1 �999999999� 73575124 WM 170 P244d 1873 43810530R NL.M DSa5E3bl fl NATIONAL LIBRARY OF MEDICINE ARMY MEDICAL LIBRARY WASHINGTON Founded 1836 Section Number Form 113c, W. D., S. G. O. -10543 (Reviled June 13, 193G) NLM052223618 DUE TWO WEEKS FROM LAST DATE Z4 GPO 322808 DISEASES NERVOUS SYSTEM; Pathology of the Nerves and Nervous Maladies. A TREATISE OF PSYCHOLOGICAL MEDICINE. BY VV. M. PARKER, M. D., AUTHOR OP "SCIENCE OP LIFE," "A TREATISE ON TOE DISEASES OP THE THHOA3! AND LUNGS," CHIEF CONSULTING PHYSICIAN OP PEABODY MEDI- CAL INSTITUTE, LATE SURGEON OP THE U. 8. ARMY, ETC., ETC. " Canst thou not minister to a mind diseased, Raze out the written troubles of the brain, And with some sweet oblivious antidote Cleanse the stuffed bosom of that perilous stuff Which weighs upon the heart? "— Shakespeare. BOSTON, MASS.: PUBLISHED BY THE PEABODY MEDICAL INSTITUTE, No. 4 Bulfinch Street. 9 A WM ITO 1213 Entered according to Act of Congress, in the year 1873, by ALBERT H. HAYES, In the Office of the Librarian of Congress at Washington. PREFACE. The author has long entertained the opinion that a popular work on " Nervousness, or the Pathology of the Nerves, and Nervous Maladies," is a desideratum. Of technical works on this subject, intended for the medical profession, the name is legion. But he knows of no popular treatise for the general and unprofessional reader. In the following pages he has endeavored to furnish such a work to the public. Having made the cure of Nervousness a spe- cialty throughout his entire professional course, and having had an enviable suecess in this specialty, he has, of course, drawn largely from his own experience in writing the following chapters. But he has had no hesitation in drawing on the experience of other practitioners as detailed in their writings, whether in the form of independent treatises, or as contributions to journals of psycholog- ical medicine, whether published in English, French, or German. It has always been his maxim to supplement and fortify his own experience by that of others. Never was psychology, or the sci- ence of mind, pursued with more fruitful results than it now is, in connection with physiology. The Nerves and Brain, which are the organs of the mind, demand as much study as the mind itself. Psychology and Physiology now go hand in hand, and shed mu- tual light on each other. The subjeot of the Nerves, and their Dis- eases and Derangements, the writer unhesitatingly pronounces to be at this fast and eventful epoch, when life is condensed, as it were, the most important in the whole range of medical pathology. Mind and body are such intimate companions, that they sympathize, so to speak, with each other perfeotly. If one is sound and buoyant, the other is ordinarily in the same condition, and vice versa. If the nerves, which are the organs of the mind, are healthy and vig- iv PREFACE. orous, the mind is bright and hopeful. On the contrary, if the nerves are jaded, diseased, and unstrung, the mind is in the same state. Mental pathology is necessarily a sad record of human wretchedness and woe ; for what torments are like those caused by " a mind diseased " ? It has been the writer's aim to make his work interesting, as well as instructive. He has dealt with nervous dis- ease in all its thousandfold and most perplexing forms and man- ifestations, and should know whereof he writes. Under the dread name of Nervous Disease, what an awful category of human ills is included ! Insanity ; suicide ; narcotism ; alcoholism ; epilepsy ; pa- ralysis ; softening of the brain; soul-crushing mental anxiety; " that strange melancholy," " which rejoiceth exceedingly, and is glad when it can find the grave," to quote from the Hebrew Scrip- tures ; that utter wreck of the will and helplessness, which is the result of self-abuse, and which is a cause of a majority of the cases of nervousness and general debility ; all these momentous subjects, of course, are fully and popularly discussed in the following pages. One word before closing on the subject of special medical prac- tice. The special medical practitioner, who, confident in his power of dealing successfully with the particular class of diseases to which he devotes himself, seeks, by all legitimate and proper means, to bring himself and his skill to public notice, must calcu- late beforehand on incurring the occasional sneers and unkindly criticism of jbalous professional brethren. If such things can even annoy him for a moment, he has mistaken his calling. A profes- sional man is either a public man, or he is nobody. If a physician has especial skill in treating, say, the diseases of the nervous sys- tem, the public want to know the fact, and ought to know it. In such a case, it is a duty to seek publicity, for it is a means of doing good. The skilful, special practitioner will have triumphs enough, in the long run, over those who sneer. He will oftentimes find such reluctantly compelled to avail themselves, and their patients in extreme cases, of his superior skill in his own particular prov- ince. In such cases he gets his revenge by affording the desired relief. Peabody Medical Institute, July 30. 4 CO^TE^sTTS. Chapter. Page. I. Tiie Nerves and the Brain......1 II. Nervous Disorders and the Temperaments . . . 11 III. A Chief Cause of Nervous Derangement ... 24 IV. Patients with the Nervous Temperament . . . 31 V. Convivial Habits and Nervousness .... 39 VI. Anxiety of Mind........43 VII. Nervousness and Religious Excitement . . . 48 VIII. Illusions and Hallucinations......52 IX. Sleep and Sleeplessness.......66 X. Epilepsy..........74 XI. The Suicidal Propensity ....... 78 XII. Treatment of the Insane.......89 XIII. Urinary Analysis, as a Detective of Disease . . 101 XIV. Various Urinary Deposits . . . . . .114 XV. Pathology of the Nerves and Nervous Maladiks . 124 XVI. A Few Hygienic Observations on Nervous Affections 132 XVII. A Curious Case of Supposed Demoniacal Possession . 140 XVIII. Hope and Confidence as Therapeutic Agents . . 146 XIX. Alcohol, Tobacco, Opium, Hacshish .... 150 XX. Body vs. Mind.........158 XXI. General Paralysis........167 XXII. Dipsomania, or Drunken Insanity.....178 XXIII. Late Suppers and Dreams......183 XXIV. The Uses and Abuses of the Popular Nervines . . 189 * THE NERVES AND THE BRAIN. CHAPTER I. INTRODUCTORY AND GENERAL REMARKS. The barbarian, and the rude, ignorant European peasant, scarcely know that they have nerves. But civilization, cul- ture, and refined artificial modes of life bring the nerves into almost fearful prominence. Few who live in cities, or come in any way within the vortex of our social life, have escaped occasional attacks of nervousness.* Is nervousness, then, asks a distinguished English writer on the physiology and pathology of the nerves, an inevitable condition of civiliza- tion, a tax we must be content to pay for our advantages ; or can we free ourselves from its assaults without paying too great a price for the immunity? What is the malady and its cause, that we may know what the cure must be? And, first, have the nerves really anything to do with it, or have they borne the blame while other portions of our organiza- tion have been at fault? When we are in that excitable, tremulous condition, in which there is a morbid anxiety to labor, with diminished power of performance ; when, without any definite ailment, we seem deadened in every faculty, while yet the least vexation is felt as an intolerable annoyance, — are we right in saying that it is especially the nervous * Vide Hinton's works, whose admirable account of the nervous system has been summarized in the following chapter, — our limits forbidding extended and scientific details, which are always tedious and often unin- telligible to the general reader, for whom we write. 2 THE NERVES AND THE BRAIN. system that breaks down ? In order to answer this question, we must get some definite idea of that complex machine, the Nervous System, as it exists in man. Beautiful and myste- rious as are its operations and results, its mode of action has been well ascertained, and is exceedingly simple. The ner- vous system is one of the chief characteristics of animal life, especially of the higher animals. By its means the various organs, which make up the body of an animal, are blended into a whole; and thus the animal is a unit or individual, while the plant always remains a mere bundle of more or less similar parts. Through the nerves the body is acted upon by, and can react upon, objects that affect it from without, not only by a motion of the part immediately affected, but by the combined movement of many, and, it may be, distant organs. In this lies the primary need of a nervous system. It is in its sim- plest aspect merely a channel by which the affections of one portion of the body are enabled to call out the activity of another. Keeping this idea in mind, we shall find there is no difficulty in following, in their general principles, the structure or functions of the nervous system, even in its most highly developed and complicated forms. If we look at the human brain, we find that it consists mainly of a vast mass of fibres. Their number, tenuity, and variety of direc- tion are so great that no skill has hitherto availed to trace them in detail, though their course has been pretty gener- ally well made out. Emanating from the brain and spinal cord, long lines of fibres pass to each region of the body, and distribute themselves in a minute net-work, that, if we could see it by itself, would appear before us a perfect image of the body, all pure nerve. The fibres which constitute the chief mass of the nervous system are simple in their struc- ture, so far as the microscope can reveal it, and present a very curious analogy to a telegraphic wire. Like the latter, INTRODUCTORY. 3 each nervous fibre consists of a small central thread (or tube, perhaps, in the case of the nerve, though the tubular structure cannot be demonstrated), surrounded by a layer of a different substance. The central thread (or axis) is of a grayish color; the surrounding material is of a glassy appearance, soon becoming an opaque white after death, and giving then the characteristic white appearance to the nerves. The fibre, consisting of these two portions, is included in a sheath, which isolates it. If we roll up a wax candle in paper, that will give us a rough illustration of the nerve fibre. The paper is the external " sheath"; the wax is the intermediate white matter; the wick is the central axis. It is most natural to believe that the analogy suggested by this structure is a true one, and that the white substance acts the part of the gutta-percha round the electric wire, as an insu- lating medium for the currents which travel along the cen- tral portion. But this is not proved. Probably, owing to the minuteness of the parts, it is beyond the possibility of experimental proof. For in man two or three thousand of these fibres would occupy but an inch in their largest part. There is another kind of nervous matter, besides the fibres, and that consists of cells. The nerve fibres sometimes run into them; sometimes they pass among them without ap- pearing to communicate. Cells of this kind form a thin layer over the surface of the brain, and its fibres for the most part have their origin from or among them. They also exist in large numbers in certain spots in the substance of the brain, and they are found within the spinal cord in its whole length. Wherever they are found they go by the name of gray matter, the nerve fibres being called the white matter. The fibres which constitute the nerves, strictly so called, are conductors, and they conduct to and from the cells. What, then, is the part played by the latter? But before answering this question, it is worth while to peruse 4 THE NERVES AND THE BRAIN. and note the extreme simplicity of form exhibited by this element of the nervous system. In the gray matter of the brain, we have arrived at the very highest organic structure, the great achievement of the vital force, the texture in which bodily life culminates, and for the sake of which, we might almost say, all the other organs exist. And we find a structure of the very lowest form. Mere cells and granules —Nature's first and roughest work, her very starting-point in the organic kingdom — strewn in a mere mass, with no appreciable order, over the ends of a multitude of fibres, and loosely folded up, as it seems, for convenient storage ! This is what meets the eye. Is this the laboratory of reason, the birthplace of thought, the home of genius and imagination, the palace of the soul ? Nay, is this even the source and spring of bodily order, the seat of government and control for the disorderly rabble of the muscles? Should we not have expected, when we came thus to the inmost shrine of life, and penetrated to the council-chamber of the mind, to find all that had before appeared of skilful architecture and elaborate machinery surpassed and thrown into the shade? But it is all cast away. Mechanical contrivances for mechanical effects ! Skil- ful grouping and complex organization there may be for the hand, eye, the tongue; for all parts and every function where the mind is not. But where the spirit comes, take all that scaffolding away ! The gray matter of the brain is very abundantly supplied with blood. What is the office of the cells or gray matter ? The spinal cord of man is a series of groups of cells, giving off nerves on each side, and connected by communicating fibres with each other, and with the larger groups in the brain, which also give off nerves to the nose and eye, the skin and muscles of the face, and other parts. Thus, in man and all animals alike, masses of gray matter, the cells, are placed at the centre, and nerve fibres connect them with the organs of the body. It has been proved also INTRODUCTORY. 5 by the beautiful experiments of Sir Charles Bell that the nerve fibres are of two kinds : some conveying an influence from the organs to the centres, where the nerve cells are placed; and others carrying back an influence from them to the organs. So these groups of cells evidently answer to the stations of the electric telegraph. They are the points at which the messages are received from one line and passed on along another. They are called ganglia in scientific lan- guage. But besides this the cells are the generators of the nervous power. For the living telegraph flashes along its wires not only messages, but the force also which ensures them fulfilment. A nerve bears inward, say from the hand or foot, an impression, it may be of the slightest kind; but the cells are thrown into active change by this slight stimu- lus, and are thus able to send out a force along the nerves leading to large groups of muscles, and excite them all to vigorous motion. In the above we have merely aimed at giving a general account of the Nervous System. The nerves are the special vehicles of will and feeling, hence their derangement is most calamitous. By them we see, taste, smell, hear, and feel. By them we command our limbs with the aid of the muscles. Hence the terrible character of nervous disease and derange- ment, which strikes at the very source of all our pleasurable activity, enjoyment, and conscious life. Diseases of the brain, of the spinal cord, of the nerve cells and of the facial nerves, and cerebro-spinal disease, compose in general terms the terrible bead-roll of nervous disorders. Under these heads come insanity, softening of the brain, epilepsy, hydro- phobia, all kinds of paralysis, neuralgia; in short, all morbid affections, which are specially characterized by pain and dethronement of the mind. Fortunately for suffering hu- manity, Dr. Hammond, in his great work on Diseases of the .Nervous System, is strictly correct when he says, that " in no 6 THE NERVES AND THE BRAIN. department of medical science has progress been more de- cided during the last decade, than in nervous affections." The writer of this treatise, with a most ample and gratifying experience in the treatment and cure of nervous disorders, is able fully to indorse the above assertion. Whether or not he himself has in his professional career contributed to this progress in the means of ameliorating the acutest human suffering, it is for his multitudinous patients to say. At any rate, he is willing to abide by their verdict. Derangements of the nervous system are seen in the par- oxysms of asthma and the seizures of epilepsy, in both of which affections the muscles are thrown into excessive con- traction through a morbid condition of the spinal cord. Of a different order are the lano-uor and feelinsr of utter disa- bility for muscular exertion which creep over us at times. These feelings show that the nerve centres which preside over muscular exertion have become oppressed and sluggish, likely enough through want of proper exercise. Of a differ ent kind, ag'ain, are tremblings of the muscles, or involuntary jerks and twitchings, and, in brief, all that condition known by the expressive name of " fidgets." What is the source of this irritability, which renders it impossible to keep the muscles still? We can answer in general that irritability means weakness. A physician of eminence compares it to the whirling motion of the hands of a watch of which the mainspring is broken. In our physical, as in our moral nature, strength is calm, patient, orderly ; weakness hurries, cannot be at rest, attempts too much. Strength in the living body is maintained by the full but natural exercise of each organ. The full access of all healthful stimuli to the skin, and through it to the nerves of sensation, is the first and chief condition of the healthful vigor of the nervous system. Among these invigorating influences, fresh air and puie INTRODUCTORY. 7 water hold the first place. The great and even wonderful advantages of cleanliness are partly referable to a skin healthily active, open to all the natural stimuli, and free from morbid irritation upon the nerve centres of which it is the appointed excitant. The state of general vigor which we call " Tone " also depends upon the healthy action of these nervous centres. It consists in an habitual moderate contraction of the mus- cles, due to a constant stimulus exerted upon them by the spinal cord, and is valuable less for itself than as a sign of a sound nervous balance. Tone is maintained, partly by healthful impressions radiated upon the spinal cord, through the nerves from all parts of the body, and partly by the stimulus poured down upon it from the brain. So it is dis- turbed by whatever conveys irritating or depressing influ- ences in either direction. A single injudicious meal, a single sleepless night, a single passion or piece of bad news, will destroy it. On the other hand, a vivid hope, a cheerful resolve, an absorbing interest, will restore it as if by magic. For in man these lower officers in the nervous hierarchy draw their very breath according to the bidding of the higher powers. A chief condition of keeping the nerves and brain healthy is to keep them in full vigor and in natural alternations of activity and repose. Muscular exercise has a most bene- ficial effect on a depressed or irritable state of mind. The bodily movement, by affording an outlet to the activity of the spinal cord, withdraws a source of irritation from the brain, or it may relieve excitement of that organ by carrying off its energy into a safe channel. We see evidence of the same law in the delightful effect of a cheerful walk, and in the demand for violent exertion, which is so frequent in insanity. The power of the brain over the vital condition of the body is exerted through a 8 THE NERVES AND THE BRAIN. particular set of nerves, which have been called " the sympa- thetic system." They are somewhat smaller and simpler than the nerves of sensation and motion, with which, how- ever, they are intimately connected. They are distributed to the organs on which life depends (the lungs, heart, stom- ach, etc.), and to the blood-vessels all over the body. Thus the condition of the brain is necessarily the key to that of.the whole body, and its influence is universally paramount, both directly by its power over the heart and breathing, and still more profoundly by its indirect control over the supply of blood. There is no mystery on the effects produced on health by excess of mental.labor, or by long-continued cares, nor in the bodily torpor which attends a merely inactive mind. " Nervousness" naturally results from an overtaxed brain. The wonder is, not that it occurs so often, but that, amid the rude shock to which our life is subject, it is not more fre- quently experienced. If Ave would have our bodies healthy, our brains must be used, and used in orderly and vigorous ways. The torpid, unhealthy frame and languid circulation of the idiot are but an exaggerated instance of the unnat- ural torpor to which he condemns himself, who wastes his life in indolence, or consumes it in dissipation. To him - Nature, indeed, has been kinder than she has to the idiot, ■' —he does but abuse her bounty to become a worse enemy to himself. The perfect health of a man is not the same as that of an ox or horse. The preponderating capacity of his nervous part demands a corresponding life. But the very causes which make the proper exercise of the brain especially needful, render its excess especially baneful. The sio-ns of this excess, or excess combined with misdirection, meet us on all hands : in weariness, despondency, disgust, or causeless anger; in racking neuralgic pains, or oradual INTRODUCTORY. 9 decay of vital power, or in the insidious threatenings of serious disease. How could these results be guarded against, we ask. The answer can be but one. Health can no more be obtained without its price than anything else. Nature has forever forbidden it. The flame of life can neither be fed nor renewed with stolen fire. The condition of rescue from overwork is rest and change, — fresh air, and the soothing influence of natural scenery, if they can be obtained. One word, before closing these somewhat general intro- ductory remarks, on the subject of cities, as our modern life is more and more concentrated in cities, which develop and intensify the nervous energy wonderfully, and by their man- ifold and constant excitements fearfully multiply nervous disease in all its forms. A distinguished author observes, that " the invention of towns were a pure gain to humanity, if due admixture of the country life can be secured." And to obtain this advantage for our laboring populations is one of the great tasks of our age, and one of the great problems for managers of railroad corporations in particular. Our physi- ology teaches us that the vice and misery of our great towns can never be successfully combated in the strongholds which they have made their own, and fortified for generations,—the courts and alleys where the poisonous atmosphere combines with all hateful sights and sounds at once to deaden and irritate the nervous sensibility. From the continued breath- ing of a vitiated atmosphere inevitably arises either apathy or a craving for intoxicating drinks ; in all probability, each in turn. On the other hand, the splendor and allurements of city life constantly acting upon the senses, especially of the young and susceptible, are calculated to produce nervous derangement, and prematurely use up those exposed to them. Indeed, modern civilization, with its splendid material tri- 10 THE NERVES AND THE BRAIN. umphs and manifold devices for comfort, luxury, and sen- sual enjoyment, grows ever more and more trying to the nerves, and has rendered completely unfashionable the plain, frugal, ascetic life of our ancestors. Hence it is that the medical practitioner, who contributes by his skill and inge- nuity to restore a jaded and disordered nervous system, and check the spread of nervous affections, is emphatically a Public Benefactor. CHAPTER II. NERVOUS DISORDER AND THE TEMPERAMENTS. A careful examination of numerous cases of nervous dis- order has satisfied me that the study of the temperaments is absolutely necessary on the part of the physician who aims at even ordinary success in the treatment of disease. For instance, were we to treat four different persons, all suffering alike from the same nervous disorder, but all of them having different temperaments, with precisely the same remedies, without taking into account the peculiarities of each, or the effect of these upon the constitution, as well as the nature of the disease,— we should be as little likely to succeed in effect- ing a cure as would the mariner in reaching his destination, who steered in a direct right line by compass for the point which he wished to reach, totally regardless of, nor making the slightest allowance for, leeway, current, or any other disturb- ing causes. It is therefore as indispensably necessary that the physician take into account, not merely the general nature and character of the disease, but also the various concomi- tant circumstances, before he incur either risk or responsibil- ity. It is the study of these circumstances, and the paying due attention to them, that constitute the accomplished and trustworthy physician; and those traits alone can ensure him success in practice. In the study of all disorders, we must take into account and carefully review both the history 12 NERVOUS DISORDER AND THE TEMPERAMENTS. of the disease and the history of the case. The first makes us acquainted with all the general phenomena and tendencies of the disorder, while the secofcl brings us into relation with all those specialties which require peculiar modifications of treatment. In the Nervous Temperament we find that the brain is large and well developed, and its energies and those of the nervous system are the most predominant, and take the lead over those of all the other organs. The features are Fig. 1. Nervous Temperament. sharp and prominent, the eye large and expressive; the mouth betokens intelligence, and frequently there is a full and intellectual forehead; the skin thin and transparent, with flossy, silky hair; the muscles small but well marked, with quick and active motions ; the face generally pale, and frequently expressive of anxiety ; the brain and whole of the nervous system in a high state of activity. Such persons are for the most part quick and intelligent, and highly sensitive NERVOUS DISORDER AND THE TEMPERAMENTS. 13 to every kind of impression; and they are readily excited and easily depressed. At one time you may find them en- joying themselves to the fullest extent, and in a very short time after, perhaps in tears. The dispositions of persons in whom this temperament predominates, are much modified by the circumstances in which they may happen to be placed. Confinement, especially if the occupation be sedentary, never fails to produce evil effects upon the constitution. Individ- uals of this temperament are highly sensitive to all those agents which act upon the nervous system. Such persons require to be treated with great care and delicacy. Fig. 2. Lymphatic Temperament. But in the Lymphatic Temperament, in which the abdomen is remarkably large and prominent; the brain dull and in- active ; the body round and soft; action slow and heavy; skin muddy and flabby; circulation weak and languid ; mus- cles soft, flaccid, and feeble, with great aversion to either 14 NERVOUS DISORDER AND THE TEMPERAMENTS. mental or bodily exercise, — we find the energies of every kind very feeble, indeed almost dormant. Thus we see that persons of this temperament differ materially in these particulars from persons of the former. Indeed, so little excitable are people of the purely lymphatic tempera- ment, that it is not without the greatest difficulty they can be aroused, or induced to exert themselves in the smallest degree, while they are quickly exhausted when aroused to exertion. It is obvious that this inert temperament is not so liable to nervous derangement as the former, and when thus disordered, that it does not require the same delicate treatment as the other. Persons of the Sanguineous Temperament differ widely Fig. 3. Sanguineous Temperament. from those of the Lymphatic. In the former, the luno-s and heart are large, and the power of the latter organ is con- NERVOUS DISORDER AND THE TEMPERAMENTS. 15 spieuous, predominating over all other systems. The pulse is strong and regular; the veins turgid, full, and blue ; the chest large ; the complexion fair and florid; muscles firm; hair reddish, chestnut, or auburn. Impressions made on the nervous system are vivid; imagination luxuriant; temper passionate, but not vindictive; and individuals of this class, though readily excited, are still easily appeased. Now were we to treat a patient of the sanguineous temperament, in the same way that we should treat one of the lymphatic, suffering from the same disease under exactly similar circumstances, the consequences would be most deplorable. For instance, wine, spirits, and such stimulants would be wholly inadmis- sible in treating a patient of the sanguineous temperament, because in such an one the heart and arteries are already too prone to over-action. The use of stimulants by a patient of sanguineous temperament would almost to a certainty bring on inflammation ; or we should by such means incur the risk of doing some violent injury to the heart or some other part of the nervous system. The Biliary Temperament, again, differs from the fore- going, thus briefly noticed. In persons of this tempera- ment, the liver is large, and its functions are readily called into activity, and there is a great tendency to a redundant secretion of bile. The pulse is stronger and more frequent than in the purely sanguineous; the veins arc prominent, the sensibility acute, and there is great constitutional energy. The skin is generally qVark or sallow, with occasionally a yellow tinge; hair black or dark brown, and often short and crisp ; tho muscles firm, and well devel- oped ; temper abrupt, but not liablo to such extremes of excitement as in those of tho purely nervous; the concep- tions are bold, while they themselves are inflexible in the pursuit of a project, nor are they so readily exhausted as persons of the nervous or other temperaments. In attaining 16 NERVOUS DISORDER AND THE TEMPERAMENTS. the object they wish, individuals of this temperament are dauntless and persevering to the last. In treating persons of biliary temperament, suffering from nervous affections, Fig. 4. Biliary Temperament. and m wnom the secretion of bile is somehow faulty, Ave must not turn our attention exclusively to the con- dition of the stomach and boAvels, as the only cause of such disorders. It is true that too much food, or food of an indigestible nature, taken into the stomach may affect the liver, derange its functions, and so vitiate its secretion, and thus bring on a train of nervous symptoms. Still, such arc not the sole causes of deranged bile ; and as the morbid effects cannot be relieved till Ave Irwo ascertained and re- moved the cause, avc must endeavor to discover this by inquiring most minutely into the history and all the circum- stances of the case as already explained. ni:::vol"s disorder and the temperaments. 17 The various passions, Avhether of a depressing or exhilarat- ing character, haA'e great influence in inducing nervous dis- order. Sudden emotions, too, have the same effect; and the more sudden and Ariolent, the greater their pernicious 'effects, not only upon tho system at large, but upon the ner- vous portion in particular,—ranging from mere temporary trepidation or excitement, to the most inveterate mania or confirmed insanity. Thus jealousy, abused confidence, fear, sudden alarm, prolonged or continued apprehension, anxiety, grief, joy, unexpected good fortune, and similar emotions, exert, very frequently, a most dangerous influence. Such effects will violent emotions of this kind produce upon tho nervous system, that the functions of different and distant parts become not only sensibly, but deeply implicated. Thus very strong impressions upon the mind Avith the concomitant conflict in the nervous system ha\'c so acted, even upon young persons, as to turn the hair gray in a single night; Avhile in other cases the skin, instead of exuding th« ordinary perspiration, has SAveated blood. These results sometimes supervene so rapidly, and come on so suddenly, as to wholly exempt them from any interference, and place them beyond all possible attempts at prevention or ar- rest. I am frequently called upon to prescribe for patients of biliary temperament suffering severely from nervous dis- order, which I have traced to deranged state of the stomach and bowels ; and these conditions were clearly referable to the abuse of purgative and mercurial medicines. Costivc- ness by no means invariably indicates tho necessity of re- course to (pening or purgative medicines. Many persons live almost entirely upon food, nearly the whole of which is not only convertible, but actually converted into nutriment and completely assimilated, thus leaving little, or rather no residue, to pass off through the bowels. If, then, in such 18 NERVOUS DISOIIDEii AND THE TEMPERAMENT8. circumstances, it should be deemed advisable to move the bowels, the more rational plan Avould be to alter the nature of the diet, and substitute more of a A'cgotablc, Avhile wo reduce in a corresponding degree the amount of tho more concentrated and nutritious food. Vegetables contain less * of the nutrient principles, and consequently leave a larger amount of residue, upon the expulsion of Avhich superfluous material the action of the bowels may be more naturally and far more legitimately and advantageously employed, than in responding to the irritating influence of drastic purgatives. "It is in cases of this description," says CoAvle, in his excel- lent Avork on tho Physiology of Digestion, rrthat the physi- cian is more frequently consulted, and that he has the best opportunity of showing his discrimination and judgment. If he and the patient arc satisfied Avith simply procuring relief, he has ready means at hand in any of the ordinary purgati\'es ; but if a cure is their object, they must go back to the root of the evil, and begin by restoring the digestive organs to health." Nervous disorder in biliary temperament is clearly traceable to tho secretion of bile being vitiated or otherwise deranged. In laying down plans for locating such affections, Ave must not only determine their nature, but inquire into and ascertain the cause, and remove this if pos- sible. If, for example, avc should find, upon careful exam- ination, irregularity in diet to be the fundamental cause of the evil, which is frequently the case, avc should most per- emptorily interdict all those kinds of food Avhich cither expe- rience or science has taught us tend to vitiate or derange tho secretion of bile ; such, for instance, as a too free use of porter, sugar, cream, butter, rich, fatty meats, ardent spirits, wine, etc. These, it is Avell known, and chemistry confirms our experience, increase the quantity of bile to an amount far beyond what is required for the purposes of healthy NERVOUS DISORDER AND THE TEMPERAMENTS. 19 digestion; and, further, the most moderate experience has repeatedly sIioavii that the superfluity often lays the foun- dation of some nervous disorder. I have also had many opportunities of Avitncs.-Ting the ill effects, on particular cases, of meat suppers taken late at night. This proves very injurious to persons of biliary tem- perament, by the formation of a large quantity of bile during the night, the individual frequently sleeping in a close, con- fined, ill-ventilated chamber, Avhile at tho same time respira- tory and circulating processes are slow and inactive. The quantity of oxygen necessary to enable the lungs to burn off the carbon being Avithheld through impurity and a defi- cient supply of air, as Avell as from other causes, the li\rer is called upon to assist in secreting the superfluous carbon under the form of bile. The person in consequence aAvakes stupid, unrefrcshed, and for the most part Avith a bad, oppressiAre headache. Indeed, so liable are biliary persons suffering from this form of nervous disorder to the consequences above stated, that I have repeatedly seen a severe attack of head- ache brought on by the patient retiring to repose in an ill- ventilated apartment, after taking a full meal. As a means of immediate relief under such circumstances, a saline purge is one of the most effectual, as it will drain the liver of its redundant bile, and thus afford instantaneous, but still only temporary relief. Permanent benefit must be sought for in avoiding the exciting cause, by the inhalation of pure, fresh air, friction and cleanliness of the skin, and Avarm bathing, Avhich Avill facilitate the exit of carbon and other impurities through the other channels, the lungs and skin. By such means, and avoiding late suppers, the liver Avill be relieved from the necessity of over-activity, and of forming a super- fluous quantity of bile; and thus, the real cause of the dis- order being removed, the morbid effects will naturally cease. Another fertile source of nervous diseases in bilious tern- 20 NERVOUS DISORDER AND THE TEMPERAMENTS. peraments, which formerly came under my observation more than at present, Avas the taking large quantities of Cod Liver Oil. It is Avell, before we indiscriminately prescribe fashionable remedies, to consider hoAV they are likely to act. The Laplander, dwelling in the arctic regions, where it is intensely cold, and the atmosphere in an equal bulk contains a large quantity of oxygen, lives principally upon carbona- ceous substances, as train oil, blubber, and fat. But the Indian, Avho lives in the torrid zone, Avhere the atmosphere is rarefied, and for equal bulk contains but little oxygen, selects rice, \regetables, and other diet containing but little carbon, and it is found that such are best suited to the cir- cumstances under which he lives. For the same reason, Cod Liver Oil administered in summer, Avhen it is hot and oppressive, more especially if given to a patient of a biliary temperament, avill seldom fail to aggravate the disease it AAras given to cure. Nature evidently intended that the liver should free the blood from those principles AA'hich form the radical or constituents of the bile, and apply them, so elimi- nated, to perfect or complete the function of digestion. But if more bile is formed than is necessary to this end, the excess acts as an irritant to the bowels, and occasions Avhat is com- monly called " bilious diarrhoea." If, howcA'cr, on the other hand, tho bile be scanty in quantity, as often occurs with persons Avho have resided long in tropical climates ; or suf- fered frequently and severely from agues; or Avho have indulged to a pernicious extent in a too free use of alcoholic liquors, in consequence of Avhich the liver pours out fibrin, which, acting as a ligature upon the portal vessels, impedes tho floAv of bile, —-the consequence is that the boAvels become constipated ; tho stools clay-colored ; the powers of digestion greatly Aveakened, and otherwise impaired, attended Avith great loss of strength and flesh. The skin becomes rou^h, hard, and dry; the countcuance assumes a sallow aspect, or NERA70US DISORDER AND THE TEMPERAMENTS. 