we may suspect natural idiosyncrasy: for Dr. Falconer met with a case, wherein the pulse did not exceed 40 in a minute, attended with numerous and evident symptons of fever; and individuals in the highest health have had their pulse at 120 and 130, while that of others has been naturally full, low, or intermitting; and it is no uncommon occurrence to meet with patients who possess the power of accelerating or retarding the pulse by the operations of volition. In many chronic affections the pulse is but little to be depended on; but with patients labouring under mental affections, whether of the melancholic or maniacal description it is a peculiarity worthy of attention, which sometimes prevails, that the pulse generally differs in the radial and carotid arteries, and, when soft and weak in the former, is full and hard in the latter, though the number of pulsations in a minute be the same in both.

Though the face be emaciated and look pale, this is not a proof that there is no morbid determination towards the head; since, notwithstanding these appearances, we often find the most unequivocal

* See his Observations on the Pulse,

marks thereof, such as sense of fulness within the cranium, of heat about the scalp, acute sense of hearing, sensation of throbbing, imaginary noises, fancied whisperings, with a protruded eye, and a degree of ophthalmia.

Having described the premonitory and concomitant symptoms of a maniacal attack, it will next be proper to notice its duration and termination. These are far from being uniform in every subject of mental disease, and the difference arises from a variety of circumstances. In some maniacs there are very few intervals of calmness, in others the hallucination occurs only at stated or unequal periods. As the attack is often sudden, so is the cessation or remission.

When the disease advances gradually, and almost imperceptibly, so as to take complete possession of the patient before any attempts are made for its removal, it is frequently of long continuance, Where the causes are accidental, or obviously corporeal, the cure of the mental malady generally advances as the bodily health improves. Sometimes madness subsides into incurable melancholy, and frequently these two states alternate with each other, but the most hopeless sequela of

disordered intellect is Idiotism.

However violent

the symptoms during the existence of the disease, the mental powers seem seldom to suffer on its removal; and it frequently happens that the patient retains the most lively and accurate recollection of every circumstance that attended the very acmé of the paroxysm. I have often observed in examining patients, whether convalescent or during a lucid interval, that many of the unnatural, peculiar, extravagant acts, which accompany the mental derangement, seemed to have originated in, or arose from, impressions on the organ of hearing occasioning false perceptions. Fancied whispering and distant voices are frequent symptoms, and I think may, in some degree, be attributed to a morbid state of the auditory nerve, the proximity of the carotid arteries, and the redundant flow of blood to the head, in mania. Though mental diseases in general steal on the patient in the most gradual and almost imperceptible manner, yet they sometimes attack suddenly in the former cases the causes are generally either obscure or purely mental, in the latter most commonly corporeal. In every case relapses are to be ex6

pected, and precautions used in order to prevent them.

OF THE REMOTE CAUSES.

These may be divided into predisponent, and exciting, or occasional; but as there are several causes whose action, in producing insanity, is not confined to either of the above, but seems, by frequent repetition, not only to bring on the disease where the predisposition already exists, but also to form that peculiar state of the body, these may with propriety be ranked under either class, or form a distinct one of themselves.

The predisponent are either Connate or Acquired and first of the connate. At the head of the list must be placed hereditary affections these often descend from sire to son, and are transmitted to successive generations. Certain temperaments have attended a whole progeny; the same habits of thinking, reasoning, and expression, similarity of voice and gait, and a propensity to particular studies, have run through whole families. These facts being indisputable, parity of reasoning allows the possibility of predisposition

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to diseases being hereditary, and this may with propriety be termed connate. It is hidden among the arcana of Nature, beyond the reach of human comprehension, on what these hereditary peculiarities depend, though various, and some very ingenious, explanations have been attempted. That certain improved states of the intellect take place uniformly in certain circumstances of the animal œconomy, as if the first depended on the last, seems evinced by what is observed in rickets, scrophula, mollities ossium, &c. where defect of conformation is compensated by mental acumen. There cannot be a more unequivocal proof that such connate predisposing causes exist, than that the same powers, acting on some individuals, produce no morbid change in the intellect, while in others predisposed, insanity uniformly follows their application. There is a connate predisposition, where certain peculiarities are exhibited, which mark men as characters who delight in oddity, in singularity of manner, modes of thinking and reasoning, such as often accompany the different temperaments when they are exquisitely marked, (See Darwin on Temperaments,) when extreme mobility of body and mind, or torpidity