1
ARMY  MEDKWL LIBRARY

        WASIIINOTON

           Founded 1836
g
ANNEX

Section
O

Number
b.^.KJ.k)
      Fobm 113e. W. D- 8. Q. O.
-10&43   (RariMd Jona S3, 1034J
 
 
 
MEDICAL  INQUffilES
AND
OBSERVATIONS,
UPON
THE DISEASES OF THE MIND.
       BY BENJAMIN RUSH, M. D.
Professor of the Institutes and Practice of Medicine, and of Clinical
      Practice, in the University of Pennsylvania.
     ■^LIBIlALY. ^

       PHILADELPHIA:
PUBLTSHED BY KIMBER & RICHARDSON,
    NO. 2373 MARKET STREET.
  Merritt, Printer, No. 9, "Watkin's Alley.
1812. 
 District of Pennsylvania, to wit;
  BE IT REMEMBERED, that on the twenty-sixth day of October,
in the thirty-seventh year of the Independence of the United States
of America, A. D. 1812, Kimber 8c Richardson, <>f the said District,
have deposited in this office, Uic title of a book, the right whereof
they claim as proprietors, in the words following, to wit:

   " Medical Inquiries and Observations, ufion the Disease*
     « of the Mind.   By Benjamin Rush,  M. D. Profes-
     " tor of the Institutes and Practice of Medicine, and
     " of Clinical Practice, in the  University of Pennsylvu-
     «nia."

  In conformity to the act of the Congress of the United State9, en-
titled,  " An act for the encouragement of learning, by securing the
copies of maps, charts, and books, to the authors and proprietors of
such copies, during the times therein mentioned."   And also to the
act, entitled,  "An act supplementary to an act, entitled, "An act
for the encouragement of learning, by securing the copies of maps,
charts, and books, to the authors and proprietors of such copies du-
ring the times therein mentioned," and extending Use benefits there-
of to the arts of designing,  engraving, and etching historical and
other prints."
                                      D.  CALDWELL,
                           Clerk of the District of Pennsylvania. 
PREFACE.
AGREEABLY to a promise made to the pub-
lie  some years ago, and in  compliance with the
solicitations of the  author's pupils, he now offers
to them a volume of Medical Inquiries and Ob-
servations, upon the Diseases of the Mind.

  The views which he has taken of the proximate
cause,  forms, and  symptoms of those diseases,
have obliged him to employ a new nomenclature
to designate some of them.  This becomes  no
less necessary where new opinions are  proposed,
or new symptoms described in the history of dis-
eases, than an  increase in the number of words,
and new combinations of them, become necessary
to accompany the increase of the wants and ob-
jects of civilized society.

  Some of the  facts contained in the  following
pages are of an old date, and will be familiar to
the  medical reader, but the republication of them,
it is hoped will be excused, when it is perceived,
that they are placed under the direction of new
principles, and that new  inferences of a practical
nature are deduced from them.  An apology may
seem  necessary likewise  for the  large number of 
vi
PREFACE.
recent facts that have been added to them.  Upon
subjects so interesting  as the present, more than
common testimony is necessary to  produce con-
viction.  Besides, facts,  or precedents,  have the
same effects in reasoning in medicine, that exam-
ples have  in morals.   They compel the reader
to admit the practice  they  are intended to  esta-
blish, provided they are applied in a proper man-
ner.
   The author has omitted referring to the books
from which he has obtained some of his facts.  His
reason for doing so was,  when he began  to collect
them, he did not expect to publish them, and of
course did not mark the  volumes and pages from
which they were extracted.   Since he formed that
design, he  has faithfully preserved references to
them both.   He  has  suppressed them, only be-
cause their partial publication would have destroy-
ed the uniformity of the  work.  He commits his
imperfect labours, now  before the reader, to  his
fellow citizens, with a hope that they may serve
as a  supplement  to materials  already  collected,
from which a system of principles may be formed
that shall lead to general  success in the  treatment
of the diseases of the mind.   Experience has ex-
hausted herself in abortive efforts for that purpose,
and  should the  following  attempt  to co-operate
with her by  principles be alike unsuccessful,  it
must be ascribed to their being erroneous, for the
author believes those diseases can be brought un-
der the dominion of medicine, only by just theo-
ries of their seats and proximate cause.
                          BKXJAMIN RUSH.
Philadelphia, October, 1812. 
CONTENTS.
                  CHAPTER  I.             Page.
Of  the Faculties and Operations of the Mind, and
   on the Proximate Cause of Intellectual Derange-
   ment.   -                  "
                  CHAPTER  II.
Of  its Remote, Exciting, and Predisposing Causes^   30
                 CHAPTER  III.
Of  Partial Intellectual Derangement, and  particu-
    larly of Hypochondriasis, or Tristimania.     -    74,
Of  the Remedies for Hypochondriasis or Tristimania.   9 S
                 CHAPTER  IV.
Of Amenomania, or  Partial  Intellectual Derange-
    ment accompanied with Pleasure, or not accom-
    panied with Distress.     -                    135
                  CHAPTER  V.
 Of General Intellectual Derangement.     -    -    141
 Of the Symptoms of  Mania.       -                l4^
 Of the different Forms of Mania.    -    -    -    l62
 Of the Inlluence of the Moon on Mania.     -      17°
                  CHAPTER  VI.
 Of the Remedies for Mania.    -    -    -    -    174
                  CHAPTER  VII.
 Of Manicula.......2U
                  CHAPTER  VIII.
 Of Manalgia.   -    -    -    -     -    "    "    ^16
 Of the Remedies for Manalgia.     -       -       221
 Of the Means of Improving  the Condition of Mad
     People.      -       -      -      -       ;    241
 Signs of a Favourabte,and Unfavourable Issue of all
    *■ the Forms of Intellectual Derangement.    -    248
 Usual Modes of Dea^i from them.     -      -     256
                   CHAPTER IX.
 Of Demcncc, or Dissociation.        -      -      359
                    CHAPTER  X.
  Of Derangement in  the Will.                       2fl 
vm
CONTENTS.
                    CHAPTER  XI.
 Of Derangement in the  Principle of Faith, or the
     Believing Faculty.      -     -       -       -    2TI
                   CHAPTER   XII.
 Of Derangement of the Memory.     -       -      276
 Of the Remedies for it.          ...    283
                   CHAPTER   XIII.
 Of Fatuity.      -       -       -       -       -    291
                   CHAPTER   XIV.
 Of Dreaming, Incubus, or  Night Mare, and  Som-
    nambulism.       -                               300
                   CHAPTER  XV.
 Of Illusions.      ...       ...    306
       4           CHAPTER   XVI.
 Of Reverie, or Absence of Mind.      -       -      310
                  CHAPTER   XVII.
 Of Derangement of the Passions.      -       -      314
 Of Love.     ...-.-   ibid.
 Of Grief......318
 Of Fear......324
 Of Anger......333
 Of the Morbid Effects of Envy, Malice, and Hatred.   340
 Of the Torpor of the Passions.     ...       345
                 CHAPTER  XVIII.
 Of the Morbid State of the Sexual Appetite.   -     347
                  CHAPTER   XIX.
Of the Derangement of the Moral Faculties.    -     357
                       ERRATA.
  Page 16, third line from the bottom, for " cases" read the cause.
 P. 23, second and third lines from the bottom, for " aimatous" read
 anzmatous.   P. 25, third line from  the bottom, for "Crcij^iiton"
 read Crichton.  P. 30, line first, add predisposing next to the word
 "exciting." P. 33, line first, read excited by, instead of "derived fW >m."
 P. 66, seventh line from the top, read to, for " for."   P. 70, line four-
 teenth from  the bottom,  read nonelastic for " noncstic."  P.  7",
 strike out the whole of the last p^'aicraj/'i.-^. 8lJ, eighth line from
 the top,  for  " least" read last.  P. 129. iuWr line from the bottom,
 read feigned a compliance with, instead of " obe* ed." P. 251, tenth
 line from the top, read obesity for •' ob  <</ ."  p. e.jj, lixth line
from the bottom, i-ead favourable instead ol  " unfavourable." 
      MEDICAL INQUIRIES

                   AND

         OBSERVATIONS,

                    ON

   THE DISEASES OF THE MIND.


              CHAPTER I.

Of the Faculties and Operations of the Mind,
  and on the Proximate Cause and Seat of Intel-
  lectual Derangement.

IN entering upon the subject of the following
Inquiries and  Observations, I feel as if I were
about  to tread upon consecrated  ground.  I am
aware of its  difficulty and importance, and I thus
humbly implore  that being, whose  government
extends to the thoughts of all his creatures, so to
direct  mine, in  this  arduous undertaking, that
nothing hurtful to my fellow citizens may fall from
my pen, and that this work may be the means of
lessening a  portion of some  of the greatest evils
of human life. 
10
ON
IHE  DISEASES
   Before I proceed to consider the diseases of the
mind, I shall  briefly mention its different facul-
ties and operations.

   Its faculties are,  understanding, memory,  ima-
gination, passions, the principle of faith, will, the
moral faculty, conscience, and the sense of Deity.

   Its principal operations, after sensation, arc per-
ception,  association, judgment, reasoning and vo- y
lition.  All its subordinate operations, which arc
known by the names of attention, reflection,  con-
templation, wit, consciousness, and the  like, are
nothing  but  modifications  of  the five  principal
operations that have been mentioned.

   The faculties of the mind have  been  called,
very happily, internal senses.   They resemble the
external  senses in  being  innate,  and  depending
wholly upon bodily impressions to produce  their
specific operations.    These impressions are made
through the medium of the external senses.   As
well might  we attempt to  excite thought  in  a
piece of  marble by  striking it with our hand, as
expect to produce a single operation of the mind
in a  person  deprived of the  external senses of
touch, seeing, hearing,  taste, and smell. 
OF  THE  MIND.             J!
   All the operations in the mind are the effects
of motions  previously excited in the brain, and
every idea and thought appears to depend upon a
motion peculiar to itself-   In a sound state of the
mind these  motions are regular, and succeed im--
pressions upon the brain  with  the  same  cer-
tainty  and  uniformity that  perceptions succeed
impressions upon the senses in their  sound state.

   In inquiring into the causes of the diseases of
the mind, and the remedies that are proper to re-
lieve them,  I shall employ the term derangement
to signify the  diseases of all the faculties of the
mind.

   As the understanding occupies the highest rank
of those faculties, and as it is most frequently the
seat of derangement, I shall begin by considering
the  causes,  and all  the  states and forms of its
diseases.

   By derangement in the understanding I mean
every departure of  the mind in its  perceptions,
judgments,  and reasonings,  from its natural and
habitual order, accompanied with corresponding
actions.  It differs from delirium, whether acute,
or chronic, in being accompanied with a departure
from habitual order, in incoherent conduct, as well 
12            ON  THE DISEASES
 as  conversation.  The latter however is not ne-
 cessary to constitute  intellectual madness, for  wc
 sometimes meet with the most incongruous actions
 without incoherent speech, and wc now and then
 meet with  incoherent speech  in mad people,  in
 whom the disease does not destroy their habits of
 regular conduct.   This is evinced  by the correct-
 ness  with which they sometimes perform certain
 mechanical and menial pieces of business.   Mad-
 ness  is to delirium what  walking  in sleep is  to
 dreaming.  It is delirium, heightened  and pro-
 tracted  by a more active and permanent stimulus
iipon the  brain.*

   Let it not be supposed that intellectual derange-
 ment always affects the understanding exclusively
 in the manner that has been mentioned.   Far from
 it.   Two or  more of the faculties are generally
 brought into sympathy with it, and  there are cases
 in which all the faculties are  sometimes deranged
 in succession, and rotation, and now and then they
 are all affected at the same  time.   This  occurs
 most frequently in the beginning of a paroxysm of

  • The reader will  find several other  distinguishing
marks between madness and delirium, applicable to legal
purposes, in the author's Introductory Lecture upon Medi-
 cal Jurisprudence, published in a volume of Lectures,  by
Bradford and Inskecp, in the year 1810.
f 
OF  THE  MIND.
13
intellectual madness, but it rarely continues to af-
fect the other faculties of the mind after two or
three weeks,  or after  the liberal use of depleting
remedies.  Thus fever in its first attack, affects
the bowels and nervous system, and in a few days
settles down into  a disease chiefly of  the blood-
vessels.

   Derangement in the understanding has been
divided  into  partial  and general.  The causes
of both are the same.  I should proceed immediate-
ly to enumerate them, but as the seat, or proximate
cause, of a disease is generally the first object of
a physician's  inquiry on entering  a sick room, it
shall be the first subject of our consideration in the
present inquiry.

   1.  The most ancient opinion of the proximate
cause  of intellectual derangement, or what  has
been called madness  is, that it is derived from a
morbid state of the liver, and that it discovers it-
self in a vitiated state of the bile.  Hippocrates
laid the foundation of this error by his encomium
upon  Democritus  whom he  found employed in
examining the liver of a dumb animal in order to
discover the cause of madness. 
14
ON  THE DISEASES
  2. Madness  has been  said to be  the effect
of a disease in the spleen.   This viscus is sup-
posed  to  be affected  in  a  peculiar  manner in
that grade of madness which has been called hyp-
pochondriasis.   For many years it was known in
England by no other name  than the spleen,  and
even to this day,  persons who are affected with it
are said to be splceny, in some parts of  the New
England states.

  3.  A late French writer,  Dr.  Prost, in an
ingenious work  entitled  "  Medicine  Eclairec
par Observation  et  l'Overture des  Corps," has
taken pains to  prove that madness  is the effect
of a disease in  the intestines,  and  particularly
of their peritoneal coat.   The marks of inflamma-
tion which appear in the bowels, in persons  who
have died of madness, have  no doubt  favoured
this opinion ; but  these morbid appearances as well
as all those  which are often met with in  the liver,
spleen, and occasionally in the  stomach in persons
who have died of madness, are the effects, and not
the causes  of  the disease.    They  are  induced
either, 1, by  the violent or protracted exercises
of the mind attracting or absorbing  the excite-
ment of those viscera,  and thereby leaving them
in  that? debilitated  state  which  naturally  dis-
poses  them to  inflammation and  obstruction. 
OF  THE  MIND.             15
Thus disease in the stomach  induces  torpor and
costiveness in the alimentary canal.   Thus too
local inflammation often induces coldness and in-
sensibility in contiguous parts of  the body.   Or,
2, they  are  induced  by  the  reaction of  the
mind from the impressions which produce mad-
ness,  being of such a nature as to throw its mor-
bid excitement upon those  viscera with so much
force  as to produce inflammation and obstructions
in them.  That they are induced by one,  or by
both  these causes, I infer from the increased se-
cretion and even discharge  of bile which succeed
a paroxysm  of anger;  from  the  pain  in the left
side,  or spleen, which  succeeds  a paroxysm of
malice or revenge;  and from the  pain, and other
signs of disease in the  bowels and stomach which
follow the chronic operations of fear and grief.
That the disease  and disorders of all the viscera
that have  been  mentioned,  are  the  effects,  and
not the causes  of madness,  I infer further from
their  existing  for  weeks,  months and  years in
countries subject to intermitting fevers, without
producing madness, or even  the least alienation
of mind.

   4.  Madness  it  has  been  said  is the effect
of a disease in the nerves.   Of this, diSLiM^ af-
ford us no proofs ; on the contrary, they generally 
16           OV  THE  DISEASES
exhibit  the nerves after death from  madness in a
sound state.  I object further, to this opinion, that
hysteria, which is universally admitted to be seated
chiefly in the nerves and muscles, often continues
for years, and sometimes during a long life, with-
out inducing madness, or if the mind be alienated
for a few minutes in one of its paroxysms, it is
only from its bringing  the  vascular system into
sympathy, in which I shall say presently the cause
ofinadncss is primarily seated.  The reaction of the
mind from  the impressions which produce hyste-
ria, discovers itself in the bowels, in the kidneys,
and in most of the muscular parts of the body.

  5, and lastly.   Madness  has been placed ex-
clusively in the mind.  I object  to this opinion,
1, because  the mind is incapable of any operations
independently of impressions communicated to it
through the medium of the body.   2, Because
there are but two  instances upon  record of the
brain being found free  from morbid appearances
in persons  who  have died of madness.  One of
these instances  is related by Dr.  Stark, the other
bv Dr.  De Haen.  They probably arose from the
brain being diseased beyond that grade in which in-
ileeeenatioaandits usual consequences take place.
D'.cscSdp)f madness  reside exclusively in the
mind, a bound  state of the  brain ought to occur
jfter nee.rlv everv death from that disease. 
OF  THE  MIND.             17
  I  object to it,  3, because  there are no  in-
stances of  primary  affections of the mind, such
as grief, love, anger, or despair, producing mad-
ness until they had induced some obvious changes
in the bo^y, such as wakefulness, a full or frequent
pulse,  costiveness,  a dry skin,  and  other  symp-
toms of bodily indisposition.

  I know  it has  been said in favour of madness
being an ideal disease, or being seated primarily in
the  mind, that  sudden  impressions from fear,
terror,  and even ridicule have  sometimes cured
it.   This is true, but they  produce their  effects
only by the healthy actions they induce  in  the
brain.  We see several other diseases, particularly
hiccup, head-ache, and even fits of epilepsy, which
are evidently affections of the body, cured in  the
same way by impressions of fear and terror upon
the mind.

  Having  rejected  the abdominal  viscera,   the
nerves, and the mind, as the  primary seats of mad-
ness, I shall now deliver an opinion,  which I have
long believed and taught in  my lectures, and that
is, that the cause of madness is seated primarily in
the blood-vessels of the brain, and that it depends
upon the same kind of morbid and irregular  ac-
tions that constitute other arterial diseases.  There
                       c 
18
ON  THE DISEASES
is nothing specific in these actions.   They are a
part of the unity of disease, particularly of fever ;
of  which madness  is a chronic form,  affecting
that part  of the  brain  which is the seat  of the
mind.                                *
  ■
   My reasons for believing the cause of madness
to be seated in the blood-vessels of the brain  are
drawn,

   I. From its remote and exciting causes, many of
which are the  same with those which induce fever
and certain diseases of the brain, particularly phre-
nitis, apoplexy, palsy,  and epilepsy, all of which
arc admitted to have their seats in a greater or less
degree in the blood-vessels.   Of thirty-six dissec-
tions of the brains  of  persons  who had died  of
madness,  Mr.  Pinel says  he could  perceive no
difference between  the morbid  appearances  in
them, and in the brains of persons who had died
of apoplexy  and epilepsy.  The sameness of these
appearances  however do not prove that all  those
diseases occupy the same parts of the brain : I be-
lieve they do  not, especially in their first  stage:
they become diffused over the whole brain, proba-
bly  in their last  stages, or in  the paroxysm  of
death.  Dr.  Johnson, of Exeter, in speaking of the
diseases of the abdominal viscera, mentions their 
OF  THE  MIND.
19
sympathy with each other, by what he very hap-
pily calls  " an intercommunion of sensation."  It
would seem as if a similar intercommunion took
place between all the diseases of the brain.  It is
remarkable they all discover, in every part of  the
brain, marks of a morbid state of the blood-ves-
sels.

   II.   From the ages and constitutions of persons
who are  most subject  to madness.   The former
are  in those  years in  which acute and  inflam-
matory arterial  diseases usually affect the body,
and the latter, in persons who labour under the
 arterial predisposition.

   III. I infer that madness  is seated in the blood
 vessels,

    1.  From  its symptoms.   These are a sense  of
 fulness,  and sometimes pain in the head; wake-
 fulness, and a redness of the eyes, such as precede
 fever, a whitish tongue, a dry or moist skin,  high
 coloured urine,  a frequent,  full, or tense pulse, or
 a pulse morbidly slow or natural as to frequency.
 These states of the pulse occur uniformly in re-
 cent madness, and one of them, that is frequency,
 is seldom absent in its chronic state. 
20
ON  THE DISEASIS
   I have  taken notice of the  presence of this
symptom  in my Introductory Lecture  upon  the
Study of Medical Jurisprudence, in which I have
mentioned, that seven-eighths of all the deranged
patients in the Pennsylvania  Hospital  in the year
1811 had frequent pulses,*  and that a pardon was
granted to  a criminal by the president of the Uni-
ted States, in  the year 1794,  who was suspected
of counterfeiting madness,  in consequence  of  its
having been declared by three physicians that that
symptom  constituted  an unequivocal mark  of
intellectual derangement.

  The connection of this disease with the state
of the pulse has been  further demonstrated by a
most satisfactory experiment, made by  Dr. Coxe,
and related by him in his Practical Observations
upon Insanity.   He gave  digitalis to  a patient
who  was  in a furious state  of  madness, with  a
pulse that  beat 90 strokes in a minute.   As soon
                 ■
  • This fact was ascertained, at  my request, with great
accuracy,by Dr. Frederick Vandyke.  It is  probable the
pulsations of the arteries in the brain were preternaturally
frequent in the brain in the few cases in which they were
natural at the wrists.  Dr. Coxe, of Bristol, informs us that
he had found the carotid artery to  be full and tense, when
the radial artery was weak and soft 
OF  THE  MIND.
21
as the  medicine reduced his pulse to 70, he be-
came rational.   Upon continuing it, his pulse fell
to 50, at which time he became melancholy.   An
additional quantity of the medicine reduced it to
40 strokes in  a minute, which nearly suspended
his life.  He  was finally  cured by lessening the
doses of the medicine so  as to elevate  his pulse
to 70 strokes in a minute, which was  probably
its natural state.   In short  there is  not a single
symptom that  takes place in an ordinary fever,
except  a  hot  skin,  that  does not occur in the
acute state of  madness.

   IV.  From its alternating  with several diseases
which are evidently  seated  in  the blood-vessels.
These are consumption, rheumatism, intermitting
and puerperile fever,  and dropsy, many instances
of which  are to  be met  with in the records of
medicine.

   V. From its blending its symptoms with several
of the forms of fever.  It is sometimes attended
widi regular  intermissions,  and remissions.   I
have once seen  it appear  with profuse sweats,
such as occur in  certain  fevers, in a madman in
the  Pennsylvania Hospital.   These sweats Jwhen
discharged from his skin,  formed  a  vapour re-
 sembling a thick fog, that filled the  cell in which 
22
ON  THE  BISEASr.o
he was confined to such a degree as to render his
body scarcely visible.

  Again,  this disease  sometimes  appears in a
typhus form, in which it is attended with cold-
ness, a feeble pulse, muttering delirium, and in-
voluntary  discharge of faeces and urine.   But it
now and  then pervades a whole country in the
form of an epidemic.   It prevailed in this way in
England  in  the  years  1355  and  1373,  and in
France and Italy in the year 1374, and Dr. Win-
tringham  mentions  its frequent occurrence in
England in the year 1719.

  A striking instance  of the union  of madness
with common fever  is mentioned by Lucian.
He tells   us  that  a  violent  fever  once  broke
out at Abdera,  which terminated  by  haemorr-
hages,  or  sweats, on the seventh  day.   During
the continuance of this fever the patients affected
with it,  repeated  passages from the tragedy of
Andromeda  with great vehemence, both  in their
sick rooms and in the public streets.   This mix-
ture of fever and madness continued until  the
coming on of cold weather.   Lucian ingeniously
and v^y properly ascribes it to the persons affect-
ed, having heard the famous player Archilaus act
a part  in the above tragedy in the middle of sum- 
OF  THE  MIND.
23
mer,  in  so  impressive  a manner  that it  excited
in  them the  seeds  of a dormant  fever  which
blended  itself with  derangement, and thus pro-
duced,  very  naturally, a repetition of the ideas
and sounds that excited their disease.

   VI. From  the appearances of the blood which
is drawn in this disease  being the  same as that
which is drawn in certain fevers.   They  are, in-
flammatory  buff, yellow,  serum, and lotura car-
nium.

   VII. From the appearances of the brain after
death from madness.   These are nearly the same
as after death  from phrenitis, apoplexy, and other
diseases  which are admitted to be primary  affec-
tions  of  the blood-vessels of the brain.   I shall
briefly enumerate them; they are, 1,  the ab-
sence of every sign of  disease.  I have ascribed
this to  that   grade  of suffocated  excitement
which prevents the effusion of red blood into the
serous vessels.  We observe the same absence of
the marks of inflammation after several other vio-
lent diseases.   Dr. Stevens  in  his ingenious in-
augural dissertation published in 1811, has called
this apparently healthy appearance,  the  'jAna-,
tous" state  of inflammation.   Perhaps it would
be more proper to call it the  "ijiiatous" state of 
\
  24           ON  THE DISEASES
  disease.  It is possible it may arise in recent cases
  of madness which terminate fatally, from the same
  retrocession of the blood  from the brain  which
  takes place from the face and external surface of
  the body, just before death.  But,

     2. Wc much oftener discover in the brain, after
  death from  madness,  inflammation, effusions  of
  water in  its ventricles, extravasation and intrava-
  sion of blood, and even pus.  After chronic mad-
  ness, we discover  some  peculiar  appearances
  which have never  been  met with  in  any  other
  disease of the brain, and these are a preternatural
  hardness, and dryness in  all its parts.   Lieutaud
  mentions it  often with the  epithets of "durum,"
  " prrcdurum,"  " siccum,"  and " exsuccum."
  Morgagni takes notice of this hardness likewise,
  and says he had observed  it  in the  cerebrum  in
  persons in whom the cerebellum retained its natu-
  ral softness.   Dr. Bailie  and Mr. John  Hunter
  have remarked, that the brain in this state discov-
  ered marks of elasticity when pressed by the fin-
  gers.  Mr.  Mickell says a cube of six lines  of
  the brain of a maniac, thus  indurated,  weighed
  seven drams, whereas a cube of the same dimen-
AsioAfa sound brain weighed but one dram, and
  between four and six grains.  I have ascribed this
  hardness, drynes^elasticity and relative weight of 
OF  THE  MIND.
25
the brain to a tendency to schirrus, such as suc-
ceeds morbid  action or inflammation in glandular
parts of the body, and particularly that early grade
of it  which occurs  in the  liver,  and which is
known by the name of hep|talgia.   The brain in
this case loses its mobility so as to become inca-
pable of emitting those motions from impressions
which produce the operations of the mind.

   3. We sometimes discover preternatural  soft-
ness in the brain, in persons who die of madness,
similar to that  which we find  in  other viscera
from  common and  febrile diseases.   This has
been  observed to occur most frequently  in the
kidneys and spleen.   The brain in this case par-
takes of its texture and imbecility in infancy, and
hence its inability  to receive, and modify the im-
pressions which  excite thought in the mind.

   4, and lastly.   We  sometimes discover a pre-
ternatural enlargement of the bones of the  head
from  madness, and sometimes a preternatural re-
duction of their thickness.   Of  216  maniacs,
whose heads  were  examined  after  death,  Dr.
Cs^Jfhton says in 160  the skull was enlarged, and
in 38 it  was reduced  in its thickness. $ow the
same  thing  succeeds  rheumatism,  and  many 
26
ON  THE DISEASES
other febrile diseases which exert their action in
the neighbourhood of bones.

  I might add further, under  this head, that  the
morbid ;.ppe.ranees in the spleen, liver, and sto-
mach,  which are seen after death from madness,
place it still  more upon a footing u ith fevers from
all its  cau-es, and particularly from koino-mias-
matic exhalations, and in a more especial manner
when they  affect the brain,  and thereby induce
primary,  or  idiopathic   phrenitis.    In  short
madness is  to phrenitis,  what pulmonary con-
sumption is to pneumony, that is a chronic state
of an  acute disease.   It  resembles   pulmonary
consumption further, in  the  excitement  of  the
muscles,  and in the appetite  continuing in a na-
tural, or in a preternatural  state.

  VIII.  I infer madness to be primarily seated in
the blood-vessels., from the remedies which most
speedily  and  certainly  cure  it,  being  exactly
the  same  as those  which  cure fever  or  dis-
ease  in the  blood-vessels from other causes, and
in other parts of the body.   They will be noticed
in their proper place.                      f^

  I have thus mentioned the facts and arguments
which prove what is commonly called  madness to 
OF  THE  MIND.             27
be  a  disease  of the  blood-vessels of the brain.
All the other  and inferior forms of derangement,
whether of the memory, the will, the principle of
faith,  the passions, and the  moral faculties, I be-
lieve  to be connected more or less  with morbid
action in the  blood-vessels  of the brain, or heart,
according  to  the  seats of those faculties of the
mind.

   In  placing  the primary seat of madness  in the
blood-vessels, I would by  no means confine the
predisposition to it exclusively to them.   It ex-
tends to the nerves, and to that part of the brain
which  is the  seat of the  mind, both  of  which
when preternaturally irritable, communicate more
promptly,  deranged action  to the blood-vessels of
the brain.   I have called the union of this diffus-
ed morbid irritability, the phrenitic predisposi-
tion.    It is from the constant presence of this pre-
disposition, that some people  are seldom affected
with  the slightest fever, without becoming deli-
rious ;  and it  is from  its absence, that many people
are affected with fevers and other diseases of the
 brain,  without being affected with derangement.
 I am aware that it may be  objected  to  the proxi-
 mate cause or seat of madness, which has been
 delivered, that dissections have sometimes discov-
 ered marks of arterial diseases in the brain similar 
28            ON  THE  DISEASES
to those that have been  mentioned, which were
not preceded by the least alienation of mind.   In
these cas« s,  I would suppose the diseases  may
have  existed  in  parts  of  the brain which  are
not occupied by the  mind,  or that the mind  may
have  been translated to  another, and  a healthy
part of the brain.  The senses of taste and hear-
ing, we know, when impaired by disease, are often
translated  to contiguous, and sometimes to remote
parts of the body.  But did we admit the objec-
tion that I have met, to militate against  madness
being an arterial disease, it would prove too much,
for we sometimes discover the same morbid appear-
ances, which produce  apoplexy  and palsy, to be
present in the brain after death, without any of the
common symptoms of those diseases having been
preceded by  them.

  Many  other organic  diseases  are  occasionally
devoid of their usual characteristic symptoms.
Neither vomiting,  nor  want of appetite, have
taken place  in stomachs in  which  mortification
has  been  discovered after  death; and  abscesses
have been found in the livers of persons,  who
have died without any one of the  common symp-
toms of hepatitis.  By allowing the same latitude
to  me "confused and irregular operations of na- 
OF  THE  MIND.
29
ture," in the brain, in the production of madness,
that we observe in the production of-all the other
diseases that have been mentioned, we  can recon-
cile its occasional  absence, with the existence  of
all the organic affections in the brain which usual-
ly produce it.

   In  reviewing  the numerou^proofs of madness,
being seated primarily in the blood-vessels, and
its being accompanied so generally  with most of
the symptoms  of  fever, we cannot help  being
struck with the histories of the disease that have
been given by many ancient and modern  physi-
cians.  Galen,  defines  it to be " delirium sine
febre."   Aritaeus says it is " semper sine febre."
Dr. Arnold quotes a group of authors, who have
adopted and propagated the  same error.   Even
Dr. Heberden admits and reasons upon it.  The
antiquity and extent of  this  error should lead  us
never tolose sight of the blood-vessels in investi-
gating the  causes  of diseases.   They are, to  a
physician, what the meridian sun is  to a mariner.
There are  but  few diseases in which it will  be
possible for him to preserve the system in a heal-
thy course, without  daily,  and often more fre-
quent observations  of the state of the  blood-ves-
sels,  as manifested by the different and varying
states of the pulse. 
               CHAPTER   II.

Of the remote y0STexciting^causes of intellec-
tual derangement.

  I have combined  both these classes of causes,
inasmuch as they most commonly act in concert,
or in a natural succession to each other.   In enu-
merating them, I shall include such as act alike
in producing partial and universal  madness.

   They  have been divided,  1, into such  as act,
directly upon the  body ;  and, 2, such as  act in-
directly upon  the  body, through the medium
of the mind.

   To the first head belongs, 1, all those  causes
which act directly upon the brain.   These  are, 1,
malconformation and  lesions of the brain.  Be-
tween  the latter, and  the  existence of madness,
there is sometimes an interval  of  several  years.
A young man died in the Pennsylvania Hospital
in the year 1809, who became deranged at twenty- 
OF  THE  MIND.
31
one, in consequence of a contusion  on his head
by  a  fall from a horse in the fifteenth year of
his  age.   A Mr. I---- died of madness in the
same place, from an  injury  done to his brain
by  being thrown out  of  his chair, between two
and three years before  he discovered any signs
of derangement.  It  is remarkable  that injuries
show  themselves more slowly in  the brain than
in other parts  of the  body.   Dr. Lettsom  men-
tions a case, in the Memoirs of the London  Medi-
cal Society, of a disease in the brain, induced by
a fall from a horse, which did not discover itself
until two and  twenty years after its occurrence.

   2. Certain local disorders, induced by enlarge-
ment  of bone,  tumors, abscesses, and  water in
the  brain.

   3. Certain  diseases  of the  brain,  particularly
apoplexy, palsy,  epilepsy,  vertigo,  and  head-
ache.   It occurs but rarely from the last of those
causes.

   4.  Insolation.  Two cases of madness from
this cause occurred under my care between July
 1807, and February 1808.

   5.  Certain  odours.   There is a place in Scot-
land  where madness is  sometimes  induced  by 
32
ON  THE  DISEASES
the fumes of lead.   Patients who  are  affected
with it bite their hands, and tear their flesh upon
the other parts of their bodies.  It is called by the
country  people  mill-reck.  Dr. Prost describes
a  furious grade of madness in Peru, brought on
by a mineral exhalation, but he does not mention
the metal  from which it is derived.   From  among
many other facts that might  be mentioned,  to
show the connection  of  odours with a  morbid
state  of  the  mind,  I shall mention one more.
An ingenious dyer, in this city, informed me that
he often  observed the men who were employed
in dying  blue, of  which  colour indigo  is  the
basis, to become peevish, and low spirited,  and
never even to hum a tune, while  engaged at their
work.

   There are  certain causes which  induce mad-
ness, by acting upon the  brain in common with
the whole body.   These are, 1, gout, dropsy,
consumption, pregnancy, and fevers of all kinds.

   2. Inanition from profuse evacuations, or from
a defect of nourishment.    Famine induces it in
part from the latter  cause.

   3. The sudden  abstraction of the stimulus
if distension.   When madness  follows parturi- 
               OF  THE  MIND.  (           3.3
                           C^&t^Z+t' J^4^
tion,  it is most  commonly cfaiDBflBdCSbSSI  this
cause.

   4.  The excessive use  of  ardent spirits.  Dur-
ing the time  Dr.  Nicholas Waters acted as resi-
dent physician and apothecary of the Pennsylvania
Hospital,  he instituted an inquiry at my request,
into the proportion of maniacs  from  this cause,
who were confined in the Hospital. They amount-
ed to one-third of the whole number.

   5.  Inordinate sexual desires and gratifications.
Several cases of madness from this  cause  have
come under  my notice.

   6.  Onanism.   Four  cases  of madness occur-
 red,  in my practice, from this cause, between the
 years 1804  and  1807.  It is  induced  more fre-
 quently by this cause in young men, than is com-
 monly supposed  by parents and physicians.   The
 morbid effects of intemperance in a sexual  inter-
 course with  women are  feeble, and of a transient
 nature, compared  with  the train of physical and
 moral evils  which this solitary vice fixes  upon
 the body and mind.

    7.  The transfusion  of blood from one animal
 into  the  blood-vessels of another.  This practice
                        E 
34
ON  THE DISEASE:;
 was employee: in France many years ago, in order
 to discover a method of restoring health,  and re-
 novating life, in sick and aged people.   All  the
 persons, Dionis  tells us, who were the subjects
 of it, died  in a state of derangement.   The prac-
 tice was founded in error; for old age and sick-
 ness  are occasioned by  exhausted or diseased
 solids, and not by any unfitness in the quality of
 the blood,  to support animal life.

   8.  Great pain.

   9.  Unusual labour or exercise.

   10.  Extremely hot and cold weather.

   3.  Madness  is induced by corporeal  causes,  ..
which act sympathetically upon the brain. These
are,  1,  certain  narcotic  substances, particularly
opium,  hemlock,  night-shade,  hen-bane, and
 acconitum, taken into  the stomach.

   2. The suppression of any usual evacuation,
such as the menses, lochia, milk, semen, or blood
from the hemorrhoidal vessels.
3.  Worms in the alimentary canal 
OF THE  MIND.              35
  4. Irritation from certain foreign matters re-
tained  in  irritable parts  of the body.   I  once
knew some small shot  which were lodged in the
foot of a school boy, induce  madness  several
years after he became a man. It has been brought
on in one instance by decayed teeth, which were
not accompanied with pain.

   4. Madness is sometimes induced by  what is
called  a  metastasis  of some other disease to  the
brain.   These  diseases are, 1, dropsy.   A case
of  madness from this cause  is  related  by Dr.
Mead.   2.  Consumption.   All the symptoms of
this disease  sometimes  suddenly  disappear,  in
consequence of  the translation of morbid excite-
ment to  the brain.

   3. St.  Vitus's dance.  I attended a young lady
 some  years ago, in whom this disease was sus-
 pended by  an attack of  madness.  Her madness
 passed out of her brain, through the same chan-
 nel by which it entered  it, that is, in convulsions
 in the limbs of  one side, which gradually yielded
 to the power of medicine.

    4. Hysteria.   The morbid commotions  in the
 nervous  system are sometimes transferred to the 
36
ON  THE  DISEASES
blood-vessels,  and the  brain, where they induce
transient or chronic madness.

  5. Certain cutaneous eruptions.  The son  of
Dr.  Zimmerman became  deranged in conse-
quence  of an  eruption being repelled from  his
skin.   I attended a private patient in the Penn-
sylvania Hospital, in whom madness was induced
by the same cause.  The healing of an old and
habitual ulcer, has sometimes produced the  same
effect.

  6. The measles.  A young man,  of sixteen
years of age, was  admitted  into the Pennsylva-
nia Hospital, in June 1812, in a high state ol de-
rangement, which followed this disease.

  II.  The causes which induce intellectual de-
rangement, by acting upon the body through the
medium of the mind, are of a direct and indirect
nature.

   The causes which act directly upon the under-
standing are,

   1. Intense study, whether of the sciences or of
the mechanical arts, and whether of real or imagi-
nary objects of knowledge.  The  latter more frc- 
OF  THE  MIND.
37
quently produce madness than the former.   They
are,  chiefly, the means of discovering  perpetual
motion ;  of converting the base metals into gold;
of prolonging life to the antediluvian age ;  of pro-
ducing perfect order and hnppiness in morals and
government,  by the operations of human reason ;
and, lastly, researches into the meaning of certain
prophesies in the  Old and New  Testaments.  I
think I  have  observed madness from  the last
cause, to arise  most frequently from an  attempt
to fix the precise  time in which those prophe-
sies  were to be fulfilled, or from a disappoint-
ment in that time, after it  had passed.

   2.  The frequent and  rapid transition of  the
mind from one  subject  to  another.  It is said
booksellers have sometimes  become  deranged
from this cause.   The debilitating effects of these
sudden transitions  upon  the  mind, are sensibly
felt  after reading a volume of reviews  or maga-
zines.  The brain in these cases  is deprived of
the benefit of habit,  which prevents  fatigue to a
certain extent, from all the exercises of the body
and mind,  when they are confined to single ob-
jects.

   It is worthy of notice that this cause of madness
 accords exactly  withN a symptom of one  of its 
38           ON THE DISEASES
forms, and that  is, a constant and rapid  transition
of die mind  to a variety of unrelated  subjects.
But the understanding is affected chiefly in an in-
direct manner.

  1. Through  the medium of the imagination.
It is conveyed  into the understanding from  this
faculty, in all those people who become deranged
from  inordinate schemes of ambition or avarice.
Mad-houses, in every part of  the world,  exhibit
instances of persons who have become insane from
this cause.  The great extent  and constant exer-
cises  of the  imagination  in poets, accounts  for
their being occasionally affected with this disease.

   2.  The  understanding is sometimes  affected
 with madness through the medium of the memo-
 rv.   Dr. Zimmerman relates the case of  a Swiss
 clergyman, in whom derangement was induced by
 undue labour   in committing his  sermons  to
 memory.

   3. But madness is excited in the understanding
 most frequently by impressions that act primarily
 upon the heart.  I shall enumerate some of these
 impressions, and afterwards mention such instan-
 ces of their morbid  effects as  I have met with in
 the  course  of my  reading  and  observations. 
OF  THE  MIND.             39
They are joy,  terror,  love, fear, grief, distress,
shame from  offended  delicacy,  defamation,  ca-
lumny, ridicule, absence from native country, the
loss of liberty,  property, and beauty, gaming, and
inordinate love of praise,  domestic tyranny, and,
lastly, the complete gratification of every wish of
the heart.

   Extravagant joy produced madness in many of
the successful adventurers in the South-Sea specu-
lation in England, in  the year  1720.

   Charles  the  Sixth,  of France,  was  deranged
from a  paroxysm of  anger.

   Terror has often induced madness in persons
who  have escaped  from fire,  earthquakes,  and
shipwreck.   Two cases from the last cause have
occurred under my notice.

   Where  is the  mad-house that does not con-
tain  patients  from  neglected,  or  disappointed
love?

   Fear  often produces madness,  Dr.  Brambilla
 tells  us, in new recruits in the Austrian army. 
40
ON  THE DISEASES
  Grief induced  madness which  continued fifty
years, in a certain Hannah Lewis,  formerly a pa-
tient in the Pennsylvania Hospital.

  Distress often produced this disease, Mr. How-
ard tells us, in the prisoners of the town of Leige.

  An exquisite sense of delicacy,  Dr. Burton
says, produced madness in a  school-master,  who
was accidentally discovered upon a close-stool by
one of his scholars.

  The Bedlams  of  Europe  exhibit many cases
of madness from  public and private defamation,
and history informs  us of ministers of state  and
generals of armies having often languished away
their lives  in a state of  partial derangement, in
consequence  of  being unjustly  dismissed  by
their sovereigns.

   A player destroyed himself in Philadelphia, in
the year  1803, soon  after  being hissed off the
stage.

  The  Swiss soldiers sometimes languish  and
die from that form of madness which is  brought
on  by absence from their native country. 
OF  THE  MIND.
41
  An  ingenious modern poet  mentions this dis-
ease, as well as its exciting cause, with peculiar
elegance.

   " The intrepid Swiss that guards a foreign shore,
   " Condemn'd  to climb his mountain-cliffs no more,
   " If chance he hear the song, so sweetly wild,
   « Which, on those cliffs, his infant hours beguil'd,
   " Melts at the long lost scenes that round him rise,
   " And sinks, a martyr to repentant sighs."

   It  is remarkable,  this disease  is  most com-
monly among  the  natives  of countries  that are
the least desirable for beauty,  fertility, climate,
or the luxuries of life.   They resemble  in this
respect, in their influence upon the human heart,
the artificial  objects  of taste  which  are  at first
disagreeable, but which from habit take a stron-
ger hold  upon the  appetite  than  such  as are
natural and agreeable.

   The Africans become insane,  we are  told, in
some  instances, soon after they  enter upon the
toils of  perpetual slavery in the West Indies.

   Hundreds have become insane  in consequence
of unexpected losses of money.  It is remarka-
ble this  disease occurs oftener among the rich
who   lose only a  part of their property, than
                        F 
42           ON THE DISEASES
among persons in moderate  circumstances,  who
lose their all.

  An American Indian  became  deranged, and
destroyed himself,  in  consequence of seeing his
face in a  looking glass soon  after  his  recovery
from  a violent  attack of the  small-pox.   The
loss of one eye, by an affray  in a country tavern,
which materially affected the beauty of the face,
produced derangement  in  a young man  who
was afterwards my patient  in the  Pennsylvania
Hospital.  There are  other  facts,  which  show
the depth of this  attachment to beauty  in the
human  mind,  and the  poignancy of  the dis-
tress occasioned by  its loss,  or  decay.   The
once  beautiful lady Mary  Wortley  Montague
tells a friend,  in one  of her letters, that she had
not seen  herself in a  looking glass  for eleven
years, solely from her inability to bear the morti-
fying contrast  between  her appearance in the
two extremes of her life.

   A  clergyman in Maryland became insane in
consequence  of having  permitted  some  typo-
graphical errors to escape  in  a sermon which
he published upon the death of general Wash-
ington. 
OF  THE  MIND.
43
 The son of a late celebrated author in England
became deranged in consequence of  the  severe
treatment he  received  from  his father  in  the
course of his education.   Several instances  of
madness,  induced by  the cruel or unjust con-
duct  of  school  masters  and guardians  to  the
persons who were  the  subjects of their  power
and care, are to be met with in the records of medi-
cine.

   Sir Philip Mordaunt  shot himself  immedi-
ately  after  succeeding to a great  estate, and to
the favour of his prince,  and  while he appeared
to be in possession of every   thing that could
constitute  the  plenitude  of  human  happiness.
The  eldest  son  of a Scotch  nobleman, of high
rank  and large fortune, destroyed himself in the
same way,  a few  weeks after the consummation
of all  his  worldly prospects   and  enjoyments
by  his  marriage  to a most accomplished  and
amiable young  lady.

   Two instances are upon record, of persons who
 destroyed themselves immediately after drawing
 high prizes in a lottery.  In all these cases death
 was  the effect of derangement. 
44
ON  THE  DISEASES
   4.  The  understanding is sometimes deranged
 through the medium of the moral  faculties.  A
 conscience burdened  with guilt,  whether real or
 imaginary, is a frequent cause of madness.  The
 latter produces it much oftener than the  former.

   An instance of insanity occurred in a married
 woman in this city some years ago,  of the  most
 exempl.iry character,  from a belief that she  had
 been unfaithful to the marriage bed.   An ac-
 cident  discovered  that the supposed criminal
 connection  was with a  man whose very person
 was unknown to her.  There  is further  a mor-
 bid sensibility in  the  conscience in some  people,
 that predisposes to madness  from the most trifling
 causes.   A  young man, of great piety, died of
 this disease  in  our Hospital a few years ago, in
 consequence of his believing that he had  offend-
 ed  his  Maker  by refusing  to say grace at the
 table of a friend.

   The  most distressing grade of derangement
 under this head is, where real  guilt,  and  a  dis-
eased imagination, concur in producing it.   The
occasional acts of  self-mutilation  which deranged
patients sometimes  inflict upon themselves, and
the painful and protracted austerities voluntarily
imposed upon the body in  Ca&olic countries, 
OF  THE  MIND.
45
appear to be  the effects of the combined opera-
tion of these two causes upon the understand-
ing.

   But we sometimes observe intellectual derange-
ment to occur  from the moral  faculties being
unduly excited by supposed visions  and revela-
tions,  instances of which will be  mentioned in
another place.

   Let not religion be  blamed  for these  cases of
insanity.   The  tendency of all its doctrines and
precepts is to prevent it  from  most of its mental
causes ;  and  even the errors  that have  been blend-
with  it  produce  madness  less frequently  than
love, and many of those common and necessary
pursuits, which constitute  the principal enjoy-
ments and business of life.

   To the history of the causes  of derangement
which has been given, I shall add, that that form
of it  which  has been called hypochondriasis,  is
sometimes induced without either the patient or his
friends being able to ascribe it to any  cause.  Dr.
Nicholas Robinson,  a physician who  lived in the
beginning of the last century, complains, in a trea-
tise which he has published upon melancholy, of
 his sufferings  from it in  the following words. 
 46            ON  THE  DISEASES^
 " When  no air has blown across my affairs, and
 no shade obscured my sun, then am I most mis-
 erable."  I have heard similar  declarations  from
 several of my patients, and particularly from a
clergyman of the most exemplar)  life and  con-
 versation.  In all such cases it would be absurd
 to  suppose the disease existed without a cause.
 Many diseases take place in the  body from causes
 that are forgotten, or from sympathies with  parts
 of  the body that  are supposed to  be in a healthy
 state.   In like manner, depression of mind  may
 be  induced  by causes that are forgotten, or by the
 presence of objects which  revive the sensation of
 distress with which it was  at one time associated,
 but without reviving the cause of it in the me-
 mory.  The former pupils of the author will re-
 collect  several instances of mental  pleasure, as
 well as pain, from association, mentioned by him
 in  his physiological lectures upon the mind,  in
 which the original causes of both had perished in
 the memory.

  Intellectual derangement is more common from
 mental, than corporeal causes.   Of 113 patients
 in the Bicetre Hospital, in France, at one time,
 Mr. Pinel tells us 34 were  from  domestic  misfor-
 tunes, 24  froni disappointments  in love, 30  from
 the distressing events of the French  Revolution, 
OF  THE  MINS.
47
and 25 from  what he calls fanaticism,  making in
all the original number.   I have taken  pains to
ascertain the  proportion of mental and corporeal
causes which have operated in producing  madness
in tlfre Pennsylvania Hospital, but I am sorry to
add, my success in this inquiry was less satisfac-
tory than I wished.  Its  causes were concealed
in some  instances, and forgotten in others.   Of
50 maniacs, the  causes  of  whose  disease were
discovered by Dr» Moore and  his  assistant Mr.
Jenney, in the month of April 1812, 7 were from
disappointments,  chiefly  in love; 7 from grief;
7 from the  loss of property;  5  from erroneous
opinions  in  religion ;  2 from jealousy;  1 from
terror; 1  from insolation; 1 from  an injury  to
the head; 2  from repelled eruptions ;  5 from in-
temperance ; 3 from onanism ; 2 from pregnancy ;
 and  1 from  fever; making in all 34 from mental,
and 16 from corporeal causes.  A predisposition
 to the disease was hereditary in but five of them.

