UNITED STATES OF AMERICA v * * ,«,4 FOUNDED 1836 r* WASHINGTON, D.C. i ■S GPO 16—67244-1 HF^ AN INAUGURAL DISSERTATION ON THE INFLUENCE OF THE PASSIONS UPON THE BODY, IN THE PRODUCTION AND CURE OF DISEASES: SUBMITTED TO THE EXAMINATION OF JOHN ANDREWS, PROVOST, PRO TEM. THE TRUSTEES AND MEDICAL FACULTY OF THE UNIVERSITY OF PENNSYLVANIA, FOR THE DEGREE OF DOCTOR OF MEDICINE, ON THE THIRD DAY Oi" THE SIXTH MO! BY JOSEPH PARRIS OF PHILADELPHIA. " Causa latet, vis est rmtissima PHILADELPHIA: PRINTED FOR THE AUTHOR, BY KIMBER, CONRAD, & CO. TO CASPAR wfeTAR, M. D. ADJUNCT PROFESSOR OF ANATOMY, SURGERY, &C IN THE UNIVERSITY OF PENNSYLVANIA, THE following pages are respectfully inscribed, as the first fruits of a medical education, conducted under his direction, and as a testimony of gratitude for much in- struction, and many valuable opportunities of improve- ment, received by his Affectionate Friend and Pupil, THE AUTHOR. 4'^ 2 77 r i/y* Ost~s cJ Jf~ PREFACE. ALTHOUGH I am sensible, that it will not be dif- ficult to detect many imperfections in the present essay, yet as liberality of sentiment is an attendant on minds that are endowed with genius and judgment; I hope to claim a share of their indulgence, and trust that proper allowance will be made for my inexperience. When speaking of the application of mental remedies to practice, I would on no account wish to be understood that I place an exclusive reliance on those powerful agents. And when treating of particular diseases, it is undoubtedly to be presumed, that other remedies, to suit the circumstances of the case, should at the same time be resorted to. In defining the passions, I have briefly noticed Love, Envy, Jealousy, &c. but I have omitted the considera- tion of their effects upon the system, as it would neces- sarily enlarge the essay beyond proper limits, and have therefore confined myself to the investigation of Fear, Anger, Joy, and Grief. It may be proper to re- mark that disappointed Love frequently terminates in those diseases which are common to the latter. INDEX. 1. Introductory observations. 2. A brief definition of the passions. 3. Cases to prove their influence in the production of diseases. 4. Cases to prove their influence in the cure of diseases. 5. An attempt to prove that mental remedies are not so uncertain in their effects, as has been general- ly believed, many valuable articles in the Materia Medica, being in some instances very precarious in their operations, owing to idiosyncrasies. 6. An attempt to prove that fear is, under all circum- stances, a sedative. 7. An attempt to reconcile the apparent contradictory . effects of the stimulating passions on the same in- dividual. 8. A brief explanation of the principles which ought to govern practitioners, in the application of mental remedies. 9. Consideration of particular diseases. 10. To conclude with a few observations on the influ- ence of the will. AN INAUGURAL DISSERTATION, &c. IN viewing the influence of the mind upon the body in the production and cure of diseases, an unbounded field opens before us, and almost discourages the traveller in an attempt to explore it* Under an impression of its vast importance, I enter with diffidence on the investiga- tion of a subject, which is at once useful and sublime. In doing this, I feel myself like an inexperienced wan- derer, on the borders of a wilderness country, but happily for me, some sagacious woodsmen have opened a path, and penetrated far enough to discover that it abounds in beauties, and in treasure. Availing myself of their la- bours, let me attempt to trace their steps, and if I only can succeed, in rendering the path, they have trodden, more open and clear, without presuming on my present strength to fell the sturdy timbers, it will be enough. It is not my intention in the course of the present es- say, to institute an inquiry into the cause of the wonder- ful action of mind and body upon each other. Great indeed is the goodness of Providence, and various parts of his benevolent plan have been unfolded,. through the aid of scientific exertions, and doubtless ma- ny important discoveries yet remain to be known ; but I am equally firm in the belief, that there are certain phe- nomena in the human system, which will never be clear- ly explained. The noble science of Chemistry, has furnished many highly useful improvements, and has elucidated subjects, that, but a few years ago, were not even imperfectly un- derstood ; but here we have the evidence of the senses to conduct our inquiries, and are enabled by analytical and 8 synthetic experiments, to ascertain the component parts of many visible, as well as invisible objects, with which we are surrounded. But how is it possible, on chemical principles, to explain the operation of the intellectual fa- culties....and where the Chemist, who, by any experi- ments which his utmost ingenuity can devise, is able to elucidate this wonderful phenomenon ? But a beneficent Creator, whose paternal care is con- spicuous throughout his works, whilst reserving some subjects within his sacred arcana, has endowed man with capacities to acquire knowledge, and with judgment to apply it. Hence the more he becomes acquainted with subordinate causes and their effects, the more he is qual- ified for being extensively useful; and perhaps no class in society have greater occasion to bend their attention to this subject, than the practitioners of the healing art; it leads them at once from unavailing attempts to investi- gate the essence, instead of attentively observing the operations of nature, and should teach man that the more he becomes acquainted with the order and har- mony established throughout the works of creation, the more he should be disposed in humility to acknowledge the limited powers of human comprehension, when com- pared with the boundless intelligence of Omnipotence itself. Having premised those general remarks, I shall pro- ceed briefly to define the different passions, but previ- ously to this, it may be proper to observe that they are of two kinds, viz. such as increase the force of the heart and arteries, and are consequently stimulant; and such as debilitate or depress them, producing a sedative ef- fect ; and as I believe few persons have been as happy in their attempts to delineate them as the ingenious Alexander Crichton, M. D. in his excellent work on mental derangement, I shall, in the general, consider him as my guide....And first, of Joy. 9 Joy is a stimulating and pleasurable passion, and out of it arise many terms to denote different degrees of mental enjoyment, which have improperly received the appellation of distinct passions, when, in reality, they are but modifications of the original. Dr. Crich- ton says, " Joy, in its strict sense, is a term applied to denote a pleasurable feeling arising from some pre- sent event." When we feel the mind under its influence in consequence of an action that is passed, we call this content ortself-satisfaction....when we anticipate some fu- ture advantage, the word hope, is used to describe it.... when we feel an obligation to another for some fa- vours bestowed, and are desirous of repaying it by pro- moting the welfare and happiness of our benefactor, this is called gratitude. A conviction of the supe- rior merit of an individual, excites our admiration and regard, while for his amiable qualities we consider him entitled to our esteem. Grief is the offspring of mental pain or suffering, and as Dr. Crichton very justly observes, " Mental pain, like mental pleasure, receives different appellations, ac- cording to its degree of violence ; or as it springs from different causes.'* For example, a person may be affected with distress, sorrow, deep sorrow, grief, melancholy, excessive grief, anguish, or despair. Repentance and contrition arise from a sense of grief or sorrow for a past event, in which we conceive our- selves to have been blamable, while a higher degree of this mental suffering is called remorse. Anger arises from an aversion to pain, and under its influence we are often led on to the commission of the most violent and unreasonable acts ; if after a person has ceased to injure us, we continue to foster the remem- brance of it, we consider him as an object of aversion, and if we injure him at any favourable opportunity, this B ID is called resentment or revenge, and we are actuated by a vindictive spirit. Fear may be considered as arising from, or rather as being a modification of self-love, and can only be excited through the medium of foresight; hence the common adage, " They that know nothing, fear nothing." Ter- ror is the consequence of some great and impending dan- ger suddenly presented to the view, while apprehension originates from the indistinct prospect of a distant and un- certain evil. Dr. Crichton observes, " When the mer- chant, a great part of whose fortune is exposed to the joint dangers of the winds and the ocean, is awakened in the middle of the night by the loud roarings of a terrible tem- pest....apprehension instantly arises in his mind; and his imagination, by representing to him what may happen, shall cause apprehension to terminate in dread." Love, when successful, is certainly a most grateful and stimulating passion, being deeply rooted in the hu- man breast; its influence is widely diffused throughout the different families of mankind, and when founded up- on correct and virtuous principles, proves a source of pure and durable enjoyment; but, when disappointed in its object....when every proferred attention is treated with neglect, it mostly terminates in those diseases which are incident to grief. Pride is very wonderful in its operation, it is the au- thor of an immense portion of evil. Ambition is a degree of the same passion, and is compared by professor Rush, to an inflammatory fever. Shame appears to be composed of fear united to a sense of guilt. Jealousy is formed by the union of anger and fear. Envy is a compound of grief and anger. Avarice seems to originate from a fear of losing what is already possessed, and a desire or hope of acquiring more. 11 HAVING paid some attention to several of the most important mental affections, it becomes necessary to take a view of their influence in the animal (economy. This subject may be divided into two parts. 