THE LATE DR. CHEYNR'S ESSAYS ON PARTIAL DERANGEMENT.

DR. JOHN CHEYNE was a Scotch practitioner, who after passing through the routine duties of an Army surgeon, and some Edin- burgh practice in conjunction with his father, took advantage of an opening and went to Dublin. Here he gradually rose to eminence ; not only attaining a very large private practice, but filling those public medical offices to which the heads of the profession are generally nominated as matter of understood custom. The fatigue and anxiety attendant upon his position seem to have undermined a constitution not naturally strong ; and in 1831, in his fifty-filth year, Dr. CHEYNE retired from Dublin, to Sherington in England, with a view of returning when he had recruited his strength. This idea, however, was soon abandoned ; for his constitution gradually gave way, and he died in 1836, in his fifty-ninth year. The position of Dr. Opines gave him many opportunities of observing derangement of mind, not only in admitted insanity, but in those more difficult and delicate cases where the intellect is rather clouded than deranged, or where an abnormal condition is shown in partial irregularities, which are called oddities or eccen- tricities, unless accident develops the germ of insanity, and the patient stands forth a lunatic. Living in a community where religion is a subject of violent strife among opposite professors, and having a religious turn himself, the Doctor took advantage of his position to inquire into some Roman Catholic miracles, as well as to examine the numerous cases where it was alleged that msd- ness was caused by religion. To exhibit the fruits of the twofold experience thus acquired, Dr. CHEYNE devoted the leisure of his declining years ; and the series of essays in which he embodied his views are contained in the posthumous volume before us.

These essays are eleven in number ; each treating of some single topic in relation to an abnormal state of mind, and chiefly in con- nexion with religion. The main positions of Dr. CHEYNE, how- ever, are two-1. That insanity is always based upon bodily dis- ease, and that its treatment by what is called moral means can rarely be effective without medical aid. 2. That true Gospel reli- gion is never a cause of insanity ; on the contrary, its tendency is preventive. The conjunction of madness and religion originates either in the patient, after he has become insane, taking up religion as one of his topics, or, when his mind has become unhinged, suddenly taking a religious turn, and his friends representing the symptom of his insanity as the cause ; and though the excite- ments of superstition or fanaticism may DO doubt be said to drive people mad, yet perhaps the peculiar temperament that indu- ces individuals to yield themselves to the excitement of Romish or sectarian outbreak is itself proof of a morbid intellect. There is also a third point connected with the two principal theories of our author which deserves mention ; and that is the extent to which he carries his view of derangement. Deducing his theory from his facts, Dr. CHEYNE would go as far as Imlac in Rasaelas, and affirm that " disorders of intellect happen much more often than super- ficial observers will easily believe. Perhaps, if we speak with rigorous exactness, no human mind is in its right state. There is no man whose imagination does not sometimes predominate over his reason, who can regulate his attention wholly by his will, and whose ideas will come and go at his command. No man will be found in whose mind airy notions do not sometimes tyrannize, and force to hope or fear beyond the limits of sober probability. All power of fancy over reason is a degree of insanity ; but while this power is such as we can control and repress, it is not visible to others, nor considered as any depravation of the mental faculties : it is not pronounced madness but when it becomes ungovernable, and apparently influences speech and action." The difference be- tween Dr. CHEYNE and Dr. JOHNSON would be rather one of cause than effect. The moralist would attribute the deviation to mental depravation, the physician to bodily derangement ; and while the Doctor of Laws would look to philosophy, the Doctor of Medicine would prescribe a dose of physic.

