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AND
'   OBSERVATIONS,
UPON
X   THE DISEASES OF THE MIND
  •,   BY BENJAMIN JEtUSH, M. D.
Professor \f the Institutes and Practice of Medicine, and of Clinical
      Practice, in the University 0f Pennsylvania.
SECOND EDITION.   &•
   PHILADELPHIA.  ,v
                 t.
PUBLISHED BY JOHN RICHARDSON,
   NO. 31, MARKET STREET.
1818.
{\/0/V3
• 
District of Pennsylvania, to tvit:  . *
  BE IT REMEMBERED, that on  the twenty-sixth day of
October, in  the  thirty-seventh year of Independence of the
United States of America, A. D. 1812, Kimber and Richard-
son, of the said District, have deposited in this office, the title of
a book,  the right whereof they claim as  proprietors in the
words following,  to wit:

  " Medical Inquiries and Observations, ufion the Diseases of
    " the Mind.   By  Benjamin  Rush,  M. D.  Professor
    " of the Institutes and Practice of Medicine, and of Cli-
    " nical Practice, in the  University of Pennsylvania"

  In conformity  to the act of the Congress of the United States,
entitled," An act for the encouragement of learning, by secu-
ring the copies of maps, charts, and books, to the authors and
proprietors of such copies, during the times therein mention-
ed."  And also to the act, entitled,  "  An act  supplementary
to an act, entitled, u An act for the encouragement of learning,
by securing the copies of maps, charts, and  books,  to the au-
thors and proprietors of  such copies, during the  times  there-
in mentioned," and extending  the benefits thereof to the arts
of designing,  engraving, and  etching  historical  and   other
prims."
                ^                 D. CALDWELL,
                        Clerk of the District of Pennsylvania
%           1 

PREFACE.
 AGREEABLY to a promise made to the pub-
 lic some years ago, and in compliance with the so-
 licitations of the author's  pupils, he now offers to
 them a volume of Medical Inquiries and Observa-
 tions, 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 followino
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  establish,
provided they are applied in a proper manner.
   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.
                         BENJAMIN 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     --_-.-_.      g
                   CHAPTER II.
Of its Remote, Exciting, and Predisposing Causes -     30
                   CHAPTER III.
Of Partial Intellectual Derangement, and particularly
  of Hypochondriasis, or Tristimania    -    -    -     74
Of the Remedies for Hypochondriasis or Tristimania     98
                  CHAPTER IV.
Of Amenomania, or Partial Intellectual Derangement
  accompanied  with Pleasure,  or not accompanied
  with Distress  -......135
                   CHAPTER V.
Of General Intellectual Derangement   -    -         141
Of the Symptoms of Mania  -    -    -    -    -    142
Of the different Forms of Mania   -    -    -    -    162
Of the Influence of the Moon on Mania  -    -    -    170
                  CHAPTER VI.
Of the Remedies for Mania.....174
                  CHAPTER VII.
OfManicula.......„14
                  CHAPTER VIII.
OfManalgia......    .    216
Of the Remedies for Manalgia    -    -    -    -    221
Of the Means of Improving the Condition of Mad
  People   -    -     -    --    -    .    .     241
Signs of a Favourable and Unfavourable Issue of all the
  Forms of Intellectual Derangement  -              248 
viii
CONTENTS.
Usual Modes of Death from them  -                  256
                  CHAPTER IX.
Of Demence,or Dissociation      -                  259
                  CHAPTER X.
Of Derangement in the Will      -    -    -    -    263
        5         CHAPTER XI.
Of Derangement in the Principle of Faith, or the Be-
  lieving Faculty.     -    -    -    -    -    ~    2^*
                  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 Somnam-
  bulism.   -        ......300
                 CHAPTER XV.
Of Illusions........306
                 CHAPTER XVI.
Of Reverie, or Absence of Mind.   -    -    -    -    310
                 CHAPTER XVII.
Of Derangement of the Passions.  -    -    -    -    314
Of Love.......-    -    ibid
OfGrief.........318
OfFear.........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 
  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.

 J.N 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.
                B 
10
ON  THE DISEASES
  Before I proceed to consider the diseases of the
mind,  I shall briefly mention its different faculties
and operations.

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

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

  The faculties of the mind have been called, very
happily,  internal senses.   They resemble the ex-
ternal 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.
11
   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 impressions
upon the  brain with  the  same certainty and uni-
formity 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 we
sometimes meet with the most incongruous actions
without incoherent speech, and  we 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
upon 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 authors's Introductory Lecture upon Medical Jurispru-
dence, published in a volume of Lectures,  by Bradford and
Inskeep, in the year 1810. 
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 don'into a disease chiefly of the blood-
vessels.

   Derangement  in the understanding  has been
divided into  partial  and  genaral.   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.

   I. 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 madrtess 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 spleeny, in some parts of the New
England states.

  3.   A  late  French  writer,  Dr.  Prost, in  an
ingenious  work entitled  *'  Medicine  Eclairee
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
cither, 1, by  the violent or protracted exercises
of the  mind  attracting orabsorbing 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.
IS
Thus diseases 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, dissections af-
ford us no proofs; on the contrary,  they  generally 
16
ON  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 thfj cause
of madness 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 exclu-
sively in the mind.  I object to this opinion, 1, be-
cause the  mind is incapable  of any operations in-
dependently 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 per-
sons  who have died  of madness.    One  of these
instances is related by Dr. Stark, the other by Dr.
De Haen.   They probably  arose from the brain
being diseased beyond that grade in which inflam-
mation and its usual consequences take place.  Did
cases of madness reside exclusively in the mind,
a  sound state of  the brain ought to occur  after
nearly every death from that disease. 
OF THE MIND.
17
   I object to  it, 3, because there are no  instances
 ©f primary affections  of the mind, such as grief,
 love,  anger, or despair, producing  madness  un-
 til they had induced some obvious changes in the
 body,  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-ach, 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 tho.^e which  induce fever
and certain diseases of the brain, particularly phre-
nitis, apoplexy, palsy, and epilepsy,  all of  which
 Bradmitted 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 DISEASES
   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 United
 States, in  the year  1794, who was suspected  of
 counterfeiting madness, in consequence of its hav-
 ing  been declared  by three physicians that  that
 symptom constituted an unequivocal  mark of in-
 tellectual 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  atrokes in a minute.   As soon

  * This fact was ascertained, at my request, with great accu-
 racy, by Dr. Frederick Vandyke. It is  probable the pulsa-
tions 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. Cox, 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
with 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,  when
discharged from  his  skin, formed a  vapour re-
sembling a  thick fog, that  filled the cell in which 
22
ON THE DISEASES
he was confined to such a degree as to render his
body scarcely visible.

  Again,  this  disease sometimes appears  in  a
typhus form, i<> 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 haemor-
rhages, or  sweats, en 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 very properly ascribes it to the persons affect-
ed, having heard the famous player A'cs ilaus 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 produced,  v ry
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-
mum.

  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 absence
of every sign of disease.  I have ascribed this to
that grade  of  suffocated excitement  which pre-
vents the effusion of red  blood into the serous
vessels.   We  observe the same absence of the
marks of inflammation after several other violent
diseases.    Dr. Stevens in his ingenious inaugural
dissertation  published in 1811> has called this appa-
rently healthy appearance, the " aimatous" state of
inflammation.    Perhaps it  would be more proper
to call it the " aimatous" state of disease.   It is 
24
ON  THE DISEASES
 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 be-
 fore death.  But,

  2.  We much oftener discover in the brain,  after
 death  from madness, inflammation, effusions of
 water in its ventricles,  extravasation and innova-
 tion 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,"
 " praedurum,"  "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
jbave 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-
 sion of a sound  brain weighed but one dram, and
 between four and six grains.  I have ascribed this
hardness, dryness, elasticity and relative weight of 
OF THE MIND.
25
the brain to  a tendency to schirrus, such  a-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 hepitalgia.   The brain in
this c.se loses its mobility so as to become incapa-
ble 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 ob-
served to occur most frequently in the kidneys and
spleen.    The brain in this case partakes  of its
texture and  imbecillity in  infancy, and  hence its
inability  to  receive and modify the impressions
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.
Creighton says in 160 the skull was enlarged, and
in 38 it was reduced in its thickness.   Now the
same thing  succeeds rheumatism,  and   many
                     D 
26
ON THE D 1SE ASES
othef febrile  diseases which exert their action m
the neighbourhood of bones.

   I might add further, under this head, that the
morbid appearances in  the spleen, liver, and sto-
mach, which are  seen  after death from madness,
place it still more upon  a footing with fevers from
all its cas  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  mad-
ness is to phrentis, What pulmonary consumption
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  natural, or in  a pre-
ternatural 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  disease in the
 blood-vessels from other causes, and in other parts
 of the body.  They will be noticed  in their proper
 place.

    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 diffu-
sed 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 cases,  I  would  supp se 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 ancther, and  a healthy
part of the brain.   The senses of  taste  and hear-
ir.g, we know, when impaired by disease, are often
translated to contiguous, and sometimes to remote
parts of t! e body.  But did we admit the objec-
tion that 1 have met,  to militate against madness
being an arterial disease, it would prove too much,
for we sometimes  discover the same morbid ap-
pearances, 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 the  " 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 numerous 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
ebre."   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 to lose 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 frequent
observations of the  state of the  blood-vessels, as
manifested by the different and  varying states of
the pulse. 
CHAPTER  II.
OF the remote and exciting causes of  intellectual
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 indi-
rectly 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 laesions 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 18p9, 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. ----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 the bone, tumors, abscesses, and water in
the  brain.

  3.  Certain  diseases of the brain, particularly
apoplexy,  palsy,  epilepsy,  vertigo,  and  head-
ach.   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 lb08.

  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,  drops
consumption, pregnancy, and fevers of all kinds.

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

   3.  The  sudden abstraction of  the  stimulus
of distension.   When madness  follows parturi- 
OF THE  MIND.
33
 tion,  it  is  most  commonly  derived from this
 cause.             .

