It is easy to see-or, at least, to belive, that this play of sympathies, or action and re-action of the two symptoms, nervous and vascular, must disturb the functions of both-and even affect their structure if long continued or excessive in degree. It appears that the upper classes of society are rather less subject to insanity than the lower. The former suffer more from the moral causes-the latter, from the physical causes of the disease. In respect to the indigent classes, Dr. B. avers that the majority of cases of insanity, in them, "originate in direct physical causes, which the privations, and consequent misery, the poor suffer in all countries, as well as their vices, greatly multiply." Dr. B. does not seem to have been able to connect insanity with trades or professions--but acknowledges, with Rush, Pinel, Hallaran, and others, the powerful influence of political or civil revolutions of states, in the production of mental alienation. The question now presents itself--do these moral causes, say grief, terror, jealousy, &c. operate directly on the mind, and induce mental derangement? --or must there always be an intervening corporeal disorder ?--We would incline to the latter position, and it is evident that Dr. Burrows is of a similar opinion. "All emotions of the mind, it is evident, are capable of disturbing the corporeal functions; and though in themselves moral causes, they become physical in their operation. Hence physical causes grow out of moral causes, and these frequently lead to insanity; not, however, by direct impressions on the organ of the mind, but through the means of those morbid changes in the system which they gradually effect." 22. Thus, then, insanity is a corporeal disease, and the manifestations of the mind are disordered because the organ of the mind is disordered. The following passage will probably excite some criticism. "Could we imagine a human being void of all feeling, moral or religious, mental derangement is not there to be expected through a moral cause. But even where reason is wanting, instinct prevails; and brutes have their passions, which, when excited to excess, or thwarted, produce madness." 23. If by madness Dr. B. merely means a temporary furor, (ira brevis furor est) then we agree that a horse or any other animal is liable to madness; but we question whether BRUTES are ever insane, in the common acceptation of the word. Monomania is the most frequent of all forms of insanity --and can Dr. B. prove that a brute has ever evinced insanity on a single point, being sane on all others? In the second Commentary Dr. Burrows discusses the knotty point whether RELIGION should be looked upon as the cause or the consequences of insanity. Dr. B. properly remarks that any single passion, excited to excess, may induce mental derangement-and consequently RELIGION, "which influences the internal man more than the passions collectively, may be a cause of insanity." "On the other hand, there is no doubt, that a lunatic may imbibe a religious as well as another hallucination, and yet be insane from a cause the reverse of religious. In the one case, however, it is a cause; in the other, an effect. "Now a great source of error seems to arise from the confounding of this necessary distinction. "Medical writers who have derived their chief experience from public practice, are most apt to err in this particular. The previous history of lunatics admitted into public asylums is rarely known; therefore the moral cause of the malady is frequently inferred from the tenour of their mental aberrations; than which nothing can be more deceptious. Hence it is to be feared, that many cases have been hastily attributed to a reiigious origin, merely because the conduct or conversation of the lunatic has exhibited traits of too vivid spiritual impressions. In private practice the opportunities of obtaining this essential information are superior; and upon a point of such serious importance, I have not omitted to avail myself of them." 25. This is, perhaps, the true state of the case. We find a certain proportion of lunatics in an asylum harping on some religious topic, or fancying themselves deities of an upper or lower region. A hasty observer would attribute all these instances of monomania to religious meditation. It is probable, however, that one half of them were merely what is called "serious people," who being exposed to some of the various causes of insanity, exhibited, when insane, a religious hallucination. But as deep meditation of the mysteries of religion tends, in general, to perplex and bewilder the strongest intellect, we may easily conceive that an ignorant person, tinged perhaps with superstition, bigotry, or fanaticism, would readily become deranged in mind by lucubrations so unfitted for his intellects. Dr. Burrows appears to labour hard to shew that pure christianity never leads to madness-but, "that it is from the perversion of it that many become the victims of insanity. We conceive that this is splitting hairs"-or rather, "cutting blocks with a razor." It is the same as proving that no man is ever injured by medicine, but only by the perverse administration thereof. Thus, a man takes too large a dose of emetic tartar, and dies. Dr. Burrows would say, t'was not the tartrite of antimony that killed the man, but the mal-administration of the remedy. But granting that it is the perversion of christianity which leads to insanity, who is to be the arbiter of this perversion? "Who can direct, when all pretend to know." We confess that we do not clearly comprehend the drift of the following passage though