G A L T 
ON 
INSANITY TN ITALY. INSANITY IN ITALY, 
B Y 
JOHN M . GALT, M . D., 
SUPERINTENDENT AND PHYSICIAN OF THE EASTERN ASYLUM OF 
VIRGINIA. 
[REPRINTED FROM THE “ JOURNAL OF INSANITY.”! 
UTICA: 
PRINTED AT THE NEW YORK STATE LUNATIC ASYLUM. 
1854. INSANITY IN ITALY. 
A knowledge of the Italian works on mental derangement being by no 
means generally diffused, we are led, in the following effort, to discuss 
some of these productions, and also to make such extracts as appear to 
be of interest. We commence with two statistical works, the first of 
which is entitled, “ Ospizio Di S. Benedetto In Pesaro ; Statistica Sul 
Movimento Degli Alienati Dali’ Anno Della Sua Fondazione, 1829. A 
Tutto Giugno Dell’ Anno Couente, 1852. Del Dottore Giuseppe Giro- 
lami, Medico Direttore;” being the statistics of the Hospital of St. 
Benedict, at Pesaro,* from the year of its foundation, 1829, to the middle 
of the year 1852. Published by Dr. Giuseppe Girolami, the Medical 
Director of the Institution. 
This publication is dedicated to His Excellency, the most Reverend 
Monsignor Pasquale Badia, Delegate of Urbino and Pesaro. And from 
some preliminary remarks, it seems that the industrious author has not 
long succeeded to a post previously occupied by the distinguished Prof. 
Meli. In the extensive statistical tables which he lays before the me- 
dical world of Italy, he certainly has made good use of his time. These 
are indeed full and elaborate, and constitute an interesting addition to 
the statements and works of an analogous character. As is usual in 
general articles of the kind, he commences with three tabular views, 
giving the number of receptions, discharges and deaths; and in a fourth, 
he presents a summary of the three preceding tables. This is as 
follows:— 
Admissions. 
Mania, 558 
Lypemania 76 
Monomania, 177 
Dementia 116 
Imbecility, 8 
Idiocy, 27 
Doubtful, 20 
Total, 982 
Discharges. 
Cured, 484 
Taken out by friends, 49 
Insauity not verified, 24 
Eloped 5 
Died 255 
Remain, July 1st, 1852, 165 
Total, 982 
* Pesaro (the ancient Pisaurum) is a town in the Papal States, near th* 
mouth of the Toglia. 4 
The synopsis just given above, is succeeded by a table of the yearly 
receptions, and one of tho yearly deaths. Then come tabular views 
of the items included under the general superscription of—Cause. 
And first as to the influence of age, there being a separate compartment 
for each of the forms of lunacy which have been named. The general 
conclusions are, that insanity is most apt to be developed between the 
ages of 30 and 40 ; and taking into consideration the special forms of 
the malady, that mania and monomania commence between 30 and 40, 
lypemania between 30 and 60, and dementia between 50 and 70. Next 
comes a table of the months in which the inmates were admitted, com- 
prehending also the forms of the disease. As MM. Anbarel and Thore* 
have shown of French lunatics, we see the effect of warm weather more 
plainly here, by looking to the months as divided into warm and cold. 
The table which follows, exhibits the same result that occurs in many 
of the Asylums on this side of the Atlantic, the single men largely out- 
numbering the married, whilst a greater number of females are married 
than the reverse. Artizans and agriculturists of course constitute a 
large proportion of the entries under the head of professions. But of 
982, 56 are ecclesiastics, lawyers, physicians, and placemen; 26 are 
beggars and vagabonds. The hereditary influence is traced in 52 cases, 
mania, 25; lypemania, 3; monomania, 9; dementia, 15. Amongst the 
direct causes, 370 are moral causes; the chief of these are domestic 
troubles, 35; religious feelings, 39; love, 52; connected with property, 
22, See.; 20 are due to fright. The physical causes amount to 249. 
Of these, the largest in the catalogue is intemperance, 143 being so at- 
tributed. This is certainly a result which we did not anticipate in wine 
drinking Italy. Twenty-seven are set down as owing to excessive 
venery, 11 to onanism, and 25 to insolation. Then the author has a 
third division, including chiefly different diseases, which he entitles 
physico-organic. Twenty-one are included under the head of organic, 
and 5 under that of palsy. It is doubtful, however, we think, whether 
we should consider these complications as simply such, or in the light 
of causative influences. As characteristic of the country, we find 24 to 
have originated from pellagra. Under the item of meningitis, 19 are 
included. 
After causation, W'e have tabular views of symptoms, in which there 
are sub-divisions of the primary forms, into which, as we have seen, 
Dr. Girolami has previously divided the manifestations of insanity. In 
these and other particulars, we deem the work to excel similar efforts 
* Recherches statistiques sur les causes de l’alienation mentale. Paris, 
1839. Elsewhere I have shown the principle to apply to the inmates of 
American Asylums, and also to cases of suicide. 5 
of English and American writers. But in the United States, we are 
as devoid of a literature in relation to the present, as we are with regard 
to other subjects. To bring forward an example of the minutiae of the 
writer, under the head of lypemania, we have the following varieties: 
ideas in connection with constant aversion to relatives and others ; sen- 
timents of desperation, evincing religious fear, and an ever-suffering 
conscience, &c. 