   I  shall now  mention all  those circumstances
 in birth,  certain  peculiarities of the  body,  age,
 sex, condition  and rank in life, intellect, occu-
 pation, climate, state of  society, forms  of go-
 vernment, revolutions, and religion,  which pre-
 dispose the  body  and mind to  be  acted upon
 by  the  remote  and exciting  causes that  have 
48
ON  THE DISEASES
been  mentioned, so as  to favour  the production
of madness.

   I. A  peculiar and hereditary sameness of  or-
ganization of the  nerves, brain,  and blood-ves-
sels,  on  which  I  said  formerly  the predisposi-
tion to madness  depended,  sometimes  pervades
whole families,  and renders them liable to this
disease from a  transient or feeble  operation of
its  causes.

  Application was  made some  years  ago  for
the admission of three members of the  same
family into  the  Pennsylvania Hospital  on the
same  day.   I have  attended two  ladies, one of
whom was  the fourth,  and  the other the  ninth,
of their respective families,  that had been affect-
ed  with this disease  in  two  generations.

  The following letter to the author, from Dr. Ste-
phen  W. Williams, of Deerfield,  in Massachu-
setts,  contains the history of two  cases of here-
ditary madness,  which,  from the singular resem-
blance in their subjects,  symptoms, and  issue,
have  seldom perhaps been  met with in the re-
cords of  medicine. 
OF  THE  MIND.
49
                             June 16th, 1812.
Dear Sir,
  " Believing that  " the  science of medicine is
related to every thing," I am induced to trans-
mit to you the  following incidents which have
lately  occurred  in  the  vicinity of  this place,
hoping that some useful inductions may be drawn
from them, for the  benefit of our profession.

  " Captains C. L. and J. L. were twin brothers,
and so great  was the similarity  in  their counte-
nances and appearance, that it was extremely dif-
ficult for strangers to  know them  apart.  Even
their   friends  were often  deceived   by  them.
Their habits  and manners were likewise simi-
lar.   Many  ludicrous  stories  are  told of peo-
ple mistaking one  for the other.

   " They both entered the American revolutionary
army at the same time.   Both held similar com-
missions, and both served with honour during
 the war.   They were  cheerful, sociable, and in
every respect gentlemen.  They were happy in
 their families, having amiable wives and children,
and they were both independent in their proper-
 ty.   Some time after  the close of the  war,  cap-
 tain J. removed to the state of Vermont, while
 captain C. remained in Greenfield, in the vicini- 
50
ON  THE DISEASES
ty of Dcerfield, and 200 miles from his  brother.
Within the  course  of three  years,  they  have
both been  subject to  turns  of  partial  derange-
ment,  but  by  no  means   rising  into mania,
nor sinking into melancholy.   They appeared to
be  hurried and confused in  their  manners, but
were  constantly able to attend to their business.
About two years ago,  captain J.  on  his return
from the general assembly of Vermont,  of which
he was  a  member,  was found in  his chamber,
early in the morning, with his throat cut, by his
own hand,  from car to  ear, shortly after which
he expired.  He  had   been  melancholy a  few
days previous to  this  fatal catastrophe,  and had
complained  of  indisposition  the  evening  pre-
vious to die event.

   " About ten days ago, captain C.  of Greenfield,
discovered signs  of melancholy, and  expressed
a  fear that  he should destroy  himself.  Early
in the morning of June fifth he got  up,  and pro-
posed to his wife  to take a ride  with him.   He-
shaved  himself as usual, wiped his  razor,  and
stepped  into  an  adjoining  room, as  his  wife
supposed, to put  it up.  Shortly after she heard
a  noise, like  water  or blood running upon the
floor.  She  hurried into the  room, but  was toe 
OF  THE  MIND.
51
late  to  save him.  He had cut his  throat with
his razor, and soon afterwards expired.

   " The mother of these two gentlemen, an aged
lady, is now in a state of derangement, and their
two sisters,  the  only survivors of their family,
have been subject,  for several years,  to the same
complaint."

   There are several peculiarities which  attend
this disease, where  the predisposition to it is
hereditary, which deserve our notice.

    1. It is excited by more feeble causes than in
 persons in whom this predisposition has been ac-
 quired.

    2. It generally attacks in those stages of life in
 which  it has appeared  in the patient's ancestors.
 A general  officer,  who served  in the American
 army during the revolutionary war, once express-
 ed a wish to a brother  officer, from whom  I re-
 ceived the  information, " that he might not live to
 be old, that he might die suddenly, and that  if he
 married, he might have no issue."   Upon being
 asked  the  reason  for  these wishes, he  said, he
 was descended  from a family .in which madness
 had sometimes appeared  about the fiftieth  year 
52            ON  THE DISEAS1S
of life,  and  that  he did not wish to  incur  the
chance of inheriting, and propagating it  to a fami-
ly of children.   He  was gratified in all his three
wishes.  He fell in battle between the thirtieth and
fortieth years of his age,  and he left  no issue,
although he had been married several years before
his death.  A  similar  instance of the disease ap-
pearing at the same  time  of life,  in three persons
of the same family,  occurred under my  notice in
the  Pennsylvania Hospital.  It  came on in  a
father and two of  his  sons between  the sixtieth
and seventieth years of their lives.

  3.  Children  born previously  to the   attack of
madness in their parents are less liable to inherit it
than those who are  born  after it.

  4.  Dr. Burton,  in his Anatomy of Melancholy,
remarks, that children born of parents who are in
the decline of life, arc more predisposed to one of
the forms of partial insanity than children born
under contrary circumstances.

  5.  A  predisposition to certain diseases seat-
ed in  parts contiguous to the seat  of  madness,
often descends from  parents to their  children.
Thus  we sometimes see madness in a son whose
father or mother had been afflicted only with hys- 
OF  THE  MIND.
53
teria,  or habitual head-ache.  The reverse of this
remark likewise  sometimes  takes  place.   I at-
tended  a respectable  mechanic  in this  city in
two attacks of madness, the  last of which termi-
nated  his life.  All  his children, six in  number,
and now  all adults,  are  afflicted  with head-ache,
but none  of them have ever discovered any sign
of madness in their conduct or conversation.

   6.  There  are  instances of  families in which
madness has existed, where  the disease has pass-
ed  by the understanding  in their posterity, and
appeared  in  great strength  and excentricity  of
the memory, and of the passions, or in great per-
version of their  moral  faculties.  Sometimes it
passes by all the faculties of  the  mind, and ap-
pears only in  the nervous system,  in persons de-
scended  from deranged parents,  and again we
see  madness  in  children whose  parents were re-
markable only for eccentricity  of mind.

   There  are  several diseases which attack the
children of the same family,  which did not exist in
their  ancestors.   I  have  called them filial dis-
eases.  They are chiefly consumption and  epi-
lepsy.   I have  attempted  to discover  whether
madness  ever appears in this way, and have heard
 of but two instances of  it.  One of them occur 
 54           ON  THE  DISEASES
 red in a family in the island of Barbadoes, in which
 four children,  descended from parents of habitual-
 ly sound minds, became deranged.   I\rhaps in
 these cases the disease had existed in their remote
 ancestors, or possibly it was translated from a dis-
 ease in some  of the contiguous systems of the
 body.   I have wished to discover whether there
 be any peculiarity of shape  in the skulls of mad
 people that predisposed to derangement, for which
purpose I  requested Dr. Vandyke, in the year
 1810, to examine the dimensions of the heads of
all the  insane  patients  in our hospital in several
different directions, and  afterwards to measure in
the same way the heads of a number of patients,
belonging to  the Hospital,  with other diseases.
The result of this inquiry was a discovery  that
there was  no departure but in  one instance from
the ordinary and natural  shape  of the head, in be-
tween sixty and seventy mad people.

  II. A predisposition to madness is  said to be
connected with dark coloured hair.   Mr. Haslam
informs us that this was the case in two hundred
and five out of two hundred  and sixty-five pa-
 tients in the Bethlehem  Hospital.   He intimates
that it was possibly from their consisting chiefly of
the natives of England, in whom that colour of the
hair  is very  general;  but the same connection 
OF  THE  MIND.
55
between madness and dark coloured hair has been
discovered in the maniacs  in  the  Pennsylvania
Hospital,  who consist of persons  from three or
four different countries, or of descendants who in-
herit their various physical characters.  Of nearly se-
venty patients, who were examined at my request,
by Dr. Vandyke, in our Hospital, in the year 1810,
with a reference to this fact, all, except one, had
dark coloured hair. In the month of  April, 1812,
I requested Dr. Vandyke to direct  his inquiries
more particularly to the colour  of  the eyes in the
maniacal patients in our Hospital. He  executed my
request with great care and correctness, and disco-
vered that fifty-six out of seventy-nine of them had
light coloured eyes, of which number but  six had
fair hair.

   III.  There is a greater predisposition to mad-
 ness between twenty and fifty, than  in any of the
 previous or subsequent years of human life.  Of
 the correctness of this  remark, Mr. Pinei has
 furnished us with the following proof.  Of 1201
 persons who were admitted into the  Bicetre Hos-
 pital,  in  France, between  the years 1784 and
 1794,  955 were between the two ages that have
 been  mentioned.  65 were between fifteen and
 twenty,  131   were  between  fifty and  sixty,
 and 51 between sixty  and  seventy-one.   Mr. 
56
ON  THE
DISEASES
 Haslam has furnished  additional evidence of the
 correctness  of this remark.  Of 1664 deranged
 patients who were admitted into the Bethlehem
 Hospital in London, between the years 1784 and
 1791,  he  tells us 910 of them were  between the
 ages mentioned  by Mr.  Pinel.   But the propor-
 tion of maniacal patients, above twenty and under
 fifty years of age, was  much greater in the Penn-
 sylvania Hospital  in the  month of  April 1812.
 It was ascertained  by Dr. Vandyke to be 68 out
 of 79, that is, nearly seven-eighths of their whole
number.   From the state of the body and mind
 within those  periods,  it  is easy to  account for
this being the case.  The blood-vessels  and the
nerves are then in  a highly excitable state, and
the former readily  assume morbid  or inflamma-
tory  action from the remote and exciting causes
of disease.   The mind too,  within  those years,
 possesses more sensibility, and of course  is more
easily acted  upon by  mental irritants, the sour-
ces of which from  family afflictions, and  dis-
appointments in  the pursuits of business,  plea-
sure and ambition,  are more numerous in those
years, than in any of the  previous or subsequent
stages of life.

  Madness,  it has been said, seldom occurs under
puberty.   To the small  number of  instances  of 
                OF THE MIND.              57
it  that are  upon record, I shall add  four  more.
Two boys, the one of eleven, and the other of
seven years of  age, were admitted into  our Hos-
pital with this disease (the  latter during the time
of my attendance  in 1799) and both discharged
cured.  I have since seen an instance of it in the
year 1803, in a child of two years old, that had been
affected with cholera infantum ;  and another  in a
child of the same age, in the year 1808, that was
affected with internal dropsy of the brain.   They
both discovered the countenance of madness, and
they  both attempted tQ bite, first their mothers,
and afterwards  their own flesh.   The reason  why
children and persons under puberty are so rarely
affected with madness must be ascribed to men-
tal impressions, which are its most frequent cause,
being too  transient in  their effects,  from the in-
stability of their minds, to excite their brains into
permanently diseased  actions.   It  is true, chil-
dren  are often affected with delirium, but this is
a symptom of  general fever, which is always in-
duced, like the few cases of madness in children
that I have mentioned, only by corporeal  causes.

   From the records of the Bicetre Hospital, in
France, it appears that madness rarely  occurs in
old  age.    Doleus and Dr.  Greding mention
several cases of it; the latter in a man of eighty-
five.   I  have  attended  two  men  between sixty
77 
53
ON  THE DISEASES
 and seventy,  and one  woman  between seventy
 and eighty, in the  Pennsylvania Hospital, and a
 private patient in the eighty-first year of his age,
 in  this disease.  It has been said that maniacs
 seldom live to be old.   I have known but few
 exceptions to this remark, and they were of per
 sons in whom  the extinction of the mind,  in idi-
 otism, "had protected the body  from  being worn
 out prematurely by its constant  and preternatural
 excitement or depression.   One of  the persons
 was Hannah Lewis, formerly mentioned, in  whom
 the disease was induced by  grief, in middle life,
 from the loss of her husband.  She died  in our
 Hospital in the year 1799, in the eighty-seventh
 year of her age.  A predisposition to longevity,
 which she derived from her ancestors,  predomi-
 nated over the tendency  of her long protracted
 disease to destroy her life.   She lost one sister in
 the eighty-second year of her age, and at the time
 of her death  had another living who was ninety-
 four,  neither  of  whom  had ever  been affected
with madness.   There are two  reasons why this
disease so rarely attacks old people.  Their blood-
vessels lose their vibratility from age, and  hence
 they are less liable to fevers than in middle life ;
and from  the  diminution of sensibility in their
nerves and brains, the causes of madness  make
but a feeble and  transient impression upon their
 minds.  In the latter condition of their bodies, 
OF THE MIND.
59
they revert to that state which takes place in chil-
dren,  and which I have said protects them from
the frequent occurrence of this disease.

   V.  Women,  in  consequence of the  greater
predisposition imparted to their bodies by men-
struation, pregnancy, and parturition, and to their
minds, by living so much alone in  their families,
are more predisposed to madness than  men.   A
woman was  admitted  into our Hospital many
years ago, who was deranged only during the time
of her menstruation, and who  in  one of those
periods hung herself with the string of her petti-
coat.  Of 1664 patients admitted into  the Beth-
lehem  Hospital,  between the  years 1784 and
1794, eighty-four of them were  women in whom
madness  followed parturition.   I have been con-
sulted in  two cases, and I have heard of a third,
in which  madness was induced by the solitude of
a country life, in women who had been accustom-
ed to live in a large social and domestic society.
Of 8874 patients  admitted into the Bethlehem
Hospital  in London, between the years  1748 and
1794, four thousand eight  hundred and thirty
two were women; nearly a fifth more than men.
In St. Luke's Hospitalin London, the proportion
of women to men who  have been admitted in a
given number of years is in the ratio of three to
two.  Br.t this disproportion of women to men. 
60
ON  1HB  DISEASES
  who are affected with madness, is by no means
  universal.  In a Hospital for mad people in Vien-
  na, one hundred and seventeen men were admit-
  ted in a given number of years, and but ninety
  four women.  In a Hospital of the same kind at
  Berlin, twice as many  males were admitted in a
  given time as females.   More of the former than
  of the latter have been admitted into  the  Penn-
  sylvania Hospital.   In  all these cases accidental
  circumstances,  such as the want of accommoda-
  tions suited to female delicacy, or deep rooted
  prejudices against public mad-houses, and a pre,
  ference of such as are private, may have lessened
  the proportion of women in the above instances,
  while  the evils of war,  bankruptcy, and habits of
  drinking, which affect  men more than women,
  and which vary in their influence upon  the. mind
I  in different countries, may  have  produced more
/  instances of madness in the former than in  the
[  latter sex.  Perhaps it would be correct to say,
I  women are more subject to madness from natural
\  causes, and men from such  as are artificial.

     What  has been  said  under this head applies
   more  particularly to general madness;  but, from,
   many facts, I am led to believe that men arc more
   subject to that grade of derangement,  which has
   been called hypochondriasm, than women.   The
   distressing impressions made  upon the  minds of 
OF THE  MIND.              61
women frequently vent themselves in tears, or in
hysterical commotions  in the nervous system,
and bowels, while the same impressions upon the
minds of men pass by their more compact nervous
and muscular fibres, and descend into the brain,
and thus more frequently bring on hypochondriac
insanity.  If this remark be correct, it will  con-
firm Dr. Heberden's assertion, that men are more
disposed to suicide than women, for it necessarily
follows their being most subject to that state of
madness.  Where  the  instances of suicide are
more frequent among  women than men, it is in
those cases only in which the former are exposed
to sudden paroxysms of vexation and despair.

   VI.  Single  persons  are  more predisposed to
 madness than  married people.  Of seventy-two
 insane  patients  in the  Pennsylvania Hospital,
 whose condition,  relative to  this question, was
 ascertained by my young friends Dr.  Moore
 and Mr. Jenny, in the  month of April  1812,
 forty-two had never been married,  and five  were
 widows  and widowers,  at the time they became
 deranged.

    The  absence of real and present care,  which
 gives the mind leisure to look back  upon past,
 and to anticipate  future and imaginary evils, and
  the  inverted  operation of all  the affections  of 
62
ON  THE DISEASES
  the heart upon itself, together with  the  waut 01
  relief in conjugal  sympathy  from the inevitable
  distresses and  vexations of life,  and  for which
  friendship  is  a cold and feeble  substitute,  arc
  probably the reasons why madness occurs more
  frequently   in  single  than  in  married  people.
  Celibacy it has been said is a pleasant  breakfast,
  a tolerable  dinner, but a very bad  supper.  The
 last comparison will appear to be an appropriate
 one, when we  consider  further,  that the supper
 is  not  only of a  bad quality,  but  eaten  alone.
 No wonder it sometimes becomes  a predispos-
 ing cause of madness.

   VII. The rich are more predisposed to madness
 than the poor, from their exposing a larger surface
 of sensibility to all its remote and exciting causes.
 Even  where  mental sensibility  is the  same  in
 both those classes  of people, the  disease is pre-
 vented  in the latter, by the  constant pressure  of
 bodily suffering, from labour, cold, and hunger.
 These  present  evils defend their minds from
 such as  are past and anticipated; and  these are
 the  principal causes  of madness.   When it oc-
curs in  poor people, it is generally the  effect  of
corporeal causes.

  VIII.  "Great wit, and  madness,"  are said  by
Dryden "to be nearly allied."  If he meant by this 
OF  THE  MIND.
63
affinity between wit and madness, the rapid exer-
cises of the mind in associating similar and dis-
similar ideas or words which are peculiar to both,
the remark is a correct one; but if he meant that
great Wits are more predisposed to madness than
other people, the remark is opposed by all that  is
known of the solidity of understanding, and cor-
rectness  of conversation and conduct of  Butler,
Chesterfield, Franklin, Johnson, and many  other
distinguished men, who possessed the talent of wit
in an eminent degree. Nor is the remark true if the
term wit  be intended to designate men of great
understandings.   Their minds are  sometimes
worn away by intense  and protracted study, but
they are rarely  perverted by  madness.  The vi-
 gorous mind of Dean  Swift  perished gradually
 only from the  former  cause.  Where madness
has been induced by intense and protracted appli-
cation to books, it has generally been in persons
of weak  intellects who were  unable to compre-
 hend the subjects of their studies.

   ix! Certain  occupations predispose to mad-
 ness more than others.   Pinel says, poets, pain-
 ters, sculptors  and musicians, are most subject
 to it,  and that  he  never knew an instance of it
 in a chemist, a naturalist, a mathematician, or a
 natural philosopher.   The reason of this will  be
 understood bv  recollecting what was said  under 
 'jl           ON THE DISEASES
 the ;   ceding head   The studies of the former
 exerc s  the unaginatio'..,  nn.l t:>e  pissicns,    .J
 the studies of the latter intercut the understand-
 ing only.  Dr.  Arnold tells  us, he has observed
 mechanics to be more affected with madness than
 merchants and members  of  the  learned  profes-
 sions.   This  may arise from the vague and dis-
 tracting exertions of genius, unassisted by educa-
 tion ;  or from corporeal causes, to which their em-
 ployments expose them more than the classes of
 men that have been mentioned.   Of the effects
 of the former of those causes,  I once saw  an
 instance  in a house  carpenter, who became de-
 ranged  in consequence of an unsuccessful at-
 tempt to contrive a new kind  of stair-case.  More
 farmers it has been  said become  deranged than
 persons of the same grade of intellect and inde-
 pendence in cities.   If this be the case, it must
 be ascribed to the greater solitude of their lives,
 more especially in the winter season, and to  their
 being more exposed from labour  and accidents,
 * > its corporeal causes.

   X.  Certain  climates  predispose to  madness.
 It is very uncommon in such us are uniform-
ly warm.  Dr. Gordon informed  mc in his \ i-
sit to  Philadelphia  in  the year  1807,  that he
had never seen,  nor heard of a  single case of
madness  during  a residence of six years  in die 
OF  THE  MIND.             65
province of  Berbice.   It is a rare disease in the
West  Indies.  While  great  and constant  heat
increases  the irritability of the  muscles,  it gra-
dually  lessens the  sensibility of the  nerves and
mind,  and  the irritability  of the blood-vessels,
and  in these I  formerly supposed  the  predis-
  sition  to  madness  to be  seated.   It is more
common in  climates  alternately  warm and cold,
but most so, in such as are generally moist  and
cold,  and accompanied at  the same time with a
cloudy sky. Instances of it are said to be  most
frequent in  England  in the month of November,
at which time the weather  is unusually gloomy
from  the above causes.  Even the transient oc-
currence of that  kind of weather in  the  United
States has  had  an influence  upon this disease.
In  the month  of May in  the year 1806 it  pre-
vailed to a great degree, during which time three
patients in the  Pennsylvania  Hospital made un-
successful attempts upon their lives, and a fourth
destroyed himself.   Two instances of suicide oc-
curred in the same month in Philadelphia.

   XI. Certain states of society, and  certain opi-
nions, pursuits, amusements, and forms of govern-
ment, have a considerable influence in predispos-
ing to derangement.   It is a rare disease among
savages.  Baron Hombolt informed  me, that he
                        i
>» 
66
ON  THE  DISEASES
did not hear of a single instance of it among the
uncivilized Indians in South America.   Infidelity
and atheism are frequent causes of it in christian
countries.  In commercial countries, where large.
fortunes arc suddenly acquired and lost, madness
is a common disease.   It is most  prevalent at
those times when speculation is  substituted Xp4"
regular commerce.  The  mad-houses  in  Eng-
land were  crowded with patients before, and af-
ter the bursting of the South Sea bubble  in the
year 1720.  In the  United States, madness has
encrcased since the year 1790.  This must  be
ascribed chiefly to an increase in the number and
magnitude  of the objects of ambition and avarice,
and to the  greater joy or distress, which is pro-
duced  by gratification or disappointments in the
pursuit of  each of them.  The funding system,
and  speculations in  bank  scrip, and new  lands,
have been  fruitful  sources of madness in our
country.  Sixteen persons perished from suicide
in the city of New York, in the year 1804, in most
of whom it was supposed to be the effect of mad-
ness,  from the different and contrary  events of
speculation.

   Even the profits and losses of regular trade and
agricultural labour,  now and then  pervert  the
understanding.   A respectable merchant died of
madness in the  Pennsylvania  Hospital, in  the 
OF  THE  MIND.
67
year 1794,  induced by a successful  East India
voyage.  A farmer near Albany, who refused to
take twenty shillings a bushel  for a large quantity
of wheat, in the year 1798 became insane from
the sudden reduction of its price.  Suicide was
induced in a farmer of great  wealth,  in York
county, in  Pennsylvania, in the spring  of 1812,
by a similar  disappointment, in obtaining a less
price than he had been previously offered for  a
quantity of clover seed.  Gaming is  an  occasion-
 al cause of madness in some countries.  At Pe-
 nang in the East Indies, where men often  stake
 their wives upon the issue of a game, this disease
 is very common.  The unfortunate gambler often
 rises from his seat in a fit of  derangement, and
 sallies  out into the street with instruments of mur-
 der in his hands.  A  bell is  rung  at  this time,
 which  drives people into  their houses, to  avoid
 being  killed.  A late German writer has remark-
 ed, that nervous diseases increase in the cities of
 Germany  in proportion to the  fondness of their
 citizens for seeing tragedies.  It is easy to con-
 ceive  they may extend their  effects a little fur-
  ther   so as to excite morbid commotions in the
  blood-vessels of  the  brain.   I have  heard the
  neater frequency of madness in England, Uian in
  some other  countries,  ascribed in part  to its inha-
  bitants preferring tragedy  to comedy, in their 
68
ON  THE DISEASES
stage entertainments.   The r«*7emotions excited
by  these  exhibitions of imaginary distress are
never accompan ied with an effort to relieve it, by
which means there is an accumulation and  reflux
of sensation in the mind, that cannot fail of affect-
ing the  nerves and brain, and thereby to predis-
pose  to, or induce madness.   Certain  forms of
government predispose to madness.   They arc
those in  which the people possess a just and ex-
quisite sense of liberty, and of the evils of aibitra-
ry powtr, against which complaints are  stifled by
a military  force.   The  conflicting tides  of the
public passions, by their operation  upon the un-
derstanding, become in these cases a cause of de-
rangement.   The  assassination  of tyrants  and
their instruments of oppression is  generally the
effect of this disease.  That madness is thus in-
duced, I infer from its occurring so rarely from a
political  cause in  the  United States.    I have
known but one instance  of it, and  that was in a
gentleman  who had  been  deranged some years
before from  debt,  contracted by extravagant
living.  In a government in which  all the power
of a country is representative, and tkeiive, a day
of general  suffrage, and  free  presses, serve, like
chimnies in a house, to conduct from  the indi-
vidual and  public  mind,  all the discontent, vexa-
tion, and resentment, which have been generated 
OF  THE  MIND.
69
in the passions, by real or supposed evils, and
thus to prevent the understanding being  injured
by them.

   In despotic countries where the public passions
are torpid,  and where  life and  property are se-
cured only by the extinction  of  the domestic
affections,  madness is  a rare  disease.   Of  the
truth of this remark I have been satisfied by Mr.
Stewart, the pedestrian  traveller, who spent some
time  in Turkey : also by Dr. Scott, who accom-
panied lord M'Cartney  in his embassy to China;
and by Mr. Joseph Roxas, a native  of  Mexico,
who passed nea^ forty years of his life among
the civilized but depressed natives  of that coun-
try.   Dr.  Scott  informed me  that  he heard of
but a single instance of madness in China,  and
that  was in a  merchant  who had suddenly  lost
100,0001. sterling by an unsuccessful speculation
in gold dust.

   Mr. Carr, in his Northern Summer, tells us,
that  madness  is an uncommon disease in Russia.
It is  a rare thing, says  this professional traveller,
to see a Russian  peasant angry.  He even per-
suades and reasons with his horse, when he wishes
him  to quicken his gait.  It is  to the long pro-
tracted civil and ecclesiastical tyranny of the late 
 70           ON  THE DISEASES
 government of Spain, that we must ascribe the
 small number  of  maniacs in  all the hospitals  in
 that country.   They amounted, according to Mr.
 Townsend, in  the year 1786, to but 664, in a
 population which  produces in Great Britain be-
 tween 4,000  and  5,000;  2,600 of  whom are  in
 the city and neighbourhood of London.   Habits
 of oppression in all those cases  expend  the ex-
 citability of the passions, and  prevent their react-
 ing upon the brain.  But in some instances the
 understanding decays  with the passions,  in des-
 potic countries.  This stqje of the mind has been
 called fatuity.  It  is very common in Turkey and
 China.   The inirritable or nonSstic state of the
 brain upon which this disorder depends, is induced
 in those countries without previous morbid excite-
 ment, in the satVic  manner that the disorder called
 hepatalgia is induced, without previous hepatitis or
 obvious and  sensible inflammation in the liver, in
 the East and West Indies.

  XII.  Revolutions in governments which are
often  accompanied with injustice,  cruelty,  and
the loss of property and friends;  and where this
is not the case,  with an inroad upon  ancient and
deep-seated principles and habits, frequently mul-
tiply instances of insanity.   Mr. Volney informed
 me, in his visit  to this city in the year 1799,  that 
OF  THE  MIND.
71
there were three times  as many cases of madness
in Paris  in the year 1795,  as  there were before
the commencement  of the  French Revolution. It
was induced,  I shall say  hereafter,  in several in-
stances,  by the events  of  the American Revolu-
tion.

   XIII.  Different religions,  and different  tenets
of  the same religion are more  or less calculated
to induce a predisposition to madness.  Dr.  Sheb-
beare  says there  are fewer  instances of suicide
(which  is generally the  effect of  madness) in
catholic, than in protestant countries.  He as-
cribes it to the facility with which the catholics
relieve their minds from  the pressure of guilt,
by means  of confession  and  absolution.   This
assertion and  the reasoning founded  upon it are
rendered doubtful  by  150 suicides having taken
place  in the  catholic  city of  Paris in the  year
1782, and but 32  in  the same year  in  the  pro-
testant city of London.   It is probable however
the greater proportion of infidels in  the former,
than  in the  latter  city at that time,  may  have
occasioned the difference in  the number of deaths
in the two places,  for suicide  will naturally fol-
low small degrees  of  insanity, where  there are
no habits of  moral order from  religion, and no
belief in a future state.   Dr.  Shebbeare's asser- 
 72           ON  THE DISEASES
 tion is rendered still less probable, by  consider-
 ing the usual effects of solitude upon the  human
 mind, and this we know acts  with peculiar force
in the cells of monks and  nuns.   This  remark
 is not the  result of reasoning  a  priori.   Of be-
 tween 240 and 250 deranged  people, who were
 confined at one  time  in a mad house in the city
 of Mexico, Mr. Roxas informed me,  in a  great
majority of them the  disease had been contracted
in those recluse and gloomy situations.

   There arc certain tenets  held by  several pro-
testant  sects of christians which  predispose the
mind to derangement.   They shall be noticed
in another place.

   I shall conclude the history of  the remote ex-
citing and predisposing causes of madness by the
following remarks.

   1. Its remote  causes generally induce  predis-
posing debility.  Its exciting causes more com-
monly  induce  that  morbid excitement  in the
blood-vessels of the  brain in  which madness is
seated, but the sudden and violent action of a re-
mote cause is often  sufficient  for  that purpose
without the aid of an existing cause. 
OF  THE  MIND.
73
  2. Both the remote and exciting causes of mad-
ness produce their morbid effects more certainly,
promptly, or slowly, according as the system is
more or less predisposed to the disease by  the
causes formerly mentioned.

   3.  The predisposing causes of madness  some-
times  act  with  so much force,  as  to induce  it
without  the  perceptible  co-operation of either  a
remote or an exciting cause.   The remote causes
of madness likewise act with so much loree in some
instances as to induce it without the perceptible co-
operation of a predisposing or exciting cause.
K 
CHAPTER  III.
Of Partial Intellectual Derangement, and par-
          ticularly of Hypochondriasis.


Jl  ARTIAL derangement consists in error in opi-
nion, and conduct, upon  some one subject only,
with soundness of mind upon all, or nearly all other
subjects.  The erf/r  in this cyrfe is two^ld.   It
isr diregjiy contrary to truths;' or it hr dispropor-
tioncd in its effects, or eju^cctcd consequences, to
the causes which induce fliem.  It has been divid-
ed by the nosologists  according to its objects.
When it relates to the persons, affairs, or condi-
tion  of the patient only, and is attended  with dis-
tress, it has been called hypechondriasis.   When
it  extends to objects external to the  patient, and
is  attended  with pleasure, or the absence of dis-
tress, it has been called melancholia.  They  arc
different grades only,  of the same morbid actions
in the brain, and they now  and then blend their
symptoms with each other. 
OF  THE  MIND.
75.
  I wish  I  could substitute a  better term than
hypochondriasis, for the lowest grade of derange-
ment.   It is true the hypochondriac region is dis-
eased in it;  so it is after autumnal fevers, and yet
we  do not designate the obstructions induced by
those fevers by that name.  It  would  be equally
proper to call every other form of madness hypo-
chondriasm, for they are all attended with more or
less  disease or disorder  in  the liver, spleen, sto-
mach and bowels, from which the name of hypo-
chondriasm is  derived.   But I have another ob-
jection  to that name, and that  is, it has unfortu-
nately been supposed to imply an imaginary dis-
ease only, and when given to the disease in ques-
tion is always offensive to patients who are affect-
ed  with it.  It is true, it is seated in the  mind;   /
but it is as  much  the effect  of corporeal causes as
a pleurisy,  or a bilious fever.  Perhaps the term
tristimania  might  be  used to express this
form of madness when erroneous opinions respect-
ing a man's person, affairs, or condition, are the
subjects of his distress.

   I object likewise to the term melancholia, when
used, as it is by Dr. Cullen,  to express partial mad-
ness  from  external causes. 
76            ON  THE  DISEASES
  1. Because  it is sometimes induced by causes
that are not external to the patient, but connected
with his person, affairs, or condition in life;  and,

  2. Because it  conveys  an idea of  its being
seated  in  the  liver, and  derived  from vitiated or
obstructed bile.   Now the seat  of the  disease,
from facts formerly mentioned,  appears to be in
the brain, and morbid or obstructed  bile is evi-
dently  an accidental symptom of it.   Perhaps  it
would  be more proper to call it  amenomania,
from the  errors  that constitute it,  being  ge-
nerally attended with pleasure, or the absence of
distress.

   The hypochondriasis, or tristimania, has some-
times  been confounded with hysteria, but differs
 from it,

   1. In being induced chiefly by mental causes,
 and particularly  by  such of them  as  act  upon
 the  understanding, through the  medium of  the
 passions  and  moral  faculties.   Hysteria is  pro-
 duced chiefly by corporeal causes. Its paroxysms
 only are excited  by such  as  are mental.   The
 chronic operation of the passions, so far from in-
 ducing it, sometimes cures it,  or changes it into
 hypochondriasm. 
OF  THE  MIND.
77
  2. In affecting men more than women.

  3. In affecting chiefly persons of sedentary em-
ployments.

  4. In the absence of globus hystericus.

   5. In affecting the blood-vessels  of the brain
 as well as the nerves. Hysteria affects the nerves
 and muscles only, and never the blood-vessels, so
 as  to  produce  derangement, except  for a short
 time, and only during its paroxysms.

   6. The nerves in hypochondriasis are in a reverse
 state from that  which  takes  place  in  hysteria.
 In the former,  they are torpid, or in what Themi-
 son calls a strictum state.  In the latter disease
 they are in  a highly excitable, or what the  same
 author has  called  a laxum  state.   These terms
 correspond  with what Dr.  Boerhaave  has  since
 denominated a rigid and lax  state of the fibres.

    7. Hypochondriasis is generally  attended  with
 costiveness or diarrhoea, and durable distress of
 mind, which are transient affections only in hys-
 teria; and, 
78           ON  THE DISEASES
/
  .8. Hypochondriasis is relieved by warm wea-
ther, and warm drinks.  Hysteria is made worse
by each of them.

  Hypochondriasis,  or  tristimania, is to hysteria
what a typhus fever is to inflammatory fever.  It
is often combined with  it, and sometimes alter-
nates  with it,  and, when  cured,  it passes out of
the system with symptoms of hysteria, in all those
cases in which it  was preceded by them.  I beg
the attention of the reader to  this v iew  of these
two forms of disease.  It is intended  to destroy
the nosological  distinctions  between them.  As
well might we divide the  first and  last stages  of
a fever by specific  characters,  as divide  those
two  grades of morbid  excitement by specific
names.

  I shall  now deliver a history of the  most cha-
racteristic symptoms of the two  different forms
of partial derangement that have been mentioned,
and afterwards take notice of the  remedies proper
for  each of them.  I shall begin  with hypochon-
driasis,  or tristimania.

  The symptoms of this form of derangement as
they appear in the  body are, dyspepsia ;  costive-
ness or diarrhoea,  with  slimy stools;  flatulency

f~ ■"•••'       ' 
OF  THE  MIND.
79
pervading the whole alimentary canal,  and called
in the bowels borborigmi;  a tumid abdomen,
especially on the right side; deficient or preter-
natural appetite; stroi^ venereal desires,  accom-
panied with nocturnal emissions of semen ;  or an
absence of venereal desires, and sometimes impo-
tence ; insensibility to cold; pains in the limbs at
times, resembling rheumatism ; cough; cold feet;
palpitation  of the  heart; head-ache ;  vertigo;
tenitus  aurium;  a  thumping like a hammer in
the temples, and sometimes within the brain;  a
disposition  to faint; wakefulness, or starting in
sleep ; indisposition to rise out of bed, and  a dis-
position to lie in it for days,  and even weeks;  a
cool  and  dry skin, and frequently of a  sallow
colour, from the want of a regular discharge of bile
from the liver, and its absorption into the blood.

   While  the alimentary canal is thus depressed,
and  the blood-vessels, nerves and muscles, robbed
of nearly all their excitement,  or possess it in
parts of the body only,  the lymphatic system is
often preternaturally excited ; hence we frequently
observe in  this disease a constant and increased
discharge of urine.

   The  characteristic symptom  of this form of
derangement, as it appears in the mind, is distress, 
  80           ON  THE DISEASES
  the causes of which are numerous,  and of a per
  sonal nature.   I shall enumerate some of them,
  as they have appeared in different people.   They
  relate, 1, to the patient's u#dy.  He erroneously
  believes himself to be afflicted with various dis-
  eases,  particularly  with  consumption,  cancer,
  stone,  and above  all, with impotence, and  the
  venereal disease.  Sometimes he supposes  himself
  to be poisoned, or that his constitution has been
  ruined  by  mercury, or that the seeds of  the hy-
  drophobia are floating in his system.

    2.  He believes that he  has  a living animal in
  his body.   A  sea  captain, formerly of this city,
  believed for  many  years  that he had  a  wolf in
  his liver.   Many persons have fancied they were
  gradually dying, from animals of other kinds prey-
  ing upon different  parts of their bodies.  3. He
u magines himself  to be converted  into an  ani-
  mal of another species, such as a  goose,  a cock,
  a dog, a cat,  a hare, a  cow,  and the like.   In
  this case  he  adopts the  noises and  gestures of
  the animals into which  he supposes himself to
  be transformed.
                           km

    4.   He  believes  he inherits,  by  transmigra-
  tion, the soul of some fellow creature,  but much
  oftener of a brute animal.   There is now  a mad- 
               OF  THE MIND.             81
                             y
man in the Pennsylvania Hospital who believes
that  he was once  a calf, and who  mentions  the
name of the butcher that killed him, and the stall
in the Philadelphia market  on which  his flesh
was sold previously to his animating his present
body.

  5. He believes he has no soul.   The late Dr.
Percival communicated to me,  many years ago,
an account  of a  dissenting minister in England
who believed that God had annihilated his soul
as a punishment for his having killed a high-way
man by grasping him  by the throat, who attempt-
ed to rob him.  His  mind was  correct upon all
other subjects.

  6. He believes  he  is transformed into a plant*
In  the  Memoirs of the Count  de Maurepas we
are told this error took possession of the mind of
one of the  princes of  Bourbon to such a degree,
that he often went and stood in his garden,  where
he insisted upon being watered  in  common with
all the plants  around him.

  7. The patient afflicted with this  disease some-
times fancies he is transformed into glass.
                       L 
82
ON
HIE  DISEASES
   8.  He  believes,  that  by discharging the con
tents of his bladder, he  shall drown the world.

 ;  9.  He believes himself to be dead.

   It  is worthy of  notice, in  all  these  cases  of   1
erroneous judgment, the patients reason correctly,
that is, draw just  inferences  from their  errors.   I
Thus the  prince of Bourbon,  when he supposed
himself to be a plant,  reasoned  justly  when  he
insisted upon  being  watered.  In  like manner,
the hypochondriac  who supposes himself  to  be
dead, reasons with the same correctness  when  he
stretches  his body  and  limbs upon a bed, or a
board, and  assumes the  stillness and silence  of
the  shroud.

   It is remarkable  further, that all the erroneous
opinions persons affected with this  form of de-
rangement entertain of themselves  are of a de-   ,
grading nature.

   But again.   The distress  of a hypochondriac
is  derived from errors  respecting, 1, his out-
ward circumstances as they relate to his property.

   2.  The conduct of his friends,  relations, or a
mistress. 
OF  THE  MIND.              83
  3. His birth place, and the society of his family,
when absent from them.

  4. The state of his  country.

  5. His spiritual state.

  The mind, in its distress from all the above caus-
es, is in a reverse state from that which was just now
mentioned,  in drawing erroneous,  or dispropor-
tionate, conclusions from just premises.  Thus the
hypochondriac who possesses an income which
he admits to be  equal to all the exigencies of his
family, reasons unjustly when  he anticipates end-
ing his days in a poor-house.   In like manner
the deranged penitent judges correctly when he be-
lieves that he has offended his Maker, but he rea-
sons incorrectly when he supposes he has exclu-
ded him  from his mercy.

  In the hypochondriasis from all the causes that
have been mentioned, the patients are for a while
peevish and  sometimes irascible.   The lightest
noises, such  as the grating  of a door upon its
hinges, or  its being  opened and shut suddenly,
produce in them anger  or terror.   They quarrel
with  their friends and  relations.  They change
their physicians and remedies, and sometimes they 
84           ON THE  DISEASES
discover the instability of their tempers by settling
and unsettling themselves half a  dozen times in
different parts of their native country, or different
foreign countries, in  the course of a few years,
leaving each of  them with  complaints of their
climate, provisions, and  the  manners of their in-
habitants.

   The hypochondriasis,  or tristimania, like most
other diseasi s, has paroxysms, and remissions or
intermissions,  all of  which  are  influenced  by
many  circumstances,  particularly by  company,
wine,  exercise, and, above all, the weather.

   A  pleasant season,  a  fine  day,  and even the
morning sun, often  suspend the  disease.   Mr.
Cowper, who knew all its symptoms by sad ex-
perience, bears  witness  to the truth  of this re-
mark, in one  of his  letters to Mr. Haley.  " I
rise,"  says he,  " cheerless  and  distressed,  and
brighten as the sun goes  on."  Its paroxysms are
sometimes  denominated  " low spirits."   They
continue from a day,  a week, a month, a season,
to a year, and sometimes longer.   The intervals
differ,  1, in being accompanied with preternatu-
ral high spirits. 2. In being attended with remis-
sions only;  and, 3,  with intermissions, or,  in 
OF  THE  MIND.
85
other words,  with correctness and equanimity of
mind.

  The  extremes of low  and high spirits which
occur in the same person, at different times, are
happily illustrated by the following case.  A phy-
sician in one  of the cities of Italy was once con-
sulted by a gentleman who  was much distressed
with a paroxysm of this intermitting state of hy-
pochondriasm.  He  advised him to seek  relief
in convivial company, and  recommended to him
in particular to find out a gentleman of the name
of Cardini, who kept all the tables in the city to
which he was occasionally invited in a  roar of
laughter.  "Alas! Sir,"  said the patient, with a
heavy  sigh,  " I am  that  Cardini."  Many  such
characters, alternately marked by high and low
spirits,  are to be found  in all the  cities in the
world.

   But there  are sometimes flashes of apparent
cheerfulness, and even  of mirth, in the intervals
of this  disease, which are accompanied with la-
tent depression of mind.   This appears  to have
been the case in Mr. Cowper: hence,  in one of
his letters to Mr. Hay ley, he says,  " I am cheer.
ful  upon paper, but the most  distressed of all 
86
ON  THE DISEASES
creatures."   It  was probably in  one of these op.
posite states of mind that he wrote his .humorous
ballad of John Gilpin.

   In the history of hypochondriasm,  as far as it
has been given,  there  is a combination of some
of the symptoms  of hysteria from the nervous
system being partially  or alternately in a strictum
or laxum, or, in other words, in an inirritable or
irritable state, and  from the  blood-vessels being
alternately in a diseased and sound state.

   This mixture of the symptoms of hypochon-
driasis and hysteria, in those two opposite states
of the system, is described with great accuracy in
the following letter  from a gentleman in Virginia,
which I received a  few years ago,  containing the
history of his own case.

                             January 25, 1808.
Sir,
   " I write to you to seek relief in a case of dis-
ease of the most inveterate, though not uncommon,
nature.   It is a  nervous affection of the most ob-
stinate kind.   An apathy and torpor of the bow-
els and stomach, and a susceptibility of the mind
exceeding all description: loss of sleep to an alarm- 
OF  THE  MIND.             87
ing degree at times, and the consequent debility,
despair, subsultus tendinum, and paralytic sensa-
tions in many parts of my  body, are the principal
evils I suffer.   My mind is liable to  be excited
by trifling and unsubstantial causes; disposed to
cleave to unpleasant usages,  to dwell on dreadful
consequences  from really  trifling circumstances,
to be  appalled  with  vain  apprehensions,  and to
cherish disgusts and disagreeable associations ; in-
deed,  to labour under a fixiditj£j}f ideas which
causes my misery.  I was attacked in the winter
1800 and 1801, and since that time have suffered
an immensity  of distress, with long intervals, how-
ever,  of capacity  for  enjoyment.  Moral causes
are the sources of my afflictions.  The barriers of
reason are cobwebs to oppose to the intrusion of
this host of enemies.   Am I in  a convivial com-
pany ? I think of  some unpleasant circumstance.
Do I eat heartily ? I still think ; my  mind  can-
not rise above its customary state  of feebleness.
When I lie  down, this fixed image  presents  it-
self.   I am distressed, alarmed,  my blood circu-
lates rapidly, my brain is fired, a train of distress-
ing ideas enter, and seize  my mind : I am, as it
were, all nerve; the least noise  is like a shock of
thunder, so that for seven  years I have been in
   IN    '                   *
the constant  habit of  stopping both cars  with
wax ; with intervals, however, of strength to bear 
88
ON  THE  DISEASES
 noise, and sometimes even I am, as I think, al-
 most well.  I am within a few days of forty-four
 years of age;  my appetite is always good ; I cat
 every thing, drink moderately of wine, have found
 no  good from any regimen,  though I have  not    i
 pursued any regimen but a very short time.

  "I go to bed, my mind is distressed, I get a lit-
 tle quiet, and perhaps I am disposed  to rest;  at
 the  moment of forgetfulness,  which  produces
 sound sleep, this image strikes my mind;  I know
 what I am to suffer, am alarmed; my blood rushes "
 through the jugular vessels ; 1 hear my heart beat,
 and feel it thumping the whole night; my mind on
 fire, able to pursue no train of pleasant thought a * ■
moment;  I  get worse ;  despair ;  think of nothing   j
 but  my wretched condition, till at last I lose  se-  J
 veral nights sleep;  my pulse is low and threaded,  1
and  at last nature makes an effort and  gradually  J*
restores me.  Such is almost always my course.   4

  "I can  assure you  that no cause of distress
vexes my mind in which my conscience or my
honour  is implicated,  or which would be  even
noticed by others.  If I could indulge in religious
duties and contemplations, to which  my  heart,
my judgment, and natural disposition would lead
me,  it would, I really believe, cure mc;  but pre- 
OF  THE  MIND.
89
vious to my first attack, near eight years ago,  in
a previous state of debility and nervous affection,
which pressed  hard on my  spirits,  I wished  to
read on religious subjects, until all at once impi-
ous and  profane ideas struck my mind:  my soul
recoiled, was  shocked; I tried  to banish them;
nothing  would  do;  not  a  moment were  those
ideas absent;  at lfast they seized so fast, that I
lost  many  nights and  days sleep;  and  I was
brought  near   the  grave.    I got better,  and
overcome, in some sort,  this immoral influence;
but shall never be able to  indulge as I wish in re-
ligious duties.   My heart often expands with en-
thusiasm, and  then I taste of the joys of heaven.
Now, Sir, can this dreadful state  of mind be cur-
ed ?  Can I be made to possess less feeling, and
more resolution to resist  moral influences on the
mind;  to bear vexatious  or distressing incidents;
and  to  break this  association,  this fixidity  of
ideas ?

   "My feet, particularly my left foot, are always
cold; and when I labour under great anxiety, both
 feet have, when warm in  bed, a sensation as if they
were asleep (as we say)  which is very distress-
ing.   My whole left side is affected more than  the
other ;  the  auditory nerve of my left ear is affect-
ed curiously, and unpleasantly, with sharp sounds, 
90
ON  THE DISEASES
as if a body touched the nerve: I cannot  well
describe it.

   "If I could be tranquil, I should be well. When-
ever I can be moved by ambitious prospects, or
entertain a desire for distinction, or any such pas-
sion,  I  am well.  This is  sometimes the case.
When hopes or wishes of this lort take possession
of my mind, they drive  out other impressions;
then I feel well.  Active employment, if I could
get in it,  would cure me, but I know of none.
When  I  feel well,  I am uncommonly  cheerful,
playful, and happy.

   "Now,  Sir, I beg you, in consideration of suf-
fering humanity, to  take  my  case  into  your
serious consideration, and extend to me the be-
nefit of your advice."