we are ready to admit that the want of comprehension is attributable to our own astuteness of intellect. "But, although this be admitted, there is not a tittle of evidence to substantiate, that Christianity, abstractedly, ever produced that effect. Such accusations are the abortions of infidelity, or of those who lack knowledge. Religion may have been reproached by careless observers as the source of mental derangement, because it is often asso. ciated with misery;-for affliction induces many earnestly to seek religious consolation, who previously never thought of it, or who but mechanically followed its outward forms. In minds broken down by adversity, and little acquainted with its genuine precepts, a consequence, opposite to that which was sought and expected from religion, sometimes ensues: in this case the moral feelings have greater force than the spiritual, and the disappointment is not the default of the principles of the Christian faith. "Constitutional temperament also interposes, and often distorts the truth; and thus generates an opinion, that melancholic insanity is the effect of religious impressions. Minds so framed view all the blessings of this, or a future life, by involution. Their greatest gratification is persistive despondency. Deaf to precept or example, they retort: "Go-you may call it madness-folly- But we shall leave this subject-convinced as we are, and even at the risk of being called infidels or ignorantes, that religious meditations, with the best intentions, precipitate many a mind, weak and strong, into the gulf of madness. This, indeed, is admitted plainly enough by Dr. B. himself at the end of the commentary. "Were I to allege one cause which I thought was operating with more force than another to increase the victims of insanity, I should pronounce, that it was the overweening zeal with which it is attempted to impress on youth the subtle distinctions of theology, and an unrelenting devotion to a dubious doctrine." 56. COMMENT. III.-PHYSICAL CAUSES. We now come to more tangible, but not less debateable ground. Dr. B. justly observes that "the great obstacle to the knowledge of the pathology of insanity, has been the long-prevailing error of studying the mental to the neglect of the corporeal phenomena which are almost always cognizable." "The hallucinations of the mind being clearly only the signs of its disorder, as symptoms are of corporeal disorders, they are but of secondary importance in the study of insanity." 59. Here Dr. B. falls into the usual error of attributing disease or disorder to the mind. If the mind be immaterial, it cannot be subject to disease If material, then it is a part of the body, and the cause of disorder is still material. A patch of erysipelas on the skin, or a thorn in the foot, will cause delirium, in which the functions of the mind are as completely deranged, to appearance, as in raging insanity. Yet, who would say this is a disorder of the immortal mind? Is it not clearly a disorder of the body perverting the manifestations of the mind? We perfectly agree with Dr. B. that it is useless-worse than useless, to dwell on the mental aberrations. Of what consequence is it, whether the lunatic fancies himself a god or a devil-a philosopher or a conjuror-a tea-pot, or a tiger? "Ought we not to prefer examining the various signs which indicate functional or structural lesion? It is useless to go over again, with Dr. Burrows, the discrepancies between the material and immaterial doctrines of insanity. Dr. B. in commenting on Mr. Coombe, makes use of the following expression. "Can any comparison be endured between the divine immaterial function of the brain, and the palpable and material functions of other parts of the human body." 65. The divine immaterial functions of a mass of matter! The palpable functions of other parts of the body! Has Dr. B. ever seen or fingered the function of secretion, for example? We can see blood going to the liver, and we see bile coming from it ;-but if any man ever saw the function of secretion, by which the one is converted into, or separated from, the other, we are ignorant of his existence. On the contrary, we fearlessly maintain that the secretion of bile in the liver is just as great a mystery to us, as the secretion of Paradise Lost from the brain of Milton. In this country, Dr. Marshall appears to have been the first who conceived that insanity might be a corporeal disease, and dependent on disease of the brain. For this opinion he was violently assailed by the late John Hunter. To support his doctrine, Dr. M. made many dissections at the Old Bethlem; but his Morbid Anatomy of the Brian, in mania and hydrophobia, was not published till 1815, after the author's death. Haslam's dissections preceded (in point of publicatian) those of Marshall. Both tended to illustrate the subject of inquiry," and fully prove a morbid condition in the encephalon of the maniacs submitted to their inspection." "However, when it was proved, beyond dispute, that the brains of maniacs commonly presented morbid appearances, it was assumed that these alterations were the causes of the disorder; but it was soon objected, that such were the effects, and not the causes, of intellectual derangement. Among these sceptics were Crowther, Black, &c., and their doubts coincide with the opinion of many eminent physiologists who have since entered upon the inquiry. Others, while they cannot yield acquiescence in these conclusions, admit them with certain modifications." 