1st, It will be proper to consider the diseases which are produced by primary affections of the mind; and 2d, the effects of the same agents in restoring the body to a state of health. With a view to elucidate those primary positions, it will be necessary to bring such facts into view, as I have been able to collect, not only from the writings of a few ancient authors, but also from the testimony of many persons in modern times. OF FEAR. CASE 1. Plater relates the following case in his Obs. lib. i. p. 36. Some young girls went one day, a little way out of town, to see a person who had been executed, and who had been hung in chains. One of them threw several stones at the gibbet, and at last struck the body with such violence as to make it move, at which the girl was so much terrified, that she imagined the dead person was alive, had come down from the gibbet, and was running after her. She hastened home, and not being able to con- quer the idea, fell into str©ng convulsions and died. Vide Crichton, vol, ii. page 262. CASE 2. Van Sweiten informs us, vol. x. p. 332. That a boy was so frightened by a large dog jumping upon him, that soon after, he fell down epileptic, and afterwards on seeing a large dog, or even hearing him bark, the pa- roxysm returned. 12 CASE 3. I have been informed by a very respectable inhabitant of Lancaster county, Pennsylvania, of a case of epilepsy, in his neighbourhood, induced by fright, which termi- nated in death in a few days. Bonetus gives a particular account of catalepsy, induc- ed by fright, in a Polish soldier, which terminated in death in the course of twenty days. Vide Crkhton, vol. ii. p. 264. CASE 4. A very ingenious man that was set apart for learning and the priest's office, was greatly terrified by a fierce and violent man, who held a musket to his breast unexpect- edly, and threatened to shoot him. The day after he became icteric, and soon after that delirious, so as to know none of his acquaintance, but cried out every now and then, Oh, vile man ! and then being seized with very great convulsive agitations, so that he could scarcely be held by the hands of many persons ; he died within four and twenty hours from the beginning of his delirium. Alexander's translat. Morgagni, Letter xxxvii.p. 213. That epilepsy may be excited only by beholding ano- ther in this dreadful disease, appears by several cases. CASE 5. A person in an hospital fell down in an epileptic fit in the sight of the other patients, the effect of this was so strong, that numbers of them became immediately affected in the same manner, and their paroxysms con- tinued and were repeated at the sight of one another in that state. The opinion of that great physician Dr. Bocrhaave, was requested on this occasion; he judicious- 13 ly reflected that these fits were originally produced by im- pressions on the mind...thatthemostproper means of cure would be to eradicate these impressions by others still more powerful. He therefore directed actual cauteries to be prepared, and kept hot, in readiness to be applied to the person who should next be affected. The conse- quence was, that afterwards not one person was seized. Vide Falconer on the passions, p. 100. CASE 6. At the performance of the ceremony of the first com- munion made in the parish of St. Roch, some years ago (1780) after the evening duty, a procession was made out of doors as was customary. The children had scarcely re- entered the church, and taken their proper seats, before a young girl was taken ill and had convulsions. This af- fection spread itself with such rapidity, that in the space of half an hour, fifty or sixty young girls from twelve to ten years of age, fell down in the same convulsions, at- tended with difficulty of breathing, a distention of the stomach, a sense of suffocation, hiccough, and convulsi- ons more or less violent. The accidents recurred to a few in the course of the week ; but the Sunday following being assembled with the matrons of St. Anne, which in- stitution is designed for the instruction of young girls, twelve of them fell in the same convulsions, and there would have been many more if they had not used the precaution to send home each child immediately to its parents. They were obliged to increase the number of the schools, and by thus separating the children, and only permitting them to meet in small companies, three weeks were sufficient to dissipate entirely this epidemic convulsive affection. Rapport des comvussaires charges par le Roy, deVexa- men du magnetisme animal, p. 54. 14 CASE r. The late Dr. Hutchinson informed Dr. Rush, that he once saw six patients in the Pennsylvania Hospital, af- fected with convulsions in consequence of seeing one of the patients fall down in a fit. Rush's 31 S. Lectures. CASE 8. These accounts correspond with a case related by Schenkius, lib. i. p. 117. from Cristoph. a Vega, who informs that he had seen a boy, who became epileptic in consequence of fright; and that another who was atten- tively beholding him that had fallen down, was suddenly seized with the same disease. CASE 9. In Mavor's collection, vol. ii. p. 164. it is related that one of the captives who was taken by the Turks along with admiral Middleton, thinking the admiral was about to lose his head, when he saw him so rudely presented to the Bashaw, fell into a swoon, and soon after died from mere apprehension. The effect this passion produces on the hair of the head? changing it to a gray colour, appears to be well authenticated. In the Literary Magazine, vol. ii.p. 195, there is an anecdote related of a boy, in one of the rudest parts of the county of Clare, in Ireland, whose hair was turned from a dark auburn to gray, in the course of a quarter of an hour. This is further confirmed by the case of a French gentleman related by Borelli, and quot- ed by Dr. Crichton, in whom the same change was ef- fected during one night. 15 The effects of fear upon the female system, under pe- culiar circumstances, is a subject well known, not only to physicians, but to many of that sex. It would be an easy task to enumerate cases illustrative of the subject, but as these would necessarily involve some circum- stances of a very delicate nature, I shall not attempt to enter upon them, but refer to authors* for two striking cases of abortion. I shall close this chapter on the effects of fear, by cit- ing a quotation from the learned and respectable Dr. Haller, who in enumerating the various consequenc- es of this passion, informs us, that it exerts a de- bilitating influence upon the heart and arteries, the sto- mach and intestines ; that it has suppressed the per- spiration, the catamenia, and the milk ; that it predis- poses the system to the reception of the plague and other diseases ; and finally, that great fear has sometimes in- duced death, of which he gives several instances. Metus multa similia facit mceroris: debilitat cordis vires, pulsumque reddit incertum et pallorem facit, et horripilationem, ut a frigore, et animi deliquium, et can- itiem subitam in nonnullis exemplis : Sanguinis motum ita moratur, ut nihil de vena fluat; hsemorrhagias sup- primit, et menses, et lac, ct perspirationem, viresque ad venerem necessarias frangit: cutis poros, aut certe pul- monis aperit ad recipiendum venenum pestis, alteriusve morbi; sudorem ciet, alvumque laxat, et icterum, scirr- humve inducit etiam subitum, puto a retento et coacto lacte; gangrsenam demum; et vulnera reddit lethalia, morbosque funestos. Etiam ventriculi et intestinorum vires debilitat, facit flatus, ructus. Semen ex metu emissum lego, sed id puto esseterroris. Denique mus- culorum motum delet, ut pratremore neque fugere pos- sint, neque se tueri. Inde tremor, etiam per viginti * Van Sweiten, vol. xii. p. 389, Schenkius Obs. Medic. Lib. i. p. 128. lfl annos non recessurus, paralysis ; amaurosis, aphonia, melancholia