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A N 
 
 INAUGURAL DISSERTATION 
 
 O N 
 
 CHRONIC MANIA. 
 
 SUBMITTED TO THE PUBLIC EXAMINATION 
 
 OF THE 
 
 FACULTY OF PHYSIC, 
 
 UNDER THE AUTHORITY OF THE 
 
 TRUSTEES OF COLUMBIA COLLEGE 
 
 IN THE 
 
 STATE OF NEW-YORK: 
 WILLIAM SAMUEL JOHNSON, LL.D. Prefident; 
 
 FOR THE DEGREE OF 
 
 DOCTOR OF PHTSIC. 
 
 ON THE THIRD DAY OF MAY, 1796, 
 
 By ALEXANDER ANDERSON, 
 
 Citizen of the State of New- York. 
 
 Chiefly where Solitude, fad nurfe of care, 
 To fickly muling gives the penfive mind, 
 There Madnefs enters; and the dim-ey'd fiend, 
 Sour Melanchuly, night and day provokes 
 Her own eternal wound. 
 
 Armstrong. 
 
 NEJT-YORK: 
 
 r>s, Printers 
 liege, No. 99 
 
 — i 79 6.— 
 
 Printed by T. and J. Swords, Printers to the Faculty of Phyfic of 
 Columbia College, No. 99 Pearl-ilreet. 
 
/If ,L^- ( '/ft / / 
 
 ' f 
 / X? 
 
 /7fl 
 
DEDICATED TO 
 
 Doctor JOSEPH YOUNG, 
 
 AS A MARK OF 
 
 RESPECT AND GRATITUDE 
 
 FOR HIS ATTENTION TO THE 
 
 MEDICAL INSTRUCTION 
 
 The Author, 
 
Digitized by the Internet Archive 
 
 in 2011 with funding from 
 
 Open Knowledge Commons 
 
 http://www.archive.org/details/inauguraldisserOOande 
 
A M 
 
 INAUGURAL DISSERTATION 
 
 O N 
 
 CHRONIC MANIA. 
 
 INTRODUCTION. 
 
 .ANKIND, from innumerable caufes, may be 
 deprived of the ufe of reafon. The difficulties at- 
 tending the inveftigation of a fubject fo intimately 
 connected with the phenomena of the mind, may 
 account for the many unfatisfaclory conjectures hi- 
 therto offered, as well as for the imperfections of the 
 following attempt. 
 
 It is difficult to define that ftate of the intellectual 
 faculties which may be faid to conftitute a reafonable 
 being •, for, fo various are the fenfations of different 
 people, and their conclufions from them— fo imper- 
 ceptible the gradations from a flight error in reafon- 
 ing to fatuity, that we can fcarcely fay where ration- 
 ality ends and folly begins. — No lefs difficult would 
 
 the 
 
i e ) 
 
 die tafk be to determine the point at which madnefs 
 commences, fince every inordinate indulgence of the 
 paffions partakes of it j and even low fpirits and ab- 
 fence of mind may be reckoned as {lighter degrees 
 of the fame affection. 
 
 Some have made the characteriftic of madnefs to 
 confift in a mode of thinking and acting different 
 from the generality of mankind : But this, if ad- 
 mitted, would evidently include every great genius, 
 who, in the purfuit of truth, dares to differ from 
 others. In fad, we find that fuch have generally 
 b^en reckoned in this clafs by thofe who compofe the 
 moft numerous rank of life. Even the Saviour of 
 the world incurred the name of a demoniac, or, in 
 other words, a madman, notwithstanding his unex- 
 ampled purity of life. The eloquent defence of St. 
 Paul, before Agrippa, did not preferve him from a 
 like epithet.* 
 
 The tranfition from poetic ardour to madnefs is 
 eafy; hence fome of the moft fublime flights of 
 imagination have been the productions of a diforr 
 dered mind. It is not improbable that the refponfes 
 of the ancient oracles were delivered by their priefts 
 
 while 
 
 * Ads xxvi. 24. 
 
I 7 ) 
 
 while in a ftate of artificial madnefs : the phrenzy of 
 the Cumaean Sibyl, as defcribed in the fixth JEneid^ 
 countenances this opinion. Even at this day the 
 dervifes and priefts of uncivilized nations, by the 
 ufe of narcotic, intoxicating fubftances, or by rapid 
 rotations of their bodies, induce a fimilar condition 
 of the fyftem, and by this counterfeit of fupernatural 
 appearances, imprefs their devotees with awe and 
 reverence. It is well known to what account Ma- 
 homet turned his epileptic fits. The fame effects 
 refult from the voluntary convulfions and whirlings 
 of the Shaking Quakers in this country. 
 