   4. The excessive use of ardent spirits.   During
 the time  Dr. Nicholas Waters  acted as  resident
 physician and apothecary of the Pennsylvania Hos-
 pital, he instituted an inquiry at my request, into
 the proportion of maniacs from this cause,  who
 were  confined in  the  Hospital.   They amounted
 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 occurred,
 in my practice, from this cause, between the years
 1804  and 1807.  It is induced  more frequently
 by this cause in young men,  than is commonly
 supposed  by parents and physicians.  The mor-
 bid effects of intemperance  in a sexual intercourse
 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  DISEASES
was employed 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 practice
was founded in error; for  old age and  sickness
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 ac-
conitum, taken into the stomach.

   2.  The  suppression  of any usual evacuation,
such as the menses, lochia, milk, semen, or  blood
from the haemorrhoidal 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 accom-
panied with pain.

  4. Madness  is sometimes  induced  by what is
called a m  tastasis 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 con-
sequence of the translation of morbid excitement
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 channel
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 of 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 fre- 
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 happiness 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 fulfiled, or from a disappointment
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 with a symptom of  one  of its 
38
OF THE DISEASES
forms, and that is,  a constant and rapid transition
of tile 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 became deranged
from  inordinate Aschemes 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-
ry.   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
o-enerals of armies having  often languished away
their lives in a  state  of  partial derangement,  in
consequence  of  being  unjustly dissmised  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.

   l< 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  ami-
able 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
exemplary 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   Catholic 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 exited  by supposed visions and  revela-
tions,  instances of  which will be  mentioned in
another place.

  Let  not  religion  be blamed for ^hese 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-
ed 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 hypocondriasis,  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 exemplary 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 from disappointments in love, 30 from
the  distressing events of  the French Revolution, 
OF THE MINB.
47
and 25 from what he calls fanaticism, making in
all the original number.  I have  taken pains  to
ascertain the proportian of mental and corporeal
causes which have operated in producing madness
in the 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
fifty 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-
temperence ; 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 fromu 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 affected
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 records
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- 
56            ON  THE  diseases
ty of Deerfield, 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 sinkings 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  ear 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  previous
to the event.

   " About ten days ago, captain C. of Greenfield,
discovered signs  of  melancholy,  and  expresed
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 too 
ON  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,  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 ao-
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 DISEASES
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
fonieth 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 mad-
ness 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 ;ife, are 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-ach.  The  reverse of this
remark likewise sometimes takes place.   I  at-
tended  a  respectable mechanic  in this city  in
two remarks of madness, the last of which termi*
nated his life.   All  his children, six in number,
and  now all adults, are afflicted  with  head ach,
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, again we see mad-
ness in  children whose parents were remarkable
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 never 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,  because deranged,   Perhaps in
tiese 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 sculls of mad
people that predisposed to derangemnnt, 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 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.  Pinel  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            5N 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
1794, 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  inflama-
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 madnes, and
they both  attempted to 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.   1 have  attended   two  men between sixt:
                      H 
58
OrtJ  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 madnes.   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  Hospital in 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.  But this disproportion of women to  men, 
60
ON  THE  DISEASES
who are affected with madness,  is  by no means
universal.   In a Hospital for  mad  people in Vi-
enna, one  hundred  and seventeen men were ad-
mitted 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  accommda-
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 in
different countries,  may have produced more in-
stances of madness in the former than  in the latter
sex.   Perhaps it would be correct to say, 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 are 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  Pensylvania 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
give  the mind  leisure to look  back  upon past,
and to anticipate future and imaginary evils, and
the inverted  operation of all the affections of the 
62
ON  THE  DISEASES
heart upon itself,  together with the want of relief
in conjugal sympathy from the inevitable distresses
and vexations of  life,  and for which friendship is
a cold and feeble substitute,  are 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 din-
ner, 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 a  bad
quality, but eaten alone.  No wonder it sometimes
becomes a predisposing cause of madness.

  VII. The rich are  more  predisposed  to mad-
ness 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 prevented in the latter, by the constant  pressure
of bodily suffering,  from  labour,  cold, and hun-
ger.  These present evils defend their minds from
such as are past and anticipated ; and these are the
principal  causes  of madness.  When  it occurs 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 
OF THE  MIND.
63
this affinity between wit and  madness, the rapid
exercises of the mind in associating similar and
dissimilar ideas of 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
correctness 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  vigorous
mind of Dean Swift perished gradually only from
the former cause.   Where madness has  been in-
duced by intense and  protracted  application to
books, it has generally  been in persons  of weak
intellects  who  were unable  to comprehend 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  chymist, a naturalist, a  mathematician, or a
natural  philosopher.  The reason of this will be
understood by  recollecting what was said under 
64
ON  THE  DISEASES
the preceding head.  The studies  of the  former,
exercise the imagination, and the passions, while
the studies of the latter interest the understand-
ing only.  Dr.  Arnold  tells us,  he has observed
mechanics to be more affected with madness than
merchants  and members vof 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  attempt
to contrive a new  kirtH  of stair-case.  More far-
mers it has been said become  deranged than per-
sons of the same  grade of intellect and indepen-
dence 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, to its
corporeal causes.

   X.  Certain  climates  predispose  to  madness.
It is very  uncommon in  such as are uniform-
ly warm.   Dr.  Gordon informed me  in  his  vi-
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  the 
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-
position  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  aecompained 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 opin-
ions, 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 
60
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 are suddenly  acquired and lost,  madness
is a common  disease.   It is most prevalent  at
those times when  speculation is substituted  to
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 17  0.  In the United  States, madness has
encreased  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 profit 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
 murder 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
greater  frequency  of  madness in  England, than
in some other  countries,  ascribed in  part  to its
inhabitants  preferring  tragedy to comedy,  in their 
68
ON  THE  DISEASES
stage entertainments.  The real emotions excited
by these  exhibitions of  imagnary distress  are
never accompanied with an effoi t 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  are
those in which the people possess a just and  ex-
quisite  sense  of liberty, and of the evils of arbi-
trary power,  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
derangement.  The assassination of tyrants  and
their  instruments  of oppression is generally the
effect  of this diease.  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 elective, 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,  madnesc  is  a  rare disease.   Of the
'mth 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 nearly  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 re-act-
 ing upon the  brain.  But in some  instances the
 understanding  decays  with  the passions,  in des-
 potic countries.  This state of the mind has been
 called fatuity.  It is very  common in Turkey and
 China.   The inirritable or non-estic  state of the
 brain upon which this disorder depends, is induced
 in those countries without previous morbid excite-
 ment in the same manner that the disorder called
 hepatalgia  is  induced,  without previous hepatisis
 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 considering
the usual effects of solitude upon the human mmd,
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 between 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 re-
cluse  and gloomy situations.

  There are certain tenets held by several protes.
tant 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^
prompdy, 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 force in some
instances as to induce it without the perceptible co-
operation of a predisposing or exciting cause.

  4.  The predisposing causes of madness in like
manner sometimes act with so much force as to
induce it without the perceptible co-operation of
a remote or  an exciting cause.
K 
               CHAPTER  III.

Of Partial Intellectual  Derangement,  and par- \
         ticularly  of Hypochondriasis*

PARTIAL derangement consists in error in opi-,
nion, and conduct, upon some one  subject  only; P±
with soundness of mind upon all, or nearly all ether
subjects.   The error in this  case is  two-fold.   It
is  directly  contrary to truth, or it  is  dispropor-
tioned in its effects  or expected consequences, to
the causes which induce them.   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 hypochondriasis.  When
it extends to objects external to the patient, and
is  attended with  pleasure, or the absence of dis-  J
tress, it  has been called melancholia.  They are
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 j 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 inques-
 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  lie 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  TUE  DISEASES
   1. Because it is sometimes induced by causes
that arc 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- f
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
passion  and moral faculties.  Hysteria is pro- t
duced  chiefly by corporeal causes.   Its paroxisms
only are excited  by such  as are  mental.  The  -i
chronic operation of the passions, so far from  in-
ducing it, sometimes cures it, or changes it  into
hypochondriasis 
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 re-
 verse 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 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 hyste-
 ria ; 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 w uh it, and,  when cured, it  passes cut of  i
the  system with symptoms of hysteria, in all those  1
cases in which it was preceded by them.   I beg  «'
the  attention of the reader  to this view 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 hppochondri-  ?
asis, 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 
OF THE MIND.
79
pervading the whole alimentary canal, and called
in the bowels borborigmi; a tumid abdomen, es-
pecially on the right  side;  deficient  or  preterna-
tural appetite; strong venereal desires, accompa-
nied 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-ach; vertigo; teni-
tus aurium ; a thumping like a hammer in the tem-
ples, and  sometimes within the brain; a disposi-
tion to faint; wakefulness,  or starting in sleep  ;
indisposition to rise out of bed, and  a disposition
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 frequendy
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 patients body.   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 hydrophobia   «!
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
preying upon different parts of their bodies.   3.
He imagines 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 ani-
mals into which he supposes himself to be trans-
formed.

   4.  He believes he inherits, by transmigration,   ■*
the  soul of some  fellow   creature,  but  much
 oftener of a brute animal.   There is now  a mad- 
OF  THE MIND.               81
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 objects.

   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.
                       t 
82
ON  THE  DISEASES
  8. He believes, that by  discharging the con-
tents of his bladder, he shall drown the world.

  9. He believes hinself to  be dead.

  It is worthy  of notice,  in  all these cases of
erroneous judgment, the patients reason correctly,
that  is, draw just  inferences from their  errors.
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 hypocondriac  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.

  Put 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 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 justnow
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 derangedfpenitent 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 thev 
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 diseases, 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-
scian 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. Hayley, 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 oppo-
site states of mind that he wrote his humerous bal-
lad 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 lax-
um, or, in other words, in an inirritable  or irrita-
ble state, and from the blood-vessels being alter-
nately 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 you to seek relief  in a case of disease
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 bowels
and stomach, and a susceptibility of the mind ex-
ceeding 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  ;
indeed, to labour under a fixidity of 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 1  have been in
the constant habit of stopping both ears with wax  ;
with intervals, however, of strength  to bear noise, 
88            ON THE DISEASES
and sometimes even I am, as I think,  almost well.
I am within a few days of forty-four years of age;
my appetite  is always good ; I  eat  every  thing,
drink moderately of wine, have found no good
from any regimen, though I have not pursued  any
regimen but a very short time.