durabilis, amentia diuturna, epilepsia. Denique magnus metus nonnunquam mortem intulit. Mortuus est, eodem die, quo mors ei fuerat praesagita, ut metus esset pro morbo. Mortuus est, cui judicium fatale erat pronuntiatum, et cui in sepulchro pes esset re- tentus, et qui intuebatur tendines sibi dissectos, et qui notas variolarum in se ipso conspexerat, et alii ex aliis causis. Etiam in cane ex fragore tormenti mors. Reperitur in ejusmodi casibus sanguis ad cor conges- tus, et polypi, et ad cerebrum collectus cruor. Haller, Element. Physiol. Tom. v. lib. xvii. p. 583. ANGER. THIS passion exerts a very stimulating effect upon the heart and arteries ; its influence over the hepatic system is remarkable; it increases the secretion of bile ; hence the word choleric is applied to persons of irascible temper ; when improperly indulged, it becomes the parent of several dangerous diseases. Vide cases as follows.... CASE 1. A man of forty, passionate, of a robust constitution, accustomed to drink strong malt liquors, after a violent fit of anger, complained of a vertigo to which he had at times been subject, and then fell into an epileptic pa- roxysm, which lasted above an hour and returned four times: each fit was preceded by a spasm, tremor, and cold- ness of the right arm, which gradually arose to the head. The pulse was strong, the face full and florid, the bel- ly bound. Duncan's Hoffman, vol. ii. p. 17. 17 CASE 2. An old German cobler, who resided in Philadelphia, was greatly irritated by some mischievous boys, blowing the smoke of tobacco through the key hole of his shop door: he ran out with an iron poker in his hand and pursued them, but not being able to catch them, and they still continuing to tantalise him, he became so high- ly enraged, that he fell dead in an apoplexy. Professor Rush's Lectures. CASE 3. A young man of a tender constitution, and prone to passion, coughed up blood for some years every spring and autumn. After a violent fit of passion, a very pro- fuse haemorrhage returned regularly every day, at four in the morning, and nine at night: in a fortnight he lost at least eight pounds of blood. Duncan's Hoffman vol. i. p. 384. CASE 4. The same author gives us a very particular account of a robust and healthy man, about fifty years of age, who was seized after a violent passion, with a tremor, shiv- ering and coldness of the extremities, great anxiety of the prsecordia, depression of the strength, nausea, retch- ings, and a bitter taste in the mouth. Vol. i. p. 240. CASE 5. Morgagni in his xxxvii. Epistle, mentions the case of a young priest in whom jaundice supervened after a per- C 18 turbation of mind, which ultimately terminated in deli- rium, convulsions, and death on the fifth day. That a paroxysm of anger, or any other violent af- fection of the mind, in a nurse, will so alter the quality of the milk, as to induce disease in the sucking infant, is a fact which has claimed the attention of practical au- thors, and is mentioned by Rossentein on the diseases of children p. 6. 34. Also, Hamilton on female complaints, p. 319. The effects produced by this passion, did not escape the notice of Dr. Haller,* who among other conse- quences resulting from it, states that it accelerates the pulse, and has induced haemorrhages, apoplexy, a great distention of the heart, that it has ruptured cicatrices of wounds, produced inflammation, profuse perspiration, a sudden secretion of bile, vomiting, and diarrhoea. GRIEF. THIS passion produces a degree of torpor in every irritable part; it diminishes the force of the circula- tion, causing a paleness of the countenance, coldness of the extremities, contraction and shrinking of the skin, weakens the appetite, and diffuses a sense of languor through the whole system. Although the effects of grief are for the most part gradual, yet when suddenly excited, it has in some cases, speedily terminated life. CASE 1. Duncan's Hoffman, vol. ii. p. 392. mentions the case of a gentleman of fifty, who after long grief became ca- chectic r the face was lurid and yellowish, the appetite and strength greatly depressed, the belly bound, with * Physiolog. Haller, Tom. v. p. 586. 19 extreme uneasiness from flatulencies ; the breathing dif- ficult, with an anxiety of the praecordia, to such a degree that at times he seemed ready to expire ; the pulse weak, for the most part unequal, and sometimes intermitting. At length an icteritious colour of the face supervened, with an increase of the oppression at the breast, and a swelling of the feet, which arose at times to the thighs and scrotum. Medicines were resorted to, which the author mentions, but the disorder grew worse, and the patient died. CASE 2. Van Sweiten vol. x. p. 250. relates from Montagne the following case, viz. While every body admired the bra- very of a soldier in battle, and were much grieved when at last they saw him fall; his arms were taken away af- ter he was dead, that they might know who he was. A nobleman (whose posterity is still in great esteem, and confirmed to me the truth of this fact) came running a- mong the rest, and seeing it was his son, he grew stiff, with his eyes open, and immediately fell down dead. The influence of the debilitating passions in predis- posing the system to the reception of diseases, has been noticed not only by Haller, but also by Dr. Clark in his " Observations on the diseases which prevail in long voy- ages to hot countries, particularly on those in the East- Indies," vol. i. p. 164....165. viz. But of all the predis- posing causes, none seemed so powerful as the debili- tating passions of the mind, such as disappointment, grief, and fear. It is owing to this circumstance that fevers and fluxes are so very fatal to young adventur- ers, who annually emigrate in expectation of acquiring riches. Upon their arrival, finding all their delusive hopes suddenly dissipated, they become low spirited, take the infection, and are carried off in an instant, whilst 20 others as little inured to the climate, and exposed to the same remote causes of disease, but who have better pros- pects, either escape the sickness, or when attacked, have it in a less malignant form. JOY. Although this is a highly pleasurable and stimulating emotion of the mind, and when moderately excited, greatly conduces to health, yet when carried to excess (and particularly if it suddenly follows extreme grief) it is capable of producing dangerous, and even fatal consequences. CASE 1. In the year 1544, the Jewish pirate, Sinamus Tafflurus, was lying in a port of the Red Sea, called Arsence, and was preparing for war, being then engaged in one with the Portuguese. While he was there, he received the unexpected intelligence that his son, who in the siege of Tunis had been made prisoner by Barbarossa, and by him doomed to slavery, was suddenly ransomed, and coming to his aid with seven ships well armed: the joy- ful news was too much for him ; he was immediately struck as with apoplexy, and expired on the spot. Vide Crichton, vol. ii. p. 170. CASE 2. Professor Rush relates in his lectures, the case of a door-keeper to the House of Congress, who suddenly died with an apoplexy, on hearing the news of Cornwal- lis's defeat. 21 CASE 3. It is related by an Italian historian, that Leo the tenth, died of a fever occasioned by the agitation of his spirits on receiving the joyful news of the capture of Milan, concerning which he had entertained much anxiety. Vide Cogan on the Passions, page 364. The case of the aged matron, mentioned by Livy is a familiar anecdote, who while lamenting the death of her son, having heard that he was slain in battle, died in his arms in the excess of joy upon his safe return. CASES, TO PROVE THE INFLUENCE OF THE PASSIONS IN THE CURE OF DISEASES. HAVING endeavoured to shew by the relation of various cases, that many diseases may be induced by mental impressions, it becomes proper to proceed to a more agreeable part of the subject, viz. The influence of the same agents in restoring the body to a state of health. FEAR. CASE 1. Van Sweiten relates from Hildanus, that a person in the gout, who for his spiteful and abusive behaviour, was very much disliked by every body, whom another person disguised in the form of a frightful spectre, snatched out of bed, and taking him upon his back walk- ed down stairs, making his feet, already in so much pain, strike all the way down against the steps, paying no re- gard in the least to his terrible cries, and at last left him on the floor. The gouty man, who before could not stir 22 a limb, got up on his legs in a hurry, ran up stairs, and opening the window of the chamber, alarmed all the neighbourhood with his noise : however he got well and never after was seized with the distemper. Van Sweiten, vol. xiii.p. 38. CASE 2. Schenkius Obs. Med. lib. i. p. 100, gives an account of a man who had been afflicted with hemiplegia for many years, neither had the exhibition of various remedies given by the most skilful physicians, or the strictest at- tention to regimen been able to mitigate his disease : at last an extraordinary circumstance