   In proportion as the hypochondriac disease ad-
vances, the symptoms of the hysteria, which are
generally combined  with  it in its first stage, dis-
appear, and all the systems  in which the  disease is
 seated  acquire  a uniformly torpid or inirritable
 state.    The    remissions   and   intermissions
 which haye been described, cease, and  even the
 transient  blaze of cheerfulness,  which  now and
 then escapes from a heart smothered with anguish, 
OF  THE  MIND.
91
is  seen no  more.  The  distress  now  becomes
constant.   " Clouds  return  after  every  rain."
Not a  ray of comfort glimmers upon the soul in
any of the prospects or retrospects  of life.   "All
is  now darkness  without and within."  These
poignant words were once uttered by a patient of
mine with peculiar emphasis,  while labouring un-
der this stage of the disease.   Neither nature nor
art now  possess  a single beauty,  nor  music or
poetry a single charm.  The two latter often give
pain, and sometimes offence.   In vain do love
and friendship, and domestic  affection, offer sym-
pathy or relief to  the mind in this awful  situation.
Even the consolations of religion are rejected, or
heard  with  silence and indifference.   Night no
longer affords a respite from  misery.   It is pass-
ed in distracting wakefulness, or in dreams more
terrible than  waking thoughts; nor does the light
of the sun chase away a single  distressing  idea.
"  I rise  in the morning," says Mr. Cowper, in a
letter to Mr. Haley, " like an infernal frog out of
Acheron, covered with the ooze and mud of me-
lancholy." No change of place is  wished for that
promises any alleviation of suffering.  " Could I
be translated to paradise," says the same elegant
historian of his own sorrows, in a letter to Lady
Hesketh, " unless I could leave my body behind
me, my melancholy  would cleave to me  there." 
 92            ON  THE  DISEASES
   But the last and worst stage of this form of de-
 rangement  remains yet  to  be described.  After
 it has completely put off all its hysterical symp-
 toms, the patients fly for relief to  such stimuli as
 act upon the  body, in order to counteract the in-
 supportable pressure of distress upon their minds.
 They take snuff,  or  chew  tobacco.   They eat
 voraciously, and drink wine and  spirits, or take
 laudanum,  in large quantities, when they are able
 to procure them.   Sometimes the pain of a bodily
 disease suspends for  a  short  time their  mental
 distress.  Mr. Boswell, in his life  of Dr. John-
 son, relates a  story of  a London tradesman, who,
 after  making  a  large  fortune, retired  into  the
 country  to  enjoy it.  Here  he became  deranged
 with hypochondriasis,  from  the want of employ-
 ment.   His existence became  finally a burden to
 him.   At length he was afflicted w ith the stone.
 In a severe paroxysm of  this  disease,  a friend
 sympathised  with  him.  "  No,  no,"   said  he,
 " don't pity me, for what I now feel is ease, com-
pared with that torture of mind from which it re-
lieves me."   A woman in this city bore a child
while she  was afflicted with  this disease.   She
declared, immediately afterwards, that she felt no
more  pain from parturition, than from  a trifling
fit of the colic.  Where counteracting  pains of
the body arc not induced by nature or accident, 
OF  THE  MIND.             93
to relieve anguish of mind, patients often inflict
them upon themselves.  Walking barefooted over
ground covered with frost and snow was resorted
to by a clergyman of great worth in England for
this  purpose.  Cardan, an eminent physician  of
the fifteenth century, made it a practice to bite his
lips  and one of his arms, also to whip his legs with
rods, in  order to ease  the distress of his mind.
Kempfer tells us that prisoners in  Japan,  who
often  became partially  deranged  from  distress,
used to divert their mental anguish by  burning
their bodies  with  moxa.   The same degree of
pain, and for the  same purpose, is often inflicted
upon the body, by cutting and mangling it in parts
not  intimately connected  with  life.   But bodily
pain, whether from an accidental disease, or inflict-
ed by the patients upon themselves, is sometimes
 insufficient  to predominate over the distress of
 their minds.   Dr. Heberden mentions an instance
 of a man who  was naturally so  much  afraid of
 pain that he dreaded even being  bled, who in a
 fit of low spirits  cut off his penis and scrotum with
 a razor, and declared, after he recovered the natural
 and healthy state of his mind, that he felt not  the
 least pain from that severe operation.   A similar
 instance of insensibility to bodily pain is related by
 Dr. Ruggieri, an Italian physician, of a hypochon-
 driac madman of the name of Loval, who fixed 
 94            ON  THE  DISEASES
 himself  upon  a  cross, and inflicted the  same
 wounds upon himself, as far as he was able, that
 had  been inflicted upon our  Saviour.   He was
 discovered in this situation, and taken down  alive.
 During the  paroxysms of his madness, he felt no
 pain from dressing his wounds, but complained as
 soon as they were  touched,  in the intervals of his
 disease.  But this is not all.   Hypochondriac dis.
 tress seeks relief in an evil still greater than  bodi-
 ly pain.  Can any thing be anticipated more dread-
 ful  than universal madness ? and  yet I once at-
 tended a lady in this city, whose sufferings  from
low spirits were of such a nature, that she ardently
 wished she might  lose her reason, in order there-
by   to  be  relieved  from  the  horror  of her
 thoughts.   This state of mind  was not  new in
 this disease.   Shakspcare has described  it in the
following lines, in  his inimitable  history of all the
forms  of derangement,  in  the  tragedy of  King
Lear.  They are as truly philosophical, as  they
are poetical.

  --------"Better I were distract;
  So should my thoughts be scver'd from my griefs,
  And woes, by wrong imaginations, lose
  The knowledge of themselves." 
OF  THE  MIND.
95
  But the most awful symptom of this  disease
remains yet to be mentioned, and that is despair.
The marks of the extreme misery included in
this word are sometimes to be seen in  the coun-
tenances   and gestures  of hypochondriacs in a
Hospital; but as it is difficult to obtain from such
persons a history of their feelings, I shall en-
deavour to give some idea of them in the follow-
ing account, communicated to me by a clergyman
who  passed four years and a half in that state of
mind.

   He said " he felt the  bodily pains and mental
anguish of the  damned ;  that he slumbered only,
but never slept soundly, during the long period
that has been mentioned; that he lost his appetites,
and passions, so  as to desire  and relish nothing,
and  to love and  hate no one ; that his feet were
constantly cold,  and the upper  part of his body
warm ; that he lost all  sense of years,  months,
weeks, days, and nights,  and even of morning
 and  evening;  that in this respect, time  was to
him,  no  more."  During the  whole period of
 his misery, he kept his hands in constant motion
 towards  his head and  thighs,  „and ceased  not
 constantly to cry out, " wretched mail, that I am!
 I am damned; oh, I am damned everlastingly." 
96
ON  THE DISEASES
   Terrible as  this picture of despair is, the dis-
 ease has symptoms which mark a still greater de-
 gree of misery.  It sometimes creates such a dis-
 gust of life, as to make  the subjects of  it wish to
 die.   How undescribable, and even incomprehen-
 sible,  must be that state of mind, which  thus ex-
 tinguishes the deep  seated principle of the love
 of life!   In the exquisite  tortures  of the  stone,
 and colic, and even  under the progress  of an ex-
 cruciating and  mortal cancer,  men are willing,
 nay anxious, to  live;  of course the sufferings from
 the anguish of  mind I have  described, exceed
 the sufferings from those diseases.   But there is
 a symptom  of despair which  places its horrors
 beyond a  mere wish  to die.   It often drives the
 distracted subject  of it  to precipitate  the  slow
 approaches of death  with his own hand.  A pis-
 tol, a  nzor, a river, a mill-dam, a halter, or  laud-
 anum, are the means  usually resorted to for this
 purpose.   Sometimes  the instruments  of death
 are of a more  painful nature.   I  have once seen
 the body of a Russian officer mangled with thirteen
 wounds  inflicted by himself.   He had fallen into
 despair in consequence  of debts  contracted in a
4breign country.   Sometimes  a horror is enter-
 tained  by0 persons  in  this  situation at  the
 crime  of suicide,  but, in  order to escape  from
 life, they  provoke death from the  hands of go- 
OF  THE  MIND.
97
vernment by committing murder;  many instan.
ces of this kind are to be met with, not only in
the records of medicine, but in our public news-
papers.   Dreadful as this state of mind  is', there
is one still more  distressing, and that is the de-
sire, and fear of death operating alternately upon
the mind.  I have  seen this state of hypochon-
driasm.  It  was  in  the  lady who wished to  be
relieved from the horror  of her thoughts by the
complete loss of her reason.

   After the  history that has been given of the
distress, despair,  and voluntary death,  which are
induced  by  that partial derangement which  has
been  described, I  should  lay down my pen, and
bedew my paper  with my tears,  did I not know
that the science of medicine has furnished a reme-
dy for it, and  that  hundreds are now alive, and
happy, who were once afflicted with it.   Blessed
science!   which thus  extends its  friendly em-
pire,  not  only over the evils of the bodies, but
over those of the minds, of the children of men!
N
/ 
wtf
0.*i  THE DISEASES
              CHAPTER  IV.

 Of the Remedies for Hypochondriasis or Tristi-
                    mania.

 1 HE remedies for this form of derangement di-
 vide themselves  into two classes.

   I. Such as are intended to act directly  upon
 the body;  and,

   II. Such as are intended to act indirectly  upon
 the body, through the medium of the mind.

   I. Before we proceed to administer the remc.
 dies that are indicated under our first head, it will
 be proper carefully to review  the history of all the
 remote and exciting causes of this  disease,  and,
 when possible, to remove them.  If this be im-
 practicable, or if the disease  continue from  habit
after all its causes have been removed, recourse
 should be had to, 
OF  THE  MIND.
99
   1. Bloodletting, if the pulse be tense, or
full; or depressed,  without either fulness, or ten-
sion.   I have prescribed this remedy with success,
and thereby in several instances suddenly prepar-
ed the way for its being cured in a few days by
other medicines.   I was led  to use  it by the fol-
lowing fact, communicated to me by the late Dr.
Thomas  Bond.   A preacher among the Friends
called  upon him, to consult him in this state of
madness.   He said  he was  possessed of a devil,
and that he felt him constantly in aches and  pains
in every part of his body.   The Doctor felt his
pulse, which he found  to be full and tense. He ad-
vised him to sit4down in his parlour, and persuaded
him to let him open a vein in his arm.  While the
blood was flowing the patient cried out, "lam re-
lieved, I  felt the devil fly out of  the orifice in
my vein as soon as it was opened."  From this
time he recovered rapidly from his  derangement.
The advantages of bleeding  are evinced still fur-
ther by the relief obtained in this disease by the
loss of blood from the hemorrhoidal vessels, and
by other accidental haemorrhages.   But, if expe-
rience had not thus established the efficacy of this
remedy, its use would be suggested by the habits
of such  patients, of indulging their appetites, not
only to satisfy hunger, but to suspend their dis-
tress ;  and by congestions  of blood in the liver 
100          ON  THE DISEASES
 and spleen, which usually  take  place in this dis-
 ease.  After bleeding, if it be required,

   2. Purges  should be given.  They arc indi-
 cated by the obstructions of  the viscera, and tor-
 por of the  alimentary canal.   They often bring
 away black bile, and  sometimes  worms.  The
 more active purges, particularly aloes, jalap, and
 calomel, should be preferred in this disease.  The
 daughters of Przetus, who supposed themselves to
 be cows, were cured by Melampus by means of
 hellebore, which is  of a purging nature.   The
 medicine has ever since bore  his name.

   3. Emetics, by exciting the stomach, often re-
 move  morbid  excitement  from  the brain,  and
 thus restore the mind to its healthy state.   They
 moreover assist purges in exciting the alimentary
canal, and in dislodging obstructions from the ab-
dominal viscera.

   4. A reduced diet, consisting of food and
drinks that contain but little nourishment should
be  combined with the three  remedies that have
 been mentioned.  As  the  stomach is frequently
in a dyspeptic state, the aliment and drinks should 
OF  THE  MIND.            101
consist of such articles as are least disposed to in-
crease or produce a morbid acid in it.

  After reducing the action of the blood-vessels to
a par of debility with the nervous system, or, to bor-
row an allusion from a mechanical art, after plumb-
ing those two systems, the remedies should con-
sist,

  5.  Of stimulating  aliment, drinks and
MEDICINES.

   The diet should consist  of solid animal  food,
with such vegetables as  are least disposed to aci-
dity, and both should be  rendered palatable by
condiments.  The drinks  should consist of old
Madeira or sherry wine, and porter diluted with
water, or taken alone, provided the  stomach be
not  affected with  a morbid acid.  I  have once
known this disease cured  by the liberal use of
Madeira wine. In some  cases, old claret is better
received by the  stomach  than  the white wines,
from its containing  less fermentable  matter in it.
 The drinks should be taken warm, for the stomach
 is generally too weak to react under  the sedative
 operation of such as are cold. Warm  tea and cof-
 fee, made weak, are generally grateful to the sto-
 mach, and should be advised, when it  is not affect- 
 102          ON THE  DISEA31 .,
 ed with dyspepsia.  The  celebrated Mr. Burke
 often relieved the low spirits which were  induced
 by the solicitude and vexations of his  political
 life, by sipping a tea-cup  full  of hot water.   In
 cases of  dyspepsia,  or indigestion, as little drink
 as possible should be taken with food.  The me-
 dicines proper in this disease should be the differ-
 ent preparations of iron.   I know they have been
 said to be hurtful in it.   It is true they are often
 ineffectual, but this is because the system is re-
 duced below their stimulus in their ordinary doses.
 When given in large doses, mixed  with  ginger,
 or black  pepper,  and the common bitters of the
 shops, and persisted in  for several months,  they
 are powerful medicines.  Tar, in the form  of pills,
 or infused in  water, and garlic in  substance,  or
 infused in pepper-mint tea, afford great relief in
 this disease, more especially when the stomach is
affected.    Magnesia, lime-water and milk, and
 the alkaline salts, should be given  to relieve aci-
dity in the stomach, should that symptom of dys-
pepsia call for them.  Assafoetida is an excellent
medicine  in  this depressed state of the  system,
 and preferable to any of the common foetid gums
that are in use to exhilarate the spirits.  But our
principal  reliance for this purpose should be upon
opium. Mr. Cowper says, ten drops of laudanum,
 taken occasionally, saved him  from being " dc- 
OF THE  MIND.
103
voured by melancholy."  This noble  medicine,
which has been  happily  called "the medicine
of the mind,"  has many advantages over ardent
spirits as  a cordial.  It affords more prompt re-
lief ; and a habit of attachment to it is more slow-
ly formed, and more easily broken.  It does not
pollute the breath, nor does it ever tend to excite,
or increase that hysterical irritability  of  temper
which is sometimes  connected  with  this disease.
However useful ardent spirits may be in transient
diseases, they cannot be used  in such as are of a
chronic nature, without inducing such a fondness
for them as  not  only to prevent their acting as
remedies, but to convert them into poisons, often
alike  fatal to  the soul and body.

   6.  The warm  bath, applied in  the form of
water, or vapour, and rendered more stimulating,
if necessary,  by the addition of saline or aromatic
substances to it.   The heat of the water should be
a little above that of the body.   It does most ser-
vice when it induces sweats.   Mr.  Cowper was
always relieved by that discharge from his skin.

   7.  The cold bath.  This remedy should not
be advised until the  system has been prepared for
it by the previous use of the  warm bath. 
104
ON
THE DISEASES
    8. Frictions to the trunk of the  body and
  limbs.  These tend very much to excite the cu-
  taneous extremities of the nerves and blood-ves-
  sels, and thus to equalize the excitement of the
  system.  I  have known two instances in which
  a recovery from this disease succeeded an attack
  of the itch.  The remedy in this case was proba-
  bly the pleasurable sensation  excited by scratch-
 ing, in order to relieve it.

   9. Exercise, especially upon horseback.  La-
 bour is still more useful,  particularly in the open
 air.

   10. The  excitement of pain.  I mentioned
 the accidental effects of the pain of a stone in the
 bladder, and of  burning  moxa on the body, in
 suspending anguish' of mind in the history of  this
 disease.   It may be excited in  various ways.
 Mustard to the feet is generally sufficient for this
 purpose.  I once attended a gentleman from Bar-
 badoes, who suffered great distress of mind from a
hypochondriac  gout which floated in his nerves
and brain ; but no sooner did the gout fix, and ex-
cite pain in his hands or feet,  than he recovered
his spirits, and became pleasant and agreeable to
all around him. 
OF THE  MIND.
105
  11. Salivation.  Mercury acts in this dis-
ease, 1,  by  abstracting morbid  excitement from
the brain to the mouth.  2, By removing visceral
obstructions.  And, 3, by-changing the cause of
our patient's complaints, and fixing them  wholly
upon his sore mouth.  The salivation will  do still
more service if it excite some degree of resentment
against  the  pntient's physician or friends.  The
effects of mercury in this disease, have sometimes
been compared to those of a handful of shot shaken
in a bottle,  lined with filth and  dirt, in order to
clean it.  It stimulates every part of the body,
renders  the  vessels  pervious  to their  natural
juices, conveys morbid action out of the body by
the  mouth, and thus restores the mind to its na-
tive seat in the brain.

   12. Blisters and issues  have  been found
 useful in this form of madness.   They are calcu-
 lated to excite the action of the  skin, and  to pro-
duce what has been happily called a centrifu-
 gal direction of the fluids.   They are more par-
 ticularly indicated, if the disease have  been indu-
 ced by eruptions  repelled from  the skin.

    II. We  come next in order  to mention  the
 remedies for the body,  which are intended  to
 act through the medium of  the mind. The
                       o 
106          ON THE DISEASES
first thing to be done by  a physician, under  this
head, is to treat the disease in a serious manner.
To consider it in any  other light, is  to renounce
all observation in medicine.   However erroneous
a patient's opinion of his case  may  be, his  dis-
ease is a real one.   It will be necessary, therefore,
for a physician to listen with attention to his tedious
and uninteresting details of  its symptoms  and
causes. In some cases, patients wish to think their
diseases are trifling, and attended with no danger,
but in hypochondriasis, they  are  always  Ivst
satisfied in believing their disease  to be difficult
and dangerous.  A  physician  should  carefully
avoid  likewise speaking  lightly of his patient's
disease to his friends  and neighbours,  for   he
will take uncommon  pains to discover, from
them, his opinion of his  case, and if it be differ-
ent from  that which has been given to him,  he
will not only reproach him with a want of can-
dour, but will immediately seek relief from ano-
ther physician.  I once knew an instance of  this
kind in this city.   The patient refused to see the
physician  afterwards, who had thus  deceived him.
In  the worst  grade of this  disease,  he will  not
bear contradiction, and  hence  it will be  neces-
sary to conform our remedies as much as possi 
OF  THE  MIND.
107
ble to his erroneous opinions of the  nature  of
his disease.   If he believe himself to be affected
with any of the diseases that were formerly named,
medicines must  be prescribed for them, and ad-
ministered in a  manner calculated to  act upon
his principle  of  faith, and to beget his confidence
in them.  In the more moderate  grade of his
errors upon the subject of his disease, contradic-
tion,  and reasoning, may be opposed  to  them.
When  these  means  are employed,  the conduct
of a  physician  should  correspond with  them.
I  once injured myself, and my patient,  who sup-
posed himself to be affected with  the venereal
disease, by  prescribing for  him a few mercu-
rial  pills, in compliance  with his earnest solici-
tations,  after having assured him  that he  had
not a  particle  of  its  virus in his system.   I
have in several instances  removed all  doubt up-
on the subject,  by  advising matrimony, or a re-.
newal of conjugal intercourse, if my patients were
 married, and by offering them at  the  same time
 a bond for a large sum of money, if any bad con-
 sequences should follow their obedience to my
 advice. In  this  way I  have made  many gentle-
 men  happy, and never in  a single instance in-
 curred the least discredit or  blame. 
108
ON  THE DISEASES
  Persons afflicted with this form of derangement,
I said formerly, now and then believe themselves
to be poisoned.   In  this case it is sometimes ne-
cessary to humour their error,  and  to  prescribe
suitable means to remove it.  Dr.  Cox, in his
Treatise  upon Insanity,  has furnished us with an
excellent precedent for this  purpose.  A gentle-
man in England  supposed a shirt which he  had
worn had been poisoned by his maid, and deter-
mined  to subject her to  the  punishment of the
law.  His physician  humoured his belief and re-
sentment, by  pretending to have discovered a
poisonous matter  in his  shirt, by  means of some
chemical experiments upon it, and concurred with
him in prosecuting his maid  for an intended mur-
der.  A  new  course was hereby  given to his
thoughts, and a new action excited in his brain, by
which he was perfectly cured.

  Terror once cured, for a while, a patient of mine,
of a belief that he  had been poisoned by taking ar-
senic as a medicine,  and that it had eaten out his
bowels.  A student of medicine,  to  whom  he
told this tale, attempted to convince him  of his er-
ror, upon which he begged him to open him, and
to satisfy himself  by examining the cavity of his
belly.  After some preparation,  the  student  laid
him upon a table, and drew the back of a knife 
OF  THE  MIND.
109
from  one extremity  of  his  belly to the other.
" Stop, stop," said my patient, " I've got guts,"
and suddenly escaped from the hands of his ope-
rator.   His cure would probabh have been dura-
ble, after the use of this remedy, had not real dis-
tress from another cause brought back that which
was imaginary.

   If our patient imagine he has a living animal in
his body, and he cannot be reasoned out of a be-
lief of it, medicines must be given to destroy it;
and if an animal, such as he supposes to be in his
body, should be secretly conveyed into his close
stool,  the deception  would be a justifiable one,
if it served  to cure him of his disease.

   If  our patient should believe  himself to  be
transformed into an animal of another species by
transmigration, or in  any other way, our remedies
should be accommodated to the grade of his mad-
ness, and the  nature  of the animal into which he
supposes himself to  be changed.  Ridicule has
sometimes been employed with success  in such
cases.  Mr.  Pinel  mentions an instance of its
sudden efficacy in curing a watch-maker in Paris,
who  believed that his head had been cut off, and
that he carried the head of a man who had been
guillotined, instead of his own. 
110          ON  THE DISEASES
  A physician, formerly of this city, used  to di-
vert his friends, by  relating the history of a cure
which' had been  performed  of a patient  in this
form  of madness, who believed himself to be  a
plant.   One of his companions, who favoured his
delusion, persuaded him he could not thrive with-
out being watered, and while  he made the patient
beli ve, for some  time, he was pouring water from
the spout of a tea-pot, discharged his urine upon his
head.  The remedy in this case was resentment
and mortification.

  Cures of patients, who suppose themselves to be
glass, may easily be  performed by pulling a chair,
upon  which  they are about  to  sit, from  under
them, and afterwards showing them a large col-
lection of pieces of glass as the fragments of their
bodies.

  An unwillingness to discharge  the contents of
the bladder, from the cause that has been mention-
ed,  was once cured by persuading the patient that
the  world was on fire, and that nothing but his
water would extinguish it.  This error was cured
by Dr. Ferriar by means of an emetic, which, by
its action upon the stomach, destroyed the com-
mand of the patient's will over the spincter of the
bladder. 
OF  THE  MIND.
Ill
  I have heard of a person afflicted with this dis-
ease, who supposed himself to be dead, who was
instantly cured by a physician proposing  to his
friends, in his hearing, to  open his body, in order
to discover the cause of his death.

  In all the  cases that have been  mentioned, of
error and distress which  relate to the body only,
similar advantages would probably  arise from ex-
citing fear or anger,  or any other powerful emo-
tion of the mind.

   I attended a young man in the year 1806,  who
 cherished an obstinate hypochondriac belief,  after
 his recovery  from the  autumnal  fever,  that he
 should die, and felt at the same time a great dread
 of death.   I  assured him over and over  that he
 was in no danger, but without being able to in-
 spire him with the least  expectation of life.   In
 one of my visits to him,  I asked him, upon enter-
 ing his room, how he was ;  «' very bad,"  said he,
 and repeated  his belief  that he should soon die.
 His nurse,  who sat by  him,  added, that he had
 fixed upon   an hour in  the approaching night as
 the time for his dissolution.  After pausing a few
 moments, I asked him if I should send a joiner to
 measure him for his coffin.   This question in-
  stantly gave a new current to his feelings, and from 
112
ON  THE DISEASES
that time  he recovered rapidly ; nor did he ever
mention an apprehension of d\ing to me, in any
of my subsequent visits to him.  Aneyr had uni-
formly the same  beneficial effects upon a gentle-
man in Maryland, who, when in health, wis  ac-
customed to speculate upon controxcrted subjects
in religion.  There was an opinion  held by one
sect of Christians, which he held in great abhor-
rence.   His friends,  who  knew this, always con-
trived, when they saw him unusually dejected, to
provoke a controversy  with him upon the subject
that was hateful to him.  It never failed to rouse
his resentment, and thereby to banish, for a while,
a paroxysm of his disease.

   If debt be  the  cause of our patient's disease,
wc may presume it has been incurred with a clear
conscience,  and a fair character, for a  dishonest
man seldom feels distress enough from  this cause
to bring on disease.   In this case we must advise
our patient to take the benefit of our insolvent and
bankrupt laws.  Many men have been thus saved
from a miserable death, and restored to health, and
usefulness to their families and society.

   If the disease has been induced by the suppos-
ed or  real ingratitude, neglect,  or  ill  usage of
friends or relations, there are two modes of treat- 
OF  THE  MIND.
113
 ing it; one consists in advising  forgiveness,  or
 contempt of the injury ;  the other,  in exciting a
 moderate degree of anger against the persons who
 have offended or injured our patients.  This an-
 ger,  by its stimulus, counteracts  the depression
 both of the body and mind.  It should be carefully
 guarded from venting itself in acts of malice  or
 revenge.

   If the disease be induced by nostalgia, or what
 is called home-sickness, the patient should be ad-
 vised  to  visit  his native country.  It was once
 cured by this means in a Welsh soldier in the Bri-
 tish army.   When  this remedy  cannot be  em-
 ployed, it should be opposed, by exciting a pow-
 erful or active counter passion.  In the year 1733
 general Praxin led a Russian army  to the banks of;
 the Rhine.  At this remote distance from their
 native country,  five or six  soldiers became unfit
 for duty every day from home sickness.  The ge-
 neral issued an order  to bury alive all who were
affected with it.  This punishment was inflicted
in two or three instances, in consequence of which
the disease instantly disappeared from the army.
Fear, excited by a far less cruel remedy, I have
no doubt would have  had the same effect,
                       F 
114          ON  1HE  DISEASES
   The remedies for this disease, when brought on
by disappointed love, and by grief, shall be men-
tioned,  when  we come  to treat of the cure of the
diseases of the passions.

   It will  naturally occur to the reader  that the
three last  causes of hypochondriac madness will
be concealed by a patient from the knowledge of
a physician. But the}  must be extorted, by direct
or  indirect  means, or  the  appropriate remedies
cannot be employed to  remove their hurtful influ-
ence upon the system.

   If the derangement of our patient has been in-
duced by  the real or supposed distresses of his
country, it will be proper to advise him to avoid
reading news-papers, and conversing upon political
subjects, and  thereby to acquire a total ignorance
of public events.  But  if he object to this reme-
dy, he  should be  advised to take  a part in  the
disputes which divide  his  fellow  citizens.   In
favour of  this  conduct, I shall  mention a single
fact.  There  was  a form of  this disease,  well
known  during the revolutionary  war in several
of the states by the names of the tory rot, and the
protection fever.   It was  confined exclusively to
those friends of Great Britain, and to those timid
Americans, who took no public part  in the war. 
OF  THE  MIND.
115
Many of them died of it, but not a single whig
nor royalist, who took an active part in the revo-
lution, was affected with  it.   This was the more
remarkable, as many of them lost their fortunes
and former rank  in society, by their exertions in
support of the principles and measures to  which
they had devoted their passions or their  lives.  By
eating garlic, we  become insensible of the breath
of persons that has  been rendered offensive by it.
In like manner, by imbibing a portion of party
spirit, we become insensible of the vices and fol-
lies of our associates in politics, and  thus dimi-
nish more or less than one half (according to the
number of our party) this  source of  hypochon-
driacal derangement.   Happily for our citizens,
the disease that has been named has passed away
with  the events of  the American revolution, and
from the general  operation of the above remedies,
as well as from causes formerly mentioned, it has
rarely been succeeded by any other form of politi-
cal hypochondriasm in the United States.

   If the disease be derived from a sense of guilt,
it is generally connected  with ignorance, or erro-
neous opinions in religion.  The former must be
removed,  by advising  the visits of a sensible and
enlightened clergyman.   The latter consist, gene-
rally  in our  patient's  believing one or  both the 
 116          ON THE DISEASES
 foPonring errors : 1.  That he is excluded from the
 divine mtrcv by an irreversible decree of the  Su-
 preme Being,  or, in  other  words, that  he  was
 created on  purpose to be made miserable for ever.
 The second error believed by our  patient  is,  that
 he has committed the unpardonable sin.  To the
 first error we  may  reply, that there  is no pagan
 opinion more  contrary to nature and reason,  and
 to the whole tenor,  as well  as  to  the  most con-
 sistent interpretations, of the Scriptures, than the
 doctrine  of men being  called into existence  on
 purpose  to endure  the  pains of eternal misery.
 To the second error we  may reply,  that no  two
 divines agree  in  what constitutes the unpardona-
 ble sin;  that many wise and good  men believe it
 is not possible to commit it, in  the present state
 of the gospel  dispensation,  and  all divines agree
 that  "no man had committed it, who was afraid ^4
 he had."   It is of consequence to a physician, to
 be fully  prepared upon the subjects of  the  two
 errors that I have named, for they  are the  two
 principal causes of religious  hypochondriasm.

  In  the application of all these remedies to the
 mind, it is of consequence to know that there
 are  acquiescing,  reasoning,  contradicting,  and
 rediculing points in this disease, above which they
respectively do  harm, and  below  which  they ;4
 are  of no efficacy.                                ^m 
OF  THE  MIND.             117
  In all cases it will be proper to seduce patients
from conversing upon their  disease.   " Conver-
sation upon melancholy," says Dr. Johnson, "feeds
it;" for  which reason he advises his friend Bos-
well, who was subject to it, " never to speak of
it, to his  friends, nor in  company."

  There  are several other remedies which act up-
on the body through the medium of the  mind,
and that  are proper,  in this disease  from  atl its
causes.   The first of these is, the destruction
of all old  associations of ideas.  Every thing a hy-
pochondriac patient sees or  hears, becomes tinc-
tured  with some sad  idea of his disease.  Hence
the  same objects and sounds never fail of renew-
ing the remembrance of it.   Change therefore his
dress, his room, his habitation, and his company,
as often as possible. A gentleman in South Caro-
lina used to cure himself of a fit of low spirits
by  changing his clothes.  Even change his per-
son as much as possible.  Long nails, a long beard,
and uncombed hair, often become exciting cau-
ses  of a paroxysm  of this disease.   They should
therefore  be carefully prevented or removed.

  2.  Employment, or business of some kind.
Man was made to  be active.  Even in paradise
he was employed in the healthy and  pleasant ex- 
118
ON  THE DISEASE6
 ercises of cultivating a garden.  Happiness, con-
 sisting in folded arms, and in pensive contempla-
 tion, beneath rural shades, and by the side of purl-
 ing brooks, ■never'had any existence, except in the
 brains of mad poets, and love-sick girls and boys.
 Hypochondriac derangement has always kept pace
 with the inactivity of body and mind which follows
 wealth and  independence in all countries.   It is
 frequently induced by this cause in those citizens,
' who retire,  after  a busy life, into the country,
 without carrying with them a relish for agriculture,
 gardening, books, or literary society.

   Building,  commerce,  a public employment, an
 executorship to a will; above all,   agriculture,
 have often cured this disease.   The last, that is,
 agriculture,  by agitating the passions  by alternate
 hope, fear, and enjoyment, and by rendering bodi-
 ly exercise or  labour necessary, is calculated to
 produce the  greatest benefit.   Great  care should
 however be taken, never to advise  retirement to a
 part  of the country  where good society cannot be
 enjoyed upon  easy terms.

   In those  cases  in which  the body cannot  be
 employed, the  mind should  be kept constantly
 busy. Mr. Cowper often relieved his  melancholy
 by reading novels.   Hence he  has well said, 
OF  THE  MIND.
119
      " Absence of occupation is not rest.
      A mind quite vacant is a mind distrest."

  I knew a lady in whom this disease was brought
on by a disappointment in love, who cured her-
self by translating Telemachus into English verse.
The remedy  here was,  chiefly, constant employ-
ment.

  Dr. Burton, in his Anatomy of Melancholy, de-
livers the following direction for  its cure: "Be
not idle; be  not solitary."  Dr. Johnson has im-
proved this advice  by the following commentary
upon it.   " When you are idle, be not solitary;
and when you are solitary, be not idle." The illus-
trious  Spinoia, upon hearing of the death of  a
friend, inquired of  what  disease he died ? " Of
having nothing to do," said the person who men-
tioned it.  " Enough," said Spinoia, " to kill  a
a general."  Not only the want of employment,
but the want  of care,  often increases,  as  well as
brings on this  disease.   This was exemplified in
the two instances, formerly mentioned, of suicide
 being induced by situations in which the heart
 wished and cared for nothing.

   Concerts, evening parties,  and the society  of
 the ladies, to gentlemen affected with this disease, 
120          ON  THE  DISEASES
  have been useful. Of the efficacy of the last, Mr.
  Green has happily said,
      " With speech so sweet, so sweet a mcin,
      They excommunicate the spleen."

    3.  Certain  amusements.  Those  should
 be preferred, which, while they interest the mind,
 afford exercise to the body.  The chase, shooting,
 playing at quoits, are all useful for this purpose.
 The  words of the poet, Mr. Green,  upon this
 subject, deserve to be committed to memory by
 all physicians.
     " To cure the mind's wrong bias, s/ileen,
     Some recommend the bowjing green
     Some hilly walks—all, exercise,
     J ling but a stone—the giant dies."

 Chess, checkers, cards, and even push-pin, should
 be preferred to idleness, when the weather forbids
 exercise in the open  air.   The theatre  has often
 been resorted to, to remove fits of low spirits; and
 it is a singular fact,  that  a tragedy oftener dissi-
pates them than a  comedy.   The remedy, though
distressing to persons  with healthy minds, is like
the temperature of cold water to persons benumb-
ed w ith  frost; it  is exactly proportioned to the
excitability  of their minds,  and  it not  only ab- 
OF  THE  "&1IND.
121
stracts their attention from themselves,  but even
revives their spirits.

  A female patient of mine, in whom this disease
had several  times been excited by family afflic-
tions,  lost a favourite child in November 1811,
which produced  many of its s\ mptoms.  Soon
afterwards her husband became sick. The lighter
and dissimilar distress occasioned by this event
suddenly  removed her disease, and she  regained,
with the recovery of her husband, her usual health
and spirits.   Mirth,  or even cheerfulness, when
employed as remedies in low spirits, are like hot
water to a frozen limb.   They are disproportion-
ed to the excitability of the mind, and,  instead of
elevating,  never  fail to  increase its  depression,
or to  irritate it.   Mr.  Cowper could  not bear to
hear his  humorous story  of John Gilpin read to
him in his paroxysms of this disease.    It was to
his  " heavy heart,"  what Solomon happily com-
pares to the conflict  produced by  pouring vinegar
upon nitre, or in other words, upon an alkaline salt.

  Certain objects, distinguished for their beauty
or grandeur, often afford  relief in this disease.
Mr. Cowper experienced a transient elevation of
spirits, from contemplating the ocean  from the 
 122          ON  THE DISEASES
 house of his friend Mr. Haley; and the unfortu-
 nate  Mrs. Robinson  soothed  the  gloom of  her
 mind, by viewing the dashing of the waves of the
 same sublime object, by the light of the moon,
 at Brighton.  Certain  animals  suspend  the an-
 guish of mind of this disease  by their innocence,
 ingenuity or  sports.   Mr.  Cowper sometimes
 found relief in playing with three tame hares, and
 in observing a number  of leeches  to  rise and fall
 in a glass with the  changes in the weather.   The
 poet says,

     " Laugh and be well.  .Monkeys have been
     Extreme good doctors for the spleen.
     And kitten—if the humour hit,
     Has harlequin'd away the fit."

   The famous Luther was cheered under his fits
 of low spirits by listening to  the prattle, and ob-
 serving the  sports and  innocent countenances of
 young children.   The  tone  of  their voices is
 probably a source of a part of the relief derived
 from  their company.   Mr. Cowper was always
 exhilarated by conversing with Mr. Hay ley's son,
 only  because he was pleased with  the  soft and
 musical  tones of his voice.

   4.  Music has often afforded great relief in this
disease.  Luther, who was sorely afflicted with it, 
                OF  THE  MIND.            123
has  left  the following  testimony  in its  favour.
" Next to Theology, I  give  the highest place to
music, for thereby all anger is forgotten; the devil,
also melancholy, and many tribulations and evil
thoughts are driven away."  For the same reason
that tragedies afford more relief than comedies,
plaintive tunes are more useful than such as are of
a sprightly nature.  I attend  a citizen  of Phila-
delphia, occasionally, in paroxysms of this disease,
who informed me that he was cured of one of
them  by  hearing  the  old hundred  psalm  tune
sung in a country church.  His disease, he said,
instantly went off in a stream of tears.  Dr. Car-
dan always felt a suspension of the anguish of his
mind  from the same  cause;  and Mr. Cowper
tells his friend Mr. Hay ley, in one  of his letters,
that he  was  " relieved as soon as his troubles
gushed from his eyes."   The tears in these cases
acted by indirectly depleting  from  the  brain.

   It is  remarkable,  that sprightly  tunes  are  as
offensive as comic representations in this disease.
This was once  exemplified by  a Mr. Derberow,
formerly a  patient  in the Pennsylvania Hospital.
In a fit  of low spirits,  he heard the sound of  a
lively tune from a flute in an adjoining room.  He
suddenly rushed into it, snatched the flute from 
124
ON  THE DISEASES
the gendeman's hands who was playing upon it,
and broke  it in pieces upon his head.

   5. Committing  entertaining passages  of prose
and verse to memory, and copying  manuscripts,
have  been  found  useful in  relieving  hypochon-
driasm.  They divert and translate  attention and
action from the understanding to a sound part of
the mind.   Reading aloud  has nearly  the same
effect.

   6.  Dr. Burton  recommends,  in  the highest
terms, the reading  of the bible to hypochondriac
patients.   He compares it to an apothecary's shop,
in which is contained remedies for  every disease
of the body.   I have frequently observed the Ian.
guor and depression of mind which occur in the
evening of life, to be much relieved by the variety
of incidents,  and the sublime and comfortable
 passages, that are contained in that only true histo-
 ry of the origin, nature, duties, and future destiny
 of man.   A captain Woodward, of Boston, who
 lately suffered all the hardships of shipwreck on
 an inhospitable island in the East  Indies, found
 great comfort in  revolving the history of Joseph
 and  his brethren  in  his mind.  A captain Ingle-
 field revived his spirits, and those of his  crew, in a
 similar situation,  by telling them pleasant  stories. 
»
                OF  THE MIND.            125
The mind  requires a  succession  of connected
events to divert it from itself, and this is the reason
why stories of all kinds, which require constant at-
tention to comprehend them,  are  so useful  in
this disease.

   Where there is no relish for the simple and in-
teresting stories contained in the Bible,  the read-
ing of novels should be recommended to our pa-
tients.  They contain a series of supposed events
which arrest the attention, and cause the mind to
forget itself.   It is because  they  so uniformly
produce this effect that they are often resorted to
by old people even of elevated understandings,
in order to divert themselves from the depression
of spirits which the death or treachery of friends,
bodily pain, and  the  dread of futurity, create in
their minds.

   7. Mentioning the name of a parent, rela-
tion or friend, from whom the patient has received
acts of kindness,  protection, or relief, in early life.
We fly from habit to  those persons, when in dis-
tress in any part of our lives, who have succoured
us under  the  pains and distresses  of childhood.
 These persons are generally our parents.  I once
assisted in performing the operation of  lithotomy
upon  a young gentleman in this city, whose only 
126
ON  THE  DISEASES
cry during the operation was, " O !  my father, my
father!" I have heard a woman utter the name of
her mother only, during the whole  time of the ex-
cision of a cancerous breast.   I attended a young
gentleman in our hospital in the year 1803 in this
disease,  who  had  lived  with a most indulgent
grandfather when a boy.   In the lowest stage of
his depression,  the mentioning the  name only, of
his grandfather revived  him,  and  often  drew
him into pleasant conversation.   The same ad-
vantages might probably  be derived, from carry-
ing a patient's  memory and  imagination back to
the innocent and delightful sports and studies of
early life.

   8. Matrimony, if our  patients are single.
The constant  pursuits  and wholesome cares of a
family  generally prevent  and cure such as are
transient and  imaginary.

   9. Terror, by the concussion it gives to  both
body and mind, has sometimes cured this disease.
A lady in New York, in whom it was induced by
the habitual use of opium, was cured by  this re-
medy,  administered by the hand of her physician.
In one of his visits to her, he took a large snuff-
box out of his pocket.  She  looked at it as if she
wished for a pinch of snuff.  The physician put it 
OF  THE  MIND.
127
into  her hands.  Upon opening it, an artificial
snake that had been coiled up in it, suddenly leap-
ed upon her shoulder.   She was convulsed  with
terror, and from time left off the use of opium,
and rapidly recovered.  She lived forty years after-
wards in good health, and finally died about eigh-
ty years of age.

   10. Travelling.   Long journies should be
preferred to short excursions from home.  They
relieve  the mind from a monotony of objects, and
awaken a constant succession of new ideas. They
moreover create  a necessity for constant bodily
exertion, and they remove the patient from the
society of his friends, who, by being obliged  to
listen to his complaints, add fuel to his disease.

   The journies  in  those  cases  should be to a
 warm climate, and the patient  should be advised,
 before  he leaves  home,  to  change every article
 of his  dress,  even the furniture of his pockets,
 that he may see  nothing while abroad, that can
 revive  his disease by association

   In the history of this disease I remarked that there
 is in hypochondriacs  a disposition  to inflict pain
 upon their bodies by means of wounds, in order to
 suspend^nguish of mind.   This should be pre- 
128           ON  THE  DISEASES
vented by removing all the instruments out of their
way  that are usually employed for that purpose.
Sometimes this  anguish of mind, I have  said,
leads its miserable  subjects  to seek to put an end
to their  existence  by  their own hands.   This   I
should be prevented, not only by  depriving them
of all the means of destroying themselves, but
by securing the windows and doors in which they
are confined,  and never permitting  them to be
alone ; also  by such  other means as accident or
design have proved to be successful, and which
act upon the  mind through the  medium of the
body, and upon the body  through the  medium
of the mind.  These are wine, blood-letting, an
unexpected  sense  of pain,  compassion, a sud-
den and violent  exertion of the active powers of
the body and mind, terror, a sense of shame, and,
lastly, infamy.   I  shall  briefly mention instances
of the efficacy  of each of them in  preventing sui-   j
cide.

   1. A gentleman  afflicted  with this disease went
with a loaded pistol into a tavern in London, with    I
a design  to destroy himself.  To  conceal his in-
tention, he  called  for a small decanter of  wine,
and,  after locking the door of the room into which
he had been conducted, cocked  his pistol, but
before he discharged its contents through his 
.*.
                 OF THE  MIND.             129

 head, determined to try the quality  of his wine.
 Perceiving it to  be very good, he drank a second,
 and then a third glass, after  which he uncocked
 his pistol, and finished the whole decanter.  Find-
 ing such a prompt remedy for his despair in  this
 cordial liquor, he continued to  use it freely,  and
 was thereby cured.

   2. In the year 1803 I visited a young gentle-
 man in our hospital,  who became deranged from
 remorse of conscience in consequence of killing
 a  friend in  a duel.   His only cry was for a pis-
 tol,  that he might put an end to his life.  I told
 him, the firing of a pistol would disturb the  pa-
 tients  in  the neighbouring cells,  and that  the
 wound made by it  would probably cover his cell
 with blood, but  that I  could take away his  life
 in a  more easy and delicate way, by bleeding him
 to death, from a vein in his arm, and retaining  his
 blood in a large bowl.   He consented at once to
 my  proposal.  I then requested Dr. Hartshorn,
 the resident physician and apothecary of the hos-
pital, to tie up his arm, and bleed him to death.
The Doctor instantly ^gpfttthis request.  After
losing nearly twenty ounces of blood,  he fainted,
became calm, and slept soundly the ensuing night.
The next day, when I visited him, he was still un-
happy ; not from  despair and a hatred of life, but
 
130          ON THE  DISEASES
 from  a dread of death;  for he now complained
 only,  that several persons in the hospital had con-
 spired to kill him.   By the continuance of de-
 pleting remedies, this error was removed, and he
 was soon afterwards discharged from the hospital.

   It will naturally occur to the reader, that this
 remedy,  and  the use of wine, should be regula-
 ted by a strict attention to the state of the pulse.

   3. A maniac in the Pennsylvania Hospital, some
 years  ago, expressed a  strong desire to drown
 himself.   Mr. Higgins, the present steward of the
 hospital,  seemed to favour this wish, and prepar-
 ed water for  the purpose.   The  distressed man
 stripped himself and eagerly jumped into it.  Mr.
 Higgins  endeavoured to plunge  his head under
 the water, in  order, he said, to hasten  his death.
 The maniac resisted, and declared he would prefer
 being burnt to death.   " You shall be gratified,*'
 said Mr. Higgins, and instantly applied a lighted
 candle  to  his flesh.   " Stop, stop," said he, " I
 will not die now;" and never afterwards attempt-
ed to destroy himself^aixp'en expressed a wish
for death.

  It has been said that persons who make unsuc-
cessful attempts to destroy  themselves,  seldom 
OF THE  MIND.             131
repeat them.   If this remark be true, I suspect
it  is  only in  those cases  in  which the attempt,
like  the one above  mentioned, has  been accom-
panied with pain.

   4.  The  famous  actress Mrs.  Bellamy, in  an
hour of despair, was restrained  from suicide  by
hearing the cry  of distress from a child,  near a
bridge from whence she was  preparing to throw
herself into the river Thames.

   5. Mr. Pinel mentions an instance  of a gentle-
man who was kept from drowning himself in the
same river, by an attempt of  two or three ruffi-
ans  to  pick  his pocket,  and  which  he  defeated
by a singular exertion of  strength  and  courage.

   6. Zacutus  relates the  history of a hypochon-
driac who had made several unsuccessful attempts
to destroy himself by fire.  His physician, in or-
 der to cure him, wrapped him in  a fresh sheep-
skin, which  he had previously wetted with spi-
rit of turpentine.  He applied fire to this skin,
 which instantly enveloped him in a blaze, that so
 terrified him, that  he never attempted afterwards
 to put an  end to his life. 
132          ON  THE DISEASES
   7. Suicide was prevented in the virgins of Mi-
 letus,  among whom it was common from the in-
 fluence of a  new and  false  opinion in religion,
 by exposing their naked bodies in  a public part
 of the  city.

   8. Dr. John Hunter tells us, in his account of
 the  diseases of Jamaica, that the negroes, when
 they become deranged, sometimes destroy them-
 selves  by eating large quantities of earth.  After
 many fruitless attempts to put a  stop to it, it was
 finally  prevented, by cutting  oft' the heads of the
 negroes who died in this manner, and exposing
 them to view in a public part  of the Island.

   Sometimes patients in this state of derangement
 destroy themselves  by abstinence  from   food
 and  drinks.   I have twice seen death induced  in
 this  way in  the  Pennsylvania Hospital, and once
 in a  private  patient.   Persuasion  and force were
 alike ineffectual  in prevailing  upon  them to take
 nourishment.  Perhaps some such  means as the
 following  might be more effectual  for that pur-
 pose.

   1. In the  Memoirs of Count  Maurcpas, it  is
related  of the same prince of Bourbon who fancied
himself to  be a plant, that he sometimes supposed 
OF  THE  MIND.
133
himself to be dead, at which time he refused to
take any food, for which he said he had no further
occasion.   To cure this alarming delusion,  they
contrived to disguise two persons who were intro-
duced to him as his grandfather, and marshal Lux-
emburg, and who, after conversing with him for
some time about  the shades that inhabited the
place of  the dead, invited him  to dine with mar-
shal Turene.  The prince followed  them into a
cellar prepared  for the purpose, where he made a
hearty meal, which immediately restored him to
a belief  that he was alive.  A similar  case of a
man being cured of a belief that he was dead,  by-
being prevailed upon to  eat,  is related by Dr.
Turner,  in "his Treatise upon the Diseases of the
Skin.

   2. Mr.  Pinel mentions an instance of a man
who determined to put an end to his life by ab-
stinence from food only,  but  who continued to
drink as usual.  His  attendants withheld drinks
from him until he consented to take food with
them.   The bodily pain of thirst,  in this  case,
predominated over the  anguish of his mind, which
had disposed him  to seek for death  in this mode
of suicide, 
134
ON  THE DISEASES
  ' 3. Leaving food in a patient's cell, or room, and
 carefully avoiding importuning him to eat.   The
 constant sight of food  will tend to excite his ap-
 petite, and a  consciousness that he possesses his
 free agency may induce him to eat, when the
 most powerful arguments for that purpose  would
 not have that effect.  I have heard of a criminal
 in Scotland who attempted to destroy himself by
 famine, in  whom it was completely prevented by
 this practice.

  It is a singular fact in  the  history  of suicide,
 that it has  sometimes been hereditary in families.
 There arc  two families in  Pennsylvania, in which
 three of their respective branches have perished by
 their own  hands, in  the course  of a few  years.
 Similar  instances of this issue of family derange-
 ment are to be met with in other countries.

  In watching patients so as to prevent their in-
juring,  or  destroying themselves,  it is of impor-
tance to know  that the paroxysm of despair that
prompts to both often comes on suddenly, and  is
sometimes  preceded  by  unusual  tranquility of
mind, and even by high spirits. 
OF THE  MIND.             135
              CHAPTER  IV.

Of Amenomania, or the second form of Partial
          Intellectual Derangement.

 1  HIS form of madness is a higher grade of hy-
pochondriasis, and often succeeds it.  It differs
from it,

  1. In the absence of dyspepsia, or in its cessa-
tion, inconsequence of the  increase of morbid ex-
citement in the brain, predominating over that
disease in the stomach.

  2. In a difference, or change, of the patient's opi-
nions respecting his health,  affairs and condition.
Instead of supposing himself to be  diseased, he
now denies that he has any disease; and instead of
feeling,  or complaining of misery, he is now hap-
py in the errors which accompany his madness.