   " I go to  bed,  my mind is distressed, I  get a
little 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 ; I 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; 1 get worse ;  despair ; think of nothing
but my wretched condition, till at last I lose seve-
ral nights sleep; my pulse is low  and threaded,
and at last nature  makes an effort  and gradually
restores  me.  Such is almost always my course.
   u I can  assure you that  no case  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 wouid, I  really believe, cure me; 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 im-
 pious  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 last 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 religious duties.   My heart
 often expands with enthusiasm, and then I taste
 of the joys of heaven   Now, Sir, can this dread-
 ful state of mind be cured ? 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 associ-
 ation, 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,
                       M 
00
ON  THE  DISEASES
as if the body touched  the  nerve:  I cannot well
describe it.

   " If I could  be  tranquil,  1  should  be well.
Whenever  I can be  moved by  ambitious pros-
pects, or entertain a desire  for distinction,  or any
such passion, I am well.  This  is sometimes the
case.  When hopes  or wishes  of this sort take
possession of my mind, they drive  out other im-
pressions ;  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 cheer-
ful, 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 benefit  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 irritable
state.  The remissions and intermissions  which
have  been described, cease,  and even the  tran-
sient  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 sympa-
thy 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 passed
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  lortune,  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 with 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 are not induced by nature or  accident, 
«F THE  MINB.
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.   Carden, 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 in-
flicted by the patients upon themselves, is some-
times insufficient to predominate over the distress
 of their minds.  Dr.  Heberden  mentions an in-
 stance 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. Ruggicri, 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
distress seeks relief in an evil still  greater than
bodily pain.   Can any thing be anticipated more
dreadful than universal madness ? and yet I once
attended a  lady in this city, whose sufferings from
low  spirits  were of such a nature,  that she ar-
dently wished she might  lose her reason, in order
thereby to  be  relieved from  the horror of her
thoughts.   This state of  mind was  not new  in
this disease.   Shakspeare  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 sever'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
Hospiial; 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 man 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 razor, 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 bodyof a Russian officer mangled with thirteen
wounds  inflicted by himself.   He had  fallen into
despair in consequence of debts contracted in a
foreign country.  Sometimes a horror is enter-
tained by   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 instances
of this kind are to be met with,  not only in the
records of medicine, but in nur public newspapers.
Dreadful as this state of mind is, there is one still
more distressing, and that is the  desire,  and fear
of death operating alternately upon the mind.   I
have  seen  this state of hypochondriasm.   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 empire,
not only over the evils of  the  bodies, but  over
those of the minds, of the children of men !
N 
98            ON THE DISEASES
               CHAPTER  IV.


Of the Remedies for Hypochondriasis or Tristi-
                    mania.


THE 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 reme-
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  pre-
pared the way for its being cured in a few days
by other medicines.  I was led to use it by the
following 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
advised him to sit down in his parlour,  and per-
suaded  him to  let him open a vein in his arm.
While the  blood was flowing the patient cried out,
" I am relieved, 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 haemorrhoidal 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 takes place in  this dis-
ease.  After bleeding, if  it be required.

  2. Purges should be  given.  They are indi-
cated by the obstructions  of the viscera, and torpor
of the alimentary canal.   They often  bring away
black bile, and sometimes worms.  The more ac-
tive purges, particularly aloes,  jalap, and  calomel,
should be preferred in this disease.  The daughters
of Praetus,  v ho 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
remove  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 borrow an allusion from a mechanical art, after
plumbing those two  systems, the remedies should
consist,

   5.  Of STIMULATING ALIMENT, DRINKS and
MEDICINES,

   The  diet should  consist of solid  animal food,
with such vegetables as are least disposed to aci-j
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  stomat*h» than the  white wine£,
from its containing less  fermentable  matter in it.
The drinks should be taken warm, for the stonv.dh
is generally too weak to react under the sedative
operation of such as arc cold. Warm tea and cof-
fee, made weak,  are generally grateful to thgr sto-
mach, and should be advised, when it i^not af- 
102
ON  THE DISEASES
fected 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 peppermint 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.   Assafcetida 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 " de- 
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 ; 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 succeded an attack
 of the itch.   The remedy to 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, ',  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 resent-
 ment against  the patient's physician or friends.
 The effects of mercury in this disease, have some^
 times been compared to those of a handful of shot
 shaken in a bottle, lined with filth and dirt, in or-
 der 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 centrifugal
 direction of the fluids.  They are more particularly
indicated, if  the  disease have  been induced 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 thi-
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  best
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  mercurial
pills,  in compliance with  his earnest solicitations,
after having assured him that  he  had not a parti-
cle of  its  virus in his  system.   I  have in several
instances  removed all doubt upon the subject, by
advising matrimony, or a renewal of  conjugal in-
tercourse,  if my patients were married, and by
offering them  at the same time a bond  for a large
sum of money, if any bad consequences should
follow their obedience to my advice.  In this way
I have made many gentlemen happy,  and never in
a  single  instance  incurred the least discredit  or
blame. 
10&          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
chymical 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
arsenic as a medicine, and that it had  eaten out
his  bowels.   A student of medicine to whom he
told his tale, attempted  to convince him of his
error, 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  probably 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
believe, 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 un-
der them,  and afterwards showing them a large
collection 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  men-
tioned, 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 up :m the stomach, destroyed
the command of the patient's will over the spinc-
ter 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, a fter
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 evei
 mention an apprehension of dying to me, in  any
 of my subsequent visits to him.   Anger had uni-
 formly the same beneficial effects upon  a gentle-
 man in Maryland, who,  when in  health, was ac-
 customed to speculate upon controverted 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,
 we 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 suppo-
sed 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 care-
 fully 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 Welch  soldier in the
British 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.
                       p 
114
ON THE DISEASES
  The remedies for  this disease, when brought
on by  disappointed love, and  by grief, shall be
mentioned, 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 they must be extorted,  by di-
rect 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, 1  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  have  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 Ameri  n 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  poli-
 tical 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,   i he  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 TUE DISEASES

following errors :  1. That he is excluded from the
divine mercy by an  irreversible  decree  of the
Supreme 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
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 ridi-
culing points in this disease, above which they  re-
spectively do harm, and  below which they are of
no efficacy. 
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 advices  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  all 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, along  beard,
and  uncombed hair, often become exciting cau-
ses of a  paroxysm  of this disease.  The)- 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  DISEASES
ercises or 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  independance 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 enjovment, 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 ocupation is not rest.
     A mind quite vacant is a mind distj-est."

  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  Spinola, 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 Spinola,  " 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, 
ISO
ON  THE  diseases
 have been useful.   Of the efficacy of the last, Mr.
 Green has happily said,

      " With speech so sweet, so sweet a mein,
      They excommunicate the spleen."

   3. Certain  amusements.  Those  should
 be perferred, 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, sfileen,
      Some recommend the bowling green.
      Some hilly waljcs—all exercise,
     Fling but a stone—-trie giant dies."

 Chess, checkers, cards and even push-pin, should
 be perferred to idleness, when the weather forbids
 exercise in the open air.  The theatre  has  often
 been restorted 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 with frost; it is exactly proportioned to the
excitability of their minds, and it  not only ab- 
QF THE MIND.
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  symptoms.   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 kitte'i-—if the humour hit,
     Has harliquin'd away the fit."

  The fsmous  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 attended 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. Hayley,  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
suddenlv rushed into it, snatched the flute from 
124
ON  THE DISEASES
the gentleman'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 campares in to an apothecary's shop,
in which  is containd remedies for  every disease
of the body.   I have frequently observed the lan-
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  MiIND.
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
attention 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 pro-
duce 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 advantages
 might probably be derived, from carrying a pa-
 tient's memory and  imagination back  to  the in-
 nocent 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 that time left off the use of opium,
and rapidly recovered.  She lived forty years after-
wards  in good health,  and finally died about eighty
years of age.

  10.  Travelling.   Long journies should be
preferred to short excursions from home.   They
relieve the mind from a  monotomy 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 diease.

  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 anguish of mind.  This should 
128   .
ON  THE  DISEASES
be prevented 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  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 un-
expected sense of pain, compassion, a sudden 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 suicide.

   1.  A gentleman afflicted with this disease went
with a loaded pistol into a tavern in London,  with
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.            J.29
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 pistol,
that he  might put an end to his life.   I told him,
the firing of a pistol would disturb the patients 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 physi-
cian and apothecary to the  hospital, to tie up his
arm, and bleed  him to death.    The  Doctor in-
stantly  feigned a  compliance with this request
After losing  nearly  twenty ounces of blood, he
fainted, became calm, and slept soundly the ensu-
 ing night.  The next day when I visited him, he
 was still unhappy;  not from despair and a hatred  rf
                        R 
130          ON THE DISEASES
life, but from the dread of death ; for he now com-
plained only, that  several persons in the hospital
had conspired to kill him.  By the continuance of
depleting 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 regulated
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  pre-
pared 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, nor even expressed a wish
for death.

   It has been said that persons who make unsuc-
cessful attempts to destroy themselves,  seldom 
OF  THE  MIND.             131
nepeat 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 accompanied
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 ruffians
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 spirit
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 off  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 derange-
ment destroy themselves  by abstinence from food
and drinks.   1 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 purpose.

   1. In the Memoirs of Count Maurepas, it is
related of the same prinee of Bourbon who fancied 
OF  THE MIND.
133
   himself to be a plant, that he sometimes supposed
   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, tnd  Marshal
   Luxemburg, 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-
1   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.                                     4

   It is a  singular fact in the history of suicide,
 that it has sometimes been hereditary in  families.
 There are 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 paroxysms 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, in consequence 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, wc  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 in-
sanity.   We see it in the enthusiastic  votaries of
all the pursuits and arts of man.   The alchymists, 
6F  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 aU
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 base
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  of just
                        s 
/
138
ON  THE DISEASES
opinions  of the  divine  wi 1, as  revealed  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 of
them to the cells of a  hospital instead of a jail, and
to the hand of a physician, instead of the hands of
i 
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 ex-
cited, by conversing upon  the  single and original
subject of their disease.

   It is remarkable that  all the errors of amenoma-
nia are the  reverse of those of tristimania, formerly
mentioned, in elevating the patient above his ordi-
nary 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 they
should  be told, that supernatural  knowledge  of
that  kind has generally been  revealed to two  or
more persons at the  same  time, and that  it has
always been accompanied with a power of work-
ing 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 favour of 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
 •ur inquiries and observations. 
OF THE MINI.
141
              CHAPTER V.