occurred. The house in which he lived took fire, and the flames had nearly ap- proached the bed in which he lay, when crying out with fear and anger, he suddenly raised up, and quickly dis- covering his strength return, he made a desperate exer- tion and precipitated himself from the upper cham- ber. He was immediately relieved from his disease, sensation and motion were restored to the affected side, so that he who had been bedridden for many years, now began to walk about without the least inconvenience, and afterwards continued free from the disease. CASE 3. A letter from Dr. Maxwell Sharp, of Logan county, Kentucky, to Dr. B. Rush, gives an account of a girl af- flicted with rheumatism, who had not walked for two years or more. Her father moved to the Red Banks on the Ohio, and took lodgings in a room belonging to a man of the name of Summers, up one pair of stairs. One evening a circumstance occurred (which is detailed in the letter) that alarmed the family to such a degree that they immediately fled down stairs. The diseased 23 girl fearing to be left alone, in her fright rose up and followed the rest of the family, and has continued free from pain ever since. Medical Museum, vol. i. no- Hi. p. 292. CASE 4. In the European Magazine, vol. xxxiv. p. 4, it is re- lated of Dr. Thornton, that when a boy, having by mis- take taken two ounces of eau-de-luce, he was thrown in- to a state of extreme agony; he rushed into the kitchen in search of water, and knocked down the servants who attempted to hold him. His dying mother, roused by the mournful cry, " I am poisoned, I am poisoned," got out of bed, and coming down stairs, found her son, now faint, and weltering in the blood which he vomited up; and not conscious of her own ills, tried to soothe those of her son, lost sight of every complaint, and though for years before she had laboured in the most dreadful manner, under asthma, and a nervous affection, she no longer felt either, and from that time, for upwards of two years, she remained in perfect health. The present judge Rush, of Berks county, in a letter to his brother Dr. B. Rush, which is published in his fifth volume of Enquires and Observations, p. 193, re- lates the case of Peter Fether, a householder in Reading, who had been severely afflicted with the gout for some years. In particular the last fit in 1785, was so severe as to induce an apprehension that it would inevitably car- ry him off; when he was suddenly relieved by the follow- ing accident.... As he lay in a small back room adjoining the yard, it happened that one of the sons in turning a waggon and horses, drove the tongue of the waggon with such force against the window, near which the old man lay stretch- ed on a bed, as to beat in the sash of the window, and to 24 scatter the pieces of broken glass all about him. To such a degree was he alarmed by the noise and violence, that he instantly leaped out of bed, forgot that he had ever used crutches, and eagerly enquired what was the matter. His wife hearing the uproar, ran into the room, where to her astonishment, she found her husband on his feet, bawling against the author of the mischief with the most passionate vehemence. From this moment he has been entirely exempt from the gout, has never had the slightest touch of it, and now enjoys perfect health, has a good appetite, and says he was never heartier in his life. Dr. Hall, in a letter to Dr. Rush, published in his second volume of Enquiries and Observations, p. 182. relates a case of ascites which was cured by fright. The same author mentions several other cases to prove the influence of fear in curing dropsy. The son of Croesus who was dumb, on seeing a Persian soldier rushing upon his father, called out immediately, 0 homo, neperimas Crxsum,* and afterwards had the use of his speech. Van Szveiten or Rollins Ancient Hist. ANGER. CASE l. Van Sweiten, vol. x. p. 280, quotes the case of a man, who during a violent passion, in endeavouring to beat his servant with a stick, was immediately cured of a con- traction of the ham, of a long standing, which had quite hindered his walking. * O man, kill not Croesus ! 25 CASE 2. The case of a man of letters is related by Van Sweiten, who having conceited hislegs to be made of glass, would not therefore presume to stand or walk upon them, but being carried from the bed to the fire-side, sat there from morning till night. The maid servant bringing some wood to keep up the fire, threw it rudely down so as to put the champion in fear of his glass legs, for which he therefore smartly rebuked her; thereupon the maid, be- ing of an angry temper, and tired of her master's foolish- ness, struck him a good blow upon the shins with one of the sticks, the smart pain of which raised his anger to get up and take revenge for the injury: soon after his anger subsided, and he grew well pleased that he could stand upon his legs again, that vain notion being thus suddenly expelled from his fancy. Van Sweiten, vol. xi. p. 101. CASE 3. Professor Rush in his lectures, mentions the case of a Scotch gentleman, ill with typhus fever, who sent for a clergyman and expressed to him his sorrow, for hav- ing written a book against Christianity. The clergyman told him he did not think the book had done much inju- ry, for that it had been but very little read, and had ne- ver circulated beyond his own neighbourhood. What is that you say ? replied the sick man....my book never read! begone, you are a fool. He began to recover from this time. I have been informed, from good authority, of a fe- male in this city, who after recovery from fever, was unable to move about without crutches, being very much irritated by another female in the family, she attempted D 26 try seize her, stepped forward for that purpose, and fell down ; finding she could make a step without crutches, she laid them aside, and was soon restored to the use of her limbs. JOY. CASE 1. A gouty person condemned to lose his head, as they carried him out in order to be executed, received the most unexpected news of his pardon, which had so re- markable an effect upon him, that although he was quite exhausted with pain, and had lost the use of every limb, yet he got up on his legs immediately, and walked with re- markable quickness and agility, and lived many years after without having the least touch of the disorder: the case is preserved in the public records, and therefore merits some degree of credit. Van Sweiten, vol. xiii. p. 38. CASE 2. The following is a brief detail of the cure of scurvy, at the siege of Breda in the year 1625, which affords a striking instance of the power of the imagination combin- ed with hope. Among other misfortunes attending the siege, scurvy made its appearance and carried off great numbers ; this, added to the other calamities, induced the garrison to incline towards a surrender, when the Prince of Orange contrived to introduce letters addressed to the men pro- misingthemthe most speedy assistance, accompanied with medicines against the scurvy, said to be of great price, 27 but of still greater efficacy, many more were to be ssnt to them. The effects of this deceit were truly astonish- ing ; three small vials were given to each physician, and it was publicly given out, that three or four drops were sufficient to impart a healing virtue to a gailon of liquor. The soldiers flocked in crouds about the physi- cians, every one soliciting that a part might be reserved for his use ; cheerfulness appeared in every countenance, and an universal faith prevailed in the efficacy of the re- medies. The effect was truly astonishing, for many were quickly and perfectly recovered; such as had not moved their limbs for a month, were seen walking the streets: they boasted of their cure by the Prince's remedy, the motion of the joints being restored by simple fric- tion with oil. Many who had declared that they had been made worse by all former remedies, recovered in a few days, to their inexpressible joy, and the no less general surprise, by their taking what was affirmed to be their gracious Prince's cure. This curious relation, adds Dr. Lind, would perhaps hardly gain credit, was it not in every respect consonant to the most accurate observations and best attested des- criptions of the disease.* It is given by an eye-witness, an author of great candour and veracity, who as he in- forms us, wrote down everyday the state of his patients, and seems more to be surprised with their unexpected recovery, than he possibly would have been, had he for- merly been acquainted with the nature of this surprising disease. As a decoction of green herbs was used, Dr. Lind asks, might not the speedy recovery of the patients be partly owing to this circumstance ; but adds, be that as it may, an important lesson in physic is here to be learned, viz. * Vide Anson's voyage, part iii. Ive's Journal, p. 94. 