 The affinity otdrmkennefs to madnefs is obvious : 
 diftinguifhed only by the greater diffufibility of the 
 caufe, and the fhorter duration of the effecT:, it will 
 frequently degenerate into the latter, efpecially in 
 thofe who are conftantly Jiarraffed with the dread 
 of impending ruin.- 
 
 Although the foregoing reflections may place 
 mankind in a point of view rather humiliating, yet the 
 confideration of them may confirm the obfervation 5 
 that the medium between enthufiafm and apathy is 
 the moft fuitable to human nature, as well as moH 
 favourable to the functions of both body and mind. 
 
 Notwithftandins: 
 
( 8 ) 
 
 Notwithstanding the many proofs to the contrary, 
 reafon is, by many, fuppofed to belong exclusively to 
 man, and to diftinguifh him fufficiently from the 
 brute creation, whom they have portioned off with 
 an imaginary Something called inftinff : the existence 
 of this can never be proved, while experience afTures 
 us that all our knowledge is derived from the opera- 
 tion of bodies on the organs of fenfe. — Innumerable 
 facts might be adduced to prove, that all animated 
 beings are endowed with the ufe of the reafoning 
 faculty, in different degrees, proportioned to their 
 various wants. In thofe which are called the lower 
 orders, its operations are lefs manifeft; ftill, to the 
 philofophic eye, they are fufficient to indicate a ra- 
 tional principle directing their efforts, and adapting 
 them to the Situations in which they may be placed.* 
 
 Surely 
 
 * Birds do not always follow the fame model in the con- 
 struction of their nefts, but vary them fo as belt to afford con- 
 cealment from their enemies, and protection from the injuries 
 of the weather. 
 
 Animals that are accufiomed to pafs the winter in a torpid 
 ftate, when removed to warm climates totally lofe this habit. 
 
 Some bees which had been tranfported to one of the Weft- 
 India iflands, finding no neceffity for their ufual labour, foon 
 neglected to construct combs and accumulate honey, and even 
 proved troublefome to the fugar-boilers. 
 
 The inftances of plants feeking the light, and performing 
 various actions with fomething like fagacity, are well known. 
 
( 9 ) 
 Surely this argues fomething more than a blind in- 
 ftinct operating in a mechanical manner. 
 
 In what, then, it may be afked, confifts the dif- 
 tinction between the human being and the brute ? I 
 anfwer, 
 
 i ft. In the formation of the body ; for, notwith- 
 ftanding the endeavours of fome naturalifts to ap- 
 proximate them, the difference between man and 
 the ouran-outang is too ftriking to allow the idea 
 of any relationfhip between them. 
 
 2d. Man's pre-eminence is chiefly founded on his 
 greater power of exerting volition. It is this which 
 enables him to fubjecl: other animals to his dominion, 
 to form languages, to labour for a circulating me- 
 dium, to form inftruments and machines ; and which 
 prompts him to adore the Deity, with the hope of 
 procuring future happinefs. 
 
 Such is the condition of man, that this very cir- 
 cumftance, by which he is elevated above other 
 animals, frequently fubjecls him to a malady, which 
 lays the mind in ruins, and transforms a rational 
 being to a fury or an ideot. 
 
 B THEORY 
 
( io ) 
 
 THEORY OF MANIA, 
 
 MADNESS may be defined a falfe perception of 
 objects, depending on morbid fenfation, with a be- 
 lief m the truth of the fuggeftions of the fenfes, 
 and in confequence of this, extraordinary and irre- 
 gular efforts to attain fome imaginary good or avoid 
 fome evil. The violence of thefe efforts will be in 
 proportion to the hrmnefs of the belief and the quan- 
 tity of volition in the perfon affected. 
 
 It differs from delirium or typhomania in the fol- 
 lowing particulars: in thefe the affection is of fhorter 
 duration, attended with an ignorance in the patient 
 of his fituation and the perfons about him, together 
 with a greater proflration of ffrength. 
 
 That form of the difeafe which I propofe to con- 
 sider, may be termed Chronic Mania., to diftinguifh 
 it from Phrenitis, and other affections of the mind 
 depending on inflammatory action. Its duration 
 likewife entitles it to this name-, for, although ex- 
 afperated at particular times, it frequently tinctures 
 the behaviour of the maniac, even in what are called 
 his lucid intervals, and is eafily excited by flight 
 caufes. 
 