Although the Treatise on Partial Derangement of Mind is not without plan,—for the book commences with a general view of Dr. CHEYNE'S ideas of the origin of those irregularities and delusions which frequently end in insanity, and each essay is devoted to a particular subject,—yet the work is rather general and desultory, as indeed is the character of its theme. No rule

or definition can be deduced from it : but perhaps no one can satisfactorily define madness—the question must be decided upon

each individual case as it arises. No particular mode of treatment can be prescribed from Dr. CHEYNE'S book; but then, every patient must be treated according to his peculiar idiosyncracy, and to the

particular organ whose function is affected. Still, with all these allowances, we think the book rather a collection of facts and opi- nions derived from a long course of observation and reading, than a methodical treatise on insanity, though containing several judi- cious hints, especially upon the tests of madness. It should also

be observed, that some of the latter chapters are rather religious than medical, and smack as much of the divine as the physician. Prefixed to the Essays is an autobiography of Dr. CIIEYNE

which is a rapid and agreeable narrative—interesting for its account of the rise of a medical man, and useful for the practical hints that the practitioner may derive from it. In fact, the autobiography strikes us as being the more complete and satisfactory work of the two ; and we shall draw upon it for extracts, more than upon the Essays.

HINTS FOR CONSULTING-PRACTITIONERS.

As I was much more generally employed as a consulting than as an attend- ing physician, 1 endeavoured to escape interruption in my chief line of busi- ness. I returned to my house at appointed times, to form new engagements; but I left no account of my route when I set out from home. When I was tracked and obliged to yield to an unexpected requisition, the patient for whom I was sent was perhaps dead ; or he was dying, and I was unable to leave him ; or the attack was over, and he was again well, and my sole recompense was a complimentary speech; or I Was led to supersede the family physician engaged elsewhere, which gave rise to explanations, and to a negotiation to replace him in the attendance. In the mean time, disappointment to these patients and their medical friends who were waiting for me necessarily occurred; and thus a ruffle of the spirits, very unfavourable to the consideration of a difficult case, arose, and continued for several hours.

Had these interruptions taken place frequently, the character for punctuality which I was exceedingly anxious to establish and maintain would soon have been destroyed. I had often observed that punctuality, which is not much Practised in Ireland, is nowhere regarded with more complacency. Punc- tuality precludes the necessity of explanations and excuses, often awkward, and more frequently than we are aware of not strictly true. Punctuality is con- sidered by junior and subordinate members of a profession as manifesting re- spect for their feelings and occupations : it is felt to be a compliment ; and it is a compliment in which there is no surrender of truth. When a case of disease was assuming an unfavourable aspect, and when the question was mooted—to whom shall we apply for further help ? it has, in a multitude of instances, been

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decided in my favour solely by the consideration that I would appoint the earliest hour for a meeting, and that I might be expected to appear within five minutes of the appointed time. 1 al wit) s endeavoured to prevent changes of the medical attendants in a family, unless in cases of obvious neglect or ignorance ; and even then I never hinted at a substitute. If requested by a patient to recommend a surgeon, accoucheur, or apothecary, to attend in his family, I mentioned the names of three or four men of established character, and advised my patient to discuss their merits with his friends, and decide at his leisure.

HOW TO DEAL WITH THE CRAFT.

I was much employed in the families of my medical brethren. I found this a painful distinction. Perhaps I was selected, not by the father of the family, but by the patient, his son or daughter; or by the mother, contrary to the father's wishes, which would have led him to introduce a friend of his own. I often had to bear all the responsibility of an attendance on a case of which I bad not the complete direction. Again, nothing,. but necessity can induce many medical practitioners to admit a physician into their families: perhaps they idly think that thus they acknowledge their own incapacity. Then, if a case proves fatal, and the treatment has deviated one hair's-breadth from that which the head of the family would have adopted, he connects the issue with the infatuation which led him to place confidence in one who, he now thinks, was his inferior in skill and experience. Still, an attendance in the family of a respectable medical practitioner cannot be declined, and, moreover, it is often highly useful; and hence it was my endeavour to make it as little irksome as possible. I made it a rule never to acquaint any one, not even my own family, with the names of the patients who were under my care. When I went into the family of a medical practitioner, I ordered my carriage to step in a neighbouring street, and walked to the house in which the patient lay : I fully and explicitly stated my opinion to the head of the family, and avoided all explanations with others ; and I generally declined writing the prescription which was to go to the apothecary. My closeness, which was proverbial, and my deportment, which was as little assuming as possible, kept these invidious attendances from being materially injurious, except from the great anxiety which they caused.