28 The wonderful and powerful influence of the passions of the mind upon the state and disorders of the body. Lind on the Scurvy, p. 352. CASE 3* Van Sweiten reports that the famous Tulpius cured an excellent painter, who fancied all his bones were soft like wax ; instead of contradicting him, he apparently admitted the truth of his opinion, promised him a cure in six days, and it was not till the third day, that he al- lowed him to stand upon his feet without stirring an inch, by the sixth day he enlarged his liberty to walking about. Van Sxveiten, vol. xi. p. 104. CASE 4. Plutarch relates-]" that the virgins of Miletus were" seized with an epidemic madness that prompted them to destroy themselves. This was in vain attempted to be prevented, until it was ordered that the bodies of those who thus put an end to their lives, should be dragged naked through the streets. Shame here proved a more powerful motive than a sense of duty, or any of the so- cial affections. The influence of the stimulating passions upon the system during the last moments of life, did not escape the observation of Dr. Haller; hence in his account of anger, he says, " et mors retardata per septem integros dies.":}: The case of Muley Moluck presents an instance " Although the introduction of Cases 3, and 4, may be a slight devi- ation from the subjeet, yet as the former is to be noticed when treating of hypochondriasis, and the latter when we speak of melancholia, it was thought best to insert them. \ De virtutibus mulierem, or Falconer p. 118. \ Physiolog. Haller, Tom. v. p. 58" 29 of this kind, who perceiving his troops to give way, he threw himself out of his litter, though very near his last agonies, rallied his army and led them on to the charge, which ended in a complete victory to his party. He had no sooner brought his men to an engagement, than find- ing himself utterly spent, he was again replaced in his litter, where laying his fingers on his mouth to enjoin se- crecy to his officers who stood around him, he died in a few moments after, in that posture. Vide Falconer, p. 34. Although no cases are inserted to shew the therapeu- tic power of grief, yet as a sedative passion, it may in certain cases be advantageously opposed to rage. OBJECTIONS TO THE USE OF MENTAL REMEDIES, NOTICED, AND ANSWERED. HAVING considered the influence of the mind, up- on the body, in the production as well as cure of diseases, and endeavoured to prove that even life may be sudden- ly extinguished by the force of mental impressions, in- dependent of corporeal injury, I shall proceed to deduce some practical inferences from the facts which have been stated; but previously to this, it will be proper to make some preliminary observations. That the different articles in our Materia Medica are varied in their qualities, and diversified in their effects, is well known to physicians; and also that some of the most active remedies in the healing art, which when rightly administered, happily conduce to the mitigation of human misery, are, when improperly introduced irito the system, often a source of incalculable injury, and not unfrequently destroy life. SO It has been urged as an argument against the employ- ment of mental remedies, in the practice of medicine, that they are very uncertain and precarious in their ope- ration, and that what would produce a dangerous effect in one system, would prove totally inert in another ; but are not the different articles in the Materia Medica, in some degree liable to the same objection ? are there not idiosyncrasies in some constitutions, which require a deviation from the common track, and demand a va- riation of our remedies, to suit the necessity of the case. In attempting to stimulate the system, how great the aptitude of some persons to be affected by a small por- tion of medicine, while others require a much greater quantity to produce an equal effect. In the exhibition of mercury, a number of facts are to be met with, illustrative of this position. I have heard of a patient who was salivated with two grains of calo- mel ; and I saw a case at the Pennsylvania Hospital, in which seven grains produced a similar effect; is there not a disposition to syncope in some persons from the loss of a very small quantity of blood, and even at seeing it drawn from another? in others great debility is induced, by the moderate operation of a cathartic. As every phy- sician must be familiarized to these things, it is needless to dwell upon them, having proceeded far enough to prove that it is a necessary part of professional duty, to study the peculiarities, and mark the varieties which oc- cur in different habits, and in the application of power- ful medicines (except in desperate cases) to be actuated by the maxim " Festina lente." Another difficulty that has been suggested against the employment of the passions, is the apparent contradic- tion observable in the effects of the same passion; for example, Fear which is a sedative, is said to be in some instances powerfully stimulant, thus it is not uncommon 31 to hear of persons under the influence of fear, giving proofs of most astonishing strength. It is with diffidence I undertake to offer a sentiment on this subject, differing from the ingenious Dr. Falconer, whose judgment and learning are general- ly acknowledged. But I have been induced to be- lieve that fear is not so uncertain in its effects, as has been generallv supposed, and it appears as if those cases which have confused the medical enquirer, have been produced by the stimulus of hope suddenly superven- ing, and prompting to exertion ; but if this be withdrawn, if the most distant prospect of relief from a perilous sit- uation, be once abstracted, the sedative power of fear must be evident. To elucidate this, let the imagination picture a com- pany of mariners, tossed upon the trackless ocean, with the heavens for their canopy, and a vast expanse of water on every side; their vessel founders ! dire necessity compels them to desert her, and commit themselves to an open boat; but hope, that anchor to the soul, dwells in their anxious bosoms, and gently whispers that some friendly shore may be near, or else perhaps a sail may heave in sight, they labour at their oars, and steer their boat with care; but day succeeds to day, night follows night, their wishes not accomplished; exhausted with fa- tigue, hope deserts them and they become victims to despair. All exertion is suspended, they resign them- selves to the prospect of impending death; at this event- ful crisis, they espy a vessel at a distance....hope again revives, with it exhausted nature summons all her latent force, making a desperate and successful effort to accom- plish the desired object. It may also be said that there is a great apparent con- tradiction in the effects of the stimulating passions, thus we hear of persons under the influence of joy, being chained (as it is called) to the spot, and deprived of all 32 command over the voluntary muscles, and in some in- stances even death is suddenly induced. May not this be referred to the principle that explains the operation of opium (which when exhibited in proper doses, is a most important medicine, and evidently a stimulant, as has been proven by the experiments of Dr. Crump) by inducing a state of debility from action, and when death takes place, it is in consequence of the system being prostrated below the point of reaction. In contrasting the present Materia Medica, with that of ancient times, the mind must at once be struck with the valuable improvements which it has recently receiv- ed ; the superstitious doctrine of signatures is now explo- ded, many inert articles have been laid aside, a variety of active medicines have been introduced, and from the present advancing state of American knowledge, we have reason to believe, that there will yet be found, in the extensive range of our country, most, if not all, of the medicines proper for the cure of its indigenous dis- eases.* The present attainments must be attributed, and the hope of future success founded on the ef- forts of genius, united with observation and experiment, and I apprehend one great cause of our imperfect know- ledge, on the subject of the present enquiry, has been owing to the slight attention which it has excited in the minds of physicians in general, but happily for mankind, the subject has, of latter years, attracted the notice of some discerning men, not only across the Atlantic, but also on the American continent, and particularly in the University of Pennsylvania, two eminent professional characters have devoted to it a share of their talents. * Our ingenious Professor of Materia Medica, has already done much towards the accomplishment of this desirable object. 