21 a general yelloAvness pervades the skin, and true or confirmed jaundice is the result. This is not unfrcquently attended with the formation of gall-stones, which greatly aggravates the evil, and leads to very unfortunate consequences, an instance of which, of remarkable severity, lately fell under Fig. 5. my observation. In this case, upon dissection after death, the gall-bladder felt like an uniformly hard, solid mass, giv- ing the impression that its cavity was wholly occupied by a single calculus. Upon opening it, however, the cavity was found filled with a number of distinct small calculi, the sur- faces so moulded and fitted to each other as to appear to the touch a single solid mass. The appearance of the gall-blad- der (in this case) laid open and the calculi exposed is Avell shoAvn in Figure 5. This patient used to suffer, at intervals, the most excruciating pain; especially during the passage of gall-stones into the intestines, which occasionally took place, and was usually attended with jaundice and other hepatic disorders. In such cases, strict attention to regimen and diet should 22 NERVOUS DISORDER AND THE TEMPERAMENTS. be enjoined; the food should be light but nutritious; the patient should abstain from all rich and fat meats, pastry, doughy puddings, and, as far as possible, from spirituous and fermented liquors. By carefully observing and abiding by these rules, a person may live for many years, though he may haAre but little liver remaining. But if persons afflicted with serious disease of the liver will still persist in indulging in the pleasures of the table, and will continue to violate those rules laid doAvn for their guidance, they Avill speedily bring existence to an end, and perish in the extreme of ema- ciation and misery. A gentleman consulted me four years ago, suffering very severely from an affection of the liver, and for Avhich, for sev- eral years, ho had been taking almost every kind of medicine, Avithout much benefit. I had every reason to believe that the patient Avould never perfectly regain his health ; yet I felt sure that much relief might be derived from the proper use of Avarm baths Avith dry cupping, and the external use of nitro-muriatic acid ; frictions to excite the skin : light, nutritious, unirritat- ing diet; the occasional use of a pill composed of aloes and rhubarb; horse exercise ; and a residence in a dry pure air, — Avere the means Avhich seemed best suited to prolong life. Ho pursued the proposed plan for about fi\rc months; and in a note Avhich I received from him, in the interval, he states : " The action of my boAvcls is hoav regular and nearly natural, and I very rarely experience the sickness after food ; I gain strength every day, and I can sleep the Avhole night Avithout being troubled Avith either sickness or nausea; I am gaining flesh; can walk a long distance Avithout fooling fatigued, and I am not Avithout hopes that I shall soon be quite Avell, and able to resume practice." This gentleman continued still to improve ; but a few months after this period, being attorney and counsel for several railway companies, he dined at sev- eral public dinners, and, indulging rather freely in the pleas- NERVOUS DISORDER AND THE TEMPERAMENTS. 23 ures of the table, drank too liberally of Avine and spirits, and died, after a six Aveeks' severe illness, greatly emaciated. Upon the post-mortem examination, the liver Avas found much atrophied, and indeed very little Avas left. Although I felt satisfied that this patient Avould never have reached a mature old age, yet I am convinced he might have lived for many years, had he but conformed to the dictates of common-sense, and abided by the rules laid doAvn for his guidance. I have at this moment a patient under my care, suffering severely from nervousness, loAvness of spirits, and great de- spondency, Avhich the yellow tinge of the conjunctiva, the harsh, hard, dry state of the skin, the feeling of uneasiness after food, frequently attended Avith Aromiting, and the clay- colored stools, enable me at once to refer to congestion of the liver as the cause. This gentleman had been under the care of his medical adviser for a considerable time, and had consulted some of the most eminent men in the profession, Avho all prescribed a Arariety of means ; yet, strange as it may seem, notwithstanding the dry, hard, harsh, and inactive state of the skin, the use of the Avarm bath — so powerful a means of promoting the action of this organ — had never been even once suggested to him. Ho has resorted uoav to the Avarm bath, and his health is steadily progressing; and I feel satisfied that to its use, and dry cupping, Ave are chiefly indebted for the improvement in the health of this patient, Avhich has recently taken place, and I have reason to believe that ho Avill perfectly recover. CHAPTER III. A CHIEF CAUSE OF NERVOUS DERANGEMENT. In another now Avell-knoAA'n work of the Avriter, he has gone at length into the subject of the abuse of the repro- ductive organs. I allude to the Avork entitled " Science of Life." Therefore there is no necessity for more than a sin- gle chapter of a general character in the present volume ou this subject. But in a work on Nervous Affections and Mal- adies, it was impossible to avoid allusion to this subject, because of the mysterious psychological influence of the organs in question on the health, and especially on the ner- vous system, and through that on the mind. There is a close connection between genital psychology and physiology and pathology. Speaking of sell-abuse and involuntary losses of vitality through the reproductive organs, tho " London Lancet " said many years ago: "It is a subject not less in- teresting to the moralist than to the medical practitioner; and it really is surprising to see that nothing worthy of notice is to be found on a matter so important in the vari- ous writings of standard authors." This Ava> written in 1841, several years before the appearance of the great work of M. Lallemand, entitled " Dos Pertes Seminales Involoutaires.'" "This circumstance," continues the "Lancet," "appears re- markable and unaccountable, Avheu experience convinces us that sexual weaknesses and imperfections, either hereditary [24] A CHIEF CAUSE OF NERVOUS DERANGEMENT. 25 or acquired, constitute the great majority, perhaps nine tenths, of the causes of nervousness, mental imbecility, and derangement. Hoav, then, are Ave to account for a fact like this — a fact of such frequent occurrence, and so highly philosophic and instructive as it undoubtedly is — having obtained so little attention? Can a general feelin^ of ill- exercised tenderness toAvards the depraved habits of most of the pitiable sufferers have operated in preventing the matter from having been duly investigated, and candidly avoAved and discussed, or has it resulted from ignorance? The former we are disposed to think can scarcely have been the case ; for with the medical practitioner, less frequently, perhaps, than with any other professionalist, from the confidence so read- ily reposed in his calling, does delicacy or prudery supersede utility." Thus far the "London Lancet." Everybody of any experience in the Avorld knoAvs that there is extant much unwholesome morality; there is much substitution of Avords for things; much false delicacy which is miscalled virtue; much traffic in " The false commerce of truth unfelt"; much conventional lying; much conventional dissimulation. For Avant of the reverse of all this, many fine minds are overthroAvn. There is nothing Avhicht.s, Avhich has actuality of existence, that should not be fathomed, and Avhose rocks and quick- sands should not be placed, as in an unfolded map, conspicu- ously in sight. Upon subjects on Avhich neither Religion nor Science disdains to treat, correct information should be dif- fused. It lies within the scope of our Avill to shun many of the first approaches of insanity; nay, even although the first steps into error are those Avhich are most easily retraced, to extricate others and ourselves from its labyrinths Avhen deeply involved in them. Into these labyrinths Ave are usu- 26 A CHIEF CAUSE OF NERA'OUS DERANGEMENT. ally misled by some of those passions and temptations Avhich, not peculiar to a few, are common to our Avhole species. We cannot knoAV too much; and minds may be capable and yet unenlightened, hearts human and yet unaAvakcned. The subject of Avhich we are speaking is one on Avhich even sane minds are apt to entertain many misconceptions. There are psychological mysteries which it lies Avithin the power of pathology to elucidate, and which avouIc! Avithout its aid remain obscure. There have frequently been Avitnessed deviations from the perfectly correct in conduct and amiable in manners; exhibitions of petulance of temper and tres- passes against the minor moralities; to account for Avhich, upon a post-mortem examination, there have been discovered traces of painful and perhaps previously unsuspected organic disease. Among our currently nomenclatured diseases are some which peculiarly tend to generate gloom, and even, in severe or long protracted cases, to incite to suicide. There are forms of gastric, hepatic, and cerebral diseases, Avhich display these or like tendencies. Sometimes it is rather ill-temper that is induced, as by attacks of the gout. Anxiety of ex- pression in the countenance is a symptom of enteritis, Avhich, although having a physical origin, has not a physical only, but implicates the condition of the mind. The mind in each of the varied forms of febrile excitement takes the peculiar course of Avandering, and surrounds itself with those peculiar groups of hallucinations, Avhich characterize the existing state of the brain and sensory system. At the same timo it may be observed, that the mind of the patient individually deter- mines the mode in Avhich various morbid states of the brain are manifested ; and aa ill be found in a greater or less degree, unless Avhen torpor and incapacity arc superinduced, to vin- dicate its oavii idiosyncrasy. While under excitement it fre- quently fhroAVs off such gigantic shadoAvs of portions of its A CHIEF CAUSE OF NERVO'JJ DERANGEMENT. 27 being, as the microscope brings into vicAv of tho minuter tex- tures of natural objects. Wo obtain glimpses of the very infusoria, so to speak, Avhich are engendered in tho reason and imagination of tho patient. There are, on the other hand, diseases, and these of a fatal character, Avhich, during the most part of their course, do not disturb the temper or trouble the mind. Consumption, not ahvays, indeed, but frequently and commonly, deals in these respects very gently Avith her Arictims. Investing them as Avith the hues of per- petual youth, she leads them to the altar crowned Avith gar- lands. Not till their near approach to tho sacrificial flame does the bright eye lose its lustre, the hectic flush give place to paleness,— do the hues fade, the garlands Avither. They gradually, though still and evermore attended by Hope, be- come less and less tenacious of existence; they are gently Aveaned from the things of time and sense, and from the love of life ; their hopes in life are displaced by hopes of the life beyond this life. We regard their fate almost Avith envy. After bereaved relatives have passed through the first bit- terness of soitoav for their loss, their reminiscences of those near and dear to them, Avho have died of this disease, become almost pleasurable. The patience of sufferers under a long-sustained mortal affliction, is naturally regarded in the most amiable light. But avc must not forget, as psychologists, that, in com- parison Avith many of the ills Avhich flesh is heir to, this complaint occasions less of bodily suffering, and less severely tests the poAvcrs of endurance. We should remember this, not that avc may cast a shadow of disparagement upon the characters of those who, having had something — probably much — to endure, have endured it patiently, and left behind them a pleasing image of tranquil resignation to the Avill of heaven in the memories of survivors ; but that Ave may be I 28 A CHIEF CAUSE Or' NERVOUS DERANGEMENT. just to such as, having had more to suffer, have naturally, and almost inevitably, displayed more of irritability and im- patience. We have noticed how boAvel disease induces cerebral dis- turbance ; hoAV, through the medium of physical organ- ization, the mind is made a party in the struggle. We thus see clearly instanced the influence of the body on the mind. The intense agony attendant upon the passage of the gall-stones, or upon a paroxysm of tic-doloreux, are too great to be borne by any human being with tranquillity. We remember having heard some severe and unkind comments passed upon a clergyman who could not refrain from mani- festations of impatience under extreme suffering from the former mentioned cause. It Avas inferred that he came short of his duty as a Christian minister in not setting his flock a better example. There is no degree of strength of mind Avhich disease and pain may not master. The influence of the mind on the body is manifold. There are the various passions which inspire, exalt, and debase humanity. There are painful or agreeable surrounding circumstances. These take each its part in influencing health ; these constitute some of the links Avhich unite physiology and pathology Avith psychology. There is also to be considered the influence of one mind upon another, Avhich is great; likewise its poAver, as exer- cised Avithin or upon itself, as Avell as upon the body. There is what is of a loftier order than intellectual, — there is moral power ; there is strength of will, of an inferior order to both, but capable of greater ostensible achievements than either. There are none Avho have not observed the effect of hope as a cordial, of fear as a depressant, upon invalids. Health and longevity depend much upon circumstances, much upon the due management of the mind. A man Avho upon a sick bed is disturbed by the reflection that he has not succeeded in making a duo provision for his family, may be inclined to A CHIEF CAUSE OF NERVOUS DERANGEMENT. 20 give himself up to despair, and actually suffer himself to die ; or his want of resignation to his fate, his cherished designs for the future, his sanguine determinations to carry out his vieAvs upon his recovery, may conduce to his convalescence. The subject is one not only of great, but of universal interest. To pursue it further Avould be to expatiate over too Avide a field. It has been shown Iioav close an affinity subsists betAveen cer- tain physical and psychological phenomena ; and Avhile it has to be conceded that there are diseases which act but slightly and inappreciably as disturbing forces upon the mind, it Avill be perceived that this concession can least of all be held to apply to organic disease or functional disorder of the gen- erative system; not genital disease indeed, only, but the ordinarily fulfilled functions of the reproductive organ's Avhile in their normal state, much influencing the mind, and pro- ducing, as the status of puberty becomes established, abso- lute and plainly perceptible changes in its character. The same truths admit of being expressed in the blunt language of science, Avhich have given Aritality to the poetry of every language. Science, Philosophy, and Song concur in telling the same tale, only that Avhat the latter generalizes, science expounds and specifics : they speak of the Master-Passion, and hymn its eulogy or lament its pangs of discomfiture : science, of its more gross and corporal elements. "Love lives; Thought dies not; the heart's music still Prolongs its cadences from age to age; Perpetuates its melodies, which thrill Through each voluptuous leaf of Nature's page." Man perishes; but the passions common to human nature will endure as long as the world exists; hence the interest in them neArer ceases, never becomes obsolete ; hence our sym- pathy Avith the joys and sorrows of the long since dead, as if they Averc yet among the living. The passions, and among these the master-passion especially, supply us Avith countless examples of the agency of the body on the mind, of the 30 *A CHIEF CAUSE OF NERVOUS DERANGEMENT. mind on the body, — of the reagency of each on the other. With the advance of life their development becomes more complete, their tendency and objects more clearly under- stood. As in the female sex the frame becomes more Avom- anly, and a thousand now graces come into ArieAV ; so tho mind itself, in becoming more mature, becomes more feminine. In both sexes, the distinctions of sex become more marked and definite ; in the male sex, not the aspect and voice only, but the mind undergoes a change. Those changes in persons of both sexes Avhich arc of a psychological character are matters of as plain recognition as those Avhich are physical; and so also are any pauses in the march of nature toAvards perfec- tion of frame and maturity of mind, which disease or other obstacles to its progress occasion; and, as Ave may add also, any forced or unnatural acceleration of its pace. The acclivity from childhood to adolescence may be ascended too rapidly; the ascent itself is not Avithout its perils and diffi- culties ; it extends indeed over one of the most dangerous tracts of country which Ave have to pass in our journey through life. Upon our safe conduct through it, the health of body and A'igor of mind of all after life greatly depend. Through educational neglect, there may be hardy but Avild and Avorthless plants; and a hot-house cultivation may pro- duce such as are only calculated for useless and idle shoAv. There may be, in fact, an extreme cultivation of the mind, Avhich shall tend eventually to incapacitate rather than to strengthen it; causing it to lose in sensitiveness, more than it gains in power; prematurely exhausting those energies Avhich are requisite to Avage tho battle of life successfully. During a requisite course of study, habits of abstraction of mind may be formed, Avhich renders persons as members of society useless, because isolated and unsocial; and Avhich, removing them from the ordinary temptations of man's Avorldly condition, leave them but a more certain and easv temptation from Avithin. CHAPTER IV. PATIENTS AVITH A NERVOUS TEAIPERAMENT. The nervous temperament, as previously stated, is to be distinguished by a quick, active brain; and the nervous sys- tem takes the lead over all the others. The eyes are large, and generally piercing; the features prominent and usually sharp; the forehead clear; the hair black, but silky, not crisp, as in the biliary temperament. The muscles, though small, are still round and well marked; the motions quick and active, and the step firm; the features generally expres- sive of anxiety. Such persons are for the most part intelli- gent, and alive to every kind of nervous impression; being easily excited and as readily depressed. Tho disposition as avcII as the mind is frequently modified b}r associations; but a sedentary and indolent life never fails to create morbid im- pressions ; the persons themselves being best suited for occupa- tions requiring activity and quickness. We very seldom, how- ever, meet Avith the nervous temperament, or, indeed, any of the others, perfectly pure and unmixed; but they run into, and are blended Avith, each other. Thus, Ave have the bilio-uervous, the nervo-lymphatic, the nervo-sanguineous temperaments. It requires some discrimination, and consid- erable practice and experience, to thorouglily comprehend the various temperaments, and modifications they are con- stantly presenting in practice to our observation. The incli- [31] 32 patients with a nervous temperament. viduals themselves often seem complete enigmas. Thus, some that are intelligent and courageous, Avill often faint even at the sight of a drop of blood. I am acquainted Avith a gentleman of highly nervous temperament, Avho is timid and fearful on trivial occasions ; yet when suddenly placed in real danger, has been known to be bold, decisive, and self- possessed. But all attempts at describing the various phases and shades assumed by this temperament must fail and prove abortive. I have seen some hundred cases of the nervous temperament, but have never yet met tAvo precisely alike in all respects. Climate, associations, hereditary tendencies, and other innumerable circumstances, as grief, disappoint- ment, etc., so far change, alter, and otherwise modify this class of persons, as to render them one and all dissimilar, — the same causes not being applied or not operating in all. What I Avish more particularly to insist on is, that Avhen the nervous temperament is present and in actiA'ity, orAvhen it is intermixed Avith others, it is of the greatest possible im- portance that it be attentively and thoroughly studied; for no treatment of disease can be permanently successful if these conditions be not taken into account. Redness, SAvell- ing, heat, pain, and throbbing, are laid doAvn, in the syste- matic Avorks upon medicine and surgery, as the characteristic or distinctive signs of inflammation; and in other tempera- ments such signs may be relied on Avith safety ; but I Avould recommend practitioners, not' much accustomed to the man- agement of nervous cases, that patients of this temperament simulate not only inflammation, but also many of the incu- rable diseases in Avhich inflammation frequently terminates. I am satisfied, after having strictly Avatched and carefully attended to a large number of cases of purely nervous disor- der, that all the phenomena indicative of acute inflammatory action may be present, and yet no inflammation Avhatever exist. PATIENTS with a nervous temperament. 33 I shall briefly notice the following interesting and instruc- tive case, Avhich Avill, perhaps, more clearly illustrate Avhat I Avish to inculcate. I Avas called, about three years ago, to visit a young lady of highly nervous temperament. She was an only child, and had been brought up in all the luxury and delicacy that affluence could procure. She suddenly com- plained of Arery severe pain in the knee, attended with all the symptoms of inflammation in the joint. The pain Avas so in- tense, that it was not Avithout difficulty she could be prevailed upon to alloAv even a superficial examination. The pain Avas very speedily folloAvcd by swelling, heat, throbbing, and all the usual symptoms of inflammation. The medical gentleman Avho previously attended the case had applied leeches in abundance, had tried cold and astringent lotions, purgatives, and such other remedies, and had persevered most steadily in the antiphlogistic plan of treatment for a considerable time, — still the pain Avas in no Avay relieved, or even abated in the slightest degree. The obstinacy and the general appear- ance of the joint led to the belief that the young lady Avas threatened with white SAvelling, and it Avas under these cir- cumstances that I Avas called upon to visit the case. When I first saAv the patient, I Avas assured that the same state of things as I then Avitnessed had existed without amelio- ration, or, indeed, the slightest change, for a period of nearly three months ; and this, too, notwithstanding the most ap- proved means of subduing inflammation had been adopted, and most strictly persevered in, ever since she had been first taken ill. I had before seen several cases of a similar de- scription. Therefore, after a minute and careful examination of the joint, I expressed my doubts of the existence of any real or true inflammation. Upon this I Avas the more de- cided, because I had in the course of my inquiries ascertained that the symptoms had neither increased nor decreased, but had continued steady and stationary; in fact, precisely as at 34 PATIENTS WITH A NERVOUS TEMPERAMENT. the very first day. Noav, it is in accordance with my expe- rience, that real inflammation, more especially Avhen acute, if not subdued, must certainly proceed to abscess or ulcera- tion, or symptoms indicating the destruction of the joint either supervene or threaten before the lapse of so long a period. These considerations, Avith the admitted irregularity in tho periodical health, the high degree of nervous excite- ment, the acute sensibility, greatly increased by a luxuriant and indolent mode of living, — induced me firmly to an- nounce it as my opinion that the patient Avas suffering from a purely nervous affection of the joint, and clearly and decidedly the result of morbid irritability. In accordance Avith these vieAvs, I recommended that the limb, Avhich had been hitherto confined in one position, should be greatly exercised ; that the patient should remove from the heated apartment to Avhich she had been so closely and strictly confined, and take carriage exercise in the open air. It Avas at the same time strongly advised that external applications to the limb should be discontinued ; for it Avas very evident that the only effects of the lotions Ave re to attract her attention to the state of the limb, and create great anxiety and alarm from the apprehension of being obliged to suffer the loss of tho leg: for she had unfortunately been told that the disease might end in Avhite SAA'elling. With the vioAv of restoring the periodical action of the uterus, Avhich had been for some time suppressed, the boAvcls Avcrc kept regular, and the patient was directed to use Avarm, salt Avatcr baths frequently ; and to give energy and tone to the general system, Avhich had been enfeebled, she Avas directed to take tho Tinct. Ferri, Acet. ^Ether, in regular doses three or four times a day. It was indeed extremely gratifying to witness the great improvement in her health, even in the course of a feAV weeks, after the alteration in tho treatment had been adopted. Pure air, regular exercise, with plain, simple, but PATIENTS AVITH A NERVOUS TEMPERAMENT. 35 nutritious diet, and the mind being set at ease, I am satis- fied had much to do in effecting the cure which speedily fol- lowed the adoption of the plan aboAre stated. Although an advocate for great simplicit}- of means in such cases, I am far from Avishing it to be understood that the treatment of them is ahvays as simple or equally successful. We have often to contend Avith prejudice, — patients and their friends having been, in most instances in which the case has been prolonged, informed that there is danger of the disease turn- ing to white swelling, and that exercise, or indeed motion of any kind, is prejudicial and attended with the greatest danger. Thus, under the influence of first impressions, they rebel against any advice to the contrary, and persist in con- fining the patient either to the bed or to the couch; and this, too, not unfrequently in a hot and ill-ventilated apartment. These nervous affections of the joint are not ahvays to be easily distinguished from organic diseases of the same struc- tures ; for it is not unusual to find that the natural appear- ance of the joint has been completely altered by the effects of repeated leeching, blistering, cupping, issues, setons, etc., so that it is often extremely difficult to decide Avhether the appearances be really in consequence of the remedies or of the disease. The practitioner, therefore, Avho has not paid special attention to these diseases, should be very care- ful before deciding positively upon the nature of such affec- tions, but more especially if the patient be a lady of the nervous or bilio-nervous temperament. It is not long since a very eminent surgeon at one of our great hospitals ampu- tated above the knee, under the notion of the existence of white swelling of the joint. But, to his great surprise, upon dissection after the operation, the joint Avas found in a per- fectly sound and healthy state, and it turned out that the disorder was purely nervous and nothing more. To fortify myself by eminent authority, I quote Sir Benja- 36 PATIENTS AVITH A NERVOUS TEMPERAMENT. min Brodie, who says, " Among the local hysterical affections, one of the most frequent is acute pain in the knee-joint. Indeed, the affection is marked by almost every sign of structural disease, save that it is more diffused. Yet this is true neuralgia." And Sir Benjamin concludes his sentence thus : " I do not hesitate to declare that among the higher classes of society, at least four fifths of the female patients who are commonly supposed to labor under diseases of the joints, labor under hysteria and nothing else." These nervous affections are not confined solely to the joints, for I am often called upon to prescribe for similar affections of the breast. Patients of this kind invariably apprehend and suspect the beginning of cancer. The dis- crimination of such cases is frequently a matter of considera- ble difficulty. And, indeed, there are many instances of breasts having been removed under the belief of the presence of cancer, Avhen really no such disease existed. While this sheet is passing through the press, I have been called upon to prescribe for a hard and painful tumor in the left breast, which, upon examination, presented many of the symptoms of cancer. This person was of a highly nervous tempera- ment, and, on her first visit, gave me the impression that she was under the influence of wine; but, upon more strict inquiry, I found it Avas laudanum, to the habitual use of which she had been addicted. I declined giving an opinion, Avhen I Avas informed that the amputation of the breast had been already resolved upon; and that she had called for my advice before submitting to the operation. I adA'ised her to go into the country, and try the effects of a pure, Avholesome atmosphere, for a fortnight at least; to leave off the use of opium; to take Avarm, sea-Avater baths; to use the plainest and simplest, but still mild and nutritious diet; to live prin- cipally upon milk, and thus remove any cause of constitu- tional irritability. During the first ten days her sufferings PATIENTS AVITH A NERVOUS TEMPERAMENT. 37 Avere most intense, in consequence of being debarred her habitual doses of opium. Her firmness and strength of mind Avere put to the severest proof in altogether renouncing the narcotic; and, as she informed mc, it Avas only the hope of being able to save her breast, that could have induced her to forego its use. Upon her return to Boston, after somcAvhat more than three Aveeks' sojourn in the country, the irritation Avas greatly reduced by change of air, bathing, and mild diet; and now a thorough examination could be endured Avithout apprehension, and was therefore readily submitted to. It at once became evident that the tumor was the result of irrita- tion, in an extremely sensitive and excitable system; and that the care-Avorn, anxious, peculiar expression of counte- nance, which Ave observe so constantly in true cancer, was, in this instance, entirely occasioned by mental anxiety, greatly increased and aggravated by the opium she Avas taking. She Avas advised to continue the plan of living which had proved so beneficial, and she faithfully promised mo that she would not again have recourse to opium, and I haA'O every reason to believe that she Avill perfectly recover. I cannot too strongly denounce the immodcrato uso of opium in these cases. If ever used at all, it should bo given Avith the great- est caution and circumspection to persons of nervous tem- perament, and still more if tho patient be young. Opium renders the nervous system highly susceptible, and alive to all sorts of nervous impressions. Nervous affections of the spino are still more common than those of the breast, and they are but too often treated as really organic diseases. It is by no means uncommon to meet Avith such instances; they are constantly presenting them- selves in practice. I have seen many Avho have been con- fined to the couch for months, or stretched for a like period upon tho inclined plane. Had the cause of the disorder been traced out and removed, instead of attending to and treating 38 PATIENTS WITtf k IvERVONS TEMPERAMENT. effects, much present suffering and subsequent misery might have been avoided. The history of the following case may perhaps prove not uninteresting : A young lady, of highly nervous temperament, was subjected to the inconvenience of confinement upon the inclined plane, for nearly nine months. This severity of discipline had its origin in the notion that this unfortunate patient was laboring under severe disease of the spine, and which, it was imagined, was the primary cause of the disordered state of her health, Avhich had been declin- ing for some years. Her symptoms were Avatchfulness and wakefulness, so that there was a total inability to sleep more than about four or five hours during the night, all the rest of which she remained awake. In consequence, her health had become delicate, which was referred to disease of the spine as the cause, as she complained of a good deal of pain in the back. A careful inquiry into her history satisfied me that the wakefulness was hereditary. From childhood she had not slept as much as other persons. For years previous to Jier birth her father had forced himself to very great mental application. Being the architect of his oavu fortune, he had not for a length of time alloAved to himself more time for repose than Avas imperatively required by exhausted nature. Had, then, the history of this case been carefully investigated at the commencement, I think Aery different results would have been arrived at, and it Avould not have been thought necessary to confine her to the inclined plane. The above cases are cited to show Iioav the cause of disease may be overlooked by eminent physicians, and to sIioav that the study of the temperaments, a more strict inquiry into the nature of nervous affections, and a more rigid investigation into the causes of disease, would tend much to relieve many of those distressing cases of nervous disorder Avhich so con* stantly come under the care of the physician. CHAPTER V. CONVIVIAL HABITS AS A CAUSE OF NERVOUSNESS. Of course the prompt and effective remedies for nervous- ness, which the writer has ready at hand, are frequently demanded to quell the nervousness of persons suffering from convivial habits and good cheer, and occasional or habitual abuse of wines and alcoholic drinks. The depression of the nervous system, induced by such indulgence, is some- times called alcoholism or alcoholic melancholy. There is in every class of society a number of persons who, although they do not become intoxicated, suffer from chronic alcoholism, from drinking more spirits, wine, or ale than agrees Avith their health. Most of these persons lead a useful and active life, and apply for medical advice, being quite unaware of the cause of their illness. The habit of indulging freely in Avine at frequent dinner parties, of drinking Avine, ale, or whiskey at times, of taking occasionally a glass of wine between meals, or of sipping every evening tAVo or three glasses of ale, or punch, or whiskey and water, is quite sufficient to bring on an attack of a^oholism. Drinking is not usually in these cases an indomitable habit, and accordingly the patient will gladly give it up, if he feels certain that by so doing his health will be improved. Sleep disturbed by dreams, some- times sleeplessness, diminution of the appetite and evacua- tions, vomiting of mucus in the morning, trembling of the [39] 40 CONVIVIAL HABITS AS A CAUSE OF NERVEOUSNESS. hands and arms more marked in the mornings, etc., arc con- sequences of these convivial habits. The chief symptoms of chronic alcoholism are trembling of the feet and hands ; in- creasing Aveakness; the sleep is much disturbed by fright- ful dreams, or it cannot be obtained either on account of neuralgic pains in the limbs, or extreme restlessness. In the more advanced stages of the disease, the night not unfre- quontly becomes a period of horrible suffering. The patient in vain seeks to place his limbs in a position which Avould afford relief to the uneasy sensations or burning pains which affect them; and if sleep or drowsiness steals upon him, it is presently driven aAvay by convulsive starlings. The neuralgic pains Avhich at first haunt solely the night, begin to affect the patient, and increase upon him by day. Vertigo often happens, and at times the A'ision is clouded. Halluci^ nations are of common occurrence. They mostly affect the organs of sight and hearing. For instance, one of my patients, Avhen Avalking in the street, had seen ropes dangling about his head ; to another, objects appeared as if they Avere double ; some occasionally perceived insects creeping about,—the various visions often disappearing as soon as the attention was directed to them. These factitious perceptions of tho sight appear sometimes so real that the individual moves aside to avoid an imaginary object standing in his Avay. A hackman I was treating for chronic alcoholism told mo he frequently pulled up his hor.