remaining 60 were of a fair skin, and light, brown, or red haired. What connection this proportion may have with the complection and colour of the hair of the people of this country in general, and what alterations may have been produced by age or residence in other climates, I am totally uninformed.
Of the power which maniacs possess of resisting cold the belief is general, and the histories which are on record are truly wonderful. It is not my wish to disbelieve, nor my intention to dispute them; it is proper, however, to state, that the patients in Bethlem hospital possess no such exemption from the effects of severe cold. They are particularly subject to mortifications of the feet; and this fact is so well established from former accidents, that there is an express order of the house, that every patient, under strict confinement, shall have his feet examined morning and evening by the keeper, and also have them constantly wrapped in flannel; and those who are permitted to go about are always to be found as near to the fire as they can get, during the winter season.
Having thus given a general account of the symptoms which I have observed to occur most commonly in persons affected with madness, I shall now lay before my readers a history of all the appearances which I have noticed on opening the heads of several maniacs, who have died in Bethlem Hospital.
CASE I.
J. H. a man twenty-eight years of age, was admitted a patient in May 1795. He had been disordered for about two months before he came into the hospital. No particular cause was stated to have brought on the complaint. It was most probably an hereditary affection, as his father had been several times insane and confined in our hospital. During the time he was in the house, he was in a very low and melancholic state; shewed an aversion to food, and said he was resolved to die. His obstinacy in refusing all nourishment was very great, and it was with much difficulty forced upon him. He continued in this state, but became daily weaker and more emaciated until August 1st when he died. Upon opening the head, the pericranium was found loosely adherent to the scull. The bones of the cranium were thick. The pia mater was loaded with blood, and the medullary substance, when cut into, was full of bloody points. The pineal gland contained a large quantity of gritty matter[1]. The consistence of the brain was natural; he was opened twenty-four hours after death.
CASE II.