 The 
 
( II ) 
 
 The infenfibility of madmen to cold has been of- 
 fered as a proof that the cfifeafe is connected with an 
 increafed action of the veffels : this, indeed, has fome 
 degree of plausibility, becaufe the inftances of their 
 refilling the power of fevere froft cannot otherwife 
 be accounted for, than on the fuppofition of a pre- 
 ternatural generation of heat, which always implies 
 increafed action of the fyftem :— But, I believe, thefe 
 cafes would be found to belong to phrenitis, a dif- 
 eafe depending on an inflammatory diathefis, in which 
 the abfcraction of heat muft be eminently ferviceable, 
 and has fometimes even reftored the patient to health : 
 on the contrary, in chronic mania, the patient is co- 
 vetous of warmth, and careful to avoid the inclemen- 
 cies of the weather; or if expofed to cold, in their 
 vagaries, without exercife of their limbs, the livid 
 colour of their extremities fufficiently indicates its 
 effects on them. Morgagni relates the cafe of one 
 who peri fried merely from neglecting to fecure him- 
 felf from the cold. 
 
 Hence, if increafed vafcular action is ever obferved 
 in this difeafe, it muft be confidered rather as,the 
 effect of the violent exertions, than the caufe. 
 
 From thefe confederations we are juftified in affert- 
 
 ing 
 
( 12 ) 
 
 ing the exigence of a morbid ftate of the mind, dif- 
 ferent from phrenitis and delirium, as well as from 
 fatuity, and confined to no peculiar temperament. 
 Its feat and caufes I mall prefently endeavour to 
 point out. 
 
 The more remarkable characteriftics of this affec- 
 tion are the following : a falfe fenfation of external 
 objects, a morbid or unufual afTociation of ideas, 
 eager purfuit of fome object, and violent exertions 
 to attain it, with indulgence of exceflive emotions, 
 particularly of fufpicion and anger : fome are marked 
 by a melancholy behaviour, bordering on ftupidity, 
 or harrailed with groundlefs fears •, while an uncom- 
 mon gaiety is the prevailing fymptom in others. 
 
 Darwin fuppofes, that the preternatural exer- 
 tions of infane perfons may be attributed to an 
 increafe of fenforial power, acted upon by the greater 
 quantity of ftimulus of deflre or averfion— while the 
 force of thefe mufcular motions may be augmented 
 by the ftimulus of pain or pleafure, as well as by 
 that of external bodies. — Whether the quantity of 
 fenforial power is preternaturally accumulated, it may 
 be difficult to fay ; but it is evident, that an increafed 
 volition is exerted in confequence of a ftrong belief 
 
 in 
 
( n ) 
 in the reality of the phantafms prefented to the ima- 
 gination : hence we are often led to impute their 
 actions to a perverfion of will ; and this has indicated 
 the neceffity of retraining, and acquiring a command 
 over madmen, in order to curb their enormities. 
 
 The conjectures of the ancients, with refpect to 
 the proximate caufe of this diforder, have been fup- 
 ported by Boerhaave and Van Swieten, who, 
 after accuiing an imaginary atrabilis of producing it, 
 and labouring to prove the exiftence of fuch a caufe, 
 at laft acknowledge, that all thefe fymptoms may 
 arife merely from an affection of the mind,, 
 
 Later theories afford but little more fatisfaction 
 on this fubject. "What idea can we form of an 
 " inequality of excitement," which a late Profeflbr 
 fo unphilofophically infers from the inequalities in 
 the confiftence of the brain ? Our ignorance of the 
 nature and functions of the brain render it needlefs 
 to fearch there for the caufes of this difeafe ; hence 
 directions of this organ throw but little light on its 
 aetiology.* The changes obferved there may be 
 
 either 
 
 * In fome maniacs the medullary part has been found 
 drier, and of lefs fpecific gravity, than is common. 
 
 Morgagni obferved, io general, a preternatural degree of 
 
I H ) 
 
 cither the caufe or the effect of the fymptoms enu- 
 merated, or perhaps totally unconnected with them ; 
 for, notwithstanding the injuries to which the brain 
 is often expo fed, fuch as erofion and ulceration, 
 drop (leal infarctions, concuflions, wounds, and even 
 the lois of considerable portions of it, no affection 
 of the mind fimilar to mania has occurred. 
 
 The investigation of the feat of ideas may appear 
 to be an ufelefs piece of fpeculation ; yet it becomes 
 efTentially neceffary, in order to determine the prox- 
 imate caufe of a diforder which more properly be- 
 longs to the mind, or at leaft the immediate agents 
 by which it receives impreffions. 
 