-e suddenly, or drove to one side of the street, lest he should run over sorno obstacle he distinctly saw in front of his horse, and which he afterwards found not to exist in reality. In most cases the patient is occasionally, or perhaps constantly, troubled Avith shadoAvs or black mist, or flying specks, passiug rapidly before his eyes, and causing a dimness of sight, especially when he is looking attentively at something; in the act of reading, for example, the book is suddenly CONVIVIAL HABITS AND NERVOUSNESS. 41 darkened, and a state of almost complete blindness ensues, lasting a few minutes. During the long and sleepless nights, aberrations of tho sight frequently happen. The Avife of a patient I Avas treating for chronic alcoholism, told me her husband often fancied, Avhilst lying awake, that he saAV rats and cats, and various other descriptions of animals, on the bedclothes ; he used to doze at intervals, and in the morning could not remember anything of the nightly visions. The aberrations of the sense of hearing are not so frequent, but I have met Avith patients who occasionally heard Aroices addressing them Avhen nobody Avas present. " Doctor, I will give you a wrinkle,'" said a friend to us, not long ago, as Ave Avere gossiping concerning Avine ; and an attendant was di- rected to descend into the cellar, and bring from a particular bin a bottle of champagne. It may be as Avell, perhaps, to remark, lest the uninitiated should stumble over the term, that a wrinkle, in the refined slang of the day, signifies a little bit of practical Avisdom. The phrase is highly meta- phorical. Worldly Avisdom iucreases Avith years ; so also do the furrows which indent the forehead. Therefore an increase of wrinkles in the forehead may be regarded as an index of increasing wisdom, and a wrinkle may stand Avell enough for an item of practical Avisdom. This by the Avay. The cham- pagne was in due time placed upon the table, and the spark- ling fluid had a most agreeable taste and refreshing effect, for the evening Avas hot and stifling. " Well, how do you like the wine ? " inquired our friend. " A pleasant drink for a scorching day," Ave replied. "Read that," he said, putting into our hands the cork AAdiich had just been extracted from the bottle, and pointing to the inner extremity, — that Avhich had been next the wine. There avc saAV and read, not a little to our astonishment, the formidable Avord mort (French death) printed in clear, bold letters. "That," said our friend, " is a trade-mark ; and when you see it affixed to the 42 CONVIVIAL HABITS AND NERVOUSNESS. cork of a champagne bottle, you may rest assured that no grapes ever contributed towards the formation of the wine." This was the wrinkle; but the singularity of the trade- mark awoke other thoughts than those immediately connected with the utility of knowing it. Should there have been a full stop after the different letters, — each having a specific signification, the formation of the Avord being merely acci- dental ? Or was the trade-mark such as we read it — Mort {DeatK) ; and if so, was it a piece of satire of the Avine mer- chant on the Avine ? Truly, a reversed cork so stamped and placed upon the plates of the guests at a feast might Avell serve the purpose of the mummy introduced at the old Egyptian banquets ; or might convey as homely but as forci- ble a lesson as that taught in Holbein's draAving of the toper in the Dance of Death, in which death is represented as officiously pouring the inebriating drink into the mouth of one of the carousers. Or may we regard this trade-mark as a foreshadoAving of that time when alcohol will no longer be known as aqua vital, but aqua mortis. And, indeed, as we become more and more familiar Avith the remote effects of alcohol upon the system, in whatever form the potent spirit be consumed, we cannot resist the conclusion that, as too commonly used, it would be more correctly termed water of death, than aqua vitas, or water of life. The Avriter can quiet the nerves shattered by vinous and alcoholic excess, and drive from his pillow the ugly visions which disturb the sleep of the victim of alcoholism. But total abstinence, as it is called, is better even than his remedies. CHAPTER VI. ANXIETY OF MIND. Anxiety ! Is there a human breast in which this aAvful word fails to produce an echo?— from the youth, who fears to be superseded in the affections of the object of his love ; from the \ arent, AvhoAvatches Avith alarm the flush in the cheek of his child, lest its vividness indicate latent consumption, —to the old man Avorndown Avith years and sorroAv, Avho tries to esti- mate the commercial convulsions that threaten to swalloAV up the hard earnings of a long life of privation, and reduce him to beggary. To specify the objects of this corroding care Avould be to enumerate all the classes of society. The man of poetical imagination might give a series of individual pic- tures whose Arividness would excite universal despair, like the single capthe of Sterne ; he might so harroAv up the feel- ings of the reader by the representation of social misery indi- vidualized, that the Avhole Avorld should seem a charnel-house of wretchedness, unworthy of the benevolence of the great Being Avho called it into existence. It is hard to believe it in times of despondency and alarm ; but the man Avho stands aloof from the turmoil of the Avorld, and occupies the higher station of independence, knows that all things work together for good ; that God does not leave to a future state the expia- tion of many of our errors and sins, but that even in this Avorld they Avork their oavh punishment. If we suffer for the [43] 44 ANXIETY OF MIND. faults and crimes of others when acquitted by our oavii con- science, Ave must endeavor to consider the misfortunes inflicted on us as a part of the moral discipline by Avhich it is His purpose to work out our improvement, and fit us for final happiness. This vieAV of the case, hoAvevcr, is appro- priately left to the clergyman. It is in the capacity of phy- sician and man of the world that I put myself forward, in the conviction that it is in my power to offer alleviation to the afflicted, to show how misfortune may be best borne, — hoAV its physical and moral consequences may have their force turned aside, and be rendered comparatively harmless; how inevitable bodily ailments may be modified or cured; how some admit of great alleviation, and some of entire removal; that even by acting on the body we may render important service to the mind, and enable it to rise elastic from the pressure that, if left alone, Avould have crushed it to the earth. It is not that I would evade the consideration of other forms of unhappiness ; on the contrary, I hope, sincerely and confidently, to render a service to my fellow-creatures by showing that in all cases Ave may anticipate and prevent, or give considerable relief to, the ailments, disorders, and diseases produced by mental causes, even when it is obviously impossible to alleviate and remove their source and origin. The mind, that is, the aggregate of the functions of the brain (for we are not hero speaking of the soul), can only produce disease by some sort of action on the physical structure and functions of the body. We see, hoAvever, that as accidental injury to the bod)' (an extensive burn or scald for example) can produce a very serious effect on the mind, so also the diseased or disordered state of body, directly caused by men- tal emotion, acts rcflexly on the functions of the brain, and very often paralyzes all the efforts of the sufferer, and render him incapable of using in its full poAver the intellect Avhich ANXIETY OF MIND. 45 avouH have otherwise shown him a mode of extrication from his embarrassment. Men who have weighty care on their mind, — statesmen AAdiose confidence of retaining their position, and ambi- tious hopes of further advancement, depend on the slender and fragile thread of popular favor; or Avhere patriotism looks forward Avith honorable fear to the result of a deep-laid scheme for the advancement of their country's Avelfare, liable at every moment to be defeated by malevolent rivals, and the unexecuted purposes rendered suspicious to those Avho judge by results alone; merchants Avho have staked vast sums on the issue of an uncertain speculation; gentlemen of fortune AArho have perilled their whole possessions and their honor on the result of a horse-race, —such men Avill, perhaps, look down Avith contempt on the petty details of the cares of humble life, but Little things are great to little men. The medical philosopher looks with as mucn interest on the anxiety of the petty tradesman, as on a great leviathan of the stock exchange or gold board, AA'hose vast speculations involve the fate of nations. There is as much real dignity in the sufferings of the one as of the other, except in so far as the Avish for Avealth is modified by the desire to possess the means of benevolent poAver, and the exercise of an enlightened beneficence (such as actuated the late Mr. Pea- body, the patron of the Peabody Medical Institute), —the hopes, fears, motives, sentiments, and feelings of the differ- ent classes, as Avell as their mental and corporeal sufferings, are essentially the same; and, if regarded from the heights of pure reason and philosophy, are equally deserving of honor or contempt. It requires no argument to prove that anxiety affects the health ; it is an object of daily experience ; our libraries 46 ANXIETY OF MIND. are full of books of counsel on the subject; medical works, in the enumeration of causes of lingering disease, are crammed with cases arising from this source alone ; and there is scarcely a disorder Avherein this state of brain is not assigned as one of the most prominent agents in disturbing the bodily health, and establishing disease. Fevers, jaun- dice, gout, consumption, insanity, dyspepsia, and a hundred other diseases are so often thus created, that it would almost appear to be the sole agent in their production. And yet, with all this profusion of advice and description, I cannot call to mind a single Avriter Avho has attempted to explain the mode in which these innumerable effects are produced; yet, till this be clearly understood, Ave are not in possession of half the available means of modifying or removing them. The distress brought on by this inability to guide the thought, — a frequent consequence of great anxiety,— this inability to use the tAvo brains concurrently, that is, to exercise attention or study, is one of the nfost pitiable states of mind that can be conceived. Happy those aa-Iio have never had experience of the infliction,—the utility of Avorks of imagination is thor- oughly appreciated in such cases, and the sufferer would be always reading. In folloAving the ideas of another man, he can generally leave his own intellectual organs in quiet; the discordant action of the two brains may thus subside per- haps into repose, and on resuming their duties they may have re-established the unison and consentaneity Avhich is necessary to the tranquil exercise of the mind. On such occasions, if there be no object of tender fondness, Avhose soothing blandishments can turn the current of the thoughts, — if a man look only Avith terror to the time Avhen " Shall dawn the dreary morrow; and the toils, The cares, the ills of life, with scarcely hope To brighten the involving gloom, and saAre The fainting spirit," ANXIETY OF MIND. 47 on these occasions, we feel acutely the value of such a Avriter as Charles Dickens, — a man Avhose medical services, if I may so term them, would have been cheaply purchased by the nation at the price of the largest fortune ever pos- sessed by an individual. How many a harassed brain has been soothed by his delightful fictions ; Iioav many a lingering disease has been rendered endurable ; from how many has he not directed the dismal prospect of inevitable death; to Iioav many an aching heart has he brought consolation and comfort and the temporary oblivion of sorroAv ; Iioav many a suicide has he prevented; and hoAV many a beAvildered brain placed in repose ! Such men have their mission, — they are sent into the world by a benevolent Deity for a specific purpose, and they may be compared to the blessed remedies Avhich haA'e been created for the relief of sufferers. I do not hesitate to say that I attribute the recovery of many a nervous patient to the mental composure produced by reading his admirable stories, in Avhich there is nothing to detract from the entire satisfaction and assent of a virtuous mind. CHAPTER VII. RELIGIOUS EXCITEMENT AND NERVOUSNESS. The Avriter has had many cases of nervous depression and melancholy resulting from religious excitement, and Avhat are known as revivals, although these cases are not so common as they formerly Avere. Occasionally a nervous patient, who believes himself or herself to have committed the unpardon- able sin, and to be, therefore, destined to everlasting perdi- tion, is brought-to the Avriter for treatment; but cases of what may be called religious insanity are not so common noAv as formerly, owing to the fact of a softening of the creeds, and the elimination of the terrible penal articles of faith, Avhich once Avere insisted on more than all the rest. Hysteria in connection Avith religious revivals is a Avell- knoAvn medical phenomenon. When the nerves, especially of uneducated people, of Avomen in particular, Avho are unaccus- tomed to self-control, are poAverfully Avrought upon by the rude but poAverful appeals and eloquence of a revivalist preacher, paroxysms, convulsions, and outcries arc the natural enough expressions of the overwrought feelings of the auditors. Hysteria seizes upon some extremely susceptible female, and becomes straightway contagious. In fact, several leading nervous disorders, such as catalepsy, ecstasy, chorea or St. Vitus' dance, and hysteria are historically associated Avith religious excitements. Dr. Hammond truly says : " Most of RELIGIOUS EXCITEMENT AND NERVOUSNESS. 49 the religious impostors, Avho have at wirious times made their appearance, and many very sincere and devout persons, have been ecstatics." "In ecstasy," he says, "the eyes arc open, the lips parted; the face is turned upAvard, the hands are often outstretched ; the body is erect and raised to its utmost height. A peculiar radiant smile illumes the countenance, and the whole aspect is that of intense mental exaltation. In its combination Avith catalepsy, chorea, and hysteria, ecstasy has played an important part in the history of the civilized world, — at one time leading to a belief in Avitch- craft; at another, to demoniac and angelic possession; at another, to mesmerism and clairvoyance ; and, in our day, to spiritualism. Ecstasy, though not entirely confined to the female sex, is very much more common in women than in men. It appears to be produced in those Avho are of deli- cate and sensitive nervous organizations by intense mental concentration on some one particular subject, — generally one connected Avith religion. It was formerly quite common among the inmates of convents, and is iioav not unfrequently met Avith at camp-meetings and spiritualistic gatherings." Chorea, or St. Vitus' dance, is another Avell-kuown form of disease having religious associations. Hence its name. The compulsions and paroxysms of this nervous affection are often of the most extraordinary character. " This affection," Ave again quote from Dr. Hammond's admirable work entitled " Diseases of the Nervous System," " has often prevailed epidemically. The first authentic visitation of the kind Avas one which occurred at Aix-la-Chapelle, in 1374. This Avas in the form of a dancing mania. It was named St. John's Dance. " The men and Avomen subject to it met in the streets and churches, where they formed circles hand in hand, and, ap- pearing to have lost all control, continued dancing, regard- less of the by-standers, for hours together, in Avild delirium,. 50 RELIGIOUS EXCITEMENT AND NERVOUSNESS. until at length they foil to the ground in a state of exhaustion. . . . While dancing, they neither saw nor heard, being insensible to external impressions through the senses, but Avere haunted by visions, — their fancies conjuring up spirits, Avhose names they shrieked out. Some of them afterwards asserted that they felt as if they had been immersed in a stream of blood, Avhich obliged them to leap so high ; others, during the paroxysm, saw the heavens open and the Saviour enthroned Avith the Virgin Mary, — according as the religious notions of the age Avere strangely or variously reflected in their imaginations. . . . " Some religious monomaniacs are never safe. Pinel re- lates the case of a fanatic Avho conceived the idea that man- kind should be regenerated by the baptism of blood; and under this delusion he cut the throats of all his children, and Avould have murdered his Avife, had she not effected her escape. Sixteen years afterwards, when a patient in the Bicetre, he murdered two of his folioAv-patients, and Avould haA^e killed all the inmates in the hospital, if his homicidal propensity had not been restrained. " In our own country we have had the Jumpers and the Shakers." In these practical, matter-of-fact days, the subjects of these nervo-religious excitements, paroxysms, and convulsions are cured of their disorders by au administration of the bro- mide of potassium, or some of the other bromides, combined Avith the oxide or sulphate of zinc and strychnia and other tonics, reinforced by a proper hygiene of exercise in the air and nutritious diet. Tho physical phenomena of " the rcvhral" can be shown to present, in their predisposing and exciting causes, in their progress and in their results, a precise resemblance to the hysteria commonly seen in medical practice, and produced either by secular terrors or by amatory reverie. We are RELIGI jUS EXCITEMENT AND NERVOUSNESS. 51 clearly entitled to consider them as belonging to the same family, and as being in fact very striking instances of morbid action. Without trespassing upon the domain of the theolo- gian, yet avc may regard these phenomena in their patholog- ical relations, and may point out the methods by which they may be prevented, and the manner in which they may be over- come. It is incontestible that love to God, founded upon an assurance of God's love to man, is the only possible basis of Christian faith and duty ; and it is inconceivable that love to God can be kindled at the flames of a literal hell. Denun- ciations of the Avrath to come, and frantic appeals to the terrors of a congregation, produce either hysteria or indif- ference,— either shake the physical frame, by positive dread of impending torture, aud mere selfish fears for personal safety, or else harden the listeners by the natural reaction of the human spirit against threats. " HoAvling about hell-fire in bad grammar," as Thackeray says, very frequently ex- presses nothing but Hie longing of the preacher to persecute. I hold, therefore, that these denunciations of the wrath to come, made prominent as the leading and essential feature of scriptural teaching, are Avithout any shadow of justifica- tion or excuse. Hysteria, originating in terror, maintained for effect, terminating in profligacy or insanity, is a sad con- trast to the peace that passeth understanding. But, as I have said, in these days of science and rational views, instances of religious melancholy and insanity are becoming fewer and fewer; as those physicians, who, like the Avriter, make the treatment of nervous affections a specialty, can testify; al- though such cases are by no means rare. Interesting cases of this kind might be cited from the author's own professional experience, and described at length, but it is, perhaps, unnecessary. More or less of such cases can be found in every lunatic asylum. Most of them are curable by the poAV- crful remedies for nervous affections, which have been added to the Materia Medica Avithin the last decade. CHAPTER VIII. ILLUSIONS AND HALLUCINATIONS. It is said that hallucinations of the senses arise from some defect in the organs of sense, or from some unusual circum- stance attending the object. Hallucinations are sometimes symptoms of general disease, as in fevers. The extent to which avc are subject to illusions and hallucinations sIioavs that we are fearfully and wonderfully made. The most aggravated murders are frequently corHmitted by. persons who are the victims of fixed ideas and hallucinations. They are often aAvare of the fact that they are laboring under mental disease, and yet they cannot hold themselves back from the perpetration of the dreadful crime to Avhich they arc irresistibly impelled. The subject of hallucination is a most important and interesting one. The various religions owe to the hallucinations of their so-called holy personages all their accounts of supernatural beings and incidents. When a person actually insists that he sees, hears, or feels what no one near him can see, hear, or feel, the question arises, Are the senses Avhich convey these impressions to the brain in a sound condition, or is his mind delirious? Is the cause of the hallucination external or internal ? In order to answer this question, Ave must first inquire hoAv far tho senses are capable of misleading the reason and urging the imagi- nation to unconnected dreams. We know that the nervous [52] ILLUSIONS AND HALLUCINATIONS. 53 system is influenced by the condition of the body. Privation of food, for instance, indulgence in alcoholic stimulants, habits of narcotism, and congestion of the brain will poAver- fully affect the nervous system, and through it produce illu- sions and hallucinations of the senses. In fact, the history of mankind, and the experience of those who have had the opportunity of studying the ills to which flesh is heir, prove that the manifold causes which give rise to hallucinations can be referred to innumerable sources, which oftentimes escape the curiosity of the most watchful and intelligent observer. The power of the imagination is proverbial. Shakespeare says the poet, the loA^er, and the madman are of imagination all compact. The latter he represents as seeing more devils than vast hell can hold. Whatever a person firmly believes, that to him is a reality. So that an illusion or hallucination, no matter how wild and irrational it may l)e, has all the effect of a reality on the subject of it. There is no limit to the force of a morbid imagination, and the mad pranks and delusions to Avhich it will reduce its unfor- tunate victims. Burton asks, "What Avill not a fearful man conceive in the dark? What strange forms of bugbears, devils, witches, goblins? Melancholy and sick men, he says, conceive so many fantastical visions, apparitions to them- selves, and have so many absurd apparitions, as that they are kings, lords, cocks, bears, apes, oavIs." Burton furnishes perhaps as many and as striking instances of illusions, delusions, and hallucinations as any other Avriter. He ghres the case of a baker, who thought he was composed of butter, and did not dare to sit in the sun or come near the fire for fear of being melted. Another hallucinant thought he Avas a nightingale, and sang all night; and another that he Avas a glass pitcher, and would let nobody approach him, lest he should be broken. Recorded delu- sions of a similar nature are innumerable. Old writers on 54 ILLUSIONS AND HALLUCINATIONS. the subject of melancholy and insanity furnish as varied instances as the most recent authorities, and apparently en- tertain as correct notions of the causes of such delusions. Wierus, an old author, illustrates the force of a diseased imagination by saying that persons suffering from hydropho- bia seem to see the picture of a dog still in their Avater. And apropos of hydrophobia, Dr. D. H. Tuke has lately published a Avork on the Influence of the " Mind upon the Body," and in it supports the proposition that hydrophobia is produced solely by the action of the imagination. The author cites cases where, beyond all doubt, hydrophobic symptoms Avere developed without inoculation. A notable instance is that of a physician of Lyons (France), named Chormel, who, having aided in the dissection of several vic- tims of the disorder, imagined that he had been inoculated with the virus. On attempting to drink he was seized with spasm of the pharynx, and in this condition roamed about the streets for three days. At length his friends succeeded in convincing him of the groundlessness of his apprehen- sions, and he at once recovered. Bush also tells of sponta- neous cases of hydrophobia from no other cause but fear and association of ideas. A German physician, too, Dr. Marx, of Gottingen, is disposed to take this view of hydrophobia, and to regard it as a psychical affection, the result of morbid excitement of the imagination. This view is confirmed by the fact that }"oung children, who are not acquainted Avith the common belief as to hydrophobia, may be bitten by mad dogs and escape spasms and madness. We are indebted to the " Popular Science Monthly " for the above statements in reference to hydrophobia. Certain it is that this aAvful affec- tion leaA^es no traces of itself on the brain and nerves of its victim. But as for young children being bitten Avith impu- nity by rabid dogs, Ave doubt. Indeed, we knoAV of cases proving as fatal to children as to adults. ILLUSIONS AND HALLUCINATIONS. 55 In countries with superstitious forms of religious belief, which nobody questions, the most intelligent traveller feels the influence of the universal superstition stealing upon him. The curse of a priest in the SandAvich Islands, in the old days of barbarism, would take visible effect upon its object, and destroy him. A superstition gets entire possession of the soul, so to speak, of the ignorant portion of a commu- nity, and it takes generations of culture to rid them of it. Their imaginations are possessed by it. Hence the strength of old religions, after they have been proved to bo false. The hallucinations of the sense of hearing are the most © frequent. Amongst those AArho are decidedly insane, this species of false perception is infinitely more common than that of any other of the senses; it is not only one voice that is heard, but many; it is not only the less instructed, but the intellectual; it is among men of great imagination and ' © © © deep learning. It haunts the mind in the form of a demon, as in the case of the poet Tasso, or as Satan Avrangling upon divinity, as it did with the disputant Luther (avIio actually %urled his inkstand at the Devil), or as a Deity revealing his Avill, with the contemplative Swedenborg, who gives the date and circumstances of his first interview Avith the Lord in the most matter-of-fact, off-hand way. The most simple of the hallucinations is that of noises in the ear, such as sounds made during the night in the chimney. I have known an invalid complain of a perfectly sleepless night occurring for Aveeks, in consequence of the idea that chvelt upon her mind that some sAvalloAvs were building a nest in her chimney. She had lately returned from the country. At tho end of a few weeks she had an intermittent fever, after which the noises ceased. A singular case is recorded in the books as having occurred in Paris in 1831, during one of those bloody emeutes Avhich have for so long a time been characteristic of that gay but ill-starred city. A female saAV 56 ILLUSIONS AND HALLUCINATIONS. her husband, a workman, fall dead at her feet, struck by a ball. A month after this event she was safely delivered of a child ; but the tenth day after her accouchement, delirium came on. At its commencement she heard the noise of cannon, the firing of pickets, the whistling of balls. She ran into the country, hoping, in getting out of the city, to escape from the noises by which she was pursued. She Avas arrested and conducted to the Salpetriere (the insane asylum). At the end of a month she Avas completely restored. During ten years, six similar paroxysms took place, and the delirium ahvays commenced Avith hallucination of sound. Always did this patient run into the country to escape from ideal dis- charges of cannon, from firing of guns. Frequently, in the precipitation of her flight, she fell into the water; twice she threw herself into it to escape the horror of the sounds that reminded her of the death of her husband, and recalled the miseries she endured. Single Aroices are seldom so common as two voices, and the subject is oftentimes accompanied and caused by some emotion in the mind. A young girl heard a voice constantly calling her thief, and reproaching her Avith the object stolen. At length she returned the article, and the hallucination soon ceased. This Avas a case of conscience as Avell as of hallucination. Conscience let loose the Furies, hideous hags, upon the miu- clerer in ancient times, giving him no rest, chasing him from land to land. Some females, Avho haA'e led the most irre- proachable lives, have heard voices calling them by the Avorst epithets. One of tho most singular hallucinations to Avhich the sense of hearing lends itself is, to the carrying on a long, uninterrupted conversation, during Avhich the indhidual speaks, addresses a third party, and Avaits to listen to the reply, Avhich seems to be perfectly iicav to the apparent lis- tener, Avho gives every attention. Who that reads the life of Tasso, the great Italian poet already alluded to, as given by ILLUSIONS AND HALLUCINATIONS. 57 his friend and biographer, Manso, does not remember to have either himself met Avith a patient Avho has reminded him of the description, or has heard from a medical friend some tale A/hich has carried the same marvellous air with it ? Any one accustomed to Avhat occurs within lunatic establishments must have seen patients walking up and doAvn, holding an imag- inary conversation, or must have heard during the night, in some cell or other, an earnest, long-continued dialogue. During the hallucinations produced by taking the Indian hemp, the intensity of tho sense of sound is most startling. The celebrated Theodore Gaultier related to Dr. Moreau, in poetic language, Avhich it is hopeless to attempt to translate so as to give an idea of the style of tho imaginative author, the sensations produced. He says that " his sense of hearing was prodigiously developed. I heard the noise of colors, — green, red, blue, yelloAV sounds, reached me in Avaves per- fectly distinct; a glass overtliroAvn, the creaking of a foot- stool, a Avord pronounced Ioav, vibrated and shook me like peals of thunder ; my oavii voice appeared to me so loud that I dared not speak, for fear of shattering the Avails around me, or of making me burst like an explosive shell; more than five hundred clocks rang out the hour Avith an harmonious, silver}- sound; every sonorous object souuded like the note of an harmonica or the seolian harp : I SAvam or floated in an ocean of sound." The imagination is engaged in a A'ery different manner Avhere the sight is in fault, than Avhere hearing is disordered ; it does not paint such exciting scenes; it does not bring the reason into action, as Ave have seen it during the dis- turbance of the latter organ, when conversations sometimes of an intellectual character occur, Avhere the indhidual has to listen to the advice, the reproaches, or the threats of a supposed stranger. It is generally one object alone that attracts the attention, or that is complained of; it may appear under various shapes, but it is more generally connected Avith 58 ILLUSIONS AND HALLUCINATIONS. some idea that has previously struck Avith great intensity on the mind; thus a person, after being in danger of his life at a bridge, saw afterwards a precipice Avith a fearful abyss at his feet. Those Avhose minds are strongly bent on devotion, and haA'e yielded up their thoughts to religion, sec angels and the Virgin Mary. I Avas once in a church Avhere the clergy- man, Avho had for some time betrayed symptoms bordering on alienation of mind, but who never had evinced its actual presence, broke off his discourse, pointing to the presence of the Holy Ghost. Ho was fortunately prcA'cnted, by timely attention, from becoming insane, but he Avas considered ever afterwards incapable of resuming his duties. It is not generally known that the first Bonaparte Avas, in the early part of his career, subject to an hallucination of sight in consequence of the vivid impression made upon his mind by one of the occurrences of his eventful life. In the heat of one of the many battles in Avhich he Avas engaged, he Avas carried, by the ardor of his courage, into the A'cry midst of the slaughter. His immediate folio Avers fled ; he was left alone, surrounded on all sides by fierce assailants. IIoav he escaped from death unhurt no one was ever able to ascertain; it was one of those miracles AA'hich seemed to be worked by his guardian genius. The deep impression, however, of the dan- ger which he had run, was not effaced when he mounted the throne ; at certain intervals a striking hallucination occurred. Suddenly, in the midst of the silence of the palace, loud cries Avere occasionally heard; the emperor Avas seen fighting Avith the utmost desperation amongst his visionary foes. It lasted but a very short period, but during that time the bat- tle seemed to be a tremendous one. This gave rise to the report that he was subject to epileptic fits. These visions Avill not unfrequently cease upon shutting the eyes : they more generally, however, are permanent. Starvation will cause hallucinations of the sight. The ILLUSIONS AND HALLUCINATIONS. 59 narratives of ships Avreckod at sea abound Avith singular phenomena; tho famished victims have seen not only beings before them luring them on with promised food, but they ha\*e had painted before them the most beautiful scenes Avhich the imagination can display,— gardens abounding with Hes- perian fruit, crystal streams, delicious rills, ever-blooming flowers, and all the fascinations that the poet and the painter give to the Elysian fields. Sometimes angels minister to them, robed in celestial garbs, and their last hours are ren- dered happy by the delusions to which the senses gladly lend themselves. There are certain tonics Avhich also have an effect someAvhat extraordinary; of this nature are the prep- arations of iron, more especially when administered to delicate females, but neither in my oavii practice nor in that of the many friends with whom I have communicated, have I learned any particulars springing from actual experience. Hallucinations affecting the sense of smell are not unfre- quent; but they seldom attract much attention, and unless they exist in unison Avith some more striking derangement of the sensorial system, afford but little scope for observation. It is very generally associated Avith a deranged state of the sense of taste ; but this does not necessarily occur. An in- sane person believed firmly that he could detect the exist- ence of cholera by the odor Avhich followed it everywhere. He was first struck Avith it, he said, while dining; it. came upon him like the smell of a dead body; he recognized its existence in a' city, directly he entered it. Esquirol had under his care a female who fancied that she had a most dis- agreeable odor about her ; and on being asked to go into the p-arden, she refused, on the plea that she Avas well aAvare that she should kill all the vegetables there, by the scent Avhich she bore. A certain person insisted that his Avife exhaled at all times a most ambrosial smell, which captivated all who approached her; Avhen the fact Avas she was very unsavory 60 ILLUSIONS AND HALLUCINATIONS. and untidy, and remarkable for anything rather than clean- liness. I have known patients who believed that every object round them Avas impregnated with some disagreeable odor. This is not at all uncommon towards the termination of fever. Those who enjoy religious ecstasies among maniacs speak of the delicious perfumes, of the divine exhalations, of the camphor, the myrrh, the frankincense; the food is holy manna, and the blood is that of the lamb, sAveet and savory. The language used by the poor beings is generally that of happiness, and they are frequently made partakers of some delicious repasts, which ordinary mortals know not of. The hallucination of touch varies exceedingly. It is sin- gular enough to find, in an establishment Avhere an individual has been admitted who believes that he has rats craAvling over him, that spiders infest him, that he receives occasional blows from an unknoAvn hand, how very soon several others of the confined persons take up the same notion; and if by any chance suspicion falls upon any attendant that he has been accessory to a bloAV, all the others Avho complain, whether from cunning or from the Avish to obtain the com- passion Avhich is generally shown, load the. servant Avith charges of being the person Avho annoys them. Some inva- lids will insist on it that cold Avater has been thrown on theiu heads; others that corrosive substances and poisonous poAV- ders have been thrown upon them.; that hence their bodies arc metamorphosed; that they are unlike Avhat they were, and that they are grossly maltreated. Some of them cannot bear the slightest breath of air to blow upon their bodies ; those Avho have Avitnessed the horror expressed by patients labor- ing under hydrophobia Avhen the least air falls upon them, can judge of the horror Avhich some experience when they fancy that they are blown upon. An actress Avho had become melancholy, after expatiating ILLUSIONS AND HALLUCINATIONS. 