  3. The errors  in this form of derangement are
more deeply seated than in  hypochondriasm.  As 
136           ON  THE  DISEASES
a proof of  this, we observe, when it arises from
love, the sight, or possession of the object beloved
relieves or  causes  it in the latter disease,  but it
has no effect in the former.  I  have seen it tried
to no purpose in a young gentleman in this city.
Dr. Nicholas Robinson  mentions an instance,  in
which even the marriage of a young woman to the
man whom she loved was so far from curing her,
that she attempted to murder  him immediately
afterwards.

  Let it not  be  supposed that  amenomania  uni-
formly succeeds hypochondriasis.   It often  pre-
cedes it,  and they both frequently  blend their
symptoms together. They likewise alternate with
each other.   There  is moreover, now and then,
a mixture of some of the symptoms of hysteria
with amenomania, as well as with hypochondriasis.
These  successive  changes and  combinations  of
those forms of disease are  to be ascribed to irri-
tability or inirritability being different in the sys-
tems in which they are  seated,  and, in  some in-
stances, to their being different in different parts
of the same system.

  Amenomania  is a common form of partial jn-
sunity.  We see it in the enthusiastic votaries of
all the pursuits and arts of man.   The alchy mists,
-  / 
QF  THE  MIND.            137
the searchers after perpetual motion,  the astrono-
mers,  the   metaphysicians,  the politicians,  the
knight errants, and the travellers, have all in their
turns furnished cases of this form of derangement.
I once met  with a striking instance of it, from al-
chymical pursuits,  in a gentleman, at the table of
Mr. Wolfe, in London.  He related the issue of
several experiments, in  which  some of the lose
metals had been  converted  into gold, and he de-
clared, further, his belief that there was at that time
a man living  in  India, whose life had  been pro-
longed above 600 years by an elixir that had been
discovered  by an alchymist.  Upon other subjects
he was rational and well  informed.  Dr. Johnson
has given a just picture of this disease in the cha-
racter of an astronomer,  in his Rasselas, prince of
Abyssinia.  Several of the nations of Europe have
lately furnished instances of men deranged, from a
belief in the possibility of producing perfection in
human nature, and in civil government, by  means
of what they absurdly called the  omnipotence of
human reason.   But we see this disease  of the
mind most frequently in the enthusiasts in religion,
in whom it discovers itself in a variety of  ways;
particularly,

   1.  In a belief that they are the peculiar favour-
ites of heaven, and exclusively possessed ol just
                        s 
138
ON  THE DISEASFS
 opinions of the divine  will, as rcveulcd in the
 Scriptures.

   2. That they see and converse with angels, and
 the departed spirits of their relations and friends.

   3. That they are favoured with visions, and the
 revelation of future events.  And,

   4. That  they are exalted into  beings of the
 highest order.  I have seen two instances of per-
 sons, who believed themselves to be the Messiah,
 and  I have heard of each of the sacred names and
 offices of the Father, Son, and Holy Ghost, having
 been assumed at the same time by  three persons,
 under the influence of this partial form of derange-
 ment, in a hospital in Mexico.

   There  was a time when persons  thus deranged
 were subjected to  fines, imprisonment,  the extir-
 pation of their  tongues, and even  to death from
 fire and the  halter.   To the  influence of the sci-
ence of medicine  we are  indebted, for teaching
that these opinions are generally as  devoid of im-
piety as an  epileptic fit;  and for consigning, by
that  humane  discovery,  the deluded subjects^
them to the cells of a hospital instead of a jail, and
to the hand of a physician, instead of the hands of
♦ 
OF  THE  MIND.
139
the last officer, of what has improperly been called,
criminal justice.

   In all  these cases of partial derangement, the
understanding  is not only  sound upon subjects
unconnected with that which produced the disease,
but all the other faculties of the mind are unim-
paired ; nor do  we observe the subjects of it, as
in general madness, to  be irritated,  or unusually
excited,  by conversing  upon the single and origi-
nal subject of their disease.

   It is remarkable  that all the errors  of ameno-
mania are the reverse of those of tristimania, former-
ly mentioned, in elevating the patient above his or-
dinary rank and condition of life.

   The physical remedies for this form of partial
derangement are nearly the same as those which
have been recommended for tristimania,  particu-
larly bleeding, purging, emetics, and low diet, in
an excited  state of the blood-vessels,  and,  after
they are reduced, stimulating diet, drinks and me-
dicines,  and a  change of company, pursuits, and
climate.  The  errors which predominate in the
mind  should be soothed, diverted, or opposed by
"reasoning or ridicule,  according to their force.
 There is one  error which is sometimes opposed 
140          ON THE DISEASES
by  reasoning with success,  and that is, a belief,
which  patients  in this pleasant state of derange.
ment now and then entertain, that they are favour-
ed with extraordinary revelations, and particularly
a knowledge  of future  events.  In  these cases
 leey  should be told,  that supernatural know-
ledge of that kind has generally been revealed to
twe   .  tore persons at  the same time, and  that
it :  <s always been accompanied with a power of
working miracles. Even the Saviour of the world
did not rest the credibility of his divine origin, and
the objects of his mission, upon his single testi-
mony in f.vourof himself, nor yet  upon the su-
preme  and  miraculous power  he exercised over
spirit and matter;  but  condescended to  receive
the testimony of his twelve apostles in favour of
the former,  and compelled a belief  in the  latter,
by  endowing them with a power, similar to his
own, over all the operations of nature.

  Both tristimania and amenomania often continue
for  months and years,  in the form in which they
have been described, but they  are as often follow-
ed by derangement in every  part of the  under-
standing, and in all, or a part of, the other faculties
of the mind.   When this is the case, it is called*
general  madness, which  is the next subject
of our inquiries  and observations. 
OF  THE  MIND.            141
               CHAPTER   V.

      Of General Intellectual Derangement.

1 SHALL divide this general form of  derange-
ment into three grades or states.

  I. Mania, by which I mean what has been calL-
ed  tonic madness by some writers,  and mania
furibunda by Vanswieten.

  II. Manicula, or madness in a reduced, and
most commonly in a chronic, state.

  III. Manalgia, or that state of general mad-
ness, in which a universal torpor takes  place  in
the  body and mind.

  This division of  general madness into  three
states, accords with similar divisions, which have
lately been adopted of several other diseases, par-
ticularly rheumatism, and inflammation of the liver. 
142
ON  THE DISEASES
    The former is known by the  names of rheuma-
    tismus, rheumaticula,  and rheumatalgia,  and the
    latter by the names  of hepatitis, hcpaticula,  and
fc  hcpjtalgia.  The  propriety of thus  conforming
    madness  to  the divisions of those two  diseases
    will appear when  we  consider the unity of their
    proximate cause,  and  that they all depend upon
    similar morbid actions  in the blood-vessels. Rhcu-
    matism and hepatitis, therefore, mav be consider-
    ed, if I may be allowed the illustration,  as mad
    ness in the joints, or liver; and madness, as rheu-
    matism,  or hepatitis, in the brain.

      I. I shall begin with  the  history and cure of
    general madness of the first  grade,  or of what'I
    have called mania.   Its  premonitory signs are,
    watchfulness,  high or  low spirits,  great  rapidity
    of thought, and eccentricity in conversation, and
    conduct; sometimes pathetic expressions of horror,
    excited by the apprehension of approaching mad-
    ness ; terrifying or distressing dreams;  great irri-
    tability of temper; jealousy ;  instability in all pur-
    suits; unusual acts of extravagance, manifested by
    the  purchases of houses,  and  certain expensive
    and unnecessary articles of furniture,  and hosti-
    lity to  relations and friends.  The  face is pale or
    flushed, the eyes  are  dull, or wild,  the  appetite
    is increased, the bowels are  costive, and the pa- 
OF  THE  MIND.
143
tient complains sometimes of throbbing in  the
temples, vertigo, and head-ache.  The gentleman
formerly mentioned, in whom madness was excit-  •
ed by a number of small shot lodged in his foot,
when a school boy was afflicted with deafness.
A sudden return  of  his hearing was always a
premonitory sign of an approaching attack of de-
rangement.

   The remedies in this  case should be,

   1.  The removal of all the remote and exciting
causes of the  disease, and particularly to abstract
the patient from study and business,  if they  have
produced it, and to  substitute in their room re-
laxation  and amusements.  Dr. Boerhaave  once
passed several weeks  without sleep, and discover-
ed other signs of approaching derangement.   He
was cured by being torn from his books, and al-
lured into agreeable company.

   2. Changing the subjects of our patients studies,
when they  are  abstruse and difficult, to such as
are of a lighter nature.  Rousseau often removed,
by  this  means,  the  premonitory  symptoms  of
madness.  The  celebrated Mr. M'Laurin, the
friend and cotemporary  of sir Isaac Newton, made
 it a practice to relieve his mind, when debilitated 
144          ON THE DISEASES
by  hard study, and  thereby predisposed to this
disease,  by reading novels and  romances; and
such  was his  knowledge  of them,  that the late
Dr. Gregory informed me  he was often appealed
to for the character of every work of that kind
that appeared  in the English language.

  3.  Low diet,  and a few  gentle doses of pur-
ging physic, and, if the pulse be  full or tense, the
loss of ten or twelve ounces of blood.  By means
of these remedies, I have in many instances pre-
vented an attack of madness.

  The  symptoms of this state  of derangement,
when completely  formed, as they appear in the
body, are, a wild and ferocious countenance, en-
larged and rolling eyes, constant singing, whist-
ling or hallowing, imitation of the noises of dif-
ferent animals, walking with a  quick step,  or
standing still,  often with the hands and eyes ele-
vated towards  the heavens; wakefulness for whole
nights,  weeks, months, and, according  to Dr.
Moreiy's account of a boy  at X pics, for years;
great  muscular strength, uncommon  adroitness in
performing certain acts, and uncommon swiftness
in running.   The nerves are  insensible to  cold,
heat,  and to irritants of all kinds.   I am aware
that insensibility  to cold is  deued by Mr.  Hal- 
OF  THE  MIND.            145
 sam to be a symptom of general madness.   I ad-
 mit that it does not take place in one of its states,
 that is, in manicula,  but it is  uniformly present,
 as  I shall prove by facts hereafter,  in  its highest
 and lowest  grades,  in  which  states the system
 resists not only  cold  and heat, but all the usual
 remote causes of fever  from the insensible quali-
 ties of the atmosphere.  Sometimes the nerves ex-
 hibit,  in  great mobility,  several of the signs of
 hysteria mixed with general madness.  The chief
 of  these signs are laughing and weeping.  They
 occur oftener in women than men.

  The skin is dry, cool, and sometimes  covered
 with profuse  sweats.   A coldness often  affects
 the feet only,  for  days and  weeks,  while the
 head, and other parts of the body, are preterna-
 turally warm,  or of their  natural temperature

  The senses of hearing and seeing are uncom-
 monly acute.   This is  obvious, from their hear-
 ing so  distinctly low and  distant sounds,  and
from  their prompt reeollection of long unseen
and forgotten  faces, and  of the  resemblance of
persons,  whom  they have never seen  before, to
their parents, or to some other of their  ancestors.
                       T
//■.:.. 
146           ON  THE  DISEASES
   The  tongue is generally moist, and frequently
has a whitish appearance, such as occurs in com-
mon  fevers.  There is sometimes a  preternatu-
ral secretion t>f saliva  and  mucus in the mouth
and throat,  which is of a viscid nature, and dis-
charged  with  difficulty  by spitting.  From  the
constancy of this symptom in some mad people,
they  obtained  the  name of sputatorcs,  or spit-
ters.  There is generally a stoppage of the se-
cretion of mucus in the nose.   Dr. Moore  found
this to be the case  in two thirds of all the mani-
acs in the Pennsylvania Hospital,  whom he ex-
amined  at my  request,  with  a reference to this
symptom.  Where this secretion was not  suspend-
ed, he found the mucus of the nose dry and hard.

   The appetite for food is great, or there is a total
want  of it.   The bowels are  generally  costive,
and the stools white, small, and hard.   The urine
is  scanty in quantity, and, for the most part, of
a high colour.

   The pulse is synocha, intermitting, preternatu-
rally slow, frequent, quick, depressed,  or morbid-
ly  natural, exactly as we find  it in  other arterial
diseases  of  great morbid action.  It is  generally
depressed, where the muscles are in a state of vio-
lent excitement. 
OF  THE  MIND.
147
 The symptoms of mania, as they appear in the
mind, vary with its  causes.  When it is induced
by impressions that have been made upon the brain
through the medium of the heart, all the faculties oi
the mind discover marks of the disease in all their
operations. In its highest grade, it produces errone-
ous perception.  In this  state of derangement, the
patient mistakes the persons and objects around him.
This may arise either from a disease in the external
senses, in which case it is called morbid sensation;
or from a disease in the brain.   It is when it arises
from  the  latter  cause  only,  a symptom  of the
first  or  highest  grade  of  intellectual   derange-
ment.  We have a striking illustration of this dis-
eased state of perception in the character of Ajax,
in  the tragedy of Sophocles.   He becomes mad,
in consequence of Ulysses being preferred  to him
in  the competition  for the arms of Achilles.  In
one of his paroxysms of  madness,  he  runs into
the fields, and slays a number of shepherds and
their  cattle, under  a  belief that they were Aga-
memnon,  Menelaus, and others, who  had been
the instruments of his dishonour.   Afterwards he
brings a number of cattle to his tent, and  among
them a large ram,  which he puts to death for his
rival  and antagonist Ulysses.   Persons  under the
influence of this grade  of  madness sometimes
\ 
148
ON  THE DISEASES
 mistake their friends for strangers, and common
 visitors for their relations and friends.   They now
 and then fancy they see good or bad spirits stand-
 ing by their bed-sides,  waiting to  carry them to
 a place of torment or happiness,  according as
 thin moral dispositions and habits  in health have
 prepared  them  for those  different  abodes  of
 wicked  or pious souls.   Not  only  the eyes,  but
 the  ears likewise, are the vehicles of false percep-
 tions, and to these  we are to ascribe the  solilo-
 quies we sometimes observe in mad  people. They
 fancy they are spoken  to, and their conversation
 frequently consists of replies only to certain ques-
 tions they  suppose to be put to them.  These
 false perceptions are more common through  the
 ears  than  the  eyes  in  mad people.  The latter
 occur constantly more or less in delirium,  but we
 occasionally see them in the highest grade of in-
 tellectual madness.   When these errors in per-
 ception take place,  madness has been  called ideal
 by Dr. Arnold, but more happily diseased percep-
 tion  by  Dr.  Creighton.   It is in  this state of
 madness only that it is  proper to say, persons are
 " out of their senses;" for the mind no longer re-
 ceives the true images  of external  objects from
them. 
OF  THE  MIND.
149
  To account for these erroneous or diseased per-
ceptions, it will be necessary to  remark, that the
correspondence  of ideas and thoughts with im-
pressions, depends upon the sameness of the im-
pressions which produced the original ideas and
thoughts.    Now  this correspondence  can take
place only when the brain is in a healthy state.
When it is diseased,  impressions induce unrelated
ideas and thoughts,  as in the case of Ajax just
now mentioned.  QTwill  be necessary to remark
further in this place, that no idea can be excited
in the mind, however erroneous it may be, from
a want of relation  between  impression and per-
ception, that did not pre-exist in the mind?)  Ajax
could not have fancied a large ram to be Ulysses,
had not his image  from a former impression of
 his  person upon his  brain, pre-existed in  his
 mind ; and it  was  because  the part of his brain
 which was stimulated by the  image of  the ram
 did not emit a corresponding perception,  but con-
 veyed the  motion  excited by  it to  that part of
 the brain in which the image of Ulysses had  been
 imprinted, that he  saw him instead  of a ram.
 The nature of this error of perception may be un-
  derstood, by recollecting how  often impressions
 upon a sound part  of the body produce sensation
  and motion, in parts that are affected with a mor-
  bid sensibility and irritability, that are remote from 
150
ON  THE DISEASES
 it.   These errors, as applied to  the  body, have
 lately  received  the  names of error  sensus, and
 error motus.  They occur in all the senses, as
 well as in the nerves, muscles and brain.

   Where these erroneous perceptions do not take
 place, the associations of a madman are often dis
 cordant, ludicrous, or offensive, and his judgment
 and reason are perverted upon all subjects.  He
 sometimes attempts  to injure himself or others.
 Even inanimate objects, such as his clothing, bed,
 chairs, tables, and the windows, doors, and walls
 of his  room, when confined, partake  of his rage.
 AH  sense of decency and  modesty is  suspended;
 hence he besmears his face with his  own  excre-
 tions, and exposes his whole body without a co-
 vering.  When he roams at large, or escapes from
 a place  of  confinement,  lonely wootls, marshes,
f caves,  or grave-yards, are his usual places of re-
 sort, or retirement.  What is called conscious-
 ness is at this time destroyed  in his mind.  He is
 ignorant of the place he occupies, and of his rank
 and  condition in society, of the lapse of time, and
[even of his own  personal  identity.   Shakspearc
[has  very happily  described a part of this state of
 mind, when he makes King Lear utter the follow
 ing  words: 
OF  THE MIND.             151
    -----------" I am mainly ignorant
    What place this is ; and all the skill I have
    Remembers not these  garments, nor I know not]
    Where I did sleep last night."

This  grade of derangement is  generally of short
duration.   It gradually leaves  the memory, and
appears with less force  in the passions and moral
faculties,  but still occupies, in a greater or less
degree,, every part of the understanding.

   The sameness in  the operations  of nature,  in
thus  gradually  contracting the seat and extent  of
this disease to one faculty of the mind, and in con-
tracting the seat and extent of violent fevers  to
the blood-vessels, was noticed in  a former  part
of these Inquiries.
                                        >■
   In this reduced state of madness, the mind be-
comes more  coherent, and perceives, and associ-
ates  correctly,   but judges incorrectly,  that  is,
draws erroneous  conclusions from false premises.
 But  there are cases  in  this reduced grade of de-
 rangement in which the patient  perceives justly,
 associates  naturally, judges   correctly, but rea-
 sons erroneously, that is, draws false conclusions
 from just prepositions.  Sometimes he discovers
 the  reverse of this state of mind,  by drawing just
 conclusions  from erroneous  perceptions, associ- 
 152           ON  THE  DISEASES
 ations  and judgments.  Thus, when he fancies
 himself to be a king, he errs  in all the ways that
 have been mentioned. But observe  his conduct:
 he covers himself  with  a blanket which he calls
 a  robe, he puts a mat  upon his head which he
 calls a crown,  struts with a  majestic step, and
 demands the  homage due  to royalty  from all
 around him.   In this respect  he reasons justly
 from false premises,  and acts conformably to the
 high opinion he entertains of his rank and power.
 In a more advanced  state of the disease, the hos-
 tility of the patient is confined to his friends and
 relations only, and this is frequently  great in pro-
 portion to the  nearness  of the connection,  and
 the extent of the  obligations he  owes to them.
 Its intensity cannot  be conceived of by  persons
 who have  observed that passion only in ordinary
 life.  I once advised a ride in a chair, for one of
 my  private patients in this state of  mind, in the
 Pennsylvania Hospital.  Before he  got  into  it,
 he made the steward  of the hospital, who was to
 accompany him, declare,  that no one of his fami-
 ly  had ever rode in  it.  But further, while  the
disease occupies the whole understanding,  the pa-
tient discovers more derangement in talking upon
some subjects  than others.  These  subjects are
 sometimes of a pleasant, but oftener  of a distress-
ing nature.  The  disease varies with  each  of 
                OF  THE  MIND.            153
them by putting on the appearance of amenoma-
nia in the former,  and tristimania in the latter
case.   It  differs  from  them both  in  the errors
and prejudices that are entertained by the  patient,
being accompanied with more corporeal and men-
tal excitement; in being less fixed to one object,
and  in occupying every part of  the understand-
ing.

   From a part of the brain being preternaturally
elevated, but not diseased, the mind sometimes dis-
covers not only unusual strength  and  acuteness,
but certain talents it never exhibited before.  The
records of the wit and cunning of madmen are
numerous  in  every country.  Talents  for  elo-
quence, poetry, music and painting, and uncom-
mon ingenuity in several of the  mechanical arts,
are often  evolved in  this state  of madness.   A
gentleman whom I attended in our hospital in the
year 1810 often delighted, as well as astonished, the
patients and officers of our  hospital, by  his  dis-
plays of oratory,  in preaching from a table in the
hospital yard  every Sunday.  A female patient
of mine, who  became  insane after  parturition in
the year  1807,  sang  hymns and songs,  of her
own composition,  during the latter  stage of her
illness, with a tone of voice so soft and pleasant,
that  I hung upon it with delight, every  time  I
                       u 
154
ON  THE DISEASES
 visited her.   She  had never discovered a talent
 for poetry nor music in any previous part of her
 life.  Two instances of a talent for draw in^, evolv-
 ed by  madness, have occurred within my know-
 ledge ; and where is the hospital for mad people,
 in which elegant  and completely rigged  ships,
 and curious peices of machinery, have not been ex-
 hibited, by persons who never discovered the least
 turn for a mechanical  art previously  to their de-
 rangement.   Sometimes we observe in mad peo-
 ple  an unexpected  resuscitation of knowledge;
 hence  we hear them describe past events,  and
 speak in ancient or modern languages,  or repeat
 long and interesting passages  from books,  none
 of which we are sure they were capable of recol-
 lecting, in the  natural and healthy state  of their   3
 minds.

r    The disease  which thus evolves these new and
 wonderful talents and operations of the mind may
 be compared  to an earthquake, which,  by convuls-
 ing the upper  strata of our globe, throws upon
 its surface  precious and splendid fossils, the ex-
 Iistcnce of which  was unknown to the  proprie-
 tors of the soil in which they were buried.

    Sometimes the cause which induced derange-
 ment is forgotten,  and the subjects of the ravings, 
OF  THE  MIND.
155
as well as the conduct of patients,  are contrary
to their usual habits;  but  they  both  more  fre-
quently accord  with  their  natural tempers  and
dispositions, and with the cause of their disease.

  Are they naturally proud and ambitious ? They
imagine themselves to be kings, or noblemen, and
demand homage and respect.   Are they natural-
ly avaricious?   They  fancy  they possess incal-
culable wealth.    Are  they ferocious and mali-
cious ? They assume the nature  of wild beasts,
and attempt to  injure  their friends and  keepers.
Are  they sensual  and slovenly  in  their dispo-
sitions and dress ? They discover marks of both
in  their conversation and appearance? Are they
pious and benevolent?   They   are  inoffensive
in  their deportment, and  spend  much time in
devotional exercises.   But the conduct  and lan-
guage of  madmen are much influenced by the
specific  cause  that  induces it.   Does  it  arise
from reciprocal love,  opposed in the object of
mutual wishes  by interested  friends?  It vents
itself in sighs and songs, or sonnets and love let-
ters.  Is madness induced  by perfidy  in a lover ?
It discovers itself in ail the  usual marks of resent-
ment, rage,  and, when  practicable, of  revenge.
Ariosto has  with great  elegance  and  correctness
described these  marks in the conduct of Orlando, 
156
ON  THE DISEASES
 when deserted by his beloved Angelica.  He lies
 down upon a bed in order to rest a few minutes,
 but the moment he recollects that  Angelica once
 slept upon that bed, he instantly starts from it, tears
 up the tree by the roots  upon which she had
 cut  her name,  and finally  dries up the water in
 which she had been accustomed to  view her face,

    Has  the disease been induced by a conflict be-
 tween the moral faculty, and the sexual appetite, or
 by the undue  gratification of it ?  The habitual
 and morbid impurity of the mind  discovers itself
 in corresponding conversations and actions.  Seve-
 ral cases of this kind in both sexes, have occurred
 in our hospital.

   But, further, is madness induced by the ingrati-
 tude or treachery of friends,  or by  the unjust ca-
 lumnies of the world ? the conversation and con-
 duct of  the patient  indicate  a coldness or  hosti-
 lity to the  whole human race.  In  this state of
 mind, the walls of  a cell, and even darkness, are
 welcomed, to protect the miserable sufferer  from
 the sight of the  supposed monster—man.

   Mr. Merry  has very  forcibly described the
feelings of a  person  deranged from this cause, in
the following lines: 
OF  THE  MIND.              157
      " By sharp sensation wounded to the soul,
    He ponders on the world ; abhors the whole.
    In the dire working of his wakeful dreams,
    The human race  a race of demons seems.
    All is unjust, discordant and  severe;
    He asks not mercy's smile, nor pity's tear. (

   Is  it induced by misfortunes in business, and
by the rapacity and cruelty of creditors ? He sees
a sheriff, or one of his deputies, in every person
that opens  his door, and talks of nothing but of
the horrors of a jail.  Mr. Merry has described this
state  of mind  likewise, with  great  correctness, in
the following  lines.

     " But most to him shall memory prove a curse,
      Who meets capricious fortune's sad reverse.
      Who once, in wealth, indulg'd each gay desire,
      While to possess, was only to require.
      Who scatter'd bounty  with a liberal hand,
      And rov'd, at .will, through pleasure's flow'ry land
      By ruin cast amongst the lowly crew,
      What doleful visions pass before his view !
      His taste, his worth, his wisdom disappear,
      His virtues, too, none notice, none revere.
      Cold is the summer friend, who liv'd to trace
      His playful fancy's ever varying grace.
      Even nature's self a different aspect wears,
      Dimm'd by the mists of slow consuming cares.
      Glows not a flower, nor pants a vernal breeze,
      As in  his hours of affluence and ease. 
158
ON  THE DISEASES
      While every luxury that the world displays
      Wounds him afresh, and tells of better days."

   Is madness induced by remorse for real or ima-
 gmary crimes ? The wretched sufferer fancies his
 bed room a dungeon, and his physician an execu-
 tioner, or he cries out to be delivered from infer-
 nal spirits, which he supposes to be waiting around
 his bed, to carry his soul to a place of torment.

   Is it induced by false  and gloomy opinions of
 the  attributes of the Deity, and a belief of being
 destined to endless  misery ? His apartment be-
 comes vocal  day and night with the  groans  and
 sighs, and the excruciating language of despair.

   Is it brought on by a  belief  in his being a pe-
 culiar favourite of heaven, and destined to fulfil
 some  of  its high and benevolent decrees ?  His
 mind  overflows  with enthusiastic joy,  and he
 stands aloof from an intercourse,  and  even from
 the contact of mortals.   Two  instances  of  this
 kind  have  come  under  my  knowledge  in  this
 city.

   Has the sudden and unexpected acquisition of
great wealth perverted the natural operations of
the mind ? The maniac from this cause is elevat-
ed, cheerful, sings and laughs from morning till 
OF  THE  MIND-
159
night.   I have seen one instance of this state of
madness in our hospital from the cause I have
mentioned. It is from such cases of madness, that
it has been said to be attended with pleasure.  Ho-
race's madman complained  of his physician,  for
restoring him to his former humble grade of life
by curing him, and Dr. Thomas Willis mentions
an instance of a man, who  was so happy in  his
paroxysms of madness, that when  he was  well
he longed with impatience for their return; but
such instances of happiness in madness are very
rare.   It is more frequently,  I shall say hereafter,
accompanied  with misery, or a total insensibility
to it.

  The nature of a paroxysm of madness is much
diversified, by its affecting the moral faculties, or
leaving them in a sound state.   Shakspeare  has
happily illustrated the encroachment of intellectual
madness upon the moral faculty, and the sudden
recovery of its correct state, in the following lines,
which he makes his mad King Lear to utter  upon
being called  upon to punish  one of his subjects
for adultery.

     " Thou shalt not die—die for adultery!
     No !—to  it luxury—pell mell—
     For I want soldiers." 
160           ON  THE DISEASES
And then, as if suddenly penetrated with a sense
of the indecency of what he had said, he adds,

     « Fie !----Fie !----Fie !----Pah !
     Give me an ounce of civet, good apothecary,
     To sweeten my imagination."

   The reader will excuse my frequent  references
to the poets for facts to illustrate  the  history of
madness.   They view the human mind in all.its
operations, whether natural or morbid, with a  mi-
croscopic eye ; and hence many things arrest theit
attention, which escape the notice of physicians.

   To the history that has been given of the cor-
respondence between the ravings and conduct of
mad people, and their natural tempers and dispo*
sitions, there are several exceptions.   These  are,
all thpse  cases in  which persons of exemplary
piety and  purity of  character utter profane, or
impious,  or  indelicate  language, and  behave in
other respects contrary to their moral habits. The
apparent vices  of such deranged people  may be
compared  to  the offensive  substances that  arc
sometimes thrown upon the surface of  the  globe
by an earthquake, mixed with the splendid  fos-
sils  formerly  mentioned, which substances  had
no existence  in  nature,  but were formed by a
new arrangement in the particles  of  matter in 
OF  THE  MIND.
161
consequence  of the  violent  commotions in the
bowels of the earth.

   Not only the ravings of mad people, for the most
part, accord  with their habitual tempers and dis-
positions,  and  the causes of their disease, but
their conduct corresponds in like manner  with
their habitual occupations.  The lawyer, the phy-
sician, and the minister of the gospel,  frequently
employ themselves in the  exercises of their seve-
ral professions.   The merchant  spends much of
his time in making out invoices, and  in writing
letters; the politician devours a daily news-paper;
the poet writes  verses ; and the painter draws pic-
tures upon the walls of their respective cells ; the
mechanic cuts  out houses,  ships, carriages,  and
bridges, from pieces of sticks, with his pen-knife;
the sailor heaves his log or his line;  and the  sol-
dier goes through his manual exercise with a cane,
and  never fails to salute his visitors by lifting the
back of his hand to the side of his head.

   These habitual actions seldom take place  until
the disease has subsided, in a considerable degree,
in the temper and passions.

   After the  detail of the symptoms of general
madness that has been  given, I  feel disposed to
                       x 
    162          ON  THE  DISEASES
    look back for a few minutes, and contemplate, with
    painful and  melancholy  wonder, the  immense
    changes in the human mind, that  are induced by
    a little alteration in the circulation of the blood iu
    the brain.  What  great  effects are  produced in
'    this instance  by  little causes! How slender the
4   tenure  by which we hold our  intellectual  and
^   moral existence ! and how humiliating our situa-
    tion from its loss !  Well might the eloquent  Mr.
    Cowper, from this  view of the mind of man, con-
    sider it as

        ■  ■ " A harp, whose chords elude the sight,
      Each yielding harmony, dispos'd aright.
      The screws rcvers'd !  (A task,  which, if he please,
      God in a moment executes with case)
      Ten thousand times ten thousand strings go loose':
      Lost! till he tunc them, all their power and use."

      There is a considerable variety in the forms of
    general madness.    It appears,

      I. In a  single acute and violent paroxysm, such
   as has been described; which  continues for days,
    weeks, and sometimes months, and ends in  death,
   a  remission, or a perfect and durable recovery.
    In one of the cases of a  protracted  paroxysm of
   madness which came under my notice, the  dis-
   ease continued from June 1810 until April  1811, 
               OF  THE  MIND.            163
with scarcely any abatement in the excitement of
the body and mind,  notwithstanding the patient
was constantly  under the operation of depleting
remedies.  I have  seen  another case, in which
the same remedies  were  insufficient  to  produce
an interruption of five minutes  of speech or voci-
ferations, except during a few short  intervals of
sleep, for two months.

   II. General  madness appears in a chronic but
more moderate form, without paroxyms.

   III. It appears with paroxysms, with chronic,
but  moderate,  derangement in  its intervals.  In
these intervals, the patient sometimes  recovers
so far as so discover derangement upon one sub-
ject only.   In these cases, a  return  of general
madness is easily excited at any time, by  touching
upon the subject of his partial insanity in convers-
ing  with him.   Thus the touch of one of the
cords of a  musical  instrument causes all its cords
to vibrate with it.   In this, I remarked formerly,
general  madness differs  from  the two forms  of
partial madness which have been described.

   IV.  It appears in paroxysms, with the restora-
tion  of reason in their intervals.  These parox-
 ysms occur  annually, or at longer intervals, tw ige 
164
ON  THE DISEASES
 a year, particularly during the equinoxes, month-
 ly, weekly, and according to Lazoni,  an Italian
 physician, every  day.   Perhaps this  diurnal  it-
 tack of madness was what has  lately  been called
 the maniacal state of fever.

   Successive paroxysms of madness, with perfect
 intervals between them, occur most frequently in
 habitual drunkards; and they would probably oc-
 cur much  oftener, were they not prevented by a
 vicarious affection of  the  stomach,  known  by
 puking, redness of the  eyes, an active pulse,  and
 a peculiar and specific foetor of the breath.   From
 the correspondence of se veral of the actions which
 take place in  this disease of the stomach,  with
 those which  take place in the  brain in  madness,
 and from the sameness of the  ordinary duration
 of a paroxysm of e-ach of them, I have called the
 former, derangement in the stomach.

   The longer the intervals between the paroxysms
 of madness, the more complete is the  restoration
 of reason.  Remissions, rather than intermissions,
 take place w hen the intervals are of short dura-
 tion, and these distinguish it from febrile delirium,
in which intermissions more generally  occur.   In
maiiy cases, every thing is remembered that passes
utder the notice of the patient during a paroxysm 
OF  THE  MIND.
165
of general madness, but in those cases in which
the memory is diseased, as well as the understand-
ing, nothing is recollected.    I attended a lady, in
the month of October 1802,  who had crossed the
Atlantic  Ocean  during a paroxysm  of derange-
ment, without recollecting  a  single circumstance
of her voyage,  any more than if she  had passed
the whole time in sleep.  Sometimes  every thing
is forgotten  in the interval of a paroxysm,  but
recollected in a succeeding paroxysm.   I once at-
tended the daughter of a British officer, who had
been educated in the habits of gay life, who  was
married to a Methodist minister. In her paroxysms
of madness she  resumed her gay  habits,  spoke
French, and ridiculed  the tenets and practices of
the sect to which she belonged.   In the intervals
of her fits she renounced her gay habits, became
zealously devoted to  the religious principles and
ceremonies  of the  Methodists, and forgot every
thing she did and said during the fits of her in-
sanity.   A de ranged sailor, some years ago in the
Pennsylvania Hospital, fancied himself to be an ad-
miral,  and walked and  commanded  with  all the
dignity and authority that are connected with that
high rank in the  navy.  He was cured and dis-
charged : his disease some  time afterwards re-
turned, and with it all  the actions of an admiral
which he  assumed and imitated in  his  former 
 166          ON  THE DISEASES
 paroxysm.   It is remarkable, some persons when
 deranged talk rationally, but act irrationally, while
 others act rationally, and talk irrationally.   We
 had a sailor some years ago in our hospital, who
 spent a whole year in building and rigging a small
 ship in his cell.   Every part o£it was formed by
 a mind apparently in a sound state.   During the
 whole of the year in which he was employed in
 this work, he spoke not a word.   In bringing his
 ship out of his cell, a part of it was broken.  He
 immediately  spoke, and became violently derang-
 ed  soon afterwards.  Again, some  madmen  talk
 rationally,  and write irrationally ; but it is more
 common for  them to utter  a few  connected sen-
 tences in conversation, but not to  be able to con-
 nect two correct sentences together  in a  letter.
 Of this  I  have  known  many instances in  our
 hospital.

  V.  Mania  is sometimes combined with phreni-
 tis. The brain in this case is in the same state, as
 the lungs when  £h acute pneumony blends itself
 with a pulmonary consumption.   Excitement in
 both cases is  abstracted from the muscles, so that
 the patients are  usually confined to their  beds.
The tongue  is more furred, and the  skin  much
warmer,  in this  mixture of  mania and phrenitis,
than in madness  alone.   It  occurs most  frequent- 
OF  THE  MIND.
167
ly after parturition.   I have taken the liberty of
calling it Phrenimania.
                                 *
   VI. Mania is  sometimes  combined with  the
burning, sweating, cold, chilly, intermitting,  and
even  hydrophobic states of  fever.   Instances of
them were  mentioned in treating upon the seat
and proximate cause of madness. A case of its union
with  hydrophobia occurred  in a lady under my
care  in the  month of February  1812.  She at-
tempted several times to bite her attendants,  and
was  greatly  agitated  when  the word  '' water"
was mentioned in  her room.  As the pulse in
this mixture of mania and common fever is gene-
rally  synochus,  I have called it Synochomania.

   In all the  forms and combinations of madness
that have been described, the duration of the  dis-
ease, after it is  completely formed, seems to be as
much fixed  by nature as the duration of an  au-
tumnal fever.  It may be weakened, and life may
be preserved during its continuance, but, unless
it be overcome in its first stage, it generally runs
its course, in spite of all the power  of medicine.

   VII. There is a form of mania which is seldom
 the object of medical attention, either in hospitals,
 or in private practice, but which is  well known, 
 168          ON THE  DISEASES
 not only to physicians, but to persons of common
 observation in every part of the world.   Dr. Cox
 has described.it very  happily and correctly  in the
 following  words.

   " Among the varieties of maniacs met with in
 medical practice,  there is one, which, though by
 no means  rare,  has ben  little noticed by writers
 on this subject:  I refer to those cases, in  which
 the  individuals  perform  most  of  the common
 duties of life with propriety, and some of them,
 indeed, with scrupulous exactness ;  who exhibit
 no strongly  marked features  of either tempera-
 ment, no traits  of superior or defective  mental
 endowment, but \ et take  violent antipathies, har-
 bour unjust suspicions, indulge strong  propensi-
 ties, affect singularity  in  dress, gait, and phrase-
 ology ;  are  proud, conceited, and  ostentatious;
 easily excited, and with difficulty appeased ;  dead
 to sensibility, delicacy,  and  refnement;  obsti-
 nately riveted to the most  absurd opinions ; prone
 to controversy,  and yet  incapable of reasoning;
alway s the hero of their  own  tale, using hyper-
bolic high-flown  language  to  express the  most
simple.ideas, accompanied by unnatural gesticu-
lation, inordinate  action,  and  frequently  by the
most alarming expression of countenance.   On
some occasions they  suspect similar  intentions 
                 OF  THE  MIND.            169
on the most trivial grounds, on others are a prey
to fear and dread from  the most ridiculous  and
imaginary  sources;  now embracing every  op-
portunity  of  exhibiting romantic  courage  and
feats of hardihood, then indulging themselves in
all manner of excesses.

  41 Persons of this description, to the casual ob-
server, might appear  actuated by a bad heart, but
the experienced  physician  knows it is  the  head
which is defective.   They seem as if constantly
affected by a greater or less degree of stimulation
from intoxicating liquors, while the expression of
countenance furnishes an infallible proof of men-
tal disease.  If  subjected to moral restraint, or a
medical  regimen, they  yield  with reluctance to
the means  proposed,  and generally refuse and re-
sist, on the ground that  such means are unneces-
sary where no disease* exists ; and when,  by the
system  adopted,  they are so far  recovered, as to
be enabled to suppress the exhibition of the  for-
mer peculiarities, and are again fit to be restored
to society, the physician,  and those friends who
put them under the physician's care, are generally
ever after  objects of enmity, and frequently of
revenge."
                       ¥ 
170
ON  THE DISEASES
  VIII.  There is a form of madness which is al-
together internal, and of which I have met with
several instances.   It consists in the  same kind
of alienation of mind  that takes place in common
madness,  but which  is subject  to the  command
of the will :  persons affected  with it  feel all  the
distraction of thoughts and anguish of madness
when alone,  and sometimes  in company,  when
they arc silent, or inattentive to conversation, but
without  discovering  any  of  its  signs in their
countenances or behaviour.  It resembles, in this
respect, that  feeble  grade  of the delirium of a
fever, which is chased away by the visit of a phy-
sician, or by speaking to the patient upon any in-
teresting  subject.   I have suspected  the  cases
of suicide, which sometimes occur in persons  ap-
parently in a sound  state of  mind,  are occasion-
ed by this form of madness.   They  may be com-
pared, in this  situation, to  patients in the  walking
state of the yellow fever, in whom all  the sympa-
thies of the  body are destroyed, in consequence
of which  its external  parts  appear  sound and
healthy,  while the stomach, and other vital parts
are perishing by disease.  I have called this inter-
nal form of madness mania larvata.

   There  has been a diversity  of opinions respect-
ing  the influence of the moon in inducing, or in- 
                  OF THE  MIND.            171
 creasing, paroxysms of madness, after it has taken
 possession of the system.  The  late Dr. James
 Hutchinson, who spent several years in the Penn-
 sylvania hospital as its  resident  physician  and
 apothecary, assured me, that  he had never  seen
 the least  change in the  disease of the maniacs
 from  the  state of the moon.   Mr.  Halsam  tells
 ns, that in two years close attention to the state of
 the maniacs in  Bethlehem Hospital, in London,
 he had never seen their  disease increase at the
 lunar  periods.   To these facts  is  opposed  the
 testimony  of ages,  in all  countries.   There is, I
 believe, an  equal portion  of truth on the side of
 both these  opinions.   In  order to reconcile them,
 it will  be proper to remark,  1st,  that in certain dis-
 eases and in certain debilitated states of the system,
 the body acquires a  kind of sixth sense, that is,
 a perception  of  heat and cold, of moisture  and
 dryness, of the  density and rarity of the air, and
 of  light and darkness, of which it is insensible in
 a healthy state.  2. The moon, when full, increas-
 es  the rarity  of  the  air and the quantity of light,
 each of  which I believe acts upon sick people in
 various diseases, and, among others,  in madness.
 A  predisposition to the  action  of such  feeble
 causes  is required in all cases.  From the con-
 version of excitability into excitement in mania,
and from its  absence in manalgia,  it is easy to 
172          ON  THE DISEASES
conceive, in both those states of derangement, tin
system  will be insensible to the influence of the
moon.   Now when wc consider that a great ma-
jority of the patients in most hospitals nre in one
of those states of madness, it is easy to account for
their  exhibiting no marks  of lunar influence, ac-
cording  to  the observations of Dr. Hutchinson
and  Mr. Hdsam.   In the  year  1807 I requested
Mr. Thornton,  then one of the apothecaries of die
hospital, to  attend particularly to  the influence of
the morning light upon ah the  maniacal  patients
that were at that time confined in it.  He inform-
ed me, that many of them became noisy as soon as
the day  begin to break, and that, with the excep-
tion of two  or three rec nt cases, they  all became
silent and quiet after night.  During  the eclipse
of the sun on the  16th of June  1806, there was a
sudden  and total silence in  all the cells of the hos-
pital.

   The inference from these facts is, that the cases
are few in which mad people feel the influence of
the moon, and that when they do, it is derived chief-
ly from  an  increase of its light. It is possible the
absence  of its  light may  be attended with equal
commotions  in the system of patients  who are
afflicted  with  that form of derangement  which I
have called  tristimania. 
                OF  THE  MIND.            17$
  It is possible, further, that in the few cases in
which the light of the  moon, or the rarity of the
air, is felt by deranged persons in a hospital, that
their  noise, by  keeping a number of patients in
neighbouring cells awake, and in a state of inquie-
tude from the want of sleep, may have contributed
to establish that general belief in the influence of
the'  me>on upon madness, which has so long ob-
tained among physicians 
174
ON  THE  DISEASES
               CHAPTER   VII.

           Of the Remedies for Mania.

 IjEFORE we proceed to mention the remedies
 for mania, or  the highest grade of general madT
 ness, it will be necessary to mention the means of
 establishing a complete government over patients
 afflicted with it, and thus, by securing their obe-
 dience, respect, and affections, to enable a physi-
 cian to apply  his  remedies with case,  certainty
 and success.

   The first thing to be done, to accomplish these
 purposes, is to  remove the patient from his family,
 and from  the society of persons whom he  has
 been  accustomed to command, to a place where
 he will be prevented from injuring himself and
 others.  If there be objections to removing him
 to a public or private madhouse,  or if this be im-
practicable, the patient  should  be confined in a
chamber, in which he has not been accustomed to 
OF  THE  MIND.
175
sleep,  and a stranger or strangers should be em-
employed, exclusively, to attend him.  The  effect
of thus depriving a madman of  his  liberty has
sometimes been of the  most salutary nature, by
suddenly creating a new current of ideas, as well
as by the depression it  produces in his mind.

   1. This preliminary measure being taken, the
first object of a physician, when he enters the cell,
or chamber, of his deranged patient, should be,
to catch his eye, and look him out of countenance.
The  dread of the eye  was early imposed upon
every beast of the field.  The tyger, the mad bull,
and the enraged dog, all fly from it:  now a man
deprived of his reason partakes  so  much of the
nature of those animals, that he  is for  the  most
part easily terrified, or composed, by the eye of a
man who possesses his reason.   I know this do-
minion of the eye over mad people  is denied by
Mr. Halsam,  from his  supposing that it consists
 simply in imparting to  the  eye  a stern  or feroci-
ous look. This may sometimes be necessary ; but
a much greater effect is produced, by looking the
 patient out of countenance  with  a mild and stea-
 dy eve, and varying its aspect from the highest
 degree of sternness, down  to the mildest degree
 of benignity ;  for there are keys in the eye, if I
 may be allowed the expression,  which should be 
176
ON  1HE DISEASES
suited to the state  of the patient's  mind, with the
same  exactness that  musical tones should he suit-
ed to the depression of spirits in hypochondriasis.
Mr.  H ilsam ag:iin asks,  4l Where is the mm that
would trust himself alone with a madman, with
no other  means of subduing him than by his eye?"
This  may be,  and yet the effiracy  < 1 the eye as a
calming  remedy not be called in question.   It is
but one of several  other remedies  that are proper
to tranquilize him ;  and, when used  alone, may
not be sufficient for that purpose.    VVlio will de-
ny the efficacy of  bleeding for the cure of mad-
ness ? and yet  who would re Iv upon it exclusively,
without the  aid of other remedies? In  fa\our of
the power of the eye, in conjunction with other
means, in composing mad  people-, I  can  speak
from  the experience of many years.  It has been
witnessed by several hundred students  of  medi-
cine in our hospital,  antl once by  several of the
managers of the hospital, in the case of a man re-
cently brought into their room-, and whose con-
duct for  a considerable time resisted its efficacy.

   2. A second means of securing the obedience of
a deranged patient to a  physician  should  lie by
his voice.  Milton calls the human lace " divine."
It would be more proper to appi\  tha' epithet to
the human voice, from its wonderful effects  upon 
OF  THE  MI»D.            177
the mind of man,  whether employed in simple
tones, in music, or in speech.   Even brutes teel
and obey it.   In governing mad people it should
be harsh, gentle, or plaintive,  according to cir-
cumstances.   I have  observed  with  great plea-
sure  the  most beneficial effects pre>duced by it in
all those ways.  A patient  in the Pennsylvania
Hospital, who called his ph)sician hisf.thtr, once
lifted his hand to strike him.   " What!" said his
physician, with a plaintive tone of voice, " strike
your father !"  The madman dropped his arm, and
instantly showed marks of contrition for his con-
duct.

  In  Java, madness of a furious kind is often
brought on by the intemperate use of opium. The
poor, when affected with it, are put to death ; but
the rich, who are able to  purchase the services of
female nurses, generally recover.  May not their
recovery be ascribed, in part, to their ears being
constantly exposed  to the gentleness and softness
of a female voice ?

  3. The countenance of a physician should
assist his eye  and voice in governing his derang-
ed patients.  It should be accommodated  to the
state of the patient's mind and conduct.  There is
something like contagion  in the different aspects
                      7! 
178          ON  THE diseases
 of the human face, and madmen feel  it in com-
 mon  with other people.  A grave countenance in
 a  physician has often checked the frothy levity of
 a  deranged  patient in an instant, and a placid one
 has as suddenly chased away his gloom.  A ste rn
 countenance in like manner has often put a stop
 to garrulity, and a cheerful one  has  extorted
 smiles even from the face of melancholy itself.

   4.  The conduct of a physician to his patients
 should be uniformly dignified, if he wishes to ac-
 quire  their  obedience  and  respect.   He should
 never descend to levity in conversing with them.
 He should hear  with silence  their rude or witty
 answers to his questions, and upon no account
 ever laugh at them, or with them.

   5. Acts of justice, and a strict regard to truth,
 tend to secure  the respect and obedience of de-
 ranged patients to their  physician.   Every thing
 necessary  for their comfort should  be  provided
 for them, and every promise made to them should
 be faithfully and punctually  performed.  I once
 lost the confidence of a  maniac, by simply failing
 to enlarge  him  on an  appointed day,  in conse-
quence of an unexpected revival of some of the
symptoms of his disease. 
OF  THE  MIND.
179
  6. A physician should treat his deranged pa-
tients with respect, and  with all the ceremonies
which are due to their former rank and habits of
living.  Carpets upon the floors of their rooms  or
cells, curtains to their beds,  taste  in the prepara-
tion and manner of serving their meals,  will  all
serve to prevent distress and irritation, from a sup-
posed change in their condition in life.  I have
known a deranged gentleman complain of being
addressed without the title of Mr.; and I have
seen several others turn  with  an indignant look
from their food, when served to them upon a table
not covered with a cloth,  or in vessels they had
not been  accustomed to in their own families.
With this habitual attachment to  forms in beha-
viour,  and taste in  living, there is in this  class of
patients a similar  respect for former  habits  of
society, for which reason they should always eat,
sit,  and partake of amusements, by  themselves.
The great advantage  which  private madhouses
have over public hospitals is derived chiefly from
their conforming to this principle in human na-
ture ; which the highest  grade of madness is sel-
dom able to  eradicate.