 It is certain that we poiTefs no ideas but what are 
 primarily acquired through the medium of the femes, 
 for thofe who have never enjoyed the ufe of the .or- 
 gans of fight or hearing, have no conception of visi- 
 ble or audible objects. This is likewife corroborated 
 
 by 
 
 liardnefs in the brain, or at leaft in fome parts of it. — Bone- 
 tus found' the cortical part dry and friable, and yellow 
 for an inch deep. — In fome the pia-mater has been found 
 thickened, and the dura-mater callous. In others the veffels 
 of the brain were unufually diftended, and the cranium thick 
 and without futures. 
 
 But what can we learn from all this? 
 
•( 15 ) 
 
 by the fact, that thofe who have loft both eye-balis 
 have been entirely deprived of all ideas of fight. 
 
 By an exertion of the memory we are enabled to 
 recall thefe ideas according to the. laws of affociation % 
 and thefe, when varioufly combined and arranged, 
 form the whole of human knowledge. This faculty 
 of compounding ideas commences at a very early 
 period, as may be obferved in the conduct of chil- 
 dren, whofe curiofity prompts them not only to ac- 
 quire notions of external bodies, but likewife to 
 combine them in every variety. The early appear- 
 ance of thefe combinations has led many to efpoufe 
 the opinion of their being innate or inftinctive : how 
 ill founded this is I have endeavoured to fiiow. 
 
 Having rendered it fufficiently probable that the 
 organs of {trSt are the feats of thought, it next be- 
 comes neceffary, in the investigation of this fubjeet, 
 to examine what are the changes on which the pro- 
 duction of ideas depends. Thefe changes are fup- 
 pofed, by Darwin, to confifl in certain configura- 
 tions, or motions of the nervous extremities, which 
 conftitute the immediate organs of ftnk. In order 
 to prove the poffibility of thefe motions taking 
 place, he has demonstrated, that even the pulpy 
 
 expanfion 
 
( 16 ) 
 
 expannon of the retina is compofed of muftular 
 fibres: its foftnefs is no argument againft this, for 
 we may fee infects of a confidence as foft, which 
 yet are capable of performing a variety of motions ; 
 and how thefe could be done without mufcles we 
 cannot conceive. 
 
 The erection of the papillae of the tongue, at the 
 approach of a fapid body, implies a fimiiar flruclure 
 in the nervous extremities of the organs of tafte. 
 
 The doctrine which may be eftabliihed from what 
 has been premifed, is this :— By the ftimulus of ex- 
 ternal bodies, certain motions or changes of figure 
 are excited in the immediate organs of fenfe: but 
 thefe, like the other mufcles, are liable to an ex- 
 haustion of their excitability ; and this indireff debi- 
 lity will take place at higher or lower degrees of ex- 
 citement, according to the proportion of fenforial 
 power diftributed to different people: hence the ex- 
 ertion of which one perfon may be capable will, in 
 another, bring on a ftate of ftupidity* 
 
 The exiftence of this indireSl debility is likewife 
 proved from the analogy of the irregular ajfociations 
 ef ideas, with the fpaftic contractions of the other 
 
 mufcles, 
 
( %f ) 
 
 mufcles, as well as from the identity of the caufe 5 
 viz. exceilive application of iiimulants. 
 
 Thefe irregular motions of the organs of fenfe 
 may be induced by any great menial ftimulus, ap- 
 plied in this debilitated (late : hence falfe fenfations, 
 in the reality of which the madman confides ; and 
 from thefe proceed all thofe eccentricities which cha- 
 racterife him. 
 
 The phenomena of a cafe of oneirodynia a£liva y 
 under my obfervation, feem to corroborate this 
 opinion. This affection almoft always occurs during 
 the firft hours of fleep, when an indirect debility of 
 the organs of fenfe, as well as of the whole body 5, 
 muft be the effect of the various exciting powers of 
 the preceding day : in this cafe no alteration is made 
 by fatigue or reft of the body, or by repletion or 
 depletion of the ftomach ; but great exercife of the 
 mind has a fenfible effecl: in aggravating the parox- 
 yfms.-— The phenomena of dreams likewife tend to 
 prove the exiftence of this ftate ; for it is well knovvn s 
 that thofe which occur towards morning are much 
 more regular than others, becaufe the excitability 
 has been renovated by the night's fleep. 
 
 C From 
 
( i8 ) 
 
 From hence we may learn why the want of fleep 
 is fo inftrumental in producing mania, fince there is 
 not only an obftacle to the accumulation of excita- 
 bility, but a frill greater wafte of it from the objects 
 which engage the attention. 
 