61 Avith considerable energy upon the miseries which Avere in- flicted upon her by unknown hands, added, " They are not satisfied with these cruelties, but they are employed bloAv- ing, night and day, ingredients Avhich destroy me, upon my skin, Avhich is as pure and unsullied as my heart." Many patients believe that they have swallowed animals, reptiles, insects ; and even those Avho have no other indication of the slightest alteration of intellect, cannot be induced to lay aside the impression. Sometimes they beat the stoma«h and bowels with great violence, often Avounding and severely hurting themselves. They assert that the internal organs have disappeared; they knoAV it by the sense of emptiness, by the hollowness of sound. They occasionally accuse a friend of being the cause, or they lay it at the door of some one to whom they have taken, Avithout apparent cause, a violent aversion. Spiders and mice are frequently charged with being the cause of the mischief, and of having entered into the stomach. Sometimes the head is very light, at others it is enormously heavy; sometimes one arm is longer than another ; there may be three arms, — in fact, Avhen the sense of touch and the general sensibility are disordered, hallucination appears in a thousand indescribable forms, altering every day, and exhibiting itself under the most extravagant guises. Sleep vanishes under their influence ; day and night, for a series of years, are the unfortunate indi- viduals haunted and persecuted ; devils take them by the feet during the night, strike them constantly upon the back at the moment when they most require repose ; they are seized by vampires, Avho during the night suck the blood from their veins till atrophy and deformity of their organs tako place. Invisible agency is constantly at work. In such morbid phenomena as these, undoubtedly Salem Avitcheraft had its rise. The beAvitched people were the subjects of hallucinations of hearing, sight, and touch. There are cases 62 ILLUSIONS AND HALLUCINATIONS. — especially in diseased states, such as delirium tremens — in Avhich the senses all partake of the hallucination alike; the eye, the touch, the hearing, the smell, and the taste are so disordered as to convey unhealthy impressions to the brain. Most generally one of the organs so predominates over the other, that its deviations only are complained of; it is only by examination of the invalid, and by repeated conversation, however, that this is perceptible. At a lead- ing iftsane asylum there is at present a female, about sixty- five years of age, Avho has iioav been of unsound mind for five or six years; she makes daily complaints of the frightful sufferings she has to endure, and Avhich are consequent upon the hallucinations in which all her senses are wrapt. At nio-ht she sees forms that menace her, — heads of bodies Avhich frighten her. Sometimes it is her own image, her oavii portrait, that is represented to her. Once she saAV her mother, Avho has been some time dead, crawl towards her on four paAvs. She constantly hears voices which insult her; oftentimes they tell her melancholy tales, — for instance, they repeat that her mother is dead. They send the bodies of putrefying children to her. She has sometimes the com- plete odor of arsenic. This Avoman Avill eat nothing but bread, because both flesh and vegetables taste of arsenic. Besides all this, she receives blows upon the head — upon the limbs. They give her cramps in the legs, icy sweats, colds ; they take away her breath, and drive the blood to her head. Sometimes an individual gets a fixed idea, Avhich remains knoAvn only to himself. He struggles Avith it perhaps for years, nor reveals the contest going on Avithin him. This " fixed idea " may be either to destroy himself, or to kill some near and dear relative, a wife or mother, for instance. It is only Avhen the madness bursts out with uncontrollable vehe- mence in the porpetration of the terrible act, that it is ILLUSIONS AND HALLUCINATIONS. 63 known. The suicide has long fought with himself, before © © he has rushed to the fatal extreme; the homicidal maniac conceals for an immense length of time the horrors by which he is pursued ; and it is only Avhen he can bear his fate no longer, that he divulges his long-kept secret. There are cases recorded Avhere men laboring under the murderous mania have had themselves bound hand and foot, notifying the persons Avhom they felt irresistibly impelled to kill, of the state of mind in which they were. Sometimes the pas- sion of fear Avill take complete possession of a person. He has a dread of the most overwhelming kind, Avhich gradually groAvs into a most complete oppression, weighing down all the other faculties of mind. It is utterly in vain that he endeavors to drive aAvay the fixed idea; it remains rooted to the Arery inmost part of his being; the very circumstance of his attempting to drive it from him only roots it deeper. At length, completely overwhelmed Avith the intensity of the suffering, he yields himself up to that sole persecuting thought; there is a complete personal inertia, Avhich for- bids him to mingle further Avith the world ; the consciousness of surrounding objects is lost, as Avell as that internal con- science which governs the internal actions of man. The © result of this state of mind is quickly coiiA'eyed to the body, Avhich not only sympathizes Avith it, but is completely gov- erned by it; it is not only that the appetite fails, the poAver of enjoyment, and the desire for locomotion, but the nutri- tion of the body ceases, the secretions are not duly per- formed, the circulation becomes languid, and all the organs are in a state of torpor; this proceeds, gradually increasing, till there is an almost complete suspension of all the poAvcrs by which life is carried on ; the blood, no longer oxygenized, is full of carbon ; it sloAvly meanders through the lhrcr, where the veins stagnate with their fluid ; tke brain is after some time surcharged with this venous blood, and that state Avhich 64 ILLUSIONS AND HALLUCINATIONS. approaches the third stage of intoxication supervenes. During this crisis there is, as in ordinary insanity, a sudden change for the better Avhere relief is obtained ; but where © it has not been.Avatched and prepared for, there is a violent paroxysm, whose intensity bears proportion to the previous depression. This action and reaction, so strongly marked in intermittent fever, affecting that portion of the nervous system Avhich is contained within tho spinal column, produc- ing the phenomenon in its greatest extent, of universal tremor, acting upon the brain, eAridently causes a large por- tion of that Avhich is displayed in the insane, under the guise of alternate depression and excitement. The sudden crisis, Avhich leads to sudden, impulsive acts, in the insane that had previously exhibited the form only of imbecility and stupidity, most probably depends upon some altered state of the arterial circulation, some momentary determination to the brain; and, Avere Ave folloAvers of the doctrines of Gall and Spurzheim to their fullest extent, we should be naturally led to inquire Avhether the organ upon which they assert that homicide depends, was the scat of some instantaneous action. When Ave find that there exists in nature vegetable substances which produce this effect, or which suddenly call into action the desire for spilling blood, we must grant that this is owing to some condition of the brain, produced by a physical agent. It is not brandy or Avhiskey alone that will, in some con- stitutions, cause a fearful ferocity (vide the daily accounts of crime in NeAv York city among the thugs of that mctrop. olis), but there is a vegetable, a species of mushroom, called Ornanita muscovia, whose effects are of the most striking character. Some of the Cossack tribes never go to battle Avithout adding a portion to the spirituous liquors which they take, and they become iuipired Avith a blood-thirstiness Avhich nothing can resist. Even the Cannabis indica has been knoAvn ILLUSIONS AND HALLUCINATIONS. 65 to inspire even a reflecting and humane individual with a desire for destruction ; it often fills the mind Avith an impulse that cannot be resisted. On one occasion, when Dr. Moreau had himself taken it, by Avay of experiment, he piteously entreated that the window should be immediately shut, as he felt coming over him an irresistible propensity to throw him- self out. CHAPTER IX. SLEEP AND SLEEPLESSNESS. What refreshment and reinvigoration good sound sleep brings to jaded, deranged nerves ! Sancho Panza blessed the man Avho invented sleep. It is, indeed, the best medicine of nervous disease, and it is precisely the most difficult thing for the nervous patient to obtain,— that is, good, sound, natural sleep. People may sleep too little or too much, too early or too late. OA^ermuch sleep leads to corpulence, sluggish- ness of the general functions, congestions of the chief viscera, especially of the head, endangering attacks of apoplexy and death. It is the bon vivant who is disposed to sleep ; a doze in his easy-chair after dinner, and an inclination to nod over the neAVspaper or during a prolonged discourse. The Avell- nourished require more sleep than the lean, and the phleg- matic more than the irritable. But in the present day som- nolent obesity is a rare phenomenon. Tho evil that we have to complain of, is an incapability of sleeping enough. There is no fixed duration for sleep. The Avorld roars around us like a torrent of events. Everything is rapid; and Ave are Avhirled Avith velocity in the midst of a vortex as vast as it is incessant. Repose there is none; and instead of sleeping on a pillow of down, Ave stand continually on the tiptoe of expectation, aAvaiting tho coming on of to-morrow, big, as it Avere, Avith the doom of some great hereafter. It [66] SLEEP AND SLEEPLESSNESS. 67 is impossible to sleep ; nay, it is scarcely possible to survive. This morbid excitement, fictitious though it be, is in reality the pregnant source of a large family of ailments, of which mania is neither the youngest nor the most insignificant child. A sleepless night cannot be recovered from by any sub- sequent siesta snatched out of the business of the day. We must wait for the following night, go to bed early, and sleep soundly, if we hope to awake refreshed the next morning. Nor can exhaustion from the want of sleep be relieved by stimulants, either in the shape of food or medicine, although the late hours of the modern world, which induce a perpetual lassitude both of mind and body, are alleged as one of the chief reasons, if not of the poor excuses, for indulging in wine and hot condiments. There is a form of conditional drunkenness to Avhich people in good society are addicted, without being aware of it, that produces effects quite as per- nicious as dram-drinking among the loAver orders : Ave mean © O the free use of Avine at the dinner-table. Such persons with- out suffering in appearance, or losing flesh, get into a chronic state of disturbed health, manifested by impaired digestion and irritable nerves. Deprived of his usual mod- icum, the gentleman is unable to sleep, and becomes in a certain degree delirious, unless alloAved to return to his ordinary habits. There is likewise a chronic sleeplessness, chiefly among the better classes, where individuals suffer from an almost total want of rest for months together, with- out any loss of flesh, or visible impairment of the constitu- tion. Such cases get well of themselves, after a shorter or longer period, and do not require any medical treatment. The eAal consequences of not sleeping enough are clearly manifested in the features, which become pale, lank, and sharp ; the eye cold, blanched, and watery ; the hair shabby, straight, and long ; the deportment wan, and the feelings Ian- 68 SLEEP AND SLEEPLESSNESS. guid. The palms of the hands are hot, the lips dry and peeling, and the utterance feeble or tremulous, while a Ioav fever feeds upon the vitals. If the want of sleep is volun- tary, as in the pursuit of some necessary or interesting occu- pation, or in consequence of fashionable engagements, it saps the strength at an early period; men become old at thirty- five or forty ; and Avomen, wasted in their prime, suffer from difficult childbirth, or die in consequence of it. A city life is most baneful in this respect, and may be considered as limiting the average of longevity to forty-five or fifty years. Those Avho go to bed late rise early, and early risers are for the most part forced to retire equally early. Students, Avho require more sleep than others, usually rise too early, and sit up too late. Modern fine children, who are taught to mimic their elders, are exotics, flowering in an artificial atmosphere, but withering without fruit long before the morning of their days has passed over their debilitated heads. Nor learning nor fame nor money nor power is equivalent to an elastic, vigorous constitution; nor are the lesser virtues usually styled accomplishments, pleasing and graceful as they may be, of any value in comparison with the decrepit nerves, and the still more decrepit morals, Avith which they have been purchased. The older physicians paid much more attention to this inquiry than modern physicians and physiologists are accus- tomed to do. Hippocrates long ago pointed out the impor- tance of denoting the kind of sleep, the nature of the dreams, and the particular posture of the sleeper hi bed, as an acces- sory means of forming a correct diagnosis of his disease. AlloAving for some puerilities peculiar to the remote epoch in which he flourished, the fourth book of his treatise, entitled "Regimen," is a much more practical essay on this subject than anything else of the sort that has yet been put forth by later pathologists. Although Dr. Marshall Hall observes SLEEP AND SLEEPLESSNESS. 69 that sleep is a cerebral affection, and that the spinal and gan glionic systems never sleep, yet our notions are, Ave cannoi help aA'OAving, somewhat different from his on this subject It seems to us that the poAver of sleeping is much more inti, mately connected Avith the medulla oblongata and spinal cord, than with the cerebrum and superior portions of tho hemispheres. The whole nervous system is a unit or entity, in its essence compounded of distinct parts, entirely united in their different, but by no means separate functions. The intellectual poAvers would seem to belong to the cerebra, perhaps to the cortical substance, or gray matter alone, as some suppose; the several senses Avould appear to have their origin or root at the base of the brain; the faculties of the mere animal organs are apparently governed by the cer- ebellum, Avhile those of locomotion, speech, respiration, etc., are evidently connected Avith the pons variolii, the medulla oblongata, and the spinal cord. N'oav sleep is an absolute suspension of sense and motion; but then these two func- tions, or sets of functions, are under the rule of the spinal cord; so that the spinal cord Avould seem to be the imme- diate locality, if not the truo centre, both of rest and action, progression and repose, locomotion and inertia, or, in other words, of Avaking and sleeping. There are several physiological as avcII as pathological phenomena confirmative of this \'icw of the case. It has been proA^ed that the pupil of tho eye is closed almost to a point not larger than a pin-hole during sleep ; that the eyeball like- Avise is turned upAvards, and that the upper eyelid falls down. These phenomena are also the symptoms set down as indicat- ing disturbance at the base of the brain among the diseases of that organ. For a very contracted pupil is almost always a fatal sign, by showing loss of poAver at the origiii of the respiratory nerves, whether from effusion or injury or natural dissolution. The turning upwards of the eyeball 70 SLEEP AND SLEEPLESSNESS. is a common symptom of convulsive affections proceeding from spinal irritation, or mechanical mischief of that part. And the drooping of the eyelid is indicative of incipient paralysis, or loss of power, in the cord and medulla oblong- ata, often forerunning paraplegia, loss of speech, and failure of the locomotive power in general. These signs, AA'hich are, physiologically speaking, in one sense the phenomena of ordinary sleep, become, in another, leading symptoms in the natural history of disease of the brain; and both the symptoms on the one hand, and the phenomena on the other, point directly to one part of the grand system of nerves, namely, the medulla oblongata and the spinal cord. That sleep should be less connected with the cerebrum than with the spinal cord is not so unlikely, if Ave consider the nature of each part of the nervous system respectively; for we shall be enabled to remark, that sleep, Avhich is the sus- pension of action, belongs to the spinal portion rather than to the brain or cerebrum, Avhich, as the focus of Avill and intelligence, only exerts itself in governing the rest of the frame, and ceases from exertion as soon as the rest of its parts cease to require governing. Disturbance of the supe- rior hemispheres will of course hinder the cord from sleep- ing quite as effectually as irritation of any other part of the body Avould do; but Ave mean that, in health, sleep belongs to tho cord rather than to the brain. Wakeful- ness is one of the most vexatious symptoms of spinal dis- ease ; of spinal exhaustion from veiiery, or excessive pedes- trianism; of spinal irritation produced by a sort of reflex action from acid indigestion accompanied Avith cramps of the legs, and of profuse diarrhoea, exhausting the spinal cord so greatly as to give rise to incurable paraplegia. All these signs, symptoms, and phenomena lead to one and the same conclusion, — that the spinal cord, rather than brain, is chiefly concerned in sleep and sleeplessness. But SLEEP AND SLEEPLESSNESS. 71 the ablest psychologist must admit that it is beyond his poAver to explain the nature of sleep. The best works on physiology offer us nothing more satisfactory than probable opinions, curious conjectures, and interesting theories, while pretending to solve a problem Avhich still remains, as it has hitherto remained, the monitor of the end of all things, — the daily rehearsal of our death. There are some curious in- stances on record of sleeping and waking. In Turkey, if a person happens to fall asleep in the neighborhood of a poppy- field, and the wind bloAVs over towards him, he becomes gradually narcotized, and Avould die, if the country people, who are well acquainted with the circumstance, did not bring him to the next Avell or stream, and empty pitcher after pitcher on his face and body. There is a reported case of a gentleman, thirty years of age, who, from long-continued sleeplessness, Avas reduced to a complete living skeleton, unable to stand on his legs. It Avas partly owing to disease, but chiefly to the abuse of mercury and opium, until at last, unable to pursue his business, he sank into abject poverty and woe. The poAver of Avill may obtain or dissipate sleep. Some persons have the poAver of Avilling themselves asleep as soon as they lie down. There is no doubt that the habit of doing so may be easily acquired. Some people require vastly more sleep than others. There are cases recorded of people sleep- ino- seventeen or eighteen hours a day for years, or taking a solid nap a month or six Aveeks in length, while in other cases four or five hours' sleep in the twenty-four was all that Avas taken or needed by persons remarkable for their activity and influence over mankind. According to Wilkinson, the ancient Egyptians, who, as everybody knoAvs, shaved their scalps, slept with their heads resting on an iron prong, like that of a pitchfork, welted with something soft. This they did for the sake of keeping their heads cool, which they sup- posed strengthened their Avits, •72 SLEEP AND SLEEPLESSNESS. The sentinel will sleep at his post; an entire battalion of cavalry have been known to sleep on the march. It is about three or four o'clock in tho morning that this pro- pensity to sleep is the most overpowering,—the moment seized upon by troops for driving in the enemy's outposts, and taking the bivouac by surprise. Maniacs are reported, particularly in the eastern hemisphere, to become furiously wakeful during the full of the moon, more especially Avhen the deteriorating ray of its polarized light is permitted to fall into their apartments, —hence the name lunatics. Sleeping directly in the moon's rays is said to be at all times preju- dicial. There is certainly a greater pronenesi to disease dur- ing sleep than in the Avaking state; for those Avho pass the night in malarious districts inevitably become infected Avith the noxious air, Avhile travellers Avho go through Avith- out stopping escape the miasma. Intense cold induces sleep, and they who perish in the shoav sleep on till they sleep the sleep of death. Children sleep a great deal; infants much more irregularly; while the old man scarcely slumbers at all, watching, as it Avere, his end approaching The bromides of potassium, etc., are iioav greatly used to drug the posset of repose in disease and nervous attacks. Allowing the patient to get up and Avash himself and walk about his room, making his bed afresh, giving him a glass of cold Avater, or wine and Avater, will often succeed in procur- ing refreshing sleep Avhen all other means have failed. These are practical points calling for experience and judgment in their application. In these instances of Avakefulness, Avhich are frequently observed towards tho close of acute diseases, it is always necessary to repeat the soporific or opiate for some time after the first symptoms have been checked. The same practice is likeAvise pre-eminently useful in the first stage of delirium tremens, in its congestive onset, before the sub- SLEEP AND SLEEPLESSNESS. 73 acute inflammation and milky effusion have ensued. The irritability, Avatchfulness, and phantasmagoria of this peculiar malady are best treated by a combination of bitters, alkalis, and opiates, or else Avith tonics and opiates at the same time. Sometimes hot sponges applied to the head will cause sleep, and sometimes cold. Nothing will relieve the Avakefulness of old age; nor should soporifics, particularly opium, ever be tried, since the dose that is sufficient to procure sleep, may end in death. CHAPTER X. EPILEPSY. Those who have attended the lectures of Brown-Sequard, the greatest living neurologist, well remember how he pro- duced the convulsions of epilepsy in a guinea-pig. This will illustrate the insight which is being obtained into the physi- ology and pathology of the nervous system. Epilepsy is the most celebrated of the neuroses. " It is,'"says Hammond, " characterized by paroxysms of more or less frequency and severity, during which consciousness is lost, and which may or may not be marked by slight spasm, or partial or gen- eral convulsions, or mental aberration, or by all these circum- stances collectively. The essential element of the epileptic spasm is loss of consciousness." Some very famous men have been epileptics. There are slight paroxysms and severe. "The respiration is forced and irregular, froth issues from the mouth, and, if the tongue has been bitten, it is covered with blood." During the seizure the epilept is liable to make the most outrageous and furious demonstrations. Some of the greatest writers have been epileptics. One of the greatest living British poets is said to be. Dr. Ham- mond gives as causes of epilepsy in one hundred and two of his cases, fright, anxiety, grief, over mental exertion, denti- tion, indigestion, venereal excesses, menstrual derangement, [74] EPILEPSY. 75 bloAvs on the head, falls, sunstroke, scarlet fever, measles, diphtheria, pregnancy, syphilis. The starting-point of epi- lepsy, according to Brown-Sequard, is often the sympathetic nerve ; but generally the seat of primary derangement is, according to Reynolds, the medulla oblongata and upper portion of the spinal cord. The derangement consists in a perverted readiness of action in these organs, the result of such action being the induction of spasm in the contractile fibres of the vessels supplying the brain, and in those of the muscles of the face, pharynx, larynx, respiratory apparatus, and limbs generally. By contraction of the vessels the brain is deprived of blood, and consciousness is arrested; the face is or may be deprived of blood, and there is pallor; by con- traction of the vessels, which haAre been mentioned, there is arrest of respiration, the chest walls are fixed, and the other phenomena of the first stage of the attack are brought on. The arrest of breathing leads to the special coiiA'ulsions of asphyxia. The subsequent phenomena are those of blood poisoned by the retention of carbonic acid, and altered by the absence of a due amount of oxygen. It may be induced by conditions acting upon the nervous centres directly, such as mechanical injuries, overwork, insolation (sunstroke), emotional disturbances, excessive venery, etc. The bromides of potassium, lithium, and sodium, and the oxide of zinc, are invaluable remedial agents in the treatment of epilepsy. It Avas anciently called the falling sickness. The importance of hygiene in this neurose is considered equal if not superior to that of medicine. There are some prac- titioners, even, who look upon medicine as utterly useless in such cases, and place their sole reliance on such measures as serve to guard the patients against the causes which induce the fits, and favor the action of such natural agents as are capable of changing the constitution. Hippocrates recom- mended a change of climate. 76 EPILEPSY. Epileptic fits are much more common in extremes of heat and cold than in a climate little subject to atmospheric changes. Excess in quantity or quality of food or drink will prove injurious. More vegetable than animal food should be taken, and cooling fruits may also be used. Complete abstinence from Avine, or at any rate the use of the least stimulant Avines, is recommended, and such should only be taken in moderation. Those patients Avho are liable to be attacked during the night, should make but a light supper, to aAroid increasing the cerebral plethora, Avhich is always greater during sleep. Cleanliness, baths, frictions, and Avarm clothing are requisite. The hair should be cut short; in bed the patient should lie with his head high, to assist the circulation of the blood through the brain. Con- stipation should be avoided. Continence is essentially the virtue of the epileptic; sexual intercourse produces a ner- vous shock, Avhich too closely resembles the emotion which occasions the epileptic attack, not to be attended Avith great danger. Those who practise onanism have in general the greatest number of fits. A peaceable and quiet life suits the epileptics best. Exercise is very salutary; an inactive, sedentary life increases the morbid predisposition, and ren- ders the consequences of the fits more deplorable. Gardening, horse exercise, the gymnasium, swimming, etc., are recommended. But out-door work, such as agri- culture and gardening, are the best exercises. Variety of occupation, intermingled with amusing relaxations, Avill prove serviceable in cases of epilepsy. Intellectual em- ployment requiring deep thought is injurious. Reading, drawing, music, light compositions, and the elements of chemistry, botany, physics, etc., afford great satisfaction, and sustain the moral powers instead of exhausting them. With respect to the treatment during the fit, it resolves itself almost entirely to the prevention of bodily danger by EPILEPSY. 77 falls or otherwise. The patient should generally be placed on his back in bed, all tight articles of clothing removed, the head a little raised by pillows, in order to diminish the determination of blood to the head, and the body placed a little on one side, in order to favor the discharge of saliva, which collects in quantity in the mouth, and might otherwise prevent the passage of air into the lungs. Some patients! Avhen attacked during the night, have an unfortunate ten- dency to turn on the face, and unless carefully watched, and their position changed, may die asphyxiated. Another acci- dent, which occurs in some instances, is the laceration, or even the amputation, of the tongue during the fit. To pre- vent this, a piece of wood, or a linen roll, may be placed between the teeth, when the fit is coming on. CHAPTER XL THE SUICIDAL PROPENSITY. It is said that as long as the most instant and efficient agents of self-destruction are openly sold in every street, at little or no price, and to any purchaser, without either let or hinderance, so long will suicides be frequent, and even in- crease. The victim of the more extreme forms of nervous disorder, from Avhatever cause arising, undoubtedly feels at times a propensity to suicide, even the valley of the shadow of death seeming to him a refuge from the ills of a deranged nervous system. The inventor of the revolver has probably furnished to the suicidally given the most efficient means of self-destruction. The Avriter Avas once talking, in his office, with a patient suffering from nervousness, avIio was detailing his misery and Avretchedness, when, in the midst of his ac- count of his condition, he suddenly drew a revolver, and put- ting the muzzle to his head, said he had a mind to bloAv his brains out on the spot. He had cocked the Aveapon, and the least motion of his tremulous forefinger Avould lurve been fatal. Here Avas a dilemma. With the utmost sang froid, the writer pretended to be struck by some peculiarity of the weapon, and quietly requested of his patient permission to ex- amine it, at the same time expressing a wish to compare it Avith a revolver belonging to himself, which Avas in a neighboring closet. The Aveapon was politely handed over for examina- [78] THE SUICIDAL PROPENSITY. 79 tion, Avhich of course terminated the possibility of a tragedy at that consultation. It is a fact that suicides are increasing to an alarming extent in this country. The most influential causes of suicide in a free, enterprising, commercial com- munity like ours are the range given to the social passions ; the hazard and losses in mercantile and joint-stock specula- tions and companies; habits of dissipation; the indolence and ennui consequent upon Avealth and sated enjoyment; the importance attaching to public opinion, and the insta- bility of that opinion; the violent shocks and collisions of opposing parties, and the details of crime and suicide which constitute a principal part of the daily reading of all classes of the community. The history of all nations has demon- strated the prevalence of this act, both as a disease and a psychological phenomenon, during periods of surpassing luxury, of criminal debasement, of public commotion, and of the decline of public and private spirit and virtue. A French writer remarks that the high civilization and refinement, the luxury, the clash of interests, the repeated political changes, combine to keep the moral feelings of the Parisians in a state of tension. Life does not roll on in a peaceful and steady current, but rushes onward Avith the force and precipitation of a torrent. The drama of life is full of miscalculations, disappointments, disgusts, and de- spair; hence the numerous suicides. When a person labors under a suicidal mania, we believe it may generally be recognized by other signs; as deep melancholy, eccentricity of conduct, etc. Most of those suicidally inclined labor under a constant depression of spirits, presaging nothing but evil; imagining that they have committed some heinous offence; that their friends have forsaken them, and are Avatching their movements; that they are hated and despised by the world; they com- plain of neglect; become morose and taciturn ; utter bitter 80 THE SUICIDAL PROPENSITY. complaints; weep; say they have committed the unpar- donable sin; that their damnation is inevitable, etc. More or less bodily derangement is usually present in these cases, as a weak and irritable nervous system, quickened circulation, imperfect digestion, and especially derange- ment of the liver or hepatic function. After this state has continued for some time, the mental derangement be- comes more prominent, and the Avretched victim begins to see A'isions and to hear strange voices, and believes that he has communications from superior beings. At this time the idea of self-destruction is frequently if not con- stantly before the mind, and unless the patient be narroAvly watched, he will finally succeed, after various attempts, in accomplishing his purpose. Suicides are most frequent among persons of the melancholy temperament and bilious constitution, Avith a pale or sallow or yellowish complexion, and hard or sharp features. But the suicidal act is not infrequently committed by the nervous and irritable, and CAren by the sanguine and plethoric. Females of this latter constitution occasionally attempt or perpetrate self-murder just before or during the catamenia, or from some irregu- larity of this evacuation. M. Esquirol states, that the scrof- ulous diathesis is remarkable in the number of suicides. Both sexes display the suicidal tendency, but the male sex most frequently. M. Esquirol considers the proportion of males to females to be three to one ; but there arc differ- ences according to countries, arising from the greater or less influence of many of the circumstances sIioavu to favor this act. Thus in France there are more suicides among women than in Germany. It has been observed, both in England and on the continent, that nearly two thirds of suicides were unmarried. This state, therefore, is much more favorable to self-destruction than the married condition. Suicides in states of mania or delirium occur either from some involun- THE SUICIDAL PROPENSITY. 81 tary or blind impulse, or from some delusion, hallucination, or false perception. A patient for whom I was consulted during an attack of mania, from which he recovered, expe- rienced after a time similar symptoms to those which ushered in the former attack. His friends Avere directed to take the necessary precautions regarding him; but these he eluded, and committed suicide. In melancholia, and other states of partial insanity, or even previously to any symptoms of in- sanity being sufficiently prominent to attract notice, or in consequence of some mental shock or perturbation, the pa- tient may conceive that an internal voice calls upon him to commit suicide, and may sometime act in conformity Avith it. A lady consulted me on account of headache, during Avhich she could not look upon a knife Avithout experiencing a strong desire to use it against her own life ; but her reason © © ? had always resisted the impulse, which disappeared after treatment. Among persons Avho have been but little accus- tomed to self-control, or to listen to the dictates of moral principles, such impulses are often soon acted upon. M. Esquirol furnishes several instances. A monomaniac, he states, heard a A'oice Avithin him say, " Kill thyself! kill thyself! " and he immediately obeyed the injunction. This Avriter remarks, that he has never known an instance of suicide from an irresistible impulse, Avithout some secret grievances, real or imaginary, serving as motives to tho suicidal propensity. There are few states of partial insanity that may not be attended or followed by this pro- pensity. Of the delusions Avhich characterize melancholia, there are none more productive of self-destruction, as Dr. Darwin has remarked, than the fear of future damnation and of present poverty, although the former apprehension o-rows less and less operative from the softening of the penal parts of religious creeds. Reverses, mortified pride, impa- tience under misfortune, and disappointments, are frequent causes of suicide, especially in commercial countries and 82 THE SUICIDAL PROPENSITY. under free governments, Avhere there is a constant straining, among almost all classes, after wealth, office, and other direct or indirect means of power. Instances of self-destruction from mortified pride, consequent upon the failure of attempts at becoming conspicuous at public meetings, in the senate, or at the bar, or even upon the boards of a theatre, are not rare in modern times. Self-murder has been often perpe- trated in order to escape exposure and punishment conse- quent upon detected crimes. Indeed, this is one of the most common moral causes of suicide in this and other civilized countries, and instances of it are of daily occurrence. The desire of escaping from moral or physical pain, or from an- ticipated or impending want, is not unfrequently productive of self-destruction. Under this head may be comprehended seduction, and despair however produced. Physical pain is much less frequently a cause of suicide than moral suffering. Many, howeA-cr, of the ancient stoics put an end to pain by terminating their lives. I have been told by several persons that, Avhile suffering the pangs of neuralgia, it required the utmost efforts of their moral principles to restrain them from perpetrating self-murder. Numerous instances arc on record of persons who, having believed themselves suffering incur- able maladies, have had recourse to suicide as a more pleas- ant mode of dying, the act being committed under the impression that a natural death is more painful than that in- flicted by themselves. But this is a mistake. Death from disease, even Avhen the mental faculties arc retained to nearly the last, is attended by a gradual abolition of the sensibility that is by no means painful or distressing; the patient ceas- ing to exist as hopefully and calmly as Avhen falling asleep, unless under peculiar circumstances. Suicide is often com- mitted in states of irritation and chagrin, particularly by per- sons of a morose, splenetic, or irritable temper. It is some- times suggested to such persons by a desire to excite regrets THE SUICIDAL PROPENSITY. 