From the table of cures according to the months, (and still in connec- 
tion with the form of insanity,) we deduce the conclusion that more 
cures had taken place in December than in any other month. But that 
the seasons stood in the following order—autumn, summer, spring, and 
winter. As a specimen of his tables, we give one of cures in relation' 
to age; the general inference being that the greatest number of reco- 
veries take place between the ages of 20 and 40. 
Mania. 
Lype- 
mania. 
Mono- 
mania. 
De- 
mentia. 
Total of 
cures. 
Under 20 years, 
18 
i 
4 
3 
26 
From 20 to 30 years, 
71 
8 
25 
0 
104 
“ 30 to 40 “ 
93 
7 
24 
1 
125 
“ 40 to 50 “ 
67 
12 
17 
4 
. 100 
“ 50 to 60 “ 
49 
5 
16 
0 
70 
“ 60 to 70 “ 
20 
3 
4 
2 
29 
Above 70, 
2 
0 
1 
0 
3 
Age unknown 
16 
6 
3 
2 
27 
— 
— 
— 
— 
336 
42 
94 
12 
484 
Of 200 deaths, 55 are assigned to unknown causes. Of the remain- 
der, 8 were from surgical causes—dislocation of the cervical vertebra, 
fracture of the neck of the femur, &c. Amongst the diseases proving 
fatal, 46 were attributed to apoplexy, 18 to gangrene, 15 to phthisis pul- 
monalis, and 57 to marasmus, (tabe.) A second table of deaths has 
reference to the month in which they have occurred, arranged under 
the heads—mania, lypemania, monomania, dementia, dementia with 
epilepsy, dementia with paralysis, dementia from pellagra, imbecility 
and idiocy; the general result being that the seasons hold the following 
order in this regard—winter, autumn, summer, spring. A third ta- 
ble relative to mortality, takes consideration of the age of those de- 
ceased ; the chief result being that the maximum of deaths occur be- 
tween the decade of 40 and 60, and that between 30 and 40 has the 
next place. 
Chapter second of the work is denominated a summary or recapitu- 
lation of the previous statistical conclusions and observations. And here 
in the first place he refers to n former work of his, which we have not 6 
yet seen, but have ordered ; and which doubtless is of great value, if 
prepared with the diligence and talent characterizing the present bro- 
chure. This work has the following title—“ Concerning the influence 
of civilization in augmenting mental maladies, and of the means which 
it possesses of reacting against this tendency. Rome, 1848.” He ob- 
serves in the production now under discussion, in an analogous relation: 
“ That our present civilization consists in great part of weak and ephem- 
eral elements, and that a material progress is not accompanied by any 
corresponding advance in manners and education, but on the other hand 
there is a weakening of religious ties.” He thinks in such a state of 
things we may find a fertile source of physical disease, and at the same 
time of many nervous affections, and insanity in all its forms. The 
“ celestial gift of reason,” says he, is disturbed too by the general want 
of self-government, and desires unchecked by a higher feeling habitually 
exercised. Further on he says that there is more insanity in New 
York than in any nation of Europe. The greater number of males in 
the Hospital of St. Benedict, he doubtless attributes very properly, not 
to there being more insane of this sex, but to the fact that there'is still a 
prejudice in Italy against sending persons to an asylum, which is felt in an 
increased degree with regard to females. And besides, they are moro 
■easily managed at home, than are men. I observe too that as in some of 
our asylums, the proportionate number of the married of the female 
sex exceeds that of the men who are married, as compared with those 
in a state of celibacy. This we think is owing to the difficulty of man- 
aging females with young children, when retained at home. In the ad- 
ditional remarks in this chapter, he refers frequently to the opinions of 
physicians of celebrity, shewing great familiarity with the leading 
French and Italian writers on the subject of insanity, and quoting from 
Esquirol, Parchappe, Anbarel and Thore, Desportes, Bouchet, Bertolini, 
Bonacossa, Greco, &c. His observations in this chapter on pellagra and 
indeed on other points, are interesting, but are somewhat beyond our 
limits. 
The third chapter, with regard to treatment and hygiene, is a mere 
outline. In cases of mania, with a high state of exaltation, he has found 
immediate and constant benefit from the warm bath, combined with the 
cold douche to the head, laxative and diluent drinks, darkness, isolation, 
a diet more or less strict. Except in rare instances, in which by reason 
of the temperament or some other circumstance to induce the applica- 
tion of leeches* ; or in cases of marked congestion, when he deems it 
prudent even to open a vein, he never resorts to bloodletting; following, 
* Emerordaln. 7 
says he, the precepts of leading physicians, and especially those of 
(preladato) Professor Meli. 
In lypemania, which he believes to be sympathetic, or visceral accord- 
ing to Pinel, he employs tonics and revulsives. Amongst which he 
mentions the martialia, particularly the chloride of iron, the alcoholic 
tincture of nux vomica, preparations of rhubarb, bitters, baths and cold 
ablutions. Purgatives he uses sparingly, and stimulants merely as ac- 
cessory. He has tried hellebore, but without any advantage. 