 People of a verfatile and trifling difpofition, and 
 whofe employments are diverfified with a pleafing 
 variety, feldom become the victims of this difeafe J 
 from this arifes the proverb, " Fools never go mad.'* 
 But thofe who are flimulated by an ardent defire of 
 fame, or of riches, or from a miftakenfenfe of duty, 
 to exert their utmoft power, and confine their atten- 
 tion too long to one fubjed, often incur this ftate of 
 the fenfes : hence the chimeras of fancy are miftaken 
 for realities, and propagated under the names of 
 virions, apparitions, &c. Sometimes the fame ex- 
 traordinary effort induces a melancholy dilpofition ; 
 and, as the patients exprefs it, they " find themfelves 
 unable to think." A refpectable clergyman, in 
 England, was an inftance of this. After confiderabie 
 application to a literary work, he became gloomy and 
 defpondingi and in this ftate he would declare that 
 God had deprived him of his rational foul, and re- 
 duced him to the condition of a vegetable. — Sir 
 Isaac Newton fell into a melancholy which de- 
 prived 
 
( i9 ) 
 
 prived him of all thought, but was foon cured by 
 converting with his friends. 
 
 Since hope and joy are mental ftimulants, the ab- 
 straction of them muft conftitute an afthenia ; hence 
 any train of thought accompanied with defpair and 
 gloomy apprehenfions, is more efpecially hurtful. 
 Such are the caufes of nojialgia^ a difeafe more or 
 lefs felt by all who are abfent from their native 
 country, and confcious of the impoflibility of revi- 
 sing it.* I have been informed that the negro 
 flaves in the Weft-Indies are no lefs fubject to this 
 malady than the Swifs foldiers. They become dif- 
 pirited, pine away, and finally lay violent hands on 
 themfelves, unlefs means are ufed to interrupt their 
 gloomy reflections. The method of cure confifts in 
 good treatment, plenty of nourishing diet, and allow- 
 ing them the pleafure of each other's company. 
 
 Such effects follow the indulgence of fecret forrow, 
 which not being alleviated by communication, gra- 
 dually undermines the powers of body and mind ; 
 hence difappointed lovers are defcribed as pale, de- 
 jected, 
 
 * The traveller Bruce, when in Abyfiinia, far diftant 
 from every civilized face, defcribes the dreadful defpondency 
 which feized him while indulging fuch reflections. 
 
( 20 ) 
 
 jected, abfent in mind, and fond of folitude, or thofe 
 fcenes which infpire a pkafing melancholy. — A re- 
 markable inftance of diretl mental debility, from the 
 abftraction of hope, is related by Zimmerman. A 
 young man, on meeting with a moft difcouraging 
 repulfe from the object of his affections, remained 
 motionlefs in his chair for half a day : from this ftate 
 he was recalled by the agreeable intelligence that his 
 fair one had relented. 
 
 Terror is fometimes productive of a flmilar ftate. 
 The operation of a fright feems to be the following : 
 a fudden abftraction of the ftimulants hope and joy, 
 and a violent exertion, frequently terminating in the 
 greateft debility. 
 
 But gloomy reflections are not the only remote 
 caufes of mania. Exceffive indulgence of joy often 
 produces the fame effect : it has been known even to 
 occasion, by its too great ftimulus, a total extinction 
 of the living principle. At the time of the South- 
 Sea bubble, Doctor Hales, who had the care of a 
 lunatic hofpital, found that the greateft number of 
 his patients were thofe who had fuddenly acquired 
 fortunes. 
 
 Pride, 
 
( 21 ) 
 
 Pride, or a too exalted opinion of one's own merit, 
 inafmuch as it fubje&s us to more frequent difap- 
 pointments, may be confidered as a remote caufe. 
 In madmen, a proud fpirit is a remarkable cha~ 
 racteriftic. 
 
 The influence of government, in predifpofing to 
 this difeafe, is a fubject worthy of confideration, 
 were I capable of properly tracing it. The referved 
 demeanour and taciturnity of the Spaniards and 
 Portuguefe have been attributed entirely to their 
 apprehenfions of the power of the Inquifition, which 
 formerly reigned with unlimited fway in thofe coun- 
 tries. In defpotic governments raving madnefs is 
 lefs frequent, becaufe flavery tends to deprefs the 
 mind, and prevent thofe exertions which mark this 
 ftage of the diforder. Such eccentricities refult 
 from a {enk of freedom ; while a gloomy melan- 
 choly is the product of defpotifm, except the atten- 
 tion be diverted, and a fuperficial gaiety induced, 
 by public fhews and entertainments, or a fplendid 
 appearance of grandeur, the common attendants of 
 fuch governments. 
 