  7. and lastly. A physician acquires the obedi-
ence and  affections of his deranged  patients by
acts of kindness.  For this purpose, all his di- 
180
ON  THE DISEASES
rections for discontinuing painful or disagreeable
remedies, and all his pleasant prescriptions, should
be delivered in the presence of his patients ; while
such as are of an unpleasant nature, should be de-
livered only to thtir keepers.   Small  presents of
fruit or sweet-cake will have a happy effect in at-
taching maniacal patients to their plnsieians, for
it  is a fact,  that in proportion to the  intensity of
misery, the  subjects of it  feel mtist sensibly the
smallest  diminution of it.  Perhaps the recovery
of the madmen in Java, just now mentioned, may
be ascribed, further, to their being nursed by wo-
men,  in whom kindness to the sick and distressed
is so universal, that it  forms an essential and pre-
dominating  feature in  the female character.

   As an inducement  to treat mad people in the
manner that has been  recommended,  I shall only
add, that in those cases in which the memory has
been  greatly  impaired, they seldom  forget three
things afttr  their  recovery, viz.  acts  of  cruelty
acts of indignity,  and acts of kindness.   1  have
known insances in which  the two former  have
been  recollected by  them  with  painful, and the
last wiih  phvsaht associations  for many years.
In gratiture lor kindness and favours shown  to
them, thty exceed ad other classes ol p.eients after
their recovery.  A physician once asked a young 
OF  THE  MIND.
181
woman of  the society  of Friends, whom he had
assisted  in curing in the Pennsylvania Hospital,
if she had forgiven him for compelling her to sub-
mit to the  remedies  that had  been employed  for
tha'  purpose.   "■ Forgive thee !" said she, " why
I love the  very ground thou walkest on."

   If all  the  means that have been  mentioned
shenild prove ineffectual to establish  a  govern-
ment over deranged patients, recourse  should be
had  to certain modes  of cesercion.  These will
sometimes be necessary in order to prevent their
destroying their clothes and the furniture of their
cells,  as well  as  to  punish outrages upon their
keepers  and  upon  each other.   The  following
means will generally be found sufficient for these
purposes.

   1. Confinement by means of a strait waistcoat,
or of a chair which I have called a tranquillizer.
He submits to them both with less d.fficulty than
to human force,  and struggles  less to  disengage
himself from them.   The tranquillizer has several
advantages over  the strait waistcoat or  mad shirt.  ^
It opposes the impetus of the blood towards the
brain, it lessens  muscular action every w here, it
reduces the force and frequency of the pulse, it
favours  the application  of cold water and ice to 
182
ON  THE DISEASES
 the head, and warm water  to the feet, both of
 which I shall say presently arc excellent re medies
 in this disease ; it enables the physician to feel
 the pulse and to bleed without any  trouble, or
 altering the erect position of the patient's body;
 and, lastly,  it relieves him,  by means of a  close
 stool, half filled with water,  over which he  con
 stantly  sits, from the fcetor and filth of his alvinc
 evacuations.*

   2. Privation of their customary pleasant  food.

   3. Pouring cold water under the coat sleeve, so
 that it may  descend into the  arm pits, and down
 the trunk of the body.

   4. The shower bath, continued for  fifteen or
 twenty  minutes.   If  all these  modes  of punish-
 ment should fail of their intended effects,  it  will
 be proper to resort to the fear of death.   Mr. Hig-
 gins proved the efficacy of this fear, in  completely
 subduing a certain Sarah T-----, whose profane
 and indecent  conversation and  loud vociferations
 offended and  disturbed  the whole   hospital.   He

    A chair such as  has been described may be seen in
the Pennsylvania Hospital, and an engraving of it in the
last volume of Dr. Coxe's Medical .Museum. 
OF THE  MIND.             183
ftad attempted in vain, by light  punishments and
threats,  to put a  stop to them.  At length  he
went to her cell, from whence he conducted her,
cursing and swearing as usual, to a large bathing
tub, in which he placed her.  " Now (said he)
prepare for death.   I will give you time enough
to say your prayers,  after which  I intend to drown
you, by plunging your  head under  this water."
She immediately uttered a prayer, such as became
a dying person.  Upon  discovering this  sign of
penitence, Mr.  Higgins  obtained from her a pro-
mise of amendment.  From that time no profane
or indecent language,  nor noises  of any  kind,
were heard in her cell.

  By the proper application of these mild and
terrifying  modes of punishment, chains will sel-
dom, and the whip never,  be required to govern
mad people.  I except only from the use of the
latter, those cases in which a sudden and unpro-
voked assault of their physicians or keepers may
render a stroke or two of a whip, or of the  hand,
a necessary measure of self-defence.

  To encourage us in the  use of all the  means
that have  been  mentioned for subduing the tem-
pers of mad people, and  acquiring a complete
government over them,  I  shall only add to the 
184           ON  THE  DISEASES
history I have given of their disease, that there is
a predisposition in their minds to be acted  upon
by  them, founded  in  their timidity.  Tht \ are
not  only  afraid of their  keepers and attendants,
but of one another.   Some years ago a madman
of the name of Hoops disturbed the whole \illagc
of Cluster, in this state, by his conduct*  A per-
son more  mad  than himself came into the town.
Hoops instantly ran  from him, and took shdter
in the court house  while  the court w\.s sitting.
There was an instance of the same  timidity in a
madman in our hospital, in the month of Februa-
ry 1310.   In consequence of the  house being
unusually  crowded  with mad  people, two  men
were confined in one  cell.   One  of them, who
was very noisy, was  instantly silenced by the re-
bukes of his less deranged companion.   He  even
crept into a corner of the cell to avoid him.

  The remedies for general mania come next un-
der our  consideration.   In enumerating them,
I shall adopt  the same  order that I followed  in
treating upon partial insanity,  by mentioning,

  I.  Such as should  be applied to the mind,
through the medium  of the body ; and, 
OF  THE  MIND.
185
  If. Such as should  be applied to the body
through the medium of the mind.

  I. The first remedy under this head should be
blood-letting.

  This evacuation is indicated,

  1. By  all the facts  and  arguments formerly
mentioned, in favour of this grade of madness be-
ing  an arterial disease, of great  morbid excite-
ment or inflammation in the brain, particularly by
the state of the pulse,  and, when this is natural,
by  the state of the countenance, by wakefulness,
and by a noisy and talkative disposition.

  2. By the appetite being uninterrupted, and of-
ten unrestrained, whereby the blood-vessels be-
come  overcharged with blood.

  3. By the importance and delicate structure of
the brain,  which forbid its bearing violent mor-
bid action for a  length of time, without  under-
going  permanent  obstruction or  disorganization.
The  danger from this  cause is much increased
by   the  wakefulness,  hollowing, singing,  and
strong muscular exertions of persons in this state
of madness.
                     A  A 
180
ON  THE DISEASES
   4. hy there being no outlet from the brain, iu
 common with other viscera,  to receive: the usual
 Ecsults of disease  or  inflammation, particularly
 the discharge of scrum from the blood-vessels.

   5. By the accidental cures  which have follow-
 ed the loss of  large quantities of blood.  Many
 mad people, who have attempted to destroy them-
 selves by cutting their throats, or otherwise opem
 ing  large  blood-vessels,  have  been cured by
 the  profuse  haemorrhages which have succeeded
 those acts.   Of this, several  instances have  oc-
 curred within my knowledge.

   6. By the morbid  appearances of the blood
 which has been drawn for the cure of this form
 of madness.  It is generally diseased beyond that
 grade  in which it exhibits a buffy coat.   Of 200
 patients  bled by Mr.  Halsam, in the Bethlehem
 Hospital, the blood was fizy in but six cases, and
 from the cause that has been assigned.   I have
 seen nearly  all the morbid appearances  of the
 blood which I have enumerated in my defence of
 blood-letting,  and  never  a  single  instance  in
 which  it put on a natural appearance.

   7. Blood-letting  is indicated by the extraordi-
nary success which  has attended its artificial use 
                of the Mind,            187
 ih the United States, and particularly in the Penn-
 sylvania Hospital.

   In the use of bleeding in this state of madness,
 the following rules should be observed :

   1. It should be copious  on the first  attack
 of the disease.  From 20  to  40 ounces of blood
 may  be taken at onee, unless fainting be induced
 before that quantity be drawn.   It  will do most
 service  if the  patient be bled in a standing  pos-
 ture.  The effects  of  this early   and copious
 bleeding are wonderful  in  calming  mad people.
 It often  prevents  the   necessity of  using  any
 other remedy,  and somejtimes it cures in a few
 hours.

  2.  It should be continued  not only while any
 of those states of morbid  action in the pulse re-
 main which require bleeding in other diseases, but
 in the absence of  them  all, provided great wake-
 fulness,  redness in the eyes, a  ferocious  coun-
tenance, and noisy and refractory behaviour con-
 tinue, all of which indicate a  highly morbid state
of the brain.   We  bleed in the same natural state
of the pulse in the  pneumonia notha.  We do
the   same thing in  a similar form  of hepatitis. 
188          ON  THE  DISEASES
The propriety of bleeding in this mania  notha, il
I may  be allowed to use a term founded upontha
unity of its cause  (that is, congestion  of blood
without  inflammation) with the  causes of  the
above  diseases of the lungs and  liver,  has often
been demonstrated in  the Pennsylvania  Hospital.
Its  advantages,  I well recollect, attracted  the
attention of the pupils of the hospital in the year
1805,  in a more than ordinary manner, in the case
of a man of the name of Pickins.   His madness
was recent, his skin was cool, and his pulse natu-
ral, but his eyes suffused with  blood, and he  was
unable to sleep.  I bled him  copiously, after which
his  pulse became frequent  and tense.   I repeat-
ed  the bleeding, and  gave  him several  doses of
purging physic, which cured him in a few days,

   3. It should be  more copious  in  phrenimania
and synochomania, than in simple madness.   Its
liberal use is  particularly indicated  in the latter,
when  it  is formed  by  the union  of  madness
with pregnancy,  or with the autumnal or puerpe-
 ral fever,  in all  which the  blood-vessels labour
 under disease  in other parts of the body, as well
as the brain,

   4. It  should be less copious in madness from
 drunkenness,  than from any of  its other causes, 
OF  THE  MIND.
189
all the circumstances that call for it being equal.
For  the  reasons for this  caution, the  reader will
please to consult the defence of blood-letting, in
the third volume of the author's Medical Inqui-
ries and  Observations.

   5. It  is indicated no  less in the seventh and
eighth forms of general mania, formerly described,
than in those which  preceded  them.   I think  I
once prevented suicide by it, in a young gentle-
man descended from a  family  in which several
of its members had perished by their own hands.

   6. The quantity of blood drawn should be great-
er than in any other organic disease.  This is indi-
cated not only by most of the reasons for bleeding
formerlv given, but by the strong and uncommon
hold which  the disease takes of the brain.  Many
circumstances  prove this to be the case, but none
more than its not being cured, and scarcely sus-
 pended, by  the acute and painful disease of par-
 turition, several instances of which have come un-
 der my  notice.   From among many  cases of the
 successful issue of profuse bleeding in this form
 of madness, I shall select  but two : the  former
 was in Mr.  T.  H. of the state of  New Jersey, a
 man of sixty-eight years of age,  from whom I
 drew  nearly 200 ounces of blood,  between the 
190          ON THE DISEASES
 20th of December and the 14th of February in
 the year 1807:  the latter  was in Mr.  1). T. of
 the  state of  New York,  who lost about  470
 ounces,  by my  order,  by  47 bleedings, between
 the months of June 1810 and April 1811.  Both
 these gentlemen were my  private patients  in the
 Pennsylvania Hospital.  Were it necessary I could
 add to these cases several  others, communicated
 to me by my pupils, particularly by Dr. Wallace,
 of  Virginia, and Dr.  Annan,  of Maryland, in
 which a similar practice had been attended with
 the  same success.

  After  all the  symptoms which  call for blood-
 letting have disappeared, we sometimes observe
 the disease to continue.  In this case morbid ex-
 citement becomes insolated, but still so considera-
 ble as not to yield  to purges or blisters.  Here
 cupping  is indicated.   The cups should  be ap-
 plied to the temples,  behind the ears,  and to the
 nape of the neck.   Leeches may be used for the
 same purpose, and to  the same places.   They
 may likewise be applied to  the hsemorrhoidal ves-
 sels  with advantage,  in persons  who have been
 subject to the piles.  The sympathy of the brain
 with these  vessels is so  intimate, that the disease
yields as readily  to the loss of blood from  them, 
OF  THE  MIND.
191
 as from the parts that have been mentioned near
 the brain.

   Arteriotomy performed upon the temporal arte-
 ry, it is said, is more  useful than venesection, or
 local bleeding with cups and leeches.  I can say
 nothing in its favour from my own experience.

   I have only to add to these remarks upon the
 use of cups and leeches, that they are not only ,
 useless, but often hurtful, if applied before the ac-
 tion of the  pulse  is reduced.   By inducing de-
 bility in the blood-vessels of the brain, they invite
 morbid excitement to it from the blood-vessels of \
 the trunk and extremities of the body,  provided
 they retain a predominance, or even an equality
 of action with the  blood-vessels of the brain.

    3. Solitude is indispensably necessary in this
 state of madness.   The passions become weak by
 the abstraction of company, and by refraining from
 conversation.   For this reason visitors should be
 excluded from the cells and apartments of highly
 deranged people, and there are times in  which the
 visits of a physician,  and of the cell-keeper or
 nurse, should be as seldom and  short as are con-
. sistent with the proper treatment and care  of the
 patient. 
192           ON  I HE  DISEASES
  4. Darkness should accompany solitude  in
the first stage of this disease.  It invites to silence,
and it induces a reduction of the pulse,  by tin
abstraction of the  stimulus of light, and  by the
influence of fear which is naturally connected with
darkness.   There are four cells in the Pennsylva-
nia  Hospital, so formed that it is possible to ren-
der them dark with but little trouble. I have seen
the  happiest effects from confining noisy patients
in them.

  5. An erect position of the body.   There is
a metfmd of taming refractory horses in England,
by first impounding them, as it is called, and then
keeping them from lying down  or sleeping,  by
thrusting sharp pointed nails into their bodies  for
two or three days and nights.  The same advan-
tages, I have no doubt,  might  be derived  from
keeping madmen in a standing posture, and awake,
for four and twenty hours, but by different and
more lenient means.   Besides producing several
of the effects of the tranquillizing chair, it would
tend to reduce excitement, by the expenditure of
excitability, from  the  constant  exertion  of the
muscles which  support the body.  The debility
thus induced in those muscles would attract  mor-
bid excitement  from the  brain,  and thereby  re-
lieve the disease.   That benefit would arise  from 
                 OF  THE  MIND.            193
 preventing sleep, I infer from  its salutary effects |/
 in preventing delirium,  and from delirium  being \
 always increased by it in fevers of great morbid
 excitement.

    6. Low  diet, consisting wholly of vegetables,
 and those of the least nutritious nature.  What
 would be  the  effect of fasting for two or  three
 days  in this   state of madness ? I  am dispo-
 sed to think favourably  of it,  from a fact com-
 municated  to  me  by  a gentleman who resided
 twenty years in the interior  parts  of India   He
 informed me that the wild elephants, when taken,
 are always tamed by depriving them of food, un-
 til they discover signs of great emaciation. They
 are then fed with mild aliment, and soon acquire
 their usual  flesh,  but without the  least  return of
 their ferocity.   Fasting is calculated to act in
 two ways, in  the cure of tonic  madness;  1, by
 lessening the quantity of blood by  the abstraction
 of aliment; and, 2,  by exciting the disease of
hunger in the stomach to such a degree, as to ena-
ble it to predominate over the  disease of the brain,
and by that means attract it to a less vital part of
the body.  The effects of this severe remedy in
curing inflammatory dropsy, render it still more
probable that it  might be employed, with advan-
tage, in this disease of the brain.  Against its  use
                      B B 
194
• M  THE DISEASES
it may be said, that the ferocity of certain wild
animals is increased by hunger; this is true, but
ferocity  is  not derangement.   It  is  possible  it
might exist for a little while, and be  attended
with symptoms totally different from those which
take place in ihadness, and of a nature  that would
yield more easily to the power of medicine.

   The drinks of a patient in this state of madness
should be of the most simple kinds.

   7.  Purginc.   Cremor  tartar, salts,  senna,
calomel and jalap, have all been employed for this
purpose.  Their use is indicated by the  obstruc-
tions in the  viscera, and torpor of the  alimentary
canal,  which generally  accompany this  form of
madness.  There  are cases in  which the purges
should be given daily, so as  to excite  an artificial
diarrhoea.  Nature, as I shall say presently, some-
times cures madness in this way.   It  is much in
favour of this chronic mode of purging, that few
persons are ever delirious in  their last moments,
who die of discharges from their bowels.   In the
mixture, which sometimes takes place, of mania
with the synochus form of  bilious fever,  purging
should be employed more freely than  in simple
madness. Calomel and jalap should be preferred
for that purpose. 
OF THE  MIND.
195
  8. Emetics are spoken of very differently by
authors.  Some commend, while others condemn,
them.  When they have done harm, it must have
been by giving them before, or after,  the system
was reduced below the emetic point. When giv-
en at that  point, they have  done good in many
cases.  I  mentioned  formerly their  manner  of
operating, in treating of their efficacy in partial de-
rangement.

  9. Nitre  has done the same service  in this
disease, that it has done in other diseases which af-
fect the blood-vessels.  Its efficacy is increased
by such additions of tartarized antimony and ca-
lomel to it, as shall increase its disposition to act
upon the bowels and skin.

  10. Blisters, like emetics, have been  con-
sidered as remedies of doubtful efficacy ; but  it is
only because they have not been employed in the
manner, or at the precise time, that was necessary
to obtain benefit from them.   In a letter which I
received  in the year 1794, from  Dr. Willis, senr.
he informed me that he always applied them to the
ancles in this disease,  instead of the head or neck.
He gave no reason for this practice,  but it imme-
diately suggested a principle to me, from which
I have derived great advantages, not only in the 
196
ON  THE DISEASES
treatment of madness, but of se vcral other diseases.
In the first  stage of tonic, or violent, matlness. the
disease  is  intrenched,  as it were,  in  the  brain.
It must be loosened, or weakened, by  depleting
remedies, before it can be disle)dgcd, or translat-
ed to another part of the body.   When this has
been effected, blisters easily attract it to the lower
limbs, and thus often convey it at once out of the
body.  The same reasoning applies, with equal
force, and the same practice with equal success, to
all  the violent diseases of the breast and bowels.
The blisters  do the same service, when applied to
the wrists, and still more,  when applied  at the
same time,  or  alternately, to both extremities.
After the complete reduction of the pulse, they
may be applied with advantage  to the neck and
head.

   11. Cold, in  the form of air,  water and ice.
The cold air should be applied both partially and
generally.   To favour  its partial action,  the hair
should be cut off, and shaved from every part of
the head.  Dr.  Moreau, a French physician, has
related a cure of madness performed by this sim-
ple remedy alone.   How tar the hair, by its sym-
pathy with the brain,  which it discovers by pre-
ternatural dryness in the forming  st ite of many
diseases, and by the alteration in its  figure,  cy 
OF THE  MIND.             197
 lour, and quantitv, from the influence of certain
 emotions and passions of the mind, may increase
 this disease, we know not; but we are certain, by
 cutting it off,  we not only expose the head  to a
 greater degree  of cold, but we favour by it, at the
 Same time, depletion from the brain, by means of
 insensible  perspiration;  for,  however strange  it
 may appear, there is a grade of action in  the per-
 spiring vessels, in which their discharges are in-
 creased by the sedative operation of cold.

   Cold  air,  by its  action upon the whole body,
 has likewise done service  in this state  of mad-
 ness.   I have  heard of two instances, in which it
 was cured by the  patients  escaping from  their
 keepers in the  evening, and passing a  night in
 the open air in the middle of winter. One of them
 relapsed ; in the other the cure was  permanent.

   Cold water should be applied in like manner to
 the head, and the whole body.  To the former it
 should be applied by means  of cloths, or a  blad-
 der, to which ice, when  it can be obtained, should
 be  added ; for the head, from its  greater insensi-
 bility to cold  than  any  other part  of the body,
 feels, in but a feeble degree, the coldness of sim-
 ple water.  I  have  found  this to be a more effec-
 tual,  as well as a more delicate, mode of applying

fy*  A**<J     /tvX^-&*£■*■///■■ /C<s  4t 
198          ON THE  DISEASES
 cold to the head, than by means of the clay cap,
 as advised by Dr. Cullen.   The  water,  or ice,
 should be frequently renewed, and they should be
 continued for several days and nights.  The  sig-
 nal for removing them should be, when they  pro-
 duce chilliness, and  sobbing or weeping in the
 patient.   The advantages of these cold  applica-
 tions to the head will be much increased,  by pla-
 cing the feet at the same time in warm water. The
 circulation is thereby more promptly  equalized.
 The reader will find a striking instance of the effi.
 cacy of using cold and warm water in this man-
 ner to the two extremities, by my advice, in a case
 of mania published by Dr. Spencc,  of  Dumfries,
 in Virginia, in Dr. Coxe's Medical Museum.

   In order to derive benefit  from the application
 of cold water to the whole body, it should be im-
 mersed in  it for several hours,  by  which means
 we prevent the reaction of the system, and thus
 render the sedative effects  of  the  water perma-
 nent.  Pumping for an  hour or  two upon a pa-
 tient acts  in the same way ;  but as it  has some-
 times been employed in curing a fit. of drunken-
 ness,  and may  be considered as a punishment,
 rather  than  a remedy,  immersion  of  the  body
 should be preferred to it.  The  patience  and in-
sensibility of the system to  cold, in this state of 
OF  THE  MIND.             199
the system,  is illustrated by a striking fact, men-
tioned by Dr. Currie in his Medical Reports.  He
tells us, a deranged young  woman slept upon a
cold floor during a  whole night, so cold as to
freeze water and milk upon her table,  without suf-
fering the least inconvenience from it.

   11. A salivation.  I mentioned the manner
in which this remedy operated upon the brain, the
bowels, and the mind,  in treating of the cure of
hypochondriac derangement.  Too much cannot
be said in its favour in general madness.  I once
advised it in a case of this  disease from  parturi-
tion, in  which the patient  conceived  an  aversion
from the infant that had been the cause of her suf-
fering.   On the day she felt the mercury in her
mouth,  she  asked for her infant, and pressed  it to
her bosom.   From that time she rapidly recover-
ed.

   It is sometimes difficult to prevail upon patients
in this state of madness, or even to compel them/
to take mercury in any  of the ways in which it is
usually  administered.  In these cases I have  suc-
ceeded,  by  sprinkling  a few grains of calomel
daily upon a piece of bread, and afterwards spread-
ing over it a thin covering of butter. 
 200          ON  THE diseases
   12. The Peruvian bark.   In  all those ca-
 ses in which  mania is complicated  with  the in-
 termitting  fever, or  with those prostrate states of
 fever in  which bark  is usualh administered, this
 medicine may be given w ith advantage.

   I have thus enumerated the principal remedies,
 which have been tmployed in reducing the pre-
 ternatural excitement of the s\ stem  which takes
 place in  tonic madness.  There are  some others
 which have been employed  for the same purpose,
 upon which I shall  make a few remarks.

   12.  Opium.  From an erroneous  belief in the
supposed sedative  power of this medicine,  it has
been prescribed in this state of derangement, but
I believe always w ith  bad  effects.  When  given
in small doses, so as  to prevent sleep, and by that
means gradually to waste the excitability, or what
Dr. Darwin calls the sensorial power of the sys-
tem, it may be useful.

   14. Digitalis.  I  have occasionally admi
nistered this medicine in tonic madness, but ne-
ver with any radical or permanent success.

   15.  Camphor  has bten  supposed to possess
specific  virtues in  this state  of madness.   1 
                OF THE MIND.            201
have often prescribed it when a young practitioner,
but  without any  obvious advantage.  I should
feel some hesitation in bearing a testimony against
this, and the preceding medicine, had I not  late-
ly discovered that my experience  of their ineffi-
cacy  in this disease, accords with that of the
ingenious Dr.  Ferriar.   They  have both derived
their credit in  madness  from their lessening the
frequency of the pulse, in which, disease has  very
improperly  been supposed  to  consist.   But the
frequency of a pulse may be lessened,  without a
reduction of its force, and even both may be ef-
fected by these  medicines upon the pulse on the
wrist, and  yet  irregular action in the blood-ves-
sels of  the  brain, which constitutes the  disease,
still continue, and until this be removed, they are
calculated to do harm,  by inducing obstructions
in the brain, and thereby perpetuating the disease.

   When madness arises from drunkenness, those
medicines are safer and  more useful, than when it
arises from those  causes which  require  copious
blood-letting.   In addition to them, volatile  salts,
bitters,  and small quantities  of ardent spirits, may
be given with advantage, provided the  system be
first moderately reduced by the  use of depleting
remedies.
                     c  c 
e»02
ON
1HE  DISEASES
   I suspect many, and perhaps all, the cures that
have been performed by opium, digitalis, and cam-
phor, hare been of madness from the intemperate
use of strong drink.  The disease in most of these
cases partakes  of the  nature of a soap bubble.
With all its apparent force, it is  both  feeble, and
transient, and not only Ixars stimulants with safe-
ty, but  sometimes requires them immediateh
after gentle evacuations of any kind.

   16.  Hellebore  has been famed,  for many
centuries, as a  specific for madness.   It is gene-
rally admitted that it is useful,- only, when it acts
as a purge.

   17.  Dr. Gregory, senr. used  to relate,  in his
lectures, a method of curing tonic madness, which
was practised by a farmer in the  neighbourhood
of Aberdeen, in Scotland.  It consisted in yoking
a number of madmen in a plough, and compelling
them, by fear or force,  to plough his fields. This
remedy acted,  by reducing and  expending the
morbid excitement of the system.   Refractor)
domestic animals are sometimes subdued  in the
same  way ; but  experience has taught us  that
they  may be  tamed  by  more  gentle  means.
Experience has  proved,  in  like  manner,  that
the system  in  tonic madness may be  reduced
by remedies that offer  less violence   to huma- 
OF  THE  MIND.
203
nity,  and that do not add to  the affliction of the
disease, by degrading the patient to a level  with
our domestic animals.

   18.  As  soon as the  disease shows  signs  of
abatement, the patient  should be relieved from
his confinement, in order to partake of the bene-
fits of fresh air and exercise.   Swinging, riding
in a carriage, and moderate walking, will be high-
ly proper in this  state of his disease.  To these
should be added,

   19.  The shower bath. This excellent reme-
dy acts upon the head, by the stimulus  arising
from the  weight  and  momentum of the water,
and by the reaction of the blood-vessels after the
sedative  effects of the  water are  over.   I  have
seen very happy  results from it.  To do much
service, it should be used two or three times a day.

   20.  The diet and drinks of  the patient should
now be of a cordial nature ; and  where obstinate
wakefulness  or restlessness attends, opium  may
be given at bed-time with safety and advantage.

   21. When the disease affects the nervous and
muscular systems, in common with the blood-ves-
sels, with hysterical or convulsive symptoms ; as-
safoetida, castor,  and the oil of amber, should be 
204           ON  THE  DISEASES
given with all the  remedies that have been men-
tioned.

  II. We come next  to mention the remedies
that are proper to  act upon  the body through the
medium of the mind.

  1. The  first  remedy under  this head is  to
divert the  ruling  passion  or subject  which  oc-
cupies the mind,  if it  be  one, and  fix  it upon
some other.   Nothing effectual  can be done
without  great  attention  to  this direction.  The
author has endeavoured to  show, in  an  inquiry
into the influence of physical causes upon  morals,
how much the passions may be made to neutral-
ize and decompose each other, and thus to lessen
their influence upon the body.  History furnishes
several examples of the truth of this remark.   I
mentioned formerly the effects  of opposing the
fear of shame to a  false opinion in religitm, in pre-
venting suicide in  the virgins of Miletus.  Achil-
les was diverted by his mother Thetys from gratify-
ing his revenge upon the body of Hector,  by sup-
planting that  baneful passion by  the  passion of
love.   Anger, and even rage, have often been op-
posed with success by terror and fear,  and delibe-
rate malice by a delicate stroke of  wit.   Where 
OF THE MIND.
205
the mind is deranged  upon  all subjects, we
should endeavour to fix it upon but one.  In or-
der to do this, it will be necessary to find out the
favourite studies and amusements of our patients.
The late Dr. Ash,  Dr. Priestly informed me,
was cured of derangement upon a variety of sub-
jects,  by seducing him to the study of mathe-
maticks, of which he had been fond in early life.
The distracted mind of  the poet Cowper was
composed,  while he was employed in  the single
business of  translating Homer  ; and I have heard
of a woman  who was cured of  madness, by keep-
ing her constantly employed for  several days in
playing cards, to which it was  known she had al-
ways had a strong  attachment.   There are few
persons so much deranged, as not to exhibit, for a
half an hour or more, marks of correctness of mind,
when drawn into conversation  upon some subject
not connected  with  their  derangement.  I ad-
mit that this diversion of the passions and un-
derstanding cannot  be effected, where the whole
mind, and all the passions, are under the influence
of madness.  Thus the virgins of Miletus could
not have been cured  by an appeal to  the female
sense of shame, had their moral faculties partaken
of  the disease of their other passions; nor could
Dr. Ash have  been cured of his intellectual de- 
^206          ON THE DISEASES
 rangement by the study of mathematicks, had he
 lost all his recollection of quantity and numbers,

   2. A sudden sense of the absurdity,  folly,
 or cruelty of certain actions, produced by con-
 versation, has sometimes cured madness. The cure
 in  this case bears a resemblance to the sudden
 reduction of a dislocated bone.   Some years ago
 a maniac  made several attempts to set fire to our
 hospital.  Upon being remonstrated  with, by Mr.
 Coats, one of its  managers he said, " I am a sala-
 mander;" " but recollect (said Mr. Coats) all the
 patients  in  the  hospital are  not  salamanders;"
 that  is true,  said the  maniac, and never after-
 wards  attempted to  burn the hospital.   Many
 similar instances of a  transient return  of reason,
 and some of cures, by pertinent and  well directed
 conversations, are to be met with in the records
 of medicine..

   3. Madness has sometimes been cured by tlie
 influence  of place, time,  and company,  upon
 the human  mind.  In  favour of the benefits of as-
 sociation  from place, I shall mention the following
 facts.  Vansweiten  relates a story  of a cabinet-
 maker, who always recovered his reason  as soon
 as  he entered his work-shop.  A  certain  Mrs.
 D---~, of this city, formerly a patient of mine, on 
OF  THE  MIND.
207
the 27th  of March 1792,  was suddenly  seized
with derangement on her way from market.  She
rambled for two hours up and down the city, and
at length was conducted to her own house.  The
moment she looked around her, she recovered her
reason,  nor did she relapse afterwards.   I have
known one clergyman, and have heard of another,
who were deranged at all times, except when they
ascended the pulpit, in which place they discover-
ed, in their prayers and sermons, all the usual
marks of sound and correct minds. I once  attend-
ed a judge, from a  neighbouring  state, who was
rational  and sensible upon  the  bench, but con-
stantly insane when off it.   Time, by its  influence
upon  a deranged mind, sometimes produces heal-
thy and regular associations of ideas and conduct.
The  late  Rev. Dr.-----, of Baltimore, was ob-
served to be less deranged on Saturdays, than on
any other day of the week, probably from that day-
being formerly  devoted  exclusively to retirement
and study, in preparing for the exercises  of the
ensuing Sabbatli.   Company  has  a similar eftect
in restoring healthy and regular associations in the
mind.   It  should always be of that kind  which
produced respect in former  times.   It will  readily
occur to the reader, that all these remedies, derived
from association, will be proper only in thedeclin-
and moderate state of the disease. 
^08
ON  HIE DISEASED
   4. Great care  should be taken by a physician,
to suit his conversation to the different and  vary-
ing states of the  minds of his patients in this dis-
ease.   In  its furious state, the\  should ne\ (r be
contradicted^ however absurd their opinions and
assertions may  be,  nor should we deny their  re-
epie sis by our answers, when it is improper to grant
them.   In the  second grade  of  this disease,  wc
should divert them from the subjects upon which
they are deranged, and  introduce, as if it were ac-
cidentally, subjects of another, and  of an agreea*
ble, nature.   When  they are upon the recovery,
we may oppose their opinions and incoherent tales
by reasoning, contradiction, and even ridicule.   I
attended a lady some years ago in our  hospital,
in whom this  practice  succeeded to my  wishes.
In the first and  raving  state  of her disease,  she
said the  spirit of general Washington visited and
conversed with here-very night.  I took no notice
of this assertion, but prescribed only for  the ex-
cited state of her pulse.  After this was  reduced,
I entered into conversation with  her, and  instantly
obtruded a subject foreign to the nightly visits ol
the spirit of general  Washington,  whenever  slit
mentioned it.  One day, when  she appeared ra-
tional upon all the subjects upon which we con-
versed, she lifted up  the skirt of her silk  gown,
and said, " See what  a  present general Washing- 
OF  THE  MIND.
209
 ton made me last night!"  O ! fie ! said I, Madam,
 I thought  you had more  understanding than to
 suppose general Washington would leave his pre-
 sent abode, to bring a silk gown to any lady upon
 the face of the earth. She  laughed at this rebuke,
 and  never  mentioned the  name of general Wash-
 ington to me afterwards, nor discovered any other
 mark of the remains of her disease.

   From the history of this case, we see there are
 the  same  acquiescing, diverting, and  opposing
 points in this grade of madness, that were men-
 tioned in treating upon the cure of tristimania, and
 amenomania, all of which should be carefully at-
 tended to,  in conversing with persons who are af-
 fected with it.

   We see  further  from this case, that the cure of
 mental and bodily disease is to be effected by the
 same means.  We first reduce the system, then
 create revulsive actions, and  finally remove sub-
sequent debility,  or  feeble morbid actions, by
stimulating remedies.   From the nature of the
last  of  these remedies, the necessity  of rescuing
maniacal patients from solitude must be very ob-
vious, in order to their producing a salutary effect.
Indeed they should never  be confined a clay after
                      D  D 
210
O.V  THE DISEASES
they cease to be disposed  to injure  themselves
or others.

   5. The  return  of regularity and order in the
operations of the mind  will  be much aided, by
obliging mad people to read with an audible voice,
to copy  manuscripts, and  to commit interesting
passages from books to memory.  By means  of
the first, their attention  will  be more  intensely
fixed upon one subject than by conversation.   In
this way only, they read  when alone,  and  in this
way only, the} comprehend what they read. They
revert  in this respect to the state of  childhood.
By copying manuscripts,  the  attention will be
still  more fixed to  one  subject,  and abstracted
from all others.   I  have witnessed the most salu-
tary  effects  from it, particularly in  a  gentleman
from  New England, whose cure was  completed
by transcribing a volume of lectures for a student
of medicine.  Committing  select passages from
books  to memory will be more  useful than either
of them, inasmuch  as it requires greater efforts of
mind to accomplish it.   To facilitate this mode
of exciting and regulating the faculties and opera-
tions  of the mind, a few entertaining books  of
history', travels, and prints, should compose a purt
of the shop furniture of every public and private
mad-house. 
OF THE MIND.
211
   6.  Music has been much commended in this
 state  of madness.  History  records two cures of
 royal patients being iffected by it.  Dr. Cox men-
 tions  a striking instance of its power over the mind
 of a madman.  It should be accommodated to the
 state  of the disease.  In that grade of it which is
 now under consideration, the tunes should be of a
 plaintive, that is, of a sedative nature.

   7.  Terror  acts  powerfully  upon  the body,
 through  the medium of the mind, and should  be
 employed in the cure of madness.  I once advis-
 ed gentle exercise upon horseback, in the case of
 a lady in Virginia who was deranged.   In one of
 her excursions  from home, her horse  ran away
 with  her.  He was stopped after a while by a
 gate.   The lady dismounted,  and when her  at-
 tendants  came up to her, they found her, to their
 great  surprise and joy,  perfectly restored to her
 reason, nor has  she had since the least  sign of a
 return of her disease.   A fall down a steep ridge
 cured a mania of twenty years continuance.  Dr.
 Joseph Cox relates three cures of madness by nearly
 similar means. Dr. M. Smith, of Georgia, inform-
ed me, that a madman had  been suddenly cured  in
 Virginia, by the breaking of a rope, by which he had
been let down into a well that was employed as a
 substitute for a bathing tub. He was nearly drown- 
212
ON  THE DISEASES
cd before he was taken out. The cures in all these
cases were effected, by the new actions induced in
the brain by the powerful  stimulant that has been
mentioned.  In  the use of it, great  care will  be
necessary to suit its force to the existing state of
the system.

   8. Fear,accompanied  with pain, and a sense
of  shame, has  sometimes cured this  disease.
Bartholin  speaks in high  terms of what he  calls
" flagillation" in certain diseases.   I  have  heard
of several instances of  its efficacy  in tonic  mad-
ness.   Two soldiers were cured by it in  the
American army, during the revolutionary war.  A
madman, who escaped from his  keepers in Mary-
land, ran to one of his  neighbours with an inten-
tion to kill him.  His neighbour met him with a
heavy whip, and beat him until he  fell upon his
knees,  and  implored him to  spare  his life.   lie
rose from his knees in a sound state of mind, and
had no symptom of his disease afterwards.   In
mentioning the  cures performed by the whip,  let
it  not be supposed that I am recommending it in
this state of madness.   Fear, pain,  and a sense of
shame, may be excited  in many other ways, that
shall not leave upon the memory of the patient the
distressing recollection,  that he owes his recovery
to such a degrading remedy. 
OF  THE  MIND.            213
  9. How far artificial grief might be employed
with advantage in this disease, I shall not deter-
mine, but I have heard of its having been sus-
pended for several days, in a clergyman now in
the Pennsylvania Hospital,  by the death of one of
his children ; and of mania of five years standing,
descending  to manalgia, in a  lady in New York,
by hearing of the death of her husband. It caused
her to weep for several weeks.  The disease in
this case, which had been diffused through all her
passions, was suddenly concentrated in but one of
them,  and in her understanding, from whence it
gradually passed out of her  system.  If these facts
should not be deemed a sufficient warrant to cre-
ate artificial grief, they will show that relief may
be expected, from  communicating to persons af-
fected with  this grade  of madness  the intelli-
gence of the death of their relations and friends.

   10. Convalescents from  derangement should be
defended from the terrifying or distressing
 noises  of patients in the raving state of this dis-
ease, by removing  the  latter to  small lodges,  re-
mote from the hospital, or  private mad-houses, or
 by confining them in cells  that  are made with
 double walls, doors, and windows, so as to ob-
 struct the passage of sound.  A relapse has often
 been induced by the neglect of this caution. 
214
ON  THE DISEASES
              CHAPTER   VII.

                II. Of Manicula.

  1  HIS second grade of general madness, which
 I have called manicula,  differs  from mania, as
 chronic  rheumatism  differs from that  which  is
 acute, that is, in being accompanied with a more
 moderate degree of  the same symptoms.  The
 pulse  is usually synochula, typhoid or typhus.
 It is in this state of madness that  we discover that
 peculiar sensibility to  cold, which is generally ab-
 sent in its  highest and lowest grades.   Shaks-
 peare,  who saw  this disease in common  life, and
 out of the restraints and conveniences of a  hospi-
 tal, has very happily illustrated this  symptom in
 the character of  Edgar, whom he often makes to
 exclaim in,  counterfeiting madness, " poor Tom's
 a cold."   From  the operations of fresh exciting
causes, manicula now and then rises  into mania,
in which state  it is sometimes cured, but it of-
tener descends in a few days or weeks to its chro-
nic, or habitual form.  It is now and then com- 
OF  THE  MIND.            215
bined with  typhus fever, in which  state  it has
been called by Dr. Cullen typhomania.  We see
it occasionally in the last stage of the puerperal,
the jail, and autumnal fever.

  The  remedies  for  this grade  of  madness
should be the same  in its inflammatory state  as
for mania, but of less force.   In its  typhoid and
typhus states, they should be the same as in the
declining state of mania, with the addition of gar-
lic in substance or infusion, and the different pre-
parations of iron.  In the typhomania, the reme-
dies  should be  combined with those usually em-
ployed in  the treatment of typhus fever, particu-
larly bark and opium.   The latter is an invalua-
ble medicine in such  cases. The dose of it should
be much larger  than in common diseases of the
same grade  of action. 
216
ON  l'HE DISEASE8
             CHAPTER  VIII.
                      ■

              III. Of Manalgia.

 1HE symptoms of this  third and last form of
general madness are, taciturnity, downcast looks,
a total neglect of dress  and person, long nails
and beard, dishevelled or matted hair, indifference
to all surrounding objects, insensibility  to heat
and cold.   A remarkable instance of insensibili-
ty to the latter occurred  in a  certain Thomas
Perrin,  who  was admitted into the Pennsylvania
Hospital, with manalgia, in March  1765, and who
died there in September  1774,  during all which
time he ate and slept in the cupola of the hospital,
and never, in the coldest weather of nine  winters,
came near to a fire.  A fixed position of the body
sometimes attends this form of madness.   Of this
there have been two remarkable instances in our
hospital.  In  one  of them, the patient sat  with
his  body  bent forward for three  years, without
moving, except when compelled  by  force, or 
OF  THE  MIND.            217
 the calls of nature.   In the other, the patient oc-
 cupied a spot in a ward, an entry, or in the hospi-
 tal yard,  where  he appeared more  like a statue
 than  a man.  Such was the torpor of his nervous
 system,  that  a  degree of  cold, so intense as to
 produce inflammation and gangrene upon his face
 and limbs, did not move him from the stand he had
 taken in the open air.  The cause of this young
 man's insanity was  as singular as its nature.  It
 was induced by his father's selling a pleasant farm,
 upon the Delaware, in the neighbourhood of Phila-
 delphia, on which he was born, and had passed his
 youth,  and which he expected to inherit after the
 death of his father.  The skin in manalgia is dry,
 coiei,  pale, yellow, brown, lived, and dark colour-
 ed, and now and then covered  here  and there
 with black spots.   The eyes, when originally dark,
 acquire a light colour  in this disease.  I took no-
 tice formerly  of  the  prevalence of  this colour in
 the deranged  patients  in the Pennsylvania  Hospi-
 tal.   It probably  arises from  the tendency of the
 system to dissolution,  for  we frequently see it in
the last stage  of  pulmonary consumption, and it
rarely  fails to take place in old age.  The appe-
 tite in manalgia is inordinate or weak, the bowels
are costive, the urine is scanty in quantity, and
 there  is some times a  discharge or  slabbering of
 saliva.  This symptom with one other, was select-
                    r. e 
218
ON  THE DISEASES
cd by David,  when  he counterfeited  madness,
in order  to  prevent the discovery of  his  per-
son by the king of G ith, after his escape from the
hands of Saul.   " And he changed his behaviour
before them (says the sacred  historian) and feign-
ed himself mad, and scrabbletl upon the  doors of
the gate, and let  his spittle  fall  down  upon  his
beard."   The discharge of saliva in this case ap-
peared to be involuntary, and in this we perceive
a  distinguishing mark  between  manalgia  and
tonic  madness, in the latter  of which, I  said for
merly, the saliva  is  discharged with difficulty by
spitting.   The respiration is slow, the breath and
perspiration have  a  peculiar  and  offensive smell,
and the pulse is languid and  frequent, but some-
times natural.  Nebuchadnezzar seems  to have
been  affected  with   this low grade of  madness.
He was  said to resemble a beast, probably from
the uncommon growth of his hair,  beard,  and
nails.

  A strong attachment to tobacco is common in
the patients who  have been previously in the ha-
bit  of using it.  They  frequently ask  strangers
for it, or for a few cents to buy it.

  These are the usual symptoms of manalgia in
hospitals,  but when persons who are affected with 
OF  THE  MIND.             219
it possess their liberty, they rather seek for, than
shun human society.   They  are often  admitted
by private families to pass  nights in their kitch-
ens,  garrets,  or  barns.   Sometimes they wander
through  neighbourhoods in  the capacity of beg-
gars.  Shakspeare has described this state of de-
rangement, very  accurately,  in  the character of
Edgar, in  King Lear, when he  makes him adopt
the resolution of counterfeiting the character of a
madman.
   " I will (says Edgar) take the basest and poorest shape,
   That ever penury, in contempt of man,
   Brought near to beast.   My face I'll grime with filth.
   Blanket my loins, tie all my hair with  knots,
   And, with presented nakedness, out-fac©
   The winds, and persecutions of the sky:
   And with this horrible object, from low farms,
   Poor pelting villagers, sheep cotes, and mills,
   Sometimes.with lunatic bans, sometimes with prayers.
   Enforce their charity."

   There are some instances  in which the moral
faculties  are  impaired  in manalgic patients, in
which case they  are mischievous and vicious, but
they are  more generally inoffensive,  and disposed
to be kind,  and even  useful, in hospitals and fa-
milies.  In some of them,  the  sense  of Deity is
not  only unimpaired,  but  in  an elevated  state.
The mad poet, Christopher Smart,  often  kneel- 
220           ON THE DISEASES
ed down and  prayed in the streets of  London,
when he was  permitted to  leave his  house, and
he never suffered any of his  visitors to leave him,
without requesting them to  pray with him.

  A late poet has described this  pious form of
manalgia, in a young woman, very happily in the
following lines :

   "  But her praise was still, to br
   Where holy  congregations bow.
   Wi.ipt in wild transports, while they sang ;
   And when they pray'd, would bow her low."

  Madness in this form sometimes continues for
ten,  fifteen, twenty, and  even  fifty years,  when
not accompanied  with  paroxysms, but it  more
generally  terminates  in death in a shorter  time,
and frequently by diseases,  to be mentioned here-
after.

  The equanimity of temper,  together  with the
want of exercise, and the inordinate appetite, which
generally accompany this  disease, sometimes pro-
duce obesity.   They had that effect, Dr. Johnson
tells  us, upon Mr. Smart.   I have seen two in-
stances of  it  in Philadelphia. 
OF  THE  MIND.
221
  The remedies  for manalgia should con-
sist,  like those under a former head, of such as
act,

  I. Upon the mind, through the medium of the
body ; and,

  II. Upon the body,  through the medium of
the mind.

  I. To the first head belong,

  1. Cordial food and drinks.  The former should
be  made savoury and grateful  to the taste, and
the  stimulus  from  the  pleasure imparted  by  it
should  be  increased by its  variety.   The latter
should  consist of wine, cyder and malt liquors.
Ardent spirits  should be given with great caution,
lest  a destructive fondness should be acquired for
them.   There is least  danger of  this being the
case, when they are given  in  an undiluted state
once or twice a week.  I  have seen the most
beneficial  effects from them, when administered
in this manner.  To patients in whom this form
of  madness has been  induced  by  intemperance
in drinking, they may be given daily, and in libe-
ral quantities. 
222
ON  THI  BISEASES
  2. The warm bath.  The water should be
heated above the natural temperature of the body,
in which state it acts powerfully upon the arterial
system. I have once known it induce 150 strokes
in the pulse in a minute, and excite the brain into
delirium, in an experiment made upon himself by a
student of medicine in the university of Pennsylva-
nia. From the occasional effects of levers, which act
in a similar  way upon the blood-vessels, I have been
led to think highly of the remedy.   An epidemic
fever, many years ago, pervaded the cells of our
hospital,  which restored the greatest part of the
maniacs to  their  reason.  These accidental cures
struck the late Dr. Bond  so forcibly, that he  at-
tempted to excite  a fever in several of his pa-
tients in manalgia afterwards, by  sending them to
the swamps of Gloucester county, near to the city,
in the state of New Jersey.   With what success
I have never heard.

  3. The cold  shower bath.  The impulse
imparted to the head by the descent of the water
upon it adds very much to its efficacy,  and gives
it great advantages over the plunging bath.

  4. The cold shower bath, in succession to the
warm bath.   While I attended the  Pennsylvania
Hospital in the summer of 1785, I often employ 
OF  THE  MIND.
223
ed these two remedies in the manner I have  men-
tioned.  I  kept  my torpid  patient in the warm
bath for an  hour or two, and  then led him, smoak-
ing with vapour, to the shower bath, which gave a
most powerful shock  to his  system.  It extorted
cries and groans from  persons that had been dumb |
for years.    In one case it relieved, and in another, j
it restored reason to  my patient; but  from his i
being confined in a damp cell, he died some time I
after his recovery from his madness,  of  a puimo-y
nary consumption.

   5. Exciting an artificial diarrhoea. In the tonic
state of madness, purging, I said formerly, acted
as a depleting remedy.  In manalgia it does good,
 by exciting a revulsive action or disease, in a less
 delicate part of the body than the brain. Nature,
 I said formerly, sometimes  cures manalgia  in this
 way.   An instance of a cure from this  cause oc-
 curred in  our hospital some years ago, in a woman
 who had  been  deranged nine years.   An  acute
 dysentery cured it  in a woman in Chester county,
 after it had continued two  years.  It may  be ex-
 cited by  a laxative diet, or any gently opening
 medicine.

    6. A Caustic applied to the back of the neck,
  or  between the shoulders,  and kept open  for 
-24          ON  THE DISEASES
months or years.   This remedy acts  by the per-
manent discharge it induces from the neighbour-
hood of the  brain.   Four patients have been cur-
ed  of  manalgia in our hospital, by abscesses in
different parts of the body.   One  of them  had
passed a third of his life  in  the hospital.   Dr.
Johnson  iehs us,  in  his Lives of the Poets, that
Dv.au Swift had a temporary return of his  reason
during the  continuance of an abscess in his eye.