In dementia he administers tonics and a nourishing diet; and some- 
times finds advantage from excitants, both moral and physical. He 
thinks also of giving a thorough trial to electricity. 
In theorizing us to treatment, he observes that he differs as much on 
the one side from Leuret, and some of the German spiritualists, who 
would adopt an exclusively moral treatment, as from Falret, Morison 
and Broussais, who adhere to an exactly contrary opinion as to the pre- 
dominance of the physical. When, he further remarks, we consider 
that man is a compound of the corporeal and the spiritual, a conclusion 
to which ancient and modern wisdom alike have arrived, is that we 
should act on the one or the other constituent, according to the circum- 
stances of the case. 
Means of repression, he says, make an essential part of the manage- 
ment of the insane. Wherever, he proceeds, the spirit of Christianity 
exists, the ancient method of treating the lunatic has been wholly aban- 
doned. In place of which a pleasant and friendly rule, though mingled 
with firmness, has been adopted generally. As means of restraint, he 
employs seclusion, the camisole, and the belt of Hallaran, and by this 
the patient is also sometimes attached to a bed or chair. The whirling 
chair is not used, as it is remarked, being unadvisable, according to Es- 
quirol and other late writers. Seclusion is always temporary; and the 
sole mode of shewing that he disapproves of the violent conduct of a 
patient, is simply abstaining from the usual familiar and confiding air 
which he displays to the mass of the insane inmates. The diet is modi- 
fied according to the case; in acute mania, it is of a lighter character, 
and more nourishing in melancholy and dementia. The florid health of 
the patients generally, and their freedom from epidemics denote the 
suitableness of the dietary. As the insane, he observes, are very sensi- 
tive to cold, care is taken to provide warm clothing. Much use is made 
of baths; and by new improvements, he anticipates carrying these 
means to great perfection. 
Chapter 4 consists of a detailed account of nine cases of insanity treat- 
ed in the Hospital of St. Benedict, three of them including necroscopic results also. In the first, a case of lypemania, in which the patient 
fancied that his family had lost their fortune, and were entirely ruined; 
cold baths, light purgatives, and subsequently tonics, were employed. 
The second was a case of religious melancholy, the patient being fifty- 
four years of age. The medical treatment consisted of Colombo, the 
martialia, the alcoholic tincture of nux vomica, and cold baths. On 
post mortem examination, the meninges were in a natural condition and 
not adherent, nor did the cerebral substance or the ventricles present any 
morbid appearance. The vessels of the cerebral convolutions were turgid 
with venous blood, and there was a serous deposit at the base of the 
brain. The cerebellum presented an unnatural hardness. The intes- 
tines were healthy. The liver was of natural size; there was some 
venous congestion on its concave face, &c. The gall bladder was elon- 
gated, without biliary calculi, &c. The spleen was in a natural condi- 
tion, the mesenteric glands larger than usual, &c. The fifth case, one 
of mania furibunda, resulted in recoveiy. The treatment comprehend- 
ed the abstraction of light and other excitants, the daily use of warm 
baths with the cold douche on the head, and the administration of diluent 
and slightly purgative drinks. 
We can not conclude the present article without reiterating our 
favorable opinion of Dr. Girolami’s performance, and we trust that it is 
an example that will be followed by the physicians of Italy, and also, 
indeed, by those of countries beyond the confines of that sunny land. 
Moreover, if, as we believe, the establishment at Pesaro is managed 
with the same care that is evinced in the preparation of Dr. Girolami’s 
brochure, it is an institution that does honor alike to its officers and to 
the Pontifical Sovereign, who is viewed with reverence and respect by 
so large a portion of the Christian world. 
We now proceed to present a similar analysis of another statistical 
effort, to that which we have elaborated above. This is also a produc- 
tion relative to a “ Casa De’ Pazzi” in the Papal Dominions, being an 
institution for the insane at Perngia, (Santa Margharita) under the 
charge of Dr. Caesar Massari. But we have already occupied more 
room than the readers of a medical journal are perhaps willing to allow 
to an essay containing little of the original, and we shall therefore re- 
serve further notice of the Italian writers on mental diseases, for 
another number of the “ Journal of Insanity.” 
8 9 
An article which we prepared for the July number of the “Journal 
of Insanity,” was principally devoted to an analysis of a publication re- 
lative to the statistics of mental disease, as exhibited in the returns of 
an institution for the insane in Italy. In accordance with a remark 
which we then made, we now proceed to notice a second statistical 
work, which is due to another of these establishments in the same 
bright land. “ Rapporto Statistico—Medico-Dodicennale, 1840-1851. 
Sulla Casa de’Pazzi in S. Margherita Di Perugia,” &c.; or, “ Report 
for the Twelve Years between 1839 and 1852, of the Hospital of St. 
Margaret, at Perugia.” This is a production of Dr. Caesar Massari, the 
Medical Director of the Institution. 