     Of General Intellectual Derangement,

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

  I. Mania, by which I  mean what  has  been
called 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  tgrpor  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, parti-
 cularly 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,  hepaticula,  and
 hepitalgia.    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. Rheu-
matism and hepatisis, therefore, may 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 ;  a great ir-
 ritability 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 MdND.
143
tient complains  sometimes of throbbing in the
temples, vertigo, and head-ach.  The gentleman
formerly mentioned, in whom madness  was ex-
cited  by a number of small  shot  lodged in his
foot, when a school boy was  afflicted with  deaf-
ness.  A sudden return of his hearing was always
a premonitory sign of an approaching attack  of
derangement.

  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 stu-
dies, when they are abstruse and difficult, to  such
as are of a lighter nature.  Rousseau often re-
moved, 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 thife
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 purging
physic, and, if the pulse be full or tense,  the loss
often or twelve ounces of blood.  By means of
these remedies, I have in many instances prevented
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 hallooing,  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.
Morely's account of a boy at Naples, 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 denied by Mr. Hal- 
OF  THE  MIND.            145
<sam to be a symptom of general madness.   1 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  cold only 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 recollection of  long unsi-en
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 of 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 symtom in some mad  people,
they  obtained  the name of sputatores, 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.   WTien it is induced
by impressions that have been made upon the brain
through the medium of the heart,  all the faculties
of the mind discover marks of the disease  in all
their operations.  In its highest grade, it produces
erroneous perception.   In  this state  of  derange-
ment, 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 higher  grade of intellectual
derangement.  We have a striking illustration of
this  diseased 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
their 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
receives 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.  It  will 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 recieved  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 cloathing, bed,
chairs, tables, and the windows, doors, and walls
of his room, when confined,  partake  of his rage.
All 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  woods, marshes,
caves, or grave-yards, are his usual places of re-
sort, or  retirement.   What  is  called consicous-
ness is at tins 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 identy.   Shakspeare
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
contracting 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  asso-
 ciates 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 fancier
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  fa-
mily 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 d<ft'ers  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  or 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 1 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  hym \s and songs, of her
own composition,  during the latter stage of her
illness, with a  tone of voice so  soft and pleasant,
that 1 hung upon it  with  delight, every  time  1
                        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 drawing, 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 pieces 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
minds.

   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-
istence of which was unknown to the proprietors 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 frequently
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 naturally
avaricious ?   They fancy they possess incalculable
wealth.  Are they ferocious and malicious ? They
assume the  nature of wild  beasts, and  attempt to
injure their  friends and keepers.   Are they sen-
sual and slovenly in their dispositions and dress ?
They  discover marks of both  in their conversa-
tion and appearance ? Are  they pious and benevo-
lent?  They are inoffensive in their deportment,
and spend  much  time in devotional exercises.
But the conduct  and  language  of madmen are
much influenced by  the specific cause  that in-
duces it.  Does it arise from reciprocal love, op-
posed in the object of mutual wishes by interested
friends ? It  vents itself in sighs and songs, or son-
nets and  love letters.  Is  madness induced by
perfidy in a lover ?  It  discovers  itself in  all the
usual marks of resentment, rage,  and, when prac-
ticable, of revenge.  Ariosto has with great ele-
gance and  correctness described  these marks in
the conduct of Orlando, when deserted by his be- 
156
ON  THE DISEASES
loved Angelica.   He lies down upon a bed in or-
der to rest  a few minutes, but the  moment  he
recollects that Angelica once slept upon that bed,
he instantly  st.rts from it, tears up the tree by the
roois upon which she had ut her name, and finally
dries  up the water in which  she had been accus
tomed 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.   Se-
veral  cases of this kind in  both sexes, have oc-
curred 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 cold-ess 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 feel-
ings 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 sratter'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
    YV hile every luxury that the world displays
    Wounds him afresh, and tells of better dayst."

  Is madness induced by remorse for real or ima-
ginary 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 eleva-
ted, 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.
Horace's  madman complained of his physician,
for restoring him to his former  humble grade of
life by curing him, and Dr. Thomas Willis  men-
tions  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.   Shakespare 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 1—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,

      « Fi.!----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 their
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 those  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 are
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 DISEASED

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 in
the brain.  What  great effects are  produced in
this instance  by little  causes !  How  slender  the
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 revers'd !  (A task, which, if he please,
    God in a moment executes with ease)
    Ten thousand times ten thousand strings go loose;
    Lost! till he tune 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 in-
terruption of five minutes of  speech or vocifera-  *
tions, 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 to discover derangement upon one subject
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 conversing 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 mad-
ness 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,  twice 
164
ON THE DISEASES
 a year, particularly during the equinoxes, monthly,
 weekly, and according to Lazoni, an Italian physi-
 cian, every day.  Perhaps  this diunv.il  attack of
 madness was what has lately been called  the mani-
 acal 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  oi the  stomach, ki own by puk-
 imr, redness of the eyes, an active pulse, and a
 peculiar and specific fcetor  of tht breath.  From
the correspondence of several 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 each 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  when  the intervals  are of short dura-
tion, and these distinguish it from febrile delirium,
in which intermissions more generally occur.   In
many cases, every thing is rem' n.bered that passes
under 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  ' 802, 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 deranged 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  of 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 deran-
ged 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 an 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 Synocomania.

   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 been 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 yet take violent antipathies, har-
 bour unjust suspicions,  indulge strong  propensi-
 ties, effect singularity in dress,  gait, and phrase-
 ology;  are  proud, conceited,  and ostentatious;
 easily excited, and with difficulty  appeased ;  dead
 to sensibility,  delicacy,  and  refinement;  obsti-
 nately riveted to the most absurd opinions ;  prone
 to controversy, and yet  incapable of  reasoning  ;
always 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.

   " 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."
                       y 
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 are 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
us, 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 sys-
tem, 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, increa-
ses  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  1HE  DISEASES
 conceive, in both those states of derangement, the
 system will be insensible to the  influence of the
 moon.   Now when we consider that a great ma-
jority ot the patients  in  most hospitals are 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. Halsam.  In the year 1807 1 requested
 x\Ir. Thornton, then one of the apothecaries of the
 hospital, to attend particularly to the influence of
the morning light upon all  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  began to break, and that, with the excep-
tion  of two or  three recent 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
chiefly from an increase of its light.  It  is possi-
ble 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.
173
  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  moon  upon madness,  which has so long ob-
tained among physicians. 
174
ON THE DISEASES
              CHAPTER VII.

          Of the Remedies of Mania.

BEFORE we proceed to mention the  remedies
for  mania,  or the highest grade of  general mad-
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 ease, 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-
ployed,  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 tiger, 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 eye,  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  THE  DISEASES
           suited to the state of the  patient's mind, with the
           same exactness that  musical tones should be suit-
           ed to the depression  of spirits in hypochondriasis.
           Mr. Halsam  again asks, "Where is  the  man that
           would trust himself alone with  a madman, with
           no other means of subduing him than  by his eye ?"
           This miy be,  and yet the efficacy of the eye as a
           calming remedy  not  be called  in question.  It  is
           but one of several other remedies that are proper
           to tranquil ze  him;  and,  when  used alone,  may
           not be sufficient  for  that purpose.   Who will de-
           ny the efficacy of bleeding for the cure  of  mad-
           ness ? and y-1 who would rely upon it exclusively,
S          without the aid of other remedies ?   In  favour 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, and 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 be by
           his voice.  Milton calls the human face "divine."
           It would be more  proper  to apply that  epithet to
           the human voice, from its wonderful effects  upon 
OF THE MIND.
177
 the mind of man, whether  employed  in  simple
 tones, in music, or in speech.  Even brutes feel
 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 produced by it in
 all those ways.  A patient  in  the  Pennsylvania
 Hospital, who called his physician his father, 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 pnysician  should
assist his eye and voice in governing his  deranged
patients.   It should be accommodated to the state
of the patient's  mind  and  conduct.   There is
something like  contagion in  the different aspects
                      z 
178
ON  THE DISEASES
of the  human face, and  madmen feel  it in corn
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 stern
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
acquire 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 consequence
 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 blip-
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 ta ble
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 hisdi- 
180
ON  THE  DISEASES
recti ons 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 their keepers.  Small presents of
fruit or sweet-cake will have a happy effect in at-
taching maniacal patients to their physicians, for
 t is a  fact, that in  proportion to the intensity of
misery, the subjects of  it feel most 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 after their recovery,  viz  acts of  cruelty,
acts of indignity, and acts of kindness.  I  have
known instances  in  which the two former  have
been  recollected by them  with  painful, and the
last  with pleasant  associations for  many  years.
In gratitude  for kindness  and favours  shown  to
them, they exceed all other classes of patients after
their  recovery.   A  physcian once asked a young 
OF THE  MIND.            181
women  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
that purpose.   " Forgive thee !"  said she,  " why
1 love the very ground thou walkest on."

   If  all  the means  that have been  mentioned
should  prove  ineffectual to establish a govern-
ment over deranged patients, recourse should be
had  to  certain modes of coercion.  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.

   I.  Confinement by means of a strait waistcoat,
or of a chair which I have called  a tranquillizer.
He submits  to them  both with less difficulty 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 where, 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 are  excellent remedies
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 alvine
evacuations.*

   2.  Privation of their customary pleasant food.

   3. Pouring cold water under the coat sleeves,  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
1
had 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.   <c 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 oniy 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.  They  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 village
of Chester, in this state,  by his conduct.   A per-
son more  mad than himself came into the town.
Hoops instantly ran from him,  and took shelter
in the court house while the court was sitting.
There was an  instance  of the same timidity in a
madman in our hospital,  in the month of February
1810.  In consequence of the house being unusu-
ally crowded with mad people, two men were con-
fined  in one cell.  One of them, who was very
noisy, was instantly silenced by the rebukes 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 treat-
ing 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
   II.  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 indicatedl

   1.  By all the facts and arguments formerly men-
 tioned, in favour of this grade of madness being an
 arterial disease, of great morbid excitement or in-
 flammation  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 morbid
action  for a  length of time,  without undergoing
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 mad-
ness.
                     a a
•J*h»& 
186
ON  THE DISEASES
   4.  By there  being no outlet  from the brain,  in
common  with  other viscera, to receive the usual
results of disease or inflammation, particularly the
discharge of serum from the blood-vessels.