 Thefe effects, however, may be varioufly modi- 
 fied by the gloom or pleafantnefs of the feafon and 
 
 fituation. 
 
( 22 ) 
 
 lituation. Hence, in dull, foggy weather, when 
 people, from confinement to the houfe, are deprived 
 of their ufual variety of objects, as well as of the 
 ftimulus of light, low fpirits or fpleen is a common 
 occurrence. 
 
 PREVENTION AND CURE, 
 
 A CONSIDERATION of the caufes enume- 
 rated may ferve to direct: us in the prevention and 
 cure of mania. 
 
 The chief indications of cure are the following : 
 
 During the intervals or /lighter degrees of the 
 affection, 
 
 To avoid intenfe application of mind to any fuhjecJ^ 
 inordinate indulgence of the appetites and paj/ions, 
 and idlenefs. 
 
 During 
 
( 23 ) 
 During the paroxyfms, 
 
 I. To remove the morbid fiat e of the fenfes, by ap- 
 plying gentle fiimuli. 
 
 II. To refirain immoderate exertions. 
 
 Of the various ftimuli by which life is fupported 
 and its functions performed, fome acl: incefTantly : 
 thus the heart and vefTels, the lungs, and inteftinal 
 canal obey their refpeclive ftimulants without lafli- 
 tude or debility. Other exciting powers, by their 
 conftant application, have a tendency to exhauft the 
 excitability ; and hence arifes the neceflity for a va- 
 riation of ftimulus, as well as for intervals of reft, 
 that the excitability may be recruited. This will ap- 
 ply as well to the mental ftimuli as the corporeal. 
 
 The importance of variety in our intellectual 
 purfuits muft be obvious to all who have experienced 
 the undefcribable and uneafy feeling which follows 
 an intenfe or too long continued application to any 
 one fubject. If a perfon makes a violent exertion 
 to recoiled any thing in hafte, he is frequently 
 baffled; nor can the idea be recalled till the mind 
 is diverted with fomething elfe. Hence, in a dif- 
 
 eafe 
 
( 24 ) 
 
 eafe of indireEl mental debility ', the moil judicious 
 practice muft be the application of objects which 
 excite trains of ideas not only different from the 
 caufe of the difeafe, but continually fhifting in . a 
 pleating variety, and fufRcient to exercife the atten- 
 tion gently. In thofe, likewife, who inherit, from 
 their parents, a predifpofition to mania, the fame 
 treatment will be neceflary as a preventive. This 
 is conducted upon the principle, that when one 
 ftimulus, by repeated application, renders the fyftem 
 infenfible to its action, there is ftill excitability 
 enough left for the operation of another. During 
 the raving flights of a maniac, who was proclaiming 
 himfelf to be the MeJJiah, I have, by a piece of 
 news, withdrawn his attention, and obtained a ra- 
 tional anfwer. 
 
 Such remedies are beft furnifhed by travelling, 
 efpecially with an agreeable companion. We have 
 the testimony of Doctor Cullen, that in feveral ca- 
 fes of complete mania a cure was effected in the 
 courfe of a journey. On this depends the benefit 
 of vifiting certain mineral waters, where the change 
 of objects and lively company contribute to divert 
 the mind. 
 
 Gaming 
 
(25 ) 
 
 Gaming is but a fallacious refource, fince the anxi- 
 ety and difappointments attending it, as well as the 
 fedentary life which it requires, infinitely overbalance 
 the diverfion procured: it is like the advice given 
 by an eminent phyfician in Europe to a hypochon- 
 driac who was inceflantly teazing him with his 
 complaints : " My friend," fays he, " your bodily 
 health is good— your mind Wants agitation — I advife 
 you to take your piftols and rob the next man you 
 meet, and then fly the kingdom for your life." 
 
 It is no lefs necefTary to avoid gloomy company, 
 and all thofe objects which are connected with former 
 fufferings or fcenes of difgufr, and horror. I knew 
 a gentleman who was always affected with the moft 
 diftrefling fenfations at the fight of a houfe in which 
 he had formerly lingered under a tedious nervous 
 complaint.* 
 
 Thofe books which bewilder the reader in a maze 
 of fanatical abfurdities, are efpecially hurtful to 
 people who have previously fufFered under miftaken 
 
 D ideas 
 
 * A curious Inftance of fympathy has occurred to me: — 
 A perfon who was formerly fubject to epilepfy is always 
 feized with an invincible propenfity to laugh whenever he fees 
 one labouring under a fit of this kind., 
 
(■ 26 ) 
 
 ideas of the Almighty, and fears of his vengeaftce. 
 I have lately {Q&n an inftance of mania, where Swe-' 
 denbourg's and Richard Brothers's reveries 
 might be fet down as the occasional caufes, in a 
 young man who, on any other topic, was perfectly 
 rational j but from the ftimulus of this train of ideas, 
 and the fruitlefs attempts to comprehend the fubject, 
 he was plunged into this condition. 
 