The work under discussion consists of three parts: First, a preface 
relative to statistical medicine, more interesting than matters of the sort 
usually are; secondly, there are a number of statistical tables, but 
without the extended remarks of Dr. Girolami; and thirdly, we have a 
detailed history of fourteen cases of mental derangement, in some in- 
stances containing also the post-mortem results, and forming collectively 
a representation of the mode of treatment pursued at St. Margaret in 
each variety of insanity. 
Dr. Massari sets out, in his preface, by declaring his allegiance to the 
principle of adhering to facts rather than theory, and repeats a declara- 
tion, to that effect, of “ the Nestor of Italian medicine, the learned 
Lanza.” After then alluding to the new science of statistics, he refers 
to an order of the Government on the subject, issued on the 13th of 
June, 1850, requiring a report of the statistics of every province, thus 
obtaining the facts required to exhibit the physical, moral, economical 
and civil condition of the nation; for which enlightened act, we at least 
are ready to assign due credit to the Papal authorities. With regard to 
statistics as applied to medicine, the writer goes on to say that a work* 
of the illustrious Dr. Antonio Salvagnoli Marchetti should not be for- 
gotten. The statistics of insanity, he observes, originated with Pinel 
and Esquirol. He proceeds to allude to the many sources of error and 
defects in the statistics of insanity, such as the want of a proper noso- 
logy, confusion of symptomatology, the want of sufficiently expressive 
scientific terms, &c. He then speaks in tones of regret, that “ Italy 
has not yet established a scientific aggregation of those physicians hav 
* “ lubtituzioni di Statistica Medica Nationale.'’ 10 
ing the care of the insane, (“ Medici alienisti,” or, “ mad doctors,”) 
in order to discuss statistical defects, and to establish fixed formulae re- 
lative to mental maladies.” He states, furthermore, that he has called 
attention to this point in his first biennial report of the Hospital of St. 
Margaret; that it is very encouraging to him to have received, in this 
connection, the spontaneous approval of those high in authority; and 
that, with not less zeal also, Professor Gualandi, of the Hospital for the 
Insane at Bologna, in 1848, published a long and appropriate article, 
recommending an association of the physicians attached to institutions 
for the insane. 
Our author then passes on to mention the advance in other countries 
in the way of a periodical literature devoted to psychological medicine. 
France, he observes, commenced the splendid series of the “ Annales 
Medico-Psychologiques,” in 1848 ; and Germany, in 1844, a publication 
of similar character ; whilst England instituted an analogous effort, in 
1848, in “The Journal of-'Psychological Medicine and Mental Patholo- 
gy.” A commencement only, he says, has been made in this line of 
endeavor in Italy, by Professor Panizza, and Dr. Verga, (Physician to 
the celebrated Senavra at Milan,) in the “ Appendice Psichiatrica” to 
the Medical Gazette of Lombardy. 
In excuse for the want of particular remarks as to the tables gene- 
rally, towards the end of this part of his pamphlet, Dr. Massari refers 
his readers to a former report, 1837-45 ; and concludes the section by 
calling attention to the increase of insanity, not only as evinced in the 
increasing number of receptions at Perugia, but as deduced from various 
facts, and shown to be general throughout Europe. This pervading in- 
crement of a sad disease he attributes chiefly to a deficiency in proper 
moral training, agreeing with M. Saint Marc Girardin, that we educate 
the intellect, but fail to act upon the heart. 
From the first two statistical tables we glean the results that during 
the twelve years from 1840 to 1851, inclusive, 299 patients were re- 
ceived—males, 196; females, 103; there being at the commencement of 
the period as residents, 40 males, and 35 females. The number of dis- 
charges is 171—males, 114 ; females, 57. The number of deaths amounts 
to 111—males, 72; females, 39. Leaving on the 31st of December, 1852, 
92 inmates—males, 50; females, 42. 
The third table refers to the seasons. The receptions in spring 
amount to 80—males, 56; females, 24. In summer to 92—males, 57; 
females, 35. In autumn to 62—males, 40 ; females, 22. In winter to 
65—males, 43; females, 22. The number of discharges in spring 
amounts to 35—males, 23; females, 12. In summer to 19—males. 11 
15; females, 4. In autumn, to 59—males, 40 ; females, 19. In win- 
ter to 32—males, 21; females, 11. Then are enrolled the deaths, be- 
ing in spring, 23—males, 16; females, 7. In summer, 22—males, 12 ; 
females, 10. In autumn, 19—males, 15; females, 4. In winter, 19— 
males, 12 ; females, 7. 
The three succeeding tables we insert in full: 
AGE. 
Years. 
Males. 
Females. 
Total. 
From 10 to 20, 
12 
15 
27 
“ 20 to 30 
55 
24 
79 
“ 30 to 40, 
57 
29 
86 
“ 40 to 50, 
38 
22 
60 
“ 50 to 60, 
25 
8 
33 
“ 60 to 70, 
6 
3 
9 
‘ “ 70 to 80, 
3 
2 
5 
SOCIAL CONDITION. 
Males. 
Females. 
Total. 