33 THE next subject claiming consideration, as a pre- lude to the application of mental remedies, is the impor- tant question....Upon what principle, or rather in what manner shall they be applied ? how shall those invisible agents be employed, which if they are capable of doing good, may also by improper management, be productive of incalculable injury? In applying these remedies, the same principle maybe observed which regulates the practice of every judicious physician in the exhibition of familiar medicines, viz. The dose must be varied, in proportion to the strength of the patient, and urgency of the case ; for example, if called to a person soon after swallowing a large portion of opium, he would immediately exhibit a most power- ful emetic, the effects of which he would dread, if given to the same individual, when the stomach was under a less violent impression. This practice is peculiarly applicable to the employment of fear in maniacal cases. Again, if the same physician be requested to prescribe for a patient in a state of extreme debility, he would ap- ply cordials, with an assiduous, yet gentle hand, increas- ing the quantity in proportion to the increase of strength, consistent with the advice of Dr. Armstrong..... " While the vital fire " Bums feebly, heap not the green fuel on, "But prudently foment the wandering spark " With what the soonest feels its kindred touch: " Be frugal e'en of that, a little give " At first, that kindled, add a little more, " Till by deliberate nourishing, the flame " Reviv'd, with all its wonted vigour glows." This law is particularly applicable to the use of the stimulating passions- It may also be proper to mention, that in addition to these two opposite states, there are others of an intermedi- E 34 ate nature, which require variation in practice, that can scarcely be reduced to any fixed laws, but must be left to the judgment of the physician. The same thing may happen, in the use of mental remedies, which ought to be adapted to desultory symptoms as they arise. The application of these remedies to practice, is now to claim attention. In this part of the subject, when treating of particular diseases, it may be well to bring some of their exciting causes into view, which necessa- rily blends the plan of prevention with the mode of cure; but previously to this, it will be proper to premise seve- ral laws of the animal oeconomy, which I shall have oc- casion to refer to in the subsequent part of this work. 1st, Impressions are weakened in their force by repe- tition. 2d, Impressions may be eradicated by exciting others still more powerful. 3d, Habit, when once established, may perpetuate dis- ease, after the exciting causes are removed. OF PARTICULAR DISEASES. EPILEPSIA. THAT this disease may be brought on by violent affections of the mind, has been proved by several facts ; that it may be reproduced by the association of ideas, is clearly evinced in the case of the boy, frightened by the dog ; that a strong tendency to imitation may excite it, is shewn in two instances, viz. Boerhaave's patients, and the French children mentioned in the report of the Commissioners ; these things teach the necessity of a- voiding exciting causes, and afford us the plan of cure adopted by the celebrated Boerhaave. Vide se- 35 xond law. Now I conceive that the fear of the actual ■cautery, gave birth to a mental affection, noticed by Dr. Falconer; this he says can scarcely be reduced to the class of passions, viz. a determined resolution of mind to resist the accession of a complaint, which however ex- traordinary it may appear, acts by inspiring tone and vi- gour into the system. In the case of the boy, the paroxysm returned on see- ing a large dog at a distance, and even on hearing him bark; here let us apply our first principle. In order to allay his fears, and reconcile him to this docile creature, let him be entertained with interesting histories, in which the name of the animal may be frequently introduced, and in which he may bear a conspicuous part for his gen- erosity and affection; let him see at a distance the gam- bols of a harmless pup, and by degrees induce him to handle it; from this lead him on to a familiar intercourse with small, and then with larger dogs, until eventually the impression of fear, at the sight of them, will be over- come. It was probably under a conviction of the truth of our third law, that the French children were so successfully treated ; their cases were very similar to Boerhaave's pa- tients : in the latter, one impression was excited to over- power another, while in the former they were imme- diately separated, and were not permitted to meet in their schools, except in very small numbers, and by per- severing in the plan for three weeks, this dangerous and forming habit was subdued. HiEMORRHAGLE. Although there is an apparent contradiction in the ef- fects of the passion of fear upon the system as respects hemorrhages, yet I apprehend it can be accounted for on reasonable principles. As relates to the suppression of 36 them, afamiliar instance presents in venesection, and Dr. Falconer very properly advises, that patients labouring under hremoptoe, should not too suddenly be encourag- ed with assurances of *afcty, which have a tendency to accelerate the circulation and increase the disease. A want of attention to this, he thinks, has been productive of much injury, and that suqh patients ought rather to be suffered to remain for a time in a state of doubt and ap- prehension, as low spirits, and even a certain degree of despondency may be of service in retarding the circula- tion of the blood, and allow time for the formation of a thrombus. If we advert to those cases wherein fear has induced haemorrhages, we shall find that this passion has been suddenly excited, and by causing the blood to retire from the surface, produces an accumulation in the large internal vessels, thus for a moment, greatly diminishing, if not entirely suspending their action. Hence irritabil- ity is increased, and the restoration of that equilibrium, so essential to health, is attended by a convulsive action in those vessels, which it is reasonable to suppose, would often end in their rupture, but for a sudden determina- tion to the kidneys ; this produces a copious flow of urine, which it would seem was kindly intended to act as a depletive remedy, and assist in preventing those un- happy consequences. FEBRES INTERMITTENTES. Numerous instances are to be met with in the history of intermittents, which leave scarcely any room to doubt the eiacacy of hope, or rather confidence, in effecting a cure ; it is on this principle we can account for the suc- cessful practice of many persons who are reputed for curing by a charm. 37 My respected preceptor informed me he was well ac- quainted with a person who had gratuitously cured num- bers in this way ; when patients applied to him it was his practice to tell them in a very confident manner, that he would cure them, that they might possibly have one more fit, but that they would certainly escape a second. After they retired, he performed some ceremony, and it mostly happened that in the course bf a week or two they returned to render him thanks. His success was so considerable, that he began to think there was a spe- cific virtue in the words which he repeated, when the following circumstance occurred....one day a patient ap- plied to him, and received the usual answer; at the ex- piration of two weeks he called upon him to tender his obligations for his cure : the gentleman had forgotten to perform the usual ceremony, and as he found a cure had taken place without it, he was induced to try the effect of his customary assurances without any subsequent in- cantation, and found the same success to attend his pre- scriptions, until his secret became known (as he talked of it very freely) when a loss of confidence in the reme- dy put an end to his practice. It is also said that many persons have been cured of this disease, by wearing round their necks a paper on which certain words have been inscribed, that are ima- gined to possess a healing virtue. Professor Rush relates a case of intermitting fever • which was cured by fear. These facts very clearly set forth the power of certain mental affections in curing this troublesome disease, and although but few physici- ans would be willing to adopt the practice of the gen- tleman alluded to, yet it certainly offers an important hint to practitioners, that even when exhibiting medi- cines of approved efficacy, they should not neglect to use proper exertions to inspire their patients with a confi- dence in the remedy. 