Insanity is rare among savage nations. But disappointments, reverses of fortune, domestic afflictions, the indulgence of the passions and many excesses and grievous violations of physical law, which appear to be the concomitants of civilization and modern refinement, are causes of its more frequent occurrence among us. Insanity is also believed to be more common in portions of Europe' than in America, and more common in the Eastern than in the Western States.

Errors in education, have made many insane. This is especially true, of those who have inherited a pre-disposition to mental diseases from their ancestors. It will not do to educate the heads of those thus exposed, without attending also to their physical education. If a youth show precocity of intellect, there is generally an effort on the part of his friends and teachers, to make a prodigy of him, and instead of causing him to throw aside his books, and engage in agricultural pursuits, or some active employment in the open air, or, in such amusements as shall develope his physical system, his brain is unfortunately overtasked, his intellect is made to blaze like a meteor, and then after emitting a brilliant but transient flash, it speedily expires.

The reading of romances among the young, and the exclusive attention to the merely ornamental branches of education, rather than to the sober and substantial, unfit the mind for rational enjoyment and thus tend at least indirectly to insanity. The moral, mental, and physical education of the young, has an important bearing upon the subject of insanity, and cannot be too attentively studied.

The loose rein given to very active imaginations, with pernicious habits of life, tend also to develope mental unsoundness, and the men also who study day and night without regard to regular hours for refreshing sleep, or without exercising the body, often get indigestion, and hypochondria, and become melancholy and insane. I believe that many whose pursuits are purely literary and scientific and who suffer premature mental decay, might by proper attention to hygienic rules, not only live to become distinguished in the sciences and the arts, but preserve their minds unimpaired, to a good old age.

The period of childhood is well nigh exempt from Insanity. In youth, it is not uncommon, but more prevalent in middle age. It exhibits itself between the sexes nearly in the relative proportion of each in the community. In this institution the applications for the admission of men, exceed those for women, and it is probable that the male population of the State, exceeds that of the female.

Of those admitted, sixty were married, and forty-four single. Though the dissensions, misfortunes, and afflictions incident to the married state, are fruitful sources of mental derangement, yet it must not be inferred from this that the married state tends to insanity, because the best authorities teach to the contrary. They teach

"that, other things being equal, it is more common among the unmarried; for the family state saves many from intemperance, ambition, selfishness, love of distinction, from avarice and from many other sources of insanity."

Of the one hundred and four cases admitted, twenty-five are known to have had insane relatives. Of those admitted to the New York Lunatic Asylum, thirty per cent. were known to have had insane relatives. At the Ohio Asylum twenty per cent., and at the State Asylum in Massachusetts, twenty-six per cent. had insane relatives or ancestors. From these, and other statistics, I infer that in this country, at least twenty-five per cent. of all the cases admitted to Hospitals for the Insane, are hereditarily pre-disposed to the disease. Hereditary insanity is more common among the rich than the poor, and is believed by many to be more frequently transmitted by the mother, than by the father. We have found it impossible to ascertain the early history of many of our patients, but we doubt not that a much greater number than that reported, has had ancestors who were insane.

By reference to the table of causes, it will be seen that only about six per cent. of all the cases admitted were the result, directly, of intemperate drinking. It should be gratifying to us as citizens of Indiana, to find that the number from this cause is so very small. It is true, that owing to the small number of admissions, our statistics are not of much value, but so far as they go, they show an exemption from the vice of intemperance that is not enjoyed by some of the older States.

Of all the patients admitted to the Massachusetts State Lunatic Asylum in 1833, twenty-five per cent. were caused by intemperance. In 1834, twenty-four per cent. In 1835, twenty-three per cent. In 1836, fifteen per cent., and as the temperance cause gradually advanced, the admissions from intemperance diminished, until in the year 1844, only eight per cent. were supposed to have originated from this cause. At the Ohio Lunatic Asylum, the admissions from intemperate drinking in 1839, were fifteen per cent., but as temperance principles triumphed in that State, the cases of insanity gradually diminished, until in the year 1848, only three per cent. were supposed to have originated from this cause.

Though it is true that the number admitted from intemperance is small, it is proper to remark that some of those reported in the table as having resulted from domestic disturbances-loss of propertydisappointments of various kinds, and ill health, are indirectly chargeable to intemperance.

The use of tobacco is, in some constitutions highly injurious to both physical and mental health. It irritates the mucous membranes of the mouth and stomach, it weakens and deranges the digestive organs, debilitates and emaciates the body and lays the foundation for serious diseases of the nervous system. I have watched its

effects attentively, upon many individuals, and am fully satisfied from close and careful observation, that the evils that arise from the use of tobacco, are neither few nor trifling.

Loss of sleep, is believed by Dr. Bingham to be the most frequent of all the immediate causes of insanity; and it is very certain that acute insanity is almost always accompanied by protracted wakeulness; but this is often the effect of insanity, as well as a frequent cause. In two cases admitted into this Hospital, I believe the exciting cause to have been loss of sleep.

Many of our business men, too eager for wealth, and ambitious to gain distinction, allow themselves too little time for sleep. The mind weighed down by excessive toil, by cares and anxieties by day, is unfitted for sound and refreshing repose at night, and, as a consequence, the general health suffers, and with it, the mind. The pernicious habit of changing day into night, and night into day is evil in its influence upon the health, and especially so, in this malarious country.

Upon this subject Dr. Bingham says: "So rarely do we see a case of insanity that is not preceded by a want of sleep, that we regard it as almost a sure precursor of mental derangement. He also believes "that ill health, loss of kindred or property, will rarely result in insanity, unless the exciting causes are such as to occasion loss of sleep."