Agriculturists, - 
46 
38 
84 
Artizans, &c., 
41 
20 
61 
Merchants, &c., 
41 
25 
66 
Soldiers, 
15 
0 
15 
Men of Science and Artists, 
15 
0 
15 
From the Aristocracy 
13 
11 
24 
Priests, 
11 
0 
11 
Servants and Beggars, 
8 
1 
9 
From the Cloister, 
5 
5 
10 
Officials, 
o 
2 
4 
Males. 
Females. 
T ota!. 
Single, 
133 
49 
182 
Married, 
55 
44 
99 
Widows, 
0 
9 
9 
Widowers 
9 
0 
9 
CIVIL CONDITION. 
Next come two tabular views, which, relating merely to locality and 
charges for board, may be passed over without further remark, save 
that of 299 admissions, 189 are classed as “ poveri.” Then we find 
tabulated the facts concerning the forms of insanity. Of the receptions, 
125 were cases of mania—males, 82; females, 43. Of monomania, 
there were 140—males, 91; females, 49. Of dementia, there were 31 
caSes—males, 20 ; females, 11. Three of the men are classed under 
the head of idiocy. The next synopsis refers to the time at which the 
mental alienation commenced, and the consequent associated facts. Of 
the whole number of receptions 147 were recent cases—males, 99; females, 48. Of inveterate cases, or those dating back beyond three 
years, the number received has been 98. The discharges under this 
head number 47—males, 32; females, 15; and the deaths 26—males, 
16; females, 10. The succeeding entry has regard to the return of the 
psychical disturbance, the number of cases so classified being 32—males, 
20; females, 12; of which 18 have been discharged—males, 12; fe- 
males, 6; and 6 have died—males, 2; females, 4. A complication with 
epilepsy occurs in 15 cases, 4 of whom have been discharged—males, 
3; female, 1; and 8 have died—males, 5; females, 3. In 7 of the in- 
mates palsy has existed—males, 6; females, 1; all of whom have died. 
The tabular views as to causation are—1st. The physical causes of 
their mental alienation in the male patients. 2d. The moral causative 
agents in the same class. 3d. The physical causes of mental disease 
in the female patients. And 4th, The moral causes in this section of 
the inmates of St. Margaret. Under the first division, the largest item 
are the cases set down as hereditary, being 29. Then follow 14 from 
intemperance and other evil courses; 13 from over-exertion and atmos- 
pheric vicissitudes; 10 are named as unknown and 5 doubtful; 4 from 
want; 2 from onanism; 1 from a blow on the head, &c. The leading 
cause in the second table is assigned to be political, in its various shapes, 
and amounts to 25. Then in order, 14 are attributed to domestic diffi- 
culties, 13 to reverses of fortune, 12 cases are from love, 10 from reli- 
gious feelings, 2 from jealousy, 1 from vampirism; 1 is a case of simu- 
lated insanity, &c. Of the physical causes in the females, 11 are here- 
ditary, 10 from excessive labor, insolation and atmospheric vicissitudes; 
8 hysterical, 2 from fright, 2 from want, 1 from intemperance, &c. 
Under the fourth head, or moral causes inducing insanity in the fe- 
males, domestic difficulties are at the top of the catalogue, amounting 
in number to 12; then comes conjugal jealousy, there being 10 cases 
from this cause; 9 are from religious feelings, 3 from political influ- 
ences; family disasters, 2; reverse of fortune, 1; avarice, 1, &c. 
Next in order follows a list of the modes of occupation pursued by 
the insane residents of St. Margaret. Of the men, 117 have been oc- 
cupied, and 79 unoccupied. The greater number have been employed 
in agricultural pursuits, and next in proportion are those assisting in 
household matters ; 19 have been engaged in some literary pursuit, a 
few in trades, and several in painting and the other fine arts. Of the 
females, 79 have been occupied and 24 not so. The separate items are 
us follows:—Sewing, 30 ; spinning, 19 ; as domestics, 10 ; preparing lint 
and bandages for the infirmary of the hospital, 9 ; weaving, 5; embroi- 
dery, 3 ; reading, 2; music, 1. 
12 13 
Immediately after the table last presented we have an important one 
giving the results of this institution in the cases of hereditary insanity 
received therein, the number being 40—males, 29 ; females, 11. The 
fate of these is as follows: discharged, 18—males, 12; females, 6. 
Died, 10—males, 8; females, 2. The number of those remaining in 
the establishment on the 31st of December, 1851, is 12—males, 9 ; fe- 
males, 3. Then ensues a statement of the condition in which those 
discharged left the asylum. The number of the recoveries is 117— 
males, 78; females, 39. The number discharged in an improved 
state is 21; males, 15; females, 6. And 7—males, 6 ; females, 1; are 
entitled “chronic.” The succeeding page furnishes the statistics of re- 
covery, as they relate to the length of time required to secure convales- 
cence. Sixty-eight patients were discharged within six months from 
the date of their admission—males, 49 ; females, 19. Thirty-five with- 
in twelve months—males, 22 ; females, 13. Ten within 18 months— 
males, 6; females, 4. Of those remaining 36 months, 11 have been 
discharged—males, 7; females, 4. The number of patients leaving 
after a stay of three years is 4 males. After a stay of 4 years, males 
5 ; whilst only three—males, 2 ; female, 1—were residents beyond 
eight years. 