38 PHRENITIS. Particular attention is required to the state of the mind in this disease ; every thing which has a tendency to irritate it, should be strictly avoided; silence and darkness are indicated; a compliance, as far as may be prudent, with the inclination of the patient, was the advice of several ancient physicians, and is consonant with the opinions of modern times. Although silence is to be preferred, yet if the patient insist on seeing any particular persons, they ought by all means to be admit- ted, but should not remain constantly in the room, lest they lose that influence which it is so desirable to main- tain. Dr. Falconer mentions from Ccelius Aurelianus, the practice of permitting the daylight, or the light of a lamp to pass through a small aperture, and be directed princi- pally to the face of the patient, as an object to fix his at- tention, and prevent the mind from wandering in uncer- tain thoughts and ideas. He adds, that it is a precaution which has been frequently used in modern practice, and known to be of the greatest efficacy, when delirium is not very violent. This author also informs, that Aretse- us directs the room of the patient to be of a moderate size, the walls uniform and regular, and not orna- mented with variety of colour or painting, as these are apt to distract the mind, and impose on the patient for realities. HYPOCHONDRIASIS. As this disease consists in many false and imaginary notions respecting the patient's health, it is sometimes ne- cessary for the physician to call in the aid of the imagi- nation as an influential agent in conducting the cure ; for there are cases in which it is totally useless to expostu- 39 late upon the unreasonableness of their opinions, they are rather strengthened by opposition, but it has happen- ed that by seemingly admitting the truth of their asser- tions and prescribing accordingly, great success has been the result, as is proved in the case of the painter, men- tioned by Van Sweiten, yet there may be cases in which it would be proper to pursue a middle path ; and while we partly admit the justness of their complaints, endea-, vour at the same time to impress the necessity of rising superior to their misfortunes, instead of tamely sub- mitting to afflictions, which are, in great measure, the common lot of humanity. If we can only prevail upon them to admit the truth of our reasoning, it may gradually be further extended, and eventually the absurdity of their notions maybe for- cibly elucidated by irresistible appeals to their reason. Anger in one instance, cured the disease, and although the means which excited it, were rather more harsh than prudent, yet it offers a hint that may be productive of advantage. HYSTERIA. An excess of sensibility accompanies this complaint, which may readily be excited by mental impressions, nothing contributes more to increase and perpetuate it, than a life of indolence and vacancy of mind; hence Sau- vage very justly observes, Dum corpus otio indulget, animae negotia facessunt pathemata, ira, invidia, zelo- tvpia, amor, taedium, lites, serumnae. This is consonant with the opinion of professor Rush, who informs his class, that few good house-wives have the hysterics ; and it is related that during the troubles in Scotland in the years 1745 and 1746, the disease scarcely made its ap- pearance. 40 In attempting its cure, the first law may be profitably resorted to. It would be right often to mention such cir- cumstances in an apparently careless manner as are disa- greeable, but which are so connected with the common occurrences of life, that at particular times it is impossi- ble to avoid them. During a fit, considerable advantage may result from the application of the second law. For example, I once saw a female in a violent paroxysm, who was dis- tressed with apprehensions of future punishment, and was upbraiding herself with being a forsaken sinner. Assafcetida and ether were exhibited with but little ef- fect, yet her mind was tranquilized, by hearing a person read some portions of the Holy Scriptures, that were cal- culated to encourage those who have deviated from the path of virtue. MANIA. Although a great deal might be said on this interest- ing subject, yet it would be incompatible with the pre- sent essay. In the management of patients in this dis- ease, it is necessary to oppose one passion to another, particularly fear to rage. Professor Rush in his instruc- tive lectures, mentions that the physician in his conduct towards his unhappy patients, should preserve a firm- ness and dignity from which he ought never to depart; every improper familiarity as laughing, &c. should be strictly avoided, and every promise faithfully complied with ; his prescriptions ought not to be given in the pre- sence of the patient, but it should appear as though they came from some other souice- By pursuing this plan he often preserves an authority that is of the greatest utility in conducting the cure. If on entering the cell he is violent, endeavour to catch his eye and stare him out of count.nr.nce. A madman should never be unne- 41 cessarily opposed ; he is generally cowardly, and fear is often employed with the utmost advantage. MELANCHOLIA. As mania, suicide, and even horrid acts of murder, are not unfrequently the consequences of melancholia, every physician is called upon to use his utmost exertion to prevent these fatal effects. As it consists in a state of insanity on one particular subject, the plan of cure which at once presents itself, is to divert the attention, as much as possible, from it, but as the causes which induce it are various, it is proper for the physician to inform himself on that subject. There are cases in which our second law may be very beneficially resorted to, as appears in the account of the virgins of Miletus. It is not uncommon for patients to insist on their be- ing in good health, and to refuse to comply with any di- rections which they suspect to be predicated on a contra- ry belief; hence in prescribing, it is requisite carefully to avoid those appearances which would induce a suppo- sition that we considered them in such a state. As travelling presents a constant change of scenery, it is considered as an excellent remedy in some cases, and Van Sweiten relates that he cured several men of letters by it, who had positively refused to go to any mineral springs (lest the world should be confirmed in their opinion respecting the nature of their malady) but who were easily induced to travel for the purpose of vi- siting some celebrated libraries, and the resorts of learn- ed persons. As apoplexy, jaundice, and haemorrhages are apt to be induced by violent mental affections, particularly anger; F 42 the propriety of guarding against them (especially by such as are predisposed to these diseases) must be self- evident. The common practice of exciting surprise to cure the hiccough, is so well known that it requires no com- ment; and it is generally admitted that fear very fre- quently suspends the pain arising from tooth-ache. GESTATION AND PARTURITION. Great attention is required to the state of the mind in females during these periods, as the happiness of an af- fectionate husband, and the welfare of a rising family are often intimately blended with the successful issue of parturient cases. It has been remarked that during gestation, the minds of women (even those whose tempers are naturally placid) are apt to be von irritable, and as there can be no doubt of the injurious effect of violent passions, the propriety of carefully guarding against their exciting causes, must be self-evident. Even joy when in excess may be inju- rious, and is capable of producing an alarming state of debility from action ; hence after parturition, especially if it be the first confinement, great care is required, lest by an improper admission of company, serious conse-* quences may result. Grief also exerts an injurious influence at this critical juncture, and it is said that those unfortunate females who are seduced from the path of virtue, and are forced to retire from their families and friends to hide the pub- licity of their shame, by continually dwelling on their u.ihajpy situation, become ultimately so very irritable, that the slightest irritation will excite convulsions.* * This observation was derived from the valuable lectures of Drs. James and Church on midwifery. I have been informed that the fact *vas noticed bv Dr. Clark. 43 Apprehension, which is a modification of fear, has not unfrequently embittered those hours which might other- wise have been passed in tranquillity. Therefore the visits of such persons as have a remarkable fondness for telling new things, ought to be prevented ; for as their unfortunate propensity is often united with great indis- cretion, it requires but a very moderate share of re- flection to convince any person, that the narration of the melancholy issue of parturient cases, must be in the high- est degree improper. The imagination may also prove a fertile source of anxiety to females in this situation; they ought therefore to be carefully prevented from reading authors who treat of their diseases, especially such as have written on parturition ; for in those books it is necessary to de- scribe cases which are of great practical utility to physi- cians, and if at all read by women, they should be such whose age will protect them from similar calamities. Van Sweiten vol. xiv. p. 155, when treating of the dis- eases of parturient women, relates that it was by a pru- dent law, provided at Haerlem (a town in Holland^ that nothing should be done, at the time of a delivery, which might interrupt the necessary repose of the lying-in wo- man ; a mark is put upon the door of a house in which a woman lies in, which being seen, no Serjeant, beadle, or any other officer of justice is allowed to enter that house. Such care, he adds, the commonwealth has thought pro- per to take of that woman, who gives a citizen to her country. In order to avoid repetition, I shall consider the mode of applying stimulating