83 or self-reproach in the minds of those who have offended them by a feeling of revenge. Most of the suicides com- mitted by children are caused by a desire of this kind, par- ticularly when they follow punishment of any description. Suicide arising from jealousy also depends chiefly upon the promptings of this feeling in connection with anger, and is most apt to occur in hysterical, nervous, or weak-minded females. Some years ago I was present at an evening party, where a young lady, engaged to a gentleman present, was seized with hysterical convulsions in consequence of his attentions to another. The following day she was taken out of a canal in her full dress, she having gone upAvards of a mile ha order to carry her design into execution. A lady on a similar occasion took a large quantity of laudanum. The usual means of restoration producing no effect, I was ultimately sent for. She was finally recovered by the effusion of cold water on her head. Domestic contrarieties and misery; the frequent recurrence of petty vexations; the tyranny of intimate connections, and the positive ill-usage of others; suits in courts (misnamed) of justice may from their continu- ance, severity, and repetition, especially under aggravating circumstances, and in states of high susceptibility in the unhappy sufferer, drive even the strong-minded and the Avell- principled into a state of temporary despair and desperation, — may fire the brain to madness, during which self-destruc- tion may be attempted. A most talented and accomplished young lady, suffering from a combination of the above cir- cumstances, took, upon retiring to rest, a very large quantity of laudanum, more than is usually productive of a fatal effect. She wakened late the following day with a most dis- tracting headache and general disorder, recollected the act of tho previous night, regretted the attempt, and sent for medical aid, determined, however, to conceal the cause. Her 84 THE SUICIDAL PROPENSITY. health from this, and other circumstances alluded to, con- tinued greatly impaired for many years, and several physi- cians were consulted. She came under my care, and at last mentioned the suicidal attempt, which was never further divulged. She now continues in good health, to ornament the society in which she moves. The state of desperation into which a person inflamed by the passion of loA'e may be thrown by disappointment, is actually that of insanity, at least moral insanity. A gentleman endeavored to obtain the favorable notice of a lady, of Avhoin he had become enamored, but had not succeeded. He committed suicide by opening a vein in his arm, and, while the blood was floAving, he wrote a note Avith it, acquainting her Avith his act. She was soon after attacked by nervous fever, Avhich Avas fol- loAved by insanity, during which she fancied that she heard a voice commanding her to commit suicide. Instances of © associated suicide are not rare, particularly in recent times. A wide publicity was not long ago given to the mutual suicide of two young girls at Lewiston, Maine, by drowning. Not unfrequently one of the parties who have agreed to commit suicide, only pretends to do it, with the intention of getting rid of an object no longer one of endearment. Mur- der is often committed first, and suicide afterward, prompted by jealousy. Suicide is often feigned or simulated Avith a view of obtaining a desired end; the lover threatens or seems to attempt it, to induce a return of affection ; the spoiled child, to obtain a compliance Avith his Avishes; and the indulged wife, submission to her caprices. In such cases but a small portion of laudanum is usually procured, and this is diluted with some fluid, to increase the apparent quantity, or a large quantity is taken when seen by some person, or Avhen instant relief may be obtained. Females have resorted to this plan to try the affection, or to compel the fulfilment of the en- gagement of their lovers; but in cases of this kind, little THE SUICIDAL PROPENSITY. 85 more is necessary to be known than that such acts are some- t hues resorted to ; and that a poisonous dose may be actually taken, in order to appear the more in earnest, knowing that assistance is near, and that it Avill be successfully employed. DroAvning even may bo feigned in similar circumstances. I have, hoAvever, seen tAvo cases in Avhich fatal results very nearly followed this experiment upon the endurance of affec- tion. Circumstances predisposing to suicide are hereditary predisposition (Dr. Gall has observed the suicidal predis- position in several successive generations, I have known it in three generations) ; the melancholic, bilious, and irritable temperaments ; the middle period of life; the unmarried state; masturbation and sexual excesses; drunkenness; immoral amusements and exhibitions; the perusal of loose productions and of criminal and suicidal details; idleness and indolence ; habitual recourse to powerful mental excite- ment ; states of the air or of the weather, occasioning depres- sion of the nervous energy; disappointed love; jealousy; o-amblin"-; poverty ; fanaticism ; debt and domestic trouble ; disgust of life ; religious excitement; matrimonial strife ; disease and pain ; crime and remorse. It is Avell known that many philosophers and distinguished Avriters have attempted to defend suicide under certain circumstances, on the ground that he to Avhom life has become a misery and burden, has a right to rid himself of it. © A French writer on the subject of suicide, dogmatically announces that " Suicide is the last term, the highest expres- sions of man's liberty ! Why have not animals ever con- ceived suicide ?'*' he asks. "Because their nature is every Avay passive. They have not the choice and the preference. Man, on the contrary, eminently active and free, has been able to push his activity even to the destruction of himself." But this is an old idea of the Roman Avriter Pliny. " Indeed," says Pliny, "this constitutes the great comfort in this imper- 86 THE SUICIDAL PROPENSITY. feet state of man, that even the Deity cannot do everything. For he cannot procure death for himself, even if he wished it, which, so numerous are the evils of life, has been granted to man as a chief good." Let us have a care. We have apolo- gists for suicide even now, and upholders of it, and the pre- scriptions of both the law and the gospel in reference to it are in a great measure unheeded. This is not a bad starting- point and groundwork in favor of a reactionary movement, sympathetic of suicide ; and if we do not take heed, we shall have our young men and maidens looking upon the deed as a matter of feeling, and not of morality, while sympathy for the self-destroyer would find an outlet in song. Would you have an example of the song ? " Then hie thee to the rope-yard, boy, And purchase me a cord; Ride slowly home and give it me, But do not speak a word." The frequency of suicides varies at different ages. Dur- ing the early epochs of existence, the sanguine expectations, Avhich are generally indulged, and Avhich soon take the place of temporary despondency and distraction occasioned by dis- appointments and losses, tend to diminish the number of sui- cides. In the middle and more advanced period of life, sensibility becomes exhausted or blunted, Avhile cares and anxieties increase in number and intensity; and the attachment to life is much impaired. The desire of life afterward increases, and frequently in proportion as old age advances. It is from thirty-five to forty-five that the greatest number of sui- cides occur. After forty-five suicide becomes more and more rare; and above seventy there are scarcely any instances of it. It is difficult to obtain the actual statistics of suicide in a given city or community, as many cases are undoubtedly reported under other heads, as " sudden," " apoplexy," etc. THE SUICIDAL PROPENSITY. 87 In a work on Nervous Affections and Nervous Disorders, it was impossible to overlook the momentous subject of sui- cide, as nervous depression, and general or partial or mo- mentary insanity, always precede the dread act of self- destruction. There is usually cerebral disorder connected Avith it. The increasing frequency of suicide, as well as of manifest insanity, forces it upon the attention of all practi- tioners AArho make nervous diseases a specialty and study. Of course, so far as suicide is a product of vicious states of society, it is beyond the power of the physician. But the nervous condition which leads to it is curable by the pow- erful remedial agents which have been added to the Materia Medica Avithin the last decade, and which enable the skilful special practitioner to minister to a mind diseased, and restore the equilibrium of the most disordered and demoralized ner- vous system. In a young and hopeful community like our oavii, Avhere "there is no shadow, no antiquity, no mystery, no picturesque and gloomy Avrong, nor anything but a com- monplace prosperity," suicide ought to be rare. But it unfortunately is not. Our people are beyond all others a nervous, and therefore, under the pressure of great mental excitement, a desperate people. NoAvhere else is there such a desperate and reckless pursuit of gain. It is to the ner- vousness of our people that the frequency of suicide Avith us is to be attributed. Of the hopeless and appalling poverty Avhich characterizes the dense communities of the Old World avc knoAV but little. But our morbid passion for excitement, our disposition to stake everything upon a single throAv, the frequency of our contested elections, and the personal and excitin^ character of our political contests, all contribute to demoralize the nervous system, and overturn the equilibrium of the brain. Add to this the variety of foods, and the burn' of eating, Avhich lead to dyspepsia, —a disease Avhich at middle age causes low spirits, listlessness, and tedium vitas, 88 THE SUICIDAL PROPENSITY. or disgust of life, the very disposition of mind which leads directly to suicide. The suicidal propensity is almost always the result and accompaniment of nervous disorder and cere- bral disease. If the medical adviser of one suicidally given has the medical means of dealing effectively and promptly with nervous disease in all its manifold gloomy and despair- ing forms, he can restore his patient to cheerfulness and health, and to that loA'e of life which is so natural to the healthy man or Avoman in a normal condition. It is need- less for the Avriter to say that in his markedly successful combats Avith nervous disease in all its forms and in thousands of patients he has utterly ignored the old-fashioned treatment, AA'hich consisted of local vascular depletion (bleeding), dry cupping, setons, blisters, repeated blood-lettings in the im- mediate vicinity of the brain, etc. He cures mental and nervous maladies by a different mothod, and by a remedy the result of a more advanced medical knoAvledge, than that which dictates such coarse and sanguinary attempts at heal- ing a disordered mind and unstrung nerves. That his rem- edy while simple is sure, prompt, and decisive in its action, hosts of those Avho owe their restoration to health, business, and society will testify. CHAPTER XII. TREATMENT OF THE INSANE. The most important question in psychological medicine and mental pathology, is concerning the treatment of the insane. Volumes luwe within a few years been Avritten on this subject in all the languages of the civilized Avorld, and the discussion still goes on. A Avriter on this subject says : " I doubt if ever the history of the Avorld, or the experience of past ages, Avould sIioav a larger amount of insanity than that of the present day. It seems, indeed, as if the world Avas moving at an advanced rate of speed proportioned to its approaching end; as though in this rapid race of time, in- creasing with each revolving century, a higher pressure is engendered in the minds of men, and Avith this there appears a tendency among all classes constantly to demand higher standards of intellectual attainment, a faster speed of intel- lectual travelling, greater forces, and larger means than are consistent with reason and health." It is a matter of no slight difficulty to determine, in all cases, the primary or predis- posing cause of mental disorders, apart from an hereditary taint existing in the constitution, and Avhere there is no posi- tive mental deficiency from birth ; for it is only too probable that from a much earlier period than the actual manifestation of disease, the fuel has been laid; and it therefore becomes a matter of grave consideration for those who may have the [89] 90 TREATMENT OF THE INSANE. poAver vested in their hands, not so much for the cure, but, Avhich is of far greater import, the prevention of disease, that many carry about Avith them unsuspected, perhaps, through a long life-time the seeds of insanity. There is a fearful balance of minds wholly free from inherited taint or consti- tutional infirmity, and yet doomed to break down in the terrible struggle of the age. Insanity A'isits all classes of society alike, with an impar- tiality like that of death. The amplest means of earthly enjoyment Avill not purchase exemption from it. Indeed, it often happens that an hereditary mental taint descends as a curse Avith hereditary Avealth and high social position. Fail- ure of health, pecuniary embarrassments, oArer anxiety, too great application to business, etc.-, are among the ordinal recruiting sergeants, so to speak, of the ranks of mental darkness and imbecility. Causes of insanity are not far to seek among those, for instance, Avho earn their bread by the sweat of their broAV; Avhose lives are a continual struggle, ©© " whoso daily toils are unmitigated by pleasure, to Avhom each morrow brings fresh cares, and night scarce brings repose. The hard-worked professional man, Avho spends his days in painful efforts to make two ends meet; the avaricious man of commerce, only aiming to double his gains and grind fresh profits from his wares; the speculating capitalist, eager to lay out his treasure in the best market; the adventurous mer- chant, Avhose temple is the counting-house. What a restless sea ! What troubled Avaves of thought and care rise up even within this single catalogue of callings! But look avc further; observe the young of all classes, Avith Avhat sui- cidal frenzy they commit themselves to sorroAv. AVhether in obedience to the promptings of high ambition, weaving an entanglement of thought, and straining the sinews of the mind in attempting to achieve the gain of riper years, and to Avrest the victory ere the battle has begun; or else, led TREATMENT OF THE INSANE. 91 spell-bound by passion, the poAArers and resources of youth are squandered in the bed of tho voluptuary ; sin sinking into the heart Avith all its accursed stains, polluting the foun- tains of reason at their source, and embittering the springs of life. Do Ave not find here predisposing causes Avith a ven- geance, borne it may be long, but only Avaiting for the spark to fall ? The tendency of dissolute habits toAvards inducing aberra- tion of mind need not be dwelt upon. If prolonged habits of dissipation frequently predispose toAvards insanity, fits of intemperance prove not seldom the immediate exciting cause. Intemperance is indeed a fertile source of insanity. The prevailing superstitions of the day — spirit-rapping, table-turning, etc. — exercise their baneful influence on sus- ceptible minds. These are rocks in the fathomless sea of mysticism, on Avhich many an empty head has split, and many a shallow mind been stranded. But to our more immediate subject, the treatment of the in- sane. Among the multitudinous works and periodical essays on this momentous subject, Avith Avhich the press has labored of late, the Avriter is happy to refer to an American book, with the significant title, "Behind the Bars," as containing, upon the whole, not only the latest but the best word upon the ques- tion under consideration. The author of this most searching and interesting exposition of the faults of the present system of treatment of the insane, apparently Avrites from his or her oavii experience as a patient. But the criticism of a vicious system is tinctured Avith no harshness for that reason. In- deed, I understand that this little book has already produced a decided amelioration and revolution in the mode of treat- ment in our oavii immediate asylums. I cannot do better than to make several extracts in extenso from this work. Says this writer: " If these nervous diseases must be treated by some systematic form, surely no suitable progress has yet been 92 TREATMENT OF THE INSANE. made towards it, and no steps taken Avhich are sufficient in conformity Avith all that it seems to require. Many afflicted Avith nervous diseases would shrink from the very name of an insane asylum, or any retreat with so professional and formidable a sound, yet Avho would gladly avail themselves of some sort of refuge, some temporary home (which asy- lums are not), where they might escape for a time the cares and toils of business, the excitements of society and pleasure, or the trials of domestic life. In England, insanity is regarded in a very different light from the way it is looked upon in this country. There it is made to appear as a disgrace or stigma of society or fami- lies, and thought next to crime itself. There is an evidence of inborn ignorance of the subject out of which all should be educated. Here, Ave believe, there is no crime (hap- pily for us) in misfortune, and it is only Avhere it can be traced to absolute vicious courses that there can exist any disgrace. It is easy to understand how persons may shrink from the very suggestion of asylums, either for friends or kindred, for there is natural horror in removing a beloved friend or relative from the home, from family or society, from independent situations, free to act and do as -they please, and subjecting them like children to the rule and government of strangers, and depriving them of nature's dearest boon—liberty." . . . " As regards the patient him- self, except in extreme cases of violent mania, never ought the asylum to be experimented with." That is good, sound doctrine. The Avriter proceeds : " There is nothing more sincerely to be desired than tho establishment of some proper sort of home or retreat, or Avhatever it may be called, for the con- cern and care, if not for any deliberate course of treatment, of nervous diseases." (The writer seems not to have been aware of the existence of the Peabody Medical Institute, an TREATMENT OF THE INSANE,. 93 establishment, one of Avhose specialties is the treatment of nervous diseases, not by any crushing system of restraint and utter seclusion, but by methods and remedies, kindly, sooth- ing, and efficient.) The Institute, indeed, is exactly the " place " which the Avriter of " Behind the Bars " desiderates, "Avhere the patient might act himself, and Avithout opposi- tion to natural tastes or positive restraint; where he might be indirectly Avatched and cared for ; where the development of the disease may go on, or Avhere it may be gently checked by some suitable regimen." Well may this Avriter say that " although much has been done of late years towards the amelioration of the treatment of the insane, yet it has not yet reached that perfection to which modern science, cultivation, and good sense should eleA'ate it." This is too true in the case of the management of public asylums, which are the chief and great receptacles of the unhappy A'ictims of nervous disease and insanity; but there are solitary practitioners here and there, as in the case of the managers of the Peabody Institute, Avho haAre sum- moned to the treatment of nervous derangement, of all de- grees and names, all the resources of " modern science, cultivation, and good sense," with a grand result of cures, which show Avhat can be done for the amelioration of the AAroes of humanity, Avhen the ruts of vicious usage and rou- tine are abandoned, and reason and common-sense are left free to act. "That the plan adopted for years past in our insane asylums is Avrong," says the writer from Avhom I am quoting, " cannot be doubted by any intelligent being avIio has seen the victims of such a system, and Avitnessed the very instru- ments of torture applied to the persons of the patients, brought to operate, as they are, upon the harmless and gen- tle, as Avell as the most violent." "Are the patients of the insane asylums treated kindly ? " " The interest which sur- 94 TREATMENT OF THE INSANE. rounds this question," says the Avriter of " Behind the Bars," "and the anxiety to learn something definite of a subject which the regulations of a system keep hid from their eyes, often lead persons to take long journeys to see some un- knoAvn patient released from an asylum, or are the impetus to some confidential correspondence, often full of anxious misgiving or bitter experiences." "That the upholders of a course of personal restraints do not mean to be cruel, and that they believe their Avay the best for the patient, may be charitably believed. . . . They believe in tying up the bod}', that they may disenthral the mind. Arc they not slugs in an age of universal activity and progression, Avhile they cling fast to the old theories, and refuse to adopt the new ? Were the non-restraint system established throughout our asylums, Ave should behold those patients Avho are so for- tunate as to obtain their release in a far different aspect. They would not still bear the marks about the world of the fetters they had Avorn. Young girls Avho had entered there at the age of development Avould not return changed in form, bent, shrunken, and sometimes crippled. It is fearful to Avit- ness the shapes of these young persons in asylums, Avho are subjected, if not daily, ahvays nightly, to the rough strait- Avaistcoats, tightly pressed against the chest, so as to prevent all expansion, and giving to them the figures of very infirm old Avomen, rather than the fulness and shapeliness of youth and health. . . . "Why is it that the non-restraint sys- tem has not been adopted in our best asylums ? Why is it that the experiment is not made of doing aAvay Avith these implements of torture? The ansAver from medical science Avill be, that the}' are done aAvay Avith ; that the chains and irons and rings and fetters, belonging to past treatment of the insane, have disappeared.* But are not the strait- * Ransack history : the insane anciently were objects of buffoonery, or burnt as being guilty of sorcery. Later, they were abandoned, and they TREATMENT OF THE INSANE. 95 Avaistcoats, the bed-straps, the leathers, the buckles, the chairs, all in common use? Are not ladies fitted to these Avaistcoats month after month, as though it Avere a legitimate night-dress ? Whoever has passed any time in the asylum Avill see plainly Avhy these appliances are still kept up. They save trouble. They save the employment of more at- tendants, and they save trouble to those already employed. Thus, the physicians say, they save attendants. The attend- ant says, they save my time. Hoav simple, upon looking at a prospective project of reform in asylum life, seems to be the alternative, — to do away Avith the troublesome accessories, conjured up by force, and to rely upon moral safeguards and persuasive strongholds, Avhich come from and aim at the heart and human sympathy, which the patient though dis- eased is still supposed to possess, and be capable of awaken- ing to and profiting by ! No non-restraint system can be adopted Avithout a vast change in the machinery of the old management, and by breaking cIoavh the tyranny, and substi- tuting a species of imaginary absolute freedom." This Avriter gives a bad account of the attendants in our lunatic asylums, of the jeering and cruel manner in Avhich they treat their unfortunate charges. Indeed, she defines a lunatic asylum to be a place where insanity is made, manufactories of mad- ness rather than healers. "Take an instance," she says ; "a young Avoman from one of our country towns appears on a certain day upon one of the best galleries. She is bright, intelligent, and active, suggesting always the idea to the mind of the beholder, that if educated she would have been rather an uncommon person. She is lively, brisk, amusing, busies herself at her needle or the care of her room, in which she is perished for want of care in hideous prisons. The Turks still maltreat their insane. In 1790 a law Avas passed in France, providing for the con- finement of furious lunatics, and mischievous and ferocious wild beasts, classing the insane with brutes. 96 TREATMENT OF THE INSANE. scrupulously neat. She not only performs these acts for her- self, but she visits the rooms of the other patients, and im- provises little reforms to be made in their clothing, offering to me rid or make garments for them, and 'fix them up' gen- erally. Of course this sort of interference does not fall to her requirement in the asylum. She must not direct, but be directed. She is an intruder, agitating the patients Avith outside influences and the like. Moreover she is very lively, and talks a great deal, — so the attendants say ; too much, say the physicians ; and so she must be moved to a less quiet and comfortable gallery. They take her aAvay. But Avhere ? To a Aviiig of the building so different, that there is not even one patient AA'ith Avhom she can haA'e a sympathetic look. They are idiotic,apathetic, cataleptic : all far, far wide of reason, incapa- ble of talking,excepting babble, or ca'cii of apprehension. Let the reader imagine for himself, let his OAvn opinion determine what the sanitary influence of society like this might have upon a person of lively mind, hoAvever disturbed, during the course of Aveeks and months. A year afterwards, the Avriter again had an opportunity of beholding this patient, for Avhom much interest had been felt. But what an object! What a contradiction of her former self Avas the unfortunate changed © to ! Her face looked as though stamped by imbecility. Her lips moAred to utter only incoherent jargon. Her eyes, Avhich had been bright and intelligently lighted, Avere like dead eyes, and she Avas in no respect unfit for the gallery to Avhich the}' had confined her." . . . What a system that would be to practise, if, instead of this, patients Avere by some charm of cunning made to feel that thev Avere roam- ing quite at large ; that they Avere not in a place of deten- tion ; that they Av^ro free to go and come; and yet all the Avhile, physicians and attendants, under these illusory devices, were having it all their own Avay, though impercep- tibly to their patients ! TREATMENT CF THE INSANE. 97 " A system of this sort Avould be Avorth inventing, and would bring honor to the inventor, because depending upon moral and higher elements than anklets for the feet and straps for the discontented body. For it is certain, that just for the reason that these patients know that they are confined, knoAV they cannot go home, knoAV they may not sec a friend or relative, it is that they arc so miserable. . ,. . It is amaz- ing Iioav the sense of liberty and the right of volition can a^cct Anolent insane patients. Under bonds and restrictions they conjure up all sorts of desperate and terrible things Avhich they Avould do were liberty alloAved them. . . . But untie their hands, take them out, unbar the door, tell them they are free,— mid what then? Are they very quick to cut off by violent acts the apprehension and enjoyment of this new-born blessing — liberty ? Not one of them would do an act of harm to himself. . . . One patient Avho wore day and night the strait-waistcoat, was perpetually imploring that she might just be allowed (a delicate favor) to fling herself upon the raihvay track, and end all by the coming train. When she Avas permitted to go out unbound, her chief fear of the Avorld outside seemed to be, the danger. suggested by the sight of a locomotive." I would gladly quote more from this most interesting writer, because his or her statements are those of an expert, Avho has fortunately recovered the full sovereignty of reason, as the book from which I have been quoting amply testifies on every page. Such testimony is invaluable. I Avill boldly affirm that the test of the civilization of a given community is the degree of science, and even of charity, with Avhich the insane are treated in that community. Notwithstanding that statistics show, during the last ten years, an increase in the number of tho insane, still I affirm that in proportion as true civil- ization shall advance, insanity will diminish its ravages in society. 98 TREATMENT OF THE INSANE. Our principal lunatic asylums are on too monstrous a scale, and there is such a host of patients in them as to render it impossible that each particular case can receive proper atten- tion. Were the Avriter to establish a lunatic asylum strictly so called, he should by all mqfms establish it in the country, because it is there only that the family life can bo realized suitably for the insane, who need air and space to act Avith- out danger to any one, and especially to be removed from the circumstances which surrounded the onset of this disease. Such an establishment would be a therapeutical centre, which would have a farm as a subsidiary establishment. The rich Avould find diversion, and the poor Avork in the .fields. The air of the fields, as says one of the princes of science, Hum- boldt, is the first and best therapeutical agent. The simple contact of man Avith nature, that influence of open air, — or in a more beautiful expression, of free air, — exert a sooth- ing power. They soften pain, and they allay the passions, Avhen the soul is agitated in its utmost depths. At Gheel, in the northeastern portion of Belgium, the insane are col- onized. In this place is the church of St. Dympna, Avhose intercession in the Middle Ages Avas supposed to cure luna- tics, Avho Avere brought hither in great numbers. The taber- nacle containing the saint's bones stands on four stone pillars behind the altar, so as thus to form a passage about three feet in height, through which lunatics, brought here for cure, were accustomed to pass on their knees. The insane colony of Gheel cannot be here described at length. Some idea of it can be obtained from the account of a visitor: "When perambulating the various hamlets vis- ited," he Avrites, " often through pretty but devious path- ways, Ave frequently noticed lunatics occupied as agricultural laborers in adjoining fields ; whilst some Avere quietly Avalk- ing to or from neighboring cottages, quite as tranquilly as ourselves. Being all acquainted Avith the inspecting phy- TREATMENT OF THE INSANE. 99 sician, these parties saluted him respectfully, and often conversed Avith us familiarly ; in short, they behaved like ordinary peasants, or any rational person. We saAV others sitting at the cottage doors, and some looking out of win- doAvs; Avhile several Avere amusing themselves Avith children of the family, in adjoining gardens or enclosures. In one of the public roads Ave met a maniac Avho lived in a cottage at some distance, then carrying an infant in his arms like any nurse. He seemed to take great care of his innocent charge ; and the physician remarked that such an occupation constituted this lunatic's chief enjoyment. Afterwards Ave encountered another insane resident — a young man —amus- ing himself Avith three little children, romping Avith them, and at the same time taking care that they did no harm. In a solitary lane, we next came up with a patient, Avho was being conducted homeAvard to dinner by the juvenile daughter of his host, after laboring in an adjacent field. In various other instances, we observed insane persons saunter- ing about, and some also going toAvards or returning from neighboring farm-houses. In truth, had it not been for the vacant-looking countenances noticed in most cases, and occa- sionally that their legs Avere loosely tied together by leathern thongs, so as to prevent the wearers frtnn running fast or going to any distance, I should scarcely have recog- nized many of the parties then enjoying themselves, Avhile breathing the pure and open air of heaven, as real lunatics residing in the Gheelois commune. Within the houses and cottages avc inspected, many insane residents Avere occupied as ordinary servants; some superintending cows, churning, laborin°* in the barn, cooking food, cleaning the house, rock- ing the cradle, and taking care of the cradle; in short, em- ployed in much the same Avay as they might have been at home, or out at service. Various male patients, again, Avere laboring in the gardens or fields ; others Avorking in carpen- 100 TREATMENT OF THE INSANE. ters' shops, also smithies, stable and farm yards ; besides being engaged in such out-door employments as are common amongst any agricultural population ; these occupations barr- ing this very great adArantage for lunatics, that Avhilst under- going physical exertion — often so beneficial for their mental malady — they, at the same time, are much in the open air, breathe a purer and more salubrious atmosphere than most inmates of Avards, day-rooms, or frequently too confined workshops, can enjoy in northern asylums. In several houses, avc also observed female lunatics comfortably sitting with their hostess at table, knitting, sewing, making clothes, and conversing as if equals, friends on a visit, or relatives. Such spectacles Avere truly pleasing; and when looking out of the cottage AvindoAVS, near such parties, upon sometimes a pretty floAver-garden, or towards open green fields, stran- gers could hence scarcely suppose, from outward appear- ances and surrounding circumstances, they Avere then A'isiting the chamber of an insane occupant, afflicted most likely Avith incurable mental alienation." What a contrast have Ave here to the hideous, strait-Avaistcoat, close-confinement, restrictive system of our great, croAvded lunatic asylums ! CHAPTER XIII. URINARY ANALYSIS, AS A DETECTIVE OF DISEASE. As a means of facilitating diagnosis or discrimination of © © disease, I Avish most strongly to inculcate the necessity of analyzing urine; and I feel satisfied from very extensive experience, that if this were more generally attended to, that diversity of opinion %hich nojv so unhappily-prevails Avould no longer exist, nor should Ave be so frequently taunted by our patients Avith the reproach, "When doctors differ, Avho is to decide ?" As I have already observed, the clammy tongue, dry skin, pain in the back, and failure of the strength may exist in so many different diseases, that avc should be unable, relying on symptoms alone, to decide with any degree of certainty the real nature of disease. But an examination of the urine Avill often lead us to the true interpretation, and under all circumstances will facilitate our inquiries into the causes of morbid phenomena. For instance, a single property from Avhich much may be determined, I need only mention that the specific gravity of the urine in health may be averaged at about one thousand and tAventy, but if the urinometer should indicate a density of one thousand and fifty, the urinary pathologist would immediately infer the presence of a large quantity of sugar, and the existence of diabetes in an aggravated degree. He Avould still further confirm his notions upon this point, by setting a portion aside [101] 102 URINARY ANALYSIS. under the proper circumstances, and inducing those fungoid vegetations, the appearance of Avhich, under the microscope, is shown in the subjoined diagram, Figure 6. Thus we Figure 6. • should be enabled by one examination to decide the nature of the disease, Avithout the possibility of mistake. For the purpose of speedily taking the specific gravity, we make use of a little instrument, contrived by the late and much to be lamented Dr. Prout, called "the urinometer." It Figure7. consists of a IioIIoav globe or glass, or thin metal, from the upper part of which projects a scale graduated from 0 to 60; in the opposite direction there is a weight to keep the stem upright. Immersed in the urine, it sinks and indicates the gravity of the urine by the figure on the stem, which coincides, or is on a level with the surface of the urine. Reference to Figure 7 will explain the use and nature of this instrument better than any description. The value of this instrument in detect- 99999 * URINARY ANALYSIS. 103 ing disease will at once be apparent, by mentioning the fol- lowing case. © A feAV days ago, a gentleman, a perfect stranger, whom I had never seen before, called upon me for my advice. I requested him to furnish me Avith a specimen of the urine, the specific gravity of which I immediately ascertained to be 1038. I boiled a small quantity in a test tube, with a solution of potass, over the spirit-lamp, Avhich speedily changed to a dark-broAvn color. This led me at once to make the following inquiries : If the thirst was not most urgent; if his appetite Avas unusually good ; if the skin Avas not unusu- ally hard and dry ; if the quantity of urine passed in tAventy- four hours did not greatly exceed what Avas natural, and if he had not lost flesh. He had as yet hardly given me any account of himself, and appeared much surprised at my inquiries, and looked steadfastly at a microscope that Avas standing upon my table; and I afterwards learned that he attributed some extraordinary influence to the polished reflector attached to the instrument. It appeared that he had been suffering for some time from all the symptoms I had mentioned, and felt at a loss hoAv I could, in so short a time, gat to knoAV so much about him, for I Avas not more than five minutes in making the examination. To the urinary pathol- ogist this could occasion no surprise, if it would be at once apparent that I had tested for diabetes. Feeling satisfied of its presence, it Avas then of course easy enough to enumerate symptoms. I have found diabetes to occur between the ages of tAvcnty-tAvo and thirty-six. I have seldom met Avith it in advanced age; a form of it sometimes occurs in young chil- dren. It is of the utmost importance that this disease should bo detected in its earliest stages, for it is only then that it can be kept in check, or possibly subdued. Instances, indeed, are not wanting of perfect cure. If food containing sugar or saccharine principles be allowed, even as luxuries, t 104 URINARY ANALYSIS. it is the opinion of most urinary pathologists that no plan of treatment can prove serviceable. " Even its occasional in- fringement," says Dr. Prout, " cannot be indulged in Avith impunity. Thus I have known," he continues, " a few saccharine pears undo in a feAv hours all that I had been laboring for months to accomplish." With the vIcav of still further impressing on the mind the necessity and importance of urinary analysis, J shall briefly mention another case of diabetes that came under my notice. The patient, a cooper, had been Avorking for six or seven years in a A'ery damp cellar. He applied to me in 1866, complaining of intense thirst. He had become greatly emaciated, Avith a voracious appetite and other symptoms usually present in diabetes. Examination of the urine fully proved the existence of the disease. I explained to him the nature of his disorder, and the necessity of at once procuring a more suitable Avorkshop, — one dry and properly venti- lated. I also inculcated the necessity of strict attention to diet, and explained some other necessary precautions calcu- lated to improve his health, and the necessity of strictly conforming to dietetic rules for some considerable time. I Avas, hoAvevcr, soon supplanted by a medical gentleman, Avho asserted that all the symptoms originated in a disordered state of the liver, at the same time undertaking to set all right in a month. To accomplish his purpose he directed blue-pills to be taken, which Avas continued for the space of ten days; but the unfortunate patient, instead of being per- fectly Ave 11 at the end of the month, as promised, had become worse, the symptoms much more severe, and he died a short time afterAvards of confirmed diabetes. Fcav persons not accustomed to the treatment of these affections Avould be- lieve the deleterious effects of oa'cu a dose ortAvo of mercury. Indeed, the mildest form of the disease may be speedily converted, by the use of calomel or blue-pul, into the most URINARY ANALYSIS. 