Of the 83 deaths—males, 53; females, 30—the annexed summary 
succinctly embraces the causation. 
Apoplexy, &c 
Males. 
Females. 
7 
Total. 
22 
Marasmus, 
15 
7 
22 
Pneumonia, 
12 
2 
14 
Acute fevers, 
5 
6 
11 
Cachexy and dropsy, 
4 
5 
9 
Inanition, 
3 
1 
4 
Suicide, 
1 
0 
1 
Last among the tables is an outline of all the changes at St. Margaret 
since its foundation:—Admissions, 693—males, 464; females, 229. Dis- 
charges, 397—males, 276; females, 121. Deaths, 204—males, 137; 
females, 67. Leaving at the close of 1851, 92 inmates—males, 50 : 
females, 42. 
A third division of Dr. Massari’s effort consists of a detailed history 
of fourteen cases, treated at St. Margaret, thus illustrating alike the 
mode of management pursued at this establishment and the general 
subject of insanity: these are rather long-winded, but we shall en- 
deavor to present a brief outline of their leading particulars. The first 
in the catalogue is entitled a case of “Monomania religiosa-politica.”— 
The patient was of bilious temperament, aged 32; the insanity being 14 
apparently caused by domestic difficulties. Dr. Massari speaks of him 
as “enamored of the sun,” and mentions that this unusual symptom ex- 
isted in a patient described by Dr. Blanch, whose life was actually ter- 
minated in the eclipse of 1833. The patient at present under conside- 
ration evinced, moreover, an aversion to kings and other rulers, using 
abusive language in alluding to them. The method of Leuret* was em- 
ployed, the cold douche being the agent, but the patient’s firmness ren- 
dered it unavailing. Subsequently, frequent warm baths and refrigerant 
and sedative decoctions were administered. It is also remarked that 
especial care was had to carry into effect the rale of Georget,f never to 
exercise the sufferer’s mind in the sense of his delusion. The individual 
recovered. 
Case II. Mania Omicida.—This person killed his father in a supposed 
paroxysm of insanity. A prominent symptom was the fancy that he had 
acquired great wealth. He was of bilious temperament and strongly 
developed muscles. Coercive means, low diet, prolonged baths, tartar 
emetic in large doses, and venesection united to diminish his restlessness 
and violence. Later in the disease he labored under the surveillance of 
an attendant, whilst low diet and abstinence from wine were continued. 
A restoration to sanity ensued. 
Case III. Mania Tesaurica; or, the mania in relation to property.— 
A poor man married the daughter of a wealthy one, but who permitted 
his son-in-law and his family to live an existence almost of want. This 
condition of things led to insanity. Of ardent disposition, with spark- 
ling eyes and sanguine temperament, he was agitated by a continuous 
mania on the subject of wealth. He was in fancy the chief and richest 
man on earth; and, with an ungovernable loquacity, he was ever repeat- 
ing words in such relation—thousands, principalities, &c. He died. 
We extract a few of the port-mortem results. Exterior.—There was 
some emaciation, a waxy appearance of the skin, and no disfiguration of 
it. The head was small and irregular, the bones of the cranium thin 
and deficient in diploe. There wras little appearance of sutures. The 
meninges were engorged. There was no organic singularity in either 
* We are pleased to see that full trial is made in Italy of the views of 
M. Leuret. They are perhaps not surpassed in originality by those of any 
other medical psychologist since Pinel and Esquirol. Iu England and America 
they have been by no means fairly tested. 
f The three excellent rules of Georget are these—1. Ne jamais exercer 
l’esprit des alienes dans le sens de leur delire. 2. Ne jamais atlaquer de front, 
ouvertement les idees, les affections et les penchans exaltes des fons. 3. Faire 
naitre, par des impressions diverses, des idees nouvelles, des affections, des 
commotions morales, reveiller ainsi des facultes inactives—De La Folie, &c. 
Par M. Georget, pgs. 280, 281, 283. 15 
the cerebrum or the cerebellum. The chest.—The left lung was hepa- 
tized, the right engorged with blood. In the right ventricle there was 
a fibrous polypus—and the writer goes on to speculate how far this last 
might have been connected with the particular symptoms of the mental 
disease. 
Case IV. Monomania Religiosa.—B. B. C., of healthy constitution, 
melancholy temperament and good habits, was attacked by religious in- 
sanity. He had gone into the army without consulting his father.—; 
From being silent at first, and willing to occupy himself, he subsequently 
commenced to talk constantly of his sins, and to make the sign of the 
cross, and passed finally into a complete delirium. The treatment con- 
sisted of the camisole, isolation, ipecacuanha and emetic tartar dis- 
solved in lemonade. After he had become tranquil, his desire continu- 
ing for a military life, he was given lessons by an old sergeant, and thus 
went forth a soldier from the lunatic asylum. 
Case V. Mania Erotica.—A. F. became a patient in 1844, and died 
of apoplexy in 1848. She was of low stature, robust form, rough coun- 
tenance, and fiery temperament, and she was also affected with goitre. 
