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قراءة كتاب Observations on Insanity With Practical Remarks on the Disease and an Account of the Morbid Appearances on Dissection
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Observations on Insanity With Practical Remarks on the Disease and an Account of the Morbid Appearances on Dissection
credulity. There are many honest men in this kingdom who would not sleep quietly, if a vessel filled with quicksilver were to be brought into their houses; they would perhaps feel alarmed for the chastity of their wives and daughters; and this, because they had been taught to consider that many strange and unaccountable properties are attached to that metal. If a lecturer on chemistry were to exhibit the same fears, there could be no doubt that he laboured under a disorder of intellect, because the properties of mercury would be known to him, and his alarms would arise from incorrectly associating ideas of danger, with a substance, which in that state is innoxious, and whose properties come within the sphere of his knowledge.
As the terms Mania, and Melancholy, are in general use, and serve to distinguish the forms under which insanity is exhibited, there can be no objection to retain them; but I would strongly oppose their being considered as opposite diseases. In both, the association of ideas is equally incorrect, and they appear to differ only, from the different passions which accompany them. On dissection, the state of the brain does not shew any appearances peculiar to melancholy; nor is the treatment which I have observed most successful, different from that which is employed in Mania.
CHAP. II.
SYMPTOMS OF THE DISEASE.
With most authors, this part of the subject has occupied the greatest share of their labour and attention: they have generally descended to minute particularities and studied discriminations. Distinctions have been created, rather from the peculiar turn of the patients propensities and discourse, than from any marked difference, in the varieties, and species of the disorder: and it has been customary to ornament this part of the work with copious citations from poetical writers. As my plan extends only to a description of that which I have observed, I shall neither amplify, nor embellish my volume by quotations.
In most public hospitals, the first attack of diseases is seldom to be observed; and it might naturally be supposed, that there existed in Bethlem, similar impediments to an accurate knowledge of madness. It is true, that all who are admitted into it have been a greater, or less time afflicted with the complaint; yet from the occasional relapses to which insane persons are subject, we have frequent and sufficient opportunities of observing the beginning, and tracing the progress of this disease.
Among the incurables, there are some who have intervals of perfect soundness of mind; but who are subject to relapses, which would render it improper, and even dangerous, to trust them at large in society: and with those who are upon the curable list, a recurrence of the malady very frequently takes place. Upon these occasions, there is ample scope for observing the first attack of the disease.
To enumerate every symptom would be descending to useless minutiæ, I shall therefore content myself with describing the more general appearances.
They first become uneasy, are incapable of confining their attention, and neglect any employment to which they have been accustomed; they get but little sleep, they are loquacious, and disposed to harangue, and decide promptly, and positively upon every subject that may be started. Soon after, they are divested of all restraint in the declaration of their opinions of those, with whom they are acquainted. Their friendships are expressed with fervency and extravagance; their enmities with intolerance and disgust. They now become impatient of contradiction, and scorn reproof. For supposed injuries, they are inclined to quarrel, and fight with those about them. They have all the appearance of persons inebriated, and people unacquainted with the symptoms of approaching mania, generally suppose them to be in a state of intoxication. At length suspicion creeps in upon the mind, they are aware of plots which had never been contrived, and detect motives that were never entertained. At last, the succession of ideas is too rapid to be examined; the mind becomes crouded with thoughts, and indiscriminately jumbles them together.
Those under the influence of the depressing passions, will exhibit a different train of symptoms. The countenance, wears an anxious and gloomy aspect. They retire from the company of those with whom they had formerly associated, seclude themselves in obscure places, or lie in bed the greatest part of their time. They next become fearful, and, when irregular combinations of ideas have taken place, conceive a thousand fancies: often recur to some former immoral act which they have committed, or imagine themselves guilty of crimes which they never perpetrated; believe that God has abandoned them, and with trembling, await his punishment. Frequently they become desperate, and endeavour by their own hands to terminate an existence, which appears to be an afflicting and hateful incumbrance.
The sound mind seems to consist in a harmonized association of its different powers, and is so constituted, that a defect, in any one, produces irregularity, and, most commonly, derangement of the whole. The different forms therefore under which we see this disease, might not, perhaps, be improperly arranged according to the powers which are chiefly affected.
I have before remarked, that the increased vigor of any mental faculty cannot constitute intellectual disease. If the memory of a person were so retentive, that he could re-assemble the whole of what he had heard, read, and thought, such a man, even with a moderate understanding, would pass through life with reputation and utility. Suppose another to possess a judgment, so discriminating and correct, that he could ascertain precisely, the just weight of every argument; this man would be a splendid ornament to human society. Let the imagination of a third, create images and scenes, which mankind should ever view with rapture and astonishment, such a phænomenon would bring Shakespear to our recollection.
If in a chain of ideas, a number of the links are broken, the mind cannot possess any accurate information. When patients of this description are asked a question, they appear as if awakened from a sound sleep; they are searching, they know not where, for the proper materials of an answer, and, in the painful, and fruitless efforts of recollection, generally lose sight of the question itself.
In persons of sound mind, as well as in maniacs, the memory is the first power which decays, and there is something remarkable in the manner of its decline. The transactions of the latter part of life are feebly recollected, whilst the scenes of youth, and of manhood, remain more strongly impressed. To many conversations of the old incurable patients to which I have listened, the topic has always turned upon the scenes of early days. In many cases, where the faculties of the mind have been injured by intemperance, the same withering of the recollection may be observed. It may perhaps arise, from the mind at an early period of life being most susceptible and retentive of impressions, and from a greater disposition to be pleased with the objects which are presented: whereas, the cold caution, and fastidiousness with which age surveys the prospects of life, joined to the dulness of the senses, and the slight curiosity which prevails, will, in some degree,