105 confirmed and aggravated diabetes. From several years' experience in the treatment of diabetes, I am decidedly of the opinion, that if early detected the disease may be re- moved ; but generally cases of this kind seldom terminate so favorably as Ave could Avish, or indeed as Ave have a right to expect, and I am satisfied this is OAving to the disease not having been detected in its early stages. Most of the pa- tients whom I haA'e seen suffering from diabetes haA'e been more or less of the phlegmatic temperament; not so, hoAV- ever, the class I am to enter upon. We often find the urine depositing certain sediments, the nature and A'ariety of Avhich are often intimately connected Avith both the temperament and the peculiar affection under Avhich the patient may bo laboring. Oxalate of lime, correct delineations of Avhich I here subjoin (Fig. 8), most frequently occurs, according Figure 8. to my experience, in the nervous and biliary temperaments, and not unfrequently in the sanguine. When it occurs in this last, it is often associated Avith an eruption of the skin, and attended Avith great mental and bodily irritation. Not long since, I was consulted by a gentleman laboring 106 URINARY ANALYSIS. under this diathesis, oxalate of lime constantly appearing in the urine. This patient was treated simply for a cutaneous disorder, an eruption having appeared upon the skin. Astringents in the form of ointments, applied to the surface, succeeded in suppressing the cutaneous disorder; but the nervous excitement and mental distress increased to an alarming extent. So severe were the symptoms, that the patient found it quite impossible to remain at rest, but felt obliged, as it Avere, to shift about from place to place. He assured me he had suffered so much, that he often felt as if he should lose his senses, were not the symptoms soon relieved. Sulphur baths Avith diaphoretics, and irritating frictions to the skin, soon brought out the eruptions again, with immediate relief to the patient. I have found almost invariably that affections of the skin, when accompanied with an unnatural or disordered state of the urine, must not be rashly interfered with, nor suppressed by external applica- tions, till the disordered state of the urine has been corrected, and the kidneys restored to the healthy discharge of their functions. When oxalate of lime is constantly present in the urine, Avhich in my opinion is much more frequently the case than is usually imagined, —the difficulty of detecting the na- ture of these crystals enabling them to escape observation, — there is frequently a feeling of distension in the stomach, more especially when that viscus is empty. This feeling frequently prevails to so great a degree, that the patient is compelled to have his dress made very loose, and to adopt every means of preventing pressure. This distension some- times extends over the Avhole region of the stomach, Avhich bulges out, occasioning great irritation and distress. The heart, or at least its motions, frequently become in- volved. I have seem many instances of what may be named nervous palpitation of the heart. Patients, from such palpita- tions, often imagine themselves the victims of real disease of URINARY ANALYSIS. 107 the heart; and this notion appears to be more strongly con- firmed by the irregularity of pulse which prevails in these circumstances, and indeed not unfrequently it intermits. A medical gentleman consulted me some little time since for a feeling of severe nervous depression, greatly aggravated by a firm belief that he should die suddenly from an affection of the heart. About two years before he consulted me, he had endeaArored to effect an insurance upon his life, which Avas refused, however, under the impression of his suffering from disease of the heart. Certainly palpitation Avas evident, and there was irregularity of pulse, great difficulty in breathing, with habitual coldness of the feet. On examining the urine © I found it loaded Avith octohedral crystals of oxalate of lime, and remarkably so after dinner; which, perhaps, might be attributed to an habitual indulgence in sAveets, etc., at this meal. The digestive functions were deeply invohred, and yet the tongue was perfectly clean. The general circumstances induced me to suspect a gouty tendency, and, on inquiry, I learned that gout prevailed in his family. By regulating the treatment upon these views, and paying due attention to the digestive organs, the patient recovered, and is uoav attending to a A'ery extensive practice, which he had been forced to relinquish. Disease of the heart is usually inferred Avhen there is habitual palpitation, Avith irregularity of pulse, difficulty of breathing, coldness of the extremities, and the pulsations of the heart audible over the Avhole extent of the chest. It Avill be well, however, to remember that all these symptoms may be present, and yet the heart itself be perfectly free from disease. I feel reluctant to refer to the numerous instances I have seen of persons whose existence has been embittered, and their prospects blighted, in consequence of functional irregularity being mistaken for organic disease of the heart. I have already mentioned a case of gout lurking in the system giving rise 108 URINARY ANALYSIS. to all the phenomena of diseased heart, and shall conclude tho subject by calling the attention of the profession to one other remarkable instance. A young gentleman, who consulted me, gave me the fol- lowing preliminary history of himself: "I enjoyed," he said, " excellent health until I Avent to Harvard University ; there I studied very hard. A friend gave an entertainment in celebration of my success in gaining a prize for a literary essay. After the entertainment we went upon a roAving ex- cursion, and I exerted myself beyond what was usual. On our return I became giddy, and at length fainted. I soon, hoAvever, recovered my recollection, but became ill, and Avas confined to bed six Aveeks. My digestion at this period Avas much disordered, the pulse irregular, with a constant feeling of uneasiness about the heart. I was advised to return home; to aA'oid all kinds of mental exertion or ex- citement, and all sorts of active exercise, especially upon ascents ; and to restrict myself to a very low and poor diet. I took foxglove for a considerable time, in order, as it was stated, to loAvcr the heart's action. My health Avas not suf- ficiently restored to admit of my return to Cambridge the following term. I remained at home for tAvelve months; and not being alloAved to read, nor to take much exercise, time hung heavily upon my hands, and at the end of that time the symptoms Avere as severe as at first. I Avas compelled to give up my studies, and have remained quite an idle man eArer since. I haA'e taken a great deal of medicine, of one kind and another, and I iioav begin quite to despair of recovering my health." Upon analyzing this patient's urine, I found the oxa- late of lime in great abundance. The powers of the digestive organs Avere greatly impaired, which I attributed principally to the kind of diet to which he had been restricted, he having lived mostly upon slops and vegcta- URINARY ANALYSIS. 109 bles, fearing that otherwise he Avould make too much blood, and disturb tho action of the heart. After hearing the his- tory of the case, and giving due attention to all the circum- stances, I came to the conclusion that the patient had greatly impaired his health by too close application to study. After severe literary exertion, the indulgence in the pleasures of the table, followed by the laborious exercise of rowing, acted as the exciting cause ; and in his excitable, but still ener- vated condition, proved quite sufficient to bring on fainting, and the disordered state of frame Avhich succeeded; that the bleedings to which he had been subjected, and the digi- talis only served to keep up a degree of irritation in the system ; and on his return home, being debarred from bodily exercise, and deprived of all mental occupation, he had too much time to think upon his disease and to dAvell upon mel- ancholy forebodings, Avhich at length brought on a permanent state of irritation in the system Acting upon these aucavs, I recomme. ded that he should resume his studies, of course under due restrictions as to intensity of application; that he should take horse exercise and adopt a more liberal and gen- erous scale of diet. I also recommended means for restoring the vigor of the digestive organs ; and advised him, during his stay in Boston, to divert his mind by visiting the differ- ent places of amusement and objects of curiosity. His health and spirits Avere greatly improved; but still I fear that the impression that his heart is seriously diseased, Avill not be easily eradicated from his mind, notwithstanding that he has been assured by the most eminent of the profession hereabouts, that no such diseased state exists. In the treatment of the oxalate of lime diathesis, great care must be taken to order that kind of food Avhich can be easily reduced by the stomach ; therefore, oily substances, as butter, cream, fat meats, should be wholly interdicted. Great atten- tion should also be paid to the nature and kind of fluids used 110 URINARY ANALYSIS. as drink ; and water impregnated with carbonate of lime should be carefully avoided. It is generally admitted that the appearance of oxalate of lime, as a deposit in the urine, is closely connected Avith the condition of the digestive organs; as it readily disappears and reappears under certain altera- tions in the diet. The dyspeptic symptoms under these cir- cumstances are often referred to acidity of the stomach as their cause. While upon this subject, therefore, I Avould strongly impress upon the mind of the practitioner the necessity of well Aveighing all the circumstances of the case before he recommends that incessant resort to carbonate of soda, so much in vogue. Acidity of stomach is iioav de- nounced as one of the most common and constant accompa- niments of nervous disorder; and carbonate of soda and liquor potassse, among the most favorite remedies. Many cases of nervous disorder haA^e fallen under my care, to remove Avhich was a work not only of time, but of extreme difficulty, in consequence of the injurious effects of an im- moderate and daily use of alkalies. A gentleman of nervous temperament, engaged in a NeAv York Avarehouse, a tall, poAverful man, applied to me in consequence of suffering from pain in the region of the stomach. The pain Avas confined to a spot Avhich he could coA'er Avith the tip of his finger. He suffered invariably after dinner from a painful feeling of distension and fulness, with an almost incessant desire of hawking up phlegm, Avhich seemed as if agglutinated in the throat, causing great irri- tation, Avith an uncontrollable desire of getting rid of it. The skin Avas dry, hard, and harsh. There Avere seA'ere peri- odical pains in the head, and, in fact, all the general symp- toms characteristic of confirmed dyspepsia. He informed me that having suffered for a considerable time, he had, upon advice, been in the habit, for the last six years, of mix- ing a quantity of carbonate of soda with the ale which he URINARY ANALYSIS. Ill used. He commenced with Avhat he called " a small pinch, or as much as Avould lie on a shilling." This quantity Avas gradually increased, till it amounted to a teaspoonful. The m soda generally relieved his distress, in some degree, for an hour or two, Avhen the uneasiness returned, and recourse to the soda again became necessary. The urine passed in my presence had a specific gravity of one thousand and tAventy-two, Avith a very faint acidulous reaction; deposited a sediment consisting of mucous and epithelium, and abounding in crystals of oxalate of lime. After standing at rest for above tAventy hours, the sur- face became covered with a pellicle, Avhich proved to be the triple phosphate, and the sediment Avas found inter- mixed Avith the same. The reaction Avas iioav alkaline. From the history and general circumstances of the case, I felt firmly convinced that the greater part, if not the whole, of the misery and distress endured by this patient, Avas caused by the inordinate daily quantity of carbonate of soda Avhich he daily took. I therefore recommended the gradual discontinuance of the medicine, substituting for it, first, the hydrochloric acid, and afterwards the nitro- muriatic, beginning with very small doses, Avhich Avere after- wards gradually increased. Frequent recourse Avas had to the Avarin bath; Avhile a plain, simple, but nutritious diet was adopted. This plan he continued for some time and Avith o-reat benefit, as he became very much better; but still he was far from being relieved. He became, however, rather impatient of restraint and rule, and gave Avay to a longing alter his favorite dose of soda-water; and as I Avould not sanction this, he got tired, and consulted another physician. I have heard from a friend of his Avho is a patient of mine, that he is constantly changing his medical attendant, and that ho is at present in very bad health. When patients, under false notions, habituate themselves to the daily use of soda, 112 URINARY ANALYSIS. they may be placed in the same category Avith the habitual opium-eater or the dram-drinker. Such endure the greatest misery, till they indulge in the accustomed dose; and few there are Avho possess firmness enough to resist the tempta- tion, or fortitude enough to abandon its use. And here again I must beg not to be misunderstood. I by no means urge that the alkalies are always injurious in nervous affec- tions ; on the contrary, I have met Avith a great number of patients Avho have derived Arery great benefit from a judicious and avell-regulated course of these remedies, as will be seen in the following example : — A gentleman of the nervo-bilious temperament, connected extensively with the public press, applied to me, complain- ing of many of the symptoms just enumerated. In this case the pain in the region of the stomach was by far more severe than in any instance I remember to have previously met with; Avhich may, perhaps, be explained by the great ner- vous excitement and mental anxiety to which he Avas almost constantly exposed, in consequence of the great responsibil- ity imposed on him by his connection with an influential daily journal. Great irregularity of habit Avas a necessary result; dining very irregularly, and at all hours. He sat up, too, almost all night, resorting to stimulants to keep aAvake and active. Indulgence of this kind generally ended in great depression and nervous exhaustion, which commonly lasted till recourse to the usual beverage aroused the energies and O © raised the spirits. I was called upon very suddenly by one of his friends to visit this gentleman, Avhom I found suffering from a very severe attack of nervous fever. It appeared that upon a recent occasion he had been confined for seA^eral hours, in a close and overheated apartment, being at the same time exposed to intense mental anxiety; he A^ery in- cautiously and most injudiciously exposed himself under these circumstances, unsuitably clad, to the open air, on a URINARY ANALYSIS. 113 raw, cold, damp morning in the month of November. The attack of nervous fever above mentioned Avas the conse- quence. In this case, the perspiration and other secretions, generally, indicated a great tendency to excesshe acidity, which justified a resort to a judicious and Avell-regulated use of the alkalies ; and, indeed, I feel that the patient is mainly indebted to their influence for his recovery. But even at the present moment, Avhen he is in the enjoyment of his usual good health, he is obliged to avoid green A^egetables, oranges, light acescent Avines, sugar, and other fermentable articles, experience haAring taught him that, in his case, acid- ity may be speedily and very easily induced by the slightest deA'iation from rule; and this acidity, Avhen brought on, is ahvays attended Avith severe pain in the stomach, intense headache, and neiwous trepidation,—effects Avhich speedily supervene, but Avhich require considerable time to subside. Figure ft CHAPTER XIV. VARIOUS URINARY DEPOSITS. Nervous patients, with the oxalate of lime diathesis, I find derive very great benefit from the exhibition of nitro- muriatic acid with tincture of cinchona. It is, hoAvever, necessary to caution against the too long-continued use of the acids. Oxalate of lime is found in urine depositing urate of ammonia, a diagram of which (Fig. 11) is subjoined, Figure 11. and even uric acid in the crystallized form, under which cir- cumstances an incautious use of the acids might lead to great inconvenience. In regulating the treatment, therefore, when oxalate of limo appears in the urine, it ought to be analyzed [114] VARIOUS URINARY DEPOSITS. 115 every third day, and immediately when either urate of am- monia, or crystallized uric acid appears, the use of acids should be suspended. Sulphate of quinine, oxide of silver, or tris- nitrate of bismuth, may be given Avith great advantage, till tho time arrives Avhen Ave may resume the acids. I have, at this moment, a patient under my care who has suffered for many years from this diathesis, and Avhose health has been much injured by an empirical resort to alkalies, but avIio is now deriving very great benefit from the cautious administration of nitro-muriatic acid and cold baths. Urea — a diagram of which (Fig. 12), crystallized from its solution in spirit, is here subjoined — is a urinary principle, Figure 12. excess or deficiency of which in the urine is often connected Avith important nervous disorders. When urea is in excess, it often causes a great deal of irritation ; there is a dull, heavy, dragging pain in the lower part of the back, Avhich is much increased by exertion. A very constant symptom, more especially in certain forms of excess of urea, is a frequent voiding of the urine. There is often a greater quantity voided than is consistent with health; but from the frequent calls, the quantity passed seems to the patient greatly to 116 VARIOUS URINARY DEPOSITS. exceed what is natural. Hence this affection is, and has often been, confounded Avith diabetes, a disease of a very different nature. In speaking of the treatment of this affection, Dr. Prout very justly observes, and in practice I find his vieAvs con- firmed, "That calomel, black doses, and saline purgatives are calculated to do infinite mischief, and will probably render a manageable disease perfectly unmanageable," —hence the necessity of at once ascertaining the true nature of the dis- order. A patient lately consulted me, whose urine had for some time contained an excess of urea. He had been taking cal- Figure 13. omel, Avhich, however, had not relieved him, and he Avas rec- ommended the daily use of fluid magnesia. Upon examining the urine under the microscope, I discov- ered crystals in beautiful tufts, Avhich Avere at once copied by the artist, and the delineations (Fig. 13) are here subjoined. Upon further inquiry, I found them to consist of urate of magnesia. This patient Avas much relieved by discontinuing the medicine,—paying strict attention to diet, and taking small doses of oxide of silver. VARIOUS URINARY DEPOSITS. 117 Iii certain forms of degeneration of the kidney — granular, for instance — the serum of the blood passes off by the kid- neys. Such urine is albuminous, coagulating by heat, more especially if a few drops of nitric acid be added. When albuminous urine depends upon granular kidney, it may be regarded as a fatal symptom. We must, however, be cau- tious in pronouncing such an unfavorable opinion. Not very long since I Avas called upon to visit a gentleman Avho Avas studying for the bar. For some time he had been suffering from severe nervous, aching pain in the back and loins. A medical gentleman, a friend of his, having discovered albu- men in the urine, pronounced him suffering from organic dis- ease of the kidneys. His friends became greatly alarmed, especially Avhen informed that nothing could be done to save the patient. At this juncture I saAV the case. The general appearance Avas not such as to excite in my mind the notion of organic disease. All those symptoms, — the sAvollen face and eyelids, the harsh, dry state of skin, the dull, stupid look and tendency to drowsiness, —Avere not present in the slightest degree, nor Avas there the least indi- cation of any tendency to dropsy. I Avas, in consequence, induced to doubt that the kidneys had anything to do Avith the diseased condition of the urine. I therefore Avashed out the bladder Avith distilled Avater, by means of a double catheter; and then made him drink, in my presence, tAvo or three tumblers of filtered Avater. He Avas placed, on his bare feet, upon a cold marble slab, and in less than ten min- utes passed a considerable quantity of urine, Avhich, on ex- amination, afforded not a trace of albumen. This sufficiently proved that the kidneys were not the source of the albumen. Upon stricter inquiry it Avas found that the albumen was de- rived from the mucous coat of the bladder. It disappeared very shortly under the influence of the tincture of sesqui- chloride of iron, in doses of tAventy drops three times a day. 118 VARIOUS URINARY DEPOSITS. I mention this case to show the necessity of caution, and the inconvenience which may result from inferring degeneration of the kidneys merely because of a little albumen in the urine. Lithic or uric acid, of Avhich there is a diagram (Fig. 14) attached, is likewise a principle by Avhich the urine is des- tined to carry out certain effete matters from the system. It however sometimes happens that more lithic acid is formed than is evacuated with the urine. The superabundance Figure 14. either is retained in the kidney, giving rise to the formation of renal calculi, or it remains in the blood, and occasions Ararious forms of nervous disorder. It is well knoAvn that in rheumatism the blood comparatively abounds in lithic acid. Occasionally this acid, after remaining for some time in the kidney, passes into and remains in the bladder, form- ing a nucleus for further deposition, and vesical calculus is the result. One of my patients requested my attention to a poor man, a shoemaker, Avho had been suffering for thirteen years from a nervous affection, Avhich latterly had increased so much, and occasioned so great a degree of distress, that he could VARIOUS URINARY DEPOSITS. 119 hardly attend to his work. He had tried a variety of reme-. dies, and consulted numerous practitioners, and various views Avere taken of the nature of the case. Having obtained several specimens of the urine, I found, upon examination, that it abounded in lithic acid, Avhich Avas deposited in the crystalline form. The appearance of the acid, Avith the general circumstances of the case, induced me to suspect the existence of stone in the bladder, as the cause of the nervous symptoms from Avhich he suffered. He came to Boston, and, on sounding, the existence of calculus Avas clearly and decidedly proved. There Avere a great number of very small calculi of the lithic kind, many of which I succeeded in crushing. He became impatient, hoAvever, it being inconvenient to him to be so much in Boston. He therefore determined upon going into the Boston Hospital to be cut for stone. The opera- tion Avas very skilfully performed, and the stones adroitly extracted from the bladder; but inflammation set in on the third day, of Avhich the patient unfortunately died. When lithic acid deposits in the joints in the form named "chalk stones," there is much nervous irritation set up in the system; and patients of this class suffer so much from ner- vous derangement, that the most trifling incidents Avill throw them into a nervous paroxysm. These gouty concretions do not consist of chalk, but of urate of soda; and the diagram (Fig. 15) shows the form of crystallization assumed by the uric acid Avhen liberated from its combination Avith the soda. When the lithic acid diathesis prevails, tho digestive func- tions arc usually much out of order, and the patient complains of flatulence and great acidity of stomach, much increased by acescent fruits and vegetables, and indulgence in port wine. It is of the utmost importance that such derangements of the system should bo speedily recognized. A feAV grains of 120 VARIOUS URINARY DEPOSITS. carbonate of potass taken three or four hours after dinner, and persevered in for a short time, will remove a great deal Figure 15. of mischief, and prevent the formation of stone in the bladder, Avhich cost the patient, Avhose case I have just mentioned, his life. Cystine, or Cystic oxide (see diagram, Fig. 16), is very Figure 16, rare, but Avhen it occurs is attended with severe nervous derangement. It Avas first described by Dr. Wollaston, and VARIOUS URINARY DEPOSITS. 121 afterwards by Marcot; and a very excellent account of the substance itself, and of the state of the urine in Avhich cystine prevails, aaois published by my friend, Dr. Venables, some years ago, in the "American Journal of Medicine." Little or nothing has been added to Dr. Venables' excellent detail. Liebig has lately announced the existence of hippuric acid (Fig. 17), as a constituent of human urine. It is occa- Figure 17. sionally present in quantity in the urine of hysterical and nervous females, and in tho urine of persons who have been compelled to live for some time upon a poor, low, and bad diet. Change of air, and good nutritious food, with tran- quillity of mind, will be found among the most effectual rem- edies. The earthy phosphates are constantly deposited from the urine of nervous patients, and many of the symptoms in such cases, are analogous to those which occur in the lithic acid diathesis. The triple or ammonio-magnesian phosphate is delineated in Fig. 18. The deposition of the prismatic phosphate is generally 122 VARIOUS URINARY DEPOSITS. accompanied Avith severe pain in the back, much increased by any kind of exertion, especially if the lumbar and dorsal muscles are much or actively employed. We frequently find cutaneous eruptions upon different parts of the body associated, or in some way connected, with the deposition of the triple salt. " That tendency to a deposition of these earthy salts in the urine," says Dr. Prout, "is sometimes hereditary, there can be no doubt. Moreover, this tendency often assumes different forms in dif- Figure 18. ferent members of the same family, and even in the same individual at different periods of his life. Thus, Avhen one individual of a family has suffered from a deposition of the phosphates, another has suffered from gout, a second from asthma, a third from cutaneous disease. I have for some time attended a gentleman who has been suffering for many years from spasmodic asthma. The urine deposits the phosphates in great abundance. I have also attended the brother of this gentleman, likewise his nephew, and three of his children, all suffering from what they name nervousness, which it is said runs in the family. No two, VARIOUS URINARY DEPOSITS. 123 hoAvever, suffer alike. The gentleman told me that he thought ho should have lost his life in consequence of having gone, on the recommendation of a physician, to a watering- place, and drank largely of an alkaline spring. He Avas reduced to such a degree, and his health so A'ery much shat- tered, that many months elapsed before it Avas restored to its ordinary 'state. One can hardly reconcile the probability of such an error, had there been even but an imperfect analysis of the urine. There is scarcely a day passes that I have not applications from members of the profession requesting me to examine the urine of their patients. This is very often accompanied Avith another, —that I Avould be so good as to forward, by return of post, a report, Avith a full account of the analysis. Perhaps the little attention bestowed upon inquiries of this sort, by gentlemen in general practice, will account for their not being aware that days are often necessary before the in- vestigation can be completed, and the analysis perfected. • CHAPTER XV. PATHOLOGY OF THE NERVES AND NERVOUS MALADIES. The dominion of the nerves over the mental and physical actions of man is unbounded. The various Avorkings of in- tellect, sensation, volition, motion, secretion, nutrition, — the essence of all these is nervous influence. There is no animal without nerves, but myriads Avithout circulation of the blood. Blood and nerve are, hoAvever, about equally implicated in the phenomena of health and disease. When the nerves are poAverfully affected, how quickly the heart is affected also ! Alarm and terror are mental impressions ; but hoAv instantaneously the heart is affected by undue enerva- tion is evidenced by palpitation, increase or arrest of cir- culation, by blush or pallor. The phenomena of mental disorders, or of a class of them, at least, are dependent on an abnormal supply of carbonized or oxygenized blood on the brain, or a deficiency of phosphorus. Excess of arterial or venous blood will equally induce a train of morbid phe- nomena in the nerve, as in any other organic tissues of the body. There is indeed a marvellous connection between the nervous and vascular systems throughout tjje animal frame. Too great action in the minute arteries, congestion in the veins, an amemious or bloodless state of the vascular sys- tem of the brain, alike induce morbidly exalted and impaired conditions of the mental and cerebral functions; spectres, [124] PATHOLOGY OF THE NERVES. * 125 delirium, insomnia or sleeplessness, amaurosis, stupor, coma ; violent involuntary actions, or paralysis of the volun- tary motions, etc' The higher the nervous energy, or the more A'igorous the circulation of the blood, the greater the poAver of the vital tissues to resist contagious diseases. Hope Avill preserve the energy of the body under the most depressing influences, the most laborious exertions. The body cannot have rest or health till the mind be satisfied. The nerves are valuable servants, but they are despotic masters. Let them once get the Avhip-hand, and avoc betide their slave. Noav, have we not an apology to make to them? We either coax and pet and indulge them as Ave do spoiled children, or Avork them to the utmost; and then we Avonder that their evil qualities turn the tables on ourselves, and render us slaves to the tempter. Let us take a brief glance at those excited conditions of the mind which are so often the spring of ner- vous maladies, real and imaginary. It is true Ave cannot ahvays " Minister to a mind diseased, Pluck from the memory a rooted sorrow; " but, by a little self-denial, a sound mind (mens sana), to a deo-ree at least, may be preserved to us. If, in the effort, even self-interest or self-gratification be sacrificed, the tran- sient tears of regret will, Ave may hope, be consecrated, and turned to those of joy and thankfulness, Avhen the struggle is over. Intense impression on the mind is a subject full of inter- est. The illusions so often induced by it are contrasted in their influence over the system. They may be consolatory, an agreeable and happy deception, and should in some cases be even encouraged. We will glance at a story told by Kotzebue, the poet, in illustration. It was of a young lady whose lover died. His harp, on Avhich he was Avont to 126 •« PATHOLOGY OF THE NERVES. accompany her, hung in her chamber. After a period of melancholy and grief, she touched the cords of her instru- ment; the harp, tuned in accordance, responded. Surprise and terror Avere at first the consequences; but these now yielded to a romantic melancholy, Avith a coiiA'iction that the spirit of her lover swept the strings of the harp. Her music became her only consolation, until a scientific friend explained to her the principle of phonic harmonies. From that moment the illusion vanished, and she drooped and died. But if the impression be foreboding of misfortune, of course it should be removed if possible. We could cite many cases of those unhappy prognostics from dreams, and the prophecy or dread of the fortune-teller, regarding the termination of bperations or of childbirth. Anxiety is pros- pective sorrow,—its subjects various. In that which may be termed moral anxiety, as that of a Avife or a mother for the safety of her husband and her child, there is a sacred- ness Avhich excites our deepest sympathy. Others have a more unholy spring; a heart tainted Avith pride or avarice, those besetting sins Avhich so deform human nature, and to the pains of Avhich there is no end, —for pride and avarice are never satisfied, — there is no real meaning but a negative one in the Avord enough. These passions are the very bane of existence. Yet how many, even of those AAdio decry them, cherish the serpents in their bosom, trusting to honor or riches for sublunary happiness, forgetting the monitory lines of Young, — " Why all this toil for triumphs of an hour? What though we wade in wealth or soar in fame ? Earth's highest station ends in ' Here he lies '; And dust to dust concludes her noblest song." The feeling of anxiety is one continued heart-ache ; it is the dread of something Avorse tb^n the present. It is nro- PATHOLOGY OF THE NERVES. 127 gressive in its degree, and therefore more poignant than real sorrow or grief, which is the pain of memory, and which so constantly, from the mere elasticity of the mind, gradually fades and disappears. For the anxious heart there is often no relief, save from the eloquent lips of sympathetic friend- ship, or the consolation of religion. If it be not relieved, Ioav nervous fever will be the consequence, with remora of the circulation, inducing local congestions ; then, not only are the secretions diminished, but those which arc formed arc depraved and unhealthy. For so surely as the enliven- ing passions oxygenize the blood, do the depressing cmo- ' tions accumulate carbon. By this poison a constant morbid and ineffective reaction is going on, which Avofully aggravates the original affection. Thus is established a train of ner- vous maladies, — neuralgia, hypochondriasis, melancholy, — inducing that corroding action in the brain, Avhich, in the Avords of the son of Sirarh, " consumeth marroAV and bone." In the end, if the brain be long oppressed by its poison- blood, taidium vital, or Aveaiiness of life, must be the result, the climax of Avhich may be suicide. During this progress the system is in a state of universal malady, — all is going wrong. Circulation, digestion, assimilation, nutrition, the nurses of life, fail; absorption of fat succeeds, and atrophy is the result. In the anxious mother, the secretion of the milk is checked or depraved, by Avhich half-poisonous fluid the numerous convulsive and gastric diseases of infancy are brought on. The influence of anxiety also constantly lights up those latent germs of constitutional disease, which might never otherwise have been developed. The miliary tubercle of phthisis is thus excited to action, and youth and beauty, till then in seemingly blooming health, are at once doomed to decay and perish. But the great source of anxiety and its train of ills is to 128 PATHOLOGY OF THE NERVES. be sought in those ardent longings for Avorldly possessions, Avhich are the especial debasement of this age. But eAren the fullest measure of success in the insane struggle for opu- lence soon palls on the sense. When all earthly grandeur and poAver are at length attained, the proud and anxious possessor stalks through his gorgeously furnished halls, counts oA^er his millions, and Avonders and deplores (that is, if he can moralize) that his heart is not sufficiently capacious to enjoy all the splendor, and opportunities of gratification, Avhich it commands. Wo cannot '' Through the loop-hole of retreat Look out upon the world," agitated as it is at this moment Avith the intense desire of gain, Avith the eager haste to be rich, Avithout a thrill of pity and sympathy for the blind votaries of Mammon, Avho daily and hourly prostrate themselves before the golden image they have themselves set up ! Tranquillity of mind ! It Avere a miracle indeed if such a condition of brain could be preserved amid tho tumult of a stock and share market and gold-board, in the face of desperate ventures, in Avhich mil- lions may be involved, and families reduced to irretrievable ruin, in the twinkling of an eye, as it Avere. And it Avere a A'ain effort to check the headlong course of one on Avhom the monomania of gaming has taken so deep a hold. Yet Avhile Mammon thus reigns in every alley, the health of the body is sapped, the intellect is impaired and perverted, the condi- tion of its organ gradually destroyed, the earthly climax of Avhich may bo drivelling or raving insanity, or death, self- inflicted from the muzzle of the revohor in the grasp of des- peration. On the slaves of pleasure, anxiety is ever an attendant demon. True, the orgies of Bacchus and Venus, during their intense excitement, drown the heart and mind in one voluptuous flood, Avhile the cup of Nepenthe or the lips PATHOLOGY OF THE NERVES. 