 The judicious adminiftration of hope and joy de- 
 mands particular notice : for the operation of thefe 
 may be compared to the circulation of the blood. 
 Arreffc this, and the functions of the animal ceafe j 
 abftract the former, and defpair enfues. — If the 
 imagination of the patient can be averted from the 
 dread, of future evil, and foothed with cheering 
 hopes, considerable progrefs is made towards ob- 
 taining a cure. But of all preventives or remedies, 
 the moft effectual is a well-grounded hope of eternal 
 happinefs. Under the influence of this, Reafon 
 holds her fway, and diffufes peace through the foul. 
 How mlftaken, then, are tfrofe who annex the ideas 
 of fuperftition and enthufiafm to the name of religion, 
 and who form their opinions of its effects from the 
 inftances of weak, ignorant minds miftaking their 
 bodily ailments for fupernatural affections ! 
 
 It 
 
( 27 ; 
 
 • It may feem rather extraordinary, that the abjlraci 
 lion of hope? or, in other words, infpiring the maniac 
 with fear, ftiould be indicated. Yet this muft be 
 understood to refer only to a fear of objects different: 
 from thofe which gave rile to the difeafe. For this 
 purpofe it becomes fometimes neceflary to ufe 
 rejlraint, and to affert an abfolute authority over the 
 patient. This, however, mould be avoided as long 
 as poffible j for it is of no fmall confcquence to treat 
 them as rational beings, and conceal from them our 
 knowledge of their real ftate ; left the recollection of 
 their 7?^ 'ait jackets, and chains and cells, fhould induce 
 a depreflion of fpirits feldom furmounted. For 
 this reafon it may fometimes be necefTary to fall in 
 with their opinions, and, by leading them to con- 
 clusions of which they were not aware, divert them 
 from their rafh defigns. Hence the moft proper 
 reftraint, where convenient, is that of parental au,- 
 thority, without expofure to ftrangers* 
 
 Shame has a coniiderable effect on madmen, for 
 few of them will indulge in public thofe irregularities 
 which mark their conduct among their relatives and 
 intimate acquaintances. Plutarch tells us, that 
 feveral virgins of Miletus, from a kind of endemic 
 madnefs, having laid violent hands on themfelves, 
 
 the 
 
( 28 ) 
 
 the example operated like contagion, and filicides 
 became very frequent among the women; till an 
 edict was publifhed, threatening to expofe to public 
 view the naked bodies of all who ihould be guilty 
 of the like act. So powerful was the fenfe of fhame 
 in people regardlefs of life itfelf, that, by this ftra- 
 tagem, an effectual check was put to the practice. 
 
 Induftrious employment is equally necefiary to pre- 
 ferve the health of both mind and body. The 
 happy ferenity infpired by the fenfe of time well 
 fpent, might be contrafted with the liftleflhefs and 
 difcontent attendant on a life of indolent fenfuality. 
 Among thofe of the latter clafs are we to look for 
 the mod: frequent inftances of madnefs ; but very 
 few among people who muft labour for their daily 
 bread.— Doctor Iberti, in an account of a lunatic 
 hofpital at Saragojfa, fays, " The cure is generally 
 attempted by cold bathing and refrigerant medicines, 
 but the treatment feldom anfwers. Conftant expe- 
 rience has fhewn, that fome employment which 
 exercifes the patient's limbs is the moft efficacious 
 method of cure. Moft of the lunatics who are 
 employed in the mops and offices of the houfe, 
 recover. Their occupations are cleaning the houfe, 
 carrying wood and water* harveft work, &c. Luna- 
 tics 
 
( n ) 
 
 tics of diftinction, who are not employed in any 
 fervile occupation, nor in labour of any fort, feldom 
 recover." 
 