   5. J3y  th» accidental cures which have follow-
ed the I^s^h  AJge quantities of blood.   Many
>flwl Jj&>pl%, who have attempted to destroy them-
selves by cutting their throats, or otherwise open-1^'
ing large  blood-vessels, have been  cured by the
profuse haemorrhages which have succeeded those
acts.  Of this, several instances have occurred with-
in my know ledge.

   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 sizy 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
in 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 once, 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  sometimes  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 1"HE DISEASES
  The propriety of bleeding in this mania notha, il
I may be allowed to use a term founded upon the
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.
                             i
  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 Inquiries
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
greater  than in any other organic  disease.  This
is indicated not only  by most of the reasons for
bleeding formerly  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 suspended, by the acute and  painful dis-
ease of parturition, several instances of which  have
come under 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. D. 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 gen-
 tlemen  were my private patients in the Pennsyl-
 vania 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. Anan, 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 haemorrhoidal 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  THE 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 the
 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.   1 have seen
 the  happiest effects from confining noisy patients
 in them.

   5. An erect position of the body.  There is   i
 a method 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  excrement  irom the brain and  thereby re-    j
lieve the disease.   That  benefit would arise from 
OF  THE  MIND.
193
preventing sleep, I infer from its alutarys 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
ON  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 lake
place in madness, 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.  Purging,   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  L w
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.
155
   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 several other diseases.
 In the first stage of tonic, or violent, madness, the
 disease is intrenched, as  it  were, in the  brain.
 It must  be loosened, or weakened, by depleting
 remedies, before it can be dislodged, or transla-
 ted to another part of the body.   WThen 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 appliedrto
 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 far the hair, by its  sym-
pathy with the  brain,  which it discovers by pre-
 ternatural dryness in the  forming  state of  many
 diseases, and by the  alteration in  its  figure, co- 
OF THE MIND.
197
lour,  and quantity,  from the influence of certain
emotions and  passions of the mind, may increase
this disease, we know not; but we are certain, by
cutting 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 % 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 
193          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 efli.
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.  Spence,  of Dumfries,
in Virginia, in Dr. Cox'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  punfghgient,
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
tlie 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 cable, 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 aver-
sion from the infant that had been the cause of
her suffering.   On the  day she felt the mercury
in her  mouth, she asked for her infant, and  press-
ed it to her bosom.  From that time she  rapidly
recovered.

   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 spreading
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 usually administered, this
medicine may be given with advantage.

  I have thus enumerated the principal remedies,
which have been  employed in reducing the pre-
ternatural excitement  of  the system  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  with 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 adminis-
tered this  medicine in tonic madness, but  never
with any radical or permanent success.

  15.  Camphor has been supposed to  pos-
sess specific virtues in this state  of madness.  I 
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 lately
    discovered that my  experience  of their inefficacy
    in this disease, accords with  that of the ingenious
    Dr. Ferriar.   They  have both derived their cerdit
    in madness  from  their  lessening the frequency
0   of the pulse, in which, disease has very improper-
    ly been supposed to consist.  But the frequency
    of a pulse may be lessened, without a reduction of
    its force, and even both  may be effected by  these
    medicines upon the pulse on  the wrist,  and yet ir-
    regular  action in  the blood-vessels of the brain,
    which constitutes the disease,  still continue, and
    until this be  removed, they  are calculated to do
    harm, by inducing  obstruction 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 re-
    medies.
c  c 
202
ON  THE  DISEASES
   I suspect many,  and perhaps all, the cures that
 have been performed by opium, digitalis, and cam-
 phor, have 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  bears stimulants with safe-
 ty, but sometimes requires them  immediately 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.   Refractory
domestic animals are sometimes subdued in the
same way ;  but  experience  has taught us  that
they may  be tamed by more gentle means.   Ex-
perience has  proved,  in  like manner,   that the
system  in  tonic  madness  may  be ruduced 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. Thisrexcellent 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.

   _0. 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 hyst'-in'.al orcon vulsive symptoms ;  as-
safcetida,  ca^o/,  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 possions 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  religion, in pre-
venting suicide  in  the virgins of Miletus.   Achil-
les was diverted  by his mother Thety s from gratify-
ing his revenge  upon the body of Hector,  by sup-
planting that  baneful passiou  by  the passion of
love.  Anger, and even rage, have often been op-
posed with succes  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 endeavoured  to fix it upon but one.   In
order 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 mathema-
tics, 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 wo-
man  who was  cured  of madness,  by  keeping
her constantly employed for  several days  in play-
ing cards, to which  it was known she had always
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  admit that
this  diversion of the passions and understanding
cannot  be effected,  where  the  whole  mind,  and
all the passions, are  under  the  influence of mad-
ness.  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 dis-
ease of their other  passions ; nor could Dr. Ash
have been cured of his intellectual derangement by 
 206         ON  THE   DISEASES

by the study of mathematics, had he lost all his re-
collection 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 sud-
den 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 sal-
amander ;" "  but recollect (said Mr. Coats) all  the
patients in the hospital are not salamanders;" that is
true,  said the  maniac,  and  never  afterwards
attempted to  burn  the  hospital.   Many  similar
instances of a transient return of reason,  and some
of eures, by pertinent  and well directed conver-
sations, are to be met with in the records of medi-
cine.

  3. Madness has sometimes been cured by  the
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.   Van Swieten 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 jof sound and correct mind.  I once attend-
ed  a judge, from a neighbouring state, who was
rational  and sensible  upoft 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
ensuirtg Sabbath.   Company has  a  similar  effect
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,  deri-
ved from association, will  be proper only in the de-
clining and moderate state of the disease. 
208
ON  THE  DISEASES
   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, they should never be
 contradicted,  however absurd their opinions and
 assertions may be, nor  should we  deny their re-
 quests by our answers, when it is improper to grant
 them.  In  the  second  grade of this disease we
 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-
 able, 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.
 Jn the first  and raving state of  her disease, she
 said  the spirit of  general Washington visited and
 conversed with her every 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 of
 the spirit of general Washington,  whenever she
 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, divertino;,  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 bodilv diseases 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 verv ob-
vious  in order *o their producing a salutary effect.
Indeed they should  never be confined a day after
                       Dd 
210          ON  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, they 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 part
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
royul patients being affected 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 advi-
sed 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
ed before he was taken out. The cures in all these
cases were effected, by the new acdons 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.
Banhoiin  speaks in  high terms of what  he calls
" flagellation" 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  in-
tention to kill him. His  neighbour met him with a
heavy whip, and beat him until  he  fell upon  his
knees, and  implejred him to spare  his  life.   He
rose from his knees in a sound state of mind, and
had no  symtom 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
 o such a degrading  remedy. 
OF THE  MINB.
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 diftused through all  her
passions, was suddenly concentrated in  but one of
them,  and in her understanding, from  whence it
gradually  passed out of her sjstem.   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 intelligence
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.

XHIS 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  synocula, 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 b) Dr. Cullen typhomania.   We see it oc-
casionally 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 ma-
nia, 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 garlic in  sub-
stance or infusion, and the  different  preparations
of iron.  In the typhomania, the remedies  should
be combined with  those usually employed in the
treatment of typhus fever,  particularly bark  and
opium.   The latter is an invaluable medicine in
such  cases.   The dose of it should be much lar-
ger than in  common  diseases of the  same grade
of action. 
216
ON  THE  DISEASES
              CHAPTER VIII.


               III.  Of Manalgia.


THE symptoms of this  third and last form of ge-
neral 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 insensibility to
the I iter 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 at-
tends this form of madness.   Of this  there  have
been  two  rem.rkahle  instances  in our hospi-
tal.  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 ac-
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.   ', he 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
Philadelphia, on which he was born, and had pass-
ed his youth, and which he expected to inherit af-
ter the death of his father.   The  skin in manalgia
is dry, cold, pale, yellow, brown, livid, and dark
coloured 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  sometimes a discharge  or  slabbering of
saliva.   This symptom with one other, was select-
                       e  e 
218         ON THE DISEASES
ed by  David,  when he  counterfeited  madness
in  order  to prevent the  discovery  of  his  per-
son by the king of Gath, 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 scrabbled 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 habit
of using it.  They frequently  abk strangers for it,
or 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 posses 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 con empt of man,
  Brought near to beast.  My lace I'll grime with filth.
  Blanket my loins, tie all my hair with knots,
  And, with presented nakedness, out-face
  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 charrity."

   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,
Avithout 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 be
    "Where holy congregations bow.
    Wrapt 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 Pliladelphia. 
OF  THE MIND.
221
   The  REMEDIES for MANALGIA should COU-
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 liberal
quantities. 
222          ON THE DISEASES

  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 u; on himself by
a student of  medicine  in the university of Penn-
sylvania.   From the occasional effects of fevers,
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 greater part of
the  maniacs  to their reason.   These accidental
cures struck the late Dr. Bond so  lorcibly, that he
attempted to excite a fever in several of his patients
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 1 attended the  Pennslyvania
Hospital, in the summer of  1765,1 often employ- 
OF THE MIND.
23
ed these two remedies in the manner 1 have men-
tioned.   1 kept my  torpid patient in the  warm
bath for an hour or two, and then led him, smoke-
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,
it restored reason to my  patient; but from his
being confined in a damp cell, he died some time
after his recovery  from his madness, of a pulmo-
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 women 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 
i224
ON  THE  DISEASES
months or years.   This remedy acts by the pre-
manent discharge it induces from the neighbour-
hood of the brain.  Four patients  have been cu-
red of  manalgia  h\ 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 tells us,  in his  Lives of the Poets, that
Dean 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 stimulant
and  tonic.  It will moreover  serve to  remove
visceral obstructions, which so  generally succeed
madness.   Where it excites a salivation, it  seems
to recusitate 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 days afterwards.