POWER OP FAITH OVER PHYSIC.

The physician who possesses the confidence of the public is able, in an ex- tensive class of obstinate diseases, to effect improvements in the health of his patients which appear to the ignorant almost miraculous. The cases to which I allude are those in which disease, however occasioned, is prolonged by de- pression of the mind, which excludes all hope of recovery. In such cases, a physician, unless be obtains dominion over his patients, so far from affording relief, fails in every prescription ; nay, prescriptions unexceptionable in all re- specie appear uniformly to aggravate the symptoms which in general they alle- viate. The physician is felt to be a chief cause of the patient's suffering; but instead of looking to those influences which improve the general health—snch as a proper regimen, air and exercise, change of scene, and amusements which do not exhaust the spirits—he is led by disappointment to the exhibition of medicines more and more active, till the patient in despair refuses all further aid, or 'eels help from some other quarter, or very generally, if affluent, goes to the metro- polis to consult the Radcliffe or the Mead of his day. A popular physician, with a composed yet decided and rather unyielding manner, to such a patient appears almost like a ministering angel. The most obvious directions appear like words of inspiration ; the merest placebo that ever was stuck upon an apothecary's file is a panacea, or is combined with consummate skill, and restores health and enjoyment of life. I have witnessed many of these Hohen- lode cases, as they are called in Ireland. In Dublin, many a patient under my care has been restored to health by the same means which have signally failed in the country : thus, in certain cases, reputation promotes success, and success continues to uphold reputation.

MUM'S THE WORD.

Professional success, like every other good thing in this life, hail in its nature many of the seeds of decay. The same circumstances which tended to bring the present favourite into general repute are probably already operating in behalf of his destined successor. Thus, the physician, to whom his fellow-citizens award the possession of most skill, is generally called upon to assist when all assist- ance is too late, and sarcastic remarks tending to promote his downfall are made when the patient dies and becomes the subject of ephemeral talk. As there are everywhere those who judge of merit by success, it is perhaps in- sinuated, that before long the favourite of fortune, who so frequently appears as the undertaker's provider, will be reduced to his proper level. I recollect a time when seven of my patients, in families who were in easy circumstances, died of fever within a week : five of them, it is true, were in a state almost hopeless when I first saw them, but this would not have preserved me from dis- trust. I owed my immunity to their belonging to different classes of society, which had no knowledge of each other, and to my rule of not talking of my patients : had the fact been known, it would probably have given a shock to my reputation from which it might not easily have recovered.

SUBJECTS FOR MIRACLES.

Whether a Roman Catholic miracle is to be attempted by a living or a dead priest, by Prince Hohenlohe or the Abbe Paris, by the holy sacrifice of the mass or the holy thorn, there are certain qualities in the subject of the miracle scarcely to be dispensed with, if success would be insured. If the disease to be removed be seated in a vital organ, it ought to be a disease of function not of structure : the imagination ought to be powerful ; there ought to be a strong tendency to hysteria ; and the party ought to he of the female sex ;—'and, by the way, these are the very qualifications which entitle an individual to the benefits of animal magnetism. if any new leader of a sect would bolster his sanctity by pretensions to supernatural power, let him not lose sight of these hints.

IRRELIGIOUS MADNESS.

Some who, while in health, apparently have no sense of religion, when they fall into melancholy are engrossed with the terrors of judgment—their certainty of punishment—the endless night of despair—the worm that never dies ; they declare that they seem to perceive the fire kindled in which they are to agonise —bear its flame crackling—are scorched by its heat—and are already living under a sulphurous canopy : yet these are, of all men, the least ready to listen to the Gospel, to the philanthropy of Christ, and the certainty of reconciliation to God. Tell them that you can insure their recovery, and they will listen to you with interest, although they may affect to disbelieve you ; but talk to them of Jesus, and probably you will confirm their despair.

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