   7. A salivation.  I  know it is difficult to
excite  this disease in the throat and mouth in ma-
nalgia, but the mercury, if given ineffectually for
this purpose, will be  useful as a general stimu-
lant and tonic.   It will moreover serve to remove
visceral obstructions, which so generally succeed
madness.  Where it excites a salivation, it seems
torecuscitate the  mind.  I have seen two instan-
ces in  our  hospital,'in which  a taciturnity of  a
year's  continuance was removed by  it.   Speech
was excited, in one of them, on the very day on
which the mercury affected the mouth, and  the
use of reason followed in a few da) s afterwards.

   8.  Exekcise.  This should  con^t  of  swing-
ing, seesaw, and an exercise  discovered by Dr.
Cox, which promises more than either of  them ,
and that is, subjecting the patient to a rotatory mo- 
OF  THE  MIND.
225
 lion, so as  to  give a centrifugal direction of the
 blood towards the brain.   He tells us he has cur-
 ed eight persons of torpid madness by  this mode
 of exercise.  I have contrived a machine for this
 purpose in our hospital, which produces the same
 effects upon the body  which are mentieuied  by
 Dr.  Cox.  These are vertigo and  nausea, and
 a general perspiration.  I have called it a Gyrater.
 It would be more perfect, did it permit the head
 to be placed at a greater  distance from its centre
 of motion.   It  produces great changes in the
 pulse.  In one experiment made with it, it increased
 the  pulse from 84 to 88 strokes  in one  minute,
 and to 120 in  two minutes.   It increased its ful-
 ness  at the same time.   In a second experiment
 made upon a  manalgic patient, it increased  the
 frequency of the pulse from 104  in two  minutes
to 150.   In a third  experiment it reduced  the
 pulse from  108 in three minutes to 100,  and les-
 sened its force.  In this patient, the pulse was pre-
 ternaturally active before  he entered  the  gyrater.

   From the strong impression this mode of ex-
 ercise makes  upon the brain,  there is reason  to
 believe it will be a  useful remedy in  manalgia.
 A cheap contrivance, to answer all its purposes,
 might easily be made, by  placing a patient upon a
 board moved at its centre upon a pivot,  with his
                       F  F 
22b           ON  THB  DISEASES
liead towards one of its extremities, and then giv-
ing it a rotatory motion.   The centrifugal force of
the blood would exceed, in this way,  that which
it receives from the chair employed by Dr.  Cox,
or from the gyrater in the Pennsylvania Hospital.
In addition to  these exercises,  pleasant amuse-
ments should  be  contrived for this class of mad
people.   If they are  unhappy, these amusements
will suspend their misery.   If they are in a tor-
pid state, a transient sense  of pleasure  will be  ex-
cited by them, which may  serve to remind them
that the chain is still unbroken which united them
with their fellow men.

   9.  Labour has several advantages over exer-
cise,  in being  not  only  more stimulating,  but
more durable  in  its  effects, whereby it  is more
calculated to arrest  wrong habits of  action,  and
to restore such as  are regular and natural.   It has
been remarked, that the maniacs of the male sex
in all hospitals, who assist  in cutting wood, mak-
ing fires, and digging in a garden, and the females
who  are  employed  in washing,  ironing,  and
scrubbing  floors, often recover,  while  persons,
whose  rank exempts them from performing such
services, languish away their lives within the walls
 of the  hospital.  In favour of the benefits of la-
 bour, in curing this disease, I shall select one from 
OF  THE  MIND.
227
among many facts that might be mentioned.   In
the year 1801  I attended an English gentleman,
soon after his arrival in America, who was afflicted
with this  grade of madness.  My  prescriptions
relieved, but did not  cure him.  He returned to
his family in Maryland, where,  in the time of hay
harvest, he  was allured  into  a  meadow, and pre-
vailed upon to  take a rake into his hands, and to
assist in making hay.  He worked for some  time,
and  brought on thereby  a profuse sweat, which
soon carried off his disease.   This account of his
remedy and cure I received from himself, in a
very sensible letter written a few weeks after  his
recovery.   I have often  wished,  and lately ad-
vised,  that the  mad people in our hospital should
be provided with the tools of a number of me-
chanical arts.  Some of them  should be labori-
ous, and employ the body chiefly ; others ingeni-
ous, and of a  nature to  exercise  and divert the
mind more than the body.  None of them should
be carried on by instruments, with which it would
be  easy for the  maniacs  to hurt themselves or
others.   For certain  exploits of industry or skill,
they should receive such rewards in food, or dress,
as accord most with  their inclinations, for few of
them are capable of any higher or other gratifica-
tion.  The advantages of thus producing a cur-
rent of new actions,  both corporeal and  mental, 
228
•N  THE DISEASES
which should continue for weeks and months, and
perhaps years, could not fail of being accompa-
nied  with  great advantages.  Some  emolument
might likewise be derived from  their labour to
their  friends, or to the institution  that supported
them.  What a different view  would a number
of mad people exhibit, all thus imitating  the ha-
bits of rational industry, compared with the antic
gestures, the rapid or sauntering walks,  the list
less attitudes, and the vociferous or muttering
conversations  they hold with  themselves,  with
which they excite pity or horror in all  who see
them.

   In both the exercises and labours of mad people,
thev should be as much separated from each other
aspossiblc. We are naturally imitative animals; and
our minds are formed  in a degree by ambient cir-
cumstances ; lor which reason mad people should
associate and  work only with  persons of sound
and healthy minds.

   10. Music should  not be omitted as a  reme-
dy  in  this state of  madness.   The tunes employ-
ed for this  purpose should be of the most invigo-
rating nature. 
OF  THE  MIND.
229
 11. Great pain.   Mr. Stewart, the pedestrian
traveller, informed me,  that he once saw a tran-
sient  interval  of reason  induced upon  several
idiots in Italy, by means of torture, inflicted from
pious, but superstitious, motives, by some priests.
Dr. Cox  mentions an instance of chronic madness
being cured by trepanning, and of the same good
effects being produced by accidental contusions of
the head.   It is probable they both acted only by
inducing  pain.   The  return  of reason, which  I
shall  say  hereafter  sometimes takes place in  the
last hours of life, is  probably  occasioned,  in part,
by the bodily pains which attend the passage  out
of life.   Should this remedy be resorted to,  it
should be induced by means  that are not  of a  de-
grading  nature,  and which  are calculated at the
same time to excite some violent passion or emo-
tion of the mind.

   12. Errhines.   These are suggested by the
 general absence of  secretion  in the nose in  mad
 people, and  by the relief which the discharge  of a
 few  drops of tears affords  in tristimania.  The
 insensibility of the  nose  to the stimulus  of com-
 mon snuff, from its habitual use by that class  of
 patients, forbids us to expect any benefit from  it,
 for which reason the sulphate of mercury, and the 
230           ON  THE  DISEASES
muriate of  ammonia,  mixed with a little flour,
should be preferred for that  purpose.

   13.  Certain odours.  The dyer, formerly
mentioned, informed me, that he had often observ-
ed the men that were employed in  dying scarlet
to be uncommonly  cheerlul,  and sometimes to
sing from morning till night.  The odour which
produces this effect is derived from a mixture of
cochineal with a solution of tin in the nitric acid.
The exhilaration produced by the fragrance of a
flower garden in the spring of the ye-ar, and of the
Spice Islands in the Indian Ocean, favours the idea
still more, of exciting the brain by means of plea-
sant odours applied to the organ  of smelling.

   14.  What would be the effect of loud and un-
common sounds, acting through the ears, upon
the brain and mind in this disease ? Menalgic pa-
tients, it has been observed, are much excited by
the military music  that  sometimes passes by
the Pennsylvania  Hospital.  It  is  still more in
favour of loud sounds, or noises, in manalgia, that
in the lowest stage of typhus fever,  they have re-
called departing life ; and in asphixia, restored  it
from  its  apparent extinction in death. 
OF THE  MIND.
231
  15.  Exciting  certain  stimulating passions
and emotions, also the domestic  affections.
I mentioned several instances of the good effects
of terror, in tristimania,  and in  tonic madness
in its declining  state.  To  be useful in manal-
gia,  it should  be often repeated.   Of  the good
benefits  of  anger,  I shall  mention  a  striking
instance.  Mr. Derborow, whose name was men-
tioned formerly, during his long confinement in
our hospital, in a state of manalgia,  became silent
for several months.   Many attempts were made
to compel him to speak, but to no purpose.  The
late Dr. Thomas Bond at length contrived to force
him  to break his long and obstinate silence.  It
was  the practice of Mr. Derborow to amuse him-
self  occasionally  during  this time  in  drawing.
 One day the Doctor looked over his shoulder, and
 saw the picture of a flower under his pencil. *' A
 very pretty cabbage," said the Doctor.  " You are
 a fool and a liar," said Mr. Derborow, " it is a
 flower."  From  that time  he continued to speak
 as usual.   Reading aloud and incorrectly to pa-
 tients in  this situation  has sometimes induced a
 transient feeling of uneasiness or irritation, which
 has  unsealed their lips, and revived their former
 habits of conversation. 
232
ON  THE DISEASES
    The advantages to be expected from exciting
 the domestic affections will  appear lr, in the lol-
 lowing fact.  A woman  in our hospital  was de-
 livered, many years  ago, of a  fine child during
 her derangement, which was of a chronic and tor-
 pid nature.   The affection  which  was  suddenly
 awakened for this child, removed  her disease for
 several days.  The child was taken from her breast,
 lest it should contract the seeds of madness from
 her milk.   Her disease immediately returned, and
 she  i> now,  and probably always will be, an in-
 curable tenant of our hospital.

   There are several  medicines  which have been
 given in this disease, upon which I shall make a
 few remarks.  These arc,

   16.  Opium,  iron, the datura  stammoniura,
 strong infusions of green tea  and green  coffee,
 garlic, valerian, the nitrous oxyd, and electricity.

   I  have administered all these medicines in this
 disease in the Pennsylvania He>spital, and some of
 them for  several months, but never  in  a single
instance with success, when given alone.   Garlic
now and  then produced  a  temporary frequency
and  fulness in the pulse, and electricity  has pro-
duced a transient excitement in  the temper,  but 
of the mind.            233
neither of them  made  a permanent  impression
upon the  disease.  Where  a recovery has suc-
ceeded the use of any of those medicines,  I have
supposed the disease was cured by time, instances
of which will be mentioned  hereafter.  In thus
stating the inefficacy of the above  medicines in
manalgia,  I would by no means reject them alto-
gether.  They may be  given as  auxiliaries to
those more powerful and rational remedies which
agitate the whole body and mind.

  In the use of all our remedies for manalgia, an
advantage will arise  from prescribing them in suc-
cession and rotation, and in choosing certain sea-
sons of the year, according to the habits of the pa-
tient, for their exhibition.

  To encourage us to persevere for years in the
use of remedies for  this disease, or to wait for a
cure from the hand  of time, founded  upon those
spontaneous changes that are always going forward
in the human body,  I shall select two cases of re-
coveries from among many others, the one from
the former, the other from the latter cause.

  1.  In the year 1795 a young man of the name
of Donaldson,  from York county, in  Pennsylva-
nia, was admitted into our hospital,  in the lowest
                    g  g 
^34
ON  il\L  DISEASES
state of manalgia.   He had been in that situation
between four and Gve years.  He appeared to have
no mind,  and scarcely  any locomotive  powers.
When placed  at the head of a pair of stairs,  he
rolled to the bottom of it.  By means of most of
the remedies I have recommended, he was nearly
cured.  He acquired the use of his speech, knew
his attendants, and called me by my name when I
visited him.   Unhappily, in his progress to a per-
fect cure he was attacked with a malignant fever,
and  died  in the hospital on the  fifth day of  his
disease.

   2.  The following account of a spontaneous  re-
covery was communicated to me, many years ago,
by Dr. A.  Hunter, with his History of the Luna-
tic Asylum in York, in Great Britain.

   "  On the twenty-fifth of October,  1778, a sea-
faring person, about forty years of age, was  re-
commended to  the Lunatic  Asylum for  cure.
About two  years before that time he had sustain-
a considerable loss by sea, which operated so vio-
lently upon his mind, as to deprive  him,  almost
instantly,  of all  his reasoning faculties.   In that
state of insensibility he was received into the Asy-
lum.   During his abode there, he was nevtr ob-
served to express any desire for nourishment; and 
•f  the  mind.            235
so great was his inattention to this particular, that
for the first six weeks it was necessary to feed him
in the  manner of an infant.  Food and medicines
were equally  indifferent to him.  A servant  un-
dressed him  at night,  and dressed him in  the
morning; after which he was conducted to his seat
in the  common parlour, where he remained all
day with  his body bent, and his  eyes fixed upon
the ground.  From  all the  circumstances  of  his
behaviour, he did not appear to be capable of re-
flection.   Every thing was indifferent to him ; and
from  the  fairest judgment that could be formed,
he  was considered by all about him as an  animal
converted nearly into a vegetable. In this state of in-
sensibility he remained till the morning of Tuesday
the fourteenth of May,  1783,  when,  upon enter-
ing the parlour, he saluted the  recovering patients
with  a " Good morrow to  you  all."  He  then
thanked the servants of the house, in the most af-
fectionate manner, for their tenderness to him ; of
which, he said, he began to be  sensible some
weeks before, but had not till  then the resolution
to express his gratitude.  A few  days after this
unexpected return to reason, he was permitted to
write a letter to his wife, in which he expressed
himself with decency and propriety.   At this time
he seemed to have a peculiar pleasure in the enjoy-
ment of the open air, and in his walks conversed 
23(3
ON  THE DISEASES
with freedom and serenity.  Talking with him on
what he felt  during the suspension of reason, he
said  that his mind was totally lost; but that about
two  months before his return to himself, he began
to have thoughts and  sensations: these, however,
only served to convey to him fears and apprehen-
sions, especially in the night  time.   With  regard
to his medical treatment, I shall only observe, that
the medicines usually prescribed for melancholic
persons were, in his case, studiously avoided, and,
instead of evacuants,  cordials and a generous diet
were constantly recommended.   Had the natural
powers been weakened, I am satisfied that the mind
never would have regained her empire.  During
the remainder of his stay in the Asylum, he con-
tinued to behave himself with steadiness and pro-
priety.   He ate  and drank  moderately, and upon
all occasions  shewed a gentle and benevolent dis-
position.  Finding his mind sufficiently strong, he
returned to his family on the twenty-eighth of May,
1783.   Soon after this  he  was  appointed  to the
command of  a ship employed in the Baltic Trade,
in which service he is at this time engaged."

   I  shall dismiss the  history of all  the  different
forms of madness, and of their respective remedies,
by remarking  that they do  not always occur in
the  order  in which they have  been  described 
OF  THE  MIND.
237
Partial and  general  madness sometimes precede
 and sometimes succeed each  other.  Manicula
 sometimes  exists  without mania, and both, with-
out  being  succeeded by manalgia.   There  are
 instances in which manalgia has preceded mania,
 and manicula; and lastly, we now and then see them
 all combine, and alternate* with each other.   From
 this view of the successive and alternate changes
 of the different forms of madness into each other,
 we  derive fresh proofs of Jthe unity  of  its cause,
 and the necessity of renouncing all  prescriptions
 for its names, and of constantly  and closely watch-
 ing the disease,  in order to vary  our remedies
 with its varying forms.

   I shall now make a few remarks, which are alike
 applicable  to all the forms of general madness.

    1. Great regard should be had to cleanliness in
 the persons and apartments  of mad people.  This
 is indispensably necessary,  not only  for their com-
 fort,  but  their cure.  A deranged  man, with a
 ragged dress, a dirty skin,  long nails and beard,
 and uncombed hair, or with his dress and person
 in  neat order, in a  filthy room, loses his consci-
 ousness of his personal identity ; and until this be
 restored, it is in vain to expect a return of the na-
 tural habits of his mind.   A close  stool,  with a 
238
ON  THE  DISEASES
pan half filled w ith water, in order to suffocate the
fee tor of his  evacuations, should be fixed in his
room,  with a cover, which should fall  down  of
itself upon the stool after it is used.

  2. Mad people should never be visited, nor even
seen by their friends, and much less by strangers,
without being accompanied by their physician,  or
by a person  to whom he shall depute his power
over them.   The  dread of being  exposed,  and
gazed at in the cell of a hospital by  an unthinking
visitor,  or an unfeeling  mob, is one of the great-
est calamities a man can anticipate in his tendency
to madness.  The apprehension of  it was so dis-
tressing to a  young gentleman in this city in a  fit
of low spirits, that he prevented  it, by discharg-
ing the contents of a loaded musket through his
brain.   But there is another advantage from con-
cealing the persons of inad people from the t) e  of
visitors  and the public.   The disease is supposed
to fix something of  a repelling nature upon per-
sons and famines, and hence it is often concealed
or denied.  Now,  by rendering the  place  in which
mad people are  confined, private—I had almost
said  sacred—members  of families may be  sent
there w ithout its being known.  Nay, they will be
sent  there upon the first appearance  of the disease,
in order to prevent its being known, and  the dis- 
OF  THE  MIND.
239
ease thereby be more frequently cured. This pri-
vacy would act with  peculiar force upon the fe-
male sex.  The obliquity and  convulsions of the
moral  faculties, which sometimes  take  place in
madness, would in this way never be known, or,
if known, would be forgotten, or never divulged.
To render a hospital still more agreeable, or less
the object  of aversion by the female sex,  they
should be carefully separated from  the men, and
they should be nursed only by  women.

   3.  In the  history  of all  the forms of general
madness, it was remarked that they were all attend-
ed, now and then, with the cheerfulness of ameno-
mania, but oftener with the distress of hypochon-
driasm.   In the latter case, it will be necessary to
use all the precautions to prevent suicide,  that were
recommended in treating upon that disease.

   4. We should be careful to distinguish between
a return of reason and a certain cunning, which
enables  mad  people to talk and  behave correctly
for a short time,  and thereby to deceive their at-
 tendants,  so  as to obtain a premature discharge
from their place of confinement.  To prevent the
evils that might arise  from a mistake of this kind,
 they should  be  narrowly  watched  during  their
convalescence, nor should they be discharged, un- 
240          ON  THE DISEASES
til their  recovery  had been confirmed  by weeks
of correct  conversation and conduct.   Three in-
stances of suicide have occurred in patients soon
after  they left the  Pennsylvania  Hospital,  and
while they were receiving the  congratulations of
their  friends upon their recovery.   The disease,
in these  cases, was probably  revived by  two
causes,

   1. By means of  association,  from the sight of
persons or objects  that first excited it,  or that
were first connected with  it; and,

  2. By exchanging the  large and noisy society
of the hospital,  for  the comparative solitude and
silence of a private family.

  The madness of Dr. Zimmerman, which  had
been suspended for three months  by  travelling,
returned  on the day he entered his own house.
To prevent this fatal or distressing recurrence  of
madness,  it would  be a  good  practice to send
patients abroad, or to reside for some time among
strangers, before  they returned  to  their families.
All me means  of destroying themselves should,
at the same time, be  kept  out of their way. 
OF  THE  MIND.           241
  The recurrence of madness,  after it has been
cured, is no objection to the power of medicine
over it.  There are  frequent returns of catarrh,
pleurisy, and intermitting  fever,  after they have
been cured,  and yet we do not ascribe them to
the uncertainty or imperfection of our science.
Of twenty-five persons that were cured of mad-
ness,  by Mr. Pinel,  but two relapsed  in the
course  of  five years,  which  is  probably much
less than the  relapses  which  occur  from the
other diseases that were mentioned.

   I cannot  conclude this  part  of the subject of s
these Ir-iqucies,  without lamenting the want of
some person  of prudence  and  intelligence in all
public receptacles of mad people, who should live
constantly with them, and have the  exclusive di-
rection of  their minds.  His business should be,
to divert them from conversing upon all the sub-
jects  upon which they had been deranged, to tell
them pleasant stories,  to read to  them select pas-
sages from entertaining books, and to oblige them
to  read to  him ;  to  superintend their  labours of
body and  mind;  to preside at the table at which
they take their meals, to protect them from rudeness
and insults from their keepers, to walk and ride
with them,  to partake with them  in their amuse-
ments, and to regulate the nature and measure of
                        H  H 
2X2
ON  1HE DISEASES
   their punishments.  Such a person would do more
.  good to mad people in one month, than the visits,
   or the accidental company, of the patient's friends
   would do in a year.  But further.  We naturally
   imitate the manners, and gradually acquire the tem-
   per of persons with whom we live, provided they
   are objects of our respect and affection.   This has
   been observed in husbands  and wives,  who have
   lived long and happily together, and even in ser-
   vants, who  are strongly attached to their masters
   and mistresses.   Similar effects might be expect-
   ed  from the constant presence of a person,  such
   as has been described, with mad people, indepen-
   dently of his performing for them any of the ser-
   vices that have  been mentioned.  We render a
   limb that has been broken,  and bent, straight,
   only by keeping it in one place by the pressure
   of splints and bandages.  In like manner, by keep-
   ing the eyes and ears  of mad  people  under  the
   constant impressions of the countenance, gestures,
   and conversation of a man of a sound understand
   ing, and correct conduct, wc should create a pres-
   sure nearly  as mechanical upon their minds, that
   could not fail of having a powerful  influence,  in
   conjunction with other remedies, in bringing their
   shattered and  crooked thoughts into their original
   and natural order. 
OF  THE  MIND.
243
   In reviewing the slender and inadequate means
that have been employed for ameliorating the con-
dition  of  mad people,  we are led  further to la-
ment the slower progress of humanity in its efforts
to relieve them,  than any other class of the afflict-
ed children of men.  For many centuries they have
been treated like criminals, or shunned like beasts
of prey ; or, if  visited, it has been only for the
purposes of inhuman  curiosity and amusement.
Even the ties of consanguinity have been dissolv-
ed by  the walls  of a  mad  house,  and  sons and
brothers have sometimes languished or sauntered
away their lives within them,  without once hear-
ing  the accents of a kindred voice.   Happily
these times of cruelty to this  class of our fellow-
creatures, and insensibility to  their sufferings, are
now passing  away.  In Great Britain, a humane
revolution, dictated by modern improvements in
the science of the mind,  as well as of  medicine,
has taken place  in the receptacles of mad people,
more especially in those that are of a private nature.
A similar change has taken place  in the Pennsyl-
vania Hospital,  under the direction of its present
managers,  in  the condition  of the deranged sub-
jects of their care.   The clanking of chains, and
the noise of the  whip, are no longer heard in their
cells.  They  now  taste of the- blessings of air,
and light and motion, in pleasant and shaded walks 
244
ON THE  DISEASES
in summer, and in spacious entries,  warmed by
staves hi winter, in both of which the sexes are
separated, and alike protected from the eye of the
visitors of the hospital.   In  consequence of these
advantage's they have recovered the human figure,
and,  with it, their long  forgotten relationship to
their friends and the public.   Much, however, re-
mains yet to be  done  for their comfort and relief.
To animate us in filling  up  the measure of kind-
ness  which has  been solicited for them, let us re-
collect the  greatness of  its  object.   It  is not to
feed  nor clothe  the body, nor yet to cure one of
its common diseases   it is to restore the disjoint-
ed or debilitated faculties of the  mind of a fellow-
creature "y  to their natural order  and offices, and

  * The following short extract, taken down by Mr. Coats,
from Uic constant conversation of a young man of a good
cducition, anel  respectable  connections,  now  deranged
in the Pennsylvania Hospital, will  exhibit  an affecting
specimen of  this disjointed state of the mind, and of the
incoherence of its operations. . " No man  can serve two
masters.  I am king Philip of Macedonia,  lawful son of
Mery queen of Scots, born in Philadelphia.  I have been
happy enough ever since I have seen general Washing-
toi with a silk handkerchief in High-street.   Money com-
m.a»ds s'lbiunuiy things, and makes the mare go; it will
bm sail mackerel, made of ten-penny nails.   Knjojmcnt
is ti.e happiness of virtue.   Yesterday cannot be recalled.
I can only walk in the night-time, when I  can cat pud- 
OF  THE  MIND.
245
to revive in  him  the knowledge  of himself, his
family, and his God.

   But in performing this atchievement of skill and
humanity,  we not  only confer a  positive good,
but  we remove a positive evil, which has no par-
rallel in the list of human sufferings.  If there were
no other  reason to believe this was the case,  than
the distress which takes place from a slight irregu-
larity in  the circulation of the blood in the brain,

ding enough.  I shall be eight years old to-morrow.  They
say R. W. is in partnership with J. W.  I believe they
are about as  good as people in common—not better, only
on certain occasions, when, for instance, a man wants to
buy chincopins, and to import sail to feed pigs.  Tanned
leather was imported first by lawyers."  Morality with vir-
tue is like vice not corrected.   L. B. came into your house
anel stole a coffee-pot in the twenty-fourth year  of his ma-
jesty's reign.  Plumb-pudding and Irish potatoes make a
very gooel dinner.  Nothing in man is comprehensible to
it.  Born in Philadelphia.   Our forefathers were better to
us than our children, because they were chosen for their
honesty, truth, virtue and innocence.  The queen's broad
R originated  from  a British  forty-two pounder,  which
makes two large a report for me.  I have no more to say.
I am thankful I am no worse this  season,  and that I am
sound in mind and memory, and could steer a ship to sea,
but am afraid of the  thiller.  ************ son of  Mary
queen of  Scots.  Born in  Philadelphia.  Born in Phila-
delphia.   King of Macedonia." 
 246           ON  THE  SISEA FS
 in  a great majority of our dreams,  it would  he
 sufficient to render their assertion  probable ;  but
 we have  many proofs  of  its  being strictly true.
 The tearing of clothes, so common in this disease,
 was one  of the instituted signs of deep distress
 among the Jews, and it was so probably, from its
 being  one of its natural signs  among the nations
 of the  East.   The  hollowing,  stamping with the
 feet, and the rattling of chains,  so generally practi-
 sed by mad people, are all resorted te), in order to
 excite  such counter-impressions upon their ears,
 as shall suspend or  overcome, by their force,  the
 anguish of their minds.  They wound and man-
 gle their  bodies  for the  same purpose.  Even in
 those solitary cases  of general madness, which arc
 accompanied with  singing and  laughter, there is
 good reason to believe the heart is depressed with
 sadness.   Nor are the silence,  and seeming apa-
 thy of  manalgia,  always signs of the absence  of
 misery.  The  " willow weeps,"  says  the poet,
 " but  cannot feel; the torpid  maniac feels, but
 cannot weep."   In  maintaining the general exis-
tence of misery in all the forms  of derangement, I
am supported, not only by the acts that have been
mentioned, but by the authority of Shakspearc, in
the following view of the images and feelings that
usually harrow up the imaginations of mad peo-
ple. 
OP  THE MIND.
247
   u Who gives any thing (says Edgar) to poor Tom,
   Whom the foul fiend has led through fire,
   And through flame, through ford, and whirlpool,
   Over bog and quagmire, that hath laid
   Knives under his pillow, and halters in his pew,
   Set rats-bane by his porridge, made him to
   Ride upon a bay trotting horse, over four-inch
   Bridges, and to course his own shadow for a traitor."

   And again, Lear,  in a language still more ex-
pressive  of suffering, complains,

                   " I am bound
   Upon  a wheel of fire, that mine  own tears
   Do scald like molten lead."

   It is no objection to the correctness of this de-
scription of  the distress and horror which distract
the minds of mad people,  that they often have no
recollection of them after their  recovery.  Happily
for them!  this is prevented,  by derangement af-
fecting the memory as well as the understanding.
Even  in those cases of  manalgia in which  the
mind  loses its sensibility to misery, and the sub-
jects of  it cease to be objects of our sympathy,
they do  not forfeit their claims to our  good offices.
Though insensible of mental  pain, they are  still
sensible of kindness,  and of corporeal pleasure.
A pleasant look, a kind word, an orange, an apple,
or even  a flower, presented to them in an affection- 
248           ON THE DISEASES
 ate manner, are cordials and donations of incstiiru
 ble value.  With these transient and casual favours
 should be united savoury food.  This is the more
 necessary to them, as their ^enses  of  smell and
 touch,  and often of hearing,  are so  much im-
 paired as to cease to  afford them any pleasure.
 Perhaps their food is more enjoyed by them upon
 that account.

   I  shall now mention the signs  of a favourable
 and  unfavourable issue  of madness,  in all  the
 forms of it which have been described.

   The longer its remote and predisposing causes
 have acted upon the  brain, and mind, the more
 dangerous  the disease, and vice versa.

   General  madness which succeeds tristimania,
 or that comes on gradually,  is more difficult  to
 cure, than that which comes on suddenly.   Here
 we see its affinity to fever.

   Madness, whicn arises from a hereditary  pre-
disposition,  is said to be more difficult to  cure,
than that which follows a predisposition to it that
has  been accjuired.  It is certainly excited  more
easily,  and is more apt to recur when cured, but 
OF  THE  MIND.
249
in general, its paroxysms yield to medicine as readi-
ly as  madness from an acquired predisposition.

  Madness  from corporeal causes is more easily
cured than from such as are mental.

   The younger the subject, the more easy the
cure.   Of 467 persons cured in Bethlehem Hos-
pital,  between the years 1784 and 1794, who were
between 20 and 50 years of age,  200 of them
were  between 20 and 30.

   It is  rarely cured in old people.  Mr. Halsam
says,  of 31 persons in advanced life,  who were ad-
mitted  into  Bethlehem Hospital,  but four  were
cured in the course of ten years.

   Persons who have children are  more difficult
to cure  than those who are childless.

   It is  more easily  cured in women than in men.
Mania yields more readily to rn^cine than  ma-
nicula,  or manalgia.  An 100  patients in mania
in its furious state,  and the same  number in its
chronic state/ were  selected in the Bethlehem Hos-
pital, in order to determine  their relative danger
and obstinacy.   Of the  former 62  were cured,
 and of the latter but twenty-seven.
                     i  i 
250          ON  THE DISEASES
   A paroxysm of mania succeeding manicula, or
manalgia, is favourable.

   A fever succeeding bleeding is favourable.  It
shows a  suffocated disease to be changed into a
diffused one.  A malignant fever, I  remarked for-
merly, once cured a  number of maniacs in our
hospital.

   Remissions and  intermissions of violent mental
excitement, are always favourable.

   Lucid intervals ■ in manicula and  manalgia are
likewise favourable.  They  show that  torpor has
not completely taken possession of the brain.

   Abscesses in any part of the body are favoura-
ble.   I formerly mentioned instances  of recove-
ries which succeeded them.

   A running from,  or moisture in the  nose, after
it has been lon^Pry, is favourable. .

   Warm  and moist hands,  after they have  been
long cold  and dry, are favourable.  *
A cessation of burning in the feet is favourable. 
OF  THE  MIND.
251
    General anasarca is favourable, provided it has
 been preceded by bleeding.  It was followed by a
 recovery in two cases in the Pennsylvania Hospi-
 tal in the year 1811.

    The continuance of  hysterical  symptoms,  or
  their revival,  after being long absent, is always  fa-
  vourable.   The latter shows the disease to be pass-
  ing  from  its seat in  the  blood-vessels  to the
.  nerves.

     A moderate degree of obfesity occurring dur-
  ing a remission of  the  disease is  favourable.   A
  greater degree of it is unfavourable.

     A return  of  one regular stool daily,.and at an
  habitual hour, is favourable.

     A diarrhoea, when moderate, is favourable.

     Madness,  from the common causes of fever,
   from parturition, and from stron^rink, generally
/(/yield to the  power of  medicine.
/
      Madness  from lesions of the brain is seldom
    cured. 
252
ON  THE. DISEASES
  Madness  which succeeds  epilepsy, or that is
alternated with it, is, I believe, always incurable.

  Madness which  succeeds head-ache, palsy, and
fatuity,  is generally incurable.

  Madness from emotions of the mind, such as an-
ger, joy and terror, is more  easily cured than when
it arises from  the  passions.   From  the  former
causes it comes  on suddenly, from the latter  gra-
dually.
                  I
  Madness is difficult to cure, when it arises from
the revival of an old and dormant passion, excited
by association, especially when that passion is  love
or grief.  It is  remarkable,  that the  love  which
causes madness  does not revive with  its cure.

  Gaiety, timidity, and good humour, are favour-
able.   IU-temper is unfavourable.

  Weeping is ^■favourable,  when the disease has
been  preceded by  hypochondriasm.  It  shows it
to be changing into  the less dangerous  and dis-
tressing disease of hysteria.

  Pensiveness  and taciturnity often  accompany
and succeed a recovery  from this disease.  This 
OF  THE  MIND.           253
is elegantly described  in Orlando Furioso, after
his recovery  from madness induced by the un-
faithfulness of his beloved  Angelica.

   Slow recoveries are most favourable.

   A discharge of blood from the  hemorrhoidal
vessels, and the return of the menses, where they
have been obstructed, are  always favourable.

   In three cases of madness that have occurred
during pregnancy, within  my knowledge,  partu-
rition did not cure, nor even mitigate them.

   A return of spelling correctly, after it had been
suspended, is favourable;  so is a return of delica-
 cy, more especially in the  female sex.

   The return of an habitual disease or appetite,
 shows an abatement  of the violence of madness
 and is always favourable.   The return of an ha-
 bitual employment  or of any  of the habits of the
 understanding or the affections, that had been sus-
 pended, is still more favourable.  I shall mention
 instances of each of them.

'   Sir George Baker declared the king of Great-
 Britain  to  be  convalescent from his  first attack 
234, •        ON THE DISEASES
 of madness, as soon as he heard him speak with a
 rapidity that had always been riatural to him, and
 which he had lost during his insanity.

   I attended a young man of the name of Wilki-
 son, in the Pennsylvania Hospital, in whom a ha-
 bit of stammering was suspended during his de-
 rangement, but which returned as soon as he be-
 gan to mend.

   The return of diseases that arc painful, such as
 head-ache,  the rheumatism, the piles,  or cough,
 also of tremors, -and cutaneous eruptions, is still
 more  favourable than the two cases of disease that
 have been mentioned.

   A  revival of an  appetite  for gingerbread, in a
 young man in our hospital, wlio had been fond of
 it when in  health,  was  soon afterwards followed
 by  his complete recovery.

   A young lady in the neighbourhood of Phila-
 delphia, who had been my patient for several weeks
 in an  attack! of madness from a fever, was observ-
 ed by her  family  to call for her pen, ink, and
 common-place book, upon a Sunday.    She had
 been  in the practice of copying select pieces  of
 poetry into it, for many years, upon that day of the 
OF. THE  MIND.
255
week.   At this time she discovered  none of the
common signs of the return of reason by her con-
duct; or conversation.   Trifling  as this incident
appeared, I encouraged her parents to expect from
it  a favourable  change  in her disease.   It took
place as I expected,  and she recovered perfectly
in the.course of a few  weeks.

   A female patient  of mine, who had acquired
pious habits  when a  child, practised them with
great  regularity during her derangement.   Her
recovery was marked by the gradual neglect of her
devotion, and by a return of the  gay  and dissi-
pated practices of her middle life.

   A Mrs. D:----, whom I supposed,  for several
months, had recovered from madness,  under my
care, said to me one day, in passing by her in our
hospital,  upon  my  asking her  how  she was,
"  that she was perfectly well, and  that she was
sure this was the case, for that  she had at last
ceased to hate me."

   A similar  instance  of a  perfect-recovery suc-
ceeding the revival of domestic respect and affec-
tion occurred in a Miss H. L. who  was confined
in our hospital in the year 1800.  For several
weeks she discovered every mark of a sound mind, 
256          ON  HIE  DISEASES
except one.   She hated her father.   On a certain
day she acknowledged, with pleasure, a return of
her filial attachment  and affection for him; soon
after she was discharged cured.

  Spontaneous recoveries now and then occur, af-
ter the disease has continued 18 and 20 years.   A
recovery after the  former period has lately  taken
place  in a German farmer, in the county of Mont-
gomery, in this state.

  Maniacal patients  sometimes  die  of its  tonic
or acute state, but in its chronic forms they more
commonly die of some one of the following dis-
eases.

  1. Atrophy.  Dr. Gredingsays 68 out of 100
patients die of this wasting disease.

  2. Pulmonary consumption.   It is remarkable
that this disease  does not so often suspend  mad-
ness, as madness does pulmonary consumption.

  3. Dropsy, particularly hydrothorax and  ana-
sarca, where they have not been preceded by bleed-
ing.   The latter disease aided madm ss  in  put-
ting an end to the miserable life of Mr. Cowper. 
                 OF THE MIND.            257
   4. A single convulsive fit, epilepsy, palsy, and
 apoplexy.

   5. Fevers.

   6.  The disease induced by fasting.

   It has been remarked, that patients who have
 long been  confined in mad houses sometimes lose
 their hearing, but seldom their sight.   I remarked
 formerly, that the  ears  are  oftener affected with
 false perceptions than the eyes, in mad people; and
 from the  nature  of the disease which produces
 those false perceptions, it is easy to conceive that
 the sense of hearing must sooner  perish than the
 sense of sight.

   Most of mad people discover a greater  or less
 degree of reason  in the last days or hours of their
 lives.  Cervantes therefore discovers both obser-
 vation and judgment, in bringing Don Quixote to
his senses just before he dies.  Thus the sun,
after a cloudy day, sometimes darts a few splendid
 rays across the earth just before he  descends be-
 low the horizon]  I  have ascribed this resuscita-
 tion of reason in the  paroxysm of  death  to the
                      K K 
258
ON  THE DISEASES
diseased blood-vessels relieving themselves by an
effusion of water in the ventricles of the brain, or
to the remains of the excitement of the system,
awakened by fever, or pain,  taking refuge in the
mind. 
OF  THE  MIND.
259
              CHAPTER  IX.

          Of Demence, or Dissociation.    •

RELATED to intellectual madness is that dis-
ease of the mind, which has received from Mr.
Pinel the name of demence.   The subjects of
it  in  Scotland  are said to  " have a bee in their
bonnets." In the United States, we say they are
" flighty," or " hair-brained," and,  sometimes, a
" little cracked."  I  have  preferred naming it,
from its principal symptom, dissociation.  It
consists not in false perceptions,  like the  worst
grade of madness, but of an association of unre-
lated perceptions,  or ideas, from  the inability of
the mind to  perform the  operations of judgment
and reason.   The perceptions are generally excit-
ed by sensible objects; but ideas, collected toge-
ther without order, frequently constitute a parox-
ysm of the disease.   It  is always  accompanied
with great volubility  of  speech,  or with bodily
gestures, performed with a kind of convulsive ra- 
260           ON  THE DISEASES
pidity.   We rarely  meet  with  this  disease in
hospitals; but there is scarcely a city, a  village,
or a country place, that docs not furnish one  or
more instances of it.   Persons who  are  affile ted
with it are good tempered and quarrelsome, ma-
licious and kind, generous and miserly, all in the
course of the same day.   In a word,  the  mind in
this  disease may be  considered  as floating in  a
ballesort,  and at the  mercy of every object and
thought that acts upon it.   It is constant  in some
people, but it  occurs more frequently in parox-
ysms, and is sometimes succeeded  by low spirits.
The celebrated Lavater was afflicted with it; and
although he  wrote with order, yet his conversa-
tion  was a mass of unconnected  ideas, accompa-
nied with bodily  gestures,  w hich indicated a de-
gree of madness.   I shall insert an account of a
visit paid to him at Zurich by the Rev. Dr. Hun-
ter, an English clergyman,  in which he exempli-
fied  the state of mind I wish to describe.

   " I was detained," says he, " the whole morn-
ing by the  strange,  wild, excentric  Lavater,  in
various conversations.   When  once  he  is set  a
going, there  is no such thing as stopping him till
he ruii3 himself out of breath.   He  starts  irom
subject to subject, flies from book to book, from 
               OF THE MIND.             261
picture to picture; measures your nose, your eye,  ]
your mouth,  with a pair of compasses;  pours
forth a torrent of physiognomy upon you ; drags ;
you, for a proof of his dogma, to a dozen  of clo-
sets, and unfolds ten thousand drawings ; but will.
not let you  open your lips to propose a difficulty ;
crams a  solution  down your throat, before  you;
have uttered half a syllable of your objection.

   He  is as  meagre as the picture of famine; his\
nose and chin almost meet.   I  read him in  my
turn,  and  found  little diiiiculty  in  discovering,
amidst great genius,  unaffected piety, unbounded
benevolence, and moderate  learning, much  ca-
price and unsteadiness ; a mind at  once aspiring
by nature,  and grovelling through necessity ;  an
 endless  turn to speculation  and project:  in  a
 word, a clever, flighty, good natured, necessitous
 man."

   I said formerly, that hysteria consisted in mo-
 bility  of the nervous and muscular system.  Dis-
 sociation seems  to  be occasioned  by a similar
 mobility of  that part of the brain  which is the
 seat of the  mind.

   The remedies  for it, when it  is attended with
 great excitement, as it  generally is, should be, 
262
ON  THE DISEASES
bleeding, low diet, purges, and all the other reme-
dies for reducing morbid excitement in the brain,
recommended formerly for the cure of intellectual
madness.

  When the disease is periodical, bark, and other
tonics, should be given in its intervals. 
OF  THE MIND.            263
              CHAPTER  X.

         On Derangement in the Will.

TWO opinions have divided philosophers and
divines, upon the subject of the operations of the
will.  It has been supposed, by one sect of each
of them, to act freely ;  and by the others to act
from  necessity,  and only in consequence  of the
stimulus of motives  upon  it.   Both these opini-
ons are supported  by an equal weight of  argu-
ments ; and however incomprehensible the  union
of two such opposite qualities  may appear in the
same function,  both opinions  appear to be alike
true.

   The  will is affected by disease in two ways.

   I. When it acts without amotive, by a kind of
involuntary power.;* Exactly the same thing takes
place in this disease  of the will, that occurs when
the  arm  or foot is moved convulsively without
 
    264           ON  THE  DISEASES

/   an act of the will,  and even in spite of it.  The
    understantiing, in this convulsed state of the will,
    is in  a stuind state, and .11  its operations are per-
    formed in a regular manner.,...Winn  the will be-
               n-. •». t**r <   .. F"»
    comes  the involuntary vehicle of vicious actions,
    through the instrumentality  of the passions, I have
    called it  moral deranckme.n 1.   For  a more
    particular account of this moral disease in the will,
    the reader is again referred to a printed lecture de-
    livered by the author, in the university of Penn-
    sylvania,  in  November  1810, upon the Study of
    Medical Jurisprudence, in which the morbid ope-
    rations of the will are confined to two acts, viz.
    murder  and theft.   I have  selected  those two
    symptoms of this disease (for  they are not vices)
    from its other  morbid effects, in order to rescue
    persons affected with them from the arm of the law,
    and to  render them the  subjects of the kind and
    lenient  hand of medicine.   But  there are  several
   • other ways,  in  which this disease in the will dis-
    covers itself, that are not cognizable by law.   I
    shall describe but two of them. These are, lying
    and  drinking.

      1. There are many instances of persons of sound
    understandings, and some ol  uncommon  talents,
    who are affected  with this lying disease  in  the
    will.   It differs from exculpative, fraudulent and
¥f*  ",
,  /■ 
OF  THE
MIND.
265
malicious lying, in being influenced by none of the
motives of any  of them.   P< rsons thus diseased
cannot speak the truth upon any subject, nor tell
the same story tv/ice in the same way,  nor de-
scribe any thing as it has appeared to other people.
Their falsehoods are seldom calculated  to injure
any body but  themselves, being for the most part
of an hybcrbolical or boasting nature, but now and
then they are  of a mischievous nature, and injuri-
ous to the characters and property of others.   That
it is a corporeal disease, I infer from its some-
times appearing in mad people, who are remarka-
ble for veracity in the healthy states of their minds,
several instances of  which I  have known in the
Pennsylvania   Hospital.   Persons  affected  with
this  disease are often amiable in  their tempers
and manners, and sometimes benevolent and cha-
ritable in their dispositions.

   Lying, as a vice, is said to be incurable.   The
 same thing may be said of it  as a disease, when it
 appears in adult life.   It  is  generally  the  result
 of a defective education.   It  is voluntary in  child-
 hood, and becomes involuntary, like certain mus-
 cular actions,  from  habit.   Its only remedy is,
 bodily pain,  inflicted by the  rod, or confinement,
                      L L 
206
ON  THE DISEASES
or',abstinence from food ;  for children arc incapable
of being  permanently influenced by  appeals  to
rea-on, natural affection, gratitude, or even a sense
of shame.

  2.  The use of strong  drink is  at first the effect
of free agency.   From  habit it takes place from
necessity.   That this is the case,  I infer from per-
sons  who are inordinately devoted  to the  use of
ardent  spirits being irreclaimable, by  all the con-
siderations which domestic obligations, friendship,
reputation,   property, and sometimes  even  by
those which religitm and the love of life, can sug-
gest to them.  An instance of insensibility  to the
last, in an habitual drunkard, occurred some years
ago  in  Philadelphia.  When strongly urged, \>y
one  of his  friends, to leave off drinking, he said,
" Were a keg of rum  in one corner e>f a room,
and   were a cannon  constantly  discharging balls
between  me and it,  I could not refrain from pass-
ing before that cannon, in order to get at the rum."

   The remedies  for  this disease have hitherta
been religious  and  moral, and they have some-
 times cured it.   They would probably  have been
 more succcsslul, had they been combined with 
OF  THE  MIND.
267
such as are of a physical nature.  For an account
of several of  them, the reader is referred  to the
first volume of the author's Medical Inquiries and
Observations.  To that account of physical reme-
dies I  shall add one  more, and that is,  the esta-
blishment of a hospital in every city and town in
the United States, for the exclusive reception of^A"
hard drinkers.  They  are  as much objects of
public   humanity  and  charity, as mad people.
They  are indeed  more hurtful  to  society, than
most of the deranged  patients  of a common hos-
pital would be, if they were set at liberty.   Who
can calculate  the extensive influence of a drunken
husband or wife upon the property and  morals of
their families, and of the waste of the former, and
corruption of the  latter, upon the  order and hap-
piness  of society ?   Let it not be said, that confin-
ing such persons in  a  hospital would be an in-
fringement upon  personal  liberty, incompatible
with the freedom  of our governments.   We do
not use  this  argument when we  confine a thief
in a jail, and yet,  taking the aggregate evil of the
preater number of  drunkards than thieves  into
o
consideration, and the greater evils which  the in-
fluence of their immoral  example and conduct
introduce into society than  stealing, it must be
obvious, that the safety and  prosperity  of a com- 
268
•N  THE DISEASES
munity will be more promoted by confining them,
than a  common thief.   To prevent  injustice or
oppression, no persem  should be si nt to the con-
templated h  spite.i, or sober house,  without be-
ing examined  and committed b\  a court, consist-
ing of a physician,  and  two or three  magistrates,
or commissioners appointed for that purpose.   If
the patient possess property, it should be put into
the hands of trustees,  to take care of it.  With-
in this house  the patient should  be debarred the
use  of ardent spirits, and drink only, for a while,
such substitutes  for them, as a physician should
direct.  Tobacco, one of the provocatives of in-
temperance in  drinking, should likewise be gradu-
ally  abstracted from them.   Their food should
be  simple,  but for a  while  moderately cordial.
They  should  be employed  in  their former re-
spective occupations, for  their own,  or for the pub-
lic benefit, and all the  religious,  moral, and phy-
sical remedies, to which I have referred, should be
employed at the same time,  for the complete and
radical cure of their disease.

   2.  Besides  the disease in the will, which has
been described, it is subject to  such a degree of
debility and torpor, as to lose all  sensibility to the
stimulus of motives, and to become incapable of 
OF  THE  MIND.            269
acting either freely, or  from necessity.  In this
respect it resembles a paralytic limb.  We some-
times say of persons who are governed by their
friends,  or a favourite, that  " they have no will y
of their own."   This  is  strictly true.   If left to
themselves, they would neither buy nor sell,  nor
transact any kind  of  business.   They will   nd
prefer nothing,  and they  do  nothing, but what  is
closely connected with their animal existence.  It
is from the habitual want of exercise in the  will
in slaves, that it is so apt to acquire this paralytic
state ; and  it is because we are  deprived of its
co-operation with  our medicines  in a  desire  of
life, that we are less successful in curing  their
diseases under  equal circumstances, than the dis-
eases  of freemen.   Animal magnetism, Mr. Bris-
set informed me, performed many cures of light
diseases  upon  the  white people in the  West  In-
dies,  but not a single slave  was benefitted by it,
and probably from the cause that has  been men-
 tioned.

   I have never been consulted in this  disease of
 the will, but I have  no doubt stimulating  and
 tonic remedies, preceded by depletion, would be
 useful in it.  Persons afflicted with this disorder
 of the mind should  be placed in situations, in 
4
       -70           ON THE  DISEASES
       which they will  be compelled to  use their wills,
       in order to escape some great and pressing evil.
       A palsy of the limbs has been cured by the cry
       of fire, and a dread of being burned.  Why should
       nor  a palsy  of  the will be  cured  in a  similar



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• P THE  MIN».             271
              CHAPTER  XI.

Of Derangement in the Principle of Faith,  or
            the Believing  Faculty.