mental remedies under one gen- eral head, viz. in all cases of debility from abstraction ; and shall also deliver some practical cautions respecting the sedative passions. In this part of the subject particu* 44 lar reference shall be made to the latter stages of typhus and scorbutus. When we find a patient reduced to this situation, it is necessary to view life, as if it were suspended in a delicate balance, and we ought to be impressed with an opinion that very slight causes will produce a preponderance in favour of death ; influenced by these sentiments, our practice will be directed to the mind as well as body, as- siduously guarding it from receiving any unfavourable impressions, at the same time endeavouring with tender- ness and care, to revive the drooping spirits of our pa- tients. To enumerate all the causes which exert an injurious influence at this critical juncture, would be not only un- necessary, but impracticable ; yet it may not be impro- per to take- a cursory view of some of them. When cast upon a bed of sickness, and reduced al- most to the confines of the grave, what is of greater im- portance, and more solacing to the mind (next to the tes- timony of an approving conscience) than the company of those we love ; and what is more likely to produce an injurious effect, than at such a period as this to be de- serted by them ? and I think there is reason to believe, that during the prevalence of the yellow fever in Phila- delphia, much injury arose in consequence of the sick being deserted by their nearest relatives, and left in the charge of uninterested, and in some instances, un- principled nurses, who were strangers to that interest in the welfare of the patient, which a mind under the influ- ence of genuine affection (and consequently awake to a just sense qf those relative duties which constitute the bond of domestic felicity) ought to feel. Another cause that may be productive of injurious consequences to the sick, is an injudicious attempt to in- form them of their danger ; perhaps there is scarcely any situation in which the exercis--of prudence andjudg- 45 ment is more strongly demanded. When we behold na- ture struggling with disease, and are convinced that the contest is doubtful, how careful should we be in not making any unfavourable impression on the mind, which would have a tendency to diminish the strength of the system. For if when in a state of health, any violent affection of this invisible agent, be capable of suddenly inducing dis- ease, and even death; what is to be expected from an application of the same causes, although in a slight de- gree, at a period when the corporeal fabric is unfitted to sustain the shock ? The practice of ringing the bells for deaths or funer- als, has a tendency to discourage the sick, and as profes- sor Rush justly observes, it immediately excites an in- quiry after the name and disease of the deceased, and this information has sometimes produced serious conse- quences. At the first dawn of convalescence, says the professor, hurry your patient out of the room in which he has just escaped from death ; the sight of pill boxes, plaisters, vials, &c. all keep up a sedative effect. But to revive the drooping spirits of a patient, and in the words of Dr. Armstrong, " Prudently foment the wandering spark <• With what the soonest feels its kindred touch," requires the utmost attention. Not only typhus fever, but scurvy is also wonderfully influenced by the passions. A remarkable instance of the power of the imagination, combined at the same time with hope, is shewn in the siege of Breda, strongly incul- cating the necessity of guarding against the effects of the sedative passions, and sedulously endeavouring to ani- mate the patients by the most exhilirating and cordial mental remedies, by inspiring them with a hope of re- covery, by representing the delightful sensations which 46 they will experience on returning to their native shores, and into the bosom of their families;* every exertion should be used which might have a tendency to rouse them from a state of despondency. However strange it may appear, yet there is reason to believe that even anger, has in certain states of extreme debility, produced very happy effects ; the case of the gentleman in typhus, related by professor Rush, may be considered as a proof of its efficacy. Now as this passion most certainly possesses a specific influence over the he- patic system, exciting an increased secretion of bile as certainly as mercury produces ptyalism, may it not be resorted to in some diseases in which the liver is in a state of torpor, and requires a potent stimulus to induce new and healthy action ? But of all the mental remedies, hope is certainly one of the most grateful; it has a direct tendency to support the strength and spirits af the sick, and may with propri- ety be resorted to by the physician, so long as a reason- able prospect of a favourable issue remains ; but when this fails, when a train of symptoms commence, that are premonitory signs of an approaching dissolution, what is then to be done? Even at this period the grate- ful cordial of hope ought not to be withheld ; but the ob- ject must be changed, it must be withdrawn from all hu- man dependance, and happy will it be if it can be fixed en the Redeemer of man. Not only at this period, but in many other cases of debility, great benefit may result from the visits of pious and experienced minds, who are properly qualified to impart the divine consolations of the Christian religion, and it is possible that this hope may produce a favourable effect on the body, and even be instrumental in restoring it to a state of health. Tcr a case of recovery from a state of extreme debility, occasioned by l". .-'.algia, vide Dunca'.'s Med. Comment, vol. vi. p. 21 J. 47 ON THE INFLUENCE OF THE WILL. The frequent instances of mental diseases which have recently occurred, is a circumstance which demands the attention of every reflecting member of the community; and when we consider the powerful agency of the will, in directing the operations of the system, the necessity of regulating it must be apparent to every one ; its influ- ence is vastly extensive over the mind as well as body; and while on the one hand, by acting without controul, it may, and often does, produce great derangement, so on the other, a neglect of exercising its latent energies, may sink one of the noblest beings in creation, into a la- mentable state of mental imbecility. Does an intemperate exercise of an individual func- tion in the corpoteal fabric, or of the whole unitedly, in- duce debility and disease ? is not violent exertion fre- quently succeeded by fever? the same thing obtains in the mind. As the body receives an increase of tone and vigour by being habituated to moderate labour, so the mind by judicious employment of its varied faculties increases in strength. Happy is that man who earl y- accustoms himself to ex- ercise dominion over his will; not only in a moral sense, but also as respects the health of mind as well as body; he enjoys many important advantages over the slaves of caprice and folly. When adversity approaches, instead of yielding as a passive victim to the stroke, he is fa- voured to rise superior to its frowns ; with manly forti- tude united to conscious innocence, he can smile in the midst of affliction ; and when the gales of prosperity are permitted to fill the canvas of his little bark, he still re- tains command of the helm, and is enabled to steer safely through the tempestuous ocean of life. Should disease seize upon his body, he still enjoys incalculable 48 advantages from his acquired dominion over that agent which possesses an astonishing influence in diminishing the acuteness of sensation. How widely different is this from that unhappy indi- vidual who has never been accustomed to controul the will; even bodily pain and danger are increased in some diseases, and should prosperity suddenly burst upon him, it not unfrequently happens that reason is incapable of sustaining the shock. But here another instance presents, of the paternal care of a benevolent Creator, who has favoured us with a re- gulating principle, calculated to promote our real feli- city ; it teaches us to exercise dominion over the will, to cultivate a love of virtue, and by advancing the happi- ness* of others to increase our own. Instructed by this divine light, every capacity of the mind becomes expand- ed, every passion properly contrOuled, forming an united whole replete with harmony and peace. One of the best means, then, of attaining longevity and escaping many diseases, consists in cultivating an ac- quaintance with virtue. Guided by this benign principle, we shall avoid innumerable dangers. Instead of languish- ing under the effects of avarice and envy, or rushing with impetuous ardour to fulfil the schemes which ambition presents, we shall be taught properly to appreciate the importance of mental tranquillity, and to view it as a most powerful agent in the prevention of disease. THE END. Me-cL Hist, i.7 0 £* i NLM010684042