 Mujic is a ftimulus which has been faid to excite 
 almoft any paffion at pleafure. Its goods effects,, 
 in calming inordinate emotions, are often witnefled, 
 efpecially where fuch pieces of mufic can be felected 
 as are aflbciated With mirthful occafions„ The 
 Scriptures inform us, that mufic was the remedy 
 employed by David to foften the ferocious mad- 
 nefs of Saul 
 
 Plunging the patient unexpectedly into cold water 
 has been recommended as highly beneficial. The 
 propriety of this practice I very much doubt, and 
 ihould be apprehenfive that the fudden fhock would 
 be detrimental, and perhaps produce fatuity. — Some 
 have directed the patient to be kept from two to fix 
 hours in fpring water, and even in baths ftill colder; 
 but this may be objected to as equally injudicious. 
 Frequent warm bathing promifes much greater ad- 
 vantages, both by applying a comfortable degree 
 of heat, and promoting perfpiration, which is com- 
 monly deficient in this ftate of the fyftem, 
 
 Opium;, 
 
( 30 ) 
 
 Opium, mufk, camphor, and other powerful fti- 
 mulants have been exhibited, but with little sood 
 effect as far as I can understand. 
 
 The refrigerant plan of cure, recommended by 
 ibme, belongs more properly to phrenitis. To this 
 may be referred bleeding, purging, vomiting, exhi- 
 bition of vinegar, and other remedies which act gene- 
 rally •, as well as thofe intended to obviate a preter- 
 natural flow of blood to the head, fuch as the ap- 
 plication of the clay-cap, ice, and ftreams of cold 
 water; and the prefTure of the carotid arteries.—^ 
 Draftic purgatives are feldom attended with the 
 good effects attributed to them by the ancients : it 
 is, however, very neceffary to prevent coftivenefs, 
 by the exhibition of gentle laxatives, 
 
 Bliftering the head is rather equivocal : in phrenitis 
 it may be highly proper ; but in a cafe of chronic 
 mania, in which I have (etn a powerful epifpaftic 
 applied, no advantage was apparently derived from 
 it. Shaving the head, or thinning the hair, is, 
 however, always advifeable. 
 
 Leprofy, and fome other eruptive difeafes have 
 been known to remove mania. How this is 
 
 effected. 
 
( * > / 
 
 effected, I am unable to explain, but on the fuppo- 
 iition that the new action of the veflels attending 
 them may produce a renovation and equable difFu- 
 fion of nervous power. Doctor Mutzell, of 
 Berlin, took the hint from nature, and thought of 
 inoculating with the matter of itch in this difeafe. 
 The cafe of a perfon on whom he made the experi- 
 ment is (6 interesting, that I mall here infert it. 
 
 " The patient was a man of twenty-eight years 
 of age, of a melancholy temperament, and by trade 
 a fhoemaker. Some family misfortunes were confi- 
 dered as the occafional caufes of his complaints. He 
 became melancholy, averfe to his bufinefs, and after 
 fome time had a wildnefs in his looks, and either 
 gave indirect anfwers, or kept an obftinate filence. 
 Many remedies were tried to no purpofe. He eve- 
 ry day grew worfe and more emaciated, and was at 
 length placed under the care of Doctor Mutzell, 
 in the royal hofpital at Berlin. He was at this time 
 inattentive to every thing about him ; he fat in bed 
 with his eyes fixed, and was fo great a ftranger to 
 hunger and thirft, that three or four days continued 
 abftinence did not excite him to feek for food. His 
 pulfe was flow and weak. Neither external nor 
 internal ftimuli feemed to have much fenfible effect 
 on hjm. Whipping with nettles hardly excited any 
 fenfe of pain ; and twenty grains of emetic tartar 
 
 produced 
 
( 3 2 ) 
 
 produced only one fit of vomiting. Neither blif- 
 tcrs, nor plunging him in cold water, nor a ftream 
 of cold water, nor plates of ice applied to his head, 
 %vere able to occafion more than a momentary uneafl- 
 nefs. In this ftate he continued two years, and it was 
 then determined to inoculate the itch. For this pur- 
 pofe, deep incifions were made in the arms and legs, 
 and the wounds were filled with itchy matter. He 
 did not feem to mind the operation ; but on the fe- 
 cond day the pulfe was ftronger, and on the fourth 
 was fo much increafed, that Doctor Mcjtzell 
 doubted whether he had ever felt a quicker pulfe. 
 This degree of fever continued during the fifth and 
 fixth days, accompanied by great anxiety and difficult 
 refpiration. On the two following days the fever 
 abated, the fkin became moift, and a number of fmali 
 red puftules were thrown out upon the furface. On 
 the ninth his fpeech and reafon returned to him. He 
 did not feem to know any thing of what had pafled 
 during the time of his being in the hofpital. In 
 three weeks the puftules were dried away, and he was 
 in perfect health." 
 
 With refpect to the diet of maniacs, it may be 
 necerTary to mention, that it mould not be very fti- 
 mulant, but fuch as is nourifhing and of eafy digef- 
 tion : the regulation of this, however, will depend 
 on the degree of exercife ufed, and the patient's 
 former habits of life. 
 
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