129 and arms of beauty throAv their spell over the senses ; but the deep anxiety of after-thought and feeling can never be com- pensated by a thousand-fold of such enjoyment. And is the penalty merely transient? Alas, it lasts a life-time ! It is deeply painful to reflect on the prolific springs of disorder from these slavish passions; the brain and heart are the especial organs into Avhich their poison is infused. Either the intellect or the senses are reduced to a brutal apathy, or the sensitiveness (hyperaesthesia) of the nervous system is so morbidly increased, that, on the slightest disappointment, or social competition even, the whole system is deranged, and there is no philosophy, no piety, to tranquillize a mind so subdued, for irreligion must be the predominant prin- ciple of such a life. Grief and its prototypes is another fertile source of deep or protracted nervous maladies. The intense degree of grief is all-absorbing. The mind broods over the one subject of its Avoe, and so reluctant is it to admit another, that it is often annoyed by conversation of friends, or even impression on the senses. Hence, the deep mourner retires into lonely seclusion, and soon may be lighted a train of feelings as dis- tressing as they are obnoxious to remedy — melancholy. When this sad condition is the result of bodily causes, Ave can cure it; but Avhen it springs from moral causes, time, of course, is an element in the cure. But the maladie imagi- naire is mostly the result of mere corporal derangement and break-doavii. We will conclude our remarks on the pathol- ogy of nervous maladies by glancing at the hygiene best adapted to remedy them. (As for their medical treatment, Ave can best administer that directly and personally, rather than through the medium of a Avork on Nervous Affections. As has already been said, the resources of the Materia Medica for nervous maladies has been poAverfully reinforced within the last ten years, by an entirely neAV class of reme- 130 PATHOLOGY OF THE NERVES. dies, based on our greater knoAvledgc of the nervous system and its action. The writer himself has introduced a new and most potent remedy.) If we believe in the irritation or disturbance of mind as a fertile source of the neuroses, or nervous affections, we may also believe that the inducing a different state of mind will prove a curative or preventive oftentimes,—at any rate, a great help to a cure. This state of mind would be the oppo- site of pride, envy, hatred, and sordid greed of gain, which passions, as a great moralist remarks, have no holidays, — that which Ave term repose, — contentment, tranquillity, happiness. By mental repose Ave do not mean the apathetic state of the thoughtless or the slothful; the dolce far niente of the useless do-nothing, is the mere scum on the surface of the cup of idleness which contains a poisonous bitter in its dregs. Under the placid condition of mind, not only is the vis medicatrix alloAved to exert its potent influence, but the various functions of the body are almost ensured, or restored to their former integrity. " To laugh and grow fat" has become a proverb. Yet, to ensure this happy mood, how manifold are the precepts, —amusements and moderate occu- pation, and those most congenial to the disposition. But this mental election must not be negative ; the mind must be brought not only to forego those perilous pleasures of sense and of sensibility, to Avhich luxury and sloth are so naturally prone, but also to act on the subject of its thoughts, not with fatigue and labor, but with that degree of energy which will afford food for immediate reflection, and the memory of which will be the constant spring of tranquil satisfaction. " We should live pleasant," and regard cheer- fulness as a duty. To ensure this requires often a high degree of self-control, as Avell as the sympathy of friendship. The greatest caution in conversation is sometimes essential ; allusions to subjects Avhich are agreeable, congenial, and PATHOLOGY OF THE NERVES. 131 consolatory to the invalid, should be adopted, both in con- versation and reading; and objects of beauty and of interest should as much as possible be presented to the mind; for it has been observed how influential are odor and color and form in mitigation of more decided maladies. Of the antipa- thies of smell and taste Ave have known very curious instances in nervous patients. The olfactory nerves may become so acutely sensitive as to be oppressed by even grateful odors, so that the poet scarcely exaggerates when he says, — '' And quick effluvia darting to the brain, Die of a rose in aromatic pain." The morbid eccentricities of touch or feeling are among the most painful maladies of the neuroses. They are eminently characteristic of hysteria. A lady, who Avas for several years under the Avriter's care for phthisis, Avas occasionally affected with intense hyperaesthesia (excessive sensitiveness) of the skin. During this state, a feather dropped on her person would instantly produce such intense agony as to draw forth a shrill and prolonged scream. But to resume our remarks on the hygiene for shattered nerves. We fear that the lesson which we are endeavoring to inculcate is not so easy in this excited, artificial age. We have, in truth, so multiplied our wants, that Ave become restless, if Ave do not accomplish all the mind can conceive. Like Ariel, we would put a girdle round the globe in forty minutes or seconds. The a°"e is a nervous one, and hence the desirability — to the world-worn, jaded man — of repose, and the exceeding need of procuring it. CHAPTER XVI. A FEAV HYGIENIC OBSERVATIONS ON NERVOUS AFFECTIONS. In regard to nervous patients, Brown-Sequard insists that " A serious aim in the daily occupations is of the greatest value, and for many persons, quite essential to prevent or to check nervous disturbances. The applications of this princi- ple are, of course, he says, very difficult, and often impossi- ble, in certain neuroses; but in those cases in which any kind of serious work, either mental or physical, but not too fatiguing or exciting, is liked by the patient, he should be induced to do it. In cases of hypochondria, of hysteria, of chorea, or even of epilepsy, a great benefit can be derived from a serious employment of the mental and physical activ- ity of the sufferer. Hoav often have I not seen young epilep- tics kept in idleness (alas ! by medical advice), and having gained more or less of the vices it leads to, improve rapidly from having their minds occupied at regular hours, in nearly the same Avay as healthy people of their age. The second principle of moral treatment is, that we must, in the interest of our nervous patients, as much as, if not more than in our own, give them confidence and hope in the treatment we rec- ommend. In hysterical and all nervous complaints allied with it, and also in hypochondria, a great hope of cure will do much to work out the cure. No doubt you Avill say, But how can you give hope ? I answer that the best means for [132] OBSERVATIONS ON NERVOUS AFFECTIONS. 133 that purpose is to have hope ourselves, and to express our hope Avith the accent of conviction. And, as you Avould ask hoAv can Ave command hope in ourselves ? I ausAver that the very knoAvledge of the truth of the principle I am now speaking of, is enough to render one hopeful. I need not noAV repeat that I am iioav only speaking of those nervous diseases in which the poAver of the mind upon the body is so great, that under the influence of an emotion, or another moral cause, a sudden or almost sudden cure is not very rare." * It has repeatedly occurred to me to see »patients who stated that they had been for years in the habit of taking large quantities of opening medicines to keep up the due action of the boAvels, but still without the slightest advantage or even effecting the purpose ; yet have I seen these persons derive infinitely more benefit, in a feAv Aveeks, from a few "globules," and strictly attending to the admirable dietetic rules prescribed by Hahnemann, viz. giving up the use of wine, spirits, and all such stimulants, than could possibly have been derived from the adoption of all the routine disci- pline so commonly insisted on. It may be said, and I have no doubt Avith a great deal of truth, that the abstaining from the use of wine and ardent spirits, with the strict attention to diet, etc., Avere really the means of cure; and that the minute doses of medicine in the globules were merely incen- tives to regimen, but in every other particular Avholly inert. Upon this, hoAvever, as a purely practical man, I need only observe, that it matters but very little to the patient by what means his health has been restored, so that he perfectly reo*ain it; nor can it interest him much Avhat particular plan © of treatment has been the truly efficacious one in curing his disorder. But if patients will not be satisfied Avithout tak- ing large quantities of medicine, they may as Avell be grati- * Lectures on the Diagnosis and Treatment of Functional Nervous Affec- tions. By C E. Brown-Sequard. 134 OBSERVATIONS ON NERVOUS AFFECTIONS. fied and amused Avith globules, or something at least equally harmless, so that they may sustain no injury, while pursuing a rational mode of living, and one conducive to health. Again, I have seen similar benefit, in habitual and obstinate constipation of the boAvcls, and indeed confirmed ill health, from a feAv months' Avell-regulatcd hydropathic treatment; and such patients have really obtained inconceivably more adArantage from strict observance of these rules, and due attention to diet, air, and exercise, than had accrued from the prolonged adoption of the plans recommended by the most judicious and skilful allopathic practitioners. In such cases, regimen seems to have been an important element of suc- cess. It has been already observed that the dietetic and sanitary measures inculcated by homoeopathy; the invigorat- ing influence of hydropathy ; and the various means at the disposal of and resorted to by the allopathist, may, Avhen prop- erly applied, prove of the greatest benefit; but on the con- trary, if indiscriminately adopted or injudiciously used, they may proAre not only inert, but often very injurious. It must therefore be apparent that, as already observed, before Ave can determine Avith any prospect of success on the treatment of disease, Ave must diligently inquire into the nature of the case, so as to ascertain tho cause and remove it; for if this be alloAved to continue in operation, it will be vain to expect that the effects will cease,—still less be permanently re- moved. But let us suppose that we should prove successful in checking or suppressing the effects, as may sometimes hap- pen, Avithout subduing the cause, avc should only aggravate the mischief, and induce confirmed derangement in the sys- tem, the cause of Avhich perhaps no subsequent efforts Avould be sufficient thoroughly to eradicate. Possibly this may be rendered more intelligible by the folloAving illustration. Purging, for instance, may be occasioned by cold applied OBSERVATIONS ON NERVOUS AFFECTIONS. 135 to the skin while it is hot and perspiring; the perspiration being suddenly and over-precipitately checked, purging is set up on the part of nature to compensate the suppressed action of the skin, and thereby relieve, at least in part, the system by the removal of noxious principles. Any similar derangement of the bowels may arise from taking too much food into the stomach. Here, then, Ave find the same effect — relaxation of the bowels — produced by two causes differ- ing altogether in their nature and mode of action. Were Ave to treat the disorder of the bowels, so occasioned, by the same means, Ave should most assuredly fail of success, the causes in each being so very different; and therefore the treatment should be varied, and suited to the peculiar circumstances of each case. Instead of checking the purging in the first instance, by administering astringents, absorb- ents, etc., the Avarm bath and the administration of medi- cines, calculated to restore the suppressed or suspended action of the skin, will be more in accordance with the true princi- ples of treatment. But, in the second case, in Avhich too much food, or of an indigestible nature, has been the cause of the derangement, the appropriate treatment Avill be its immediate evacuation by an emetic or a suitable laxative. A very frequent cause of nervous affections is, intense or unsea- sonable application of the mind, as in reading while at din- ner. By this untimely exercise of the brain, the blood is diverted from its proper course — viz. the stomach — at a time Avhen it is particularly required there to enable the vis- cus to secrete and supply a sufficiency of gastric juice. Such patients cannot be benefited except they alter their habits, because so -long as they force the current ofblood towards the brain, Avhen the vital fluid is required elseAvhere for the purpose of digestion, this function Avill be impaired, and but very imperfectly performed, and nervous derangement Avill continue to result. 136 OBSERVATIONS ON NERVOUS AFFECTIONS. Another and very common cause of nervous disorder I have found to prevail much amongst gentlemen engaged the whole day in the city, and Avho seldom take any food till they return home to a six-o'clock dinner. They then indulge too freely in the pleasures of the table, and burden the stomach Avith more food than there is gastric juice to dissolve ; con- sequently a considerable portion of the food remains undi- gested, and, undergoing spontaneous decomposition, gives rise to the evolution of different gases in large quantities in the stomach, painfull}' distending the organ, and causing belching, acidity, acrid eructations, hiccup, etc. Unless Ave remove the cause by a more suitable mode of living, the effects Avill not cease. Medicines may relieve, but Avill not cure the patient. Nervous disorder proceeding from another and very differ- ent cause, frequently falls under my notice. The affection is attended Avith violent nervous headache, severe palpita- tions of the heart, Avith a sense of sinking and exhaustion. It occurs in persons who are engaged for many hours during the day in active exercise of both mind and body, and Avho at certain seasons cannot spare time for refreshment till a very late hour, Avhen the energies of the frame have become, as it Avere, completely exhausted. But even at this late period they are frequently disturbed and called aAvay, before they have had time to finish their repast. Under such cir- cumstances, the frame is enfeebled and overpoAvered before any opportunity for refreshment presents itself, the stomach naturally participates in the general debility, and in conse- quence becomes unequal to healthy digestion. Hence, such individuals emaciate, become feeble, and ultimately* are pros- trated both in mind and body. In such cases medicine is of little or no use ; nothing but a more rational mode of living can restore such persons to health and strength. Indeed, it is surprising to sec Iioav speedily they recoA'-er, AArhen, by OBSERVATIONS ON NERVOUS AFFECTIONS. 137 altering their mode of life, the cause of disorder has been removed. Analogies drawn from the inferior animals often lead us to the knowledge of the true principles of cure. Experience has taught the groom the evil consequences that result from feeding the horse immediately after severe exercise ; and phys- iology unfolds to us the rationale. The blood requisite to enable the stomach to form and secrete a sufficient quantity of gastric juice for the purpose of digestion, has not yet reverted from the muscles, A\diither the current of blood had been more abundantly directed, to increase the muscular energies and activity, and proportion them to the exertions they were called upon to make while under the stimulus of severe exercise. Hence it is necessary to alloAv the animal sufficient time for repose, that the muscular system may relapse into its ordinary state of quiescence. The animal may then be fed, not only with safety, but with advantage ; the stimulus Avhich the food creates brings an increased afflux of blood to the stomach; gastric juice is secreted more copiously, and poured in sufficient quantity into the cavity of the viscus, and, acting with energy upon the food, it is readily dissolved, and prepared for its final formation into nourishment. The same laAvs hold good with respect to man; and thus it is that analogies often lead to the adoption of true principles, as well as to their explanation. "Nervousness," says Dr. Trail, "is as much distinguished from all other maladies by mental perversity, as it is by bodily infirmity. Without being criminal or addicted to any particular vices, nervous persons are ill-tempered, peevish, jealous, passionate, and always unreliable. They are un- trustworthy, not because of dishonest motives, but because of ungovernable impulses. They are unreliable, not because of intentional Avrong, but because of fickleness of disposition and feebleness of will power. They are very selfish, and 138 OBSERVATIONS ON NERVOUS AFFECTIONS. sometimes mean, not because they lack benevolent emotions and a right conscience, but because their outward conduct expresses their internal conditions. Cure them of their ner- vousness, and they may become agreeable, generous, truth- ful, and faithful, as ihey have been before. But everything has a cause, and so has nervousness. It has many causes, as many as individuals have unhygienic habits. All personal habits that are unwholesome conduce to it. But in all cases there is some local point of irritation or obstruction, perhaps trivial in itself, from which the whole trouble proceeds. A person may be very Aveak, as in cholera or paralysis, with- out being nervous." "He maybe dangerously sick, as of fever, and no one accuse him of nervousness. But if the blood is congested in some part or organ, no matter where nor from what cause, to the extent of disturbing the equilibrium of the circulation, yet not sufficient to occasion acute disease, the person so affected will inevitably have a more or less aggravated form of nervousness. And this fact explains Avhy so many persons are more or less nervous, and why this ailment is peculiar to high civilization." Among the more prominent special causes are too much night work, want of sleep, great mental anxiety, indigestible viands, narcotic stimulants, as alcohol and tobacco, late sup- pers, and sedentary habits. Any cause, also, that impairs the vitality and drains the vital fluids, as running sores, fre- quent bleedings, chronic diarrhoea, Avill result in nervousness. A very torpid liver, a very inactive skin, and prolonged constipation, never fail to occasion severe and obstinate forms of nervousness. Obstruction, therefore, being the primary and predisposing cause, and unbalanced circulation the proximate condition, the remedial plan is self-evident. Promote circulation to the Avhole surface as much as possible by occasional bathing, and daily frictions with dry toAvels; OBSERVATIONS ON NERVOUS AFFECTIONS. 139 use only plain and simple viands, so that the internal viscera may be unloaded; and exercise as much as possible, Avithin the limits of fatigue. Sleep all you can, avoid all convert sation concerning your manifold miseries, and in due time this nervousness will disappear. Great numbers of men in the vortex of city life seem to suppose that they can indulge constantly and Avith impunity in sensual excesses, and especially the abuse of Avines and liquors, of gaod cheer, of venereal pleasures, and intellectual excesses, represented particularly by prolonged watchings and preoccupations Avith business enterprises, works, etc. But sooner or later all such find their mistake in shattered and disordered nervous systems. The Avriter has by his remedies enabled hundreds of persons guilty of such habitual excesses and violation of the plainest hygienic laws to escape the consequences of their folly. But he has done it by his insisting, when his reme- dies had clone their perfect work in restoring the nerves to their wonted healthful action, upon an entire abandonment of previous bad habits and practices, so that the effects of his medicine might be reinforced by a proper regimen and life. I CHAPTER XVII. A CURIOUS CASE OF SUPPOSED DEMONIAC POSSESSION. I could very easily fill a dozen chapters with interesting narratives of the manifold illusions, delusions, and hallucina- tions Avhich I have had to deal with in treating a vast num- ber of nervous cases. These various instances of the maladie imaginaire have been, of course, the results of a disturbed condition of the functions of the brain and nervous system. Several years ago a patient was under my treat- ment, who Avas thoroughly convinced that he was possessed by unclean or evil spirits. This person was a gentleman of uncommon intellectual power and culture, and on all other subjects, except that of his own demoniacal possession, Avas sensible, rational, and intelligent. On his first visit at my office, he placed in my hands a lengthy account of his sup- posed affliction. It was addressed to me, and Avas in the form of a letter. It is too long for the limits of this volume entire, but I will give the most interesting portions of it, merely prefacing it with the remark that the Avriter Avas ulti- mately cured of his most uncomfortable monomania, and now looks back upon it with almost the curiosity of a disinter- ested third person. The epistle is subjoined. " Dear Doctor : "It Avas my intention, some time since, to have Avritten you a short account of the sufferings I have experienced for [140] SUPPOSED DEMONIAC POSSESSION. 141 several years past, from the possession of evil spirits ; but in consequence of having been constantly pitied and smiled at, and having met Avith no one Avho would sympathize Avith me, Avhenever I have broached such a notion, and instanced myself as a proof of the existence of such spirits, I had almost come to the conclusion not to Avrite at all. Unac- quainted as I am with theological discussion, and Avholly unused to argumentative composition, I am at a loss in Avhat manner to set about an explanation on the subject required." (Here the writer gives a sketch of his life. It seems that he was living with his wife and several fine children in the city of New York, engaged in professional pursuits, which yielded him a lucrative income at the time he Avas attacked by the singular monomania.) "The profits from my profession," he Avrites, "still continuing on the increase, I at this period entered into some money speculations, which caused me a little anxiety and some pecuniary embarrassment, but I retained all my usual buoyancy of spirit. It was then Avhile taking a quiet Avalk one evening, far from the busy hum of men, I heard the sound of voices near me, speaking of me. I looked in every direction, but could not discover any one. I got over some banks, thinking that, probably, the persons might have been concealed from vieAV by them; but no human creatures were there. I Avalked aAvay from the spot, still the voices pursued me. I mixed Avith the thickest of the throng in the metropolis; the voices still continued to haunt me, and the Avords then uttered Avere 'Who is he? — do you know who he is?' The response was, ' He is Satan's oavii.' These words seemed continuously to proceed from the persons I passed. I crossed and re-crossed the streets ; still the same voices folloAved me. Every one appeared to ask the same or a like question, and there Avas a similar reply. Other queries and answers succeeded to these relat- ino- to my Avalking,—for my pace Avas very rapid, as I 142 SUPPOSED DEMONIAC POSSESSION. trusted to escape the notice or recognition of the passers-by ; but the " Devil's Own " was either Avhispered or shouted to me, apparently by almost every one; and those from whom the sounds did not emanate, appeared hastily to get out of my way, or, in my imagination, shrunk from me with looks expressive of surprise. No doubt, hoAvever, that my strides were those of a possessed person, and caused those I met or overtook to make ample space for me. " The whole night did I thus perambulate NeAv York and its environs, occasionally dozing, as I stood still for a few minutes; and in this manner I twice accomplished the cir- cuit of the great city, vainly hoping that daylight Avould end my illusion. Such hope Avas indeed vain, and I must men- tion, that not merely the " Devil's Own " Avas sounded in my ears, but observations and conversations relating to me inces- santly occurred. Yet was I perfectly in my senses. I went to the place in which the sounds first reached me, and exam- ined it and the neighborhood minutely; of course I could not discover any human power to account for them. I then began to think of spiritualism, on which I had thought little before, as an explanation of the strange phenomena. . . . The voices loudly and clamorously spoke of all my misdeeds, and taxed me Avith sins of which I had not been guilty. And I Avas dared to meet the parties Avho charged me Avith such and with other crimes. I did accordingly go to a friend of mine, who is now dead, and told him I had been affected, and that I Avished him to be present to hear the voices, if he could, and the charges to be made against me, Avhich I Avas to deny, or to admit, as the circumstances might be. Sev- eral voices then made various accusations against me, and I appeared to be put on a regular trial. I replied to the charges by my thoughts, without speaking, but occasionally my tongue could not refrain from moving Avithin my lips, to express my thoughts without, however, giving utterance to them. SUPPOSED DEMONIAC POSSESSION. 143 "One of the voices was remarkably clear and loud. It appeared to be that of a being of authority in conversation with another, and although slightly favorable in his expres- sions of my good conduct throughout life, yet strong and severe Avere his animadversions on my bad thoughts and actions. And here everything I had said or done, or omitted, Avas elucidated instantly; hidden motives and thoughts and actions Avere unravelled, to my great astonishment, and my heart and brain seemed completely laid open. All was written doAvn or directed so to be, and the next day Avas appointed for a further examination. I asked my friend repeatedly during this trial if he heard any voices. He told me he did not. I mentioned Avhat Avas now and then said to me, and of me. I smiled at myself, for I kneAV I Avas only in a room, and that it Avas impossible for any worldly being to speak or communicate Avith me except my friend. I looked at him — he Avas deeply engaged in writing; could there be any ventriloquism in the case ? I kneAV that my friend Avas not thus gifted; besides, the voices were Avith me before I saAV him that day. What could have occasioned the sensation of sound I had experienced ; the direct appeal to my heart and brain ? I was entirely in my senses, and reasoned on the absurdity of my harboring any opinion contrary to my own received notion of the ordinary laws of nature. I began to think of spiritualism—of clairvoyance. . . . The more I thought, the less could I account for the extraordinary ordeal to Avhich I Avas subjected. I did not believe in evil spirits. ... I did not believe in the commonly received notions of hell-fire, and flames had no terrors for me, nor have they iioav. . . . The next day I went prepared for another examination, but I was not again put on trial. The parties seemed partly satisfied Avith my mental engagement of com- pensation, as far as I had the ability, of any persons I might have injured in thought, Avord, or deed. ... I returned; 144 SUPPOSED DEMONIAC POSSESSION. still the voices followed me. ... In the day-time I did not feel the annoyance so much, but in the stillness of night, the torments I endured Avere unutterable — indescribable. The hellish sounds, the dreadful impieties that Avere spoken of, that were foisted on me. . . . When I attempted to pray, I could not, for the jeering and laughter. . . . For change of scene, and hoping I could get rid of the voices, ) went tAvice abroad. I tried all kinds of amusements, an<) also the effect of living very Avell, thinking my nerves mighl be improved by a still more generous regimen than I had ever been accustomed to. These having no effect, I had myself cupped, and entirely altered my diet, living chiefly on vegetables, and avoiding all vinous or spirituous liquors. Nothing, hoAvever, made any difference in my sensations. The sounds accompanied me everywhere, and I still contin- ued the prey of evil spirits. I could plainly distinguish about seven voices : tAvo of them struck me as the voices of females; one of them sometimes spoke in over-soothing, complaisant accents to me, but these Ave re generally used to turn me into ridicule aftenvards. . . . It is iioav five years and four months that I have had this singular visita- tion from God, and although I have no faith in dreams, yet most singularly I dreamt of my father's death about the time it occurred, and I have not dreamt of him since, until the beginning of this month of September, Avhen I dreamt that I saw him interceding with God for the suspension of my sufferings from evil spirits, and, strange to say, I expe- rienced for a time relief from their presence and perse- cutions. . . . Suffice it to say that the Avriter finally became a firm believer in evil or unclean spirits, and their power to haunt or possess man. He concluded his singular communication to me, Avhich is very long, in the followino- words : " It strikes me that many persons, Avho are consid- ered and pronounced deranged, are, really, instead, possessed SUPPOSED DEMONIAC POSSESSION. 145 by eAril spirits. It may be said that I may myself be in a state of derangement. To this I Avould oppose these facts — that I do not pretend to having had any ocular demonstration of any spirit, nor have I had any distorted visions or ideas. I have not spoken incoherently, nor have I acted contrary to rationality; but I have ahvays been blessed Avith my senses, notAvithstanding this heavy calamity of evil possession Avith which it has pleased God to visit me. . . . " I am, sir, your obedient servant, » ?<_______ _____ " When the writer of the above singular account came uifdei my treatment, he had only occasional and greatly mitigated attacks from his imaginary infernal tormentors. In fact, the case had ceased to be very distressing, notAvithstanding the patient had become a firm believer in demoniacal influences. He was a sceptic, in tho height of his monomania and suffer- ing. It perhaps should be remarked that the gentleman was the son of Avhat is called an Eurasian; that is, his grand- father Avas English and his grandmother an East Indian lady, Avhich fact accounted for certain psychological peculiarities as well as peculiarities of temperament. I easily reinforced the happy effects Avhich the lapse of years had begun to have on this patient's most delicate and excitable nervous system, with a class of remedies specially adapted to such a case, which Avas marked by a morbid condition of the auricular nerve. Tho patient was completely cured under my treat- ment, and I finally succeeded in demonstrating to him that demoniacal possession Avas nothing more nor less than one of the forms of nervous malady. The belief in possession by unclean spirits Avas natural enough in ages of ignorance and superstition, when the mysteries and peculiarities of the nervous system Avere not in the least understood, and per- sonal agencies Avere supposed to account for everything. CHAPTER XVIII. HOPE AND CONFIDENCE AS THERAPEUTICAL AGENTS. The physician who cannot inspire hope and confidence ic his patient, might as well understand that he has mistaken his • calling; and just in proportion as the medical man is able to excite these two exhilarating, buoyant, and curative emotions in the breasts of those Avhom he treats, just in that propor- tion ordinarily will be his success. In treating diseases of the melancholic-nervous class, especially, the physician Avithout self-reliance cannot hopo to beget reliance in his patient. A third thing, says old Burton, in his famous book on Melan- choly, to be required in a patient, is confidence, to be of good cheer, and have sure hope that his physician can help him. Galen, the old Greek physician, holds confidence and hope to be more good than physic. He cures most, in Avhom most are confident. The great success of another old Greek physician, Hippocrates, was accounted for on the ground that the common people had a most strong conceit of his worth. The young student of medicine is told in Faust, " If you on yourself rely, Others on you will place reliance." It is wonderful the healing effect Avhich a hopeful, confi- dent state of mind in the patient has upon his disease. But when one considers the intimate connection of mind and [140] HOPE AND CONFIDENCE AS THERAPEUTICAL AGENTS. 147 body, the mystery is solved Reputation and wide-spread notoriety are valuable to a physician, because they give him a power and sort of magical influence over the mind of his patient. This influence, too, may be given by personal qual- ities, such as appearance, etc. There is a certain genius for the cure of disease, and an intuitive insight into the ills to Avhich flesh is heir, Avhich some men possess, and Avhich are more valuable than the fruits of the profoundest study. A perusal of the lives of eminent physicians will convince one of the fact, or an acquaintance with one of these natural con- querors of disease. Their presence inspires a certain con- fidence in the patient, a sort of magnetic influence, which reinforces the medicines administered, and causes the happi- est effects. Professional jealousy and rivalry may cause these born physicians to be denounced as quacks and empirics, but the public cannot be diverted from recourse to such. Per- sonal power, a strong Avill, is as necessary in a conqueror of disease, as of armies. In nervous-melancholic maladies, the first thing Avhich the physician has to contend against in his patient, is a fearful depression and downheartedness. Out of this abyss of despair he must be able by his will to lift the victim of nervous malady who has recourse to him. For the Arictims of nervous disease dwell, as it AA'ere, "in a land of darkness, as darkness itself; and of the shadow of death . . . and Avhere the light is as darkness." To quote from quaint old Burton again : " Of those diverse gifts which our Apostle Paul saith God hath bestoAved on man, this of physic is not the least, but most necessary, and especially conducing to the good of mankind. Next, there- fore, to God, in all our extremities ('for of the most high cometh healing'), we must seek to and rely upon the physi- cian, who is Planus Dei (the hand of God), and to Avhom he * hath oiven knoAvlcdge, that he might be glorified in his wondrous Avorks. With such doth he heal men, and take 148 HOPE AND CONFIDENCE AS THERAPEUTICAL AGENTS. away their pains. When thou hast need of him, let him not go from thee. When we have now got a skilful, an honest physician to our mind, if his patient Avill not be con- formable, and content to be ruled by him, all his endeavors will come to no good end. Many things arc necessarily to be observed and continued on the patient's behalf: first, that he be not too niggardly miserable of his purse, or think it too much he bestows upon himself, and, to save charges, endanger his health. The Abderites, when they sent for Hippocrates, promised him what reward he would, "all the gold they had, if all the city were gold he should have it." Naaman the Syrian, when he went into Israel to Elisha to be cured of his leprosy, took with him ten talents of silver, six thousand pieces of gold, and ten changes of raiment." We are not sure but that Burton's Anatomy of Melancholy is not even yet the best treatise on Nervousness and Nervous Maladies, quaint as it is. " Melancholy," he says, " is either in disposition or habit. In disposition is that transitory mel- ancholy, which goes and comes upon every small occasion of sorrow, need, sickness, trouble, fear, grief, passion, or perturbation of the mind; any manner of care, discontent, or thought which causeth anguish, dulness, heaviness, and vexation of spirit; any ways opposite to pleasure, mirth, joy, delight, causing frowardness in us, or a dislike. In which equivocal and improper sense, Ave call him melan- choly, that is, dull, sad, sour, lumpish, ill-disposed, solitary, any way moved, or displeased. And from these melan- choly dispositions, no man living is free; no stoic, none so wise, none so happy, none so patient, so generous, so godly, so divine, that can vindicate himself. Melancholy in this sense is the character of mortality. The name is imposed from the matter, and the disease denominated from the ma- terial cause, viz. black bile." Among the causes of melan-* choly he includes the imagination^ which, he says, as it is HOPE AND CONFIDENCE AS THERAPEUTICAL AGENTS. 