As  this faculty has not yet  found its way into
our systems of physiology, I shall briefly remark,
that I mean by  it that principle in the mind,  by
which we believe in the evidence of the senses, of
reason, and of human testimony.   It is  as much
a native faculty as memory or  imagination.   The
objects of human  testimony  are  extensive and
important.  St. Paul alludes  to them in the fol-
lowing passage  of  the  eleventh chapter of  his
Epistle to the Hebrews.   " Through faith we un-
derstand that  the worlds were framed by  the word
of  God,  so that things  which are seen were  not
made of things which do appear."   The greatest
part of all we believe of history, geography, and
public events, and all that we believe of our rela-
tion to our parents,  brothers and sisters, by  the
ties of consanguinity, are  derived from it.   Hap-
pily for us! its operations are involuntary in its      ^



       '            ■          .         /.*-,-£". *~  - • kU 
 272          ON THE  DISEASES
 sound state.  Happily for us, likewise!  a source
 of knowledge,  so necessary to indbiduil comfort
 and social existence,  has not been  m.idc  depen-
 dant upon our senses,  nor  left to the slow induc-
 tions  of reason.   The world could not exist in
 its  present  circumstances  without it.   It is no
 objection to its necessity and usefulness,  that we
 are  sometimes deceived by it.   The same objec-
 tion applies with  equal  force  to our senses and
 reason,  as sources of knowledge.

   Persons affected with this disease in the  principle
 of faith,  as far as relates to human testimony, believe
 and report every thing they hear. The) are inca-
 pable  of comparing dates and circumstances,  and
 tell  stories of the  most improbable and incongru-
ous  nature.   Sometimes they propagate  stories
 that are probable, but false ;  and thus deceive
 their friends and  the  public.   There is  scarcely
 a village or city, that dots not contain one or more
 persons  affected  with  this  disease.   Horace de-
 scribes a man of  that character in Rome, of the
 name  of A; eila.   The  predisposition of such
 persons to believe  what is neither true, nor proba-
 ble,  is often sported with  by their  acquaintances,
 by which means their siorie soften gain a currency
 through  whole communities. 
OF  THE  MINI.
273
   It is probable the confinement of persons afflict-
ed with this malady, immediately after they hear
any thing new,  might cure them.   Perhaps ridi-
cule might assist this remedy.  I  think  I once
saw  it effectual  in  an  old quidnunc during the
revolutionary  war.

   This faculty of the mind is subject to disorder
as well as to disease ; that is, to an inability to be-
lieve things that are  supported by all  the evidence
that usually enforces belief.  Mr. Burke has de-
scribed the conduct of persons  affected with this
disorder  in  the  following  words:   "  They  be-
lieve nothing that they do not see, or hear, or mea-
sure by a twelve inch rule."  An Indian once ex-
pressed the state of  mind in which this torpor in
the principle of faith takes place, by saying, when
a truth was proposed to his  belief, " that it would
not believe for  him."   This  incredulity is not
confined  to human testimony.    It extends to
the evidence of reason,  and (it has been said) of
the senses.   The followers of Dr.  Berkley either
felt, or affected, the  last  grade of this disorder in
the principle of faith.   That it is often affected, I
infer froin persons who deny their  belief in the
utility of  medicine,  as practised by  regular bred
physicians, believing implicitly  in quacks;  also
from persons who refuse to admit human testimo-
                       M  M 
 214,          ON THE  BISEASES

 ny in favour of the truths of the christian religion,
 believing in all the events of profane history ; and,
 lastly, from persons  who contradict the evidence
 of their senses in favour of matter, being as much
 afraid of bodily  pain  from material  or sensible
 causes as other people.

   The remedy for this  palsy of the believing fa-
 culty, should consist in proposing propositions of
 the most simple  nature to  the  mind,  and,  after
 gaining the assent to them, to rise to propositions
 of a more difficult nature.   The  powers of oratory
 sometimes awaken the torpor of the  principle of
 faith.   This was evinced, in a remarkable manner,
 in the speech which king Agrippa made  to St.
 Paul, after he had heard his eloquent  oration in
 favour of Christianity ;  " almost thou  persuadest
 me to be a Christian."   Perhaps great bodily pain
 would have the same, or a greater, effect in cur-
 ing this disorder of the mind.   It has often cured
 paralytic affections of the body,  and of other fa-
culties of the mind.

  Sometimes a strong passion,  or emotion, by
 preoccupying the  mind,  prevents the exercise
of belief.  Thus we read, that the disciples of our 
OF  THE  MIND.
275
Saviour could not believe the news of his resur-
rection " for joy."  In such cases the predomi-
nating passion, or emotion, should be  abstracted,
or weakened,  before an appeal is made to the prin-
ciple of faith. 
276
ON  THE DISEASES
              CHAPTER   XII.

         Of Derangement in the Memory.

  I  HIS disease is  attended  with the  following
 grades:

   1. There is an oblivion of names, and vocables
of all kinds.

   2. There is an oblivion of names and vocables,
 and a substitution of a word  no ways  related to
 them.   Thus I knew a  gentleman, afflicted with
 this disease, who, in calling for a knife,  asked for
 a bushel of wheat.

   3. There  is an oblivion of the names of sub*
 stances in a vernacular language, and a  facility of
 calling them by  their proper names in a dead, or
 foreign language.  Of this Wcpfcr relates three
 instances.   They were all Germans, and yet they
 called the objects around  them  only  by Latin 
OF  THE  MIND.
277
names.   Dr.  Johnson,  when  dying,  forgot  the
words of the  Lord's prayer in English, but  at-
tempted to repeat them in Latin.   Delirious per-
sons, from this disease in the  memory often  ad-
dress their physicians in  Latin, or in a foreign
language.

   4.  There is an oblivion of  all foreign and ac-
quired languages, and  a recollection only  of a
vernacular language.  Dr. Scandella,  an ingeni-
ous Italian, who visited this country a few years
ago,  was master of the Italian, French and Eng-
lish languages.  In the  beginning of the  yellow
fever, which terminated  his  life,  in  the city of
New York,  in the  autumn  of 1798, he spoke
English  only  ; in  the middle  of his  disease, he
spoke French only;  but on the day of his death, he
spoke only in the language of his native country.

   5. There is an oblivion of the sound of words,
but not of the letters which compose them. I have
heard of a clergyman in Newbury Port, who, in
conversing with his neighbours,  made it  a prac-
 tice to spell every word that he employed to con-
 vey his ideas  to them.

    6. There is an oblivion of the mode of spelling
 the most familiar words.  I once met with it as a 
278
ON  THE DISEASES
 premonitory symptom of palsy.   It occurs in old
 people, and extends to an  inability, in  some in.
 stances, to remember any more of their names than
 their initial  letters.  I once saw a  will  subscrib-
 ed in this manner, by a man in the eightieth year
 of his age,  who, during his life, always wrote a
 neat and leeible hand.

   7. There  is an oblivion of the qualities or num-
 bers of the most familiar objects.   I know a man
 in this city, who has  never been able to remember
 the difference between  a jug and a pitcher ; and I
 know a physician,  who for many years could not
 recollect that the umbilical  cord  consisted of two
 arteries and one vein, without associating the for-
 mer with the double a in the last syllable of the
 name of Dr.  Boerhaave-.

  There appears to be  something like a palsy in
 the memory quoad these  specific objects.

  8. There  is  an  oblivion  of events,  time and
place,  w ith a perfect recollection of persons and
names.  This is the case with the  Rev.  Dr. Ma-
gaw,  formerly  minister of  S\ Paul's church  in
this city.  This disease in his memory was in-
duced by a paralytic affection. 
OF  THE  MIND.
279
  9. There is an oblivion of names and ideas, but
not of numbers.  We had a citizen of Philadel-
phia,  many years ago, who, in  consequence of a
slight paralytic disease, forgot  the, names of all
his  friends, but  could designate  them correctly
by  mentioning their ages, with which he had pre-
viously made himself acquainted.

  10.  However strange it may appear, it has been
remarked, that there is sometimes an oblivion  of
the  most recent, the most important, and the most
interesting events.  Of this I could  mention  se-
veral  instances that have come within  my own
knowledge.   One of them occurred to Dr. Priest-
ly.   I have ascribed the oblivion  of such events,
to the memory being  over stimulated from an un-
due effort to retain  them.   Something similar
to it occurs in the  inability' of lovers to dream  of
each other.
           t
  The objects of knowledge either perish, or sleep,
only in the mind.   In the latter  case, they are re-
vived by means  to be mentioned presently.

  Wepfer takes notice of the following symp-
toms  occurring  with the loss  or suspension  of
memorv. 
280
ON  THE DISEASES
  A sense of pain or heaviness in the forehead,
a disposition  to  rub it with the hand,  a l<<rmica-
tinu, that is, a sense e>f something creeping up the
left arm, and the fingers  «>f both hands, a dispo-
sition to wecp,^md an involuntary flow of urine.

  The causes of the  weakness and loss of memo-
ry are corporeal and mental.  To the first belong,

  1. Intemperance in eating.  Suetonius  tells us
the  Roman emperor Claudius lost his memory
so entirely from this cause, that he not only for-
got the  names and persons to whom  he wished
to ^peak, but even what he wished to say to them.

  2. Intemperance   in drinking.  It  was  from
the effect of strong drink,  in  weakening or  de-
stroying the memory, that an old Spanish law re-
fused to admit  any  person  to be a  witness in
court that had been convicted of drunkenness.

  3. Excess in venery.

  4. Fevers, particularly such as are of a malig-
nant nature, or  that  affect  the brain.   The Rev.
William Tennent, formerly the pastor of a Pres-
byterian church  at Freehold, in New Jersey, for-
got every thing  he had  learned, even the letters 
OF  THE  MIND.
281
of the alphabet,  in  consequence  of an attack of
tt  fever when he was about  eighteen  years  of
age.

   5.  Vertigo, epilepsy, palsy, and apoplexy.

   6.  Drying up  an issue.   Laesions of the brain.

   7.  The use of snuff.   It  was induced  by  this
cause in sir John Pringle.

   II. The mental causes are,

   1.  Grief.  I once met with  a woman, who  had
recently lost her husband and several children,
 who  told me she forgot, at times, even her own
 name.

   2.  Terror.  Artemidorus,  a celebrated gram-
 marian, was so terrified with the  sight of a croco-
 dile,  that he immediately lost all the knowledge
 that  he had treasured up in  his memory in  the
 course of his life.                     £

   3. Oppressing the memory in early life  with
 words and studies disproportioned  to its strength.
 The  Latin and Greek languages, and the prema-
 ture  application  of  the  mind to mathematics, I
                     N  N 
282
ON  THE  DISEASES
believe, have weakcred or dcsrroycd not only me
mory, but even intellect, in many young minds. *

   4. The  undue exercise  of  the memory  upon
any one subject often weakens it upon all others.
The famous African calculator Thomas Fuller, of
Virginia, whose memory was exercistd exclusive-
ly upon numbers, had so little recollection of faces,
that  he  was unable to recognise the persons who
had spent hours in conversing with him, and lis-
tening to his calculations, the  next day after  he
saw  them.   Overcharging the   memory  with
words h is the same effect.   A celebrated player
in London, his son  informed  me, lost the  re col-
lection of the names of all his  children, from this
cause.

   5. Neglecting to exercise the memory.

   6. Cessation from study.   Sir Isaac Newton
forgot the contents of his " Principia" by ceasing
to exercise his mind in study.

 The famous Mr. Hudde had  spent several years
in close application  to conic sections.  Leibnitz,
in reo.iniing from his travels called  to  sec him,
and expected t>> have been  highly entertained by
conversing with him upon the  subject of his stu- 
                OF THE MIND.            286
dies.   "Here,"  said Mr. Hudde, sighing, "look
over this manuscript.   I  have  forgotten  every
thing in it since I became  burgomaster of Am-
sterdam."

   The  remedies for  this  disease  are corporeal
and  mental.

   To the First,  or corporeal remedies, belong,

   1. Abstracting all its exciting causes.  Sir John
Pringle's memory was restored, in a great degree,
by leaving off the use of snuff.

   2. Depleting  remedies, if plethora  attend,  and
the  pulse be  tense or oppressed.   These should
be, bleeding, purges, and low diet.  After the re-
duction of the system, the remedies should be,

   3. Blisters.   Wepfer speaks in high terms of
their efficacy,  when applied  to  the  elbows  and
oalves of the legs, in this disease.

   4. Issues in the arms.
5.  Errhines. 
284
ON  THE DISEASES
   6. Certain aromatic medicines.   Etmullcr says,
 when a young man, hcgrca'ly  improved his me-
 mory  by swallowing three or four culx-bs every
 day.   Fh   card  mon seeds  are said to have the
 same effect.   Lavender and  rosemary, or cloves,
 may be substituted for both of them.

   7.  The cold bath and cold weather.   Milton's
 memory w as always improved by the latter.

   8. E.xercise.   Mr. Pope commends a trotting
 horse above all things in order  to excite dormant
 ideas.   It is from the motion excited in the brain,
 by means of a fever,  that persons in that disease,
 often recollect events and speak  languages, which
 appeared  to have perished  in  their  memories.
 The late  Mr. Frederic A. Muhlenberg inform-
 ed me- that his father, who was for many years mi-
 nister of the Lutheran church in Philadelphia, in
 visiting the old Swedes who inhabited the South-
ern district of the  city upon their death  beds, was
 much struck in hearing some of them pray in the
 Swedish language, who he was sure had not spoken
it for 50 or 60 years before, and who had  proba-
bly cviiruy  forgotten it.   It  was revived by  the
stimulus of the fever m their brains which attend- 
OF
THE
MTND.
285
ed the close of their lives.  The Rev. Dr. Muh-
lenberg of  Lancaster has furnished me with a fact
from his own observation, similar  to  that which
was communicated  to me by his brother,  in the
following extract of a letter which I lately receiv-
ed from him.  " That  people generally pray in
their last hours in their native  language is a fact
which  I have found true, in innumerable cases,
amongst my German  hearers,  although  hardly-
one word of German was spoken by them in com-
mon life and in days of health."  Dr. Hutchin-
son, in his Biographia Medica, relates an anecdote
of a physician of the name of Connor,  who had re-
nounced the principles of the church of Rome in
early life, who,  in the delirium of a fever which
preceded his death,  prayed only in the forms of
that church.  His fever  had excited those  forms,
while those of  the protestant religion which he
had embraced were obliterated, by the same fever,
from his mind.

   In some cases, time performs a cure of the loss
of memory.  This  oftenest occurs,  when it has
been induced by a fever.  I have known one in-
stance  of it,  and have  heard  of several others.
One of the latter was in the Rev. Mr. Tennent.
whose name was just now mentioned, who standing 
286
ON  THE  DISEASES
one day, at the feet of his master, suddenly threw
down l>is grammar, and called  for one of tht  La-
tin classics, which  he had begun to read previ-
ouslv to the attack of his fever.   At that instant
all that he had ever learned before, revived in his
mind.   The fever  which  deprived  him of his
memory was  attended  with  apparent death for
two or three days.

  II. The mental remedies for the loss, or decay,
of memory should be,

  1. Frequently  repeating what we  wish to re-
member.  The benefits of repetition are striking-
ly illustrated in  the history of a printer in London,
who, after w orking seven years in composing the
bible, was able to repeat every  chapter and verse
in it  by memory.   We see  the advantages of
this mode of strengthening the memory, in persons
who repeat questions or whole  sentences that are
proposed to them, before  they can answer them.
The door  of the mind in such people  reejuires
two knocks before it can be opened, one by the
person who asks, the other by the person who
answ ers the  questions ; or, to speak more simply,
the mind requires a double impression from words,
before it is able to convert them into thoughts. 
OF  THE  MIND.
287
  2. Calling in the aid of two or more  of the
senses, to assist in the  retention of knowledge.
We seldom forget what  we have handled, or  tast-
ed, as well as seen or heard.  It is for this reason
that physicians  who are  educated in an apotheca-
ry's  shop, never forget the  sensible qualities  or
doses of medicines.  The eyes  assist  the  ears,
and the ears the eyes.  We are seldom satisfied
in hearing a  news-paper read ;  hence, when it is
thrown down, we take it up, and  convey to our
minds, through the medium of our own eyes, the
facts we  have  just before heard.  Children and
the vulgar, whose memories are alike  weak, are
unable to retain what they  read,  unless they re-
cieve it at the  same time  through their eyes and
ears ; hence the practice by both of them of  read-
ing when alone, with an audible voice.   In  some
cases they are unable to remember even their own
thoughts, without rendering them audible ; hence
we so often hear them talking to themselves.  We
observe  the  same thing in the low and  chronic
state of madness, and in part from the same cause.
Where the eyes  and ears cannot both be employ-
ed in acquiring  knowledge, the  use of the ears
should be preferred.  Julius Caesar  says  the rea-
 son why  the ancient Druids did not commit their
instructions to  writing was, that their pupils might,
 by receiving  them through their ears, more  ea- 
288
ON  THE DISEASES
 silv acquire,  and irmrc durably retain, them  in
 their mem- rics.   The ear is less apt  to be dis-
 tracted than the eye by the obtrusion of surround-
 in   bjects. the one being more constant than the
 ot1.  .   The mind moreover is  more  concentra-
 ted m hearing than in seeing.  The  truth of all
 these remarks is confirmed, by few of the savings
 or songs learned by the ear only, and in the nur-
 sery, being ever forgotten.

   3. The  memory is restored and  strengthened
 by means of association.  The principal circum-
 stances which influence this operation of die mind
 are,  time,  place,  pleasure,  pain, sounds,  words,
 letters, habit and  interest.

   4. Filling  the mind with that kind of know-
 ledge only, which is  supposed, or  admited, to
 be  true.    The errors and falsehoods  which are
 crowded into the  memories of boys, in our mo-
 dern systems of education, are calculated ever af-
 terwards to  weaken  their retentive powers to
 such subjects  as  are  true, and  of  a useful and
 practical nature.

  5. The memory is  improved by using it.  Its
low  state among savages is  occasioned bv  the
small number of  objects  upon which they exer-
cise  it. 
OF THE  MIND.            289
   6.  The memory is aided in hearing, and after
 reading, by shutting  the eyes.  In this way Mr.
 Woodfall received and retained the speeches of
 the  members of the British parliament until he
 committed  them to paper,  after which he  pub-
 lished and forgot them.

   7.  Ideas, and even words, that have  been for-
 gotten, are  often recalled  by conversation  upon
 subjects that  are related  to them.   This is ef-
 fected by some incidental word,  or idea, awaken-
 ing by association the word, or  idea, we wish to
 revive in  our  minds.

  8. Dr. Van Rohr, a Danish physician, who visit-
 ed  this city in the year 1793, informed me  that
 he could  at any time  excite the remembrance of
 words, by committing two or three lines of poetry
 co memory.

  9.  Singing  aids  the memory in  acquiring a
knowledge of  words,  and of the  ideas connected
with them.  A song is always learned sooner  than
the same number of words not set to music.  Vir-
gil  seems to have  understood this  perfectly.
Hence he says,
                     o o 
Otj          ON  THE DISEASES
             " S.vpc ego longas,
    Cantando pucrum, me mini me
    Condcrc."----■

 10. Reading, or repeating what we wish to com-
mit to  memory, the  last thing we do before we
go to bed.

   11. Learning a number of technical or arbitra-
ry terms, and associating ideas with  them.   The
rules for making syllogisms are taught in our sys-
tems of logic in this way.   Dr.  Grey's Memoria
Technica may be read, with advantage, for much
useful knowledge under this head. 
OF  THE  MIND.
291
             CHAPTER  XIII.

                 Of Fatuity.

 X  HIS affection of the mind consists  in a total
absence of understanding  and memory.  It has
different grades,  from the  lowest degree of ma-
nalgia, down to that which discovers itself in si
vacuity of the eye and countenance, in silence or
garrulity, slobbering,  lolling of the tongue, and /
ludicrous gestures of the head and limbs.

  It differs further, in  being accompanied with
activity mi the will, or  a total paralysis of it, and
with  active  passions,  or  the total  absence of
them.   The passions which most commonly ap-
pear in idiots are, anger,  fear, and love.  They
moreover sometimes  feel an inordinate degree
of the sexual appetite, and are generally  great
feeders.   Lastly, they are innocent, or extremely
vicious,  v 
292           ON THE  DISEASES
  Fatuity, or idiotism, is,
             p
  1. Congenial.   In tlv se cases the skull is Irss,
and inferior in height to the skulls of maniacs, and
there is a great disproportion  between the  face and
head, the former being much larger than the latter.
The bones of the head are preternaturally thick.
 This is  the  case  we are told  with the  Cretins.
Dr.  Fodcrce, who has written  an interesting ac-
count of  them,  says they have  no  knowledge of
their parents, nor are they able  to feed themselvfc*
until they are eight or ten years  of age.   All their
senses are torpid.   The venereal appetite exists
in them with great force, and they gratify it after
puberty by the  practice  of  onanism.  They are
generally  inoffensive, but now and then very mis-
chievous.   Then  is  a  case of  congeni il idiot-
ism in a boy at Kensington,  in the neighbourhood
of this city,  in which the powers of the  body and
mind  are in a  still lower state than  in  the Cre-
tins.  He was  born on  the 5th of August 1792,
 and is at this time unable to walk or speak.   He
 has the  head of a man, but all  the  parts of his
 body below it resemble those of a child of two
 or three years old, particularly his genitals and
 his pulse; the latter beats from 90 to 120 strokes
 in  a minute.   He  has  shed his  teeth twice, and
 now exhibits a third set, in three distinct  rows 
OF  THE  MIND.
293
 ia  his upper jaw.   With all  this furniture  for
 mastication, he is unable  to  chew his food, and
 all that he  takes of a solid nature is first chewed
•for him  by  his sister.   His ears are  very large.
 He cries when hungry and in pain,  but offener
 laughs for hours, and sometimes for whole nights
 together, and so  loud as  to disturb the sleep of
 his  family.  He discovers  mind in  but three
 things, viz. in an  affection  for  his mother  and
 sister, and in a love for  a dog, and  for money.
 His father sometimes comes home from his work
„ in a state  of intoxication, at which time he abu-
 ses  his mother  and sister.  During this time he
 appears  pensive, and refuses to eat  any thing.
 He discovers distress when his dog is out of his
 sight, or his place in the  family occupied by  the
 dog  of  any of  the neighbours.   Of his love of
 money  the  following is  a striking proof.   I
  threw a piece of silver into his lap.   He instantly
  laughed, and showed other signs of pleasure.  I
  found upon inquiry that  he was fond of  ginger-
  bread,  and that  he had just memory enough to
  associate the pleasure of  eating it with the sight
  of the means of procuring it.

     Fatuity is induced by all  the  causes which
  bring on  mania,  particularly by chronic  fevers.
  It sometimes succeeds protracted  manalgia.  In 
294
ON  THE DISEASES
complete fatuity, every part of the brain is torpid
or paralytic, but where it  exists with any of the
passions  we  have  mentioned, it  is accompanied
with partial diseased action in the brain.

   3.  Fatuity  is  induced  by old  age,  in con-
sequence  of  the   brain   becoming  so  torpid,
and  insensible,  as to  be unable  to  transmit
impressions made upon it to the mind.   It is par-
tial, or general, according to the greater or less ex-
tent of the palsy of the brain.

   Fatuity, whether a partial disease, or a disorder,
has been cured,

   1. By another disease.   The author has  men-
tioned, in his Introductory  Lecture upon the Stu-
dy of Medical Jurisprudence, a curious instance
of a young woman, who  was an idiot from her
childhood, and continued  so until her 35th year,
at which  time she was affected with pulmonary
consumption.   The impetus of  the blood in the
hectic fever of this disease, acting upon her brain,
awakened her long dormant mind, and produced
in her such marks of reason,  that she astonished
all her attendants by her conversation. 
OF  THE  MIND.
295
  2. It has been cured by  accidents,  such as
burns,  and falls, and  particularly  when they
affect the head.  Dr. Haller relates a case of this
kind.  Dr. Nicholas Robinson mentions another,
in which  the  cure was  affected  by a  fall  from a
horse.  After  the disease  induced by this  fall
ceased, the fatuity returned.

   3.  Time has sometimes cured fatuity.  This
has frequently been observed in that form of  it
which succeeds a chronic fever.

   4. From the accidental effects of the remedies
that have  been enumerated, it is reasonable  to
expect, that powerful stimulants, which act alike
upon the  whole body and the brain, might be use-
ful  in  fatuity.   These remedies should be the
same  that  were  recommended  formerly  for the
cure of manalgia.   That form  of fatuity, which
sometimes follows a fever, generally yields to the
most lenient of these remedies.

   In order to assist all the remedies that have been
 mentioned, it will be useful, as soon as our patients
 begin  to discover any marks  of the revival  of
 mind,  to  oblige them  to apply their  eye  to some
 simple and entertaining book.   They will much
 sooner acquire ideas in this way, than by our con- 
296           ON  THE  DISEASES
 versing  with them, in consequence of the longer
 impressions  of  words upon  the  eyes  than upon
 the ears, when they are pronounced in the ordinary
 rapid  manner of common  conversation.   Dull
 boys are sometimes by this means nv-de scholars,
 and,  on the  contrary, bens  of active  minds  ure
 sometimes made dull by it.   The forcible impres-
 sions of words in the latter case over-stimulates the
 mind.  Such boys learn  more easily and rapidly
 by oral instruction.

  Fatuity  from old  age  cannot be cured, but it
 may  be prevented, by employing the mind con-
 stantly in reading and conversation,  in the evening
 of life.  Dr.  Johnson ascribes the fatuity of Dean
 Swift to two  causes;  1,  to a resolution he made
 in his youth,  that he  would never wear spectacles,
 from  the want of which he was unable to read in
 the decline of life ; and, 2, to his avarice,  which
 led him to abscond from visitors, or to deny him-
 self to company,  by which  meang he deprived
 himself of the only  two methesds by which new
ideas  are acquired, or old ones renovated.   His
mind  from these causes languished from the want
 of exercise, and  gradually collapsed into idiotism,
 in which state he  spent the close of his life in a
 hbspital founded by himself for  persons afflicted
 With the same disorder ; of which he finally died. 
OF  THE  MIND.
297
   Country people, who have no relish for books,
When  they lose the ability to work,  or of going
abroad, from age,  or weakness, are very apt to be-
come  fatuitous, especially as they are too  often
deserted in their old age by the younger branches
of their families,  in consequence of  which  their
minds become torpid,  from the  want of society
and conversation.   Fatuity is more rare in  cities
than in country places,  only because  society and
conversation can be had in them upon more  easy
terms;  and it is  less  common among  women
than men, only because they  seldom survive  their
ability to work, and because  their employments
are of such a  nature, as to admit of  their being
carried  on  by their fire sides, and in  a sedentary
posture.

   The illustrious Dr. Franklin exhibited a strik-  /
ing instance of the influence of reading, writing,  ,j
and  conversation,  in prolonging a sound and ac-  .
tive state of all the faculties of his mind.   In his
eighty-fourth year he discovered no one mark, in
any of them, of the weakness or decay usually ob-  /
served in the minds of persons at  that  advanced;'
period of life.

  I cannot dismiss this subject without remarking,
that  the moral faculties,  when properly regulated
                    p  r 
298
ON THE DISEASES
and directed, never partake of the decay of the in
tellectual faculties in old age, even in persons of
uncultivated minds. It would seem as if they were
thus placed beyond the influence, not emly of time,
but often of diseases  and  accidents,  from their
exercises being so indispensably necessary to our
happiness,  more especially in the evening of life.

  The  Rev. Dr.  Magaw,  I said  formerly,  had
lost, with his memory for events,  his conscious-
ness of place and time, by a paralytic disease, and
yet in this situation he retained, for several years,
so high a sense of religious obligation, that he  per-
formed his devotions morning and evening, and
at his meals, with as much regularity and correct-
ness, as ever he did in the most vigorous and heal-
thy state of his mind.

  There is a state  of fatuity,  related to that which
has been described, in which there exists, with great
feebleness of mind, a species of low wit and cun-
ning,  accompanied  at  times  with   mimickry.
Shakspeare has  described this grade of idiotism
in his character of the fool, in the tragedy of King
Lear.   Such  persons were  formerlv in demand
at courts, as jesters, in order to dissipate, by their 
OF THE MIND.
299
buffoonery, the ennui  which is created  by a su-
perfluity of the enjoyments of life.

  It is  possible  this mental disease might be re-
lieved by the  same remedies that have  been re-
commended for common fatuity. 
300
ON  THE DISEASES
             CHAPTER  XIV.

 Of Dreaming,  Incubus,  or  .Yight Marc, and
                Somnambulism.

 1 O enumerate all the phenomena  of dreams,
and  to attempt an explanation of their proximate
cause,  would  require a jrcvious account of the
theory of sleep, and tins would rentier it necessa-
ry to introduce  several physiological  principles,
all oi which would be foreign to  the practical ob-
jects ol  this work ;  for which  reason I  shall barely
remark, that dreaming is the effect of  unsound or
imperfect sleep.   Thai this is the case is obvious,
from is being  uncommon among persons who
labour,  and sleep soundly afterwards, and from
its  causes to be mentioned presently.  It is al-
ways induced by morbid or  irregular  action in
the blood-vessels of the brain, and hence it is ac-
companied wi'h the same erroneous train, or the
same incoherence of thought,  which takes place in
delirium.   This is so much the case, that a dream
may be considered as a transient-paroxysm of 
OF  THE  MIND.
301
delirium, and  delirium  as a permanent dream.
It differs from madness in not being attended with
muscular action.

   As dreams are generally accompanied with dis-
tress, and are often the premonitory signs of acute
diseases, their cure is an important object of the
science  of medicine.  Their remote cause are an
increase, or diminution, of stimuli upon the brain.

   I.  The increased stimuli are corporeal, and
mental.

    1. The corporeal stimuli are, an excessive quan-
 tity of aliments or drinks, or of both, of an offen-
 sive quality to the stomach, a position of the head
 not habitual to the patient, cold, heat, noises, a
 tight collar or wrist-bands, a fever,  opium,  a full
 bladder, inclination to go to ste>ol, and, lastly,  light.
 It is from the stimulus of the last cause, that we
 dream most after day-break in the morning.

    2.  The mental stimuli are, all  disquieting pas-
 sions, difficult studies begun at bed-time, and an
 undue weight of business.

    II. Dreams are induced by the diminution of
 habitual stimuli, such as customary food, drinks, 
302          ON THE DISEASES

exercise,  labour,  studies,  and business.   They
are sometimes terrifying, or distressing, and not
onl\ detract from the happiness of life, but, when
neglected, become the cause of more serious
diseases  in the brain.   The  remedies for  them,
when tiiey are induced by an  increase of stimuli,
whether corporeal or mental,  should  be

   1.  Bleeding, or gentle purges,  and low  diet.
The  famous pedestrian traveller, Mr. Stewart,
inft rmcd me that he never dreamed, when he lived
exclusively upon vegetable food.

   2.  Exercise, or labour,  which reduces excite-
ment, iiiul wastes excitability down  to the point
of natural anel sound sleep.  Persons  who work
hard during the day, seldom  dream.

   3. Avoiding all its remote and exciting causes,
more especially  such of them as act upon  the
mind in  the evening.

   4.  When dreaming  arises  from a  diminution
of customary stimu'i, a light supper, a draught of
porter, a glass of wine, or  a dose of opium,  ge-
nerally prevent  them.   Habitual  noises,  when
suspended,  should be restored. 
OF  THE  MIND.            $0>,
        Of the Incubus, or Night Mare.

  This disease is induced by a stagnation of the
blood  in  the brain, lungs, or  heart.   It  occurs
when sleep is more profound  than natural.   Its
remote causes arc the same as of dreams.  To these
may be added sleeping upon the back, by which
means the blood is disposed to stagnate in the places
above mentioned, from an excess or diminution of
the force that moves it.  Persons who go to bed in
good health,  and  are found dead in their beds in
the morning, it is supposed, generally die of this
disease.

  Its remedies should be the same as for dreams,
with the additional one of sleeping  alternately on
each side.

              Of Somnambulism.

  I shall introduce my remarks upon this disease,
by copying Dr. Hartley's correct and perspicuous
account of its cause, in his  " Observations upon
Man."

  " Those who walk and talk in their sleep (says
the doctor) have evidently the nerves of the mus- 
304
ON  THE  DISEASES
 I  cles concerned so free,  as that vibrations [or ncr
   vous influence] can descend from the inn rnal parts
 i  of the brain, the peculiar residence of ideas, into
   them.   At  the  same time, the  brain  itself is so
   oppressed,  that they have  scarce  any memory.
   Persons  who  read inatttntivelv, that is, see and
   speak  almost  without  remembering; also  those
   who labour under such  a morbid loss of memory,
 ,  as that though they see, hear, speak and act, pro ne
 I  nata, from moment to moment,  yet forget all im-
   mediately, somewhat resemble  the persons who
i   walk and talk  in their sleep."

     Dreaming, I have said, is a transient paroxysm
   of  delirium.  Somnambulism is nothing  but a
   higher grade of the same disease.   It is a transient
X  paroxysm of  madness.   Like madness it  is ac-
   companied with  muscular action, with incoherent,
   or coherent  conduct,  and  with that  complete ob-
   livion of both, which takes place in the worst grade
   of madness.  Coherence of conduct discovers it-
   self, in persons who are affected  with it undertak-
   ing, or resuming, certain habitual exercises or em-
   ployments.  Thus we read of the scholar resum-
   ing his studies,  the poet his pen, and the artizan
  his labours, while under its influence, with their
   usual industry, taste and correctness.  It extend-
   ed still further in the late Dr. Blacklock, of Edin- 
                OF  THE  MIND.            305
burgh, who rose from his bed, to which he had
retired at an early hour, came into the room where
his family  was assembled, conversed with them,
and afterwards  entertained  them with a pleasant
song, without any  of them suspecting he  was
asleep, and without his retaining,  after he awoke,
the least recollection of what he had done.

   Persons  who  are  affected  with  this disease
sometimes  appear pale, and  covered with profuse
sweats.

   Its remedies should be the same as for dream-
ing, when it arises from an increase of corporeal or
mental stimuli.   I  have  read an account of  two
cures being performed, by placing a tub of water in
the bed-room  of patients who were afflicted with
it.
q.<i 
306           ON  THE  DISEASES
              CHAPTER  XV.

                  Of Illusions.

J3 Y this term I mean that disease, in which fylse
perceptions take place in the ears and eyes in the
waking state, from a morbid affection of the brain,
or of the sense which is the seat of the illusion.
It may be considered as a waking  dream.   Per-
sons  affected with  it fancy the)' hear voices,  or
see objects that do not exist.  These false percep-
tions are said,  by superstitious people, to be pre-
monitions of death.   They sometimes indicate
either the forming state,  or the actual existence
of disease, which being seated most  commonly in
a highly vital part of the bodv, that  is the brain,
now and then ends in death, and thus administers
support to superstition.  They  depend, like  false
perception in madness, upon motion being excited
in a part  of  the ear or the eye, which  does not
vibrate  with  the  impression made  upon it, but 
OF  THE  MIND.             307
communicates it to a part upon which the impres-
sion of the noise heard, or of the person seen,
was formerly  made, and hence the one becomes
audible, and the other visible.

   The deception, when  made upon the ears, con- i
sists most commonly in  hearing our own names, i
and for this obvious reason;  we are accustomed to j
hear them pronounced more freementiy than  any
other words, and hence die  part of the ear, which
vibrates  with  the  sound of our names, moves
more promptly, tiom habit,  than any other part of
it.  For the same reason the deception, when made
upon the eyes, consists in seeing our own persons,
or the persons of our intimate friends, whether liv-
ing or dead, oftener than any other people.   The
part  upon the retina,  from which  those images
are reflected, move more promptly, from habit,
than  any  other  of that part of the organ  of
vision.

   The voice which is supposed to be heard, and
the objects which  are supposed to be seen,  are
never heard nor seen by  two persons, even when
they are close  to  each  other.  This proves them
both to be the effect of disease in the  single per-
son who  hears, or sees, the supposed voice or ob-
ject.  I am aware toat this explanation of illusions 
308           ON  THE DISEASES
may be applied to invalidate the accounts that arc
given in the Old and New Testaments of the su-
pernatural voices and objects, that were heard or
seen by individuals, particularly b\ Daniel, Elisha,
and St. Paul; but they should no more have that
effect, than the cures of diseases that are perform-
ed by natural means  should invalidate the accounts
that are given  in those books, of the same diseases
being cured in a miraculous manner.  But, ad-
mitting the voices or objects that were heard or
seen, by the prophets and apostle above mention-
ed, to  have been produced by  a change  in the
natural actions  of the  brain, or of the organs of
hearing or  seeing,  that  change,  considering  its
design, was no less  supernatural, than if the voi-
ces  or objects supposed  to have  been  heard, or
 seen, had been real.  It is remarkable, that in all
 those cases, where miracles were necessary to es-
 tablish a divine commission,  or a new doctrine,
 every  circumstance  connected  with them was
 distinctly heard, or seen, not by an individual only,
 but by two or  three, and sometimes by  several
 hundred witnesses,  in all of whom it is scarcely
 possible for an illusion to have existed at the same
 time from natural causes.

   The remedies for illusions should be, bleeding,
 purges,  and low diet, when  the pulse  indicates 
OF  THE  MIND.
309
undue excitement in the arterial system.   A cer-
tain Mr. Nicolai, a member of the academy of sci-
ences in Berlin, was much relieved of this disease
by  the application of leeches to  the hsemorrhoi-
dal vessels.

   In a reduced  state  of the system, the reme-
dies should be, cordial diet and tonic  medicines.
Mr.   Nicolai heard  the voices of his friends
only  when he  was alone, and  in a state  of inac-
tion.   This  fact suggests the advantages of com-
pany and  exercise, as additional remedies in this
disease. 
310
ON  THE DISEASES
              CHAPTER XVI.

        Of Reverie, or Absence of Mind.

 1  HIS disease is induced by two causes,

  1.   By the stimulus of ideas of  absent  sub-
jects being so powerful, as to destroy the percep-
tion of present objects ; and,

  2. By a torpor of mind so  great, as not to
feel the impressions of surrounding objects upon
the  senses.  It is an inferior or feeble  grade of
catalepsy.

  It is more common  from  the latter than  the
former cause.   It is no objection to this assertion,
that it sometimes occurs in schol,»rs,  and in men
celebrated for their  great literan  attainments.   A
cape city for acquiring knowledge is a  cheap  en-
dowment, and differs widely from that capacity,
which enables a man not only  to acquire know- 
OF  THE  MIND.
311
ledge from books,  but to create it by observa-
tion  and reflection,- and to apply it to the useful
purposes  of  life.   The  following  account  of a
clergyman who  died a few years ago in England,
extracted from a late  periodical work,  will serve
to exhibit the nature and extent of this intellec-
tual  disease, from the latter cause that%was men-
tioned.

   "Mr. George Harvest,  minister of ThamesDit-
ton, was one of the most absent men of his time ;
he was a lover of good eating, almost to gluttony ;
and was further remarkable as a great fisherman ;
very negligent  in  his dress,  and  a  believer in
ghosts.    In  his youth  he was contracted  to  a
daughter  of  the bishop  of London;  but on his
 wedding day, being gudgeon  fishing, he overstaid
 the  canonical hour; and  the lady, justly  e)ffended
 at his neglect,  broke off the match.   He had at
 that time an  estate of 3001. per annum, but, from
 inattention and absence,  suffered his  servants to
 run him  in  debt so much, that it was soon spent.
 It is said, that his maid frequently gave balls to
 her friends and fellow servants of  the neighbour-
 hood ; and persuaded her master that the noise he
 heard was the effect of wind. 
312            ON  THE  DISEASES
 In the latter part of his life no one would lend, or
let him a horse, as he frcqucntiy lost his beast from
unde i  him,  or at least out of his hands, it being
his practice to dismount  and  lead his horse, put-
ting the bridle under  his arm,  which the horse
sometimes shook off, anel sometimes it was taken
off by the  boys, and the parson  seen drawing his
bndie after him.

 Sometimes  he would  purchase a penny-worth of
shrimps, and put them in his waistcoat pocket,
among  tobacco, worms,  gentles for fishing,  and
other trumpery :  these  he often carried about him
till they stunk so as  to make  his presence almost
insufferable.   I  once saw such a melange turned
out of his pocket by  the dowager lady Pembroke.
With all these peculiarities, he was a man of some
classical  learning, antl  a  deep metaphysician,
though generally reckoned a little crack'd.

  Such was  his absence and distraction,  that he
freejuently  used to forget the prayer days, and to
walk  into  his church  with his gun, to see what
could have assembled the people there.

  In company he never put the bottle round, but
always lined when it stood opposite to him ; so that
he very  often took half a dozen  glasses running. 
                OF  THE MIND.            313
That he alone was drunk, and the rest of the com-
pany sober, is not, therefore, to be wondered at-

  One  day Mr.  H irvcst, being in a punt on the
rive-r Thmes with ivir.  Osi<>u,  began to read a
beautiful  passage in some  Greek author,  and,
throwing himself backwards in  mextacy, fell  into
the water, whence he was  with  difficulty fished
out.

  Once being to  preach before the clergy at the
visi ation,  he had three sermons in  his pocket:
some wags got  possession  of them, mixed the
leaves,  anel sewed them  all up as one : Mr.  Har-
vest began his sermon, and soon lost the thread of
his discourse, and got confused ;  but nevertheless
continued, till he had preached  out  first all the
church-wardens,  and next the  clergy ;  who
thought he was  taken mad."

  It is possible  moderate depletion, succeeded by
constant anel noisy companv, might peodup^n the
mind a  predominance of impressions from pre-
sent objects, over those of the ideas of absent sub-
jects.   S  imulants, particularly such as act upon
the brain and nervous system, would probabiy be
useful,  when the disorder ^arises  from torpor of
mind, or insensibility of  the senses.
                       R R 
314           ON  1HE  DISEASES
             CHAPTER  XVII.

       Of Derangement of the Passions.

 X  HE passions have been divided into two great
classes, 1, such as are intended to impel us to real,
or suoposed good ; and, 2, such as are intended to
defend us from real, or supposed evil.  The for-
mer are objects of  desire,  the latter of aversion.
Those of them which are most subject to derange-
ment,  or to an unreasonable and morbid excess,
are, love, grief, fear, and anger.  Alter mention-
ing the symptoms of their diseases, and their re*
medies, 1 shall consider the morbid phaenomena of
jov, envy,  malice, and hatred,  anel con*'hide the
chapter with a few remarks upon the torpor of the
passions.

                   Of Love.

  This passion, which was implanted in the human
breast  for the p irpose of brin.^i.ig  the sexes  to-
gether, and thereby increasing their happiness, be- 
OF THE  MIND.
315
comes a disease only where it is disappointed in
its object.  The symptoms of love, when it creates
disease, are, sighing, wakeful  ess, perpetual talk-
ing, or silence, upon the subject of the object be-
loved, and a predilection  to  solitude.   Where
these  symptoms do  not discover its existence, it
may  be known in a man, by blushing, and an in-
creased frequency of pulse, when the name of the
person beloved is mentioned ; and in a  woman,
according to La Bruere, "by her constantly looking
at the man she loves when  in  company, or never
looking at  him at all."   It is known further in a
woman, by her retiring to decorate herself upon
the appearance of the man in  company whom she
loves.  It always renders a woman awkward, but
it  polishes the  manners of men.   The  effects of
unsuccessful  love  are dyspepsia, rnsteria, hypo-
chondriasis, fever,  and madness.    The last has
sometimes induced suicide,  while all the others
have now and then ended in death.

   The  remedies for this disease, when accompa-
nied with fever, or great  excitement in the brain,
or any other part of the system, should be,

   1. Bleeding, blistering, and the other remedies
for similar states of the system from other causes.
It is remarkable, that persons who have been cured
of the diseases from love, by  these remedies, re- 
  316           ON THE DISEASES
  cover without feeling anv aff< rti'»r, lor the persons
  they  have h v  d.   This was the rase with one of
  the  princes ol Cei;.cle.   He complained, in   is
  state  of hi> mind,  that his physicians had drawn off
  all his love for his mistress  by  the ir depleting re-
  medies.

    2.  Ovid t'dvises  what  he calls  a " binam ami-
  cam," that is, a new mistn. ss, for unsuccessful love.
  I have known this  remedv  to  succeed in several
  instances.  The sincerity of a  former  attachment
  is often Called  in question, bv a suelden translation
  of the affections to a second mistress, but w itlffmt
  am foundation.  Indeed, it pr< -vi s its sincerity,
  for its ardour admits of no other cure.

    3.  The same  mister  of the subject of  love,
  Ovid, advises an  unsuccessful  lover to find out,
  and dwell upon all the bad  qualities, and delects
  in person and accomplishments," of  his  mistress.
  " If  she  have  a bad  voice (says he} press her to
  sing; if she touch a musical instrument clumsily,
  beg her  ro expose  herself  by  playing upon  one
.  of them."

    4.  The company of the person  beloved should
  be carefully  avoided.    A  voyage  or journey
  should  b  advised in this case, for absence  has
  been justly styled the tomb of love.   The com- 
OF  THE  MIND.
317
pany  of strangers, by cheeking  all conversation
about  the  person beloved, prevents the  passion
being cherished by it.

   5.  Constant employment will  aid absence as a
remedy for hopeless love.  The more that em-
ploy ment  interests the  understanding,  the more
completely it  will have that effect.   The disease
is more than half cured, when the distressed lover
ceases to think of the object of his affections,

   6. As hope and love are born together, so they
 can only die  together.   Uncommon pains there-
 fore should be taken, in curing love, to extinguish
 every  spark of  hope in a lover.   This advice is
 given with singular good  sense and humanity by
 Dr. Gregory, in his Legacy to his Dau-hters, upon
 the subject of courtship and marriage.

    7.  Unsuccessful love  is cured by  exciting a
 more  powerful passion in the mind.  Ambition
 should be preferred for this purpose.  Its efficacy
. is taken notice of by the  duke of Rochefaucault.
 « Ambition (he says) may succeed love, but love
 never cures ambition." 
318
ON  THE DISEASES
                   Of Grief.

  Physicians, in their unsuccessful efforts to save
life, are often obliged to witness this passion.   It
is of consequence for them, therefore, to be well
acquainted with its  symptoms and cure.

  Its symptoms are acute and chronic.   The for-
mer are, insensibility, syncope, asphyxia, and apo-
plexy ;  the latter arc, fever, wakefulness, sighing,
with and without tears,  d)sptpsia, hvpochondri-
asis,  loss of memory, gray hairs, marks of prema-
ture  old age in  the countenance, catalepsy, and
madness.   It sometimes brings on sudden death,
without any  signs of previous disease, cither acute
or chronic.   Dissections of  persons who have
died of grief show congestion in, and inflammation
of, the heart, with  a rupture of its auricles and
ventricles.   But there are instances, in which the
sympathy of the heart with the  whole system is so
completely  dissevered by  grief, that the subject
of it discovers not one mark of it in his countenancee
or behaviour.  On the contrary, he sometimes ex- .
hibits signs ol unbecoming  levity in his inter-
course with the world.   This state of mind soon
passes away, and is generally followed by all the 
                OF  THE MIND.            319
obvious and  natural signs of the most poignant
and durable erief.

   There  is another symptom of grief which is
not often noticed, a .d that  is profomid sleep.   I
have  Of'en witnessed it even in mothers, imme-
diately after the death  oi a child.   Criminals, we
are te>ld by  Mr. Ake-man,  the keeper of New-
gat, in  London, often sleep soundly the night be-
fore their execution.   The son of general Custine,
slept nine hours, the night before he wis led to the
guillotine in P-iris.  These  facts, and many simi-
lar ones that  mi^ht be mentioned,  will serve  to
vindicate the disciples  of our Saviour from a want
of sympathy  with him in  his  suffering.  They
slept during his agony in the garden, because their
" flesh was weak," and in consequence of" sorrow
having  filled their hearts."

   The remedies f< r grief are physical, and moral.
To enumerate the keter would be foreign to the
                                      o
design  of  these inquiries.   They  belong more-
over to  anothc e  proicssion.   I shall barely glance
at them, without separating them from  those that
are of a physical nature.

   The  first remedy  that is indicated  in recent
grief  is, opium.   It should be given  in  liberal 
320
ON  THE DISEASES
doses in its first  paroxysm, and it should  be re
peated afterwards,  in order to obviate wakeful-
ness.

  2.  From the relief which the discharge of tears
affords in grief, p.iins should b  taken to procure
if.  The means for this  purpose  are, obtruding
upon  the mind  i sorrow of a less grade than that
by which  it  is di-p^-ssed.  Ancient  history fur-
nishes us with a pathetic example of the efficacy'
of this remedy.   Psamminitus, one of the kings of
Egypt, with his son,  daughter and servant, were
taken prisoners by Cambysis, king  of  Persia.
Soon  after his captivity,  he b-held his daughter
sent in the habit of a servant to draw water.   This
sight drew tears from his attendants, but produced
no sign of distress in the king of Egypt.   Imme-
diately afterwards his  son was  cemductrd  before
his eyes to a  place of execution.   This sight he
likewise saw without  an emotion  of any kind.
His servant next appeared be fore him, among a
number of other captives.   This sight, although
accompanied  with less distress than the two  for-
mer, overcame  him, and he  suddenly  burst  into
tears.  It has been said, that" sorrows seldom come
alone."   The goodness of  heaven is obvious in
thfs dispensation of the evils of life; for, as sorrows
generally differ  in their degrees,  such of them as 
OF  THE  MIND.
321
are great, by weakening sensibility, lessen the pain
from the pressure of successive lighter ones, while
such as are originally light prepare the mind  for
the pressure of such as exceed them.