Erotic insanity succeeded a disappointment in love; and, on emerging 
from a filthy prison, under the influence of the comfort and neatness of 
the hospital, in a few weeks she became tranquil and related her love- 
affair. Then she passed to the inertness of a stony silence, with fixed 
eyes, and head bent towards the earth, and with an irresistible propen- 
sity to crouch upon the naked pavement. Muttering at one time prayers 
and at another imprecations, she fiercely opposed every one that inter- 
rupted her. She gave way to a blind and causeless anger, using the 
most insulting language, and then she became torpid again. Her men- 
struation was regular but scanty. Bleeding and drugs alike were so 
difficult to carry into effect, that all hope of a cure was lost. The most 
peculiar result of autopsy of the brain was the presence of a tumor of 
the kind called by Sebert, fibro-plastic, of which a close analysis, both 
chemical and pathological, is given, but for the details of which we have 
no room. 
Case VI. Mania Puerperale Lattea.—The patient was about 36, the 
mother of four sons; suppression of the lacteal secretion and suppura- 
tion led to puerpural insanity. She recovered in two years. There 
was at first continual and violent excitement. The treatment consisted 
primarily in abstracting all stimuli, both physical and moral. The 
symptoms continuing, some repose was attained by ordinary baths, and 
more from cold immersion, succeeded immediately by the warm bath. 
As exhibiting the scientific character of the Italian physicians, we may 16 
remark that mention is made of detecting the presence of free lactic 
acid in this patient, which had been evinced through a specific sourness 
in the perspiration; this reddened the azure of the tincture of turn sol* 
subsequently, in the way of treatment, vesication was employed, and 
antimonial frictions along the spine. Her diet was farinaceous, some 
fruits being also allowed, and a little bread and wine. If the food was 
at all augmented, the symptoms would become worse. The next addi- 
tional means of treatment consisted in prescribing every six days mag- 
nesia and the flowers of sulphur; afterwards she was given copious 
depurative decoctions and prolonged warm baths, with, at the same 
time, a sprinkle of cold water on the head. Ultimately she was put to 
spinning, entered into the common life of the other inmates, and was 
allowed a more nutritive diet. Medical means were kept up, and she 
took generous doses of the depurative decoctions of guiacum, of dulca- 
mara and cina.f The disease then terminating in alarming anemia, 
medicines were abandoned and moral means resorted to. 
Case VII. Mania Collerica Polcnziale.—This patient was a nun, 27 
years old, of sanguine temperament, who, in consequence of some slight 
from the superior of the religious house to which she belonged, became 
violently insane, tore her garments, refused food, &c. The curative 
means were repression, isolation, leeching and the warm bath. Then 
calomel, lauro-cerasus and digitalis. She was also prescribed a veget- 
able diet. On recovery, after a year’s residence in her family, she re- 
turned to the convent, where she subsequently enjoyed great tranquillity 
of mind. 
Case VIII. Mania Continua Agitata.—The author entitles this case 
“ agitata,” as that last mentioned is entitled “ collerica,” because of the 
former being marked by agitation and the latter by violence. As a part 
of some preliminary remarks, he says that refusal of food is due either 
to some fancied command from Heaven, or to a special hallucination, or 
to a suicidal tendency, or else to a morbid state of the nervous, ganglio- 
nary and splancnic system, from which proceeds an oppressed and, as it 
were, paralyzed condition of the gastro-enteric organs. In a note, he 
gives an amusing instance of the blunders which foreigners sometimes 
make in English and American names. For he observes that he has 
“ perused with pleasure the short but pithy article of Dr. Luther, ‘ On 
the forced Alimentation of the Insane.’ Annali Medico-Psychol. di 
Parigi, 1852. Aprile, pag. 299.” Now in reality, this was an article 
taken originally from the “ Journal of Insanity,” and contributed thereto 
by the able and distinguished physician of the McLean Asylum, Dr 
* Litmus. 
t Artemisia santonica. 17 
Luther V. Bell; the editors of the “ Annales Medico Psychologiques” 
having made a mistake in his name, and this is repeated here by Dr. 
Massari; he speaks of the production of Dr. Bell as “ parole del Dott. 
Luther.” But to return : the patient in the present case was a servant, 
aged 38, of nervous temperament. His malady was owing to too great 
fatigue from a varied daily avocation, together with the abuse of wine 
and the apprehensions attending the historical events which occurred 
at Rome in 1849. On his arrival at St. Margaret, he appeared quiet 
and tranquil, then suddenly he commenced refusing food. At night he 
was sleepless, but without special disturbance. His disease assumed 
the form of “ mania agitata”—that is, rather of agitation than of fury, the 
most prominent symptom being the refusal of food. There was also 
some cardiac derangement of nervous character, and an obstinate con- 
stipation. In fifteen days there were lucid intervals. The treatment 
consisted of baths, purgatives, emetics, frequent clysters and vesioatories. 
He recovered. 