   8. Exercise.  This  should consist  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.
22S
lion, so  as to give a centrifugal direction of the
blood towards  the brain.    He  tells  us he  has
cured 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  mentioned  by
Dr.  Cox.    These  are  vertigo and  nausea,  and
a general perspiration.   1 have called it  Gyrater.
It would be  more perfect, did it permit the head
to be placed  at a greater distance from its ctntre
of  motion.   It  produces  great changes in  the
pulse.   In one experiment made with it, it increa-
sed the pulse from  4 to 88 strokes in  one minute,
and to 120 in two minutes.   It increased its  full-
ness at the same time.   In a second experiment
made upon a manalgic patient, it increased the fre-
quency 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 lessened its
force.   In this patient, the pulse was preternatural-
ly 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
                       Ff 
226
ON  THE  DISEASES
 head towards one of its extremities, and  then  giv-
 ing it a rotatory motion.  The centrifugal fo'ce of
 the blood would  exceed,  in  this way, that  which
 it receives from the chair employed by  Dr. Ccx,
 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 sen-e 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  act on, 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,  ma-
 king 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 lrom 
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 p oducing a cur-
rent of new actions,  both corporeal  and mental. 
228
ON  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 habits
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,
they should be as  much  separated from each  other
as possible. We are naturally imitative animals; and
our minds are formed  in a degree by ambient cir-
cumstances; for which reason mad people should
associate and work  only with persons  of sound
and healthy minds.

   10.  Music should not be omitted as a remedy
in this state of madness.  The tunes  employed
for this purpose should be  of  the  most invigora-
ting nature. 
OF THE MIND.
229
  11. Great pain. Mr. Stewart, the pedestrian
traveller, informed me,  that  he or.ee 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 chrome madness
beini^ cured by trepanning, and of the same good
effects being produced by accidental  contusions of
the head.  It  is probable that 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.  Erbhines.  These are suggested by the
general absence  of secretion  in the nose in mad
people, and  by the  relief which the  discharge of a
lew 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 
L2$0         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  dyeing scarlet
to be  uncommonly  cheerful, 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 year, 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 fa-
vour 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 prettv 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 from  die fol-
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 is now, and probably always will be,  an incu-
rable tenant of our  hospital.

   There are  several medicines which have  been
given in this disease, upon which 1 shall make a
few remarks.  These are,

   16.  Opium, iron, the datura stammonium, strong
infusions of green tea and  green coffee, garlic, va-
lerian,  the nitrous oxyd, and electricity.

 "I have administered all  these medicines in this
disease  in  the  Pennsylvania Hospital, and some
of them for sever/tl  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 elt ctricity nas 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 rej -ct 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 c 
234
ON  THE  DISEASES
state of manalgia.  He had been in that situation
between four and five 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 lunatic
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 hue  sustained
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 never ob-
served to express any desire for nourishment; and 
OF  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
insensibility he remained till the morning of  Tues-
day the fourteenth of May,  1783, when, upon en-
tering the parlour, he saluted the recovering pa-
tients with a " Good morrow to you all."  He
then thanked the servants of the house, in the most
affectionate 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 
236
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, c ordials 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 28th 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 in-
stances  in which manalgia has  preceded mania,
and  manicula;  and lastly, we now and then see
thtm 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 the unity of its
cause, and the necessity of renouncing all prescrip-
tions for  its names, and of constantly and close-
ly watching the disease,  in order to vary  our re-
medies 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
i  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
s 
238
ON THE DISEASES
pan half filled with water, in order to suffocate the
fcetor of his evacuations,  should be fixed in his
room, with a cover, which should fall down of it-
self upon the stool after it is used.

  2.  Mad people  should never be visited, nor
even seen by their friends, and much less by stran-
gers, without being accompanied by their physcian,
or by a person t© 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 ad vantage from con-
cealing the persons of mad people from  the eyes of
visitors and the public.   The di rase is supposed
to fix something of a repelling nature  upon  per-
sons and families, and hence  it i; 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 without its being known.  Nay, they will be
sent there upon the first  appearance  of the  disease,
*n 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  then
 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  soilitude  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 pa-
tients abroad, or to reside  for  some  time among
strangers,  before they returned to their families.
All  the 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 madness,
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
these  Inquiries, without lamenting  the want  of
some  person of prudence and intelligence  in  all
public receptacles of mad people, who should live
constandy 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 t • him ; to superintend their labours of
body  and  mind ;  to preside  at the table  at which
they take  their meals, to protect them from rude-
ness 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 
 242           ON  THE  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
 temper 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
 servants, 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, we 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 m 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
stoves in winter, in both of which the sexes are
separated, a id alike protected from the eye of the
visitors  of the hospital.   In consequence of these
advantages they have recovered the human figure,
and,  with it, their long forgotten relationship to
their friends and the  public.  Much,  however,
remains 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* to their  natural order  and  offices,  and

  * The following short extract, taken  down  by Mr. Coats,
from the constant conversation of a young man of a good
ed ucation, and  respectable  connexions, 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
Mary queen of Scuis, born  in Philadelphia.  I have been
happy enough ever  since I have  seen  general Washing-
ton with a silk handkerchief in High-street.  Money com-
mands sublunary things, and makes  the mare go; it will
buy salt mackerel,  made of ten-penny nails. Enjoyment
is the happiness of virtue.  Yesterday cannot be  recalled.
1  can only walk in the night-time when I can eat pud- 
OF  THE  MIND.
245
 to revive  in him the  knowledge of  himself,  his
 family, and his God.

   But in performing this achievement 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 salt  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
 and stole a coffee-pot in the  twenty-fourth year  of his ma-
 jesty's reign.  Plum-pudding and Irish potatoes  make a
 very good 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 0f  jyrarv
queen of Scots.   Born  in Philadelphia.  Born in Philadel-
phia.   King  of Macedonia. 
 246           ON THE DISEASES

 in a great majority of our  dreams, it  would  be
 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 hallooing, stamping with the
 feet, and the rattling of chains, so generally practi-
 sed by mad people, are all resorted to, 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 are
 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,
 w but cannot  feel; the  torpid  maniac feels,  but
 cannot weep."  In maintaining the general exist-
ence 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 Shakspeare, in
the following view of the images  and feelings that
usually harrow up the imaginations of mad  peo-
ple. 
OF  THE MIND.
247
  « Who gives any thing (says Edgar) to poor Tom,
  Whom the foul fiend has led through fire,
  And through flame, through ford, and whirlpool,
  Ovf r bog and quagmire, that hath laid
  Knives under his pillow, and halters in his pew,
  Set r*t's-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-
cription of the distress and horror which distracts
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 inestima-
ble value.  With these transient and casual favours
should be united savoury food.  This is the more
necessary  to  them, as  their  senses  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, which 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 acquired.   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 cu-
red 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  medicine 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-
pit-'.l, 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 favouable.  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 andi ntermissions 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 thenose, after
it has been long dry,  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 diseases to be
passing  from its seat  in the blood-vessels to the
nerves.

   A  moderate  degree of obesity occuring  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 strong drink, generally
 yield to the power of medicine.

   Madness from  laesions of the brain is  seldom
 cured, 
252           ON  THE  DISEASED

  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.

  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.  Ill-temper is favourable.

   Weeping is favourable, when the disease  has
been preceded  by  hypocondriasm.   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 unfaithful-
ness of  his beloved Angelica.

  Slow recoveries are most favourable.

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

  In three cases of madness that have occurred du-
ring pregnancy, within  my knowledge, parturition
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 famale 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  habitual
 employment or of any of the habits of the under-
 standing or the affections, that had been suspend-
 ed, is  still more favourable.  I shall mention in-
 stances of each of them.

    Sir George Baker declared the  king of Great-
 Britain to  be convalescent  from  his first attack 
 254          ON THE DISEASES

 of madness, as soon as he heard him speak with a
 rapidity  that had always been natural 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  are painful,  such
 head-ach, 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, who 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
weelc.  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 recoverd 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  THE  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 zO 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. Greding says 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 madness  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 horison.   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 thev 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  perception,  like  the  worst
grade of madness, but of an association of unre-
lated perceptions,  or ideas,  from the  inhability of
the mind to  perform the operations  of  judgment
and reason.   The perceptions  are generally exci-
ted 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 hos-
pitals;  but there is scarely  a city,  a  village,
or a country place,  that does  not furnish one or
more  instances of it.  Persons who  are  afflicted
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
balloon, and at  the mercy  of every  object and
thought that acts  upon it.   It  is constant in some
people,  put 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, which  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 seta
going, there is no such thing as stopping him till
he runs himseli  out of breath.   He  starts from
subject to subject, flies from book to book, from 
OF THE MIND.             261
pictuie 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  difficulty 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 a motive, 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
undersanding, in this convulsed  state of the will,
is in a sound state, and all  its operations are per-
formed in a regular manner.  When the will be-
comes the involuntary vehicle of vicious actions,
through the instrumentality of the passions, I have
called it  moral  derangement.   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  of uncommon talents,
who  are affected  with  this lying disease  in the
will.  It differs from exculpative, fraudulent and 
OF  THE  MIND.
265
malicious lying, in being influenced by none of the
motives of any of them.   Persons thus diseased
cannot speak the truth upon any subject nor tell
the same story twice  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 a hyberbolical of 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.   1 in
 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 
266
ON  THE  DISEASES
or abstinence from food ; for children are incapable
of being permanently influenced by appeals to rea-
son, natural affection, gratitude, or evena 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, 1 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 religion and the love of life,  can sug-
gest to them.   An instance of insensibility to  the
last, in  a  habitual drunkard,  occured  some years
ago in  Philadelphia.  When strongly urged, by
one of his friends, to leave off  drinking, he said,
" Were a keg of rum  in  one corner  of, 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  hitherto
been religious and  moral,  and  they have some-
times cured it.  They  would probably have been
more successful, 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 thataccount 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
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
greater number  of drunkands  than thieves into
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          ON THE   DISEASES

munity will be more promoted by confining them,
than a common thief.  To prevent injustice or
oppression, no person should be sent to the con-
templated hospital, or  sober house, without be-
ing examined and committed by 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 physi-
cal remedies, to which 1 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
of their own."   This is strictly true.  If left to
themselves, they would  neither buy nor  sell, nor
transact any kind  of  business.   They  xoill and
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 tinder 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 benefited 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, \v 
270
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
not a palsy of the will be cured in a similar way9 
OF THE MIND.
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  1  mean by it that  principle in the  mind, by
which we believe in the evidence of the senses, of
reason,  and  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 it? 
272
ON  THE DISEASES
sound state.   Happily for us, likewise !  a source
of knowledge, so necessary to individual  comfort
and social existence, has not been made 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-
tions  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.   They are inca-
pable of comparing dates and circumstances,  and
tell stories of the most improbable and incongru-
ous  nature.   Sometimes they propagate stpries
that are probable, but false;  and  thus  deceive
their  friends and the public.   There is  scarcely
a village or city, that does not contain one or more
persons affected with this disease.  Horace de-
scribes a man of that character in Rome, of the
name of^pella.   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 stories often gain a currency
through whole communities. 
OF THE MIND.
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.  1 think I once saw
it effectual in an old quidnunc during the  revo-
lutionary 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 the
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 from persons  who deny their belief in the
utility of medicine,  as practised by  regular bred
                       m m 
274          ON  THE  DISEASES

physicians, believing  implicitly  in  quacks ; also
from persons who refuse to admit human testimo-
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 ot  the body, and of other facul-
ties of the mind.
   Sometimes  a strong   passion, or emotion,  by
pre-occupying  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 joys."  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,

THIS  disease  is  attended  with  die 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 name 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 Wepfer  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 dian
 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 legible 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, -with  a perfect  recollection of persons and
names.   This is the  case with the Rev.  Dr. Ma-
gaw,  formerly  minister  of St. Paul's church in
this  city.   This disease  in  his  memory was  in-
duced by a paralytic affection. 
OF  THE  MIN».
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 oblivian 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
undue effort  to  retain  them.  Something similar
to it occurs in the inability of lovers to dream  of
each other.