   3. Should  the system react, and symptoms  of
great  excitement appear  in the  blood-vessels or
brain, bleeding and purges should be prescribed.
The latter will be rendered necessary, by the ex-
hibition of opium.

   4.  The persons  afflicted with grief should  be
carried from  the room  in which their relations
have died, nor should they ever see their  bodies
afterwards.   They should by  no means be per-
mitted to follow them to the grave.  It would be
useful to inter the  body of the deceased as far as
possible from the view of the person,  who is the
subject of grief.   Grave-yards in a city, and in
places of public resort, are  very  improper, inas-
much as they either renew,  and perpetuate grief,
or create insensibility  to death,  and  a criminal
indifference to human dust.  The patriarch Abra-
ham  understood these principles in the  human
heart;  hence we read, when his wife died, he re-
fused to bury her in the sepulchres of the sons of
Heth,  but entreated them to sell him a piece of
ground, that he might " bury her out of his sight."
                      s  s 
322           ON  THE DISEASES

A similar practice was adopted by the descendants
of this  patriarch who  inhabited ancient  Judea.
Their grave-yards were always placed 2000 cubits
from their, cities.   The sepulchres or vaults of
the  wealthy  were  in  their gardens, which were
situated in  the  neighbourhood of their cities.
These facts  will render not only more credible,
but  more intelligible, the account given in the New
Testament of the agony of our Saviour being in a
garden, near the city of Jerusalem, and his tomb, a
sepulchre in which no man had laid.

   The Chinese, like the Jews, inter their dead out
of their cities.  The  Russians  bury  their  dead
after night, probably to prevent unnecessary grief.

   5. As soon  as the ceremonies and bustle of the
funeral are over, persons afflicted with grief should
be advised to receive the visits of their friends, ol
 whom the physician should always be one.  In their
 first visit to persons recently bereaved of their re
 lations, they should imitate the conduct of Job's
 friends, who after weeping for  his losses and afflic-
 tions when they beheld him  afar off,  the sacred
 historian tells  us,  "sat down  with  him upon the
 ground, seven days, and seven  nights, and none
 spake a word to him,  for  they saw  his grief was
 very great."  Mr. Sterne has imitated,  but not 
OF  THE  MIND.
323
equalled, this delicate and affecting'passage, in his
history  of his uncle Toby.   In his first visit to
his brother, after  the death of his son, "  he sat
down (says  Sterne) in an arm chair, at the head of
a bed in which his brother lay, — and-----said
nothing."   There is science, as well as sympathy
in this silence, for in this way, grief most  rapidly
passes from the bosom  of the sufferer into that
of his friend.

   As soon as it is proper to begin a conversation
with a person under the pressure of  recent grief,
such consolations should be  suggested, as  are of-
fered by reason and religion.  Dr.  Stonehousc,
the physician and friend of the pious Mr. Harvey,
made it a practice to send a copy of a little work,
entitled " the Mourner," written by Dr. Grovenor,
to the friends of every patient he lost.  It is an
excellent book, and well calculated to compose the
mind under this kind of affliction.  A physician
should listen to the history of the last stage of his
patient's disease, and to the details of the appearan-
ces of the body after death.  Much  knowledge
may be picked up in this way, which would other-
wise  perish.   If  any prejudice  or mistake  has
taken place respecting his opinion of the  nature
of the disease of which his patient has died, or of
the effects-of any  of his remedies, he may remove 
324
ON  THE DISEASES
or correct them.  By a visit  thus paid, and em-
ployed, a physician not only wards off any  com-
plaint of his want of skill, but increases the confi-
dence of his patients in it, and often  secures their
attachment to him through his subsequent life.

  6. After the expiration of the weeks of mourning
care should be taken never to mention the names
of the deceased persons to any of their friends, nor
to allude to any thing that by means of association
can revive their memories.   The appearance of
mirth,  and even cheerfulness, should be avoided.
They both often give  not only pain, but offence,
to a mind rendered excmisitely sensible by recent
grief.

  Physicians are sometimes  called upon to  men-
tion the deaths of relations to their patients.   This
should never be done  at once.  They should be
first told that they were sick, and in great danger,
and the news of their death should not be commu-
nicated until after a second or third visit.

                   Of Fear.

  There  are so much danger  and evil in our
world,  that the  passion of fear was  implanted in 
OF  THE  MIND.            325
our minds for the wise and benevolent purpose of
defending us from them.

  The objects of fear are of two kinds,

  I.  Reasonable.  These are,  death, and surgical
operations.  And,

  II. Unreasonable.    These are, thunder, dark-
ness, ghosts, speaking in public, sailing,  riding,
certain animals, particularly cats, rats, insects, and
the like.

   The effects of fear, when it acts suddenly upon
the system, are, tremors, quick pulse and respira-
tion, globus hystericus, a discharge of pale urine,
diarrhoea, and sometimes an involuntary discharge
of the faeces, aphonia, fever, convulsions, syncope,
mania, epilepsy, asphyxia, death.   Dr. Brambdla
relates the case of a soldier, in whom fear produced
not  only a fever,  but a mortification from a blis-
ter on the leg, which destroyed his life.   Besides
these general effects of fear,  it acts in a peculiar
manner upon the hair of the head.   1. In causing
it to stand perpendicular.  This has been happily
described by Virgil and Shakespeare.  2. In con-
verting it suddenly to a gray or white colour, and,
 3, in causing it to come out by the roots, and to 
326
ON  THE DISEASES
fall off the head.   Of this Dr. Huch informed mc
he knew an  instance In a gentleman who w is in
Lisbon, at the time of the great earthquake in
1755.  Other effects of fear have been lately no-
ticed.  The  earthquake which  took  place on the
shores of the  Mississippi, in December 1811, pro-
duced silence, or great  talkativeness,  and mo-
ping  stillness,  or constant  motion,  in  different
people.

  The remedies for fear are physical, rational, and
moral; and  here, as in the  preceding chapter, I
shall only  hint at the moral remedies, and blend
them  with such as are of  a rational and  physical
nature.

  I.  Of the  remedies  for the reasonable  objects
 >f fear.

  The first object of fear under  this head is death.
Its remedies  are,

  1. Just opinions of the divine government, and
of the relation we sustain  to the great  Author of
our being.   These opinions may be  best formed
by reading the scriptures, and such other books as
derive their  arguments for  fortifying the mind
against this fear from them, particularly the works 
OF  THE  MIND.
327
of Dr.  Sherlock and Mr.  Drelincourt, both of
which contain a treasure of knowledge and conso-
lation upon this subject.

   2.  As much of the  fear of death  is produced
by the dread of the  pains which attend it, let us
inform our  patients  that these pains are  by no
means  universal, that  they are less  severe  than
 the pains of many common diseases, from which
 there are  daily  recoveries, and that heaven has
 kindly furnished us with several remedies, which
 remove or mitigate them.   " It is less distressing
 to die  (says Mr. Pascall) than to think of death."
 This I believe is strictly true in most cases.

    3. The recollection of frequent  escapes from
 death.  David met Goliah without fear, when he
 recollected his escapes from  his conflicts with a
 lion and a bear.  Soldiers become brave, in pro-
 portion to the number of battles they have sur-
  vived.

    4.  The frequent  meditation upon death.  Dr„
  Horn mentions an instance o£ a man, who was not
  only cured of the fear of  death by  setting a por-
  tion of time every day to meditate upon it,  but
  the subject  at length became agreeable to him.
  In this, as well as in  many other instances, pair- 
 328          ON  THE DISEASES
 ful impressions upon the  mind  are  upon a foot-
 ing with  painful impressions upon the body, in
 being converted by  repetition into such as arc of
 a pleasurable nature.

   5. Constant  employment is an antidote to
 the fear of death; for fear, like vice, is the offspring
 of idleness.

   6. Wc have an account of a method of obviating
 the fear of death from a public  execution, in Miss
 Williams's history of the conduct of the marquis
 de  Chatelet,  and general Miranda, during  their
 confinement  in  Paris, and at a time when they
 expected  every  day  to be led to the  guillotine.
 They read books of history and  science constant-
 ly when alone, and conversed upon no other sub-
jects when together;  anel although they were con-
 fined for six  months in the same apartment, they
 never spoke to each other of their impending and
 expected fate, by which means they  lessened the
 fear of it.   This account was confirmed to me by
 general Miranda,  in his  visit  to this city a  u w
 years ago.  Boys obviate  fear  in like manner, by
 silence in  passing by a ^rave-yard, or by conver-
 sing upon subjects unconnected with death.   It
 s not peculiar to the passion of fear to be  increas- 
                OF  THE  MIND.           329
ed by conversation.   All the other passions  arc
excited by it.

  7.  The fear of death is sometimes obviated by
company in the last hours of life.  "It is not so
difficult a  thing  to  die  (said Lewis the Four-
teenth, on his death  bed) as I expected."  Vol-
taire,  who mentions this anecdote, endeavours to
account for it, by adding, that all men  die with
composure or fortitude,   who die  in company.
The courage of soldiers is derived, in a great de-
gree,  from being  surrounded by persons  who will
bear a testimony in its favour.

  8.  Music suspends the fear of death;  henae its
universal use in battle.   Even noise of any kind
dissipates fear; hence boys obviate it not only by
silence when in company, but by whistling, or
hollowing when they pass by a grave-yard alone,
after night.

  9.  Opium has a wonderful effect in lessening
the fear of death.   I have seen  patients  cheerful
in their last  moments, from the operation of this
medicine upon the body  and mind.

  2.  The fear of a surgical operation  may  be
very much lessened by previous company, and a
                     . T T 
330           ON THE DISEASES
large dose of opium.  Its pain may be mitigated
Xby the gradual application of the knife, and, in te-
dious operations, by short intermissions in the use
of it.

  II. Of the unreasonable objects of fear. These
are,

  1. Thunder.  The remedies for it arc,

  1. Living in a house  defended by a  lightning
rod.

  2. Sitting in the middle of a room, and remote
from the doors and windows of a house, not de-
fended by a lightning rod.

  3. A citizen of Philadelphia, who was under
the influence  of this fear, obviated it in a degree
by closing the door and  windows of a room, and
sitting with a lighted candle in it.   By this means
he avoided the sight of the lightning, and the an-
ticipation of the noise of the thunder which usual-
ly follows it.

  4. A lady of respectable character, formerly of
this city,  usually  fainted with terror during  the
time of a thunder-gust, and discovered,  by a livid
countenance, and  cold and clammy  sweats,  the 
OF  THE  MIND.
331
signs of approaching death.   She was apparently
kept alive, by pouring into her stomach three or
four wine  glasses of Jamaica  spirits: it  was re-
markable she  never was  intoxicated by it, and
that it was disagreeable to her at all  other times.

   5.  I crossed the Atlantic Ocean with a lady, in
whom an acute head-ache was always induced by
thunder.   It left her as soon as the thunder ceased.
He'* only remedies for it were, quietness and si-
lence.   It is probable a large dose  of laudanum,
taken upon the appearance of a thunder-gust, would
have prevented this head-ache, as well as obviated
the terror mentioned in the two  preceding cases,
more effectually than a close room artificially light-
ed, or a large quantity of ardent spirits.

   2. The fear which is excited by  darkness may
eadly be overcome by a proper mode of educa-
tion in early life.   It consists in compelling chil-
dren to go to bed without a candle, or without per-
mitting company to remain with them until they
fall a sleep.

   3.  The fear of ghosts should be prevented or
subdued  in early  life, by teaching children the
absurdity and falsehood of all  the stories that are
fabricated by nurses upon that subject. 
332
ON  THE DISEASES
  4. The  fear from speaking in public was  al-
ways obviated by Mr. John Hunter,  by taking a
a dose of laudanum before he met his class every
day.

  5. The fear from sailing, riding, and  from cer-
tain animals and insects,  may all be cured by  re
solution.  It should be counteracted in  early life.
The existence of it always shews a defective euu-
cation.   Peter the Great, of Muscovy,  was  born
with a dread of water.  He cured it, by  throwing
himself head  long into  a boat  when obliged to
cross  a river.  The horror  he felt in doing this
often  induced syncope.   He finally conquered  his
dread of water,  so as to cross seas in pursuit of
the great objects  which  characterised his life and
reign.

   In  cases of sudden fear from  any cause,  hold-
ing the breath, coughing, or hawking, often ^ve
immediate relief.   They impart  tone to  the brain,
by promoting a determination of blood to it, and
thus infuse vigour into the mind.

   To obviate fear from all its  causes,  great  ad-
vantages will arise from creating counter motives
in  the  mind.  The fear of death  in a battle is
overcome  by  the powerful sense of  glory, or 
OF  THE  MIND.            333
shame.   The fear of the pain of an operation, such
as drawing a tooth in a child, is overcome by the
expectation of receiving afterwards a piece of mo-
ney, and the prospect of all the pleasures it will
procure.

   Great advantages  may likewise be derived  for
the  cure  of fear, by a proper application of the
principle of association.  A horse will seldom be
*     *_____________   —----------;—      \ >
moved  by the firing  of a gun, or thebeating of a V
drum, if he hear them  for the first time while  he
is eating ; nor will he start, or retire  from a wheel-
barrow, or a millstone, or any other  object of that
kind, after  being once or twice fed upon them.
 The same law of association may be applied in a
 variety of instances to the human mind, as  well
 to the prevention, as cure,  of fear.

                   Of Anger.

    This passion was implanted in the human mind
 for wise and useful purposes.  Its exercises, with-
 in  certain  limits, are admitted  in  the scriptures.
 It is only when it ascends to rage and  fury, or
 when  it is protracted into malice and  revenge,
 that it becomes a sin and a disease.
/  fAU^  #~~  »*»**+  "***
/.
ft^y  ...  '**'' 
334          ON THE DISEASES
   A morbid paroxysm of anger appears in a pre-
ternatural determination of  blood to the  brain, a
turgescence of the blood vessels of the face, a red-
ness of the eyes, an increased secretion of saliva,
which is discharged by  foaming  at  the  mouth,
great volubility, or a total suppression of  speech,
agitations of the fists, stamping of the feet,  uncom-
mon bodily strength, convulsions, hysteria, bleed-
ing at the nose, apoplexy, and death.  Sometimes
this disease appears with paleness,  tremors, sick-
ness at stomach, quick respiration, puking,  syn-
cope, and asphyxia.  It is in  this case generally
combined with fear, and hence arises the abstrac-
tion of blood from the brain, and its determination
to other parts of the body.

 The remedies for anger, when  it becomes a dis-
ease, divide themselves into two classes; I, such as
are proper during its paroxysms ; and II,  such as
are proper in their intervals, to prevent their re-
currence.

   I. To the  first head belong,

   1.  A draught of cold water.   This acts in
two ways;  1, asasedative; and 2,  by giving time
for reflection. 
OF  THE  MIND.
335
  2. Cold  water  thrown over the whole body
has in several instances cured a paroxysm of an-
ger.   It never fails to part two angry, contending
dogs.

  3. Silence. This should be observed by per-
sons, when they are disposed to excessive anger.
If this be impracticable, let the angry  person re-
peat the Lord's prayer, or, if he be indisposed to
do this, let him count twenty.   The action of the
organs of speech, employed in either, will serve to
convey off a portion of excitement  from his mind,
as  well as to  give time for the reflux of blood
from the brain.

   4. The celebrated general Galvez, formerly of
the Spanish army, made it a  practice, when he felt
himself disposed to be angry, to drink a bottle of
claret.  It instantly composed his mind, probably
by overcoming a weak morbid action, and pro-
ducing agreeable and healthy excitement in his
brain.  A dose of laudanum would  be a better
remedy  for this purpose.   It  could  not fail of
being effectual in anger attended with  fear, and a
determination of the blood to the stomach and vis
cera of the thorax. 
336
ON  THE DISEASES
   II. The means  of  preventing  the  recurrence
of anger should be,

   1.  A milk and vegetable diet.   Dr.  Arbuthnot
says  he  has  seen an irascible  diathesis perfectly
cured by this remedy.

  2.  Avoiding speaking with a loud voice at all
times, and especially when disposed to anger.

  3.  Avoiding the use of ardent  and  fermented
liquors.   They  predispose to anger, even where
they do not intoxicate.

 4. Ballonius says, that  fatigue and  thirst  pre
dispose to anger.  Hunger certainly has that ef-
fect.  They  should both  therefore be carefully
avoided by irascible persons.

  5.  Opposing  to anger other passions  which
destroy it.  Thetys, I remarkctl formerly, eradicat-
ed the anger of her son Achilles, by exciting in
his  mind the  passion of love.   Fear has had the
same  effect.  The  threat and  the  dread  of a se-
vere punishment has often prevented it in school
boys  and servants. 
OF  THE  MIND.
337
  6. The cultivation of the  understanding has a
great influence in destroying the predisposition to
anger.   Science of all kinds is useful for this pur-
pose,  but the mathematics possess this property
in the most eminent  degree.  They produced that
effect upon  the temper of sir Isaac Newton, of
which the following  instance  is mentioned by one
of his cotemporaries.

   Upon seeing a large collection of papers on fire
that contained the calculations of  many years,  in
consequence of  his little dog jumping upon his
table, and oversetting his candle  upon them, he
barely  uttered the following words;  "O!   Dia-
mond !  Diamond !  little de>st thou know the  mis-
chief thou hast done thy master."  I  shall men-
tion in  another place an instance of one of his ap-
petites being subdued in like manner, by his mind
being constantly occupied by  mathematical and
philosophical studies.   I am disposed to ascribe
more to those studies  than to any others,  from
their extending a sedative and  moral influence to
 all the  passions.   The late Rev. Mr. Farmer, one
 of the ministers of the catholic church in this city,
 informed me, that demonstrating two or three pro-
 positions in Euclid, before he retired to his closet
 for the purpose of  devotion, never failed to have
 that effect upon his mind.
                       v xr 
>3tt          ON THE DISEASES
  7. It will be useful for persons subject to the
criminal degrees of this passion, to reflect, that it is
not only contrary  to religion  and morals, but to
liberal  manners.  The  term gentleman implies a
command of this passion, above all others.

                   Of Joy.

  This emotion is attended sometimes with pain
in the region of the heart, a change  in the voice,
tears, syncope, and death.  Mr. Bruce mentions
another symptom of excessive joy, and that is
thirst,  which he felt in a  high degree, when he
reached the long sought for head of the Nile.   He
gratified it, he  tells us, by drinking  the health of
his sovereign, George  the Third, and of his mis-
tress, by a draught from the fountain of that cele-
brated river.

   Joy is most intense, when it has been preceded
 by fear.  The Indian Chief, Logan, has designat-
 ed this form of joy in his eloquent speech, preset v-
 cd by Mr. Jefferson, in  his Notes upon Virginia,
 when  he declares that "he knew not the  ioy of
 1 v.ai.

   There are many instances upon record, of dea:ii
 being induced by a sudden paroxysm of joy.  The 
OF  THE  MIND.
339
son of the famous Leibnitz died from this cause,
upon his opening an old chest, and unexpectedly
finding in it a large quantity of gold.  Joy, from
the successful issue of political schemes or wishes,
has often produced the same effect.  Pope Leo
the Tenth died of joy, in consequence of hearing
of a great calamity that  had  befallen the French
nation.  Several persons died from the same cause,
Mr. Hume tells us, upon witnessing the restoration
of Charles the Second to the British throne; and
it is well known the door-keeper of congress died
of an apoplexy, from joy upon hearing  the news
of the  capture of lord Cornwallis and his  army,
during the American revolutionary war.

   During a paroxysm of joy,  if it be attended
with  danger  to life, a new emotion or passion
should be excited, particularly terror, anger, fear,
or  grief.  Perhaps the  affusion of  cold water
might have that effect.   The stimulus of artificial
pain should likewise be tried.  It should be of a
nature calculated to produce  the most prompt ef-
fects.

   The morbid  state of joy should  be prevented,
 by imparting the news which we expect will create
 it, in a gradual manner, and with the alloy of some
 unpleasant circumstances. 
340
ON  THE DISLAiES
   Connected with joy, but produced by different
causes, is laughter.  It is a convulsive disease,
and sometimes induces a rupture of a blood-vessel
in the lungs, spleen, or brain.   1 have seen an
instance of haemoptysis induced by it,  which had
a  fatal issue.   Two sudden  deaths arc upon  re-
cord from it, the one of Chrysippus,  an ancient
Greek philosopher, the other of a pope.  It was
induced in the latter, while he was confined to  his
bed  with a light  indisposition, by see  ing a tame
monkey  put on  a part of  his  pontifical rtibcs.
Excessive laughter, when not attended  w ith  these
fatal effects, is often  followed with a pain in the
left side, hiccup, and low spirits.

   The  remedies  for  a paro:„)sm  of laughter
should be, fear, terror,  or any other counter im-
pression.   Pinching  the body, or  the affusion of
cold  water over it, is calculated to produce the
same good effects.   Laudanum seldom fails of
relieving the pain, hiccup, and low spirits, which
sometimes follow it.

  Of the Morbid Effects of Envy, Malice,  and
                   Hatred.

   As envy is commonly the parent of malice and
hatred, I shall  make a few remarks upon it, and 
                OF  THE  MIND.            341
afterwards mention the combined effects of them
all upon the body.

   Of this vice it may  be truly asserted, that it is
deep seated, and always painful; hence it has been
said, by an inspired writer, to resemble " rotten-
ness in the  bones;" and by lord Bacon, " to know
no holidays."  It is likewise a monopolizing vice.
Alexander envied his successful generals, andGar-
rick was hostile to all the popular players oi%is day.
It is moreover a paricide vice, for it not only emits
its poison against its friends, but  against the per-
sons, who,' by the favours it has  conferred upon
those  who  cherish  it, have become  in one res-
pect the authors of their being; and, lastly, it pos-
sesses a  polypus life.  No kindness, gentleness,
or generosity, can destroy it.   On the contrary, it
derives fresh strength from every  act which it ex-
perienced of any of them.   It likewise survives
and often forgives the resentment it sometimes
occasions, but without ceasing to  hate the talents,
virtues or personal endowments, by which  it was
originally excited.  Nor  is it satiated by the ap-
parent extinction of them in death.   This  is ob-
vious, from its so frequently  opening the sanctua-
ry of the grave, and  robbing the possessors of
those qualities of the slender remains it had left
 them of posthumous  fame. 
342          ON  THE DISEASES
   However devoid this vice and its offspring may
be of remissions, they now and then appear in the
form of paroxysms, which discover themselves in
tremors, paleness,  and  a suffusion of the face with
red blood.  The face in this case performs the vi-
carious office which has lately been ascribed to the
spleen.   But their effects  appear more frequently
in slow fevers, and in a long train of nervous dis-
eases.   Persons affected  with them  seldom ac-
knowledge their true cause.  A single  instance
only of this candour is mentioned by  Dr. Tissot.
He tells us he was once consulted by a gentleman,
who told him all his complaints were brought on
by his intense and habitual hatred of an enemy.
Many of the chronic diseases of high life, and pro-
fessional men, I have no doubt are induced by the
same cause.

  I once thought that medicine had not a single reme-
dy in all its stores, that could subdue or even palliate
the diseases induced by the baneful passions that
have been described, and that an antidote to them
was to be found only in  religion ; but I have since
recollected one, and heard of  another  physical
remedy, that will at least palliate  them.   The first
is, frequentconvivialsociety between persons who
are hostile to each other.   It never fails to  soften
resentments,  and sometimes to produce  reconci- 
OF  THE  MIND.
343
  liation, and friendship.  The reader will be sur-
  prised, when I add, that the second physical reme-
  dy was suggested to me by a madman  in the
  Pennsylvania  Hospital.  In conversing with him,
  he produced a large collection of papers, which he
  said contained his Journal.   " Here (said he) I
  write down every thing that passes in my mind,
  and particularly  malice and revenge.  In record-
  ing the latter, I  feel my  mind emptied of some-
  thing disagreeable to it, just as a vomit empties
  the stomach of bile.   When I  look at what  I
  have written  a day or two afterwards, I feel asham-
  ed  and disgusted with  it, and wish  to throw it
  into the fire."  I have no doubt of the  utility of
  this remedy  for envy, malice,  and hatred, from
  its salutary effects in a  similar case.  A  gentle-
  man in this city informed me, that after  writing
  an  attack for the press upon a person  who had
  offended him, he was so struck  with its malignity,
  upon reading it, that  he instantly destroyed  it.
* The  French nobility sometimes cover the walls
  and ceiling  of a room in their houses with look-
  ing-glasses.  The room, thus furnished, is called
  a Boudoir.   Did ill-naturcel people imitate the
  practice of the  madman and gentleman  I  have
  mentioned,   by  putting their envious,  melicious,
  and  revengeful  thoughts upon paper,  it would
  form a mirror that would serve the same purpose 
344
ON  THE
DISEASES
      of pointing out, and remedying, the evil ehsposi
      tions of the mind,  that  the boudoirs in France
      serves, in discovering and remedying the defects ii
      the attitudes and dress of the body.

        To persons who are not ashamed, nor disgust-
      ed, with the first sight of their malevolent effusion*,
      upon paper, the same  advice may be given, that
      Dr. Franklin gave  to a gentleman, who read part of
      a humorous satyre which he had written upon the
  1 »'   person and  character of a respectable citizen of
i^Y   Philadelphia.   Alter he had  finished reading  it,
   \   he asked the Doctor what he thought of his pub-
   I  lishingit ?  " Keep it by you, said the Doctor, for
      one  year, and then ask me that  question."   The
      gentleman  felt the force of this answer, and went
      immediately to the printer, who had composed the
      first page of it, took it from him, and consigned the
      whole manuscript to oblivion.

        I shall conclude the history of the passions, by
      remarking,  that their  symptoms, and force,  are
      varied by a difference in predisposition, age, rank
      iji society,  profession, moral and  religious habits,
      duration, and by their acting singly, or in combi-
      .nation u i th each other. 
                 OF  THE  MIND.             345
    There is now and  then a tor tor of the pas-
 sions, the reverse of the diseases  in them which
 have been described.  Instead of being unduly ex-
 cited, they are devoid of all sensibility and irrita-
 bility.   Persons who are thus affected love  and
 fear nothing.   They  are strangers to grief and an-
 ger ; they envy and  hate nobody;  and they  are
 alike insensible to mental pleasure and pain.  I
 was  once consulted by a citizen of Philadel-
 phia, who was  remarkable for his strong affec-
 tion  for his wife and children when his mind
 was in a sound state,  who was occasionally afflict-
 ed with this apathy, and when  under its influence
 lost his affection for them all, so entirely, that he
 said he could see them butchered before his eyes
 without feeling any distress, or even an inclination
 to rise from his chair to protect them.

   This paralytic state of all the passions continues
 during  life in some people :  a  physician of great
 eminence, who died some  years ago in England,
 declared,  upon his death bed, that  he had never
 known what it was to love man, woman, or child.
 But we sometimes meet with this disorder in a
partial state.   Thus are there men who have never
 loved, others who have never feared, others who
have  never  shed a tear,  and  others  in whom  no
injuries have ever  excited, an emotion of anger.
                       xx    » 
346
ON  THE DISEASES
In such persons, the mind is in a mutilated state ;
for man, without all his passions, is an imperfect
being, both as to his duties and happiness.

   The remedies for this torpid state of the pas-
sions,  whether general or partial, should be suited
to the state of the system.   Depletion will  be
proper, if the blood-vessels are oppressed.  In a
contrary state of the system, powerful stimulants,
particularly pain, labour, the cold bath, and a sali-
vation  are indicated.    I  mentioned  formerly  an
instance  in  which mercury restored  the  affection
of a mother for  her child in a day or two after it
affected her mouth. 
OF  THE MIND.
347
            CHAPTER  XVIII.

   Of the Morbid state of the Sexual Appetite.

 1HIS appetite, which was implanted in our na-
tures for the purpose of propagating our species,
when excessive, becomes a disease both of the body
and mind.  When restrained, it produces tremors,
a  flushing of the face, sighing,  nocturnal pollu-
tions, hysteria, hypochondriasis, and in women the
furor uterinus.   When indulged in an undue or
a  promiscuous intercourse  with  the female sex,
or in onanism, it produces seminal weakness, im-
potence, dysury, tabes dorsalis,  pulmonary con-
sumption,  dyspepsia,  dimness of  sight,  vertigo,
epilepsy, hypochondriasis, loss of  memory,  ma-
nalgia,  fatuity, and death.   From  a  number of
letters addressed to me,  for advice, I shall select
but three, in which many of those symptoms are
mentioned,  and deplored  in  the  most  pathetic
terms.  The first is from a physician in Massa-
chusetts, dated September 4th, 1793.

                          I 
348           ON THE DISEASES
   " The gentieman whose case is now submitted
to you is about twenty-five years of age, meagre,
gloomy, and restless, has  a bad countenance, and
a lax  state of bowels.  He imputes his indisposi-
tion to his excessive devotedness to Venus, which
he thinks has  been induced by a morbid state of
his body.  He has been married three years, had
no connection  with  the sex  before he  married,
and, although  he  feels disgusted with his strong
venereal propensities, he cannot resist them.  I ad-
vised him  to  separate himself from his wife by
travelling, which he did, but without experiencing
any relic f from his disease.  He has earnestly re-
quested me to render him impotent, if I could
not give  him  the command  of himself in any
other way.  I have  tried  several  remedies in his
case;  nothing has done him any good except the
sugar of lead,  which I was soon obliged to lay
aside, from its producing  a severe nervous cholic.
Wishing to  know whether his disease was not
seated in his  imagination only, I asked whether
the gratification of his appetite was equal to his
desires.  Dixit, per annos tres, quinqu% vices se
coitum fccisse in horis viginti quatuor,  ct sempef
semine ejecto."

   The second letter, to which I  have alluded, is
from the miserable subject of the  disease that is 
OF THE MIND.
349
described in it.   After acknowledging its cause to
be from onanism, he adds, "I rest badly at nights,
and am much troubled with dreams.  I have fre-
quent nocturnal erections, accompanied'with a sen-
sation of uneasiness, instead of desire or  pleasure;
and from dreams, frequent emissions take  place,
which are much more fluid than natural.   The
external organs of generation have a numb,  or
dead, feeling.   The  lower part of my back is
 veak ;  my  eyes are often painful and my eye-lids
3 welled and red.  I have an almost constant cold.
and oppression at my  stomach.   In short, I had
rather be laid  in the silent tomb, and  encounter
that dreadful uncertainty, hereafter, than remain
in  my present unhappy and  degraded situation.
 These  are  humiliating concessions, and it is ex-
 tremely painful for me to make them ; but  let my
 melancholy situation be my apology for theni."

    The third  and last letter upon this  subject is
 from a physician in Virginia, in which he describes
 the disease of a patient then under his care, in the
 following words.  " A.  B. aged seventeen, of a
 cold phlegmatic temperament of body, of a sedan-
 tary life, and studious habits, in  consequence of
 indulging in the solitary vice of onanism, has late-
 ly become very much diseased.   His vision is
 indistinct, and his memory much impaired, and he 
350
ON  THE DISEASES
now labours  under much  muscular  relaxation,
prostration of strength, atrophy, and  depression
of spirits.   His system is so very irritable, that
the least agitation of mind, or riding on horseback,
or gently rubbing his breast, or even combing his
hair, seminis  emissionem inducunt.  Any  plan
you may suggest for the relief of this truly wretch-
ed being will  be gratefully received."

  But these are not all the melancholy and dis-
gusting effects of excess in the indulgence of the
sexual appetite.   They sometimes discover them-
selves in the imagination and senses, in a fondness
for obscene conversation and books, and in a wan-
ton dalliance with women,  long after  the ability
to gratify the  appetite has perished from disease,
or age.

  The remote and exciting causes of this disease
in the  sexual appetite are,

  1. Excessive eating, more especially of high
seasoned animal food.   The vices of the cities of
the plain were  derived  in part from their " fulness
of bread;" by which is meant an excess of nou-
rishing aliment. 
OF  THE  MIND.
351
  2. Intemperance in drinking.  Hence the fre-
quent transition from  the bottle  to  the brothel!
It is because it is so common and natural, that the
former is generally mentioned as an apology for
the disease contracted in the latter, by young men,
in their application to physicians for  remedies for
it.  The incestuous gratification of the sexual ap-
petite, which was the first sin that revived in the
world after the flood, was the effect we are told
of the intemperate use of wine.

   3. Idleness.   This was another of the causes
mentioned  in the Old Testament of the  vices of
the cities of the plain.   It is  from the effects of
indolence and sedentary habits that the venereal ap-
petite prevails with so much force, and with such
odious  consequences, within  the  walls  of those
seminaries of learning, in which a number of young
men are herded together, and lodge in the same
rooms,  or in the same beds.

   The remedies for this appetite, when inordinate,
are natural, physical and  mental.  They are,

   1. Matrimony; but where  this is  not practica-
ble, the society  of chaste and modest  women.
While  men live by  themselves (says La Bruere)
they do not view washerwomen or oyster-wenches 
352
ON  THE DISEASES
as  washerwomen or oyster wenches, but simply
as women.  But by  mixing with the sex, they
lose the habit of associating the idea of the sex of
the women with  a cap or a petticoat.   I have
known few young men of loose morals, who have
attached themselves to the society of the  ladies.
They not only polish their manners, but  purify
their imaginations.

  2. A diet, consisting simply of vegetables, and
prepared without any of the usual condiments that
are taken with them.  Dr.  Stark  found his vene-
real desires nearly extinguished  by living  upon
bread and water.   They  revived upon a diet of
bread and milk, and became more  active by eat-
ing six or eight ounces of roasted goose every day,
with a proportionable quantity of bread.   Persons
afflicted with  this disease  should  use but little
salt  in  dieir aliment.  Plutarch  tells us, it wee
avoided by the priests in his  day, from its dispo-
sing to venery.  The birth of Venus from the sea
was probably intended to signify the connection
between the use of salt and the venereal  appetite.
In recommending a vegetable diet for the cure ol
this disease, I would  remark, that  it is  effectual
only when it succeeds a  full animal diet; for we
read not only of individuals, but of whole nations,,
that live upon vegetables and ether simple  food, 
OF  THE  MIND.
353
in whom the sexual appetite exists  in  its usual
and natural force.   In such persCns the appetite
should be weakened, by reducing the quantity of"
their aliment.

   3. Temperance in drinking, or rather the total
abstinence from all fermented and distilled liquors.

   4. Constant employment in bodily labour or
exercise.   They  both lessen venereal excitability
and  promote  healthy  excitement.  Hippocrates
tells us the Sy thians, who nearly lived upon horse-
back, were free  from   venereal  desires.  Long
journeys on horseback should therefore be recom-
mended for the morbid degrees of this  appetite.
The chase would probably serve the  same pur-
pose.  The connection  between this exercise and
chastity is  happily illustrated by  the poets in  the
character of Diana, who lived by hunting.  The
Indians owe the weakness of their venereal desires
to this, among other invigorating employments.

   5.  The cold bath.  There is a debility of body
which is connected with venereal excitability, and
which the cold bath is calculated to remove. This
excitability is  most apt  to occur during the con-
valescence, or soon after the recovery front ma
                     v  y 
354           ON  THE  DlStASES
lignant  or  chronic fevers.    Twelve  marriages
took place of the patients who recovered from the
yellow fever  at Bush-Hill, in  the neighbourhood
of this city, in the year 1793 ; and a greater num-
ber were detected in a criminal intercourse with
each other, in the private apartments and tents be-
longing to the hospital.  I have known two in.
stances  of young clergymen, who married the wo-
men who nursed them in chronic fevers, both of
whom were in very humble life.  The celebrated
Mr. Howard  did  the  same thing.   These une
qual matches appear to have been the effects of a
morbid sexual appetite, that suddenly succeeded
their fevers, and which they did not dare to grati-
fy but in a lawful  way.

   6.  A salivation, by diverting morbid excitabili-
ty  from the genitals  to the  mouth  and  throat,
would probably be useful in this disease.

   7.  Avoiding all dalliance with the female sex.
I knew a gentleman in'this city, who assured mc
he had gained a complete  victory over his vene-
real desires by a  strict regard to this direction;
and I have  heard  of a  clergyman, who overcame
this appetite by never  looking directly in the ficr
of a woman. 
OF  THE  MIND.
355
   8. Avoiding the sight of obscene pictures, therea-
ding obscene books, and listening to obscene con-
versation, all of which administer fuel to the sex-
ual appetite.

   9. Certain tones of music have sometimes sud-
denly relieved a  paroxysm of venereal desires.

   10.  Dr. Boerhaave says a sudden fit of laugh*
ter has sometimes had the same effect.

   11.  Close application of the mind to business, or
study of any kind,  more especially to the mathe-
matics.  Sir Isaac Newton conquered this appe-
tite  by means of the latter  study, and the late
Dr. Fothergill by constant application to business.
Both these great and good  men lived and died
batchelors,  and  both declared,  upon their  death
beds, that they never had known, in a single  in-
stance, a criminal  connection  with the  female
sex.

   12. The influence of an active passion, that shall
predominate over the sexual appetite.  The love
of military glory, so common  among the Ameri-
can Indians, by combining with the hardships of a
 savage life, contributes very much to weaken their
venereal desires. 
356          ON THE DISEASES
   13. Several medicines have been recommended,
to  subdue  the excess of the sexual appetite;
among these, the castor oil nut, and camphor, have
been most commended.   The former acts only by
opening the bowels, and thereby taking off the ten-
sion of the contiguous genital  organs.  Any other
lenient purge would probably have the same ef-
fect.  If camphor have any virtues, in this disease,
it  must be by  its  stimulating powers  removing
that nervous debility,  upon which venereal excita-
bility depends.   Any  other stimulating medicine,
given in a similar state of the system, would pro-
bably have the  same,  or a greater, effect.

   I have thus mentioned all the remedies for de-
rangement  in the  passions and  sexual  appetite.
While I admit  the necessity of their being aided
by religious influence, in order to render them suc-
cessful, I maintain that religious  influence is sel-
dom effectual for that purpose, unless it be com-
bined with those physical remedies.   This opi-
nion is amply supported by numerous precepts in
the Old and  New Testaments, and  it is only  by
inculcating those physical precepts,  with such as
are of a  religious and moral nature, that the lat-
ter can produce tjieir full effects  upon the 'body
and mind. 
OF  THE  MIND.
357
              CHAPTER XIX.

    Of Derangement in the Moral Faculties.

1 TOOK notice formerly of moral derangement in
the will, and mentioned its symptoms, as they ap-
peared in several specific vices.   This disease dis-
covers itself only in the moral faculty, and exists
with a sound state of the conscience and sense of
deity.  Under the present head, I shall make a few
remarks upon moral derangement, as it appears in
all those  moral faculties of the mind.

   For an account of the nature and offices of the
moral faculty and conscience, and of the difference
between  them, the reader is referred to an  ora-
tion delivered by the author before the American
Philosophical Society, in the year 1786, and pub-
lished in the first volume of his Medical Inquiries
and Observations.  For proofs of the existence of
an innate sense of deity in the  human mind, the
reader is referred to  lord Kaim's Sketches of the 
358          ON  THE DISEASES

History of Man.  All these faculties are liable to
derangement, partially and universally.

   I.  Partial derangement in them is sometimes
induced,

   I.  By ardent  spirits.

   2.  By famine, the effects of which in annihila-
ting the obligations, not only of morality, but of
consanguinity, and inducing  the  grossest acts of
cruelty are recorded in the 56th and  57th verses
of the 28th chapter of Deuteronomy.   The con-
sonance of the prediction contained in those ver-
ses with the  state  of  the human mind, in similar
circumstances of distress from hunger,  has been
established in many instances,  in the histories of
crews who have sought relief from shipwreck in a
boat,  or on a  desolate  shore.

  II. The moral faculty, conscience, and the sense
of deity,  are  sometimes totally deranged.  The
duke of Sully has  given us a striking instance of
this universal moral derangement, in  the charac-
ter of a young man who belonged to  his suit, of
the name of Servin, who, after a life uncommonly
distinguished by every possible vice, died,  cur-
sing and  denying his God.    Mr. Halsam has 
OF  THE  MIN».
359
described two cases  of it in the.Bethlehem Hospi-
tal, one of whom, a boy of thirteen years of age,
was perfectly sensible of his depravity, and  often
asked, " why God had not made  him like   other
men."   He  was, as might be expected, complete-
ly miserable,  and often expressed  a wish for death.
An epitome  of all that has been recorded, or per-
haps  seen, of this derangement in the moral facul-
ties has been given by Edgar of himself,  in  the
tragedy of King Lear, in the following lines.

    " I was a serving man, proud in heart and mind,
    That served the lust of my mistress' heart,
    And did the act of darkness with her;
    Swore as many oaths as I spake words;
    Wine I lov'd  deeply, dice dearly:
    I was false of heart, light of ear, and bloody of hand ;
    Hog in filth, fox in stealth, wolf in greediness,
    Dog in madness, and lion in prey."

    In the course of my life, I have been consult-
 ed in three  cases of the  total perversion  of the
 moral faculties.  One of them  was in a young
 man, the  second  in a  young  woman, both of
 Virginia, and the third was in the daughter  of a
 citizen  of  Philadelphia.   The last was addicted
 to every kind of mischief.  Her wickedness  had
 no intervals while she was awake, except when she
 was kept busy in  some  steady  and difficult  em- 
360
ON  THE DISEASES
 ployment.  In all these cases of innate, prcternatu-
 ral moral depravity, there is probably an original
 defective organization in those parts of the body,
 which are occupied by the moral faculties of the
 mind.

   How far the persons whose  diseases have been
 mentioned, should  be considered as responsible
 :o human  or divine laws  for their actions, and
 where the line should be drawn  that divides free
 agency from necessity, and vice from disease,  I
 .un unable to determine.  In whatever manner
 this question may be settled, it will readily be ad-
 mitted that such persons are, in a pre-eminent de-
 gree,  objects of compassion, and  that it is the bu-
 siness of medicine to aid both religion  and law,
in preventing and curing their moral  alienation of
 mind.  We are encouraged to undertake this en-
 terprise of humanity, by the sameness of the laws
 which govern the body and  the moral faculties of
 man.   I shall venture to point out  the sameness
 of those laws in a few instances, by mentioning the
 predisposition  and proximate  causes, the symp-
 toms, and the remedies of corporeal and moral dis
 eases.

   1.  Is debility the predisposing cause of elr>-
 e*ace in the body ?  so  it is  of  vice in the mind 
of the  mind.            361
This debility in the mind consists in indolence, or
a want of occupation.   Bunyan has justly said, in
support of this remark, that " an idle man's brain
is  the devil's work  shop."  The young woman,
whose moral derangement I mentioned a little
while ago, was always inoffensive when she was
busy.   The employment contrived for her by her
parents was, to  mix two or three*papers of pins of
different sizes together, and afterwards, to oblige
her to separate, and sort  them.   The near rela-
tion of  debility and vice  has been expressed by
the schoolmen in the following words " non posse,
est malum posse."  To do nothing, is generally
to do evil.

   2.  Do we prevent disease, by  removing  the
body out of the way of its exciting  causes acting
upon debility ? In like manner,  we prevent vice,
by removing the mind, in  its debilitated state, out
of the way of bad  company, and thus abstract it
from the stimulus of vicious motives upon  the
will.

   3.  Does  bodily  disease consist in morbid ex-
 citement, or irregular action ? Vice consists in like
manner in undue excitement of the passions and
 will,  and in their irregular,  or, to use a scriptural
 epithet, in their "crooked"  actions.
                       z z 
 J62           ON  THE  DISEASES

   4.  Is bodily disease a unit ? So is vice.  All its
 innumerable forms are derived simply from inor-
 dinate self-love.

   5.  Do  high degrees  of morbid bodily excite-
 ment require depleting remedies?   High degrees
 of vice require remedies of a similar nature, such
 as  the abstraction  of company,  and  the exces-
 sive or criminal gratification of the passions and
 senses.

   6.  Do  wc ov ercome  morbid action in a bodily
 disease in a highly  vital  part, by exciting it in a
 part less essential to life ?  In  like manner we cure
 the odious vice of avarice, and a debasing love of
 pleasure, by the less odious and debasing vice of
 ambition.

   7.  Is it impossible to  produce two sensations of
 unequal force, at the same time, in the body ?  It
 is equally impossible for the mind to act under
the impression of two motives at the same time.
Hence the truth of that declaration of our Saviour,
 "that no man can serve two masters, that is,  God
r.nd Mammon." Tn*e predominance of the motive
excited by one of them,  will always destroy the
oti.cr. 
OF  THE MIND.
363
  8. Do we accommodate stimuli to the  state of
excitability in diseases of the body ? The same
thing is done in all the successful applications of
moral stimuli, or motives, to  the will.  Qur Sa-
viour hints at this accommodation of moral reme-
dies to the peculiar state of the mind, when he al-
ludes to the practice of not putting new wine,
full of an active fermenting principle, into old bot-
tles, which in ancient Judea, were made of leather,
and of course, became weak from age.

  9. Is the excessive morbid excitement of a dis-
ease worn down by labour? Excessive  vicious
excitement is reduced in like manner by the same
means, and, in addition  to it, by solitude, shame,
and  certain restraints or  pains inflicted upon the
body, of a nature calculated to act indirectly upon
the mind.  I acknowledge the first impressions of
confinement and bodily pain  generally produce a
vicious fretfulness, and sometimes  impious ex-
pressions and immoral conduct; but these effects
of those moral remedies are generally very tran-
sient.  When continued long enough, they never
fail of producing a change in  the moral temper of
the mind.  A remarkable instance of the  truth of
this  remark occurred some years ago in the jail of
Philadelphia.   A notorious offender  amused him-
self, for some time after his confinement, by draw- 
364           ON  THE DISEASES
ing pictures, and  writing verses of a ludicrous
nature, upon the walls of his solitary cell.  At the
end of several  weeks he became silent and pen-
sive, and at the same time the following passage
of scripture, written by him, was discovered upon
one of the walls of  his cell.   " Come unto me,
all ye  who labour  and are heavy  laden,  and I
will give you rest."

   10. Are bodily sensibility and irritability weak.
ened, or destroyed, by  the protracted application
of morbid  stimuli to sensible and irritable parts ?
The same thing takes place from the long applica-      M'
tion of vicious impressions to the  moral faculties
of the mind.   They become, in such cases, to use
the words of one of the apostles, "dead," and
"seared with a red hot iron."  A disease resemb-
ling a palsy affects them all.

   I might go on further, and mention, more par-
ticularly,  the analogy between  bodily and moral
diseases, and the  propriety of  adapting specific
remedies to specific vices; but enough I hope has
been said to show the truth and importance of the
subject, and the practicability of the undertaking,
by persons whose professional studies and employ-
ments are more  nearly  related  to it than the au-
thor's.  However useful the rational and physical 
OF  THE  MIND.            365
remedies that have been mentioned may be to pre-
vent or cure vice, they never  can perform that
work completely, without the aid of that supernatu-
ral and mysterious remedy which it hath pleased
God to unite with them in his  moral government
of his creatures, and that is,  the forgiveness of
it.   In vain have legislators  substituted the exter-
minating axe and halter, and the influence of ig-
nominious or painful corporeal  punishments, for
this divine mode of curing moral evil.   The dan-
ger and mortality of the venereal disease were en-
creased, in former times, by the contempt, neglect,
and  corporeal chastisement, to  which persons af-
fected with it were exposed.  Since the pain and
shame of the disease have been considered as its
ample punishments, and the subjects of it restor-
ed to  public favour, the disease has every where
declined, and is now rarely  attended with danger,
or the loss of life. The abolition of the punishment
 of death, and of cropping,  branding, and public
whipping, and substituting for  them, confinement,
labour,  simple  diet,  cleanliness,  and affectionate
 treatment, as means of reformation and forgiveness,
 have produced similar moral effects in  the jail of
 Philadelphia.  If this original and humane institu-
 tion, in which science and religion have blended their
 resources together, has not been attended with uni- 
366
ON  THE DISEASES
   form success,  it must be ascribed wholly to the
   imperfect manner with which the principles that
   suggested it have been carried  into eftect.  They
   have been rendered abortive, chiefly, by the crimi-
Y  nals sleeping in the same room, and by the facility
   and frequency with which pardons are  obtained
   for them.   The former prevents the resuscitation
   of conscience, and all moral and religious  reflec-
   tion.  The latter is opposed  to the great axioms
   upon  which the  penal law of Pennsylvania  is
   founded ; that " punishments should be certain^
   but not  severe, and  that a  pardoning  power
   should not be lodged in any department  of a go-
   vernment."

     May this christian system of criminal jurispru-
   dence  spread,  without  any  of its  imperfections,
   throughout the world !  and may the rulers of na-
   tions learn from it, that the reformation of crimi-
   nals, as well as  the prevention of crimes, should be
   the objects of all punishments, and that the latter
A  can be effected much  better by  living than by
   dead examples!

     Here the reader and the author must take leave
   uf each other.  Before I retire  from his sight, I
   shall only add, if I have not advanced, agreeably 
OF  THE  MIND.
367
to my wishes, the interests  of medicine  by this
work, I hope my labours in the cause of humanity
will not be alike unsuccessful; and that the suf-
ferings of  our fellow creatures, from  the causes
that have been mentioned, may find sympathy in
the bosoms, and relief from the kindness, of every
person who shall think it worth while to read this
history of them.
THE END.
 
 
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