It would seem that the celebrated poet Southey, became insane from loss of sleep; for Wordsworth says of him, "that he fell a victim, not to literary toil, but to his strong affection for his wife, which led him night after night to watch with sleepless anxiety over her sick bed." And that "his mind gave way under the long continued deprivation of the natural rest of the body."

NATURE AND TREATMENT OF INSANITY.

It is difficult, if not impossible, to give an exact and unexceptionable definition of insanity. The following, from Dr. Brigham, is as good as any I have seen: "Insanity is a chronic disease of the brain, producing either derangement of the intellectual faculties, or, prolonged change of the feelings, affections, and habits of an individual." It seems that certain phenomena, are witnessed in those persons who suffer from chronic irritation of the brain, and that these phenomena, have received the name of insanity.

Mental derangement, always depends upon either functional or organic disease of the brain, and without such disease, we see no derangement of mind. The causes of this cerebral disease, may be either physical or moral.

Intense application to study sometimes produces mind's organ, the brain, and insanity is the result.

irritation of the Dyspepsia may

produce insanity; but in such cases the brain suffers from sympathy with the diseased stomach, to the extent that it cannot perform its work correctly. It is not very uncommon for a sour stomach to produce a sour temper, and a change in the disposition of an individual, and as you remove the acidity of the one, you also correct or lessen the waywardness of the other.

Independent of its physical connections and relations, it is not easy to believe that the mind is susceptible of disease. If the strings of a harp be broken or untuned, the sounds produced will be discordant. And so it is with the mind; for if by any of the thousand accidents of life the delicate structure of that portion of the brain concerned in mental manifestation, becomes diseased, disjointed and delusive thoughts arise, and are conveyed by words which fall unharmoniously upon the ear.

As a general rule, insanity is only curable in its early stages. Of those who die of chronic insanity, the brain is found to have suffered permanent injury. There is then lesion of its structure: while in acute insanity the brain has received no such permanent injury. We can, therefore, but urge the importance of early treatment, while repairs are practicable, and while a very large per cent. of cases are certainly curable. As many of the recent cases of insanity can be cured, as of almost any other acute disease, and many more, than of some.

Treatment. There are no specifics known to us in the treatment of insanity; but the same general principles have guided us here that should guide us in the treatment of other diseases. Harsh treatment, either medical or moral, is not suited to the insane, but, on the contrary, the mildest treatment, in our hands, has succeeded best.

Bleeding is a remedy which, so far as I know, is not now used to any considerable extent in any well conducted institution for the insane. I think all agree that general bleeding is very rarely indicated. Cupping and leeching are occasionally required, but not very frequently. There has not been any case under care in this Institution, that, in our judgment, would bear general bleeding since admission. There may have been a combination of symptoms before admission to the Hospital, that justified bleeding, but not since.

Raving mania can be much more permanently controlled by the use of the warm bath, cold applications to the head, warm foot bath, mild cathartics and anodynes, and in some cases by nauseants. Bleeding quiets the patient temporarily, but the excitement returns with greater fury, and the system is less able to bear it than before. So far as I have observed the practice, bleeding does not accomplish the desired object, but the contrary; for it impoverishes the blood, reduces the strength of the patient, and thereby renders the nervous system more excitable.

The venerable Dr. Woodward says:-" When blood-letting has been employed freely and frequently in active mania, if the excitement for an hour or two, and sometimes for a day or two abates, it is generally renewed with increased violence, and under circumstances far less favorable for the benefit of other remedies." Depletion of any kind is not generally indicated in insanity, for in a majority of cases the system will be found to be below par, and will need tonics to bring it up.

Cathartics are highly useful, but they should be of the milder class. Drastic purging is not good. In a majority of cases laxatives have seemed to do better than purgatives. Blue pill in small doses has been frequently prescribed where there has been torpor of the liver, and to obviate costiveness we have often given the spiced syrup of rhubarb, extract of senna, aromatic tincture of guiacum, prescribed diet, &c. &c.

Narcotics are much used in many Institutions for the Insane. Opium, especially in some of its forms, is often prescribed, and in many cases, I believe, with benefit. In cases of high maniacal excitement, with hot skin, dry tongue, and contracted pupils, we never prescribe it; but with a class of symptoms the opposite of these, we have often prescribed it in mania, and with much benefit. We have not given it in extremely large doses as many recommend, but have prescribed it at first in the ordinary quantities, watching its effects, and increasing it gradually, where the symptoms have not contra-indicated it, until the desired object has been obtained. We have also found the extract of hyoscyamus a valuable remedy of this class of medicines, and not liable to some of the objections that can be urged against the use of opium.

Tonics have seemed to be indicated in a large number of those committed to our care, and we have often administered them in combination, in various forms, with narcotics and anodynes. Wine, iron, barks, and generous diet, have seemed to us to be far more frequently demanded than any other class of remedies.

Blisters, moxas, and setons are very rarely used at the present day for the cure of the insane. They were formerly much used, but without good results. Dr. Brigham observes, "that they sometimes direct the attention of the patient from his imaginary sufferings and delusions, and thus indirectly do good."

There are great advantages resulting from the use of bathsfrom a well regulated diet-change of scenery and old associations -change of habits of life where they have been pernicious to health regular exercise in the open air, at some useful employment-regular hours of refreshing sleep the attendance upon religious worship on the Sabbath-the diversion of the mind by various innocent amusements-the use of a well selected library-and by attending generally to all those hygienic rules which are calculated to give tone and vigor to the physical system, and by such