   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 formication,
that is, a sense of something creeping up the left,
arm, and the fingers of both hands, a disposition
to weep, and 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 forgot the
names and persons  to whom he wished to speak,
but even what he wished to say to them.

  2. Intemperance in drinking.  It was  from the
effect of strong drink, in  weakening or  destroying
the memory, that an old Spanish law refused to ad-
mit 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
a. fever when  he  was  about eighteen years of
age.

  5. Vertigo, epilepsy, palsy, and appoplexy.

  6. Drying up an issue.   Lassions 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 weakened or destroyed 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 exercised exclusive-
ly upon numbers,  had so little recollection of faces,
that  he was unable to recognize 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  has  the same effect.   A celebrated  player
in London, his son informed me,  lost the recol-
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 returning  from  his travels  called to see him,
and expected to have been highly  entertained by
conversing with him upon the  subject of his stu- 
                OF  THE MIND.             283

dies.   "Here," said Mr. Hude,  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.  Absracting all its exciting cause.  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
calves of the legs, in this disease.

   4. Issues in the arms.
5. Errhines 
284
ON  THE  DISEASES
   6.  Certain aromatic medicines.   Etmuller says,
 when a young man,  he greatly improved his me-
 mory by swallowing three  or  four cubebs cx^ry
 day.   The  cardamon  seeds are said to have the
 same effect.  Lavender and rosemary,  or  cloves
 may be substited for both of them.

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

   8.  Exercise.  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
 Sweedish language, who he was sure had not spoken
 it  for 50 or 60 years  before, and who had  proba-
 bly entirely forgotten it.  It was  revived  by the
stimulous of the fever in their brains which attend- 
OF THE MIND.
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-
e 1 from him.   " That  people generally pray in
their list  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.  1 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 his grammer, and called for one of the La-
tin  classics,  which he  had begun  to read previ-
ously 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 working 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
proprosed to them, before they can answer them.
The door of the mind in such people requires two
knocks  before it  can be  opened,  one  by the
person who  asks,  the other  by the person who
answers 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
sences,  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-
ceive 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
sily acquire,  and more durably retain, them in
their  memories.  The ear is less apt to be dis-
tracted than the eye by the  obtrusion of surround-
ing objects, the one being more constant than the
other.   The  mind moreover is more  concentra-
ted in hearing  than in seeing.   The  truth of all
these remarks is confirmed, by  few of the sayings
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 the 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 admitted, 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  by 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 tc them.  This is effect-
ed  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
to 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,
Go 
290
ON  THE  DISEASES
   ■■        « Saepe ego longas,
   Cantando pueruni, memini me
   Condere."

  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.

THIS  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  a
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 in 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. 
292          ON THE DISEASES
   Fatuity, or idiotism, is,

   1. Congenial.  In these cases the skull is less,
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. Fodere,  who  has  written an interesting ac-
count  of them, says  they have  no knowledge  of
their parents,  nor are they able to feed diemselves
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.  There is  a  case of congenial 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
in 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 oftener
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  conse-
quence of the brain becoming so torpid,  and insen-
sible, as to be unable to transmit impressions made
upon it to the mind.  It is partial, or general, ac-'*
cording to the greater or less extent 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 rime 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 cea-
sed, 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-
t 
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 made scholars,
and, on the contrary, boys of active  minds  are
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 fatuitv of Dean
Swift to two causes; 1, to  a resolution  he made  ,   *»
                                              ,3^  <
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,  whichf
led him to abscond from visitors,  or   deny him-
self  to company,  by which  means he deprived
himself of the only two  methods  by   which new
ideas are acquired, or old ones renovated. His mind
from these causes languished from the  want  of ex-
ercise, and  gradually collapsed into idiotism,  in
which state he spent the close of his life in a hospi-
tal 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 consetnience 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,
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
                       pp 
£98           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 only 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  formerly  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. 
j 00
ON
THE DISEASES
              CHAPTER XIV.

  Of Dreaming,  Incubus,  or Night Mare, and
               Somnambulism.

'I O  enumerate all  the  phenomena of dreams,
and to attempt an explanation of their proximate
cause, would  require a previous account of the
theory of sleep, and this would render it necessary
to introduce  several phisiological  principles, all
of which would  be foreign to the practical  ob-
jects of this work ; for which reason I shall barely
remark, that dreaming is the effect of unsound or
imperfect sleep.  That this is the case is obvious,
from  its  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 with 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 causes are an
increase, or diminution, of stimuli upon the brain.

  I. The  increased  stimuli  are  corporeal,  and
mental,

  I. 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 stool, 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
only detract from the happiness of life, but, when
neglected,  become the  cause  of more  serious
diseases in the  brain.  The remedies  for  them,
when they 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,
informed me  that he never dreamed, when he lived
exclusively upon vegetable food.

   2, Exercise,  or  labour,  which reduces excite-
ment, and wastes excitability down  to the  point
of natural and  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. WThen  dreaming arises  from  a diminution
of customary stimuli, a light supper, a draught of
porter, a glass of wine, or a dose of opium,  gene-
rally prevent  them.  Habitual noises, when sus-
pended, should be restored. 
OF  THE MIND.
303
        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 re-
mote causes are 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. Hartly'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  mu s 
301           OaV THE DISEASES

cles concerned so free, as that vibrations [or nei
vous influence] can descend from the internal parts
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 inattentively, 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
nata,  from moment to moment, yet forget all im-
mediately, somewhat resemble  the  persons who
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
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
itself,  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 artisan
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.
^ 
306
ON  THE  DISEASES
               CHAPTER  XV.

                  Of Illusions.


13Y this term I mean that disease, in which false
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 they  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 body, 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-
sists most commonly in hearing  our own  names,
and for this obvious reason; we are accustomed to
hear them pronounced more frequently than any
other words,  and hence the part of the ear, which
vibrates with the sound of our names, moves more
promptly, from 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 vi-
sion.

   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 that this explanation of illusions 
308
ON  THE  DISEASES
may be applied to invalidate the accounts that are
given in the Old  and New Testaments of the su-
pernatural voices  and objects,  that were heard or
seen by individuals, particularly by Daniel, Elisha,
and  St. Paul; but they should no more have that
effect, than the cures of diseases that are performed
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 voices
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 dis-
tinctly 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 haemorrhoi-
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.

THIS disease is induced by two causes,

  I. 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 sense.  It is an inferior or feeble grade of ca-
talepsy.

  It is more common from the  latter than the
former cause. It is no objection to this assertion,
that it  sometimes occurs in scholars, and m men
celebrated for their great literary attainments.   A
capacity 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 observatiqn
and reflection, and to apply it to the useful purpo-
ses 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 intellectual disease,
from the latter cause that was mentioned.

   " Mr. George Harvest, minister of Thames Dit
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  offended
 at his neglect, broke off the match.  He had at
 that time an estate of 3001.   per annum, but, from
 in attention 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 frequently lost his beast from
under 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, and sometimes it was taken
off by the boys, and the parson seen drawing his
bridle 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,  and  a  deep metaphysician,
though generally reckoned a little crack'd

   Such was  his absence  and distraction, that he
frequently 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 filled 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 a#

   One day Mr. Harvest, being in a punt  on the
 river Thames with  Mr. Ostow, began to  read a
 beautiful  passage  in some  Greek author,  and,
 throwing himself backwards in an extacy, fell into
 the  water, whence he was with difficulty fished
 out.

   Once being to  preach be fore the clergy at the
 visitation,  he  had three  sermons in his  pocket:
 some  wags got possession of them,  mixed  the
 leaves and 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 and noisy company, might produce in the
 mind a predominance of impressions  from pre-
 sent objects, over those of the ideas of absent sub-
jects.  Stimulants, particularly such as act upon
the brain and nevous  system, would probably be
 useful,  when the  disorder  arises from  torpor of
mind,  or insensibility of the senses.
                      r r 
S14
ON  THE  DISEASES
*
             CHAPTER XVII.

       Of Derangement of the Passions:

 1 HE passions have been divided into two great
classes, 1, such as are intended to impel us to real,
or supposed good; and, 2, such as are intended to
defend us from real, or supposed evil.  The for-
mer are  objects of desire,  the  latter ef aversion.
Those of them which are  most subject to derange-
ment, or to an unreasonable and  morbid excess,
are,  love, grief, fear, and anger.  After mention-
ing the symptoms of their diseases, and their re-
medies, I shall consider the morbid phaenomena of
joy, envy, malice, and hatred,  and conclude 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 purpose of bringing the sexes toge-
 ther,  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, wakefulness, 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 LaBruere, "by her constantly look-
ing at the man she loves, when in company, or  nev-
er 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
usuccessful  love are dyspepsia,  hysteria,  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 any affeetion for the persons
they have loved.   This was the case with one  of
the princes  of Conde.   He complained,  in this
state of his mind, that his physicians had drawn off
all his love for his mistress by their depleting re-
medies.

  2. Ovid advises what he calls a " binam amicam,"
that is,  a new mistress, for unsuccessful love.  I
have known  this remedy to succeed in several in-
stances.  The  sincerity  of  a former attachment
is often called in question, by a sudden translation
of the affections to a second mistress, but without
any foundation.   Indeed, it proves its sincerity,
for its ardour admits of no other cure.