69. Bonetus, Morgagni, and other anatomists, indeed, had not been able always to find corporeal disorder in the heads of maniacs-and such is the case with modern pathologists. "I have myself (says Dr. B.) assisted at several accurate anatomical investigations, conducted by eminent demonstrators, of the crania of insane patients who have been under my care, and who had exhibited up to the hour of their decease the most furious symptoms of mania for months, and yet not a vestige of disease could be traced." 70. But, as Dr, B. properly observes, we are not in a condition to know when disease exists in the brain. Could any one detect the changes which obtain during functional disorders in the brain and other organs? No, indeed! And yet there must always be some change in a part corresponding with the functional disorder of that part, however incapable we may be of detecting it by the scalpel. "This, however, is certain-that when an insane person has been cut off by an acute disease or accident, or has destroyed himself, and the insanity has been of short duration, there are seldom exhibited any alterations, or morbid appearances in the encephalon, beyond slight vascular congestions or effusion. But in long-standing cases, a post-mortem examination generally exhibits strong evidence of disease in that organ. Sometimes, however, violent insanity has continued for years, and not a visible trace of diseased structure or action has been discovered in the brain or elsewhere." 71. Dr. B. asks, "is not the human body subject to, and influenced by peculiar diatheses?" He refers to the apoplectic, hydrocephalic, scrofulous, and gouty diatheses, which may exist without any appreciable change of structure. "Were we to insulate a portion of a dead body, and examine its texture, without a previous knowledge of the disease affecting the person while living, could we decide what disease had existed? Why, therefore, should not the brain be influenced by the same laws, and undergo a specific change, and be the site of disease of which there is no visible trace? Why, in fine, should we expect to discover by the eye the maniacal diathesis, when all others are impenetrable?" ́ 73. Dr. B. asks farther:-" who can say what excitement, nay inflammation itself, has not existed in the brain, if the circulation through a great part of it is, as it is said to be, colourless ?" A morbid action, as we before observed, of other important organs is indicated by appropriate symptoms; and yet, on dissection, the organ suspected often appears sound. It is so with the brain. It may be, and is, capable of manifesting correctly the operations of the mind, long before its disorder is appreciable by the senses. To argue, as some have done, that, as there is no appreciable lesion of brain in insanity, so there is no use in directing any material remedies to the body, is sheer nonsense. The same argument might equally be applied to all other diseases. They are at first functional, and the appreciable change is a subsequent process. In respect to the changes actually found-and we believe they will be found in at least four cases out of five-after death, there is no doubt that some of them are post-mortem changes, and therefore not to be considered either as causes or effects of insanity. Serous effusion may be instanced in illustration. "Much important information may be elicited from the labours of men possessing such extensive opportunities as Greding, Esquirol, Georget, Neumann, &c. And the collection made by Dr. Scipion Pinel, embracing those of Messrs. Esquirol, Villermai, Beauvais, and Schwilgae, and which, in the aggregate, comprise two hundred and fifty-nine dissections of maniacs, offers a mass of pathological examinations particularly worthy of record. They are thus classed: "In the other fifty-six corpses there was no visible evidence of disease in any of the viscera of the three great cavities! The spinal chord was examined in only two cases. "From these dissections it follows: 1. That lesions of the brain, the organ of the intellectual functions, are in the proportion of one to two of those of the other viscera; 2. That more than one in five corpses of maniacs present no evidence of any disease whatever! 3. That in a great majority of cases, the insanity was a sympathetic affection; aud, 4. That as, in more than a fifth of 259 dissections, no lesion or alterations could be detected, it strongly corroborates the opinion, that, when such lesions or alterations are observed, they are posterior, and not anterior, to the developement of the mental derangement." 75. Certainly they are posterior. Take the pleura, the peritoneum, the stomach, the liver, or any other organ. The disorder of function always precedes the change of structure. In the brain this is peculiarly the case, from the multiplicity and spiritual nature of its functions. But, as our author ob serves: "From whatever predisponent cause insanity may proceed, if it be not primarily an organic affection of the brian, it ends in being so. This seems demonstrated by the facility of its cure at the beginning of an attack of mania, comparatively with the attempt made at a more protracted period." 76. Although absurd speculations have been entertained respecting the character of the living, as ascertained by the appearances of the dead brain; yet one thing is certain, that-"in the brains of connate fools, some defect or anomaly is always discovered, from which it might be inferred, that for the mind to be perfect, the organ of the mind, ab origine, must also be perfect." This is a natural enough conclusion-and although men have appeared to be possessed of perfect minds, whose brains were found imperfect after |