149 eminent in all, so most especially it rageth in melancholy persons. . . . This Ave see verified in sleepers, who by reason of humors and concourse of vapors troubling the phantasy, will give many times absurd and prod'igious things, and in such as are troubled Avith incubus (night- mare), if they lie on their backs, they suppose a hag rides and sits hard upon them, that they are almost stifled for Avant of breath. . . . This is also evident in such as Avalk at night in their sleep and do strange feats. . . . All ecstacics are referable to this force of imagination, such as lie whole days together in a trance ; as that priest Avhom Celsus speaks of, that could separate himself from his senses when he list, and lie like a dead man A'oid of life and sense. . . . Many times such men, Avhen they come to themselves, tell strange things of heaven and hell, what A'isions they have seen. . . . The like effects, almost, are seen in such as are aAvake ; how many chimeras, antics, golden moun- tains, and castles in the air, do they build unto them- selves ? " CHAPTER XIX. ALCOHOL, TOBACCO, OPIUM, HACSHISH, LEAD. It is through the nerves that the five dread agents enu- merated at the head of this chapter have their fearful hold upon humanity. These five agents are continually making war upon the healthy equilibrium of the nervous system, and through that deteriorating the race. The symptoms of alcoholic poisoning are those of alternate excitement and depression. Partial paralyses are but the precursors of more grave affections, Avhich terminate finally in general paralysis, deterioration, and ultimate loss of intelligence. A French writer maintains that insanity is merely the last degree of degeneracy. In the first generation you have immorality, depravity, alcoholic excess, brutish disposition ; in the second, hereditary drunkenness, maniacal accessions, and general paralysis; in the third, sobriety, hypochondriac and maniacal tendencies, systematic ideas of persecutions and homicidal impulses; in the fourth, weak intelligence originally, access of mania, stupor, transition to idiocy; finally, extinction of the race. M. Morel, the French writer, already alluded to, asks, in his work on the " De- generacy of the Human Race," what may be the part which tobacco plays in the production of degeneration? And admitting even that its degenerative action is an ascer- tained fact, how far would it be good medical hygiene to [150] ALCOHOL, TOBACCO, OPIUM, HACSHISH, LEAD. 151 attack the usage of tobacco, which has become for all nations not only a habit but an imperious necessity, to be satisfied at any risk? I have no intention, he says, of attacking its use, and this for many motives : first, it is far from being proved that the habit of smoking, in moderation, is in any way injurious; and, secondly, it Avould not be without dan- ger to invoke the force of an absolute legislation against a habit passed into such an irresistible necessity. Medical men engaged in the investigation and treatment of the dis- eases of the brain and disorders of the mind, occasionally have brought under their notice cases of severe nervous dis- order and mental impairment, clearly traceable to an exces- sive and immoderate use of tobacco. Shattered nervous system, premature loss of mental vigor, impaired memory, mental alienation, are too often the well-defined result of excessive tobacco-smoking. These are facts that cannot be ignored Avhen considering the question. If society were in a more natural condition, or one more in accordance with the most obAjious rules of hygiene, it is highly probable that no poisonous agent, whether narcotic or stimulant, Avould be habitually desirable or alloAvable. It would not be easy to define accurately what is a natural state of society ; but it is easy to say what is not. For instance, it is not natural for man to pass his life underground, as in mines ; to be exposed, in addition to the ordinary atmospheric changes, to those of moisture and cold, in connection with sieges and the life of armies in active service, and to migra- © * © tions from mild to extreme climates and new conditions of existence ; to be immersed perpetually in poisonous or irri- tating vapors, as in various branches of art or industry; to be suffering the extremes of misery, privation, and heredi- tary disease. It does not appear improbable that in the war- fare Avith evil influences which man is constantly called upon to Avage, that Avithin moderation the use of tobacco may have 152 ALCOHOL, TOBACCO, OPIUM, HACSHISH, LEAD. as beneficial effect in enabling him to resist successfully some of these influences, as any other prophylactic agency may have in other cases. It may be injurious to the normal con- stitution normally treated, but may it not avert or resist the abnormal consequences of a different condition? In other words, the use of tobacco in moderation, and under circum- stances of great hardship and privation, is upheld by many men of high scientific attainments and sound judgment, as not only not injurious, but beneficial. Then, again, it is said by high authorities, that cases of general paralysis and soft- ening of the brain are fearfully multiplied by tobacco-smok- ing. As for opium, that is an agent whose effect upon the nervous system is of an appalling character. The use of this seductive drug is enormous. The Indian hemp or Hacshish forms the basis of most of the intoxicating prepa- rations in Egypt, Syria, and most Oriental countries. The leaves are smoked alone or mixed with tobacco. Besides the habitual hallucinations Avhich the extract of Indian hemp produces in some individuals, its prolonged usage induces incurable dementia. There is reason to believe that such is the case in many persons met Avith in the cities of Egypt, who are venerated as holy men (santons) by the people, but who are merely fallen into a state of dementia from the use of hacshish. To return to tobacco for a moment. A dis- tinguished English physician avers his belief that cases of general paralysis are more frequent in England than they used to be, and he suspects that smoking tobacco is one of the causes of that increase. He further believes that if the habit of smoking advances in England as it has done for the last ten years, that the English character will lose that com- bination of energy and solidity that has hitherto distin- guished it, and that England will sink in the scale of nations. Tobacco is reprobated because it produces insanity, paralysis, consumption, laryngitis, tonsillitis, short sight, emaciation, ALCOHOL, TOBACCO, OPIUM, HACSHISH, LEAD. 153 dyspepsia, and an infinity of minor disorders. It is upheld because it is pleasant; because it is a valuable therapeutic and hygienic agent, a preservative against cold and starva- tion, a substitute for food, a solace to the weary, whether of mind or body. One writer attempts to settle its value by an appeal to final causes, asking, "Why was tobacco created, if not to be smoked ? " perhaps overlooking the fact that the same trenchant argument applies to every vice. Another writer says, if the evil ended with the individual who, by the indulgence of a pernicious custom, injures his own health and impairs his faculties of mind and body, he might be left to his enjoyment, his fool's paradise unmolested. This, how- ever, is not the case. In no instance is the sin of the father more strikingly visited upon the children than in the sin of tobacco-smoking. The enervation, the hypochondriasis, the hysteria, the insanity, the dwarfish deformities, the con- sumption, the suffering lives and early deaths of the children of inveterate smokers, bear ample testimony to the feebleness and unsoundness of the constitution transmitted by this per- nicious habit. This is the age of narcotics and narcotism, and they undoubtedly have much to do with the marked in- crease in the number of cases of disease of the brain and nervous system We think the fact is indisputable. Phy- sicians who have favorable opportunities of investigating this subject, not only agree in opinion that such diseases are of more frequent occurrence, but that a certain unfavorable (but in its incipient stage certainly not incurable) type of cerebral disorganization develops itself in the present age at a much earlier period than formerly. Softening of the brain, for example, now manifests itself at the early age of thirty and thirty-five! It is indeed lamentable that the brain and mind should yield to the influence of certain nox- ious moral and physical agents, at a time of life Avhen the intellect ought to be in an active and vigorous condition of exercise and health. 154 ALCOHOL, TOBACCO, OPIUM, HACSHISH, LEAD. Speaking of the immense use of narcotics, let us take China, whose habit of opium-smoking has invaded Europe and our Pacific slope. Neither tobacco nor Indian hemp (norperhaps alcohol) compares with opiums either in the con- stitutional result, or in the difficulty of breaking the habit. China presents a curious spectacle of moral disease. Three hundred millions of individuals united under one absolute government, speaking the same language and having identi- cal religious notions, present to us the sad spectacle of a people menaced, as to its dearest interests, by the most fatal and degrading habit that it is possible to conceive — that of smoking opium. The effects of this habit, immediate and remote, are thus described: "The first impression is a feel- ing of content and slight excitement, manifested by loquacity and involuntary laughter. Sometimes there are fits of anger. Soon the eyes become brilliant, and the respiration and circulation are quickened and excited. At this stage of the nervous exaltation, the smoker feels a peculiar comfort, and the temperature is augmented. The impressions are lively, and the imagination wanders into strange illusions. Now we observe a phenomenon frequently remarked in men- tal alienation. Facts and ideas, long forgotten, present themselves to the mind in all their original freshness. The future appears all bright, and every happiness ever Avished for appears realized by the smoker. If he continues smok- ing, exaltation gives place to depression and utter prostra- tion. The action of the senses is suspended. Pie hears nothing; he becomes silent; his face becomes pale, his tongue hangs out; a cold SAveat inundates the Avhole body ; and insensibility supervenes, often lasting for several hours. The awakening is Avhat might be expected after such a debauch." Except some few smokers, who, thanks to an exceptional organization, can restrain themselves Avithin the bounds of moderation, all the others attain rapidly a fatal termination, ALCOHOL, TOBACCO, OPIUM, HACSHISH, LEAD. 155 haA'ing passed in quick succession the stages of idleness, debauch, misery, the ruin of their physical strength, and the utter degradation of their moral and intellectual faculties. Nothing can cure an adA'anced smoker of opium. Another poisonous agent which wages Avar upon human- ity and conduces to degeneracy, is lead. There are analo- gies between lead colic, and partial lead paralysis, and alcoholic poisoning. There is, in the commencement, trem- bling, weakness, and paralysis of»the lower extremities, and diminution of the general sensibility. Soon there are twitchings and cramps, dizziness, fantastic dreams and hal- lucinations ; and these are exactly the symptoms of the anaesthetic form of alcoholic poisoning. These are the symptoms inseparable from all chronic poisonings; and more than that, they are the essential signs which announce, by their duration and their constant progress, that the indi- vidual is smitten in the most important functions, and is tending to degenerative transformation more and more radi- cal. Those avIio present the first signs of the action of the poison of lead, as the blue line in the gums, and the yellow tinge of skin, appear for a time to be quite well; all the func- tions are correctly performed; the subject complains of no pain, and follows his employment as usual. The nervous lesions which ultimately occur assume all forms of delirium, coma, epilepsy, etc., sometimes after several attacks of colic, sometimes unpreceded by it. After the occurrence of these, especially the epileptic seizure, the reason is never sound ao-ain. In lead poisoning, the individuals affected are too few, comparatively, and the fatal termination too sudden, to permit any very definite calculation as to the effect finally upon the race. But the effects which the use of alcohol, tobacco, and opium, wide-spread as it is and has been, has had upon the Nervous System of the 'Race, both directly and by transmission, must defy calculation. What a sum- 156 ALCOHOL, TOBACCO, OPIUM, HACSHISH, LEAD. total of degeneracy and degradation, both moral and physi- cal, have these mighty agents of nervous elevation and depression caused ! What wonder that general paralysis and softening of the brain are becoming the most frequent diseases mentioned in the death-list! No one is ignorant that many organic dispositions in the human race are trans- missible from one generation to another; but it is not gen- erally knoAvn how far this principle extends. It is believed in general that form and appearance are transmissible, but it o-oes much further than this. It is ascertained that all mor- bid dispositions, all pathological predispositions, are inherit- able from parents to children, as Avell those belonging to the organs of vegetative as of animal life. The predisposi- © O tion to nervous maladies, to epilepsy, to mania, is transmissi- ble as Avell as that of gout, rheumatism, scrofula, etc. Now the predispositions have not constantly existed in all preced- ing generations, but have been acquired by some part of the ancestry, and handed down to the descendants, the morbid taint becoming more and more pronounced in every genera- tion. Whatever may be the form of the physical degradation, and whatever the nature of the lesions experienced by the individual, whether arising from alcohol, opium, or other causes, it is not necessarily the same typical form, nor the same lesions, which are to be expected in his descendants. The deviation from the normal type of humanity shoAvs itself in succeeding generations, by internal and external signs perhaps much more alarming: since they represent enfee- bled faculties, an addiction to the worst tendencies, and the limitation of intellectual life to a certain period, beyond Avhich the individual is no longer in condition to fulfil the functions of humanity. In contemplating successive generations under these unhappy conditions, we observe a series of manifold nervous phenomena-having in general a convulsive type; and forming those pallid, suffering, and morbid temperaments, ALCOHOL, TOBACCO, OPIUM, HACSHISH, LEAD. 157 as well as those incredible moral perversities and intel- lectual aberrations, Avhich, by their nature and frequency, justly astonish those Avho have not Avatched intently the for- mation of such degenerate races. As long ago as the last part of the eighteenth century, the abuse of alcoholic liquors in SAveden had produced a degeneracy in stature and physi- cal strength among the people of that country. In this country, at the present time, the annual list of the victims of alcoholism is enormous. The moral effect of the use of opium in China is marked. It is almost impossible to imag- ine, says Hue, the readiness Avith Avhich the Chinese commit suicide. The merest trifle, or a Avord, induces them to hang or drown themselves, the favorite modes of suicide. Mental aberration, serious as it is in any point of vieAv, in this light becomes doubly so, Avhen it is not merely an individual affec- tion, but the fatal climax, and as it Avere resume of a long line of individual and hereditary affections. It is easy to con- ceive Iioav, from one generation to another, the moral and physical condition is greatly deteriorated, when what wras the habit merely of one generation, became an instinct and impulse in the next; when, added to the hereditary taint, was the force of example positively, and negatively the absence of all instruction and useful education ; Avhen to the disease of the mind already existing, either actually or potentially, was systematically denied the exercise of the commonest rules of hygiene or therapeutics, and the ordinary restraints of morals and religion. In cases representing so deplorable an ancestry as this, medicine will do little in altering the condi- tion of the individual, Avhich may be considered virtually beyond cure ; but there remains a noble part to play in the enunciation of principles Avhich, when carried out, will tend to the removal of tjiose causes to Avhich so many of these evils are attributable. CPIAPTER XX. BODY VS. MIND. It is a curious and interesting study to trace the variety of opinions Avhich have been held concerning the respective existence and the mutual relations of the Body and the Mind, — opinions which have, in turn, taken up every position betAveen the absolute non-existence of Mind, save as a form or function of Matter, on the one hand; and, on the other, the merely phenomenal existence of Matter dependent upon the Arariations of a sentient or thinking immaterial existence, — the Mind. The scientists now generally maintain that Mind is a result of organization. But for ages the belief has been that man is a compound being, consisting of a material man, the Body, and an immaterial active principle, the intelligent Mind. Those that maintain this doctrine are now called animists, from anima, the soul. In the old gentile nations the body was carefully trained along with the mind. But under the peculiar views of Christianity, when it was introduced into the Avorld, the body became gradually neglected and despised, though this result was naturally of tardy growth. Chris- tianity Avas not at the start muscular, as the phrase iioav is. The Christian doctrine of immortality, though a belief in immortality Avas not peculiar to Christianity, gave to the mind, or spirit, which was supposed to be the deathless prin- [158] BODY VS. MIND. 159 ciple in man, a supremacy over the body in the estimation of believers. Body and Mind began henceforth to be held, by philosopher and Christian, to have separate and antagonistic interests. To the former, the body Avas a clog, an impedi- ment to the acquisition of knowledge, a something perpetu- ally interfering, by its pains, its sorrows, and its imperfections, with the clear views of truth which he supposed the unencum- bered soul would obtain, —constantly distracting the atten- tion by its material relations and requirements, — ever of the earth, earthly,—tending to its OAvn source, bending and drag- ging the soul along Avith it. To the Christian, the body was sin incarnate, the source of all evil and temptation, the bar- rier betAveen the soul and heaven. In the early centuries of our era, the body seemed to be of ever less and less estima- tion. There is something even amusing in the excess of contempt in which it was held and the abuse heaped upon it. A prison-house, a cage, aweary load of mortality, — these were by comparison complimentary terms. One old ascetic Christian writer, a saint of course, calls the body " an ill-sav- ored sink," " a begrimed, pestiferous Avorkshop," " a lump of flesh, Avhich mouldereth away and draweth near to corruption while Ave speak of it. " The torments of the body Avere so utterly despised as to be scarcely considered personal matters. In fine, the body Avas considered the source of all evil, and, as such, worthy of no consideration. The saints and philosophers held that these our mortal members do pro- duce the effect of fear, desire, joy, and sorrow, in our bodies ; from which four passions the whole inundation of man's enormities have their source and spring. One old sect of relioionists held that the body was so evil, that its crea- © tion cannot be ascribed to the same author as that of the soul. They held all flesh the work of the Devil. In their opinion the o-reat object of the government of the God of light Avas to deliver the captive souls of men from their corporeal 160 BODY VS. MIND. prisons. Of course these folks must have regarded a skilful physician as a servant of the Evil One, because he cured the body of disease, and prolonged its existence. Thus did theology cause an antagonism, a division of in- terests, so to speak, between the material and the immaterial elements of man's nature,—one which in various forms, in accordance with the spirit of the times, has been propagated even until the present; now one and now the other being held in paramount esteem, in accordance with the demands necessary to be made upon their functions. Here, brain has been had in honor; there, thews and sinews. But the pres- ent is essentially an iron and a practical age; both strong limbs and thoughtful minds are in requisition; and the spirit of the age is in nothing more manifest than in the manifold attempts, by the spread of national education and the increased attention to the sanitary condition of the masses, to balance the interests of these hitherto conflicting elements. The present prime minister of Great Britain, Mr. Gladstone, about half a generation ago, said, "There still remains in some quarters a vulgar notion that there is a nat- ural antagonism between corporeal and mental excellence. I trust that corporal education will never be forgotten; that the pursuit of manly sports Avill always receive the counte- nance and encouragement, not only of the boys who engage in them, but of the masters who are responsible for the welfare of those boys." These were memorable words at the time they were uttered, and produced an effect which is perceptible on both sides of the water, especially in our colleges and schools. Now, our leading clergymen are foremost as hunters and fishers and rovers of the forest and lake. Fifteen j^ears ao-o, before the revolution in regard to gymnastics in our institu- tions of learning had fully taken place, the " London Times " said, "It Avas a great point in ancient philosophy, the value it BODY VS. MIND. 161 attached to the body, and the proper training of it, the pres- ervation of its health, strength, and all its proper powers. Ancient philosophy did not despise the body, did not regard it as a mere husk and outside of human nature, or treat it as a despicable and absolutely vile thing; it regarded the body as a true part of human nature, deserving of proper deference, for the failure of Avhich it Avas sure to retaliate upon the Avhole man. Hence the gymnastics of the Greeks, which were not only fostered by the boxers and wrestlers, but went on under the solemn sanction of sages. There is a distinction between ancient and modern thought on this subject, and the ancient has certainly the advantage over the modern in this particu- lar point — at least over the modern before the latest im- provements. It has been too much the fashion with us to decry the body, to talk it doAvn, to speak scornfully of it in every possible way, to be always comparing it Avith the mind for the sole purpose of showing hoAv vile and worthless it is in comparison, — a mode of speaking Avhich if it be abstractly true, may be indulged in such a degree as to involve a prac- tical untruth. . . . After all our sublime abuse of the body, a body man has, and that body is part of himself; and if he is not fair to it, he himself will be the sufferer. The Avhole man will be the sufferer, — not the corporeal man only, but the intellectual man as well. If the body is thoroughly out of condition, the mind will suffer. It may show a morbid enlargement of one faculty or another, but tho direct- ing principle — that which alone can apply any faculty or knoAvledge to a good purpose, can regulate its use and check its extravagances — is Aveakened and reduced. How miser- able is the spectacle of morbid learning, Avith its buried hoards, and its voracious, insatiable appetite for acquisition, united with the judgment of a child ! Such study does, in short leave men children with remarkable memories and 162 BODY VS. MIND. acquisitive powers, who know as much history, philosophy, and poetry as would make a learned man, but who are not a bit nearer being men in consequence, because they simply knoAV by rote what they know, — they do not understand their OAvn knowledge. This is to a considerable extent the case with all morbid learning, where the general intelligence has not been cultivated, — which general intelligence depends on the soundness and health of the whole man, body and mind too. The picture of a Kirke White dying at the age of tAventy-one of nocturnal study, wet towels round heated temples, want of sleep, want of exercise, want of air, want of everything which Nature intended for the body, is not only melancholy because it is connected with an early death : it is melancholy, also, on account of the certain effect Avhich would have folloAved such a course unchecked if he had lived. We see, when we look down the vista of such a life, an en- feebled and a prostrated man, very fit to be made a lion of, like a clever child, and to be patted on the head by patrons and patronesses of genius, but Avithout the proper intellect and judgment of a man. How sad even is the spectacle of that giant of German learning, Neander, lying his Avhole length on the floor among his books, absorbing recondite matter till the stupor of repletion comes over him, forgetful of time and place, not knoAving where he is, on earth or in the moon, led like a child by his sister to the lecture-room Avhen the lecture hour came, and led away home again, Avhen it is over. Is this humanity, we ask, as Providence designed us to be? Is illegitimate, rational human nature? It can hardly be called so. We must not let the mind feed itself by the ruin of the body. The mind has no right to this indulgence, this dissi- pation and whole-length abandonment to its cravings, any more than the body has to sensual indulgence. This mental drain, the noxious stimulant which produces this overgrowth of mind, is as contrary to nature as the coarser stimulant BODY VS. MIND. 163 which unduly excites the body. The mind should be a good, strong, healthy feeder, but not a glutton. We have no right to despise the body, or to speak of it only and exclusively as something which is vile in comparison with the mind. This language Avill lead astray; it will make ardent, ambitious student youth neglect health, and abandon themselves to the process of acquisition at the cost of body, and ultimately of mind too. Do not use too unsparingly the motive of ambi- tion in dealing with youth. It is a motive Avhich is perfectly honest and natural within proper limits, but Avhen pushed to excess it produces a feeble, sickly, unmanly groAvth of char- acter ; it creates that whole brood of fantastic theorists, sentimentalists, and speculators, which in art, science, and theology alike, are the seducers and the corrupters of man- kind. Nowadays there is happily no danger of neglect of the body. The mind is now studied in connection Avith the nervous system. Brain and mind are now used convertibly. The brain proper is the one organ Avhich increases from the fish to man in proportion to the intelligence. It is now rec- ognized that without a healthy body the mind cannot be healthy or sane. Within a few years past we have seen the students of our oldest university contending with those of an English university, not in scholarship, but in the purely physical art of rowing. It is scarcely necessary to allude even slightly to the proof that the brain is the material organ (and the only one) through which the mind acts, and communicates Avith the external world,—this is generally acknowledged. It is less understood that the brain, as an organ, is subject to precisely the same bows, chemical, dynamic, and automatic, as other organs and tissues. It is also not disputed that every action of the body is attended by the phenomenon of nutri- tion, including the decomposition of some of the old tissue, and the supply of its place by new particles; and that the 164 BODY VS. MIND. evidences of such decompositions in the blood and the excre- tions are in exact ratio to the energy and and continuity of such actions. But although the laws of nutrition arc in as active operation in the brain as iu any part of the system, we find it at first difficult to realize the fact so avcII established by undisputed physiological testimony, that these acts of nutrition are in their essence the necessary conditions of every act of intelligence, perception, or volition ; that, like all other tissues actively concerned in the vital operations, nervous matter is subject to a waste or disintegration, Avhich bears an exact pro- portion to tho activity of its operations ; or, in other Avords, that every act of the nervous system involves the death and decay of a certain amount of nervous matter, the replacement of which Avill be requisite in order to maintain the system in a fit state for action ;* in short, that every idea, every emotion, every act of volition, and every perception, however passive or fleeting, is necessarily attended by a waste and decay of a certain portion of brain tissue. Carpenter says, " In the healthy state of the body, when the exertion of the nervous system by day does not exceed that which the repose of the night may compensate, it is maintained iu a condition which fits it for moderate constant exercise ; but unusual demands upon its powers — whether by the long-continued and severe ex- ercise of the intellect, by excitement of the emotions, or by the combination of both in that state of anxiety which the circumstances of man's condition too frequently induce — produce an unusual waste, which requires for the res- toration of its powers prolonged repose." It is certainly inexplicable Iioav matter and mind can act and react one upon another; the mystery is acknowledged by all to be past finding out, and will probably ever remain so; the co-ordinate phenomena, however, are open to investigation, and it is clearly ascertained that to certain mental condi- * Carpenter. BODY VS. MIND. 165 tions a certain state of the material organ is attached; and for certain mental acts, certain chemical changes in this organ are requisite. A German physiologist says, " With- out phosphorus, without thought. A due supply of arterial blood is requisite for the proper action of the mind. Loss of consciousness follows abstraction of this stimulus. The quality of the blood circulating through the brain also influ- ences the development of ideas ; if it be deficient in oxy- gen, delirium of course follows. The digestion of food introduces a quantity of imperfectly assimilated material into the circulation; until this new material has undergone the necessary changes, and while certain matters, altogether unfit for nutrition, are mingled with it, it is not adapted to excite those states of the brain which are necessary for the proper manifestation of mind; and as it is conveyed to that organ by the circulation, it produces an injurious change in it, and impedes or destroys the mental functions. Hence the indisposition to mental labor experienced by some persons after meals."* The same effects are produced in a more marked degree by wine, spirituous liquids, narcotics, and the presence of bile or urea in the blood. The organic affec- tions of the brain necessarily and obviously modify the men- tal conditions, not only by destroying the efficiency of a certain portion of the tissue, but by interfering Avith the clue per- formance of the organic changes in the other parts. All this is sufficiently comprehensible, that the organ being deranged is no longer capable of performing the behests of the mind. It is much less so how the derangement of the immaterial essence can effect the organic structure; yet the fact is indis- putable. The simplest illustration may be draAvn from an occurrence not unfrequent in ordinary experience. A per- son in perfect health receives a letter containing, perhaps, some fatal neAvs; he drops down, smitten with appolexy, and after * Miiller. 166 BODY VS. MIND. death it is found that the cerebral tissue is torn by an effu- sion of blood into its substance. Joyous emotion may pro- duce the same or analogous result. A young Frenchman received a complimentary letter from the Directory; he was struck motionless, and his head immediately became affected in a manner from Avhich he never recovered. The paleness of the skin, and Aveakness of the circulation accompanying the depressing emotions ; blushing, and other determination of blood ; excitement of the arterial action, under the influence of anger and the allied passions, — all illustrate powerfully and sufficiently the force of mind. Enough has been said to shoAv the powerful influence which states of mind have upon the body. • CHAPTER XXI. GENERAL PARALYSIS. A preliaientary idea of the nature of the affection of which we speak may be obtained by a glance over the various names by which it has been known. It has been called general paralysis of the insane, paralytic insanity. Incomplete and progressive paralysis, from its symptoms and its connection with mental disorder, from its usual pathological characteris- tics it has been termed sIoav or chronic meningitis, and men- ingo-cerebritis. It is a disease which may be briefly said to be characterized by disorder of the intellectual and volitional powers, —not always, or even generally, in strict proportion one to the other. The mental affection is usually of the expansive character, attended by exaggerated notions of the Avealth, position, or personal qualifications of the subject, terminating in dementia, or total eclipse of the mind. The physical disorder consists in a progressive weakness and un- certainty of action of the voluntary muscular system gener- ally ; in a majority of cases, beginning with the muscles of the tongue, and those connected with articulation, so that stammering is very often the first symptom of the invasion of this affection. In a patient who has evinced any tendency to mental derangement, there can be few symptoms of more serious import than this, —a tendency to stammer, or a diffi- culty of pronunciation of certain words; it may be appre- [167] 4 168 GENERAL PARALYSIS. hended Avith a great amount of certainty that general paral- ysis is imminent, and that death, soon or late, will folloAv as the almost necessary result, let the physical health have been up to that time oa'ci- so good. It may be expected that very soon the tongue and the muscles of the face Avill act irregu- larly and tremulously, and that this feebleness and uncer- tainty of function will extend to the entire locomotive system, sometimes attacking first the inferior and sometimes the supe- rior extremities. The term "general paralysis" is, hoAvever, someAvhat deceptive, as not indicative of the absolute phe- nomena of the disease in its progress. It is not until the latest stages that the paralysis becomes truly general, and no voluntary power is left, not even of tho sphincters. But it is in so far general that it is not hemiplegian or paraplegia, nor local paralysis, differing from all these essentially, inas- much as all the muscles of the body are indiscriminately liable to be attacked, and sooner or later are so affected. It is rather singular that a disease so Avell marked in its phenomena, and so serious iu its results, should only have attracted attention in so comparatively late a period of medical history. Many of our hospitals for the insane simply refuse admission to patients affected Avith paralysis, as being incurable. This is a highly important subject, and Avhy ? it is getting to be, even numerically, very prominent in the causes of death affecting our bills of mortality, much more so than has hitherto been suspected. There are forcible reasons, in a scientific point of A'icAv, Avhy it is deserving of special attention. The physical causes of insanity are hitherto involved in great uncertainty. Some pathologists go so far as to assert that in a majority of changes cases of simple derangement of intellect, no morbid condition of the nervous centres can be detected, and that in a majority of the remainder, such changes are too unimportant and too undefined and unspecific to be considered as causes. Others aver that they have never examined the brain of a GENERAL PARALYSIS. 169 patient Avho has died insane, Avithout detecting some morbid alteration of the brain or its membranes ; and these authorities are certainly amongst those Avho have had opportunities, not by units or tens, but by hundreds of cases. Again, others affirm that the visible and palpable changes are certainly in many cases deficient, but would, doubtless, be revealed Avere our means of investigation by the microscope and by chemical analysis more perfect. And, in addition to all this variety of opinion, it has to be taken into account that what- ever may haAre been the proximate cause of the mental affec- tion, certain additional, physical changes must have taken place in order to cause death; and there is the superadded difficulty of deciding what has dethroned reason, and what has destroyed life. In short, Ave are still ignorant of what may cause mental aberration, and what is its essential, mate- rial element; nor have we as yet obtained any certain start- ing-point, any positive data Avhereon to found a clearly inductive system of research. One of the principally con- tested points concerning this affection is, Avhetheritis essen- tially connected or not Avith mental disorder, for it appears to occur sometimes entirely independent of mental affection ; sometimes to supervene upon it; and sometimes to precede it by months, or perhaps years. The causes of general paralysis are immediate and predisposing. The former are such in gen- eral as produced prolonged over-excitement of the brain, — sensual excesses, especially the abuse of intoxicating drinks, over-feeding, sexual indulgence, and intellectual excesses, accompanied by prolonged vigil. The predisposing causes may be considered to be such as belong to insanity and brain affection