   3.  The  same  master of  the  subject of love,
Ovid, advises an unsuccessful lover  to find out,
and dwell upon all the bad. qualities,  and  defects,
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 to expose herself by playing upon one of
them."

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

   5. Constant  employment will aid absence as a
remedy  for hopeless  love.  The  more  that em-
ployment  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 Daughters, up-
on the subject of courtship and  marriage.

   7. Uusuccessful love is cured by exciting a more
powerful passion in the mind.  Ambition  should
be preferred for this  purpose.   Its efficacy is ta-
ken notice of by the duke  of Rochefaucalt. "Am-
bition (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 are, fever, wakefulness, sighing,
with and  without  tears, dyspepsia, hypochondri-
asis, loss of memory, grey 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, either 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 counte-
 «
nance or behaviour. On the contrary, he sometimes
exhibits signs of 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 grief.

   There is another symptom  of grief which is
not often noticed, and that is profound sleep.   I
have often witnessed it even in  mothers,  imme-
diately after the death of a child.   Criminals, we
are told by Mr. Akerman,  the  keeper"?of New-
gate in  London, often sleep soundly the night be-
fore their execution. The son of general Custine,
slept nine hours, the night before he was led to the
guilotine in Paris.   These facts, and many simi-
lar ones that might 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 for grief are physical, and moral.
 To enumerate the latter  would be  foreign to the
 design of these  inquiries.  They belong more-
 over to another  profession.   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, pains should be taken to procure
it-   The means for this purpose are,  obtruding
upon the mind a sorrow of a less grade than that
by which it is depressed.   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 beheld  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 conducted  before
his eyes to a place  of execution.  This sight he
likewise saw without  an  emotion  of any  kind.
His servant next appeared  before 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
this dispensation of the evils of life; for, as sorrows
generally differ  in their degrees, such of them as 
OF  THE  MINI:.
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 redact, 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." 
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 af-
ter 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, of
whom the physician should always be  one.   In
their  first  visit to  persons  recently bereaved of
their relations, they should imitate the conduct of
Job's friends, who after  weeping for his  losses and
afflictions when they beheld him afar off,  the, sa-
cred 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.  Stonehouse,
 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
 patients disease, and  to the details of the  appear-
 ances 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 mourn-
ing, 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 associa-
tion 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 exquisitely 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. Brambilla
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 Shakspeare.  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 me
he knew an instance in  a  gentleman who was 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  moping
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 of
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  Authorfeof
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 of 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, painful 
328
ON  THE DISEASES
 impressions  upon the mind are upon a footing
 with painful impressions upon the body, in being
 converted  by repetition into such as are of a plea-
 surable nature.

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

   6. We 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;  and 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 few
 years ago.  Boys obviate fear in like manner, by
 silence in passing by a grave-yard, or by conver-
 sing upon  subjects unconnected with  death.   It
 is not peculiar to the passion of fear to  be inereas* 
OF  THE MIND.
329
ed by conversation.  All  the  other  passions are
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; hence 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   »
                      T t 
330
ON  THE  DISEASES
large dose of opium.   Its pain may be mitigated
by 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 are,

  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-ach was always induced by
thunder.  It left her as soon as the thunder ceased.
Her 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
easily  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 asleep.

   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. 
33%          ON  THE  DISEASED

   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 edu-
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^
jng the breath, coughing, or hawking, often give
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.             33o
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  pkaswes  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 the beating of a
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. 
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 the 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, as a sedative;  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 or-
gans 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 produ-
cing 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 effec-
tual in anger  attended with  fear, and a determina-
tion of the blood to the stomach and viscera of the
thorax.     * 
236
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 li-
quors.  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 effect.
They should both therefore  be carefully  avoided
by irascible persons.

   5. Opposing to anger other passions which de-
stroy it. Thetys,  I remarked formerly, eradicated
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 severe pun-
ishment 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 dost thou know the mis-
 chief thou hast done thy roaster."   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.
                     U u 
338          oN  HIE 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 froj| the fountain of that cele-
brated river.            «
  Joy is most intense,  when it  has been preceded
by fear.   The Indian  Chief* Logan, has designa-
ted this form of joy in his eloquent speech, preserv-
ed by Mr. Jefferson, in his Notes upon Virginia,
when he declares  that  " he knew not  the  iov of"
fear."                                    J *
  There are many instances upon record, of death
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 effects.

   The morbid state of joy should be prevented,
by imparting the news  which we expect will cre-
ate it, in a gradual  manner, and with  the alloy  of
some unpleasant circumstances. 
340
ON THE DliitiASES
  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.  I have  seen  an in-
stance of haemoptysis induced by it, which had a
fatal issue.   Two sudden deaths are upon record
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 seeing a tame monkey put
on a part of his pontifical robes.  Excessive laugh-
ter, when not attended with these fatal  effects, is
often followed with  a pain in the left side, hiccup,
and low spirits.

  The remedies for a paroxysm  of laughter should
be, fear,  terror, or any other counter  impression.
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, and Gar-
rick was hostile to all the popular players of his 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  re-
spect  the  authors  of  their being ; and, lastly, it
possesses 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 sanctuary
 of the grave, and robbing the possessors of those
 qualities of the slender remains it had left them of
 posthumous fame. 
342           QN  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
remedy in all its stores, that could subdue or even
 palliate the  diseases  induced by the baneful pas-
sions that have been described, and that an antidote
to them was to be found  only in religion ;  but 1
have since recollected  one, and heard of  another
physical remedy, that will at least palliate them.
 The first  is, frequent convivial society between
 persons who are  hostile to each other.   It never
 fails  to soften resentments, and sometimes to pro- 
OF THE  MIND.
343
dtice reconliation, and friendship.  The reader will
be surprised, when I add, that the second physical
remedy 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  asha-
med 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 Bourdoir.   Did  ill-natured people  imitate the
practice  of the madman and  gentleman I  have
mentioned,  by putting their envious, malicious,
and  revengeful thoughts  upon  paper,  it would
form a mirror, that would serve the same purpose 
314
ON  THE
DISEASES
of pointing out,  and remedying, the evil disposi-
tions of the mind,  that the boudoirs  in  France
serves, in discovering and remedying  the defects
in the attitudes and dress of the body.

  To persons who are not ashamed, nor disgust-
ed, with the first sight of their malevolent effusions
upon paper, the same advice may be  given, that
Dr. Franklin gave  to a gentleman, who read part
of a humorous  satire which he had written upon
the person and character of a respectable citizen of
Philadelphia.    After he  had  finished  reading  it,
he asked the Doctor what  he thought of his pub-
lishing it.   "  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
in society,  profession, moral and religious habits,
duration, and by their acting singly, or in combi-
nation  with each other. 
OF THE  MIND.
345
   There is now and then a torpor 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 Philadelphia,
 who was  remarkable for his strong affection for
 his wife and children when his mind was in a sound
 state, who was occasionally afflicted with  this apa-
 thy,  and when under its  influence lost his affec-
' tion 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.
                      x x 
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.

   THIS 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, manal-
   gia, 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 Massachusetts, dated
    September 4th, 1793. 
348
ON  THE  DISEASES
   " The gentleman 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 experien-
 cing any relief from his  disease.  He has earnestly
 requested 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, quinque vices se
 coitum fecisse  in horis  viginti quatuor, et semper
 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
weak ; my eyes are often painful and  my eye-lids
swelled 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 them."

   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 tged seventeen,  of  a
cold phlegmatic temperament of body, of a seden-
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 " fullness
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 their aliment.   Plutarch tells  us, it was
 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  of
 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 other simple  food, 
OF  THE  MIND,             353
in whom  the sexual appetite exists  in its usual
and • natural force.  In such persons 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 Scythians, 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 from  ma- 
354
ON  THE  DISEASES
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 gratify
but in a lawful way.

   6. A Salivation, by diverting morbid excitabili-
ty from the gentials 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 me
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 face
of a woman. 
OF  THE  MIND
355
 8. Avoiding the sight of obscene pictures, the rea-
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.   Tfc  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. 
3M)
ON THE DISEASES
  13. Several medicines have been recommended u,
subdue the excess of the sexual appetite ;  among
these, the castor oil nut, and camphor, have  been
most commended.  The former acts only by open-
ing the bowels, and thereby taking off the  tension
of the contigous genital organs.  Any other lenient
purge would probably have  the  same  effect.  If
camphor have  any virtues, in this disease, it must
be by its stimulating powers removing  that ner-
vous debility  upon which venereal excitability de-
pends.  Any other stimulating medicine, given in
a similar state  of the system, would probably hav*
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 th t purpose, unless it be com-
bined  with those physical remedies.  This opi-
nion is amply supported by  numerous precepts in
the Old and New testament, and it is only by  in-
culcating those physical precepts, with such as are
of a religious and moral nature, that the latter can
produce their  full effects upon the body and mind. 
OF THE MIND.            357
             CHAPTER XIX.

    Of Derangement in the Moral Faculties.

I 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,

   1.  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 2Sth 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 bv every possible vice,  died,  cur-
sing  and  denying  his  God.  Mr,  Halsam has 
OF  THE  MIND.
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 loved 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, preternatu-
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
to 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
am 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.

   I.  Is debility  the  predisposing cause of  dis-
use in the body "?  so it is of vice  in  the  mind. 
                 OF THE MIND.            361
                               r
 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 devils 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 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 ?, 
362
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 we overcome 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
and Mammon." The predominance of the motive
excited by one  of them, will always destroy the
other. 
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.   Our 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 continaed 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 1HE DISEASES

ing pictures, and writing verses of a ludicrous na-
ture, 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 hirn,  was discovered  upon
one of the walls  of his  cell.   " Come unto me, all
ye who labour and  are  heavy laden,  and I  \vil>
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-
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 resem-
bling a palsy effects 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 superna-
tural 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  resto-
red 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 an humane institu-
tion, in which science and religion have blended theif
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 effect.  They
have been rendered abortive, chiefly, by the crimi-
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
can be  effected  much better by  living than by
dead examples!

   Here the reader and the author must take leave
of 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, 1 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.
T$g END^
•^braS
 
 
 
 
Books, and all object!
of Natural History
A. E. FOOTE, M. D
1223 Belmont Ave.,
Philadelphia, Pa.
Med* H 1st.
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