Case IX. Monomania Politico-Religiosa.—This patient was a physi- 
cian, of low stature, dark complexion and eyes, and bilious temperament, 
with some hepatic obstruction. The historical events of Rome, in 1849, 
predisposed him to insanity. He forsook his profession, and (being 
from the country) took refuge in Perugia, which was then under Aus- 
trian protection ; whilst there, for a fortnight he was in prison. The 
treatment, resulting in recovery, appears to have been purgatives (de- 
obstruents) and baths. As an occupation, he was assigned the task of 
copying an article on mental alienation, (a translation from Signor 
Dalberg’s Dictionary of Medicine, vol. 1, article, Mental Alienation.) 
On recovering, he soon regained his practice, so great was the confi- 
dence of the public in his skill. 
Case X. Acute Hystero Mania.—Of the various cases of this char- 
acter treated by the writer during late years, the present was the 
most grave in its symptoms. The patient was the wife of a baker, aged 
30, of low stature, robust in form, of florid complexion, eyes black and 
sparkling, and with an animated countenance; endowed with every 
virtue, religious and domestic, habitually talkative and otherwise gay, of 
sanguine temperament, and naturally inclined to matrimonial indul- 
gence. After the birth of a daughter she became barren, and her 
menstruation grew sluggish and scanty. From the fatigues of her oc- 
cupation, the great heat of the oven, labor at night, and a partial abuse 
of wine and of conjugal pleasures, hystero-mania of high grade set in, 
presenting at the outset phenomena which were more or less intense 
and constant for the long period of ten months. On her admission she 18 
was much excited, with countenance distorted by abnormal twitchings, 
with eyes sparkling and bold. Every motion betokened a violent irri- 
tation in the sexual organs, to which she would convey her hands in 
order to produce friction. All who approached her she met with vio- 
lence and angry gestures. The straitwaistcoat was applied, and she 
was given a warm bath, prolonged with the cold douche to the head. 
An emetic was also administered. After some rest, she commenced 
uttering loud cries, pulling up and tearing her clothing, laughing im- 
moderately, and exhibiting obscene actions. The baths were continued, 
with the addition of a suitable diet and calomel, to overcome the obstinate 
constipation. Menstruation not appearing, was replaced, as it were, by 
leucorrhea, serving still more to excite the genitalia. Leeching was then 
used, (emeroidale,) and next a vesicatoiy to meet an apparent tendency 
to paralysis. And for the immobility of the right arm, opodeldoc was 
resorted to, through which means the torpor gradually disappeared. 
Other grave symptoms followed—tearing the hair, compressing the ute- 
rus with her fists, urinating in bed, chipping the wall and refusing sus- 
tenance. For three weeks subsequently she continued to show mania- 
cal symptoms. A light bleeding was then adopted, and she went on 
with the baths. Later, the tincture of iron and saffron was adminis- 
tered in a saturated decoction of maiden-hair,* and she likewise engaged 
in a little work. Subsequently, on the occurrence of a heaviness in the 
head, and a weight in the uterine region, a full bleeding in the foot was 
employed. She recovered. 
Case XI. Was one in which the patient, a canon, imagined himself 
possessed by an evil spirit; the alienation came on after a fever, and 
resulted in death. The treatment consisted of bland purgatives, 
clysters, emeto-acidulated drinks; vesicatories and sinapisms were used 
ultimately; the camisole, baths and the douche; the autopsy of this case 
is also given, but we must hurry on to a close, and have therefore no 
room for such details. 
Case XII. Merely remained for a short time in the hospital, and ulti- 
mately committed suicide, being essentially so inclined. The only cir- 
cumstance of note requiring mention here is the treatment of a diar- 
rhea, -with which he was seized on the 8th day of his stay at St. Marga- 
ret—it consisted of a refrigerant diet, and the pulp of tamarinds and 
cassia, with an emulsion of gum arabic. 
Case XIII. Was an Englishman who attempted suicide. A purga- 
tive treatment, and occupation of the mind by translating Metastasio. 
were the curative means employed. He recovered. 
* Adiantum pedatum. 19 
Case XIV, and the last, was one of peurile dementia in connection 
with epilepsy. The patient, Marietta Scarsella, of Rome, was previ- 
ously a healthy child, both as to mind and body, when, at three years of 
age, she experienced an attack of epilepsy, after having been frightened. 
No great increase of morbid symptoms occurred until she was five, 
when her mind began to weaken, and, when eight years of age, she was 
admitted into the hospital of St. Margaret, on the 23d of December, 1849. 
After an attack of fever in March, she was placed on a depurative de- 
coction; and in June the antimonial friction advised by Autenrieth was 
applied to the head. This produced so profuse a secretion from the con- 
sequent eruption, as to require astringents for its diminution, and tonics 
for the debility that ensued. Counter-irritation was, however, continued, 
and with such apparent benefit, that, in September, 1851, she had not 
experienced an access of epilepsy since the previous March, whilst her 
mind had decidedly improved, so that she was discharged on the 18th 
of September. With reference to the permanence of the amelioration 
in the case of this unfortunate, it should be remembered that Dr. Mas- 
sari’s report is dated only in the following June, (1852). And, moreover, 
we observe that, in speaking of her amendment, he alludes to her 
“ learning, prayers, and to cross herself” ; now it may be mentioned 
that there is not a more common symptom of epileptic insanity than an 
exaltation of the religious feelings.